Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial

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 3 months. 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 3 months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. (C) 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.