UNASSIGNED: The holistic health and wellness Kneipp concept, has a long tradition in Europe with demonstrated health benefits. Based on the five elements of the Kneipp concept, kindergartens in and around Germany are used to certify \"Kneipp Kindergartens\" that practice regular Kneipp applications and activities: cold water applications, exercise, nutrition, herbs and mind-body interventions. Little is known about the potential health benefits for children, however. This study protocol describes our study design and intervention of the Kita Kneipp Study to investigate the effect of the Kneipp concept on kindergarten children aged 2-6 years.
UNASSIGNED: The Kita Kneipp Study, registered with the German Clinical Trial Register (DRKS-ID: DRKS00029275), is a confirmatory, mixed-method, two-armed, waitlist, clinical, cluster randomized controlled trial (RCT). Kindergartens in Berlin, Germany that would like to implement the Kneipp concept into their facility will be recruited and randomized to the intervention or control group. Changes in the number of kindergarten sick days will be the primary outcome measure. Kindergarten attendance and reason for absence including illness will be collected on a weekly basis at two time points for 6 weeks from the parents and kindergarten directors: baseline and 1 year after baseline. Secondary outcomes will measure cold symptoms through the Common Cold Questionnaire (CCQ) and National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) Scales describing gastroenterological-based symptoms Kindergarten educator sick days will be aggregately reported for the same time period. Kneipp concept activities will be recorded on a weekly basis over the one-year intervention period. To understand the experience of Kneipp concept implementation and possible changes in the kindergarten, expert interviews will be conducted with intervention kindergarten educators and focused ethnographies will be planned to observe and analyze the intervention activities.
UNASSIGNED: This mixed method study design has potential to help identify if the Kneipp concept can be used for salutogenic purposes among young children and provide insights and experience of the implementation and practicing a holistic health and wellness concept in a kindergarten setting.

Healthy aging is a crucial goal in aging societies of the western world, with various lifestyle strategies being employed to achieve it. Among these strategies, hydrotherapy stands out for its potential to promote cardiovascular and mental health. Cold water therapy, a hydrotherapy technique, has emerged as a lifestyle strategy with the potential capacity to evoke a wide array of health benefits. This review aims to synthesize the extensive body of research surrounding cold water therapy and its beneficial effects on various health systems as well as the underlying biological mechanisms driving these benefits. We conducted a search for interventional and observational cohort studies from MEDLINE and EMBASE up to July 2024. Deliberate exposure of the body to cold water results in distinct physiological responses that may be linked to several health benefits. Evidence, primarily from small interventional studies, suggests that cold water therapy positively impacts cardiometabolic risk factors, stimulates brown adipose tissue and promotes energy expenditure-potentially reducing the risk of cardiometabolic diseases. It also triggers the release of stress hormones, catecholamines and endorphins, enhancing alertness and elevating mood, which may alleviate mental health conditions. Cold water therapy also reduces inflammation, boosts the immune system, promotes sleep and enhances recovery following exercise. The optimal duration and temperature needed to derive maximal benefits is uncertain but current evidence suggests that short-term exposure and lower temperatures may be more beneficial. Overall, cold water therapy presents a potential lifestyle strategy to enhancing physical and mental well-being, promoting healthy aging and extending the healthspan, but definitive interventional evidence is warranted.

Background: The number of children experiencing postnatal situations of neurological risk (such as psycho-motor developmental disorders and delays) after birth has increased in recent years. These infants often require multiple pediatric interventions to address functional problems that might generate stress, anxiety, and discomfort. The aim of the present study is to determine whether the level of salivary cortisol, as a stress marker, increases after hydrotherapy and land-based therapy in children at risk of or currently presenting delayed psycho-motor development. Methods: Saliva samples were collected from 25 children (aged 3-36 months) between June 2022 and January 2023 at the Rehabilitation and Physical Medicine Clinical Management Unit of the Virgen de las Nieves University Hospital, Granada, Spain. Three samples were collected from each child, representing baseline, post-hydrotherapy and post-land-based therapy. Result: All salivary cortisol levels were within the normal range. Resting values were the highest, and both modes of therapy decreased salivary cortisol levels. There were no statistically significant differences between the two therapies. Conclusions: Both therapies appear to be useful for treating children with psychomotor developmental disorders without increasing stress during physiotherapy sessions. Although cortisol levels were slightly higher with hydrotherapy than with land-based therapy, this may be due to the small sample size.

