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Spa and Integrative Medicine: The Future of Health and Wellness

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  1. Spa and Integrative Medicine: The Future of Health and Wellness Brent A. Bauer MD Director, Complementary and Integrative Medicine Program Mayo Clinic Department of Medicine

  2. Learning Objectives • Understand the evolution of CAM and the emergence of “Integrative Medicine”. • Be able to communicate the evidence from Integrative Medicine and how that science validates Spa • Prepare strategically for the opportunities where Spa and IM meet

  3. Quotable quote “The greatest opportunity to touch the lives of the greatest number of people with a lifestyle that promotes wellness and health is where Spa and Integrative Medicine meet” Brent A. Bauer MD, 2009 ISPA CONFERENCE

  4. Scope of the Issue • United States Adults • 2/3 are overweight or obese • 1/2 have a chronic disease • e.g. heart disease, stroke, diabetes, cancer • One in four have heart disease • One in three have high blood pressure • 24 million Americans have type 2 diabetes Trust for America’s Health (www.healthyamericans.org)

  5. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  6. 1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1988-2008.

  7. Barnes, 2008

  8. Integrative Medicine “The practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing." Consortium of Academic Health Centers for Integrative Medicine

  9. Institute of Medicine • Integrative Medicine: • “Orienting the health care process to create a seamless engagement by patients and caregivers of the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health”. www.iom.edu

  10. Institute of Medicine • “…to explore issues, opportunities, and approaches for shifting our health care system to a focus on efficient, evidence-based prevention, wellness, and patient-centered care that is personalized, predictive, preventive and participatory.” www.iom.edu

  11. Time for a change? • “If no one wants to be hospitalized and no one wants to be sick, then it’s time to establish a health care system that not only treats sickness, but also focuses on keeping people healthy”. Denis Cortese, M.D., CEO emeritus, Mayo Clinic Mayo Clinic Health Policy Center

  12. Time for a change? • Taking charge of your health. • Eat a healthy diet • Get regular exercise • Don’t use tobacco • Actively manage stress “These practices will keep you healthier, happier and more productive” Denis Cortese, M.D., Mayo Clinic

  13. Massage Therapy – Mayo Clinic Pilot trial • 58 cardiac surgery patients • Massage therapy vs. quiet relaxation • Decreased • Pain • Anxiety • Tension Bauer, Comp. Therap.Clin. Practice, Submitted

  14. Massage Therapy after CV Surgery VAS Anxiety Level

  15. Massage Therapy after CV Surgery VAS Pain Level

  16. Massage Therapy – Mayo Clinic • Randomized, controlled trial • 113 cardiac surgery patients • MT therapy days 2,4 vs. quiet relaxation • Decreased pain p <0.001 • Decreased anxiety p <0.001 • Decreased tension p <0.001 • Increased relaxation p <0.001 Bauer, Comp. Therap. Clin. Practice, In press

  17. Massage Therapy – CRS N = 20

  18. Massage Therapy – Mayo Clinic • Randomized, controlled trial • 130 cardiac pts going to invasive procedure • MT x 20” prior vs. quiet relaxation • Decreased pain p <0.001 • Decreased anxiety p <0.001 • Decreased muscle tension p <0.001 • Improved satisfaction Bauer, submitted

  19. Massage Therapy – Mayo Clinic • Echocardiographers • 45 full-time cardiac-sonographers • 30” chair massage each week vs. stretching • Modest impr. in work-related discomfort • Marked increase in satisfaction Bauer, submitted

  20. Massage Therapy – Mayo Clinic • Cardiac Cath Lab personnel • 50 staff members (MD’s, RN’s, technicians) • On-site, table massage, 30” x 10 • Outcomes: pain, fatigue, anxiety • Preliminary • Positive feedback Bauer, analysis

  21. Massage Therapy - MSKCC • Memorial Sloan-Kettering Cancer Center • 1,290 patients treated over 3 yr period • Pre- and Post-therapy sxs recorded • Pain • Fatigue • Stress/Anxiety • Depression • Nausea Cassileth, J Pain Symptom Manage. 2004

  22. Massage Therapy - MSKCC • Results: SymptomImprovement Pain 40% Fatigue 41% Anxiety 52% Nausea 21% Depression 31% Cassileth, J Pain Symptom Manage. 2004

  23. Massage and Fibromyalgia • Clinical Trial, N = 50 women w/ FMS • Manual lymph drainage = 25 • Connective tissue massage = 25 • 5X/week for 3 weeks • Improved • Pain intensity, pain pressure threshold, HRQoL • AM tiredness, anxiety, FIQ better with MLD Ekici, J Manip. Physiol Ther 2009

  24. Massage and Fibromyalgia

  25. CAM and the Relaxation Response • Therapies with good efficacy/ low risk • Massage - Meditation • Acupuncture - Music Therapy • Yoga - Hypnosis • Spirituality - Tai chi • Guided imagery - etc.

  26. Relaxation Response • RCT N = 41, U of Wisconsin • Meditation vs. wait list control • 8-wk program > vaccinated • Meditators had • Measurable change in brain electrical pattern • Higher antibody titers “…meditation may change brain and immune function in positive ways” Davidson, Psych Med 2003

  27. Davidson, Psych Med 2003

  28. Davidson, Psych Med 2003

  29. ISPA “Spas offer…a time and place to…recharge your mind, body and spirit.  The opportunity to bring your physical, mental, emotional and spiritual selves back into alignment”. http://www.experienceispa.com/spa-goers/why-spa/

  30. Ruth Stricker Spa and Wellness Award • Created in 2008 • First recipient - Dr. Jen Seda “Our research is designed to show the biological, emotional, and mental benefits of a typical spa experience”

  31. Ornish, Lancet Oncology 2008

  32. “Comprehensive lifestyle modification” • Lifestyle modifications included: • Low fat, whole foods, plant-based diet • Mod. aerobic exercise (walking 30”/d, 6 d/wk) • Stress management (gentle yoga stretching, breathing, meditation 60”/day, 6 d/wk) • 1-h group support session once per week. Ornish, Lancet Oncology 2008

  33. Questions??? bauer.brent@mayo.edu