Although body-warming with hot spa-bathing has been proposed to exert medical therapeutic effects on certain diseases, whether body-warming has preventive and promotive effects remains unknown. To clarify this issue, an epidemiological questionnaire study regarding personal hot spa-bathing habits and disease history was carried out in Japan, where individuals engage in daily warm water bathing. Questionnaires regarding hot spa-bathing habits and disease history were randomly sent to 20,000 residents aged ≥65 years living in Beppu, a city in Japan that has the highest concentration of hot spa sources in the world. The results showed that habitual hot spa-bathing exerts preventive or promotive effects on the occurrence of certain diseases, such as hypertension (preventive) and collagen disease (promotive) in women, and cardiovascular diseases (preventive) in men. These findings suggest that habitual body warming is an effective and economical method with beneficial preventive and promotive effects on various diseases.

  Japan has abundant hot springs resources that have been empirically used for medical treatment and recreation for people with various diseases or injuries. In 1926, the University of Tokyo inaugurated the Department of Physical Medicine for the scientific study of the effects of hot springs on the human body and mind. Thereafter, balneological research institutes or spa hospitals were established that were affiliated with six national universities; Kyushu, Hokkaido, Okayama, Tohoku, Kagoshima and Gunma had been established by 1951. Although these balneological institutes, including the University of Tokyo, greatly advanced the basic and clinical research on the therapeutic effects of hot springs, they all were either closed or integrated into the main hospital of the university between 1994 and 2018, owing both to government reforms to national universities and decreased government financial support. A brief history of each institute and several titles of published research studies performed there are provided in this article.

  The closing of these research institutes is regrettable; however, balneological research is today an important field that contributes to maintenance and promotion of health for the sharply rising number of aged people in Japan. It is expected that a member of the Japanese Society of Balneology, Climatology and Physical Medicine will further develop balneological research using advanced scientific technologies, based on the results achieved in the seven historical institutes mentioned above.

Introduction: Optimization of muscle strength is crucial for motor control efficiency and the prevention of musculoskeletal disorders.

Objective: Analyze the effects of aquatic physiotherapy using the Bad Ragaz method for the strengthening and endurance of the trunk muscles.

Methods: An experimental, descriptive and quantitative study. Sixteen healthy, sedentary women with an average age of 19.4±1.6 years and BMI of 22.8±2.7 took part in this study. The trunk muscle strength was evaluated using isokinetic dynamometry and abdominal (one min test) and lumbar endurance tests.

Results: The Shapiro-Wilk normality test, Cochran test, t-Student parametric test and Wilcoxon non-parametric test were applied at a significance level of p ≤ 0.05. There was a significant improvement in the trunk extensor muscle strength for peak torque, p = 0.000, work, p = 0.000 and power, p = 0.008. With respect to the trunk flexor muscle strength, increases in the values for work, p = 0.032 and power, p = 0.022 were detected. A significant improvement in the flexor/ extensor ratio for work, p = 0.023, was also noted, and also in the abdominal endurance (p = 0.000) and Lumbar muscular-endurance (p = 0.000) tests.

Conclusions: The aquatic physiotherapy program using the Bad Ragaz method was efficient in strengthening the trunk musculature of young, healthy and sedentary women.

  【Background and Objectives】The visitors who suffered from skin diseases and underwent hot-spring cure at Toyotomi Hot Spring were speculated to have been affected by the vicious cycle of heavy stress and aggravation of skin conditions. I, in collaboration with the Toyotomi Fureai Center, investigated whether the hot-spring cure at Toyotomi Hot Spring reduced stress in these visitors.

  【Methods and Results】This study was conducted from September 1, 2016 to August 31, 2018. The data were analyzed from the questionnaire that had been administered to the 115 visitors before and after hot-spring cure at Toyotomi Hot Spring.

  A reduction in total stress was reported by 108 of 115 (93.9%) visitors. The average of the total stress scale after hot-spring cure had significantly reduced compared to the scale before cure (P < 0.001). The 108 visitors additionally rated the effect of the different factors contributing to stress relief. The effect of the Toyotomi Hot Spring water dominantly contributed to stress reduction (P < 0.001).

  The visitors answered a questionnaire including 29 items in 6 categories (vigor, impatience, exhaustion, insecurity, depressive mood, and body complaints) of the stress check recommended by the Ministry of Health, Labor and Welfare, Japan. A reduction in stress levels after hot-spring cure was observed in all 6 categories (P < 0.001).

  Of the 115 visitors, 105 (91.3%) had actually felt an improvement in their skin condition. The total stress scale of visitors whose skin condition improved after hot-spring cure was significantly lower than that of visitors whose skin condition had not improved (P < 0.01). The score for reduction in stress levels of visitors whose skin condition had improved was significantly higher in categories of vigor, depressive mood, and body complaints (P < 0.05).

  【Conclusion】The stress of visitors with skin diseases was significantly reduced after hot-spring cure at Toyotomi Hot Spring by the dominant effect of the hot-spring water. Their stress reduction seemed to be closely associated with the improvement in skin condition. More studies with objective evaluations may help elucidate the mechanisms of the hot-spring cure, which can break the vicious cycle of heavy stress and aggravation of skin conditions.

  Objective: Beppu city is a world-famous resort. Spa bathing has been reported to yield psychophysiological relaxation. Beppu city office planned a health-promoting tour including spa-bathing activities in Beppu for the aging population, which is growing rapidly in Japan. This tour provided spa-bathing experiences, walks through urban districts where old townscapes remain, yoga, mountain hikes and shrine visits. We investigated whether such a short tour brought about a detectable medical effect toward health promotion for the elderly.