Spinal cord injury (SCI) is a severe medical condition resulting in substantial physiological and functional consequences for the individual. People with SCI are characterised by a chronic, low-grade systemic inflammatory state, which contributes to further undesirable secondary injuries. This study aimed to evaluate the effect of adding aquatic therapy to the standard physiotherapy treatment, implemented in two different schedules, on systemic inflammation in SCI patients. Additionally, the relationship between cytokine blood levels and changes in functionality (measured with the 6MWT, 10MWT, WISCI, BBS, and TUG tests) throughout the study was assessed. A quantitative multiplexed antibody assay was performed to measure the expression level of 20 pro- and anti-inflammatory cytokines in blood samples from SCI patients at three time points: baseline, week 6, and immediately post-intervention (week 12). This study identified a complex signature of five cytokines (IL-12p70, IL-8, MCP-1, IL-1α, and IP10) associated with the time course of the two physiotherapy programs. Two other cytokines (IL-4 and TNF-α) were also associated with the functional recovery of patients. These could be important indicators for SCI prognosis and provide a basis for developing novel targeted therapies.

Several therapies have been developed to reduce cognitive decline associated with aging. Aquatic exercises, which are widely used to enhance functional capacity, may play a role in stimulating cognitive functions. This study investigated the effects of a 3-month aquatic exercise program on cognitive functions in community-dwelling older adults. In this prospective, single-blinded, controlled clinical trial, 31 participants were allocated to either the experimental (aquatic exercises) or control (no-exercise) group. The intervention program consisted of exercises conducted twice a week in a 1.2 m deep indoor pool. The main outcome measures were cognitive functions, assessed using Raven\'s Progressive Matrices test and the Wisconsin Card Sorting Test. A repeated-measures analysis of variance was used to assess the impact of the exercise program. The effect sizes (η2p) were reported when a level of significance was achieved (p < 0.05). Compared with the control group, the participants who underwent aquatic exercises showed positive outcomes in Raven\'s Progressive Matrices test (p = 0.046; η2p = 0.131) and the Wisconsin Card Sorting Test (p = 0.001, η2p = 0.589). Complementary analyses of the Wisconsin Card Sorting Test indicated that the benefits of the aquatic exercise were observed in terms of the number of trials (p = 0.001, η2p = 0.478), number of errors (p = 0.001, η2p = 0.458), and number of non-perseverative errors (p = 0.001, η2p = 0.302). The results indicate that a period of three months of aquatic exercise was beneficial for stimulating specific aspects of the cognitive function of community-dwelling older individuals. Aquatic exercise should be prescribed to this population.

UNASSIGNED: This study aimed to investigate the effects of Warm Water Immersion (WWI) on inflammation, kidney function, and kidney tissue damage in rats with diabetes mellitus (DM).
UNASSIGNED: Forty male rats were divided into four groups: Healthy Control (HC), Diabetic Control (DC), Diabetic Rats treated with WWI (DW), and Healthy Rats treated with WWI (HW). Daily 15-minute WWI sessions at 43 °C were administered for eight weeks. Various parameters including lipids, fasting blood sugar (FBS), HbA1C, insulin, advanced glycation end products (AGEs), HSP70, glomerular filtration rate (GFR), urinary albumin excretion, creatinine, blood urea nitrogen (BUN), oxidative stress, anti-oxidant parameters, and gene expression of RAGE, VEGF, and TGFß1 were assessed. Histological examination of kidney tissue was also conducted.
UNASSIGNED: Significant reductions in FBS, AGEs, glutathione, superoxide dismutase (SOD), and nitric oxide (NO) levels were observed in the DW group compared to DC. Expression of RAGE, VEGF, and TGFß1 genes decreased in DW. Triglycerides, total cholesterol, and LDL cholesterol were lower in DW. Insulin, HDL cholesterol, catalase, total anti-oxidant capacity (TAC), and tissue HSP70 were higher in DW. Histological assessment revealed reduced kidney damage in DW compared to DC.
UNASSIGNED: WWI for eight weeks shows promise in mitigating diabetic nephropathy in rats, suggesting its potential as a non-invasive adjunctive therapy for managing diabetes complications.

