Inexperienced water users can “Float to Live” in realistic open water conditions

Inexperienced water users can “Float to Live” in realistic open water conditions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Inexperienced water users can “Float to Live” in realistic open water conditions Clare Eglin, Heather Massey, Geoff Long, Adrian Mayhew, Michael Tipton This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4318349/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jul, 2024 Read the published version in BMC Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background The RNLI “Float to Live” campaign is based on research conducted in indoor pools with experienced open water swimmers. Study 1 investigated whether the RNLI “Float to Live” guidance would enable less experienced individuals to float in realistic open water conditions. Study 2 examined the separate effects of practice and coaching on floating competence. Methods Study 1: Inexperienced water users conducted floats in either still, open fresh (n = 22) or open sea water (n = 13), followed by moving sea (n = 6) or fresh water (n = 5). Participants undertook three 2-minute floats in still water wearing swimwear and one clothed float: 1) naïve; 2) following RNLI “Float to live” messaging; 3) individual float coaching; 4) simulated fall wearing summer clothing. In moving sea water, participants undertook two floats equivalent to Floats 3 and 4. In moving fresh water, participants undertook 3 floats: 1) naïve; 2) following “defensive floating” coaching; 3) simulated fall wearing summer clothing. Study 2: Two groups matched for skinfold thickness undertook three 2-minute floats in a flume wearing swimwear. PRAC group (n = 12): 1) naïve; 2) following float practice; 3) float coaching; COACH group (n = 11) coaching followed by practice. Floating difficulty, confidence, competence, “efficiency” and perceived exertion were analysed using either a Friedman test or mixed model ANOVA. Results In both fresh water and sea water, participants’ floating competence and confidence increased after viewing the RNLI messaging, it was further improved with individualised float coaching. The additional helpful instructions included: 1) “head back with ears submerged”; 2) “relax”; 3) “breathe normally”; 4) “it is OK if your legs sink”; 5) an accurate description of sculling for “active” floaters that needed it; 6) spread arms and legs for stability. The simulated fall with clothing did not impair floating competence. No difference in floating competence was seen between PRAC and COACH, though confidence may be increased sooner in COACH. Conclusions The RNLI float advice can be applied in realistic open water settings by less experienced water users. Additional content could be included to make the messaging even more effective. drowning prevention water safety floating water immersion Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction There are an estimated 236,000 annual drowning deaths worldwide (World Health Organization 2023 ), with 226 accidental drowning fatalities occurring in the United Kingdom in 2022 (National Water Safety Forum, 2023). Approximately half of the UK drowning victims had not intended to go into the water and were therefore not prepared (National Water Safety Forum, 2024). One of the potential causes of drowning is the initial cardio-respiratory responses to cold water immersion, otherwise known as the cold shock response (CSR; Tipton 1989 ). The CSR comprises an inspiratory gasp (of approximately 2.5 litres), followed by uncontrollable hyperventilation during which voluntary breath holding is severely compromised thus increasing the risk of drowning (Tipton 1989 ). Heart rate, blood pressure and workload of the heart are also increased and arrhythmias may occur which may precipitate a cardiac arrest in individuals with underlying cardiovascular disease (Tipton 1989 ). Whilst the responses peak in water temperature between 15°C and 10°C (Tipton et al. 1991 ), the CSR can occur in warmer water (Mekjavic & Bligh 1989 ) and therefore most of the open water around the UK is cold enough to evoke the CSR, even in summer. The risk of drowning is increased if individuals attempt to swim when the CSR is at its peak, waiting 90 seconds for the hyperventilation to subside improves subsequent swimming ability (Golden et al. 1986 ; Tipton et al. 1991 ). To prevent drowning, the Royal National Lifeboat Institution (RNLI) has, based on the research noted above, been promoting a “Float to Live” message since 2017. This aims to keep the airway clear of the water on initial immersion by encouraging floating (Barwood et al. 2018 ) until the CSR has subsided, and before trying to swim (Golden et al. 1986 ). The RNLI “Float to Live” messaging provides instruction about how to stay afloat – undertaking the minimum amount of activity possible, thereby minimising the challenge to the airway and strain placed on the heart, as well as maximising the amount of air retained within clothing layers, which provides additional buoyancy (Barwood et al. 2011 ). However, this advice is based on research conducted in indoor pools with confident and experienced open water swimmers. The current study tested the hypotheses that the RNLI “Float to Live” messaging would enable inexperienced water users to float in realistic open water conditions (still and moving open fresh water and sea water), and that floating confidence and competence could be further improved with individual float coaching. Since this involved an inevitable component of practice, in a second study, the effectiveness of float practice and coaching on floating confidence and competence were compared. It was hypothesised that coaching would improve floating competence and confidence more than practice. Methods In Study 1, a total of 25 participants undertook four floats in still open water (fresh or sea water). Six of these participants undertook a further two floats in moving sea water and five participants undertook a further three floats in moving fresh water. In Study 2, 23 participants undertook three floats in an indoor swimming flume. Participants Volunteers (men and women aged 18 to 60 years) were recruited from University staff and students and the general population, they provided informed written consent prior to their participation. A favourable opinion was given by the Faculty of Science and Health, University of Portsmouth Research Ethics Committee for both studies (SHFEC-2022-066 and SHFEC-2023-005). The minimum water experience for participants undertaking floats in still water (open water or flume) was to be comfortable in chest-deep, still water. Participants undertaking floats in moving water were also required to be comfortable out of their depth in still water and be able to swim more than 25 m. Participants’ maximum water experience was recreational swimming with no regular swimming in open water (other than the odd dip on holiday) and no competitive swimming (indoor, outdoor or triathlon/duathlon). Volunteers were also excluded if they had any cardiovascular or pulmonary disease, asthma triggered by cold or exercise, family history of sudden cardiac death, musculo-skeletal injuries that may impair movement in water, or had a fear of water. Participant demographics (age, sex, self-reported race) were recorded and anthropometric measurements were made in a private room and included measurements of height (SECA 213, SECA, UK), body mass (SECA 899, SECA, UK), circumferences of the waist, hip, chest, thigh and arm (anthropometric tape, Rosscraft, Canada) and skinfold measures taken using callipers (Harpenden skin fold calliper, Baty International, UK) at the bicep, tricep, subscapula, supra iliac and thigh. All anthropometric variables were measured and recorded by the same researcher for each study according to the guidelines produced by the International Society for the Advancement of Kinanthropometry. Study 1 Still open water floats Twenty-two participants conducted floats in open still fresh water (a lake or lagoon), and thirteen participants conducted floats in sea water in Langstone harbour (during slack water). All floats were on the back, face up. Participants undertook four floats in still water, each lasting 2 minutes. The first three floats (standard floats) were undertaken wearing swimwear and neoprene shoes with neutral buoyancy, and the final float wearing summer clothing (T-shirt and shorts, with at least the T-shirt being dry). Prior to each float, participants were instructed to: “stay at the surface with the minimum effort that you need to keep your head above water for 2 minutes”. They then walked into the water until they were waist deep and were then given a countdown to start their float. The first float was conducted in waist to chest deep water, if they floated in a vertical position, participants were moved to deeper water (but only if they were comfortable to do so). For the final float (simulated fall), participants stepped into deep water from a platform (stairs or mega stand up paddleboard [SUP]) with a freeboard of no more than 10 cm, and were given the additional instruction to guard their mouth and nose with their hand as they entered the water to prevent a glossopharyngeal reflex. For safety reasons, the simulated fall was conducted last and only if the participant, researchers and experienced swim instructors were happy for them to do so. Participants who were not confident to step into deep water undertook a standard float wearing clothing. The floats were conducted in the order shown below so that the instructions given were incremental and, for safety reasons, the simulated fall occurred after a combination of instruction and practice: No instruction (naïve) After viewing the RNLI “Float to Live” video and poster Following coaching from an experienced swim teacher and qualified open water swim coach Simulating a fall wearing summer clothing (shorts and T-shirt) Prior to their second float, participants watched the RNLI’s “Float to Live” video (Royal National Lifeboat Institute 2022) and looked at the associated poster. They were allowed to watch the video as many times as they wished and spend as long as they wanted looking at the poster. Before attempting the third float, coaching was provided by an experienced swim teacher, qualified open water swim coach. This was individualised to help the participant improve their floating technique. Most of the instruction was given out of the water and included showing them short video clips of their previous floating attempts to aid their learning. Some participants were given extra in-water instruction. Between their floats, participants dried off, put on a robe and were offered hot drinks to warm them up. Participants did not undertake their next float until they felt warm and therefore the duration between floats varied between individuals and with weather conditions. Ten participants volunteered for still water floats in both fresh water and sea water and for logistic reasons they undertook their floats in fresh water first. Since they already had float coaching (from the RNLI video and swim teachers), they only completed two floats in sea water, one standard float and one wearing clothing after a simulated fall (equivalent to Floats 3 and 4 above). Moving open water floats For safety reasons, participants completed floats in still water (as detailed above) prior to undertaking their floats in moving water. For the moving sea water condition, six participants undertook two floats in Langstone harbour, UK when the current was at its fastest during a rising or falling tide. Participants had either undertaken four floats in still sea water or four floats in still fresh water followed by two floats in still sea water beforehand. For the first moving water float, participants were transported against the current on a megaSUP to the point of entry into the water. They gently entered the water (sliding off the SUP from a seated position) wearing swim wear and neoprene shoes and commenced their float for up to 2 minutes. For the second float, the participants wore dry shorts and T-shirt and stepped off the paddle board into deep water before commencing their float. As with the still water, the participants were instructed to guard their mouth and nose with their hand as they entered the water. No additional instructions/coaching were given during the moving sea water floats as water turbulence and aeration were similar in the still and moving sea water. The study team stayed adjacent to the participants throughout their floats for their safety and to allow data collection. Five participants conducted floats in moving fresh water at the bottom of the white-water course at Cardiff International White Water Centre (CIWWC), with the flow set to 4 cubic metres per second, simulating a Grade 1 river which is typical of UK inland water. Participants undertook three floats as follows: No instruction (naïve to moving water) With coaching from a Surf Life Saving Great Britain (SLSGB) instructor on techniques to use in moving water Simulating a fall wearing summer clothing (shorts and T-shirt) Participants were ferried across to the centre of the water course in an inflatable rescue boat which was then tethered to ensure the participant would enter the water in the middle of the flow of water. For their first two floats participants wore swim wear and neoprene shoes, sat on the sponson with their feet facing down stream and slid into the water as gently as possible. On the final float, participants wore summer clothing (dry shorts and T-shirt), sat on the sponson with their feet facing downstream and fell into the water. Participants floated downstream to another rescue boat, the floating route and duration varied with each individual and during each of their floats, but typically lasted less than one minute. Between each float, the participants immediately dried off, donned a robe and stood in the sun to keep warm. Additional instructions were given to the participants in the moving fresh water as there was increased turbulence, aeration and obstacles in the moving water compared to the still water. After the first float, an experienced, qualified SLSGB instructor coached participants when out of water on the correct technique to adopt in moving water (“defensive” floating). Although standardised instructions and demonstrations were given, participants were allowed time to ask questions and clarify the actions required. The following instructions were given: feet downstream chin on chest and look where you are going legs together, knees bent and heels lower than bottom arms out for stabilisation adopt “normal” float as soon as possible when in calmer water The order of floats undertaken by the participants for each of the conditions is shown in Fig. 1 A. Study 2 Twenty-three volunteers undertook three test floats wearing swimwear in a swimming flume (SwimEx 600-T Therapy Pool, length 4.2 m, width 2.3 m and depth 1.5 m) containing fresh water at 31°C with no flow. Participants attended an initial session in the laboratory where anthropometric measurements (as detailed above) were taken and subsequently used to create matched pairs of volunteers (matched for sum of skinfolds). One of the matched pairs was then randomly assigned (by the flip of a coin) to the practice session first (PRAC) or the coaching session first (COACH). Participants entered the water via a ladder and stood in the water (between waist and chest depth) before commencing their float. The first float was naïve with no prior coaching or practice allowed. Following this they either practiced their floating technique with no coaching for up to 5 minutes (PRAC) or were given individualised float coaching by a swim teacher (COACH) for up to 5 minutes before undertaking their second 2 minute float. Participants in the PRAC group were then given individualised float coaching, and those in the COACH group practiced their floating with no additional instruction (both for up to 5 minutes) before undertaking their final float. Each float lasted for up to 2 minutes and Floats 2 and 3 did not commence until heart rate had returned to baseline levels. The order of floats undertaken by both groups are shown in Fig. 1 B. Measurements Air temperature was measured close to the site of water entry using a wet bulb globe thermometer and recorded every minute on a data logger (Squirrel, Grants Instruments, UK). At Langstone harbour, wind speed and direction were measured at an adjacent building (Tudor Sailing Club, 2022 ) and recorded prior to each float. The fresh open water sites were relatively sheltered therefore wind speed was not measured. Water temperature was measured using calibrated thermometers at depths of 5 cm and 50 cm placed adjacent to the participant and recorded for each float. Specific gravity of the water was measured on each testing day using a refractometer. Water flow was measured at the point of water entry using a flowmeter (Model 001 Flowmeter, Valeport, UK). In the sea, wave height adjacent to the participant was assessed over a 20 second period during the float (retrospectively from video analysis) using a graduated pole, or estimated from the height of the SUP freeboard. Prior to any floats or instruction, participants completed a pre-float questionnaire asking them to indicate their current participation in water-based activities. Self-reported water confidence in waist deep water and in water out of their depth using a 5-point Likert scale (1 = very unconfident; 2 = unconfident; 3 = neutral; 4 = confident; 5 = very confident). Participants were asked whether they could swim 25 m in a heated swimming pool without putting their feet down, and also to indicate their swimming ability on a scale of 1–10, where 1 was “I cannot swim at all” and 10 was “I am a great swimmer”. Participants were asked how difficult they find floating which was reported using a 5-point Likert scale (1 = very easy; 2 = easy; 3 = neutral; 4 = difficult; 5 = very difficult), and how much confidence they have in their ability to float, again using a 5-point Likert scale (1 = very unconfident; 2 = unconfident; 3 = neutral; 4 = confident; 5 = very confident). Finally, they were asked to list the actions they thought they needed to take in order to float. In Study 2, participants were also asked if they had tried to float before and if so, how long ago that was. Prior to each float, participants were asked to rate how difficult they thought their next float would be and how much confidence they had in their ability to float. All floats were filmed using two mobile cameras (GoPro HERO8, GoPro USA) which were positioned to obtain an aerial and a close up or underwater view of the participant. Floating