Thermal Medicine in Elderly Patients

7/29/2019 Thermal Medicine in Elderly Patients

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Thermal medicine in elderly patients

Fabio Monzani

Geriatrics Section, Department of Internal Medicine, University of Pisa

Termas de CuntisMay 4-7, 2012


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Green and its nuances: > 70 aa

Ocher: 50-69 aa

Red and its nuances: < 50 aa

Brown: < 35 aa

The Aging World

Data updated to 2006


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European aging

Map of Europe showing the percentage of the

population over 65 in 2010 for each country

Data from the CIA World Factbook


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Chronic (degenerative) diseases

Risk factors

Effect

Slow onset (years)

Slow progression (years/decades)

Progressive deterioration

Cardiovascular diseases

Respiratory diseases

Tumors

Dementia

Parkinson disease

Osteoarthritis

Increased risk


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Subjects older than 60 years affected by chronic

diseases in UK from 1996 to 2066


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65-69 70-74 75-79 80-84 Total

Angina Pectoris 6,1 8,3 8,0 7,6 7,3

Myocardical infarction 5,9 8,7 8,2 7,4 7,3

Arrhythmia 18,4 22,1 26,5 26,7 22,4

Systemic hypertension 60,0 67,4 66,6 64,7 64,0

Heart failure 3,7 6,5 7,7 11,8 6,5

Diabetes 11,7 15,5 14,1 11,9 13,2

- Type I 0,3 0,3 0,2 0,3 0,3

- Type II 10,9 15,1 13,4 11,4 12,6Osteoarthritis 61,7 59,8 61,1 60,2 60,9

COPD 19,1 19,9 24,0 22,5 20,9

Peripheral vascular disease 4,8 7,0 7,9 8,7 6,5

Prevalence of chronic disease in elderly population

in Italy (Studio ILSA)

Age represent the most important risk factor for

the developing of osteoarthritis


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The impact of Musculoskeletal diseases on the

new millennium

Kofi Annan,

UN Secretary General 1999

"There are effective ways to prevent and

treat these disabling disorders, but we

must act now. Joint diseases, back

complaints, osteoporosis and

arthropathies have an enormous impacton individuals and societies, and on

healthcare services and economies."


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OA epidemiology

Muscoloskeletal diseases are the major cause of severe painand long-term disability1

About 1/4 european subject is affected by some kind ofarthropathies; 1/5 assumes chronic therapy 1,2

OA is the most common joint disease in elderly and it is themost important cause of disability1

The cost of OA for healthcare services and economies isabout 11 billions/year.

1. European Bone and Joint Health Strategies Project. European Action Toward Better Musculoskeletal

Health, 2005.2. European Opinion Research Group. EEIG. Health, food and alcohol and safety. Special Eurobarometer

186, 2003.s


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Arthropathies as the first cause of disability

(USA)1,2

Arthropathies

Spinal disorders

0 2 4 6 8 10 12 16 18

Disabilit (%)

Cardiac diseases

Pulmonary diseases

Hearing impairment

Leg and harm stiffness

Mental disorders

Diabetes

Visual impairment

Ictus

About 39 milions of medical examination/year2

> 500.000 hospitalization/year2

1. McNeil JM, Binette J.MMWR. 2001;50:120-1252. CDC. National Arthritis Action Plan. A Public Health Strategy. 1999.


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Therapy

joint supplements : Chondroitin,Glucosamine

Nonsteroidal Anti-inflammatory Drugs

e COX-1 inhibitor

Analgesic drugs: paracetamol,

tramadol

Physiotherapy

Thermal medicine


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NSAID adverse events

GI Tract: Ulcers, perforations, bleeding, obstruction strictures,enteropathy

Kidney: NSAIDs tend to promote Sodium and water retention

and edema. PGs have minimal impact on normal renal blood

flow, but become important in the compromised kidney.

Patients (particularly elderly and volume depleted) are at risk of

renal ischemia with NSAIDs.

Liver: NSAID can cause an hepatocellular damage, including an

acute liver failure, through a immunological idiosyncrasy. The

epidemiological risk of clinically apparent liver injury is low (18cases per 100000 patient years of NSAID use).

Myelopoiesis: platelet Dysfunction. Occasionally, NSAIDs have

been associated with myelotoxicity, thereby creating a toxic

neutropenia.


