Role of Exercise Intensity in Water Aerobics: Improving Health Markers in Adults and Older Adults—A Randomized Controlled Trial

Abstract

Purpose

This study aimed to determine the effects of 24 weeks of moderate- and high-intensity water aerobics on physical fitness, cardiovascular health, and well-being in adults and older adults.

Methods

Twenty women (67.10±9.08 years) were randomized into two groups, each performing water aerobics twice a week for 24 weeks. One group performed at moderate intensity (MIG; n=10), while the other group performed at high intensity (HIG; n=10). Participants were evaluated before and after the program. Assessments included muscle endurance, explosive strength, body mass, body mass index, fat mass, fat-free mass, triglycerides, total cholesterol, blood pressure, resting heart rate, general quality of life (QoL), general health, and the physical, psychological, social relationships, and environmental domains of QoL.

Results

Fat mass (η_p²=0.35; P=0.006), fat-free mass (η_p²=0.30; P=0.01), total cholesterol (η_p²=0.34; P=0.007), and triglycerides (η_p²=0.24; P=0.03) showed greater improvement with HIG than with MIG. Both exercise intensities improved upper muscular endurance, but only HIG increased lower limb muscular endurance and reduced diastolic BP.

Conclusion

High-intensity water aerobics appears to be more effective than moderate-intensity water aerobics in improving certain health markers, including body composition, lipid profile, diastolic BP, and lower strength endurance. Both intensities improved upper muscular endurance.

Trial Registration.

ClinicalTrials.gov NCT06529354. retrospectively registered on 15/07/2024.

Keywords

Aquatic exercise / Physical fitness / Health-related / Quality of life

References

[1] Alves RV, Mota J, Da Cunha Costa M, Bezerra Alves JG. Physical fitness and elderly health effects of hydrogymnastics. Rev Bras Med Esporte, 2004, 10(1): 31-43

[2] American College of Sports Medicine. ACSM’s health-related physical fitness assessment manual. 9th ed. Indianapolis: LWW Wolters Kluwer.

[3] Ayán C, Carvalho P, Varela S, Cancela JM. Effects of water-based exercise training on the cognitive function and quality of life of healthy adult women. J Phys Act Health, 2017, 14(11): 899-904

[4] Barbosa TM, Sousa VF, Silva AJ, Reis VM, Marinho DA, Bragada JA. Effects of musical cadence in the acute physiologic adaptations to head-out aquatic exercises. J Strength Cond Res, 2010, 24(1): 244-50

[5] Beaudart C, Dawson A, Shaw SC, Harvey NC, Kanis JA, Binkley N. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int, 2017, 28: 1817-33

[6] Benelli P, Ditroilo M, De Vito G. Physiological responses to fitness activities: a comparison between land-based and water aerobics exercise. J Strength Cond Res, 2004, 18(4): 719-722

[7] Bergamin M, Ermolao A, Matten S, Sieverdes JC, Zaccaria M. Metabolic and cardiovascular responses during aquatic exercise in water at different temperatures in older adults. Res Q Exerc Sport, 2014, 86(2): 163-171

[8] Broman G, Quintana M, Lindberg T, Jansson E, Kaijser L. High intensity deep water training can improve aerobic power in elderly women. Eur J Appl Physiol, 2006, 98(2): 117-123

[9] Butts NK, Tucker M, Smith R. Maximal responses to treadmill and deep water running in high school female cross country runners. Res Q Exerc Sport, 1991, 62(2): 236-9

[10] Cheikh IB, Marzouki H, Selmi O, Cherni B, Bouray S, Bouhlel E, Bouassida A, Knechtle B, Chen YS. Effect of water-based aerobic training on anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women: a randomized controlled trial. PeerJ, 2025, 13 e19020

[11] Cohen J. Statistical Power Analysis for the Behavioral Sciences, 19882nd edErlbaum

[12] Colado JC, Tella V, Triplett NT, González LM. Effects of a short-term aquatic resistance program on strength and body composition in fit young men. J Strength Cond Res, 2009, 23(2): 549-59

