The Effects of Thermal Water Physical Exercise in Patients with Lower Limb Chronic Venous Insufficiency Monitored by Bioimpedance Analysis

Abstract

Background: Lower limb chronic venous diseases (CVD) lead to possible edema. The aim of the present investigation was to study the effect of thermal aquatic standardize exercise on lower limb edema control in CVD patients assessed by bioimpedance analysis (BIA). Methods: Seventeen patients (34 legs) affected by CVD clinical class CEAP C3,4c,Ep,As,Pr were included. All the cohort performed a standardized exercise protocol in thermal water environment for a total of five sessions. BIA, leg volume, and heart rate at rest were measured. Results: After the five exercise sessions, BIA showed a significant percentage of extracellular water (ECW) reduction from 42.1 ± 5.8 to 41.24 ± 5.5%; p < 0.001. Moreover, an improvement of resistance (p < 0.0009) and reactance (p < 0.009) was assessed. At the same time, the leg volume reduction rate was 15.7%, p <0.0001. A moderate-strong correlation was found between % ECW and leg volume variation (R = 0.59, p < 0.01). Finally, a significant HR at rest reduction was recorded, p < 0.0001. Conclusion: The investigated exercise protocol significantly affects the lower limb volume, and BIA parameters related to the tissue drainage improvement. The correlation founded between the ECW rate and volume variations suggest the possible use of BIA as a biomarker for monitoring the treatments aimed to reduce edema in CVD.

Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients

“…From a data collection related to the effects of a standardized aquatic exercise protocol, sixteen (16) CVD patients were assessed for cardiovascular and musculoskeletal outcome measures before and after the physical activity. 19…”

“…The water temperature was maintained at 33° which was the same temperature used in a previous studies of our group performed both in non-thermal and thermal environment, 15,17,19 so avoiding the potential bias of different temperatures.…”

“…An extracellular fluid reduction related to improvement in lower limb edema, was verified by fluid reabsorption during exercise in a thermal aquatic environment. 19 Based on the significant resting heart rate (HR) reduction identified in the first part of the study 19 it was hypothesized that aquatic exercise may also improve cardiovascular adaptation and physical fitness level which in turn can promote a more active lifestyle.…”

Physiotherapy in Chronic Venous Disease

“…The special water properties containing different chemical ingredients, e.g. Natrium or Kalium, may have played a role in these results [54]. A randomized controlled trial involved 201 patients for aqua exercises (walking in water, swimming) vs. control.…”

Vascular Biomarkers: Physics Parameters and Circulating Molecules Can Be Two Faces of the Same Coin

“…Menegatti and collaborators explored for the first time the effects of aquatic exercise on cellular and extracellular water distribution. It is known that aquatic exercise, by increasing the external component of the transmural pressure, is beneficial for tissue drainage, but now the bio-impedance assessment adds a novel tool that can be used in the field to monitor the results of the vascular fitness in the water [ 12 ].…”