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Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Dec 2003; 62(12): 1162–1167.
PMCID: PMC1754378

Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme


Objective: To compare the effects of a hydrotherapy resistance exercise programme with a gym based resistance exercise programme on strength and function in the treatment of osteoarthritis (OA).

Design: Single blind, three arm, randomised controlled trial.

Subjects: 105 community living participants aged 50 years and over with clinical OA of the hip or knee.

Methods: Participants were randomised into one of three groups: hydrotherapy (n = 35), gym (n = 35), or control (n = 35). The two exercising groups had three exercise sessions a week for six weeks. At six weeks an independent physiotherapist unaware of the treatment allocation performed all outcome assessments (muscle strength dynamometry, six minute walk test, WOMAC OA Index, total drugs, SF-12 quality of life, Adelaide Activities Profile, and the Arthritis Self-Efficacy Scale).

Results: In the gym group both left and right quadriceps significantly increased in strength compared with the control group, and right quadriceps strength was also significantly better than in the hydrotherapy group. The hydrotherapy group increased left quadriceps strength only at follow up, and this was significantly different from the control group. The hydrotherapy group was significantly different from the control group for distance walked and the physical component of the SF-12. The gym group was significantly different from the control group for walk speed and self efficacy satisfaction. Compliance rates were similar for both exercise groups, with 84% of hydrotherapy and 75% of gym sessions attended. There were no differences in drug use between groups over the study period.

Conclusion: Functional gains were achieved with both exercise programmes compared with the control group.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kerr RG, Al-Kawan RH. Osteoarthritis. A primary care approach for physicians in 2000 and beyond. Saudi Med J. 2001 May;22(5):403–406. [PubMed]
  • McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993 Apr;52(4):258–262. [PMC free article] [PubMed]
  • Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997 Jul 15;127(2):97–104. [PubMed]
  • Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. J Rheumatol. 2001 Jan;28(1):156–164. [PubMed]
  • Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000 Feb 1;132(3):173–181. [PubMed]
  • Hurley MV, Scott DL. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. Br J Rheumatol. 1998 Nov;37(11):1181–1187. [PubMed]
  • Røgind H, Bibow-Nielsen B, Jensen B, Møller HC, Frimodt-Møller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. 1998 Nov;79(11):1421–1427. [PubMed]
  • Maurer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR., Jr Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Arch Phys Med Rehabil. 1999 Oct;80(10):1293–1299. [PubMed]
  • van Baar ME, Assendelft WJ, Dekker J, Oostendorp RA, Bijlsma JW. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 1999 Jul;42(7):1361–1369. [PubMed]
  • Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982 May 29;284(6329):1607–1608. [PMC free article] [PubMed]
  • Clark MS, Bond MJ. The Adelaide Activities Profile: a measure of the life-style activities of elderly people. Aging (Milano) 1995 Aug;7(4):174–184. [PubMed]
  • Jenkinson C, Layte R. Development and testing of the UK SF-12 (short form health survey). J Health Serv Res Policy. 1997 Jan;2(1):14–18. [PubMed]
  • Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989 Jan;32(1):37–44. [PubMed]
  • Green J, McKenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. Br J Rheumatol. 1993 Sep;32(9):812–815. [PubMed]
  • Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001 Aug;15(3):337–340. [PubMed]
  • Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov;32(11):1396–1405. [PubMed]
  • Sharkey NA, Williams NI, Guerin JB. The role of exercise in the prevention and treatment of osteoporosis and osteoarthritis. Nurs Clin North Am. 2000 Mar;35(1):209–221. [PubMed]
  • Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am. 1999 May;25(2):283–vi. [PubMed]
  • Ettinger WH, Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997 Jan 1;277(1):25–31. [PubMed]
  • Greig CA, Young A, Skelton DA, Pippet E, Butler FM, Mahmud SM. Exercise studies with elderly volunteers. Age Ageing. 1994 May;23(3):185–189. [PubMed]

Figures and Tables

Figure 1
Flow of study participants through selection and intervention protocols. Forty six (44%) participants were recruited from orthopaedic surgery waiting lists, 16 (15%) from rheumatology patient databases, 12 (11%) from physiotherapy referrals, and 31 (30%) ...
Figure 2
Medians and interquartile ranges for change scores in strength and physical function measures. For walking distance the hydro group was significantly different from the control group (p = 0.048). No other differences were significant. For walking speed ...

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