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 Santé

Affective response to whole-body cryotherapy: Influence of sex, body mass index, age, time of day, and past experience.

par SFCCE | 2020 | Publication Santé

Objective: Whole-Body Cryotherapy (WBC) has seen a recent surge in popularity with patients with inflammatory conditions, athletes, and even people seeking to improve general health and quality of life. WBC treatment usually requires participation in a dozen of 3-min long sessions. But compliance is considered difficult due to possible cold-induced unpleasant sensations. Based on hedonic psychology assumptions, ratings of pleasure-displeasure experienced during a taks or activity may be important to understand individual differences in attendance.

Methods: Two hundred fifty-nine customers from two French cryocenters took the Feeling Scale immediately after their first WBC session.

Results: End affect appeared to be negatively valenced (M = -1.85, SD = 1.38, 95 % confidence interval: -2.02 to -1.68). Additional statistical analyses revealed a moderating influence of past experience, in women only. Similarly, BMI was found to be negatively associated with displeasure in women, but not in men.

Conclusion: These findings are discussed, and further research directions are suggested.

Legrand, FD, Bogard, F, Beaumont, F, Bouchet, B, Blancheteau, Y, Polidori, G. (2020)

Full article :  https://pubmed.ncbi.nlm.nih.gov/33234406/ 

karinezag Santé

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

par SFCCE | 2020 | Publication Santé

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

Polidori, G, Elfahem, R, Abbes, B, Bogard, F, Legrand, F, Bouchet, B, Beaumont, F.(2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/33130106/ 

468
karinezag Santé

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

par SFCCE | 2020 | Publication Santé

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

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

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

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

Stanek, A, Wielkoszyński, T, Bartuś, S, Cholewka, A. (2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/33371392/ 

468
karinezag Santé

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

par SFCCE | 2020 | Publication Santé

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

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

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

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

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

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

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

Garcia, C, Karri, J, Zacharias, NA, Abd-Elsayed, A. (2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/33315183/ 

karinezag Santé

The impact of whole-body cryotherapy on lipid profile: A systematic review and meta-analysis.

par SFCCE | 2020 | Publication Santé

Purpose: Whole-body cryotherapy (WBC) is an already proven method of supportive therapy in somatic medicine. Emerging evidence suggests that WBC might exert beneficial effects on lipid profile; however, studies in this field have provided mixed findings.

Objective: We aimed to perform a systematic review and meta-analysis of studies investigating the impact of WBC on lipid profile.

Methods: Electronic databases (the MEDLINE, the ERIC, the CINAHL Complete, the International Pharmaceutical Abstracts as well as the Academic Search Ultimate and the Health Source: Nursing/Academic Edition) were searched from their inception until 25th April 2020. Meta-analysis was performed using random-effects models and Hedges g’ was calculated as the effect size estimate.

Results: We identified seven eligible studies. Pooled data analysis revealed significantly lower levels of triglycerides after WBC. Sensitivity analysis also demonstrated significantly lower levels of total cholesterol and low-density lipoproteins (LDL) after removing single studies. Meta-regression analysis showed that lower baseline body mass index (BMI) was significantly associated with greater changes in the levels of total cholesterol and LDL during WBC.

Conclusions: Our findings imply that WBC may exert beneficial effects on the lipid profile in terms of lowering the levels of total cholesterol, LDL and triglycerides. Lower BMI may predict a greater improvement of lipid profile during WBC. However, caution should be taken as to the way our results are being interpreted due to low number of studies and considerable methodological heterogeneity of studies included in our meta-analysis.

