BACKGROUND The aim of this pragmatic study was to explore the intervention of acupuncture combined with hydrotherapy and perceived effects in type 2 diabetic patients with recently diagnosed, mild, lower-extremity arterial disease (LEAD) in comparison with a control group. MATERIAL AND METHODS One hundred twenty-six diabetes patients who were diagnosed mild LEAD according to ankle-brachial blood pressure index (ABPI) and peripheral neuropathy symptom were randomly assigned to either an experimental (n=64) or control group (n=62). The experimental group attended and completed (1) a 30-min session of acupuncture in certain selected points, and (2) a 30-min hydrotherapy exercise every 2 days for 15 weeks. The outcome parameters were assessed at baseline, after intervention, and at 6-week follow-up. RESULTS The intervention was associated with an improvement in leg flow conductance and partial physical capacities, including chair-sit-and-reach, the walking impairment questionnaire (WIQ), and physical component summary score (PCS), compared to the control group. The treatment benefits were sustained throughout the 6-week follow-up endpoint. There was no difference in fasting glucose levels, Hb1Ac, blood pressure, or BMI after the intervention. At the endpoint of 6-week follow-up, acupuncture plus hydrotherapy appeared to reduce inflammatory response by decreasing IL-6, TNF-α, malondialdehyde, and SOD, and increasing glutathione. CONCLUSIONS Acupuncture plus hydrotherapy, without significant glycemic-controlling effects in the type 2 diabetic patients with mild LEAD, exerts a measurable benefit in disease-specific physical functions and health-related quality of life.Our results suggest that the combined therapy regulates the inflammatory process and oxidative stress and contributes to immune protection.

Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of"thermal exercise"may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people. To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 degrees C, 2-3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months. The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.

The red cell glutathione levels of 10 healthy volunteers who are accustomed to winter-swimming were measured before and after this short-term whole body exposition to hypothermic environment. From the increases of the erythrocytic level of oxidized glutathione (GSSG) and of GSSG: total glutathione ratio an extensive formation of oxygen free radicals during and following the exposition to the intensive cold stimulus was concluded. That is in accordance with the finding on the drastic decrease of the concentration of uric acid as an important radical scavenger of the human blood plasma. Furthermore, the initial erythrocytic concentrations of reduced glutathione (GSH) and GSSG of subjects accustomed to winter-swimming were compared with those of healthy control persons who are not accustomed to regular winter-swimming. The markedly increased concentration of GSH and the reduced GSSG:total glutathione ratio in the erythrocytes of winter-swimmers reflect the adaptation to a regular oxidative stress. This antioxidative adaptation is postulated as a new basic mechanism of the hardening by exposition to an intensive short-term cold stimulus often applied within the hydrotherapy.

AIMS:The aims of this study were to determine whether yoga and hydrotherapy training had an equal effect on the health-related quality of life in patients with heart failure and to compare the effects on exercise capacity, clinical outcomes, and symptoms of anxiety and depression between and within the two groups.

METHODS:The design was a randomized controlled non-inferiority study. A total of 40 patients, 30% women (mean±SD age 64.9±8.9 years) with heart failure were randomized to an intervention of 12 weeks, either performing yoga or training with hydrotherapy for 45-60 minutes twice a week. Evaluation at baseline and after 12 weeks included self-reported health-related quality of life, a six-minute walk test, asit-to-stand test, clinical variables, and symptoms of anxiety and depression.

RESULTS:Yoga and hydrotherapy had an equal impact on quality of life, exercise capacity, clinical outcomes, and symptoms of anxiety and depression. Within both groups, exercise capacity significantly improved (hydrotherapy p=0.02; yoga p=0.008) and symptoms of anxiety decreased (hydrotherapy p=0.03; yoga p=0.01). Patients in the yoga group significantly improved their health as rated by EQ-VAS ( p=0.004) and disease-specific quality of life in the domains symptom frequency ( p=0.03), self-efficacy ( p=0.01), clinical summary as a combined measure of symptoms and social factors ( p=0.05), and overall summary score ( p=0.04). Symptoms of depression were decreased in this group ( p=0.005). In the hydrotherapy group, lower limb muscle strength improved significantly ( p=0.01).

CONCLUSIONS:Yoga may be an alternative or complementary option to established forms of exercise training such as hydrotherapy for improvement in health-related quality of life and may decrease depressive symptoms in patients with heart failure.

AIMS:The aims of this study were to determine whether yoga and hydrotherapy training had an equal effect on the health-related quality of life in patients with heart failure and to compare the effects on exercise capacity, clinical outcomes, and symptoms of anxiety and depression between and within the two groups.

METHODS:The design was a randomized controlled non-inferiority study. A total of 40 patients, 30% women (mean±SD age 64.9±8.9 years) with heart failure were randomized to an intervention of 12 weeks, either performing yoga or training with hydrotherapy for 45-60 minutes twice a week. Evaluation at baseline and after 12 weeks included self-reported health-related quality of life, a six-minute walk test, asit-to-stand test, clinical variables, and symptoms of anxiety and depression.

