The Best New Performance Enhancing “Drug” – Near Infrared Lamp Saunas | SaunaSpace

The Best New Performance Enhancing “Drug” – Near Infrared Lamp Saunas

Pocket Sauna Performance Enhancement Drug pill on finger

There have been recent articles illustrating the beneficial relationship between sauna therapy and athletic performance. Much of the information in those articles comes from the work of Dr. Rhonda Perciaville Patrick, PhD. She authored a blog article and has a video about heat conditioning as well.

Hyperthermic or Heat Therapy

Traditional saunas (e.g. Finnish saunas), far infrared saunas, and near infrared saunas all provide the level of heat necessary for an effective thermal healing environment. Heat acclimation through sauna use can promote physiological adaptations that result in increased endurance, easier acquisition of muscle mass, and a general increased capacity for stress tolerance. Deliberately acclimating yourself to heat, independent of working out, can be defined as “hyperthermic conditioning.” Saunas raise the core body temperature resulting in many beneficial health effects. There are positive effects of heat acclimation on the brain, including the growth of new brain cells, improvement in focus, learning and memory, and ameliorating depression and anxiety. Modulation of core temperature might even be largely responsible for “runner’s high” via an interaction between the dynorphin/beta-endorphin opioid systems. Hyperthermic Conditioning results in a sweat response leading to detoxification and sauna use, leads to stress relief and relaxation promoting a parasympathetic response.

Hyperthermic Conditioning or heat therapy occurs in all saunas and accounts for the performance enhancing changes described in the above article and other similar articles.

Inside a Near Infrared Pocket Sauna

Exercise particularly intense or extreme exercise increases body temperature. Exercise also often occurs in a setting of high ambient temperature making heat stress injury (heat stroke) more likely. The exercise induced sweat response is not very effective for detoxification and exercise generally occurs in a state of sympathetic nervous system activation.There is, however, a marked interest among a great many people to increase athletic performance and endurance.

Sauna use has a major impact on athletic performance. Heat tolerance is increased, lessening the chance of heat injury or heat stroke. Circulation is generally increased especially to the heart and musculature resulting in reduced cardiovascular strain and lowering of resting heart rate.[1]Hannuksela ML, Ellahham S. Benefits and Risks of Sauna Bathing Am J Med. 2001 Feb;110(2):118-26.

Performance endurance is improved up to 32%. Plasma volume is increased by 7.1% and red blood cells (RBC’s) by 3.5%.[2]Scoon GS, Hopkins WG, Mayhew S, Cotter JD. Effect of post-exercise sauna bathing on the endurance performance of competitive male runners . J Sci Med Sport. 2007 Aug;10(4):259-62. Epub 2006 Jul 31.

Muscles will use less glycogen. Hyperthermic therapy can reduce glycogen use by 40-50% and lactic acid build up is decreased with heat acclimation.[3]King DS, Costill DL, Fink WJ, Hargreaves M, Fielding RA. Muscle metabolism during exercise in the heat in unacclimatized and acclimatized humans . J Appl Physiol (1985). 1985 Nov;59(5):1350-4.

Sauna use synergistically combines with high intensity exercise, and intermittent fasting to naturally produce human growth hormone production and release.[4]Felsing NE, Brasel JA, Cooper DM. Effect of Low and High Intensity Exercise on Circulating Growth Hormone in Men . J Clin Endocrinol Metab. 1992 Jul;75(1):157-62. [5]Ftaiti F, Jemni M, Kacem A, Zaouali MA, Tabka Z, Zbidi A, Grélot L. Effect of hyperthermia and physical activity on circulating growth hormone . Appl Physiol Nutr Metab. 2008 Oct;33(5):880-7. doi: 10.1139/H08-073. [6]Ho KY, Veldhuis JD, Johnson ML, et al. Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man . Journal of Clinical Investigation. 1988;81(4):968-975.

