• Galina Мratskova Department of Medical Rehabilitation and Ergotherapy, Physical Medicine and Sports, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria



Long-term effects of COVID-19, Post-COVID-19 syndrome (PCS), rehabilitation, balneotherapy, SPA therapy, peloidotherapy, mud treatment


Balneotherapy is one of the most used therapies, where natural factors are applied for treatment and prevention. It is used in various pathological conditions, with evidence of a good effect in rheumatic and neurological diseases, and in recent years also in patients recovering from COVID-19. The therapeutic factors that are used include: natural mineral or thermal waters, natural peloids (mud) and other environmental therapeutic factors. The pandemic of COVID-19 turned out to be a significant factor that led to changes in lifestyle and habits and, accordingly, the use of balneotherapy procedures for prevention and treatment. Balneotherapy (SPA-therapy) is recommended by the European SPA association after COVID-19, for better recovery of health and limitation of long-term symptoms in patients with post-COVID-19 syndrome (PCS). It is suggested that balneo-climate-treatment can improve lung function, increase the physical activity capacity and the performance of therapeutic exercises as well as the quality of life of patients in the recovery phase after COVID-19. The purpose of the present review is to investigate the benefits and effectiveness of both balneo and mud therapy in patients with long-term post-COVID-19 sequelae. Materials and methods: For the purpose of the present study, a review was made of the known scientific articles published in the world databases (Google Scholar, Pubmed, Science Direct Web of Science, Scopus, and literary sources in Cyrillic). The results were searched for the following keywords: post-COVID-19 condition, long-term effects of COVID-19, post-COVID-19 syndrome (PCS), rehabilitation, balneotherapy, SPA therapy, peloidotherapy, mud treatment, lye therapy, treatment with Rapa (highly concentrated solution of salts (most often NaCl)). Results: The review of the scientific literature published in specific medical journals found evidence for the therapeutic effectiveness and benefits of balneo and mud therapy in patients with long-term consequences of COVID-19. The described application methods are characterized by variety in the application methodology, both for external (baths, bathtubs, showers, therapeutic SPA applications) and for internal application (mainly through inhalations). On the other hand, different recommendations were found regarding the type and chemical characteristics of mineral (thermal) water and therapeutic mud that are preferred for therapy. Overwhelmingly, studies recommend combining balneo (SPA) and mud therapy with resort and climate treatment, moderate physical activity and a dietary regimen tailored to the individual characteristics of patients. Conclusion: Balneo (SPA) treatment, therapies with natural and preformed physical factors could have a preventive role, in order to improve the body’s reactivity to the adverse factors of the external environment and pathogenic microorganisms and to increase insusceptibility to infectious diseases.


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Abuseva GR, Antipenko PV, Arkov VV. (2020). Physical and rehabilitation medicine: national guidelines. Interregional Scientific Society of Physical and Rehabilitation Medicine. Moscow. GEOTAR-Media, 688p.

Angelova, T. (а) Balneotherapy and health. (2022) In Spiro. The consequences of COVID-19 and balneology, 1(64)

Angelova, T. (2022) (b) The role of balneotherapy in restoring human health. In Spiro. The consequences of COVID-19 and balneology, 1 (64)

Antonelli, M., & Donelli, D. (2020). Respiratory rehabilitation for post-COVID19 patients in spa centers: first steps from theory to practice. International journal of biometeorology, 64(10), 1811–1813.

Bernetti, A., Mangone, M., Alviti, F. et al. (2020). Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy. International journal of biometeorology, 64(6), 905–914.

Carubbi, C., Masselli, E., Calabrò, E., et al. (2019). Sulphurous thermal water inhalation impacts respiratory metabolic parameters in heavy smokers. International journal of biometeorology, 63(9), 1209–1216.

Cohen M. (2020). Turning up the heat on COVID-19: heat as a therapeutic intervention. F1000Research, 9, 292.

Corradi, M., Folesani, G., Gergelova, P. et al. (2012). Effect of salt-bromide-iodine thermal water inhalation on functional and biochemical lung parameters. ISRN Pulmonology, 1–8.

Edreva, V. (2009). Present and future of Bulgarian mineral waters. Prevention and rehabilitation.2009;3(1-2):4-8.

ESPA. Post-corona treatments.

Fioravanti, A., Bacaro, G., Giannitti, C., et al. (2015). (a) One-year follow-up of mud-bath therapy in patients with bilateral knee osteoarthritis: a randomized, single-blind controlled trial. International journal of biometeorology, 59(9), 1333–1343.

Fioravanti, A., Giannitti, C., Cheleschi, S. et al. (2015). (b) Circulating levels of adiponectin, resistin, and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis. International journal of biometeorology, 59(11), 1691–1700.

Gerasimova, D., Gatsova, N., Takeva, I., Pencheva T. (2021) Еffectiveness of comprehensive rehabilitation following an infection with COVID-19. Physical medicine Rehabilitation Health, 20(2):17:21.

Grishechkina, I. A., Lobanov, A. A., Andronov, S. V. et al. (2023). Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study. European journal of translational myology, 33(2), 10.4081/ejtm.2023.11063.

