Effects of Aquatic Therapy in Multiple Sclerosis Patients

Examining the potential physical and psychosocial benefits of Ai Chi for patients diagnosed with MS  


Truman Cowles, BSN, RN and Jong-Mi Lee, MSN, NP conducted a study on the effects of aquatic therapy in Multiple Sclerosis patients. Patients diagnosed with multiple sclerosis (MS) often seek complementary and alternative medicine (CAM) to assist with symptom management and to improve quality of life. Research on the use of Ai Chi, a form of aquatic CAM involving continuous movement of the arms, legs, and trunk combined with deep breathing, is limited in the MS patient population.



Truman Cowles  and Jong-Mi Lee consulted with the Office of Research to examine the potential physical and psychosocial benefits of Ai Chi, a form of aquatic therapy, for patients diagnosed with multiple sclerosis (MS). The study team compared functional outcomes in patients randomized either to Ai Chi or Chair Yoga. Ai Chi involves a series of continuous slow and broad movements. It was developed in 1993 by Jun Konno, owner of an Aquadynamics Institute in Yokohama, Japan. Ai Chi’s 19 movements include the use of arms, legs, and trunk combined with deep breathing.  Use of Ai Chi in patients with MS is not well known, and a few studies have been performed to determine the effectiveness of this therapy.


Cowles and Lee enrolled 23 patients at the Stanford Neuroscience Health Center.  Six withdrew from the study, and one was lost to follow-up, leaving 16 subjects for analysis. Subjects were randomized to two comparison CAM groups: a 45-minute Ai Chi class in a heated pool (=10) and a 45-minute chair yoga class (=6), both occurring once a week for 12 weeks. All participants were evaluated on functional outcomes before and after the 12-week intervention period. Evaluations were a Medical Outcomes Study (MOS) pain effects score, a Modified Fatigue Impact Scale (MFIS), a timed 25-foot walk test, and a Health Status Questionaire (SF-36). 


Subjects’ mean age was 53.69 (median=51.50, IQR=46.75-61.25), and most were female (81%) with no prior CAM experience (88%). Post intervention, MOS mean Ai Chi score went from 16.50 (median=18.50, IQR=11.25-21.25) to 10.40 (median=10, IQR=6.25-13.75) vs. 17.67 (median=18, IQR=14-19.75) to 16.50 (median=16.50, IQR=12-20.25) for yoga. MFIS mean Ai Chi score went from 11.20 (median=11, IQR=9.25-12.75) to 7.40 (median=7, IQR=5-11.50) vs. 13.17 (median=13.50, IQR=11.50-14.75) to 8.66 (median=7, IQR=6-10.25) for yoga. Mean Ai Chi walk time went from 9.35 to 7.23 sec vs. 9.13 to 7.53 sec for yoga. Health Status Questionaire (SF-36) analysis is in progress.


Patients with MS were observed to experience positive effects after participating in both types of CAM therapy. Ai Chi tended to be at least as effective in reducing pain and fatigue as chair yoga. Based on these outcomes, Ai Chi may be a reasonable CAM option for patients with MS to minimize pain and fatigue. Study limitations include a small sample size, lack of a control group, and difficulty with blinding.

To learn more about the Stanford Office of Research - Patient Care Services, visit them at -  www.orpcs.org​

Clinical Implications

This study identified the potential to improve quality of life for patients living with MS through a weekly Ai Chi program. Clinicians would be able to offer a complementary program to help reduce patients’ pain and fatigue in conjunction with standard medical care, perhaps improving the well-being of patients living with and beyond the disease.


Contributed by:

TC Cowles, BSN, RN

300 Pasteur Dr
Palo Alto, 94304


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