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

Grüner Sveälv B, Cider A, Täng MS, Angwald E, Kardassis D, Andersson B - Cardiovasc Ultrasound (2009)

Bottom Line: Regular physical activity and exercise are well-known cardiovascular protective factors.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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Molecular and Clinical Medicine/Cardiology, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden. bente@wlab.gu.se

ABSTRACT

Background: 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).

Methods: 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 degrees C).Twelve of these patients completed 8 weeks of control period followed by 8 weeks of hydrotherapy twice weekly.

Results: 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.

Conclusion: 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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Decreased postsystolic contraction during warm water immersion. A patient with left bundle branch block demonstrates a different pattern of the left atrioventricular plane recording on land compared with water. 2A. Standing position on land, AVPD 3.5 mm, post-systolic contraction 6.1 mm. 2B. Standing position in warm water, AVPD 8.2 mm, post-systolic contraction 1.4 mm. 1) Start of LV contraction; 2) end of LV contraction; 3) start of early diastolic filling; 4) end of diastolic filling, beginning of diastasis; 5) end of diastasis, beginning of atrial contraction; 6) end of atrial contraction. 7) start of next contraction. AVPD: atrioventricular plane, SC: systolic contraction, PSC: post-systolic contraction.
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Figure 2: Decreased postsystolic contraction during warm water immersion. A patient with left bundle branch block demonstrates a different pattern of the left atrioventricular plane recording on land compared with water. 2A. Standing position on land, AVPD 3.5 mm, post-systolic contraction 6.1 mm. 2B. Standing position in warm water, AVPD 8.2 mm, post-systolic contraction 1.4 mm. 1) Start of LV contraction; 2) end of LV contraction; 3) start of early diastolic filling; 4) end of diastolic filling, beginning of diastasis; 5) end of diastasis, beginning of atrial contraction; 6) end of atrial contraction. 7) start of next contraction. AVPD: atrioventricular plane, SC: systolic contraction, PSC: post-systolic contraction.

Mentions: In three patients with left bundle branch block, we observed pronounced post-systolic contraction when the patients were investigated on land. During WWI, this abnormal contraction was abolished (Figure 2A–B). Furthermore, a more regular heart rate was observed (Figure 3A–B).


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

Grüner Sveälv B, Cider A, Täng MS, Angwald E, Kardassis D, Andersson B - Cardiovasc Ultrasound (2009)

Decreased postsystolic contraction during warm water immersion. A patient with left bundle branch block demonstrates a different pattern of the left atrioventricular plane recording on land compared with water. 2A. Standing position on land, AVPD 3.5 mm, post-systolic contraction 6.1 mm. 2B. Standing position in warm water, AVPD 8.2 mm, post-systolic contraction 1.4 mm. 1) Start of LV contraction; 2) end of LV contraction; 3) start of early diastolic filling; 4) end of diastolic filling, beginning of diastasis; 5) end of diastasis, beginning of atrial contraction; 6) end of atrial contraction. 7) start of next contraction. AVPD: atrioventricular plane, SC: systolic contraction, PSC: post-systolic contraction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713206&req=5

Figure 2: Decreased postsystolic contraction during warm water immersion. A patient with left bundle branch block demonstrates a different pattern of the left atrioventricular plane recording on land compared with water. 2A. Standing position on land, AVPD 3.5 mm, post-systolic contraction 6.1 mm. 2B. Standing position in warm water, AVPD 8.2 mm, post-systolic contraction 1.4 mm. 1) Start of LV contraction; 2) end of LV contraction; 3) start of early diastolic filling; 4) end of diastolic filling, beginning of diastasis; 5) end of diastasis, beginning of atrial contraction; 6) end of atrial contraction. 7) start of next contraction. AVPD: atrioventricular plane, SC: systolic contraction, PSC: post-systolic contraction.
Mentions: In three patients with left bundle branch block, we observed pronounced post-systolic contraction when the patients were investigated on land. During WWI, this abnormal contraction was abolished (Figure 2A–B). Furthermore, a more regular heart rate was observed (Figure 3A–B).

Bottom Line: Regular physical activity and exercise are well-known cardiovascular protective factors.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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Molecular and Clinical Medicine/Cardiology, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden. bente@wlab.gu.se

ABSTRACT

Background: 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).

Methods: 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 degrees C).Twelve of these patients completed 8 weeks of control period followed by 8 weeks of hydrotherapy twice weekly.

Results: 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.

Conclusion: 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.

Show MeSH
Related in: MedlinePlus