ATF · FOR PATIENTS, CLIENTS AND FAMILIES
For Participants
A free, plain-language guide for people who use water for health and for the families who help them: what aquatic therapy is, what research published in 2024–2026 says about your condition, how to find a pool program, and how to keep going after therapy ends.
Important: The research on this page covers only studies published in 2024–2026. Earlier studies may also support aquatic therapy for your condition. Read why
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. See competing-interest statement.
Last reviewed: October 22, 2026
How to cite this page
How to cite
Salzman, A. (Ed.). (2026). For participants. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-participants/
Click the citation (or press and hold on a phone) to select it, then copy. Add the date you read the page. Permissions and the full citation are in How to cite this page near the bottom.
Start here
Tap a card to jump to what you need. Each section is short and written in everyday words.
Is aquatic therapy for me?
Aquatic therapy is skilled, goal-directed treatment in water from a licensed clinician, such as a physical therapist. Aquatic fitness is a water exercise class for people who are able to exercise on their own, led by a fitness instructor. Both use water, but only aquatic therapy is treatment (Encyclopedia: Aquatic therapy and related terms; Encyclopedia: Aquatic fitness).
Aquatic therapy
Treatment from a licensed clinician, such as a physical therapist or occupational therapist.
Read more
- Starts with a check of your health and goals.
- Has a plan made for you, often one-on-one.
- Your clinician tracks your progress and adjusts the plan.
- May be covered by health insurance in some cases.
Aquatic fitness
A group or solo water exercise class for general fitness, led by a fitness instructor.
Read more
- For people who are cleared to exercise on their own.
- Builds fitness, strength and flexibility.
- Is not medical treatment.
- Is usually paid for like a gym class or pool membership.
Why water?
Water pushes up on your body and supports it. That means you can often move with less weight on your joints than on land (Encyclopedia: Buoyancy). Warm water can also feel relaxing. Many people find they can do more in water than on land, at least at first.
What does “evidence” mean?
- Evidence means what careful research studies found when they tested a treatment with real people.
- One study is not enough. The strongest evidence comes from systematic reviews, where researchers gather every good study on a question and look at them together.
- “May help” is honest. Most research on water exercise uses small groups of people, so many reviews say a treatment “may” help. That means the early signs are good, but more research is needed.
- Your results can differ. Research tells us what happened on average. Your own clinician can tell you what fits you.
Does the research support aquatic therapy or aquatic exercise for my condition?
Find your condition, read the one-line answer, then tap “See the studies” to open matching papers in our Evidence Library.
All 34 ratings below start from studies published in 2024–2026. We then checked them against research reviews and guidelines from any year.
Jump to: Joints, back and muscle pain (9) · Brain and nerve conditions (7) · Conditions that start in childhood (5) · Heart, lungs and blood pressure (3) · Mental health and long-lasting fatigue (3) · Other health conditions and life stages (7)
How to read the ratings
- ●●● Research supports it: at least three research reviews published in 2024–2026 and held in our Evidence Library agree that water exercise helps, and the reviewers rate the evidence as moderate or the results as consistent.
- ●●○ Some research supports it: at least one 2024–2026 research review found a benefit, but the studies are small, mixed or low in certainty.
- ●○○ Too little research yet: we found no strong research review for this condition published in 2024–2026. Older studies may exist. This does not mean water exercise does not help.
- Checked against older reviews: we then compared each rating with systematic reviews and guidelines from any year, and raised or lowered it where they disagreed. Many cards name those reviews under “Also checked against.”
Joints, back and muscle pain
Knee osteoarthritis
●●● Research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise can ease pain and help with daily activities and walking. Benefits look similar to land exercise, so choose the one you will keep doing.
Key review: Minea et al., Medicina, 2026
Hip osteoarthritis
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may ease pain and help function for a while. Most hip studies are small or are combined with knee studies.
Key review: Zhou et al., Frontiers in Physiology, 2026
Knee or hip replacement
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
After knee replacement, water therapy eased pain about as well as land exercise and built more leg strength. After hip replacement, one small review found water exercise helped daily function.
Key review: Alrashedi et al., Healthcare, 2026
Also checked against: Centurião et al., 2024 (review of hip replacement)
Long-lasting low back pain
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may ease pain and make daily tasks easier, especially as part of a wider care plan.
Key review: Wu et al., Frontiers in Medicine, 2026
Fibromyalgia
●●● Research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise can ease pain in the short term and may help with anxiety and low mood.
