Are aquatic exercises feasible post stroke? What do we know after an overview of systematic reviews?

Background Aquatic exercises might be considered a safe modality for the treatment of individuals after stroke. Objective To assess the effectiveness of aquatic exercise (AE) compared to land-based conventional therapy or no intervention. Methods This overview of systematic reviews (SR) followed the recommendations of the Cochrane Collaboration, the protocol was registered on PROSPERO, and the risk of bias was assessed by AMSTAR-2. The databases Medline, Embase, Web of Science, SportDiscus, Cinahl, Scopus, Scielo, and PEDro, from 1945 to 2024, were used. Results In total, 15 SRs were included. All reviews showed methodological failure according to the AMSTAR-2 classification, being shown to be critically low. The domains that presented the worst performance were related to the registration of the protocol, assessment of the risk of bias of the primary studies, and adequate conduction of the meta-analysis. Conclusions According to the included reviews, aquatic exercise can be effective, especially in improving balance, however, caution is needed to interpret these findings due to their critically low methodological quality. No adverse effects were reported in any of the reviews.