ATF · FOR RESEARCHERS AND FACULTY
For Researchers
A free reference page for researchers, faculty and graduate students who study aquatic therapy and aquatic exercise: how the Foundation’s Evidence Library is built, how to use the Aquatic Therapy Encyclopedia™, where the research gaps are, how to cite and reuse our material, and how to suggest a paper.
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education. See competing-interest statement.
Last reviewed: October 19, 2026
How to cite this page
How to cite
Salzman, A. (Ed.). (2026). For researchers. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-researchers/
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 a section. Each section states its sources and the date it was checked.
Key facts (checked October 19, 2026)
- The Foundation’s Evidence Library (also called the Aquatic Therapy Hot List™) is a free, searchable list of English-language research on aquatic therapy, mainly peer-reviewed journal articles. The current beta covers more than 600 papers published in 2024–2026, and more years are being added.
- A paper is included when aquatic work is a substantive part of the study. Listing a paper is not an endorsement, and the Foundation did not conduct the studies.
- Outcome measures, sample size, intervention and key finding are taken from the PubMed abstract or, when a free full text is available, from its Methods. Each is labelled with its source, nothing is inferred, and “Not stated” is shown when the source does not say.
- The free Aquatic Therapy Encyclopedia™ (version 0.1, beta) has 42 entries available and 91 more listed as coming soon. Every statement carries an evidence label: [Verified], [Needs verification] or [Expert opinion].
- On the For Participants page, 34 conditions are rated from Evidence Library papers and then checked against systematic reviews and guidelines from any year: 4 “Research supports it,” 21 “Some research supports it” and 9 “Too little research yet.” The research gaps list 17 condition questions and 12 gaps that published reviews name themselves.
- You may quote and cite Foundation pages with attribution. Reproducing the Evidence Library or its tagging system, or full Encyclopedia entries, requires written permission from ATU Educational Services, LLC.
How the Evidence Library is built
The Evidence Library is the Foundation’s free list of published research on aquatic therapy. It is a starting point for finding studies, not a systematic review and not a complete search.
What is included
- English-language research on aquatic therapy, mainly peer-reviewed journal articles.
- A paper is included when aquatic work is a substantive part of the study.
- The list also holds protocols and registered trials, case reports, qualitative studies, theses and dissertations, and a few books. Protocols and registered trials, and a few theses and books, show only when you pick their type.
- Drowning prevention papers focus on people with disabilities. General drowning papers are not included.
Date range
This beta covers papers published in 2024–2026, and more years are being added.
Read more
With records current as of October 22, 2026, the list showed 633 papers. Older studies exist and are not yet in the list, so an absence in the Library is not an absence in the literature.
What each record shows
- Title, authors, year, journal and a link (DOI or PubMed), plus a free full-text link when one exists.
- Outcome measures, sample size, intervention and a key finding. These come from the PubMed abstract or, when a free full text was available, from its Methods. Each is labelled with its source, nothing is inferred, and “Not stated” is shown when the source does not say.
- The key finding is a sentence quoted from the abstract’s conclusion.
- A Profession tag appears only when the title or abstract names that profession.
What it is not
- It is for education, not medical advice.
- The Aquatic Therapy Foundation did not conduct these studies, and listing a paper is not an endorsement.
- It is not a substitute for a documented, reproducible database search. A thesis or review still needs its own search of databases such as PubMed/MEDLINE, CINAHL and PEDro.
- Always read and cite the original study, not the Evidence Library entry.
Search tips
- Search box: search by topic, author, journal, DOI or outcome measure, then press Search or Enter. Sort by best match, newest or oldest, or click a column heading.
- Quick starts: “Find high quality studies” shows randomized trials with a PEDro score above 5/10. Other quick starts show safety and adverse effects, drowning prevention, free full text, and the newest papers.
- Filters: type of paper, condition or population, outcome measure, profession and year. “Limit to only clinical populations” hides studies of healthy or general-population participants. “Hide passing mentions” hides papers that mention water-based exercise only in passing.
- Record details: click the arrow at the start of a title to see study type, population and notes. Use Columns to add fields such as PMID, DOI, evidence grade, sample size or the quoted key finding.
- Shareable searches: a search can be linked directly by adding
?q=and your term to the address, for example evidence-library/?q=heart failure. Every “Search the Library” button on this page works this way. Results change as papers are added.
About the PEDro cutoff. PEDro scores in the Library come from the PEDro database; they were not rated by the Foundation. The above-5/10 cutoff is a convenient threshold chosen for this list, not a validated quality threshold. PEDro itself states that its score bands have not been validated, and for complex interventions such as exercise, 8/10 is the practical maximum because therapists and participants usually cannot be blinded (Cashin and McAuley, J Physiother, 2020). Appraise each trial yourself.
How the condition ratings are made
The For Participants page gives a plain-language rating for 34 conditions. This is how those ratings are made, so you can check or challenge them.
- Source: only papers in the Foundation’s Evidence Library (the 2025–2026 beta, which held 361 English-language papers when the ratings were last checked on October 19, 2026). Older research exists and is not counted.
