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17 pages, 1656 KiB

Open AccessArticle

Effects of Aquatic Therapy for Children with Autism Spectrum Disorder on Social Competence and Quality of Life: A Mixed Methods Study

by Javier Güeita-Rodríguez, Anna Ogonowska-Slodownik, Natalia Morgulec-Adamowicz, Mar Lledó Martín-Prades, Juan Nicolás Cuenca-Zaldívar and Domingo Palacios-Ceña

Int. J. Environ. Res. Public Health 2021, 18(6), 3126; https://doi.org/10.3390/ijerph18063126 - 18 Mar 2021

Cited by 13 | Viewed by 8472

Abstract

Autism Spectrum Disorder (ASD) is a constellation of social deficits and repetitive sensory-motor behaviours. Aquatic therapy (AT) may be effective in improving the social interactions and behaviours in children with ASD. The objective of this study was to evaluate the effects of an [...] Read more.

Autism Spectrum Disorder (ASD) is a constellation of social deficits and repetitive sensory-motor behaviours. Aquatic therapy (AT) may be effective in improving the social interactions and behaviours in children with ASD. The objective of this study was to evaluate the effects of an AT program on social competence and quality of life and to understand participant’s experiences related to the intervention by obtaining qualitative data. A mixed methods intervention study was conducted among 6 children with ASD and their parents, with two research phases in a concurrent embedded design (an aquatic intervention as the quantitative design and a qualitative design in second step). The intervention and qualitative design followed international guidelines and were integrated into the method and reporting subheadings. Significant improvement was observed in the physical competence (p = 0.026) and important improvements in school functioning and aquatic skills, with no adverse events. Qualitative findings described: the meaning of AT intervention, patterns of behaviour and activities changes, social communication and social interaction. The aquatic intervention showed positive results for the social and physical competence, with elements of discordance, expansion, and confirmation between quantitative and qualitative results. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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11 pages, 1932 KiB

Open AccessArticle

Immediate Effects of Aquatic Therapy on Balance in Older Adults with Upper Limb Dysfunction: An Exploratory Study

by Maria Graça, José Alvarelhão, Rui Costa, Ricardo J. Fernandes, Andrea Ribeiro, Daniel Daly and João Paulo Vilas-Boas

Int. J. Environ. Res. Public Health 2020, 17(24), 9434; https://doi.org/10.3390/ijerph17249434 - 16 Dec 2020

Cited by 2 | Viewed by 2973

Abstract

Background: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body’s physiological response to the physical and mechanical properties of water during passive [...] Read more.

Background: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body’s physiological response to the physical and mechanical properties of water during passive immersion. The purpose of this study was to evaluate the effects of a single 45-min active aquatic physiotherapy session on standing balance and strength, and its relationship with functional reach in persons 55 years and older with upper limb dysfunction. Methods: The intervention group (n = 12) was assessed before and after a single aquatic physiotherapy session, while the control group (n = 10) was evaluated before and after 45 min of sitting rest. Functional assessment was made using the visual analogue pain scale (points), step test (repetitions), functional reach test (cm), and global balance-standing test on a force platform (% time). A two-way repeated-measures ANOVA was applied (p < 0.05). Results: The intervention group showed non-significant improvements between measurement before and after the intervention: Pain: 6.2 ± 1.9 vs. 5.2 ± 2.3 cm, steps: 7.0 ± 2.0 vs. 7.4 ± 1.8 repetitions, reach: 9.1 ± 2.8 vs. 10.4 ± 3.8 cm, and balance: 61.7 ± 5.9 vs. 71.3 ± 18.2% time in balance on the platform. The control group showed fewer changes but had better baseline values. A comparison between groups with time showed no significant differences in these changes. Conclusions: No significant immediate effects were found for one session of aquatic physiotherapy applied to patients older than 55 years with upper limb dysfunction. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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12 pages, 1261 KiB

Open AccessArticle

Relationship between Oxygen Uptake, Heart Rate, and Perceived Effort in an Aquatic Incremental Test in Older Women

by Luana Siqueira Andrade, Ana Carolina Kanitz, Mariana Silva Häfele, Gustavo Zaccaria Schaun, Stephanie Santana Pinto and Cristine Lima Alberton

Int. J. Environ. Res. Public Health 2020, 17(22), 8324; https://doi.org/10.3390/ijerph17228324 - 11 Nov 2020

Cited by 6 | Viewed by 1862

Abstract

Different parameters can be used to control the intensity of aerobic exercises, a choice that should consider the population and exercise environment targeted. Therefore, our study aimed to verify the relationship between oxygen uptake (VO₂), heart rate (HR), rating of perceived [...] Read more.

