Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial

Objectives To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD). Design Randomised controlled trial. Setting University-based outpatient clinic. Participants Thirty-six patients with predominantly moderate-to-severe COPD completed the study. Intervention Patients were evaluated at baseline, at 3 months and at the end of the programme (i.e. 6 months). For both groups, the 6-month protocol consisted of high-intensity endurance and strength exercises with gradual increase in time and/or workload, totalling 60 sessions. Main outcomes Objective monitoring of physical activity in daily life (PADL, primary outcome), lung function, peripheral and respiratory muscle strength, body composition, maximal and submaximal exercise capacity, functional status, quality of life, and symptoms of anxiety and depression. Results After 6 months of training, a significant improvement in PADL was seen for both groups [mean difference (95% confidence interval): land group 993 (358 to 1628) steps/day; water group 1669 (404 to 2934) steps/day]. Significant improvements were also seen in inspiratory, expiratory and peripheral muscle strength; maximal and submaximal exercise capacity; quality of life and functional status for both groups. There were no significant improvements in lung function, body composition, and symptoms of anxiety and depression for either group. No difference was found in the magnitude of improvement between the two types of training for any outcome. Conclusion High-intensity exercise training in water generates similar effects compared with training on land in patients with moderate-tosevere COPD, rendering it an equally beneficial therapeutic option for this population. (C) 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.