- Check: each rating is then compared with systematic reviews, meta-analyses and clinical guidelines from any year, and raised or lowered where they disagree (first done October 2026). The For Participants cards name the reviews checked.
- Weighting: the most weight goes to systematic reviews and meta-analyses. Single trials that scored above 5 out of 10 on the PEDro scale are also considered.
- Reading: each review’s own conclusion is used, including how certain its authors said they were. When in doubt, the lower rating is chosen.
- Linking: each condition links to one key paper with its DOI and to a live Evidence Library search, which changes as papers are added.
●●● Research supports it
At least three research reviews in the 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 research review found a benefit, but the studies are small, mixed or low in certainty.
●○○ Too little research yet
There is no strong research review for this condition yet. This does not mean water exercise does not help; it means the question is open.
Ratings were last checked on October 19, 2026: 4 conditions rated “Research supports it,” 21 “Some research supports it” and 9 “Too little research yet.” These are educational summaries for the public, not a formal certainty-of-evidence grading such as GRADE.
The Aquatic Therapy Encyclopedia™
The free Aquatic Therapy Encyclopedia™ gives plain-language definitions, sources and search links for aquatic therapy techniques, concepts and terms. It is in beta (version 0.1): 42 entries are available now and 91 more are listed as coming soon, with entries growing through 2026 and 2027.
Evidence labels
- [Verified]: the cited source was located and supports the statement as worded.
- [Needs verification]: a source is named or a draft is written, but it has not been confirmed.
- [Expert opinion]: practitioner teaching material with no outside support.
Labels show how well a statement is sourced. They are not a grade of clinical effectiveness.
Core and short entries
Core entries have resource and reference lists. Short entries start with a short Encyclopedia definition and a link to search the Evidence Library; full entries are planned for 2027.
Read more
Core entries now: Ai Chi, Bad Ragaz Ring Method, Halliwick Concept, Watsu, Aquatic cognitive-motor training and Aquatic therapy terminology.
Linked to the Library
Every entry links to an Evidence Library search for its term, using alternate names where helpful.
Read more
Use an entry to settle terminology for a protocol or review, then follow its search link to the studies.
Citing an entry: use the “Cite this entry” row on the entry’s page and cite the version you used, because beta entries change.
Research gaps: open questions
These 29 open questions come from 17 conditions rated on the For Participants page and from 12 gaps that published reviews name themselves. The gaps come from 2024–2026 studies, checked against systematic reviews and clinical guidelines from any year (October 2026). Each condition card names the key paper behind the rating, the reviews that call for the research, and a live Evidence Library search.
Read these as starting points, not conclusions. They are not a research agenda set by the Foundation. Seven questions were narrowed because reviews already answer part of them. Search the wider literature and trial registries before you plan a study.
Too little research yet (2 conditions)
Spinal cord injury
●○○ Too little research yet
Open question: Beyond feasibility and acceptability, do randomized trials show that aquatic programs improve gait and balance in subacute incomplete spinal cord injury?
Plain-language summary on For Participants: 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 (non-randomized trial): Menchero et al., Journal of Spinal Cord Medicine, 2025
Reviews that call for it: Evidence of benefit is weak, and only 3 randomized trials could be analysed (Li et al., 2017; Palladino et al., 2023).
Dementia, memory and thinking
●○○ Too little research yet
Open question: Does aquatic exercise improve cognition, function or quality of life in people living with dementia, not only in older adults without dementia?
Plain-language summary on For Participants: 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
Reviews that call for it: No systematic review of aquatic programs in people living with dementia was found. A 2024 narrative review of land and water aerobic activity in Alzheimer’s disease draws on animal and patient studies and notes that “implementing exercise protocols for patients is challenging” (Gelfo et al., 2024). Reviews call for studies across severity levels (Song et al., 2026; Jaana et al., 2026; Campos et al., 2021).
Some research supports it (15 conditions)
Rheumatoid and other inflammatory arthritis
●●○ Some research supports it
Open question: Can the fitness gains seen after 12 weeks of aquatic high-intensity interval training in rheumatic and musculoskeletal diseases be kept beyond 6 months, and what helps people keep them?
Plain-language summary on For Participants: 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
Reviews that call for it: Short-term benefits are reported, but long-term effects are unknown and certainty is low to moderate (Al-Qubaeissy et al., 2013; Verit et al., 2026; England et al., 2023, the 2022 American College of Rheumatology (ACR) guideline).
Ankylosing spondylitis
●●○ Some research supports it
Open question: In adequately powered head-to-head trials, how does aquatic exercise compare with land-based physical therapy for function and spinal mobility in axial spondyloarthritis? Pooled small trials show effects on pain and disease activity only.
Plain-language summary on For Participants: 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 2019 ACR guideline, so ask your care team.
Key review: Kong et al., PeerJ, 2025
Reviews that call for it: Pooled trials show pain and disease-activity effects only, and the guideline prefers land-based therapy (Liang et al., 2021; Ward et al., 2019, the 2019 spondyloarthritis guideline from the ACR and two spondylitis research groups).
