Aquatic cycling improves knee pain and physical functioning in patients with knee osteoarthritis: a randomised controlled trial

Stefanie Rewald, Ton Lenssen, Pieter J. Emans, Rob A. de Bie, Gerard van Breukelen, Ilse Mesters*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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

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

SETTINGS: OA outpatient clinic of the Maastricht University Medical Center.

PARTICIPANTS: Patients (N=111, 50-70 years old) with unilateral mild to moderate knee OA.

INTERVENTIONS: Participants (AC, n=55) received aquatic cycling sessions of 45 min twice-weekly. Each session combined up-right seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care group (UC, n=47) continued with usual care and was offered twelve aquatic cycling 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, post-intervention and 24-weeks follow-up. Multilevel (mixed regression) analysis examined the effects.

RESULTS: Average attendance rate for the aquatic cycling sessions was 80%. Statistically significant differences at post-intervention and follow-up were found for knee pain (UC pretest 57.89 ±15.26, posttest 55.90 ±18.04, follow-up 57.24 ±19.16; AC pretest 56.96 ±12.96, posttest 63.55 ±15.33, follow-up 64.35 ±17.26, Estimate 8.16, SE 3.27, 95% CI 1.67 to 14.64; ES = 0.50) and physical functioning (UC pretest 66.32 ±16.28, posttest 66.80 ±19.04, follow-up 65.42 ±17.98; 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 favour of the aquatic group.

CONCLUSION: The results suggest that a 12-week aquatic cycling training programme improves self-reported knee pain and physical functioning in patients with mild to moderate knee OA compared to usual care.

Original languageEnglish
Pages (from-to)1288-1295
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Issue number8
Early online date10 Mar 2020
Publication statusPublished - Aug 2020


  • 6-MINUTE
  • Exercise therapy
  • HIP
  • Knee
  • Osteoarthritis
  • Pain
  • Randomized controlled trial
  • Rehabilitation

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