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CBD Literature

General/Overview

Effects of cryotherapy methods on circulatory, metabolic, inflammatory and neural properties: a systematic review

Introduction: The cooling therapy (cryotherapy) is commonly used in clinical environmental for the injuries treatment according to its beneϐicial effects on pain, local inϐlammation and the recovery time of patients. However, there is no consensus in the literature about the effects of cryotherapy in the physiological reactions of affected tissues after an injury.

Objective: To realize a systematic review to analyze the cryotherapy effects on circulatory, metabolic, inϐlammatory and neural parameters. Materials and methods: A search was performed in PubMed, SciELO, PEDro and Scopus databases following the eligibility criteria. Included studies were methodologically assessed by PEDro scale. Results: 13 original studies were selected and presented high methodological quality.

Discussion: The cryotherapy promotes a signiϐicant decrease in blood ϐlow, in venous capillary pressure, oxygen saturation and hemoglobin (only for super- ϐicial tissues) and nerve conduction velocity. However, the effect of cryotherapy on the concentration of inϐlammatory substances induced by exercise, as the creatine kinase enzyme and myoglobin, remains unclear.

Conclusion: The physiological reactions to the cryotherapy application are favorable to the use of this therapeutic tool in inϐlammatory treatment and pain decrease, and demonstrate its importance in the neuromuscular system injuries rehabilitation.

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Whole-body cryotherapy: empirical evidence and theoretical perspectives

Whole-body cryotherapy (WBC) involves short exposures to air temperatures below –100°C. WBC is increasingly accessible to athletes, and is purported to enhance recovery after exercise and facilitate rehabilitation postinjury. Our objective was to review the efficacy and effectiveness of WBC using empirical evidence from controlled trials. We found ten relevant reports; the majority were based on small numbers of active athletes aged less than 35 years. Although WBC produces a large temperature gradient for tissue cooling, the relatively poor thermal conductivity of air prevents significant subcutaneous and core body cooling. There is weak evidence from controlled studies that WBC enhances antioxidant capacity and parasympathetic reactivation, and alters inflammatory pathways relevant to sports recovery. A series of small randomized studies found WBC offers improvements in subjective recovery and muscle soreness following metabolic or mechanical overload, but little benefit towards functional recovery. There is evidence from one study only that WBC may assist rehabilitation for adhesive capsulitis of the shoulder. There were no adverse events associated with WBC; however, studies did not seem to undertake active surveillance of predefined adverse events. Until further research is available, athletes should remain cognizant that less expensive modes of cryotherapy, such as local ice-pack application or cold-water immersion, offer comparable physiological and clinical effects to WBC.

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Thermal, Circulatory, And Neuromuscular Responses To Whole- Body Cryotherapy

The purpose of this study was to examine thermal (body temperature, thermal sensation and comfort ratings), circulatory (blood pressure, heart rate variability) and neuromuscular performance responses to whole-body cryotherapy (WBC, -110 °C).

Altogether 66 healthy subjects were exposed to WBC for two minutes. The acute and longterm changes were examined, when the subjects were exposed to WBC three times a week during three months.

Skin temperatures decreased very rapidly during WBC, but remained such a high level that there was no risk for frostbites. The effects on rectal temperature were minimal. Repeated exposures to WBC were mostly well tolerated and comfortable and the subjects became habituated at an early stage of trials. WBC increased both systolic (24 mmHg) and diastolic (5 mmHg) blood pressures temporarily. Adaptation of blood pressure was not found during three months. The acute cooling-related increase in high-frequency power of RR-intervals indicated an increase in cardiac parasympathetic modulation, but after repeated WBC the increase was attenuated. The repeated WBC exposure-related increase in resting low frequency power of RR-intervals resembles the response observed related to exercise training. There are signs of neuromuscular adaptation, especially in dynamic performance. A single WBC decreased flight time in drop-jump exercise, but after repeated WBC these changes were almost vanished. This adaptation was confirmed by the change of the activity of the agonist muscle, which increased more and the change of the activity of antagonist muscle, which increased less/did not change after repeated WBC indicating reduced co-contraction and thus, neuromuscular adaptation.

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The effect of prolonged whole-body cryostimulation treatment with different amounts of sessions on chosen pro- and anti-inflammatory cytokines levels in healthy men.

Cryotherapy is used in the early treatment of acute injuries (sprains, strains, fractures) yet only a few papers discuss the possible influence of whole-body cryostimulation on inflammation mechanisms or immunology. It is postulated that cold exposure can have an immunostimulating effect related to enhanced noradrenaline response and can be connected with paracrine effects. The aim of this study was to examine the effect of different sequences of whole-body cryostimulations on the level of pro- and anti-inflammatory cytokines in healthy individuals. The research involved 45 healthy men divided into three groups. The groups were subjected to 5, 10 or 20, 3-minute long whole-body cryostimulations each day at -130°C. Blood was collected for analysis before the stimulations, after completion of the whole series, and 2 weeks after completion of the series, for the examination of any long-term effect. The analysis of results showed that in response to cryostimulation, the level of ani-inflammatory cytokines IL-6 and IL-10 increased while Il-1α cytokine level decreased. It seems that the most advantageous sequence was the series of 20 cryostimulations due to the longest lasting effects of stimulation after the completion of the whole series of treatments.

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Do sessions of cryostimulation have influence on white blood cell count, level of IL6 and total oxidative and antioxidative status in healthy men?

The influence of extremely low temperatures on the human body and physiological reactions are not fully recognized. It has been postulated that cryostimulation could modify immunological reactions, leukocytes mobilization and levels of cytokines. The aim of this research was to estimate the influence of a ten sessions 3-min-long exposures to cryogenic temperature (-130 degrees C) on the white blood cell (WBC) count, level of IL6 and the total oxidative and antioxidative status in 15 young, clinically healthy men. Blood samples were obtained in the morning before cryostimulation, again 30 min after treatment and the next day in the morning, both during the first and tenth session. The WBC count, level of IL6 and total lipid peroxides as the total oxidative status and the total antioxidative status (TAS), were measured. After completing a total of ten whole-body therapy sessions a significant increase in WBC count, especially lymphocytes and monocytes was noted. There was an increase in level of IL6 after first and the last cryostimulation the most pronounced after tenth session. On the contrary the TAS level decreased significant after the treatment. It was concluded that repeated expositions to extremely low temperatures use in cryostimulation have mobilization effect on immunological system.

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Whole Body Cryotherapy : The Three Levels of Cure

The word ”Cryotherapy” originates from the Greek words: “cryo” = cold, and ”therapeia” = cure. Hence, Cryotherapy is a curative health treatment involving extremely low temperatures (below – 130oC/ below -266oF). Modern ”Whole Body Cryo Therapy” (WCT), also referred to as ”Air Cryo Therapy” (ACT) and “Cryosauna,” is rooted in the practice of Dr. Yamaguchi of Japan who, in 1978, started using freezing treatments of short duration on his rheumatoid arthritis patients‟ skin surface for pain management purposes. With these cryo-procedures, Dr. Yamaguchi found he could significantly reduce the soreness and pain his patients usually felt during manipulation of their joints, because the rapid decrease of temperature of the outer layer of skin led to the immediate release of endorphines and therefore less sensitivity to pain. In the 1980s, while continuing his research, now on the effects of Whole Body Cryotherapy, Dr.Yamaguchi and his associates came to this conclusion: that rapid short-term freezing of the skin‟s surface to a temperature of -1 oC/32oF while inside the cryo-chamber has a more beneficial effect on the human body than its gradual cooling while immersed in an ice bath, where the lowest temperature possible is 5oC/41oF. As a result of thorough and sustained research, Dr. Yamaguchi further formulated that Whole Body Cryotherapy (WCT) affects the body on three different levels: – The Biochemical level – the circulatory system – The Energy level – the energy meridians – The Information level – the nervous system.

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Impact of 10 Sessions of Whole Body Cryostimulation on Cutaneous Microcirculation Measured by Laser Doppler Flowmetry

The aim of the present study was to evaluate the basic and evoked blood flow in the skin microcirculation of the
hand, one day and ten days after a series of 10 whole body cryostimulation sessions, in healthy individuals.
The study group included 32 volunteers – 16 women and 16 men. The volunteers underwent 10 sessions of
cryotherapy in a cryogenic chamber. The variables were recorded before the series of 10 whole body cryostimulation
sessions (first measurement), one day after the last session (second measurement) and ten days later (third
measurement). Rest flow, post-occlusive hyperaemic reaction, reaction to temperature and arterio–venous reflex index
were evaluated by laser Doppler flowmetry.


The values recorded for rest flow, a post-occlusive hyperaemic reaction, a reaction to temperature and arterio –
venous reflex index were significantly higher both in the second and third measurement compared to the initial one.
Differences were recorded both in men and women. The values of frequency in the range of 0,01 Hz to 2 Hz (heart
frequency dependent) were significantly lower after whole-body cryostimulation in both men and women. In the range
of myogenic frequency significantly higher values were recorded in the second and third measurement compared to the
first one.


Recorded data suggest improved response of the cutaneous microcirculation to applied stimuli in both women
and men. Positive effects of cryostimulation persist in the tested group for 10 consecutive days.

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Heart rate variability in women exposed to very cold air (−110 °C) during whole-body cryotherapy

Heart rate monitoring was used to measure heart rate variability (HRV) at thermoneutral conditions (Ta 24 °C) in healthy women resting in supine position before and after acute and after repeated (3 times a week during a 3-month period) whole-body cryotherapies (WBC), at −110 °C. The observed acute cooling-related increase in high frequency power (HFP) of RR-intervals indicates an increase in cardiac parasympathetic modulation. After 3 months of repeated WBC the increase in parasympathetic tone was attenuated, which may be interpreted as an adaptation of autonomic function. The repeated WBC exposures-related increase in resting low frequency power (LFP) of RR-intervals during the 3 months resembles the response observed related to exercise training.

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Acute effect of a single whole-body cryostimulation on prooxidant–antioxidant balance in blood of healthy, young men

1. We have examined the prooxidative–antioxidative reaction to extremely low temperatures (−130 °C) during a one-time cryostimulation in 15 young, clinically healthy individuals.

