Spa therapy and peripheral serotonin and dopamine function: a systematic review.

Spa therapy consists of multiple techniques based on the healing effects of water, including hydrotherapy, balneotherapy, and mud therapy, often combined with therapeutic exercises, massage, or physical therapy. Balneotherapy is a clinically effective complementary approach in the treatment of low-grade inflammation- and stress-related pathologies, especially rheumatic conditions due to its anti-inflammatory properties. The main objective of this investigation was to conduct a systematic review analyzing the available evidence on the effect of spa therapy on serotonin and dopamine function. The databases PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were used from June to July 2023. Exclusion criteria were (1) articles not written in English, (2) full text not available, (3) article not related to the objective of the review. JADAD scale was used for methodological quality evaluation. Four studies were included in the systematic review. Two studies were related to serotonin in healthy individuals, one to serotonin in fibromyalgia, and one to dopamine in healthy individuals. One of the studies evaluated hydrotherapy, another one balneotherapy and mud-bath therapy, and the other two assessed balneotherapy interventions. Studies were very heterogeneous, and their methodological quality was low, making it difficult to draw clear conclusions regarding the effect of spa therapy on peripheral serotonin and dopamine function. The findings of this review highlight the lack of studies evaluating these neurotransmitters and hormones in the context of spa therapy. Further research is needed to evaluate the potential effects of these therapies on serotonin or dopamine function.

Effectiveness of balneotherapy in reducing pain, disability, and depression in patients with Fibromyalgia syndrome: a systematic review with meta-analysis.

Balneotherapy, using heated natural mineral waters at 36-38 °C, presents a comprehensive treatment approach for Fibromyalgia Syndrome (FMS). This study aims to assess the effect of balneotherapy in reducing pain intensity, disability, and depression in patients with FMS. We want to assess this effect at just four time-points: immediately at the end of the therapy, and at 1, 3, and 6 months of follow-up. Following PRISMA guidelines, we conducted an aggregate data meta-analysis, registered in PROSPERO CRD42023478206, searching PubMed Medline, Science Direct, CINAHL Complete, Scopus, and Web of Science until August 2023 for relevant randomized controlled trials (RCTs) that assess the effect of balneotherapy on pain intensity, disability, and depression in FMS patients. Methodological quality was assessed using the Cochrane methodology, and the pooled effect was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Sixteen RCTs were included in the meta-analysis. Balneotherapy is effective in reducing pain intensity (SMD - 1.67; 95% CI -2.18 to -1.16), disability (SMD - 1.1; 95% CI -1.46 to -0.7), and depression (SMD - 0.51; 95% CI -0.93 to -0.9) at the end of the intervention. This effect was maintained at 1, 3, and 6 months for pain intensity and disability. Balneotherapy improves both pain intensity and disability in patients with FMS, providing evidence that its positive effects are sustained for up to 6 months of follow-up. Nevertheless, it is important to note that the improvement in depression varies across different temporal phases.

Balneotherapy and cortisol levels: an updated systematic review and meta-analysis.

The main objective of this review is to examine the impact of balneotherapy on serum and salivary cortisol concentrations. A systematic search was conducted in PubMed, Scopus, Web of Science, PEDro, and Google Scholar. The databases were screened from inception up until April 2024. After screening the scientific literature, 845 articles were retrieved and 17 studies, involving a total of 765 participants, were eventually included in the review. Among them, four were randomized controlled trials, five were non-randomized studies, and eight were pre-post studies with no control group. The evidence gathered in this review indicates a significant short-term reduction in cortisol levels in healthy individuals undergoing balneotherapy, particularly those experiencing high levels of stress. Conversely, in patients with rheumatic conditions (especially if elderly), increases in cortisol levels induced by balneotherapy can act as beneficial hormetic stress, reducing inflammatory mediators and improving pain and functional quality of life. The meta-analysis shows an overall trend of reduction in stress hormone levels, more pronounced in the intervention group undergoing mud-balneotherapy compared to the control group, a finding that, however, does not reach statistical significance (g=-0.11 [95% CI: -0.30; 0.08]; p > 0.05). Current scientific evidence demonstrates that balneotherapy has a positive impact on the regulation of cortisol levels. The regulation of the hypothalamic-pituitary-adrenal axis and the beneficial effects observed on health parameters and quality of life allow mud-balneotherapy to be classified as eustressful stimuli useful in preventing stress-related pathologies in healthy individuals and in alleviating symptoms in patients with chronic conditions. Future research on the topic is advised.

Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review.

Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data.

Advances in modern Balneology: new evidence-based indications from recent studies.

Balneotherapy (BT) is a therapeutic approach that utilizes various forms of water-based treatments to promote health and well-being. BT possesses a rich historical heritage and has garnered recognition from esteemed institutions such as the World Health Organization (WHO). Recent scientific research enables the identification of relevant diseases (obesity, metabolic diseases, sleep disorders, mental health conditions, Long-COVID-19, and cancer rehabilitation) that could potentially benefit from balneo-therapeutic treatments, thereby presenting new avenues of opportunity for SPA ("Salus per Aquam") medicine. These conditions exemplify the potential benefits of BT for ailments beyond the traditional scope of treatment associated with BT (most commonly osteoarthritis, fibromyalgia, rheumatic back pain, and chronic inflammatory respiratory or skin disorders). Overall, the current scientific evidence suggests that BT holds significant potential for enhancing both individual wellbeing and public health. However, further high-quality clinical trials are essential to corroborate these preliminary findings and to provide critical insights into the therapeutic benefits of BT, paving the way for its broader integration into healthcare practices and public health initiatives.

Efficacy of balneotherapy on pain, function, and sleep quality in patients with chronic low-back pain: a prospective observational study.

The aim of this prospective observational study was to evaluate the efficacy of a cycle of sulfate-arsenical-ferruginous mud bath therapy on pain, function, and sleep quality in patients with chronic low-back pain (CLBP). One hundred twenty-three patients treated at Levico Spa Center (Italy) with 12 daily local mud packs and generalized thermal baths were included in this experience. General medical assessments were performed before starting the therapy, at the end of the treatment, and 3 months later. Pain intensity and stiffness were measured by a 0 to 10 cm visual analogue scale (VAS); the range of mobility of the lumbar spine was evaluated using the Schober test and functional disability by the Roland-Morris Disability Questionnaire (RMDI). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The VAS score for pain and stiffness showed a significant reduction (p < 0.0001) at the end of the treatment persisting for 3 months of follow-up. Similarly, a significant improvement was found for the Schober test and RMDQ. Finally, we showed a significant decrease of PSQI score at the end of the cycle of mud bath and at 3 months of follow-up. The Spearman analysis showed a significant positive correlation between the score of PSQI and VAS pain, VAS stiffness, and RMDQ. In conclusion, this preliminary study confirms the beneficial and long-term efficacy of balneotherapy on pain and function and, for the first one, shows the positive effect on quality of sleep in patients with CLBP treated with a cycle of mud bath therapy.

[Dependence of medical rehabilitation effectiveness of patients with somatic diseases and meteopathology on features of weather-forming factors of the Moscow region]. / Zavisimost' effektivnosti meditsinskoi reabilitatsii patsientov s somaticheskimi zabolevaniyami i meteopatologiei ot osobennostei pogodoobrazuyushchikh faktorov Moskovskogo regiona.

Climate change and formation of regional weather features increase both direct (immediate effects of extremal temperature and other weather and climatic anomalies) and indirect (environmental deterioration, etc.) consequences of global climate change. The development of investigations of medical weather assessment, medical and meteorological forecasting system, the use of treatment and preventive measures give the opportunity to prepare for weather biotropic conditions and reduce weather-conditioned exacerbations. OBJECTIVE: To assess the clinical effectiveness of non-drug comprehensive methods, including balneotherapy and physiotherapy, in patients with somatic diseases, complicated by increased meteosensitivity, depending on the features of weather conditions in the Moscow region. MATERIAL AND METHODS: The study included 120 patients diagnosed with «osteoarthrosis/osteoarthritis¼ with predominant hip and knee joint damage. The majority of patients had comorbidities, namely hypertensive disease (67.2%), ischemic heart disease (32.8%), chronic obstructive pulmonary disease and bronchial asthma (10.8%), grade II-III obesity (10%) and compensated diabetes mellitus (9.2%). The severity and main symptoms of the meteopathic reactions' manifestation were assessed by questionnaires consisting of three blocks, HAM, SF-36 tests and psychological stress scale. Medical and meteorological assessment of weather conditions in Moscow included analysis of the main weather-forming factors for 4 main synoptic observations in 10-minute mode for current and predictive 2 days, as well as daily characteristics of solar activity. Treatment methods included alternating magnetic field (AMF) procedures, general sodium chloride baths, massage and rehabilitation exercises (RE) (1st group); AMF, «dry¼ carbon dioxide baths, applications with brine on the affected joints and RE (2nd group); AMF, «dry¼ radon baths, applications with brine and RE (3rd group). RESULTS: The conducted studies have revealed the trigger role of most biotropic combinations of weather-forming factors that provoke exacerbation in patients with joint diseases. Sodium chloride, «dry¼ carbon dioxide and radon baths combined with AMF, applications with brine on the affected joints and RE are pathogenetically justified and contribute to increase of adaptive potential, functional reserves of the body and provide significantly high (p<0.05) meteocorrective action. CONCLUSION: The obtained results can be used for rehabilitation of patients with joint diseases complicated by increased meteosensitivity.

