Effect of aquatic resistance, balance, and proprioception training on lower limb muscle performance in bilateral knee osteoarthritis

Objectives: Knee osteoarthritis (KOA) leads to persistent pain, joint stiffness, and muscle weakness, significantly limiting physical activity. Treatment options include surgical interventions, non-invasive alternatives, and exercise-based therapies. Land-based training (LBE) strengthens muscles, reduces pain, and improves function. In contrast, aquatic exercise (AQE) offers comfort. The study aimed to investigate the impact of aquatic resistance, balance, and proprioception training on lower limb muscle performance in bilateral KOA patients. Methods: This randomized clinical trial included 290 participants assigned to Groups A (Control group) and B (Interventional group), with 145 participants in each group. Over eight weeks, participants engaged in both LBE and AQE. Visual analog scale (VAS), 1 repetition maximum (RM) leg press test, proprioception, timed up-and-go (TUG) test, 40-m fast-paced walk test (40 mFPWT), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were utilized to evaluate the results. Results: The results revealed highly significant improvements in both groups’ VAS and WOMAC scores ( P = 0.0001). However, when compared to Group A, Group B demonstrated significantly better outcomes in the 1RM leg press test, proprioception, TUG test, and the 40 mFPWT ( P = 0.0001). Conclusion: The study found that an eight-week aquatic training program helped alleviate pain and improved lower limb muscle performance in bilateral KOA patients.