Aquatic Versus Land Exercise: Which Yields Greater Benefits for Osteoarthritis (OA) Patients?

Osteoarthritis (OA) affects nearly 27 million U.S. adults ages 25 years or older, and is marked by symptoms of joint pain and stiffness. Seeking treatment and relief, in 2008, OA patients made 36 million office visits. Over-the-counter and prescription analgesics, and intra-articular corticosteroid injections are the mainstays of primary treatment. Matthew Silvis, M.D., Penn State Hershey Bone and Joint Institute, points out, “Regular exercise also eases OA symptoms, mainly because it strengthens supporting muscles which help to stabilize the joint and absorb the impact of movement.” The American College of Sports Medicine (ACSM) recommends that patients with OA engage in moderate activity for thirty minutes, at least five times per week.

male patient on underwater treadmill“The major challenge many physicians face is how to get their patients with OA moving. There’s currently very little empirical evidence defining what type of exercise is best or most effective for relieving OA symptoms.” To help address these questions, Silvis and his colleagues examined three different types of exercise for OA symptoms and daily functioning; the results of the investigation were presented at the Annual American Medical Society for Sports Medicine meeting in San Diego, California1. OA patients (30 to 70 years of age) with knee pain were randomly assigned to exercise using an underwater treadmill, a regular treadmill, or an upright stationary cycle for thirty minutes, three times per week for eight weeks. Patients were allowed to continue their regular oral or topical analgesic treatments for OA.

“Because in water about 80 percent of the patient’s bodyweight is offloaded, and results in the least weight bearing, we hypothesized that the water treadmill would yield the greatest benefits,” explains Silvis. As expected, all of the exercise regimens significantly relieved OA symptoms and improved daily functioning, although results favored the water treadmill. “About 80 percent of the water treadmill patients experienced clinically significant OA symptom improvement, versus about 60 percent of patients in the other exercise groups. More water treadmill patients stuck with the regimen and completed the study,” notes Silvis. Improvements began to emerge after four weeks. This is one of the first controlled trials to evaluate how best to achieve the benefits of exercise for OA patients.

“While we confirmed that any type of exercise can help, patients randomized to the underwater treadmill were more likely to improve with aquatic exercise and less likely to drop out.”


headshot photo of Matthew Silvis, M.D.

Matthew Silvis, M.D.

Matthew Silvis, M.D.

  • Associate professor, family and community medicine and orthopaedics and rehabilitation
  • Director, primary care sports medicine
  • Phone: 717-531-8752
  • Fellowship: Sports medicine, Wake Forest University Baptist Medical Center, Winston Salem, NC
  • Residency: Family and sports medicine, Wake Forest University Baptist Medical Center, Winston Salem, NC
  • Medical School: Penn State College of Medicine, Hershey, PA

1. Silvis M, Sylvester J, Hacken B, et al. Comparison of the Underwater Treadmill, Land Based Treadmill, and Exercise Cycle on Patient Reported Symptoms of Knee Osteoarthritis. Presented at the Annual meeting of the American Medical Society for Sports Medicine, April 17-21, 2013, San Diego, CA.

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Filed under Healthcare Practice, Musculoskeletal Sciences

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