[Hydrogen sulfide balneotherapy in comprehensive sanatorium-resort treatment of post-burn scars in children]. / Serovodorodnaya bal'neoterapiya v kompleksnom sanatorno-kurortnom lechenii posleozhogovykh rubtsov u detei.

Thermal lesions in children leave behind cicatricial contractions, contractures, deformations of the wrists, feet, face. Sanatorium-resort treatment using balneotherapy is an integral part of rehabilitation measures in such patients. OBJECTIVE: To analyze the results of hydrogen sulfide balneotherapy in children with consequences of thermal injury. MATERIAL AND METHODS: A single-center observational retrospective non-controlled study was carried out, in which sanatorium-resort treatment concerning post-burn scars in 812 children aged 5-17 years was analyzed. Hydrogen sulfide balneotherapy was prescribed to patients depending on the age in mild (5-6 years) or moderate-to-high (7-17 years) exposure modes. The imported hydrogen sulfide mineral water from the T-2000 well of the Matsesta field with the H2S total concentration of 410-420 mg/l was used for treatment. The applications were performed to children alternate days, 8 procedures of balneotherapy per course. RESULTS: Lightening of the affected areas of the skin, reduction of the sensation of contraction and tension of the scars, which became softer, more elastic and more mobile with regard to the subjacent tissues have been noted in patients after the course of balneotherapy. The head mobility increased after applications in the presence of scars. The large joints' range of motion grew up. In addition, an increase in the mobility of the fingers of wrists and feet, a decrease in the stiffness of movements, increase or recovery of the affected skin's tactile sensitivity have been observed. Children well tolerated procedures, adverse events were seen in 0.7% of cases in the form of mild reactions at the beginning of the applications' course, namely of balneological (0.6%) and toxico-allergic (0.1%) nature. CONCLUSION: Hydrogen sulfide balneotherapy in combination with rehabilitation exercises and other sanatorium-resort factors is an effective mean of post-burn scars correction in children.

Rationale and current evidence of aquatic exercise therapy in venous disease: A narrative review.

Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.

Comparative analysis of balneotherapy in European public health systems: Spain, France, Italy, and Portugal.

Balneotherapy comprises the use of natural mineral waters for health and/or well-being purposes. When balneotherapy is offered by the public health system, some countries with Latin-based languages call it social thermalism. The aim of this study is to compare balneotherapy in health systems of Spain, France, Italy, and Portugal. The study involves a qualitative systematic review of the literature using the systematic search flow method. Twenty-two documents, from 2000 to 2022, were included and its findings were described in seven categories: the first outlines the historical characterization of social thermalism in the systems analyzed and the others outline the components of the health systems: coverage/access, health financing, workforce, inputs and techniques, organization and regulation, and network provision of services. The models of insurance and social security that cover part of the thermal treatment are highlighted. Doctors with competence in medical hydrology constitute the majority of the workforce. Similarities regarding inputs and techniques are observed, with variation in the number of days of the balneotherapy treatment cycle. In the regulation of services, the Ministry of Health of each country is prominent. The provision of services is mainly performed in specialized care in accredited balneotherapy establishments. Despite the limitations of the method, the comparisons made may serve to support public policies for balneotherapy.

Cross-cultural adaptation of the spa therapy checklist (SPAC) in Greek.

