June 14, 2008

Health Benefits for Women Staying With Their Husbands During a Long- Term Trip to a Hot Springs Spa

By Toda, Masahiro Makino, Hiroaki; Kobayashi, Hidetoshi; Morimoto, Kanehisa

ABSTRACT. The authors collected saliva samples from 15 married couples and 13 women staying with a female companion (N = 43) during an 8-day stay at a spa resort in Nagano, Japan. To examine changes in endocrinological stress markers, the authors evaluated participants' levels of salivary cortisol and chromogranin A (CgA) by enzyme-linked immunosorbent assay. By the eighth day, women staying with their husbands had significantly increased levels of cortisol and CgA. During the protocol, the authors observed no significant variation in levels of cortisol or CgA for either the women who were staying with same-sex companions or the male spouses. These findings suggest that the effects of long-term stays in a spa resort are more beneficial for married women staying with their husbands than for either married men or women staying with female companions. KEYWORDS: chromogranin A, cortisol, health benefits, travel

Traveling to another place for a vacation represents a complete change from everyday life-which is often stressful-but scientific researchers have yet to document any beneficial health effects. In previous research,1 using salivary cortisol and chromogranin A (CgA) as endocrinological stress markers, we found that although longterm stays in spa resorts likely yield health benefits, these vary according individual characteristics, such as recent life events and lifestyle. During their stay at the spa, participants who reported short sleeping hours or numerous life events in ordinary life were more likely to acquire eu-stress (comparable to euphoria; the experience of feeling uplifted or fulfilled), probably because of they were able to relax at the spa.1

We conducted the present study to elucidate the health effects of vacation. We examined changes in salivary endocrinological stress markers of married couples and women staying with same-sex companions during the course of a long-term stay at a hot springs spa. Evaluation of salivary endocrinological stress markers is a useful method for assessing stress objectively via quantitative measurement (vs self-reported or interview-based data); furthermore, collection of saliva is a convenient sampling method because it is noninvasive and relatively nonstressful.2

Produced in the adrenal cortex, cortisol is the main glucocorticoid hormone in humans. It is released in response to various psychosocial stimuli originating from the hypothalamuspituitary-adrenal (HPA) axis. The cortisol level in saliva accurately reflects the level of active, free (ie, nonbound) cortisol in the blood.2,3 CgA is an acidic glucoprotein that is released along with catecholamines from the adrenal medulla and the sympathetic nerve endings.4"6 According to Saruta et al,7 CgA is produced by human submandibular glands and secreted into saliva. Salivary CgA has recently begun to be recognized as a stress marker.8,9



Participants were 15 male (M age = 71.7 +- 4.7 years) and 28 female (71.5 +- 6.3 years) volunteers. Fifteen women were staying with their husbands; that is, 15 married couples were included in the study. The remaining 13 women were staying with female companions. All participants were guests in a resort hotel at the Kakeyu Spa in Nagano Prefecture, Japan for 8 days. The hotel imposed no schedule on the guests, and most participants spent large parts of their waking time bathing in the hot springs and taking walks.

Saliva Sampling

Immediately after waking, each participant swabbed his or her mouth for 2 minutes using a cotton ball (a) 2 days before leaving for the spa, (b) daily while at the spa, and (c) 2 days after returning home from the spa. In a previous study10 of salivary cortisol and CgA levels, we found that results from samples taken at waking were more accurate indicators of stress responses than were results from samples taken before lunch or dinner. A Salivette device (Sarstedt Co Ltd, Numbrecht, Germany) extracted the saliva samples by centrifuging (at 3,000 rpm for 15 min) each participant's cotton balls. We stored the samples at -80[degrees]C. Following a previously described method,11,12 we evaluated the levels of salivary cortisol and CgA using enzyme-linked immunosorbent assay. To estimate the trip's overall effect on stress level, we stratified results obtained during the stay into 3 periods: days 1-3 (early), days 4 and 5 (middle), and days 6-8 (late).

Fig. 1. For people staying 8 days at a spa hotel/ changes in mean measured values (+- SD) of (A) salivary cortisol and (B) chromogranin A (CgA) in samples taken from women staving with spouses (e, n = 15)/ women staving with female companions rather than spouses (a, n = 13)/ and male spouses (o/ n = 15). 'Significantly different from before travel, p < .05. tSignifieanHy different from after travel, p < .05 (repeated measures analysis of variance and Bonferrom's test).

Health-Related Lifestyle Factors and Life Events

Before the trip, we evaluated participants' lifestyle and life events by means of a written questionnaire. We assessed health- related lifestyle factors with the 8-item Health Practice Index (HPI)11-15: smoking habits, drinking habits, daily consumption of breakfast, appropriate daily duration of sleep and work, regular physical activity, nutritionally balanced diet, and appropriate levels of subjective stress. On the basis of the lifestyle study by Belloc and Breslow16-and taking into consideration cultural differences-we customized the questionnaire and scoring for Japanese participants. Modifications particularly addressed nutritional balance and mental stress. For instance, many Japanese are aware that a diet containing a large quantity of vegetables and little meat may lower mortality from some cancers.17,18 Furthermore, Japanese society differs from US society in that work and social activities are much more closely related.

