human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS Hydrotherapy , i.e. exercise in warm water , as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure ( CHF ) due to the increased venous return caused by the hydrostatic pressure . However , hydrotherapy has advantages compared to conventional training . We studied the applicability of an exercise programme in a temperature-controlled swimming pool , with specific reference to exercise capacity , muscle function , quality of life and safety . METHODS AND RESULTS Twenty-five patients with CHF ( NYHA II-III , age 72.1+/-6.1 ) were r and omised into either 8 weeks of hydrotherapy ( n=15 ) , or into a control group ( n=10 ) . The training program was well tolerated with no adverse events . Patients in the hydrotherapy group improved their maximal exercise capacity ( + 6.5 vs.-5.9 W , P=0.001 ) , isometric endurance in knee extension ( + 4 vs.-9 s , P=0.01 ) together with an improvement in the performance of heel-lift ( + 4 vs. -3 n.o . , P=<0.01 ) , shoulder abduction ( + 12 vs. -8 s , P=0.01 ) and shoulder flexion ( + 6 vs. + 4 , P=0.01 ) in comparison to patients in the control group . CONCLUSION Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF . This new approach broadens the variety of training regimes for older patients with CHF Abstract Background : No controlled studies have investigated whether balneotherapy is effective in  atopic dermatitis ( AD ) .  Objectives : To investigate the efficacy and safety of balneotherapy performed at Comano spa ( Trentino , Italy ) compared to topical corticosteroids ( TCS ) in the treatment of AD . Methods : This was an open , r and omized , clinical trial including 104 children ( aged 1–14 years ) with mild to moderate AD who were assigned either to balneotherapy ( n = 54 ) or TCS ( n = 50 ) once daily for 2 weeks . AD severity and quality of life were measured using the SCORAD , investigator global assessment ( IGA ) , patients ' self global assessment ( PSGA ) , children 's dermatology life quality index ( CDLQI ) and family dermatitis impact question naire ( FDIQ ) . Subjective measures were re-evaluated 4 months after the end of therapy . Results : Balneotherapy and TCS result ed in a significant reduction of all parameters at week 2 . TCS were more effective than balneotherapy  regarding SCORAD ( 46 % ± 7.71 vs 26 % ± 9.4 , mean ± SD ; p < 0.03 ) . In contrast , IGA , PSGA , CDLQI and FDIQ improvement was similar . At month 4 , the number and duration of relapses were less in patients treated with balneotherapy compared to those treated with TCS ( p < 0.0001 ) . Conclusions : Balneotherapy at Comano spa appears to be beneficial in children with mild to moderate AD Thermal water inhalations have been traditionally used in the treatment of upper and lower chronic airway diseases . However , the benefit and the mechanism of this treatment have not been properly assessed . To determine whether inhaled salt-bromide-iodine thermal water improves lung function , quality of life and airway inflammation , 39 patients with chronic obstructive pulmonary disease ( COPD ) were r and omly assigned to receive 2-weeks inhalation treatment with thermal water ( active , no. = 20 ) or normal saline ( control , no. = 19 ) in single blind . Lung volumes were measured , Saint George 's respiratory question naire ( SGRQ ) was administered and induced sputum was performed before and after treatment . No changes in pre- and post-salbutamol lung volumes was observed after inhalation treatment in both groups . SGRQ score showed a significant improvement in active group compared with control group at the end of the trial . The concentration of total cells in induced sputum increased significantly in both active ( P < 0.05 ) and control groups ( P < 0.05 ) . Inhalation of thermal water induced a small but significant decrease in percentages of sputum neutrophils ( P < 0.01 ) and a parallel increase in macrophages ( P < 0.01 ) . In contrast , normal saline inhalation was not associated with changes in differential sputum cell counts . In conclusion , treatment with inhaled salt-bromide-iodine thermal water in COPD is associated with a reduced proportion of neutrophils in induced sputum suggesting that thermal water may have a mild anti-inflammatory effect on the airways . However , the short-term improvement in some components health-related quality of life was not related with changes in lung function or with the degree of airway inflammation The upper airway respiratory diseases ( i.e. common cold , allergic rhinitis , nonallergic/vasomotor rhinitis , acute and chronic rhinosinusitis and nasal polyposis ) in which nasal congestion is a common symptom are often undertreated due to the frequent inadequate efficacy and safety concern with current