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Citation: Baek, J.-E.; Kim, S.-H.; Shin,
H.-J.; Cho, H.-Y. Effect of a Healing
Program Using Marine Resources on
Reducing Pain and Improving
Physical Function in Patients with
Non-Specific Chronic Low Back Pain:
A Randomized Controlled Trial Study.
Medicina 2025,61, 172. https://
doi.org/10.3390/medicina61020172
Copyright: © 2025 by the authors.
Published by MDPI on behalf of the
Lithuanian University of Health
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Article
Effect of a Healing Program Using Marine Resources on
Reducing Pain and Improving Physical Function in Patients with
Non-Specific Chronic Low Back Pain: A Randomized Controlled
Trial Study
Ji-Eun Baek 1, † , Sung-Hyeon Kim 1, † , Ho-Jin Shin 2and Hwi-Young Cho 1,*
1Department of Physical Therapy, Gachon University, Incheon 21936, Republic of Korea;
baekjieun421@gmail.com (J.-E.B.); gpgkorea30@gmail.com (S.-H.K.)
2Wellness Center, Industry-University Collaboration Group, Ansan University,
Ansan 15328, Republic of Korea; hojin0911@ansan.ac.kr
*Correspondence: hwiyoung@gachon.ac.kr; Tel.: +82-32-820-4560
†These authors contributed equally to this work.
Abstract: Background and Objectives: Chronic low back pain is a widespread condition,
particularly in older populations, contributing to physical, mental, and social burdens.
Traditional treatments, such as medications and surgery, carry long-term risks, including
dependency, side-effects, and complications from invasive procedures. Additionally, health-
care accessibility is limited due to high costs, long waiting times, and geographic disparities
in healthcare services, particularly in rural areas. For these reasons, non-pharmacological
approaches that address both physical and psychological aspects are increasingly recog-
nized as effective. This study aimed to evaluate the effectiveness of a marine resource-based
healing program in Taean, South Korea, in improving pain, physical function, and mental
health in patients with non-specific chronic low back pain. Materials and Methods: This
randomized controlled trial involved 46 participants with non-specific chronic low back
pain (mean age, 68.7
±
5.1 years), randomly allocated to either an experimental group
(marine healing program) or a control group (core exercises). The experimental group
participated in a 4-night, 5-day intervention comprising heated peat pack therapy, mind-
fulness meditation, core exercises, and local tourism. The control group performed core
exercises without additional interventions. Key outcomes included pain, muscle properties,
functional disability, lower extremity function, balance, gait, and depression. Results: The
experimental group demonstrated significant reductions in resting pain (p< 0.001), im-
proved pressure pain threshold at L3 (p< 0.001), decreased L3 muscle tone (p= 0.015), and
improved functional disability scores (p< 0.001). Functional gains were observed in lower
extremity function scores (p< 0.001), balance (sway area: p= 0.046), gait velocity (p< 0.001),
and depression levels (p< 0.001). Conclusions: The marine healing program significantly
improved pain, functional abilities, and mental well-being in patients with non-specific
chronic low back pain, highlighting its potential as an integrative approach to chronic
low back pain management. Further studies are recommended to explore long-term and
generalized effects.
Keywords: non-specific chronic low back pain; marine therapy; physical health; psychological
health
Medicina 2025,61, 172 https://doi.org/10.3390/medicina61020172
Medicina 2025,61, 172 2 of 15
1. Introduction
Back pain is a common health problem worldwide, and its prevalence is increasing, es-
pecially due to population aging and lifestyle changes [
1
–
4
]. Chronic low back pain (CLBP)
continues to be defined as pain localized in the lumbar region, lasting for at least half the
days in the past 6 months without an identifiable specific pathology [
5
]. It is particularly
prevalent among women and individuals aged 40 to 80, but recent studies have highlighted
a growing incidence among younger adults, driven by sedentary lifestyles, prolonged
sitting, and reduced physical activity [
6
]. This trend underscores the need for proactive
management across all age groups. However, older adults face distinct challenges, includ-
ing a higher prevalence of comorbidities, reduced mobility, and greater vulnerability to the
long-term risks associated with conventional treatments, such as medication dependency
and surgical complications [
7
]. Furthermore, healthcare accessibility issues—particularly
for rural or underserved populations—make non-pharmacological, integrative approaches
more critical for this demographic. These approaches, which address both physical and
psychosocial aspects, are vital for reducing the overall disease burden, improving patient
outcomes, and lowering healthcare costs, especially in older adults with limited access to
specialized care.
