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

Mauricio Koprowski Garcia, Limanara Rizzo, Paulo Yazbek-Júnior, Daniela Yutiyama, Fabiola Jomar da Silva, Denise Matheus, Luiz Eduardo Mastrocolla, Eduardo Massad, Mauricio Koprowski Garcia, Limanara Rizzo, Paulo Yazbek-Júnior, Daniela Yutiyama, Fabiola Jomar da Silva, Denise Matheus, Luiz Eduardo Mastrocolla, Eduardo Massad

Abstract

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.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Test conducted on an underwater treadmill under supervision of a cardiologist.
Figure 2
Figure 2
Data collected at five moments, both on land and in water.
Figure 3
Figure 3
Major effects CAD and Health groups for land versus water, profile for test time measured in minutes and seconds.

References

    1. Schmid JP, Noveanu M, Morger C, Gaillet R, Capoferri M, Anderegg M, et al. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure. Heart. 2007;93((6)):722–7. doi: 10.1136/hrt.2006.094870.
    1. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122((2)):191–225. doi: 10.1161/CIR.0b013e3181e52e69.
    1. Norsk P, Bonde-Petersen F, Walberg J. Central venous pressure and plasma arginine vasopressin in man during water immersion combined with changes in blood volume. Eur J Appl Physiol Occup Physiol. 1986;54((6)):608–16. doi: 10.1007/BF00943349.
    1. Arborelius M, Jr, Ballidin UI, Lilja B, Lundgren CE. Hemodynamic changes in man during immersion with the head above water. Aerosp Med. 1972;43((6)):592–8.
    1. Risch WD, Koubenec HJ, Beckmann U, Lange S, Gauer OH. The effect of graded immersion on heart volume, central venous pressure, pulmonary blood distribution, and heart rate in man. Pflugers Arch. 1978;374((2)):115–8. doi: 10.1007/BF00581289.
    1. Lange L, Lange S, Echt M, Gauer OH. Heart volume in relation to body posture and immersion in a thermo-neutral bath. A roentgenometric study. Pflügers Arch. 1974;352((3)):219–26. doi: 10.1007/BF00590487.
    1. Weston CF, O'Hare JP, Evans JM, Corrall RJ. Hemodynamic changes in man during immersion in water at different temperatures. Clin Sci (London) 1987;73((6)):613–6. doi: 10.1042/cs0730613.
    1. Becker BE, Cole AJ. DeLisa JA. Physical Medicine and rehabilitation: principles and practice. 4th ed. Philadelphia: Lippincott; 2005. Aquatic rehabilitation; pp. 479–92. (eds)
    1. Epstein M. Renal effects of head-out water immersion in humans: a 15-year update. Physiol Rev. 1992;72((3)):563–621.
    1. Bruce RA, Pearson R, Lovejoy FW, Jr, Yu PN, Brothers GB. Variability of respiratory and circulatory performance during standardized exercise. J Clin Invest. 1949;28((6 Pt 2)):1431–8. doi: 10.1172/JCI102208.
    1. Christie JL, Sheldahl LM, Tristani FE, Wann LS, Sagar KB, Levandoski SG, et al. Cardiovascular regulation during head-out water immersion exercise. J Appl Physiol. 1990;69((2)):657–64.
    1. Yazbek P, Jr, Carvalho RT, Sabbag LM, Battistella LR. Ergoespirometria. Teste de Esforço Cardiopulmonar, Metodologia e Interpretação. Arq Bras Cardiol. 1998;71((5)):719–24. doi: 10.1590/S0066-782X1998001100014.
    1. Gabrielsen A, Johansen LB, Norsk P. Central cardiovascular pressures during graded water immersion in humans. J Appl Physiol. 1993;75((2)):581–5.
    1. Craig A, Dvorak M. Comparison of exercise in air and in water of different temperatures. Med Sci Sports. 1969;1:124–30.
    1. Harrison RA, Bulstrode S. Loading of the lower limb when walking partially immersed. Physiotherapy. 1992;78((3)):164–6. doi: 10.1016/S0031-9406(10)61377-6.
    1. Gleim GW, Nicholas JA. Metabolic costs and heart rate responses to treadmill walking in water at different depths and temperatures. Am J Sports Med. 1998;17((2)):248–52. doi: 10.1177/036354658901700216.
    1. Hall J, Macdonald IA, Maddison PJ, ÓHare JP. Cardiorespiratory responses to underwater treadmill walking in healthy females. Eur J Appl Physiol Occup Physiol. 1998;77((3)):278–84. doi: 10.1007/s004210050333.
    1. Craig AB, Jr, Ware DE. Effect of immersion in water on vital capacity and residual volume of the lungs. J Appl Physiol. 1967;23((4)):423–5.
    1. Hall J, Bisson D, ÓHare P. The physiology of immersion. Physiotherapy. 1990;76((9)):517–21. doi: 10.1016/S0031-9406(10)63019-2.
    1. Cider A, Sunnerhagen KS, Schaufelberger M, Andersson B. Cardiorespiratory effects of warm water immersion in elderly patients with chronic heart failure. Clin Physiol Funct Imaging. 2005;25((6)):13–7. doi: 10.1111/j.1475-097X.2005.00633.x.
    1. Brandão MR, Pereira MH, Oliveira R, Matsudo VK. Percepção de esforço: uma revisão da área. Revista Brasileira de Ciências do Movimento. 1989;3((1)):34–40.
    1. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. (9th ed.) Boston: Little, Brown & Co; 1994. pp. 253–256.
    1. Greenhouse SW, Geisser S. On methods in the analysis of profile data. Psychometrika. 1959;24((2)):95–112. doi: 10.1007/BF02289823.
    1. Mauchly JW. Significance Test for Sphericity of a Normal n-Variate Distribution. The Annals of Mathematical Statistics. 1940;11((2)):204–9. doi: 10.1214/aoms/1177731915.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera