Physical activity patterns and vaccination attitudes among thermal spa attendees: a cross-sectional study

Thermal spas are increasingly visited for both therapeutic and wellness purposes and may represent potential setting for preventive health promotion, in line with the Ottawa Charter. Although spa attendees often include older adults and individuals with chronic conditions, evidence regarding their attitudes towards key preventive behaviors remains limited, particularly physical activity and vaccination. A cross-sectional survey was conducted between April 2022 and April 2023 at the Margherita di Savoia thermal spa (Italy). A total of 319 attendees completed a structured questionnaire assessing physical activity habits and vaccination status for influenza, pneumococcal, herpes zoster, and COVID-19 vaccines. Physical activity was classified according to World Health Organization recommendations. Multivariable linear and logistic regression models were used to identify determinants of preventive attitudes and behaviors. Adjusted effect estimates with 95% confidence intervals (CI) are reported. Participants had a mean age of 64.2 ± 14.1 years;69.9% reported at least one chronic condition. Moderate physical activity was common (89.1%), whereas vigorous activity (20.7%) and sport participation (19.1%) were limited, particularly among older individuals. Vaccination coverage was high for COVID-19 (95.0%) but remained low for pneumococcal (16.0%) and herpes zoster (4.1%) vaccines and moderate for influenza (49.5%). Reciving a medical recommendation was significantly associated with a more positive perception of vaccines (β = 0.62; 95% CI 0.36–0.88; p < 0.001). Age was inversely associated with being physically active (aOR 0.96 per year; 95% CI 0.94–0.99; p = 0.002), while employment was positively associated (aOR 2.76; 95% CI 1.30–5.84; p = 0.008). No significant association was observed between physical activity and vaccination uptake. Spa-goers display favorable preventive attitudes; however,both physical activity levels and vaccination coverage remain suboptimal. Thermal spas may represent complementary environments for structured preventive counseling, particularly for t higher risk populations. Further multicentre studies are warranted.