title: A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis. The PICO project: aquatic exercise for knee osteoarthritis in overweight and obese individuals The effects of a water-based exercise program on strength and functionality of older adults. Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Muscle function in aged women in response to a water-based exercises program and progressive resistance training. THE EFFECTS OF A TWENTY‐FOUR‐‐WEEK AQUATIC TRAINING PROGRAM ON MUSCULAR STRENGTH PERFORMANCE IN HEALTHY ELDERLY WOMEN Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVE To compare the efficacy of aquatic exercise and a l and -based exercise programme vs control in patients with knee osteoarthritis .  METHODS Primary outcome was change in pain , and in addition Knee Injury and Osteoarthritis Outcome Score question naire ( KOOS ) . St and ing balance and strength was also measured after and at 3-month follow-up . Seventy-nine patients ( 62 women ) , with a mean age of 68 years ( age range 40 - 89 years ) were r and omized to aquatic exercise ( n = 27 ) , l and -based exercise ( n = 25 ) or control ( n = 27 ) . RESULTS No effect was observed immediately after exercise cessation ( 8 weeks ) . At 3-month follow-up a reduction in pain was observed only in the l and -based exercise group compared with control ( -8.1 mm , ( 95 % confidence interval -15.4 to -0.4 ; p = 0.039 ) , but no differences between groups were observed for KOOS ; and no improvement following aquatic exercise . Eleven patients reported adverse events ( i.e. discomfort ) in l and -based exercise , while only 3 reported adverse events in the aquatic exercise . CONCLUSION Only l and -based exercise showed some improvement in pain and muscle strength compared with the control group , while no clinical benefits were detectable after aquatic exercise compared with the control group . However , aquatic exercise has significantly less adverse effects compared with a l and -based programme OBJECTIVE To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis ( OA ) . METHOD Seventy-nine adults , 65 years of age or older with hip OA and at least 1 fall risk factor , were r and omly assigned to 1 of 3 groups : aquatics and education ( AE ; aquatic exercise twice a wk with once-a-wk group education ) , aquatics only ( A ; 2 wk aquatic exercise ) and control ( C ; usual activity ) . Balance , falls efficacy , dual-task function , functional performance ( chair st and s ) , and walking performance were measured pre- and postintervention or control period . RESULTS There was a significant improvement in fall risk factors ( full-factorial MANCOVA , baseline values as covariates ; p = .038 ) ; AE improved in falls efficacy compared with C and in functional performance compared with A and C. CONCLUSION The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis Background Aquatic exercise is recommended by the Osteoarthritis Research Society ( OARSI ) , by the American College of Rheumatology ( ACR ) and by the European League Against Rheumatism ( EULAR ) as a nonpharmacological method of controlling the knee osteoarthritis ( KOA ) symptoms . Moreover , given that weight loss results in a reduction of the load that is exerted upon the knee during daily activities , obesity is also considered to be a modifiable risk factor for the development and or exacerbation of KOA . The implementation of an exercise based weight loss program may , however , itself be limited by the symptoms of KOA . The aquatic program against osteoarthritis ( termed “ PICO ” in Portuguese ) prioritizes the control of symptoms and the recovery of functionality , with an attendant increase in the patient ’s physical activity level and , consequently , metabolic rate . Our laboratory is assessing the effectiveness of 3 months of PICO on the symptoms of KOA , on physical function , on quality of life and on gait . In addition , PICO shall examine the effects of said exercise intervention on inflammatory biomarkers , psychological health , life style and body composition . Methods / Design The trial is a prospect i ve , single-blinded , r and omized controlled trial , and involves 50 overweight and obese adults ( BMI = 28–43.5 kg/m2 ; age 40–65 yrs ) with radiographic KOA . The participants are r and omly allocated into either an educational attention ( control ) group or an aquatic ( exercise program ) group .  