Different parameters can be used to control the intensity of aerobic exercises, a choice that should consider the population and exercise environment targeted. Therefore, our study aimed to verify the relationship between oxygen uptake (VO₂), heart rate (HR), rating of perceived exertion (RPE), and cadence during an aquatic incremental test in older women. Nine older women (64.3 ± 4.4 years) engaged in a water-based aerobic training performed an aquatic incremental test using the stationary running exercise (cadence increases of 15 b·min⁻¹ every 2 min) until participants’ volitional exhaustion. VO₂, HR, and RPE data were measured, and the percentage of peak VO₂ (%VO_2peak) and percentage of maximal HR (%HR_max) were calculated. Linear and polynomial regression analyses were performed (α = 0.05). Polynomial regressions revealed the best adjustments for all analyses. Data showed a significant relationship (p < 0.001) between %VO_2peak and %HR_max (r = 0.921), %VO_2peak and RPE (r = 0.870), and %HR_max and RPE (r = 0.878). Likewise, significant relationships between cadence (p < 0.001) and %VO_2peak (r = 0.873), %HR_max (r = 0.874), and RPE (r = 0.910) were also observed. In summary, the physiological, subjective, and mechanical variables investigated were highly associated during an aquatic incremental test to exhaustion in older women. Therefore, these different parameters can be employed to adequately prescribe water-based programs according to preference and availability. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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14 pages, 651 KiB

Open AccessArticle

Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

by Carla Morer, Alfredo Michan-Doña, Antonio Alvarez-Badillo, Pilar Zuluaga and Francisco Maraver

Int. J. Environ. Res. Public Health 2020, 17(21), 8163; https://doi.org/10.3390/ijerph17218163 - 05 Nov 2020

Cited by 4 | Viewed by 3286

Abstract

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are [...] Read more.

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild–moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32–34 °C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured (p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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12 pages, 822 KiB

Open AccessArticle

Influence of an Aquatic Therapy Program on Perceived Pain, Stress, and Quality of Life in Chronic Stroke Patients: A Randomized Trial

by Sagrario Pérez-de la Cruz

Int. J. Environ. Res. Public Health 2020, 17(13), 4796; https://doi.org/10.3390/ijerph17134796 - 03 Jul 2020

Cited by 20 | Viewed by 8065

Abstract

Pain and depressive states may have a negative impact on the quality of life of individuals with stroke. The aim of this study was to evaluate the effects of a program of Ai Chi aquatic therapy on pain, depression, and quality of life [...] Read more.

Pain and depressive states may have a negative impact on the quality of life of individuals with stroke. The aim of this study was to evaluate the effects of a program of Ai Chi aquatic therapy on pain, depression, and quality of life in a sample of people with stroke. Forty-five participants received physiotherapy treatment on dry land (control group), an experimental group received aquatic Ai Chi therapy, and a combined therapy group received alternating sessions of physiotherapy on dry land and aquatic Ai Chi therapy. The Visual Analog Scale (VAS) scale for pain, the resilience scale, and the SF-36 quality of life scale were used as outcome measures. Statistically significant differences were found in the experimental group and the combined intervention group for post treatment pain and resilience (p < 0.001). Concerning the SF-36, statistically significant changes (p < 0.01) were found in the experimental group and the combined therapy group for all items except general health, vitality, and social function, where no between group differences were observed (p = 0.001). In conclusion, physical exercise performed in water has positive effects on several factors that contribute towards improving the mood and quality of life of people with acquired brain injury. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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12 pages, 1151 KiB

Open AccessArticle

Comparison of Aquatic Therapy vs. Dry Land Therapy to Improve Mobility of Chronic Stroke Patients

by Sagrario Pérez-de la Cruz

Int. J. Environ. Res. Public Health 2020, 17(13), 4728; https://doi.org/10.3390/ijerph17134728 - 01 Jul 2020

Cited by 7 | Viewed by 8517

Abstract

One of the most serious and disabling problems of stroke is pain and a decrease in balance, with the consequent increased risk of falls. The aim of the randomized controlled trial study was to compare the efficacy of three different treatment proposals to [...] Read more.

