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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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Echocardiographic data between three sessions on land and during warm water immersion. 4A. Effect of warm water immersion with respect to stroke volume. 4B. Effect of warm water immersion with respect to heart rate. A: Baseline; B: After 8 weeks of control period without changes in daily lifestyle; C: After 8 weeks of hydrotherapy twice weekly. **p < 0.01, mean ± SEM (land vs. warm water immersion).
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Figure 4: Echocardiographic data between three sessions on land and during warm water immersion. 4A. Effect of warm water immersion with respect to stroke volume. 4B. Effect of warm water immersion with respect to heart rate. A: Baseline; B: After 8 weeks of control period without changes in daily lifestyle; C: After 8 weeks of hydrotherapy twice weekly. **p < 0.01, mean ± SEM (land vs. warm water immersion).

Mentions: The effect of WWI was similar during all three sessions with no significant differences after 8 weeks of hydrotherapy (Table 3 and Figure 4). There were no significant differences in BNP during the study period. The levels at baseline, after the control period and after 8 weeks of hydrotherapy were 169 ± 158, 134 ± 102 and 147 ± 125 ng/L, respectively. In addition, exercise and cardiopulmonary function were unchanged (data not shown).


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)

Echocardiographic data between three sessions on land and during warm water immersion. 4A. Effect of warm water immersion with respect to stroke volume. 4B. Effect of warm water immersion with respect to heart rate. A: Baseline; B: After 8 weeks of control period without changes in daily lifestyle; C: After 8 weeks of hydrotherapy twice weekly. **p < 0.01, mean ± SEM (land vs. warm water immersion).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Echocardiographic data between three sessions on land and during warm water immersion. 4A. Effect of warm water immersion with respect to stroke volume. 4B. Effect of warm water immersion with respect to heart rate. A: Baseline; B: After 8 weeks of control period without changes in daily lifestyle; C: After 8 weeks of hydrotherapy twice weekly. **p < 0.01, mean ± SEM (land vs. warm water immersion).
Mentions: The effect of WWI was similar during all three sessions with no significant differences after 8 weeks of hydrotherapy (Table 3 and Figure 4). There were no significant differences in BNP during the study period. The levels at baseline, after the control period and after 8 weeks of hydrotherapy were 169 ± 158, 134 ± 102 and 147 ± 125 ng/L, respectively. In addition, exercise and cardiopulmonary function were unchanged (data not shown).

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