handout two
DESCRIPTION
TRANSCRIPT
Spa and Integrative Medicine: Spa and Integrative Medicine: The Future of Health and Wellness The Future of Health and Wellness
Spa and Integrative Medicine: Spa and Integrative Medicine: The Future of Health and Wellness The Future of Health and Wellness
Brent A. Bauer MDBrent A. Bauer MD
Director, Complementary and Director, Complementary and Integrative Medicine ProgramIntegrative Medicine Program
Mayo ClinicMayo Clinic
Department of MedicineDepartment of Medicine
Brent A. Bauer MDBrent A. Bauer MD
Director, Complementary and Director, Complementary and Integrative Medicine ProgramIntegrative Medicine Program
Mayo ClinicMayo Clinic
Department of MedicineDepartment of Medicine
Learning ObjectivesLearning ObjectivesLearning ObjectivesLearning Objectives
• Understand the evolution of CAM and the Understand the evolution of CAM and the emergence of “Integrative Medicine”.emergence of “Integrative Medicine”.
• Be able to communicate the evidence Be able to communicate the evidence from Integrative Medicine and how that from Integrative Medicine and how that science validates Spascience validates Spa
• Prepare strategically for the Prepare strategically for the opportunities where Spa and IM meet opportunities where Spa and IM meet
• Understand the evolution of CAM and the Understand the evolution of CAM and the emergence of “Integrative Medicine”.emergence of “Integrative Medicine”.
• Be able to communicate the evidence Be able to communicate the evidence from Integrative Medicine and how that from Integrative Medicine and how that science validates Spascience validates Spa
• Prepare strategically for the Prepare strategically for the opportunities where Spa and IM meet opportunities where Spa and IM meet
Quotable quoteQuotable quoteQuotable quoteQuotable quote
““The greatest opportunity to touch the The greatest opportunity to touch the lives of the greatest number of people lives of the greatest number of people with a lifestyle that promotes wellness with a lifestyle that promotes wellness and health is where Spa and Integrative and health is where Spa and Integrative Medicine meet”Medicine meet”
Brent A. Bauer MD, Brent A. Bauer MD,
2009 ISPA CONFERENCE2009 ISPA CONFERENCE
““The greatest opportunity to touch the The greatest opportunity to touch the lives of the greatest number of people lives of the greatest number of people with a lifestyle that promotes wellness with a lifestyle that promotes wellness and health is where Spa and Integrative and health is where Spa and Integrative Medicine meet”Medicine meet”
Brent A. Bauer MD, Brent A. Bauer MD,
2009 ISPA CONFERENCE2009 ISPA CONFERENCE
Scope of the IssueScope of the IssueScope of the IssueScope of the Issue
• United States AdultsUnited States Adults– 2/3 are overweight or obese2/3 are overweight or obese– 1/2 have a chronic disease1/2 have a chronic disease
e.g. heart disease, stroke, diabetes, cancere.g. heart disease, stroke, diabetes, cancer
– One in four have heart diseaseOne in four have heart disease– One in three have high blood pressureOne in three have high blood pressure– 24 million Americans have type 2 diabetes24 million Americans have type 2 diabetes
• United States AdultsUnited States Adults– 2/3 are overweight or obese2/3 are overweight or obese– 1/2 have a chronic disease1/2 have a chronic disease
e.g. heart disease, stroke, diabetes, cancere.g. heart disease, stroke, diabetes, cancer
– One in four have heart diseaseOne in four have heart disease– One in three have high blood pressureOne in three have high blood pressure– 24 million Americans have type 2 diabetes24 million Americans have type 2 diabetes
Trust for America’s Health Trust for America’s Health (www.healthyamericans.org)(www.healthyamericans.org)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the 1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1988-2008.Current Employment Statistics Survey (April to April) 1988-2008.
Barnes, 2008Barnes, 2008
B a se : T o ta l S am p le (n = 1 00 0 ); S u rve y Q u e s tio n : # 18
H o u s eh o ld U s a g e o f C A M
13
5
4
30
6
27
32
0 20 40 60 80 100
Yoga/Tai Chi
Acupressure
Hypnosis/Guided Imagery
Herbs/Dietary Supps
Acupuncture
Massage Therapy
Chiropractic
Percentage
Integrative MedicineIntegrative MedicineIntegrative MedicineIntegrative Medicine
““The practice of medicine that reaffirms The practice of medicine that reaffirms the importance of the relationship the importance of the relationship between practitioner and patient, focuses between practitioner and patient, focuses on the whole person, is informed by on the whole person, is informed by evidence, and makes use of all evidence, and makes use of all appropriate therapeutic approaches, appropriate therapeutic approaches, healthcare professionals and disciplines healthcare professionals and disciplines to achieve optimal health and healing."to achieve optimal health and healing."
