Metabolic costs and heart rate responses to treadmill walking in water at different depths and temperatures

Quantifying physiological and biomechanical responses of shallow water walking: a systematic review and meta-analysis

Detecting the physiological and biomechanical alterations in shallow water walking (SWW) due to water depth and speed is important for health professionals to perform accurate exercise prescription. This systematic review with meta-analysis aimed to investigate the acute physiological and biomechanical responses of SWW at different immersion depths in comparison to dry land walking. The main result (initial search: 1960 studies; systematic review: 42 studies; meta-analysis: 22 studies) indicated that metabolic power was higher in the immersion depth levels of xiphoid process (standardized mean differences (SMD) = 0.90; 95% confidence intervals (CI): 0.26 to 1.54) and waist (SMD = 3.35; 95% CI: -0.18 to 6.87) in comparison to dry land. SWW at xiphoid and waist depths seems to be an adequate exercise if the objective is to increase the energy expenditure and cardiovascular demand while the lower limb impact forces are reduced in comparison to dry land walking. PROSPERO registration: CRD42018113040.

Peak oxygen uptake and respiratory muscle performance in patients with chronic obstructive pulmonary disease: Clinical findings and implications

The maximal oxygen uptake (VO2max) is the gold standard measure of aerobic exercise capacity and is an important outcome measure in patients with chronic obstructive pulmonary disease (COPD). And respiratory muscle performance is also an important functional parameter for COPD patients. In addition to the traditional respiratory muscle strength test, the Test of Incremental Respiratory Endurance has recently been introduced and validated in patients with COPD. However, the relationship between VO2 and respiratory muscle performance in COPD is not well understood. Therefore, this study investigated the correlations among VO2 and respiratory muscle performance and other functional markers in COPD. A total of 32 patients with COPD were enrolled. All study participants underwent the following assessments: cardiopulmonary exercise test, pulmonary function test, respiratory muscle strength test, peripheral muscle strength test, and bioelectrical impedance analysis. When comparing VO2peak and respiratory muscle parameters, the sustained maximal inspiratory pressure (SMIP) was the only factor with a significant relationship with VO2peak. Among other functional parameters, the forced expiratory volume in one second (FEV1) showed the strongest correlation with VO2peak. It was followed by phase angle values of lower limbs, leg extension peak torque, age, and total skeletal muscle mass. When comparing respiratory muscle performance with other functional parameters, the SMIP showed the strongest correlation with hand grip strength, followed by peak cough flow, forced vital capacity, maximal inspiratory pressure, and FEV1. The results showed that the SMIP was more significantly correlated with VO2peak than the static measurement of respiratory muscle strength. This suggests that TIRE may be a useful assessment tool for patients with COPD. Additionally, FEV1 and other functional markers were significantly correlated with VO2peak, suggesting that various parameters may be used to evaluate aerobic power indirectly.

Development of a Cardiopulmonary Exercise Test Protocol Using Aquatic Treadmill in Healthy Adults: A Pilot Study

Traditional cardiopulmonary exercise test (CPET) protocols are difficult to apply to patients who have difficulty walking on a treadmill. Therefore, this study aimed to develop an aquatic treadmill (AT) CPET protocol involving constant increments in exercise load (metabolic equivalents (METs)) at regular intervals. Fourteen healthy male participants were enrolled in this study. The depth of the water pool was set to the umbilicus level of each participant, and the water temperature was maintained at 28−29 °C. The testing protocol comprised a total of 12 stages at different speeds. The starting speed was 0.7 km/h, which was increased by 0.6 or 0.7 km/h every 2 min. Heart rate, blood pressure, oxygen uptake, minute ventilation, respiratory exchange ratio, and rate of perceived exertion were recorded at each stage. All values showed a significant increasing trend with stage progression (p < 0.001). Peak oxygen uptake and heart rate values were 29.76 ± 3.75 and 168.36 ± 13.12, respectively. We developed a new AT CPET protocol that brings about constant increments in METs at regular intervals. This new AT CPET protocol could be a promising alternative to traditional CPET protocols for patients who experience difficulty walking on a treadmill.

The impact of water depth and speed on muscle fiber activation of healthy dogs walking in a water treadmill

BACKGROUND

Water treadmills are frequently used in the rehabilitation of dogs, for example with the purpose of re-building muscular strength after surgery. However, little is known about how different water depths and velocities affect the muscular workload during aquatic locomotion. This study used acoustic myography to assess hind limb muscle fiber activation in 25 healthy large-breed dogs walking in a water treadmill. Acoustic myography sensors were attached to the skin over the vastus lateralis of the quadriceps and the biceps femoris muscles. The dogs walked at two velocities (30 and 50 m/min) and four water depths: bottom of the pads, hock, stifle and mid-femur. Acoustic myograph signals were analyzed for changes in three muscle function parameters: efficiency/coordination (E-score) and spatial (S-score) and temporal (T-score) summation.

RESULTS

Differences between E, S, and T were statistically significant compared across different speeds (30, 50) and water levels (0, 1, 2, 3) using a one-way ANOVA with multiple comparisons (Tukey; Geisser-Greenhouse correction) as well as a two-tailed one sample t-test. At 50 m/min in water at the mid-femur, the biceps femoris was less efficient (P < 0.001) and recruited more fibers (P = 0.01) at a higher firing rate (P = 0.03) compared to working in shallower water, while the vastus lateralis was also less efficient (P < 0.01), but spatial and temporal summation did not change significantly. At 30 m/min, biceps efficiency was reduced (P < 0.01) when water was at the mid-femur compared to the bottom of the pads level. Walking in stifle- or hock-deep water did not show increased muscle activation for either muscle compared to walking in water at the bottom of the pads.

CONCLUSION

More muscle activation was required to walk in water at a depth at the level of the mid-femur compared to shallower water, and this exercise was more demanding for the biceps femoris, a muscle engaged in propulsion, than for vastus lateralis. These findings may help practitioners towards making more precise rehabilitation protocols.

Lower-Body Aquatic Training Prescription for Athletes

ABSTRACT

Holmberg, PM, Gorman, AD, Jenkins, DG, and Kelly, VG. Lower-body aquatic training prescription for athletes. J Strength Cond Res 35(3): 859-869, 2021-Traditionally prescribed to manage various medical ailments and promote healing, aquatic immersion may provide a favorable environment to undertake preparatory training tasks given its profound biological effects that extend across most homeostatic systems. In addition to understanding these effects, which are related to the fundamental principles of hydrodynamics, there is a need to consider the acute physiomechanical responses to alterations of key constraints associated with particular preparatory tasks. Evidence suggests that the manipulation of different constraints during aquatic training can enable a unique setting to complement, supplement, or supplant land-based programming to maintain or improve physical capacities in athletes without exacerbating physiological stress. Thus, this article focuses on the interplay of constraints and their associated outcomes to provide information that can be used to program lower-body aquatic training for athletes. In addition, the aim of the article is to summarize the literature on aquatic training to highlight the outcomes that occur when certain constraints are manipulated.

