Energetics of wet-suit diving in Japanese male breath-hold divers

Treating exertional heat stroke: Limited understanding of the female response to cold water immersion

According to an expansive body of research and best practice statements, whole-body cold water immersion is the gold standard treatment for exertional heat stroke. However, as this founding evidence was predominantly drawn from males, the current guidelines for treatment are being applied to women without validation. Given the recognised differences in thermal responses experienced by men and women, all-encompassing exertional heat stroke treatment advice may not effectively protect both sexes. In fact, recent evidence suggests that hyperthermic women cool faster than hyperthermic men during cold water immersion. This raises the question of whether overcooling is risked if the present guidelines are followed. The current mini-review examined the literature on women's response to cold water immersion as a treatment for exertional heat stroke and aimed to clarify whether the current guidelines have appropriately considered research investigating women. The potential implications of applying these guidelines to women were also discussed.

Thermoregulatory and Metabolic Demands of Naval Special Warfare Divers During a 6-h Cold-Water Training Dive

Introduction: Extreme environmental conditions induce changes in metabolic rate and substrate use due to thermoregulation. Cold-water full-body submersion for extended periods of time is inevitable for training and missions carried out by Naval Special Warfare divers. Anthropometric, physiologic, and metabolic data have been reported from partial immersion in cold water in non-thermally protected men; data is limited in thermally protected divers in extremely cold water. Thermoregulatory and metabolic demands during prolonged cold-water submersion in Naval Special Warfare divers are unknown. Objective: Assess thermoregulatory and metabolic demands of Naval Special Warfare divers surrounding prolonged cold-water submersion. Materials and Methods: Sixteen active-duty U.S. Navy Sea Air and Land (SEAL) operators tasked with cold-water dive training participated. Divers donned standard military special operations diving equipment and fully submerged to a depth of ∼ 6 m in a pool chilled to 5°C for a 6-h live training exercise. Metabolic measurements were obtained via indirect calorimetry for 10-min pre-dive and 5-min post dive. Heart rate, skin temperature, and core temperature were measured throughout the dive. Results: Core temperature was maintained at the end of the 6-h dive, 36.8 ± 0.4°C and was not correlated to body composition (body fat percentage, lean body mass) or metabolic rate. SEALs were not at risk for non-freezing cold injuries as mean skin temperature was 28.5 ± 1.6°C at end of the 6-h dive. Metabolic rate (kcal/min) was different pre- to post-dive, increasing from 1.9 ± 0.2 kcal/min to 2.8 ± 0.2 kcal/min, p < 0.001, 95% CI [0.8, 1.3], Cohen's d effect size 2.3. Post-dive substrate utilization was 57.5% carbohydrate, 0.40 ± 0.16 g/min, and 42.5% fat, 0.13 ± 0.04 g/min. Conclusion: Wetsuits supported effective thermoprotection in conjunction with increase in thermogenesis during a 6-h full submersion dive in 5°C. Core temperature was preserved with an expected decrease in skin temperature. Sustained cold-water diving resulted in a 53% increase in energy expenditure. While all participants increased thermogenesis, there was high inter-individual variability in metabolic rate and substrate utilization. Variability in metabolic demands may be attributable to individual physiologic adjustments due to prior cold exposure patterns of divers. This suggests that variations in metabolic adjustments and habituation to the cold were likely. More work is needed to fully understand inter-individual metabolic variability to prolonged cold-water submersion.

Evaluating the thermal protection provided by a 2‒3 mm wet suit during fin diving in shallow water with a temperature of 16‒20°C

INTRODUCTION

The purpose of the study was to evaluate the thermal protection provided by a 2-3 mm surfing wet suit during at least two hours of fin diving in shallow water with a temperature of 16-20°C. We examined the effect of wearing the suit while diving in cold water on cognitive performance, muscle strength, and hand motor function.

METHODS

Subjects were six male well-trained rebreather divers, 19-23 years old, acclimatised to cold. They attended the laboratory on three separate occasions, when we conducted the experiment at one of three temperatures, 16, 18, and 20°C. Core temperature (gastrointestinal system), skin temperature, oxygen consumption, and cold perception were evaluated during the test. Before and immediately after the dives, subjects performed a series of cognitive, manual dexterity, and muscle strength tests.

RESULTS

Core temperature decreased by 0.35-0.81°C over the two hours at all three water temperatures. No subject reached a core temperature below 35°C. The decrease in upper body skin temperature during the two hour dive ranged between 5.97 and 8.41°C (P < 0.05). Two hours diving in 16-20°C water resulted in a significant increase in the time taken to perform the task of unlinking and reassembling four shackles (∼30% longer, P < 0.05). No effect was found on the cognitive or muscle strength tests.

