Sport Sciences Research Institute Studies in Sport Medicine 2322-1658 17 45 2025 09 23 Risk of Fall and Dynamic Balance after Aquatic Exercise at Different Depths in Elderly Women with Knee Osteoarthritis Risk of Fall and Dynamic Balance after Aquatic Exercise at Different Depths in Elderly Women with Knee Osteoarthritis 73 94 4692 10.22089/smj.2025.18060.1812 FA Faezeh Zamanian Assistant Professor of Physical Education & Sport Science, Iran University of Art, Tehran, Iran 0000-0003-0433-9602 Mahdi Armandnia Assistant Professor of Physical Education & Sport Science, Iran University of Art, Tehran, Iran 0000-0002-0117-7305 Mahdieh Gharehlar Department of physical education & sport science, Ur.C., Islamic Azad University, Urmia, Iran 0009-0001-5311-4795 Majid Vesalinaseh Assistant Professor Department of Physical Education and Sport Sciences, National University of Skill (NUS), Tehran, Iran 0000-0003-3113-7133 Journal Article 2025 06 02 <strong><span style="mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Background and Purpose</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">In the elderly with knee osteoarthritis, postural fluctuations and the risk of falling increase significantly (1). Elderly individuals suffering from knee osteoarthritis often experience pronounced postural instability and an elevated risk of falls. [Therefore, improving balance and reducing pain in these individuals is an effective strategy to mitigate fall risk (2).] Consequently, interventions aimed at enhancing balance and alleviating pain are critical methods for fall prevention. Many exercises have been proposed to improve balance and thus reduce fall incidence. Various forms of exercise are recognized to bolster balance and diminish fall-related risks.</span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">However, arthritis pain frequently hinders patients’ ability to pursue and benefit from exercising (2). Nonetheless, pain associated with arthritis often undermines exercise adherence and effectiveness. Exercising in water is more suitable for individuals with musculoskeletal problems than land-based exercise. Aquatic exercise offers an advantageous alternative, providing a supportive environment particularly beneficial for those with musculoskeletal limitations. This is because as water depth increases, joint load and pain sensation decrease (3). Increasing immersion depth reduces joint loading and pain perception.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">However, as water depth increases, if the foot loses contact with the pool floor, proprioceptive input diminishes, weakening balance-related sensory feedback. Yet, in deeper water, lack of foot-ground contact diminishes proprioceptive cues essential for postural control and fall prevention. This proprioceptive perception is vital for maintaining balance and decreasing fall risk. The integrity of proprioception is paramount in sustaining postural stability.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Hence, the fundamental question arises: which water depth maximizes improvements in balance, fall risk reduction, and pain alleviation? Therefore, identifying the optimal pool depth for maximizing therapeutic benefits on balance, fall risk, and pain is crucial. Water depth influences training efficacy through variables such as gravity, hydrostatic pressure, and exercise chain configurations (open or closed) (4). Training parameters, including gravitational forces, hydrostatic pressure, and kinetic chain characteristics, vary with water depth and impact outcomes.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Accordingly, the purpose of this research was to investigate the effects of training in two water depths—shallow water, where the feet maintain contact with the pool floor, and deep water, where feet do not touch the bottom—on dynamic balance, fall risk, and pain in elderly women with knee osteoarthritis. This study compares shallow and deep water exercise effects on dynamic balance, fall risk, and pain among elderly women afflicted with knee osteoarthritis.</span></span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-bidi-font-size: 14.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Methods</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">This semi-experimental, pretest-posttest study involved 43 elderly women aged 55 and older with chronic knee osteoarthritis of at least eight months duration. A semi-experimental design with pretest and posttest measurements was used on 43 elderly female participants (age ≥ 55) diagnosed with chronic knee osteoarthritis of minimum eight months.  The intervention lasted 12 weeks with three training sessions per week in two aquatic environments: shallow and deep water. Participants underwent 12 weeks of aquatic training, thrice weekly, in either shallow or deep water settings.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">After preliminary assessments and informed consent, participants were divided into three groups: two shallow water exercise groups (14 each), one deep water exercise group (14), and one control group. Following baseline evaluation and consent, subjects were assigned to three groups: two shallow water exercise groups (each n=14), one deep water exercise group (n=14), and a control group.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Dynamic balance, fall risk, and pain were measured using the Star test (5), Berg Balance Scale (6), and KOOS questionnaire (7), respectively. Outcome measures included the Star Excursion Balance Test for dynamic balance, the Berg Balance Scale for fall risk assessment, and the KOOS (Knee Injury and Osteoarthritis Outcome Score) for pain evaluation.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Data analysis employed a 2 (time: pretest/posttest) × 3 (group: shallow water/deep water/control) repeated-measures ANOVA with LSD post hoc tests at a significance level of p < 0.05. Statistical analyses were conducted via repeated-measures ANOVA (2 × 3 design) with LSD post hoc tests, maintaining an alpha of 0.05.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">[SPSS version 26 was used for all statistical analyses. All analyses utilized SPSS version 26.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span> <strong><span style="mso-bidi-font-size: 14.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Results</span></strong> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Table 1 presents the demographic characteristics of participants across groups.