Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy of acute respiratory distress syndrome (ARDS) patients has recently been identified as an important therapeutical tool and has become an important evidence-based component in the management of these patients. Nevertheless, availability and quality of physiotherapy performed in intensive care units (ICUs) is often inadequate. The aim of this review is to describe recent progresses in application of physiotherapy in ARDS patients. The assessment and evidence-based treatment of these patients should include prevention and reduction of adverse consequences of immobilization and weaning failure. A variety of modalities of early physiotherapy in ICU are suggested by clinical research and should be applied according to the stage of disease, comorbidities, and patient's level of cooperation. Early ICU physiotherapy is an interdisciplinary team activity, involving physical therapists, occupational therapists, nurses and medical staff.