This study aims to investigate the effects of water immersion and exercise on heart function and blood flow in patients with chronic stable heart failure.

Inclusion Criteria:

• Age >18
• Established diagnosis of heart failure with NTpro BNP >100

Exclusion Criteria:

• Uncontrolled or severe heart failure, defined by NYHA class IV symptoms (breathlessness at rest)
• Severe fluid overload characterised as more than minimal pitting oedema of the ankles only
• Presence of haemodynamically significant valvular heart disease in the opinion of the investigator
• Haemoglobin <125 g/L
• Weight >120 kilograms
• Requiring long term oxygen supplementation in the community
• Hospitalisation for any cause within the last 6 weeks, that in the opinion of the investigator would affect the patients wellbeing in this study
• Unstable or severe stable angina that requires three or more antianginals
• Patients known to have disease causing immunocompromise such as HIV infection or undergoing chemotherapy
• Patients with active infection
• Dialysis patients
• Uncontrolled seizures; patients in whom the pool environment may trigger seizures, new diagnosis of epilepsy
• Insulin treated diabetic patients with hypoglycaemic episodes in the last 3 months.
• Pregnant women
• Central venous lines which are not tunnelled and are exposed superficially.
• Open access ports to lungs including tracheotomy sites
• Ventilation tubes for ears
• Nasogastric or gastrostomy tube in situ
• Presence of colostomy, ileostomy or urostomy.
• Presence of open, macerated, infected or non-intact skin or oedema with leakage of serous fluid.
• Skin condition such as severe eczema or psoriasis
• Any surgery or invasive devices fitted within the last 4 weeks
• Any form of mobility impairment requiring mobility aids (e.g. stick or wheelchair) or rendering patient unable to perform gentle exercises, including recent injury or trauma
• History of chlorine sensitivity
• Urinary or faecal incontinence
• Hydrophobia
• Unable to give consent

open label