Key review: Rodríguez-Domínguez et al., Brazilian Journal of Physical Therapy, 2025
Rheumatoid and other inflammatory arthritis
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Reviews suggest water exercise can ease pain and help daily function in the short term. How long the benefits last is not known.
Key study (randomized trial): Bunæs-Næss et al., BMJ Open, 2025
Also checked against: England et al., 2023 (American College of Rheumatology guideline); Medrado et al., 2022 (review); Al-Qubaeissy et al., 2013 (review)
Ankylosing spondylitis
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Small studies show water exercise can ease pain and disease activity, but not daily function or spine movement. Land-based exercise is recommended first in the American College of Rheumatology’s 2019 guideline, so ask your care team.
Key review: Kong et al., PeerJ, 2025
Also checked against: Ward et al., 2019, the 2019 spondyloarthritis guideline from the American College of Rheumatology and two spondylitis research groups; Liang et al., 2021 (review)
Anterior cruciate ligament (ACL) knee injury and surgery
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
Two trials found water-based rehab improved knee stability or walking pattern more than land-based rehab after an ACL injury or surgery. One trial was very small, and we found no research review on this yet.
Key study (randomized trial): Liu et al., Journal of Sport Rehabilitation, 2026
Ankle sprains and unstable ankles
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
Small trials in athletes with weak, unstable ankles found water exercise improved balance and ankle function. Land exercise did better on some tests. We found no research review on this yet.
Key study (randomized trial): Zarei et al., Journal of Sport Rehabilitation, 2026
Brain and nerve conditions
Stroke
●●● Research supports it
2024–2026 studies only. Earlier research may also exist.
Water therapy can improve balance. Effects on walking vary between studies.
Key review: Liu et al., European Journal of Physical and Rehabilitation Medicine, 2026
Parkinson’s disease
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may help movement, quality of life, pain and sleep. Reviews do not agree yet on whether it beats land exercise.
Key review: Seyedahmadi et al., Physiotherapy Research International, 2025
Multiple sclerosis
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water therapy may ease tiredness (fatigue) and help mobility and quality of life. The studies are few and small.
Key review: Santamaría et al., Journal of Functional Morphology and Kinesiology, 2026
Spinal cord injury
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
One small pilot study (12 people, no control group) found a water program was safe and well accepted. Better-controlled studies are needed.
Key study: Menchero et al., Journal of Spinal Cord Medicine, 2025
Dementia, memory and thinking
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
In older adults, water exercise may help thinking skills about as much as land exercise. Very little research includes people living with dementia.
Key review: Song et al., Journal of Sports Science and Medicine, 2026
Thinking skills in older adults
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may help thinking skills in older adults about as much as land exercise. Programs that add thinking tasks in the water may help most. The studies are small.
Key review: Song et al., Journal of Sports Science and Medicine, 2026
Also checked against: Jaana et al., 2026 (review); Campos et al., 2021 (review)
Muscular dystrophy and other muscle diseases
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
Two small pilot studies found water training improved strength, balance or getting around, in adults with myotonic dystrophy and in children with Duchenne or Becker muscular dystrophy. Larger studies are needed.
Key study (pilot randomized trial): Ballaz et al., Neuromuscular Disorders, 2026
Also checked against: Ogonowska-Slodownik et al., 2022 (scoping review)
Conditions that start in childhood
Cerebral palsy
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may help movement and walking in children and teens, and many enjoy it. Results look similar to land exercise.
Key review: Pauluka et al., Child: Care, Health and Development, 2025
Autism
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water activities may improve behavior and social skills in children. The studies are small, and many have design problems.
Key review: Xin et al., Frontiers in Behavioral Neuroscience, 2026
Juvenile idiopathic arthritis (childhood arthritis)
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
A review of trials found water therapy eased pain and improved fitness in children with arthritis compared with usual care, but not daily function. The certainty of the evidence ranges from very low to moderate.
Key study (non-randomized study): Gnasso et al., Journal of Functional Morphology and Kinesiology, 2026
Also checked against: Verit et al., 2026 (review)
Intellectual disability and Down syndrome
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Reviews suggest water exercise can improve fitness, strength and balance in people with intellectual disabilities. Effects on thinking skills and mental health are still unclear.
Key study (randomized trial): Nalbant et al., Palaestra, 2025
Also checked against: Salse-Batán et al., 2023 (review); Cánovas et al., 2026 (review)
ADHD and developmental coordination disorder
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
In one small study without a comparison group, children at risk for coordination disorder moved and balanced better after 10 weeks of swimming. A review found swimming lessons build swimming skills in these children. Research on ADHD is still early.