The importance of spa therapy is growing worldwide, with care practitioners paying more attention to how this intervention can alleviate various health issues. Multiple studies have been performed and reported on the efficiency of balneotherapy, creating a need to understand the quality of the information in the existing studies and how they can inform practitioners in promoting evidence-based practice. The SPAC assessment tool describes and assesses the quality of reports of interventional trials in balneotherapy. The present study had two goals. The first goal was the translation and cross-cultural adaptation of the SPAC assessment tool in Greek language following an internationally accepted methodology. The second goal was to assess the reliability of the tool employing test-retest and interrater reliability studies in a sample of 15 relative RCT papers and to assess the criterion validity of the Greek version by comparing its results with the original English version when assessing the same 15 papers. The results revealed that the SPAC checklist was translated and adapted in Greek without difficulties between the translators. Reliability of the SPAC was found excellent in both test-retest (ICC = .98) and interrater (ICC = .95) indexes. The criterion validity assessment for Greek version of SPAC checklist was also almost perfect (ICC = .98). In the present study, the Greek version of the SPAC checklist was found to be a comprehensible, reliable, and valid tool to assess the quality of interventional trial reports on the efficacy of spa therapy for cure and health enhancement.

Evaluation of the effects of Lake Hévíz sulfur thermal water on skin microbiome in plaque psoriasis: An open label, pilot study.

Psoriasis is a chronic inflammatory skin disease. It is associated with changes in skin microbiome. The aim of this study was to evaluate how Lake Hévíz sulfur thermal water influences the composition of microbial communities that colonizes skin in patients with psoriasis. Our secondary objective was to investigate the effects of balneotherapy on disease activity. In this open label study, participants with plaque psoriasis underwent 30-min therapy sessions in Lake Hévíz, at a temperature of 36 °C, five times a week for 3 weeks. The skin microbiome samples were collected by swabbing method from two different areas (lesional skin-psoriatic plaque and non-lesional skin). From 16 patients, 64 samples were processed for a 16S rRNA sequence-based microbiome analysis. Outcome measures were alpha-diversity (Shannon, Simpson, and Chao1 indexes), beta-diversity (Bray-Curtis metric), differences in genus level abundances, and Psoriasis Area and Severity Index (PASI). Skin microbiome samples were collected at baseline, and immediately after treatment. Based on the visual examination of the employed alpha- and beta-diversity measures, no systematic difference based on sampling timepoint or sample location could be revealed in these regards. Balneotherapy in the unaffected area significantly increased the level of Leptolyngbya genus, and significantly decreased the level of Flavobacterium genus. A similar trend was revealed by the results of the psoriasis samples, but the differences were not statistically significant. In patients with mild psoriasis, a significant improvement was observed in PASI scores.

Effect of hydrotherapy, balneotherapy, and spa therapy on blood pressure: a mini-review.

Hypertension (high blood pressure) is one of the most common health conditions. When your blood pressure is high for a long term, it can cause health problems, such as heart disease. In addition to the main methods of treatment, there are various methods of adjuvant therapy, one of the most common of which is hydrotherapy. In this review study, we examined the effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure. We searched the PubMed/MEDLINE, Web of Science, Scopus, and Science Direct databases until April 2022 using related keywords. In summary, the current study shows that different hydrotherapy methods may improve blood pressure. Hydrotherapy as one of the adjunctive therapy methods can be effective in lowering blood pressure. Blood circulation is smoothed by the warmth of the water. This improvement may be achieved by regulating heart rate, releasing hormones that control blood pressure, or regulating the activity of baroreceptors or chemoreceptors. In addition to using medications, hypertension patients also use non-pharmacological approaches in their care, including hydrotherapy, balneotherapy, and warm water foot soaks performed at home. Although several lines of evidence show the potential effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure, many clinical trials are needed.

The effects of immersion in 42℃ radon, natrium, calcium, bicarbonate content thermal-mineral water on chronic low back pain. Controlled, follow-up study.

In our minimized follow-up trial with 137 participants with chronic low back pain, one group of participants received regular outpatient care, and the other group received balneotherapy by immersion in 42℃ thermal-mineral water in addition to regular outpatient care on 15 occasions for 3 weeks. Pain on movement and at rest on the 0-100 mm visual analogue scale (VAS), Oswestry index, the number of participants evaluating the symptoms clinically acceptable (Patient Acceptable Symptom State, PASS) and the EuroQol-5D-5L (EQ-5D-5L) quality of life questionnaire were assessed at basal time (at week 0) and after balneotherapy (at weeks 3 and 12). The VAS pain scores, the Oswestry index, the EQ-5D-5L index and the EQ-VAS significantly improved in the balneotherapy group after treatment at week 3 (p < 0.001) and week 12 (p < 0.001) compared to baseline, with a significant between group difference at week 3 (p < 0.001) and week 12 (p < 0.001). The pain VAS score on movement was 66.82 ± 11.48, 26.69 ± 21.49, and 20.09 ± 23.29 in the balneotherapy group, and 63.67 ± 14.77, 67.35 ± 15.44, and 70.23 ± 18.26 in the control group at the consecutive visits. The PASS increased in both groups at week 3 and week 12 compared to the baseline, with a significant between-group difference at week 3 and week 12 for the balneotherapy group. Our results suggest the therapeutic efficacy of immersion in 42℃ thermal mineral water on chronic low back pain.ClinicalTrials.gov Identifier: NCT05342051.

