Aim: exploring literature on water immersion, balneotherapy aqua exercise and swimming in patients with left ventricular dysfunction (LVD) and/or stable chronic heart failure (CHF). Aqua exercise is recommended for low-risk cardiac patients, but it is not clear whether it is safe, or what optimal water temperature in patients with CHF is. With water immersion, the water rises pressure on the body surface and blood volume shifts to the central circulation, resulting in marked volume loading of the heart, but only if immersion is up to the neck, with enlargement of all 4 chambers, in 6 seconds up to 30% increase in heart size. (1)

Results: Until now, based on exploratory studies of central hemodynamics and neurohumoral responses of aquatic therapies it is clear that: 1) In patients with LVD a positive effect of therapeutic warm-water tub bathing is due to afterload reduction caused by peripheral vasodilatation with warm water; 2) In coronary patients with LVD, at low-level water cycling, the heart is working more efficiently than at low-level cycling outside of water; 3) In patients with previous extensive myocardial infarction, immersion to the neck resulted in temporary pathological increases in mean pulmonary artery pressure (mPAP) and mean pulmonary capillary pressures (mPCP); 4) During slow swimming the mPAP and/or PCP were higher than during supine cycling outside water at a 100W load; 5) In CHF patients, neck-deep immersion resulted in a decrease or no change in stroke volume; 6) Even hemodynamically compromised, patients feel well during aquatic therapy: 7) Decompensated heart failure is an absolute contraindication for immersion or swimming; 8) Patient with severe LVD or CHF who can sleep in a flat position can bath in the tube, immersed no deeper up the xiphoid; 9) Therapeutic water exercise in a pool can be allowed, provided that the patient is in an upright position immersed no deeper than up to xiphoid. (2)

Conclusion: Based on these findings, whether swimming is truly safe, yet needs to be proven for patients with severe LVD.