Key study (pre-post study): Zhao et al., Frontiers in Psychology, 2026
Also checked against: Graham et al., 2026 (review of swimming lessons)
Heart, lungs and blood pressure
COPD (chronic lung disease)
●●● Research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise can improve how far you can walk and the strength of your breathing muscles, often as much as or more than land exercise. The studies are still small.
Key review: Du et al., Life, 2026
Heart failure and heart disease
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may improve how much activity you can handle and some heart and blood-vessel measures. The studies are few, and they include only people whose heart failure is stable.
Key review: Alikhajeh et al., Biological Research for Nursing, 2025
Also checked against: Adsett et al., 2015 (review of stable heart failure)
High blood pressure
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may lower blood pressure. Study quality varies, so more research is needed.
Key review: Chang et al., Frontiers in Physiology, 2026
Mental health and long-lasting fatigue
Depression, anxiety and stress
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Reviews suggest water exercise can lift mood and ease anxiety, including for people with disabilities. Most studies are small, so more high-quality research is needed. Water exercise does not replace mental health care.
Key review: Wu et al., Frontiers in Psychology, 2026
Also checked against: Tang et al., 2022 (review)
ME/CFS (myalgic encephalomyelitis or chronic fatigue syndrome)
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
In one small trial, gentle, self-paced water exercise improved walking, strength, tiredness and mood without making symptoms worse. More studies are needed.
Key study (randomized trial): Broadbent et al., European Journal of Applied Physiology, 2025
Long COVID (post-COVID condition)
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
One trial found spa bathing eased muscle pain and tiredness, but some benefits faded. In children, water and land exercise both improved lung function. Larger studies are needed.
Key study (randomized trial): Ovejero et al., BMC Complementary Medicine and Therapies, 2025
Also checked against: Ferrara et al., 2025 (review of spa therapy)
Other health conditions and life stages
Breast cancer and lymphedema
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Early reviews suggest water exercise may ease pain and help quality of life and shoulder movement after breast cancer, but the evidence is very uncertain. Whether it helps lymphedema swelling is still uncertain.
Key review: Silva et al., Brazilian Journal of Physical Therapy, 2025
Also checked against: Muñoz-Gómez et al., 2022 (review); Aguilera-Eguía et al., 2026 (overview of reviews); Yeung and Semciw, 2018 (review)
Pregnancy
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Reviews suggest water exercise is suitable throughout pregnancy and may help with weight gain and quality of life. The blood-pressure finding is still preliminary: only two trials tested it. Follow your prenatal care team’s advice.
Key review: Chen et al., Pregnancy Hypertension, 2026
Also checked against: Cancela-Carral et al., 2022 (review); Zhao et al., 2024 (review)
Balance and falls in older adults
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water training can improve balance and leg strength, two of the main risk factors for falls. Results look similar to land training. Few studies count falls themselves. If you are frail, ask your clinician first: a major guideline advises against water exercise for frail people because of the risk of injury.
Key review: Reichert et al., Journal of Aging and Physical Activity, 2026
Also checked against: Buitrago-Restrepo et al., 2024 (review); Melo et al., 2023 (review); Bannuru et al., 2019, the osteoarthritis guideline from the Osteoarthritis Research Society International (OARSI)
Overweight and obesity
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water aerobics for more than 10 weeks led to small drops in body weight (about 6 pounds on average) and waist size.
Key review: Ding et al., BMJ Open, 2025
Type 2 diabetes
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Water exercise may improve blood sugar control about as much as land exercise.
Key review: Pereira et al., Healthcare, 2026
After menopause
●●○ Some research supports it
2024–2026 studies only. Earlier research may also exist.
Reviews suggest water exercise can improve strength, flexibility and quality of life after menopause, about as much as land exercise. Early studies suggest it may also help blood pressure.
Key review: Li et al., Frontiers in Medicine, 2026
Also checked against: Zhou et al., 2023 (review); Saquetto et al., 2022 (review)
Blindness and low vision
●○○ Too little research yet
2024–2026 studies only. Earlier research may also exist.
One small trial in blind women found water exercise strengthened leg muscles. More studies are needed.
Key study (randomized trial): Salari et al., PLOS One, 2025
Important: this page only covers research from 2024–2026
Every research rating and summary on this page is based only on studies published in 2024–2026. Right now, those are the only years our Evidence Library covers.
Many earlier studies, published before 2024, may also support aquatic therapy or aquatic exercise for your condition. They are not counted here. So a rating of “Some research supports it” or “Too little research yet” does not mean water exercise does not help. It may only mean there are few studies from these three years.
We then checked every rating against systematic reviews and clinical guidelines from any year, and raised or lowered a rating where they disagreed.
