Improvement in ejection fraction by hydrotherapy as rehabilitation in patients with chronic pulmonary emphysema

It has been reported that breathing exercise by immersion in combination with expiring into water improved pulmonary function and blood-gas exchange in patients with chronic obstructive pulmonary disease (COPD). This effect may result from respiratory muscle exercise against hydraulic pressure and decreased dead space by increased sub-abdominal pressure. Increased cardiac function by bathing is suggested to contribute to the effect. To clarify the effect of the breathing exercise by immersion on cardiac function, a study was made of cardiac function during the exercise in patients with emphysema.

Echocardiography, respiratory function test and arterial blood gas analysis were performed during a two-month breathing exercise programme in a pool filled with 38 degrees C water for 12 patients (aged 70.9 +/- 9.1 years) with stable chronic pulmonary emphysema who were treated at our hospital between 1993 and 1996. The patients breathed in whilst standing in a pool and breathed out through the mouth while sinking the nose under water. This exercise was repeated for 30 min per day and continued for six days a week for two months.

The ejection fraction increased significantly after each 30-minute exercise (N = 12; p < 0.01) as well as after the two-month exercise programme (N = 12, p < 0.05). Left ventricular end-diastolic and systolic dimensions at rest decreased significantly after the two-month exercise programme (N = 12, p < 0.01). The ratio of forced expired volume in one second to forced vital capacity (FEV1:FVC) increased and PaCO2 decreased following this programme (N = 12, p < 0.05).

These results suggest that the breathing exercise by immersion is useful not only in treating emphysema but also in improving cardiac function.