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Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure.
Heart. 2007 Jun; 93(6):722-7.H

Abstract

BACKGROUND

Whole-body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation.

AIM

To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF).

METHODS

10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (Vo(2)) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak Vo(2) 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak Vo(2) 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32 degrees C) water immersion and exercise was measured using a non-invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming.

RESULTS

Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). Vo(2) during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls.

CONCLUSIONS

Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak Vo(2) of at least 15 ml/kg/min during a symptom-limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and Vo(2) are lower than in patients with CAD with preserved left ventricular function and controls, these patients are able to increase cardiac index adequately during water immersion and swimming.

Authors+Show Affiliations

Cardiovascular Prevention & Rehabilitation, Swiss Cardiovascular Centre, Bern University Hospital (Inselspital), Bern, Switzerland. jean-paul.schmid@insel.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17164483

Citation

Schmid, Jean-Paul, et al. "Influence of Water Immersion, Water Gymnastics and Swimming On Cardiac Output in Patients With Heart Failure." Heart (British Cardiac Society), vol. 93, no. 6, 2007, pp. 722-7.
Schmid JP, Noveanu M, Morger C, et al. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure. Heart. 2007;93(6):722-7.
Schmid, J. P., Noveanu, M., Morger, C., Gaillet, R., Capoferri, M., Anderegg, M., & Saner, H. (2007). Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure. Heart (British Cardiac Society), 93(6), 722-7.
Schmid JP, et al. Influence of Water Immersion, Water Gymnastics and Swimming On Cardiac Output in Patients With Heart Failure. Heart. 2007;93(6):722-7. PubMed PMID: 17164483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure. AU - Schmid,Jean-Paul, AU - Noveanu,Markus, AU - Morger,Cyrill, AU - Gaillet,Raymond, AU - Capoferri,Mauro, AU - Anderegg,Matthias, AU - Saner,Hugo, Y1 - 2006/12/12/ PY - 2006/12/14/pubmed PY - 2007/5/23/medline PY - 2006/12/14/entrez SP - 722 EP - 7 JF - Heart (British Cardiac Society) JO - Heart VL - 93 IS - 6 N2 - BACKGROUND: Whole-body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. AIM: To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). METHODS: 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (Vo(2)) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak Vo(2) 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak Vo(2) 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32 degrees C) water immersion and exercise was measured using a non-invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. RESULTS: Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). Vo(2) during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. CONCLUSIONS: Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak Vo(2) of at least 15 ml/kg/min during a symptom-limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and Vo(2) are lower than in patients with CAD with preserved left ventricular function and controls, these patients are able to increase cardiac index adequately during water immersion and swimming. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/17164483/Influence_of_water_immersion_water_gymnastics_and_swimming_on_cardiac_output_in_patients_with_heart_failure_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=17164483 DB - PRIME DP - Unbound Medicine ER -