Effectiveness of Hydrotherapy
Effectiveness of Hydrotherapy
Effectiveness of Hydrotherapy
Original Article
Rosyidah Arafat, MN
Lecturer Dr., Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
Correspondence: Andi Masyitha Irwan, RN, MAN, PhD Lecturer, Department of Gerontological
Nursing, Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
Email: [email protected]
Abstract
Background: Hypertension is a chronic cardiovascular disease and the leading cause of morbidity and
mortality worldwide. Around 53% of patients with hypertension cannot control their blood pressure and
are at risk for complications. Currently, the treatment of hypertension consists of lifestyle modification
and pharmacological treatment. However, most people need two or more antihypertensive drugs to lower
blood pressure. Lifestyle modification can also increase the effect of antihypertensive treatment, one of
which is a complementary therapy, such as hydrotherapy. Hydrotherapy is very easy for everyone,
inexpensive, has no harmful side effects, and a method of treatment, healing by using a water medium to
obtain a therapeutic effect, especially for older people and someone with physical limitations that are
mainly related to orthopedic dysfunction due to water floatation that can reduce the force of gravity.
Purpose: This systematic review aimed to explore the effectiveness of hydrotherapy in lowering blood
pressure on hypertensive patients, with a variety of relevant studies.
Methods: The study was a systematic review using PubMed, Science Direct, Proquest, EBSCO Host,
Wiley, Garuda, and gray literature databases. We included hydrotherapy studies focused on reducing
blood pressure in hypertension patients, published in the last ten years (2010 - 2020), had full text
available, used randomized controlled trial study design, and published in English and Indonesian.
Results: Eight studies were identified and reviewed. Seven studies revealed the type of water-based
exercise hydrotherapy. Only one study revealed the immersion of feet with warm water. All studies
showed that hydrotherapy significantly reduced blood pressure in hypertensive patients with varying
degrees of decline.
Conclusion: Hydrotherapy effectively lowers blood pressure in patients with hypertension. It can be
used as an addition to other therapies. However, further research is needed with follow-up to further
ensure the effectiveness of hydrotherapy interventions for the long term in lowering blood pressure.
Keywords: Hypertension, Hydrotherapy, Blood pressure, Systematic review.
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groups treated
equally?
7 Are the effects of the Yes Yes Yes Yes Yes Yes Yes Yes
intervention reported
comprehensively?
8 Is the unanimity of Yes Yes Yes Yes Yes Yes Yes Yes
the estimated effects
of the intervention
reported?
9 Are the benefits of Yes Yes Yes Yes Yes Yes Yes Yes
the study
comparable to the
disadvantages and
costs used?
10 Can all clinical Yes Yes Yes Yes Yes Yes Yes Yes
outcomes be applied
to your local
population?
11 Are benefits worth Yes Yes Yes Yes Yes Yes Yes Yes
the cost?
Note. CASP = Critical Appraisal Skills Programme
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1 Random process + + + + + + + +
2 Concealing allocation - + - - - + + +
6 Reporting bias + + + + + + + +
7 Other biases + + + + + +
+ = Low risk of bias, - = High risk of bias,? = Unambiguous risk of bias
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Articles identified
Exclusion:
(n =1088)
> 10 years (n =578)
Not in English (n =196)
Not relevant to the research
question (n =210)
(n =104)
Exclusion:
No full text (n = 58)
Not in humans (n = 5)
Other combination interventions
(n = 2) Duplicate (n =18)
Articles
Eligibility
corresponding to
research questions
Exclusion:
Not consistent with the results of
the study (n =13)
Included
Articles containing
inclusions
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Author, year, Design Age Number Blood pressure Hypertensi Length of Healthcare
(years) of on suffering professionals
Country (mmHg) initial
Samples Categories from who perform
hypertension
Stage 2
(Arca et al., Between 140/90
RCT >64 52 Hypertensi Not specified Physiotherapist
2014); Brazil and 179/109
on
Stage 2
(Bocalini et al., Systole 155±4 and
RCT > 60 45 Hypertensi Not specified Not specified
2017); Brazil diastole 92 ± 3
on
Stage 2
(de Barros Cruz et Systole >140
RCT >50 44 Hypertensi Five years Not specified
al., 2017); Brazil Diastole >90
on
Stage 2
(Guimãraes et al., Systole >140
RCT 40-65 32 Hypertensi Five years Not specified
2018); Brazil Diastole >90
on
Stage 1
(Ngomane et al., Systole 131 ± 9
RCT >60 45 Hypertensi Five years Not specified
2019); Brazil Diastole 81 ± 9
on
Systole ≥ 130 Stage 1
(Ruangthai et al.,
RCT >60 53 Diastole ≥ 80 Hypertensi 6,5 years Not specified
2020); Thailand
on
Stage 2
(Malibel et al. Systole 144
RCT 50-59 60 Hypertensi Not specified Nurses
2020); Indonesia Diastole 91
on
Stage 2
(Cunha et al., Systole ≥ 160
RCT 60-70 32 Hypertensi Not specified Physiotherapist
2012); Brazil Diastole ≥100
on
Note. RCT = Randomized controlled trials; mmHg = Milimeter merkuri hydrargyrum.
