Browse > Article
http://dx.doi.org/10.15268/ksim.2021.9.3.19

Short-term Effect of Gyeongsangnam-do Wellness Tourism on Inflammatory and Immune System Markers, Emotion, Fatigue, Stress, Quality of Life, and Quality of Sleep  

Lee, Sae-Rom (Dept. of Family Medicine, Pusan National University Yangsan Hospital)
Lee, Ye-Li (Integrated Research Institute for Natural Ingredients and Functional Foods)
Lee, Sang-Yeoup (Integrated Research Institute for Natural Ingredients and Functional Foods)
Publication Information
Journal of The Korean Society of Integrative Medicine / v.9, no.3, 2021 , pp. 19-35 More about this Journal
Abstract
Purpose : Recently, there has been a growing social interest in aging well. Consequently, wellness tourism has begun to attract attention. However, no studies on whether wellness tourism has any objective health benefits have been carried out yet. In this study, we assess the health benefits as well as the degree of improvement in health of a wellness tourism program. Methods : The study involved 30 adults over the age of 19 who live in the Gyeongsangnam-do region. Participants were evaluated on health indicator before and after participating in wellness tourism program. Participants took heart rate variability (HRV) test, and LFT, RFT, CBC, FBS HbA1C, and CRP test were conducted before and after the tour. Additionally, a survey was conducted before and after the program, and participant satisfaction was evaluated. Statistical differences in the tests conducted before and after the program were analyzed using a design t-test, a Wilcoxon signed-rank test, and McNemar's test. Results : The study showed that participants were very satisfied with and had significant health improvements after the wellness tourism program. The program was also found to be beneficial in improving participants' emotions as follows: BDI (p<.001), fatigue recovery (p=.006), stress relief (p=.003), improved quality of life (p<.05), and improved sleep quality (p<.001). Conclusion : Wellness tourism programs are specifically beneficial for improving participants' emotions (depression, anxiety), fatigue, stress levels, quality of life, and sleep. Therefore, they are beneficial to the overall health. Further research in the future by way of a follow-up study on the long-term effects on health after short-term interventions will provide more validation data.
Keywords
inflammatory tests; heart rate variability; survey scales; wellness tour;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Zimmerman MC, Lazartigues E, Sharma RV, et al(2004). Hypertension caused by angiotensin II infusion involves increased superoxide production in the central nervous system. Circ Res, 95(2), 210-216. https://doi.org/10.1161/01.RES.0000135483.12297.e4.   DOI
2 Cummings M, Merone L, Keeble C, et al(2015). Preoperative neutrophil: lymphocyte and platelet: lymphocyte ratios predict endometrial cancer survival. Br J Cancer, 113(2), 311-320. https://doi.org/10.1038/bjc.2015.200.   DOI
3 Luo H, He L, Zhang G, et al(2019). Normal reference intervals of eutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio, and systemic immune inflammation index in healthy adults: a large multi-center study from Western China. Clin Lab, 65(3), 255-265. https://doi.org/10.7754/Clin.Lab.2018.180715.   DOI
4 Malik M, Camm AJ(1993). Components of heart rate variability--what they really mean and what we really measure. Am J Cardiol, 72(11), 821-822. https://doi.org/10.1016/0002-9149(93)91070-X.   DOI
5 Oylumlu M, Yildiz A, Oylumlu M, et al(2015). Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol, 15(4), 277-283. https://doi.org/10.5152/akd.2014.5366.   DOI
6 Proctor MJ, Morrison DS, Talwar D, et al(2011). A comparison of inflammation based prognostic scores in patients with cancer. A Glasgow inflammation Outcome Study. Eur J Cancer, 47(17), 2633-2641. https://doi.org/10.1016/j.ejca.2011.03.028.   DOI
7 Yu CP, Lin CM, Tsai MJ, Tsai YC, et al(2017). Effects of short forest bathing program on autonomic nervous system activity and mood states in middle-aged and elderly individuals. Int J Environ Res Public Health, 14(8), 897.   DOI
8 Lolli C, Basso U, Derosa L, et al(2016). Systemic immune-inflammation index predicts the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Oncotarget, 7(34), Printed Online. https://doi.org/10.18632/oncotarget.10515.   DOI
9 Yu SH, Lee H(2018). Development of a conceptual model of wellness tourism: Focused on hedonic and eudaimonic perspectives. J Tour Sci, 42(7), 183-209. https://doi.org/10.17086/JTS.2018.42.7.183.209.   DOI
10 Armutlu K, Korkmaz NC, Keser I, et al(2007). The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res, 30(1), 81-85. https://doi.org/10.1097/MRR.0b013e3280146ec4.   DOI
11 Zeigler ZS, Swan PD, Bhammar DM, Gaesser GA(2015). Walking workstation use reduces ambulatory blood pressure in adults with prehypertension. J Phys Act Health, 12(s1), S119-S127. https://doi.org/10.1123/jpah.2013-0487.   DOI
12 Zheng L, Zou K, Yang C, et al(2017). Inflammation based indexes and clinicopathologic features are strong predictive values of preoperative circulating tumor cell detection in gastric cancer patients. Clin Transl Oncol, 19(9), 1125-1132. https://doi.org/10.1007/s12094-017-1649-7.   DOI
13 Ministry of Culture, Sports and Tourism. Selected as one of the 25 wellness tourism selections, health and healing tourism development. 2017. Available at https://www.mcst. go.kr/kor/s_notice/press/pressView.jsp?pSeq=16057 Accessed May 17, 2021.
