Whole- and partial-body cryostimulation/cryotherapy: Current technologies and practical applications

PPARγ/NF-κB axis contributes to cold-induced resolution of experimental colitis and preservation of intestinal barrier

BACKGROUND

Environmental stress is a significant contributor to the development of inflammatory bowel disease (IBD). The involvement of temperature stimulation in the development of IBD remains uncertain. Our preliminary statistical data suggest that the prevalence of IBD is slightly lower in colder regions compared to non-cold regions. The observation indicates that temperature changes may play a key role in the occurrence and progression of IBD. Here, we hypothesized that cold stress has a protective effect on IBD.

METHODS

The cold exposure model for mice was placed in a constant temperature and humidity chamber, maintained at a temperature of 4 °C. Colitis models were induced in the mice using TNBS or DSS. To promote the detection methods more clinically, fluorescence confocal endoscopy was used to observe the mucosal microcirculation status of the colon in the live model. Changes in the colonic wall of the mice were detected using 9.4 T Magnetic Resonance Imaging (MRI) imaging and in vivo fluorescence imaging. Hematoxylin and eosin (H&E) and Immunofluorescence (IF) staining confirmed the pathological alterations in the colons of sacrificed mice. Molecular changes at the protein level were assessed through Western blotting and Enzyme-Linked Immunosorbent Assay (ELISA) assays. RNA sequencing (RNA-seq) and metabolomics (n = 18) were jointly analyzed to investigate the biological changes in the colon of mice treated by cold exposure.

RESULTS

Cold exposure decreased the pathologic and disease activity index scores in a mouse model. Endomicroscopy revealed that cold exposure preserved colonic mucosal microcirculation, and 9.4 T MRI imaging revealed alleviation of intestinal wall thickness. In addition, the expression of the TLR4 and PP65 proteins was downregulated and epithelial cell junctions were strengthened after cold exposure. Intriguingly, we found that cold exposure reversed the decrease in ZO-1 and occludin protein levels in dextran sulfate sodium (DSS)- and trinitrobenzenesulfonic acid-induced colitis mouse models. Multi-omics analysis revealed the biological landscape of DSS-induced colitis under cold exposure and identified that the peroxisome proliferator-activated receptor (PPAR) signaling pathway mediates the effects of cold on colitis. Subsequent administration of rosiglitazone (PPAR agonist) enhanced the protective effect of cold exposure on colitis, whereas GW9662 (PPAR antagonist) administration mitigated these protective effects. Overall, cold exposure ameliorated the progression of mouse colitis through the PPARγ/NF-κB signaling axis and preserved the intestinal mucosal barrier.

CONCLUSION

Our study provides a mechanistic link between intestinal inflammation and cold exposure, providing a theoretical framework for understanding the differences in the prevalence of IBD between the colder regions and non-cold regions, and offering new insights into IBD therapy.

Effect of whole-body cryotherapy on recovery after high-intensity training in elite rowers

The purpose of this study was to investigate the effect of whole-body cryotherapy (WBC) on acute recovery after a single high-intensity training day. Twelve elite professional male rowers from the national aquatic training base. They were randomly divided into a WBC group (n = 6) and a control group (CON group, n = 6). They performed a high-intensity training program, with a single session immediately followed by WBC (-110°C, 3 min) or recovered naturally for 3 min (CON group). Rowing performance, skin temperature, heart rate, blood pressure, and blood lactate concentrations were recorded before training, immediately, 5 min, and 15 min after the intervention. Blood samples were collected early in the morning of the day of intervention and that of the following day. The results indicated that 1) the blood lactate concentrations after WBC were significantly lower than pre-training (p < 0.05); 2) the maximum power significantly decreased immediately after WBC compared to pre-training (p < 0.05); 3) a significant main effect of time was observed for average speed, which significantly decreased after WBC (p < 0.05); 4) a significant main effect of time for blood parameters was observed. Specifically, hematocrit, cortisol, and hemoglobin were significantly lower after WBC than pre-intervention, whereas testosterone/cortisol was significantly higher than pre-intervention (p < 0.05). The results of this study showed that a single session of WBC had a positive effect on accelerating the elimination of blood lactate after HIT, but did not significantly change rowing performance and physiological parameters. A single session of WBC was not an effective strategy for elite rowers for acute recovery after HIT.

Effects of repeated cryostimulation exposures on sleep and wellness in healthy young adults

The aim of this study was to evaluate the effects of daily whole-body cryostimulation (WBC) sessions during 5 consecutive days on wellness and sleep parameters in healthy young men and women. Twenty healthy subjects (9 women; 11 men) aged 23.1 ± 2.6 years old participated in this randomized protocol, with 5 consecutive days with (CRYO) or without WBC (CONT) exposure. Sleep was analyzed over the 5 nights in each condition. Sleep quality and quantity were assessed via actimetry, cerebral activity and questionnaires. Nocturnal heart rate variability (HRV) was also recorded and questionnaires were given to assess wellness and mood. Repeated WBC exposures had a beneficial impact on mood and anxiety. It also improved subjective sleep quality (scored from 3.6 ± 0.5 pre to 3.9 ± 0.3), especially in women. Also, repeated WBC sessions modulated sleep architecture by increasing slow wave sleep duration (+7.3 ± 16.8 min) during the nights without impacting other sleep parameters, nor nocturnal HRV. In conclusion, repeated WBC seems to be an effective strategy to improve slow wave sleep duration in healthy young subjects. The reported psychological improvements may better benefit women than men.

The effects of cold water immersion and partial body cryotherapy on subsequent exercise performance and thermoregulatory responses in hot conditions

This study investigated the effects of cold water immersion (CWI) and partial body cryotherapy (PBC) applied within a 15-min post-exercise recovery period on thermoregulatory responses, subjective perceptions, and exercise performance under hot conditions (39 °C). Twelve male soccer players participated in team-sports-specific assessments, including Agility T-test (T-test), 20-m sprint test (20M-ST), and Yo-Yo Intermittent Endurance Test Level 1 (YY-T), during two exercise bouts (1st bout and 2nd bout) with a 15-min post-exercise recovery period. Within the recovery period, a 3-min of PBC at -110 °C or CWI at 15 °C or a seated rest (CON) was performed. Mean skin temperature (Tskin) decreased by 4.3 ± 1.08°C (p < 0.001) immediately after PBC, while CWI induced a reduction of 2.5 ± 0.21°C (p < 0.01). Furthermore, PBC and CWI consistently reduced Tskin for 15 and 33 min, respectively (p < 0.05). During the 2nd bout, core temperature (Tcore) was significantly lower in PBC compared to CON (p < 0.05). Heart rate (HR) was significantly lower in CWI compared to CON and PBC during the intervention period. Thermal sensation (TS) was significantly greater in PBC compared to CON and CWI (p < 0.05). Compared to the 1st bout, PBC alleviated the declines in T-test (p < 0.05) and 20M-ST (p < 0.05), while CWI alleviated the decreases in T-test (p < 0.05) and YY-T (p < 0.05), concurrently significantly enhancing 20M-ST (p < 0.05). 20M-ST and YY-T was greater from PBC (p < 0.05) and CWI (p < 0.05) compared with CON in 2nd bout. Additionally, the T-test in CWI was significantly greater than CON (p < 0.05). These results indicate that both PBC and CWI, performed between two exercise bouts, have the potential to improve thermoregulatory strain, reduce thermal perceptual load, and thereby attenuate the subsequent decline in exercise performance.

