{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:37:16Z","timestamp":1778254636450,"version":"3.51.4"},"reference-count":80,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: In the cardio-respiratory rehabilitation field, thermal medicine represents an interesting complementary therapy approach. It can aid in complex medical contexts characterized by cardio-respiratory deficiency, functional limitation, and pain determined by the invasiveness of pharmacological and surgical treatments in combination with limited post-surgical physical activity. Methods: We investigated the evolution of cardio-respiratory and functional performances following the application of the Integrated Thermal Care (ITC) protocol in 11 mastectomized\/quadrantectomized women (mean age of 54 years). The ITC protocol consisted of hydroponic treatments, steam inhalations treatment, hydrokinesitherapy, and manual treatments. Patients were assessed before and after a cycle of 1 h long treatment sessions, which were performed 5 days a week for 4 weeks. The outcomes were measured through the following scales and tests: Piper Fatigue Scale (PIPER), 6-Minute Walking Test (6MWT), Five Times Sit-to-Stand (5STS), Range of Arm Motion (ROM), Disability of the Arm\u2013Shoulder\u2013Hand Scale (DASH), and Numeric Pain Rating Scale (NPRS). Results: We found appreciable improvements in cardio-respiratory efficiency and in pain perception exemplified by a reduction of PIPER, 5STS, DASH, and NPRS values together with an increase in 6MWT and ROM values. Conclusions: We conclude that ITC is a promising rehabilitative tool to enhance cardio-respiratory and functional performance and reduce pain after mastectomy\/quadrantectomy.<\/jats:p>","DOI":"10.3390\/life15030374","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T03:37:57Z","timestamp":1740627477000},"page":"374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cardio-Respiratory, Functional and Antalgic Effects of the Integrated Thermal Care Protocol After Breast Cancer Surgery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6788-5665","authenticated-orcid":false,"given":"Giovanni","family":"Barassi","sequence":"first","affiliation":[{"name":"Castelnuovo della Daunia Thermal Medicine Center, 71034 Castelnuovo della Daunia, Italy"},{"name":"Center for Physiotherapy, Rehabilitation and Re-Education (Ce.Fi.R.R.) Venue \u201cG. d\u2019Annunzio\u201d University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Spina","sequence":"additional","affiliation":[{"name":"Spasticity and Movement Disorders \u201cReSTaRt\u201d, Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"D\u2019Alessandro","sequence":"additional","affiliation":[{"name":"Castelnuovo della Daunia Thermal Medicine Center, 71034 Castelnuovo della Daunia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loris","family":"Prosperi","sequence":"additional","affiliation":[{"name":"Center for Physiotherapy, Rehabilitation and Re-Education (Ce.Fi.R.R.) Venue \u201cG. d\u2019Annunzio\u201d University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celeste","family":"Marinucci","sequence":"additional","affiliation":[{"name":"Center for Physiotherapy, Rehabilitation and Re-Education (Ce.Fi.R.R.) Venue \u201cG. d\u2019Annunzio\u201d University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Oncology Sector, \u201cTeresa Masselli Mascia\u201d Hospital, 71016 San Severo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Panunzio","sequence":"additional","affiliation":[{"name":"Responsible Research Hospital, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-8485","authenticated-orcid":false,"given":"Andrea","family":"Santamato","sequence":"additional","affiliation":[{"name":"Spasticity and Movement Disorders \u201cReSTaRt\u201d, Physical Medicine and Rehabilitation Section, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/S0738-081X(96)00083-1","article-title":"Balneology, mineral water, and spas in historical perspective","volume":"14","author":"Routh","year":"1996","journal-title":"Clin. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"566","DOI":"10.3889\/oamjms.2017.126","article-title":"History of the baths and thermal medicine","volume":"5","author":"Gianfaldoni","year":"2017","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_3","first-page":"275","article-title":"SPAs Thermal Treatments in Italy","volume":"146","author":"Bellometti","year":"2009","journal-title":"Presse Therm. Clim."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s40899-017-0136-1","article-title":"Spa techniques and technologies: From the past to the present","volume":"5","year":"2019","journal-title":"Sustain. Water Resour. Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00484-019-01731-z","article-title":"Spa therapy and rehabilitation of musculoskeletal pathologies: A proposal for best practice in Italy","volume":"64","author":"Bernetti","year":"2020","journal-title":"Int. J. Biometeorol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.38025\/2078-1962-2020-96-2-3-6","article-title":"Spa-therapy can improve quality of life in chronic musculoskeletal disorder subjects: A narrative review","volume":"2","author":"Maccarone","year":"2020","journal-title":"Bull. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Jo\u00e3o Martins, M. (2022). Thermal Waters in Otorhinolaryngology. Mineral Water: From Basic Research to Clinical Applications, Nova Science Publishers Inc.. Chapter 3.","DOI":"10.52305\/IVAQ8581"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s00405-012-2024-5","article-title":"Spa therapy of upper respiratory tract inflammations","volume":"270","author":"Passali","year":"2013","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Barassi, G., Panunzio, M., Di Iulio, A., Di Iorio, A., Pellegrino, R., Colombo, A., Di Stefano, G., Galasso, P., Spina, S., and Vincenzi, U. (2023). Integrated Thermal Rehabilitation Care: An Intervention Study. Healthcare, 11.","DOI":"10.3390\/healthcare11172384"},{"key":"ref_10","first-page":"1","article-title":"Integrated Thermal Care and Bio-Physico-Metric Approach for The Treatment of Long-Covid Patients","volume":"13","author":"Barassi","year":"2024","journal-title":"Eur. J. Musculoskelet. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1007\/s00484-023-02512-5","article-title":"Effect of hydrotherapy, balneotherapy, and spa therapy on blood pressure: A mini-review","volume":"67","author":"Jazani","year":"2023","journal-title":"Int. J. Biometeorol."},{"key":"ref_12","first-page":"269","article-title":"Role of aquatic therapy and speleotherapy as complementary therapies in the respiratory system","volume":"29","author":"Karampitsakos","year":"2016","journal-title":"Pneumon"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114505","DOI":"10.1016\/j.jep.2021.114505","article-title":"Inhalations with thermal waters in respiratory diseases","volume":"281","author":"Zajac","year":"2021","journal-title":"J. Ethnopharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3233\/BMR-2011-0276","article-title":"The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia","volume":"24","author":"Kesiktas","year":"2011","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_15","first-page":"441","article-title":"The effects of balneotherapy on disease activity, functional status, pulmonary function and quality of life in patients with ankylosing spondylitis","volume":"35","author":"Aydemir","year":"2010","journal-title":"Acta Reumatol. Port."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9631684","DOI":"10.1155\/2016\/9631684","article-title":"Stress and Fatigue Management Using Balneotherapy in a Short-Time Randomized Controlled Trial","volume":"2016","author":"Razbadauskas","year":"2016","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_17","first-page":"12","article-title":"Long-term fatigue state in postoperative patients with breast cancer","volume":"26","author":"Tan","year":"2014","journal-title":"Chin. J. Cancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1002\/cncr.27475","article-title":"Cancer-related fatigue: Implications for breast cancer survivors","volume":"118","author":"Berger","year":"2012","journal-title":"Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1111\/j.1742-1241.2006.01152.x","article-title":"Morbidity after breast cancer treatment and physiotherapeutic performance","volume":"61","author":"Gomide","year":"2007","journal-title":"Int. J. Clin. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1177\/105413730501300306","article-title":"Depression and anxiety in mastectomy cases","volume":"13","author":"Farooqi","year":"2005","journal-title":"Illn. Cris. Loss"},{"key":"ref_21","first-page":"19","article-title":"The psychological impacts of post-mastectomy breast reconstruction: A systematic review","volume":"8","author":"Roy","year":"2023","journal-title":"Ann. Breast Surg. Open Access J. Bridge Breast Surg. Across World"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5498\/wjp.v14.i1.8","article-title":"Effects of psychological intervention on negative emotions and psychological resilience in breast cancer patients after radical mastectomy","volume":"14","author":"Wang","year":"2024","journal-title":"World J. Psychiatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/j.bbi.2012.06.011","article-title":"Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications","volume":"30","author":"Bower","year":"2013","journal-title":"Brain Behav. Immun."