competence was assessed over the last 30 seconds of each float by the same two researchers (CE and HM) from analysis of the videos using a slightly modified version of the Moran floating scale (for score 1–2 the word excessive was replaced with energetic as this was a more accurate description of the activity; Moran 2014 ). During some of the floats in Study 2, the movement of the participant set up a standing wave in the flume which interfered with floating. In these cases, if there had been no change in float technique, floating competence was assessed earlier when the water was calmer. Immediately after their float, participants were asked to rate their perceived exertion (RPE) using the 0–10 Borg ( 1982 ) scale, floating difficulty, whether they thought the float was more or less difficult than they anticipated (1 = a lot less difficult; 2 = less difficult; 3 = about the same; 4 = more difficult; 5 = a lot more difficult) and floating confidence. They were also asked which instructions or practice helped them to float (except after the first float when no instruction was given) or if any other information (not given) would have been useful. In Study 2, after the third float, participants were also asked whether practice or instruction helped them float the most and in which order they would be most beneficial. Floating “efficiency” was estimated from floating competency divided by RPE for each float. Where the Moran score or RPE was 0, this was entered as 0.1 so that a value for floating “efficiency” could be obtained. In Study 2, heart rate was measured using a Polar heat rate monitor (Polar H10, Polar, UK) and recorded at 30 second intervals during the three floats. Floating angle of the torso (from shoulder to hip) viewed from a window at the side of the flume was estimated in the final minute of each float using a protractor. The float coaching given to the participants by the swim instructors was recorded, transcribed and coded into different themes. These corresponded to instructions regarding head position, relaxing, breathing, limb movement, leg position, arm position and core activity. These were then compared to the instructions reported by the participants as useful, in order to identify key phrases which enabled participants to improve their floating competence. Data analyses Pre-float floating difficulty and confidence, floating competence (Moran scale), RPE, post-float floating difficulty and confidence were compared between floats within conditions using a Friedman test (with post hoc Wilcoxon tests if appropriate) when three or more floats were compared, or Wilcoxon tests if only two floats were compared. Comparisons were also made between the final two floats in fresh water and the two floats in sea water. In Study 2, between group comparisons were made using a mixed model ANOVA with pairwise comparisons. Sphericity was assessed using Mauchly’s test and where sphericity could not be assumed epsilon corrections were utilised. It was apparent that some participants could float with little or no movement whereas others required activity to maintain their airway clear of the water. Therefore, participants in Study 1 were classified as either “active” or “passive” floaters based on the arm and/or leg action during the last 30 s of their third float. “Active” floaters required arm or leg action to maintain their airway clear whereas “passive” floaters used limb movement only for stabilisation. The responses of these two groups were analysed separately to determine whether different instructions were required to improve their floating competency and the results are given in the supplementary material. Relationships between anthropometric variables and floating competency (Float 1 – naïve and Float 3 – after float coaching) in still fresh water and still sea water (standard float after float coaching) were investigated using Spearman’s rank correlations. Values are presented as mean (standard deviation) and statistical significance was taken as P ≤ 0.05. Results Participants A total of twenty-five participants (11 women and 14 men) volunteered for the floats in different water conditions in Study 1, and 23 participants (10 women and 13 men) volunteered for the floats in the swimming flume in Study 2 (Table 1 ). The activities the participants undertook at the time of testing in and around water are shown in Table 2 . Participants reported being either confident (n = 10) or very confident (n = 12) in water up to their chest (one of the inclusion criteria) and out of their depth their confidence averaged 4.0 (0.8) where 0 = very unconfident and 5 = very confident. All participants reported being capable of swimming 25 m in a heated swimming pool without assistance; reported swim ability was 6.2 (1.6) for participants in Study 1, 6.8 (1.1) for PRAC and 6.5 (1.1) for COACH (1 = “I cannot swim at all”; 10 = “I’m a really good swimmer”) and none of the participants were or had been competitive swimmers. Table 1 Mean (standard deviation) participant characteristics and environmental conditions during the floats for Study 1 and 2. (W = women) Study 1 Study 2 Still fresh water Still sea water Moving fresh water Moving sea water COACH PRAC Participant characteristics N 22 (10 W) 13 (7 W) 5 (1 W) 6 (3 W) 11 (4 W) 12 (6 W) Age (y) 34.3 (10.1) 29.5 (10.3) 41.8 (16.5) 31.5 (14.4) 19.8 (1.1) 20.2 (1.2) Height (cm) 175.4 (8.7) 174.6 (9.0) 178.4 (10.4) 177.5 (9.9) 173.8 (8.8) 173.8 (7.9) Mass (kg) 80.8 (15.2) 81.6 (14.3) 80.0 (16.8) 80.5 (16.4) 67.7 (13.2) 70.7 (8.5) BMI (kg.m − 2 ) 26.2 (4.4) 26.7 (3.9) 25.0 (3.8) 25.3 (3.8) 22.2 (2.6) 23.6 (3.7) Σ skinfolds (mm) 62.8 (22.9) 63.1 (16.7) 56.9 (7.9) 83.3 (12.6) 38.9 (14.0) 49.5 (21.6) Body fat (%) 26.8 (7.3) 27.2 (6.1) 23.4 (8.2) 26.2 (4.6) 18.0 (6.6) 21.6 (8.7) Waist:hip ratio 0.89 (0.05) 0.89 (0.04) 0.86 (0.06) 0.89 (0.05) 0.79 (0.06) 0.80 (0.06) Environmental conditions Air temperature (°C) 26.2 (3.7) 24.6 (3.7) 14.3 (0.5) 26.7 (5.4) 24.4 (1.6) 24.2 (1.3) WBGT (°C) 22.2 (2.4) 21.5 (2.4) 12.3 (0.8) 22.7 (2.4) 22.3 (1.7) 21.7 (2.0) Average wind speed (knots) na 9.5 (5.4) na 9.5 (5.9) Gust speed (knots) na 12.8 (4.9) na 11.8 (4.5) Water temperature 5 cm (°C) 22.9 (2.1) 20.9 (0.7) 18.1 (0.0) 21.9 (1.6) 31.1 (0.7) 31.6 (0.8) Water temperature 50 cm (°C) 22.5 (2.0) 20.7 (0.6) 17.9 (0.0) 21.8 (1.6) Water flow (m.s − 1 ) 0.0 0.0 (0.04) 1.4–1.7 0.4 (0.09) Average wave height (cm) na 6.9 (2.1) na 5.0 (1.3) Maximum wave height (cm) na 12.2 (3.8) na 8.3 (2.1) Water specific gravity 1.000 1.027 (0.001) 1.000 1.027 (0.001) Table 2 Water and swimming experience of participants. Note that the percentages do not add up to 100% as some participants reported undertaking water-based activities and swimming Percentage engagement Study 1 Study 2 Activity/experience PRAC COACH No water-based activity 56 18 42 Activities around (but not in or on) water 32 73 42 Water-based activities 20 9 17 Infrequently swim for recreation 16 27 0 Swim once a week for recreation 12 0 8 Swim regularly for recreation (2–3 times per week) 4 0 0 Swim for fitness 4 18 0 Prior to any floats, participants were asked to describe the actions they would undertake to float and their responses are summarised in Table 3 . The most common response from participants in Study 1 was to lie back but only 28% of these specified head back, the next most common response was to relax or stay calm. Eight participants reported arm/leg movement, three of which described sculling, four were vague and one suggested pushing down on water. Many thought the legs should be up on the surface and the core “engaged”, only five identified having arms/legs out as being necessary. Two participants stated breathing should be controlled and two said the lungs should be inflated. In Study 2, all participants reported attempting to float previously and this was, on average, 1.7 (3.0) years ago (range 1 month to 10 years) for the PRAC group and 3.2 (5.2) years ago (range 1 week to 13 years) for the COACH group. In both groups, approximately half of the participants stated you should lie back to float, only 3 (2 in PRAC, 1 in COACH) specified head back and 6 (2 in PRAC, 4 in COACH) said head up or out of water (Table 3 ). Approximately half of the participants reported arm/leg movement, although these were generally vague with only 1 participant describing sculling. Six participants in PRAC and four in COACH reported a starfish shape, although one participant in COACH stated the arms should be at the side. Several participants (3 in PRAC, 4 in COACH) reported the core should be engaged, in PRAC one participant thought the legs should be kept up whilst in COACH one participant thought the legs should be down. None of the participants in Study 2 reported relaxing as being necessary for floating. Table 3 Initial perceived actions required to undertake a float prior to any floats or instruction. “Accurate” indicates correct action described (e.g. movement: sculling described), “Vague” indicates a response which may or may not be accurate (e.g. breathing: full lungs will increase buoyancy but is not sustainable) and “Hinder” indicates actions that are likely to hinder floating (e.g. pushing down on the water describes the incorrect action for sculling; engaging the core and keeping legs up will cause unnecessary effort and prevent relaxation). Values are percentage response for each group and therefore do not add up to 100%. % Study 1 Study 2: PRAC Study 2: COACH Accurate Vague Hinder Accurate Vague Hinder Accurate Vague Hinder Head back 20 52 17 33 17 9 45 36 Relax 36 12 Arms/legs spread 28 50 36 9 Movement 12 16 4 50 9 45 Breathing 16 8 8 9 9 Engage core 20 25 36 Legs up 28 8 Study 1: Still fresh water floats Participant characteristics and environmental conditions are shown in Table 1 . Perceived floating difficulty prior to the float decreased over the first three floats (P < 0.05, Fig. 2 A). Float 4 was expected to be more difficult than either Float 2 (P < 0.05) or Float 3 (P = 0.001) with the perceived difficulty expected with clothing and the simulated fall being similar (P = 0.417). Confidence prior to the floats increased over the first three floats (P < 0.01, Fig. 2 B). Participants felt less confident prior to Float 4 compared to Float 3 (P < 0.01) with the impact of clothing and the simulated fall being the same. Confidence in floating with clothes during Float 4 was greater than prior to Float 1 (P = 0.004). Floating competence, as assessed using the Moran scale, improved with each float (P < 0.01, Fig. 2 C), with less movement required to keep the airway clear with each successive float. Although most participants with a Moran score of 8 or above floated horizontally on the surface, there were some participants who could float with minimal movement in a more vertical position. This was associated with a reduction in perceived exertion (RPE) with successive floats (P < 0.05, Fig. 2 D). However, although RPE during Float 4 was lower than Float 1 and 2, it was not different from Float 3. Combining the Moran scores and RPE scores to get an index of floating efficiency showed that participants became more efficient with successive floats (P < 0.05, Fig. 2 E), though no further improvement was seen between Floats 3 and 4. Compared to Float 1 and 2, participants reported floating was easier during Float 3 and 4 (P < 0.01), however there was no difference in perceived difficulty between Floats 1 and 2 or Floats 3 and 4 (Fig. 2 F). For all floats, participants reported floating being between “about the same” and “less difficult” than they thought (Fig. 2 G). Confidence in floating ability increased with successive floats (P < 0.05, Fig. 2 H), though confidence did not significantly increase between Floats 3 and 4. The percentage of participants that reported their breathing on immersion interfered with their ability to float is shown in Table 4 . Interference from the cold shock decreased over the first three immersions (P < 0.05), but increased during Float 4 compared to Float 3 (P = 0.038) due to head immersion during the simulated fall. Less than 25% of participants reported any interference from shivering and no significant difference was observed between floats (Table 4 ). Table 4 Percentage of participants reporting breathing and shivering affecting their ability to float at the start of their immersion in water at 23°C Float 1 Float 2 Float 3 Float 4 Naive RNLI Coaching Fall Breathing Not at all 32 59 67 50 A little bit 41 18 33 32 Quite a lot 14 18 0 14 Greatly affected 9 5 0 5 Breathing stopped me floating 5 0 0 0 Shivering Not at all 77 77 86 77 A little bit 14 5 14 14 Quite a lot 9 18 0 9 The majority of participants (64%) found the RNLI messaging helpful. After watching the RNLI “Float to Live” video and looking at the associated poster, 7/22 participants reported the instruction to “put your head back” helped them to float (Table 5 ). 4/22 participants found putting their arms or legs out helped. 3/22 of participants reported the instructions to relax, control breathing or move their limbs helped. Two thought that practice had helped them. On the other hand, two reported that keeping their legs up was useful, however for these two individuals this probably increased the effort required as they naturally floated in a vertical position. Four participants did not find the instructions helped their float and four reported they were confusing or unhelpful (“ video didn't help, concentrated too much and didn't relax”; “image - bent knees & let bum sink”; “Move arms and legs - vague & not helpful”; “Use arms and legs - didn't help how should they be used? Swim and shout for help counter to previous floating advice” ). The most helpful instructions provided by the swim instructors were to put their head back further (so the ears were submerged), relax and not to hold their breath but to keep breathing (Table 5 ). Instructions on limb action were also helpful and these included: “ stroking the dog, kicking a little”; “hands in sideways motion rather than up and down”; “sculling deeper, kicking legs” . Being told it didn’t matter if their legs sank helped four participants and not having to be in a starfish position also helped another participant. On the final float, the most frequent helpful instructions reported by the participants were to relax and put their head back (Table 5 ). Other comments included: “ not worrying if legs sink”; “stroke cat/dog lower in water”; “calm breathing as quickly as possible”. Study 1: Still sea water floats Participant characteristics and environmental conditions are shown in Table 1 . Three participants undertook all four floats (1. naïve, 2. following RNLI instruction, 3. following float coaching from a swim instructor and 4. a simulated fall) in still sea water; their responses are given in the supplementary material. The responses to floats following coaching either in fresh water or sea water and following a simulated fall are shown in Fig. 3 . Floating competence improved (less movement was required to maintain the float, Fig. 3 C) in the final float (simulated fall), however this was not accompanied by any change in perception of the difficulty or confidence in floating either prior to (Figs. 3 A and B) or after the float (Figs. 3 F to H). Instructions that helped the participants to float are shown in Table 5 . Those most frequently reported were: head back (one participant stated string on back of head instruction ), relax or stay calm and control breathing. Having the arms or legs wide and adjusting them to the wave motion was also reported as helpful. Eight participants indicated that they would have benefitted from knowing how to deal with waves e.g. “ how to relax/breathe with wave splash over face ”. One participant reported that it would be helpful if information on “ the difference between floating in sea and fresh water ” was given as they did not know they were more buoyant in sea water, this was probably the case with other participants but it was not reported. Table 5 Instructions from the RNLI video and poster, following float coaching and following the last float (Sim fall), that the participants reported helping their floating. Percentage response is given for all participants and those considered active or passive floaters. Still fresh water Sea water All (n = 22) Active floaters (n = 9) Passive floaters (n = 13) Still (n = 13) Moving (n = 6) RNLI video Float coaching Sim fall RNLI video Float coaching Sim fall RNLI video Float coaching Sim fall Float coaching Sim fall Float 1 Sim Fall Head back 32 45 45 44 33 56 23 54 38 54 54 83 75 Arms/legs out 18 18 14 11 11 23 23 23 31 15 17 25 Relax 14 45 55 44 44 23 46 62 38 54 50 100 Breathing 14 41 32 22 22 23 54 38 31 38 33 50 Limb movement 14 45 27 22 78 44 8 23 15 8 8 17 0 Practice 9 5 15 8 17 25 Legs up 9 27 27 22 33 33 15 23 31 8 50 75 None 18 5 5 22 15 8 8 Unhelpful 18 23 Fresh vs sea water floats Ten participants (6 women, 4 men; height: 176.3 [8.8] cm; mass: 84.5 [15.8] kg; BMI: 27.0 [4.3] kg.m − 2 ; sum of skinfolds: 62.0 [15.4] mm; body fat: 28.2 [5.2]; waist:hip ratio: 0.90 [0.04]) undertook floats in still fresh water and sea water. Prior to their still water floats, participants perceived floating in sea water would be more difficult than in fresh water (P = 0.035, Fig. 4 A) and had less confidence (P = 0.034, Fig. 4 B). Although their floating competence was better in sea water compared to fresh water (P = 0.031, Fig. 4 C) this was not reflected in their reported perception of effort (Fig. 4 D), difficulty (Fig. 4 F and G) or confidence (Fig. 4 H). When asked which condition they thought was easiest to float in, most participants stated sea water was easier (8/10). Two participants (both with a Moran score of 10 in fresh water) found fresh water floats easier due to wave action in the sea. No differences were observed between the floats in fresh water or sea water following a simulated fall (Fig. 4 ). Study 1: Moving sea water floats Participant characteristics and environmental conditions are shown in Table 1 . Prior to their floats, no difference in anticipated floating difficulty or confidence was observed between still or moving sea water conditions (Figs. 5 A and B). Compared to still sea water, floating in moving sea water was perceived to be more difficult (Fig. 5 F, P = 0.025) and require greater exertion (Fig. 5 D, P = 0.046) although there was no difference in floating competence (Fig. 5 C) or efficiency (Fig. 5 E). Floating confidence following the floats was not different between the two conditions (Fig. 5 H). Instructions that the participants reported helping them to float in moving water were similar to those reported for the still sea water (Table 5 ), however a greater proportion reported having their head back (83% vs 54%) and relaxing (50% vs 