studies on the effects of spa therapy on endocrine functions

1. studies on the effects of spa therapy on endocrine functions Prof Dr Hatice Gürdal İstanbul University, İstanbul Faculty of Medicine Medical Ecology and Hydroclimatology department

2. spatherapy

3. spatherapy • spatherapy can be regarded as a kind of stimulus - adaptation therapy because patients are repeatedly exposed therapeutic stimulations including thermomineral and peloid baths, exercises and other complementer therapies. • The direct effects of thermomineral baths on the body are mainly consist of physical , thermal and chemical effects.

4. The complex therapeutical factors work to alter the physiological functions comprehensively and non-specifically. The process of alteration is considered to be mediated by the autonomic nervous system, endocrine system and immun system Most physiological functions exhibit a circaseptan (about 7 days ) or a circadecan (about 10 days ) rhythm during the course of adaptation to the therapeutic normalizations It generally takes three to four weeks to achive these changes

5. Such effects of long- term balneotherapy have been examined using various indicators such as catecholamine ,cortisol, blood pressure and pulse rate and other parameters. During the course of treatment , a variety of physiological functions have been found to be normalized

6. ( Agishi& Ohtsuka , 1995 ) • Figure 4 shows weekly change in circadian rhytm of plasma cortisol during 4 weeks balneotherapy in hospitalized patients .it clearly demonstrates the lowering of acrophase and the decrease of the amplitude during the cure

8. Bursa Military Hospital in Turkey • The studies, which we performed in Bursa Military Hospital using the acratothermal water of this place to investigate the endocrinological nonspecific effects of balneotherapy

9. URINARY CORTISOL LEVELS DURING BALNEOTHERAPY WITH ACRATOTHERMAL WATER Hatice GÜRDAL, Bora GÜVENER, Selahattin SÜRGİT , Elif ÖZKÖK, Kamil YAZICIOĞLU, Yağız ÜRESİN, Nurten ÖZER Proceedings of The 33rd Conference of SITH in Hakone, Kanagawa, Japan December 1-6 1997 This work was supported by Istanbul University Research Fund. Project Number 485-230791

10. Bursa Military Hospital • The acratothermal water in Bursa Military Hospital is mostly used in rheumatological diseases as balneotherapy. • The total mineral content of the water is 606.33 mg / lt ( Na , Ca , Mg , HCO3 , SO4 , H2SiO3 ) and the Radon ( Rn222 ) content is 3329 pci / lt..

11. PATİENTS and METHOD • I- The balneotherapy group :had twenty-four patients ( 5 males, 19 females ; mean age 59.3 years ) • II- The control group eleven patients (4 males , 7 females ; mean age 61.4 years ) • patients which in both groups were primary osteoarthritis • All subjects were hospitalized in Bursa Military Hospital and had not any medical treatments excluding analgesic.

12. General datas of two groups (patient who suffering from primary osteoarthritis) in Bursa Military Hospital

13. The balneotherapy group patients have had a whole body immersion bath, once at morning for 15 minutes in 360 C ± 20 C with acratothermal water and appliedphysiotherapy and physical exercises for 3 weeks balneotherapy cure period. • The control group patients have had only physiotherapy as with infrared, ultrasound and short-wave diathermy and physical exercises along the cure period.

15. urine samples • The 24 hrs. urine samples were collected on the 1st, 4th, 7th, 11th and 19th days of study period (in the course of the the three weeks of cure ). • All samples acidified immediately and transported in ice-boxes to the analytical department and stored in deep-freezer (-200 C) until analysis.

16. Methods for analyses • Diethyleter was used for the extraction of cortisol from urine samples and the levels were determined by high-performance liquid chromatography (HPLC ) method byusing Waters HPLC equipment ( Millipore Corp.U.S.A.). • 24-hour urine total catecholamines were measured by HPLC for separationwith electrochemical detection and quantification, in a methodmodified from Holmes et al.(measuredusing liquid chromatography) and creatinine.

17. statistical evaluation • The results of both groups and the mentioned days were analyzed statistically with One-Way ANOVA test method among each other separately. • According to the ANOVA test the mean values were not significantly different ( P > 0.05 ) .

