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The effects of aquatics versus land therapy on patients with COPD on quality of life and physical f unction. Suzette Austin Kori Ivanchak Erica Jeszke Nancy Marshall. Background.

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The effects of aquatics versus land therapy on patients with COPD on quality of life and physical function

Suzette Austin

Kori Ivanchak

Erica Jeszke

Nancy Marshall

  • By 2020, Chronic Obstructive Pulmonary Disease (COPD) will be the 3rd most common cause of death globally. (Shead, 2012)
  • COPD limits ability to do activities of daily living which results in a deterioration in health. (Wadell, 2004)
  • People with COPD are often elderly and living with co-morbidities. (Shead, 2012)
background cont
Background cont.
  • Hydrotherapy is considered beneficial therapy for osteoarthritis, rheumatoid arthritis, and stroke. (McNamara, 2011)
  • Only been considered as a treatment option for COPD in the last decade. (McNamara, 2011)
  • Training in water was safe and applicable in patients with COPD. (Perk, 1996)

P: Persons with COPD

I: Aquatic therapy

C: Dry land therapy

O: Quality of life

Physical Function

results wadell 2004


Distance walked in Endurance Shuttle Walking Test

Physical health score in SF-36

Activity score in SGRQ

Results: Wadell, 2004


  • Distance walked in Incremental Shuttle Walking Test
results wadell 2005
Results: Wadell, 2005

9 months vs. Baseline:

9 months vs. 3 months:

Increased walk distance– ISWT

Decrease in VO2peak

No significant changes in SGRQ or SF-36

Control decreased in PCS

Decreased VO2peak, time cycled, work rate

Decreased HRQoL, SF-36

results de souto araujo 2012
Results: de SoutoAraujo, 2012

SQRQ: Improvement in floor group

No change in aquatics group

Decline in control group

  • Overall, increase in pulmonary function
  • Both groups showed improvements in endurance
  • Conflicting evidence in SGRQ
  • Patients with secondary health conditions
  • Reducing the frequency of training was not effective for maintaining fitness level
  • Limited number of studies on topic
  • Small sample sizes
  • Low to moderate quality
  • Motivational factor/patient preference
  • Exclusion of people with certain comorbidities

Based on available studies, there is not enough quality evidence to support if hydrotherapy increases quality of life and physical function in comparison to land therapy.

additional resources
Additional Resources
  • APTA Aquatics Section
  • American Lung Association
  • PT Opinion Article
  • de SoutoAraujo ZT, de Miranda Silva Nogueira PA, Cabral EE, de Paula Dos Santos L, da Silva IS, Ferreira GM. Effectiveness of low-intensity aquatic exercise on COPD: a randomized clinical trial. Respir Med. Nov 2012;106(11):1535-1543.
  • McNamara RJ, Alison JA, McKeough ZJ. Water-based exercise in chronic obstructive pulmonary disease. Physical Therapy Reviews. 2011;16(1):25-30.
  • Perk J, Perk L, Boden C. Cardiorespiratory adaptation of COPD patients to physical training on land and in water. European Respiratory Journal. 1996;9(2):248-252.
  • Shead D, Aswegen HV. Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review. Physical Therapy Reviews. 2012;17(5):271-283.
  • Wadell K, Henriksson-Larsén K, Lundgren R, Sundelin G. Group training in patients with COPD-long-term effects after decreased training frequency. Disability & Rehabilitation. 2005;27(10):571-581.
  • Wadell K, Sundelin G, Henriksson-Larsén K, Lundgren R. High intensity physical group training in water—an effective training modality for patients with COPD. Respiratory Medicine. 2004;98(5):428-438.