therapies . In scientific literature , few studies seem to support the hypothesis that nasal inhalatory treatment with thermal water promotes the improvement of nasal symptoms , even if the mechanisms by which the improvement from SPA therapy can be expected remain debated . A prospect i ve comparative study with a pre – post design has been performed consecutively enrolling 33 ( males 70 % ) patients of both genders older than 12 years of age , affected by chronic sinonasal inflammation . All patients underwent a 14-days course of radioactive water warm vapour inhalations followed by nasal aerosol of the same thermal water 10 min each once/day at Merano Therme . At the beginning and end of the study , in all the subjects , nasal function evaluation by active anterior rhinomanometry , mucociliary transport time ( MCTt ) determination and nasal cytology were performed . After the inhalatory treatment , the mucociliary function was improved and the pathologic mucociliary transport times recorded at the beginning of the study being significantly reduced to physiologic ones . Besides , before treatment , the cytologic picture showed an inflammatory cell infiltration ( eosinophils , neutrophils with/without bacteria , mast cells ) in 37 % of patients ; after therapy in 66 % of these patients , the rhinocytogram was normal . Our results suggest , according to the literature data , that SPA therapy with radioactive water could represent an alternative choice in chronic inflammatory diseases of the upper airways , nonresponsive to pharmacological therapy Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments Objective . To assess the one-year effectiveness on weight loss of a 3-week balneotherapy program ( BT ) . Method . A Zelen double consent r and omised controlled trial to compare one-year BMI loss between a 3-week  BT program versus usual care ( UC ) for overweight or obese patients ( BMI : 27–35 kg/m2 ) , associated or not with a dietary motivational interview ( DMI )  during the follow-up , using a 2 × 2 factorial design . Main analysis was a per protocol analysis comparing patients attending BT to patients managed by UC , matched on sex , overweight or obese status , DMI r and omisation and a propensity score to attend BT or to be managed by UC . Results . From the 257 patients who completed the follow-up , 70 patients of each group could be matched . Mean BMI loss was 1.91 kg/m2 [ 95%CI : 1.46 ; 2.35 ] for the BT patients and 0.20 kg/m2 [ −0.24 ; 0.64 ] for the UC patients ( P < 0.001 ) , corresponding to a significant BT benefit of 1.71 kg/m2 [ 1.08 ; 2.33 ] . There was no significant effect of DMI and no interaction with BT or UC . No adverse reaction was observed for patients attending BT . Conclusion . A 3-week BT program provided a significant one-year benefit over the usual GP dietary advice for overweight and obese patients Background : Inhalation of thermal water ( TW ) is traditionally used as part of the treatment of chronic obstructive pulmonary disease ( COPD ) , but its benefit and mechanisms are controversial . We previously observed a reduced proportion of neutrophils in induced sputum after treatment with TW . Objectives : The aim of this study was to determine whether inhalation of TW in COPD patients is associated with biochemical changes of airway lining fluid , including a reduction in the neutrophil chemoattractant leukotriene B4 ( LTB4 ) . Methods : Thirteen COPD patients were r and omly assigned to receive a 2-week course of TW and normal saline inhalation in a cross-over , single-blind study design . Exhaled breath condensate ( EBC ) was collected before and after treatments . LTB4 concentrations in EBC were determined by  ELISA  , and EBC pH was measured before and after argon deaeration . Results : No significant differences in LTB4 concentrations in EBC were detected with either treatment . A significant decrease in pH of non-deaerated EBC was observed after a st and ard course of TW ( median 7.45 , interquartile range 6.93–7.66 , vs. median 6.99 , interquartile range 6.57–7.19 ; p = 0.05 ) , which disappeared after argon deaeration . Conclusions : There is no evidence that TW treatment affects LTB4 concentration in EBC . The results of EBC pH measurements suggest that TW inhalation induces an imbalance of volatile components of the buffer system in airway lining fluid Conclusions : In order to confirm these preliminary results , a prospect i ve double-blind study has been instituted in Padova University ENT Section to compare the efficacy of sulphurous-arsenical-ferruginous thermal water nasal irrigations vs isotonic sodium chloride solution nasal irrigations after functional endoscopic sinus surgery for chronic sinusitis . Objectives : Despite their widespread use , much uncertainty exists about