Lower-body positive pressure diminishes surface blood flow reactivity during treadmill walking

Objective

The purpose of this study was to determine the effects of the lower-body positive pressure on surface blood flow during standing still and treadmill walking to explore cardiovascular safety for application to rehabilitation treatment. Thirteen healthy volunteers participated in the experiment and surface blood flows were measured in the forehead, thigh, calf, and the top of the foot during standing still and walking under various pressure conditions (0 kPa, 5 kPa, and 6.7 kPa).

Results

Lower-body positive pressure decreased the blood flow in the forehead and the thigh during walking (p < .05 for each), whereas an increasing trend in blood flow was observed during standing still (p < .05). Furthermore, in the forehead and thigh, the extent of blood flow increase at the onset of walking was found to decrease in accordance with the applied pressure (p < .01 for each). These findings suggest that during walking, lower-body positive pressure modulates the blood flow, which implies safeness of this novel apparatus for use during orthopedic rehabilitation treatment.

The effect of aquatic high-intensity interval training on aerobic performance, strength and body composition in a non-athletic population: systematic review and meta-analysis

Objective:

In a non-athletic population, to (1) investigate the effectiveness of high-intensity interval training in an aquatic environment (A-HIIT) on aerobic performance, strength, and body composition and (2) report on safety of this approach.

Method:

A systematic search was undertaken of six databases until May 2018. Trials were eligible for inclusion if they compared the effect of A-HIIT in a non-athletic population with a control group that received no exercise training. Data were extracted independently by two reviewers and meta-analyses were undertaken using a random effects model to produce standardized mean difference (SMD) and 95% confidence intervals (CIs). Risk of bias was assessed using Cochrane’s risk of bias tool. All studies were graded using Physiotherapy Evidence Database (PEDro) and Consensus for Exercise Reporting Template (CERT) scales to determine quality of reporting.

Results:

Eight studies reported over 13 papers met study criteria ( n = 377). Compared with a control group, those who completed a program of A-HIIT demonstrated greater aerobic performance (SMD 0.69 (95% CI 0.39–0.98); I2 = 0%; n = 191) and lower limb muscle strength (SMD 0.30 (95% CI 0.04–0.56); I2 = 0%; n = 237). No differences were seen in measures of body composition or the number of adverse events. All studies were at risk of performance bias. The (mean ± SD) PEDro and CERT scores were 4.9 ± 1.5 and 15.1 ± 2.1, respectively.

Conclusion:

In a non-athletic population, A-HIIT was safe and may have improved aerobic performance and lower limb strength. The exercise interventions were well described and monitoring and reporting of exercise intensity in water was feasible.

The influence of water depth on kinematic and spatiotemporal gait parameters during aquatic treadmill walking

The purpose of this study was to investigate kinematic and spatiotemporal variables of aquatic treadmill walking at three different water depths. A total of 15 healthy individuals completed three two-minute walking trials at three different water depths. The aquatic treadmill walking was conducted at waist-depth, chest-depth and neck-depth, while a customised 3-D underwater motion analysis system captured their walking. Each participant's self-selected walking speed at the waist level was used as a reference speed, which was applied to the remaining two test conditions. A repeated measures ANOVA showed statistically significant differences among the three walking conditions in stride length, cadence, peak hip extension, hip range of motion (ROM), peak ankle plantar flexion and ankle ROM (All p values < 0.05). The participants walked with increased stride length and decreased cadence during neck level as compared to waist and chest level. They also showed increased ankle ROM and decreased hip ROM as the water depth rose from waist and chest to the neck level. However, our study found no significant difference between waist and chest level water in all variables. Hydrodynamics, such as buoyancy and drag force, in response to changes in water depths, can affect gait patterns during aquatic treadmill walking.

Shock attenuation, spatio-temporal and physiological parameter comparisons between land treadmill and water treadmill running

PURPOSE

The purpose of this study was to compare shock attenuation, spatio-temporal and physiological parameters during water immersed (depth: anterior superior iliac spine) aquatic treadmill (ATM) running and land based treadmill (LTM) running matched for speed.

METHODS

Six participants completed 15 min running under 2 conditions (LTM and ATM) in a randomised and balanced order, matched for speed. Synchronised tri-axial accelerometers placed at the distal tibia, lumbar region, and forehead were used to identify running dynamics and measure acceleration on impact and its attenuation. Expired respiratory gases and heart rate were sampled on a breath-by-breath basis for physiological variable collection throughout each trial.

RESULTS

Participants experienced reduced accelerations on impact at the distal tibia (p < 0.0001) but not the lower back (p = 0.1363) or forehead (p = 0.0551) during ATM compared to LTM. Consequently, large reductions in shock attenuation occurred during the ATM compared to LTM (p = 0.0001). Stride frequency was greater (p < 0.0001) and stride length was shorter (p = 0.0341) as a result of reduced swing time (p = 0.0201) for LTM, whilst ATM running increased physiological demand for both heart rate (p < 0.0001) and O₂ (p < 0.0001) compared to LTM.

CONCLUSION

These findings show ATM reduces impact stress on the passive structures of the lower limbs whilst increasing physiological demand when running at matched speeds.

Workload of horses on a water treadmill: effect of speed and water height on oxygen consumption and cardiorespiratory parameters

Background

Despite the use of water treadmills (WT) in conditioning horses, the intensity of WT exercise has not been well documented. The workload on a WT is a function of water height and treadmill speed. Therefore, the purpose of this study was to determine the effects of these factors on workload during WT exercise.

Fifteen client-owned Quarter Horses were used in a randomized, controlled study. Three belt speeds and three water heights (mid cannon, carpus and stifle), along with the control condition (dry treadmill, all three speeds), were tested. Measured outcomes were oxygen consumption (V̇O₂), ventilation (respiratory frequency, tidal volume (V_T)), heart rate (HR), and blood lactate. An ergospirometry system was used to measure V̇O₂ and ventilation. Linear mixed effects models were used to examine the effects of presence or absence of water, water height and speed (as fixed effects) on measured outcomes.

Results

Water height and its interaction with speed had a significant effect on V̇O₂, V_T and HR, all peaking at the highest water level and speed (stifle at 1.39 m/s, median V̇O₂ = 16.70 ml/(kg.min), V_T = 6 L, HR = 69 bpm). Respiratory frequency peaked with water at the carpus at 1.39 m/s (median 49 breaths/min). For a given water height, the small increments in speed did not affect the measured outcomes. Post-exercise blood lactate concentration did not change.

