BACKGROUND: Water-based exercises have the potential to reduce impairments and walking limitations after stroke. OBJECTIVE: To examine the effects of water-based exercises on walking speed, balance, and strength after stroke. DATA SOURCES: Eletronic searches on Medline, CINAHL, Embase, Cochrane, PsycINFO, and PEDro databases. ELIGIBILITY CRITERIA: The review included randomized trials. Participants in the reviewed studies were ambulatory adults, who have had a stroke. The experimental intervention was comprised of water-based exercises. DATA SYNTHESIS: Outcome data related to walking speed, balance, and strength were extracted from the eligible trials and combined in meta-analyses. The quality of the included trials was assessed by the PEDro scores and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Thirteen trials involving 464 participants were included. Random-effects meta-analyses provided moderate-quality evidence that water-based exercises significantly increase walking speed by 0.06 m/second (95% CI 0.01 to 0.10) and balance by 4.5 points on the Berg Balance scale (95% CI 2.2 to 6.8), compared with land-based exercises, without concurrent changes in strength (MD 5.2 Nm/kg; 95% CI -1.4 to 11.9). CONCLUSIONS: This systematic review provided low-quality evidence regarding the efficacy of water-based exercises, compared with no intervention. However, there is moderate quality evidence, which suggested significant benefits of water-based exercises in walking speed and balance, compared with land-based exercises. Differences appear small to be considered clinically relevant, and, therefore, water-based exercises can be prescribed as alternative interventions, based upon individuals' exercise preferences. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42018108419).

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