Post-Covid rehabilitation at the spa — what the programme includes and why
Months after Covid, you still get out of breath climbing the stairs, your head refuses to work at full capacity and the fatigue will not let go even though you sleep enough. Post-Covid syndrome — known in the medical literature as long Covid — affects some of the people who have been through the illness and involves several organ systems at once: breathing, muscles and joints, sleep, mood and concentration.
Mariánské Lázně (Marienbad) is well placed for post-Covid rehabilitation: natural carbon dioxide from the Maria Spring, inhalations of mineral water, the status of a climatic spa since 2023 and a long tradition of treating diseases of the respiratory system. This article describes what the spa programme includes, what the studies say about balneotherapy for post-Covid syndrome and how insurance cover works. A spa stay complements the care of your GP, pulmonologist or other specialist; it does not replace it, so always discuss the suitability of a stay with them.
What the studies have shown
Balneotherapy for post-Covid syndrome is a new field. The two most important studies:
A randomised trial from Barcelona. 98 adults with post-Covid syndrome (mostly middle-aged women, in whom fatigue, muscle pain and difficulty concentrating predominated) were divided into two groups; the treated group completed 12 sessions of balneotherapy with aquatic exercise over one month. Compared with the control group, their fatigue and pain improved (SF-36 subscales by 17 and 22 points out of 100 respectively), as did sleep quality and anxiety. Seventeen of the 51 treated participants reported a mild and transient worsening of fatigue in the first sessions; there were no serious adverse events. The authors point out that persistence of the effect one month after the end of treatment is uncertain (Ovejero et al., 2025, BMC Complement Med Ther).
A systematic review. A review of six studies with 617 patients describes reduced fatigue and muscle pain after spa treatment; in the largest of them (159 people) fatigue fell by 47% and muscle pain by 48%. Most of the included studies were observational, and the authors call for larger randomised trials (Ferrara et al., 2025, Healthcare).
These studies point to a realistic expectation: spa treatment can ease fatigue and muscle pain and improve sleep, particularly in people whose main complaints are precisely fatigue and pain.
The treatments on which post-Covid rehabilitation is built
The specific programme is put together by the spa physician at the initial examination, according to your complaints, medical records and contraindications. It usually combines the following treatments:
Dry CO₂ baths
Marienbad's flagship treatment. The patient lies in a sealed bag filled with natural CO₂ from the Maria Spring at a purity of 99.7%. It is a passive treatment requiring no physical exertion, which matters for patients whose fatigue is worsened by effort. Spa physicians traditionally prescribe it for disorders of the circulatory system and during convalescence. The number of baths and their frequency is set by the physician; a detailed description can be found on the page on CO₂ therapy and in the article on gas injections.
Inhalation therapy
Inhalations of a mineral aerosol from the local springs moisten the mucous membranes of the airways. A systematic review of 27 studies of inhalations of thermal mineral waters described improved nasal patency, mucociliary clearance and some lung parameters; the quality of the studies was low and they did not concern Covid specifically (Fontana et al., 2025, Int J Biometeorol). The frequency and length of inhalations is set by the physician; they are usually combined with respiratory rehabilitation.
Respiratory rehabilitation
Individual work with a physiotherapist includes practising diaphragmatic breathing, prolonged-exhalation techniques and exercises with breathing trainers. The aim is to teach you techniques you will keep using after you return home. Many people switch to shallow chest breathing after Covid; respiratory rehabilitation helps them re-engage the diaphragm.
Exercise in water and climate therapy
Exercise in a warm pool was part of the programme in the Barcelona trial mentioned above. The buoyancy of the water takes weight off the body, so you move with less effort.
Marienbad has held the status of a climatic spa since 2023. Terrain therapy — guided walks along marked routes of defined difficulty — allows exertion to be increased gradually and under control. The physician chooses a route that matches your current fitness and increases the intensity in small steps; with post-Covid fatigue the rule is little and regularly rather than a lot at once.
Peat wraps and mineral baths
For muscle and joint pain, the physician may add peat wraps (applied at 38–42 °C) and baths in mineral water. These are traditional spa treatments for the musculoskeletal system; whether they are included is decided by the spa physician.
Insurance, vouchers and practical questions
The spa treatment voucher
For guests insured in the Czech Republic, spa treatment can be covered by public health insurance. The Czech indication list has no separate item for "post-Covid syndrome". Some consequences of Covid can be proposed under existing items, for example V/3 — conditions after complicated pneumonia (basic stay in comprehensive care, 21 days) in the group of non-tuberculous diseases of the respiratory system. Whether your condition matches one of the items is assessed by the proposing doctor — a GP or pulmonologist — and approved by the health insurer.
Under comprehensive spa care (K), the insurer covers treatment, accommodation and meals. Under contributory care (P), it covers treatment only; the patient pays for accommodation and meals. A detailed guide to the whole process, from the doctor's visit to arrival at the spa, can be found in the article on spa treatment.
Which examinations the proposal should include, and how long after the acute infection it should be submitted, is decided by the proposing doctor on the basis of your records.
Self-paying stays
Post-Covid rehabilitation is available without a voucher, too. A therapeutic stay with a full programme of treatments can be taken as a self-paying guest — the initial examination with the spa physician takes place on the day of arrival, and the physician draws up an individual treatment plan.
How long a stay to choose
For a covered stay, the length is set by the indication list and the doctor's proposal; for item V/3 it is 21 days. Self-paying guests most often choose 1–3 weeks in consultation with the spa physician; expert correspondence regards 2–3 weeks with 10–21 treatments as the norm for spa treatment (Karagülle and Karagülle, 2021, Int J Biometeorol). Shorter stays are regenerative rather than therapeutic in character. The Barcelona trial followed patients for one month after the end of treatment.
Why Marienbad
There are a number of spa resorts in the Czech Republic with post-Covid programmes. Marienbad differs in several respects.
Natural CO₂ from the Maria Spring at a purity of 99.7% makes dry CO₂ baths and gas injections possible straight from the local source.
A combination of healing resources — more than 40 mineral springs of differing composition, peat from the Slavkov Forest and natural CO₂ — makes it possible to build a programme for the airways and the musculoskeletal system in a single stay. Post-Covid syndrome affects several systems at once, and a comprehensive programme can respond to that.
Climatic spa status confirms that the local environment meets the criteria for climate therapy — clean air, a suitable altitude and natural surroundings for terrain therapy.
Professional expertise in the interconnected Ensana hotels — Ensana Nové Lázně, Ensana Centrální Lázně, Ensana Hvězda and Maria Spa — includes physicians and physiotherapists specialising in respiratory rehabilitation. Treatments take place under one roof, so you do not have to move between buildings.
What to bring
- Medical records — reports from your pulmonologist, spirometry, a chest CT (if one was done), a list of medications
- Comfortable clothing and good shoes for terrain therapy
- Swimwear for mineral baths and exercise in water
- Patience — in the Barcelona trial, some patients reported a transient worsening of fatigue in the first sessions; tell the physician about it and they will adjust the intensity of the programme
Spa rehabilitation offers what outpatient care usually cannot: daily treatments over several weeks, a combination of several methods and a calm setting. If long Covid is limiting your everyday life, talk to your doctor about whether a spa stay is suitable for you and whether you are entitled to a voucher.
