Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 Synthesis Report on HEALPS’ main outputs: WP 2: Medical-scientific characterization of Alpine Health Resources WP T1: Assessment of Alpine regions’ Health Tourism Policy and Development Process D.T1.1.1: Synthesis report on HEALPS’ main outputs (I/IV) Lead Partner Paracelsus Medical University Salzburg Institute of Ecomedicine Authors: Christina Pichler, Renate Weißböck-Erdheim, Johanna Freidl, Carina Ro- modow, Michael Bischof, Arnulf Hartl Contact: [email protected] Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 Content 1 Report context 3 1.1 ARPAF project HEALPS 3 1.2 Alpine Space Project HEALPS 2 5 2 Identification of Alpine natural health resources 6 3 Characterization of Alpine natural health Resources: Medical Evidence and Checklist for Health Tourism Development 7 3.1 Methodological Approach 7 3.2 Medical-scientific characterization & Checklist 10 3.2.1 Air ions 10 3.2.2 Balneotherapy in Alpine healing waters 12 3.2.3 Alpine water – Blue space 20 3.2.4 Alpine creeks for Kneipp hydrotherapy 26 3.2.5 Waterfalls 30 3.2.6 Alpine mountain hiking 32 3.2.7 Climbing / Outdoor bouldering 41 3.2.8 Forest therapy 46 3.2.9 Protected areas & biodiversity 51 3.2.10 Alpine Farming and Alpine pastures - Environmental microbes 56 3.2.11 High altitude 62 3.2.12 Moderate altitude 63 3.2.13 Apitherapy 71 3.2.14 Honey 74 3.2.15 Alpine milk and dairy products 76 3.2.16 Plants / Phytotherapy 81 3.2.17 Winter - snow-based activities 85 3.2.18 Winter - Not snow-based activities 94 3.2.19 Radon 98 3.2.20 Speleotherapy 101 4 References 102 5 Figures 126 6 Tables 126 page 2 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 1 Report context The present synthesis report summarizes the results of work package 2 - Mapping of Alpine health resources within the ARPAF project HEALPS for the integration in the Health Tourism Assessment and Benchmarking Tool (HTAB) of the Project HEALPS2. The analysis was carried out by the Institute of Ecomedicine at the Paracelsus Medi- cal University Salzburg. 1.1 ARPAF project HEALPS HEALPS was a project funded by the Alpine Region Preparatory Action Fund (ARPAF) and built the base for the Alpine Space Project HEALPS2. Project Title: HEALPS - Alpine Health Tourism – Positioning the Alpine region as globally attractive health promoting place Project Partners: • Innovation and Technology Transfer Salzburg (AT, Lead) • Foundation Cluster Technologies For Living Environments (IT) • University of Applied Sciences Chur (CH) Funding: The project is co-financed by the European Union (Alpine Region Preparatory Action Funds - ARPAF) Start and closure dates: January 2018 to June 2019 Project Outline: Outdoor recreation in natural environments is becoming an important aspect of healthy living and a remedy against the deficiencies of urban life separated from na- ture. With its exceptional nature, cultural heritage, healthy climate and long tourism tradition, the Alpine region possesses significant prerequisites to benefit from this trend. However, to date there is no awareness of the unique health-promoting po- tential of the Alpine region. Major reasons for this lack of awareness are insufficient visibility and knowledge of health-promoting Alpine assets. In contrast to the current, fragmented approaches towards the promotion of Alpine assets, the project HEALPS aims to develop a common basis for the positioning of the Alpine region as an attractive health-promoting place through data compilation, page 3 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 generation and the visualisation of unique Alpine assets related to health. The project incorporates four different perspectives: Alpine resources, customers and providers as major stakeholders, education and technology. This approach addresses EUSALP’s strategy of a better utilisation of Alpine-specific resources and creates a basis for the development of Alpine health tourism value chains to drive job creation and growth in remote Alpine areas. In this way, it coun- teracts depopulation in these areas through new business opportunities and posi- tions the Alpine region as healing environment for tourists and as an attractive envi- ronment for working and residing. The project covers six work packages (see Figure 1) The present report summarizes the medical evidence regarding unique Alpine assets as a basis for evidence-based health tourism development that can be integrated in hands-on tools within the Alpine Space Project