Ask your clinician about the full body of evidence, including older studies. Cochrane plain-language summaries also cover older research (see Learn about your diagnosis).
This date limit applies to the research ratings. The safety, access and insurance tips on this page come from public guidance documents, which are listed in the References.
General education, not medical advice
This is general education, not medical advice; talk with your own clinician. These ratings describe research on groups of people. They cannot tell you whether water exercise is right for you. Always check with your own doctor or therapist before you start.
How we chose these ratings
- We used only papers in the Foundation’s Evidence Library. For these ratings we used the 633 English-language papers the Library listed on October 22, 2026, all published in 2024–2026. Older research exists and is not counted here, so some ratings may rise as earlier years are added.
- We gave the most weight to systematic reviews and meta-analyses (studies that combine many studies). We also looked at single trials that scored above 5 out of 10 on the PEDro scale, a 10-point checklist of how well a trial was designed.
- We read each review’s own conclusion, including how certain the authors said they were. When in doubt, we chose the lower rating.
- Then, in October 2026, we checked every rating against systematic reviews, meta-analyses and clinical guidelines from any year. Five ratings changed: four went up (rheumatoid and other inflammatory arthritis, ankylosing spondylitis, breast cancer and lymphedema, pregnancy) and one went down (balance and falls in older adults). We also added 12 conditions. A few reviews we used are not yet in the Evidence Library.
- Each card links to one key paper with its DOI (a permanent web address for a research paper) and to a search of the Evidence Library. The search results change as papers are added.
- Ratings were last checked on October 22, 2026, when we added the 2024 papers. No rating changed. Today: 4 conditions rated “Research supports it,” 21 rated “Some research supports it” and 9 rated “Too little research yet.”
Spotted something we should check? Email info@aquatictherapyfoundation.org.
How to learn about your diagnosis and what the evidence says
You do not need to be a scientist to find good health information. Follow these four steps, in order.
Four steps to trustworthy answers
- Ask your clinician. Ask: “What is my diagnosis called?” “Could water exercise help me?” “Is there any reason I should not use a pool?” “What should I watch for?” Write down the answers, or bring someone to help you remember.
- Look up words in the Encyclopedia. The free Aquatic Therapy Encyclopedia™ explains water therapy terms in one or two sentences, with sources.
- Search the Evidence Library. Type your condition into the Evidence Library search box. Start with papers marked as reviews or meta-analyses. Each paper links to the original study. The Library holds only papers published in 2024–2026 for now, so ask your clinician about older studies too.
- Read plain-language summaries. Every Cochrane review includes a plain language summary written for the public (Cochrane, Our evidence). MedlinePlus, from the U.S. National Library of Medicine, explains more than 1,000 health conditions in easy words, for free and with no ads (MedlinePlus, About MedlinePlus). PubMed lists research papers; many have a free full-text link.
Tips: Look for who wrote the page and when. Be careful with sites that sell a product. Bring what you find to your clinician and ask, “Does this apply to me?”
Finding a program: questions to ask
Use these questions when you call a clinic, hospital, community center or pool. The Foundation does not rank or recommend providers.
Search by ZIP code: Find an Aquatic Therapy Pool (2026 beta: Tennessee, Texas, Wisconsin, Florida, Vermont and Idaho).
About the people
- Who will work with me in the water? Are they licensed, for example as a physical or occupational therapist?
- Will someone check my health and goals before I start?
- Will the same person work with me each time?
- Is a lifeguard or trained staff member on duty?
About the pool
- How warm is the water?
- How deep is it? Is there a shallow area where I can stand?
- How do people get in and out: a lift, a ramp, stairs with rails or a ladder?
- Is the pool area quiet or busy at the time I would go?
About the plan
- What will we work on, and how will we measure progress?
- How long is each session, and how many sessions are planned?
- Will I get exercises to do on my own?
- What happens when therapy ends? Can you help me find a community program?
About cost and timing
- Do I need a referral or a prescription?
- Do you take my insurance? What will I pay per visit?
- Do you offer early, late or weekend times?
- What is your cancellation policy?
Tip: If a program cannot answer these questions clearly, keep looking or ask your clinician for other options.
Getting in the water: access and your rights
The Americans with Disabilities Act (ADA) helps people with disabilities use public pools. Under the 2010 ADA Standards, newly built and altered pools must have accessible ways to get in and out (ADA.gov, Accessible Pools).
What the ADA requires
Large pools (more than 300 feet of pool wall) need two accessible ways in, and at least one must be a pool lift or sloped entry. Smaller pools need one, and it must be a lift or sloped entry (ADA.gov, Accessible Pools).