This paper describes the experimental protocol that is used in the PICO project . Discussion The PICO program shall provide insight into the effectiveness of an aquatic exercise program in the control of KOA symptoms and in the improvement of the quality of life . As such , they are likely to prove a useful reference to health professionals who intend to implement any kind of therapeutic intervention based around aquatic exercise . Trial registration NCT01832545 OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response OBJECTIVE To investigate whether an exercise program , initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only , in reducing activity limitations in patients with knee osteoarthritis ( OA ) and instability of the knee joint . DESIGN A single-blind , r and omized , controlled trial involving 159 knee OA patients with self-reported and /or biomechanically assessed knee instability , r and omly assigned to two treatment groups . Both groups received a supervised exercise program for 12 weeks , consisting of muscle strengthening exercises and training of daily activities , but only in the experimental group specific knee joint stabilization training was provided . Outcome measures included activity limitations ( Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function , primary outcome ) , pain , global perceived effect and knee stability . RESULTS Both treatment groups demonstrated large ( ∼20 - 40 % ) and clinical ly relevant reductions in activity limitations , pain and knee instability , which were sustained 6 months post-treatment . No differences in effectiveness between experimental and control treatment were found on WOMAC physical function ( B ( 95 % confidence interval - CI ) = -0.01 ( -2.58 to 2.57 ) ) or secondary outcome measures , except for a higher global perceived effect in the experimental group ( P = 0.04 ) . CONCLUSIONS Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee . In knee OA patients suffering from knee instability  , specific knee joint stabilization training , in addition to muscle strengthening and functional exercises , does not seem to have any additional value . Dutch Trial Register ( NTR ) registration number : NTR1475 AIMS The study aims to compare changes over time among three study groups on the primary outcome , pain , as well as on the secondary outcomes , other symptoms , activities of daily living function , sport and recreation function , knee-related quality of life , knee range of motions and the six-minute walk test and to investigate whether aquatic exercises would be superior compared with l and exercise on pain reduction . BACKGROUND Osteoarthritis is a prevalent musculoskeletal disorder . Appropriate exercise may prevent osteoarthritis-associated disabilities and increase life quality . To date , research that compares the effects of different types of exercise for knee osteoarthritis has been limited . DESIGN The study is a r and omised trial . METHODS Eighty-four participants with knee osteoarthritis were recruited from local community centres . Participants were r and omly assigned to the control , aquatic or l and -based exercise group . Exercise in both groups ran for 60 minutes , three times a week for 12 weeks . Data were collected at baseline , week 6 and week 12 during 2006 - 2007 . The instruments included the Knee Injury and Osteoarthritis Outcome Score , a st and ard plastic goniometer and the six-minute walk test . Generalised estimation equations were used to compare changes over time among groups for key outcomes . RESULTS Results showed statistically significant group-by-time interactions in pain , symptoms , sport/recreation and knee-related quality of life dimensions of Knee Injury and Osteoarthritis Outcome Score , knee range of motions and the six-minute walk test . However , the aquatic group did not show any significant difference from the l and group at both weeks 12 and 6 . CONCLUSIONS Both aquatic and l and -based exercise programmes are effective in reducing pain , improving knee range of motions , six-minute walk test and knee-related quality of life in people with knee osteoarthritis . The aquatic exercise is not superior to l and -based exercise in pain reduction . RELEVANCE TO CLINICAL PRACTICE Similar outcomes could be possible with the two programmes . Health care professionals may consider suggesting well- design ed aquatic or l and -based exercise classes for patients with osteoarthritis , based on their preferences and convenience OBJECTIVE To ascertain the effectiveness of the National Arthritis Foundation ( NAF ) aquatic and on-l and exercise programs on functional fitness and perceived ability to perform activities of daily living ( ADL ) measures in older adults with arthritis . DESIGN The effects of aquatic and on-l and exercise intervention programs were analyzed by repeated- measures analysis of variance by using a planned comparison approach with an independent 3 x 2 ( group by test ) design . omega(2 ) analyses were used to ascertain the relative treatment magnitude of each dependent variable . SETTING Testing in an indoor track facility ; exercise programs conducted in community setting s. PARTICIPANTS A volunteer sample of 30 men and women with arthritis ( osteoarthritis , n=22 ; rheumatoid arthritis , n=8 ) , r and omly assigned into either an aquatic exercise ( n=10 ) , on-l and exercise ( n=10 ) , or control group ( n=10 ) . INTERVENTION Eight-week on-l and and aquatic exercise program . MAIN OUTCOME MEASURES Functional fitness , ADLs , and h and -held dynamometry measures assessed on a 1-day pretest and posttest session , before and after an 8-week exercise