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Mayo Clin Proc. 2010 July; 85(7): 693.
PMCID: PMC2894727

Does Thermal Therapy Benefit Patients With Chronic Heart Failure?–Reply–I

Dr Hanlon raises an interesting and thought-provoking point regarding the beneficial effects of Waon therapy (soothing warm therapy) in patients with CHF. This therapy, which uses repeated 15-minute treatments in a 60°C infrared sauna, has been reported in small studies to improve left ventricular systolic function and favorably affect natriuretic peptide levels.1 Several behavioral and nontraditional approaches have been studied in CHF, including conscious breath control with extended expiration and reduced respiratory rate,2,3 enhanced external counterpulsation,4 and warm water immersion.5 However, these therapies have not gained widespread acceptance, not because of third-party reimbursements but rather because the history of therapeutic trials in CHF has taught us several important lessons. First, the benchmark of therapeutic efficacy must be assessed by multicenter studies because single-center studies often provide findings that cannot be replicated by other groups and are debunked in larger well-controlled investigations. Second, the placebo effect and clinical trial inclusion (“Hawthorne” effect) can have a significant positive influence on study findings—simply via more frequent physician visits or patient-perceived benefits.6 Finally, a satisfactory duration of follow-up is required to ensure safety and retention of benefit.7 Consequently, although Waon therapy may show some promise as a therapy in patients with CHF, additional randomized, multicenter studies documenting safety and efficacy are needed before inclusion of this therapy in an evidence-based discussion of heart failure therapeutics.


1. Miyata M, Kihara T, Kubozono T, et al. Beneficial effects of Waon therapy on patients with chronic heart failure: results of a prospective multicenter study. J Cardiol. 2009;53(2):214-218 [PubMed]
2. Bernardi L, Spadacini G, Bellwon J, et al. Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure. Lancet 1998;351(9112):1308-1311 [PubMed]
3. Bernardi L, Porta C, Spicuzza L, et al. Slow breathing increase arterial baroreflex sensitivity in patients with chronic heart failure. Circulation 2002;105(2):143-145 [PubMed]
4. Feldman AM, Silver MA, Francis GS, et al. Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol. 2006;48(6):1198-1205 [PubMed]
5. Cider A, Schaufelberger M, Sunnerhagen KS, Andersson B. Hydrotherapy—a new approach to improve function in the older patient with chronic heart failure. Eur J Heart Fail 2003;5(4):527-535 [PubMed]
6. Gottlieb SS, Pina IL. Enhanced external counterpulsation: what can we learn from the treatment of neurasthenia [editorial]? J Am Coll Cardiol. 2006;48(6):1206-1207 [PubMed]
7. Cohn JN, Goldstein SO, Greenberg BH, et al. A dose–dependent increase in mortality with vesanrinone among patients with severe heart failure. N Engl J Med. 1998;339(25):1810-1816 [PubMed]

Articles from Mayo Clinic Proceedings are provided here courtesy of The Mayo Foundation for Medical Education and Research