Endurance Exercise Performance Is Reduced after 6-h Dives at 1.35 ATA When Breathing 100% Oxygen Compared with Air.

INTRODUCTION: Long-duration dives on consecutive days reduces muscular performance, potentially affecting military personnel. However, a paucity of data exists on how breathing gases affect endurance performance. This study examined the influence of long-duration diving with different breathing gases on aerobic endurance and handgrip performance. METHODS: Twenty-three military divers completed a single 6-h dive (single dive [SD]) and five 6-h dives over consecutive days (dive week [DW]) with 30-min cycling intervals using air (AIR, n = 13) or 100% oxygen (OXY, n = 10). Before and after SD and DW, subjects completed a maximum handgrip strength test, a handgrip endurance test at 40% maximal strength, and a time to exhaustion run. RESULTS: Handgrip endurance decreased after DW in OXY (SD, 1.9 ± 0.0 vs 1.4 ± 0.3 min) compared with AIR (1.8 ± 0.0 vs 1.8 ± 0.2 min) ( P < 0.001). Run time decreased after SD (Pre, 20.7 ± 10.4 min; Post, 16.6 ± 7.6 min; P = 0.039) and DW (Pre, 21.6 ± 9.0 min; Post, 11.2 ± 4.0 min; P < 0.001) in OXY and after overall diving in AIR (Pre, 26.5 ± 10.2 min; Post, 22.3 ± 7.5 min; P = 0.025). V̇O 2 decreased after diving only in AIR (Pre, 42.6 ± 3.4 mL·kg -1 ⋅min -1 ; Post, 40.4 ± 3.7 mL·kg -1 ⋅min -1 ; P = 0.010). There were no other significant effects. CONCLUSIONS: Breathing 100% oxygen during long-duration dives on consecutive days may exacerbate decreases in aerobic endurance and impairs handgrip endurance compared with air. Additional research is needed to elucidate mechanisms of action and possible mitigation strategies.

Diver Underwater Cycling Endurance After Short-Term Warm and Hot Water Acclimation.

INTRODUCTION: It is unclear whether immersion heat acclimation benefits exercise in warm water conditions. This study examined the effects of heat acclimation strategies on heart rate (HR), core temperature, and time to exhaustion (TTE) during cycling exercise in varying warm water conditions. METHODS: Twenty male divers completed this study at the Navy Experimental Diving Unit. Subjects were randomly assigned to one of two 9-day heat acclimation groups. The first group (WARM; n = 10) cycled for 2 hours at 50 W in 34.4 °C water, while the second group (HOT; n = 10) cycled for 1 hour against minimal resistance in 36.7 °C water. Following acclimation, TTE was tested by underwater cycling (30 W) in 35.8 °C, 37.2 °C, and 38.6 °C water. RESULTS: Throughout acclimation, the rate of core temperature rise in the first 30 minutes of exercise increased (P = .02), but the maximum core temperature reached was not different for either group. Time to exhaustion (TTE) was reduced, and the rate of core temperature rise during performance testing increased (both P < .001) with increasing water temperature but was not different between groups. Core temperature and HR increased throughout performance testing in each water condition and were lower in the HOT compared to the WARM acclimation group (all P < .05) with the exception of core temperature in the 37.2 °C condition. CONCLUSIONS: Underwater exercise performance did not differ between the two acclimation strategies. This study suggests that passive acclimation to a higher water temperature may improve thermoregulatory and cardiovascular responses to exercise in warm water. Hot water immersion adaptations are dependent on exercise intensity and water temperature.

Exercise during hot-water immersion in divers habituated to hot-dry and hot-wet conditions.

Purpose: Diving in warm water increases thermal risk during exercise compared to thermoneutral waters. The purpose of this study was to evaluate exercise endurance in warm- and hot-water conditions in divers habituated to wet or dry heat. Methods: Nineteen male divers completed this study at the Navy Experimental Diving Unit. Subjects were assigned DRY or WET heat habituation groups. The DRY group (n=9) cycled at 125-150W for one hour in a non-immersed condition (34.4˚C, 50%RH), while the WET group (n=10) cycled at 50W for one hour while immersed in 34.4˚C water. Exercise time to exhaustion was tested on an underwater cycle ergometer in 35.8˚C (WARM) and 37.2˚C (HOT) water at 50W. Core temperature (Tc) was continuously recorded and for all dives. Results: Time to exhaustion was reduced in HOT compared to WARM water (p ≺0.01) in both DRY (92.7 ± 41.6 minutes in 35.8°C vs. 43.4 ± 17.5 minutes in 37.2°C) and WET (95.9 ± 39.2 minutes in 35.8°C vs. 53.4 ± 27.5 minutes in 37.2°C) groups, but did not differ between groups (p=0.62). Rate of Tc rise was greater with higher water temperature (p ≺0.01), but was not different between groups (p=0.68). Maximum Tc (p=0.94 and p=0.95) and Tc change from baseline (p=0.38 and p=0.34) was not different between water temperatures or habituation group, respectively. Conclusion: Endurance decreased with increased water temperature but was not different between WET and DRY. Divers became exhausted at a similar core temperature during WARM- and HOT-water exercise. Mechanisms and applications of heat acclimation for warm-water diving should be further explored.