In particular, the management of non-specific chronic low back pain (NSLBP) has
emerged as an important task in public health [
8
]. Because the pathoanatomical cause of
NSLBP is unclear, a customized, non-pharmacological treatment approach that goes beyond
pain relief to address psychosocial and lifestyle factors is required. Such management plays
a vital role in reducing the overall burden of disease and improving patient outcomes by
lowering healthcare costs and enhancing productivity.
Current approaches to managing low back pain have several limitations and chal-
lenges. Most treatments are hospital-based, limiting patient access, and drug treatments, in
particular, carry the risk of developing resistance [
9
]. Additionally, surgery is considered a
last resort for chronic low back pain, which increases the burden on patients and limits the
sustainability of treatment. To address these issues, there is a growing need for safe and
accessible alternative treatment methods. Heat therapy and exercise have been proposed
as effective, low-risk alternatives. Heat application is widely used to relieve chronic muscu-
loskeletal pain, while exercise plays a critical role in alleviating pain, improving muscle
strength, and enhancing motor function in patients with NSLBP.
The integration of neuroscience-based pain education (PNE) with exercise therapy
has demonstrated promising results in managing non-specific chronic low back pain
(CLBP). PNE educates patients about the biological and physiological mechanisms of
pain, fostering improved self-management and reducing fear-avoidance behaviors. When
combined with neuromuscular or targeted exercise programs, this approach effectively
alleviates pain intensity, reduces functional disability, and addresses psychological barriers
such as kinesiophobia and catastrophizing beliefs. For instance, a study evaluating the
effects of an eight-week PNE and neuromuscular exercise program reported significant
improvements in pain, disability, and fear-avoidance behaviors compared to exercise
alone [
10
]. Similarly, research indicates that combining PNE with motor control training
yields greater reductions in central sensitization and psychological distress than standalone
interventions [
11
]. Furthermore, a multimodal approach incorporating PNE, physical
exercises, mindfulness, and behavior change strategies has been shown to enhance overall
health outcomes and reduce reliance on primary healthcare services [12].
Additionally, previous studies have demonstrated the effectiveness of various physical
and occupational therapy interventions for managing chronic low back pain, including
core stabilization exercises, aquatic therapy, manual therapy, and psychosocial approaches
such as cognitive-behavioral therapy (CBT) and yoga. These interventions have shown
Medicina 2025,61, 172 3 of 15
significant benefits in reducing pain, improving function, and enhancing mental well-
being [
13
–
17
]. Nonetheless, clinical trials on interventions for chronic NSLBP remain
insufficient [18].
The effective management of chronic back pain must go beyond physical treatment to
comprehensively address the patient’s psychological, mental, and emotional state. Recent
studies have demonstrated that these factors significantly influence the occurrence, per-
sistence, and chronicity of low back pain, suggesting that psychosocial approaches, such
as cognitive behavioral therapy, may be effective [
19
–
22
]. Thus, in the management of
chronic low back pain, understanding and addressing psychological, mental, and emotional
factors are as important as physical treatment, making the development and application of
integrated treatment approaches essential.
Taean’s marine environment provides ideal conditions for managing chronic back
pain, offering an abundance of marine resources and natural healing properties. This
region is rich in healing resources, particularly peat, which is a decomposed organic
material found in wetland environments. Rich in humic acids and minerals, peat possesses
anti-inflammatory and thermotherapeutic properties, making it effective for managing
musculoskeletal pain [
23
,
24
]. Additionally, Taean’s natural environment supports healing
programs that leverage elements such as sunlight, the sound of waves, and fresh air, all
of which contribute to improved physical and mental health [
25
,
26
]. Research has shown
that visiting natural environments reduces depression and high blood pressure, viewing
natural scenery alleviates pain and anxiety, and sunlight exposure is especially beneficial in
improving mood [
27
,
28
]. Exercise in a marine environment like Taean can enhance mental
health, while elements such as ocean sounds and sand have potential for use in natural
healing programs [
29
–
31
]. Taean’s unique environment presents a novel direction in the
utilization of natural healing resources for chronic pain management and can become a
cornerstone of preventive medicine.
This study aims to contribute to the development of an integrative and sustainable non-
pharmacological management approach for non-specific chronic low back pain (NSLBP),
with a particular focus on utilizing marine resources. This novel intervention seeks to
complement existing hospital-based treatments by addressing physical, psychological, and
environmental factors.
