Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis.

For children and adolescents with cerebral palsy, physiotherapists often weigh whether water-based exercise offers anything beyond land-based programs for improving gross motor function, meaning skills like sitting, standing, and walking. This review pooled results from 15 randomized trials involving 369 children, comparing different types of aquatic exercise, including aquatic physical therapy, the Halliwick method, and swimming, against land-based exercise. The pooled result for aquatic physical therapy specifically showed somewhat better gross motor function than land-based exercise, though the effect was small and based on only four trials with 93 children. For Halliwick and swimming approaches, no statistically significant difference from land-based exercise was detected.

The authors rated the overall evidence as low quality, mainly because most included studies carried a high risk of bias and had small sample sizes, so these findings should be read as preliminary rather than conclusive.

If your child has cerebral palsy, you may have wondered whether exercising in water offers any extra benefit over exercising on land for improving movement skills like walking or standing. This review combined results from 15 small studies involving a total of 369 children and teenagers with cerebral palsy to compare different types of water-based exercise against land-based exercise. For one type, called aquatic physical therapy, children showed somewhat better gross motor function scores than those doing land-based exercise, though this was based on a small group of only 93 children across four studies.

For other approaches, including the Halliwick method and swimming, no clear difference from land-based exercise was found. The researchers rated the overall quality of this evidence as low, largely because the individual studies were small and often had weaknesses in how they were designed. This means the findings are an early signal rather than a settled answer, and more well-designed research is needed before drawing firm conclusions.

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

This review addresses a recurring clinical question: when selecting exercise interventions to improve gross motor function in children and adolescents with cerebral palsy, does an aquatic environment offer any advantage over land-based programs? The synthesis pooled 15 randomized controlled trials totaling 369 participants, most ambulatory with spastic hemiparetic or diparetic presentations, comparing several categories of aquatic intervention (aquatic physical therapy, Halliwick, swimming, gait training) against land-based exercise. The only subgroup reaching statistical significance was aquatic physical therapy, with a small standardized mean difference (SMD 0.47) favoring aquatic therapy over land-based exercise, drawn from four trials and 93 participants, low heterogeneity (I² = 5%). Halliwick and swimming subgroups showed no statistically significant difference from land-based comparators.

Given that this is one significant result among several subgroup comparisons, it should be interpreted as a possible signal rather than a confirmed advantage, particularly since GRADE rated the overall evidence as low quality due to high risk of bias, imprecision, and inconsistency across the included trials. The review does not establish that combining aquatic and land-based therapy adds benefit beyond land-based therapy alone, nor does it clarify dosage, delivery, or long-term outcomes; the authors explicitly call for better-powered trials testing combined approaches against land-based therapy alone before this question can be settled.