Regenerative and Preventive Thermal Treatments

Sustainable Tourism and the Culture of Thermal Wellbeing

We are often asked to define sustainable tourism. Sustainable tourism is not only about sustainability for the environment, the economy, or society, but also for ourselves: for our health, spirit, and inner wellbeing.

Already the ancient Romans considered thermal baths a place of civilization, social interaction, and business meetings.

Natural thermal baths are ideal for regenerating body and mind: mens sana in corpore sano. Thanks to their properties, thermal waters, muds, and treatments have positive effects, helping to rebalance the psycho-physical state.

Benefits of Thermal Baths for the Human Body

1) Immune System

The immune system is stimulated through temperature, minerals (chemistry), and bacteria (biology). Similar to training, thermal baths stimulate the body like physical exercise in the gym. This “training effect” helps activate the immune system and support the body in repairing small damages or inflammatory symptoms such as cellulite, acne, arthrosis, and injuries.

2) Skin

Thermal waters—sometimes a mix of seawater and spring water—help rebalance the microbiome (which is linked to dermatitis, psoriasis, and acne). Thanks to the high mineral content (about 20g per liter), the microbiome is rebalanced, helping restore healthy skin.

3) Muscles & Bones

Imbalance, or oxidative stress, is at the root of inflammation in muscles and bones. Conditions such as arthrosis, arthritis, injuries, muscular and joint stress (including in athletes), and general inflammation can be improved through thermal treatments.

4) Respiratory System

The respiratory tract can improve its condition through bacterial action and anti-inflammatory minerals that eliminate pathogens and can help treat:

• Allergic rhinitis

• Asthma

• COPD (chronic obstructive pulmonary disease)

In general, post-COVID symptoms such as fatigue, weakness, and respiratory problems can also be improved.

MUD & THERMAL WATERS

At thermal spas, there are three main beneficial interactions: contact with mud, bathing in thermal waters, and drinking thermal water.

The Importance of Mud

Therapeutic mud comes from clay caves or quarries and is matured in outdoor basins for six months.

Mud has a strong detoxifying effect:

• sweating

• stimulation of liver, kidney, and skin function

It is:

• detoxifying

• anti-inflammatory

• regenerating

Thermal Water

Thermal waters originate from magmatic chambers deep underground and emerge from natural springs. These waters have never previously reached the Earth’s surface and therefore retain all their properties.

They provide mineral exchange including:

• Calcium (articular, osteo-, cardiovascular system)

• Magnesium (neuro-muscular system)

• Iodine (thyroid and immune system)

Combined with a healthy anti-inflammatory diet rich in fruit, vegetables, legumes, and blue fish, the body receives everything it needs to regenerate itself and prevent disease.

*Blue fish: mackerel, swordfish, tuna, anchovies, sardines — rich in Omega 3.

The properties of thermal water include minerals such as iron, magnesium, sodium, and iodine. Mud helps eliminate toxins through sweating (triggered by heat), as well as through liver and urine pathways, while thermal water nourishes cells and supports the body’s natural systems.

The Island of Ischia

Ischia is unique as a wellness culture rooted in natural thermal springs that have emerged for thousands of years due to its geology. Ischia has 26 different springs, each with unique biological and chemical properties, offering extensive benefits for healing, prevention, and wellbeing.

The waters can reach very high temperatures (600–800 degrees underground) and are salso-bromo-iodic in nature. They vary across different areas of the island in their chemical, physical, and biological properties, providing unique therapeutic effects.

These waters also contain bacteria and microorganisms such as the thermal microbiome, which is likely one of the key sources of the strong healing power of Ischia’s thermal baths.

Nationally Recognized Benefits

In Italy, thermal medicine is officially recognized: treatments are even reimbursed or subsidized by the National Health Service (ASL) or INPS. In some cases, users benefit from a contribution of around €65 per treatment cycle.

These cycles are personalized and may include a mix of:

• 6 mud treatments

• 6 thermal baths over one week

• various massage therapies (drainage massages, muscular treatments, etc.)

The recognition of Italy’s thermal medicine system is of great international importance. It serves as an example for other countries. In the past, places like Ischia were part of national therapeutic programs.

For example, Germany’s social healthcare system (Krankenversicherung) previously recognized thermal treatments abroad. A list of approved spa destinations allowed health insurance to reimburse medical treatments and partially cover travel costs.

Ischia, as one of these approved destinations, was a major hub for German therapeutic tourism. Today, after the system was discontinued, there has been a noticeable decline in German spa tourism.

Both Italy and thermal destinations could enhance their cultural and historical heritage by creating new agreements to promote sustainable, healing, and regenerative tourism. This could help build a green and circular economy, promote cultural entrepreneurship, and create jobs for future generations without harming the planet.

Acknowledgements

We would like to thank the Hotel Regina Isabella, whose two springs at 56°C and the Roman-era well reaching 76°C were a great source of inspiration for this research.

We are especially grateful to biologist Dr. Valerio Galasso, Dr. Vincenzo Buono, and Pro Loco representative Dr. Catrin Cigliano for interviews, connections, availability, kindness, and valuable information.

Finally, we would like to highlight that research by Prof. Berrino from the University of Naples on the history of thermal medicine was of great help.