Skip to main content

Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review

Rheumatology International (2022)Cite this article

Abstract

Spondyloarthritis and rheumatoid arthritis are classified as inflammatory arthritis and represent a significant source of pain and disability. Non-pharmacological intervention with physical exercise is among the therapeutic approaches most used by health professionals. This study aimed to investigate the effectiveness of aquatic exercise in the treatment of inflammatory arthritis. The review was registered on the PROSPERO (CRD42020189602). The databases (PubMed, PEDro, Web of Science, and SciELO) were searched for studies involving adults with inflammatory arthritis and subjected to rehabilitation with aquatic exercise compared to any other control group, from the year 2010 to March 2022. Pain, disease activity, and physical function were regarded as primary outcomes. Two reviewers completed the eligibility screening and data extraction, and disagreements were resolved by a third reviewer. The methodological quality was assessed using the PEDro scale. A total of 5254 studies were identified, and nine articles were included, totalling 604 participants. Regarding pain, two studies showed that aquatic exercise was superior to home exercise. One study showed that disease activity was significantly improved in the aquatic group compared to the land-based exercise and the control groups (no exercise). Two studies reported that therapy containing aquatic exercise was able to improve physical function. Overall, the studies included in this review indicate that aquatic exercise is effective in treating pain, disease activity, and physical function in individuals with inflammatory arthritis. However, further studies carrying stronger evidence should be conducted to determine whether the treatment with aquatic exercise is superior to other types of therapies.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Sieper J, Braun J, Dougados M, Baeten D (2015) Axial spondyloarthritis. Nat Rev Dis Primers 1:15013. https://doi.org/10.1038/nrdp.2015.13

    Article  PubMed  Google Scholar 

  2. Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K (2018) Rheumatoid arthritis. Nat Rev Dis Primers 4:18001. https://doi.org/10.1038/nrdp.2018.1

    Article  PubMed  Google Scholar 

  3. Schneider S, Schmitt G, Richter W (2006) Prevalence and correlates of inflammatory arthritis in Germany: data from the First National Health Survey. Rheumatol Int 27:29–38. https://doi.org/10.1007/s00296-006-0153-0

    CAS  Article  PubMed  Google Scholar 

  4. Pisetsky DS, Ward MM (2012) Advances in the treatment of inflammatory arthritis. Best Pract Res Clin Rheumatol 26:251–261. https://doi.org/10.1016/j.berh.2012.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  5. Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907. https://doi.org/10.7326/0003-4819-136-12-200206180-00011

    Article  PubMed  Google Scholar 

  6. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25. https://doi.org/10.1186/1477-7525-7-25

    Article  PubMed  PubMed Central  Google Scholar 

  7. Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Álvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernández L, Smolen JS, Skingle D, Szekanecz Z, van Vollenhoven R (2017) 2016 Update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 76:948–959. https://doi.org/10.1136/annrheumdis-2016-210602

    Article  PubMed  Google Scholar 

  8. Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL, Husebø M, Köke A, Paskins Z, Pitsillidou IA, Savel C, Austin J, Hassett AL, Severijns G, Stoffer-Marx M, Vlaeyen J, Fernández-de-Las-Peñas C, Ryan SJ, Bergman S (2018) EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:797–807. https://doi.org/10.1136/annrheumdis-2017-212662

    Article  PubMed  Google Scholar 

  9. Powell AP, English J (2018) Exercise for athletes with inflammatory arthritis. Curr Sports Med Rep 17:302–307. https://doi.org/10.1249/JSR.0000000000000518

    Article  PubMed  Google Scholar 

  10. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP (2011) American college of sports medicine position stand quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb

    Article  PubMed  Google Scholar 

  11. Rausch Osthoff AK, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, Duruoz T, Esbensen BA, Günther KP, Hurkmans E, Juhl CB, Kennedy N, Kiltz U, Knittle K, Nurmohamed M, Pais S, Severijns G, Swinnen TW, Pitsillidou IA, Warburton L, Vliet Vlieland T (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:1251–1260. https://doi.org/10.1136/annrheumdis-2018-213585

    Article  PubMed  Google Scholar 

  12. Layne M (2015) Water exercise. Human Kinects, Champaign, IL

    Google Scholar 

  13. Pereira Neiva H, Brandão Faíl L, Izquierdo M, Marques MC, Marinho DA (2018) The effect of 12 weeks of water-aerobics on health status and physical fitness: an ecological approach. PLoS ONE 13:e0198319. https://doi.org/10.1371/journal.pone.0198319

