110 redakcyjna_Layout 1 - Agencja Wydawnicza MEDSPORTPRESS

Transcription

110 redakcyjna:Layout 1 2014-03-20 12:22 Strona 1
SCIENTIFIC COUNCIL
Aleksander Sieroń, Bytom, Poland
– HEAD OF SCIENTIFIC COUNCIL
Artur Badyda, Warsaw, Poland
Josep Benitez, Valencia, Spain
Eugeniusz Bolach, Wrocław, Poland
Jurgis Bredikis, Kaunas, Lithuania
Anna Cabak, Warsaw, Poland
Grzegorz Cieślar, Bytom, Poland
Santos Sastre Fernandres, Barcelona, Spain
Peter Harding, Birmingham, UK
Tadeusz Kasperczyk, Cracow, Poland
Ireneusz Kotela, Warsaw, Poland
Aleksandras Krisciunas, Kaunas, Lithuania
Grazina Krutulyte, Kaunas, Lithuania
Petr Louda, Liberec, Slovakia
Yasser Alakhdar Mohmara, Valencia, Spain
Dariusz Mucha, Cracow, Poland
Zbigniew Obmiński, Warsaw, Poland
Inesa Rimdeikiene, Kaunas, Lithuania
Suzanne Robert-Ouvray, Paris, France
Guy G. Simoneau, Wisconsin, USA
Krzysztof Sobiech, Wrocław, Poland
Aleksander Stasch, Oedheim, Germany
Agata Stanek, Bytom, Poland
Narasimman Swaminathan, Delhi, India
Jan Szczegielniak, Głuchołazy, Poland
Zbigniew Śliwiński, Zgorzelec, Poland
Piotr Tomasik, Cracow, Poland
Wiesław Tomaszewski, Warsaw, Poland
Aivars Vctra, Riga, Latvia
Table of Contents
I. Editorial
Review Articles
81. INGA SCHOROWSKA
Somayog – a method of relaxation, prevention, therapy
and personal growth
89. DOMINIKA OBARA, PRZEMYSŁAW JAN TOMASIK, PIOTR TOMASIK
Low glycemic index based diet as a tool of complementary
therapy and prophylaxis
Original Articles
95. EWA OSIAK, EDYTA SZCZUKA, WIESŁAW TOMASZEWSKI
Colour therapy – the relationship between the quality
of life (QOL) and colour selection according
to the Lüscher test
101. EUGENIUSZ BOLACH, KAMILA LISOWSKA
Evaluation of traditional and rubber cupping massage
techniques applied to female patients with low back pain
109. EDYTA SZCZUKA, ŁUKASZ BOGUCKI
The impact of a single sauna session on the electrodermal
activity (EDA) as evaluated with the Ryodoraku method
117. ZBIGNIEW OBMIŃSKI, KATARZYNA LERCZAK
Appraisal of the physiological cost of soccer match based
on changes in selected blood indices and perceived fatigue
after the effort
123. JUSTYNA DRZAŁ-GRABIEC, MACIEJ RACHWAŁ, KATARZYNA WALICKA-CUPRYŚ
The shape of feet in women after mastectomy
EDITORIAL BOARD
127. ZBIGNIEW OBMIŃSKI, HELENA MROCZKOWSKA
EDITOR-IN-CHIEF
Edyta Szczuka Ph.D.
DEPUTY EDITOR-IN-CHIEF
Wiesław Tomaszewski M.D.Ph.D.
MANAGING EDITOR
Katarzyna Salamon-Krakowska Ph.D.
TOPIC EDITOR
Zbigniew Obmiński Ph.D.
LANQUAGE EDITOR
Ewa Węgrzyn
STATISTIC EDITOR
Artur Badyda Sc.D.
TECHNICAL EDITOR
Wojciech Sikorzak
INTERNET EDITOR
Rafał Dowgwiłłowicz-Nowicki M.A.
ADVERTISING MANAGER
Andrzej Szczepanek M.A.
SUBSCRIPTIONS MANAGER
Beata Popielarz-Miziołek M.A.
Do personality traits determine future achievements
in the sport of archery?
133. DOROTA JAKUBIEC, KRYSTYNA CHROMIK, KAMIL GAJDA
Evaluation of energy and nutritive value of physiotherapy
students diet in terms of their awareness and knowledge
of nutritional therapy of the patient
143. EWELINA ŻUK, ALEKSANDRA TRUSZCZYŃSKA
Influence of aqua aerobics on disability among persons
with degenerative changes in the lumbar spine
Case Studies
147. ANNA KONIECZNA-GORYSZ, EWA DEMCZUK-WŁODARCZYK,
MAŁGORZATA FORTUNA, KATARZYNA HEŁMECKA
Influence of sensory integration (SI) on psychomotor
development of a boy with early infantile autism
153. MONIKA MUCHA-JANOTA, ROMUALDA MUCHA, ALEKSANDER SIEROŃ
PUBLISHER
Publishing House Medsportpress, Ltd
Al. Stanów Zjednoczonych 72/176,
04-036 Warsaw, Poland
tel./fax: (48) 22 834 67 72 or (48) 22 405 42 72
e-mail: [email protected] (Editor-in-Chief )
[email protected] or [email protected]
KRS: 0000353342, NIP: 522-294-53-82
Konto: 12 1560 0013 2447 1933 3801 0002
www.medsport.pl
Hamilton Depression Scale (HDS) as depression
and hypomania's physical treatment factor
157. ANNA KONIECZNA-GORYSZ, ADA KASZEWSKA, MAŁGORZATA FORTUNA,
BARBARA STONOGA
161.
The influence of music therapy on the child
with developmental disorders
Editorial Policy
CAMS 2/2013
I
Complementary
& Alternative
Medicine
in Science
Vol. 1,
1, 2013,
2013, 2(2)
Vol.
1(2)
PATRONAGE
Polish Society for Rehabilitation of the Disabled
Polskie Towarzystwo Walki z Kalectwem
PUBLISHER
111 Schorowska1:Layout 1 2014-03-20 12:33 Strona 1
REVIEW ARTICLE
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN SCIENCE | VOL. 1, 2013, 2(2), 81-88
Somayog – a method of relaxation, prevention,
therapy and personal growth
Inga Schorowska
SOMAYOG ASSOCIATION, WROCŁAW, POLAND
SUMMARY
Somayog is one of the most recent holistic methods combining the ancient practice of hatha yoga with contemporary Western techniques such as McKenzie method,
Alexander Technique or Somatics. The Somayog practice is based on simple exercises, however performed in such a way so as to fully restore a practitioner’s contact
with his or her own body. The heightened mindfulness indispensable to identify body’s needs and reactions helps not only to change injurious movement habits but
also to restore harmony in emotional, spiritual and mental spheres, thus becoming an important factor of personal growth. In this paper the author presents an outline
of the Somayog method based on her own experience as a Somayog therapist. Referring to the latest scientific publications she also analyses research areas within yoga
which can be employed in future experimental research dedicated to Somayog.
KEY WORDS: awareness, education, personal growth, therapy, yoga
STRESZCZENIE
Somayog – metoda relaksacji, profilaktyki, terapii i rozwoju osobistego
Somayog jest jedną z najnowszych, holistycznych metod łączących starożytną praktykę hatha jogi i współczesne techniki Zachodu, takie jak metoda McKenziego,
Technika Alexandra czy Somatics. Praktyka Somayog opiera się na wykonywaniu prostych ćwiczeń, prowadzonych jednak w taki sposób, aby możliwe było całkowite
przywrócenie kontaktu z własnym ciałem. Wymaga to od ćwiczącego skupienia się na identyfikacji potrzeb i reakcji ciała, co sprzyja uzyskaniu zmian nie tylko w zakresie
m.in. niekorzystnych nawyków ruchowych, ale wspomaga też proces przywracania harmonii w sferze emocjonalnej, duchowej i mentalnej, stając się istotnym elementem
rozwoju osobistego. Autorka, opierając się na swoim doświadczeniu terapeutycznym w zakresie prowadzenia terapii metodą Somayog, przedstawia w niniejszej pracy
zarys metody. Analizuje także, w oparciu o najnowsze doniesienia naukowe, obszary badawcze w zakresie jogi, które mogłyby stanowić możliwe implikacje do
przeprowadzania w przyszłości badań eksperymentalnych w zakresie Somayog.
SŁOWA KLUCZOWE: świadomość, edukacja, rozwój, terapia, joga
Research areas in yoga on the basis
of the latest scientific reports
Yoga classes are ever more often offered by fitness clubs
or psychosomatic rejuvenation centres. Despite their
growing popularity some people brought up in the Western culture oppose their popularization because in some
parts of the society yoga evokes unfavourable associations with religion, not quite accepted mysticism or
culturally foreign lifestyle. Somayog, the system of physical
exercises and mental work presented below, is more
acceptable for people of the West because of its undogmatic and universal character.
Somayog, as a new proposal aiding the quest for
balance and sense of full health in life, is an answer to
numerous painful problems of Westerners who are stressed
and alienated from their own psychical and physical
needs. Unfortunately, despite its growing popularity
Somayog has not yet been scientifically tested; however,
more and more intensive research on other yoga kinds
can provide useful hints to researchers who would like to
asses its efficacy in future.
Blibliometric data analysis by Khalsa confirms that the
number of scientific publications dedicated to the use of
yoga for therapeutic purposes is growing. Yoga-related
research projects are published not only in Indian scientific journals, but ever more often in European countries
or in the U.S.A. [1]. It is possible thanks to gradual change
of yoga’s ontological status especially in exact science
which gradually abandons reductionist views on holistic
therapies [2].
Undoubtedly there exists a need to create therapy
protocols for yoga research within the limits of the
evidence-based medicine. On the other hand, yoga specialists are afraid of possible misuse: that yoga, as a system
respecting the multi-layered and dynamic aspect of life,
would be stripped of its crucial elements only to serve
egoistic scientific aims [3,4]. Scientific surveys on yoga,
however, have the positive effect disproving stereotypes
inconsistent with historical facts [5,6].
Srinivasan maintains that yoga as a holistic therapy
can serve as a kind of model applicable to different health
problems, while the role of science is basically searching
for mechanisms which would help understand better the
influence of yoga exercises on the body-mind sphere [7].
Cote and Daneault, the authors of a comprehensive
meta-analysis on applicability of yoga in patients with
cancer, also emphasise the need of research in this area [8].
In concord with demographic predictions increase in
cancer diseases soon will become a significant health and
social problem. Identifying and assessing the efficacy of
methods which could aid the therapy of these diseases
with all probability will become an important subject of
scientific studies in the near future. It is therefore important
to define and create therapeutic procedures adjusted to
the needs of cancer patients. Buffart et al. in an metaanalysis of available research data on administering of
yoga to patients with breast cancer stated that its effects
CAMS 2/2013
81
Schorowska I. Somayog – a method of relaxation, prevention, therapy and personal growth
were most pronounced in the psycho-social sphere [9].
Palica and Zwierzchowska, analysing the question of
therapeutic advantages of yoga, noted that its impact
seemed related mostly to the quality of life sphere, especially in psycho-emotional and volitional aspects [10].
The social group especially interested in practicing
yoga are professionals subject to strong stress and pressure from their superiors. In one of the scientific surveys
dedicated to the yoga theory and practice an idea of
Personal Vitality Coaching (PVC) was created to meet the
needs of people for whom good health is important in
the light of their high workload. The PVC interventions
were to consist of mental elements helping preserve
energy through relaxation techniques (e.g. yoga); physical elements helping preserve vitality (and especially aerobic capacity) through physical activity; and diet as
a means of upkeeping high energy levels.
The subjects in the quoted study were intensively
working people who participated in a 6- or 12-month
physical activity programme named VEP (Vitality Exercise
Programme). It was comprised of yoga relaxation exercises
(hatha-yoga asanas, pranayam, relaxation exercises) as
well as aerobic exercises augmenting muscle tone and
general fitness. Moreover, within the programme’s framework the participants met a personal coach who carried
out individual behavioural trainings. The analysis of the
VEP programme has shown the increase in productivity
and withdrawal of chronic ailments not related to the
timespan of intervention (i.e. in groups training for 6 or
12 months). However, in both test groups the general
level of vital energy increased significantly [11].
Furthermore, a meta-analysis by Boehm et al. concerning the efficacy of various yoga practices (hatha-yoga,
Iengar, asanas, Patanjali, Sahaja and Tibetan yoga) in people
in different health states has shown moderate influence
of these practices on the reduction of weariness and on
the level of vital energy [12].
The experiments in proposing yoga to seniors also
seem interesting. In this case the important questions are
the safety of exercises and age-related limitations which
require specific adaptations of training sessions. To assess
this type of risks a biomechanical analysis of the active
skeletal-muscular apparatus in people participating in
a 32-week hatha-yoga programme was performed [13].
In other studies the safety and possibility of performing
yoga exercises in sitting position by seniors exposed to
the risk of falling was assessed [14]. Tiedeman et al. took
up a similar research subject, assessing the effects of
a 12-week Iyengar yoga programme in seniors [15].
Zettergren on the other hand performed a pilot study in
assessing posture control (Berg Balance Scale), mobility
(Timed-Up&Go), gait speed and the subjective estimation
of falling risk (Activities-Specific Balance Scale) in people
who attended an 8-week Kripali yoga programme. The
advantages of practicing yoga by people aged 60-70 with
82
CAMS 2/2013
type 2 diabetes with respect to selected biochemical
parameters were also proved [17].
Yoga was researched in relation to numerous health
problems. Systematic review and meta-analysis of studies
dedicated to the yoga efficacy in menopausal symptoms
has led the authors to the conclusion that yoga can be
recommended as a short-term intervention method alleviating psychical problems related to menopause [18].
Gordon et al. have proved in randomized studies the
efficacy of hatha-yoga in reducing oxidative stress indicators in patients with renal failure [19]. In other studies
a beneficial influence of yoga and massages with warm
oil in 60 patients with sciatica was stated [20]. The influence
of a 6-month yoga practice in obese patients suffering
from symptoms of depression and anxiety was measured
using Hamilton Depression Rating Scale. The results of the
study suggest that yoga can be helpful for these patients
on condition that the intervention is long-term [21].
A relatively new research problem is yoga practice for
youths with intellectual disability [22,23]. The results of
a meta-analysis on practising yoga by patients with schizophrenia indicate a limited usefulness of this kind of
therapies and a need for more insightful assessment of
their safety in this type of patients [24]. In other metaanalysis dedicated to use of yoga as a complementary
therapy in depressive disorders, anxiety, schizophrenia
and PTSD the authors emphasize yoga’s suitability for
problems with obesity and circulatory system diseases
co-occuring in the studied population [25].
The influence of yoga breathing exercises (chandra nadi
pranayama) on selected circulatory parameters in hypertensive patients was also analysed [26]. Another study
indicates the advantages of combining physiotherapy with
yoga exercises in patients after total knee arthroplasty in
comparison with the group subjected only to conventional physiotherapy [27]. Other authors compared the
results of a physical exercise programme including yoga
on the anxiety symptoms in young women with polycystic
ovary syndrome [28]. Mishra et al., on the basis of existing
publications, performed a critical analysis of yoga applicability as a complementary or alternative therapy in
neurological problems related to epilepsy, multiple
sclerosis, Alzheimer disease, in peripheral nervous system
diseases, fibromyalgia and in stroke prevention [29].
Other reports, interesting from the viewpoint of
modern scientific paradigms, suggest that yoga can have
significant influence on the brain’s neuroplasticity [30].
Despite promising studies on its use in neurological or
neuropsychiatric problems the analyses of these reports
reveal numerous methodological shortcomings caused
by the lack or insufficient blinding of the tests, insufficient
sample size or group randomization, lack of correlating
of such interventions to pharmacotherapeutic efficacy,
lack of comparative studies or not using objective neuroimaging methods employing biomarkers’ analysis to
illustrate the activity of the neurological system [31].
Somayog – etymology of the word
Somayog is a combination of Indian yoga belonging to
the advaita vedanta tradition with contemporary techniques of bodywork originating from the West. It was created in the 90s and since then its popularity has been
increasing; it is taught not only in India, but also on the
European and American continents. Its name was
borrowed from Sanskrit. Soma – or amrit – is “the nectar
of immortality” providing with eternal youth everyone
who consumes it. The word “yoga” has many translations,
the most often used being “connection” or “union”, “unity”,
but also “method”. “Yoga is perceived as a state of the
utmost spiritual perfection in the form of a higher kind of
awareness (…), as a way to fulfil this state, as every possible
spiritual practice (…), as a teaching on this method, on this
way and on its aim” and also “proper understanding of yoga
means living in the way which facilitates fullness of physical,
spiritual and moral life” [32].
Somayog can be also translated as “a yoga of eternal
youth” which describes perfectly the results of its practising,
since a young figure and a youthful agility are among the
advantages of its prolonged practice. Other changes,
related to the sphere of awareness, are as important for the
life quality as a fit body. The creator of this compilation is
Danielle Munoz (known under her Indian name Deep
Priya), a French therapist and yogini practising in India.
She combined into one system several seemingly discrepant techniques which on the basis of her therapeutic
experience she deemed complementary and effective.
Apart from hatha-yoga, other methods included into
Somayog were: Somatics, Alexander technique, Feldenkrais method, McKenzie method, pranayam, Hellerwork,
Schultz’s autogenic training, Jacobson relaxation method,
and Shyam Dhyaan meditation. In this compilation East
meets West and the past meets the present. The ancient
tradition of hatha-yoga and pranayam’s efficacy in
improving energy flow within the body was augmented
with contemporary techniques of bodywork and mindwork which enhance body’s awareness and help utilize
more fully the potential of one’s mind [32,33].
Somayog practice
Working with body awareness
The practice of Somayog begins with return to one’s own
body, as the majority of people had lost even basic
contact with it. The function of the senses informing
about body’s state and position is usually impaired, and
as consequence apparently healthy and fit people display
a wide spectrum of posture dysfunctions and movement
impediments instead of a straight and elegant figure. The
source of this situation is the fact that in response to life’s
challenges and experiences each of us develops specific
emotional and physical behavioural patterns. These
patterns and habits shape our psyche and posture,
decide how we react and move. Careful analysis of posture
and movement manner of a person usually makes it
possible to read his or her psychological profile, since the
emotions and thoughts influence directly the shape of
our physical body.
People whose psychophysical development and
expression of emotions were not disturbed do not fight
with the gravitational force and retain straight posture
with grace; their movements reveal confidence and
power; all body parts are developed harmoniously;
breathing and other life functions are performed without
limitations expressing full acceptance of their own being
and ability to fulfil their potential.
However, the above described ideal situation is extremely rare. Usually in reaction to the life stress we develop
specific types of reaction which require some restrictions
in body function. When repeated, these reactions influence our posture and movement manner. As a result
people can be overly relaxed, excessively stiff or contracted; with the whole body or its parts locally weakened
or overdeveloped – always in relation to their typical
emotional reaction to life challenges. With some skill one
can read a person’s character just watching his or her
stature and movements [34].
Most people are usually quite unaware of this fact and
lack knowledge to remedy the above described limitations
on their own. Their senses do not register real information
from the body and therefore present an incorrect picture
of the situation. Frederick Matthias Alexander called it an
“untrustworthy sensory appreciation”: as a result of repetitive adverse habits incorrect tensions and positions of
the body become fixed and with time start to be
perceived as a norm [35]. Thomas Hanna coined a term
“sensory-motor amnesia”: everyday stresses and traumas
result in specific muscle reflexes which take on the form
of tensions in different body parts, and because of the
repeating character of these reflexes the habitual muscle
tension is retained, so we do not remember anymore how
to relax them or how to regain normal muscle tone.
People are normally not aware of this excessive
tension resulting in limitations of movement, in stiffness
and pain. They forget how they should feel their bodies
and cannot control them. The incorrect perception or
sensory amnesia is the reason behind most of the
changes related to the process of aging. The problem
afflicts younger people, too, and even children exposed
to a long-term stress or sustaining physical or psychological
traumas [36].
Responsible for the above mentioned reactions are
innate reflexes whose primary role is to adapt body to
changing conditions. One of them is the stress (shock)
reflex, named also “the red light reflex” or “the startle
reflex”, and the other – the reflex preparing us to action,
in other words “the green light reflex”. Usually they act
antagonisticically. The first one is a defensive, fight or
flight reaction associated with the sense of fear. It manifests
CAMS 2/2013
83
itself through activation of muscles bending the trunk and
limbs into a contracted position. The role of the other reflex
is to prepare us to action, so it activates extensor muscles
at the back of body and limbs, like in the stance “at attention”. It is activated in anticipation of an effort.
Both reflexes are essential for our functioning in the
world, but they fulfil their role if – after activating them –
we are able to return to the initial state. Unfortunately,
multiple repetitions of the same actions cause habitual
fixation of their effects and inability to return to the original
muscle tone. When combined with specific physical
traumas and their compensations; incorrect posture
habits; a work which engages the same muscles, as well
as mental and emotional habits – the result is an ever
stronger tension of antagonistic muscle groups which
restrict one another rather than co-operate and complement one another. It causes increasing chronic stiffness,
discomfort and finally pain which again intensifies stress
– and this in turn once again activates defensive reflexes
in the form of increased muscle tension.
There is a way out of this vicious circle, since this state
is acquired. It was learned gradually and therefore we can
un-learn it, equally gradually restoring our innate fitness
and mobility. The body remembers its correct state and
always reacts to achieving it with feelings of pleasure and
comfort. Following this rule and restoring due importance to the body awareness we can reverse the process
of degradation usually identified with the old age. We can
well prevent the effects of stress, as long as they do not
manifest themselves yet physically. All we have to do is
to un-learn things that do not serve our bodies and to
remember the innate state of comfort. [36].
Somayog is a tool which can accelerate this process
effectively without impending the mechanisms which
adapt us to life in the civilised world. The therapy begins
with the self-observation employing all senses except the
sight – because as a dominant sense it absorbs our attention excessively. Firstly, we have to learn how to register
information from out physical body, which immediately
begins to send us signals.
Usually the first to be sensed are alarm signals from
places so tensed that they cause pain in consequence of
an already existing pathological process. The first sensations are very often unpleasant because we start to register
the feelings of discomfort formerly suppressed to withdraw the attention from the overburdened body parts.
Sometimes the unblocking of suppressions takes a long
time, similarly as is the case with psychological traumas.
And as in the work with the emotional traumas we have
to consciously accept this discomfort first before we can
eliminate it. Working with physical limitations, mobilizing
the body and perfectioning its harmony, as if by the way,
we can change harmful mental and emotional patterns
until they start to agree with us. In the Somayog practice
we have first to sense the limitations arising from incorrect
body use or harmful movement and mental patterns. In
84
CAMS 2/2013
the next stage we gently restore agility of body and mind,
so that the return to harmony be spontaneous and
unconstrained, because only then we can preserve
beneficial changes in a conscious way and in harmony
with our body [33].
Working with breathing
After we have gathered information from our mind and
physical body there comes the time for work with breathing. Basic pranayam techniques teach how – using our
mind – we can control partly automatic actions such as
breathing, blood circulation, muscle tone. The work with
breathing seems the easiest, because it is a partly volitional process and through the right training we can learn
to control it much better than an average person.
In this way we gain the possibility to work with
emotions whose influence on breathing is quite evident.
The same rule works the other way round, too. The aim
of learning how to control breathing and how to breathe
efficiently is to prevent hypoxia or hyperventilation in
a stressing situation and – by concentrating on the act of
breathing rather than on the stressor – how to gain
perspective which facilitates objective assessment of the
situation and proper action.
Particularly important are the exercises in breath
holding, ever longer with practice. The longer we hold
our breath, the longer is the gap between the moment
when the nervous impulse reaches brain and the
response to it, which brings about a sense of deep calm.
During breathing and physical exercises, as well as during
relaxation, mental instructions – after F.M. Alexander
called directions – are given. They reverse the effects of
the adaptive reflexes and – in lack of conscious muscle
activity – make it possible to go around movement habits,
thus efficiently helping relax tensions in places where no
volitional activity would give such effect [37,38].
Working with locomotor system
Conscious breathing is followed by conscious movement.
Somayog makes it possible to mobilize stiffened parts of
the body gently and according to their actual capability,
to stretch and strengthen shortened and weakened
muscles – in synchronism with breathing. These actions
are performed with full attention because conscious use
of the body improves co-ordination and movement
elegance as well as results in an even development of
cerebral hemispheres. In Somayog, asanas (body positions) are combined with exercises; while the exercises
mobilize and strengthen muscles and increase metabolism, the asanas engage consciousness and concentration,
relax and stretch muscles as well as decrease metabolism.
Asanas and exercises act complementary and usually are
performed alternately.
What is more, asanas affect hormones’ secretion and
electrochemical activity of the nervous system – the
effects impossible to be achieved by exercises alone [39].
On the other hand, the exercises performed with maximal
conscious attention influence not only muscles, but
above all brain, where they activate sensory-motor areas.
As a result the practitioners can gain and preserve full
internal control over their muscle action.
The exercises concentrate on places with sensorymotor amnesia. Some of them sensitize and engage the
muscles in the centre of the body, mostly the postural
ones, whose function as a result of incorrect habits was
taken over by other muscles not prepared to the
prolonged effort of counteracting the gravitational force.
Other exercise series activate limbs and neck, still others
facilitate the processes of breathing and walking, where
the effects of sensory-motor amnesia are most often
experienced.
Each exercise is performed slowly, so that the movement can be stopped and reversed any moment. This not
only activates the consciousness, but also guarantees
that every movement sequence is performed safely and
according to actual capability. Every now and then the
participants stop in a given stretching position (asana) to
further observe tensions in their bodies and relax those
parts which they perceive as tense – either employing
their willpower, if they have already obtained some
control over their body’s motor activity, or using mental
directions which switch off unconscious habitual muscle
Pic. 1. Exercise on conscious use of the muscles in the back of the trunk, facilitating co-ordination of movements in the back side of
the body
The course of the exercise
Breath-in raising the head and one leg, looking straight and without tensing of the shoulder girdle muscles. The movement is made with
the minimal possible use of muscles. The most important thing is to feel how the distance between the head and the raised leg grows,
and not to rise the leg as high as possible.
Breath-out lowering the raised body parts onto the floor and with a full relaxation of the practising muscles. Change of the practising leg.
Recommendations
The exercise is recommended in nape, shoulder and lower part of the back tensions and in the weakened sense of the tensions of the back
muscles.
Pic. 2. Exercise for the side muscles of the trunk
Breath-in raising the head supported by the arm so that the neck remains relaxed. Simultaneous raising of the shank without separating
the knees; the movement is performed through hip rotation. Both parts of the body are moved using the waist muscles.
Breath-out with lowering of the practising body parts and full relaxation of the muscles.
The exercise begins with raising of the head and arm only, then the leg is raised only and as the last stage both movements are performed
simultaneously.
Recommendations
The exercise is helpful in scoliosis and in the asymmetric weakening of the trunk muscles. Healthy participants practise both sides
symmetrically, in the case of those with scoliosis the therapeutic elements of the exercise can be chosen and the fragments deepening the
defect can be omitted.
CAMS 2/2013
85
(trauma, hard physical work etc.), but much more often
have psychological character, as the majority of physical
diseases have a source in our minds. During the classes
there are many opportunities and time to find out the
reasons hidden behind a given symptom. Usually these
are various stressing factors, and the way a person reacts
to them is not necessarily beneficial for his or her health.
Through conscious work on this deeper level practitioners
have a chance to modify both their actions and their
thoughts in such a way that both cease to be harmful and
to produce pathological symptoms [33].
Pic. 3. Trunk and neck rotations
Trunk rotations combined with looking as far as possible in the
movement direction without raising the hand put on the floor and
combined with relaxation of the shoulders. The hips take active
part in the movement. Breathing regular and full.
Recommendations
The exercise activates different parts of the spine simultaneously;
one of a few exercises which increase flexibility of the dorsal spine.
At the same time it activates gently and deeply cervical and lumbar
spine. It is performed on both sides except in people with asymmetric
posture defects who do not practise the movements deepening the
defect. The exercise is recommended for back muscle tensions,
defects of posture related to the spine, and for the back movement
limitations.
tightening. The directions are effective in any position or
action, since through the power of our mind we are
activating the natural mechanism restoring harmony
within the body.
Every participant needs to be treated individually, so
the groups are small, the overriding rule being the comfort
principle. If a given movement or position turns out to be
difficult or painful, it needs to be modified in such a way
that the practitioner could reach the final effect without
unnecessary stress caused by discomfort, as this would
increase tension through the body’s defensive reflex
rather than lead to the expected relaxation. Somayog has
therefore a significant therapeutic potential, because
classes are open to people who are physically not fully fit,
after surgeries, traumas, with chronic diseases of the
locomotive system, older or too weak to practice other
types of yoga. The method facilitates gradual improvement
of fitness or return to full health without adverse side
effects, since the whole process is performed in accordance with body’s capabilities, allowing for its limitations.
The majority of the limitations expressing themselves
in the form of disease, when analysed attentively reveal
a deeper-lying cause. These causes sometimes are physical
86
CAMS 2/2013
Working with mind
Improving our physical body we improve our mind,
which in turn influences its ability to control thoughts
and emotions. The last part of a typical Somayog session
addresses this aspect directly. In the state of deep relaxation, combined with Alexander’s directions and breathing
observation to free all the remaining tensions, a basic
meditation technique is introduced. It consists of observation of mind’s activity, i.e. thoughts, emotions and
moods, from the position of an disinterested observer,
without getting engaged in the thoughts’ or emotions’
contents and without assessing them. To be able to work
on something, we have first to get acquainted with it.
Through observation of our own mind we realize that
we are more than just a mind, if we are able to subject it
to an objective study. This is the first step on the way to
using correctly this most perfect tool which full potential
still remains unknown. On this level a Somayog practitioner learns to react constructively to any life ordeals and
not only to free oneself from the stress consequences, but
also to perceive stressing situations differently. This stage
facilitates effective work with neuroses, depression,
insomnia, migraine, digestive problems and other ailments
caused by uncontrolled mind action.
Here begins also a spiritual journey in search of our
own identity, because the former identification with the
mind (or the body) is no longer justified. The observer of
mind and body is their user and owner, but at the same
time someone infinitely greater. What we really are we
can define only through direct experience, and not
through intellectual divagations of mind unable to surpass
its limited comprehension. Such experience, however, is
possible only to a mind which can direct this quest. Only
when the mind’s exhausts its capabilities and at the same
time it is trained so that it can pause at this stage without
escaping into habitual chaotic thoughts – a space for
pure awareness opens.
The experience of pure awareness changes completely
the perspective on reality and it is the aim of classically
understood yoga. A “side” effect is psychical and physical
health providing us with a quite new quality of life.
Healthy body moves with pleasure; its every position and
every movement is a source of bliss. The same relates to
the healthy mind: its every action results in a sense of
happiness and peace. The potential of every person is
inexhaustible and absolutely everyone is capable of realizing it within one life [33].
17.
References
18.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Bussing A, Khalsa SBR, Michalsen A, Sherman KJ,
Telles S. Yoga as a therapeutic intervention. eCAM
2012; 174291.
Hankey A. The ontological status of western science
and medicine. J Ayurveda Integr Med 2012; 3 (3): 11923.
Sherman KJ. Guidelines for developing yoga interventions for randomized trials. eCAM 2012; 143271.
Bhavanani AB. Yoga is not an intervention but may
be yogopathy is. Int J Yoga 2012; 5 (2): 157-8.
Konecki KT. Body as the temple of the soul – the
process of building the identity of hathayoga practitioner. Constructing a private quasireligion (in
Polish), Przegl. Socjol. Jakosc 2012; 8 (2): 64-111.
McCall MC. Yoga beyond union. Int J Yoga 2012; 5 (2):
160.
Srinivasan TM. Model and mechanisms in yoga
research. Int J Yoga 2012; 5 (2): 83-84.
Cote A, Daneault S. Effect of yoga on patients with
a cancer. Can Fam Physician 2012; 58: 475-9.
Cramer H, Lange S, Klose P, Paul A, Dobos G. Yoga for
breast cancer patients and survivors: a systematic
review and meta-analysis. BMC Cancer 2012; 18 (12):
412.
Palice D, Zwierzchowska A. Therapeutic qualities of
the yoga system – a literature review(in Polish). Hygeia Public Health 2012; 47 (4): 418-23.
Strijk JE, Proper KI, Mechelen W, Beek AJ. Effectiveness of a worksite lifestyle intervention on vitality,
work engagement, productivity, and sick leave:
results of a randomized controlled trial. Scand J Work
Environ Health 2013; 39 (1): 66-75.
Boehm K, Ostermann T, Milazzo S, Bussing A. Effects
of yoga interventions on fatigue: a meta-analysis.
eCAM 2012; 124703.
Wang MY, Yu SSY, Hashish R, Samarawickrame SD,
Kazadi L, Greendale GA et al. The biomechanical
demands of standing yoga poses in seniors: The Yoga
empowers seniors study (YESS). eCAM 2013; 13: 8.
Galantino ML, Green L, Decesari JA, Mackain NA,
Rinaldi SM, Stevens ME et al. Safety and feasibility of
modified chair-yoga on functional outcome among
elderly at risk for falls. Int J Yoga 2012; 5 (2): 146-50.
Triedemann A, O’Rourke S, Sesto R, Sherrington C. A
12-week Iyengar yoga programme improved balance
and mobility in older community-dwelling people:
a pilot randomized controlled trial. J Gerontol A Biol
Sci Med Sci 2013; 68 (9): 1068-75.
Zettergren KK, Lubeski JM, Viverito JM. Effects of
a yoga programme on postural control, mobility,
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
and gait speed in community-living older adults:
a pilot study. J Geriatr Phys Ther 2011; 34 (2): 88-94.
Beena RK, Sreekumaran E. Yogic practice and
diabetes mellitus in geriatric patients. Int J Yoga
2013; 6 (1): 47-54.
Cramer H, Lauche R, Langhorst J, Dobos G. Effectiveness of yoga for menopausal symptoms: a systematic
review and meta-analysis of randomized controlled
trials. eCAM 2012; 863905.
Gordon L, McGrowder DA, Pena YT, Cabrera E,
Lawrence-Wright MB. Effect of yoga exercise therapy
on oxidative stress indicators with end-stage renal
disease on haemodialysis. Int J Yoga 2013; 6 (1): 31-8.
Singh AK, Singh OP. A preliminary clinical evaluation
of external snehan and asanas in the patients of
sciatica. Int J Yoga 2013; 6 (1): 71-5.
Dhananjai S, Sadashiv, Tiwari S, Kumar R. Reducing
psychological distress and obesity through yoga
practice. Int J Yoga 2013; 6 (1): 66-70.
Hawkins BL, Stegall JB, Weber MF, Ryan JB. The influence of a yoga exercise programme for young adults
with intellectual disabilities. Int J Yoga 2012; 5(2):
151-6.
Singh S. Intellectual disabilities and yoga. Int J Yoga
2013; 6 (1): 80-1.
Cramer H, Lauche R, Klose P, Langhorst J, Dobos G.
BMC Psychiatry 2013; 13: 32.
Cabral P, Meyer HB, Ames D. Effectiveness of yoga
therapy as a complementary treatment for major
psychiatric disorders: a meta-analysis. Prim Care
Companion CNC Disord 2011; 13 (4) : doi: 10.4088/
PCC.10r01068
Bhavanani AB, Madanmohan, Sanjay Z. Immediate
effect of chandra nadi pranayama (left unilateral
forced nostril breathing) on cardiovascular parameters in hypertensive patients. Int J Yoga 2012; 5 (2):
108-11.
Bedekar N, Prabhu A, Shyam A, Sancheti K, Sancheti
P. Comparative study of conventional therapy and
additional yogasanas for knee rehabilitation after
total knee arthroplasty. Int J Yoga 2012; 5 (2): 118-22.
Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R.
Effect of holistic yoga programme on anxiety symptoms in adolescent girls with polycystic ovarian
syndrome: A randomized control trial. Int J Yoga
2012; 5 (2): 112-7.
Mishra SK, Singh P, Bunch SJ, Zhang R. The therapeutic value of yoga in neurological disorders. Ann
Indian Acad Neurol 2012; 15: 247-54.
Froeliger B, Garland EL, McClernon FJ. Yoga meditation
practitioners exhibit greater gray matter volume and
fewer reported cognitive failures: results of a preliminary voxel-based morphometric analysis. eCAM 2012;
821307.
Balasubramaniam M, Telles S, Doraiswamy PM. Yoga
on our minds: a systematic review of yoga for neu-
CAMS 2/2013
87
32.
33.
34.
35.
36.
37.
88
ropsychiatric disorders. Front Psychiatry 2013; 25 (3):
117.
Tokarski S. Yogins and Communities, (in Polish), Ossolineum, 1987.
Schorowska I. Somayog, How to Draw the Time Back?
[in Polish], Purana 2010.
Keleman S. Emotional Anatomy – the Structure of
Experience, Center Press, Berkeley, 1985.
Alexander FM, The Use of the Self, Victor Gollancz,
London, 1985.
Hanna T. Somatics, Addison-Wesley Publishing Company, Inc. 1992.
Vishnu-Devananda S. Meditation and Mantras, Motilal
Banarsidas Publishers, 1999.
CAMS 2/2013
38. Saraswati SN. Prana, Pranayama, Prana Vidya, Yoga
Publication Trust, Munger, Bihar, India 1994.
39. Saraswati SS. Asana Pranayama Mudra Bandha, Yoga
Publication Trust, Munger, Bihar, India 2002.
ADDRESS FOR CORRESPONDENCE
Inga Schorowska
Somayog Association
ul. Legnicka 65, 54-206 Wrocław, Poland
e-mail: [email protected]
tel./fax: +48 22 834 67 72
Received: 12.01.2013
Accepted: 26.05.2013
112 Tomasik1:Layout 1 2014-03-20 12:34 Strona 1
REVIEW ARTICLE
Low glycemic index based diet as a tool
of complementary therapy and prophylaxis
Dominika Obara1, Przemysław Jan Tomasik2, Piotr Tomasik1
1
2
CRACOW COLLEGE OF HEALTH PROMOTION, CRACOW, POLAND
COLLEGIUM MEDICUM, JAGIELLONIAN UNIVERSITY, CRACOW, POLAND
SUMMARY
Diet is a widely used therapeutic and prophylactic tool in hands of physicians and individual consumers. The diets offered by several authors usually put some limits on
the amount of consumed products as well as put some meals into priority. Calorific value of taken food is a leading parameter in the composing dietetic meals. In this
paper a diet based on glycemic index and glycemic load is presented. It can be tailored individually for the individuals based on anticipated target to be met that is
