Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial)

Int J Cardiol. 2014 Mar 15;172(2):434-41. doi: 10.1016/j.ijcard.2014.01.100. Epub 2014 Jan 24.


Background: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients.

Methods: This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32°C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM).

Results: 32 patients (HEx n=16; control n=16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mmHg). HEx decreased 24-hour systolic (from 137±23 to 120±12 mmHg, p=0.001) and diastolic BPs (from 81±13 to 72±10 mmHg, p=0.009); daytime systolic (from 141±24 to 120±13 mmHg, p<0.0001) and diastolic BPs (from 84±14 to 73±11 mmHg, p=0.003); and nighttime systolic (from 129±22 to 114±12 mmHg, p=0.006) and diastolic BPs (from 74±11 to 66±10 mmHg, p<0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs.

Conclusion: HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.

Keywords: Ambulatory blood pressure monitoring; Blood pressure; Exercise training; Heated water; Hypertension.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Pressure / physiology
  • Blood Pressure Monitoring, Ambulatory
  • Exercise Therapy / methods*
  • Female
  • Hot Temperature / therapeutic use*
  • Humans
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Male
  • Middle Aged
  • Treatment Outcome
  • Water*


  • Water