Introduction: Fibromyalgia is a chronic pain syndrome that significantly affects pain, quality of life, and physical function. Among non–pharmacological approaches, hydrokinesiotherapy and land–based exercise are frequently used in the management of women with fibromyalgia; however, direct comparisons of their effects remain inconsistent. Purpose: The aim of this diploma thesis was to systematically review the literature in order to determine whether the effects of hydrokinesiotherapy and land–based exercise in women with fibromyalgia differ with regard to pain, quality of life, and functional, mobility–related, and cardiorespiratory outcomes. Methods: A systematic literature review was conducted. The search was performed in the PubMed, Web of Science, and PEDro databases between 6 October 2025 and 15 October 2025. Randomised controlled trials published in English were included if they compared hydrokinesiotherapy with land–based exercise in women with fibromyalgia and reported outcomes related to pain, quality of life, or functional, mobility–related, and cardiorespiratory outcomes. Six studies were included in the final analysis. According to the PEDro scale, the methodological quality of the included studies ranged from 4 to 8 points. Results: Both exercise approaches were associated with beneficial effects, as at least some clinically relevant outcomes improved in both groups in most studies. Regarding pain, the effects of hydrokinesiotherapy appeared partially more favorable mainly in specific pain–related indicators and the number of tender points. Regarding quality of life, advantages of hydrokinesiotherapy were observed primarily in individual domains rather than consistently in the total questionnaire scores. Functional, mobility–related, and cardiorespiratory outcomes were inconsistent, which was also related to the use of different outcome measures and differently designed exercise programs. Discussion and conclusion: The superiority of hydrokinesiotherapy over land–based exercise was not consistently confirmed across all outcomes and in all participants. The findings suggest that both exercise approaches may be beneficial; therefore, the choice of exercise environment should be individualized according to the patient's pain, exercise tolerance, functional limitations, and program availability. Interpretation of the results is limited by methodological differences between studies, small sample sizes, non–uniform exercise programs, and different follow–up periods.
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