Aqua Lymphatic Therapy, developed by Dorit Tidhar (MScPT, CLT, ALT), is based on the principles of the Casley–Smith exercise program for lymphedema and is applied in an aquatic environment. The method enhances the lymphedema therapy by combining principles of lymphatic anatomy and physiology with the effect of water immersion.

The water temperature ranges from 31°C to 33°C (87.8-91.4°F). At this temperature slow limb movement can be performed without increasing swelling. The buoyancy of the water holds the limb afloat, enabling exercises and self massage with minimal effort while swelling reduction is facilitated by the hydrostatic pressure of the water which increases lymph and venous return (similar to the effect of a compression garment).

ALT is a self-treatment in a group setting. The participants are encouraged to choose the exercises, which benefit them the most. They are provided a chart with their limb measurement results every month to help them decide how best to continue their individual treatment plan. The participants are thus provided with the tools they need to carry out self-treatment at their convenience and the physiotherapist serves as a resource, but does not direct the individual plans of care. This method provides active opportunities for self directed care that may enhance self-advocacy, independence and self-esteem.

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