Thermal Sensations During a Partial-Body Cryostimulation Exposure in Elite Basketball Players

Abstract

Partial-body cryostimulation is used to improve recovery after exercise, especially during competitions or heavy training; however, a limited number of studies have been conducted with international-level athletes in situ during competitions. This study was undertaken to assess the thermal sensation ratings during 3 min of cold exposure (at –130°C) in 24 international-level athletes during the European Basketball Championship. The mean thermal sensation score, measured using a perceptive scale, increased significantly (p < 0.05) during partial-body cryostimulation exposure in athletes from 3.0 ± 1.7 at 30 s to 5.7 ± 2.3 at 3 min (maximal observed value = 10.0). The mean value of 5.7 is considered a “cold” sensation on the scale (ranging from 0 = neutral sensation to 10 = very cold). However, we observed a large inter-individual variation in the perceived thermal sensations. The body mass index was significantly and negatively correlated with the thermal sensation value after 2 min 30 s and 3 min of exposure in females (r = –0.61, n = 13, p < 0.05; r = –0.56, n = 13, p = 0.054, respectively). Three participants reported high perceived thermal sensation after 30 s of exposure and their cold-induced discomfort worsened as the exposure continued. In conclusion, a 3-min exposure is globally well tolerated by athletes and can be used during a heavy competition period and/or during a training period. However, special attention should be given to female athletes with a low body mass index as they seem to be much more sensitive to cold.

Full text

Journal of Human Kinetics volume 62/2018, 55-63 DOI: 10.1515/hukin-2017-0158 55
Section II‐ Exercise Physiology & Sports Medicine
1 - Université de Franche Comté, Laboratoire C3S (EA 4660), Unité de Promotion, de Formation et de Recherche (UPFR) des Sports,
31 rue de l’Epitaphe, 25000 Besançon, France.
2 - Université de Poitiers, EA 6314, laboratoire « Mobilité, Vieillissement et Exercice (MOVE) », Faculté des sciences du sport,
86000 Poitiers, France.
3 - Société Cryantal Développement, 15 cours du Luzard, 77186 Noisiel, France.
.
Authors submitted their contribution to the article to the editorial board.
Accepted for printing in the Journal of Human Kinetics vol. 62/2018 in June 2018.
Thermal Sensations During a Partial‐Body Cryostimulation
Exposure in Elite Basketball Players
by
Romain Bouzigon1,3, Gilles Ravier1, Benoit Dugue2, Frederic Grappe1
Partial-body cryostimulation is used to improve recovery after exercise, especially during competitions or
heavy training; however, a limited number of studies have been conducted with international-level athletes in situ
during competitions. This study was undertaken to assess the thermal sensation ratings during 3 min of cold exposure
(at –130°C) in 24 international-level athletes during the European Basketball Championship. The mean thermal
sensation score, measured using a perceptive scale, increased significantly (p < 0.05) during partial-body
cryostimulation exposure in athletes from 3.0 ± 1.7 at 30 s to 5.7 ± 2.3 at 3 min (maximal observed value = 10.0). The
mean value of 5.7 is considered a “cold” sensation on the scale (ranging from 0 = neutral sensation to 10 = very cold).
However, we observed a large inter-individual variation in the perceived thermal sensations. The body mass index was
significantly and negatively correlated with the thermal sensation value after 2 min 30 s and 3 min of exposure in
females (r = –0.61, n = 13, p < 0.05; r = –0.56, n = 13, p = 0.054, respectively). Three participants reported high
perceived thermal sensation after 30 s of exposure and their cold-induced discomfort worsened as the exposure
continued. In conclusion, a 3-min exposure is globally well tolerated by athletes and can be used during a heavy
competition period and/or during a training period. However, special attention should be given to female athletes with a
low body mass index as they seem to be much more sensitive to cold.
Key words: competition, cryotherapy, international-level athletes, perceived cold sensation, recovery.
Introduction
Partial body cryostimulation (PBC)
consists of extreme cold exposure lasting from 1
to 4 min in a cabin with an air temperature of –130
°C (according to the manufacturer) or less in
minimal clothing (a bathing suit, cap, gloves,
socks, slippers) (Bouzigon et al., 2016). PBC
apparatus is an open cabin where subjects,
excluding the head and neck, are exposed. This
technique is used to treat pain and inflammation,
recover faster after injuries or surgery, improve
the quality of life in patients suffering
inflammatory pathologies and recover faster after
physical exercise (Banfi et al., 2010; Dugue and
Leppanen, 2000; Dugue, 2015; Lombardi et al.,
2017; Miller et al., 2016; Mikołajec et al., 2017).
Though not completely clear, the
mechanism leading to recovery improvement
seems to be related to cold-induced analgesia and
a lower level of exercise-induced inflammation
(Hausswirth et al., 2011; Leppaluoto et al., 2008;
Pournot et al., 2011). Stimulation of the
sympathetic system, release of noradrenalin and
vasoconstriction during and after cold
exposure have a significant impact on pain and
muscle soreness (Leppaluoto et al., 2008). Muscle
cooling during and after cold exposure may also