The Effect of Physical Activity and Repeated Whole-Body Cryotherapy on the Expression of Modulators of the Inflammatory Response in Mononuclear Blood Cells among Young Men

Background: Series of whole-body cryotherapy (WBC) among healthy and physically active individuals can potentially reduce inflammatory response, although exact mechanisms remain unclear. Methods: The impact of whole-body cryotherapy on inflammation modulators among 28 young males, categorized as non-training (NTR, N = 10), non-training with WBC (NTR-WBC, N = 10), and training with WBC (TR-WBC, N = 8), is investigated in this study. Over a period of eight weeks, NTR-WBC and TR-WBC subjects underwent 24 WBC treatments (-130 °C for 3 min, three times a week), examining changes in mRNA expressions of IL-1A, IL-6, IL-10, IFN-G, SIRT1, SIRT3, SOD2, GSS, and ICAM-1. Results: The received data indicate an acute inflammatory response to initial WBC (increased IL-1A, IL-6, and SIRT), with a greater effect in NTR-WBC. Subsequent sessions showed enhanced expressions of antioxidative genes in both WBC groups, particularly non-trained, suggesting improved oxidative stress adaptation. A notable decrease in ICAM-1 mRNA post-24 WBC treatments in NTR-WBC signifies a potential systemic anti-inflammatory effect. Conclusions: The findings of the study suggest that the combination of regular physical activity with WBC administered three times per week can potentially modulate inflammatory and antioxidant responses. This modulation is evidenced by changes in the expression of genes related to these processes.

Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp

BACKGROUND

Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events.

OBJECTIVE

To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD).

METHODS

A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS).

RESULTS

The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05).

CONCLUSION

This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases.

Partial-body cryostimulation procured performance and perceptual improvements in amateur middle-distance runners

The purpose of this study was to investigate the effects of partial-body cryostimulation on middle-distance runners before two 3000-m tests at the speed of the first and second ventilatory threshold, and before a time to exhaustion test at 110% of the maximal aerobic speed. Twelve amateur runners (age: 46 ± 9 years; VO2max: 51.7 ± 4.9 ml·kg-1·min-1) completed six running testing sessions in a randomized counterbalanced cross-over fashion: three of them were preceded by a partial-body cryostimulation and the other three by a control condition. The testing sessions consisted of: 1) a 3000-m continuous running test at the speed of the first ventilatory threshold; 2) a 3000-m continuous running test at the speed of the second ventilatory threshold; 3) a time to exhaustion test at 110% of the maximal aerobic speed. Heart rate, ratings of perceived exertion and visual analogue scale relative to muscle pain were recorded throughout the tests. Total quality recovery was evaluated 24-48 h after the end of each test. Distance to exhaustion was higher after partial-body cryostimulation than control condition (p = 0.018; partial-body cryostimulation: 988 ± 332 m, control: 893 ± 311 m). There were differences in the ratings of perceived exertion during each split of the 3000-m continuous running test at the speed of the second ventilatory threshold (p = 0.001). Partial-body cryostimulation can be positively considered to enhance middle-distance running performance and reduce perception of effort in amateur runners.

The influence of whole-body cryotherapy or winter swimming on the lipid profile and selected adipokines

PURPOSE

The aim of this study was to investigate the effect of a series of 20 whole-body cryotherapy (WBC) sessions and 20 winter swimming sessions on the lipid profile and selected adipokines.

MATERIALS/METHODS

The experimental group consisted of 30 people who underwent a series of WBC treatments and 30 people who underwent a winter swimming. The control group consisted of 30 people - without intervention. Study 1: on the day of the commencement of whole-body cryotherapy / at the beginning of the winter swimming season; and Study 2: after a series of 20 cryotherapy sessions / at the end of the winter swimming season. The control group was also tested twice (4-week break). There were 20 WBC treatments - 5 times a week (4 weeks) and 20 cold water baths - once a week (20 weeks).

RESULTS

A statistically significant increase in the concentration of adiponectin, resistin and leptin in women and resistin and leptin in men was observed after the winter swimming season. Differences were also found in the second study between the groups of women using WBC and the control group, as well as the groups of women swimming and the control group. In men, however, these differences were observed in WBC and the control group. The significance level of α = 0.05 was adopted in the analyzes.

CONCLUSIONS

The use of WBC may changes in the lipid profile and selected adipokines in men. Regular winter swimming may changes of selected adipokines in both women and men.

Evaluating safety risks of whole-body cryotherapy/cryostimulation (WBC): a scoping review from an international consortium

Over the two last decades, whole-body cryotherapy/cryostimulation (WBC) has emerged as an exciting non-pharmacological treatment influencing inflammatory events at a cellular and physiological level, which can result in improved sleep quality, faster neuromuscular recovery after high-intensity exercise, and chronic pain relief for patients suffering different types of diseases (fibromyalgia, rheumatism, arthritis). Some evidence even suggests that WBC has benefits on mental health (depression, anxiety disorders) and cognitive functions in both adults and older adults, due to increased circulating BDNF levels. Recently, some safety concerns have been expressed by influential public health authorities (e.g., FDA, INSERM) based on reports from patients who developed adverse events upon or following WBC treatment. However, part of the data used to support these claims involved individuals whose entire body (except head) was exposed to extreme cold vaporized liquid nitrogen while standing in a narrow bathtub. Such a procedure is known as partial-body cryotherapy (PBC), and is often erroneously mistaken to be whole-body cryotherapy. Although having similarities in terms of naming and pursued aims, these two approaches are fundamentally different. The present article reviews the available literature on the main safety concerns associated with the use of true whole-body cryotherapy. English- and French-language reports of empirical studies including case reports, case series, and randomized controlled trials (RCTs) were identified through searches of PubMed, Scopus, Cochrane, and Web of Science electronic databases. Five case reports and two RCTs were included for a total of 16 documented adverse events (AEs). A critical in-depth evaluation of these AEs (type, severity, context of onset, participant's medical background, follow-up) is proposed and used to illustrate that WBC-related safety risks are within acceptable limits and can be proactively prevented by adhering to existing recommendations, contraindications, and commonsense guidelines.

Partial-body cryostimulation does not impact peripheral microvascular responsiveness but reduces muscular metabolic O2 consumption (mV˙O2) at rest

This study aimed to investigate the effect of partial-body cryostimulation (PBC) on microvascular responsiveness and muscular metabolic O2 consumption rate (mV˙O2). Twenty healthy young adults (ten males and ten females) underwent a post-occlusive reactive hyperemia (PORH) test at the flexor digitorum superficialis area before and after a 3-min PBC session and a 3-min control session. Using near-infrared spectroscopy, occlusion and reperfusion slopes were calculated: oxyhemoglobin ([HbO2]) decrease rate ([HbO2] slope 1), deoxyhaemoglobin ([HHb]) increase rate ([HHb] slope 1), [HbO2] increase rate ([HbO2] slope 2), and [HHb] increase rate ([HHb] slope 2. Using HbO2 kinetics during the occlusion, mV˙O2 was also calculated to characterize myocytes' metabolic O2 consumption. HbO2 slope 1 value was lower after PBC than before PBC (-0.15 ± 0.08 vs -0.24 ± 0.11 s-1; respectively; P < 0.05) in male participants only. A lower [HHb] slope 1 was also observed after PBC compared to before PBC (0.18 ± 0.10 vs 0.24 ± 0.16 s-1; P < 0.05) with no interaction for sex categories. mV˙O2 was significantly lower after PBC than before (pre values 14.75 ± 3.94 vs 18.47 ± 5.73 μMO2Hb.s-1; respectively; P < 0.01) with no interaction between sex categories. No changes in the calculated slope 2 were observed. These findings suggest that a single session of PBC reduces the muscular metabolic O2 needs at rest; however, it does not alter the vascular ability to provide O2 to the myocytes.

Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective

Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.

Thermal responses induced by nitrogen and forced convection based partial-body cryostimulation

Partial Body Cryostimulation (PBC) involves a very cold air flow directed to the body of subjects with minimal clothing. PBC is performed in a rapid timeframe, inside an on-purposed designed cryo-cabin. Recently, cryo-cabins have been built with different energy systems, however a validation study on relative thermal responses is missing. This study was aimed at comparing thermal responses following a PBC in an electrically powered cryo-cabin based on forced convection or into a standard nitrogen-fueled cryo-cabin. In a randomized crossover fashion, thirty-six subjects (F=20; M=16) underwent both cryo-exposures lasting 150 s each. Thermal responses were assessed before and immediately after completing each PBC session. Mixed model analysis of variance revealed a significantly colder temperature after electric PBC in all the body regions (except for the thighs) with respect to a standard nitrogen based PBC (F: 16.4 ± 1.4 vs 18 ± 5.8 °C; M: 16.4 ± 1.7 vs 20.9 ± 4 °C). Moreover, a significant lower thermal discomfort was perceived at the end of electric PBC as compared to that one felt following standard PBC. For the first time, the safety and thermo-effectiveness of an electric cryo-cabin based on forced convection was ensured. This methodology can be viable for practitioners of PBC and clinicians.

