Comparative Rehabilitation Benefits of Water-Based Versus Land-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

TL;DR

Water-based exercise offers better lung function, exercise capacity, and respiratory muscle improvements for COPD patients compared to land-based exercise.

Contribution

This study provides the first systematic review and meta-analysis comparing water-based and land-based exercise for COPD rehabilitation.

Findings

Water-based exercise significantly improves FEV1% predicted and FEV1/FVC in COPD patients.

Water-based exercise increases six-minute walk distance more than land-based exercise.

Water-based exercise enhances maximal inspiratory and expiratory pressures in COPD patients.

Abstract

Patients with chronic obstructive pulmonary disease (COPD) commonly experience impaired lung function, reduced exercise tolerance, and respiratory muscle weakness. Owing to the unique properties of the aquatic environment, water-based exercise may provide rehabilitation benefits that differ from those of traditional land-based exercise. Objective: This systematic review and meta-analysis aimed to compare the effects of water-based versus land-based exercise on lung function, exercise capacity, and respiratory muscle function in patients with COPD, thereby providing evidence to inform the optimization of pulmonary rehabilitation exercise modalities. Methods: PubMed, Web of Science, CNKI, and other databases were systematically searched to identify randomized controlled trials comparing water-based and land-based exercise interventions in adults with COPD. Primary outcomes included lung function (FEV1% predicted and FEV1/FVC), exercise capacity (six-minute walk distance, 6MWD), respiratory muscle strength (maximal inspiratory pressure (MIP]) and maximal expiratory pressure (MEP). Meta-analyses were performed using Stata 17.0. Results: A total of 14 RCTs were included. Meta-analysis showed that, compared with land-based exercise, water-based exercise significantly improved FEV1% predicted (WMD = 3.33, 95% CI: 0.02–6.64) and FEV1/FVC (WMD = 4.00, 95% CI: 1.27–6.73). Regarding exercise capacity, water-based exercise significantly increased 6MWD (WMD = 47.81 m, 95% CI: 20.19–75.44), with more pronounced improvements observed in short-term interventions (≤8 weeks). Respiratory muscle function analyses demonstrated significant improvements in MIP (WMD = 14.22 cmH2O, 95% CI: 7.75–20.69) and MEP (WMD = 14.40 cmH2O, 95% CI: 4.92–23.89). Conclusions: Compared with land-based exercise, water-based exercise demonstrates consistent advantages in improving exercise capacity and respiratory muscle function in patients with COPD and shows additional benefits for lung function indices. Therefore, water-based exercise may serve as a valuable adjunct to land-based training within pulmonary rehabilitation programs.

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