therapy of certain diseases, particularly these associated with malfunctions of organs involved in metabolizing meals (pancreas, liver, intestine and so on), in reducing
overweight, and in prophylaxis. In this diet the calorific value of meals is not essential.
KEY WORDS: cardiovascular disease, diabetes, glycemic load, overweight
STRESZCZENIE
Dieta w oparciu o niski indeks glikemiczny jako narzędzie komplementarnej terapii i profilaktyki
Dieta jest narzędziem terapeutycznym i profilaktycznym powszechnie stosowanym przez lekarzy i konsumentów indywidualnych. Diety oferowane przez kilku autorów
zwykle nakładają limity odnośnie do ilości spożywanych produktów, jak również określają priorytety co do rodzaju posiłków. Głównym parametrem w komponowaniu
posiłków dietetycznych jest wartość kaloryczna przyjmowanej żywności. W niniejszym artykule prezentowana jest dieta oparta na indeksie glikemicznym i ładunku
glikemicznym. Może być ona dostosowana indywidualnie do danej osoby w oparciu o zamierzony cel, jakim jest leczenie pewnych chorób, zwłaszcza związanych
z nieprawidłową pracą narządów biorących udział w metabolizowaniu posiłków (trzustki, wątroby, jelit itp.), redukcja nadwagi czy profilaktyka. W diecie tej kaloryczność
posiłków nie jest elementem zasadniczym.
SŁOWA KLUCZOWE: choroba niedokrwienna serca, cukrzyca, ładunek glikemiczny, nadwaga
Background
Diet, in general, is a way of nutrition and even style of life
which results from our taste and availability of food products. However sometimes philosophic and/or religious
as well as medical prescriptions influence our nutrition.
These regulations are considered as a remedy for curing
various malaises, dysfunctions of some organs, reducing
excessive bodyweight treated as an origin of certain
diseases or causing esthetic discomfort. There is a number
of diets connected with religions, among them with
a long tradition such as vegetarian and vegan. The well
known prohibition of eating of pork meat in Judaism and
Islam was connected with the role of pigs in the Near East.
These animals were all-eating including carrion, so
consumption of their meat were connected with high risk
of disease transmission (incl. trichinosis or swine flu) [1].
Several diets promoting healthy style of life such as Duncan
diet [2], Kwaśniewski diet [3] Mediterranean diet [4] and
several others have been recommended. Straightly medical
diets are composed to cooperate with pharmacological
treatment. Sometimes diet is a medical cure per se-as low
phenylalanine diet in the case of patients with phenylketonuria [5]. However it should also be underlined that
style of eating in healthy people has also a great prophylactic potential. Classical diets either put some limits on
uptake of certain foodstuffs (meat, other protein, fat,
carbohydrates) or completely exclude them from consumption and/or suggest some proportions of the compo-
nents in meals. As a rule, they are composed for groups of
consumers without considering their individual problems
and preferences. Moreover, usually they advice limitations in foodstuff daily uptake and suggest frequency of
meals. The new concept of diet was presented by Michael
Montignac almost 30 years ago [6-9]. The scientific basis
of this concept was prepared by several scientific publications showing benefits with low glycemic index diet. In
1984 it was proofed that this diet reduces risk of diabetes
[10]. Next year Jenkins et al. [11] showed that low glycemic
diet improve lipid profile and reduces risk of cardiovascular incidences. And finally in 1986, Montignac [6-9]
developed his method based on low-caloric diet for
everyone. It can be tailored individually for the individuals based on anticipated target to be met that is therapy
of certain diseases, particularly these associated with
malfunctions of organs involved in metabolizing meals
(pancreas, liver, intestine and so on), reducing overweight,
and prophylaxis. The diet is based on so-called glycemic
index (GI) of foodstuffs and their glycemic load (GL).
Glycemic index (GI) and glycemic
load (GL)
Glycemic index (GI) is defined [12] as an extent to which
carbohydrates raise blood sugar levels after eating. It is
expressed in figures ranging on a scale from 0 to 100.
Foods characterized with a high GI are rapidly digested
and absorbed causing marked fluctuations in blood
CAMS 2/2013
89
Obara D. et al. Low glycemic index based diet
sugar levels. In contrast to them, low-GI foods are slowly
digested and absorbed, producing a gradual rise in blood
sugar. Standardized determination of food's GI involves
(i) feeding 10 healthy people after an overnight fast with
a food containing 10 - 50 grams of carbohydrate(ii) taking
finger-prick blood samples at 15-30 minute intervals over
the next two hours. Based on the results a blood sugar
response curve for the two hour period is drawn. The area
under the curve (AUC) reflects the total rise in blood
glucose levels after eating the test food. Obviously, various
carbohydrates differently contribute to the level of glucose
therein. Jenkins [13] who was the first who determined
IG for a variety of meals took glucose as the standard for
which 100% was accepted. Thus, GI rating (%) is calculated by dividing the AUC for the test food by the AUC for
the reference food (same amount of glucose) and multiplying by 100. [14] These GI values are average values of
several estimations [15]. Carbohydrates of high GI readily
are absorbed from the gut to the blood and easily
metabolize to glucose, thus the rate of increase in the
blood glucose concentration is high. Since the natural
reaction of human organism is insulin secretion, glucose
is metabolize fast and the feeling of hunger is soon
developed inducing further eating [16]. In contrast to
that, food of low GI are metabolized and absorbed from
the gut slowly. The glucose level in the blood is not so
high and lasting longer, therefore feeling of satiety lasts
longer. Although generally, carbohydrates which are
readily metabolized have a high GI but some carbohydrates characterized with low GI may significantly increase
the glucose level in the blood. Glycemic load (GL)estimates
how much the food will raise a person's blood glucose level
after eating it. The concept of GL was introduced in 1997
toquantify the overall glycemic effect of a portion of food
[17]. One unit of GL approximates the effect of consuming
one gram of glucose [18]. GL of a food is derived multiplying GI by the amount of carbohydrate in grams provided in specified serving size of the food and dividing
the total by 100. Dietary GL is the sum of GLs for all foods
in the diet. Ranges of low, medium and high GL are
estimated for ≤ 10, 11-19 and ≥ 20, respectively. The level
of GL can be controlled either by selecting food of low GI
or decreasing amount of consumed carbohydrates.
GI and GL load based diet
For promoting good health, the consumption of a highcarbohydrate diet (≥55% of energy from carbohydrate),
should be accompanied with the bulk of carbohydratecontaining foods being rich in non-starchy polysaccharides
with a low GI. In Australia, official dietary guidelines for
healthy elderly people specifically recommend the consumption of low-GI cereal foods for good health [19,20],
and a GI trademark certification program isin place to put
GI values on food labels as a means of helping consumers
to select low-GI foods [21].There are several evidences that
90
CAMS 2/2013
a low-GI diet might also protect against the development
of obesity[22-24], colon cancer [25], and breast cancer [26].
Also several large-scale, observational studies from Harvard
University indicate that the long-term consumption of
a diet with a high glycemic load is a significant independent predictor of the risk of developing type 2 diabetes
[27,28] and cardiovascular disease [29].
Thus, for particular individuals, preferably after examination of the level of glucose in their blood and checking
the rate of the glucose metabolism after uptake, the
proper diet can be composed based on GI and GL of
a variety of foodstuffs tabulated in various sources.
One of the most common such kind approaches is
known as the Montignac diet [6-9]. It focuses on treating
diabetics, overweight, and cardiovascular problems. It
rejects limitations in amount of meals. The sole restrictions deal with the use of carbohydrates which are
selected according to their GI and GL. Table 1 contains G I
values for selected foodstuffs. Full list of GI and GL values
can be found in paper by Foster-Powell et al. [14,30] and
other sources, for instance, that by Sinska and Wójcik [31].
Insight in Table 1 [32] reveals that starch and starchy
products are key components of foodstuffs raising GI of
meals. Generally, processed carbohydrates have higher
GI than carbohydrates unprocessed. Also GI of fruits and
vegetables increases by their either mechanical or thermal
processing. Fat and proteins slow down empting of
stomach, hence, digestion and absorption of metabolites
in intestine is slower [33]. Therefore, their GIs are lower.
Frequently, natural non-processed foods, for instance,
seeds of legumes contain components considered harmful
at higher concentration. They obstruct action of digestive
enzymes and, in consequence, they cause stomach problems. Boiling decomposes majority of these components.
Some of them such as phytinans and tannins are thermoprocessing resistant. By slowing down digestion and
absorption of metabolites they decrease GI. Such compounds exist in legume seeds, full grain and bran [34].
According to the Montignac method the diet should
be applied in two stages. One of them takes reducing
body weight as its target. This attempt simultaneously
stabilizes the activity of pancreas i.e. insulin excretion.
Usually that phase should last 2 months but it can be
maintained for unlimited period without a danger of
excessive losing weight. The period of this stage of keeping
diet depends on BMI index defined as
In order to meet success one should consume carbohydrates of GI ≤ 50 and avoid consumption of carbohydrates of GI ≥ 35 with saturated fatty acids. Unsaturated
fatty acids should be consumed instead. There are no
limits put on consumption of proteins. The following
additional recommendations should be implemented [8]:
• Eat to afford satiety without any control of the calorific
value of the meals,
• Take rigorously three meals a day always in the same
day period,
•
•
•
•
•
Keep 3 hr break between the meals, but in case of
meals rich in fat that break should reach 4 hrs. Supper
should be taken 3-4 hrs before sleep,
Composition of the meals be diverse,
Eliminate carbohydrates of GI ≥ 50 (sweets, chips,
French fries, wheat bakery products, potatoes and so
on) and replace them with full grain bakery products,
durum noodles, basmati rice and so on,
Limit uptake of saturated fats (meat, butter, full dairy
products, fatty sausage) implementing olive and
other vegetable as well as fish oil. Fatty fish is recommended,
Skimmed dairy products are recommended for consumption with carbohydrates but in moderate doses
•
•
(for instance, up to 2 yogurts daily). Full dairy products,
mould and matured cheese, cream, mozzarella, feta,
butter and small amount of yogurts are applicable for
fatty meals,
Fresh vegetables as source of carbohydrates, fiber,
vitamins, other antioxidants and minerals catalyzing
metabolism of lipids can be consumed without any
limits,
Consumption of fruits should be controlled. Fresh,
fermenting in gastric tracts such as apples, pierces,
should be taken preferably 30 min prior to breakfast.
There are no limits for uptake of currants, raspberries
blackberries, blueberries, strawberries, and boiled
fermenting fruits. Sweet fruits should not be consumed
Table 1. GI values for selected foods
CAMS 2/2013
91
before the sleep. They should not replace regular
meal,
• Volume of fruit juices should be limited for their high
GI,
• Reject sweetened soft drinks, tea and coffee,
• Limit amount of strong coffee as it promotes ejection
of excessive insulin.
After reaching a goal of the first stage diet, its second
stage can be applied in two modifications i.e. that rigorous
without exclusions and that with some exclusions. In the
first case foods of GI ≥ 50 can be introduced into the diet
(rice basmati, noodles al dente) provided uptake of saturated fatty acids is rigorously controlled, particularly in
the last evening meal. In the second case, components
with high GI should be equilibrated with components of
low GI providing average GI of meals on the level of ≤ 50.
Once that style of diet is chosen, fairly precise control of
the meal composition is required.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Closing remarks
Michael Montignac died in 2010, but his books are continuously paying attention and up today over 15 million
copies of his books was sold all over the world. One
should know that this diet is not easy in implementation
because practitioners should use a number of tables and
apply some rules. It is difficult to compose and/or
followed rules of Montignac method for persons using
budget restaurants or fast-foods services. Nevertheless,
accepted diversity of meals is advantageous.
11.
12.
13.
References
1.
92
Seef S, Jeppsson A. Is it a policy crisis or it is a health
crisis? The Egyptian context analysis of the Egyptian
health policy for the H1N1 flu pandemic control. Pan
Afr Med J 2013; 14: 59.
CAMS 2/2013
14.
Duncan P. The Duncan Diet. Hodder & Stoughton,
London, 2010.
www.poradnikzdrowie.pl/odchudzanie/diety/dietaoptymalna-dr-jana kwasniewskiego_ 36806, html.
Willett WC. Mediterranean diet; science and practice.
Public Health Nutr 2006; 9(1A): 105-110.
Van Calcar SC, Ney DM. Food products made with
glycomacropeptide, a low phenylalanine whey protein, provide a new alternative to amino acid-based
medical foods for nutrition management of phenylketonuria. J Acad Nutr Diet 2012; 112: 1201-10.
Montignac M, Grey J, Perel L. The Montignac Diet.
Dorling Kindersley Publ. Ltd, 2005.
Montignac M. Glycemic Index, Diet for Weight Loss.
Dorling Kindersley Publ. Ltd, 2005.
Montignac M. The Montignac Method Just for Women.
Montignac Publ. (UK), 1995.
http://www.montignac.com/pl/metoda-montignac/
Walker AR,Walker BF. Glycemic index of South
African foods determined in rural blacks – a population at low risk of diabetes. Hum Nutr Clin Nutr 1984;
38: 215-22.
Jenkins DJ, Wolever TM, Kalmusky J, Giudici S,
Giordano C, Wong G S, Bird JN, Patten R, Hall M,
Buckley G. Low glycemic index carbohydrate foods
in the management of hyperlipidemia. Am J Clin
Nutr 1985; 42: 604-17.
Burani J. Practical Use of the GI. American Diabetes
Association 2006.
Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden
HB, Baldwin JM, Bowling AC, Newman HC, Jenkins
AL, Goff DV. Glycemic index of foods a physiological
basis for carbohydrate exchange. Am J Clin Nutr
1981; 34: 362-66.
Foster-Powell K, Holt SHA, Brand-Miller C. International table of glycemic index and glycemic load
values. Am J Clin Nutr 2002; 76: 5-56.
15. Wolever T, Brand-Miller J, Abernathy J, et al. Measuring the glycemic index of foods: interlaboratory
studies. Am J Clin Nutr 2008; 87: 247S-257S.
16. Gallop R, Sole MJ. The G.I. Diet. Virgin Books, Ebury
Publ. London, 2010.
17. Salmeron J, Manson J, Stampfer M, Colditz G, Wing
A, Willett W. Dietary fiber, glycemic load, and risk of
non-insulin-dependent diabetes mellitus in women.
JAMA 1997; 277: 472-7.
18. Glycemic Load Defined. Glycemic Res. Inst., 2013,
http://www.glycemic.com/GlycemicIndex-LoadDefined.htm.
19. Jenkins DJ, Kendall CW, McKeown-Eyssen G et al.
Effect of a low-glycemic index or a high-cereal fiber
diet on type 2 diabetes: a randomized trial JAMA
2008; 300: 2742-53.
20. Brand-Miller J, Bell L, Denning K, Browne D. In search
of more low glycemic index foods. Proc Nutr Soc Aust
1995; 19: 177.
21. Krezowski PA, Nuttal FQ, Gannon M , Billington CJ,
Parker S. Insulin and glucose responses to various
starch-containing foods in type II diabetic subjects,
Diabetes Care 1987; 10: 205-12.
22. Jenkins DJA, Wesson V, Wolever TMS, Jenkins AL,
Kalmusky J, Guidici S et al. Whole meal versus whole
grain breads: proportion of whole or cracked grain
and the glycemic response. Br Med J Clin Res Ed 1988;
297: 958-60.
23. Liljeberg H, Granfeldt Y, Björck I. Metabolic responses
to starch inbread containing intact kernels versus
milled flour. Eur J Clin Nutr 1992; 46: 561-75.
24. Brand-Miller JC. Glycemic index and obesity. Am J
Clin Nutr 2002; 76: 281S-5S.
25. Brown D, Tomlinson D, Brand Miller J. The development of low glycemic index breads. Proc Nutr Soc
Aust 1992; 17: 62.
26. Brand-Miller J, Buyken A.The glycemic index issue.
Curr Opin Lipidol 2011; 23: 62-67.
27. Wolever TMS, Vuksan V, Katzman Relle L, Jenkins AL,
Josse RG, Wong GS et. al. Glycemic index of fruits and
fruit products in patients with diabetes. Int J Food Sci
Nutr 1993; 43: 205-12.
28. Brand-Miller JC, Allwan C, Mehalski K, Brooks D. The
glycemic index of further Australian foods. Proc Nutr
Soc Aust 1998; 22: 110.
29. Bornet FRJ, Costagliola D, Rizkalla S, Blayo A, Fontvielle
AM. Haardt MJ et al. Insulinemic and glycemic
indexes of six starch-rich foods taken alone and in
a mixed meal by type 2 diabetics. Am J Clin Nutr
1987; 45:588-95.
30. Atkinson FS, Foster-Powell K, Brand-Miller C. International table of glycemic index and glycemic load
values:2008. Diabetes Care 2008; 31: 2281-3.
31. Sińska B, Wójcik Z. Glycemic index and load (in Polish),
Polfa, Rzeszów, 2008.
32. http://dietamm.com/indeks-glikemiczny
33. Leeds A, Brand-Miller CJ, Foster-Powell K, Colagiuri
S. You do not Need to Count Calories (Polish transl.),
Wyd. Amber, Warszawa 2002.
34. Kuchanowicz H, Nadolna I, Przygoda B, Iwanow K.
Healthy Eating (in Polish), PZWL, Warszawa, 2011.
Piotr Tomasik
Cracow College of Health Promotion
ul. Krowoderska Street 37, 31-158 Cracow, Poland
tel. /fax: +48 (22) 834 67 72
CAMS 2/2013
93
94
CAMS 2/2013
113 Tomaszewski1:Layout 1 2014-03-20 12:33 Strona 1
ORIGINAL ARTICLE
Colour therapy – the relationship between
the quality of life (QOL) and colour selection
according to the Lüscher test
Ewa Osiak1, Edyta Szczuka2,Wiesław Tomaszewski1
1
2
COLLEGE OF PHYSIOTHERAPY, WROCŁAW, POLAND
DEPARTMENT OF SPORT FOR PERSONS WITH DISABILITIES, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCŁAW, POLAND
SUMMARY
Background. Colour therapy is used not only in prophylaxis and complementing the basic treatment of the patient but also as an independent therapeutic method.
Despite intensive development of this method theoretical foundations of the practice are lacking. The selection of colours used in the treatment is based on general
indications and not on individual needs necessary for application of a targeted therapy. The aim of the study was to check a possible relationship between quality of life
(QOL) estimated with SF-36 questionnaire and the results of the colour selection according to the Lüscher test.
Material and methods. The study was conducted on two groups of subjects: one consisting of 40 healthy persons aged 20 to 30 (the young group) and the other
consisting of 40 healthy people aged 50 to 65 (the elderly group). The study involved the short Lüscher colour test and SF–36 questionnaire for the estimation of the
QOL. Depending on the sequence order resulting from the application of the Lüscher colour test, individuals in both groups were arranged into 8 subgroups which then
were analyzed for QOL involving the SF–36 questionnaire.
Results. In both groups relationships between QOL and the choice of colours for some aspects of life quality were observed.
Conclusions. Demonstrated relationship shows that for patients treated with colour therapy an individual, targeted therapeutic treatment should be arranged, based
on the fundamental goal of therapy related to personal development and the improvement of the patient's QOL.
KEY WORDS: quality of life (QOL), colours, SF-36 questionnaire, Lüscher test
STRESZCZENIE
Koloroterapia – związek pomiędzy jakością życia (QOL) a wyborem kolorów w teście Lüschera
Wstęp. Koloroterapia stosowana jest nie tylko w celach profilaktycznych i uzupełnienia podstawowego leczenia pacjenta, ale też jako samodzielna metoda terapeutyczna.
Pomimo intensywnego rozwoju tej metody wciąż brakuje teoretycznych podstaw jej praktykowania, co sprawia, że dobór kolorów oparty jest raczej o ogólne w tym zakresie wskazania, a nie indywidualnie dobraną, celowaną terapię. Celem badania było sprawdzenie możliwego związku pomiędzy jakością życia (QOL) mierzoną kwestionariuszem SF-36 a wyborem kolorów w teście Lüschera.
Materiał i metody. Grupę badaną stanowiło 40 zdrowych osób w wieku od 20 do 30 lat, grupę kontrolną 40 zdrowych osób w wieku od 50 do 65 lat. Do badań wykorzystano krótki test kolorów Lüschera oraz badania QOL kwestionariuszem SF- 36. W zależności od sekwencji uporządkowania kolorów testem Lüschera, badanych przydzielano do odpowiednich podgrup, w których następnie dokonywano analizy QOL.
Wyniki. W obu badanych grupach wykazano zależność pomiędzy QOL a wyborem kolorów.
Wnioski. Wykazana zależność pokazuje, że do pacjentów leczonych metodą koloroterapii należy stosować indywidualne postępowanie terapeutyczne, w oparciu o zasadniczy cel terapii związany z rozwojem osobistym pacjenta oraz poprawą jego QOL.
SŁOWA KLUCZOWE: jakość życia (QOL), kolory, kwestionariusz SF- 36, test Luschera
Background
The importance of colours for life and health and their
effect on the mind and the human body was noted
already four thousand years ago, when in ancient Egypt,
India, China, and also in Greece and Tibet, chromotherapy
was introduced. The first written sources about the use of
the methods were found in the areas of ancient Egyptian
civilization. Even by that time many therapies were supported with wearing items in the appropriate colours, as
well as the addition of a variety of colourful spices into the
food. Colour therapy was considered then as a method for
restoring harmony in the human body. This method gained
importance again only in the nineteenth century [1,2].
Babbit [3] observed that colours stimulated the autonomic nervous system, responsible for metabolism and
secretion of hormones. He also introduced a number of
techniques and methods of treatment with colours.
Therapy with colours began to develop in the second
half of the twentieth century, especially in the United
States and Western Europe. This method is currently used
in both academic and unconventional medicine, also
referred to as complementary or alternative. In Poland
this method is used primarily by psychologists, physiotherapists and educators as well as physicians. The social
significance of each colour is strongly related to symbolism of particular cultures. Some meanings of colours
cannot be rationally explained, as they are linked to emotions in a given society, as well as distinctive geographical
and natural conditions [4,5].
Doctors and other therapists recognize the positive
impact of colours on the course of the therapy. Colours
evoke a variety of reactions, they can stimulate the body
but also tranquilize it. Increasingly, public buildings, offices,
hospital rooms consciously use specific sets of colours, in
order to achieve certain effects. Contemporary colour
therapy is based on the exposure of the body to sunlight
or light emitted by special lamps and colour filters. It is
believed that colours have certain spiritual, therapeutic
and cosmetic properties. The human body is healthy when
CAMS 2/2013
95
Osiak E. et al. Colour selection and the quality of life
it emits oscillations of similar frequencies. In a healthy
person, frequency of these oscillations is balanced but it
is distorted during illness. The balance can be restored
when an appropriate colour is directed to the ill organ.
Chromotherapy (or its selected elements) is also used,
among other things, in the individual or collective therapeutic activities in kindergartens, schools, hospitals, or
nursing homes. Such activities are often combined with
breathing exercises during which imagination is developed. Participants imagine that they inspire colourful air,
which then spreads throughout the body [6,7].
Colour perception is explained [8] on the basis of the
following theories:
• Young-Helmholtz, where in the eyes there are three
types of nerve fibres and three types of light-sensitive
cells that work together and are responsible for reception of green, red and violet colours;
• Hering, which is based on the principle of the occurrence of pairs of colours, such as black-white, red-green
and blue-yellow;
• Ladd-Franklin, which explains the basic issues of colour
components which have been registered by photosensitive cells.
A properly functioning organ of sight provides stimuli
affecting the observer’s psyche and the emotional and
intellectual sphere. One can look for a relationship between
the perception of colours and associations connected
with them. Such a phenomenon would explain the theory
of association, which is manifested by connecting two
independent qualities. This can be illustrated by the
exciting and irritating influence of red and the soothing
effect of the green colour. Associations are characteristic
of an individual observer, and depend mainly on his or
her personal experience. Most psychological theories on
colour clearly indicate the role of symbolism and associations. Perception of colour is considerably influenced by
the personality of the observer. Functional imaging
research and studies of brain-damaged patients suggest
the mechanisms of color perception and color imagery
have some degree of overlap. It is believed that at least
60% of the human responses in a particular situation
depend on individual colour perception. Colour is of
importance in the process of building individual identity.
Clothing and colour, as well as the setting of contrasts
shall inform the surrounding people about a person’s
preferred values, norms and patterns of behaviour. Nutritionists recommend dividing a meal into portions of
specific colour groups [9,10].
Treatment with colours is now applied in the areas
such as traumatology, rheumatology, sports medicine,
neurology, physiotherapy, surgery, or dermatology. Colour
therapy boosts the process of wound healing (eg. pressure
ulcers or burns) and tissue regeneration after surgery, as
well as improves bone mineralization. It has an immunostimulatory, anti-inflammatory, decongestant and pain
96
CAMS 2/2013
relieving properties. Colour therapy also supports the
treatment of psoriasis, acne, keloids and venous ulcers,
improves microcirculation, promotes metabolism, and is
an established method of treatment of seasonal depression
[11,12].
Picel [13] described the popular art of feng shui,
where colour is recognized as an energy carrier and,
according to the principles of Chinese medicine, has
a huge impact on the human body, which in turn translates into quality of life. Also Wolfgang Goethe already in
1810 mentioned the relationship of colour to the quality
of human life. There is still ongoing research on colour
therapy and its impact on the quality of life [6].
Chang and Zhang [14] in their study confirmed that
colour therapy, in combination with pharmacotherapy, in
a positive way contributed to the alleviation of depression
in women from Macau. Cingi et al [15] demonstrated in
their study the effectiveness of colour therapy in improving
the quality of life of people with allergic rhinitis. They
showed that colour therapy reduces the amount of
inflammatory cells, relieves symptoms of allergic rhinitis,
which affects the quality of life of the patient.
Recent years have brought a growing interest in
assessment of the quality of life in clinical trials, as well as
in determining effects of therapy. The quality of life is
associated primarily with the issue of life satisfaction [16].
In colour therapy practice two methods are distinguished:
a light-employing method and a molecular method.
Colour light therapy (light chromotherapy) employs the
visible portion of the electromagnetic radiation produced
artificially or derived from sunlight. Molecular chromotherapy in its principle allows for the interaction of
matter of a certain colour with the human psyche.
According to Lüscher, the choice of a specific colour could
be considered as psychophysical evidence for specific
needs of the body. According to Lüscher [17], colour
preferences are unconscious choices made prior to conscious processing of colour stimuli. Colours have universal
impact on the recipient, that is, they are independent of
age, gender, and so on.
The aim of the study was to investigate whether in
two 40-person groups of different age there is a relationship between the quality of life, analyzed using the SF-36,
and the choice of colours according to the Lüscher test.
Material and methods
Material
The young group consisted of 40 people (25 women, 15
men) aged 20 to 30 and the elderly group included 40
people (20 women, 20 men) aged from 50 to 65. At the
start of the study a short interview was conducted in both
groups for the profession, the current family situation and
completed in the past diseases of the participants of the
study.
Methods
1. Lüscher test
Each participant received 8 coloured cartons (4 of them
were coloured in primary colours : red, yellow, green,
blue, and 4 other were painted with secondary colours:
black, gray, brown, violet). Then the participants were
asked to arrange the cartons beginning from the colour
they liked they most. It was believed that the choice of
four basic colours in the first place showed the best
psychophysical condition of the subject.
the questions, summed the results of these values were
summed separately for each aspect. Were then transform
the results to yield a value from 1-100 for each scale
(aspect). The higher the scale values for FP, RP, GH, V, SF,
RE, MH, the result was better. Only in the case of the BP
scale lower values indicated better quality of life.
To examine the effect of the colour selection on the
quality of life in the younger RG1 and RG4 subgroups the
t-Student’ test was applied. For the elderly group used
the same test was used for CG1 and CG2 subgroups.
Results
2. The SF–36 questionnaire
The study used the SF–36 questionnaire [18] in the
Polish version. It contained 36 questions grouped in eight
scales, relating to the f physical, mental and social aspects
of investigated subjects that is: physical functioning (PF),
role limitations due this physical problems (RP ), bodily
pain (BP), general health (GH), vitality (V), social functioning (SF), role limitations due this emotional problems (RE)
and mental health (MH). After completing the SF-36
questionnaire by the subjects and checking the correctness
of their fill, questionnaires were recalibrated. Recalibration
was to assign numbers circled by the respondent answers
to a corresponding numerical values, called the transformed value. Transformed values for individual answers
in the questionnaire were based on empirical research.
After obtaining the transformed values for each answer
In the present experiment elderly subgroups were made
depending on the sequence of colour selection [Tab. 1].
Analysis of QOL in different subgroups within the
younger group and reference the results of these studies
to the sequence of the colour selection indicated that
QOL significantly correlated with the choice of a certain
colours. The more primary colours the given persons
chose, the higher was his QOL. In this study, this trend
was evident in the PF, RP, BP, V and MH scales [Tab. 2].
Statistically significant differences between the mean
values for RG1 and RG4 subgroups amounted to p = 0.001
p = 0.012 and p = 0.013 for PF, RP and BP, respectively.
QOL analysis of various subgroups of the elderly and
reference these results to the sequence of colour selection
indicated that, as in the younger group, the quality of life
Tab. 1. Distribution of respondents into subgroups depending on the choice of colours
Tab. 2. Quality of life ( QOL ) in the younger group
CAMS 2/2013
97
Tab. 3. Quality of life ( QOL ) in the elderly group
significantly correlated with the sequence of selection of
specific colours. The more primary colours favoured
subjects in their choice, the higher was their QOL. In the
elderly group, this trend was a unidirectional (in the area
of all subgroups) in terms of RP and RE scales and
comparatively between groups CG1 and CG3 in the scales
of PF, GH and SF. In the case of physical pain scale (BP) QOL
mean values with respect to a choice of colours were completely opposite to these in the younger group. For example, observed in the control group, the highest QOL in
a subgroup of CG3, in the area of pain (BP = 21.11), is not
associated with higher here (compared to groups CG2 and
CG1) preference choice of primary colours [Tab. 3].
Statistically significant differences between mean
values in the subgroups of CG1 (people who first opted
for all 4 primary colours) and CG3 (persons who have
chosen the first two primary colours and three secondary
colours) were significant for RE (p = 0.048) and BP
(p = 0.026).
Discussion
Usefulness of the Lüscher test is quite strongly criticized
[19], especially in the personality testing projection methods, although colour matching and assignment is
a preferential choice, and thus relates to the associated
preferences [20]. Zielinski [21] reports that Goldstein’s or
Lüscher’s theories have a much wider range of applications
than the diagnosis of personality and they assume that
the surrounding colour affects physiological, cognitive,
and emotional reactions. Kuloglu et al [22] studied colour
preferences (the Lüscher test) among a number of psychiatric patients. They found that the gender and cultural
environment are more related to making preferences for
colours and numbers than psychiatric diagnosis.
Analysis of QOL in terms of the results from the
Lüscher test confirmed the thesis promoted by Lüscher,
that preference for primary colours relates to a high level
of mental and physical balance. When one of the primary
colours in the test was rejected, it meant that a significant
psychological need for the test was not met.
98
CAMS 2/2013
The members of the younger group had a better
quality of life than the elder members of the second
group. In both groups, there was a pattern of choosing
the colour and quality of life of the individuals. People
who chose most primary colours were characterized by
the highest quality of life; responses indicated that they
enjoyed good physical and mental health, and their life
was free of fear and stress. There was, however mental
load characteristic for this group, which might, however,
arise from the way of life and the ubiquitous rush. The
lower the standard of living of the respondents, the more
secondary colours were selected.
Conclusions
Lüscher test can be a very useful tool in the work of
a physiotherapist, for evaluating the psychophysical
condition of the patient before the targeted treatment
colour therapy (eg. selection of a curing light of a specific
colour).
References
1.
2.
3.
4.
5.
6.
Rzepińska M. Historia koloru w dziejach malarstwa
europejskiego. [History of colour in European painting].
Arkady, Warszawa, 2009: 77–105 (in Polish).
Gerber R. A practical guide to vibrational medicine.
Quill, New York, 2000: 219–60.
Babbitt E. The principles of light and color. University
Books, New York, 1967.
Jurek K. Znaczenie symboliczne i funkcje koloru
w kulturze. [The symbolic meaning and functions of
the color in the culture.] Kultura – Media – Teologia
2011; 6: 68–80 (in Polish).
Gage J. Kolor i znaczenie. Sztuka, nauka, symbolika.
[Color and meaning. Art, science and symbolism.]
Universitas, Kraków 2010: 21–33 (in Polish).
Kolek Z. Psychofizyka barwy. [Psychophysical aspects
of colour.] Prace Instytutu Elektrotechniki 2010; 244:
5–8 (in Polish).
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Popek S. Barwy i psychika. [Colour and psychical.]
Uniwersytet Marii Curie–Skłodowskiej, Lublin 1999:
11–13 (in Polish).
Pasek J, Cieślar G, Pasek T, Sieroń A. Leczenie światłem
spolaryzowanym – nowe możliwości światłolecznictwa? [Treatment with polarized light – new modality
of light therapy?] Balneologia Polska 2008; 50(2): 93–
98 (in Polish).
Chang S, Lewis DE, Pearson J. The functional effects
of color perception and color imagery. J Vis 2013;
13(10): 1–10.
Gimbel T. Terapia kolorami. [The colour therapy.] Studio
Astropsychologii, Białystok 2001: 36, 97 (in Polish).
Janosik E. Światło spolaryzowane i jego zastosowanie w medycynie. [Polarized light and its medical
applications.] Prace Instytutu Elektrotechniki 2006;
228: 317–26 (in Polish).
Skoracka J, Torlińska T, Huber J, Witkowska A. Wpływ
światła spolaryzowanego liniowo o różnej długości
fali na czynność jednostek ruchowych mięśnia żwacza. [The influence of different wavelengths of
polarized light on masseter muscle motor units
activity.] Nowiny Lekarskie 2007; 76(2): 114–20 (in
Polish).
Picel J. Metody diagnostyki i leczenia wykorzystujące
prawo 5 elementów. [Methods of diagnosis and treatment using the law of 5 elements.] Poligraf, Wrocław
1999 (in Polish).
Chan MF, Zeng W. Investigating factors associated
with depression of older women in Macau. J Clin
Nurs 2009; 18(21): 2969–77.
Cingi C, Yaz A, Cakli H, Ozudogru E, Kecik C, Bal C. The
effects of phototherapy on quality of life in allergic
rhinitis cases. Eur Arch Otorhinolaryng 2009; 266(12):
1903–8.
Szczuka E. Jakość życia osób niepełnosprawnych. W:
J. Migasiewicz, E. Bolach (red.), Aktywność ruchowa
osób niepełnosprawnych. [Quality of life of people
17.
18.
19.
20.
21.
22.
with disabilities. In: J. Migasiewicz, E. Bolach (eds),
Physical activity of people with disabilities.] Wrocław
TWK 2008: 285–91(in Polish).
Lüscher M, Leśniak FL, Dąbowa K. Diagnostyka kolorami Maxa Lüschera [Max Lüscher color diagnostics.]
Polskie Towarzystwo Higieny Psychicznej, Warszawa
1998 (in Polish).
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health
Survey: Manual and Interpretation Guide Boston: The
Health Institute, New England Medical Center 1997.
Bartsch A, Simmel H, Witt E. Lüscher colour test in
orthodontic patients. Practicability for compliance
assessment? J Orofac Orthop 1997; 58(3):166–73.
Chmiel A. Sukces ostateczna ucieczka od wolności?
Psychoanaliza skojarzeń symbolicznych sukcesu
młodzieży klas maturalnych. [Success – the ultimate
escape from freedom? Psychoanalysis of symbolic
associations of pupils in the final year of secondary
school.] In: Przedsiębiorczość i Zarządzanie 2009;
10(10): 93-111 (in Polish).
Zieliński P. Wpływ barw otoczenia na reakcje fizjologiczne i zachowanie – przegląd badań i próba oceny.
[Effects of environmental color on physiological reactions and behavior: a review and critical evaluation.]
Roczniki Psychologiczne 2007; 10(1): 11–25 (in Polish).
Kuloglu M; Caykoylu A, Yilmaz E: Do psychiatric
disorders affect colour and number preferences?
Yeni Symposium 2009; 47 (3): 113.
Wiesław Tomaszewski
Al. Stanów Zjednoczonych 72/176, w.E, 04-036 Warsaw, Poland
tel./fax: +48 (22) 834 67 72
CAMS 2/2013
99
100
CAMS 2/2013
114 bolach banki:Layout 1 2014-03-20 12:31 Strona 1
ORIGINAL ARTICLE
Evaluation of traditional and rubber cupping
massage techniques applied to female patients
with low back pain
Eugeniusz Bolach1, Kamila Lisowska2
1
2
DEPARTMENT OF SPORT FOR PERSONS WITH DISABILITIES, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCLAW, POLAND
FACULTY OF PHYSICAL EDUCATION AND PHYSIOTHERAPY, THE OPOLE UNIVERSITY OF TECHNOLOGY, POLAND
SUMMARY
Background. Lumbosacral pain affects around 8 million people in Poland. This is one of the chief complaints among Polish population. The main reasons for low back
pain are the lack of prophylaxis and workplace ergonomics. The medical treatments frequently suggested to patients with this condition are pharmacotherapy and
physiotherapy. The objective of this dissertation was to compare the efficacy of traditional massage with rubber cupping massage in female patients with low back pain.
Material and methods. The research was conducted in 60 female patients suffering from low back pain. The first group of 30 randomly selected women received
traditional massage while the remaining group underwent cupping massage. The treatment groups received a session of 10 massages. Each patient who participated
in the experiment assessed subjective pain level in accordance with VAS and Laitinena scales. The duration of a single session for each type of massage was 20 minutes.
Classical massage was performed using techniques like: stroking, rubbing, kneading, and vibration. During the cupping massage, practitioner used stroking and tapping
with pinching techniques as well as massage with the use of three different sized rubber cups.
Results. The research showed that both compared modalities resulted in pain reduction. However, according to the findings based on VAS and Laitinena scales, the
pain relief level was much more significant and noticeable after session with the cupping massage.
Conclusions. According to statistics provided in this study, the massage using the cupping method proved to be a more effective alternative cure reducing low back
pain as compared with the effect of classical massage.
KEY WORDS: classical massage, cupping massage, pain release
STRESZCZENIE
Ocena zastosowania masażu klasycznego i bańką gumową u kobiet z bólami odcinka L-S kręgosłupa
Wstęp. W Polsce na bóle odcinka lędźwiowo-krzyżowego kręgosłupa cierpi około 8 milionów ludzi, jest to jedna z najczęstszych dolegliwości, na które skarżą się pacjenci.
Przyczyną bólu dolnego odcinka kręgosłupa jest najczęściej brak profilaktyki oraz problem ergonomii miejsca pracy. W leczeniu bólu stosowana jest najczęściej
farmakoterapia, fizjoterapia oraz w ostateczności zabiegi operacyjne. Celem pracy było porównanie zastosowania masażu klasycznego z masażem bańką gumową
u kobiet z bólami odcinka lędźwiowo-krzyżowego kręgosłupa.
Materiał i metody. Badania przeprowadzono u 60 pacjentek z bólami odcinka lędźwiowo-krzyżowego kręgosłupa. Pierwszych losowo wybranych 30 kobiet miało
wykonany masaż klasyczny, a następnie druga połowa masaż bańką. Zarówno przed, jak i po wykonaniu serii 10 zabiegów masażu, każda z kobiet oceniła poziom