56 Thermal sensations during a partial-body cryostimulation exposure in elite basketball players
Journal of Human Kinetics - volume 62/2018 http://www.johk.pl
lower enzyme activities, lower the metabolism
and limit protein degradation after exercise-
induced ischemia, which can be an important
feature for recovery improvement (Bleakley and
Hopkins, 2010; Costello et al., 2012). Moreover,
athletes using PBC during high-level international
tournaments seem to have an enhanced quality of
sleep (Bouzigon et al., 2014). PBC has therefore
been well accepted by many athletes and
professional sport teams (Banfi et al., 2009). PBC is
available in a mobile device which enables its use
at training and competition sites.
Benefits of PBC for physical recovery
improvement have been demonstrated (Bouzigon
et al., 2016). However, whether an exposure at –
130 °C or less is well tolerated by athletes during a
competition is questionable. Such exposure could
be perceived as too painful, stressful and even
dangerous and could lower or eliminate the
beneficial effects of cryostimulation. During
competition, psychological stress increases in
athletes (Filaire et al., 2001). Moreover,
international-level athletes are subjects with very
special kinds of psychological and physiological
adaptations, and when experiencing high levels of
stress (e.g. during international competition), they
may react differently (Harung et al., 2011;
Sternberg et al., 1998) than during periods of
lower amounts of physical and psychological
loads. Such changes may have an influence on the
athlete’s thermal sensitive capacities (Sternberg et
al., 1998). At the current time, there are no data
available concerning cold-perceived sensation in
international athletes (Hohenauer et al., 2015), and
therefore it is important to assess the thermal
sensation during cold exposure in international-
level athletes during the competitive period.
Anthropometric characteristics including
relative mass and size of the contact area are
known to influence tissue cooling, transfer of heat
from the body and perceived thermal sensations
in humans subjected to cold stimuli (Dugue and
Leppanen, 2000; Glickman-Weiss et al., 1993;
Zhang et al., 2001). Moreover, it seems that gender
may also have an effect as females show a
different level of perceived thermal sensation than
males when exposed to cold stimuli (Cuttell et al.,
2017; Hammond et al., 2014).
This study was undertaken to assess the
thermal sensation ratings during 3 min of cold
exposure (at –130 °C) in elite athletes during
international competitions. We examined whether
a 3-min PBC exposure at –130 °C remained
comfortable for competitive athletes; whether
male and female athletes perceived the cold
stimulus in a similar way and whether athletes
with a lower BMI perceived the cold stimulus in a
similar way compared to athletes with a higher
BMI. The data obtained in this study should
therefore be useful in the world of professional
sports, and teams could obtain information on
whether PBC is suitable for the athletes during
competitions.
Methods
Participants
Twenty-four international-level basketball
players (13 females and 11 males, aged 25.7 ± 3.5
years) from the French national team participated
in this study. The athletes’ characteristics are
presented in Table 1 and were obtained from the
team organisers. We calculated the BMI, which is
the body mass divided by the square of the body
height. Thorough investigations of the athletes
were not possible in the context of the European
Basketball Championship.
All the participants were informed about
the experimental procedure along with the
purpose of this study and gave written informed
consent. The protocol was approved by the local
ethics committee and adhered to the latest
amendments of the Declaration of Helsinki.
Design and Procedures
This field study was carried out during
the two weeks of the 2013 European Basketball
Championship preparation tournament. Cold
exposure was performed using PBC apparatus
(Universal Cryosana; Mecacel, Mouroux, France),
and cooling of the cryocabin was performed with
nitrogen spraying inside the chamber. Although
the cryo spray did not directly touch the athlete’s
skin, the temperature through the exposure was
adjusted with the nitrogen supply. The PBC
device was a mobile PBC integrated in a trunk.
The exposures were performed next to the hotel of
the French Team. The device was equipped with
adjustable walls enabling athletes of different
heights to have similar exposure. The PBC
procedure was a 3-min exposure at –130 °C that
occurred in the afternoon after training (between
4 and 9 pm). Such a protocol is regularly used in
the exercise recovery context and has been shown