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totale da 61 a 70 da 60 a 80 oltre 80

Reported adverse events of the most prescribed

drugs in elderly in 2008


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Risk for hospitalization for

upper gastrointestinal hemorrhage

among elderly patients using

prescribed NSAIDs

Prevalence on NSAID use and hospital

admission for upper gastrointestinal

hemorrhage

NSAID and upper gastrointestinal hemorrhage


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The effect of age on the relative risk of upper

gastrointestinal hemorrhage(Hernandez Diaz e Rodriguez, Arch Intern Med, 2000)


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Thermal treatments (bath therapy, mud

treatments, mud-bath treatments, inhalations

and thermal rehabilitation treatments) can be

considered as a true and natural answer to

prevention, rehabilitation and treatment of

serious pathologies.

Moreover, thermal environment can promote a

correct life style and balanced diet


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Major indications of thermal hydrokinesitherapy

Neurological disease: Peripheral paralysis

(poliomyelitis, neuritis..)

Central nervous system disease

(paraplegia, hemiplegia..)

Myopathy

Traumatology

Fractures Muscle trauma,

Tendon injuries

Orthopedic disease Dysmorphism of the developmental

age (scoliosis, kyphosis..)

Effects of surgical interventions

Rheumatology Degenerative joint disease

Inflammatory joint disease

(not in acute phase)

Back and neck pain

Periarteritis

Muscle stiffness and hypotonia


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8 GRUPPI DI MALATTIE

SENSIBILI ALLA TERAPIA TERMALE

d.m. 15 dicembre 1994G.U. n. 57 - 9 marzo 1995

UNIVERSIT DI PISAFacolt di Medicina e ChirurgiaScuola di Specializzazione in Idrologia Medica

UNIVERSIT DI PISA

Scuola di Specializzazione in Idrologia Medica


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Decreto

ministeriale 15

dic 1994 Osteoartrosi e altre forme degener.

AFFEZIONI

ACCREDITABILIS.S.N.

MAL. ARTROREUMOPATICHE

Reumatismi extra articolari

Sindr. rino-sinuso-bronchiali cron.

MAL. VIE RESPIRATORIE

Broncopneumopatie croniche semplici

ostruttive (escluso asma o enfisema

avanzato complicato o no da insuff. resp.

grave o cuore polmonare cronico)

Psoriasi

MAL. DERMATOLOGICHE

Eczema e dermatite atopica

Dermatite seborroica ricorrente

Sclerosi dolorosa connettivo pelvico

MAL. GINECOLOGICHE

Leucorrea persistente da vaginiti

Croniche aspecifiche o distrofiche

Rinopatia vasomotoria

MAL. ORL

Faringolaringiti croniche

MAL. APPARATO URINARIO

Sinusiti croniche

Sordit rinogena (ototubarite eotitie catarrale cronica)

Otiti croniche purul. non

colesteatomatose

MAL. GASTROENTERICHE

Urolitiasi e sue recidive

Dispepsia di origine gastroenterica e

biliare

Sindrome del colon iirritabile nella

variet con stipsi

Postumi di flebopatie di tipo cronico

MAL. VASCOLARI


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Balneotherapy in patients with chronic inflammatory

musculoskeletal diseases

B l h i i i h h i


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Balneotherapy in patients with chronic non-

inflammatory musculoskeletal diseases


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osteoarthritis of the knee chronic low back pain

Gal J et al 2008


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Group 1: Balneotherapy (n=25; 36 C, 20 min; 10 sessions)

Group 2: Mud-pack therapy (n=25; 42 C, 20 min; 10 sessions)

Group 3: Hot-pack therapy (n=25; 42 C, 20 min; 10 sessions)Join Bone Spine 2007


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The maximum walking distance was improved in both Group 1 and 2

(p


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237 outpatients:117 patients assigned to BT

120 patients to paroxetine.

Dubois O et al. 2010

Improvement HAM-A scoresin BT group 12.0

In paroxetine group 8.7

(p < 0.001).


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Balneotherapy in metabolic conditions


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Stress hormones liberated by

fangotherapy. ACTH and -endorphin

levels under heat stressGiusti P, Cima L, Tinello A, Cozzi F, Targa L, Lazzarin P, Todesco

Fortschr Med. 1990

The repeated brief increases in plasma -

endorphin during thermal treatment result in

progressive improvement in articular and

muscular symptomatology. The results of our

study on plasma levels of ACTH confirm that the

thermal stress associated with mud therapyactivates the pituitary gland.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Giusti%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cima%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Tinello%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cozzi%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Targa%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lazzarin%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lazzarin%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lazzarin%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lazzarin%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Targa%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Targa%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Targa%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cozzi%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cozzi%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cozzi%20F%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Tinello%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Tinello%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Tinello%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cima%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cima%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cima%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Giusti%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Giusti%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Giusti%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Giusti%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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Beta-endorphin and stress hormones in

patients affected by osteoarthritis

undergoing thermal mud therapy

It may be suggested that thermal

treatment, by reducing inflammation,reduced pain and therefore diminished

the cause of stress.

