Home Health Should you try aquatic therapy?
physical therapy in a pool
Exercising in water allows people with MS to improve their balance, strength, flexibility and other functional skills. Photo: Linda Huey, CompletePT, Los Angeles

Should you try aquatic therapy?

C’mon in, the water’s fine! Even people with heat sensitivity and other MS symptoms can benefit from aquatic therapy.

by Stephanie Stephens

Aquatic therapy can be an effective and fun alternative to traditional physical therapy for people with multiple sclerosis, says Yasser Salem, PhD, MS, NCS, PCS, a physical therapist and associate professor of physical therapy at the University of North Texas Health Science Center.

In 2010, Dr. Salem, who holds an additional certification in neurology, served as co-lead author on two prominent studies on the benefits of aquatic therapy for MS symptoms. If you’re considering dipping a toe into aquatic therapy, read on.

First, why exercise in water?

Dr. Salem: Fatigue and sensitivity to heat discourage some people with MS from exercising. Aquatic exercise allows any body heat generated during exercise to taper off. Plus, water’s unique properties can help people with MS exercise more easily.

For example, water has buoyancy: It reduces the influence of gravity, so you feel lighter and movement is easier. Water also has viscosity. It creates resistance, like weights do in the gym, but without putting any additional stress on your joints.

Water exerts hydrostatic pressure evenly across the entire body. This delivers a feeling of compression and support, much like support hosiery, allowing participants to exercise longer without developing sore muscles. Finally, because we can control the temperature of water, it can help relax muscles. (Check that the temperature in the pool you use isn’t too warm for you.) Participants also may have less fear of falling than when they’re on land. Some people in our studies were able to walk in the pool without using the assistive devices they normally use on land. This can lead to greater relaxation, confidence and perhaps mobility on dry land.

Tell us about your research.

Dr. Salem: My colleagues and I, in conjunction with the National MS Society, held aquatic exercises twice weekly for 60 minutes. The classes included aerobic, strength, flexibility, balance and walking activities. We assessed each participant’s motor function using standardized tests that measure mobility, balance, grip strength, fatigue and quality of life. In general, participants improved in all areas after training.

What about any potential complications from aquatic therapy?

Dr. Salem: In our studies and other studies of people with MS, no injuries or MS-related exacerbations were reported. However, people with more advanced cognitive problems, such as impaired attention, problems with critical thinking or inability to follow simple commands, should take precautions and exercise under supervision.

How frequently should a person do aquatic therapy?

Dr. Salem: We don’t really have answers in terms of minimum or maximum—it’s all so individual, based on each person’s condition, including functional abilities, associated disorders and endurance level.

Can people do water exercises on their own?

Dr. Salem: Aquatic therapy is different from plain recreational swimming. A professional can design a program to address a person’s individual needs and limitations.
If certain clients have access to a pool, we may give them instructions that are safe for them to follow on their own—especially if they can get in and out of the pool without help. (See “Join the ‘get wet’ set.”) However, our research has found that group participants are more motivated and enjoy the social interaction of exercising together.

Does insurance cover aquatic therapy?

Dr. Salem: Check with your insurance company.

How can people find an aquatic therapy specialist who’s experienced with MS?

Dr. Salem: I highly recommend the American Physical Therapy Association’s Aquatic Physical Therapy Section’s website,, and its “Find an Aquatic PT Clinic” feature. Just click on your state and you’ll see a list of places that offer aquatic therapy. You can also call an MS Navigator at 1-800-344-4867 to find out if other resources are available in your area.

Stephanie Stephens is a multimedia journalist specializing in health and lifestyle topics.

Tags: fall 2013