Aquatic Exercise for Managing MS Symptoms

This brief explores the use of aquatic exercise for managing common and debilitating symptoms of Multiple Sclerosis (MS), such as fatigue, balance issues, and depression. It provides evidence-based protocols and practical tips for implementing aquatic therapy in your practice.

Research: November 2025

This image illustrates various aquatic exercises that can be adapted for individuals with MS to improve strength, balance, and flexibility.

Key Findings

1Aquatic therapy significantly improves balance in individuals with MS.
2Long-term aquatic exercise is effective in reducing physical, cognitive, and psychological fatigue.
3Aquatic therapy can help alleviate symptoms of depression in people with MS.
4The buoyancy of water provides a safe and supportive environment for exercise, reducing the risk of falls.

For your patients with MS, the pool can be a game-changer. Aquatic therapy offers a unique environment where the buoyancy of water supports the body, making it easier and safer to move. This is especially beneficial for individuals with MS who often struggle with weakness, spasticity, and poor balance. A 2022 systematic review and meta-analysis by Shariat et al. found that long-term aquatic exercise significantly improves both balance and fatigue in people with MS. The study, which included 16 trials and 794 participants, highlighted the positive effects on physical, cognitive, and psychological fatigue. Another meta-analysis in 2024 by Naeimi et al. further supports these findings, showing that aquatic therapy is effective in improving not only balance and fatigue but also depression. The typical aquatic therapy program for MS patients involves a combination of aerobic, strengthening, and flexibility exercises performed in a heated pool (around 82-86°F or 28-30°C). Sessions are usually 45-60 minutes long, 2-3 times per week. The intensity should be moderate, with a focus on controlled movements and proper form. For example, you might have your patient perform walking or jogging in the water, leg kicks with a kickboard, or gentle stretching exercises using the side of the pool for support.

Clinician's Note

In my experience, the biggest barrier for patients with MS starting an aquatic program is often fear of the unknown. They might be worried about getting in and out of the pool, or how their body will react to the water. I've found that a thorough orientation to the pool area and a gradual introduction to the exercises can make a huge difference. Start with simple movements and gradually increase the complexity and intensity as your patient becomes more comfortable. Also, be mindful of the pool temperature. While a warm pool is generally recommended, some patients with MS are sensitive to heat, so you may need to adjust the temperature or the duration of the session accordingly.

Clinic Action Plan

1. Patient Selection: Patients with MS who have mild to moderate disability (EDSS 2.0-6.5) and are able to safely enter and exit the pool are good candidates for aquatic therapy. 2. Initial Assessment: Before starting, assess the patient's baseline levels of fatigue (e.g., using the Modified Fatigue Impact Scale), balance (e.g., using the Berg Balance Scale), and mood (e.g., using the Beck Depression Inventory). 3. Protocol: Start with a 5-10 minute warm-up of gentle stretching and walking in the water. Follow with 20-30 minutes of moderate-intensity aerobic and strengthening exercises (e.g., water walking, leg kicks, arm exercises with water weights). End with a 5-10 minute cool-down of gentle stretching. 4. Progression: Gradually increase the duration and intensity of the exercises as the patient's strength and endurance improve. You can also introduce more challenging exercises, such as deep-water running or Ai Chi. 5. Red Flags: Monitor the patient for signs of overexertion, such as increased fatigue, muscle soreness, or changes in gait. If any of these occur, reduce the intensity or duration of the session.

Common Mistakes to Avoid

•Starting with too high of an intensity or duration.
•Not providing a thorough orientation to the pool and equipment.
•Failing to monitor the patient for signs of fatigue or overexertion.
•Using a pool that is too hot or too cold for the patient's comfort.

Frequently Asked Questions

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