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Bermingham, M. A. (2004). Blood lipids of cardiac patients after acute execise on land
and in water. Arch Phys Med Rehabil. 85: 509-511.
Chu, K. S., J. J. Eng, et al. (2004). Water-based exercise for cardiovascular fitness in
people with chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 85:
OBJECTIVE: To evaluate the effect of an 8-week, water-based exercise program
(experimental group) with that of an upper-extremity function program (control
group) to increase cardiovascular fitness within a community setting for people
with stroke. DESIGN: Single-blind randomized controlled trial. SETTING: Public
community center. PARTICIPANTS: A volunteer sample of 12 communitydwelling people with stroke with mild to moderate residual motor deficits.
INTERVENTION: Study subjects participated in group exercise programs for 1
hour, 3 times a week for 8 weeks. The experimental group exercised in chestdeep water at targeted heart rates. The control group performed arm and hand
exercises while sitting.Main outcome measures The primary outcome measure
was cardiovascular fitness (V(O2)max). Secondary measures were maximal
workload, muscle strength, gait speed, and the Berg Balance Scale score.
RESULTS: The experimental group attained significant improvements over the
control group in cardiovascular fitness, maximal workload, gait speed, and
paretic lower-extremity muscle strength. The relatively short program (8 wk) of
water-based exercise resulted in a 22% improvement in cardiovascular fitness in
a small group of people with stroke who had relatively high function.
CONCLUSIONS: A water-based exercise program undertaken as a group
program may be an effective way to promote fitness in people with stroke.
Cider A, Schaufelberger M, et al. (2003). Hydrotherapy--a new approach to improve
function in the older patient with chronic heart failure. Eur J Heart Fail. 5: 527 - 535.
AIMS: Hydrotherapy, i.e. exercise in warm water, as a rehabilitation program has
been considered potentially dangerous in patients with chronic heart failure
(CHF) due to the increased venous return caused by the hydrostatic pressure.
However, hydrotherapy has advantages compared to conventional training. We
studied the applicability of an exercise programme in a temperature-controlled
swimming pool, with specific reference to exercise capacity, muscle function,
quality of life and safety. METHODS AND RESULTS: Twenty-five patients with
CHF (NYHA II-III, age 72.1+/-6.1) were randomised into either 8 weeks of
hydrotherapy (n=15), or into a control group (n=10). The training program was
well tolerated with no adverse events. Patients in the hydrotherapy group
improved their maximal exercise capacity (+6.5 vs.-5.9 W, P=0.001), isometric
endurance in knee extension (+4 vs.-9 s, P=0.01) together with an improvement
in the performance of heel-lift (+4 vs. -3 n.o., P=<0.01), shoulder abduction (+12
vs. -8 s, P=0.01) and shoulder flexion (+6 vs. +4, P=0.01) in comparison to
patients in the control group. CONCLUSION: Physical training in warm water was
well tolerated and seems to improve exercise capacity as well as muscle function
in small muscle groups in patients with CHF. This new approach broadens the
variety of training regimes for older patients with CHF.
PMID: 12921815 [PubMed - indexed for MEDLINE]
GOTTLIEB S.S., F. M. L. (1999). "Effects of Exercise Training on Peak Performance
and Quality of Life in Congestive Heart Failure Patients." Journal of cardiac failure 5(3):
Hanna RD, S. L., Tristani FE (1993). Effect of enhanced preload with head-out water
immersion on exercise response in men with healed myocardial infarction. Am J
Cardiol. 1;71: 1041-4.
Head-out water immersion shifts venous blood to the central vasculature and
heart and subsequently increases cardiac preload. In healthy men, cardiac
output and stroke volume are greater during upright leg cycle exercise in water
than on land. Heart rate is similar during work loads < 50% of peak oxygen
consumption but is decreased in water at higher work intensities. To determine if
men with myocardial infarction (MI) show a similar response, 15 men with a
documented MI exercised upright on a leg cycle ergometer on land and
immersed in water (31 +/- 1 degree C) to the level of the shoulders. Heart rate,
cardiac output (carbon dioxide rebreathing procedure) and oxygen consumption
were measured at rest and at work loads corresponding to approximately 40, 60
and 75% of peak oxygen consumption in both environments. At rest, cardiac
output and stroke volume were elevated (p < 0.05) in water. During exercise,
heart rate, cardiac output and stroke volume did not differ between water and
land. When subjects were given beta-blocking medications (n = 8) and subjects
with exercise-induced ST-segment depression (n = 5) were separately excluded
from the analysis, water immersion still did not significantly change exercise
responses. These results suggest that MI alters the normal cardiac response to
increased preload during exercise. The alteration may involve reduced
myocardial compliance or near-complete use of the Frank-Starling reserve, or
both, during land exercise.
Journeay W. Shane, R. D., et al. (2003). Cardiovascular responses to apneic facial
immersion during altered cardiac filling. Journal of Applied Physiology. 94: 2249-2254.
Mangold, G. (1997). Zur Eignung von Bewegungsprogrammen im Wasser als ein Teil
rehabilitativer Massnahmen fuer herzkranke Kinder und Jugendliche (Teil II):
Darstellung in einer Einzelfallstudie unter Verwendung mobiler HerzfrequenzKontrollgeraete. / (Suitability of water exercise movement programs as a part of
rehabilitation measures for children and youth suffering from heart diseases (part II):
representation in an individual case study using mobile heart rate monitors.). Leipziger
Sportwissenschaftliche Beitraege (Sankt Augustin). 38: 68-84.
Meyer, K., Bucking, J. (2004). Exercise in Heart failure: should Aqua Therapy and
Swimming be allowed. Medicine and science in sports and exercise. 36: 2017-2022.
Pechter, U., J. Maaroos, et al. (2003). Regular low-intensity aquatic exercise improves
cardio-respiratory functional capacity and reduces proteinuria in chronic renal failure
patients. Nephrol Dial Transplant. 18: 624-5.
Tokmakidis, S., A. Spassis, et al. (2002). Specific adaptations following a waterexercise program in coronary artery disease patients. (Abstract). In Koskolou, M. (ed.),
European College of Sport Science, Proceedings of the 7th annual congress of the
European College of Sport Science, Athens, Greece, 24-28 July 2002, Athens,
Pashalidis Medical Publisher, c2002, p.335.