Comparative Analysis of Land-Based vs. Water-Based Balance Training on Quality of Life and Physical and Psychological Deficits in Athletes with Chronic Ankle Instability: A Randomized Controlled Trial Assessing the Influence of Exercise Environment

Background Aquatic training is recognized for its effective and gentle rehabilitation benefits, yet its effects on athletes with chronic ankle instability (CAI) is not well-studied. This research aims to compare the effects of water-based (WBBE) and land-based (LBBE) balance training on functional performance, dynamic balance, fear of reinjury, and quality of life in athletes with CAI, hypothesizing that aquatic training will lead to greater improvements. Methods Forty-one athletes with CAI were randomly assigned to either the WBBE group (n = 21) or the LBBE group (n = 20). Both groups participated in an identical balance training program consisting of 24 sessions over 8 weeks, each lasting 30–45 minutes. Functional ankle instability was assessed using the Cumberland Ankle Instability Tool (CAIT), kinesiophobia with the Tampa Scale for Kinesiophobia (TSK-17), and quality of life with the Short Form-36 Health Survey (SF-36). Dynamic postural control was measured with the Y Balance Test (YBT), and functional performance was evaluated through the Figure-8 hop (F8H) and the single-limb side-hop (SLSH) tests. Perceived treatment effects were assessed using the Global Rating of Change (GROC). Data were analyzed using mixed-design ANOVA (P ≤ 0.05). Results The statistical analysis of the study revealed no significant time × group interaction effects for CAIT scores, kinesiophobia scores, the Psychological Quality of Life (QoL) Component, or SEBT scores (p > 0.05). The LBBE group showed significant improvements in functional tasks, specifically in F8H and SLSH scores, compared to the WBBE group (p < 0.05), while the WBBE group had better outcomes in overall Quality of Life and the Physical QoL Component than the LBBE group (p < 0.05). Conclusion Both land-based and water-based balance exercises offer unique benefits for rehabilitating athletes with CAI, with land-based exercises improving functional performance and water-based exercises enhancing overall and physical Quality of Life. A flexible, individualized rehabilitation program that incorporates both modalities can optimize recovery and address specific needs like Quality of Life and functional performance, despite no significant differences in ankle stability, kinesiophobia, psychological QoL, and dynamic balance between the two approaches. Trial registration Clinical Trials: UMIN000051746