Human growth hormone (HGH) levels drop dramatically as we age, worsening the aging process and associated muscle loss. Maintaining HGH levels is critical to prevent muscle atrophy and muscle loss associated with aging. Sauna use along with exercise can help slow down the aging process and also promotes the release of BDNF (Brain Derived Neurotrophic Factor) important for brain health.[7]Goekint M, Roelands B, Heyman E, Njemini R, Meeusen R. Influence of citalopram and environmental temperature on exercise-induced changes in BDNF . Neurosci Lett. 2011 Apr 25;494(2):150-4. doi: 10.1016/j.neulet.2011.03.001. Epub 2011 Mar 6.

Healthy levels of heat stress encountered in the sauna induce the production of heat shock proteins (HSPs). When cells in our bodies are exposed to heat stress DNA separation leads to HSP synthesis. “Heat shock proteins (HSPs) chaperone other cellular proteins, guarding them from going astray, folding improperly or misassembling while forming larger aggregates”.[8]Srivastava PK. Role of Heat Shock Proteins [Supplement to Article Could Our Own Proteins Be Used to Help Us Fight Cancer?] . Sci Am. 2008(July). HSPs help prevent and repair damaged proteins promoting muscle growth. HSPs eliminate free radicals and maintain healthy glutathione levels supporting intracellular antioxidant capability.

Illustration of Heat Stress Causes Production of Heat Shock Proteins
Sauna therapy promotes HSP production, & HSPs facilitate repair of damaged proteins.

Animal studies suggest that marked muscle regrowth may occur when subjects are exposed to heat stress. Sauna use dramatically slows muscle atrophy during disuse after muscle injury and immobilization. Animal studies demonstrate a 30% increase in muscle regrowth after immobilization.[9]Selsby JT, Dodd SL. Heat treatment reduces oxidative stress and protects muscle mass during immobilization . Am J Physiol Regul Integr Comp Physiol. 2005 Jul;289(1):R134-9. Epub 2005 Mar 10.  In our drug driven society the use of prescription medications is at an all-time high. Cholesterol-lowering statin drugs are widely used. One side effect of their use is rhabdomyolysis, a very serious degenerative muscle disorder that results in profound muscle loss. Heat shock proteins help protect against this complication.[10]Nath KA, Balla G, Vercellotti GM, et al. Induction of heme oxygenase is a rapid, protective response in rhabdomyolysis in the rat . Journal of Clinical Investigation. 1992;90(1):267-270.

A recent study widely reported in the media examined Finnish men over 20+ year period demonstrating a significant increase in longevity as well as a profound decrease in fatal cardiac and other fatal vascular events.[11]Laukkanen T, Hassan Khan H, Zaccardi F, Laukkanen J. Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events . JAMA Intern Med. February 23, 2015. doi:10.1001/jamainternmed.2014.8187. Animal studies suggest that HSP’s may be directly involved in these fantastic benefits of sauna use.

Hyperthermic (“sauna”) conditioning may indirectly improve athletic performance by improving insulin sensitivity. At least one animal study found that hyperthermic treatment decreased insulin levels.[12]Kokura S, Adachi S, Manabe E, Mizushima K, Hattori T, Okuda T, Nakabe N, Handa O, Takagi T, Naito Y, Yoshida N, Yoshikawa T. Whole body hyperthermia improves obesity-induced insulin resistance in diabetic mice . Int J Hyperthermia. 2007 May;23(3):259-65. Insulin not only controls glucose homeostasis but affects protein metabolism too. Improving insulin sensitivity tends to decrease muscle catabolism and increase muscle synthesis. There are implications here for not only muscle performance but for Type 2 Diabetes and Metabolic Syndrome as well.

Sauna use (hyperthermic conditioning or therapy) helps to reset the balance between new protein synthesis and protein degradation to a state of net protein synthesis. Sauna therapy acts synergistically to increase muscle growth with heat shock proteins (HSPs) slowing and preventing muscle protein degradation. Sauna use acts to increase muscle growth by three mechanisms

  • Heat Shock Proteins (HSPs)
  • Marked increase in Growth Hormone production (HGH)
  • Improved Insulin Sensitivity

Many of the changes that proceed from Sauna use benefit both the musculoskeletal system and the brain and nervous system. Sauna use will benefit not only for those seeking to increase athletic performance but cognitive performance as well.

