Search Results (131)

Heart failure (HF) is a heterogeneous clinical syndrome with increasing prevalence among adults worldwide. It is characterized by complex central and peripheral alterations that contribute to exercise intolerance, fatigue, dyspnea, and reduced quality of life. Inspiratory muscle weakness (IMW) plays a key role in this vicious cycle by exacerbating symptoms and further limiting functional capacity. Inspiratory muscle training (IMT) has emerged as a potential adjuvant in comprehensive HF management and is a physiologically grounded and promising tool in the contemporary HF therapeutic toolkit. Its integration into multimodal rehabilitation programs may mitigate the cycle of dyspnea and deconditioning in patients with HF. On this basis, we provide an overview of the pathophysiological mechanisms underlying IMW and present the practical characteristics of IMT programs, synthesizing current evidence regarding its clinical efficacy and implementation challenges. Full article

Background: Prehabilitation aims to optimise patients before cardiac procedures through interventions including exercise training, respiratory conditioning, nutritional support, psychological preparation and multimodal lifestyle programmes. Evidence from systematic reviews and meta-analyses is increasing but remains heterogeneous due to variation in intervention design, patient populations and overlap of primary studies. Methods: We conducted an umbrella review of 17 systematic reviews and meta-analyses evaluating prehabilitation prior to cardiac surgery and structural heart interventions in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of included reviews was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Outcomes of interest were postoperative pneumonia, hospital length of stay (LOS), and mortality. Results: Across pooled analyses, the most consistent finding was a reduction in postoperative pneumonia, particularly in studies incorporating inspiratory muscle training (IMT), with relative risk reductions of approximately 55–62%, corresponding to a modest absolute risk reduction. Reductions in hospital LOS were also reported, although effect sizes were smaller and more variable. In contrast, no consistent reduction in short-term mortality was demonstrated, likely reflecting low event rates. The evidence base was limited by substantial overlap between reviews and predominantly low or critically low methodological quality. Conclusions: Prehabilitation, particularly when incorporating IMT, is consistently associated with a reduction in postoperative pneumonia and may contribute to modest reductions in hospital LOS. However, the evidence base is constrained by heterogeneity, study overlap and low methodological quality. Further high-quality, adequately powered randomised trials are required to define the role of prehabilitation in contemporary cardiac surgical and structural intervention practice. Full article

Background: Respiratory muscle strength (RMS) is a critical factor influencing athletic performance, particularly in high-intensity or prolonged activities. RMS encompasses inspiratory (IMs) and expiratory muscles (EMs), which differ in anatomical structure, fiber composition, and responsiveness to training. Methods: This pilot interventional within-subject study investigated the effects of two resistive respiratory muscle training (RMT) protocols on RMS and small airway function in eight physically active adults (two females, six males). Maximal inspiratory (MIP) and expiratory pressures (MEP), along with pulmonary function tests (PFTs), were measured using the Airofit PRO™ device and spirometry before and after two consecutive 7-day training protocols, with a 2-day break between interventions. The workload was progressively increased by lengthening the duration of forced inhalation and exhalation, while keeping the air resistance constant. Results: Results demonstrated significant improvements in MEP across both protocols and after a 10-day washout period (p < 0.001–0.03), whereas MIP showed no significant changes (p = 0.19–0.66). Moderate transient improvements were observed in small airway flow (MEF25%) following the first protocol (ES = 0.62), which regressed after the second. Conclusions: These outcomes suggest differential responsiveness of respiratory muscles to RMT; EMs, characterized by a higher proportion of fast-twitch type II fibers and a predominantly passive role in normal breathing, respond rapidly to short-duration, high-intensity forced expiration training through neuromuscular adaptations. Conversely, IMs, dominated by slow-twitch type I fibers, require longer-duration, higher-load training to elicit meaningful adaptations, explaining the limited changes in MIP. Small airway function appeared minimally trainable due to structural and physiological constraints, with short-term improvements likely reflecting effort-dependent factors rather than lasting adaptations. Finally, RMT can selectively enhance EM performance through appropriately designed short-duration, high-intensity interventions, while IMs may necessitate prolonged or higher-load stimuli. The findings highlight the importance of targeted training strategies, individualized to muscle fiber composition and functional demands, to optimize respiratory performance. Future research should investigate longer interventions, larger diverse cohorts, and precise measurement methods to further elucidate RMT’s effects on both respiratory muscles and small airway function. Full article

