One hundred and eleven patients with symptomatic knee OA were randomized to receive 12 weeks of aquatic cycling exercise treatment or standard care (e.g., physical therapy or bracing). The primary outcomes of interest were knee pain and physical function on the Knee Injury and Osteoarthritis Outcomes Score (KOOS) questionnaire. Secondary outcomes of interest included KOOS symptoms, sports and recreation, and quality of life sub-scales, Lower Extremity Function Scale (LEFS) scores, pain on a Numeric Rating Scale (NRS), Patient Global Assessment (PGA) of general health, 6 minute walk test scores, Timed Up and Go test scores, and quadriceps strength. Outcomes were assessed immediately post-treatment at 12 weeks and at 24 weeks follow-up. Main results revealed significantly favourable KOOS pain and physical function scores at all time-points in the aquatic cycling group compared to the standard care group. Similarly, significantly favourable KOOS quality of life scores post-treatment, as well as 6 minute walk test results, quadriceps strength (isokinetic 180 deg), and Timed Up and Go test results were observed in the aquatic cycling group compared to the control group. All remaining outcomes were not statistically significant different between the two treatment arms.