Hip osteoarthritis
●●○ Some research supports it
Open question: Does aquatic exercise improve pain and function in hip osteoarthritis when people with hip osteoarthritis are studied, or reported, separately from those with knee osteoarthritis?
Plain-language summary on For Participants: 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
Reviews that call for it: Hip-only aquatic data are scarce, and the 2019 osteoarthritis guideline from the Osteoarthritis Research Society International (OARSI) does not recommend aquatic exercise for hip osteoarthritis (Bartels et al., 2016 (Cochrane review); Beumer et al., 2016; Bannuru et al., 2019, the OARSI osteoarthritis guideline).
Long-lasting low back pain
●●○ Some research supports it
Open question: Which aquatic exercise types, doses and combinations work best for chronic low back pain, and what do they add to multimodal care? Reviews point to benefit, but certainty is low or very low.
Plain-language summary on For Participants: 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
Reviews that call for it: Effects consistently point to benefit, at low or very low certainty (Wu et al., 2026; Babiloni-Lopez et al., 2024).
Parkinson’s disease
●●○ Some research supports it
Open question: Under matched dosing, how does aquatic exercise compare with land exercise in Parkinson’s disease? What dose works best, and do gains last or carry over to activity and participation?
Plain-language summary on For Participants: 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
Reviews that call for it: Balance benefits look similar to or greater than land, but activity and participation effects, dosing and long-term effects are unclear (Santamaría et al., 2025; Braz de Oliveira et al., 2024; Liu et al., 2023; Carroll et al., 2020). A 2024 Cochrane network meta-analysis found “little evidence of differences” between exercise types and states: “Larger, well-conducted studies are needed to increase confidence in the evidence” (Ernst et al., 2024 (Cochrane review)).
Multiple sclerosis
●●○ Some research supports it
Open question: Do larger trials confirm the effects of aquatic therapy on fatigue, mobility and quality of life in multiple sclerosis?
Plain-language summary on For Participants: 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
Reviews that call for it: Small trials show positive effects, and reviews call for larger, better-reported trials (Santamaría et al., 2026; Shariat et al., 2022; Amedoro et al., 2020; Chauhan, 2024).
Cerebral palsy
●●○ Some research supports it
Open question: Aquatic and land exercise give similar gross motor results in children and adolescents with cerebral palsy. Which children gain more from one than the other, and do the gains last?
Plain-language summary on For Participants: 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
Reviews that call for it: Gross motor results are comparable to land (low-quality evidence), and dose and follow-up are not standardized (Pauluka et al., 2025; Roostaei et al., 2017; Liberchuk Ferreyra and De Larrosa, 2024).
Autism
●●○ Some research supports it
Open question: Do rigorously designed trials confirm the behavioural and social benefits of aquatic activities for children with autism?
Plain-language summary on For Participants: 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
Reviews that call for it: Studies have a high risk of bias, and only one trial used a land-based comparator (Zhao et al., 2026; Shariat et al., 2024; Ghuntla and Dholakiya, 2024).
Heart failure and heart disease
●●○ Some research supports it
Open question: Do larger trials confirm improvements in exercise capacity and haemodynamic measures after aquatic exercise training in heart failure?
Plain-language summary on For Participants: 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
Reviews that call for it: Studies are small and cover clinically stable patients, and immersion safety data are inconclusive (Alikhajeh et al., 2025; Shah et al., 2017; Adsett et al., 2015).
Breast cancer and lymphedema
●●○ Some research supports it
Open question: What are the effects of aquatic exercise on limb volume and lymphedema after breast cancer, and can higher-quality trials firm up the reported effects on pain, fatigue and quality of life?
Plain-language summary on For Participants: 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
Reviews that call for it: Effects on lymphedema are uncertain, with no advantage over land shown (Aguilera-Eguía et al., 2026; Yeung and Semciw, 2018; Silva et al., 2025; Muñoz-Gómez et al., 2022; Solanki and Gahlot, 2024 (conference abstract)).
Pregnancy
●●○ Some research supports it
Open question: Does aquatic exercise during pregnancy lower gestational blood pressure or the risk of gestational hypertension? In the network meta-analysis cited here, only two trials tested it.
Plain-language summary on For Participants: 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
Reviews that call for it: Other pregnancy outcomes are better studied, but only two trials tested blood pressure (Chen et al., 2026; Cancela-Carral et al., 2022).
Overweight and obesity
●●○ Some research supports it
Open question: Programs of water aerobics longer than about 10 weeks, at moderate or higher intensity, appear to reduce body weight and waist size. Which lengths and intensities produce clinically meaningful changes that last?
Plain-language summary on For Participants: 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
Reviews that call for it: Certainty is moderate only for weight and waist size, and long-term maintenance is unknown (Ding et al., 2025; Zhu et al., 2023).
Type 2 diabetes
●●○ Some research supports it
Open question: Aquatic and land exercise improve glycaemic control by similar amounts. For which adults with type 2 diabetes is aquatic exercise the better choice, and why?
Plain-language summary on For Participants: Water exercise may improve blood sugar control about as much as land exercise.
