Studies on Pathophysiology and Possible Cause of Hie-Symptom ─Findings on Sublingual and Body Surface Temperature, Venous Gas Partial Pressure and the Effects of Oral Administration of PDE-5 Inhibitor Tadarafil─ / 日本温泉気候物理医学会雑誌

  Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied.   Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day.   Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom.  Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.

Studies on Pathophysiology and Possible Cause of Hie-Symptom ─Findings on Sublingual and Body Surface Temperature, Venous Gas Partial Pressure and the Effects of Oral Administration of PDE-5 Inhibitor Tadarafil─ / 日本温泉気候物理医学会雑誌

  Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied.   Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day.   Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom.  　Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.

My Research on Balneology, Sauna, Exercise and Rehabilitation Medicine / 日本温泉気候物理医学会雑誌

  My research started in 1973 at Kagoshima University Hospital Kirishima Branch founded at 1937. The hospital was reorganized as the Department of Rehabilitation Medicine and Kirishima Rehabilitation Center in 1988.   I established a new pharmacological method to measure integrated cardiovascular autonomic nervous functions, and essential hypertension was classified into two types, Type I with low sympathetic, low renin, Na-retention type and Type II with high sympathetic, high rennin, non-Na-retention type.   By bathing at 41°C for 10 min, an increase in HR and CO and decrease in TPRi was shown. Using autonomic blockers, tachycardia was shown to be derived by vagal inhibition and vasodilation by a non-autonomic mechanism. Scarlet coloring of venous blood due to increased pO2 and decreased pCO2 highly suggested improved tissue oxygenation as the basic bathing effects.   Tachycardia during exercise was derived firstly by increased sinus automaticity, and secondly vagal inhibition and sympathetic activation. Athletic bradycardia was induced firstly by decreased sinus automaticity, and secondly by vagal activation and sympathetic suppression.   Hemodynamic studies of Ibusuki sandbath showed a remarkable increase in CO and decrease in TPRi, and an increase in RAP and PAP due to heavy sand. Increased venous pO2 and decreased pCO2 and lactate-pyruvate level indicate highly accelelated tissue oxygenation and clearance of wasted material by increased peripheral circulation.   Although ICG clearance rate was reduced, increased acetoaminophen absorption indicated an increased intestinal blood flow. Increased RPF and unchanged GFR suggested suppressed intra-glomerular pressure from bathing. Urodynamic study after bathing, showed reduced intravesical pressure and increased bladder volume indicating the effects of bathing on pollakiuria in winter due to the relaxation of detrusor muscle.   Against the usual concept that bathing is harmful for CHF, we showed bathing at 40°C for 10 min was a very useful tool as a new vasodilation therapy for CHF. Sauna bathing at 60°C for 15 min was more convenient and Dr. Tei named it Waon therapy. He achieved remarkable improvements in NYHA class symptoms and circulatory parameters in severe CHF, i.e., CO, EF, intra cardiac pressure and BNP. Waon therapy was also shown to be very useful in peripheral arterial disease, post-operative paretic ileus and fibromyalgia.

My Research on Balneology, Sauna, Exercise and Rehabilitation Medicine / 日本温泉気候物理医学会雑誌

  My research started in 1973 at Kagoshima University Hospital Kirishima Branch founded at 1937. The hospital was reorganized as the Department of Rehabilitation Medicine and Kirishima Rehabilitation Center in 1988.<BR>  I established a new pharmacological method to measure integrated cardiovascular autonomic nervous functions, and essential hypertension was classified into two types, Type I with low sympathetic, low renin, Na-retention type and Type II with high sympathetic, high rennin, non-Na-retention type.<BR>  By bathing at 41°C for 10 min, an increase in HR and CO and decrease in TPRi was shown. Using autonomic blockers, tachycardia was shown to be derived by vagal inhibition and vasodilation by a non-autonomicmechanism. Scarlet coloring of venous blood due to increased pO₂ and decreased pCO₂ highly suggested improved tissue oxygenation as the basic bathing effects.<BR>  Tachycardia during exercise was derived firstly by increased sinus automaticity, and secondly vagal inhibition and sympathetic activation. Athletic bradycardia was induced firstly by decreased sinus automaticity, and secondly by vagal activation and sympathetic suppression.<BR>  Hemodynamic studies of Ibusuki sandbath showed a remarkable increase in CO and decrease in TPRi, and an increase in RAP and PAP due to heavy sand. Increased venous pO₂ and decreased pCO₂ and lactate-pyruvate level indicate highly accelelated tissue oxygenation and clearance of wasted material by increased peripheral circulation.<BR>  Although ICG clearance rate was reduced, increased acetoaminophen absorption indicated an increased intestinal blood flow. Increased RPF and unchanged GFR suggested suppressed intra-glomerular pressure from bathing. Urodynamic study after bathing, showed reduced intravesical pressure and increased bladder volume indicating the effects of bathing on pollakiuria in winter due to the relaxation of detrusor muscle.<BR>  Against the usual concept that bathing is harmful for CHF, we showed bathing at 40°C for 10 min was a very useful tool as a new vasodilation therapy for CHF. Sauna bathing at 60°C for 15 min was more convenient and Dr. Tei named it Waon therapy. He achieved remarkable improvements in NYHA class symptoms and circulatory parameters in severe CHF, i.e., CO, EF, intra cardiac pressure and BNP. Waon therapy was also shown to be very useful in peripheral arterial disease, post-operative paretic ileus and fibromyalgia.