Read more
A pool lift must be at the poolside and working whenever the pool is open, even a portable one. Staff should be trained to use it (ADA.gov, Accessible Pools).
Older pools
Older public pools must also improve access. State and local government pool programs must be accessible, and businesses that are open to the public must remove barriers when it is “readily achievable” (ADA.gov, Accessible Pools).
Read more
If you believe you were treated unfairly because of a disability, you can file an ADA complaint with the U.S. Department of Justice (ADA.gov, File a Complaint). The ADA Information Line is 800-514-0301 (voice) or 1-833-610-1264 (TTY) (ADA.gov, Accessible Pools).
Lifts, ramps and steps
- Lift: a seat that lowers you into the water. Ask staff to show you how it works before your first visit.
- Sloped entry (ramp): you walk or roll in slowly. Some pools have a water wheelchair you can use on the ramp.
- Stairs with handrails: good if you can step with support.
Changing rooms: what to ask
- Is there a private or family changing room?
- Is there a shower with a seat and a grab bar?
- Is there room for a wheelchair and a helper?
- Is the floor non-slip, and how far is it to the pool?
What to bring
- A swimsuit you can move in, and a towel. A robe or cover-up for the walk to the pool.
- Water shoes, if you have them, for slippery floors.
- A water bottle. Warm water and deep immersion can mask thirst and raise dehydration risk, so drink water after your session (APTA Academy of Aquatic Physical Therapy, 2024 Aquatics Infographic; CDC: Heat and Athletes).
- Any medicine you might need during exercise, such as an inhaler, and your clinician’s instructions.
- A lock, a bag for wet things, and a change of clothes.
Staying safe
Talk to your own clinician before you start. Some health problems mean you should not use a pool, or should only use one with extra care. Your clinician checks this for you, one person at a time (Encyclopedia: Contraindications and precautions).
We do not list conditions here
This page does not list conditions that rule out pool use. Those lists are written for clinicians, they differ between guidance documents, and they need a professional to apply them. Your clinician will check your health, your medicines and whether the pool setting is appropriate before you start (APTA Standards of Practice for Physical Therapy; AAPT: Is Aquatic Therapy Right for My Patient?).
Simple ways to stay safe
- Tell staff about your health, including any recent changes, before you get in.
- If you are frail, ask your clinician first. A major osteoarthritis guideline advises against water exercise for frail people because of the risk of accidental injury (Bannuru et al., 2019).
- Heart failure: the research covers only people whose heart failure is stable. Ask your heart team before you start (Adsett et al., 2015).
- “No side effects reported” does not prove it is safe. Many studies do not report side effects at all (Aguilera-Eguía et al., 2026). Your clinician’s advice still comes first.
- Stop and tell staff right away if you feel dizzy, faint, short of breath, have chest pain or feel unwell (CDC: Heat and Athletes; ACOG: Exercise During Pregnancy — warning signs). Injuries are less likely when trained staff and safety equipment are present (CDC: Preventing Swimming-related Illnesses). Ask how you will get in and out of the pool (ADA.gov: Accessible Pools).
- Walk slowly on wet floors, and use handrails.
- Get out slowly. Your body can feel heavy when you leave the water. Sit down if you feel light-headed.
- Drink water after your session (CDC: Heat and Athletes).
Healthy swimming from CDC
- Stay out of the water if you have diarrhea (CDC, Preventing Swimming-related Illnesses, 2025).
- Shower before you get in. A one-minute shower removes most of the dirt, sweat and oils on your body (CDC, Preventing Swimming-related Illnesses, 2025).
- Don’t swallow the water. Even water that looks clean can have germs (CDC, Preventing Swimming-related Illnesses, 2025).
- If you have a cut or wound, ask your clinician first. If you do go in, cover it fully with a waterproof bandage (CDC, Preventing Swimming-related Illnesses, 2025).
- Children, pregnant women and people with weakened immune systems are most at risk from germs in the water (CDC, Preventing Swimming-related Illnesses, 2025).
Your first session
Knowing what to expect can make the first visit easier.
What usually happens
Your clinician asks about your health and goals and may test how you move on land first.
Read more
Then you will learn how to get in and out of the pool safely, and you will try some easy movements. The first session is often gentle.
Water temperature
Therapy pools are warm. UK guidance for hydrotherapy pools recommends 32–35.5°C (about 90–96°F), with 34–35°C (about 93–95°F) as the best range (ATACP guidance, 2021, amended 2025).
Read more
Community and fitness pools are usually cooler. Ask the pool what temperature to expect.
