Aquatic Exercise Interventions for Knee Osteoarthritis Management

Aquatic exercise interventions have emerged as a non‐pharmacological cornerstone in knee osteoarthritis management, harnessing the unique physical properties of water to alleviate joint loading and enhance functional capacity. The buoyancy of water reduces gravitational forces, permitting safer and more comfortable movement, while hydrostatic pressure supports inflamed tissues and moderates swelling. Aquatic programmes encompass aerobic, strength and resistance modalities, often delivered in heated pools to promote muscle relaxation and analgesia. Evidence indicates improvements in pain, mobility, gait and quality of life across diverse patient populations, including overweight older adults and post-menopausal women. Protocols typically involve two to three sessions per week over three to six months. Interventions aim to mitigate symptoms through muscle strengthening, proprioceptive training and cardiovascular conditioning, while also addressing modifiable risk factors such as obesity. Integration of aquatic therapy within multidisciplinary care pathways emphasises its utility for individuals contraindicated for land-based exercise or awaiting surgical procedures. Ongoing research explores optimal dosing parameters and potential effects on cartilage morphology. The global significance of these interventions is underscored by their adaptability across healthcare settings and their capacity to support long-term self-management of osteoarthritis.

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Aquatic Exercise Interventions for Knee Osteoarthritis Management publication trend

The graph below shows the total number of articles in aquatic exercise interventions for knee osteoarthritis management across all publications each year (not limited to Nature Index journals).

Technical terms

Buoyancy: The upward force exerted by water that counteracts gravity and reduces joint load during movement.

Hydrostatic pressure: The uniform pressure applied by water against immersed body parts, aiding in oedema reduction and proprioceptive feedback.

Aquatic resistance exercise: Training performed in water using resistance provided by water viscosity or specialised equipment to strengthen muscles.

Range of motion (ROM): The measurable movement around a joint, often assessed in degrees to evaluate flexibility and function.

Kellgren–Lawrence grading: A radiographic scale (I–IV) used to classify the severity of osteoarthritis based on joint space narrowing and osteophyte formation.

References

1. The Properties of Water and their Applications for Training. Journal of Human Kinetics (2014).
2. Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskeletal Disorders (2011).
3. Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up. Osteoarthritis and Cartilage (2017).
4. Effects of a progressive aquatic resistance exercise program on the biochemical composition and morphology of cartilage in women with mild knee osteoarthritis: protocol for a randomised controlled trial. BMC Musculoskeletal Disorders (2013).
5. The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation (2020).