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Physical and Mental Effects of Bathing: A Randomized Intervention Study

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Abstract

Showering is the most common form of bathing worldwide. Whole-body immersion bathing in warm water (~40°C) is common in Japan and exerts sufficient hyperthermic action to induce vasodilatation and increase blood flow, supplying more oxygen and nutrients to the periphery. Cross-sectional studies report better subjective health status with an immersion bathing habit. This randomized controlled trial compared the effects on health of immersion bathing and shower bathing in 38 participants who received 2-week intervention of immersion bathing in warm water (40°C) for 10 min (bathing intervention) followed by 2-week shower bathing without immersion (showering intervention) or vice versa (n = 19 each group). Visual analog scale scores were significantly better for fatigue, stress, pain, and smile and tended to be better for self-reported heath and skin condition after bathing intervention than after showering intervention. The SF-8 Health Survey showed significantly better general health, mental health, role emotional, and social functioning scores. Profile of Mood State scores were lower for stress, tension-anxiety, anger-hostility, and depression-dejection. Immersion bathing, but not shower bathing, exerts hyperthermic action that induces increased blood flow and metabolic waste elimination, which may afford physical refreshment. Immersion bathing should improve both physical and emotional aspects of quality of life.
Research Article
Physical and Mental Effects of Bathing: A Randomized
Intervention Study
Yasuaki Goto ,1Shinya Hayasaka,1,2 Shigeo Kurihara,1and Yosikazu Nakamura3
1ONSEN Medical Science Research Center, Japan Health & Research Institute, 3-1-4 Nihonbashi, Chuo-ku, Tokyo 103-0014, Japan
2Tokyo City University, 8-9-18 Todoroki, Setagaya-ku, Tokyo 158-8586, Japan
3Jichi Medical University, 3311-1 Yakushiji, Shimosa City, Tochigi 329-0498, Japan
Correspondence should be addressed to Yasuaki Goto; yasuakigotoh@gmail.com
Received 8 February 2018; Revised 23 April 2018; Accepted 14 May 2018; Published 7 June 2018
Academic Editor: Albert S. Yeung
Copyright ©  Yasuaki Goto et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Showering is the most common form of bathing worldwide. Whole-body immersion bathing in warm water (C) is common
in Japan and exerts sucient hyperthermic action to induce vasodilatation and increase blood ow, supplying more oxygen and
nutrients to the periphery. Cross-sectional studies report better subjective health status with an immersion bathing habit. is
randomized controlled trial compared the eects on health of immersion bathing and shower bathing in  participants who
received -week intervention of immersion bathing in warm water (C) for  min (bathing intervention) followed by -week
shower bathing without immersion (showering intervention) or vice versa (n =  each group). Visual analog scale scores were
signicantly better for fatigue, stress, pain, and smile and tended to be better for self-reported heath and skin condition aer bathing
intervention than aer showering intervention. e SF- Health Survey showed signicantly better general health, mental health,
role emotional, and social functioning scores. Prole of Mood State scores were lower for stress, tension-anxiety, anger-hostility,
and depression-dejection. Immersion bathing, but not shower bathing, exerts hyperthermic action that induces increased blood
ow and metabolic waste elimination, which may aord physical refreshment. Immersion bathing should improve both physical
and emotional aspects of quality of life.
1. Introduction
Lifestyles can vary widely, and several lifestyle factors such as
diet, exercise, sleep, alcohol consumption, and smoking are
associated with health and survival [–]. Another aspect of
lifestyle that varies is bathing, several forms of which include
bathing in a conventional shower, steam shower, sauna, or
bathtub. Bathing in a shower is the most common form of
bathing. In Japan, immersion of the whole body in warm
water (around C) is a common habit [, ]. It is known that
the most benecial eect of so-called immersion bathing is
vasodilation induced by hyperthermic action, which results
in systemic elevation of the supply of oxygen and nutrients
to the periphery and increased elimination of carbon dioxide
and metabolic waste materials [–].
A survey of bathing practices in Japan revealed that
% of participants enjoyed bathing (either in a bathtub or
shower) and more than % reported sensations or feelings of
warmth, relaxation, relief from fatigue, and refreshment aer
immersion bathing []. e weekly frequency of bathing
varies by season: in summer, shower bathing occurs, on
average . times per week versus immersion bathing at .
times (at . ±.Cfor.±. min); in winter, immersion
bathing occurs, on average, . times per week (at . ±
.Cfor.±. min) and shower bathing at . times
[].
Our previous cross-sectional studies found good sub-
jective health status, sucient sleep and rest, low levels of
stress, and high subjective happiness in individuals who had
a habit of bathing in hot water everyday [, ]. However, the
benetsofcertainperiodsofbathinginterventionshavenot
been reported.
is randomized controlled trial assessed the eects of
a total of  weeks of intervention consisting of  weeks of
immersion bathing intervention (bathing intervention) and
 weeks of shower bathing without immersion intervention
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2018, Article ID 9521086, 5 pages
https://doi.org/10.1155/2018/9521086
Evidence-Based Complementary and Alternative Medicine
T : Self-reported health status (VAS score) before and aer bathing intervention.
Before Aer Dierence p value
Mean SD Mean SD Mean
Self-reported health . ±. . ±. . <. ∗∗
Skin condition . ±. . ±. . <. ∗∗
Fatigue . ±. . ±. . <. ∗∗
Stress . ±. . ±. . <. ∗∗
Pain . ±. . ±. . <. ∗∗
Smile . ±. . ±. . <. ∗∗
∗∗p<..
