By Joel Dovenbarger, DAN Director of Medical Services
(First appeared September/October 1999 – DAN Alert Diver magazine)
Your Personal Fitness Level
Scuba diving offers opportunities for travel, family fun and friendly interaction with the environment. So, why the concern for diving physical evaluations?
The answers can vary with the numbers of individual divers. In short, however, it’s because we need a certain level of fitness to ensure our best performance and enjoyment of diving.
As divers of all ages and athletic abilities pursue recreational diving, they need to take the time to consider the fitness level required for scuba. Although the relatively weightless underwater environment makes diving appear almost effortless, scuba diving does require a measure of strength and stamina.
With this introductory story, DAN explains why overall fitness is important to a diver, when you may need to postpone diving based on medical conditions, why there’s a need for a pre-certification physical examination, and the impact of medications on diving. In addition, DAN addresses scuba diving safety for individuals with underlying health conditions such as asthma and diabetes (See the related story "Diving & The Body Systems: Diving with conditions of the endocrine, pulmonary and cardiac systems," by Guy de Lisle Dear, M.B., FRCA, DAN Assistant Medical Director).
Learning to Scuba Dive
If you’re considering learning to dive, keep in mind that not all your diving will be the same – water and weather conditions vary from dive to dive and even from the beginning to the end of some dives.
You may be required to maneuver through strong currents to reach your dive site or perform a long surface swim at the end of a dive. Divers need to be able to perform unexpected strenuous physical tasks. Also, they should not have any health conditions or be taking any medications that may cause problems while diving.
Students learning to dive complete a medical history form before getting into the water, but a physician’s examination may not be required. In some cases, students report medical problems that may prevent them from diving or temporarily restrict their involvement in scuba. These students may be allowed to dive once they have been evaluated and receive a physician’s consent.
Restrictions on Diving
Some medical conditions – such as colds, flu, injury or pregnancy – will temporarily restrict diving. Why? With colds or flu, swelling or blockage in the Eustachian tubes or sinuses may prevent adequate equalization of these air spaces with the water pressure. Injuries to joints and muscles may not only reduce diving ability, but they also increase susceptibility to decompression illness. Therefore, it is best to postpone diving until injuries are fully healed. Because little is known about the effects of scuba diving on an unborn child, it is recommended that pregnant women wait to dive until after a pregnancy.
Other medical conditions that restrict the movement of a diver’s arms and legs may in turn limit in-water mobility. Some people may simply be out of shape and experience pain or discomfort with the physical exertion of scuba diving. Such health issues require individual evaluation by a physician prior to learning to dive.
Pre-dive Physical Examination
A student is sent for physician referral when a dive instructor requires more information about that individual’s health. The most common reason for referral is that a student has a medical condition or is under the care of a physician. The evaluation is simply an assessment of scuba’s compatibility with various medical conditions.
If you have questions about your fitness to dive, or if you need evaluation by a diving doctor, DAN can provide you with a list of specialists in your area. Call DAN’s Dive Safety and Medical Information Line from 9 a.m. to 5 p.m. Eastern Time.
Other reasons a diving student may be asked to see a doctor include (but are not limited to):
- A history of heart or lung disease;
- An unexplained loss of consciousness or "blackout";
- A history of nausea or vomiting;
- The use of prescription or non-prescription medications;
- Shortness of breath;
- Repeated trouble clearing air spaces;
- The appearance of not being physically fit.
No upper age limit for participation in scuba diving exists, provided a diver is healthy and fit and has no disqualifying medical conditions. Some divers may be asked by their physician to perform an exercise tolerance test to rule out any cardiovascular (heart) problems – this is appropriate when the diver is older or appears generally out of shape. This test allows a physician to collect information about how well an individual responds to exercise.
Diving While Using Medications
Let your dive instructor know if you are taking any medications, whether they’re prescribed by your doctor or purchased over the counter. Most medications will have no effect on diving, but some may cause drowsiness or fatigue, which may increase the susceptibility to nitrogen narcosis. Others may affect heart rate. Read the warning labels and precautions before using prescription or over-the-counter drugs, especially if you plan to dive.
The likelihood of an unexpected reaction to medications at depth varies from diver to diver, and even from day to day. If you start a new medication, be sure there are no side effects at the surface before entering the water. (This is especially true of anti-motion sickness medications.) If a medication "may cause drowsiness" or suggests restricting the use of machinery after taking the medication, it may be best to reconsider your plan to dive and wait until you’re no longer taking that medication.
For more in-depth information, see "Taking Drugs When you Dive?: If You’re Using Any Medication, Make Sure You’re Informed About Drugs and Diving Before You Take the Plunge," By Bryan G. Levano, M.S., R.Ph., in the January/February 1999 issue.
Asthma and Diabetes
There is concern in the diving medical community about the advisability of allowing individuals with asthma or insulin-dependent diabetes mellitus to dive.
Some individuals with a history of asthma are permitted to dive by their physicians – after a careful evaluation. Diabetes and many other medical conditions must be evaluated on a case-by-case basis with an appropriate medical specialist.
DAN continues to research the safety of scuba diving for individuals with underlying health problems. Your DAN membership helps support these studies.
For more in-depth information, see:
- "Asthma & Diving," and
- "Diabetes & Diving: Current practices demonstrate that many with diabetes do take the plunge,"
- Both articles are by DAN Associate Medical Director Guy de Lisle Dear, M.B., FRCA, in the January/February 1997 issue of Alert Diver.
Scuba diving is an activity that anyone with good health and fitness can enjoy for a lifetime. To get the most out of your lifetime of diving, practice disease and injury prevention and participate in a health maintenance program.
- See your physician for regular checkups in addition to when you’re ill;
- Participate in a regular exercise program;
- Be rested and well-nourished before diving;
- Use proper exposure protection and equipment;
- Plan your dive to avoid overexertion.
Good advice: Don’t hide or downplay any medical condition or health problem: it’s better to have an open and frank discussion before a problem arises than to wonder if the injury could have been avoided.
Finally, call DAN if you have questions on: your own diving fitness; certain medical conditions when diving; or how to find a diving doctor in your area. If your physician has any questions he or she can call DAN and speak with a medically trained professional about diving and medical conditions.
Need More Info?
Call DAN’s Dive Safety and Medical Information Line at +1-919-684-2948 (or call 1-800-446-2671, press 2, in the United States and Canada) from 9 a.m.-5 p.m. Eastern Time.
This text – "Health & Fitness in Scuba Diving" – is also available in a brochure from Divers Alert Network for distribution to all divers. If you’d like to order some for students, customers or your dive club, call DAN.