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Aquatic exercise for the treatment of knee and hip osteoarthritis
Open accessAbstract
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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In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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Altowairqi, W. M., Alshanbari, M. A., Attiah, N. T., Radwan, M. H., Al-Jassas, T. M., Mathkoor, O. H., Alsufyani, T. M., Alsufyani, F. M., & Alzhrany, F. A. (2022) · Journal of Population Therapeutics and Clinical Pharmacology · doi:10.53555/jptcp.v29i04.5812
Held, N. J., Cramm, H. A., & Miller, J. D. (2025) · Research Square · doi:10.21203/rs.3.rs-4559483/v1
Miglietta, M., Maunder, L., Rooke, P., Gorchinsky, E., Keshavari, S., Douglas, G., & Held, N. J. (2025) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2024-0051
Konservative Therapie des patellofemoralen Knorpelschadens und der patellofemoralen Arthrose
Runer, A., & Nardelli, P. (2025) · Die Orthopädie · doi:10.1007/s00132-025-04650-7
Metadata
- 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)
- 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)
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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