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Review Article

Scientific Evidence-Based Effects of Hydrotherapy

on Various Systems of the Body
Mooventhan A, Nivethitha L1

Naturopathy Clinical, SDM College of Naturopathy and Yogic Sciences, Ujire, 1Department of Research and Development,
S-VYASA University, Bangalore, Karnataka, India

Abstract
The use of water for various treatments (hydrotherapy) is probably as old as mankind. Hydrotherapy is one of the basic methods of treatment
widely used in the system of natural medicine, which is also called as water therapy, aquatic therapy, pool therapy, and balneotherapy. Use
of water in various forms and in various temperatures can produce different effects on different system of the body. Many studies/reviews
reported the effects of hydrotherapy only on very few systems and there is lack of studies/reviews in reporting the evidence-based effects
of hydrotherapy on various systems. We performed PubMed and PubMed central search to review relevant articles in English literature
based on “effects of hydrotherapy/balneotherapy” on various systems of the body. Based on the available literature this review suggests
that the hydrotherapy has a scientific evidence-based effect on various systems of the body.

Keywords: Evidence-based effects, Hydrotherapy, Various systems

Address for Correspondence: Dr. Mooventhan A., Department of Naturopathy clinical, SDM College of Naturopathy and Yogic Sciences, Ujire,
Karnataka, India. E-mail: dr.mooventhan@gmail.com

Introduction with the aim and objective to report scientific evidenced-

based effects of hydrotherapy on various systems of
Hydrotherapy is the external or internal use of water the body. In order to provide a general overview, we
in any of its forms (water, ice, steam) for health performed PubMed and PubMed central search to
promotion or treatment of various diseases with various review relevant articles in English literature based on
temperatures, pressure, duration, and site. It is one of “effects of hydrotherapy/balneotherapy” on various
the naturopathic treatment modality used widely in systems of the body. Articles published from 1986 to
ancient cultures including India, Egypt, China, etc.[1] 2012 were included in this review.
Though many countries used water to produce different
physiological/therapeutic effects on different part of the Hydrotheraphy in general
system for maintaining health, preventing, and treating Superficial cold application may cause physiologic
the diseases, the scientific evidence-based effects are reactions such as decrease in local metabolic function,
not well documented. There are many studies/reviews local edema, nerve conduction velocity (NCV), muscle
that reported either physiological or therapeutic or spasm, and increase in local anesthetic effects.[2]
combination of both the effects of hydrotherapy on
particular system but did not report in all the major One hour head-out water immersions (WI) in various
systems of the body, which made us to do this review temperatures (32°C, 20°C, and 14°C) produced various
effects. Immersion at 32°C did not change metabolic rate
Access this article online (MR) and rectal temperature (Tre), but it lowered the
heart rate (HR) by 15%, systolic blood pressure (SBP)
Quick Response Code:
Website: and diastolic blood pressure (DBP) by 11% and 12%,
www.najms.org
respectively, compared, with controls at ambient air
temperature. Along with HR and blood pressure (BP), the
DOI: plasma renin activity, plasma cortisol, and aldosterone
10.4103/1947-2714.132935 concentrations were also lowered by 46%, 34%, and 17%,
respectively, while diuresis was increased by 107%.[3]

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

Immersion at 20°C produced similar decrease in After ST reduced level of total and low density
plasma renin activity, HR, SBP, and DBP, in spite of lipoprotein (LDL)-cholesterol concentration, while
lowered Tre and increased MR by 93%. Plasma cortisol increased level of high density lipoprotein (HDL)-
concentrations tended to decrease, while plasma cholesterol was observed. These changes are good
aldosterone concentration was unchanged. Diuresis was prognoses for the prevention of ischemic heart disease.[7]
increased by 89%. No significant differences in changes ST increases endothelial nitric oxide synthase (eNOS)
in plasma renin activity, aldosterone concentration, and activity and improves cardiac function in heart failure
diuresis compared with subjects immersed in 32°C.[3] and improve peripheral blood flow in ischemic limbs.
In myocardial infarction (MI)-induced Wistar rats ST
Immersion at 14°C lowered Tre and increased MR by increases myocardial eNOS, vascular endothelial growth
350%, HR, SBP, and DBP by 5%, 7%, and 8%, respectively. factor mRNA levels. It attenuates cardiac remodeling
Plasma noradrenaline and dopamine concentrations after MI through improving coronary vascularity in
were increased by 530% and by 250%, respectively, the noninfarcted myocardium and thus ST might serve
while diuresis increased by 163%, which was more than as a novel noninvasive therapy for patients with MI.[8]
at 32°C. Plasma aldosterone concentrations increased Acute MI was thought to result from thrombosis or
by 23%. Plasma renin activity was reduced. Cortisol plaque rupture because of coronary artery spasm. The
concentrations tended to decrease. Plasma adrenaline vasospasm might be induced by stimulation of the alpha-
concentrations remained unchanged. Changes in plasma adrenergic receptors during alternating heat exposure
renin activity were not related to changes in aldosterone during sauna bath followed by rapid cooling during
concentrations.[3] cold water bath. This effect showed the dangers of rapid
cooling after sauna bathing in patients with coronary risk
WI in different temperatures did not increase blood factors.[9] Regular ST (either radiant heat or far-infrared
concentrations of cortisol. There was no correlation units) appears to be safe and produce multiple health
between changes in Tre and changes in hormone benefits but use of ST in early pregnancy is a potential
production. The physiological changes induced by WI concern because evidence suggesting that hyperthermia
are mediated by humoral control mechanisms, while might be teratogenic.[10]
responses induced by cold are mainly due to increased
activity of the sympathetic nervous system (SNS).[3] Cold water immersion (CWI) induces significant
physiological and biochemical changes in the body
Regular winter swimming significantly decreased such as increase in HR, BP, metabolism, and peripheral
tension, fatigue, memory, and mood negative state points catecholamine concentration; and decrease in cerebral
with the duration of swimming period; significantly blood flow.[11]
increased vigor-activity scores; relieved pain who
suffered from rheumatism, fibromyalgia, or asthma; and Reduction in HR, and increases in systolic and diastolic
improved general well-being in swimmers.[4] biventricular functions, were observed during acute
warm-WI.[12] In contrast, increase in HR and a decrease
in SBP and DBP were observed in 30 min of head-out
Cardiovascular system WI (38.41 ± 0.04°C).[13]
Cold exposure (CE) to small surface area produced
compensatory vasodilatation in deeper vascular system Hyperthermic immersion (HI) produced shortening
resulting increased blood flow to the tissues underlying of activated partial thromboplastin time. During HI
the site of exposure. This vascular reaction occurs mainly plasminogen activator inhibitor (PAI) activity was
to maintain constant deep tissue temperature.[2] decreased; thrombocyte count was increased; increases
in tissue-type plasminogen activator concentration and
In patient with chronic heart failure (CHF), thermal leukocytes count were attributed to hemoconcentration.
vasodilatation following warm-water bathing and low- Immediately after HI, fibrinogen concentration decreased
temperature sauna bathing (LTSB) at 60°C for 15 min but increased during recovery. During thermo-neutral
improves cardiac function;[5] repeated sauna-therapy (ST) immersion prothrombin time, PAI activity and
increased left ventricular ejection fraction; increased 6-min granulocyte count ecreased. Warm water bathing
walk distance in association with improvement in flow- leads to hemoconcentration and minimal activation
mediated dilation and increase in number of circulating of coagulation; decrease in PAI-1 activity. During
CD34 (+) cells; reduced plasma levels of norepinephrine warm water bathing, marked risk for thrombotic or
and brain natriuretic peptide. These indicates that bleeding complications in healthy males could not be
ST improves exercise tolerance in association with ascertained.[14] During contrast baths, longer duration
improvement in endothelial function.[6] LTSB improves in the second heating phase was required to produce
peripheral circulation in cerebral palsy (CP).[5] sufficient fluctuation in blood flow.[15]

