Physiological Actions of Spa therapy on different systems of the body Aix-Les-Bains 2006, France Cem Ekmekcioglu Vienna, Austria.
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Physiological Actions of Physiological Actions of Spa therapy on different Spa therapy on different
systems of the bodysystems of the bodyAix-Les-Bains 2006, FranceAix-Les-Bains 2006, France
Cem EkmekciogluCem Ekmekcioglu
Vienna, AustriaVienna, Austria
Content of the lectureContent of the lecture
Effect of spa therapy onEffect of spa therapy on
• Blood flow and vesselsBlood flow and vessels
• Respiratory SystemRespiratory System
• MetabolismMetabolism– Free RadicalsFree Radicals– Hormones Hormones
• Nervous Autonomic SystemNervous Autonomic System
Physiological Physiological changes in changes in the the cardiovasculcardiovascular system ar system during during bathingbathing
Becker BE, Cole AJ, Aquatic Rehabilitation, from Rehabilitation Medicine 1998, Raven Press
Blood flow and vessels: COBlood flow and vessels: CO22-baths -baths (1)(1)
Before bath After bath
from Stein & Weinstein Am Heart J, 1942
Blood flow and vessels: COBlood flow and vessels: CO22--baths (2)baths (2)
• Absorption of 30 ml COAbsorption of 30 ml CO22 x min x min-1-1 x (m x (m22) ) -1-1 through the skin (Schmidt KL 1989, through the skin (Schmidt KL 1989, Pratzel H 1984)Pratzel H 1984)
• Elevation of tissue pCOElevation of tissue pCO22
• Right shifting of the oxygen binding Right shifting of the oxygen binding curve, improvement of tissue oxygenationcurve, improvement of tissue oxygenation
• Dilatation of precapillaries, opening of Dilatation of precapillaries, opening of functional closed capillaries – improved functional closed capillaries – improved perfusionperfusion
Blood flow and vessels: COBlood flow and vessels: CO22--baths (3)baths (3)
• Reddening of the skinReddening of the skin• Modulation of thermo-sensors Modulation of thermo-sensors
(inhibition of cold sensors, stimulation (inhibition of cold sensors, stimulation of warm sensors)of warm sensors)
• Blood pressure Blood pressure (through decline in (through decline in peripheral resistance ?, probably peripheral resistance ?, probably through altered sympathicotone and through altered sympathicotone and NO production)NO production)
• Improvement of blood fluidityImprovement of blood fluidity
Blood flow and vessels: COBlood flow and vessels: CO22-baths -baths (4)(4)
• COCO22-bathing induces VEGF -bathing induces VEGF expression and NO-dependent expression and NO-dependent neocapillary formation in ischemic neocapillary formation in ischemic hindlimbs of mice hindlimbs of mice (Irie H et al. Circulation 2005)(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 2005Irie H et al. Circulation 2005
Blood flow and Blood flow and vessels:Thermal therapy (1)vessels:Thermal therapy (1)• Augmentation of Augmentation of
angiogenesis angiogenesis through thermal through thermal therapy in a mouse therapy in a mouse model of hindlimb model of hindlimb ischemiaischemia
Akasaki Y et al. Circ J 2006
Blood flow and vessels: Blood flow and vessels: Thermal therapy (2)Thermal therapy (2)Sauna (thermal) therapySauna (thermal) therapy• Increases arterial Increases arterial
endothelial NOS-endothelial NOS-expression and NO-expression and NO-production in production in cardiomyopathic cardiomyopathic hamsters hamsters (Ikeda Y et al. 2005)(Ikeda Y et al. 2005)
• Through improvement Through improvement of vascular function, of vascular function, reduction of preload reduction of preload and afterload, better and afterload, better cardiac output and cardiac output and shear stress ? shear stress ?
Blood flow and Blood flow and vessels:Thermal therapy (3)vessels:Thermal therapy (3)• Mud packs: in Mud packs: in
patients with lower patients with lower limb venous limb venous insufficiency insufficiency
((Poensin D et al. Joint Bone spine 2003)Poensin D et al. Joint Bone spine 2003)
• Through local heating + Through local heating + other unknown factors other unknown factors (effects lasted longer (effects lasted longer than temp. increase)than temp. increase)
shoulder
Respiratory changes Respiratory changes (challenge) during (challenge) during
Head Out Water Immersion
Respiratory conclusionRespiratory conclusion
• Repeated challenge to the Repeated challenge to the respiratory system: respiratory system:
Can it raise the efficiency of the Can it raise the efficiency of the respiratory system ? - Studies ?respiratory system ? - Studies ?
Metabolic changes by Metabolic changes by balneotherapybalneotherapy
• Free RadicalsFree Radicals
• HormonesHormones
• LipidsLipids
• OthersOthers
Free Radicals and antioxidative Free Radicals and antioxidative defense (1)defense (1)
• Radon therapy: Reduction of lipid Radon therapy: Reduction of lipid peroxide levels peroxide levels (Yamaoka K et al. J Radiat Res (Yamaoka K et al. J Radiat Res
2004) 2004) and induction ofand induction of SOD and SOD and catalase activities 10 days after first catalase activities 10 days after first treatmenttreatment
through low dose through low dose -ray irradiation, -ray irradiation, which induces free radical formation which induces free radical formation (?)(?)