2. The total lipid peroxides as the total oxidative status (TOS) and the total antioxidative status (TAS) were measured in blood plasma collected in the morning of the day of cryostimulation, 30 min after the cryostimulation, and on the following morning.
3. The level of stress expressed by total oxidative status in plasma, resulting from exposure to extremely low temperatures, was statistically significantly lowered 30 min after leaving the cryochamber than prior to the exposure. The next day, the TOS level still remained lower than the initial values. The TAS level decreased after leaving the cryochamber and remained elevated the following day.

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Oxidative stress, inflammation, and cancer: How are they linked?

Extensive research during last two decades has revealed the mechanism by which continued oxidative stress can lead to chronic inflammation, which in turn could mediate most chronic diseases including cancer, diabetes, cardiovascular, neurological and pulmonary diseases. Oxidative stress can activate a variety of transcription factors including NF-κB, AP-1, p53, HIF-1α, PPAR-γ, β-catenin/Wnt, and Nrf2. Activation of these transcription factors can lead to the expression of over 500 different genes, including those for growth factors, inflammatory cytokines, chemokines, cell cycle regulatory molecules, and anti-inflammatory molecules. How oxidative stress activates inflammatory pathways leading to transformation of a normal cell to tumor cell, tumor cell survival, proliferation, chemoresistance, radioresistance, invasion, angiogenesis and stem cell survival is the focus of this review. Overall, observations to date suggest that oxidative stress, chronic inflammation, and cancer are closely linked.

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Clinical Relevance of Whole Body Cryotherapy

Whole Body Cryotherapy (WBC) is a hypothermic application designed to reduce musculoskeletal pain and inflammation. WBC stimulates the sympathetic nervous system via alpha-adrenergic receptors, causing dramatic peripheral vasoconstriction. This induces adaptive changes correlating with effects of analgesia, reduction of inflammation, and increases in serum markers of tissue repair. Research conducted over the last two decades, primarily in Europe, has established therapeutic efficacy of WBC in a wide range of clinical areas. The largest focuses of research have been pain management and athletic performance. It has been shown to effectively reduce pain and swelling and improve physical performance. Due to the numerous adaptive physiological responses, WBC has also been studied as an adjunct treatment for: atopic dermatitis, cardiovascular health, depression and Multiple Sclerosis.

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Monitoring of whole body cryotherapy effects by thermal imaging: preliminary report.

In whole body cryotherapy the whole human body is exposed to low temperature below -100 degrees C in a special room called cryogenic chamber for a very short period of time (2-3 minutes). The impact of cold can cause many different biochemical and physiological reactions of the organism. The skin temperature response due to whole body cryotherapy was studied by means of infrared measurements. The thermograms of chosen body parts of patients suffering from low back pain were performed before and after whole body cooling on the 1(st), 5(th) and the last (10(th)) day of medical treatment. Infrared imaging performed after cold impact owing to the enhancement of the skin temperature profile may reveal a slight decrease of the inflammatory states as a result of the 10 sessions of cryotherapy.

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Effect of short-term cryostimulation on antioxidative status and its clinical applications in humans

Whole body cryostimulation (WBCT) is becoming popular in medicine and sport as an adjuvant form of treatment since late 1970s. Only a few works concerning antioxidant protection after WBCT have been published. The aim of this study was to determine the eVect of a ten 3-min-long exposures (one exposure per day) to cryogenic temperature (¡130°C) on the level of total antioxidant status (TAS), activity of selected antioxidant enzyme superoxide dismutase (SOD) and main non-enzymatic antioxidant—uric acid (UA) in WBCT study group (man n = 24; female n = 22) and non-WBCT control subjects (man n = 22; female n = 26). Moreover, we evaluated the lipid peroxidation measured as thiobarbituric acid reactive substances products. Their blood samples were collected twice at an interval of 10 days in both study group and control subjects. The activity of antioxidant enzyme and lipid peroxidation was assayed in erythrocytes, while the concentration of uric acid was measured in plasma. After completing a total of ten WBCT sessions a signiWcant increase (p < 0.001) of TAS and UA levels in plasma (p < 0.001) in comparison to non-WBCT was observed. Our data showed that there was statistically signiWcant increase of the activities of SOD in erythrocytes obtained from WBCT study group compared to non-WBCT controls after 10 days of treatment (p < 0.001). It was concluded that expositions to extremely low temperatures use in cryostimulation improve the antioxidant capacity of organism.

Full Text: EVect of short-term cryostimulation on antioxidative status and its clinical applications in humans

Whole Body Cryotherapy | Benefits Overview
  • Motor activities and physical efficiency
  • Cardiovascular response
  • Lipid profiles
  • Hematology
  • Hormones
  • Antioxidant defense system
  • Immunology and inflammation
  • Recovery from exercise-induced muscle damage

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Neuromuscular adaptation after repeated exposure to whole-body cryotherapy (−110 °C)

The aim of the study was to evaluate the effects of single and repeated whole-body cryotherapy (WBC, air −110 °C) on the neuromuscular performance in healthy subjects (n=14). The flight times in a drop-jump exercise decreased after a single WBC exposure, but these changes almost vanished after repeated WBC for 3 months. This adaptation was accompanied by a decreased co-contraction of lower leg muscles during the drop-jump. In conclusion, in dynamic exercise, neuromuscular functioning may be able to adapt to repeated WBC, which might enhance the effects of therapeutic exercises in patients after the WBC.

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Post Surgical Recovery

Is cold therapy really efficient after knee arthroplasty?

Introduction: Knee arthroplasty is a frequently used surgery. The purpose of this study is to evaluate the effects of cold therapy after knee arthroplasty. Methods: 60 patients who were operated in our clinic between the years 2013 and 2014 were evaluated prospectively, and the patients were randomized into two groups. The cold therapy by Cryo/Cuff application was started 2 h before the surgery in Group-2 patients; it was repeated in a postoperative 6th hour and continued for postoperative four days. We analyzed the visual analog scales (VAS) for pain, Knee Society Scores (KSS), hemoglobin, and bleeding parameters.

Results: The data of the group that did not receive the Cryo/Cuff application (Group-1) are as follows; the number of the patients was 33; the mean age value was 68,4 (53e78). Group-2 data was as follows; the number of the patients was 27; the mean age value was 67.2 years (range 57e78). The mean KSS scores of the patients increased from 79.6 (75e83) and to 90.5 (88e92) postoperatively (p < 0.05).

Discussion: In our study, the pain and functional knee scores of the patients who received Cryo/Cuff application were significantly different and as expected, the use of analgesics was much lower. Cryotherapy did not affect the amount of bleeding during the surgery (p > 0.05), which was not reported previously in the literature.

Conclusion: After knee arthroplasty, the preoperative and postoperative use of cryotherapy is effective in terms of the pain control and functional knee scores without a significant change in surgical blood loss

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Athletes & Fitness

Impact of 10 sessions of whole body cryostimulation on aerobic and anaerobic capacity and on selected blood count parameters
The systemic effect of low temperature suggests that sessions in a cryogenic chamber might improve athletes’ capacity as a standard element of training. Therefore the authors decided to evaluate the impact of 10 sessions of whole body cryostimulation (WBCT) on aerobic and anaerobic efficiency as well as on selected blood count parameters. The study group included 32 volunteers – 16 women and 16 men. The volunteers underwent 10 sessions of WBCT in a cryogenic chamber. Blood samples (RBC, WBC, PLT, HGB, HCT) were taken, and aerobic and anaerobic efficiency and lactate concentration in capillary blood were measured before the first session and one day after the last one. No significant differences were observed in values of aerobic capacity after 10 sessions of WBCT. There was a rising trend in men and a declining trend in women. The lactate concentration did not differ significantly before and after WBCT. A slight rise in aerobic and anaerobic threshold was observed in men, while in women the values slightly fell. The Wingate test showed no significant differences in results before and after cryostimulation. Only the TOBT was significantly shorter in men (6.12± 1.49 vs 3.79± 1.14 s). The WBCT sessions resulted in a significant rise of the haematological parameters both in women and men, excluding HCT, which showed a statistically insignificant rise. Ten sessions of whole body cryostimulation did not affect aerobic or anaerobic capacity in the tested group, although it improved the blood count parameters.
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Effects of the whole-body cryotherapy on NTproBNP, hsCRP and troponin I in athletes.

Whole-body cryotherapy refers to brief exposure to very cold air for treating symptoms of various illnesses. In sports medicine, whole-body cryotherapy is administered to improve recovery from muscular trauma. As specific studies are lacking, we measured cardiac markers in 10 top-level rugby players of the Italian National team before and after a 1-week course of daily sessions of whole-body cryotherapy. All subjects continued with the same training workload as that of the previous weeks. N-terminal pro B-type natriuretic peptide (NTproBNP) levels increased but remained within the normal range, whilst troponin I (TnI) and high sensitivity C-reactive protein (hsCRP) were unchanged. Whole-body cryotherapy did not impair cardiac function in this sample of elite athletes.

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Beneficial Effects Of The Whole-Body Cryotherapy On Sport Haemolysis

Background. Sport’s anemia is a common risk for athletes. The principal source of an accelerated turnover of the erythrocytes in sportsmen is the intravascular hemolysis. This phenomenon is induced by mechanical breakage for impact of feet and muscular contractions, but also by osmotic changes causing membrane fragility, typically evident after exercise, when free radicals are increased. Wholebody cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking.

Design and Methods. We recruited ten rugby players of the Italian National Team. In these athletes we measured hematological parameters, before including mean sphered cell volume (MSCV) by means of Coulter LH750, besides of haptoglobin, and after WBC. The subjects underwent five sessions on alternate days once daily for one week. During the study period, the training workload was the same as that of the previous weeks.

Results. We observed in the athletes increase of haptoglobin and an increase of MSCV after the treament period.