Introduction: Post-hospital rehabilitation is essential for survivors of severe COVID-19, as prolonged immobility and clinical severity often lead to muscle weakness, reduced cardiovascular capacity, and impaired respiratory function. Physical exercise during and after hospitalization may mitigate these effects and support functional recovery. This study aimed to evaluate the effectiveness of a physical exercise-based rehabilitation program in survivors of severe COVID-19. Methodology: A randomized clinical trial was conducted with 30 survivors allocated to two groups: multicomponent exercise (GEm) and multicomponent exercise combined with inspiratory muscle training (GEmTMI). The interventions were performed three times per week for 40–60 min. Quality of life, physical activity level, functional status, and physical capacity were assessed before and after six weeks. Results: Comparisons between GEm and GEmTMI showed significant differences in the 6 min walk test (6MWT) at baseline (p = 0.043) and in the Physical Activity Index (IPAQ) after the intervention (p = 0.002). When the total sample was analyzed, significant improvements were observed across all outcomes after rehabilitation, including quality of life (SF-36), functional capacity (PCFS), physical activity level (IPAQ), respiratory muscle strength, and additional functional tests. Notable improvements included SF-36 Physical Functioning (p = 0.006) and Social Functioning (p = 0.009), PCFS (p = 0.011), IPAQ (p = 0.012), and performance in the 6MWT, STS, STS-1min, TUG, handgrip strength, PEmax, and PImax (all p < 0.001). Discussion: Multicomponent physical rehabilitation, with or without inspiratory muscle training, produced significant gains in physical activity level, functional capacity, dynamic balance, neuromuscular fitness, respiratory muscle strength, and quality of life. These findings underscore the importance of structured post-ICU rehabilitation to support comprehensive physical and psychosocial recovery in survivors of severe COVID-19. Full article

Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH₂O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Full article

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating skeletal muscle weakness and fatigue, leading to reduced functional independence and impaired quality of life (QoL). Although exercise has historically been discouraged due to concerns about symptom exacerbation, emerging evidence suggest that structured exercise programs may be safe and beneficial in clinically stable patients. This systematic review critically evaluates current evidence on exercise and physical activity interventions in MG, focusing on effectiveness, safety, and impact on functional outcomes, fatigue, and QoL. Materials and Methods: A systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Web of Science, Google Scholar, Scopus and ScienceDirect for studies published between 2015 and 2025. Keywords included MG, physical activity, aerobic training, resistance training, and respiratory muscle training. Methodological quality was assessed using the Downs and Black checklist. Results: Eight controlled studies met the inclusion criteria, encompassing aerobic, resistance, combined, and respiratory muscle training interventions. Sample sizes ranged from small pilot studies to moderate-size randomized controlled trials. Overall, exercise interventions were well tolerated, with no evidence of sustained symptoms exacerbation. Aerobic and combined programs consistently improved functional capacity, muscle strength, and activities of daily living. Respiratory muscle training demonstrated improvements in pulmonary function and inspiratory muscle strength, although findings were more heterogeneous. Study quality ranged from poor to excellent, with common limitations including small sample size, short follow-up duration, and heterogeneity in exercise programs. Conclusions: Current evidence supports the safety and potential efficacy of individualized, symptom-guided exercise interventions in clinically stable MG. Regular physical activity exercise may reduce secondary deconditioning, improve functional outcomes, and enhance QoL. However, larger, high-quality randomized controlled trials with standardized programs and longer follow-up periods are required to strengthen clinical recommendations and clarify long-term effects. Full article

