Miglietta (2025) A scoping review of the effectiveness of underwater treadmill exercise in clinical trials of chronic pain

Exploring the Effectiveness of Underwater Treadmill Exercise in Chronic Pain Management

Introduction: Addressing the Global Burden of Chronic Pain

Chronic pain affects over 20% of the adult population and significantly impacts physical, emotional, and social well-being. Traditional treatments often fail to offer long-term relief. As interest grows in alternative and low-impact exercise interventions, underwater treadmill exercise has emerged as a promising method within aquatic therapy, particularly for conditions like osteoarthritis (OA).

Study Purpose and Methodology

In this 2025 scoping review by Miglietta et al., researchers systematically analyzed clinical trials spanning from 1947 to 2024 to assess the effectiveness of underwater treadmill exercises in improving physical function and quality of life (QoL) in adults with chronic pain. The review included randomized controlled trials, feasibility studies, and pilot interventions with no restriction on specific pain diagnoses.

Out of 2,209 studies screened, only nine met the strict eligibility criteria. All included participants were diagnosed with osteoarthritis, most commonly knee OA. Trials ranged in duration from 1 to 8 weeks, with exercise sessions typically conducted 3 times per week.

Key Findings: Functional and Therapeutic Benefits

Across the studies, participants engaging in underwater treadmill training showed consistent improvements in:

• Pain reduction (significant decreases in VAS/NPRS scores)

• Mobility and gait (improved sit-to-stand times, walking speed)

• Balance and strength (notably in quadriceps and joint stability)

• Quality of life (greater self-reported satisfaction post-intervention)

Compared to land-based exercises, underwater treadmill workouts offered similar or superior benefits with reduced joint stress, making them ideal for aging populations and individuals with movement restrictions.

Limitations and Research Gaps

While the results are promising, limitations include a narrow focus on osteoarthritis, relatively small sample sizes (n=337 across studies), and a lack of standardization in intensity and duration. The authors call for broader research, particularly RCTs involving diverse chronic pain conditions beyond OA.

Conclusion: A Promising Tool for Low-Impact Pain Management

Underwater treadmill exercise presents a safe, effective intervention for managing chronic pain, especially in individuals with osteoarthritis. Its potential for enhancing mobility, reducing discomfort, and improving overall quality of life makes it a valuable addition to pain management protocols. As research evolves, this modality could become a cornerstone of holistic rehabilitation.