““The practice of medicine that reaffirms The practice of medicine that reaffirms the importance of the relationship the importance of the relationship between practitioner and patient, focuses between practitioner and patient, focuses on the whole person, is informed by on the whole person, is informed by evidence, and makes use of all evidence, and makes use of all appropriate therapeutic approaches, appropriate therapeutic approaches, healthcare professionals and disciplines healthcare professionals and disciplines to achieve optimal health and healing."to achieve optimal health and healing."
Consortium of Academic Health Consortium of Academic Health Centers for Integrative MedicineCenters for Integrative Medicine
Institute of MedicineInstitute of MedicineInstitute of MedicineInstitute of Medicine
• Integrative Medicine:Integrative Medicine:– ““Orienting the health care process to create Orienting the health care process to create
a seamless engagement by patients and a seamless engagement by patients and caregivers of the full range of physical, caregivers of the full range of physical, psychological, social, preventive, and psychological, social, preventive, and therapeutic factors known to be effective therapeutic factors known to be effective and necessary for the achievement of and necessary for the achievement of optimal health”. optimal health”.
• Integrative Medicine:Integrative Medicine:– ““Orienting the health care process to create Orienting the health care process to create
a seamless engagement by patients and a seamless engagement by patients and caregivers of the full range of physical, caregivers of the full range of physical, psychological, social, preventive, and psychological, social, preventive, and therapeutic factors known to be effective therapeutic factors known to be effective and necessary for the achievement of and necessary for the achievement of optimal health”. optimal health”.
www.iom.eduwww.iom.edu
Institute of MedicineInstitute of MedicineInstitute of MedicineInstitute of Medicine
• “…“…to explore issues, opportunities, and to explore issues, opportunities, and approaches for shifting our health care approaches for shifting our health care system to a focus on efficient, evidence-system to a focus on efficient, evidence-based prevention, wellness, and patient-based prevention, wellness, and patient-centered care that is personalized, centered care that is personalized, predictive, preventive and participatory.” predictive, preventive and participatory.”
• “…“…to explore issues, opportunities, and to explore issues, opportunities, and approaches for shifting our health care approaches for shifting our health care system to a focus on efficient, evidence-system to a focus on efficient, evidence-based prevention, wellness, and patient-based prevention, wellness, and patient-centered care that is personalized, centered care that is personalized, predictive, preventive and participatory.” predictive, preventive and participatory.”
www.iom.eduwww.iom.edu
Time for a change?Time for a change?Time for a change?Time for a change?
• ““If no one If no one wantswants to be hospitalized and to be hospitalized and no one no one wantswants to be sick, then it’s time to to be sick, then it’s time to establish a health care system that not establish a health care system that not only treats sickness, but also focuses on only treats sickness, but also focuses on keeping people healthy”.keeping people healthy”.
Denis Cortese, M.D., Denis Cortese, M.D., CEO emeritus, Mayo ClinicCEO emeritus, Mayo Clinic
Mayo Clinic Health Policy Center Mayo Clinic Health Policy Center
• ““If no one If no one wantswants to be hospitalized and to be hospitalized and no one no one wantswants to be sick, then it’s time to to be sick, then it’s time to establish a health care system that not establish a health care system that not only treats sickness, but also focuses on only treats sickness, but also focuses on keeping people healthy”.keeping people healthy”.
Denis Cortese, M.D., Denis Cortese, M.D., CEO emeritus, Mayo ClinicCEO emeritus, Mayo Clinic
Mayo Clinic Health Policy Center Mayo Clinic Health Policy Center
Time for a change?Time for a change?Time for a change?Time for a change?