The primary purpose of this study is to evaluate the effectiveness of a healing program
utilizing marine resources for patients with non-specific chronic low back pain (NSLBP).
This study hypothesizes that this marine healing program will be more effective than
conventional core exercises in reducing pain, improving function, and promoting men-
tal health.
2. Materials and Methods
2.1. Study Design
This study was conducted as a single-blinded, randomized controlled study. To main-
tain blinding, data were coded to ensure that the analyst was unaware of the participants’
group allocations.
2.2. Participants
Participants in this study were recruited through poster advertisements and coopera-
tion with the Taean County Health and Medical Center located in Taean, Chungcheongnam-
do. Among the volunteers who wanted to participate, those who reported a pain score of 3
or higher on the visual analog scale (VAS) at rest in the back and legs, had pain for more
than 6 months, and required medication to relieve pain were recruited. The exclusion crite-
ria were as follows: (1) individuals requiring other medical, pharmacological, or alternative
Medicina 2025,61, 172 4 of 15
treatments for back pain symptoms during the intervention period, (2) individuals with
musculoskeletal conditions (including a history of surgery) or pain caused by identifiable
neurological pathologies that could affect measurements, (3) individuals who had difficulty
communicating in Korean, and (4) individuals at risk of mental health issues as indicated
through self-report.
A total of 46 patients with back pain who met the criteria ultimately participated
in the experiment. Before participating in this study, all subjects signed an informed
consent form after receiving an explanation of the study. This study was conducted after
receiving approval from the Gachon University Institutional Review Board (approval
number: 1044396-202108-HR-181-01 and 9 October 2021) and was registered with the
Clinical Research Information Service of the Korea Disease Control and Prevention Agency
(registration number: KCT0009103).
2.3. Sample Size
The software G*Power 3.1.9.7 (Universität Kiel, Kiel, Germany) was used to calculate
the sample size. According to the study by Faul et al., the effect size was set at 0.25, 80%
power, and
α
= 0.05, requiring 34 participants. Considering a dropout rate of 20%, a total of
51 participants were recruited, and ultimately 46 participants completed this study.
2.4. Study Sites
The intervention in this study was divided into an experimental group and a control group.
The experimental group conducted activities at a training center located in
Cheongpodae-gil, Nam-myeon, Taean-gun, Chungcheongnam-do, South Korea. The
nearby Cheongpodae Beach consists of a dense pine forest and a wide sandy beach. The
white sandy beach, composed of silica sand, spans an area of 30,000 m
2
, with a length
of 1000 m and a width of 30 m. Its gentle slope of 6 degrees makes it suitable for beach
trekking [32].
In contrast, the control group performed core exercises between their home and school
without separate accommodation.
2.5. Procedure
Participants, selected after considering the inclusion and exclusion criteria, signed the
consent form for participation in this study and completed pre-intervention measurements.
They were then randomly assigned to one of two groups (experimental or control group)
and participated in their respective interventions for 4 nights and 5 days. Random allocation
in this study was performed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA),
where participants were randomly assigned to the experimental and control groups using
blocks of size 4. Randomization was performed by a physical therapist who was blinded
to the study hypothesis and group assignments. Post-measurements were conducted
immediately after completing the interventions (Figure 1).
All interventions and measurements were conducted by licensed physical therapists
with more than 3 years of clinical experience. These therapists were not involved in the
recruitment of participants, to ensure objectivity.
Medicina 2025,61, 172 5 of 15
Medicina 2025, 61, x FOR PEER REVIEW 5 of 16
Figure 1. Flowchart.
All interventions and measurements were conducted by licensed physical therapists
with more than 3 years of clinical experience. These therapists were not involved in the
recruitment of participants, to ensure objectivity.
2.6. Intervention
Participants performed the assigned interventions for 4 nights and 5 days (Table 1).
The experimental group underwent a program involving heated peat packs, core exer-
cises, mindfulness meditation, and local tourism, while the control group performed only
core exercises in the city center.
Table 1. Schedule of the experimental group.
Time Day 1 Day 2 Day 3 Day 4 Day 5
07:00–
08:00
Coastal walk Coastal walk Coastal walk Coastal walk
08:00–
09:00 Breakfast Breakfast Breakfast Breakfast
09:00–
10:00 CORE exercise CORE exercise CORE exercise CORE exercise
10:00–
11:00
Mindfulness
meditation
Mindfulness
meditation
Mindfulness
meditation
Mindfulness
meditation
11:00–
12:00 Break time Break time Break time Post-measure-
ment
12:00–
13:00 Lunch Lunch Lunch
13:00–
14:00 Orientation CORE exercise CORE exercise CORE exercise Lunch
14:00–
15:00
Pre-measure-
ment
Nordic walk-
ing
Visiting
Cheongsan
Tideland activ-
ity Check-out
Figure 1. Flowchart.
