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Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi Exposures following Severe Exercise


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The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.
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Time-Course of Changes in Inflammatory Response after
Whole-Body Cryotherapy Multi Exposures following
Severe Exercise
, Franc¸ois Bieuzen
*, Julien Louis
, Jean-Robert Fillard
, Etienne Barbiche
, Christophe
1Research Department, National Institute of Sport, Expertise and Performance (INSEP), Paris, France, 2Laboratory of Physiological Adaptations, Motor Performance and
Health (EA 3837), Faculty of Sport Sciences of Nice-Sophia Antipolis, Nice, France, 3Medical Department, National Institute of Sport, Expertise and Performance (INSEP),
Paris, France, 4Capbreton, France
The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical
markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race.
Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover
design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise
(repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The
Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-a), protein C-reactive (CRP) and white blood cells count
were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect
was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p,0.05).
Indeed, IL-1b(Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared
to PAS. In WBC condition (p,0.05), TNF-a, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results
indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by
vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines
Citation: Pournot H, Bieuzen F, Louis J, Fillard J-R, Barbiche E, et al. (2011) Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy
Multi Exposures following Severe Exercise. PLoS ONE 6(7): e22748. doi:10.1371/journal.pone.0022748
Editor: Alejandro Lucia, Universidad Europea de Madrid, Spain
Received April 26, 2011; Accepted June 29, 2011; Published July 28, 2011
Copyright: ß2011 Pournot et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was entirely supported by the French Ministry of Sports. The funders had no role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail:
Athletes participating in competitive sports are often exposed to
over-load training and competition, which may include repeated,
high-intensity exercise sessions performed multiple times per week
[1]. Intense training and competition particularly with under-
recovery time could induce muscle damage and subsequent
inflammation indicated by muscle soreness, swelling, prolonged
loss of muscle function and the leakage of muscle proteins, such as
C-Reactive Protein (CRP) in the circulation [2,3]. The essential
component of the physical stress theory is that high intensity
physical exercise creates muscle damage and inflammation leading
to disturbance in cellular homeostasis and discomfort, a phenom-
enon that is referred to as delayed onset muscle soreness (DOMS)
[4–7]. In this context, the scientific interest in sports recovery
modalities has been increasing in the recent years [8]. However,
few studies have focused on surrogate outcomes as markers of
inflammation and skeletal muscle recovery (i.e. leukocytes,
enzymes activity, CRP) related to recovery after cold treatment
following a single bout of severe exercise [7,9,10].
High training volumes and/or insufficient recovery has been
associated with muscular fatigue, soft tissues injury, and/or
immune compromise [6]. The mechanical damage to the
contractile unit or plasma membrane occurs primarily due to
the eccentric component of muscle movement. This insult may
initiate metabolic/chemical pathways in the following hours or
days, creating further damage causing an alteration in the flow,
quantity and function of the immune system [2,11,12]. These
events lead to a generalized biphasic inflammatory cascade in
response to muscle damage, which involves briefly the release of
various cytokines.
Strenuous exercise induces an increase in the pro-inflammatory
cytokines Tumor Necrosis Factor alpha (TNF-a) and interleukin 1
Beta (IL-1b) and a dramatic increase in the inflammation
responsive cytokine interleukin 6 (IL-6). This is balanced by the
release of cytokine inhibitors interleukin 1 receptor alpha (IL-1ra)
and the anti-inflammatory cytokine interleukin 10 (IL-10) [11].
The highest concentration of IL-6 has been found immediately
after a marathon race, whereas IL-1ra peaks 1 h post-exercise
(128-fold and 39-fold increases, respectively, compared to the pre-
exercise values). The plasma level of IL-10 showed a 27-fold
increase immediately post-exercise. The plasma level of IL-1band
TNF-apeak in the first hour after the exercise (2.1-, 2.3- fold,
respectively). The pro inflammatory cytokines including IL-1b
PLoS ONE | 1 July 2011 | Volume 6 | Issue 7 | e22748
facilitate an influx of lymphocytes, neutrophils, monocytes, which
participate in the healing of tissue [11,13]. Moreover, the plasma
level of C-reactive protein (CRP) increases and peaks 24 h (3-fold)
after plyometric exercise or a marathon race compared to the pre-
exercise value [3,11,13,14]. However, inadequate or excessive
inflammatory response may lead to improper cellular repair, tissue
damage, and muscle dysfunction leading to loss in performance
Achieving an appropriate balance between training and
competition stresses and recovery is important in maximizing
the performance of athletes [16]. In this context, the development
of methods to speed-up the recovery of elite athletes from intense
training and/or competition has been a major target of athletes
and their support staff for many years [8]. Athletes, therefore, use
many different therapeutic interventions, such as low intensity
exercise and cold therapy (i.e. ice pack, shower, fan, ice ingestion,
wet towel, cold water immersion (CWI)), in an effort to speed-up
recovery between intense bouts of exercise or competition stress
and maintain sport performance [7,17]. Cold therapy is
commonly used as a procedure to alleviate pain symptoms,
particularly in inflammatory diseases, injuries and overuse
symptoms and thereby aiding recovery after soft-tissue trauma
[18–20]. Although CWI has a relative low cost, the time required
for therapists to prepare CWI is time consuming. In addition, the
water and ice used in CWI can only be used once, and it is
relatively difficult to control the temperature during the treatment
[9]. A recent method designated the whole-body cryotherapy
(WBC) has been progressively used as an efficient tool in biological
regeneration of healthy and physically fits individuals [17,21].
WBC consists in a brief exposure in minimal clothing to very dry
cold air (ranging from 2110uCto2180uC) to the surface of the
body for 2–3 min to treat the symptoms of various diseases such as
arthritis, fibromyalgia and ankylosing spondylitis [18]. It already
has been already demonstrated that WBC stimulated physiological
reactions of an organism which result in analgesic, anti-swelling,
antalgic immune and circulatory system reactions and then could
improve recovery after muscle injury from muscular trauma [22–
24]. The reported general effect of WBC suggests that it may be
beneficial to sportsmen also. A recent work has shown that three
repeated WBC events by the day before each training session,
benefits the time it takes for the kayaker to return to full fitness and
may avoid surgery [25]. The authors demonstrated that after 6
days of elite training kayakers with a mean of 4 h per day, at an
extremely low temperature, was associated with a decrease of
234% in the activity of creatine kinase (CK) and a slight decrease
25% in cortisol concentration compare to the week without
cryostimulation exposure [25]. Moreover, after 3 h per day of an
elite rugby training program, 1 repeated WBC treatment each day
over 5 days has also been shown to decrease IL-2, IL-8, CK,
prostaglandin E2 (PGE2) activity, and exhibited increased
concentrations of anti-inflammatory cytokines (IL-10) in periph-
eral blood, suggesting a local and systemic anti-inflammatory effect
[10]. However, there was no precision in this study regarding
when the treatment was applied before (pre-cooling) or at the end
(post-cooling) of exercise. Furthermore, no case-control protocol
was applied in this study and the interaction of exercise and cold
exposure on immune function has not been well studied [26,27]
making it difficult to evaluate the real potential of this method of
In this context, very limited specific studies and data on
inflammatory mediators are available using WBC like methods of
recovery after exercise. Therefore, the primary aim of this
investigation was to analyze the effect of two different recovery
modalities (WBC vs. PAS) after exercise in the proposed markers
for muscle damage, systemic inflammation (CRP, IL-6, IL-1b, IL-
1ra, IL-10, TNF-a) and immune cell mobilization (total leuko-
cytes, neutrophils, monocytes and lymphocytes). We hypothesized
that WBC compared to PAS, accelerate the recovery in reducing
exercise-induced muscle damage (EIMD) by decreasing the acute
phase of inflammation in response to a single bout of exercise. A
complementary aim of this study was to determine whether WBC
had a positive effect on recovery from exertional muscle damage
and immune function during 4 days following a single bout of
exercise in well-trained runners.