14 Ministry of Culture, Sports and Tourism. Developing local wellness tourism to seek healing for body and mind. 2018. Available at https://www.mcst.go.kr/kor/s_notice/press/pressView.jsp?pSeq=16682 Accessed May 17, 2021.
15 Group TE(1990). EuroQol-a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199-208. https://doi.org/10.1016/0168-8510(90)90421-9.   DOI
16 Grivennikov SI, Greten FR, Karin M(2010). Immunity, inflammation, and cancer. Cell, 140(6), 883-899. https://doi.org/10.1016/j.cell.2010.01.025.   DOI
17 Feng JF, Chen S, Yang X(2017). Systemic immuneinflammation index (SII) is a useful prognostic indicator for patients with squamous cell carcinoma of the esophagus. Med, 96(4), Printed Online. https://doi.org/10.1097/MD.0000000000005886.   DOI
18 Garcea G, Ladwa N, Neal CP, et al(2011). Preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg, 35(4), 868-872. https://doi.org/10.1007/s00268-011-0984-z.   DOI
19 Gary T, Pichler M, Belaj K, et al(2014). Lymphocyte-to-monocyte ratio: a novel marker for critical limb ischemia in PAOD patients. Int J Clin Pract, 68(12), 1483-1487. https://doi.org/10.1111/ijcp.12495.   DOI
20 Hong X, Cui B, Wang M, et al(2015). Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med, 236(4), 297-304. https://doi.org/10.1620/tjem.236.297.   DOI
21 Hu P, Shen H, Wang G, et al(2014). Prognostic significance of systemic inflammation based lymphocyte monocyte ratio in patients with lung cancer: based on a large cohort study. PloS One, 9(9), Printed Online. https://doi.org/10.1371/journal.pone.0108062.   DOI
22 Hung HY, Chen JS, Yeh CY, et al(2011). Effect of preoperative neutrophil lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis, 26(8), 1059-1065. https://doi.org/10.1007/s00384-011-1192-x.   DOI
23 Maeda T, Makino N, Horiuchi T(2019). A spa-resort tour in Japan relieves mental and physical stress and corrects serum cortisol levels. The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine, 82(2), 70-77. https://doi.org/10.11390/onki.2320.   DOI
24 Cha KS(2017). Research trends in wellness : Focusing on the journal of wellness. J Wellness, 12(3), 623-633.
25 Hage FG, Szalai AJ(2007). C-reactive protein gene polymorphisms, C-reactive protein blood levels, and cardiovascular disease risk. J Am Coll Cardiol, 50(12), 1115-1122. https://doi.org/10.1016/j.jacc.2007.06.012.   DOI
26 Kocas C, Yildiz A, Abaci O, et al(2015). Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in patients with non-ST-segment elevation acute coronary syndrome. Angiology, 66(10), 964-968. https://doi.org/10.1177/0003319715578057.   DOI
27 Asher V, Lee J, Innamaa A, et al(2011). Preoperative platelet lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol, 13(7), 499-503. https://doi.org/10.1007/s12094-011-0687-9.   DOI
28 Keizman D, Ish-Shalom M, Huang P, et al(2012). The association of pre-treatment neutrophil to lymphocyte ratio with response rate, progression free survival and overall survival of patients treated with sunitinib for metastatic renal cell carcinoma. Eur J Cancer, 48(2), 202-208. https://doi.org/10.1016/j.ejca.2011.09.001.   DOI
29 Sproston NR, Ashworth JJ(2018). Role of C-reactive protein at sites of inflammation and infection. Front Immunol, 9, Printed Online. https://doi.org/10.3389/fimmu.2018.00754.   DOI
30 Tomita M, Shimizu T, Ayabe T, et al(2011). Preoperative neutrophil to lymphocyte ratio as a prognostic predictor after curative resection for non-small cell lung cancer. Anticancer Res, 31(9), 2995-2998.
