Who benefits from exercise in water?

What makes water exercise different?

Water's buoyancy supports body weight and reduces load on the joints, while its resistance strengthens muscles in every direction of movement. The pressure of the water can reduce swelling, and warm water helps muscles relax.

These properties allow people to walk, move and exercise in ways that may be too painful or unsafe on land, and they reduce the fear of falling.

Does water exercise help osteoarthritis?

A Cochrane review of 13 trials with 1,190 people with knee or hip osteoarthritis found that aquatic exercise, lasting an average of 12 weeks, gave small short-term improvements in pain, disability and quality of life compared with control groups 1. The effects on pain and disability corresponded to about five points on a 100-point scale, and no serious adverse events were reported 1.

Water exercise can be a useful starting point for people who find land exercise too painful, with a gradual move to land-based strengthening and walking when possible.

Does water exercise help fibromyalgia?

A Cochrane review of 16 aquatic exercise studies with 881 participants with fibromyalgia found improvements compared with control groups in overall function, physical function, pain (by about seven units on a 100-point scale) and stiffness (by about 18 units), as well as muscle strength and walking distance 2.

When aquatic exercise was compared with land-based exercise, there were no significant differences in function, pain or stiffness 2. People can therefore choose the setting they prefer or can access.

Who else may benefit?

Water exercise is also used for people with back pain, after joint replacement once wounds have healed, with obesity, in pregnancy and for some neurological conditions such as multiple sclerosis, Parkinson's disease and stroke, to practise balance and walking with reduced risk of injury.

For people with multiple sclerosis who are sensitive to heat, pools at a cooler temperature are generally more comfortable, as overheating can temporarily worsen symptoms.

Who should avoid water exercise or seek advice first?

People with open wounds, active skin infections, uncontrolled epilepsy, severe heart or lung disease, incontinence that cannot be managed, or recent surgery should seek advice before using a pool.

Those with low blood pressure or heart conditions should be cautious with very warm pools, which can cause dizziness.

How can I move from water to land exercise?

Many people start in water because it feels easier and then gradually add exercises on land, such as sit-to-stand, step-ups and short walks. Keeping one water session and adding one land session each week is a common way to build confidence.

Land exercise loads bones and trains balance in everyday conditions, which water cannot fully replicate. Combining both settings gives the benefits of each, and a physiotherapist can help plan the transition.

What should I bring and expect at my first session?

Bring a swimsuit, towel, water bottle and non-slip pool shoes if you have balance problems. Tell the instructor about your health conditions, medicines and any recent falls. Arrive early to allow time to change and to get in and out of the pool safely using steps, rails or a hoist.

It is normal to feel tired after the first few sessions, as moving against water resistance uses more energy than it seems. Drink water, cool down gradually and allow time to rest afterwards.

What does a water exercise session involve?

Sessions often include walking forwards, backwards and sideways in the pool, leg and arm movements against water resistance, balance exercises and stretching. Floats and noodles add support or resistance.

Supervised sessions with a physiotherapist or trained instructor are helpful for people with complex needs. Getting in and out of the pool safely should be planned.

Frequently asked questions