Approximately 30% of the 700,000 US veterans of the 1990-1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (= 32) were randomly assigned to the intervention (= 22) or a four-week waitlist control (= 10). The daily 4-6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran's Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; -0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.

OBJECTIVES: There is little information on lipid metabolism after sauna treatment in the literature. The present research is aimed to determine the influence of sauna baths on fat metabolism in young women. MATERIALS AND METHODS: Twenty healthy, eumenhorreic, female volunteers (19-21 yr old) were exposed to Finnish sauna bath seven times every second day. In group I (n = 10) each time the sauna treatment lasted 30 min, whereas in group II (n = 10) 40 min with 5-minute break to cool down. Body mass, heart rate and blood pressure were measured before and after sauna bath. Rectal temperature was monitored during stay in sauna room. Prior to the sauna bath and during its last two minutes the minute oxygen uptake and the level of CO2 exhalation were analyzed in the exhaled air, and the respiratory quotient RQ was calculated. In the blood samples collected before the sauna bath and immediately afterwards hematocrit, hemoglobin, and lipid profile--total lipids, free fatty acids, total free fatty acids, triacylglycerols, total cholesterol (TC), high density lipids (HDL), low density lipids (LDL) were analyzed. RESULTS: Rectal temperature was lower in the last sauna bath than in the first one. Losses of plasma were greater during the seventh bath than during the first one. Acceleration of the metabolism of lipids occurs after every sauna bath. A reduced level of TC and LDLC and a raised level of HDL was observed after repeated sauna baths. CONCLUSION: After 2 weeks of repeated sauna session some changes in total cholesterol and concentration of LDLC were observed, while concentration of HDLC increased after 7th sauna bath in group I. Those kinds of changes may be good prognoses of ischemic heart disease prevention, but further research on the influence of sauna on fat metabolism is needed.

Sauna therapy has been used to treat a number of different diseases known or thought to have a tetrahydrobiopterin (BH4) deficiency. It has been interpreted to act in multiple chemical sensitivity by increasing chemical detoxification and excretion but there is no evidence that this is its main mode of action. Sauna therapy may act to increase BH4 availability via two distinct pathways. Increased blood flow in heated surface tissues leads to increased vascular shear stress, inducing increased activity of GTP cyclohydrolase I (GTPCH-I) in those vascular tissues which will lead to increasing BH4 synthesis. A second mechanism involves the heat shock protein Hsp90, which is induced by even modest heating of mammalian tissues. Sauna heating of these surface tissues may act via Hsp90, which interacts with the GTPCH-I complex and is reported to produce increased GTPCH-I activity by lowering its degradation. The increased consequent availability of BH4 may lead to lowered nitric oxide synthase uncoupling, such as has been reported for the eNOS enzyme. Increased BH4 synthesis in surface tissues of the body will produce increased circulating BH4 which will feed BH4 to other body tissues that may have been BH4 deficient. Similar mechanisms may act in vigorous exercise due to the increased blood shear stresses and possibly also heating of the exercising tissues and heart. There is a large and rapidly increasing number of diseases that are associated with BH4 depletion and these may be candidates for sauna therapy. Such diseases as hypertension, vascular endothelial dysfunction, multiple chemical sensitivity and heart failure are thought to be helped by sauna therapy and chronic fatigue syndrome and fibromyalgia may also be helped and there are others that may be good candidates for sauna therapy.

A 48-year-old married woman diagnosed with rheumatoid arthritis (RA) in 2007, came to our hospital in July 2014 with the complaint of severe pain and swelling over multiple joints, especially over small joints, which was associated with stiffness (more in morning), deformities of fingers and toes, with disturbed sleep and poor quality of life (QOL) for the past 7 years. She received a combination of electro acupuncture (14 sessions), massage (18 sessions), mud (18 sessions), and sauna (3 sessions) (EMMS) therapies for 30-min, 45-min, 30-min, and 15-min per session, respectively for 3 weeks. During and postintervention assessment showed reduction in visual analog scale score for pain, Depression Anxiety and Stress Scales and the Pittsburgh Sleep Quality Index scores. It also showed an increase in the scores of 10-Meter Walk Test, isometric hand-grip test, and short form-36 version-2 health survey. This result suggest that, the EMMS therapy might be considered as an effective treatments in reducing pain, depression, anxiety, and stress with improvement in physical functions, quality of sleep and QOL in patient with RA. EMMS therapies were tolerated and no side effects were reported by the patient. Though the results are encouraging, further studies are required with larger sample size and advanced inflammatory markers.

