Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis.

Water-based exercise is a fairly common addition to stroke rehabilitation programs, but how it stacks up against no treatment or against standard land-based therapy has not been clearly settled. This review pooled 28 randomized controlled trials, involving 961 stroke survivors, comparing aquatic therapy to either no intervention or to land-based exercise across outcomes like walking, balance, strength, mood, and quality of life. Compared with no intervention, aquatic therapy was associated with improvements in walking, balance, emotional status, quality of life, spasticity, and physiological markers.

Compared with land-based exercise, it showed advantages in balance, walking, strength, proprioception, quality of life, and cardiorespiratory fitness, though the two approaches produced similar effects on independence in daily activities. Established water-therapy methods such as Halliwick, Ai Chi, Watsu, and Bad Ragaz appeared more effective than aquatic treadmill walking. The authors themselves caution that the current evidence base is not yet strong enough to firmly establish this therapy within evidence-based practice.

If you or someone you know is recovering from a stroke, you may wonder whether exercising in water offers any real advantage over exercising on land. This review looked at 28 smaller studies, together involving 961 stroke survivors, to compare water-based therapy against either no extra therapy or standard land-based exercise programs. The results suggest that exercising in water was linked to improvements in walking, balance, mood, quality of life, muscle stiffness, and certain physical measures compared to not receiving that therapy.

When compared directly to land-based exercise, water therapy showed some added benefit for balance, walking, strength, and cardiorespiratory fitness, though for everyday independence, both approaches worked about the same. Certain established water-therapy techniques seemed to work better than simply walking on a treadmill submerged in water. It's encouraging to see a consistent pattern across many small studies, but the researchers themselves say the evidence isn't yet solid enough to be considered firmly established.

This is a promising area, not a settled conclusion.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis synthesized 28 randomized controlled trials (N = 961) evaluating aquatic therapy in stroke rehabilitation, searched across PubMed, Cochrane CENTRAL, and PEDro through May 2020. Effect sizes were calculated per study and outcome, comparing aquatic therapy against either no intervention or land-based exercise across domains including gait, balance, muscular strength, proprioception, spasticity, emotional status, health-related quality of life, physiological indicators, and cardiorespiratory fitness. Relative to no intervention, aquatic therapy showed favorable effects across most domains.

Relative to land-based interventions, it demonstrated superior effects on balance, walking, strength, proprioception, quality of life, physiological indicators, and cardiorespiratory fitness, while showing no statistically significant difference for activities-of-daily-living independence. Subgroup comparisons suggested established methods (Halliwick, Ai Chi, Watsu, Bad Ragaz Ring) outperformed aquatic treadmill training. Despite pooling 28 trials, the authors explicitly state the evidence is currently insufficient to support aquatic therapy within evidence-based rehabilitation frameworks, implying concerns about study quality, heterogeneity, or trial size that limit certainty.

Clinicians should interpret these consistent but preliminary findings as hypothesis-generating rather than definitive, pending more rigorous confirmatory trials.