One hundred and thirteen patients with chronic low back pain were randomized to receive 12 weeks of aquatic exercise therapy (n=56) or physical therapy modalities (transcutaneous electrical nerve stimulation and infrared ray thermal therapy; n=57). The primary outcome of interest was the Roland-Morris Disability Questionnaire (RMDQ), a measure of daily activities of living and functionality. Secondary outcomes of interest included patient-reported measures of pain, anxiety, depression, sleep quality, fear of movement, and adverse events. Outcomes were assessed over a 12 month follow-up period. Results revealed significantly greater improvement in RMDQ scores in the aquatic group. Moreover, patients in the aquatic exercise group reported greater pain relief, quality of life scores, sleep quality scores, and less fear of movement, with a greater perceived improvement vs. physical therapy modalities.