ArticlePDF Available

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

Authors:
  • Uniwersity of Physical Education, Poland, Kraków

Abstract

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.
Journal of Human Kinetics volume 30/2011, 75 - 83DOI:10.2478/v10078-011-0075-075
Section II- Exercise Physiology & Sports Medicine
1 - Department of Physical Education and Physiotherapy, Technical University, Opole, Poland.
2 - Institute of Human Physiology, University School of Physical Education, Krakow, Poland.
3 - Department of Internal Diseases, VoivodshipHopsital, Opole, Poland.
Authors submitted their contribution of the article to the editorial board.
Accepted for printing in Journal of Human Kinetics vol. 30/2011 on December 2011.
Impact of 10 Sessions of Whole Body Cryostimulation on
Cutaneous Microcirculation Measured
by Laser Doppler Flowmetry
by
Szyguła Renata1, Dybek Tomasz1, Klimek Andrzej2, Tubek Sławomir3
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.
Key words: cryotherapy, skin blood flow, rest flow, post-occlusive hyperaemic reaction, arterio–venous reflex index
Introduction
Whole body cryotherapy (WBCT) is more
and more frequently used to complete
pharmacotherapy and kinesiotherapy that are
applied in rheumatologic and neurological
diseases as well as in therapy of injuries of the
locomotor system or in overload syndromes. It is
also a modern, effective and safe procedure for
athletes’ recovery (Hubbard et al., 2004).
The procedure of whole body
cryostimulation is based on exposure of the
organism to extremely low temperature (-110°C to
-160°C) for a very short period (1 – 3 minutes)
without provoking hypothermia or congelation
(Westerlund et al., 2003). Cryogenic temperatures
trigger physiological thermoregulation
mechanisms, which results in analgesic (Long et
al., 2005; Brandner et al., 1996; Ingersoll et al.,
1991), anti-inflammatory (Banfi et al., 2010;
Knight, 1995), anti-oedematic (Meeusun et al.,
1998) and anti-oxidative effects (Akhalaya et al.,
2006; Dugue et al., 2005) and stimulate the
immune system (Lubkowska et al., 2010b). The
effect of low temperature is especially
pronounced in skin microcirculation of upper and
lower limbs. After exposure to extreme cold, in
the first phase constriction of skin vessels and
76 Impact of 10 sessions of whole body cryostimulation on cutaneous microcirculation measured
Journal of Human Kinetics volume 30/2011, http://www.johk.pl
opening of arterio-venous shunts occurs, due to
increased sympathetic stimulation, presynaptic
norepinephrine release and increased affinity of
the postsynaptic α2 receptors (Flouris and
Cheung, 2009; Charkoudian, 2003; Chotani et al.,
2000; Stephens et al., 2001; Koganezawa et al.,
2006). Most of the blood flows to the body cavities
in order to minimalize heat losses. The skin blood
flow is significantly decreased and may be
completely reduced (Charkoudian, 2003). Several
seconds after cessation of the stimulus, reflexive
hyperaemia of the tissues occurs due to decreased
sympathetic stimulation and local mechanisms –
mainly accumulation of metabolites in previously
hypoperfused areas as it was confirmed by
studies using thermovision (Bauer et al., 1997).
Active reperfusion of the skin
microcirculation persists for several hours after
single cryotherapy procedure. Although the effect
of a series of whole body cryotherapy sessions
remains unknown. Therefore 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
WBCT sessions in healthy individuals.
Material and methods
The study group included 32 healthy,
nonsmoking volunteers, students of physical
education at the Opole University of Technology -
16 women (F) and 16 men (M), who had never
experienced cryotherapy before. Prior to the test
they had a medical examination to rule out
contraindications for cryonic sessions.
Basic anthropometric measurements were
performed prior to the test. Body weight and
composition were evaluated with the use of
electric impedance (Tanita Body Composition
Analyzer, TBF-330). The results are shown in
Table 1.
The volunteers underwent 10 sessions of
WBCT in a cryogenic chamber of Pulmonology-
Rheumatology Hospital (Poland). The procedures
took place once a day in the morning from
Monday till Friday, for 3 minutes in the
temperature of -130°C. Each session was preceded
by adaptation in the temperature of -60°C for 30
seconds. Participants' dressing was consistent
with regulation for cryonic procedures
(swimsuits, covered feet, hands, ears and
airways).
The test of selected variables of skin
microcirculation.
The microcirculation was measured using
Doppler laser flowmeter Perifluks 4001 (Perimed,
Sweden). Laser-Doppler measurement of
cutaneous microvascular perfusion in humans has
many advantages: the measurement is
continuous, non-invasive and specific to the
cutaneous microcirculation. The technique
applied in the instrument uses the laser light of
wavelength 780 nm. With this technique the laser
light is used to transluminate approximately one
cubic millimeter of skin tissue and Doppler
principle is adopted to measure the velocity of red
blood cells in skin microvasculature.
Table 1
Somatic characteristics of the female and male study participants
Variables Male n=16 (x±SD) Female n=16 (x±SD)
AGE [years] 21.69±1.89 20.13±0.95
BODY HEIGHT [cm] 190.56±5.20 162.46±6.41
BODY MASS [kg] 84.87±8.74 53.65±7.94
BODY MASS INDEX [kg x cm-2] 23.38±2.31 20.21±1.98
FAT [%] 15.04±10.45 19.81±2.26
FAT MASS [kg] 11.26±4.14 10.83±2.57
FAT-FREE MASS [kg] 73.60±5.24 42.79±5.73
by Szyguła R. et al. 77
© Editorial Committee of Journal of Human Kinetics
The LDF signal is a stochastic
representation of the number of moving cells in
the tissue volume multiplied by their velocities.