As mentioned above sauna use combines with exercise and intermittent fasting to result in neuronal production of BDNF activating stem cells to produce more brain tissue. BNDF helps protect the motor side of the nervous system from age related atrophy and induces the production of multiple other beneficial chemicals. Heat stress is also implicated in increasing brain focus and attention levels. Myelin growth may be promoted. Myelin is the key component of the sheath surrounding neuronal cells. Heat stress also boosts endorphin release.

Phototherapy or Light Therapy (includes Color Therapy)

Near Infrared Light Photobiological Effects Graph
near infrared light absorption by human cell receptors profoundly effects the cells and tissues of the body, listed above.

A large and rapidly growing body of knowledge supports the use of near infrared light to treat and prevent many illnesses, physical and toxic injuries, and other health conditions.[13]Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294. A few are listed above.

Near Infrared Light (NIR): The Magic Wavelength

Only NIR Light Has a Photobiological Effect on Humans

Humans and other animal and plant species, by Nature’s design, have been programmed to utilize near infrared light. Sunlight that reaches the earth’s surface contains 52% to 55% infrared light.[14]American Society for Testing and Materials. Reference Solar Spectral Irradiance: Air Mass 1.5 ASTM. Sep 28, 2013. Our bodies have tiny receptors called chromophores that absorb near infrared light between 600 nanometers (nm) and 950 nm.[15]Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294.

“Mitochondria are thought to be a likely site for the initial effects of light, leading to increased ATP production, modulation of reactive oxygen species and induction of transcription factors. These effects in turn lead to increased cell proliferation and migration (particularly by fibroblasts), modulation in levels of cytokines, growth factors and inflammatory mediators, and increased tissue oxygenation.” [16]Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294.

Flow chart of how NIR light influences anti-aging transcription factors
NIR light absorption causes activation of important anti-aging transcription factors like KFkB and AP1.

Principal tissue chromophores such as hemoglobin and melanin absorb light below 600 nm and water (H2O) begins to absorb incoming light above 1150nm. There is an optical window of reduced absorption in human tissue between 600 nm and 1150nm where penetration is maximized.[17]Whelan HT, Buchmann EV, Dhokalia A, Kane MP,Whelan NT, Wong-Riley M, Eells J T, Gould LJ, Hammamieh R, Das R, Jett M. Effect of NASA Light-Emitting Diode Irradiation on Molecular Changes for Wound Healing in Diabetic Mice . Journal of Clinical Laser Medicine & Surgery. April 2003, 21(2): 67-74. doi:10.1089/104454703765035484.

For light to be beneficial to our bodies the light has to penetrate our tissue and the penetrating light has to be utilized by some chromophore or other light sensitive system. Only near infrared light meets these criteria. Virtually all studies of Low Level Light Therapy (LLLT) utilize near infrared (NIR) light because the key systems in our bodies that are affected by light do not absorb far infrared light. Mitochondrial ATP pathways, including Cytochrome-C-oxidase, and other critical cell processes involving ATP production and cell signaling absorb only NIR light.

Living Tissue Action Spectra Graph
Living tissue has an active photobiological window within the near infrared light band.

Studies from many laboratories confirm that the action spectra of living tissues and cells is between 600nm and 950nm, exclusively within the near infrared light band.[18]Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294. Here is a compiled graphic of this data.[19]Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294.

Healing or other beneficial sauna effects ascribed by some to far infrared light likely arise either from the thermal effects (hyperthermic therapy) of sauna use or the inclusion of NIR light in their emission spectra. Claims that mid or far infrared light has specific beneficial photo-biological effects become difficult to support on a scientific basis. Far infrared light does not penetrate enough to reach deeper tissues and, quite simply, there are no biologic receptors to use FIR light.

Direct Metabolism Boost

This effect cannot be overstated. Everything works better when oxidative phosphorylation (ATP production) improves. Mitochondria ramp up ATP production when excited with NIR light.

