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
cardiovascul
ar system
during
bathing
Becker BE, Cole AJ, Aquatic
Rehabilitation, from
Rehabilitation Medicine 1998,
Raven Press

Blood flow and vessels: CO2-baths

from Stein & Weinstein Am Heart J, 1942
(1) Before bath
After bath

Blood flow and vessels: CO2baths (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: CO2baths (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)

shoulde
r

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

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

Strauss-Blasche
G et al. 2003
FKKN

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
11.41 vs.
10.55

12.93 vs.
13.80
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 24BP 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 HFpower 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