Background: Clinical practice guidelines for patients with chronic low back pain (CLBP) recommend therapeutic exercise, and recently, interventions for pain neuroscience education (PNE) are also recommended. Objectives: To investigate the effects of aquatic exercise combined with PNE on pain, disability, and fear-avoidance beliefs in patients with CLBP. Design: Randomized control trial. Methods: The 27 participants recruited in this study were randomly allocated as pain neuroscience education combined with aquatic exercise group (PAEG, n=14) and aquatic exercise group (AEG, n=13). Both groups performed aquatic exercise for 50 minutes, 3 times a week for 6 weeks, and only PAEG received additional PNE. Numeric pain rating scale (NPRS), modified oswestry disability questionnaire (MODQ), and fear-avoidance beliefs questionnaire (FABQ) were used as evaluation methods before and after intervention. Results: Statistically significant decrease in NPRS, MODQ and FABQ (physical activity and work score) before and after intervention in PAEG. However, there were statistically significant changes in NPRS, MODQ and FABQ (physical activity score) before and after intervention in AEG. PAEG and AEG before and after intervention indicated statistically significant differences in MODQ and FABQ (work score). Conclusion: Aquatic exercise combined with PNE improved disability (MODQ) and fear-avoidance beliefs (FABQ) has been shown to have additional benefits. Therefore, combining PNE as a clinical intervention for CLBP patients will enhance the therapeutic effect.