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

WI up-to shoulder levels at different temperatures cold.[23] A male track and field athlete, a case of breathing
(25°C, 34°C, and 40°C) showed no significant effect on difficulties at rest and during exercise, was exacerbated
cardiac output in 25°C compared with 34°C, but in 40°C a in the supine position and during WI.[24]
considerable increase in cardiac output was observed.[16]
Nervous system
Carbon dioxide (CO2) enriched WI reduced free radical
Three cold modalities such as ice massage, ice pack, and
plasma levels, raised antioxidants levels, and induce
CWI applied to right calf region for 15min reduced skin
peripheral vasodilatation suggests improvement in
temperature (Tsk) (mean 18.2°C); reduced amplitude
microcirculation.[17,18] Decrease in tympanic temperature;
and increased latency and duration of compound action
increase in cutaneous blood flow at immersed site was
potential. It also reduced sensory NCV by 20.4, 16.7,
significantly greater in CO2-WI compared with fresh
and 22.6 m/s and motor NCV by 2.5, 2.1, and 8.3 m/s,
WI.[18] The three main effects of CO2 enriched WI are
respectively. Even though all three modalities effectively
decline in core temperature, increase in cutaneous blood
reduced Tsk and sensory conduction at a physiological
flow, and elevation of score on thermal sensation, which
level, CWI is the most indicated, effective modality
were analyzed.[19]
for inducing therapeutic effects associated with the
reduction of motor nerve conduction.[25]
Respiratory system
WI up-to shoulder levels at different temperatures (25°C, Temperature and pressure of water in aquatic or
34°C, and 40°C) showed increased MR, oxygen (O2) hydrotherapy can block nociceptors by acting on thermal
consumption (VO2) only at 25°C. Two main factors receptors and mechanoreceptors and exert positive
affecting O2 transport during immersion are temperature effect on spinal segmental mechanisms, which is useful
and hydrostatic pressure. O2 transport was improved for painful condition.[26] Forty sessions of Ai Chi aquatic
above neutral temperature, because of increase in exercise (AE) program improves pain, spasms, disability,
cardiac output resulting from the combined actions of fatigue, depression, and autonomy in patient with
hydrostatic counter pressure and body heating. Below multiple sclerosis.[27]
neutral temperature, O2 transport is altered. At any of
the temperatures tested, the pulmonary tissue volume In a study on physiotherapy on land or water in patient
and arterial blood gases were not significantly affected.[16] with Parkinson’s disease (PD), functional reach test
was improved in both therapies, but Berg Balance Scale
Significant decrease in vital capacity (VC) with bath (BBS) and Unified Parkinson’s Disease Rating Scale
temperature was observed (i.e., VC at 40°C >34°C >25°C). (UPDRS) were improved only in aquatic therapy group.
Significant increase in tidal volume (VT) in cold or hot It indicates improvement in postural stability in PD was
water compared with thermo neutral water (i.e., VT significantly larger after aquatic therapy.[28]
40°C >34°C< 25°C). Alterations in respiratory muscles
functioning might produce variations of the pulmonary Sauna bath on paraplegic (P) group and tetraplegic (T)
volumes as a function of water temperature.[20] group, HR increased significantly during sauna but
decreased significantly during postsauna phase in
CWI was associated with increase in respiratory minute P group. DBP significantly reduced in T group during
volume and decrease in end tidal CO2 partial pressure.[11] postsauna phase but no significant changes in SBP in
Repeated cold water stimulations reduced frequency of both the groups.[29]
infections; increased peak expiratory flow, lymphocyte
counts, and expression of gamma-interferon; modulated In a study on CP, LTSB produced increase in HR and
interleukin expression; and improved quality of life cardiac output; decrease in BP and total peripheral
(QOL) in patients with chronic obstructive pulmonary resistance; significant improvement in skin blood
disease.[21] flow, blood flow velocity, pulsatile index, and resistive
index; decrease in numbness and chronic myalgia of the
In children suffering from recurrent and asthmatic extremities with no adverse effects.[5]
bronchitis in remission, a single total air bath, or douche
and local (cooling of the feet with water) exposure to mild Ten minutes of immersions in whirlpools produced
cold did not raise noticeable disorders of the respiratory increases in pulse and finger temperature with increased
function. Local cold procedures improve bronchial feelings of well-being and decreased state anxiety.[30] CO2-
patency but heat exposure resulted in its worsening.[22] WI activates parasympathetic nerve activity in humans.[18]

Inhaling hot air while in a sauna produced no significant Adapted cold shower might have antipsychotic effect
impact on overall symptom severity of common similar to that of electroconvulsive therapy because it