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article

Background and Objectives: The hypertrophic adaptation of the diaphragm to inspiratory muscle training (IMT) remains insufficiently characterized, particularly in healthy and athletic populations. To address this gap, we conducted a meta-analysis and meta-regression to evaluate the effects of IMT on diaphragm thickness and identify potential moderating factors. Materials and Methods: A systematic search was conducted across PubMed, MEDLINE, Embase, CINAHL, and SPORTDiscus as well as Google Scholar (gray literature) through November 2025. Eight studies involving 203 healthy participants met the inclusion criteria. A random-effects model was used to calculate pooled effect sizes and meta-regression estimates. Results: IMT produced a statistically significant moderate increase in diaphragm muscle thickness, with a standardized mean difference (SMD) of Hedges’ g = 0.52 (95% CI: 0.19 to 0.85; p < 0.05). Subgroup analyses indicated that IMT with 50% maximal inspiratory pressure (MIP) produces a statistically significant effect (p = 0.0069), whereas fitness status and age did not significantly influence outcomes (p = 0.589 and p = 0.126, respectively). Meta-regression analyses revealed that only baseline MIP value (β = 0.030; 95% CI: 0.009 to 0.050; p = 0.004) was associated with diaphragm hypertrophy. Conclusions: IMT with 50% of MIP elicits meaningful diaphragmatic hypertrophy in healthy individuals. This response appears independent of fitness status or age, but is significantly influenced by baseline inspiratory muscle strength (MIP). These findings support the utility of IMT in enhancing respiratory muscle morphology in health and performance contexts. Full article

Objectives: This study investigated the effects of trunk extension-based inspiratory muscle strengthening on respiratory function, balance, and gait in patients with stroke. Methods: Thirty stroke patients were randomly assigned to the study group (n = 15) or control group (n = 15). The study group performed inspiratory muscle strengthening exercises in a trunk extension posture, while the control group received conventional inspiratory muscle training. Both groups trained five times per week for six weeks. Outcome measures included maximal inspiratory pressure (MIP), maximal inspiratory flow rate (MIFR), maximal inspiratory volume (MIV), peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV₁), Berg Balance Scale (BBS), weight distribution ratio (WDR), limits of stability (LOSs), Timed Up and Go (TUG), gait velocity, cadence, and stride length. Results: The study group showed significantly greater improvements in respiratory parameters (MIP, MIFR, MIV, PEF, FEV₁) and functional outcomes (WDR, LOS, BBS, TUG, gait velocity, cadence, stride length) compared to the control group. Conclusions: Trunk extension-based inspiratory muscle strengthening effectively improves respiratory function, balance, and gait in stroke patients, and may serve as a valuable addition to stroke rehabilitation programs. Full article

Background/Objective: Post-COVID survivors present significant respiratory deficiency that has been associated with ongoing shortness of breath and impaired lung function. Inspiratory muscle training (IMT) is increasingly used in survivors of COVID-19 rehabilitational programs as a means to facilitate recovery of the respiratory system. Yet, its home-based effectiveness across clinically relevant outcomes remains unclear. This systematic review aimed to present current evidence on home- or tele-delivered IMT in the post-COVID-19 population. Methods: PubMed, Scopus, Cochrane library and Science Direct were systematically searched for studies evaluating home-based (or telerehabilitation) IMT, alone or as part of a respiratory muscle training program, in adults with post-COVID-19 symptoms. The primary outcome was inspiratory muscle strength. Secondary outcomes included dyspnea, pulmonary function, exercise capacity and health-related quality of life. The methodological quality of the included studies was assessed via the PEDro scale. Owing to clinical and methodological heterogeneity, we performed only a qualitative synthesis. Results: Eight studies met the inclusion criteria. Two included both inspiratory and expiratory muscles training and three included physical training as well. The methodological quality was found to be good. IMT consistently increased inspiratory muscle strength across trials. Respiratory muscle training (RMT) programs that combined inspiratory and expiratory training also improved maximal expiratory pressure. IMT reduced dyspnea versus control/sham or baseline and several studies reported improvements in exercise capacity and physical function. Spirometry/DLCO changes were small or null in most cohorts. HRQoL gains were domain-specific in anxiety and depression. Adherence was generally good. No serious adverse events attributable to IMT were reported. Conclusions: Home-based IMT for adults with post-COVID-19 conditions is safe and seems to improve inspiratory muscle strength and dyspnea, with signs of benefit for exercise capacity, physical function, and selected HRQoL domains. Effects on ventilatory efficiency and conventional lung function appear limited. Future multicenter, sham-controlled RCTs should further explore the characteristics of IMT, employ core outcome sets, include longer follow-up, and predefine phenotype-based subgroups. Full article

