A Biopsychosocial Approach to Aquatic-Based Exercise Interventions for Chronic and Disabling Conditions

Heather Scott

doi:10.25907/00284

Purpose: The purpose of this research was to explore aquatic-based exercise as an intervention for chronic and disabling conditions. This research explored the implications of aquatic-based exercise interventions and links to participation and adherence from the perspective of key stakeholders. Method: A pragmatic approach was taken to this research, influenced by the researcher's occupational therapy background and by the biopsychosocial model; the most practical method for answering each of the research questions was employed. The biopsychosocial model directed the exploration of aquatic-based exercise interventions and provided a structure to organise the aquatic research, to identify gaps that need to be addressed, and to provide a platform for the development of practice principles. Guided by the biopsychosocial lens, this research involved reviewing the literature to identify and synthesise the current best evidence for the effectiveness of aquatic-based exercise interventions. This was followed by three qualitative studies that involved a series of focus groups with key stakeholders in order to address gaps identified by the literature reviews, identify factors associated with participation and adherence, and to provide input into the development of aquatic-based exercise principles. In a practical sense, this research sought to address the 'why' and 'how' of aquatic-based exercise interventions. The 'why' was addressed in the first part of this research where the evidence for the effectiveness of aquatic-based exercise was explored. This part of the research involved reviewing the literature, in the form of an evidence map and scoping review, to identify and synthesise the current best evidence for the effectiveness of aquatic-based exercise interventions. This was followed by a series of focus groups to expand on current understanding of the effectiveness of such interventions and to gather input from aquatic users. The 'how' was addressed through a series of focus groups, the data from which supported the development of a set of principles to guide the implementation of aquatic-based exercise interventions that promote participation and adherence with these interventions. Findings: Aquatic-based exercise appears to be an effective intervention for meeting the complex needs of people with chronic and disabling conditions. This research suggests that users of aquatic-based exercise can experience benefits across biological, psychological and social domains, and consideration of several program factors not only impacts these benefits, but also promotes participation and adherence with aquatic-based exercise, an important aspect to consider given the chronicity of these conditions. The culmination of literature and research studies was the development of theory driven, evidence-based principles to guide the development and implementation of aquatic-based exercise interventions with a focus on clients with chronic and disabling conditions. These principles can be used to support the successful implementation of aquatic-based exercise interventions, help guide the referral of clients to the aquatic environment and assist with delivery of the aquatic interventions. Furthermore, these principles can serve as a template for future researchers for development of additional symptom-specific or disease-specific guidelines related to aquatic-based exercise interventions.

A Biopsychosocial Approach to Aquatic-Based Exercise Interventions for Chronic and Disabling Conditions

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