Do hydrotherapy exercise programmes improve exercise tolerance and quality of life in patients with chronic heart failure? A systematic review

ML Roberts Prize Winner

Abstract

The purpose of this study was to evaluate whether hydrotherapy programmes improve exercise tolerance and quality of life in patients with chronic heart failure. Data sources utilised were EBSCO, Scopus, Medline, PubMed, OVID, Proquest, PEDro and Cochrane Systematic Reviews databases. A systematic review of randomised controlled trials or quasi randomised controlled trials investigated hydrotherapy compared with a suitable control. Methodological quality was assessed using a modified version of the Downs and Black critical appraisal tool. Findings demonstrated that hydrotherapy was well tolerated with few adverse events reported. Two studies demonstrated hydrotherapy intervention groups significantly improved 6MWT from baseline (p ≤ 0.05), while two studies found significantly greater improvements when compared to non-exercising (p = 0.01) and land based exercising (p = 0.001) controls. Four studies found significant gains (p ≤ 0.05) in VO2 peak from baseline following hydrotherapy interventions. Two studies reported significant (p = 0.01) intragroup improvements in total score of the Minnesota Living with Heart Failure Questionnaire in hydrotherapy intervention groups when compared with baseline and a non-exercising control respectively. In conclusion, hydrotherapy exercise programmes were well tolerated and appear to improve exercise capacity and quality of life in people with chronic heart failure but firm conclusions could not be drawn due to the poor to moderate quality of the evidence.