A regular soak in a hot bath could help to improve a common painful circulatory disease, with this strategy being studied by researchers at Manchester Metropolitan University, thanks to funding from the British Heart Foundation.
The team behind the project are investigating whether immersion in hot water may relieve the symptoms of peripheral artery disease, which affects one in five people over the age of 60 in the UK to some degree.
Researchers are hosting regular hot tub sessions to test out the heat therapy - submerging people up to their shoulders in 40 °C water for an average of around 40 minutes.
Peripheral artery disease (PAD) is a condition where the arteries carrying blood from the heart are narrowed by a build-up of fatty material. It usually affects arteries in the legs, causing leg pain when walking even short distances.
Frequent heat therapy - such as a bath or hot tub session - can restore some blood flow to the legs, so could improve people’s pain and help them walk further, transforming their quality of life.
Hot Tub Therapy
The Manchester study, called HEATPAD (HEAT Therapy for Peripheral Artery Disease), which aims to recruit 70 people and has already begun, asks volunteers to bring their swimming costumes and sit in a hot tub three times a week. They will do this for eight weeks. One of the participants, Ken Heywood, was able to tackle his ‘Everest’ - a steep hill in his local park – after taking part.
Amy Harwood, professor in clinical exercise physiology at Manchester Metropolitan University Institute of Sport, leads the project, with co-supervision provided by Dr Tom Cullen from the University of Hull.
Professor Harwood said: “People with PAD are often advised to exercise to increase the blood flow to their legs. But the pain they experience can make walking and exercise less than enjoyable.
“If a hot tub or bath can provide similar benefits to exercise, then that could be much more pleasurable for people.
“It is up to people how they take their bath, and whether they want to include bubbles or a rubber duck, but the hot water is the important element, which we know has important cardiovascular benefits.
“We hope we will find evidence that it can relieve the pain of PAD, and improve people’s quality of life.”
People with PAD who are considering changing their bathing schedule should consult their GP, as being in hot water for long periods can cause blood pressure to drop and lead to dizziness. Many people with PAD also have cardiovascular disease, making this more of a risk.
Researchers will closely monitor the blood pressure of people in the new research project along with feelings of dizziness. However they hope to find a significant increase in people’s mobility as a result of the heat therapy.
Increase Independence
Some people with PAD can manage no more than 30 steps (22 meters) before they are in pain, and walk only half the length of a football pitch (59 meters) before they have to stop. Being able to walk further could increase independence and greatly improve their quality of life.
In order to cool down, when you are in a hot bath or hot tub, heat is carried in your blood to the surface of the skin, so it can escape from the body. The blood vessels expand to do this, increasing blood flow. This may relieve the symptoms of PAD, because more oxygen-rich blood reaches the leg muscles.
The team will measure how far people can walk before and after eight weeks of regular bathing, as well as changes in leg and foot pain, and discomfort from pins and needles, cold feet and ulcers caused by a lack of blood flow.
The project volunteers will report if everyday tasks like washing and dressing or doing housework, become easier. They will fill out questionnaires on limitations doing activities like sports and socializing, feelings of anxiety and depression, and PAD-related fears about becoming housebound or losing a limb.
Researchers hope these measures may improve following regular hot tub sessions.
Soaking in a bath or hot tub can be a good way to relax and there is evidence that doing this regularly may be good for the heart. So it will be very interesting to see if hot baths could also help to alleviate the symptoms of peripheral artery disease."
Regina Giblin, Senior Cardiac Nurse, British Heart Foundation (BHF)
“Living with pain, which strikes after walking only a short distance, has a real impact on people’s wellbeing and independence. They may find physical activity uncomfortable, so it would be incredibly useful to find other strategies for managing PAD which could help alongside exercise.
“Until there are results from this project, however, we would always advise people with cardiovascular concerns to speak to their GP or cardiac nurse before using hot tubs or taking very hot baths, especially if they’ve experienced angina, arrhythmias, or unstable blood pressure.”
“Alternative Needed”
William Carey, a PhD candidate who is running the research project from the Department of Sport and Exercise Sciences, at Manchester Metropolitan University Institute of Sport, said: “Hot tubs can be expensive, but baths are easier to use in everyday life.
“If we find that regular 40 °C baths can alleviate the symptoms of PAD, that would give us another option to offer people.
“It is important because many people advised to exercise have disabling pain, lack of facilities and low motivation to do physical activity. An alternative is greatly needed.”
