karinezag Santé

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

SFCCE I 2023 I Publication Santé

Abstract

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

Fabien D Legrand 1, Benoît Dugué 2, Joe Costello 3, Chris Bleakley 4, Elzbieta Miller 5, James R Broatch 6, Guillaume Polidori 7, Anna Lubkowska 8, Julien Louis 9, Giovanni Lombardi 10, François Bieuzen 11, Paolo Capodaglio 12

Full article : Sur PubMed

karinezag Santé

L’Ictus amnésique : qu’est-ce ?

par SFCCE | 2021 | Synthèse bibliographique du Pr D. BRASSAT

Il s’agit d’une perte de la mémoire à court terme uniquement associée à une désorientation dans le temps et l’espace, survenant le plus souvent chez des personnes ayant plus de 50 ans, et de courte durée (toujours moins de 24 heures, le plus souvent 4 à 8 heures) avant un retour à la normale. Pendant l’épisode, les personnes présentent un état décrit comme une perplexité anxieuse : ils répètent toujours les mêmes questions « quels jours sommes-nous, qu’est-ce que je fais ici » avec une anxiété apparente. Par contre, la personne sait qui elle est, où elle habite, etc. Il n’y a pas d’autres signe neurologique (1).

Est-ce grave ?
Le retour à la normale des capacités de mémoire à court terme se fait toujours après 24h. Par contre, la personne ne garde pas le souvenir de l’ictus. Il est habituel de considérer que l’ictus n’est pas associé à un risque plus important de démence, ni d’accident vasculaire cérébral, ni d’épilepsie. Il est par contre plus fréquent chez les migraineux (2).

Comment en faire le diagnostic?
Il est uniquement clinique (3) en observant la personne pendant l’ictus, ou en interrogeant un témoin après coup. Lors de l’épisode, l’examen neurologique est normal. Les examens complémentaires sont normaux : prise de sang électroencéphalogramme, séquences classique d’IRM (1).

Pourquoi fait-on un ictus ?
Les circonstances déclenchantes les plus classiques sont par ordre de fréquence (4,5) : un effort physique, le stress, une immersion en eau froide, un rapport sexuel, un effort de vomissement ou de toux, une douleur intense.
Les personnes faisant un ictus auraient plus fréquemment une HTA. A l’inverse le diabète protègerait. Les autres facteurs de risques vasculaires ne jouent pas (dyslipidémie) (6). Il existe actuellement 2 théories pour expliquer l’ictus, soit un équivalent migraineux, soit un mauvais retour veineux (1).

Risque-t-on une récidive ?
Les études les plus récentes, ont inclus jusqu’à 1044 patients (6). 15% d’entre eux ont présenté une ou plusieurs récidives (jusqu’à 9 fois, le plus souvent 3 fois). La récidive est plus fréquente lorsque le premier ictus survient jeune et qu’il existe une histoire familiale ou personnelle de migraine.

La cryothérapie peut-elle provoquer des ictus ?
Dans les descriptions historiques, il a été montré que l’ictus pouvait survenir après une immersion en eau froide. Récemment un article de l’UFC que choisir décrit un cas après une séance de cryothérapie. Il reste difficile cependant de pouvoir affirmer la causalité. La proximité entre 2 évènements n’est pas la demonstration que l’un provoque l’autre.

La conclusion de la SFCCE
Il est actuellement impossible d’affirmer ou d’infirmer que la CCE peut provoquer un ictus. Quant bien même il y aurait un jour un lien établi, il est communément admis que l’ictus est un épisode banal, extrêmement rare qui ne laisse aucune séquelle.

Chez une personne ayant eu un ictus il est préférable de déconseiller la CCE car un ictus recidive chez une personne sur 6.

La SFCCE est une société savante dédiée à un encadrement par des professionnels de santé de la CCE et au développement des connaissances concernant les bienfaits du froid. Elle représente près de 20 centres en France et plusieurs milliers de passages en CCE.

