Effects of Aquatic Exercise on Balance, Motor Function and Neuromuscular Performance in Children and Young Adults with Disabilities: A Systematic Review.

Background/

Objectives

Aquatic therapy is widely used in pediatric rehabilitation because buoyancy and water resistance facilitate movement practice under reduced gravitational load. The Halliwick Method is a prominent approach; however, its effects on balance, motor function, and neuromuscular performance in children and young adults with disabilities have not been comprehensively synthesized. This systematic review summarized the effects of Halliwick aquatic therapy and aquatic exercise on balance, strength, and functional mobility in this population.

Methods

This review followed Cochrane and PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025635215). PubMed, MEDLINE Complete, PEDro, Web of Science, and Google Scholar were searched from inception to November 2025. Randomized controlled trials (≥2 weeks; ≥10 participants per trial) involving individuals aged 3-29 years with disabilities were included. Risk of bias was assessed using the Cochrane RoB2 tool.

Results

Eight randomized controlled trials (involving 222 participants) met inclusion criteria. Despite heterogeneity in diagnoses and protocols (Halliwick-based hydrotherapy, swimming, strengthening, task-oriented balance training), most studies reported improvements in balance and postural control (BBS/PBS, WOTA2), gross motor function (GMFM), and functional mobility (6MWT, TUG, gait indices). Several trials demonstrated gains in strength, and one reported favorable changes in lower-limb electromyographic activation. Methodological limitations included small samples, limited blinding, variable dosing, and scarce follow-up. Due to heterogeneity in interventions and outcomes, findings were synthesized narratively.

Conclusions

Halliwick aquatic therapy and aquatic exercise appear to improve balance, motor function, and neuromuscular performance in children and young adults with disabilities. However, evidence is limited by heterogeneity and methodological constraints. More robust, standardized RCTs with direct muscle and neuromuscular assessments are needed.