The Thermal Effects of Water Immersion on Health Outcomes: An Integrative Review

The relationship between muscle oxygen saturation kinetics and maximal blood lactate accumulation rate across varying sprint cycle durations

This study evaluated the relationship between muscle oxygen saturation (SmO2) and the maximal blood lactate accumulation rate (vLamax) during three test durations (10, 15 and 30 s) to validate the optimal test duration of vLamax protocol. Thirteen developmental trained males (age: 27 ± 6 years and peak power: 1133 ± 185W and 14.88 ± 1.61 W·kg-1) performed three maximal cycle tests (10, 15 and 30 s). Performance metrics were measured throughout; peak power, mean power, and cadence. vLamax was determined using blood lactate concentrations following each test. SmO2 of the vastus lateralis was measured using a MOXY device via near-infrared spectroscopy, throughout all experimental conditions. The shortest test (10 s) produced a significantly (p = 0.005; p < 0.001) higher vLamax (0.83 ± 0.15 mmol·L-1·s-1) than 15 s (0.67 ± 0.13 mmol·L-1·s-1) and 30 s (0.43 ± 0.06 mmol·L-1·s-1). Three relationships between SmO2 kinetics and vLamax were observed: (1) a very strong inverse relationship (r = -0.994, p < 0.001) between SmO2 desaturation and vLamax time dependent kinetics, (2) a significant inverse relationship (r = -0.648, p < 0.001) between SmO2 time spent at the nadir and vLamax and (3) a moderate relationship (r = 0.508, p = 0.11) and similar time to attain the SmO2 nadir (8.47 ± 1.50s) and vLamax (8.92 ± 0.77s). These results validate the 10-s test duration for determination of vLamax verified with mathematical modelling predicting peak vLamax occurs at ∼9 s. SmO2 desaturation closely reflects the vLamax kinetics, with the time points of the SmO2 nadir and peak vLamax closely corresponding.

Aquatic exercise interventions in the treatment of musculoskeletal upper extremity disorders: A scoping review

OBJECTIVE

To identify literature on aquatic exercise therapy used to manage upper extremity musculoskeletal disorders and identify key concepts, intervention components, and gaps in the evidence base.

DATA SOURCES

The comprehensive search included MEDLINE (Ovid), CINAHL (EBSCOHost), Embase (Ovid), CENTRAL (Cochrane Central Register of Controlled Trials) databases and grey literature sources.

REVIEW METHODS

JBI Scoping review methodology guided this review through protocol development, searching, screening, data extraction and analysis. Study Selection included: Participants - Adults with upper extremity musculoskeletal disorders; Concept - Aquatic based exercise therapy; Context - any setting in any very highly developed nation.

RESULTS

The search identified 5045 sources with 68 studies included in the final synthesis. Findings outlined shoulder problems were the most reported upper extremity condition treated (n = 78) especially following rotator cuff repair (n = 17), followed by the hand and wrist (n = 9), and elbow (n = 6). Range of movement (n = 36) and resistance exercises (n = 17) were the most common interventions reported for aquatic therapy, however compliance with reporting guidance across included studies was poor. Sixteen health domains were identified with range of movement (n = 21) and pain (n = 20) the most common, and 62 outcome measures were reported related to the identified domains. Qualitative aspects of aquatic interventions were evaluated in two papers.

CONCLUSION

There is a need for more primary experimental and qualitative studies related to the upper extremity and aquatic therapy. Improved reporting quality of aquatic therapy exercise intervention is required as is the need to establish specific core outcome sets and domains in this area.

A Warm Water Immersion Intervention for Symptoms of PTSD in Military Veterans: A Qualitative Descriptive Study

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a substantial problem for Veterans and active members of armed forces across the globe, resulting in debilitating mental and physical comorbidities. Evidence-based treatments have demonstrated some success; however, many Veterans remain symptomatic mandating the urgent need for innovative treatment strategies.

PURPOSE

The purpose of this study was to explore the lived experience of military Veterans with PTSD symptoms who participated in a therapeutic warm water immersion intervention aimed at reducing their symptoms.

METHODS AND PROCEDURES

A standardized warm 33 °C (92 °F) water immersion intervention to the chest, lasting 45 min was implemented. Semi-structured interviews were conducted with the 13 participants (age 23-41) after engaging in the intervention. Using a qualitative descriptive design informed by phenomenology, thematic analysis was completed, applying criteria of rigor throughout the process.

RESULTS

Five main themes explicated the participants' experience: the rhythm of relaxed, embracing the properties of the water, the pain floats away, acclimatize to calmness, and a place to set your mind. Participants described a sense of relaxation, calmness, pain reduction, and a means to control intrusive thoughts. All indicated they would recommend the intervention and provided feedback on how to refine it.

CONCLUSIONS

As a component of a larger study, these qualitative findings revealed the potential for therapeutic effects of a novel water immersion intervention. The findings serve to inform revisions to the intervention for future research and practice. Immersion provides a fast-acting, non-stigmatizing adjunct therapy for student Veterans who continue to experience symptoms during and after standard evidence-based treatment.

The Combined Effects of Cold Foot Bath and Lavender Oil Inhalation on Autonomic Variables in Healthy Volunteers: A Randomized Controlled Trial

BACKGROUND AND AIM

An essential function of the autonomic nerve system is to regulate physiological processes and stress responses in the body. Cold foot baths and aromatherapy with lavender oil each influence autonomic functions, but their combined effect in healthy individuals is unknown. The purpose of this study is to look into how autonomic variability in healthy volunteers is affected by both inhaling lavender oil and taking cold foot baths.

METHODS

A total of 60 healthy individuals were randomized to be placed in either the control group (n=30) or the experimental group (n=30) and were instructed to attend a single designated session. The control group underwent a 20-minute cold foot bath, while the experimental group received a 20-minute cold foot bath combined with lavender oil inhalation. Assessments were carried out before, during, and after the interventions.

OUTCOME MEASURES

To evaluate autonomic variables, we monitored galvanic skin response (GSR) and Heart Rate Variability (HRV) using an equivital belt. Furthermore, we measured blood pressure (BP) and mean arterial pressure (MAP) before, during (20 minutes) the intervention, and after a 10-minute resting period; post-intervention measurements were taken.

RESULTS

Repeated measures analysis revealed a significant difference in standard deviation of normal-to-normal intervals (SDNN), pNN50, and heart rate (HR) for time-domain variables (p<0.05), whereas the frequency-domain analysis showed a significant difference over time in LF/HF, LF, and HF (p<0.05). When these were compared between the groups, a significant difference was observed only in LF and HF (p<0.04). Additionally, a statistically significant difference (p<0.001) in diastolic and systolic blood pressure between the groups was noted.

CONCLUSION

The combination of a cold foot bath and lavender oil inhalation may modulate autonomic activity, promoting relaxation by vagal balance in healthy individuals.

Unravelling the benefits of thermal waters enhancing oral health: a pilot study

BACKGROUND

Oral health represents a public health problem due to its remarkable social impact and medical costs. Crenotherapy with sulfur water is shown to be a complementary, less toxic, and traumatizing therapy, but the number of studies that evaluate the effect of natural mineral waters effect on oral health are scarce. The aim of this pilot study is to evaluate the impact of thermal water therapy on the oral health of the participants, assessing parameters such as plaque index, gingival bleeding index and periodontal probing depth as well on the perception of symptoms of oral mucosa diseases (OMD).

