Does whole-body cryotherapy improve vertical jump recovery following a high-intensity exercise bout?

A evidence-based approach to selecting post-exercise cryostimulation techniques for improving exercise performance and fatigue recovery: A systematic review and meta-analysis

Rationale

Cryostimulation involves using water environments and low temperatures as intervention mediums, with main methods including CWI (cold water immersion), CWT (contrast water therapy), and WBC (whole-body cryostimulation). Previous systematic reviews focused on the effect of cryostimulation on muscle fatigue and sports performance. However, studies on the selection of different cryostimulation methods and their intervention effects present inconsistent results.

Introduction

To systematically review and methodologically appraise the quality and effectiveness of existing intervention studies that the effects of various cryostimulation methods, including CWI, CWT, and WBC, on exercise performance and fatigue recovery.

Methods

Following PRISMA guidelines, we conducted searches in PubMed, Embase, The Cochrane Library, Web of Science, and EBSCO databases to gather randomized controlled trials or self-controlled trials involving CWI/CWT/WBC and their effects on exercise performance or fatigue recovery. The search period ranged from November 2013 to November 2, 2023. Literature screening was performed using EndNote X9.1, and the quality of included studies was assessed using the Cochrane risk of bias assessment tool. Meta-analysis was conducted using RevMan 5.3 software.

Results

This study included a total of 18 articles, included a total of 499 healthy participants, comprising 479 males and 20 females. Among them, participants underwent cryostimulation, including 102 using CWT, using CWI, and 58 using WBC. Compared to the control group, cryostimulation can significantly alleviate muscle pain intensity (SMD -0.45, 95% CL -0.82 to 0.09, P = 0.01). Specifically, CWI significantly reduced muscle pain intensity (SMD = -0.45, 95% CI: 0.820.09, P = 0.01), WBC significantly decreased C-reactive protein levels (SMD = -1.36, 95% CI: 2.350.36, P = 0.008). While, CWT showed no significant differences from the control group in exercise performance and fatigue recovery indicators (P > 0.05).

Conclusion

Cryostimulation can significantly reduce muscle pain intensity and perceived fatigue. Specifically, CWI significantly alleviates muscle pain intensity, WBC significantly lowers markers of inflammation caused by fatigue after exercise, in contrast, CWT does not significantly improve exercise performance and fatigue recovery. After exercise, compared with rest, using cryostimulation may have more noticeable benefits for muscle fatigue and muscle pain, with recommendations prioritizing WBC and CWI particularly for addressing inflammation and muscle pain. However, all cryostimulation may have no significant influence on exercise performance.

The Acute Influence of Whole-Body Cryotherapy on Electromyographic Signals and Jumping Tasks

Whole-body cryotherapy (WBC) is a popular treatment in prevention as well as post-injury therapy. The parameter used to assess the risk of injury is the ability of the human body to absorb and recover energy (elasticity). Therefore, this study aimed to assess the impact of whole-body cryotherapy (WBC) at 1 and 3 min intervals on the bioelectric activity of lower-limb muscles and countermovement jumps (CMJs) using trained subjects. A total of 24 individuals participated in the study. The mean age of the study group was 27.9 ± 7.9 years, mean body weight was 77.9 ± 8.8 kg, and mean body height was equal to 181 ± 6 cm. The training routine included 2–4 training sessions per week that lasted for at least 2 h at a time (mainly football). Along with the surface electromyography (sEMG) test of the rectus femoris, the BTS G-Sensor inertia measurement device was applied. After three minutes of WBC, a 6% difference in take-off force was noted, with a 7% (p < 0.04) decrease in elasticity. In the bioelectrical activity of the rectus femoris after MVC normalization, differences (p < 0.05) were noted 3 min after WBC. In this conducted study, a reduction in flexibility of the lower-limb muscle groups in the CMJ task was noted after 3 min of WBC.

In-Season Nutrition Strategies and Recovery Modalities to Enhance Recovery for Basketball Players: A Narrative Review

Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players' recovery for training and competition throughout the season.

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.

The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.

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.

