A total of nine studies (n=178 participants) were included in this review; two RCTs (n=45) and seven case series (total n=133).
Effects of aquatic-exercise on cardiovascular fitness: Three studies (n=68 participants) including one RCT and two case-series assessed this outcome. The RCT reported significant improvements in various physiological measures of cardiorespiratory fitness when comparing aquatic exercise with no exercise. The two uncontrolled case-series' also found beneficial improvements.
Land versus aquatic therapy for cardiovascular fitness: One RCT (n=15 participants) and five case series studies (n=95 participants) reported on this outcome. The RCT found similar improvements in cardio-vascular fitness for participants exercising on land, in cold water and in warm water. All case-series studies reported water exercise as equal to, or better than, land exercise for eliciting cardiovascular responses.
The review also presents an overview of the effects of water temperature, water depth, speed of movement, and upper versus lower extremity exercises.