odczucia bólu za pomocą skal VAS i Laitinena. Czas trwania zabiegu masażu obiema metodami wynosił 20 minut. Masaż klasyczny wykonywany był z wykorzystaniem
technik głaskania, rozcierania, ugniatania oraz wibracji. W masażu bańką wykonywano techniki głaskania, oklepywania szczypczykowego oraz z wykorzystaniem trzech
gumowych baniek o różnej wielkości.
Wyniki. Wykazano zmniejszenie odczucia bólu zarówno po zabiegach masażu klasycznego jak i bańką. Z tym, że w ocenie skali VAS i Laitinena nie stwierdzono różnicy
odczucia bólu po wykonaniu masażu klasycznego. Natomiast po wykonaniu masażu bańką odczucie bólu znacznie się zmniejszyło.
Wnioski. Masaż bańką wykazał, istotną statystycznie, większą efektywność w zakresie zmniejszania dolegliwości w porównaniu z masażem klasycznym.
SŁOWA KLUCZOWE: masaż klasyczny, masaż bańkami, uśmierzanie bólu
Background
Cupping therapy is a specific form of massage applied in
local and general treatment. The oldest records of this
form of treatment were found on the clay tablets of
Mesopotamia. The records indicate that in Mesopotamia,
animal horns/antlers were used instead of glass cups. The
descriptions as well as the drawings presenting the
application of cups were also found in ancient Egypt. In
Europe, Hippocrates, Paracelsus and Ambroise Pare were
the pioneers of cupping therapy. In China the vacuum
therapy has been applied for thousands of years. The
earliest cups were made of bamboo, the later ones were
made of glass. The first records about cupping were
found in the book of Ge Hong, the Daoist herbalist [1,2].
Both cupping massage and therapy stimulate the immune system to fight the disease. During the procedure,
the skin is sucked into the cup which causes that a certain
amount of blood migrates beyond the capillary beds. This
blood is regarded as a foreign body by the immune system
and stimulates the organism to produce big amounts of
immune cells which successfully fight a disease. Cups are
also used to alleviate pain, because they cause relaxation
of muscles and dilation of the blood vessels. Blood supply
in the inflamed tissues is improved, which contributes to
excretion of toxic substances from the organism. Negative pressure, due to its mechanical effect on the skin,
stimulates dermal nerve endings, improving the blood
supply and the previously impaired function of internal
organs, connected with the dermal zone [3,4]. The principle of cupping in clearly defined body areas, depending
on the disease, can be explained by taking advantage of
the knowledge applied in acupuncture. Fireless cups are
as effective as the conventional “hot” cups. The difference
is that the negative pressure in the new type of cups is
obtained by pumping out or squeezing the air from a cup
CAMS 2/2013
101
Bolach E. et al. Evaluation of traditional and rubber cupping massage techniques applied to patients with back pain
and not by burning. Massage using a rubber cup involves
movements of the cup when the patient’s skin gets
sucked into it in the area where treatment is applied.
After placing a cup on a given point, the skin gets sucked
into the cup and 1-3 cm bulb is formed there. As with the
conventional cupping technique, the negative pressure
acts mechanically on the skin stimulating its nerve
endings. Due to the dermo-visceral reflex, functions of
the internal organs are improved; this is connected with
the dermatome where the cups are applied. Apart from
the reflex, some immune mechanisms are activated. The
blood components sucked out from small vessels by the
negative pressure, namely the white and red blood cells,
become foreign bodies for the organism which is
prompted to fight pain and inflammatory conditions.
Cups cause a strong hyperemia in the treated areas of the
body. The small blood vessels break and the treated areas
are stimulated for quick regeneration. Due to this effect,
more oxygen and nutrients are supplied to the tissues
while the reconstructive mechanisms are stimulated. At
the same time, the body is cleansed from toxins [2,5,6]. It
is generally believed that cupping massage affects
deeper layers than classical hand massage. Its effect is
connected with the improvement of blood supply to the
tissues in the treated body area, the improvement of the
tissue nutritional status and acceleration of venous blood
and lymph outflow, facilitating elimination of metabolic
waste products and other harmful substances. Moreover,
this form of treatment is the best way of muscle relaxation. Vacuum massage not only has a favorable effect
directly on muscles and the skin, but also, through reflexes,
it affects internal organs, strengthens the immune system
and cleanses the body from toxins which enter it from the
air, water, foods and some pharmaceuticals.
The aim of the study was to compare classical massage
with cupping massage in female subjects with low back
pain [7,8].
Material
60 females aged 50-60 years participated in the experiment. All the subjects had university degrees. Their jobs
involved work at the desk. The women participating in
the experiment were earlier diagnosed with pain in the
lumbosacral spine by the orthopedist. 30 randomly
selected females underwent classical massage and the
remaining 30 females underwent cupping massage. The
subjects underwent a series of 10 classical massage
procedures and cupping massage procedures. During the
experiment, the subjects did not undergo any additional
physiotherapy procedures and did not take any analgesic
agents.
102
CAMS 2/2013
Methods
1. Classical massage and cupping massage procedures
The study was carried out in the Municipal Healthcare
Unit in Zabrze, 4 Zamkowa Street. All the massage procedures were performed in the same room within 4 weeks.
The areas treated with both forms of massage included:
thoracic, lumbar and sacral segments of the spine.
The classical massage involved the following techniques: segmental stroking, oblong and transverse in the
intercostals spaces, oblong rubbing, transverse in the intercostals spaces, transverse kneading along the vertebral
column, transverse kneading of the trunk and vibration
along the vertebral column. The massage ended with
stroking with load and without load; the load was applied
with the other hand towards the heart. The duration of
each procedure was 20 minutes. The percussion technique was not applied, because it intensely stimulates
muscles for contraction, which could enhance their
pathological tension. After the massage, the patients
rested for 15 minutes. During the first week the patients
underwent two procedures – on Tuesday and on Friday.
During the second and the third week they underwent
three procedures within each session – on Monday,
Wednesday and Friday. During the fourth week, each
session, held on Monday and Wednesday comprised two
procedures.
At the beginning of the cupping massage classical
techniques of superficial strokes and percussion with
load and pinching tapotement were applied. The main
massage technique involved cupping using three rubber
cups of different sizes, adjusted to the size of the treated
area subject and to the patients’ sensations. Two forms of
cupping massage were applied. The first one involved
movements on the patient’s skin surface using a cup after
the skin got sucked into it. The second one involved lifting of the cup sucked to the patient’s skin slightly and
moving it along her body (Figure 1.). The first technique
is less painful and is usually applied at the beginning of
a series of massage procedures. After the patients got
used to it, the second technique was applied. The massage
procedure lasted 20 minutes. After the treatment, the
patient rested for 15 minutes. During the first week the
patients underwent two massage procedures – on Tuesday
and Friday. During the second and the third week they
underwent three procedures – on Monday, Wednesday
and Friday. During the fourth week they underwent two
procedures – on Monday and Wednesday. The patients
reported long lasting warming sensation. Prior to the
subsequent procedure no redness or hematomas were
observed on their skin surface.
2. Assessment of pain intensity
Prior to the treatment and after a series of 10 massage
procedures the patients assessed their pain levels. The
Fig. 1. The cup sucked to the patient’s skin and lifted
Results
went classical massage procedures, the level of subjective
pain remained unchanged after the treatment. Prior to
the treatment, the mean pain level was similar in both
groups, the difference in mean values was 0.4 which was
statistically insignificant (p>0.05). After the treatment, the
average pain level in the group that underwent cupping
massage was evidently lower than in the group which
underwent classical massage. The difference in the mean
values after the procedures was 1.9, the value statistically
highly significant (p<0.01) (Table 1).
The distributions of pain reduction after cupping
massage and classical massage procedures, presented in
Table 2 indicate that the scope of these changes was
bigger after cupping massage. Moreover, after this type
of massage, in most of the studied cases the subjective
pain was reduced by 5 points on average in VAS (8 patients) while after classical massage the subjective pain
was reduced by 2 points on average (13 patients).
1. Pain assessment using VAS
The comparison of the pain sensation prior to and after
the applied massage procedures indicated decreased
levels of pain after the application of both massage techniques in the studied females. Alleviation of pain was
noted in all the subjects. Only in the group which under-
2. Assessment of pain using Laitinen Pain Indicator
Questionnaire
The applied massage procedures resulted in reduction of
all aspects related to pain, included in Laitinen Pain Indicator Questionnaire. Table 3 presents the detailed distribution of the results obtained prior to and following both
assessment was made using the Visual Analog Scale
(VAS). Both groups of patients assessed their pain levels
in 0 to 10 Numeric Pain Rating Scale. The next research
tool was Laintinen Pain Indicator Questionnaire, based
on a set of questions concerning the nature of pain and
the effect of pain on everyday activity performance.
Moreover, it contained questions about taking analgesics.
Each answer was attributed a given numerical value and
the total maximal score was 16 points.
3. Statistical analysis of the results
The basic statistical description of the studied material
included the mean values determined in the study. The
comparative analysis of cupping massage and classical
massage used Student’s-t test for independent samples.
Statistical significance level was set at p=0.05.
Tab. 1. Pain rated in visual analog scale (VAS) prior to and following treatment, depending on the type of massage
CAMS 2/2013
103
Tab. 2. Distribution of the scope of changes (reduction) in subjective pain in the studied females after cupping massage and classical
massage
Tab. 3. Distribution of the results of pain rating using Laitinen Pain Indicator Questionnaire before and after the treatment, depending
on the type of applied massage
massage procedures. However, there were some cases
with no improvement noted after massage. A higher
percentage of improvement was noted in the patients
who underwent cupping massage treatment. Changes
in the mean scores in individual subscales of Laitinen Pain
Indicator Questionnaire after a series of massages (alleviation of pain) were on average higher after cupping
massage, regardless the fact that the mean values
obtained in individual scales were slightly lower in the
104
CAMS 2/2013
group of patients who underwent classical massage
(which means that the condition of these patients was
slightly better prior to the treatment) (Table 4). A statistically significant improvement was obtained in subjective
sensation of pain in the patients who underwent cupping
massage as compared with the patients who underwent
classical massage (Table 5).
Tab. 4. Mean values of the results obtained in Laitinen Pain Indicator Questinnaire, depending on the type of massage
Tab. 5. Comparison of the distribution of the values indicating improvement (according to Laitinen Pain Indicator Questionnaire)
after cupping massage and classical massage
Discussion
The study compared classical massage with cupping
massage in women with low back pain. In traditional
medicine, cupping therapy is a popular and commonly
applied form of treatment. In eastern countries, such
treatment approaches as cupping massage are not only
based on the culture and multi-age experience of using
this form of therapy, but also on the national pro-health
policy. In China, Korea or Japan, apart from acupuncture,
moxa, herbs or manual therapy, various forms of cupping
are the main treatment approaches. Such therapies are
introduced to the national healthcare systems and
refunded by state-based insurance systems [9]. Cao et al.,
in their review of literature from the period 1992-2010,
on various aspects of cupping treatment, report that the
majority of publications concern the effectiveness of such
approaches in the treatment of herpes zoster, Bell’s palsy,
cough and dyspnea, acne, and thoracic and lumbar discopathy. Analysis of the sample indicates that the so
called wet cupping was most often the treatment of
choice. Other frequent treatment approaches involved
retained cupping, moving cupping, e.g. in massage, flash
cupping, medicinal cupping, needle cupping and combined cupping respectively. The authors of this paper,
however, emphasize the low methodological quality of
the studies conducted to date [10]. This opinion is shared
by Ma Cui et al. in their review of treatment approaches
involving the application of Duhuojisheng Tang supplement alone or combined with surgical interventions, traction, acupuncture, massage and cupping therapies in
patients with intervertebral disc prolapse [11]. Wang et
al., in their analysis of treatment approaches used in
Chinese Medicine in hypertensive patients, conclude that
the potential benefits of such methods of treatment as
cupping, acupuncture, moxa, qigong or Tai Chi require
improved experiment designs involving evidence-based
medicine [12]. There is a need of a more precise definition
of safety when applying cupping therapy, especially in
patients with health problems [13]. Yu et al. present the
CAMS 2/2013
105
case of a 40 year old patient with 10 years psoriasis, who
developed Koebner’s phenomenon maintaining for over
5 days after the application of glass flash cups. According
to physicians, unstable psoriasis is a condition with
contraindication for cupping therapy [14]. Assessment of
the effectiveness of cupping in pain alleviation is not
a frequently studied issue, although there are several
scientific reports on it. Mu-Lien et al., in their experiment,
using VAS assessed the effectiveness of laser treatment
and negative pressure soft cups in comparison with the
sham group in back pain treatment [15]. The application
of cups was also assessed in pain alleviation in patients
with osteoarthritis in the knee [16,17]. Teut et al. [16] used
silicon negative pressure cups for this purpose. The treatment was applied within 4 weeks and comprised the total
of 8 sessions. Like in this experiment, the researchers obtained pain alleviation and functional improvement
measured using VAS, The Western Ontario and McMasters
Universities Osteoarthritis Index (WOMAC) and the Quality
of Life Questionnaire - SF-36. The assessment of cupping
was performed during the fourth week and next, during
the twelfth week of the experiment. The exclusion criteria
for cupping therapy applied in the reported experiment
are worth noting . This is important as there are no scientific reports about study protocols for cupping treatment.
In this experiment, the patients were excluded in the
following cases: taking anticoagulants, coagulopathies,
undergoing any cupping treatment within the last 12
months, intra-articular corticosteroid injections or using
nonsteroidal antiinflammatory drugs (NSAIDs) on the
knee joint within the last four months, arthroscopy of the
knee joint within the last twelve months and taking
corticosteroids within the last four months. Further contraindications included any physical therapy procedures,
leaches or acupuncture within the last four months or any
other therapy involving the application of complementary
and alternative medicine (CAM) approaches within the
last four months. The methodology of treatment
applied in this experiment was also interesting since the
cups were applied not only on the knee joint area, but
also on the corresponding perispinal segment. Khan
et al. [17] in their randomized trial assessed the objective
and subjective effects of cupping treatment in osteoarthritis of the knee on pain, swelling and knee stiffness.
The authors found that the effectiveness of cupping
treatment is comparable to that of pharmacotherapy, but
with no side effects resulting from the impact of drugs
on the alimentary tract. Tae-Hun et al., analyzing the
effectiveness of 2-week cupping treatment (dry vacuum
cups), combined with exercises in the employees using
display terminals, concluded that the underlying mechanisms of the therapeutic effects of cupping on cervical
pain have not been fully explained. The authors believe
that for further development of this fort treatment, studies
involving identification of individual properties of various
kinds of cups seem essential as it is necessary to assess
106
CAMS 2/2013
the effect of cupping application depending on the size
of cups and to determine precisely the standards cupping
treatment [18]. Other researchers have analyzed the costeffectiveness of herpes zoster treatment in 500 patients
using conventional approaches, acupuncture, moxa and
medicinal cups [19]. The effectiveness of cupping treatment
compared with progressive muscle relaxation in patients
with non-specific chronic neck pain was assessed by
Lauche et al. The treatment was applied twice a week
within twelve weeks. Pain assessment was made using
VAS. A significant alleviation of pain was noted in both
studied groups, although improved well-being and
a lower sensitivity to pressure generated by cups was
noted after cupping treatment [20]. No side effects of the
applied forms of treatment were noted. The increased
congestion of the massaged area after treatment with
rubber cups turned out to be transient. The problems
connected with adverse side effects after using different
types of cups and those related to safety of this approach
are relatively frequent research issues. A significant
increase in d-dimer (6110 ng / ml , the norm < 350 ng/ml)
level and excessive pigmentation of the skin, maintaining
for over a month in a 46-year old male patient who
underwent flash cupping treatment (30 procedures every
day) due to chronic musculoskeletal pain. Elevated
d-dimer plasma levels result from the activation of coagulation and plasma fibrinolytic system. It is observed after
surgeries, with hemorrhages, after injuries, in neoplastic
diseases, inflammatory conditions and congestive heart
failure. According to the hypothesis made by the authors
of this report, negative pressure generated by cups
causes ecchymoses and bruises. Subdermal bleeding
activates coagulation factors which results in clot formation. As a consequence of fibrinolysis, excessive d-dimers
are produced [21]. Other researchers have analyzed the
treatment using medicinal cups; Hejamat believes that
traditional phlebotomy is a potential risk of hepatitis in
the population of Iran [22,23].
Classical massage and cupping massage resulted in
pain reduction in the subjects participating in the reported
experiment. The only difference was that subjectively
assessed pain was significantly less intense in the group
which underwent cupping massage. The latter patients
more seldom complained of fatigue, headaches and pain
in the lower limbs. Moreover, improvement of well-being
was noted in the patients. Classical massage probably
acts more superficially on soft tissues.
The therapist performing classical massage affects the
skin, the subdermal tissue and muscle tissue.
This type of massage does not stimulate dermatomes.
Conversely, cupping massage has a deeper effect as it
influences the dermo-visceral reflex improving the function
of internal organs connected with the dermal zone. In the
available literature, reports on comparative studies assessing the effectiveness of cupping treatment as compared
with other approaches are sparse. El Sayed et al., analyz-
ing different methodologies of wet cupping treatment
concluded that wet cups applied twice in one procedure
more effectively purify blood [24].
Conclusions
1. Cupping massage reduces subjective pain sensation,
expressed in Visual Analog Scale (VAS) to a significantly
higher extent, as compared with classical massage;
2. In all aspects of pain considered in the Laitinen Pain
Indicator Questionnaire, cupping massage proved
more effective in reducing pain as compared with
classical massage.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Arabas I, Arabas S. Leki i metody leczenia w japońskiej tradycji. Farm Pol 1998; 54 (10): 461-8.
Talik H, Talik W. Therapy by cupping (in Polish). Yang
Yinn, Kraków, 1996.
Majdak J. Cupping massage (in Polish). Świat Kosm
Prof 2008; 26: 24.
Sadowska J. Ancient, oriental prophylactic and therapeutic methods and their contemporary evaluation (in Polish. Arch Histor Filozof Med 2007; 70: 46-9.
Musioł M. Krupienicz A. Medical cups – practical
applications (in Polish). Med Rodz 2009, 4:75-7.
Bołtryk G. Cups in another way (in Polish). Mag Pieleg
Połoz 1996; 4:50-1.
Godek P. Diagnosics in the osteopth practice in case
of the lumbar – sacral spine pain (in Polish). Fizjoter
Rehabil Prakt 2011; 14: 9.
Majdak J. Cupping massage (in Polish). Świat Kosm
Prof 2008; 26: 24.
Park HL, Lee HS, Shin BC, Liu JP, Shang Q, Yamashita
H, Lim B. Traditional medicine in China, Korea, and
Japan: a brief introduction and comparison. eCAM
2012; 429103.
Huijuan C, Xun L, Jianping L. An updated review of
the efficacy of cupping therapy. PLoS ONE 2012; 7: 2.
Ma Y, Cui J, Huang M, Meng K, Zhao Y. Effects of
duhuojisheng tang and combined therapies on prolapse of lumbar intervertebral disc: a systematic review of randomized control trails. J Tradit Chin Med
2013, 15; 33(2): 145-55.
Wang J, Xiong X. Evidence-based Chinese medicine
for hypertension. eCAM 2013; 978398.
Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al.
Clinical research evidence of cupping therapy in
China: a systematic literature review. BMC Compl
Altern Med 2010; 10: 70.
14. Yu R, Hui Y, Li C. Köebner phenomenon induced by
cupping therapy in a psoriasis patient. Dermatol
Online J 2013; 19(6):17.
15. Lin ML, Wu HC, Hsieh YH, Su CT, Shih YS, Liu CW, Wu
JH. Evaluation of the effect of laser acupuncture and
cupping with Ryodoraku and Visual Analog Scale on
low back pain. eCAM 2012; 521612.
16. Teut M, Kaiser S, Ortiz M, Roll S, Binting S, Willich SN,
et al. Pulsative dry cupping in patients with osteoarthritis of the knee – a randomized controlled
exploratory trial. BMC Compl Altern Med 2012; 12: 184.
17. Khan AA, Jahangir U, Urooi S. Managment of knee
osteoarthtritis with cupping therapy. J Adv Pharm
Technol Res 2013; 4 (4): 217-23.
18. Kim TH, Kang JW, Kim KH, Lee MH, Kim JE, Kim JH, et
al., Cupping for treating neck pain in video display
terminal (VDT) users: a randomized controlled pilot
trial. J Occup Health 2012; 54: 416–26.
19. Li X, Yang Y, Xie X, Bai L, Zhang X. Economic evaluation
of treating herpes zoster with various methods of
acupuncture and moxibustion. J Tradit Chin Med
2012, 15; 32(1): 125-8.
20. Lauche R, Materdey S, Cramer H, Haller H, Stange R,
Dobos G, et al. Effectiveness of home-based cupping
massage compared to progressive muscle relaxation
in patients with chronic neck pain – a randomized
controlled trial. PLoS ONE 2013, 8(6).
21. Zhang W, Wang J, Yu B. Cupping therapy-induced
elevated D-dimer. Chin Med J 2012, 125 (19):3593-4.
22. Ghadir MR, Belbasi M, Heidari A, Sarkeshikian SS,
Kabiri A, Ghanooni AH. Prevalence of hepatitis D
virus infection among hepatitis B virus infected
patients in Qom province, center of Iran. Hepat Mon
2012; 12(3): 205-8.
23. Alavian SM. We have more data regarding epidemiology of hepatitis D in Iran but there are defects to
be filled yet! Hepat Mon 2008; 8(4): 245-7.
24. El Sayed SM, Mahmoud HS, Nabo MMH. Methods of
wet cupping therapy (Al-Hijamah): in light of modern and prophetic medicine. Altern Integ Med 2013;
2: 122.
Eugeniusz Bolach
Department of Sport for Persons with Disabilities, University School
of Physical Education in Wroclaw
al. Ignacego Jana Paderewskiego 35, 51-612 Wrocław, Poland
tel. 503 166 328
CAMS 2/2013
107
108
CAMS 2/2013
115 Bogucki1:Layout 1 2014-03-20 12:24 Strona 1
ORIGINAL ARTICLE
The impact of a single sauna session
on the electrodermal activity (EDA) as evaluated
with the Ryodoraku method
Edyta Szczuka, Łukasz Bogucki
DEPARTMENT OF SPORT FOR PERSONS WITH DISABILITIES, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCLAW, POLAND
SUMMARY
Background. The problem of measurements of electrodermal activity (EDA) with the use of the Ryodoraku method, after application of Finnish sauna, has not been
previously discussed in scientific reports.
Material and methods. The study involved 46 healthy men aged 21–24 years. The experimental measurement of EDA was made before and after a Finnish sauna session.
In order to check normality of the distribution of the obtained results the Kolmogorov–Smirnov test (K–S test) and the Lilliefors test were used. In order to assess the
statistical significance of differences between the mean values of the first and second measurement, the parametric Student's t-test was applied for dependent samples.
The level of significance was set at p < 0.05.
Results. Significant differences between the measurements before and after the sauna session, except for the lung meridian and the liver meridian, were noted. The
differences between the measurements, observed in the experiment, did not show a unidirectional trend for all measured points. The mean values of the following
meridians: heart, small intestine, triple burner, large intestine, kidney, gallbladder, and stomach, showed a statistically significant increase in the second measurement.
A significant decrease in the measured values was recorded in the case of the pericardium, spleen-pancreas, and urinary bladder meridians.
Conclusions. Analysis of the results of EDA measurements taken in this study indicates a complex nature of the response of the autonomic nervous system related to
a sauna session.
KEY WORDS: electrodermal activity (EDA), Ryodoraku method, sauna
STRESZCZENIE
Wpływ jednorazowego wejścia do sauny na aktywność elektrodermalną (EDA), oceniany metodą Ryodoraku
Wstęp. Problem pomiarów aktywności elektrodermalnej (EDA) metodą Ryodoraku po zastosowaniu sauny fińskiej nie był dotychczas poruszany w doniesieniach
naukowych.
Materiał i metody. W eksperymencie uczestniczyło 46 zdrowych mężczyzn w wieku 21–24 lata. U badanych dokonano pomiaru EDA przed i po zabiegu w saunie fińskiej.
Do sprawdzenia normalności rozkładu otrzymanych wyników użyto testów Kołmogorowa–Smirnowa (K–S) i Lillieforsa. W celu określenia istotności różnic dla wartości
średnich w pierwszym i drugim pomiarze zastosowano parametryczny test t-Studenta dla prób zależnych. Przyjęto poziom istotności statystycznej p < 0,05.
Wyniki. Odnotowano istotne różnice pomiędzy pomiarami przed i po zabiegu sauny, z wyjątkiem meridianu płuc oraz meridianu wątroby. Wykazane w badaniach
różnice pomiędzy pomiarami nie miały charakteru jednokierunkowej tendencji w odniesieniu do wszystkich punktów pomiarowych. Średnie wartości meridianów: serca,
jelita cienkiego, potrójnego ogrzewacza, jelita grubego oraz nerek, pęcherzyka żółciowego i żołądka wykazały istotny statystycznie wzrost w drugim pomiarze. Istotny
spadek wartości pomiarowych odnotowano natomiast w przypadku meridianu osierdzia, śledziony-trzustki oraz pęcherza moczowego.
Wnioski. Analiza EDA w przeprowadzonych badaniach wskazuje na złożony charakter reakcji autonomicznego układu nerwowego związanej z zabiegiem sauny.
SŁOWA KLUCZOWE: aktywność elektrodermalna (EDA), metoda Ryodoraku, sauna
Background
The use of sauna in Poland is increasingly becoming an
indicator of a healthy lifestyle, just as it was earlier in Germany, and originally in the Nordic countries. It seems that
in Poland a situation where there is, on average, one
sauna to 3–4 people, as it is in Finland, is still very remote;
however, because of its multidimensional effect on the
body, it is considered in Poland, in addition to regular
physical activity, the easiest and best way to reduce stress
[1]. The impact of the sauna on the body is mainly considered to be preventive, but more and more scientific reports describe possible areas of application of the sauna
in people with health problems. According to Crinnion
[2], the use of sauna can be effective for persons with
hypertension, congestive heart failure, and for post-myocardial infarction care. Also some individuals with chronic
obstructive pulmonary disease, chronic fatigue, chronic
pain, or addictions are reported to benefit from sauna
therapy. Crinnion claims that there is evidence in support
of the use of sauna as a component of purification, or
cleansing, procedures for environmentally-induced illness.
Generally, regular sauna therapy seems to be safe and
offers numerous health benefits to the users. One potential
area of concern, as some evidence suggests, is that
hyperthermia might be teratogenic in early pregnancy.
Issues concerning the impact of the sauna on the
body are discussed in a number of scientific reports. Pilch
et al. [3] carried out a study on the effect of Finnish sauna
bathing on the white blood cell profile, cortisol levels and
selected physiological indices in athletes and non-athletes.
The results indicated that the use of sauna stimulated the
immune system in the group of athletes compared to the
non-athletes.
In another study, rapid weight loss (RWL) processes in
combat sports were analyzed. The methods used by the
athletes, such as laxatives, diuretics, use of plastic or
rubber suits, and sauna, are harmful to performance and
health, as RWL affects physical and cognitive capacities,
and may increase the risk of death [4].
CAMS 2/2013
109
Szczuka E. et al. The impact of a single sauna session on the electrodermal activity (EDA)
Lee et al. [5] studied physiological effects of bathing
methods including the mist sauna on recovery from muscle fatigue. The bathing methods included: full immersion
bath, shower, mist sauna, and no bathing as a control. The
authors evaluated the mean power frequency of the electromyogram (EMG), rectal temperature, skin temperature,
skin blood flow, concentration of oxygenated hemoglobin,
and subjective assessment.
Other authors evaluated safety of the mist sauna as
compared to the dry sauna. To test the hypothesis that
the mist sauna is a safer way of bathing than the dry
sauna, they compared changes in circulatory and thermoregulatory functions during a 10-minute mist sauna
session at 40°C with a relative humidity of 100%, with the
changes observed during a dry infrared sauna session at
70°C with a relative humidity of 15%. The results suggest
that the mist sauna bathing may be safer physiologically,
and provide more effective vascular dilatation and sweating than the dry sauna bathing [6].
De Boer et al. [7] report that fundamental in traditional postpartum recovery in Lao PDR is, among other
things, the use of steam sauna and steam baths. During
the steam bath following the steam sauna the mother
cleanses the perineum with a medicinal plant infusion.
The medical literature reports health hazards for law
enforcement personnel from repeated exposure to
methamphetamine and related chemical compounds.
Ross and Sternquist suggest that utilizing sauna and
nutritional therapy may alleviate chronic symptoms
appearing after chemical exposures associated with methamphetamine-related law enforcement activities [8].
Modern technology makes it possible to expand the
knowledge on the effects of the sauna on the human
body with the use of more and more advanced facilities.
A new area of research in this respect is to assess the impact of the sauna on the functional state of a healthy or
diseased organism as a whole. As different from previous
approaches, which only dealt with the impact of the
sauna on selected aspects of human body functions, the
present work is an attempt at a comprehensive look at
the functioning of the body in the sauna.
The aim of the study was to evaluate the effect of
a single sauna session on the electrodermal activity in
males, as measured with the Ryodoraku method.
Material
The study involved 46 healthy men, students of the University School of Physical Education in Wroclaw, aged
21–24 years (mean 22.8). All the subjects had previous experience with the use of sauna. Based on the taken medical history, the following criteria for exclusion from
participation in the experiment were established: the
value of systolic blood pressure > 140 mmHg, and diastolic
> 90 mmHg, chronic diseases of different etiology, acute
and subacute inflammation, systemic viral or bacterial
infection, strenuous physical activity on the day preceding
the examination, a night’s rest of less than seven hours,
and malaise on the day of the experiment.
Methods
The study was conducted in the experiment room of the
Department of Biological Regeneration of the University
School of Physical Education in Wroclaw, situated at 25a
Witelona street, in the autumn-winter period, during antemeridian hours (8.00–11.00).
1. A dry Finnish sauna session
The heating element in the sauna room was a stove
equipped with electric heaters, on which basalt stones
were placed. The mean temperature in the sauna room
was 108 ± 4°C (according to the indicator situated outside
the sauna). The relative humidity was 13 ± 4%. For cooling
of the body, a paddling pool with a size of 2.5m x 2.0 m,
depth of ca 1.5 m, and capacity of ca 3000 l, was used. The
temperature of the water used for the cooling phase was
16–18°C.
Fig. 1. Location of Ryodoraku representative measuring points (RMP) on the hands (Bohuń et al. 2003)
110
CAMS 2/2013
2. Measurement of electrodermal activity (EDA) with the
Ryodoraku method
The diagnostic and therapeutic Ryodoraku method is
based on the principles of Traditional Chinese Medicine
(TCM) and consists in measuring EDA at 24 points taken
as representative (RMP points) for the activity of particular meridian pathways. Symmetrical points on the hands
(H1–H6) and feet (F1–F6) were measured. EDA measurements were taken of the following meridians: lung P9
(H1), pericardium O7 (H2), heart S7 (H3), small intestine
Jc5 (H4), triple burner Po4 (H5), large intestine Jg5 (H6),
spleen-pancreas ŚT3 (F1), liver W3 (F2), kidney N5 (F3),
urinary bladder Pm65 (F4), gallbladder Pż40 (F5), and
stomach Ż42 (F6) [Figs 1–2] [9].
The Ryodoraku measuring device, manufactured by
the KOLMIO company [Fig. 3], which was used in the
study, is composed of three main components: a central
control panel, a passive electrode, and an active electrode. The measurement of the RMP electroconductivity
was performed according to the instructions given by the
manufacturers of the device [10]. The abbreviations of the
meridians’ names used in this article are different from
the English ones, as they are taken from the manufacturer’s instructions, written in Polish.
The experiment
Before participation in the experiment, each of the subjects was informed in detail about its course, aim, and the
possibility to withdraw from participation in the study at
any time. The first measurement by the Kolmio Ryodoraku device was taken just before entering the sauna. After
the measurements, each participant took a hygienic
shower and then, having carefully wiped the entire body,
entered the previously heated sauna chamber. The subjects stayed in the sauna for 8 minutes, in groups of maximum 5 people. After leaving the sauna, the subjects
rinsed the body under a cool shower, and then went into
a pool of cold water for 3 minutes. During the cooling in
the pool, the participants went neck deep into the water,
each of them also repeatedly cooling the whole head by
keeping it for a few seconds in the water. After the cooling
phase, each subject rested for eight minutes in a sitting
position in a room where the temperature was in the
range 21–23°C. After the resting phase, the microcycle
Fig. 2. Location of Ryodoraku representative measuring points (RMP) on the feet (Bohuń et al. 2003)
Fig. 3. Kolmio Ryodoraku device
CAMS 2/2013
111
was repeated: body heating in the sauna, cooling, and
rest. During the experiment, three full microcycles were
carried out. After the last one, a second measurement
with the Kolmio Ryodoraku device was performed in
each of the subjects.
Statistical analysis of the data
In the statistical processing of the obtained results basic
statistical methods were used such as the mean value,
standard deviation, median and coefficient of variation.
In order to check normality of the distribution of the
obtained results the Kolmogorov–Smirnov test (K–S test)
and the Lilliefors test were used. In order to assess the statistical significance of differences between the mean
values of the first and second measurement, the parametric Student’s t-test was applied for dependent samples.
The level of significance was set at p < 0.05. All calculations were performed using Statsoft Statistica PL statistical software package.
Results
I. Analysis of the results of the RMP measurement
of hand meridians (H1–H6)
Table 2 shows that the difference in mean values between
the first and second measurement of hand meridians is
statistically significant (p < 0.05) for both the left and right
side, except for the lung meridian (H1).
II. Analysis of the results of the RMP measurement
of foot meridians (F1–F6)
Table 4 shows that the difference in mean values between
the first and second measurement of foot meridians is
statistically significant (p < 0.05) for both the left and right
side, except for the liver meridian (F2).
Discussion
Significant differences between the measurements
before and after the sauna session, except for the lung
meridian (H1) and the liver meridian (H2), were noted. In
the case of the lung meridian, the result is quite surprising, considering the severe response of the respiratory
system after a sauna session described the literature. On
the other hand, it should be also taken into account that
the tested group of males were persons with a high level
of fitness, and hence a sound respiratory system. The
explanation of this fact requires further analysis.
It should be emphasized that the significant differences between the measurements, observed in the
experiment, did not show a unidirectional trend for all
RMPs. The mean values of the following meridians: heart
(H3L and H3P), small intestine (H4L and H4P), triple
burner (H5L and H5P), large intestine (H6L and H6p),
kidney (F3L and F3P), gallbladder (F5L and F5P), and
stomach (F6L and F6P), showed a statistically significant
increase in the second measurement. A significant de-
Tab. 1. Descriptive characteristics of RMP results of the right and left hand (H1–H6) in the 1st and 2nd measurement
112
CAMS 2/2013
Tab. 2. Results of the Student's t-test for dependent samples of hand meridians (H1–H6)
Tab. 3. Descriptive characteristics of RMP results of the right and left foot (F1–F6) in the 1st and 2nd measurement
CAMS 2/2013
113
Tab. 4. Results of the Student's t-test for dependent samples of foot meridians (F1–F6)
crease in the measured values was recorded in the case
of the pericardium (H2L and H2P), spleen-pancreas (F1L
and F1P), and urinary bladder (F4L and F4P) meridians.
These results may represent different body reactions to
a sauna session. In a previous study by the author [11],
where EDA was measured in taekwondo practitioners
with the Ryodoraku method, post-exercise changes in
EDA were unidirectional and associated with an increase
114
CAMS 2/2013
in the mean measured values in comparison with the
control group. The results obtained in that study may
represent post-exercise stimulation of the sympathetic
part of the autonomic nervous system. Post-exercise
changes in terms of the autonomic nervous system
response were also presented by Wu et. al [12]. They
report that a six-week exercise training program resulted
in a significant increase in the average electrical conduc-
tance, which returned to the pre-training level after three
months of cessation of the exercise training. An important finding in this study is that the heart rate variability
(HRV) data showed no similar changes, suggesting that
Ryodoraku is a useful tool in detecting subtle, non-cardiovascular physical responses. Researchers working with
the Ryodoraku method argue that EDA measurement
results reflect the dynamic state of physiological reactivity
of the body to stimuli from the external environment, and
also reflect internal psychoemotional states. If the measurements of individual meridians are within the average
range for the population studied, and the standard deviations are small, it reflects a broadly defined standard. It
also means that the functions of the autonomic nervous
system remain in balance. Values above the channel
indicate arousal of the sympathetic nervous system
(“excess” energy), and those below the channel demonstrate inhibition of the sympathetic nervous system
(“deficiency” energy). In the present study, the large standard deviations in mean values of the triple burner (H5)
and kidney (F3) meridians may, in accordance with the
Ryodoraku table of symptoms (Żytkowski 1999) [13],
relate to, in the case of H5, symptoms such as breathing
problems, subfebrile temperature, redness and sweating
of the face, or a feeling of exhaustion. In the case of the
F3 meridian (which is functionally responsible, among
other things, for the kidneys and adrenals) Ryodoraku
pathological symptoms are associated with malaise, irritability, or feeling of heat in the lower limbs, among other
things. The above-mentioned symptoms may correspond