METHODS

An observational, longitudinal and comparative study was designed, and 90 thermalists were randomly allocated to two treatment groups for 14 days: Thermal sulfuric natural mineral water of the Amarante Thermal baths group (TW_TA group) (n = 45) or saline solution (control group) (n = 45), in May 2022. The study was based on clinical observation and application of a self-response questionnaire involving sociodemographic data and quality of life assessment. The evaluation was carried out in 2 different moments: before and at the end of treatment (14 days).

RESULTS

The study involved 90 thermal practitioners, evenly split between the TW_TA group and a control group. Most participants were women (70%), with a similar average age in both groups. Oral examination showed a high prevalence of filled and missing teeth, and around 25% of participants used removable prostheses, predominantly in the control group. Thermal treatment had a positive impact on oral health. In the TW_TA group, gingival bleeding significantly decreased from 68.9% to 40%, while it remained unchanged in the control group. Periodontal health improved, with no participants in the TW_TA group having pockets deeper than 5 mm by the end of the study, indicating reduced periodontal pathology. Also, plaque levels dropped in both groups after treatment, as assessed by the O'Leary index. Additionally, quality of life related to OMD improved, particularly in the TW_TA group. The overall reduction in symptoms was significant, although the differences between groups were not statistically significant.

CONCLUSIONS

This study demonstrates the positive effects of thermal water treatment on oral health, including reduced gingival bleeding and plaque levels, along with improved quality of life related to OMD. Further targeted research is needed to explore the benefits of thermal water effects and optimize oral health practices in Portugal using thermal waters.

Rehabilitation Technologies by Integrating Exoskeletons, Aquatic Therapy, and Quantum Computing for Enhanced Patient Outcomes

Recent advancements in patient rehabilitation integrate both traditional and modern techniques to enhance treatment efficacy and accessibility. Hydrotherapy, leveraging water's physical properties, is crucial for reducing joint stress, alleviating pain, and improving circulation. The rehabilitation of upper limbs benefits from technologies like virtual reality and robotics which, when combined with hydrotherapy, can accelerate recovery. Exoskeletons, which support and enhance movement, have shown promise for patients with neurological conditions or injuries. This study focused on implementing and comparing proportional-integral-derivative (PID) and fuzzy logic controllers (FLCs) in a lower limb exoskeleton. Initial PID control tests revealed instability, leading to a switch to a PI controller for better stability and the development of a fuzzy control system. A hybrid strategy was then applied, using FLC for smooth initial movements and PID for precise tracking, with optimized weighting to improve performance. The combination of PID and fuzzy controllers, with tailored weighting (70% for moderate angles and 100% for extensive movements), enhanced the exoskeleton's stability and precision. This study also explored quantum computing techniques, such as the quantum approximate optimization algorithm (QAOA) and the quantum Fourier transform (QFT), to optimize controller tuning and improve real-time control, highlighting the potential of these advanced tools in refining rehabilitation devices.

WATSU (Water-Shiatsu) increases body awareness and improves pain and mood: A randomised controlled study

BACKGROUND AND PURPOSE

WATSU (Water-Shiatsu) is a body-oriented therapy in warm-water pool with passive movements, massage and breathing techniques. The present study investigated the short-term effect of a single session of WATSU on body awareness.

MATERIALS AND METHODS

In a randomized-controlled study 60 volunteers (18-65 years) were assigned to a 20-min intervention of WATSU or to a 20-min lecture on WATSU. Immediately before and after the intervention they had to answer questionnaires. Primary endpoint of the investigation was the change of the total score of the non-verbal Awareness Body Chart (ABC). Secondary endpoints were the changes of the scores of the 14 single body parts of the ABC, of the Visual Analogue Pain Scale, of a German self-perception questionnaire (KEKS) and changes in mood scored with a German questionnaire on mood (Bf-SR). To compare groups, Mann-Whitney U tests were used.

RESULTS

The WATSU group had a significantly higher increase in the ABC total score in comparison to the lecture group (WATSU: 0.3 (IQR 0 - 0.8), lecture: 0.1 (IQR -0.2 - 0.2), p = 0.014). In the KEKS no group differences were seen. In WATSU a significantly stronger improvement of pain (Visual Analogue Pain Scale: WATSU: -15 (IQR -29 to -8), lecture: -4 (IQR -9 - 2), p < 0.001) and of mood (Bf-SR: WATSU: -6 (IQR -14 to -2), lecture: -1 (IQR -5 - 1), p = 0.003) could be observed.

CONCLUSION

This study showed that WATSU immediately increases body awareness and improves pain and mood.

The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial

Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic pain that is unresponsive to conventional treatment. Materials and Methods: This randomized controlled trial included 44 women with endometriosis. They were randomly allocated to either the 'HAMMAM' group (n = 21) or to a control group (n = 23). The primary outcome, pain intensity, was evaluated using numeric rating scales (NRSs). The secondary outcomes were pain interference, pain-related catastrophic thoughts, pressure pain thresholds (PPTs), subjective well-being, functional capacity and QoL, which were evaluated using the brief pain inventory (BPI), the pain catastrophizing scale (PCS), algometry, the subjective well-being scale-20 (EBS-20), the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and the Endometriosis Health Profile-30 Questionnaire (EHP-30), respectively. The primary and secondary outcomes were measured at the baseline and after the intervention. The statistical (between-group analyses of covariance) and clinical effects were analyzed by the intention to treat. Results: The adherence rate was 100.0% and the mean (± standard deviation) satisfaction was 9.71 ± 0.46 out of 10. No remarkable health problems were reported during the trial. The 'HAMMAM' intervention improved dysmenorrhea and dyspareunia after the intervention with large and moderate effect sizes, respectively. Improvements in pain interference during sleep and PPTs in the pelvic region were also observed in women allocated to the 'HAMMAM' group. No effects were observed in catastrophizing thoughts, well-being nor QoL, except for the sleep subscale. Conclusions: A 4-week program of an integral 'HAMMAM' experience combining hydrotherapy and massage in a multisensorial immersive environment is a feasible and effective intervention to alleviate pain during menstruation and sexual intercourse as well as pain interference with sleep in women with endometriosis.

Does dry needling aid in post-training recovery? A critically appraised topic

CLINICAL SCENARIO

Following intense physical training, it is common for athletes to develop muscle soreness, muscle tightness and a sense of fatigue. Minimizing the time spent in this state is advantageous to limit time off from sport, potential injury and lack of mental focus.

CLINICAL QUESTION

Does dry needling aid in post-training recovery in athletes?

SUMMARY OF KEY FINDINGS

A search was performed for articles exploring the effect of dry needling on exercise/training recovery in athletes. Six articles were included in this critically appraised topic. Three articles were randomized controlled trials, one was a cross-over design, one was a case series, and one was a survey. Five of the six studies demonstrated that dry needling had some sort of positive effect on post-training recovery. One article found DN did not improve muscle soreness after a long distance race.

CLINICAL BOTTOM LINE

Based on six studies, DN provides mixed results on a variety of physiological and subjective measures. No adverse effects were reported with the use of DN on athletes following post-training.

STRENGTH OF RECOMMENDATION

In agreement with the Center of Evidence-Based Medicine, the consistent results from three Level II and two Level III intervention studies designate that there is grade D evidence that DN may aid in some post-training recovery variables.

