Climate Therapy: Marienbad's Healing Microclimate

What climate therapy is

Climate therapy is the therapeutic use of the local climate: the patient spends a prescribed part of the day outdoors — walking on marked paths, resting in the spa park or doing breathing exercises — and the spa physician determines how much, for how long and at what pace. In Mariánské Lázně (Marienbad) it is part of the treatment programme alongside the mineral springs, natural carbon dioxide (CO₂ therapy) and peat (peloid therapy); the climate is the town's fourth natural healing resource.

The town lies in a sheltered valley basin at an altitude of 630 metres, surrounded by the forests of the Slavkov Forest Protected Landscape Area. The local climate is described as sub-montane and tonic — mildly stimulating, without the temperature extremes of the lowlands. Since 2023 Mariánské Lázně has held the status of a climatic spa: the Czech Hydrometeorological Institute measured the air quarterly throughout the year from May 2021, and the values recorded lay below the limits set by Czech legislation. The status is state recognition of the climatic conditions as a natural healing resource; what a particular patient can expect from a stay is shown by the studies summarised below.

How climate therapy works

The spa physician prescribes climate therapy in three forms, which are usually combined during the stay.

1. Terrain cure

The core of climate therapy. The spa parks lead straight into the woods of the Slavkov Forest, and a network of marked paths begins a few hundred metres from the colonnade — from level promenades to forest routes with climbs. The physician chooses a route to match your current condition and increases the load in small steps; the pace, length and frequency of walks are set individually. Anyone who wants to find their own way around the terrain will find tips on the day trips page.

2. Open-air rest

Rest lying or sitting at the resting places and on the terraces of the spa parks, usually 30 to 60 minutes as prescribed by the physician. This is the passive form of climate therapy for patients with limited mobility or in convalescence, for whom the physician does not yet prescribe the terrain cure.

3. Outdoor breathing exercises

Practice of diaphragmatic breathing and prolonged exhalation with a physiotherapist, carried out on the terraces or in the park. The aim is to learn techniques the patient can go on using after returning home. For diseases of the respiratory tract, breathing exercises are usually combined with inhalations of mineral water from the Forest Spring.

How long a course lasts

Climate therapy is prescribed for every day of the stay, as a rule one or two walks or one period of open-air rest a day. The length of the stay is determined not by a general rule but by the Czech indication list and the treating doctor's proposal: in comprehensive spa care covered by insurance it is 21 or 28 days depending on the item of the list, in contributory care 14 or 21 days (the specific lengths for individual diagnoses are in the overview below). Self-paying guests choose the length in consultation with the spa physician; shorter stays are regenerative rather than therapeutic in character.

Which conditions it is used for

Climate therapy is not a separate item of the Czech indication list; the spa physician builds it into the treatment programme for these indication groups:

Diseases of the respiratory system (group V). Bronchial asthma and chronic obstructive pulmonary disease, conditions after complicated pneumonia, conditions after surgery of the respiratory tract, bronchiectasis and other items of the list. The terrain cure and outdoor breathing exercises form the exercise part of a programme that is complemented by inhalations and respiratory rehabilitation — more in the article on post-Covid rehabilitation.

Skin diseases (group X). Atopic eczema (X/1, basic stay 21 days in both comprehensive and contributory care) and generalised and arthropathic psoriasis (X/2, basic stay 28 days in comprehensive or 21 days in contributory care). Here the physician prescribes open-air rest and terrain walks as part of the daily regime alongside baths, peloids and phototherapy; the whole programme is described in the article on spa treatment of skin conditions and on the page skin diseases in the indication list.

As the exercise component of other indications. On the basis of long spa practice, spa physicians also prescribe the terrain cure as controlled physical activity for diseases of the circulatory and musculoskeletal systems and in convalescence; an overview of all the diagnoses treated is on the indications and contraindications page.

Stress and exhaustion. These are not items of the indication list; self-paying guests may choose a stay in a quiet setting as regeneration. A spa stay does not replace psychotherapy or psychiatric care — for long-term anxiety or depression, consult your doctor.

When climate therapy is not suitable

The general contraindications of spa rehabilitation care apply: infectious diseases transmissible from person to person, all diseases in the acute stage (including an acute worsening of asthma or COPD), clinical signs of circulatory failure, malignant arrhythmias and persistently high blood pressure, conditions within 3 months of deep vein thrombosis, uncontrolled epilepsy, pregnancy and others — the complete list is on the indications and contraindications page. For indication group V (diseases of the respiratory system), nicotine dependence is also a contraindication to covered care. The physician does not prescribe the terrain cure, or interrupts it, in cases of fever, breathlessness at rest, chest pain and an unstable condition; in such cases they choose passive open-air rest or postpone climate therapy.

