RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
146
Articles
Moises Mendoza Toledo
Universidad Adventista de Bolivia, Bolivia
moises.mendoza@uab.edu.bo
ORCID https://orcid.org./0009-0005-8359-3554
Dora Abigail Chura Ruiz
Universidad Adventista de Bolivia, Bolivia
abigail.chura@uab.edu.bo
ORCID https://orcid.org/0009-0000-6428-0919
Abstract: Introduction: Arterial hypertension
(AHT) in young adults is a clinical challenge
requiring effective non-pharmacological strategies.
Objective: To determine the influence of an Aqua
Aerobics program on blood pressure in a 25-year-
old patient with Stage I AHT. Methodology: A case
study with a mixed-method approach and an
embedded design was conducted. The intervention
lasted eight weeks, with three 45-minute sessions
per week divided into two phases (Aqua Dynamic
and Aqua Gym). Intensity was monitored using the
Borg Scale (12-14 points). Blood pressure values
were recorded before, during, and after each
session. Results: Following the program, the
patient stabilized her blood pressure at 120/80
mmHg, starting from a baseline of 130/90 mmHg.
A significant reduction in symptoms (headaches
and tinnitus) and improved post-exercise recovery
were observed. Conclusion: Aqua Aerobics, as a
complementary therapy to pharmacological
treatment (Losartan), proved effective in reducing
and stabilizing blood pressure levels, enhancing the
quality of life and hemodynamic response in the
young patient evaluated.
Keywords: Blood pressure, Aquatic environment,
Swimming, Hydrostatic pressure, Aqua Aerobics.
Influence of Aqua Aerobics on Arterial Hypertension in a 25-Year-Old
Patient
Moises Mendoza Toledo
1
& Dora Abigail Chura Ruiz
2
RIAF. International Journal of Physical Activity
Universidad de Guayaquil, Ecuador
Frequency: Semi-annual
Vol. 4, N° 2, 2026
revista.riaf@ug.edu.ec
Received: June 5th, 2026
Approved: July 6
th
, 2026
Published: July 25
th
, 2026
URL: https://revistas.ug.edu.ec/index.php/riaf
DOI: https://doi.org/10.53591/riaf.v4i2.3179
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RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
147
Introduction
Currently, arterial hypertension (AHT) represents one of the leading causes of morbidity and mortality
worldwide, constituting a critical challenge for public health. In this context, physical activity emerges as
an essential intervention in blood pressure management. According to Diaztagle (2022), AHT is a
problem of vast prevalence in which a considerable proportion of affected individuals are unaware of
their condition, increasing the risk of fatal outcomes without prior manifestations.
This cardiovascular risk is complicated by factors such as sedentary lifestyle, obesity, and dysregulation
of the renin-angiotensin-aldosterone system. Therefore, hydrotherapy or aquatic therapy, defined by
Martínez et al. (2025) as an exercise program performed in immersion, takes advantage of the physical
properties of water to facilitate movement and optimize functional rehabilitation. This modality
capitalizes on buoyancy and temperature to reduce joint load and enhance health.
Recent scientific literature corroborates the effectiveness of these interventions. Kruel et al. (2021)
evaluated blood pressure responses in hypertensive women practicing water aerobics, concluding that
both continuous and interval protocols are safe and present no significant differences in blood pressure
response. These findings validate aquatic practice as an alternative with high cardiovascular safety for
populations with chronic diseases.
Likewise, research by Gutiérrez et al. (2020) demonstrated that a 16-week moderate physical exercise
program significantly reduces both systolic blood pressure (SBP) and diastolic blood pressure (DBP).
This positive impact is crucial in young populations, where AHT requires management that avoids
excessive dependence on pharmacological agents. Villarreal et al. (2023) emphasize that overweight is the
strongest risk factor, recommending healthy lifestyles from early ages.
