The WATER study: Which AquaTic ExeRcises increase muscle activity and limit pain for people with low back pain?

Objective Aquatic exercise therapy is used for the treatment and management of chronic low back pain (CLBP). However, to the authors' knowledge, no studies to date have compared muscle activity between different aquatic exercises performed by people with CLBP. As such, this study assessed and compared muscle activity, pain, perceived exertion and exercise intensity between different rehabilitative aquatic exercises. Design Cross-sectional. Setting A 25-m indoor swimming pool within a university building. Participants Twenty participants with non-specific CLBP. Assessment Twenty-six aquatic exercises in shallow water (1.25-m depth). Muscle activity was quantified bilaterally for the erector spinae, multifidus, gluteus maximus and medius, rectus abdominis, and external and internal obliques. Main outcomes Mean and peak muscle activity, pain (visual analogue scale), perceived exertion (Borg scale) and exercise intensity (heart rate). Results Hip abduction/adduction and extension/flexion exercises produced higher activity for gluteal muscles. Variations of squat exercises increased the activity of back extensors. Higher abdominal muscle activity was produced with exercises that made use of buoyancy equipment and included leg and trunk movements while floating on the back, and with some proprioceptive and dynamic lower limb exercises. Pain occurrence and intensity were very low, with 17 exercises being pain free. Conclusions This study provides evidence on trunk and gluteal muscle activity, pain, intensity and perceived exertion for people with CLBP performing aquatic exercises. The findings may be useful when prescribing exercises for rehabilitation, as physiotherapists seek to implement progression in effort and muscle activity, variation in exercise type, and may wish to target or avoid particular muscles. (C) 2022 The Authors. Published by Elsevier Ltd on behalf of Chartered Society of Physiotherapy.

Automated summary

This study assessed and compared muscle activity, pain, intensity, and perceived exertion in people with chronic low back pain (CLBP) performing different aquatic exercises. The results showed that different aquatic exercises elicited different levels of muscle activity in various muscle groups, and most exercises had minimal impact on pain. These findings provide guidance for prescribing and implementing rehabilitative aquatic exercises.