Conclusions. WBC reduces sports haemolysis, as judged from MSCV and haptoglobin data, supported from other haematological values, as well as the absence of mean corpuscolar volume and reticulocytes increase. The treatment is useful to prevent the physiological impairments derived from sport haemolysis.

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The effects of a single whole body cryotherapy exposure on physiological, performance and perceptual responses of professional academy soccer players following repeated sprint exercise.
In professional youth soccer players, the physiological, performance and perceptual effects of a single whole body cryotherapy (WBC) session performed shortly after repeated sprint exercise were investigated. In a randomized, counter-balanced and crossover design, 14 habituated English Premier League academy soccer players performed 15 x 30 m sprints (each followed by a 10 m forced deceleration) on two occasions. Within 20 min of exercise cessation, players entered a WBC chamber (Cryo: 30 s at -60[degrees]C, 120 s at -135[degrees]C) or remained seated (Con) indoors in temperate conditions (~25[degrees]C). Blood and saliva samples, peak power output (countermovement jump) and perceptual indices of recovery and soreness were assessed pre-exercise and immediately, 2 h and 24 h post-exercise. When compared to Con, a greater testosterone response was observed at 2 h (+32.5 +/- 32.3 pg[BULLET OPERATOR]ml-1, +21%) and 24 h (+50.4 +/- 48.9 pg[BULLET OPERATOR]ml-1, +28%) post-exercise (both P=0.002) in Cryo (trial x treatment interaction: P=0.001). No between trial differences were observed for other salivary (cortisol and testosterone/cortisol ratio), blood (lactate and Creatine Kinase), performance (peak power output) or perceptual (recovery or soreness) markers (all trial x treatment interactions: P>0.05); all of which were influenced by exercise (time effects: all P<0.05). A single session of WBC performed within 20 min of repeated sprint exercise elevated testosterone concentrations for 24 h but did not affect any other performance, physiological or perceptual measurements taken. While unclear, WBC may be efficacious for professional soccer players during congested fixture periods.
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Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. An Updated Review of the Literature
Nowadays, whole-body cryotherapy is a medical physical treatment widely used in sports medicine. Recovery from injuries (e.g., trauma, overuse) and after-season recovery are the main purposes for application. However, the most recent studies confirmed the anti-inflammatory, anti-analgesic, and anti-oxidant effects of this therapy by highlighting the underlying physiological responses. In addition to its therapeutic effects, whole-body cryotherapy has been demonstrated to be a preventive strategy against the deleterious effects of exercise-induced inflammation and soreness. Novel findings have stressed the importance of fat mass on cooling effectiveness and of the starting fitness level on the final result. Exposure to the cryotherapy somehow mimics exercise, since it affects myokines expression in an exercise-like fashion, thus opening another possible window on the therapeutic strategies for metabolic diseases such as obesity and type 2 diabetes. From a biochemical point of view, whole-body cryotherapy not always induces appreciable modifications, but the final clinical output (in terms of pain, soreness, stress, and post-exercise recovery) is very often improved compared to either the starting condition or the untreated matched group. Also, the number and the frequency of sessions that should be applied in order to obtain the best therapeutic results have been deeply investigated in the last years. In this article, we reviewed the most recent literature, from 2010 until present, in order to give the most updated insight into this therapeutic strategy, whose rapidly increasing use is not always based on scientific assumptions and safety standards.
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Influence of the ten sessions of the whole body cryostimulation on aerobic and anaerobic capacity.

OBJECTIVES: The aim of this study was to determine the influence of whole body cryostimulation on aerobic and anaerobic capacities.
MATERIALS AND METHODS: To test the hypothesis that whole body cryostimulation improves physical capacity, thirty subjects (fifteen males and fifteen females) undertook two ergocycle trials before and after the ten sessions of cryogenic chamber treatment. To assess baseline aerobic capacity, the progressive cycle ergometer test was applied. This allowed determination of maximal oxygen uptake and ventilatory thresholds. Twenty-second Wingate test was performed to assess baseline levels of anaerobic power. After finishing the treatments in the cryogenic chamber, the exercise protocol was repeated. Before the first, and after the last whole body cryostimulation, venous blood samples were drawn to determine basic blood values, including levels of erythrocytes, leukocytes and thrombocytes, hemoglobin concentration, and hematocrit.
RESULTS: There were no changes in aerobic capacity, in both females and males, after ten sessions of 3-minute-long exposures to cryogenic temperature (-130 degrees C). Participation in the whole body cryostimulation caused an increase in maximal anaerobic power in males (from 11.1 to 11.9 W x kg(-1); P < 0.05), but not in females.
CONCLUSIONS: It can be concluded that whole body cryostimulation can be beneficial, at least in males, for increasing anaerobic capacity in sport disciplines involving speed and strength.

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Whole-body cryostimulation in kayaker women: a study of the effect of cryogenic temperatures on oxidative stress after the exercise.

AIM: The aim of this study was to determine the effect of whole-body cryostimulation on the activity of selected antioxidant enzymes and the concentration of lipid peroxidation products in kayaker women in the course of training.
METHODS: The study was performed on the group of 9 kayaker women, who underwent two training cycles: one typical ten-day training cycle and the another ten-day cycle preceded by cryostimulation sessions twice a day. The activity of antioxidant enzymes was assayed in erythrocytes, while the concentration of lipid peroxidation products was measured both in erythrocytes and in blood plasma.
RESULTS: A statistically significant increase in superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity in erythrocytes and in concentration of conjugated dienes (CD) in blood plasma and erythrocytes and thiobarbituric acid reactive substances (TBARS) in plasma was revealed in kayaker women after the first six days of training without cryostimulation. Comparing two performed training cycles, after the first six days of training preceded by cryostimulation lower SOD and GPx activity in erythrocytes was detected, as well as lower CD levels in blood plasma and erythrocytes and lower TBARS concentration in blood plasma of kayaker women than after the six days of training without cryostimulation.
CONCLUSIONS: Whole-body cryostimulation improves the antioxidant capacity of organism exposed to intense exercise. Brief application of cryogenic temperatures is likely related to the activation of adaptive homeostatic mechanisms in accordance with the hormetic dose-response model.

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Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise.

The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.

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The influence of single whole body cryostimulation treatment on the dynamics and the level of maximal anaerobic power

Objectives: The objective of this work was to determine the dynamics of maximal anaerobic power (MAP) of the lower limbs, following a single whole body cryostimulation treatment (WBC), in relation to the temperature of thigh muscles. Materials and

Methods: The subjects included 15 men and 15 women with an average age (±SD) of 21.6±1.2 years. To evaluate the level of anaerobic power, the Wingate test was applied. The subjects were submitted to 6 WBC treatments at –130°C once a day. After each session they performed a single Wingate test in the 15, 30, 45, 60, 75 and 90th min after leaving the cryogenic chamber. The order of the test was randomized. All Wingate tests were preceded by an evaluation of thigh surface temperature with the use of a thermovisual camera.

Results: The average thigh surface temperature (Tav) in both men and women dropped significantly after the whole body cryostimulation treatment, and next increased gradually. In women Tav remained decreased for 75 min, whereas in men it did not return to the basal level until 90th min. A statistically insignificant decrease in MAP was observed in women after WBC. On the contrary, a non-significant increase in MAP was observed in men. The course of changes in MAP following the treatment was similar in both sexes to the changes in thigh surface temperature, with the exception of the period between 15th and 30th min. The shorter time to obtain MAP was observed in women till 90th min and in men till 45 min after WBC compared to the initial level.

Conclusions: A single whole body cryostimulation may have a minor influence on short-term physical performance of supramaximal intensity, but it leads to improvement of velocity during the start as evidenced by shorter time required to obtain MAP.

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Time-course of changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise.

The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.

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Effect of whole body cryotherapy on the levels of some hormones in professional soccer players

INTRODUCTION: The study was undertaken to determine blood serum concentrations of selected steroid hormones (estradiol–E(2), testosterone–T, dehydroepiandrosterone sulfate–DHEA-S) and luteinizing hormone (LH) in professional footballers subjected to whole body cryotherapy.

MATERIAL AND METHODS: Twenty-two clinically healthy males, mean age 26.7 years, were studied. The subjects underwent ten sessions of whole body cryotherapy in Wroclaw-type chamber, with kinesitherapy following each session. Blood samples were collected before and two days after the treatment and the results were analyzed statistically.
RESULTS: After the treatment there was a significant decrease in the concentrations of T (6.01 vs. 4.80 ng/mL, p < 0.01) and E(2) (102.3 vs. 47.5 pg/mL, p < 0.00001), but no DHEA-S and LH. The T/E(2) ratio showed a significant increase form 72.2 to 136.5 (p < 0.01).
CONCLUSIONS: Whole body cryotherapy leads to a significant decrease in serum T and E(2), with no effect on LH and DHEAS levels. As a results of cryotherapy, the T/E(2) ratio was significant increased. The changes observed are probably due to cryotherapy-induced alternation in the blood supply to the skin and subcutaneous tissue, as well as to modulation of the activity of aromatase which is responsible for conversion of testosterone and androstenedione to estrogens.

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Effects of Whole-Body Cryotherapy vs. Far-Infrared vs. Passive Modalities on Recovery from Exercise-Induced Muscle Damage in Highly-Trained Runners

Enhanced recovery following physical activity and exercise-induced muscle damage (EIMD) has become a priority for athletes. Consequently, a number of post-exercise recovery strategies are used, often without scientific evidence of their benefits. Within this framework, the purpose of this study was to test the efficacy of whole body cryotherapy (WBC), far infrared (FIR) or passive (PAS) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race. In 3 non-adjoining weeks, 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill, designed to induce muscle damage. Immediately (post), post 24 h, and post 48 h after exercise, all participants tested three different recovery modalities (WBC, FIR, PAS) in a random order over the three separate weeks. Markers of muscle damage (maximal isometric muscle strength, plasma creatine kinase [CK] activity and perceived sensations [i.e. pain, tiredness, well-being]) were recorded before, immediately after (post), post 1 h, post 24 h, and post 48 h after exercise. In all testing sessions, the simulated 48 min trail run induced a similar, significant amount of muscle damage. Maximal muscle strength and perceived sensations were recovered after the first WBC session (post 1 h), while recovery took 24 h with FIR, and was not attained through the PAS recovery modality. No differences in plasma CK activity were recorded between conditions. Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities.