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

could work as mild electroshock applied to sensory body fatigue. It indicates CWT for 6 min assisted
cortex. Additionally, cold shower is example of stress- acute recovery from high-intensity running and CWT
induced analgesia and would also be expected to “crowd duration did not have dose-response effect on running
out” or suppress psychosis-related neurotransmission performance recovery. [38] Contrast baths have been
within mesolimbic system.[31] suggested for reducing pain; hand volume; and stiffness
in affected extremities but it had no significant effect on
CE can activate components of reticular activating pre- and/or postoperative hand volume in carpal tunnel
system such as locus ceruleus and raphe nuclei, which syndrome.[39]
can result in activation of behavior and increased
capacity of central nervous system (CNS) to recruit Cold water or cold/thermoneutral water did not induce
motoneurons.[32] CE activates SNS; increase blood level of modifications of inflammatory and hematological
beta-endorphin and noradrenaline; and increase synaptic markers. The performances of athletes were not
release of noradrenaline in brain. Antidepressive effect negatively influenced by CWI or CWT. Reduced
of cold shower attributed to presence of high density of perception of fatigue after training session was the
cold receptors in skin expected to send an overwhelming principal effect of CWI[45] because CE increases opioid
amount of electrical impulses from peripheral nerve tone and high MR, which could diminish fatigue by
endings to the brain. It has significant analgesic effect reducing muscle pain and accelerating recovery of
and it does not cause dependence or noticeable side fatigued muscle, respectively,[32] which can improve
effects. [33] Most narcotics administered rectally can training and competitions in young soccer players.[40]
cause intoxication. There is a significant co-morbidity
of schizophrenia with intestinal illnesses and thus colon A systematic review on management of fibromyalgia
cleansing can significantly improve mental state.[31] syndrome (FMS) through hydrotherapy described as
“there is strong evidence for the use of hydrotherapy
in the management of FMS” and it showed positive
Musculo skeletal system
outcomes for pain; tender point count; and health-
Walking in water at umbilical level increases the activity status.[41] Combination of ST (once daily for 3 days/week)
of erector spinae and activates rectus femoris to levels and underwater exercise (once daily for 2 days/week)
near to or higher than walking on dry ground.[34] CWI for 12 weeks significantly reduced pain and symptoms
<15°C is one of the most popular intervention used (both short- and long-term); and improved QOL
after exercise,[11,35] which significantly lowered ratings in patients with FMS. [42] Pool-based exercise using
of fatigue and potentially improved ratings of physical deep water running three times/week for 8 weeks
recovery immediately after immersion with reduction is safe and effective intervention for FMS because it
in delayed onset muscle soreness at 24, 48, 72, and showed significant improvement in general health
96 h follow-ups after exercise compared with passive and QOL compared with control; and significant
interventions involving rest or no intervention.[35] improvement in fibromyalgia impact questionnaire
score, incorporating pain; fatigue; physical function;
Rate of decrease in plasma lactate concentration over stiffness; and psychological variables.[43]
30 min recovery period after intense anaerobic exercise
was significantly higher in contrast-WI [hot (36°C) and Hydrotherapy may have some short-term benefit to
cold (12°C)] compared with passive recovery on bed for passive range of movement in rehabilitation after rotator
both genders.[36] cuff repair.[44] Spa water (37°C) and tap water heated to
37°C for the duration of 20 min/day for 5 days/week for
Leg immersion in warm water (44 ± 1°C) for 45 min the period of 2 weeks with home-based exercise program
before stretch-shortening exercise reduced most of the improved the clinical symptoms and QOL in patient
indirect markers of exercise-induced muscle damage, with osteoarthritis of knee (OAK). However, pain and
including muscle soreness, creatine kinase activity in the tenderness statistically improved in spa water.[45] It may
blood, maximal voluntary contraction force, and jump be due to that spa waters are not only naturally warm,
height. Decreasing muscle damage did not improve but their mineral content is also significant. Spa water
voluntary performance, therefore clinical application of has mechanical, thermal, and chemical effects.
muscle prewarming may be limited.[37]
In ankylosing spondilitis (AS) patients, balneotherapy
Contrast water therapy (CWT) [alternating 1-min statistically improved pain; physical activity; tiredness
hot (38°C) and 1-min cold (15°C)] for 6/12/18 min and sleep score; Bath Ankylosing Spondilitis Disease
lowered subjective measures of thermal sensation and Activity Index (BASDAI); Nottingham Health Profile
muscle soreness compared with control (seated rest) (NHP); patient’s global evaluation and physician’s
but no consistent differences were observed in whole global evaluation at 3 weeks, but only on modified

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

Shober test and patient’s global evaluation parameters that water drinking could assist overweight children in
at 24 weeks. It indicates the effect of balneotherapy in weight loss or maintenance.[55] Exposure to cold increases
improving disease activity and functional parameters MR, for example, head-out immersion in cold water of
in AS patients.[46] Infrared sauna, a form of total-body 20°C almost doubles MR, while at 14°C it is more than
hyperthermia was well tolerated; no adverse effects; quadrupled.[3]
and no exacerbation of disease were reported in patients
with rheumatoid arthritis (RA) and AS in whom pain, When very-HC applied to lumbar region of healthy female
stiffness, and fatigue showed clinical improvements for 10-min blood flow to the back increased to 156% with
during the 4 weeks treatment period but these did not increased blood flow to upper arm. Immediately after
reach statistical significance.[47] HC, bowel sounds increased 1.7 times compared with
before application, which suggest that a very HC can be
Aqua-jogging without caloric restrictions in obese useful to promote flatus or defecation.[56] Low mineral
persons for 6 weeks was associated with reductions water intake normalizes the intestinal permeability of
in waist circumference and body fat; improvement of patients with atopic dermatitis.[57]
aerobic fitness and QOL.[48]
Warm water is effective for colonic spasm in which
AE may be an excellent alternative to land exercise significantly less discomfort was reported compared
for individuals who lack confidence, have high risk of with control group and this may be useful as an
falling, or have joint pain.[49] Water buoyancy reduces alternative for glucagon (expensive) and hyoscyamine
the weight that joints, bones, and muscles have to (has side effects) because it has no side effects and costs
bear.[50] Warmth and pressure of water also reduce practically nothing.[58]
swelling and reduces load on painful joints, remotes
muscle relaxation.[51] AE has significant effects on pain In patients with acute anal pain due to hemorrhoids
relief and related outcome measurements for locomotor or anal fissures, neither cold water (<15°C) nor
diseases. Patients may become more active and improve hot water (>30°C) sitz bath (SB) did control pain
their QOL as a result of AE.[52] Water-based and land- statistically.[59] Similarly, after sphincterotomy for anal
based exercises reduced pain and improved function in fissure, SB produced no significant difference in pain but
patients with OAK and that water-based exercise was significant relief in anal burning and better satisfaction
superior to land-based exercise for relieving pain before score with no adverse effects were observed compared
and after walking.[53] Hydrotherapy is highly valued with control group.[60] Healing and pain relief was not
by RA patients who were treated with hydrotherapy significant in SB but it improved patient satisfaction in
(30-min session/week) reported feeling much better/ acute anal fissures.[61]
very much better than those treated with land exercises
(similar exercises on land) immediately on completion Though there was no strong evidence to support the use
of the treatment program (6 weeks). But this benefit of SB for pain relief and to accelerate fissure or wound
was not reflected on 10 m walk times, functional scores, healing among adult patients with anorectal disorders
QOL measures, and pain scores by differences between (ARDs), patients were satisfied with using SB and no
groups.[51] Hot compress (HC) with surrounding electro- severe complications were reported.[62] In contrast, warm-
acupuncture needling was significantly effective on rear water SB (40°C, 45°C, and 50°C for 10 min each time) in
thigh muscles strain and it was superior to conventional ARD, pain relief was more evident and lasted longer
at higher bath temperatures. Pain relief after SB might
needling method and cupping in improving symptoms
attribute to internal anal-sphincter relaxation, which
and physical signs as well as recovery of walking
might be due to thermosphincteric reflex, resulting in
function of athletes.[54]
diminution of the rectal neck pressure. The higher the
bath temperature, the greater the drop in rectal neck
Gastrointestinal system pressure and internal sphincter electromyographic
Drinking water significantly elevates the resting energy activity, and longer the time needed to return to pretest
expenditure (REE) in adults but in overweight children levels.[63]
transient decrease in REE was observed immediately after
drinking 10 ml/kg cold water (4°C). Then a subsequent In posthemorrhoidectomy care, water spray method
rise in REE was observed, which was significant after could provide a safe and reliable alternative to SB as a
24 min and the maximal mean REE values were seen more convenient and satisfactory form of treatment.[64]
after 57 min, which was 25% higher than baseline. The
recommended daily amount of water consumption in Spa treatment with mineral water Nizhneivkinskaya
children could result in energy expenditure equivalent (sulfate calcium) induced clinical remission of the disease,
to additional weight loss of about 1.2 kg/year suggesting normalization of the echoscopic picture of stomach and

