ms monterey pool class with group in water


Hydrotherapy is the therapeutic use of water, and one type involves exercises in a swimming pool. The unique properties of water mean that the activity can be beneficial for a person with multiple sclerosis (MS) symptoms such as balance problems and reduced muscle strength.

In addition, hydrotherapy in a group setting can reduce feelings of isolation and improve mental health. It may also be safer than exercising on land because there is a lower likelihood of injury from a fall and less chance of muscle pain or fatigue.

This article discusses aerobic hydrotherapy and provides detail of the potential benefits and results for a person with MS. It also provides a brief overview of MS, including how doctors diagnose it and the outlook for people with this condition.

What is hydrotherapy?

Hydrotherapy is the therapeutic use of water as a treatment for various issues, including chronic health conditions.

  • steam inhalation
  • sitz baths
  • hot and cold compresses
  • whirlpool baths
  • underwater massage
  • mineral baths

Aerobic hydrotherapy

Aquatic exercises, which some people may refer to as pool exercise or water therapy, are a type of aerobic hydrotherapy. They are exercises that a person performs in the water and can involve swimming, specific exercises, or water-based games. The Centers for Disease Control and Prevention (CDC)Trusted Source state that aquatic activities can provide physical and mental benefits.

Water has properties that allow a person to practice various exercises that might not be possible in nonwater-based environments. These properties include:

  • Buoyancy: This upward force acts in opposition to gravity, reducing a person’s apparent body weight. As a result, it can make it easier to do exercises that involve a range of motion and can also reduce pressure on a person’s joints.
  • Hydrostatic pressure: This is the force that water exerts on an immersed object, and it increases with depth. It may help reduce swelling.
  • Resistance: Force is necessary to overcome water resistance, which can help with strength training.
  • Turbulence: The swirling or irregular motion of water is called turbulence, and it can help with balance training with little risk of injury.

How does exercise help a person with MS?

The National Multiple Sclerosis Society (NMSS) says that individuals with MS may benefit from physical exercise. However, land-based exercises can worsen MS symptoms and place additional stress on a person’s body. Water-based exercise, in which a person benefits from cooler temperatures and buoyancy, can be a better option.

Although the properties of water allow for movements that would be difficult to do on land, the NMSS notes that there are some general safety principles for water-based exercises. These include correct posture, breathing, and positioning. In addition, a person with MS will need to monitor their body’s responses to avoid fatigue.

Types of water-based exercises

There are several types of water-based exercises, including swimming, group classes, and individual programs.

A 2012 study found that a 20-week aquatic exercise program significantly reduced pain intensity in people with MS. Other noted benefits of the program included improvements in depression and fatigue. The researchers chose to use Ai Chi, a water-based version of Tai Chi, as the exercise program.

Ai Chi involves gentle, controlled movements, and the benefits include:

  • stress management
  • postural control
  • body awareness
  • weight shifting
  • strength
  • balance

Group or individual aquatic exercise programs generally focus on improving balance and flexibility, along with increasing muscle strength and endurance. The classes may involve slow exercises such as:

  • water walking
  • knee extension
  • toe and heel lifts
  • games

How the exercises help with MS symptoms

In general, exercise can help manage some symptoms of MS by improving fitness, strength, and flexibility. In addition, physical activity can improve mood and lessen fatigue.

The NMSS explains that aquatic exercises can benefit people with MS by:

  • promoting socialization and reducing isolation
  • raising self-esteem
  • maintaining or increasing joint flexibility and range of motion
  • preventing complications, such as pressure sores, reduced muscle size, and joint contracture

A person can work with a physical therapist to decide on a group or individual program that best suits their needs.

About MS

MS is a lifelong condition resulting from the immune system’s attack on myelin, the material that coats and protects nerve cells. The National Institute of Neurological Disorders and Stroke (NINDS) explains that the symptoms can range in severity “from relatively benign to somewhat disabling to devastating,” with some people experiencing an inability to speak, write, and walk.

The course is unpredictable, and the symptoms tend to come and go. Although there is no cure for the condition, treatment may slow its progression.

MS affects approximately 400,000 people in the United States, and the first symptoms generally appear between the ages of 20 and 40 years. However, late onset MS, in which the first symptoms appear after the age of 50 years, can occur in rare cases.

Some individuals receive a diagnosis of MS soon after the symptoms start. However, doctors may not be able to diagnose other people until years later because of confusing symptoms that alternately worsen and get better.


Hydrotherapy for people with MS may take many forms, including pool exercises, Ai Chi, pool games, and individual programs. Water-based exercise is valuable for relieving many symptoms of MS, and it can help in maintaining mobility.

A person with MS may wish to speak with their doctor or a physical therapist about joining an aquatic exercise class or putting together a personal program.

Medically reviewed by Nancy Hammond, M.D. — Written by Mary West on May 27, 2021

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