January 2018: Cardiovascular & Heart Health

Spotlight on Aquatics & Cardiovascular & Heart Health

THE POOL IS CUSTOM-MADE FOR TREATING CARDIOVASCULAR Dx 

Heart Health and AquaticsContent courtesy of the National Swimming Pool Foundation
Recent publications which show how water works for cardiovascular & heart health

For generations, swimming has been the exercise recommendation of choice for patients with many maladies. But strangely, during the same time period, very few investigators examined the benefits of any vertical aquatic exercise for the cardiopulmonary compromised patient. In fact, patients with congestive heart failure, myocardial insufficiencies, or peripheral vascular diseases were often warned vehemently against getting in the pool. 
In effect, the pool became off-limits for this population. Wrongly so.

Why? 

1. Swimming and aquatic vertical exercise were inappropriately lumped into the same risk category. Swimming – especially for the novice or marginal swimmer – requires very high oxygen demands and can easily bump a compromised patient into near maximum VO2 levels. Vertical aquatic exercise, on the other hand, has a shallower learning curve. It requires less skill and coordination to execute. More importantly, the effects of hydrostatic pressure on the immersed lower extremities create a pressure gradient which propels blood up to the chest. This results in greater myocardial perfusion and makes for a more efficient cardiac workout.

2. Individuals exercising in water improperly used land-based models for calculating target heart rates. The traditional method for determining exercise intensity (220 - your age x 60%-80%) is grossly inadequate for use in the pool, especially for the cardiopulmonary compromised patient. The hydrostatic pressure gradient allows the heart to expel a larger quantity of blood with each compression. This improved stroke volume allows the heart to beat less frequently for a given cardiac output. Thus, aquatic target heart rate zones should be established at 12-17 beats-per-minute lower than their land-based equivalent.

3. Individuals with low vital capacities were not aware of simple positional changes which would improve respiratory comfort during immersion. The hydrostatic pressure of the water against the chest wall of a respiratory –compromised patient may make breathing difficult. There are three simple options to remedy this situation. Exercise in shallower water. Exercise in a supine position (usually with floats). Or intermittently use this increased resistance as a progressive resistive exercise program for the diaphragm and inter-costal muscles.

4. Physicians equated the temperatures of therapeutic pools with hot-tubs. However, most therapy pools (and all traditional swimming pools) use water which chills the body during quiet immersion. A pool must be heated to 93-94° Fahrenheit in order for an individual at rest to gain heat during immersion. However, if a patient has difficulty “throwing off” heat built up during exercise in water which is near thermoneutral (90-93° Fahrenheit), care should be taken to allow radiation and evaporation to occur. This can be accomplished by keeping the head uncovered, keeping humidity near or below 50%, and allowing rest breaks.

The concept of vertical aerobic exercise in the pool (labeled as hydro-gymnastics) gained exposure in the early 1900s. By the 1950s and 1960s, the age of space exploration did much to stimulate research into the effects of immersed exercise on breathing and circulation. But it wasn’t until the 1990s that therapy and fitness providers brought the same popularity to vertical aquatic exercise as horizontal swimming had enjoyed.

Today, there are dozens of strong, solid studies and many systematic reviews heralding the benefits of aquatic exercise for this population. Take a look and see for yourself.

RECENT ANNOTATED REFERENCES

Adsett, J. J., Morris, N., Kuys, S., Hwang, R., Mullins, R. M., Khatun, M., ... & Mudge, A. M. (2016). (2016). Aquatic exercise training is effective in maintaining exercise performance in trained heart failure patients. European Journal of Heart Failure, 18(1), 115. Retrieved from https://espace.library.uq.edu.au/view/UQ:393296

Adsett, J. A., Mudge, A. M., Morris, N., Kuys, S., Paratz, J. D., Julie, A., … Paratz, J. D. (2015). Aquatic exercise training and stable heart failure: A systematic review and meta-analysis. International Journal of Cardiology, 186, 22–28. http://doi.org/10.1016/j.ijcard.2015.03.095

Adsett, J. A., Mudge, A. M., Morris, N., Kuys, S., & Paratz, J. D. (2015). Aquatic exercise training and stable heart failure: A systematic review and meta-analysis. International Journal of Cardiology, 186, 22–8. http://doi.org/10.1016/j.ijcard.2015.03.095

Adsett, J., & Hons, B. (2010). Evidence Based Guidelines for Exercise and Chronic Heart Failure, 1–33.

