Is Water Therapy a Safe Option for COPD?

Some like it hot. Some like it cold. But is water therapy a good idea if you have COPD? Get the lowdown on this alternative therapy.

The idea of water therapy may have you floating — immersing yourself in water and just “being” might sound like a small luxury.

Water therapy comes in various forms. While saunas are spa-day staples, cold water therapy has become a social media trend, thanks partly to celebrities posting photos of themselves taking the cold plunge.

But will doing the same (or opting for a sauna or other hot water treatments) worsen or help your COPD?

“While water therapy, including cold plunging, has gained popularity for its potential health benefits, it’s crucial for individuals with COPD to approach this trend with caution and a clear understanding of the associated risks and benefits,” said Nadeem Y. Ali, MD, a pulmonologist at Hackensack Meridian Health.

Doctors discussed the research (it’s sparse) on cold and warm water therapy, as well as aquatic exercises. They also gave actionable tips for reducing risks and questions to ask yourself and your care team before diving in.

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Cold plunging: What it is, pros, and cons

Musicians like Lady Gaga and Harry Styles are among the international celebrities who say they’re fans of cold plunging. But are there a million reasons to give it a try? First, let’s discuss what it is.

“Cold plunging involves dunking your body in cold water set at 50°F to 59°F (10°C to 15°C)for a short time,” said Raj Dasgupta, MD, a physician at Keck Medicine of USC’s Division of Pulmonary, Critical Care and Sleep Medicine. “It’s popular for reducing inflammation, improving blood flow, and boosting mood.”

Sometimes, the water will be even colder. Ali says the temperature triggers a “cold shock,” which sounds jarring (and can be) but is a natural physiological response.

“This response involves a rapid increase in heart rate and blood pressure, followed by a decrease in blood flow to the skin and extremities,” Ali said. “The body also releases hormones like adrenaline and endorphins.”

He explained that the pool of research on cold plunging for COPD relief is relatively shallow.

The same goes for risks, so each expert I spoke with stressed the importance of speaking with a doctor before using cold water therapy.

If the doctor green lights cold therapy, Ali said top-line safe precautions are:

• limiting immersion time to a few minutes
• ensuring the temperature doesn’t feel too cold
• wearing a wetsuit or other protective clothing to minimize body heat loss
• using a breathing mask or scarf to protect your airways from the cold

Here’s what doctors and research say about the potential COPD-related benefits and safety concerns for cold plunging.

Con: Respiratory risks

This is one of the most significant concerns pulmonologists have about cold plunging.

“Cold plunging can also result in hyperventilation or at least a faster respiratory rate,” said Jimmy Johannes, MD, a pulmonologist at Memorial Care Medical Group. “For those with COPD, especially those with moderate to severe COPD, extra time might be needed to exhale out all the air breathed into the lungs.”

Johannes said excessive faster breathing doesn’t give a person’s body the time it needs to exhale, making trapped air worse. It can also lead to hyperinflation of the lungs.

“This can accelerate a sense of shortness of breath,” he said, adding that it can also increase the stress on the lungs.

Pro: Improved circulation and exercise recovery

“Cold water can stimulate blood flow, which may improve circulation and oxygen delivery to the lungs,” Ali said. This perk can speed up exercise recovery, allowing people to reap the benefits of moving, including for lung health.

A 2023 meta-analysis suggested that cold water therapy could help with exercise fatigue. The research is not specific to COPD, but one pulmonologist says the benefits could extend to people with COPD.

“Cold plunging can help mitigate pain and stiffness and create a sense of invigoration,” Johannes explained.

Ali added that cold water therapy might also soothe muscle soreness from coughing.

Pro/Con: Airway inflammation

Inflammation from exercise isn’t the only inflammation that cold plunging might help alleviate.

“Cold water immersion can reduce inflammation throughout the body, which may be beneficial for individuals with COPD who experience chronic inflammation in their airways,” Ali said.

However, it can also make it worse. The American Lung Association (ALA) states cold weather can worsen COPD symptoms.

“Cold water can trigger bronchospasm, a sudden narrowing of the airways,” Ali said, making breathing difficult.

Pro/con: Immune health

Respiratory infections can be more dangerous with COPD. Dr. Ali said the belief is that cold water immersion stimulates the immune system and lowers the risk of these infections.

A 2020 review suggested that people with COPD with five cold-water stimulations in 10 weeks had fewer infections.

That said, it’s not a slam dunk.

“Cold water can suppress the immune system, making individuals more susceptible to infections,” Ali said. “Maintain good hygiene practices. Avoid cold plunging if you are feeling unwell.”

Pro: Mood

Dasgupta said cold water therapy might boost a person’s mood and mental health. As with many chronic conditions, anxiety and depression are common with COPD. The 2020 review also found that cold water stimulation for 10 weeks improved the participants’ quality of life.