T : Self-reported health status (VAS score) before and aer showering intervention.
Before Aer Dierence p value
Mean SD Mean SD Mean
Self-reported health . ±. . ±. . <. ∗∗
Skin condition . ±. . ±. . <. ∗∗
Fatigue . ±. . ±. . <. ∗∗
Stress . ±. . ±. . <. ∗∗
Pain . ±. . ±. . <. ∗∗
Smile . ±. . ±. . <. ∗∗
∗∗p<..
(showering intervention) in order to compare the physical
and mental eects between the two interventions.
2. Materials and Methods
2.1. Sample Preparation. Subjects were  healthy adults
( women,  men; mean age, . years, SD = .). We
recruited the subjects from a Japanese portal site named
KARADAKARA, which was an Internet circle where people
are interested in health consisting of about  thousand
people. e Ethics Committee of Japan Health & Research
Instituteapprovedthestudyprotocol,andallworkwas
conducted in accordance with the Declaration of Helsinki
(). Written informed consent was obtained from each
subject before commencing the study. is study is registered
in the UMIN Clinical Trials Registry (UMIN).
is intervention study was conducted from October
 to November , , to investigate the two bathing
methods of immersion bath in hot water (C) for  min
(bathing) and showering without immersion (showering).
Subjects were randomized to the groups, and the eects of
bathing for  weeks and showering for  weeks continuously
were compared using a cross-over method. No washout was
performed.
2.2. Assessment Measures. Perceivedhealthisassociatedwith
mortality [], so self-reported health status (health, skin
condition, pain, fatigue, stress, and smile in the mirror) was
assessed using a -mm visual analog scale (VAS; extremely
bad  [le] to extremely good  [right]) aer bathing
every day during the intervention periods. To assess health
and mood states during each intervention period, partici-
pants retrospectively completed the Japanese versions of the
-item Short Form Health Survey (SF-) and a short form of
the Prole of Mood States (POMS), respectively, aer each
-week intervention period. e SF- [] uses single-item
scales to assess  items: general health, physical functioning,
role limitations due to physical health problems, bodily pain,
vitality (energy/fatigue), social functioning, mental health,
and role limitations due to emotional problems. Physical
and Mental Component Summary scores are also calculated.
e POMS [] is used worldwide for the assessment of
mood states, measuring the constructs of tension-anxiety,
depression-dejection, anger-hostility, fatigue, confusion, and
vigor.
2.3. Statistical Analysis. e paired t-test was used to com-
pare subjective health status before and aer bathing every
day and between the -week bathing intervention and the -
week showering intervention periods. e statistical package
SPSS .J (IBM, Tokyo, Japan) was used for analysis.
3. Results
Subjects of the analysis were  of the  participants who
remained in good health during the -week intervention
study and completed all measurement items without missing
data.Fivesubjectsexcludedfromthisstudycouldnot
continue this bathing method because of their private matter
which is not a health problem.
3.1. Self-Reported Health Status. Tables  and  show the VAS
scores for self-reported health status every day before and
aer the bathing and showering interventions, respectively.
Signicant improvements were observed for all assessed
items aer each intervention.
Evidence-Based Complementary and Alternative Medicine
T : Dierences in self-reported health status (VAS score) between bathing and showering interventions.
Bathing Showering Dierence p value
Mean SD Mean SD Mean
Self-reported health . ±. . ±. . .
Skin condition . ±. . ±. . .
Fatigue . ±. . ±. . .
Stress . ±. . ±. . . ∗∗
Pain . ±. . ±. . .
Smile . ±. . ±. . .
p<. and ∗∗p<..
T : Health-related quality of life (SF- scores) reported retrospectively for each intervention period.
Bathing Showering Dierence p value
Mean SD Mean SD Mean
General health . ±. . ±. . . ∗∗
Physical functioning . ±. . ±. . .
Role physical . ±. . ±. . .
Bodily pain . ±. . ±. . .
Vitality . ±. . ±. . .
Social functioning . ±. . ±. . .
Mental health . ±. . ±. . .
Role emotional . ±. . ±. . .
Physical component summary . ±. . ±. . .
Mental component summary . ±. . ±. . . ∗∗
p<. and ∗∗p<..
T : Retrospectively assessed mood states during each intervention (POMS scores).
Bathing Showering Dierence p value
Mean SD Mean SD Mean
Tension-Anxiety . ±. . ±. . .
Depression-Dejection . ±. . ±. . .
Anger-Hostility . ±. . ±. . .
Fatigue . ±. . ±. . .
Confusion . ±. . ±. . .
Vigor . ±. . ±. . .
p<..
Table  shows the results for self-reported health status
during each intervention completed retrospectively aer each
intervention period. VAS scores were higher for self-reported
health and skin condition (p <.) and signicantly higher
for smile (p <.) during bathing intervention than during
showering intervention. In addition, fatigue, stress, and pain
scores were signicantly lower during bathing intervention
than during showering intervention (p <.).
3.2. Health-Related Quality of Life Assessment. Tab l e  s h ows
theindividualscoresfortheitemsontheSF-andthe
Physical and Mental Component Summary scores indicating
health status during each -week intervention, as retro-
spectively self-reported aer completing each intervention.