How it should feel
The water should feel supportive. Many people find moving easier than on land.
Read more
It is common to feel tired afterward. Warmer water (about 96°F) increases heart rate and cardiovascular demand, and exercise adds to that load (AAPT 2024 Aquatics Infographic). Tell your clinician if pain gets worse during or after a session, or lasts into the next day.
Paying for it
Not billing advice
This section is not billing advice. Coverage depends on your plan, your diagnosis and your clinician’s documentation. Ask your insurer and your clinic’s billing office for answers about your own plan.
Call the member number on your insurance card and ask:
- Does my plan cover physical or occupational therapy in a pool (aquatic therapy)?
- Do I need a referral, a prescription or prior approval first?
- How many therapy visits does my plan allow each year? Do pool visits count toward the same limit?
- What will I pay per visit: a copay, coinsurance or the full cost until I meet my deductible?
- Is the clinic I chose in my plan’s network?
- Does my plan help pay for a pool membership or community exercise classes after therapy ends?
Tip: Write down the date, the name of the person you spoke with and a reference number for the call.
Have Medicare? Read Does Medicare cover aquatic therapy? It explains, in plain words, when Medicare helps pay for therapy in a pool.
After discharge: keep the habit going
Therapy ends, but the benefits last longer when you keep moving. Ask your clinician for exercises you can continue on your own, and for water programs in your area that match your goals (CDC: Adult Activity Guidelines; CDC: Older Adult Activity).
Before your last visit
Ask your clinician for a written home or pool exercise plan.
Read more
- Which exercises should I keep doing, and how often?
- Which signs mean I should stop or call you?
- Which community programs would suit me?
Community options
Examples include general swim times, learn-to-swim lessons, disability swim clubs, water aerobics and gentle water exercise classes for long-term conditions.
Read more
Ask the pool if a class is suitable for your level, and tell the instructor about your health.
How much activity?
Adults need at least 150 minutes of moderate activity a week, such as 30 minutes a day, 5 days a week, plus 2 days of muscle-strengthening activity (CDC, Adult Activity: An Overview).
Read more
Adults 65 and older also need balance activities each week (CDC, Older Adult Activity: An Overview). Start where you are, and build up slowly with your clinician’s advice.
Tips that help the habit stick
- Pick a regular day and time, and put it on your calendar.
- Go with a friend or family member.
- Track one thing you care about, such as walking farther or sleeping better.
- If you miss a week, just go back. Any activity is better than none.
CDC notes that water-based exercise can improve quality of life and decrease disability in older adults (CDC, Swimming and Your Health, 2024).
For caregivers and families
Family members and caregivers often make pool visits possible. Here is how to help, and how to look after yourself too.
Helping safely
- Ask staff to show you how to help with transfers and the lift. Don’t lift alone if you have not been trained.
- Ask whether you are allowed, or expected, to be in the water.
- Keep an eye on children at all times. Kids can drown in seconds and in silence (CDC, Preventing Swimming-related Illnesses, 2025).
- Use a well-fitting, Coast Guard-approved life jacket if one is needed, not water wings (CDC, Preventing Swimming-related Illnesses, 2025).
Looking after yourself
- Plan travel and changing time so visits feel less rushed.
- Ask about family changing rooms.
- Some pools offer a free or reduced entry for a support person. Ask.
Free, trusted resources
Free websites from public agencies and research groups. Listed alphabetically. Linking is not endorsement.
ADA.gov: accessible pools
The U.S. Department of Justice explains the pool access rules in plain terms.
ADA.gov: file a complaint
Steps to report disability discrimination, including at a public pool.
CDC: physical activity basics
How much activity adults and older adults need each week.
CDC Healthy Swimming
How to avoid getting sick from pool water, with tips for families.
Cochrane plain language summaries
Easy-to-read summaries of systematic reviews, searchable by condition.
MedlinePlus
Free, easy-to-read information on health conditions from the U.S. National Library of Medicine.
Common questions
What is the For Participants page?
It is the Aquatic Therapy Foundation’s free, plain-language guide for patients, clients and families who use water for health. It explains what aquatic therapy is, what research published in 2024–2026 says about 34 conditions, how to find and get into a pool program, how to stay safe, and how to keep exercising after therapy ends.
What is the difference between aquatic therapy and aquatic fitness?
Aquatic therapy is skilled, goal-directed treatment in water from a licensed clinician, such as a physical therapist. Aquatic fitness is a water exercise class for people who can exercise on their own, led by a fitness instructor. Only aquatic therapy is medical treatment (Encyclopedia: Aquatic fitness).
