Effects of aquatic high-intensity interval training on patient-reported outcome measures and quality-adjusted life-years in adults with rheumatic and musculoskeletal diseases: a secondary analysis of the AquaHigh randomised controlled trial

Heidi Bunæs-Næss; Birgitta Blakstad Nilsson; Linda Aimée Hartford Kvæl; Sophie E Heywood; Romée Btw Gerritsen; Kristi Elisabeth Heiberg

doi:10.1136/bmjopen-2025-102841

Effects of aquatic high-intensity interval training on patient-reported outcome measures and quality-adjusted life-years in adults with rheumatic and musculoskeletal diseases: a secondary analysis of the AquaHigh randomised controlled trial

BMJ Open. 2025 Nov 13;15(11):e102841. doi: 10.1136/bmjopen-2025-102841.

Authors

Heidi Bunæs-Næss¹, Birgitta Blakstad Nilsson^{2

3}, Linda Aimée Hartford Kvæl⁴, Sophie E Heywood^{5

6

7}, Romée Btw Gerritsen⁸, Kristi Elisabeth Heiberg²

Affiliations

¹ Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway heidibun@oslomet.no.
² Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway.
³ Division of Medicine, Department of Clinical Services, Oslo University Hospital, Oslo, Norway.
⁴ Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
⁵ St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia.
⁶ Hydro Functional Fitness, Melbourne, Victoria, Australia.
⁷ Department of Physiotherapy, University of Melbourne VCCC, Parkville, Victoria, Australia.
⁸ Health Economics, Oslo University Hospital Clinical Trials Unit, Oslo, Oslo, Norway.

Abstract

Objectives: To examine the effects of 12 weeks group-based peer-led aquatic high-intensity interval training (AHIIT) compared with aquatic moderate continuous training (AMICT) on patient-reported outcome measures (PROMs) and quality-adjusted life-years (QALYs).

Design: A single-blind, parallel-group, randomised trial with a 1:1 allocation ratio.

Setting: Community-based setting.

Participants: 89 participants (mean age 62 (SD 13) years) with rheumatic and musculoskeletal diseases, including hip and knee osteoarthritis, fibromyalgia, rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis, were randomly allocated to an AHIIT (n=44) or an AMICT (n=45) group.

Interventions: The intervention consisted of AHIIT (four intervals of 4 min at high intensity, Borg scale 14-18) or AMICT (Borg scale 12-13), conducted twice weekly for 12 weeks.

Main outcome measures: Outcomes included disease activity (measured by the Patient Global Assessment), fatigue, pain and health-related quality of life (HRQoL), measured by the EQ-5D utility index (five-dimensional health status measure) and EQ VAS (self-rated overall health scale) for overall health, physical and social activities. All outcomes were assessed at baseline, 3 months and 6 months. To compare the overall benefit of these interventions, QALYs were estimated based on HRQoL. Linear mixed models for repeated measures were used to estimate the mean difference (95% CI) in outcomes.

Results: No statistically significant differences between the groups were found in any outcomes at either three or 6 months (p>0.05).

Conclusion: No difference between the groups was found on PROMs and QALYs. Future research should include larger sample sizes and a non-exercising control group to better determine the efficacy of AHIIT and clarify the role of exercise intensity in symptom management.

Trial registration number: NCT05209802.

Keywords: Exercise; Fatigue; Quality of Life; REHABILITATION MEDICINE; RHEUMATOLOGY.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Exercise Therapy* / methods
Female
High-Intensity Interval Training* / methods
Humans
Male
Middle Aged
Musculoskeletal Diseases* / rehabilitation
Musculoskeletal Diseases* / therapy
Patient Reported Outcome Measures*
Quality of Life
Quality-Adjusted Life Years*
Rheumatic Diseases* / rehabilitation
Rheumatic Diseases* / therapy
Single-Blind Method

Associated data

ClinicalTrials.gov/NCT05209802