Transcript Physiological Effects of Balneotherapy

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
Physiological
changes in the
cardiovascular
system during
bathing
Becker BE, Cole AJ, Aquatic
Rehabilitation, from Rehabilitation
Medicine 1998, Raven Press
Blood flow and vessels: CO2-baths (1)
from Stein & Weinstein Am Heart J, 1942
Before bath
After bath
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: 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: CO2-baths (4)
• CO2-bathing induces VEGF expression and
NO-dependent neocapillary formation in
ischemic hindlimbs of mice (Irie H et al. Circulation 2005)
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)
• 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)
Sauna (thermal) therapy
• Increases arterial
endothelial NOSexpression and NOproduction 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)
• 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 changes (challenge)
during
Head Out Water Immersion
Respiratory conclusion
• Repeated challenge to the respiratory
system:
Can it raise the efficiency of the
respiratory system ? - Studies ?
Metabolic changes by
balneotherapy
• Free Radicals
• Hormones
• Lipids
• Others
Free Radicals and antioxidative defense (1)
• Radon therapy: Reduction of lipid peroxide
levels (Yamaoka K et al. J Radiat Res 2004) and
induction of SOD and catalase activities 10
days after first treatment
 through low dose -ray irradiation, which
induces free radical formation (?)
Hormesis
Feinendegen LE 2005 Br J Radiol
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
• 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*
• ACTH- ↑ or ↓ (cortisol increase, unchanged
or decrease)
• Beta-endorphin ↑
• Growth Hormone ↑
• Norepinephrine ↑
• Prolactin ↑
*All results reported in more than 2 studies
Derived from the review by Hannuksela ML,
Ellahham S. Am J Med 2001
Spa therapy and blood lipids: Seasonal effects
fig 1b
fig 1a
290
75
70
270
65
60
230
mg/dl
mg/dl
250
210
55
50
45
40
190
170
CHOL pre
35
HDL pre
CHOL post
30
HDL post
25
150
spring
summer
fall
spring
w inter
fig 1c
summer
fall
w inter
fig 1d
280
210
190
230
150
mg/dl
mg/dl
170
130
Strauss-Blasche G
et al. 2003 FKKN
180
130
110
LDL pre
90
80
TG pre
LDL post
TG post
70
30
spring
summer
fall
w inter
spring
summer
fall
w inter
Reasons for the seasonal
differences
• Dietary factors ?
• Environmental factors ?
• Endogenous factors ?
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
12.93 vs. 13.80
11.41 vs. 10.55
n.s.
P = 0.016
Leibetseder V et al. 2004 Clin Chim Acta
Autonomic Nervous System
• 24h-Blood Pressure
• Heart Rate Variability
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
• 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)
• 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)
*
Bart V et al. J Gravit Physiol 2003;
*sitting in thermoneutral water
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
• 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
Thank you