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gallbladder, their motor function, tesiocrystalloscopic a steam bath prepared with various plants (commonly
characteristics of saliva suggest its effectiveness in the essential oil plants) is traditionally used in Minahasa
rehabilitation of patients with gastric and gallbladder (Indonesia) mainly for recuperation after childbirth. It
motor-evacuatory dysfunction. [65] Intake of sulfate- is based onthermotherapy with aromatherapy which
chloride-sodium mineral water activates regulation of attribute for its therapeutic effects. Thermotherapy
carbohydrate metabolism by insulin and cortisol due to soothes symptoms such as heaviness in limbs, edema,
the formation of adaptive reactions. It promoted trophic muscular strain, loss of appetite, and constipation.
effects of insulin and gastrin in animals with significant Essential oils of the plants used have antiseptic,
reduction in peptic ulcer size and enhanced resistance antiphlogistic, and immunostimulant effect. Hence it can
to stressful factors.[66] be an effective and safe method for recuperation after
child birth.[76] In postnatal mothers, alternate (hot and
Immersion in Dead Sea water produced significant cold) compress and cold cabbage leaves were equally
reduction in blood glucose in type-2 diabetes mellitus effective in reducing breast engorgement, but in relieving
(DM) and no significant differences in insulin, cortisol, breast engorgement pain, alternate compresses were
and c-peptide levels were observed between DM patients more effective than cold cabbage leaves.[77]
and healthy volunteers following immersion.[67]
Warm-SB (40-45°C) for 10 min, for at least 5 days
Genito urinary system immediately after the removal of Foley urethral catheter
in patient undergone transurethral resection of prostate,
Mean labor pain scores were significantly higher in
significantly reduced urethral stricture compared
control group than immersion bath (IB) group suggest
with no SB group who had 1.13-fold increased risk of
that use of IB as an alternative form of pain relief
re-hospitalization within 1 month after surgery due to
during labor.[68] WI in primipara at any stage of labor,
postoperative complications compared with warm-SB
from 2 cm external opening of the uterine cervix,
group.[78] Thirty healthy volunteers and 21 patients with
significantly decreased parturition duration compared
urinary retention after hemorrhoidectomy underwent SB
with traditional delivery. It raised both the amplitude
at 40°C, 45°C, and 50°C where the number of spontaneous
and frequency of uterine contractions proportional to
micturitions increased with higher-temperature baths
uterine cervix gaping with no disturbances in contraction
and it seems to be initiated by reflex (thermo-sphincter
activity of the uterus. A 3-cm gaping of uterine cervix
reflex) internal urethral sphincter relaxation. The urethral
is the optimal timing for WI in the primipara because
pressure both in normal and retention subjects showed
earlier WI at 2-cm uterine cervix gaping also accelerated
significant reduction, which increased with higher
the labor but required repetitions of WI or use of oxytocin
temperature; and vesical pressure or EMG activity of
for correcting weakened uterine contraction.[69]
the external urethral sphincter did not show significant
differences.[79]
In contrast, IB did not influence the length of labor and
uterine contractions frequency. However, contractions
length was statistically shorter in IB and it can be an Hematology/immunology
alternative for woman’s comfort during labor, since Subsequent CE induced increase of leukocytes,
it provides relief to her without interfering on labor granulocytes, circulating levels of interleukin (IL)-6,
progression or jeopardizing the baby.[70] and natural killer (NK) cells and its activity. Leukocytes,
granulocyte, and monocyte responses were augmented
WI during first stage of labor reduces the use of epidural/ by pretreatment with exercise in water (18°C) and thus
spinal/paracervical analgesia/anesthesia compared with acute-CE has immune-stimulating effects.[80]
controls and there is no evidence of increased adverse
effects to fetus/neonate or woman from laboring in water Daily brief cold stress can increase both numbers and
or water birth.[71] Neonatal swimming can accelerate activity of peripheral cytotoxic T-lymphocytes and NK
babies growth in early stage.[72] In a microbiological cells, the major effectors of adaptive and innate tumor
study, comparing neonatal bacterial colonization after immunity, respectively. It (for 8 days) improved survival
water birth to conventional bed deliveries with or of intracellular parasite Toxoplasma gondii infected mice,
without relaxation bath showed no significant difference with consistent enhancement in cell-mediated immunity.
between three groups in neonatal outcome, infant’s and The sustained/longer-term effects of cold stress repeated
maternal infection rate.[73] daily over the period of 5 days to 6 weeks increased
plasma levels of tumor necrosis factor-, IL-2, IL-6. A
Cold-SB but not warm-SB, significantly reduced edema hypothesis describes, daily brief cold-water stress over
during postepisiotomy period[74] and perineal pain, many months could enhance antitumor immunity
which was greatest immediately after the bath.[75] Bakera, and improve nonlymphoid cancer survival rate. The

