Aquatic and Land Exercises for Chronic Low Back Pain (AquaLand-CLBP)

Effectiveness of Aquatic and Land Exercises on Chronic Nonspecific Low Back Pain: A Randomised Study

This study aims to learn about the effects of aquatic and land exercises on managing chronic low back pain in adults aged 18-65. The participants engage in a 12-week supervised land and water-based exercise program.

The main questions this study aims to answer are:

• How effective are aquatic exercises on low back pain, functional disability, Kinesiophobia, sleep quality, and overall quality of life?
• Is aquatic therapy more effective than land exercises for treating LBP or vice versa?

Study Overview

• Status: Completed
• Conditions: Chronic Low Back Pain (Non-specific, Uncomplicated)
• Intervention / Treatment: Other: Aquatic Exercises; Other: Land Exercises

• Study Type: Interventional
• Enrollment (Actual): 32
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Edinburgh, United Kingdom, EH8 8AQ
    • St. Leonard building, The University of Edinburgh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 18 and 65
• Both Genders
• Literate in the English language to understand instructions/ to complete a self-report questionnaire.
• Having non-specific Chronic low back pain (≥12 weeks)
• Patient willingness to be a part of any randomly selected treatment groups.

Exclusion Criteria:

• Pregnant Females
• If they had low back pain as the result of diagnosis of severe osteoporosis, spinal bone disorders such as spondylosis and spondylolisthesis, fractures, lumbar spine stenosis, lower limb joint replacement surgery, hip orthosis, ankylosing spondylitis, rheumatoid arthritis, infective or inflammatory disease, compression of the radial nerve, meningitis, arthrosis, lumbar region tumours, Leg length discrepancy, previous back surgery.
• Uncontrolled hypertension, Severe postural hypotension, any heart disease like Left heart failure or exercise-induced angina. Medical illnesses without a medical managing plan in place, e.g., uncontrolled epilepsy, diabetes mellitus. Neurologic deficit, open wounds, current or recurrent radiation treatment.
• Patients with severe depression and psychosis
• People who are already participating in an individually-prescribed exercise programme for LBP.

Aquatic exercises /Pool specific:

• Individuals with hydrophobia/ water-related anxiety, or inability to adapt to an aquatic environment.
• Allergy to chlorine, Severe limiting airway disease
• Faecal or urinary incontinence, diarrhoea, and vomiting.
• Weight more than the emergency evacuation manual handling risk assessment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aquatic Exercise Group; The aquatic exercise session is approximately 45-60 minutes, thrice a week, for twelve weeks, 36 sessions total. They are supervised by an experienced researcher who is a qualified Physiotherapist. The one-hour session generally includes a warm-up, the main exercise session, and a cool-down period. The exercises include balance and agility training, cardio exercises, flexibility, upper and lower limb stretching and strengthening exercises, trunk rotations, etc. Additionally, the group receives back care education involving guidelines and recommendations for adopting good posture, self-management, and active lifestyle advice each week of the intervention. Also, the participants are given a participant education handbook containing all the information and resources about LBP.	Other: Aquatic Exercises; The aquatic exercise intervention consists of structured, supervised, water-based exercises designed and delivered by an experienced physiotherapist specifically for individuals with chronic low back pain. Sessions are conducted in a temperature-controlled swimming pool with proper warm-up and cool-down. The intervention follows a progressive intensity approach with easy, medium, and hard approaches.; Other Names: Aquatic Physical Therapy; Aquatic Therapy; Hydrotherapy; Aquatic Physiotherapy; Aquatic Rehabilitation; Water-Based Exercises; Pool-Based Rehabilitation; Therapeutic Water Exercise
Active Comparator: Land Exercise Group; The land exercise group will follow the same structured protocol as the aquatic exercise group regarding duration, frequency, and intensity.	Other: Land Exercises; The land-based exercise intervention mirrors the aquatic exercise protocol regarding exercise type, duration, frequency, and progression but is performed on land.; Other Names: Land-Based Exercise Therapy; Physiotherapy-Based Exercise; Musculoskeletal Rehabilitation Program; Therapeutic Exercise Routine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity is measured by the Numerical Pain Rating Scale where the participants will report their pain as 0 (no pain) and 10(worst imaginable pain).	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).
Functional Disability	Functional disability is assessed by the Roland-Morris Disability Questionnaire, a 24-item self-reported measure evaluating the impact of low back pain on daily activities.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health-Related Quality of Life	Quality of Life is assessed by the Short-Form Health Survey 36, a validated questionnaire measuring the eight physical and mental health domains.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).
Sleep Quality	The Pittsburgh Sleep Quality Index measures the sleep quality, its scores measured from 0-21, with higher scores indicating poor sleep quality.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).
Kinesiophobia (Fear of Movement-Related to Pain)	Kinesiophobia is measured with the Tampa Scale of Kinesiophobia, a 17-item questionnaire designed to measure the fear associated with the chronic pain and movement.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).
Dynamic Balace Performance	The Y balance test measures dynamic balance by measuring stability while reaching in three directions: anterior, posteromedial, and posterolateral.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).
Hamstring Flexibility	The active knee extension test is a clinical measure of the hamstring flexibility.	Baseline before the intervention/pre-testing, at the 8th week of the intervention, within a week after the last training session, and three months after the end of the training (Follow-up period).

Collaborators and Investigators

• Sponsor: University of Edinburgh

Study record dates

Study Major Dates

• Study Start (Actual): March 6, 2025
• Primary Completion (Actual): November 28, 2025
• Study Completion (Actual): November 28, 2025

Study Registration Dates

• First Submitted: March 7, 2025
• First Submitted That Met QC Criteria: March 7, 2025
• First Posted (Actual): March 13, 2025

Study Record Updates

• Last Update Posted (Actual): December 2, 2025
• Last Update Submitted That Met QC Criteria: November 28, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Quality of life; Aquatic therapy; Chronic low back pain; Functional Disability; Exercise intervention; Hydrotherapy; Water-based exercise; Land Exercise; Rehabilitation research
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Low Back Pain; Therapeutics; Physical Therapy Modalities; Rehabilitation; Hydrotherapy; Aquatic Therapy
• Other Study ID Numbers: NARS01072024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No