[13] Colado JC, Triplett NT, Tella V, Saucedo P, Abellán J. Effects of aquatic resistance training on health and fitness in postmenopausal women. Eur J Appl Physiol, 2009, 106(1): 113-122

[14] Costa MJ, Oliveira C, Teixeira G, Marinho DA, Silva AJ, Barbosa TM. The influence of musical cadence into aquatic jumping jacks kinematics. J Sports Sci Med, 2011, 10(4): 607-15

[15] Costa RR, Pilla C, Buttelli ACK, Barreto MF, Vieiro PA, Alberton CL, Bracht CG, Kruel LFM. Water-based aerobic training successfully improves lipid profile of dyslipidemic women: a randomized controlled trial. Res Q Exerc Sport, 2018, 89(2): 173-82

[16] Cruz-Montecinos C, Castro RT, Otto-Yáñez M, Barros-Poblete M, Valencia C, Campos A, Jadue L, Barros M, Solis-Navarro L, Resqueti V. Which sit-to-stand test best differentiates functional capacity in older people?. Am J Phys Med Rehabil, 2024, 103(10): 925-928

[17] Dalamitros AA, Kouloglou A, Nasoufidis G, Stogiannidou K, Eradli N, Manou V. Impact of a 10-week aqua fitness intervention on physical fitness and psychosocial measures in inactive healthy adult women. Healthcare, 2025, 13(3): 334

[18] Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet, 2016, 38710022957-67

[19] Farinha C, Santos H, Serrano J, Oliveiros B, Silva FM, Cascante-Rusenhack M, Teixeira AM, Ferreira JP. The impact of aquatic exercise programs on the intima-media thickness of the carotid arteries, hemodynamic parameters, lipid profile and chemokines of community-dwelling older persons: a randomized controlled trial. Int J Environ Res Public Health, 2022, 19(6 3377

[20] Faíl LB, Marinho DA, Marques EA, Costa MJ, Santos CC, Marques MC, Izquierdo M, Neiva HP. Benefits of aquatic exercise in adults with and without chronic disease—a systematic review with meta-analysis. Scand J Med Sci Sports, 2022, 323): 465-86

[21] Faíl LB, Marinho DA, Marques EA, Gonçalves JM, Gil MH, Pereira RA, Marques MC, Izquierdo M, Neiva HP. Effects of 12-week moderate-intensity versus high-intensity water-aerobic training on physical fitness, cardiovascular health, and well-being in adults and older adults: a pragmatic randomized controlled trial. Health Sci Rep, 2024, 7(12 e70223

[22] Fosstveit SH, Lindberg K, Bjørnsen T, Sibayan EE, Fjeller JS, Løvold S, Kolnes T, Vårvik FT, Berntsen S, Lohne-Seiler H. Associations between power training-induced changes in body composition and physical function in older men: a pre-test–post-test experimental study. Int J Environ Res Public Health, 2023, 2022 7070

[23] Garrido N, Silva JDP, Novaes JS, Cirilo-Sousa MS, Neto GR. Effect of water aerobics on the quality of life, satisfaction, and perception of body image among elderly women. J Exerc Physiol Online, 2016, 195): 30-7

[24] Gellish RL, Goslin BR, Olson RE, McDonald A, Russi GD, Moudgil VK. Longitudinal modeling of the relationship between age and maximal heart rate. Med Sci Sports Exerc, 2007, 39(5): 822-9

[25] Green JS. Effects of a water aerobics program on the blood pressure, percentage of body fat, weight, and resting pulse rate of senior citizens. J Appl Gerontol, 1989, 8(1): 132-138

[26] Harris C, Wattles AP, DeBeliso M, Sevene-Adams PG, Berning JM, Adams KJ. The seated medicine ball throw as a test of upper body power in older adults. J Strength Cond Res, 2011, 25(8): 2344-2348

[27] Hopewell S, Chan A-W, Collins GS, Hróbjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson D, Vohra S, White IR, Boutron I. CONSORT 2025 statement: updated guideline for reporting randomised trials. BMJ., 2025, 389 e081123