Key review: Pereira et al., Healthcare, 2026
Reviews that call for it: Glycaemic effects are similar to land, heterogeneity is high, and no review examines which patients benefit more (Pereira et al., 2026; Rees et al., 2017).
Knee or hip replacement
●●○ Some research supports it
Open question: Is aquatic therapy after hip replacement effective, how early can it safely start, and is it cost-effective? Only 3 randomized trials cover hip replacement.
Plain-language summary on For Participants: After knee replacement, water therapy eased pain about as well as land exercise and built more leg strength. Few studies look at hip replacement.
Key review: Alrashedi et al., Healthcare, 2026
Reviews that call for it: One review covers 3 randomized trials after hip replacement, early aquatic therapy did not increase wound complications, and economic analysis is needed (Centurião et al., 2024; Villalta and Peiris, 2013; Gibson and Shields, 2015).
High blood pressure
●●○ Some research supports it
Open question: Do high-quality randomized trials confirm that aquatic exercise lowers blood pressure in hypertension, given that study quality varies?
Plain-language summary on For Participants: Water exercise may lower blood pressure. Study quality varies, so more research is needed.
Key review: Chang et al., Frontiers in Physiology, 2026
Reviews that call for it: Pooled trials show reductions, but study quality is mixed and reviews call for high-quality randomized trials (Rodríguez-Otero et al., 2026; Chang et al., 2026; Igarashi and Nogami, 2018).
Gaps the reviews name themselves (12 questions)
Long-term follow-up
Open question: Do the benefits of aquatic programs last after the program ends? Few trials follow people beyond the end of the program, and effects may fade.
Reviews that call for it: Duan et al., 2022; Al-Qubaeissy et al., 2013; Liu et al., 2023; McNamara et al., 2013 (Cochrane review); Tedeschi et al., 2024.
Standard protocols and dose reporting
Open question: What aquatic exercise prescription works best, and can trials report dose in full so results can be compared and repeated? Reviews in stroke, Parkinson’s disease, cerebral palsy, joint surgery and lower-limb osteoarthritis call for this.
Reviews that call for it: Manning et al., 2023; Leveck et al., 2025; Carroll et al., 2020; Alrashedi et al., 2026; Zhou et al., 2026; Liberchuk Ferreyra and De Larrosa, 2024; Theresia and Rahman, 2024.
Reporting side effects
Open question: Is aquatic exercise safe and feasible for each group studied? Many trials do not report side effects, and the absence of reported adverse events does not confirm safety.
Reviews that call for it: Terrens et al., 2018; Aguilera-Eguía et al., 2026.
Frail older adults
Open question: Can adapted aquatic programs be safe and helpful for people with frailty? The OARSI guideline does not recommend aquatic exercise for frailty because of the risk of accidental injury, and no review has tested adapted programs in this group.
Reviews that call for it: Bannuru et al., 2019, the OARSI osteoarthritis guideline.
Severe stroke
Open question: Does aquatic therapy help people with severe impairment after stroke? Trials mostly enrol people with mild to moderate impairment, and reviews also call for qualitative studies.
Reviews that call for it: Manning et al., 2023.
Lymphedema in the legs
Open question: Does aquatic therapy help lower-limb lymphedema? Trials so far are in arm lymphedema after breast cancer.
Reviews that call for it: Yeung and Semciw, 2018.
Adolescents and adults with cerebral palsy
Open question: How does aquatic therapy work for adolescents and adults with cerebral palsy, including from their own point of view?
Reviews that call for it: Huf et al., 2026.
Coronary artery disease
Open question: A 2024 network meta-analysis found that water-based exercise improved peak oxygen consumption in coronary heart disease, but it reported quality-of-life and mortality benefits only for other exercise types. Does water-based exercise improve quality of life and longer-term outcomes in coronary artery disease?
Reviews that call for it: Faíl et al., 2022; Gomes-Neto et al., 2024.
Counting falls, not only fall risk
Open question: Does aquatic training reduce falls and injurious falls in older adults? Reviews mostly measure balance and strength (fall risk factors), and certainty is low or very low. Balance and falls in older adults is now rated “Some research supports it” on For Participants.
Reviews that call for it: Reichert et al., 2026; Buitrago-Restrepo et al., 2024; Melo et al., 2023.
Cost-effectiveness
Open question: Are aquatic programs cost-effective, for example alongside joint-replacement trials? A review calls for economic analysis.
Reviews that call for it: Gibson and Shields, 2015.
Older adults in long-stay care
Open question: Does aquatic therapy help older adults who live in long-stay care, and older adults with different levels of cognitive impairment? No reviewed study was done in long-stay care.
Reviews that call for it: Sarmento Gda et al., 2011; Jaana et al., 2026.
Daily activity and participation in Parkinson’s disease
Open question: Do aquatic programs improve daily activities and participation in Parkinson’s disease, not only balance? Current trials show balance effects but no clear activity or participation effects.
Reviews that call for it: Braz de Oliveira et al., 2024.