Eleven well-trained runners participated in the study (see
Table 1 for characteristics), all with similar training levels and
statures. The selected runners regularly engaged in long distance
running events (e.g. marathon, trails) and presented no contrain-
dications to cryotherapy, such as claustrophobia and cold
hypersensitivity. All subjects were volunteers and were informed
about the study protocol, the risks of tests and investigations, and
their rights according to the Declaration of Helsinki. All subjects
accepted to participate and completed the written informed
consent and a health history questionnaire. The study was
approved by the local Ethics Committee (I
ˆle-de-France XI,
France; Ref. 200978) before its initiation.
Study Design
An overview of the experimental protocol is presented in
Figure 1. All participants used both recovery modalities. Between
trials, a minimum of three weeks of low intensity training was
ensured. Once a month, subjects completed a simulated trail run
on a treadmill followed by one of the two recovery modalities
presented in a random order (WBC or PAS). Before (Pre), after the
simulation (Post), after the first recovery session (Post 1 h), and
before the following recovery sessions (Post 24 h, Post 48 h, Post
72 h, Post 96 h), blood samples, were collected to analyzed several
markers of inflammation, muscle damage (IL-1ra, IL-1b, IL-6, IL-
10, TNF-a, CRP) and the haematological profile. One week
before the experiment, subjects were familiarized with the test
scheme and location and preliminary testing was performed. From
that week onwards until the end of the experimentation period, the
training loads of all subjects were imposed and under control. The
subjects refrained from consumption of any anti-inflammatory pills
and did not use any additional methods to aid recovery (i.e.
stretching, massage or active recovery). Participants completed
food and activity diaries to standardise hydration and nutrition
Table 1. Characteristics of the study group.
Subject characteristics Means ±SEM
Age (years) 31.8 61.96
Height (cm) 179 61.81
Weight (kg) 70.6 61.96
(ml. min
MAS (km.h
10 km-run (min) 34.48 60.71
max: Maximal oxygen uptake; MAS, Maximal Aerobic Speed. Values are
expressed as means 6SEM of the means.
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during the week prior to each session and no caffeine was ingested
before and throughout the duration of the tests
Preliminary Testing
One week before the experiment started, subjects came to the
laboratory for a preliminary testing procedure. Maximal oxygen
uptake (,V.O
) was determined in running using a motorized
treadmill (H/P/CosmosHSaturn, Traunstein, Germany). The test
consisted of a 6 min warm-up at 12 km.h
and an incremental
period in which the running speed was increased by 1 km.h
2 min until volitional exhaustion. Oxygen uptake (,V.O
), minute
ventilation (,V.E), and respiratory exchange ratio (RER) and
respiratory rate (RR) were continuously recorded with a breath
by breath gas exchange analyzer (Quark CPET, Cosmed, Roma,
Italy). Heart rate (HR) was recorded using a chest belt (Cosmed
wireless HR monitor, Roma, Italy). The criteria used for the
determination of ,V.O
were threefold: a plateau in ,V.O
an increase in power output, a RER above 1.1, and a heart rate
(HR) above 90% of the predicted maximal HR [28]. ,V.O
determined as the average of the four highest ,V.O
values recorded
(mean ,V.O
max: 62.063.9 mL.min
). The first and the
second ventilatory thresholds (VT1 and VT2) were determined as
previously described [29]. The maximal aerobic speed (MAS) was
the highest running velocity completed in 2 min (mean MAS:
18.761.1 km.h
). Thereafter, individuals were exposed individu-
ally to a one-time session of extremely low temperature (2110uC) in
a cryogenic chamber (IcelabH, Zimmer MedizinSysteme, Neu-Ulm,
Germany) next to the laboratory. The session lasted 1 min. This
previous familiarization session was done to check the tolerance of
extremely low temperature by subjects before to start of the
experiment and to accustom themselves to the cryochambers after
an high intensity exercise.
Simulated Trail Running Race
Once a month, subjects completed a simulated trail running
race designed to generate fatigue, on the same treadmill used for
preliminary testing. The trail run was designed to replicate as
completely as possible the race constraints encountered in a trail
run [30]. The race lasted 48 min and was divided in 5 blocks. The
first block included 6 min on the flat (0% gradient), followed by
3 min uphill (+10% gradient) and 3 min downhill (215%
gradient). Velocity was continuously adjusted as a function of
gradient in order to obtain a variety of intensities and elicit a
similar metabolic demand to trail races in the field (Figure 1).
Therefore, velocity at the 0% gradient was between VT1 and VT2
(mean Vflat: 15.560.9 km.h
), while velocity at a +10% gradient
corresponded to <80% (mean Vuphill: 11.160.9 km.h
) of the
maximal aerobic velocity at the 10% gradient [31], and velocity at
215% corresponded to velocity at VT1 (mean Vdownhill:
14.260.7 km.h
). Blocks 2–5 consisted of 3 min at 0u, followed
by 3 min uphill and 3 min downhill at the gradients and velocities
previously described.
Recovery Modalities (WBC vs. PAS)
Subjects were randomly assigned to one recuperation modality
(WBC or PAS) to be used after the simulated trail running race
Post, Post 24 h, Post 48 h, Post 72 h and Post 96 h. All subjects
used each of the recovery modalities in the course of the
experiment. WBC sessions were administered in a specially built,
temperature-controlled unit (Zimmer MedizinSysteme GmbH,
Ulm,, Germany), which consisted of three rooms (210, 260 and
2110uC). The temperature of all rooms remained constant
throughout the experiment. During each WBC session, subjects
traversed the warmer rooms and remained in the therapy room for
3 min. In the familiarization session, exposure was reduced to
1 min. Subjects were instructed to dry eventual sweat, wore a
bathing suit, surgical mask, earband, triple layer gloves, dry socks
and sabots. During the 3 min, subjects avoided tension by slightly
moving their arms and legs by walking. After the WBC session,
subjects spent 10 min seated comfortably in a temperate room
(24uC) wearing a bath robe. The second recovery modality was a
passive recovery (control modality) during which each subject was
seated comfortably in an armchair for 30 min, in which they were
not allowed to speak to anyone.