A 48-year-old married woman diagnosed with rheumatoid arthritis (RA) in 2007, came to our hospital in July 2014 with the complaint of severe pain and swelling over multiple joints, especially over small joints, which was associated with stiffness (more in morning), deformities of fingers and toes, with disturbed sleep and poor quality of life (QOL) for the past 7 years. She received a combination of electro acupuncture (14 sessions), massage (18 sessions), mud (18 sessions), and sauna (3 sessions) (EMMS) therapies for 30-min, 45-min, 30-min, and 15-min per session, respectively for 3 weeks. During and postintervention assessment showed reduction in visual analog scale score for pain, Depression Anxiety and Stress Scales and the Pittsburgh Sleep Quality Index scores. It also showed an increase in the scores of 10-Meter Walk Test, isometric hand-grip test, and short form-36 version-2 health survey. This result suggest that, the EMMS therapy might be considered as an effective treatments in reducing pain, depression, anxiety, and stress with improvement in physical functions, quality of sleep and QOL in patient with RA. EMMS therapies were tolerated and no side effects were reported by the patient. Though the results are encouraging, further studies are required with larger sample size and advanced inflammatory markers.

During the last few years, sauna has become the epitome of wellness. Besides studies in general medicine evaluating the health benefit of sauna, e.g. on the cardiovascular system, no systematic study regarding skin physiology has been published. The present exploratory study was intended to analyse the effect of regular Finnish sauna on skin physiology. The effect of regular sauna bathing was assessed with non-invasive instruments: stratum corneum water-holding capacity, skin redness, transepidermal water loss and surface skin pH were analysed in 41 healthy volunteers, aged 20-49 years, in a group with regular sauna exposure compared to a control group with no regular sauna exposure. A more stable epidermal barrier function, an increase in stratum corneum hydration, a faster recovery of both elevated water loss and skin pH after exposure to 2 x 15 min sauna at 80 degrees C could be demonstrated in volunteers with regular sauna. Heart beat rate and ionic concentration in sweat as well as epidermal blood perfusion showed a training effect under regular sauna. A decrease in casual skin sebum content on the skin surface of the forehead was observed in these volunteers. The present data suggest a protective effect of regular sauna on skin physiology, especially surface pH and stratum corneum water-holding capacity.

PURPOSE:We investigated the effect of post-exercise sauna bathing on plasma volume (PV) expansion and whether such responses can be tracked by changes in heart rate (HR)-based measures.

METHODS:Seven, well-trained male cyclists were monitored for 35 consecutive days (17 days baseline training, 10 days training plus sauna, 8 days training). Sauna exposure consisted of 30 min (87°C, 11 % relative humidity) immediately following normal training. Capillary blood samples were collected while resting seated to assess PV changes. HR (HRwake) and vagal-related HR variability (natural logarithm of square root mean squared differences of successive R-R intervals, ln rMSSDwake) were assessed daily upon waking. A sub-maximal cycle test (5 min at 125 W) was performed on days 1, 8, 15, 22, 25, 29, and 35 and HR recovery (HRR60s) and ln rMSSDpostex were assessed post-exercise. Effects were examined using magnitude-based inferences.

RESULTS:Compared with baseline, sauna resulted in: (1) peak PV expansion after four exposures with a likely large increase [+17.8 % (90 % confidence limits, 7.4; 29.2)]; (2) reduction of HRwake by a trivial-to-moderate amount [-10.2 % (-15.9; -4.0)]; (3) trivial-to-small changes for ln rMSSDwake [4.3 % (1.9; 6.8)] and ln rMSSDpostex [-2.4 % (-9.1; 4.9)]; and (4) a likely moderate decrease in HRR60s [-15.6 % (-30.9; 3.0)]. Correlations between individual changes in PV and HR measures were all unclear.

