Does aquatic exercise help people with arthritis?

Sophie Heywood

Yes, aquatic exercise works!

Aquatic exercise is as effective as land exercise at improving pain and walking for people with musculoskeletal conditions including arthritis (1). It has also been shown to improve quality of life for people with arthritis which usually includes both physical and mental health and well-being. Hydrotherapy is another term which is used to describe movement and rehabilitation in water.

Exercise has got huge value when you have arthritis. It is recommended as a key strategy to manage hip and knee arthritis in all International Guidelines as well as our Australian GP guidelines.

Research shows that you need to complete 2-3 sessions a week of aquatic exercise for at least 6 weeks to see improvements in your movement, walking or pain. For some people the benefits may not be clear until after 12 weeks.

How do pool exercises work?

There are lots of useful things connected to physiology and how the body systems change when you are in water. Reduced load on your joints due to buoyancy means exercises are less painful and the water allows you to perform important weight bearing exercises such as walking and squats in a supported manner. 

Body weight load depends on the depth you are in when standing. Standing in water up to your waist is about 50% of your body weight and standing in water up to your chest is about 30% of your body weight. 

One way to change the resistance, or the difficulty of an exercise is to adjust the depth of water in which you are standing.

What are the best pool exercises for arthritis?

Any exercise is good exercise! That is why many people with arthritis say that they use the pool to exercise- it is an environment that may allow you to work harder and for longer even if your joints are sore. 

The pool is a great place to keep moving, try something different and challenge your body. It may be particularly useful if you have a lot of pain or have difficulty exercising on land. The best exercises in the pool for arthritis will relate to your individual problems – for example, stiffness, pain, weakness, walking or balance. Your local physiotherapist will be things you want to focus on improving. Or you can contact us and one of our physiotherapists can conduct a virtual assessment or speak to you on the phone and set you up with a hydrotherapy program. 

The programs will be different for each individual however our research has shown that power based exercises must be included to help improve with day to day activities. Research also suggests that strengthening and fitness exercises are recommended and should be prioritised for hip and knee arthritis. Our programs also include power based exercises based on our research which are helpful in improving everyday activities.

Pain is lower with squats in water for people with knee arthritis

We have done some research to show that for people over 60 with knee arthritis have much less pain when doing a squat in water. Squats are useful exercises because they are “functional” which means they mimic movements we do every day, like getting out of a chair, or bending down to pick something up. With less pain with squats in water, this is an opportunity to regain your strength and control in this movement. As you progress you will improve your confidence and muscle control and be able to see improvements in everyday life.


(1)Barker, A. L., Talevski, J., Morello, R. T., Brand, C. A., Rahmann, A. E., & Urquhart, D. M. (2014). Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Archives of physical medicine and rehabilitation, 95(9), 1776-1786.

(2) Heywood, S., McClelland, J., Mentiplay, B., Geigle, P., Rahmann, A., & Clark, R. (2017). Effectiveness of aquatic exercise in improving lower limb strength in musculoskeletal conditions: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 98(1), 173-186.

(3) Heywood, S., McClelland, J., Geigle, P., Rahmann, A., Villalta, E., Mentiplay, B., & Clark, R. (2019). Force during functional exercises on land and in water in older adults with and without knee osteoarthritis: Implications for rehabilitation. The Knee. 26(1), 61-72.