Researchers Evaluate Whether Aquatic Exercise Is Most Effective Therapy for IA


Research supports that aquatic exercise is effective at reducing pain and disease activity and improving physical function, although it is unclear whether it is more effective than any other form of therapy for inflammatory arthritis (IA).

While aquatic exercises have been deemed an effective form of physical therapy in general and for patients with inflammatory arthritis (IA), authors of a review published in Rheumatology International said it is unclear whether aquatic exercise is more effective than any other form of therapy for IA.

To answer the question of how aquatic exercise influences pain, disease activity, and physical function in patients with IA—which included rheumatoid arthritis (RA) and spondyloarthritis (SpA)—the review authors analyzed 9 studies with 604 participants.

All studies were published between 2010 and March 2022, involved adults with IA who participated in rehabilitation with aquatic exercise, and compared this group to a control group.

“Furthermore, this wider approach follows the recent recommendations for clinical management of inflammatory arthritis, which considered grouping these diseases, because they share clinical characteristics, and several non-pharmacological interventions are similarly effective for all of them,” the authors wrote.

Of the 9 studies, 2 of them deemed aquatic exercise superior to home or land-based exercise in terms of pain improvement. According to other reviews, aquatic exercise has also been shown to soften pain intensity in patients with RA or other locomotor diseases.

One study said disease activity was also significantly improved in the aquatic group, compared with the land-based exercise and no exercise groups. An analysis of multiple studies demonstrated that aquatic exercise therapy on its own or alongside drug treatment is effective over time in patients with RA, and its effects can be further enhanced by adding aquatic and land balance exercises to therapy among patients with ankylosing spondylitis.

In terms of physical function, 2 studies found that aquatic exercise either alone or in addition to land-based exercise showed improvement.

“Additionally, aquatic jogging associated with land exercises and patient education is effective in improving physical function over time in individuals with rheumatoid arthritis, a positive effect that is optimized by adding balance exercises to the protocol in individuals with ankylosing spondylitis,” the authors found. “Furthermore, spa treatments involving mud packs, thermal baths, and water exercises are also effective in improving physical function in individuals with ankylosing spondylitis.”

High-frequency and long duration workouts including various aquatic exercises may be even more effective at improving physical function in individuals with IA.

Despite these findings, the authors said there is not enough scientific evidence that points to the overall superiority of aquatic exercise compared with land-based exercise or medication, especially when considering long-term efficacy.

Main limitations included the small amount of clinical trials aimed at evaluating the effectiveness of aquatic exercise in the treatment of IA, restrictive inclusion criteria, and varying methods used in each study.

“Further studies assessing the effects of aquatic exercise on individuals diagnosed with inflammatory arthritis should be performed and researchers should also be encouraged to detail the exercise prescription performed as it allows the protocol to be reproduced in further research works and clinical practice,” the authors concluded.


Medrado LN, Mendonça MLM, Budib MB, Oliveira-Junior SA, Martinez PF. Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review. Rheumatol Int. Published online May 28, 2022. doi:10.1007/s00296-022-05145-w

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