Pr David BRASSAT

References :
1. Transient global amnesia: functional anatomy and clinical implications.
Bartsch T, Deuschl G. Lancet Neurol. 2010 Feb;9(2):205-14. doi: 10.1016/S1474-4422(09)70344-8.
2. The long-term prognosis of Transient Global Amnesia: a systematic review.
Liampas I, Raptopoulou M, Siokas V, Tsouris Z, Brotis A, Aloizou AM, Dastamani M, Dardiotis 
Rev Neurosci. 2021 Jan 29.
3. Syndromes of transient amnesia: towards a classification. A study of 153 cases.
Hodges JR, Warlow CP. J Neurol Neurosurg Psychiatry. 1990 Oct;53(10):834-43. 
4. Selective affection of hippocampal CA-1 neurons in patients with transient global amnesia without long-term sequelae. Bartsch T, Alfke K, Stingele R, Rohr A, Freitag-Wolf S, Jansen O, Deuschl G. Brain. 2006 Nov;129(Pt 11):2874-84. 
5. What does transient global amnesia really mean? Review of the literature and thorough study of 142 cases. Quinette P, Guillery-Girard B, Dayan J, de la Sayette V, Marquis S, Viader F, Desgranges B, Eustache F. Brain. 2006 Jul;129(Pt 7):1640-58. 
6. Factors Associated With Risk of Recurrent Transient Global Amnesia. Morris KA, Rabinstein AA, Young NP. JAMA Neurol. 2020 Aug 31;77(12):1-8. 

karinezag Sport

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

par SFCCE | 2020 | Publication Sport

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

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

Design: Crossover study.
Setting: Laboratory.
Patients or other participants: Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years).

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

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

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

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

Qu, C, Wu, Z, Xu, M, Qin, F, Dong, Y, Wang, Z, Zhao, J. (2020)

Full Article : https://pubmed.ncbi.nlm.nih.gov/32160058/

karinezag Sport

Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control.

par SFCCE | 2018 | Publication Sport

Purpose: Cryotherapy is an increasingly popular recovery strategy used in an attempt to attenuate the negative impact of strenuous physical activity on subsequent exercise. Therefore, this study aimed to assess the effects of whole body cryotherapy (WBC) and cold water immersion (CWI) on markers of recovery following a marathon.

Methods: Thirty-one endurance trained males completed a marathon. Participants were randomly assigned to a CWI, WBC or placebo group. Perceptions of muscle soreness, training stress and markers of muscle function were recorded before the marathon and at 24 and 48 h post exercise. Blood samples were taken at baseline, post intervention and 24 and 48 h post intervention to assess inflammation and muscle damage.

Results: WBC had a harmful effect on muscle function compared to CWI post marathon. WBC positively influenced perceptions of training stress compared to CWI. With the exception of C-reactive protein (CRP) at 24 and 48 h, neither cryotherapy intervention positively influenced blood borne markers of inflammation or structural damage compared to placebo.

Conclusion: The findings show WBC has a negative impact on muscle function, perceptions of soreness and a number of blood parameters compared to CWI, contradicting the suggestion that WBC may be a superior recovery strategy. Further, cryotherapy is no more effective than a placebo intervention at improving functional recovery or perceptions of training stress following a marathon. These findings lend further evidence to suggest that treatment belief and the placebo effect may be largely responsible for the beneficial effects of cryotherapy on recovery following a marathon.