Grozeva, A, Angelova–Popova G. (2017). The role of therapeutic education in rehabilitation of metabolic syndrome patients. Knowledge International Journal, 19(4), 1439 - 1442.

Grozeva, A. (2022). Possibilities of mud therapy and sea therapy for the rehabilitation of patients with late post-covid syndrome. In spiro, 1 (64)

Grozeva, A. Spa resources in Burgas region. (2019) Signs ISBN: 978-6197497-31-1.

Grozeva, A., Ribagin, S., & Angelova –Popova, G. (2021). Telemedicine and balneotherapy – opportunities in the conditions of a COVID-19 pandemic. KNOWLEDGE - International Journal , 48(3), 531–534.

Gvozdjáková, A., Sumbalová, Z., Kucharská, J. et al. (2023). Mountain spa rehabilitation improved health of patients with post-COVID-19 syndrome: pilot study. Environmental science and pollution research international, 30(6),

Ismailova, A., Nikolova, D., Alieva, B., Shankulova M. Peloid therapy. (2018) Therapeutic properties of mud. Varna Medical Forum, 7(4):300-305.

Jimeno-Almazán, A., Pallarés, J.G., Buendía-Romero, Á. et al. (2021). Post-COVID-19 Syndrome and the Potential Benefits of Exercise. Int J Environ Res Public Health. 18(10), 5329.

Kaisinova, A., Achabaeva, A., Starokozhko, L. et al. (2021). Georgian medical news, (318), 110–114.

Kashilska, Y. & Petkov, A. (2021) Economic effects and expected results from the introduction of outpatient post - COVID 19 rehabilitation. Knowledge – International Journal, 49(4), 617-623.

Katsarova, S. (2021). Development of Bulgaria as a sustainable health tourism destination and application of good practices in the field of medical spa, spa and wellness tourism in the times of the СOVID-19 pandemic. International Interdisciplinary Virtual Meeting “Alumni Club and Friends”. Book of Proceedings. 166-172.

Katsarova, S. (2022). It's time for prevention and rehabilitation through balneology. The fight against Covid–19 does not only involve vaccines! In Spiro. The consequences of COVID-19 and balneology, 1(64)) Retrieved from

Khaltaev, N., Solimene, U., Vitale, F., & Zanasi, A. (2020). Balneotherapy and hydrotherapy in chronic respiratory disease. Journal of thoracic disease, 12(8), 4459–4468.

Khan, M.A., Razumov, A.N., Korchazhkina, N.B. (2018). Physical and rehabilitation medicine in pediatrics. Moscow. “GEOTAR-Media”, 408 p.

Koçak, F. A., Kurt, E. E., Milletli Sezgin, F. et al. (2020). The effect of balneotherapy on body mass index, adipokine levels, sleep disturbances, and quality of life of women with morbid obesity. International journal of biometeorology, 64(9), 1463–1472.

Kokhan, S., Kolokoltsev, M., Vorozheikin, A. et al. (2022). Physical rehabilitation of patients with post-COVID syndrome. Journal of Physical Education and Sport, 22(9), 2005-2011. DOI:10.7752/jpes.2022.09255

Koleva, I. & Yoshinov B. (2022). Introduction to Physical Prevention, Physical Therapy and Rehabilitation. (pp. 95-130), Steno-Sofia.

Krumova, P., & Uzunova, A. (2022). Health care for the elderly and old people during the covid pandemic. KNOWLEDGE - International Journal , 55(4), 581–585.

Lobzin, Yu.V., Cherkashina, I.V., Samojlova, I.G. 2020; Medical rehabilitation of children who have suffered COVID-19]. Journal of Infectology, 12(S3): 64-74. (In Russ.)

Maccarone, M.C., Magro, G., Solimene, U. & Masiero, S. (2020). (a)The effects of balneotherapy on human immune function: should baths and mud applications have a role during Covid-19 pandemic? Bulletin of rehabilitation medicine, 97 (3): 22-24.

Maccarone, M. C., & Masiero, S. (2021). Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role? Environmental science and pollution research international, 28(33), 46063–46066.

Maccarone, M. C., Kamioka, H., Cheleschi, S., Tenti, S., Masiero, S., & Kardeş, S. (2021). Italian and Japanese public attention toward balneotherapy in the COVID-19 era. Environmental science and pollution research international, 28(43), 61781–61789.

Marinkev, M. & Angelov, I. (2008). Climatic and balneological factors supporting the health and longevity of the elderly. Physical medicine rehabilitation health, 3, 26-30.

Masiero, S., Maccarone, M. C., & Agostini, F. (2020). Health resort medicine can be a suitable setting to recover disabilities in patients tested negative for COVID-19 discharged from hospital? A challenge for the future. International journal of biometeorology, 64(10), 1807–1809.

Masiero, S., Vittadini, F., Ferroni, C. et al. (2018). The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. International journal of biometeorology, 62(2), 243–252.

