BACKGROUND: The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking. METHODS: Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training. RESULTS: Significant differences were observed in the change in %body fat (TW -2.7%, AW -2.8%, CON -0.4%), total cholesterol level (TW -23.6 mg/dL, AW -27.2 mg/dL, CON 15.8 mg/dL), resting heart rate (TW -6.3 bpm, AW -6.9 bpm, CON 1.3 bpm), and cardiorespiratory fitness expressed as VO2peak (TW 2.3 mL/kg/min, AW 2.0 mL/kg/min, CON -2.5 mL/kg/min) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups. CONCLUSION: AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.

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