Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective To examine the efficacy and safety of aquatic exercise for people with knee osteoarthritis. Data sources PubMed, Web of Science, Embase, CENTRAL, CNKI and WanFang databases were searched from 1966 to September 2022. Review methods Randomized controlled trials evaluating aquatic exercise for people with knee osteoarthritis compared with no exercise and land-based exercise were included. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the certainty of evidence. Results Twenty-two studies with 1394 participants were included. Compared with no exercise (13 trials with 746 participants), low-to high-certainty evidence revealed that aquatic exercise yielded significant improvements in patient-reported pain (SMD −0.58, 95% CI −0.82 to −0.33), stiffness (SMD −0.57, 95% CI −1.03 to −0.11) and physical function (SMD −0.35, 95% CI −0.52 to −0.18) immediately postintervention. A sustained effect was observed only for pain at three months postintervention (SMD −0.48, 95% CI −0.91 to −0.06). The confidence intervals demonstrated that the pooled results do not exclude the minimal clinically important differences. There were no significant differences between the effects of aquatic exercise and land-based exercise (13 trials with 648 participants) on pain (SMD −0.12, 95% CI −0.29 to 0.04), stiffness (SMD −0.17, 95% CI −0.49 to 0.16) or physical function (SMD −0.13, 95% CI −0.28 to 0.02). No study reported a serious adverse event in relation to aquatic exercise. Conclusion Aquatic exercise provides a short-term clinical benefit that is sustained for at least three months postintervention in terms of pain in people with knee osteoarthritis.

Effectiveness of aquatic exercise versus other therapeutic modalities in patients with knee osteoarthritis pain: A systematic review with meta-analysis

“…In contrast to previous systematic reviews [7,[24][25][26][27][28][29][30][31], this meta-analysis showed that aquatic exercise improved functionality measured with TUG, decreased joint stiffness measured with WOMAC, and relieved knee joint pain measured with VAS. These signi cant changes occurred for 1 to 4 months while the intervention was maintained.…”

“…Likewise, another review reports that aquatic exercise is bene cial for the reduction of knee OA pain, especially if the water is warmer [28]. Finally, a recent systematic review evaluates the effect of aquatic exercise in patients with knee OA compared to land-based exercise, with the main result that aquatic exercise provides a clinical bene t in the short term that is maintained for 3 months after the intervention [29]. This review is the one that most closely resembles the present study; however, the difference is the fact that we included studies that incorporated an educational program in addition to other exercise modalities.…”

Chinese guidelines for the rehabilitation treatment of knee osteoarthritis: An CSPMR evidence‐based practice guideline

“…Aquatic exercise is considered a safe alternative for patients who are not suitable for weight‐bearing exercises due to its ability to reduce joint weight‐bearing and potential joint damage. According to current evidence, 48–54 the guideline panel found that aquatic exercise provides pain relief (SMD = −0.52, 95% CI: −0.74 to −0.3), improves functional capacity (SMD = −0.37, 95% CI: −0.7 to −0.04), and enhances the 6‐min walking distance (SMD = 0.44, 95% CI: 0.08 to 0.8). However, the sustained effect of symptom relief from water exercise is shorter, with effectiveness lasting up to 3 months postintervention.…”

“…According to current evidence, [48][49][50][51][52][53][54] −1.12 to 0.15) in patients with knee osteoarthritis, according to metaanalyses. 82,83 It has also demonstrated some benefits for joint mobility and walking performance.…”