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Alikhajeh Y, Afroundeh R, Mohammad Rahimi GR, Bayani B. The Effects of Aquatic Exercise Training on Functional and Hemodynamic Responses in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Biol Res Nurs 2024:10998004241263943. [PMID: 38904085 DOI: 10.1177/10998004241263943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Objective: This study aimed to investigate the impacts of water exercise training on functional and hemodynamic responses in HF patients. Methods: A systematic review and meta-analysis were conducted until February 15, 2024, using multiple databases. Mean difference (MD) with corresponding 95% confidence intervals (CIs) were calculated. Results: Sixteen studies, comprising 349 participants with HF, were included. Water exercise led to enhancements in peak VO2 (MD, 2.85 mL/kg/min; 95% CI, 1.89 to 3.80; p < .00001) and resting heart rate (MD, -4.16 bm; 95% CI, -6.85 to -1.46; p = .002) compared to no exercising controls. Water plus land exercise reduced resting heart rate (MD, -1.41 bm; 95% CI, -2.13 to -0.69; p = .0001) compared to land exercise alone. Furthermore, acute water exercises decreased resting heart rate (MD, -3.85 bm; 95% CI, -6.49 to -1.21; p = .004) and increased stroke volume (MD, 14.68 mL/beat; 95% CI, 8.57 to 20.79; p < .00001) and cardiac output (MD, 0.5 L/min; 95% CI, 0.27 to 0.73; p < .00001) compared to baseline. Conclusion: These findings suggest that water exercise holds promise as an effective intervention for enhancing functional capacity and hemodynamic parameters in individuals with HF, highlighting the importance of further research to optimize its implementation and elucidate long-term benefits.
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Affiliation(s)
- Yaser Alikhajeh
- Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Roghayyeh Afroundeh
- Department of Physical Education and Sport Sciences, Faculty of Education Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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Ksela J, Kafol J, Vasic D, Jug B. Effects of Water-Based Exercise on Patients Older than 60 Years Undergoing Cardiac Rehabilitation after Coronary Intervention. J Cardiovasc Dev Dis 2024; 11:151. [PMID: 38786973 PMCID: PMC11122512 DOI: 10.3390/jcdd11050151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiac rehabilitation (CR) plays a crucial role in managing patients who have undergone coronary intervention (CI) following acute myocardial infarction. While water-based exercise is gaining recognition as an exercise modality in this patient population, its impact on the subgroup of older adults remains unexplored. In this post hoc analysis, we investigated the effects of water-based exercise on adults older than 60 years undergoing CR after CI, comparing it to land-based exercise and a control group. In total, 45 patients aged over 60 participated in 14-day exercise programs, featuring two daily 30-min sessions. We assessed exercise capacity (VO2peak), vascular function (flow-mediated vasodilation (FMD)), heart rate variability (HRV), and blood markers (Interleukins 6, 8, and 10, P-Selectin, ICAM, and High-sensitivity CRP) before and after CR. VO2peak in the water-based group improved significantly after CR in comparison with the land-based group: 1.35 kg/mL/min (95% CI [0.20-2.50], p = 0.022). The significant difference between water-based and land-based groups was observed in several HRV parameters: Total power -1129.20 ms2 (95% CI [-1951.92--306.49], p = 0.008); peak LF 0.04 Hz (95% CI [0.00-0.08], p = 0.036); SD1 -9.02 millisecond (95% CI [-16.86--1.18], p = 0.025); and SD2 -19.71 ms (95% CI [-35.08--4.34], p = 0.013). FMD and blood markers did not vary significantly based on the exercise group. These findings suggest that short-term water-based CR may have potential as an alternative to traditional land-based CR, improving VO2peak and cardiorespiratory fitness among adults over 60 years undergoing CR after CI.
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Affiliation(s)
- Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.K.); (B.J.)
| | - Jan Kafol
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.K.); (B.J.)
| | | | - Borut Jug
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (J.K.); (B.J.)
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Guimarães ALA, Gomes-Neto M, Conceição LSR, Saquetto MB, Gois CO, Carvalho VO. Water-Based Exercises on Peak Oxygen Consumption, Exercise Time, and Muscle Strength in Patients with Coronary Artery Disease: A Systematic Review with Meta-Analysis. Cardiovasc Ther 2023; 2023:4305474. [PMID: 37404774 PMCID: PMC10317579 DOI: 10.1155/2023/4305474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Background There is a growing use of water-based exercises in cardiac rehabilitation programs. However, there is little data concerning the effects of water-based exercise on the exercise capacity of coronary artery disease (CAD) patients. Objective To perform a systematic review to investigate the effects of water-based exercise on peak oxygen consumption, exercise time, and muscle strength in patients with CAD. Methods Five databases were searched to find randomized controlled trials that evaluated the effects of water-based exercise for coronary artery disease patients. Mean differences (MD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Results Eight studies were included. Water-based exercise resulted in an improvement in peak VO2 of 3.4 mL/kg/min (95% CI, 2.3 to 4.5; I2 = 0%; 5 studies, N = 167), exercise time of 0.6 (95% CI, 0.1 to 1.1; I2 = 0%; 3 studies, N = 69), and total body strength of 32.2 kg (95% CI, 23.9 to 40.7; I2 = 3%; 3 studies, N = 69) when compared to no exercising controls. Water-based exercise resulted in an improvement in peak VO2 of 3.1 mL/kg/min (95% CI, 1.4 to 4.7; I2 = 13%; 2 studies, N = 74), when compared to the plus land exercise group. No significant difference in peak VO2 was found for participants in the water-based exercise plus land exercise group compared with the land exercise group. Conclusions Water-based exercise may improve exercise capacity and should be considered as an alternative method in the rehabilitation of patients with CAD.
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Affiliation(s)
- Alana Lalucha Andrade Guimarães
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
| | - Mansueto Gomes-Neto
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Bahia, Brazil
| | - Lino Sérgio Rocha Conceição
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
| | - Micheli Bernardone Saquetto
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Bahia, Brazil
| | - Caroline Oliveira Gois
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
| | - Vitor Oliveira Carvalho
- The GrEAt Group (Grupo de Estudos em Atividade Física), Brazil
- Physical Therapy Department, Federal University of Sergipe, Brazil
- Post-Graduate Program in Health Sciences, Federal University of Sergipe, Brazil
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Andrejeva J, Mockute E, Sniepiene G, Malyško E, Istomina N, Hendrixson V. The impact of WATSU as Physiotherapy Method on Fatigue for People Diagnosed with Multiple Sclerosis. ACTA BALNEOLOGICA 2023. [DOI: 10.36740/abal202301103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim: To identify the impact of WATSU method on fatigue which has an impact on sleep and quality of life, pain and depression or its
aggravation.