Free Radicals and antioxidative Free Radicals and antioxidative defense (2)defense (2)• Sauna therapy in patients with cardiovascular risk Sauna therapy in patients with cardiovascular risk
factorsfactors
Masuda A, et al. Jpn Heart J 2004
Hormonal Changes: Hormonal Changes: Head Out Water Immersion Head Out Water Immersion
• Increase in ANPIncrease in ANP
• Decrease in Renin-ActivityDecrease in Renin-Activity
• Decrease in Aldosteron ProductionDecrease in Aldosteron Production
• Decrease in Anti-Diuretic HormoneDecrease in Anti-Diuretic Hormone
• Increase in DopamineIncrease in Dopamine
→→ DiuresisDiuresis
Short Term Metabolic Changes Short Term Metabolic Changes After Sauna Bathing*After Sauna Bathing*
• ACTH- ACTH- ↑ or ↓↑ or ↓ (cortisol increase, (cortisol increase, unchanged or decrease)unchanged or decrease)
• Beta-endorphin Beta-endorphin ↑↑
• Growth Hormone Growth Hormone ↑↑
• Norepinephrine Norepinephrine ↑↑
• Prolactin 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 Spa therapy and blood lipids: Seasonal effectseffects
fig 1a
150
170
190
210
230
250
270
290
spring summer fall w inter
mg/
dl
CHOL pre
CHOL post
fig 1b
25
30
35
40
45
50
55
60
65
70
75
spring summer fall w inter
mg/
dl
HDL pre
HDL post
fig 1c
70
90
110
130
150
170
190
210
spring summer fall w inter
mg/
dl
LDL pre
LDL post
fig 1d
30
80
130
180
230
280
spring summer fall w inter
mg/
dl
TG pre
TG post
Strauss-Blasche G et al. 2003 FKKN
Reasons for the seasonal Reasons for the seasonal differencesdifferences
• Dietary factors ?Dietary factors ?
• Environmental factors ?Environmental factors ?
• Endogenous factors ?Endogenous factors ?
Effect of season on lipoprotein Effect of season on lipoprotein lipase activity lipase activity
Donahoo WT et al. 2000 J Clin Endocrin Metab
Effect of regular sulphur baths on plasma homocystein levels
Leibetseder V et al. 2004 Clin Chim Acta
11.41 vs. 10.55
P = 0.016
12.93 vs. 13.80
n.s.
Autonomic Nervous SystemAutonomic Nervous System
• 24h-Blood Pressure24h-Blood Pressure
• Heart Rate VariabilityHeart Rate Variability
Main findings and Main findings and mechanisms:mechanisms:• A 3 week spa therapy lead to a decrease in A 3 week spa therapy lead to a decrease in
24-BP especially in patients with medium-24-BP especially in patients with medium-high initial values high initial values
• A clear improvement in circadian variation A clear improvement in circadian variation variables was detected in patients with high variables was detected in patients with high BP.BP.
• Mechanisms: Mechanisms: – COCO22-baths ? + (?) -baths ? + (?) – Physiological Adaptation ? + (?) Physiological Adaptation ? + (?) – Recovery from chronic stress ? (?) Recovery from chronic stress ? (?)
Heart Rate Variability: Heart Rate Variability: GeneralGeneral• Good tool to assess the function of the Good tool to assess the function of the
autonomic nervous systemautonomic nervous system• AnalysisAnalysis
– Time domain (differences between cycle Time domain (differences between cycle intervals, SDNN, pNN50, RMSSD)intervals, SDNN, pNN50, RMSSD)
– Frequency domain (How does the HRV Frequency domain (How does the HRV distributes as a function of frequency?)distributes as a function of frequency?)• High frequency (HF) power- Vagal ActivityHigh frequency (HF) power- Vagal Activity• Low frequency (LF)- Sympathetic modulation Low frequency (LF)- Sympathetic modulation • Ratio LF/HF- good indicator for dominance of vagal or Ratio LF/HF- good indicator for dominance of vagal or
sympathetic activitysympathetic activity
Heart Rate Variability: clinics Heart Rate Variability: clinics (examples)(examples)
• Reduced HRV is an indicator for an Reduced HRV is an indicator for an increased risk for complications increased risk for complications (mortality etc.) after myocardial (mortality etc.) after myocardial infarctioninfarction
• Non-survivors after myocardial Non-survivors after myocardial infarction had a higher LF-power and infarction had a higher LF-power and lower HF-power than survivors lower HF-power than survivors (Balanescu et (Balanescu et al. 2004 Med Sci Monit)al. 2004 Med Sci Monit)
Heart Rate Variability: Effect of Heart Rate Variability: Effect of Head Out Water Immersion Head Out Water Immersion (HOWI)(HOWI)
Bart V et al. J Gravit Physiol 2003;
*sitting in thermoneutral water
*
Further Studies: HRV and Further Studies: HRV and HOWIHOWI
• Thermoneutral baths: decrease in LF-Thermoneutral baths: decrease in LF-power and increase in HF-power power and increase in HF-power (Miwa C (Miwa C et al. 1996 Environ Med, Aviat Space Environ Med 1997)et al. 1996 Environ Med, Aviat Space Environ Med 1997)
• Hot water baths (40 °C): unspecific Hot water baths (40 °C): unspecific findings findings (Nagasawa Y et al. 2001 Jpn Circ J)(Nagasawa Y et al. 2001 Jpn Circ J)
ConclusionsConclusions
• Balneotherapy has clear Balneotherapy has clear physiological and biochemical effectsphysiological and biochemical effects
• The mechanisms have only been The mechanisms have only been partly investigated yetpartly investigated yet
• However, relating to the studies However, relating to the studies available, it is quite evident that the available, it is quite evident that the positive effects of balneotherapy are positive effects of balneotherapy are not only related to stress relief and not only related to stress relief and well-beingwell-being
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