The flow was measured in conventional Perfusion
Units score (PU), in proportion to the energy of
the Doppler signal. 1 PU corresponds to the
voltage of 10 mV at the outlet (Sundberg, 1984;
Cankar and Strucl, 2008). The test was performed
in horizontal position (on the back), in constant
surrounding temperature of 21C1,2 C, air
humidity 40-60%, after ca. 20 minutes of
adaptation (Beradesca et al., 2002; Fullerton et al.,
2002). The optode was placed on the skin of the
back of the hand between the first and second
metacarpal bones using special both sides
adhesive ring. The tested skin area was healthy
and shaved (Johnson and Kellogg, 2010). The
participants were asked not to take part in
physical activities and to avoid products that
influence the circulation (coffee, tea and Coca-
Cola) for at least 6 h prior to the study. Directly
before the start of the test the volunteers were
instructed to keep the lying position, not move
and keep a steady breathing pattern (Looga,
2005).
The study protocol:
1. The procedure was started after 20 minutes
of stabilization of the circulatory system in
the horizontal position.
2. Blood pressure measurement (mmHg) was
performed on the brachial artery.
3. Registration of the rest flow (RF) in
horizontal position, on a dominating upper
limb, registration time 4 min.
4. Registration of the flow after occluding the
arm with the cuff of the manometer filled
with air up to pressure exceeding the
formerly measured systolic pressure by 50
mmHg, biological zero (BZ), registration
time 4 min.
5. Registration of the reactive hyperemia (RH)
after loosening the cuff, registration time 4
min.
6. Stabilization of the blood flow back to rest
values.
7. Rising the optode’s temperature up to 44C,
using the built-in heating module, 1 min.
8. Registration of thermal hyperemia (TH),
registration time 4 min.
9. Stabilization of the blood flow back to rest
values.
10. Changing the position from horizontal to
vertical.
11. Registration of the RF in a standing
position, after 2 minutes adaptation (ST).
Rest flow (RF), hyperaemic (RH),
hyperthermic (TH) reactivity of skin
microcirculation and arterio – venous reflex index
(VAR) were evaluated. The arterio–venous reflex
index calculated according to the formula RF –
ST/RF x 100%. The variables were recorded before
the series of 10 WBCT sessions (first
measurement- I), one day after the last session
(second measurement-II) and ten days later (third
measurement-III).
Frequency of signals (FS) received by
means of the laser Doppler fluximetry between
0.01 up to 2 Hz during basic flow was also
analyzed. In this range five groups were singled
out: I – frequency band between 0.01-0.02 Hz; II –
frequency band between 0.021-0.05 Hz; III –
frequency band between 0.051-0.145 Hz; IV –
frequency band between 0.15-0.5 Hz; V –
frequency band between 0.01-0.02 Hz. In each
band range there is a different factor which
determines blood flow oscillation. I – shows
vascular oscillations depending on the
endothelium metabolic activity (EF); II – shows
the effect of the sympathetic system on skin flow
(SF); III – illustrates oscillations resulting from the
arteriola basic systolic tonus which occurs due to
discharges of particular myocytes forming a
circular layer of the vessel muscle coat, this
response is often referred to as myogenic and it is
independent of the sympathetic system (MF); IV –
breath frequency (BF); V – heart frequency (HF).
Time of 0.03 s was selected, and every blood flow
signal was taken at the frequency of 32 Hz
(Kvernmo et al., 1999). Apart from frequency, the
signal power (SP) was also analyzed.
The distribution of dependent variables
was tested with the use of the Shapiro-Wilk test.
The differences between the tested variables in
specific periods (dependent variables), as well as
between men and women (independent variable),
were evaluated with the use of analysis of
variance (ANOVA) with repeated measurements.
In case of significant effects the differences among
the medians were evaluated with the post hoc
multiple comparisons test (Tukey test). The values
of the variables are shown as mean (x) ± standard
deviation (SD). The level of statistical significance
78 Impact of 10 sessions of whole body cryostimulation on cutaneous microcirculation measured
Journal of Human Kinetics volume 30/2011, http://www.johk.pl
was set at p<0,05.
All participants were informed about the
aim and course of the experiment and signed their
written consents. The experiment was accepted by
Bioethical Committee of the Regional Medical
Council in Opole (Resolution No 163/2009).
Results
After a series of WBCT the resting flow
(RF) increased significantly both in women
(p=0,0001) and in men (p=0,01). After subsequent
10 days the values of RF decreased insignificantly
compared to values recorded right after the
procedures. No interactions between men and
women were noticed.
Biological zero did not change
significantly at any stage.
A statistically significant increase of mean
values of post-occlusive hyperaemic reaction was
observed during the second measurement in both
groups: women (p=0,0001) and men (p=0,0001).
Although the increase in women was significantly
higher than in men (p=0,0005). The mean values of
third measurement did not alter significantly
compared to the second measurement. The values
of HRmax were also significantly increased at the
second measurement in both groups (women-
p=0,0001, men -p=0,0001), whereas after 10 days
the values fell in women and rose in men. The
interaction between men and women was
statistically significant p=0,01.