General health, social functioning, mental health, and Mental
Component Summary scores were signicantly higher dur-
ing bathing intervention than during showering intervention
(p <.). ere were no dierences in role physical,
physical functioning, bodily pain, role emotional, or Mental
Component Summary scores.
3.3. Mood States. Table  shows mood states assessed aer
the -week bathing intervention and the -week showering
intervention, measured using the -item POMS. Scores were
signicantly lower for tension-anxiety, depression-dejection,
and anger-hostility during bathing intervention than during
showering intervention (p <.). ere were no signicant
dierences in fatigue, confusion, or vigor.
4. Discussion
is randomized controlled trial comparing the physical and
mental eects of  weeks of bathing intervention and  weeks
of showering intervention (without immersion) showed that
Evidence-Based Complementary and Alternative Medicine
bathing intervention was more benecial than showering
intervention.esamplesizeissmall,whichmeansthisresult
haslimitedpower.Howeverthisisacross-overstudy,sothat
we think the result which we showed is a casual relationship.
Self-assessment of health status before and aer inter-
vention every day showed health improvement aer both
bathing and showering interventions, although the degree of
improvement was larger aer the former than aer the latter.
isresultsuggeststhateitherinterventionimprovesphysical
and mental condition. Bodily cleanliness and a feeling of
refreshment are benets oered by bathing and showering.
Bathing intervention did, however, show better subjective
health status (VAS scores) than showering intervention.
Our previous cross-sectional studies [, ] suggested
that people who had a habit of bathing in hot water have good
subjective health status, sucient sleep and rest, low levels of
stress, and high subjective happiness. e results of this study
support that the psychological benets of bathing are a real
causal relationship.
During bathing, several actions unique to bathing will
be exerted on the body, including hyperthermic action,
hydrostatic pressure, buoyancy, and viscosity of water.
e most important of these is hyperthermic action,
which warms the blood in supercial vessels, thereby increas-
ing the deep body temperature through circulation. With
an increase in body temperature, heat-sensitive neurons
areexcitedwhilecold-sensitiveneuronsareinhibitedin
the thermoregulatory center of the hypothalamus, causing
inhibition of the sympathetic nerves and stimulation of
the parasympathetic nerves, leading to vasodilatation and
induced perspiration to decrease the body temperature. Heart
rate will rise by % to %, and peripheral pO2will increase
while pCO2will decrease, thereby stimulating metabolism
and inducing elimination of metabolic waste materials, which
in turn refreshes the body [–]. In terms of hydrostatic
pressure, it induces venous ow, thereby increasing cardiac
outputandimprovingmetabolism.Also,ahabitofimmer-
sionbathinginhotwaterwasshowntobeassociatedwith
strengthened immune function [, ].
A bathing study using patients with cardiovascular dis-
eases showed the improvement of hemodynamics by heating
eect []. On the other hand, for aged generation especially
patients for cardiovascular diseases, full body immersion
wouldbeunbenecialbecausehydrostaticpressurecauses
venous return load.
is study showed better self-assessment results for
fatigue, subjective health, skin condition, and smile as well
as a better SF- Physical Component Summary score during
the intervention with daily immersion bathing, suggesting
systemic improvement of metabolism by taking an immer-
sion bath. Furthermore, hyperthermic action is expected to
systemically relax the muscles, soen collagen in ligaments
and articular capsules, and improve musculoskeletal func-
tion. e pain-relieving eect of bathing [] may explain
the reduction in self-rated pain reported by subjects in the
present study. Lastly, the downward force of gravity is reduced
by buoyancy during bathing, which may in turn lead to
the improvements seen in the POMS constructs of tension-
anxiety, depression-dejection, and anger-hostility, suggesting
positive eects of stress relief, refreshment, and relaxation
from immersion bathing.
e limitations of this study are as follows. is trial
wasconductedinthefall(October-November),andseasonal
dierences in bathing habit (e.g., autumn versus summer
or winter) were not taken into account. Also, the timing of
body immersion and the temperature of water in the bathtub
were not strictly dened. Interventional studies using tightly
controlled conditions will provide insight that is useful for
health promotion. In addition, there may be a bias caused by
the fact that Japanese likes bathing in general. Even though we
think that heating eect of bathing does not dier depending
on races, if we do the same intervention study with people
in Europe, the result may be changed because the favor
regarding bathing may be dierent between Japanese and
people in other countries
5. Conclusions
Routine immersion bathing appeared more benecial to
mental and physical health than routine shower bathing
without immersion. Further interventional studies that con-
sider seasonal factors and physiological factors in relation
to eective bathing temperature and timing are anticipated
to show the eect of immersion bathing and clarify the
benecial eects on health.
Data Availability
edatausedtosupportthendingsofthisstudywere
provided by Japan Health & Research Institute under license
and so cannot be made freely available. Access to these
data will be considered by the author upon request, with
permission of Yasuaki Goto.
Disclosure
A part of this study was presented at st American Public
Health Association Annual Meeting and Exposition .
Conflicts of Interest
e authors have no conicts of interest to declare.
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... Another study (Goto et al., 2018) highlighted the benefits of immersion bathing. Hot water immersion bathing, which is different from showering, applies a hyperthermic action that triggers an increased blood flow and eliminates metabolic waste, which brings about physical refreshment (Goto et al., 2018). ...