  Methods: Twenty applicants (mean age: 67.7±3.5 years; male, n＝9 [mean age, 68.9±2.9 years]; female, n＝11 [mean age, 66.7±3.7 years]), joined the tour. These voluntary participants, who were over 60 years of age, participated in a five-day-tour in Oita prefecture. Health checks were conducted on the first and last days of the tour. This tour was conducted in areas containing a gulf, mountain areas, lakeside areas, forests and shrines. Participants visited these areas during the tour.

  Outcome Measures: The following parameters of the participants were measured at the beginning and end of tour: stress score, blood pressure, salivary amylase level, serum C-reactive protein level, and serum cortisol level. The results were compared and analyzed by a paired t-test and a simple regression analysis.

  Results: The mean values of the following parameters (pre-intervention and post-intervention) showed significant changes after the program: stress score (43.7±8.05 and 39.4±6.57; p-value＝0.005); systolic blood pressure (131±17.8 mmHg and 125±16.2 mmHg; p＝0.018); diastolic blood pressure (73±7.3 mmHg and 70±6.6 mmHg; p＝0.016); serum cortisol (7.7±3.16 µg/dL and 6.1±1.82 µg/dL; p＝0.027). Moreover, the participants’ cortisol levels tended to converge into a normal range.

  Conclusion: Tourism in a spa resort can relieve mental and physical stress, reducing blood pressure and correcting the adrenocortical function.

  A person regulates body temperature by outside and inside heat from change of environmental temperature. One of the inside heats includes drinking water. However, the effect of drinking water temperature on body temperature is not clear. The purpose of this study was to examine how water temperature influences the change in body temperature. The study participant were 13 men (average age, 21.3 ± 0.8 years), and they drank water at 3°C, room temperature, and 60°C; in addition, one more task was not to drink water. We measured tympanic temperature using a thermometer, skin blood flow using a laser Doppler flow meter, and sweating rate using the capsule ventilation method. The mean skin temperature was measured at seven body points with a thermistor and calculated. Tympanic temperature of drinking water at 3°C and 60°C was significantly in comparison with other conditions. As for skin blood flow between water temperature at 60°C and 3°C, sweating rate between water temperature at 60°Cand other conditions, and mean skin temperature between water temperature at 3°C and other conditions significant differences were recognized. It is thought that the response to early change to drinking water at different temperatures is by responses of thermo-receptors and subsequently by the thermal energy of the drinking water.

  Purpose: Age-associated changes in arterial structure and function increase risk of cardiovascular disease. Previous studies have found that the body temperature response might influence acute changes in arterial stiffness after exercise. However, the relationship between increased body temperature during warm bathing and arterial stiffness has not been clarified. Therefore, the present study aimed to determine the effects of increases in body temperature by bathing in warm water on arterial stiffness in elderly subjects.

  Methods: Healthy elderly 8 subjects (8 males, mean age ± standard error: 61.1 ± 1.1 years) bathed in water at 35°C, 38°C, and 40°C for 15 min. Carotid-femoral pulse wave velocity (aortic PWV) and femoral-ankle PWV (leg PWV), blood pressure, heart rate, and rectal temperature were measured at baseline and at 30 and 60 min after bathing, in a quiet and air-conditioned room at the same time in the morning.

  Results: Rectal temperature was significantly increased at 30 and 60 min after bathing at 38°C and 40°C, whereas leg PWV significantly decreased. Heart rate significantly increased at 30 and 60 min after bathing at 40°C. Blood pressure did not change after bathing at any temperature.

  Conclusion: The present study showed that leg PWV significantly decreased in elderly subjects after bathing at 40°C, but not at 35°C and 38°C. However the underlying mechanism of the decrease remains unknown and these effects might depend on increased body temperature. Thus, it is suggested that warm bathing might affect the decrease in leg arterial stiffness.

  The Ministry of the Environment is promoting an Onsen Stay policy, is suggesting long stays at spa health resorts and is working on activation in a spa from 2017. What kind of program can be carried out to accept long stay guests at the spa which fills the capacity of the health resort? Programs targeted for Gero Spa, the Osaka hot spring village (Yuya Spa, Shimojima Spa and Nigorigo Spa), Yuwaku Spa, the Hakusan hot spring village (Tedori Spa, new Iwama Spa, Ichirino Spa and Chugu Spa) and Yunokuchi Spa were investigated in this survey.

  The necessity of creating a space of relaxation suitable for a stay was shown to add new space value and experience value when the area resources including the ambient surroundings in a spa were utilized for long stays in a thesis of Shimomura, who studied the spatial form of the spa and the spatial structure, and in an Onsen Stay promotion plan of the Ministry of the Environment.

  In the above-named 10 spas the extent to which space value and experience value was added was investigated by listening to the guests concerned and by a local inspection of whether such a program was carried out. Since the program’s implementation in Gero Spa, the Osaka hot spring village and Ichirino Spa, as a result, I found that the long-stay program was feasible. But I also found that there are almost no long-stay guests who utilized the program because needs weren’t taken into consideration in the utilization. In high plains areas in the mountains, I also found that eco-tourism is considered as a stay plan and that town walks utilizing cultural facilities in downtown, walks and day trips to the surrounding scenic and recreation spots are considered as a stay plan in the newly-formed spa towns.

  I suggest that an investigation in spas where long-stay programs have been put into effect is the next necessary step in this research.