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CBS story on water-based physical therapy stays in the shallow end

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Whether you call it water running, aqua jogging or hydrotherapy, you can’t beat a workout in water for an array of health benefits, many experts say. Everyone from pro athletes to stroke survivors are benefitting from aquatic exercise that combines walking or running against the natural resistance of the water to help build strength and endurance.

Running and walking in water is an excellent form of physical therapy for people rehabilitating from hip, knee and back injuries and surgeries. It’s also an easy-on-the joints form of exercise for seniors and others who suffer from arthritis, and a recent study shows it can speed recovery from stroke faster than using a traditional treadmill.

It’s just an all-around good aerobic conditioner for athletes, too, sports medicine expert Dr. Naresh Rao, told CBS News. Rao is the Olympic Team USA Water Polo Physician for the 2016 Summer Games.

“We’ve been using hydrotherapy to help decrease any sort of gravity that can affect joint function,” said Rao, who is also with the department of family medicine at Plainview Hospital in Plainview, New York. “I personally prescribe it for knee issues and low back issues.”

Hydrotherapy uses a water-friendly treadmill that can be placed in a pool. Another method involves a specially designed treadmill tank.

Matt Johnson, a physical therapist at St. Luke’s Hospital in Bethlehem, Pennsylvania, told CBS News that the tank is basically a freestanding tub, about six feet long by three feet wide, with a motorized belt. The water height can be adjusted to the patient’s abilities. The buoyancy of the water helps someone who’s been injured to walk and run a little sooner than they’d be able to do on dry ground, he explained.

“In water, we can teach them sooner. They can really work on their gait, walk without pain, do exercises in water that you wouldn’t be able to do on land,” said Johnson.

hydrotrack-1.jpg

A physical therapy patient at St. Luke’s in Bethlehem, Pennsylvania, participates in water therapy in a Hydro Track system by Conray Incorporated.

PHYSICAL THERAPY AT ST. LUKE’S HOSPITAL, BETHLEHEM, PA.

He uses a HydroTrack Underwater Treadmill System – professional sports teams including the New York Yankees and the Miami Dolphins, have used it, too. The nice thing about it, said Johnson, is that people can step right into the tank at ground level and then the water fills up around them. It works like a lock on a canal, he said. So, even older patients with limited mobility and balance don’t have to negotiate getting down into a pool.

Johnson starts off recuperating athletes and patients in water somewhere between waist and chest height. The treadmill speed can be set anywhere from 0.3 to 7.1 miles per hour depending on how much resistance a person can handle.

“At waist height, it’s at about 50 percent of body weight. At chest height, it’s about 30 percent of body weight,” Johnson said, noting, for example, that a person with an injured knee who weighs 100 pounds who is running in waist-high water would only feel like 50 pounds on the bad knee.

“Taking some of that pressure off the knee helps them tolerate that knee injury longer,” said Johnson.

A recent study in the American Journal of Physical Medicine and Rehabilitation showed that water workouts might benefit stroke survivors. Researchers asked 21 patients who’d had a stroke within the past two months to undergo two treadmill exercise tests – one submerged in water and one on a regular treadmill. They gradually increased walking speed and slope over time until the patients couldn’t go any further. Walking on the underwater treadmill produced better measures when it came to maximal oxygen consumption (VO2max), a reflection of heart and lung function during exercise, and metabolic equivalents, a measure of energy use.

“The study proposes a different, very innovative approach” to rehabilitation after stroke, said Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Health in Great Neck, New York.

Wolfe-Klein told CBS News she has tried water workouts and said you don’t even feel like you break a sweat even if your heart rate is up. “It’s a very pleasant way of achieving exactly what you’re trying to do – allowing a cardio-respiratory response,” Wolfe-Klein told CBS News.

She noted that medicine’s veterinary counterparts have been using water therapy for years with injured racehorses.

Budd Coates, training director at Runner’s World magazine, said runners don’t just plunge intowater therapy when they’re injured; it’s a great conditioning method for healthy athletes, too. Some recreational swimming pools and homeowners with backyard pools have manual treadmills that are water-safe and can be plunked right in the water.

An alternative to a water treadmill: Some pool companies will install a water flow system you can work out against.

“It creates a water force and helps keep you jogging in place,” said Coates.

For those without access to a water treadmill, you can purchase a foam vest specifically designed for water jogging or use foam barbells to help keep you afloat. Some pools may loan them out, too.

Or, Coates suggested, just try it freeform with waist- or chest-high water to start. If you have trouble getting in out of a recreational pool, look for one that has a slanting beach-style entry into the water, or one with a robotic chair lift. Ask a pool lifeguard or certified swim instructor to help you.

If running’s not your thing, but the water looks inviting, Coates said there are also spin bikes that can be used underwater.

Coates said the beauty of water running (or even walking) is that it’s great for any age and any level of ability, from elderly stroke survivors to Olympic athletes.

Galen Rupp, the 2016 Rio Olympics men’s marathon bronze medalist, relies on it as part of his training.

“He and some of the other guys on the Nike team, it’s well known they take advantage of the anti-gravity treadmill and the aqua track,” Coates said.

