Aquatic Therapy for Parkinson’s Disease: Evidence from a Systematic Review and Meta-analysis

Parkinson’s disease (PD) is a progressive neurological disorder characterized by tremor, rigidity, bradykinesia, impaired balance and gait disturbances. In addition to these motor symptoms, many people with Parkinson’s experience sleep disorders and reduced quality of life. A 2025 systematic review and meta-analysis evaluated whether exercise interventions, including aquatic therapy, improve physical function and sleep quality in people with Parkinson’s disease. The review included 62 randomized controlled trials involving 3,274 participants, making it one of the most comprehensive analyses currently available.

Why aquatic therapy is suitable for Parkinson’s disease

Water provides a unique rehabilitation environment for people with Parkinson’s disease.

Buoyancy reduces body weight, making walking and balance exercises safer while decreasing fear of falling. Water resistance provides multidirectional strengthening without external weights, and hydrostatic pressure enhances postural stability and sensory feedback during movement.

These properties allow patients to practice functional activities that may be difficult or unsafe on land.

About the systematic review

The authors searched five major scientific databases and included randomized controlled trials published up to December 2023.

Exercise interventions evaluated included:

• Aquatic therapy
• Underwater exercise
• Aerobic exercise
• Resistance training
• Tai Chi
• Yoga
• Tango
• Traditional Chinese exercise
• Nordic walking

The primary outcomes included:

• Sleep quality
• Motor function
• Balance
• Gait performance
• Quality of life

Aquatic therapy was analysed both within the overall exercise results and as a separate subgroup whenever sufficient studies were available.

Overall effects of exercise

Across all exercise interventions, significant improvements were found in multiple clinical outcomes.

Compared with control groups, exercise significantly improved:

• Sleep quality
• Motor function (UPDRS-III)
• Balance
• Timed Up and Go Test (TUGT)
• Stride velocity
• Step length
• Quality of life

These findings reinforce current recommendations that structured exercise should be considered an essential component of Parkinson’s disease management.

Benefits of aquatic therapy

Improved balance

Aquatic therapy showed a significant positive effect on balance performance.

Compared with control interventions, water-based exercise improved Berg Balance Scale (BBS) scores, indicating better postural control and stability during functional activities.

Better gait performance

One of the strongest findings for aquatic therapy involved gait.

Patients participating in aquatic rehabilitation demonstrated significantly better performance on the Timed Up and Go Test (TUGT) compared with control groups.

These improvements suggest that water-based rehabilitation can enhance functional mobility while allowing patients to practice walking with a reduced risk of falling.

Improved quality of life

The meta-analysis found that aquatic therapy significantly improved health-related quality of life as measured by the Parkinson’s Disease Questionnaire (PDQ-39).

Improved mobility, confidence and functional independence may contribute to these positive outcomes.

How aquatic therapy compares with other exercise types

The review compared several exercise modalities.

Aquatic therapy demonstrated significant improvements in:

• Balance
• Functional mobility (TUGT)
• Quality of life

Other exercise programmes, including aerobic exercise, resistance training and traditional Chinese exercises, also produced meaningful improvements in motor performance and sleep quality.

Rather than identifying a single superior intervention, the authors conclude that multiple exercise approaches—including aquatic therapy—can provide clinically relevant benefits for people with Parkinson’s disease.

Exercise prescription

Subgroup analyses explored factors that may influence treatment outcomes.

Exercise programmes generally ranged from 3 to 52 weeks, with both shorter (≤12 weeks) and longer (>12 weeks) interventions producing significant improvements in motor function and balance.

Programmes performed more than three times per week and sessions lasting 60 minutes or longer were generally associated with greater functional improvements, although benefits were also observed with lower training frequencies.

Clinical applications

Aquatic therapy may be particularly valuable for people with Parkinson’s disease who experience:

• Balance impairments
• Gait disturbances
• Fear of falling
• Reduced mobility
• Functional limitations during land-based exercise

The supportive aquatic environment enables safe practice of walking, turning, balance challenges and functional strengthening while reducing joint loading and improving confidence during movement.

Limitations

Although this review included a large number of studies, several limitations remain.

Considerable heterogeneity existed between exercise programmes, intervention duration and outcome measures. Aquatic therapy represented only one subgroup within the broader exercise literature, making it difficult to determine whether it is superior to other forms of exercise. In addition, many included studies involved relatively small sample sizes and varying methodological quality.

Conclusion

This systematic review demonstrates that aquatic therapy for Parkinson’s disease is an effective rehabilitation intervention that improves balance, functional gait and quality of life. Together with evidence supporting improvements from aerobic exercise, resistance training and other structured exercise programmes, the findings reinforce the important role of regular physical activity in Parkinson’s disease management. Aquatic therapy offers a particularly safe and supportive environment for individuals with mobility and balance impairments, making it a valuable component of multidisciplinary neurological rehabilitation.