The purpose of this study was to review several kinds of checklists and statements of studies in human subjects, and to examine reporting methods in order to improve the quality of studies concerning hot springs.
For randomized controlled trials (RCTs), “the CONSORT Statement” (Moher et al. JAMA 2001) consisting of 22 terms is the most well known checklist. In addition, different versions and new checklists have been developed depending upon the content of the studies (such as intervention methods) or field of the studies. There is also “the QUOROM Statement” (Moher et al. Lancet 1999) for a systematic review (SR) of RCTs, “the TREND Statement” (Jarlais et al. Am J Public Health 2004) for nonrandomized controlled trials, “the STROBE Statement” (Elm et al. Ann Inter Med 2007) for observational studies, and “the MOOSE Checklist” (Stroup et al. JAMA 2000) as a SR of observational studies. With regard to studies on hot springs, however, terms in the checklists and the statements described above are insufficient or inappropriate because of difficulties in performing such studies in a blinded manner, and the diversity of intervention methods, such as the quellen charakter.
Improvement of the quality of reports is important for validation of evidence. In order to improve the quality of assessments and reports of studies on hot springs, it may be necessary to develop a unique checklist based on the above-described statements and checklists.

The purpose of this study was to examine how constitutions, blood profiles, knee and back pain, and the psychological state of middle-aged and elderly women were influenced by comprehensive health education that consisted of instructions in appropriate ways of bathing in hot springs and education on lifestyle and exercise.
Of the middle-aged and elderly female residents in village A in Nagano prefecture, 266 underwent health check-ups in August and September 2002. Fifty-six of these women voluntarily participated in this study, and were divided into an intervention and a control group randomly. Finally, the intervention group and control groups consisted of 22 and 26 subjects, respectively, who were considered suitable for study purposes.
The intervention group received comprehensive health education once a week for 3 months (total 11 times) between the latter part of September and the middle of December. For the comprehensive health education, subjects participated in hot spa bathing in a salt spring for 20 minutes in all (two 10-minute periods), and lifestyle education and exercise, including stretching, walking, light sports, dietary instruction, etc., during 60-minute sessions. After the series of comprehensive health education was completed, the following improvements were noted in the intervention group. As to blood profiles, the plasma level of uric acid significantly decreased from 4.4±1.1mg/dl to 4.1±1.1mg/dl (p<0.05) and the arterioloscerotic index decreased from 2.85±0.90 to 2.68±0.83 (p=0.07). The intensity of lumbago expressed on a visual analogue scale significantly decreased from 23.5±28.4% to 14.2±21.5% (p<0.01). The intensity of psychological tension decreased from 45.3±6.3 points to 43.2±6.0 points (p=0.06). The mean number of comprehensive health education sessions attended was 9.9±1.4 (range 7 to 11). The number of improvements implemented with regard to a healthy lifestyle significantly increased (p<0.05). Behavior of the subjects in the intervention group appeared to have changed towards a desirable lifestyle.
The results of this study show that even intermittent and brief health education combining “hot spa bathing and lifestyle education and exercise” is effective to maintain and improve health of middle-aged and elderly women.

Balneotherapy includes several modalities of treatments and wellness programs, such as physiological and pharmacological effects of hot spring bathing and aqua-exercise, relaxing and biorhythm adjusting effects of staying in the urban climates and educational instruction for healthier life style. We examined health promoting effects of the comprehensive balneotherapy as a whole by the randomized controlled study. 89 women, who had no medical care, and were aged 40-65 years (mean +/- SD age: 59.0 +/- 8.0 years), volunteered for this investigation. Subjects were assigned at random to three groups; group 1 was the control group without any intervention; group 2 with exercise for 60min and educational guidance; group 3 with exercise for 30min and balneotherapy including aquaexercise for 30min and bathing in hot spring for 30min in addition to educational guidance. Each group followed the prescribed program twice a week for 3 months. There was no significant difference in age, body mass index (BMI), blood pressure, heart rate, %FAT, diet/exercise custom and psychological conditions among the three groups. Before and after the program, the physiological, biochemical and psychological measurements were performed: body weight, blood pressure, heart rate, physical strength using ergometer, serum lipids, liver function and questionnaires with profile of mood state (POMS) and self relating depression scale (SDS). After excluding 4 subjects who were dropped out because of their convenience, the results were compared. In group 2 (N=28) and 3 (N=28), body weight, BMI, blood pressure and heart rate were significantly decreased and their physical strength and psychological condition were improved significantly (p<0.05). Furthermore only in group 3, serum total cholesterol, atherogenic index and triglyceride were significantly decreased (p<0.05). The difference between these two groups was not due to changing of their diet and estimated energy consumption by daily activities during 3 months. These data suggest the efficacy of balneotherapy with hot spring bathing and aqua-exercise for health promotion.