Adsett, J., Morris, N., Kuys, S., Hwang, R., Mullins, R., Khatun, M., … Mudge, A. (2016). Aquatic Exercise Training is Effective in Maintaining Exercise Performance in Trained Heart Failure Patients: A Randomised Crossover Pilot Trial. Heart, Lung and Circulation. http://doi.org/10.1016/j.hlc.2016.10.017

Arca, E. A., de Paiva Carvalho, R. L., Barrile, S. R., Gimenes, C., Martinelli, B., da Silva Franco, R. J., & Martin, L. C. (2016). Effectiveness of aquatic exercise on reduction B-type natriuretic peptide values in postmenopausal hypertensive women: a randomized clinical trial. Sport Sciences for Health, 12(2), 255–260. http://doi.org/10.1007/s11332-016-0284-y

Arca, E. A., Martinelli, B., Martin, L. C., Waisberg, C. B., & Franco, R. J. da S. (2014). Aquatic Exercise is as Effective as dry Land Training to Blood Pressure Reduction in Postmenopausal Hypertensive Women. Physiotherapy Research International, 19(2), 93–98. http://doi.org/10.1002/pri.1565

Asa, C., Maria, S., Katharina, S. S. S., Bert, A., Åsa, C., Maria, S., … Bert, A. (2012). Aquatic exercise is effective in improving exercise performance in patients with heart failure and type 2 diabetes mellitus. Evidence-Based Complementary and Alternative Medicine : eCAM, 2012, 349209. article. http://doi.org/10.1155/2012/349209

Battistella, L., Junior, P., & Garcia, M. (2015). Comparative study of a cardiopulmonary exercise test on land and underwater in patients with chronic heart failure. Physiotherapy. Retrieved from https://scholar.google.com/scholar?start=40&q=%22aquatic+therapy%22+OR+%...

Becker, B. (2011). Aquatic Exercise Benefits in Heart and Kidney Health AQUATIC EXERCISE IN, (719), 1–12. 

Boussuges, A., Rossi, P., Poirette, L., & Gavarry, O. (2017). Heart rate recovery improves after exercise in water when compared with on land. Clinical Physiology and Functional Imaging. http://doi.org/10.1111/cpf.12464

Caminiti, G., Volterrani, M., & Rosano, G. (2010). With reference to hydrotherapy to heart failure patients. International Journal of Cardiology. article. http://doi.org/10.1016/j.ijcard.2010.04.045

Caminiti, G., Volterrani, M., Marazzi, G., Cerrito, A., Massaro, R., Sposato, B., … Rosano, G. (2011). Hydrotherapy added to endurance training versus endurance training alone in elderly patients with chronic heart failure: a randomized pilot study. International Journal of Cardiology, 148(2), 199–203. article.

Carvalho, V. O., & Guimaraes, G. V. (2010). Hydrotherapy to heart failure patients. International Journal of Cardiology. article. http://doi.org/10.1016/j.ijcard.2010.02.050

Castro, R. E., Guimarães, G. V., Da Silva, J. M. R., Bocchi, E. A., Ciolac, E. G., Rodrigues da Silva, J. M., … Ciolac, E. G. (2015). Postexercise Hypotension after Heart Transplant: Water- versus Land-Based Exercise. Medicine and Science in Sports and Exercise, 48(5), 804–10. http://doi.org/10.1249/MSS.0000000000000846

Choi, J. H., Kim, B. R., Joo, S. J., Han, E. Y., Kim, S. Y., Kim, S. M., … Yoon, H. M. (2015). Comparison of cardiorespiratory responses during aquatic and land treadmill exercise in patients with coronary artery disease. Journal of Cardiopulmonary Rehabilitation and Prevention, 35(2), 140–6. http://doi.org/10.1097/HCR.0000000000000094

Dionne, A., Leone, M., Goulet, S., Andrich, D. E., Pérusse, L., & Comtois, A.-S. (2016). Acute effects of water immersion on heart rate variability in participants with heart disease. Clinical Physiology and Functional Imaging. http://doi.org/10.1111/cpf.12405

Dionne, A., Leone, M., Goulet, S., Andrich, D. E., Pérusse, L., & Comtois, A.-S. (2016). Acute effects of water immersion on heart rate variability in participants with heart disease. Clinical Physiology and Functional Imaging, Epub ahead of print. http://doi.org/10.1111/cpf.12405

Dionne, A., Pérusse, L., Comtois, A.-S., & Leone, M. (2018). Acute cardiorespiratory responses in participants with heart disease during cycling at different immersion levels. Clinical Physiology and Functional Imaging, 38(1), 100–107. http://doi.org/10.1111/cpf.12389

Dionne, A., Pérusse, L., Comtois, A.-S., & Leone, M. (n.d.). Acute cardiorespiratory responses in participants with heart disease during cycling at different immersion levels. Clinical Physiology and Functional Imaging, 38(1). http://doi.org/10.1111/cpf.12389

Gomes, S. G., Silva, L. G., Santos, T. M., Totou, N. L., Souza, P. M., Pinto, K. M. C., … Becker, L. K. (2016). Elderly Hypertensive Subjects Have a Better Profile of Cardiovascular and Renal Responses during Water-Based Exercise. Journal of Exercise Physiology Online, 19(4), 21. 