Conclusions

Varying water height and speed affects the workload associated with WT exercise. The conditions utilized in this study were associated with low intensity exercise. Water height had a greater impact on exercise intensity than speed.

Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study

OBJECTIVE

To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals.

METHODS

The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - β) power of 0.861. ClinicalTrials.gov: NCT00989248 (22).

RESULTS

Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB), (p>0.01), oxygen consumption (VO2), (p>0.01) and carbon dioxide production (VCO2) (p<0.01). Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB) all of than (p<0.01). The stages for data collected featured the subject's performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE), HB, VO2, VCO2 and VO2/HB (p<0.01) showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01). Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg's perceived exertion scale in the water than at every one of the test stages on land (p<0.01).

CONCLUSION

This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that coronary artery disease patients are able to do physical exercise in water and that the physiological effects of immersion do not present any risk for such patients, as exercise was well tolerated by all subjects.

Acute cardiorespiratory responses in participants with heart disease during cycling at different immersion levels

Physical activity is often avoided or practised at a low-intensity level because of the limited ability of patients with heart disease (HD) to provide sustained effort. Immersible training has been suggested as a possible alternative as hydrostatic pressure can modify some hemodynamic parameters in healthy patients and potentially increase the exercise capacity in patients with HD. The purpose of this study was to examine the acute cardiorespiratory adaptations at different levels of immersion using an immersible ergometer (IE) in patients with HD. Twenty-one patients and 13 healthy controls (HC) participated in this study. Several cardiorespiratory parameters were assessed at two levels of immersion (hips and xiphoid) for five different pedalling rates (40, 50, 60, 70 and peak rpm). At submaximal intensity, HD and HC participants did not differ significantly for most variables. However, for nearly and/or maximal workload, HD participants showed significantly lower values for VO₂ and higher values for V_E /VO₂ and V_E /VCO₂ for both immersion levels. The increase in immersion level from hips to xiphoid resulted in a significant decrease in VO₂ in both HC and HD groups at the same exercise intensity. In addition, the increase in the effects of size values based on the exercise workload indicates that group differences are accentuated with the highest pedalling rates. Our data suggest that participants with HD may benefit from the hydrostatic effect during IE cycling by allowing them to alleviate their submaximal efforts and increasing their maximal cardiorespiratory capacity during hip immersion.

Human Physiology in an Aquatic Environment

Water covers over 70% of the earth, has varying depths and temperatures and contains much of the earth's resources. Head-out water immersion (HOWI) or submersion at various depths (diving) in water of thermoneutral (TN) temperature elicits profound cardiorespiratory, endocrine, and renal responses. The translocation of blood into the thorax and elevation of plasma volume by autotransfusion of fluid from cells to the vascular compartment lead to increased cardiac stroke volume and output and there is a hyperperfusion of some tissues. Pulmonary artery and capillary hydrostatic pressures increase causing a decline in vital capacity with the potential for pulmonary edema. Atrial stretch and increased arterial pressure cause reflex autonomic responses which result in endocrine changes that return plasma volume and arterial pressure to preimmersion levels. Plasma volume is regulated via a reflex diuresis and natriuresis. Hydrostatic pressure also leads to elastic loading of the chest, increasing work of breathing, energy cost, and thus blood flow to respiratory muscles. Decreases in water temperature in HOWI do not affect the cardiac output compared to TN; however, they influence heart rate and the distribution of muscle and fat blood flow. The reduced muscle blood flow results in a reduced maximal oxygen consumption. The properties of water determine the mechanical load and the physiological responses during exercise in water (e.g. swimming and water based activities). Increased hydrostatic pressure caused by submersion does not affect stroke volume; however, progressive bradycardia decreases cardiac output. During submersion, compressed gas must be breathed which introduces the potential for oxygen toxicity, narcosis due to nitrogen, and tissue and vascular gas bubbles during decompression and after may cause pain in joints and the nervous system.

Metabolic and cardiovascular responses during aquatic exercise in water at different temperatures in older adults

PURPOSE

The aim of this study was to investigate the physiological responses during upper-body aquatic exercises in older adults with different pool temperatures.

METHOD

Eleven older men (aged 65 years and older) underwent 2 identical aquatic exercise sessions that consisted of 3 upper-body exercises using progressive intensities (30, 35, and 40 metronome beat · min(- 1)) on separate visits. Water temperatures for the visits were 28°C (cold water [CW]) and 36°C (hot water [HW]), and water depth ranged from 1.2 m to 1.4 m. Measurements for heart rate (HR), blood pressure (BP), oxygen consumption (VO2), and rate of perceived exertion (RPE) were compared between the CW and HW conditions.

RESULTS

The comparison between temperatures showed a higher HR response during exercise in HW, particularly when participants exercised at the highest intensities. During a 30-min postexercise period in resting conditions, HR was statistically significantly higher for the HW condition compared with the CW condition, with a large effect size (15.9%, d = 1.23). Systolic and diastolic BPs were found to be lower for the HW condition ( - 7.2%, d = - 0.60; - 10.1%, d = - 0.65), while VO2 and RPE showed no differences. The effect size between double products (HR · systolic BP) for the 2 conditions was small (CW = 8,649 ± 1,287, HW = 9,340 ± 1,672; d = 0.36), suggesting similar myocardial oxygen requirements.

CONCLUSION

This study showed that HR response was higher in an HW condition for older men. Warmer environments may add additional stressors to the body, which may impact training strategies and should be considered when estimating the effort of performing aquatic exercise.

Cardiovascular response during submaximal underwater treadmill exercise in stroke patients

Objective

To evaluate the cardiovascular response during head-out water immersion, underwater treadmill gait, and land treadmill gait in stroke patients.

Methods

Ten stroke patients were recruited for underwater and land treadmill gait sessions. Each session was 40 minutes long; 5 minutes for standing rest on land, 5 minutes for standing rest in water or on treadmill, 20 minutes for treadmill walking in water or on land, 5 minutes for standing rest in water or on treadmill, and 5 minutes for standing rest on land. Blood pressure (BP) and heart rate (HR) were measured during each session. In order to estimate the cardiovascular workload and myocardial oxygen demand, the rate pressure product (RPP) value was calculated by multiplying systolic BP (SBP) by HR.

Results

SBP, DBP, mean BP (mBP), and RPP decreased significantly after water immersion, but HR was unchanged. During underwater and land treadmill gait, SBP, mBP, DBP, RPP, and HR increased. However, the mean maximum increases in BP, HR and RPP of underwater treadmill walking were significantly lower than that of land treadmill walking.

