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

1. Physiological Actions of Spa therapy on different systems of the bodyAix-Les-Bains 2006, France Cem Ekmekcioglu Vienna, Austria

2. Content of the lecture Effect of spa therapy on • Blood flow and vessels • Respiratory System • Metabolism • Free Radicals • Hormones • Nervous Autonomic System

3. Physiological changes in the cardiovascular system during bathing Becker BE, Cole AJ, Aquatic Rehabilitation, from Rehabilitation Medicine 1998, Raven Press

4. Blood flow and vessels: CO2-baths (1) from Stein & Weinstein Am Heart J, 1942 Before bath After bath

5. 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

6. 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

7. 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)

8. Angiographic analysis. Arrows indicate ligated ends of femoral arteries Increase in collateral vessels in the CO2-bath Irie H et al. Circulation 2005

9. 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

10. 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 ?

11. 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

12. Respiratory changes (challenge) during Head Out Water Immersion

13. Respiratory conclusion • Repeated challenge to the respiratory system: Can it raise the efficiency of the respiratory system ? - Studies ?

14. Metabolic changes by balneotherapy • Free Radicals • Hormones • Lipids • Others

15. 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 (?)

16. Hormesis Feinendegen LE 2005 Br J Radiol

17. Free Radicals and antioxidative defense (2) • Sauna therapy in patients with cardiovascular risk factors Masuda A, et al. Jpn Heart J 2004

18. 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

19. 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

20. Spa therapy and blood lipids: Seasonal effects Strauss-Blasche G et al. 2003 FKKN

21. Reasons for the seasonal differences • Dietary factors ? • Environmental factors ? • Endogenous factors ?

22. Effect of season on lipoprotein lipase activity Donahoo WT et al. 2000 J Clin Endocrin Metab

23. 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

24. Autonomic Nervous System • 24h-Blood Pressure • Heart Rate Variability

26. 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 ? (?)

27. 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

28. 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)

29. Heart Rate Variability: Effect of Head Out Water Immersion (HOWI) * Bart V et al. J Gravit Physiol 2003; *sitting in thermoneutral water

30. 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)

31. 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

32. Thank you