Multiple Cryotherapy Attenuates Oxi-Inflammatory Response Following Skeletal Muscle Injury

The oxi-inflammatory response is part of the natural process mobilizing leukocytes and satellite cells that contribute to clearance and regeneration of damaged muscle tissue. In sports medicine, a number of post-injury recovery strategies, such as whole-body cryotherapy (WBC), are used to improve skeletal muscle regeneration often without scientific evidence of their benefits. The study was designed to assess the impact of WBC on circulating mediators of skeletal muscle regeneration. Twenty elite athletes were randomized to WBC group (3-min exposure to −120 °C, twice a day for 7 days) and control group. Blood samples were collected before the first WBC session and 1 day after the last cryotherapy exposure. WBC did not affect the indirect markers of muscle damage but significantly reduced the generation of reactive oxygen and nitrogen species (H₂O₂ and NO) as well as the concentrations of serum interleukin 1β (IL-1β) and C-reactive protein (CRP). The changes in circulating growth factors, hepatocyte growth factor (HGF), insulin-like growth factor (IGF-1), platelet-derived growth factor (PDGF^BB), vascular endothelial growth factor (VEGF), and brain-derived neurotrophic factor (BDNF), were also reduced by WBC exposure. The study demonstrated that WBC attenuates the cascade of injury–repair–regeneration of skeletal muscles whereby it may delay skeletal muscle regeneration.

Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond

Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of 3-6 h with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.

No Effect of Partial-Body Cryotherapy on Restoration of Countermovement Jump or Well-Being Performance in Elite Rugby Union Players During the Competitive Phase of the Season

PURPOSE

Partial body cryotherapy (PBC) has been shown to be beneficial for postexercise recovery; however, no study has demonstrated the effectiveness of PBC for recovery following elite rugby union training. Rugby union is a unique sport that involves high-velocity collisions and may induce greater performance decrements than other sports; thus, PBC could be beneficial. The application of PBC in "real world" has rarely been investigated during the competitive phase of a playing season and warranted investigation.

METHODS

In a counterbalanced sequential research design, professional rugby athletes (n = 18; age 25.4 [4.0] y; training age 7.2 [4.0] y; mass 99.8 [10.6] kg; height 188.3 [6.0] cm) were assigned to a 12-week PBC intervention, washout period (4 wk), and reassessed as their own controls. Self-reported well-being, muscle soreness, sleep quality, and countermovement jump height were assessed before and 40 hours after "real-world" training. Wilcoxon signed-rank tests and Cohen d were used for statistical analysis.

RESULTS

No differences were observed between PBC and control conditions (P > .05; d = 0.00-0.14) for well-being (-0.02% [0.08%] vs 0.01% [0.06%]), muscle soreness (-0.01% [0.11%] vs 0.01% [0.16%]), sleep quality (-0.03% [0.14%] vs 0.10% [0.29%]), or countermovement jump height (36.48-36.59 vs 38.13-37.52 cm; P = .54).

CONCLUSIONS

These results suggest PBC is ineffective for the restoration of selected performance parameters during the performance maintenance phase of the competitive season. To ascertain the appropriation of its use, future investigations should seek to assess the use of cryotherapies at various phases of the elite rugby union competitive season.

Partial-body cryotherapy (-135°C) and cold-water immersion (10°C) after muscle damage in females

