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.

Aquatic exercise produced significant improvements in muscle strength in older adults.

• Analysis was based on 19 RCTs with 866 total participants.
• Databases searched included ClinicalTrials.gov, Scopus, Medline, PubMed, Embase, Web of Science, and the Cochrane Library from inception to August 1, 2025.
• Meta-analytical methods were used for outcome assessment following PRISMA guidelines.
• Heterogeneity, risk of bias, and certainty of evidence were evaluated alongside mean differences.

Aquatic exercise significantly improved flexibility in older adults.

• Flexibility was identified as one of the physical indicators assessed alongside muscle strength and mobility.
• The finding was derived from the pooled analysis of 19 RCTs (n = 866 participants).
• Meta-regression analyses were also conducted to further assess outcomes.
• The review characterized aquatic exercise as 'a viable intervention strategy for preserving muscle function, flexibility, and lipid homeostasis.'

Aquatic exercise improved functional mobility as evidenced by better performance on the Timed Up and Go (TUG) test.

• The TUG test was used as the primary measure of functional mobility outcomes.
• Improvements in TUG performance were observed across the included RCTs.
• The analysis included 19 RCTs with a total of 866 participants.
• Functional mobility was assessed as a related physical indicator alongside flexibility.

Aquatic exercise significantly reduced body fat percentage in older adults.

• Body fat percentage reduction was noted as a 'notable improvement in metabolic indicators.'
• This finding contrasted with the lack of significant effect on body weight and BMI.
• The analysis pooled data from 19 RCTs (n = 866 participants).
• Body composition outcomes assessed included body weight, BMI, and body fat percentage.

Aquatic exercise significantly reduced total cholesterol levels in older adults.

• Total cholesterol reduction was described as a 'notable improvement in metabolic indicators.'
• The intervention did not yield significant effects on HDL-C, LDL-C, or triglyceride levels.
• Lipid profile outcomes assessed included total cholesterol, HDL-C, LDL-C, and triglycerides.
• Findings were based on meta-analysis of 19 RCTs (n = 866 participants).

Aquatic exercise did not produce significant effects on body weight, BMI, HDL-C, LDL-C, or triglycerides in older adults.

• Body weight and BMI were not significantly changed despite significant reductions in body fat percentage.
• HDL-C, LDL-C, and triglyceride levels showed no significant improvement.
• These null findings were identified across the pooled analysis of 19 RCTs (n = 866).
• The authors noted that 'a multicenter study with large sample sizes and long-term follow-up is necessary to further validate the generalizability of the metabolic benefits.'

The systematic review included 19 RCTs with 866 participants and searched seven databases from inception to August 1, 2025.

• Databases searched: ClinicalTrials.gov, Scopus, Medline, PubMed, Embase, Web of Science, and the Cochrane Library.
• The review was registered with PROSPERO (Identifier CRD42024568443).
• The review adhered to PRISMA guidelines.
• Meta-analyses and meta-regressions were conducted, and heterogeneity, risk of bias, and certainty of evidence were evaluated.