CONCLUSIONS

A 2-3 mm wet suit provides adequate thermal protection in trained and cold-acclimatised young males engaged in active diving in shallow water with a temperature of 16°C and above.

Characterisation of regional skin temperatures in recreational surfers wearing a 2-mm wetsuit

The purpose of this study was to investigate skin temperatures across surfers' bodies while wearing a wetsuit during recreational surfing. Forty-six male recreational surfers participated in this study. Participants were instrumented with eight wireless iButton thermal sensors for the measurement of skin temperature, a Polar RCX5 heart rate monitor and a 2-mm full wetsuit. Following instrumentation, participants were instructed to engage in recreational surfing activities as normal. Significant differences (p < 0.001) in skin temperature (T_sk) were found across the body while wearing a wetsuit during recreational surfing. In addition, regional skin temperature changed across the session for several regions of the body (p < 0.001), and the magnitude of these changes varied significantly between regions. We show for the first time that significant differences exist in skin temperature across the body while wearing a wetsuit during a typical recreational surfing session. These findings may have implications for future wetsuit design. Practitioner Summary: This study investigated the impact of wearing a wetsuit during recreational surfing on regional skin temperatures. Results from this study suggest that skin temperatures differ significantly across the body while wearing a 2-mm wetsuit during recreational surfing. These findings may have implications for future wetsuit design.

Lost at sea: the medicine, physiology and psychology of prolonged immersion

In most countries, immersion represents the second most common cause of accidental death in children and the third in adults. Between 2010 and 2013, 561 deaths worldwide involving recreational divers were recorded by the Divers Alert Network. Consequently, there is no room for complacency when diving. Being lost at sea is a diver's worst nightmare. In 2006, a diver was lost at sea off the coast of New Zealand for 75 hours. It is unprecedented that, after such a long time immersed in temperate (16-17°C) waters, he was found and survived. His case is presented and utilised to illustrate the many physiological and psychological factors involved in prolonged immersion and what might determine survival under such circumstances. We also briefly review options for enhancing diver location at sea and a few issues related to search and rescue operations are discussed.

Argon used as dry suit insulation gas for cold-water diving

Background

Cold-water diving requires good thermal insulation because hypothermia is a serious risk. Water conducts heat more efficiently compared to air. To stay warm during a dive, the choice of thermal protection should be based on physical activity, the temperature of the water, and the duration of exposure. A dry suit, a diving suit filled with gas, is the most common diving suit in cold water. Air is the traditional dry suit inflation gas, whereas the thermal conductivity of argon is approximately 32% lower compared to that of air. This study evaluates the benefits of argon, compared to air, as a thermal insulation gas for a dry suit during a 1-h cold-water dive by divers of the Royal Netherlands Navy.

Methods

Seven male Special Forces divers made (in total) 19 dives in a diving basin with water at 13°C at a depth of 3 m for 1 h in upright position. A rubber dry suit and woollen undergarment were used with either argon (n = 13) or air (n = 6) (blinded to the divers) as suit inflation gas. Core temperature was measured with a radio pill during the dive. Before, halfway, and after the dive, subjective thermal comfort was recorded using a thermal comfort score.

Results

No diver had to abort the test due to cold. No differences in core temperature and thermal comfort score were found between the two groups. Core temperature remained unchanged during the dives. Thermal comfort score showed a significant decrease in both groups after a 60-min dive compared to baseline.

Conclusions

In these tests the combination of the dry suit and undergarment was sufficient to maintain core temperature and thermal comfort for a dive of 1 h in water at 13°C. The use of argon as a suit inflation gas had no added value for thermal insulation compared to air for these dives.

Insulation and Body Temperature of Prepubescent Children Wearing a Thermal Swimsuit During Moderate-Intensity Water Exercise

This study investigated thermal swimsuits (TSS) effects on body temperature and thermal insulation of prepubescent children during moderate-intensity water exercise. Nine prepubescent children (11.0+/-0.7 yrs) were immersed in water (23 degrees C) and pedalled on an underwater cycle-ergometer for 30 min with TSS or normal swimsuits (NSS). The rectal temperature (Tre) was maintained slightly higher with TSS than with NSS. The total insulation (Itotal) was significantly higher with TSS. The DeltaTre, Deltamean body temperature (Tb), and tissue insulation (Itissue) in the NSS condition were correlated with % body fat, which indicated that the insulation layer of subjects with low body fat was thinner than that of obese subjects, and tended to decrease body temperature. Wearing TSS increased Itotal, thereby reducing heat loss from subjects' skin to the water. Consequently, subjects with TSS were able to maintain higher body temperatures. In addition, TSS is especially advantageous for subjects with low body fat to compensate for the smaller Itissue.

