Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis

Phys Ther. 2014 Oct;94(10):1383-95. doi: 10.2522/ptj.20130417. Epub 2014 Jun 5.


Background: Current management of osteoarthritis (OA) focuses on pain control and maintaining physical function through pharmacological, nonpharmacological, and surgical treatments. Exercise, including therapeutic aquatic exercise (TAE), is considered one of the most important management options. Nevertheless, there is no up-to-date systematic review describing the effect of TAE on symptoms and function associated with lower limb OA.

Purpose: The purpose of this study was to conduct a systematic review with meta-analysis to determine the effect of TAE on symptoms and function associated with lower limb OA.

Data sources: The data sources used in this study were: MEDLINE, PubMed, EMBASE, CINAHL, PEDro, and SPORTDiscus.

Study selection: All studies selected for review were randomized controlled trials with an aquatic exercise group and a nontreatment control group. In total, 11 studies fulfilled the inclusion criteria and were included in the synthesis and meta-analysis.

Data extraction: Data were extracted and checked for accuracy by 3 independent reviewers.

Data synthesis: Standardized mean difference (SMD) with 95% confidence interval (95% CI) was calculated for all outcomes. The meta-analysis showed a significant TAE effect on pain (SMD=0.26 [95% CI=0.11, 0.41]), self-reported function (SMD=0.30 [95% CI=0.18, 0.43]), and physical functioning (SMD=0.22 [95% CI=0.07, 0.38]). Additionally, a significant effect was seen on stiffness (SMD=0.20 [95% CI=0.03, 0.36]) and quality of life (SMD=0.24 [95% CI=0.04, 0.45]).

Limitations: Heterogeneity of outcome measures and small sample sizes for many of the included trials imply that conclusions based on these results should be made with caution.

Conclusions: The results indicate that TAE is effective in managing symptoms associated with lower limb OA.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Confidence Intervals
  • Exercise Therapy / methods*
  • Humans
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / psychology
  • Musculoskeletal Pain / rehabilitation*
  • Odds Ratio
  • Osteoarthritis, Hip / complications
  • Osteoarthritis, Hip / psychology
  • Osteoarthritis, Hip / rehabilitation*
  • Osteoarthritis, Knee / complications
  • Osteoarthritis, Knee / psychology
  • Osteoarthritis, Knee / rehabilitation*
  • Pain Measurement
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Swimming / physiology*