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


2 Star



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.


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?


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?


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?


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?


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

Total Score: 4 of 10 Satisfactory


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