... Another study (Goto et al., 2018) highlighted the benefits of immersion bathing. Hot water immersion bathing, which is different from showering, applies a hyperthermic action that triggers an increased blood flow and eliminates metabolic waste, which brings about physical refreshment (Goto et al., 2018). Thus, immersion bathing improves physical as well as emotional aspects of life quality. ...
... Thus, immersion bathing improves physical as well as emotional aspects of life quality. In an investigation of immersion bathing in 40°C water for 10 minutes bathing vs showering, subjects were placed in groups, and the results of bathing and showering for two weeks were compared by a cross-over method (Goto et al., 2018). The results showed that immersion bathing was more rewarding when compared to showering. ...
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Police officers engage in dangerous and potentially highly traumatizing circumstances. It is common for officers to experience PTSD, depression, anxiety, and other mental health issues that affect their work performance and family life. Often seeking support from their institution or organization is stigmatized and experienced as a significant drawback to their work environment. The number of variables that affect an officer's mental health are numerous and cannot be undermined. For example, a negative world view, lack of family support, traumatic events, suppression of emotions, self-medicating, toxic work environment, unsupportive organization, and lack of peer support all intertwine to create a whirlwind of adverse mental health outcomes. The organization has made some attempts to support police officers with their mental health needs, such as a post-critical incident seminar by the Federal Bureau of Investigation. Unfortunately, this is just one element that has been put in place, but there remains an enormous gap in providing the needed support. In this paper, we highlight and inform on practices to prevent and cope with job demands that can be implemented in the organization and individually, such as mental detachment, reframing, refrain from personalization, permeance, and catastrophizing. Some strategies that can decrease organizational stress are meditation, showering and bathing practices, exercise, peer and group support, quality sleep, good nutrition, listening to music, and organization of the work environment. This paper highlights how crucial peer and organizational support is in the lives of police officers. The need for normalizing their experience by sharing with
... Another study (Goto et al., 2018) highlighted the benefits of immersion bathing. Hot water immersion bathing, which is different from showering, applies a hyperthermic action that triggers an increased blood flow and eliminates metabolic waste, which brings about physical refreshment (Goto et al., 2018). ...
... Another study (Goto et al., 2018) highlighted the benefits of immersion bathing. Hot water immersion bathing, which is different from showering, applies a hyperthermic action that triggers an increased blood flow and eliminates metabolic waste, which brings about physical refreshment (Goto et al., 2018). Thus, immersion bathing improves physical as well as emotional aspects of life quality. ...
... Thus, immersion bathing improves physical as well as emotional aspects of life quality. In an investigation of immersion bathing in 40°C water for 10 minutes bathing vs showering, subjects were placed in groups, and the results of bathing and showering for two weeks were compared by a cross-over method (Goto et al., 2018). The results showed that immersion bathing was more rewarding when compared to showering. ...
Article
Full-text available
Police officers engage in dangerous and potentially highly traumatizing circumstances. It is common for officers to experience PTSD, depression, anxiety, and other mental health issues that affect their work performance and family life. Often seeking support from their institution or organization is stigmatized and experienced as a significant drawback to their work environment. The number of variables that affect an officer's mental health are numerous and cannot be undermined. For example, a negative world view, lack of family support, traumatic events, suppression of emotions, self-medicating, toxic work environment, unsupportive organization, and lack of peer support all intertwine to create a whirlwind of adverse mental health outcomes. The organization has made some attempts to support police officers with their mental health needs, such as a post-critical incident seminar by the Federal Bureau of Investigation. Unfortunately, this is just one element that has been put in place, but there remains an enormous gap in providing the needed support. In this paper, we highlight and inform on practices to prevent and cope with job demands that can be implemented in the organization and individually, such as mental detachment, reframing, refrain from personalization, permeance, and catastrophizing. Some strategies that can decrease organizational stress are meditation, showering and bathing practices, exercise, peer and group support, quality sleep, good nutrition, listening to music, and organization of the work environment. This paper highlights how crucial peer and organizational support is in the lives of police officers. The need for normalizing their experience by sharing withothers who have had similar experiences and been given the tools to cope are an essential part of the efforts put forward to assist police officers and their families.
... There have been some international studies, some of which have reported the safety and efficacy of bathing for terminally ill patients. 3,4,[6][7][8][9][10][11][12][13][14] Fujimoto reported that bathing was a safe and comfortable care practice for terminally ill patients, because it did not cause significant fluctuations in circulatory dynamics, and it reduced anxiety. 11 In the author's preliminary study, a comparison of before and after bathing for terminal cancer patients showed that it was safe and reduced fatigue. ...
... 1,3,6,[9][10][11]15,16 However, it is often difficult for terminally ill patients, especially in their last month, to bathe independently because of their severe symptoms and decreased ADL, because they require the assistance of two or more nurses to take a bath. 4,11,14,16,22,23 Although there is a high need for bathing even among terminally ill cancer patients, in this study, only 40% (n = 353) of the patients could actually bathe. This gap might be owing to terminal cancer patients being in poor condition, having a short hospital stay, and limitations of the facilities, such as a limited number of nursing staff. ...