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Five-Day Whole-Body Cryostimulation, Blood Inflammatory Markers, and Performance in High Ranking Professional Tennis Players

Context: Tournament season can provoke overreaching syndrome in professional tennis players, which may lead to deteriorated performance. Thus, appropriate recovery methods are crucial for athletes in order to sustain high-level performance and avoid injuries. We hypothesized that whole-body cryostimulation could be applied to support the recovery process.

Objective: To assess the effects of 5 days of whole-body cryostimulation combined with moderate-intensity training on immunologic, hormonal, and hematologic responses; resting metabolic rate; and tennis performance in a posttournament season.

Design: Controlled laboratory study. Setting: National Olympic Sport Centre. Patients or Other Participants: Twelve high-ranking professional tennis players. Intervention(s): Participants followed a moderate-intensity training program. A subgroup was treated with the 5-day wholebody cryostimulation (1208C) applied twice a day. The control subgroup participated in the training only.

Main Outcome Measure(s): Pretreatment and posttreatment blood samples were collected and analyzed for tumor necrosis factor a, interleukin 6, testosterone, cortisol, and creatine kinase. Resting metabolic rate and performance of a tennis drill were also assessed.

Results: Proinflammatory cytokine (tumor necrosis factor a) decreased and pleiotropic cytokine (interleukin 6) and cortisol increased in the group exposed to cryostimulation. In the same group, greater stroke effectiveness during the tennis drill and faster recovery were observed. Neither the training program nor cryostimulation affected resting metabolic rate.

Conclusions: Professional tennis players experienced an intensified inflammatory response after the completed tournament season, which may lead to overreaching. Applying wholebody cryostimulation in conjunction with moderate-intensity training was more effective for the recovery process than the training itself. The 5-day exposure to cryostimulation twice a day ameliorated the cytokine profile, resulting in a decrease in tumor necrosis factor a and an increase in interleukin 6.

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Whole-Body Cryotherapy in Athletes

Cold therapy is commonly used as a procedure to relieve pain symptoms, particularly in inflammatory diseases, injuries and overuse symptoms. A peculiar form of cold therapy (or stimulation) was proposed 30 years ago for the treatment of rheumatic diseases. The therapy, called whole-body cryotherapy (WBC), consists of exposure to very cold air that is maintained at -110C to -140C in special temperature-controlled cryochambers, generally for 2 minutes. WBC is used to relieve pain and inflammatory symptoms caused by numerous disorders, particularly those associated with rheumatic conditions, and is recommended for the treatment of arthritis, fibromyalgia and ankylosing spondylitis. In sports medicine, WBC has gained wider acceptance as a method to improve recovery from muscle injury. Unfortunately, there are few papers concerning the application of the treatment on athletes. The study of possible enhancement of recovery from injuries and possible modification of physiological parameters, taking into consideration the limits imposed by antidoping rules, is crucial for athletes and sports physicians for judging the real benefits and/or limits of WBC.

According to the available literature, WBC is not harmful or detrimental in healthy subjects. The treatment does not enhance bone marrow production and could reduce the sport-induced haemolysis. WBC induces oxidative stress, but at a low level. Repeated treatments are apparently not able to induce cumulative effects; on the contrary, adaptive changes on antioxidant status are elicited – the adaptation is evident where WBC precedes or accompanies intense training. WBC is not characterized by modifications of immunological markers and leukocytes, and it seems to not be harmful to the immunological system. The WBC effect is probably linked to the modifications of immunological molecules having paracrine effects, and not to systemic immunological functions. In fact, there is an increase in antiinflammatory cytokine interleukin (IL)-10, and a decrease in proinflammatory cytokine IL-2 and chemokine IL-8. Moreover, the decrease in intercellular adhesion molecule-1 supported the anti-inflammatory response. Lysosomal membranes are stabilized by WBC, reducing potential negative effects on proteins of lysosomal enzymes. The cold stimulation shows positive effects on the muscular enzymes creatine kinase and lactate dehydrogenase, and it should be considered a procedure that facilitates athletes’ recovery. Cardiac markers troponin I and high-sensitivity C-reactive protein, parameters linked to damage and necrosis of cardiac muscular tissue, but also to tissue repair, were unchanged, demonstrating that there was no damage, even minimal, in the heart during the treatment. N-Terminal pro B-type natriuretic peptide (NT-proBNP), a parameter linked to heart failure and ventricular power decrease, showed an increase, due to cold stress. However, the NT-proBNP concentrations observed after WBC were lower than those measured after a heavy training session, suggesting that the treatment limits the increase of the parameter that is typical of physical exercise. WBC did not stimulate the pituitary-adrenal cortex axis: the hormonal modifications are linked mainly to the body’s adaptation to the stress, shown by an increase of noradrenaline (norepinephrine).

We conclude that WBC is not harmful and does not induce general or specific negative effects in athletes. The treatment does not induce modifications of biochemical and haematological parameters, which could be suspected in athletes who may be cheating. The published data are generally not controversial, but further studies are necessary to confirm the present observations.

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The effect of whole-body cryostimulation on the prooxidant-antioxidant balance in blood of elite kayakers after training.

The effect of whole-body cryostimulation prior to kayak training on the prooxidant-antioxidant balance was evaluated and compared to the effect of a single cryostimulation treatment in untrained men. The kayakers underwent a ten-day training cycle with pre-training daily whole-body cryostimulation for three min (temperature: -120 to -140 degrees C) and training without cryostimulation as a control. Blood samples were obtained before and after the sixth and the tenth day of training and from the untrained men before and 20 min after cryostimulation. In untrained men cryostimulation induced an increase in the activity of superoxide dismutase (SOD) by 36% (P<0.001) and glutathione peroxidase (GPx) by 68% (P<0.01) in the erythrocytes and an increase in the conjugated dienes (CD) in plasma by 36% (P<0.05) and in the erythrocytes by 71% (P<0.001). In the kayakers comparing both types of training after the sixth day, the level of CD in plasma was 46 (P<0.001) and 40% (P<0.01) lower in erythrocytes, and the concentration of thiobarbituric acid-reactive substances in plasma was 24% (P<0.05) lower with pre-training cryostimulation. After the sixth day of training with cryostimulation, SOD activity was also 47% (P<0.001) lower, while GPx activity after the tenth day was reduced by more than 50% (P<0.01) as compared to control training. Whole-body cryostimulation per se stimulates the generation of reactive oxygen species. Yet, the oxidative stress induced by kayak training was reduced by prior exposure to extremely low temperatures.

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Physical Exercise Combined with Whole-Body Cryotherapy in Evaluating the Level of Lipid Peroxidation Products and Other Oxidant Stress Indicators in Kayakers

The influence of exercise combined with whole-body cryotherapy (WBC) on the oxidant/antioxidant balance in healthy men was assessed. The study included 16 kayakers of the Polish National Team, aged 22.7 ± 2.6, subjected to WBC (−120∘ C–−145∘ C; 3 min) twice a day for the first 10 days of a 19-day physical training cycle: pre exercise morning stimulation and post exercise afternoon recovery. Blood samples were taken on Day 0 (baseline) and on Days 5, 11 and 19. The serum concentration of malondialdehyde (MDA), conjugated dienes (CD), thiobarbituric acid reactive substances (TBARS), protein carbonyls, vitamin E, urea, cortisol, and testosterone were determined, along with the glutathione peroxidase (GPx) activity, the total antioxidant capacity (TAC), and morphological blood parameters. On 5th day of exercise/WBC, the baseline GPx activity decreased by 15.1% (? < 0.05), while on 19th day, it increased by 19.7% (? < 0.05) versus Day 5. On Day 19 TBARS concentration decreased versus baseline and Day 5 (by 15.9% and 17.4%, resp.; ? < 0.01). On 19 Day urea concentration also decreased versus 11 Day; however, on 5th and 11th days the level was higher versus baseline. Combining exercise during longer training cycles with WBC may be advantageous.

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The Effect of Submaximal Exercise Preceded by Single Whole-Body Cryotherapy on the Markers of Oxidative Stress and Inflammation in Blood of Volleyball Players

The aim of the study was to determine the effect of single whole-body cryotherapy (WBC) session applied prior to submaximal exercise on the activity of antioxidant enzymes, the concentration of lipid peroxidation products, total oxidative status, and the level of cytokines in blood of volleyball players. The study group consisted of 18 male professional volleyball players, who were subjected to extremely cold air (−130∘ C) prior to exercise performed on cycloergometer. Blood samples were taken five times: before WBC, after WBC procedure, after exercise preceded by cryotherapy (WBC exercise), and before and after exercise without WBC (control exercise). The activity of catalase statistically significantly increased after control exercise. Moreover, the activity of catalase and superoxide dismutase was lower after WBC exercise than after control exercise (? < 0.001). After WBC exercise, the level of IL- 6 and IL-1? was also lower (? < 0.001) than after control exercise. The obtained results may suggest that cryotherapy prior to exercise may have some antioxidant and anti-inflammatory properties. The relations between the level of studied oxidative stress and inflammatory markers may testify to the contribution of reactive oxygen species in cytokines release into the blood system in response to exercise and WBC.

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Hormones & Bloodwork

Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females.