to the results of the measurement of the H5 and F3
meridian points taken after the sauna session.
Effects of sauna on the autonomic nervous system is
a topic not often discussed in the literature. Kunbootrsi
et al. [14] investigated the effects of a six-week repeated
sauna treatment on the autonomic nervous system, peak
nasal inspiratory flow, and lung functions in Thai patients
with allergic rhinitis. Heart rate variability, peak nasal
inspiratory flow, and lung function were measured at the
beginning and after three and six weeks of the treatment.
According to Gayda et al. [15], a single sauna bath induced changes of autonomic control of the cardiovascular system in patients with untreated hypertension, which
manifested as increased sympathetic and decreased
parasympathetic activity. Data from a previous study on
younger, healthy subjects, reflect the same kinetics of
sympathetic and parasympathetic drive, but with differences in the amplitudes of variations: a much greater
increase in sympathetic activities and a greater decrease
in parasympathetic activities were observed. Gayda et al.
also point to important implications for further research
in this area. However, they report that these changes
were normalized within 15 to 120 minutes after sauna
bathing, suggesting higher autonomic nervous system
reactivity in hypertensive patients compared to that found
in the previous studies of healthy younger subjects.
The sauna as a systemic treatment is considered to be
one of the strongest (in terms of stimulation) treatments.
Non-unidirectionality of the EDA changes of individual
meridians can be an expression of different reactivity of
the body to the treatment. The observed changes may
represent a kind of instability in the body regulation
systems. These systems, under the influence of such
a strong stimulus as the sauna, trigger a number of mechanisms compensating for the problem of overheating of
the body in the sauna environment. In this way the body
also tries to cope with varying stimuli (overheating in the
sauna vs. cooling after the sauna). Therapeutic experience
of classical medicine, associated with the effects of the socalled post-treatment response, confirms that there is temporary destabilization of the body in response to a strong
therapeutic stimulus. And the sauna is undoubtedly such
a stimulus. This effect, however, is needed to achieve
a new, more harmonious, state of balance of the body.
And, actually, in such a way the remote, multidirectional,
beneficial effects of the sauna should be understood.
EDA measurement with the Ryodoraku method entails
a number of limitations. Mist et al. [16], who studied the
reliability of a system for measuring EDA at acupoints
called AcuGraph, claim that there are many commercially
available instruments for measuring electrical conductance, but there is little information about their reliability.
Ahn et al. report [17] that the electrodermal reading
of acupuncture points is influenced by important technical issues which are often overlooked, such as electrode
polarizability, stratum corneum impedance, presence of
sweat glands, choice of contact medium, electrode geometry, etc. They suggest that these factors may cause doubts
about the validity of available electrodiagnostic devices.
It is particularly difficult to assess psychoemotional
states using EDA measurements. Su et al. [18], in their
study involving the Ryodoraku method, report that
during a long-term exposure to high intensity of illumination and high colour temperature (2000Lux–6500K)
the effect on psychological responses turned moderate
after the human visual system adopted to the lighting
environment. However, this effect was more considerable
with the increase of perceptive time. According to the
authors, the effect of long time exposure to a lighting
environment on physiological responses is greater than
its effect on psychological responses, a conclusion which
is different from the traditional belief that the effect on
psychological responses is greater.
Conclusions
Analysis of the results of EDA measurements with the
Ryodoraku method taken in this study indicates a complex
nature of the response of the autonomic nervous system
related to a sauna session.
CAMS 2/2013
115
References
1.
Papp AA, Alhava EM. Sauna-bathing with sutures.
A prospective and randomised study. Scand J Surg
2003; 92(2): 175-7.
2. Crinnion WJ. Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant – induced and
other chronic health problems. Altern Med Rev 2011;
16(3): 215–25.
3. Pilch W, Pokora I, Szyguła Z et al. Effect of a single
finnish sauna session on white blood cell profile and
cortisol levels in athletes and non-athletes. J Hum
Kinet 2013; 31,39: 127–35.
4. Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: physiological, psychological and performance effects. J Int Soc Sports Nutr 2012; 9: 52.
5. Lee S, Ishibashi S, Shimomura Y, Katsuura T. Physiological functions of the effects of the different
bathing method on recovery from local muscle
fatigue. J Physiol Anthropol 2012; 31: 26.
6. Iwase S, Kawahara Y, Nishimura N. Effects of dry and
mist saunas on circulatory and thermoregulatory
functions in humans. Health 2013; 5, 2: 267–73.
7. De Boer HJ, Lamxay V, Björk L. Steam sauna and
mother roasting in Lao PDR: practices and chemical
constituents of essentials oils of plant species used
in postpartum recovery. BMC Complementary & Alternative Medicine 2011; 11: 128.
8. Ross GH, Sternquist MC. Methamphetamine exposure and chronic illness in police officers: significant
improvement with sauna-based detoxification therapy. Toxicol Ind Health 2012; 28(8): 758–68.
9. Bohuń L, Jarosiński W, Kiełkowski M. Metoda Ryodoraku [The Ryodoraku method]. Kolmio Kiełkowscy,
Gdańsk 2003 (in Polish).
10. Kiełkowski M. Instrukcja obsługi Kolmio Ryodoraku
– aparat do diagnozy i terapii metodą Ryodoraku
[Kolmio Ryodoraku user manual: a diagnostic and
therapeutic device using the Ryodoraku method].
Kolmio Kiełkowscy, Gdańsk 2006 (in Polish).
11. Szczuka E, Tomaszewski W, Szafraniec R, Postawa A.
Electrodermal activity of the skin assessed using
116
CAMS 2/2013
12.
13.
14.
15.
16.
17.
18.
Ryodoraku method after a single training session in
taekwondo competitors. JCSMA 2012; 3(2): 79–85.
Wu SD, Gau JT, Wang YH. Ryodoraku as a tool monitoring the effects of walking exercise. Journal of
hinese Integrative Medicine 2011; 12: 1319–25.
Żytkowski A, Czernicki J, Krukowska J. Ryodoraku
– metoda obiektywnej oceny i regulacji zaburzeń
wegetatywnych narządów wewnętrznych. Część III
– metodyka i interpretacja wyników pomiarów oraz
zasady terapii. [ Ryodoraku – a method of objective
testing and balancing of the vegetative disorders of
internal organs. Part III – Electrodiagnostic procedure.] Akup Pol 1999; 15,16: 493–501 (in Polish).
Kunbootsri N, Janyacharoen T, Arrayawichanon P et
al. The effect of six-weeks of sauna on treatment
autonomic nervous system, peak nasal inspiratory
flow and lung functions of allergic rhinitis Thai
patients. Asian Pac J Allergy Immunol 2013; 31(2):
142–7.
Gayda M; Bosquet L, Paillard F et al. Effects of sauna
alone versus postexercise sauna baths on short-term
heart rate variability in patients with untreated
hypertension. JCRP 2012; 32: 147–54.
Mist SD, Mikel A, Kalnins P et al. Reliability of AcuGraph system for measuring skin conductance at
acupoints. Acupunct Med 2011; 29(3): 221–6.
Ahn AC, Martinsen OG. Electrical characterization of
acupuncture points: Technical issues and challenges.
J Altern Complement Med 2007; 13(8): 817–24.
Su DY, Liu CC, Chiang CM, Wang W. Analysis of the
long-term effect of office lighting environment on
human reponses. World Academy of Science, Engineering and Technology 2012; 6: 265–72.
Edyta Szczuka
Department of Sport for Persons with Disabilities,
University School of Physical Education in Wroclaw
Al. Ignacego Jana Paderewskiego 35, 51-612 Wrocław, Poland
tel./fax: +48 (22) 834 67 72
116 Obminski pilka:Layout 1 2014-03-20 12:32 Strona 1
ORIGINAL ARTICLE
Appraisal of the physiological cost of soccer
match based on changes in selected blood indices
and perceived fatigue after the effort
Zbigniew Obmiński1, Katarzyna Lerczak2
1
2
DEPARTMENT OF ENDOCRINOLOGY, INSTITUTE OF SPORT, WARSAW, POLAND
DEPARTMENT OF BIOCHEMISTRY, INSTITUTE OF SPORT, WARSAW, POLAND
SUMMARY
Background. The aim of the study was to examine post soccer match temporary and transient changes in biochemical blood status and rate of its normalization during
recovery in the order to estimation of physiological cost of the effort.
Material and methods. The study comprised 17 players engaged in a friendly soccer match against the foreign team. The coach wanted to examine the level of technical
skills, endurance, and cooperative abilities each of the selected player, and blood biochemical responses to the match based on cortisol (C), testosterone (T), T/C ratio,
creatine kinase (CK), glucose (Glu) and urea (U) assessments in capillary blood sampled at three time points: a day prior to the day of game, i.e. -32h prior the match, and
subsequently at +12h and +32h after its.
Results. The biochemical status was not depended on the plying position of the players. Mean post match (+12h) CK -519 U/L) and U -6.6 mmol/L were somewhat
higher compared to those at baseline:359 U/L and 5.9 mmol/L, and showed tends to their normalization at +32h. Mean Glu significantly dropped after the match (from
5.6 to 5.1 mmol/L) and did not fully return to the baseline value after 32h recovery. Mean C and T at +32h were practically unchanged, but T/C ratio was higher from pre
and post match values.
Conclusions. Lowered post match Glu and its lack of full normalization over 32h recovery and it is main symptom of the physiological cost of the effort. During competitive
season soccer played have to apply more carbohydrate-enriched diet.
KEY WORDS: soccer match, hormones, metabolites, fatigue , recovery
STRESZCZENIE
Ocena fizjologicznego kosztu meczu piłkarskiego na podstawie zmian wybranych wskaźników we krwi i odczuwanego zmęczenia po wysiłku
Wstęp. Celem pracy było zbadanie chwilowych i przejściowych zmian w statusie biochemicznym i szybkości ich normalizacji po meczu piłki nożnej w celu oceny kosztu
fizjologicznego wysiłku.
Materiał i metody. Badaniem objęto 17 graczy piłki nożnej zaangażowanych w mecz towarzyski przeciw zagranicznej drużynie. Trener chciał zbadać wyszkolenie techniczne,
wytrzymałość i zdolności do kooperacji każdego gracza oraz reakcje biochemiczne na mecz w oparciu o pomiary we krwi kapilarnej kortyzolu (C), , testosteronu (T),
wskaźnika T/C , kinazy kreatynowej (CK), glukozy (Glu) i mocznika (U) w trzech punktach czasowych, dzień przed grą ( -32h), a następnie, +12h i +32h po meczu.
Wyniki. Biochemiczny status nie zależał od pozycji graczy na boisku. Po meczu (+12h) stężenia CK -519 U/L i U -6.6 mmol/L były nieco wyższe od wartości wyjściowych
(359 U/L i 5.9 mmol/L) i w +32h wykazywały tendencję do normalizacji. Glu znacząco zmniejszyło się po meczu (z 5.6 do 5.1 mmol/L) i nie powróciło do wartości wyjściowych
po +32h restytucji. Średnie stężenia C i T w +32h nie uległy znamiennym zmianom, ale wartość wskaźnika T/C była wyższa niż przed meczem.
Wnioski. Obniżone stężenie Glu po meczu i niepełna normalizacja po +32h restytucji jest głównym symptomem kosztu biologicznego. W czasie sezonu startowego
zawodnicy powinni stosować dietę bogata w węglowodany
SŁOWA KLUCZOWE: mecz piłki nożnej, hormony, metabolity, zmęczenie, restytucja
Background
A soccer match lasts 90 minutes, and after half-time of
a game the players have a 15 minute break. Despite of that
intermission, the entire effort is considered as an exhaustive one, because it is combined with an engagement of
some cognitive functions like perception, attention, and
the need to rapid and accurate decisions-making. Numerous scientific studies dealing with physiology in soccer
players over the last decade, but still there are some
issues to be explore, especially behavior in blood these
indices after a single match, which provide information
about magnitudes of acute post-match fatigue, time
course of recovery rate and readiness to a subsequent
matches. A soccer match is known as a exhaustive physical effort of variable intensity, when players have to
accelerate and decelerate during runs with maximal
speed on a short distances or dribbling. The distance covered by the players who complete the whole match often
reaches 10 km. In addition, this effort is combined with
focused attention on the situation in the field of games,
thus, beside of well physical capacity also perception and
cognitive abilities are needed, for instance, to make a decision accurately and rapidly. It seems, that a goal-keeper
does not need a high level of physical endurance, but
rather short time response, spatial orientation and good
explosive strength. During a match, soccer players are
exposed to collisions with the others, and that is responsible for occurrence of severe injuries of lower extremities
[1-3] and head [4]. The risk of these bodily failures are
higher among these players, who display higher trait anxiety, experience more daily hassles or other stressful lifeevents [5]. Obviously, injuries and concussions are caused
to a greater extent by more aggressive players, who are
more often punished for fouls. Interestingly, it was found,
that number of fouls and penalties for non acceptable
behaviors correlated positively with salivary testosterone
level [6].
CAMS 2/2013
117
Obmiński Z. et al. The physiological cost of soccer match
Because of the strenuous and long-lasting effort and
involvement of concurrently psycho-motor abilities, the
whole team who has to compete against the opponent
consists of first team, 11 players plus a goal keeper, and
additionally reserve players, who are able to exchange
exhausted players during the match. It is worth to note,
that during competitive period, for example a league,
some players have to participate in 2 matches per week.
This could lead to the physical and mental accumulating
of fatigue similar to that observed by us among volleyball
players, participating into five successive matches played
day-by-day. We found, that increments of perceived
psycho-physical stress (state anxiety and malaise during
the tournament corresponded with lowered morning
testosterone and higher CK activity [7]. Similarly more
prolonged physical activity with inadequate rest periods
between the matches, which took place throughout the
Polish Volleyball League brought about changes in the
selected biochemical parameters in blood [8]. We expect
that also similar physiological symptoms of excessive
activity may occur among these soccer players, who are
engaged in more than single match. These suppositions
has been confirmed by Mortatti and co-authors [9], who
found symptoms of disturbance in immunological system
induced by seven subsequent soccer matches played in
20 days. This physiological state expressed itself as
elevated salivary cortisol, lowered IgA and rise of incidents
of upper respiratory tract infections during a competitive
period. After single soccer match the player display muscles damage and deterioration strength and sprint abilities sustaining themselves even through 72h recovery
[10,11]. Elevated CK activity, the crucial evidence for
muscle micro-injury is related (r=0.88) to the number of
sprints (38±18) performed during a match [12]. Such
deep post-match physiological changes suggest, that in
some cases length of intermissions between successive
matches played during the season might be inadequate
for full recovery. Indeed, Silva at al [13] found negative
correlation between individual playing time during entire
season and the level of performance of some exercisetests. Thus, the length of time interval between the two
matches and time playing play a crucial role in the magnitude of risk of accumulation of fatigue. We guess, that
the higher physiological cost of subsequent matches the
higher risk of the chronic fatigue and prevalence of
injuries. Based on our mentioned studies carried out
among volleyball players we assumed, that determination of post-match changes in blood cortisol ( C), testosterone (T), CK, urea (U) and glucose (Glu) would be the
best way for estimation of the physiological cost of a soccer
match. Considering the above we undertook the study,
which aimed to found the rate of normalization of
selected hormones and metabolites during +32h recovery
after a single soccer match.
The protocol study has been designed together with the
coach, who wanted to examine each of 17 players. They
took part in friendly match played in the afternoon
(17:00-19:00 pm) against a foreign team. Excluding the
position of goalkeeper, the other playing positions (central
defender, fullback, midfield, forward) did not strictly
assigned to the each player over the entire play. Capillary
blood specimens were sampled in the morning, a day
prior the day of the event (-32h), and subsequently after
overnight recovery (+12h after the end of the match) and
in the next morning (+32h after end of the match).
Plasma corrtisol (C), testosterone (T), glucose (Glu), urea
(U) and CK activity levels were determined by commercial
kits, as described earlier [7]. Perceived fatigue was selfreported rated at 4 time points, -32h, directly after match,
+12h and +32h with using of the
5-point scale, from 0 points (lack of any fatigue) to
5 points (huge fatigue). One-way analysis of variance
(ANOVA) using program of STATISTICA version 10 was
utilized for comparison the means. The study protocol
was approved by the Ethical Commission at Institute of
Sport, Warsaw.
Results
Results of determination of plasma indices with results of
statistical comparison is given in Table 1. Likewise, rating
of perceived fatigue is displayed in Table 2
The resultant data showed varied responses to the
match. C levels showed lack of changes at each time
points, with its slightly lowered value (11%) at +32h
recovery compared to the initial level. At the same time
points T was somewhat higher (by 16.7%), thus, at the
end of 32h recovery T/C ratio was significantly higher (by
35%) from that prior to the match. That change indicate
Tab. 1. Changes in the blood hormones and metabolites caused by a soccer match
118
CAMS 2/2013
Tab. 2. Time course of perceived fatigue over the period
shift of protein metabolism toward anabolism. At the first
glance, the direction of that change, however, seems to
be not agree with the behavior of U which somewhat
higher levels during recovery suggests higher rate of proteolysis. The main finding is diminished after the match
glucose level. Despite 32h recovery its value did not
return to the initial one.
Discussion
Considering statistical calculations the obtained results
showed lack of significant changes in majority of blood
indices observed in three time points excluding Glu and
T/C ratio. However CK activity, a very sensitive marker of
muscle damage induced by vigorous exertions, increased
only by 45% compared to the pre-match. That elevation
was less than the higher rise (by 84%), but also non
significant change noted by Thorpe [12]. However, it is
worth to note in our study, the relative high pre-match
activity of CK. That may indicate the high-intensity training performed few days prior to the match. Although, we
had no information from the players or their coach what
type of trainings were perform earlier, but perceived
fatigue before the match was the same as after overnight
post-game recovery, and was two-fold higher than that
at the end of 32h full rest. In our study cortisol was unchanged over the entire period of observation, with
slightly tendency to the drop after 32h recovery. We
guess, that directly prior- and after the match the variable
was strongly elevated, in the first case in result of precompetitive stress, and in the second case it was induced
by physical strain. That assumption is based on the study
on the behavior of salivary cortisol over the 24h priorand 24h post rugby match [14]. The hormone level
increased from 24 hours pre-match to 30 minutes prematch, and 24h post-match the value was higher than
24h pre-match one. The other study showed rise of
plasma cortisol (by 78%), and testosterone (by 44%)
directly after soccer match [12]. Thus, as regards to examination of hormonal responses to psychological and
physical effort blood for analysis should be sampled
“a closer” to the event.
Interestingly, after 32h recovery slightly decrease of
C occurred with simultaneous slightly increase of T. These
changes were not significant, but resulted in significant
T/C ratio, indicator commonly used for rating of balance
between the rate of anabolism and catabolism. Compared
to our results, T/C ratio after an official soccer match was
decreased until 48h recovery in seven high-level players
[15]. Presumably, these responses were differ because of
higher rank of an official match and in an consequence
a higher emotional stress and higher level of engagements, compared to that in case of participation in
a friendly meeting. Moreover, in our study not all of 17
players take part in the entire mach, some of them served
as the reserve, being inactive, or playing very short time. In
such case, especially players-spectators were not physically
fatigued, and they recovered only from psycho-emotional stress. Watching of a match, however, also induces
temporary, hormonal changes [16], slightly elevation of
salivary testosterone and stronger rise of cortisol elevating gradually during a match. These changes were found
among the fans of Spanish players, thus, we may assume
much more stronger excitation and responses in our
reserve players watching the actions of their fellows.
As mentioned, professional soccer players may experience state of overloading throughout competitive season. There are several useful tools for detections this
syndrome [17,18], from examination of the performance
of field test (agility, sprints, countermovement jumps),
using psychological questionnaires for assessment of
mood state, up to more advanced methods including
blood analysis. Induced by excessive physical effort
decrease of blood or salivary testosterone is a clear signal
for athletes or their coach for an intervention regarding
need of reduction of excessive training and taking a rest
period. Among athletes who did not experience nonfunctional overreaching, even few days of tapper is sufficient to normalization androgenic status, which play also
in soccer players an important role [19], as a factors
responsible for the rate of post-effort recovery, vigor and
explosive strength.
Our study showed slightly, non significant elevation
of U, by 12%, at +12h. U is a final product of protein
metabolism (catabolism) may indicate increased rate
proteolysis, when U concentration in blood is higher. On
the other hand, U levels may be elevated due to renal
function which may be impaired after strenuous endurance
exertion [20,21]. The most spectacular symptom of higher
physiological cost is significant lowered G levels at +12h
and even +32h post match recovery. Although none of
subject showed post match hypoglycemia (>4.1 mmol/L),
observed lowered mean Glu may be related to glycogen
depletion, however, Krustrup showed elevated blood
glucose after exercise simulating the game, despite significant loss of muscle glycogen [22]. Generally, an effort
similar to a soccer match regarding timing and intensity
decreases carbohydrate resources, and lowered glycogen
content affects poorer sprint abilities, while lowered
blood glucose negatively affects some cognitive disposi-
CAMS 2/2013
119
tions like time responses [23-25]. For that reason the
replenish of carbohydrates is widespread recommended
for soccer players during an intermission followed by
after one-half game and after entire match. Changes in
perceived fatigue shoved moderate exhaustion directly
after the match and normalization to the initial state after
night recovery (+12h). It should be stressed the effect of
continued recovery up to +32h on perceived fatigue. At
this time the parameters was almost two-fold lower than
that prior to the effort. This might be elucidated as results
of moderate state of overstrain before the match.
9.
10.
11.
Conclusions
Soccer match elicited a disturbance in the system responsible for glucose homeostasis. Lowered Glu level sustaining
itself over 32h period indicates the need for carbohydrate-rich diet and/or the use of appropriate supplements during competitive period.
12.
13.
References
1.
2.
3.
4.
5.
6.
7.
8.
Quisquater L, Bollars P, Vanlommel L, Claes S, Corten
K, Bellemans J. The incidence of knee and anterior
cruciate ligament injuries over one decade in the
Belgian Soccer League. Acta Orthop Belg. 2013; 5:
541-546.
Vanlommel L, Vanlommel J, Bollars P, et al. Incidence
and risk factors of lower leg fractures in Belgian
soccer players. Injury 2013; 12: 1847-1850.
Brito J, Malina RM, Seabra A, et al. Injuries in Portuguese youth soccer players during training and
match play. J Athl Train. 2012; 2: 191-197.
Covassin T, Elbin RJ, Bleecker A, Lipchik A, Kontos AP.
Are there differences in neurocognitive function and
symptoms between male and female soccer players
after concussions? Am. J. Sports Med. 2013; 12: 28902895.
Ivarsson A, Johnson U, Podlog L. Psychological
predictors of injury occurrence: a prospective investigation of professional Swedish soccer players. J.
Sport Rehabil. 2013; 1: 19-26.
Perciavalle V, Di Corrado D, Petralia MC, Gurrisi L,
Massimino S, Coco M. The second-to-fourth digit
ratio correlates with aggressive behavior in professional soccer players. Mol. Med. Rep. 2013; 6: 17331738.
Obmiński Z, Lerczak K, Mroczkowska H, Witek K.
Changes in psycho-physiological indices in male
volleyball players during 5-day international tournament. Pol. J. Sports Med. 2012; 29(1): 67-73.
Obmiński Z, Lerczak K, Witek K. The effect of repeated volleyball matches on the morning plasma levels
of hormones, metabolites, and muscle, and liver
enzymes in male volleyball players. Pol. J. Sports
Med. 2013; 29(1): 37-43.
120
CAMS 2/2013
14.
15.
16.
17.
18.
19.
20.
21.
Mortatti AL, Moreira A, Aoki MS, et al. Effect competition on salivary cortisol, immunoglobulin A, and
upper respiratory tract infection in elite young
soccer players. J. Strength Cond. Res. 2012; 26(5):
1396-1401.
Ascensão A, Rebelo A, Oliveira E, Marques F, Pereira
L, Magalhães J. Biochemical impact of a soccer
match - analysis of oxidative stress and muscle damage markers throughout recovery. Clin. Biochem.
2008; 41(10-11): 841-851.
Fatouros IG, Chatzinikolaou A, Douroudos II, et al.
Time-course of changes in oxidative stress and antioxidant status responses following a soccer game.
J. Strength Cond. Res. 2010; 24(12): 3278-3286.
Thorpe R, Sunderland C. Muscle damage, endocrine,
and immune marker response to a soccer match. J.
Strength Cond. Res. 2012; 26(10): 2783-2790.
Silva JR, Magalhães JF, Ascensão AA, Oliveira EM,
Seabra AF, Rebelo AN. Individual match playing time
during the season affects fitness-related parameters
of male professional soccer players. J. Strength Cond.
Res. 2011; 25(10): 2729-2739.
McLellan CP, Lovell DI, Gass GC. Markers of postmatch fatigue in professional Rugby League players
J. Strength Cond. Res. 2011; 25(4): 1030-1039.
Silva JR, Ascensão A, Marques F, Seabra A, Rebelo A,
Magalhães J. Neuromuscular function, hormonal
and redox status and muscle damage of professional
soccer players after a high-level competitive match.
Eur. J. Appl. Physiol. 2013; 113(9): 2193-2201.
van der Meij L, Almela M, Hidalgo V, et al.Testosterone and cortisol release among Spanish soccer
fans watching the 2010 World Cup final. PLoS One
2012; 7(4): e34814. doi:10.1371/journal.pone.0034814.
Epub 2012 Apr 18.
Brink MS, Visscher C, Coutts AJ, Lemmink KA.
Changes in perceived stress and recovery in overreached young elite soccer players. Scand. J. Med.
Sci. Sports 2012; 22(2): 285-292.
Schmikli SL, Brink MS, de Vries WR, Backx FJ. Can we
detect non-functional overreaching in young elite
soccer players and middle-long distance runners
using field performance tests? Br. J. Sports Med.
2011; 45(8): 631-636.
Moreira A, Mortatti A, Aoki M, Arruda A, Freitas C,
Carling C. Role of free testosterone in interpreting
physical performance in elite young Brazilian soccer
players. Pediatr. Exerc. Sci. 2013; 25(2): 186-197.
Mydlík M, Derzsiová K, Bohus B. Renal function
abnormalities after marathon run and 16-kilometre
long-distance run. Przegl. Lek. 2012; 69(1): 1-4.
Tian Y, Tong TK, Lippi G, Huang C, Shi Q, Nie J. Renal
function parameters during early and late recovery
periods following an all-out 21-km run in trained
adolescent runners. Clin. Chem. Lab. Med. 2011;
49(6): 993-997.
22. Krustrup P, Mohr M, Steensberg A, Bencke J, Kjaer M,
Bangsbo J. Muscle and blood metabolites during
a soccer game: implications for sprint performance.
Med. Sci. Sports Exerc. 2006; 38(6): 1165-1174.
23. Wiśnik P, Chmura J, Ziemba AW, Mikulski T, Nazar K.
The effect of branched chain amino acids on psychomotor performance during treadmill exercise of
changing intensity simulating a soccer game. Appl.
Physiol. Nutr. Metab. 2011; 36(6): 856-862. doi:
10.1139/h11-110. Epub 2011 Nov 3.
24. Russell M, Benton D, Kingsley M. Influence of carbohydrate supplementation on skill performance
during a soccer match simulation. J. Sci. Med. Sport.
2012; 15(4): 348-354. doi: 10.1016/j.jsams.2011.12.006.
Epub 2012 Jan
25. Kingsley M, Penas-Ruiz C, Terry C, Russell M. Effects
of carbohydrate-hydration strategies on glucose
metabolism, sprint performance and hydration during a soccer match simulation in recreational players.
J. Sci. Med. Sport. 2013; 20: 1440-2440. doi: 10.1016/
j.jsams.2013.04.010.
Zbigniew Obmiński
Department of Endocrinology, Institute of Sport
ul. Trylogii 2/16, 01-982 Warsaw, Poland
tel. +48 (22) 834 95 07
CAMS 2/2013
121
122
CAMS 2/2013
117 Drzal1:Layout 1 2014-03-20 12:33 Strona 1
ORIGINAL ARTICLE
The shape of feet in women after mastectomy
Justyna Drzał-Grabiec, Maciej Rachwał, Katarzyna Walicka-Cupryś
INSTITUTE OF PHYSIOTHERAPY, UNIVERSITY OF RZESZÓW, POLAND
SUMMARY
Background. Mastectomy is an intervention which causes multiple changes in a woman’s body as a result of the altered statics of the body. The study aims at assessing
the shape of feet in women after mastectomy compared with healthy females.
Material and methods. The participants included 58 women after single mastectomy, members of the Amazon Club in the Podkarpackie (Subcarpathia) Province (study
group) and 54 healthy women (control group). The mean age of the controls was 59+/-6.7 years, and in the study subjects - 60+/-7.2 years. Each woman was subjected
to photogrammetric examination of the shape of feet based on the phenomenon of projection moiré.
Results. Wejsflog index for the right foot in the study group was lower (p=0.0210). The ALPHA angle of the left foot and the GAMMA angle of the right foot were also
found to vary, and the ALPHA angle was significantly smaller in the study group (p=0.0269) while the GAMMA angle was significantly larger (p=0.0001). Differences
were also found in the longitudinal arch of the feet, and the feet of the women in the study group were characterized by a higher value of Clarke’s angle. In the case of
the left foot this difference was statistically significant (p=0,0320).
Conclusions. Mastectomy leads to lowering of the transverse arch of the foot. Following breast amputation, women tend to have a more pronounced longitudinal arch
in the feet.
KEY WORDS: feet, photogrammetric method, mastectomy
STRESZCZENIE
Ukształtowanie stóp kobiet po mastektomii
Wstęp. Mastektomia jest zabiegiem który powoduje wiele zmian w ciele kobiety w skutek zmian statyki ciała. Ocena wpływu zabiegu mastektomii na parametry
antropometryczne i biomechaniczne jest istotna z uwagi na potrzebę planowania efektywnej, komplementarnej rehabilitacji pacjentek. W dostępnej literaturze brak
doniesień na temat ukształtowania czy wysklepienia stóp kobiet po mastektomii. Celem pracy była ocena ukształtowania stóp u kobiet po zabiegu mastektomii w porównaniu do kobiet zdrowych.
Materiał i metody. Do badań włączono 58 kobiet po mastektomii jednostronnej należące do Klubów Amazonek na terenie podkarpacia (grupa badana) oraz 54 kobiety
zdrowe (grupa kontrolna). Średnia wieku kobiet z grupy kontrolnej to 59+/-6,7 lat, a z grupy badanej 60+/-7,2 lat U każdej z kobiet wykonano fotogrametryczne badanie
ukształtowania stóp oparte na zjawisku mory projekcyjnej.
W pracy obliczono statystyki opisowe badanych parametrów w grupie badanej i kontrolnej: średnią [ ], odchylenie standardowe [s] oraz medianę [Me]. Do porównania
parametrów postawy ciała pomiędzy grupą badaną i kontrolną wykorzystano nieparametryczny testu U Manna-Whitneya.
Wyniki. Wskaźnik Wejsfloga stopy prawej u kobiet z grupy badanej jest niższy (p=0,0210). Kąt ALFA stopy lewej oraz kąt GAMMA stopy prawej również wykazują zróżnicowanie, przy czym kąt ALFA jest istotnie mniejszy w grupie badanej (p=0,0269), a kąt GAMMA istotnie wyższy (p=0,0001). Różnice wykazuje również wysklepienie łuku
podłużnego stóp, gdzie stopy kobiet z grupy badanej charakteryzują się większą wartością kata Clarka. Różnica ta w przypadku stopy lewej wykazuje istotność statystyczną
(p=0,0320).
Wnioski. Zabieg mastektomii wpływa na obniżenie łuku poprzecznego stóp. Kobiety po zabiegu amputacji piersi charakteryzują się wyższym wysklepieniem łuku
podłużnego stóp.
SŁOWA KLUCZOWE: stopy, metoda fotogrametryczna, mastektomia
Background
Mastectomy is a procedure resulting in numerous changes in women’s bodies [1]. Medical procedures save
patients’ lives, but they do not reduce body deformities.
It is estimated that only one of ten women decides to
reconstruct the amputated breast. The body and appearance are integral parts of one’s identity and affect the way
we are perceived by other people. Appearance is especially important for women as it is believed that bodiliness is a fundamental of women’s identity which is always
subject to judgement [2]. It has been proved that surgical
procedures negatively affect body posture [1,3,4,5]. However, no study showing the effect of surgical procedures
and the associated changes in body statics on the distal
components of the musculoskeletal system, such as feet,
has been conducted so far. A leg is a weight bearing
structure which can be affected by improper loading.
The aim of the study was to assess the shapes of the
feet in women after mastectomy as compared with those
of their healthy counterparts.
58 women after single mastectomy, belonging to “Amazon”
clubs associating women after mastectomy in Podkarpackie (Subcarpathia) Province (study group) and 54
healthy women (control group) were included in the
study. The mean age in the experimental and the control
groups was 59+/-6.7 and 60+/-7.2 years respectively. Each
participant underwent photogrammetric measurements
of the shape of their feet based on projection moiré phenomenon. The measurements were performed using CQ
Elektronik System according to the manufacturer’s recommendations. The method is based on visible light and
thus, is noninvasive [6,7,8]. The study was conducted
between June and November 2012, after gaining
approval of the Bioethics Committee of the University of
Rzeszow No 16/12/2012. The parameters used in the
paper are presented in Table 1.
CAMS 2/2013
123
Drzał-Grabiec J. et al. The shape of feet in women after mastectomy
Tab. 1. Parameters used during the study
Statistical analysis
Descriptive statistics were used to calculate the studied
parameters in the study group and the control group,
namely: the mean value [x], standard deviation (SD) [s]
and the median value [Me]. In order to compare the
studied parameters between the groups, due to the nonconformity of most of the distributions with the normal
distribution (verified using Shapiro-Wilk test) and the lack
of uniform data (verified using Levene’s test), the nonparametric Mann-Whitney U test was used. The differences between the parameters obtained from both groups
were found at the level of statistical significance p<0.05.
Fig. 1. Example of photogrammetric measurement of the feet
124
CAMS 2/2013
Results
The results obtained in the study show differences in the
transverse arch of the feet, measured using Weisflog
index. In the case of the right foot, the differences show
statistical significance; the index obtained from the right
foot in the study group is lower (p=0.0210) compared
with that of the control group. The ALPHA angle of the
left foot and the GAMMA angle of the right foot also show
some differences and the ALPHA angle is significantly
smaller in the study group (p=0.0269) while the GAMMA
angle is significantly bigger (p=0.0001) in this group. Dif-
ferences were also found in the longitudinal arch of the
feet. The Clarke’s angle is bigger in the study group. This
difference is significant for the left foot (p=0.0320). The
remaining parameters showed no statistically significant
differences between the groups. The detailed results are
presented in Table 2 and Figure 2.
Tab. 2. Comparison of the tested parameters in the study and the control group are indicated using red color
Fig. 2. Parameters showing statistically significant differences
CAMS 2/2013
125
Discussion
Conclusions
The results obtained in the study reflect differences in
foot shapes in women from the study group and the control group, however few data show statistically significant
differences. The difference in Clarke’s angle values reflecting the type of the longitudinal arch of the foot is of note
as well as the Weisflog index, reflecting the type of the
transverse arch. In the case of the right and the left foot
the tendencies are similar, namely the Clarke’s angle is
bigger in both feet in the study group while the Weisflog
index is lower in both feet in women after mastectomy.
Since breast amputation results in deepening of the
physiological curvatures of the spine and forward trunk
tilt aimed at minimizing pain and the posture fixes with
time, the feet become more overloaded. The center of
mass shifts downward and forward and the load shifts to
the forefoot. Maintaining such a position for a long time
results in pathological foot loading and is likely to cause
flattening of the transverse arch. This can cause lightening
of the load of the dynamic arch, manifested by the increase
in Clarke’s angle. The remaining relationships seem accidental and do not require discussion.
In the available literature there are no reports on the
shape or arch of the foot in women after mastectomy.
Assessment of the effect of mastectomy on anthropometric and biomechanical parameters is significant due
to the need of effective rehabilitation planning. Moreover,
it is interesting how single breast amputation alters body
statics as well as the proximal and distal components of
the musculoskeletal system. The results obtained in this
study of feet shapes as well as the results obtained by
other researchers suggest that the exercises forming the
habitual correct posture and correct loading of the feet
should be included in the planning of rehabilitation
exercises. Such exercises will allow preventing lowering
of the transverse arch of the feet which can result in pain,
hallux valgus and painful calluses. Since posture correction in adult people is not very effective and can only stop
further deformation processes, the intervention should
comprise prevention of postural deformities due to
significant changes in statics and postural re-education
in women after breast amputation.
The studies showing possible disorders in women
after mastectomy seem justifiable as it is important not
to treat, but to prevent and develop reliable rehabilitation
programs, implementing primary prophylaxis of possible
disorders resulting from breast amputation.
Mastectomy leads to lowering of the transverse arch of
the foot. Following breast amputation, women tend to
have a more pronounced longitudinal arch in the feet.
126
CAMS 2/2013
References
1.
2.
3.
4.
5.
6.
7.
8.
Rostkowska E, Bąk M, Samborski W. Body posture in
women after mastectomy and its changes as a result
of rehabilitation. Advances in Medical Sciences 2006;
51;287-97.
Marcinkowska U, Babińska A, Flak B, Bajer M, Biedak
M, Jośko J. The body image of women with breast
cancer in internet users opinions. Onkologia Polska
2012, 15, 2: 49-53.
Hanuszkiewicz J, Malicka I , Stefańska M, Barczyk K,
Woźniewski M. Body posture and trunk muscle
activity in women following treatment of breast cancer. Ortopedia, traumatologia, rehabilitacja 2011; 13
(1):45-57.
Malicka I, Hanuszkiewicz J, Stefańska M, Barczyk K,
Woźniewski M. Relation between trunk muscle
activity and posture type in women following treatment for breast cancer. J Back Musculoskelet Rehabil
2010;23(1):11-19.
Bąk M, Cieśla S. Assessment of postural disorders in
women after radical mastectomy followed by immediate breast reconstruction. Fizjoterapia 2009; 17(1):
30-37.
Tokarczyk R, Mazur T. Photogrammetry – principles
of operation and application in rehabilitation. Rehabilitacja Medyczna 2006; 10(4): 31-38
Drzał-Grabiec J, Snela S. The influence of rural environment on body posture. Ann Agric Environ Med
2012; 19(4):846-50.
Drzał-Grabiec J, Szczepanowska-Wołowiec B. Weightheight ratios and parameters of body posture in
7-9-year-olds with particular posture types. Ortopedia Traumatologia Rehabilitacja 2011; 13(6).
Justyna Drzał-Grabiec
Institute of Physiotherapy, University of Rzeszów
35-205 Rzeszów, ul. Warszawska 26A, Poland
Tel: 691-588-185, Fax: +48 17 872 19 42
118 Obminski luki:Layout 1 2014-03-20 12:32 Strona 1
ORIGINAL ARTICLE
Do personality traits determine future achievements
in the sport of archery?
Zbigniew Obmiński1, Helena Mroczkowska2
1
2
DEPARTMENT OF ENDOCRINOLOGY, INSTITUTE OF SPORT, WARSAW, POLAND
DEPARTMENT OF PSYCHOLOGY, INSTITUTE OF SPORT, WARSAW, POLAND
SUMMARY
Background. Psychological studies play an important role in understanding behaviours such as social relationships, decision-making, coping with stress and other
activities. Several epidemiological psycho-medical observations carried out throughout the last decade have revealed close relationships between personality and the