38%) as helpful for the moving water. Study 1: Moving fresh water floats Participant characteristics and environmental conditions are shown in Table 1 . Prior to the floats in moving fresh water there was no difference in anticipated floating difficulty or confidence (Fig. 6 A and B). On the first immersion in moving fresh water, all participants managed to float with their airway clear of the water and the average float competency was the same as in still water (Moran score during Float 3 in still water = 6.8 [1.6]; Float 1 in moving fresh water = 6.8 [1.6]). All but one participant showed an improvement in their moving water technique (Fig. 6 C) following coaching by a SLS-GB instructor (however, this participant reported the floating difficulty was reduced and confidence was increased following instruction). The breakdown of actions correctly undertaken by the participants during their immersions is given in Table 6 . Floating difficulty showed a trend towards being reduced (χ 2 = 5.60, P = 0.061, Fig. 6 E). Rating of perceived exertion (Fig. 6 C) and floating confidence (Fig. 6 G) did not differ between the floats. On entry into the water, all participants either had their face splashed or their head was submerged under the water. Breathing interfered with the ability to float during the first float (4 out of 5 participants) and less so following instruction (1/5) or the simulated fall (2/5). There was a trend towards a significant decrease in breathing interference between the first and second floats (χ 2 = 6.50, P = 0.039; Z = -1.89, P = 0.059). The instructions that helped the participants float during their first float in fresh moving water were similar to those in still fresh water and included head back (n = 4), relax (n = 3), leg and arm position. The instructions that the participants reported being helpful on their second and third floats reflected in the instructions given by the SLS-GB instructor (Table 6 ). Table 6 Percentage of participants that correctly undertook the actions recommended by SLS-GB during their moving fresh water immersions as assessed from video analysis and instructions that the participants found helpful during their floats (n = 5). Actions correctly performed Helpful instructions Naïve Coaching Simulated fall Coaching Simulated fall Feet downstream 40 80 80 40 80 Chin on chest 40 80 80 60 20 Knees bent 20 100 100 40 20 Legs together 0 40 40 Heels lower than bottom 40 60 80 Arms out for stabilisation 100 100 100 20 When calm float 100 80 100 40 40 Defensive position 20 20 Relax 40 Anthropometric factors influencing floating competence Correlations were conducted between floating competence as assessed using the Moran scale and participants’ anthropometric measurements. In still fresh water, floating competence during the first float was positively correlated with skinfold thickness at the bicep (P < 0.001; Fig. 7 A), tricep (P = 0.003; Fig. 7 B) and thigh (P < 0.001; Fig. 7 C) as well as the sum of 4 skinfolds (bicep, tricep, subscapular and supra iliac; P = 0.001; Fig. 7 D), sum of 5 skinfolds (bicep, tricep, subscapular, supra iliac and thigh; P < 0.001; Fig. 6 E) and percentage body fat (P < 0.001; Fig. 6 F). Floating competence during Float 3 (after instruction) in still fresh water was correlated with the same variables as seen in Float 1: bicep skinfold (P < 0.001; Fig. 6 G); tricep skinfold (P < 0.001; Fig. 7 H); thigh skinfold (P < 0.001; Fig. 7 I); sum of 4 skinfolds (P = 0.001; Fig. 7 J), sum of 5 skinfolds (P < 0.001; Fig. 7 K) and percentage body fat (P < 0.001; Fig. 7 L). No significant correlations were observed with mass, BMI, waist:hip ratio, subscapular skinfold or supra iliac skinfold and floating competency for either Float 1 or Float 3. Fewer relationships were observed between floating competency in still sea water (following instruction in either fresh water or sea water) and anthropometric measures. As with the floats in still fresh water, correlations were observed between bicep skinfold (P = 0.003; Fig. 8 A), tricep skinfold (P = 0.031; Fig. 8 B), thigh skinfold (P = 0.005; Fig. 8 C), sum of 5 skinfolds (P = 0.007; Fig. 8 D) and percentage body fat (P = 0.002; Fig. 8 E). No significant correlations were observed with any of the other measures. Study 2: Coaching versus practice Participant characteristics and environmental conditions are shown in Table 1 . Prior to floating, there was no difference in perceived float difficulty or confidence between PRAC and COACH (Fig. 9 A and 9 B). There was a trend for a main effect of float with perceived difficulty decreasing between Float 1 (naïve) and Float 3 (P = 0.061). No differences were observed between PRAC and COACH for floating competency (Fig. 10 A), RPE (Fig. 10 B), efficiency (Fig. 10 C), heart rate (Fig. 10 D) and angle (Fig. 10 E). However, there was a main effect of float, with float efficiency improving between Float 1 and 3 (P = 0.047; Fig. 10 C); float angle becoming more horizontal between Float 1 and 2 (P = 0.005) and Float 1 and 3 (P = 0.006; Fig. 10 E); heart rate decreasing between Float 1 and 2 (P = 0.020) and Float 1 and 3 (P = 0.006; Fig. 10 D); and RPE decreasing between Float 1 and 2 (P = 0.014) and Float 1 and 3 (P = 0.001; Fig. 10 A). There was also a trend for float competency to improve between Float 1 and 3 (P = 0.055; Fig. 10 A). Post float difficulty was not different between groups and reduced with successive floats (Float 1 vs 2, P = 0.001; Float 2 vs 3, P = 0.001; Float 1 vs 3, P < 0.001; Fig. 9 C). Participants also reported finding the float less difficult than they thought in Float 1 compared to Float 2 (Fig. 9 D). Post float confidence was increased with successive floats (Float 1 vs 2, P < 0.001; Float 2 vs 3, P = 0.015; Float 1 vs 3, P < 0.001; Fig. 9 E). There was an interaction effect between float and group with COACH increasing their confidence after their 2nd float (Float 1 vs 2, P < 0.001; Float 1 vs 3, P < 0.001; Float 2 vs 3, P = 0.168) and PRAC increasing their confidence after their 3rd float (Float 1 vs 2, ns; Float 1 vs 3, P = 0.026; Float 2 vs 3, P = 0.074). However, there was no between group difference. Discussion This is the first study to evaluate the effectiveness of a public safety campaign on floating competence of inexperienced water users in realistic open water conditions. The RNLI messaging did improve float competence and confidence whilst reducing perceived difficulty. However, further improvements were made following individualised float coaching indicating the messaging could be refined further especially for active floaters. Importantly these instructions were applicable in a range of realistic open water scenarios (open fresh and sea water, slow moving water, with clothing and following a simulated fall) and therefore we can accept our hypothesis. The participants who volunteered for the current studies were not experienced water users and none were trained or competitive swimmers and only 32% were confident in their ability to float prior to taking part. Participants in Study 1 were men and women from a wide age range (20 to 60 years old) with a similar BMI to the adult UK population (27.6 kg.m − 2 ; National Health Service 2022) and therefore representative of the general adult population regarding their physical characteristics. Floating competence in still fresh water was improved with the combination of instruction and practice. This was associated with an improved float efficiency and decreased RPE. As a consequence, perceived floating difficulty decreased and confidence increased. The RNLI messaging helped most of the participants (64%) to float, with the instruction to “put your head back” being reported the most helpful (Table 5 ). The swim teachers we able to emphasise this body position by giving more specific instructions (put head back so the ears are submerged) which was helpful to additional participants (Table 5 ). This corresponds to backstroke swimming where inexperienced observers did not fully appreciate the importance of the correct head position compared to experienced swim teachers (Stibilj et al. 2020 ). From the RNLI messaging, many of the participants interpreted that a horizontal float position should be adopted and as a result some expended considerable energy keeping their legs up. Being told by the swim teachers that it is OK if their legs dropped was found to be helpful, particularly for the participants who naturally floated in a more vertical position. One of the most frequent instructions given by the swim teachers was to relax, interestingly participants seemed to report this as more helpful the more floating practice they had, with it helping 45% on their 3rd float, 55% on their 4th float (simulated fall with clothing), with all of the participants finding it helpful following a simulated fall into moving sea water (after 6 to 8 floats; Table 5 ). The RNLI messaging to “use your arms and legs to keep you afloat” was not found helpful and if done incorrectly would actually impede floating. The participants who were “active” floaters benefitted from the additional instructions given by the swim teachers describing sculling. For some participants, the analogy of “stroking a dog” to describe the sculling action was particularly helpful. The use of analogies has been found to facilitate implicit learning (Liao & Masters 2001 ; Tse et al. 2017 ) and enhance motor skill acquisition in swimming whilst still enabling learners to develop individual movement patterns (Komar et al. 2014 ). Therefore, combining implicit (sculling analogy) and explicit (head position) instructions is important as the required floating technique is individual and dependent on anthropometric characteristics as well as environmental conditions. Furthermore, a motor skill developed through implicit learning is less affected by stress (Liao & Masters 2001 ; Lola & Tzetzis 2021 ) and retained for longer (Allen & Reber 1980 ), both factors being important in the event of an accidental immersion. In the current study, floating competence was not impaired (and actually improved) following a simulated fall despite participants feeling less confident prior to the float. This could reflect the robustness of the prior implicit learning which was unaffected by the stress associated with head submersion. Whilst we did not measure skill retention specifically, 10 participants undertook floats in sea water 25 days (range 2 to 54 days) after being coached in fresh water and no difference in float competence was observed indicating floating skills had been retained. The inclusion of analogies to promote implicit learning may be beneficial in public messaging as it is less affected by intelligence than explicit learning (Reber et al. 1991 ) and will therefore be useful to a wider audience. The skills learnt in still water enabled successful floats in moving water indicating that the floating skills learnt in a pool will be transferrable to a wide range of open water environments. Where water is turbulent, aerated or obstacles are present, defensive floating would be more appropriate. However even in the moving fresh water representative of a Grade 1 river, participants were able to float successfully. Participants perceived that wearing clothing would make floating more difficult. However, despite the worst-case scenario of a vertical drop into the water (which removes most of the inherent buoyancy provided by clothing) floating competency was found to further improve. This is similar to previous research (Tipton & Massey 2018 ), where despite clothing increasing buoyancy it was perceived to increase the difficulty of floating by “dragging people down”. Another misconception was that it would be harder to float in the sea, with some participants not knowing that they would be more buoyant in salt water. Whilst less activity was required to maintain a float in sea water compared to fresh water for active floaters (Fig. 3 ), participants who were motionless in the still lake needed to undertake some activity in the sea to stabilise themselves in the slight chop. The second study was conducted to examine the relative role of practice and instruction on floating skill acquisition. Unlike the study in open water, no statistically significant improvements in floating competence (using the Moran score) were observed after practice, instruction or a combination practice and instruction (Fig. 10 ). However, heart rate was reduced and this was accompanied by a reduction in perceived effort and difficulty and increased confidence (Figs. 9 and 10 ). The lack of effect of either training or practice on floating competence in Study 2 is probably due to combination of the situation and the poor sensitivity of Moran score to measure floating competence. The restricted size of the flume meant that participants who floated vertically had to actively raise their legs and the actions of some participants set up a standing wave which increased the difficulty of the float. Although the results did not support our hypothesis, that coaching would improve floating competence more than practice, 86% participants stated a preference for coaching followed by practice as this increased their confidence level early and provided an opportunity to practice later. Correlations between body composition and floating competency (Figs. 7 and 8 ) indicate that higher levels of subcutaneous body fat were advantageous to floating as they reduced the activity required to maintain a float. This finding is unsurprising given the buoyancy afforded by body fat. Previous studies have demonstrated that airway freeboard during floating is correlated with both sum of skinfold thickness and percentage body fat (Barwood et al. 2011 ). Neither BMI nor waist to hip ratio acted as surrogates for body fat measurement as no correlations were found between them and floating competency. This is not surprising since BMI does not distinguish between muscle and fat mass whereas fat, but not muscle, increases buoyancy. Therefore, simple measures (such as BMI or girth measurements) that the general population could do on themselves would not be reliable indicators of their buoyancy and, therefore, whether they are likely to be “active” or “passive” floaters. Further research is required to develop a comprehensive floating topography from recording the range of actions and positions which enable successful floats in individuals encompassing a wide range of body compositions and anthropometry. Despite the temperature of the open water averaging 23°C, 68% of participants found that breathing affected their ability to float to lesser or greater extent. It is a commonly held misconception that the cold shock response is only seen in water temperatures of 15°C or below (Wilson et al. 2023 ), in fact the maximum response is evoked between 10°C and 15°C (Tipton et al. 1991 ). Therefore, any messaging should make the public aware that even in open water usually considered “warm”, individuals may experience the cold shock and that this will impact on their ability to breath hold and float. In colder water, both the magnitude and duration of the cold shock response would be increased (Tipton et al. 1991 ) and this may impair the ability to float. As expected interference from the cold shock decreased over the first three immersions (P < 0.05), but increased during Float 4 compared to Float 3 (P = 0.038) due to head immersion during the simulated fall. This reduction in response is due to habituation of the cold shock response with repeated immersions (Golden and Tipton 1988 ) and can occur even when immersions occur on the same day (Eglin et al. 2015). Less than 25% of participants reported any interference from shivering during their floats (Table 4 ) and this was due to the relatively warm water and the short duration of immersion. In colder water, when there is greater skin cooling and during prolonged immersions (where core cooling will also occur) the shivering response will be much greater (Tikuisis and Giesbrecht 1999 ). The combination of the behavioural response to curl up (to reduce the surface area for heat loss) and intensive shivering is likely to reduce the ability to float. Conclusions This study has demonstrated that a public health campaign “Float to Live” can improve the floating competence and confidence of inexperienced water users in realistic open water scenarios. Further improvements were observed following additional instructions provided by swim teachers. As a result, “tilt your head back with ears submerged”, “relax and move your hands to help you stay afloat” and an image of an individual floating in a more vertical position have now been incorporated into the new RNLI “Float to Live” messaging. Importantly, the skills acquired were applicable in a range of realistic open water scenarios (open fresh and sea water, slow moving water, with clothing and following a simulated fall) and were retained. Given there were no differences in floating competence between the COACH and PRAC groups, individuals should practice floating as the skills learnt are transferable to a range of open water conditions. Abbreviations ANOVA analysis of variance CIWWC Cardiff International White Water Centre COACH Group undertaking floats in following order: 1) naïve, 2) after coaching, 3) after practise CSR cold shock response PRAC Group undertaking floats in following order: 1) naïve, 2) after practise, 3) after coaching RNLI Royal National Lifeboat Institute RPE rating of perceived exertion SLS GB–Surf Life Saving GB SUP stand up paddleboard Declarations Funding This project was funded by the Royal National Lifeboat Institute, UK. Author Contribution CE, HM, GL and MT were involved in conception of the project and all authors contributed to the design of the project. CE, HM and GL were involved in data acquisition and analysis. CE, HM, GL and MT were involved in interpretation of the data. CE wrote the first draft of the manuscript and all authors reviewed and approved the final submission. Acknowledgements This research was funded by the Royal National Lifeboat Institution (RNLI). Many thanks to: the participants for their courage, especially to those who went considerably outside their comfort zone; the swim instructors, Bekki Kingshott and Chris Pitman for imparting their knowledge to the participants in such a friendly way; SLS-GB for sharing their wealth of knowledge on moving water and keeping us all safe; the locations we used (Andark Lake, Andrew Simpson Centre and Cardiff International White Water) and the support they generously provided. Finally, thanks to Peter, Jen and Josh for their help. Data Availability The anonymised data collected are available as open data via the University of Portsmouth online data repository References Allen R, Reber AS. Very long term memory for tacit knowledge. Cognition. 