On the other hand, authors such as Álvarez (2025) have demonstrated the viability of aqua fitness
programs to promote healthy habits in communities with a prevalence of diabetes and hypertension.
Despite these benefits, Martins et al. (2009) warn that a considerable portion of the hypertensive
population does not possess the desirable profile of regular physical activity practice. This justifies the
need to validate specific low-impact protocols that foster treatment adherence.
Finally, this research is justified by providing evidence on the efficacy of Aqua Aerobics in a 25-year-
old young patient. Theoretically, the study is based on the concept of Chronic Adaptation by volume
Overload (Maron and Thompson, 2020), where immersion increases central venous return and decreases
sympathetic tone. The general objective is to determine the influence of this practice on AHT, evaluating
hemodynamic response and clinical symptomatology during the 2025 management period.
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148
Materials and Methods
Study Design
The research was developed under a mixed-
method approach with an embedded design
(DIAC) of descriptive-propositive type.
According to Martínez et al. (2025), this model
allows the integration of quantitative data from
blood pressure measurements with the patient's
qualitative perception of her well-being.
As this was a single case study, longitudinal
observation was prioritized over eight weeks,
allowing the identification of specific
physiological adaptations in response to the
aquatic exercise stimulus.
Participant and Ethical Considerations
The unit of analysis was a 25-year-old female
with a diagnosis of Stage I Arterial Hypertension
(130/90 mmHg) and a history of sedentary
behavior. In accordance with the protocols of the
American College of Sports Medicine (ACSM,
2022), informed consent was obtained for
participation and data publication. The patient
maintained her pharmacological treatment with
Losartan (50 mg/day) and a low-sodium diet to
ensure that observed changes could be attributed
to the Aqua Aerobics intervention.
Data Collection Instruments
For the quantification of systolic and diastolic
blood pressure, a medical-grade digital
sphygmomanometer was employed, following
the monitoring guidelines of the American Heart
Association. Exercise intensity was measured
using the Borg Scale (6-20), a tool validated by
Kruel et al. (2021) for controlling internal load in
aquatic exercises. Additionally, a clinical log was
used to record symptoms such as headaches and
tinnitus before and after each session.
Intervention Protocol (Aqua Aerobics
Program)
The designed program was implemented with
a frequency of three weekly sessions of 45
minutes each. Following the structure proposed
by Martins et al. (2009), each session was divided
into three phases: warm-up (10 min), aerobic core
"Aqua Dynamic" (25 min), and cool-down "Aqua
Gym" (10 min). Intensity was maintained within
a range of 12 to 14 points on the Borg Scale,
ensuring moderate aerobic work that favored the
hypotensive response.
Quantitative data processing was performed
using descriptive statistics, employing frequency
tables and line graphs to observe blood pressure
trends.
As suggested by Zhou and Yázigi (2023), data
triangulation allowed the contrast of physical
measurements with the evolution of the patient's
perceived quality of life. This comprehensive
analysis facilitated the validation of the protocol
as a coadjuvant strategy in the management of
juvenile arterial hypertension.
Results
After conducting the eight-week intervention
and hemodynamic control tests, the following
data based on the patient's response to effort
were obtained and calculated:
Optimal Time (Optimal Blood
Pressure): The lowest blood pressure reading
achieved after the "Aqua Dynamic" phase.
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149
Table 1.
Comparison of Blood Pressure Values (Pre-test
vs. Post-test)
Variable
Pre-test
(Week 0)
Post-
test
(Week
8)
Difference
Systolic
Blood
Pressure
130 mmHg
120
mmHg
-10 mmHg
Diastolic
Blood
Pressure
90 mmHg
80
mmHg
-10 mmHg
Resting
Heart Rate
82 bpm
74 bpm
-8 bpm
Symptom
Perception
(Headaches)
Frequent
(3-4
times/week)
Absent
100%
reduction
Note. Final values show stabilization within
normal ranges according to AHA criteria.
