November 2018: Aquatics & Respiratory Compromise



Content courtesy of the National Swimming Pool Foundation


Immersion in water creates a dramatic cascade of effects on the human body. The rib cage is compressed inward, the diaphragm is shoved inward and upward, and the blood that was pooling down in the legs resettles northward – into the chest – making for a huge change in the work of respiration. In fact, immersion in neck-deep water can result in a 60% increase in the work of breathing – and this is all before exercising a single muscle. 

Even healthy people have a drop in their vital capacity and a huge increase in airway resistance when standing in a pool. Imagine the patient with pulmonary or respiratory compromise! Surely, you would think that the pool is an intolerable environment for exercise for patients with emphysema or asthma. 

Not true!

Despite the massive changes which occur with immersion, research has shown that there is no significant increase in acute respiratory attacks or other negative reactions with immersion. What’s more, when patients with respiratory difficulties exercise in water, wonderful things can occur.

During immersion, the muscles which allow patients to breathe are challenged in a nearly perfect way. Some researchers think that one of the reasons this is possible is that – with immersion – patients receive an effect somewhat similar to the “lean forward” posture that many people with respiratory illnesses assume. Patients who feel that they cannot catch their breath need only step into shallower water for this discomfort to be alleviated. In fact, it is possible to find the perfect “sweet spot” in the pool which permits a challenging respiratory program without distress. 

Of course, there is always risk with aquatic exercise. Individuals who exercise in an indoor pool need to make sure that the air quality is good (a bad sign? eye irritation, coughing, a strong “bleach” smell). Respiratory inhalers need to be brought onto the pool deck, in case they are needed in a hurry. It is even possible for people to use their oxygen in the pool; the oxygen tanks only need to be secured and the tubing long enough to permit freedom. There are floats made for portable oxygen tanks for individuals who wish to walk or swim laps, unencumbered by long swaths of tubing. 

The jury remains out on whether water-based exercise is more effective than land-based exercise, but it appears to be at least as effective and, more importantly, feasible and safe. It is indeed a “sweet spot” for the patient who cannot – or will not – exercise on land.


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