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Underwater treadmill

Overview
References
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Application

Underwater treadmills, or pool treadmills, are a key modality in modern water‑based rehabilitation. By combining buoyancy with controlled, repetitive walking, they allow patients to move with far less joint loading and pain. This makes them particularly suitable for people with orthopedic and neurological conditions, or those with chronic joint problems who struggle to exercise on land.

In the supportive environment of warm water, patients can safely practice their walking pattern, improve joint mobility and build strength without aggravating their symptoms. Adjustable speed and water depth make it possible to tailor each session to the individual, so that both early‑stage rehabilitation and later, more intensive training can be performed in the same system.

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Product

The underwater treadmill is the next step in active and safe rehabilitation. Using the water’s buoyancy, resistance and hydrostatic pressure, patients can start walking exercises earlier, with less pain and reduced joint loading. This is an ideal environment to restore gait patterns, build strength and improve confidence.

Our EWAC movable floors can be fitted with a fully integrated underwater treadmill that meets high standards for usability, adjustability and operational stability. Water depth is precisely adjustable, allowing a controlled progression from partial to near full weight bearing.

For pools without a movable floor, we offer a standalone drop‑in underwater treadmill that can be placed directly on the pool floor, transforming an existing pool into an effective hydrotherapy facility. A separate drop‑in underwater treadmill lifting system lets clinicians raise and lower the treadmill during training, fine‑tuning exercise depth, loading and accessibility without structural pool changes.

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Knowledge

An underwater treadmill combines reduced weight bearing with controlled walking, so stiff or injured joints can move safely with minimal impact. Growing evidence in aquatic therapy shows benefits for joint mobility, strength and cardiovascular fitness while clearly lowering joint load.

Underwater treadmills are especially suitable for three applications:

  1. Orthopedic rehabilitation after injury or surgery, enabling earlier and less painful gait training.

  2. Neurological gait and balance training, using the steady belt rhythm and safe environment to promote a more symmetrical and stable walking pattern.

  3. Metabolic and weight‑management training, offering low‑impact but intensive exercise for people with obesity or limited load tolerance.

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Experience

For over 25 years, EWAC Medical has designed and built movable swimming pool floors and has completed over 1.000 projects worldwide. We are constantly striving for improvement and innovation. Despite the fact that aquatic treadmills are a relatively new development, experience with these products is rapidly growing. Because underwater treadmills can be integrated into any of the current EWAC Medical products, our offering is extremely competitive.

That is why EWAC Medical is world market leader in hydrotherapy.

Underwater treadmill functionality

Exercising on an underwater treadmill combines the beneficial effects of water with stationary walking exercises. An underwater treadmill transforms the pool into a virtually infinite pool, eliminating the need for the patient to turn at the end. Water has numerous beneficial effects on the rehabilitation process. The buoyancy reduces weight bearing in the legs, making it easier for an injured patient to exercise. At the same time, the warm water makes the ligaments more elastic, increasing range of motion. Additionally, submersion in water reduces pain sensation.

All of these benefits combine to make the underwater treadmill an excellent piece of exercise equipment that can be extremely beneficial for obesity treatment, sports endurance training, and general joint rehabilitation.

The underwater treadmill’s strict rhythm can be very beneficial in treating neurological patients.

By incorporating an underwater treadmill into a movable swimming pool floor, the user can tailor the loading on the patient’s lower extremities to the stage of rehabilitation. Walking exercises at various body loads are possible with a fully integrated underwater treadmill. The parallel bars can be removed, freeing up the entire area of the movable swimming pool floor for other hydrotherapy methods.

The underwater treadmill can be installed in any new pool floor, but it is also ideal for existing EWAC Medical movable swimming pool floors.

EWAC Medical not only provides underwater treadmills, but also actively participates in the acquisition and dissemination of hydrotherapy knowledge. In addition, we are actively involved in the development of new underwater exercise equipment for rehabilitation purposes. This page contains more detailed information about all of the factors that must be considered when using an underwater treadmill.

The proven value of exercising on an underwater treadmill

Exercising on an EWAC Medical underwater treadmill offers a great number of advantages.

Advantage Result
Actuated with safe low voltage power drive Optimal security of patients is guaranteed
Infinitely adjustable speeds from 0,1 up to 11 km/h Precise control of exercise intensity
Slow up and down tuning during start and stop Pleasurable walking experience
Patient training program can be stored Follow progress of the rehabilitation process
Can be mounted into an existing pool Added functionality of existing situations
Can be mounted in a modular pool Added functionality of existing and new situations
Can be integrated in an adjustable floor Adjust for optimal weight loading of the patient
Can be retrofitted in existing adjustable floors Increase the possibilities of a current installation
Flush with deck of adjustable floor More functionality within the same available space
ctive interaction in the water between patient and therapist Therapist can actively manipulate the patient during exercises

Overview of our options (see our product configurator)

Underwater treadmill running

Underwater camera

This special underwater camera enables the therapist to track the movements of the patients, and if necessary record the movements for further analysis. By comparing images from multiple sessions one can get a clear picture of the progress made by the patient.

Underwater treadmill running

Counter current unit or Jetstream

Countercurrent unit or jetstream. A jetstream offers exercise resistance to the patient moving against the flow. A wall nozzle produces a strong water jet which is aimed at the patient, and depending of the required exercise load, can be softened with air.

Underwater treadmill running

Underwater lighting

Underwater lighting is highly recommended to improve the sight through, for example, an underwater window. The lighting can be either delivered in monochrome or in colours.

Underwater treadmill running

Observation windows

Observation windows can be placed in regular pools as well as modular pools. Observation windows enable the therapist to supervise the executions of the patient optimally.