Materials and Methods: The study involved the four participants. The following instruments were used: Multiple Sclerosis Quality of Life questionnaire; Pittsburgh Sleep Quality Index; Burns Depression Checklist; Fatigue Impact Scale. The study was carried out in medical center in Lithuania from 09-11-2019 till 18-01-2020 during 10 weeks. Each participant of the study received ten WATSU sessions. The research data was processed using SPSS Statistics 20. Qualitative Outcome Measures were conducted by content analysis, observation, semi-structured individual interview methods.
Results: After 10 sessions, fatigue lessened in all people investigated. Initially, the average of fatigue was 70 points and decreased to 34 points after the investigation. The average sleep quality index was as high as 5 points, after ten weeks the average decreased to 3 points. Changes in assessment of major to mild depression: initially, the average was 36 points, which decreased to 14 points after ten weeks.
Conclusions: The WATSU method was effective in reducing fatigue as a physiotherapy method. Along with changes in fatigue, the Pittsburgh Sleep Quality Index decreased, energy and motivation increased, quality of life improved, level of depression reduced, and the change was statistically significant. While assessing the quality of life, pain was found to be decreased – it became less frequent after ten weeks of sessions and less intense or even absent, its influence on daily activities decreased.
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Affiliation(s)
- Julija Andrejeva
- Klaipeda State University of Applied Sciences, Klaipeda, Lithuania
| | - Elinga Mockute
- Klaipeda State University of Applied Sciences, Klaipeda, Lithuania
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Schitter AM, Frei P, Elfering A, Kurpiers N, Radlinger L. Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial. Contemp Clin Trials Commun 2022; 26:100904. [PMID: 35243125 PMCID: PMC8886016 DOI: 10.1016/j.conctc.2022.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. Methods In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0–100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). Discussion The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. Trial registration The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018–00461). Trial registration is intended at ClinicalTrials.gov.
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Application areas and effects of aquatic therapy WATSU - A survey among practitioners. Complement Ther Clin Pract 2021; 46:101513. [PMID: 34844068 DOI: 10.1016/j.ctcp.2021.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION WATSU (WaterShiatsu) is a treatment administered in warm water. The present study investigated if and how frequently scientifically studied application areas and effects of WATSU occur in practice, whether similar effectiveness of WATSU is observed in trials and practice, and whether practitioners can contribute additional application areas and effects of WATSU. METHODS Application areas and effects of WATSU reported in a recent systematic review were extracted verbatim to be assessed in a worldwide multilingual cross section online survey, generating quantitative and qualitative data. A pre-test and retest were conducted to ensure quality and evaluate the questionnaire's psychometric properties. RESULTS Answers of 191 respondents were processed. All proposed 26 application areas and 20 effects were confirmed, each with relatively high ratings of observed effectiveness of WATSU. WATSU was frequently applied in healthy individuals (including during pregnancy), and individuals in various pain- (e.g., low back pain, neck pain, myofascial pain, fibromyalgia) and stress-related (e.g., stress, depression, sleep disorders, fatigue, anxiety disorders) conditions. Frequently confirmed effects were physical relaxation, relief of physical tension, pain relief, increased mobility and flexibility, improved quality of life, spiritual experiences, and increased psychological health. Respondents contributed 73 additional application areas and effects (both, mental and physical) of WATSU. CONCLUSIONS Application areas and effects of WATSU are consistently employed practically and scientifically. Respondents' ratings of effectiveness of WATSU match tentative research efforts. WATSU is cautiously recommended for the use in pain- and stress-related conditions. Short- and long-term effectiveness of WATSU need to be evaluated in high level intervention studies.
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Lindgren M, Börjesson M. The importance of physical activity and cardiorespiratory fitness for patients with heart failure. Diabetes Res Clin Pract 2021; 176:108833. [PMID: 33895194 DOI: 10.1016/j.diabres.2021.108833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 01/02/2023]
Abstract
The present review highlights current research on the importance of PA and fitness for patients with heart failure and recommendations with respect to heart failure phenotypes and special populations. Furthermore, the evidence for various exercise types and intensities/doses as an "exercise prescription", are discussed. The strong association between heart failure and traditional risk factors, physical inactivity and low fitness, underlines the importance of regular PA and exercise for prevention and treatment of heart failure. This is illustrated by cardiac stiffness which typically accelerates in middle-life and could be reversed by aerobic exercise. In patients with HFpEF, regular PA counteracts many of the changes observed, both metabolic and functional. Indeed, exercise-based cardiac rehabilitation has received a class 1A recommendation in current guidelines [1], in order to improve functional capacity, quality of life and lower the risk of rehospitalization. An individually tailored plan based on risk stratification, clinical assessment and cardiopulmonary exercise testing is encouraged before initiation of exercise training in patients with heart failure. In general, a combination of aerobic exercise and resistance training protocols is recommended (Table 1) [2], preferably throughout life. More studies are needed, regarding the role of PA and exercise in specific populations, such as frail patients with heart failure.
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Affiliation(s)
- Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital/Östra, SE 416 85 Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital/Östra, SE 416 85 Gothenburg, Sweden; Center for Health and Performance, Gothenburg University, Gothenburg, Sweden.
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Ye WN, Thipse M, Mahdi MB, Azad S, Davies R, Ruel M, Silver MA, Hakami L, Mesana T, Leenen F, Mussivand T. Can heat therapy help patients with heart failure? Artif Organs 2020; 44:680-692. [PMID: 32017138 DOI: 10.1111/aor.13659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/16/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.
