Underwater Treadmill Training (UTT)
Underwater treadmill training (UTT) is largely unexamined as a means of improving walking performance and balance in people with SCI (Morgan & Stevens 2024). Primarily used in animal rehabilitation and sports medicine facilities, this water-based therapy to improve mobility and physical function in persons with neurological disease is new and innovative (Morgan & Stevens 2024). The use of a treadmill submerged in a self-contained, water-filled tank allows for the precise control of water depth, walking speed, and water temperature, a trio of variables that can markedly influence training responses (Stevens et al. 2015).
Discussion
Treadmill training performed in a water environment has been shown to serve as an effective alternative or support to land-based physical activity and walking programs in adults who experience balance problems and lower-limb muscle weakness (Stevens et al. 2015); however, there is limited research on this intervention for persons with SCI. Stevens et al. (2015) found significant gains (p<0.05) of moderate to large magnitude in leg strength (57%), balance (39%), preferred and rapid walking speed (34% and 61%, respectively), 6-min walk distance (82%), and daily step activity (121%). In a small case series study, the majority of individuals reported that water felt like a safer environment in which to stand (although most participants perceived that they swayed more in water, in contrast to on land) (Marinho-Buzelli et al. 2019).
Although more research is needed, mainly because the sample size and quality of studies were low; the use of smaller, portable underwater treadmills may also extend the accessibility of UTT beyond the research environment and into public fitness settings to enhance ambulatory status and physical function in people with SCI and other severe neuromuscular disorders (Morgan & Stevens 2024).
Conclusions
There is level 4 evidence (from 1 pre-post study: Stevens et al. 2015) that eight weeks of UTT provides significant gains of moderate to large magnitude in leg strength, balance, preferred and rapid walking speed, 6MWT, and daily step activity in participants with incomplete and chronic SCI.
