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Clinical Effects of Regular Dry Sauna Bathing: a Systematic Review

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Clinical Effects of Regular Dry Sauna Bathing: a Systematic Review Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2018, Article ID 1857413, 30 pages https://doi.org/10.1155/2018/1857413 Review Article Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review Joy Hussain and Marc Cohen School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia Correspondence should be addressed to Joy Hussain; [email protected] Received 9 October 2017; Revised 14 December 2017; Accepted 8 January 2018; Published 24 April 2018 Academic Editor: Kieran Cooley Copyright © 2018 Joy Hussain and Marc Cohen. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Many health benefts are claimed by individuals and facilities promoting sauna bathing; however the medical evidence to support these claims is not well established. Tis paper aims to systematically review recent research on the efects of repeated dry sauna interventions on human health. Methods. A systematic search was made of medical databases for studies reporting on the health efects of regular dry sauna bathing on humans from 2000 onwards. Risk of bias was assessed according to the Cochrane Collaboration guidelines. Results. Forty clinical studies involving a total of 3855 participants met the inclusion criteria. Only 13 studies were randomized controlled trials and most studies were small (� < 40). Reported outcome measures were heterogeneous with most studies reporting benefcial health efects. Only one small study (� = 10) reported an adverse health outcome of disrupted male spermatogenesis, demonstrated to be reversible when ceasing sauna activity. Conclusions. Regular dry sauna bathing has potential health benefts. More data of higher quality is needed on the frequency and extent of adverse side efects. Further study is also needed to determine the optimal frequency and duration of distinct types of sauna bathing for targeted health efects and the specifc clinical populations who are most likely to beneft. 1. Introduction with similar exposure times [2]. Both traditional Finnish and infrared sauna bathing can involve rituals of cooling-of Sauna bathing is a form of whole-body thermotherapy that f periods and rehydration with oral fuids before, during, has been used in various forms (radiant heat, sweat lodges, and/or afer sauna bathing. etc.) for thousands of years in many parts of the world Sauna bathing is inexpensive and widely accessible with for hygiene, health, social, and spiritual purposes. Modern Finnish-style saunas more ofen used in family, group, and day sauna use includes traditional Finnish-style sauna, along public settings and infrared saunas more commonly built and with Turkish-style Hammam, Russian Banya, and other marketed for individual use. Public sauna facilities can be cultural variations, which can be distinguished by the style located within exercise facilities and the relationship between of construction, source of heating, and level of humidity. saunas and exercise, which may include synergistic hormetic Traditional Finnish saunas are the most studied to date responses, is an area of active research [3–8]. Te use of and generally involve short exposures (5−20 minutes) at private saunas, especially involving infrared saunas, is also ∘ ∘ temperatures of 80 C–100 Cwithdryair(relativehumidityof increasing and saunas are used for physical therapy in mas- 10% to 20%) interspersed with periods of increased humidity sage clinics, health spas, beauty salons, and domestic homes. created by the throwing of water over heated rocks [1]. In the Tis trend is capitalising on the call for additional lifestyle past decade, infrared sauna cabins have become increasingly interventions to enhance health and wellness particularly popular. Tese saunas use infrared emitters at diferent wave- in populations that have difculty exercising (e.g., obesity, lengths without water or additional humidity and generally chronic heart failure, chronic renal failure, and chronic ∘ run at lower temperatures (45–60 C) than Finnish saunas liver disease) [9]. Facilities ofering sauna bathing ofen 2 Evidence-Based Complementary and Alternative Medicine claim health benefts that include detoxifcation, increased 2. Methods metabolism, weight loss, increased blood circulation, pain reduction, antiaging, skin rejuvenation, improved cardiovas- PRISMA guidelines for conducting systematic reviews were cular function, improved immune function, improved sleep, followed, including the use of validated tools to assess the risk stress management, and relaxation. However, rigorous medi- of bias in randomized controlled trials [70–72]. cal evidence to