title: Outcomes from a three-arm randomized controlled trial of frequent immersion in thermoneutral water on cardiovascular risk factors.
abstract: BACKGROUND
  Cardiovascular diseases are a main cause of mortality worldwide. Spa bathing and immersion in thermoneutral water (ITW) have a long history in the treatment of cardiovascular risk factors.
  
  
  METHODS
  We conducted a three-arm parallel-group, randomized controlled study to investigate the effects of frequent ITW on moderately elevated blood pressure (BP). Here, we report on the secondary outcomes, i.e. the influence of immersion in thermoneutral water on further cardiovascular risk factors: body mass index (BMI), waist circumference, blood lipids, fasting blood glucose and C-reactive protein. Patients (age 57.6 ± 9.6 years, BMI 29.5 ± 5.7 kg/m(2)) with mild to moderately elevated BP received ITW for 45-60 min in pools of thermal-mineral water at 34.0-36.0 °C four times a week for 4 weeks. One group (Bath1) reduced the intensity to one bath a week for a further 20 weeks, while the other group (Bath2) continued bathing four times a week. The control group was instructed to relax for 45-60 min four times a week for 24 weeks using a relaxation CD.
  
  
  RESULTS
  The secondary analysis of the intention-to-treat population (N = 59) did not show a significant reduction of BMI, waist circumference, blood lipids, fasting blood glucose or C-reactive protein in patients with a mild to moderately elevated BP after 4 and 24 weeks ITW, respectively. There were no significant differences between the groups.
  
  
  CONCLUSIONS
  Thus, we did not find evidence to support our ITW program being an efficacious intervention to induce cardiovascular alterations in this population of hypertensive patients.
  
  
  BACKGROUND
  DRKS00003980 at drks-neu.uniklinik-freiburg.de, German Clinical Trials Register (registration date 2012-07-10).
authors.affiliation: Interdisciplinary Center for Treatment and Research in Balneology, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Faculty, Medical Center University of Freiburg, Breisacher Straße 115b, Freiburg im Breisgau, 79106, Germany. johannes.naumann@uniklinik-freiburg.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Naumann
authors.affiliation: Interdisciplinary Center for Treatment and Research in Balneology, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Faculty, Medical Center University of Freiburg, Breisacher Straße 115b, Freiburg im Breisgau, 79106, Germany.
authors.forename: Catharina
authors.identifier: http://orcid.org/0000-0003-1088-9643
authors.initials: C
authors.lastname: Sadaghiani
authors.affiliation: Interdisciplinary Center for Treatment and Research in Balneology, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Faculty, Medical Center University of Freiburg, Breisacher Straße 115b, Freiburg im Breisgau, 79106, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Bureau
authors.affiliation: Department of Psychosomatic Medicine, Medical Faculty, Medical Center University of Freiburg, Hauptstraße 8, Freiburg im Breisgau, 79104, Germany.|Institute of Transcultural Health Studies, European University Viadrina Frankfurt (Oder), Grosse Scharrnstr. 59, 15230, Frankfurt (Oder), Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, Medical Faculty, Medical Center University of Freiburg, Breisacher Straße 115b, Freiburg im Breisgau, 79106, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Huber
mesh_terms: D000328:Adult; D000368:Aged; D001452:Balneology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Balneotherapy; Cardiovascular; Hydrotherapy; Hypertension; Immersion