2.6. Intervention
Participants performed the assigned interventions for 4 nights and 5 days (Table 1).
The experimental group underwent a program involving heated peat packs, core exercises,
mindfulness meditation, and local tourism, while the control group performed only core
exercises in the city center.
A heated peat pack, maintained at 40
◦
C, was applied to the experimental group for
40 min on the area experiencing back pain. An electric heating pack ensured consistent
heat conduction. Mindfulness meditation, focusing on breathing and bodily sensations,
was provided to the experimental group as part of a marine healing program. Previous
studies have shown that this type of intervention reduces stress and improves health [
33
,
34
].
Additionally, the experimental group participated in local tourism activities near Taean,
including walking along the coast, visiting the Cheongsan Arboretum, attending the Taean
Light Festival, and experiencing tidal flats. Local tours were conducted under researcher
supervision to ensure participant safety.
The experimental and control groups both performed core exercise interventions. The
50 min sessions included a warm-up, main exercise, and cool-down. The warm-up and
cool-down exercises focused on stretching and improving mobility, while the main exercise,
lasting 30 min, involved core muscle function training, including abdominal breathing,
bridge exercises, dead bug exercises, plank exercises, bird dog exercises, and side bridge
exercises. Participants began with static exercises (e.g., abdominal breathing, planks) and
progressed to dynamic exercises (e.g., bird dogs, side bridges). Each exercise was performed
for 3 sets of 10 repetitions and was tailored to the individual abilities of participants. The
difficulty was gradually increased as participants adapted to the exercises.
Medicina 2025,61, 172 6 of 15
Table 1. Schedule of the experimental group.
Time Day 1 Day 2 Day 3 Day 4 Day 5
07:00–08:00 Coastal walk Coastal walk Coastal walk Coastal walk
08:00–09:00 Breakfast Breakfast Breakfast Breakfast
09:00–10:00 CORE exercise CORE exercise CORE exercise CORE exercise
10:00–11:00 Mindfulness
meditation
Mindfulness
meditation
Mindfulness
meditation
Mindfulness
meditation
11:00–12:00 Break time Break time Break time Post-measurement
12:00–13:00 Lunch Lunch Lunch
13:00–14:00 Orientation CORE exercise CORE exercise CORE exercise Lunch
14:00–15:00 Pre-measurement Nordic walking
Visiting
Cheongsan
Arboretum Tideland activity Check-out
15:00–16:00
16:00–17:00 CORE exercise Heated peat
pack treatment
Heated peat
pack treatment
Heated peat
pack treatment
17:00–18:00 Heated peat
pack treatment Break time Break time Dinner
18:00–19:00 Dinner Dinner Dinner Visiting Taean
Light Festival
19:00–20:00 Individual marine
healing activities
Individual marine
healing activities
Individual marine
healing activities
20:00–21:00 Washing and personal care
21:00–22:00 Sleeping
The control group received the same core exercises as the experimental group but did
not participate in heated peat packs, mindfulness meditation, or local tourism.
To minimize potential biases related to human or seasonal factors, the same research
team administered the interventions to both the experimental and control groups, ensuring
consistency, with a one-week interval between the groups.
2.7. Outcome Measures
2.7.1. Primary Outcome (Pain, Pressure Pain Threshold, Properties of Muscles, Disability)
The Visual Analog Scale (VAS) was used to determine participants’ pain levels. Partic-
ipants were instructed to draw a straight line perpendicular to a line marked with 0 (no
pain) and 10 (most severe pain imaginable) to indicate their level of back pain at rest and
during activities such as housework or daily tasks. The test–retest reliability of this tool
was found to be 0.97 [35].
The threshold for pressure-induced pain was measured using a digital algometer
(PAIN TEST
TM
FPIX, Greenwich, CT, USA). While lying prone in a comfortable position,
participants indicated when they first experienced discomfort or pain as the evaluator
applied increasing pressure 2 cm lateral to the spinous processes of the L3 and L5 vertebrae.
The intra-rater reliability for this tool was 0.932 [36].