Functional Recovery and Cognitive Improvement in Poststroke Rehabilitation through Integrated Yoga and Naturopathy Intervention

Despite advancements in acute medical management, poststroke rehabilitation (PsR) remains a critical aspect in maximizing recovery and quality of life (QOL) for stroke survivors. In the present case report, poststroke survivor was administered a 90-day tailored integrated yoga and naturopathy (IYN) intervention including daily neutral arm bath, partial massage, and yoga therapy. Following interventions, clinically significant improvement in the range of motion of joints, handgrip strength (Lt. 2.7 kg vs. 14.9 kg), improvement in mid-arm circumference, gait, and cognition (Montreal Cognitive Assessment scores 16 vs. 29) was achieved. In QOL, there was an improvement in each domain of the Short Form 36 questionnaire except for role limitations due to the physical health domain. Improvement in blood pressure (150/60 mmHg vs. 118/70 mmHg) led to a reduction in need of medication. Notably, there was improvement in depression (19 vs. 08), anxiety (18 vs. 08), and stress (21 vs. 07) scores. This case report underscores the potential of IYN intervention in PsR.

Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay

Background

In modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.

Methods

To assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.

Results

Participants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. -0.34 ± 0.31%, p = 0.007).

Conclusion

Our findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.

Optimal dosage ranges of various exercise types for enhancing timed up and go performance in Parkinson's disease patients: a systematic review and Bayesian network meta-analysis

Objective

To examine the dose-response relationship between specific types of exercise for alleviating Timed up and Go (TUG) in Parkinson's disease PD.

Design

Systematic review and Bayesian network meta-analysis.

Data sources

PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 5th, 2024.

Study analysis

Data analysis was conducted using R software with the MBNMA package. Effect sizes of outcome indicators were expressed as mean deviation (MD) and 95% confidence intervals (95% CrI). The risk of bias in the network was evaluated independently by two reviewers using ROB2.

Results

A total of 73 studies involving 3,354 PD patients. The text discusses dose-response relationships in improving TUG performance among PD patients across various exercise types. Notably, Aquatic (AQE), Mix Exercise (Mul_C), Sensory Exercise (SE), and Resistance Training (RT) demonstrate effective dose ranges, with AQE optimal at 1500 METs-min/week (MD: -8.359, 95% CI: -1.398 to -2.648), Mul_C at 1000 METs-min/week (MD: -4.551, 95% CI: -8.083 to -0.946), SE at 1200 METs-min/week (MD: -5.145, 95% CI: -9.643 to -0.472), and RT at 610 METs-min/week (MD: -2.187, 95% CI: -3.161 to -1.278), respectively. However, no effective doses are found for Aerobic Exercise (AE), Balance Gait Training (BGT), Dance, and Treadmill Training (TT). Mind-body exercise (MBE) shows promise with an effective range of 130 to 750 METs-min/week and an optimal dose of 750 METs-min/week (MD: -2.822, 95% CI: -4.604 to -0.996). According to the GRADE system, the included studies' overall quality of the evidence was identified moderate level.

Conclusion

This study identifies specific exercise modalities and dosages that significantly enhance TUG performance in PD patients. AQE emerges as the most effective modality, with an optimal dosage of 1,500 METs-min/week. MBE shows significant benefits at lower dosages, catering to patients with varying exercise capacities. RT exhibits a nuanced "U-shaped" dose-response relationship, suggesting an optimal range balancing efficacy and the risk of overtraining. These findings advocate for tailored exercise programs in PD management, emphasizing personalized prescriptions to maximize outcomes.Systematic Review Registration: International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024506968).

Efficacy of the combination of water aerobics and metacognitive training on psychological and physical health variables and their relationship with SP1 and SP4 biomarkers in people with psychosis: a study protocol

Background

Metacognitive Training (MCT) is widely used and effective in reducing positive symptoms in psychosis. Physical exercise, such as Water Aerobics (WA), improves general health, quality of life and symptoms as a low impact activity that allows social interactions. Preliminary results suggest a relationship between dopamine and psychotic symptoms, through SP transcription factors, SP1 and SP4 biomarkers. The aims of the project are to evaluate the efficacy of a combined intervention (WA and MCT) for psychosis to improve psychotic symptoms, physical health, and transcription levels of SP biomarkers.

Materials and methods

This is a unicentric randomized controlled trial of three parallel intervention groups: MCT, WA and combined intervention. The estimated sample will be 48 patients with a psychotic spectrum disorder diagnosis. The assessment will be performed at baseline and at 2-months' follow-up. Instruments used in the assessment will include clinical, cognitive, metacognitive, social cognitive and psychosocial variables.

Discussion

This will be the first study investigating the impact of the combination of MCT and WA in psychosis. Moreover, it will be the first study analyzing changes in the transcriptional biomarkers SP1 and SP4 after interventions. The results of this study may have clinical implications contributing to the improvement of treatment selection.

Clinical trial registration

https://clinicaltrials.gov/, identifier: NCT05455593.

Hot water immersion is associated with higher thermal comfort than dry passive heating for a similar rise in rectal temperature and plasma interleukin-6 concentration

PURPOSE

To compare the perceptual responses and interleukin-6 (IL-6) concentration following rectal temperature-matched dry heat exposure (DH) and hot water immersion (HWI).

METHODS

Twelve healthy young adults (BMI 23.5 ± 3.6 kg/m2; age: 25.8 ± 5.7 years) underwent 3 trials in randomised order: DH (air temperature 68.9 °C), HWI (water temperature 37.5 °C), and thermoneutral dry exposure (CON, air temperature 27.3 °C). Blood samples to determine IL-6 plasma concentration were collected; basic affect and thermal comfort, rectal and skin temperature (Tskin) were assessed throughout the intervention.

RESULTS

Rectal temperature (Trec) did not differ between DH (end temperature 38.0 ± 0.4 °C) and HWI (37.9 ± 0.2 °C, P = 0.16), but was higher compared with CON (37.0 ± 0.3 °C; P ≤ 0.004). Plasma IL-6 concentration was similar after DH (pre to post: 0.8 ± 0.5 to 1.4 ± 1.5 pg·ml-1) and HWI (0.5 ± 0.2 to 0.9 ± 0.6 pg·ml-1; P = 0.46), but higher compared with CON (0.6 ± 0.5 to 0.6 ± 0.4 pg·ml-1; P = 0.01). At the end of the intervention, basic affect and thermal comfort were most unfavourable during DH (Basic affect; DH: - 0.7 ± 2.9, HWI: 0.8 ± 1.9, CON 1.9 ± 1.9, P ≤ 0.004; Thermal comfort; 2.6 ± 0.8, HWI: 1.4 ± 0.9 and CON: 0.2 ± 0.4; P ≤ 0.004). Mean Tskin was highest for DH, followed by HWI, and lowest for CON (DH: 38.5 ± 1.3 °C, HWI: 36.2 ± 0.5 °C, CON: 31.6 ± 0.7 °C, P < 0.001).

CONCLUSION

The IL-6 response did not differ between DH and HWI when matched for the elevation in Trec. However, thermal comfort was lower during DH compared to HWI, which may be related to the higher Tskin during DH.

Treatment of rheumatic musculoskeletal disorders

Non-medicinal therapies with water, salts, exercise, massage, supportive devices, and electricity have been used for centuries and continue to be of benefit for some people with musculoskeletal disorders. Historical texts refer to the two electuaries mithridatium and theriaca as early therapeutic attempts of man to provide relief of musculoskeletal symptoms and attempt disease cures. For over 200 years, morphine-derived products have been used for musculoskeletal pain. The development of acetyl salicylic acid was a major breakthrough in joint pain management. This was followed by the introduction of nonsteroidal anti-inflammatory agents, paracetamol, and the use of corticosteroids. The gold-based compounds were the initial disease-modifying drugs and have been followed by the highly successful biologics agents. The basic objectives of musculoskeletal pain management include: reduction or elimination of joint pain; improvement or restoration of joint function and mobility; improvement of muscle strength to protect cartilage, ligaments, and joint capsule; prevention and reduction of damage to joint cartilage and supporting structures.

