Background: We hypothesized that a 2-week twice daily aquatic endurance plus calisthenics exercise training program: (i) increases aerobic exercise capacity (peak oxygen uptake/$\dot{\mathrm{V}}$O₂peak), (ii) improves endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces circulating markers of low-grade inflammation and hemostasis, as compared to land-based endurance plus calisthenics exercise training or no exercise in patients undergoing short-term residential cardiac rehabilitation after a recent coronary artery disease (CAD) event. Methods: Patients with a recent myocardial infarction or revascularization procedure were randomized into two interventional groups and a control group. The interventional groups underwent supervised aerobic endurance plus calisthenics exercise training either in thermo-neutral water or on land at moderate intensity (60–80% of the peak heart rate achieved during symptom-limited graded exercise testing) for 30 min twice daily for 2 weeks (i.e., 24 sessions). The control group was deferred from supervised exercise training for the 2-week duration of the intervention, but was advised low-to-moderate intensity physical activity at home while waiting. At baseline and after the intervention period, all participants underwent estimation of aerobic exercise capacity, brachial artery flow-mediated dilatation (FMD, measured ultrasonographically at rest and during reactive hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8, IL-10), cell adhesion (ICAM, P-selectin), and hemostasis (fibrinogen, D-dimer). Results: A total of 89 patients (mean age 59.9 ± 8.2 years, 77.5% males, $\dot{\mathrm{V}}$O₂peak at baseline 14.8 ± 3.5 ml kg^-1 min^-1) completed the study. Both exercise modalities were safe (no significant adverse events recorded) and associated with a significant improvement in $\dot{\mathrm{V}}$O₂peak as compared to controls: age and baseline $\dot{\mathrm{V}}$O₂peak-adjusted end-of-study $\dot{\mathrm{V}}$O₂peak increased to 16.7 (95% CI 16.0–17.4) ml kg^-1 min^-1 with land-based training (p < 0.001 for change from baseline) and to 18.6 (95% CI 17.9–19.3) ml kg^-1 min^-1 with water-based training (p < 0.001 for change from baseline), but not in controls (14.9 ml kg^-1 min^-1; 95% CI 14.2–15.6; p = 0.775 for change from baseline). FMD also increased in both intervention groups (from 5.5 to 8.8%, p < 0.001 with land-based, and from 7.2 to 9.2%, p < 0.001 with water-based training, respectively), as compared to controls (p for change 0.629). No significant changes were detected in biomarkers of inflammation, cell adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac dysfunction) decreased in the water-based training group (p = 0.07 vs. controls). Conclusion: Endurance plus calisthenics exercise training in thermo-neutral water is safe, and improves aerobic exercise capacity and vascular function in patients undergoing short-term residential cardiac rehabilitation after a recent CAD event. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02831829.

An effective lifestyle strategy to reduce cardiovascular diseases risk (CVD) factors is needed. We examined the effects of a whole-food plant-based (WFPB) lifestyle program on dietary intake and cardiovascular (CV) risk factors in 151 adults (mean 39.6 (SD 12.5) years). Adherence was categorised into short-, medium- and long-term (years: (0.5–<2), (2–<5) and (5–10)), for both genders separately. Dietary intakes were assessed, fasting blood lipids and blood pressure (BP) were measured, and % participants reaching guideline recommended targets for LDL-cholesterol, triglycerides and BP in the primary CVD prevention was assessed. There were no statistically significant differences in intakes of energy and most nutrients among participants (both genders), that were short-, medium- and long term in our program. Diet was mainly composed of unprocessed vegetables/fruits, whole grains, legumes, potatoes, and nuts/seeds. LDL-cholesterol, triglycerides, systolic and diastolic BP were within targets for: 93%, 97%, 88% and 95% participants, respectively. In females (vs. males), total- and HDL-cholesterol were higher (mean): 3.8 (SD 0.7) vs. 3.4 (SD 0.9), p = 0.002 and 1.5 (SD 0.3) vs. 1.1 (SD 0.2) mmol/L, p < 0.001), systolic BP was lower (113 (SD 11) vs. 120 (SD 10) mmHg, p = 0.001), while there was no difference in diastolic BP (71 (SD 9) vs. 72 (SD 8) mmHg, p = 0.143). More females vs. males reached target triglycerides (99% vs. 91%, p = 0.021) and systolic BP (92% vs. 79%, p = 0.046), while similar females and males reached target LDL-cholesterol (94% vs. 91%, p = 0.500) and diastolic BP (93% vs. 100%, p = 0.107). Participation in our WFPB lifestyle program is associated with favourable dietary intakes, safety markers, and CV risk factor profiles.