CONCLUSIONS:Sauna bathing following normal training largely expanded PV in well-trained cyclists after just four exposures. The utility of HR and HRV indices for tracking changes in PV was uncertain. Future studies will clarify mechanisms and performance benefits of post-training sauna bathing.

PURPOSE:We investigated the effect of post-exercise sauna bathing on plasma volume (PV) expansion and whether such responses can be tracked by changes in heart rate (HR)-based measures.

METHODS:Seven, well-trained male cyclists were monitored for 35 consecutive days (17 days baseline training, 10 days training plus sauna, 8 days training). Sauna exposure consisted of 30 min (87°C, 11 % relative humidity) immediately following normal training. Capillary blood samples were collected while resting seated to assess PV changes. HR (HRwake) and vagal-related HR variability (natural logarithm of square root mean squared differences of successive R-R intervals, ln rMSSDwake) were assessed daily upon waking. A sub-maximal cycle test (5 min at 125 W) was performed on days 1, 8, 15, 22, 25, 29, and 35 and HR recovery (HRR60s) and ln rMSSDpostex were assessed post-exercise. Effects were examined using magnitude-based inferences.

RESULTS:Compared with baseline, sauna resulted in: (1) peak PV expansion after four exposures with a likely large increase [+17.8 % (90 % confidence limits, 7.4; 29.2)]; (2) reduction of HRwake by a trivial-to-moderate amount [-10.2 % (-15.9; -4.0)]; (3) trivial-to-small changes for ln rMSSDwake [4.3 % (1.9; 6.8)] and ln rMSSDpostex [-2.4 % (-9.1; 4.9)]; and (4) a likely moderate decrease in HRR60s [-15.6 % (-30.9; 3.0)]. Correlations between individual changes in PV and HR measures were all unclear.

CONCLUSIONS:Sauna bathing following normal training largely expanded PV in well-trained cyclists after just four exposures. The utility of HR and HRV indices for tracking changes in PV was uncertain. Future studies will clarify mechanisms and performance benefits of post-training sauna bathing.

PURPOSE:This study investigated effects of far-infrared sauna (FIRS) bathing on recovery from strength training and endurance training sessions, but also possible differences between FIRS and traditional (TRAD) Finnish sauna bathing.

METHODS:Ten healthy physically active male volunteers had on various days either a 60 min hypertrophic strength training session (STS) or a 34-40 min maximal endurance training session (ETS), which was following by 30 min bathing in special FIRS sauna at temperature of 35-50°C and humidity of 25-35%. After the sauna, subjects sat for 30 min at room temperature (21°C and 25-30%humidity). In comparison, 30 min of TRAD took place at 35-50°C and in 60-70% humidity. Performance tests included maximal isometric bench press and leg press, counter movement jump (CMJ) and maximal oxygen uptake on a treadmill.

RESULTS:After STS, there were decreases in maximal isometric bench press (p < 0.001), maximal isometric leg press (p < 0.001), CMJ (p < 0.001) and pH (p < 0.001), but increases in heart rate (p < 0.001) and lactate concentration (p < 0.001) as expected. During recovery there were no differences in any variables between FIRS and no sauna bathing (NO SAUNA). Maximal ETS increased oxygen uptake (p < 0.001), heart rate (p < 0.001), lactate concentration (p < 0.001) and decreased pH (p < 0.001) as expected. During recovery at 30 min, CMJ was significantly (p < 0.05) higher (0.34 ± 0.09 m) after FIRS bathing than after sitting with NO SAUNA (0.32 ± 0.0 m). After sauna heart rate was higher (p < 0.05) in TRAD (92 ± 13 beats/min) than in FIRS (71 ± 7 beats/min).

