Aquatic Therapy After Stroke

Stroke is one of the leading causes of long-term disability in older adults. Many stroke survivors experience impaired balance, reduced mobility, muscle weakness and a loss of independence in daily activities. A 2025 narrative review highlights how aquatic therapy after stroke can support recovery by improving both physical function and psychological well-being.

Why aquatic therapy is beneficial after stroke

Recovering from a stroke often requires intensive rehabilitation. However, many older adults struggle with conventional land-based exercise due to weakness, poor balance or fear of falling.

Aquatic therapy provides a safe and supportive rehabilitation environment. The buoyancy of water reduces the effects of gravity, making movement easier while allowing patients to practise functional activities with greater confidence. At the same time, water resistance helps strengthen muscles and improve cardiovascular fitness without placing excessive stress on the joints.

Key findings from the review

The review analysed five clinical studies investigating aquatic therapy in older adults recovering from stroke. Together, these studies demonstrated consistent improvements in several important rehabilitation outcomes.

Improved balance and postural control

Improved balance was the most consistent finding across the reviewed studies. Participants demonstrated better static and dynamic balance, improved postural stability and greater confidence during movement.

Several studies also reported a reduced risk of falls following aquatic rehabilitation.

Better walking ability and mobility

Aquatic therapy improved functional mobility and gait performance. Studies evaluating underwater treadmill training found greater improvements in balance and lower limb motor function compared with conventional treadmill training.

These improvements support safer walking and greater independence in everyday activities.

Increased muscle strength and range of motion

The natural resistance of water helps strengthen the muscles of both the upper and lower limbs while allowing movements to be performed comfortably.

Several studies also reported improvements in flexibility and joint range of motion, contributing to better functional performance.

Reduced pain and improved quality of life

In addition to physical improvements, aquatic therapy reduced pain and improved overall quality of life.

Patients participating in programmes such as Ai Chi also experienced improvements in emotional well-being and resilience, particularly when aquatic therapy was combined with conventional rehabilitation.

Why exercising in water works

The therapeutic properties of water create an ideal rehabilitation environment for stroke survivors.

Buoyancy supports safe movement

Water reduces body weight, allowing patients to practise movements with less effort and lower joint loading. This encourages earlier mobilisation and greater confidence during rehabilitation.

Hydrostatic pressure improves stability

Hydrostatic pressure provides gentle support around the body, enhancing proprioception and postural control while helping patients maintain balance during exercise.

Water resistance strengthens muscles

Water provides continuous resistance throughout every movement, allowing muscles to strengthen without the need for heavy external loads. This contributes to improved endurance, coordination and motor control.

Warm water promotes relaxation

Warm therapeutic pools help reduce muscle stiffness and spasticity while improving circulation. This creates a comfortable environment that supports rehabilitation and encourages patient participation.

Clinical implications

The evidence suggests that aquatic therapy after stroke is an effective complement to conventional neurological rehabilitation.

It may be particularly beneficial for older adults who experience:

• Balance impairments
• Reduced mobility
• Muscle weakness
• Fear of falling
• Pain during land-based exercise
• Reduced confidence during walking

Integrating aquatic therapy with conventional physiotherapy may further enhance functional recovery and improve long-term independence.

Conclusion

This 2025 narrative review demonstrates that aquatic therapy after stroke offers important physical and psychological benefits for older adults recovering from stroke.

Improvements in balance, mobility, muscle strength, pain and quality of life make aquatic therapy a valuable addition to comprehensive stroke rehabilitation programmes. The authors conclude that hydrotherapy provides a safe, effective and evidence-based non-pharmacological approach for supporting recovery after stroke.