Physiological, Functional and Inflammatory Effects of Thermal-Water Exercise and Heat-Based Interventions: A Systematic Review Protocol

v e T h i s systematic review aims to synthesise and compare the physiological, functional and inflammatory effects of thermal-water exercise, balneotherapy, thermo-mineral and peloid-based therapies, multimodal spa programmes and heatbased exercise interventions in adult populations.Specifically, it seeks to examine cardiovascular, metabolic, respiratory, functional and inflammatory outcomes associated with these interventions, and to contrast response patterns between aquatic and thermo-mineral modalities and exercise performed under thermal stress.Rationale Thermal-water exercise, balneotherapy, thermo-mineral therapies and heat-based exercise interventions are increasingly used as nonp h a r m a c o l o g i c a l s t r a t e g i e s t o i m p r o v e cardiovascular, metabolic, functional and inflammatory health in adults.However, the existing evidence is highly heterogeneous in terms of intervention modalities, thermal parameters, mineral composition, population characteristics and outcome measures.Most studies examine t h e s e i n t e r v e n t i o n s i n i s o l a t i o n , l i m i t i n g understanding of whether observed effects are primarily attributable to thermal load, hydrostatic pressure, mineral components, exercise stimuli, or their interaction.Therefore, a systematic synthesis integrating thermal-water exercise, thermo-mineral and multimodal spa programmes alongside heatbased exercise comparators is warranted to clarify r e s p o n s e p a t t e r n s , i d e n t i f y c o n s i s t e n t physiological and inflammatory adaptations, and highlight methodological gaps.This review aims to provide an integrative framework to support clinical, rehabilitative and preventive applications of thermal-based interventions and to inform future mechanistic and standardised research.Condition being studied This review focuses on physiological, functional and inflammatory responses associated with thermal-based interventions in adults.These include thermal-