Flávia Yázigi, Diogo Veiga, Pablo J Marcos-Pardo, Margarida Espanha


Background: Pain is the main symptom of Knee Osteoarthritis (KOA) and aquatic exercise has been indicated as an effective non-pharmacological treatment for KOA symptoms. In general, KOA pain is assessed by simple scales or by multicomponent self-reported questionnaires, mainly the Knee Injury and Osteoarthritis Outcome Score (KOOS) and WOMAC Osteoarthritis Index. Some studies had reported the effectiveness of aquatic exercise on KOOS pain dimension but not on each pain item.

Objectives: This study aimed to investigate how pain items of KOOS questionnaire are affected by 3 months’ aquatic exercise program for overweight and obese individuals with KOA (PICO).

Method: Eligibility criteria were 40 ≤ age ≤ 65 years; BMI ≥ 28kg/m²; clinical and radiographic KOA. Participants were randomized in aquatic exercise group (AEG) and control group (CG). Pain was assessed by KOOS. Descriptive statistics and Univariate Analyses of Covariance (ANCOVA) were used as primary analyses.

Results: Final sample included 48 adults (BMI: 35.0±4.9 kg/m², age: 55±7 years), 23 in the CG and 25 in AEG. Table 1 presents ANCOVA analysis for each item of Pain dimension of KOOS. Significant group effect was found in all pain items (p <.05), except for pain frequency (P1) and pain on bending knee fully (P4). Better group effect was found in the item pain on walking (P5) (p <.001).

Conclusions: PICO aquatic program was effective in improving knee pain in seven of nine activities in individuals with KOA.

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(1) Bartels, E. M., Lund, H., Hagen, K. B., Dagfinrud, H., Christensen, R., & Danneskiold-Samsoe, B. (2007). Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Systematic Reviews, 17(4), CD005523. doi:10.1002/14651858.CD005523.pub2

(2) Bartels, E. M., Juhl, C. B., Christensen, R., Hagen, K. B., Danneskiold-Samsoe, B., Dagfinrud, H., & Lund, H. (2016). Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Systematic Reviews, 3, CD005523. doi:10.1002/14651858.CD005523.pub3

(3) Batterham, S. I., Heywood, S., & Keating, J. L. (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. doi:10.1186/1471-2474-12-123

(4) Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. Physical Medicine and Rehabilitation, 1(9), 859-872. doi:10.1016/j.pmrj.2009.05.017

(5) Brosseau, L., Taki, J., Desjardins, B., Thevenot, O., Fransen, M., Wells, G. A.,… McLean, L. (2017). The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clinical Rehabilitation, 31(5), 596-611. doi:10.1177/0269215517691084

(6) Coudeyre, E., Jegu, A. G., Giustanini, M., Marrel, J. P., Edouard, P., & Pereira, B. (2016). Isokinetic muscle strengthening for knee osteoarthritis: A systematic review of randomized controlled trials with meta-analysis. Annals of Physical and Rehabilitation Medicine, 59(3), 207-215. doi:10.1016/

(7) Dong, R., Wu, Y., Xu, S., Zhang, L., Ying, J., Jin, H., . . . Tong, P. (2018). Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine (Baltimore), 97(52), e13823. doi:10.1097/MD.0000000000013823

(8) Farr, J. N., Going, S. B., Lohman, T. G., Rankin, L., Kasle, S., Cornett, M., & Cussler, E. (2008). Physical activity levels in patients with early knee osteoarthritis measured by accelerometry. Arthritis & Rheumatology, 59(9), 1229-1236. doi:10.1002/art.24007

(9) Franco, M. R., Morelhao, P. K., de Carvalho, A., & Pinto, R. Z. (2017). Aquatic Exercise for the Treatment of Hip and Knee Osteoarthritis. Physical Therapy, 97(7), 693-697. doi:10.1093/ptj/pzx043

(10) Gay, C., Chabaud, A., Guilley, E., & Coudeyre, E. (2016). Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Annals of Physical and Rehabilitation Medicine, 59(3), 174-183. doi:10.1016/

(11) Goncalves, R. S., Cabri, J., Pinheiro, J. P., & Ferreira, P. L. (2009). Cross-cultural adaptation and validation of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score (KOOS). Osteoarthritis Cartilage, 17(9), 1156-1162. doi:10.1016/j.joca.2009.01.009

(12) Hartmann, S., & Huch, R. (2005). Response of pregnancy leg edema to a single immersion exercise session. Acta Obstetricia et Gynecologica Scandinavica, 84(12), 1150-1153. doi:10.1111/j.0001-6349.2005.00829.x

(13) Hinman, R. S., Heywood, S. E., & Day, A. R. (2007). Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Physical Therapy, 87(1), 32-43. doi:10.2522/ptj.20060006

(14) Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., Guyatt, G., McGowan, J., … Tugwell, P. (2012). American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 64(4), 465-474.