Muscle tone and stiffness were assessed using the Myoton (Myoton AS, Tallinn,
Estonia) while participants lay prone. The tool was applied 2 cm lateral to the spinous
processes of the L3 and L5 vertebrae. The intra-rater reliability of this tool was above
0.750 [37].
The Oswestry Disability Index (ODI) was used to evaluate functional disability due
to back pain. This self-administered questionnaire consists of 10 questions scored on a
5-point scale. The total score is multiplied by 2 to generate a percentage, with higher scores
indicating greater disability. The Cronbach’s αvalue of this tool was 0.73 [38].
Medicina 2025,61, 172 7 of 15
2.7.2. Secondary Outcome (Lower Extremity Function, Balance, Gait, Depression)
Lower extremity function was evaluated using the Short Physical Performance Battery
(SPPB), which includes static balance, walking speed, and chair rise tests. The test–retest
reliability of this tool was over 0.83 [39].
Balance ability was assessed using the Accusway force plate (Advanced Mechanical
Technology, Inc., Watertown, MA, USA) by measuring shifts in the center of gravity during
standing with eyes open and closed. Participants stood with their heels approximately
9 cm apart and arms crossed in front of their chest and focused on an X-shaped target at
eye level. The reliability of this tool was above 0.7 [40].
Gait ability was measured using the GAITRite walkway (CIR Systems Inc., Franklin,
NJ, USA). Spatiotemporal walking variables were calculated from center of pressure (COP)
data obtained using sensors embedded in the mat. Measurements were conducted in a
disturbance-free environment, with participants instructed to walk at a comfortable speed.
The reliability of this tool was above 0.92 [41].
Depression severity was assessed using the Beck Depression Inventory (BDI), a self-
report questionnaire with 21 items. Scores were categorized as follows: 0–9 (no or minimal
depression), 10–18 (mild to moderate depression), 19–29 (moderate to severe depression),
and 30–63 (very severe depression). The Cronbach’s αvalue of this tool was 0.89 [42].
2.8. Statistical Analysis
Data collected in this study were analyzed using SPSS version 25.0 (IBM Corp., Ar-
monk, NY, USA). The normality of the data was confirmed using the Shapiro–Wilk test.
Homogeneity between groups was assessed using independent t-tests and chi-squared
(
χ2
) tests. Differences within and between groups were analyzed using mixed repeated-
measures analysis of variance (ANOVA). Tukey’s HSD test was used for post hoc testing.
Statistical significance was set at α= 0.05.
3. Results
3.1. General Characteristics of Participants
All participants completed the program without dropping out. The demographic
characteristics of the participants in this study are as follows (Table 2).
Table 2. General characteristics.
Variables G1 G2 p-Value
Age (y) a68.91 ±5.07 68.57 ±5.05 0.817 †
Sex (M/F) b7/16 8/15 0.753 ‡
Height (cm) a158.24 ±7.65 158.46 ±7.62 0.924 †
Weight (kg) a62.23 ±9.69 61.89 ±9.43 0.905 †
BMI (kg/m2)a24.80 ±3.00 24.61 ±2.92 0.823 †
Percent body fat (%) a33.24 ±6.82 34.26 ±6.20 0.599 †
Skeletal muscle mass (kg) a22.38 ±4.58 24.25 ±5.05 0.196 †
a
Values are expressed as the mean
±
SD.
b
Values are expressed as numbers.
†
Independent t-test used for
comparison of continuous variables.
‡
Chi-squared test used for comparison of categorical variables. BMI, body
mass index.
3.2. Primary Outcomes
The primary outcomes in this study were as follows (Table 3).
Medicina 2025,61, 172 8 of 15
Table 3. Primary outcomes.
