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.

Conceito Halliwick inclusão e participação através das atividades aquáticas funcionais / The Halliwick Concept, inclusion and participation through aquatic functional activities

Este trabalho apresenta os resultados qualitativos e quantitativos de um grupo 674 usuários que por 12 meses participaram do Projeto Halliwick - atividades aquáticas funcionais - do Instituto de Medicina Física e Reabilitação do Hospital das Clínicas FMUSP e suas amplas repercussões na vida da pessoa com deficiência. O conceito Halliwick foi desenvolvido em 1949 por James McMillan na Inglaterra e está fundamentado em princípios da hidrostática, hidrodinâmica e na mecânica dos corpos na água. Objetivo: O Programa dos 10 Pontos do conceito Halliwick é a aplicação prática e fornece estrutura aos processos de ensinar e aprender com segurança, lógica e progressivamente. Método: O trabalho se desenvolve em grupos que motivam e favorecem a interação social, ao mesmo tempo que otimizam o aprendizado. O Halliwick introduz a água como um novo fator ambiental para se trabalhar estratégias do movimento e controle motor de forma diferente. Os atributos da piscina, especificamente as propriedades físicas de água, promovem o bem estar de estruturas físicas e função corporal, independência funcional, novos padrões de movimentos, entendimento de diferentes conceitos sobre motricidade, processamento sensorial, aprendizado cognitivo, organização de padrões de movimentos e controle de atividades diversas. A fisiologia da imersão responde pela ativação de orgãos e sistemas do corpo melhorando seus desempenhos. Resultados: Com apoio da Associação Halliwick Internacional e Associação Brasil Halliwick o projeto, pioneiro no país, possibilitou atendimento a milhares de usuários garantindo acesso igualitário, pois foca a inclusão e participação da pessoa com e sem deficiência. Conclusão: A característica holística do Halliwick influenciou sobre maneira o tradicional ensino de natação e trouxe uma série de refinamentos às técnicas de hidroterapia, demonstrando que programas terapêuticos e recreativos combinados oferecem uma reabilitação contínua para todas as pessoas. Ainda permite o alcance do máximo potencial, trazendo benefícios físicos, psicológicos e social.

This paper presents the qualitative and quantitative data derived from studying the impact on the lives of 674 disabled individuals after they had followed the Halliwick method for one year at the Institute of Medicine and Rehabilitation - Hospital das Clinicas - University of Sao Paulo. The Halliwick Concept was developed in 1949 by James McMillan in England and is based on the principles of hydrostatics, hydrodynamics, and body mechanics in water. Objective: Halliwick?s 10-Point Program forms the practical application of its concept. It helps to structure the processes of teaching and learning, logically, progressively, and safely. Method: The method involves working in groups that help motivate and encourage social interaction, whilst optimizing learning. Halliwick?s Concept introduces water as an environment in which to work movement and motor control exercises in an innovative way. The physical properties of water promote the well being of the body?s physical structures and functions, independence of movement, the understanding of new concepts of motor skills, sensory processing, cognitive learning, organization of movement patterns, and control of a diverse range of activities. The physiology of immersion is responsible for activating organ systems and improving their capacity and performance. Results: This pioneering project, which received support from the International Halliwick?s Association and its branch, the Brazilian Halliwick Association, made the initiative accessible to thousands of disabled users in Brazil who benefited from its non-discriminatory approach. Traditional techniques for teaching swimming have been influenced greatly by the holistic characteristics of the Halliwick method, which also introduced significant refinements to hydrotherapy techniques. Conclusion: The method developed new ways of exercising and showed that rehabilitation programs that offer combined therapeutic and recreational activities provide consistent rehabilitation to the disabled as well as the able-bodied person. Furthermore, it allows for the individual to achieve their maximum potential and enjoy physical, psychological and social benefits.