OBJECTIVE: Cold therapy is used to relieve pain and inflammatory symptoms. The present study was designed to determine the influence of long-term regular exposure to acute cold temperature. Two types of exposure were studied: winter swimming in ice-cold water and whole-body cryotherapy. The outcome was investigated on humoral factors that may account for pain alleviation related to the exposures.
MATERIAL AND METHODS: During the course of 12 weeks, 3 times a week, a group of healthy females (n = 10) was exposed to winter swimming (water 0-2 degrees C) for 20 s and another group (n = 10) to whole-body cryotherapy (air -110 degrees C) for 2 min in a special chamber. Blood specimens were drawn in weeks 1, 2, 4, 8 and 12, on a day when no cold exposure occurred (control specimens) and on a day of cold exposures (cold specimens) before the exposures (0 min), and thereafter at 5 and 35 min.
RESULTS: Plasma ACTH and cortisol in weeks 4-12 on time-points 35 min were significantly lower than in week 1, probably due to habituation, suggesting that neither winter swimming nor whole-body cryotherapy stimulated the pituitary-adrenal cortex axis. Plasma epinephrine was unchanged during both experiments, but norepinephrine showed significant 2-fold to 3-fold increases each time for 12 weeks after both cold exposures. Plasma IL-1-beta, IL-6 or TNF alpha did not show any changes after cold exposure.
CONCLUSIONS: The main finding was the sustained cold-induced stimulation of norepinephrine, which was remarkably similar between exposures. The frequent increase in norepinephrine might have a role in pain alleviation in whole-body cryotherapy and winter swimming.

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Effects of repeated whole-body cold exposures on serum concentrations of growth hormone, thyrotropin, prolactin and thyroid hormones in healthy women.

Cold therapy is used to relieve pain and inflammatory symptoms. Humoral changes may account for the pain alleviation related to the cold exposures. The aim of the present study was to examine the effects of two types of cold therapy, winter swimming in ice-cold water (WS) and whole body cryotherapy (WBC), on the serum levels of the growth hormone, prolactin, thyrotropin and free fractions of thyroid hormones (fT3, fT4). One group of healthy females (n = 6) was exposed to WS (water 0-2 degrees C) for 20 s and another group (n = 6) to WBC (air 110 degrees C) for 2 min, three times a week for 12 weeks. Blood samples used for the hormone measurements were taken on weeks 1, 4 and 12 before and 35 min after the cold exposures and on the days of the respective weeks, when the cold exposures were not performed. During the WS treatments, serum thyrotropin increased significantly at 35 min on weeks 1 (p < 0.01) and 4 (p < 0.05), but the responses were within the health-related reference interval. During the WS, the serum prolactin measured at 35 min on week 12 was lower than during the control treatment, and no changes in fT3 or fT4 were observed. During the WBC, no changes in the serum levels of the studied hormones were observed during the 12 weeks. In conclusion, repeated WS and WBC treatments for healthy females do not lead to disorders related to altered secretions of the growth hormone, prolactin, thyrotropin, or thyroid hormones.

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Changes in lipid profile in response to three different protocols of whole-body cryostimulation treatments.

Systemic cryostimulation is useful treatment, both in sport and medicine, during which human body is exposed to very low, cryogenic temperature (below -100 degrees C). Although there exists some evidence of its beneficial effect in biological regeneration, so far it has not been unequivocally determined if the positive effect of repeated stimulations depends on their number in a series. The aim of this research was to estimate the influence of 5, 10 and 20 sessions of 3 min-long exposures to cryogenic temperature (-130 degrees C) on the lipid profile in physically active men. Sixty-nine healthy volunteers participated in the study. The blood samples were taken in the morning, after overnight fasting, before the first cryostimulation session, and the following morning after the last one (5th,10th, 20th). In serum specimens the concentration of total cholesterol (TCh), HDL cholesterol and triglicerydes were determined using enzymatic methods. LDL cholesterol level was calculated using Friedewald formula. The changes in lipid profile (LDL decrease with simultaneously HDL increase) occurred after at least 10 sessions of cryostimulation.

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Physical Therapy & Rehab

Cryotherapy: Physiological Considerations and Applications to Physical Therapy

Contemporary cryogenics has been developing from the end of the 19th century since the liquefaction of oxygen, nitrogen, carbon dioxide and hydrogen, and also the industrial production and storage of liquid coolants, enabled the development of cryobiology and the use of extremely low temperatures in medicine. The term “cryotherapy” was first used in 1908 by A.W. Pusey to describe the treatment of skin lesions with very low temperatures [Zagrobelny et al. 1999; Jezierski 2006;]. Currently, cryotherapy refers to various treatments aimed at lowering the body surface temperature without tissue destruction, whereas in cryosurgery diseased tissues are destroyed through freezing. The world’s first cryogenictemperature chamber was set up in Japan, in 1978. Thanks to Yamauchi and his team, cryotherapy began to be widely used in medicine [Zagrobelny 2003; Skrzek 2009]. The clinical application of low temperatures is recommended for inflammatory conditions, such as swelling and acute localised pain. It is essential to clarify the distinction and clear labelling of methods based on low temperature usage and the intended purpose, as the body’s response to low temperature depends on the temperature, method of application, exposure time, method and rate of heat loss, humidity of the cooled air, and the characteristics and age of the subjects. Cryostimulation requires making use of a suitable croyogenic liquid as a coolant source. It is based on the use of very low temperatures (-100ºC and lower) in order to induce a physiological reaction to cold. A different category of treatment in modern medicine and rehabilitation, the cooling of tissues, is based on different methods and rates of tissue heat loss using various temperatures and methods of application achieved by the use of bags of ice, frozen silicone gel, salt solution, wet cold (which is not tolerated well by many people), partial bathing in cold water or whole body bath (temperature below 10ºC). Cooling results in heat loss, the treated body area experiences vasoconstriction, a long-duration decrease in the temperature of the exposed tissues, decrease in inflammatory reaction and inhibition of strong symptoms of inflammatory reaction, but without any stimulatory effect [Rawecka & Rokita, 2006].

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Arthritis

Whole-Body Cryotherapy In Inflammatory And Non-Inflammatory Rheumatic Diseases

Since 1999, our clinic is equipped with a whole-body cryochamber which is used to combat rheumatic disorders. The cryochamber design is a two-chamber system consisting of an antechamber with a temperature of approx. -60°C and a main chamber with a temperature of about -110°C. Patients change into bathing costume, trainers, gloves, nose mask and headband when they enter the chamber. At first, they stay in the antechamber for 1 minute, then they proceed to the main chamber with a temperature of -110°C where they keep moving for up to 3 minutes. After the first year of operation, the gathered data were critically evaluated to take stock.

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Whole-body cryotherapy in patients with inflammatory rheumatic disease. A prospective study

BACKGROUND: As yet, whole-body cryotherapy is especially used for the therapy of chronic inflammatory arthritis. An analgetic effect has been described in several studies. However, only few data exist concerning the long-term effects of this therapy.
PATIENTS AND METHODS: A total of 60 patients with rheumatoid arthritis (n = 48), and ankylosing spondylitis (n = 12) was analyzed. Patients underwent treatment with whole-body cryotherapy twice a day. The average age was 55.7 +/- 10.33. The study group consisted of 48 female and twelve male patients. The average number of therapeutic treatments with cryotherapy was 15.8 +/- 8.37, the average follow-up 63.4 +/- 63.48 days.
RESULTS: 13 patients (21.7%) discontinued treatment because of adverse effects. For patients with rheumatoid arthritis, DAS28 (Disease Activity Score) and VAS (visual analog scale) were determined. A significant reduction of both parameters was found (DAS 3.9 +/- 1.22 vs. 3.4 +/- 1.08; p < 0.01; VAS 51.4 +/- 16.62 vs. 37.9 +/- 19.13; p < 0.01). BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was analyzed for patients with ankylosing spondylitis, and also showed a significant reduction (4.4 +/- 1.91 vs. 3.1 +/- 1.34; p = 0.01).
CONCLUSION: Thus, whole-body cryotherapy is an effective option in the concept of treatment of inflammatory rheumatic diseases. The relief of pain allows an intensification of physiotherapy. A significant reduction of pain over a period of 2 months could be shown.

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Serial whole-body cryotherapy in the criostream for inflammatory rheumatic diseases. A pilot study

BACKGROUND AND PURPOSE: Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]alpha and interleukin-[IL-]1), and improvement in functional scores.
PATIENTS AND METHODS: Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time).
RESULTS: Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-alpha (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold).
CONCLUSION: The criostream offers an elegant and, from the patient’s point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.

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Cryotherapy in inflammatory rheumatic diseases: a systematic review

The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed 10 a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA 15 patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. 20 However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.

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Cryotherapy decreases histamine levels in the blood of patients with rheumatoid arthritis.

INTRODUCTION: Conventional physiotherapy (electrotherapy, magnetic fields), kinesitherapy, and whole-body cryotherapy (plus kinesitherapy) are used to relieve pain and inflammation or to improve function in rheumatic diseases. The aim of this study was to investigate the effects of different physiotherapies and cryotherapy on biochemical blood parameters of patients with rheumatoid arthritis (RA) and osteoarthritis (OA).
MATERIALS AND METHODS: Twenty patients with RA and 17 patients with OA received whole-body cryotherapy at -140 to -160 degrees C for 2 to 3 min, once daily for 4 weeks. The second group of patients (24 with RA and 28 with OA) received conventional physiotherapy for 4 weeks. We measured the parameters of neutrophil activation (respiratory burst, calprotectin) and markers of cartilage metabolism [N-acetyl-beta-D-hexosaminidase (NAHase), ectonucleotide pyrophosphohydrolase (NTPPHase)] twice: before and 3 months after cryotherapy or physiotherapy.
RESULTS: We showed, for the first time, that cryotherapy significantly reduced (P < 0.001) histamine levels in the blood of patients with RA. The effect was long-lasting (for at least 3 months). The levels of blood histamine in patients with OA were not changed significantly. Cryotherapy also downregulated the respiratory burst of PMNs and NAHase activity and upregulated calprotectin levels and the activity of NTPPHase. However, these changes were not statistically significant. In contrast, there were no significant changes in histamine levels or the other biochemical parameters measured in groups of patients treated only with physiotherapy and kinesitherapy.
CONCLUSION: It may be concluded that the beneficial clinical effects of cryotherapy in RA patients are in part due to the action on the production, release, or degradation of histamine.

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Effectiveness of different cryotherapies on pain and disease activity in active rheumatoid arthritis. A randomised single blinded controlled trial.