Conclusion

Stroke patients showed different cardiovascular responses during water immersion and underwater gait as opposed to standing and treadmill-walking on land. Water immersion and aquatic treadmill gait may reduce the workload of the cardiovascular system. This study suggested that underwater treadmill may be a safe and useful option for cardiovascular fitness and early ambulation in stroke rehabilitation.

Physiological and biomechanical responses to walking underwater on a non-motorised treadmill: effects of different exercise intensities and depths in middle-aged healthy women

Non-motorised underwater treadmills are commonly used in fitness activities. However, no studies have examined physiological and biomechanical responses of walking on non-motorised treadmills at different intensities and depths. Fifteen middle-aged healthy women underwent two underwater walking tests at two different depths, immersed either up to the xiphoid process (deep water) or the iliac crest (shallow water), at 100, 110, 120, 130 step-per-minute (spm). Oxygen consumption (VO2), heart rate (HR), blood lactate concentration, perceived exertion and step length were determined. Compared to deep water, walking in shallow water exhibited, at all intensities, significantly higher VO2 (+13.5%, on average) and HR (+8.1%, on average) responses. Water depth did not influence lactate concentration, whereas perceived exertion was higher in shallow compared to deep water, solely at 120 (+40%) and 130 (+39.4%) spm. Average step length was reduced as the intensity increased (from 100 to 130 spm), irrespective of water depth. Expressed as a percentage of maximum, average VO2 and HR were: 64-76% of peak VO2 and 71-90% of maximum HR, respectively at both water depths. Accordingly, this form of exercise can be included in the "vigorous" range of exercise intensity, at any of the step frequencies used in this study.

The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis

Objective:

To assess the effectiveness of aquatic physical therapy in the treatment of fibromyalgia.

Data sources:

The search strategy was undertaken using the following databases, from 1950 to December 2012: MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, WEB OF SCIENCE, SCOPUS, SPORTDiscus, Cochrane Library Controlled Trials Register, Cochrane Disease Group Trials Register, PEDro and DARE.

Review methods:

The studies were separated into groups: Group I – aquatic physical therapy × no treatment, Group II – aquatic physical therapy × land-based exercises and Group III – aquatic physical therapy × other treatments.

Results:

Seventy-two abstracts were found, 27 of which met the inclusion criteria. For the functional ability (Fibromyalgia Impact Questionnaire), three studies were considered with a treatment time of more than 20 weeks and a mean difference (MD) of −1.35 [−2.04; −0.67], P = 0.0001 was found in favour of the aquatic physical therapy group versus no treatment. The same results were identified for stiffness and the 6-minute walk test where two studies were pooled with an MD of −1.58 [−2.58; −0.58], P = 0.002 and 43.5 (metres) [3.8; 83.2], P = 0.03, respectively.

Conclusion:

Three meta-analyses showed statistically significant results in favour of the aquatic physical therapy (Fibromyalgia Impact Questionnaire, stiffness and the 6-minute walk test) during a period of longer than 20 weeks. Due to the low methodological rigor, the results were insufficient to demonstrate statistical and clinical differences in most of the outcomes.

Consumo de oxigênio e índice de esforço percebido em diferentes ritmos de execução na hidroginástica

O objetivo do estudo foi correlacionar o consumo de oxigênio (VO2) e o percentual do VO2 máximo (%VO2máx) com o índice de esforço percebido (IEP) e comparar essas variáveis entre exercícios de hidroginástica executados no meio aquático em diferentes ritmos de execução. Seis mulheres realizaram quatro sessões de testes, uma no meio terrestre (teste de esforço máximo) e três no meio aquático, cada uma com a execução de um exercício de hidroginástica: corrida estacionária, deslize lateral e chute frontal até 45°. Cada exercício aquático foi realizado em três ritmos de execução, 80, 100 e 120bpm, durante 6 min (intervalo de 30 min). Para todas as variáveis, não foram observadas diferenças significativas entre os três exercícios, todavia, as mesmas apresentaram diferenças significativas entre os ritmos, indicando que com o aumento do ritmo, o esforço para executar os exercícios foi intensificado. Correlações significativas foram observadas entre VO2 e IEP e entre %VO2máx e IEP. Logo, baseado nessas associações, sugere-se que a prescrição da intensidade dos exercícios analisados possa ser feita através do IEP durante aulas de hidroginástica.

The metabolic response to treadmill graded exercise: traditional vs. underwater

The purpose of this study was to determine the metabolic effect(s) of four graded exercise tests (GXT) performed on the underwater treadmill (UWT), and compare them to the results from performing the standard Bruce protocol on a traditional land treadmill (LT). Twelve male Division I college athletes performed the stand Bruce protocol on a LT and 4 different GXT protocols on the UWT. Each test was performed to volitional max. oxygen consumption (VO2), heart rate (HR), respiratory exchange ratio (RER) and blood lactate (BL), which were measured at regular intervals throughout each of the GXTs. A two-way ANOVA with repeated measures was used to determine any main effect among the variables within the protocols and within the stages. Established effects were identified further using Tukey's post-hoc analysis. VO2and HR were positively correlated in all the GXTs, (r=0.992−0.999). When comparing the UWT GXTs to the Bruce, significant (P≤0.001) differences were found within certain stages for each of the dependent variables. While the Bruce resulted in attainment of VO2max, (mean = 55.72±5.92 ml/kg/min), only one of the UWT GXTs resulted in the same level of metabolic stress. At maximum speed and water velocity, the UWT produced a mean VO2of 53.9±3.68 ml/kg/min. HR and RER both increased by stage in all the GXTs as did BL. The onset of blood lactate accumulation (OBLA) was identified in all of the GXTs with the exception of one of the UWTs. Mean BL at OBLA ranged from, 3.12+1.31 to 5.98+4.24 mmol/dl. Our results suggest that an UWT GXT protocol can be developed that would produce metabolic results similar to the Bruce through stage 5. Buoyancy and variation in biomechanics need to be studied further for their effects on energy metabolism while performing work on the UWT. However, this study provides a better understanding of the metabolic demands at different treadmill speeds and water jet settings with the UWT.

