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Background: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group.Methods: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days.Results: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP.Conclusions: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach.Trial Registration: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered. [ABSTRACT FROM AUTHOR]

Population aging is one of the greatest socio-economic challenges of the 21st century, as aging is a well-known risk factor for the development of chronic diseases and functional disabilities. A sedentary life-style promotes the progression of chronic diseases and impaired mobility in older people. Therefore, physical activity is essential for healthy aging. The optimal exercise program for older persons, which covers fall prevention as well as endurance and strength, still remains unclear. We performed a longitudinal, randomized, controlled intervention study to investigate the combined effects of moderate mountain hiking and balneotherapy on gait, balance, body composition and quality of life on high-functioning people aged 65–85 years. The intervention group (n = 106) participated in a seven-day holiday with mountain hiking tours. In addition, balneotherapy was applied. The control group (n = 33) spent a typical seven-day cultural holiday with sightseeing. Medical examinations were performed before (day 0) and after the intervention week (day 7), after two months (day 60) and after half a year (day 180). Statistical analysis was done by fully nonparametric analysis of variance-type testing. An improvement of static balance was observed in the intervention group (treatment effect p = 0.02). No significant changes were found in dynamic balance, measured as center of pressure, gait parameters and self-assessed balance confidence. Only for gait speed, a short-term effect was observed (treatment p = 0.03). The gait speed increased in the intervention group. Although quality of life improved significantly in both groups, a sustainable effect until day 60 is only visible in the intervention group (interaction effect for treatment and day-60 p = 0.02). Significant interaction effects of treatment and time were found for total body water (p = 0.04), appendicular muscle mass (p = 0.04) and fat free mass index (p = 0.03), all indicating an increase of these variables in the intervention group. A seven-day intervention with moderate mountain hiking in combination with balneotherapy is an effective training for highly functioning older persons, inducing short-term improvements in static balance and quality of life. • Mountain hiking and balneotherapy improve static balance (treatment, p = 0.025). • No influences of moderate hiking/balneotherapy or sightseeing on dynamic balance • Sustainable improvement of quality of life in the intervention group until day 60 (p = 0.017) • Mountain hiking and balneotherapy improve gait speed (treatment effect, p = 0.03). [ABSTRACT FROM AUTHOR]