The Influence of Single Whole-Body Cryostimulation on Cytokine Status and Oxidative Stress Biomarkers during Exhaustive Physical Effort: A Crossover Study

The purpose of the study was to assess the impact of single whole-body cryostimulation (WBC) preceding submaximal exercise on oxidative stress and inflammatory biomarkers in professional, male athletes. The subjects (n = 32, age 25.2 ± 37) were exposed to low temperatures (−130 °C) in a cryochamber and then participated in 40 min of exercise (85% HRmax). Two weeks afterwards, the control exercise (without WBC) was performed. Blood samples were taken before the start of the study, immediately after the WBC procedure, after exercise preceded by WBC (WBC exercise) and after exercise without WBC. It has been shown that catalase activity after WBC exercise is lower in comparison with activity after control exercise. The interleukin 1β (IL-1-1β) level was higher after control exercise than after WBC exercise, after the WBC procedure and before the start of the study (p < 0.01). The WBC procedure interleukin 6 (IL-6) level was compared with the baseline level (p < 0.01). The level of Il-6 was higher both after WBC exercise and after control exercise compared with the level recorded after the WBC procedure (p < 0.05). Several significant correlations between the studied parameters were shown. In conclusion, the changes in the cytokine concentration in the athletes’ blood confirm that body exposition to extremely low temperatures before exercise could regulate the inflammatory reaction course and secretion of cytokines during exercise. A single session of WBC in the case of well-trained, male athletes does not significantly affect the level of oxidative stress indicators.

Enhanced bone healing using local cryostimulation: In vivo rat study

A short-term intense cooling through the skin causes a response of the body. Potentially, it can be used to enhance bone healing. The aim of this study is to evaluate an effectiveness of a bone defect cryostimulation in the Wistar rat model in vivo. Through holes with a diameter of 2.15 mm were formed in the cortical layer of the diaphysis of the hind paws of rats. Further animals were subjected to cryotherapy 1 and 2 times a week (up to 6 weeks). The local average skin surface temperature dropped from 28 to 14 °C. The decrease in temperature in a control point inside the biological tissue was 5.3 °C. Micro CT and histological analyses showed that cryostimulation twice a week is efficient treatment. In this case, there was an acceleration of maturation of the newly formed bone tissue replacing the defect region. In the control, the newly formed immature bone with a large number of osteocytes and vessels was detected. In the experiment, the newly formed bone had a more mature structure with signs of a compact bone (formation of Haversian canals, reduction in the number of osteocytes, appearance of gluing lines). Morphometric analysis has showed a 2-fold decrease of the relative vessels area near the defect region and an increase of 30% in the content of mast cells in the entire bone marrow and especially near the site of osteogenesis. Generally, the complete filling of the critical size defect and almost complete mineralization have been observed. This information is expected to be useful for understanding the effect-exposure correlation of the cryotherapy and in the design of the cryotherapy protocols.

Efficacy of whole-body cryotherapy in the treatment of chronic low back pain: Quasi-experimental study

STUDY DESIGN

Single arm, quasi-experimental study design.

BACKGROUND

To describe the effects of whole-body cryotherapy on pain, disability, and serum inflammatory markers in patients with chronic low back pain.

METHODS

A quasi-experimental trial was performed on adult patients between 18 and 65 years with chronic low back pain. After obtaining informed consent, participants underwent 20 sessions of whole-body cryotherapy (at -160 °C) during a 5-week time span. Patient reported pain and disability measures (Pain Numerical Rating Scale [PNRS], Oswestry Disability Index [OSI], and Roland Morris Questionnaire [RMQ]) were obtained at each of the twenty sessions. Blood samples were obtained to analyze serum inflammatory markers at baseline, 10th and 20th session.

RESULTS

Forty-one participants were included in the study. A significant decrease was observed between the initial and final PNRS, ODI, and RMQ scores (p < 0.001). A significant reduction in the PNRS was found after 4 sessions of whole-body cryotherapy (p < 0.001). We observed decreasing values of pro-inflammatory serum marker IL-2 (p = 0.046) and a significant increase in the anti-inflammatory serum marker IL-10 (p = 0.003). No adverse events were reported during the study.

CONCLUSIONS

Whole-body cryotherapy is an effective therapy for pain and disability treatment in chronic low back pain. It also produces changes in serum markers of inflammation, decreasing pro-inflammatory markers and increasing anti-inflammatory markers.

The Use of Cryotherapy in Cosmetology and the Influence of Cryogenic Temperatures on Selected Skin Parameters—A Review of the Literature

Cryotherapy is becoming an increasingly popular method used in medicine, physiotherapy, and cosmetology. It is used in the form of whole-body cryotherapy (WBC) and local cryotherapy. It is a tool for achieving analgesic and anti-inflammatory effects. Since the beginning of its use, its influence on the mental state has also been pointed out. The aim of this study was to analyze the available literature on the effect of cryogenic temperatures on the skin and the mechanisms induced by such a stimulus and its influence on well-being. A literature search of keywords or phrases was performed in PubMed®. Various effects of WBC on skin characteristics (hydration, pH, level of transepidermal water loss), mechanisms of anti-inflammatory effects, and effects on adipocytes were shown. Research on the impact of individual skin characteristics is not consistent. Positive effects on the reduction of inflammation and oxidative stress have been noted. Cryotherapy is also successfully used in dermatology to treat lentil spots, actinic keratosis, and ingrown toenails, remove viral warts, or relieve itching in atopic dermatitis. The results of the review also indicate the effectiveness of WBC as an adjunctive treatment for obesity. The number of papers available on the direct effects of WBC on the skin is still limited, despite the fact that it represents the first contact of the human body with cryogenic temperatures. Available data show that cold as a physical stimulus can be a safe and useful tool in cosmetology.

Experimental Models for Cold Exposure of Muscle in vitroand in vivo

Work in cold environments may have a significant impact on occupational health. In these and similar situations, cold exposure localized to the extremities may reduce the temperature of underlying tissues. To investigate the molecular effects of cold exposure in muscle, and since adequate methods were missing, we established two experimental cold exposure models: 1) In vitroexposure to cold (18°C) or control temperature (37°C) of cultured human skeletal muscle cells (myotubes); and 2) unilateral cold exposure of hind limb skeletal muscle in anesthetized rats (intramuscular temperature 18°C), with contralateral control (37°C). This methodology enables studies of muscle responses to local cold exposures at the level of gene expression, but also other molecular outcomes. Graphical abstract.

Whole-Body Cryostimulation in Fibromyalgia: A Scoping Review

Currently, all available therapies for the control and management of fibromyalgia (FM) are mostly focused on relieving patients’ symptoms and improving their quality of life. The purpose of this review is to provide an up-to-date overview of the evidence supporting the beneficial effects of whole-body cryostimulation (WBC) in patients with FM and evidence-based guidance on the possible adjuvant use of WBC in the treatment of FM. We searched the most recent literature by retrieving 10 eligible studies, 4 of which were abstracts only, from a total of 263 records. Thermal stress caused by cryostimulation induces an analgesic effect, improving pain, redox balance, and inflammatory symptoms in an exercise-mimicking fashion. In addition, it reduces the feeling of fatigue, improves mood, and reduces mental health deterioration with positive consequences on depressive states and improved sleep quality. Although the studies included in this review are not of sufficient quality and quantity to draw definitive conclusions about the effectiveness of WBC in FM, initial evidence indicates WBC as a promising add-on option in the multidisciplinary treatment of FM, due to its rapid action and high patients’ compliance. The application of WBC protocols has the potential to expand therapeutic options for the treatment of FM and related disorders; however, larger, high-quality primary studies are still needed.

Timing of Preexercise Partial-Body Cryotherapy Exposure to Promote Jump Performance

PURPOSE

This study evaluated the effect of partial-body cryotherapy (PBC) exposure 1, 2, or 3 hours before maximal-effort jump performance, salivary enzyme concentration, perceived readiness, and well-being.