by Romain Bouzigon et al. 57
© Editorial Committee of Journal of Human Kinetics
to provide benefits in athletes (Klimek et al., 2010;
Mila-Kierzenkowska et al., 2013; Sutkowy et al.,
2014). In the cryocabin, athletes wore underwear,
gloves, socks and slippers.
Measures
The perception of thermal sensation
during exposure within the cryocabin was
recorded every 30 s. The participants were asked
to rate their perceptual thermal sensation using a
ten-point scale (Lundgren et al., 2014), which had
been shown to be valid and reliable to assess
human thermal perception in an extremely cold
environment (Lundgren et al., 2014). The scale
was shown to the participants every 30 s, and the
following question was asked: “How cold do you
feel right now?". The athletes answered verbally
from 0 (“neutral”) to 10 (“unbearably cold”)
(Figure 1), and the given score was registered. All
the scores were obtained during the exposure. At
the third minute, the thermal sensation was
evaluated just before the end of the exposure.
It was not possible to perform other
assessments on athletes during competition.
Statistical analysis
The statistics program used was
Sigmaplot 12.0 Software (Systat Inc. San Jose, CA,
USA). The results were expressed as mean and
standard deviation (SD). Homogeneity of variance
was assessed with a F-test Levene’s test. The
changes in the evolution of the thermal sensation
scores during the exposures in male and female
athletes were analysed by a two-way analysis of
variance (ANOVA) with repeated measures
(Gender x Duration). Thus, the evolution of the
thermal sensation score during the exposure was
analysed. We also investigated whether the
changes in the thermal sensation were similar or
different in males and females. Thermal sensation
data were logarithmically transformed to reduce
non-uniformities of their distribution when they
were not normally distributed in a Gaussian
manner (Hopkins et al., 2009). Post hoc
comparison was performed using the
Tukey/Kramer test. Correlation analyses between
the BMI and thermal sensation were performed
using the Spearman test. The level of statistical
significance was set at p < 0.05.
Results
Thermal sensation seemed to increase
every 30 s during PBC exposure in both male and
female athletes and in all athletes (p < 0.001; F =
37.41). The significant differences between each
time interval are shown in Table 2.
The evolution of the thermal sensation
scores during exposure was similar in males and
females (p < 0.001; F = 15.13 and p < 0.001; F = 7.2,
respectively, with no significant interaction). The
data obtained at each measurement time are
shown in Table 2.
In females, the BMI became significantly and
negatively correlated with thermal sensation
during the last minute (at 150 s: r = –0.61, n = 13, p
< 0.05; at 180 s: r = –0.56, n = 13, p < 0.05), i.e.
female athletes with a lower BMI had more
uncomfortable thermal sensations than female
athletes with a higher BMI (Figure 2). No
significant correlations between the BMI and
perceived thermal scores were found in male
athletes.
Figure 1
Thermal sensation scale