• Taking charge of your health. Taking charge of your health. – Eat a healthy dietEat a healthy diet– Get regular exerciseGet regular exercise– Don’t use tobaccoDon’t use tobacco– Actively manage stressActively manage stress
““These practices will keep you healthier, These practices will keep you healthier, happier and more productive”happier and more productive”
• Taking charge of your health. Taking charge of your health. – Eat a healthy dietEat a healthy diet– Get regular exerciseGet regular exercise– Don’t use tobaccoDon’t use tobacco– Actively manage stressActively manage stress
““These practices will keep you healthier, These practices will keep you healthier, happier and more productive”happier and more productive”
Denis Cortese, M.D., Mayo ClinicDenis Cortese, M.D., Mayo Clinic
Massage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic
Pilot trial Pilot trial – 58 cardiac surgery patients58 cardiac surgery patients– Massage therapy vs. quiet relaxationMassage therapy vs. quiet relaxation– Decreased Decreased
PainPain AnxietyAnxiety TensionTension
Pilot trial Pilot trial – 58 cardiac surgery patients58 cardiac surgery patients– Massage therapy vs. quiet relaxationMassage therapy vs. quiet relaxation– Decreased Decreased
PainPain AnxietyAnxiety TensionTension
Bauer, Comp. Therap.Clin. Practice, SubmittedBauer, Comp. Therap.Clin. Practice, Submitted
Anxiety LevelAnxiety Level
VVAASS
Massage Therapy after CV SurgeryMassage Therapy after CV Surgery
Massage Therapy after CV SurgeryMassage Therapy after CV Surgery
VVAASS
Pain LevelPain Level
Massage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic
• Randomized, controlled trial Randomized, controlled trial – 113 cardiac surgery patients113 cardiac surgery patients– MT therapy days 2,4 vs. quiet relaxationMT therapy days 2,4 vs. quiet relaxation– Decreased painDecreased pain p <0.001 p <0.001– Decreased anxietyDecreased anxiety p <0.001 p <0.001– Decreased tensionDecreased tension p <0.001 p <0.001– Increased relaxationIncreased relaxation p <0.001 p <0.001
• Randomized, controlled trial Randomized, controlled trial – 113 cardiac surgery patients113 cardiac surgery patients– MT therapy days 2,4 vs. quiet relaxationMT therapy days 2,4 vs. quiet relaxation– Decreased painDecreased pain p <0.001 p <0.001– Decreased anxietyDecreased anxiety p <0.001 p <0.001– Decreased tensionDecreased tension p <0.001 p <0.001– Increased relaxationIncreased relaxation p <0.001 p <0.001
Bauer, Comp. Therap. Clin. Practice, In pressBauer, Comp. Therap. Clin. Practice, In press
Massage Therapy – CRSMassage Therapy – CRS
5.3
1.85
4.95
1.15
4.65
1.25
0
1
2
3
4
5
6
7
8
9
10
Pain Tension Anxiety
Pre Post
N = 20
Massage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic
• Randomized, controlled trial Randomized, controlled trial – 130 cardiac pts going to invasive procedure130 cardiac pts going to invasive procedure– MT x 20” prior vs. quiet relaxationMT x 20” prior vs. quiet relaxation– Decreased painDecreased pain p <0.001 p <0.001– Decreased anxietyDecreased anxiety p <0.001 p <0.001– Decreased muscle tensionDecreased muscle tension p <0.001 p <0.001– Improved satisfaction Improved satisfaction
• Randomized, controlled trial Randomized, controlled trial – 130 cardiac pts going to invasive procedure130 cardiac pts going to invasive procedure– MT x 20” prior vs. quiet relaxationMT x 20” prior vs. quiet relaxation– Decreased painDecreased pain p <0.001 p <0.001– Decreased anxietyDecreased anxiety p <0.001 p <0.001– Decreased muscle tensionDecreased muscle tension p <0.001 p <0.001– Improved satisfaction Improved satisfaction
Bauer, submittedBauer, submitted
Massage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic
• EchocardiographersEchocardiographers– 45 full-time cardiac-sonographers 45 full-time cardiac-sonographers – 30” chair massage each week vs. stretching30” chair massage each week vs. stretching– Modest impr. in work-related discomfort Modest impr. in work-related discomfort – Marked increase in satisfactionMarked increase in satisfaction
