February 2018: Multiple Sclerosis

Spotlight on Aquatics & Multiple Sclerosis


Content courtesy of the National Swimming Pool Foundation

Recent publications which show how water works for multiple sclerosis

Aquatic Therapy for Multiple SclerosisMultiple Sclerosis (MS) is the most frequent disabling neurological disease in young and middle-aged North American adults. Women are diagnosed more than men, by about 2 to 1, and the incidence of new MS cases appears to be increasing, although this may be due in part to easier and more precise diagnosis. Multiple sclerosis comes in many forms. The relapsing-remitting form is the most common, while the progressive form is more likely to occur in childhood and middle age. 

MS is an inflammatory disease. It is characterized by a disruption to the outer coating (the “sheath”) of the nerve fibers in the central nervous system. With MS, nerve impulses are forced to travel down the nerve fiber itself, but this method of transportation is much slower than when it is possible to travel on the superhighway (the sheath itself). Multiple sclerosis produces many unusual symptoms, none of them pleasant. Some individuals show weakness, sensory loss and/or incoordination; others complain of pain, strange sensations, and involuntary movements. 

Sadly, for most, the disease tends to wax and wane over a period of about 15 years resulting in permanent neurological deficits. Life expectancy is reduced by 5 to 10 years as compared to the general population. 

What brings on these intermittent symptoms? Exacerbations are often triggered by illnesses such as colds and influenza, and may increase with emotional stress and pregnancy. Almost any neurological sign or symptom may be produced by MS, but optic neuritis, spasticity, ataxia, and dysarthria are the most common. Depression is common and cognitive impairment occurs with progressive disease, while bowel and bladder difficulties are the principal source of disability. 

Although incurable, it can be treated and symptoms managed by an increasing number and variety of therapeutic approaches. Aquatic exercise has been part of the physical therapy armamentarium for MS rehabilitation for several decades, with reports of improved strength, endurance, work and power. Aquatic treatments have generally been given at water temperatures below 85ºF because of concern about functional deterioration at higher temperatures, with exacerbation of MS reported after core temperature increases of 0.8 to 4.1ºF. This requirement for cold water seems to be overstated, however. Aquatic exercise in 94ºF water has been reported to produce improvement in mobility and manual muscle test grades without fatigue or heat sensitivity. It is now normal for treat patients with MS on a case-by-case basis, determining tolerance for warmer water individually.  

There has been a huge upswing in publications on the benefits of aquatic-based exercise for the MS patient. See some of the best literature to come out in the last 8-10 years below.


Bahmani, D., Farnia, V., & Shakeri, J. (2015). The comparison of the effect of yoga and aquatic exercises on depression and fatigue in patients with multiple sclerosis. Pharmacopsychiatry, 25(6), 52. Retrieved from https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0035-1557990 

Bakry, W., Salem, Y., & Elokda, A. (2015). Effectiveness of aquatic exercise program for patients with multiple sclerosis: A systematic review. Physiotherapy (United Kingdom). Retrieved from http://www.physiotherapyjournal.com/article/S0031-9406(15)01285-7/abstract 

Barbar, A., Bahadoran, R., & Ghasemzadeh, Y. (2014). The effect of aquatic exercise on balance of adults with multiple sclerosis. European Journal of Experimental Biology, 4(1), 38–43. Retrieved from http://www.imedpub.com/articles/the-effect-of-aquatic-exercise-on-balance-of-adults-with-multiple-sclerosis-ali-barbar-reza-bahadoran-and-yaser-ghasemzadeh.pdf 

Chard, S. (2016). Qualitative perspectives on aquatic exercise initiation and satisfaction among persons with multiple sclerosis. Disability and Rehabilitation, Epub ahead of print. https://www.tandfonline.com/doi/abs/10.1080/09638288.2016.1194897 

Dolbow, J. J., Gassler, J., & Dolbow, D. (2016). Underwater Treadmill Training After Neural-Paralytic Injury. Clinical Kinesiology (Online), 70(1), 1–8. Retrieved from http://go.galegroup.com/ps/anonymous?id=GALE%7CA461529255&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=08969620&p=AONE&sw=w&authCount=1&isAnonymousEntry=true 

Donzé, C. (2015). Update on rehabilitation in multiple sclerosis. La Presse Médicale, 44(4 Pt 2), e169–76. https://www.sciencedirect.com/science/article/pii/S0755498215000627 

Felten-Barentsz, K. M., Haans, A. J. C., Slutsky, A. S., Heunks, L. M. A., & van der Hoeven, J. G. (2015). Feasibility and safety of hydrotherapy in critically ill ventilated patients. American Journal of Respiratory and Critical Care Medicine, 191(4), 476–7. https://www.sciencedirect.com/science/article/pii/S0755498215000627 

Garopoulou, V., & Tsimaras, V. (2014). The effect of an aquatic training program on walking ability and quality of life of patients with multiple sclerosis. Journal of Physical Education and Sport, 14(1), 106–114. Retrieved from https://search.proquest.com/openview/9c0ab10735b1b2ea975734c851bfe7d2/1?pq-origsite=gscholar&cbl=1006394 

Giesser, B. (2015). Exercise in the management of persons with multiple sclerosis. Therapeutic Advances in Neurological Disorders, 8(3), 123–130. http://journals.sagepub.com/doi/abs/10.1177/1756285615576663 