The effectiveness of these blood pressure
changes is attributed to the precise dosing of
effort during sessions. Table 2 describes the
structure of the biphasic protocol used,
highlighting that the majority of effective work
time was maintained within a moderate intensity
range (12-14 points on the Borg Scale).
This organization allowed maximizing the
benefits of hydrostatic pressure without
compromising the participant's cardiovascular
safety.
Exercise/Running intensity: The high-
intensity phases in the water (Aqua
Dynamic) were carried out seeking the
greatest possible metabolic expenditure.
The patient managed to maintain an
intensity of 14 points on the Borg Scale
("Somewhat hard") without reporting
hypertensive spikes.
Table 2.
Applied Biphasic Intervention Protocol
Phase
Principal
Activity
Duratio
n
Intensity
(Borg)
Warm-up
Joint mobility
and
displacements
10 min
9 - 10
Warm-up
Joint mobility
and
displacements
10 min
9 - 10
Aqua
Dynamic
Aerobic
exercises of
hydrodynamic
resistance
25 min
12 - 14
Aqua
Gym
Localized
muscle toning
and stretching
10 min
11 - 12
Total
Session
45 min
Moderate
Note: Frequency of 3 weekly sessions. Intensity
monitored to avoid Valsalva maneuver.
The 10-mmHg reduction observed in Table 1 is
clinically significant, as according to the literature,
a decrease of even 5 mmHg in systolic pressure
drastically reduces the risk of cerebrovascular
events in the long term.
Result:
118/78 mmHg (recorded in week 7).
Fatigue Index / Hemodynamic Recovery:
Pre-test (Baseline): The patient started with
130/90 mmHg. After effort, recovery to baseline
values took more than 30 minutes.
Post-test (End of program): The patient
stabilized her blood pressure at 120/80 mmHg.
Post-exercise recovery time decreased
significantly, achieving stable levels in less than 15
minutes after the session.
Points observed during protocol execution:
Recovery Control: Following the 24-second
recovery logic of sprint tests, the pause between
blocks of aquatic exercises was monitored. The
patient showed a recovery heart rate 15% more
efficient in the final phase of the study compared
to the initial phase.
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Verbal Information and Monitoring:
Constant feedback was provided to the patient
regarding her respiratory technique and execution
time (every 5 and 10 minutes during the aerobic
core) to avoid the Valsalva maneuver, which is
contraindicated in hypertensive patients.
Incidents and Reliability:
No falls or trips
occurred during sessions in the aquatic
environment. The buoyancy of water
(Archimedes' Principle) allowed the patient to
perform jumping movements and displacements
that on dry land generated premature fatigue and
headaches.
Symptomatology:
At baseline (Pre-test), the
patient reported headaches and tinnitus in 80% of
sessions. At the end of the study (Post-test), the
incidence of these symptoms was reduced to 0%,
confirming the safety of the protocol.
Discussion
The reduction of blood pressure to levels of
120/80 mmHg observed in this case study
coincides with the findings of Gutiérrez et al.
(2020), who demonstrated that constant
moderate exercise is a significant reducer of SBP
and DBP in women. The particularity of this case
lies in the patient's age (25 years), demonstrating
that the hypotensive response is not exclusive to
older adults. These data reinforce the idea that
early intervention can mitigate target organ
damage.
Unlike common concerns about intensity, this
protocol demonstrated total cardiovascular
safety. As noted by Kruel et al. (2021), there are
no significant differences in blood pressure
responses between continuous and interval
protocols in water, which allowed the application
of the "Aqua Dynamic" phase with confidence.
The absence of hypertensive peaks during the
eight weeks suggests that hydrostatic pressure
acts as a protective factor and facilitator of central
venous return.
