Aquatic Physical Therapy and Aquatic Exercise

Aquatic Physical Therapy and Aquatic Exercise

By Mick Nelson  | Sunday, February 12, 2017

The term Water Therapy or Aquatic Therapy is being used more and more when new facilities are in the planning stages or existing facilities are looking for new revenue streams. This is a much needed community benefit, however, the model for this service needs to be understood.

Terminology – We would love to tell you that the names we use are standardized and that we all mean the same thing when we use terms like Aquatic Therapy – but that is not the way it is in the real world. One of our most common hurdles is to make sure we in one area of the aquatics business are talking the same language as someone from another area of the same business – e.g. A Facility Director and a Physical Therapist and an Aquatic coach or specialist. Most of the time the following is accurate:

Aquatic Physical Therapy = Medicaid/Medicare or Insurance reimbursable services that are delivered by a licensed Physical Therapist at an inspected and approved facility.

Aquatic Exercise = Aquatic services that are “private pay” and that should be delivered by a professional with certification such as offered by the AEA (Aquatic Exercise Association)

(Note: Aquatic Therapy or Rehab. = Nebulous terms (among many) that sometimes are used when referring to either of the first two terms.)

There are a few things that need to be seriously considered when planning a facility that will include either or both of these programs.

Aquatic Physical Therapy

Aquatic Therapy PoolAt least one pool (preferably two) needs to be designed strictly for aquatic therapy. These pools must be designated strictly for therapy during the identified hours, in other words, shared programming is not allowed if it is reimbursable therapy. The pool can be used for other programs before or after the hours for therapy but not during or simultaneously. These pools do not have to be large – in fact they can be as small as 10’ wide x 15’ long x 4’ deep as long as they have stairs or a ramped entry and a lift. Water temperature should be between 88 and 92 degrees.

When addressing aquatic therapy, other considerations that need to be addressed in the planning stage:

  • Unisex assisted care-giver dressing rooms and showers
  • Examine and treatment rooms for the therapist to evaluate patients
  • Land based exercise equipment for cross training and evaluation purposes
  • Waiting areas and other amenities
Dry Exercise Area in Aquatic Therapy Facility

99% of the time the facility or club will not want to get involved in the daily business of water therapy. This is something to leave to the professionals! Plan to stay in the “water rental” business. There are many hospitals that want to move away from the “sick environment” and move into places where there is a “wellness environment” with active people trying to be healthy. For a hospital, or independent therapist to operate an average size therapy pool and business, it will cost them around $82 per hour. That includes, chemicals, equipment upkeep and repair, utilities (a big part of the expense), a Certified Pool Operator, cleaning crew, guards, tech’s for assistance, etc. The operational cost and intensive staffing are the main reasons many therapy pools are not built. However, if a facility would add a therapy pool to the plans and maintain and staff it professionally, the hospital/therapist should willingly pay $70 per hour rental. They can make a very nice profit and the facility can operate the pool with much of the existing staff they need for other pools anyway.

Aquatic Exercise

The pool for aquatic exercise needs to be larger that the designated therapy pool. Size will depend on the community the program serves and the other supporting programs at the same location. A versatile size is 75’ long x 45’ wide with depths ranging from 4’ to 6’. Ramped entry is also a very good idea. Temperature should be able to be controlled from 83 degrees to 86 degrees (or warmer). If necessary, the pool size can be reduced to as little as 45’ x 25’.

The aquatic exercise pool is also a great setting for Learn-to-Swim classes, 1:1 Aquatic Personal Training, and a host of other warmer activities including 10 and under competitive swimmers practices.

If a specialty pool is not in the plans, a more conventional lap pool can also be used for aquatic exercise as long as the temperature, access, and depth issues are all properly addressed. It should be obvious that a 50 meter long, 7 foot deep, 81 degree pool with ladders for entry would have very limited programming opportunities.

The aquatic exercise business is something a facility/club should consider being in. Two out of every three patients that are released from physical therapy are immediately looking for a safe and comfortable environment in which to continue their exercise regime and maintain their newly found healthy lifestyle. This is can be offered as a membership program.

An aquatic exercise programming can develop into a major part of a facilities income potential plus be a very valuable community service. Truly a win-win situation.


  • A split therapy pool (2 tanks) design with dressing areas can be designed in approximately 2,000 square feet.
  • The land based supporting rooms and exercise area can be designed in approximately 3,500 square feet
  • The aquatic exercise “continuum area” can be designed in approximately 6,000 square feet
  • Add an additional 4,000 square feet for meeting rooms, hallways, concession areas, public areas, storage, offices, cleaning & laundry, etc.
  • Therefore the total square feet needed is approximately 15,500 square feet

For design and planning information please contact Mick Nelson .  For programming information please contact Sue Nelson For Aquatic Therapy information please visit For Aquatic Exercise information please visit



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