Does aerobic training enhance effects of spa therapy in back pain patients? A randomized, controlled clinical trial.

OBJECTIVES: The aim of the present study was to evaluate the effects of 3 weeks of individualized aerobic exercise training combined with conventional spa therapy on patients' assessment of chronic pain and quality of life. PATIENTS AND METHODS: 44 patients of either sex and advanced age (50-70 years) with chronic pain underwent an inpatient spa therapy in Bad Tatzmannsdorf, Austria. Participants were randomized into 2 groups, a control group receiving spa therapy alone, and a training group carrying out an additional aerobic training. Every participant performed an exhaustive bicycle exercise test at the beginning of the study. Subsequently, participants of the training group performed individualized training programs, controlled and documented by ambulatory heart rate monitors. At the beginning and the end of the study the following outcome measures were assessed by use of questionnaires: positive and negative mood, general depression, health satisfaction, general pain, exhaustion, abdominal complaints, and cardiac pain. The results of the questionnaires were analyzed by use of a MANOVA to evaluate differences between the two groups. RESULTS: We observed positive effects in all participants and on all parameters investigated after 3 weeks of spa therapy. However, no significant differences could be demonstrated between the two groups (all p > 0.05). CONCLUSION: Individualized aerobic training does not seem to enhance beneficial effects of a 3-week spa therapy on chronic pain and quality of life.

Combined inpatient rehabilitation and spa therapy for breast cancer patients: effects on quality of life and CA 15-3.

The present study investigated the changes of quality of life, mood, and the tumor marker CA 15-3 associated with a 3-week inpatient breast cancer rehabilitation program incorporating spa therapy. One hundred forty-nine women, 32 to 82 years, participated in the study 3 to 72 months after breast cancer surgery. Quality of life (QoL, EORTC QLQ-C30), anxiety, and depression (HADS) were measured 2 weeks before, at the end, and 6 months after rehabilitation; CA 15-3 at the beginning, end, and at 6 months follow-up. Patients received an individualized rehabilitation program incorporating manual lymph drainage, exercise therapy, massages, psychological counseling, relaxation training, carbon dioxide baths, and mud packs. Quality of life and mood improved significantly, the greatest short-term improvements found for mood-related aspects of quality of life, the most lasting improvements found for physical complaints (eg, fatigue). Also, the tumor marker CA 15-3 declined significantly to follow-up. Patient characteristics, as well as the time since surgery, moderated rehabilitation outcome to a limited extent. Older patients, nonobese patients, patients with a greater lymphedema, and patients with an active coping style showed slightly greater improvements. Hot mud packs inducing hyperthermia did not affect CA 15-3. In conclusion, the combination of inpatient rehabilitation with spa therapy provides a promising approach for breast cancer rehabilitation.

Effect of vacation on health: moderating factors of vacation outcome.

BACKGROUND: Vacation has recently become a topic of interest in health research as both beneficial and adverse health effects have been documented. The present study was aimed at identifying vacation characteristics predicting health-related vacation outcome. METHODS: One hundred ninety-one predominantly white-collar employees (109 female, 82 males; mean age 37.8 yr, range 16-62 yr) received a questionnaire in the week after vacation assessing subject characteristics, physical vacation characteristics, the individual structuring of the day, health and social behavior, and stress during vacation as well as the perceived change of recuperation and exhaustion from before to after a vacation. Regression analysis was used to identify variables predicting vacation outcome. RESULTS: Twenty-seven percent of the variance of the change of recuperation and 15% of the change of exhaustion could be explained. Recuperation was facilitated by free time for one's self, warmer (and sunnier) vacation locations, exercise during vacation, good sleep, and making new acquaintances, especially among vacationers reporting higher levels of prevacation work strain. Exhaustion was increased by vacation-related health problems and a greater time-zone difference to home, and was reduced by warmer vacation locations. CONCLUSION: Health-related vacation outcome is significantly affected by the way an individual organizes his or her vacation.

Vacation at moderate and low altitude improves perceived health in individuals with metabolic syndrome.

BACKGROUND: Recent data suggest that vacation may improve cardiovascular health, an effect possibly moderated by altitude. The aim of the present study was to study the effect of a 3-week vacation at moderate and low altitude on perceived health in individuals with increased cardiovascular risk. METHODS: Seventy-two overweight males, both occupationally active and retired (mean age=56.6 +/- 7.2 years), with signs of metabolic syndrome were randomly assigned to identical sojourns at either moderate (1,700 m) or low (300 m) altitude and engaged in four 3- to 4-h heart-rate-controlled hiking tours per week. Perceived health was measured 2 weeks before vacation, at the beginning and end of vacation, and 7 weeks after vacation. RESULTS: Fitness, recreational ability, positive and negative mood and social activities improved during vacation, independent of altitude and occupational status, although the day-to-day improvement in quality of sleep was delayed at moderate altitude. During the follow-up examinations, improvements in all reported aspects of health except for social activities were maintained. In comparison to retired individuals, active individuals showed a greater long-term improvement in social activities. CONCLUSION: Vacation positively affects perceived health independent of altitude or occupational status in generally inactive overweight males.