METHODS

Male team-sport players (N = 27; 24.2 [3.6] y; 91.5 [13.2] kg) were exposed to a blinded bout of PBC (-135°C [6°C]) and control (-59°C [17°C]) either 1, 2, or 3 hours prior to countermovement jumps. Passive saliva samples were collected to determine α-amylase concentration. Self-reported performance readiness and well-being questionnaires were completed using a 1-5 Likert scale.

RESULTS

Differences in the change in mean countermovement jump velocity and absolute power between PBC and control were unclear at 1 hour (+1.9% [5.3%], P = .149; +0.7% [10.6%], P = .919; mean difference [90% confidence limits]), 2 hours (+3.3% [2.7%], P = .196; +7.8% [7.4%], P = .169), and 3 hours postexposure (+3.1% [3.3%], P = .467; +0.7% [4.8%], P = .327). Salivary α-amylase concentration was elevated 15 minutes postexposure in the 1-hour (+61% [14%], P = .008) and 2-hour groups (+55% [12%], P = .013). The increase in self-reported performance readiness was higher after PBC (+2.4 [1.2] units, P = .046) in the 2-hour group and by 1.4 (1.1) units (P = .023) after 3 hours. Mental fatigue was favorably decreased 2 hours after PBC exposure (+0.5 [0.1], P = .041).

CONCLUSIONS

An acute exposure of PBC elicits potentially favorable but unclear changes in countermovement jump performance. The PBC enhances salivary α-amylase concentration and perceived performance readiness, reduces mental fatigue, and could be useful in sport-specific training or competitions.

Whole-Body Cryotherapy as an Innovative Treatment for COVID 19-Induced Anosmia-Hyposmia: A Feasibility Study

The article entitled, "Whole-Body Cryotherapy as an Innovative Treatment for COVID 19-Induced Anosmia-Hyposmia: A Feasibility Study," by Legrand FD, Polidori G, Beaumont F, Bouchet B, Morin A, Derruau S, and Brenet E (Epub ahead of print Jan 13, 2022; DOI: 10.1089/jicm.2021.0254) is officially retracted at the request of the authors. This request came after the paper had undergone full peer review, three rounds of revisions, acceptance, page proofs, and ultimately, online publication. The Methods section of the published paper states that the study had "secured University ethics clearance…"¹ but the authors explained that, "after re-discussion and internal reassessment, it appears clearly that this study required, according to French law, the approval of a specific committee known as the '[C]ommittee for the [P]rotection of [P]ersons (CPP)' and not a simple ethical agreement. For this reason, [we] request, in good faith, that the article be retracted. We apologize for this delay in taking a position, but this study gave rise to a re-discussion with our peers of the methodology which led us to realize our error 'a posteriori.'" The authors' respective institutions have been notified by the publisher. Journal of Integrative and Complementary Medicine is committed to upholding the rigors of scientific publishing and the veracity of the literature. Reference 1. Legrand FD, Polidori G, Beaumont F, et al. Whole-body cryotherapy as an innovative treatment for COVID 19-induced anosmia-hyposmia: a feasibility study. Epub ahead of print Jan 13, 2022; DOI: 10.1089/jicm.2021.0254.

The Physiological Profile Following Two Popular Cold Interventions After Activity in Hot and Humid Environment

This research aims to describe and compare the effects of partial-body cryotherapy (PBC) and cold-water immersion (CWI) on the physiological responses of soccer players after cycling in a hot and humid environment. Sixteen elite soccer players participated in three experiments, and received CWI (13°C for 15 min), PBC (110°C−140°C for 3 min), and CON (room temperature: 21°C ± 2°C), respectively, after aerobic and anaerobic cycling in a hot and humid environment (temperature: 35°C–38°C; humidity: 60%–70%). Heart rate (HR), blood lactate (BLa-), perfusion index (PI), oxygen saturation (SaO₂), core temperature (Tc), skin temperature (Ts), and rating of perceived exertion (RPE) were assessed at baseline and through 20 min (5-min intervals). HR was lower in CWI than CON after 20 min (p < .05). SaO₂ was higher in CWI than PBC and CON between 10 and 20 min (p < .05). Tc was lower from CWI and PBC than CON between 10 and 20 min (p < .05). Ts was lower in PBC than CWI between 15 and 20 min (p < .05). RPE was lower in PBC than CON 20 min after the exercise (p < .05). No main group differences for BLa- and PI were observed. The physiological effects of PBC are generally similar to CWI. Compared with CON, both CWI and PBC could promote the recovery of physiological indexes within 20 min of exercise in a hot and humid environment. However, PBC can lead to a decrease in SaO₂ due to excessive nitrogen inhalation.

Partial-Body Cryotherapy Exposure 2 Hours Prior to a Shuttle Run Does Not Enhance Running Performance

PURPOSE

To determine whether a single acute preexercise bout of partial-body cryotherapy (PBC) enhanced maximal-effort shuttle run performance, salivary enzyme concentration, and self-reported performance readiness.

METHODS

A total of 18 male rugby league players (age = 20.1 [0.5] y; mass = 91.4 [12.4] kg) were exposed to either PBC for 3 minutes at -136°C (1°C) or a control condition prior to a continuous, high-intensity 6 × 40-m shuttle run test. Passive saliva samples were collected to determine salivary alpha amylase (sAA) concentration. Perceived performance readiness and well-being questionnaires were completed using a 1-to-7 Likert scale.

RESULTS

The PBC exposure did not elicit a greater improvement in 6 × 40-m shuttle run performance in comparison with the control condition (standardized difference; +0.4 [5.9%]; P = .881; mean ± 90% confidence limits). The increase in sAA concentration was moderately greater 15 minutes after PBC compared with the control group (+67 [32%], P = .012) and remained moderately higher up to 2 hours post-PBC exposure compared with the control condition (+41 [40%], P = .045). There were greater improvements in self-reported perceptions of muscle soreness (+0.6 [0.4%], P = .043; units ±90% confidence limits) and mood (+0.6 [0.7%], P = .038) after PBC compared with control.

CONCLUSIONS

It appears that a single 3-minute bout of PBC does not augment maximal effort shuttle run performance in elite rugby league players. Beneficial increases in sAA concentration, coupled with improved perceptions of muscle soreness and mood, should be explored further for alternative training or precompetition practices.

Cryostimulation for Post-exercise Recovery in Athletes: A Consensus and Position Paper

Recovery after exercise is a crucial key in preventing muscle injuries and in speeding up the processes to return to homeostasis level. There are several ways of developing a recovery strategy with the use of different kinds of traditional and up-to-date techniques. The use of cold has traditionally been used after physical exercise for recovery purposes. In recent years, the use of whole-body cryotherapy/cryostimulation (WBC; an extreme cold stimulation lasting 1-4 min and given in a cold room at a temperature comprised from -60 to -195°C) has been tremendously increased for such purposes. However, there are controversies about the benefits that the use of this technique may provide. Therefore, the main objectives of this paper are to describe what is whole body cryotherapy/cryostimulation, review and debate the benefits that its use may provide, present practical considerations and applications, and emphasize the need of customization depending on the context, the purpose, and the subject's characteristics. This review is written by international experts from the working group on WBC from the International Institute of Refrigeration.

A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems

OBJECTIVE

To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems.

METHODS

A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges' g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I² statistics.

RESULTS

Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges' g = 1.63, CI: 1.05-2.21), with high heterogeneity (I² = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges' g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges' g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges' g = 0.76, CI: 0.17-1.36).

CONCLUSIONS

Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.

Pre-Exercise Whole- or Partial-Body Cryotherapy Exposure to Improve Physical Performance: A Systematic Review

Whole- (WBC) and partial-body cryotherapy (PBC) are commonly used sports medicine modalities for the treatment of injury and exercise recovery. Physiological and perceptual effects have the potential to be utilised in a novel application that involves pre-exercise WBC and PBC exposure to improve physical performance. A systematic literature search of multiple databases was conducted in July 2021 to identify and evaluate the effects of pre-exercise exposure of WBC or PBC on physical performance measures, and any potential translational effects. The following inclusion criteria were applied: (1) use of WBC or PBC exposure pre-exercise, (2) use of WBC or PBC in healthy and/or athletic populations, (3) control group was used in the data collection, and (4) investigated physiological, psychosocial or direct physical performance impacts of pre-exercise cryotherapy exposure. A total of 759 titles were identified, with twelve relevant studies satisfying the inclusion criteria after full-text screening. The twelve studies were categorised into three key areas: performance testing (n = 6), oxidative stress response (n = 4) and lysosomal enzyme activity (n = 2). The potential for eliciting favourable physical and physiological responses from pre-exercise WBC or PBC is currently unclear with a paucity of good quality research available. Furthermore, a lack of standardisation of cryotherapy protocols is a current challenge.

