Hydrotherapy in Heart Failure: A Case Report

Heart failure is considered to be the last stage of heart disease and a significant cause of morbidity and mortality worldwide. It is characterized by the persistent activation of the neurohormonal system, endothelial dysfunction, exercise intolerance, high mortality and a poor quality of life. Exercise training has been strongly recommended as a safe and important tool for the non-pharmacological treatment of heart failure. Exercise training improves exercise capacity, quality of life, endothelial dysfunction, skeletal muscle oxidative capacity, the cathecolamine plasma level and the autonomic and ventilatory responses. In heart failure patients, designing an appropriate aerobic exercise routine is crucial for obtaining both an increase in exercise capacity and the reasonable control of exercise-related risks. Hydrotherapy (i.e., exercise in warm water) had been considered potentially dangerous in heart failure patients due to the increased venous return caused by the hydrostatic pressure. However, it is now known that cardiac function actually improves during water immersion due to the increase in early diastolic filling and decrease in heart rate, resulting in improvements in stroke volume and ejection fraction. Studies with sauna therapy (i.e., warming) have demonstrated important improvements in neurohormonal attenuation and exercise status in heart failure patients. These data suggest that hydrotherapy is a good potential treatment for heart failure patients. However, few studies are available, and none have compared conventional rehabilitation to hydrotherapy. This study was partially supported by “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior”.