18. Statistical data • ANOVA test and post hoc test were used to compare the changes and to determine the differences in level cortisol and catecholamine among two groups for the three weeks

19. results • The urinary cortisol levels of patients of balneotherapy and control groups are shown in figures • As seen from figures, the levels varied between large distance ( 0.041 and 108.87 mcg / 24-hrs. ) • The very high cortisol levels of some patients in the first week of the cure

22. mean urinary cortisol levels at balneotherapy and control groups during 3 weeks cure in Bursa Military Hospital

23. female patients in control group

28. DISCUSSION and CONCLUSION • there was an increase at mean urinary cortisol level on fourth day of Spa therapy • there was an increase at mean urinary cortisol level on seventh day of physiotherapy group • the catecholamine levels were slightly increased at seventh day of cure but not statistically significant . • According to the ANOVA test the mean values were not significantly different ( P > 0.05 ) .

30. As seen from the figure, mean cortisol levels increased on the 4th day of the cure at balneotherapy group and increased on the 7th day of the cure at control group • The very high cortisol levels of some patients in the first week of the cure left us think about the possibility of the outcome of a cure crisis .

31. These finding left us think about the possibility of the outcome of a cure crisis during the course of adaptation to the therapeutic normalizations.

32. conclusion • at the end of the cure , Increasing of cortisol levels in patients with low beginning levels at balneotherapy group • Decrease in cortisol level at the end of physiotherapy ( control group ) was less manifest • These finding left us think about the possibility of the Regulatory effect of balneotherapy??!!

33. On the other hand the effects of single or cure therapy in hyperthermic bath or sauna were studied and the change of stress hormon levels were investigated (8 , 9 ,10 ,11 ). Bühring et al. have shown that plasma cortisol levels increased two fold after single hyperthermic bath therapy ( 12 ).

34. But Epstein et al . have demonstrated that there was no difference in the urinary or plasma 17- OHCS levels between health subjects of therapy and control groups after an immersion in hot water ( 34 0C ) ( 13 ) .

35. Ayats et al. have showed the increase of ACTH levels but there was no change of urinary cortisol levels after hydrotherapy cure in patients with chronic rheumatic pain ( 14 ) .

36. It seems that our results are similar with the results of Ayats et al.,but in conclusion , we think that more detailed investigations should be carried on the effect of balneotherapy with acratothermal water ,

37. for example bath application in different temperature, with healthy subjects , with subjects in different age groups and cure periods .

38. Recent studies of urinary catecholamines have shown that the excretion of these hormones is detectably related to life-styles, habits and subjective feelings on a • population basis (Jenner, Reynolds, Harrison and Palmer )

39. Urinary catecholamine excretion rates, previously shown to be related to lifestyles and environmental influences, Significant inter-population differences in excretion rates and in creatinine-related excretion were observed. most of the studies were carried out retrospectively output was expressed relative to creatinine

40. Recent studies showed that internal and external effective factors on endocrin responses to spa therapy

41. Water composition Radon gas content Bath temperature Bath duration Time of bath application Number of Bath Additional therapies Cure duration Age Sex Healthy or morbid kind of disease disease characteristics primary promoting factors on hormone levels during spa therapy

45. K. Yamaoka, F.Mitsunobu, et all , Study on Biologic Effects of Radon and Thermal Therapy on Osteoarthritis, The Journal of Pain, Vol 5, No 1, :( pp 20-25) 2004 • the effect of the radioactivity of radon and the thermal effect were compared at room temperature or a hot spring condition with the same chemical component by using • The results were about 2-fold larger in the radon effects than in the thermal effects. • This suggests that the antioxidation function was more enhanced by radon therapy than by thermal therapy,

46. K. Yamaoka, F.Mitsunobu, et all , Study on Biologic Effects • of Radon and Thermal Therapy on Osteoarthritis, • The Journal of Pain, Vol 5, No 1, :( pp 20-25) 2004 • Radon therapy increases the ANP level and decreases the level of vasopressin, an antidiuretic hormone, in the blood of patients with osteoarthritis. • In addition, -endorphin and ACTH significantly increased, suggesting a part of the mechanism of alleviation of pain by radon. These findings suggest that an appropriate amount of active oxygen is produced in the body after radon inhalation.

47. There were statistically significant differences between the control and the aquatic exercise groups for the 6 months percent of changes in IGF-1insulin like growth fact.( p<0.001), GH growth hormone (p<0.001), PTH parathormone (p<0.001) and CT calcitonin (p<0.01). • Conclusions. Aquatic exercise was determined to be effective to make an anabolic effect on the bone of the postmenopausal sedentary subjects. • Ay A., Yurtkuran M.: Anabolic effect of aquatic exercise on bone. Am J Phys Med Rehabil 2003;82:942-9

48. to compare the effects of peat and water baths

49. Circadian differences of the secretory responses to thermal stimulation are shown by cortisol( Agishi,Ohtsuka& Watanabe,1996,