Masiero, S., & Maccarone, M. C. (2021). Health resort therapy interventions in the COVID-19 pandemic era: what next? International journal of biometeorology, 65(11), 1995–1997.

Matsumoto S. (2018). Evaluation of the Role of Balneotherapy in Rehabilitation Medicine. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi, 85(4), 196–203.

Milanova, H. & Georgiev, G. (2021) Rehabilitation in severe COVID-19 in acute and subacute phase (Clinical experience) Physical medicine Rehabilitation Health, 20(1):23-31.

Milushev, E. (2021) Design’ specifics and methodological features of the rehabilitation programme during the acute phase of coronavirus infection in the intensive care unit and the therapeutic WARD. Physical medicine Rehabilitation Health, 20(2), 5:10

Mollova, K., Valeva, S., Bekir, N., & Uzunova, A. (2021). Pulmonary rehabilitation in post - covid syndrome. Knowledge - International Journal, 49(4), 661–666.

Monova, H., Ismai, I., Radeva, N., Kircheva, K. (2022) Mud therapy—sustainable for centuries. The road to health and longevity. Varna Medical Forum, 11(1): 126-131.

Мratskova, G. (2021) Clinical aspects of rehabilitation of a patient with ischemic Stroke after bilateral COVID-19 Pneumonia. A Case Report.” Trakia Journal of Sciences, 19 (2): 18-25.

Mratskova, G. & Elkova, H. (2022). Physical therapy and rehabilitation for late post COVID-19 consequences. A Case report – Bulgarian Medical Journal, 16, 2022, № 1, 36-41, 34-39.

Nikityuk YuV, Khan MA, Mikitchenko NA. (2020). The use of dry carbon dioxide baths in the medical rehabilitation of children with various diseases. Bulletin of Rehabilitation Medicine, 4(98): 62-70. (In Russ.)

Niknam, Z., Jafari, A., Golchin, A. et al. (2022). Potential therapeutic options for COVID-19: an update on current evidence. Eur J Med Res 27, 6 (2022).

Pascarelli, N. A., Cheleschi, S., Bacaro, G. et al. (2016). Effect of Mud-Bath Therapy on Serum Biomarkers in Patients with Knee Osteoarthritis: Results from a Randomized Controlled Trial. The Israel Medical Association journal : IMAJ, 18(3-4), 232–237.

Passali, D., De Corso, E., Platzgummer, S. et al. (2013). Spa therapy of upper respiratory tract inflammations. Eur Arch Otorhinolaryngol, 270(2):565–570.

Passali, D., Gabelli, G., Passal,i G.C., Mösges, R. & Bellussi, L.M. (2017). Radon-enriched hot spring water therapy for upper and lower respiratory tract inflammation. Otolaryngol Pol., 71(4):8–13.

Petrova, M., Takuchevа, K. & Mollovа, K. (2023). Recovery of post COVID-19 survivors with the methods of sanatorial and SPA treatmen. KNOWLEDGE – International Journal, 55(4), 699-704.

Petrova, M. S. (2022). Sanatorium-and-spa treatment of patients who have had a new coronavirus infection (COVID-19). Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury, 99(3), 5–9.

SPA THERAPY & COVID-19 ON THE EUROPEAN MARKET Study and evaluation of good practices

Szromek, A.R. (2021) The Role of Health Resort Enterprises in Health Prevention during the Epidemic Crisis Caused by COVID-19. J. Open Innov. Technol. Mark. Complex, 7, 133.

Taboada M, Cariñena A, Moreno E. Post-COVID-19 functional status six-months after hospitalization. J Inf Secur. 2021;82:e31–e33.

Taboada, M., Cariñena, A., Moreno, E. et al. (2021). Post-COVID-19 functional status six-months after hospitalization. The Journal of infection, 82(4), e31–e33.

Takeva, I., Popova, I., Ilieva, E. (2021) Rehabilitation of patients with COVID-19 and post-COVID symptoms. Physical medicine Rehabilitation Health, 19(3-4):18-26.

Valiullina, S.A. & Pogonchenkova, I.V. (2020). Medical rehabilitation of children with COVID-19 in Moscow (regional features): Temporary methodological recommendations (Version1). Moscow. Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine of the Department of Health of the City of Moscow. 89 p. (In Russ.)

Vladeva, E., Mihajlova, M., Todorov, I., Todorov, T. (2014) Our experience of treatment of arthrosis disease and some enthesopathy with geothermal water from spring R-119X. Varna Medical Forum, 3(1):57-61.

Vladimirova G. (2022) Balneo- and hydrotherapy in the context of modern medicine. Vladimirova G. The healing waters of Bulgaria (pp.18-23). Milenium ISBN 978-954-515-586-4

Walle-Hansen, M. M., Ranhoff, A. H., Mellingsæter, M., Wang-Hansen, M. S., & Myrstad, M. (2021). Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC geriatrics, 21(1), 199.




How to Cite

Мratskova G. (2023). BENEFITS OF BALNEO AND MUD TREATMENT FOR LATE SEQUENCES OF COVID-19. MEDIS – International Journal of Medical Sciences and Research, 2(3), 11–17.