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Affiliation(s)
- Winnie N Ye
- Department of Electronics, Carleton University, Ottawa, ON, Canada
| | - Madhura Thipse
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Maleka Ben Mahdi
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sharlin Azad
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ross Davies
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc Ruel
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc A Silver
- Heart Failure Institute, Advocate Christ Medical Centre, Oak Lawn, IL, USA
| | - Lale Hakami
- Medical Center, University of Munich, Munich, Germany
| | - Thierry Mesana
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Frans Leenen
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Tofy Mussivand
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Shah P, Pellicori P, Kallvikbacka-Bennett A, Zhang J, Pan D, Clark AL. Warm water immersion in patients with chronic heart failure: a pilot study : Shah immerse: HF. Clin Res Cardiol 2018; 108:468-476. [PMID: 30267153 PMCID: PMC6484774 DOI: 10.1007/s00392-018-1376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with chronic conditions, such as heart failure, swim regularly and most rehabilitation exercises are conducted in warm hydrotherapy pools. However, little is known about the acute effects of warm water immersion (WWI) on cardiac haemodynamics in patients with chronic heart failure (CHF). METHODS Seventeen patients with CHF (NYHA I and II; mean age 67 years, 88% male, mean left ventricular ejection fraction 33%) and 10 age-matched normal subjects were immersed up to the neck in a hydrotherapy pool (33-35 °C). Cardiac haemodynamics were measured non-invasively, and echocardiography was performed at baseline, during WWI, 3 min after kicking in the supine position and after emerging. RESULTS In patients with CHF, compared to baseline, WWI immediately increased stroke volume (SV, mean ± standard deviation; from 65 ± 21 to 82 ± 22 mL, p < 0.001), cardiac output (CO, from 4.4 ± 1.4 to 5.7 ± 1.6 L/min, p < 0.001) and cardiac index (CI, from 2.3 ± 0.6 to 2.9 ± 0.70 L/min/m², p < 0.001) with decreased systemic vascular resistance (from 1881 ± 582 to 1258 ± 332 dynes/s/cm5, p < 0.001) and systolic blood pressure (132 ± 21 to 115 ± 23 mmHg, p < 0.001). The haemodynamic changes persisted for 15 min of WWI. In normal subjects, compared to baseline, WWI increased SV (from 68 ± 11 to 80 ± 18 mL, p < 0.001), CO (from 5.1 ± 1.9 to 5.7 ± 1.8 L/min, p < 0.001) and CI (from 2.7 ± 0.9 to 2.9 ± 1.0 L/min/m², p < 0.001).In patients with CHF, compared to baseline, WWI caused an increase in left atrial volume (from 57 ± 44 to 72 ± 46 mL, p = 0.04), without any changes in left ventricular size or function or amino terminal pro B-type natriuretic peptide. CONCLUSIONS In patients with CHF, WWI causes an acute increase in cardiac output and a fall in systemic vascular resistance. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT02949544) https://clinicaltrials.gov/ct2/show/NCT02949544?cond=NCT02949544&rank=1 .
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Affiliation(s)
- Parin Shah
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Anna Kallvikbacka-Bennett
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Jufen Zhang
- Clinical Trials Unit, Postgraduate Medical Institute, Faculty of Medical Science, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, CM1 1SQ, UK
| | - Daniel Pan
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK
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Totou NL, Moura SS, Coelho DB, Oliveira EC, Becker LK, Lima WG. Swimming exercise demonstrates advantages over running exercise in reducing proteinuria and glomerulosclerosis in spontaneously hypertensive rats. Physiol Int 2018; 105:76-85. [PMID: 29602293 DOI: 10.1556/2060.105.2018.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Experimental studies in animal models have described the benefits of physical exercise (PE) to kidney diseases associated with hypertension. Land- and water-based exercises induce different responses in renal function. Our aim was to evaluate the renal alterations induced by different environments of PE in spontaneously hypertensive rats (SHRs). The SHRs were divided into sedentary (S), swimming exercise (SE), and running exercise (RE) groups, and were trained for 8 weeks under similar intensities (60 min/day). Arterial pressure (AP) and heart rate (HR) were recorded. The renal function was evaluated through urinary volume at each week of training; sodium and potassium excretions, plasma and urinary osmolarities, glomerular filtration rate (GFR), levels of proteinuria, and renal damage were determined. SE and RE rats presented reduced mean AP, systolic blood pressure, and HR in comparison with S group. SE and RE rats showed higher urine osmolarity compared with S. SE rats showed higher free water clearance (P < 0.01), lower urinary density (P < 0.0001), and increased weekly urine volume (P < 0.05) in comparison with RE and S groups. GFR was increased in both SE and RE rats. The proteinuria of SE (7.0 ± 0.8 mg/24 h) rats was decreased at the 8th week of the PE in comparison with RE (9.6 ± 0.8 mg/24 h) and S (9.8 ± 0.5 mg/24 h) groups. The glomerulosclerosis was reduced in SE rats (P < 0.02). SE produced different response in renal function in comparison with RE, in which only swimming-trained rats had better profile for proteinuria and glomerulosclerosis.
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Affiliation(s)
- N L Totou
- 1 Department of Biological Sciences (DECBI), Federal University of Ouro Preto , Minas Gerais, Brazil
| | - S S Moura
- 2 Sports Center (CEDUFOP), Federal University of Ouro Preto , Minas Gerais, Brazil
| | - D B Coelho
- 2 Sports Center (CEDUFOP), Federal University of Ouro Preto , Minas Gerais, Brazil
| | - E C Oliveira
- 2 Sports Center (CEDUFOP), Federal University of Ouro Preto , Minas Gerais, Brazil
| | - L K Becker
- 2 Sports Center (CEDUFOP), Federal University of Ouro Preto , Minas Gerais, Brazil
| | - W G Lima
- 1 Department of Biological Sciences (DECBI), Federal University of Ouro Preto , Minas Gerais, Brazil
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Habitual hot water bathing protects cardiovascular function in middle-aged to elderly Japanese subjects. Sci Rep 2018; 8:8687. [PMID: 29930309 PMCID: PMC6013438 DOI: 10.1038/s41598-018-26908-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/21/2018] [Indexed: 01/29/2023] Open
Abstract
Favorable effects of sauna bathing on cardiovascular disease have been demonstrated. Hot water bathing is an alternative, and could also have similar effects. Information pertaining to hot water bathing frequency and water temperature was obtained from 873 subjects. Carotid mean and max intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were measured as indices of atherosclerosis. Central haemodynamics were evaluated using radial pulse waveform analyses. Plasma levels of B-type natriuretic peptide (BNP) were measured as an index for cardiac loading. The mean duration of a single hot bath was 12.4 ± 9.9 min. Subject bathing in hot water ≥5 times per week had significantly lower baPWV, central pulse pressure (PP), and BNP after correcting for possible confounding parameters. Stepwise regression analyses revealed that hot water temperature was negatively associated with baPWV, while bathing frequency was negatively related to central PP and BNP. A longitudinal follow-up in 164 subjects showed that hot water bathing ≥5 times per week was associated with significantly lower increase in BNP over time, while the temperature of the water tended to be related to lower increases in carotid max IMT and baPWV. Hot water bathing showed a favorable effect on atherosclerotic and central haemodynamic parameters.