Rheumatoid arthritis (RA) is a disease characterized by symmetrical erosive polyarthritis that results in progressive disability. In patients with RA, the clinical course can be intermittent or progressive, depending on the severity of the symptoms. As complications of RA may develop within months of presentation, it is recommended that patients seek treatment with disease-modifying antirheumatic drugs as soon as possible. Wrists, proximal interphalangeal joints, metacarpophalangeal joints, and metatarsophalangeal joints are the most commonly involved joints, with the spinal joints and distal interphalangeal joints usually spared. The term cervical spondylosis refers to the general wear and tear of the cervical spine (neck) caused by aging, which can result in neck pain, neck stiffness, etc. Cervical degenerative spondylosis is caused by arthritic changes to the osseocartilaginous components of the cervical spine. This may result in compression of spinal nerve roots or the spinal cord, leading to pain in the neck, radiculopathy, or myelopathy. The present case report is of a 57-year-old female having pain in her neck and lower back for 20 years. She also complained of pain in the bilateral wrist joint, proximal interphalangeal joints, distal interphalangeal joints, metacarpophalangeal joints, and metatarsophalangeal joints. The pain was insidious in onset and gradually progressive. The pain has progressed to such an extent that it was hindering her day-to-day activities. The pain progressed on movement and was relieved with rest and medications. The pain was not associated with tingling or numbness. Physical therapy aims to strengthen weak structures, lessen pain, increase joint range of motion, improve movement patterns, increase cardiovascular endurance, and enhance the patient\'s quality of life.

BACKGROUND: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball.
OBJECTIVE: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training.
METHODS: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18-30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups.
RESULTS: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*).
CONCLUSIONS: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.

BACKGROUND: People with Parkinson\'s Disease (PwPD) have motor symptoms that directly interfere on dry land walking performance. Despite the shallow water walking is a viable and beneficial physical intervention for PwPD, it lacks information on the comparison of the biomechanical responses of the shallow water walking by PwPD and age paired healthy individuals.
OBJECTIVE: Are there differences in the spatiotemporal and angular responses of shallow water walking by older adults with and without Parkinson\'s disease?
METHODS: In this cross-sectional study, ten older adults (9 men/1 women) with Parkinson disease (PwPD group) and ten older adults (3 men/7 women) without Parkinson\'s disease (Older group) walked in shallow water at self-selected comfortable speed on pool floor in the immersion depths of waist and xiphoid levels. The 2D kinematic data from the sagittal plane was collected to calculate the walking speed, stride length, stride frequency, duty factor, walk ratio, lower limb joints\' range of motion and peak angular speed RESULTS: Both groups reduced similarly the walking speed with the immersion depth increase. The speed decrease was achieved by a reducing both the stride frequency and stride length only in the PwPD. The PwPD had lower contact phase than Older in the waist depth, probably due to the reduced risk of fall in water immersion and to attenuate drag force effects. The total range of joint motion was similar between groups, while the peak angular speed of ankle and knee reduced in the deeper depth in both groups.
CONCLUSIONS: The present findings can help professionals of aquatic rehabilitation to choose the best depth for exercise programs, according to the treatment objectives. To our knowledge, this was the first study that analyzed spatiotemporal and angular variables during shallow water walking of PwPD at different depths and compared them with older people without Parkinson\'s disease.

BACKGROUND: Virtual Reality (VR) has been frequently used as an engaging, interactive, and effective non-pharmacological distraction technique for children during painful procedures, including burnt wound care.
OBJECTIVE: This study aimed to evaluate the effect of virtual reality on pain and clinical outcomes during hydrotherapy for children with burns.
METHODS: A randomized controlled pretest, during, and post-test research design was utilized.
METHODS: Sixty children with burns underwent hydrotherapy, divided randomly and assigned equally into two groups. Children of the control group received the standard pharmacological treatment of the unit to manage pain and stabilize their physiological parameters throughout the three days of study. Children of the virtual reality intervention group received all basic standard care as the control group plus VR intervention across different software content, and interaction immersion designs which took place using a cell phone coupled with the three-dimensional (3D) image glasses. Outcome measures were physiological parameters, wound healing, and Face, Leg, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Scale.
METHODS: This study was carried out in the burns unit at the Plastic, Reconstructive, and Burns Surgery Center affiliated to Mansoura University, from September to November 2023.
RESULTS: Children in the study group had lower pain scores, more stable physiological parameters, and higher rates of wound healing compared to the control group with a statistically significant difference between both groups.
CONCLUSIONS: Using VR intervention significantly reduced pain intensity, enhanced physiological parameters and promoted the rate of wound healing in children with burns during hydrotherapy.