Graetz Bhsc, B., Sullivan, M., Robertson, T., Reeve, J., Graetz, B., & Robertson, S. M. (2014) Do hydrotherapy exercise programmes improve exercise tolerance and quality of life in patients with chronic heart failure? A systematic review. http://doi.org/10.15619/NZJP/43.2.07

Hägglund, E., Hagerman, I., & Strömberg, A. (2018). Response to the Letter to the Editor on: Effect of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing, 17(1), 94–94. http://doi.org/10.1177/1474515117735097

Hägglund, E., Hagerman, I., & Strömberg, A. (2017). Response to the Letter to the Editor on: Effect of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing, Epub ahead of print. http://doi.org/10.1177/1474515117735097

Igarashi, Y., & Nogami, Y. (2018). The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials. European Journal of Preventive Cardiology, 25(2). http://doi.org/10.1177/2047487317731164

Korzeniowska-Kubacka, I., Bilińska, M., Dobraszkiewicz-Wasilewska, B., Baranowski, R., Piotrowicz, E., & Piotrowicz, R. (2016). The influence of water-based training on arrhythmia in patients with stable coronary artery disease and preserved left ventricular function. Cardiology Journal, 23(1), 93–9. http://doi.org/10.5603/CJ.a2015.0065

L, M., & C, M. (2014). Changes in Heart Function in Patients with Heart Failure after the Completion of Land-Based and Partial Water-Based Exercise Programmes. Journal of Clinical and Experimental Research in Cardiology. http://doi.org/10.15744/2394-6504.1.105

Moore, C., Fournier, S., DeVallance, E., Lee, K., Bonner, D., Donley, D., … Chantler, P. (2015). Deep Water Exercise Training is Associated with Decreased Arterial Stiffening in Women. FASEB J, 29(1_Supplement), 677.24-. http://doi.org/10.1096/fj.1530-6860

Mourot, L., & Monpère, C. (2014). Changes in Heart Function in Patients with Heart Failure after the Completion of Land-Based and Partial Water-Based Exercise Programmes. J Clin Exp Res Cardiol, 1(1), 105. 

Mourot, L., Teffaha, D., Bouhaddi, M., Ounissi, F., Vernochet, P., Dugue, B., … Monpère, C. (2010). Exercise rehabilitation restores physiological cardiovascular responses to short-term head-out water immersion in patients with chronic heart failure. Journal of Cardiopulmonary Rehabilitation and Prevention, 30(1), 22–27. 

Neto, M. G., Conceição, C. S., De Jesus, F. L. A., & Carvalho, V. O. (2015). Hydrotherapy on exercise capacity, muscle strength and quality of life in patients with heart failure: A meta-analysis. International Journal of Cardiology, 198, 216–219. http://doi.org/10.1016/j.ijcard.2014.10.132

Rico-Martín, S., Santano-Mogena, E., Cobos-Serrano, J. L., & Calderón-García, J. F. (2018). Comments on: Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing, 17(1), 93–93. http://doi.org/10.1177/1474515117731403

Rico-Martín, S., Santano-Mogena, E., Cobos-Serrano, J. L., Calderón-García, J. F., Hägglund, E., Hagerman, I., … Strömberg, A. (2017). Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study. European Journal of Cardiovascular Nursing, Epub ahead of print. http://doi.org/10.1177/1474515117690297

Sveälv, B. G., Täng, M. S., & Cider, Å. (2012). Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure? Journal of Geriatric Cardiology, 9(4), 408–410. http://doi.org/10.3724/SP.J.1263.2012.06121

Zanoni, C. C. T., Galvão, F., Cliquet Junior, A., Saad, S. T. O., Junior, A. C., Saad, S. T. O., … Saad, S. T. O. (2015). Pilot randomized controlled trial to evaluate the effect of aquatic and land physical therapy on musculoskeletal dysfunction of sickle cell disease patients. Revista Brasileira de Hematologia E Hemoterapia, 37(2), 82–89. http://doi.org/10.1016/j.bjhh.2014.11.010