Michalsen Andreas, Lüdtke Rainer, Bühring Malte, Spahn Günther, Langhorst Jost, Dobos Gustav J
Kliniken Essen Mitte, Department of Internal Medicine V, Essen, Germany.
Am Heart J. 2003 Oct;146(4):728-33. doi: 10.1016/S0002-8703(03)00314-4.
Chronic heart failure is characterized by increased peripheral vascular resistance and reduced peripheral perfusion due to adrenergic and renin angiotensin activation and impaired endothelial function. Recent studies have shown that nonpharmacological peripheral vasodilation with thermal therapy by means of warm-water baths and sauna has beneficial effects in chronic heart failure. European hydrotherapy (according to Kneipp) additionally uses short cold water stimuli, which lead to prolonged vasodilation and adaptive responses. Studies on the efficacy of hydrotherapy in chronic heart failure are lacking.
We studied 15 patients (5 men, 10 women, mean (+/- SD) age 64.3 +/- 1.8 years) with mild chronic heart failure (NYHA functional class II to III, ejection fraction 30%-40%). Patients were randomly assigned to 6 weeks of intensive home-based hydrotherapy or 6 weeks restriction in a crossover intervention trial. Quality of life and heart-failure--related symptoms were assessed by means of a validated questionnaire (PLC). Graded bicycle exercise test with incremental workloads (0, 50, 75, 100 watts) was performed at the end of each treatment period. The hydrotherapeutic program consisted of a structured combination of daily home-based external warm- and cold-water applications.
Baseline characteristics were balanced between the groups. With hydrotherapy, a significant (P < or =.05) improvement in 3 of 6 dimensions of quality of life (mood, physical capacity, enjoyment) and a significant reduction in heart-failure-related symptoms was found. Heart rates at rest and at 50-Watt workload were significantly reduced by hydrotherapy; blood pressure decreased nonsignificantly at rest and during exercise. The hydrotherapeutic treatment was well accepted and no relevant adverse effects were observed.
A home-based hydrotherapeutic thermal treatment program improves quality of life, heart-failure-related symptoms and heart rate response to exercise in patients with mild chronic heart failure. The results of this investigation suggest a beneficial adaptive response to repeated brief cold stimuli in addition to enhanced peripheral perfusion due to thermal hydrotherapy in patients with chronic heart failure.
慢性心力衰竭的特征是由于肾上腺素能和肾素血管紧张素激活以及内皮功能受损，导致外周血管阻力增加和外周灌注减少。最近的研究表明，通过温水浴和桑拿进行热疗的非药物性外周血管舒张对慢性心力衰竭具有有益作用。欧洲水疗法（根据克内普疗法）还使用短时间冷水刺激，这会导致血管舒张延长和适应性反应。缺乏关于水疗法对慢性心力衰竭疗效的研究。
我们研究了15例轻度慢性心力衰竭患者（5例男性，10例女性，平均（±标准差）年龄64.3±1.8岁）（纽约心脏协会心功能分级II至III级，射血分数30%-40%）。在一项交叉干预试验中，患者被随机分配接受为期6周的强化家庭水疗法或6周的限制措施。通过一份经过验证的问卷（PLC）评估生活质量和与心力衰竭相关的症状。在每个治疗期结束时进行递增负荷（0、50、75、100瓦）的分级自行车运动试验。水疗方案包括每日家庭式外部温水和冷水应用的结构化组合。
两组间基线特征均衡。通过水疗法，生活质量的6个维度中的3个（情绪、身体能力、愉悦感）有显著（P≤0.05）改善，与心力衰竭相关的症状显著减少。水疗法使静息心率及50瓦负荷时的心率显著降低；静息时和运动期间血压无显著下降。水疗治疗耐受性良好，未观察到相关不良反应。
家庭式水疗热疗方案可改善轻度慢性心力衰竭患者的生活质量、与心力衰竭相关的症状以及运动时的心率反应。本研究结果表明，慢性心力衰竭患者除了因热疗水疗法增强外周灌注外，对反复短暂冷刺激还有有益的适应性反应。
