CHRISTOPH GUTENBRUNNER - Health Prevention
-
Upload
vectweb-lda -
Category
Documents
-
view
219 -
download
0
description
Transcript of CHRISTOPH GUTENBRUNNER - Health Prevention
Health prevention – from the
viewpoint of medicine
Christoph Gutenbrunner
Christoph Gutenbrunner, MD, PhD, Professor
Department for Rehabilitation Medicine
Institute for Balneology and Medical Climatology
Hanover Medical School
D-30625 Hannover
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Overview
Health prevention: what is it?
Chronic health conditions: how do they begin?
Recovery and Adaptation: how does it work?
Health prevention: what are the strategies?
Health resort: why to go there?
Effects: do we have any scientific evidence?
Conclusions: what are the preconditions?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health prevention: what is it?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health strategies: ICHA-HC (OECD 2001; 2010)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health prevention: ICHA-HC (OECD 2001)
Prevention and public health services:
◦ Maternal and child health
◦ Family planning and counselling
◦ School health services
◦ Prevention of communicable diseases (e.g. vaccination)
◦ Prevention of non-communicable diseases
- public health services of health education, disease prevention
(incl. Interventions against smoking, alcohol abuse)
- services provided by self-help groups; general health education
and health information (incl. campaigns in favour of
healthier life-styles, safe sex, etc.)
◦ Occupational health care
◦ All other miscellaneous public health services
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health prevention: what is it?
Health prevention in health resorts may aim at
◦ diagnosis and assessement of risk factors (e.g. physical
inactivity, obesity and metabolic syndrome,
distress, smoking etc.)
◦ reducing risk factors (e.g. weight reduction, blood
pressure normalisation, stop smoking etc.)
◦ health education (reducing risk behavior, supporting
healthy life style)
◦ normalise autonomuos dysfunction and enhance physical
capacity (both cardiovasular and muscular
performance)
◦ improve mood, energy and drive
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Chronic health conditions: how do they
begin?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Metabolic syndrome in obesity
0
50
100
150
200
250
300
350
400
450
500 Plasma glucose
0
20
40
60
80
100
120
140
160
180
200
220
Plasma insulin blood sugar
regulation
in the i.v.-glucose-
tolerance test
(5th min)
Normal body weight
Overweight
n=16, each
Data from
Melani et al. (1967)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Chronic health conditions: how do they begin?
Risk factors for chronic health conditions (examples)
◦ physical inactivity
◦ unhealthy food
◦ distress
◦ smoking
Early signs for chronic health conditions (examples)
◦ insuline resistance
◦ blood pressure dysregulation
◦ muscle weakness
◦ reduced airway clearance
Conclusion: most chronic health condition initially start from
dysregulation of autonomous functions
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Recovery and Adaptation: how does it
work?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Recovery and Adaptation: how does it work?
Short-term recovery (minutes)
◦ recovery of local metabolic processes
Sleep-wakefulness (day)
◦ recovery of autonomous functions
Functional adaptation (weeks)
◦ improvement of autonomous regulation
Trophical adaptation (months)
◦ growth of (specific) tissues
Neuroplasticity (months to years)
◦ enhancement of neuronal functions
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Functional adaptation
Functional adaptive processes evoked by balneological
stimuli may lead to adaptive normalization of functions
controlled by the autonomous regulation system
◦ e.g. cardio-respiratory, metabolic, digestive or immune
functions
Adaptive normalization is formally characterized by
◦ convergence of functional parameters
◦ aiming at normal values
◦ coincidence of normal values with functional optima
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Adaptive normalisation (blood pressure)
Systo
lic b
loo
d p
res
su
re [
mm
Hg
]
Days of treatment
Hypertension
(n=8)
Normal blood
pressure (n=80)
Low blood
pressure (n=16)
Gutenbrunner &
Ruppel: Phys
Med Rehab Kuror
1992; 2: 58-64
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Initial values (classes of 10 mmHg) days 1-3
Ch
an
ge o
f b
loo
d p
ressu
re (
lin
ear
reg
ressio
n)
days 4
-28
Normalisation
of the systolic
blood pressure
Target value
Norm
al ra
nge
Decre
ase
Inc
reas
e
Gutenbrunner
& Ruppel:
Phys Med
Rehab Kuror
1992; 2: 58-64
Adaptive normalisation (blood pressure)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Reaction time
Patients
Controls
optical
acoustical
Shimmer test
Days of treatment
Fre
quency [H
z]
Reaction tim
e [m
s]
Cited from: Gutenbrunner &
Hildebrandt: Handbuch der
Balneologie und medizinischen
Klimatologie, Springer 1998
Reactive periods (vigilance functions)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Long-term effects (physical working capacity)
Group 1 (n = 17)
Group 2 (n= 45)
W1
30
[% o
f in
itia
l va
lue]
Weeks Months after end of treatment
Cited from:
Gutenbrunner C,
Hildebrandt G:
Handbuch der
Balneologie und
medizinischen
Klimatologie, Springer
1998
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Study on body weight changes
Aim of the study: formal evaluation of the body weight changes
undergoing complex spa treatment
Patients: 646 patients undergoing spa treatment in Bad
Wildungen, most of the because of musculoskeletal
problems (low back pain, cervical pain, osteoarthritis of
knee and or hip)
Inclusion: consecutive patients (with wide range of body weight)
Evaluation:
◦ Daily blood pressure measurements
◦ Body weight at the begin and at the end of treatment
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Changes of body weight
Gutenbrunner C, Ruppel K: Akt
Ernähr Med 1992; 17: 8 (1992).