HEALPS2. Figure 1: HEALPS work packages page 4 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 1.2 Alpine Space Project HEALPS 2 Tourism is a major engine for job creation and a driving force for economic growth and development in the Alpine programme area. Yet alpine tourism is currently ex- periencing challenges such as climate change and is often only focussed on specific regions. Global trends such as a thirst for nature-based experiences and increased health consciousness hold considerable opportunities for developing innovative na- ture-based health tourism experiences. To fulfil this potential, the project will provide policy-makers, regional developers, Alpine regions and SMEs access to innovation knowledge and to implementation tools. Building on the ARPAF project HEALPS, the aim is to improve framework conditions for utilising Alpine natural health resources by developing health tourism products and service chains. Lessons learnt from existing innovative, but fragmented cases will be elevated to a transnational level. Supported by the combination of the latest re- search results with digital solutions, the nature-based health tourism approach will be tested in pilot regions and the experiences then translated into relevant tools for Alpine regional development. By engaging quadruple helix stakeholders, cross ferti- lisation between tourism, health and other relevant sectors and co-learning is stim- ulated at transnational level. This shared knowledge at various scales facilitates framework conditions for value generation based on location-bound Alpine assets. Recommendations for different policy levels as well as guidelines & implementation toolkits for product and service chain development reflect the purpose of a broad implementation of hands-on knowledge for the stimulation of SME- and destination driven innovation. Two international conferences on Alpine health tourism will allow transnational & transversal knowledge transfer from academia to regions and SMEs. Thus, the project contributes to the positioning of the Alpine Space as globally at- tractive health promoting place. HEALPS2 lasts from October 2019 to June 2022 and is co-financed by the European Regional Development Fund through the Interreg Alpine Space programme (Total budget: 2.169.952,65€ - ERDF grant: 1.844.459,74€). page 5 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 2 Identification of Alpine natural health resources 20 Alpine health resources relevant for the development of Alpine health tourism were identified and are shown in Figure 2. Figure 2: Identified Alpine natural health resources page 6 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 3 Characterization of Alpine natural health Resources: Medical Evidence and Checklist for Health Tourism Development 3.1 Methodological Approach The 20 identified resources were characterized regarding their impact on human health and well-being using an indication-based approach. The research was con- ducted using the biomedical database PubMed (NCBI, 2019). A database was created and systematically analyzed using an indication-based approach (see Figure 3and Figure 4). Each identified Alpine resource was characterized regarding its potential health ef- fects based on available published data. The evidence level of each resource regard- ing specific indications was visualized by use of the Evidence Levels of the Agency for Health Care Policy and Research (AHCPR, see Table 1). In this way, also research gaps were identified. Figure 3: Extract from the HEALPS database page 7 of 126 Healing Alps: Tourism based on natural health resources as strategic innovation for the development of Alpine regions ASP815 Figure 4: Indication-based approach to the medical-scientific characterization of Alpine resources Evidence levels of Agency for Health Care Policy and Research (AHCPR) Level Type of scientific evidence Scientific evidence obtained from meta-analyses of randomized clini- Ia cal trials. Ib Scientific evidence obtained from at least one randomized clinical trial. Scientific evidence obtained from at least one well-designed, non-ran- IIa domized prospective study. Scientific evidence obtained from at least one well-designed, quasi-ex- IIb perimental study. Scientific evidence obtained from well-designed observational studies, III such as comparative studies, correlation study or case-control studies. Scientific evidence obtained from documents or opinions of expert IV committees and/or clinical experience of renowned