OBJECTIVE: To assess the efficacy of a 12-week aquatic cycling training program for improving knee pain and physical functioning in patients with knee osteoarthritis. DESIGN: Two-arm, single-blind, parallel-group randomized controlled trial. SETTINGS: OA outpatient clinic of the Maastricht University Medical Center. PARTICIPANTS: Patients (N = 111, 50 to 70 years old) with unilateral mild to moderate knee OA. INTERVENTIONS: Participants (AC, n = 55) received aquatic cycling sessions of 45 min twice-weekly. Each session combined up-right seated cycling with out-of-saddle positions and exercises for the upper and lower body. The usual care group (UC, n = 47) continued with usual care and was offered twelve aquatic cycling sessions in a local swimming pool after their trial participation. MAIN OUTCOME MEASURES: The Knee Injury and Osteoarthritis Outcome Score (KOOS) on knee pain and physical function was assessed at baseline, post-intervention and 24-weeks follow-up. Multilevel (mixed regression) analysis examined the effects. RESULTS: Average attendance rate for the aquatic cycling sessions was 80%. Statistically significant differences at post-intervention and follow-up were found for knee pain (UC pretest 57.89 +/- 15.26, posttest 55.90 +/- 18.04, follow-up 57.24 +/- 19.16; AC pretest 56.96 +/- 12.96, posttest 63.55 +/- 15.33, follow-up 64.35 +/- 17.26, estimate 8.16, SE 3.27, 95% CI 1.67 to 14.64; ES 0.50) and physical functioning (UC pretest 66.32 +/- 16.28, posttest 66.80 +/- 19.04, follow-up 65.42 +/- 17.98; AC pretest 61.89 +/- 17.151, posttest 70.14 +/- 17.52, follow-up 69.00 +/- 16.84, estimate 7.16, SE 3.19, 95% CI 0.83 to 13.49, ES 0.43) in favour of the aquatic group. CONCLUSION: The results suggest that a 12-week aquatic cycling training programme improves self-reported knee pain and physical functioning in patients with mild to moderate knee OA compared to usual care.

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