Detecting the physiological and biomechanical alterations in shallow water walking (SWW) due to water depth and speed is important for health professionals to perform accurate exercise prescription. This systematic review with meta-analysis aimed to investigate the acute physiological and biomechanical responses of SWW at different immersion depths in comparison to dry land walking. The main result (initial search: 1960 studies; systematic review: 42 studies; meta-analysis: 22 studies) indicated that metabolic power was higher in the immersion depth levels of xiphoid process (standardized mean differences (SMD) = 0.90; 95% confidence intervals (CI): 0.26 to 1.54) and waist (SMD = 3.35; 95% CI: -0.18 to 6.87) in comparison to dry land. SWW at xiphoid and waist depths seems to be an adequate exercise if the objective is to increase the energy expenditure and cardiovascular demand while the lower limb impact forces are reduced in comparison to dry land walking. PROSPERO registration: CRD42018113040.
Keywords: Head-out aquatic immersion; aquatic exercise; biomechanics; energy expenditure; locomotion.