Applying Heart Rate Variability to Monitor Health and Performance in Tactical Personnel: A Narrative Review

Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an increased understanding of its importance and the commercial availability of assessment tools, the use of heart rate variability (HRV) to address this need is becoming more common in the tactical community. Measuring HRV is a non-invasive, practical method for objectively assessing a performer's readiness, workload, and recovery status; when combined with additional data sources and practitioner input, it provides an affordable and scalable solution for gaining actionable information to support the facilitation and maintenance of operational performance. This narrative review discusses the non-clinical use of HRV for assessing, monitoring, and interpreting autonomic nervous system resource availability, modulation, effectiveness, and efficiency in tactical populations. Broadly, HRV metrics represent a complex series of interactions resulting from internal and external stimuli; therefore, a general overview of HRV applications in tactical personnel is discussed, including the influence of occupational specific demands, interactions between cognitive and physical domains, and recommendations on implementing HRV for training and recovery insights into critical health and performance outcomes.

Whole-Body Cryotherapy Increases the Activity of Nitric Oxide Synthase in Older Men

Aging causes oxidative stress, endothelial dysfunction and a reduction in the bioavailability of nitric oxide. The study aim was to determine whether, as a result of repeated whole-body exposure to cryogenic temperature (3 min −130 °C), there is an increase of inducible nitric oxide synthase (iNOS) concentration in senior subjects (59 ± 6 years), and if this effect is stronger in athletes. In 10 long-distance runners (RUN) and 10 untraining (UTR) men, 24 whole-body cryotherapy (WBC) procedures were performed. Prior to WBC, after 12th and 24th treatments and 7 days later, the concentration of iNOS, asymmetric dimethylarginine (ADMA), 3-nitrotyrosine (3-NTR), homocysteine (HCY), C-reactive protein (CRP) and interleukins such as: IL-6, IL-1β, IL-10 were measured. In the RUN and UTR groups, after 24 WBC, iNOS concentration was found to be comparable and significantly higher (F = 5.95, p < 0.01) (large clinical effect size) compared to before 1st WBC and after 12th WBC sessions. There were no changes in the concentration of the remaining markers as a result of WBC (p > 0.05). As a result of applying 24 WBC treatments, using the every-other-day model, iNOS concentration increased in the group of older men, regardless of their physical activity level. Along with this increase, there were no changes in nitro-oxidative stress or inflammation marker levels.

Whole Body Cryotherapy and Hyperbaric Oxygen Treatment: New Biological Treatment of Depression? A Systematic Review

Treatment with antidepressants is often insufficiently effective, especially in treatment-resistant depression. In such a situation, it is possible to change the drug, add a second antidepressant, or use pharmacological and non-pharmacological methods of augmenting the effect of pharmacotherapy. New methods that may fall into the scope of multi-module depression treatment as an augmentation of depression treatment are whole body cryotherapy (WBC) and hyperbaric oxygen treatment (HBOT). 545 records were selected and analyzed for these two treatments and finally three clinical trials were selected for analysis. The review also includes data on the possibility of using WBC and HBOT in somatic indications and in organic mental syndromes. Despite the small number of studies on the effectiveness of WBC or HBOT in depression, the current data show that both methods may be effective in the treatment of depression. WBC may be effective in the augmentation of antidepressants, and additionally, it is a method in which a quick antidepressant effect is obtained. HBOT may be effective in endogenous depression, just as it is effective in the treatment of somatic depression symptoms. The results are very preliminary, but if confirmed in subsequent studies, both WBC and HBOT may become new treatment options in treating depression. The authors point to the need and directions for further research into these treatment methods as an augmentation strategy for pharmacological treatment of depression.

Assessment of the Dynamics of Temperature Changes in the Knee Joint Area in Response to Selected Cooling Agents in Thermographic Tests

Although local cryotherapy (LC) is performed with various cooling agents (C_Ag) such as ice, water, and gasses, in clinical practice, it is mostly performed with cooling gasses. Presently, LC with cooling gasses is very popular but the inference about the thermal (stimulus) effect on the tissues is mainly based on research carried out using ice packs. The proposed objective of the study was to evaluate the dynamics of temperature changes in the knee joint area in response to a 3-min exposure to liquid nitrogen vapors (LNVs), cold air (CA) and ice bag (IB). The study group included 23 healthy volunteers with an average age of 26.67 ± 4.56. The exposed (ROI_E) and contralateral (ROI_NE) areas of the knee joint after exposure to C_Ag were observed. Immediately after 3 min of LC, the ROI_E temperature dropped by 10.11 ± 0.91 °C after LNV, 7.59 ± 0.14 °C after IB and 6.76 ± 1.3 °C after CA. Significant tissue cooling was maintained up to 15 min after LNV (p < 0.01), 10 min after IB (p < 0.05) and 5 min after CA (p < 0.05). LC causes significant temperature changes both in ROI_E and ROI_NE. The greatest cooling potential was demonstrated for LNV and the lowest for CA.

Novel methods for cold exposure of skeletal muscle in vivo and in vitro show temperature-dependent myokine production

Proteins secreted from skeletal muscle serving a signalling role have been termed myokines. Many of the myokines are exercise factors, produced and released in response to muscle activity. Cold exposures affecting muscle may occur in recreational, occupational and therapeutic settings. Whether muscle temperature independently affects myokine profile, is still to be elucidated. We hypothesized that manipulating muscle temperature by means of external cooling would change myokine production and release. In the present study we have established new models for cold exposure of muscle in vivo and in vitro where rat hind limb or cultured human myotubes were cooled to 18 °C. After a recovery period, muscle tissue, cells and culture media were harvested for further analysis by qPCR and immunoassays. Expression of several myokine genes were significantly increased after cold exposure in both models: in rat muscle, mRNA levels of CCL2 (p = 0.04), VEGFA (p = 0.02), CXCL1 (p = 0.02) and RBM3 (p = 0.02) increased while mRNA levels of IL-6 (p = 0.03) were decreased; in human myotubes, mRNA levels of IL6 (p = 0.01), CXCL8 (p = 0.04), VEGFA (p = 0.03) and CXCL1 (p < 0.01) were significantly increased, as well as intracellular protein levels of IL-8 (CXCL8 gene product; p < 0.01). The corresponding effect on myokine secretion was not observed, on the contrary, IL-8 (p = 0.02) and VEGF (VEGFA gene product) p < 0.01) concentrations in culture media were reduced after cold exposure in vitro. In conclusion, cold exposure of muscle in vivo and in vitro had an effect on the production and release of several known exercise-related myokines. Myokine expression at the level of mRNA and protein was increased by cold exposure, whereas secretion tended to be decreased.

Partial-Body Cryostimulation Increases Resting Energy Expenditure in Lean and Obese Women

Cryostimulation is currently seen as a potential adjuvant strategy to tackle obesity and dysmetabolism by triggering cold-induced thermogenesis. Although suggestive, the underlying mechanisms are still poorly elucidated. We tested whether single or repeated applications of partial-body cryostimulation (PBC) could influence resting energy expenditure (REE) in exposed individuals. Fifteen middle-aged obese and sixteen control lean women (body mass index 31 ± 1.6 kg/m² and 22 ± 1.7 kg/m²) underwent a daily PBC (−130 °C × 150 s) for five consecutive days. Resting energy metabolism (REE) was assessed by indirect calorimetry pre- and post-PBC on day 1 and day 5. As concerns REE, the linear mixed model revealed that REE changes were explained by session and time (F_1,29 = 5.58; p = 0.02; ƞ_p² = 0.16) independent of the group (F_1,29 = 2.9; p = 0.09; ƞ_p² = 0.09). REE pre-PBC increased from day 1 to day 5 either in leans (by 8.2%, from 1538 ± 111 to 1665 ± 106 kcal/day) or in obese women (by 5.5%, from 1610 ± 110 to 1698 ± 142 vs kcal/day). Respiratory quotient was significantly affected by the time (F_1,29 = 51.61; p < 0.000001, ƞ_p² = 0.64), as it increased from pre- to post-PBC, suggesting a shift in substrate oxidation. According to these preliminary data, cold-induced thermogenesis could be explored as a strategy to elevate REE in obese subjects. Longitudinal studies could test whether chronic PBC effects may entail favorable metabolic adaptations.

