The psychosocial and mental health benefits of aquatic physical activity for individuals with disabilities: a systematic review from a sport psychology perspective

Individuals with disabilities worldwide are facing a critical challenge: a significantly higher risk of physical inactivity, which in turn, precipitates severe mental health issues and profound social isolation. However, a groundbreaking systematic review, published on June 25, 2026, in Frontiers in Psychology, has illuminated the substantial psychosocial and mental health benefits offered by aquatic physical activity for this population. The study, guided by the International Classification of Functioning, Disability, and Health (ICF) framework and Self-Determination Theory (SDT), synthesizes evidence up to February 2026, painting a compelling picture of water as a powerful therapeutic medium.

Water as a ‘Natural De-Marginalisation Space’

The review highlights that aquatic environments act as a unique "natural de-marginalisation space." Unlike land-based activities where mobility aids like wheelchairs or crutches can serve as constant visual markers of disability, the aquatic setting neutralizes these physical differences. As explained by the research team, the moment an individual enters the water, the societal emphasis on visible physical limitations diminishes. This environmental equalization significantly reduces feelings of social marginalization and fosters more genuine peer interactions. This is supported by findings from a meta-analysis by Jeong and Kim (2025), which revealed a substantial effect size of 0.76 for improved social skills through physical activity, with peer-interactive aquatic interventions showing an even higher effect size of 1.15.

This concept of the aquatic environment as an equalizer is crucial. Societal "ableism," defined as discrimination in favor of able-bodied people, often creates significant psychological barriers for individuals with disabilities. The study by Elipe-Lorenzo et al. (2025) identified "ableism" and a lack of adaptive psychological support as primary obstacles to inclusion in mainstream sports. The water, by its very nature, negates many of these terrestrial challenges, offering a more equitable playing field.

Addressing Mental Health Challenges: A Powerful Intervention

The systematic review underscores the potent impact of aquatic physical activity on mitigating common mental health challenges faced by individuals with disabilities, such as depression and anxiety. A meta-analysis by Jacinto et al. (2023) found that physical activity significantly reduces depressive symptoms, reporting a Z-score of -2.294 (p=0.022), indicating a statistically significant and large effect. This is further bolstered by Zhang et al. (2026), whose recent meta-analysis demonstrated that exercise is highly effective in alleviating anxiety and psychiatric comorbidities, particularly in pediatric populations.

The unique physical properties of water, including buoyancy and hydrostatic pressure, create a safe and supportive environment that significantly reduces the fear of falling and injury. This is a critical factor, as internal psychological barriers, such as fear of movement (kinesiophobia), often outweigh external physical constraints for individuals with disabilities, as noted by Ascondo et al. (2023). The ability to perform movements in water that may be impossible on land directly boosts perceived competence and autonomy. Mohamed et al. (2025), in a high-quality randomized controlled trial (RCT) involving children with cerebral palsy, observed significant improvements in Gross Motor Function Measure (GMFM) and Pediatric Balance Scale (PBS) scores (p < 0.001) following aquatic core stability training. These physiological gains, the researchers argue, act as crucial mediators that enhance psychological wellbeing by reducing kinesiophobia and increasing self-efficacy.

The Role of Self-Determination Theory (SDT)

The review’s grounding in Self-Determination Theory (SDT) provides a robust theoretical framework for understanding these benefits. SDT posits that three basic psychological needs—autonomy, competence, and relatedness—are fundamental for human motivation and psychological wellbeing. The aquatic environment, as highlighted by the study, uniquely addresses these needs:

• Competence: The reduced impact of gravity and increased support from buoyancy allow individuals to experience successful movements and skill acquisition, thereby enhancing their sense of competence. This is particularly important for individuals who may struggle with land-based activities due to physical limitations.
• Autonomy: The ability to control movements and experience a greater range of motion in the water fosters a sense of autonomy and self-efficacy. Participants can often achieve more independently in the water than they can on land, leading to greater self-reliance.
• Relatedness: As mentioned earlier, the aquatic setting promotes social interaction and connection. Group aquatic activities provide opportunities for peer support, shared experiences, and the development of meaningful relationships, fulfilling the need for relatedness.

