The oldest medicine in the world
Hippocrates knew it two and a half thousand years ago: "Walking is the best medicine." Modern medicine agrees with him. The World Health Organization recommends that adults take 150–300 minutes of moderate-intensity exercise a week plus strength training twice a week, and reminds us that any movement is better than none (Bull et al., 2020, Br J Sports Med).
In Mariánské Lázně (Marienbad), this is not about an air-conditioned fitness centre. It is about movement in the woods of the Slavkov Forest, at an altitude of 630 metres, in a silence you will not find in a city, and under the supervision of a physician.
Terrain therapy: movement on prescription
Terrain therapy is a Marienbad tradition reaching back to the 19th century. It is not a stroll — it is medically prescribed walking on trails with a defined gradient, length and elevation gain.
At the initial examination, the spa physician recommends a specific route according to:
- Fitness — from level walks to steep ascents
- Diagnosis — cardiovascular patients follow different routes from orthopaedic patients
- Goal — rehabilitation, weight reduction, improved fitness
Why does it work differently from an ordinary walk?
Terrain therapy combines three things that do not come together in a city:
- Controlled exertion — the gradient and length of the route are set by the physician and increased step by step
- Forest setting — time spent in the forest is linked in meta-analyses to a short-term drop in the stress hormone cortisol (Antonelli et al., 2019, Int J Biometeorol) and to reduced anxiety (Kotera et al., 2020, Int J Ment Health Addict); these are short-term effects and expectation may also play a role
- Regularity — you walk every day, not once a week
Nordic walking in the spa park
Nordic walking, walking with poles, engages the arms and torso as well as the legs. A systematic review of 16 randomised and 11 observational studies with almost 1,900 participants found that Nordic walking improves resting heart rate, blood pressure, exercise capacity and quality of life, and in some measures outperforms brisk walking without poles; the studies included diverse patient groups (Tschentscher et al., 2013, Am J Prev Med).
In Marienbad, Nordic walking routes lead straight from the spa park into the surrounding forests. The trails are marked and graded by difficulty:
- Green — level, 2–4 km, suitable for beginners and seniors
- Blue — gentle elevation gain, 4–8 km, moderately fit
- Red — demanding, 8–15 km, for active sportspeople
Which route to choose after surgery or with a chronic condition is decided by the spa physician.
Exercise in water: movement with less load
For those with joint problems, the spa hotels offer exercise in a warm pool. The buoyancy of the water takes weight off the body, so you move more easily and with less strain on the joints.
For knee and hip osteoarthritis the effect is documented: a Cochrane review of 13 randomised trials with 1,190 participants found a small short-term improvement in pain and function compared with the control group, roughly 5 points on a 100-point scale, with 12 weeks of exercise on average; the evidence is of moderate quality (Bartels et al., 2016, Cochrane Database Syst Rev). In spa practice, exercise in water is also used in rehabilitation after joint surgery and for back pain; whether it is included is decided by the spa physician according to your condition.
What the science says
More steps, lower risk. A meta-analysis of 15 cohorts with 47,471 adults followed for a median of 7 years found that people with a higher daily step count had markedly lower all-cause mortality than the least active; the benefit levelled off at around 6,000–8,000 steps a day in people over 60 and 8,000–10,000 steps in younger adults (Paluch et al., 2022, Lancet Public Health). These are observational data — they show an association, not directly a cause.
Movement as part of spa treatment. In a French randomised trial with 145 patients with knee osteoarthritis, three-week spa treatment that included exercise improved function and pain still at 6 months compared with usual care; the study was not blinded (Forestier et al., 2025, Int J Biometeorol). In a Lithuanian randomised trial with 373 people with high stress levels, 6–11-day spa programmes improved fatigue, sleep and quality of life with an effect lasting up to 6 months, and worked better than a stay in nature without treatments (Rapolienė et al., 2025, Int J Biometeorol).
A habit that lasts. In a French randomised trial with 228 spa patients, 81% of those who received coaching and an app at the spa were meeting physical activity recommendations a year later, compared with 67% in the control group (Fillol et al., 2021, J Med Internet Res). A spa stay is a good framework for turning movement into a habit.
A movement plan for a spa week
The following plan is an example; the actual programme is put together by the spa physician after the initial examination.
| Day | Morning | Afternoon |
|---|---|---|
| Mon | Initial examination | Walk in the park (2 km) |
| Tue | Group exercise | Terrain therapy — green route |
| Wed | Exercise in water | Drinking cure + rest |
| Thu | Nordic walking (5 km) | Sauna + relaxation |
| Fri | Terrain therapy — blue route | Individual exercise |
| Sat | Trip to Kladská | Free programme |
| Sun | Morning yoga in the park | Final consultation |
Who should come?
An active spa stay suits most people — from convalescents to sportspeople looking for active regeneration. It is particularly suitable for:
- Over-50s — the WHO recommends that older adults add strength and balance exercises to walking
- Sedentary professions — rebuilding movement habits
- After injuries and operations — guided rehabilitation in nature
- Sportspeople — regeneration and training in forest terrain
If you are being treated for a chronic condition, consult your doctor before booking; the intensity of movement at the spa is set by the spa physician at the initial examination.
Read more about activities in Marienbad and planning your stay.
