The Effect of Water Physical Exercise Program in Thermal Water and Hydropinotherapy on Cardiovascular Health

Interleukin-6 (IL-6)

Change in serum interleukin-6 (IL-6) concentration (pg/mL), measured by enzyme-linked immunosorbent assay (ELISA)

Time frame: 16 weeks

C-reactive protein (CRP)

Change in serum C-reactive protein concentration (mg/L) measured by chemiluminescent microparticle immunoassay (CMIA).

Time frame: 16 weeks

Plasma Glucose

Change in fasting plasma glucose concentration (mg/dL), measured using standard laboratory methods.

Time frame: 16 weeks

Insulin

Change in fasting serum insulin concentration (µIU/mL), measured using standard laboratory methods.

Time frame: 16 weeks

Hemoglobin A1C (HbA1c)

Change in glycated hemoglobin (HbA1c, %), measured using standard laboratory methods.

Time frame: 16 weeks

Hepatic enzymes

Change in serum aspartate transaminase (AST) activity (U/L), alanine transaminase (ALT) activity (U/L), measured by enzymatic spectrophotometry.

Time frame: 16 weeks

Bilirubin

Change in total bilirubin concentration (mg/dL), measured by enzymatic spectrophotometry.

Time frame: 16 weeks

Blood pressure

Change in systolic and diastolic blood pressure (mmHg), measured using a digital blood pressure monitor following a standardized seated protocol, with the average of two readings recorded.

Time frame: 16 weeks

Waist and hip circumferences

Change in waist circumference (cm) and hip circumference (cm), measured using a non-elastic measuring tape according to ISAK protocols.

Time frame: 16 weeks

Body composition

Change in total fat mass (kg), truncal fat mass (kg), abdominal fat mass (kg), lean body mass (kg), assessed by dual-energy X-ray absorptiometry (DXA).

Time frame: 16 weeks

Bone mineral density

Change in bone mineral density (g/cm²) from baseline to 16 weeks, assessed by dual-energy X-ray absorptiometry (DXA).

Time frame: 16 weeks

Maximal oxygen uptake (VO₂ max)

Change in maximal oxygen uptake (mL/kg/min), assessed using a graded treadmill exercise test to volitional exhaustion.

Time frame: 16 weeks

Isokinetic muscle strength

Change in peak torque (Nm) of knee flexors and extensors, hip flexors/extensors and abductors/adductors, and ankle dorsiflexors and plantarflexors, assessed using isokinetic dynamometry.

Time frame: 16 weeks

Sleep quality

Change in sleep quality score, assessed by the Pittsburgh Sleep Quality Index (PSQI; score range 0-21, higher scores indicate worse sleep quality).

Time frame: 16 weeks

Health-related quality of life

Change in health-related quality of life score from baseline to 16 weeks, assessed by the Short Form-36 Health Survey (SF-36; score range 0-100, higher scores indicate better health status).

Time frame: 16 weeks

Pain intensity

Change in pain intensity score from baseline to 16 weeks, assessed by the Numeric Rating Scale (NRS; score range 0-10, higher scores indicate worse pain).

Time frame: 16 weeks

Psychosocial risk factors

Change in psychosocial risk classification from baseline to 16 weeks, assessed by the Start Back Screening Tool (SBST; score range 0-9, higher scores indicate higher psychosocial risk).

Time frame: 16 weeks

Total energy intake

Change in total energy intake (kcal/day), assessed using a 24-hour dietary recall administered by a trained nutritionist.

Time frame: 16 weeks

Macronutrient intake

Change in macronutrient intake (g/day: proteins, total fats, carbohydrates, fiber), assessed using a 24-hour dietary recall administered by a trained nutritionist.

Time frame: 16 weeks