Short-time effects of spa rehabilitation on pain, mood and quality of life among patients with degenerative or post-surgery musculoskeletal disorders.

Clinical trials have demonstrated traditional spa therapy effects in musculoskeletal disorders (MSDs). This is the first observational study in Italy aimed at evaluating in real-life the short-time effects of spa rehabilitation on pain, mood and quality of life (QoL) among degenerative or post-surgery MSDs patients. Through the involvement of six Italian spa facilities, 160 patients were enrolled; data from 123 patients were finally analysed. Seventy-nine patients (64.3%) accessed the spa for degenerative MSDs, while 44 (35.8%) had a post-surgical condition. All the patients included in the study underwent 12 sessions of water-based exercise (joint exercises, muscle strengthening, gait training, proprioceptive and balance techniques) conducted in thermal or in warm water pools, six sessions per week, for a period of 2 weeks from March 2019 up to October 2019. A group of 45 patients (36.6%) also received traditional thermal therapies, including 12 mud therapy sessions and 12 thermal baths, six times each week, for 2 weeks. Evaluation before and after the treatment included the Numerical Rating Scale (NRS), the Short Form Health Survey (SF-12) and the EuroQol-5D (EQ-5D). The analysis of the scores reported in the questionnaires after the treatment showed a significant improvement in all the scores evaluated. Comparison between patients that performed water-based exercise protocols alone (group A) and patients that in addition to water exercise performed traditional thermal interventions (group B) showed no statistically significant differences in NRSp, NRSa, NRSm, SF-12 PCS, SF-12 MCS and EQ-5D variations; only NRSa value reduction was lower in group B. Sulphate water was found to be associated with a lower reduction of all the scores considered, when compared to the other water types. Patients with degenerative or post-surgery MSDs showed favourable effects on pain, mood and QoL after water exercise training alone or in combination with traditional thermal therapy. Our research provides the first proof that spa rehabilitation can be in real-life conditions an appropriate alternative strategy for post-orthopaedic surgical outcomes recovery. In the future, these results will need to be further investigated.

Study on nondrug intervention of 7 days of balneotherapy combined with various sleep-promoting measures on people with sleep disorders: preliminary and pilot study.

To preliminarily explore a nondrug intervention method and evaluate its effects (sleep quality, physical examination indicators, and general physical symptoms) on people with sleep disorders. The intervention was based on regular balneotherapy, coupled with targeted health education, appropriate exercise, diet management, and other sleep-promoting measures. It was the combined effects that we evaluated. We recruited 31 volunteers with sleep disorders to receive a 7-day sleep-promoting experience in Tianxing International Hot Spring City, Nanchuan District, Chongqing. The intervention adopted a plan that combined balneotherapy with various sleep-promoting measures. Persisting baths in hot springs 1-2 times per day targeted health lectures about 1 h every morning, appropriate exercise every day (sleep-aid yoga, forest hiking, morning exercises, etc.), and diet management (the principle is to control oil, salt, and sugar, diversify food, keep meat and vegetable balanced, and control total calories. The dinner is light and easy to digest). During the intervention period, all participants followed the above intervention plan, and they lived in the spa resort to accept unified arrangement. This study adopted a self-contrast method by comparing the changes in sleep quality, physical examination indicators, and general physical symptoms before and after the intervention through physical examinations and questionnaire surveys. After the intervention, the subjects' total score of Insomnia Severity Index (ISI) decreased significantly (P = 0.006), and all seven dimensions showed a decrease, four of which included early morning awakening, sleep dissatisfaction, noticeability of sleep problems by others, and distress caused by sleep problems decreased significantly (all P < 0.05). The subjects' body mass index, waist circumference, fasting blood glucose, and triglycerides decreased significantly (all P < 0.05), and systolic blood pressure increased significantly (P = 0.006). Total cholesterol, high-density lipoprotein, low-density lipoprotein, and diastolic blood pressure did not change significantly (all P > 0.05). To some extent, all general health problems were improved than before the intervention (the improvement rate was up to 70% or more). The non-pharmacological intervention of balneotherapy combined with various sleep-promoting measures showed positive effects on sleep quality, general physical symptoms, and some physical examination indicators of sleep disorders. This comprehensive intervention may be an effective way to improve people's health with sleep disorders.

