Martin Švec(2025) THE-USE-OF-AQUATIC-CYCLING-IN-THE-REHABILITATION-OF-PATIENTS-WITH-TOTAL-HIP-ARTHROPLASTY-A-PILOT-STUDY
Aquatic Cycling After Total Hip Arthroplasty
Total hip arthroplasty (THA) is one of the most common orthopaedic procedures for treating advanced hip osteoarthritis. Following surgery, rehabilitation focuses on restoring mobility, reducing pain and stiffness, and improving walking ability. A 2025 pilot study investigated whether aquatic cycling after total hip arthroplasty could enhance recovery compared with standard land-based physiotherapy.
Why aquatic cycling is beneficial after hip replacement
Early rehabilitation is essential after hip replacement, but conventional exercise can be challenging due to pain, joint stiffness and reduced confidence during walking.
Aquatic cycling combines the therapeutic benefits of water with repetitive cycling movements. Buoyancy reduces joint loading, hydrostatic pressure supports circulation and water provides a safe environment for controlled movement with a low risk of falling. This allows patients to begin aerobic and functional exercise with minimal stress on the new hip joint.
Study design
Sixteen patients with primary unilateral total hip arthroplasty participated in this pilot study.
Participants were randomly assigned to:
An aquatic cycling group combined with standard physiotherapy
A control group receiving standard land-based physiotherapy only
The aquatic cycling programme lasted 8 weeks and included:
Two sessions per week
45-minute supervised sessions
Therapeutic pool temperature of 32°C
Cycling at 40–60% heart rate reserve (115–125 bpm)
Heart rate was continuously monitored throughout the exercise sessions to maintain the prescribed training intensity.
Improved functional mobility
The aquatic cycling group demonstrated clinically meaningful improvements in several functional mobility tests.
Better Timed Up and Go performance
The largest treatment effect was observed in the Timed Up and Go (TUG) test.
Participants improved from an average of 12.8 seconds before treatment to 9.1 seconds after the intervention, indicating faster transfers and improved functional mobility.
Compared with the control group, the aquatic cycling programme produced the largest between-group effect for this outcome.
Faster walking speed
Walking speed improved during the 10-Metre Walk Test (10MWT).
Participants reduced their average walking time from 11.8 seconds to 8.8 seconds, suggesting improved gait efficiency following aquatic cycling.
Greater walking endurance
Performance during the Six-Minute Walk Test (6MWT) also improved substantially.
Walking distance increased from approximately 284 metres to 401 metres, demonstrating better endurance and functional walking capacity after the eight-week programme.
Reduced pain and joint stiffness
Patient-reported outcomes were measured using the WOMAC questionnaire, which evaluates pain, stiffness and physical function.
Following aquatic cycling:
Pain scores decreased
Joint stiffness improved
Physical function improved
The largest between-group treatment effects were observed for physical function and pain, suggesting that aquatic cycling may contribute to better daily functioning after hip replacement surgery.
Why exercising in water works
Several characteristics of aquatic exercise may explain the observed improvements.
Reduced joint loading
Buoyancy decreases the mechanical load placed on the hip joint, allowing patients to exercise comfortably during the early stages of recovery.
Continuous aerobic exercise
Cycling provides repetitive, controlled lower-limb movement that promotes cardiovascular fitness while maintaining smooth joint motion.
Improved confidence
The supportive aquatic environment reduces the fear of falling, encouraging patients to move more freely during rehabilitation.
Comfortable exercise environment
The therapeutic pool temperature of 32°C promotes muscle relaxation and improves comfort throughout the exercise session.
Clinical implications
Although this was a pilot study with a relatively small number of participants, the findings suggest that aquatic cycling may be a valuable complement to conventional rehabilitation following total hip arthroplasty.
Potential benefits include:
Improved functional mobility
Faster walking speed
Greater walking endurance
Reduced pain
Less joint stiffness
Better physical function
The authors suggest that aquatic cycling may be particularly suitable for older adults and patients who have difficulty tolerating higher-impact land-based rehabilitation.
Limitations
Several limitations should be considered when interpreting the findings.
The study included only 16 participants, reducing its statistical power. Although clinically meaningful improvements were observed, none of the measured outcomes reached statistical significance. The intervention lasted only eight weeks, and no long-term follow-up was performed to determine whether the improvements were maintained over time.
Conclusion
This pilot study suggests that aquatic cycling after total hip arthroplasty is a safe and feasible addition to conventional rehabilitation. Participants demonstrated clinically meaningful improvements in mobility, walking performance, pain and physical function compared with standard physiotherapy alone. Although larger randomised controlled trials are needed to confirm these findings, aquatic cycling appears to be a promising rehabilitation option following hip replacement surgery.
