Aquatic Therapy for Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurological disorder that can significantly affect mobility, balance and walking endurance. A 2025 systematic review and meta-analysis evaluated the effects of exercise interventions in people with relapsing-remitting multiple sclerosis (RRMS) and found that regular exercise significantly improves dynamic balance and walking endurance. The review also highlights aquatic therapy as a particularly promising rehabilitation approach.

Why aquatic therapy is beneficial for multiple sclerosis

People with multiple sclerosis often experience muscle weakness, impaired balance, fatigue and reduced walking ability. These symptoms can make conventional land-based exercise physically demanding.

Aquatic therapy provides a supportive environment where buoyancy reduces the load on the joints and lower limbs, allowing patients to move with greater confidence. Water resistance strengthens muscles while hydrostatic pressure enhances postural stability and sensory feedback, making aquatic exercise well suited for neurological rehabilitation.

Key findings from the review

The systematic review analysed ten clinical studies involving thirteen exercise intervention groups. Researchers assessed walking endurance using the Six-Minute Walk Test (6MWT) and dynamic balance using the Timed Up and Go (TUG) test.

Improved walking endurance

Exercise significantly increased the distance participants were able to walk during the 6MWT.

Across all exercise programmes, participants improved their walking distance by an average of 29 metres, demonstrating better endurance and functional mobility.

Interestingly, the aquatic conditioning programme included in the review produced the largest improvement in walking distance among all interventions, suggesting aquatic therapy may offer particular benefits for people with RRMS.

Better dynamic balance

Participants also demonstrated significant improvements in dynamic balance.

Exercise reduced the average completion time of the Timed Up and Go test by 1.4 seconds, indicating better balance, mobility and functional independence.

Both lower- and higher-intensity exercise programmes resulted in meaningful improvements, although lower-intensity programmes produced slightly greater overall gains.

Benefits of early and regular exercise

The authors conclude that regular exercise should be introduced early in the rehabilitation process.

Maintaining physical activity may help preserve walking ability, improve balance and support long-term independence for people living with relapsing-remitting multiple sclerosis.

Why exercising in water works

The physical properties of water make aquatic therapy particularly suitable for neurological rehabilitation.

Buoyancy supports movement

Water reduces body weight, making walking and balance exercises easier to perform while decreasing the risk of falls.

Hydrostatic pressure improves stability

The gentle pressure of water enhances proprioception and postural control, helping patients maintain balance during functional exercises.

Water resistance strengthens muscles

Natural resistance is present throughout every movement, allowing patients to improve muscle strength and endurance without the need for heavy external loads.

Warm water promotes confidence

Warm therapeutic pools may reduce muscle stiffness and create a comfortable environment that encourages movement, particularly for individuals with mobility limitations.

Clinical implications

Although the review evaluated many different forms of exercise, the aquatic conditioning programme demonstrated the greatest improvement in walking endurance.

The authors therefore recommend further high-quality research into aquatic therapy, as it may provide additional benefits beyond conventional exercise programmes for people with relapsing-remitting multiple sclerosis.

Aquatic therapy may be particularly valuable for individuals who experience:

• Impaired balance
• Walking difficulties
• Muscle weakness
• Fatigue
• Reduced exercise tolerance
• Fear of falling

Conclusion

This systematic review and meta-analysis confirms that regular exercise significantly improves dynamic balance and walking endurance in people with relapsing-remitting multiple sclerosis.

Although only one aquatic exercise study was included, it demonstrated the largest improvement in walking endurance, highlighting the potential value of aquatic therapy for multiple sclerosis. The authors recommend further research to better understand the role of aquatic rehabilitation in neurological care.