Land-based exercise is often difficult for people with COPD who have co-existing obesity, musculoskeletal or neurological conditions. This randomised controlled trial aimed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to land-based exercise training and control (no exercise) in people with COPD and physical co-morbidities. Participants referred to pulmonary rehabilitation were randomly allocated to a water-based exercise, land-based exercise or control group. The two exercise groups trained for eight weeks, three sessions per week. Forty-five of 53 participants (mean (SD) age 72 (9) years, FEV1 59 (15) % predicted), completed the study. Compared to control, water-based exercise training significantly increased 6-minute walk distance, incremental and endurance shuttle walk distances, and improved Chronic Respiratory Disease Questionnaire (CRDQ) dyspnoea and fatigue. Compared to land-based exercise training, water-based exercise training significantly increased incremental shuttle walk distance (mean difference 39 m, 95% CI 5 to 72), endurance shuttle walk distance (mean difference 228 m, 95% CI 19 to 438) and improved CRDQ fatigue. Water-based exercise training was significantly more effective than land-based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical co-morbidities.
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