01-2 Special effects and mechanism of Ibusuki hot spring sand bath / 日本温泉気候物理医学会雑誌

  Ibusuki hot spring sand bath (SB) (Sunamushi) has traditionally been used for the relief of musculoskeletal pain. It is specified by piling up heavy (40-60 kg) and hot (50°C) sands on the lied body heated by the hot spring water gushed at the seashore of Ibusuki. In this study, remarkable circulatory activation and metabolic improvements probably due to thermal vasodilation and higher hydrostatic pressure is examined. Subjects: The subjects examined were 20 healthy males (34.3±10.5 yrs) who accepted informed consents. Methods: The subjects were thin bathrobe and kept rest for 30 min in the supine position. BP, HR and sublingual temperature measurements and venous blood sampling from the indwelling catheter was done. Blood counts, blood gas pressure and plasma chemistry were examined. Then sand bath carried out for 10 min and 30 min rest under keeping sufficient warmth by blankets. Results: Systolic blood pressure was significantly increased though diastolic blood pressure was significantly reduced. HR and sublingual temperature were significantly increased by +22 bpm and +1.1°C, respectively, just after 10 min SB. Venous blood pO2 and pH were significantly increased by +18.3 mm Torr and +0.03pH, and pCO2 was significantly reduced by -5.8 mm Torr. Lactate and pyruvate were significantly reduced after 10 min and 30 min after sand bath suggesting the improved peripheral oxidative metabolism. Conclusion: Increase in blood pressure and heart rate indicating cardiac acceleration was considered to be induced by hydrostatic pressure with heavy sands and thermal vasodilation. Improved peripheral circulation and oxidative metabolism were also suggested by increased pO2, decreased pCO2 and decreased lactate and pyruvate level. Sufficient O2 supply and removal of wasted substances due to activated circulation was considered to be the basic mechanism of the effects of sand bath.

SL1 Cardiovascular and metabolic effects of Ibusuki Hotspring sand bath (Sunamushi) / 日本温泉気候物理医学会雑誌

  Ibusuki hotspring sand bath (SB)(Sunamushi) is a special thermal therapy using heated sands by natural hotspring gushed at the seashore of Ibusuki city. Heated heavy sands (50°C, 40-60kg) was piled on the lied body. It has traditionally been used here for 250 years to relieve muculoskeletal and neuralgic pain, and still accepts 260 thousands visitors a year. In the present study, cardiovascular and metabolic effects by SB was studied from the viewpoint of accelerated circulation. Subjects and Methods: General physical parameters (BP, HR, sublingual temperature) and plasma chemistry were examined in 20 healthy males(36 ± 10yrs). The subjects wore thin bathrobe and a venous catheter for blood sampling were set in the forearm. They kept rest in the supine position for 30min and subjected 10min SB at the municipal SB institute with hotspring piping under the sands. In another 28 healthy subjects (44.3 ± 2.4yrs), cardiac outputs and plasma catecholamines (CA) and renin activity (PRA) were measured. In 6 subjects intracardiac study by Swan-Ganz catheterization were performed. Results: Diastolic pressure were significantly decreased by 6mmHg, and heart rate and sublingual temperature were significantly increased by +20bpm and +1.1°C, respectively, after 10min SB. Venous blood pO2 and pH was significantly increased by 20mm Torr and 0.03pH, and pCO2 was significantly reduced by 5mm Torr. Lactate, pyruvate and L/P ratio were significantly reduced suggesting improved oxidative metabolism of peripheral tissues. Plasma CAs and PRA were elevated after SB. All of these results gradually returned to the resting level after 30min. Cardiac output (CO) measured by dye dilution or thermo-dilution method was significantly increased from 5.6l/min to 10.5 l/min after 10min SB, and reduced to 8.1 l/min by removing piled heavy sands. Calculated total peripheral resistance (TPR) was significantly decreaased suggesting thermal vasodilation. Although mean right atrial pressure and pulmonary arterial pressure were increased during SB, they were immediately decreased by removing piled sands. Discussion: All of these results indicate that the basic effects of SB are derived from strong hydrostatic pressure of piled heavy sands and thermal vasodilation. Increased CO due to accelerated venous return and reduced afterload (TPR) will induce sufficient oxygen supply and increased discharge of wasted matters from peripheral tissues. These data seem to be compatible with the clinical effects of SB to relieve musculoskeletal pain and fatigue. Conclusion: Significant clinical effects is induced by increased CO due to the increased hydrostatic pressure of piled sands and thermal vasodilation.

