Application of aquatic therapy in cardiovascular disease: a bibliometric analysis from 1992 to 2025

Aquatic therapy has emerged as a promising approach for cardiovascular diseases (CVD). To evaluate trends and hotspots in this area, a bibliometric analysis was conducted from 1992 to 2025.

A systematic search was conducted on the Web of Science Core Collection database (SCIE and SSCI) to identify publications on aquatic therapy in CVD from 1992 to 2025. A disease-specific search strategy using validated CVD terminology was employed, followed by manual relevance screening to ensure corpus specificity. Bibliometric analysis used VOSviewer (v1.6.20), CiteSpace (v6.3.R1) and R package "Bibliometrix" (V4.5.2).

The analysis included 94 articles by 473 authors from 321 institutions across 34 countries. The annual publication growth rate was 6.07%. Brazil, China, and Sweden were the most productive countries. Universidade de São Paulo published the most articles. High-impact journals such as International Journal of Biometeorology and European Journal of Heart Failure were key in disseminating research. Authors Guimarães Guilherme Veiga and Bocchi Edimar Alcides emerged as central figures in collaboration networks. Keyword analysis identified six thematic clusters: (1) hemodynamic responses and exercise protocols; (2) cardiac rehabilitation, vascular function, and clinical outcomes; (3) CVD risk management and clinical guidelines; (4) exercise prescription, quality of life, and program design; (5) balneotherapy, blood pressure control, and comorbid conditions; and (6) aquatic exercise, physical activity, and population-specific interventions. Research evolved from physiological responses and protocol development to quality of life, patient-centered outcomes, and clinical implementation. Burst analysis showed "cardiac rehabilitation," "endothelial function," and "physical activity" as prominent research frontiers since 2018.

This bibliometric analysis provides an overview of research in aquatic therapies for CVD. The field has evolved from early physiological investigations toward clinical applications within cardiac rehabilitation frameworks. Future research trends are expected to focus on the integration of aquatic therapy into evidence-based cardiac rehabilitation programs, long-term outcome evaluation, and patients' quality of life.