1980; 8(2):175-85. doi: 10.1016/0010-0277(80)90011-6. Barwood MJ, Bates V, Long G, Tipton MJ. "Float First": Trapped Air Between Clothing Layers Significantly Improves Buoyancy After Immersion. Int J Aquatic Res Edu. 2011; 5(2). Barwood M, Massey H, Tipton M. “Float First”: evidence-base for the Royal National Lifeboat Institute’s “Respect the Water” Campaign. 2018, University of Portsmouth report to the Royal National Lifeboat Institute. Borg GAV. (1982). Psychophysical bases of perceived exertion. Med Sci Sport Exer. 1982; 14 ( 5), 377–381. https://doi.org/10.1249/00005768-198205000-00012. Eglin C, Butt G, Howden S, Nash T, Costello J. Rapid habituation of the cold shock response. In Proceedings of the 16th International Conference on Environmental Ergonomics, Portsmouth, UK 29th June to 3rd July 2015, p54. Golden FStC, Tipton MJ. Human adaptation to repeated cold immersions. J Physiol. 1988; 396:349-63. Golden F, Hardcastle PT, Pollard CE, Tipton MJ. Hyperventilation and swim failure in man in cold water. J Physiol. 1986; 378, 94. Komar J, Chow JY, Chollet D, Seifert L. Effect of Analogy Instructions with an Internal Focus on Learning a Complex Motor Skill. J Appl Sport Psychol. 2014; 26:1, 17-32, DOI: 10.1080/10413200.2013.771386. Lola AC, Tzetzis GC. The effect of explicit, implicit and analogy instruction on decision making skill for novices, under stress. Int J Sport Exer Psychol. 2021; DOI: 10.1080/1612197X.2021.1877325. Liao C-M, Masters RSW. Analogy learning: A means to implicit motor learning, J Sports Sci. 2001; 19:5, 307-319, DOI: 10.1080/02640410152006081. Mekjavic IB, Bligh J. The increased oxygen uptake upon immersion. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4318349","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":296461834,"identity":"e3f7e7fa-49a6-420c-b9ba-7bd44838eabf","order_by":0,"name":"Clare Eglin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYDACdijNx8zA+AAhfACPFmYozcbMwGwApCVI0AJEEkRp4W9mfvbhA4ONXRs777Hqgop7dQzshx8w85zBrUXiMJvxzBkMacltzHxpt2ecKZZg4EkzYOa5gVuLATODMTMPw+FkNmYes9u8bQlAh+UwMPN8wKeF/TPzH4b/YC3FYC38bwhp4TEGhsABO5AWZrAWCZAteBwmcZinmLHHIDkBqMVYesaZBMk2iWcGB+fg8T5/e/tmhh8Vdvb8/GcMPxdUJPDz8yc/fPDmGG4tUOcxJDYwQOMIGEF4IxIO7BkYENE6CkbBKBgFowAFAABl7j2PSSgnpAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Portsmouth","correspondingAuthor":true,"prefix":"","firstName":"Clare","middleName":"","lastName":"Eglin","suffix":""},{"id":296461835,"identity":"c71f22a2-b266-43d4-b19b-b1a3b1040cde","order_by":1,"name":"Heather Massey","email":"","orcid":"","institution":"University of Portsmouth","correspondingAuthor":false,"prefix":"","firstName":"Heather","middleName":"","lastName":"Massey","suffix":""},{"id":296461836,"identity":"860f0bf3-aa09-4746-8a7c-b11bf0f83e8d","order_by":2,"name":"Geoff Long","email":"","orcid":"","institution":"University of Portsmouth","correspondingAuthor":false,"prefix":"","firstName":"Geoff","middleName":"","lastName":"Long","suffix":""},{"id":296461837,"identity":"7e03abb9-1168-4e68-8d64-5669656be15d","order_by":3,"name":"Adrian Mayhew","email":"","orcid":"","institution":"Surf Life Saving GB","correspondingAuthor":false,"prefix":"","firstName":"Adrian","middleName":"","lastName":"Mayhew","suffix":""},{"id":296461838,"identity":"94886916-4ef0-4b8b-bf13-9ef9da2d2918","order_by":4,"name":"Michael Tipton","email":"","orcid":"","institution":"University of Portsmouth","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Tipton","suffix":""}],"badges":[],"createdAt":"2024-04-24 12:49:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4318349/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4318349/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-024-19409-6","type":"published","date":"2024-07-29T15:57:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55809134,"identity":"6fc87143-8e08-45b5-b7a0-2b9c462d6b3a","added_by":"auto","created_at":"2024-05-03 15:37:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44188,"visible":true,"origin":"","legend":"\u003cp\u003eOrder of floats undertaken by participants in Study 1 (A) for each of the conditions (still and moving fresh water and sea water). Order of floats undertaken by participants in the PRAC and COACH groups in Study 2 (B). The number of participants undertaking each float is also shown.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/6828f51f024c8cb9cbc24c73.png"},{"id":55809140,"identity":"97de447b-bd21-4086-8fa8-e2e1521dc244","added_by":"auto","created_at":"2024-05-03 15:37:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":91002,"visible":true,"origin":"","legend":"\u003cp\u003eResponses before (Pre float), during and after (Post float) floats in fresh water (n = 22). The width of the violin plot indicates the frequency distribution. Bars indicate significant differences between floats * P \u0026lt; 0.05, ** P \u0026lt; 0.01 and *** P \u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/c9305d2a26de4441be15c7e7.png"},{"id":55809137,"identity":"fab8dcd0-e2af-495d-837f-a8facf3c6c01","added_by":"auto","created_at":"2024-05-03 15:37:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75152,"visible":true,"origin":"","legend":"\u003cp\u003eIndividual responses of the participants who undertook floats in still sea water. 10 participants had coaching and previous floating practice (4 floats) in still fresh water and 3 participants had coaching and previous floating practice (2 floats) in still sea water. The width of the violin plot indicates the frequency distribution (the wider the violin, the more participants reported this score and \u003cem\u003evice versa\u003c/em\u003e), * P \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/154e3614d11b1d27a45eee55.png"},{"id":55809988,"identity":"eab6a4bd-ac0f-43f0-968c-0c10d6ab6913","added_by":"auto","created_at":"2024-05-03 15:45:34","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":69189,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of floats in still fresh water and sea water. Individual responses are shown for the standard floats (wearing swim wear - Float 3 in fresh water vs float 1 in sea water; n = 10) and floats following a simulated fall (wearing shorts and T-shirt - Float 4 in fresh water vs float 2 in sea water n = 8), * P \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/8719ccba7e6d246aaabcfcec.png"},{"id":55809143,"identity":"804a2218-4300-481b-9db5-c806468d664d","added_by":"auto","created_at":"2024-05-03 15:37:35","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":63099,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of floats in still and moving sea water. Individual responses are shown for standard floats (wearing swim wear; n = 6) and following a simulated fall (wearing shorts and T-shirt; n = 4) in still and moving sea water. * P \u0026lt; 0.05 between still and moving standard floats, no statistics were conducted on the floats following a simulated fall owing to the small sample size.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/0d566ecd418c3e19b7c5585d.png"},{"id":55809145,"identity":"1f790534-f7bd-4734-a737-00a98a2a70c9","added_by":"auto","created_at":"2024-05-03 15:37:35","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":83432,"visible":true,"origin":"","legend":"\u003cp\u003eIndividual responses of the participants who undertook floats in moving fresh water (n = 5).\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/a0ea679ed1b493482c091e5f.png"},{"id":55809146,"identity":"d29ed18a-ea7a-4d33-ab92-66d93bd58c48","added_by":"auto","created_at":"2024-05-03 15:37:35","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":52748,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations between anthropometric measures and floating competence in still fresh water in Float 1 (naïve, A to F) and Float 3 after instruction (G to L). Individual data points, regression line and R value are shown (n = 21).\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/40b33c97209b90533e8b3dc9.png"},{"id":55809144,"identity":"98971dcd-6720-4c12-bff1-94edf0b87127","added_by":"auto","created_at":"2024-05-03 15:37:35","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":39810,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations between anthropometric measures and floating competence in still sea water after instruction in either fresh or sea water. Individual data points, regression line and R value are shown (n = 13).\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/4ec1a9a5032c3258426e20de.png"},{"id":55809142,"identity":"b59db29d-bea3-40c5-9c9d-7fce4a36d317","added_by":"auto","created_at":"2024-05-03 15:37:34","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":74420,"visible":true,"origin":"","legend":"\u003cp\u003ePre and post float perceived floating difficulty and confidence for PRAC (n = 11) and COACH (n = 12) groups floating in a flume in Study 2. The width of the violin plot indicates the frequency distribution and the dashed line the median. Bars indicate significant differences between floats * P \u0026lt; 0.05, ** P \u0026lt; 0.01 (Panel E: solid bars show differences between floats for COACH and dashed bars show differences between floats for PRAC).\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/5cf5fb2ad098f8409a44294b.png"},{"id":55809141,"identity":"08e2fa7c-4f33-42d1-a866-dd029c06459d","added_by":"auto","created_at":"2024-05-03 15:37:34","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":79321,"visible":true,"origin":"","legend":"\u003cp\u003eResponses to floats in the flume for PRAC (n = 11) and COACH (n = 12) groups in Study 2. The width of the violin plot indicates the frequency distribution and the dashed line the median. Bars indicate significant differences between floats * P \u0026lt; 0.05 and ** P \u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/79b0e8f9e335d072a1511f2e.png"},{"id":61793537,"identity":"c6ae9875-fbcf-4fad-ae50-6e0a79f400d2","added_by":"auto","created_at":"2024-08-05 16:13:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1437108,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4318349/v1/ca84b0af-6265-4ec5-ba83-e33bc0f80ee4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Inexperienced water users can “Float to Live” in realistic open water conditions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThere are an estimated 236,000 annual drowning deaths worldwide (World Health Organization \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), with 226 accidental drowning fatalities occurring in the United Kingdom in 2022 (National Water Safety Forum, 2023). Approximately half of the UK drowning victims had not intended to go into the water and were therefore not prepared (National Water Safety Forum, 2024). One of the potential causes of drowning is the initial cardio-respiratory responses to cold water immersion, otherwise known as the cold shock response (CSR; Tipton \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1989\u003c/span\u003e). The CSR comprises an inspiratory gasp (of approximately 2.5 litres), followed by uncontrollable hyperventilation during which voluntary breath holding is severely compromised thus increasing the risk of drowning (Tipton \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1989\u003c/span\u003e). Heart rate, blood pressure and workload of the heart are also increased and arrhythmias may occur which may precipitate a cardiac arrest in individuals with underlying cardiovascular disease (Tipton \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1989\u003c/span\u003e). Whilst the responses peak in water temperature between 15\u0026deg;C and 10\u0026deg;C (Tipton et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1991\u003c/span\u003e), the CSR can occur in warmer water (Mekjavic \u0026amp; Bligh \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1989\u003c/span\u003e) and therefore most of the open water around the UK is cold enough to evoke the CSR, even in summer.\u003c/p\u003e \u003cp\u003eThe risk of drowning is increased if individuals attempt to swim when the CSR is at its peak, waiting 90 seconds for the hyperventilation to subside improves subsequent swimming ability (Golden et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1986\u003c/span\u003e; Tipton et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). To prevent drowning, the Royal National Lifeboat Institution (RNLI) has, based on the research noted above, been promoting a \u0026ldquo;Float to Live\u0026rdquo; message since 2017. This aims to keep the airway clear of the water on initial immersion by encouraging floating (Barwood et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) until the CSR has subsided, and before trying to swim (Golden et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1986\u003c/span\u003e). The RNLI \u0026ldquo;Float to Live\u0026rdquo; messaging provides instruction about how to stay afloat \u0026ndash; undertaking the minimum amount of activity possible, thereby minimising the challenge to the airway and strain placed on the heart, as well as maximising the amount of air retained within clothing layers, which provides additional buoyancy (Barwood et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). However, this advice is based on research conducted in indoor pools with confident and experienced open water swimmers. The current study tested the hypotheses that the RNLI \u0026ldquo;Float to Live\u0026rdquo; messaging would enable inexperienced water users to float in realistic open water conditions (still and moving open fresh water and sea water), and that floating confidence and competence could be further improved with individual float coaching. Since this involved an inevitable component of practice, in a second study, the effectiveness of float practice and coaching on floating confidence and competence were compared. It was hypothesised that coaching would improve floating competence and confidence more than practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn Study 1, a total of 25 participants undertook four floats in still open water (fresh or sea water). Six of these participants undertook a further two floats in moving sea water and five participants undertook a further three floats in moving fresh water. In Study 2, 23 participants undertook three floats in an indoor swimming flume.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e Volunteers (men and women aged 18 to 60 years) were recruited from University staff and students and the general population, they provided informed written consent prior to their participation. A favourable opinion was given by the Faculty of Science and Health, University of Portsmouth Research Ethics Committee for both studies (SHFEC-2022-066 and SHFEC-2023-005).\u003c/p\u003e \u003cp\u003eThe minimum water experience for participants undertaking floats in still water (open water or flume) was to be comfortable in chest-deep, still water. Participants undertaking floats in moving water were also required to be comfortable out of their depth in still water and be able to swim more than 25 m. Participants\u0026rsquo; maximum water experience was recreational swimming with no regular swimming in open water (other than the odd dip on holiday) and no competitive swimming (indoor, outdoor or triathlon/duathlon). Volunteers were also excluded if they had any cardiovascular or pulmonary disease, asthma triggered by cold or exercise, family history of sudden cardiac death, musculo-skeletal injuries that may impair movement in water, or had a fear of water.\u003c/p\u003e \u003cp\u003eParticipant demographics (age, sex, self-reported race) were recorded and anthropometric measurements were made in a private room and included measurements of height (SECA 213, SECA, UK), body mass (SECA 899, SECA, UK), circumferences of the waist, hip, chest, thigh and arm (anthropometric tape, Rosscraft, Canada) and skinfold measures taken using callipers (Harpenden skin fold calliper, Baty International, UK) at the bicep, tricep, subscapula, supra iliac and thigh. All anthropometric variables were measured and recorded by the same researcher for each study according to the guidelines produced by the International Society for the Advancement of Kinanthropometry.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eStill open water floats\u003c/h2\u003e \u003cp\u003eTwenty-two participants conducted floats in open still fresh water (a lake or lagoon), and thirteen participants conducted floats in sea water in Langstone harbour (during slack water). All floats were on the back, face up. Participants undertook four floats in still water, each lasting 2 minutes. The first three floats (standard floats) were undertaken wearing swimwear and neoprene shoes with neutral buoyancy, and the final float wearing summer clothing (T-shirt and shorts, with at least the T-shirt being dry). Prior to each float, participants were instructed to: \u0026ldquo;stay at the surface with the minimum effort that you need to keep your head above water for 2 minutes\u0026rdquo;. They then walked into the water until they were waist deep and were then given a countdown to start their float. The first float was conducted in waist to chest deep water, if they floated in a vertical position, participants were moved to deeper water (but only if they were comfortable to do so). For the final float (simulated fall), participants stepped into deep water from a platform (stairs or mega stand up paddleboard [SUP]) with a freeboard of no more than 10 cm, and were given the additional instruction to guard their mouth and nose with their hand as they entered the water to prevent a glossopharyngeal reflex. For safety reasons, the simulated fall was conducted last and only if the participant, researchers and experienced swim instructors were happy for them to do so. Participants who were not confident to step into deep water undertook a standard float wearing clothing. The floats were conducted in the order shown below so that the instructions given were incremental and, for safety reasons, the simulated fall occurred after a combination of instruction and practice:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo instruction (na\u0026iuml;ve)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAfter viewing the RNLI \u0026ldquo;Float to Live\u0026rdquo; video and poster\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFollowing coaching from an experienced swim teacher and qualified open water swim coach\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSimulating a fall wearing summer clothing (shorts and T-shirt)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003ePrior to their second float, participants watched the RNLI\u0026rsquo;s \u0026ldquo;Float to Live\u0026rdquo; video (Royal National Lifeboat Institute 2022) and looked at the associated poster. They were allowed to watch the video as many times as they wished and spend as long as they wanted looking at the poster. Before attempting the third float, coaching was provided by an experienced swim teacher, qualified open water swim coach. This was individualised to help the participant improve their floating technique. Most of the instruction was given out of the water and included showing them short video clips of their previous floating attempts to aid their learning. Some participants were given extra in-water instruction. Between their floats, participants dried off, put on a robe and were offered hot drinks to warm them up. Participants did not undertake their next float until they felt warm and therefore the duration between floats varied between individuals and with weather conditions.