Aquatic exercise for the treatment of knee and hip osteoarthritis

Bartels, Else Marie; Lund, Hans; Hagen, Kåre Birger; Dagfinrud, Hanne; Christensen, Robin; Danneskiold-Samsøe, Bente

doi:10.1002/14651858.cd005523.pub2

Cited by 303Osteoarthritis Treatment and MechanismsMusculoskeletal pain and rehabilitationPhysical Activity and Health

Aquatic exercise for the treatment of knee and hip osteoarthritis

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Bartels, Else Marie, Lund, Hans, Hagen, Kåre Birger, Dagfinrud, Hanne, Christensen, Robin, Danneskiold-Samsøe, Bente·2007·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd005523.pub2PMC PMC9942938

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Abstract

BACKGROUND: Clinical experience indicates that aquatic exercise may have advantages for osteoarthritis patients. OBJECTIVES: To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis. SEARCH STRATEGY: We searched MEDLINE from 1949, EMBASE from 1980, CENTRAL (Issue 2, 2006), CINAHL from 1982, Web of Science from 1945, all up to May 2006. There was no language restriction. SELECTION CRITERIA: Randomised controlled trials or quasi-randomised clinical trials. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Pooled results were analyzed using standardized mean differences (SMD). MAIN RESULTS: There is a lack of high-quality studies in this area. In total, six trials (800 participants) were included. At the end of treatment for combined knee and hip osteoarthritis, there was a small-to-moderate effect on function (SMD 0.26, 95% confidence interval (CI) 0.11 to 0.42) and a small-to-moderate effect on quality of life (SMD 0.32, 95% CI 0.03 to 0.61). A minor effect of a 3% absolute reduction (0.6 fewer points on a 0 to 20 scale) and 6.6% relative reduction from baseline was found for pain. There was no evidence of effect on walking ability or stiffness immediately after end of treatment. No evidence of effect on pain, function or quality of life were observed on the one trial including participants with hip osteoarthritis alone. Only one trial was identified including knee osteoarthritis alone, comparing aquatic exercise with land-based exercise. Immediately after treatment, there was a large effect on pain (SMD 0.86, 95%CI 0.25 to 1.47; 22% relative percent improvement), but no evidence of effect on stiffness or walking ability. Only two studies reported adverse effects, that is, the interventions did not increase self-reported pain or symptom scores. No radiographic evaluation was performed in any of the included studies. AUTHORS' CONCLUSIONS: Aquatic exercise appears to have some beneficial short-term effects for patients with hip and/or knee OA while no long-term effects have been documented. Based on this, one may consider using aquatic exercise as the first part of a longer exercise programme for osteoarthritis patients. The controlled and randomised studies in this area are still too few to give further recommendations on how to apply the therapy, and studies of clearly defined patient groups with long-term outcomes are needed to decide on the further use of this therapy in the treatment of osteoarthritis.

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For people with hip or knee osteoarthritis, the overview authors report that the Bartels 2007 review found a statistically significant reduction in pain immediately after exercise intervention, but the effect was not clinically significant.
“Statistically significant post-intervention in hip + knee OA group, but not clinically significant”
From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as Bartels 2007
For people with hip or knee osteoarthritis, the overview authors report that the Bartels 2007 review found a statistically significant improvement in function immediately after exercise intervention only, and the effect size was small.
“Function was significantly improved in people with hip + knee OA immediately post-intervention only -small effect size only”
From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as Bartels 2007
For people with knee-only osteoarthritis, the overview authors report that the Bartels 2007 review found a moderate to large and statistically significant effect on pain immediately after exercise intervention.
“Knee-only OA had moderate to large effect size (statistically significant) immediately post-intervention”
From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as Bartels 2007
For the Bartels 2007 review, the overview authors report that adverse events were recorded but none occurred.
“Adverse events were recorded (and reported), but none occurred”
From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as Bartels 2007
Evidence may be sufficient to recommend aquatic exercise for osteoarthritis pain.
“although evidence may be sufficient to recommend it for osteoarthritis pain. 26”
From A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference (2018) · cites this paper as [26]

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Authors: Bartels, E. M., Lund, H., Hagen, K. B., Dagfinrud, H., Christensen, R., & Danneskiold-Samsøe, B.
Affiliations: Copenhagen University Hospital (DK)
University of Southern Denmark (DK)
University of Oslo (NO)
Frederiksberg Hospital (DK)
ORCID: Bartels, Else Marie
Lund, Hans
Hagen, Kåre Birger
Dagfinrud, Hanne
Christensen, Robin
Venue: Cochrane Database of Systematic Reviews
Publisher: John Wiley & Sons, Ltd
Published: 2007-10-17
Volume: 3
Issue: 4
Pages: CD005523-CD005523
ISSN: 1361-6137 (ISSN-L)
DOI: 10.1002/14651858.cd005523.pub2
PMC: PMC9942938
OpenAlex: W1961599657
Cited by: 302
References: 96
Citations by year: 2026: 1 · 2025: 12 · 2024: 17 · 2023: 17 · 2022: 26 · 2021: 19 · 2020: 16 · 2019: 22 · 2018: 19 · 2017: 22 · 2016: 20 · 2015: 14 · 2014: 22 · 2013: 16 · 2012: 10
Type: reference entry
Language: en
Update notices: new_version (2016-03-23)
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords: aquatic exercise, knee osteoarthritis, hip osteoarthritis, exercise therapy, joint pain, joint function, quality of life, walking ability, joint stiffness, adverse effects, treatment effectiveness and safety, low back pain, neck pain, shoulder pain
MeSH terms: Balneology, Chronic Disease, Exercise Therapy, Humans, Hydrotherapy, Swimming, Water, Osteoarthritis, Hip, Exercise, Randomized Controlled Trials as Topic, Osteoarthritis, Knee

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Aquatic exercise for the treatment of knee and hip osteoarthritis

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