Background: Our hospital is located in Beppu city, which bears the most hot spring fountainheads in the world. Here we present two studies showing the therapeutic and preventive effects of hot spring bathing. Hot spring bathing has been reported to be therapeutically useful for mentally and physically pathophysiological conditions because of its thermal and pharmacological effects. (1) The verification of the therapeutic effect of pelotherapy for the patients with fibromyalgia. (2) The epidemiological study by a questionnaire with questions of past history of hot bathing and diseases including depression and lifestyle related diseases of citizens over 65 years old of Beppu city. Methods: (1) Seven patients with fibromyalgia (age; 60-78 y.o.) were treated by pelotherapy for 30 days. The patients took mud-bathing at 40 C for 10 minutes a day on weekday. Geriatric Dementia Scale (GDS; 15 for full score) and Face Scale (FS; 20 for full score) for systemic pain were evaluated before and after pelotherapy. (2) Twenty thousand Beppu citizens over 65 y.o. were sent the questionnaire including questions of the participants’ past history of diseases including cancers, apoplexy, ischemic heart disease, diabetes mellitus, asthma bronchiale, collagen diseases, etc. and of their habits of hot spring bathing. The logistic analysis was used for statistical analysis. Results: (1) The mean GDS score and the mean FS score before pelotherapy were 6.6+2.5 and 12.9+5.1, and those after pelotherapy 3.3+1.3, 6.1+5.5, respectively. (2) We received filled-out questionnaires from 4,706 men and 6,352 women. Forty-eight percent of the replying participants take a hot spring bath daily. Age adjusted, hot spring users showed less rate of some diseases, All (daily % : non-daily % (p-value), Ischemic heart disease 6.2 : 7.2 (0.047), Apoplexy 2.0 : 3.1 (<0.001), Hypertension 36.2 : 38.5 (0.016), Arrhythmia 7.9 : 9.5 (0.004), Bronchial Asthma 3.0 : 4.4 (<0.001), Diabetes Mellitus 12.4 : 14.2 (0.006), Renal disease 2.9 : 3.9 (0.009), Depression 1.5 : 2.7 (<0.001)), Men (daily % : non-daily % p-value, Apoplexy 3.1 : 4.2 (0.045), Renal disease 3.8 : 5.4 (0.011)), and Women (Ischemic heart disease 3.8 : 5.1 (0.018), Apoplexy 1.1 : 2.3 (0.001), Arrhythmia 6.7 : 8.4 (0.011), Bronchial Asthma 2.9 : 4.6 (<0.001), Diabetes Mellitus 8.6 : 10.8 (0.004), Depression 1.6 : 3.3 (<0.001)). Conclusion: Pelotherapy raises efficiently body temperature leading to relieve mental and physical stress, that is, depression and pain. The study with questionnaire showed that hot spring bathing may be beneficial for lowering incidents of some diseases with gender association. The results of both studies highlightened the physical and mental effects of hot spring bathing for disease-prevention and -therapy.

  Objective: Beppu city is a world-famous resort. Spa bathing has been reported to yield psychophysiological relaxation. Beppu city office planned a health-promoting tour including spa-bathing activities in Beppu for the aging population, which is growing rapidly in Japan. This tour provided spa-bathing experiences, walks through urban districts where old townscapes remain, yoga, mountain hikes and shrine visits. We investigated whether such a short tour brought about a detectable medical effect toward health promotion for the elderly.  Methods: Twenty applicants (mean age: 67.7±3.5 years; male, n＝9 [mean age, 68.9±2.9 years]; female, n＝11 [mean age, 66.7±3.7 years]), joined the tour. These voluntary participants, who were over 60 years of age, participated in a five-day-tour in Oita prefecture. Health checks were conducted on the first and last days of the tour. This tour was conducted in areas containing a gulf, mountain areas, lakeside areas, forests and shrines. Participants visited these areas during the tour.  Outcome Measures: The following parameters of the participants were measured at the beginning and end of tour: stress score, blood pressure, salivary amylase level, serum C-reactive protein level, and serum cortisol level. The results were compared and analyzed by a paired t-test and a simple regression analysis.  Results: The mean values of the following parameters (pre-intervention and post-intervention) showed significant changes after the program: stress score (43.7±8.05 and 39.4±6.57; p-value＝0.005); systolic blood pressure (131±17.8 mmHg and 125±16.2 mmHg; p＝0.018); diastolic blood pressure (73±7.3 mmHg and 70±6.6 mmHg; p＝0.016); serum cortisol (7.7±3.16 µg/dL and 6.1±1.82 µg/dL; p＝0.027). Moreover, the participants’ cortisol levels tended to converge into a normal range.   Conclusion: Tourism in a spa resort can relieve mental and physical stress, reducing blood pressure and correcting the adrenocortical function.

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

Objective：The aim of this study was to develop an 8-item Japanese Arthritis Self-Efficacy Scale (ASES-8J）and perform pilot testing of its face validity and internal consistency in patients with osteoarthritis of the knee.Methods：Translation of the ASES-8J from English into Japanese was performed via forward-translation, back-translation, review by the original developer, and production of the pre-final version. We calculated the mean and standard deviation and Cronbach's alpha coefficient to assess internal consistency. Face validity was assessed by reviewing the results of the pilot study and using in-depth questionnaires on the responders' understanding of the ASES-8J.Results：Forty-one patients with osteoarthritis of the knee participated in the pilot study, with 38 providing valid responses. The mean ± standard deviation was 5.7 ± 2.2. Cronbach's alpha coefficient was 0.96, indicating high internal consistency. Of the responders, 54.9％ stated that it the ASES-8J was very easy or easy to answer. The original developer reviewed ASES-8J to confirm its usefulness.Conclusion：The results indicate that ASES-8J is a useful tool to assess the self-efficacy of patients with osteoarthritis of the knee.

Objective：The aim of this study was to develop an 8-item Japanese Arthritis Self-Efficacy Scale (ASES-8J）and perform pilot testing of its face validity and internal consistency in patients with osteoarthritis of the knee.Methods：Translation of the ASES-8J from English into Japanese was performed via forward-translation, back-translation, review by the original developer, and production of the pre-final version. We calculated the mean and standard deviation and Cronbach's alpha coefficient to assess internal consistency. Face validity was assessed by reviewing the results of the pilot study and using in-depth questionnaires on the responders' understanding of the ASES-8J.Results：Forty-one patients with osteoarthritis of the knee participated in the pilot study, with 38 providing valid responses. The mean ± standard deviation was 5.7 ± 2.2. Cronbach's alpha coefficient was 0.96, indicating high internal consistency. Of the responders, 54.9％ stated that it the ASES-8J was very easy or easy to answer. The original developer reviewed ASES-8J to confirm its usefulness.Conclusion：The results indicate that ASES-8J is a useful tool to assess the self-efficacy of patients with osteoarthritis of the knee.