Physiological and blood biochemical variables in horses exercising on a treadmill submerged in water

The blood lactate concentration (LA) and heart rate (HR) of 10 horses exercising in water on a treadmill were examined. With the water at 10 and 50% of the withers height (WH), the blood LA increased up to mean values around 1.9 mm during the standardized exercise test (SET) until after step 3 of 5 (each step lasted 5 min, speed increasing step by step). Thereafter, blood LA of horses remained constant, while with the water at 80% of WH, the blood LA decreased from the mean peak of 2.16 ± 0.62 mm after the 4th step. The HR of the horses increased to 132 ± 14 beats/min until the 3rd step of SET with the water at 10% of WH, up to the 2nd step with the water at 50% (134 ± 10 beats/min) and up to the 1st step only with the water at 80% of WH (134 ± 10 beats/min). In another SET, horses were exercised five times for 5 min at the maximal attainable speed of 5.5 m/s in water at 20% of the withers height in step 1, 35% in step 2, 49% in step 3, 63% in step 4 and 77% in step 5. On using this SET, blood LA increased to 1.91 ± 0.25 mm until after the 2nd step and decreased after the 3rd step. The HR increased between before commencing SET and the 1st step (143 ± 13 beats/min) and remained constant thereafter. In conclusion, increasing water height and speed of exercise does not augment continuously blood LA and HR of horses exercising in water treadmills.

VO2 prediction and cardiorespiratory responses during underwater treadmill exercise

We compared cardiorespiratory responses to exercise on an underwater treadmill (UTM) and land treadmill (LTM) and derived an equation to estimate oxygen consumption (VO2) during UTM exercise. Fifty-five men and women completed one LTM and five UTM exercise sessions on separate days. The UTM sessions consisted of chest-deep immersion, with 0, 25, 50, 75, and 100% water-jet resistance. All session treadmill velocities increased every 3 min from 53.6 to 187.8 m x min(-1). Cardiorespiratory responses were similar between LTM and UTM when jet resistance for UTM was 50%. Using multiple regression analysis, weight-relative VO2 could be estimated as: VO2 (mLO2 c kg(-1) x min(-1)) = 0.19248 x height (cm) + 0.17422 x jet resistance (% max) + 0.14092 x velocity (m x min(-1)) -0.12794 x weight (kg)-27.82849, R2 = .82. Our data indicate that similar LTM and UTM cardiorespiratory responses are achievable, and we provide a reasonable estimate of UTM VO2.

Heart rate responses during acclimation of horses to water treadmill exercise

REASONS FOR PERFORMING STUDY

The use of water treadmill exercise in horses is popular, although little is known about the physiological responses to this form of exercise. No information exists regarding the time taken to acclimate to water treadmill exercise compared to that of high-speed treadmill exercise, for both physiological and biomechanical parameters.

OBJECTIVE

To determine heart rate responses during acclimation to water treadmill exercise with and without sedation on first time exposure.

METHODS

All horses were exercised on a water treadmill at the walk for 15 min once a day for 4 days. Fourteen horses (mean +/- s.d. age 9 +/- 3.2 years) were assigned randomly to Group A (sedated) and Group B (nonsedated). Group A were given 20-30 microg/kg bwt romifidine within 10-15 min prior to the start of the first acclimating run. Acclimation was determined by the time taken to reach a threshold heart rate value.

RESULTS

Group A and B reached threshold heart rate values by the 6th minute of the 4th run (72.8 beats/min) and the 6th min of the 3rd run (78.7 beats/min), respectively. No significant difference was found (P>0.05) between Group A and B in the time taken to reach threshold heart rate values. Acclimation to water treadmill exercise requires a minimum of 2 x 15 min nonsedated acclimating runs. Sedation can be used to prevent horses panicking during the first exposure but thereafter does not affect the time taken to acclimate.

POTENTIAL RELEVANCE

Previous experience of water treadmill exercise should be taken into consideration prior to collecting physiological and biomechanical data. Further studies detailing the physiological and biomechanical responses are required prior to making recommendations for the incorporation of this mode of exercise into rehabilitation programmes.

Aquatic therapy: scientific foundations and clinical rehabilitation applications

The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.

Influência da imersão nas respostas cardiorrespiratórias em repouso

Diversos benefícios nos componentes da aptidão física podem ser adquiridos com a prática de exercícios aquáticos. Além disso, a água proporciona um ambiente para a prática de exercícios com reduzido impacto nos membros inferiores e maior ou menor sobrecarga cardiorrespiratória, de acordo com os movimentos realizados. Porém, tais exercícios podem produzir respostas fisiológicas diferentes daquelas ao ar livre, visto que ocorrem alterações fisiológicas importantes durante a imersão, sendo importante a compreensão das mesmas em repouso para melhor prescrição nesse meio. O presente estudo tem como objetivo revisar estudos sobre o comportamento da frequência cardíaca e do consumo de oxigênio durante a imersão em repouso e compreender os fatores que influenciam nesse comportamento. Várias pesquisas indicam que a frequência cardíaca de repouso é reduzida com a imersão em meio aquático, porém, é importante salientar que fatores tais como temperatura da água, posição corporal, profundidade de imersão e frequência cardíaca inicial podem minimizar ou maximizar tais respostas. Os estudos que abordaram as respostas de consumo de oxigênio não são conclusivos; entretanto, ao contrário da frequência cardíaca, os mesmos indicam semelhante ou maior resposta durante a imersão em repouso. Assim, pode-se concluir que, devido às alterações cardiorrespiratórias verificadas com a imersão em ambiente aquático, a prescrição de exercícios nesse meio deve ser diferenciada daquela para exercícios em ambiente terrestre.

Comparison of maximal and spontaneous speeds during walking on dry land and water

The aim of this study was to quantify spontaneous and maximal speeds on dry land and in water, in four modalities of walking [forward (F), backward (B) and lateral walking (L)], with chest immersion level. Lateral walking was studied with the upper limbs of the subject alongside the body with hands placed on the lateral face of the thighs (L1) and upper limbs tightened behind the back with the hands joined (L2). 16 males (age 22.8+/-1.8 years, height 178.1+/-6.1cm, body mass 73.5+/-6.6 kg) and 15 females (age 22.8+/-2.1 years, height 171.5+/-5.8 cm, body mass 69.2+/-9.3 kg) were evaluated using the four modalities of walking on dry land and in water. The speed increments between spontaneous and maximal speeds on dry land for F, B and L1 and L2 were 60.2%, 60.9%, 64.3% and 65.3% for males and 47.3%, 48.3%, 44.5% and 53.1% for females. In the water, these variation values for F, B, L1 and L2 for males were 44.6%, 26.1%, 48.8%, and 42.1%. The values for females were 31.7%, 21.6%, 32.8%, and 34.6%. Spontaneous and maximal speeds of walking were substantially reduced in water with the chest immersed, compared to speeds on dry land for the four modalities and the two genders. These findings may be used by therapists who utilize the various modalities of walking in aquatherapy.