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span></strong><strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 1. Descriptive statistics related to the individual characteristics of the subjects by groups</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Groups</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Control</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">(n=14)</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep-water</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">(n=14)</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow-water (n=14)</span></strong> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">63.41 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 5.16</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">63.11 <span dir="RTL" lang="FA">±</span> 5.37</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">62.41 <span dir="RTL" lang="FA">±</span> 5.16</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Age (year)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">154.85 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 3.99</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">155.22 <span dir="RTL" lang="FA">±</span> 4.03</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">154.92 <span dir="RTL" lang="FA">±</span> 4.63</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Height (cm)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">60.13 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 10.86</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">61.03 <span dir="RTL" lang="FA">±</span> 11.20</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">59.84 <span dir="RTL" lang="FA">±</span> 10.45</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Weight (kg)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">25.83 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 4.21</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">26.11 <span dir="RTL" lang="FA">±</span> 4.09</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">25.71 <span dir="RTL" lang="FA">±</span> 3.96</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Body mass index (kg/m²)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">31.17 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 7.55</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">31.83 <span dir="RTL" lang="FA">±</span> 6.88</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">30.69 <span dir="RTL" lang="FA">±</span> 7.24</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">fat percentage (%)</span> <span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 2 depicts the result of two factor repeated measure ANOVAs of main effects (within groups: aquatic exercise and between groups: depth of water) on dynamic <span style="letter-spacing: -.2pt;">balance, falling risk and pain were statistically significant.</span></span> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">Table 2. The result of main effects on dynamic</span></strong><strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> <span style="letter-spacing: -.2pt;">balance, falling risk, quality of life, and pain</span></span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Source</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">df1</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">df2</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">F</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">p</span></strong> <strong>^{<span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'B Nazanin'; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">2</span>}</strong><strong><em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: Cambria; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: Cambria; mso-bidi-font-family: Cambria;">η</span></em></strong> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Dynamic Balance</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.06</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.01^*</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.08</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.15</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.01^*</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.08</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">4.90</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.007^**</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.13</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Falling risk</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">8.72</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.20</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.39</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.23</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">12.40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.35</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Pain</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.04</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.21</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.67</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.24</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">12.97</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.35</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">* Significance at p≤0.05, **significance at p≤0.01, ***significance at p≤0.001</span> <span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">Due to the significance of the main effect of water depth, the LSD test was used to perform multiple comparisons. </span><span lang="EN-GB" style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt; mso-ansi-language: EN-GB;">R</span><span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">esults are shown in table 3.</span> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 3. The results of LSD test for between groups comparison of dynamic balance, falling risk and pain.