Clinics (Sao Paulo). 2017 November; 72(11): 667-674.

Copyright © 2017 CLINICS

Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study

Mauricio Koprowski Garcia I * , Limanara Rizzo II , Paulo Yazbek-Júnior I , Daniela Yutiyama I , Fabiola Jomar da Silva I , Denise Matheus I , Luiz Eduardo Mastrocolla III , Eduardo Massad II

Instituto de Medicina e Reabilitacao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

Departamento de Medicina Legal e Etica Medica, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR

Instituto de Cardiologia Dante Pazzanase, Sao Paulo, SP, BR

*Corresponding author. E-mail:

received February 20, 2017; revised May 30, 2017; accepted July 21, 2017.



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.


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. NCT00989248 (22).


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).


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.

Keywords: Cardiopulmonary Stress Test, Immersion, Individual Capability, Exercise

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