Some clients may have difficulty performing the HW test using these standardized procedures. Accurate test results are highly dependent on the client’s skill, cooperation, and motivation. The following section addresses the use of modified HW procedures, as well as other questions and concerns about the use of this method.
What should I do when my client is unable to blow out all of the air from the lungs or remain still while under water?
You will likely come across clients who are uncomfortable expelling all of the air from their lungs during HW. In such cases, you can weigh these individuals at functional residual capacity (FRC) or total lung capacity (TLC) instead of RV. Thomas and Etheridge (1980) underwater-weighed 43 males, comparing the body densities measured at FRC (taken at the end of normal expiration while the person was submerged) and at RV (at the end of maximal expiration). The two methods yielded similar results. Similarly, Timson and Coffman (1984) reported that Db measured by HW at TLC (vital capacity + RV) was similar (less than 0.3% BF difference) to that measured at RV if TLC was measured in the water. However, when the TLC was measured out of the water, the method significantly overestimated Db. When using these modifications of the HW method, you must still measure RV in order to calculate the FRC or TLC of your client. Also, be certain to substitute the appropriate lung volume (FRC or TLC) for RV in the calculation of BV.
People uncomfortable under water tend to have difficulty being still while fully submerged. Your client’s movement under water causes the arm of the scale to move. In addition to prolonging the time your client is under water, it may preclude your ability to confidently determine your client’s underwater weight. The damping technique as described by Moon and colleagues (2011) reduces the magnitude of the swings in the scale arm until the client and chair become stable under water. Damping is performed by temporarily holding the moving part of the scale (where the chair attaches) to apply an upward force that counters the motion associated with submersion or movement in the chair. Gently releasing the hold prior to the end of the maximal exhalation maneuver allows the scale arm to stabilize for a more accurate measurement. The damping technique produced similar underwater weights compared to hydrodensitometric assessments made via load cell and without damping (Moon et al. 2011).
Because of their lower Db, clients with greater amounts of body fat are more buoyant than leaner individuals; therefore, they have more difficulty remaining motionless while under the water. To correct this problem, place a weighted scuba belt around the client’s waist. Be certain to include the weight of the scuba belt when measuring and subtracting the tare weight of the HW system.
What should I do when my clients are afraid to put their face in the water or are not flexible enough to get their backs and heads completely submerged?
Occasionally, you will encounter clients who are extremely fearful of being submerged, who dislike facial contact with water, or who are unable to bend forward to assume the proper body position for HW. In such cases, a satisfactory alternative would be to weigh your clients at TLC while their heads remain above water level. Donnelly and colleagues (1988) compared this measure (i.e., TLCNS or total lung capacity with head not submerged) to the criterion Db obtained from HW at RV for 75 men and 67 women. Vital capacity was measured with the subject submerged in the water to shoulder level. Regression analysis yielded the following equations for predicting Db at RV, using the Db determined at TLCNS as the predictor:
Db at RV = 0.5829(Db at TLCNS) + 0.4059
r = 0.88, SEE = 0.0067 gÂ·cc-1
Db at RV = 0.4745(Db at TLCNS) + 0.5173
r = 0.85, SEE = 0.0061 gÂ·cc-1
The correlations (r) between the actual Db at RV and the predicted Db at RV were high, and the standard errors of estimate (SEE) were within acceptable limits. These equations were cross-validated for an independent sample of 20 men and 20 women. The differences between the Db from HW at RV and the predicted Db from weighing at TLCNS were quite small (less than 0.0014 gÂ·cc-1 or 0.7% BF). This method may be especially useful for HW of older adults, obese individuals with limited flexibility, and people with physical disabilities.
Will the accuracy of the HW test be affected if I estimate RV instead of measuring it?
Several prediction equations have been developed to estimate RV based on the individual’s age, height, gender, and smoking status (see appendix D.1, "Prediction Equations for Residual Volume"). However, these RV prediction equations have large prediction errors (SEE = 400 - 500 ml). When RV is measured, the precision of the HW method is excellent (\lte\1% BF). However, this precision error increases substantially (Â±2.8 - 3.7% BF) when RV is estimated (Morrow et al. 1986). Therefore, always measure RV when you are using the HW method.
When is the best time during the menstrual cycle to hydrostatically weigh my female clients?
Some women, particularly those whose body weight fluctuates widely during their menstrual cycles, may have significantly different estimates of Db and %BF when weighed hydrostatically at different times in their cycles. Bunt, Lohman, and Boileau (1989) reported that changes in total body water values due to water retention during the menstrual cycle partly explain the differences in body weight and Db during a menstrual cycle. On the average, the relative body fat of the women was 24.8% BF at their lowest body weights, compared to an average of 27.6% BF at their peak body weights during their menstrual cycles. Because their low and peak body weights occurred at different times during the menstrual cycle (varied from 0 to 14 days prior to the onset of the next menses), the effect of total body water fluctuations cannot be routinely controlled by using the same day of the menstrual cycle for all women. However, when you are monitoring changes in body composition over time or establishing healthy body weight for a female client, it is recommended that you hydrostatically weigh her at the same time within her menstrual cycle and outside of the period of her perceived peak body weight.