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Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial [with consumer summary]
de Castro LA, Felcar JM, de Carvalho DR, Vidotto LS, da Silva RA, Pitta F, Probst VS
Physiotherapy 2020 Jun;107:58-65
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN: Randomised clinical trial. SETTING: University-based, outpatient, physical therapy clinic. SUBJECTS: Fifty individuals with COPD. INTERVENTIONS: Participants were assigned at random to the land group (LG; n = 27) or the water group (WG; n = 23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES: Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS: Seventeen subjects completed the intervention in the LG (nine males, mean age 64 (standard deviation (SD) 8) years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted) compared with 14 subjects in the WG (nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted). Water-based exercise training had a positive effect on functional balance (TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; p = 0.006), whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; p < 0.001). CONCLUSION: Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER: NCT01691131.

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