Article
Background: Bathing in a tub is integral to Japanese culture. It improves palliative care patients' symptoms and may improve quality of life. Objectives: This study aimed to determine the prevalence and impressions of bathing for terminally ill cancer patients and its relations to the evaluations of perceived end-of-life care and achievement of a good death. Design: This was a cross-sectional, anonymous, self-report questionnaire survey. Setting/subjects: The questionnaire for this study was sent to bereaved family members who had lost loved ones in 14 general hospitals and 187 palliative care wards in Japan. Measurements: The bereaved family members of the patients who had actually bathed were asked about their impression of bathing. The short version of the Good Death Inventory (GDI) and the Care Evaluation Scale were used to evaluate "achievement of a good death." In total, 1819 surveys were sent between July and September 2018 to bereaved family members of patients who had died between February 2014 and January 2018 in 14 general hospitals and 187 palliative care wards in Japan. Overall 885 questionnaires (valid response rate 48%) returned by bereaved family members were analyzed. Results: Overall, 85% of bereaved family members of patients who bathed evaluated the experience positively, 86% reported that the patient's face seemed to become calm after the bath, and 28% of bereaved family members whose loved one had not bathed reported regretting it. The total GDI score for the bereaved family's desired death was 82.7 ± 13.0 for the bathing group and 75.4 ± 15.7 for the no bathing group, a significant difference (effect size = 0.52, p < 0.01). Conclusions: Bathing before death was evaluated positively and was associated with the achievement of a good death.
... Nonfatal bathroom accidents are a common reason for broken bones in older adults [18]. A safe bathroom for the elderly could significantly reduce the likelihood of anger-hostility, tension-anxiety, and depression-dejection [19]. ...
... A safe neighborhood environment is also beneficial to older adults' autonomy and sense of direction [64], as well as being low in risk of injury or death [65]. Consistent with previous findings by James et al. [32], Goto et al. [19], and Yu et al. [29], after controlling for demographic factors, access to local stores and amenities may improve older adults' health-related well-being (p 0.033, 95% CI 0.006, 0.146). Respondents walked to community facilities regularly when the town was easily accessible. ...
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In Malaysia, the population of older adults will increase in the coming years. In this context, there is a requirement to build an age-friendly environment to enable the elderly to age healthily. Many studies have shown that a built environment that allows older adults to age in place improves their mental health. However, person-environment analysis that considers mental well-being has remained rare for older adults living in Malaysia. This study examines the relationship between Malaysian seniors’ perceptions of their surroundings at home and in the neighborhood and their mental health. Using stratified sampling, 510 seniors aged 60 and over were interviewed. The results showed that accessibility (p-value 0.033, 95% CI for coefficients 0.006, 0.146), environmental qualities (0.015, 0.014, 0.129) and neighborhood problems (0.000, −0.299, −0.146) were significant determinants of elderly people’s mental health. With respect to respondents’ socio-demographic characteristics, female elderly (0.000, 0.616, 0.782), older adults with an elementary education (0.000, 0.263, 0.685) or a college degree (0.026, 0.019, 0.294), being married (0.005, 0.047, 0.259), the ability to drive (0.000, 0.993, 1.315), the number of dependents in the family (0.003, −0.060, −0.012), and homeownership (0.000, −0.602, −0.271) were significantly related to mental well-being.
... and promotive effects in certain diseases, such as hypertension (preventive) in women and cardiovascular diseases (preventive) and colon cancer survival (promotive) in men. 16 Nauman et al 13 suggested that outpatients with confirmed depressive disorder bathing in a tub at least twice each week showed improved depression, sleep, and heart rate, allowing for better relaxation. These reports support the efficacy of bathing for a wide range of symptoms, which may benefit terminally ill cancer patients. ...
... Previous studies have found that healthy individuals took baths almost daily in Japan. 16 The survey in this study found that, when the patients were healthy, they enjoyed bathing in a tub daily, but approximately 90% of the terminal cancer patients had not been able to bathe in a tub for at least a few weeks before admission to the palliative care ward. The unique Japanese health consciousness and expectations related to bathing in a tub might lead to relief of painful symptoms. ...
Article
This observational, controlled study explored the effects of bathing on the physical and psychological aspects of terminal cancer patients on a palliative care ward. With nurses' assistance, the patients evaluated and recorded the severity of their symptoms at 10:00 AM, 30 minutes after initial bathing, and at 5:00 PM. The bathing care was provided as routine care according to the patients' wishes. Twelve symptoms were measured using 9 items (numbers 1-9) from the Edmonton Symptom Assessment System-Revised Japanese version and 3 items from the Cancer Fatigue Scale. Outcomes were compared between bathing days and nonbathing days (control) and between before and after bathing. Of the 57 bathers, data were available for both bathing days and nonbathing days for 42 bathers. In the comparison between bathing and nonbathing days, tiredness was significantly improved (effect size [ES], 0.35; P = .02). On the basis of the pre-post bathing comparison, 6 symptoms, namely, tiredness (ES, 0.40; P < .01), lack of appetite (ES, 0.36; P = .01), decreased well-being (ES, 0.33; P = .01), anxiety (ES, 0.36; P = .01), pain (ES, 0.31; P = .02), and depression (ES, 0.30; P = .02), were significantly improved. Bathing in a tub effectively improves tiredness and might be effective for distressing symptoms in end-of-life cancer patients.
... Importantly, beyond the physiological effects of water-based therapy, psychological benefits can also be observed, such as mental relaxation, mental fatigue recovery, management of pain, lower stress, a better quality of life, lower anxiety, and lower depression-dejection scores (Mizuno et al. 2010;Han et al. 2014;Goto et al. 2018), all of them being described in the literature as significantly affected among patients with COVID-19 infection (Steardo et al. 2020;Deng et al. 2021). As displayed in Fig. 1, many symptoms due to COVID-19 infection match the treatments and benefits already provided by thermal centers. ...