Does research show that aquatic therapy works?
For some conditions, yes. Looking only at studies published in 2024–2026 in the Foundation’s Evidence Library, reviews support water exercise for knee osteoarthritis, fibromyalgia, balance after stroke, COPD, and balance and strength in older adults. For many other conditions the research is promising but limited, and for some there is too little research yet. Many earlier studies are not counted here and may add more support. See Research by condition.
Is aquatic therapy safe for me?
Only your own clinician can answer that. Before treatment, your clinician should examine and evaluate you as an individual and confirm the pool setting is appropriate for your plan of care (APTA Standards of Practice for Physical Therapy). This is general education, not medical advice; talk with your own clinician.
Do I need to know how to swim?
Usually not. Many aquatic therapy sessions take place in water shallow enough to stand in. Tell the staff if you cannot swim or feel nervous in water, so they can plan for it.
Does a public pool have to let me in if I use a wheelchair?
Under the ADA, newly built and altered public pools must have accessible ways to get in and out, such as a pool lift or sloped entry, and lifts must be working whenever the pool is open. Existing pools must also improve access (ADA.gov, Accessible Pools).
Will insurance pay for aquatic therapy?
It depends on your plan. Ask your insurer whether pool-based physical or occupational therapy is covered, whether you need a referral, and how many visits are allowed. The questions in Paying for it can help. This is not billing advice.
How do I keep going after therapy ends?
Ask your clinician for a written exercise plan and for community programs that suit you. Adults need at least 150 minutes of moderate activity a week plus 2 days of muscle strengthening, and adults 65 and older also need balance activities (CDC, Adult Activity: An Overview; CDC, Older Adult Activity: An Overview).
How do I report an error or suggest a resource?
Email info@aquatictherapyfoundation.org. Tell us the page, the section and the source you suggest.
How to cite this page
Last reviewed October 22, 2026 · Permanent URL: https://aquatictherapyfoundation.org/for-participants/
How to cite
Salzman, A. (Ed.). (2026). For participants. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-participants/
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. Public guidance comes first, then the research papers in the order of the condition cards. External information was checked on October 19, 2026.
Show all 67 references
- Aquatic Therapy Association of Chartered Physiotherapists (ATACP). Guidance on Aquatic Physiotherapy Practice 2021 (amended March 3, 2025). UK professional guidance (retained for the therapy-pool temperature band on this page). Accessed October 19, 2026. ATACP guidance (PDF)
- APTA Academy of Aquatic Physical Therapy. 2024 Aquatics Infographic. Accessed October 24, 2026. aquaticpt.org (PDF)
- American Physical Therapy Association. Standards of Practice for Physical Therapy. Accessed October 24, 2026. apta.org (PDF)
- Centers for Disease Control and Prevention. Heat and athletes. Heat Health. Accessed October 24, 2026. cdc.gov
- American College of Obstetricians and Gynecologists. Exercise during pregnancy. FAQ. Accessed October 24, 2026. acog.org
- APTA Academy of Aquatic Physical Therapy. Is Aquatic Therapy Right for My Patient? PathLMS course. Accessed October 24, 2026. pathlms.com/aapt
- 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 19, 2026. ada.gov
- U.S. Department of Justice, Civil Rights Division. File a complaint. ADA.gov. Accessed October 19, 2026. ada.gov
- Centers for Disease Control and Prevention. Preventing swimming-related illnesses. Healthy Swimming. June 6, 2025. Accessed October 19, 2026. cdc.gov
- Centers for Disease Control and Prevention. Swimming and your health. Healthy Swimming. May 8, 2024. Accessed October 19, 2026. cdc.gov
- Centers for Disease Control and Prevention. Adult activity: an overview. Physical Activity Basics. Accessed October 19, 2026. cdc.gov
- Centers for Disease Control and Prevention. Older adult activity: an overview. Physical Activity Basics. Accessed October 19, 2026. cdc.gov
- Cochrane. Our evidence: plain language summaries. Accessed October 19, 2026. cochrane.org
- National Library of Medicine. Learn about MedlinePlus. Accessed October 19, 2026. medlineplus.gov
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- Alikhajeh Y, Afroundeh R, Mohammad Rahimi GR, Bayani B. The effects of aquatic exercise training on functional and hemodynamic responses in patients with heart failure: a systematic review and meta-analysis. Biol Res Nurs. 2025;27(1):127-141. doi: 10.1177/10998004241263943 PMID 38904085