</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Groups</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Mean difference</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Standard error</span></strong> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">P</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Dynamic Balance</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.58</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.89</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">5.58</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.83</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2.00</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.90</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.02^*</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Falling risk</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">6.69</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.96</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">16.01</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.74</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.32</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1.08</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Pain</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">7.53</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.78</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">17.07</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.54</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.54</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.69</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">*Significance at p≤0.05, *** significance at <em>p</em>≤0.001</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">descriptive statistics (Table 1) report participant demographics by group.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Results demonstrated that 12 weeks of aquatic exercise in both shallow and deep water significantly improved dynamic balance and reduced fall risk and pain. Both shallow and deep water exercise groups exhibited significant post-intervention improvements in dynamic balance and reductions in fall risk and pain.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Improvements were more pronounced in the shallow water group compared to the deep water group. Notably, enhancements were significantly greater for the shallow water group. This suggests that foot contact with the pool floor facilitates more effective proprioceptive feedback, stimulating balance mechanisms more robustly than skin receptor stimulation via hydrostatic pressure alone (3). The presence of foot-floor contact in shallow water likely provides superior proprioceptive stimulation compared to deep water’s reliance on hydrostatic pressure and cutaneous receptors.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water training also yielded greater reductions in fall risk and pain, likely due to more considerable balance improvements. These superior outcomes in fall risk and pain may be mediated by enhanced balance function observed in the shallow water cohort. Improved balance corrects motor patterns and establishes effective muscle coordination, crucial for postural stability, thereby reducing pain and fall risk (8). Enhanced postural stability involves coordinated muscular control, mitigating pain and decreasing susceptibility to falls.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Overall, these findings support the therapeutic efficacy of aquatic exercise, particularly in shallow water, for elderly individuals with knee osteoarthritis. The results corroborate prior evidence endorsing water-based therapy and emphasize shallow water exercise’s superiority for this population.</span> <span style="font-size: 10.0pt; mso-bidi-font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Article Message</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Elderly individuals with chronic knee osteoarthritis can benefit significantly from water-based exercise to improve balance, reduce pain, and lower fall risk. Aquatic exercise provides substantial benefits for elderly patients with chronic knee osteoarthritis in terms of balance, pain relief, and fall prevention. Adjusting water depth to chest level, where feet maintain contact with the pool floor, is more effective than exercising in deep water. Optimizing water depth to allow foot-floor contact enhances therapeutic outcomes more than training in non-weight-bearing deep water.</span> <strong><span style="mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Authors’ Contributions</span></strong> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Conceptualization: Faezeh Zamanian, Mahdi Armandnia</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Data Collection: Faezeh Zamanian, Mahdie Gharehlar</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Data Analysis: Mahdi Armandnia, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Manuscript Writing: Faezeh Zamanian, Mahdi Armandnia, Mahdie Gharehlar, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Review and Editing: Mahdi Armandnia</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; background: white;">Responsible for funding:</span><span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;"> No financial support was received for this study.</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; background: white;">Literature Review:</span><span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;"> Faezeh Zamanian<span dir="RTL" lang="AR-SA"> و</span> Mahdi Armandnia, Mahdie Gharehlar, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Project Manager: Mahdi Armandnia, Faezeh Zamanian</span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Ethical Considerations</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">The ethical code is </span><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; color: windowtext; text-decoration: none; text-underline: none;">UMIN000058649</span><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">. This study was approved under ethical code UMIN000058649.</span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Conflict of Interest</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">The authors have no conflict of interest. The authors declare no conflicts of interest.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Acknowledgments</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">We are grateful to all individuals and participants who provided significant help during our research. The authors express sincere gratitude to all participants and collaborators who contributed to this study.