After a series of WBCT, there was a
significant increase of mean and maximal values
of microcirculation’s reaction to temperature
(mean values:women- p=0,0001, men - p=0,0001).
The third measurement showed an insignificant
increase of the studied variable in men and
similarly insignificant decrease in women,
compared to values from the second
measurement. The interaction was not significant
(p=0,08). In turn, the maximal values increased in
women and decreased in men. Interaction was
significant (p=0,00005).
Table 2
Mean values (x) and standard deviation (SD) of the analyzed variables in succeeding
measurements for both sexes with statistical verification
Variables
[VU]
Sex I measurement
(x±SD)
II measurement
(x±SD)
III measurement
(x±SD)
RF F 10.32±2.56 10.89±2,31* 10.11±3.17
M 13.67±3.19 14.25±4.93* 13.83±4.68
BZ F 2.77±0.11 2.69±0.24 2.81±0.41
M 2.66±0.21 2.48±0.06 2.41±0.52
RH F 75.13±17.99 108.85±33.88* 110.84±30.02**
M 101.44±27.42 121.93±38.41* 123.94±40.42**
RHmax F 88.56±23.26 117.32±38.93* 119.43±41.44**
M 127.56±34.81 149.32±46.82* 148.77±39.88**
TH F 143.88±43.9 186.24±37.77* 180.38±40.81**
M 171.21±49.11 206.02±45.02* 209.01±30.86**
THmax F 169.42±49.11 194.82±44.91* 199.52±36.77**
M 196.34±58.11 229.02±51.72* 222.09±34.45**
VAR [%] F 38.44±4.97 49.38±5.99* 50.1±4.75**
M 42.33±5.08 55.42±6.12* 57.19±6.39**
* statistically significant differences between I and II measurement
** statistically significant differences between I and III measurement
RF – mean values of rest flow; BZ – mean values of biological zero
RH – mean values of reactive hyperemia
RHmax – maximal values of reactive hyperemia
TH - mean values of thermal hyperemia
THmax – maximal values of thermal hyperemia
VAR -arterio – venous reflex index
by Szyguła R. et al. 79
© Editorial Committee of Journal of Human Kinetics
Table 3
Mean values (x) and standard deviation (SD) of the variables analyzed in basal flow
in particular frequencies in succeeding measurements
for both sexes with statistical verification
I measurement I measurement I measurement
Frequency
of signals
[cycles/min]
Signal
power
Frequency
of signals
[cycles/min]
Signal
power
Frequency of
signals
[cycles/min]
Signal
power
HF F 71.87±3,19 0.64±0,22 65.22±3.44* 0.69±0.11 66.19±3.01** 0.68±2.89
M 68.83±5.12 0.7±0.31 62.6±4.66* 0.73±0.19 62.9±3.87** 0.71±1.37
BF F 12.81±0.87 0.51±0.19 13.03±2.12 0.51±0.17 13.01±1,01 0.49±0.1
M 12.02±0.59 0.49±0.2 12.73±0.72 0.47±0.11 12.71±0.91 0.5±0.09
MF F 5.95±0.49 1.64±1.02 6.76±0.77* 1.66±0.9 6.81±0.64** 1.54±0.91
M 6.11±0.71 1.73±0.99 6.81±0.56* 1.69±0.85 6.8±0.59** 1.69±0.75
SF F 1.9±0.46 0.52±0.31 2.04±0.62* 0.5±0.39 2.0±0.57 0.52±0.36
M 2.0±0.41 0.46±0.26 2.03±0.44 0.49±0,33 2.05±0.49 0.49±0.31
EF F 0.9±0.0 3.82±1.03 0.9±0.0 4.01±1.57 0.9±0.0 3.92±1.35
M 0.9±0.0 3.87±0.97 0.9±0.0 3.79±1.06 0.9±0.0 3.99±1.76
* statistically significant differences between I and II measurement
** statistically significant differences between I and III measurement
HF – mean values of heart frequency; BF – mean values of breath frequency
MF – mean values of myogenic frequency
SF – mean values of sympathetic frequency
EF – mean values of endothelium frequency
The arterio–venous reflex index
(microcirculation’s reaction to change of position)
was significantly higher after WBCT in both
groups (women- p=0,0001, men - p=0,0001). Ten
days later men showed further significant
increase compared to the second measurement
(p=0,01). In women the increase was insignificant.
The interaction between men and women was
significant (p=0,00018).The recorded results
(values recorded for post-occlusive hyperaemic
reaction, reaction to temperature and the arterio–
venous reflex index) are shown in Table 2.
The myogenic frequency (MF)
significantly rose in the second measurement
compared to the first one in both men and women
(p=0,0001) and on the third measurement did not
change significantly with values close to those
obtained during the second measurement.
Heart frequency (HF) decreased
remarkably after cryostimulation (F, M p=0,0001)
and remained stable after ten days in both groups.
Neurogenic rhythm (SF) increased
significantly after cryostimulation in women
(p=0,016).
Other variables did not alter significantly.
The recorded results (the values of frequency in
the range of 0,01 Hz to 2 Hz) are shown in Table 3.