support these claims is scant and incomplete, 2.1. Eligibility Criteria. Studies of humans undergoing as emphasized in a recent multidisciplinary review of sauna repeated dry sauna bathing that reported on health measures studies [10]. were included in the review. Studies were included for initial Tere is considerable evidence to suggest that sauna review if they were published in English language from bathing can induce profound physiological efects [4, 11–17]. January 2000 onwards and involved research in humans Intense short-term heat exposure elevates skin temperature undergoing repeated dry sauna sessions with at least one andcorebodytemperatureandactivatesthermoregula- reported health outcome. Studies involving predominantly tory pathways via the hypothalamus [18] and CNS (central high-humidity (>50%) wet/steam “sauna” or immersion nervous system) leading to activation of the autonomic hydrotherapy were excluded for the potential confounding nervous system. Te activation of the sympathetic ner- mechanisms of diferential sweating rates and explicit focus vous system, hypothalamus-pituitary-adrenal hormonal axis, of this review limited to “dry sauna” interventions. Studies and the renin-angiotensin-aldosterone system leads to well- of partial body heating were excluded since proposed documented cardiovascular efects with increased heart rate, mechanisms of action may or may not be the same as whole- skin blood fow, cardiac output, and sweating [1, 11]. Te body heating. Studies reporting primarily animal-based, resultantsweatevaporatesfromtheskinsurfaceandproduces nonhuman fndings were excluded given the recognized cooling that facilitates temperature homeostasis. In essence, diferences in end-organ (skin) structure and responses sauna therapy capitalises on the thermoregulatory trait of (sweating mechanisms) between animals and humans. homeothermy, the physiological capability of mammals and Studies of “sauna” as a recruitment venue for potential sexual birds to maintain a relatively constant core body temperature activity, primarily regarding men who have sex with men with minimal deviation from a set point [19]. It is currently (MSM), were excluded since these studies lacked details unclear whether steam saunas invoke the same degree of of sauna interventions, confounding whether wet or dry physiological responses as dry saunas [20], as the higher interventions, and measured health metrics focused to sexual humidity results in water condensation on the skin and activity but not necessarily to sauna activity. reduced evaporation of sweat [21]. On a cellular level, acute whole-body thermotherapy 2.2. Search Strategy. PubMed, Web of Science, Scopus, and (both wet and dry forms) induces discrete metabolic changes Proquest were initially searched with keyword “sauna” and that include production of heat shock proteins, reduction date restrictions of January 2000–April 2017. Search dates of reactive oxygenated species, reduced oxidative stress and were chosen to focus on updated fndings refecting advanc- infammation pathway activities, increased NO (nitric oxide) ing technology in both diagnostics and physiological mon- bioavailability, increased insulin sensitivity, and alterations itoring to build upon the foundational literature of prior in various endothelial-dependent vasodilatation metabolic nonsystematic clinical reviews of sauna activity published in pathways [22]. It has been suggested that heat stress induces the early 2000s. Afer further restrictions of English language adaptive hormesis mechanisms similar to exercise, and there and humans, records were then expanded using Google are reports of cellular efects induced by whole-body hyper- Scholar, with searches for other research by key authors, thermia in conjunction with oncology-related interventions searches of citations and reference lists of original and review (i.e., chemotherapy and radiotherapy) [23]; however the articles, and other “related articles”. Additional searches with mechanisms by which the physiological and cellular changes expanded keywords relating to sauna including “interven- induced by sauna bathing contribute to enhanced health tional study”, “whole body hyperthermia”, and “whole body and/or therapeutic efects is still being explored [4, 7, 8, 24– thermotherapy” were also conducted with the same initial 27]. restrictions. Te following systematic review was undertaken to explore recent research on the clinical efects of repeated dry 2.3. Data Extraction. Abstracts of initially identifed studies sauna bathing (Finnish-style, infrared, or other dry sauna were screened by investigator JH and then the complete forms) to document the full range of medical conditions full-text articles of potentially eligible studies
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