Ch
an
ge o
f b
od
y w
eig
ht
[kg
]
Deviation from normal weight [%]
(begin of treatment)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Body weight changes and calorie intake
Gutenbrunner C, Ruppel
K: Akt Ernähr Med 1992;
17: 8 (1992).
Ch
an
ge o
f b
od
y w
eig
ht
[kg
]
Deviation from normal weight [%]
(begin of treatment)
Diet:
2300 kcal/day
1000 kcal/day
800 kcal/day
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Recovery and Adaptation: how does it work?
Short-term recovery (one night of good sleep; relaxation at weekend)
lead to improvement of body functions, well being and
performance but does not normalize autonomous regulation
Long-term recovery or functional adaptation (three to six weeks of
adaptation) improve regulation capacity
◦ physical and psychological stress can be compensated
◦ performance is increase for many months
◦ risk factors may be reduced
Long-term training (mostly more than six weeks of adaptation) increases
capacity of specific functional tissues (muscle strength, bone
density and others)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health prevention: what are the
strategies?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health prevention: what are the strategies?
Analizing risk factors and diagnosing early signs of chronic
diseases (check-up)
Improving autonomous regulation by functional adaptation and
increase performance
Training to compensate insufficient functions
Teach health generating factors and pathophysiological knowledge
Enable persons to handle with stress
Modify behavior aiming at reducing risk behavior and support
healthy living
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health resort: why to go there?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Health resort: why to go there?
Specific health promoting factors
◦ climate
◦ landscape, training facilities
Expertise to solve the problem and to treat the health condition and
means to do so , e.g.
◦ doctors, psychologists, therapists, dieticians
◦ baleotherapy, physiotherapy, training
Environment supporting well-being, e.g.
◦ scenery and architecture
◦ cultural events, places for spirituality
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Balneotherapy: modalities
Substances, e.g.:
◦ Mineral waters (Na, Ca, Mg, Cl, SO4, H2S, CO2, trace elements)
◦ gases (CO2, H2S, Rn)
◦ peloids (mud, peat, fango and others)
Modes of application, e.g.:
◦ bathing
◦ drinking
◦ inhalation
Dosage, e.g.:
◦ single use
◦ series
◦ combination
Gutenbrunner C et al.:
J Biometeorol 2010;
54: 459-507
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Effective factors of health resort treatments
Health resort medicine: performance of comprehensive medical
concepts for prevention, therapy and rehabilitation including
◦ medical examination
◦ balneotherapy
◦ hydrotherapy
◦ physiotherapy
◦ diet
◦ psychotherapy
◦ education
◦ change of environment
◦ climate
◦ cultural factors
◦ and others
Gutenbrunner C et al.:
J Biometeorol 2010;
54: 459-507
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Effects: do we have any scientific
evidence?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Lower Saxony Cardiovascular Prevention Study
Aim of study: Are inpatient rehabilitative measures effective in
patients with an elevated cardio-vascular risk factor
profile?
