Ricerc@Sapienza

Abstract
Background: Balneotherapy has been considered beneficial in patients with chronic venous disease due to patientreported positive outcomes on improvement of symptoms and quality of life.
Study aim: Assessing the effects of prolonged water immersion (WI) on leg edema and epifascial thickness and to
compare these data with those achieved after continuous walking on ground.
Material and methods: On three consecutive days, 14 otherwise healthy volunteers (9 females, 5 males, mean age 53
10 years) affected by occupational edema (OE), defined as the edema developing during the time period of the working day
and disappearing overnight, stayed standing immobile in a swimming pool for 30 minutes (30’), continuously walking again
for 30’ in the same pool and walking on ground for 30’ without interruptions in a randomized sequence. Leg volume, ankle
circumference and epifascial thickness of both legs were assessed each day before and after each intervention.
Results: Leg volume showed a median reduction by 4.20% (IQR 5-3.6) (p ¼ 0.0002) after 30’ of immobile standing
immersion and by 6.50% (IQR 7.30-5.61) (P < 0.0001) when the patients walked in the pool. Ankle circumference
showed a median reduction by 2.89% (IQR 4.23-2.03) (p ¼ 0.02) with the subjects staying standing still in water and
by 5.98% (IQR 7.47-4.14) (p ¼ 0.0002) after 30’ walking in the pool. Epifascial thickness showed a median reduction by
24.35% (IQR 35.26-22.5) (P < 0.0001) when the volunteers remained standing still and by 32.66% (IQR 36.91-28-84)
(P < 0.0001), when walking in water. Leg volumetry showed a median reduction by 0.20% (IQR-0.44-0.29) (p ¼ 0.375)
after walking on ground for 30’. Ankle circumference and epifascial thickness did not show any difference walking on
ground compared to baseline situation.
Conclusions: This study showed that 30’ of WI, especially when associated with walking, reduced leg volume in
otherwise heathy subjects with OE and that walking outside the water did not