Are water-based exercises more effective than land-based exercises at reducing pain and increasing function in individuals with
knee or hip osteoarthritis?
To answer this question, we performed a comprehensive search of the PubMed database (October 2010) for randomized, controlled trials.
Five studies met the search criteria, comparing land and
water-based exercise in patients with knee osteoarthritis (2,3,5) and knee or hip osteoarthritis (1,4). All five studies found significant improvements in pain, function or physical performance with either
type of exercise, with minimal between-group differences.
Gill et al evaluated a 7-wk program among 82 patients awaiting knee or hip joint replacement, and found both types of exercise significantly improved pain, function and physical performance.(1) The water-based program was better tolerated, with patients
experiencing less pain immediately after exercise and the next day (1). Lund et al found that 8 wks of exercise showed small improvements in pain and strength among 79 patients with knee osteoarthritis (2). In addition, the water-based program showed
fewer adverse events (2). Silva et al evaluated an 18- wk program among 64 patients with knee osteoarthritis, and found that both programs resulted in significant improvements in pain and function (3). In this study, the water-based group had lower pain before and after a walk test compared to the land based group (3). Foley et al conducted a randomized controlled trial of 105 subjects with knee or hip osteoarthritis, and concluded that 6 wks of either land- or water-based strengthening exercises are equally effective in improving measures of physical function such as strength and walking speed and distance (4). Wyatt et al studied 46 patients with knee osteoarthritis and concluded that 6 wks of land- or water-based exercise results in decreased pain, increased knee range of motion, and improved walking times (5).
Based on this review, it can be concluded that either
land- or water-based exercise improves pain and
function among patients with knee osteoarthritis, with
neither being superior to the other.
References
- Gill SD, McBurney H, Schulz DL. Land-based vs pool-based exercise for people awaiting joint replacement surgery of the hip or
knee: results of a randomized controlled trial. Arch Phys Med Rehabil. 2009 Mar;90(3):388-94. PubMed PMID: 19254601. - Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, Danneskiold-Samsøe B, Bliddal H. A randomized controlled
trial of aquatic and land-based exercise in patients with knee osteoarthritis. J Rehabil Med. 2008 Feb;40(2):137-44. PubMed
PMID: 18509579. - Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, Natour J. Hydrotherapy vs conventional land-based exercise
for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008 Jan;88(1):12-21.
Epub 2007 Nov 6. PubMed PMID: 17986497. - Foley A, Halbert J, Hewitt T, Crotty M. Does hydrotherapy improve strength and physical function in patients with osteoarthritis–a
randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis. 2003
Dec;62(12):1162-7. PubMed PMID: 14644853; PubMed Central PMCID: PMC1754378. - Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee
osteoarthritis. J Strength Cond Res. 2001 Aug;15(3):337-40. PubMed PMID: 11710661.