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Published on: January 15, 2020
by Women’s Brain Health Initiative:
SWEAT IT OUT
Sauna bathing, a form of passive heat therapy, is a traditional activity in Finland that is primarily used for relaxation purposes and is becoming increasingly common in many other populations. The typical Finnish sauna is characterized by dry air and relatively high temperature. The recommended temperature for a sauna bath is from 80 to 100 degrees Celsius at the level of the bather’s head, but is lower at the floor level, which helps ensure efficient ventilation and comfortable bathing conditions.
Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked with several health benefits, including a reduction in the risk of high blood pressure or hypertension, stroke, neurocognitive diseases, and pulmonary diseases.
Research conducted in Eastern Finland by Dr. Jari Laukkanen and colleagues – published in JAMA Internal Medicine in April 2015 – found that middle-aged men (between the ages of 42 and 60) who had sauna bathing sessions four to seven times per week were at a reduced risk of sudden cardiac death, fatal coronary heart disease, and fatal cardiovascular disease, as well as a considerable decreased risk of all-cause mortality events.
More recently, the research team investigated the association between sauna bathing and the risk of dementia using the same cohort of middle-aged men. Their findings were published in the March 2017 issue of Age and Ageing. The researchers discovered a strong inverse association between the frequency of sauna bathing and the risk of dementia and Alzheimer’s disease, which was independent of known risk factors.
The more frequently a participant used a sauna each week, the lower the risk of dementia. More specifically, among those participants who used a sauna four to seven times per week, the risk of dementia was 66% lower than among those who used a sauna just once a week, and the risk of Alzheimer’s disease was 65% lower. Dr. Laukkanen and colleagues noted, however, that these results are still early and further studies are needed to replicate these findings in different populations.
After conducting a comprehensive review of the existing evidence (up until February 2018) on the various health benefits of sauna bathing, Dr. Laukkanen and colleagues concluded that “sauna bathing may be a remedy to the call for additional lifestyle interventions needed to enhance health and wellness, particularly in populations that have difficulty exercising, and also as an adjunct to exercise.”
The review article – which was published in the Mayo Clinic Proceedings in August 2018 – notes that the responses produced by an ordinary sauna bath correspond to those produced by moderate- or high-intensity physical activity such as walking.
Although the research team notes that sauna bathing is generally a “safe activity,” individuals should consult with their physicians before engaging in sauna sessions.
THE SWEET SMELL OF SUCCESS
Aromatherapy is based on the theory that essential oils, derived from plants, have beneficial properties. Aromatherapy scents are released by warming oil in oil burners, adding it to baths, dripping the scent onto pillows and tissues, or massaging infusions of the oil into the skin with cream.
There is clinical evidence to suggest that aromatherapy may be effective in helping to treat the behavioural symptoms of Alzheimer’s patients, such as aggression and agitation.
Currently, the management of these symptoms often relies on the employment of antipsychotic drugs, which are usually used to treat people with schizophrenia or depression. However, not all antipsychotics have the same benefits, and risperidone is the only antipsychotic that is currently approved for the treatment of aggression in Alzheimer’s disease (and is only licensed for short-term use).
Treating Alzheimer’s behavioural changes with drugs intended for other mental health conditions – as opposed to its own discrete disease process – poses a significant problem, observed Dr. Giacinto Bagetta, a professor in the department of Pharmacy, Health Science and Nutrition at the University of Calabria in Italy. “It’s a problem of unmet needs. We don’t know how to treat Alzheimer’s. We are trying to treat it with what we have.”
Long-term treatment with antipsychotics “may damage exactly what remains of the neural network,” warned Dr. Bagetta. What’s more, these drugs have only a “modest” effect in treating those with dementia, according to a study published in JAMA in 2005, “and [is] further complicated by an increased risk of stroke.” Because of the complexity of this issue and the lack of targeted pharmaceuticals, Dr. Bagetta and his colleagues are looking at aromatherapy for treating the behavioural effects of the disease.
Dr. Bagetta is quick to note that, even though it has been around for ages, “very little is known about aromatherapy” scientifically, and therefore additional research must be conducted in order to better understand the ways in which essential oils affect the body.
According to Dr. Bagetta, there is evidence that most essential oils have anti-inflammatory properties, and many also have analgesic (i.e. pain-relieving) qualities. “Animal models have shown this, but good clinical evidence is still needed on humans.”
