Whole-body cryotherapy: empirical evidence and theoretical perspectives

Figures & data

Table 1 Study characteristics

Study design	Participants	WBC (control)	Outcomes
			Higher values in WBC (vs control)	Lower values in WBC (vs control)	No between-group differences
Mila-Kierzenkowska et al^Citation5 Crossover study (4-month washout)	n=9 Olympic-level kayakers undertaking a 10-day training cycle (all female, mean age 23.9±3.2 years) Cointerventions Antioxidant supplementation	n=9 exposed to −120°C to −140°C for 3 minutes; 20 sessions in total: twice per day over a 10-day period (n=9 no WBC)	Catalase TBARS	Superoxide dismutase Glutathione peroxidase
Hausswirth et al^Citation6 Randomized crossover study (3-week washout)	n=9 well-trained runners undertaking a simulated 48-minute trail run (all male, mean age 31.8±6.5 years)	n=9 exposed to −110°C for 3 minutes; 3 sessions in total: immediately, 24, and 48 hours postexercise (n=9 seated rest)	Strength	Pain Tiredness	Creatine kinase
Pournot et al^Citation7 Randomized crossover study (3-week washout)	n=11 trained runners undertaking a simulated 48-minute trail run (all male, mean age 31.8±6.5 years)	n=11 exposed to −110°C for 3 minutes; 4 sessions in total: immediately, 24, 48, and 72 hours postexercise (n=11 seated rest)	IL-1ra	CRP	IL-1β IL-6 IL-10 TNFα Leukocyte count
Ziemann et al^Citation8 Randomized controlled trial	n=12 professional male tennis players undertaking moderate-intensity training for 5 days (all male, mean age 20±2 years control, 23±3 years WBC)	n=6 exposed to −120°C for 3 minutes; 10 sessions in total: twice per day over 5 days (n=6 no WBC)	IL-6 Tennis-stroke effectiveness	TNFα	Creatine kinase Leukocyte count Cortisol Testosterone
Miller et al^Citation9 Controlled trial	n=94 healthy participants (46 male, 48 female, mean age 37.5±3.1 years WBC, 37.9±2.1 years control)	n=46 exposed to −130°C for 3 minutes; 10 sessions in total: 1 session per day over 10 days (n=48 no WBC)	Total antioxidant status Superoxide dismutase Uric acid TBARS
Costello et al^Citation10 Randomized controlled trial	n=36 healthy participants (24 male, 12 female, mean age 20.8±1.2 years)	n=16 exposed to −110°C for 3 minutes; 2 sessions in a single day, 2 hours apart (n=16 exposed to 15°C)			Joint positional sensea MVIC
Costello et al^Citation10 Randomized controlled trial	n=18 participants (4 female, 14 male, mean age 21.2±2.1 years) undertaking 100 high-force maximal eccentric contractions of the left knee extensors	n=9 exposed to −110°C for 3 minutes; 2 sessions in a single day, 2 hours apart (n=9 exposed to 15°C)			MVIC Pain Peak power output
Fonda and Sarabon^Citation11 Randomized crossover (10-week washout)	n=11 participants (all male, mean age 26.9±3.8 years) undertaking high-load and eccentric lower-limb exercises	n=11 exposed to −140°C to −195°C for 3 minutes; 6 sessions in total: 1 per day over 6 days (n=11 no WBC)		Pain at rest Pain on squat	Creatine kinase Lactate dehydrogenase Aspartate aminotransferase Performanceb
Hausswirth et al^Citation12 Controlled trial	n=40 healthy participants (all male; mean age 33.9±12.3 years control, 34.6±11.5 years WBC, 33.3±13.8 years PBC)	n=15 exposed to −110°C WBC for 3 minutes; n=15 exposed to −160°C PBC for 3 minutes; (n=10 seated rest)	Norepinephrine Dopamine (WBC) Heart-rate variability		Epinephrine Dopamine (PBC)
Ma et al^Citation13 Randomized controlled trial	n=30 participants with adhesive capsulitis of the shoulder joint (24 female, 6 male, mean age 57.2±6.6 years)	n=15 exposed to −110°C for 4 minutes; 24 sessions in total: 2 sessions per day, 3 times per week over 4 weeks plus standard physiotherapy treatment (n=15 standard physiotherapy treatment only)	ROM Function	Pain
Schall et al^Citation14 Randomized crossover (1-week washout)	n=11 participants (all female, mean age 20.3±1.8 years) undertaking a 3-minute-maximum swimming exercise bout	n=9 exposed to −110°C for 3 minutes; 1 session immediately after exercise (n=9 30 minutes of passive recovery)	Indices of heart-rate variability Metabolic recovery (lactate VO2 peak) Subjective recovery		Performance (subjective judging in synchronized swimming)

Notes:

a Absolute, relative, and variable error

b countermovement jump, power, strength.

Abbreviations: WBC, whole-body cryotherapy; vs, versus; TBARS, thiobarbituric acid reactive substances; IL, interleukin; ra, receptor antagonist; CRP, C-reactive protein; TNF, tumor necrosis factor; MVIC, maximum voluntary isometric contraction; PBC, partial body cryotherapy; ROM, range of movement.

Table 2 Tissue-temperature reductions by cooling modalities

	Ice pack (10 minutes)	CWI (4–5 minutes, 8°C–10°C)	WBC (3 minutes)
Skin temperature	18b,^Citation15	6.2 (0.5)^Citation24	3.5–8.7^Citation27
	20a,^Citation16	8.4 (0.7)^Citation25	6.7b,^Citation28
	20b,^Citation17	9.0 (0.8)^Citation26	8.1 (0.4)c,^Citation12
	20^Citation18		12.1 (1.0)^Citation25
	22a,b,^Citation19		10.3 (0.6)^Citation26
	25.7–26.4^Citation20		13.7 (0.7)^Citation12
			19.4b,^Citation29
Intramuscular temperature (2 cm depth)	1.76 (1.37)^Citation21	1.7 (0.9)^Citation25	1.2 (0.7)^Citation25
	2.0a,^Citation16
	2.0a,b,^Citation19
	2.7b,^Citation15
	−3.88 (1.83)^Citation22
Core temperature	0a,^Citation16	0.2 (0.1)^Citation24	0^Citation29
	0^Citation23	0.4 (0.2)^Citation25	0.3 (0.2)^Citation25

Notes:

a Data extracted from graphs with permission: Arch Phys Med Rehabil, 2001;82, Jutte LS, Merrick MA, Ingersoll CD, Edwards JE. The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming. 845–850.¹⁶ © 2001 with permission from Elsevier; and Merrick MA, Jutte LS, Smith ME. Cold modalities with different thermodynamic properties produce different surface and intramuscular temperatures. J Athl Train. 2003;38:28–33.¹⁹

b standard deviation not available.

c PBC. All values are degrees celsius (means ± standard deviation).

Abbreviations: CWI, cold-water immersion; WBC, whole-body cryotherapy; PBC, partial body cryotherapy (head out).

Figure 1 Forest plot of perceived sensation.

Abbreviations: IV, inverse variance; CI, confidence interval; WBC, whole-body cryotherapy.

Figure 2 Forest plot of performance outcomes.

Abbreviations: IV, inverse variance CI, confidence interval; WBC, whole-body cryotherapy.

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