Aquatic Therapy for Stroke, Parkinson Disease and Multiple Sclerosis: What Is Known

Check First, Then Use Supervised Care

Aquatic therapy here means exercise or rehabilitation done in a pool, usually led by a trained clinician. It is information, not a treatment plan. Talk with your neurologist or rehabilitation team before starting, and do not stop or change medicines or other care because of anything below. In the US, call 911 for sudden weakness, trouble speaking, face drooping, or if a person is in difficulty in water. People with stroke, Parkinson disease or multiple sclerosis (MS) can have balance, fatigue, muscle-control and temperature-control problems that change what is safe in a pool. For pool rules, see pool safety for exercise and therapy.

What the Evidence Looks Like

Most of the research is on supervised programs of exercise or therapy in a pool, often compared with land-based exercise or with no added therapy. People cannot be blinded to being in water, so results on how people feel or how they rate themselves may be shaped by expectation. See how hydrotherapy research is done. The tables below use our plain labels.

Stroke

A 2021 systematic review of 28 randomized trials (961 people) reported that, against no intervention, aquatic therapy was effective for walking, balance, emotional status, quality of life and spasticity. [1] Against land-based exercise it reported better balance, walking, muscle strength and fitness, while independence in daily activities was similar. [1] The same authors still concluded that the evidence is insufficient to support aquatic therapy within evidence-based rehabilitation, and asked for more research. [1]

A review of 17 trials (629 people) comparing aquatic therapy with land-based exercise after stroke found a moderate benefit for balance and small benefits for walking speed and mobility. [2] The authors said longer-term follow-up is needed. [2] A third review suggested aquatic therapy may be a valid means of rehabilitation and could be combined with conventional physical therapy. [3]

1. Balance and walking after stroke

   Promising but limited

   Better than land exercise in two reviews; small to moderate effects

2. Daily-living independence

   Mixed

   Similar to land exercise

3. Whether it should be standard care

   Insufficient evidence

   Review authors called evidence insufficient

Related stroke pages: acupuncture for stroke recovery and TCM for stroke recovery.

Parkinson Disease

The NHS lists physiotherapy and occupational therapy among supportive treatments for Parkinson disease, alongside medicines. [4] A 2019 review of seven trials (six pooled, 159 people) found aquatic exercise gave slightly to moderately greater benefit than land exercise for balance, fear of falling and quality of life, with similar results on other outcomes. [5] A 2025 review of 13 trials (511 people) found no serious adverse events in most studies, and benefits for quality of life, mental health, pain, flexibility and sleep against land exercise. [6] For balance, gait and strength it called the comparison inconclusive because the programs varied. [6] Overall label: promising but limited. For a land-based option see Tai Chi for Parkinson disease.

Multiple Sclerosis

A 2020 review of 11 trials concluded aquatic physical therapy is a valid means of rehabilitation in MS, and that more participants and follow-up are required. [7] A 2022 review of 16 trials (794 people) reported positive effects on fatigue and balance. [8] A 2026 review of seven trials found a large reduction in fatigue and no adverse events reported, but warned that the small trials differed a lot. [9] Overall label: promising but limited.

Heat Sensitivity in MS

The MS Trust (UK) says as many as 8 in 10 people with MS report symptoms worsening with a temperature change, and that the effect is temporary. [10] A change of as little as 0.5°C can matter. [10] It lists warm baths, showers, saunas and steam rooms among heat triggers. [11] The same page says swimming and other water-based exercise can be a good option because it may lower the risk of overheating. [11] Pool temperature is therefore a question for your care team and the pool operator. We do not give a safe temperature. The reviews above did not give us a pool temperature that applies to everyone, so none is stated here.

If symptoms have not resolved after 24 hours, the MS Trust advises contacting your GP or MS team. [10] For hot baths and saunas more broadly, see hydrotherapy safety.

Who Provides It

Aquatic therapy is usually delivered by a physical therapist or physiotherapist. Training and regulation differ by country and state and are not covered by the sources we read. See aquatic physical therapy: who provides it and aquatic therapy and land-based exercise compared.