Discussion
Despite the fact that WBCT has become an
accepted physiotherapy method, it remains
unclear how the extremely low temperatures
work, what is the optimal number of sessions and
how long the positive therapeutic effects for the
cutaneous microcirculation last. In healthy
individuals the analgesic and relaxing effects
persist for several months after a series of
cryotherapy sessions (Zagrobelny and Zimmer,
1999; Wojtecka-Lukasik et al., 2010). In this study
10 cryogenic sessions were applied during 10
consecutive days as this is the most frequently
applied procedure, recommended by the
producers of cryogenic chambers, which does not
mean it is optimal. Lubkowska et al. (2010a)
proved that best therapeutic effect was observed
after 20 sessions. The flows in the cutaneous
80 Impact of 10 sessions of whole body cryostimulation on cutaneous microcirculation measured
Journal of Human Kinetics volume 30/2011, http://www.johk.pl
microcirculation were measured with the use of
laser Doppler flowmeter. It is a safe, non-invasive
and reproducible method and it records data from
thermoregulation area of the vessel bed excluding
the tissues underneath (Rousti et al., 2010;
Sokolnicki et al., 2009). No reference values have
been determined for this method, therefore the
status of the skin vessel bed is defined with the
use of provoked reactions to heat, occlusive or
orthostatic stimulus. Many authors studied
changes in skin microcirculation after local
cooling but there are no data regarding the impact
of extreme low temperature (WBCT) in this area.
The results obtained by the authors
showed that a series of 10 WBCT sessions did not
lead to significant changes in basal blood flow
measured one and ten days after the sessions. The
values were in the range of 10 – 20 PU, presumed
by Oimomi et al. (1985) as normal. In women the
values of baseline RF were lower than in men,
which was previously reported by other authors
(Pollock et al., 1993; Maurel et al., 1991).
Authors’ own research showed
significantly increased values of post-occlusive
hyperaemic reaction after a series of WBCT in the
second and third measurement that was similar in
both female and male group. The mechanism of a
hyperaemic reaction to occlusion is similar to the
response to extremely low temperatures. Initially,
hypoperfusion of the tissues occurs, leading to a
decrease in pO2 and accumulation of the
metabolites that results in active hyperaemia after
cessation of the stimulus (Strucl et al., 1994).
WBCT provokes active reperfusion of the skin
microcirculation of the whole body of much more
profound intensity than in case of local occlusive
stimulation. It can be presumed that a better
reaction of the skin microcirculation to occlusion
in the second and third measurement resulted
from increased reactivity of the smooth muscles of
the vessels that adapted their function to
cryogenic temperatures applied. Increased
frequency in the range of 0,051 – 0,145 Hz
suggests that extremely low temperature impacts
the myogenic control of the blood flow, although
the mechanism of the adaptation requires further
studies.
Authors’ own research used heat stimulus
of 44°C as this temperature warrants maximal
response of the skin vessel bed (Charkoudian,
2003). In the first phase a rapid vasodilation
occurs due to heat dependent decreased
sympathetic stimulation, later hyperaemia is
sustained by increased NO secretion (Brothers et
al., 2010; Rousti et al., 2010; Minson et al., 2001).
Significantly higher values of hyperaemic reaction
to heat were recorded after a series of WBCT
compared to initial values. It can be explained by
a more efficient response of the cutaneous
microcirculation to decreased sympathetic
stimulation. Better reactivity of the
microcirculation may also explain a 50% decrease
in blood flow in the arteriovenous reflex index.
Change of the position from horizontal to vertical
is a strong stimulus provoking vasoconstriction in
order to avoid a rapid and excessive increase of
hydrostatic pressure.
There is a remarkable decrease in
frequency in the range of 0,01 – 0,02 Hz. Most
probably it results from a move of the autonomic
balance towards parasympathetic component.
Such a reaction to extremely low temperature was
reported by Lee et al. (2011).
The cryostimulation–related increase in
neurogenic rhythm noted only in women can be
explained by higher levels of estrogens. The
estrogens induce increased susceptibility of the α2
adrenergic receptorsby increasing the oscillation
neurogenic (Colucci et al., 1982).
The variations between men and women
are most likely related to the hormonal
differences. Over the last decade, the impact of
sex hormones on skin microcirculation in women
and men have been analyzed. Most studies were
concentrated on estrogens, which decrease the
number of angiotensin type 1 receptors (AT1) and
the concentration of angiotensin convertase
inhibitors (ACE) that results in vasodilation.
Estrogens modulate the function of the
baroreceptors and ion channels (K+, Ca2+) as well
as increase endothelium-dependent vaso-dilating
mechanisms by regulating the expression of genes
of nitric oxide synthase (eNOS) or endothelin-1.
They also stimulate the synthesis of
prostaglandins (PG) and increase the
susceptibility of the vessels to acetylcholine (Ach).
Progesterone and testosterone also influence sex-
related regulation of the vessel bed but their role
remains controversial. Some authors report their
vasodilating function whereas other suggest their
vasoconstrictive effects (Mercuro et al., 1999;
Sudhir et al., 1996; Huang and Kaley, 2004;
by Szyguła R. et al. 81
© Editorial Committee of Journal of Human Kinetics
Gonzales et al., 2008).
There is no doubt that the activity of sex
hormones has an impact on flows in the skin
microcirculation and on reactivity of the skin
vessel bed and that the differences in their
concentration are probably responsible for the
interaction between the groups of men and
women. Although the impact of hormones on
circulation in women and men still remains
unclear and warrants further studies.