OBJECTIVE: Local cryotherapy is used to relieve pain and inflammation in injuries and inflammatory conditions. Whole-body cryotherapy is an extreme method administered at -110 degrees C for 2 to 3 minutes. The aim of the study was to compare the effect of cryotherapies on pain and inflammation in patients with rheumatoid arthritis (RA).
METHODS: Sixty patients with active seropositive RA were recruited in a randomised controlled single-blinded study to receive whole-body cryotherapy at -110 degrees C, whole-body cryotherapy at -60 degrees C, application of local cold air at -30 degrees C and the use of cold packs locally. In the final analysis, the last 2 groups were pooled. The patients had 2-3 cryotherapy sessions daily for one week plus conventional physiotherapy. Clinical and laboratory variables and patient’s and physician’s global assessments were used to assess the outcome. Disease activity was calculated by DAS.
RESULTS: Pain decreased in all treatment groups, most markedly in the whole-body cryotherapy (-110 degrees C) group. DAS decreased slightly with no statistically significant differences between the groups. No serious or permanent adverse effects were detected. Six of 40 patients (15%) discontinued the whole-body cryotherapy.
CONCLUSION: Pain seemed to decrease more in patients in the whole-body cryotherapy at -110 degrees C than during other cryotherapies, but there were no significant differences in the disease activity between the groups. However, cryotherapy at -110 degrees C is expensive and available only in special centres and may have minor adverse effects. Based on our results, whole-body cryotherapy at -110 degrees C is not superior to local cryotherapy commonly used in RA patients for pain relief and as an adjunct to physiotherapy.

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Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases--pilot study

Cryotherapy as a whole-body cold therapy (with cold air cooled by addition of nitrogen blown on the patients in an open cabin) for treatment of inflammatory rheumatic diseases already started in Bad Säckingen in 1986. In 1996, a new cold chamber (this time a closed chamber without any addition of nitrogen) based on compressor technology was introduced. The aim of our study was to test whether significant pain relief could be achieved by means of this cold therapy. Furthermore, we were interested in the practicability and acceptance of this new technique. Wellbeing during the treatment application and pain level were assessed using verbal and numerical rating scales. The sample consisted of 120 consecutive patients (75% women, age: 30-67 yrs, M = 52.6 yrs). These patients were suffering from primary fibromyalgia (40.7%), rheumatoid arthritis (17.3%), chronic low back pain (16.4%), ankylosing spondylitis (10.9%), osteoarthritis (9.1%), secondary fibromyalgia (3.6%) and other autoimmune diseases (1.8%) (mean duration of symptoms: 4 yrs). The patients were treated 2.5 minutes on average in the main chamber (mean temperature: -105 degrees C). The patients’ statements concerning their pain level were analyzed by means of analyses of variance with repeated measures and paired-sample t-tests.
RESULTS: The pain level after application of the cold therapy decreases significantly. The pain reduction lasts about 90 minutes. The initial pain level decreases during the whole time of treatment, no significant improvement, though, can be shown from the middle to the end of the four-weeks treatment. According to the results of our study, there is evidence that the whole-body cold therapy generates important short-term effects and somewhat weaker effects over the treatment period as a whole. Short-term pain reduction facilitates intensive application of physiotherapy and Occupational Therapy. The treatment procedure is practicable, and all in all well tolerated. From the patients’ point of view, whole-body cold therapy is an essential part of the rehabilitation programme.

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Hormonal and hemodynamic changes caused by whole body cooling in patients with rheumatoid arthritis

A limited number of experiments have shown that treatment of rheumatoid arthritis by means of cooling the entire body in cryogenic chamber reduces the pain in joints affected by inflammatory process and increases their mobility. The aim of the present thesis was to try explain the mechanisms responsible for the observed improvement of the patients’ condition, and an investigation of the treatment’s effect on selected hemodynamic indices. Tests were carried out on 63 patients with rheumatoid arthritis mainly in the 3rd and 4th stage of illness, all of whom had been treated for 14 days, once daily, by cooling the body for two-minute periods in cryogenic chamber with temperatures ranging from -110 degrees C to -160 degrees C, followed by kinesitherapy. It was demonstrated that after a single session in the cryogenic chamber, after 7 and 14 days the level of ACTH, cortisol and beta-endorphins in blood serum rises. The level of TSH, T4, T3, GH and 6-keto-PGF1 alpha+, however, remains unchanged. The cryogenic chamber treatment does not affect the heart rate, arterial blood pressure nor the value of the left ventricle fractional shortening index and its ejection, neither does it cause of arrhythmias and ischemic changes of the heart.

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Cryotherapy in osteoporosis

Cryotherapy is use of temperature lower than -100 degrees C onto body surface, for 2-3 minutes, in aim to cause physiological reactions for cold and to use such adapting reactions. Organism’s positive response to cryotherapy supports treatment of basic disease and facilitates kinesitherapy. Low temperature may be obtained by use of air flow cooled with liquid nitrogen; this could be applied either locally, over chosen part of the body, or generally, over the whole body, in cryosauna or in cryochamber. The most efficiently is applying cryotherapy twice a day, with at least 3 hours interval. Kinesitherapy is necessarily used after each cryotherapy session. Whole treatment takes 2 to 6 weeks, depending on patient’s needs. Cryotherapy reduces pain and swellings, causes skeletal muscles relaxation and increase of their force, also, motion range in treated joints increases. Thus, cryotherapy seems to fulfill all necessary conditions for rehabilitation in osteoporosis. Cryotherapy represents numerous advantages: it takes short time for applying, being well tolerated by patient, also patient’s status improves quickly. In addition, contraindications against cryotherapy are rare. All this makes cryotherapy a method for a broad use in prophylactics and treatment of osteoporosis.

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Adhesive Capsulitis (Frozen Shoulder)

Cryotherapy effective for treating frozen shoulder

In patients with adhesive capsulitis (AC) of the shoulder, the addition of whole-body cryotherapy (WBC) to physical
therapy and joint mobilization appears to be more effective than the latter two alone, research shows.
Indeed, patients receiving additional WBC achieved “clinically significant” improvements of over 20% relative to the
physical therapy and mobilization group, suggesting it could become “the preferred treatment strategy,” according
to Hyeong-Dong Kim (Korea University, Seoul) and colleagues.
In total, 30 patients with AC of the shoulder were randomly assigned to either a “WBC group,” which received WBC
in addition to physical therapy and passive joint mobilization of the shoulder, or a “non-WBC group,” which received
only physical therapy and passive joint mobilization.
Patients were assessed before and after treatment for pain, using the visual analogue scale (VAS); active range of
motion of flexion, abduction, internal and external rotation of the shoulder; and American Shoulder and Elbow
Surgeons Standardized Shoulder Assessment Form (ASES).
Kim et al report that, after 4 weeks of treatment, patients in both groups showed significant improvements in range
of motion, pain, and shoulder function.
However, the WBC group showed greater improvements on average than the non-WBC group

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Effects of Whole-Body Cryotherapy in the Management of Adhesive Capsulitis of the Shoulder

Objective: To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder.

Design: A randomized trial. Setting: Hospital.

Participants: Patients with AC of the shoulder (N30). Intervention: Patients were randomly assigned to 2 groups. The WBC group received physical therapy modalities, passive joint mobilization of the shoulder, and WBC, whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder.

Main Outcome Measures: Visual analog scale (VAS), active range of motion (ROM) of flexion, abduction, internal and external rotation of the shoulder, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were measured before and after the intervention.

Results: A statistically significant difference between groups was found for the VAS, active ROM of flexion, abduction, internal rotation, and external rotation, and the ASES with greater improvements in the WBC group (Ps.01). Overall, both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P.01.

Conclusions: There is significant improvement with the addition of WBC to treatment interventions in this sample of patients.

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Spine

Thermovision diagnostics in chosen spine diseases treated by whole body cryotherapy

The non-invasive infrared technique was used in case of the thermal imaging of patients suffering from spine diseases. Measurements were performed for the group of 50 patients during whole body cryotherapy at the second, fifth and tenth day of the rehabilitation cycle. An enhancement of the profile of skin temperature due to body cooling caused an increase in the diagnostic sensitivity of thermovision. The temperature parameters such as temperature contrast (DT = Tmax – Tmin) and relative change of contrast ratio defined as (DT)/(Tmean) in the region of interest (ROI’s) were used to point out differences between the healthy patients and patients suffering from ankylosing spondylitis, sciatica and spondyloarthrosis. The value of the thermovision diagnostic in the case of spine diseases was confirmed by statistical analysis.

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Effect of Whole Body Cryotherapy with Spinal Decompression on Cervical Disc Herniation by Digital Infrared Thermal Imaging

[Purpose] This study investigated the effects and safety of whole body cryotherapy (WBC) and spinal decompression on the pain, cervical function, and body surface temperature of cervical herniated nucleus pulposus (C-HNP) patients.

[Subjects] The subjects were 20 patients (6 males and 14 females) with cervical disc herniation (C5-6) who visited Hospital S in Daejeon, Korea.

[Methods] Treatment Group 1 (3 males and 7 females) received interference current therapy, ultrasonic therapy, spinal decompression therapy, and WBC. Treatment Group 2 (2 males and 8 females) received interference current therapy, ultrasonic therapy, and spinal decompression therapy.

[Results] Visual Analog Scale (VAS), Neck Disability Index (NDI), and differences in body surface temperatures between left and right upper extremity muscles decreased after treatment compared to prior to treatment. The group receiving spinal decompression and WBC application had a greater degree of change in VAS and NDI. However, change of body surface temperatures of the upper extremities after treatment between the two treatment groups was not statisticaly significant.

[Conclusion] A combination of spinal decompression therapy and WBC offers a safe and appropriate treatment for cervical disc herniation.

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The assessment of pelvic statics in patients with spinal overload syndrome treated in whole-body cryotherapy.

Background. In pain syndromes involving the lumbo-sacral region, the pelvis, and the lower extremities, the mobility of the hip joint is disrupted by structural and functional changes in tissues, which also cause irritation of the ligaments and muscles of the pelvis. Dislocation of the pelvis with incorrect alignment of the sacroiliac bone leads to an oblique load on the lumbar vertebrae and muscle tension. In recent years wholebodycryotherapy has come to be more and more often applied in the comprehensive treatment of spinal overload syndrome, to reduce pain, relax skeletal muscles, and increase joint mobility.

