Aquatic Exercise Found to Ease Fatigue, Improve Balance in MS

Aquatic exercise therapy can help to ease fatigue and improve balance in people with multiple sclerosis (MS), without notable side effects, according to a review of published studies.

These findings have important implications for MS patients, as fatigue is among the main symptoms of the disease and can severely impact quality of life.

“Even though there is still a need for more comprehensive studies on the effects of aquatic therapy on patients with MS, this modality can be considered a potentially effective strategy in occupational therapy of patients with MS, considering its positive effects on fatigue and postural balance in these patients,” researchers wrote. “The safety and enjoyability of aquatic therapy may have roles in increasing the patients’ adherence to treatment, which is another strength of this intervention.”

The study, “A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis,” was published in Multiple Sclerosis and Related Disorders. The work was funded by the University of Tehran, in Iran.

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It’s generally recommended people with MS try to stay physically active, though the precise effects of exercise on MS remain incompletely understood.

Investigating aquatic therapy in MS

Aquatic therapy is a form of exercise therapy done while standing mostly submerged in water. Compared with other kinds of exercise, aquatic therapy has some theoretical advantages for MS patients — being in buoying water can help patients stay supported, and may ease stress on joints, particularly the knees, ankles, and hips.

Doing therapy in water also may help keep patients cool during exercise — which may prevent a temporary worsening of symptoms due to increases in body temperature.

Here, to assess how aquatic therapy affects balance, fatigue, and motor function in people with MS, a team of scientists in Iran and South Africa conducted a review and meta-analysis of the scientific literature. Meta-analysis is a type of study in which researchers pool data from multiple previous papers, providing a more precise estimate of the impact of a given approach.

This meta-analysis included data from six prior studies. Collectively, these studies enrolled 794 people with MS, of whom 493 completed the respective study. All of the trials compared aquatic therapy against conventional nonexercise occupational therapy, and five also included a land-based exercise comparison group.

The studies ranged in duration from three weeks to about five months, and the time of each exercise session ranged from 45 minutes to slightly over two hours.

The researchers assessed available data for a number of standardized measures of fatigue, balance, and other disease symptoms.

Scores on the Fatigue Severity Scale (FSS), based on data from 138 patients in three studies, improved significantly more in patients given aquatic therapy than those on conventional occupational therapy.

Available data for the Modified Fatigue Impact Scale (MFIS), which assesses fatigue in a trio of domains — physical, cognitive, and psychosocial — showed that aquatic therapy outperformed conventional therapy across all three.

“We found that aquatic therapy positively affects fatigue in patients with MS, which has important implications as fatigue is one of the main symptoms of MS and decreases the quality of life in these patients,” the researchers wrote.

The team noted that nearly all of the studies that assessed fatigue showed a significant effect of aquatic therapy. The lone exception was a study that lasted only three weeks, which “may not be enough to see beneficial effects of aquatic therapy on fatigue considering the chronicity of fatigue in patients with MS,” they added.

Scores on the Berg Balance Scale (BBS) also improved significantly with aquatic therapy compared with conventional interventions, based on data from 58 patients in two studies. The studies generally did not report any safety issues related to aquatic therapy.

The scientists noted this analysis is limited by the relatively small number of studies available in the analysis, highlighting a need for further research. They also noted that some of the studies enrolled only female participants, so these findings may not apply to all patients.