Hyperoxic myopia: a case series of four divers.

Hyperoxic myopia is a phenomenon reported in individuals who have prolonged exposure to an increased partial pressure of oxygen (PO2) and subsequently have a myopic (nearsighted) change in their vision. To date, there are numerous accounts of hyperoxic myopia in dry hyperbaric oxygen treatment patients; however, there have been only three confirmed cases reported in wet divers. This case series adds four confirmed cases of hyperoxic myopia in wet divers using 1.35 atmospheres (ATM) PO2 at the Navy Experimental Diving Unit (NEDU). The four divers involved were the first author's patients at NEDU. Conditions for two divers were confirmed via record review, whereas the other two divers were diagnosed by the first author. All subjects were interviewed to correlate subjective data with objective findings. Each subject completed five consecutive six-hour hyperoxic (PO2 of 1.35 ATM) dives with 18-hour surface intervals. Each individual was within the U. S. Navy Dive Manual's standards for general health. Visual acuity was measured prior to diving. Within three to four days after diving, the individuals reported blurry vision with an associated myopic refraction shift. Each diver had spontaneous resolution of his myopia over the next two to three weeks, with no significant residual symptoms. The divers in this case series were exposed to an increased PO2 (1.35 ATM for 30 hours over five days), a lesser exposure than that in other reports of hyperoxic myopia in wet divers diagnosed with hyperoxic myopia (1.3-1.6 ATM for 45-85 hours in 12-18 days). Furthermore, this pulse of exposure was more concentrated than typically seen with traditional hyperbaric oxygen therapy. Hyperoxic myopia continues to be a risk for those conducting intensive diving with a PO2 between 1.3-1.6 ATM. Additional investigation is warranted to better define risk factors and PO2 limits regarding ocular oxygen toxicity.

Consecutive, Resting, Long-Duration Hyperoxic Exposures Alter Neuromuscular Responses During Maximal Strength Exercises in Trained Men.

Purpose: The main objective of this study was to investigate the physiological effects of repetitive diving-induced hyperoxic conditions at 1.35 atmospheres absolute (ATA) on neuromuscular strength performance. We hypothesized that following five days of consecutive, resting, long-duration (6 h or more) hyperoxic water immersions (WIs) neuromuscular strength performance would be reduced with a longer recovery time in comparison to previously reported normoxic WIs. Methods: Thirteen (n = 13) active male divers [31.3 ± 1.7 (24-43) years, mean ± years] completed five consecutive days of 6-h resting WIs with 18-h surface intervals while breathing 100% O2 (n = 13) at 1.35 ATA. Skeletal muscle performance assessments occurred immediately before and after each WI and 24 and 72 h after the final WI. Performance assessments included maximum voluntary isometric contraction (MVIC) and maximal isokinetic (IK) knee extensions and elbow flexions, and isometric maximum handgrip (MHG) strength. Neuromuscular activation was also measured on the quadriceps, biceps brachii, and brachioradialis via surface electromyography (sEMG). Results: MHG declined by 7.8% (p < 0.001) by WI 5 with performance returning to baseline by 24-h post-WI. Brachioradialis neuromuscular activation increased by 42% on WI 5. MVIC knee extension performance dropped by 4% (p = 0.001) on WI 3 with a 11% overall decrease in quadriceps neuromuscular activation. Maximal IK knee extension dropped by 3.3% on WI 5 with 9% drop in overall quadriceps activation during the same period. MVIC elbow flexion declined by 5.1% on WI 5 but returned to baseline by 72-h post-WI. Maximal IK elbow flexion performance dropped by 8.6% on WI 5 with a continual decline in biceps brachii neuromuscular activation of 24% on WI 5. Conclusion: Consecutive, resting, long-duration hyperoxic WIs reduce muscular performance in multiple muscle groups and alter neuromuscular activation after 3 days of WI with performance adaptations recovering toward baseline by the end of the WI 5. However, neuromuscular activation remains decreased and appears to last beyond the 72-h post-WI recovery period.

