Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role?

Abstract

Pulmonary rehabilitation is essential in post-COVID subjects, reporting respiratory impairment after the discharge from the hospital. Because the number of patients with respiratory outcomes is high and there are few facilities available, we wonder if a spa setting could represent a valid out-of-hospital alternative. We aim to explore recent evidence related to respiratory rehabilitation in the spa environment to understand if it can represent an appropriate setting for respiratory rehabilitation interventions in post-COVID subjects. Studies were found by screening PubMed, MEDLINE, and Google Scholar databases from 2011 up to February 2021. Studies were eligible if they were reviews, randomized controlled trials (RCTs), or clinical trials, investigating respiratory interventions in the spa environment. Recent evidence has shown that inhalations and mineral-rich water immersions are effective in fighting and preventing multiple chronic respiratory tract diseases. Therefore, these treatments could also be applied to post-COVID patients with medium long-term respiratory outcomes.

Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes?

“…Respiratory performance also appears to improve with the application of a water exercise program, reconfirming what has already been suggested in the literature. 19 Since patients with chronic fatigue and reduced exercise tolerance are increasing worldwide in proportion to the increase in COVID-19 infection cases, there is an urgent need for innovative and effective protocols to treat these subjects. In recent months, it has already been suggested that specific water exercise protocols, including the use of thermal water and the adoption of multidisciplinary interventions (motor programs, respiratory rehabilitation and neuropsychological interventions), can be employed to treat chronic fatigue in post COVID-19 subjects.…”

“…In recent months, it has already been suggested that specific water exercise protocols, including the use of thermal water and the adoption of multidisciplinary interventions (motor programs, respiratory rehabilitation and neuropsychological interventions), can be employed to treat chronic fatigue in post COVID-19 subjects. 20 Thermal mineral water-based treatments may improve the physical symptoms of chronic fatigue and modulate the immune imbalance, reducing persisting inflammation. Additionally, rehabilitative protocol in the aquatic setting could also properly address comorbidities that can be present in post-COVID patients, such as obesity and other neurological and/or musculoskeletal problems.…”

“…Additionally, rehabilitative protocol in the aquatic setting could also properly address comorbidities that can be present in post-COVID patients, such as obesity and other neurological and/or musculoskeletal problems. 20,21 Innovative and efficient therapy paradigms that can address the COVID-19 infection outcomes, paying particular attention to those connected to comorbidities, should therefore be developed. In-water balancing and muscular strengthening activities, as well as walking recovery and improvement in cardiac or pulmonary performance, could be offered to post COVID-19 individuals taking advantage of the physical and chemical properties of mineral and/or thermal waters.…”

Health management of patients with COVID-19: is there a room for hydrotherapeutic approaches?

“…In addition, the inexpensive nature of spa therapy would represent a relevant financial strategy in the medico-economic management of the present health crisis (Kardeş 2021 ). While the pandemic crisis and the consecutive lockdowns distancing restrictions have critically affected their activity, hydrothermal centers should then be considered today as medically and economically pertinent alternatives to face the urgent need for interventions among COVID-19 patients (Masiero et al 2020a , b ; Maccarone and Masiero 2021 ; Kardeş 2021 ). Indeed, beyond the virtues of thermal waters, thermal institutions present several multidisciplinary health care programs combining alternative medicine with respiratory care, adapted physical activity programs, nutritional support, psychological support, physiotherapy, massage, music, or aromatherapy, in relaxing environments and under medical supervision.…”

“…Yet, other types of alternative medicines have also been proposed as innovative rehabilitative treatments, such as health resort medicine that has been suggested as a suitable setting to take care of discharged patients (Masiero et al 2020a). Since much evidence demonstrated the efficiency of spa environment on several respiratory diseases, spa setting might indeed represent a relevant out-of-hospital alternative (Maccarone and Masiero 2021), especially in the context of an increasing number of patients with respiratory outcomes whereas only a few facilities remain available. As mineral-rich waters were found to improve immune function, the potential benefits of such waters might also be discussed in the era of COVID-19 (Masiero et al 2020b).…”