The values recorded in the second and
third measurement were very similar and
significantly higher compared to the first
measurement, which suggests positive impact of
10 sessions of WBC on skin microcirculation and
persistence of the effect for the following 10 days.
Lack of similar studies makes a comparison
difficult and shows the need for further studies.
Conclusions
A series of 10 procedures of whole body
cryostimulation resulting in a significant increase
of post-occlusive hyperemic reaction, hyperemic
reaction to temperature and orthostatic reaction in
both women and men suggests positive effects of
extremely low temperatures on reactivity of the
skin microcirculation in healthy persons,
persisting during whole cryostimulation period.
References
Akhalaya MY, Platonov AG, Baizhumanov AA. Short-term cold exposure improves antioxidant status and
general resistance of animals. Bull Exp Biol Med, 2006; 141: 26-29.
Banfi G, Lombardi G, Colombini A, Melegati G. Whole-Body Cryoytherapy in Athletes. Sports Medicine,
2010; 40(6): 509-517.
Bauer J, Hurnik P, Zdziarski J, Mielczarek W, Skrzek A, Podbielska H, Zagrobelny Z.The use of
thermography in the assessment of the effects ofcryotherapy. Acta Bio-Opt Inform Med, 1997; 3:
51-55 (in Polish, abstract in English).
Beradesca E, Leveque JL, Masson P, & the EEMCO Group. EEMCO guidance for the measurement of skin
microcirculation. Skin Pharmacol Appl Skin Physiol, 2002; 15: 442-456.
Brandner B, Munro B, Bromby LM, Hetreed M. Evaluation of the contribution to postoperative analgesia by
local cooling of the wound. Anasthesia, 1996; 51: 1021-1025.
Brothers RM, Wingo JE, Hubing KA, Crandall CG. Methodological assessment of skin and limb blood flows
in the human forearm during thermal and baroreceptor provocations. J Appl Physiol, 2010; 109(3):
895-900.
Cankar K, Strucl M. The effect of glibenclamide on cutaneous laser-Doppler flux. Microvasc Res, 2008; 75: 97-
103.
Charkoudian N. Skin blood flow in adult human thermoregulation: How it works, when it does not, and
why. Mayo Clin Proc, 2003; 78: 603-612.
Chotani MA, Flavahan S, Mitra S, Daunt D, Flavahan NA. Silent alpha(2C)-adrenergic receptors enable cold-
induced vasoconstriction in cutaneous arteries. Am J Physiol Heart Circ Physiol, 2000; 278(4):
H1075-1083.
Colucci WS, Gimbrone MA, Mc Laughlin MK, Halpern W, Alexander RW. Increased vascular catecholamine
sensitivity and α-adrenergic receptor affinity in female and estrogen-treated male rats. Circ Res,
1982; 50: 805-811.
Dugue B, Smolander T, Westerlund T. Acute and long-term effects of winter swimming and whole-body
cryotherapy on plasma antioxidative capacity in healthy women. Scand J Clin Lab Invest, 2005; 65:
395-402.
Flouris AD, Cheung SS. Influence of thermal balance on cold-induced vasodilation. J Appl Physiol, 2009; 106:
1264-1271.
Fullerton A, Stücker M, Wilhelm KP, Wӓrdell K, Anderson C, Fischer T. Guidelines for visualization of
82 Impact of 10 sessions of whole body cryostimulation on cutaneous microcirculation measured
Journal of Human Kinetics volume 30/2011, http://www.johk.pl
cutaneous blood flow by laser Doppler perfusion imaging. Contact Dermatitis, 2002; 46: 129-140.
Gonzales RJ, Bryant JM, Naik JS, Resta TC, Walker BR. Gender differences in mesenteric vasoconstrictor
reactivity following chronic hypoxia. Microcirculation, 2008; 15: 473-484.
Huang A, Kaley G. Gender-Specific Regulation of cardiovascular function: Estrogen as key player.
Microcirculation, 2004; 11: 9-38.
Hubbard TJ, Aronson SL, Denegar CR. Does cryotherapy hasten return to participation? A systematic
review. J Athl Train, 2004; 39(1): 88-94.
Ingersoll CD, Mangus BC. Sensations of cold reexamined: a study using the McGill pain questionnaire. J
Athl Train, 1991; 26: 240-245.
Johnson JM, Kellogg DL. Mechanisms of thermoregulatory and thermal control in the human cutaneous
circulation. Front Biosci, 2010; 2: 825-853.
Knight KL. Cryotherapy in sport injury management. Human Kinetics. Champaign, IL, 1995.
Koganezawa T, Ishikawa T, Fujita Y, Yamashita T, Tajima T, Honda M, Nakayama K. Local regulation of
skin blood flow during cooling involving presynaptic P2 purinoreceptors in rats. Br J Pharmacol,
2006; 148(5): 579-586.
Kvernmo HD, Stefanovska A, Kirkeboen KA, Kvernebo K. Oscillations in the human cutaneous blood
perfusion signal modified by endothelium – dependent vasodilators. Microvasc Res, 1999; 57(3):
298-309.
Lee HY, Bak WS, Choi JH, Lee SH, Eom A. Impact of a cryotherapy and Tai Chi self-help program on
women with fibromyalgia Syndrome. Korean J Adult Nurs, 2011; 23(1): 10-19.
Long BC, Cordova ML, Brucker JB, Demchak TJ, Stone MB. Exercise and quadriceps muscle cooling time. J
Athl Train, 2005; 40:260-263.
