Background: Aquatic exercise (AE) is a method for exercise and rehabilitation to enhance function for various clients. Objectives: Investigate the effects of head-out AE interventions on the physiological and psychological outcomes of healthy postmenopausal women of age 50–70 years. Search Strategies: Databases searched included Scopus, ScienceDirect, ResearchGate, PubMed/MEDLINE, PEDro, CINAHL, The Cochrane Library, Nursing & Allied Health Collection: Comprehensive, JSTOR, and OTSeeker.com, through January 2015. Search Criteria: Randomized controlled trial and quasi-randomized controlled trial studies. Data Collection and Analysis: Two researchers scanned studies based on inclusion and exclusion criteria. Studies included were critically appraised using the Physiotherapy Evidence Database scale (PEDro scale). Results: A total of 15 studies including postmenopausal women and head-out AE intervention were reviewed. Considerable variation existed in the interventions and assessments. Outcome measures showed anthropometric measures (body mass index, circumference, skinfolds, and body fat) were inconclusive; upper and lower body strength improved; flexibility improved; all functional movements (short-distance walk, long-distance walk/run, power, agility, balance and falls) improved; bone density improved; biochemical and hormonal variables were inconclusive; and quality of life outcomes improved. Conclusions: Head-out AE appears to be an effective training and conditioning method for postmenopausal women to improve strength, flexibility, functional movements, bone density, and quality of life.