Hall Jane, Grant Jim, Blake David, Taylor Gordon, Garbutt Gerard
Physiotherapy Department, Royal United Hospital, Bath, UK.
Physiother Res Int. 2004;9(2):59-73. doi: 10.1002/pri.303.
Hydrotherapy is popular with patients with rheumatoid arthritis (RA). Its efficacy as an aerobic conditioning aid is equivocal. Patients with RA have reduced muscle strength and may be unable to achieve a walking speed commensurate with an aerobic training effect because the resistance to movement increases with speed in water. The physiological effects of immersion may alter the heart rate-oxygen consumption relationship (HR-VO2) with the effect of rendering land-based exercise prescriptions inaccurate. The primary purpose of the present study was to compare the relationships between heart rate (HR), and ratings of perceived exertion (RPE), with speed during land and water treadmill walking in patients with RA.
The study design used a two-factor within-subjects model. Fifteen females with RA (47+/-8 SD years) completed three consecutive bouts of walking for five minutes at 2.5, 3.5 and 4.5 km/h(-1) on land and water treadmills. Expired gas, collected via open-circuit spirometry, HR and RPE were measured.
HR and RPE increased on land and in water as speed increased. Below 3.5 km/h(-1) VO2 was significantly lower in water than on land (p<0.01). HR was lower (p<0.001), unchanged and higher (p<0.001) at 2.5, 3.5 and 4.5 km/h(-1) in water than on land. RPE was significantly higher in water than on land (p<0.05). VO2 was approximately 60% of the predicted VO2max during the fast walking speed in water. For a given VO2, HR was approximately nine beats/min(-1) and RPE 1-2 points on the 6-20 Borg scale, higher in water than on land.
The study showed that the metabolic demand of walking at 4.5 km/h(-1) was sufficient to stimulate an increase in aerobic capacity. The use of land-based prescriptive norms would underestimate the metabolic cost in water. Therefore, in water HR should be increased by approximately 9 beats/min(-1) to achieve similar energy demands to land treadmill walking.
水疗法在类风湿关节炎（RA）患者中很受欢迎。其作为有氧调节辅助手段的功效尚无定论。RA患者肌肉力量减弱，且由于水中运动阻力随速度增加，可能无法达到与有氧训练效果相称的步行速度。浸入水中的生理效应可能会改变心率与耗氧量的关系（HR-VO2），从而导致基于陆地的运动处方不准确。本研究的主要目的是比较RA患者在陆地和水中跑步机行走时心率（HR）、自觉用力程度（RPE）与速度之间的关系。
本研究设计采用双因素被试内模型。15名患有RA的女性（47±8标准差岁）在陆地和水中跑步机上以2.5、3.5和4.5千米/小时的速度连续完成三轮五分钟的行走。通过开路肺量计收集呼出气体，测量HR和RPE。
随着速度增加，陆地和水中的HR和RPE均升高。在3.5千米/小时以下，水中的VO2显著低于陆地（p<0.01）。在2.5、3.5和4.5千米/小时时，水中的HR比陆地低（p<0.001）、无变化和高（p<0.001）。水中的RPE显著高于陆地（p<0.05）。在水中快走速度时，VO2约为预测VO2max的60%。对于给定的VO2，水中的HR比陆地高约9次/分钟，RPE在6-20 Borg量表上高1-2分。
研究表明，以4.5千米/小时的速度行走的代谢需求足以刺激有氧能力的增加。使用基于陆地的规定标准会低估水中的代谢成本。因此，在水中HR应增加约9次/分钟，以达到与陆地跑步机行走相似的能量需求。
