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The effect of spa therapy, a non-pharmacological treatment for chronic low back pain (CLBP) has been evaluated by several randomized clinical trials. This randomized controlled trial was conducted to compare the effect of balneotherapy alone versus balneotherapy with physical exercise. Participants (n = 60) with low back pain for more than 6 months and attending a musculoskeletal clinic were recruited into this study. They were randomized to either the balneotherapy group (immersion in thermo-mineral water) or to a balneotherapy + exercise group (group exercises delivered in addition to balneotherapy). Before intervention and 3 and 6 months after intervention, statistically significant decreases were observed according to a visual analog scale of pain intensity (p < 0.05). Improvements recorded on a health assessment questionnaire lasted up to 6 months in both groups; however, values were not statistically significant. Fingertips-to-floor distance and Schober's Index measurements showed significant decreases in the balneotherapy + exercise group after treatment and at 3 months and only after treatment in the balneotherapy alone group. The Waddell Disability Index showed better recovery for the balneotherapy group at the end of the treatment and at the 3rd month. When the two groups were compared using the Waddell evaluation, the balneotherapy group was found to be superior (p < 0.047). Although two weeks of spa therapy was beneficial in improving pain and physical function in patients with CLBP, there was no difference between balneotherapy combined with physical exercise therapy and balneotherapy alone. However, this therapeutic approach seemed advantageous in improving mobility and flexibility in these patients. [ABSTRACT FROM AUTHOR]