Variables Group Pre-Test Post-Test p-Value
ANOVA
η2p
Mean ±SD Mean ±SD
PPT
L3
G1 6.09 ±2.72 7.76 ±2.70 <0.001
G2 6.12 ±2.61 6.19 ±2.17 0.756 <0.001 0.34
p-value 0.968 0.035
L5
G1 5.73 ±3.10 6.91 ±3.16 0.030
G2 6.05 ±3.16 5.64 ±2.32 0.305 0.017 0.12
p-value 0.725 0.127
VAS
Resting pain G1 4.11 ±1.75 1.17 ±1.45 <0.001
G2 3.89 ±1.70 3.40 ±1.42 0.017 <0.001 0.39
p-value 0.663 <0.001
Movement pain G1 5.74 ±1.98 1.68 ±1.61 <0.001
G2 5.47 ±1.99 4.74 ±1.61 0.010 <0.001 0.38
p-value 0.645 <0.001
Myoton
L3 Tone
G1 19.00 ±4.24 17.19 ±2.30 0.015
G2 19.62 ±4.32 19.34 ±4.02 0.286 0.042 0.09
p-value 0.625 0.031
L3 Stiffness
G1 402.48 ±112.61 357.00 ±61.51 0.017
G2 377.79 ±90.84 376.45 ±91.35 0.372 0.016 0.12
p-value 0.418 0.402
L5 Tone
G1 17.19 ±2.69 16.23 ±4.04 0.045
G2 16.30 ±3.06 16.57 ±3.22 0.438 0.036 0.10
p-value 0.300 0.751
L5 Stiffness
G1 374.74 ±93.14 350.87 ±89.78 0.058
G2 340.83 ±95.67 341.87 ±98.30 0.900 0.092 0.06
p-value 0.230 0.747
ODI
G1 42.06 ±12.61 24.72 ±9.81 <0.001
G2 43.67 ±13.84 40.72 ±11.37 0.141 <0.001 0.28
p-value 0.682 <0.001
η2p, partial eta squared. PPT, pain pressure threshold; L, lumbar spine; VAS, visual analog scale; ODI, Oswestry
Disability Index.
3.2.1. Pain
Pain at rest and pain during movement showed significant improvement in both the
experimental and control groups after the intervention, and in particular, the experimental
group showed greater improvement than the control group (p< 0.05).
3.2.2. Pressure Pain Threshold
The pressure pain threshold at L3 and L5 levels was significantly improved in the
experimental group after intervention (p< 0.05). On the other hand, no significant changes
were observed in the control group (p> 0.05).
3.2.3. Properties of Muscles
Among muscle properties, tone and stiffness at the L3 level and tone at the L5 level
were significantly improved in the experimental group after intervention (p< 0.05). How-
ever, in the case of stiffness at the L5 level, no significant improvement was observed
in both the experimental and control groups (p> 0.05). There was no change in muscle
properties in the control group (p> 0.05).
3.2.4. Disability
In the case of disability level, significant improvement was observed in the experimen-
tal group after intervention (p< 0.05). There was no significant improvement in the control
group (p> 0.05).
Medicina 2025,61, 172 9 of 15
3.3. Secondary Outcomes
The secondary outcomes in this study were as follows (Table 4).
Table 4. Secondary outcomes.
Variables Group Pre-Test Post-Test p-Value
ANOVA
η2p
Mean ±SD Mean ±SD
SPPB
G1 9.46 ±1.74 10.96 ±1.11 <0.001
G2 9.63 ±1.37 9.72 ±1.36 0.539 <0.001 0.35
p-value 0.709 0.002
BDI
G1 23.61 ±12.36 6.74 ±4.71 <0.001
G2 22.14 ±11.56 21.90 ±11.81 0.336 <0.001 0.47
p-value 0.679 <0.001
Balance ability
Sway area (cm2)
G1 289.55 ±230.78 208.80 ±143.03 0.046
G2 303.28 ±238.40 316.46 ±267.96 0.182 0.021 0.11
p-value 0.844 0.096
Sway velocity
(cm/s)
G1 15.87 ±8.24 13.96 ±7.16 0.242
G2 16.71 ±8.71 16.80 ±7.94 0.901 0.256 0.03
p-value 0.738 0.209
Gait ability
Velocity
(cm/s)
G1 110.70 ±13.09 122.84 ±12.67 <0.001
G2 104.56 ±14.16 106.86 ±26.45 0.636 0.065 0.08
p-value 0.134 0.012
Cadence
(step/min)
G1 109.27 ±6.91 113.41 ±7.63 <0.001
G2 103.21 ±9.77 100.24 ±15.86 0.355 0.036 0.10
p-value 0.019 <0.001
Step length
(cm)
G1 60.68 ±6.87 64.24 ±8.58 0.020
G2 64.01 ±8.57 63.97 ±7.34 0.971 0.048 0.09
p-value 0.153 0.911
η2p, partial eta squared; SPPB, Short Physical Performance Battery; BDI, Beck Depression Inventory.
3.3.1. Lower Extremity Function
Lower extremity function showed significant improvement in the experimental group
after intervention (p< 0.05). No significant changes were observed in the control group
(p> 0.05).
3.3.2. Balance
In terms of balance ability, the sway area showed significant improvement in the
experimental group after intervention (p< 0.05). However, in the case of sway velocity, no
significant changes were observed in all groups (p> 0.05).