</span> <strong><span style="mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Background and Purpose</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">In the elderly with knee osteoarthritis, postural fluctuations and the risk of falling increase significantly (1). Elderly individuals suffering from knee osteoarthritis often experience pronounced postural instability and an elevated risk of falls. [Therefore, improving balance and reducing pain in these individuals is an effective strategy to mitigate fall risk (2).] Consequently, interventions aimed at enhancing balance and alleviating pain are critical methods for fall prevention. Many exercises have been proposed to improve balance and thus reduce fall incidence. Various forms of exercise are recognized to bolster balance and diminish fall-related risks.</span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">However, arthritis pain frequently hinders patients’ ability to pursue and benefit from exercising (2). Nonetheless, pain associated with arthritis often undermines exercise adherence and effectiveness. Exercising in water is more suitable for individuals with musculoskeletal problems than land-based exercise. Aquatic exercise offers an advantageous alternative, providing a supportive environment particularly beneficial for those with musculoskeletal limitations. This is because as water depth increases, joint load and pain sensation decrease (3). Increasing immersion depth reduces joint loading and pain perception.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">However, as water depth increases, if the foot loses contact with the pool floor, proprioceptive input diminishes, weakening balance-related sensory feedback. Yet, in deeper water, lack of foot-ground contact diminishes proprioceptive cues essential for postural control and fall prevention. This proprioceptive perception is vital for maintaining balance and decreasing fall risk. The integrity of proprioception is paramount in sustaining postural stability.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Hence, the fundamental question arises: which water depth maximizes improvements in balance, fall risk reduction, and pain alleviation? Therefore, identifying the optimal pool depth for maximizing therapeutic benefits on balance, fall risk, and pain is crucial. Water depth influences training efficacy through variables such as gravity, hydrostatic pressure, and exercise chain configurations (open or closed) (4). Training parameters, including gravitational forces, hydrostatic pressure, and kinetic chain characteristics, vary with water depth and impact outcomes.</span></span> <span style="mso-bookmark: _Hlk199752719;"><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Accordingly, the purpose of this research was to investigate the effects of training in two water depths—shallow water, where the feet maintain contact with the pool floor, and deep water, where feet do not touch the bottom—on dynamic balance, fall risk, and pain in elderly women with knee osteoarthritis. This study compares shallow and deep water exercise effects on dynamic balance, fall risk, and pain among elderly women afflicted with knee osteoarthritis.</span></span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-bidi-font-size: 14.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Methods</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">This semi-experimental, pretest-posttest study involved 43 elderly women aged 55 and older with chronic knee osteoarthritis of at least eight months duration. A semi-experimental design with pretest and posttest measurements was used on 43 elderly female participants (age ≥ 55) diagnosed with chronic knee osteoarthritis of minimum eight months.  The intervention lasted 12 weeks with three training sessions per week in two aquatic environments: shallow and deep water. Participants underwent 12 weeks of aquatic training, thrice weekly, in either shallow or deep water settings.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">After preliminary assessments and informed consent, participants were divided into three groups: two shallow water exercise groups (14 each), one deep water exercise group (14), and one control group. Following baseline evaluation and consent, subjects were assigned to three groups: two shallow water exercise groups (each n=14), one deep water exercise group (n=14), and a control group.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Dynamic balance, fall risk, and pain were measured using the Star test (5), Berg Balance Scale (6), and KOOS questionnaire (7), respectively. Outcome measures included the Star Excursion Balance Test for dynamic balance, the Berg Balance Scale for fall risk assessment, and the KOOS (Knee Injury and Osteoarthritis Outcome Score) for pain evaluation.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Data analysis employed a 2 (time: pretest/posttest) × 3 (group: shallow water/deep water/control) repeated-measures ANOVA with LSD post hoc tests at a significance level of p < 0.05. Statistical analyses were conducted via repeated-measures ANOVA (2 × 3 design) with LSD post hoc tests, maintaining an alpha of 0.05.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">[SPSS version 26 was used for all statistical analyses. All analyses utilized SPSS version 26.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span> <strong><span style="mso-bidi-font-size: 14.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Results</span></strong> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Table 1 presents the demographic characteristics of participants across groups.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span></strong><strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 1. Descriptive statistics related to the individual characteristics of the subjects by groups</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Groups</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Control</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">(n=14)</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep-water</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">(n=14)</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow-water (n=14)</span></strong> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">63.41 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 5.16</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">63.11 <span dir="RTL" lang="FA">±</span> 5.37</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">62.41 <span dir="RTL" lang="FA">±</span> 5.16</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Age (year)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">154.85 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 3.99</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">155.22 <span dir="RTL" lang="FA">±</span> 