SL1Cardiovascular and metabolic effects of Ibusuki Hotspring sand bath (Sunamushi) / 日本温泉気候物理医学会雑誌

  Ibusuki hotspring sand bath (SB)(Sunamushi) is a special thermal therapy using heated sands by natural hotspring gushed at the seashore of Ibusuki city. Heated heavy sands (50°C, 40-60kg) was piled on the lied body. It has traditionally been used here for 250 years to relieve muculoskeletal and neuralgic pain, and still accepts 260 thousands visitors a year. In the present study, cardiovascular and metabolic effects by SB was studied from the viewpoint of accelerated circulation.<BR><b>Subjects and Methods: </b>General physical parameters (BP, HR, sublingual temperature) and plasma chemistry were examined in 20 healthy males(36 ± 10yrs). The subjects wore thin bathrobe and a venous catheter for blood sampling were set in the forearm. They kept rest in the supine position for 30min and subjected 10min SB at the municipal SB institute with hotspring piping under the sands. In another 28 healthy subjects (44.3 ± 2.4yrs), cardiac outputs and plasma catecholamines (CA) and renin activity (PRA) were measured. In 6 subjects intracardiac study by Swan-Ganz catheterization were performed. <BR><b>Results: </b>Diastolic pressure were significantly decreased by 6mmHg, and heart rate and sublingual temperature were significantly increased by +20bpm and +1.1°C, respectively, after 10min SB. Venous blood pO₂ and pH was significantly increased by 20mm Torr and 0.03pH, and pCO₂ was significantly reduced by 5mm Torr. Lactate, pyruvate and L/P ratio were significantly reduced suggesting improved oxidative metabolism of peripheral tissues. Plasma CAs and PRA were elevated after SB. All of these results gradually returned to the resting level after 30min. Cardiac output (CO) measured by dye dilution or thermo-dilution method was significantly increased from 5.6l/min to 10.5 l/min after 10min SB, and reduced to 8.1 l/min by removing piled heavy sands. Calculated total peripheral resistance (TPR) was significantly decreaased suggesting thermal vasodilation. Although mean right atrial pressure and pulmonary arterial pressure were increased during SB, they were immediately decreased by removing piled sands.<BR><b>Discussion: </b>All of these results indicate that the basic effects of SB are derived from strong hydrostatic pressure of piled heavy sands and thermal vasodilation. Increased CO due to accelerated venous return and reduced afterload (TPR) will induce sufficient oxygen supply and increased discharge of wasted matters from peripheral tissues. These data seem to be compatible with the clinical effects of SB to relieve musculoskeletal pain and fatigue.<BR><b>Conclusion: </b>Significant clinical effects is induced by increased CO due to the increased hydrostatic pressure of piled sands and thermal vasodilation.