Illustration of how NIR light absorption promotes ATP production
Near infrared light directly stimulates cytochrome\noxidase, which catalyzes energy production by the mitochondria.

Brain and other Nervous System Effects

The above illustration also demonstrates effects on the nervous system by Low Level Near Infrared Light. NIR light is absorbed  by Cytochrome oxidase, the terminal enzyme in the mitochondrial respiratory chain. Cytochrome oxidase has a key role in neuronal physiology, as it serves as an interface between the oxidative energy metabolism and cell survival signaling pathways. Cytochrome oxidase is an ideal target for cognitive enhancement, as its expression reflects the changes in metabolic capacity underlying higher-order brain functions. This is a photochemical mechanism for cognitive-enhancing and brain-stimulatory effects in animal models and humans. NIR light directly provides neuroprotection and cognitive enhancement by facilitating mitochondrial respiration, with hormetic dose–response effects and brain region activational specificity.[20]Rojas JC, Gonzalez-Lima F. Neurological and psychological applications of transcranial lasers and LEDs . Biochem Pharmacol. 2013 Aug 15;86(4):447-57. doi: 10.1016/j.bcp.2013.06.012. Epub 2013 Jun 24. These effects are independent of beneficial effects to the brain by hyperthermic conditioning.

Body Fat & Help Control Focal Cellulite

Cellulite on thighWhile not directly involved with performance enhancement concern about body fat and cellulite is almost universal. NIR light works synergistically with exercise to increase weight loss.  This study group lost 444% more body weight by combining NIR light therapy with exercise than the control group doing exercise only.[21]Möckel F, Hoffmann G, Obermüller R, Drobnik W, Schmitz G. Influence of water-filtered infrared-A (wIRA) on reduction of local fat and body weight by physical exercise . Ger Med Sci. 2006; 4: Doc05. Studies using NIR phototherapy alone and in combination with other modalities have demonstrated decreases in cellulite accumulation.[22]Alster TS, Tanzi EL. Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device . J Cosmet Laser Ther. 2005 Jun;7(2):81-5. [23]Alster TS, Tanzi EL. Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device . J Cosmet Laser Ther. 2005 Jun;7(2):81-5.

Deep Tissue Penetration & Higher Energy

NASA studies have shown that NIR light penetrates up to 9 in (23 cm) of tissue, activating chromophores and cytochrome systems across that depth.[24]Whelan HT, Buchmann EV, Dhokalia A, Kane MP,Whelan NT, Wong-Riley M, Eells J T, Gould LJ, Hammamieh R, Das R, Jett M. Effect of NASA Light-Emitting Diode Irradiation on Molecular Changes for Wound Healing in Diabetic Mice . Journal of Clinical Laser Medicine & Surgery. April 2003, 21(2): 67-74. doi:10.1089/104454703765035484. Multiple energy systems are stimulated in and outside key mitochondrial processes.

Tissue Injury and Tissue & Wound Healing

Multiple studies show accelerated healing of wounds and other types of tissue injury using NIR light. A great example is the use of NIR light therapy to treat disorders and injury to the eyes.[25]Eells JT, Wong-Riley MT, VerHoeve J, Henry M, Buchman EV, Kane MP, Gould LJ, Das R, Jett M, Hodgson BD, Margolis D, Whelan HT. Mitochondrial signal transduction in accelerated wound and retinal healing by near-infrared light therapy . Mitochondrion. 2004 Sep;4(5-6):559-67. Rather than causing injury to the eye, near infrared light helps the eyes heal. In a scientific study, mice were blinded by chemical injury (methanol) and the blindness was reversed with the application of NIR light therapy.[26]Eells JT, Henry MM, Summerfelt P, Wong-Riley MTT, Buchmann EV, Kane M, Whelan NT, and Whelan HT. Therapeutic photobiomodulation for methanol-induced retinal toxicity . Proc Natl Acad Sci U S A. 2003 Mar 18; 100(6): 3439–3444. Published online 2003 Mar 7. doi: 10.1073/pnas.0534746100 There is a growing body of evidence demonstrating the powerful healing effects of NIR light. NIR light promotes faster cell regeneration and human tissue growth.

