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 (?)(?)

HormesisHormesis

Feinendegen LE 2005 Br J Radiol

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

Thank youThank you