Exploring the potential role of health resort medicine in the management of breast cancer-related lymphedema: a viable alternative for innovative rehabilitation opportunities?

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients.

The Benefits of Water from Nitrodi's Spring: The In Vitro Studies Leading the Potential Clinical Applications.

Natural products (water, plants, and minerals) have been studied for diverse applications in health and disease. Since there has been a growing interest in the introduction of thermal water as a clinical complementary approach in the treatment of low-grade inflammation and stress-related conditions, this review focuses on the oldest spa in the world: Nitrodi's spring. Substantial studies in the 1960s showed that both the internal and external use of Nitrodi's water yielded several benefits in physiological processes and in treating certain disorders, mainly allergic and autoimmune inflammatory conditions. More recently, a novel interest in Nitrodi's water has prompted researchers to further explore the effects of this water and shed light on the molecular mechanisms sustaining its therapeutic efficacy. In different epithelial cell models, Nitrodi's water had strong promotional effects on proliferation, cell migration, cell viability, and fibroblast to myofibroblast transition, all of which essential for wound healing and tissue remodeling. Moreover, Nitrodi's water exhibited anti-oxidant and anti-inflammatory properties through the inhibition of ROS production and protein S-nitrosylation. Here, we have collected the clinical and basic data on Nitrodi's water and reviewed articles that have discussed its use as a potential treatment for several inflammatory and autoimmune diseases and age-related skin deterioration.

[Comparison of balneotherapy and balneotherapy combined with magnetic-laser therapy at a sanatorium-resort stage of treatment of patients with eczema]. / Sravnenie bal'neoterapii i bal'neoterapii v sochetanii s magnitolazernoi terapiei na sanatorno-kurortnom etape lecheniya bol'nykh s istinnoi ekzemoi.

The search for new rational ways to improve the effectiveness of treatment and rehabilitation measures of patients with true eczema continues to be one of the pressing issues in modern clinical dermatology. OBJECTIVE: The comparative analysis of influence of different variants of SCL: balneotherapy and balneotherapy combined with magnetic laser therapy on the dermatological status, IL-4 and IL-13 level, psycho-emotional state and QOL evaluation in patients with true eczema. MATERIAL AND METHODS: The study involved 112 patients with true eczema undergoing spa treatment (SCR) (54 in the balneotherapy group and 58 in the balneotherapy group combined with magnetic laser therapy. The effectiveness of SCR was assessed using the EASI, HARS and MADRS scales, and the DLQI questionnaire. The dynamics of IL-4 and IL-13 plasma levels were studied. The duration of the study was 6 months and 14 days. RESULTS: After 14 days of SCR, a statistically significant reduction of the EASI index was more pronounced in the balneotherapy group in combination with MLT compared to the balneotherapy group (p=0.041). Balneotherapy combined with MLT contributed to a statistically significant reduction in the HARS and HDRS scores. The decrease in IL-4 and IL-13 levels was statistically more significant in the balneotherapy group in combination with MLT. The combined use of balneotherapy and MLT in comparison with the balneotherapy group was accompanied by a more pronounced improvement in QOL. The combined use of balneotherapy and MLT in the follow-up phase showed a long-term positive effect: 6 months after completing SCR, the number of patients who had clinical remission was statistically significantly higher than that of the balneotherapy group (87.4% vs 22.5%). CONCLUSION: The combined use of balneotherapy and MLT compared with balneotherapy in patients with true eczema on SCR was shown to be advantageous. The complex application of balneotherapy and MLT decreases inflammatory biomarker scores, improves dermatological and psychoemotional status, QOL parameters and is well tolerated.

The importance of body core temperature evaluation in balneotherapy.

It is not wrong to say that there are no application standards or best practices in balneotherapy considering traditional applications. There is not enough information about how changes in body temperature, duration, and frequency of exposure to heat affect therapeutic outcomes of balneotherapeutic applications. Body core temperature (BCT) is probably the best parameter for expressing the heat load of the body and can be used to describe the causal relationship between heat exposure and its effects. There are several reasons to take BCT changes into account; for example, it can be used for individualized treatment planning, defining the consequences of thermal effects, developing disease-specific approaches, avoiding adverse effects, and designing clinical trials. The reasons why BCT changes should be considered instead of conventional measures will be discussed while explaining the effects of balneotherapy in this article, along with a discussion of BCT measurement in balneotherapy practice.