Knee and Osteoarthritis Exercise Management





  • Have osteoarthritis of the knee
  • Are male or female and aged over the age of 65 years old
  • Would like to find out whether water-based exercise provides greater outcomes than land-based exercise
  • Would like to find out the costs, risks and benefits associated with water and land-based exercise


  • What sort of exercise do I enjoy?
  • What sort of exercise do I dislike?
  • What are my goals?
  • Can I see myself completing this type of exercise for at least 6 weeks? What are the costs associated with each type of exercise?
  • What are the potential risks and benefits associated with each type of exercise?


Osteoarthritis is the most common chronic joint pain in Australia. Knee osteoarthritis occurs when the ‘cushioning’ also known as the cartilage between the bones wear away. This can cause swelling, stiffness, pain, decreased range of motion and in turn decreased function. In some cases, it can also cause bone spurs. Osteoarthritis does not usually occur until later years and has been proven to affect women more than men. Initially, osteoarthritis can be managed with pain medications and/or corticosteroids. Weight loss is recommended for obese or overweight individuals. Furthermore, research has shown that exercise has shown the greatest outcomes regarding pain reduction and increased function. In worst-case scenarios, surgery can be done however, exercise rehabilitation is usually recommended first. Pain medications, weight loss and exercise combined have also shown to be extremely beneficial.


Studies have shown that the most important goal for individuals with osteoarthritis is pain reduction.

Research has found that increasing physical activity can significantly increase the ease of completing activities of daily living and reduce pain for most individuals, but especially for those who have knee osteoarthritis.

Evidence conveys that both water-based exercises, as well as land-based exercises, have shown great outcomes in pain reduction.

The most important thing to consider when choosing one of these modalities is personal exercise preference, personal limitations, and barriers in order to ensure adherence and long-term benefits can be obtained.


Water-based exercise is also known as hydrotherapy. Hydrotherapy involves completing exercises in a pool in which the water is warmed. The temperature of the water has been shown to provide immediate pain relief for individuals with knee osteoarthritis. Research indicates that hydrotherapy reduces the chance of injury occurring due to the reduced force and load placed on the joints. It also requires less balancing compared to land-based exercise which could prove to be beneficial for overweight or obese individuals. The warm temperature of the water encourages increased lymphatic drainage which will aid in decreased swelling and inflammation and in turn increase mobility and range of motion. Land-based resistance exercises can still be completed in the water to improve muscular strength and endurance. Foam dumbbells or pool noodles can be utilised for these exercises. Water treading or swimming laps can also aid in improving cardiovascular fitness. Hydrotherapy rooms are often small holding a limited a number of people creating a calm and peaceful environment.


The land-based exercise involves gym-focused activities but can also include running or cycling outside or playing a sport. Research has shown that consistent land-based exercise does also reduce knee pain associated with knee osteoarthritis but is only evident over a longer period of time compared to water-based exercise which is sometimes immediate. A risk associated with land-based exercise is the incidence of injury. A lot of force and load is placed on the joints during exercise on land. Gym environments are often large, busy and loud which could be a confronting space for patients. However, private clinics are much smaller and could be more suitable for clients who are new to exercise and prefer smaller, quieter environments.


Regarding costs, there are some slight differences. Most leisure centres will charge the same membership fee for access to the pools or the gym. Some centres even have dual memberships where members can get access to both, but this option will be costlier. Completing land-based exercise at home or in a park is free and therefore the cheapest option. Having an Exercise Physiologist present for the first few sessions would be recommended and therefore will require a payment per session if your health care does not cover this.

Land-based exercises have fewer barriers regarding access. Land-based exercise can be completed at home, outside in a park or at a gym. Water-based exercise can only be completed at a centre that has the relevant facilities. Transport can also prove to be an issue for individuals who cannot drive themselves to and from destinations.

Although water-based exercise provides many benefits including immediate pain relief, increased mobility and increased lymphatic drainage, it also presents some barriers. Hydrotherapy may not be suitable for individuals who have recently had surgery and have open wounds or poor immune function due to the increased risk of infection.

Participating in either land or water-based exercise at a facility will provide the chance for social interaction and improve your health and well-being. Both exercise modalities reduce pain; water-based is more immediate, but land-based has been shown to have the greatest long-term pain relief. Either option will improve your quality of life it just depends on your personal goals, values and preferences.

By Danielle Coetzee

Accredited Exercise Physiologist


Australian Institute of Health and Welfare. (2020). Osteoarthritis. Retrieved from:              conditions/osteoarthritis/contents/what-is-osteoarthritis

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.

Silva, L. E., Valim, V., Pessanha, A. P. C., 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), 1221.

Tamin, T. Z., & Loekito, N. (2018). Aquatic versus land-based exercise for cardiorespiratory          endurance and quality of life in obese patients with knee osteoarthritis: a randomized           controlled trial. Medical Journal of Indonesia, 27(4), 284-92.

Wang, T. J., Lee, S. C., Liang, S. Y., Tung, H. H., Wu, S. F. V., & 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.


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