The Effectiveness of Aquatic Exercise in Reducing Pain and Improving Muscles Strength in Knee Osteoarthritis Patient: A Systematic Review and Meta-Analysis

Abstract

Background: Knee osteoarthritis is a degenerative joint disease as the result of wear and tear of joint and progressive loss of cartilage. It affects functional ability in the elderly who manifested with pain upon movement, morning stiffness, reduction of range of movement and joint enlargement. There are numerous conservative treatment options available such as pharmacological management, knee bracing, cryotherapy, activity modification, exercises, or interventional procedures. Of all, it was believed that conventional physical therapy with exercises by stretching and strengthening of muscles, balance training, activity modification for daily tasks are vital to reduce pain and improve joint function. However, therapeutic interventions with aquatic exercise may be helpful for OA knee patients as various evidence suggest that hydrotherapy is beneficial if the pain level is very high and analgesia is not tolerated. Moreover, it can be useful to build up strength and reduce stiffness around the knee joint in a non-weight-bearing position.

Objective: The study aims to compare the effectiveness of aquatic exercise to conventional physical therapy in reducing pain and improving muscle strength.

Methods: A systematic review of all randomised controlled trials (RCTS) articles related to aquatic exercises and subjects inflicted with knee osteoarthritis. The search covered from January 2003 to September 2022 from 10 database (i.e., CINAHL, PubMed, PubMed Central, COCHRANE Library, Google scholar, Clinical key, EMBASE, PEDro, SCIELO and LILACS). All studies contain information regarding the effectiveness of aquatic exercise towards pain and muscle strength for knee osteoarthritis subjects.

Results: After removing duplicates, there are a total of 448 studies left out of 1054 selected studies. 439 studies were left after 9 studies were eliminated for writing in languages other than English. Following the exclusion of 374 papers for failing to meet the inclusion criteria and those without complete articles, 65 studies were left after a review of the titles and abstracts. Finally, 30 studies that satisfied the required inclusion criteria for this study were chosen, and 35 studies were eliminated since they were different sorts of studies, such systematic reviews and meta analyses. Further examination resulted in the inclusion of 7 studies that satisfy the requirements, and the exclusion of 23 studies. The outcomes of the relevant studies demonstrated that aquatic exercise benefits older people with osteoarthritis of the knee. Aquatic exercise can also be utilised as an alternate strategy for older patients with knee osteoarthritis, according to the studies examined. However, there is no discernible difference between aquatic exercise and regular physical activity in terms of pain reduction and boosting muscle strength, after a thorough investigation and meta-analysis.

Conclusion: This study concluded that aquatic exercises including group aquatic physical exercise, aquatic swimming, aquatic resistance exercise and aquatic intervention in the form of foundation aquatics program (AFAP) can be used in reducing osteoarthritis pain and improving muscle strength. Overall studies have proven that aquatic exercise is effective or has similar results compared to land-based exercise, hence, can be used as an alternative intervention when dealing with knee osteoarthritis with therapeutic interventions.