RESULTS:Yoga and hydrotherapy had an equal impact on quality of life, exercise capacity, clinical outcomes, and symptoms of anxiety and depression. Within both groups, exercise capacity significantly improved (hydrotherapy p=0.02; yoga p=0.008) and symptoms of anxiety decreased (hydrotherapy p=0.03; yoga p=0.01). Patients in the yoga group significantly improved their health as rated by EQ-VAS ( p=0.004) and disease-specific quality of life in the domains symptom frequency ( p=0.03), self-efficacy ( p=0.01), clinical summary as a combined measure of symptoms and social factors ( p=0.05), and overall summary score ( p=0.04). Symptoms of depression were decreased in this group ( p=0.005). In the hydrotherapy group, lower limb muscle strength improved significantly ( p=0.01).

CONCLUSIONS:Yoga may be an alternative or complementary option to established forms of exercise training such as hydrotherapy for improvement in health-related quality of life and may decrease depressive symptoms in patients with heart failure.

The aim of this study was to investigate whether or not the human immune system can be activated by a noninfectious stimulus, thereby improving the physiological status of the individual. The effect of a single cold water immersion (14 degrees C for 1 h) on the immune system of athletic young men, monitored immediately after immersion, was minimal. With the continuation of the cold water immersions (three times a week for a duration of 6 weeks) a small, but significant, increase in the proportions of monocytes, lymphocytes with expressed IL2 receptors (CD25) and in plasma tumour necrosis factor alpha content was induced. An increase in the plasma concentrations of some acute phase proteins, such as haptoglobin and haemopexin, was also observed. After 6 weeks of repeated immersions a trend towards an increase in the plasma concentrations of IL6 and the amount of total T lymphocytes (CD3), T helper cells (CD4), T suppressor cells (CD8), activated T and B lymphocytes (HLA-DR) and a decrease in the plasma concentration of alpha 1-antitrypsin was observed. Concentrations of IL1 beta, neopterin, C-reactive protein, orosomucoid, ceruloplasmin, macroglobulin, immunoglobulins (IgG, IgM, IgA) and C3, C4 components of the complement, as well as the total number of erythrocytes, leucocytes, granulocytes and neutrophils showed no significant changes after the repeated cold water immersions. It was concluded that the stress-inducing noninfectious stimuli, such as repeated cold water immersions, which increased metabolic rate due to shivering the elevated blood concentrations of catecholamines, activated the immune system to a slight extent. The biological significance of the changes observed remains to be elucidated.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often suffer from exacerbations caused by infections of the bronchial tract. OBJECTIVE: What effects do hydrotherapeutic applications according to Kneipp have on lung function, blood gases, immune system and quality of life of patients with COPD? Patients and Methods: 20 patients with COPD (17 males, 3 females); mean age: 64; forced expiratory volume (FEV1): 62 of 100% (on average); no acute exacerbations, no oral corticosteroids. Measurements were performed (I) at 10 weeks pre-treatment, (II) immediately before therapy (I-II: baseline-period), (III) after 10 weeks treatment with 3 cold affusions and 2 cold washings of the upper part of the body (self-treatment) per week each, (IV) 3 months after completion of the treatment (follow- up). The following parameters were measured: lung function, blood gases, routine lab, experimental lab (interleukines, lymphocytes), maximal expiratory flow (PEF), quality of life and respiratory infections. RESULTS: The pH increased over the course of the study. PEF and the number of lymphocytes significantly increased over the treatment (II-III). Intracellular expression of IL-4 by T lymphocytes decreased. However, the expression of IFN-gamma increased. Frequency of infections was lower during follow-up (IV) than before and during therapy. Quality of life after treatment was estimated to be good in all patients. CONCLUSIONS: Repeated cold stimulations (affusions) can influence the frequency of respiratory infections and improve subjective well-being. It may cause an immunological modulation in terms of the Th1-type pattern.

The objective of this work was to update the rheumatologic indications of spa therapy, based on clinical practice guidelines published by the French National Authority for Health (HAS) and the European League Against Rheumatism (EULAR), and on the results of randomized clinical trials (RCT)

METHODOLOGY: We first examined the indications for which spa therapy is mentioned and/or recommended in HAS and EULAR guidelines. We then identified RCTs in spa therapy and rheumatology by using the key words spa therapy, balneology, balneotherapy, hydrotherapy, mud therapy and mineral water in the Pubmed, Pascal and Embase databases. Only RCTs including a statistical analysis of between-group outcomes were retained We also examined the possible contribution of RCTs not listed in the bibliography of the guidelines.

RESULTS: RECOMMENDATIONS: spa therapy is recommended by HAS for chronic lower back pain, rank B and for stabilized rheumatoid arthritis, rank C. In ankylosing spondylitis, EULAR classifies spa therapy along with physiotherapy, rank A. In fibromyalgia, EULAR recommends hot-water balneology, an important component of spa therapy, rank B, based on five RCTs, of which three were carried out in thermal springs. Nineteen RCTs that comprised a statistical comparison of between-group outcomes were identified Sixteen studies indicated a persistent improvement (at least twelve weeks) in pain, analgesic and non-steroidal antiinflammatory drug consumption, functional capacity and/or quality of life, in the following indications: chronic lower back pain, knee osteoarthritis, hand osteoarthritis, fibromyalgia, ankylosing spondylitis andrheumatoidarthritis (PR).

