Efficacy of hydrokinesis therapy in reducing fatigue and stress in patients with fibromyalgia: A systematic review

Background Fibromyalgia is a chronic syndrome with widespread pain and multisystem symptoms. Hydrokinesitherapy, combining exercise and water immersion, may reduce pain, improve function, and enhance quality of life. It may be more effective than land-based therapy, though protocols remain unstandardized. This study evaluated its effectiveness in fibromyalgia. Objective This systematic review aimed to evaluate the effectiveness of hydrokinesitherapy compared to land-based exercise or placebo intervention in women with fibromyalgia, with particular focus on its impact on pain, physical function, well-being, and quality of life assessed through the fibromyalgia impact questionnaire (FIQ). Methods A literature review was conducted using the following databases until may 28 th 2025: PubMed, Scopus, and Web of Science. Studies were deemed eligible based on the following PICO criteria: P) Participants: women diagnosed with fibromyalgia; I) Intervention: hydrotherapy; C) Control: land-based exercise or placebo/sham treatments; O) Outcome: Fibromyalgia Impact Questionnaire (FIQ). Only randomized controlled trials RCTs with two groups and full text in English were included. Results This review included 10 RCTs with 469 participants, 238 treated with hydrokinesitherapy. Results showed significant improvements in pain, function, sleep, depression, and quality of life in women with fibromyalgia. Outcomes were better than land-based exercise, but benefits decline without continued therapy; long-term studies are needed to define optimal duration and structure. Conclusion Hydrokinesitherapy combined with exercise benefits from warm-water immersion, reducing joint stress and improving movement tolerance in fibromyalgia. This review confirms its effectiveness in reducing pain, enhancing physical and psychological well-being, and improving quality of life.