Con: Low body temperature

Naturally, your body temperature lowers when immersed in cold water. If it lowers too quickly, a person is at risk for hyperthermia, which happens when the body loses heat faster than the body can make it. Ali says this condition is life threatening, especially for people with underlying health conditions.

Con: Cardiovascular risks

According to Sandeep Gupta, MD, a pulmonologist at Memorial Hermann Health in Texas, the cold-shock response may be physiologically normal, but it carries potential risks.

“It can lead to increasing heart rate and blood pressure,” Gupta said. “Some may even feel an initial difficulty breathing and gasp for breath.”

Ali suggested speaking with a cardiologist before cold plunging if you also have a heart condition.

Hot application: What it is, pros, and cons

Long, hot baths are typically considered more soothing than cold plunges. Dasgupta said it’s used in the general population to help relieve pain and treat conditions and can include:

• warm water soaks
• steam baths
• water jets
• saunas

Like cold plunging, limited research points to its benefit for COPD, but pulmonologists say it can help. However, it also carries risks, so speaking with a healthcare professional is essential.

Ali said other safety tips include:

• starting with lukewarm water
• maxing out at a water temperature of around 85°F to 92°F (29°C to 33°C)
• maintaining good hygiene practices, like showering before and after
• avoiding the pool if you have open wounds or infections

Pro: Relaxing

Dasgupta said warm water can be soothing for the mind and body.

“Warm water helps relax your muscles and lowers stress, which can make breathing easier,” he said.

Pro/con: Humidity and airways

Humidity — including steam showers — is often considered to worsen COPD. And it can (and we’ll delve into that). However, it’s possible that humidity in small doses may have some short-term benefits.

Gupta said humidity and steam can help clear airways. However, humid conditions in warm water pool environments also carry risks. Similar to cold therapy, Ali said humidity can tighten the airways and make breathing challenging.

A study from 2018 suggested humidification therapies might help relieve nasal symptoms but didn’t show long-term benefits. Other research surrounding humid weather suggested humidity could worsen COPD.

Pro/con: Respiratory muscle resistance

Whether relaxing or treading warm water, your lungs are getting a workout.

“Breathing while in a bath can provide a mild amount of additional resistance to the respiratory muscles, which may help strengthen them,” Johannes said.

A much older study from 1989 suggested that sauna bathing could improve lung function. However, Ali cautioned that resistance is a potential risk of exertion and emphasizes the importance of tuning into your body.

Pro/con: Illness

A 2020 review suggests that sauna bathing can lower a person’s risk for pneumonia.

However, Ali said the practice can also increase the risk of getting sick.

“The warm, humid environment of a therapy pool can increase the risk of bacterial or fungal infections, especially for individuals with compromised immune systems,” Ali said, bubbling up the importance of hygiene, like showering before and after treatment.

Con: Hypothermia

Yes, it’s possible to get hypothermia in warm water.

“Individuals with COPD may be more susceptible to hypothermia due to impaired circulation and difficulty regulating body temperature,” Ali said.

Con: Drowning

“Individuals with severe COPD may have an increased risk of drowning due to impaired lung function and difficulty staying afloat,” Ali said.

Ali recommends:

• having a qualified therapist or supervisor present during treatment
• using floating devices like a lifejacket
• avoiding swimming or deep-water activities

What about exercise in warm water?

Of all the types of therapy, experts are keenest on recommending water exercise as a treatment for people with COPD. Johannes said it’s typically performed in a pool environment and works strength and mobility.

Think water aerobics and using water weights. The water is key to reducing the impact on the joints, making it more accessible for people who experience pain during land-based workouts.

Ali says there are tons of benefits, including:

• improved lung function
• strength
• reduced joint pain and stiffness
• improved exercise tolerance
• mental health boost

“By improving lung function, exercise capacity, and overall well-being, water exercise can significantly improve the quality of life for individuals with COPD,” Ali said.

However, humid conditions, overexertion, and drowning remain risks with water therapy. So, he said, taking the above precautions applies.

Takeaway

Cold water therapy or “cold plunging” is popular on social media for its purported benefits for improving the immune system, speeding exercise recovery, and promoting better mental health. Warm water therapy enthusiasts make similar claims.

There isn’t much evidence supporting either, particularly with people with COPD. Cold and humid environments can also worsen symptoms, so speaking with your doctor is important. However, some people might notice some benefits.

Pulmonologists say that exercise in warm water pools can be of particular benefit because it’s a low impact way to move and improve organ health, including the lungs.

Starting with lukewarm water and gradually raising or lowering it over time can help the body adjust. Wearing a floating device and doing therapy or exercise with an accredited supervisor can increase safety.