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TitleEffekt av trening i varmtvannsbasseng for personer med muskelskjelettlidelser
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Page 1

Muskelskjelettlidelser er utbredt i den norske befolkningen, og kostnader knyt-
tet til slike lidelser er betydelige og økende. Trening i varmtvannsbasseng er et
av mange behandlingsalternativer for denne pasientgruppen. Kunnskapssen-
teret har oppsummert forskning om effekt av trening i varmtvannsbasseng på
egenmeldt sykefravær. Vi inkluderte to kontrollerte studier. Vi har vurdert doku-
mentasjonen til å ha svært lav kvalitet.
Vi fant at: • Kvinner med fi bromyalgiplager og kronisk utbredt smerte som fi kk
trening i varmtvannsbasseng i kombinasjon med opplæringsprogram var ikke
mindre borte fra arbeid enn dem som kun fi kk tilbud om opplæringsprogram.
Funnet er svært usikkert. • Kvinner med fi bromyalgi som fi kk trening i varmt-
vannsbasseng i kombinasjon med trening på land, kognitiv atferdsterapi og en
brosjyre, hadde færre fraværsdager enn dem som kun fi kk en brosjyre. Vi har
svært liten tillit til dette resultatet. • Vi fant ingen kontrollerte studier som eva-
luerte effekt av trening i varmtvannsbasseng på sykefravær for

Effekt av trening i varmtvanns-
basseng for personer med muskel-

Rapport fra Kunnskapssenteret nr 11–2015

Systematisk oversikt

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Nasjonalt kunnskapssenter for helsetjenesten
Postboks 7004, St. Olavsplass
N-0130 Oslo
(+47) 23 25 50 00
Rapport: ISBN 978-82-8121-960-1 ISSN 1890-1298

nr 11–2015

andre pasientgrupper enn personer med fi bromalgi eller kro-
nisk utbredt smerte.

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OBJECTIVES: The aim of this systematic review was to evaluate the effectiveness of hydrothera-

py in the management of patients with RA.

METHOD: AMED, CINAHL, EMBASE, MEDLINE, PubMed, Science Direct and Web of Science

were searched between 1988 and May 2011. Keywords used were rheumatoid arthritis, hydro-

therapy, aquatic physiotherapy, aqua therapy and water therapy. Searches were supplemented

with hand searches of references of selected articles. Randomized controlled trials were assessed

for their methodological quality using the Physiotherapy Evidence Database (PEDro) scale. This

scale ranks the methodological quality of a study scoring 7 out of 10 as 'high quality', 5-6 as

'moderate quality' and less than 4 as 'poor quality'.

RESULTS: Initially, 197 studies were identified. Six studies met the inclusion criteria for further

analysis. The average methodological quality for all studies was 6.8 using the PEDro scale. Most

of the studies reported favourable outcomes for a hydrotherapy intervention compared with no

treatment or other interventions for patients with RA. Improvement was particularly noted in

reducing pain, joint tenderness, mood and tension symptoms, and increasing grip strength and

patient satisfaction with hydrotherapy treatment in the short term.

CONCLUSIONS: There is some evidence to suggest that hydrotherapy has a positive role in re-

ducing pain and improving the health status of patients with RA compared with no or other interven-

tions in the short term. However, the long-term benefit is unknown. Further studies are needed.

3 Cairns AP, McVeigh JG. A systematic review of the effects of dynamic exercise in rheumatoid

arthritis. Rheumatology International 2009;30(2):147-158.

Abstract: Exercise is commonly used in the management of patients with rheumatoid arthritis

(RA); however, there is little consensus in the literature to support its use. This systemic review

aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of

Medline (1949–2007), Cinahl (1982–2007), Embase (1974–2007) and Cochrane library was

performed for randomised-controlled trials using the keywords “rheumatoid arthritis” and “ex-

ercise” or “training” or “sport”. The methodological quality of studies was assessed using a ten-

point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean

methodological quality score was 6.9/10. Studies using aerobic training, strength training and

combinations of both were included. Patients with early, stable, and active RA were studied. A

number of studies reported improvement in muscle strength, physical function and aerobic ca-

pacity with dynamic exercise. Some studies also reported improvements in disease activity

measures, and small improvements in hip bone mineral density. One study reported significant-

ly less progression of small joint radiographic damage of the feet in the dynamic exercise group.

However, one study also reported worse large joint radiographic damage in patients using dy-

namic exercise who had pre-existing large joint damage, though this was a retrospective analy-

sis. No studies reported worse outcomes for function, disease activity or aerobic capacity with

dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were

presented to assess the effect of exercise on patients with significant underlying cardiovascular

disease. This systematic review suggests that the majority of patients with RA should be encour-

aged to undertake aerobic and/or strength training exercise. Exercise programmes should be

carefully tailored to the individual, particularly for patients with underlying large joint damage

or pre-existing cardiovascular disease.

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4 Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy interventions for ankylosing spondylitis.

Cochrane Database of Systematic Reviews 2008 (1):CD002822.

Abstract: Background: Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease.

