Aquatic Therapy and Alzheimer’s Disease

It is estimated that 5.2 million Americans have Alzheimer’s disease (AD), and one in three older adults dies with AD or another dementia. In the absence of a cure for AD, there are numerous physical and cognitive interventions that attempt to slow further cognitive decline and improve quality of life, particularly in achieving greater independence in activities of daily living (ADLs). Exercise therapy is one of these modalities that has shown the potential to improve physical and cognitive functioning in persons of all ages. To maintain health in older adults, the American College of Sports Medicine and the American Heart Association recommend a variety of land-based exercises that involve aerobic activity, muscular strengthening, flexibility, and balance; however, nonambulatory patients with advanced AD are generally incapable of performing the same activities as their ambulatory peers. Therefore, it may be questionable whether land-based exercise could provide these nonambulatory patients with any measurable benefits. The aquatic environment provides buoyancy, which confers an enhanced ability for nonambulatory patients to practice ambulatory and balancing skills. As a result, aquatic therapy (AT) has been used for a variety of neurological and musculoskeletal conditions, including balance disorders, post-stroke effects, Parkinson’s disease, total brain injuries, and lower extremity arthritis, but has not been used specifically for dementia. In this article, we present a case report of a nonambulatory patient with advanced AD who underwent AT using the Halliwick concept (Table 1). This form of AT was originally developed in the 1930s to help patients with physical disabilities to become independent in the water, and it is based on a 10-point program that focuses on skills such as mental adjustment, postural control, balance, ambulation in the water, and, ultimately, basic swimming movements. Our case report suggests that AT may possibly enhance the cognitive and motor skills in patients with advanced AD.