Rymaszewska, JE, Stańczykiewicz, B, Lion, K, Misiak, b. (2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/33220621/ 

468
karinezag Santé

New Strategies for Rehabilitation and Pharmacological Treatment of Fatigue Syndrome in Multiple Sclerosis.

par SFCCE | 2020 | Publication Santé

Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system (CNS), with an inflammatory demyelinating basis and a progressive course. The course of the disease is very diverse and unpredictable. Patients face many problems on a daily basis, such as problems with vision; sensory, balance, and gait disturbances; pain; muscle weakness; spasticity; tremor; urinary and fecal disorders; depression; and rapidly growing fatigue, which significantly influences quality of life among MS patients. Excessive fatigue occurs in most MS patients in all stages of this disease and is named MS-related fatigue. The crucial issue is the lack of effective treatment; therefore, this review focuses not only on the most common treatment methods, but also on additional novel therapies such as whole-body cryotherapy (WBC), functional electrical stimulation (FES), and non-invasive brain stimulation (NIBS). We also highlight the advantages and disadvantages of the most popular clinical scales used to measure fatigue. The entire understanding of the origins of MS-related fatigue may lead to the development of more effective strategies that can improve quality of life among MS patients. A literature search was performed using MEDLINE, EMBASE, and PEDro databases.

Zielińska-Nowak, E, Włodarczyk, L, Kostka, J, Miller, E. (2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/33171768/ 

karinezag Santé

Cerebral bleeding during a cryotherapy session: A case report

par SFCCE | 2020 | Publication Santé

Introduction: Whole body cryotherapy is a new therapeutic for pain treatment. Cryotherapy is, so far, a controversial technique challenged for its efficacy and its security.

Case report: This is the case of a 61-year-old woman suffering from a haemorrhagic cerebrovascular accident during a whole-body cryotherapy session. The patient was treated for a psoriatic arthritis and was in remission. The aetiological screening was negative.

Conclusion: We hypothesize that the whole-body cryotherapy was responsible for this stroke.

Cronier, R, Fardellone, P, Goëb, V. (2020)

Full Article :  https://pubmed.ncbi.nlm.nih.gov/32994067/ 

karinezag Santé

Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review.

par sfcce | 2020 | Publication Santé

Objective: The aim of this scoping review is to outline the current evidence regarding the management of restless legs syndrome (RLS) with nonpharmacologic approaches. To categorize the efficacy of conservative approaches in reducing symptoms of RLS, we have identified and summarized the current data regarding diagnostic criteria and relevant outcome measures, to inform future research and to guide clinical practice.

Methods: A scoping review was conducted using the National Center for Biotechnology Information; EBSCO; the Manual, Alternative and Natural Therapy Index System; the Cumulative Index to Nursing & Allied Health Literature; and Scopus. All literature related to RLS was extracted, screened, and reviewed based on titles and abstract contents. The authors then extracted data from the 24 admissible studies, that is, the ones about manual therapy, exercises, and alternative treatments for RLS. The Physiotherapy Evidence Database scale was used to rate the methodological quality of the included randomized controlled trials by 2 independent readers.

Results: In the 24 articles fulfilling the selection criteria, there was a consistent trend in the findings showing positive results in lowering RLS symptom severity. Most clinical studies based their diagnosis on the International Restless Legs Syndrome Study Group diagnostic criteria; the International Restless Legs Syndrome Study Group rating scale was the most often used outcome measure. The efficacy of exercise, yoga, massage, acupuncture, traction straight leg raise, cryotherapy, pneumatic compression devices, whole-body vibration, transcranial and transcutaneous stimulation, and near-infrared lights showed different effects on RLS symptom severity, and the level of evidence was evaluated.

Conclusion: Our results showed clinically significant effects for exercises, acupuncture, pneumatic compression devices, and near-infrared light. Short-lasting effects were identified with whole-body cryotherapy, repetitive transcranial stimulation, and transcutaneous stimulation. More studies are necessary to investigate efficacy of yoga, massage, traction straight leg raise, and whole-body vibration. No adverse effects were identified for moderate-intensity exercise, yoga, massage, and pneumatic compression devices.

Guay, A, Houle, M, O’Shaughnessy, J, Descarreaux, M. (2020) 

Full Article :  https://pubmed.ncbi.nlm.nih.gov/32900545/