[The influence of single immersion in Dead Sea water on glucose, insulin, cortisol and C-peptide levels in type 2 diabetes mellitus patients].

BACKGROUND: Bathing in sweet or mineral water can induce significant physiological changes in several body systems including the endocrine system. To date, there have only been a small number of reports that balneology can reduce blood sugar Levels in patients with type 2 diabetes mellitus (DM]. OBJECTIVE: To compare the effects of a single immersion in sweet or mineral water on blood glucose, insulin, cortisol and c-peptide levels in patients with type 2 DM. METHODS: Fourteen patients with type 2 DM and six healthy volunteers were immersed in water twice, with an interval of two weeks in between immersions. The first immersion was in Dead Sea water and the second in sweet water. In both cases the water was warmed to a temperature of 35 degrees C and the bath continued for 20 minutes. Three blood samples were taken from each of the participants at every immersion. The first sample was taken just prior to the start of immersion, the second sample was taken directly at the end of immersion, and the third sample, one hour later. In each sample the blood was tested for glucose, insulin, cortisol, and c-peptide Levels. RESULTS: A significant reduction was seen in blood glucose levels among DM patients who were immersed in Dead Sea water. The glucose levels dropped from a base Line level of 163 +/- 32.4 mg/dl prior to immersion, to 151 +/- 28.8 at the end of the immersion, and to 141 +/- 34.6 an hour later. All the differences were statistically significant: baseline to end of immersion (P = 0.006), end of immersion to one hour later (P = 0.024), and baseline to one hour after immersion (P=0.005). The difference in blood glucose was much Less following immersion in sweet water and did not reach statistical significance except between the end of immersion and one hour later. No significant differences were found for insulin, cortisol, and c-peptide levels between DM patients and healthy volunteers following immersion. CONCLUSION: One-time immersion in Dead Sea water reduces blood glucose levels in type 2 DM patients compared to healthy volunteers.

A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial.

BACKGROUND: Gait and balance impairments may increase the risk of falls, the leading cause of accidental death in the elderly population. Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering. A rapid step is the most important protective postural strategy, acting to recover equilibrium and prevent a fall from initiating. It can arise from large perturbations, but also frequently as a consequence of volitional movements. We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling. We describe the water-based balance training program and a study protocol to evaluate its efficacy (Trial registration number #NCT00708136). METHODS/DESIGN: The proposed water-based training program involves use of unpredictable, multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses. Perturbations are made by pushing slightly the subjects and by water turbulence, in 24 training sessions conducted over 12 weeks. Concurrent cognitive tasks during movement tasks are included. Principles of physical training and exercise including awareness, continuity, motivation, overload, periodicity, progression and specificity were used in the development of this novel program. Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning. A prospective, randomized, cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program. A total of 36 community-dwelling adults (age 65-88) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group (no training). Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training. DISCUSSION: This study will determine whether a water-based balance training program that includes perturbation exercises, in a group setting, can improve speed of voluntary stepping responses and improve balance control. Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly.

The interactions between spatial summation and DNIC: effect of the distance between two painful stimuli and attentional factors on pain perception.

The ability of a painful stimulus to suppress pain in another, remote area (DNIC) has been intensely studied. However, the effect of the distance between the two painful stimuli and the attentional factors during the measurement of pain perception received minimal treatment. We evaluated the effect of these factors on DNIC and on the interaction between DNIC and spatial summation (SS) of pain. Subjects rated the intensity of a test stimulus (applied to one hand) alone and simultaneously with conditioning stimuli applied to four different locations; 5 and 30cm from the test stimulus on the same hand, the contralateral hand and contralateral leg. In each location, ratings were performed under three different instructions: summation, attention to test stimulus, attention to conditioning stimulus. The distance between the conditioning and test stimulus significantly affected pain perception (p<0.01) regardless of the instructions; SS occurred only at a distance of 5cm and DNIC occurred only in the remaining distances. DNIC's magnitude increased as the distance between the two stimuli increased (p<0.01). However, the instruction to summate attenuated DNIC and the DNIC instruction attenuated SS of pain. Attention to the conditioning stimulus induced a stronger DNIC than attention to the test stimulus (p<0.001). We conclude that (1) DNIC and SS of pain appear to be antagonistic processes. (2) DNIC is affected by the distance between two noxious stimuli and to a lesser extent, by attention. (3) The interaction between DNIC, SS and attention is complex and reflects the role of sensory-cognitive integration in pain perception.