Research findings whole-body cryo – 3/2020
30 April 2020 / 0 comments

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Every month ProCcare extracts the new research studies on local cryotherapy, water immersion, and whole-body cryotherapy. These studies are the basis of our literature database and form the foundation of our ProCare method. In each newsletter, we provide an overview of the new research studies. Additionally, we offer exciting insights that assist implementation based on the findings of two studies that we selected from the list.

Study: Qu, C. et al. Cryotherapy Models and timing-Sequence Recovery of Exercise-Induced Muscle Damage in Middle- and Long-Distance Runners. J Athl Train (2020) doi:10.4085/1062-6050-529-18.

Method: In this crossover study, the authors investigate the effects of cold-water immersion (CWI), contrast-water therapy (CWT), whole-body cryotherapy (WBC) and a control treatment (CON) after exercise-induced muscle damage (EIMD) on the timing-sequence recovery through different indicator responses in mid and long-distance runners.

Primary findings by the authors: Given that WBC enhanced muscle recovery and reduced muscle performance decrements after exercise-induced muscle damage, this method was a useful nonpharmacological and noninvasive therapy for promoting muscle recovery

Comment Dr. E. Hohenauer (post-doctoral researcher at the University of Portsmouth and a senior researcher at the University of Applied Sciences and Arts of Southern Switzerland):

The main results of this study demonstrate that WBC exhibited better timing-sequence recovery effects for soreness and CK activity compared to CWI and CON(p<0.05). C -reactive protein values were also lower after WBC compared to the other interventions. Vertical jump height also decreased to a smaller amount in the WBC compared to CWI and CON (p<0.05). In conclusion, this study shows that WBC has a positive effect on soreness, creatine kinase, c-reactive protein, and vertical jump height recovery after EIMD.

I would say that these findings show that WBC is superior compared to the other forms at specific time-points in this population. The study indicates that extremely low temperatures, combined with adequate treatment duration, as used in this study, lead to beneficial subjective and objective recovery characteristics. For sports practice, these results are very interesting as they contribute to the current literature regarding the investigations of WBC on post-exercise recovery and show the potential behind this recovery treatment. However, I think that we need further studies with large sample sizes, to investigate further and understand the exact mechanisms of WBC, which lead to these beneficial results. Before we do not know the exact mechanisms, it is difficult to give an explicit suggestion regarding this treatment. 

ProCcare’s take-home message

In line with Erich, we agree that the results of the study are interesting for sports practice. Both WBC, CWI, and CWT provide significant beneficial effects over the control conditions for mid- and longterm endurance runners, where WBC seems to perform superior. Additionally, the study also illustrates that WBC, CWT, and CWI are three different recovery modalities having different effects when appropriately applied, as is done in this study. Therefore, these recovery modalities should be used differently in practice. Three minutes WBC at -110°C/-166°F, as used in this study, will extract less energy from the body opposed to 12 minutes of immersion in 15°C/59°F, due to a difference in thermal conductivity (air versus water). Measuring muscle performance by maximal vertical jump testing directly after the recovery protocol will have an impact on the results. As more energy (equals heat), is extracted following CWI, tissue temperature will be significantly lower. This lower tissue temperature hurts the power that can be generated (one of the reasons why we always do a warm-up before exercise), resulting in lower vertical jump heights compared to the WBC condition. In our opinion, it is therefore not possible to conclude that WBC is superior to CWI or CWT for soreness and muscle performance, as the timing of the measurement in the case of CWI was not right. Another methodological consideration that should be taken into account to translate the results to practice is the used fixed order of the interventions. There will be an adaptation effect on the used protocol. This results in a less pronounced EIMD following week four compared to week 2, thereby having less room for potential benefit in week four where CWI was prescribed.

How to apply these findings in practice:

Prescribing CWI for acute recovery (the recovery on the same day) needs consideration. Exercise, directly following CWI, should either start with a focus on properly warming up the tissue or, based on the results of this study, WBC should be the preferred intervention. For chronic recovery(the recovery over days), the results from this study illustrate a significant benefit for WBC as well (and less for CWI) and can, therefore, be recommended. Takingother studies into account as well, this mainly accounts for perceived soreness and muscle damage. For muscle performance recovery, based on the known physiological mechanisms and other data (for example, Abaida and colleagues 2016), contrary to the results of this study, CWI seems to be superior over WBC. For proper implementation of WBC, CWI, and CWT, it is essential to prescribe these recovery modalities in the right way, while understanding the physiological impact at a given time. This clinical decision making is imperative to fully benefit from the use of these modalities. We focus on the clinical decision-making process in our accredited, online courses on water immersion, and whole-body cryo, which can be found on the CustoRec platform.

New studies on whole-body cryo:

Qu, C. et al. Cryotherapy Models and Timing-Sequence Recovery of Exercise-Induced Muscle Damage in Middle- and Long-Distance Runners. J Athl Train (2020) doi:10.4085/1062-6050-529-18.

Lombardi, G., Ziemann, E. & Banfi, G. Whole-Body Cryotherapy: Possible Application in Obesity and Diabesity. in Rehabilitation interventions in the patient with obesity (ed. Capodaglio, P.) 173–188 (Springer International Publishing, 2020). doi:10.1007/978-3-030-32274-8_11.

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