Wilson LJ, Cockburn E, Paice, K, Sinclair, S, Faki, T, Hills, FA, Gondek, MB, Wood,A, Dimitriou, L. (2018)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/29127510/ 

karinezag Sport

Whole-Body Cryotherapy: Potential to Enhance Athlete Preparation for Competition?

par SFCCE | 2019 | Publication Sport

The final hours of preparation before competition are important for performance. Recovery, preparation and warm up protocols are evolving continuously and include passive and active modalities often developed by “trial and error” approaches. Passive modalities, such as whole-body cryotherapy (WBC), have the potential to enhance both recovery and preparation. Whole-body cryotherapy has generally been used within a recovery setting after competition or strenuous training for athletes, and in clinical settings for the general population. However, the acute hormonal, anti-inflammatory, perceptual and psychological responses yielded by a single, or repeated, bouts of WBC indicate that this practice could enhance an athlete’s competition readiness when used alongside traditional elements of active warm-ups in the hours before competition in addition to aiding recovery in the hours after. Here we summarize and evaluate the acute effects of WBC exposures on physiological, performance and perceptual responses, and examine the likelihood these responses could theoretically translate into enhanced athletic performance. The potential to enhance an athlete’s performance using acute passive WBC exposure is a novel intervention that requires further investigation.

Partridge, EM, Cooke, J, McKune, A, Pyne, DB. (2019)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/31447697/ 

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karinezag Sport

Whole-Body Cryotherapy in Sports Medicine.

par SFCCE | 2019 | Publication Sport

Cryotherapy has gained popularity among athletes across many sports. The main goals of cryotherapy, and specifically whole-body cryotherapy, are for injury prevention and counteracting negative inflammatory symptoms following athletic performance in hopes of improving recovery.

Patel, K, Bakshi, N, Freehill, MT, Awan, TM. (2019)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/30969239/ 

karinezag Sport

Circulating soluble intercellular adhesion molecule-1 (sICAM-1) after exercise-induced muscular damage: Does the use of whole-body cryostimulation influence its concentration in blood?

par SFCCE | 2019 | Publication Sport

As soluble intercellular adhesion molecule-1 (sICAM-1) was recently hypothesized to be a key player in the mechanisms involved in exercise-induced muscular damage (EIMD), we investigated its circulating concentration changes in athletes before and after EIMD with and without the use of whole-body cryostimulation (WBC; 3 min at -110 °C) at the exercise end and repeated once a day during 4 days. We previously characterized plasma specimens from 11 endurance athletes who performed twice (randomized crossover design) strenuous running leading to EIMD, followed by passive recovery or WBC. Muscle soreness and inflammatory response were observed in both cases but the use of WBC induced a significant reduction in these responses (PlosOne 2011; 6:e22748). We now found that sICAM-1 concentration slightly increased in both circumstances and remained elevated for 24 h (p < 0.01). However, no significant WBC effect was observed concerning sICAM-1 changes indicating that this compound is not a major player both in EIMD and WBC physiological impacts.

Bieuzen, F, Hausswirth, C, Dugué, B. (2019)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/30707962/ 

karinezag Sport

3-min whole body cryotherapy/cryostimulation after training in the evening improves sleep quality in physically active men.

par SFCCE | 2019 | Publication Sport

Exercise training during evening may disturb sleep patterns and hinder recovery process. The present study aimed to examine the effect of whole body cryotherapy (WBC) exposure after training in the evening on sleep quality and night heart rate variability (HRV). A total of 22 physically active men were randomized to undergo either WBC (3-min at -40°C, wind speed of 2.3 m s-1) or passive recovery (control) following an evening training consisting of 25 min of continuous running at 65% of the maximal aerobic speed (MAS) followed by intermittent running at 85% of the MAS. Each night following the training, the number of movements and HRV during sleeping time were recorded. The next morning, subjective sleep quality and perceived pain were assessed using Spiegel questionnaire and a visual analogue scale, respectively. The number of movements during the night following WBC was significantly reduced (p < 0.05) compared with the control condition. Subjective sleep quality following WBC was significantly better than the control group (p < 0.05). During the estimated slow-wave sleep (SWS), the high frequency power (HF) was higher in the WBC group than the control group (p < 0.05), and the low frequency power (LF) and the LF/HF ratio were lower than the control group (p < 0.05). Pain was significantly reduced following WBC compared to the control (p < 0.01). In conclusion, the use of 3-min WBC after training in the evening improves subjective and objective sleep quality in physically active subjects, which may be due to greater pain relief and improved parasympathetic nervous activity during the SWS period.