Effects of Repeated, Long-Duration Hyperoxic Water Immersions on Neuromuscular Endurance in Well-Trained Males.

PURPOSE: This study examined the effects of repeated long-duration hyperoxic water immersions (WIs) at 1.35 atmospheres absolute (ATA) on neuromuscular endurance performance. We hypothesized that over a 5-day period of consecutive, resting, long-duration hyperoxic WIs there would be a decrease to neuromuscular endurance performance and tissue oxygenation with the quadriceps muscle, but not with the forearm flexors. METHODS: Thirteen well-trained, male subjects completed five consecutive 6-h resting WIs with 18-h surface intervals during the dive week while breathing 100% oxygen at 1.35 ATA. We assessed skeletal muscle endurance performance before and after each WI, and 24 and 72 h after the final WI. Muscular endurance assessments included 40% maximal handgrip endurance (MHE) and 50-repetition maximal isokinetic (IK) knee extensions. Near-infrared spectroscopy (NIRS) was used to measure muscle oxidative capacity (MOC) of the vastus lateralis and localized muscle tissue oxygenation of the vastus lateralis and flexor carpi radialis. Simultaneously, we measured brachioradialis neuromuscular activation by surface electromyography (SEMG). RESULTS: MHE time-to-fatigue performance declined by 15% at WI 3 (p = 0.009) and by 17% on WI 5 (p = 0.002). Performance continued to decline by 22% at 24-h post-WI (p < 0.001) and by 12% on 72-h post-WI (p = 0.019). Fifty-repetition IK knee extension total work decreased by 5% (p = 0.002) on WI 3, and was further reduced by 7.5 and 12.3% (p = 0.032) at pre-WI 5 and 24-h post-WI, respectively. However, the rate of fatigue was 8 (p = 0.033) and 30% (p = 0.017) lower at WI 3 and 24-h post-WI when compared to WI 1, respectively, demonstrating the muscles were still fatigued from the previous hyperoxic WIs. We detected no significant limitations in oxygen off-loading kinetics during the exercise or MOC measurements. CONCLUSION: Repeated, resting, long-duration hyperoxic WIs caused significant reductions to muscular endurance but not to indirect measures of oxygen kinetics in load bearing and non-load bearing muscles.

Divers risk accelerated fatigue and core temperature rise during fully-immersed exercise in warmer water temperature extremes.

Physiological responses to work in cold water have been well studied but little is known about the effects of exercise in warm water; an overlooked but critical issue for certain military, scientific, recreational, and professional diving operations. This investigation examined core temperature responses to fatiguing, fully-immersed exercise in extremely warm waters. Twenty-one male U.S. Navy divers (body mass, 87.3 ± 12.3 kg) were monitored during rest and fatiguing exercise while fully-immersed in four different water temperatures (Tw): 34.4, 35.8, 37.2, and 38.6°C (Tw34.4, Tw35.8, Tw37.2, and Tw38.6 respectively). Participants exercised on an underwater cycle ergometer until volitional fatigue or core temperature limits were reached. Core body temperature and heart rate were monitored continuously. Trial performance time decreased significantly as water temperature increased (Tw34.4, 174 ± 12 min; Tw35.8, 115 ± 13 min; Tw37.2, 50 ± 13 min; Tw38.6, 34 ± 14 min). Peak core body temperature during work was significantly lower in Tw34.4 water (38.31 ± 0.49°C) than in warmer temperatures (Tw35.8, 38.60 ± 0.55°C; Tw37.2, 38.82 ± 0.76°C; Tw38.6, 38.97 ± 0.65°C). Core body temperature rate of change increased significantly with warmer water temperature (Tw34.4, 0.39 ± 0.28°C·h-1; Tw35.8, 0.80 ± 0.19°C·h-1; Tw37.2, 2.02 ± 0.31°C·h-1; Tw38.6, 3.54 ± 0.41°C·h-1). Physically active divers risk severe hyperthermia in warmer waters. Increases in water temperature drastically increase the rate of core body temperature rise during work in warm water. New predictive models for core temperature based on workload and duration of warm water exposure are needed to ensure warm water diving safety.