Biochemical Analyses
To avoid inter-assay variation, all blood samples were analyzed
in a single batch at the end of the study, with the exception of
haematological measures, which were performed on the day of
collection. Blood samples were collected from a superficial forearm
vein using standard venipuncture techniques. For each blood
sampling, 33 ml was directly collected into EDTA tubes (5 tubes
EDTA = 6 mL and 1 tube EDTA = 3 mL) (Greiner Bio-one;
Frickenhausen, Germany).
ENZYMATIC ANALYSES – The 5 tubes of 6 mL was
centrifuged at 3000 rev.min
for 10 min, +4uC to separate
plasma. The obtained plasma sample was then stored in multiple
aliquots (Eppendorf type, 1500 mL per samples) at 280uC until
analysis. From these samples, TNF-a, IL-6, IL-10, IL-1ra, IL-1aˆ
and CRP were determined in plasma by enzyme-linked immuno-
sorbent assay with commercially available high sensitivity ELISA
kits (R&D Systems, Minneapolis, MN, USA). All blood samples
Figure 1. Study design - Recovery: PAS or WBC.
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were analyzed in duplicate at respective wavelength on a
spectrophotometer Dynex MRXe (Magellan Biosciences, Chelms-
ford, MA, USA). The sensitivity limit of CRP, TNF-a´ , IL-1ra, IL-
1aˆ, IL-6, IL-10 assay were respectively 0.010, 0.106, 6.26, 0.057,
0.016-0.110 (range), 0.5 pg.mL
HEMATOLOGIC PROFILE - Blood from the 3 mL tube
were analysed for leukocyte and erythrocyte count using an
automated cell counter (Cell-DynHRuby
, Abbott, IL, USA) by
standard laboratory procedures (flow cytometry) previously
described in detail [32].
Figure 2. Changes in CRP (A), IL-1b(B) and IL-1ra (C) from post-running exercise to recovery. #, significant difference between groups
(p,0.05). WBC, whole body cryotherapy; PAS, passive rest recovery.
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Statistical Analyses
Statistical analysis was performed using the SPSS 19 package
(IBM corporation, Inc. NY, USA). We assessed the distribution of
the analyzed variables using a Shapiro-Wilk test. The results
showed that the distributions deviated from normal distribution, so
a detailed statistical analysis using nonparametric tests was
necessary: a Wilcoxon matched-pairs test was completed to assess
significantly difference between groups and a Friedman rank test
was undertaken to evaluate the statistical differences in time for
each recovery modality. When a significant F-value in Friedmans’
analysis was found, a post-hoc test with a Bonferroni correction
was used to determine the between-means differences. For the
parameters with normal distribution the results are expressed as
the mean value with standard error of the mean (6SEM), in other
cases the results are expressed as median, the value of the lower
quartile (Q
) and the value of the upper quartile (Q
). The level
of significance was set at p,0.05.
There were no statistically significant differences in the initial
levels of any of the studied cytokines between the examined
groups. These values were low and typical for healthy persons.
The results obtained in subsequent samples were referred to the
initial level for the group, treated as the control level.
Enzymatic Analyses
Tumor Necrosis Factor-a.For both recovery modalities,
there was no time effect on TNF-aand no differences between
groups at anytime point (Table S1).
Interleukin -6 and Interleukin -10. The Wilcoxon
matched-pairs test indicated no significant difference on IL-6
and IL-10 levels from post-exercise between PAS and WBC
conditions. For both groups, a significant time effect (P,0.05) was
observed with very similar inflammatory response regardless of
recovery mode. Both IL-6 and IL-10 level increase immediately
after exercise.
Interleukin -1band Interleukin -1 ra. The Wilcoxon
matched-pairs test revealed (Figure 2B and 2C, respectively)
significant differences between recovery modalities at Post 1 h
(p,0.05). At Post 1 h, DIL-1band DIL-1ra showed significant
higher and lower values in the PAS condition compared to the
WBC, respectively. There was also a significant (p,0.05) difference
in DIL-1ra with lower values for the WBC condition compared to
the PAS condition at Post 24 h. On raw data, the Friedman test
revealed a significant difference between time measurements for
both groups for each of these cytokines (P,0.05) (Table S1). Post-
hoc analyses revealed that the decrease of IL-1ra occurs earlier after
cryotherapy treatment than after the PAS modality (WBC: Post
24 h vs. PAS: Post 72 h). Post-hoc analysis on IL-1brevealed that
plasma concentrations at Post 1 h were significantly higher
(P,0.05) than Pre only for the PAS condition (Table S1).
Plasma C-reactive protein (CRP). CRP level is steady
whatever the condition at Post and Post 1 h compared to basal
value. Analyses of Delta CRP (DCRP) from Post measurement
showed significant (p,0.05) difference between recovery
modalities at Post 1 h, 24 h, 48 h, 72 h and 96 h from exercise
with significant higher values in the PAS condition compared to
the WBC (Fig. 2A). A significant time effect was recorded for both
groups. CRP increased (p,0.05) and peaked 24 h post-exercise in
both groups (WBC = +123% vs. PAS = +515%). In the PAS
group, 48 h after exposure the increased CRP level persists (at
72 h, P = 0.052 with Bonferroni’s correction) while the levels of
WBC group return to the initial state.
Leukocytes Counts
Leukocytes counts showed no significant differences (p,0.05)
between modalities. The Friedman test revealed a trend towards
significance between time measurements. Post-hoc analyses
showed a significant increase (p,0.05) at Post 1 h of 52% and
returns to the initial state by Post 24 h in both groups.
Additionally, the increase concerned the number of neutrophils.
There were no statistically significant changes in monocytes and
lymphocytes (Table S2).
This study was conducted in order to analyze the effect of two
different recovery modalities on classical markers of exercise-
induced muscle damage (EIMD) and inflammation obtained after a
simulated trail running race. We chose to compare changes in
immune cell mobilisation and CRP level because they are reliable
indicators of acute performance deterioration, muscle damage and/
or inflammation routinely evaluated in the general population and
in athletes [3,10]. The major finding was that a single exposure to
WBC significantly alleviated inflammation after a strenuous exercise
run. i) Delta IL-1bwas significantly suppressed 1 h after exercise
following WBC, compared to the PAS condition ii) Delta IL-1ra
increased 1 h and 24 h after exercise following WBC compared to
PAS iii) CRP increase was strongly limited in the WBC group
compared to the PAS group at 24 h and until 48 h after exercise.
Principally, trail exercise will involve substantial uphill and
downhill elements. The uphill tends to result in a greater exercise
intensity and hence an increased metabolic cost [33]. Conversely,
downhill results in a lower metabolic cost than level and uphill
walking at the same absolute speed [34], but it imposes greater
forces on the lower limbs [35], resulting in greater eccentric
loading. These eccentric muscle actions during downhill can result
in temporary EIMD, which is manifested as reduced muscle
function, muscle soreness (DOMS), efflux of intramuscular
enzymes, and limb swelling that may last for several days after
the exercise bout [36].