This randomized controlled trial examined the effects of cold‐water immersion (CWI), partial‐body cryotherapy (PBC), or a passive control (CON) on physiological and recovery variables following exercise‐induced muscle damage (EIMD, 5 × 20 drop jumps) in females. Twenty‐eight females were allocated to PBC (30 seconds at −60°C, 2 minutes at −135°C), CWI (10 minutes at 10°C), or CON (10 minutes resting). Muscle oxygen saturation (SmO₂), cutaneous vascular conductance (CVC), mean arterial pressure (MAP), and local skin temperature were assessed at baseline and through 60 minutes (10‐minute intervals), while delayed onset of muscle soreness (DOMS), muscle swelling, maximum voluntary isometric contraction (MVIC), and vertical jump performance (VJP) were assessed up to 72 hours (24‐hour intervals) following treatments. SmO₂ was lower in PBC (Δ‐2.77 ± 13.08%) and CWI (Δ‐5.91 ± 11.80%) compared with CON (Δ18.96 ± 1.46%) throughout the 60‐minute follow‐up period (P < .001). CVC was lower from PBC (92.7 ± 25.0%, 90.5 ± 23.4%) and CWI (90.3 ± 23.5%, 88.1 ± 22.9%) compared with CON (119.0 ± 5.1 and 116.1 ± 6.6%, respectively) between 20 and 30 minutes (P < .05). Mean skin temperature was lower from CWI vs PBC (between 10 and 40 minutes, P < .05). Mean skin temperature was higher in CON compared with CWI up to 60 minutes and compared with PBC up to 30 minutes (P < .05). DOMS was lower following both PBC and CWI compared with CON through 72‐hour (P < .05), with no difference between groups. No main group differences for swelling, MVIC, and VJP were observed. In conclusion, CWI elicited generally greater physiological effects compared with PBC while both interventions were more effective than CON in reducing DOMS in females, but had no effect on functional measures or swelling.

Whole-body cryotherapy does not augment adaptations to high-intensity interval training

The aim of this study was to investigate the effects of regular post-exercise whole-body cryotherapy (WBC) on physiological and performance adaptations to high-intensity interval training (HIT). In a two-group parallel design, twenty-two well-trained males performed four weeks of cycling HIT, with each session immediately followed by 3 min of WBC (−110 °C) or a passive control (CON). To assess the effects of WBC on the adaptive response to HIT, participants performed the following cycling tests before and after the training period; a graded exercise test (GXT), a time-to-exhaustion test (T_max), a 20-km time trial (20_TT), and a 120-min submaximal test (SM₁₂₀). Blood samples were taken before and after training to measure changes in basal adrenal hormones (adrenaline, noradrenaline, and cortisol). Sleep patterns were also assessed during training via wrist actigraphy. As compared with CON, the administration of WBC after each training session during four weeks of HIT had no effect on peak oxygen uptake (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{\rm{V}}}$$\end{document}V˙O_2peak) and peak aerobic power (P_peak) achieved during the GXT, T_max duration and work performed (W_Tmax), 20_TT performance, substrate oxidation during the SM₁₂₀, basal adrenaline/noradrenaline/cortisol concentrations, or sleep patterns (P > 0.05). These findings suggest that regular post-exercise WBC is not an effective strategy to augment training-induced aerobic adaptations to four weeks of HIT.

Post-Exercise Whole Body Cryotherapy (-140 °C) Increases Energy Intake in Athletes

PURPOSE

The purpose of the present study was to investigate the effect of whole-body cryotherapy (WBC) treatment after exercise on appetite regulation and energy intake.

METHODS

Twelve male athletes participated in two trials on different days. In both trials, participants performed high-intensity intermittent exercise. After 10 min following the completion of the exercise, they were exposed to a 3-min WBC treatment (-140 °C, WBC trial) or underwent a rest period (CON trial). Blood samples were collected to assess plasma acylated ghrelin, serum leptin, and other metabolic hormone concentrations. Respiratory gas parameters, skin temperature, and ratings of subjective variables were also measured after exercise. At 30 min post-exercise, energy and macronutrient intake were evaluated during an ad libitum buffet meal test.

RESULTS

Although appetite-regulating hormones (acylated ghrelin and leptin) significantly changed with exercise (p = 0.047 for acylated ghrelin and p < 0.001 for leptin), no significant differences were observed between the trials. Energy intake during the buffet meal test was significantly higher in the WBC trial (1371 ± 481 kcal) than the CON trial (1106 ± 452 kcal, p = 0.007).

CONCLUSION

Cold exposure using WBC following strenuous exercise increased energy intake in male athletes.

