Aquatic Exercise Training Outcomes on Functional Capacity, Quality of Life, and Lower Limb Lymphedema: Pilot Study.

OBJECTIVE: To investigate whether patients with lower limb lymphedema (LLL) can benefit from water immersion exercise training to improve functional capacity, quality of life (QOL), and help control/diminish limb volume. DESIGN: A before-after trial. SETTING: A community University Sports Center. SUBJECTS: Eleven participants were recruited to participate and four declined to pursue the study for personal reasons. A convenient sample of seven female affected by either bilateral or unilateral LLL volunteered for this pilot study. Patients had primary or secondary lymphedema as complications of melanoma or gynecologic cancers. INTERVENTIONS: An aquatic training exercise intervention of moderate to vigorous intensity was conducted for a 6-week period (12 sessions of 45 min). This innovative circuit training program consisted of yoga exercises, aqua-jogging, pedaling on a water bike, and muscular training on an aquastep and a trampoline. OUTCOME MEASURES: The physical characteristics of water could be used to overcome the physical and medical limitations encountered on dry land for patients with LLL to exercise and reach training benefits. Outcome measures were the 6-min walk test (6MWT), handgrip strength test, QOL for limb lymphedema questionnaire (LYMQOL), bioelectrical impedance spectroscopy, and limb circumference. RESULTS: The distance covered in the 6MWT and the handgrip strength were significantly improved. A trend toward an increase in the overall QOL score was noticeable, whereas a significantly improved emotions score was observed with the LYMQOL questionnaire. Limb circumferential volume was significantly lower and impedance was increased, denoting a decrease in lymphatic fluid. CONCLUSIONS: Innovative aquatic exercise training program allows moderate and vigorous intensity activities for patients with LLL, increases functional capacity and QOL. Thus, immersion exercise does not appear to exacerbate LLL and a randomized clinical trial with larger numbers is essential to consolidate the results of this study.

Acute effects of water immersion on heart rate variability in participants with heart disease.

BACKGROUND: Water immersion and aquatic exercise can be an important therapeutic tool in patients suffering from heart disease (HD). However, the effects of water immersion on heart rate variability (HRV) in HD participants remain unknown. METHODS: Twenty-eight volunteers in sinus rhythm within the same age range took part in this study: 18 HD and ten healthy controls (HC). Heart rhythm was collected with a heart rate monitor (sampling rate 1000 Hz) for periods of 10 min at rest in the supine position on land, standing on land (STL) and standing in water (STW) to the xiphoid process. RESULTS: Heart disease participants had the same response as HC participants to the three experimental conditions (no significant between-group differences in all HRV variables). STW (immersion) caused in both groups to increase HRV when compared to supine and STL. CONCLUSION: Heart disease participants demonstrate similar beneficial adaptations as HC participants to the effects of immersion, reinforcing the concept that immersion can be a valuable aquatic cardiac rehabilitation tool to acutely increase HRV. Approaches that improve HRV in both healthy and cardiac patients may have a positive impact on the reduction of morbidity and mortality.

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 VE /VO2 and VE /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.

Acute breathing patterns in healthy and heart disease participants during cycling at different levels of immersion.

We aimed to determine the effect of aquatic cycling and different levels of immersion on respiratory responses in healthy and heart disease (HD) volunteers. Thirty-four age matched volunteers, 21 HD and 13 healthy controls (HC) took part in this study. The ventilatory pattern, phase 1VE and steady-state ventilatory responses to progressive exercise from 40 to peak rpm, were measured while participants exercised on a water stationary bike (WSB) at different levels of immersion. No effect of immersion was observed on steady-state respiratory responses in the HD group, but immersion reduced VE phase 1 by ∼79% at pedaling cadences of 40, 50 and 60rpm. In conclusion, immersion at hips and xiphoid process blunted the fast drive to breathe in the HD group. This transient effect on the respiratory response to immersed exercise cannot be considered a contraindication for exercise in HD individuals.