Central and eastern Europe, from Estonia in the north to Ukraine in the south, is blessed with a rich well of natural resources. Mineral water, mud, salt, herbs, heat and gases have been an integral part of cultural tradition as much as they’ve been the mainstay of healthcare for more than three centuries.

At the same time, wellness tourism is gaining traction and Europe is leading the way. In March, the Global Wellness Tourism Congress (GWTC) announced that Europe ranks number one in the world for wellness tourism with its 203 million annual trips and number two for expenditures, accounting for US$158.4bn (€114.3, £95.2) annually. “Europeans are the most sophisticated, experienced wellness- and prevention-focused travellers on the planet,” says GWTC chair and CEO Susie Ellis. “They not only take frequent trips in their own countries and across Europe, they’re also pegged as the largest source market for international wellness travel.”

It’s a good time, therefore, to focus more specifically on the natural resource lexicon in this part of Europe, starting with, perhaps the most idiosyncratic – gases. Broadly, gas in this context refers to naturally-occurring carbon dioxide (CO2) that’s generally administered to ease pain and boost blood circulation. It can also refer to nitrogen gas, which is used in cryotherapy, or simply the movement of intensely hot air, which is at the heart of traditional sauna experiences.

It’s important to remember that while some of these gas therapies may sound unusual, they came about only after meticulous study by scientists and chemists during the 18th and 19th centuries.

Carbon dioxide
Naturally-occurring carbon dioxide gas features prominently in the traditional spa treatments of the Czech Republic and Transylvania in Romania. In the spa town of Mariánské Lázn? (formerly known as Marienbad) in the Czech Republic, gas of volcanic origin, containing 99.7 per cent CO2, seeps out of the ground. It’s prevalent in the local mineral spring water and is harnessed for use in a number of therapies that boost blood circulation for an anti-inflammatory effect.

CO2 is also used in ‘dry gas bath’ treatments, where concentrated amounts of it are pumped into plastic bags around the body (see above) working directly on skin receptors to affect vasodilation. The improved blood flow accelerates wound healing and stimulates kidney activity. A very particular benefit is the stimulation in the production of sex hormones: testosterone and oestradiol, a type of oestrogen produced in the ovaries. Thus it’s successfully used to reverse gynaecological problems and sexual dysfunction and to relieve menopause symptoms.

CO2 is also prescribed to be delivered by hypodermic injection into the muscles of the back (see p46). The principle effect is pain reduction, because when CO2 is received through the skin, it causes the blood vessels to relax and allows blood to flow more quickly around the body.

In Transylvania, CO2 is administered in another form to treat patients with hypertension and related heart disorders. At the Dr Benedek Ge’za Cardiovascular Rehabilitation Hospital in Covasna, the state pays for the treatment of 14,000 people a year. Here patients stand, fully clothed and en masse in a wooden amphitheatre in which air with a 96 per cent concentration of CO2 escapes from the underlying fissures in the rock. This sort of exposure also causes the blood vessels to relax and encourages a greater flow of oxygen around the body, as well as increasing blood flow to the heart.

Carbon dioxide is denser than air, which means it doesn’t rise above a certain height. However, to be sure, conditions in the pit are still carefully monitored – with a lit flame that goes out if there’s not enough oxygen – to ensure that CO2 is not the main gas that’s inhaled.

These particular treatments in Transylvania are officially known as mofetta. The sessions are restricted to 20 minutes, after which mild breathlessness sets in. For heart healthy patients in the region, mofetta is colloquially known as natural viagra because of how CO2 stimulates the sex hormones. Increased blood flow is also felt most strongly in the pelvic region where there are a large number of smaller blood vessels.

Mofetta is also a term used to describe the many natural pools, bubbling with carbon dioxide, that are free for use in the Transylvanian countryside. Families and friends spend summer days picnicking around them and swimming in them.

Cryotherapy
Cryotherapy is the medical use of nitrogen gas at very low temperatures – selected because it has the ability to reach -160?C.

There are several types of cryotherapy. Whole body cryotherapy is known for treating a range of ailments – professional tennis players have cryotherapy on-site at grand slams to help muscle function, for example, while in central and eastern Europe, it’s used for general health purposes.

The other method of using cryotherapy is to treat benign and malignant tumours.

Whole body cryotherapy involves standing in a chamber filled with nitrogen gas for up to three minutes. Cooling the body to such an extreme for short periods of time subsequently boosts blood circulation, which speeds up metabolic processes. This, in turn, helps with the elimination of toxins.

As a reaction to the cold, the body also starts to produce more endorphins and corticosteroids which have an analgesic and regenerative effect, easing pain and inflammation and boosting both the immune system and mood. As a result, whole body cryotherapy has beneficial effects on many conditions: rheumatic, neurological, inflammatory, metabolic and degenerative.

Smoke saunas and pirts
As well as playing a central role in living well, natural resources in central and eastern Europe are a primary motivation for social recreation. This is particularly the case with the smoke sauna culture in Estonia and the pirts in Lativa – two national variations of the Russian sauna or banya (see p50).

Both the smoke sauna and pirts are best described as a marriage between health and spirituality. They involve a three-hour procedure in intense heat, which is puffed around the body with veniks (a generic Russian term for natural fans made from tree branches), cold water plunging and intervals of relaxation with friends and family. These rituals ease physical tensions and clean the skin but it’s believed that they also nourish the soul – think of them as a full-service mind-body-spirit treatment.

Pirts customs focus on top-to-toe tapping with birch branches (or linden or oak) to stimulate the lymphatic system and accelerate the excretion of toxins. This ritualistic fanning, flicking and steady thwack of birch on skin is also designed to clear the aura and release bad omens.

In Estonia, standalone smoke saunas are regarded as a hallowed place for prayer. The facilities became a secret place of worship in a Soviet era that curbed religious practice.

Contrary to suggestion, the smoke element is precisely what makes the air in the smoke sauna so clean. The buildings are built without chimneys and seven hours of stoking an open fire with pine or elder wood kills all bacteria. The smoke is then released through a briefly opened door and the sauna is ready for use.

Climate therapy
Climate therapy – the formal use of fresh air for therapeutic purposes – is a bona fide wellness modality in this region. The topography from the Baltic to the Black Sea – particularly on the coasts – provides a mild climate, scientifically acknowledged to be ideal for human health in terms of improving metabolism, appetite, sleep and general frame of mind.

The theory of climate therapy is that air which has the optimal levels of atmospheric pressure, temperature and humidity, wind strength and sun intensity, has a positive influence on the health of all living organisms.

These elements are studied at the Institute of Climate Therapy and Pulmonology, in Yalta, Crimea. The particular geography of sea, pine forest and mountain has brought wellness tourists to this coast for centuries, including many of Russia’s elite, such as playwright Anton Chekhov and composer Sergei Rachmaninoff, for doctor-led treatment protocols which are based on walking in the outdoors.

Health and custom
By looking at just one very narrow field of natural resource – namely gases and air – we get some understanding of the importance of nature for both health and local custom in this part of the world. As the relief of physical pain and the stimulation of emotional wellbeing are two very real objectives for tourists and health visitors, it’s likely that wellness tourism in the region will only continue to grow.