Looga R. The Valsalvanmanoeuvre-cardiovascular effects and performance technique: A critical review.
Resp Physiol Neur, 2005; 147:39-49.
Lubkowska A, Banfi G, Dołęgowska B, Melzid-Eril GV, Łuczak J, Barrassi A. Changes in lipid profile in
response to three different protocols of whole-body cryostymulation treatments. Cryobiology,
2010a; 61(1): 22-26.
Lubkowska A, Szyguła Z, Klimek AJ, Torii M. Do sessions of cryostimulation have influence on white blood
cell count, level of IL6 and total oxidative and antioxidative status inhealthy men? Eur J Appl
Physiol, 2010b; 109: 67-72.
Maurel A, Hamon P, Macquin-Mavier I, Lagrue G. Cutaneous microvascular flow studied by laser-Doppler.
A study of 100 healthy volunteers. Presse Med, 1991; 20(26): 1205-1209.
Meeusun R, Van der Venn P, Joos E, Roeykens J, Bossuyt A, De Meirleir K. The influence of cold and
compression on lymph flow at the ankle. Clin J Sport Med, 1998; 8: 266-271.
Mercuro G, Pitzalis L, Podda A, Zoncu S, Pilia I, Melis GB, Cherchi A. Effects of acute administration of
natural progesterone on peripheral vascular responsiveness in healthy postmenopausal women.
Am J Cardiol, 1999; 84: 214-218.
Minson CT, Berry LT, Yoyner MJ. Nitric oxide and neurally mediated regulation of skin blood flow during
local heating. J Appl Physiol, 2001; 91: 1619-1626.
Oimomi M, Nishimoto S, Matsumoto S, Hatanaka H, Ishikawa K, Baba S. Evaluation of periflux blood flow
measurement in diabetic patients with autonomic neuropathy. Diabetes Res Clin Prac, 1985, 1(2):
81-85.
Pollock FE, Koman La, Smith BP, Holden M, Russell GB, Poehling GG. Measurement of hand microvascular
blood flow with isolated cold stress testing and laser Doppler fluxmetry. J Hand Surg Am, 1993;
18(1): 143-150.
by Szyguła R. et al. 83
© Editorial Committee of Journal of Human Kinetics
Rousti M, Blaise S, Millet C, Cracowski JL. Reproducibility and methodological issues of skin post-occlusive
and thermal hyperemia assessed by single-point laser Doppler flowmetry. Microvasc Res, 2010;
79(2): 102-108.
Sokolnicki LA, Strom NA, Roberts SK, Kingsley-Berg SA, Basu A, Charkoudian N. Skin blood flow and nitric
oxide during body heating in type 2 diabetes mellitus. J Appl Physiol, 2009; 106(2): 566-70.
Stephens DP, Aoki K, Kosiba WA, Johnson JM. Nonnoradrenergic mechanism of reflex cutaneous
vasoconstrictor in men. Am J Physiol Heart Circ Physiol, 2001; 280: H1496-H1504.
Strucl M, Peterec D, Finderle Z, Maver J. Pressure sensitivity of flow oscillations in postocclusive reactive
skin hyperemia. Am J Physiol, 1994; 266(5Pt2): H1762-H1768.
Sudhir K, Jennings GL, Funder JW, Komesaroff PA. Estrogen enhances basal nitric oxide release in the
forearm vasculature in perimenopausal women. Hypertension, 1996; 28(3): 330-334.
Sundberg S. Accute effects and long-term variation in skin blood flow measured with Laser Doppler
flowmetry. Scand J Clin Lab Invest,1984; 44: 341-345.
Westerlund T, Oksa J, Smolander J, Mikkelsson M. Thermal responses during and after whole-body
cryotherapy (-110°C). J Thermal Biol, 2003; 28: 601-608.
Wojtecka-Lukasik E, Ksiezopolska-Orlowska K, Gaszewska E, Krasowicz-Towalska O, Rzodkiewicz P,
Maslinska D, Szukiewicz D, Maslinski S. Cryotherapy decrease histamine levels in the blood of
patients with rheumatoid arthritis. Inflamm Res, 2010; 59 (Suppl 2): S253-S255.
Zagrobelny Z, Zimmer K. Cryogenic temperatures application in sports medicine and physiotherapy. Med
Sportowa, 1999; 6: 8-13.
Corresponding author:
Dr Renata Szyguła
Department of Physical Education and Physiotherapy, Technical University, Opole, Poland.
Prószkowska 76
45-758 Opole
Poland
Phone: 697310368
Email: r.szygula@po.opole.pl
... The purpose of this study was to determine the effect of repeated WBC sessions on the results of two simple neuromus-cular tests in young healthy adults: simple reaction time (SRT) and joint position sense (JPS). Based on Lubkowska et al. 4) , Szygula et al. 6) , and their results regarding the optimal number of exposures to produce beneficial hormonal changes, it was hypothesized that a standard treatment (10 WBC sessions) would have no effect on the tests scores while a longer treatment (20 or 30 WBC sessions) would decrease simple reaction times and reduce joint positioning errors. ...
... Therefore, the CNS searches for alternative, more credible inputs that have the capacity to participate and play important roles, even after the training or cold exposure is terminated. Secondly, the increase in blood circulation, which is typically associated with increased physical activity, shows a similarly elevated level during and just after cold application 6) . ...
