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01.12.2009 | Research | Ausgabe 1/2009 Open Access

Cardiovascular Ultrasound 1/2009

Benefit of warm water immersion on biventricular function in patients with chronic heart failure

Cardiovascular Ultrasound > Ausgabe 1/2009
Bente Grüner Sveälv, Åsa Cider, Margareta Scharin Täng, Eva Angwald, Dimitris Kardassis, Bert Andersson
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-7-33) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

Each author has contributed significantly to this submitted work. BGS contributed to the design of the study, participated in the cardiopulmonary exercise test, performed the ultrasound investigations, measurements, calculation and statistical analysis, interpretation of data, wrote the manuscript and was responsible for the final version. ÅC contributed to the design of the study, trained the patients in warm water, and contribute to important intellectual content. MST participated in the ultrasound performance, and contributed to important intellectual content. EA participated in the cardiopulmonary exercise test and collected the blood sample. DK was responsible for the safety during the cardiopulmonary exercise test. BA contributed to the design of the study, interpretation of data, revised the article for important intellectual content. All authors read and approved the final manuscript.



Regular physical activity and exercise are well-known cardiovascular protective factors. Many elderly patients with heart failure find it difficult to exercise on land, and hydrotherapy (training in warm water) could be a more appropriate form of exercise for such patients. However, concerns have been raised about its safety.
The aim of this study was to investigate, with echocardiography and Doppler, the acute effect of warm water immersion (WWI) and effect of 8 weeks of hydrotherapy on biventricular function, volumes and systemic vascular resistance. A secondary aim was to observe the effect of hydrotherapy on brain natriuretic peptide (BNP).


Eighteen patients [age 69 ± 8 years, left ventricular ejection fraction 31 ± 9%, peakVO2 14.6 ± 4.5 mL/kg/min] were examined with echocardiography on land and in warm water (34°C).
Twelve of these patients completed 8 weeks of control period followed by 8 weeks of hydrotherapy twice weekly.


During acute WWI, cardiac output increased from 3.1 ± 0.8 to 4.2 ± 0.9 L/min, LV tissue velocity time integral from 1.2 ± 0.4 to 1.7 ± 0.5 cm and right ventricular tissue velocity time integral from 1.6 ± 0.6 to 2.5 ± 0.8 cm (land vs WWI, p < 0.0001, respectively). Heart rate decreased from 73 ± 12 to 66 ± 11 bpm (p < 0.0001), mean arterial pressure from 92 ± 14 to 86 ± 16 mmHg (p < 0.01), and systemic vascular resistance from 31 ± 7 to 22 ± 5 resistant units (p < 0.0001).
There was no change in the cardiovascular response or BNP after 8 weeks of hydrotherapy.


Hydrotherapy was well tolerated by all patients. The main observed cardiac effect during acute WWI was a reduction in heart rate, which, together with a decrease in afterload, resulted in increases in systolic and diastolic biventricular function. Although 8 weeks of hydrotherapy did not improve cardiac function, our data support the concept that exercise in warm water is an acceptable regime for patients with heart failure.
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