program . RESULTS Aquatic and on-l and exercise subjects showed significant improvements on 9 of 12 functional fitness , 3 of 4 ADLs , and 7 of 8 h and -held isometric strength tests after their respective exercise programs . No significant changes were found in any of these measures for the control group . CONCLUSION Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis AIM The purpose of the present study was to determine the effects of a water-based exercise program on muscle function compared with regular high-intensity resistance training . METHODS Older women ( n = 87 ) were recruited from the local community . The inclusion criteria were , to be aged 60 years or older , able to walk and able to carry out daily living activities independently . Participants were r and omly assigned to one of the following groups : water-based exercises ( WBG ) , resistance training ( RTG ) or control ( CG ) . The experimental groups carried out 12 weeks of an excise program performed on water or on l and . The dynamic strength , the isometric peak , and rate of torque development for the lower limbs were assessed before and after interventions . RESULTS The water-based program provided a similar improvement in dynamic strength in comparison with resistance training . The isometric peak torque increased around the hip and ankle joints in the water-based group , and around the knee joint in the resistance-training group ( P < 0.05 ) . The rate of torque development increased only in the water-based group around the hip extensors muscles ( P < 0.05 ) . CONCLUSIONS Water-based programs constitute an attractive alternative to promote relevant strength gains using moderate loads and fast speed movements , which were also effective to improve the capacity to generate fast torques The purpose of the present study was to determine the effectiveness of a 24-week aquatic training ( AT ) program , which included both aerobic and resistance components , on muscle strength ( isometric and dynamic ) , flexibility , and functional mobility in healthy women over 60 years of age . Twenty-two subjects were assigned r and omly to either an  AT ( n = 12 ) or a  control ( C , n = 10 ) group . Volunteers participated in a supervised shallow-water exercise program for 60 minutes a day , 3 days a week ; the exercise program consisted of a 10-minute warm-up and stretching , 25 minutes of endurance-type exercise ( dancing ) at 80 % of heart rate (HR)max , 20 minutes of upper- and lower-body resistance exercises with specialized water-resistance equipment , and a 5-minute cool down .  Maximal isometric torque of knee extensors ( KEXT ) and knee flexors ( KFLEX ) were evaluated by a Cybex Norm dynamometer , grip strength ( HGR ) was evaluated using a Jamar hydraulic dynamometer , and dynamic strength was evaluated via the 3 repetition maximum ( 3RM ) test for chest press , knee extension , lat pull down , and leg press . Jumping performance was evaluated using the squat jump ( SJ ) , functional mobility with the timed up- and -go ( TUG ) test , and trunk flexion with the sit- and -reach test . Body composition was measured using the bioelectrical impedance method . The AT induced significant improvements in KEXT ( 10.5 % ) and KFLEX ( 13.4 % ) peak torque , HGR strength ( 13 % ) , 3RM ( 25.7–29.4 % ) , SJ ( 24.6 % ) , sit- and -reach ( 11.6 % ) , and TUG ( 19.8 % ) performance . The AT group demonstrated a significant increase in lean body mass ( 3.4 % ) . No significant changes in these variables were observed in the C group . The results indicate that AT , with both aerobic and resistance components , is an alternative training method for improving neuromuscular and functional fitness performance in healthy elderly women AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients Background and Purpose : This study was design ed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis ( OA ) of the knee compared with subjects with OA of the knee who performed l and -based exercises .  Subjects and Methods : Sixty-four subjects with OA of the knee were r and omly assigned to 1 of 2 groups that performed exercises for 18 weeks : a water-based exercise group and a l and -based exercise group . The outcome measures included a visual analog scale ( VAS ) for pain in the previous week , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , pain during gait assessed by a VAS at rest and immediately following a 50-foot ( 15.24-m ) walk test ( 50FWT ) , walking time measured at fast and comfortable paces during the 50FWT , and the Lequesne Index . Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention . Results : The 2 groups were homogenous regarding all parameters at baseline . Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups . Pain before and after the 50FWT decreased significantly over time in both groups . However , the water-based exercise group experienced a significantly greater decrease in pain than the l and -based exercise group before and after the 50FWT at the week-18 follow-up . Discussion and Conclusion : Both water-based and l and -based exercises reduced knee pain and increased knee function in participants with OA of the knee .  