Two types of underwater treadmills

EWAC Medical supplies two different underwater treadmills:

  • Integrated underwater treadmill in an adjustable pool floor

The built-in underwater treadmill is flush with the adjustable pool floor. The patient’s weight bearing can be adjusted by lowering the adjustable floor. The combination of an underwater treadmill and an adjustable floor provides an excellent exercise environment for children and adults at any stage of rehabilitation.

When the treadmill is not in use, removing the parallel bars allows the entire exercise pool to be used for other underwater exercises.

The underwater treadmill can be installed in any new adjustable pool floor, but it also works well in existing EWAC Medical movable floors.

  • Drop-in underwater treadmill

The drop-in underwater treadmill is an excellent piece of exercise equipment for existing pools with a fixed depth. The freestanding underwater treadmill can be placed in any position on the pool’s bottom. The underwater treadmill converts the pool into a multi-purpose, low-impact exercise environment. To make room for other underwater exercises, the underwater treadmill can be completely removed from the pool.

It can be used in virtually any existing pool situation and works plug and play. Both underwater treadmills meet the demands set in the ISO-norm 13485.

Drop-in underwater treadmill Intergrated underwater treadmill
Dimensions – Total L 1540 x B 1040 x H 1740 mm (including handrails) L 1750 x B 1200 mm
Dimensions – Training area L 1150 x B 550 mm L 1400 x B 850 mm
Speed capabilties 0,1 – 11.0 km/h 0,1 – 11.0 km/h
Power supply 16 Amp 220/240 V single phase 50/60Hz 16 Amp 220/240 V single phase 50/60Hz
Maximum load 500 kg 500 kg

Methods

Bad Ragaz Ring Method Clinical AiChi Fall prevention training Halliwick Therapy Walking exercises

Target Groups

Elderly Mobility therapy Postoperative rehabilitation Sports rehabilitation Tackling obesity Treatment post CVA

Sub-products

Integrated underwater treadmill

An underwater treadmill designed to fit perfectly in one of our movable swimming pool floors.

Drop-in underwater treadmill

An underwater treadmill able to be moved in and out of the pool regardless of its environment.

Underwater treadmill lifting system

A lifting system specially designed for the drop-in underwater treadmill to be lowered in any aquatic environment.

Related resources

Product videos

Articles

Miglietta (2025) A scoping review of the effectiveness of underwater treadmill exercise in clinical trials of chronic pain

Chen (2021) Combined effect of hydrotherapy and transcranial direct-current stimulation on children with cerebral palsy

Ma (2022) Overall treatment effects of aquatic physical therapy in knee osteoarthritis a systematic review and meta-analysis

Song (2022) Effects of Aquatic Exercises for Patients with Osteoarthritis Systematic Review with Meta-Analysis

Jung (2018) The influence of water depth on kinematic and spatiotemporal gait parameters during aquatic treadmill walking

Jara (2019) Aquatic treadmill walking at three depths of water in people with traumatic brain injury

Kwok (2022) The effect of aquatic High Intensity Interval Training on cardiometabolic and physical health markers in women: A systematic review and meta-analysis

Lambeck (2022) IATF expert opinion Enhancing the quality of aquatic therapy for subacute and chronic stroke patients

Park (2014) The Effect of Underwater Gait Training on Balance Ability of Stroke Patients

Felten-Barentz et al (2018), Patient views regarding the impact of hydrotherapy on critically ill ventilated patients: A qualitative exploration study

Chen (2021) Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease (COPD)

Waller (2017) Effects of high intensity resistance aquatic training on body composition and walking speed in women with mild knee osteoarthritis: a 4-month RCT with 12-month follow-up

Morer (2020) Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

Cuesta-Vargas (2020) Identification of Tools for the Functional and Subjective Assessment of Patients in an Aquatic Environment A Systematic Review

Graca (2020) Immediate Effects of Aquatic Therapy on Balance in Older Adults with Upper Limb Dysfunction: An Exploratory Study

Chien (2020) Land versus water HIIE (HIIT) effects on muscle oxygenation and physiological parameter responses in postmenopausal women (Scientific Reports by Nature)

Niks & ‘t Hoofd (2017) Aquamentia, Introducing a Newly Developed Swimming Intervention for People With Dementia

Andrade (2017) Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia; A randomized controlled trial

Pérez-de la Cruz (2020) Comparison of Aquatic Therapy vs. Dry Land Therapy to Improve Mobility of Chronic Stroke Patients

Heywood (2018) Force during functional exercises on land and in water in older adults with and without knee osteoarthritis; Implications for rehabilitation

Ayan (2015): Parkinson systematic review

Felten-Barentz et al (2015), Feasibility and Safety of Hydrotherapy in Critically Ill Ventilated Patients

Squires Blackwell (2012) relationship of metabolic costs of aquatic treadmill versus land treadmill running

Pohl (2003) The physiological responses to running and walking in water at different dephts

Brochures

Corporate Brochure EWAC Medical (Spanish) – Folleto Corporativo

Brochure Water treatment (EN)

Brochure Obstacle Course (EN)

Brochure Underwater Bicycle (EN)

Corporate Brochure EWAC Medical (EN)

Brochure Pooltrack Curve (EN)

Brochure Modular pool (EN)

Brochure movable swimming pool floor (EN)

Slides

Lambeck (2015) Proprioceptive and muscular training through therapeutic aquatic exercise in MSK rehabilitation

Lambeck (2021) Aquatic Therapy influences chronic low grade inflammation

Rehabilitation concepts using hydrotherapy

The importance of the right depth

The importance of water hygiene in an aquatic exercise environment

Mechanics and Fluidmechanics (Pöyhönen 2009)

(Hulselmans 2011) Aquatic treadmill training for stroke patients
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