The purpose of this study was to clarify the relationship between frequency of bathing in a spa and at home and the characteristics of the body, blood, and lifestyle of white-collar and blue-collar male employees.
To recruit subjects, two baseline data for randomized controlled trials in two places in Shimane Prefecture and in Nagano Prefecture were used. In the two-month period between August and September 2006, 43 of 311 white-collar male employees aged between 30 and 57 years in the Unnan municipal office volunteered to participate in this study. Similarly, 44 blue-collar workers in Nagano Prefecture volunteered to be involved in this study as a result of an appeal for volunteers in local newspapers and public information journals published by large local enterprises from September through November 2006. A total of 87 men were subjects of this study. Items evaluated in this study with respect to physique included height, weight, body mass index, waist circumference, hip circumference, and percent of body fat. With respect to strength, they were grip strength, abdominal strength, back strength, and anteflexion. With respect to characteristics of the blood, they were serum glucose, hemoglobin A1c, fructosamine, lactic acid, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, free fatty acid, GOT, GPT, γ-GTP, cholinesterase, natural killer cell activity, T cell, B cell, CD4+, CD8+, CD4/8 and uric acid. With respect to mood, Profile of Mood States was evaluated. With respect to lifestyle, the frequency of monthly bathing in a spa and at home was evaluated.
No significant correlation was revealed between frequency of monthly spa bathing and the health indices in the white and blue-collar male workers. The items that were significantly correlated (p<0.05) with frequency of monthly bathing at home were GOT (positive), CD8+ (positive), and mental stress (negative).
In this study, frequency of monthly spa bathing was found to have no significant correlation with the health indices.

In this study, we investigated whether subjects with a Lower Maximum Step Length (MSL) Percentage (LMP) display unstable locomotion while negotiating an obstacle. Data were collected using a three-dimensional motion analysis system. The toe-obstacle clearance of the leading limb was monitored in 10 young adults while stepping over three height obstacles from 30%, 40% and 50% of MSL. The vertical clearance at the time of the obstacle crossing decreased systematically with more complicated experimental set up. In particular, subjects with LMP showed smaller clearances than subjects with a Higher Maximum step length Percentage (HMP). Furthermore, a significant correlation was observed between the toe-obstacle clearance and MSL. The mean of variance value of toe-obstacle clearance of the leading limb differed between the subjects with LMP and those with HMP. Our findings help to explain the relation of MSL and gait adaption ability to negotiate obstacles safely during obstacles crossing.

 The purpose of this study was to systematically review non-randomized controlled trials of balneotherapy effects on locomotorium diseases in order to assess their quality and organize the evidence.
 We searched the databases of PubMed, CINAHL, Web of Science, JDream ll, and lchushi-Web forpapers published from 1990 to December 2, 2008. Eligible studies were non-randomized controlled trials in which balneotherapy exclusive of underwater exercise was the primary intervention. There was no limitation on the language in which the paper was written.
 We found only 4 papers (2 in English, 1 in Croatian, and 1 in Japanese) that fulfilled the eligibility criteria. These papers differed in the type of diseases studied, so a meta-analysis could not be applied. Their individual results showed that hot springs treatment in combination with a comprehensive fitness class was more effective than hot springs treatment alone, and that balneotherapy had therapeutic effects on arthrosis deformans, psoriatic arthritis, and lumbago. However, it was difficult to accurately interpret the effects because these papers were deficient in providing descriptions of important details of the studies.
 To improve the quality of future investigations performed with non-randomized controlled trials, we suggest that investigators design a study based on various checklists, implement interventions, conduct evaluations, finally write papers summarizing their findings.