Hydrotherapy was superior to l and -based exercise in relieving pain before and after walking during the last follow-up . Water-based exercises are a suitable and effective alternative for the management of OA of the knee OBJECTIVE To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis ( OA ) . DESIGN R and omized controlled trial . SETTING Community . PARTICIPANTS Persons ( N=39 ; mean±SD age , 74±6y ; 26 women ) with mild to moderate OA and at risk for falling met study criteria , were measured at baseline , and were r and omly assigned to the intervention ( n=23 ) and control groups ( n=16 ) . INTERVENTIONS Water-based program ( 12wk , twice weekly ; intervention group ) or a time-matched computer training program ( control group ) . MAIN OUTCOME MEASURE The primary outcome was the short-form Physiological Profile Assessment ( PPA ) . Secondary outcomes included the Step Test , Timed Up and Go Test , Western Ontario and McMaster Universities OA Index ( Likert 3.0 version ) , Arthritis Impact Measurement Scales 2 , and Activity-specific Balance Confidence Scale . RESULTS No statistically significant between-group differences were found for any outcome measured ( n=35 ; 4 lost to follow-up ) . Within-group analysis indicated that Step Test results improved significantly in both groups ( mean change : control group , left leg , 2.07 ; 95 % confidence interval , 3.19-.95 ; P=.002 ; intervention group , 2.14 ; 95 % confidence interval , 3.20 - 1.08 ; P=.000 ) . Two PPA item scores ( reaction time , contrast sensitivity ) improved significantly ( 86.83 ; 95 % confidence interval , 9.86 - 163.79 ; P=.03 ; 1.43 ; 95 % confidence interval , 2.35-.50 ; P=.005 , respectively ) in the control group , result ing in a lower falls risk score . CONCLUSIONS Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class . Our study is , to our knowledge , the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity . Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation OBJECTIVE To design an aquatic exercise ( AQE ) and l and -based exercise ( LBE ) program to enhance knee function and reduce body fat in patients with obesity and knee osteoarthritis and to investigate the effectiveness of AQE and LBE on body fat , functional fitness , and functional status . SETTING Outpatient clinic at a Seoul National University Bundang Hospital . PARTICIPANTS Obese patients with knee osteoarthritis were recruited from patients who visited the rehabilitation , orthopedic surgery , and geriatric outpatient clinics at the hospital . Study participants were limited to those who met the following criteria : body mass index more than 25 kg/m(2 ) , abdominal circumference more than 90 cm ( men ) or 85 cm ( women ) , clinical ly diagnosed osteoarthritis with Kellgren-Lawrence scale 2 or higher on radiographic studies , and independent ambulation state . METHODS Participants were r and omly allocated into 3 groups : AQE ( n = 26 ) , LBE ( n = 25 ) , and the control group ( n = 24 ) . Exercise interventions were conducted 3 times a week for 8 weeks . OUTCOME MEASURES Body fat analysis , brief pain inventory , Western Ontario and McMaster Universities ' osteoarthritis index , Short Form-36 question naire , and knee isokinetic tests were evaluated to assess changes in body fat composition , pain , physical function , and quality of life before and after the exercise program . RESULTS Although no significant difference was found in general characteristics among the 3 groups before exercise , body fat proportion in the AQE group decreased significantly ( mean + /- SD , from 34.4 + /- 4.7 to 33.3 + /- 4.7 ; P = .031 ) after intervention . The body mass index was slightly reduced after intervention , but it was not statistically significant . The AQE group showed significant improvements in pain , disability , and quality of life . Notably , the change in pain interference in the AQE group ( mean + /- SD , from 25.8 + /- 15.1 to 18.8 + /- 13.1 ; P = .009 ) was greater than that of the LBE group . Both exercise groups showed significant improvements in Western Ontario and McMaster Universities ' osteoarthritis index disability compared with the control group . CONCLUSIONS AQE had an advantage in controlling the interference with activity because of pain . AQE may be an effective tool for patients with obesity who have difficulties with active exercise due to knee osteoarthritis
target: Beneficial effects of aquatic exercise were found on physical function .
background: Water-based exercises are recommended for people with osteoarthritis ( OA ) , due to the beneficial effects on physical function , quality of life and symptom reduction .
  However , the effects on muscle strength are still controversial .
  The aim of this review was to assess and compare the effects of aquatic exercise programs on muscle strength and physical function in people with OA .