The Effects of Aquatic Exercise on Balance in Individuals with Multiple Sclerosis

Balance deficiencies are common amongst individuals with Multiple Sclerosis (MS), resulting in limited activities of daily living and an increased fall risk. Exercise, especially recently studied aquatic exercise, has been documented to be effective in increasing function and improving quality of life. Limited studies have examined the effects of aquatic exercise on balance outcomes using biomechanical methods. PURPOSE: The purpose of this study was to examine the effects of an aquatic exercise program on balance in people with MS. The study findings were expected to provide more scientific and objective evidence to assist clinicians and rehabilitation specialists in developing effective MS intervention programs. METHODS: Twenty participants (18-65 years old) with MS were recruited, and randomly assigned to either the intervention (aquatic exercise) or control group (no exercise). The aquatic exercise intervention took place in an accessible swimming pool (82-86° F). The aquatic group (n=10) participated in one hour of aquatic exercise, two times a week for 10 weeks. Each 60-minute exercise session included a warm-up (five minutes), strength and balance training (50 minutes) and cool down (five minutes). The control group (n=10) did not participate in any exercise and were instructed to continue daily activities. Balance was measured before and after the 10-week session in both groups, using a computerized posturographic balance assessment machine. Variables assessed were latency, sway energy, transfer time, rising and impact index through the following five tests: Sensory organization test (SOT), motor control (MC) and adaptation test (AT), sit to stand (STS) and step up and over (SUO) test. RESULTS: A mixed-model ANOVA showed that there was a significant between-group interaction in MC, AT, STS and SUO (all p’s <0.05). The aquatic group showed decreases in STS and SUO time, latency in MC and sway energy in AT while the control group did not show changes in these variables. Within-group analyses showed that the aquatic group had significant decreases in STS and SUO time (all p’s <0.05). No significant difference was found in SOT for either group. CONCLUSION: The results suggest that aquatic exercise can improve functional balance in people with MS. Although no statistically significant differences were found in the SOT, many participants showed a trend of improvements of static and dynamic balance after aquatic intervention.