\u003c/p\u003e \u003cp\u003e Ten participants volunteered for still water floats in both fresh water and sea water and for logistic reasons they undertook their floats in fresh water first. Since they already had float coaching (from the RNLI video and swim teachers), they only completed two floats in sea water, one standard float and one wearing clothing after a simulated fall (equivalent to Floats 3 and 4 above).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eMoving open water floats\u003c/h2\u003e \u003cp\u003eFor safety reasons, participants completed floats in still water (as detailed above) prior to undertaking their floats in moving water. For the moving sea water condition, six participants undertook two floats in Langstone harbour, UK when the current was at its fastest during a rising or falling tide. Participants had either undertaken four floats in still sea water or four floats in still fresh water followed by two floats in still sea water beforehand. For the first moving water float, participants were transported against the current on a megaSUP to the point of entry into the water. They gently entered the water (sliding off the SUP from a seated position) wearing swim wear and neoprene shoes and commenced their float for up to 2 minutes. For the second float, the participants wore dry shorts and T-shirt and stepped off the paddle board into deep water before commencing their float. As with the still water, the participants were instructed to guard their mouth and nose with their hand as they entered the water. No additional instructions/coaching were given during the moving sea water floats as water turbulence and aeration were similar in the still and moving sea water. The study team stayed adjacent to the participants throughout their floats for their safety and to allow data collection.\u003c/p\u003e \u003cp\u003eFive participants conducted floats in moving fresh water at the bottom of the white-water course at Cardiff International White Water Centre (CIWWC), with the flow set to 4 cubic metres per second, simulating a Grade 1 river which is typical of UK inland water. Participants undertook three floats as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo instruction (na\u0026iuml;ve to moving water)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWith coaching from a Surf Life Saving Great Britain (SLSGB) instructor on techniques to use in moving water\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSimulating a fall wearing summer clothing (shorts and T-shirt)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eParticipants were ferried across to the centre of the water course in an inflatable rescue boat which was then tethered to ensure the participant would enter the water in the middle of the flow of water. For their first two floats participants wore swim wear and neoprene shoes, sat on the sponson with their feet facing down stream and slid into the water as gently as possible. On the final float, participants wore summer clothing (dry shorts and T-shirt), sat on the sponson with their feet facing downstream and fell into the water. Participants floated downstream to another rescue boat, the floating route and duration varied with each individual and during each of their floats, but typically lasted less than one minute. Between each float, the participants immediately dried off, donned a robe and stood in the sun to keep warm.\u003c/p\u003e \u003cp\u003eAdditional instructions were given to the participants in the moving fresh water as there was increased turbulence, aeration and obstacles in the moving water compared to the still water. After the first float, an experienced, qualified SLSGB instructor coached participants when out of water on the correct technique to adopt in moving water (\u0026ldquo;defensive\u0026rdquo; floating). Although standardised instructions and demonstrations were given, participants were allowed time to ask questions and clarify the actions required. The following instructions were given:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003efeet downstream\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003echin on chest and look where you are going\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003elegs together, knees bent and heels lower than bottom\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003earms out for stabilisation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eadopt \u0026ldquo;normal\u0026rdquo; float as soon as possible when in calmer water\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe order of floats undertaken by the participants for each of the conditions is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eStudy 2\u003c/h2\u003e \u003cp\u003eTwenty-three volunteers undertook three test floats wearing swimwear in a swimming flume (SwimEx 600-T Therapy Pool, length 4.2 m, width 2.3 m and depth 1.5 m) containing fresh water at 31\u0026deg;C with no flow. Participants attended an initial session in the laboratory where anthropometric measurements (as detailed above) were taken and subsequently used to create matched pairs of volunteers (matched for sum of skinfolds). One of the matched pairs was then randomly assigned (by the flip of a coin) to the practice session first (PRAC) or the coaching session first (COACH).\u003c/p\u003e \u003cp\u003eParticipants entered the water via a ladder and stood in the water (between waist and chest depth) before commencing their float. The first float was na\u0026iuml;ve with no prior coaching or practice allowed. Following this they either practiced their floating technique with no coaching for up to 5 minutes (PRAC) or were given individualised float coaching by a swim teacher (COACH) for up to 5 minutes before undertaking their second 2 minute float. Participants in the PRAC group were then given individualised float coaching, and those in the COACH group practiced their floating with no additional instruction (both for up to 5 minutes) before undertaking their final float. Each float lasted for up to 2 minutes and Floats 2 and 3 did not commence until heart rate had returned to baseline levels. The order of floats undertaken by both groups are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eAir temperature was measured close to the site of water entry using a wet bulb globe thermometer and recorded every minute on a data logger (Squirrel, Grants Instruments, UK). At Langstone harbour, wind speed and direction were measured at an adjacent building (Tudor Sailing Club, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and recorded prior to each float. The fresh open water sites were relatively sheltered therefore wind speed was not measured.\u003c/p\u003e \u003cp\u003eWater temperature was measured using calibrated thermometers at depths of 5 cm and 50 cm placed adjacent to the participant and recorded for each float. Specific gravity of the water was measured on each testing day using a refractometer. Water flow was measured at the point of water entry using a flowmeter (Model 001 Flowmeter, Valeport, UK). In the sea, wave height adjacent to the participant was assessed over a 20 second period during the float (retrospectively from video analysis) using a graduated pole, or estimated from the height of the SUP freeboard.\u003c/p\u003e \u003cp\u003e Prior to any floats or instruction, participants completed a pre-float questionnaire asking them to indicate their current participation in water-based activities. Self-reported water confidence in waist deep water and in water out of their depth using a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;very unconfident; 2\u0026thinsp;=\u0026thinsp;unconfident; 3\u0026thinsp;=\u0026thinsp;neutral; 4\u0026thinsp;=\u0026thinsp;confident; 5\u0026thinsp;=\u0026thinsp;very confident). Participants were asked whether they could swim 25 m in a heated swimming pool without putting their feet down, and also to indicate their swimming ability on a scale of 1\u0026ndash;10, where 1 was \u0026ldquo;I cannot swim at all\u0026rdquo; and 10 was \u0026ldquo;I am a great swimmer\u0026rdquo;. Participants were asked how difficult they find floating which was reported using a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;very easy; 2\u0026thinsp;=\u0026thinsp;easy; 3\u0026thinsp;=\u0026thinsp;neutral; 4\u0026thinsp;=\u0026thinsp;difficult; 5\u0026thinsp;=\u0026thinsp;very difficult), and how much confidence they have in their ability to float, again using a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;very unconfident; 2\u0026thinsp;=\u0026thinsp;unconfident; 3\u0026thinsp;=\u0026thinsp;neutral; 4\u0026thinsp;=\u0026thinsp;confident; 5\u0026thinsp;=\u0026thinsp;very confident). Finally, they were asked to list the actions they thought they needed to take in order to float. In Study 2, participants were also asked if they had tried to float before and if so, how long ago that was. Prior to each float, participants were asked to rate how difficult they thought their next float would be and how much confidence they had in their ability to float.\u003c/p\u003e \u003cp\u003eAll floats were filmed using two mobile cameras (GoPro HERO8, GoPro USA) which were positioned to obtain an aerial and a close up or underwater view of the participant. Floating competence was assessed over the last 30 seconds of each float by the same two researchers (CE and HM) from analysis of the videos using a slightly modified version of the Moran floating scale (for score 1\u0026ndash;2 the word excessive was replaced with energetic as this was a more accurate description of the activity; Moran \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). During some of the floats in Study 2, the movement of the participant set up a standing wave in the flume which interfered with floating. In these cases, if there had been no change in float technique, floating competence was assessed earlier when the water was calmer.\u003c/p\u003e \u003cp\u003eImmediately after their float, participants were asked to rate their perceived exertion (RPE) using the 0\u0026ndash;10 Borg (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1982\u003c/span\u003e) scale, floating difficulty, whether they thought the float was more or less difficult than they anticipated (1\u0026thinsp;=\u0026thinsp;a lot less difficult; 2\u0026thinsp;=\u0026thinsp;less difficult; 3\u0026thinsp;=\u0026thinsp;about the same; 4\u0026thinsp;=\u0026thinsp;more difficult; 5\u0026thinsp;=\u0026thinsp;a lot more difficult) and floating confidence. They were also asked which instructions or practice helped them to float (except after the first float when no instruction was given) or if any other information (not given) would have been useful. In Study 2, after the third float, participants were also asked whether practice or instruction helped them float the most and in which order they would be most beneficial.\u003c/p\u003e \u003cp\u003eFloating \u0026ldquo;efficiency\u0026rdquo; was estimated from floating competency divided by RPE for each float. Where the Moran score or RPE was 0, this was entered as 0.1 so that a value for floating \u0026ldquo;efficiency\u0026rdquo; could be obtained.\u003c/p\u003e \u003cp\u003eIn Study 2, heart rate was measured using a Polar heat rate monitor (Polar H10, Polar, UK) and recorded at 30 second intervals during the three floats. Floating angle of the torso (from shoulder to hip) viewed from a window at the side of the flume was estimated in the final minute of each float using a protractor.\u003c/p\u003e \u003cp\u003e The float coaching given to the participants by the swim instructors was recorded, transcribed and coded into different themes. These corresponded to instructions regarding head position, relaxing, breathing, limb movement, leg position, arm position and core activity. These were then compared to the instructions reported by the participants as useful, in order to identify key phrases which enabled participants to improve their floating competence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analyses\u003c/h2\u003e \u003cp\u003ePre-float floating difficulty and confidence, floating competence (Moran scale), RPE, post-float floating difficulty and confidence were compared between floats within conditions using a Friedman test (with \u003cem\u003epost hoc\u003c/em\u003e Wilcoxon tests if appropriate) when three or more floats were compared, or Wilcoxon tests if only two floats were compared. Comparisons were also made between the final two floats in fresh water and the two floats in sea water. In Study 2, between group comparisons were made using a mixed model ANOVA with pairwise comparisons. Sphericity was assessed using Mauchly\u0026rsquo;s test and where sphericity could not be assumed epsilon corrections were utilised.\u003c/p\u003e \u003cp\u003eIt was apparent that some participants could float with little or no movement whereas others required activity to maintain their airway clear of the water. Therefore, participants in Study 1 were classified as either \u0026ldquo;active\u0026rdquo; or \u0026ldquo;passive\u0026rdquo; floaters based on the arm and/or leg action during the last 30 s of their third float. \u0026ldquo;Active\u0026rdquo; floaters required arm or leg action to maintain their airway clear whereas \u0026ldquo;passive\u0026rdquo; floaters used limb movement only for stabilisation. The responses of these two groups were analysed separately to determine whether different instructions were required to improve their floating competency and the results are given in the supplementary material.\u003c/p\u003e \u003cp\u003eRelationships between anthropometric variables and floating competency (Float 1 \u0026ndash; na\u0026iuml;ve and Float 3 \u0026ndash; after float coaching) in still fresh water and still sea water (standard float after float coaching) were investigated using Spearman\u0026rsquo;s rank correlations.\u003c/p\u003e \u003cp\u003eValues are presented as mean (standard deviation) and statistical significance was taken as P \u0026le; 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of twenty-five participants (11 women and 14 men) volunteered for the floats in different water conditions in Study 1, and 23 participants (10 women and 13 men) volunteered for the floats in the swimming flume in Study 2 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The activities the participants undertook at the time of testing in and around water are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Participants reported being either confident (n\u0026thinsp;=\u0026thinsp;10) or very confident (n\u0026thinsp;=\u0026thinsp;12) in water up to their chest (one of the inclusion criteria) and out of their depth their confidence averaged 4.0 (0.8) where 0\u0026thinsp;=\u0026thinsp;very unconfident and 5\u0026thinsp;=\u0026thinsp;very confident. All participants reported being capable of swimming 25 m in a heated swimming pool without assistance; reported swim ability was 6.2 (1.6) for participants in Study 1, 6.8 (1.1) for PRAC and 6.5 (1.1) for COACH (1 = \u0026ldquo;I cannot swim at all\u0026rdquo;; 10 = \u0026ldquo;I\u0026rsquo;m a really good swimmer\u0026rdquo;) and none of the participants were or had been competitive swimmers.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean (standard deviation) participant characteristics and environmental conditions during the floats for Study 1 and 2. (W\u0026thinsp;=\u0026thinsp;women)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eStudy 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eStudy 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStill fresh water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStill sea water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMoving fresh water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMoving sea water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCOACH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePRAC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (10 W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (7 W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1 W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (3 W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (4 W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12 (6 W)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.8 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.5 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19.8 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.2 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175.4 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174.6 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e178.4 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e177.5 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e173.8 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e173.8 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.8 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.6 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.0 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80.5 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67.7 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70.7 (8.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBMI (kg.m\u003csup\u003e\u0026minus;\u0026thinsp;2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.7 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.0 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.2 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.6 (3.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eΣ skinfolds (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.8 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83.3 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38.9 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49.5 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBody fat (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.8 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.2 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.4 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.2 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.0 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.6 (8.