Gastroesophageal reflux disease (GERD) is a common chronic condition mainly caused by the dysfunction of the antireflux mechanism at the gastroesophageal junction. This is composed of the lower esophageal sphincter and the crural diaphragm. Increasing evidence suggests that diaphragmatic dysfunction and reduced inspiratory muscle strength may contribute to the persistence of GERD symptoms. Although respiratory physiotherapy has shown beneficial effects, the role of a structured inspiratory muscle training (IMT) program has not been sufficiently examined. This study aims to investigate the effects of an inspiratory muscle training program on inspiratory muscle strength and secondary clinical outcomes in individuals with GERD. A total of thirty adults with a confirmed GERD diagnosis will be enrolled in a two-arm randomized controlled trial. These volunteers will be randomly assigned either to the experimental group, which will undergo a 3-month inspiratory muscle training (IMT) using tapered flow resistive loading at 40% of maximal inspiratory pressure (MIP), or to the control group, which will receive sham IMT with a consistent low resistance. Primary outcomes will include maximal inspiratory pressure (MIP) and maximal dynamic inspiratory pressure (S-index). Secondary outcomes will assess GERD symptoms, disease-related quality of life, and pulmonary function. Measurements will be performed at baseline, at three months of intervention, and at six months from recruitment (follow-up). IMT is expected to lead to significant improvements in inspiratory muscle strength, symptom burden, and quality of life compared with sham training. This trial will provide novel evidence regarding the role of inspiratory muscle training as a non-pharmacological intervention in the management of GERD. Trial registration: ClinicalTrials.gov Identifier: NCT07131397. Full article

Objectives: The aim of the study was to assess the impact of oncological treatment including surgery and radiotherapy on the respiratory function and quality of life of women treated for breast cancer, considering the effects of physiotherapy and additional inspiratory muscle training. Methods: A quantitative, repeated-measures study included 26 women (aged 30–69) with breast cancer who had undergone breast-conserving surgery and radiotherapy, randomly assigned to an IMT group or a sham IMT group. The following tests were performed on each patient: respiratory function, respiratory muscle strength, the WHOQOL-Bref questionnaire. The tests were performed five times as follows: before surgery, after surgery (4–6 days), before the start of radiotherapy (4–5 weeks after surgery), after the end of radiotherapy, and follow-up 4 weeks after the end of radiotherapy. Group I-IMT: patients underwent physiotherapy according to hospital rehabilitation standards and inspiratory muscle strength training at 15–60% PI_max. Group II-sham-IMT: patients underwent physiotherapy according to hospital rehabilitation standards and inspiratory muscle strength training at 15% PI_max. Results: After the surgery, a reduction in all parameters was observed, which improved gradually and depending on the group after physiotherapy and inspiratory muscle training. The PI_max value decreased significantly after the procedure in both groups (p = 0.00), but its significant increase after 4 weeks and radiotherapy (p = 0.00) was noted only in the I-IMT group. The quality of life assessed by women (WHO1) was significantly higher (p = 0.009) only in the group using IMT training with a load of 60% PI_max. Conclusions: Radical breast cancer treatment, including surgery and radiotherapy, significantly impairs respiratory function and quality of life in women, with the greatest deterioration observed after surgery. The use of prehabilitation and postoperative physiotherapy reduces the adverse effects of radical treatment, while additional inspiratory muscle training supports the improvement of respiratory function and the subjective assessment of quality of life in patients. Full article