Pulmonary effects of repeated six-hour normoxic and hyperoxic dives.

This study examines differential effects of immersion, elevated oxygen partial pressure, and exercise on pulmonary function after series of five daily six-hour dives at 130 kPa (1.3 ATA), with 18 hours between dives. Five cohorts of 10 to 14 divers participated. The exposure phases were resting while breathing O2 or air in the water ("wetO2", "wetAir") or O2 in the hyperbaric chamber ("dryO2"), and exercise in the water while breathing O2 or air ("wetO2X", "wetAirX"). Respiratory symptoms were recorded during and after each dive, and pulmonary function (forced flow-volume) was measured twice at baseline before diving, after each dive both immediately and on the following morning, and three days post diving ("Day+3"). The incidences of symptoms and of flow volume changes from baseline greater than normal limits ("ΔFV") were assessed, as were mean ΔFV. The parameters examined were forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expired flow from 25% to 75% volume expired (FEF25-75). The phases ranked from greatest to least fraction of diver-days with symptoms were wetO2X (56%) > dryO2 (42%) > wetO2 (13%) > [wetAir (2%) or wetAirX (1%)] (p<0.05). FEV1 and FEF25-75 were depressed in the morning following wetO2 and wetO2X and on Day+3 after and wetO2X, but increased immediately following each wetAirX dive. O2 exposures caused symptoms and ΔFV suggestive of pulmonary oxygen toxicity,exacerbated by exercise. Indices of small airway function showed late (17-hour) post-O2 exposure deficits, but, particularly with exercise, improvement was evident early after exposure with or without O2. FEF25-75 and FEV1 remained depressed on Day+3 after wetO2 and wetO2X.

Effects of Resting, Consecutive, Long-Duration Water Immersions on Neuromuscular Endurance in Well-Trained Males.

Purpose: This study examined the effects of repeated long-duration water immersions (WI)s at 1.35 atmospheres absolute (ATA) on neuromuscular endurance performance. We hypothesized that, following 5 days of consecutive, resting, long-duration WIs, neuromuscular endurance performance would decrease. Methods: Fifteen well-trained, male subjects completed five consecutive 6-h resting WIs with 18-h surface intervals during the dive week while breathing compressed air at 1.35 ATA. Skeletal muscle endurance performance was assessed before and after each WI, and 24 and 72 h after the final WI. Muscular endurance assessments included 40% maximum handgrip endurance (MHE) and 50-repetition maximal isokinetic knee extensions. Near infrared spectroscopy was used to measure muscle oxidative capacity of the vastus lateralis and localized muscle tissue oxygenation of the vastus lateralis and flexor carpi radialis. Simultaneously, brachioradialis neuromuscular activation was measured by surface electromyography. Results: A 24.9% increase (p = 0.04) in the muscle oxidative capacity rate constant (k) occurred on WI 4 compared to baseline. No changes occurred in 40% MHE time to exhaustion or rate of fatigue or total work performed for the 50-repetition maximal isokinetic knee extension. The first quartile of deoxygenated hemoglobin concentration showed a 6 and 35% increase on WIs 3 and 5 (p = 0.026) with second quartile increases of 9 and 32% on WIs 3 and 5 (p = 0.049) during the 40% MHE testing when compared to WI 1. Conclusion: Our specific WI protocol resulted in no change to muscular endurance and oxygen kinetics in load bearing and non-load bearing muscles.

Effects of repeated long-duration water immersions on skeletal muscle performance in well-trained male divers.

PURPOSE: The objective of this study was to examine the effects of repeated long-duration water immersions (WI)s at 1.35 atmospheres absolute (ATA) on neuromuscular performance in load bearing and non-load bearing muscle groups. METHODS: During a dive week (DW), fifteen well-trained male divers completed five consecutive 6-h resting dives with 18-h surface intervals while breathing compressed air at 1.35 ATA. Skeletal muscle performance assessments occurred immediately before and after each WI, and 24 and 72 h after the final WI. Exercise assessments included maximum voluntary isometric contraction (MVIC), maximal isokinetic (IK) contraction, maximum handgrip strength (MHG). Surface electromyography measured neuromuscular activation of the quadriceps, biceps brachii (BB), and brachioradialis. RESULTS: MVIC torque of knee extensors and BB decreased by 6% (p = 0.001) and 2% (p = 0.014), respectively, by WI 3. Maximal IK torque of knee extensors increased by 11 and 5% post-WI on WIs 3 and 5 (p < 0.001) with greater neuromuscular activation post-WI than pre-WI (p < 0.001). Maximum IK elbow flexion torque did not change throughout the DW with BB neuromuscular activation greater post-WI than pre-WI (p < 0.001). MHG force output was 4% greater post-WI than pre-WI (p < 0.001) with increased brachioradialis activation through 72-h post-WI (p < 0.001). All muscle performance metrics returned baseline levels by 72-h post-WI. CONCLUSION: Our findings indicate that repeated WIs caused noticeable decrements in neuromuscular activation and performance of load bearing muscles on WI 3 while full recovery was observed by 72-h post-WI.

