BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable condition, characterized by persistent airflow limitation. Exercise training is a core component of pulmonary rehabilitation in people with COPD. Water-based exercise has been studied, but it remains unclear whether water-based exercise program leads to the improvement in respiratory function, muscle strength, balance ability, and exercise capacity. We aim to study the effect of an 8-week water-based exercise program on respiratory function, muscle strength, balance ability, and exercise capacity in people with COPD. METHODS: Fourteen stable COPD participants (FEV1 56.8 +/- 24.6%pred) were recruited and randomized into a water-based exercise or a land-based exercise group. Both groups were trained for 8 weeks, two sessions per week. Pulmonary function, respiratory muscle strength, peripheral muscle strength, balance ability, exercise capacity (6-min walking test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT)) were assessed at baseline and at the end of the program. ANCOVA was used to conduct between-group comparisons of outcomes after adjusting for pre-intervention values. RESULTS: Baseline characteristics of participants were not significantly different between the two groups (p >= 0.05). After the 8-week training program, participants in the intervention group achieved larger gains in ESWT (delta 663.4 +/- 279.5 versus delta 45.4 +/- 93.2 s, p = 0.001). In addition, maximal inspiratory pressure (MIP) was significantly increased more in the intervention group (delta 11.1 +/- 7.8 versus delta 1.1 +/- 5.7 cmH2O, p = 0.026). However, no significant differences in pulmonary function, peripheral muscle strength, balance ability variables, 6MWD (p = 0.248), and ISWT (p = 0.506) were observed between the two groups. CONCLUSIONS: The water-based exercise program could be recommended to the COPD rehabilitation program for improving the endurance exercise capacity and inspiratory muscle strength. CLINICAL TRIAL REGISTRATION: www.thaiclinicaltrials.org, identifier: TCTR20210125005.

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