Article
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.
... The thermal springs are a part of the geothermal energy manifestations that are observed in all continents [2]- [4]. The exploration for thermal water resources with medical applications has increased since the nineteenth century [5]- [7], however, biological research in thermal water began in the 1950's [8]. The microbial community present on the thermal water consist of bacteria and archaea of a thermophilic and hyperthermophilic nature [9], [10]. ...
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This paper deals with the results of a hydrogeochemical study of two thermal springs that originate from in very high altitudes in southwestern Peru with outflow temperatures of maximal 38,4 °C and flow rates of 1.08 - 2.02 l/s. Water samples from the Pojqpoquella and Phutina geothermal wells, were collected during the period between September 2018 and January 2019 in the main area of Puno. Chemical types of the thermal spring are Na+, Ca2+, Cl ⁻ and CO 3 2 − in Ayaviri and Putina. According to the Piper and Schoeller diagrams for the Pojqpoquella thermal spring water is classified as Na++ K+ (75 %) and Cl ⁻ (60 %) type water while that of the Phutina thermal spring is classified as Na++ K+ (76 %) and Cl ⁻ (72 %) type water. The electrical conductivity (EC) values for the Pojqpoquella and Phutina thermal spring waters is 2160 - 3142 μS/cm and 3160 - 3184 μS/cm, respectively, the thermal spring waters have a high electrical conductivity which shows that it has interacted with the host rock for a long time. The reservoir rocks of the Pojqpoquella thermal system consist of a red sandstones and conglomerate rocks while the reservoir rocks of the Phutina thermal system consist of a thick sequence of cretaceous rocks.
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Systemic lupus erythematosus is a chronic inflammatory autoimmune disease characterized by fatigue, with meaningful effects on patients' life. The aim of this study was to examine the effect of using warm shower and warm water footbath with and without adding Epsom Salt on fatigue level in systemic lupus patients. The study was conducted at Kasr Al Ainy teaching hospital, Cairo University. Ninety consecutive patients (30 in each experimental group). Quasi-experimental design was used. Data was collected using demographic sheet, Fatigue severity scale and thermometer. The study results revealed that in the warm shower group, there was a significant reduction in fatigue level from baseline assessment to day 7 by 2.9 points (54.13± 5.21 and 51.23 ± 5.36). Warm shower is effective in reducing fatigue level. Further investigation into using warm water footbath with adding Epsom salt and its effect on fatigue, may lead to an improvement in the complementary therapy and management modality of this chronic inflammatory disease.
Chapter
Many patients with hidradenitis suppurativa (HS) do not achieve adequate symptom coverage with conventional therapies and often resort to complementary and alternative medicine (CAM) in hopes of achieving relief. Current evidence suggests CAM use is popular among HS patients. This chapter discusses the various types of CAM as well as their demonstrated or potential utility for the treatment of HS in conjunction with current conventional therapies. While there has not been high quality level of evidence for CAM therapies in HS, the benefits and the favorable side effect profile of these modalities that have been seen in other inflammatory conditions can be considered in HS. Future investigations are needed to elucidate the mechanism, efficacy, and safety of CAM in HS.
Chapter
In this chapter, the authors review what is known about urban blue spaces, health, and well-being. Urban blue spaces are made up of multiple typologies, spanning natural, seminatural and manmade, in the form of rivers, coast, lakes, canals, ponds, and sustainable drainage features. Urban blue space research is more limited than green space research but is a growing field that is proposing nuanced benefits and challenges of how urban water bodies can contribute to health and well-being. The authors summarize this research and include anthropological and environmental justice reflections on people’s engagement with urban water bodies. They summarize work from a local blue space project in East London focused on local community and place and suggest some innovative ways of engaging constructively with urban blue spaces that could offer opportunities for creatively using blue space-focused nature-based solutions to enhance the climate resilience and beauty of urban areas, while also positively impacting health and well-being of people and the urban environment.
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Background Recently, mist saunas have been used in the home as a new bathing style in Japan. However, there are still few reports on the effects of bathing methods on recovery from muscle fatigue. Furthermore, the effect of mist sauna bathing on human physiological function has not yet been revealed. Therefore, we measured the physiological effects of bathing methods including the mist sauna on recovery from muscle fatigue. Methods The bathing methods studied included four conditions: full immersion bath, shower, mist sauna, and no bathing as a control. Ten men participated in this study. The participants completed four consecutive sessions: a 30-min rest period, a 10-min all out elbow flexion task period, a 10-min bathing period, and a 10-min recovery period. We evaluated the mean power frequency (MNF) of the electromyogram (EMG), rectal temperature (Tre), skin temperature (Tsk), skin blood flow (SBF), concentration of oxygenated hemoglobin (O2Hb), and subjective evaluation. Results We found that the MNF under the full immersion bath condition was significantly higher than those under the other conditions. Furthermore, Tre, SBF, and O2Hb under the full immersion bath condition were significantly higher than under the other conditions. Conclusions Following the results for the full immersion bath condition, the SBF and O2Hb of the mist sauna condition were significantly higher than those for the shower and no bathing conditions. These results suggest that full immersion bath and mist sauna are effective in facilitating recovery from muscle fatigue.