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Abstract
It is not clear whether swimming is safe in patients with chronic heart failure. Ten studies examining the hemodynamic effects of acute water immersion (WI) (155 patients; average age 60 years; 86% male; mean left ventricular ejection fraction (LVEF) 29%) and 6 randomized controlled trials of rehabilitation comparing swimming with either medical treatment only (n = 3) or cycling (n = 1) or aerobic exercise (n = 2), (136 patients, average age 59 years; 84% male, mean LVEF 31%) were considered. In 7 studies of warm WI (30-35°C): heart rate (HR) fell (2% to -15%), and both cardiac output (CO) (7-37%) and stroke volume (SV) increased (13-41%). In 1 study of hot WI (41°C), systemic vascular resistance (SVR) fell (41%) and HR increased (33%). In 2 studies of cold WI (12-22°C), there were no consistent effects on HR and CO. Compared with medical management, swimming led to a greater increase in peak VO2 (7-14%) and 6 minute walk test (6MWT) (7-13%). Compared with cycle training, combined swimming and cycle training led to a greater reduction in resting HR (16%), a greater increase in resting SV (23%) and SVR (15%), but no changes in resting CO and a lesser increase in peak VO2 (6%). Compared with aerobic training, combined swimming and aerobic training lead to a reduction in resting HR (19%) and SVR (54%) and a greater increase in SV (34%), resting CO (28%), LVEF (9%), and 6MWT (70%). Although swimming appears to be safe, the studies conducted have been small, very heterogeneous, and inconclusive.
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Pharr J, Irwin C, Layne T, Irwin R. Predictors of Swimming Ability among Children and Adolescents in the United States. Sports (Basel) 2018; 6:E17. [PMID: 29910321 PMCID: PMC5969197 DOI: 10.3390/sports6010017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 11/16/2022] Open
Abstract
Swimming is an important source of physical activity and a life skill to prevent drowning. However, little research has been conducted to understand predictors of swimming ability. The purpose of this study was to understand factors that predict swimming ability among children and adolescents in the United States (US). This was a cross-sectional survey conducted between February and April of 2017 across five geographically diverse cities. Participants were accessed through the Young Christian Men's Association (YMCA) and included parents of children aged 4⁻11 years old and adolescents aged 12⁻17 years old. Independent t-test, analysis of variance (ANOVA), and univariate and multivariate analyses were conducted. Several factors were significant (p ≤ 0.05) predictors of swimming ability and explained 53% of the variance in swimming ability. Variables that were positively associated with swimming ability included: ability of parent(s) to swim, child/adolescent age, a best friend who enjoys swimming, water-safety knowledge, pool open all year, and encouragement to swim from parent(s). Variables that were negatively associated with swimming ability included: fear of drowning, being African American, and being female. Interventions and programs to improve the swimming ability of children and adolescents could be developed with these predictors in mind.
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Affiliation(s)
- Jennifer Pharr
- School of Community Health Sciences, University of Nevada, Las Vegas, NV 89154, USA.
| | - Carol Irwin
- School of Health Studies, University of Memphis, Memphis, TN 38152, USA.
| | - Todd Layne
- School of Health Studies, University of Memphis, Memphis, TN 38152, USA.
| | - Richard Irwin
- Office of Academic Innovation and Support Services, University of Memphis, Memphis, TN 38152, USA.
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Silva VZMD, Santana ANC. Noninvasive positive airway pressure: from critically ill patients to physical exercise in outpatients. ACTA ACUST UNITED AC 2018; 43:405-406. [PMID: 29340485 PMCID: PMC5792036 DOI: 10.1590/s1806-37562017000060001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hägglund E, Hagerman I, Dencker K, Strömberg A. Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. Eur J Cardiovasc Nurs 2017; 16:381-389. [PMID: 28128646 DOI: 10.1177/1474515117690297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The aims of this study were to determine whether yoga and hydrotherapy training had an equal effect on the health-related quality of life in patients with heart failure and to compare the effects on exercise capacity, clinical outcomes, and symptoms of anxiety and depression between and within the two groups. METHODS The design was a randomized controlled non-inferiority study. A total of 40 patients, 30% women (mean±SD age 64.9±8.9 years) with heart failure were randomized to an intervention of 12 weeks, either performing yoga or training with hydrotherapy for 45-60 minutes twice a week. Evaluation at baseline and after 12 weeks included self-reported health-related quality of life, a six-minute walk test, a sit-to-stand test, clinical variables, and symptoms of anxiety and depression. RESULTS Yoga and hydrotherapy had an equal impact on quality of life, exercise capacity, clinical outcomes, and symptoms of anxiety and depression. Within both groups, exercise capacity significantly improved (hydrotherapy p=0.02; yoga p=0.008) and symptoms of anxiety decreased (hydrotherapy p=0.03; yoga p=0.01). Patients in the yoga group significantly improved their health as rated by EQ-VAS ( p=0.004) and disease-specific quality of life in the domains symptom frequency ( p=0.03), self-efficacy ( p=0.01), clinical summary as a combined measure of symptoms and social factors ( p=0.05), and overall summary score ( p=0.04). Symptoms of depression were decreased in this group ( p=0.005). In the hydrotherapy group, lower limb muscle strength improved significantly ( p=0.01). CONCLUSIONS Yoga may be an alternative or complementary option to established forms of exercise training such as hydrotherapy for improvement in health-related quality of life and may decrease depressive symptoms in patients with heart failure.