Impact of acute partial-body cryostimulation on cognitive performance, cerebral oxygenation, and cardiac autonomic activity

We assessed the effects of a 3-min partial-body cryostimulation (PBC) exposure—where the whole body is exposed to extreme cold, except the head—on cognitive inhibition performance and the possible implications of parasympathetic cardiac control and cerebral oxygenation. In a randomized controlled counterbalanced cross-over design, eighteen healthy young adults (nine males and nine females) completed a cognitive Stroop task before and after one single session of PBC (3-min exposure at − 150 °C cold air) and a control condition (3 min at room temperature, 20 °C). During the cognitive task, heart rate variability (HRV) and cerebral oxygenation of the prefrontal cortex were measured using heart rate monitoring and near-infrared spectroscopy methods. We also recorded the cerebral oxygenation during the PBC session. Stroop performance after PBC exposure was enhanced (562.0 ± 40.2 ms) compared to pre-PBC (602.0 ± 56.4 ms; P < 0.042) in males only, accompanied by an increase (P < 0.05) in HRV indices of parasympathetic tone, in greater proportion in males compared to females. During PBC, cerebral oxygenation decreased in a similar proportion in males and females but the cerebral extraction (deoxyhemoglobin: ΔHHb) remained higher after exposure in males, only. These data demonstrate that a single PBC session enhances the cognitive inhibition performance on a Stroop task in males, partly mediated by a greater parasympathetic cardiac control and greater cerebral oxygenation. The effects of PBC on cognitive function seem different in females, possibly explained by a different sensitivity to cold stimulation.

The impact of a single whole body cryostimulation treatment on selected skin properties of healthy young subjects

INTRODUCTION

Systemic cryotherapy is a popular treatment involving a short stay in a cryogenic chamber at a temperature below -100 °C. This leads to a number of physiological reactions, some of them also observed in the skin. The aim of the study was to analyze the effect of a single cryogenic treatment on selected skin characteristics (skin pH, level of hydration and TEWL - Transepidermal Water Loss) in young, healthy people.

MATERIALS AND METHODS

Skin characteristics in 77 young people (23.63 ± 1.36 years) were assessed. In the study, 43 women and 33 men who took part in a one-time treatment (-120 °C) lasting 3 min. Measurements were made on the forearm skin and (in men) on the face twice: before and immediately after the procedure.

RESULTS

Initial differences in hydration of the stratum corneum and TEWL were observed between the group of women and men. After one treatment, the examined characteristics of the forearm skin did not change, and an unfavorable increase in TEWL in men was indicated in the facial area.

CONCLUSIONS

A single stay in the cryogenic chamber, while maintaining the correct methodology of the treatment, is safe for the skin. The changes taking place depend on the body surface area tested, which indicates that the skin on the limbs and on the face reacts differently to the cryogenic stimulus.

The Effects of Age and Body Fat Content on Post-Downhill Run Recovery Following Whole Body Cryotherapy

This study explored the effects of age and body fat content on responses to whole body cryotherapy (WBC) following a downhill running bout. Forty-one male participants (mean ± SD age 42.0 ± 13.7 years, body mass 75.2 ± 10.8 kg) were allocated into WBC (n = 26) and control (CON, n = 15) groups. WBC participants were divided into old (OLD, ≥45 years, n = 10) and young (YNG, <40 years, n = 13), as well as high fat (HFAT, ≥20%, n = 10) and low fat (LFAT ≤ 15%, n = 8) groups. Participants completed a 30 min downhill run (15% gradient) at 60% VO2 max. The WBC group underwent cryotherapy (3 min, -120 °C) 1 h post-run and CON participants passively recovered in a controlled environment (20 °C). Maximal isometric leg muscle torque was assessed pre and 24 h post-run. Blood creatine kinase (CK) and muscle soreness were assessed pre, post, one hour and 24 h post-run. Muscle torque significantly decreased in both groups post-downhill run (WBC: 220.6 ± 61.4 Nm vs. 208.3 ± 67.6 Nm, p = 0.02; CON: 239.7 ± 51.1 Nm vs. 212.1 ± 46.3 Nm, p = 0.00). The mean decrease in WBC was significantly less than in CON (p = 0.04). Soreness and CK increased 24 h post for WBC and CON (p < 0.01) with no difference between groups. Muscle torque significantly decreased in OLD participants (p = 0.04) but not in YNG (p = 0.55). There were no differences between HFAT and LFAT (all p values > 0.05). WBC may attenuate muscle damage and benefit muscle strength recovery following eccentrically biased exercises, particularly for young males.

Effectiveness and safety of a thermal insulating coverage on the top of the cryo-cabin during a partial-body cryostimulation

Partial Body Cryostimulation (PBC) consists of exposing minimally dressed participants to very cold air, in a specially designed cabin (cryo-cabin), for a short period of time. In recent years, cryo-cabins have been launched with a coverage to limit thermo-dispersion, however a validation study is lacking. The aim of this study was to compare thermal responses after a PBC protocol in an open cryo-cabin or into a cryo-cabin closed at the top with a polyurethane-made lid. Eighteen young male adults completed the two 150 s PBC sessions in a cross-over fashion. Temperature of the inner cabin and thermal responses were measured prior and 1, 5, 10, 20 min after completing each PBC session. When covered, cryo-cabins maintained a lower temperature in the front with respect to the back. There was a significant interaction regarding coverage*time*position with a main effect of coverage. Body surfaces were significantly colder under covered condition compared to open PBC. Subjects perceived a greater thermal discomfort during a covered PBC rather than during an open condition. For the first time, the use of a coverage placed on the top of the cabin was demonstrated to maintain lower temperatures of the inner environment and the users' skin with respect to a standard PBC. This evidence indicates that practitioners and clinicians making use of PBC can successfully and safely cover cryo-cabins with an insulating lid so to improve the effectiveness of their treatments.

Blood pro-oxidant/antioxidant balance in young men with class II obesity after 20 sessions of whole body cryostimulation: a preliminary study

Objectives: In obesity, there is a shift in the pro-oxidative-antioxidant balance towards the oxidationreactions. However, it has been shown that in people with normal body composition, after a series of whole-body cryotherapy (WBC), the balance shifts in the opposite direction.

Design: The aim of the study was to assess the impact of 20 WBC treatments on blood pro-oxidative-antioxidant balance.

Interventions: Study included 14 obese (BMI > 35) and 10 non-obese volunteers.

Methods: The total antioxidative (TAS/TAC) and pro-oxidative status (TOS/TOC) in serum and activity of antioxidant enzymes in erythrocytes were determined before the first and 2 hours after the last cryostimulation.

Results: In the obese group, a significantly higher level of TOS/TOC, and its significant decrease after the WBC series, was observed. Cryotherapy had no influence on TAS/TAC level which was similar in both groups. Changes in activity of antioxidant enzymes were multidirectional. An increase in CAT activity in the obese group was observed. OSI, both before and after a series of treatments, was significantly higher in obese subjects.

Conclusions: A beneficial effect on the level of TOS/TOC and CAT activity was indicated, but the proposed number of treatments for patients with class II obesity turned out to be insufficient.

Trial registration:Australian New Zealand Clinical Trials Registry identifier: ACTRN12619000524190.

The improvement of cognitive deficits after whole-body cryotherapy - A randomised controlled trial

BACKGROUND

Whole-body cryotherapy (WBC) - a repetitive, short-term exposure to extremely low temperatures - may become an effective early intervention for mild cognitive impairment (MCI). It is a heterogeneous group of symptoms associated with cognitive dysfunction which is estimated to transform into dementia in 50% cases.

