Sarcopenia—the progressive loss of muscle mass and strength that is a natural part of ageing—is now one of the main public health challenges, particularly in Italy, which has one of the highest life expectancies in Europe. This condition reduces autonomy and quality of life, and increases the risk of falls, hospitalisation, and disability. In response to this growing health issue, a pioneering research project led by Professor Nicola Veronese, a lecturer in Geriatrics and Internal Medicine at UniCamillus, has just been awarded significant national recognition.
The FoRST Foundation (Foundation for Thermal Scientific Research) has announced its co-funding of the project, ‘Aquatic thermal therapy for Enhancing MusculosKeletal Strength in Older Adults with Sarcopenia: a randomized, controlled, feasibility trial’, presented as part of the 7th Call for Proposals (2025).
The project is a clinical trial designed to enhance muscle strength through thermal water.
The study will be conducted at the Terme di Monticelli thermal baths in Parma and will involve 74 adults over the age of 60 who are considered to be at risk of sarcopenia. This controlled pilot study is the first essential step for future large-scale trials.
Participants will be divided into two groups: an intervention group, who will follow a structured programme of therapeutic exercises in thermal water for nine months, and a control group who will receive standard care. “Participants in the intervention group will follow a programme of exercises in thermal water twice a week for nine months”, explains Professor Veronese. “These sessions are not just swimming lessons, but a comprehensive therapeutic programme. We’ll start with a warm-up aimed at mobilising the joints and gently awakening the muscles. Then we’ll move on to the most demanding part, where we’ll work on all the main muscle groups, gradually increasing the intensity by speeding up the movements and using the natural resistance of the water. Finally, there is a cool-down phase designed to promote recovery and restore balance to the body. The intensity is regulated using the Borg scale, which enables each participant to find their own pace safely and avoid overexertion”. The Borg scale is a system that enables individuals to indicate the perceived intensity of an exercise, ranging from ‘very light’ to ‘very intense’. This allows the activity to be adjusted in a safe and personalised manner. The aim is to evaluate the intervention’s benefits, as well as its actual feasibility in terms of adherence, safety, and measurable clinical outcomes.
The 74 participants are all over 60 years of age and attend the Terme di Monticelli for inhalation treatments. “We are looking for participants at risk of developing sarcopenia”, explains Veronese, which is why a SARC-F score of at least 2 will be one of the main requirements, as this is an index of suspected loss of strength and muscle mass. However, individuals with conditions that could interfere with the safety or validity of the study are excluded, such as those with type 1 or 2 diabetes, active cancer, those undergoing high-dose corticosteroid therapy, or those in clinical situations with a poor prognosis. Once enrolments have been collected and the criteria verified, participants are randomly assigned to the intervention or control group to ensure the impartial evaluation of results.
The study will last nine months, but some positive effects may be apparent within the first few weeks. “Although the main objective is to assess changes at six and nine months, exercising in thermal water can offer early benefits”, explains Professor Veronese. “It reduces joint stress, has anti-inflammatory and anti-oedema properties, and improves comfort and adherence to physical activity”. These effects can translate into an increased sense of well-being, reduced muscle stiffness, and improved mobility. However, the actual clinical outcomes will be measured later using standardized tests.
UniCamillus’ role in the project
UniCamillus is the lead organisation and coordinates all phases of the study. “We are responsible for overall coordination, training the Terme di Monticelli staff, preparing the data management platform, statistical analysis, and drafting the research paper”, explains Professor Veronese. “We also have a dedicated researcher, and we are responsible for administrative management and budgeting, ensuring that each phase proceeds according to plan”.
As Scientific Director, Professor Veronese oversees the entire process directly: “My responsibilities include designing and planning the study, training and supervising staff, standardising procedures and tests, coordinating scientific and clinical activities, analysing data and interpreting results, drafting the final report and publications, and managing local, national, and international collaborations”.
Why thermal water?
Its anti-inflammatory, muscle-relaxant and analgesic properties, combined with reduced stress on the joints, create an ideal environment for exercises aimed at strengthening muscles, particularly for frail individuals.
According to the research hypothesis, combining thermal therapy with guided exercises in water could improve muscle strength and mass, balance, motor function, and the perception of well-being and quality of life.
If the project confirms the effectiveness and feasibility of this approach, it could pave the way for larger clinical trials, standardised physical therapy protocols in thermal water, and the integration of thermal treatments as an official rehabilitation option for sarcopenia.
Towards new rehabilitation strategies for older adults
If the results of the study are positive, they could have a significant impact on several levels. From a clinical point of view, “we could see a reduction in frailty and the risk of falls”, says Professor Veronese, emphasising that these are key factors in helping older adults to maintain their independence. Other expected benefits include a reduced need for intensive rehabilitation or hospitalisation, and an overall improvement in quality of life. In an ideal scenario, “structured physical activity in thermal water could become an integral part of functional ageing prevention programmes”.
The effects would also extend to the social sphere, with possible outcomes including reduced healthcare costs related to disability, greater participation of older adults in daily life, and an enhanced role for spas within the healthcare system. “Spas could once again be perceived not only as places of well-being, but also as spaces with recognised therapeutic value”.
Could this therefore also have a positive impact on the Italian NHS? Professor Veronese is cautious. “Our work does not officially comment on this point”, he says, but he adds that there is already solid evidence of balneotherapy’s effectiveness in treating other conditions, such as osteoarthritis. The aim of this project is to establish the foundations for a larger, definitive study, which is necessary in order to influence healthcare guidelines and policies. If the intervention proves to be effective and sustainable, it could be considered as an integrated rehabilitation option in the future, particularly for older adults with severe frailty.