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Cardiorespiratory fitness (CRF) is a key marker of health and performance, commonly assessed through treadmill running (TR). However, deep-water running (DWR) has emerged as an alternative modality, minimizing joint impact while preserving cardiovascular stimuli. Despite its potential, inconsistencies in CRF responses between TR and DWR remain unexplored in a systematic synthesis. To systematically review and compare the cardiorespiratory responses of maximal CRF tests performed in DWR and TR. This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42021260382). Searches were conducted in PubMed, Scielo, Embase, Scopus, and Web of Science, without publication date restrictions. Inclusion criteria encompassed studies assessing healthy adults (18–59 years) performing maximal CRF tests in both DWR and TR. Cardiorespiratory variables analyzed included VO₂max, heart rate (HR), pulmonary ventilation (VE), and respiratory exchange ratio (RER). Study quality was assessed using the TESTEX scale. Fourteen studies comprising 225 participants met the inclusion criteria. VO₂max values in DWR ranged from 76% to 90% of those observed in TR. HR, VE, and blood lactate accumulation were significantly lower in DWR, whereas perceived exertion remained similar. Differences were attributed to hydrostatic pressure, reduced activation of antigravity muscles, altered biomechanics, and enhanced thermoregulation. TR elicits higher cardiometabolic demands than DWR. While DWR is a submaximal alternative, its prescription should be based on aquatic-specific testing. Future studies should refine standardized protocols and investigate chronic adaptations.

A aptidão cardiorrespiratória (ACR) é um marcador essencial de saúde e desempenho, comummente avaliado através da corrida em passadeira (RT). No entanto, a corrida em água profunda (DWR) surgiu como uma modalidade alternativa, minimizando o impacto nas articulações e preservando os estímulos cardiovasculares. Apesar do seu potencial, as inconsistências nas respostas do CRF entre o TR e o DWR não foram exploradas numa síntese sistemática. Rever e comparar sistematicamente as respostas cardiorrespiratórias dos testes de ACR máximos realizados em DWR e TR. Esta revisão sistemática seguiu as diretrizes PRISMA e foi registada no PROSPERO (CRD42021260382). As pesquisas foram realizadas na PubMed, Scielo, Embase, Scopus e Web of Science, sem restrições de data de publicação. Os critérios de inclusão incluíram estudos que avaliaram adultos saudáveis ​​(18–59 anos) a realizar testes de CRF máximo em DWR e TR. As variáveis ​​cardiorrespiratórias analisadas incluíram o VO₂máx, a frequência cardíaca (FC), a ventilação pulmonar (VE) e o quociente respiratório (RER). A qualidade dos estudos foi avaliada através da escala TESTEX. Foram incluídos catorze estudos com um total de 225 participantes. Os valores de VO₂máx no DWR variaram entre 76% e 90% dos observados no TR. A FC, o VE e a acumulação de lactato sanguíneo foram significativamente menores no DWR, enquanto a perceção de esforço se manteve semelhante. Estas diferenças foram atribuídas à pressão hidrostática, à redução da ativação muscular antigravidade, às modificações biomecânicas e à melhor termorregulação. O TR impõe maiores exigências cardiometabólicas que o DWR. Embora a DWR seja uma alternativa submáxima, a sua prescrição deve ser baseada em testes específicos para o meio aquático. Estudos futuros devem refinar protocolos padronizados e investigar adaptações crónicas. Cardiorespiratory fitness (CRF) is a key marker of health and performance, commonly assessed through treadmill running (TR). However, deep-water running (DWR) has emerged as an alternative modality, minimizing joint impact while preserving cardiovascular stimuli. Despite its potential, inconsistencies in CRF responses between TR and DWR remain unexplored in a systematic synthesis. To systematically review and compare the cardiorespiratory responses of maximal CRF tests performed in DWR and TR. This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42021260382). Searches were conducted in PubMed, Scielo, Embase, Scopus, and Web of Science, without publication date restrictions. Inclusion criteria encompassed studies assessing healthy adults (18–59 years) performing maximal CRF tests in both DWR and TR. Cardiorespiratory variables analyzed included VO₂max, heart rate (HR), pulmonary ventilation (VE), and respiratory exchange ratio (RER). Study quality was assessed using the TESTEX scale. Fourteen studies comprising 225 participants met the inclusion criteria. VO₂max values in DWR ranged from 76% to 90% of those observed in TR. HR, VE, and blood lactate accumulation were significantly lower in DWR, whereas perceived exertion remained similar. Differences were attributed to hydrostatic pressure, reduced activation of antigravity muscles, altered biomechanics, and enhanced thermoregulation. TR elicits higher cardiometabolic demands than DWR. While DWR is a submaximal alternative, its prescription should be based on aquatic-specific testing. Future studies should refine standardized protocols and investigate chronic adaptations.         La aptitud cardiorrespiratoria (CRF) es un marcador clave de salud y rendimiento, evaluado comúnmente a través de la carrera en cinta rodante (TR). Sin embargo, la carrera en aguas profundas (DWR) ha surgido como una modalidad alternativa, minimizando el impacto articular mientras preserva los estímulos cardiovasculares. A pesar de su potencial, las inconsistencias en las respuestas de la CRF entre TR y DWR no han sido exploradas en una síntesis sistemática. Revisar y comparar sistemáticamente las respuestas cardiorrespiratorias de las pruebas máximas de CRF realizadas en DWR y TR. Esta revisión sistemática siguió las directrices PRISMA y fue registrada en PROSPERO (CRD42021260382). Se realizaron búsquedas en PubMed, Scielo, Embase, Scopus y Web of Science, sin restricciones de fecha de publicación. Los criterios de inclusión abarcaron estudios que evaluaron adultos sanos (18–59 años) realizando pruebas máximas de CRF en DWR y TR. Las variables cardiorrespiratorias analizadas incluyeron VO₂max, frecuencia cardíaca (FC), ventilación pulmonar (VE) y cociente respiratorio (RER). La calidad de los estudios se evaluó mediante la escala TESTEX. Se incluyeron catorce estudios con un total de 225 participantes. Los valores de VO₂max en DWR oscilaron entre el 76% y el 90% de los observados en TR. La FC, la VE y la acumulación de lactato sanguíneo fueron significativamente menores en DWR, mientras que la percepción del esfuerzo se mantuvo similar. Estas diferencias se atribuyeron a la presión hidrostática, la reducción de la activación muscular antigravitatoria, las modificaciones biomecánicas y la mejora de la termorregulación. La TR impone mayores demandas cardiometabólicas que la DWR. Aunque DWR es una alternativa submáxima, su prescripción debe basarse en pruebas específicas para el medio acuático. Futuros estudios deben refinar los protocolos estandarizados e investigar las adaptaciones crónicas.