[28] Igarashi Y, Nogami Y. The effect of regular aquatic exercise on blood pressure: a meta-analysis of randomized controlled trials. Eur J Prev Cardiol, 2018, 25(2): 190-9

[29] Irandoust K, Taheri M. The effects of aquatic exercise on body composition and nonspecific low back pain in elderly males. J Phys Ther Sci, 2015, 27(2): 433-435

[30] Jasiński R, Socha M, Sitko L, Kubicka K, Woźniewski M, Sobiech KA. Effect of nordic walking and water aerobics training on body composition and the blood flow in lower extremities in elderly women. J Hum Kinet, 2015, 45(1): 113-22

[31] Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof, 2021, 18: 17

[32] Kantyka J, Herman D, Roczniok R, Kuba L. Effects of aqua aerobics on body composition, body mass, lipid profile, and blood count in middle-aged sedentary women. Hum Mov, 2015, 16(1): 9-14

[33] Klonizakis M, Hunt BE, Woodward A. The association between cardiovascular function, measured as FMD and CVC, and long-term aquatic exercise in older adults (ACELA study): a cross-sectional study. Front Physiol, 2020, 11 603435

[34] Klonizakis M, Mitropoulos A. Assessing the effect of regular swimming exercise on the micro-and macrovascular physiology of older adults (ACELA II study). Front Physiol, 2023, 14: 1223558

[35] Kravitz L, Mayo JJ. The physiological effects of aquatic exercise. Int J Med. 2007. https://www.unm.edu/~lkravitz/Article%20folder/aqua.html.

[36] Kruel LFM, Bgeginski R, Kanitz AC, Pinto SS, Almada BP, Finatto P, Alberton CL. Blood pressure responses in hypertensive women to water aerobics. Apunts Educ Fis Deportes, 2021, 144: 25-32

[37] Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol, 2013, 4(NOV): 863

[38] Leonel LDS, Danielevicz A, Delevatti RS. Comparison between water aerobics and deep-water running on middle-aged adults’ anthropometric, hemodynamic and functional outcomes. Int J Environ Res Public Health, 2025, 221 106

[39] Lewington S, Clark R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002, 36093491903-13

[40] López JAH, Martínez PYO, Meza EIA, Moncada-Jiménez JA, Garcia Bertruy O, Dantas EH. Hydrogymnastics training program on physical fitness in elderly women. Rev Int Med Cienc Act Fis Deporte, 2017, 66: 283-98

[41] Magalhães MEC. New cholesterol targets of SBC guidelines on dyslipidemia. Int J Cardiovasc Sci, 2017, 30(6): 466-468

[42] Marfell-Jones MJ, Stewart AD, de Ridder JH. International standards for anthropometric assessment. Wellington, New Zealand: International Society for the Advancement of Kinanthropometry; 2011.

[43] Moreira OC, Lopes GS, de Matos DG, Mazini-Filho ML, Aidar FJ, Silva SF, de Oliveira CE. Impact of two hydrogymnastics class methodologies on the functional capacity and flexibility of elderly women. J Sports Med Phys Fitness, 2019, 59(1): 126-31

[44] Moura EG, Nunes WMS, Pinto LM, Santos NG, de Oliveira G, Gross DA. Effects of hydrogymnastics practice for 45 weeks on the lipid, hemodynamic and anthropometry profile of elderly when untrained for 30 days in the intervention. Sci Sports, 2020, 35(2): 103.e1-103.e9

[45] Neiva HP, Faíl LB, Izquierdo M, Marques MC, Marinho DA. The effect of 12 weeks of water-aerobics on health status and physical fitness: an ecological approach. PLoS One, 2018, 13(5): 1-15

[46] Novaes GS, Novaes JS, Vilaça-Alves J, Silva GCE, Garrido ND, Furtado H, Reis VM. Chronic effects of strength training vs hydro aerobics on functional and cardiorespiratory ability in postmenopausal women. J Hum Kinet, 2014, 43(1): 57-66

[47] Nuttamonwarakul A, Amatyakul S, Suksom D. Effects of water-based versus land-based exercise training on cutaneous microvascular reactivity and C-reactive protein in older women with type 2 diabetes mellitus. J Exerc Physiol Online, 2014, 17(4): 27-33