Questions that cut across conditions
- Aquatic or land? For several conditions, including knee osteoarthritis, cerebral palsy, balance in older adults, type 2 diabetes and knee replacement, the key reviews report results similar to land exercise. When outcomes are similar, what should decide the setting: adherence, access, cost, preference or safety?
- How long do benefits last? In the AquaHigh trial, the fitness gain after 12 weeks was gone at 6 months (Bunæs-Næss et al., 2025). Few studies report long-term follow-up.
- Bigger and better-reported trials. A “Some research supports it” rating means the studies are small, mixed or low in certainty. Adequately powered trials that fully describe the water program (see Reporting tools) would help most conditions on this list.
Plan and report a study
Free tools that help aquatic studies get found, compared and replicated.
Check what already exists
Search the peer-reviewed literature and thesis databases with the same terms, and keep a record of your searches. Check registries for planned or ongoing work: PROSPERO or the Open Science Framework for reviews, ClinicalTrials.gov for trials.
Report the design
Use the reporting guideline that fits your design, such as PRISMA for systematic reviews or the CONSORT extension for pilot and feasibility trials. The EQUATOR Network lists them all.
Describe the water program
TIDieR is a checklist for describing any intervention so others can replicate it (Hoffmann et al., BMJ, 2014). CERT is a template for reporting exercise programs (Slade et al., Br J Sports Med, 2016).
More tools for students, including outcome-measure databases and thesis repositories, are on the For Students page.
Cite and reuse
Cite the original study whenever you can. Cite the Evidence Library or the Encyclopedia only when you refer to the resource itself, for example in a methods section, and always include the date you accessed it.
The Evidence Library
Salzman, A. (Ed.). (2026). Evidence Library (Hot List™). ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/evidence-library/
Permissions: You may cite this list with attribution. Reproducing the list or its tagging system requires written permission from ATU Educational Services, LLC.
The Encyclopedia
Salzman, A. (Ed.). (2026). Aquatic Therapy Encyclopedia™. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/encyclopedia/
Permissions: You may quote and cite this content with attribution. Reproducing or adapting full entries or the Encyclopedia requires written permission from ATU Educational Services, LLC. Cite the version you used.
This page
Salzman, A. (Ed.). (2026). For researchers. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-researchers/
Permissions: You may quote and cite this page with attribution. Reproducing or adapting the full page requires written permission from ATU Educational Services, LLC.
- Cited third-party works, including the studies listed in the Evidence Library, keep their own copyright and licenses.
- Key findings in the Library are quoted from each paper’s abstract. When you quote one, cite the paper, not the Library.
- To ask for written permission, for example to reproduce the list, its tagging system or a full Encyclopedia entry in a publication, course or dataset, email info@aquatictherapyfoundation.org.
Suggest a paper
Know a study that belongs in the Evidence Library, or spotted an error in a record? Email info@aquatictherapyfoundation.org. We review every suggestion.
What the Library includes
- English-language research on aquatic therapy, mainly peer-reviewed journal articles.
- Aquatic work is a substantive part of the study, not a passing mention.
- Published in 2024, 2025 or 2026 for this beta. Earlier years are being added, so older papers are welcome too.
- Drowning prevention papers about people with disabilities. General drowning papers are not included.
What to send
- The title, authors, journal and year.
- The DOI or PubMed ID (PMID).
- One sentence on the aquatic part of the study.
- If you are an author of the paper, please say so.
Reporting an error
- The paper’s DOI or title.
- The field that looks wrong, such as sample size or outcome measures.
- The page or section of the paper that shows the correct value.
Suggestions are reviewed against the criteria above. A suggestion is not guaranteed to be added, and listing a paper is not an endorsement.
Common questions
What is the For Researchers page?
It is the Aquatic Therapy Foundation’s free reference page for researchers, faculty and graduate students. It explains how the Evidence Library is built and searched, how the condition ratings on For Participants are made, how to use the Aquatic Therapy Encyclopedia™, which research questions are still open, how to cite and reuse Foundation material, and how to suggest a paper.
Can I use the Evidence Library as the search for my systematic review?
No. Use it as a starting point. A thesis or review needs its own documented, reproducible search of databases such as PubMed/MEDLINE, CINAHL and PEDro. The Library’s beta also covers only 2024–2026.
Which papers does the Evidence Library include?
English-language research on aquatic therapy, mainly peer-reviewed journal articles, in which aquatic work is a substantive part of the study. The beta covers papers published in 2024–2026; with records current as of October 22, 2026, it listed 633 papers. Drowning prevention papers focus on people with disabilities.
Where do the PEDro scores come from?
From the PEDro database. They were not rated by the Foundation. The above-5/10 cutoff used by the “Find high quality studies” quick start is a convenient threshold, not a validated one (Cashin and McAuley, J Physiother, 2020).
How are the condition ratings on For Participants made?
From Evidence Library papers (2025–2026), giving the most weight to systematic reviews and meta-analyses and choosing the lower rating when in doubt. Each rating is then checked against systematic reviews and guidelines from any year. See How the condition ratings are made.