Within the injured muscle tissue there is leukocyte infiltration
and local production of various pro- and anti-inflammatory
cytokines which are crucial for initiating the breakdown and the
subsequent removal of damaged muscle fragments [37]. As
expected, the present study demonstrates that trail exercise
induces a significant release and peak of IL-6 (16 fold) and IL-
10 (7 fold) levels early after trail exercise compared to rest (means
of both groups), followed by a rapid decrease toward pre-exercise,
as demonstrated in previous studies [6,11,13]. However there was
no significant change in the plasma concentration of the pro-
inflammatory cytokine TNF-a. This lack of change was consistent
with a 42 km marathon [38] and iron man race, suggesting that
our population is well trained to this type of exercise [39].
Moreover, the fact that the plasma level of TNF-awas not affected
immediately after the trail exercise, might explain why the
monocytes were also not activated by the exercise [14]. It is also
well established that high intensity exercise (.75% VO2max) is
associated with significant increases in circulating leukocytes (i.e.
increases of neutrophils and falls in lymphocytes) during recovery
[7]. In the present study, leukocytes increase an average of 34%
above resting level. This is mainly due to an increase of the
neutrophils number by 64% whereas lymphocytes felt to an
average of 10% Post (mean of both groups). Furthermore, as
previously described [11], high plasma concentration of IL-6
induces a peak expression of IL-1ra and IL-1b1 h after exercise,
345% and 138%, respectively (PAS group values compared to Pre
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Consistent with previous studies, we find similarly that increased
cytokines levels were related to a significant increase and peak in
CRP 24 h after exercise [3,40]. In the present study, the CRP level
of the PAS group increased 6-fold 24 h after the simulated running
race compare to Pre value vs. 3 fold or 31 fold in previous studies
[3,39]. However, these differences compared to the first study
might be explained by the greater muscle mass mobilized by lower
limb vs. elbow or the used of eccentric activation vs. concentric
actions in the previous study [3]. Secondly, unlike results with the
second study cited [39] may be explained by the difference in the
type and duration of exercise leading to greater acute phase
response than following trail exercise. Indeed the iron man
triathlon race consisted of about 10 h of exercise (swim, bike, run)
vs. only 48min trail run exercise in the present study.
The amalgamation of these damaging effects can be problem-
atic for activity on subsequent days, and there may be a greater
risk of injury due to residual soreness and perturbations in muscle
function [41]. This study measured the selected cytokines TNF-a,
IL-6, IL-10, IL-1ra, IL-1band CRP in well-trained athletes for up
to 96 h following a trail exercise. IL-6 and IL-10 levels are not
influenced by one session of WBC repeated on four consecutive
days. However, contrary to previous reports suggesting that WBC
exposure increased the anti-inflammatory cytokine IL-10 produc-
tion [10], our results present no significant changes after 4
exposures to WBC, compared to PAS modality. Nevertheless, the
different type of exercise, 3 h by day of Elite training rugby during
4 days vs. 48 min running exercise in the first day might explain
this difference of result between studies. However this previous
study did not utilize a control passive group as in the present study,
in order to state that the increase in IL-10 is due to cryotherapy
and not to the repetition of exercise itself. Moreover, they
conducted the study on a more acute time line, 7 days vs. 5 days in
the present study, which might lead for the difference of IL-10
There is accumulating evidence in the literature that IL-1bis
balanced by the release of cytokine inhibitors such as IL-1ra which
restrict the magnitude and duration of the inflammatory response
to exercise [11]. At Post 1 h, DIL-1ra and DIL-1bfrom Post are
up-regulated and down-regulated after a single WBC session,
respectively, and DIL-1bremain significantly different (p,0.05) at
Post 24 h when compared to values taken during control passive
rest recovery (Figure 2). Excepted the study of Lubkowska et al.
[21] that showed changes of the IL-6 and IL-1 level, after multiple
WBC exposure, literature on the cytokines cascade after exercise
and the influence of WBC is very sparse and do not provide
related results to both IL-1 and IL-6.
WBC is not effective in modulation of leukocytes population
after 4 sessions of WBC following trail exercise. This result is in
accordance with a previous study, which showed no significant
changes in leukocytes count after 10 sessions of WBC, applied 2
days following progressive ergocycle test until volitional exhaustion
[42]. In parallel to IL-1 modulation, neutrophils numbers were
recovered 24 h after exercise in both groups. However to the best
of our knowledge, there is no previous study related to neutrophils
following exercise and WBC sessions. Published data suggest that
WBC has no detrimental effect on immunological parameters,
although the observation period in the present study may be too
short to evaluate changes in monocytes, lymphocyte involvement
and function [10].
A previous study presented a negligible effect of WBC on CRP
[10]. However, we find that a single WBC exposure suppresses the
peak increase in CRP 24 h after exercise and the difference
(p,0.05) of DCRP with PAS group initiate at 1 h until 96 h after
exercise (Figure 2 A). However, the differences in exercise type
between studies as previously described might also explain the
differences in results. Moreover, the lower body mass index (BMI)
in the study, 21.161.1 kg.m
herein vs. 27.262.3 kg.m
for the
population study in Banfi et al. (2008) [10] might lead to a
different impact of cold at both skin and core levels. Indeed, some
studies indicate reduced cold-induced thermogenesis, due to a high
level of insulation in obesity under severe cold conditions [43], and
decreased autonomic responsiveness [44]. Indeed, a stimulating
effect of cold exposure was found to depend on the relationship
between the decrease in core temperature, and the duration of
exposure [45].
In the present study, using a single exposure in WBC is
associated Post 1 h with a significant decrease (p,0.05) of the pro-
inflammatory mediator IL-1b(Figure 2 B) and an increase of the
anti-inflammatory cytokine IL-1ra (Figure 2 C) compared to PAS.
In accordance with the present results, it was shown that
prolonged cold-wet (5uC) exposure following strenuous exercise
also differentially modulated cytokine production, up regulating
(1263.7%) IL-1ra production and down regulating (1.160.05%)
IL-1bsecretion [46]. Moreover consistent with a previous report
using cold-pack application, WBC exposure immediately after
exercise had no effect on IL-6 levels and was associated with a
significant decrease of IL-1b[8]. In contrast, previous study
associated exercise with ice application recovery showed a
significant decrease (29%) in the anti-inflammatory marker IL-
1ra compare to the pre-exercise value [8]. The discrepancy for the
differences in cytokine responses between studies is likely due to
the nature of exercise and the aim of the method of cold exposure
(i.e. decrease skin temperature or core body temperature)
[8,10,46]. Cryotherapy exposure causes a drive to maintain core
body temperature, resulting in local vasoconstriction [47]. In this
case, the skin temperature would be a determining factor in the
shortening or relaxing rate of smooth muscle in the vessel wall
[48]. It has been suggested that the vasoconstriction resulting from
cold exposure may result in a redistribution of blood flow away
from the skin towards the muscle and core. However, data of a
recent study showed that more blood was distributed to the skin in
cold water [49]. This suggests that colder temperatures may be
associated with reduced muscle blood flow, which could provide
an explanation for the benefits of cold in alleviating exercise-
induced muscle damage in sports and athletic contexts [49]. In
addition, during a severe cold exposure, such as WBC, skin
temperature decreases quickly due to vasoconstriction and direct
skin cooling, most markedly in the extremities [50]. Indeed, this
previous study showed that skin temperature recorded in the calf
was 9.0463.78uC immediately after WBC [51]. Thus WBC
2110uC might induce a greater fluid shift than other method,
which accelerates turn-over process.
