Question: In patients with chronic obstructive pulmonary disease (COPD) who have physical comorbidities, is water-based exercise more effective than land-based exercise for improving exercise capacity and health-related quality of life (HRQoL)? Design: Randomised controlled trial with concealed allocation and blinding of outcome assessors. Setting: The outpatient department or hydrotherapy pool of a hospital in Sydney, Australia. Participants: Adults with stable COPD were included if they had at least one physical comorbid condition that was likely to compromise their capacity to participate in land-based exercise (eg, musculoskeletal conditions, peripheral vascular disease, neurological conditions or body mass index ≥32 kg/m2). Exclusion criteria were unstable cardiac disease or a contraindication to water-based exercise, such as open wounds or incontinence. Randomisation allocated 18 participants to the water-based exercise (WBE) group, 20 to the land-based exercise (LBE) group and 15 to the control group. Interventions: Both WBE and LBE required participants to attend three 60-minute sessions each week, for 8 weeks. The WBE group and LBE group were matched as closely as possible in terms of intensity and the muscle groups exercised. Intensity was titrated to achieve moderate dyspnoea. Those in the control group continued with usual medical care. Outcome measures: The primary outcome was exercise capacity measured using the endurance shuttle walk test (ESWT) at 8 weeks. Results: A total of 45 participants completed the study. On completion of the training period, compared with the control group, greater gains were seen in the distance walked during the ESWT in the WBE group (309 m, 95% CI, 96 to 522 m) but not in the LBE group (81 m, 95% CI, −136 m to 297 m). The gains seen in the WBE group were also greater than those seen on the LBE group (228 m, 95% CI, 19 to 438 m). Similar results were demonstrated for the distance achieved during the incremental shuttle walk test and the fatigue domain of the Chronic Respiratory Disease Questionnaire (ie, a domain of HRQoL). Conclusion: In people with COPD and physical comorbidities, WBE appears to confer greater gains in exercise capacity and fatigue, when compared with LBE
2014. Vol. 60, no 1, 57-57 p.