Some limited work with lavender essential oil has been shown to help improve symptoms of agitation in dementia patients. For instance, in one study published in the International Journal of Geriatric Psychiatry in April 2002, Dr. Clive Holmes and colleagues administered lavender essential oil through a steam diffuser for two hours per day, every other day, for a total of ten treatment sessions. The researchers found that most patients experienced a lessening of agitation, though the sample size was quite small.
Lemon balm has also been used to treat behavioural symptoms with success. In one study involving lemon balm – published in the July 2002 issue of the Journal of Clinical Psychiatry – participants with severe dementia experienced a lessening of what is referred to as “clinically significant agitation” when this essential oil was added to lotion and applied to the skin by caregivers.
Although aromatherapy cannot prevent or cure Alzheimer’s disease, the outcomes and effects of essential oils in these limited studies “are not less than what we see with neuroleptics,” said Dr. Bagetta, and they offer a safer treatment option for dementia patients than the drugs currently used.
What is still needed, Dr. Bagetta noted, is a large-scale, international clinical trial to test the efficacy of aromatherapy in humans. More work needs to be done, though, to change the composition of the essential oils in order to mask their well-known smells (so as to ensure proper placebo control).
Another challenge with using aromatherapy in clinical trials is guaranteeing the consistency of the particular oil components being tested, since many oils have different degrees of purity and complexity. These are expensive problems for scientists, and because aromatherapy is a “natural” treatment option, they do not attract significant investor or industry interest or funding.
Nalini Sen, Director of the Research Program at the Alzheimer Society of Canada, noted that research in aromatherapy and dementia to date has shown “that aromatherapy may be effective in helping people with dementia to relax,” and it can have a calming effect in some individuals “in the early to middle stages of the disease,” just as it does for those without dementia. (For instance, a review article published in 2018 in the Journal of Contemporary Chiropractic found that aromatherapy used in testing environments helped reduce “test anxiety” for college students.)
As Alzheimer’s disease progresses, though, an individual’s sense of smell can become impaired, which may alter the effectiveness of aromatherapy.
Sen nevertheless believes that no harm has been identified in using aromatherapy or experimentation with safe, familiar scents that might trigger memories, such as pine needles, chocolate, and cinnamon (often emitted through candles or microwaveable heating pads). However, with respect to any measurable effects in terms of disease progression, much more research needs to be done, she said, “as there is no concrete evidence that demonstrates that to date.”
RUB IT IN
Similar to aromatherapy, massages may be useful for treating the behavioural symptoms of dementia. “There’s a small amount of evidence that massage therapy can help to manage symptoms associated with dementia, such as anxiety, agitation, and depression,” noted Sen.
A pilot study published in Applied Psychophysiology and Biofeedback in December 2018 investigated the effect of hand massage on stress and agitation levels in individuals with dementia. Nurses were asked to administer seven hand massages to male and female dementia patients over the course of three weeks, while the researchers monitored salivary cortisol and alpha-amylase levels (both of which are indictors of stress).
After an initial increase in levels, cortisol and alpha-amylase levels had dropped by the end of the three-week period, which is a positive outcome. Agitation levels in the intervention group decreased as well in comparison to the control group, but just marginally.
The researchers concluded that multiple massages were needed to experience results, and they also called for more work to be done on the nurse-patient relationship and how that connection may be implicated in the positive results.
Another recent study – published in the Evidence Based Care Journal in 2018 – found that head and face massages applied to Alzheimer’s patients who were agitated had a beneficial effect on agitation levels.
These preliminary findings suggest that massage-based practice might be an effective tool for caregivers to quell behavioural outbursts.
“Massage has been shown to relax the body and trigger a state of well-being,” said Sen. One study published in Pain Medicine in December 2018 examined the effectiveness of hand massage on the pain and anxiety of the “cardiac surgery critically ill” patients in a Quebec hospital. Those who received two 20-minute hand massages had significantly lower scores on “pain intensity, pain unpleasantness, and anxiety” than the control groups.
With Alzheimer’s disease specifically, patients may not be able to communicate their likes and dislikes as easily as they once did. “It depends on the stage of the disease that they’re in, in terms of how much feedback people may have, or the ability to express their preferences,” explained Sen.
Therefore, “it’s important to ask if they want to try it and see if there are any sensitivities they may have as it relates to being touched.” The goal is for the individual to enjoy the experience and hopefully feel calmer.
Like many of the complementary therapies, though, more research needs to be conducted to quantify results. “Although massage therapy shows promise, so far studies haven’t been rigorous enough to provide solid evidence,” Sen noted. It is always important to discuss options with doctors and primary care advisors before engaging in complementary therapies.
Source: MIND OVER MATTER V9
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