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International Journal of Physiotherapy and Allied Health SciencesIJPAHS · Published by Avyakt Pharma · www.ijpahs.com
Review Article · Volume 1, Issue 1 (2026)

Effects of Water-Based versus Land-Based Exercise Training on Muscle Strength in Patients with Multiple Sclerosis: A Review Study

Namrata Chaudhari, Aneri Desai

Shree Swaminarayan Physiotherapy College, Kadodara, Surat, Gujarat, India

Corresponding author: Aneri Desai — desai.aneri26@gmail.com

Vol. 1 · Issue 1 · Pages 20–26Published: 26 July 2026Open Access · CC BY 4.0

Abstract

Background: Multiple Sclerosis (MS) is a chronic disorder of the central nervous system that commonly produces muscle weakness, fatigue, and reduced mobility. Land-based exercise can directly improve muscle strength but may be limited by fatigue, heat sensitivity, and fall risk, whereas water-based exercise offers buoyancy, reduced joint loading, and better thermoregulation. Comparative evidence on the relative effectiveness of these two approaches for muscle strength in MS remains limited. Objective: To review and evaluate the effects of water-based and land-based exercise training on muscle strength in patients with Multiple Sclerosis. Methods: A comprehensive literature review was conducted using PubMed, Scopus, Google Scholar, and Science Direct to identify randomised and non-randomised controlled trials, systematic reviews, and observational studies (published 2004–2024) involving adult patients with MS who underwent waterbased, land-based, or combined exercise training. Data on study design, intervention type, duration, and outcomes related to muscle strength, balance, mobility, and fatigue were extracted and synthesised. Results: Nineteen articles met the inclusion criteria, of which nine were characterised in detail. Both aquatic and land-based training improved muscle strength, balance, mobility, and reduced fatigue in patients with MS. Aquatic and combined training produced slightly greater benefits, attributable to buoyancy-related reduction in joint loading and fatigue, with one trial additionally reporting favourable cytokine and neurotrophin regulation after aquatic endurance training. Conclusion: Aquatic, land-based, and combined exercise programmes are safe and effective for improving muscle strength, balance, and mobility, and for reducing fatigue in patients with MS. Aquatic and combined approaches appear to confer a modest additional benefit. Regular training 2–3 times per week for 3–12 weeks is recommended to support functional independence and quality of life.

Keywords

multiple sclerosis; aquatic exercise; land-based exercise; muscle strength; rehabilitation;

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