01-2Special effects and mechanism of Ibusuki hot spring sand bath / 日本温泉気候物理医学会雑誌

  Ibusuki hot spring sand bath (SB) (Sunamushi) has traditionally been used for the relief of musculoskeletal pain. It is specified by piling up heavy (40-60 kg) and hot (50°C) sands on the lied body heated by the hot spring water gushed at the seashore of Ibusuki. In this study, remarkable circulatory activation and metabolic improvements probably due to thermal vasodilation and higher hydrostatic pressure is examined.<BR><b>Subjects:</b> The subjects examined were 20 healthy males (34.3±10.5 yrs) who accepted informed consents. <BR><b>Methods:</b> The subjects were thin bathrobe and kept rest for 30 min in the supine position. BP, HR and sublingual temperature measurements and venous blood sampling from the indwelling catheter was done. Blood counts, blood gas pressure and plasma chemistry were examined. Then sand bath carried out for 10 min and 30 min rest under keeping sufficient warmth by blankets.<BR><b>Results:</b> Systolic blood pressure was significantly increased though diastolic blood pressure was significantly reduced. HR and sublingual temperature were significantly increased by +22 bpm and +1.1°C, respectively, just after 10 min SB. Venous blood pO₂ and pH were significantly increased by +18.3 mm Torr and +0.03pH, and pCO₂ was significantly reduced by -5.8 mm Torr. Lactate and pyruvate were significantly reduced after 10 min and 30 min after sand bath suggesting the improved peripheral oxidative metabolism. <BR><b>Conclusion:</b> Increase in blood pressure and heart rate indicating cardiac acceleration was considered to be induced by hydrostatic pressure with heavy sands and thermal vasodilation.Improved peripheral circulation and oxidative metabolism were also suggested by increased pO₂, decreased pCO₂ and decreased lactate and pyruvate level. Sufficient O₂ supply and removal of wasted substances due to activated circulation was considered to be the basic mechanism of the effects of sand bath.

Comparative Study on the Effects of Health Promotion of Single Bathing and 200m Running / 日本温泉気候物理医学会雑誌

Purpose  The effects of 10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions. Subjects and Methods  The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading. Results and Discussion  The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation.  After bathing, venous pO2 was significantly increased and pCO2 was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO2 was decreased and pCO2 was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO2 by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested.  As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running. Conclusion  Health promotion by bathing seems to be conducted through sufficient O2 supply and washout of CO2 by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.

Comparative Study on the Effects of Health Promotion of Single Bathing and 200m Running / 日本温泉気候物理医学会雑誌

<B>Purpose</B><br> The effects of10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions.<br><B>Subjects and Methods</B><br> The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading.<br><B>Results and Discussion</B><br> The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation.<br> After bathing, venous pO<SUB>2</SUB> was significantly increased and pCO<SUB>2</SUB> was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO<SUB>2</SUB> was decreased and pCO<SUB>2</SUB> was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO<SUB>2</SUB> by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested.<br> As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running.<br><B>Conclusion</B><br> Health promotion by bathing seems to be conducted through sufficient O<SUB>2</SUB> supply and washout of CO<SUB>2</SUB> by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.

Quantitative Measurement of Blood Glucose Disposition Rate by Intravenous Glucose Infusion and the Effects of Warm Water Bathing / 日本温泉気候物理医学会雑誌

 Blood glucose disposition rate after intravenous glucose infusion is considered to reflect mainly the rate of cellular glucose uptake, the rate of glucose degradation process and gluconeogenesis. excluding the influense of glucose absorption. <br> When it is hypothesized that the elevated blood glucose is disposed by constant rate (one-compartment theory), the following formula will be realized.<br> Ct = A (1— k)^t   Ct = blood glucose level at t-minutes after infusion<br>            A = initial glucose level after infusion<br>            k = constant glucose disposition index / min<br> log Ct = log A (1—k) ^t= log A + t log (1 — k)<br> This formula demonstrates that logarithm of blood glucose concentration (Ct) is a one-dimensional (linear) function of time t with a slope log (1 — k), and blood glucose disposition index k can be calculated from this slope.<br> To examine the validity of this hypothesis, 1.5 ml / kg of 20% glucose (0.3g / kg) was infused at rest within 3 minutes into an antecubital vein and plasma glucose was determinned at 1, 3, 5, 10, 15, 20, 30 and 40 min after the cessation of infusion.<br> In 10 healthy subjects, linear regression coefficient between logarithm of plasma glucose and time t was significantly higher (r= 0.992 ± 0.006, p<0.001) during 5 to 40 min. Calculated k index ranged from 0.78 to 4.54% / min and the correlation between the 1st and the 2nd measurements (n=5) within a week was also significantly high (0.92±0.06, p<0.01). These results highly support the validity of basic formula (one-compartment theory) and practical procedure to measure k index.<br> The effects of warm water bathing (42 C, 10min) was examined in 7 subjects keeping warmth by blankets. After bathing, k value remained in nearly the same in 4 subjects, decreased in 2 and increased in 1. Although more detailed studies are needed, the effect of single bathing on glucose disposition seems to be not so significant.