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Affiliation(s)
- Ewa Hägglund
- 1 Department of Cardiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sweden
| | - Inger Hagerman
- 1 Department of Cardiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sweden
| | - Kerstin Dencker
- 1 Department of Cardiology, Karolinska Institutet, Karolinska University Hospital Huddinge, Sweden
| | - Anna Strömberg
- 2 Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Sweden.,3 Department of Cardiology, Linköping University, Sweden.,4 UCI program in Nursing Science, University of California Irvine, USA
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Rivas E, Newmire DE, Ben-Ezra V. Obese type 2 diabetics have a blunted hypotensive response to acute hyperthermia therapy that does not affect the perception of thermal stress or physiological strain compared to healthy adults. Physiol Behav 2016; 165:374-82. [PMID: 27570191 DOI: 10.1016/j.physbeh.2016.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/21/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The objective of this study was to test the hypothesis that a hyperthermia-hypotensive challenge via whole body hot water immersion would alter the perception of hyperthermia and physiological strain in obese type 2 diabetics (T2DM) compared to healthy non-obese (HC) individuals. Additionally, we hypothesize that the mechanisms would be attributed to impaired blood pressure adjustments and afferent signals (via changes in internal and mean skin temperatures). METHODS In random order, eleven obese T2DM (50±12y, 45±7% fat mass, 7.5±1.8% HbA1c) and nine similar aged (41±14y, P>0.05) HC non-obese (33±8% fat mass, P<0.01) non-diabetic (5.3±0.4% HbA1c, P<0.01) underwent a 60min bout of whole body passive hyperthermia followed by 60min of recovery or a 2h resting control condition. The perception of thermal sensation (TS, scale range: 1-13), calculated physiological strain (PSI), internal (Tre, rectal) and mean skin (Tsk) temperatures, heart rate (HR) and blood pressures (BP) were the primary dependent variables. RESULTS Hyperthermia similarly increased Tre by 1.4±0.4°C, Tsk by 6.5±0.8°C and HR by 34±8bpm in both groups (P>0.5). Hyperthermia reduced diastolic BP (27% in T2DM and 33% in HC, P<0.05) and mean arterial BP (reduced by 15% in T2DM and by 19% in HC) relative to control conditions (P<0.05). The reduction of mean arterial BP area under the curve was attenuated in T2DM (12%) compared to HC (30%) (group×condition, P<0.01). TS and PSI during hyperthermia were not different between groups. Pearson product correlation reported strong correlations (r=0.69-0.89) with Tre and Tsk with TS in both populations. The linear stepwise regression analysis revealed similar relative contributions for Tre (~60%) and Tsk (~40%) on TS for both groups. CONCLUSIONS These data indicate that obese T2DM with moderate metabolic control have an attenuated hyperthermia-hypotensive response that does not affect TS and PSI. This also may suggest behavioral thermoregulation is intact in this study group.
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Affiliation(s)
- Eric Rivas
- Division of Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Dan E Newmire
- Department of Kinesiology, Texas Woman's University, Denton, TX, USA
| | - Vic Ben-Ezra
- Department of Kinesiology, Texas Woman's University, Denton, TX, USA
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Hydrotherapy on exercise capacity, muscle strength and quality of life in patients with heart failure: A meta-analysis. Int J Cardiol 2015; 198:216-9. [PMID: 26173056 DOI: 10.1016/j.ijcard.2014.10.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022]
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18
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Lai B, Jeng B, Vrongistinos K, Jung T. Post-exercise hypotensive responses following an acute bout of aquatic and overground treadmill walking in people post-stroke: a pilot study. Top Stroke Rehabil 2015; 22:231-8. [PMID: 26084324 DOI: 10.1179/1074935714z.0000000016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the effects of a single-bout of aquatic treadmill walking (ATW) and overground treadmill walking (OTW) on the magnitude and duration of post-exercise ambulatory blood pressure (BP) in people post-stroke. METHODS Seven people post-stroke participated in a cross-sectional comparative study. BP was monitored for up to 9 hours after a 15-minute bout of ATW and OTW at approximately 70% of maximal oxygen consumption (VO2max), performed on separate days. Mean systolic and diastolic BP values were compared between both exercise conditions and a day without exercise (control). RESULTS Three hours after OTW, mean SBP increased by 9% from pre-exercise baseline compared to a 3% decrease during the control day (P < 0.05). A similar trend was observed after the third hour of ATW (P = 0.06). However, ATW demonstrated a 3% overall decline in DBP after exercise compared to a 1% DBP increase of the control day (P < 0.05). Additionally, ATW showed a 6% reduction in mean systolic BP at the ninth hour post-exercise (P < 0.05) compared to baseline. CONCLUSION Our results indicate people post-stroke can sustain sufficient walking intensities necessary to reduce BP following cardiovascular exercise. Also, these data suggest that ATW can elicit clinically meaningful reductions in DBP and night-time SBP. Thus, it is recommended for clinicians to consider ATW as a non-pharmaceutical means to regulate DBP and promote nighttime dipping of SBP in people post-stroke. However, caution is advised during the immediate hours after exercise, a period of possible BP inflation.
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Aquatic exercise training and stable heart failure: A systematic review and meta-analysis. Int J Cardiol 2015; 186:22-8. [DOI: 10.1016/j.ijcard.2015.03.095] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/20/2015] [Accepted: 03/07/2015] [Indexed: 12/12/2022]
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Schitter AM, Nedeljkovic M, Baur H, Fleckenstein J, Raio L. Effects of Passive Hydrotherapy WATSU (WaterShiatsu) in the Third Trimester of Pregnancy: Results of a Controlled Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:437650. [PMID: 25815033 PMCID: PMC4359846 DOI: 10.1155/2015/437650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/26/2014] [Accepted: 09/15/2014] [Indexed: 12/03/2022]
Abstract
Background. WATSU (WaterShiatsu) is a complementary therapeutic treatment method comprising passive stretches and massage techniques administered in 35°C warm water. Pregnant women claim safe methods to reduce pain, stress, and fatigue. Therefore, we conducted a pilot study evaluating the effects of WATSU on pregnancy-related complaints in third trimester pregnant women. Methods. Nine healthy pregnant women at gestational week ≥34 were included in an intervention group (receiving WATSU) and compared to eight women in a passive control group (receiving no treatment). WATSU was performed on days 1 and 4 of the study, accompanied by ultrasound examinations. Outcomes include physiological and psychometric as well as qualitative data. Participants in the control group completed questionnaires only. Results. WATSU was found to significantly lower participants' levels of stress and pain and to improve their mental health-related quality of life and mood. In comparison to the passive control group, participants in the intervention group reported reduction in perceived stress from day 1 to day 8 (P = 0.036, Cohen's f = 0.57). Qualitative data indicate that WATSU was appreciated as enjoyable and deeply relaxing. No negative side effects were reported. Conclusion. Our findings support the notion that WATSU yields therapeutic benefits for pregnant women and warrant further research. This study has been registered at ClinicalTrials.gov: NCT01708018.