the indications and therapeutic mechanisms of nasal thermal water inhalations in the treatment of sinonasal chronic disease . The aim of the present study was to evaluate the effects of sulphurous-arsenical-ferruginous thermal water inhalations on nasal respiratory flow , mucociliary transport , nasal cytology , and chemo-physics of nasal mucus in a group of consecutive patients with chronic sinonasal disease . Patients and methods : Thirty-seven patients with chronic sinonasal disease underwent a 12-day course of sulphurous-arsenical-ferruginous thermal water warm vapour inhalations ( 38 ° C ) followed by nasal aerosol of the same thermal water ( 7 microns micelle ) . Results : This preliminary study showed that a course of sulphurous-arsenical-ferruginous thermal water inhalations determined a significant improvement in nasal flow and reduction of nasal resistance ; a statistically significant reduction of mean mucociliary transport time , from pathologic to physiologic values , has also been shown . Statistical analysis of our data confirmed that the presence of nasal bacteria was significantly reduced by thermal water inhalations The effectiveness of spa therapy in the management of patients with Parkinson 's disease ( PD ) has never been evaluated . This is assessed in this pilot study . A prospect i ve , r and omized , cross-over , controlled study was conducted in 31 PD patients who underwent a 20-week spa period , including spa therapy for 3 weeks , and a 20-week non-spa period .  Effectiveness was assessed using quality of life scales ( PDQ-39 and SF-36 ) , motor scale ( UPDRS ) and psychological question naire ( GHQ-28 ) , at baseline and at 4 ( T4 ) and at 20 weeks ( T20 ) . Direct medical costs ( radiological and laboratory tests , physician fees , drug therapy , and ancillary care ) were recorded over each 20-week period . At T4 , spa therapy improved significantly several dimensions of PDQ-39 and SF-36 , part IV of the UPDRS , and GHQ-28 . At T20 , no difference in any parameter was found . The mean direct medical cost over 20 weeks ( euro;1,328 + /- 167 ; pound 776 + /- 97 per patient ) in the spa period was slightly but significantly reduced in comparison with that of the non-spa period ( euro;1380 + /- 523 ; pound 807 + /- 306 
    Output:
    
agent
HRM  treatment is associated with clinical improvement in diseases of the skin , respiratory , circulatory , digestive and nervous system among others .
The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of  HRM .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS Hydrotherapy , i.e. exercise in warm water , as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure ( CHF ) due to the increased venous return caused by the hydrostatic pressure . However , hydrotherapy has advantages compared to conventional training . We studied the applicability of an exercise programme in a temperature-controlled swimming pool , with specific reference to exercise capacity , muscle function , quality of life and safety . METHODS AND RESULTS Twenty-five patients with CHF ( NYHA II-III , age 72.1+/-6.1 ) were r and omised into either 8 weeks of hydrotherapy ( n=15 ) , or into a control group ( n=10 ) . The training program was well tolerated with no adverse events . Patients in the hydrotherapy group improved their maximal exercise capacity ( + 6.5 vs.-5.9 W , P=0.001 ) , isometric endurance in knee extension ( + 4 vs.-9 s , P=0.01 ) together with an improvement in the performance of heel-lift ( + 4 vs. -3 n.o . , P=<0.01 ) , shoulder abduction ( + 12 vs. -8 s , P=0.01 ) and shoulder flexion ( + 6 vs. + 4 , P=0.01 ) in comparison to patients in the control group . CONCLUSION Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF . This new approach broadens the variety of training regimes for older patients with CHF Abstract Background : No controlled studies have investigated whether balneotherapy is effective in  atopic dermatitis ( AD ) .  Objectives : To investigate the efficacy and safety of balneotherapy performed at Comano spa ( Trentino , Italy ) compared to topical corticosteroids ( TCS ) in the treatment of AD . Methods : This was an open , r and omized , clinical trial including 104 children ( aged 1–14 years ) with mild to moderate AD who were assigned either to balneotherapy ( n = 54 ) or TCS ( n = 50 ) once daily for 2 weeks . AD severity and quality of life were measured using the SCORAD , investigator global assessment ( IGA ) , patients ' self global assessment ( PSGA ) , children 's dermatology life quality index ( CDLQI ) and family dermatitis impact question naire ( FDIQ ) . Subjective measures were re-evaluated 4 months after the end of therapy . Results : Balneotherapy and TCS result ed in a significant reduction of all parameters at week 2 . TCS were more