general health level; therefore, some psychological investigations might be considered as a diagnostic tool for preventive medicine. For a long time sport has been
a testing ground for experimental, concurrent biomedical studies on the human mind and bodily development in healthy youths and young adults. Hence, the intent
of our study was to identify possible relationships between selected personality traits among young male and female archers and their sport achievements in the future.
Material and methods. 20 male and 19 female archers of a similar average age (16.4 and 16.5, respectively) completed appropriate psychological tests with the use of
standardized inventories in order to determine selected personality traits. 16 years later the data were analyzed with regards to sport achievements expressed by
numerical rating, which had been recorded until the end of their career.
Results. There were no significant differences between the males and females in the scores of the examined features, that is: trait anxiety, neuroticism, extraversion,
briskness, perseveration, sensory sensitivity, emotional reactivity, endurance, activity and motivation to achieve. There were no relationships between sport achievements
and any of the examined traits in the males, while among female archers there were significant positive correlations between sport achievements and anxiety, neuroticism,
and emotional reactivity in the scores (r= 0.61, 0.59, 0.50, respectively).
Conclusions. In young archers there are no significant sex-related differences in personality traits, but this thesis is of limited value because of the small sample size.
Assuming that the personality of young athletes is not very stable, it is recommended that prognoses regarding sport achievements be only short-term.
KEY WORDS: personality traits, gender, sport achievements
STRESZCZENIE
Czy cechy osobowości determinują w przyszłości osiągnięcia sportowe w łucznictwie?
Wstęp. Badania psychologiczne odgrywają ważną rolę w zrozumieniu zachowań takich jak relacje społeczne, sposób podejmowania decyzji, radzenie sobie ze stresem
i inna aktywność. Wiele psycho-medycznych obserwacji przeprowadzonych w ostatniej dekadzie ujawniło ścisły związek pomiędzy osobowością a ogólnym stanem
zdrowia, dlatego niektóre psychologiczne badania mogą być uznane za diagnostyczne narzędzie w medycynie prewencyjnej. Sport od dawna był poligonem doświadczalnym dla eksperymentalnych, równoległych badań na rozwojem ludzkiego ciała i umysłu u młodzieży oraz dorosłych, młodych osób. Z tego powodu intencją naszych
badań była identyfikacja możliwych zależności pomiędzy wybranymi cechami osobowości młodych łuczników i łuczniczek a ich przyszłymi osiągnięciami sportowymi.
Materiał i metody. Zbadano wybrane cechy osobowości u 20 zawodników i 19 zawodniczek łucznictwa w podobnym wieku (odpowiednio 16.4 and 16.5 lat) przy użyciu
standaryzowanych testów psychologicznych. Po upływie16 lat wyniki te analizowano w zestawieniu z numerycznymi osiągnięciami sportowymi uzyskanymi do czasu
zakończenia kariery sportowej.
Wyniki. Nie było różnic pomiędzy kobietami i mężczyznami odnośnie do badanych cech, to jest lęku, neurotyzmu, ekstrawersji, żwawości, perseweratywności, wrażliwości
sensorycznej, reaktywności emocjonalnej, wytrzymałości, aktywności i motywacji osiągnięć. Wśród mężczyzn nie odnotowano związku pomiędzy osiągnięciami
sportowymi a jakąkolwiek badaną cechą, podczas gdy u kobiet ujawniono dodatnie korelacje pomiędzy osiągnięciami a lękiem, neurotyzmem i reaktywnością emocjonalną
(r=0.61, 0.59, 0.50 odpowiednio).
Wnioski. Nie ma zależnych od płci różnic w cechach osobowości u młodych łuczników, ale ta teza ma ograniczoną pewność z powodu małej liczebności badanych grup.
Z powodu niezbyt stabilnej osobowość młodych sportowców, należy przyjąć, że prognozy sportowych osiągnięć mogą być jedynie krótkoterminowe.
SŁOWA KLUCZOWE: łucznictwo, cechy osobowości, płeć, osiągnięcia sportowe
Background
Archery is practiced as a type of recreation or a competitive
sport by both sexes. Modern competitive archery involves
shooting arrows at a target for accuracy from set distances, the indoor distances being 18 and 25 m while the
outdoor ones ranging from 30 to 90 m. The main effort
during a competition is performed by upper extremities;
it involves development of dynamic bowstring stretching
(the maximal strength is 18–20 kg) and maintaining this
static force for a few seconds prior to the shot. The relative
short time intervals between successive shots seem to be
sufficient to avoid deterioration of muscle strength and
some metabolic changes like blood lactate accumulation.
Although according to our best knowledge there are no
studies among archery contestants supporting this thesis,
our assumptions are based on the rapid and full restoration
of the maximal strength of muscle contraction following
a very short rest after an anaerobic and continued effort,
despite the elevated blood lactate level [1]. As mentioned, archery competition is characterized by very mild
physical activity; hence, this sport is not interesting as
a study object for physiologists who examine metabolic
changes induced by exercises of high, or even moderate,
physical intensity. For that reason, biomedical studies
among archers involve other topics, mainly biomechanical examinations and neuro-muscular activation during
development of the static force [2,3]. There are studies
providing the evidence that practising archery develops
some cognitive functions of the brain and improves the
activity of the neural network, especially via activation of
the prefrontal cortex, lingual cortex, retrosplenial cortex
CAMS 2/2013
127
Obmiński Z. et al. Archers’ personality profiles and sport achievements
and parahippocampal gyrus [4,5]. Generally, shooting
improves the activity of the neural network [6,7].
Despite the very low physical activity during archery
shooting, the autonomic nervous system is excited, and
in consequence it increases the heart rate. This effect is
a disadvantage for shooting performance; however, the
influence of that effect is different among novice and
experts archers [8,9]. Moreover, it should be stressed that
another factor is the tremor of shoulder muscles recorded
in the full drawing position after a series of shots. This
tremor may negatively affect shooting performance
when muscles are fatigued after a series of shots [10].
There are only a few studies aimed at searching the factors which are related to the level of archery performance
during competition and/or which may determine development of the sport career in the future. It was found that
in the beginners there is a strong influence of the interaction between the hand preference and eye dominance on
shooting performance [11]. In turn, measurements of forearm EMG during shooting by various skilled archers
revealed diagnostic EMG data for the evaluation of the
archers` progress and the identification of talents [12].
It is worth noting that the human mind plays a crucial
role in the phenomena such as emotions, motivation
(engagement), perception, decision-making and many
other regulators of actions and behaviours. All of them
may be explored with the use of psychological tools,
allowing to determine athletes` personality profiles. The
question whether personality traits may indentify more
or less successful athletes has to be considered in the
future. On the other hand, it seems that the levels of some
personality traits among athletes, like neuroticism, emotional reactivity and anxiety, together with information
processing, cognitive function and social intelligence, are
important for a good collaboration with the coach and
solving athletic problems. Some changeable psychological features, like state anxiety and mood, may with high
accuracy predict athletic outcomes throughout a shortterm period [13]. This study aimed to verify the hypothesis
that determination of some personality traits allows to
distinguish better archers from worse ones.
Tabl. 1. Personality traits in young male and female archers
128
CAMS 2/2013
Twenty male and nineteen female archers (of the age up
to 18), with sport experience ranging from 2 to 6 years,
were recruited for a study on selected personality traits.
The study was carried out at the time when all the individuals belonged to a junior division. After a 16-year
period, when a vast majority of the archers ended their
sport career, overall sport achievements were rated for all
the subjects using a 6-point scale as follows:
1 – medals of Polish Junior Archery Championships (age
up to 18) but no medals in the categories of youths
(up to 21) and seniors (>21)
2 – medals of Polish Junior/Youth Archery Championships but no medals of Polish Senior Archery
Championships
3 – medals of Polish Senior Archery Championships only
4 – medals of European Senior Archery Championships
5 – medals of World Senior Archery Championships
6 – medals of World Senior Archery Championships plus
qualification for the Olympic Games.
The Behaviour-Temperament Inventory designed by
Zawadzki-Strelau (FCB-TI) [14] was used for recognition
of some personality traits, the Spielberger Inventory [15]
was used for measurements of anxiety, levels of neuroticism and extraversion were measured using the questionnaire by Eysenck [16], motivation to achieve was rated
using the experimental scale by Mroczkowska [17].
Statistical differences between the males and females
for all the variables were verified by the non-parametric
U-Mann-Whitney test. The relationships among the variables, including sport achievements in scores, were
assessed by Spearman’s coefficient of correlations. The
parents of the examined archers provided a written
consent for psychological research involving their children, and the Ethical Commission at the Institute of Sport
approved the study design.
Results
Mean psychometric variables and sex-related differences
are displayed in Table 1.
Tab. 2. Matrix of correlation coefficients among personality traits (significant coefficients are marked in bold)
The relationships between the variables in the males
and females are given in Table 2.
Statistical analysis showed lack of significant differences
between the sexes. The females displayed somewhat
higher scores (by 11.5%) of neuroticism and of emotional
reactivity (by 8.7%) but lower motivation for achievement
(by 8%). Some variables significantly correlated with one
another but the value of these relationships was different in
the males and the females. Among the male archers there
were no connections between success and personality.
Discussion
There were unsurprising sex-related relations between
personality traits and sport achievements in the future.
More successful adult females demonstrated scores of
higher anxiety, neuroticism and emotional reactivity
recorded at their adolescent age. Higher scores of these
personality components are considered as negative and
undesirable in competitive sport. According to a widespread opinion, the above-mentioned features do not
facilitate effective coping with stress. Additionally, it is
hard to elucidate the negative, although non-significant,
correlation between motivation and success among the
females. It is probably either the fact that the intensity of
motivation is not a very stable parameter throughout
a long time period, or that high motivation among
beginners may be strongly blunted later in the case of
repeated failures in competitive sport, that lead to a premature ending of the career. Trying to understand this
paradoxical phenomenon, we have to consider that personality traits were examined among adolescent athletes,
at the beginning of their sport career, while the best
outcomes, medals of European/World Championships
and the participation in the Olympic Games were achieved
by the same individuals at the adult age, when their personality traits were not the same as before. The assumption that personality may change with age is supported
by several studies on stability of the psychological profile.
For instance, the five broad domains, or dimensions, that
are used in psychology to describe human personality,
the so-called Big Five personality traits, are considered as
CAMS 2/2013
129
relatively stable psychological features throughout a long
period among adults [18]. In older people some traits
change, especially openness to new experiences tends
to decrease [19,20]. Among adolescents, the personality
profile is not ultimate but demonstrates a substantial
change over time. There is no known quantitative extent
of this change throughout a short time interval such as
1–2 years, but from adolescents to adults the T-scores
of neuroticism, extraversion, openness, anxiety, angry
hostility, impulsiveness and vulnerability decrease, while
agreeableness and conscientiousness increase [21].
According to the above facts, it seems obvious that
the time of the examination of personality traits should
be relatively concurrent with the period when the archers
achieve their best success. In such a case the results of
a study on personality are more in accordance with the
observed psycho-physiological responses to a stressful
event [22] and more accurately show efficiency of coping
with stress [23]. There was a statistically significant correlation among the traits; however, the most reliable and
worth discussion are those which are similar in both
sexes. When considering the negative relationship
between motivation and anxiety and neuroticism, two
different components of the overall personality structure,
motive for success (MS) and motive to avoid failure (MAF)
should be noted. Olson et al [24] reported positive correlation between overall motivation and extraversion and
neuroticism, and negative correlation between general
motivation and agreeableness. Analysis of separate components of motivation showed positive correlation of MS
with extraversion, openness and conscientiousness, and
negative with neuroticism, while MAF correlated positively with neuroticism, and negatively with openness
[25]. Based on that, the results of our study indicated
a larger contribution of MS to the overall motivation.
There we no sex-related differences in the anxiety
scores. This is in accordance with the results of our earlier
study on state anxiety among senior rovers [26], but in
junior rovers females were more anxious [27]. It is worth
noting, however, that individual higher state anxiety prior
to competition could not be considered as a simple predictor of performance. According to the IZOF theory, each
performer has his or her optimal state arousal when an
athletic task may be executed best [28]. Although examinations of personality traits in both sexes engaged in competitive sport provide sometimes contradictory results, the
general conclusion is that female athletes demonstrate
a somewhat lower self-esteem and motivation for training,
but higher susceptibility to psycho-physical stress, which
is expressed by a lower rate of post- effort recovery, lower
sleep quality during a heavy training period, and higher
prevalence of major depression [29–33].
It should be stressed that the last decade brings a new
approach to human physical and mental possibilities due
to the availability of more advanced tools for their examination. Genetic studies show that some genes are respon-
130
CAMS 2/2013
sible for the rate of development of physical endurance
and strength induced by appropriate exercises. Similarly,
some researches point out that the personality profile and
character traits may be in part gene-dependent [34–39].
Finally, it should be emphasized that there are links
between personality and somatic health. Psychological
examinations play an important role not only for appraisal
of the risk of antisocial behaviour, or effective functioning
in the everyday life and under stressful conditions. Several
studies reveal that there are links between various personality patterns, which are defined as types from A to D,
and the risk of cardiovascular disease development [40,41].
Hence, a diagnosis of a risky personality should be a first
step in psychological intervention. In the examined athletes, all the analysed traits were within normal ranges.
Conclusions
1. The results of the study showed lack of statistical differences in personality traits between young male and
female archers. Because of the small size of the sample,
this conclusion may not be considered as
ultimate, thus the undertaken topic merits further
investigation.
2. Still, the results showed significant relationships
between the personality profile in young female
archers and the best achievements in the future, at the
adult age. However, based on the data documented
by others, i.e. lack of stability in personality traits during
adolescence, it seems that prediction of success
among younger athletes might be more reliable
when done for a short-term period.
References
1.
2.
3.
4.
5.
6.
7.
Skof B, Strojnik V. Neuro-muscular fatigue and recovery dynamics following anaerobic interval workload. Int. J. Sports Med. 2006; 27(3): 220-225.
Ertan H, Kentel B, Tümer ST, Korkusuz F. Activation
patterns in forearm muscles during archery shooting. Hum. Mov. Sci. 2003; 22(1): 37-45.
Ertan H. Muscular activation patterns of the bow arm
in re-curve archery. J. Sci. Med. Sport. 2009; 12(3):
357-360.
Kim YT, Seo JH, Song HJ, et al. Neural correlates
related to action observation in expert archers. Behav.
Brain Res. 2011; 223(2): 342-347.
Seo J, Kim YT, Song HJ, et al. Stronger activation and
deactivation in archery experts for differential
cognitive strategy in visuospatial working memory
processing. Behav Brain Res. 2012; 229(1): 185-193.
Chang Y, Lee JJ, Seo JH, et al. Neural correlates of
motor imagery for elite archers. NMR Biomed. 2011;
24(4): 366-732.
Baeck JS, Kim YT, Seo JH, et al. Brain activation
patterns of motor imagery reflect plastic changes
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
associated with intensive shooting training. Behav.
Brain Res. 2012; 234(1): 26-32.
Robazza C, Bortoli L, Nougier V. Emotions, heart rate
and performance in archery. A case study. J. Sports
Med. Phys. Fitness 1999; 39(2): 169-176.
Carrillo AE, Christodoulou VX, Koutedakis Y, Flouris
AD.Autonomic nervous system modulation during
an archery competition in novice and experienced
adolescent archers. J. Sports Sci. 2011; 29(9): 913-917.
Lin JJ, Hung CJ, Yang CC, Chen HY, Chou FC, Lu TW.
Activation and tremor of the shoulder muscles to the
demands of an archery task. J. Sports Sci. 2010; 28(4):
415-422.
Laborde S, Dosseville FE, Leconte P, Margas N. Interaction of hand preference with eye dominance on
accuracy in archery. Percept. Mot. Skills 2009; 108(2):
558-564.
Ertan H, Soylu AR, Korkusuz F. Quantification the
relationship between FITA scores and EMG skill
indexes in archery. J. Electromyogr. Kinesiol. 2005;
15(2): 222-227.
Reglin JS. Psychological factors in sport performance:
The mental Heath Model Revisited. Sports Med.
2001; 31(12): 875-890.
Zawadzki B, Strelau J. The formal characteristics of
behavior –Temperament Inventory (FCB-TI): theoretical assumption and scale construction. Eur. J. Personality 1993; 7: 313-336.
Spielberger CD, Gorsuch RL, Lushene RE. Manual for
the State-Trait Anxiety Inventory. Calif. Palo Alto:
Consulting Psychologists Press; 1979.
Eysenck SB, Eysenck HJ. An improved Short Questionnaire for the measurement of extraversion and
neuroticism. Life Sci. 1964; 3: 1103-1109.
Mroczkowska H. Task and ego motivation, evaluation
of own possibilities and chances of success in woman
and men. Phys. Educ. Sports 2001; 3: 299-308.
Rantanen J, Metsäpelto RL, Feldt T, Pulkkinen L,
Kokko K. Long-term stability in the Big Five personality traits in adulthood. Scand. J. Psychol. 2007; 48(6):
511-518.
Allemand M, Zimprich D, Hertzog C. Cross-sectional
age differences and longitudinal age changes of
personality in middle adulthood and old age. J. Pers.
2007; 75(2): 323-358.
Allemand M, Zimprich D, Martin M. Long-term
correlated change in personality traits in old age.
Psychol. Aging. 2008; 23(3): 545-557.
Chan W, McCrae RR, De Fruyt F,et al. Stereotypes of
age differences in personality traits: universal and
accurate? J. Pers. Soc. Psychol. 2012; 103(6): 10501066.
Binboga E, Guven S, Catıkkaş F, Bayazıt O, Tok S.
Psychophysiological responses to competition and
the big five personality traits. J. Hum. Kinet. 2012; 33:
187-194.
23. Allen MS, Greenlees I, Jones M. An investigation of
the five-factor model of personality and coping
behavior in sport. J. Sports Sci. 2011; 29(8): 841-850.
24. Olson KR, Weber DA. Relations between big five
traits and fundamental motives. Psychol. Rep. 2004;
95(3): 795-802.
25. Diseth A, Martinsen Ø. Personality traits and achievement motives: theoretical and empirical relations
between the NEO Personality Inventory-Revised and
the Achievement Motives Scale. Psychol. Rep. 2009;
104(2): 579-592.
26. Obmiński Z, Mroczkowska H, Kownacka I. State
anxiety and perception of fatigue following Rowing
Regatta. Pol. J. Sports Med. 2010; 26(5): 260-266.
27. Obmiński Z, Mroczkowska H, Stupnicki R. Preexercise cortisol and testosterone levels in relation
to selected psycho-emotional variables in male and
female junior rowers. Biol. Sport 1995; 12: 43-48.
28. Eysenck MW. Anxiety and cognitive performance:
Attentional Control Theory. Emotion 2007; 7(2): 336353.
29. Hanrahan SJ, Cerin E. Gender, level of participation,
and type of sport: differences in achievement goal
orientation and attributional style. J. Sci. Med. Sport.
2009; 12(4): 508-512.
30. di Fronso S, Nakamura FY, Bortoli L, Robazza C,
Bertollo M. Stress and recovery balance in amateur
basketball players: differences by gender and preparation phase. Int. J Sports Physiol. Perform. 2013;
8(6): 618-622.
31. Schaal K, Tafflet M, Nassif H, et al. Psychological
balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One 2011;
6(5): e19007.
32. Findlay LC, Bowker A. The link between competitive
sport participation and self-concept in early adolescence: a consideration of gender and sport orientation. J. Youth Adolesc. 2009; 38(1): 29-40.
33. Moreno Murcia JA, Cervelló Gimeno E, GonzálezCutre Coll D. Relationships among goal orientations,
motivational climate and flow in adolescent athletes:
differences by gender. Span J. Psychol. 2008; 11(1):
181-191.
34. Zawadzki G, Strelau J, Oniszczenko W, Rieman R,
Angleitner A. Genetic and environment al influence
on temperament. Eur. Psychol. 2001; 6(4): 272-286.
35. Oniszczenko W, Dragan W. Association between
dopamine D receptor Exon III polimorphism and
emotional reactivity as a temperamental trait. Twin
Res. Hum. Gen. 2005; 8(6): 633-637.
36. Gillespie NA, Zhu G, Evans DM, Medland SE, Wright
MJ, Martin NG. A genome-wide scan for Eysenckian
personality dimensions in adolescent twin sibships:
psychoticism, extraversion, neuroticism, and lie.
J Pers. 2008; 76(6): 1415-1446.
CAMS 2/2013
131
37. Pełka-Wysiecka J, Ziętek J, Grzywacz A, KucharskaMazur J, Bienkowski P, Samochowiec J. Association
of genetic polymorphisms with personality profile
in individuals without psychiatric disorders. Prog.
Neuropsychopharmacol. Biol. Psychiatry 2012; 39(1):
40-46.
38. Schosser A, Fuchs K, Scharl T, et al. Interaction
between serotonin 5-HT2A receptor gene and dopamine transporter (DAT1) gene polymorphisms influences personality trait of persistence in Austrian
Caucasians. World J. Biol. Psychiatry. 2010;11(2 Pt 2):
417-424.
39. Strohmaier J, Amelang M, Hothorn LA, et al. The
psychiatric vulnerability gene CACNA1C and its sexspecific relationship with personality traits, resilience
factors and depressive symptoms in the general
population. Mol. Psychiatry. 2013; 18(5): 607-613.
132
CAMS 2/2013
40. Jamil G, Haque A, Namawar A, Jamil M. "Personality
traits and heart disease in the Middle East". Is there
a link? Am. J. Cardiovasc. Dis. 2013; 16(3): 163-169.
41. Svansdottir E, Denollet J, Thorsson B, et al. Association of type D personality with unhealthy lifestyle,
and estimated risk of coronary events in the general
Icelandic population. Eur. J. Prev. Cardiol. 2013; 20(2):
322-330.
Zbigniew Obmiński
Department of Endocrinology, Institute of Sport
ul. Trylogii 2/16, 01-982 Warsaw, Poland
tel. +48 (22) 834 95 07
119 Chromik1:Layout 1 2014-03-20 12:23 Strona 1
ORIGINAL ARTICLE
Evaluation of energy and nutritive value
of physiotherapy students diet in terms of their
awareness and knowledge of nutritional therapy
of the patient
Dorota Jakubiec1, Krystyna Chromik2, Kamil Gajda1
1
2
THE DEPARTMENT OF HUMAN BIOLOGY, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCLAW, POLAND
THE UNIT OF PHYSICAL ANTHROPOLOGY, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCLAW, POLAND
SUMMARY
Background. Various degrees of malnutrition occur in about half of patients treated in hospitals. The physiotherapy student, as a future therapist engaged in treatment
of different diseases and injuries, should be aware of the importance of the patient’s proper nutrition in a complex therapy of the disease. The objective of the study was
to evaluate the energy and nutritive value of the diet of the Physiotherapy students from the University School of Physical Education in Wroclaw at different times of the
academic year, in terms of their awareness and knowledge of nutritional therapy of the patient.
Material and methods. 30 individuals participated in the study, including 15 females (mean age 23 ± 0.5 year) and 15 males (mean age 23 ± 0.7 year). The study was
conducted as a 24-hour diet recall interview, including 7 days of the didactic period and 7 days of the examination period. The results were statistically analysed using
the STATISTICA 10 PL computer software.
Results. The energy value of daily food ration (DFR) of both sexes was significantly lower than the demand defined by age- and sex-specific standards. A significant
deficiency of fibre, calcium, magnesium, iron and B-group vitamins in the diet of both sexes was found. Sodium intake by students of both sexes significantly exceeded
the recommended level, whereas phosphorus was consumed in excess exclusively by men. No statistically significant differences in the supply of selected ingredients
during the didactic and examination weeks were observed. Nevertheless, the consumption level of these ingredients by women and men differed to a large extent.
Conclusions. The diet of the Physiotherapy students in terms of energy and nutritive value deviate from the applicable standards to a large extent. The conducted study
can be used to monitor further students’ nutritional behaviours. There is a need to shape proper eating habits within the curriculum of the University.
KEY WORDS: education, nutrition, , nutritional deficiencies
STRESZCZENIE
Ocena wartości energetycznej i odżywczej diety studentów fizjoterapii w aspekcie ich świadomości i wiedzy na temat leczenia żywieniowego pacjenta
Wstęp. Różnego stopnia niedożywienie występuje u około połowy chorych leczonych w szpitalach. Student fizjoterapii, jako przyszły terapeuta uczestniczący w leczeniu
różnych chorób i obrażeń, powinien zdawać sobie sprawę z tego jak istotne jest właściwe żywienie pacjenta w procesie kompleksowej terapii danego schorzenia. Celem
pracy była ocena wartości energetycznej i odżywczej diety studentów Wydziału Fizjoterapii Akademii Wychowania Fizycznego we Wrocławiu w różnych okresach roku
akademickiego, w aspekcie ich świadomości i wiedzy na temat leczenia żywieniowego pacjenta.
Materiały i metody. W badaniu wzięło udział 30 osób, w tym 15 kobiet (średnia wieku 23 ± 0,5 lat) i 15 mężczyzn (średnia wieku 23 lata ± 0,7). Badania przeprowadzono
metodą 24–godzinnego wywiadu żywieniowego, obejmującego 7 dni okresu dydaktycznego i 7 dni okresu sesji egzaminacyjnej. Wyniki poddano analizie statystycznej
za pomocą pakietu obliczeniowego STATISTICA 10 PL.
Wyniki. Wartość energetyczna dziennej racji pokarmowej (DRP) obu płci była znacznie niższa niż zapotrzebowanie określone normami dla płci i wieku. Stwierdzono
znaczne niedobory błonnika, wapnia, magnezu i żelaza oraz witamin z grupy B w diecie obu płci. Spożycie sodu przez studentów obu płci znacznie przekraczało poziom
zalecany, a fosfor był spożywany w nadmiarze tylko przez mężczyzn. Nie zaobserwowano istotnych statystycznie różnic podaży wybranych składników w tygodniu
dydaktycznym i tygodniu sesji. Jednak wielkość spożycia tychże składników przez kobiety i mężczyzn różniła się istotnie.
Wnioski. Dieta studentów fizjoterapii w zakresie wartości energetycznej i odżywczej odbiega w istotny sposób od obowiązujących norm. Przeprowadzone badania
posłużyć mogą dalszemu monitorowaniu zachowań żywieniowych studentów. Istnieje potrzeba kształtowania prawidłowych nawyków żywieniowych w programie
edukacyjnym szkoły wyższej.
SŁOWA KLUCZOWE: edukacja, niedobory żywieniowe, odżywianie
Background
For many years, it was thought that malnutrition is common in the so – called “third world” countries and it concerns economically developed, wealthy Western countries
to a small extent. When in the late sixties of the previous
century, nutritional assessment methods were introduced into clinical practice, it was found that various
degrees of malnutrition occur in about half of patients
treated at hospitals across the U.S., Western Europe, and
also in Poland [1]. It can be concluded with full awareness
that nutritional status disorders (malnutrition as well as
obesity) are the most common deviation from the health
condition. Malnutrition is an independent, but the
strongest, next to an organ failure, risk factor for a variety
of diseases, the treatment of complications and even the
patient’s death. Obesity contributes to development of
cardiovascular, respiratory diseases and diabetes, musculoskeletal system disorders and injuries, and others. By
worsening the condition and efficiency of most organs
and systems, it leads to increased disease incidence and
mortality during the treatment of other diseases [2].
There is no doubt that proper nutrition, in particular
of the ill, balanced in terms of composition, quality and
quantity of consumed food should be controlled and
adjusted in the same way as administered drugs. Despite
CAMS 2/2013
133
Jakubiec D. et al. Diet of physiotherapy students and their awareness of nutritional therapy
the development of knowledge of the causes, occurrence, diagnosis, consequences and treatment of eating
disorders, no attention is usually paid to the nutritional
status of patients in clinical practice, while a nutritional
therapy is frequently initiated without indications or too
late, mostly carried out erratically and involving a significant number of complications [2].
The negative impact of improper nutrition on the
results of treatment of most diseases and existing nutritional treatment options lead to every clinician, rehabilitation and physiotherapy specialist being able to recognise
eating disorders in a patient, and above all prevent them
from occurring. This concerns equally the Physiotherapy
student, as a future therapist, whose knowledge as well
as position and ability to influence the ill patient can be
invaluable.
During the period of studies, a great deal of effort,
both physical and mental, is required. The condition for
the body to function properly is to supply the right amount
of energy as energy substrates: carbohydrates, fats and
proteins; nutrients: proteins and micro-and macro-elements and regulatory substances: micro-and macro-elements and vitamins. The proportion between the energy
supplied and the energy used by the body is called the
energy balance, which should be balanced in a healthy
person. Energy expenditure is related to basal metabolic
rate (BMR), thermogenesis and physical activity [3].
The student diet is usually composed quite accidentally and unbalanced, while meals are eaten irregularly.
This is due to a large number of classes, studying, taking
odd jobs and having social life. Having only two or three
meals a day, "fast food" type meals, consumed hurriedly,
leads, on the one hand, to a rapid deficit of basic nutrients
and minerals, on the other hand it causes an increase in
some nutrients above the standard level. As a consequence, this may lead to a lower psychophysical efficiency,
poor concentration and problems with learning [4].
The stress faced by students during the examination
period may lead to changes in the number and composition of meals eaten. The "snacking" phenomenon is
fairly common. According to Lattimore and Caswell,
maintaining the discipline of proper nutrition absorbs so
much energy that only a small amount of energy is left
to fight the stress [5].
All nutrients, to a lesser or greater extent, affect the
proper brain function. The brain is treated within the
body as a priority and nourished before other organs, and
even at their expense. It is difficult to accurately determine the effect of each vitamin and each microelement
on the specific cognitive functions of the brain, nevertheless it is known that thiamine, riboflavin, niacin and folate,
by improving biochemical changes in cells, enhance the
efficiency of abstract thinking. Vitamin C improves visualspatial imagination, while vitamins A and E, and cobalamin and pyridoxine enhance abstract reasoning and
visual – spatial memory [6].
134
CAMS 2/2013
To determine whether the supply of energy and
nutrients in the diet meets the needs of the respondents,
it is referred to standards that reflect the current knowledge about human requirement for energy and nutrients,
and thus undergo continuous adjustments due to the
development of knowledge in the field of nutritional
physiology and change of living conditions and human
work. Nutrition standards define the amount of energy
and essential nutrients, including differences in the body
requirement, depending on age, sex, physiological state,
physical activity, living conditions and lifestyle, specific
for the selected groups [7].
The basis for safe consumption standards was a recommended intake [called Recommended Dietary Allowances,
RDA], defined as an average daily intake sufficient to meet
the needs of almost all healthy individuals in the group
(97-98%), taking into account the stage of their life and
the type of group. The RDA value does not consider the
needs of sick people or the chronically ill. These standards
include a safety margin – healthy individuals can consume at least 67% RDA on average, still being properly
nourished [7].
The aim of the study was to evaluate the energy and
nutritive value of meals consumed by students in different
times of the academic year and:
• to examine the extent to which the student diet
meets the requirement for various nutrients in accordance with human nutrition standards;
• to determine the difference in the energy and nutritive value of meals consumed per didactic and examination week – both in the female and male groups.
The obtained results aimed to indirectly determine
the Physiotherapy students’ awareness and knowledge
of the so-called nutritional therapy as a complementary
method in a complex therapy of numerous diseases and
injuries.
The study involved 30 students of the University School
of Physical Education in Wroclaw, including 15 females
and 15 males. The group surveyed was at the same time
a control group. The average age in the female group was
23 years (± 0.5) and 23 years (± 0.7) in the male group. The
body mass index [BMI] in the female group was 21 (± 0.1)
and 25 (± 0.3) in the male group. The total metabolic rate
(TMR) in the female group was 2,296 kcal, while the average rate in the male group was 3149 kcal. The total metabolic rate (TMR) was determined based on the basal
metabolic rate (BMR), calculated from the Harris – Benedict formulas, multiplied by an activity factor of 1.6 in
accordance with the PAL classification (Physical Activity
Level) FAO / WHO / UNU, 2004.
To assess daily food rations (DFR), a 24 – hour diet
recall interview method was applied. This method involves
writing down all the dishes, foods, snacks and drinks
consumed by the respondents throughout the day. Before
starting the assessment, the subjects were instructed to
write down their meals using household measures or
a metric weight for the specific product, and to include
even the smallest portions. The first part of the interview
covered 7 days of the didactic week in the period from
30.05.2011 to 05.06.2011, whereas the second part
included 7 days of the examination week from 11.06.2011
to 17.06.2011.
The daily food rations were evaluated in terms of
energy value and intake of essential nutrients, minerals
and vitamins. It was established to which extent the
declared supply meets the respondents’ demand specified
by standards. To analyse the data from interviews, the
computer software DIETETYK 2 of the National Institute
of Food and Nutrition in Warsaw was used. The portion
size and weight were estimated based on "Product and
food photography album" developed at the National
Institute of Food and Nutrition in Warsaw [8].
The statistical analysis of the obtained results was
carried out using the STATISTICA 10 PL software. A descriptive statistics test was used to determine the mean,
median, minimum and maximum values, and standard
deviations for all parameters. A normality test was used
to determine the normal distribution of individual parameters.
The comparison of intake of individual nutrients in
both groups and both weeks was carried out using
a t–test for independent groups, and between the didactic
and examination weeks using a t–test for dependent
samples.
Results
The statistical analysis of the results obtained in the diet
recall interview gave an average nutritive value of daily
food ration (DFR) of the respondents for both weeks. It is
worth noting that the supply of energy in DFR of both
sexes is much lower than the demand, defined by sex –
and age – specific standards, which amounts to 1,800 kcal
for women and 2650 kcal for men aged 19 – 25 years. The
nutritive and energy value of average daily diet of women
and men in the didactic and examination week is presented in Table 1.
In the didactic week, a significant deficiency of most
minerals, vitamins and fibre was observed in the female
students’ diet. There was only an excessive sodium intake,
whereas phosphorus and vitamin C intakes [Tab. 2] were at
the normal level. In the examination week, dietary intakes
of selected ingredients in the women’s diet was similar to
those during the didactic week. A higher deficiency of the
same ingredients and a slightly lower sodium intake,
though still well above the recommended levels [Tab. 3],
were observed. For men, in the didactic week, there were
lower deficiency of minerals and vitamins and increased
sodium and phosphorus intake compared to the exami-
nation week. A significant increase in vitamin A and B12
consumption was also observed during the examination
week [Tab. 2 and 3].
To estimate the influence of different weeks of the
academic year on nutrient intake, a comparison of individual nutrients, recorded in the females’ diet during the
didactic and examination weeks, was carried out. The
study found a statistically significant difference exclusively in the case of lactose intake. Higher lactose intake
in the females’ diet was identified in the didactic week
compared to the examination week [Tab. 4]. Comparing
the consumption level of selected nutrients in the males’
diet in various weeks of the academic year, no statistically
significant differences (p < 0.05) were recorded.
The analysis of intake of other nutrients in the women’s
group between the weeks covered by the study showed
no statistically significant differences. Nevertheless, a general trend involving a consumption decrease in all nutrients
can be noted in the examination week compared to the
didactic one. The following parameters are not statistically
significant; nonetheless their values may affect learning
process and development of diet-related diseases in later
life [Tab. 5].
The comparison of nutritive and energy value in the
females’ and males’ DFRs during the didactic and examination weeks revealed statistically significant differences
(p < 0.05) with regards to the intake of most ingredients.
A significant difference in the intake of consumed potassium, phosphorus and magnesium was noted between
the female and male groups, both in the didactic and
examination week. Higher intake of these elements was
observed in the male students’ group than in the female
students’ group. In the study, lower consumption of
B-group vitamins in the female student group was
observed during the examination week compared to the
didactic week, apart from vitamin B12 which intake was
higher during the examination week. In the male students’ diet, there was a lower thiamine, pyridoxine and
folic acid consumption, whereas higher riboflavin and
niacin consumption during the examination week compared to the didactic week. Differences in vitamin B
intake for women and men were statistically significant
(p < 0.05). A higher intake of B-group vitamins was
observed in the group of male students [Tab. 1].
An insignificant difference in sodium, calcium, folate,
A, E and C vitamin intake was found between the group
of women and men during both the didactic and examination week. As for the iron intake, the difference was
insignificant between the group of women and men in
the exam week. Nevertheless, higher intakes of these
nutrients occurred in the male students’ group than in the
female students’ one [Tab. 1].
The appropriate intake of nutrients such as sodium,
potassium, calcium, phosphorus, magnesium, iron and
B-group vitamins is required for the body to function
properly.
CAMS 2/2013
135
Tab. 1. Nutritive and energy value of the female and male students’ diet during the didactic and examination week – comparison
of nutrient intake in DFR
136
CAMS 2/2013
Tab. 2. Percentage of nutrition standard implementation in the females’ and males’ DFR in the didactic week
Tab. 3. Percentage of nutrition standard implementation in the females’ and males’ DFR in the examination week
Tab. 4. Differences in lactose intake in the females’ diet between the didactic examination weeks
CAMS 2/2013
137
Tab. 5. Comparison of average intake of selected minerals in the females’ and males’ DFR between the didactic and examination
weeks
Discussion