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Affiliation(s)
- Agnes M. Schitter
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Marko Nedeljkovic
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Heiner Baur
- Department of Health, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Johannes Fleckenstein
- Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology Inselspital, University Hospital of Bern, Effingerstrasse 102, 3010 Bern, Switzerland
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Guimaraes GV, de Barros Cruz LG, Fernandes-Silva MM, Dorea EL, Bocchi EA. Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial). Int J Cardiol 2014; 172:434-41. [PMID: 24491874 DOI: 10.1016/j.ijcard.2014.01.100] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/12/2013] [Accepted: 01/19/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients. METHODS This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32°C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). RESULTS 32 patients (HEx n=16; control n=16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mmHg). HEx decreased 24-hour systolic (from 137±23 to 120±12 mmHg, p=0.001) and diastolic BPs (from 81±13 to 72±10 mmHg, p=0.009); daytime systolic (from 141±24 to 120±13 mmHg, p<0.0001) and diastolic BPs (from 84±14 to 73±11 mmHg, p=0.003); and nighttime systolic (from 129±22 to 114±12 mmHg, p=0.006) and diastolic BPs (from 74±11 to 66±10 mmHg, p<0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs. CONCLUSION HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
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Affiliation(s)
- Guilherme Veiga Guimaraes
- Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | | | | | - Egidio Lima Dorea
- University Hospital, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure? J Geriatr Cardiol 2013; 9:408-10. [PMID: 23341846 PMCID: PMC3545259 DOI: 10.3724/sp.j.1263.2012.06121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/20/2012] [Accepted: 11/30/2012] [Indexed: 11/25/2022] Open
Abstract
Hydrotherapy (exercise in warm water) is considered to be a safe and beneficial method to use in the rehabilitation of stable heart failure patients, but there is little information on the effect of the increased venous return and enhanced preload in elderly patients with biventricular heart failure. We present a case of an elderly man who was recruited to participate in a hydrotherapy study. We compared echocardiographic data during warm water immersion with land measurements, and observed increases in stroke volume from 32 mL (land) to 42 mL (water), left ventricular ejection fraction from 22% to 24%, left ventricular systolic velocity from 4.8 cm/s to 5.0 cm/s and left atrioventricular plane displacement from 2.1 mm to 2.2 mm. By contrast, right ventricular systolic velocity decreased from 11.2 cm/s to 8.4 cm/s and right atrioventricular plane displacement from 8.1 mm to 4.7 mm. The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during warm water immersion. Thus, although left ventricular systolic function was relatively unaffected during warm water immersion, we observed a decrease in right ventricular function with an augmented right ventricular pressure. We recommend further investigations to observe the cardiac effect of warm water immersion on patients with biventricular systolic heart failure and at risk of elevated right ventricular pressure.
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Xu L, Shi R, Wang B, Geng J, Zhou L, Zhang Y, Guo G, Chen J, Cao X, Zhang S. 21-day Balneotherapy Improves Cardiopulmonary Function and Physical Capacity of Pilots. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Li Xu
- Department of Medical Affairs, Lintong Sanatorium of Lanzhou Military Region
- Department of Aerospace Biodynamics, Fourth Military Medical University
| | - Runze Shi
- Department of Health, Lanzhou Military Region
| | - Bing Wang
- The Key Laboratory of Aerospace Medicine, Chinese Ministry of Education
| | - Jie Geng
- Department of Aerospace Biodynamics, Fourth Military Medical University
| | - Linfu Zhou
- Department of Medical Affairs, Lintong Sanatorium of Lanzhou Military Region
| | | | - Guanghui Guo
- Department of Medical Affairs, Lintong Sanatorium of Lanzhou Military Region
| | - Jingzao Chen
- Department of Aerospace Biodynamics, Fourth Military Medical University
| | - Xinsheng Cao
- Department of Aerospace Biodynamics, Fourth Military Medical University
| | - Shu Zhang
- The Key Laboratory of Aerospace Medicine, Chinese Ministry of Education
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Bigot M. [Global therapy management of chronic heart failure during cardiac rehabilitation]. Ann Cardiol Angeiol (Paris) 2012; 61:37-41. [PMID: 22015049 DOI: 10.1016/j.ancard.2011.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 07/24/2011] [Indexed: 05/31/2023]
Abstract
Heart failure is a complex syndrome, whose treatment associates diet, medicine, educational sessions, exercise training, psychological and social help. During cardiac rehabilitation, heart failure patients start exercise training against reconditioning and wasting muscle tissues: segmental rehabilitation, steady state exercise or interval training, breathing physiotherapy, swimming pool, low frequency electric muscle stimulation, according to individualized training program, in association with salt free diet and fight against cardiovascular risk factors. Rehabilitation also helps to increase the dose of drugs according to international recommendations, looking after clinical and biological parameters, and allows including patients in educational sessions. These two last points seem to be a key role of rehabilitation. Thanks to these many actions, hold by multidisciplinary team trained to take care of chronic heart failure patients and to lead therapeutic education, cardiac rehabilitation is very useful for chronic heart failure patients, to help hospital and liberal management therapy of chronic heart failure and reduce medical cost. Rehabilitation counsels should be carried on in home-based program.
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Affiliation(s)
- M Bigot
- Clinique de réadaptation cardiaque et vasculaire, cardiocéan, 25 allée de La-Tourtillière, Puilboreau, France.