One of the most serious and disabling problems of stroke is pain and a decrease in balance, with the consequent increased risk of falls. The aim of the randomized controlled trial study was to compare the efficacy of three different treatment proposals to improve pain, gait, and balance in chronic stroke patients. Forty patients diagnosed with stroke were divided into three groups: the dry-land therapy group (control group) received sessions that included walking exercises and trunk mobility. The experimental group received Ai Chi aquatic therapy, and the combined group received alternating dry-land therapy sessions and Ai Chi aquatic therapy. The measurement instruments used were: the Tinetti balance and gait scale, the visual analog scale (VAS), 360° turn, single leg stance, and the 30-s stand test (CS-30). After twelve weeks of treatment, the results were significantly better for the combined therapy group and the experimental group compared to the dry-land therapy group (p < 0.01) in the VAS scale, CS-30, and 360° turn, although improvements were also found in the evaluations carried out in the aquatic therapy group. In total, for the Tinetti scale and single-leg stance, the differences between the groups were evident, although not statistically significant (p = 0.001). Aquatic therapy with Ai Chi and the combination of aquatic therapy with dry-land therapy was effective in improving pain, balance, and gait in patients with chronic stroke, thus improving their functional capacity and quality of life. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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25 pages, 3000 KiB

Open AccessArticle

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

by Ántonio Cuesta-Vargas, Jaime Martín-Martín, David Pérez-Cruzado, Carlos L. Cano-Herrera, Javier Güeita Rodríguez, Jose Antonio Merchán-Baeza and Manuel González-Sánchez

Int. J. Environ. Res. Public Health 2020, 17(13), 4696; https://doi.org/10.3390/ijerph17134696 - 30 Jun 2020

Cited by 3 | Viewed by 3579

Abstract

Background: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. Aim: To compare muscle activity between two groups (healthy young [...] Read more.

Background: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. Aim: To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements. Methods: Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit TO Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1). Results: Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent. Conclusions: Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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12 pages, 551 KiB

Open AccessArticle

Influence of a Water-Based Exercise Program in the Rate of Spontaneous Birth: A Randomized Clinical Trial

by Raquel Rodríguez-Blanque, María José Aguilar-Cordero, Ana Eugenia Marín-Jiménez, Ana María Núñez-Negrillo, Antonio Manuel Sánchez-López and Juan Carlos Sánchez-García

Int. J. Environ. Res. Public Health 2020, 17(3), 795; https://doi.org/10.3390/ijerph17030795 - 28 Jan 2020

Cited by 10 | Viewed by 3141

Abstract

Introduction: Many women change their lifestyles and habits when they become pregnant, to avoid potentially harmful effects to themselves and their babies. This is especially so with respect to physical exercise, which is often greatly reduced due to ignorance of the benefits [...] Read more.

Introduction: Many women change their lifestyles and habits when they become pregnant, to avoid potentially harmful effects to themselves and their babies. This is especially so with respect to physical exercise, which is often greatly reduced due to ignorance of the benefits it provides during pregnancy. Aim: To evaluate the prevalence of spontaneous birth among women who participated in a water-based physical exercise program. Methods: A randomized clinical trial was conducted with a sample of 129 pregnant women (Control Group, CG = 64; Exercise Group, EG = 65). A physical exercise protocol, specifically designed for pregnant women, was created and applied. Those in the EG performed 60 min exercise sessions, three times per week for 17 weeks. The participants in the CG received routine check-ups and advice throughout their pregnancy. Findings: The women in the EG presented better results for the onset of spontaneous birth (OR = 2.060 (0.980–4.332)) and for neonate Apgar score of 10 at five minutes (OR = 8.53 (3.60–20.17)). Those who had normal weight at the start of pregnancy achieved better results for spontaneous delivery (OR = 2.099 (1.017–4.335)) than those with overweight/obesity. The rate of caesarean delivery was higher in the women with overweight/obesity (OR = 3.570 ((1.226–10.397)) than in those with normal weight. Conclusions: In our study, the women who followed the water-based exercise program gained less weight during pregnancy, which facilitated a better rate of spontaneous, non-instrumental childbirth, together with a better Apgar test score at five minutes. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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19 pages, 1503 KiB