Motor symptoms of Parkinson's disease are affected by temperature: A controlled pilot study

PURPOSE

The motor symptoms (MS) of Parkinson's disease (PD) have been affecting the quality of life in patients. In clinical practice, most patients with PD report that MS are more severe in winter than in summer, and hyperthermic baths (HTB) could temporarily improve MS. The study aimed to evaluate the effects of seasonal variation and aquatic thermal environment of HTB on the MS of PD.

PATIENTS AND METHODS

A cross-sectional study of 203 Chinese Han patients was performed. Univariate and multivariate analyses were performed to analyze seasonal variation in MS relative to baseline data (sex, age at onset, duration, season of birth, Hoehn and Yahr stage, family history, levodopa equivalent dose, and the effect of HTB on MS). Ten subjects participated in the HTB study, and one patient dropped out. The paired Wilcoxon rank test was used to assess the differences in the Movement Disorder Society-United Parkinson's disease Rating Scale (MDS-UPDRS) part III motor examination total scores and the modified Webster Symptoms Score between non-HTB and before HTB and between non-HTB and after HTB.

RESULTS

The improvement of MS after HTB was an independent risk factor for seasonal variation in MS (OR, 25.203; 95% CI, 10.951-58.006; p = .000). Patients with PD had significant improvements in the MDS-UPDRS part III motor examination total scores, especially in bradykinesia (p = .043), rigidity (p = .008), posture (p = .038), and rest tremor amplitude (p = .047).

CONCLUSION

Seasonal variation in temperature and water temperature of HTB may affect MS in some patients with PD. Simple HTB could be recommended as physiotherapy for patients with PD who report temperature-sensitive MS.

Experimental study on dynamic thermal responses and comfortable evaluations under bathing conditions

This study investigated the dynamic thermal responses and comfortable boundaries under different bathing conditions through a series of human subject experiments. Eleven subjects' subjective questionnaires and physiological parameters were collected. During the 40-min 40 °C bath, subjects' whole-body thermal sensation, sweating sensation, and fatigue relieving vote increased from 0 (neutral) to 2.6 (near 'hot' sensation), 3.5 (near 'very sweaty' sensation), and 1.6 (near 'relieved' vote), respectively. Thermal comfort vote firstly increased to 1.5 (near 'comfortable' sensation) in the first 10 min, then decreased to -0.5 (between 'neutral and slightly uncomfortable' sensation), and eventually remained around 1.1 ('slightly comfortable' sensation) after the bath. After the 40-min bath, the skin temperature and core temperature rose by 2.0 °C and 0.9 °C respectively. The mean heart rate increased by 45% and blood pressure decreased in most subjects. The percentage of β brain wave (representing concentration emotion) decreased while that of δ brain wave (representing relaxing emotion) increased, indicating that the bathed subjects tended to be more relaxed and sleeping emotionally. Based on these observations, we inferred that bathing thermal comfort can be influenced by multiple factors simultaneously but effective evaluation tools quantifying bathing thermal comfort are yet to be produced. Compared with showering, bathing usually induces more intensive thermal stress to the body, causing similar changing patterns but stronger amplitudes in subjective and physiological responses. These results can provide references for more comfortable and healthier bathroom environment design and relevant environmental conditioning products.

Impact of different ground-based microgravity models on human sensorimotor system

This review includes current and updated information about various ground-based microgravity models and their impact on the human sensorimotor system. All known models of microgravity are imperfect in a simulation of the physiological effects of microgravity but have their advantages and disadvantages. This review points out that understanding the role of gravity in motion control requires consideration of data from different environments and in various contexts. The compiled information can be helpful to researchers to effectively plan experiments using ground-based models of the effects of space flight, depending on the problem posed.

Thermoregulation and thermal sensation during whole-body water immersion at different water temperatures in healthy individuals: A scoping review

BACKGROUND

Severe thermal discomfort may increase risk of drowning due to hypothermia or hyperthermia from prolonged exposure to noxious water temperatures. The importance of using a behavioral thermoregulation model with thermal sensation may predict the thermal load that the human body receives when exposed to various immersive water conditions. However, there is no thermal sensation "gold standard" model specific for water immersion. This scoping review aims to present a comprehensive overview regarding human physiological and behavioral thermoregulation during whole-body water immersion and explore the feasibility for an accepted defined sensation scale for cold and hot water immersion.

METHODS

A standard literary search was performed on PubMed, Google Scholar, and SCOPUS. The words "Water Immersion," "Thermoregulation," "Cardiovascular responses" were used either as independent searched terms and MeSH terms (Medical Subject Headings) or in combination with other text words. The inclusion criteria for clinical trials terms to thermoregulatory measurements (core or skin temperature), whole-body immersion, 18-60 years old and healthy individuals. The prementioned data were analyzed narratively to achieve the overall study objective.

RESULTS

Twenty-three published articles fulfilled the review inclusion/exclusion criteria (with nine measured behavioral responses). Our outcomes illustrated a homogenous thermal sensation in a variety of water temperatures ranges, that was strongly associated with thermal balance, and observed different thermoregulatory responses. This scoping review highlights the impact of water immersion duration on human thermoneutral zone, thermal comfort zone, and thermal sensation.

CONCLUSION

Our findings enlighten the significance of thermal sensation as a health indicator for establishing a behavioral thermal model applicable for water immersion. This scoping review provides insight for the needed development of subjective thermal model of thermal sensation in relation to human thermal physiology specific to immersive water temperature ranges within and outside the thermal neutral and comfort zone.

Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review

Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline, Scopus, PubMed, Web of Science, and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy-thermal water immersion alone (five studies); 1.b Balneotherapy-thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise-balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise-balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.

Aqua Walking as an Appropriate and Healthy Winter and Summer Physical Practice? An Exploratory Study

(1) Background: Aqua-walking in a natural environment is a health promoting physical activity that is gaining popularity and appropriate for a variety of populations, however, to date, there is little scientific evidence supporting the efficacy and safety of this activity for older adults. The objective was to propose a preliminary exploration of psychometric and metabolic responses to an acute Aqua walking session either during winter or summer in older adults Aqua walking exercisers. (2) Methods: Heart rate, body temperature, glycemia, and blood pressure were monitored in 37 (30 women, 7 men) participants aged 52 to 83 years old in two Aqua walking sessions (water at 13 °C and 18.5 °C, respectively). Anthropometry (body weight, waist, and hip circumferences), body composition, physical activity level, sedentary time, sleep quality, quality of life, physical self-perception, and perceived health and feelings on various parameters were also assessed. (3) Results: Present results revealed a greater quality of life, physical self-perception, and perceived health in aging Aqua walking exercisers compared to those found in the literature in younger populations. None of the metabolic or psychometric measurements were found to be different between classically calibrated Aqua walking sessions performed in winter compared to summer. By contrast, there was a time effect during the sessions for body temperature (p < 0.001), SBP (p = 0.17), perceived mental and physical well-being (p = 0.006 and p < 0.001, respectively), and anxiety (p < 0.001). Leg discomfort also showed a time effect (p = 0.0009) and interaction effect (p = 0.025). (4) Conclusion: Aqua walking appears here to be an accessible practice that can be performed all year long with a range of physical and mental benefits for older adults. Future studies should investigate the metabolic responses of Aqua walking in different populations.