Material and method. The research was conducted in the SP ZOZ outpatient rehabilitation clinic in Zgorzelec, Poland, from December 2004 to March 2005. The study group consisted of 20 persons, 13 women (65%) and 7 men (35%), ranging in age from 23 to 77 years (mean age 47). Each of the subjects received wholebody cryotherapy in a 20-day cycle, once a day for 3 minutes at a temperature of -130 degrees C. The length of the pelvic muscles implicated in overload syndrome, the pain pressure of the pelvic ligaments, the Pidelou test, and Patrick’s symptom were assessed before therapy was commenced and after its completion. Immediately after each session thepatients received kinesitherapy under supervision of a physiotherapist, Magine exercises, post-isometric relaxation using Mitchel’s method for the muscles and the intraspinal, lumbo-sacral and ilio-lumbar ligaments, active of the lumbar spine in the non-painful direction, and neuromobilization using Butler’s method. This was supplemented by exercises on the ergometer in horizontal position.

Results. Wholebody cryotherapy applied together with kinesitherapy was effective in reducing pressure pain in the ligaments (average 20%) and tension in significant pelvic muscles (average 30%).

Conclusions. The cryotherapy and kinesitherapy combination applied to the treatment of spinal overload syndrome gives satisfactory clinical outcome.

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Ankylosing Spondylitis

The impact of whole-body cryotherapy on parameters of spinal mobility in patients with ankylosing spondylitis.

Background. The aim of our study was to assess the impact of wholebody cryotherapy with subsequent kinesitherapy on spinal mobility parameters in patients with ankylosing spondylitis.

Material and methods. We enrolled 32 men with ankylosing spondylitis in a clinical trial. The subjects were randomly divided into 2 groups consisting of 16 persons, with no significant differences in age, duration, or stage of disease, treatedwith a cycle of 10 wholebody cryotherapy procedures with subsequent kinesitherapy or kinesitherapy alone, respectively. Routine spinal mobility parameters were determined for all patients before and after the end of the therapeutic cycle.

Results. Significant improvement of spinal mobility was observed in both groups of patients, but in patients exposed to wholebody cryotherapy with subsequent kinesitherapy the percentage changes in the values of particular parameters were more distinct as compared to patients in whom kinesitherapy alone was used, mainly in respect to lumbar and thoracic spinal mobility.

Conclusion. The use of wholebody cryotherapy as a component of comprehensive therapy inpatients with ankylosing spondylitis produces significant improvements in spinal mobility parameters as compared to patients in whom kinesitherapy alone is used.

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Influence of Cryogenic Temperatures on Inflammatory Markers in Patients with Ankylosing Spondylitis

The aim of this study was to estimate the influence of cryogenic temperatures used for whole-body cryotherapy on inflammatory markers in patients with ankylosing spondylitis (AS) and healthy volunteers. The study involved 32 male persons: 16 patients with AS and 16 healthy volunteers. All subjects were exposed to a cycle of 10 daily procedures of whole-body cryotherapy at a temperature of -120°C lasting 2 minutes with subsequent kinesitherapy. In both groups, before and after a cycle of whole-body cryotherapy with subsequent kinesitherapy, serum C-reactive protein, fibrinogen, mucoprotein, soluble intercellular adhesion molecule-1 levels and erythrocyte sedimentation rate were estimated. The results of this study indicate that cryogenic temperatures used for whole-body cryotherapy decrease the levels of inflammatory markers both in patients with ankylosing spondylitis and healthy volunteers.

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The assessment of pelvic statics in patients with spinal overload syndrome treated in whole-body cryotherapy.

Background. In pain syndromes involving the lumbo-sacral region, the pelvis, and the lower extremities, the mobility of the hip joint is disrupted by structural and functional changes in tissues, which also cause irritation of the ligaments and muscles of the pelvis. Dislocation of the pelvis with incorrect alignment of the sacroiliac bone leads to an oblique load on the lumbar vertebrae and muscle tension. In recent years wholebodycryotherapy has come to be more and more often applied in the comprehensive treatment of spinal overload syndrome, to reduce pain, relax skeletal muscles, and increase joint mobility.

Material and method. The research was conducted in the SP ZOZ outpatient rehabilitation clinic in Zgorzelec, Poland, from December 2004 to March 2005. The study group consisted of 20 persons, 13 women (65%) and 7 men (35%), ranging in age from 23 to 77 years (mean age 47). Each of the subjects received wholebody cryotherapy in a 20-day cycle, once a day for 3 minutes at a temperature of -130 degrees C. The length of the pelvic muscles implicated in overload syndrome, the pain pressure of the pelvic ligaments, the Pidelou test, and Patrick’s symptom were assessed before therapy was commenced and after its completion. Immediately after each session thepatients received kinesitherapy under supervision of a physiotherapist, Magine exercises, post-isometric relaxation using Mitchel’s method for the muscles and the intraspinal, lumbo-sacral and ilio-lumbar ligaments, active of the lumbar spine in the non-painful direction, and neuromobilization using Butler’s method. This was supplemented by exercises on the ergometer in horizontal position.

Results. Wholebody cryotherapy applied together with kinesitherapy was effective in reducing pressure pain in the ligaments (average 20%) and tension in significant pelvic muscles (average 30%).

Conclusions. The cryotherapy and kinesitherapy combination applied to the treatment of spinal overload syndrome gives satisfactory clinical outcome.

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Multiple Sclerosis

Whole-body cryostimulation (cryotherapy) provides benefits for fatigue and functional status in multiple sclerosis patients. A case-control study.

OBJECTIVES: To study the effects of whole-body cryostimulation (WBC) on fatigue and functional status in multiple sclerosis (MS) patients with different levels of fatigue.
SUBJECTS AND METHODS: Two groups of 24 MS patients with fatigue were studied. At the beginning of the study, the first group presented a Fatigue Severity Scale (FSS) score between 38 and 42 (low-fatigue (LF) group), and the second group had an FSS score between 48 and 52 (high-fatigue (HF) group). Both groups were matched for age and sex. All patients were exposed to 10.3-min session of WBC (one exposure per day at -110°C or lower). Functional status was assessed before and after the series of WBC exposures using the Rivermead Motor Assessment (RMA), the Multiple Sclerosis Impact Scale (MSIS-29), and the Expanded Disability Status Scale (EDSS). The RMA was estimated in three sections: gross function (RMA1), leg and trunk (RMA2), and arm (RMA3). MSIS-29 consists of two subscales assessing the physical (MSIS-29-PHYS) and psychological (MSIS-29-PSYCH) status.
RESULTS: In both groups, the WBC sessions induced a significant improvement in the functional status and in the feeling of fatigue. However, the changes observed in HF patients were significantly greater than those observed in LF patients, especially in the MSIS-29-PHYS, MSIS-29-PSYCH, RMA1, and RMA3. The changes observed in the EDSS, RMA2, and FSS were similar in both groups.
CONCLUSIONS: WBC appears to be effective in improving functional status and the feeling of fatigue in patients with MS and especially in those who are the most fatigued.

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Effects of whole-body cryotherapy on a total antioxidative status and activities of antioxidative enzymes in blood of depressive multiple sclerosis patients.

OBJECTIVES: Oxidative stress (OS) plays an important role in the pathogenesis of multiple sclerosis (MS). In MS patients depression is often observed. Cryotherapy might have an effect on OS. The aim of this study was to compare the effects of whole body cryotherapy (WBCT) on changes in total antioxidative status (TAS) of plasma and activities of antioxidative enzymes in erythrocytes from depressive and non depressive MS patients.
METHODS: Twenty-two MS patients with secondary progressive disease course (12 depressive and 10 non depressive) were treated with 10 exposures in a cryochamber. Before and after WBCT the plasma TAS and the activities of superoxide dismutase (SOD) and catalase (CAT) in the erythrocytes were measured.
RESULTS: The level of TAS in depressive MS group was significantly lower than in non depressive MS (P < 0.0003). WBCT increased the level of TAS in depressive (P < 0.002) more than in non depressive MS patients (P < 0.01). WBCT treatment of MS patients resulted in the significant increase of TAS level in plasma but had no effects on activities of SOD and CAT.
CONCLUSIONS: Our results indicate that WBCT suppresses OS in MS patients, especially in depressive patients.

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Effect of whole body cryotherapy on uric acid concentration in plasma of multiple sclerosis patients

Many clinical studies show lower concentration of uric acid (UA) in plasma multiple sclerosis (MS) patients than in healthy controls.
UA has been suggested as a marker of disease activity. Increasing UA concentration has been proposed as a therapy for the treatment of neurodegenerative diseases including MS because of the neuroprotective properties of UA. Using whole body cryotherapy (WBCT) becoming popular in Poland because of improving functional activity of MS patients, decreased of spastisity and analgesic properties of cryogenic temperatures.
Material and methods. The study estimate UA concentration in plasma of MS patients (n=32) and healthy controls (n=35) before and after 10 (3 minutes) exposures of WBCT.
Results. UA concentration in plasma of MS patients 4.0±0.57 mg/dl is lower than in healthy controls (5,1 ±0.3 mg/dl). After using 10 exposures of WBCT we observed increase of UA concentration after WBCT treatment higher in MS patients (5,6 ±0.74
mg/dl) than in controls subjects (5,5 ±0.48 mg/dl).
Conclusions. Results of our study indicate significant increase of UA concentration in plasma of MS patients (p<0.001) and
healthy controls (p<0.01). WBCT might to be the therapy which affected on the increase of the concentration of UA in MS patients.

