Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial

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To compare the effectiveness of aquatic exercises with patient-education in individuals with knee osteoarthritis.


Randomized controlled trial with blinded assessor and intention-to-treat analysis.


Aquatic Physiotherapy Centre and Primary Health Care Unit.


A total of 60 patients, aged 68.3 (SD = 4.8) with clinical symptoms and radiographic grading (Kellgren–Lawrence 1–4) of knee osteoarthritis were included.


An eight-week treatment protocol of aquatic exercise (n = 31) (16 individual sessions, twice a week) and an educational program (group sessions, once a week) (n = 29).

Main measures:

Before, after eight-week intervention, and a three-month follow-up with results for the following outcome measures: pain, function, quality of life, functional mobility, and depression.


At the end of treatment, the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) functional capacity values reduced in favour of the aquatic exercise group for both the total score MD (mean difference) = –14.2; 95% CI (confidence interval) (−18; −10.5), P = 0.04 and the pain domain MD = −3.8 points; 95% CI (−8.71; −1), P = 0.021. The total score also reduced in the follow-up: MD = −12.3 points; 95% CI (−24.7; −6.1), P = 0.017. No differences were found for the outcomes functional mobility or depression.


Aquatic exercise improved pain and function after eight weeks, and function at the three-month follow-up compared to the patient-education program.

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