In general, we observed an exercise induced neutrophilia in all
trials (Table S2). During recovery after WBC, circulating
neutrophil counts increased by an average of 114% above baseline
value, with the largest increase 1 h after exercise. In contrast, the
average increase in neutrophil counts was lower during PAS
(101%). In accord with the result of a previous study, acute cold
stress increased significantly circulating neutrophil counts [7,52].
In the literature, neutrophils depletion significantly impaired their
angiogenic function (via the vascular endothelial growth factor
(VEGF)) [53]. This adaptive change (angiogenesis) is one of the
physiological adaptations for the improvement of perfusion,
physical performance and other health benefits [54]. Thus,
WBC might contribute to angiogenesis, and decrease DOMS
and time of recovery.
Limited evidence suggests that cold exposure may also initiate
changes in cytokine expression associated with a nonspecific acute
Inflammatory Response after Whole-Body Cryotherapy
PLoS ONE | 6 July 2011 | Volume 6 | Issue 7 | e22748
phase reaction [27]. Downstream of the change in cytokine levels,
especially IL-1, we observed in this study a concomitant down-
regulation of CRP when athletes used the WBC treatments.
Indeed, in a previous study, the correlation between IL-1 and CRP
release was stronger than that IL-6 and CRP suggesting that IL-1b
is probably the more powerful stimulant of CRP release [55]
Contrary to previous studies, we observe a significant decrease in
CRP after WBC compared to PAS, while others have indicated
negligible changes after WBC or CWI [10,56]. Nevertheless, in
both studies there is no assessment 24 h post-exercise attesting a
significant increase or control group to observe any significant
difference. Second, for Halson et al. (2008) [56], 1 min of exposure
repeated 3 times to cold temperature of 11.5uC during the CWI
method seems to be limited to induce sufficient physiological
changes [57].
The mechanism underlying the abovementioned differences in
cytokine generation is not clear, but it can be argued that cold-
associated modulation of cytokine production may be provoked by
alterations in central hemodynamics associated with enhanced
thermoregulatory demands and therefore may influence immune
homeostasis in cold environments [27,46]. Since recently the
direct effect of cytokines on neuroendocrine axes has been
demonstrated [58]. Inflammation and immunity are under the
control of many different systems, including the nervous, the
endocrine and the vascular systems. Nerve endings release
norepinephrine in the tissues [58]. Cold-induced vasoconstriction
should be related to the reflex sympathetic activity and its
attendant increase in the affinity of a-adrenoceptors in the
vascular wall for norepinephrine (not measured in the present
study) [59]. It binds aand b-adrenergic receptors expressed on
immune cells. Moreover, a previous study demonstrated that
norepinephrine was the only hormone that responded positively to
WBC treatment (i.e. three time exposure, over one week) and that
the sustained norepinephrine could have a role in pain alleviation
(DOMS) [60]. Thus, another hypothesis has been formulated to
explain the cytokines modulation. The findings of the present
study (Table S1) are consistent with investigations indicating that
adrenergic/noradrenergic mechanisms are intimately involved in
the regulation of cytokines production with physical stress [61].
The stimulation of b-adrenoceptors during stress attenuates
excessive synthesis of pro-inflammatory cytokines (IL-1band
TNF-a), and elevates anti-inflammatory cytokines (IL-6, IL-1ra
and IL-10) [62]. In this context, the current observations showing
that cold exposure suppressed IL-1bbut stimulated IL-1ra
expression, indicating that b-adrenergic mechanisms may have
predominated when cold stress was preceded by exercise. This
confirmed that the treatment induced an anti-inflammatory
protection [10].
In conclusion, a unique session of WBC (3 min at 2110uC)
performed immediately after exercise enhanced muscular recovery
by restricting the inflammatory process. These findings suggest
that multiple interactions between cytokines are likely involved in
the physiological response to exertional fatigue and cold may serve
to limit the severity of the host inflammatory response. In this case,
accordingly with our hypothesis, multiple WBC exposures can
enhance recovery, by decreasing the acute phase inflammatory
response after a running trail exercise, thus contributing to its
beneficial role in organ protection after muscle damage. The
present study suggests that soluble receptor antagonist IL-1ra
increases after a single whole body cryostimulation (2110uC) and
restrict the inflammatory response to exercise by decrease in the
magnitude of IL-1band CRP. In term of practical applications,
data confirm that the treatment induces an anti-inflammatory
protection effect, and suggest that WBC reduce the time of
recovery by positive effects on immunological parameters and the
regeneration process.
Supporting Information
Table S1 Time course changes in cytokines before and after
exercise following WBC or PAS.
Table S2 Leukocytes count before and after exercise following
The authors are especially grateful to the athletes for their help and
cooperation and Dr. Remi Mounier for his help in the biological analysis.
This study was made possible by technical support from the French
Ministry of Sport.
Author Contributions
Conceived and designed the experiments: HP FB JL J-RF EB CH.
Performed the experiments: HP FB JL J-RF EB CH. Analyzed the data:
HP FB JL J-RF EB CH. Contributed reagents/materials/analysis tools:
HP FB JL J-RF CH. Wrote the paper: HP FB JL CH.
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... The benefits of WBC in fatigue-related symptom reduction have been observed previously in groups of healthy subjects. WBC led to a decrease in the perception of muscular tiredness and pain after physical exercise compared to other recovery interventions [23]. A WBC programme in elite female synchronized swimmers, applied following training sessions, improved sleep quantity during the period of intensive training programme before the Olympic Games [24]. ...
Full-text available
Background The aim of this study was to explore the tolerability and effect of static stretching (SS) and whole body cryotherapy (WBC) upon fatigue, daytime sleepiness, cognitive functioning and objective and subjective autonomic nervous system functioning in those with Chronic Fatigue Syndrome (CFS) compared to a control population. Methods Thirty-two CFS and eighteen healthy controls (HC) participated in 2 weeks of a SS + WBC programme. This programme was composed of five sessions per week, 10 sessions in total. Results A significant decrease in fatigue was noted in the CFS group in response to SS + WBC. Some domains of cognitive functioning (speed of processing visual information and set-shifting) also improved in response to SS + WBC in both CFS and HC groups. Our study has confirmed that WBC is well tolerated by those with CFS and leads to symptomatic improvements associated with changes in cardiovascular and autonomic function. Conclusions Given the preliminary data showing the beneficial effect of cryotherapy, its relative ease of application, good tolerability, and proven safety, therapy with cold exposure appears to be an approach worth attention. Further studies of cryotherapy as a potential treatment in CFS is important in the light of the lack of effective therapeutic options for these common and often disabling symptoms.
