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Abstract: Purpose: To assess if Hydrotherapy (HT) added to endurance training (ET) is more effective than ET alone in order to improve exercise tolerance of elderly male patients with chronic heart failure (CHF). Methods: Twenty-one male CHF patients, age 68+/−7 (mean+/−DS) years; ejection fraction 32+/−9. NYHA II–III were enrolled. Eleven pts were randomized to combined training (CT) group performing HT+ET and 10 patients to ET group (ET only). At baseline and after 24weeks all patients underwent: 6-minute walking test (6MWT), assessment of quadriceps maximal voluntary contraction (MVC) and peak torque (PT), blood pressure and heart rate (HR), echocardiography and non-invasive hemodynamic evaluation. HT was performed 3 times/week in upright position at up to the xyphoid process at a temperature of 31°C. ET was performed 3 times/week. Results: Exercise was well tolerated. No patients had adverse events. Distance at 6MWT improved in both groups (CT group: 150+/−32m; ET group:105+/−28m) with significant intergroup differences (p 0.001). On land diastolic BP and HR significantly decreased in the CT group while remained unchanged in the ET group (−11mmHg+/−2, p 0.04; e — 12bpm, p 0.03; respectively) CO and SV had a relative despite no significant increase in CT group TPR on land significantly decreased in CT group (−23+/−3mmHg/l/m; p 0.01) while remained unchanged in ET group. Patients of CT group had no significant higher increase of both MVC and PT than ET group. Conclusions: CT training, significantly improves exercise tolerance and hemodynamic profile of patients with CHF. [Copyright &y& Elsevier]