... Thus, the elevated arousal following the series of WBC may have facilitated the ability of our participants to discriminate between relevant and extraneous cues during performance and to react faster to the visual stimuli. One last factor that may have supported the improved neuromuscular performance of our participants was better nourishment and oxygenation of body organs, which is associated with body cooling from vasoconstriction 6) . In cryotherapy, vasoconstriction leads to peripheral blood shunting, which results in larger blood flow and oxygen delivery to other tissues and temporarily enhances their function. ...
Article
Full-text available
[Purpose] Whole body cryotherapy has been shown to have many benefits, yet nothing is known if and how this modality can improve neuromuscular performance and retain those improvements. [Subjects and Methods] Joint position sense based on the bilateral knee joint matching test and simple reaction time was investigated in 25 young healthy adults who underwent an extended period of whole body cryostimulation. The measurements were taken at baseline and after 10, 20, and 30 whole body cryotherapy sessions, with three days elapsing after the last treatment, and comparing the results with 24 control subjects. [Results] Only when 20 sessions were completed did joint position sense and simple reaction time improve in the intervention group. After 30 sessions, the outcome was similar. Equal results were found at baseline and after 10 sessions in both groups, but the intervention group outstripped controls after 20 and 30 sessions in both joint position sense and simple reaction time. [Conclusion] These results indicate that the common standard of 10 sessions is insufficient, while approximately 20 sessions of whole body cryotherapy may efficiently enhance neuromuscular performance with an ability to sustain the effects for at least three days.
... Infrared (IR) thermography, in contrast, does not require any direct contact with the patient and allows remote and non-contact assessment of the surface temperature distribution of the examined body [28,29]. The method is widely used for superficial temperature distribution' measurements in medicine, e.g., screening tests [30], prevention [31], diagnosis [32,33], treatment' assessment [34][35][36], physiotherapy [37,38] as well as personalized medicine [39,40]. ...
Article
Full-text available
Cellulite, the problem of dimpled appearance of the skin, affects approximately 85% of female population in developed countries and is classified as one of the worst tolerated by women deteriorating their quality of life and self-esteem. There is a lack of early, objective, quantitative and personalized diagnosis of different stages of cellulite, thus making prevention or early therapeutic intervention difficult. We have demonstrated the efficacy of thermal imaging using IR thermography in a group of female volunteers with different stages of cellulite. By analyzing the superficial temperature distribution of the body, it was possible to diagnose the cellulite stage. The thermal images of posterior site of thighs were recorded, and cellulite areas were identified for further quantitative analysis. We used a custom-designed classification scheme for automatic recognition of the different stages of cellulite as per the well-known Nürnberger–Müller diagnosis scheme. It was possible to diagnose the cellulite stages with over 80% accuracy. The accuracy can be further increased to over 97% using a threshold value correction scheme. Our work has shown that IR thermography when coupled with computer-aided imaging analysis and processing can be a very convenient and effective tool to enable personalized diagnosis and preventive medicine to improve the quality of life of women with cellulite problem.
... W pracy [65] u osób zdrowych po 10, 20 i 30 zabiegach kriostymulacji z jednej strony obserwowano obniżenie poziomu hemoglobiny, hematokrytu, stężenia haptoglobiny oraz interleukiny 3, a z drugiej zaobserwowano wzrost stężenia bilirubiny i erytropoetyny. Liczba erytrocytów po 10 i 20 zabiegach była znamiennie niższa i powróciła do liczby wyjściowej po 30 zabiegach kriostymulacji. ...
... These results are in line with a published study that examined skin blood flow after ten WBC sessions using LDF. 37 This increase in microcirculation may have occurred due to the sudden cooling of the body, stimulating sympathetic vasoconstrictors, leading to a strong reactive hyperemia after the exposure. 38 The images of the LSCI device revealed that a strong reactive response was not observed immediately after the CWI treatment, indicating that the short and extreme cold exposure to the vaporized nitrogen itself may have triggered these primary neuronal-driven control mechanisms of skin blood flow. ...
Article
Full-text available
The aim of this study was to compare i) the physiological responses following cold-water immersion (CWI) and partial-body cryotherapy (PBC) and ii) the effects on recovery following a muscle-damaging protocol (5 x 20 drop jumps). Nineteen healthy males were randomly allocated into either a CWI (10 °C for 10 min; n = 9) or a PBC (-60 °C for 30 sec, -135 °C for 2 min; n = 10) group. The physiological variables (thigh muscle oxygen saturation [SmO2 ], cutaneous vascular conductance [CVC], mean-arterial pressure [MAP] and local skin temperature) were assessed immediately prior and up to 60 min post-treatment (10 min intervals). The recovery variables (thigh muscle swelling, maximum voluntary contraction [MVC] of the right knee extensors, vertical-jump performance [VJP] and delayed-onset of muscle soreness [DOMS]) were measured immediately prior and up to 72 h post-treatment (24 h intervals). Compared to PBC values, CVC (at 30 min), SmO2 (at 40 min) and lower extremity-skin temperature (thigh/shin at 60 min) were significantly reduced in the CWI group after the treatment (all p < 0.05). Only lower extremity-skin temperature was significantly reduced in the PBC group directly post-treatment (all p < 0.05). MAP significantly increased in both groups after the treatments (both p < 0.05). DOMS did not differ between groups. MVC and VJP returned to baseline in both groups after 24 h (p > 0.05). CWI had a greater impact on the physiological response compared to PBC. However, both treatments resulted in similar recovery profiles during a 72 h follow-up period. This article is protected by copyright. All rights reserved.