Who decides on inclusion

Whether climate therapy is included, and in what form, intensity and length, is decided by the spa physician after the initial examination on the day of arrival, on the basis of your medical records and current condition. During the stay the plan is adjusted according to how you tolerate the load. The spa paths and parks are open to all guests, but a walk becomes a therapeutic terrain cure only with a medical prescription.

What a patient can realistically expect

Few studies exist for climate therapy at an altitude of around 600 metres; the closest evidence comes from comparable Central European spas and from research on inhalations and time spent in forests.

Respiratory tract. At a Hungarian spa centre in the Mátra mountains, which like Marienbad lies at a lower altitude (about 700 m), 678 patients with asthma, COPD or allergic rhinitis (mean age 61) completed a three-week programme of breathing exercises on outdoor terraces twice a day and rehabilitation exercise. The mean FEV1 — the volume of air exhaled in the first second — rose from 71 to 77.7% of the predicted value. The study had no control group, so the effect of the climate cannot be separated from that of the exercise and medical supervision (Müller et al., 2018, Eur J Integr Med).

Inhalations. Inhalations of mineral water are part of the programme for diseases of the respiratory tract. A systematic review of 27 studies of thermal mineral water inhalations described improvements in nasal patency, mucociliary clearance and some lung parameters; the quality of the studies was low and they mostly concerned waters other than those of Marienbad (Fontana et al., 2025, Int J Biometeorol).

Time in the forest and stress. A meta-analysis of eight studies found lower salivary cortisol after time in a forest than in a city; this is a short-term effect in mostly healthy volunteers, and the authors point out that expectation may also play a role (Antonelli et al., 2019, Int J Biometeorol). What else the studies say about time in the forest is summarised in the article on forest bathing in the Slavkov Forest.

The realistic expectation, then, is this: regular guided walking and breathing exercises in surroundings free of dust and smog, which gradually increase the load under medical supervision and teach techniques that can be used at home as well. Climate therapy supplements the treatment of your pulmonologist, allergist or dermatologist; it does not replace it.

The Slavkov Forest and the spa paths

The Slavkov Forest is a protected landscape area with extensive stands of spruce, pine and beech, without industry or through traffic. The spa woods above the colonnade are threaded with maintained paths with benches and resting places; north of the town, routes lead to the Kladská nature reserve with its peat bogs and a nature trail along a wooden boardwalk.

Practical information

Climate therapy is possible all year round; the physician adapts the length and intensity of walks to the weather and your condition. Patients with pollen allergies usually plan their stay outside the main pollen season of their allergy — consult your allergist. In winter the terrain cure is shortened and supplemented by open-air rest; you will need warm layered clothing and shoes with non-slip soles.

The spa paths and parks are free to use and open without restriction. The climate therapy treatment plan — route, pace, length and frequency — is drawn up by the spa physician at the initial examination; for a stay covered by insurance it forms part of the proposal for spa care, for self-paying guests it is agreed on the day of arrival.

Frequently asked questions about climate therapy

What makes the Marienbad climate special?

The town lies in a sheltered basin at an altitude of 630 metres, surrounded by the woods of the Slavkov Forest; the climate is described as sub-montane and tonic. Since 2023 Mariánské Lázně has held the status of a climatic spa on the basis of year-round air measurements by the Czech Hydrometeorological Institute.

What is the terrain cure?

Medically prescribed walking on marked paths with a defined climb and length. The spa physician sets the route, pace and frequency individually and adjusts them during the stay.

For which indications is climate therapy prescribed?

Above all for non-tuberculous diseases of the respiratory system (indication group V, for example asthma and COPD) and for skin diseases (group X, atopic eczema and psoriasis). As controlled physical activity the terrain cure is also included for other indications.

Is climate therapy possible with limited mobility?

Yes. Alongside the terrain cure there is passive open-air rest at the resting places in the spa parks and outdoor breathing exercises; the spa physician decides on the suitable form.

Do I need a medical prescription?

The paths and parks are open to everyone. Within a spa cure, however, the form, intensity and length of climate therapy are set by the spa physician after the initial examination so that they match your state of health.