The disappearance of symptoms such as
headaches and tinnitus aligns with the perspective
of Martínez et al. (2025), who validated that
aquatic exercise notably improves the perception
of health-related quality of life. The aquatic
environment not only benefited the patient's
hemodynamics but also reduced orthopedic
stress. This is fundamental for treatment
adherence in young patients who, according to
Martins et al. (2009), typically present physical
activity levels below recommended values.
Finally, the success of the intervention is
grounded in the mechanism of chronic
adaptation by volume overload described by
Maron and Thompson (2020). Prolonged
immersion and regular aerobic exercise induced a
decrease in sympathetic tone, allowing sustained
blood pressure stabilization. This case study
provides practical evidence for Aqua Aerobics to
be considered a formal clinical prescription tool,
complementary to standard pharmacological
treatment in juvenile hypertension.
This suggests that this training regimen could
have induced certain positive physiological
adaptations because of the high requirements and
intensity of the exertions, leading to enhanced
anaerobic power and capacity, as well as an
improved fatigue index.
The fatigue index was one of the variables that
improved, but despite having a significant
improvement percentage, it remains low
compared to other studies, so it is necessary to
carry out better preparation to increase the
repeated sprint ability (RSA).
Conclusions
The Aqua Aerobics program proved to be an
effective non-pharmacological intervention for
blood pressure regulation in a 25-year-old young
patient. After eight weeks of intervention, blood
pressure stabilization at 120/80 mmHg was
achieved, starting from a baseline of 130/90
mmHg. This finding confirms that exercise in an
aquatic medium, thanks to hydrostatic pressure,
potentiates the hypotensive response and
improves the efficiency of the cardiovascular
RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
151
system in populations with Stage I hypertension.
It is concluded that the applied methodology
(Aqua Dynamic and Aqua Gym phases) offers
high cardiovascular safety, completely eliminating
initial clinical symptomatology such as headaches
and tinnitus. The absence of adverse effects and
the improvement in post-exercise recovery
validate Aqua Aerobics as an ideal low-impact
modality for patients requiring hemodynamic
control without the orthopedic stress of land-
based exercise. The Borg Scale (12-14 points)
proved to be a precise and reliable intensity
monitoring instrument.
Finally, the results suggest that the integration
of aquatic exercise with pharmacological
treatment (Losartan) favors a positive chronic
adaptation, optimizing venous return and
reducing sympathetic tone. The implementation
of this standardized protocol in public health
programs and physical rehabilitation centers is
recommended. This case study lays the
foundation for future research exploring the
dose-response relationship of aquatic exercise in
young adults with cardiovascular risk factors.
References
Álvarez-Ochoa, R., Torres-Criollo, L. M., Ortega,
J. P. G., Coronel, D. C. I., Cayamcela, D. M.
B., Pelaez, V. D. R. L., & Salinas, A. S. S.
(2022). Factores de riesgo de hipertensión
arterial en adultos. Una revisión crítica. Revista
Latinoamericana de Hipertensión, 17(2), 129-
137.
https://www.redalyc.org/pdf/1702/1702788
35007.pdf
Álvarez et al., (2025) Academia Aquafitness
Waves Para Adultos en la Ciudad de Tuluá,
Valle del Cauca – Colombia 2025”
https://repositorio.uceva.edu.co/bitstream/h
andle/20.500.12993/5160/TG-aalvarez.pdf?
sequence=2&isAllowed=y
Ballone, A. (2022). Programa de inmersión en
Medicina del Estilo de Vida y sus efectos sobre
los factores de riesgo cardiovasculares:
Immersion program in Lifestyle Medicine and
its effects on cardiovascular risk factors.
Revista de la Facultad de Medicina Humana,
22(1).
https://revistas.urp.edu.pe/index.php/RFM
H/article/view/4337
Chávez, et al., (2023). Recomendaciones para la
prevención de la hipertensión arterial en niños
y adolescentes: revisión sistemática de alcance.