Open AccessArticle

Priming Effects of Water Immersion on Paired Associative Stimulation-Induced Neural Plasticity in the Primary Motor Cortex

by Daisuke Sato, Koya Yamashiro, Yudai Yamazaki, Koyuki Ikarashi, Hideaki Onishi, Yasuhiro Baba and Atsuo Maruyama

Int. J. Environ. Res. Public Health 2020, 17(1), 215; https://doi.org/10.3390/ijerph17010215 - 27 Dec 2019

Cited by 5 | Viewed by 3092

Abstract

We aimed to verify whether indirect-wave (I-wave) recruitment and cortical inhibition can regulate or predict the plastic response to paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), and also whether water immersion (WI) can facilitate the subsequent PAS25-induced plasticity. To [...] Read more.

We aimed to verify whether indirect-wave (I-wave) recruitment and cortical inhibition can regulate or predict the plastic response to paired associative stimulation with an inter-stimulus interval of 25 ms (PAS25), and also whether water immersion (WI) can facilitate the subsequent PAS25-induced plasticity. To address the first question, we applied transcranial magnetic stimulation (TMS) to the M1 hand area, while alternating the direction of the induced current between posterior-to-anterior and anterior-to-posterior to activate two independent synaptic inputs to the corticospinal neurons. Moreover, we used a paired stimulation paradigm to evaluate the short-latency afferent inhibition (SAI) and short-interval intracortical inhibition (SICI). To address the second question, we examined the motor evoked potential (MEP) amplitudes before and after PAS25, with and without WI, and used the SAI, SICI, and MEP recruitment curves to determine the mechanism underlying priming by WI on PAS25. We demonstrated that SAI, with an inter-stimulus interval of 25 ms, might serve as a predictor of the response to PAS25, whereas I-wave recruitment evaluated by the MEP latency difference was not predictive of the PAS25 response, and found that 15 min WI prior to PAS25 facilitated long-term potentiation (LTP)-like plasticity due to a homeostatic increase in cholinergic activity. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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11 pages, 2627 KiB

Open AccessArticle

Investigation the EMG Activities of Lower Limb Muscles When Doing Squatting Exercise in Water and on Land

by Calvin H.N. Yuen, Christine P.Y. Lam, Kate C.T. Tong, Jessica C.Y. Yeung, Chloe H.Y. Yip and Billy C.L. So

Int. J. Environ. Res. Public Health 2019, 16(22), 4562; https://doi.org/10.3390/ijerph16224562 - 18 Nov 2019

Cited by 9 | Viewed by 4114

Abstract

(1) Background: Squatting is one of the common closed-kinetic chain (CKC) exercises for knee rehabilitation. Some patients cannot perform squatting exercises on land occasionally due to knee pain. Several studies had suggested that lower limb muscle activities are lower in water than [...] Read more.

(1) Background: Squatting is one of the common closed-kinetic chain (CKC) exercises for knee rehabilitation. Some patients cannot perform squatting exercises on land occasionally due to knee pain. Several studies had suggested that lower limb muscle activities are lower in water than on land while performing CKC exercises. The purpose of this study is to investigate the surface electromyography (sEMG) activities of Rectus femoris (RF) and Biceps femoris (BF) muscles when doing a squatting exercise in water and on land. (2) Methods: This was a cross-sectional experimental study. A total of 20 healthy participants (10 males, 10 females) were recruited by convenience sampling. The sEMG of RF and BF muscles in water and on land were collected and the knee motions were videotaped. Participants were instructed to perform closed kinetic-chain back squatting exercises at a specific speed (30 beats per minute) in water and on land at angular speed of 45°/s. Eight repetitions of the squatting exercise (0–90° knee flexion) were performed. The mean percentage maximal voluntary contraction (%MVC) between two muscles was compared in two conditions. The %MVC of RF and BF muscles at different specific knee flexion angles (30°, 60° and 90° knee flexion) was also identified. (3) Result: Muscle activities of RF (p = 0.01) and BF (p < 0.01) muscles were significantly lower in water than on land. The %MVC of RF and BF muscles was found to be 15.01% and 10.68% lower in water than on land respectively. For different knee angle phases, the differences in %MVC between land and water had significant difference for both RF muscles and BF muscles. (4) Conclusion: This study found a difference of mean percentage MVC of RF and BF muscles between land and water in different phases of squatting. The water medium reduced the two muscles’ activities to a similar extent. The result showed that the aquatic environment allows an individual to perform squatting with less muscle activation which may serve as an alternative knee exercise option for patients who encounter difficulty in land squatting due to lower limb muscle weakness or a high level of knee pain. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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Review