Improving homocysteine levels through balneotherapy: effects of sulphur baths.

BACKGROUND: Plasma homocysteine (tHcy) is a risk factor for cardio-vascular diseases. Furthermore it has been associated with antioxidative status. Additionally balneotherapeutic sulphur baths have been shown to influence antioxidative status. METHODS: 40 patients with degenerative osteoarthrosis were randomised into two equal groups, a treatment group, receiving stationary spa therapy plus daily sulphur baths (sulphur group) and a control group receiving spa therapy alone (control group). Blood tHcy levels and urinary 8-OHdG (an indicator for oxidative stress) were measured at the beginning and the end of spa therapy. RESULTS: tHcy (micromol/l) was significantly reduced from 11.41 (+/-2.91) to 10.55 (+/-2.28) in the sulphur group (p=0.016) and rose insignificantly from 12.93 (+/-2.28) to 13.80 (+/-3.87) in the control group. 8-OHdG (ng 8-OHdG/mg creatinine) declined from 18.00 (+/-18.28) to 11.16 (+/-5.33) in the sulphur group (n.s.) and from 17.91 (+/-5.87) to 18.17 (+/-5.70) in the control group (n.s.). Differences between the two groups showed significant effects of sulphur baths for tHcy (p=0.006) but not for 8-OHdG (p=0.106). CONCLUSIONS: Sulphur baths exert beneficial effects on plasma tHcyt whereas effects on 8-OHdG seem to be unlikely.

Quantitative analysis of peroxisome proliferator-activated receptor gamma (PPARgamma) expression in arteries and hearts of patients with ischaemic or dilated cardiomyopathy.

PPARgamma, a nuclear transcription factor, is expressed in various cells within the vasculature and in cardiomyocytes. It has been suggested that PPARgamma is involved in atherogenesis and in cardiac hypertrophy. Therefore, we sought to quantify PPARgamma mRNA in coronary arteries, the aorta and left ventricular specimens from patients with ischaemic (CHD) and dilated cardiomyopathy (CMP). Using real-time PCR, we were able to demonstrate the expression of PPARgamma in all of the human specimens. The lowest expression of PPARgamma was detected in the aorta specimens of both groups (this was set to one). In comparison, the expression in coronary arteries was 2.32-fold in CHD- and 3.78-fold in CMP specimens and in the left ventricle specimens, 2.12-fold in CHD- and 3.51-fold in CMP. Samples from CHD patients showed a higher expression of PPARgamma in all of the samples compared to those from CMP patients (aorta: 1.99-fold; coronary arteries: 1.35; left ventricles: 1.23). PPARgamma levels were not significantly correlated to CD 36 expression values in any group, suggesting that higher levels of PPARgamma are not principally due to increased PPARgamma expression in macrophages. This was confirmed by immunohistochemical analysis, which showed that PPARgamma is also located in the smooth muscle layer and in cardiomyocytes. In conclusion, our observations of increased PPAR mRNA expression in the coronary arteries and left ventricles from CHD and CMP patients suggest an important function of this nuclear receptor in the pathogenesis of heart disease.

Serum lipids responses to a respite from occupational and domestic demands in subjects with varying levels of stress.

OBJECTIVES: To investigate the effect of a temporary respite from domestic and job demands on serum lipid concentrations in subjects with high and low levels of perceived demands. METHODS: 111 females and 42 males (mean age 57.1+/-9.8) staying at a health resort for 3 weeks and receiving spa treatments participated in the study. Serum cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG) and LDL/HDL were measured at the beginning and end of the stay. In addition, levels of perceived demands were assessed. Data were analysed with MANCOVA for repeated measures with known confounding variables as covariates. RESULTS: Subjects with a higher level of perceived demands had higher levels of CHOL, LDL/HDL and TG and lower levels of HDL-c. In response to the respite, subjects experiencing more demands showed a greater decrease of LDL-c (P<.01) and LDL/HDL (P<.001). Sex moderated these stress-related respite effects for HDL-c (P<.01) and LDL/HDL (P<.005), high demand males showing a smaller decrease in HDL and a greater decrease in LDL/HDL than females in response to the respite. CONCLUSIONS: The results indicate that a respite from chronic demands may reduce LDL-c and LDL/HDL in chronically stressed individuals.

The melatonin receptor subtype MT2 is present in the human cardiovascular system.