• EchocardiographersEchocardiographers– 45 full-time cardiac-sonographers 45 full-time cardiac-sonographers – 30” chair massage each week vs. stretching30” chair massage each week vs. stretching– Modest impr. in work-related discomfort Modest impr. in work-related discomfort – Marked increase in satisfactionMarked increase in satisfaction
Bauer, submittedBauer, submitted
Massage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic
• Cardiac Cath Lab personnelCardiac Cath Lab personnel– 50 staff members (MD’s, RN’s, technicians)50 staff members (MD’s, RN’s, technicians)– On-site, table massage, 30” x 10On-site, table massage, 30” x 10– Outcomes: pain, fatigue, anxietyOutcomes: pain, fatigue, anxiety– PreliminaryPreliminary
Positive feedbackPositive feedback
• Cardiac Cath Lab personnelCardiac Cath Lab personnel– 50 staff members (MD’s, RN’s, technicians)50 staff members (MD’s, RN’s, technicians)– On-site, table massage, 30” x 10On-site, table massage, 30” x 10– Outcomes: pain, fatigue, anxietyOutcomes: pain, fatigue, anxiety– PreliminaryPreliminary
Positive feedbackPositive feedback
Bauer, analysisBauer, analysis
Massage Therapy - MSKCCMassage Therapy - MSKCCMassage Therapy - MSKCCMassage Therapy - MSKCC
• Memorial Sloan-Kettering Cancer CenterMemorial Sloan-Kettering Cancer Center– 1,290 patients treated over 3 yr period1,290 patients treated over 3 yr period– Pre- and Post-therapy sxs recordedPre- and Post-therapy sxs recorded
PainPainFatigueFatigueStress/AnxietyStress/AnxietyDepressionDepressionNauseaNausea
• Memorial Sloan-Kettering Cancer CenterMemorial Sloan-Kettering Cancer Center– 1,290 patients treated over 3 yr period1,290 patients treated over 3 yr period– Pre- and Post-therapy sxs recordedPre- and Post-therapy sxs recorded
PainPainFatigueFatigueStress/AnxietyStress/AnxietyDepressionDepressionNauseaNausea
Cassileth, J Pain Symptom Manage. 2004
Massage Therapy - MSKCCMassage Therapy - MSKCCMassage Therapy - MSKCCMassage Therapy - MSKCC
• Results:Results:SymptomSymptom ImprovementImprovement
PainPain 40%40%FatigueFatigue 41%41%AnxietyAnxiety 52%52%NauseaNausea 21%21%DepressionDepression 31%31%
• Results:Results:SymptomSymptom ImprovementImprovement
PainPain 40%40%FatigueFatigue 41%41%AnxietyAnxiety 52%52%NauseaNausea 21%21%DepressionDepression 31%31%
Cassileth, J Pain Symptom Manage. 2004
Massage and FibromyalgiaMassage and FibromyalgiaMassage and FibromyalgiaMassage and Fibromyalgia
• Clinical Trial, N = 50 women w/ FMSClinical Trial, N = 50 women w/ FMS– Manual lymph drainage Manual lymph drainage = 25 = 25– Connective tissue massage = 25Connective tissue massage = 25– 5X/week for 3 weeks5X/week for 3 weeks– ImprovedImproved
Pain intensity, pain pressure threshold, HRQoLPain intensity, pain pressure threshold, HRQoL AM tiredness, anxiety, FIQ better with MLDAM tiredness, anxiety, FIQ better with MLD
• Clinical Trial, N = 50 women w/ FMSClinical Trial, N = 50 women w/ FMS– Manual lymph drainage Manual lymph drainage = 25 = 25– Connective tissue massage = 25Connective tissue massage = 25– 5X/week for 3 weeks5X/week for 3 weeks– ImprovedImproved
Pain intensity, pain pressure threshold, HRQoLPain intensity, pain pressure threshold, HRQoL AM tiredness, anxiety, FIQ better with MLDAM tiredness, anxiety, FIQ better with MLD
Ekici, J Manip. Physiol Ther 2009Ekici, J Manip. Physiol Ther 2009
Massage and FibromyalgiaMassage and FibromyalgiaMassage and FibromyalgiaMassage and Fibromyalgia
SiteSite YearYear RandomRandom NN OutcomeOutcome
U of MiamiU of Miami 19961996 YY 3030
U Hospital, Uppsala U Hospital, Uppsala 19991999 YY 4848
U of MiamiU of Miami 20022002 YY 2424
Ohio State UOhio State U 20062006 NN 1010
Ahi Evran U, TurkeyAhi Evran U, Turkey 20092009 YY 5050
CAM and the Relaxation ResponseCAM and the Relaxation ResponseCAM and the Relaxation ResponseCAM and the Relaxation Response
• Therapies with good efficacy/ low riskTherapies with good efficacy/ low risk
– Massage Massage - Meditation- Meditation– AcupunctureAcupuncture - Music Therapy- Music Therapy– YogaYoga - Hypnosis- Hypnosis– SpiritualitySpirituality - Tai chi- Tai chi– Guided imageryGuided imagery - etc.- etc.