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

possible mechanism of nonspecific stimulation of cellular Eye, skin, and hair

immunity might attribute to transient activation of SNS, Warm moist air device seems to be safe and produced
hypothalamic-pituitary-adrenal (HPA) and hypothalamic- improvement in tear stability and symptomatic relief
pituitary-thyroid axes. Though daily moderate cold in ocular fatigue in patients with meibomian gland
hydrotherapy does not appear to have noticeable adverse dysfunction.[89] Sauna (80°C) produced stable epidermal
effects on normal subjects, some studies showed that it barrier function; increase in stratum corneum hydration;
can cause transient arrhythmias in patients with heart faster recovery of both elevated water loss and skin pH;
problems and can also inhibit humoral immunity. Sudden decrease in casual skin sebum content on skin surface
ice-cold WI can produce transient pulmonary edema of forehead; increase in ionic concentration in sweat and
and increase blood-brain barrier permeability, thereby epidermal blood perfusion in volunteers. It suggests
increasing mortality of neurovirulent infections. Studies protective effect of ST on skin physiology.[90] Clinical
are required to warrant this hypothesis for immunotherapy remission of atopic dermatitis has been reported after
development for some (nonlymphoid) cancers, including intake of low-salt water.[57] Application of heated mustard
those caused by viral infections.[81] compress produced second-degree, partial-thickness
burn followed by hyperpigmentation and hypertrophic
Warm water (28°C) treatment could not only cure scarring.[91] Persistent use of cold pillow compress could
bacterial cold-water disease but also immunize against reduce hair follicles inhibition or damage caused by
causative agent Flavobacterium psychrophilum.[82] chemotherapeutic agents. So alopecia can be decreased
or prevented.[92]
Head-out WI (38.41 ± 0.04°C) for 30 min decreased blood
viscosity; red blood cells count; and mean hematocrit Temperature regulation
without significant changes in leukocytes and platelets
count; mean corpuscular volume; plasma viscosity; Very-HC applied to lumbar region of healthy female
erythrocyte filtration time and red cell deformability for 10 min increased back Tsk to 41.1-43.1°C under HC,
index. [13] Application of hyper-thermic water bath followed by decreased rapidly but no changes observed
produced significant reduction of relative B-lymphocyte. in BT.[56] A case of 20% of 2nd degree burns and severe heat
Whole-body hyperthermic water bath reduced relative stroke followed by temperature rose up to 40.5°C and
total T-lymphocyte counts; increased relative CD8+ patient developed severe multiorgan failure and critical
polyneuropathy was reported after exposure to extreme
lymphocyte; NK cell counts and its activity, which were
heat in sauna for unknown period of time.[93] The most
probably dependent on increased somatotropic hormone
effective method of reducing body core temperature
production.[83]
appears to be immersion in iced water, main predictor
of outcome in exertional heatstroke is the duration
Endocraine/hormonal system and degree of hyperthermia where possible patients
During CE increase levels of circulating norepinephrine should be cooled using iced-WI, but if it is not possible,
was observed [80] and exercising HPA system by combination of other techniques may be used to facilitate
repeated CE could potentially restore its normal rapid cooling[94] such as fan-therapy, CWI, iced-baths,
function in chronic fatigue syndrome, or at least and evaporative cooling.[95]
increase net HPA activity (without changing baseline
activity).[84] It produces temporary increase in plasma Wet-ice, dry-ice, and cryogen packs applied to skin
levels of adrenocorticotropic hormone (ACTH), beta- overlying right triceps surae muscle for 15 min on
endorphin, and cortisol.[32] The sustained/longer-term 10 females decreased mean Tsk 12°C, 9.9°C, and 7.3°C,
effects of cold stress repeated daily produced increase respectively. None of the modalities produced Tsk
in ACTH, corticosterone, and decrease in -1-antitrypsin cooling below 17°C and no cooling was demonstrated
and testosterone.[81] Cold stress reduces level of serotonin 1 cm proximal or distal to any modalities after 15 min of
in most regions of brain (except brainstem).[32] Cold application. Significant mean Tsk reduction in between
stress-induced analgesia might be mediated by increased pretreatment rest interval (time 0) and 15 min after
production of opioid peptide beta-endorphin (an removal of modality (time 30) was observed only in
endogenous pain-killer).[85,86] wet-ice. It suggests wet-ice was significantly more efficient
in reducing Tsk than dry-ice and cryogen packs.[96]
Exposure to sauna and ice-WI significantly elevated
epinephrine levels in winter swimmer.[87] Steam bath After exercise at 65% maximal oxygen consumption at
produced increase in blood serum concentrations of ambient temperature of 39°C until Tre increased to 40°C
gastric and aldosterone, with decrease in concentrations of produced no difference in cooling rate between WI at
cortisol in athlete-fighters.[88] Whole-body hyperthermic 8°C, 14°C, and 20°C but cooling rate was significantly
bath increased STH activity in 8 out of 10 volunteers.[83] greater during 2°C, which was almost twice as much