Chapter
A new disease, named a chronic pain, which affects more than 20% of adult population, has been recognized. The chronic pain patients need to cope with the effects of that treatment resistant being to an ailment such as emotional overloading, disability, sleep and mood disturbances, etc. A novel idea for the effective chronic pain control is focused on identifying one of the three possible pain mechanisms: a nociceptive, neuropathic, or a nociplastic pain related to the central sensitization (CS). This differentiation means that the treatment should follow the pain type. However, the problem of determining the dominant pain component has not yet been solved. The current trend in the research related to pain diagnostics is a desire to define an objective tool for the CS confirmation. It is hypothesized that the autonomic nervous system, dysregulation measurement (response to noxious stimuli) can be one of the parameters for the objective CS confirmation. The new validated and awarded method to confirm the myofascial pain syndrome (MPS) dependent on the central sensitisation process has been presented. The protocol of the method is considered a new type of the active dynamic thermography. The involvement of the CS related to muscles is confirmed objectively being based on the visualization of the perceived pain area by presenting the vasomotor response to stimulation. Unfortunately, the main disadvantages of that method is time consuming of the manual thermal data analysis. The use of the MATLAB® software for the thermal data analysis seems interesting for consideration.
Article
Full-text available
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 −110°C to −140°C 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.
Article
Full-text available
The past 10-15 years has been a time of focus on the mechanisms of control in the human cutaneous circulation. Methodological developments have provided powerful means for resolving the important contributors to the reflex control of skin blood flow (thermoregulatory control) and also for the equally impressive effects of direct heating and cooling of the skin (thermal control). This review is devoted largely to that recent literature. We treat the sympathetic vasoconstrictor system and its transmitters and modulatory factors and the sympathetic active vasodilator system and its abundant mysteries, with focus on the putative transmitters and cotransmitters, the involvement of nitric oxide and the relationship to sweating and modulatory factors. We also deal with the current understanding of the mechanisms of vasoconstriction and vasodilation that accompany direct skin cooling and heating, noting that adrenergic function, afferent nerve function and the nitric oxide system are involved in the vascular responses to both thermal stimuli.
Article
Full-text available
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.
Article
Purpose: The purpose of this study was to evaluate the impact of a protocol of cryotherapy and Tai Chi on women with Fibrolmyalgia Syndrome. Methods: The study design was a pretest and posttest quasi-experimental, nonrandom assignment. The subjects were 48 outpatients with a diagnosis of fibromyalgia based on the American College of Rheumatology Standards. The setting was a University Medical Center in S city. The protocol was self administered ten times a week, for a two week period resulting in twenty treatments. Results: A protocol of cryotherapy and Tai Chi self-help program showed significant improvement in the fibromyalgia impact as measured by reports of physical impairment, feeing good, number of missed work days, ability to perform work, reports of pain, fatigue, rest, stiffness, anxiety and depression as reported by the comparison group (p
Article
The effect of whole-body cryotherapy (WBC) on rectal and skin temperatures was measured in healthy subjects before, during and after WBC exposure. WBC did not cause any significant change in rectal temperature. The lowest local skin temperatures were recorded in the forearm, 5.2 (2.8)°C, and in the calf, 5.3 (3.0)°C. WBC involves no risk for frostbites. After WBC, all skin temperatures recovered rapidly, indicating that the analgetic effects of WBC only occur during a limited period after the exposure.
Article
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.
Article
The primary objective of this study was to evaluate 1-week reproducibility of post-occlusive reactive hyperemia (PORH) and local thermal hyperemia (LTH) assessed by single-point laser-Doppler flowmetry (LDF) on different skin sites. We also evaluated spatial reproducibility of both tests on the forearm. Finally, we assessed the influence of mental stress and room temperature variations on PORH and LTH. We performed PORH and LTH assessing skin blood flow on the forearm and on the finger pad with LDF. We repeated the sequence 1 week later. We also performed PORH and LTH during mental stress (Stroop test) and at room temperatures of 21 degrees C and 27 degrees C. Data were expressed as cutaneous vascular conductance (CVC), as a function of baseline and as a function of 44 degrees C vasodilation (%CVC(44)). Reproducibility was expressed as within subject coefficients of variation (CV) and intra-class correlation coefficients (ICC). Fourteen Caucasian healthy volunteers were recruited. Median age was 25 (2.7) and 50% were female. Median body mass index was 21.2 (5). PORH was reproducible on the finger, whether expressed as raw CVC (CV=25%; ICC=0.56) or as %CVC(44) (CV=24%; ICC=0.60). However, PORH showed poor reproducibility on the forearm. In the same way, LTH was reproducible on the finger pad when expressed as CVC (CV=17%; ICC=0.81) but not on the forearm. Spatial reproducibility was poor on the forearm. Elevated room temperature (27 degrees C) affected PORH and LTH on the finger pad (p<0.05) but not on the forearm. Single-point LDF is a reproducible technique to assess PORH and LTH on the finger pad when data are expressed as raw CVC or %CVC(44). On the forearm, however, it shows great inter-day variability, probably due to spatial variability of capillary density. These results highlight the need for alternative techniques on the forearm.
Article
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). 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. 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. 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.