Time-varying analysis of electrodermal activity during exercise.

The electrodermal activity (EDA) is a useful tool for assessing skin sympathetic nervous activity. Using spectral analysis of EDA data at rest, we have previously found that the spectral band which is the most sensitive to central sympathetic control is largely confined to 0.045 to 0.25 Hz. However, the frequency band associated with sympathetic control in EDA has not been studied for exercise conditions. Establishing the band limits more precisely is important to ensure the accuracy and sensitivity of the technique. As exercise intensity increases, it is intuitive that the frequencies associated with the autonomic dynamics should also increase accordingly. Hence, the aim of this study was to examine the appropriate frequency band associated with the sympathetic nervous system in the EDA signal during exercise. Eighteen healthy subjects underwent a sub-maximal exercise test, including a resting period, walking, and running, until achieving 85% of maximum heart rate. Both EDA and ECG data were measured simultaneously for all subjects. The ECG was used to monitor subjects' instantaneous heart rate, which was used to set the experiment's end point. We found that the upper bound of the frequency band (Fmax) containing the EDA spectral power significantly shifted to higher frequencies when subjects underwent prolonged low-intensity (Fmax ~ 0.28) and vigorous-intensity exercise (Fmax ~ 0.37 Hz) when compared to the resting condition. In summary, we have found shifting of the sympathetic dynamics to higher frequencies in the EDA signal when subjects undergo physical activity.

Changes in Posture Following a Single Session of Long-Duration Water Immersion.

Transitioning between different sensory environments is known to affect sensorimotor function and postural control. Water immersion presents a novel environmental stimulus common to many professional and recreational pursuits, but is not well-studied with regard to its sensorimotor effects upon transitioning back to land. The authors investigated the effects of long-duration water immersion on terrestrial postural control outcomes in veteran divers. Eleven healthy men completed a 6-hour thermoneutral pool dive (4.57 m) breathing diver air. Center of pressure was observed before and 15 minutes after the dive under 4 conditions: (1) eyes open/stable surface (Open-Stable); (2) eyes open/foam surface (Open-Foam); (3) eyes closed/stable surface (Closed-Stable); and (4) eyes closed/foam surface (Closed-Foam). Postdive decreases in postural sway were observed in all testing conditions except for Open-Stable. The specific pattern of center of pressure changes in the postdive window is consistent with (1) a stiffening/overregulation of the ankle strategy during Open-Foam, Closed-Stable, and Closed-Foam or (2) acute upweighting of vestibular input along with downweighting of somatosensory, proprioceptive, and visual inputs. Thus, our findings suggest that postimmersion decreases in postural sway may have been driven by changes in weighting of sensory inputs and associated changes in balance strategy following adaptation to the aquatic environment.

Feasibility Testing of Hydrophobic Carbon Electrodes for Acquisition of Underwater Surface Electromyography Data.

Underwater surface electromyography (sEMG) signals are especially of interest for rehabilitation and sports medicine applications. Silver/silver chloride (Ag/AgCl) hydrogel electrodes, although the gold standard for sEMG data collection, require waterproofing for underwater applications. Having to apply waterproof tape over electrodes impedes the deployment of sEMG in immersed conditions. As a better alternative for underwater applications, we have developed carbon black/polydimethylsiloxane (CB/PDMS) electrodes for collecting sEMG signals under water. We recruited twenty subjects to collect simultaneous recordings of sEMG signals using Ag/AgCl and CB/PDMS electrodes on biceps brachii, triceps brachii, and tibial anterior muscles. The Ag/AgCL electrodes were covered in waterproof tape, and the CB/PDMS electrodes were not. We found no differences in sEMG signal amplitudes between both sensors, for the three muscles. Moderate mean correlation between Ag/AgCl and CB/PDMS electrodes was found on the linear envelopes (≥ 0.7); correlation was higher for power spectral densities (≥ 0.84). Ag/AgCl electrodes performed better in response to noise, whilst the CB/PDMS electrodes were more sensitive to myoelectric activity in triceps and tibialis, and exhibited better response to motion artifacts in the measurements on the triceps and tibialis. Results suggest that sEMG signal collection is possible under water using CB/PDMS electrodes without requiring any waterproof or adhesive tape.