How do I cite the Evidence Library or the Encyclopedia?
Cite the original study whenever you can. To cite the resource itself, use the citations in Cite and reuse and add the date you accessed it. For an Encyclopedia entry, use the “Cite this entry” row on its page and cite the version you used.
Can I reproduce the list, its tags or an Encyclopedia entry?
You may quote and cite with attribution. Reproducing the Evidence Library or its tagging system, or reproducing or adapting full Encyclopedia entries, requires written permission from ATU Educational Services, LLC. Email info@aquatictherapyfoundation.org.
Does listing a paper mean the Foundation endorses it?
No. The Foundation did not conduct these studies, and listing a paper is not an endorsement.
How do I suggest a paper or report an error?
Email info@aquatictherapyfoundation.org with the title, authors, journal, year and DOI or PMID. See Suggest a paper.
How to cite this page
Last reviewed October 19, 2026 · Permanent URL: https://aquatictherapyfoundation.org/for-researchers/
How to cite
Salzman, A. (Ed.). (2026). For researchers. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. https://aquatictherapyfoundation.org/for-researchers/
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 published source cited on this page, in AMA style: methods and reporting papers first, then the key papers behind the research-gap cards in card order. Foundation pages were checked on October 19, 2026.
Show all 66 references
- Cashin AG, McAuley JH. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. J Physiother. 2020;66(1):59. doi: 10.1016/j.jphys.2019.08.005 PMID 31521549
- Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. doi: 10.1136/bmj.g1687 PMID 24609605
- Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50(23):1428-1437. doi: 10.1136/bjsports-2016-096651 PMID 27707738
- Zhou W, Yan Y, Zhou H, et al. Effects of aquatic exercise on pain and physical function in overweight/obese patients with lower limb osteoarthritis: a systematic review and meta-analysis. Front Physiol. 2026;17:1864401. doi: 10.3389/fphys.2026.1864401 PMID 42389754
- Wu H, Diao P, Del Coso J, et al. In water or on land? A network meta-analysis of aquatic and land-based exercise interventions for pain and disability in chronic lower back pain. Front Med (Lausanne). 2026;13:1739263. doi: 10.3389/fmed.2026.1739263 PMID 41704683
- Bunæs-Næss H, Heywood SE, Kvæl LAH, et al. Effects of aquatic high-intensity interval training on aerobic capacity in adults with rheumatic and musculoskeletal diseases: the AquaHigh randomised controlled trial. BMJ Open. 2025;15(3):e090612. doi: 10.1136/bmjopen-2024-090612 PMID 40132852
- Kong L, Yu C, Wang C, Meng Z. Comparative efficacy of different exercise interventions in patients with ankylosing spondylitis: a systematic review and network meta-analysis. PeerJ. 2025;13:e20336. doi: 10.7717/peerj.20336 PMID 41321953
- Seyedahmadi M, Ebrahimi Atri A, Akbari H, Sahebozamani M. Can water exercise improve motor function in Parkinson’s disease more than land exercise? A systematic review and meta-analysis. Physiother Res Int. 2025;30(3):e70088. doi: 10.1002/pri.70088 PMID 40650396
- Santamaría G, Jiménez-Callejo E, Rodríguez López N, et al. Effects of aquatic therapy on fatigue, mobility, physical function, and quality of life in people with multiple sclerosis: a systematic review and meta-analysis. J Funct Morphol Kinesiol. 2026;11(2):219. doi: 10.3390/jfmk11020219 PMID 42346748
- Menchero R, Martínez-Galán I, Alcobendas-Maestro M, et al. Feasibility and impact of a Water Specific Therapy program in individuals with subacute incomplete spinal cord injury: a non-randomized controlled trial. J Spinal Cord Med. 2025;48(6):997-1005. doi: 10.1080/10790268.2025.2472098 PMID 40163138
- Pauluka E, Ceolin LS, Fontanela LC, et al. Aquatic compared with land-based exercises on gross motor function of children/adolescents with cerebral palsy: a systematic review with meta-analysis. Child Care Health Dev. 2025;51(1):e70023. doi: 10.1111/cch.70023 PMID 39688349
- Xin X, Guo Y, Qi Z, et al. Effects of aquatic exercise on symptoms, behaviors, and motor function in children with autism spectrum disorder: a systematic review and meta-analysis. Front Behav Neurosci. 2026;20:1927011. doi: 10.3389/fnbeh.2026.1927011 PMID 42656763
- Song J, Ma Z, Luo B, et al. Comparative efficacy of different aquatic exercise modalities on cognitive function in the elderly: a systematic review and network meta-analysis. J Sports Sci Med. 2026;25(2):381-394. doi: 10.52082/jssm.2026.381 PMID 42318267
- 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
- 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
- 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
- Al-Qubaeissy KY, Fatoye FA, Goodwin PC, et al. 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
