Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial.

BACKGROUND: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group. METHODS: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days. RESULTS: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP. CONCLUSIONS: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach. TRIAL REGISTRATION: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Feasibility of Ski Mountaineering for Patients Following a Total Knee Arthroplasty: A Descriptive Field Study.

Background: Total knee arthroplasty (TKA) is socially relevant due to its high prevalence, high incidence and the affected population. A subpopulation of TKA patients exists that strives to be active and also return to sports after total joint replacement. In this context, a further group of TKA patients is interested in high-impact physical activities and want to proceed with such activities even after surgery. Focusing on winter sports, there is still a lack of evidence on whether ski mountaineering is feasible for this subgroup of patients. Therefore, this feasibility study examines the effects of moderate ski mountaineering on strength, balance, functional abilities and mental health in persons following a TKA. Methods: Eight patients (six males, two females; median age, 63 ± Interquartile range 9 years) with TKA were included in this study. The volunteers, who were pre-selected for a 7-day holiday in Sankt Johann (Tyrol, Austria), participated in five guided ski mountaineering tours. Statistical analyses of non-parametric longitudinal data were performed using analysis of variance. For gait parameters and the Feeling Scale, one-factor longitudinal models were used. Statistical significance was set at the level of p < 0.05. Results: A significant decrease in the S3-Check MFT stability index (p = 0.04), a significant increase in general well-being (p = 0.05), and a trend towards a decrease in general stress (p = 0.1) were detected, while all other parameters were unaffected. Conclusion: A 7-day recreational ski mountaineering holiday had no negative effects on ski-experienced patients with TKA and seemed to increase well-being. Further studies should focus on larger groups and use controlled designs. Additionally, long-term effects should be evaluated.

Effects of moderate mountain hiking and balneotherapy on community-dwelling older people: A randomized controlled trial.

BACKGROUND: Population aging is one of the greatest socio-economic challenges of the 21st century, as aging is a well-known risk factor for the development of chronic diseases and functional disabilities. A sedentary life-style promotes the progression of chronic diseases and impaired mobility in older people. Therefore, physical activity is essential for healthy aging. The optimal exercise program for older persons, which covers fall prevention as well as endurance and strength, still remains unclear. METHODS: We performed a longitudinal, randomized, controlled intervention study to investigate the combined effects of moderate mountain hiking and balneotherapy on gait, balance, body composition and quality of life on high-functioning people aged 65-85 years. The intervention group (n = 106) participated in a seven-day holiday with mountain hiking tours. In addition, balneotherapy was applied. The control group (n = 33) spent a typical seven-day cultural holiday with sightseeing. Medical examinations were performed before (day 0) and after the intervention week (day 7), after two months (day 60) and after half a year (day 180). Statistical analysis was done by fully nonparametric analysis of variance-type testing. RESULTS: An improvement of static balance was observed in the intervention group (treatment effect p = 0.02). No significant changes were found in dynamic balance, measured as center of pressure, gait parameters and self-assessed balance confidence. Only for gait speed, a short-term effect was observed (treatment p = 0.03). The gait speed increased in the intervention group. Although quality of life improved significantly in both groups, a sustainable effect until day 60 is only visible in the intervention group (interaction effect for treatment and day-60 p = 0.02). Significant interaction effects of treatment and time were found for total body water (p = 0.04), appendicular muscle mass (p = 0.04) and fat free mass index (p = 0.03), all indicating an increase of these variables in the intervention group. CONCLUSIONS: A seven-day intervention with moderate mountain hiking in combination with balneotherapy is an effective training for highly functioning older persons, inducing short-term improvements in static balance and quality of life.

Winter Exercise Reduces Allergic Airway Inflammation: A Randomized Controlled Study.