• Therapies with good efficacy/ low riskTherapies with good efficacy/ low risk
– Massage Massage - Meditation- Meditation– AcupunctureAcupuncture - Music Therapy- Music Therapy– YogaYoga - Hypnosis- Hypnosis– SpiritualitySpirituality - Tai chi- Tai chi– Guided imageryGuided imagery - etc.- etc.
Relaxation ResponseRelaxation ResponseRelaxation ResponseRelaxation Response
• RCT N = 41, U of WisconsinRCT N = 41, U of Wisconsin– Meditation vs. wait list control Meditation vs. wait list control – 8-wk program > vaccinated 8-wk program > vaccinated – Meditators hadMeditators had
Measurable change in brain electrical patternMeasurable change in brain electrical pattern Higher antibody titersHigher antibody titers
“…“…meditation may change brain and immune meditation may change brain and immune function in positive ways” function in positive ways”
• RCT N = 41, U of WisconsinRCT N = 41, U of Wisconsin– Meditation vs. wait list control Meditation vs. wait list control – 8-wk program > vaccinated 8-wk program > vaccinated – Meditators hadMeditators had
Measurable change in brain electrical patternMeasurable change in brain electrical pattern Higher antibody titersHigher antibody titers
“…“…meditation may change brain and immune meditation may change brain and immune function in positive ways” function in positive ways”
Davidson, Psych Med 2003Davidson, Psych Med 2003
Davidson, Psych Med 2003Davidson, Psych Med 2003
Davidson, Psych Med 2003Davidson, Psych Med 2003
ISPAISPAISPAISPA
““Spas offer…a time and place to…Spas offer…a time and place to…recharge your mind, body and spirit. The recharge your mind, body and spirit. The opportunity to bring your physical, opportunity to bring your physical, mental, emotional and spiritual selves mental, emotional and spiritual selves back into alignment”.back into alignment”.
““Spas offer…a time and place to…Spas offer…a time and place to…recharge your mind, body and spirit. The recharge your mind, body and spirit. The opportunity to bring your physical, opportunity to bring your physical, mental, emotional and spiritual selves mental, emotional and spiritual selves back into alignment”.back into alignment”.
http://www.experienceispa.com/spa-goers/why-spa/http://www.experienceispa.com/spa-goers/why-spa/
Ruth Stricker Spa and Wellness Ruth Stricker Spa and Wellness AwardAward
Ruth Stricker Spa and Wellness Ruth Stricker Spa and Wellness AwardAward
• Created in 2008Created in 2008
• First recipient - Dr. Jen SedaFirst recipient - Dr. Jen Seda
““Our research is designed to show the Our research is designed to show the biological, emotional, and mental biological, emotional, and mental
benefits of a typical spa experience”benefits of a typical spa experience”
• Created in 2008Created in 2008
• First recipient - Dr. Jen SedaFirst recipient - Dr. Jen Seda
““Our research is designed to show the Our research is designed to show the biological, emotional, and mental biological, emotional, and mental
benefits of a typical spa experience”benefits of a typical spa experience”
Ornish, Lancet Oncology 2008Ornish, Lancet Oncology 2008
““Comprehensive lifestyle modification”Comprehensive lifestyle modification”““Comprehensive lifestyle modification”Comprehensive lifestyle modification”
• Lifestyle modifications included:– Low fat, whole foods, plant-based diet– Mod. aerobic exercise (walking 30”/d, 6 d/wk)– Stress management (gentle yoga stretching,
breathing, meditation 60”/day, 6 d/wk)– 1-h group support session once per week.
• Lifestyle modifications included:– Low fat, whole foods, plant-based diet– Mod. aerobic exercise (walking 30”/d, 6 d/wk)– Stress management (gentle yoga stretching,
breathing, meditation 60”/day, 6 d/wk)– 1-h group support session once per week.
Ornish, Lancet Oncology 2008Ornish, Lancet Oncology 2008
