Is hydrotherapy an appropriate form of exercise for elderly patients with biventricular systolic heart failure?
A 82-year-old man with CHF with etiology of ischemic cardiomyopathy was recruited to participate in a hydrotherapy study at Sahlgrenska University Hospital because of physical impairments that negatively affected his mobility. Exclusion criteria were hypertension, primary valve disease, and pacemaker rhythm. The patient was in a stable condition without changes in medical treatment in the past two months. Regurgitations in the aortic, mitral, and tricuspid valve were all mild. Demographic data are presented in .\nWritten informed consent was obtained from the patient, and the study was approved by the ethics committee at the University of Gothenburg. The patient was monitored by electrocardiography and examined while standing in a slightly tilted position both on land and in a swimming pool for 20–30 min with the water level up to his sternal notch. Transthoracic echocardiography examinations were performed using Siemens Sequoia 512 with a 3v2c transducer (Mountain View, CA, USA), and data were stored digitally on magnetic optical disks. To protect the probe from water, the transducer was placed in a latex stocking. In accordance with the recommendations of the American Society of Echocardiography, left ventricular ejection fraction (LVEF) was calculated using the method of discs, modified Simpson rule. Ventricular long axis function was assessed with M-mode and pulsed-wave tissue Doppler imaging. With the exception of LVEF, measurements were averaged from at least three heart beats.\nWe compared echocardiographic data in the swimming pool with land measurements and observed small increases in systolic LV function: stroke volume increased from 32 mL to 42 mL, cardiac output from 3.0 L/min to 3.5 L/min and LVEF from 22% to 24% (land vs. WWI). LV systolic velocity increased from 4.8 cm/s to 5.0 cm/s and LV atrioventricular plane displacement from 2.1 mm to 2.2 mm (land vs. WWI).\nBy contrast, we found a decrease in right ventricular (RV) function: RV systolic velocity decreased from 11.2 cm/s to 8.4 cm/s and lateral RV systolic atrioventricular plane displacement from 8.1 mm to 4.7 mm (land vs. WWI). The tricuspid pressure gradient rose from 18 mmHg on land to 50 mmHg during WWI. The heart rate decreased from 93 beats/min to 83 beats/min (land vs. WWI).\nThe patient reported well-being during the WWI with no increase in breathlessness. However, he felt very cold for several hours after immersion and this prevented him from participating in the scheduled hydrotherapy sessions.