CONCLUSION:In conclusion, deep penetration of infrared heat (approximately 3-4 cm into fat tissue and neuromuscular system) with mild temperature (35-50°C), and light humidity (25-35%) during FIRS bathing appears favorable for the neuromuscular system to recover from maximal endurance performance. FIRS bathing is a very light loading for the body and provides a comfortableand relaxing experience.

PURPOSE:This study investigated effects of far-infrared sauna (FIRS) bathing on recovery from strength training and endurance training sessions, but also possible differences between FIRS and traditional (TRAD) Finnish sauna bathing.

METHODS:Ten healthy physically active male volunteers had on various days either a 60 min hypertrophic strength training session (STS) or a 34-40 min maximal endurance training session (ETS), which was following by 30 min bathing in special FIRS sauna at temperature of 35-50°C and humidity of 25-35%. After the sauna, subjects sat for 30 min at room temperature (21°C and 25-30%humidity). In comparison, 30 min of TRAD took place at 35-50°C and in 60-70% humidity. Performance tests included maximal isometric bench press and leg press, counter movement jump (CMJ) and maximal oxygen uptake on a treadmill.

RESULTS:After STS, there were decreases in maximal isometric bench press (p < 0.001), maximal isometric leg press (p < 0.001), CMJ (p < 0.001) and pH (p < 0.001), but increases in heart rate (p < 0.001) and lactate concentration (p < 0.001) as expected. During recovery there were no differences in any variables between FIRS and no sauna bathing (NO SAUNA). Maximal ETS increased oxygen uptake (p < 0.001), heart rate (p < 0.001), lactate concentration (p < 0.001) and decreased pH (p < 0.001) as expected. During recovery at 30 min, CMJ was significantly (p < 0.05) higher (0.34 ± 0.09 m) after FIRS bathing than after sitting with NO SAUNA (0.32 ± 0.0 m). After sauna heart rate was higher (p < 0.05) in TRAD (92 ± 13 beats/min) than in FIRS (71 ± 7 beats/min).

CONCLUSION:In conclusion, deep penetration of infrared heat (approximately 3-4 cm into fat tissue and neuromuscular system) with mild temperature (35-50°C), and light humidity (25-35%) during FIRS bathing appears favorable for the neuromuscular system to recover from maximal endurance performance. FIRS bathing is a very light loading for the body and provides a comfortableand relaxing experience.

BACKGROUND: The aim of the present study was to determine whether repeated 60 degrees C sauna treatment improves cardiac arrhythmias in chronic heart failure (CHF) patients, because ventricular arrhythmias are an important therapeutic target in CHF. METHODS AND RESULTS: Thirty patients (59+/-3 years) with New York Heart Association functional class II or III CHF and at least 200 premature ventricular contractions (PVCs)/24 h assessed by 24-h Holter recordings were studied. They were randomized into sauna-treated (n=20) or non-treated (n=10) groups. The sauna-treated group underwent a 2-week program of a daily 60 degrees C far infrared-ray dry sauna for 15 min, followed by 30 min bed rest with blankets, for 5 days per week. Patients in the non-treated group had bed rest in a temperature-controlled room (24 degrees C) for 45 min. The total numbers of PVCs/24 h in the sauna-treated group decreased compared with the non-treated group [848+/-415 vs 3,097+/-1,033/24 h, p<0.01]. Heart rate variability (SDNN, standard deviation of normal-to-normal beat interval) increased [142+/-10 (n=16) vs 112+/-11 ms (n=8), p<0.05] and plasma brain natriuretic peptide concentrations decreased [229+/-54 vs 419+/-110 pg/ml, p<0.05] in the sauna-treated group compared with the non-treated group. CONCLUSION: Repeated sauna treatment improves ventricular arrhythmias in patients with CHF.

OBJECTIVE:Chronic fatigue syndrome (CFS) is a disabling condition of unknown etiology, and no definitive therapy has been identified to date. We developed Waon therapy, a form of thermal therapy using a far-infrared dry sauna, and in this study herein examined its feasibility and safety in patients with CFS.