A BATTERY OF FIELD TESTS FOR PREDICTING THE GENERAL PHYSICAL FITNESS LEVEL OF MALE PARAPLEGICS IN ACTIVE DAILY LIFE / 体力科学

<b>Purpose:</b> To investigate the factorial structure of physical fitness of male paraplegics with thoracic or lumbar spinal cord injury and to develop a battery of field tests for predicting their general physical fitness level.<b>Methods:</b> Fifty-three active male paraplegics with spinal cord injury (PSCI) (age range: 18-54; spinal cord injury level: T4 to L4) were examined. Thirteen feasible variables were selected using physical fitness components based on the International Committee for the Standardization of Physical Fitness Tests and previous PSCI studies. Factor analysis was applied to 14 variables; 13 of these involved physical fitness tests stratified by age to determine the factorial structure of physical fitness variables. Multiple regression analysis was performed to obtain a linear regression equation using a representative variable for each factor in the factorial structure as an independent variable. A first principal component score was obtained by principal component analysis using each variable as a dependent variable.<b>Results:</b> For factorial structure, wheelchair driving ability (3-minute shuttle run), body composition (sebum thickness), respiratory function (vital capacity) and shoulder joint extension force factors were obtained. The results of multiple regression analysis involved 5 variables (the 4 above-mentioned variables plus age); and the first principal component score of each subject from all variables provided a significant linear regression equation (r = 0.934, <i>P</i> ＜0.01) when the body composition factor was excluded.<b>Conclusions:</b> The representative measurement variables obtained from the factorial structure allowed for the development of a battery of field tests for predicting general physical fitness level of PSCI.

Acceleration of the Effects of Forearm Bathing by L-Arginine Ingestion / 日本温泉気候物理医学会雑誌

 In this study, we investigated the effects of L-Arginine, which increases the production of nitricoxide (NO) with vasodilative actions, on forearm bathing. The subjects were 12 healthy adult males with 24±1 years old. We compared the changes of blood pressure, heart rate, deep/superficial temperatures, and dermal blood flow by forearm batlmg with or without the oral ingestion of 2000mg L-Arginine. After a 30-minute rest following ingestion, the subjects took a forearm bathing ; immersion of the right forearm below the elbow in 41°C hot water for 15 minutes. There were no significant differences neither in blood pressure, heart rate, nor sublingual temperature between the changes by L-Arginine and water ingestion. Although the superficial temperature of the left toe was significarttly increased 15 minutes after the start of bathing regardless of the presence or absence of L-Arginine (p<0.01), the increase with L-Argilline ingestion was significantly greater (p<0.01) than that without L-Arginine. Furthemore, an increase in left dorsal skin blood flow after 10 to 15 minutes bathing with L-Arginine was more marked than that without L-Arginine. The increasing ratio of blood flow after 15 minutes of right forearm bathing against pre-bathing value was significantly higher (p<0.05) in case with L-Argitme than that in its absence. These results suggest that the oral administration of L-Arginine accelerates thermal vasodilative effects during forearm bathing.

Effects of Whole Body Warm Water Immersion on Indocyanine Green (ICG) Excretion Test in Healthy Human / 日本温泉気候物理医学会雑誌

Objective: Warm water immeresion (WWI) has been customary in Japan as useful thermal therapy. However, a comprehensive investigation of the effects of WWI on internal organs has never been undertaken. The purpose of this study was to examine the effects of single WWI on indocyanine green (ICG) excretion in healthy humans. Subjects: 23 healthy males. (32.6±1.9 [mean±SEM] years) Methods: 1CG was administered intravenously (0.5mg/kg) to calculate excretion rate (ER). ICG injection was given before and after WWI (10min at 41°C). Sublingual temperature (ST), blood pressure (BP), heart rate (HR), and cardiac output (CO) were simultaneously measured by noninvasive methods. Results: Significant changes were observed after WWI. These included an increase in ST, HR, and CO and a decrease in systolic BP (p<0.01). ER significantly decreased from 0.210±0.015 to 0.168±0.009 (p<0.01). Front-back ratio of ICG-ER which was calculated in order to evaluate the effect of aging increased significantly with age (R=0.582, p<0.0001). Conclusion: These results indicate that although CO increased due to the vasodilating effects of WWI, hepatic blood flow decreased after WWI and its response reduced with age even in before middle age.