4.03</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">154.92 <span dir="RTL" lang="FA">±</span> 4.63</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Height (cm)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">60.13 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 10.86</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">61.03 <span dir="RTL" lang="FA">±</span> 11.20</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">59.84 <span dir="RTL" lang="FA">±</span> 10.45</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Weight (kg)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">25.83 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 4.21</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">26.11 <span dir="RTL" lang="FA">±</span> 4.09</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">25.71 <span dir="RTL" lang="FA">±</span> 3.96</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Body mass index (kg/m²)</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">31.17 </span><em><span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'Cambria',serif; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-bidi-font-family: Cambria;">±</span></em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> 7.55</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">31.83 <span dir="RTL" lang="FA">±</span> 6.88</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">30.69 <span dir="RTL" lang="FA">±</span> 7.24</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">fat percentage (%)</span> <span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 2 depicts the result of two factor repeated measure ANOVAs of main effects (within groups: aquatic exercise and between groups: depth of water) on dynamic <span style="letter-spacing: -.2pt;">balance, falling risk and pain were statistically significant.</span></span> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">Table 2. The result of main effects on dynamic</span></strong><strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> <span style="letter-spacing: -.2pt;">balance, falling risk, quality of life, and pain</span></span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Source</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">df1</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">df2</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">F</span></strong> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">p</span></strong> <strong>^{<span dir="RTL" lang="FA" style="font-size: 10.0pt; line-height: 107%; font-family: 'B Nazanin'; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">2</span>}</strong><strong><em><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: Cambria; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: Cambria; mso-bidi-font-family: Cambria;">η</span></em></strong> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Dynamic Balance</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.06</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.01^*</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.08</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.15</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.01^*</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.08</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">4.90</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.007^**</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.13</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Falling risk</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">8.72</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.20</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.39</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.23</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">12.40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.35</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Pain</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.04</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.21</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Depth (shallow/ deep/ control)</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.67</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.24</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Aquatic exercise<span dir="RTL" lang="FA">× </span>Depth</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">40</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">12.97</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.35</span> <span style="font-size: 9.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">* Significance at p≤0.05, **significance at p≤0.01, ***significance at p≤0.001</span> <span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">Due to the significance of the main effect of water depth, the LSD test was used to perform multiple comparisons. </span><span lang="EN-GB" style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt; mso-ansi-language: EN-GB;">R</span><span style="font-size: 11.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; letter-spacing: -.2pt;">esults are shown in table 3.</span> <strong><span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Table 3. The results of LSD test for between groups comparison of dynamic balance, falling risk and pain.</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Variables</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Groups</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;"> </span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Mean difference</span></strong> <strong><span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Standard error</span></strong> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">P</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi;">Dynamic Balance</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">3.58</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.89</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">5.58</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.83</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">2.00</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.90</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.02^*</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Falling risk</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">6.69</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.96</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">16.01</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.74</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.32</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">1.08</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-fareast-theme-font: major-fareast; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; letter-spacing: -.2pt;">Pain</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">7.53</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.78</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">17.07</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.54</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Deep water</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Control</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">9.54</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.69</span> <span style="font-size: 10.