The therapeutic effect of Värska mud and Värska mineral water baths on the overuse pain and muscle tension syndromes in the working age population

The effects of bath therapy are complex and result from a unique interaction between the aquatic environment and the human body functions. The effect of bath therapy depends on both water temperature and chemical additives (mineral substances and humic substances). Värska Resort Centre, in south-eastern Estonia, uses for the balneotherapy the local curative mud and mineral water. The aim of the study was to evaluate and compare the effects of Värska's local mud bath and mineral water bath on moderate musculoskeletal pains in working-age people. The study involved 64 working-age subjects: within two weeks, 32 of them received five general mineral water baths, and another 32 received five general curative mud baths. Pain was assessed with the Nordic Musculosceletal Questionnaire, and muscle tension was measured with a myotonometer in m. erector spinae and m. trapezius. Measurements were performed three times: before the start of the study, immediately after the last procedure, and 2-3 weeks after the last procedure. Both the Värska curative mud bath and the Värska mineral water bath showed a positive effect on musculoskeletal pain and muscle tension. Both procedures can be recommended as drug-free interventions for mild to moderate musculoskeletal pain syndrome and muscle tensions, in both prevention and treatment.

Impact of Hydrotherapy on Antioxidant Enzyme Activity in an Elderly Population

Oxidative stress is defined as the imbalance between reactive species and antioxidant agents. One of the effects of oxidative stress is the normal process of cellular aging that stems from the accumulation of tissue damage. Epidemiological studies show that regular physical exercise prevents the injuries caused by aging. The objective was to evaluate whether the practice of hydrotherapy, in an elderly population, positively influenced the activity of the enzymes superoxide dismutase, glutathione peroxidase and reductase that act by reducing reactive species in the body. The study involved 37 participants aged ≥ 60 years, of both sexes, divided into experimental and control groups. The experimental group performed 15 hydrotherapy sessions. Enzyme activity was evaluated in two moments: T0-before the first session, and T1-after the last session, with blood collections conducted in both. In T1, there was a significant increase vs. T0 of glutathione peroxidase activity (57.72 ± 19.99 vs. 48.14 ± 17.22 U/g Hb) and glutathione reductase activity (100.18 ± 30.85 vs. 78.44 ± 21.26 U/L). Both sexes tended to show higher values at T1. We concluded that hydrotherapy proved to be a positive stimulus for the enzymatic antioxidant activity of the elderly, suggesting that a regular and moderate practice of physical exercise induces better and higher quality of life.

Health management of patients with COVID-19: is there a room for hydrotherapeutic approaches?

With highly variable types of coronavirus disease 2019 (COVID-19) symptoms in both severity and duration, there is today an important need for early, individualized, and multidisciplinary strategies of rehabilitation. Some patients present persistent affections of the respiratory function, digestive system, cardiovascular function, locomotor system, mental health, sleep, nervous system, immune system, taste, smell, metabolism, inflammation, and skin. In this context, we highlight here that hydrothermal centers should be considered today as medically and economically relevant alternatives to face the urgent need for interventions among COVID-19 patients. We raise the potential benefits of hydrotherapy programs already existing which combine alternative medicine with respiratory care, physical activity, nutritional advice, psychological support, and physiotherapy, in relaxing environments and under medical supervision. Beyond the virtues of thermal waters, many studies reported medical benefits of natural mineral waters through compressing, buoyancy, resistance, temperature changes, hydrostatic pressure, inhalations, or drinking. Thermal institutions might offer individualized follow-up helping to unclog hospitals while ensuring the continuity of health care for the different clinical manifestations of COVID-19 in both post-acute and chronic COVID-19 patients. Our present review underlines the need to further explore the medical effectiveness, clinical and territorial feasibility, and medico-economic impacts of the implementation of post-COVID-19 patient management in hydrotherapeutic establishments.

Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial

Background: Gout arthritis is an autoinflammatory arthritis that generates chronic long-term pain. Pain impacts physical activities, joint mobility, stress, anxiety, depression, and quality of life. Cold-water immersion therapy reduces inflammation and pain associated with gout arthritis. However, cold-water immersion therapy has not been conducted among people worldwide with gout arthritis. Objective: To investigate the cold-water immersion intervention on pain, joint mobility, physical activity, stress, anxiety, depression, and quality of life among acute gout patients. Methods: A community-based randomized control trial design with two parallel-intervention groups: a cold-water immersion group (20–30°C 20 minutes/day for 4 weeks) and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were recruited using a multi-stage sampling method and were randomly assigned using block randomization. A generalized estimating equation model was used to analyze the results (coef. β) and produce 95% confidence intervals (CIs). A path analysis was used to analyze mediating effects. Results: Significant pain alleviation ( β = −2.06; −2.42), improved joint mobility ( β = 1.20, 1.44), physical activity ( β = 2.05, .59), stress ( β = −1.25; −1.35), anxiety ( β = −.62; −1.37), and quality of life ( β = 5.34; 9.93) were detected after cold-water immersion at the second-week, and were maintained to the fourth-week time point, compared to pre-intervention and the control group. Depression ( β = −1.80) had decreased by the fourth week compared to the pre-test and control group. Cold-water immersion directly mediated alleviation of pain ( β = −.46, p ≤ .001) and to promote the quality of life ( β = .16, p = .01). Conclusions: Cold-water immersion decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. It mediated alleviation of pain to increase the quality of life.

The importance of body core temperature evaluation in balneotherapy

It is not wrong to say that there are no application standards or best practices in balneotherapy considering traditional applications. There is not enough information about how changes in body temperature, duration, and frequency of exposure to heat affect therapeutic outcomes of balneotherapeutic applications. Body core temperature (BCT) is probably the best parameter for expressing the heat load of the body and can be used to describe the causal relationship between heat exposure and its effects. There are several reasons to take BCT changes into account; for example, it can be used for individualized treatment planning, defining the consequences of thermal effects, developing disease-specific approaches, avoiding adverse effects, and designing clinical trials. The reasons why BCT changes should be considered instead of conventional measures will be discussed while explaining the effects of balneotherapy in this article, along with a discussion of BCT measurement in balneotherapy practice.

[Speciality of restoring the psychophysiological parameters of laboratory rats with the help of balneological procedures during the periods of equinox]

Currently methods development for restoring physiological functions and increasing the adaptive capabilities of the body after prolonged stress exposure of various genesis is an urgent problem in the field of balneology and physiotherapy. It is known that the adaptive potential of the organism is not the same in different seasons of the year. In this regard, it becomes necessary to take into account the seasonality factor when carrying out recreational activities.

PURPOSE OF THE STUDY

To perform a comparative study of balneotherapeutic procedures effectiveness in the form of water and antler baths in relation to the restoration of the psychophysiological parameters of laboratory rats after a consistent stressful effect of light desynchronosis and physical activity to a state of complete fatigue during autumn and spring equinoxes.

MATERIAL AND METHODS

The experiment was carried out during the periods of the spring and autumn equinoxes on 160 male Wistar rats weighing 220-250 g. In each season, the animals were divided into 8 groups of 10 individuals. Two groups were in natural lighting conditions. Animals of the 1st group (intact) were not exposed to experimental influences; rats of the 2nd group were exposed to physical activity in the form of a swimming test until complete fatigue for 5 days in a row in the morning; animals of groups 3-8 were exposed to stress loads in the form of 10-day light desynchronosis (light or dark deprivation) followed by physical activity. In the 4-th, 5-th, 7-th and 8-th groups, post-experimental post-stress recovery programs were carried out using water baths (groups 4 and 7) and baths with drug «Pantovanna» (groups 5 and 8). After the completion of exposures, the animals were tested in the «open field» according to the standard method. The level of corticosterone in the blood serum was determined by ELISA.