58 Thermal sensations during a partial-body cryostimulation exposure in elite basketball players
Journal of Human Kinetics - volume 62/2018 http://www.johk.pl
Figure 2
Results of the Spearman correlation test between thermal sensations
after 3 min of exposure and the BMI in female athletes
Table 1
Characteristics of the 24 athletes (expressed as the mean ± standard deviation)
All Males Females
Age (years)
25.7 ± 3.5 25.5 ± 3.6 25.9 ± 3.5
Body mass (kg)
88.5 ± 15.7 100.2 ± 12.4 78.5 ± 10.7
Body Height (cm)
192.5 ± 11.8 201.9 ± 7.2 184.5 ± 8.6
BMI (kg/m2)
23.7 ± 2.3 24.5 ± 2.0 23.0 ± 2.4
BSA (m²)
2.18 ± 0.25 2.39 ± 0.18 2.01 ± 0.17
BSA/BM (cm²/kg)
2.50 ± 0.17 2.39 ± 0.13 2.58 ± 0.16

by Romain Bouzigon et al. 59
© Editorial Committee of Journal of Human Kinetics
Table 2
Perception of thermal sensation (Mean ± SD) and extreme observed values
in brackets during a 3-min whole-body cryostimulation exposure in 24 athletes
30 s 60 s 90 s 120 s 150 s 180 s
All athletes
3.0 ± 1.7* 3.8 ± 1.7§ 4.3 ± 1.7‡|| 4.7 ± 1.9§¶ 5.3 ± 2.1||** 5.7 ± 2.3¶
(0.0 – 7.0) (0.0 – 7.5) (0.0 – 8.0) (0.0 – 9.0) (0.0 – 9.5) (0.0 – 10.0)
Males
2.9 ± 1.6‡ 3.8 ± 1.4†§||¶ 4.5 ± 1.5 4.9 ± 1.6 5.5 ± 1.9 6.0 ± 1.9
(1.0 – 6.0) (2.0 – 6.0) (2.0 – 8.0) (3.0 – 9.0) (3.0 – 9.5) (3.0 – 10.0)
Females
3.1 ± 1.8‡ 3.8 ± 2.0†§|| 4.2 ± 1.9‡||¶ 4.6 ± 2.1‡§¶** 5.2 ± 2.4§||** 5.5 ± 2.6||¶
(0.0 – 7.0) (0.0 – 7.5) (0.0 – 8.0) (0.0 – 8.0) (0.0 – 9.0) (0.0 – 9.0)
(Abbreviations: * significantly different from the data obtained at other time points;
Value significantly different from the data obtained at other time points: except for 30 s: †;
Except for 60 s: ‡; Except for 90 s: §; Except for 120 s: ||; Except for 150 s: ¶; Except for 180 s: **)
Discussion
This study was undertaken to evaluate
the thermal sensation during PBC exposure in
international-level athletes in situ during periods
of competition. Relevant and valuable outcomes
concerning thermal perception during PBC
exposure were obtained.
The main finding of this study is that PBC
does not seem to represent a high thermal
perceptual strain for the majority of the
participating athletes. However, we observed a
large inter-individual variation in the perceived
thermal sensations. The female athletes with the
lowest BMI had the highest scores in the thermal
scale we used.
Thermal sensation scores gradually
increased during the course of the 3-min
exposure, with the scores rapidly increasing
during the first minute and then stabilizing
during the final two minutes. After the total
exposure time (3 min), the mean perceived
thermal sensation score was 5.7, which indicates a
“cool” sensation. Therefore, a 3-min exposure at –
130 °C did not appear to add unnecessary strain