Effect of Shallow and Deep SCUBA Dives on Heart Rate Variability.

Prolonged and high pressure diving may lead to various physiological changes including significant alterations of autonomic nervous system (ANS) activity that may be associated with altered physical performance, decompression sickness, or central nervous system oxygen toxicity. Ideally, researchers could elucidate ANS function before, during, and after dives that are most associated with altered function and adverse outcomes. However, we have a limited understanding of the activities of the ANS especially during deeper prolonged SCUBA diving because there has never been a convenient way to collect physiological data during deep dives. This work is one of the first studies which was able to collect electrocardiogram (ECG) data from SCUBA divers at various depths (33, 66, 99, 150, and 200 ftsw; equivalent to 10.05, 20.10, 30.17, 45.72, and 60.96 m of salt water, respectively) breathing different gas mixtures (air, nitrox and trimix). The aim of this study was to shed light on cardiac ANS behavior during dives, including deep dives. With the aid of dry suits, a Holter monitor that could handle the pressure of a 200 ft. dive, and a novel algorithm that can provide a useful assessment of the ANS from the ECG signal, we investigated the effects of SCUBA dives with different time durations, depths and gas mixtures on the ANS. Principal dynamic mode (PDM) analysis of the ECG, which has been shown to provide accurate separation of the sympathetic and parasympathetic dynamics, was employed to assess the difference of ANS behavior between baseline and diving conditions of varying depths and gas mixtures consisting of air, nitrox and trimix. For all depths and gas mixtures, we found consistent dominance in the parasympathetic activity and a concomitant increase of the parasympathetic dynamics with increasing diving duration and depth. For 33 and 66 ft. dives, we consistently found significant decreases in heart rates (HR) and concomitant increases in parasympathetic activities as estimated via the PDM and root mean square of successive differences (RMSSD) for all time intervals (from the first 5 min to the last 30 min) at the bottom depth when compared to the baseline depth at sea level. The sympathetic dynamics did not change with dive duration or gas mixtures, but at the 150 and 200 ft. dives, we found a significant increase in the sympathetic dynamics in addition to the elevated parasympathetic dynamics when compared to baseline The power spectral density (PSD) measures such as the low frequency (LF), high frequency (HF) and its ratio, and approximate entropy (ApEn) indices were not as consistent when compared to PDM-derived parasympathetic dynamics and RMSSD index.

Effects of prolonged and repeated immersions on heart rate variability and complexity in military divers.

BACKGROUND: The influence of prolonged and repeated water immersions on heart rate variability (HRV) and complexity was examined in 10 U.S. Navy divers who completed six-hour resting dives on five consecutive days. Pre-dive and during-dive measures were recorded daily. METHODS: Dependent variables of interest were average heart rate (HR), time-domain measures of HRV [root mean square of successive differences of the normal RR (NN) interval (RMSSD), standard deviation of the NN interval (SDNN)], frequency-domain measures of HRV [low-frequency power spectral density (psd) (LFpsd), low-frequency normalized (LFnu), high-frequency psd (HFpsd), high-frequency normalized (HFnu), low-frequency/ high-frequency ratio (LF/HF)], and non-linear dynamics of HRV [approximate entropy (ApEn)]. A repeated-measures ANOVA was performed to examine pre-dive measure differences among baseline measures. Hierarchical linear modeling (HLM) was performed to test the effects of prolonged and repeated water immersion on the dependent variables. RESULTS: Pre-dive HR (P=0.005) and RMSSD (P⟨0.001) varied significantly with dive day while changes in SDNN approached significance (P=0.055). HLM indicated that HR decreased during daily dives (P=0.001), but increased across dive days (P=0.011); RMSSD increased during daily dives (P=0.018) but decreased across dive days (P⟨0.001); SDNN increased during daily dives (P⟨0.001); LF measures increased across dive days (LFpsd P⟨0.001; LFnu P⟨0.001), while HF measures decreased across dive days (HFpsd P⟨0.001; HFnu P⟨0.001); LF/HF increased across dive days (P⟨0.001); ApEn decreased during daily dives (P⟨0.02) and across dive days (P⟨0.001). CONCLUSIONS: These data suggest that the cumulative effect of repeated dives across five days results in decreased vagal tone and a less responsive cardiovascular system.