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25 pages, 744 KiB

Open AccessReview

Head-Out Water-Based Protocols to Assess Cardiorespiratory Fitness—Systematic Review

by Anna Ogonowska-Slodownik, Paula Richley Geigle and Natalia Morgulec-Adamowicz

Int. J. Environ. Res. Public Health 2020, 17(19), 7215; https://doi.org/10.3390/ijerph17197215 - 02 Oct 2020

Cited by 5 | Viewed by 2788

Abstract

The aquatic environment offers cardiorespiratory training and testing options particularly for individuals unable to adequately train or test on land because of weight bearing, pain or disability concerns. No systematic review exists describing cardiorespiratory fitness protocols used in an aquatic environment. This review [...] Read more.

The aquatic environment offers cardiorespiratory training and testing options particularly for individuals unable to adequately train or test on land because of weight bearing, pain or disability concerns. No systematic review exists describing cardiorespiratory fitness protocols used in an aquatic environment. This review investigated the different head-out water-based protocols used to assess cardiorespiratory fitness. Our comprehensive, systematic review included 41 studies with each included paper methodological quality assessed using the statistical review of general papers checklist. Diverse protocols arose with three major categories identified: conducted in shallow water, deep water, and using special equipment. Thirty-seven articles presented data for peak/maximal oxygen consumption (VO_2peak/VO_2max). Twenty-eight of 37 studies predefined criteria for reaching a valid VO_2peak/VO_2max with shallow water exercise demonstrating 20.6 to 57.2 mL/kg/min; deep water running 20.32 to 48.4 mL/kg/min; and underwater treadmill and cycling 28.64 to 62.2 mL/kg/min. No single, accepted head-out water-based protocol for evaluating cardiorespiratory fitness arose. For clinical use three cardiorespiratory fitness testing concepts ensued: water temperature of 28–30 °C with difference of maximum 1 °C between testing participants and/or testing sessions; water depth adapted for participant aquatic experiences and abilities; and intensity increment of 10–15 metronome beats per minute. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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14 pages, 797 KiB

Open AccessReview

Identification of Tools for the Functional and Subjective Assessment of Patients in an Aquatic Environment: A Systematic Review

by Antonio Cuesta-Vargas, Jaime Martin-Martin, Manuel Gonzalez-Sanchez, Jose Antonio Merchan-Baeza and David Perez-Cruzado

Int. J. Environ. Res. Public Health 2020, 17(16), 5690; https://doi.org/10.3390/ijerph17165690 - 06 Aug 2020

Cited by 1 | Viewed by 2895

Abstract

Aquatic therapy is one of the most common treatments for alleviating musculoskeletal pathologies. Its effectiveness has been evaluated with functional tests and questionnaires. Functional tests are used in aquatic therapy; however, in most cases, they are carried out in a non-aquatic environment and, [...] Read more.

Aquatic therapy is one of the most common treatments for alleviating musculoskeletal pathologies. Its effectiveness has been evaluated with functional tests and questionnaires. Functional tests are used in aquatic therapy; however, in most cases, they are carried out in a non-aquatic environment and, as such, their results may differ from those of tests performed in an aquatic environment. A systematic review was performed to assess the accuracy of functional tests and patient-reported outcomes to assess aquatic therapy interventions. The authors conducted a literature search in July 2019. In total, 70,863 records were identified after duplicates removed. Of these, 14 records were included about functional tests assessment in aquatic environment and 725 records for questionnaires. The majority of the tests had also been assessed in a dry environment, allowing differences and similarities between the tests in the two environments to be observed. Different variables have been assessed in tests included in the present systematic review (cardiorespiratory, neuromuscular, kinematic, physiological, kinetic responses and rating of perceived exertion) which are included in the manuscript. Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and the 12-item Short Form Health Survey were the assessments most commonly used by the different authors. Full article

(This article belongs to the Special Issue Immersing in an Enriched Environment: Aquatic Therapy in a Modern Perspective)

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