BackgroundThere is a growing use of water-based exercises in cardiac rehabilitation programs. However, there is little data concerning the effects of water-based exercise on the exercise capacity of coronary artery disease (CAD) patients.ObjectiveTo perform a systematic review to investigate the effects of water-based exercise on peak oxygen consumption, exercise time, and muscle strength in patients with CAD.MethodsFive databases were searched to find randomized controlled trials that evaluated the effects of water-based exercise for coronary artery disease patients. Mean differences (MD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using theI2test.ResultsEight studies were included. Water-based exercise resulted in an improvement in peak VO2of 3.4 mL/kg/min (95% CI, 2.3 to 4.5;I2= 0%; 5 studies,N= 167), exercise time of 0.6 (95% CI, 0.1 to 1.1;I2= 0%; 3 studies,N= 69), and total body strength of 32.2 kg (95% CI, 23.9 to 40.7;I2= 3%; 3 studies,N= 69) when compared to no exercising controls. Water-based exercise resulted in an improvement in peak VO2of 3.1 mL/kg/min (95% CI, 1.4 to 4.7;I2= 13%; 2 studies,N= 74), when compared to the plus land exercise group. No significant difference in peak VO2was found for participants in the water-based exercise plus land exercise group compared with the land exercise group.ConclusionsWater-based exercise may improve exercise capacity and should be considered as an alternative method in the rehabilitation of patients with CAD.