Many scholars have dealt with the subject related to eating disorders amongst students and the consequences
of these disorders – deficiencies, excess amounts or
differences in diet composition between women and
men [9–13].
In their studies Gawęcki et al. evaluated reliability of
information by means of the 24–hour recall interview. The
authors found that this method can be useful and reliable
in determining nutrient intake amongst students with
different level of nutrition knowledge [14]. Pac and Florek
in their studies on the reliability of diet recall interview
amongst school-aged children stated that it provides
useful information on their diet [15]. Thompson and Byers
recognised the 24-hour diet recall interview, conducted reliably, as a credible method enabling an objective analysis
of nutrient consumption at the group level [16].
Inadequate students’ diet leads to deficiency or excess
of minerals and vitamins, which consequently may result
in metabolic disorders, diet – related diseases and poorer
academic performance [17]. The studies’ results indicate
the energy supply in DFR within groups of women and
men is much lower than the demand defined by age – and
sex – specific standards. When analysing the diet of female
students from the Gdansk University of Physical Education
and Sport, Walentukiewicz found the implementation of
standards defining energy demand was at the level of 69%.
According to the author, following the nutrition rules and
maintaining a balanced diet is crucial in diet of individuals
characterised by significant energy expenditure associated
with mental and physical activity [12].
In their own study, the authors observed a higher
sodium intake, in relation to nutrition standards, amongst
the female as well as male students. This may indicate
excessive consumption of convenience food, which is com-
138
CAMS 2/2013
mon part of students’ daily diet. The main source of sodium
in the diet are products and drinks containing sodium chloride or commonly used sodium glutamate [18].
The results of the studies by Czerwińska and Czerniawska also indicate an increased amount of sodium
chloride consumed by men and women. The study was
conducted amongst 21 women and 21 men aged 20-30
years. The sodium intake in men was significantly higher
than in women [19]. Seidler and Szczuko proved the
sodium intake to be higher than accepted nutrition standards, both in the group of women and men – students
of the University of Agriculture in Szczecin. A higher
sodium intake was also observed in the group of male
students [11]. Ekstrenowicz and Napierała noted that in
the diet of female students of Physical Education at the
University of Bydgoszcz, the sodium intake was at the
level of 478% in relation to the standards [20]. According
to Mojska et al. a higher sodium content in the diet of
young people is caused by growing consumption of fastfood type products that have a high salt content [21].
A significant deficiency of consumed nutrients such
as potassium, calcium, magnesium and iron was observed
in relation to the nutrition standards, amongst women as
well as men in both weeks covered by the study. Nevertheless, higher deficiency of these elements was identified in the diet of female students.
As magnesium takes part in activation of more than
300 enzymes, including enzymes involved in catabolic
processes of carbohydrates, fats, proteins and nucleic
acids, it is a vital element in creation and decomposition
of high – energy ATP bonds. All reactions involving ATP,
which also contribute to efficient brain functioning,
require magnesium. In animal experiments, magnesium
deficiency resulted in a permanent ischemic lesions in
brain [6].
A proper development and functioning of the brain
is determined by an adequate iron supply, and its deficiency causes two types of disorder: 1. concerning oxygen
supply to the brain, 2. concerning reduced activity of
cytochrome oxidase consequently resulting in reduced
efficiency of energy transformation in brain cells. Iron
deficiency reflects in apathy, annoyance, problems with
concentration and ability to focus attention and memorise
– even if the blood chemistry did not show anaemia [6,22].
The study on the diet of female students, conducted
by Czeczelewski and Raczyńska, indicate significant deficiencies of potassium and calcium in the diet with an
adequate magnesium and iron content [9]. Walentukiewicz
recorded smaller intake of calcium, potassium and magnesium, and a higher one of iron and phosphorus in
relation to the accepted nutrition standards. The author
points out that lower intake of calcium compared to the
phosphorus one (recommended ratio 1:1) in the diet
increases the risk of premature osteoporosis symptoms.
These results may indicate a limited knowledge of proper
nutrition amongst students [12].
Examining the iron content in the diet of the selected
groups from Wielkopolska region, female students showed
a 26% lower supply of iron in relation to the recommended level and compared to male students [23].
Seidler and Szczuko also observed a reduced calcium
intake within the groups of female and male students
from the University of Agriculture in Szczecin. In the
women’s diet, there was no magnesium deficiency or
excess, and deficiency of this element in the male student
diet was insignificant. The opposite results were obtained
as regards iron and potassium intake, where the excess
of these elements in the students’ diet was reported [11].
For Warsaw University of Life Sciences (SGGW) students
the potassium intake was found at 85% of the standard
level [24].
In the diet of the Physiotherapy students from the
University School of Physical Education in Wroclaw, phosphorus excess was found in both groups, though a higher
intake was recorded in the men’s group. According to
Czeczelewski and Raczynska, a high phosphorus intake
is due to its prevalence in food and the use of phosphates
as additives. [9]
In the diet of Physiotherapy students within the own
study there was also deficiency of most B – group vitamins found amongst both male and female students in
both weeks covered by the study. The exception is vitamin B12 which deficiency occurred only in the female
students’ diet, while its consumption level amongst the
male students met the demand level, and during the
examination week it exceeded the demand level by 33%.
The presence of thiamine (B1) is vital for the brain
work, as it plays an active role in the glucose metabolism.
This greatly affects cognitive functions. In volunteer studies,
a thiamine deficiency, after six days of the experiment,
resulted in tiredness and lower scores on intelligence
tests. Its deficiency within the diet – like vitamin C, cobalamin, and alpha – tocopherol deficiency is associated with
the risk of Alzheimer's disease [6].
The emotional balance between depression brought
about by a thiamine deficiency, and excessive stimulation
caused by a niacin deficiency (B3 or PP) is kept in the diet
due to the presence of riboflavin (B2), which affects the
metabolism of both above mentioned vitamins. On the
contrary, the concentration of pyridoxine (B6) in the brain
is over hundred times higher than in blood, as it takes
part in the synthesis of neurotransmitters and tryptophan
metabolism, and it prevents weakness, annoyance, and
depression symptoms. The study showed a positive
correlation between the pyridoxine level in blood and the
results of memory tests. Similarly, cobalamin (B12) supplementation enhanced performance and cognitive
functions of the brain. The cobalamin deficiency causes
neurological symptoms far earlier than its decrease can
be observed in the blood [6].
The studies, by Bieżanowska – Kopeć et al., conducted
amongst women aged 20 – 25 years, revealed significant
B – group vitamin deficiencies in the diet within the
autumn – winter as well as spring – summer period.
According to the authors, a folate intake in the springsummer period was at 75.4% of the demand level. The
percentage of nutrition standard implementation was as
follows: thiamine 63.5%, riboflavin – 86.9%, niacin –
71.1% and pyridoxine – 78.7%. Based on these results, the
authors recommend B – group vitamin supplementation
in the diet of young women [25].
Walentukiewicz concluded the supply of B1, B2, B6,
B12 vitamins as higher than the EAR level. Nevertheless,
the level of B1, B3, folates and vitamin C was significantly
lower than the RDA. The supply of niacin was only 91.41%
of the EAR level. Nonetheless, the lowest value was found
in the amount of folates, which amounted to 34% of the
recommended intake [12].
In the Physiotherapy students, the authors found no
statistically significant differences in the nutritional intake
in the group of men and women between the didactic
and examination weeks. Nevertheless, numerous authors
brought up the subject of nutritional behaviours while in
stress or problem situation. The studies by Michaud and
et al. on the diet of students aged 15-19 found that on
the examination day the surveyed group consumed
a greater amount of calories, carbohydrates and fats compared to the day after passing the exam. In the group of
girls there was a significantly higher caloric supply and
increased fat intake, whereas in the group of boys there
was a statistically significantly higher percentage of fat
intake [26].
Other conclusions were reached by Morley et al., who
found that a special event does not lead to the increase
of snacks and calories consumed by both women and men.
A stressful situation does not cause increased consumption of sweets or the so-called empty calories either [27].
CAMS 2/2013
139
Lattimore and Caswell demonstrated a change in nutritional behaviour caused by stress in individuals on
a diet. They noted that those on a diet consume a great
deal of energy to control their eating habits, which in
a stressful situation entails consumption of larger amount
of nutrients of which supplied energy is needed to cope
with the stress [5].
Jenkins et al. also took up the subject of stress. They
concluded abnormal nutritional behaviours in children to
be a way of mitigating the effects of stress. It was most apparent in the group of Hispanic children, followed by Afro
– Americans and least visible in Caucasian children [28].
The results obtained in the own study demonstrated
the diet of the Physiotherapy students to be inadequate
and to significantly deviate from the applicable nutrition
standards. The authors hypothesize that this is due to not
only a permanent lack of time, unhealthy lifestyle and
neglecting of this very important, in the context of the so
– called “Public health”, matter , but also a lack of awareness and knowledge amongst students (future therapists) in this area. It should be emphasised that each
therapy team member should have such knowledge and
experience to be able to apply them in a comprehensive
treatment of the majority of the so – called civilisation
diseases. Unfortunately, in everyday clinical practice, this
vital part of therapy, defined as a nutritional therapy within
complementary and alternative medicine, is undervalued
or even belittled by physiotherapy specialists as well as
physicians and other members of the therapy team.
Conclusions
The diet of the Physiotherapy students in terms of energy
and nutritive value deviate from the applicable standards
to a large extent. The conducted study can be used to
monitor further students’ nutritional behaviours. There is
a need to shape proper eating habits within the curriculum
of the University.
4.
5.
6.
7.
8.
9.
10.
11.
References
1.
2.
3.
Tomaszewski W. Podstawowe zasady żywienia i doustnego wspomagania suplementacyjnego w chorobach różnego pochodzenia, po urazach, zabiegach
operacyjnych i w okresie rekonwalescencji [Basic
principles for nutrition and oral supplementation in
diseases of varying etiology, trauma, surgical operations, and reconvalescence]. Ortop Traumatol Rehabil 2000; 2(2): 105–7.
Pertkiewicz M, Korta T, et al. Standardy żywienia
pozajelitowego i żywienia dojelitowego [Standards
of parenteral nutrition and enteral nutrition]. Wyd
Lek PZWL, Warszawa 2005 (in Polish).
Jeszka J, Sadowska K. Zapotrzebowanie energetyczne organizmu człowieka w zależności od aktywności fizycznej [Energy demand of the human body
140
CAMS 2/2013
12.
13.
14.
depending on physical activity]. W: Gawęcki J, Jeszka
J (red), Energia w żywności i żywieniu [The energy
in food and nutrition]. Wydawnictwo Uniwersytetu
Przyrodniczego w Poznaniu, Poznań 2010; 73–82
(in Polish).
Kowalska A. Zwyczaje żywieniowe studentów Uniwersytetu Ekonomicznego we Wrocławiu [Dietary
habits of students at the University of Economics in
Wroclaw]. Roczn PZH 2010; 3: 277–82 (in Polish).
Lattimore P, Caswell N. Differentia effects of active
and passive stress on food intake In restrained and
unrestrained eaters. Appetite 2004; 42(2): 167–73.
Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on
dietary requirements for brain. Part 1: Micronutrients.
J Nutr Health Aging 2006; 10(5): 377–85.
Jarosz M, Bułhak-Jachymczyk B. Normy żywienia
człowieka [Human nutrition standards]. Wydawnictwo Lekarskie PZWL, Warszawa 2008 (in Polish).
Szpondar L, Wolnicka K, Rychlik E. Album fotografii
produktów i potraw. [Album products and dishes].
Instytut Żywności i Żywienia. Warszawa 2000 (in
Polish).
Czeczelewski J, Raczyńska B. Zawartość wapnia
i fosforu w całodziennych racjach pokarmowych
dzieci i młodzieży z powiatu bialskiego [The content
of calcium and phosphorus in the all-day starvation
rations of food poisoning of children and young
people from the Bielsko-Biala district]. Roczn. PZH
2005; 56(3): 237–43 (in Polish).
Dybowska E, Świderski F, Waszkiewicz-Robak B.
Zawartość witamin z grupy B w dietach młodzieży
zamieszkałej w Warszawie [The content of B vitamins
in the diets of adolescents in Warsaw]. Probl Hig Epidemiol 2011; 92(3): 660–2 (in Polish).
Seidler T, Szczuko M. Ocena sposobu żywienia
studentów Akademii Rolniczej w Szczecinie w 2006
roku [Evaluation of the diet of students agricultural
University of Szczecin in 2006]. Cz. I. Spożycie wybranych składników odżywczych [Intake of selected nutrients]. Roczn PZH 2009; 60(1): 59–64 (in Polish).
Walentukiewicz A. Ocena wartości odżywczej diet
studentek AWFiS w Gdańsku [Assessment of the
nutritional value of the diet female students in Gdansk
AWFiS]. Cz. II. Witaminy i składniki mineralne. Roczn
Nauk AWFiS w Gdańsku 2010; 20: 108–14 (in Polish).
Bronkowska M, Karcz I. Ocena zawartości wybranych
mikro- i makroelementów w całodziennych racjach
pokarmowych kobiet o niskiej aktywności fizycznej
[Evaluation of the contents of the selected microand macro-elements in food starvation rations low
women's all-day physical activity]. Roczn PZH 2007;
58(4): 609–15 (in Polish).
Gawęcki J, Czarnocińska J, Buszkiewicz K, Reguła J.
Walidacja metody 24-godzinnego wywiadu żywieniowego w wybranych grupach młodzieży [Validation
15.
16.
17.
18.
19.
20.
21.
22.
23.
method of a 24-hour interview in selected food
groups of young people]. Now Lek 2002; 71(1): 53–6
(in Polish).
Pac A, Florek M. Wiarygodność wywiadu żywieniowego z dziećmi w wieku szkolnym [Validity of dietary recall with schoolchildren]. Prob Hig Epidemiol
2008; 89(3): 383–8 (in Polish).
Thompson FE, Bers T. Dietary Assessment Resource
Manual. J Nutr 1994; 124: 2245–317.
Ziemlański Ś, Wartanowicz M. Rola folianów w żywieniu kobiet i dzieci [The role of folates in women
and children nutrition]. Pediatr Współcz 2001b; 3(2):
Ziemlański Ś. Normy żywienia człowieka. Fizjologiczne podstawy [Human nutrition standards. Physiological basis]. Wydawnictwo Lekarskie PZWL,
Warszawa 2001a (in Polish).
Czerwińska D, Czerniawska A. Ocena spożycia sodu,
z uwzględnieniem soli kuchennej jako jego źródła,
w wybranej populacji warszawskiej [Assessment of
the dietary intake of sodium, including common salt
as its source, in the population of Warsaw]. Roczn
PZH 2007; 58(1): 205–10 (in Polish).
Eksterowicz J, Napierała M. Ocena sposobu żywienia
studentów z kierunku wychowania fizycznego podczas letniego obozu sportowego [Evaluation of the
diet of physical education students during the summer sports camp]. Roczn. PZH 2008; 59(1): 75–82
(in Polish).
Mojska H, Świderska K, Stoś K, Jarosz M. Produkty
fast food jako źródło soli w diecie dzieci i młodzieży
[Fast food products as a source of salt in the diet of
children and adolescents]. Probl Hig Epidemiol 2010;
91(4): 556–9 (in Polish).
Osendarp SJM, Murray-Kolb LE, Black MM. Case
study on iron in mental development – in memory
of John Beard (1947–2009). Nutrition Reviews 2010;
68(Suppl.1): 48–52.
Szajkowski Z. Badania nad zawartością i wzajemnymi relacjami wybranych składników mineralnych
24.
25.
26.
27.
28.
w całodziennych racjach pokarmowych wytypowanych populacji z regionu Wielkopolski [Research on
content and reciprocal relationships of selected minerals in the food of the region's population selected
all-day starvation rations]. Część IV. Wzajemne relacje między Fe i Cu. Now Lek 2000; 69(1): 24–37 (in
Polish).
Frąckiewicz J, Hamułka J, Wawrzyniak A, Górnicka M.
Sposób żywienia młodzieży akademickiej a ocena
zagrożenia chorobami układu krążenia [Academic
youth nutrition and cardiovascular disease risk assessment]. Roczn PZH 2009; 60(3): 269–74 (in Polish).
Bieżanowska-Kopeć R, Leszczyńska T, Pisulewski PM.
Oszacowanie zawartości folianów i innych witamin
z grupy B w dietach młodych kobiet (20-25 lat)
z województwa Małopolskiego [Rating the content
of folates. and other B vitamins in the diets of young
women (20-25 years) of Malopolska province].
Żywność. Nauka. Technologia Jakość 2007; 6(55):
Michaud CL, Kahn JP, Musse N, Burlet C, Nicolas JP,
Mejean L. Relationships between a critical life event
and eating behaviour in high-school students. Stress
Medicine 1990; 6: 57–64.
Morley JE, Willenbring ML, Lovinc AS. Stress induced
eating and food preference in humans: A pilot study.
Journal of Eating Disorders 1986; 5(5): 855–64.
Jenkins SK. Eating behaviors among school–age
children associated with perceptions of stress. Pediatric Nursing 2005; 28: 175–91.
Dorota Jakubiec
Department of Human Biology
University School of Physical Education in Wroclaw
al. I.J. Paderewskiego 35, 51-612 Wrocław, Poland
tel. +48 600906040
CAMS 2/2013
141
142
CAMS 2/2013
120 Truszczynska1:Layout 1 2014-03-20 12:23 Strona 1
ORIGINAL ARTICLE
Influence of aqua aerobics on disability
among persons with degenerative changes
in the lumbar spine
Ewelina Żuk, Aleksandra Truszczyńska
FACULTY OF REHABILITATION, JÓZEF PIŁSUDSKI UNIVERSITY OF PHYSICAL EDUCATION IN WARSAW, POLAND
SUMMARY
Background. Back pain is the most common cause of musculoskeletal pain and limitation of functioning among adults. In the elderly population, the incidence of back
pain affects almost 50% of the population, and in the group with sciatica and neurological deficits it causes a decrease in the ability to fulfil activities of daily living. One
of the forms of treatment and improving the level of fitness in people with osteoarthritis is aqua aerobics. However, the effectiveness of this form of exercise has not
been confirmed in the literature, and the reports provide conflicting results. The aim of this study was to assess the influence of aqua aerobics in patients with degenerative
changes of the lumbar spine.
Materials and methods. The effectiveness of aqua aerobics in diminishing the disability and reducing the use of analgesics or the use of physical therapy was analyzed.
The study involved 50 people (40 women and 10 men) aged 59-86 years, mean 69.16, sd. 7.55. All subjects had degenerative changes of the lumbar spine. The subjects
attended aqua aerobics for three months, twice a week, and each class lasted 50 min. All patients underwent 2 examinations - before and after a 3-month training period.
The assessment methods included an anonymous survey and the Oswestry Disability Index (ODI).
Results. No statistically significant changes were found in the activities of daily living under the influence of aqua aerobics. There was no statistically significant difference
between the first and the second examination in the degree of disability measured with ODI. In addition to this, no decrease in the use of analgesic treatment including
pharmacotherapies, physical therapy and massage was found.
Conclusions. 1. Aqua aerobics showed no positive effects on the reduction of disability in people with osteoarthritis of the lumbar spine. 2. There were no statistically
significant changes as for the reduction of the use of analgesics or the use of physical therapy.
KEY WORDS: aqua aerobics, lumbar spine degenerative changes, Oswerstry Disability Index
STRESZCZENIE
Wpływ aqua aerobiku na niepełnosprawność osób ze zmianami zwyrodnieniowymi kręgosłupa lędźwiowego
Wstęp. Zespoły bólowe kręgosłupa są najczęstszą przyczyną dolegliwości bólowych narządu ruchu i ograniczenia funkcjonowania wśród osób dorosłych. W populacji
osób starszych występowanie bólów kręgosłupa dotyczy prawie 50% populacji, a grupie osób z promieniowaniem bólu do kończyny i objawami neurologicznymi wypełnianie aktywności dnia codziennego jest znacznie ograniczone. Jedną ze stosowanych form leczenia jak i poprawy sprawności u osób ze zmianami zwyrodnieniowymi
jest aqua aerobik. Jednak skuteczność tej formy ćwiczeń nie została potwierdzona w piśmiennictwie, a doniesienia są sprzeczne. Celem pracy była ocena wpływu
aktywności w środowisku wodnym na zmniejszenie niepełnosprawności u osób ze zmianami zwyrodnieniowymi odcinka lędźwiowego kręgosłupa.
Materiał i metody. Badaniami objęto 50 osób w tym 40 kobiet i 10 mężczyzn, w wieku 59-86 lat średnio 69,16 (sd. 7,55). Wszystkie osoby badane miały zmiany zwyrodnieniowe kręgosłupa lędźwiowego, u 14 osób (28,0%), zmianom zwyrodnieniowych towarzyszyła choroba dyskowa, a u 6 osób – kręgozmyk (12,0%). Badania zostały
przeprowadzone za pomocą ankiety anonimowej oraz skali niepełnosprawności Oswestry. Badana grupa wzięła udział w zajęciach aqua aerobiku, który odbywał się na
pływalni „WISŁA” przy ul. Inflanckiej w Warszawie. Zajęcia odbywały się 2 razy w tygodniu i trwały 50 min. Pierwsza seria badań przeprowadzona była na początku, czyli
przed rozpoczęciem treningu i na koniec – po 3 miesiącach. Wszyscy badani uczęszczali na zajęcia regularnie.
Wyniki. Nie zanotowano istotnych statystycznie zmian w zakresie czynności dnia codziennego w zakresie tych czynności pod wpływem aqua-aerobiku. Nie zaobserwowano istotnej statystycznie różnicy pomiędzy pierwszym i drugim badaniem w zakresie stopnia niepełnosprawności w skali Oswestry. Nie stwierdzono również
ograniczenia korzystania z leczenia przeciwbólowego obejmującego farmakoterapie i fizykoterapię oraz masaż.
Wnioski. 1. Aqua aerobik nie wykazał pozytywnego wpływu na zmniejszenie niepełnosprawności osób ze zmianami zwyrodnieniowymi odcinka lędźwiowego
kręgosłupa. 2. Nie zaobserwowano zmiany istotnej statystycznie dotyczącej zmniejszenia przyjmowania leków przeciwbólowych lub korzystania z fizykoterapii.
SŁOWA KLUCZOWE: aqua aerobik, zmiany zwyrodnieniowe odcinka lędźwiowego kręgosłupa, skala niepełnosprawności Oswestry
Background
Back pain is the most common cause of musculoskeletal
pain and limitation of functioning among adults. In the
elderly population, the incidence of back pain affects
almost 50% of the population, and in the group with
sciatica and neurological deficits, it causes a decrease in
the ability to fulfil activities of daily living [1]. The pathomechanism of the development of degenerative changes
is associated with the dehydration of the intervertebral
disc and its shrinking [2,3]. This leads to sinking of the
motion segment, relaxation of ligaments, bulging of the
fibrous ring, and folding and thickening of the yellow
ligaments [4,5]. The increased pressure exerted by the
articular apophyses on the zygapophyseal joints leads to
the development of hypertrophic degenerative changes
[6]. Osteoarthritis is a progressive process that cannot be
stopped, but adequate conservative treatment can slow
down its dynamics.
Exercising in aquatic environment reduces pain perception, provides greater freedom of movement, reduces
increased muscle tone, gives satisfaction and pleasure,
and brings a sense of having greater abilities. In addition
to this, it has a relaxing influence through relieving effect,
and resistance of water gives the exercising person the
ability to increase muscle strength by training. It also
improves blood circulation in the heart and lungs.
CAMS 2/2013
143
Żuk E. et al. Influence of aqua aerobic on low back pain
Objectives of the work
The aim of this study was to assess the impact of the
activity performed in the aquatic environment on reducing
disability in people with osteoarthritis of the lumbar spine.
The study involved 50 people, including 40 women and
10 men, aged 59-86 years (mean - 69.16; sd. - 7.55). All
subjects had degenerative changes in the lumbar spine.
In 14 patients (28.0%) degenerative changes were accompanied by a disc disease, and in 6 people by spondylolisthesis (12.0%).
The inclusion criteria for the study: pain in the lumbar
spine confirmed clinically and radiologically (X-ray and
MRI), no other motion organ dysfunctions and neurological
conditions, consent to participate in the study.
Criteria for exclusion from the study: lack of consent
to participate in the study, lack of degenerative changes
in the lumbar spine, degenerative changes in other joints,
other neurological diseases not associated with the
symptoms from the spine.
The testing was conducted using an anonymous
questionnaire and the Oswerstry Disability Index. It consists of 10 questions, which mainly relate to the intensity
of pain and activities of daily living. Each question is
scored from 0, i.e. no disability, to 5, i.e. high level of
disability, which limits the person’s functioning. Next, all
responses are summed. The maximum number of points
that one could get was 50 [7].
The study group participated in aqua aerobics classes,
which took place at the swimming pool “WISŁA” in
Inflancka Street in Warsaw. The classes were held twice
a week and lasted 50 minutes each. They were carried out
by a qualified person, who has the authority to conduct
this type of activity. The water temperature was 24-25o C.
The exercises were performed to the music. These were
general-fitness exercises, which strengthened the muscular corset around the paraspinal area and the pelvic
girdle. The study lasted three months and the testing took
place in two series. The first series of examination was
carried out before the 3-month training period, and the
second after its completion. All subjects attended classes
regularly.
Results
Both in the first and in the second examination, the
majority of the respondents indicated difficulty and pain
when bending over and standing (Table 1). There were
no statistically significant changes noted as regards the
activities of daily living under the influence of aqua
aerobics.
The changes in the degree of disability measured by
the Oswerstry Disability Index are presented in Table 2.
The summary is supplemented with the values of the
Student's t-test for dependent samples.
There was no statistically significant difference
observed between the first and the second examination
as regards the degree of improvement specified in percentage.
In addition to this, no decrease in the administration
of analgesic treatment including pharmacotherapies,
physical therapy and massage was found. The results of
this study are summarized in Table 3. Binomial distribution
was used.
Tab. 1. The frequency distribution – activities of daily living causing difficulty to the subjects
Tab. 2. Results of changes in the degree of disability measured by ODI
144
CAMS 2/2013
Tab. 3. The frequency distribution - coping strategies applied by the respondents concerning disability and pain
Discussion
Spine pain radiating to the lower extremities and reduced
mobility lead to a significant limitation of the level of
fitness and disorders of the capacity to participate in the
society [8,9,10].
The analysis of the literature concerning the improvement of physical fitness tested using the Oswerstry
Disability Index and the intensity of pain, showed positive
changes. Dundar et al., 2009, compared the efficacy of
exercises in water with exercises performed on a stable
surface. The study subjects were 65 patients with chronic
low back pain. In both groups, a statistically significant
difference in the level of pain intensity was observed,
whereas the improvement in physical functioning tested
by the Oswerstry Disability Index was more effective in
the group performing exercises in water [11].
Research conducted by Baena-Beato et al., 2013, was
aimed at comparing the effects of different training
frequencies (2 and 3 times a week). The study was participated by 54 people with chronic lumbar pain. The effectiveness of the therapy was tested using VAS, the Oswerstry
Disability Index and the Short-Form Health Survey 36. Both
groups showed a significant improvement in the perception of pain and disability. However, the group that performed exercises 3 times a week achieved better
results in reducing the degree of pain and disability [12].
Interesting research was conducted by Zameni L and
Haghighi M, 2011. It concerned the effects of exercises in
water on reducing the degree of pain, disability measured
by the Oswerstry Disability Index and improving static
balance evaluated by the Romberg’s test. The study
involved 28 patients suffering from low back pain. The
tests showed improvement in static balance, and the level
of perception of pain was noted to have decreased [13].
Cuesta-Vargas et al., 2011, evaluated the effectiveness
of a multimodal physiotherapy program combined with
running in deep water with individual leg work load. The
study involved 46 patients with nonspecific chronic low
back pain. It showed that the level of pain and disability
caused by it, as well as muscular strength, endurance and
overall health improved in both groups, but the difference was not statistically significant [14].
Kim et al., 2010, examined 30 men after surgery due
to herniated nucleus pulposus at L3-S1 levels. After the
end of the study period, maximum isometric strength of
the lumbar spine was measured in 7 different starting
positions (degrees of trunk flexion). The study showed
that exercises in the conditions of resistance ensured by
aquatic environment had a positive effect on the increase
of the strength of the muscles stabilizing the spine [15].
An interesting study, though on a small group of 15
people, was conducted by Kim SB and O'Sullivan DM,
2013. The aim of this study was to assess the impact of
aqua aerobics on the biomechanical and physiological
parameters of gait in the elderly. They analyzed the
strength and elasticity of the muscles of the lower limbs,
and maintaining balance. Statistically significant reduction
in the body weight and body fat was recorded, as well as
balance improvement. There was observed a significant
increase in the muscle strength and the ability of the
subjects to recover balance [ 16].
Our study has not confirmed these results. The outcome of the study might have been related to a good
state of the patients and a mild disease process. Participation in this form of physical activity 2 times a week was
not sufficiently effective. The obtained results may be due
to the too general form of exercises, or insufficient intensity
and frequency.
Limitations of the study. It is possible that the form of
the therapy (intensity and frequency of exercise) was
unsuited to the tested group or the research tools were
imprecisely selected. In the analyzed group, there were
people with a minimal level of disability due to degenerative changes in the lumbar spine, and so ODI as a research tool might have not been sensitive enough. The
study did not analyze the psycho-emotional sphere or
the quality of life of the patients, and perhaps in this area
such form of exercises would prove to have a more
beneficial effect.
It is important to adjust aqua aerobics exercises to
a particular test group as for the intensity or type of
exercise. Probably, a longer period of observation would
provide more data.
CAMS 2/2013
145
Conclusions
1. Aqua aerobics showed no positive effects on the
reduction of disability in people with osteoarthritis of
the lumbar spine.
2. There were no statistically significant changes as for
the reduction of the use of analgesics or the use of
physical therapy.
3. People participating in aqua aerobics classes should
be selected for various groups depending on the clinical diagnosis and the degree of disability to achieve
improvement in their functional status.
4. The continuation of the present study should include
an analysis of other spheres of life, including the psychological and social sphere.
9.
10.
11.
12.
References
1.
2.
3.
4.
5.
6.
7.
8.
Ghanei I, Rosengren BE, Hasserius R, Nilsson JA, Mellström D, Ohlsson C, Ljunggren O, Karlsson MK. The
prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2013
Dec 27. [Epub ahead of print]
Łukawski St: Stenoza kanału kręgowego, red. Rąpała
K. Zespoły bólowe kręgosłupa – zagadnienia wybrane; PZWL Warszawa 2004
Willen J, Danielson B, Gaulitz A, Niklason T, Schonstrom N, Hansson T. Dynamic effects on the lumbar
spinal canal. Axially loaded CT- Myelography and
MRI in patients with sciatica and/or nuerogenic
claudication. Spine 1997;22:2968-2976.
Hur JW, Hur JK, Kwon TH, Park YK, Chung HS, Kim JH.
Radiological significance of ligamentum flavum
hypertrophy in the occurrence of redundant nerve
roots of central lumbar spinal stenosis. J Korean Neurosurg Soc. 2012;52(3):215-20
Altinkaya N, Yildirim T, Demir S, Alkan O, Sarica FB:
Factors associated with the thickness of the ligamentum flavum: is ligamentum flavum thickening due
to hypertrophy or buckling? Spine (Phila Pa 1976).
2011 15;36(16):E1093-7.
Abbas J, Hamoud K, Peleg S, May H, Masharawi Y,
Cohen H, Peled N, Hershkovitz I. Facet joints arthrosis
in normal and stenotic lumbar spines. Spine (Phila
Pa 1976). 2011;15;36(24):E1541-1546.
Truszczyńska A, Nowak-Misiak M, Rąpała K, Walczak
P: Tuberculosis of the spine masquerading as a spine
lymphoma. A case report and discussion of diagnostic
and therapeutic traps. Neurol Neurochir Pol. 2013;
47(2):189-93
Backstrom KM, Whitman JM, Flynn TW. Lumbar
spinal stenosis-diagnosis and management of the
aging spine. Manual Therapy 2011;16(4):308–317.
146
CAMS 2/2013
13.
14.
15.
16.
Weiner DK, Haggerty CL, Kritchevsky SB, Harris T,
Simonsick EM, Nevitt M, Newman A. Health, Aging,
and Body Composition Research Group. How does
low back pain impact physical function in independent, well-functioning older adults? Evidence from
the health ABC cohort and implications for the
future. Pain Medicine 2003;4:311–319.
Tong HC, Haig AJ, Geisser ME, Yamakawa KS, Miner
JA. Comparing pain severity and functional status of
older adults without spinal symptoms, with lumbar
spinal stenosis, and with axial low back pain. Gerontology 2007;53:111–115.
Dundar U, Solak O, Yigit I: Clinical effectiveness of
aqua exercises to treat chronic low back pain: a randomized trial. Spine 2009, 34(14), 1436-1476.
Baena-Beato PA, Arroyo-Morales M, DelgadoFernández M, Gatto-Cardia MC, Artero EG.: Effects of
different frequencies (2-3 days/week) of aquatic
therapy program in adults with chronic low back
pain. A non – randomized comparison trial. Pain
Medicine 2013, 14(1), 145-158.
Zameni L, Haghighi M: The effect of aquatic exercise
on pain and postural control in women with low
back pain. International Journal of Sport Studies
2011, 1(4), 152-156.
Cuesta-Vargas AI, García-Romero JC, Arroyo-Morales
M, Diego-Acosta AM, Daly DJ. Exercise, manual therapy, and education with or without high-intensity
deep-water running for nonspecific chronic low
back pain: a pragmatic randomized controlled trial.
Am J Phys Med Rehabil. 2011;90(7):526-34;
Kim YS, Park J, Shim JK: Effect of aquatic backward
locomotion exercise and progressive resistance
exercise on lumbar extension strength in patient
who have undergone lumbar discectomy. Arch Phys
Med Rehabil. 2010, 91(2), 208-214.
Kim SB, O'sullivan DM. Effects of Aqua Aerobic Therapy Exercise for Older Adults on Muscular Strength,
Agility and Balance to Prevent Falling during Gait.
J Phys Ther Sci. 2013;25(8):923-7. doi: 10.1589/jpts.
25.923. Epub 2013 Sep 20.
Aleksandra Truszczyńska
Faculty of Rehabilitation, Józef Piłsudski University
of Physical Education in Warsaw,
ul. Marymoncka 34, 00-968 Warszawa, Poland
tel. +48 601 566 789
121 Konieczna1:Layout 1 2014-03-20 12:25 Strona 1
CASE STUDY
Influence of sensory integration (SI)
on psychomotor development of a boy
with early infantile autism
Anna Konieczna-Gorysz1, Ewa Demczuk-Włodarczyk1, Małgorzata Fortuna2,
Katarzyna Hełmecka1
¹ FACULTY OF PHYSIOTHERAPY, UNIVERSITY SCHOOL OF PHYSICAL EDUCATION IN WROCŁAW, POLAND
² FACULTY OF NATURAL SCIENCES AND TECHNOLOGY, KARKONOSZE COLLEGE IN JELENIA GÓRA, POLAND
SUMMARY
Background. The theory of sensory integration (SI) is based on neurophysiological knowledge and links processes occurring in the brain with human behaviour. Determining the influence of SI on psychomotor development of an autistic child seems to be an interesting issue. The aim of the study was to determine the influence of SI
on psychomotor development of a boy with early infantile autism.
Material and methods. The study involved a 6-year-old boy with autism. In medical examinations conducted before the boy was 2 years old, infantile encephalopathy
and early infantile autism were diagnosed. Since the time of the diagnosis the boy has undergone a psychological and speech therapy, hippotherapy, and canine-assisted
therapy, as well as attended classes in a rehabilitation and educational centre (REC). In the REC the patient is managed with the NDT-Bobath and SI methods. The boy
also participates in occupational therapy workshops. A six-month therapy with the SI method was assessed. Clinical observation (CO) was used for evaluation of the
development of SI processes. The therapeutic procedure consisted in carrying out, once a week, individual 45-minute SI classes. During the classes, activities oriented
at intensification and development of disordered psychomotor spheres were conducted. Exercises providing tactile, vestibular, and proprioceptive stimuli were used.
Observation of the influence of the SI therapy was conducted from November 2009 to May 2010.
Results. The SI classes positively affected the examined psychomotor features. This influence particularly concerns improvement of sensory integration processes, static
and dynamic balance and core stabilization. Improvement in the boy’s emotional functioning and his increased self-esteem were noticed.
Conclusions. A six-month SI therapy positively influenced sensory integration processes in the examined boy with early infantile autism. From the level of sensory
integration disorders he moved to the level of the risk of sensory integration disorders.
KEY WORDS: autism, psychomotor performance, sensory integration (SI)
STRESZCZENIE
Wpływ integracji sensorycznej (SI) na rozwój psychomotoryczny chłopca z autyzmem wczesnodziecięcym
Wstęp. Teoria integracji sensorycznej (SI) oparta jest na wiedzy neurofizjologicznej i wiąże procesy zachodzące w mózgu z zachowaniem człowieka. Interesujące wydaje
się określenie wpływu oddziaływania SI na rozwój psychomotoryczny dziecka autystycznego. Celem niniejszej pracy było określenie wpływu SI na rozwój psychomotoryczny
chłopca z autyzmem wczesnodziecięcym.
Materiał i metody. Badanie zostało przeprowadzone u 6-letniego chłopca z autyzmem. W badaniach medycznych przed ukończeniem 2 roku życia, u chłopca zdiagnozowano encefalopatię dziecięcą, autyzm wczesnodziecięcy. Od czasu postawienia diagnozy prowadzono terapię psychologiczno-logopedyczną, zajęcia w ośrodku
rehabilitacyjno-edukacyjnym (ORE), hipoterapię, dogoterapię. W ORE pacjent prowadzony jest metodą NDT-Bobath i metodą SI. Chłopiec uczestniczy również w warsztatach
terapii zajęciowej. Ocenie poddano sześciomiesięczną terapię metodą SI. Do oceny rozwoju procesów SI wykorzystano obserwację kliniczną (CO). Postępowanie
terapeutyczne polegało na prowadzeniu indywidualnych, 45-minutowych zajęć SI 1 raz w tygodniu. W trakcie zajęć prowadzono postępowanie polegające na wzmacnianiu
i rozwijaniu zaburzonych sfer psychomotorycznych. Zastosowano ćwiczenia dostarczające bodźców dotykowych, przedsionkowych i proprioceptywnych. Obserwacja
wpływu terapii SI była prowadzona od listopada 2009 do maja 2010 roku.
Wyniki. Zajęcia SI pozytywnie wpłynęły na badane cechy psychomotoryczne. Dotyczy to zwłaszcza poprawy procesów integracji sensorycznej, równowagi statycznej
i dynamicznej oraz stabilizacji tułowia. Zaobserwowano poprawę w funkcjonowaniu emocjonalnym chłopca i jego zwiększoną samoocenę.
Wnioski. Sześciomiesięczna terapia metodą SI wpłynęła na poprawę procesów integracji sensorycznej u badanego chłopca z autyzmem wczesnodziecięcym. Z poziomu
zaburzeń integracji sensorycznej przeszedł na poziom ryzyka zaburzeń integracji sensorycznej.
SŁOWA KLUCZOWE: autyzm, integracja sensoryczna (SI), sprawność psychomotoryczna
Background
Human psychomotor development is dependent on
many factors, hence more and more attention is paid to
methods for its comprehensive stimulation. Sensory
integration (SI) refers to the relation between processes
occurring in the brain and human behaviour, develops in
a hierarchical manner, and determines psychomotor
development of the child. SI is based on three principles:
brain plasticity, or the ability to change and modify under
the influence of proprioceptive and tactile stimulation,
sequential development of sensory integration processes
that occur on the basis of previous experience and allow
the emergence of more and more complex behaviours,
and the proper functioning of the cortical and subcortical
regions of the brain [1,2].
Development of sensory integration occurs during
the first seven years of life [3]. It seems appropriate to
introduce the SI method in children with autism in early
childhood in order to stimulate their psychomotor development. Scientific reports describing the importance of
this method in the progress of the development of children with autism are not numerous. Presumably the