Liu et al. (2025) identified the lack of perceived psychological competence as a core barrier to physical activity for students with disabilities, emphasizing the need for environmental adaptations that foster this sense of capability. Aquatic interventions, by their design, offer a potent solution.

Bridging the Body-Mind Connection with the ICF Framework

The International Classification of Functioning, Disability, and Health (ICF) framework further aids in understanding the holistic impact of aquatic physical activity. The review applies the ICF domains to interpret the synthesized findings:

• Body Functions and Structures: Aquatic environments directly improve physiological functions such as core muscle activation, dynamic balance, and gross motor skills, as demonstrated by studies like Mohamed et al. (2025).
• Activities and Participation: Enhanced physical capabilities in the water translate to increased engagement in meaningful activities and greater social participation. This includes improved social skills and a higher likelihood of community inclusion, as indicated by Luarte-Rocha et al. (2025).
• Environmental Factors: Aquatic settings are identified as significant facilitators that reduce both physical and psychological barriers. However, the review also notes that access to trained adaptive coaches and inclusive aquatic programs remain important environmental considerations for widespread adoption.
• Personal Factors: Successful participation and skill mastery in aquatic activities lead to significant personal growth, including increased self-efficacy, perceived competence, and autonomy. This often results in a shift towards a more empowered self-concept, moving away from a purely disability-focused identity.

The implications of this synthesized evidence are far-reaching, suggesting that aquatic physical activity is not merely an exercise regimen but a comprehensive health intervention that addresses physical, mental, and social dimensions of wellbeing for individuals with disabilities.

Timeline of Research and Future Directions

The systematic review meticulously searched for literature up to February 2026, with a focus on studies published from January 2014 onwards. This contemporary approach ensures that the findings reflect the latest advancements in research and practice. The inclusion of studies from 2023 through 2026, such as those by Jacinto et al., Zhang et al., Jeong and Kim, Mohamed et al., Mueller et al., and Elipe-Lorenzo et al., highlights the growing body of evidence supporting aquatic interventions.

While the review provides a strong foundation, it also acknowledges limitations, such as the inherent difficulty in blinding participants in aquatic studies. Looking forward, the researchers suggest that integrating emerging technologies like Virtual Reality (VR) could offer novel avenues for intervention. Li et al. (2025) have already explored the use of VR in combat sports for disability adaptation, noting its potential to decrease initial kinesiophobia and improve rehabilitation adherence. Future research could investigate VR as a pre-aquatic exposure tool to mitigate initial anxieties and hydrophobia, thereby broadening access to aquatic activities.

Implications for Practitioners and Policymakers

The findings of this systematic review carry significant weight for sport psychology practitioners, coaches, and policymakers. The evidence strongly advocates for the recognition of aquatic physical activity as a primary psychological health intervention, complementing traditional rehabilitation and mental health services.

• For Sport Psychology Practitioners and Coaches: The review urges a shift in approach from purely performance-oriented goals to strategies that actively foster autonomy, competence, and relatedness. Creating supportive aquatic environments, setting achievable challenges, and providing positive reinforcement are key to strengthening intrinsic motivation and promoting long-term engagement.
• For Policymakers: The research emphasizes the critical need for investment in inclusive aquatic infrastructure, adaptive equipment, and comprehensive training programs for aquatic professionals. Ensuring equitable access to aquatic sports and physical activities is paramount to fostering social inclusion and establishing sustainable pathways for lifelong participation among individuals with disabilities.

The review concludes that aquatic physical activity is a safe, highly effective, and evidence-based adaptive health intervention. By embracing its potential, stakeholders can work collaboratively to design inclusive, confidence-building programs that empower individuals with disabilities and enhance their overall quality of life. The study’s call to action is clear: prioritize universal design in aquatic facilities and place mental health and psychological empowerment at the forefront of adaptive sports initiatives.