The effects of aquatic exercises on body functions, activity and participation in children and adolescents with cerebral palsy: a systematic review

Abstract

Introduction: Aquatic exercises may benefit children and adolescents with cerebral palsy (CP). Never-theless, there are few studies about the efficacy and safety of those interventions for this population. Therefore, the objective of this study was to perform a systematic review of the effects of aquatic interventions in children and adolescents with CP, considering outcomes related to the body structure, function, activity, and participation; based on the World Health Organization International Classification of Functioning, Disability and Health framework (ICF).

Methods: We searched for experimental or quasi-experimental studies about aquatic exercises’ effects on children and adolescents with CP. We used the databases PubMed/MEDLINE, CINAHL, Scielo, LILACS, SPORTDiscus, Cochrane Reviews, Trials, and PEDro, from January 1st, 2011, to December 31st, 2020. In addition, the risk of bias was assessed with the PEDro tool.

Results: 10 randomized clinical trials and five quasi-experimental studies were included. The focus was on aerobic activities in children with spastic CP, mainly classified as levels I to III in the Gross Motor Function Classification System (GMFCS), outcomes related to structure and function, and activity. Thir-teen studies reported positive effects, but the methodological quality was low.

Discussion: Aquatic exercise programs are feasible and demonstrate a positive effect on this population. There is a need for studies of better methodological quality, including children classified as GMFCS V and outcomes based on the domain of participation.

Keywords: cerebral palsy; water; aquatic; hydrotherapy; swimming