We evaluated life events using the Holmes and Rahe Social Readjustment Rating Scale19 in which the number of life change units- points allocated to events experienced over the past year-are added up. This scale is based on the premise that life events can increase stress levels and make one more susceptible to illness and mental health problems.

Statistical Analyses

We performed analyses of variance (ANOVAs) with repeated measures to detect intergroup and time-related differences. We also used an ANOVA to analyze differences in HPI and life-event scores among the groups. We used Bonferroni's test for multiple comparisons and considered values to be significantly different at p < .05.


Figure 1 shows mean levels of salivary cortisol and CgA in women staying with their husbands, women staying with female companions, and men staying with their wives during their time at the spa. For women staying with husbands, salivary cortisol levels were significantly higher during the middle and end of their stay than before and after the trip (F[4, 56] = 4.75, p < .01). Furthermore, this group had significantly higher CgA levels during mid-stay than before the trip (F[4, 56] - 3.78, p < .01). During the protocol, neither women staying with female companions nor men staying with their wives showed any significant variation in the levels of cortisol or CgA.

The average HPI score for women staying with their husbands was 6.7 +- 1.2; women staying with female companions, 6.7 +- 0.8; and men staying with their wives, 6.2 +- 1.1. Life-event scores were 84.9 +- 67.4, 71.6 +- 70.9, and 81.7 +- 54.2, respectively. We observed no significant differences among the groups in HPI or life- events scores.


Cortisol secretion is characterized by a strong circadian rhythm. The levels peak within 30 minutes of awakening and then decrease gradually over the course of the day.3,20 Researchers have also reported that aging,21,22 fatigue,23,24 stress,25 and amnesia26 can lower morning cortisol levels, which is likely linked to decreased hippocampal functioning.27 Thus, higher levels of cortisol in the morning-the time of the acrophase-may be associated with good health. Of the 3 groups, women staying with their husbands had the lowest baseline levels of cortisol 2 days before departure (p < .05). In this group, however, cortisol levels increased significantly during the trip. These findings may have resulted from the fact that they were all housewives and thus had no household chores during the trip. This conjecture would also account for a decrease in the levels of cortisol in this group after the trip, at which time a backlog of housework presumably had accumulated. Furthermore, for women staying with their female friends, all but one was widowed or unmarried, and, for men staying with their wives, all but one was retired. Thus, they may experience less stress than do housewives in everyday life.

Whereas cortisol levels are reflective both mental and physical stress, levels of salivary CgA are an index only of mental stress, which responds more sensitively (than cortisol) to levels of positive mental eu-stress and negative distress.8,9 In recent research, we found that in healthy persons, eu-stress inducers-such as laughter, spa bathing, or coffee intake-are associated with significant increases salivary CgA levels.28"30 Furthermore, we found that elevated salivary CgA levels during a short stay (2 nights) in a spa resort were attributed to eu-stress.10 When the duration of stay was longer (eg, 7 nights) and all participants were repeat visitors, the increase in CgA levels was likely associated more with feeling fulfilled rather than uplifted.1 For women staying with their husbands in the current study, we observed a significant increase in the levels of CgA during the trip. We saw no such change in either women staying with female companions or in men staying with their wives. These findings suggest that women staying with their husbands acquired eu-stress in the form of feeling fulfilled. As described previously, women who ordinarily have more extensive household responsibilities may have been more relieved by the leisure afforded by the trip and more satisfied by its contrast with their everyday routine. Because only 1 of the women who were staying at the spa with female companions lived with husbands, we suggest further investigation of married women taking vacations with female companions to confirm this finding.

In a recent study, we found that long-term stays likely have beneficial health effects, but these varied according individual characteristics, such as health-related lifestyle or life events.1 In the present study, however, we found no significant difference among the groups in HPI or life-events scores. These findings suggest that in addition to personal characteristics, responsibilities associated with a particular social role (eg, a housewife) alter the effects of staying at a spa.

Our findings suggest that long-term stays in a spa probably yield beneficial health effects, especially for housewives. This research, however, was limited in several ways: all participants were staying at a luxurious resort hotel. Furthermore, the average age of the clientele meant that most of the men were retired and that most women staying with female companions were widowed. To establish general findings, therefore, further studies with different populations are required.


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Masahiro Toda, PhD; Hiroaki Makino, MCE; Hideioshi Kobayashi, BA; Kanehisa Morimoto, DMSc

Masahiro Toda and Kanehisa Morimoto are with the Department of Social and Environmental Medicine at Osaka University Graduate School of Medicine in Osaka, Japan. Hiroaki Makino and Hidetoshi Kobayashi are with the Japan Travel Bureau Foundation in Tokyo.

The authors thank the staff of hotel Saito for their cooperation.

For comments and further information, address correspondence to Prof Kanehisa Morimoto, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada- oka, Suita, Osaka, Japan 565-0871.

E-mail: [email protected]

Copyright Heldref Publications Spring 2008

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