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Pendergast DR, Moon RE, Krasney JJ, Held HE, Zamparo P (2015) Human physiology in an aquatic environment. Compr Physiol 5:1705–1750. https://doi.org/10.1002/cphy.c140018

    Article  PubMed  Google Scholar 

  15. Batterham SI, Heywood S, Keating JL (2011) Systematic review and meta-analysis comparing land and aquatic exercise for people with hip or knee arthritis on function, mobility and other health outcomes. BMC Musculoskelet Disord 12:123. https://doi.org/10.1186/1471-2474-12-123

    Article  PubMed  PubMed Central  Google Scholar 

  16. Al-Qubaeissy KY, Fatoye FA, Goodwin PC, Yohannes AM (2013) The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskelet Care 11:3–18. https://doi.org/10.1002/msc.1028

    Article  Google Scholar 

  17. Zão A, Cantista P (2017) The role of land and aquatic exercise in ankylosing spondylitis: a systematic review. Rheumatol Int 37:1979–1990. https://doi.org/10.1007/s00296-017-3829-8

    Article  PubMed  Google Scholar 

  18. Liang Z, Fu C, Zhang Q, Xiong F, Peng L, Chen L, He C, Wei Q (2019) Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil 43:895–902. https://doi.org/10.1080/09638288.2019.1645218

    Article  PubMed  Google Scholar 

  19. Zhao Q, Dong C, Liu Z, Li M, Wang J, Yin Y, Wang R (2020) The effectiveness of aquatic physical therapy intervention on disease activity and function of ankylosing spondylitis patients: a meta-analysis. Psychol Health Med 25:832–843. https://doi.org/10.1080/13548506.2019.1659984

    Article  PubMed  Google Scholar 

  20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  21. Breedland I, van Scheppingen C, Leijsma M, Verheij-Jansen NP, van Weert E (2011) Effects of a group-based exercise and educational program on physical performance and disease self-management in rheumatoid arthritis: a randomized controlled study. Phys Ther 91:879–893. https://doi.org/10.2522/ptj.20090010

    Article  PubMed  Google Scholar 

  22. Mihailov CI, Mindru T (2015) Hydrotherapy and pain management in early rheumatoid arthritis. J Environ Prot Ecol 16:328–332

    CAS  Google Scholar 

  23. Mateen S, Moin S, Khan AQ, Zafar A, Fatima N, Shahzad S (2018) Role of hydrotherapy in the amelioration of oxidant-antioxidant status in rheumatoid arthritis patients. Int J Rheum Dis 21:1822–1830. https://doi.org/10.1111/1756-185X.13118

    CAS  Article  PubMed  Google Scholar 

  24. Siqueira US, Orsini Valente LG, de Mello MT, Szejnfeld VL, Pinheiro MM (2017) Effectiveness of aquatic exercises in women with rheumatoid arthritis: a randomized, controlled, 16-week intervention-the hydra trial. Am J Phys Med Rehabil 96:167–175. https://doi.org/10.1097/PHM.0000000000000564

    Article  PubMed  Google Scholar 

  25. Ciprian L, Lo Nigro A, Rizzo M, Gava A, Ramonda R, Punzi L, Cozzi F (2013) The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors. Rheumatol Int 33:241–245. https://doi.org/10.1007/s00296-011-2147-9

    Article  PubMed  Google Scholar 

  26. Dundar U, Solak O, Toktas H, Demirdal US, Subasi V, Kavuncu V, Evcik D (2014) Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int 34:1505–1511. https://doi.org/10.1007/s00296-014-2980-8

    CAS  Article  PubMed  Google Scholar 

  27. Gunay SM, Keser I, Bicer ZT (2018) The effects of balance and postural stability exercises on spa based rehabilitation programme in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 31:337–346. https://doi.org/10.3233/BMR-169755

    Article  PubMed  Google Scholar 

  28. Gurpinar B, Ilcin N, Savci S, Akkoc N (2021) Do mobility exercises in different environments have different effects in ankylosing spondylitis? Acta Reumatol Port 46:297–316

    PubMed  Google Scholar 

  29. Nilssen IR, Koksvik HS, Grønning K, Steinsbekk A (2020) Rehabilitation in warm climate for young adults with inflammatory arthritis: a 12-month randomized controlled trial. J Rehabil Med 52(4):jrm00040

    Article  Google Scholar 

  30. Nikiphorou E, Santos E, Marques A, Böhm P, Bijlsma JW, Daien CI, Esbensen BA, Ferreira R, Fragoulis GE, Holmes P, McBain H, Metsios GS, Moe RH, Stamm TA, de Thurah A, Zabalan C, Carmona L, Bosworth A (2021) 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis 80:1278–1285. https://doi.org/10.1136/annrheumdis-2021-220249