Pizzoferrato et al. Minerva Medica 2000


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Mud modifies NO, myeloperoxidase and glutathione

peroxidase serum levels in arthritic patients and -

endorphin and stress hormones in patients affected

by osteoarthritis by reducing inflammation. Thermalstress associated with mud therapy activates the

pituitary gland. The biochemical effects of peat

components are aside from their physical-thermal

effects.

Is mud an anti-inflammatory?Giacomino MI, de Michele DF.

An Med Interna. 2007
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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Balneotherapy for osteoarthritis.

Verhagen APBierma-Zeinstra SMBoers MCardoso JRLambeck Jde Bie RAde Vet

HC

Cochrane Database Syst Rev. 2007

We found silver level evidence concerning the beneficial

effects of mineral baths compared to no treatment.However, the scientific evidence is weak because of the

poor methodological quality and the absence of an

adequate statistical analysis and data presentation.

Therefore, the noted "positive findings" should beviewed with caution.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Boers%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cardoso%20JR%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lambeck%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Bie%20RA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Vet%20HC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Vet%20HC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Vet%20HC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Vet%20HC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Bie%20RA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Bie%20RA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Bie%20RA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22de%20Bie%20RA%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lambeck%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lambeck%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Lambeck%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cardoso%20JR%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Boers%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bierma-Zeinstra%20SM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhagen%20AP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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Sauna bath and in general

thermal therapies have been

traditionally considered

inappropriate for patients with

congestive heart failure (CHF).

Repeated thermal therapy improves impaired vascular


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Imamura M et al. J Am Coll Cardiol 2001

Repeated thermal therapy improves impaired vascular

endothelial function in patients with coronary risk

factors

R t d t t t i l d th li l


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Repeated sauna treatment improves vascular endothelial

and cardiac function in patients with chronic heart failure

Kihara T et al M et al. J Am Coll Cardiol 2002

20 patients (62 15 yrs) in NYHA functional class II orIII CHF were treated in a dry sauna at 60 degrees C for15 and then kept on bed rest with a blanket for 30, dailyfor 2 weeks. 10 patients, matched for age, gender andNYHA functional class, served as control group


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41 patients with chronic heart failure (mean age 68.3 13.5 years old) underwentWaon therapy 5 times a week for 3 weeks.

6-minute walk distance increased from 337120 to 379 126 m, (p


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In summary

Many evidences documented an improvement of

cardiovascular hemodynamics in patients with chronic

CHF due to ischemic or idiopathic dilated

cardiomyopathy. This is presumably due to a reduction

in cardiac preload and afterload by thermal systemicarterial, pulmonary arterial, and venous vasodilation.

These data suggest that thermal vasodilation has

salutary effects even for patients with severe heart

failure and may represent a novel nonpharmacological

therapy for patients with CHF. The long-term benefits ofthese interventions warrant further investigation.


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In conclusion, thermal therapy could

represent an important step in thetherapeutic approach to elderly patients

affected by OA.

Thermal therapy could not only act on joint

disease, reducing pain and disability, but also

could improve heart failure and depressive

symptoms as well as quality of life.

Moreover a decrease of pain could reduce the

assumption of anti-inflammatory drugs and

their adverse effects

P j t f lti t t d


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To evaluate the role of crenokinesiterapia and balneotheraphy

in reducing pain and improving joint mobility and functional

autonomy in patients older than 65 years affected by

ostheoarthrosis.

Project of multicenter study

All patients will be submitted to 2 complete thermal treatment of six days

length (total 12 days).

Biochemical (i.e. CBC, renal function, glycemia, BNP, inflammatory indices) and

clinical parameters will be evaluated.

Moreover, all patients will be submitted to a complete multifunctional

assessment [The Arthritis Impact Measurement Scales (AIMS), Lequesne

index, Roland and Morris Disability Questionnaire, Neck Pain Disability Index,

Short Form 36 (SF-36), Geriatric Depression Scale (GDS)]. Pain will be assessedby VAS.

All these evaluations will be performed before and after the treatment and

also after 3 and 6 months.

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Thermal Medicine in Elderly Patients