Aim of the present study is to clarify energy expenditure of gymnastic exercise during water immersion. Method : 13 males participated to the test. Oxygen consumption (VO₂) and ventilation were continuously measured by open circuit. Heart rate (HR) was automatically obtained by telemetoring. Six kinds of repeating movement of extremities were performed on land and in water in the same manner. Immersing depth was to the xyphoid level. Rhythms of the movement were adjusted so as to continue for several minutes. Result : Their OPW were 14∼20 ml/kg/min, MV were 38∼53 l/min. OPW increased remarkably by swings of both arms crossing in front of chest or alternant back-and-forth, and swings of a hemi-leg in water, compared to that on land. OPW was as half as on land by jump in situ, and equivalent by steps like marching. Notably, oxygen pulse increased by arm and leg exercise more than that on land, accompanied by increase of ventilation. Gymnastic exercise in water showed different effect on oxygen consumption and cardiac response from that on land. Manner of the movements in water also affect the difference. Those kinds of exercise in water can be utilized clinically for training and promotion of fitness.

Usefulness of balneotherapy in diabetics were discussed. Plasma glucose levels in diabetics treated with insulin decreased significantly after thirty minutes exercise under 38°C hot springs pool. There were positive relationships on plasma glucose levels between before and after exercise in hot springs. Lipids metabolism were improved during three months' balneotherapy. The ratio of VLDL·LDL-cholesterol/HDL-cholesterol decreased. Basal levels of plasma cyclic AMP decreased slightly and plasma cyclic GMP significantly increased. Intrathecal injection of vitamin B₁₂ (mecobalamin, 2500μg) was apparently effective to reduce the pain on under limb in patients with diabetic peripheral neuropathy whose subjective symptom could not improved by any medications. The effect of mecobalamin was increased by bathing in hot springs. Usually, balneotherapeutic hospitals have facilities of rehabilitation system in Japan.
In conclusion, the balneotherapy by adding physical treatment is very benefit to normalize carbohydrate and lipid metabolism. Tranquilizing function of hot springs are effective on psychological disturbance, diabetic autonomic and peripheral neuropathy.

The direct effect of bathing on R-R interval was examined in six healthy men (mean age, 40±11 years).
Bathing at 37-38°C produced signifficant shortening of mean R-R intervals (mRR) during usual and deep breathing (6times/min), and signifficant decrease of their coefficients of variation (CV; SD/mRR×100) during deep breathing.
In ten minutes after the end of bathing, mRR recovered, but not CV.
These data suggest that the bathing at those temperature might stimulate the sympathetic drive and suppress the parasympathetic drive to the heart.

The effect of underwater exercise on respiratory resistance (Rrs) was examined in 12 patients with chronic obstructive pulmonary disease (COPD). Rrs was measured while the patients were sitting on land with quiet respiration, while immersed in water (at 38°C) up to the upper abdomen and upper chest in standing position, and while sitting on land with quiet respiration after mild underwater exercise. The mean Rrses in each condition were 0.37, 0.37, 0.42, 0.33kp/1/s. Rrs increased by 14% (p<0.005) after immersion in water up to the upper chest and decreased by 12% (p<0.001) after underwater exercise. The change after exercise showed a popitive correlation with FEV_1.0/FVC on spirogram. Although water immersion or underwater exercise of these COPD patients caused a slight load in ventilation, no significant aggravation of the subjective symptom was found.
The above results suggested that uoderwater exercise was beneficial as a physical treatment for mild cases of COPD.