RESULTS

It was found that in laboratory rats sensitivity to stressful influences - light desynchronosis followed by physical activity to the point of fatigue, as well as active post-stress recovery were determined by the nature of desynchronosis and the season of the year. The stress load was accompanied by a phase of exhaustion during the spring equinox and by a phase of anxiety during the autumn equinox. In the spring, antler baths as a procedure for active post-stress recovery were ineffective; in autumn, they had a normalizing effect on the level of corticosterone and behavior only after dark deprivation.

CONCLUSION

The conducted experiment indicates the need to take into account the season of the year and the direction of the transmeridian flight to sanatorium-and-spa treatment with balneotherapy procedures. Using the example of equinoxes under experimental conditions on laboratory rats, it has been shown that balneological procedures will more effectively perform rehabilitative functions when the light phase of the day expands as a result of such a shift, but not the dark one.

Identifying Frailty in Thermal/Spa Clinical Setting: A Cross-Sectional Study

Background

No investigation has assessed frailty in the clinical setting of thermal/spa facilities, which often receive older patients with osteo-articular and musculoskeletal conditions.

Objective

To examine the prevalence of frailty in older adults receiving thermal/spa treatment and to gather preliminary evidence about the feasibility of integrating geriatric assessments, including frailty, in the routine clinical consultations in spa facilities.

Methods

Mixed design, with a quantitative cross-sectional investigation performed among 197 volunteer patients (mean age 73.2 ± 6.4 years-old; 82.2% women) of seven French thermal/spa facilities and a qualitative investigation (semi-structured interviews) with the nine physicians working in the participating facilities. Frailty was defined according to a modified Fried frailty phenotype based on six self-reported criteria (including mobility impairment, nutritional status, and fatigue): individuals meeting ≥3 criteria were considered frail; 1-2 criteria, pre-frail; no criterion, robust. Interviews with the participating physicians on the feasibility of integrating geriatric assessments in routine clinical consultations at spa facilities were recorded and their content, analyzed.

Results

Frailty was detected in 112 individuals (56.9%), 26 (13.2%) were considered prefrail, and 59 (29.9%), robust. Regarding the interviews, three physicians indicated the geriatric assessments could be integrated in the routine spa consultations; two, in the consultations of specific/targeted patients, but not in routine; two, only in the context of health education; two, in the context of research protocols. The content of interviews highlighted geriatric assessments provided a better overview of the health/clinical status of the patients.

Conclusion

Frailty is very prevalent in older patients of spa facilities. Such facilities may constitute an interesting clinical setting for screening for frailty through the implementation of geriatric assessments.

Clinical efficacy of medical hydrology: an umbrella review

The aim of this research was to summarize available scientific evidence on the efficacy of medical hydrology for the management of any health condition. The search was conducted on 26th March 2021, in the following databases: Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, and Google Scholar. All relevant literature reviews investigating the clinical efficacy of interventions characterized by the use of natural mineral waters and muds were included. The quality of studies was assessed with the "AMSTAR 2" tool. After article screening, 49 reviews were included in this work. Overall, retrieved scientific evidence suggests that spa therapy is beneficial for patients affected by some specific musculoskeletal conditions, with improvements potentially lasting up to 9 months. Moreover, balneotherapy can be an integrative support for the management of chronic venous insufficiency and some inflammatory skin diseases like psoriasis. The role of spa therapy in rehabilitation appears relevant as well. More limited, although interesting evidence exists for inhalation and hydropinic therapies. Globally, retrieved evidence suggests that, besides individual wellbeing, medical hydrology can be useful for public health. In particular, higher-quality studies seem to support the integrative use of spa-related interventions for conditions like osteoarthritis, fibromyalgia, low back pain of rheumatic origin, and chronic venous insufficiency. However, the body of evidence has some limitations and further clinical trials should be designed for each relevant application to consolidate and expand acquired knowledge.

Water intake meets the Water from inside the human body – physiological, cultural, and health perspectives - Synthetic and Systematic literature review

Background. The average adult human body of 70 kilograms consists in about 67.85% water distributed evenly to an average of 70 % in all major organs of the body: skin, muscles, brain, spinal cord, liver, heart, lungs, spleen, kidneys, pancreas and gastro-intestinal tract. A smaller percentage is found in the bones (30%), teeth (5%) and fat tissue (50%). Objective. This review article attempts to present different perspectives on the physiological properties of water in the human body. We describe from the ancient Chinese medicine theory about water being one of the 5 elements of nature and its harmonious interrelation with the other elements in order to balance the human body, to the successful experiments of researchers which demonstrated waters’ capability to change its molecular structure based on feelings, intentions and energy it was exposed to. We briefly describe the role of water for the human body and what effects can the lack of it have, especially dehydration with all the phases of severity. Also, we present the health benefits of drinking water and which type of water is best to consume. We shorty review the different types of natural mineral waters in Romania and the importance of the Romanian researches for balneology and how the waters cand be administrated in crenotherapy for different types of pathologies. Methods. To elaborate our systematic review, we have searched for relevant open access articles and review articles in ISI Web of Science, published from January 2017 until August 2021. The terms used were water AND health in the title. Articles were excluded in the second phase if they did not reach the relevance citation criterion. The eligible articles were analyzed in detail regarding water importance for human health. Results. Our search identified, first, 548 articles. After applying a PEDro like selection filter and, we selected 93 articles with a minimum of 8 points on our PEDro like filtering scale (good, very good, and excellent articles with a minimum of 5 citations per year). Detailed analysis of the 93 selected articles has conducted us to the elimination of 33 of them as being on a different subject than that of our article. To the 60 full articles retained for this systematic and synthetic article, we have added 10 articles found through a separate Google search, as being considered of high relevance for our subject and necessary to be included. Conclusions. Water is essential for the entire planet and also indispensable for the survival of the human body. Keywords: water intake, water balance, body water, water molecular structure, dehydration, crenotherapy

Monitoring Dysfunction after Stroke Sequelae in Patients undergoing Hydro-/ Thermo-/ Kinesio-Therapy

Stroke is an important health problem generating a set of musculoskeletal and cognitive consequences that significantly affect the patient’s clinical-functional status and quality of life, as well as the effectiveness of the recovery treatment. Hydro-/ thermo-/ kinesio-therapy with water from Lake Techirghiol, known for its special properties, is also used for patients with neurological disorders and consists in immersing the patient in the therapeutic pool with specific exercises under the strict supervision of specialized medical staff. The aim of this study is to analyze the effects of Lake Techirghiol water on the functional deficit in patients with post-stroke sequelae. In this sense, 200 patients who were hospitalized in the Balneal Rehabilitation Sanatorium of Techirghiol, Constanta County, Romania during 2018-2020 were included in the study and they were divided into two groups: patients from group 1 performed on a daily basis, for 12 days, hydro-/ thermo-/ kinesiotherapy and other physical-kinetic procedures, and the patients from group 2 performed on a daily basis, for 12 days, only physical-kinetic procedures, without hydro-/ thermo-/ kinesio-therapy. Patients’ assessment was made based on the Functional Independence Measure scale and a better evolution was observed in the patients who performed hydro-/ thermo-/ kinesio-therapy as compared to those who did not perform this procedure, in the sense of a diminution of the functional deficit by making self-service activities easier and by improving gait disorders and transfers. We consider appropriate that we extend the period of patients’ treatment and follow-up in our next research so as to highlight, if relevant, any notable changes in terms of increasing functional independence also in the case of patients undergoing land-based kinesiotherapy.