SANUS: Revista del Departamento de
Enfermería de la Universidad de Sonora, 8, 2.
https://www.redalyc.org/journal/7482/7482
77397019/748277397019.pdf
Diaztagle et al., (2022). Hipertensión arterial y
riesgo cardiovascular. Revista Repertorio De
Medicina Y Cirugía, 31(3), 230-241.
https://doi.org/10.31260/RepertMedCir.012
17372.1160
Floyd et al. (2022). Efecto de un programa de
ejercicios funcionales en el medio acuático en
los niveles de obesidad de la población adulta
de la Clínica de Rehabilitación de la Ciudad de
Guadalajara de Buga. Tuluá: Unidad Central
del Valle del Cauca, Facultad de Educación,
Programa Licenciatura en Educación Básica
con Énfasis en Educación Física, Recreación y
Deportes.
https://repositorio.uceva.edu.co/handle/20.
500.12993/2838
Gallo, B., Zamunér, A. R., Silva, V. C., Ferreira,
D. G., Sakabe, D. I., de Souza, L. D. K., ... &
Moreno, M. A. (2025). Beneficios de la
hidroterapia en pacientes con enfermedad
pulmonar obstructiva crónica: resultados
adicionales de un ensayo clínico aleatorizado.
Pensar en Movimiento: Revista de Ciencias del
Ejercicio y la Salud, 23(2), 4.
https://dialnet.unirioja.es/servlet/articulo?co
digo=10464724
RIAF Journal ISSN: 2953-6693 Vol – 4 No. 2, July 2026
152
Gutiérrez-Huamani, Ó., Franco, M. A. C.,
Callirgos, M. M. M., Lope, F. R. N., Mejía, C.
R. A., & Escriba, G. I. (2020). Efectos del
ejercicio físico en la presión arterial en
mujeres. Revista Digital: Actividad Física Y
Deporte, 6(2), 5-13.
https://revistas.udca.edu.co/index.php/rdaf
d/article/view/1565
Álvarez et al. 2021, La medida de la presión
arterial en niños y adolescentes: Elemento
clave en la evaluación de la hipertensión
arterial Medición de la presión arterial en niños
y adolescentes: Elemento clave en la
evaluación de la hipertensión arterial,
https://www.sciencedirect.com/science/artic
le/pii/S1695403322001382
Kruel et al. (2021). Blood Pressure Responses in
Hypertensive Women to Water Aerobics.
Apunts. Educación Física y Deportes, 144, 25-
32. https://doi.org/10.5672/apunts.2014-
0983.es.(2021/2).144.04
Martínez et al. (2025). Efectos de un programa de
ejercicio físico en agua sobre los niveles de
composición corporal y capacidad funcional
en pacientes con obesidad. Transdigital, 6(12),
e498.
https://doi.org/10.56162/transdigital498
Martins et al. (2009). Nivel de actividad física en
portadores de hipertensión arterial. Revista
Latinoamericana de Enfermagem, 17 , 462-
467.https://www.scielo.br/j/rlae/a/zPJsH5r
ZN4JD7XZFzwMpnTF/?format=html&lan
g=esreflexiones y propuestas prácticas.
https://www.researchgate.net/profile/Juan-
Murcia-
9/publication/367296837_Actividades_acuati
cas_Evidencias_reflexiones_y_propuestas_pr
acticas/links/63cac43ad9fb5967c2ef5253/Ac
tividades-acuaticas-Evidencias-reflexiones-y-
propuestas-practicas.pdf#page=17
Valdespino-Mendieta, F. O., Begoña-Zubero, M.,
& Wong-Silva, J. (2025). Efectividad del
ejercicio físico en el control de la hipertensión
arterial en adultos: revisión sistemática y
metaanálisis. Revista Información Científica,
104.
Declaration of conflicts of interest by the
authors:
The authors declare having no conflicts of
interest.
Declaration of participation in the research
by the authors:
The authors participated in the data collection
process, in the diagnosis of the intervention, and
in the post-intervention.