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


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.

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Fig. 1

Data availability

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


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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.


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.

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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.

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Correspondence to Paula Felippe Martinez.

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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.

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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).

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  • Exercise
  • Hydrotherapy
  • Ankylosing spondylitis
  • Rheumatoid arthritis