Water Gymnastics for Pelvic Pain in Pregnancy

A review of the effect of water gymnastics on pelvic and back pain during pregnancy was conducted by researchers in The Cochrane Collaboration.  After searching for all relevant studies, they found one study.  Their findings are summarised below. 

Please note that this Cochrane review has been updated since the summary below. See the abstract of that update here.

Low back pain during pregnancy - why water gymnastics?

Many women experience back or pelvic pain during pregnancy. This pain generally increases as pregnancy advances. It can interfere with daily activities, can prevent women from going to work, and sometimes disturbs sleep.

Water gymnastics during pregnancy are exercise classes that take place in a swimming pool and that are specially designed for pregnant women.

The aim of water gymnastics for pregnant women is to improve general fitness, to strengthen muscles, to avoid back pain, and to give relaxation. The idea behind water gymnastics is that by exercising the stomach muscles, your posture may improve and the strain on your back may be reduced.

The changes that take place in your body during pregnancy, such as laxity of joints and increased weight could mean that you are more easily injured during exercise. Water gymnastics are seen as particularly suitable for pregnant women because the water supports their weight, allowing them to exercise their muscles without straining them. At the same time, the pressure of the water as you move through it may exercise your muscles more efficiently.

What does the research say?

Not all research provides the same quality of evidence. The higher the quality, the more certain we are about what the research says about an effect. The words will (high quality evidence), probably (moderate quality evidence) ormay (low quality evidence) describe how certain we are about the effect.

For pregnant women with low back pain, water gymnastics may decrease sick leave because of back pain.

We are very uncertain whether water gymnastics reduces pain during pregnancy.

The study did not measure the effect of water gymnastics on pain or on the ability to perform daily activities.

In general, side effects are poorly documented and it is difficult to provide precise information. In this study, no side effects of water gymnastics, including urinary and vaginal infections, were seen.   

Table of results

What was measured  

No water gymnastics  

Water gymnastics  

Quality of evidence 

Pain improved  

We are very uncertain whether water gymnastics reduces pain during pregnancy

Very low  

Women on sick leave because of back pain
after an average of 32 weeks  

14 per 100  

6 per 100
(2 to 13 per 100)1  


Ability to perform daily activities  

Not measured in these studies


Side effects  

No side effects seen  


1The numbers in the brackets show the range in which the actual effect could be.

Where does this information come from?

The Cochrane Collaboration is an independent global network of volunteers, dedicated to summarizing research about health care.

This information is taken from this Cochrane Review: Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD001139. DOI: 10.1002/14651858.CD001139.pub2.

This summary was prepared by:

Claire Glenton and Gunn Vist, the Nordic Cochrane Centre's Norwegian branch, Norwegian Knowledge Centre for Health Services, on behalf of the Cochrane Complementary and Alternative Medicine Field, and with funding from the US National Center for Complementary and Alternative Medicine (NCCAM) of the US National Institutes of Health (grants number R24 AT001293).

Water gymnastics for pelvic and back pain in pregnancy

Patient or population: patients with pelvic and back pain in pregnancy
Settings: Sweden
Intervention: water gymnastics


Illustrative comparative risks* (95% CI)  

Relative effect
(95% CI)

No of Participants

Quality of the evidence


Assumed risk 

Corresponding risk 
(Water gymnastics)

Reduction in pain  

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Not estimable


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One study reported a p value of 0.034 as significantly less pain intensity at one week postpartum, measured on VAS scale from 0 to 10. The actual results were not presented

Number of women taking sick leave because of back pain
(follow-up: mean 32 weeks)

14 per 100  

6 per 100
(2 to 13)

RR 0.40 
(0.17 to 0.92)




Disability, measure of difficulty undertaking everyday activities  

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Not estimable


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None of the studies reported on disability

adverse events  

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Not estimable


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None of the studies reported on adverse events

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. Thecorresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect. 

Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Very low quality: We are very uncertain about the estimate.

1 Unclear if there was losses to follow up, the numbers reported in the study do no add up
2 Only one study with few events in few participants