Effect of Exercise Bath on Quality of Life (QOL) / 日本温泉気候物理医学会雑誌

<b>Objective</b>: Exercise baths are generally considered to be one of the most appropriate and advantageous rehabilitative therapies, yet their effects have not been comprehensively investigated. The aim of this study is to assess the efficacy of exercise baths on quality of life (QOL).<br><b>Methods</b>: The 49 subjects consisted of 20 patients with brain disease, 21 patients with orthopaedic disease, and 8 patients with other diseases (i.e., 7 life-style related diseases and one heat burn). In the present study, all patients were first treated by conventional rehabilitation comprising physical therapy and occupational therapy for 4.2±1.4 weeks. Exercise baths were then added to the rehabilitation program for a further 4.4±1.2 weeks. The subjects were immersed in water at 38°C for 30-60min, twice a week. QOL was evaluated by alterations in the MOS Short-Form 36-item Health Survey (SF-36). We defined the period from admission to exercise bath start as Treatment I, and the period from exercise bath start to discharge (exercise bath finish) as Treatment II. On admission, before and after exercise bath, QOL was evaluated using the SF-36 scores.<br><b>Results</b>: We found that the increase of all eight subscales of the SF-36 was smaller in Treatment I period than in Treatment II period. Increases in SF-36 scores were observed in all patients, in all eight domains. Specifically, after exercise baths, increased scores of Physical functioning (PF), Role physical (RP), General health (GH), Vitality (VT), Role emotional (RE) and Mental health (MH) subscales of the SF-36 were observed in the patients with brain disease. Further, after exercise baths, increased scores of PF, RP, Bodily pain (BP), GH, VT, RE and MH subscales of the SF-36 were observed in the patients with orthopedic disease.<br><b>Conclusions</b>: It was concluded that exercise baths are an effective non-pharmacological treatment that might facilitate rehabilitation programs.

The Effects of Warm Water Bathing on Renal Function / 日本温泉気候物理医学会雑誌

The effects of the bathing on renal function were studied in 12 healthy men (32.3±7.7y. o.). The subjects took 41°C, 10min bathing and kept warm by a blanket for 30min, and then a mixture of 10% para-aminohippurate (PAH, 0.3<i>ml</i>/kg) and 10% sodium thiosulfate (NTS, 80<i>ml</i>) was infused intravenously. Clearance of PAH and NTS was calculated as the index of renal plasma flow (RPF) and glomerular filtration rate (GFR). PAH and NTS clearance test was also done at rest without bathing in another day. Blood Pressure (BP), Heart rate (HR), cardiac output (CO), sublingual temperature by electric thermista as deep body temperature were measured during the experiment. 30min after bathing, sublingual temperature was significantly increased by 0.9°C, and CO by +40%. After bathing, renal plasma flow (PAH clearance) significantly increased from 388.5±158.9<i>ml</i>/min to 572±170.7<i>ml</i>/min. Glomerular filtration rate (NTS clearance) was, however, unchanged from 115.6±37.3<i>ml</i>/min to 119.3±51.3<i>ml</i>/min. Filtration fraction (GFR/RPF) was significantly decreased. These results indicated that GFR was not improved by bathing although CO and RPF was increased by thermal vasodilation effect. The mechanism of unchanged GFR, despite of increased RPF, is probably that glomerular filtration pressure unchanged by thermal vasodilation of glomerular efferent and afferent arterioles.

Effects of High Concentration Mineral Water Bathing on Deep Body Temperature and Circulatory Function / 日本温泉気候物理医学会雑誌

The effects of high concentration mineral water bating (31.16g/kg, mainly composed of Na, Ca, Mg chloride and sulfate) were studied in 13 healthy men (44.9±16.3y.o.). The subjects took 41°C, 10min bathing and kept warmth by a blanket for 30min. Blood pressure (BP), Heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and sublingual temperature by electric thermista as deep body temperature were measured during and after bathing. Skin blood flow by LASER doppler flow meter and venous partial gas pressure and pH were also measured.<br>Sublingual and forehead temperature was increased significantly by +1.4°C after 10min bathing and +0.9°C increase continued even after 30min. Diastolic BP and TPR were significantly decreased, and HR and CO were significantly increased by +20bpm and +2.7<i>l</i>/min, respectively. Significant increase of skin blood flow was also demonstrated. Significant increase of venous pO₂ (+20 Torr) and decrease of pCO₂ (-8.0 Torr) suggested the improvement of peripheral oxidative metabolism due to increased CO.<br>High concentration mineral water bathing was highly effective than simple water bathing probably due to the thick coating effect by binding concentrated minerals with skin furface protein.