impact of the SI method is individual. The characteristic
symptoms of dysfunction of sensory integration processes in children with autism are the following: improper
CAMS 2/2013
147
Konieczna-Gorysz A. et al. Influence of sensory integration on psychomotoric development of a boy with autism
reception of external stimuli, gravitational insecurity and
tactile hypersensitivity, disorder of awareness and correct
identification of one’s own body, and abnormal motivational processes [4,5].
The SI method aims to deliver a controlled amount of
sensory stimuli, and is conducted through play and fun
activities appropriate to the level of the child’s development [1]. The aim of the study was to determine the effect
of SI on psychomotor development of a boy with early
infantile autism.
Material
The study involved a 6-year-old boy with early infantile
autism. In medical examinations conducted before the
boy was 2 years old, infantile encephalopathy of unknown
etiology was diagnosed. In the earlier stage of the boy’s
life, the regularity of his development compared to his
peers was considered to be normal. Since the time of the
diagnosis the boy has undergone a psychological and
speech therapy, hippotherapy, and canine-assisted
therapy, as well as attended classes in a rehabilitation and
educational centre (REC). In the REC the patient is managed
with the NDT-Bobath and SI methods. He also participates in occupational therapy workshops. The boy’s compulsory education is carried out in an integrated school.
position of his upper limbs. The ATNR was also assessed
in the position on all fours. Turning the child’s head to the
right and to the left, the therapist observed the reaction of
his upper limbs. Next, the symmetrical tonic neck reflex
(STNR) was examined in the supine position, with the legs
bent at the knees, the arms folded on the chest, and the
head lifted up. The duration and the quality of maintaining such a posture were assessed. This was followed by
evaluation of co-contraction, which is done in a sitting
position, where the child, grasping the therapist’s thumb,
tries to overcome the resistance and maintain his upper
limbs and trunk in a stable position, while the therapist
pushes and pulls him repeatedly [7]. Balance reactions
were examined with the boy taking a test on a balance
board, called a cradle. To assess the ability to maintain
balance, the Romberg test was also used, in which the
subject stands with the feet together and the eyes closed
[8]. Oculomotor functions were tested by observing the
movement of the child’s eyeballs and the stabilization of
his head, while tracking an object that was being moved
by the therapist in different directions. The finger-thumb,
eye-hand preference, as well as postrotary nystagmus
tests were also conducted [7]. Furthermore, in the CO,
special attention was paid to muscle tension while the
child was playing, when he was at rest, and when he
assumed a sitting position.
Results
Methods
A six-month therapy using the SI method was subject to
evaluation. The duration of the classes was 45 minutes,
and they were carried out once a week. The classes were
conducted by a certified therapist with a specialization
in the second degree SI method course. The activities
were done on an individual basis. For evaluation of the
development of SI processes, clinical observation (CO)
was used [6], based on tests and, additionally, on observation of the child’s spontaneous play. In the CO, a set of
17 standardized tests were carried out, with a scale ranging
from 0 (incorrect result) to 6 (correct result). The sum total
of the points scored by the child determined the level of
development of sensory integration which he could
reach: 66–60 points – no disorders, 59–45 points – risk of
disorders, 45–25 points – disorders, 25–6 points – serious
disorders.
In the CO, among other things, postural reaction was
evaluated, with the use of a test in which the child
assumes the prone position. The way and time of holding
up outstretched upper and lower limbs and the head
were evaluated. Another feature examined during the CO
was the asymmetrical tonic neck reflex (ATNR) [6]. It was
assessed using Schilder’s Arm Extension Test (AET) [6], in
which the child stands with closed eyes and upper limbs
outstretched in front, and the therapist, standing behind
him, moves the child’s head from side to side and
watches how he maintains balance and changes the
148
CAMS 2/2013
In the CO, 17 tests were used [Tab. 1]. Analysis of the
results listed in Table 1 shows that there was improvement
in 10 tests, and 7 remained unchanged, with 3 tests
scoring the maximum number of points already at the
beginning, and 4 tests where no changes were recorded
after six months of the therapy. Based on the results of
test 4, improvement in the planning and execution of
purposeful movements can be observed. The result of
test 5 shows improvement in praxis, i.e. applying the
correct sequence of movements, which is linked to the
feeling of touch and proprioception in subcortical structures. The result of test 6 shows improvement in the
operation in terms of praxis, the proprioceptive and
vestibular systems, and the postural mechanism. The
improvement noted in test 7 indicates changes in the
vestibular-proprioceptive system. The effect concerns the
action of the back extensor muscles and the improved
postural mechanism. Higher scores obtained in tests 8,
11, and 12 indicate better functioning of the proprioceptive system and postural mechanisms. With the use of CO,
static and dynamic body balance and core stabilization
were assessed [Tab. 2]. Static balance improved by one
point. The time of standing on one leg with open and
closed eyes was measured. Before the therapy, the time
in the static balance test with open eyes was 6 seconds,
and with closed eyes 2 seconds. The total time for static
balance, prior to the therapy, was 8 seconds. After the
6-month therapy, the time in the static balance test with
open eyes was 10 seconds, and with closed eyes 6 seconds.
This amounted to 16 seconds in total, which indicates
balance improvement by one point. Dynamic body
balance improved by one point. In the CO, maintaining
balance with the eyes closed and open while walking
foot by foot, was evaluated. Scoring one point at the
beginning of the therapy meant difficulty in completing
the task with the eyes closed and open. After the therapy,
the score was two points, which meant maintaining balance with open eyes while walking foot by foot. In this
task, the subject failed to maintain balance with his eyes
closed. Better results in tests 13 and 14 reflect improvement
in the functioning of the proprioceptive and vestibular
systems as well as the postural mechanism. The improved
result in test 16 indicates more efficient functioning of
postural mechanisms. Analysis of the above CO results
shows that prior to the therapy the boy received 40
points, the maximum score being 66 (Fig.1). This result
classifies the subject as suffering from sensory integration
disorders. After six months of therapy, the outcome
changed by 10 points and in the final assessment amounted to 50 points. This result means transition to the risk
level of sensory integration disorders.
Tab. 1. Clinical observation – results before and after the therapy
Tab. 2. Clinical observation – static balance (results before and after the therapy)
Fig. 1. Results of clinical observation
CAMS 2/2013
149
Discussion
Sensory processes in children with autism were for the
first time described by Schopler [9]. He pointed to abnormal reactions to visual, vestibular, and auditory stimuli.
He believed that the treatment of sensory disorders
should be regarded as a basic therapy in people with
autism. Disorders of registering sensory stimuli have
been described as an impaired ability to organize and
respond to these stimuli. These symptoms were observed
in the examined boy. Disturbed processing in the vestibular
system was manifested by decreased muscle tension, abnormal postural reactions, and poor balance reactions.
Research on SI in children with autism conducted by
other authors has shown that using the SI and occupational therapy methods in this group of patients is effective.
Results of therapy using the two methods were very
similar, and the children showed similar changes in
behaviour [10]. Research done by Ayres [11] has identified
two types of sensory integration dysfunction in children
with autism: impaired registration of sensory stimuli and
disturbed modulation of sensory inputs. Impaired registration includes mainly visual and auditory stimuli, and
can also relate to olfactory, gustatory, vestibular, and
tactile stimuli. Modulation disorders are manifested by
tactile defensiveness, gravitational insecurity, and intolerance to movement. Disorders observed in the boy with
early infantile autism who was the subject of this study
can be classified as impaired registration of sensory stimuli.
Abnormal response to sensory stimuli in children with
autism is explained as weaker cooperation between the
amygdala, basal ganglia and hippocampus in the processing of sensory stimuli. Disorders of postural and
bilateral integration were among the many syndromes
identified by Ayres [7]. These disorders manifest themselves through poorly integrated postural mechanisms
and the occurrence of persistent primitive postural
reflexes, impaired balance reactions, and poor visual
control. This syndrome is often accompanied by muscular
hypotonia. All these symptoms are associated with the
vestibular-proprioceptive system, which regulates the
posture, muscle tension, and balance, through the integration of afferent and efferent information. The diagnosis
of disorders in the boy described in this work confirms
the above studies. Influence of a tonic labyrinthine reflex
response, reduced muscle tone, and weaker central
stabilization were identified in the boy. Research by Ayres
[7,11] demonstrates that the lower the level of integration, the stronger the symptoms of dysfunction. Disorders of the first level of integration, related to linking
proprioceptive and vestibular information with the sense
of balance, lead to impaired perception of gravity and
postural reflex reaction, and to irregular, uncoordinated
movement. Disorders of the second level of integration
can be manifested by disturbances of coordination of
both sides of the body, motion and activity planning,
150
CAMS 2/2013
mental alertness, and emotional stability. The result is an
incorrect perception of one’s own body and abnormal
muscle tone. The third level of integration is characterized
by the ability to speak, eye-hand coordination, visual
perception, and purposeful activity. Reaching the fourth
level of integration allows complex processing at all levels
of the nervous system. Ayres emphasizes the role of the
SI method as an art of controlled monitoring of the stimuli
affecting normalization of the senses. Disorders of the
1st, 2nd, and 3rd level were identified in the examined boy.
After six months of therapy using the SI method, progress
in the psychomotor development of the child was
observed.
Conclusions
A six-month SI therapy positively influenced sensory
integration processes in a boy with early infantile autism.
From the level of sensory integration disorders he moved
to the level of the risk of sensory integration disorders.
The therapy using the SI method resulted in improvement of the boy’s static and dynamic balance and core
stabilization, better emotional functioning, as well as
increased self-esteem.
References
1.
2.
3.
4.
5.
6.
7.
Przyrowski Z. Zaburzenia modulacji sensorycznej
[Sensory modulation disorders]. Integracja Sensoryczna 2007;7(2) :9–15 (in Polish).
Godwin Emmons P, McKendry Anderson L. Dzieci
z zaburzeniem integracji sensorycznej [Children with
sensory integration dysfunction]. Warszawa: wyd.
Liber; 2007 (in Polish).
Wilczyński J. Integracja sensoryczna w reedukacji
posturalnej [Sensory integration in postural re-education]. Promocja Zdrowia: wyd. Anthropos; 2000 (in
Polish).
Kułakowska Z. Wczesne uszkodzenie dojrzewającego
mózgu – od neurofizjologii do rehabilitacji [Early
damage of a maturing brain – from neurophysiology
to rehabilitation]. Lublin: wyd. Folium; 2003 (in
Polish).
Sadowska L. Podstawy anatomiczne i patofizjologiczne [Anatomical and pathophysiological bases].
In: Sadowska L. red. Neurokinezjologiczna diagnostyka i terapia dzieci z zaburzeniami rozwoju psychoruchowego. Wrocław: wyd. AWF; 2004, s. 40–61 (in
Polish).
Przyrowski Z. Kliniczna obserwacja. Podręcznik [Clinical observation. A manual]. Warszawa: Empis; 2013
(in Polish).
Ayres AJ. Southern California Postrotary Nystagmus
Test. Los Angeles: Western Psychological Services;
1981.
8.
Montgomery P. Assessment of vestibular function in
children. In: Ottenbacher KJ, Short MA, (Eds). Vestibular
Processing Dysfunction in Children. The Haworth Press.
New York; 1985.
9. Blanche EI, Botticelli TM, Hallway MK. Neurodevelopmental Treatment and Sensory Integration Principles. San Antonio: Therapy Skill Builders; 1995.
10. Watling RL, Dietz J. Immediate effect of Ayers’s
sensory integration-based occupational therapy
intervention on children with autism spectrum disorders. American Journal of Occupational Therapy
2007; 61(5): 574–583.
11. Ayres AJ. Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services;
1974.
Anna Konieczna-Gorysz
Faculty of Physiotherapy, University School of Physical Education
Al. I. J. Paderewskiego 35
51-612 Wroclaw, Poland
tel. +48 (71) 347 30 87
CAMS 2/2013
151
152
CAMS 2/2013
122 Mucha:Layout 1 2014-03-20 12:27 Strona 1
CASE STUDY
Hamilton Depression Scale (HDS) as depression
and hypomania's physical treatment factor
Monika Mucha-Janota, Romualda Mucha, Aleksander Sieroń
CLINICAL WARD OF INTERNAL DISEASES, ANGIOLOGY AND PHYSICAL MEDICINE OF THE CHAIR OF INTERNAL DISEASES AND THE CENTRE OF DIAGNOSTICS
AND LASER THERAPY IN BYTOM, POLAND
SUMMARY
Background. Women get sick about three times more often than men. It is assumed that, women are more prone to depression disorders, but none of the theories
explains what the reasons are. Depression and hypomania are periodic disorders connected with season of the year, affected by mood depression or mood rise, named
seasonal pathology. The aim of the work was analysis and to present methods and resources of use of physical treatment in depression and seasonal hypomania treatment.
Material and methods. The study involved three patients, aged 35-55years old.. Two of them were diagnosed with seasonal depression, and one of them with diagnosed
seasonal depression and hypomania., all with a refferal to a psychiatrist. Patients were subjected to measurement of pulse pressure, BP, flexibility examination and
Hamilton Depression Scale (HDS) ,before and after physical treatment. There was used 17 points HD Scale, where 0-4 points is the most popular scale of depression
disorders, 30-52 points in this measurement prove really deep depression.
Results. In the initial studies, patients received high notes 20-29 HDS points. That showed high depression. After use of physical treatment there was observed pulse
and BP normalization. Two of the patients gained 10-12 points in HDS scale, which is characterized with low depression, one with diagnosed depression and hypomania.
One of the patients gained under 8 points, pointing depression release.
Conclusions. The usage of physical treatment in the fight against depression and seasonal hypomania allowed to symptom release at two patients. For one them, that
allowed to alleviate symptopms to mild depression.
KEY WORDS: depression, hypomania, physical treatment
STRESZCZENIE
Skala Depresji Hamiltona (HDS) jako wskaźnik leczenia fizykalnego depresji i hipomanii
Wstęp. Kobiety chorują około trzy razy częściej niż mężczyźni. Zakłada się, że kobiety są bardziej podatne na zaburzenia depresyjne, ale żadna teoria nie wyjaśnia, jakie
są tego powody. Depresja i hipomania to okresowe związane z porą roku zaburzenia dotyczące obniżenia lub w zwyżki nastroju, zwane patologią sezonowa. Celem
pracy była analiza i pokazanie środków i metod z szeroko pojętego leczenia fizykalnego w leczeniu depresji i hipomanii sezonowej.
Materiał i metody. Badaniu poddano trzy pacjentki w wieku 35-55 lat dwie z rozpoznaną depresją sezonową i jedną z depresją i hipomanią sezonową , wszystkie ze
skierowaniem do lekarza psychiatry. Pacjentki poddano pomiarowi tętna i ciśnienia RR, badaniu gibkości i Depression Scale (HDS) Skala Depresji Hamiltona przed i po
leczeniu zabiegami fizykalnymi. Posłużono się 17 punktową HDS w ocenie od 0 – 4 punktów jako najczęściej stosowaną skalą zaburzeń depresyjnych , gdzie uzyskany
wynik 30-52 punkty świadczy o bardzo ciężkiej depresji.
Wyniki. Pacjentki w badaniach początkowych uzyskały wysokie notowania 20 -29 punktów w HDS, wskazujące na ciężką depresję. Po leczeniu zabiegami fizykalnymi
u pacjentek zaobserwowano normalizację tętna i ciśnienia RR. Dwie pacjentki w skali HDS uzyskały 10 -12 punktów charakterystycznych dla łagodnej depresji w tym
pacjentka z początkowo rozpoznaną depresją i hipomanią, a jedna pacjentka uzyskała poniżej 8 punktów świadczących o ustąpieniu depresji.
Wnioski. Zastosowanie leczenia fizykalnego w walce z depresją i hipomanią sezonową pozwoliło na ustąpienie objawów u dwóch pacjentek a jednej na złagodzenie
dolegliwości do łagodnej depresji.
SŁOWA KLUCZOWE: depresja, hipomania, leczenie fizykalne
Background
Depression is a state of depressed mood, decreased
activity, and slow thinking. Sleep and appetite disorders
are typical.At some patients can appear cancellation and
suicidal thoughts. Hypomania is a mild elevation of mood
or irritability lasting several days. We can observe clear
impediment of functioning, but not in significant or
relevant level. Cyclical repetition of mood disorders is
attributed to autumn depression time, during spring
time-hypomania. Both of the diagnosis should be differentiate from mania, which is characterized by a significant
increase in mood or high irritation, completely disrupting
psychosocial functioning [1]. More often we meet with
the seasonal mood change, which developes from
disturbed mood to depression or hypomania on psychiatric undertow. We face with the problem of dealing with
everyday life. No proper psychosocial funtioning is
reflected in the reduced quality of life. The World Health
Organization (WHO) defines quality of life as ‘’a comprehensive evaluation by the unit, her physical health state,
emotional state, independence in life and level of independence from the enviroment, as well as the relationship
with the enviroment and attitude to enviroment.”As it
follows from the definition of relationship between man
and the enviroment and the attitude to enviroment,
builds relationship between man, attitude and conciousness of his quality of life. This relathionship is shattered
even during seasonal depression [2]. Hamilton Depression
Scale (HDS) allows to asses depression symptoms, such
as: mood depression, anxiety, daily routine disorders,
sleeping disorders, psychomotor slack, libido decrease,
lower self-esteem, guiltiness, hypochondria, weight loss,
psychical and somatic anxiety and co-existing somatic
ailments [3]. HDS served as, an indicator of progress of
depression and hypomania physical treatment before
women psychiatric treatment.
CAMS 2/2013
153
Mucha-Janota M. et al. HDS in depression and hypomania
The study involved three patients healed in Specialist
Neurological Clinic, directed to Specialist Psychiatric
Clinic with the earlier refferal on complex physical treatment. Women aged 35-55, two of them with diagnosed
seasonal depression and one, with seasonal hypomania.
Patients agreed to attend on physical treatment before
psychical treatment. Pharmacologically they were treated
with permanent hypertension medicine and two of them,
I and II woman ingested herbal remedy for states of
depressed mood, depressive type, like mood swings
typical for the weather change, states of nervous tensions
and anxiety or neurovegetative disorders of menopause
time. III woman did not ingest any antydepression medicine. Patients were subjected to measurement of pulse
pressure, BP, flexibility examination and Hamilton Depression Scale (HDS) ,before and after physical treatment.
Pulse measurement was made on forearm radial artery.
Blood pressure was measured by sphygmomanometer
gauge on the patients’ left shoulder. The so-called centimeter, flexibility test was made. The examination was
conducted in simple seat. Feet ordered to deploy with 25
centimeters break. Centimeter tape positioned, so that
35 cm value was in an ankle area and tape beginning
directed to knees. Patients performed torse bend with
joined hands as far ahead. There were made three
attempts reaching hands far as possible, the longest
distance was written. At patients was used magnetic field
from magneto-symulation, there was used Viofor JPS
driver as well, expecting increased electrolyte exchange,
improving fluids flow and obtaining analgesic effect.
There was used irradiation with Led light from red light
range around spine area , using the repairitive-regenera-
tive action. To improve mood, there was used phototherapy of light therapy and colour therapy with Q.Light
lamp, changing psychoneuroimmunological system.
Exposures were used alternately for two weeks in the
chair position at a distance of 40 cm from the light source,
without looking directly at the light intensity of 750010 000 lux at 30-60 minutes. Vibroacoustics was used for
local massage and to enforce analgesic effects. There was
used classic massage and a massage with hot basalt stones
with volcanic origin of high index of thermal storage with
pine oil scent aromatherapy. To improve the proper
lymph flow there was used kinezjotaping on paintful and
low stretched places. To 20 minutes exercises with thera
band, there was used a music as a form of music therapy,
abreactive-imaginative and activating emotions by using
movie music like for example Ludovico Einaudi-Una
Mattina. In the end, there was used exercises with yoga
elements like asans:power, mountain, half-moon position. To improve circulation, hot water 37 C and cold
water 20 C legs watering. Ater two weeks of therapy with
break for Saturday and Sunday, daily using the set of five
treatments according to guidelines and art of physical
treatment, combining treatments of magnetic field, phototherapy, massage, exercises and relax, the patients were
examined once more.
Results
All of the patients sustained ten days of treatments , ecercieses and relaxation. During eleventh day patients were
examined according to pulse pressure, BP, flexibility and
Hamilton Depression Scale test . The results are presented
in Tab. 1 and 2.
Tab. 1. Characteristics of women before and after treatment
Tab. 2. Characteristics of women in HDS scale before and after treatment
154
CAMS 2/2013
Discussion
Factors which influence on increased morbidity of
depression and hypomania is latitude, which determines
the sunlight. The genetic factor which increases mental
toughness , an attitude to low temperatures and tolerance to lack of the daylight. Gender, women get sick
more often, heredity, and the incidence in the family is
a epidemiological factor[4]. Light has a huge influence on
depression or seasonal hypomania incidence. The light
stops the melatonin production. At the time of decreased
sunlight emission , there is automatically higher level of
melatonin[5]. It is why we reach for the light therapy the
most often and in the easiest way, with high effectiveness. Phototherapy under the name of light therapy,
where we use white light and colour therapy with the
usage of color light, quickly reacts on the way of retina,
brain, conarium, pituitary, emitting hormones which
improve our mood and prevent from depression [6].
Biological effect which, is made in tissues under influence
of low-energetic light we use by ledotherapy. Her action
effects depend on used power , and the effects are the
results of phototherapy not warm influence [7]. Light is
necessary to human life, it does not only improve our
mood, but it is also a basic element of every biological
ecosystem. Everyone knows the influence of light, during
light and sunny days we feel better, than during dark,
cloudy days. Opposite to natural sunlight, which occurence
and intensivity is dependable from the part of the day
and year, modern light therapy can be used on every part
of the day and everywhere. Light therapy is a perfect fullfilment of traditional treating method. Improvement of
the general condition,in some cases, we can observe after
short time- without drugs usage or side effects [8]. Therapy
with visible light (385-780nm) without UV rays and
infrared is fully safe. Colours are huge usable tools in treating many diseases, from small ailments such as: headaches, apathy to chronic disorders, where they causes
balance restorement, energy animation in whole body.
Color therapy activates local and systemic microcirculation, improves permeability of cell membranes, increases
cell metabolism, stimulates the lymphatic activity, regulates
hormonal system. Magnetic field therapy of low frequency,
fullfils the treatment of another methods,as well as, is
a basic prevention of civilization diseases and rehabilitation
in many parts of clinical medicine [9,10]. At patients was
used magnetic field of magneto-stymulation which
affected on cell and tissue level. There is stimulated elektolyte exchange between cell and its area , there is higher
miotic activity, antymutagenic activity, enzymatic activity,
there is also bigger ATP and DNA synthesis. Achievement
from recent years are studies, that prove that combined
therapy like magnetoledotherapy gives measurable therapeutic effects [11]. At the same time, usage of both types
of electromagnetic radiation can occure in synergistic
action, really beneficial in cases of depressed mood treat-
ment. Body oxygenate and stimulation of central neurvous
system (CNS), these are benefits from magnetoledotherapy. Vibroacoustic therapy it is a microvibrates usage of
amplitute and frequency of vibration , approximately
similar to those produced by a living organism, by movement of muscles fibers, caused by physiological muscular
tone. The source of vibrates of vibroacoustic therapy
device are microvibrates formed on the elastic aplicators
membranes stimulated by the small elecromagnet. The
frequency of shakes generated by the device change
according to programed aplicator to avoid the effect of
tissue accustom to stimulus. Accompanied to mechanical
effect of mikrovibrations are accoustic sound vibrations
coupled with aplicators microvibrates. To vibroaccoustic
effects are attributed the decogenstans actions and
improving the local microcirculation and that gives the
relaxing effect. Hot stone massage combines the effects
of both termotherapy, drainage, acupressure, aromatherapy and classic massae as well. The main base of broad
influence are thermoreceptors which are located in patient’s skin. As a result of reflex action occurs the temperature raise of massage areas and secondary vasolidation.
At the same time, this reaction influences on increase of
the capacity of the vascular. The proper mood, usage of
etherical oils and proper music, influence calmly on
patient, stopping the action of limbic system, which
decreases the stress. Watering is an hydrotherapeutic
action, where we use the influence of temperature factor
on the skin in the character of hot then cold water with
low pressure. Glazing legs start from external side of foot
in the anckle area. Then we water internal calf area
toward to knee and to internal part of crus till the area of
internal anckle. In the similar way we water the front and
the back part of crus. We gain circulation stimulation by
draining veins, which gives relax and reduce the legs
severing. Flexibility is very important element of whole
organism efficiency. International Fitnes Association (IFA)
recommends easy test so-called: centimeter test[12]. This
test not measure the flexibility of whole body, but legs
and backs. But it is consider as a measurable indicator of
whole flexibility. The result is interpreted according to sex,
age and four degree scale.Condition to make this movement exercise is : the proper state of muscle tension, the
proper range of movement in each articulation and in
whole biokinematic net.The lack of movement is caused
by akinetic lifestyle, and is attributed to depsression state,
which has an impact on worse patient condition. It is why
flexibility test is a good index of treatment progress. We
can underline two types of flexibility: comprehensive,
which is useful in everyday life and a special flexibility
which is shaped with determined psychical treatment.
Results of our studies confirmed the right of our thesis,
usage physical factors to healing depression and hypomania. Movement exercises, which were conducted by
our patients allowed on oxygenation, flexibility of motion
activity improvement, distraction from your mental state
CAMS 2/2013
155
let to pulse, pressure, flexibility, and mental condition
normalization.
Conclusions
The use of physical treatment in the fight against depression and seasonal hypomania allowed on symptoms
relief at two patients, and for one patient allowed on
alleviate symptoms to mild depression on three healing
patients. This method requires further observation and
studies on a larger number of patients.
References
1.
2.
3.
4.
5.
6.
7.
Alasdair DC. Psychiatria [Psychiatry]. Wyd. II. Wrocław:
Urban & Partner; 2005: 14-15 (in Polish).
Tobiasz-Adamczyk B. Wybrane elementy zdrowia
i choroby [Selected elements of health and illness].
Kraków: Wydawnictwo Uniwersytetu Jagiellońskiego;
2000: 233-251 (in Polish).
Bowling A. Measuring disease. A review of diseasespecific quality of life measurement scales. Buckingham: Open Universiy Pres; 1995.
Święcicki Ł. Depresja – zwykła choroba? [Depression
– a common illness?] Wrocław: Urban & Partner;
2010. ISBN 978-83-7609-276-8 (in Polish).
Święcicki Ł. Depresja jednak istnieje! [Depression
does exist!] Medycyna po Dyplomie – Zeszyt Edukacyjny 2011; 4: 39 (in Polish).
Timonen M, et al. Transcanial Brain- Targeted Bright
Light Treatment via Ear Canalsin Seasonal Affective
Disorder 9SAD). 2011.11.9-10; Poster presentation at
the 11 th IFMAD Conference.
Mucha R, Malec P, Pasek J, Sieroń A. Światło spolaryzowane w leczeniu zespołów bólowych lędźwiowego
odcinka kręgosłupa – badania własne [Polarized light
in the treatment of low back pain – own research].
Chir. Kolana Artroskopia Traumatol. Sport. 2008; 2:
27-32 (in Polish).
156
CAMS 2/2013
8.
Pasek J, Cieślar G, Pasek T, Sieroń A. Leczenie
światłem spolaryzowanym nowe możliwości światłolecznictwa [Treatment using polarized light; new
opportunities for phototherapy]. Balneol. Pol. 2008;
2: 93-98 (in Polish).
9. Szajkowski S, Suszyński K, Sieroń A. Nowatorska
metoda aplikacji zmiennego pola magnetycznego
[An innovative approach involving application of
changeable magnetic field]. II Kongres Polskiego
Towarzystwa Medycyny Fotodynamicznej i Laserowej
wraz z XXV Sympozjum Fizjoterapeutów Med. & Life
w ramach Śląskich Medycznych Spotkań Uzdrowiskowych. Ustroń: Program i Abstrakty; 2008: 76 (in
Polish).
10. Cieślar G, Sieroń A. Magnetostymulacja – nowa
forma niefarmakologicznego leczenia depresji lekoopornej [Magnetic stimulation – a new form of nonpharmacological treatment of medication-resistant
depression]. 2013.09.5-8; Świeradów Zdrój: XXIV Kongres Balneologiczny; Acta Balneol. 2013; 3: 194 (in
Polish).
11. Sieroń A. Współczesna medycyna fizykalna [Contemporary physical medicine]. 2013.09. 5-8; Świeradów
Zdrój: XXIV Kongres Balneologiczny; Acta Balneol.
2013; 3: 198 (in Polish).
12. http://www.mediweb.pl/interactive/test12.php.
Romualda Mucha
Clinical Ward of Internal Diseases, Angiology and Physical Medicine
of the Chair of Internal Diseases and The Centre of Diagnostics
and Laser Therapy
ul. Batorego 15, 41-902 Bytom, Poland
+48 (32) 78 61 598
123 konieczna muza1:Layout 1 2014-03-20 12:20 Strona 1
CASE STUDY
The influence of music therapy on the child
with developmental disorders
Anna Konieczna-Gorysz1, Ada Kaszewska1, Małgorzata Fortuna2, Barbara Stonoga1
1
2
FACULTY OF PHYSIOTHERAPY, THE UNIVERSITY SCHOOL OF PHYSICAL EDUCATION, WROCŁAW, POLAND
FACULTY OF NATURAL SCIENCES AND TECHNOLOGY, KARKONOSZE COLLEGE IN JELENIA GÓRA, POLAND
SUMMARY
The aim of the study was to determine the effect of music therapy on emotional, social, cognitive and motor development in a child with profound intellectual disability.
A six year old boy with cerebral palsy (hemiplegia bilateralis) and profound intellectual disability was subjected to psychomotor therapy with the use of music. Music
therapy classes were held in one of the Rehabilitation and Education Centres in Wroclaw from September 2009 to May 2010. At the beginning and end of the 8-month
therapy the assessment of emotional, cognitive, social and motor development was made using Behaviour Observation Scale (BOS) (M. Bogdanowicz, E. Lubraniec).
During the entire period of therapy, the therapist's own observation was carried out. After 8 months of therapy, the biggest improvement was noted in the boy’s cognitive
development (25%) while the smallest one was observed in his motor development (11.1%). The data from the therapist's own observations, conducted during the
therapy confirmed the qualitative changes that occurred in specific areas of the boy's development.
KEY WORDS: music therapy, disabled child, psychomotor development
STRESZCZENIE
Wpływ muzykoterapii na rozwój dziecka z zaburzeniami psychoruchowymi
Celem pracy było określenie wpływu zajęć muzykoterapeutycznych na rozwój emocjonalny, społeczny, poznawczy i ruchowy dziecka z niepełnosprawnością intelektualną
w stopniu głębokim. Terapii psychomotorycznej z zastosowaniem muzyki był poddany 6-letni chłopiec, u którego zdiagnozowano mózgowe porażenie dziecięce (hemiplegia bilateralis) i niepełnosprawność intelektualną w stopniu głębokim. Zajęcia z muzykoterapii odbywały się we wrocławskim Ośrodku Rehabilitacyjno-Edukacyjnym
w okresie od września 2009 do maja 2010. Na początku i na końcu 8-miesięcznej terapii został oceniony rozwój emocjonalny, poznawczy, społeczny i ruchowy badanego
dziecka za pomocą Skali Obserwacji Zachowań (SOZ) w opracowaniu M. Bogdanowicz i E. Lubraniec, a w trakcie trwania całej terapii chłopca prowadzona była obserwacja
własna. Po 8 miesiącach terapii największy wzrost nastąpił w rozwoju poznawczym (25 %), a najmniejszy w rozwoju ruchowym (11,1%) badanego dziecka. Dane
z obserwacji prowadzone w czasie trwania terapii potwierdzają jakościowo zmiany, jakie zanotowano w badanych sferach rozwoju.
SŁOWA KLUCZOWE: muzykoterapia, dziecko niepełnosprawne, rozwój psychoruchowy
Background
Music therapy is a form of treatment in children with
disabilities; it takes advantage of music and other acoustic
phenomena to stimulate, rehabilitate, compensate and
correct developmental disorders due to developmental
defects or deficits to adapt the patients with physical and
mental disabilities to optimal functioning [1,2]. The structural elements of music, such as rhythm, meter, tempo,
dynamics or colour of sound affect non-verbally and subconsciously the emotional sphere of a child’s personality
[3]. It affects, inter alia, the vegetative system through
psychomotor activation, stimulation, calming or psychophysical relaxation. Moreover, music affects biochemical
responses and physiological activities. It harmonizes and
coordinates psychomotor skills in a child, if they are disordered by developmental deficits, inadequate conditions
of development, education and everyday life. This is manifested, inter alia, by coordination of movements, reduction
of involuntary movements, synkinesis, reduction of muscle
spasticity and normalization of muscle tension [1].
The most often used form of therapy in children with
disabilities is active music therapy which takes advantage
of singing, movement, playing musical instruments, painting, storytelling, etc. Receptive music therapy involving
listening to music [1] is also used. The aim of music
therapy result from the specificity of a child’s disability
and the functions performed both by music and by the
therapist. Music therapy is aimed at the achievement of
optimal physical, psychomotor, intellectual, emotionalsocial and spiritual fitness.
The aim of the study was to determine the effect of
music therapy sessions on emotional, social, cognitive
and motor development of a child with profound intellectual disability.
Case study
6 year-old boy named Chris (the name has been changed),
diagnosed with infantile cerebral palsy (hemiplegia bilateralis), epilepsy, congenital hydrocephalus and profound
intellectual disability was subjected to the study. The boy
was born during the 35th week of pregnancy due to
hydrocephalus, diagnosed during the prenatal period.
The baby was born via c-section and was scored 5 points
in Apgar scale. Chris has been attending the Rahabilitation and Education Center since he was four, to undergo
complex treatment. His psychomotor development is
significantly impaired. The boy cannot sit unaided, he
moves rolling. He rises when he is pulled by hands and
lifts his head. His grip is weak and he can hold objects
only for a short while due to flexion contracture in several
fingers of both hands. The boy recognises people from
his closest environment and familiar voices. With strangers,
CAMS 2/2013
157
Konieczna-Gorysz A. et al. Psychomotor therapy with the use of music
he maintains eye contact only for a while and does not
accept being touched. He can focus on the tasks for
a while only when he is interested in them. He reacts correctly to simple commands, such as pointing at his nose
or other part of the body. His emotional responses are
quite often noncompliant with the situation. Chris does
not speak, he communicates using facial mimics. He
shows emotions: anger, making a sad face, or joy, smiling,
laughing aloud and clapping his hand. He manifests excessive muscular and emotional tension by gnashing his
teeth. He eats only blended foods and drinks from a mug,
only with somebody else’s support. His mouth is open,
he salivates and puts his hands into his mouth. He
requires full support from adults due to the profound and
complex disability.
Tab. 1. Therapeutic and educational aims
158
CAMS 2/2013
At the beginning and end of the 8-month long therapy,
the boy was assessed in terms of emotional, cognitive,
social and motor development levels using Behaviour
Observation Scale (BOS) developed by M. Bogdanowicz
and E. Lubraniec [4]. During the entire period of therapy,
the boy was observed by the researchers for qualitative
assessment of the child’s condition which is a necessary
component of psychomotor therapy.
Music therapy sessions were held at a constant time
twice a week. Each session lasted 30 minutes. Group,
receptive and active music therapy was applied. The
group subjected to treatment comprised 5-8 children;
each child was with his or her carer who had to help the
child with of each exercise. The children and the instructor
formed a circle. The music therapist tailored his program
to apply a different kind of music therapy during each
class. The forms of therapy used by the instructor included
active music therapy with singing and playing drums,
active music therapy with elements of developmental
movement exercises according to Veronica Sherborne
and receptive music therapy involving relaxation. The
topic of the classes was always functional, taken from children’s everyday life. The topics were related to seasons of
the year, animals and everything a child can observe in
his/her closest environment. The therapist selected
exercises according to the participants’ intellectual potential. The selection of songs was not incidental, the
songs were simple, their words were easy to understand
and the tune was easy to remember.
The exercises and songs were cyclically repeated (e.g.
with the change of the season) to make the child remember them. Therapeutic aims determined for Chris are
presented in Table 1.
Results and Conclusions
The analysis of the research using the Behaviour Observation Scale (BOS) involved comparison of results obtained
by the child prior to (test 1) and after therapy (test 2),
which is presented in Figure 1.
reacted positively to caresses and never reciprocated
them; after several weeks of therapy he more often
reacted to touch with a smile. His non-verbal communication also improved and his eye contact became slightly
longer. With time, he learned to focus attention on the performed tasks a little longer. His relaxation ability, which
was very poor at the beginning, significantly improved.
The music he listened to calmed him and his muscle
tension markedly decreased. Music therapy favourably
affected the boy’s psychomotor development.
In conclusion, it should be emphasized that a child
with intellectual disability needs multilateral development stimulation, both to develop the impaired spheres
and to support and enhance the already acquired skills.
Music can play an important role in the process of supporting ones development involving a wide range of
skills – physical, intellectual, emotional and aesthetic.
Music can encourage children to do things they would
never dare to do and integrates children who are mistrustful and unwilling to accept any change in their environment [5]. Inclusion of music therapy or rehabilitation in
the treatment of children with disabilities is a proof of our
humanity. Music therapy teaches to experience surrounding world anew and provide an immeasurable joy of life
for such children [6]. Subjective experience is part of
Test I
Test II
Cognitive
development
Emotional
development
Social
development
Motor
development
Fig. 1. Percentage values obtained in each sphere of development in the studied child prior to (test 1) and after therapy (test 2)
The analysis of the results presented in Figure 1
revealed the biggest improvement in cognitive development (25%) after 8 months of therapy (25 %) and the
smallest – in motor development (11,1%) of the studied
child. The data obtained from our observation carried out
during the therapy confirm the qualitative changes that
