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Advancements in Water-Based Exercises for Health Promotion and Rehabilitation
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Advancements in Water-Based Exercises for Health Promotion and Rehabilitation

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 15 March 2027 | Viewed by 4915

Editors

Dr. Billy C. L. So

E-Mail Website
Guest Editor
Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
Interests: aquatic physiotherapy; exercise; biomechanics; rehabilitation; health
Dr. Siu Shing Man

E-Mail Website
Guest Editor
School of Design, South China University of Technology, Panyu District, Guangzhou 510006, China
Interests: safety and health; human factors and ergonomics; engineering management; industrial design
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Water-based exercises, recognized for their unique properties such as buoyancy, resistance, and reduced gravitational load, have increasingly emerged as an effective approach for health promotion and rehabilitation. These exercises facilitate improved physical fitness, reduced pain, enhanced mobility, and accelerated recovery across diverse populations, including elderly individuals, people with chronic illnesses, and athletes in rehabilitation. Recent advancements in technology, exercise protocols, and methodological approaches have further expanded aquatic exercise applications, promoting physical and psychological health outcomes.

For this Special Issue, we invite the submission of original research articles, systematic reviews, clinical trials, and evidence-based case studies addressing novel interventions, physiological and biomechanical responses, psychosocial impacts, technological advancements (e.g., wearable devices and virtual reality applications), and best practices in water-based exercise programs. Multidisciplinary contributions integrating perspectives from sports medicine, physical therapy, biomechanics, public health, and rehabilitation sciences are particularly welcome. Submissions that provide practical insights into protocol standardization, efficacy evaluation, or translation into clinical practice are highly encouraged. This Special Issue seeks to bridge the gap between research and clinical communities, ultimately advancing the scientific understanding and practical application of water-based exercises for optimized health promotion and effective rehabilitation.

In this Special Issue, original research articles and reviews are welcome to be submitted. Research areas include, but are not limited to, the following:

  • Hydrotherapy;
  • Aquatic Physiotherapy;
  • Buoyancy-Assisted Training;
  • Health Promotion;
  • Exercise Physiology;
  • Biomechanical Analysis;
  • Neurological Rehabilitation;
  • Cardiovascular Fitness;
  • Psychological Wellbeing;
  • Quality of Life;
  • Wearable Technology;
  • Virtual Reality;
  • Telehealth in Aquatics;
  • Exercise Adherence;
  • Evidence-Based Practice.

We look forward to receiving your contributions.

Dr. Billy C. L. So
Dr. Siu Shing Man
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • water-based exercises
  • health
  • rehabilitation
  • training
  • technology

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Published Papers (3 papers)