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

as other conditions. It suggests that 2°C WI is the most Am J Physiol Heart Circ Physiol 2011;301:H548-54.
effective treatment for exercise-induced hyperthermia.[97] 9. Imai Y,Nobuoka S, Nagashima J, Awaya T, Aono J, Miyake F,
When hyperthermic individuals are immersed in 2°C et al. Acute myocardial infarction induced by alternating
exposure to heat in a sauna and rapid cooling in cold water.
water for approximately 9 min to Tre cooling limit of
Cardiology 1998;90:299-301.
38.6°C negated any risk associated with overcooling.[98]
10. Crinnion WJ. Sauna as a valuable clinical tool for
cardiovascular, autoimmune, toxicant- induced and other
Whole body immersion in moderately cold water is chronic health problems. Altern Med Rev 2011;16:215-25.
effective cooling maneuver for lowering BT and body heat 11. BleakleyCM, Davison GW. What is the biochemical and
content of approximately 545 kJ at the end of immersion physiological rationale for using cold-water immersion
in absence of severe physiological responses generally in sports recovery? A systematic review. Br J Sports Med
associated with sudden cold stress.[99] Significant less BT 2010;44:179-87.
variability and an overall higher BT were observed in 12. Grüner Sveälv B, Cider A, Täng MS, Angwald E, Kardassis D,
Andersson B. Benefit of warm water immersion on
late preterm infants following tub bathing procedure.[100] biventricular function in patients with chronic heart failure.
Cardiovasc Ultrasound 2009;7:33.
Conclusion 13. Digiesi V, Cerchiai G, Mannini L, Masi F, Nassi F.
Hemorheologic and blood cell changes in humans during
Based on available literature, this review suggests that partial immersion with a therapeutic method, in 38oC water.
hydrotherapy was widely used to improve immunity Minerva Med 1986;77:1407-11.
and for the management of pain, CHF, MI, chronic 14. Boldt LH, Fraszl W, Röcker L, Schefold JC, Steinach M,
Noack T, et al. Changes in the haemostatic system after
obstructive pulmonary diseases, asthma, PD, AS, thermoneutral and hyperthermic water immersion. Eur
RA, OAK, FMS, anorectal disorders, fatigue, anxiety, J Appl Physiol 2008;102:547-54.
obesity, hypercholesterolemia, hyperthermia, labor, etc. 15. Shih CY, Lee WL, Lee CW, Huang CH, Wu YZ. Effect of
It produces different effects on various systems of the time ratio of heat to cold on brachial artery blood velocity
body depending on the temperature of water and though during contrast baths. Phys Ther 2012;92:448-53.
these effects are scientifically evidence based, there is lack 16. Choukroun ML, Varene P. Adjustments in oxygen
of evidences for the mechanism on how hydrotherapy transport during head-out immersion in water at different
improves these diseases, which is one of the limitations temperatures. J Appl Physiol 1990;68:1475-80.
17. DogliottiG, Galliera E, Iorio E, De Bernardi Di Valserra M,
of hydrotherapy, and further studies are required to find
Solimene U, Corsi MM. Effect of immersion in CO2-enriched
the mechanism of hydrotherapy on various diseases. water on free radical release and total antioxidant status in
peripheral arterial occlusive disease. Int Angiol 2011;30:12-7.
References 18. Sato M, Kanikowska D, Iwase S, Nishimura N, Shimizu Y,
Belin de Chantemele E, et al. Effects of immersion in water
1. Fleming SA, Gutknecht NC. Gutknecht. Naturopathy and containing high concentrations of CO2 (CO2-water) at
the Primary Care Practice. Prim Care 2010;37:119-36. thermoneutral on thermoregulation and heart rate variability
2. Weston M, Taber C, Casagranda L, Cornwall M. Changes in humans. Int J Biometeorol 2009;53:25-30.
in local blood volume during cold gel pack application to 19. PagoureliasED, Zorou PG, Tsaligopoulos M, Athyros VG,
traumatized ankles. J Orthop Sports Phys Ther 1994;19:197-9. Karagiannis A, Efthimiadis GK. Carbon dioxide
3. Srámek P, Simecková M, Janský L, Savlíková J, Vybíral S. balneotherapy and cardiovascular disease. Int J Biometeorol
Human physiological responses to immersion into water of 2011;55:657-63.
different temperatures. Eur J Appl Physiol 2000;81:436-42. 20. Choukroun ML, Kays C, Varène P. Effects of water
4. Huttunen P, Kokko L, Ylijukuri V. Winter swimming temperature on pulmonary volumes in immersed human
improves general well-being. Int J Circumpolar Health subjects. Respir Physiol 1989;75:255-65.
2004;63:140-4. 21. Goedsche K, Förster M, Kroegel C, Uhlemann C. Repeated
5. Iiyama J, Matsushita K, Tanaka N, Kawahira K. Effects cold water stimulations (hydrotherapy according to
of single low-temperature sauna bathing in patients with Kneipp) in patients with COPD. Forsch Komplementmed
severe motor and intellectual disabilities. Int J Biometeorol 2007;14:158-66.
2008;52:431-7. 22. IaroshAM, Kurch TK.The effect of cold exposure on the
6. Ohori T, Nozawa T, Ihori H, Shida T, Sobajima M, Matsuki respiratory function in children suffering from inflammatory
A, et al. Effect of repeated sauna treatment on exercise lung diseases. Vopr Kurortol Fizioter Lech Fiz Kult 1995;1:9-
tolerance and endothelial function in patients with chronic 11.
heart failure.Am J Cardiol 2012;109:100-4. 23. Pach D, Knöchel B, Lüdtke R, Wruck K, Willich SN, Witt CM.
7. Pilch W, Szyguła Z, Klimek AT, Pałka T, Cisoń T, Pilch P, Visiting a sauna: Does inhaling hot dry air reduce common
et al.Changes in the lipid profile of blood serum in women cold symptoms? A randomised controlled trial. Med J Aust
taking sauna baths of various duration. Int J Occup Med 2010;193:730-4.
Environ Health 2010;23:167-74. 24. Whyte GP, Harries M, Dickinson J, Polkey MI. Breathless in
8. Sobajima M, Nozawa T, Shida T, Ohori T, Suzuki T, the bath. Br J Sports Med 2006;40:554-5.
Matsuki A, et al. Repeated sauna therapy attenuates 25. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor
ventricular remodeling after myocardial infarction in rats by and sensory nerve conduction are affected differently by
increasing coronary vascularity of noninfarcted myocardium. ice pack, ice massage, and cold water immersion. Phys Ther

206 North American Journal of Medical Sciences | May 2014 | Volume 6 | Issue 5 |
[Downloaded free from http://www.najms.org on Thursday, May 29, 2014, IP: 112.196.14.6]  ||  Click here to download free Android application for this journal

Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

2010;90:581-91. 44. Hay L, Wylie K.Towards evidence-based emergency

26. Bender T, Karag¨ulle Z, B´alint GP, Gutenbrunner C, medicine: Best BETs from the Manchester Royal Infirmary.
B´alint PV, Sukenik S. Hydrotherapy, balneotherapy, and spa BET 4: Hydrotherapy following rotator cuff repair. Emerg
treatment in pain management. Rheumatol Int 2005;25:220-4. Med J 2011;28:634-5.
27. Castro-Sánchez AM, Matarán-Peñarrocha GA, Lara- 45. Yurtkuran M, Yurtkuran M, Alp A, Nasircilar A, Bingöl U,
Palomo I, Saavedra-Hernández M, Arroyo-Morales M, Altan L, et al. Balneotherapy and tap water therapy in the
Moreno-Lorenzo C. Hydrotherapy for the treatment of treatment of knee osteoarthritis. Rheumatol Int 2006;27:19-
pain in people with multiple sclerosis: A randomized 27.
controlled trial. Evid Based Complement Alternat Med 46. Altan L, Bingöl U, Aslan M, Yurtkuran M. The effect of
2012;2012:473963. balneotherapy on patients with ankylosing spondylitis.
28. Vivas J, Arias P, Cudeiro J. Aquatic therapy versus Scand J Rheumatol 2006;35:283-9.
conventional land-based therapy for Parkinson’s disease: An 47. Oosterveld FG, Rasker JJ, Floors M, Landkroon R, van
open-label pilot study. Arch Phys Med Rehabil 2011;92:1202- Rennes B, Zwijnenberg J, et al. Infrared sauna in patients with
10. rheumatoid arthritis and ankylosing spondylitis. A pilot
29. Gerner HJ, Engel P, Gass GC, Gass EM, Hannich T, study showing good tolerance, short-term improvement of
Feldmann G. The effects of sauna on tetraplegic and pain and stiffness, and a trend towards long-term beneficial
paraplegic subjects. Paraplegia 1992;30:410-9. effects. Clin Rheumatol 2009;28:29-34.
30. Robiner WN. Psychological and physical reactions to 48. Wouters EJ, Van Nunen AM, Geenen R, Kolotkin RL,
whirlpool baths. J Behav Med 1990;13:157-73. Vingerhoets AJ. Effects of Aquajogging in Obese Adults: A
Pilot Study. J Obes 2010;2010:231074.
31. Shevchuk NA. Hydrotherapy as a possible neuroleptic and
sedative treatment. Med Hypotheses 2008;70:230-8. 49. Arnold CM, Busch AJ, Schachter CL, Harrison EL,
Olszynski WP. A Randomized clinical trial of aquatic versus
32. Shevchuk NA. Possible use of repeated cold stress for
land exercise to improve balance, function, and quality of
reducing fatigue in chronic fatigue syndrome: A hypothesis.
life in older women with osteoporosis. Physiother Can
Behav Brain Funct 2007;3:55.
2008;60:296-306.
33. Shevchuk NA. Adapted cold shower as a potential treatment 50. Biscarini A, Cerulli G. Modeling of the knee joint load
for depression. Med Hypotheses 2008;70:995-1001. in rehabilitative knee extension exercises under water. J
34. Chevutschi A, Lensel G, Vaast D, Thevenon A. An Biomech 2006;17:1-11.
Electromyographic Study of Human Gait both in Water and 51. Eversden L, Maggs F, Nightingale P, Jobanputra P. A
on Dry Ground. J Physiol Anthropol 2007;26:467-73. pragmatic randomised controlled trial of hydrotherapy and
35. Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, land exercises on overall well being and quality of life in
Davison GW. Cold-water immersion (cryotherapy) for rheumatoid arthritis. BMC Musculoskelet Disord 2007;8:23.
preventing and treating muscle soreness after exercise. 52. Honda T, Kamioka H. Curative and health enhancement
Cochrane Database Syst Rev 2012;2:CD008262. effects of aquatic exercise: Evidence based on interventional
36. Morton RH. Contrast water immersion hastens plasma studies. Open Access J Sports Med 2012;3:27-34.
lactate decrease after intense anaerobic exercise. J Sci Med 53. Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S,
Sport 2007;10:467-70. Jones A, et al. Hydrotherapy versus conventional land-based
37. Skurvydas A, Kamandulis S, Stanislovaitis A, Streckis V, exercise for the management of patients with osteoarthritis of
Mamkus G, Drazdauskas A. Leg immersion in warm water, the knee: A randomized clinical trial. Phys Ther 2008;88:12-
stretch-shortening exercise, and exercise-induced muscle 21.
damage. J Athl Train 2008;43:592-9. 54. Xu XS, Lin WP, Chen JY, Yu LC, Huang ZH. Efficacy
38. Versey NG, Halson SL, Dawson BT. Effect of contrast water observation on rear thigh muscles strain of athletes treated
therapy duration on recovery of running performance. Int with surrounding needling of electroacupuncture and
J Sports Physiol Perform 2012;7:130-40. hot compress of Chinese medicine. Zhongguo Zhen Jiu
39. Janssen RG, Schwartz DA, Velleman PF. A randomized 2012;32:511-4.
controlled study of contrast baths on patients with carpal 55. Dubnov-Raz G, Constantini NW, Yariv H, Nice S, Shapira N.
tunnel syndrome. J Hand Ther 2009;22:200-7. Influence of water drinking on resting energy expenditure
40. De Nardi M, La Torre A, Barassi A, Ricci C, Banfi G. Effects in overweight children. Int J Obes (Lond) 2011;35:1295-300.
of cold-water immersion and contrast-water therapy after 56. Hishinuma M, Hiramatsu N, Kasuga M, Ooyoshi M,
training in young soccer players. J Sports Med Phys Fitness Kaharu C, Misao H, et al.The effect on bowel sounds of very
2011;51:609-15. hot compresses applied to the lumbar region. Nihon Kango
41. McVeigh JG, McGaughey H, Hall M, Kane P. The Kagakkaishi 1997;17:32-9.
effectiveness of hydrotherapy in the management of 57. Dupuy P, Cassé M, André F, Dhivert-Donnadieu H, Pinton J,
fibromyalgia syndrome: A systematic review. Rheumatol Int Hernandez-Pion C. Low-salt water reduces intestinal
2008;29:119-30. permeability in atopic patients. Dermatology 1999;198:153-5.
42. Matsumoto S, Shimodozono M, Etoh S, Miyata R, 58. Church JM. Warm water irrigation for dealing with spasm
Kawahira K. Effects of thermal therapy combining during colonoscopy: Simple, inexpensive, and effective.
sauna therapy and underwater exercise in patients with Gastrointest Endosc 2002;56:672-4.
fibromyalgia. Complement Ther Clin Pract 2011;17:162-6. 59. Maestre Y, Parés D, Salvans S, Ibáñez-Zafón I, Nve E, Pons
43. Cuesta-Vargas AI, Adams N. A pragmatic community-based MJ, et al. Cold or hot sitz baths in the emergency treatment
intervention of multimodal physiotherapy plus deep water of acute anal pain due to anorectal disease? Results of a
running (DWR) for fibromyalgia syndrome: A pilot study. randomised clinical trial. Cir Esp 2010;88:97-102.
Clin Rheumatol 2011;30:1455-62. 60. Gupta PJ. Effects of warm water sitz bath on symptoms

North American Journal of Medical Sciences | May 2014 | Volume 6 | Issue 5 | 207
[Downloaded free from http://www.najms.org on Thursday, May 29, 2014, IP: 112.196.14.6]  ||  Click here to download free Android application for this journal

Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

in post-anal sphincterotomy in chronic anal fissure — a 79. Shafik A. Role of warm water bath in inducing micturition
randomized and controlled study. World J Surg 2007;31:1480- in postoperative urinary retention after anorectal operations.
4. Urol Int 1993;50:213-7.
61. Gupta P. Randomized, controlled study comparing sitz- 80. Brenner IK, Castellani JW, Gabaree C, Young AJ, Zamecnik J,
bath and no-sitz-bath treatments in patients with acute anal Shephard RJ, et al.Immune changes in humans during cold
fissures. ANZ J Surg 2006;76:718-21. exposure: Effects of prior heating and exercise. J Appl
62. Lang DS, Tho PC, Ang EN. Effectiveness of the Sitz bath Physiol 1999;87:699-710.
in managing adult patients with anorectal disorders. Jpn 81. Shevchuk NA, Radoja S. Possible stimulation of anti-tumor
J Nurs Sci 2011;8:115-28. immunity using repeated cold stress: A hypothesis. Infect
63. Shafik A. Role of warm-water bath in ano-rectal conditions. Agent Cancer 2007;2:20.
The thermo-sphincteric reflex. J Clin Gastroenterol 82. Sugahara K, Eguchi M.The use of warmed water treatment to
1993;16:304-8. induce protective immunity against the bacterial cold-water
64. Hsu KF, Chia JS, Jao SW, Wu CC, Yang HY, Mai CM, et disease pathogen Flavobacterium psychrophilum in ayu
al. Comparison of clinical effects between warm water (Plecoglossus altivelis). Fish Shellfish Immunol 2012;32:489-
spray and sitz bath in post-hemorrhoidectomy period. J 93.
Gastrointest Surg 2009;13:1274-8. 83. Blazícková S, Rovenský J, Koska J, Vigas M. Effect of hyper
65. Guliaeva SF, Pomaskina TV, Guliaev PV, Martusevich AK, thermic water bath on parameters on cellular immunity. Int
Aistov VI. Efficacy of sulfate calcium mineral water in J Clin Pharmacol Res 2000;20:41-6.
disorders of motor evacuatory function of the stomach and 84. Dorfman M, Arancibia S, Fiedler JL, Lara HE. Chronic
gallbladder. Vopr Kurortol Fizioter Lech Fiz Kult 2004;6:20-2. intermittent cold stress activates ovarian sympathetic nerves
66. Razumov AN, Surkov NV, Frolkov VK, Ziniakov NT. and modifies ovarian follicular development in the rat. Biol
Therapeutic and preventive effects of sulfate-chloride- Reprod 2003;68:2038-43.
sodium mineral water in experimental peptic ulcer. Vopr 85. Gerra G, Volpi R, Delsignore R, Maninetti L, Caccavari R,
Kurortol Fizioter Lech Fiz Kult 2009;3:22-5. Vourna S, et al. Sex-related responses of beta-endorphin,
67. Mizrahi E, Liberty I, Tsedek I, Harari M, Friger M, Sukenik S. ACTH, GH and PRL to cold exposure in humans. Acta
The influence of single immersion in Dead Sea water on Endocrinol (Copenh) 1992;126:24-8.
glucose, insulin, cortisol and C-peptide levels in type 2 86. Glickman-Weiss EL, Nelson AG, Hearon CM, Goss FL,
diabetes mellitus patients. Harefuah 2011;150:646-9, 689, 688. Robertson RJ. Are beta-endorphins and thermoregulation
68. Da Silva FM, de Oliveira SM, Nobre MR. A randomised during coldwater immersion related? Undersea Hyperb
controlled trial evaluating the effect of immersion bath on Med 1993;20:205-13.
labour pain. Midwifery 2009;25:286-94. 87. KauppinenK, Pajari-Backas M, Volin P, Vakkuri O.Some
69. Malarewicz A, Wydrzynski G, Szymkiewicz J, Adamczyk- endocrine responses to sauna, shower and ice water
Gruszka O. The influence of water immersion on the course immersion. Arctic Med Res 1989;48:131-9.
of first stage of parturition in primiparous women. Med 88. Panov SF, Pleshakov AA. Effect of steam bath on gastric
Wieku Rozwoj 2005;9:773-80. secretion and some endocrine changes of athlete-fighters.
70. Da Silva FM, de Oliveira SM. The effect of immersion baths Fiziol Cheloveka 2011;37:92-9.
on the length of childbirth labor. Rev Esc Enferm USP 89. Matsumoto Y, Dogru M, Goto E, Ishida R, Kojima T,
2006;40:57-63. Onguchi T, et al. Efficacy of a new warm moist air device
71. Cluett ER, Burns E. Immersion in water in labour and birth. on tear functions of patients with simple meibomian gland
Cochrane Database Syst Rev 2009;2:CD000111. dysfunction. Cornea 2006;25:644-50.
72. Zhao S, Xie L, Hu H, Xia J, Zhang W, Ye N, et al. A study 90. Kowatzki D, Macholdt C, Krull K, Schmidt D, Deufel T,
of neonatal swimming (water therapy) applied in clinical Elsner P, et al. Effect of regular sauna on epidermal barrier
obstetrics. J Matern Fetal Neonatal Med 2005;17:59-62. function and stratum corneum water-holding capacity
73. Fehervary P, Lauinger-Lörsch E, Hof H, Melchert F, Bauer L, in vivo in humans: A controlled study. Dermatology
Zieger W. Water birth: Microbiological colonisation of the 2008;217:173-80.
newborn, neonatal and maternal infection rate in comparison 91. Linder SA, Mele JA 3rd, Harries T. Chronic hyperpigmentation
to conventional bed deliveries. Arch Gynecol Obstet from a heated mustard compress burn: A case report. J Burn
2004;270:6-9. Care Rehabil 1996;17:351-2.
74. LaFoy J, Geden EA. Post episiotomy pain: Warm versus cold 92. Li LC, Wang M, Ning XC. Study on preventing alopecia
sitz bath. J Obstet Gynecol Neonatal Nurs 1989;18:399-403. caused by chemotherapy with cold pillow compresses. Chin
75. Ramler D, Roberts J. A comparison of cold and warm sitz J Nurs 1995;30:643-5.
baths for relief of postpartum perineal pain. J Obstet Gynecol 93. Rünitz K, Jensen TH. Heat stroke and burns resulting from
Neonatal Nurs 1986;15:471-4. use of sauna. Ugeskr Laeger 2009;171:305-6.
76. Zumsteg IS, Weckerle CS. Bakera, a herbal steam bath for 94. Smith JE. Cooling methods used in the treatment of
postnatal care in Minahasa (Indonesia): Documentation exertional heat illness. Br J Sports Med 2005;39:503-7.
of the plants used and assessment of the method. J 95. HarkerJ, Gibson P. Heat-stroke: A review of rapid cooling
Ethnopharmacol 2007;111:641-50. techniques. Intensive Crit Care Nurs 1995;11:198-202.
77. Arora S, Vatsa M, Dadhwal V. A Comparison of cabbage 96. Belitsky RB, Odam SJ, Hubley-Kozey C. Evaluation of
leaves vs. hot and cold compresses in the treatment of breast the effectiveness of wet ice, dry ice, and cryogen packs in
engorgement. Indian J Community Med 2008;33:160-2. reducing skin temperature. Phys Ther 1987;67:1080-4.
78. Park SU, Lee SH, Chung YG, Park KK, Mah SY, Hong SJ, 97. Proulx CI, Ducharme MB, Kenny GP. Effect of water
et al. Warm sitz bath: Are there benefits after transurethral temperature on cooling efficiency during hyperthermia in
resection of the prostate? Korean J Urol 2010;51:763-6. humans. J Appl Physiol 2003;94:1317-23.

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Mooventhan and Nivethitha: Evidence-based hydrotherapy: A review

98. Gagnon D, Lemire BB, Casa DJ, Kenny GP. Cold-water Reilly J, et al. Tub bathing improves thermoregulation of the late
immersion and the treatment of hyperthermia: Using 38.6°C preterm infant. J Obstet Gynecol Neonatal Nurs 2012;41:171-9.
as a safe rectal temperature cooling limit. J Athl Train
2010;45:439-44. How to cite this article: Mooventhan A, Nivethitha L. Scientific evidence-
based effects of hydrotherapy on various systems of the body. North Am
99. Marino F, Booth J. Whole body cooling by immersion in water J Med Sci 2014;6:199-209.
at moderate temperatures. J Sci Med Sport 1998;1:73-82.
Source of Support: Nil, Conflict of Interest: None declared.
100. Loring C, Gregory K, Gargan B, LeBlanc V, Lundgren D,

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