FOR CLINICIANS · PLANNING RESOURCE
Building a Therapy Pool
When a pool makes sense, the decisions that shape it and the cost questions to ask first.
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education.
A 3–4 minute read · Last reviewed: October 22, 2026
When does a pool make sense?
A therapy pool is a long-term commitment of space, money and staff. It usually makes sense when three things are true.
The evidence fits your patients
Recent reviews often find aquatic exercise comparable to land exercise, and better for some outcomes, such as musculoskeletal pain (Deng et al., BMC Musculoskeletal Disorders, 2026) and COPD exercise capacity (Du et al., Life, 2026). Not every review favors water, for example in knee osteoarthritis (Amaral et al., Healthcare, 2026).
Comparable still matters: hip and knee joint forces were 36–55% lower in chest-high water than on land (Kutzner et al., PLoS One, 2017), so water may let a patient start sooner.
The hours will fill
Expert opinion
A pool costs money every open hour, used or not. Plan therapy blocks, fill quieter hours with community programs and estimate weekly hours of use.
Not sure yet? Many programs rent time in an existing pool first to test demand. See Renting a Pool for Therapy.
Plan the program before the pool
As Sue Nelson put it, “programming precedes design.” Decide who you will serve, which programs you will run and how many hours the water will be used. The program then sets the depth, temperature, access and staffing.
[Expert opinion] Practical guidance adapted from ATU Educational Services, LLC source material. Not rated as evidence.
Depth
Deeper water supports more of the body (Torres-Ronda & del Alcázar, Journal of Human Kinetics, 2014), but fast movements and resistive fins can raise joint forces again (Kutzner et al., PLoS One, 2017).
Expert opinion
A range of depths, or an adjustable floor, lets one pool serve standing gait work, seated exercise and deeper-water work.
Water and air temperature
Water temperature, air temperature and humidity belong in each pool user’s screen (ATACP, Guidance on Aquatic Physiotherapy Practice, 2021, amended 2025).
Expert opinion
Therapy usually needs warmer water than lap swimming, which raises energy and air-handling costs. Set targets with current professional guidance and your local code.
Access and entry
Under the 2010 ADA Standards, new and altered public pools need accessible entry: one lift or sloped entry for smaller pools, and two means of entry for pools with more than 300 linear feet of wall (ADA.gov, Accessible Pools Means of Entry and Exit). Many therapy programs plan for more than the minimum.
Air quality
Indoor pool air can carry chloramines that irritate eyes and airways, so air handling must bring in enough fresh air (CDC, Chloramines and Pool Operation, 2025).
Codes and plan review
CDC’s Model Aquatic Health Code is guidance that states and localities use to write pool codes; your own state or local code is what applies (CDC, About the Model Aquatic Health Code).
Expert opinion
Expect plan review before construction. Bring in design professionals with therapy-pool experience early.
People and support spaces
Expert opinion
Plan for clinicians with aquatic training, assistants supervised under state and payer rules, rescue-trained staff and a trained pool operator, plus accessible changing rooms, transfer space and storage.
Cost and return questions to ask first
Answer these in writing before you ask anyone to approve a pool.
Expert opinion
- What does one open hour cost: staff, chemicals, energy for water and air, dehumidification, maintenance, insurance, permits and inspections?
- How many hours a week must be filled to cover that cost?
- Which payers cover aquatic therapy for our patients, and under what conditions?
- Which community programs or partners could use, share or fund the pool when therapy does not?
- What one-time costs have qualified professionals quoted in writing?
- What will we measure in year one, and what would make us change course?
Costs vary widely by region, pool size and building, so use local written estimates.
Next steps
- Ask your referral sources which patients they cannot place now.
- Pick two or three matching reviews from the Evidence Library, limits included.
- Consider renting pool time first to test demand.
- Ask your health department about plan review, and talk to design professionals early.
- Write a one-page case for the people who will decide.
Informational only. This page is general education, not legal, financial, insurance, engineering, reimbursement or medical advice. Talk to qualified professionals before you sign or build anything.
