The research on the effects of aquatic exercise is a field that has grown rapidly in the last decade. The majority of the available literature is focused on the benefits of water-based exercise programs for people with rheumatologic disease and back pain; however, there is a lack of evidence reporting the effects of exercise performed in an aquatic medium for healthy elderly adults. The purpose of this study was to critically review the existing evidence of a potential relationship between water-based exercise and improvement of physical fitness in healthy elderly subjects. A systematic database search for manuscripts and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials (RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified as high quality studies. One RCT, one randomized UT and one CTwere considered low quality studies. Strong evidence supports the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits on flexibility, and inconclusive evidence was found supporting the modification of body composition.

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