[48] Palatini P, Casiglia E, Pauletto P, Staessen J, Kaciroti N, Julius S. Relationship of tachycardia with high blood pressure and metabolic abnormalities: a study with mixture analysis in three populations. Hypertension, 1997, 30(5): 1267-1273

[49] Penaforte FRO, Calhau R, Mota GR, Chiarello PG. Impact of short-term water exercise programs on weight, body composition, metabolic profile and quality of life of obese women. J Hum Sport Exerc, 2015, 10(4): 915-26

[50] Piotrowska-Całka E. The effects of a 24-week deep water aerobic training program on cardiovascular fitness. Biol Sport, 2010, 27(2): 95-98

[51] Pöyhönen T, Sipilä S, Keskinen KL, Hautala A, Savolainen J, Mälkiä E. Effects of aquatic resistance training on neuromuscular performance in healthy women. Med Sci Sports Exerc, 2002, 34(12): 2103-9

[52] Raffaelli C, Milanese C, Lanza M, Zamparo P. Water-based training enhances both physical capacities and body composition in healthy young adult women. Sport Sci Health, 2016, 12(2): 195-207

[53] Ramírez-Campillo R, Martínez C, De La Fuente CI, Cadore EL, Marques MC, Nakamura FY, Loturco I, Caniuqueo A, Cañas R, Izquierdo M. High-speed resistance training in older women: the role of supervision. J Aging Phys Act, 2017, 25(1): 1-9

[54] Rathore P, Sahu M, Narvariya P, Pandey P. Aqua training and its effect on physical and physiological parameters in middle-aged women. Fizjoter Pol, 2024

[55] Rauner A, Mess F, Woll A. The relationship between physical activity, physical fitness and overweight in adolescents: a systematic review of studies published in or after 2000. BMC Pediatr, 2013, 13(1): 19

[56] Rikli RE, Jones CJ. Functional fitness normative scores for community-residing older adults, ages 60–94. J Aging Phys Act, 1999, 72162-81

[57] Serra AV, Canavarro MC, Simões MR, Pereira M, Gameiro S, Quartilho MJ, Rijo D, Carona C, Paredes T. Estudos psicométricos do instrumento de avaliação da qualidade de vida da organização mundial de saúde (WHOQOL-Bref) para Português de Portugal. In PC, 2006, 27: 41-49

[58] Sampaio PYS, Ito E. Activities with higher influence on quality of life in older adults in Japan. Occup Ther Int, 2013, 20(1): 1-10

[59] Sobczak K, Wochna K, Antosiak-Cyrak K, Domaszewska K. The effects of 6-month aqua aerobics training on cardiometabolic parameters in perimenopausal women—a randomized controlled trial. Biol, 2023, 12(4 588

[60] Stein RA, Michielli DW, Glantz MD, Sardy H, Cohen A, Goldberg N, Brown CD. Effects of different exercise training intensities on lipoprotein cholesterol fractions in healthy middle-aged men. Am Heart J, 1990, 1192 PART 1): 277-83

[61] Takeshima N, Rogers ME, Watanabe E, Brechue WF, Yamada AOT, Islam MM, Hayano J. Water-based exercise improves health-related aspects of fitness in older women. Med Sci Sports Exerc, 2002, 34(3): 544-51

[62] Tsourlou T, Benik A, Dipla K, Zafeiridis A, Spiros K. The effects of a twenty-four-week aquatic training program on muscular strength performance in healthy elderly women. J Strength Cond Res, 2006, 38: 1422-44

[63] Yamada M, Uemura K, Mori S, Nagai K, Uehara T, Arai H, Aoyama T. Faster decline of physical performance in older adults with higher levels of baseline locomotive function. Geriatr Gerontol Int, 2012, 12(2): 238-46

[64] Yeung SSY, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CGM, Maier AB. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle, 2019, 10(3): 485-500

Funding

National Funds by FCT - Portuguese Foundation for Science and Technology

RIGHTS & PERMISSIONS

Beijing Sport University