Water exercise is becoming a recommended alternative exercise for cardiac patients outside of traditional cardiac rehabilitation. There are many exercise responses that need to be considered when exercising in the water that include, heart rate, blood pressure, volume of oxygen consumed, muscle capacity and strength, ventricular function and quality of life. These factors change within every individual in water due to the effects of water immersion, temperature, and type of movement while in the water. The aim of this review was to understand how water exercise affects cardiac patients and to identify considerations and recommendations when prescribing exercise in water as compared to on land. The first review section starts by explaining the common cardiac diseases studied previously and benefits shown in patients after cardiac rehabilitation programs including improvements in muscular strength and capacity, blood lipid profiles, blood pressures, and assessments of quality of life. The second section in the review then compares exercise intensities on land to exercise intensities when in the water. The most common measures used to monitor exercise intensity are heart rate and rating of perceived exertion. These are greatly affected by the level of immersion and temperature of the water. Immersion in the water has a large influence over the body including a change in blood flow from the periphery to the central vascular system, which then changes and influences heart rate and blood pressure. The third section of the review explains the effect of water exercise on specific cardiac patients. Most researchers have measured blood pressure, muscular strength and capacity, volume of oxygen consumed and ventricular function in response to water exercise. And finally, the fourth section of the paper summarizes some considerations and recommendations to consider and use while working with any cardiac population when exercising and training in the water.


Lynn A. Darby

Second Reader

Bonnie G. Berger