Background: Chronic kidney disease (CKD) is a progressive pathology that affects millions of people worldwide, becoming a public health challenge due to its high prevalence and mortality. In its advanced stages, patients require therapies such as haemodialysis (HD), which often entails physical complications, so incorporating physiotherapy as an essential part of the treatment of these patients becomes evident. Objective: To analyse the effectiveness of physiotherapy in patients undergoing haemodialysis before, during and after the treatment. Methodology: This study is a systematic review conducted following the PRISMA statements. An electronic literature search was performed in the following databases: PubMed, PEDro, Chorane Library, ScienceDirect and Dialnet. The inclusion criteria were: controlled and uncontrolled clinical trials published in the last 10 years in English or Spanish, in patients with chronic kidney disease on haemodialysis treatment, aged 18 years or older. Results: 22 studies were included in this review. A total of 1786 patients participated in the included studies. Most of the investigations used cycloergometers, treadmills and bicycles. The programmes varied in types of exercise, with combinations of aerobic, endurance and inspiratory muscle training, with assessments at baseline and at the end of the intervention, some with additional measurements at 8, 12 or 16 weeks, and others with no specified follow-up time. Conclusions: The analysed literature showed that therapeutic exercise can be beneficial for haemodialysis patients, improving muscle strength, aerobic capacity and quality of life. Its implementation, both before, during and after haemodialysis sessions, also helped to reduce fatigue and depression. These results support the importance of exercise in the comprehensive treatment of patients with chronic kidney disease in haemodialysis. Full article

(1) Background: Pulmonary hypertension (PH) is characterized by respiratory muscle weakness, limited exercise tolerance, and reduced quality of life, but inspiratory muscle training (IMT) has emerged as a potential non-pharmacological strategy to improve functional outcomes in this population. This systematic review and meta-analysis evaluated the effects of isolated IMT on respiratory function, exercise capacity, symptom burden, and safety in adults with PH. (2) Methods: A systematic search was conducted in accordance with PRISMA guidelines. Randomized controlled trials involving adults with PH who underwent isolated IMT were included, and respiratory muscle strength, spirometric parameters, exercise capacity, dyspnea, fatigue, quality of life, and adverse events were the outcomes that were assessed. Data were pooled using meta-analytic techniques where appropriate. (3) Results: A total of 130 participants, assigned to five randomized controlled trials, met the inclusion criteria. IMT significantly improved maximal inspiratory pressure (MD = +24.01 cmH₂O), maximal expiratory pressure (MD = +23.64 cmH₂O), and six-minute walk distance (MD = +60.61 m), but no significant changes were observed in spirometric indices (FEV₁%, FVC%, and FEV₁/FVC). While several individual studies demonstrated clinically relevant improvements in six-minute walk distance, the pooled analysis did not demonstrate a statistically significant effect. IMT consistently reduced dyspnea and fatigue and improved quality-of-life domains. No serious adverse events were reported, and adherence was high. (4) Conclusions: IMT is a safe and feasible adjunct intervention in PH, providing meaningful improvements in respiratory muscle strength and symptom burden. Further large-scale trials are warranted to confirm its long-term clinical benefits. Full article

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: 0.02–6.64) and FEV₁/FVC (WMD = 4.00, 95% CI: 1.27–6.73). Regarding exercise capacity, water-based exercise significantly increased 6MWD (WMD = 47.81 m, 95% CI: 20.19–75.44), with more pronounced improvements observed in short-term interventions (≤8 weeks). Respiratory muscle function analyses demonstrated significant improvements in MIP (WMD = 14.22 cmH₂O, 95% CI: 7.75–20.69) and MEP (WMD = 14.40 cmH₂O, 95% CI: 4.92–23.89). 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. Full article