Joint & Muscle Pain

Low level light therapy has been shown to reduce joint and muscle pain in rats.[27]Hamblin M. Can osteoarthritis be treated with light? . Arthritis Research & Therapy. 2013, 15:120 doi:10.1186/ar4354. Penetrating near infrared light attacks joint and muscle problems from multiple angles.[28]Gale GD, Rothbart PJ, Li Y. Infrared therapy for chronic low back pain: a randomized, controlled trial . Pain Res Manag. 2006 Autumn;11(3):193-6.

Muscle Circulation

NIR light leads to the release of nitric oxide stimulating vasodilation of the microcirculatory system bringing more blood supply to muscles.
Better Endurance and muscle healing. NIR light exposure alone reduces muscle fatigue. NIR light accelerates healing of muscle and other tissue injury. Endurance capability is improved. Inflammation associated with muscle and joint disorders is diminished.

Illustration of how NIR light promotes NO production in cells
NIR light promotes improved muscle circulation by increasing nitrous oxide (NO) production by the the cell mitochondria.

Detoxification

The deeply penetrating near infrared light helps unlock even hard to get toxins. The rapid and profound sweating response that takes place in the relaxed atmosphere of a near infrared sauna under parasympathetic nervous system control (“rest & digest” not “flight or fight”) combines with NIR phototherapy to produce marked detoxification.[29]Wilson L, MD . Sauna Therapy for Detoxification and Healing . Prescott, AZ: LD Wilson Consultants, Inc; 2011.

Skin Rejuvenation

Near infrared light stimulates vital collagen and elastin production. Collagen helps plump the skin, while elastin firms the skin. The visible red and NIR light energizes and repairs damaged cells, stimulating collagen and elastin and returning the skin to a more youthful look. NIR light is being used currently to treat specific skin problems such as psoriasis, acne scars, eczema, rosacea and more.[30]Ablon G. Combination 830-nm and 633-nm light-emitting diode phototherapy shows promise in the treatment of recalcitrant psoriasis: preliminary findings . Photomed Laser Surg. 2010 Feb;28(1):141-6. doi: 10.1089/pho.2009.2484.

References   [ + ]