Background: Physical exercise is often recommended as additional treatment for people suffering from allergic rhinitis and/or asthma, but less is known about the specific effects of recreational winter outdoor exercise on allergic airway inflammation. Methods: We performed a longitudinal, randomized controlled intervention study to investigate the effects of recreational winter exercise on allergic airway inflammation, quality of life, spirometry and cardiorespiratory fitness in adults suffering from allergic rhinitis and/or asthma. The exercise group participated in a ten-day winter sports program. The control group did not receive any intervention. Results: A significant improvement of fractional oral exhaled nitric oxide (FeNO; p = 0.008, day 10) and a significant decrease in FeNO after a single 4 h hiking tour (p < 0.001, time effect) were observed for the exercise group. The nasal eosinophilic cell count revealed a short-term reduction (p = 0.021, treatment effect) in the exercise group and for the visual analogue scale sustainable improvements in allergic symptoms (p < 0.001, day 60) were found. No adverse effects of outdoor winter exercise were observed. Conclusion: Recreational winter exercise at moderately cold temperatures reduces allergic airway inflammation measured as FeNO, nasal eosinophilic cell count and induces sustainable improvements in allergic symptoms.

Does waterfall aerosol influence mucosal immunity and chronic stress? A randomized controlled clinical trial.

BACKGROUND: The specific microclimate of alpine waterfalls with high levels of ionized water aerosols has been suggested to trigger beneficial immunological and psychological effects. In the present three-armed randomized controlled clinical study, we focused on effects on (i) immunological reagibility, on (ii) physiological stress responses, and on (iii) stress-related psychological parameters. METHODS: People with moderate to high stress levels (n = 65) spent an active sojourn with daily hiking tours in the National Park Hohe Tauern (Großkirchheim, Austria). Half of the group was exposed to water aerosol of an alpine waterfall for 1 h/day (first arm, n = 33), whereas the other half spent the same time at a distant site (second arm, n = 32). A third arm (control, n = 26) had no intervention (except vaccination) and stayed at home, maintaining their usual lifestyle. The effect of the interventions on the immune system was tested by oral vaccination with an approved cholera vaccine and measuring specific salivary IgA antibody titers. Lung function was determined by peak expiratory flow measurement. Electric skin conductance, heart rate, and adaption of respiration rate were assessed as physiological stress parameters. Psychological stress-related parameters were analyzed by questionnaires and scales. RESULTS: Compared to the control group, both intervention groups showed improvement of the lung function and of most physiological stress test parameters. Analysis of the mucosal immune response revealed a waterfall-specific beneficial effect with elevated IgA titers in the waterfall group. In line with these results, exposure to waterfall revealed an additional benefit concerning psychological parameters such as subjective stress perception (measured via visual analog scale), the Global Severity Index (GSI), and the Positive Symptom Total (PST). CONCLUSIONS: Our study provides new data, which strongly support an "added value" of exposure to waterfall microclimate when combined with a therapeutic sojourn at high altitude including regular physical activity.

No Concentration Decrease of House Dust Mite Allergens With Rising Altitude in Alpine Regions.

PURPOSE: Several studies over the past 4 decades have indicated a significant reduction in house dust mite (HDM) and HDM allergen concentration in areas higher than 1,500 m above sea level. These have served as basis of allergen avoidance therapies for HDM allergy and asthma. However, modern construction techniques used in the insulation, heating, and glazing of buildings as well as global warming have changed the environmental parameters for HDM living conditions. The present study revisits the paradigm of decreasing HDM allergen concentrations with increasing altitude in the alpine region of Germany and Austria. METHODS: A total of 122 dust samples from different abodes (hotels, privates and mountain huts) at different altitudes (400-2,600 m) were taken, and concentrations of HDM allergens were analyzed. Humidity and temperature conditions, and numerous indoor environmental parameters such as fine dust, type of flooring, age of building, and frequency of cleaning were determined. RESULTS: HDM allergen concentrations did not significantly change with increasing altitude or relative humidity. At the level of indoor parameters, correlations could be found for different flooring types and the concentration of HDM allergens. CONCLUSIONS: In contrast to the widespread view of the relationship between altitude and HDM allergen concentrations, clinically relevant concentrations of HDM allergens could be detected in high-lying alpine regions in Austria and Germany. These results indicate that improvement in conditions of asthmatic patients sensitized against HDMs during a stay at high altitude can no longer be ascribed to decreased levels of HDM allergens, instead, other mechanisms may trigger the beneficial effect.