Aquatic Therapy Versus Land-Based Therapy in Patients with Parkinson's Disease: A Systematic Review

Background: Parkinson's Disease (PD) is the second most prevalent neurodegenerative disease worldwide. Motor and non-motor symptoms of PD cause functional disabilities. Aquatic-based therapeutic exercise (AT) is a potential approach that may improve the management of PD, given its hydrostatic and hydrodynamic properties. We aimed to evaluate the effectiveness and safety of AT compared to traditional land-based therapeutic exercise (LT) in patients with PD. Methods: Based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, we systematically reviewed studies indexed in PubMed, Scopus, Web of Science, PEDro, CINAHL, and Cochrane. Registered in PROSPERO (CRD42024528310), this review involved original studies published from 2014 to December 2024, with a randomized controlled trial (RCT) design, in which the intervention group performed AT, and the control group performed LT. The outcomes evaluated were balance, gait, quality of life, strength, mental health, pain, flexibility, and sleep quality. Results: Of the 413 records identified, 135 duplicates were removed, and 265 did not meet the selection criteria. Thirteen RCTs comprising 511 patients (age range: 50-80 years) were eligible. Most studies reported beneficial effects of AT, with no serious adverse events. Compared to LT, AT led to significant improvements (p < 0.05) in quality of life, mental health, pain, flexibility, and sleep quality. No evidence was provided of the beneficial effects of AT compared to LT on balance, gait, and strength; however, significant improvements were observed in the AT group from baseline (p < 0.05). Conclusions: AT appears to be a safe and effective intervention for improving the quality of life, mental health, pain, flexibility, and sleep quality in PD patients. While balance, gait, and strength may also benefit, the evidence comparing AT to LT remains inconclusive due to variability in study protocols.