Sleep and spa therapies: What is the role of balneotherapy associated with exercise? A systematic review

Abstract

Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline, Scopus, PubMed, Web of Science, and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy–thermal water immersion alone (five studies); 1.b Balneotherapy–thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise–balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise–balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.

Evaluation of the benefits of neutral bicarbonate ionized water baths in an open-label, randomized, crossover trial

“…Balneotherapy over a period of 2 to 3 weeks may have beneficial effects on sleep quality 29 . It is thought to improve sleep by lowering systemic blood pressure and core body temperature by dilating peripheral blood vessels throughout the body, reducing pain by inhibiting inflammation and pain-related substances, and relaxing muscles 30 . The decrease in blood pressure occurs when the parasympathetic nervous system is dominant.…”

The Benefits of Neutral Bicarbonate Ionized Water Baths: An Open-Label, Randomized, Crossover Trial

“…20 It is thought to improve sleep by lowering systemic blood pressure and core body temperature by dilating peripheral blood vessels throughout the body, reducing pain by inhibiting in ammation and pain-related substances, and relaxing muscles. 21 The PSQI-J, the primary sleep endpoint in this study, assesses subjective sleep quality, including insomnia; the total score ranges from 0 to 21, and a score of 6 or more indicates a potential sleep problem. 14,22 In the present study, the PSQI-J score con rmed that the NBIW intervention led to signi cantly greater improvements in subjective sleep quality than the control intervention.…”

The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review

“…An immediate versus a delayed spa therapy was evaluated in a 12-month randomized clinical trial, demonstrating a clinically significant improvement at 6 months that persisted for 12 months in those who performed the immediate spa therapy [ 135 ]. Furthermore, balneotherapy and spa therapy can lead to increased quality and quantity of sleep, by affecting some hormones such as histamine and serotonin and regulating body temperature [ 135 , 136 , 137 , 138 ].…”