- Silva CT, Silva CK, Casonatto J, et al. Effects of aquatic exercises in woman who have undergone surgery after breast cancer: a systematic review with meta-analysis. Braz J Phys Ther. 2025;29(5):101230. doi: 10.1016/j.bjpt.2025.101230 PMID 40633233
- Chen G, He J, Wan T, Ruan H. Comparative effectiveness of exercise modalities for gestational blood pressure and gestational hypertension: a network meta-analysis of randomized trials. Pregnancy Hypertens. 2026;46:101522. doi: 10.1016/j.preghy.2026.101522 PMID 42710170
- Reichert T, Silva LL, Freitas AKF, et al. The role of aquatic training in improving risk of falls in older adults: a systematic review with meta-analysis and meta-regression. J Aging Phys Act. Published online August 14, 2026:1-17. doi: 10.1123/japa.2025-0083 PMID 42603704
- Ding Z, Gao Z, Zhou H, Park J. Effects of water aerobics on body composition in obesity and overweight people: a systematic review and meta-analysis. BMJ Open. 2025;15(3):e091743. doi: 10.1136/bmjopen-2024-091743 PMID 40068888
- Pereira JN, Ferreira FA, Costa Lima V. Effects of aquatic exercise on type 2 diabetes management in adulthood: a systematic review and meta-analysis, including evidence on the use of wearable devices. Healthcare (Basel). 2026;14(8):998. doi: 10.3390/healthcare14080998 PMID 42072899
- Alrashedi SN, Fahmy EK, Eladl HM, et al. The role of hydrotherapy in enhancing recovery after knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Healthcare (Basel). 2026;14(13):2005. doi: 10.3390/healthcare14132005 PMID 42451015
- Centurião JHVM, Obara K, Silva CT, et al. Effects of aquatic exercises in patients after total hip arthroplasty: a systematic review. Physiother Res Int. 2024;29(1):e2043. doi: 10.1002/pri.2043 PMID 37602930
- Chang P, Wang H, Zhang J, et al. Effect of aquatic exercise on blood pressure and related physiological indicators in hypertensive patients: a systematic meta-analysis of randomized controlled trials. Front Physiol. 2026;17:1876479. doi: 10.3389/fphys.2026.1876479 PMID 42523585
- England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2023;75(8):1603-1615. doi: 10.1002/acr.25117 PMID 37227116
- Medrado LN, Mendonça MLM, Budib MB, Oliveira-Junior SA, Martinez PF. Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: systematic review. Rheumatol Int. 2022;42(10):1681-1691. doi: 10.1007/s00296-022-05145-w PMID 35633390
- Al-Qubaeissy KY, Fatoye FA, Goodwin PC, Yohannes AM. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal Care. 2013;11(1):3-18. doi: 10.1002/msc.1028 PMID 22806987
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2019;71(10):1285-1299. doi: 10.1002/acr.24025 PMID 31436026
- Liang Z, Fu C, Zhang Q, et al. Effects of water therapy on disease activity, functional capacity, spinal mobility and severity of pain in patients with ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil. 2021;43(7):895-902. doi: 10.1080/09638288.2019.1645218 PMID 31355676
- Liu Z, Zhang X, Yan S, et al. Effects of Aquatic Therapy on Gait Symmetry and Muscle Properties Following Anterior Cruciate Ligament Reconstruction: A Pilot Randomized Controlled Trial. J Sport Rehabil. 2026;35(3):207-216. doi: 10.1123/jsr.2024-0128 PMID 40701190
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- Campos DM, Ferreira DL, Gonçalves GH, Farche ACS, de Oliveira JC, Ansai JH. Effects of aquatic physical exercise on neuropsychological factors in older people: A systematic review. Arch Gerontol Geriatr. 2021;96:104435. doi: 10.1016/j.archger.2021.104435 PMID 34030045
- Ballaz L, Varcin F, Hammad R, et al. Aquatic training improves muscle strength and functional mobility in adults with myotonic dystrophy type 1: a pilot randomized trial. Neuromuscul Disord. 2026;65:106485. doi: 10.1016/j.nmd.2026.106485 PMID 42398272
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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. ATU teaches some of the methods described in the Encyclopedia. This page does not sell, rank or recommend any course, credential or product, and ATF does not endorse any program.
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.
Corrections and questions
If you spot an error or an outdated link, or want to suggest a free public resource for patients and families, 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 official sources on October 19, 2026, and may have changed since then. This page is general education. It is not medical advice. Talk with your own clinician before you start or change any exercise program.
Author: 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.
Competing interests: The author 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 methods mentioned in the Encyclopedia are labeled [Expert opinion] and are not rated as evidence. ATF has a conflict-of-interest policy.