... For preventing or reducing the negative effects of inflammatory response the negative feedback system should be activated. In this regard, one of the methods is the use of nonsteroidal anti- Khosravi inflammatory drugs (NSAIDs) [4]. However, long-term use of these drugs has side effects. ...
Full-text available
Objective: Aerobic exercise and Saffron has beneficial effects on inflammatory response. The present study aims to investigate the effect of aerobic exercise combined with saffron extract supplementation on serum levels of Tumor Necrosis Factor-α (TNF-α) and C-Reactive Protein (CRP) in rats following an aerobic exercise until exhaustion Methods: This is an experimental study. Forty eight Wistar male rats were assigned into four groups: control (C), supplementation) SE), training (AT), and training+supplementation (AT+SE). Aerobic exercise was performed for 8 weeks (five sessions a week). supplementation was done by administrating 100 mg/kg/day saffron extract by oral gavage. At the end of experiment, half of the rats was killed immediately before exhaustion and the remaining immediately after performing an acute aerobic exercise until exhaustion by running on the treadmill. Serum CRP and TNF-α levels were measured by ELISA method. The data were analyzed using one-way ANOVA, considering the significance level of P< 0.05. Results: Following an exhausting exercise, serum levels of CRP and TNF-α in the AT+SE group significantly lower than in groups C (PCRP = 0.001; PTNF-α=0.001), SE (PCRP=0.001; PTNF-α=0.001) and AT (PCRP= 0.021; PTNF-α =0.046). These markers in the AT group significantly lower than in groups C (PCRP=0.004; PTNF-α=0.039) and SE (PCRP= 0.014; PTNF-α=0.043). There was no significant difference between the other groups. Conclusion: Aerobic exercise alone and in combination with the use of saffron extract may reduce the inflammatory responses following an exhausting exercise.
... Dulian et al. (2015) confirmed the anti-inflammatory effect of WBC in people with obesity, reporting that the decline in CRP levels was similar in both the low fitness (LFL) and high fitness (HFL) level group with obesity regardless of the number of sessions (either 1 and 10). A similar decrease was also observed in well-trained athletes exposed to 5 sessions of WBC for up to 96 h after exercise (Pournot et al., 2011). However, WBC did not induce significant changes in men or menopausal women with obesity, regardless of their body mass (high or normal) or comorbidity with metabolic syndrome reproducing the results obtained by Ś liwicka and colleagues who did not show significant changes in CRP levels after 10 WBC treatments in 20-year-old men without obesity, regardless of their fitness level (Śliwicka et al., 2020). ...
Currently available treatments for the management of obesity struggle to provide clinically significant weight loss and reduction of the chronic low-grade inflammatory state in order to reduce obesity-related complications. This scoping review aims to provide an up-to-date picture of the therapeutic effects of Whole-Body Cryostimulation (WBC) in patients with obesity and evidence-based indications for its complementary use in the treatment of obesity. We searched the literature until the end of August 2021, retrieving 8 eligible studies out of 856, all evaluated for their methodological quality using the Downs and Black checklist. Overall, the limited data presented in this review article seem to support the efficacy of WBC as an adjuvant treatment in obesity. The cryogenic stimulus has important anti-inflammatory/antioxidant effects and its effectiveness is directly related to the individual percentage of fat mass and initial fitness capacity, mimicking an exercise-induced effect. Based on the limited results gathered, WBC emerges as a promising adjuvant therapy to reduce systemic inflammation, oxidative stress, abdominal obesity, and body mass. However, the data presented in this review article fail to reach definitive conclusions with regards to the efficacy of WBC in the treatment of obesity. Application of WBC protocols yields the potential to widen the therapeutic armor for the treatment of obesity and obesity-related disorders but larger, high-quality studies are still needed.
... Additionally, studies assessing cryotherapy on promoting post-exercise recovery have shown reduction of systemic inflammation and lower concentrations of markers for muscle cell damage [63,64]. However, not all studies have reported improvements in muscle damage, reduction in inflammation, or performance-related outcomes with cryotherapy after exercise [65][66][67]. ...
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Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players’ recovery for training and competition throughout the season.
Full-text available
Despite several established benefits of Whole Body Cryotherapy (WBC) for post-exercise recovery, there is a scarcity of research which has identified the optimum WBC protocol for this purpose. This study investigated the influence of WBC treatment timing on physiological and functional responses following a downhill running bout. An additional purpose was to compare such responses with those following cold water immersion (CWI), since there is no clear consensus as to which cold modality is more effective for supporting athletic recovery. Thirty-three male participants (mean ± SD age 37.0 ± 13.3 years, height 1.76 ± 0.07 m, body mass 79.5 ± 13.7 kg) completed a 30 min downhill run (15% gradient) at 60% VO 2 max and were then allocated into one of four recovery groups: WBC1 (n = 9) and WBC4 (n = 8) underwent cryotherapy (3 min, −120 • C) 1 and 4 h post-run, respectively; CWI (n = 8) participants were immersed in cold water (10 min, 15 • C) up to the waist 1 h post-run and control (CON, n = 8) participants passively recovered in a controlled environment (20 • C). Maximal isometric leg muscle torque was assessed pre and 24 h post-run. Blood creatine kinase (CK), muscle soreness, femoral artery blood flow, plasma IL-6 and sleep were also assessed pre and post-treatment. There were significant decreases in muscle torque for WBC4 (10.9%, p = 0.04) and CON (11.3% p = 0.00) and no significant decreases for WBC1 (5.6%, p = 0.06) and CWI (5.1%, p = 0.15). There were no significant differences between groups in muscle soreness, CK, IL-6 or sleep. Femoral artery blood flow significantly decreased in CWI (p = 0.02), but did not differ in other groups. WBC treatments within an hour may be preferable for muscle strength recovery compared to delayed treatments; however WBC appears to be no more effective than CWI. Neither cold intervention had an impact on inflammation or sleep.