STUDY DESIGN

The prospective randomised double-blind sham-controlled study aimed to determine the efficacy of WBC on cognitive functioning and biological mechanisms. The study was registered with Australian New Zealand Clinical Trials Registry (ACTRN12619001627145).

METHODS

Participants with MCI (n = 62; (20<MoCA>26) were randomly allocated to cryogenic temperatures (-110 °C till -160 °C) (EG, n = 33) or placebo-controlled group (CG, n = 29). Cognitive functions were measured at baseline (T1), after the 10th WBC session (T2) and after 2 week-break (T3) with DemTect, SLUMS and Test Your Memory (TYM). Secondary outcome measures included quality of life (WHOQoL-BREF), self-reported well-being (VAS) and depressive symptoms (GDS). Whole blood samples (10 ml) were collected at T1 and T2 to evaluate levels of cytokines, neurotrophins, NO and biochemical parameters CRP total cholesterol, prolactin).

RESULTS

There were significant differences between groups measured at T2 in immediate recall (DemTect) and in orientation (TYM) in favour of WBC group. Improvement in mood was detected in self-reported depressive symptoms level (WHOQoL-26; T2 p = 0.04; VAS mood T2 p = 0.02; T3 p = 0.07). The significant reduction of BDNF level was observed (p < 0.05).

CONCLUSIONS

WBC may increase the performance of cognitive functions. It seems promising to combine WBC with existing behavioural and cognitive trainings in the future studies investigating early interventions methods in MCI.

Serial whole-body cryotherapy in fibromyalgia is effective and alters cytokine profiles

Introduction

Whole-body cryotherapy (WBC) has shown to be beneficial in the treatment of fibromyalgia (FM). There is cumulative evidence that cytokines play a crucial role in FM. It’s unknown whether clinical effects of WBC can be demonstrated at the molecular level and how long the effects last.

Methods

We compared effects of serial WBC (6 sessions (− 130 °C in 6 weeks) in FM patients and healthy controls (HC). Primary outcome was the change in pain level (visual analogue scale 0–100 mm) after 6 sessions. Secondary outcomes were a change in disease activity (revised Fibromyalgia Impact Questionnaire) and pain after 3 sessions and 3 months after discontinued therapy and in cytokine levels (interleukin (IL-)1, IL-6, tumor necrosis factor α (TNF-α) and IL-10). The patients’ opinions on the satisfaction, effectiveness and significance of WBC were evaluated.

Results

Twenty-three FM patients and 30 HC were enrolled. WBC resulted in a significant reduction in pain and disease activity after 3 and 6 sessions. No clinical benefit could be measured 3 months after discontinued treatment. Overall, probands were satisfied with WBC and considered WBC to be important and effective. FM patients had significantly different levels of IL-1, IL-6, TNF-α and IL-10 at each reading point compared to HC. Levels of IL-1, IL-6 and IL-10 were significantly altered over time in FM patients. Compared to HC FM patients showed a significantly different response of IL1, − 6 and − 10 to WBC.

Conclusion

Serial WBC is a fast acting and effective treatment for FM. Proven effects of WBC may be explained by changes in cytokines.

Gut microbiota in dementia. Critical review of novel findings and their potential application

There is a great deal of impetus for the comprehensive understanding of the complete pathological function, genetic information, and functional diversity of the gut microbiota that favors the development of dementia. It has been reported that patients with mild cognitive impairment and Alzheimer's disease present with several metabolic and immune-inflammatory alterations. The recently highlighted aspects of human health linked to cognitive decline include insulin-resistance, obesity, and chronic low-grade inflammation. Gut microbiota is known to produce neurotransmitters, such as GABA, acetylcholine, dopamine or serotonin, vitamins, intestinal toxins, and modulate nerve signaling - with emphasis on the vagus nerve. Additionally, gut dysbiosis results in impaired synthesis of signaling proteins affecting metabolic processes relevant to the development of Alzheimer's disease. Due to numerous links of gut microbiota to crucial metabolic and inflammatory pathways, attempts aimed at correcting the gut microflora composition may affect dementia pathology in a pleiotropic manner. Taking advantage of the metabolic effects of cold exposure on organisms by the introduction of whole-body cryostimulation in dementia patients could lead to alterations in gut microbiota and, therefore, decrease of an inflammatory response and insulin resistance, which remain one of the critical metabolic features of dementia. Further studies are needed in order to explore the potential application of recent findings and ways of achieving the desired goals.

Whole-Body Cryostimulation Improves Inflammatory Endothelium Parameters and Decreases Oxidative Stress in Healthy Subjects

BACKGROUND

The purpose of this study was to estimate the effect of whole-body cryostimulation (WBC) and subsequent kinesiotherapy on inflammatory endothelium and oxidative stress parameters in healthy subjects.

METHODS

The effects of ten WBC procedures lasting 3 min per day and followed by a 60-min session of kinesiotherapy on oxidative stress and inflammatory endothelium parameters in healthy subjects (WBC group n = 32) were analyzed. The WBC group was compared to a kinesiotherapy only (KT; n = 16) group. The following parameters were estimated one day before the start, and one day after the completion of the studies: oxidative stress parameters (the total antioxidant capacity of plasma (FRAP), paraoxonase-1 activity (PON-1), and total oxidative status (TOS)) and inflammatory endothelium parameters (myeloperoxidase activity (MPO), serum amyloid A (SAA), and sCD40L levels).

RESULTS

A significant decrease of PON-1 and MPO activities and TOS, SAA, and sCD40L levels as well as a significant FRAP increase were observed in the WBC group after the treatment. In addition, the SAA levels and PON-1 activity decreased significantly after the treatment in both groups, but the observed decrease of these parameters in the WBC group was higher in comparison to the KT group.

CONCLUSION

WBC procedures have a beneficial impact on inflammatory endothelium and oxidative stress parameters in healthy subjects, therefore they may be used as a wellness method.

Estimulação elétrica nervosa transcutânea e crioterapia no tratamento de estudantes com dismenorreia primária: estudo piloto

Objetivo: Comparar os efeitos da Estimulação Elétrica Nervosa Transcutânea (TENS) e da crioterapia no alívio da sintomatologia dolorosa de estudantes com dismenorreia primária (DP). Métodos: Estudo transversal e quantitativo, com 20 mulheres universitárias aleatoriamente divididas em dois grupos: Grupo TENS (GT) cujas participantes foram submetidas a uma sessão de 45 min de TENS com frequência de 120 Hz e duração de pulso de 100 µs e Grupo Crioterapia (GC) cujas participantes foram submetidas a sessão de crioterapia por 20 min. Foram incluídas mulheres com ciclos menstruais regulares, nuligestas, sem relato de doença pélvica e com dismenorreia com nível de dor entre 4 e 10 durante os três primeiros dias de menstruação. Foram excluídas aquelas com contraindicação ao uso da TENS e crioterapia ou que fizeram uso de medicamentos até 24 h antes da intervenção. Foi registrado o nível de dor das participantes antes e logo depois da intervenção. Resultados: Foram avaliadas mulheres com idade variando entre 18 e 27 anos (média 22,8 ± 2,4 anos). Todas apresentaram além dos sintomas dolorosos algum outro sintoma associado, sendo os mais comuns diarreia e fadiga (80%, cada). O teste ANOVA two-way de medidas repetidas considerando como fatores grupo e avaliação, revelou efeito apenas para o fator avaliação (p < 0,001), não apresentando efeito para a interação grupo/avaliação (p = 0,09). Conclusão: TENS e crioterapia são recursos eficientes para o alívio dos sintomas álgicos de mulheres com DP, não havendo superioridade entre as abordagens.

Use of Cryotherapy for Managing Chronic Pain: An Evidence-Based Narrative

Background

Cryotherapy has been used to reduce chronic pain for many years due in part to its ease of use, affordability, and simplicity. It can be applied either locally (e.g., ice packs) or non-locally (e.g., partial and whole-body cryotherapy) depending on the location of the pain.

