Water-Based Exercises on Peak Oxygen Consumption, Exercise Time, and Muscle Strength in Patients with Coronary Artery Disease: A Systematic Review with Meta-Analysis

Table 2

Characteristics of the included studies.

	Study	Patients ( analysed, age, gender)	Muscle strength	Exercise tolerance	Key findings
1	Scheer et al., 2021 [15]	, 68 years, 80.7% male; 45 patients with stable CAD	Muscle strength (1-RM); Total body strength (biceps curl, latissimus dorsi pull-down, hamstring curl, and leg press)	Peak VO2, rating of perceived exertion, exercise duration	Both modes of exercise training improved exercise capacity (peak VO2) to a similar extent and the land group increased exercise time. Both the water and land groups increased leg strength, but only the land group significantly improved latissimus pull-down strength.
2	Vasić et al., 2019[14]	, 59.9 years, 77.5% male, 89 patients after a recent CAD event	—	Peak VO2	Both exercise modalities were associated with a significant improvement in peak VO2 as compared to controls.
3	Lee et al., 2017 [28]	, 73 years, 71.9% male; 60 patients with CAD	—	Peak VO2	Significant differences were observed in the change of cardiorespiratory fitness expressed as peak VO2 over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the treadmill walking and aqua walking groups.
4	Fiogbé and Moreno, 2014 [32]	, 59.3 years, 100% male; 26 patients with stabilized CAD	—	Peak VO2	There was an increase in the values of peak VO2 and oxygen pulse.
5	Teffaha et al., 2011 [29]	, 52.45 years, 100% male; 24 patients with stabilized CAD and 24 patients with CHF	—	Peak VO2	Significant increases in peak VO2, heart rate, and power output were observed in all patients after rehabilitation in exercise test. The increase in left ventricular ejection fraction at rest, in heart rate, and power output at the exercise peak was slightly higher in the water group than in the land group.
6	Laurent et al., 2009 [6]	, 53.75 years, 100% male; 24 patients with stabilized CAD and 24 patients with CHF	—	Peak VO2	In every group, the cardiorespiratory capacity of patients was significantly increased after rehabilitation.
7	Tokmakidis et al., 2008 [30]	, 51.6 years, 100% male; 21 patients with CAD	Muscle strength (1-RM); Total body strength (pec-deck, seated row, lateral pull-down, chest press, leg extension, and leg flexion)	Peak VO2, 6 min water walking test, exercise duration	The exercise group improved their stress test time, peak VO2, and total body strength after the training period; detraining tended to reverse these positive adaptations. Resumption of training increased the beneficial effects obtained after the initial training period to exercise stress, peak VO2, and total strength. The patients in the control group did not show any significant alterations throughout the study.
8	Volaklis et al., 2007 [31]	, 54 years, 100% male; 30 patients with CAD and none participated in an exercise program at least 6 months before the study	Muscle strength (1-RM); Total body strength (bench press, pull-down, seated row, “peck-deck,” leg extension, and hamstring curl)	Exercise stress test on the treadmill, exercise duration	Water-based group improved exercise time and muscle strength in a similar manner compared to the patients who trained on land.

CAD: coronary artery disease; peak VO₂: peak oxygen uptake; 1-RM: one repetition maximum.