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14 pages, 1072 KB  
Article
Four-Days of Passive Heat Acclimation Increases Exercise Capacity in Healthy Older Adults Living in the UK
by Laura J. Wilson, Emma V. Ward and Luke W. Oates
Healthcare 2026, 14(8), 1005; https://doi.org/10.3390/healthcare14081005 - 11 Apr 2026
Viewed by 1695
Abstract
Background: Older adults are particularly vulnerable to heat related illness due to impaired thermoregulatory responses. Heat acclimation (HA) strategies can mitigate the negative impacts of high environmental temperatures on physiological and perceptual responses. Whilst active HA strategies may prove problematic for older adults, [...] Read more.
Background: Older adults are particularly vulnerable to heat related illness due to impaired thermoregulatory responses. Heat acclimation (HA) strategies can mitigate the negative impacts of high environmental temperatures on physiological and perceptual responses. Whilst active HA strategies may prove problematic for older adults, passive approaches such as hot water immersion (HWI) may be more feasible. Methods: This study investigated the effects of four consecutive days of HWI on physiological and perceptual markers in individuals aged over 65 years during moderate exercise. Nine healthy, recreationally active participants (76 ± 5 years) completed two 30 min cycling bouts at 75–80% age predicted HRmax pre- and post-four days of HWI at 40 °C. Measures of average HR, gastrointestinal temperature, skin temperature, thermal sensation, thermal comfort, rate of perceived exertion, power output, and distance covered were recorded during both exercise bouts. Results: Results showed a significant increase in exercise capacity as measured by power output (p < 0.05, 7.45 W) post-intervention, despite no change in ratings of perceived exertion, and reductions in average heart rate (112 ± 3 vs. 109 ± 4 bpm). There were no alterations in gastrointestinal or skin temperature, and ratings of thermal comfort and sensation remained unchanged post-intervention. Conclusions: These preliminary findings provide important new evidence that four days of passive HWI may be a practical and effective method of inducing physiological adaptations in older individuals, which may be of use in interventions to mitigate the negative impact of high environmental temperatures in this population. Full article
(This article belongs to the Special Issue Advancements in Water-Based Exercises for Health Promotion and Rehabilitation)
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19 pages, 1364 KB  
Systematic Review
Effects of Aquatic Exercise on Type 2 Diabetes Management in Adulthood: A Systematic Review and Meta-Analysis, Including Evidence on the Use of Wearable Devices
by Josiane Nicolle Pereira, Francisco A. Ferreira and Vinícius Costa Lima
Healthcare 2026, 14(8), 998; https://doi.org/10.3390/healthcare14080998 - 10 Apr 2026
Viewed by 1215
Abstract
Background/Objectives: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder associated with major cardiovascular and metabolic complications. Regular physical activity is recommended for glycaemic management, but barriers such as obesity, joint pain, and impaired mobility may limit participation in land-based exercise. [...] Read more.
Background/Objectives: Type 2 Diabetes Mellitus (T2DM) is a prevalent metabolic disorder associated with major cardiovascular and metabolic complications. Regular physical activity is recommended for glycaemic management, but barriers such as obesity, joint pain, and impaired mobility may limit participation in land-based exercise. Aquatic exercise may provide a feasible alternative as water buoyancy reduces joint loading while allowing aerobic and resistance training. This systematic review and meta-analysis evaluated the effects of aquatic exercise interventions on glycaemic control in adults with T2DM. Methods: The review followed the PRISMA 2020 guidelines. MEDLINE, Cochrane CENTRAL, Scopus, Web of Science, and IEEE Xplore databases were searched. Randomised and non-randomised longitudinal studies involving adults aged ≥35 years with T2DM participating in structured aquatic exercise programmes were eligible. The primary outcome was glycated haemoglobin (HbA1c). Risk of bias was assessed using RoB 2 and RoBANS 2, and certainty of evidence was evaluated using GRADE. Random-effects meta-analysis calculated mean differences (MDs) with 95% confidence intervals. Results: Eleven randomised controlled trials involving 335 participants were included. Aquatic exercise significantly reduced HbA1c compared with passive control conditions (MD = −0.76%; 95% CI −1.21 to −0.32), although heterogeneity was high. No significant differences were observed between aquatic and land-based exercise interventions. Eight studies used wearable heart-rate monitors to regulate exercise intensity. Conclusions: Aquatic exercise may improve glycaemic control compared with sedentary conditions and yields effects comparable to those of land-based exercise in adults with T2DM. Further high-quality trials are needed to clarify optimal exercise dose–response and evaluate more advanced wearable technologies. Full article
(This article belongs to the Special Issue Advancements in Water-Based Exercises for Health Promotion and Rehabilitation)
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25 pages, 1130 KB  
Systematic Review
Effects of Aquatic Exercise on Sleep Quality in Patients with Chronic Diseases: A Meta-Analysis
by Shuzhang Zhou, Ming Fang, Billy Chun-Lung So, Hei Wa So, Paul H. Lee and Siushing Man
Healthcare 2026, 14(5), 661; https://doi.org/10.3390/healthcare14050661 - 5 Mar 2026
Cited by 1 | Viewed by 1144
Abstract
Background/Objectives: This study systematically synthesized the evidence on the effectiveness of aquatic exercise (AE)-based interventions for improving sleep quality in patients with chronic diseases and identified key moderating factors. Methods: A meta-analysis of 11 randomized controlled trials sourced from Google Scholar, PubMed, Web [...] Read more.
Background/Objectives: This study systematically synthesized the evidence on the effectiveness of aquatic exercise (AE)-based interventions for improving sleep quality in patients with chronic diseases and identified key moderating factors. Methods: A meta-analysis of 11 randomized controlled trials sourced from Google Scholar, PubMed, Web of Science, Embase, Cochrane Library, and Scopus (published between 2016 and 2025) was conducted. Sleep quality was assessed using subjective tools (e.g., PSQI). Results: While AE-based interventions showed potential for enhancing nighttime sleep quality (standard mean difference = 0.825, p < 0.001), high statistical heterogeneity (I2 = 93.41%) was observed. Given this variance, the analysis prioritized the clinical outcomes of specific patient populations over the pooled effect size. Preliminary evidence suggests significant improvements were confirmed in populations with post-COVID syndrome (p < 0.001), Parkinson’s disease (p = 0.002), and chronic back pain (p = 0.008). Conversely, no significant benefits were observed in fibromyalgia (p = 0.191), ankylosing spondylitis (p = 0.737), or type 2 diabetes (p = 0.836). Moderator analysis further indicated that the mode of AE might influence outcomes, with recreational aquatic therapy and deep-water running suggesting superior efficacy compared to resistance training. Conclusions: AE-based interventions were suggested as an effective intervention for improving sleep quality. The observed benefits likely stem from the synergistic effects of physical exercise and the unique physiological properties of the aquatic environment, such as buoyancy and hydrostatic pressure. However, the field relies heavily on subjective questionnaires and lacks physiological mechanism studies. These findings provide a preliminary evidence-based framework for clinicians to develop targeted AE-based interventions for chronic disease patients. Full article
(This article belongs to the Special Issue Advancements in Water-Based Exercises for Health Promotion and Rehabilitation)
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