Our research

The Medical Health Center’s main areas of research include sports and occupational medicine as well as sports physiology and immersion physiology within the Swiss Olympic Medical Center.

Below, we report on individual projects taking place at the Medical Health Center as well as on collaborative projects with other research groups and participating partners. The diverse and complex issues covered require an interdisciplinary approach to be applied at the level of sports medicine/rehabilitation and project management as well as with respect to the technology used by the research units.

The investigations are based on applied research. They aim to promote health-conscious behaviour and the use of health-related resources with the aid of the findings.

Aquamove 36.5° C

The “Aquamove 36.5°C” concept is looking into aspects of exercise in water. The objective is to develop a basis for facilitating greater and more targeted exercise and relaxation in the thermal water, with the results then being made available to thermal spa guests.

The idea behind the project stems from the observation that the thermal spa is primarily used for relaxation purposes and less so for exercise. The majority of thermal spa guests perform practically no exercise or at least not to the recommended extent. There are, however, a number of reasons for taking advantage of the benefits of training in warm water. This is particularly true for overweight individuals or people whose musculoskeletal systems are showing symptoms of degeneration and who are therefore unable to place too much strain on their bodies. In the case of inflammation and soft-tissue rheumatism, the warmth can help to relieve pain. In many cases, water-based movements thus offer the only opportunity to exercise adequately.

The provision of visual materials (illustration of motion sequences) and apps (videos) aim to enable thermal spa guests to exercise in the water in an independent and targeted manner, allowing them to develop a further way of improving their health.

Practical and balneological bathing programmes

When faced with chronic stress, it is the part of our autonomic nervous system which increases performance that becomes active. Over the long term, this leads to exhaustion.

Spa treatment offers a means of restoring your autonomic balance and returning it to normal. Different stimuli (cold/heat) promote the recovery processes, but only if a sufficient dose of the respective stimulus is applied and the temperature is adequately controlled as the thermal stimuli are switched.

To structure the alternation of the stimuli, recommendations regarding bathing programmes are made, and precautionary measures and behaviour which is conducive to stress are discussed. .

Effectiveness of treatment with a kneecap mobilisation splint (pilot project 2013)

Effectiveness of treatment with a kneecap mobilisation splint (pilot project 2013) A knee rehabilitation device (KRD) developed by the University of Applied Sciences Rapperswil was used for the first time during post-operative early rehabilitation and as part of the delayed treatment of chronic cases at the Klinik Gut St. Moritz and at the Medical Health Center Bad Ragaz. The mobilisation of the kneecap at as early a stage as possible is an important post-operative measure. This minimises the impact of the tissue damage caused by the operation, which may manifest itself as knee irritation, soft tissue oedema or swelling. The newly developed mobilisation device guarantees the mobility of the kneecap in four quadrants and applies the principle of “continuous passive motion”. During the study aimed at assessing the practicability and usage benefits of the new device, standardised clinical studies and surveys were used. The feasibility study revealed that the mobilisation treatment works and was met with acceptance.

According to both the patients and therapists, the quality of after-care was enhanced by the use of the KRD. Functional parameters, such as levels of movement, also speak in favour of the use of the KRD. For this reason, a multi-centre study is to follow the pilot project in order to demonstrate the benefits of the apparatus-supported therapy.

Results of studies with the Reha Aquabike (2011 to 2014)

Health care institutions are increasingly calling for the securing of processes and measures for aqua therapy and aqua training, two areas which are important for health spas. On the basis of the physiological data available, the superiority of these therapeutic approaches can be partially justified for a large number of defined illnesses. Nevertheless, the shortage of structured and dosed therapy plans for individual and group therapy is still an issue. Outside of laboratory conditions, there remains an inability to precisely regulate the level of exertion and measure both strength and muscular effort, something which has been standard for land-based exercise for some time. On the basis of four example examinations, the practical use of the performance ergometer for therapeutic purposes in the thermal spa was examined. These enquiries are not a purely scientific matter. With the support of the CTI funding agency (Swiss Federal Commission for Technology and Innovation), it was possible to develop a water therapy device (Reha Aquabike) with a muscular effort control as part of an interdisciplinary research project with csemAlpnach, the Swiss Paraplegic Centre Nottwil and Swissrehamed. The functioning of the synchronously operated arm/leg crank ergometer requires the use of a relatively large portion of the skeletal musculature under changing levels of strain. Furthermore, the technology used to measure muscular effort and resistance in water allows for investigations into the level of physical strain to be conducted – as is routine on land. This should lead to an improvement in existing interventions (according to the criteria of “evidence-based medicine”) and allow for activity in water to be better assessed. With the development of the Reha Aquabike, experimental work, which is presented below (four articles), was performed at the Grand Resort Bad Ragaz:

  1. Measurement of muscular effort in water with a new force-measuring crank system
    Phys Med Rehab Kuror, 2010 (20) 27–31 In general, evidence of a reliable and precise resistance setting is required for new ergometers. For this reason, the measurement error was initially determined by performing several measurement series successively and checking the ergometric control technology on the basis of physiological parameters (oxygen intake and heart rate). It was demonstrated that the Reha Aquabike enables a water-land comparison to be made on the basis of identical workloads and records the actual level of strain in the water.