CONCLUSION: Spa therapy, or hot-water balneology, appears to be indicated for chronic low back pain, stabilized rheumatoid arthritis, ankylosing spondylitis and fibromyalgia. RCT findings suggest that patients with knee and hand osteoarthritis might also benefit.

Beta-endorphin (betaE) is an important reliever of pain. Various stressors and certain modalities of physiotherapy are potent inducers of the release of endogenous betaE to the blood stream. Most forms of exercise also increase blood betaE level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level. Age, gender, and mental activity during exercise also may influence betaE levels. Publications on the potential stimulating effect of manual therapy and massage on betaE release are controversial. Sauna, mud bath, and thermal water increase betaE levels through conveying heat to the tissues. The majority of the techniques for electrical stimulation have a similar effect, which is exerted both centrally and--to a lesser extent--peripherally. However, the parameters of electrotherapy have not yet been standardised. The efficacy of analgesia and the improvement of general well-being do not necessarily correlate with betaE level. Although in addition to blood, increased brain and cerebrospinal fluid betaE levels are also associated with pain, the majority of studies have concerned blood betaE levels. In general, various modalities of physical therapy might influence endorphin levels in the serum or in the cerebrospinal fluid--this is usually manifested by elevation with potential mitigation of pain. However, a causal relationship between the elevation of blood, cerebrospinal fluid or brain betaE levels and the onset of the analgesic action cannot be demonstrated with certainty.

Beta-endorphin (betaE) is an important reliever of pain. Various stressors and certain modalities of physiotherapy are potent inducers of the release of endogenous betaE to the blood stream. Most forms of exercise also increase blood betaE level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level. Age, gender, and mental activity during exercise also may influence betaE levels. Publications on the potential stimulating effect of manual therapy and massage on betaE release are controversial. Sauna, mud bath, and thermal water increase betaE levels through conveying heat to the tissues. The majority of the techniques for electrical stimulation have a similar effect, which is exerted both centrally and--to a lesser extent--peripherally. However, the parameters of electrotherapy have not yet been standardised. The efficacy of analgesia and the improvement of general well-being do not necessarily correlate with betaE level. Although in addition to blood, increased brain and cerebrospinal fluid betaE levels are also associated with pain, the majority of studies have concerned blood betaE levels. In general, various modalities of physical therapy might influence endorphin levels in the serum or in the cerebrospinal fluid--this is usually manifested by elevation with potential mitigation of pain. However, a causal relationship between the elevation of blood, cerebrospinal fluid or brain betaE levels and the onset of the analgesic action cannot be demonstrated with certainty.

Beta-endorphin (betaE) is an important reliever of pain. Various stressors and certain modalities of physiotherapy are potent inducers of the release of endogenous betaE to the blood stream. Most forms of exercise also increase blood betaE level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level. Age, gender, and mental activity during exercise also may influence betaE levels. Publications on the potential stimulating effect of manual therapy and massage on betaE release are controversial. Sauna, mud bath, and thermal water increase betaE levels through conveying heat to the tissues. The majority of the techniques for electrical stimulation have a similar effect, which is exerted both centrally and--to a lesser extent--peripherally. However, the parameters of electrotherapy have not yet been standardised. The efficacy of analgesia and the improvement of general well-being do not necessarily correlate with betaE level. Although in addition to blood, increased brain and cerebrospinal fluid betaE levels are also associated with pain, the majority of studies have concerned blood betaE levels. In general, various modalities of physical therapy might influence endorphin levels in the serum or in the cerebrospinal fluid--this is usually manifested by elevation with potential mitigation of pain. However, a causal relationship between the elevation of blood, cerebrospinal fluid or brain betaE levels and the onset of the analgesic action cannot be demonstrated with certainty.

Ten healthy subjects who swim regularly in ice-cold water during the winter (winter swimming), were evaluated before and after this short-term whole body exposure. A drastic decrease in plasma uric acid concentration was observed during and following the exposure to the cold stimulus. We hypothesize that the uric acid decrease can be caused by its consumption after formation of oxygen radicals. In addition, the erythrocytic level of oxidized glutathione and the ratio of oxidized glutathione/total glutathione also increased following cold exposure, which supports this hypothesis. Furthermore, the baseline concentration of reduced glutathione was increased and the concentration of oxidized glutathione was decreased in the erythrocytes of winter swimmers as compared to those of nonwinter swimmers. This can be viewed as an adaptation to repeated oxidative stress, and is postulated as mechanism for body hardening. Hardening is the exposure to a natural, e.g., thermal stimulus, resulting in an increased tolerance to stress, e.g., diseases. Exposure to repeated intensive short-term cold stimuli is often applied in hydrotherapy, which is used in physical medicine for hardening.