Caminhada em ambiente aquático e terrestre: revisão de literatura sobre a comparação das respostas neuromusculares e cardiorrespiratórias

O objetivo deste estudo foi realizar uma revisão de literatura sobre a comparação das respostas neuromusculares e cardiorrespiratórias durante a caminhada em meio aquático e em meio terrestre. As respostas foram apresentadas para a caminhada em piscina rasa e para a caminhada em piscina funda. Em relação à caminhada em piscina rasa, as respostas neuromusculares (sinal EMG) e cardiorrespiratórias (FC e VO2) são muito dependentes da velocidade do exercício. As respostas neuromusculares podem ser menores no meio aquático quando a velocidade da caminhada é menor nesse ambiente. Por outro lado, quando o exercício é realizado com velocidades similares, a atividade dos músculos propulsores pode ser superior durante a caminhada aquática. Da mesma forma, respostas cardiorrespiratórias maiores são registradas no exercício aquático quando velocidades similares de caminhada são utilizadas. Contudo, com velocidades menores, essas respostas são semelhantes ou menores que as encontradas em meio terrestre. No que diz respeito à caminhada em piscina funda, as respostas neuromusculares diferem daquelas encontradas durante a caminhada em meio terrestre devido à ausência das forças de reação com o solo. Essa característica possivelmente modifica os músculos envolvidos na produção de força propulsiva nesse exercício. Além do mais, durante a caminhada em piscina funda, as respostas cardiorrespiratórias parecem sempre mais baixas devido à grande redução no peso hidrostático e à menor atividade dos músculos posturais e pela utilização do cinturão flutuador nessa modalidade.

Respostas de freqüência cardíaca, consumo de oxigênio e sensação subjetiva ao esforço em um exercício de hidroginástica executado por mulheres em diferentes situações com e sem o equipamento aquafins

As aulas de hidroginástica estão cada vez mais diversificadas com o uso de materiais apropriados ao meio aquático. Entretanto, poucos estudos verificaram a influência da utilização de tais materiais nas respostas cardiorrespiratórias. O objetivo foi analisar as respostas de freqüência cardíaca, consumo de oxigênio e sensação subjetiva ao esforço em mulheres durante a execução de um exercício de hidroginástica em diferentes situações com e sem o equipamento resistivo Aquafins®. Onze mulheres realizaram o exercício deslize frontal com a flexão e extensão horizontal de ombros em quatro situações: sem equipamento resistivo (S-FINS), com Aquafins nos membros inferiores (FINS-MIs), com Aquafins nos membros superiores (FINS-MSs) e com Aquafins nos membros superiores e inferiores (FINS-MIs/MSs). Em todas as situações foi verificado a FC, o VO2 e a SSE. Utilizou-se ANOVA para medidas repetidas, com post-hoc de Bonferroni (p < 0,05). A FC foi significativamente mais elevada nas situações FINS-MIs/MSs (159 ± 12bpm) e FINS-MIs (147 ± 18bpm), comparando-as com as demais situações. No entanto, a situação FINS-MIs apresentou FC similar à FINS-MSs (148 ± 16 bpm). Por sua vez, as três situações com o Aquafins foram diferentes da situação S-FINS (131 ± 14bpm). Para o VO2 houve diferença significativa entre a situação FINS-MIs/MSs (22,77 ± 3,58ml.kg-1.min-1), comparando-a com as demais. As situações FINS-MSs (19,67 ± 4,29ml.kg-1.min-1) e FINS-MIs (20,38 ± 3,99ml.kg-1.min-1) apresentaram VO2 significativamente maior que S-FINS (15,18 ± 4,67ml.kg-1.min-1). A SSE foi significativamente maior na situação FINS-MIs/MSs (16 ± 1,55), comparando-a com FINS-MIs (14 ± 0,9) e S-FINS (13 ± 1,29), entretanto, não foi diferente da FINS-MSs (14 ± 1,57). Portanto, a utilização de equipamentos que promovam resistência ao movimento na hidroginástica é indicada para melhorias no sistema cardiorrespiratório.

Efeitos de um programa de hidroterapia na pressão arterial e freqüência cardíaca de mulheres idosas sedentárias

Este estudo visou analisar as conseqüências cardiocirculatórias (na pressão arterial, PA, e freqüência cardíaca, FC) de um programa de hidroterapia cujo objetivo clínico era ganho de força muscular e flexibilidade para mulheres idosas saudáveis e sedentárias. Participaram 16 idosas, de 65 a 70 anos. O programa constou de 32 sessões, com uma hora de duração cada, de exercícios em imersão para ganho de força muscular e flexibilidade, com grau de dificuldade crescente, em sete fases. As quatro primeiras sessões foram usadas para adaptação ao meio aquático e desconsideradas para coleta de dados. As medidas de PA e FC foram coletadas ao final de cada fase, em quatro momentos: repouso fora da água, em repouso 3 minutos após imersão, em imersão ao final dos exercícios, e três minutos após a saída da piscina. Os dados foram analisados estatisticamente com nível de significância a p<0,05. Da sessão de base (5a) para a última (32ª), foram observadas quedas significantes de 5,6 mmHg na média da PA sistólica de repouso e de 9,7 mmHg na média da PA diastólica de repouso, tendo a classificação do nível da PA das participantes passado de normal-limítrofe para normal; e um aumento, não estatisticamente significativo, de 1,0 bpm na média da FC de repouso. Os achados sugerem que, embora não tenham afetado a FC, exercícios de força e flexibilidade em imersão, com grau de dificuldade crescente, não sobrecarregam - e podem afetar positivamente - o sistema cardiocirculatório de idosas com 65 a 70 anos.

Evaluation of two cold thermoregulatory models for prediction of core temperature during exercise in cold water

Cold thermoregulatory models (CTM) have primarily been developed to predict core temperature (T(core)) responses during sedentary immersion. Few studies have examined their efficacy to predict T(core) during exercise cold exposure. The purpose of this study was to compare observed T(core) responses during exercise in cold water with the predicted T(core) from a three-cylinder (3-CTM) and a six-cylinder (6-CTM) model, adjusted to include heat production from exercise. A matrix of two metabolic rates (0.44 and 0.88 m/s walking), two water temperatures (10 and 15 degrees C), and two immersion depths (chest and waist) were used to elicit different rates of T(core) changes. Root mean square deviation (RMSD) and nonparametric Bland-Altman tests were used to test for acceptable model predictions. Using the RMSD criterion, the 3-CTM did not fit the observed data in any trial, whereas the 6-CTM fit the data (RMSD less than standard deviation) in four of eight trials. In general, the 3-CTM predicted a rapid decline in core temperature followed by a plateau. For the 6-CTM, the predicted T(core) appeared relatively tight during the early part of immersion, but was much lower during the latter portions of immersion, accounting for the nonagreement between RMSD and SD values. The 6-CTM was rerun with no adjustment for exercise metabolism, and core temperature and heat loss predictions were tighter. In summary, this study demonstrated that both thermoregulatory models designed for sedentary cold exposure, currently, cannot be extended for use during partial immersion exercise in cold water. Algorithms need to be developed to better predict heat loss during exercise in cold water.