Objectives

To determine the overall effectiveness of cryotherapy at reducing chronic pain by characterizing the currently available evidence supporting the use and effects of cryotherapy on chronic pain associated with chronic diseases.

Study Design

A narrative review of original research studies assessing the efficacy of cryotherapy in alleviating chronic pain.

Methods

A PubMed database search was performed to find human studies between the years 2000 and 2020 that included the application of cryotherapy in patients with chronic pain associated with chronic diseases. A review of the relevant references was also performed to gather more articles. Data was extracted, summarized into tables, and qualitatively analyzed.

Results

Twenty-five studies (22 randomized controlled trials, one prospective analysis, 1 one-group pretest/posttest study, and one case–control study) were included after the literature search. Both local and non-local cryotherapy applications show promise in reducing chronic pain associated with various chronic diseases including those of rheumatic and degenerative origin. Cryotherapy appears to be a safe therapy in carefully selected patients, with only minimal adverse effects reported in the literature.

Limitations

Meta-analysis was not possible given the many differences between studies. Cross-study data homogenization and comparison between studies proved fairly difficult due to the lack of standardized studies, various uses and practice types of cryotherapy, and lack of control groups in some studies.

Conclusions

Local and non-local cryotherapy can be low-risk and easy treatment options to add in the management of chronic pain in carefully selected patients. However, long-term effects, a standardized approach, and careful study of other chronic pain syndromes should be considered in future research to further support the use of cryotherapy in the management of chronic pain.

Preliminary study on the effect of sex on skin cooling response during whole body cryostimulation (-110 °C): Modeling and prediction of exposure durations

In order to determine the required duration of whole-body exposure to extreme cold (-110 °C) in males and females for achieving the same cold-induced response, a mathematical model of skin cooling kinetics was developed. This modeling is derived from the implementation of a new experimental cryotherapy protocol to obtain continuous skin temperature maps over time. Each 3-min whole-body cryostimulation session was divided into six incremental sessions of 30 s carried out over six consecutive days. Seventeen young, healthy subjects (8 males aged 22.6 ±3.0 years and 9 females aged 23.7 ±4.7 years) agreed to participate in this study. The smallest sex-related difference in temperature was found in the trunk area (2.93 °C after 3 min) while the greatest temperature drop was found in the lower limbs (5.92 °C after 3 min). The largest temperature variation was observed between the trunk and the lower limbs, and peaked at 2.67 °C in males and 6.99 °C in females. For both sexes, skin cooling kinetics showed a strong transient exponential type decrease followed by linear regression behavior. It appeared that for achieving the same cold-induced response, the required duration of cryostimulation is longer for males. For example, a trunk skin cooling of -12 °C could be achieved in 125s for females vs 170s for males (+36% longer); for the lower limbs, the same skin cooling magnitude could be reached after 87s for females vs 140s for males (+62% longer).

Short-Term Resistance Training Supported by Whole-Body Cryostimulation Induced a Decrease in Myostatin Concentration and an Increase in Isokinetic Muscle Strength

The study aimed to determine whether combining cryostimulation with resistance training would effectively increase muscle strength, and if so, whether this adaptation would be related to changes in circulating levels of exerkines (i.e., mediators of systemic adaptation to exercise). Twenty-five students completed 12 sessions of resistance training, each followed by either cryostimulation (n = 15, 3 min exposure at -110 °C) or passive recovery (n = 10). Prior to and post this intervention, participants performed two eccentric cycling bouts (before and after training). At these points, serum concentrations of muscle damage marker (myoglobin), exerkines (interleukin 6 (IL-6), interleukin 15 (IL-15), irisin, brain-derived neurotrophic factor), hypertrophy-related factors (myostatin, insulin-like growth factor 1), and muscle strength were measured. The applied procedure reduced the physiological burden of the second eccentric cycling bout and myoglobin concentrations only in the group subject to cryostimulation. The same group also exhibited decreased levels of myostatin (from 4.7 ± 1.7 to 3.8 ± 1.8 ng·mL^-1, p < 0.05). A significant and large interaction between the group × time was noted in IL-15 concentration (p = 0.01, ηp2=0.27). Training and cryostimulation induced a positive and likely significant improvement of isokinetic muscle strength. Altogether, obtained results support the claim that resistance training combined with cold exposure modified muscle strength through modulation of myostatin and IL-15 concentrations.

Effects of whole-body cryotherapy on 25-hydroxyvitamin D, irisin, myostatin, and interleukin-6 levels in healthy young men of different fitness levels

Skeletal muscle and adipose tissue play an important role in maintaining metabolic homeostasis and thermogenesis. We aimed to investigate the effects of single and repeated exposure to whole-body cryotherapy in volunteers with different physical fitness levels on 25-hydroxyvitamin D (25(OH)D) and myokines. The study included 22 healthy male volunteers (mean age: 21 ± 1.17 years), who underwent 10 consecutive sessions in a cryogenic chamber once daily (3 minutes, −110 °C). Blood samples were collected before and 30 minutes and 24 hours after the first and last cryotherapy sessions. Prior to treatment, body composition and physical fitness levels were measured. After 10 cryotherapy treatments, significant changes were found in myostatin concentrations in the low physical fitness level (LPhL) group. The 25(OH)D levels were increased in the high physical fitness level (HPhL) group and decreased in the LPhL group. The HPhL group had significant changes in the level of high-sensitivity interleukin-6 after the first treatment. The LPhL group had significant changes in 25(OH)D, irisin, and myostatin levels after the tenth treatment. Our data demonstrated that in healthy young men, cryotherapy affects 25(OH)D levels, but they were small and transient. The body’s response to a series of 10 cryotherapy treatments is modified by physical fitness level.

Cryotherapy Models and Timing-Sequence Recovery of Exercise-Induced Muscle Damage in Middle- and Long-Distance Runners

CONTEXT

Among sports-recovery methods, cold-water immersion (CWI), contrast-water therapy (CWT), and whole-body cryotherapy (WBC) have been applied widely to enhance recovery after strenuous exercise. However, the different timing effects in exercise-induced muscle damage (EIMD) after these recovery protocols remain unknown.

OBJECTIVE

To compare the effects of CWI, CWT, and WBC on the timing-sequence recovery of EIMD through different indicator responses.

DESIGN

Crossover study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years).

INTERVENTION(S)

Participants were treated with different recovery methods (control [CON], CWI, CWT, WBC) immediately postexercise and at 24, 48, and 72 hours postexercise.

MAIN OUTCOME MEASURE(S)

We measured perceived sensation using a visual analog scale (VAS), plasma creatine kinase (CK) activity, plasma C-reactive protein (CRP) activity, and vertical-jump height (VJH) pre-exercise, immediately postexercise, and at 1, 24, 48, 72, and 96 hours postexercise.

RESULTS

For the VAS score and CK activity, WBC exhibited better timing-sequence recovery effects than CON and CWI (P < .05), but the CWT demonstrated better effects than CON (P < .05). The CRP activity was lower after WBC than after the other interventions (P < .05). The VJH was lower after WBC than after CON and CWI (P < .05).

CONCLUSIONS

The WBC positively affected VAS, CK, CRP, and VJH associated with EIMD. The CWT and CWI also showed positive effects. However, for the activity and timing-sequence effect, CWT had weaker effects than WBC.

Critical Evaluation of Whole-Body Cryostimulation Protocol in Race Horses

Cold therapy is commonly used to relieve pain and inflammation and to aid in muscle recovery after exercise in human medicine. A number of applications have also been observed in veterinary practice. In this article, a critical evaluation of equine protocol applied with a new commercial concept of equine whole-body cryostimulation (WBC) was made. With this new concept of WBC, the protocol usually utilized for relieving pain and discomfort in humans has been extended to horses. The investigations described herein focus on the reduction of horse skin temperature when applying human WBC protocols. Based on infrared thermography measurements, results show that exposing a horse for 3 minutes to a temperature of -140°C, which are conventional parameters used for humans, does not induce sufficient skin thermal gradients in horses. Consequently, beneficial cold reflexes such as vasomotor, neuroconduction, and biochemical reactions cannot be triggered. Further investigations should therefore be carried out to design an adequate protocol specifically aimed at horses.