Imanipour, V., Seyedhosseini, M., & Tarmast, D. (2015). Effect of 10 weeks aquatic training on serum Cytokines in the women with multiple sclerosis. Indian Journal of Applied & Pure Biology, 30(1), 61–66. Retrieved from https://www.researchgate.net/profile/Vahid_Imanipour/publication/295605809_Effect_of_10_weeks_aquatic_training_on_serum_Cytokines_in_the_women_with_multiple_sclerosis/links/59ea35534585151983c7eaeb/Effect-of-10-weeks-aquatic-training-on-serum-Cytokines-in-the-women-with-multiple-sclerosis.pdf 

Jin, J., Ko, I., Kim, S., & Shin, M. (2014). Swimming exercise ameliorates multiple sclerosis-induced impairment of short-term memory by suppressing apoptosis in the hippocampus of rats. Journal of Exercise Rehabilitation, 10(2), 69–74. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025552/ 

Kalron, A., Nitzani, D., Magalashvili, D., Dolev, M., Menascu, S., Stern, Y., … Achiron, A. (2015). A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort. BMC Neurology, 15(1), 281. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0281-9 

Kooshiar, H., Moshtagh, M., Sardar, M. A., Foroughipour, M., Shakeri, M. T., & Vahdati Nia, B. (2014). Aquatic exercise effect on fatigue and quality of life of women with multiple sclerosis: a randomized controlled clinical trial. The Journal of Sports Medicine and Physical Fitness, 55(6), 668–74. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25303070

Lange, A. M., Smith, K., Hurtado, I., Narasaki-Jara, M., Todd, T., Vrongistinos, K., & Jung, T. (2016). The Effects of Aquatic Exercise on Gait and Strength in Individuals with Multiple Sclerosis. Medicine and Science in Sports and Exercise, 48(5 Suppl 1), 381. https://insights.ovid.com/medicine-science-sports-exercise/mespex/2016/05/001/effects-aquatic-exercise-gait-strength-individuals/1145/00005768 

Majdinasab, N., Nakhostin-Mortazavi, A., Bahadoram, M., Pouretezad, M., & Afraz, P. (2016). Effect of Aquatic Therapy on Functional Balance in Patients with Multiple Sclerosis: A Randomized Controlled Trial. Persian Journal of Medical Sciences (PJMS), 3(1). Retrieved from http://persianjms.com/index.php/PJMS/article/view/42 

Marinho-Buzelli, A. R., Bonnyman, A. M., & Verrier, M. C. (2014). The effects of aquatic therapy on mobility of individuals with neurological diseases: A systematic review. Clinical Rehabilitation, Epub ahead of print. http://journals.sagepub.com/doi/abs/10.1177/0269215514556297 

Methajarunon, P., Eitivipart, C., Diver, C. C. J., & Foongchomcheay, A. (2016). Systematic review of published studies on aquatic exercise for balance in patients with multiple sclerosis, Parkinson’s disease, and hemiplegia. Hong Kong Physiotherapy Journal, 35, 12–20. https://www.sciencedirect.com/science/article/pii/S1013702515300178 

Paul K Canavan. (2016). Evidence Based Therapeutic Exercise Recommendations for Patients with Multiple Sclerosis: A Physical Therapy Approach. Journal of Gerontology & Geriatric Research, 5(1), 2. Retrieved from https://www.researchgate.net/profile/Paul_Canavan/publication/298430023_Evidence_Based_Therapeutic_Exercise_Recommendations_for_Patients_with_Multiple_Sclerosis_A_Physical_Therapy_Approach/links/5700f89008aee995dde8bb19/Evidence-Based-Therapeutic-Exercise-Recommendations-for-Patients-with-Multiple-Sclerosis-A-Physical-Therapy-Approach.pdf 

Plecash, A. R., & Leavitt, B. R. (2014). Aquatherapy for neurodegenerative disorders. Journal of Huntington’s Disease, 3(1), 5–11. https://content.iospress.com/articles/journal-of-huntingtons-disease/jhd140010 

Razazian, N., Yavari, Z., Farnia, V., Azizi, A., Kordavani, L., Bahmani, D. S & Brand, S. (2016). Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with Multiple Sclerosis. Medicine and science in sports and exercise, 48(5), 796-803. http://europepmc.org/abstract/med/26656775

Roos, J. (2016). Combination aquatic and land physical therapy program improved function and reduced spasticity after acute illness and exacerbation of multiple sclerosis: A case report. Physical Medicine and Rehabilitation Research, 1(3), 65–70. http://www.oatext.com/pdf/PMRR-1-118.pdf  

Kawasaki, M. (2009). The Effects Of Aquatic Exercise On Balance Outcomes In Individuals With Parkinson's Disease: 1705. Medicine & Science in Sports & Exercise, 41(5), 102. https://insights.ovid.com/medicine-science-sports-exercise/mespex/2009/05/001/effects-aquatic-exercise-balance-outcomes/1905/00005768 

Vanbellingen, T., & Kamm, C. P. (2016). Neurorehabilitation Topics in Patients with Multiple Sclerosis: From Outcome Measurements to Rehabilitation Interventions. Seminars in Neurology, 36(2), 196–202. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0036-1579694 

Zanloo, Z., & Zareei, N. (2016). Effect of Selected Water Exercises on Balance and Life Quality of Women with Multiple Sclerosis. International Journal of Biology, Pharmacy and Allied Sciences, 5(1), 409–423. Retrieved from http://ijbpas.com/pdf/2016/January/1452607225MS%20IJBPAS%202016%20JAN%20SPCL%201120.pdf