- Verit G, Anwar D, Greenberg M, et al. Effects of Hydrotherapy on Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis. Pediatr Phys Ther. 2026;38(1):20-30. doi: 10.1097/PEP.0000000000001256 PMID 40982358
- 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
- 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
- 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
- Li C, Khoo S, Adnan A. Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: A systematic review. Medicine (Baltimore). 2017;96(11):e6328. doi: 10.1097/MD.0000000000006328 PMID 28296754
- Palladino L, Ruotolo I, Berardi A, et al. Efficacy of aquatic therapy in people with spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2023;61(6):317-322. doi: 10.1038/s41393-023-00892-4 PMID 36966260
- Jaana M, Cruise D, Georges C. Effects of swimming on cognitive and health outcomes in older adults and insights into participation facilitators and barriers: a systematic review. Front Med (Lausanne). 2026;13:1839102. doi: 10.3389/fmed.2026.1839102 PMID 42517048
- Campos DM, Ferreira DL, Gonçalves GH, et al. 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
- Aguilera-Eguía RA, Zaror C, Gutiérrez-Arias R, et al. Effectiveness of Physical Exercise Programs in Reducing Secondary Lymphedema Associated with Breast Cancer: An Overview of Systematic Reviews. J Clin Med. 2026;15(13):5001. doi: 10.3390/jcm15135001 PMID 42452464
- Yeung W, Semciw AI. Aquatic Therapy for People with Lymphedema: A Systematic Review and Meta-analysis. Lymphat Res Biol. 2018;16(1):9-19. doi: 10.1089/lrb.2016.0056 PMID 28346851
- Muñoz-Gómez E, Arnal-Gómez A, López Cascón A, et al. Systematic review of aquatic therapeutic exercise efficacy in breast cancer survivors. Support Care Cancer. 2022;31(1):44. doi: 10.1007/s00520-022-07460-1 PMID 36525089
- Cancela-Carral JM, Blanco B, López-Rodríguez A. Therapeutic Aquatic Exercise in Pregnancy: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(3):501. doi: 10.3390/jcm11030501 PMID 35159953
- Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3(3):CD005523. doi: 10.1002/14651858.CD005523.pub3 PMID 27007113
- Beumer L, Wong J, Warden SJ, et al. Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis. Br J Sports Med. 2016;50(8):458-63. doi: 10.1136/bjsports-2015-095255 PMID 26612846
- Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589. doi: 10.1016/j.joca.2019.06.011 PMID 31278997
- Babiloni-Lopez C, Fritz N, Ramirez-Campillo R, et al. Water-Based Exercise in Patients With Nonspecific Chronic Low-Back Pain: A Systematic Review With Meta-Analysis. J Strength Cond Res. 2024;38(1):206-219. doi: 10.1519/JSC.0000000000004635 PMID 38085630
- Santamaría G, Fernández-Gorgojo M, Gutiérrez-Abejón E, et al. Aquatic Therapy Versus Land-Based Therapy in Patients with Parkinson’s Disease: A Systematic Review. J Funct Morphol Kinesiol. 2025;10(2):170. doi: 10.3390/jfmk10020170 PMID 40407454
- Braz de Oliveira MP, Rigo Lima C, da Silva SLA, et al. Effect of aquatic exercise programs according to the International Classification of Functionality, Disability and Health domains in individuals with Parkinson’s disease: a systematic review and meta-analysis with GRADE quality assessment. Disabil Rehabil. 2024;46(3):429-442. doi: 10.1080/09638288.2022.2164800 PMID 36644928
- Liu Z, Huang M, Liao Y, et al. Long-term efficacy of hydrotherapy on balance function in patients with Parkinson’s disease: a systematic review and meta-analysis. Front Aging Neurosci. 2023;15:1320240. doi: 10.3389/fnagi.2023.1320240 PMID 38152605
- Carroll LM, Morris ME, O’Connor WT, et al. Is Aquatic Therapy Optimally Prescribed for Parkinson’s Disease? A Systematic Review and Meta-Analysis. J Parkinsons Dis. 2020;10(1):59-76. doi: 10.3233/JPD-191784 PMID 31815701
- Shariat A, Ghayour Najafabadi M, Soroush Fard Z, et al. A systematic review with meta-analysis on balance, fatigue, and motor function following aquatic therapy in patients with multiple sclerosis. Mult Scler Relat Disord. 2022;68:104107. doi: 10.1016/j.msard.2022.104107 PMID 35988329
- Amedoro A, Berardi A, Conte A, et al. The effect of aquatic physical therapy on patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2020;41:102022. doi: 10.1016/j.msard.2020.102022 PMID 32114368
- Roostaei M, Baharlouei H, Azadi H, et al. Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review. Phys Occup Ther Pediatr. 2017;37(5):496-515. doi: 10.1080/01942638.2016.1247938 PMID 27967298
- Zhao M, Chen C, Shen Y, et al. The effects of aquatic interventions on emotional and behavioral outcomes in children with autism spectrum disorder. Front Psychol. 2026;17:1929354. doi: 10.3389/fpsyg.2026.1929354 PMID 42846127
- Shariat A, Najafabadi MG, Dos Santos IK, et al. The Effectiveness of Aquatic Therapy on Motor and Social Skill as Well as Executive Function in Children With Neurodevelopmental Disorder: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2024;105(5):1000-1007. doi: 10.1016/j.apmr.2023.08.025 PMID 37690741