3.3.3. Gait
The experimental group showed significant improvement in all variables of walking
ability after intervention (p< 0.05). The control group showed no significant changes
(p> 0.05).
3.3.4. Depression
There was significant improvement in the level of depression in the experimental
group after intervention (p< 0.05). There was no significant change in the control group
(p> 0.05).
4. Discussion
In this study, we found that a natural healing program using Taean’s marine resources
was effective in reducing pain, decreasing muscle tension, and improving daily living skills
in patients with non-specific chronic low back pain (NSLBP). These results suggest that
marine healing programs can contribute to improving both physical and mental health.
Medicina 2025,61, 172 10 of 15
Visiting natural environments can play an important role in pain management, as it
has been shown to increase the pain threshold and tolerance [
43
]. The results of this study
are consistent with previous findings that demonstrated positive effects of meditation and
exercise in marine areas on various health aspects, including pain intensity, tactile spatial
accuracy, balance, overall quality of life, and depression scores [44].
This study suggests that the effects of the marine healing program on pain reduction
and functional improvement in patients with non-specific chronic low back pain (NSCLBP)
may be attributed to its psychological and mental benefits. Chronic pain patients often
experience anxiety, depression, and cognitive impairments, which are associated with struc-
tural and functional changes in the brain, particularly in gray matter volume [
45
]. These
neurological changes affect regions involved in pain processing, emotional regulation, and
cognition. Notably, individuals with chronic low back pain (CLBP) have been reported to
struggle with emotional processing [
20
,
21
]. Previous studies have highlighted the effective-
ness of psychosocial approaches such as CBT, yoga, and relaxation techniques in reducing
pain perception and improving overall quality of life for chronic pain
patients [46,47].
En-
vironmental factors, lifestyle modifications, and mind–body practices such as yoga and
meditation have been shown to mitigate pain perception and counteract brain changes
associated with chronic pain [
45
]. Furthermore, nature-based meditation has demonstrated
significant effects in enhancing psychological and physiological well-being, fostering inter-
personal relationships, increasing positive emotions, and reducing negative emotions [
48
].
Marine healing programs, in particular, promote emotional stability and alleviate stress,
which may contribute to reducing low back pain and improving functional outcomes [
49
].
These interventions address the psychological factors associated with pain chronicity, sim-
ilar to the benefits observed in the marine healing program. Moreover, the program’s
unique combination of peat therapy, mindfulness meditation, and natural environmental
exposure enhances emotional stability and reduces stress, contributing to pain alleviation
and functional improvement. Taean’s marine resources, including coastal scenery and
fresh air, further amplify these benefits, aligning with findings that natural environments
positively influence physical and mental health [
50
–
52
]. The findings of this study support
the conclusion that marine healing programs enhance participants’ emotional processing
abilities, thereby contributing to the reduction in low back pain.
Marine therapy, encompassing marine-derived treatments such as thalassotherapy
and algotherapy, has demonstrated substantial benefits in managing various diseases due
to the bioactive compounds in marine resources. Thalassotherapy, involving seawater,
sand, and marine products, is known for its anti-inflammatory and immunomodulatory
effects, particularly in dermatological conditions like psoriasis, eczema, and vitiligo, as
well as rheumatologic disorders such as fibromyalgia and rheumatoid arthritis [
53
]. Al-
gae, central to algotherapy, contain high levels of vitamins, amino acids, and minerals
that aid in cardiovascular health, metabolic regulation, and skin repair [
54
]. Seawater’s
mineral-rich composition further supports wound healing, antioxidant activity, and disease
management [55].
Core exercises are widely recognized for their ability to strengthen trunk muscles
and enhance lumbar stability, which can contribute to pain relief and improved spinal
support [
56
,
57
]. By strengthening the core, these exercises help alleviate strain on the spine
and promote a better balance of the muscles surrounding the spinal column [
58
]. As a result,
core exercises may have a positive impact on improving individuals’ ability to carry out
daily activities by reducing pain, improving static balance, and enhancing lower extremity
function and walking ability. In the program conducted as part of this study, participants
engaged in core exercises daily throughout the intervention period. Although the program
lasted only five days, the benefits of these exercises likely contributed to the reduction in
Medicina 2025,61, 172 11 of 15
participants’ low back pain. Although muscle strengthening typically requires sustained
exercise programs over weeks or months, short-term interventions can transiently reduce
muscle tone and stiffness through increased circulation and neuromuscular activation [
24
].
