Purpose/Hypothesis: Exercise for chronic heart failure improves physical capacity and quality of life. Safety and efficacy of aquatic exercise for this population is not well determined, due to potentially altered heart function caused by water immersion. However, the aquatic environment may further the benefit of exercise corn pared to land-based exercise. Therefore, the primary purpose is to search the existing literature to determine if aquatic exercise is safe and effective for improving heart function and quality of life for adults with heart failure. The secondary purpose is to determine if aquatic therapy is more effective than land exercise Materials/Methods: An electronic search for articles was conducted through February 10, 2013 Search terms included aquatic exercise, aquatic therapy, aqua therapy, water-based exercise, water exercise, hydrotherapy, cardiac, heart failure, chronic heart failure. Inclusion criteria: participants with chronic heart failure who had more than1 session of water-based exercise intervention, and spoke the English language. Data from studies meeting Present criteria were combined to calculate grand effect sizes and95% confidence intervals. Results: Six articles with level of evidence 1B-2B met the criteria to be included in this review. Analysis of the within group changes for aquatic exercise showed statistically significant improvements. The grand effect size (95% CI) for the 6-Minute Walk Test (6MWT) was 1.33 (0.07, 2.60), orygen consumption (VO2) 0.5 (0.15,0.85), muscle power 0.42(O.07,0.77), and quality of life -0.54 (-0.97, -0.10). Ejection fraction was not significantly changed after water exercise’0.08 (-0.30,0.45). Measures for between group differences were not statistically significant [VO2 0.16 (-0.42,0.75),muscle power 0.47 (-0.I2, 1.06)1. Additionally, clinically13significant improvements were found within-groups, and in favour of aquatic exercise for between-groups. Conclusions: Aquatic exercise is a safe and effective form of exercise for adults with mild to moderate chronic heart failure. Patients with chronic heart failure who participate in aquatic therapy programs can expect an increase in exercise tolerance and quality o flife, without significant changes in ejection fraction. Additionally, no statistically significant differences in functional outcomes were found between land-based exercise and aquatic exercise for this population; however, more research is needed to corroborate obtained clinical differences that favoured aquatic exercise.