- Shah P, Pellicori P, Macnamara A, et al. Is Swimming Safe in Heart Failure? A Systematic Review. Cardiol Rev. 2017;25(6):321-325. doi: 10.1097/CRD.0000000000000154 PMID 28767502
- Adsett JA, Mudge AM, Morris N, et al. Aquatic exercise training and stable heart failure: A systematic review and meta-analysis. Int J Cardiol. 2015;186:22-8. doi: 10.1016/j.ijcard.2015.03.095 PMID 25804460
- Zhu H, Jin J, Zhao G. The effects of water-based exercise on body composition: A systematic review and meta-analysis. Complement Ther Clin Pract. 2023;52:101766. doi: 10.1016/j.ctcp.2023.101766 PMID 37167802
- Rees JL, Johnson ST, Boulé NG. Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta Diabetol. 2017;54(10):895-904. doi: 10.1007/s00592-017-1023-9 PMID 28691156
- 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
- Villalta EM, Peiris CL. Early aquatic physical therapy improves function and does not increase risk of wound-related adverse events for adults after orthopedic surgery: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(1):138-48. doi: 10.1016/j.apmr.2012.07.020 PMID 22878230
- Gibson AJ, Shields N. Effects of Aquatic Therapy and Land-Based Therapy versus Land-Based Therapy Alone on Range of Motion, Edema, and Function after Hip or Knee Replacement: A Systematic Review and Meta-analysis. Physiother Can. 2015;67(2):133-41. doi: 10.3138/ptc.2014-01 PMID 25931664
- Rodríguez-Otero H, Hernandez-Lucas P, Escobio-Prieto I, et al. Effects of Aquatic Exercise on Individuals with Hypertension: A Systematic Review. Healthcare (Basel). 2026;14(4):513. doi: 10.3390/healthcare14040513 PMID 41754026
- Igarashi Y, Nogami Y. The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2018;25(2):190-199. doi: 10.1177/2047487317731164 PMID 28914562
- Duan X, Wei W, Zhou P, et al. Effectiveness of aquatic exercise in lower limb osteoarthritis: a meta-analysis of randomized controlled trials. Int J Rehabil Res. 2022;45(2):126-136. doi: 10.1097/MRR.0000000000000527 PMID 35437296
- McNamara RJ, McKeough ZJ, McKenzie DK, et al. Water-based exercise training for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;2013(12):CD008290. doi: 10.1002/14651858.CD008290.pub2 PMID 24353107
- Manning OJ, Rancourt S, Tomasone JR, et al. Water-based therapeutic exercise in stroke: a scoping review. Disabil Rehabil. 2023;45(9):1549-1562. doi: 10.1080/09638288.2022.2063415 PMID 35450495
- Leveck GC, Christinelli T, de Souza SF, et al. Aquatic aerobic exercise prescription in Parkinson’s disease: A scoping review. J Bodyw Mov Ther. 2025;42:249-258. doi: 10.1016/j.jbmt.2024.12.038 PMID 40325677
- Terrens AF, Soh SE, Morgan PE. The efficacy and feasibility of aquatic physiotherapy for people with Parkinson’s disease: a systematic review. Disabil Rehabil. 2018;40(24):2847-2856. doi: 10.1080/09638288.2017.1362710 PMID 28793808
- Huf I, Soh SE, Morgan P. Aquatic exercise for adolescents and adults with cerebral palsy: a mixed methods scoping review. Disabil Rehabil. 2026;48(4):874-885. doi: 10.1080/09638288.2025.2523973 PMID 40607697
- Faíl LB, Marinho DA, Marques EA, et al. Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. Scand J Med Sci Sports. 2022;32(3):465-486. doi: 10.1111/sms.14112 PMID 34913530
- 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. 2026;:1-17. doi: 10.1123/japa.2025-0083 PMID 42603704
- Buitrago-Restrepo CM, Patiño-Villada FA, Arango-Paternina CM. Effects of Aquatic Exercise on Physical Performance in Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act. 2024;32(5):651-667. doi: 10.1123/japa.2023-0192 PMID 38710486
- Melo RS, Cardeira CSF, Rezende DSA, et al. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis. PLoS One. 2023;18(9):e0291193. doi: 10.1371/journal.pone.0291193 PMID 37683025
- Sarmento Gda S, Pegoraro AS, Cordeiro RC. Aquatic physical therapy as a treatment modality in healthcare for non-institutionalized elderly persons: a systematic review. Einstein (Sao Paulo). 2011;9(1):84-9. doi: 10.1590/S1679-45082011RW1695 PMID 26760560
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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.
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© 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.
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If you spot an error or an outdated link, or want to suggest a paper or a free research resource, contact us at info@aquatictherapyfoundation.org.
Last reviewed: October 19, 2026. External information was checked against official sources on October 19, 2026, and may have changed since then. This page is general education for researchers. It is not medical advice, and the research-gap questions are not funding priorities or a research agenda set by the Foundation.
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.