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Lower mortality has been reported in light-to-moderate alcohol drinkers. We examined the association between the amount and frequency of alcohol consumption and all-cause mortality in a Japanese population. We conducted a prospective cohort study among 8934 Japanese people (3444 men and 5490 women) who completed a baseline survey between 1992 and 1995. We confirmed the date and cause of death by referring to death certificates. The Cox proportional hazards model was used to evaluate the effect of alcohol consumption on risk for all-cause mortality, after adjustment for potential confounding factors. We identified 637 (397 men and 240 women) deaths during the 12.0 years of mean follow-up. Among men, as compared with non-drinkers, the relative risk was higher in ex-drinkers (hazard ratio [HR], 1.18), lower in light drinkers (HR, 0.95) and moderate drinkers (HR, 0.91), and significantly higher in heavy drinkers (HR, 1.67; 95% confidence interval, 1.10-2.55). Among women, light, moderate, and heavy drinkers were grouped into current drinkers. The relative risk was slightly higher in current drinkers (HR, 1.23), and that in ex-drinkers was near 1.0 (HR, 0.97). In stratified analysis, the harmful effects of heavy drinking were more severe among male smokers and younger men. In terms of frequency, men who drank only on special occasions had the highest mortality (HR, 1.28), regardless of alcohol intake per drinking session. In men, a near J-shaped association was identified between alcohol consumption and all-cause mortality. Both the amount and frequency of alcohol consumption were related to mortality.
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Risk charts are used to estimate the risk of cardiovascular diseases; however, most have been developed in Western countries. In Japan, currently available risk charts are based on mortality data. Using data on cardiovascular disease incidence from the JMS Cohort Study, we developed charts that illustrated the risk of stroke. The JMS Cohort Study is a community-based cohort study of cardiovascular disease. Baseline data were obtained between 1992 and 1995. In the present analysis, the participants were 12 276 subjects without a history of stroke; the follow-up period was 10.7 years. Color-coded risk charts were created by using Cox's proportional hazards models to calculate 10-year absolute risks associated with sex, age, smoking status, diabetes status, and systolic blood pressure. The risks of stroke and cerebral infarction rose as age and systolic blood pressure increased. Although the risk of cerebral hemorrhage were generally lower than that of cerebral infarction, the patterns of association with risk factors were similar. These risk charts should prove useful for clinicians and other health professionals who are required to estimate an individual's risk for stroke.
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Kaplan, G. A. (Human Population Laboratory, Berkeley, CA 94704) and T. Camacho. Perceived health and mortality: a nine-year follow-up of the Human Population Laboratory cohort. Am J Epidemiol 1983; 117: 292–304. The association between perceived health ratings (“excellent, ” “good, ” “fair,” and “poor”) and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California, and a subsequent nine-year follow-up. Risk of death during this period was significantly associated with perceived health rating in 1965. The age-adjusted relative risk for mortality from all causes for those who perceived their health as poor as compared to excellent was 2.33 for men and 5.10 for women. The association between level of perceived health and mortality persisted in multiple logistic analyses with controls for age, sex, 1965 physical health status, health practices, social network participation, income, education, health relative to age peers, anomy, morale, depression, and happiness.
Article
We studied the effects of bathing in warm water on cerebral blood flow (CBF). Seven healthy male volunteers were subjected to experiments. The subjects were bathed in warm water at 39°C for 20 minutes in a sitting position immersed up to the neck. Each subject received two CBF examinations: one under normal conditions and the other after taking a bath mentioned above. There was an interval of at least seven days between the two examinations. To measure CBF, we used the Patlak plot method with technetium- 99m ethyl cysteinate dimer (99m-Tc ECD). To examine CBF alter bathing, 99m- Tc ECD was injected within 10 minutes after bathing. Brain perfusion index (BPI) and regional CBF (rCBF) were used as indexes for evaluating CBF. The body temperature, pulse, blood pressure, arterial oxygen and carbon dioxide pressure, and hematocrit were also measured. Wilcoxon's signed rank test was used for statistical analyses. The following were observed: 1) BP1 increased significantly after bathing (p<0.05). 2) rCBF in the cerebral cortex, particularly in the frontal lobe, tended to increase after bathing (p<0.05). No definite changes were observed in the cerebellar cortex, caudate nucleus, or thalamus. 3) The body temperature and pulse increased significantly after bathing. No definite changes were observed in blood pressure, arterial oxygen and carbon dioxide pressure, or hematocrit. From the above, we conclude that bathing in warm water causes the cerebral blood flow to increase in healthy subjects.
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Balneotherapy has been shown to reduce systemic blood pressure in healthy volunteers. Hyperthermia might ameliorate the inflammatory status in heart failure through improving cardiac function. The purpose of this study was to examine the beneficial effects of balneotherapy in patients with chronic heart failure (CHF). Thirty-two patients with systolic CHF classified as New York Heart Association functional status II or III were randomized to divide either a balneotherapy group or a control group. The patients in the balneotherapy group were immersed in a hot spring at 40°C for 10 min daily for 2 weeks; the control group patients took a shower daily. The left ventricular ejection fraction (EF) and cardiothoracic ratio (CTR) were evaluated and plasma brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 levels were measured. The clinical symptoms improved after 2 weeks of hot spring therapy. Although the heart rate did not change, clinical symptoms, CTR, EF, and BNP were significantly improved. Moreover, the inflammatory responses, including hsCRP, TNF-α and IL-6 decreased significantly after balneotherapy. The improvement of BNP correlates with the changes in inflammatory biomarkers. Repeated hyperthermia by bathing in a hot spring is therefore considered to improve the cardiac and inflammatory status in patients with CHF.