Physiological and Biochemical Evaluation of Different Types of Recovery in National Level Paralympic Powerlifting

Background: Recovery from training is vital as it ensures training and performance to continue at high intensities and longer durations to stimulate the body and cause further adaptations. Objective: To evaluate different methods of post-workout recovery in Paralympic powerlifting athletes. Methods: Twelve male athletes participated (25.4 ± 3.3 years; 70.3 ± 12.1 kg). The presence of muscle edema, pain threshold, plasma cytokines, and performance measurement were evaluated five times. The recovery methods used in this study were passive recovery (PR), dry needling (DN), and cold-water immersion (CWI). Results: The data analysis showed that the maximal force decreased compared to the pretest value at 15 min and 2 h. The results also revealed that CWI and DN increased Interleukin 2 (IL-2) levels from 24 to 48 h more than that from 2 h to 24 h. After DN, muscle thickness did not increase significantly in any of the muscles, and after 2 h, muscle thickness decreased significantly again in the major pectoralis muscle. After CWI, pain pressure stabilized after 15 min and increased significantly again after 2 h for acromial pectoralis. Conclusion: The strength training sessions generate several changes in metabolism and different recovery methods contribute differently to maintain homeostasis in Paralympic powerlifting athletes.

Effects of 12 sessions of steam bath intervention on spirometry parameters among healthy adult volunteers

OBJECTIVES

Steam bath is extensively used around the world. However, its physiological influence is not understood in detail. Objective of the current study is to examine the effects of 12 sessions of steam bath on spirometric parameters among healthy participants.

METHODS

Forty healthy adult volunteers of both sex (14 male and 26 female) aged 26.38 ± 8 years participated in the study. A steam bath session (10-15 min) was given once a week for 12 weeks. The spirometric parameters [forced expiratory volume in the 1st second (FEV1, L), forced vital capacity (FVC, L), FEV1/FVC ratio (absolute value), maximal mid-expiratory flow (MMEF, L/s) and peak expiratory flow (PEF, L/s)] were measured by Helios 401 spirometer.

RESULTS

Compared to baseline, post-intervention spirometric parameters showed significant (p<0.05) improvement in the FVC (82.40 ± 11.24 to 96.91 ± 18.76), FEV1 (86.13 ± 14.39 to 91.17 ± 12.48), FEV1/FVC ratio (86.96 ± 3.64 to 93.75 ± 4.80), MMEF 25-75% (86.96 ± 3.64 to 94.16 ± 11.57), peak expiratory flow rate (79.82 ± 14.90 to 92.18 ± 18.96).

CONCLUSIONS

Taking steam bath improves the spirometric parameters of healthy adult participants. However, future randomized controlled trials with on a large scale have to done to validate our findings.

Comparison of effect of aquatic interventions on cardiac modulation of obese young males in motion. A crossover trial

Study aim: The study aimed to compare the effects of passive Watsu therapy and immersion on cardiac locomotor synchronization of obese young males.

Material and methods: Twenty-six volunteer obese males participated in this study (age 18.3 ± 0.32, BMI 36.9 ± 6.52). Heart rate variability parameters were recorded in different positions by the Polar H7 heart rate sensor and HRV+ software. Participants were assigned to two groups, randomly, in a single-blinded crossover design. Kubios HRV 2.2 and MATLAB were used to analyze the bio-signals. Statistical analysis was performed via t-test and ANOVA (analysis of variance) using SPSS. For the significance in results and group comparison, the paired t-test and the independent t-test were used respectively.

Results: Combined results indicated that Watsu therapy increased 3 HRV vertical position parameters and immersion increased 3 HRV non-locomotor parameters, significantly (p < 0.05).

Conclusion: The findings show that Watsu and immersion improved the specific autonomic cardiac modulation. However, non-contact immersion seemed to provide better synchronization of cardiac control and locomotion. The close contact Watsu approach provided improvements in autonomic cardiac regulation. Collectively, these improvements suggest the combination of both therapies in maximizing the cardiac benefits sought by aquatic therapy programs.

Natural Odor Inhalers (AromaStick®) Outperform Red Bull® for Enhancing Cognitive Vigilance: Results From a Four-Armed, Randomized Controlled Study

Two recent publications demonstrated that specifically designed essential odor inhalers can enhance performance through (a) better selective attention and scanning speed and (b) physiological changes of increased heart rate variability and blood oxygenation. In this study, we compared two natural odor inhalers with a popular energy drink (Red Bull®) with regard to their ability to improve vigilance on a computerized attention test. We employed a four-armed, randomized controlled experimental design and used a modified version of the CompACT-Vi test module to investigate whether deep inhalations of essential oil scents improved vigilance. Both inhalers markedly improved the number of correctly identified targets and participants' reaction time when compared to a control condition and consumption of Red Bull® (0.9 < d < 1.3). Additionally, the number of correctly solved mathematical sums during the second half of the vigilance test was substantially higher (d = 1.3) with the use of inhalers than for the control and Red Bull participants. Inhaler use was also associated with relatively increased heart rate variability (d = 1.0) as a mechanism of adapting to the experimental demands. Thus, short and deep inhalations of essential oil scents delivered directly to the nose improved vigilance, while a popular energy drink failed to show an effect beyond that of a control group receiving no stimulant.

Head-Out Water-Based Protocols to Assess Cardiorespiratory Fitness-Systematic Review

The aquatic environment offers cardiorespiratory training and testing options particularly for individuals unable to adequately train or test on land because of weight bearing, pain or disability concerns. No systematic review exists describing cardiorespiratory fitness protocols used in an aquatic environment. This review investigated the different head-out water-based protocols used to assess cardiorespiratory fitness. Our comprehensive, systematic review included 41 studies with each included paper methodological quality assessed using the statistical review of general papers checklist. Diverse protocols arose with three major categories identified: conducted in shallow water, deep water, and using special equipment. Thirty-seven articles presented data for peak/maximal oxygen consumption (VO_2peak/VO_2max). Twenty-eight of 37 studies predefined criteria for reaching a valid VO_2peak/VO_2max with shallow water exercise demonstrating 20.6 to 57.2 mL/kg/min; deep water running 20.32 to 48.4 mL/kg/min; and underwater treadmill and cycling 28.64 to 62.2 mL/kg/min. No single, accepted head-out water-based protocol for evaluating cardiorespiratory fitness arose. For clinical use three cardiorespiratory fitness testing concepts ensued: water temperature of 28–30 °C with difference of maximum 1 °C between testing participants and/or testing sessions; water depth adapted for participant aquatic experiences and abilities; and intensity increment of 10–15 metronome beats per minute.

