Changes in Respiratory Muscle Pressure of Healthy Individuals with Different Levels of Immersion in Water: Observational Study

Abstract

Introduction Understanding the physiological effects of immersion, particularly on pulmonary dynamics in healthy individuals is important to predict and interpret the physiological responds in unhealthy group. The aim of our study is to evaluate the inspiratory and expiratory muscle strength and cough strength in healthy individuals during water immersion at different water depths. Methods A cross-sectional study was conducted in 24 healthy individuals with the mean age 20.0 years. Respiratory muscle strength test and cough force were tested on dry land and in pool at iliac crests, xiphoid appendix of the sternum and clavicles levels. Measurements were randomized at each level. The Friedman test was used for repeated measures with Wilcoxon signed ranks test with Bonferroni correction was applies to compare the variables. Results A significant difference between dry land and immersion in water of different levels for MEP (p=0.001) and PEF (p= 0.015). multiple comparisons showed no difference between levels in PEF (p<0.001), whereas MEP values measured in clavicles level was significantly higher than both dry land and iliac crest level (p<0.017). Conclusion Clavicular level immersion alters respiratory muscle strength when compared with the values measured out of the water and immersed at the iliac crista level in healthy individuals.

Keywords

• immersion
• pulmonary function test
• respiratory muscle

References

1. Becker BEJP. Aquatic therapy: scientific foundations and clinical rehabilitation applications. Pm&r. 2009;1(9):859-72.
2. Yamashina Y, Yokoyama H, Naghavi N, Hirasawa Y, Takeda R, Ota A, et al. Forced respiration during the deeper water immersion causes the greater inspiratory muscle fatigue in healthy young men. J Phys Ther Sci. 2016;28(2):412-8.
3. Yamashina Y, Hirayama T, Aoyama H, Hori H, Morita E, Sakagami N, et al. Effects of Water Immersion in Different Water Depths on Respiratory Function and Respiratory Muscle Strength among Elderly People: An Observational Study. Advances in Aging Research. 2021;10(4):71-7.
4. Prefaut C, Lupi-h E, Anthonisen N. Human lung mechanics during water immersion. J Appl Physiol. 1976;40(3):320-3.
5. Dahlbäck G, Jönsson E, Liner M. Influence of hydrostatic compression of the chest and intrathoracic blood pooling on static lung mechanics during head-out immersion. Undersea Biomed Res. 1978;5(1):71-85.
6. Buono MJ. Effect of central vascular engorgement and immersion on various lung volumes. J Appl Physiol. 1983;54(4):1094-6.
7. de Andrade AD, Júnior JC, Lins de Barros Melo TL, Rattes Lima CSF, Brandão DC, de Melo Barcelar J. Influence of different levels of immersion in water on the pulmonary function and respiratory muscle pressure in healthy individuals: observational study. Physiother Res Int. 2014;19(3):140-6.
8. Park JH, Kang S-W, Lee SC, Choi WA, Kim DH. How respiratory muscle strength correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J. 2010;51(3):392-7.

9. McNamara RJ, McKeough ZJ, McKenzie DK, Alison JA. Water-based exercise in COPD with physical comorbidities: a randomised controlled trial. Eur Respir J. 2013;41(6):1284-91.
10. Felcar J, Probst V, De Carvalho D, Merli M, Mesquita R, Vidotto L, et al. Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial. Physiotherapy. 2018;104(4):408-16.
11. Ogonowska-Slodownik A, Labecka MK, Kaczmarczyk K, McNamara RJ, Starczewski M, Gajewski J, et al. Water-Based and Land-Based Exercise for Children with Post-COVID-19 Condition (postCOVIDkids)—Protocol for a Randomized Controlled Trial. Int J Environ Res Public Health. 2022;19(21):14476.
12. Hammill HV, Ellapen TJ, Strydom GL, Swanepoel M. The benefits of hydrotherapy to patients with spinal cord injuries. African journal of disability. 2018;7(1):1-8.
13. Marinho-Buzelli AR, Bonnyman AM, Verrier MC. The effects of aquatic therapy on mobility of individuals with neurological diseases: a systematic review. Clin Rehabil. 2015;29(8):741-51.
14. Becker BE. Aquatic therapy in contemporary neurorehabilitation: an update. PM&R. 2020;12(12):1251-9.
15. Gurpinar B, Ilcin N, Savci S, Akkoc N. Do mobility exercises in different environments have different effects in ankylosing spondylitis? Acta Reumatologica Portuguesa. 2021;46(4):297-316.
16. Medrado LN, Mendonça MLM, Budib MB, Oliveira-Junior SA, Martinez PF. Effectiveness of aquatic exercise in the treatment of inflammatory arthritis: Systematic review. Rheumatol Int. 2022;42(10):1681-91.
17. Laveneziana P, Albuquerque A, Aliverti A, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019;53(6):1801214
18. Vepo AA, Martinez CS, Wiggers GA, Peçanha FM. Incentive spirometry and breathing exercises were not able to improve restrictive pulmonary characteristics induced by water immersion in healthy subjects. Int J Physiother Res. 2016;4(2):1415-22.
19. Peignot S, Mettay T, Hotton R. Impact of immersion at different levels on respiratory function in healthy subjects. Eur Respir J. 2015;46(suppl 59):PA4212.
20. Chen H, Li P, Li N, Wang Z, Wu W, Wang J. Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Medicine. 2021;100(33).
21. Agostoni E, Gurtner G, Torri G, Rahn H. Respiratory mechanics during submersion and negative-pressure breathing. J Appl Physiol. 1966;21(1):251-8.
22. Hoshi D, Fukuie M, Tamai S, Momma R, Tarumi T, Sugawara J, et al. Influence of water immersion on the airway impedance measured by forced oscillation technique. Respir Physiol Neurobiol. 2022;295:103779.
23. Kim J-S, Park M-C. Changes in the Respiratory Function of Stroke Patients on the Ground and Immersed under Water. PNF and Movement. 2018;16(3):389-95.