# Effects of aquatic exercise on improving body composition and muscle strength in the older adults: a systematic review and meta-analysis of randomized controlled trials

## TL;DR

Aquatic exercise improves muscle strength and flexibility in older adults but has limited effects on weight and cholesterol levels.

## Contribution

This study provides a comprehensive meta-analysis of aquatic exercise's effects on physical and metabolic health in older adults.

## Key findings

- Aquatic exercise significantly improves muscle strength and flexibility in older adults.
- It reduces body fat percentage and total cholesterol levels.
- No significant changes were observed in body weight or BMI.

## Abstract

Due to the challenges posed by aging such as decreased physical abilities and higher susceptibility to chronic illnesses, effective exercise interventions are crucial for older individuals. Despite the potential benefits of aquatic exercise, there is a lack of robust evidence supporting their efficacy. To address this gap, a systematic review and meta-analysis were conducted in this study to comprehensively assess the impact of aquatic exercise on muscle strength, body composition, and related physical (flexibility, mobility) and metabolic indicators (lipid profiles) in the older adults, aiming to inform the development of intervention strategies.

We searched seven databases (ClinicalTrials.gov, Scopus, Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from inception to August 1, 2025. Our analysis included 19 Randomized controlled trials (RCTs) (n = 866 participants) and adhered to Preferred Reporting Project for Systematic Reviews and Meta-analyses (PRISMA) guidelines, employing meta-analytical methods for outcome assessment. Meta-analyses and meta-regressions were conducted to determine the mean difference Additionally, heterogeneity, risk of bias, and certainty of evidence were evaluated.

The meta-analysis findings indicated significant enhancements in muscle strength and flexibility among older adults engaging in aquatic exercise. Additionally, improvements in functional mobility were observed, as evidenced by better performance on the Timed Up and Go test. Moreover, reductions in body fat percentage and total cholesterol levels were observed as notable improvements in metabolic indicators. Nonetheless, the intervention did not yield significant effects on body weight, body mass index, or levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides.

This review indicates that aquatic exercise may serve as a viable intervention strategy for preserving muscle function, flexibility, and lipid homeostasis in the older adults population, thereby offering a novel perspective on maintaining functional independence. These findings underscore the potential application of aquatic exercise in geriatric care; however, a multicenter study with large sample sizes and long-term follow-up is necessary to further validate the generalizability of the metabolic benefits and long-term safety.

Identifier CRD42024568443.