A Qualitative Study of Patients' Beliefs and Perception on Medicinal Properties of Natural Hot Spring Bath for Musculoskeletal Problems

Natural therapy modalities such as thermal therapy and balneotherapy are commonly being practiced for the management of chronic aches and pain all over the world. Nepal has many such natural hot water springs among which few are famous for therapeutic purposes. Thousands of people with some musculoskeletal problem visit those places in the hope of getting rid of their problems. This study aimed to understand their belief in such therapies, expectations, and satisfaction after treatment along with their knowledge of the safety of hot spring water bath. Among 126 participants interviewed, 31% had inflammatory arthritis, followed by degenerative disorders in 29.4% and soft-tissue rheumatism in 12.7%. Around three-quarters believed that hot spring water has natural healing power and thus can improve their pain. Many even believed that water in natural springs is devoid of any chemicals. So, it is a safe treatment option. Regarding the expectation of cure, they had mixed opinions. Naïve participants hoped they might find a permanent cure in thermal baths. However, repeated visitors said that the effect usually lasted for a few months and they have to visit there regularly. Almost two-thirds of people thought that such natural treatment does not have any side effects. Few stated that they had faced certain problems after the treatment. The water tested from the study site showed that it contained a higher amount of chlorine and sulfate in comparison to other hot water springs in Nepal. The minerals present in water might be a cause of temporary relief of pain. Also, outbreaks of infection from common spring baths have to be considered as such cases have been reported in the past. In conclusion, the medicinal benefits of such natural hot water springs have to be studied further and awareness regarding safety should be given to the people seeking treatment.

Changes in Muscle Contractile Properties after Cold- or Warm-Water Immersion Using Tensiomyography: A Cross-Over Randomised Trial

Muscle contractile properties in clinical practice are often measured using either subjective scales or high-cost, inaccessible equipment. In this randomised cross-over study, we aimed to explore the use of tensiomyography (TMG) to assess changes in muscle contractile properties after cold- and warm-water immersion. The muscle contractile properties of the biceps femoris (BF) were assessed using TMG in 12 healthy active men (mean age 23 ± 3 years, Body Mass Index 22.9 ± 1.3 kg/m²) before and after a 20-min warm- or cold-water immersion over a period of 40 min. Muscle displacement (Dm) and contraction time (Tc) were registered as the main variables of the study. There was a significant condition by time interaction for Dm (p < 0.01). Post hoc analysis showed that, compared to the baseline, there was an increase in Dm 40 min after warm-water immersion (p < 0.01) and a decrease at 10 min after cold-water immersion (p < 0.01). No significant effect was found for Tc. Our results indicate that muscle contractile properties are affected by water temperature and time after the immersion; therefore, these factors should be taken into account when water-immersion is used as a recovery strategy.

Mathematical estimation of fluid concentration in human skin during water immersion

Introduction

The concentration of fluid and its analysis in human skin is innately a challenge due to its continuous movement and involvement in maximum life processes. The concentration of the fluid gets affected by the diffusion of fluids through the skin, which acts as the main barrier between the human body and the external environment. Therefore, it becomes imperative to study the process and impact of the diffusion of fluids through the skin. The problem becomes more interesting when the human body is immersed in water.

Objectives

The present paper studies the change in the fluid distribution of human skin during its immersion in water of different temperatures. The application part of the paper visualizes various impaired vascular function and muscle soreness by water immersion during the physiotherapy treatment.

Methods

A mathematical model based on the two-dimensional diffusion equation, along with appropriate boundary conditions, has been formulated. The maximum of the relevant parameters, such as fluid regulation, transfer coefficient, evaporation rate, etc., influencing the fluid distribution, have been incorporated. The model has been solved by variational finite element method, and numerical results have been obtained by the Crank-Nicholson scheme.

Results

The increase in fluid concentration due to treatment with cold and acute hot water immersion has been noted, and the role of water immersion in enhancing the recovery in exercise-induced muscular damage has been analyzed.

Conclusions

The paper addressed the issue of rate of water diffusion through human skin, which otherwise couldn't be drawn from the analogy of gas diffusion through the membrane due to the variation in permeabilities of the two processes. The paper has applications in water immersion therapies and other activities like monitoring swimming induced pulmonary edema, etc.

Safety and efficacy of Chinese herbal bath for psoriasis vulgaris: A protocol for systematic review and meta-analysis

BACKGROUND

Psoriasis is a common, chronic, and recurrent skin inflammatory disease, with psoriasis vulgaris considered as the most prevalent type of psoriasis. Chinese herbal bath, a type of traditional Chinese medicine, is an external therapy widely used to treat psoriasis vulgaris in China, and it has achieved satisfactory clinical effects. However, there are few studies evaluating the safety and efficacy of Chinese herbal bath compared with other external therapies administered under similar conditions. The purpose of this study is to comprehensively evaluate the clinical safety and efficacy of Chinese herbal bath in the treatment of psoriasis vulgaris through a systematic evaluation of the literature, so as to provide a reference basis for future clinical applications.

METHODS

PubMed, Embase, CENTRAL, the Web of Science, the China Biology Medicine Database (CBM), the China National Knowledge Database (CNKI), the Wan Fang Database, and the Chong Qing VIP Database will be searched to collect randomized controlled trials of Chinese herbal bath used to treat psoriasis vulgaris. The search time limits will be from the establishment of the database to December 2019. Two researchers will independently screen the studies, extract data, and evaluate the risk of bias of the studies. Meta-analysis will be carried out with the RevMan5.3 software. The mean difference will be used as the effect index for the measurement data, and the odds ratio will be used as the effect index for the enumeration data. The 95% confidence interval will be provided for each effect. Heterogeneity among the results of each study will be evaluated by the Chi-square test.

RESULTS

This study will comprehensively evaluate the clinical safety and efficacy of Chinese herbal bath in the treatment of psoriasis vulgaris, so as to provide a reference basis for future clinical applications.

CONCLUSION

This study will provide a theoretical basis for the standardized administration of Chinese herbal bath. OSF REGISTRATION NUMBER:: doi: 10.17605/OSF.IO/4HRPJ.

Microwave Hydrodiffusion and Gravity (MHG) Extraction from Different Raw Materials with Cosmetic Applications

Microwave hydrodiffusion and gravity (MHG) and ethanolic solid-liquid extraction were compared using selected plant sources. Their bioactive profile, color features, and proximate chemical characterization were determined. MHG extracts, commercial antioxidants, and three distinct types of thermal spring water were used in a sunscreen cream formulation. Their bioactive capacity, chemical and rheological properties were evaluated. MHG Cytisus scoparius flower extract provided the highest bioactive properties. Pleurotus ostreatus MHG liquor exhibited the highest total solid extraction yield. The Brassica rapa MHG sample stood out for its total protein content and its monosaccharide and oligosaccharide concentration. Quercus robur acorns divided into quarters supplied MHG extract with the lowest energy requirements, highest DPPH inhibition percentage, total lipid content and the highest enzyme inhibition. The chemical and bioactive capacities stability of the sunscreen creams elaborated with the selected MHG extracts and the thermal spring waters showed a similar behavior than the samples containing commercial antioxidants.

Essential oil inhaler (AromaStick®) improves heat tolerance in the Hot Immersion Test (HIT). Results from two randomized, controlled experiments

BACKGROUND

A recent review article on an aromatherapeutic inhaler demonstrated clinical effects on a number of bodily systems, like the cardiovascular system, the respiratory system, the nervous system and the endocrine system.

OBJECTIVE

This paper extends these findings and investigates whether specially designed essential oils inhalers are capable to counter experimentally induced stressful heat sensations.

METHOD

Two prospective, randomized, controlled experiments using the Hot Immersion Test Paradigm (HIT) were conducted to investigate whether deep odor inhalations increase heat tolerance.

RESULTS

In both experiments, the inhaler strongly prolonged pain tolerance and increased blood oxygenation (1 < d < 1.3). In the second experiment, the inhaler also increased heart rate variability (d = 1.3) as a mechanism to cope with heat stress.

CONCLUSION

The ability to resist a stressful thermal stimulus can be exogenously improved by short and deep inhalations of essential scents directly delivered to the olfactory system.