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Yoon SJ, Park JK, Oh S, Jeon DW, Yang JY, Hong SM, Kwak MS, Choi YS, Rim SJ, Youn HJ. A Warm Footbath Improves Coronary Flow Reserve in Patients with Mild-to-Moderate Coronary Artery Disease. Echocardiography 2011; 28:1119-24. [DOI: 10.1111/j.1540-8175.2011.01493.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rodriguez D, Silva V, Prestes J, Rica RL, Serra AJ, Bocalini DS, Pontes FL. Hypotensive response after water-walking and land-walking exercise sessions in healthy trained and untrained women. Int J Gen Med 2011; 4:549-54. [PMID: 21887107 PMCID: PMC3160863 DOI: 10.2147/ijgm.s23094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to compare post-exercise hypotension after acute sessions of water-walking and land-walking in healthy trained and untrained women. Methods: Twenty-three untrained (n = 12) and trained (n = 11) normotensive women performed two walking sessions in water and on land at 40% of peak VO2 for 45 minutes. Systolic and diastolic blood pressure and mean arterial pressure were measured 15, 30, 45, and 60 minutes after the exercise sessions. Results: No differences were found between the groups for age and anthropometric parameters, but peak VO2 for the trained women (45 ± 8 mL/kg/minute) was higher than for the untrained women (31 ± 3 mL/kg/minute). No differences were found between the groups with regard to systolic and diastolic blood pressure and mean arterial pressure after water immersion. The heart rate in the trained group (62 ± 3 beats per minute [bpm]) was significantly lower (P < 0.05) than in the untrained group (72 ± 4 bpm) on land, and after water immersion, this difference disappeared (58 ± 5 bpm in the trained women and 66 ± 5 bpm in the untrained women). Sixty minutes after water-walking, systolic blood pressure (108 ± 8 mmHg vs 97 ± 3 mmHg), diastolic blood pressure (69 ± 5 mmHg vs 62 ± 5 mmHg), and mean arterial pressure (82 ± 6 mmHg vs 74 ± 4 mmHg) decreased significantly with rest in the untrained group, and no differences were found after land-walking. In the trained group, significant (P < 0.05) differences were found only for systolic blood pressure (110 ± 9 mmHg vs 100 ± 9 mmHg) after 60 minutes of water-walking; decreases in systolic blood pressure were found after 45 minutes (99 ± 7 mmHg) and 60 minutes (99 ± 6 mmHg) compared with rest (107 ± 5 mmHg) after land-walking. Conclusion: Single water-walking and land-walking sessions induced important hypotension following exercise. Additionally, walking performed in chest-deep water has a better effect on exercise-induced hypotension in untrained healthy women than walking at a similar intensity on land.
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Oláh M, Koncz Á, Fehér J, Kálmánczhey J, Oláh C, Nagy G, Bender T. The effect of balneotherapy on antioxidant, inflammatory, and metabolic indices in patients with cardiovascular risk factors (hypertension and obesity)--a randomised, controlled, follow-up study. Contemp Clin Trials 2011; 32:793-801. [PMID: 21763463 DOI: 10.1016/j.cct.2011.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/31/2011] [Accepted: 06/28/2011] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The primary objective of our study was to explore the changes of antioxidant, inflammatory, and metabolic parameters in obese and hypertension people patients during balneotherapy and to evaluate the safety of balneotherapy in these participants. METHODS Following randomisation, 22 obese and 20 hypertensive patients underwent balneotherapy with thermal water of 38°C temperature, in 15 sessions of 30 minutes. An additional 22 obese and 20 hypertensive patients served as controls. Antioxidant, inflammatory, and metabolic parameters were determined at baseline, as well as post-treatment and at the end of follow-up (at 15 weeks). RESULTS As regards changes observed in hypertensive patients subjected to balneotherapy, differences could be detected between baseline and post-treatment albumin and haemoglobin A(1c) levels only; however, these were no longer significant after 3 months. Although the difference between transferrin levels determined at the end of balneotherapy and 3 months later was significant, it remained within the physiological range, as well as it was accompanied by normal serum iron level and therefore, it was considered irrelevant. C-reactive protein levels of balneotherapy patients decreased significantly after treatment. In obese patients, haemoglobin A(1c) level decreased after balneotherapy, but this difference was not observed either after 3 months. Similarly, both transferrin and C-reactive protein levels changed from baseline, but not between groups. CONCLUSIONS This study contributes important information regarding the safety of balneotherapy in hypertensive and obese diabetics by showing no alterations of antioxidant, inflammatory, or metabolic indices. The findings of this study confirm that balneotherapy is not contraindicated for hypertensive or obese patients.
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Affiliation(s)
- Mihály Oláh
- Hungarospa Hajdúszoboszló Private Limited Company, Budapest, Hungary
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Caminiti G, Volterrani M, Marazzi G, Cerrito A, Massaro R, Sposato B, Arisi A, Rosano G. Hydrotherapy added to endurance training versus endurance training alone in elderly patients with chronic heart failure: A randomized pilot study. Int J Cardiol 2011; 148:199-203. [DOI: 10.1016/j.ijcard.2009.09.565] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 08/24/2009] [Accepted: 09/13/2009] [Indexed: 10/20/2022]
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Carvalho VO, Guimarães GV. Hydrotherapy to heart failure patients. Int J Cardiol 2010; 145:377. [DOI: 10.1016/j.ijcard.2010.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/14/2010] [Indexed: 10/19/2022]
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Schmid JP, Morger C, Noveanu M, Binder RK, Anderegg M, Saner H. Haemodynamic and arrhythmic effects of moderately cold (22 degrees C) water immersion and swimming in patients with stable coronary artery disease and heart failure. Eur J Heart Fail 2010; 11:903-9. [PMID: 19696059 DOI: 10.1093/eurjhf/hfp114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Data on moderately cold water immersion and occurrence of arrhythmias in chronic heart failure (CHF) patients are scarce. METHODS AND RESULTS We examined 22 male patients, 12 with CHF [mean age 59 years, ejection fraction (EF) 32%, NYHA class II] and 10 patients with stable coronary artery disease (CAD) without CHF (mean age 65 years, EF 52%). Haemodynamic effects of water immersion and swimming in warm (32 degrees C) and moderately cold (22 degrees C) water were measured using an inert gas rebreathing method. The occurrence of arrhythmias during water activities was compared with those measured during a 24 h ECG recording. Rate pressure product during water immersion up to the chest was significantly higher in moderately cold (P = 0.043 in CHF, P = 0.028 in CAD patients) compared with warm water, but not during swimming. Rate pressure product reached 14200 in CAD and 12 400 in CHF patients during swimming. Changes in cardiac index (increase by 5-15%) and oxygen consumption (increase up to 20%) were of similar magnitude in moderately cold and warm water. Premature ventricular contractions (PVCs) increased significantly in moderately cold water from 15 +/- 41 to 76 +/- 163 beats per 30 min in CHF (P = 0.013) but not in CAD patients (20 +/- 33 vs. 42 +/- 125 beats per 30 min, P = 0.480). No ventricular tachycardia was noted. CONCLUSION Patients with compensated CHF tolerate water immersion and swimming in moderately cold water well. However, the increase in PVCs raises concerns about the potential danger of high-grade ventricular arrhythmias.
