Intervention
The water-based and land-based exercise training groups attended three 60-min sessions a week of supervised exercise led by the same experienced physiotherapist for 8 weeks, with a maximum of 12 participants per session. Exercise in water and on land was matched as closely as possible for intensity, duration and muscle groups trained, considering the different exercise media (notably the increased resistance experienced during movement in water) (table 1). Participants were encouraged to exercise at an intensity rating of three to five on the modified Borg scale for dyspnoea and perceived exertion. Training intensity was measured three times during each exercise session and the mean value recorded. If the intensity reported was below three, participants were encouraged to increase their intensity as detailed in table 1.