 

Rating

2 Star

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The water workout trend health experts are gushing over

Our Review Summary

under water treadmillThis story offers a general overview of the potential benefits of running or walking underwater, either using a specially-designed underwater treadmill or in a pool. The story notes that this reduces stress on a patient’s joints, and refers to a relatively recent study showing possible cardiovascular benefits for stroke patients.

The story highlights several reasons why water-based therapy may be appealing (leading to “health experts gushing” over it), but provides no evidence to show that people get better using this therapy, or that it works better than standard physical therapy.  And that’s important to discuss, considering the presumed higher price tag and lack of availability compared to standard PT–though the story doesn’t discuss these points, either.

 

Why This Matters

For people recovering from an injury or illness requiring physical therapy, water-based therapy may be an appealing alternative. But does it work? Or is it an expensive gimmick? This story doesn’t provide the details needed for readers to get a sense of how effective it is.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost is not discussed, which is a significant oversight. At least some idea of what the out-of-pocket costs are for this kind of therapy is important.

While we wouldn’t expect the story to necessarily address all the following issues, these are the kinds of questions people have when considering what kind of therapy to receive.

First, the treadmill systems: It is difficult for consumers to find a cost for underwater treadmills, as most of the companies that sell them tell potential customers to contact the company for a quote. However, the treadmill company mentioned by name in the article quotes $65,000 in the example on how its leasing program works. And a 2013 story in USA Today says that underwater treadmill systems range in price from $33,000 to $270,000. A 2014 story in Runner’s World says that insurance may cover the use of such a treadmill system at a physical therapist’s office, if the system is being used for injury recovery. The CBS story doesn’t even give us that much information.

Second, this story also mentions pools that have a “water flow system you can work against.” Again, it’s not clear what the costs of such a system would be, but one such company notes that its least expensive therapy pool options start at $7,400 (yet, the same company notes that its standard system “starts at $22,900”).

Third, the story also refers to simply exercising in a pool with a foam vest or foam handbells. This is, of course, far more affordable for most people. But it’s not clear, at all, how comparable the benefits of this sort of activity are to the use of the high-end systems discussed in the rest of the article.

Lastly, for a story like this, it would be great to know how water-based physical therapy compares in cost to standard PT. It may not be covered by a patient’s insurance and result in higher out of pocket costs, for example.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story focuses on multiple benefits, none of which are quantified. For example, the story discusses the ways in which being underwater can reduce joint pain during exercise. How much does it reduce pain? What are the benefits in terms of health outcomes? Unclear. There also was no attempt to quantify speed of recovery and final recovery state compared to other treatments such as standard physical therapy.

It also cites a study showing cardiovascular benefits for stroke patients, but it doesn’t even appear that this study directly compared outcomes of water-based PT vs. standard PT in patients following a stroke. Rather, it sounds like the study compared physiologic measures in stroke patients comparing two forms of exercise testing, which isn’t proof that one method resulted in better recovery outcomes for patients.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story doesn’t discuss harms. There don’t appear to be any particular health risks associated with the use of underwater treadmills that wouldn’t apply to beginning any exercise or rehabilitation regime — but that’s actually a point worth making.

However, exercising in a pool poses risks of its own — particularly for patients who may be recovering from surgery or stroke. As a result, it would be wise to explain that these patients (or any patient who is not confident in the water) should have supervision. And, this therapy may induce anxiety among people who can’t swim or are anxious around water.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story refers only to a single study, and doesn’t give readers much information on how to find the study it does refer to. It does tell readers where the study was published (though not when), that the study compared on-land treadmill use and underwater treadmill use among stroke survivors, and that the study involved 21 patients. (If you’re curious, we found the relevant study. It’s here.)

There was no evidence provided to support the claims of any benefits other than cardiovascular benefits for stroke survivors.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here. Though, the story implies that this form of therapy can be used for just about any condition where treadmill or bike treatment is indicated. So not disease mongering, but possibly treatment mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes four experts, making this a strong point. It would have been helpful for one of these experts to point out that there is very little evidence supporting water-based PT compared to standard PT.

Does the story compare the new approach with existing alternatives?

Satisfactory

The alternative to using a treadmill underwater would be to engage in cardiovascular exercise on dry land. The story addresses this, noting both the treadmill comparison study (mentioned above) and the fact that exercising in water reduces stress on joints. So, we’ll give it a Satisfactory rating.

However, the story intimates that exercising in a pool and exercising on an underwater treadmill are comparable. It’s not clear that this is the case, and the 2014 story from Runner’s World indicates that they are actually quite different. What’s more, there is no discussion of another form of aquatic exercise: swimming. Is swimming a viable option for cardiovascular recovery?

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

It’s not clear from the story how widely available underwater treadmills are for the general public.

Does the story establish the true novelty of the approach?

Not Satisfactory

Underwater treadmills are not particularly new (the research literature on them goes back to at least 1989). Frankly, it’s not clear why this story was written now, or what is novel about underwater treadmill exercise (given how the story indicates that it is comparable to walking in a pool with a foam vest).

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to be based on a news release.

Total Score: 4 of 10 Satisfactory

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