were noted in the studied spheres of development. At
the beginning of the treatment the boy avoided contacts
with other persons, but with time he established personal
relationships more easily. At the beginning, he rarely
human personality, therefore the effectiveness of music
therapy classes in children with profound intellectual
disabilities should not be based on numerical scales of
the development of each sphere only. Qualitative assessment, based on observation, enabling complex assessment
of a child’s development, should always be considered.
Music therapy can be the first and the only way of
communicating with a child, especially when other methods prove ineffective or impossible to apply.
CAMS 2/2013
159
References
1.
2.
3.
4.
5.
Sadowska L. Neurophysiological rehabilitation methods for children with developmental disorders,
Publishing House of the University of Physical Education of Wroclaw; 2004 (in Polish).
Wasyluk I. Supporting role of music in revalidation
of persons with deep mental handicap, Special School
4; 2005 (in Polish).
Verdeau-Pailles J. Musicotherapie, W: Richard J.
Rubio L, La Therapie psychomotrice, Masson, Paris;
1994.
Bogdanowicz M i wsp., Weronika Sherborne method
in therapy and supporting child development. Warszawa: wyd. Szkolne i Pedagogiczne; 1997 (in Polish).
Raszewska M. Music therapy as an element supporting psychophysical development in children with
160
CAMS 2/2013
6.
various degrees of mental handicap of coupled
nature Revalidation 1; 2001 (in Polish).
De Haan M. Psychomotor education – meaningful
movements. in: Sekułowicz M. et al. (editor), Music
Therapy in Children with Infantile Cerebral Palsy –
Selected Examples, Scientific Publishing House of
the University of Lower Silesia in Wroclaw; 2008.
Anna Konieczna-Gorysz
Faculty of Physiotherapy, University School of Physical Education
al. I. J. Paderewskiego 35, 51-612 Wrocław, Poland
tel: +48 (71) 347 30 87
124 regulamin:Layout 1 2014-03-20 12:32 Strona 1
Editorial Policy
Preparing the manuscript for submission
The total length of the manuscript (including figures and tables) should not exceed 10 standard pages of 1800 characters.
The editors reserve the right to edit the manuscript for formatting.
1. Title page
• the full name of each author (without academic titles),
• the organizational affiliation of each author (workplace),
• the full title of the article in both Polish and English,
• in the case of titles containing more than 10 words, a title alias,
• 3–6 key words selected in accordance with the MeSH (Medical Subject Headings) system (http://www.nlm.nih.
gov/mesh/meshhome.html),
• the full name, address, telephone and/or fax number, and e-mail address of the first author, responsible for the
preparation of the manuscript for print,
• the sources of any material support, in the form of grants and subsidies (citing the source and grant number),
subventions, equipment, medicines, etc. (if any), or the authors’ financial and personal relationships that might bias
their work (see below: Conflict of interest).
2. Summary (applies to original articles)
The summary should be in a structured form, not exceeding 230 words, and should consist of four paragraphs, labeled:
• Background: the purpose of the article or research, the primary thesis;
• Material and methods: a brief description of the research; in the case of a review or opinion article, a characterization of the literature; for a case study, a brief description of the patient, the main parameters measured, etc.;
• Results: the most significant results achieved;
• Conclusions: the most important conclusions derived by the authors from the results presented in the article.
Strict compliance with the above-described structure is not required in the case of articles other than original research articles.
3. Structure of the text (applies to original articles)
The text of the article should be divided into six main sections, complemented by two additional ones, if necessary:
• Background – should give the scientific and/or clinical rationale for researching the given topic, the primary issues and controversies, an explanation of the aim of the study and the primary thesis;
• Material and methods – should contain essential information regarding how the experiment or research was
conducted, including characteristics of the experimental and control groups, clearly defined inclusion and exclusion
criteria (age, gender, etc.), randomization, and the randomization and masking (blinding) method used. The protocol of data acquisition, procedures, investigated parameters, methods of measurements and apparatus should be
described in sufficient detail to allow other scientists to reproduce the results. In the case of published methods, the
names and appropriate references should be given. A brief description should be provided for methods that have
been published but are not well known, whereas new or substantially modified methods should be described in
detail. The rationale for using such new or unknown methods should be discussed, along with a balanced evaluation
of these methods, not omitting their limitations. Drugs and other chemicals should be precisely identified, including
the generic name, dosage, and route of administration. Whenever possible, the statistical methods used should be
described in detail. Information regarding the patients' informed consent should be included in the text of the article
(see below: Patient confidentiality);
• Results – concisely and reasonably summarize the findings in the form of text, tables and figures arranged in a
logical and internally self-consistent manner. The number of tables and figures should be limited to those absolutely
needed to confirm or refute the thesis. Data given in graphs and tables should not be automatically repeated in the
text (a reference will suffice). The number of observations should be indicated, as well as the number of and reasons
for exclusions from the study. Any complications that may occur in treatment or examination should be reported;
• Discussion – should deal only with new and/or important aspects of the results obtained, without repeating in
detail data or other material previously presented in Background or Results. The Discussion should focus on the theCAMS 2/2013
161
oretical implications and/or practical consequences of the findings, including suggestions for further research. The
Discussion should compare the results of the present study with those obtained by other investigators mentioned in
the text;
• Conclusions – must be linked with the goals of the study. New hypotheses with recommendations for further research should be advanced only when fully warranted and explicitly justified. Broad generalizations and conclusions
not supported by the data obtained should be avoided;
• References – chosen for their importance and accessibility, are numbered consecutively in the order of their occurrence in the text. References first cited in tables or figure legends must be numbered in such a way as to maintain
numerical sequence with the references cited in the text. References should be cited using square brackets. Polish
authors are required to maintain a balance between the number of Polish references and those in other languages.
References to articles in Polish should also include the English title of the paper and the journal. The style of references, which will be strictly observed, is that of Index Medicus. In the case of review articles, the list of references should
include 40–50 works cited in the text, out of which a minimum of 75% should have been published in the last 5 years.
Additional sections:
• Acknowledgements – list all those who have contributed to the research but do not meet the criteria for authorship, such as assistants, technicians, or department heads who provided only general support. Financial and other
material support should be disclosed and acknowledged;
• Appendix.
Sections should be separated, and their headings centered and boldfaced.
Review articles do not need to follow the format described above, provided that their structure is clear and consistent.
If the editors upon review of the manuscript feel that it should be structured, they will ask the author to do so prior
to publication.
4. References
Careful compilation of the list of references, in terms of both content and form (proper style, punctuation, etc.) is the
responsibility of the author. According to the rules stated in the Uniform Requirements for Manuscripts Submitted to
Biomedical Journals (N Eng J Med 1997; 336:309–15; www.acponline.org/journals/resource/unifreqr.htm), each reference should include: authors’ surnames with initials of first names, title of the article, abbreviated title of the journal,
year of publication, volume number, issue number, and page numbers. When an article has six or fewer authors, all
should be listed; when there are seven or more, only the first three are listed, followed by “et al.”. If the article or book
is in Polish, a translation of its title into English should be added.
Standard journal article
Colloca L, Klinger R, Flor H, Bingel U. Placebo analgesia: Psychological and neurobiological mechanisms. Pain 2013;
154 (4): 511–4.
Article published in electronic form only
Furlan AD, Yazdi F, Tsertsyadze A et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety
of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat
Med. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC32236015.
Published online 2011 November 24. doi: 10.1155/2012/953139
Scientific monograph
Szulc W. Sztuka w służbie medycyny od antyku do postmodernizmu [Art in the service of medicine from antiquity to
postmodernism]. Poznań: Wydawnictwo Naukowe Akademii Medycznej; 2001 (in Polish).
Book, personal author(s)
Gerber R. A practical guide to vibrational medicine. New York: Harper Collins Publishers 2001.
Book, editor(s) as author
Ernst E (ed.). Complementary Therapies for Pain Management: An Evidence-Based Approach. Mosby: Churchill Livingstone; 2007.
162
CAMS 2/2013
Book, organization as publisher
Duke Center for Integrative Medicine. The Duke encyclopedia of new medicine: conventional and alternative medicine for all ages. New York: Rodale Books International; 2006.
Chapter in a book
Bukowska A, Konieczna A. Neuromuzykoterapia w pracy muzykoterapeutów, fizjoterapeutów, logopedów i terapeutów zajęciowych [Neurologic music therapy in the work of music therapists, physiotherapists, speech therapists and
occupational therapists]. In: Cylulko P, Gładyszewska-Cylulko J (eds). Muzykoterapia, tożsamość-transgresja, transdyscyplinarność [Music therapy, identity-transgression, transdisciplinarity]. Wrocław: Wydawnictwo Akademii Muzycznej; 2010: 45–51 (In Polish)
Conference proceedings
Duda-Chodak A, Tarko T, Walczycka M, Jaworska G (eds). Materiały z X Konferencji Naukowej z cyklu „Żywność XXI
wieku” – Żywność projektowana [Proceedings of the 10th Scientific Conference “Food of the 21st Century” – Designed
Food]; 2011.09.22–23; Kraków, Polska: Oddział Małopolski Polskiego Towarzystwa Technologów Żywności; 2011.
Abstracts or reviews should generally not be cited as references, nor should “unpublished data” or “personal communications”. If such material is necessary, it may be incorporated in the text at the appropriate place.
5. Formatting requirements for the manuscript and illustrations
The manuscript should be sent in the form of electronic files without final formatting (12-point black font, 1.5 line
spacing, standard margins).
6. Tables and illustrative material (figures, graphs, diagrams, charts, photographs)
• Titles and descriptions of tables, photographs and illustrations should be given both in Polish and English;
• Illustrative material should be sent separately, in jpg format;
• The position of tables, figures and other illustrative material should be indicated in the text [in square brackets];
• Text in the legends to the tables and figures should not be duplicated in the tables or figures themselves;
• The arrangement of the table should be as simple as possible, without adding unnecessary horizontal or vertical
subdivisions;
• Explanations, including the clarification of non-standard abbreviations, should be provided in footnotes under
the table, and not in the table itself. Footnotes below the table should be numbered separately, starting from number
1 with each table;
• Care should be taken that each table and figure is in fact mentioned in the text. Tables and figures should be
numbered consecutively according to the order in which they are first cited in the text;
• If a table or figure has been previously published, the original source must be acknowledged and written permission should be obtained from the copyright holder to reproduce the material, except for documents in the public
domain;
• CAMS prints black-and-white photographs as standard practice; color photographs may be printed if the author
is willing to participate in bearing the additional costs entailed. The fee is agreed with the Publisher of CAMS on a
case-by-case basis;
• Photomicrographs should have internal scale markers. The symbols, arrows, or letters used in photomicrographs
should contrast with the background. If photographs of people are used, either the identity should be masked or
written permission should be obtained to use the photograph;
• Measurements of length, height, weight, and volume should be reported in metric units (e.g. meter, kilogram, or
liter) or their decimal multiples (e.g. decimeters). Temperatures should be in degrees Celsius. Blood pressures should
be in millimeters of mercury;
• All hematological and clinical chemistry measurements should be reported in the metric system in a manner
consistent with the International System of Units (SI). Alternative or non-SI units should be added in parentheses;
• Use only standard abbreviations. Abbreviations in the title of the manuscript and in the summaries should not
be used. The spelled-out abbreviation followed by the abbreviation in parentheses should be used on first mention
unless the abbreviation is a standard unit of measurement.
7. Sending the article to CAMS
Editors of CAMS accept submissions by e-mail ([email protected] or [email protected]), or by conventional
mail, sent to the address of the journal’s Editorial Board.
CAMS 2/2013
163
• The manuscript (title page, abstracts, body of text, references, etc.) should be submitted as ONE TEXT FILE. Figures, tables, diagrams, and photographs should be provided as SEPARATE attachments in jpg format. The length of the
e-mail message should not exceed 10 MB;
• The manuscript should be accompanied by a Cover Letter regarding the article submitted to CAMS, together with
original signatures of the authors (see below: Cover Letter). The Cover Letter, scanned and signed, should be sent to
the editors by electronic or conventional mail.
8. Review procedure
The reviewers for CAMS are the members of the journal’s Scientific Committee, as well as independent external reviewers chosen by the editors. The external reviewers for CAMS are scientists from Poland and abroad, who are experts in
a particular area of knowledge and clinical practice and are not formally members of the journal’s Scientific Committee. If a manuscript is received that does not fall into the area of expertise of the journal but represents a related area,
Editor-in-Chief assigns a “super-reviewer” who is a specialist in that area.
Each article submitted to CAMS is registered in the article database. The author(s) receive a return e-mail stating the
registration number.
Received manuscripts are first examined by CAMS editors. They evaluate the article on the basis that it falls within the
thematic scope of the journal and choose two independent reviewers not associated with the institution with which
the authors are affiliated. A double-blind review process is used. Manuscripts considered unsuitable for publication
are returned to the main author without further review. The same applies to the papers that are prepared not in accordance with the instructions (see above); however, they may be re-submitted after necessary correction. Scientific
evaluation of the submitted article, based on two reviewers’ opinions, is sent to the author/s. If the reviewers differ in
their opinions, Editor-in-Chief assigns a “super-reviewer”, whose decision is binding. The ultimate decision to accept
a work for publication is taken after the correction requested by the reviewer has been made. The decision to reject
a manuscript lies within the prerogative of the editors and is not subject to appeal. The editors are not obligated to
justify their decision. The list of reviewers is published in the last issue of each year.
9. Declarations
CAMS editors endorse the principles embodied in the Helsinki Declaration and expect that all research involving humans has been performed in accordance with these principles.
For animal experimentation reported in the journal, it is expected that investigators will have observed the Interdisciplinary Principles and Guidelines for the Use of Animals in Research, Testing, and Education issued by the New York
Academy of Sciences' Ad Hoc Committee on Animal Research. All human and animal studies must have also been
approved by the main author’s institutional review board. A copy of the relevant documentation should be included
with the manuscript.
Ghostwriting and guest authorship are examples of scientific misconduct. Any identified cases will be disclosed, including notification of appropriate bodies or institutions (authors' home institutions, scientific societies, associations
of academic editors, etc.).
As “ghostwriting” are qualified cases in which someone has made a substantial contribution to a publication, without
revealing his/her participation as one of the authors, or without being mentioned in the acknowledgments enclosed
to the publication.
“Guest authorship” (“honorary authorship”) are considered situations in which the author's contribution is insignificant (or does not exist), and yet he/she is the author/co-author of the publication.
The Cover Letter (available at www.medsport.pl/czasopisma) should include a statement that:
• the manuscript is original work,
• the research results have not been previously published or submitted for publication,
• all the authors listed on the title page of the manuscript have agreed to its being submitted to CAMS.
164
CAMS 2/2013
10. Conflict of interest
Editors of CAMS expect that authors of articles will not have any financial interest in a company that makes a product
discussed in the article, or in a competing company.
The authors should disclose at the time of submission any financial arrangement they may have with a company
whose product is discussed in the submitted manuscript. Such information will be held in confidence while the paper
is under review and will not influence the editorial decision, but if the article is accepted for publication, the editors
will either agree with the authors how such information is to be communicated to the reader, or decide to forego such
action.
Journal policy requires that reviewers and editors reveal in a letter to the Editor-in-Chief any relationships that they
have that could be construed as causing a conflict of interest with regard to the author of a manuscript under review.
The letter should also include a statement of any financial relationships with commercial companies involved with a
medical product under study.
11. Patient confidentiality
Study subjects should be identified only by arbitrarily assigned initials or numbers. Any information contained in
photographs, tables, images, or other illustrations that could serve to reveal the person’s identity should be thoroughly camouflaged or concealed. The faces of persons appearing in photographs should be masked or covered with
a black band. If the text or illustrations of an article make it possible in any way to determine or infer the identity of
a patient, the authors must supply the written consent of the patient or guardian to publish his/her data, including
photographs and radiological images. Details of the race, ethnicity, religion, or cultural background of a study subject
should be mentioned only when they are believed to have an impact on the course of the disease and/or treatment
discussed in the study.
12. Copyright transfer
Upon acceptance of the manuscript for publication, the authors transfer copyright to MEDSPORTPRESS, the Publisher
of CAMS. Once the article is accepted for publication in the journal, the information it contains cannot be released to
the media until the issue in which the article appears has been released for circulation. The article accepted for publication may not be published elsewhere without written permission from MEDSPORTPRESS.
13. Permissions for reproduction
Materials taken from other sources must be accompanied by a written statement from both the first author and the
publisher of the original publication in which the materials appeared, giving permission for reproduction in CAMS.
In the case of unpublished materials or personal communications permission should be obtained in writing from the
person providing unpublished data used in the article.
14. Disclaimer
Every effort is made by the Publisher and the Scientific Committee to see that no inaccurate or misleading data,
opinions, or statements appear in any article published in CAMS. However, the contents of the articles and advertisements are ultimately the responsibility of the contributor, sponsor or advertiser concerned. Accordingly, the Publisher
and the Scientific Committee accept no liability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Readers are advised that any methods and techniques described in CAMS should
only be followed in conjunction with the drug or equipment manufacturer's own published literature in the reader's
own country.
The above instructions are in compliance with the Uniform Requirements for Manuscripts Submitted to Biomedical
Journals (N Eng J Med 1997; 336: 309–15; http://www.icmje.org/index.html).
Contact:
Publishing House MEDSPORTPRESS, Ltd.
Editorial Office „Complementary and Alternative Medicine in Science”
al. Stanów Zjednoczonych 72/176
04-036 Warszawa, Poland
tel./fax: (48 22) 834-67-72 or 405-42-72, mobile: (48) 501-174-360
e-mail: [email protected] or [email protected]
CAMS 2/2013
165
Regulamin wydawniczy
Przygotowanie prac do złożenia
Praca w całości (łącznie z rycinami i tabelami) nie powinna przekraczać 10 stron standardowego tekstu komputerowego – 1800 znaków na stronie.
Redakcja zastrzega sobie prawo do redagowania artykułu pod względem formatowania.
1. Strona tytułowa
• imię i nazwisko każdego Autora (bez tytułów),
• jednostkę organizacyjną każdego Autora (miejsce pracy),
• tytuł artykułu w języku polskim i angielskim,
• skrócony tytuł (nie więcej niż 10 słów),
• 3–6 słów kluczowych, wybranych zgodnie z systemem MeSH (Medical Subject Headings), http://www.nlm.nih.
gov/mesh/meshhome.html,
• imię i nazwisko, adres, numer telefonu i/lub faksu oraz adres e-mail pierwszego Autora, który odpowiada za
przygotowanie pracy do druku,
• źródła wsparcia materialnego w postaci grantów i dotacji (z podaniem źródła i numeru grantu), subwencji, sprzętu, leków itp. (jeżeli takie istnieją) lub powiązań mogących budzić zastrzeżenia (por. poniżej: Konflikt interesów).
2. Streszczenie (dotyczy prac oryginalnych)
Streszczenie nie może przekraczać 230 słów. Streszczenie musi być ustrukturowane:
• Wstęp: cel artykułu lub badań, główna teza badawcza;
• Materiał i metody: krótki opis przeprowadzonych badań; w przypadku np. artykułu przeglądowego lub poglądowego – charakterystyka literatury przedmiotu; w przypadku artykułu kazuistycznego – krótki opis pacjenta,
główne badane parametry itp.;
• Wyniki: najważniejsze wyniki z przeprowadzonych badań;
• Wnioski: najważniejsze wnioski wyciągnięte przez Autorów z przedstawionych wyników odnoszące się do celu
pracy.
W streszczeniach prac innych niż oryginalne stosowanie wyżej wymienionej struktury nie jest wymagane.
3. Układ tekstu (dotyczy prac oryginalnych)
Tekst artykułu należy podzielić na 6 działów podstawowych, uzupełnionych ewentualnie o dwa dodatkowe:
• Wstęp – obejmuje naukowe i/lub kliniczne uzasadnienie podjęcia tematu, główne zagadnienia i kontrowersje,
wyjaśnienie celu badań i głównej tezy badawczej;
• Materiał i metody – obejmuje niezbędne informacje na temat przeprowadzenia eksperymentu lub badań (w tym
charakterystykę grup badanych – eksperymentalnych i kontrolnych), jasno określone, stosowane kryteria włączające
i wyłączające (np. wiek, płeć), randomizację oraz metodę randomizacji i maskowania („ślepej próby”). Opis powinien być na tyle szczegółowy pod względem metod zbierania danych, procedur badawczych, badanych parametrów,
stosowanych miar oraz sprzętu, aby inni badacze mogli odtworzyć eksperyment uzyskując podobne wyniki. Należy
podać nazwy i odniesienia do stosowanych metod już opublikowanych. W przypadku metod opublikowanych, lecz
mało znanych, niezbędna jest krótka charakterystyka. Należy szczegółowo opisać nowe lub gruntownie zmienione
metody. Autorzy powinni uzasadnić stosowanie nowych, nieznanych metod i ocenić je, ze szczególnym uwzględnieniem ograniczeń. Leki i inne środki chemiczne należy identyfikować dokładnie za pomocą nazwy gatunkowej, z
dawkowaniem i drogą podawania. Stosowane metody statystyczne należy, w miarę możliwości, opisać szczegółowo.
Informacje dotyczące świadomej zgody pacjentów na udział w badaniu należy podać w tekście artykułu (por. poniżej:
Poufność informacji o pacjencie);
• Wyniki – stanowią zwarte i zrozumiałe podsumowanie tego, co stwierdzono w badaniach i są przedstawiane w
tekście oraz w tabelach i na rycinach w sposób logiczny i konsekwentny. Liczbę tabel i rycin należy ograniczyć do
niezbędnego minimum, w celu potwierdzenia lub odrzucenia tezy. Dane zawarte w wykresach i tabelach nie powinny
być ponownie omawiane w tekście (wystarczy odwołanie). Należy podać liczbę obserwacji, jak również liczbę i powód
wykluczeń z eksperymentu. Należy poinformować w tekście o powikłaniach związanych z leczeniem lub badaniem;
166
CAMS 2/2013
• Dyskusja – przedstawia wyłącznie nowe i/lub ważne aspekty związane z uzyskanymi wynikami, pomijając zbędne
powtarzanie danych i materiałów już uprzednio przedstawionych we Wstępie lub Wynikach. Dyskutuje się znaczenie i
skutki stwierdzonych w Wynikach prawidłowości, w tym postulaty do dalszych badań. Należy porównywać uzyskane
przez Autorów wyniki z doniesieniami innych badaczy cytowanych w tekście;
• Wnioski – muszą być związane z celami badań. Nowe hipotezy, z zaleceniami do nowych badań, można wysunąć
jedynie po przeprowadzeniu poprawnego metodologicznie uzasadnienia. Należy unikać stwierdzeń nadmiernie uogólnionych lub niewynikających z rezultatów uzyskanych w badaniach własnych;
• Piśmiennictwo – zawiera pozycje z literatury ponumerowane w kolejności ich występowania w tekście, wybrane pod
względem ważności i dostępności. Pozycje występujące po raz pierwszy w tabelach lub na rycinach należy ponumerować
tak, aby utrzymać kolejność z pozycjami cytowanymi w tekście. Piśmiennictwo powinno być cytowane w nawiasach
kwadratowych. Redakcja wymaga od polskich autorów zachowania równowagi pomiędzy cytowanym piśmiennictwem
polskim i zagranicznym. W cytowaniach piśmiennictwa polskiego obowiązuje również podanie tytułu pracy i czasopisma
w języku angielskim. Redakcja oczekuje także konsekwentnego i starannego stosowania stylu piśmiennictwa Index Medicus. W przypadku artykułów przeglądowych piśmiennictwo powinno zawierać od 40 do 50 pozycji, w tym minimum 75%
z ostatnich 5 lat;
Działy dodatkowe:
• Podziękowania – podkreślają wkład wszystkich osób, które pomagały w prowadzeniu badań i które nie spełniają
kryteriów włączenia do zespołu Autorów, np. asystenci, technicy, kierownicy jednostek, dający tylko ogólne wsparcie.
Autorzy mają obowiązek ujawnić fakt otrzymywania wsparcia finansowego lub materialnego;
• Aneks.
Działy powinny być wydzielone, a ich nazwa wyśrodkowana i wytłuszczona.
W pracach przeglądowych można stosować odmienny układ, jednak pod warunkiem, że struktura pracy jest jasna,
przejrzysta i konsekwentna. Redakcja zastrzega sobie prawo zwrócenia pracy do Autora w celu poprawienia jej układu.
4. Piśmiennictwo
Autorzy zobowiązani są do starannego doboru i rzetelnego opracowania piśmiennictwa nie tylko pod względem
merytorycznym, ale także stylistycznym, z użyciem określonych znaków interpunkcyjnych. Zgodnie z zasadami ustalonymi przez Jednolite wymagania dotyczące prac złożonych do druku w czasopismach biomedycznych (Uniform
Requirements for Manuscripts Submitted to Biomedical Journals N Eng J Med 1997; 336:309–15; www.acponline.org/
journals/resource/unifreqr.htm), każda pozycja piśmiennictwa powinna zawierać: nazwiska i pierwsze litery imion autorów, tytuł artykułu, skrót tytułu czasopisma, rok wydania, numer tomu, numer wydania i numery stron. W przypadku artykułu mającego nie więcej niż sześciu współautorów należy podać wszystkie nazwiska, natomiast w przypadku
siedmiu lub więcej współautorów podaje się tylko pierwsze trzy nazwiska, dodając „i wsp.”, ew. „et al.”.
Typowy artykuł w czasopiśmie
Colloca L, Klinger R, Flor H, Bingel U. Placebo analgesia: Psychological and neurobiological mechanisms. Pain 2013;
154 (4): 511–4.
Artykuł opublikowany wyłącznie elektronicznie
Furlan AD, Yazdi F, Tsertsyadze A i wsp. A systematic review and meta-analysis of efficacy, cost-effectiveness, and
safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement
Alternat Med. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC32236015. Published online 2011 November 24. doi:
10.1155/2012/953139
Monografia naukowa
Szulc W. Sztuka w służbie medycyny od antyku do postmodernizmu. Poznań: Wydawnictwo Naukowe Akademii Medycznej; 2001.
Książka
Gerber R. A practical guide to vibrational medicine. New York: Harper Collins Publishers 2001.
Książka pod redakcją
Ernst E (red.). Complementary Therapies for Pain Management: An Evidence-Based Approach. Mosby: Churchill Livingstone; 2007.
CAMS 2/2013
167
Książka wydana przez organizację
Duke Center for Integrative Medicine. The Duke encyclopedia of new medicine: conventional and alternative medicine for all ages. New York: Rodale Books International; 2006.
Rozdział w książce
Bukowska A, Konieczna A. Neuromuzykoterapia w pracy muzykoterapeutów, fizjoterapeutów, logopedów i terapeutów zajęciowych. W: Cylulko P, Gładyszewska-Cylulko J (red.). Muzykoterapia, tożsamość-transgresja, transdyscyplinarność. Wrocław: Wydawnictwo Akademii Muzycznej; 2010: 45–51.
Materiały kongresowe
Duda-Chodak A, Tarko T, Walczycka M, Jaworska G (red.). Materiały z X Konferencji Naukowej z cyklu „Żywność XXI
wieku” – Żywność projektowana; 2011.09.22–23; Kraków, Polska: Oddział Małopolski Polskiego Towarzystwa Technologów Żywności; 2011.
Nie należy na ogół cytować abstraktów i przeglądów, jak również „niepublikowanych danych” oraz „informacji ustnej”.
Jeżeli jednak są niezbędne, można je włączyć do tekstu w odpowiednim miejscu.
5. Wymagania dotyczące formatowania rękopisu i ilustracji
Praca powinna być przesłana w formie elektronicznej bez końcowego formatowania (12 pkt. czcionka czarna, interlinia 1,5 pkt., margines standardowy).
6. Tabele i materiał ilustracyjny (ryciny, wykresy, fotografie)
• Wymagane są polskie i angielskie tytuły i opisy tabel, rycin, wykresów i fotografii;
• Należy je przesłać oddzielnie, w formie plików jpg;
• W tekście należy zaznaczyć miejsce ich występowania [w nawiasach kwadratowych];
• W oknach tabel i rycin nie należy umieszczać powtórzonego tekstu zawartego w podpisie;
• Wskazany jest najprostszy układ tabeli (bez zbędnych poziomych lub pionowych linii podziału);
• Wyjaśnienia (w tym tłumaczenia niestandardowych skrótów) należy umieścić w przypisach pod tabelą – nie w
samej tabeli. Dolne przypisy pod tabelą należy ponumerować odrębnie, zaczynając od 1 dla każdej tabeli;
• Należy się upewnić, czy każda tabela i rycina jest wymieniona w tekście. Numeracja musi być zgodna z kolejnością występowania pierwszego odwołania w tekście;
• Jeżeli dana rycina lub tabela została już opublikowana, należy podać źródło i uzyskać pisemną zgodę osoby mającej prawa autorskie na przedruk materiału (za wyjątkiem dokumentów stanowiących dobro publiczne);
• Redakcja drukuje standardowo zdjęcia w postaci czarno-białej. Istnieje możliwość wydrukowania zdjęcia w pełnym kolorze, za opłatą. Opłata ta jest każdorazowo ustalana z Wydawcą CAMS;
• Zdjęcia mikroskopowe powinny mieć wewnętrzne oznaczenie skali. Używane w zdjęciu mikroskopowym symbole, strzałki i litery powinny być w kolorze kontrastującym z tłem. W przypadku fotografii badanych osób należy
ukryć tożsamość lub uzyskać pisemną zgodę na opublikowanie zdjęcia;
• Jednostki miary (długości, wysokości, wagi i objętości) powinny być podane w jednostkach metrycznych (np.
metr, kilogram, litr i inne) lub w systemie dziesiętnym (np. decymetry). Temperatura musi być podana w stopniach
Celsjusza. Ciśnienie tętnicze powinno być podane w milimetrach słupa rtęci;
• Wszystkie kliniczne pomiary hematologiczne i chemiczne powinny być podane w systemie metrycznym według
Międzynarodowego Systemu Miar (SI). Alternatywne jednostki, niepochodzące z tego systemu, powinny być dodane
w nawiasach;
• Redakcja wymaga stosowania standardowych skrótów. Nie należy używać skrótów w tytule i w streszczeniach.
Pełna wersja nazwy, dla której używa się danego skrótu, musi być podana przed pierwszym wystąpieniem skrótu w
tekście, za wyjątkiem standardowych jednostek miar.
7. Wysłanie artykułu do czasopisma
Redakcja CAMS przyjmuje do druku prace przesłane pocztą elektroniczną: [email protected] lub [email protected], bądź za pośrednictwem poczty na adres Redakcji czasopisma.
• Tekst pracy (strona tytułowa, streszczenia, tekst pracy, piśmiennictwo itd.) powinien być przygotowany W JEDNYM PLIKU TEKSTOWYM. Ryciny, tabele, wykresy i fotografie powinny być załączone ODDZIELNIE w formie plików
graficznych jpg. Objętość e-maila nie powinna przekraczać 10 MB;
• Manuskryptowi powinno towarzyszyć Oświadczenie Autorów dotyczące nadesłanego do Redakcji CAMS artykułu, wraz z oryginalnym podpisem Autorów publikacji (por. poniżej: Oświadczenie). Zeskanowane (podpisane)
Oświadczenie prosimy przesłać do Redakcji (drogą elektroniczną lub pocztą).
168
CAMS 2/2013
8. Procedura recenzowania
Recenzentami czasopisma Complementary and Alternative Medicine in Science są członkowie Rady Naukowej czasopisma, jak również wybrani przez Redakcję niezależni recenzenci zewnętrzni. Zewnętrznymi recenzentami CAMS
są naukowcy z Polski i ze świata, reprezentujący określony obszar wiedzy i praktyki klinicznej, niebędący formalnie
członkami RN czasopisma. W przypadku otrzymania przez Redakcję pracy z obszaru niemieszczącego się w dziedzinach, w których specjalizuje się czasopismo (a jest obszarem pokrewnym), Redaktor Naczelny powołuje każdorazowo
„Superrecenzenta” z danego obszaru.
Każdy nadesłany do Redakcji artykuł rejestrowany jest w bazie czasopisma. Autor/Autorzy otrzymują e-mailem informację zwrotną dotyczącą numeru rejestracyjnego.
Redaktorzy podejmują decyzję o wstępnej kwalifikacji pracy do druku. Oceniają czy nadesłana praca jest zgodna z
obszarem zainteresowań czasopisma i decydują o wyborze dwóch niezależnych recenzentów spoza jednostki, którą
reprezentują Autorzy. Stosuje się zasadę „double-blind review process”. W przypadku uznania pracy za ewidentnie
niewłaściwą do publikacji, otrzymane materiały zostają odesłane do głównego Autora bez dalszej recenzji. Podobnie
jest w przypadku, gdy prace są przygotowane niezgodnie z instrukcjami (zob. powyżej), jednak po stosownej korekcie
mogą być złożone ponownie. Merytoryczna recenzja – sporządzona na podstawie opinii dwóch Recenzentów – zostaje przesłana Autorowi/Autorom. W przypadku sprzecznych recenzji, Redaktor Naczelny powołuje „Superrecenzenta”,
którego decyzja jest obowiązująca. Ostateczna decyzja odnośnie akceptacji pracy do druku następuje po wykonaniu
zaleconej przez Recenzenta korekty. Decyzja o odrzuceniu pracy należy do uprawnień Redakcji i nie podlega odwołaniu. Redakcja nie musi uzasadniać podjętych decyzji. Lista recenzentów jest publikowana w ostatnim numerze
danego roku.
9. Oświadczenia
Redakcja CAMS uznaje zasady zawarte w Deklaracji Helsińskiej i w związku z tym oczekuje od Autorów, aby wszelkie
badania wykonane z udziałem człowieka zostały przeprowadzone zgodnie z tymi zasadami.
W przypadku eksperymentów na zwierzętach wymagamy przestrzegania międzynarodowych zasad i wytycznych w
zakresie udziału zwierząt w badaniach i edukacji wydanych przez Komisję ds. Badań na Zwierzętach przy Nowojorskiej
Akademii Nauk. Wymagana jest również zgoda komisji bioetycznej, właściwej dla głównego Autora, na prowadzenie
eksperymentów z udziałem ludzi lub zwierząt. Wskazane jest załączenie kopii wyżej wymienionego dokumentu do
złożonej pracy.
Redakcja wyjaśnia, że wszelkie zdarzenie typu „ghostwriting”, „guest authorship” są przejawem nierzetelności naukowej, a wszelkie wykryte przypadki będą demaskowane – włącznie z powiadomieniem odpowiednich podmiotów
(instytucje zatrudniające Autorów, towarzystwa naukowe, stowarzyszenia edytorów naukowych itp.).
Z „ghostwriting” mamy do czynienia wówczas, gdy ktoś wniósł istotny wkład w powstanie publikacji, bez ujawnienia
swojego udziału jako jeden z autorów lub bez wymienienia jego roli w podziękowaniach zamieszczonych w publikacji.
Z „guest authorship” („honorary authorship”) mamy do czynienia wówczas, gdy udział autora jest znikomy lub w ogóle
nie miał miejsca, a pomimo to jest autorem/współautorem publikacji.
Oświadczenie (dostępne na www.medsport.pl/czasopisma) jest zgodne ze stwierdzeniem, że:
• złożona praca jest własna,
• wyniki badań nie zostały wcześniej opublikowane lub złożone do druku w innym czasopiśmie,
• wszyscy Autorzy wymienieni na stronie tytułowej wyrazili zgodę na złożenie tej pracy do czasopisma CAMS.
10. Konflikt interesów
Redakcja CAMS oczekuje, że Autorzy artykułów nie będą mieli udziału finansowego w firmie mającej w ofercie produkt przedstawiany w tekście lub w innej firmie konkurującej z tą firmą.
W przeciwnym wypadku powinni ujawnić (w momencie złożenia pracy) istnienie jakichkolwiek umów z firmą, której
produkt jest przedmiotem dyskusji w pracy. Podczas procesu recenzowania informacje te pozostają do wyłącznej
wiadomości Redakcji i nie będą miały wpływu na naukową ocenę pracy. Jednak w momencie zatwierdzania artykułu
do druku, Redakcja uzgodni z Autorem formę upowszechnienia tej informacji lub odstąpi od tego.
CAMS 2/2013
169
Regulamin czasopisma wymaga, aby Recenzenci i Redaktorzy ujawnili (w piśmie do Redaktora Naczelnego) istnienie
jakichkolwiek związków, które mogłyby stanowić podstawę do podejrzenia konfliktu interesów wobec Autora pracy.
Pismo winno zawierać również ujawnienie jakichkolwiek umów z firmą komercyjną związaną z przedstawianym w
artykule produktem medycznym.
11. Poufność informacji o pacjencie
Badanych należy identyfikować wyłącznie za pomocą inicjałów lub cyfr. Informacje zawarte na fotografiach, w tabelach i rycinach, które mogą ujawnić tożsamość osoby badanej, muszą być starannie wymazane lub zamaskowane.
Twarze osób pokazanych na zdjęciach należy zamaskować lub pokryć czarnym paskiem. Jeżeli zawarte w artykule
informacje umożliwiają w jakikolwiek sposób ustalenie tożsamości badanej osoby, Autorzy muszą uzyskać pisemną
zgodę tej osoby lub jej opiekuna na opublikowanie wyników (w tym zdjęć fotograficznych, obrazów radiologicznych i
innych). Szczegóły dotyczące rasy, pochodzenia etnicznego, kulturowego i religii osoby badanej powinny być podane
wyłącznie w przypadku, gdy, zdaniem Autora, wywierają wpływ na przebieg choroby i/lub terapii dyskutowanych w
treści pracy.
12. Przekaz praw autorskich
Po akceptacji pracy do druku w Complementary and Alternative Medicine in Science Autorzy cedują prawa autorskie
na rzecz Agencji Wydawniczej MEDSPORTPRESS Sp. z o.o. Od tego momentu nie wolno ujawniać zawartych w niej
informacji (do czasu ukazania się numeru czasopisma, w którym artykuł występuje). Bez pisemnej zgody MEDSPORTPRESS nie można opublikowanej pracy wykorzystywać w innych celach.
13. Zezwolenia na druk
Materiałom wykorzystanym z innych źródeł musi towarzyszyć pisemna zgoda pierwszego Autora oraz wydawcy pierwotnej publikacji. W przypadku prac niepublikowanych lub informacji ustnych, należy uzyskać pisemną zgodę osoby
udostępniającej niepublikowane dane wykorzystywane w artykule.
14. Odpowiedzialność cywilna
Wydawca i Rada Naukowa czynią wszelkie starania, aby zapewnić rzetelność informacji, opinii i stwierdzeń zawartych w każdym artykule ukazującym się w Complementary and Alternative Medicine in Science. Niemniej jednak,
za treść artykułów i reklam odpowiada wyłącznie Autor, sponsor lub firma marketingowa. Zgodnie z powyższym ani
Wydawca, ani Rada Naukowa nie ponoszą odpowiedzialności za skutki ewentualnych nierzetelności. Redakcja zaleca
Czytelnikom, aby wszystkie metody i techniki opisane w Complementary and Alternative Medicine in Science były
stosowane wyłącznie zgodnie z instrukcjami i zaleceniami producentów leków lub sprzętu, wydanymi w kraju danego czytelnika.
Niniejszy regulamin jest zgodny z wytycznymi opracowanymi przez Wspólny Komitet Wydawców Czasopism Biomedycznych, opublikowanymi w opracowaniu pt. „Jednolite wymagania dotyczące prac złożonych do druku w czasopismach biomedycznych” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals N Eng J Med 1997;
336: 309–15; http://www.icmje.org/index.html).
Kontakt:
Agencja Wydawnicza MEDSPORTPRESS Sp. z o.o.
Redakcja „Complementary and Alternative Medicine in Science”
al. Stanów Zjednoczonych 72/176
04-036 Warszawa
tel./faks: (48 22) 834-67-72 lub 405-42-72, tel. kom.: (48) 501-174-360
e-mail: [email protected] lub [email protected]
170
CAMS 2/2013

110 redakcyjna_Layout 1 - Agencja Wydawnicza MEDSPORTPRESS

Transcription

Similar documents

Haramara flyer

healing yoga for cancer survivors

(2 Blocks West Of Un i versity Ju st South Of Richmond

Yoga Therapy Clinic - Bodhi Tree Yoga Centre

Air Zero-G Massage Chair - Tai Sheng Healthcare Machinery Co., Ltd.

free intro11.16.13fullpg

Ashiatsu at Spa qualia

chanting flyer - Open Sky Yoga Center

unique gif ts salon and spa

the brochure