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The effects of whole-body cryotherapy and melatonin supplementation on total antioxidative status and some antioxidative enzymes in multiple sclerosis patients

Oxidative stress is an important factor which contribute to the pathogenesis of lesions in multiple sclerosis (MS). Whole body cryotherapy (WBCT) is often used in treatment neurological and orthopedic diseases.
THE AIM, MATERIAL AND METHODS: The aim of this study was to determinate the level of total antioxidative status (TAS) in plasma and activity of superoxide dismutase (SOD) and catalase (CAT) in erythrocytes of MS patients (n = 28) before and after 10 exposures of WBCT (-120 degrees C/3 minutes/day). 16 MS patients during 10 exposures of WBCT additionally were supplemented by 10 mg of melatonin.
RESULTS: Increasing of TAS level in plasma as well as supplemented with melatonin and non-supplemented MS patients was observed after 10 exposures of WBCT Melatonin statistically significant increased activity of SOD and CAT in erythrocytes of MS patients treated with WBCT.
CONCLUSIONS: Results of our study indicate significant increase of TAS level in plasma of MS patients of WBCT treatment. This indicate that WBCT might be a therapy which suppress oxidative stress in MS patients.

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Effects of the whole-body cryotherapy on a total antioxidative status and activities of some antioxidative enzymes in blood of patients with multiple sclerosis, preliminary study

Objective. There is evidence that multiple sclerosis (MS) is not only characterized by immune mediated inflammatory reactions but also by neurodegenerative processes. Neutralization of oxidative stress and excitotoxicity, might represent a therapeutic
approach to provide neuroprotection in MS. The purpose of this study was to compare changes in total antioxidative status and activities of chosen antioxidative enzymes, such as : SOD, CAT in erythrocytes of patients with MS before and after using WBCT with control
group.

Materials and methods. 32 patients with multiple sclerosis (ICD10-G35) and 20 healthy subjects were recruited for the study. The examined MS group (n=16) was treated with a series of 10 daily exposures in a cryogenic chamber (2-3 min, from -120- to -110) and program of exercises. The control MS group (n=16) had only exercises. Plasma TAS as well as SOD and CAT activities in erythrocytes were measured.

Results. The level of TAS in MS patients was distinctly reduced compared to healthy subjects. After two weeks of WBCT treatment an increase of TAS in the whole examined group (p 0,01) were observed in relation to control MS group. There was not increase of CuZnSOD and CAT activities.

Conclusion. Our results suggest positive antioxidant effects of WBCT as a short-term adjuvant treatment for patients suffered due to MS.

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Mental Health & Mood

The influence of whole body cryotherapy on mental health

The paper presents a little known issue about the influence of wholebody cryotherapy on mental health. Observations of patients‘ behaviour after passing the cryogenic chamber leads to an interesting hypothesis. Short exposition to extreme cold has doubtless a profitable influence on man’s frame of mind. Immediately after passing the cryogenic chamber, apart from the well known analgetic effect, we detect changes in patients‘ mental state such as improvement of mood, deep relaxation, freshening up, consolation, euphoria. This unusual state lasts for a long time after ending the cycle of cryotherapy. Different mechanisms of this effect are considered. New possibilities of this method have been presented. Durability of such an advantageous phenomenon are investigated in our research centre in Wrocław.

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Influence of whole body cryotherapy on depressive symptoms -preliminary report

Background: Cryotherapy has a long tradition in somatic medicine. Yet we know very little about its impact on psyche and mood disturbances in particular. Therefore there is a real need for scientific investigations into this problem. Objective: The study reported here was an initial approach to whole-body cryotherapy (WBCT) as a potential treatment modality for depression and was expected to provide rough data helping to design a future project with extended methodology, larger sample groups and longer follow-up.

Methods: Twenty-three patients aged 3770 years gave informed consent to participate in the study. Ten WBCT procedures (160 s, 150C) were applied within 2 weeks. Participants were recruited from depressed day hospital patients. Antidepressive medication was not ceased. Symptoms were rated at the beginning and end of this intervention using the 21-item Hamilton Depression Rating Scale (HDRS). Changes in scores were analyzed in the group of patients for every item separately as well as for the sum of all items for each patient.

Results: Almost for each individual HDRS item, the overall score for all patients together was significantly lower after WBCT. This means that all symptoms, except for daynight mood fluctuations, were presumably positively influenced by cryotherapy. The HDRS sum-score for each patient after WBCT was lower than that of the baseline and reached statistical significance in a paired samples t-test. Every patient was therefore considerably relieved after WBCT.

Conclusions: It appears that WBCT helps in alleviating depression symptoms. Should this be confirmed in the extended study we are currently implementing, WBCT may become an auxiliary treatment in depression.

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Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety

Aim. The whole body cryotherapy (WBCT) is becoming a more popular adjuvant method in rehabilitation and renewal. The objective was to evaluate influence of WBCT on depressive and anxiety symptoms.
Materials and methods. The study group (n=26) was treated using a series of 15 daily visits to a cryogenic chamber (-110° to 160°C) which lasted 2-3 minutes each. A control (n=34) group was similar to the study group as concerning diagnoses (anxiety and depressive disorders), age and gender. Both groups received standard out-patient psychopharmacotherapy. The Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were used to evaluate the severity of symptoms before and after WBCT (3 weeks observation). The self-rating life satisfaction scale was used as well. Two efficacy measures were established: a significantly greater reduction of the scales’ scores and mean scores lower at the endpoint in the study group in comparison to the control group.
Results. Both efficacy criteria were fulfilled for the depression scale in 12 of the 16 HDRS items exceptbgastrointestinal and genitourinary symptoms, hypochondria, body mass and criticism. Concerning the HARS scale, in 11 of 14 anxiety items (except gastrointestinal and genitourinary symptoms and behavior) the mean reduction was significantly bigger and the mean final status was better in the experimental group in comparison to the control one. As for the life satisfaction scale, efficacy was shown in 6 of the11
items: physical and mental health, everyday activity, vocational activity, hobbies and general life satisfaction – in the experimental group.
Conclusion. These findings suggest a possible role for WBCT as a short-term adjuvant therapy for depressive
and anxious patients.

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Can short-term exposure to extremely low temperatures be used as an adjuvant therapy in the treatment of affective and anxiety disorders?

AIM: The aim of the research was to assess the effect of whole-body cryotherapy (WBCT) on the symptoms observed in a group of patients suffering from affective and anxiety disorders and their own subjective assessment of life satisfaction.
METHOD: The study group was given short-term exposure (120-180 sec.) to temperatures between -110 degrees C and -160 degrees C on each working day for a period of 3 weeks (a total of 15 treatments). Both the study group (n=26) and control group (n=34) were observed at the beginning and the end of this 3 week interval. Standard psychopharmacological treatment was carried out in both groups, independently of whether cryotherapy was used or not. Hamilton’s scales of depression and anxiety were used, together with the life satisfaction scale.
RESULTS: A statistically significant larger improvement, together with a better mean state after 3 weeks, was observed with respect to 11 of the 14 components of the anxiety scale in the study group compared to the control group (except symptoms associated with the gastrointestinal and genitourinary symptoms and behaviour at interview). A larger improvement, together with a better mean state after 3 weeks, was observed with respect to 12 of the 16 components of the depression scale (except digestive, sexual life hypochondria, body weight and criticism) and 6 of the 11 components of the life satisfaction scale (physical well-being, physical condition, domestic activity, professional activity, personal interests and general satisfaction from life) in the study group.
CONCLUSIONS: Cyclic short-term whole-body exposition to extremely low temperatures significantly reduced the severity of depressive and anxiety symptoms and increased the life satisfaction.

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Medical Ailments

Evaluation of effectiveness of whole-body cryotherapy in patients with tinnitus

INTRODUCTION: The aim of the study was evaluation of effectiveness of whole-body cryotherapy in patients with tinnitus.
MATERIALS AND METHODS: The research was carried out in 120 patients (aged 20-68) with tinnitus, divided into two groups: I–80 patients treated by cryotherapy and II–40 patients non treated. There were: 73 women and 47 men. Among patients of I group: 39 reported bilateral tinnitus, 20 reported right tinnitus, 15 reported left tinnitus and 6 reported tinnitus in head. Duration of the ailment took from 1 month to 23 years. The methods included: taking a history, otolaryngological physical examination, audiometry establishing level of tinnitus, medical consultation, X-ray examination of chest and cervical spine and CT of head. After examinations and additional consultations the patients were qualified for cryotherapy unless there were some contraindications. The patients underwent 10 procedures in two cycles with the weekend break. They were in cryochamber in temperature of -110 degrees C for 3 minutes. After cryotherapy they used kinesitherapy for 45 minutes. Intensity and troublesomeness of tinnitus was evaluated using self-assessment chart (point scale 0-100) and audiometry establishing level of tinnitus before and after treatment.
RESULTS: The results indicates complete elimination of tinnitus in 4 patients, decrease in their intensity in 47 patients, maintenance of the ailment on the same level in 13 people and slightly increase of tinnitus in 16 patients. In audiometry we could observe in I group changes in frequency of tinnitus in 138 ears and changes in intensity of tinnitus in 91 ears. After treatment decrease of average hearing loss and average hearing damage were observed.
CONCLUSIONS: Treatment of tinnitus may be effective by using whole-body cryotherapy.

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Translating whole-body cryotherapy into geriatric psychiatry – A proposed strategy for the prevention of Alzheimer’s disease

Alzheimer’s disease (AD), which is the most common form of dementia, constitutes one of the leading causes of disability and mortality in aging societies. Currently recommended medications used in treating AD include cholinesterase inhibitors and the NMDA antagonist – memantine, but poorly counteract progression of the disease. According to current knowledge, the neuropathological process underlying the etiology of AD begins many years, if not decades, before the development of overt symptoms of dementia. Mild cognitive impairment (MCI) is regarded as the first detectable manifestation of cognitive decline. Nowadays, there is a general consensus that vascular alterations, oxidative stress and inflammatory response contribute to the development of AD. Following these mechanisms and tracing the anti-inflammatory and anti-oxidative effects of cryostimulation, we postulate that whole-body cryotherapy (WBCT) might be utilized as a means of preventing AD. WBCT is a relatively safe and cost-effective procedure, which is widely applied in various medical specialties. Thus, there is an urgent necessity to evaluate the long-term effectiveness of WBCT in the prevention of AD in patients with MCI and healthy individuals.

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