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Warm water immersion in patients with chronic heart failure: a pilot study: Shah immerse: HF

Shah, Parin; Pellicori, Pierpaolo; Kallvikbacka-Bennett, Anna; Zhang, Jufen; Pan, Daniel; Clark, Andrew L.


Parin Shah

Pierpaolo Pellicori

Anna Kallvikbacka-Bennett

Jufen Zhang

Daniel Pan

Andrew L. Clark


Patients with chronic conditions, such as heart failure, swim regularly and most rehabilitation exercises are conducted in warm hydrotherapy pools. However, little is known about the acute effects of warm water immersion (WWI) on cardiac haemodynamics in patients with chronic heart failure (CHF).

Seventeen patients with CHF (NYHA I and II; mean age 67 years, 88% male, mean left ventricular ejection fraction 33%) and 10 age-matched normal subjects were immersed up to the neck in a hydrotherapy pool (33–35 °C). Cardiac haemodynamics were measured non-invasively, and echocardiography was performed at baseline, during WWI, 3 min after kicking in the supine position and after emerging.

In patients with CHF, compared to baseline, WWI immediately increased stroke volume (SV, mean ± standard deviation; from 65 ± 21 to 82 ± 22 mL, p less than 0.001), cardiac output (CO, from 4.4 ± 1.4 to 5.7 ± 1.6 L/min, p less than 0.001) and cardiac index (CI, from 2.3 ± 0.6 to 2.9 ± 0.70 L/min/m², p less than 0.001) with decreased systemic vascular resistance (from 1881 ± 582 to 1258 ± 332 dynes/s/cm5, p less than 0.001) and systolic blood pressure (132 ± 21 to 115 ± 23 mmHg, p less than 0.001). The haemodynamic changes persisted for 15 min of WWI. In normal subjects, compared to baseline, WWI increased SV (from 68 ± 11 to 80 ± 18 mL, p less than 0.001), CO (from 5.1 ± 1.9 to 5.7 ± 1.8 L/min, p less than 0.001) and CI (from 2.7 ± 0.9 to 2.9 ± 1.0 L/min/m², p less than 0.001).In patients with CHF, compared to baseline, WWI caused an increase in left atrial volume (from 57 ± 44 to 72 ± 46 mL, p = 0.04), without any changes in left ventricular size or function or amino terminal pro B-type natriuretic peptide.

In patients with CHF, WWI causes an acute increase in cardiac output and a fall in systemic vascular resistance.


Shah, P., Pellicori, P., Kallvikbacka-Bennett, A., Zhang, J., Pan, D., & Clark, A. L. (2019). Warm water immersion in patients with chronic heart failure: a pilot study: Shah immerse: HF. Clinical Research in Cardiology, 108(5), 468–476.

Journal Article Type Article
Acceptance Date Sep 20, 2018
Online Publication Date Sep 28, 2018
Publication Date 2019-05
Deposit Date Oct 18, 2018
Publicly Available Date Oct 27, 2022
Print ISSN 1861-0684
Electronic ISSN 1861-0692
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 108
Issue 5
Pages 468–476
Keywords Heart failure; Exercise; Water immersion; Swimming
Public URL
Publisher URL


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© The Author(s) 2018<br /> Open Access<br /> This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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