Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes

This review investigated the effects of aquatic compared to land based exercise on function, mobility or participants' perception of programs for people with arthritis.Medline, CINAHL, AMED and the Cochrane Central Register of Controlled Clinical Trials were searched up to July 2010. Ten randomised, controlled clinical trials that compared land to aquatic exercise for adults with arthritis were included. Study quality was assessed with the PEDro scale. Data relevant to the review question were systematically extracted by two independent reviewers. Standardised mean differences between groups for key outcomes were calculated. Meta-analyses were performed for function, mobility and indices that pooled health outcomes across multiple domains.No differences in outcomes were observed for the two rehabilitation strategies in meta-analysis. There was considerable variability between trials in key program characteristics including prescribed exercises and design quality. Components of exercise programs were poorly reported by the majority of trials. No research was found that examined participant preferences for aquatic compared to land based exercise, identifying this as an area for further research.Outcomes following aquatic exercise for adults with arthritis appear comparable to land based exercise. When people are unable to exercise on land, or find land based exercise difficult, aquatic programs provide an enabling alternative strategy.Aquatic therapy encompasses a range of approaches and may include passive immersion in mineral, hot or cold water. It may also incorporate the use of saunas, spas or exercise therapy. Aquatic exercise utilises the principles of hydrostatics and hydrodynamics to create challenges that promote health through exercise in water. The benefits of aquatic exercise are thought to result from water's unique characteristics including warmth that reduces pain and muscle spasm [1-3], buoyancy that decreases loading of joints [4], resistance to movem