Aquatic exercise for the treatment of knee and hip osteoarthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 14 AUG 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Samsøe B. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005523. DOI: 10.1002/14651858.CD005523.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
Clinical experience indicates that aquatic exercise may have advantages for osteoarthritis patients.
To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.
We searched MEDLINE from 1949, EMBASE from 1980, CENTRAL (Issue 2, 2006), CINAHL from 1982, Web of Science from 1945, all up to May 2006. There was no language restriction.
Randomised controlled trials or quasi-randomised clinical trials.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Pooled results were analyzed using standardized mean differences (SMD).
Thre is a lack of high-quality studies in this area. In total, six trials (800 participants) were included. At the end of treatment for combined knee and hip osteoarthritis, there was a small-to-moderate effect on function (SMD 0.26, 95% confidence interval (CI) 0.11 to 0.42) and a small-to-moderate effect on quality of life (SMD 0.32, 95% CI 0.03 to 0.61). A minor effect of a 3% absolute reduction (0.6 fewer points on a 0 to 20 scale) and 6.6% relative reduction from baseline was found for pain. There was no evidence of effect on walking ability or stiffness immediately after end of treatment. No evidence of effect on pain, function or quality of life were observed on the one trial including participants with hip osteoarthritis alone. Only one trial was identified including knee osteoarthritis alone, comparing aquatic exercise with land-based exercise. Immediately after treatment, there was a large effect on pain (SMD 0.86, 95%CI 0.25 to 1.47; 22% relative percent improvement), but no evidence of effect on stiffness or walking ability. Only two studies reported adverse effects, that is, the interventions did not increase self-reported pain or symptom scores. No radiographic evaluation was performed in any of the included studies.
Aquatic exercise appears to have some beneficial short-term effects for patients with hip and/or knee OA while no long-term effects have been documented. Based on this, one may consider using aquatic exercise as the first part of a longer exercise programme for osteoarthritis patients. The controlled and randomised studies in this area are still too few to give further recommendations on how to apply the therapy, and studies of clearly defined patient groups with long-term outcomes are needed to decide on the further use of this therapy in the treatment of osteoarthritis.
Plain language summary
Aquatic exercise for osteoarthritis
This summary of a Cochrane review presents what we know from research about the effect of aquatic exercise for osteoarthritis of the hip or knee. The review shows that:
There is gold level evidence that for osteoarthritis of the hip or knee, aquatic exercise probably slightly reduces pain and slightly improves function over 3 months.
The progression of damage in osteoarthritis as seen on x-rays was not measured. Therefore, it is not known whether aquatic exercise improves the progression of osteoarthritis.
Aquatic exercise may not cause harm. But there is not enough evidence to be certain.
More research is needed to determine long term effects and to understand which type of aquatic exercise, how often and for how long, might be beneficial.
What is osteoarthritis and what is aquatic exercise?
Osteoarthritis (OA) is the most common form of arthritis that affects the hips and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. Aquatic exercise is sometimes known as 'pool therapy' or 'hydrotherapy'. It involves exercises in water that is heated to about 32 to 36 degrees Celsius. Exercises may include aerobic activities, stretching and strengthening, and range of motion.
What are the effects of aquatic exercise?
In the studies, some people did aquatic exercises for different lengths of time and number of sessions per week, while other people did no exercise or exercises on land. The effects were mainly measured at 3 months.
In people with osteoarthritis of the hip or knee,
- pain may decrease by 1 more point on a scale of 0 to 20 with aquatic exercise
- function may improve by 3 more points on a scale of 0 to 68 with aquatic exercise
- progress of damage of osteoarthritis as seen on x-rays was not measured
- there may be little or no difference in harms such as pain or other symptoms with aquatic exercises than with no exercise
搜尋包括MEDLINE from 1949, EMBASE from 1980, CENTRAL (Issu, 2006), CINAHL from 1982, Web of Science from 1945, all up to May 2006。
本領域缺乏高品質研究。6個研究包含800例病患於分析中。合併膝及髖關節分析，治療結束後，對功能效果為小到中，SMD 0.26, 95% CI 0.11 to 0.42，生活品質效果為小到中SMD 0.32, 95% CI 0.03 to 0.61。疼痛方面絕對減少僅3% (0.6 fewer points on a 0 to 20 scale) 及相對減少6.6% 。對運動後立即的走動能力及僵硬無顯著差異。1篇只有髖關節病人的研究顯示功能、生活品質、疼痛皆無顯著差異。1篇只有膝關節病人的水上運動與陸上運動比較研究顯示水上運動後立即的疼痛減少有大的效果SMD 0.86, 95% CI 0.25 to 1.47﹝相對改善22% ﹞，但對走動能力及僵硬無顯著差異。只有2篇研究報告副作用，即增加疼痛或症狀的分數報告。無任一報告作X光評估。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
金級證據顯示，水上運動治療膝及髖退化性關節炎3個月後可稍微減少疼痛及增進功能。 X光進展未有研究作評估，因而無由得知。水上運動可能不會造成傷害，但無足夠證據確認。需更長期研究結果以決定水上運動之形式、時間長短等用於治療退化性關節炎的長期效果。水上運動有時稱為“池療”或“水療”，為在32到36度攝氏水溫之運動，包括有氧運動，伸展及伸長及活動範圍運動，通常3個月後評估效果。水上運動治療膝及髖退化性關節炎後可減少疼痛1點或以上﹝0 to 20點評估﹞，功能進步3點或以上﹝ o 68點評估﹞。