studies on the effects of spa therapy on endocrine functions

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studies on the effects of spa therapy on
endocrine functions

• Prof Dr Hatice Gürdal
• Istanbul University, Istanbul Faculty of Medicine
• Medical Ecology and Hydroclimatology department

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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.
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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.

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( Agishi Hildebrandt, 1989 Agishi Ohtsuka ,1995 )

• 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

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• 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

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( 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

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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

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URINARY CORTISOL LEVELS DURING BALNEOTHERAPY
WITH ACRATOTHERMAL WATER

• Hatice GÜRDAL, Bora GÜVENER, Selahattin SÜRGIT ,
  Elif ÖZKÖK, Kamil YAZICIOGLU, Yagiz ÜRESIN,
  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

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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..

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PATIENTS 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.

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

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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.

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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 by using Waters
  HPLC equipment ( Millipore Corp.U.S.A.).
• 24-hour urine total catecholamines were measured
  by HPLC for separation with electrochemical
  detection and quantification, in a method
  modified from Holmes et al. (measured using
  liquid chromatography) and creatinine.

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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 gt 0.05 ) .

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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

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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

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mean urinary cortisol levels at balneotherapy and
control groups during 3 weeks cure in Bursa
Military Hospital
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female patients in control group
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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 gt 0.05 ) .
  

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• 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 .

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

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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??!!

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• 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 ).

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• 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 ) .

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• 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 ) .

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• 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 ,

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

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• 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 )

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• 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

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

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primary promoting factors on hormone levels
during spa therapy

• 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

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Schnizer w. 1995 N24 32-36oC 30-60 minute Immersion 3weeks Blood cortisol -0.6 Adrenaline 3.4
Jezova D. 1994 N16 80oC-90oC 20-30 minute Hypertermia in sauna Blood cortisol ACTH Adrenaline increase
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Kukonen 1989 N 8 80-100oC 30-60 minute in sauna Plasma cortisol decreased Acth and Adrenaline increased
Kurabayashi 2001 N7 37oC- 42oC 10 minute Headout water immersion Catecholamine decreased ( 37oC) increased ( 42oC)
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Yamaoka 2004 N 15 Male 36oC Radon hot spring 42oC sauna Plasma ACTH Increased ( 40 fold higher ) in Radon group
Yamaoka 2004 N20 42oC room temp. after radon therapy 2hrs, 2 weeks , 4 weeks, 6 weeks Plasma ACTH Increased at weeks 2 and 4
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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,

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• 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.

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• 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.( plt0.001), GH
  growth hormone (plt0.001), PTH parathormone
  (plt0.001) and CT calcitonin (plt0.01).
• 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
  200382942-9

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to compare the effects of peat and water baths
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• Circadian differences of the secretory responses
  to thermal stimulation are shown by cortisol(
  Agishi,Ohtsuka Watanabe,1996,

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( Agishi Ohtsuka, 1996 ).

• Daily changes in cortisol,noradrenaline and
  adrenaline during 4 weeks balneotherapy in a
  patient with Non-insulin-dependant diabetes a
  circaseptan (about 7 days ) or a circadecan
  (about 10 days ) rhythmical changeThe typical
  charcteristics of these periodicities during the
  course of adaptation

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Endocrin responses to thermal stimuli by
head-out water immersion

• In general, hormone secretion tends to increase
  when the water temperature reaches 40oC or
  higher.When the water temperature reaches 25oC
  or lower,secretion of some hormones is enhanced
  (noradrenaline, cortisol,Atrial natriuretic
  peptide,etc ) while that of other hormones is
  suppressed( ADH, renin,etc.)

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Plasma cortisol

• Plasma cortisol declined gradually by a hot water
  bathing at 42oC in the morning, but a significant
  increase was found in the evening.
• Cold water bathing at 25oC caused significant
  increments of plasma cortisol in the morning but
  no change was observed in the evening as shown
  in figure (Agishi Hildebrandt, 1989 )
• These results suggest that there is a circadian
  difference of responsiveness of plasma cortisol
  to 42oC and 25oC water bathing (Agishi
  Hildebrandt, 1989 )

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Circadian difference of responsiveness of
plasma cortisol to 42oC and 25oC water bathing
(Agishi Hildebrandt, 1989 )
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  Sapporo ( 1989 ) . 11-23

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• 5 - YAMEN , A . GÜRDAL , H. CANBAZ , M. ÖZER
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