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patients treated
or untreated
(de Barros RCT To see the heat- 44 resistant The control group maintains Intervention group pretest Water-based
Cruz et al., based effects of hypertensive their habitual activities by systole 162.2 ± 23.2, pretest running
2017) heated exercise patients. practicing calisthenic exercises diastole 83.8 ± 2.5, and exercises
(HEX) in HEX (N = 28) and running in heated pools for posttest systole 135.5 ± 11, significantly
hypertensive Control group (n = 1 hour, three times a week for posttest diastole 76.7 ± 2.1. reduce
patients resistant 16) 12 weeks. The control group pretest systolic and
to the decrease systole 157.6 ± 17.6, pretest diastolic BP
in BP diastole 86.4 ± 2.5, and
posttest systole 157.8 ± 16.6,
posttest diastole 87.1 ± 2.0. (p
<0.05).
(Guimãraes RCT To find out 32 patients Given 36 sessions (60 minutes) Intervention group: systolic Water-based
et al., whether water- Hypertension of warm-up exercises in a hot BP -19.5 ± 4.6 mmHg and warm-up
2018); based heating resistant HEx tub (32o C) diastolic -11.1 ± 2.4 exercises
Brazil exercises (HEX) group (n = 16) The control group was Systolic BP control group have a
can reduce BP in Control group (n = evaluated over the same period 3.0± 0.7 mmHg and diastolic significant
patients with 16) and instructed to maintain their 2.06 ± 0.9 mmHg, (p = 0.001) effect on
resistant habitual activity for 12 weeks lowering
hypertension (training), followed by 12 systolic and
weeks of cessation of training. diastolic BP
(Ngomane RCT To test the 45 older age At controlled room temperature Hex group pretest systole 132 Exercise
et al., hypothesis that systemic (LEx and CON) (21–23 °C) or ± 15 and pretest diastole 81 ± walking in
2019); HEx is superior hypertension controlled swimming pool 10, posttest systole 132 ± 15 the pool has
Brazil to LEx for patients temperature (Hex) (29–32 °C), and posttest diastole 81 ± 9. a significant
acutely reducing Heated water- at the same time Lex group: pretest systole 129 effect on
BP in older age. based (HEx) group Both HEx and LEx consist of a ± 16 and pretest diastole 83 ± lowering
(n=15) 5-minute warm-up, a 30-minute 13, posttest systole 129 ± 16 systolic and
Land-based walk in the pool (HEx), a and posttest diastole 81 ± 13. diastolic BP.
exercise (LEx) motorized treadmill (LEx), and Control group pretest systole
group (n=15) a 5-minute cool-down. 130 ± 11 and pretest diastole
Control The control group (CON) was 81 ± 10, posttest systole 130 ±
intervention given 40 minutes of rest quietly 11 and posttest diastole 86 ±
in a sitting position. 13
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(Ruangthai RCT To compare 53 older people The pond water temperature LET group systolic BP Pool-based
et al., combined water with hypertension with a temperature of 26-29 ° C decreased by 11.6 mmHg exercise has
2020); and land-based Land-based and a depth between the (8.2), p < 0.01) and diastolic a significant
Thailand training exercise (LET) xiphoid process and the 10.6 mmHg (7.5%) (p < 0.05) effect on
programs group (n = 17) shoulder (1.2 meters). WET group systolic BP 6.5 lowering
(aerobic and Water-based The intervention group: the mmHg (4.6%) (p < 0.01) and systolic and
resistance) on exercise (WET) exercise session consisted of 10 diastolic 7.6 mmHg (5.4%) (p diastolic BP
functional group (n = 16) minutes of warm-up with < 0.01)
cardiometabolic Control group stretching, 20 minutes of Control group (CON), there is
parameters. (CON) (n = 20). aerobic exercise, 20 minutes of no change in BP.
Fitness and resistance training, and 10
quality of life minutes of stretching and
(QoL) in older cooling down.
people with Ground exercise group: training
hypertension. sessions including aerobic
exercise, resistance training,
and stretching exercise: 10
minutes
warm-up with stretching
exercises, 20 minutes aerobic
exercise, 20 minutes resistance
training, and 10 minutes
stretching and cool-down
exercises.
The intervention was conducted
three sessions a week for 60
minutes for 12 weeks.
(Malibel et RCT To determine 60 Hypertension Do soaking feet using warm Intervention pretest average Soak the
al. 2020); the effect of BP patients water with a temperature of 38- systole: 144.33 mmHg, foot of
Indonesian before and after Intervention group 40oC for 20-30 minutes, and posttest: 131.00 mmHg warm water
warm water foot (n=30) the length of the intervention is Pretest diastole: 91.00 mmhg, has
soak therapy in not explained. posttest: 83.00 mmhg significant
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(Cunha et RCT To evaluate the 32 women's older A swimming pool as deep as EP group pretest systole: Water
al., 2012); behavior of people with 1.4 m with an average 135.46 (- 7.42), posttest: gymnastics
Brazil subacute BP in hypertension temperature of 28.5 C. 126.93 (- 11.51)
the older woman Experimental A 40-minute water training CP group pretest systole: significantly
with groups (EP) (N = session, mostly aerobics, was 138.25 (- 12.78), posttest: reduces
hypertension 16) done. 137.06 - 16.20 systolic BP
after a water Control Group The EP group starts with 5 (p=0,014)
gymnastics (CP) (n = 16) minutes period. The main part
session. of the session lasts 30 minutes
and a cooling session for 5
minutes.
Hout any physical exercise, for
the same period (40 minutes)
The CP group also occurs
aquatic center pool, a condition
like EP, but without any
physical exercise, for the same
period (40 minutes)
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