title: Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure.
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.
  
  
  OBJECTIVE
  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.affiliation: Cardiovascular Prevention & Rehabilitation, Swiss Cardiovascular Centre, Bern University Hospital (Inselspital), Bern, Switzerland. jean-paul.schmid@insel.ch
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Cyrill
authors.initials: C
authors.lastname: Morger
authors.forename: Raymond
authors.initials: R
authors.lastname: Gaillet
authors.forename: Mauro
authors.initials: M
authors.lastname: Capoferri
authors.forename: Matthias
authors.initials: M
authors.lastname: Anderegg
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002302:Cardiac Output; D016022:Case-Control Studies; D006173:Gymnastics / Q000502:physiology*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D007101:Immersion / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D013550:Swimming / Q000502:physiology*; D014655:Vascular Resistance