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Patient Resources

Water-based exercise for knee and hip osteoarthritis

Patient Resources
        1. Water-based exercise for knee and hip osteoarthritis

First published: 28 May 2020

The RACGP gratefully acknowledge the following contributor:

  • Zoe Michaleff, Institute for Evidence-Based Healthcare, Bond University

Related GP HANDI entry Aquatic exercise for knee and hip osteoarthritis


Your doctor has recommended water-based exercise for your hip or knee joint pain.

Key points

  • Exercising in a heated pool can help reduce joint pain. It can also improve your ability to do everyday activities.
  • Ask about water-based exercise programs at community leisure centres, physiotherapy clinics or your local Arthritis Australia office.
  • You do not need to be able to swim to take part.

What is water-based exercise?

  • Water-based exercise means exercising in a pool, which is usually heated. The water is usually chest deep. Water-based exercise is also known as ‘hydrotherapy’ or ‘pool therapy’.
  • The types of exercises may include those that help with:
    • flexibility – stretching and range of movement exercises
    • strengthening your muscles
    • balance
    • overall (aerobic) fitness – exercises that increase your heart rate
  • Spa treatments are not water-based exercise.

How can water-based exercise help with osteoarthritis?

  • Water-based exercise can help improve muscle strength, joint flexibility, coordination and balance. All this can improve your ability to do everyday activities.
  • Exercising in water can be easier and more comfortable than exercising on land. The water helps to support your body weight, which reduces pressure on your joints. Being in warm water can also reduce joint pain and relax your muscles.

How do I get started?

  • If you are new to water-based exercise, you can join a program that is run by a physiotherapist or a trained instructor in a hydrotherapy pool. Hydrotherapy pools are usually heated to 32–36°C. They can be found at some hospitals, rehabilitation centres, physiotherapy clinics and community leisure centres. The pools usually have a ramp or gentle stairs with a rail to make it easier to get in and out.
  • Before starting the program, you will usually be assessed to make sure the exercises meet your needs.
  • To get the most benefit, exercises should be made more difficult over time (e.g. do harder exercises, move faster, repeat the movement more times or exercise for longer).
  • After the program ends, you can continue your water-based exercise by going to your local pool and exercising on your own or by joining other water exercise classes. You need to exercise two or three times a week.


  • Water-based exercise is generally safe. When you first start, you may have a mild, temporary discomfort in your muscles and joints. This is normal and should not make you stop exercising. Start slowly and make the exercise more difficult or longer over time.
  • You do not need to know how to swim or have to put your head in the water but you do need to feel comfortable walking in the pool.
  • Ask about costs of attending a hydrotherapy pool or program.
  • All exercise types may benefit osteoarthritis so it is important you choose the type of exercise that you enjoy and will do regularly.
  • Talk to your doctor if you have any concerns.

Learn more about osteoarthritis myjointpain
Learn more about how to manage knee or hip pain
Learn simple ways to manage your pain with Musculoskeletal Australia’s free online book: Managing your pain: An A-Z guide
Learn more about water exercise
Examples of water exercises: Mayo Clinic slide show (with pictures)
Call Arthritis Australia 1800 011 041 or Musculoskeletal Australia 1800 263 265 to ask about managing pain or about hydrotherapy pools and services in your area.

Find a health professional who can provide hydrotherapy sessions or help develop a water-based exercise program for you.
Find a physiotherapist through the Australian Physiotherapy Association or an accredited exercise physiologist through Exercise and Sports Science Australia
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