METHODS:Ten consecutive inpatients with CFS stayed in a 60°C sauna for 15 minutes and then rested on a bed under a blanket for an additional 30 minutes outside the sauna room. The treatments were performed once a day, five days a week for four weeks. Perceived fatigue, the primary outcome measure, was evaluated using a numerical rating scale before, during (two weeks after the commencement of therapy) and after therapy. The pain level, evaluated using a numerical rating scale, mood, assessed using the Profile of Mood States questionnaire, and performance status, assessed using a scale developed for CFS patients were also examined before and after therapy.

RESULTS:Perceived fatigue significantly decreased after therapy, although no significant reductions were observed during therapy. In addition, a negative mood, including anxiety, depression and fatigue, and the performance status significantly improved after therapy. However, the levels of pain and vigor did not change significantly. No patients reported any adverse effects during the therapy.

CONCLUSION:These findings suggest that Waon therapy may be a useful and safe treatment for CFS.

Humans are intimately connected to nature, and our physical and mental health is influenced strongly by our environment. The"elements,"classically described in humoral theory as Fire, Water, Earth, and Air, all may impact our mental health. In a contemporary sense, these elements reflect a range of modifiable factors: UV light or heat therapy (Fire); sauna, hydrotherapy, and balneotherapy (Water); nature-based exposure therapy and horticulture (Earth); oxygen-rich/clean air exposure; and breathing techniques (Air). This theoretical scoping review paper details the emerging evidence for a range of these elements, covering epidemiological and interventional data, and provides information on how we can engage in"biophilic"activities to harness their potential benefits. Interventional examples with emerging evidentiary support include"forest-bathing,"heat therapy, sauna, light therapy,"greenspace"and"bluespace"exercise, horticulture, clay art therapy activities, and pranayamic yoga breathing exercises. Further robust research is however required to firmly validate many of these interventions, and to establish their therapeutic applications for the benefit of specific mental health disorders.

BACKGROUND:High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness.

OBJECTIVES:This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group.

PATIENTS AND METHODS:A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage.

RESULTS:The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P<0.05).

CONCLUSIONS:Sauna application prior to the exercise-induced muscle damage demonstrated effectiveness in reduction of sensory impairment (PF-ROM and PE-ROM) and improvement of muscle functions (GS, and WES) in wrist extensor muscle group.

OBJECTIVES: The purpose of this study was to determine the mechanism by which 60 degrees C sauna treatment improves cardiac function in patients with chronic heart failure (CHF). BACKGROUND: We have previously reported that repeated 60 degrees C sauna treatment improves hemodynamic data and clinical symptoms in patients with CHF. We hypothesized that the sauna restores endothelial function and then improves cardiac function. METHODS: Twenty patients (62 plus minus 15 years) in New York Heart Association (NYHA) functional class II or III CHF were treated in a dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min, daily for two weeks. Ten patients with CHF, matched for age, gender and NYHA functional class, were placed on a bed in a temperature-controlled (24 degrees C) room for 45 min as the nontreated group. Using high-resolution ultrasound, we measured the diameter of the brachial artery at rest and during reactive hyperemia (percent flow-mediated dilation, %FMD: endothelium-dependent dilation), as well as after sublingual administration of nitroglycerin (%NTG: endothelium-independent dilation). Cardiac function was evaluated by measuring the concentrations of plasma brain natriuretic peptide (BNP). RESULTS: Clinical symptoms were improved in 17 of 20 patients after two weeks of sauna therapy. The %FMD after two-week sauna treatment significantly increased from the baseline value, whereas the %NTG-induced dilation did not. Concentrations of BNP after the two-week sauna treatment decreased significantly. In addition, there was a significant correlation between the change in %FMD and the percent improvement in BNP concentrations in the sauna-treated group. In contrast, none of the variables changed at the two-week interval in the nontreated group. CONCLUSIONS: Repeated sauna treatment improves vascular endothelial function, resulting in an improvement in cardiac function and clinical symptoms.

No abstract available

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.