Is water-based exercise training sufficient to improve physical fitness in the elderly?

The research on the effects of aquatic exercise is a field that has grown rapidly in the last decade. The majority of the
available literature is focused on the benefits of water-based exercise programs for people with rheumatologic disease and
back pain; however, there is a lack of evidence reporting the effects of exercise performed in an aquatic medium for healthy
elderly adults. The purpose of this study was to critically review the existing evidence of a potential relationship between
water-based exercise and improvement of physical fitness in healthy elderly subjects. A systematic database search for manuscripts
and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition
outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials
(RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified
as high quality studies. One RCT, one randomized UT and one CT were considered low quality studies. Strong evidence supports
the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits
on flexibility, and inconclusive evidence was found supporting the modification of body composition.