How to cite this page
Last reviewed October 22, 2026 · Permanent URL: https://aquatictherapyfoundation.org/for-clinicians/building-a-therapy-pool/
How to cite
Salzman, A. (Ed.). (2026). Building a therapy pool. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-clinicians/building-a-therapy-pool/
Permissions: You may quote and cite this page with attribution. Reproducing or adapting the full page requires written permission from ATU Educational Services, LLC.
Cite the date you accessed this page, because content may change.
References
Every source cited on this page, in AMA style. Each link goes to the DOI or the official free copy.
Show all 9 references
- Deng X, Li Y, Wu Z, Wang Z. The dose-response relationship of aquatic exercise for musculoskeletal pain relief: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2026;27:698. doi: 10.1186/s12891-026-09953-0 PMID 42265644 (CC BY-NC-ND)
- Du W, Zhou J, Chi A. Comparative rehabilitation benefits of water-based versus land-based exercise in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Life (Basel). 2026;16:207. doi: 10.3390/life16020207 PMID 41752845 (CC BY)
- Amaral M, Correia B, Oliveira M, et al. Comparative effectiveness of aquatic versus land-based exercise on pain, physical function, and quality of life in people with knee osteoarthritis: an updated systematic review of randomised controlled trials. Healthcare. 2026;14:3388. doi: 10.3390/healthcare14203388 (CC BY 4.0)
- Kutzner I, Richter A, Gordt K, et al. Does aquatic exercise reduce hip and knee joint loading? In vivo load measurements with instrumented implants. PLoS One. 2017;12(3):e0171972. doi: 10.1371/journal.pone.0171972 PMID 28319145
- Torres-Ronda L, del Alcázar XS. The properties of water and their applications for training. J Hum Kinet. 2014;44:237-248. doi: 10.2478/hukin-2014-0129 PMID 25713684
- Aquatic Therapy Association of Chartered Physiotherapists (ATACP). Guidance on Aquatic Physiotherapy Practice 2021 (amended March 3, 2025). Accessed October 19, 2026. ATACP guidance (PDF)
- U.S. Department of Justice, Civil Rights Division. ADA requirements: accessible pools, means of entry and exit. ADA.gov. Updated February 28, 2020. Accessed October 22, 2026. ada.gov
- Centers for Disease Control and Prevention. Chloramines and pool operation. Healthy Swimming. June 23, 2025. Accessed October 22, 2026. cdc.gov
- Centers for Disease Control and Prevention. About the Model Aquatic Health Code. Updated November 6, 2024. Accessed October 22, 2026. cdc.gov
About this page
Competing interests
This page was prepared under the direction of Aquatic Therapy Foundation (ATF) leadership. ATF’s CEO also founded Aquatic Therapy University (ATU) and directs it. Practical guidance on this page is adapted from ATU material and is labeled [Expert opinion]. This page does not sell, rank or recommend any course, credential, consultant, pool or product, and ATF does not endorse any program. The phrase “programming precedes design” is credited to Sue Nelson and is not part of the ATU material.
Copyright
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. Adapted from material originally developed by ATU Educational Services, LLC. Cited third-party works keep their own copyright and licenses.
Corrections and questions
If you spot an error or an outdated link, contact us at info@aquatictherapyfoundation.org.
This page was drafted with AI assistance under the editorial direction of the Aquatic Therapy Foundation, checked against its cited sources, and corrected when errors are reported. Report errors to info@aquatictherapyfoundation.org.
Last reviewed: October 22, 2026. External information was checked against its sources on October 22, 2026, and may have changed since then. This page is general education, not legal, financial, insurance, engineering, reimbursement or medical advice. Talk to qualified professionals before you sign or build anything.
Editor: Andrea Salzman, MS, PT · ORCID: https://orcid.org/0009-0009-5255-7074
Copyright: © 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. Cited third-party works keep their own copyright and licenses.
Source: Adapted from material originally developed by ATU Educational Services, LLC.
Competing interests: The editor is the founder of Aquatic Therapy University (ATU) and Chief Executive Officer of the Aquatic Therapy Foundation (ATF). ATU sells aquatic therapy education products. ATU material used on this page is labeled [Expert opinion] and is not rated as evidence. ATF has a conflict-of-interest policy.