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.2500\/ajra.2012.26.3733","article-title":"Crenotherapy modulates the expression of proinflammatory cytokines and immunoregulatory peptides in nasal secretions of children with chronic rhinosinusitis","volume":"26","author":"Passariello","year":"2012","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"B\u0142o\u0144ska-Sikora, E., Orlewska, E., and Klusek, J. (2018). The Influence of Crenotheraphy with SHS Water on the Concentration of Glutathione in Blood of People with Rheumatoid Arthritis. Preprints.","DOI":"10.20944\/preprints201811.0356.v1"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"158","DOI":"10.36740\/ABal202403102","article-title":"Crenotherapy with therapeutic sulfide water as a new direction of health resort treatment on the example of the Sulfide Reduction Diet","volume":"181","author":"Wrzochal","year":"2024","journal-title":"Acta Balneol."},{"key":"ref_27","first-page":"2996","article-title":"Crenotherapy in inflammatory diseases of the upper air passages","volume":"56","author":"Schmidt","year":"1965","journal-title":"Minerva Medica"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Costantino, M., Conti, V., Corbi, G., Giudice, V., Caro, F.D., and Filippelli, A. (2023). Marked Reduction of Oxidant Species after Sulfureous Crenotherapy in Females with Joint Diseases and Psoriasis: A Retrospective Real-Life Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175731"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jbmt.2011.01.022","article-title":"Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer","volume":"16","year":"2012","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1038\/s41523-021-00321-w","article-title":"Trigger point injection for post-mastectomy pain: A simple intervention with high rate of long-term relief","volume":"7","author":"Khoury","year":"2021","journal-title":"NPJ Breast Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.apmr.2012.09.008","article-title":"The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: A randomized controlled trial","volume":"94","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_32","first-page":"70","article-title":"The Contribution of Hydrotherapy and Swimming to Post-Mastectomy Functional Rehabilitation","volume":"62","author":"Baltag","year":"2023","journal-title":"Phys. Educ. Sports Kinetotherapy J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"R141","DOI":"10.1186\/ar4603","article-title":"Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: A qualitative systematic review and meta-analysis of randomized controlled trials","volume":"16","author":"Naumann","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/j.1742-1241.2009.02062.x","article-title":"The therapeutic effect of balneotherapy: Evaluation of the evidence from randomised controlled trials","volume":"63","author":"Falagas","year":"2009","journal-title":"Int. J. Clin. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1007\/s00432-022-03947-w","article-title":"Water therapies (hydrotherapy, balneotherapy or aqua therapy) for patients with cancer: A systematic review","volume":"148","author":"Reger","year":"2022","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1080\/02640410903178344","article-title":"Requirements for ethics approvals","volume":"27","author":"Winter","year":"2009","journal-title":"J. Sports Sci."},{"key":"ref_38","unstructured":"De Sanctis, V., Soliman, A.T., Daar, S., Tzoulis, P., Fiscina, B., and Kattamis, C. (2022). Retrospective observational studies: Lights and shadows for medical writers. Acta Bio-Medica Atenei Parm., 93."},{"key":"ref_39","first-page":"677","article-title":"The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer","volume":"25","author":"Piper","year":"1998","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_40","unstructured":"Rehwaldt, M.A. (1998). Validity of the Revised Piper Fatigue Scale for Detecting Fatigue in Women with Breast Cancer Undergoing Treatment. [D.N.Sc. Dissertation, Rush University, College of Nursing]."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1123\/japa.2015-0056","article-title":"The six-minute walk test as a measure of health in breast cancer patients","volume":"24","year":"2016","journal-title":"J. Aging Phys. Act."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1111\/jocn.16299","article-title":"Self-performed Five Times Sit-To-Stand test at home as (pre-) screening tool for frailty in cancer survivors: Reliability and agreement assessment","volume":"32","author":"Hoedjes","year":"2023","journal-title":"J. Clin. Nurs."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.jbmt.2017.04.009","article-title":"Concurrent validity of pain scales in individuals with myofascial pain and fibromyalgia","volume":"22","author":"Cheatham","year":"2018","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1097\/01893697-201331040-00003","article-title":"Internal consistency of the disability of arm, shoulder and hand (DASH) outcome measure in assessing functional status among breast cancer survivors","volume":"31","author":"Davies","year":"2013","journal-title":"Rehabil. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3109\/09593985.2012.757683","article-title":"Upper extremity strength and range of motion and their relationship to function in breast cancer survivors","volume":"29","author":"Harrington","year":"2013","journal-title":"Physiother. Theory Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/5584_2020_605","article-title":"Manual Pressure Release and Low-Grade Electrical Peripheral Receptor Stimulation in Nonspecific Low Back Pain: A Randomized Controlled Trial","volume":"1324","author":"Barassi","year":"2021","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_47","first-page":"61","article-title":"Rehabilitation of neuromotor disabilities in aquatic microgravity environment","volume":"Volume 1113","author":"Pokorski","year":"2019","journal-title":"Respiratory Ailments in Context"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Burguin, A., Diorio, C., and Durocher, F. (2021). Breast cancer treatments: Updates and new challenges. J. Pers. Med., 11.","DOI":"10.3390\/jpm11080808"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.breast.2022.02.003","article-title":"Global challenges in breast cancer detection and treatment","volume":"62","author":"Barrios","year":"2022","journal-title":"Breast"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ctcp.2019.01.004","article-title":"Complementary and alternative medicine use in cancer: A systematic review","volume":"35","author":"Keene","year":"2019","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Kosaka, M., Sugahara, T., Schmidt, K.L., and Simon, E. (2001). Clinical usefulness of long-term thermohydrotherapy (balneotherapy). Thermotherapy for Neoplasia, Inflammation, and Pain, Springer Nature. Chapter 33.","DOI":"10.1007\/978-4-431-67035-3"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Khudoev, E.S., Khodasevich, L.S., Naslednikova, I.O., and Khodasevich, A.L. (2021). Balneotherapy in Post-Surgical Recovery for Patients with Breast Neoplasms at the Resort (Literature Review). Mod. Issues Biomed., 5.","DOI":"10.51871\/2588-0500_2021_05_01_3"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1007\/s00484-017-1421-2","article-title":"The role of mineral elements and other chemical compounds used in balneology: Data from double-blind randomized clinical trials","volume":"61","author":"Morer","year":"2017","journal-title":"Int. J. Biometeorol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s00484-019-01800-3","article-title":"Balneotherapy for musculoskeletal pain: Does the mineral content matter?","volume":"64","author":"Razbadauskas","year":"2020","journal-title":"Int. J. Biometeorol."},{"key":"ref_55","first-page":"91","article-title":"Treatment of chronic inflammation of the upper respiratory airways by inhalation thermal therapy with sulfur-sulfate-bicarbonate-carbonate-alkaline earth mineral water: A study of nasal cytology","volume":"16","author":"Cristalli","year":"1996","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3343","DOI":"10.1016\/j.fct.2008.08.008","article-title":"Sulphurous mineral water oral therapy: Effects on erythrocyte metabolism","volume":"46","author":"Albertini","year":"2008","journal-title":"Food Chem. Toxicol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/s13075-015-0784-1","article-title":"Fatigue in chronic inflammation\u2014A link to pain pathways","volume":"17","author":"Louati","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1158\/1078-0432.CCR-05-2398","article-title":"Inflammatory biomarkers for persistent fatigue in breast cancer survivors","volume":"12","author":"Bower","year":"2006","journal-title":"Clin. Cancer Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"3743","DOI":"10.1007\/s00520-020-05865-4","article-title":"Physical activity, cardiorespiratory fitness, and cognitive function in postmenopausal women with breast cancer","volume":"29","author":"Bender","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.apmr.2007.10.018","article-title":"Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points","volume":"89","author":"Shah","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/AJP.0b013e3181f18c36","article-title":"Myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivtiy in patients with postmastectomy pain: Evidence of peripheral and central sensitization","volume":"26","year":"2010","journal-title":"Clin. J. Pain"},{"key":"ref_62","first-page":"77","article-title":"Efficacy of myofascial release therapy on the cardiorespiratory functions in patients with COVID-19","volume":"16","author":"Fereydounnia","year":"2022","journal-title":"J. Mod. Rehabil."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/j.1526-4637.2012.01416.x","article-title":"Accelerated muscle fatigability of latent myofascial trigger points in humans","volume":"13","author":"Ge","year":"2012","journal-title":"Pain Med."