Peak Cardiorespiratory Responses during Aquatic and Land Treadmill Exercise

PURPOSE

Aquatic treadmill exercise has traditionally been used for aerobic training during rehabilitation; however, its ability to elicit comparable cardiorespiratory stress compared with land exercise is unclear. The purpose of this study was to investigate the cardiorespiratory (CR) responses elicited during maximal-effort protocols using an aquatic treadmill (ATM) and a land treadmill (TM).

METHODS

Twenty-three college runners participated in two continuous, incremental peak oxygen consumption protocols (ATM and TM) until volitional exhaustion. For the ATM protocol, subjects were submerged in 28 degrees C water to the xiphoid process. ATM speed was increased incrementally to 206.8+/-23.1 m.min, and water jet resistance was increased 10% every minute thereafter. For the TM protocol, speed was increased to 205.3+/-22.3 m.min, and grade was increased 2% every minute thereafter. Rest between sessions was at least 48 h. Oxygen consumption (VO2), heart rate (HR), minute ventilation (VE), tidal volume (VT), breathing frequency (f), and respiratory exchange ratio (RER) were measured continuously, with peak values used for analysis. Rating of perceived exertion (RPE) was recorded immediately after each test, and blood lactate (LA) was measured 3 min afterward.

RESULTS

VE and f were significantly greater in ATM versus TM; however, VO2, HR, VT, RER, LA, RPE, speed, and exercise times were similar for both protocols.

CONCLUSIONS

Despite differences in VE and f, it seems that the fluid resistance created by water and jets in an ATM elicits peak CR responses comparable with those seen with inclined TM. These findings suggest that ATM running may be as effective as TM running for aerobic conditioning in fit individuals.

Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses

The purpose of this study is to assess cardiovascular responses to lower body positive pressure (LBPP) and to examine the effects of LBPP unloading on gait mechanics during treadmill ambulation. We hypothesized that LBPP allows comfortable unloading of the body with minimal impact on the cardiovascular system and gait parameters. Fifteen healthy male and female subjects (22–55 yr) volunteered for the study. Nine underwent noninvasive cardiovascular studies while standing and ambulating upright in LBPP, and six completed a gait analysis protocol. During stance, heart rate decreased significantly from 83 ± 3 beats/min in ambient pressure to 73 ± 3 beats/min at 50 mmHg LBPP ( P < 0.05). During ambulation in LBPP at 3 mph (1.34 m/s), heart rate decreased significantly from 99 ± 4 beats/min in ambient pressure to 84 ± 2 beats/min at 50 mmHg LBPP ( P < 0.009). Blood pressure, brain oxygenation, blood flow velocity through the middle cerebral artery, and head skin microvascular blood flow did not change significantly with LBPP. As allowed by LBPP, ambulating at 60 and 20% body weight decreased ground reaction force ( P < 0.05), whereas knee and ankle sagittal ranges of motion remained unaffected. In conclusion, ambulating in LBPP has no adverse impact on the systemic and head cardiovascular parameters while producing significant unweighting and minimal alterations in gait kinematics. Therefore, ambulating within LBPP is potentially a new and safe rehabilitation tool for patients to reduce loads on lower body musculoskeletal structures while preserving gait mechanics.

Cardiorespiratory responses to aquatic treadmill walking in patients with rheumatoid arthritis

BACKGROUND AND PURPOSE

Hydrotherapy is popular with patients with rheumatoid arthritis (RA). Its efficacy as an aerobic conditioning aid is equivocal. Patients with RA have reduced muscle strength and may be unable to achieve a walking speed commensurate with an aerobic training effect because the resistance to movement increases with speed in water. The physiological effects of immersion may alter the heart rate-oxygen consumption relationship (HR-VO2) with the effect of rendering land-based exercise prescriptions inaccurate. The primary purpose of the present study was to compare the relationships between heart rate (HR), and ratings of perceived exertion (RPE), with speed during land and water treadmill walking in patients with RA.

METHOD

The study design used a two-factor within-subjects model. Fifteen females with RA (47+/-8 SD years) completed three consecutive bouts of walking for five minutes at 2.5, 3.5 and 4.5 km/h(-1) on land and water treadmills. Expired gas, collected via open-circuit spirometry, HR and RPE were measured.

RESULTS

HR and RPE increased on land and in water as speed increased. Below 3.5 km/h(-1) VO2 was significantly lower in water than on land (p<0.01). HR was lower (p<0.001), unchanged and higher (p<0.001) at 2.5, 3.5 and 4.5 km/h(-1) in water than on land. RPE was significantly higher in water than on land (p<0.05). VO2 was approximately 60% of the predicted VO2max during the fast walking speed in water. For a given VO2, HR was approximately nine beats/min(-1) and RPE 1-2 points on the 6-20 Borg scale, higher in water than on land.

CONCLUSIONS

The study showed that the metabolic demand of walking at 4.5 km/h(-1) was sufficient to stimulate an increase in aerobic capacity. The use of land-based prescriptive norms would underestimate the metabolic cost in water. Therefore, in water HR should be increased by approximately 9 beats/min(-1) to achieve similar energy demands to land treadmill walking.

The physiology of deep-water running

Deep-water running is performed in the deep end of a swimming pool, normally with the aid of a flotation vest. The method is used for purposes of preventing injury and promoting recovery from strenuous exercise and as a form of supplementary training for cardiovascular fitness. Both stroke volume and cardiac output increase during water immersion: an increase in blood volume largely offsets the cardiac decelerating reflex at rest. At submaximal exercise intensities, blood lactate responses to exercise during deep-water running are elevated in comparison to treadmill running at a given oxygen uptake (VO2). While VO2, minute ventilation and heart rate are decreased under maximal exercise conditions in the water, deep-water running nevertheless can be justified as providing an adequate stimulus for cardiovascular training. Responses to training programmes have confirmed the efficacy of deep-water running, although positive responses are most evident when measured in a water-based test. Aerobic performance is maintained with deep-water running for up to 6 weeks in trained endurance athletes; sedentary individuals benefit more than athletes in improving maximal oxygen uptake. There is some limited evidence of improvement in anaerobic measures and in upper body strength in individuals engaging in deep-water running. A reduction in spinal loading constitutes a role for deep-water running in the prevention of injury, while an alleviation of muscle soreness confirms its value in recovery training. Further research into the applications of deep-water running to exercise therapy and athletes' training is recommended.

