Water-based exercise training in people with stable coronary heart disease- Study B

Study B is part of a broader project investigating the effects of water-based exercise in people with coronary heart disease. This study will involve a 12 week randomised controlled trial involving participants who will be randomised into one of three groups: *12 weeks of land-based exercise * 12 weeks of water-based exercise * A control group who will maintain their usual activities for 12 weeks. The training groups will be supervised by a health professional (majority of sessions supervised by a physiotherapist) and group training sessions (maximum of 10 participants) will be conducted three times per week, for one hour and 10 minute sessions, for 12 weeks (36 sessions total). The training programs will commence and conclude with 5 minutes of light aerobic activity (e.g. walking) and stretching. Moderate intensity exercises will alternate resistance (strength) and aerobic (fitness) stations. There will be 7 resistance and 8 aerobic stations lasting for 90 seconds, with 30 seconds of active recovery between exercises. Participants will build up to completing 2 circuits per session. During water-based exercise participants will be submerged to their xiphoid process (lower chest) in a heated swimming pool. Aerobic exercises will be monitored and matched by heart rate (60-80% of a participant’s heart rate maximum) and rating of perceived exertion (11-14 rating on the Borg Rating of Perceived Exertion Scale). Training will commence at approximately 60% of participants’ VO2peak and progress to 80% over the course of the training, as individually tolerated. Water-based aerobic exercises will include jogging, quick stepping/ jumping and high knees. Land-based aerobic exercises will include cycling, treadmill jogging and recumbent cycling. Resistance exercises will be matched for muscle group, Borg rating (between 11-14) and quantified resistance per station. Water-based exercises will utilise custom-designed resistance equipment (paddles), developed by this research team previously. Water-based resistance exercises will include; shoulder flexion and extension, shoulder abduction and adduction, hip flexion and extension, knee flexion and extension and hip abduction. Land-based exercises will include; shoulder flexion/ extension, modified shoulder abduction/ adduction, knee extension, hamstring curls, hip flexion/ extension and hip abduction. Resistance will be provided by machines, pulleys, free weights and ankle weights and the weight lifted can be used to quantify resistance. Participant attendance will be recorded for each session, as will a selection of perceived exertion, heart rate and resistance measures for each session. Strength, fitness, vascular function, brain blood flow, body composition, blood profiles and elements of cognition will be assessed before and after the 12 week period. Vascular function will be assessed fortnightly during the 12 week period in a subgroup of 14 participants from each of the training groups. Participants will be invited to take part in this as they enroll chronologically, until we reach the 14 participants required.