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWaist:hip ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89 (0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.79 (0.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.80 (0.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eEnvironmental conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAir temperature (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.6 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.3 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.7 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.2 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWBGT (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.7 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.3 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.7 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage wind speed (knots)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.5 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGust speed (knots)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.8 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.8 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater temperature 5 cm (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.9 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.9 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.1 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.9 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31.6 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater temperature 50 cm (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.9 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.8 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater flow (m.s\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0 (0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u0026ndash;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4 (0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage wave height (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.9 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaximum wave height (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ena\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.3 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater specific gravity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.027 (0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.027 (0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWater and swimming experience of participants. Note that the percentages do not add up to 100% as some participants reported undertaking water-based activities and swimming\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePercentage engagement\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eStudy 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity/experience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePRAC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCOACH\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo water-based activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivities around (but not in or on) water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater-based activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfrequently swim for recreation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwim once a week for recreation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwim regularly for recreation (2\u0026ndash;3 times per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwim for fitness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePrior to any floats, participants were asked to describe the actions they would undertake to float and their responses are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The most common response from participants in Study 1 was to lie back but only 28% of these specified head back, the next most common response was to relax or stay calm. Eight participants reported arm/leg movement, three of which described sculling, four were vague and one suggested pushing down on water. Many thought the legs should be up on the surface and the core \u0026ldquo;engaged\u0026rdquo;, only five identified having arms/legs out as being necessary. Two participants stated breathing should be controlled and two said the lungs should be inflated.\u003c/p\u003e \u003cp\u003eIn Study 2, all participants reported attempting to float previously and this was, on average, 1.7 (3.0) years ago (range 1 month to 10 years) for the PRAC group and 3.2 (5.2) years ago (range 1 week to 13 years) for the COACH group. In both groups, approximately half of the participants stated you should lie back to float, only 3 (2 in PRAC, 1 in COACH) specified head back and 6 (2 in PRAC, 4 in COACH) said head up or out of water (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Approximately half of the participants reported arm/leg movement, although these were generally vague with only 1 participant describing sculling. Six participants in PRAC and four in COACH reported a starfish shape, although one participant in COACH stated the arms should be at the side. Several participants (3 in PRAC, 4 in COACH) reported the core should be engaged, in PRAC one participant thought the legs should be kept up whilst in COACH one participant thought the legs should be down. None of the participants in Study 2 reported relaxing as being necessary for floating.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInitial perceived actions required to undertake a float prior to any floats or instruction. \u0026ldquo;Accurate\u0026rdquo; indicates correct action described (e.g. movement: sculling described), \u0026ldquo;Vague\u0026rdquo; indicates a response which may or may not be accurate (e.g. breathing: full lungs will increase buoyancy but is not sustainable) and \u0026ldquo;Hinder\u0026rdquo; indicates actions that are likely to hinder floating (e.g. pushing down on the water describes the incorrect action for sculling; engaging the core and keeping legs up will cause unnecessary effort and prevent relaxation). Values are percentage response for each group and therefore do not add up to 100%.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eStudy 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eStudy 2: PRAC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eStudy 2: COACH\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccurate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVague\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHinder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccurate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVague\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHinder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAccurate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eVague\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHinder\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHead back\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArms/legs spread\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMovement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreathing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEngage core\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegs up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Still fresh water floats\u003c/h2\u003e \u003cp\u003eParticipant characteristics and environmental conditions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Perceived floating difficulty prior to the float decreased over the first three floats (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Float 4 was expected to be more difficult than either Float 2 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) or Float 3 (P\u0026thinsp;=\u0026thinsp;0.001) with the perceived difficulty expected with clothing and the simulated fall being similar (P\u0026thinsp;=\u0026thinsp;0.417).\u003c/p\u003e \u003cp\u003eConfidence prior to the floats increased over the first three floats (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). Participants felt less confident prior to Float 4 compared to Float 3 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) with the impact of clothing and the simulated fall being the same. Confidence in floating with clothes during Float 4 was greater than prior to Float 1 (P\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e \u003cp\u003eFloating competence, as assessed using the Moran scale, improved with each float (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC), with less movement required to keep the airway clear with each successive float. Although most participants with a Moran score of 8 or above floated horizontally on the surface, there were some participants who could float with minimal movement in a more vertical position. This was associated with a reduction in perceived exertion (RPE) with successive floats (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). However, although RPE during Float 4 was lower than Float 1 and 2, it was not different from Float 3. Combining the Moran scores and RPE scores to get an index of floating efficiency showed that participants became more efficient with successive floats (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE), though no further improvement was seen between Floats 3 and 4.\u003c/p\u003e \u003cp\u003eCompared to Float 1 and 2, participants reported floating was easier during Float 3 and 4 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), however there was no difference in perceived difficulty between Floats 1 and 2 or Floats 3 and 4 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF). For all floats, participants reported floating being between \u0026ldquo;about the same\u0026rdquo; and \u0026ldquo;less difficult\u0026rdquo; than they thought (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eG). Confidence in floating ability increased with successive floats (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH), though confidence did not significantly increase between Floats 3 and 4.\u003c/p\u003e \u003cp\u003eThe percentage of participants that reported their breathing on immersion interfered with their ability to float is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Interference from the cold shock decreased over the first three immersions (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but increased during Float 4 compared to Float 3 (P\u0026thinsp;=\u0026thinsp;0.038) due to head immersion during the simulated fall. Less than 25% of participants reported any interference from shivering and no significant difference was observed between floats (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of participants reporting breathing and shivering affecting their ability to float at the start of their immersion in water at 23\u0026deg;C\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFloat 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFloat 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFloat 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFloat 4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNaive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRNLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCoaching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eBreathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA little bit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuite a lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreatly affected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreathing stopped me floating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eShivering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA little bit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuite a lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe majority of participants (64%) found the RNLI messaging helpful. After watching the RNLI \u0026ldquo;Float to Live\u0026rdquo; video and looking at the associated poster, 7/22 participants reported the instruction to \u0026ldquo;put your head back\u0026rdquo; helped them to float (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). 4/22 participants found putting their arms or legs out helped. 3/22 of participants reported the instructions to relax, control breathing or move their limbs helped. Two thought that practice had helped them. On the other hand, two reported that keeping their legs up was useful, however for these two individuals this probably increased the effort required as they naturally floated in a vertical position. Four participants did not find the instructions helped their float and four reported they were confusing or unhelpful (\u0026ldquo;\u003cem\u003evideo didn't help, concentrated too much and didn't relax\u0026rdquo;; \u0026ldquo;image - bent knees \u0026amp; let bum sink\u0026rdquo;; \u0026ldquo;Move arms and legs - vague \u0026amp; not helpful\u0026rdquo;; \u0026ldquo;Use arms and legs - didn't help how should they be used? Swim and shout for help counter to previous floating advice\u0026rdquo;\u003c/em\u003e).\u003c/p\u003e \u003cp\u003eThe most helpful instructions provided by the swim instructors were to put their head back further (so the ears were submerged), relax and not to hold their breath but to keep breathing (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Instructions on limb action were also helpful and these included: \u0026ldquo;\u003cem\u003estroking the dog, kicking a little\u0026rdquo;; \u0026ldquo;hands in sideways motion rather than up and down\u0026rdquo;; \u0026ldquo;sculling deeper, kicking legs\u0026rdquo;\u003c/em\u003e. Being told it didn\u0026rsquo;t matter if their legs sank helped four participants and not having to be in a starfish position also helped another participant.\u003c/p\u003e \u003cp\u003eOn the final float, the most frequent helpful instructions reported by the participants were to relax and put their head back (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Other comments included: \u0026ldquo;\u003cem\u003enot worrying if legs sink\u0026rdquo;; \u0026ldquo;stroke cat/dog lower in water\u0026rdquo;; \u0026ldquo;calm breathing as quickly as possible\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Still sea water floats\u003c/h2\u003e \u003cp\u003eParticipant characteristics and environmental conditions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Three participants undertook all four floats (1. na\u0026iuml;ve, 2. following RNLI instruction, 3. following float coaching from a swim instructor and 4. a simulated fall) in still sea water; their responses are given in the supplementary material. The responses to floats following coaching either in fresh water or sea water and following a simulated fall are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Floating competence improved (less movement was required to maintain the float, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC) in the final float (simulated fall), however this was not accompanied by any change in perception of the difficulty or confidence in floating either prior to (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and B) or after the float (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eF to H).\u003c/p\u003e \u003cp\u003eInstructions that helped the participants to float are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Those most frequently reported were: head back (one participant stated \u003cem\u003estring on back of head instruction\u003c/em\u003e), relax or stay calm and control breathing. Having the arms or legs wide and adjusting them to the wave motion was also reported as helpful. Eight participants indicated that they would have benefitted from knowing how to deal with waves e.g. \u0026ldquo;\u003cem\u003ehow to relax/breathe with wave splash over face\u003c/em\u003e\u0026rdquo;. One participant reported that it would be helpful if information on \u0026ldquo;\u003cem\u003ethe difference between floating in sea and fresh water\u003c/em\u003e\u0026rdquo; was given as they did not know they were more buoyant in sea water, this was probably the case with other participants but it was not reported.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInstructions from the RNLI video and poster, following float coaching and following the last float (Sim fall), that the participants reported helping their floating. Percentage response is given for all participants and those considered active or passive floaters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003eStill fresh water\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e \u003cp\u003eSea water\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eActive floaters (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003ePassive floaters (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eStill (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003eMoving (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRNLI video\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFloat coaching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSim fall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRNLI video\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFloat coaching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSim fall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRNLI video\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFloat coaching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSim fall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFloat coaching\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSim fall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eFloat 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eSim Fall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHead back\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArms/legs out\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreathing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLimb movement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePractice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegs up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnhelpful\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFresh vs sea water floats\u003c/h2\u003e \u003cp\u003eTen participants (6 women, 4 men; height: 176.3 [8.8] cm; mass: 84.5 [15.8] kg; BMI: 27.0 [4.3] kg.m\u003csup\u003e\u0026minus;\u0026thinsp;2\u003c/sup\u003e; sum of skinfolds: 62.0 [15.4] mm; body fat: 28.2 [5.2]; waist:hip ratio: 0.90 [0.04]) undertook floats in still fresh water and sea water.