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Supplementation with cannabidiol (CBD) may expedite recovery when consumed after exercise. The purpose of this study was to determine if supplementation with CBD reduces inflammation and enhances performance following strenuous eccentric exercise in collegiate athletes. Twenty-four well-trained females (age = 21.2 ± 1.8 years, height = 166.4 ± 8 cm, weight = 64.9 ± 9.1 kg) completed 100 repetitions of unilateral eccentric leg extension to induce muscle damage. In this crossover design, participants were randomized to receive 5 mg/kg of CBD in pill form or a placebo 2 h prior to, immediately following, and 10 h following muscle damage. Blood was collected, and performance and fatigue were measured prior to, and 4 h, 24 h, and 48 h following the muscle damage. Approximately 28 days separated treatment administration to control for the menstrual cycle. No significant differences were observed between the treatments for inflammation, muscle damage, or subjective fatigue. Peak torque at 60°/s (p = 0.001) and peak isometric torque (p = 0.02) were significantly lower 24 h following muscle damage, but no difference in performance was observed between treatments at any timepoint. Cannabidiol supplementation was unable to reduce fatigue, limit inflammation, or restore performance in well-trained female athletes.
Study design Single arm, quasi-experimental study design. Background To describe the effects of whole-body cryotherapy on pain, disability, and serum inflammatory markers in patients with chronic low back pain. Methods A quasi-experimental trial was performed on adult patients between 18 and 65 years with chronic low back pain. After obtaining informed consent, participants underwent 20 sessions of whole-body cryotherapy (at −160 °C) during a 5-week time span. Patient reported pain and disability measures (Pain Numerical Rating Scale [PNRS], Oswestry Disability Index [OSI], and Roland Morris Questionnaire [RMQ]) were obtained at each of the twenty sessions. Blood samples were obtained to analyze serum inflammatory markers at baseline, 10th and 20th session. Results Forty-one participants were included in the study. A significant decrease was observed between the initial and final PNRS, ODI, and RMQ scores (p < 0.001). A significant reduction in the PNRS was found after 4 sessions of whole-body cryotherapy (p < 0.001). We observed decreasing values of pro-inflammatory serum marker IL-2 (p = 0.046) and a significant increase in the anti-inflammatory serum marker IL-10 (p = 0.003). No adverse events were reported during the study. Conclusions Whole-body cryotherapy is an effective therapy for pain and disability treatment in chronic low back pain. It also produces changes in serum markers of inflammation, decreasing pro-inflammatory markers and increasing anti-inflammatory markers.
Background/Aims For the management of sports injury, cryotherapy is commonly applied, yet modalities differ extensively in application including levels of compression. The aim of this study was to provide a comprehensive review of the current position in the literature on contemporary cryo-compression applications for musculoskeletal sports injury management. Methods A total of eight databases were searched: Sport Discus, Science Direct, CINHAL, Scopus, PubMed, Cochrane, ProQuest and MEDLINE. Publications were restricted to 30 years and had to be in the English language. Medical subject headings, free-text words, and limiting descriptors for concepts related to cryotherapy and compression for sports injury were applied. Inclusion criteria determined at least one modality of cryotherapy treatment applied simultaneous to compression or as a comparison, relevant to sports injury management. Modalities included cryo-compressive devices and gel/ice packs, in association with concomitant compression. Male, female, healthy and injured participants were included. Two reviewers independently selected eligible articles, resulting in 22 studies meeting the inclusion criteria following full-text appraisal. Results Inconsistent methodologies, low sample sizes and variability in outcome measures provided uncertainty over optimum protocols. A lack of previous understanding in the protocols in the available literature for isolated cryotherapy/compression applications prevents understanding of the therapeutic benefits of combined cryo�compression. No definitive agreement behind optimal cryo-compression applications were identified collectively from studies other than the consensus that compression aids the magnitude of cooling. Conclusions Although compression appears a useful adjunct to cooling modalities for the management of sports injury, no definitive agreement on optimum compression concurrent with cooling protocols were drawn from the studies. This was because of several methodological gaps in reporting throughout studies, highlighting a lack of studies that represent applications of compression and cryotherapy within a sporting context or applied nature within the available research.
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Athletes, military personnel, fire fighters, mountaineers and astronauts may be required to perform in environmental extremes (e.g. heat, cold, high altitude and microgravity). Exercising in hot versus thermoneutral conditions (where core temperature is ≥1°C higher in hot conditions) augments circulating stress hormones, catecholamines and cytokines with associated increases in circulating leukocytes. Studies that have clamped the rise in core temperature during exercise (by exercising in cool water) demonstrate a large contribution of the rise in core temperature in the leukocytosis and cytokinaemia of exercise. However, with the exception of lowered stimulated lymphocyte responses after exercise in the heat, and in exertional heat illness patients (core temperature >40°C), recent laboratory studies show a limited effect of exercise in the heat on neutrophil function, monocyte function, natural killer cell activity and mucosal immunity. Therefore, most of the available evidence does not support the contention that exercising in the heat poses a greater threat to immune function (vs thermoneutral conditions). From a critical standpoint, due to ethical committee restrictions, most laboratory studies have evoked modest core temperature responses (<39°C). Given that core temperature during exercise in the field often exceeds levels associated with fever and hyperthermia (>39.5°C) field studies may provide an opportunity to determine the effects of severe heat stress on immunity. Field studies may also provide insight into the possible involvement of immune modulation in the aetiology of exertional heat stroke (core temperature >40.6°C) and identify the effects of acclimatisation on neuroendocrine and immune responses to exercise-heat stress. Laboratory studies can provide useful information by, for example, applying the thermal clamp model to examine the involvement of the rise in core temperature in the functional immune modifications associated with prolonged exercise. Studies investigating the effects of cold, high altitude and microgravity on immunity and infection incidence are often hindered by extraneous stressors (e.g. isolation). Nevertheless, the available evidence does not support the popular belief that short- or long-term cold exposure, with or without exercise, suppresses immunity and increases infection incidence. In fact, controlled laboratory studies indicate immuno-stimulatory effects of cold exposure. Although some evidence shows that ascent to high altitude increases infection incidence, clear conclusions are difficult to make because of some overlap with the symptoms of acute mountain sickness. Studies have reported suppressed cell-mediated immunity in mountaineers at high altitude and in astronauts after re-entering the normal gravity environment; however, the impact of this finding on resistance to infection remains unclear.
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AimsThis review focuses first of all on the effects of the cold and/or contrast water immersion techniques on muscular recovery to determine practical implications for athletes. Then, the present review summarizes the effects of whole-body cryotherapy and its potential benefits.ActualitiesThe multitude of protocols concerning the cold water immersion technique and the contrast water technique explains the large variety of the results reported in the literature on this topic. This recovery strategy seems mainly recommended after strength training and anaerobic solicitations, when it is planed during the 20 min following the fatiguing task. Immersion in warm water is not supported by the literature; only the depth of the immersion looks essential, an immersion to the neck is associated with positive effects. Concerning the whole-body cryotherapy, few data are available about its benefits on recovery after exercise. Nevertheless, the literature reports interesting results on its positive impact relating to inflammatory factors, antioxidant status, mood and syndromes of depression.Perspectives and prospectsFurther studies are needed to investigate the potential positive effects of whole-body cryotherapy on recovery by athletes.