The study is recruiting people aged 18 and over, who have PAD and intermittent claudication, and have received treatment within Manchester University NHS Foundation Trust.
Intermittent claudication, the main symptom of PAD, is the medical term for pain in the legs when walking which goes away with rest.
At least 400,000 people in the UK have been diagnosed with PAD.
Case Study:
Getting into his swimming trunks and sitting in a hot tub for 45 minutes became one of Ken Heywood’s favorite activities during his involvement in the HEATPAD project.
The 75-year-old, from Stockport, Greater Manchester, had never been in a hot tub before and rarely took a bath, preferring his daily shower. But he soaked in hot water three times a week for two months after signing up to the clinical trial run by Manchester Metropolitan University to see if heat therapy can relieve the symptoms of peripheral arterial disease (PAD).
Having lived with PAD for almost 40 years, Ken’s condition became much worse two years ago, when he could only walk 100 yards with his dog without needing to stop because of the leg pain.
But after having the heat therapy, he was able to conquer his ‘Everest’ - a steep hill in a nearby park which he hadn’t climbed since he was a young man.
A ‘shower person’ for most of his life, he now has three baths a week, in the hope that he can continue to benefit from the hot water immersion.
“Nice and Relaxing”
Ken, a retired engineering manager, said: “I know that peripheral arterial disease can put you in a wheelchair, or lead to an amputation. At the age of 75, my priorities are keeping moving, keeping mobile, and carrying on with life as normal, so I was keen to try anything which might reduce my pain and improve the circulation in my legs.
‘My friends and family were jealous when I told them I would be sitting in a hot tub to try to achieve this. It was a very enjoyable, nice and relaxing study to be involved in.’
The grandfather-of-two was first diagnosed with peripheral arterial disease at the age of 38, when he immediately quit smoking and reduced his consumption of fried food.
He has a family history of heart problems, with his paternal grandfather and uncle both having died from heart attacks at the age of 49, while his father had one aged 56.
But Ken lived reasonably well with PAD, while taking a statin to reduce his cholesterol, and drugs for high blood pressure, until two years ago, when his leg pain became worse.
“Embarrassed”
He said: “My stride shortened, I got more wobbly on my feet, and I could only walk 100 yards without needing to stop, usually for five or six minutes, until the pain subsided and I could walk again. I had some male pride about that - I felt embarrassed, and would pretend to be looking in a shop window or hold my phone up to my ear, so it looked like I’d stopped for a reason.
“I had bad days and the pain, which is like extreme cramp, was worse in cold weather. When I was sent for hospital treatment and saw people who had lost their mobility from PAD, it underlined to me that I wanted to take action.”
Before taking part in the current trial, Ken had physiotherapy for his PAD, then signed up for an exercise program. Both involved walking on a treadmill, climbing stairs, sitting and standing, as exercise helps to reduce the severity and frequency of his symptoms. Afterwards, he more than doubled how long he could walk on a treadmill before needing to stop - from around three minutes to seven minutes.
Next, he signed up to the heat therapy trial, with the target of improving his pain enough that he could climb a steep hill in his local park.
The hill, which he had run and cycled up as a young man, but had not climbed for years, seemed impossible when his PAD was at his worst. But Ken, who goes walking every day with his 12-year-old dog, Maddie - a Shih Tzu and Tibetan spaniel-cross - was determined to reach the top of the incline connecting Vernon Park in Stockport with Woodbank Park.
Huge Achievement
He said: “After the heat therapy, I finally reached the top of my Everest - the Vernon Park hill - in August. I even managed to climb all the steps running alongside it, of which there are about 60. I immediately sent a text message to the researcher leading the study to tell him I’d done it!
‘It may sound small, and I still had to stop a couple of times, but it felt like a huge achievement.
“This study really did feel as if it worked for me, to reduce my pain and extend the distance I could walk, and I hope it’s proven to be effective, so heat therapy might be available to more people.’
Ken, who lives with his wife of 56 years, 75-year-old Maureen, had never really understood why she loved baths so much, often heading off to have a long soak with her tablet device in her hand.
But now he has a bubble bath two to three times a week. He said: “I’ve surprised myself because I actually now quite enjoy lying there in the bath, relaxing with my own thoughts. It’s a chance to switch off and enjoy some alone time.
“If it might help my legs as well, that’s a real bonus.”
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