\u003c/p\u003e \u003cp\u003ePrior to their still water floats, participants perceived floating in sea water would be more difficult than in fresh water (P\u0026thinsp;=\u0026thinsp;0.035, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA) and had less confidence (P\u0026thinsp;=\u0026thinsp;0.034, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Although their floating competence was better in sea water compared to fresh water (P\u0026thinsp;=\u0026thinsp;0.031, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC) this was not reflected in their reported perception of effort (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD), difficulty (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eF and G) or confidence (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eH). When asked which condition they thought was easiest to float in, most participants stated sea water was easier (8/10). Two participants (both with a Moran score of 10 in fresh water) found fresh water floats easier due to wave action in the sea. No differences were observed between the floats in fresh water or sea water following a simulated fall (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Moving sea water floats\u003c/h2\u003e \u003cp\u003eParticipant characteristics and environmental conditions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Prior to their floats, no difference in anticipated floating difficulty or confidence was observed between still or moving sea water conditions (Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA and B). Compared to still sea water, floating in moving sea water was perceived to be more difficult (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eF, P\u0026thinsp;=\u0026thinsp;0.025) and require greater exertion (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eD, P\u0026thinsp;=\u0026thinsp;0.046) although there was no difference in floating competence (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC) or efficiency (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eE). Floating confidence following the floats was not different between the two conditions (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eH).\u003c/p\u003e \u003cp\u003eInstructions that the participants reported helping them to float in moving water were similar to those reported for the still sea water (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), however a greater proportion reported having their head back (83% vs 54%) and relaxing (50% vs 38%) as helpful for the moving water.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Moving fresh water floats\u003c/h2\u003e \u003cp\u003eParticipant characteristics and environmental conditions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Prior to the floats in moving fresh water there was no difference in anticipated floating difficulty or confidence (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA and B). On the first immersion in moving fresh water, all participants managed to float with their airway clear of the water and the average float competency was the same as in still water (Moran score during Float 3 in still water\u0026thinsp;=\u0026thinsp;6.8 [1.6]; Float 1 in moving fresh water\u0026thinsp;=\u0026thinsp;6.8 [1.6]). All but one participant showed an improvement in their moving water technique (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eC) following coaching by a SLS-GB instructor (however, this participant reported the floating difficulty was reduced and confidence was increased following instruction). The breakdown of actions correctly undertaken by the participants during their immersions is given in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Floating difficulty showed a trend towards being reduced (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.60, P\u0026thinsp;=\u0026thinsp;0.061, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eE). Rating of perceived exertion (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eC) and floating confidence (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eG) did not differ between the floats. On entry into the water, all participants either had their face splashed or their head was submerged under the water. Breathing interfered with the ability to float during the first float (4 out of 5 participants) and less so following instruction (1/5) or the simulated fall (2/5). There was a trend towards a significant decrease in breathing interference between the first and second floats (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.50, P\u0026thinsp;=\u0026thinsp;0.039; Z = -1.89, P\u0026thinsp;=\u0026thinsp;0.059).\u003c/p\u003e \u003cp\u003eThe instructions that helped the participants float during their first float in fresh moving water were similar to those in still fresh water and included head back (n\u0026thinsp;=\u0026thinsp;4), relax (n\u0026thinsp;=\u0026thinsp;3), leg and arm position. The instructions that the participants reported being helpful on their second and third floats reflected in the instructions given by the SLS-GB instructor (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of participants that correctly undertook the actions recommended by SLS-GB during their moving fresh water immersions as assessed from video analysis and instructions that the participants found helpful during their floats (n\u0026thinsp;=\u0026thinsp;5).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eActions correctly performed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHelpful instructions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNa\u0026iuml;ve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSimulated fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCoaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSimulated fall\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeet downstream\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChin on chest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnees bent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegs together\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeels lower than bottom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArms out for stabilisation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen calm float\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefensive position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric factors influencing floating competence\u003c/h2\u003e \u003cp\u003eCorrelations were conducted between floating competence as assessed using the Moran scale and participants\u0026rsquo; anthropometric measurements. In still fresh water, floating competence during the first float was positively correlated with skinfold thickness at the bicep (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eA), tricep (P\u0026thinsp;=\u0026thinsp;0.003; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eB) and thigh (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eC) as well as the sum of 4 skinfolds (bicep, tricep, subscapular and supra iliac; P\u0026thinsp;=\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eD), sum of 5 skinfolds (bicep, tricep, subscapular, supra iliac and thigh; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eE) and percentage body fat (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eF).\u003c/p\u003e \u003cp\u003eFloating competence during Float 3 (after instruction) in still fresh water was correlated with the same variables as seen in Float 1: bicep skinfold (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eG); tricep skinfold (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eH); thigh skinfold (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eI); sum of 4 skinfolds (P\u0026thinsp;=\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eJ), sum of 5 skinfolds (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eK) and percentage body fat (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003eL). No significant correlations were observed with mass, BMI, waist:hip ratio, subscapular skinfold or supra iliac skinfold and floating competency for either Float 1 or Float 3.\u003c/p\u003e \u003cp\u003eFewer relationships were observed between floating competency in still sea water (following instruction in either fresh water or sea water) and anthropometric measures. As with the floats in still fresh water, correlations were observed between bicep skinfold (P\u0026thinsp;=\u0026thinsp;0.003; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eA), tricep skinfold (P\u0026thinsp;=\u0026thinsp;0.031; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eB), thigh skinfold (P\u0026thinsp;=\u0026thinsp;0.005; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eC), sum of 5 skinfolds (P\u0026thinsp;=\u0026thinsp;0.007; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eD) and percentage body fat (P\u0026thinsp;=\u0026thinsp;0.002; Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eE). No significant correlations were observed with any of the other measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStudy 2: Coaching versus practice\u003c/h2\u003e \u003cp\u003eParticipant characteristics and environmental conditions are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Prior to floating, there was no difference in perceived float difficulty or confidence between PRAC and COACH (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003eA and \u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003eB). There was a trend for a main effect of float with perceived difficulty decreasing between Float 1 (na\u0026iuml;ve) and Float 3 (P\u0026thinsp;=\u0026thinsp;0.061).\u003c/p\u003e \u003cp\u003eNo differences were observed between PRAC and COACH for floating competency (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eA), RPE (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eB), efficiency (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eC), heart rate (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eD) and angle (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eE). However, there was a main effect of float, with float efficiency improving between Float 1 and 3 (P\u0026thinsp;=\u0026thinsp;0.047; Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eC); float angle becoming more horizontal between Float 1 and 2 (P\u0026thinsp;=\u0026thinsp;0.005) and Float 1 and 3 (P\u0026thinsp;=\u0026thinsp;0.006; Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eE); heart rate decreasing between Float 1 and 2 (P\u0026thinsp;=\u0026thinsp;0.020) and Float 1 and 3 (P\u0026thinsp;=\u0026thinsp;0.006; Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eD); and RPE decreasing between Float 1 and 2 (P\u0026thinsp;=\u0026thinsp;0.014) and Float 1 and 3 (P\u0026thinsp;=\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eA). There was also a trend for float competency to improve between Float 1 and 3 (P\u0026thinsp;=\u0026thinsp;0.055; Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003ePost float difficulty was not different between groups and reduced with successive floats (Float 1 vs 2, P\u0026thinsp;=\u0026thinsp;0.001; Float 2 vs 3, P\u0026thinsp;=\u0026thinsp;0.001; Float 1 vs 3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003eC). Participants also reported finding the float less difficult than they thought in Float 1 compared to Float 2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003eD). Post float confidence was increased with successive floats (Float 1 vs 2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Float 2 vs 3, P\u0026thinsp;=\u0026thinsp;0.015; Float 1 vs 3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003eE). There was an interaction effect between float and group with COACH increasing their confidence after their 2nd float (Float 1 vs 2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Float 1 vs 3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Float 2 vs 3, P\u0026thinsp;=\u0026thinsp;0.168) and PRAC increasing their confidence after their 3rd float (Float 1 vs 2, ns; Float 1 vs 3, P\u0026thinsp;=\u0026thinsp;0.026; Float 2 vs 3, P\u0026thinsp;=\u0026thinsp;0.074). However, there was no between group difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study to evaluate the effectiveness of a public safety campaign on floating competence of inexperienced water users in realistic open water conditions. The RNLI messaging did improve float competence and confidence whilst reducing perceived difficulty. However, further improvements were made following individualised float coaching indicating the messaging could be refined further especially for active floaters. Importantly these instructions were applicable in a range of realistic open water scenarios (open fresh and sea water, slow moving water, with clothing and following a simulated fall) and therefore we can accept our hypothesis.\u003c/p\u003e \u003cp\u003eThe participants who volunteered for the current studies were not experienced water users and none were trained or competitive swimmers and only 32% were confident in their ability to float prior to taking part. Participants in Study 1 were men and women from a wide age range (20 to 60 years old) with a similar BMI to the adult UK population (27.6 kg.m\u003csup\u003e\u0026minus;\u0026thinsp;2\u003c/sup\u003e; National Health Service 2022) and therefore representative of the general adult population regarding their physical characteristics.\u003c/p\u003e \u003cp\u003eFloating competence in still fresh water was improved with the combination of instruction and practice. This was associated with an improved float efficiency and decreased RPE. As a consequence, perceived floating difficulty decreased and confidence increased. The RNLI messaging helped most of the participants (64%) to float, with the instruction to \u0026ldquo;put your head back\u0026rdquo; being reported the most helpful (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The swim teachers we able to emphasise this body position by giving more specific instructions (put head back so the ears are submerged) which was helpful to additional participants (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This corresponds to backstroke swimming where inexperienced observers did not fully appreciate the importance of the correct head position compared to experienced swim teachers (Stibilj et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). From the RNLI messaging, many of the participants interpreted that a horizontal float position should be adopted and as a result some expended considerable energy keeping their legs up. Being told by the swim teachers that it is OK if their legs dropped was found to be helpful, particularly for the participants who naturally floated in a more vertical position. One of the most frequent instructions given by the swim teachers was to relax, interestingly participants seemed to report this as more helpful the more floating practice they had, with it helping 45% on their 3rd float, 55% on their 4th float (simulated fall with clothing), with all of the participants finding it helpful following a simulated fall into moving sea water (after 6 to 8 floats; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe RNLI messaging to \u0026ldquo;use your arms and legs to keep you afloat\u0026rdquo; was not found helpful and if done incorrectly would actually impede floating. The participants who were \u0026ldquo;active\u0026rdquo; floaters benefitted from the additional instructions given by the swim teachers describing sculling. For some participants, the analogy of \u0026ldquo;stroking a dog\u0026rdquo; to describe the sculling action was particularly helpful. The use of analogies has been found to facilitate implicit learning (Liao \u0026amp; Masters \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Tse et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and enhance motor skill acquisition in swimming whilst still enabling learners to develop individual movement patterns (Komar et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Therefore, combining implicit (sculling analogy) and explicit (head position) instructions is important as the required floating technique is individual and dependent on anthropometric characteristics as well as environmental conditions. Furthermore, a motor skill developed through implicit learning is less affected by stress (Liao \u0026amp; Masters \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Lola \u0026amp; Tzetzis \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and retained for longer (Allen \u0026amp; Reber \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1980\u003c/span\u003e), both factors being important in the event of an accidental immersion. In the current study, floating competence was not impaired (and actually improved) following a simulated fall despite participants feeling less confident prior to the float. This could reflect the robustness of the prior implicit learning which was unaffected by the stress associated with head submersion.\u003c/p\u003e \u003cp\u003eWhilst we did not measure skill retention specifically, 10 participants undertook floats in sea water 25 days (range 2 to 54 days) after being coached in fresh water and no difference in float competence was observed indicating floating skills had been retained. The inclusion of analogies to promote implicit learning may be beneficial in public messaging as it is less affected by intelligence than explicit learning (Reber et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1991\u003c/span\u003e) and will therefore be useful to a wider audience.\u003c/p\u003e \u003cp\u003eThe skills learnt in still water enabled successful floats in moving water indicating that the floating skills learnt in a pool will be transferrable to a wide range of open water environments. Where water is turbulent, aerated or obstacles are present, defensive floating would be more appropriate. However even in the moving fresh water representative of a Grade 1 river, participants were able to float successfully.\u003c/p\u003e \u003cp\u003eParticipants perceived that wearing clothing would make floating more difficult. However, despite the worst-case scenario of a vertical drop into the water (which removes most of the inherent buoyancy provided by clothing) floating competency was found to further improve. This is similar to previous research (Tipton \u0026amp; Massey \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), where despite clothing increasing buoyancy it was perceived to increase the difficulty of floating by \u0026ldquo;dragging people down\u0026rdquo;. Another misconception was that it would be harder to float in the sea, with some participants not knowing that they would be more buoyant in salt water. Whilst less activity was required to maintain a float in sea water compared to fresh water for active floaters (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), participants who were motionless in the still lake needed to undertake some activity in the sea to stabilise themselves in the slight chop.