Effect of Water Immersion on Dual-task Performance: Implications for Aquatic Therapy

Physiother Res Int. 2016 Sep;21(3):147-54. doi: 10.1002/pri.1628. Epub 2015 Apr 17.


Background and purpose: Much is known about cardiovascular and biomechanical responses to exercise during water immersion, yet an understanding of the higher-order neural responses to water immersion is unclear. The purpose of this study was to compare cognitive and motor performance between land and water environments using a dual-task paradigm, which served as an indirect measure of cortical processing.

Design: A quasi-experimental crossover research design is used.

Methods: Twenty-two healthy participants (age = 24.3 ± 5.24 years) and a single-case patient (age = 73) with mild cognitive impairment performed a cognitive (auditory vigilance) and motor (standing balance) task separately (single-task condition) and simultaneously (dual-task condition) on land and in chest-deep water. Listening errors from the auditory vigilance task and centre of pressure (CoP) area for the balance task measured cognitive and motor performance, respectively.

Results: Listening errors for the single-task and dual-task conditions were 42% and 45% lower for the water than land condition, respectively (effect size [ES] = 0.38 and 0.55). CoP area for the single-task and dual-task conditions, however, were 115% and 164% lower on land than in water, respectively, and were lower (≈8-33%) when balancing concurrently with the auditory vigilance task compared with balancing alone, regardless of environment (ES = 0.23-1.7). This trend was consistent for the single-case patient.

Conclusion: Participants tended to make fewer 'cognitive' errors while immersed chest-deep in water than on land. These same participants also tended to display less postural sway under dual-task conditions, but more in water than on land. Copyright © 2015 John Wiley & Sons, Ltd.

Keywords: aquatic therapy; brain activity; hydrotherapy; postural sway; rehabilitation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Cross-Over Studies
  • Environment*
  • Female
  • Humans
  • Hydrotherapy / methods*
  • Immersion*
  • Male
  • Postural Balance / physiology*
  • Qualitative Research
  • Reference Values
  • Task Performance and Analysis
  • Water


  • Water