The impact of repetitive long-duration water immersion on vascular function.

While physiological responses to water immersion (WI) are well-studied, the vascular responses after WI are less understood. Fifteen male subjects performed six-hour resting thermoneutral water immersions (WI) at 1.35 atmospheres absolute for four consecutive days, with follow-up on the fifth day. Measurements included peripheral endothelial function and augmentation index (PAT, peripheral arterial tonometry), beat-to-beat blood pressure (BP, photoplethysmography), heart rate (HR), and plasma volume (PV) calculated from changes in hemoglobin and hematocrit. The reactive hyperemia index (RHI), a marker of peripheral endothelial function, increased with repeated immersions (p = 0.008). By WI2 and WI3, RHI increased 12% and 16%, respectively, compared to WI1 values, but no significant differences were detected between WI4 and WI1 for either measure. Absolute augmentation index (AI) increased by an average of 33% (p<0.001) and AI normalized for HR (AI@75) by 11% (p = 0.12) following each WI. PV decreased significantly by 13.2% following WI and remained 6.8% lower at follow-up compared to pre-WI. Systolic blood pressure significantly decreased by an average of 2.5% following each WI (p = 0.012). Compared to pre-WI HR, average post-WI HR decreased 4.3% lower (p<0.001), but increased overall by 8.2% over the course of repeated WI (p<0.001). Total peripheral resistance increased by an average of 13.1% following WI (p = 0.003). Thus, peripheral endothelial function increases after two days of WI, and PAT-derived measures of arterial stiffness increase transiently post-WI. Additionally, BP and PAT-derived endothelial function diverge from their usual associations with arterial stiffness (i.e. augmentation index) in the context of WI.

Electrodermal Activity Is Sensitive to Cognitive Stress under Water.

When divers are at depth in water, the high pressure and low temperature alone can cause severe stress, challenging the human physiological control systems. The addition of cognitive stress, for example during a military mission, exacerbates the challenge. In these conditions, humans are more susceptible to autonomic imbalance. Reliable tools for the assessment of the autonomic nervous system (ANS) could be used as indicators of the relative degree of stress a diver is experiencing, which could reveal heightened risk during a mission. Electrodermal activity (EDA), a measure of the changes in conductance at the skin surface due to sweat production, is considered a promising alternative for the non-invasive assessment of sympathetic control of the ANS. EDA is sensitive to stress of many kinds. Therefore, as a first step, we tested the sensitivity of EDA, in the time and frequency domains, specifically to cognitive stress during water immersion of the subject (albeit with their measurement finger dry for safety). The data from 14 volunteer subjects were used from the experiment. After a 4-min adjustment and baseline period after being immersed in water, subjects underwent the Stroop task, which is known to induce cognitive stress. The time-domain indices of EDA, skin conductance level (SCL) and non-specific skin conductance responses (NS.SCRs), did not change during cognitive stress, compared to baseline measurements. Frequency-domain indices of EDA, EDASymp (based on power spectral analysis) and TVSymp (based on time-frequency analysis), did significantly change during cognitive stress. This leads to the conclusion that EDA, assessed by spectral analysis, is sensitive to cognitive stress in water-immersed subjects, and can potentially be used to detect cognitive stress in divers.

Highly sensitive index of sympathetic activity based on time-frequency spectral analysis of electrodermal activity.