An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis

Introduction: The aim of the present work was to perform a meta-analysis evaluating the impact of recovery techniques on delayed onset muscle soreness (DOMS), perceived fatigue, muscle damage, and inflammatory markers after physical exercise. Method: Three databases including PubMed, Embase, and Web-of-Science were searched using the following terms: ("recovery" or "active recovery" or "cooling" or "massage" or "compression garment" or "electrostimulation" or "stretching" or "immersion" or "cryotherapy") and ("DOMS" or "perceived fatigue" or "CK" or "CRP" or "IL-6") and ("after exercise" or "post-exercise") for randomized controlled trials, crossover trials, and repeated-measure studies. Overall, 99 studies were included. Results: Active recovery, massage, compression garments, immersion, contrast water therapy, and cryotherapy induced a small to large decrease (-2.26 < g < -0.40) in the magnitude of DOMS, while there was no change for the other methods. Massage was found to be the most powerful technique for recovering from DOMS and fatigue. In terms of muscle damage and inflammatory markers, we observed an overall moderate decrease in creatine kinase [SMD (95% CI) = -0.37 (-0.58 to -0.16), I2 = 40.15%] and overall small decreases in interleukin-6 [SMD (95% CI) = -0.36 (-0.60 to -0.12), I2 = 0%] and C-reactive protein [SMD (95% CI) = -0.38 (-0.59 to-0.14), I2 = 39%]. The most powerful techniques for reducing inflammation were massage and cold exposure. Conclusion: Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage, or water immersion.

Pre-exercise β-hydroxy-β-methylbutyrate free-acid supplementation improves work capacity recovery: a randomized, double-blinded, placebo-controlled study

The purpose of this study was to investigate the effects of a single-dose of β-hydroxy-β-methylbutyrate free acid (HMB-FA) supplementation on muscle recovery after a high-intensity exercise bout. Twenty-three trained young males were randomly assigned to receive either a single-dose supplementation of 3 g of HMB-FA (n = 12; age, 22.8 ± 3.0 years) or placebo (PLA; n = 11; age, 22.9 ± 3.1 years). A muscle damage protocol was applied 60 min after supplementation, and consisted of 7 sets of 20 drop jumps from a 60-cm box with 2-min rest intervals between sets. Muscle swelling, countermovement jump (CMJ), maximal voluntary isometric torque (MVIT), and work capacity (WC) were measured before, immediately after, and 24, 48, and 72 h after the exercise protocol. Muscle swelling, CMJ, and MVIT changed similarly in both groups after the exercise protocol (p < 0.001), but returned to pre-exercise levels after 24 h in both groups. WC decreased similarly in both groups after the exercise protocol (p < 0.01). For HMB-FA, WC returned to pre-exercise level 24 h after exercise protocol. However, for PLA, WC did not return to pre-exercise level even 72 h after the exercise protocol. In summary, a single-dose of HMB-FA supplementation improved WC recovery after a high-intensity exercise bout. However, HMB-FA did not affect the time-course of muscle swelling, MVIT, and CMJ recovery.

The effect of local cryotherapy on subjective and objective recovery characteristics following an exhaustive jump protocol

The purpose of this controlled trial was to investigate the effects of a single local cryotherapy session on the recovery characteristics over a period of 72 hours. Twenty-two young and healthy female (n=17; mean age: 21.9±1.1 years) and male (n=5;mean age: 25.4±2.8 years) adults participated in this study. Following an exhaustive jump protocol (3×30 countermovement jumps), half of the participants received either a single local cryotherapy application (+8°C) or a single local thermoneutral application (+32°C) of 20-minute duration using two thigh cuffs. Subjective measures of recovery (delayed-onset muscle soreness and ratings of perceived exertion) and objective measures of recovery (vertical jump performance and peak power output) were assessed immediately following the postexercise applications (0 hours) and at 24 hours, 48 hours, and 72 hours after the jump protocol. Local cryotherapy failed to significantly affect any subjective recovery variable during the 72-hour recovery period (P>0.05). After 72 hours, the ratings of perceived exertion were significantly lower in the thermoneutral group compared to that in the cryotherapy group (P=0.002). No significant differences were observed between the cryotherapy and the thermoneutral groups with respect to any of the objective recovery variables. In this experimental study, a 20-minute cryotherapy cuff application failed to demonstrate a positive effect on any objective measures of recovery. The effects of local thermoneutral application on subjective recovery characteristics were superior when compared to the effects of local cryotherapy application at 72 hours postapplication.