Physiotherapy is considered an important part of the overall management of AS.Objectives: To

summarise the available scientific evidence on the effectiveness of physiotherapy interventions

in the management of AS.Search methods: We searched the Cochrane Central Register of Con-

trolled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to January

2007 for all relevant publications, without any language restrictions. We checked the reference

lists of relevant articles and contacted the authors of included articles.Selection criteria: We in-

cluded randomised and quasi-randomised studies with AS patients and where at least one of the

comparison groups received physiotherapy. The main outcomes of interest were pain, stiffness,

spinal mobility, physical function and patient global assessment.Data collection and analysis:

Two reviewers independently selected trials for inclusion, extracted data and assessed trial qual-

ity. Investigators were contacted to obtain missing information.Main results: Eleven trials with a

total of 763 participants were included in this updated review. Four trials compared individual-

ised home exercise programs or a supervised exercise program with no intervention and report-

ed low quality evidence for effects in spinal mobility (Relative percentage differences (RPDs)

from 5-50%) and physical function (four points on a 33-point scale). Three trials compared su-

pervised group physiotherapy with an individualised home-exercise program and reported mod-

erate quality evidence for small differences in spinal mobility (RPDs 7.5-18%) and patient global

assessment (1.46 cm) in favour of supervised group exercises. In one study, a three-week inpa-

tient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (with-

out spa) was compared with weekly outpatient group physiotherapy alone; there was moderate

quality evidence for effects in pain (18%), physical function (24%) and patient global assessment

(27%) in favour of the combined spa-exercise therapy. One study compared daily outpatient bal-

neotherapy and an exercise program with only exercise program, and another study compared

balneotherapy with fresh water therapy. None of these studies showed significant between-

group differences. One study compared an experimental exercise program with a conventional

program; statistically significant change scores were reported on nearly all spinal mobility

measures and physical function in favour of the experimental program.Authors' conclusions:

The results of this review suggest that an individual home-based or supervised exercise program

is better than no intervention; that supervised group physiotherapy is better than home exercis-

es; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better

than group physiotherapy alone.

5 Gaudin P, Leguen-Guegan S, Allenet B, Baillet A, Grange L, Juvin R. Is dynamic exercise beneficial

in patients with rheumatoid arthritis? Joint, Bone, Spine 2008;75(1):11-17.

Abstract: INTRODUCTION: Dynamic exercise therapy as defined by the American College of

Sports Medicine for healthy individuals is of unclear relevance to patients with rheumatoid ar-

thritis (RA). No recommendations on this issue are available. Few studies have evaluated the op-

timal program, frequency, or target population; furthermore, there is no consensus about the

best assessment tools for monitoring clinical, functional, and structural parameters during dy-

Page 94


women with fibromyalgia/chronic widespread muscle pain. Arthritis Care & Research 2001
Feb;45(1):42-47 2001.

20. Kesiktas N, Karakas S, Gun K, Gun N, Murat S, Uludag M. Balneotherapy for chronic low back
pain: A randomized, controlled study. Rheumatology International 2012;32(10):3193-3199.

21. Kim IS, Chung SH, Park YJ, Kang HY. The effectiveness of an aquarobic exercise program for
patients with osteoarthritis. Applied Nursing Research 2012;25(3):181-189.

22. Kostopoulos D. Comparative effects of aquatic recreational and aquatic exercise programs on
mobility, pain perception, and treatment satisfaction among elderly persons with osteoarthritis of
the knee. 2000(88 p).

23. Landewe RBM, Peeters R, Masek BA, Verreussel RLP, The HSG. A 12 weeks clinical-trial to the
effect of hydrotherapy in a thermomineral institution compared with hydrotherapy in a hospital-
exercice-bath in patients with rheumatoid-arthritis. British Journal of Rheumatology 1992;31:31-

24. Latorre PA, Santos MA, Heredia-Jimenez JM, Delgado-Fernandez M, Soto VM, Manas A, et al.
Effect of a 24-week physical training programme (in water and on land) on pain, functional
capacity, body composition and quality of life in women with fibromyalgia. Clinical and
Experimental Rheumatology 2013;31(SUPPL.79):72-80.

25. Lim JY, Tchai E, Jang SN. Effectiveness of Aquatic Exercise for Obese Patients with Knee
Osteoarthritis: A Randomized Controlled Trial. PM and R 2010;2(8):723-731

26. Marcu IR, Patru S, Bighea A, Popescu RS, Bumbea AM. Effect of hydrotherapy vs. Conventional
land-based exercise in patients with hiparthroplasty for osteoarthritis. Osteoporosis International

27. Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise
in patients with rheumatoid arthritis and osteoarthritis. Arthritis and Rheumatism

28. Munguia-Izquierdo D, Legaz-Arrese A. Exercise in warm water decreases pain and improves
cognitive function in middle-aged women with fibromyalgia. Clinical and Experimental
Rheumatology 2007;25(6):823-830.

29. Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of
aquatic exercise for persons with osteoarthritis. Medical Care 2001;39(5):413-424.

30. Patrick M, Patrick D, Maciejewski M, Topolski T, Belza B. How does aquatic exercise affect quality
of life in persons with osteoarthritis? Arthritis and Rheumatism 2004;50(9):S469-S469.

