BACKGROUND AND PURPOSE: Pain and cancer-related fatigue (CRF) are impairments from breast cancer or the medical and surgical therapies for breast cancer. Aquatic therapy has been found to be effective for the problems of pain and CRF. The purpose of this systematic review was to determine whether aquatic therapy reduced pain and CRF among people with breast cancer and to identify any elements of aquatic therapy associated with those effects. METHOD(S): The protocol for this systematic review was registered with PROSPERO, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards were followed. Four databases were searched, and studies were selected on the basis of predetermined criteria. Data were extracted into a template for analysis and thematic synthesis. Measures of methodological quality (risk of bias) and level of evidence were applied. RESULT(S): Six studies involving 137 subjects who received treatment were included. Subjects received aquatic therapy (water-based exercise for rehabilitation) that was compared with various land-based interventions. Studies were evaluated with the Oxford Centre for Evidence-based Medicine Levels of Evidence for Therapy/Prevention Studies Rating Scale, and all studies had a high or acceptable level of evidence. Studies were evaluated with the APTA Critical Appraisal Tool for Experimental Intervention Studies, and 5 studies had a high or acceptable quality. High-quality evidence supported the use of aquatic therapy for reducing CRF, and acceptable quality evidence supported the use of aquatic therapy for reducing pain. Adverse responses to aquatic therapy were minor symptoms that resolved within days and had no effect on attrition. LIMITATION(S): Searches were limited to publications in English. Analysis was confounded by heterogeneity of pain measures. CONCLUSION(S): Aquatic therapy is recommended as an intervention for the impairments of pain and CRF associated with breast cancer. Aquatic therapy is safe and feasible for this population.

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