Aquatic therapies in patients with compromised left ventricular function and heart failure

Abstract

With water immersion, gravity is partly eliminated, and the water exerts a pressure on the body surface. Consequently there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This paper presents a selection of published literature on water immersion, balneotherapy, aqua exercises, and swimming, in patients with left ventricular dysfunction (LVD) and/or stable chronic heart failure (CHF). Based on exploratory studies, central hemodynamic and neurohumoral responses of aquatic therapies will be illustrated. Major findings are: 1. In LVD and CHF, a positive effect of therapeutic warm-water tub bathing has been observed, which is assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. 2. In coronary patients with LVD, at low-level water cycling the heart is working more efficiently than at lowlevel cycling outside of water. 3. In patients with previous extensive myocardial infarction, upright immersion to the neck resulted in temporary pathological increases in mean pulmonary artery pressure (mPAP) and mean pulmonary capillary pressures (mPCP). 4. Additionally, during slow swimming (20-25m/min) the mPAP and/or PCP were higher than during supine cycling outside water at a 100W load. 5. In CHF patients, neck- deep immersion resulted in a decrease or no change in stroke volume. 6. Although patients are hemodynamically compromised, they usually maintain a feeling of well-being during aquatic therapy. Based on these findings, clinical indications for aquatic therapies are proposed and ideas are presented to provoke further research.

Biophysiologic Effects of Warm Water Immersion

“…E-mail khildenbrand@wsu.edu. heart injury (Gabrielsen et al, 2001;Gabrielsen, Sorensen et al, 2000;Hanna, Sheldahl, & Tristani, 1993;Heigenhauser, Boulet, Miller, & Faulkner, 1977;Jiang et al, 1994;Magder, Linnarsson, & Gullstrand, 1981;McMurray, Avery, & Sheps, 1988;Meyer & Leblanc, 2008).…”

Therapeutic swimming

“…Predlažu se igre u vodi bez velikog naprezanja, igre i vježbe navikavanja, a obuka plivanja uz pomoć pomagala (plutače). Najčešće se uči plivanja leđnom tehnikom i kraul ili prsno [4,12].…”

Age-Dependent Autonomic Changes Following Immersion in Cool, Neutral, and Warm Water Temperatures

“…Therefore, using aquatic exercise as a means of cardiac rehabilitation can be beneficial, especially after ischemic heart injury caused by a decreased blood flow (Cider, Schaufelberger, Sunnerhagen, & Andersson, 2003;Cider, Sunnerhagen, Schaufelberger, & Andersson, 2005;Cider et al, 2006;Gabrielsen et al, 2000;Gruner Svealv et al, 2009;Jiang et al, 1994;Meyer & Leblanc, 2008;Mussivand et al, 2008;Tei et al, 1995;Tei & Tanaka, 1996a, 1996b. Over time, the cardiac muscle, as with all aging muscles, takes longer to achieve peak force and has an extended refractory period.…”