31. Reid A, Brady A, Cusack T, Blake C, Mongey AB, Veale DJ, et al. Functional benefits following
dynamic exercise in patients with RA taking anti-TNF therapy reflected in lower limb function tests
but not the HAQ. Arthritis and Rheumatism 2010;62:2135.

32. Reid A, Brady A, Cusack T, Blake C, Mongey AB, Veale DJ, et al. Improvements in function
following dynamic exercise in patients with RA taking anti-TNFalpha therapy. Irish Journal of
Medical Science 2011;180:S211.

33. Reid A, Brady A, Cusack T, Blake C, Mongey AB, Veale DJ, et al. Improvements in function
following dynamic exercise in patients with RA taking anti-TNFalpha therapy reflected in lower
limb function tests. Irish Journal of Medical Science 2011;180:S171-S172.

34. Reid A, Brady A, Cusack T, Blake C, Mongey AB, Veale DJ, et al. RCT Examining the effects of
exercise for people with rheumatoid arthritis on anti-TNFalpha medication. Rheumatology

35. Rimmer B, Berry-Merriam D, Lineker S, Elsbett-Koeppen R, Fortier-Hughes J. The benefits of
group recreational aquatic programs compared to land-based exercise programs for clients with
self-reported arthritis: A pilot study. Journal of Aging and Physical Activity 2004;12(3):374-374.

36. Risum T, Lyngberg K, Telling M, Danneskiold-Samsøe B. Water exercise therapy for patient with
rheumatoid arthritis. Scandinavian journal of rheumatology Supplement 1986;59:49.

37. Siu AM, Chui DY. Evaluation of a community rehabilitation service for people with rheumatoid
arthritis. Patient education and counseling 2004;55(1):62-69.

38. Stenstrom CH, Lindell B, Swanberg E, Swanberg P, Harms-Ringdahl Nordemar KR. Intensive
dynamic training in water for rheumatoid arthritis functional class II - A long-term study of effects.
Scandinavian Journal of Rheumatology 1991;20(5):358-365.

39. Tomas-Carus P, Gusi N, Hakkinen A, Hakkinen K, Leal A, Ortega-Alonso A. Eight months of
physical training in warm water improves physical and mental health in women with fibromyalgia:

Page 95


A randomized controlled trial. Journal of Rehabilitation Medicine 2008;40(4):248-252.
40. Tomas-Carus P, Hakkinen A, Gusi N, Leal A, Hakkinen K, Ortega-Alonso A. Aquatic training and

detraining on fitness and quality of life in fibromyalgia. Medicine and Science in Sports and
Exercise 2007;39(7):1044-1050.

41. Tomas-Carus P, Gusi N, Hakkinen A, Hakkinen K, Raimundo A, Ortega-Alonso A. Improvements
of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia:
An 8-month randomized controlled trial. Rheumatology 2009;48(9):1147-1151.

42. Wang TT. Aquatic exercise improves flexibility, strength, and walk time in osteoarthritis. University
of Washington; 2004. p. 157 p.

Ekskludert på grunn av dubletter

1. Adams N, Cuesta Vargas A. Multimodal physiotherapy plus deep water running (DWR) for
fibromyalgia: A community based study. European Journal of Pain Supplements 2011;5(S1):43.

2. Jespersen A, Kendall SA, Lund H, Ribel-Madsen S, Bliddal H, Danneskiold-Samsoe B. Effects of
water- and landbased strength training on isokinetic muscle strength in patients with fibromyalgia.
Annals of the Rheumatic Diseases 2003;62:77-78.

3. Jespersen A, Kendall SA, Lund H, Ribel-Madsen S, Bliddal H, Danneskiold-Samsoe B. Effects of
water- and land-based strength training on isokinetic muscle strength in patients with
fibromyalgia. Arthritis and Rheumatism 2003;48(9):S693-S693.

4. Silva LE, Pessanha AC, Oliveira LM, Myamoto S, Valim V, Jones A, et al. Efficacy of water exercise
in the treatment of patients with knee osteoarthritis: A randomized, single-blind, controlled clinical
trial. Annals of the Rheumatic Diseases 2005;64:556-556.

5. Stenström C, Lindell B, Swanberg E, Swanberg P, Nordemar R. Intensive water exercise in
functional class-II rheumatoid-arthritis (RA). Scandinavian Journal of Rheumatology 1986:49-49.

6. Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education
program for patients with fibromyalgia syndrome. A prospective, randomized study. Journal of
Rheumatology 2000;27(10):2473-2481.

7. Mannerkorpi K, Ahlmen M, Ekdahl C. Pool exercises combined with patient education for patients
with fibromyalgia syndrome. A six-month follow-up. Arthritis and Rheumatism 2000;43(9):S169-

8. Mungufa-Izquierdo D, Legaz-Arrese A, Munguia-Alcalde V. Effects of exercise in warm water on
pain and cognitive function in middle-aged women with fibromyalgia. Annals of the Rheumatic
Diseases 2007;66:62-62.

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