In the last decades head-out aquatic exercises became one of the most important physical activities within the health system. Massive research has been produced throughout these decades in order to better understand the role of head-out aquatic exercises in populations’ health. Such studies aimed to obtain comprehensive knowledge about the acute and chronic response of subjects performing head-out aquatic exercises. For that, it is assumed that chronic adaptations represent the accumulation of acute responses during each aquatic session. The purpose of this study was to describe the “state of the art ”about physiological assessment of head-out aquatic exercises based on acute and chronic adaptations in healthy subjects based on a qualitative review. The main findings about acute response of head-out aquatic exercise according to water temperature, water depth, type of exercise, additional equipment used, body segments exercising and music cadence will be described. In what concerns chronic adaptations, the main results related to cardiovascular and metabolic adaptations, muscular strength, flexibility and body composition improvements will be reported.