1. Hannuksela ML, Ellahham S. Benefits and Risks of Sauna Bathing Am J Med. 2001 Feb;110(2):118-26.
2. Scoon GS, Hopkins WG, Mayhew S, Cotter JD. Effect of post-exercise sauna bathing on the endurance performance of competitive male runners . J Sci Med Sport. 2007 Aug;10(4):259-62. Epub 2006 Jul 31.
3. King DS, Costill DL, Fink WJ, Hargreaves M, Fielding RA. Muscle metabolism during exercise in the heat in unacclimatized and acclimatized humans . J Appl Physiol (1985). 1985 Nov;59(5):1350-4.
4. Felsing NE, Brasel JA, Cooper DM. Effect of Low and High Intensity Exercise on Circulating Growth Hormone in Men . J Clin Endocrinol Metab. 1992 Jul;75(1):157-62.
5. Ftaiti F, Jemni M, Kacem A, Zaouali MA, Tabka Z, Zbidi A, Grélot L. Effect of hyperthermia and physical activity on circulating growth hormone . Appl Physiol Nutr Metab. 2008 Oct;33(5):880-7. doi: 10.1139/H08-073.
6. Ho KY, Veldhuis JD, Johnson ML, et al. Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man . Journal of Clinical Investigation. 1988;81(4):968-975.
7. Goekint M, Roelands B, Heyman E, Njemini R, Meeusen R. Influence of citalopram and environmental temperature on exercise-induced changes in BDNF . Neurosci Lett. 2011 Apr 25;494(2):150-4. doi: 10.1016/j.neulet.2011.03.001. Epub 2011 Mar 6.
8. Srivastava PK. Role of Heat Shock Proteins [Supplement to Article Could Our Own Proteins Be Used to Help Us Fight Cancer?] . Sci Am. 2008(July).
9. Selsby JT, Dodd SL. Heat treatment reduces oxidative stress and protects muscle mass during immobilization . Am J Physiol Regul Integr Comp Physiol. 2005 Jul;289(1):R134-9. Epub 2005 Mar 10.
10. Nath KA, Balla G, Vercellotti GM, et al. Induction of heme oxygenase is a rapid, protective response in rhabdomyolysis in the rat . Journal of Clinical Investigation. 1992;90(1):267-270.
11. Laukkanen T, Hassan Khan H, Zaccardi F, Laukkanen J. Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events . JAMA Intern Med. February 23, 2015. doi:10.1001/jamainternmed.2014.8187.
12. Kokura S, Adachi S, Manabe E, Mizushima K, Hattori T, Okuda T, Nakabe N, Handa O, Takagi T, Naito Y, Yoshida N, Yoshikawa T. Whole body hyperthermia improves obesity-induced insulin resistance in diabetic mice . Int J Hyperthermia. 2007 May;23(3):259-65.
13, 15, 16, 18, 19. Hamblin M, Demidova T. Mechanisms of low level light therapy . Proc. SPIE 6140, Mechanisms for Low-Light Therapy. 614001 (Feb 2006); doi:10.1117/12.646294.
14. American Society for Testing and Materials. Reference Solar Spectral Irradiance: Air Mass 1.5 ASTM. Sep 28, 2013.
17, 24. Whelan HT, Buchmann EV, Dhokalia A, Kane MP,Whelan NT, Wong-Riley M, Eells J T, Gould LJ, Hammamieh R, Das R, Jett M. Effect of NASA Light-Emitting Diode Irradiation on Molecular Changes for Wound Healing in Diabetic Mice . Journal of Clinical Laser Medicine & Surgery. April 2003, 21(2): 67-74. doi:10.1089/104454703765035484.
20. Rojas JC, Gonzalez-Lima F. Neurological and psychological applications of transcranial lasers and LEDs . Biochem Pharmacol. 2013 Aug 15;86(4):447-57. doi: 10.1016/j.bcp.2013.06.012. Epub 2013 Jun 24.
21. Möckel F, Hoffmann G, Obermüller R, Drobnik W, Schmitz G. Influence of water-filtered infrared-A (wIRA) on reduction of local fat and body weight by physical exercise . Ger Med Sci. 2006; 4: Doc05.
22, 23. Alster TS, Tanzi EL. Cellulite treatment using a novel combination radiofrequency, infrared light, and mechanical tissue manipulation device . J Cosmet Laser Ther. 2005 Jun;7(2):81-5.
25. Eells JT, Wong-Riley MT, VerHoeve J, Henry M, Buchman EV, Kane MP, Gould LJ, Das R, Jett M, Hodgson BD, Margolis D, Whelan HT. Mitochondrial signal transduction in accelerated wound and retinal healing by near-infrared light therapy . Mitochondrion. 2004 Sep;4(5-6):559-67.
26. Eells JT, Henry MM, Summerfelt P, Wong-Riley MTT, Buchmann EV, Kane M, Whelan NT, and Whelan HT. Therapeutic photobiomodulation for methanol-induced retinal toxicity . Proc Natl Acad Sci U S A. 2003 Mar 18; 100(6): 3439–3444. Published online 2003 Mar 7. doi: 10.1073/pnas.0534746100
27. Hamblin M. Can osteoarthritis be treated with light? . Arthritis Research & Therapy. 2013, 15:120 doi:10.1186/ar4354.
28. Gale GD, Rothbart PJ, Li Y. Infrared therapy for chronic low back pain: a randomized, controlled trial . Pain Res Manag. 2006 Autumn;11(3):193-6.
29. Wilson L, MD . Sauna Therapy for Detoxification and Healing . Prescott, AZ: LD Wilson Consultants, Inc; 2011.
30. Ablon G. Combination 830-nm and 633-nm light-emitting diode phototherapy shows promise in the treatment of recalcitrant psoriasis: preliminary findings . Photomed Laser Surg. 2010 Feb;28(1):141-6. doi: 10.1089/pho.2009.2484.