},{"key":"ref_64","first-page":"28","article-title":"Breathing pattern disorders and functional movement","volume":"9","author":"Bradley","year":"2014","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_65","first-page":"971","article-title":"A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: Part 2, a case series","volume":"11","author":"Chapman","year":"2016","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/09593980701429406","article-title":"Breathing retraining in patients with chronic fatigue syndrome: A pilot study","volume":"24","author":"Nijs","year":"2008","journal-title":"Physiother. Theory Pract."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Liu, Q., Zhang, W., Tian, T., Liu, Y., Bai, H., Hu, Q., and Qi, F. (2023). Latent myofascial trigger points injection therapy for adult cough variant asthma: A randomized controlled trial. Front. Med., 10.","DOI":"10.3389\/fmed.2023.937377"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Domaszewska, K., Pie\u0144kowski, T., Janiak, A., Bukowska, D., and Laurentowska, M. (2019). The influence of soft tissue therapy on respiratory efficiency and chest mobility of women suffering from breast cancer. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16245092"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3109\/02770903.2010.520229","article-title":"Musculoskeletal dysfunction and pain in adults with asthma","volume":"48","author":"Lunardi","year":"2011","journal-title":"J. Asthma"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1590\/bjpt-rbf.2014.0162","article-title":"Posture and mobility of the upper body quadrant and pulmonary function in COPD: An exploratory study","volume":"20","author":"Morais","year":"2016","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.jse.2011.07.032","article-title":"Defining functional shoulder range of motion for activities of daily living","volume":"21","author":"Namdari","year":"2012","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"S\u00f6zen, S., and Emir, S. (2022). Physiotherapeutic Management in Breast Cancer Patients. Breast Cancer Updates, IntechOpen.","DOI":"10.5772\/intechopen.104150"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/pon.1685","article-title":"Predictors of arm morbidity following breast cancer surgery","volume":"19","author":"Hack","year":"2010","journal-title":"Psycho-Oncology"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Money, M.E., Matthews, C.M., and Tan-Shalaby, J. (2022). Review of under-recognized adjunctive therapies for cancer. Cancers, 14.","DOI":"10.3390\/cancers14194780"},{"key":"ref_75","first-page":"S317","article-title":"The underutilization of rehabilitation to treat physical impairments in breast cancer survivors","volume":"9","author":"Stubblefield","year":"2017","journal-title":"PMR"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3846\/20294913.2015.1070768","article-title":"Infrastructure and logistics divide: Regional comparisons between North Eastern & Southern Italy","volume":"23","author":"Carlucci","year":"2017","journal-title":"Technol. Econ. Dev. Econ."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"102550","DOI":"10.1016\/j.ctim.2020.102550","article-title":"The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial","volume":"54","author":"Kaki","year":"2020","journal-title":"Complement. Ther. Med."},{"key":"ref_78","first-page":"CD006864","article-title":"Balneotherapy for osteoarthritis","volume":"4","author":"Verhagen","year":"2007","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Aleksi\u0107-Milenkovi\u0107, I., Stojanovi\u0107, S., Stamenkovi\u0107, B., Jevtovi\u0107-Stoimenov, T., \u0160ari\u0107, S., and Dankovi\u0107, G. (2025). The impact of balneotherapy on IL-6 cytokine levels, disease activity, functional ability, fatigue and depression in patients with rheumatoid arthritis. Srpski Arhiv za Celokupno Lekarstvo, 6.","DOI":"10.2298\/SARH240808006A"},{"key":"ref_80","unstructured":"Barassi, G., Spina, S., D\u2019Alessandro, F., Prosperi, L., Lombardi, M., Panunzio, M., and Santamato, A. (2024, January 5\u20137). Cardio-Respiratory, Functional and Antalgic Effects of the Integrated Thermal Care Protocol after Breast Cancer Surgery. Proceedings of the 18th Conference \u201cAdvances in Pneumology\u201d, Martin, Slovakia."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/3\/374\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:00Z","timestamp":1760028180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/3\/374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":80,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["life15030374"],"URL":"https:\/\/doi.org\/10.3390\/life15030374","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}