Aquatic Versus Land-Based Exercise in Women With Lipedema

Inclusion Criteria: * Women diagnosed with lipedema for at least five years * Had stage 2 or 3 and type 2 or 3 disease * Had a body mass index of ≥25 and \<40 kg/m² * Able to walk independently, with or without their usual assistive device * Had received medical clearance to participate in moderate-intensity aquatic and land-based exercise * Able to understand the study procedures and provide written informed consent. Exclusion Criteria: * Had clinically significant lymphedema, uncontrolled chronic venous insufficiency, acute thrombosis, or another major cause of lower-limb edema * Had open wounds, active skin infection, fever, or another infectious condition incompatible with pool use * Had uncontrolled cardiovascular, metabolic, respiratory, or neurological disorder that could compromise exercise safety; a cardiac pacemaker or congestive heart failure; pregnancy; active cancer or ongoing chemotherapy, immunotherapy, or radiotherapy * Had history of bariatric surgery, recent major surgery, or liposuction; current use of weight-loss medication * Had current participation in structured aquatic or lower-limb exercise exceeding the protocol-defined threshold; or severe fear of water or inability to enter and exit the pool safely.