31 Azab B, Bhatt VR, Phookan J, et al(2012). Usefulness of the neutrophil to lymphocyte ratio in predicting short and long term mortality in breast cancer patients. Ann Surg Oncol, 19(1), 217-224. https://doi.org/10.1245/s10434-011-1814-0.   DOI
32 Kim SH, Hwang JS, Km TW, et al(2012). Validity and reliability evaluation for EQ-5D in Korea. Support Care Cancer, 20(12), 3155-3160. https://doi.org/10.1007/s00520-012-1457-0.   DOI
33 Krupp LB, LaRocca NG, Muir-Nash J, et al(1989). The Fatigue Severity Scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol, 46(10), 1121-1123. https://doi.org/10.1001/archneur.1989.00520460115022.   DOI
34 Kim DR, Kang KH, Park A, et al(2021). An integrative review of well-aging research in Korea. J Korea Acad Industr Coop Soc, 22(3), 190-198. https://doi.org/10.5762/KAIS.2021.22.3.190.   DOI
35 Kim HS, Han KH, Chung HH, et al(2010). Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison. Eur J Surg Oncol, 36(7), 691-698. https://doi.org/10.1016/j.ejso.2010.05.004.   DOI
36 Kim KS(2020). Analysis of leisure awareness before and after 5-day and 52-hour work week using big data. Journal of Sport and Leisure Studies, 80, 297-308. https://doi.org/10.51979/KSSLS.2020.04.80.297.   DOI
37 Kitano Y, Yamashita YI, Yamamura K, et al(2017). Effects of preoperative neutrophil-to-lymphocyte and platelet-tolymphocyte ratios on survival in patients with extrahepatic cholangiocarcinoma. Anticancer Res, 37(6), 3229-3237. https://doi.org/10.21873/anticanres.11685.   DOI
38 Koh CH, Bhoo Pathy N, Ng KL, et al(2015). Utility of pretreatment neutrophil lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer, 113(1), 150-158. https://doi.org/10.1038/bjc.2015.183.   DOI
39 Rhee MK, Lee YH, Park SH, et al(1995). A standardization study of Beck Depression Inventory I-Korean version (K-BDI): reliability and factor analysis. Korean J Psychopathol, 4, 77-95.
40 Sharaiha RZ, Halazun KJ, Mirza F, et al(2011). Elevated preoperative neutrophil: lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol, 18(12), 3362-3369. https://doi.org/10.1245/s10434-011-1754-8.   DOI
41 Sohn SI, Kim DH, Lee MY, et al(2012). The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath, 16(3), 803-812. https://doi.org/10.1007/s11325-011-0579-9.   DOI
42 Song YM, Lee HK, Kim JW, et al(2012). Reliability and validity of the Korean Version of Beck Depression Inventory-II via the internet: Results from a university student sample. J Korean Neuropsychiatr Assoc, 51(6), 402-408. https://doi.org/10.4306/jknpa.2012.51.6.402.   DOI
43 Sunbul M, Gerin F, Durmus E, et al(2014). Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens, 36(4), 217-221. https://doi.org/10.3109/10641963.2013.804547.   DOI
44 Smith JA(2011). Is there more to yoga than exercise?. Altern Ther Health Med, 17(3), 22.
45 Templeton AJ, McNamara MG, Seruga B, et al(2014). Prognostic role of neutrophil to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst, 106(6), Printed Online. https://doi.org/10.1093/jnci/dju124.   DOI
46 Thomas G, Martin P, Klara B, et al(2013). Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One, 8(7), Printed Online. https://doi.org/10.1371/journal.pone.0067688.   DOI
47 Yang HJ, Jiang JH, Liu QA, et al(2017). Preoperative platelet-to-lymphocyte ratio is a valuable prognostic biomarker in patients with hepatocellular carcinoma undergoing curative liver resection. Tumour Biol, 39(6), Printed Online. https://doi.org/10.1177/1010428317707375.   DOI
48 Devaraj S, Venugopal S, Jialal I(2006). Native pentameric C-reactive protein displays more potent pro-atherogenic activities in human aortic endothelial cells than modified C-reactive protein. Atherosclerosis, 184(1), 48-52. https://doi.org/10.1016/j.atherosclerosis.2005.03.031.   DOI
49 Beck AT, Ward CH, Mendelson M, et al(1961). An inventory for measuring depression. Arch Gen Psychiatry, 4(6), 561-571. https://doi.org/10.1001/archpsyc.1961.01710120031004.   DOI
50 Beck AT, Epstein N, Brown G, et al(1988). An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol, 56(6), 893-897. https://doi.org/10.1037//0022-006x.56.6.893.   DOI
51 Belza BL(1995). Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol, 22(4), 639-643.
52 Buysse DJ, Reynolds 3rd CF, Monk TH, et al(1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4.   DOI
53 Ciubotaru I, Potempa LA, Wander RC(2005). Production of modified C-reactive protein in U937-derived macrophages. Exp Biol Med, 230(10), 762-770. https://doi.org/10.1177/153537020523001010.   DOI
54 Balta S, Ozturk C(2015). The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets, 26(7), 680-681. https://doi.org/10.3109/09537104.2014.979340.   DOI
55 Kwon SM(1997). Assessment of psychopathology in anxiety disorder. Kor J Psychopathol, 6, 37-51.
56 Laborde S, Mosley E, Thayer JF(2017). Heart rate variability and cardiac vagal tone in psychophysiological research-recommendations for experiment planning, data analysis, and data reporting. Front Psychol, 8, Printed Online. https://doi.org/10.3389/fpsyg.2017.00213.   DOI
57 Lee S, Oh SY, Kim SH, et al(2013). Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer, 13(1), Printed Online. https://doi.org/10.1186/1471-2407-13-350.   DOI
58 Lesage FX, Berjot S, Deschamps F(2012). Clinical stress assessment using a Visual Analogue Scale. Occup Med, 62(8), 600-605. https://doi.org/10.1093/occmed/kqs140.   DOI