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">0.001^***</span> <span style="font-size: 10.0pt; line-height: 107%; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">*Significance at p≤0.05, *** significance at <em>p</em>≤0.001</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">descriptive statistics (Table 1) report participant demographics by group.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Results demonstrated that 12 weeks of aquatic exercise in both shallow and deep water significantly improved dynamic balance and reduced fall risk and pain. Both shallow and deep water exercise groups exhibited significant post-intervention improvements in dynamic balance and reductions in fall risk and pain.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Improvements were more pronounced in the shallow water group compared to the deep water group. Notably, enhancements were significantly greater for the shallow water group. This suggests that foot contact with the pool floor facilitates more effective proprioceptive feedback, stimulating balance mechanisms more robustly than skin receptor stimulation via hydrostatic pressure alone (3). The presence of foot-floor contact in shallow water likely provides superior proprioceptive stimulation compared to deep water’s reliance on hydrostatic pressure and cutaneous receptors.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Shallow water training also yielded greater reductions in fall risk and pain, likely due to more considerable balance improvements. These superior outcomes in fall risk and pain may be mediated by enhanced balance function observed in the shallow water cohort. Improved balance corrects motor patterns and establishes effective muscle coordination, crucial for postural stability, thereby reducing pain and fall risk (8). Enhanced postural stability involves coordinated muscular control, mitigating pain and decreasing susceptibility to falls.</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Overall, these findings support the therapeutic efficacy of aquatic exercise, particularly in shallow water, for elderly individuals with knee osteoarthritis. The results corroborate prior evidence endorsing water-based therapy and emphasize shallow water exercise’s superiority for this population.</span> <span style="font-size: 10.0pt; mso-bidi-font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Article Message</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Elderly individuals with chronic knee osteoarthritis can benefit significantly from water-based exercise to improve balance, reduce pain, and lower fall risk. Aquatic exercise provides substantial benefits for elderly patients with chronic knee osteoarthritis in terms of balance, pain relief, and fall prevention. Adjusting water depth to chest level, where feet maintain contact with the pool floor, is more effective than exercising in deep water. Optimizing water depth to allow foot-floor contact enhances therapeutic outcomes more than training in non-weight-bearing deep water.</span> <strong><span style="mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Authors’ Contributions</span></strong> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Conceptualization: Faezeh Zamanian, Mahdi Armandnia</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Data Collection: Faezeh Zamanian, Mahdie Gharehlar</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Data Analysis: Mahdi Armandnia, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Manuscript Writing: Faezeh Zamanian, Mahdi Armandnia, Mahdie Gharehlar, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;">Review and Editing: Mahdi Armandnia</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; background: white;">Responsible for funding:</span><span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;"> No financial support was received for this study.</span> <span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; background: white;">Literature Review:</span><span style="font-size: 11.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-bidi-language: AR-SA;"> Faezeh Zamanian<span dir="RTL" lang="AR-SA"> و</span> Mahdi Armandnia, Mahdie Gharehlar, Majid Vesalinaseh</span> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Project Manager: Mahdi Armandnia, Faezeh Zamanian</span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Ethical Considerations</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">The ethical code is </span><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; color: windowtext; text-decoration: none; text-underline: none;">UMIN000058649</span><span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">. This study was approved under ethical code UMIN000058649.</span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Conflict of Interest</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">The authors have no conflict of interest. The authors declare no conflicts of interest.</span> <span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;"> </span> <strong><span style="mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">Acknowledgments</span></strong> <span style="font-size: 11.0pt; mso-bidi-font-size: 12.0pt; mso-ascii-font-family: 'Times New Roman'; mso-ascii-theme-font: major-bidi; mso-hansi-font-family: 'Times New Roman'; mso-hansi-theme-font: major-bidi; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi;">We are grateful to all individuals and participants who provided significant help during our research. The authors express sincere gratitude to all participants and collaborators who contributed to this study.</span> https://smj.ssrc.ac.ir/article_4692_dba1cdfcf6359389d170caadb3223ad2.pdf