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Affiliation(s)
- Jean-Paul Schmid
- Cardiovascular Prevention and Rehabilitation, Swiss Cardiovascular Centre Bern, University Hospital (Inselspital), 3010 Bern, Switzerland.
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Oláh M, Koncz A, Fehér J, Kálmánczhey J, Oláh C, Balogh S, Nagy G, Bender T. The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2010; 54:249-54. [PMID: 19937457 DOI: 10.1007/s00484-009-0276-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/19/2009] [Accepted: 10/20/2009] [Indexed: 05/21/2023]
Abstract
An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades. In the present study, 42 ambulatory patients (23 males and 19 females, mean age 59.5 years) with degenerative musculoskeletal disease were randomised into one of two groups-bathing in tap water or in mineral water at the same temperature-and subjected to 30-min balneotherapy sessions on 15 occasions. Study parameters comprised serum levels of sensitised C-reactive protein (CRP), plasma lipids, heat shock protein (HSP-60) and total antioxidant status (TAS). In both groups, CRP levels followed a decreasing tendency, which still persisted 3 months later. At 3 months after balneotherapy, serum cholesterol levels were still decreasing in patients who had used medicinal water, but exhibited a trend towards an increase in the control group. Triglyceride levels followed a decreasing trend in both patient groups. TAS showed a declining tendency in both groups. No changes of HSP-60 levels were observed in either group. Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period.
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Affiliation(s)
- Mihály Oláh
- Hungarospa Hajdúszoboszló, Hajdúszoboszló, Hungary
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Exercise Rehabilitation Restores Physiological Cardiovascular Responses to Short-term Head-Out Water Immersion in Patients With Chronic Heart Failure. J Cardiopulm Rehabil Prev 2010; 30:22-7. [DOI: 10.1097/hcr.0b013e3181c8595c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 2009; 1:859-72. [PMID: 19769921 DOI: 10.1016/j.pmrj.2009.05.017] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/28/2009] [Accepted: 05/28/2009] [Indexed: 11/19/2022]
Abstract
The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.
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Affiliation(s)
- Bruce E Becker
- Washington State University, National Aquatics and Sports Medicine Institute, Department of Rehabilitation Medicine, University of Washington School of Medicine, Spokane WA 99224, USA.
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Ovando AC, Eickhoff HM, Dias JA, Winkelmann ER. Efeito da temperatura da água nas respostas cardiovasculares durante a caminhada aquática. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000700002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo foi verificar o efeito da temperatura da água nas respostas cardiovasculares: frequência cardíaca (FC), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), durante a caminhada aquática em três temperaturas (29°C, 33°C e 37°C). Participaram do estudo 10 homens, com média de idade de 23,2 ± 2,25 anos, massa corporal de 78,4 ± 4,01kg e estatura de 1,774 ± 0,017m. Os participantes realizaram caminhadas aquáticas durante 30 min, a uma cadência controlada de 55 passos/minuto, na altura do processo xifoide, em dias diferentes para cada temperatura, sendo as respostas cardiovasculares monitoradas nos minutos 5, 10, 20 e 30. Apesar do efeito principal de 75,4% (p < 0,001) da temperatura da água sobre a variação da FC, também foi identificado um efeito do tempo de exercício de 91,8% (p = 0,001). A FC aumentou gradativamente no decorrer da caminhada, especialmente na temperatura de 37°C (71,3 ± 8,4 para 114,6 ± 4,4); ao final da caminhada foi maior que os 29°C (p < 0,01) e 33°C (p < 0,05); estas últimas não apresentaram diferença entre si. A temperatura parece ter tido pouco efeito sobre a PAS, visto que apenas nos minutos 20 e 30 foi maior aos 33°C comparada com a de 29°C (p < 0,05). A PAD sofreu efeito da temperatura, diminuindo gradativamente no decorrer da caminhada, especialmente na temperatura de 37°C (70,0 ± 5,0 para 40,0 ± 2,5); apresentou diferença significativa em relação às temperaturas de 29°C e 33°C (p < 0,05), as quais não mostraram diferença entre si. Considerando o efeito da temperatura da água sobre a FC e a PAD durante a caminhada aquática, sugere-se que, quando piscinas terapêuticas forem utilizadas para realização de caminhada na água, a escolha da temperatura da água seja considerada, recomendando-se valores entre 29°C e 33°C para menor estresse cardiovascular.
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Affiliation(s)
- Angélica Cristiane Ovando
- Universidade do Noroeste do Estado do Rio Grande do Sul, Brasil; Universidade do Estado de Santa Catarina, Brasil
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Grüner Sveälv B, Cider A, Täng MS, Angwald E, Kardassis D, Andersson B. Benefit of warm water immersion on biventricular function in patients with chronic heart failure. Cardiovasc Ultrasound 2009; 7:33. [PMID: 19580653 PMCID: PMC2713206 DOI: 10.1186/1476-7120-7-33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 07/06/2009] [Indexed: 01/14/2023] Open
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°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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Affiliation(s)
- Bente Grüner Sveälv
- Department of Molecular and Clinical Medicine/Cardiology, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden.
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Water Exercise in Patients With and Without Cardiovascular Disease: Benefits, Rationale, Safety, and Prescriptive Guidelines. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609334756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research regarding the benefits of exercise-based cardiac rehabilitation is extensive and well documented. Water exercise, in the form of stretching, walking, jogging, aerobics, strength and balance training, and swimming, provides an attractive alternative from traditional land-based exercise for achieving improved health and fitness. Patients with orthopedic or musculoskeletal limitations, pulmonary disease, excess adiposity, and other medical conditions may significantly benefit from a water-based exercise program. Although water exercise is beneficial for varied patient populations, the safety and appropriateness of higher intensity activities such as swimming should be considered. Because coronary patients have a reduced ability to identify ischemic symptoms in water, water exercise should be prescribed with caution in high-risk patients, individuals with limited swimming skills, and those with significant left ventricular dysfunction. Furthermore, the acute physiological responses during water submersion and exercise may vary considerably from land-based activity and require attention when prescribing a water-based exercise program for patients with and without coronary artery disease.
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Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP) - São Paulo/SP, Brazil
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (LATIS-CEPEUSP) - São Paulo/SP, Brazil.
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Carvalho VO, Bocchi EA, Guimarães GV. The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy. Circ J 2009; 73:1871-6. [DOI: 10.1253/circj.cj-09-0333] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
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