\u003c/p\u003e \u003cp\u003eThe second study was conducted to examine the relative role of practice and instruction on floating skill acquisition. Unlike the study in open water, no statistically significant improvements in floating competence (using the Moran score) were observed after practice, instruction or a combination practice and instruction (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e). However, heart rate was reduced and this was accompanied by a reduction in perceived effort and difficulty and increased confidence (Figs.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e and \u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e). The lack of effect of either training or practice on floating competence in Study 2 is probably due to combination of the situation and the poor sensitivity of Moran score to measure floating competence. The restricted size of the flume meant that participants who floated vertically had to actively raise their legs and the actions of some participants set up a standing wave which increased the difficulty of the float. Although the results did not support our hypothesis, that coaching would improve floating competence more than practice, 86% participants stated a preference for coaching followed by practice as this increased their confidence level early and provided an opportunity to practice later.\u003c/p\u003e \u003cp\u003eCorrelations between body composition and floating competency (Figs.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e) indicate that higher levels of subcutaneous body fat were advantageous to floating as they reduced the activity required to maintain a float. This finding is unsurprising given the buoyancy afforded by body fat. Previous studies have demonstrated that airway freeboard during floating is correlated with both sum of skinfold thickness and percentage body fat (Barwood et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Neither BMI nor waist to hip ratio acted as surrogates for body fat measurement as no correlations were found between them and floating competency. This is not surprising since BMI does not distinguish between muscle and fat mass whereas fat, but not muscle, increases buoyancy. Therefore, simple measures (such as BMI or girth measurements) that the general population could do on themselves would not be reliable indicators of their buoyancy and, therefore, whether they are likely to be \u0026ldquo;active\u0026rdquo; or \u0026ldquo;passive\u0026rdquo; floaters. Further research is required to develop a comprehensive floating topography from recording the range of actions and positions which enable successful floats in individuals encompassing a wide range of body compositions and anthropometry.\u003c/p\u003e \u003cp\u003eDespite the temperature of the open water averaging 23\u0026deg;C, 68% of participants found that breathing affected their ability to float to lesser or greater extent. It is a commonly held misconception that the cold shock response is only seen in water temperatures of 15\u0026deg;C or below (Wilson et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), in fact the maximum response is evoked between 10\u0026deg;C and 15\u0026deg;C (Tipton et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). Therefore, any messaging should make the public aware that even in open water usually considered \u0026ldquo;warm\u0026rdquo;, individuals may experience the cold shock and that this will impact on their ability to breath hold and float. In colder water, both the magnitude and duration of the cold shock response would be increased (Tipton et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1991\u003c/span\u003e) and this may impair the ability to float. As expected interference from the cold shock decreased over the first three immersions (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but increased during Float 4 compared to Float 3 (P\u0026thinsp;=\u0026thinsp;0.038) due to head immersion during the simulated fall. This reduction in response is due to habituation of the cold shock response with repeated immersions (Golden and Tipton \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1988\u003c/span\u003e) and can occur even when immersions occur on the same day (Eglin et al. 2015).\u003c/p\u003e \u003cp\u003eLess than 25% of participants reported any interference from shivering during their floats (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and this was due to the relatively warm water and the short duration of immersion. In colder water, when there is greater skin cooling and during prolonged immersions (where core cooling will also occur) the shivering response will be much greater (Tikuisis and Giesbrecht \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). The combination of the behavioural response to curl up (to reduce the surface area for heat loss) and intensive shivering is likely to reduce the ability to float.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study has demonstrated that a public health campaign \u0026ldquo;Float to Live\u0026rdquo; can improve the floating competence and confidence of inexperienced water users in realistic open water scenarios. Further improvements were observed following additional instructions provided by swim teachers. As a result, \u0026ldquo;tilt your head back with ears submerged\u0026rdquo;, \u0026ldquo;relax and move your hands to help you stay afloat\u0026rdquo; and an image of an individual floating in a more vertical position have now been incorporated into the new RNLI \u0026ldquo;Float to Live\u0026rdquo; messaging. Importantly, the skills acquired were applicable in a range of realistic open water scenarios (open fresh and sea water, slow moving water, with clothing and following a simulated fall) and were retained. Given there were no differences in floating competence between the COACH and PRAC groups, individuals should practice floating as the skills learnt are transferable to a range of open water conditions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eanalysis of variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCIWWC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiff International White Water Centre\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOACH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGroup undertaking floats in following order: 1) na\u0026iuml;ve, 2) after coaching, 3) after practise\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecold shock response\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGroup undertaking floats in following order: 1) na\u0026iuml;ve, 2) after practise, 3) after coaching\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRNLI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRoyal National Lifeboat Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRPE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003erating of perceived exertion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSLS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGB\u0026ndash;Surf Life Saving GB\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSUP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estand up paddleboard\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis project was funded by the Royal National Lifeboat Institute, UK.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCE, HM, GL and MT were involved in conception of the project and all authors contributed to the design of the project. CE, HM and GL were involved in data acquisition and analysis. CE, HM, GL and MT were involved in interpretation of the data. CE wrote the first draft of the manuscript and all authors reviewed and approved the final submission.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThis research was funded by the Royal National Lifeboat Institution (RNLI). Many thanks to: the participants for their courage, especially to those who went considerably outside their comfort zone; the swim instructors, Bekki Kingshott and Chris Pitman for imparting their knowledge to the participants in such a friendly way; SLS-GB for sharing their wealth of knowledge on moving water and keeping us all safe; the locations we used (Andark Lake, Andrew Simpson Centre and Cardiff International White Water) and the support they generously provided. Finally, thanks to Peter, Jen and Josh for their help.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe anonymised data collected are available as open data via the University of Portsmouth online data repository\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAllen R, Reber AS. Very long term memory for tacit knowledge. Cognition. 1980; 8(2):175-85. doi: 10.1016/0010-0277(80)90011-6. \u003c/li\u003e\n\u003cli\u003eBarwood MJ, Bates V, Long G, Tipton MJ. \u0026quot;Float First\u0026quot;: Trapped Air Between Clothing Layers Significantly Improves Buoyancy After Immersion. Int J Aquatic Res Edu. 2011; 5(2). \u003c/li\u003e\n\u003cli\u003eBarwood M, Massey H, Tipton M. \u0026ldquo;Float First\u0026rdquo;: evidence-base for the Royal National Lifeboat Institute\u0026rsquo;s \u0026ldquo;Respect the Water\u0026rdquo; Campaign. 2018, University of Portsmouth report to the Royal National Lifeboat Institute.\u003c/li\u003e\n\u003cli\u003eBorg GAV. (1982). Psychophysical bases of perceived exertion. \u003cem\u003eMed Sci Sport Exer. 1982; 14\u003c/em\u003e\u003cem\u003e(\u003c/em\u003e5), 377\u0026ndash;381. https://doi.org/10.1249/00005768-198205000-00012.\u003c/li\u003e\n\u003cli\u003eEglin C, Butt G, Howden S, Nash T, Costello J. Rapid habituation of the cold shock response. In Proceedings of the 16th International Conference on Environmental Ergonomics, Portsmouth, UK 29th June to 3rd July 2015, p54.\u003c/li\u003e\n\u003cli\u003eGolden FStC, Tipton MJ. Human adaptation to repeated cold immersions. J Physiol. 1988; 396:349-63.\u003c/li\u003e\n\u003cli\u003eGolden F, Hardcastle PT, Pollard CE, Tipton MJ. Hyperventilation and swim failure in man in cold water. J Physiol. 1986; 378, 94. \u003c/li\u003e\n\u003cli\u003eKomar J, Chow JY, Chollet D, Seifert L. Effect of Analogy Instructions with an Internal Focus on Learning a Complex Motor Skill. J Appl Sport Psychol. 2014; 26:1, 17-32, DOI: 10.1080/10413200.2013.771386.\u003c/li\u003e\n\u003cli\u003eLola AC, Tzetzis GC. The effect of explicit, implicit and analogy instruction on decision making skill for novices, under stress. Int J Sport Exer Psychol. 2021; DOI: 10.1080/1612197X.2021.1877325. \u003c/li\u003e\n\u003cli\u003eLiao C-M, Masters RSW. Analogy learning: A means to implicit motor learning, J Sports Sci. 2001; 19:5, 307-319, DOI: 10.1080/02640410152006081. \u003c/li\u003e\n\u003cli\u003eMekjavic IB, Bligh J. The increased oxygen uptake upon immersion. The raised external pressure could be a causative factor. Eur J Appl Physiol. 1989\u003cem\u003e;\u003c/em\u003e 58:556-62.\u003c/li\u003e\n\u003cli\u003eMoran K (2014) \u0026quot;Can You Swim in Clothes?\u0026rdquo; An Exploratory Investigation of the Effect of Clothing on Water Competency. Int J Aquatic Res Edu. 2014; 8 (4): Article 5. DOI: 10.25035/ijare.08.04.05. \u003c/li\u003e\n\u003cli\u003eNational Health Service. Health Survey for England 2019: Adult and child overweight and obesity. 2020. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2019/health-survey-for-england-2019-data-tables. \u003c/li\u003e\n\u003cli\u003eNational Water Safety Forum. Water Incident Database Reports Interactive Report 2014 to 2022 (2024). Retrieved 9\u003csup\u003eth\u003c/sup\u003e April 2024 from: https://www.nationalwatersafety.org.uk/waid/waid-interactive-report.\u003c/li\u003e\n\u003cli\u003eNational Water Safety Forum. Water Incidence Database (WAID) UK 2022 Summary for the National Water Safety Forum. 2023. Retrieved 9th April 2024 from https://www.nationalwatersafety.org.uk/media/1358/waid-uk-2022-summary-v3-final-for-website.pdf.\u003c/li\u003e\n\u003cli\u003eReber AS, Walkenfeld FF, Hernstadt R. Implicit and explicit learning: individual differences and IQ. J Exp Psychol Learn Mem Cogn.1991; 17(5):888-96. doi: 10.1037//0278-7393.17.5.888.\u003c/li\u003e\n\u003cli\u003eRoyal National Lifeboat Institute. Float to live. 2022. Retrieved 19th October 2022 from https://rnli.org/video-download?videoid=FBA9EEE5-6326-4BC6-A7C1E21939ED6824\u003c/li\u003e\n\u003cli\u003eStibilj J, Ko\u0026scaron;mrlj K, Kapus, J. Evaluation of mistakes in backstroke swimming. \u003cem\u003eKinesiologia Slovenica\u003c/em\u003e. 2020; \u003cem\u003e26:\u003c/em\u003e 5-15.\u003c/li\u003e\n\u003cli\u003eTipton MJ. The initial responses to cold-water immersion in man. Clin Sci. 1989; 77(6), 581-588.\u003c/li\u003e\n\u003cli\u003eTipton MJ, Stubbs D, Elliott D. Human initial responses to immersion in cold water at three temperatures and after hyperventilation\u003cem\u003e. \u003c/em\u003eJ Appl Physiol. 1991; 70:317-22.\u003c/li\u003e\n\u003cli\u003eTipton MJ, Massey H. Floating \u0026ndash; Research to inform messaging for the Royal National Lifeboat Institute\u0026rsquo;s Respect the Water Campaign. 2018. University of Portsmouth report to the Royal National Lifeboat Institute.\u003c/li\u003e\n\u003cli\u003eTikuisis P, Giesbrecht GG. Prediction of shivering heat production from core and mean skin temperatures. Eur J Appl Physiol Occup Physiol. 1999; 79(3):221-9. doi: 10.1007/s004210050499. PMID: 10048626.\u003c/li\u003e\n\u003cli\u003eTse ACY, Fong SSM, TWL, Masters R. Analogy motor learning by young children: a study of rope skipping, Eur J Sport Sci. 2017; 17:152-159, DOI: 10.1080/17461391.2016.1214184. \u003c/li\u003e\n\u003cli\u003eTudor Sailing Club. 2022. https://www.tudorsailing.org.uk/TudorSailing/10_weathercentre/latest.php\u003c/li\u003e\n\u003cli\u003eWilson A, Massey M, Eglin C. Evaluation of online information on the cold shock response to accidental immersion in cold water. Physiological Society Drowning Prevention and Treatment Virtual Conference, 11-13th Oct 2023.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Drowning. 2023. Retrieved 9th April 2024 from: https://www.who.int/news-room/fact-sheets/detail/drowning.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"drowning prevention, water safety, floating, water immersion","lastPublishedDoi":"10.21203/rs.3.rs-4318349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4318349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe RNLI \u0026ldquo;Float to Live\u0026rdquo; campaign is based on research conducted in indoor pools with experienced open water swimmers. Study 1 investigated whether the RNLI \u0026ldquo;Float to Live\u0026rdquo; guidance would enable less experienced individuals to float in realistic open water conditions. Study 2 examined the separate effects of practice and coaching on floating competence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eStudy 1: Inexperienced water users conducted floats in either still, open fresh (n\u0026thinsp;=\u0026thinsp;22) or open sea water (n\u0026thinsp;=\u0026thinsp;13), followed by moving sea (n\u0026thinsp;=\u0026thinsp;6) or fresh water (n\u0026thinsp;=\u0026thinsp;5). Participants undertook three 2-minute floats in still water wearing swimwear and one clothed float: 1) na\u0026iuml;ve; 2) following RNLI \u0026ldquo;Float to live\u0026rdquo; messaging; 3) individual float coaching; 4) simulated fall wearing summer clothing. In moving sea water, participants undertook two floats equivalent to Floats 3 and 4. In moving fresh water, participants undertook 3 floats: 1) na\u0026iuml;ve; 2) following \u0026ldquo;defensive floating\u0026rdquo; coaching; 3) simulated fall wearing summer clothing. Study 2: Two groups matched for skinfold thickness undertook three 2-minute floats in a flume wearing swimwear. PRAC group (n\u0026thinsp;=\u0026thinsp;12): 1) na\u0026iuml;ve; 2) following float practice; 3) float coaching; COACH group (n\u0026thinsp;=\u0026thinsp;11) coaching followed by practice. Floating difficulty, confidence, competence, \u0026ldquo;efficiency\u0026rdquo; and perceived exertion were analysed using either a Friedman test or mixed model ANOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn both fresh water and sea water, participants\u0026rsquo; floating competence and confidence increased after viewing the RNLI messaging, it was further improved with individualised float coaching. The additional helpful instructions included: 1) \u0026ldquo;head back with ears submerged\u0026rdquo;; 2) \u0026ldquo;relax\u0026rdquo;; 3) \u0026ldquo;breathe normally\u0026rdquo;; 4) \u0026ldquo;it is OK if your legs sink\u0026rdquo;; 5) an accurate description of sculling for \u0026ldquo;active\u0026rdquo; floaters that needed it; 6) spread arms and legs for stability. The simulated fall with clothing did not impair floating competence. No difference in floating competence was seen between PRAC and COACH, though confidence may be increased sooner in COACH.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe RNLI float advice can be applied in realistic open water settings by less experienced water users. Additional content could be included to make the messaging even more effective.\u003c/p\u003e","manuscriptTitle":"Inexperienced water users can “Float to Live” in realistic open water conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-03 15:37:28","doi":"10.21203/rs.3.rs-4318349/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-08T09:27:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-28T23:59:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-28T23:59:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-04-24T12:46:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"061049b6-8a56-4070-9044-dd7037b472b1","owner":[],"postedDate":"May 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-05T16:03:10+00:00","versionOfRecord":{"articleIdentity":"rs-4318349","link":"https://doi.org/10.1186/s12889-024-19409-6","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2024-07-29 15:57:35","publishedOnDateReadable":"July 29th, 2024"},"versionCreatedAt":"2024-05-03 15:37:28","video":"","vorDoi":"10.1186/s12889-024-19409-6","vorDoiUrl":"https://doi.org/10.1186/s12889-024-19409-6","workflowStages":[]},"version":"v1","identity":"rs-4318349","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4318349","identity":"rs-4318349","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}