Aquatic Cycling Improves Knee Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Published:March 10, 2020DOI:


      • Twelve weeks of aquatic cycling training improved self-reported physical functioning and knee pain in patients with mild-to-moderate osteoarthritis.
      • The posttreatment group differences in physical functioning and knee pain were secured for at least 3 months.
      • The aquatic cycling group showed a short-term improvement in disease-specific quality of life after a 12-week aquatic cycling training program.
      • Attendance of sessions was high (>80%) indicating adequate tolerance.



      To assess the efficacy of a 12-week aquatic cycling training program for improving knee pain and physical functioning in patients with knee osteoarthritis (OA).


      Two-arm, single-blind, parallel-group randomized controlled trial.


      OA outpatient clinic of the Maastricht University Medical Center+.


      Patients (N=111, 50-70y) with unilateral mild-to-moderate knee OA.


      Participants (aquatic cycling [AC] group, n=55) received AC sessions of 45 min each 2 times per week. Each session combined upright seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care (UC) group (n=47) continued with UC and was offered 12 AC sessions in a local swimming pool after their trial participation.

      Main Outcome Measures

      The Knee Injury and Osteoarthritis Outcome Score (KOOS) on knee pain and physical function was assessed at baseline, postintervention, and at 24-wk follow-up. Multilevel (mixed regression) analysis examined the effects.


      Average attendance rate for the AC sessions was 80%. Statistically significant differences at postintervention and follow-up were found for knee pain in mean ± SD (UC pretest, 57.89±15.26; posttest, 55.90±18.04; follow-up, 57.24±19.16; and AC pretest, 56.96±12.96; posttest, 63.55±15.33; follow-up, 64.35±17.26; estimate, 8.16; SE, 3.27; 95% confidence interval [CI], 1.67-14.64; effect size [ES], 0.50) and physical functioning (UC pretest, 66.32±16.28; posttest, 66.80±19.04; follow-up, 65.42±17.98; and AC pretest, 61.89±17.151; posttest, 70.14±17.52; follow-up, 69.00±16.84; estimate, 7.16; SE, 3.19; 95% CI, 0.83-13.49; ES, 0.43) in favor of the aquatic group.


      The results suggest that a 12-week AC training program improves self-reported knee pain and physical functioning in patients with mild-to-moderate knee OA compared to UC.


      Lists of abbreviations:

      AC (aquatic cycling), CI (confidence interval), ES (effect size), KOOS (Knee Injury and Osteoarthritis Outcome Score questionnaire), MUMC+ (Maastricht University Medical Center+), OA (osteoarthritis), QoL (quality of life), RCT (randomized controlled trial), TUG (timed Up and Go test), UC (usual care), 6MWT (6-Minute Walk Test)
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