Metabolic and cardiovascular response to shallow water exercise in young and older women

PURPOSE

The purpose of this study was to compare the metabolic and cardiovascular responses of young (Y) and older (O) women ages 19-24 yr (N = 11) and 63-72 yr (N = 11), respectively, while performing shallow water exercise (SWE).

METHODS

Resting metabolic rate was determined as was the metabolic (indirect calorimetry) and heart rate (Polar monitor) responses to five submaximal and one maximal SWE bout, and to a 40-min SWE class.

RESULTS

1) One metabolic equivalent (MET) equaled (mean +/- SE) 3.3 +/- 0.2 mL O(2).min-1.kg-1 (Y) and 2.8 +/- 0.1 mL O(2).min-1.kg-1 (O) (P < 0.05); 2) submaximal (bouts 1-5) MET and HR responses ranged from 3.5 to 8.6 and 95 to 144 bpm (Y), and 3.2 to 6.3 and 92 to 124 bpm (O); 3) estimated MET, % HR(peak), and kcal O(2) per minute at given relative efforts (% [OV0312]O(2peak)) were greater for the older group (P < 0.05), whereas no difference in RPE was found; 4) peak MET and HR equaled 11.7 +/- 0.8 and 182 +/- 3 bpm (Y) and 7.6 +/- 0.4 and 156 +/- 5 bpm (O), respectively (P < 0.05); 5) SWE class: overall, estimated average MET level was 4.9 +/- 0.3 (O) and 5.8 +/- 0.4 (Y) (P > 0.05); the overall relative intensity (% MET(peak)) was greater for the O group (61.5 +/- 2.5 vs 48.8 +/- 2.2) (P < 0.05).

CONCLUSIONS

SWE elicited metabolic and cardiovascular responses that met ACSM's guidelines for establishing health benefits. Furthermore, older females may self-select a greater relative exercise intensity during SWE compared with younger counterparts when provided with the same verbal instructions and encouragement.

Body temperature, oxygen uptake and heart rate during walking in water and on land at an exercise intensity based on RPE in elderly men

The purpose of this study was to clarify the characteristics of the physiological response that occurs while walking in water and on land at an exercise intensity based on the rating of perceived exertion (RPE) in elderly men. Nine elderly men ranging from 66-70 years of age participated in this study as subjects. The actual trials consisted of walking for 20 minutes in 31 degrees C and 35 degrees C water on an underwater treadmill. The water depth of the treadmill corresponded to the level of the xiphoid process in the subject. The same subjects performed on-land walking using a moving belt treadmill for 20 minutes at a room temperature of 27 degrees C. The exercise intensity during walking in the two water trials and the on-land trial was the same "somewhat hard" measured on the basis of the subject's RPE rating of 13. There was no significant difference between the subjects' rectal temperatures among the three trials. The mean skin temperature and mean body temperature while walking for 20 minutes in 35 degrees C water were significantly higher (P<0.01) than in 31 degrees C water and on land. There were no significant differences in oxygen uptake and heart rate among the two trials in water and the on-land trial. The above results suggest that the exercise intensity based on a subject's RPE may be an effective index for the prescription of thermoneutral water walking in the same way that it is for land walking in the elderly.

Cardiorespiratory response to low-intensity walking in water and on land in elderly women

The purpose of the present study was to determine whether or not the exercise intensity of water-walking for elderly women could be accurately prescribed by heart rate data obtained during treadmill exercise on land. Six healthy female volunteers, with a mean age of 62.2 +/- 4.2 years, took part in this study. Walking on land was performed on a treadmill. Each subject completed three consecutive 4-minute walks at a progressively increasing velocity (40, 60 and 80 m.min-1), with a 1-minute rest after both the first and second walks. The room temperature and relative humidity were 24.5 +/- 0.2 degrees C and 54.8 +/- 4.0%, respectively. Walking in water was performed in a Flowmill, which is a treadmill positioned at the base of a water flume. Each subject completed three consecutive 4-minute walks at a progressively increasing belt and water-flow velocity (20, 30 and 40 m.min-1), with a 1-minute rest after both the first and second walks. The water depth was at the level of the xiphoid process of each subject. The water temperature was 30.7 +/- 0.1 degrees C. The exercise intensity at the highest workrate was equivalent to 44.2 +/- 10.3% of the heart rate reserve (HRR) during water-walking and 38.4 +/- 4.7% of the HRR during land-walking. There was a highly significant linear relationship between heart rate (HR) and oxygen uptake (VO2) during both water-walking and land-walking. The relationship between HR and VO2 in both exercise modes was similar. Thus, the relationship of HR to VO2 derived from a treadmill-graded walking test on land may be used to prescribe exercise intensity for water-walking in thermoneutral water.

Physiological responses to water-walking in middle aged women

The purpose of the present study was to examine the physiological responses to water-walking using the Flowmill, which has a treadmill at the base of a water-flume, in two groups of women. In the first group, the women were known to regularly swim and exercise in water (group A), while in the second, they did not routinely participate in water-exercise (group B). In both groups, twelve healthy female volunteers in their fifties participated in the study. All of the subjects walked in water using the Flowmill for the first time. Subjects completed four consecutive bouts of 4-minute duration at progressively increasing speeds (20, 30, 40, and 50 m.min-1), with 1-minute rests between each bout. In addition, water-velocity was adjusted to the walking speed of each bout. The water-depth of the Flowmill was the level of the xiphoid process. The water and room temperatures were 30.3 +/- 0.1 degrees C and 24.9 +/- 0.4 degrees C, respectively. In both groups, the relationship between walking speed and oxygen uptake (VO2) as well as that between walking speed and heart rate (HR) changed exponentially as the walking speed increased, and the relationship between HR and VO2 was linear. The relationship between HR and VO2 was similar in both groups, and there was no significant difference between the predicted maximal oxygen uptake (VO2max) of the two groups. VO2 and HR of group B during water-walking, however, were significantly higher than those of group A at all walking speeds. The results of this study clearly showed that experience in moving through the water strongly affects physiological responses to water-exercise, even when fitness levels are equivalent.

WARD: a pneumatic system for body weight relief in gait rehabilitation

The paper presents Walking Assistance and Rehabilitation Device (WARD), a system for walking rehabilitation devised to relieve the patient of his/her body weight of a constant and prescribed amount by externally supporting the subject at the upper trunk and pelvis level by means of a harness. The system is based on a pneumatic actuator that has proved to be effective at maintaining a constant relief force. The constancy of this force that should be maintained even under high body weight support (BWS) conditions (70-80% of body weight) seems to be important for a correct motor pattern. A law has been identified that may be useful to adjust walking speed as a function of the prescribed BWS. WARD is simple to construct, practical to use, and has been characterized on healthy subjects.