{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:18:24Z","timestamp":1791364704472,"version":"4.3.1"},"reference-count":63,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004772","name":"Ningxia Natural Science Foundation","doi-asserted-by":"publisher","award":["2025AAC030630"],"award-info":[{"award-number":["2025AAC030630"]}],"id":[{"id":"10.13039\/501100004772","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Patients with chronic obstructive pulmonary disease (COPD) commonly experience impaired lung function, reduced exercise tolerance, and respiratory muscle weakness. Owing to the unique properties of the aquatic environment, water-based exercise may provide rehabilitation benefits that differ from those of traditional land-based exercise. Objective: This systematic review and meta-analysis aimed to compare the effects of water-based versus land-based exercise on lung function, exercise capacity, and respiratory muscle function in patients with COPD, thereby providing evidence to inform the optimization of pulmonary rehabilitation exercise modalities. Methods: PubMed, Web of Science, CNKI, and other databases were systematically searched to identify randomized controlled trials comparing water-based and land-based exercise interventions in adults with COPD. Primary outcomes included lung function (FEV1% predicted and FEV1\/FVC), exercise capacity (six-minute walk distance, 6MWD), respiratory muscle strength (maximal inspiratory pressure (MIP]) and maximal expiratory pressure (MEP). Meta-analyses were performed using Stata 17.0. Results: A total of 14 RCTs were included. Meta-analysis showed that, compared with land-based exercise, water-based exercise significantly improved FEV1% predicted (WMD = 3.33, 95% CI: 0.02\u20136.64) and FEV1\/FVC (WMD = 4.00, 95% CI: 1.27\u20136.73). Regarding exercise capacity, water-based exercise significantly increased 6MWD (WMD = 47.81 m, 95% CI: 20.19\u201375.44), with more pronounced improvements observed in short-term interventions (\u22648 weeks). Respiratory muscle function analyses demonstrated significant improvements in MIP (WMD = 14.22 cmH2O, 95% CI: 7.75\u201320.69) and MEP (WMD = 14.40 cmH2O, 95% CI: 4.92\u201323.89). Conclusions: Compared with land-based exercise, water-based exercise demonstrates consistent advantages in improving exercise capacity and respiratory muscle function in patients with COPD and shows additional benefits for lung function indices. Therefore, water-based exercise may serve as a valuable adjunct to land-based training within pulmonary rehabilitation programs.<\/jats:p>","DOI":"10.3390\/life16020207","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:05:27Z","timestamp":1769504727000},"page":"207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative Rehabilitation Benefits of Water-Based Versus Land-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6966-6027","authenticated-orcid":false,"given":"Weiping","family":"Du","sequence":"first","affiliation":[{"name":"School of Physical Education, Ningxia Normal University, Guyuan 756099, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Physical Education, Ningxia Normal University, Guyuan 756099, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6804-2731","authenticated-orcid":false,"given":"Aiping","family":"Chi","sequence":"additional","affiliation":[{"name":"School of Physical Education, Shaanxi Normal University, Xi\u2019an 710119, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","first-page":"447","article-title":"NIHR RESPIRE Global Respiratory Health Unit. 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