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Although many population-based studies have reported an association between physical activity and cardiovascular disease (CVD) among healthy populations, the association among CVD survivors has been less reported. We examined the relationship between physical activity and CVD risk among survivors. This was a prospective cohort study of 12,490 Japanese participants, including 754 individual CVD survivors. Between April 1992 and July 1995, a baseline survey was conducted in 12 communities in Japan. The mean follow-up period was 11.9 years, during which time 74 individuals had non-fatal CVD and 51 cases were fatal CVD. Among CVD survivors, analysis was performed after exclusion of participants with a history of cancer and those who died within the first 2 years of follow-up. Physical activity was analyzed in tertiles (low, moderate and heavy), and the hazard ratios (HRs) were calculated for non-fatal or fatal CVD among CVD survivors. After setting the low group as the reference, the HRs for non-fatal CVD in the moderate and heavy groups were 0.61 (95% confidence interval: 0.30-1.24) and 0.50 (0.20-1.25) (P for trend = 0.059), respectively, and the HRs for fatal CVD were 0.75 (0.33-1.69) and 0.18 (0.04-0.83) (P for trend = 0.026), respectively. Physical activity reduced the risk of CVD, both fatal and non-fatal events, among CVD survivors.
The POMS (Profile of Mood States) was translated into Japanese, and reliability and validity of the Japanese edition was assessed on 354 healthy males aged 20 to 59 years (mean 42). The following findings were obtained. 1) Reliability coefficients (Cronbach's alpha) were 0.779-0.926 for six mood scales measured by the Japanese edition, i.e. "Depression-Dejection", "Vigor", "Anger-Hostility", "Fatigue", "Tension-Anxiety" and "Confusion." 2) Five factors were extracted by factor analysis for the 65 items of the POMS. "Vigor" and "Anger-Hostility" were solely explained by their respective factors, indicating that these two scales had the highest factorial validity. "Fatigue" had the second highest factorial validity; and "Tension-Anxiety" was third. "Confusion" and "Depression-Dejection" were related to the same one factor. 3) In 33 of the subjects, the scores for mood measured by the POMS were significantly correlated to ratings by a psychiatrist, indicating that the POMS had good criterion-related validity, except for "Anger-Hostility".
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This paper explores the relationship of seven personal health practices and subsequent mortality in the years between an initial survey of 6,928 adults made in Alameda County, California, in 1965 and a follow-up survey in 1974. The seven health practices are: never smoking cigarettes, regular physical activity, moderate or no use of alcohol, 7–8 hr sleep/day regularly, maintaining proper weight, eating breakfast, and not eating between meals. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with age-adjusted mortality rates, especially for men. Men following seven health practices had a mortality rate only 28% that of men following zero to three health practices. Women following seven health practices had a mortality rate 43% that of women following zero to three health practices. Both the health practices themselves and their relationship to mortality are shown to be reasonably stable over the -year period of follow-up. These results lend support to the hypothesis that good health practices and not the initial health status of the survey respondents are largely responsible for the observed mortality relationships. These and other methodological issues are explored.
Article
A warm-water bath (WWB) or sauna bath (SB) has generally been considered inappropriate for patients with severe congestive heart failure (CHF). However, a comprehensive investigation of the hemodynamic effects of thermal vasodilation in CHF has not been previously undertaken. To investigate the acute hemodynamic effects of thermal vasodilation in CHF, we studied 34 patients with chronic CHF (mean age, 58 +/- 14 years). Clinical stages were New York Heart Association functional class II in 2, III in 19, and IV in 13 patients. Mean ejection fraction was 25 +/- 9%. After a Swan-Ganz catheter was inserted via the right jugular vein, the patient had a WWB for 10 minutes at 41 degrees C or an SB for 15 minutes at 60 degrees C. Blood pressure, ECG, echo-Doppler, expiration gas, and intracardiac pressures were recorded before, during, and 30 minutes after each bath. Oxygen consumption increased mildly, pulmonary arterial blood temperature increased by 1.2 degrees C, and heart rate increased by 20 to 25 beats per minute on average at the end of WWB or SB. Systolic blood pressure showed no significant change. Diastolic blood pressure decreased significantly during SB (P < .01). Cardiac and stroke indexes increased and systemic vascular resistances decreased significantly during and after WWB and SB (P < .01). Mean pulmonary artery, mean pulmonary capillary wedge, and mean right atrial pressures increased significantly during WWB (P < .05) but decreased significantly during SB (P < .05). These pressures decreased significantly from the control level after each bath (P < .01). Mitral regurgitation associated with CHF decreased during and 30 minutes after each bath. Cardiac dimensions decreased and left ventricular ejection fraction increased significantly after WWB and SB. In an additional study, plasma norepinephrine increased significantly during SB in healthy control subjects and in patients with CHF and returned to control levels by 30 minutes after SB. Hemodynamics improve after WWB or SB in patients with chronic CHF. This is attributable to the reduction in cardiac preload and afterload. Thus, thermal vasodilation can be applied with little risk if appropriately performed and may provide a new nonpharmacological therapy for CHF.