Improvement of Exercise Torelance after Hot Water Bathing in Aged Men / 日本温泉気候物理医学会雑誌

Treadmill exercise tolerance test(Modified Bruce Method) was performed with and without warm water bathing (WWB, 41°C, 10min) in 14 healthy aged men and women over 65y. o. (68.6±6.0y.o).<br>Increase in HR, BP and PRP during exercise was reduced after WWB. Duration of exercise and ST depression and occurrence of arrythmia during treadmill exerecise were significantly improved after WWB. Fatigability of the legs and Borg's index were also decreased aftr WWB. These results indicated the improvement of exercise tolerance after WWB was probably due to the increase in cardiac functions and collagenous viscosity (extensivility) of the musculoskeletal system.

Circulatory Effects of Bath Agent with Senkyu and Chimpi Extract in Healthy Men / 日本温泉気候物理医学会雑誌

Phthalides and ligustilide in Senkyu extract and limonene and fravonoids in Chimpi extract have been reported to have strong vasodilation effects.<br>In the present study the circulatory effects of Senkyu and Chimpi extract (crude drug extract) were studied as bath agent in 40.0°C bath water (Senkyu ext. 224mg and Chimpi ext. 272mg/2001). Thirteen healthy men (36.2±5.8 years old) took a bath at 40.0°C for 10 min with and without (only with flavor and dye) crude drug extract and the circulatory effects were followed for 30 min after bathing.<br>Heart rate and cardiac output were increased equally by 10 min bathing either with or without crude drug extract. Although systolic blood pressure was slightly increased during bathing, diastolic blood pressure and total peripheral resistance were significantly decreased during and after bathing with and without crude drug extract. Forehead skin blood flow and sublingual temperature were significantly increased during bathing, and remained at higher level for 10-30 min after bathing with crude drug extract. Venous blood pO₂ and pH were significantly increased and pCO₂ was decreased equally with and without crude drug extract. Plasma NE was significantly increased by bathing with crude drug extract.<br>Bath agent with Senkyu and Chimpi extract are considered favorable as bath agent to keep high skin blood flow and sublingual temperature probably due to its vasodilating effects.

Effects of Cold and Warm Water Bathing of Hemiplegic Lower Limb on Its Isokinetic Muscle Strength / 日本温泉気候物理医学会雑誌

Effects of cold and warm water bathing of hemiplegic lower limb on its isokinetic muscle strength were studied in 12 chronic stroke patients (9 males and 3 females, 53.3±14.2 yo, Ueda's grading 8.5±1.6 Grade).<br>Measurements of the isokinetic muscle strength of the knee flexion/extension were repeated three times; 1) after sitting for 10min at room temperature (21-22°C) as a control, 2) after cold water bathing (18°C) of hemiplegic lower limb for 5min, 3) after warm water bathing (41°C, 700ppm artificial CO₂ bath) of hemiplegic lower limb for 10min. The measurements were performed, using Cybex 6000 (Cybex international Co) at velocities of 60, 120, 180 and 240°/sec. Artificial CO₂ bath was prepared by dissolving Kao Babu (Kao Co) in 41°C warm water.<br>Peak torque of the knee flexions at any velocity decreased significantly after cold water bathing and imcreased after warm water bathing. Change in the maximum power and total work were similar to that of the peak torque. The muscle strength of the knee extension were not changed by neither cold nor warm water bathing.<br>The correlation coefficient between Ueda's Grade and its isokinetic muscle strength ranged from 0.3 to 0.6 and significantly improved after warm water bathing at velocity of 120 (°/second) in flexion. Warm water bathing might make it easy to exert their muscle strength at 120°/sec in flexion corresponding to their severity of their hemiplegia.<br>Regarding to the influence of spasticity, patients with no ankle clonus or pseudoclonus showed a tendency to increase in muscle strength of flexion and extension after warm water bathing. In patients with evident clonus, a tendency to decrease on extension and increase on flexion was seen after warm water bathing.<br>Further studies on the effects of warm water bathing of partial and full immersion in the treatment for spasticity of hemiplegic limb would contribute to stroke rehabilitation.