Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis
Abstract
Objective To investigate the effectiveness of aquatic exercise in the management of musculoskeletal conditions.Data sources A systematic review was conducted using Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and The Cochrane Central Register of Controlled Trials from earliest record to May 2013.Study selection We searched for randomized controlled trials (RCTs) and quasi-RCTs evaluating aquatic exercise for adults with musculoskeletal conditions compared with no exercise or land-based exercise. Outcomes of interest were pain, physical function, and quality of life. The electronic search identified 1199 potential studies. Of these, 1136 studies were excluded based on title and abstract. A further 36 studies were excluded after full text review, and the remaining 26 studies were included in this review.Data extraction Two reviewers independently extracted demographic data and intervention characteristics from included trials. Outcome data, including mean scores and SDs, were also extracted.Data synthesis The Physiotherapy Evidence Database (PEDro) Scale identified 20 studies with high methodologic quality (PEDro score ≥6). Compared with no exercise, aquatic exercise achieved moderate improvements in pain (standardized mean difference [SMD]=-.37; 95% confidence interval [CI], -.56 to -.18), physical function (SMD=.32; 95% CI, .13-.51), and quality of life (SMD=.39; 95% CI, .06-.73). No significant differences were observed between the effects of aquatic and land-based exercise on pain (SMD=-.11; 95% CI, -.27 to .04), physical function (SMD=-.03; 95% CI, -.19 to .12), or quality of life (SMD=-.10; 95% CI, -.29 to .09).Conclusions The evidence suggests that aquatic exercise has moderate beneficial effects on pain, physical function, and quality of life in adults with musculoskeletal conditions. These benefits appear comparable across conditions and with those achieved with land-based exercise. Further research is needed to understand the characteristics of aquatic exercise programs that provide the most benefit.
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Exercise, including aerobic, strengthening and aquatic exercise, reduces pain and improves physical function and quality of life in chronic pain.
“Exercise, including aerobic, strengthening and aquatic exercise has been shown to reduce pain and improve physical function and quality of life [15–17]”
Studies have shown that aquatic therapy results in less pain and stiffness compared to land based exercise.
“Studies have shown that aquatic therapy results in less pain and stiffness compared to land based exercise.[ 26 , 29 - 31 ]”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
Buoyancy reduces load bearing stress on the knees, hips, and spine by 50 to 70% and decreases joint load.
“Buoyancy reduces load bearing stress on the knees, hips, and spine by 50 to 70% and decreases joint load.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
Aquatic exercises are safe and effective for older and overweight individuals.
“Aquatic exercises are a safe and effective exercise method for older and overweight individuals.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
Aquatic therapy is beneficial for individuals with OA, chronic low back pain, or movement restriction.
“Aquatic therapy is beneficial for individuals with OA, chronic low back pain, or movement restriction.[ 26 - 28 ]”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
The buoyancy of water, sensory input from water temperature, hydrostatic pressure, and turbulence facilitate exercise performance.
“The buoyancy of water, sensory input from water temperature, hydrostatic pressure, and turbulence facilitates exercise performance.[ 2 , 3 , 26 , 27 ]”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
The water environment reduces joint load, facilitates balance, and provides strength gain through resistance.
“The water environment reduces joint load, facilitates balance, and provides strength gain through resistance.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
Improvements in blood pressure and body composition demonstrate positive effects of hydrostatic pressure and water temperature on the circulatory system.
“Improvements in blood pressure and body composition demonstrate the positive effects of hydrostatic pressure and the temperature of water on the circulatory system.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
Aquatic flexibility exercises in obese individuals reduce joint load by 50 to 70%.
“Aquatic f lexibility exercises in obese individuals reduce joint load by 50 to 70%.”
From Exercise approaches in obese individuals with physical limitations (2026) · cites this paper as [26]
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References 49 · Cited by 173
- Authors
- Barker, A. L., Talevski, J., Morello, R. T., Brand, C. A., Rahmann, A. E., & Urquhart, D. M.
- Affiliations
- Monash University (AU)
- The University of Melbourne (AU)
- The University of Queensland (AU)
- Corresponding author
- Barker, Anna Lucia
- ORCID
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 95
- Issue
- 9
- Pages
- 1776-1786
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W2054051540
- Cited by
- 173
- References
- 49
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 16 · 2023: 10 · 2022: 16 · 2021: 17 · 2020: 16 · 2019: 12 · 2018: 14 · 2017: 13 · 2016: 18 · 2015: 9 · 2014: 2
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- aquatic exercise, musculoskeletal disorders, pain, physical function, quality of life, land-based exercise, exercise therapy, physiotherapy
- MeSH terms
- Exercise Therapy, Humans, Musculoskeletal Diseases, Osteoarthritis, Pain, Pain Measurement, Quality of Life, Swimming, Physical Therapy Modalities
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