Effectiveness of Aquatic Exercises in Women With Rheumatoid Arthritis: A Randomized, Controlled, 16-Week Intervention-The HydRA Trial

Am J Phys Med Rehabil. 2017 Mar;96(3):167-175. doi: 10.1097/PHM.0000000000000564.


Objective: The purpose of this study was to compare the effectiveness of land-based (LB) and water-based (WB) aerobic exercises in women with rheumatoid arthritis (RA).

Design: A total of 133 women with RA were included in this randomized, blinded, prospective, 16-week controlled trial. The subjects were randomized into 3 groups: WB (n = 33), LB (n = 33), and control (n = 34). Muscle strength (MS) was measured using an isokinetic dynamometer. Disease activity (DAS-28) and functional ability (health assessment questionnaire) were measured by an expert rheumatologist. Total body densitometry was used to assess body composition. The intervention was performed 3 times per week, and all groups were evaluated at baseline and after 8 and 16 weeks. Compliance, concomitant medications, and adverse events were recorded. The data were analyzed by intention to treat. P < 0.05 was set as significant.

Results: Of the 133 patients recruited, 100 were randomized and 82 completed the study. In the first evaluation, the 3 groups were matched to age, body composition, functional capacity, MS, and concomitant medications. After 16 weeks, there were no significant changes of knee MS neither body composition among the groups. However, there was a significant improvement in disease activity and functional ability in the WB after 8 and 16 weeks.

Conclusion: Aquatic exercises provided significant improvement in disease activity, pain, and functional capacity.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthritis, Rheumatoid / physiopathology
  • Arthritis, Rheumatoid / rehabilitation*
  • Blood Sedimentation
  • Body Composition / physiology
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Knee Joint / physiopathology
  • Middle Aged
  • Muscle Strength / physiology
  • Patient Compliance
  • Prospective Studies
  • Swimming Pools*
  • Visual Analog Scale


  • Anti-Inflammatory Agents, Non-Steroidal