  2. Measurement of muscular effort in water with a new force-measuring crank system
    Phys Med Rehab Kuror, 2013 (23) 225–230 The paper entitled “High power spectral density of heart rate variability as a measure of exercise performance in water” looked at the question of whether heart rates recorded on land can also be used as a reference when controlling the level of strain for exercise in water. The mean difference between the heart rates recorded in water was 5.5 beats per minute, and the largest deviation – determined on the basis of the 95% limits of agreement method – was 15.4 beats per minute. When deriving recommendations for regulating water-based exercise on the basis of heart rate figures recorded on land, an overestimation of the level of strain thus resulted. In the same study, the suitability of heat rate variability (HRV) for determining the VT2 ventilatory threshold and RCP (recompensation point) was also investigated. To this end, we investigated the effects of strain in the water with respect to anaerobic functions. The results of this work showed that, given that an ECG has to be derived in any case, conclusions on exercise control using the HRV method can be drawn without significant extra work and can be incorporated into therapy and training programmes for making targeted adjustments.

  3. As part of the same study (“unpublished article, being drafted”), the subjects were also investigated as regards the effect of strain on both their arms and legs (A + L) and their legs (L) alone on land and in water. On land, activities such as Nordic walking, exercising on cross-trainers and cross-country skiing have proven to be a means of ensuring a high level of overall energy consumption. For exercise in water, there is an equally diverse range of endurance sports available, including, shallow/deep water running, swimming and, as a recent addition, equipment-based training (e.g. aqua cross) which involves the use of large muscle masses. However, there is a lack of physiological findings on the effectiveness of this water-based exercise. Result: When using arms and legs (A + L) on an arm/leg crank ergometer, a greater amount of oxygen (VO2) is required for the same ergometrically set performance level compared to when working with legs (L) alone. This finding can be explained by the mass of tissue being actively used and the requirement to cover the greater needs of the cardiopulmonary system. The higher oxygen uptake and increased metabolic activity appear to be accounted for by the additional arm work. This effect was less pronounced in the water.
    It was also observed that the increased demands on the respiratory and cardiovascular systems, with the greater metabolic strain for A + L relative to L alone, changed the point at which anaerobic energy was called on (level of performance-related anaerobic threshold). The aerobic metabolic process for A + L relative to L alone could be kept up longer in water than was the case under the conditions on land. The findings suggest that the metabolic transfer rate (oxidative energy generation) is boosted in water when working with A + L. The effects of the physical properties of water include the reduced sympathicotonia with the vascular dilations in partial circulatory systems. The increased blood supply to the active tissue increases the amount of oxygen available in the working skeletal muscles and boosts oxygen extraction capacity.

  4. Release of ANP and fat oxidation in overweight persons during anaerobic exercise in water
    The International Journal of Sports Medicine, 2013 (34) 1–5

    Based on physical performance measurements, a further experimental study was undertaken which looked at the differences in lipometabolism on land and in water. The main area of interest was the heart hormone ANP (atrial natriuretic peptide) which responds to the expansion of the atria and is produced in greater volumes as a result of hydrostatic pressure experienced when in water and as a consequence of physical strain. In water, ANP triggers various processes for the regulation of the body’s water balance and the cardiovascular system. Its role in reducing blood pressure and adapting blood volume is recognised, as are its metabolic effects, which were proven in 1997: ANP boosts lipometabolism by improving the transmission of signals to isolated fat cells. As such, the study aimed to investigate the responsiveness of ANP to the control systems (lipometabolism) in overweight individuals, comparing their results in water with those on land.

    The blood serum concentration of ANP was higher in water than on land, which indicates a direct change in metabolism. Increased use of free fatty acids could not be demonstrated, however. It was apparent that a saturation effect had been achieved and the increased ANP blood plasma level did not have an immediate impact on the rate of lipometabolism. The mobilisation effect on the subcutaneous fatty tissue presumably only improves under fasting conditions, as has been demonstrated by researchers to be the case on land.

  5. Does continuous endurance exercise in water elicit a higher release of ANP and BNP and a higher plasma concentration of FFAs in pre-obese and obese men than high intensity intermittent endurance exercise? – Study protocol for a randomized controlled trial
    Trials, 2013 (14:328) 1–7
    We looked at this question for future research work. In the journal Trials, a working hypothesis was formulated according to which a greater volume of ANP is released through high intensity intermittent endurance exercise, with lipometabolism being stimulated via excess post-exercise oxygen consumption, an indication of the increased metabolic strain (oxidation rates in muscle metabolism). During the required period of regeneration and induced by the activity-related energy deficit, the mitochondrial β-oxidation system burns more fats, which are released by the liver, during resting metabolism. A qualitative examination of the questions raised here could form the basis for future research work.

Rocking chair

Using a conventional ECG, basic physical rhythms such as sleeping and waking rhythms, processes linked to our metabolism and hormonal balance as well as the coordination of our heart, circulation and respiration can be made visible. These rhythms are all linked as part of a very specific ratio. The coordination of the bodily rhythms over time can be established by applying mathematical algorithms to the heart rate. The heart rate, in turn, normally varies temporally from beat to beat.

This takes place because both branches of the autonomic nervous system, the sympathetic and the parasympathetic, influence the heart beat as pulse generators with their electronic signals. The hypothesis now is that the stimulation of a rocking movement will result in a change to the breathing rhythm and thus also to heart rate and blood pressure regulation. The changes to the oscillating blood flow and heart rate can also be identified in the rhythm of the temporal rocking sequences. The rhythm of the blood circulation and blood pressure fluctuations lead to deeper relaxation, which is reflected in the variability of the heart rates.

In cooperation with the HRS (University of Applied Sciences Rapperswil), the Medical Health Center and Srm-Projects from Chur are combing their expertise in order to examine the effect of rocking movements on relaxation. Srm-Projects is supporting and coordinating the research-based project and will promote benefits for clients through entrepreneurial implementation.