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Physiological Actions of Spa therapy on different systems of the body Aix-Les-Bains 2006, France. Cem Ekmekcioglu Vienna, Austria. Content of the lecture. Effect of spa therapy on Blood flow and vessels Respiratory System Metabolism Free Radicals Hormones Nervous Autonomic System.

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physiological actions of spa therapy on different systems of the body aix les bains 2006 france

Physiological Actions of Spa therapy on different systems of the bodyAix-Les-Bains 2006, France

Cem Ekmekcioglu

Vienna, Austria

content of the lecture
Content of the lecture

Effect of spa therapy on

  • Blood flow and vessels
  • Respiratory System
  • Metabolism
    • Free Radicals
    • Hormones
  • Nervous Autonomic System
physiological changes in the cardiovascular system during bathing
Physiological changes in the cardiovascular system during bathing

Becker BE, Cole AJ, Aquatic Rehabilitation, from Rehabilitation Medicine 1998, Raven Press

blood flow and vessels co 2 baths 1
Blood flow and vessels: CO2-baths (1)

from Stein & Weinstein Am Heart J, 1942

Before bath

After bath

blood flow and vessels co 2 baths 2
Blood flow and vessels: CO2-baths (2)
  • Absorption of 30 ml CO2 x min-1 x (m2) -1 through the skin (Schmidt KL 1989, Pratzel H 1984)
  • Elevation of tissue pCO2
  • Right shifting of the oxygen binding curve, improvement of tissue oxygenation
  • Dilatation of precapillaries, opening of functional closed capillaries – improved perfusion
blood flow and vessels co 2 baths 3
Blood flow and vessels: CO2-baths (3)
  • Reddening of the skin
  • Modulation of thermo-sensors (inhibition of cold sensors, stimulation of warm sensors)
  • Blood pressure  (through decline in peripheral resistance ?, probably through altered sympathicotone and NO production)
  • Improvement of blood fluidity
blood flow and vessels co 2 baths 4
Blood flow and vessels: CO2-baths (4)
  • CO2-bathing induces VEGF expression and NO-dependent neocapillary formation in ischemic hindlimbs of mice (Irie H et al. Circulation 2005)
slide8

Angiographic analysis. Arrows indicate ligated ends of femoral arteries

Increase in collateral vessels in the CO2-bath

Irie H et al. Circulation 2005

blood flow and vessels thermal therapy 1
Blood flow and vessels:Thermal therapy (1)
  • Augmentation of angiogenesis through thermal therapy in a mouse model of hindlimb ischemia

Akasaki Y et al. Circ J 2006

blood flow and vessels thermal therapy 2
Blood flow and vessels: Thermal therapy (2)

Sauna (thermal) therapy

  • Increases arterial endothelial NOS-expression and NO-production in cardiomyopathic hamsters (Ikeda Y et al. 2005)
  • Through improvement of vascular function, reduction of preload and afterload, better cardiac output and shear stress ?
blood flow and vessels thermal therapy 3
Blood flow and vessels:Thermal therapy (3)
  • Mud packs: in patients with lower limb venous insufficiency

(Poensin D et al. Joint Bone spine 2003)

  • Through local heating + other unknown factors (effects lasted longer than temp. increase)

shoulder

respiratory conclusion
Respiratory conclusion
  • Repeated challenge to the respiratory system:

Can it raise the efficiency of the respiratory system ? - Studies ?

metabolic changes by balneotherapy
Metabolic changes by balneotherapy
  • Free Radicals
  • Hormones
  • Lipids
  • Others
free radicals and antioxidative defense 1
Free Radicals and antioxidative defense (1)
  • Radon therapy: Reduction of lipid peroxide levels (Yamaoka K et al. J Radiat Res 2004) and induction ofSOD and catalase activities 10 days after first treatment
  • through low dose -ray irradiation, which induces free radical formation (?)
hormesis
Hormesis

Feinendegen LE 2005 Br J Radiol

free radicals and antioxidative defense 2
Free Radicals and antioxidative defense (2)
  • Sauna therapy in patients with cardiovascular risk factors

Masuda A, et al. Jpn Heart J 2004

hormonal changes head out water immersion
Hormonal Changes: Head Out Water Immersion
  • Increase in ANP
  • Decrease in Renin-Activity
  • Decrease in Aldosteron Production
  • Decrease in Anti-Diuretic Hormone
  • Increase in Dopamine

→Diuresis

short term metabolic changes after sauna bathing
Short Term Metabolic Changes After Sauna Bathing*
  • ACTH- ↑ or ↓ (cortisol increase, unchanged or decrease)
  • Beta-endorphin ↑
  • Growth Hormone ↑
  • Norepinephrine ↑
  • Prolactin ↑

Derived from the review by Hannuksela ML, Ellahham S. Am J Med 2001

*All results reported in more than 2 studies

spa therapy and blood lipids seasonal effects
Spa therapy and blood lipids: Seasonal effects

Strauss-Blasche G et al. 2003 FKKN

reasons for the seasonal differences
Reasons for the seasonal differences
  • Dietary factors ?
  • Environmental factors ?
  • Endogenous factors ?
effect of season on lipoprotein lipase activity
Effect of season on lipoprotein lipase activity

Donahoo WT et al. 2000 J Clin Endocrin Metab

effect of regular sulphur baths on plasma homocystein levels
Effect of regular sulphur baths on plasma homocystein levels

12.93 vs. 13.80

n.s.

11.41 vs. 10.55

P = 0.016

Leibetseder V et al. 2004 Clin Chim Acta

autonomic nervous system
Autonomic Nervous System
  • 24h-Blood Pressure
  • Heart Rate Variability
main findings and mechanisms
Main findings and mechanisms:
  • A 3 week spa therapy lead to a decrease in 24-BP especially in patients with medium-high initial values
  • A clear improvement in circadian variation variables was detected in patients with high BP.
  • Mechanisms:
    • CO2-baths ? + (?)
    • Physiological Adaptation ? + (?)
    • Recovery from chronic stress ? (?)
heart rate variability general
Heart Rate Variability: General
  • Good tool to assess the function of the autonomic nervous system
  • Analysis
    • Time domain (differences between cycle intervals, SDNN, pNN50, RMSSD)
    • Frequency domain (How does the HRV distributes as a function of frequency?)
      • High frequency (HF) power- Vagal Activity
      • Low frequency (LF)- Sympathetic modulation
      • Ratio LF/HF- good indicator for dominance of vagal or sympathetic activity
heart rate variability clinics examples
Heart Rate Variability: clinics (examples)
  • Reduced HRV is an indicator for an increased risk for complications (mortality etc.) after myocardial infarction
  • Non-survivors after myocardial infarction had a higher LF-power and lower HF-power than survivors (Balanescu et al. 2004 Med Sci Monit)
heart rate variability effect of head out water immersion howi
Heart Rate Variability: Effect of Head Out Water Immersion (HOWI)

*

Bart V et al. J Gravit Physiol 2003;

*sitting in thermoneutral water

further studies hrv and howi
Further Studies: HRV and HOWI
  • Thermoneutral baths: decrease in LF-power and increase in HF-power (Miwa C et al. 1996 Environ Med, Aviat Space Environ Med 1997)
  • Hot water baths (40 °C): unspecific findings (Nagasawa Y et al. 2001 Jpn Circ J)
conclusions
Conclusions
  • Balneotherapy has clear physiological and biochemical effects
  • The mechanisms have only been partly investigated yet
  • However, relating to the studies available, it is quite evident that the positive effects of balneotherapy are not only related to stress relief and well-being