Article Text

Download PDFPDF
Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure
  1. Jean-Paul Schmid,
  2. Markus Noveanu,
  3. Cyrill Morger,
  4. Raymond Gaillet,
  5. Mauro Capoferri,
  6. Matthias Anderegg,
  7. Hugo Saner
  1. Cardiovascular Prevention & Rehabilitation, Swiss Cardiovascular Centre, Bern, Switzerland
  1. Correspondence to:
    Dr J-P Schmid
    Cardiovascular Prevention & Rehabilitation, Swiss Cardiovascular Centre, Bern University Hospital (Inselspital), 3010 Bern, Switzerland; jean-paul.schmid{at}


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 (V̇o2) 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 V̇o2 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak V̇o2 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32°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). V̇o2 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 V̇o2 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 V̇o2 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.

  • CAD, coronary artery disease
  • CHF, chronic heart failure
  • MET, metabolic equivalent
  • NYHA, New York Heart Association
  • o2, oxygen consumption

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 12 December 2006

  • Competing interests: None declared.