Aquatic exercise for adolescents and adults with cerebral palsy: a mixed methods scoping review

To identify characteristics of participants, intervention features and outcomes in studies examining aquatic exercise for adolescents and adults with cerebral palsy (CP). Four electronic databases were systematically searched on 15 August 2024. Studies that included people with a diagnosis of CP (mean age ≥15 years), and an intervention that involved an aquatic based activity were considered for inclusion. Quantitative and qualitative results were reported using narrative syntheses. Database searches yielded 299 studies of which 11 met inclusion criteria with 66 participants in total. Eight studies used a non-experimental quantitative design. Three studies included participants with greater disability (Gross Motor Function Classification System Level V); four studies included participants older than 30 years. Aquatic program components were variable. Reporting of parameters such as intensity, adverse events, and safety measures was generally poor. Participation outcomes were included in only three studies. No study formally gathered participant experiential data. Aquatic programs for individuals with CP appear predominantly focused on younger people and those with mild to moderate disability. Poor reporting of program design has led to non-reproducible studies and inconsistent approaches to aquatic exercise for adolescents and adults with CP. Participant, carer, and clinician perspectives on aquatic programs remain unknown. Aquatic therapy, comprising a variety of exercise components, may be safe for adolescents and adults with cerebral palsy (CP).Few aquatic exercise programs including older adolescents and adults with CP, as well as those with more complex disability have been rigorously evaluated.Improved consistency in reporting of safety measures, adverse events, and program parameters (especially intensity) is required to build the evidence base for aquatic exercise in a CP population.Rehabilitation professionals should consider the use of participation outcomes, and evaluate participant, carer and clinician experiences to embrace a whole-of-person approach. Aquatic therapy, comprising a variety of exercise components, may be safe for adolescents and adults with cerebral palsy (CP). Few aquatic exercise programs including older adolescents and adults with CP, as well as those with more complex disability have been rigorously evaluated. Improved consistency in reporting of safety measures, adverse events, and program parameters (especially intensity) is required to build the evidence base for aquatic exercise in a CP population. Rehabilitation professionals should consider the use of participation outcomes, and evaluate participant, carer and clinician experiences to embrace a whole-of-person approach.