60 Thermal sensations during a partial-body cryostimulation exposure in elite basketball players
Journal of Human Kinetics - volume 62/2018 http://www.johk.pl
for the majority of the athletes during the
competition phase. The maximum score of
perceived thermal sensation (coldest sensation =
10) was reached only at 180 s in one subject. The
majority of the participants did not feel especially
cold after the end of the exposure. Nevertheless,
at 30 s, three participants reported relatively high
perceived thermal sensation scores (≥6), and their
cold-induced discomfort worsened as the
exposure continued.
The second important finding of this
study is the negative correlation between the BMI
of the athletes and thermal sensations, especially
in females, during the exposure. It seems that the
morphology of the participants may influence
heat transfer from the body to the environment,
especially as the duration of cold exposure
increases. Recently, Cholewka et al. (2012)
demonstrated that the magnitude of the skin
temperature response to extremely low
temperatures used in WBC was dependent on
individual features, such as the BMI. Depending
on age and sex, the BMI has been shown to be
closely correlated with body fat (Gallagher et al.,
1996), and it is known that fat tissues in skin or in
muscles may act as thermal insulation. Therefore,
the subjects with a lower BMI may be more prone
to transfer heat and may be more sensitive to the
cold environment. The gender-linked discrepancy
in thermal sensation could be related to different
thermoregulation abilities in males and females.
This might be explained by anthropometric and
thermoregulatory differences. Indeed, females
have 20% lower body mass, 14% more fat, 33%
less lean body mass and 18% less surface area
(Burse, 1979) and a higher subcutaneous to
visceral fat ratio than males (Enzi et al., 1986).
Moreover, when exposed to cold environments,
females generally have a lower ability to shiver
(Burse, 1979) and a greater reduction in skin
temperature than males (Cuttell et al., 2017;
Hammond et al., 2014; Stocks et al., 2004). This
may explain, in part, the higher scores for cold
sensation recorded by females.
It has also been shown that the
temperature in an empty cryocabin is lower than
in a cryocabin with a participant inside (Savic et
al., 2013). Therefore, the morphology of the
participant and the duration of the exposure
could influence the temperature inside the
cryocabin. Currently, chamber temperature
cannot be monitored continuously, and the actual
cold stimulation may not have been completely
consistent among participants. The only
temperature control is performed at the position
of the nitrogen nozzle. Recent investigation
showed that temperature variation may occur
next to the skin (5–10 °C depending on the
subjects) (Savic et al., 2013). Moreover, significant
temperature differences were shown among
different body regions due to the colder
temperature at the bottom of the cabin (cold air
has higher density than warm air). Furthermore,
PBC consists of an open tank at the head level that
facilitates the entry of warmer air into the system;
the system does not provide a constant and
homogeneous temperature in the cabin. In our
setting, subjects with the lowest BMI might be
more sensitive to cold exposure (higher cold
perception), have transferred a higher amount of
heat during the exposure or have been subjected
to colder temperatures than subjects with a higher
BMI.
Globally, a 3-min exposure at –130 °C is
well tolerated by athletes and can be used during
a heavy competition period and/or during a
training period when the load of physical exercise
is very important. PBC is not perceived as
extremely uncomfortable or stressful by most
athletes; however, special attention should be
given to female athletes with a low BMI as they
seem to be much more sensitive to cold. Our
recently published review emphasizes that further
studies should be developed to analyse thermal
sensation in connection to the physical
characteristics and gender of the participants to be
able to provide the most relevant PBC exposure
(Bouzigon et al., 2016). The link found between
the BMI and cold-perceived sensation should be
explored with further analysis including
subcutaneous (and even intramuscular) fat
content. Technical improvements concerning
temperature monitoring during cold exposure are
also necessary so that the chamber can be adjusted
to a given temperature throughout the exposure
and to allow for an even temperature in the
chamber. Indeed, only two studies have presented
the actual temperature in a PBC device (Criomed,
Kherson, Ukraine) and a WBC device (Cryantal
Developpement, Noisiel, France) during an
exposure (Bouzigon et al., 2017; Savic et al., 2013).

by Romain Bouzigon et al. 61
© Editorial Committee of Journal of Human Kinetics
Acknowledgements
We thank all the volunteers and their professional teams who participated in this study. Samuel
Queniart and Jean Gratacos and their team from Cryantal are also warmly thanked for their logistic support.
The experiment performed in this study complies with the current laws of the French country.
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Corresponding author:
Romain Bouzigon,
Université de Franche Comté, Laboratoire C3S (EA 4660), Unité de Promotion, de Formation et de Recherche
(UPFR) des Sports, 31 rue de l’Epitaphe, 25000 Besançon, France.
Société Cryantal Développement, 15 cours du Luzard, 77186 Noisiel, France.
Author personal address: 16 rue des Geais, 39270 PLAISIA, France.
Phone number: (+33)6.70.27.93.27
E-mail: romain.bouzigon@gmail.com