Design of study: Prospective controlled study
Inclusion criteria: At least two cardiovascular risk factors or
LDL<135 mg%
Intervention: Three weeks inpatient rehabilitative measures in a
specialized rehab centre including physical medicine,
balneotherapy, diet and health education
Controls: Care of their family doctors
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Parameters: Metabolic risk factors, blood pressure, behavioral
risk factors (diet, stress behavior), psychometric variables
Time points: Two weeks before (T1), two weeks after (T2) and
one year after the treatment or control period (T3)
(all measurements were carried out at day-to-day-
conditions)
Number of cases:
◦ Includes cases: n = 199 (49 women, 150 men)
◦ Drop outs: n = 23
◦ evaluable cases:
- study group: n = 82
- control group: n = 94
Lower Saxony Cardiovascular Prevention Study
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Parameter p-value ( T1-T2) p-value ( T1-T3)
Overall effect p = 0,000*) p = 0,020*)
BMI [kg/m2] p = 0,000**) p = 0,021**)
Apolipoprotein B [mg/dl] p = 0,015**) p = 0,008**)
Fasting insulin [mg/dl] p = 0,035**) p = 0,034**)
Fibrinogen [mg/dl] p = 0,950**) p = 0,215**)
Mean arterial blood pressure [mmHg] p = 0,002**) p = 0,101**)
Lower Saxony Cardiovascular Prevention Study
Gutenbrunner et al.: Phys Med Rehab Kuror 2001; 12: 272-283
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
-15
-10
-5
0
5
10
p<0,05
[mg/dl]
Change of
Apolipo-
protein B
diffe
rence
control group
(n=82)
study group
(n=71)
0,0
0,1
0,2
0,3
0,4
0,5
0,6
T1-T2 T1-T3T1-T2 T1-T3
Effect size
eff
ect
siz
e
Gutenbrunner et al.:
Phys Med Rehab Kuror 2001; 12: 272-283
Lower Saxony Cardiovascular Prevention Study
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
-2,0
-1,5
-1,0
-0,5
0,0
0,5
1,0
p<0,001
[kg/m²]
Change
of BMI
diffe
rence o
f B
MI
control group
(n=50)
study group
(n=49)
0,0
0,1
0,2
0,3
0,4
0,5
0,6
T1-T2 T1-T3T1-T2 T1-T3
Effect size
eff
ect
siz
e
Gutenbrunner et al.:
Phys Med Rehab Kuror 2001; 12: 272-283
Lower Saxony Cardiovascular Prevention Study
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Renal stone formation metaphylaxis study
Design of the Study:
◦ Controlled study, cross-over-design
Patients:
◦ Patients with multi-episodic CaOx-urolithiasis (n=34)
Setting:
◦ Everyday activities, nutrition protocol
Intervention:
◦ 1.5 l/d bicarbonated water (2,673 mg HCO3/l)
◦ 1.5 l/d low-mineralized water (98 mg HCO3/l)
Main Outcome Parameters:
◦ urinary pH, magnesium- and citrate excretion
◦ CaOx supersaturation
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
1,0
1,5
2,0
2,5
3,0
3,5
4,0
******
[l]
Patients with Recurrent Urolithiasis
n = 34
Urinary
Volume
Baseline
Controls
Baseline
Bicarbonate Water
5,5
6,0
6,5
7,0
***
*
Urinary
pH
1,0
1,5
2,0
2,5
3,0
3,5
4,0
4,5
******
Supersaturation
CaOx
Karagülle et al.,
World J Urol 2007;
25: 315-323
Renal stone formation metaphylaxis study
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Germa Spa Visit Study
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Effects: do we have any scientific evidence?
It has been shown that serial application of belnotherapy and
exercise can induce functional adaptation leading to
improved autonomous regulation (with long-term effects)
Clinical preventions studies show that systematic and medically
driven health resort interventions lead to a reduction of
cardiovascular risk factors and increase physical
performance (long-tem effects)
Clinical studies with patients show beneficial effects of balneo-
therapy and health resort medicine on pain in muskulo-
skeletal disorders (e.g. low-back-pain, osteoarthritis), mental d
isorder (anxiety, depression) and others (skin disorders,
cardiovascular disorder, airway disease)
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Conclusions: what are the
preconditions?
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Conclusions: what are the preconditions?
For health prevention health resorts must provide:
◦ Medical check-up done by a doctor
◦ individual prevention plan
◦ balneotherapy according to individual need (prescription!)
◦ supervised exercise treatment
◦ dietary programs
◦ health education programs
Clients must
◦ actively participate in the program
◦ stay long enough (3 to 6 weeks)
From the medical perspective outcome research is a must!
Health prevention – from the viewpoint of medicine
Christoph Gutenbrunner
16th Annual ESPA Congress
Belek, May 25th, 2011
Christoph Gutenbrunner, MD, PhD, Professor
Department for Physical Medicine and Rehabilitation
Institute for Balneology and Medical Climatology
Hanover Medical School
D-30625 Hannover