Aquatic Cycling Improves Knee Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2020 Aug;101(8):1288-1295. doi: 10.1016/j.apmr.2019.12.023. Epub 2020 Mar 10.


Objective: To assess the efficacy of a 12-week aquatic cycling training program for improving knee pain and physical functioning in patients with knee osteoarthritis (OA).

Design: Two-arm, single-blind, parallel-group randomized controlled trial.

Settings: OA outpatient clinic of the Maastricht University Medical Center+.

Participants: Patients (N=111, 50-70y) with unilateral mild-to-moderate knee OA.

Interventions: Participants (aquatic cycling [AC] group, n=55) received AC sessions of 45 min each 2 times per week. Each session combined upright seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care (UC) group (n=47) continued with UC and was offered 12 AC sessions in a local swimming pool after their trial participation.

Main outcome measures: The Knee Injury and Osteoarthritis Outcome Score (KOOS) on knee pain and physical function was assessed at baseline, postintervention, and at 24-wk follow-up. Multilevel (mixed regression) analysis examined the effects.

Results: Average attendance rate for the AC sessions was 80%. Statistically significant differences at postintervention and follow-up were found for knee pain in mean ± SD (UC pretest, 57.89±15.26; posttest, 55.90±18.04; follow-up, 57.24±19.16; and AC pretest, 56.96±12.96; posttest, 63.55±15.33; follow-up, 64.35±17.26; estimate, 8.16; SE, 3.27; 95% confidence interval [CI], 1.67-14.64; effect size [ES], 0.50) and physical functioning (UC pretest, 66.32±16.28; posttest, 66.80±19.04; follow-up, 65.42±17.98; and AC pretest, 61.89±17.151; posttest, 70.14±17.52; follow-up, 69.00±16.84; estimate, 7.16; SE, 3.19; 95% CI, 0.83-13.49; ES, 0.43) in favor of the aquatic group.

Conclusions: The results suggest that a 12-week AC training program improves self-reported knee pain and physical functioning in patients with mild-to-moderate knee OA compared to UC.

Keywords: Exercise therapy; Knee; Osteoarthritis; Pain; Randomized controlled trial; Rehabilitation.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bicycling
  • Exercise
  • Exercise Therapy / adverse effects
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Knee Joint / physiopathology
  • Male
  • Middle Aged
  • Musculoskeletal Pain / etiology
  • Musculoskeletal Pain / therapy*
  • Osteoarthritis, Knee / complications
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / rehabilitation*
  • Pain Measurement
  • Patient Compliance
  • Physical Functional Performance
  • Quality of Life
  • Single-Blind Method
  • Water


  • Water

Associated data

  • NTR/NTR3766