Time-domain indices of electrodermal activity (EDA) have been used as a marker of sympathetic tone. However, they often show high variation between subjects and low consistency, which has precluded their general use as a marker of sympathetic tone. To examine whether power spectral density analysis of EDA can provide more consistent results, we recently performed a variety of sympathetic tone-evoking experiments (43). We found significant increase in the spectral power in the frequency range of 0.045 to 0.25 Hz when sympathetic tone-evoking stimuli were induced. The sympathetic tone assessed by the power spectral density of EDA was found to have lower variation and more sensitivity for certain, but not all, stimuli compared with the time-domain analysis of EDA. We surmise that this lack of sensitivity in certain sympathetic tone-inducing conditions with time-invariant spectral analysis of EDA may lie in its inability to characterize time-varying dynamics of the sympathetic tone. To overcome the disadvantages of time-domain and time-invariant power spectral indices of EDA, we developed a highly sensitive index of sympathetic tone, based on time-frequency analysis of EDA signals. Its efficacy was tested using experiments designed to elicit sympathetic dynamics. Twelve subjects underwent four tests known to elicit sympathetic tone arousal: cold pressor, tilt table, stand test, and the Stroop task. We hypothesize that a more sensitive measure of sympathetic control can be developed using time-varying spectral analysis. Variable frequency complex demodulation, a recently developed technique for time-frequency analysis, was used to obtain spectral amplitudes associated with EDA. We found that the time-varying spectral frequency band 0.08-0.24 Hz was most responsive to stimulation. Spectral power for frequencies higher than 0.24 Hz were determined to be not related to the sympathetic dynamics because they comprised less than 5% of the total power. The mean value of time-varying spectral amplitudes in the frequency band 0.08-0.24 Hz were used as the index of sympathetic tone, termed TVSymp. TVSymp was found to be overall the most sensitive to the stimuli, as evidenced by a low coefficient of variation (0.54), and higher consistency (intra-class correlation, 0.96) and sensitivity (Youden's index > 0.75), area under the receiver operating characteristic (ROC) curve (>0.8, accuracy > 0.88) compared with time-domain and time-invariant spectral indices, including heart rate variability.

Power Spectral Density Analysis of Electrodermal Activity for Sympathetic Function Assessment.

Time-domain features of electrodermal activity (EDA), the measurable changes in conductance at the skin surface, are typically used to assess overall activation of the sympathetic system. These time domain features, the skin conductance level (SCL) and the nonspecific skin conductance responses (NS.SCRs), are consistently elevated with sympathetic nervous arousal, but highly variable between subjects. A novel frequency-domain approach to quantify sympathetic function using the power spectral density (PSD) of EDA is proposed. This analysis was used to examine if some of the induced stimuli invoke the sympathetic nervous system's dynamics which can be discernible as a large spectral peak, conjectured to be present in the low frequency band. The resulting indices were compared to the power of low-frequency components of heart rate variability (HRVLF) time series, as well as to time-domain features of EDA. Twelve healthy subjects were subjected to orthostatic, physical and cognitive stress, to test these techniques. We found that the increase in the spectral powers of the EDA was largely confined to 0.045-0.15 Hz, which is in the prescribed band for HRVLF. These low frequency components are known to be, in part, influenced by the sympathetic nervous dynamics. However, we found an additional 5-10% of the spectral power in the frequency range of 0.15-0.25 Hz with all three stimuli. Thus, dynamics of the normalized sympathetic component of the EDA, termed EDASympn, are represented in the frequency band 0.045-0.25 Hz; only a small amount of spectral power is present in frequencies higher than 0.25 Hz. Our results showed that the time-domain indices (the SCL and NS.SCRs), and EDASympn, exhibited significant increases under orthostatic, physical, and cognitive stress. However, EDASympn was more responsive than the SCL and NS.SCRs to the cold pressor stimulus, while the latter two were more sensitive to the postural and Stroop tests. Additionally, EDASympn exhibited an acceptable degree of consistency and a lower coefficient of variation compared to the time-domain features. Therefore, PSD analysis of EDA is a promising technique for sympathetic function assessment.

Novel Conductive Carbon Black and Polydimethlysiloxane ECG Electrode: A Comparison with Commercial Electrodes in Fresh, Chlorinated, and Salt Water.

In this study, we evaluated the performance of two novel conductive carbon black (CB) and polydimethlysiloxane (PDMS) bio-potential electrodes, with and without an integrated flexible copper mesh, against commercially available electrodes (Polar(®) textile, Silver-coated textile, and carbon rubber). The electrodes were tested in three types of water (fresh/unfiltered, chlorinated, and salt water). Our testing revealed that our CB/PDMS electrode with integrated copper mesh provided a high-fidelity ECG signal morphologies without any amplitude degradation in all of the types of water tested (N = 10). The non-meshed CB/PDMS electrodes were also subjected to a long-term durability test by the US Navy SCUBA divers during which the electrodes maintained ECG signal quality for a 6 h period of continuous use. The results of a material degradation analysis revealed the CB/PDMS composite material does not exhibit significant changes in physical integrity after prolonged exposure to the test conditions. The newly developed meshed CB/PDMS electrodes have the potential to be used in a wide variety of both dry and wet environments including the challenge of obtaining ECG signals in salt water environments.