Thermal Insulation and Body Temperature Wearing a Thermal Swimsuit during Water Immersion

This study evaluated the effects of a thermal swimsuit on body temperatures, thermoregulatory responses and thermal insulation during 60 min water immersion at rest. Ten healthy male subjects wearing either thermal swimsuits or normal swimsuits were immersed in water (26 degrees C or 29 degrees C). Esophageal temperature, skin temperatures and oxygen consumption were measured during the experiments. Metabolic heat production was calculated from oxygen consumption. Heat loss from skin to the water was calculated from the metabolic heat production and the change in mean body temperature during water immersion. Total insulation and tissue insulation were estimated by dividing the temperature difference between the esophagus and the water or the esophagus and the skin with heat loss from the skin. Esophageal temperature with a thermal swimsuit was higher than that with a normal swimsuit at the end of immersion in both water temperature conditions (p<0.05). Oxygen consumption, metabolic heat production and heat loss from the skin were less with the thermal swimsuit than with a normal swimsuit in both water temperatures (p<0.05). Total insulation with the thermal swimsuit was higher than that with a normal swimsuit due to insulation of the suit at both water temperatures (p<0.05). Tissue insulation was similar in all four conditions, but significantly higher with the thermal swimsuit in both water temperature conditions (p<0.05), perhaps due to of the attenuation of shivering during immersion with a thermal swimsuit. A thermal swimsuit can increase total insulation and reduce heat loss from the skin. Therefore, subjects with thermal swimsuits can maintain higher body temperatures than with a normal swimsuit and reduce shivering thermo-genesis.

Energetics of underwater swimming with SCUBA

Underwater swimming has unique features of breathing apparatus (SCUBA), thermal protective gear, and fins. The energy cost of underwater swimming is determined by the drag while swimming and the net mechanical efficiency. These are influenced by the cross-sectional area of the diver and gear and the frequency of the leg kick. The speeds that divers can achieve are relatively low, thus the VO(2) increases linearly with values of VO(2)*d(-1) of 30-50 l*km(-1)for women and men, respectively. Diving experience had little effect on VO(2) for women; however, male divers with experience had lower VO(2) than beginners. The location and density of the gear can alter the diver's attitude in the water and increase the energy cost of swimming by 30 percent at slow speeds. The type of fin used has an effect on the depth and frequency of the kick, thus on drag and efficiency, with a range of VO(2) from 25 to 50 l*km(-1). A large flexible fin had the lowest energy cost and a large rigid fin the highest. Adding extra air tanks or a dry suit increased the cost of swimming by 25 percent. The energy cost of underwater swimming is influenced by gender, gear and its placement, fin type, and experience of the diver.

Heart rate in humans during underwater swimming with and without breath-hold

Heart rate was monitored, by way of radiotelemetry, from 6 male subjects of mean age (+/- SE) 24 +/- 1 years and of mean mass 73.5 +/- 2.5 kg. Measurements were made in a 25 m pool at a water temperature of 28 degrees C. Resting heart rate was 67 +/- 3.7 beats X min-1 and when the subjects submerged themselves completely in the pool, but remained inactive, there was a prompt, gradual reduction in heart rate which reached 48 +/- 2.6 beats X min-1 within 30 sec and 40 +/- 2.6 beats X min-1 within 59 +/- 5.6 sec (maximum duration). When they propelled themselves under water for 33 sec by kicking their legs and breathed through a snorkel tube, heart rate increased progressively to a value of 118 +/- 4.1 beats X min-1 at 28 sec. However, when they performed the same manoeuvre while holding their breath, there was an initial increase in heart rate to 106 +/- 5.7 beats X min-1 within the first 10 sec. This was followed by a decline in heart rate which was more rapid than that recorded during inactive submersion and which eventually reached 48 +/- 4.4 beats X min-1 at mean underwater duration of 33 +/- 1.8 sec. It is concluded that during the first 10-15 sec of underwater breath-hold swimming in humans, the cardiovascular response (as indicated by heart rate) is similar to that seen during a similar level of exercise while breathing air. From then on there is a progressively more intense bradycardia which is probably indicative of an oxygen conserving response consisting of reduced perfusion of most of the body except the heart, CNS and active locomotory muscles. The degree and rate of onset of this proposed oxygen conserving response are influenced by the intensity of the exercise performed while under water and whether or not the period of underwater breath-hold swimming is preceded by exercise.