The aim of this review was to summarize the level of evidence and grades of recommendation regarding therapeutic aquatic exercise interventions in chronic obstructive pulmonary disease (COPD) patients. We conducted a systematic search to identify relevant studies published from 1996 until 2010. Methodological quality of trials was assessed using the Delphi list and the grades of recommendation according to the DUODECIM (Finnish Medical Society Duodecim). The reviewed articles covered incremental therapeutic aquatic exercise with an intensity ranging from 50% to 90% of VO2max with sessions of 30 to 50 minutes 2-5 days a week, for a total of 8-24 weeks at water temperatures ranging from 29 ºC to 38 ºC. The few clinical trials on patients with COPD showed no beneficial effects on lung function.