Exercising In Water Reduces
Osteoarthritis Pain
For patients suffering from osteoarthritis of the hip or knee, doing
aerobic and stretching exercises in warm water can bring some relief
from the pain and could improve daily function, a new review has found.
Knee and hip osteoarthritis are widespread diseases seen in up to 6
percent of the population. The main goal of treatment is to improve pain
control, according to a team of Danish reviewers, which included Bente
Danneskiold-Samsøe, professor at The Parker Institute in Frederiksberg.
The aim of the systematic review was to determine the effectiveness of
one form of such treatment aquatic exercise.
The review appears in the current issue of The Cochrane Library,
a publication of The Cochrane Collaboration, an international
organization that evaluates research in all aspects of health care.
Systematic reviews draw evidence-based conclusions about medical
practice after considering both the content and quality of existing
trials on a topic.
According to the Arthritis Foundation, osteoarthritis is the oldest and
most common form of arthritis and affects an estimated 21 million
Americans. This chronic condition causes the breakdown of the joint's
cartilage, which then causes the bones to rub against each other,
leading to stiffness, pain and loss of movement in the joint. The
Cochrane reviewers write that osteoarthritis accounts for "more
trouble in walking and climbing stairs than any other musculoskeletal
disease."
Treating osteoarthritis typically includes a combination of medication,
weight control, physical therapy and exercise. In aquatic exercise, also
known as "pool therapy" or "hydrotherapy," patients
perform tasks, such as aerobic activities or stretching and
strengthening and range of motion exercises, in water heated to about 90
to 97 degrees Fahrenheit.
The Cochrane reviewers analyzed six trials that had 800 participants who
all were living with osteoarthritis. Four studies included patients with
osteoarthritis of either the knee or hip, one study followed patients
with only hip arthritis and one included patients with only knee
arthritis.
In the studies, some patients did aquatic exercises for different
lengths of time and numbers of sessions per week, while other patients
did no exercise or exercised on land. Most of the studies measured
patients after three months of therapy.
Based on the studies' results, the reviewers said, "In people with
osteoarthritis of the hip or knee, pain may decrease by 1 more point on
a scale of 0 to 20 with aquatic exercise, and function may improve by 3
more points on a scale of 0 to 68."
"There is gold-level evidence that for osteoarthritis of the hip or
knee, aquatic exercise probably slightly reduces pain and slightly
improves function over three months," the reviewers wrote.
"Based on this, one may consider using aquatic exercise as the
first part of a longer exercise program for osteoarthritis
patients."
The reviewers were unable to find evidence on whether aquatic exercise
affected patients' walking ability or stiffness after treatment
sessions.
Wanda Evans, a physical therapy resource specialist at Kaiser
Permanente, said that her clinic uses aquatic therapy to treat 80
percent to 90 percent of patients with hip and knee osteoarthritis and
"100 percent" of them experience some improvement.
"Oftentimes, aquatics are the primary course of treatment if the
patient is obese and 80 percent of our patients with this diagnosis are
obese," Evans said. "Otherwise, it is considered an adjunct to
the primary course of treatment, which is land-based exercises."
The reviewers concluded that more research could help determine
long-term effects and to understand which types of aquatic exercise as
well as for how often and how long might benefit osteoarthritis
sufferers.
Evans said in her experience, whether the beneficial results of aquatic
exercise are short- or long-term varies among patients.
"Because this condition is a degenerative process, no conservative
treatment will ever give you complete long-term results," she said.
"However, aquatic exercise will absolutely prolong the need for
surgical intervention and, in some cases, can delay the need for surgery
for years."
The Cochrane Collaboration is an international nonprofit, independent
organization that produces and disseminates systematic reviews of health
care interventions and promotes the search for evidence in the form of
clinical trials and other studies of interventions.
Bartels EM, et al. Aquatic exercise for the treatment of knee and hip
osteoarthritis (Review). Cochrane Database of Systematic Reviews 2007,
Issue 4.
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