Waller (2016) The effect of aquatic exercise on symptoms, function, body composition and cartilage in knee osteoarthritis

Summary: Aquatic Exercise in Knee Osteoarthritis Management


Knee osteoarthritis (OA) is the most prevalent joint disease, often leading to pain and reduced functional capacity. Managing knee OA is comprehensive, ranging from injury prevention to late-stage disease management. A particular focus is on preventing cartilage degeneration and functional loss in early OA through exercise interventions. Aquatic exercise, while popular, has been under-researched in this context. This dissertation aimed to explore the role of aquatic exercise in managing knee OA, especially its effects on functional capacity and knee cartilage composition.


The study comprised two systematic reviews with meta-analysis and a 4-month randomized controlled trial followed by a 12-month follow-up. The first review assessed aquatic exercise’s impact on pain and functional capacity in individuals with lower limb OA, including 11 studies. The second review compared the effects of aquatic exercise on functional capacity aspects, such as muscle strength, agility, and walking ability, against control and land-based exercise in healthy older adults, encompassing 28 studies. The trial examined the effects of a progressive aquatic resistance training program on walking ability, cardiovascular fitness, muscle strength, symptoms, and body composition in 87 postmenopausal women with mild knee OA. It also investigated the intervention’s impact on tibiofemoral cartilage’s biochemical composition using T2 mapping and delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC index).


The results indicated that aquatic exercise led to a statistically significant but small decrease in pain and improvements in walking ability and joint flexibility in individuals with lower limb OA. Compared to control interventions, aquatic exercise significantly improved muscle strength, agility, flexibility, walking speed, and aerobic fitness in healthy older adults. It was as effective as land-based exercise in enhancing functional capacity. After four months of aquatic resistance training, significant increases in walking speed, cardiovascular fitness, and a decrease in fat mass were noted. Improvements in walking speed were maintained after 12 months. A small effect on the biochemical composition of the tibiofemoral cartilage was observed post-intervention.


Aquatic exercise positively impacts various functional capacity aspects in both healthy adults and individuals with knee OA. The effects on cartilage composition warrant further investigation.

Keyphrase: Aquatic Exercise in Knee Osteoarthritis Management

Keywords: Osteoarthritis, Aquatic exercise, qMRI, Cartilage, Walking ability

download article