    Article  PubMed  Google Scholar 

  31. Lundberg IE, Nader GA (2008) Molecular effects of exercise in patients with inflammatory rheumatic disease. Nat Clin Pract Rheumatol 4:597–604. https://doi.org/10.1038/ncprheum0929

    CAS  Article  PubMed  Google Scholar 

  32. Becker BE (2009) Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R 1:859–872. https://doi.org/10.1016/j.pmrj.2009.05.017

    Article  Google Scholar 

  33. Carayannopoulos AG, Han A, Burdenko IN (2020) The benefits of combining water and land-based therapy. J Exerc Rehabil 16(1):20–26

    Article  Google Scholar 

  34. Verhagen AP, Cardoso JR, Bierma-Zeinstra SM (2012) Aquatic exercise and balneotherapy in musculoskeletal conditions. Best Pract Res Clin Rheumatol 26:335–343. https://doi.org/10.1016/j.berh.2012.05.008

    Article  PubMed  Google Scholar 

  35. Lee YC (2013) Effect and treatment of chronic pain in inflammatory arthritis. Curr Rheumatol Rep 15:300. https://doi.org/10.1007/s11926-012-0300-4

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. Rodríguez-García E, Barnes-Ortiz S, Pérez-Mármol JM (2020) Self-efficacy, pain intensity, rheumatic disease duration, and hand functional disability on activities of daily living. Nurs Res 69:E208–E216. https://doi.org/10.1097/NNR.0000000000000466

    Article  PubMed  Google Scholar 

  37. Martin A, Chopra R, Nicassio PM (2021) Nonpharmacologic pain management in inflammatory arthritis. Rheum Dis Clin North Am 47:277–295. https://doi.org/10.1016/j.rdc.2020.12.009

    Article  PubMed  Google Scholar 

  38. Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S, Okada S, Kitayuguchi J, Kamada M, Shiozawa N, Honda T (2010) Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol 20:2–12. https://doi.org/10.2188/jea.je20090030

    Article  PubMed  PubMed Central  Google Scholar 

  39. Brown GA, Cotton A, Guinto J, Sharma A, Ciurtin C (2017) Outcome measures of disease activity in inflammatory arthritis. Br J Hosp Med 78:432–437

    Article  Google Scholar 

  40. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Chathuranga R, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF (2020) World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 54:1451–1462. https://doi.org/10.1136/bjsports-2020-102955

    Article  PubMed  Google Scholar 

  41. Reimer DJ (1998) Physical fitness training. In: Field manual no 21-20: 241. US-Army, Washington, DC

Download references

Acknowledgements

The authors are grateful to Ivy Gobeti for English editing and to the members of the Striated Muscle Study Laboratory from Universidade Federal de Mato Grosso do Sul.

Funding

This study had financial support from Universidade Federal de Mato Grosso do Sul–UFMS/MEC–Brasil, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil (CAPES)–Fincance Code 001. The supporters had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Striated Muscle Study Laboratory, Integrated Institute of Health, Federal University of Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n‑Cidade Universitária, Universitário, 79070‑900, Campo Grande, MS, Brazil

    Larissa Nakahata Medrado, Maria Lua Marques Mendonça, Mariana Bogoni Budib, Silvio Assis Oliveira-Junior & Paula Felippe Martinez

Authors
  1. Larissa Nakahata Medrado
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Lua Marques Mendonça
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariana Bogoni Budib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvio Assis Oliveira-Junior
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paula Felippe Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors whose names appear on the submission made substantial contributions to the conception or design of the work. Analysis or interpretation of data. Drafted the work or revised it critically for important intellectual content. Approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specifically, LNM and PFM provided the idea for the article. LNM and MLMM performed the literature search and data analysis. LNM, SAOJ, MBB and PFM drafted and/or critically revised the work.

Corresponding author

Correspondence to Paula Felippe Martinez.

Ethics declarations

Conflict of interest

Author Larissa Medrado, author Maria Lua Mendonça, author Mariana Budib, author Sílvio Oliveira Júnior and author Paula Martinez declare that they have no conflict of interest.

Ethical approval

This is a systematic review and no ethical approval is required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Medrado, L.N., Mendonça, M.L.M., Budib, M.B. et al. Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review. Rheumatol Int (2022). https://doi.org/10.1007/s00296-022-05145-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00296-022-05145-w

Keywords

  • Exercise
  • Hydrotherapy
  • Ankylosing spondylitis
  • Rheumatoid arthritis