Mayo Clinic Proceedings Home
MCP Digital Health Home

Cardiovascular Responses to Immersion in a Hot Tub in Comparison With Exercise in Male Subjects With Coronary Artery Disease

      In order to test the safety of hot tub use for persons with heart disease, 15 men with clinically stable coronary artery disease underwent 15 minutes of immersion in a hot tub at 40°C. On another day, they exercised on a cycle ergometer for 15 minutes; target heart rate was determined by standard methods. Tympanic temperature, skin temperature, electrocardiographic findings, blood pressure, plasma catecholamines, subjective comfort, and cardiovascular symptoms were monitored. The peak heart rate was significantly lower during the hot tub session versus the exercise session (85 ± 14 versus 112 ± 19 beats/min), as were the systolic (106 ± 15 versus 170 ± 21 mm Hg) and diastolic (61 ± 6 versus 83 ± 8 mm Hg) blood pressure measurements (P<0.01). Tympanic temperature increased by a mean of 0.6 ± 0.3°C during immersion and 0.1 ± 0.1°C during exercise. No ischemic electrocardiographic changes or clinical complications occurred. Simple ventricular ectopic activity and “just noticeable” chest pain were more frequent during exercise than during immersion. Plasma norepinephrine increased during exercise but not during immersion. These data suggest that hot tub use within these time and temperature constraints should be safe for men with stable heart disease who can follow an exercise regimen at home.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Brown V
        Spa associated hazards: an update and summary. US Consumer Product Safety Commission, Washington (DC)1981
        • Turner B
        • Pennefather J
        • Edmonds C
        Cardiovascular effects of hot water immersion (suicide soup).
        Med J Aust. 1980; 2: 39
        • Luurila OJ
        Cardiac arrhythmias, sudden death and the Finnish sauna bath.
        Adv Cardiol. 1978; 25: 73-81
        • Romo M
        Factors related to sudden death in acute ischaemic heart disease: a community study in Helsinki.
        Acta Med Scand [Suppl]. 1972; 547: 1-92
        • Romo M
        Heart-attacks and the sauna [letter].
        Lancet. 1976; 2: 809
        • Hülleman K-D
        • Matthes D
        Comparative telemetric measurements on heart attack patients and normal persons in the sauna, taking an ergometer test, at sports and at an interview.
        in: Teir H Collan Y Valtakari P Sauna Studies. The Finnish Sauna Society, Helsinki1976: 181-189
        • McCance AJ
        • Forfar JC
        Myocardial ischaemia and ventricular arrhythmias precipitated by physiological concentrations of adrenaline in patients with coronary heart disease.
        Br Heart J. 1991; 66: 316-319
        • Rocco MB
        • Barry J
        • Campbell S
        • Nabel E
        • Cook EF
        • Goldman L
        • et al.
        Circadian variation of transient myocardial ischemia in patients with coronary artery disease.
        Circulation. 1987; 75: 395-400
        • Møller N
        • Beckwith R
        • Butler PC
        • Christensen NJ
        • Ørskov H
        • Alberti KGMM
        Metabolic and hormonal responses to exogenous hyperthermia in man.
        Clin Endocrinol (Oxf). 1989; 30: 651-660
        • Dimsdale JE
        • Hartley LH
        • Guiney T
        • Ruskin JN
        • Greenblatt D
        Postexercise peril: plasma catecholamines and exercise.
        JAMA. 1984; 251: 630-632
        • Rowell LB
        • Brengelmann GL
        • Freund PR
        Unaltered norepinephrine-heart rate relationship in exercise with exogenous heat.
        J Appl Physiol. 1987; 62: 646-650
        • American College of Sports Medicine
        Guidelines for Exercise Testing and Prescription. 4th ed. Lea & Febiger, Philadelphia1991: 93-159
        • Borg GAV
        Perceived exertion: a note on “history” and methods.
        Med Sci Sports. 1973; 5: 90-93
        • Allison TG
        • Reger WE
        Thermoregulatory, cardiovascular, and psychophysical response to alcohol in men in 40°C water.
        J Appl Physiol. 1992; 72: 2099-2107
        • Nadel ER
        • Horvath SM
        Comparison of tympanic membrane and deep body temperatures in man.
        Life Sci. 1970; 9: 869-875
        • Bove AA
        • Dewey JD
        • Tyce GM
        Increased conjugated dopamine in plasma after exercise training.
        J Lab Clin Med. 1984; 104: 77-85
        • Devalon ML
        • Miller TD
        • Squires RW
        • Rogers PJ
        • Bove AA
        • Tyce GM
        Dopa in plasma increases during acute exercise and after exercise training.
        J Lab Clin Med. 1989; 114: 321-327
        • Faithfull NS
        • Reinhold HS
        • van den Berg AP
        • van Rhoon GC
        • van der Zee J
        • Wike-Hooley JL
        Cardiovascular changes during whole body hyperthermia treatment of advanced malignancy.
        Eur J Appl Physiol. 1984; 53: 274-281
        • Versteegh PMR
        • van den Hoogen RHWM
        • Zwaveling A
        Systemic hyperthermia by the immersion bath method.
        Neth J Surg. 1981; 33: 195-199
        • Kirsch KA
        • Röcker L
        • von Ameln H
        • Hrynyschyn K
        The cardiac filling pressure following exercise and thermal stress.
        Yale J Biol Med. 1986; 59: 257-265
        • Arborelius Jr, M
        • Balldin UI
        • Lilja B
        • Lundgren CEG
        Hemodynamic changes in man during immersion with the head above water.
        Aerospace Med. 1972; 43: 592-598
        • Begin R
        • Epstein M
        • Sackner MA
        • Levinson R
        • Dougherty R
        • Duncan D
        Effects of water immersion to the neck on pulmonary circulation and tissue volume in man.
        J Appl Physiol. 1976; 40: 293-299
        • Echt M
        • Lange L
        • Gauer OH
        Changes of peripheral venous tone and central transmural venous pressure during immersion in a thermo-neutral bath.
        Pflugers Arch. 1974; 352: 211-217
        • Rowell LB
        • Brengelmann GL
        • Blackmon JR
        • Murray JA
        Redistribution of blood flow during sustained high skin temperature in resting man.
        J Appl Physiol. 1970; 28: 415-420
        • Rowell LB
        • Brengelmann GL
        • Detry J-MR
        • Wyss C
        Venomotor responses to rapid changes in skin temperature in exercising man.
        J Appl Physiol. 1971; 30: 64-71
        • Shah SD
        • Tse TF
        • Clutter WE
        • Cryer PE
        The human sympathochromaffin system.
        Am J Physiol. 1984; 247: E380-E384
        • Ratge D
        • Gehrke A
        • Melzner I
        • Wisser H
        Free and conjugated catecholamines in human plasma during physical exercise.
        Clin Exp Pharmacol Physiol. 1986; 13: 543-553
        • Hartley LH
        • Mason JW
        • Hogan RP
        • Jones LG
        • Kotchen TA
        • Mougey EH
        • et al.
        Multiple hormonal responses to graded exercise in relation to physical training.
        J Appl Physiol. 1972; 33: 602-606
        • Bloom SR
        • Johnson RH
        • Park DM
        • Rennie MJ
        • Sulaiman WR
        Differences in the metabolic and hormonal response to exercise between racing cyclists and untrained individuals.
        J Physiol (Lond). 1976; 258: 1-18
        • Taggart P
        • Parkinson P
        • Carruthers M
        Cardiac responses to thermal, physical, and emotional stress.
        BMJ. 1972; 3: 71-76