We showed that the melatonin receptor subtype, MT1, is expressed in healthy and diseased human coronary arteries. As studies in experimental animals suggest that the MT2 melatonin receptor subtype is also present in the vasculature, we investigated whether the MT2 is expressed in human aorta and coronary arteries. Additionally, MT2 expression in human ventricular specimens was analysed, as melatonin was shown to affect myocyte function. Expression of the MT2-receptor was studied in sections of isolated coronary arteries, aorta and left ventricular specimens from healthy heart donors (control) and patients with dilated or ischemic cardiomyopathy. MT2 expression was found by reverse transcriptase (RT)-nested-polymerase chain reaction (PCR) in all of the specimens (aorta, left ventricle and coronary arteries) derived from controls. Also, visible evidence for receptor expression was found in 12 of 15 samples from cardiomyopathy patients and 10 of 15 of coronary heart disease patients. Additionally, the expression of MT2-receptor between aorta, left ventricle and coronary arteries varied among the individuals, some of them showing highest expression in the aorta while in others principal expression sites were coronary arteries or left ventricles. In conclusion, the MT2-receptor subtype is present in human arteries and left ventricles and it is suggested that in coronary heart disease MT2-receptor expression is altered. Furthermore, there is evidence for heterogeneous MT2 expression patterns in individual patients.

Contribution of individual spa therapies in the treatment of chronic pain.

OBJECTIVES: The aim of the present study was to evaluate the contribution of individual spa therapies administered during a period of 3 weeks on measures of well being and pain in a sample of patients with chronic back pain. DESIGN: One hundred fifty-three patients with chronic back pain undergoing inpatient spa therapy in Bad Tatzmannsdorf, Austria, participated in the study. According to the prescription of their spa physician, patients underwent two or more of the following treatments: mud packs, carbon dioxide baths, massages, exercise therapies, spinal traction, and electrotherapy. The outcome measures were general pain, back pain, negative mood, and health satisfaction. Regression analyses were conducted to predict the 4 outcome measures at the end of spa therapy and at 6 weeks' follow-up for all therapies applied. The pretreatment outcome measure, age, and sex were controlled for by entering them into the analysis. RESULTS: Patients showed significant improvements in all 4 outcome measures. The prediction of improvement was generally small: only 1% to 11% of the change of the outcome measures could be explained by the type and number of therapies received. On a short-term basis, mud packs and exercise were found to be associated with a greater improvement in mood, whereas a greater frequency of massage therapy and carbon dioxide baths was associated with a smaller improvement in health satisfaction. On a long-term basis, exercise therapy and spinal traction were associated with a greater reduction in back pain. CONCLUSIONS: The results indicate that, in addition to the individual therapies, other factors relating to spa therapy as a whole must contribute to overall treatment outcome. In addition, the results support the efficacy of exercise therapy for chronic back pain.

Urinary excretion of 8-iso-PGF(2 alpha) in three patients during sepsis, recovery and state of health.

Sepsis is known to be associated with oxidative stress. Novel markers of oxidative stress are now believed to be F2-isoprostanes which are produced in situ in phospholipids and subsequently released into circulation and excreted in the urine. This study, therefore, sought to investigate whether the excretion of the isoprostane, 8-iso-PGF(2 alpha), is elevated during sepsis. The excretion of 8-iso-PGF(2 alpha), in the 24 h urine of three patients was studied in the septic stage, during mobilisation and in the state of health by a radioimmunological method. Extrapolating the urinary excretion of 8-iso-PGF(2 alpha) over time showed an insignificant variation in the excretion values during 24 h. The amount of mean 24 h urinary 8-iso-PGF(2 alpha) was about similar in the septic stage and in the state of health but increased remarkably during mobilisation in two of the patients. We suggest that mobilisation of septic patients can be associated with an increase of oxidative stress which may stem from an increase in oxygen consumption and/or from a depletion of antioxidants leading to the enhanced formation of free radicals.

Seasonal variation in effect of spa therapy on chronic pain.

This study sought to investigate whether the effects of spa therapy are subject to seasonal variation as suggested by conventional spa therapy research. A total of 268 female (age 31-90 yr) and 119 male (age 35-85 yr) patients with noninflammatory chronic pain were studied. Patients stayed at an Austrian spa for 3 wk and received 2-4 treatments per day, including mudpacks, massages, and exercise therapy. In different groups of patients for 2 yr, pain (self-assessed by questionnaire and Likert scales) and associated variables (mood, fatigue) were measured at the beginning, end, and 6 wk after spa therapy. Data were analyzed by multivariate analysis of covariance controlling for possible group differences between seasons and cosinor analysis. The effect of spa therapy on pain was seasonally dependent; short-term decrease of pain was best between April and June and medium-term decrease of pain was best between October and November, with a second minor peak in fall and spring, respectively. The magnitude of the seasonal variation was greater for back (approximately 30%) than for joint (approximately 20%) pain. Positive mood also improved most between April and June. The observed semi-annual variations of pain do not correspond to the well-known annual change in many physiological and psychological variables. The results suggest that the effects of spa therapy and possibly other related treatments, such as physical and alternative therapies, are subject to seasonal variation.