Douzi, D, Dupuy, O, Tanneau, M, Boucard, G, Bouzigon, R, Dugué, B. (2019)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/30551730/ 

karinezag Sport

Whole body cryotherapy, cold water immersion, or a placebo following resistance exercise: a case of mind over matter?

par SFCCE | 2019 | Publication Sport

Purpose: The use of cryotherapy as a recovery intervention is prevalent amongst athletes. Performance of high volume, heavy load resistance exercise is known to result in disturbances of muscle function, perceptual responses and blood borne parameters. Therefore, this study investigated the influence of cold water immersion (CWI), whole body cryotherapy (WBC) or a placebo (PL) intervention on markers of recovery following an acute resistance training session.

Methods: 24 resistance trained males were matched into a CWI (10 min at 10 °C), WBC (3- and 4 min at – 85 °C) or PL group before completing a lower body resistance training session. Perceptions of soreness and training stress, markers of muscle function, inflammation and efflux of intracellular proteins were assessed before, and up to 72 h post exercise.

Results: The training session resulted in increased soreness, disturbances of muscle function, and increased inflammation and efflux of intracellular proteins. Although WBC attenuated soreness at 24 h, and positively influenced peak force at 48 h compared to CWI and PL, many of the remaining outcomes were trivial, unclear or favoured the PL condition. With the exception of CRP at 24 h, neither cryotherapy intervention attenuated the inflammatory response compared to PL.

Conclusion: There was some evidence to suggest that WBC is more effective than CWI at attenuating select perceptual and functional responses following resistance training. However, neither cryotherapy intervention was more effective than the placebo treatment at accelerating recovery. The implications of these findings should be carefully considered by individuals employing cryotherapy as a recovery strategy following heavy load resistance training.

Wilson, LJ, Dimitriou, L, Hills, FA, Gondek, MB, Cockburn, E. (2019)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/30310979/ 

karinezag Sport

Whole-body cryotherapy (-110 °C) following high-intensity intermittent exercise does not alter hormonal, inflammatory or muscle damage biomarkers in trained males.

par SFCCE | 2019 | Publication Sport

Purpose: This study examined the acute effects of a single session of Whole-body Cryotherapy (WBC) following severe intermittent running exercise on biomarkers of inflammation, muscle damage and stress.

Methods: Endurance-trained males (n = 11) were tested twice using a within-participant, balanced cross-over design that consisted of 5 × 5 min of high-intensity running (HIR) followed by either 3 min of WBC at -110 °C or a passive control condition (CON). Before the HIR and after 60 min of recovery a ramp-test was completed. At seven time points up to 24 hrs post exercise venous blood samples were analyzed for serum levels of interleukin 6 (IL-6), interleukin 10 (IL-10), c-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), myoglobin, cortisol, and testosterone.

Results: HIR induced significant increases in all biomarkers except sICAM-1 in both recovery conditions, respectively. Compared to the CON condition WBC did not attenuate exercise- induced changes in IL-6, IL-10, sICAM-1, myoglobin, cortisol, testosterone or their ratio. Increased levels of cortisol following exercise were negatively correlated with subsequent running performance in both conditions (WBC: r = -0.61, p = 0.04; CON: r = -0.64, p = 0.04).

Conclusion: The results of this study suggest that the postulated physiological mechanisms by which WBC is proposed to improve recovery, i.e. reductions in inflammation and muscle damage, may not be accurate.

Krueger, M, Costello, JT, Achtzehn, ST, Dittmar, KH, Mester. J (2019).

Full Article :  https://pubmed.ncbi.nlm.nih.gov/30031682/ 

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