title: Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure.
abstract: BACKGROUND
  Chronic heart failure is characterized by increased peripheral vascular resistance and reduced peripheral perfusion due to adrenergic and renin angiotensin activation and impaired endothelial function. Recent studies have shown that nonpharmacological peripheral vasodilation with thermal therapy by means of warm-water baths and sauna has beneficial effects in chronic heart failure. European hydrotherapy (according to Kneipp) additionally uses short cold water stimuli, which lead to prolonged vasodilation and adaptive responses. Studies on the efficacy of hydrotherapy in chronic heart failure are lacking.
  
  
  METHODS
  We studied 15 patients (5 men, 10 women, mean (+/- SD) age 64.3 +/- 1.8 years) with mild chronic heart failure (NYHA functional class II to III, ejection fraction 30%-40%). Patients were randomly assigned to 6 weeks of intensive home-based hydrotherapy or 6 weeks restriction in a crossover intervention trial. Quality of life and heart-failure--related symptoms were assessed by means of a validated questionnaire (PLC). Graded bicycle exercise test with incremental workloads (0, 50, 75, 100 watts) was performed at the end of each treatment period. The hydrotherapeutic program consisted of a structured combination of daily home-based external warm- and cold-water applications.
  
  
  RESULTS
  Baseline characteristics were balanced between the groups. With hydrotherapy, a significant (P < or =.05) improvement in 3 of 6 dimensions of quality of life (mood, physical capacity, enjoyment) and a significant reduction in heart-failure-related symptoms was found. Heart rates at rest and at 50-Watt workload were significantly reduced by hydrotherapy; blood pressure decreased nonsignificantly at rest and during exercise. The hydrotherapeutic treatment was well accepted and no relevant adverse effects were observed.
  
  
  CONCLUSIONS
  A home-based hydrotherapeutic thermal treatment program improves quality of life, heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure. The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure.
authors.affiliation: Kliniken Essen Mitte, Department of Internal Medicine V, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Rainer
authors.initials: R
authors.lastname: Lüdtke
authors.forename: Malte
authors.initials: M
authors.lastname: Bühring
authors.forename: Günther
authors.initials: G
authors.lastname: Spahn
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001494:Baths / Q000379:methods; D002908:Chronic Disease; D018592:Cross-Over Studies; D017679:Cryotherapy / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology