Background: Sarcopenia is characterized by progressive skeletal muscle mass depletion and strength impairment, causing severe biomechanical alterations in gait kinematics and static postural control. While conventional land-based resistance training is the gold-standard intervention, aquatic exercise emerges as a therapeutic alternative for patients with osteoarticular limitations. However, the specific kinesiological impact of this modality on reversing sarcopenia-associated deficits requires synthesis. Aim: This narrative review correlated functional biomechanical alterations secondary to sarcopenia and evaluated current evidence regarding the role of aquatic exercise and hydrotherapy in mitigating specific deficits in postural control and mobility. Methods: A structured search was conducted across PubMed/MEDLINE and the Consensus AI platform using MeSH terms and keywords: "sarcopenia", "hydrotherapy", "aquatic exercise", "resistance training", "biomechanics", and "physical function". The selection prioritized high-impact systematic reviews, meta-analyses, and randomized controlled trials (RCTs) published in English within the last five years. Results: Sarcopenia-induced muscle depletion causes axial instability, increased center-of-pressure oscillation, and impaired kinematics during high-power movements, such as sit-to-stand transfers (evidenced by reduced Timed Up and Go and Chair Stand performance). Data demonstrate that aquatic training induces favorable hydrodynamic adaptations, promoting contractile strength increments and optimizing dynamic balance. However, a pronounced scarcity of direct comparative data was revealed: only one study isolated aquatic exercise as a primary sarcopenia intervention, and another utilized swimming merely as a control group, precluding head-to-head efficacy comparisons with dry-land protocols. Conclusions: Biomechanical alterations in sarcopenia critically compromise functional independence. Aquatic exercise and hydrotherapy possess solid biological plausibility and intrinsic efficacy in improving postural control and mobility. Nonetheless, the absence of direct comparative RCTs prevents determining superiority or equivalence relative to land-based training, establishing the aquatic modality as an excellent strategic alternative for patients with contraindications to mechanical impact.
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