effective than balneotherapy  regarding SCORAD ( 46 % ± 7.71 vs 26 % ± 9.4 , mean ± SD ; p < 0.03 ) . In contrast , IGA , PSGA , CDLQI and FDIQ improvement was similar . At month 4 , the number and duration of relapses were less in patients treated with balneotherapy compared to those treated with TCS ( p < 0.0001 ) . Conclusions : Balneotherapy at Comano spa appears to be beneficial in children with mild to moderate AD Thermal water inhalations have been traditionally used in the treatment of upper and lower chronic airway diseases . However , the benefit and the mechanism of this treatment have not been properly assessed . To determine whether inhaled salt-bromide-iodine thermal water improves lung function , quality of life and airway inflammation , 39 patients with chronic obstructive pulmonary disease ( COPD ) were r and omly assigned to receive 2-weeks inhalation treatment with thermal water ( active , no. = 20 ) or normal saline ( control , no. = 19 ) in single blind . Lung volumes were measured , Saint George 's respiratory question naire ( SGRQ ) was administered and induced sputum was performed before and after treatment . No changes in pre- and post-salbutamol lung volumes was observed after inhalation treatment in both groups . SGRQ score showed a significant improvement in active group compared with control group at the end of the trial . The concentration of total cells in induced sputum increased significantly in both active ( P < 0.05 ) and control groups ( P < 0.05 ) . Inhalation of thermal water induced a small but significant decrease in percentages of sputum neutrophils ( P < 0.01 ) and a parallel increase in macrophages ( P < 0.01 ) . In contrast , normal saline inhalation was not associated with changes in differential sputum cell counts . In conclusion , treatment with inhaled salt-bromide-iodine thermal water in COPD is associated with a reduced proportion of neutrophils in induced sputum suggesting that thermal water may have a mild anti-inflammatory effect on the airways . However , the short-term improvement in some components health-related quality of life was not related with changes in lung function or with the degree of airway inflammation The upper airway respiratory diseases ( i.e. common cold , allergic rhinitis , nonallergic/vasomotor rhinitis , acute and chronic rhinosinusitis and nasal polyposis ) in which nasal congestion is a common symptom are often undertreated due to the frequent inadequate efficacy and safety concern with current therapies . In scientific literature , few studies seem to support the hypothesis that nasal inhalatory treatment with thermal water promotes the improvement of nasal symptoms , even if the mechanisms by which the improvement from SPA therapy can be expected remain debated . A prospect i ve comparative study with a pre – post design has been performed consecutively enrolling 33 ( males 70 % ) patients of both genders older than 12 years of age , affected by chronic sinonasal inflammation . All patients underwent a 14-days course of radioactive water warm vapour inhalations followed by nasal aerosol of the same thermal water 10 min each once/day at Merano Therme . At the beginning and end of the study , in all the subjects , nasal function evaluation by active anterior rhinomanometry , mucociliary transport time ( MCTt ) determination and nasal cytology were performed . After the inhalatory treatment , the mucociliary function was improved and the pathologic mucociliary transport times recorded at the beginning of the study being significantly reduced to physiologic ones . Besides , before treatment , the cytologic picture showed an inflammatory cell infiltration ( eosinophils , neutrophils with/without bacteria , mast cells ) in 37 % of patients ; after therapy in 66 % of these patients , the rhinocytogram was normal . Our results suggest , according to the literature data , that SPA therapy with radioactive water could represent an alternative choice in chronic inflammatory diseases of the upper airways , nonresponsive to pharmacological therapy Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments Objective . To assess the one-year effectiveness on weight loss of a 3-week balneotherapy program ( BT ) . Method . A Zelen double consent r and omised controlled trial to compare one-year BMI loss between a 3-week  BT program versus usual care ( UC ) for overweight or obese patients ( BMI : 27–35 kg/m2 ) , associated or not with a dietary motivational interview ( DMI )  during the follow-up , using a 2 × 2 factorial design . Main analysis was a per protocol analysis comparing patients attending BT to patients managed by UC , matched on sex , overweight or obese status , DMI r and omisation and a propensity score to attend BT or to be managed by UC . Results . From the 257 patients who completed the follow-up , 70 patients of each group could be matched . Mean BMI loss was 1.91 kg/m2 [ 95%CI : 1.46 ; 2.35 ] for the BT patients and 0.20 kg/m2 [ −0.24 ; 0.64 ] for the UC patients ( P < 0.001 ) , corresponding to a significant BT benefit of 1.71 kg/m2 [ 1.08 ; 2.33 ] . There was no significant effect of DMI and no interaction with BT or UC . No adverse reaction was observed for patients attending BT . Conclusion . A 3-week BT program provided a significant one-year benefit over the usual GP dietary advice for overweight and obese patients Background : Inhalation of thermal water ( TW ) is traditionally used as part of the treatment of chronic obstructive pulmonary disease ( COPD ) , but its benefit and mechanisms are controversial . We previously observed a reduced proportion of neutrophils in induced sputum after treatment with TW . Objectives : The aim of this study was to determine whether inhalation of TW in COPD patients is associated with biochemical changes of airway lining fluid , including a reduction in the neutrophil chemoattractant leukotriene B4 ( LTB4 ) . Methods : Thirteen COPD patients were r and omly assigned to receive a 2-week course of TW and normal saline inhalation in a cross-over , single-blind study design . Exhaled breath condensate ( EBC ) was collected before and after treatments . LTB4 concentrations in EBC were determined by  ELISA  , and EBC pH was measured before and after argon deaeration . Results : No significant differences in LTB4 concentrations in EBC were detected with either treatment . A significant decrease in pH of non-deaerated EBC was observed after a st and ard course of TW ( median 7.45 , interquartile range 6.93–7.66 , vs. median 6.99 , interquartile range 6.57–7.19 ; p = 0.05 ) , which disappeared after argon deaeration . Conclusions : There is no evidence that TW treatment affects LTB4 concentration in EBC . The results of EBC pH measurements suggest that TW inhalation induces an imbalance of volatile components of the buffer system in airway lining fluid Conclusions : In order to confirm these preliminary results , a prospect i ve double-blind study has been instituted in Padova University ENT Section to compare the efficacy of sulphurous-arsenical-ferruginous thermal water nasal irrigations vs isotonic sodium chloride solution nasal irrigations after functional endoscopic sinus surgery for chronic sinusitis . Objectives : Despite their widespread use , much uncertainty exists about the indications and therapeutic mechanisms of nasal thermal water inhalations in the treatment of sinonasal chronic disease . The aim of the present study was to evaluate the effects of sulphurous-arsenical-ferruginous thermal water inhalations on nasal respiratory flow , mucociliary transport , nasal cytology , and chemo-physics of nasal mucus in a group of consecutive patients with chronic sinonasal disease . Patients and methods : Thirty-seven patients with chronic sinonasal disease underwent a 12-day course of sulphurous-arsenical-ferruginous thermal water warm vapour inhalations ( 38 ° C ) followed by nasal aerosol of the same thermal water ( 7 microns micelle ) . Results : This preliminary study showed that a course of sulphurous-arsenical-ferruginous thermal water inhalations determined a significant improvement in nasal flow and reduction of nasal resistance ; a statistically significant reduction of mean mucociliary transport time , from pathologic to physiologic values , has also been shown . Statistical analysis of our data confirmed that the presence of nasal bacteria was significantly reduced by thermal water inhalations The effectiveness of spa therapy in the management of patients with Parkinson 's disease ( PD ) has never been evaluated . This is assessed in this pilot study . A prospect i ve , r and omized , cross-over , controlled study was conducted in 31 PD patients who underwent a 20-week spa period , including spa therapy for 3 weeks , and a 20-week non-spa period .  Effectiveness was assessed using quality of life scales ( PDQ-39 and SF-36 ) , motor scale ( UPDRS ) and psychological question naire ( GHQ-28 ) , at baseline and at 4 ( T4 ) and at 20 weeks ( T20 ) . Direct medical costs ( radiological and laboratory tests , physician fees , drug therapy , and ancillary care ) were recorded over each 20-week period . At T4 , spa therapy improved significantly several dimensions of PDQ-39 and SF-36 , part IV of the UPDRS , and GHQ-28 . At T20 , no difference in any parameter was found . The mean direct medical cost over 20 weeks ( euro;1,328 + /- 167 ; pound 776 + /- 97 per patient ) in the spa period was slightly but significantly reduced in comparison with that of the non-spa period ( euro;1380 + /- 523 ; pound 807 + /- 306 
    Output:
    