This aligns with the observed improvements in muscle tone after 5 days of basic exercises.
The results of this study demonstrate the significant potential of Taean’s marine
resources for enhancing both physical and mental health. The natural environment of
this region offers benefits such as reducing inflammation and pain, while the marine ele-
ments, in combination with exercise and healing programs, contribute to improved mental
well-being [
25
–
27
]. Previous studies have similarly highlighted the benefits of natural
environments for alleviating depression and hypertension, with sunlight exposure playing
a particularly effective role in improving depressive symptoms [
28
]. These elements of
the marine environment can play a vital role in chronic pain management and preventive
healthcare. Taean’s marine resource healing program, by harnessing these natural elements,
presents a promising approach to health promotion. Moreover, this study aligns with
the principles outlined in the latest clinical practice guidelines, including those from the
American College of Physicians (ACP) and the National Institute for Health and Care
Excellence (NICE) [
7
,
59
]. By integrating evidence-based exercise therapy with innovative
interventions like marine healing programs, the findings highlight the potential for ad-
vancing noninvasive and patient-centered care for chronic low back pain. These results
reinforce the conclusion that Taean’s marine resource healing program can significantly
contribute to health promotion. While this study clarified the various positive effects of
the marine healing program on patients with non-specific chronic low back pain, several
limitations warrant caution in generalizing the findings. First, the study involved a limited
number of participants, and the sample was drawn from a specific region, restricting the
generalizability of the results. Future studies should aim to include a larger and more
diverse population to enhance the scope and applicability of the findings. Second, the
short duration of the study (4 nights and 5 days) limits the ability to comprehensively
assess the program’s long-term benefits. Longitudinal studies with extended follow-up
periods are essential, particularly to determine the persistence of physical gains over time
and to evaluate the broader effects on functional outcomes. Third, the pressure pain
threshold (PPT) measurements were limited to symptomatic areas (L3 and L5). While
this approach allowed for a focused evaluation of the intervention’s localized effects on
pain sensitivity and muscle properties, it did not account for potential systemic effects
that could be observed by assessing PPT at distant, asymptomatic regions. Future studies
should consider incorporating PPT measurements at both symptomatic and distant sites
to provide a more comprehensive understanding of the intervention’s impact. Finally,
comparative studies with other healing programs are needed to assess the relative effects
of the marine healing program. The synergistic effects of the marine healing program and
exercise likely contributed to the observed outcomes. While the psychological benefits
of the marine environment, such as stress reduction and emotional regulation, enhance
physical recovery, further studies are needed to evaluate the standalone efficacy of the
marine healing program compared to exercise alone. Addressing these limitations through
more comprehensive and rigorous study designs will allow for a more precise evaluation
of the program’s effectiveness.
5. Conclusions
A marine healing program utilizing Taean’s marine resources is effective in reduc-
ing pain, alleviating muscle tension, and improving daily living skills in patients with
non-specific chronic low back pain (NSLBP). This integrative approach addresses the
limitations of conventional treatments by incorporating natural environmental benefits,
Medicina 2025,61, 172 12 of 15
physical therapy, and mindfulness practices. Future studies should focus on evaluating the
program’s long-term effects and comparing its efficacy with other established interventions.
Expanding the participant pool and diversifying demographics will also provide more
generalizable results.
Author Contributions: Conceptualization, H.-Y.C.; methodology, J.-E.B. and S.-H.K.; formal analysis,
S.-H.K.; investigation, H.-J.S.; data curation, J.-E.B. and H.-J.S.; writing—original draft preparation,
J.-E.B., S.-H.K. and H.-Y.C.; writing—review and editing, H.-Y.C.; visualization, J.-E.B.; supervision,
H.-Y.C.; funding acquisition, H.-J.S. and H.-Y.C. All authors have read and agreed to the published
version of the manuscript.
Funding: This work was supported by the National Research Foundation of Korea (NRF) grant
funded by the Korea government (MSIT) (RS-2022-NR074290 and RS-2023-00239573).
Institutional Review Board Statement: This study was conducted in accordance with the Declaration
of Helsinki and approved by the Institutional Review Board of Gachon University (1044396-202108-
HR-181-01 and 9 October 2021). The study was registered with the Clinical Research Information
Service No. KCT0009103.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data used in this study are available from the corresponding author
upon request but are not publicly accessible, due to ethical restrictions.
Conflicts of Interest: The authors declare no conflicts of interest.
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