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Is swimming safe in heart failure? : a systematic review

Shah, Parin M.; Pellicori, Pierpaolo; Macnamara, Alexandra; Urbinati, Alessia; Clark, Andrew L.


Parin M. Shah

Pierpaolo Pellicori

Alexandra Macnamara

Alessia Urbinati

Andrew L. Clark


It is not clear whether swimming is safe in patients with chronic heart failure. Ten studies examining the hemodynamic effects of acute water immersion (WI) (155 patients; average age 60 years; 86% male; mean left ventricular ejection fraction (LVEF) 29%) and 6 randomized controlled trials of rehabilitation comparing swimming with either medical treatment only (n = 3) or cycling (n = 1) or aerobic exercise (n = 2), (136 patients, average age 59 years; 84% male, mean LVEF 31%) were considered. In 7 studies of warm WI (30–35°C): heart rate (HR) fell (2% to −15%), and both cardiac output (CO) (7–37%) and stroke volume (SV) increased (13–41%). In 1 study of hot WI (41°C), systemic vascular resistance (SVR) fell (41%) and HR increased (33%). In 2 studies of cold WI (12–22°C), there were no consistent effects on HR and CO. Compared with medical management, swimming led to a greater increase in peak Vo₂ (7–14%) and 6 minute walk test (6MWT) (7–13%). Compared with cycle training, combined swimming and cycle training led to a greater reduction in resting HR (16%), a greater increase in resting SV (23%) and SVR (15%), but no changes in resting CO and a lesser increase in peak Vo₂ (6%). Compared with aerobic training, combined swimming and aerobic training lead to a reduction in resting HR (19%) and SVR (54%) and a greater increase in SV (34%), resting CO (28%), LVEF (9%), and 6MWT (70%). Although swimming appears to be safe, the studies conducted have been small, very heterogeneous, and inconclusive.


Shah, P. M., Pellicori, P., Macnamara, A., Urbinati, A., & Clark, A. L. (2017). Is swimming safe in heart failure? : a systematic review. Cardiology in review, 25(6), 321-325.

Journal Article Type Article
Acceptance Date Jun 22, 2017
Online Publication Date Nov 1, 2017
Publication Date 2017-11
Deposit Date Nov 10, 2017
Publicly Available Date Oct 27, 2022
Journal Cardiology review
Print ISSN 1061-5377
Electronic ISSN 1538-4683
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 25
Issue 6
Pages 321-325
Keywords Heart failure; Water immersion; Swimming
Public URL
Publisher URL
Additional Information This is the accepted manuscript of an article published in Cardiology in review, 2017. The version of record is available at the DOI link in this record.


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