(15) Jordan, K. M., Arden, N. K., Doherty, M., Bannwarth, B., Bijlsma, J. W., Dieppe, P., ... Dougados, M. (2003). EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Annals of The Rheumatic Diseases, 62(12), 1145-1155.

(16) Kim, I. S., Chung, S. H., Park, Y. J., & Kang, H. Y. (2012). The effectiveness of an aquarobic exercise program for patients with osteoarthritis. Applied Nursing Research, 25(3), 181-189. doi:10.1016/j.apnr.2010.10.001

(17) Lim, J. Y., Tchai, E., & Jang, S. N. (2010). Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. Physical Medicine and Rehabilitation, 2(8), 723-731; quiz 793. doi:10.1016/j.pmrj.2010.04.004

(18) Lund, H., Weile, U., Christensen, R., Rostock, B., Downey, A., Bartels, E. M., ... Bliddal, H. (2008). A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. Journal of Rehabilitation Medicine, 40(2), 137-144. doi:10.2340/16501977-0134

(19) Messier, S. P., Legault, C., Mihalko, S., Miller, G. D., Loeser, R. F., DeVita, P., ... Nicklas, B. J. (2009). The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale. BMC Musculoskelet Disord, 10, 93. doi:10.1186/1471-2474-10-93

(20) Pais, S. C. (2007). Aquatic exercise in knee osteoarthritis Patients: effects on symptoms, range of motion, proprioception, strength,function,ground reaction forces and plantar pressures. (PhD. PhD), Univ de Lisboa, Lisboa. Retrieved from (TD043 FMH MH8 2007 )

(21) Rahmann, A. E. (2010). Exercise for people with hip or knee osteoarthritis: a comparison of land-based and aquatic interventions. Open Access Journal of Sports Medicine, 1, 123-135.

(22) Roos, E. M., & Lohmander, L. S. (2003). The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health and Quality of Life Outcomes, 1, 64. doi:10.1186/1477-7525-1-64

(23) Rosemann, T., Kuehlein, T., Laux, G., & Szecsenyi, J. (2008). Factors associated with physical activity of patients with osteoarthritis of the lower limb. Journal of Evaluation in Clinical Practice, 14(2), 288-293. doi:10.1111/j.1365-2753.2007.00852.x

(24) Seib, C., & Anderson, D. (2017). Can dance-based aquatic exercise improve functionality in obese women with knee osteoarthritis? Menopause, 24(7), 724-725. doi:10.1097/GME.0000000000000930

(25) Silva, L. E., Valim, V., Pessanha, A. P., Oliveira, L. M., Myamoto, S., Jones, A., & Natour, J. (2008). Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Physical Therapy, 88(1), 12-21. doi:10.2522/ptj.20060040

(26) Suomi, R., & Collier, D. (2003). Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Archives of Physical Medicine and Rehabilitation, 84(11), 1589-1594.

(27) Taylor, R. (1990). Interpretation of the correlation coefficient: a basic review. Journal of Diagnostic Medical Sonography, 6(January), 35-39. doi:10.1177/875647939000600106

(28) Thorstensson, C. A., Roos, E. M., Petersson, I. F., & Ekdahl, C. (2005). Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]. BMC Musculoskelet Disord, 6, 27. doi:10.1186/1471-2474-6-27

(29) Wang, T. J., Lee, S. C., Liang, S. Y., Tung, H. H., Wu, S. F., & Lin, Y. P. (2011). Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing, 20(17-18), 2609-2622. doi:10.1111/j.1365-2702.2010.03675.x

(30) Yazigi, F., Pinto, S., Colado, J., Escalante, Y., Armada-Da-Silva, P., Brasil, R., & Alves, F. (2013a). The cadence and water temperature effect on physiological responses during water cycling. European Journal of Sport Science, 1-7. doi:10.1080/17461391.2013.770924

(31) Yazigi, F., Pinto, S., Colado, J., Escalante, Y., Armada-Da-Silva, P. A., Brasil, R., & Alves, F. (2013b). The cadence and water temperature effect on physiological responses during water cycling. European Journal of Sport Science. doi:10.1080/17461391.2013.770924

(32) Zhang, W., Nuki, G., Moskowitz, R. W., Abramson, S., Altman, R. D., Arden, N. K.,... Tugwell, P. (2010). OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage, 18(4), 476-499. doi:10.1016/j.joca.2010.01.013


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ISSN: 2530-805X

Revista de Investigación en Actividades Acuáticas | Año 2019

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