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Whole-body cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking. To fill this gap, we compared changes in immunological parameters (C3, IgA, IgM, IgG, C-reactive protein, PGE2), cytokines (IL-2, IL-8, IL-10), adhesion molecules (sICAM-1), and muscle enzymes (creatine kinase [CK], lactate dehydrogenase [LAD]) before and after WBC in 10 top-level Italian National team rugby players. The subjects underwent five sessions on alternate days once daily for 1 week. During the study period, the training workload was the same as that of the previous weeks. Compared to baseline values, immunological parameters remained unchanged, while CK and LAD levels significantly decreased after treatment. No alterations in immunological function were observed but there is a decrease in pro-inflammatory cytokine/chemokine and an increase in anti-inflammatory cytokine.As measured by changes in serum CK and LAD concentrations, and cytokines pathway, short-term cold air exposure was found to improve recovery from exercise-induced muscle injury and/or damage associated with intense physical training.
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Cryotherapy is used in the early treatment of acute injuries (sprains, strains, fractures) yet only a few papers discuss the possible influence of whole-body cryostimulation on inflammation mechanisms or immunology. It is postulated that cold exposure can have an immunostimulating effect related to enhanced noradrenaline response and can be connected with paracrine effects. The aim of this study was to examine the effect of different sequences of whole-body cryostimulations on the level of pro- and anti-inflammatory cytokines in healthy individuals. The research involved 45 healthy men divided into three groups. The groups were subjected to 5, 10 or 20, 3-minute long whole-body cryostimulations each day at -130°C. Blood was collected for analysis before the stimulations, after completion of the whole series, and 2 weeks after completion of the series, for the examination of any long-term effect. The analysis of results showed that in response to cryostimulation, the level of ani-inflammatory cytokines IL-6 and IL-10 increased while Il-1α cytokine level decreased. It seems that the most advantageous sequence was the series of 20 cryostimulations due to the longest lasting effects of stimulation after the completion of the whole series of treatments.
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An ever-growing volume of peer-reviewed publications speaks to the recent and rapid growth in both scope and understanding of exercise immunology. Indeed, more than 95% of all peer-reviewed publications in exercise immunology (currently >2, 200 publications using search terms "exercise" and "immune") have been published since the formation of the International Society of Exercise and Immunology (ISEI) in 1989 (ISI Web of Knowledge). We recognise the epidemiological distinction between the generic term "physical activity" and the specific category of "exercise", which implies activity for a specific purpose such as improvement of physical condition or competition. Extreme physical activity of any type may have implications for the immune system. However, because of its emotive component, exercise is likely to have a larger effect, and to date the great majority of our knowledge on this subject comes from exercise studies. In this position statement, a panel of world-leading experts provides a consensus of current knowledge, briefly covering the background, explaining what we think we know with some degree of certainty, exploring continued controversies, and pointing to likely directions for future research. Part one of this position statement focuses on 'immune function and exercise' and part two on 'maintaining immune health'. Part one provides a brief introduction and history (Roy Shephard) followed by sections on: respiratory infections and exercise (Maree Gleeson); cellular innate immune function and exercise (Jeffrey Woods); acquired immunity and exercise (Nicolette Bishop); mucosal immunity and exercise (Michael Gleeson and Nicolette Bishop); immunological methods in exercise immunology (Monika Fleshner); anti-inflammatory effects of physical activity (Charlotte Green and Bente Pedersen); exercise and cancer (Laurie Hoffman-Goetz and Connie Rogers) and finally, "omics" in exercise (Hinnak Northoff, Asghar Abbasi and Perikles Simon). The focus on respiratory infections in exercise has been stimulated by the commonly held beliefs that the frequency of upper respiratory tract infections (URTI) is increased in elite endurance athletes after single bouts of ultra-endurance exercise and during periods of intensive training. The evidence to support these concepts is inconclusive, but supports the idea that exercised-induced immune suppression increases susceptibility to symptoms of infection, particularly around the time of competition, and that upper respiratory symptoms are associated with performance decrements. Conclusions from the debate on whether sore throats are actually caused by infections or are a reflection of other inflammatory stimuli associated with exercise remains unclear. It is widely accepted that acute and chronic exercise alter the number and function of circulating cells of the innate immune system (e.g. neutrophils, monocytes and natural killer (NK) cells). A limited number of animal studies has helped us determine the extent to which these changes alter susceptibility to herpes simplex and influenza virus infection. Unfortunately, we have only 'scratched the surface' regarding whether exercise-induced changes in innate immune function alter infectious disease susceptibility or outcome and whether the purported anti-inflammatory effect of regular exercise is mediated through exercise-induced effects on innate immune cells. We need to know whether exercise alters migration of innate cells and whether this alters disease susceptibility. Although studies in humans have shed light on monocytes, these cells are relatively immature and may not reflect the effects of exercise on fully differentiated tissue macrophages. Currently, there is very little information on the effects of exercise on dendritic cells, which is unfortunate given the powerful influence of these cells in the initiation of immune responses. It is agreed that a lymphocytosis is observed during and immediately after exercise, proportional to exercise intensity and duration, with numbers of cells (T cells and to a lesser extent B cells) falling below pre-exercise levels during the early stages of recovery, before returning to resting values normally within 24 h. Mobilization of T and B cell subsets in this way is largely influenced by the actions of catecholamines. Evidence indicates that acute exercise stimulates T cell subset activation in vivo and in response to mitogen- and antigen-stimulation. Although numerous studies report decreased mitogen- and antigen-stimulated T cell proliferation following acute exercise, the interpretation of these findings may be confounded by alterations in the relative proportion of cells (e.g. T, B and NK cells) in the circulation that can respond to stimulation. Longitudinal training studies in previously sedentary people have failed to show marked changes in T and B cell functions provided that blood samples were taken at least 24 h after the last exercise bout. In contrast, T and B cell functions appear to be sensitive to increases in training load in well-trained athletes, with decreases in circulating numbers of Type 1 T cells, reduced T cell proliferative responses and falls in stimulated B cell Ig synthesis. The cause of this apparent depression in acquired immunity appears to be related to elevated circulating stress hormones, and alterations in the pro/anti-inflammatory cytokine balance in response to exercise. The clinical significance of these changes in acquired immunity with acute exercise and training remains unknown. The production of secretory immunoglobulin A (SIgA) is the major effector function of the mucosal immune system providing the 'first line of defence' against pathogens. To date, the majority of exercise studies have assessed saliva SIgA as a marker of mucosal immunity, but more recently the importance of other antimicrobial proteins in saliva (e.g. alpha-amylase, lactoferrin and lysozyme) has gained greater recognition. Acute bouts of moderate exercise have little impact on mucosal immunity but prolonged exercise and intensified training can evoke decreases in saliva secretion of SIgA. Mechanisms underlying the alterations in mucosal immunity with acute exercise are probably largely related to the activation of the sympathetic nervous system and its associated effects on salivary protein exocytosis and IgA transcytosis. Depressed secretion of SIgA into saliva during periods of intensified training and chronic stress are likely linked to altered activity of the hypothalamic-pituitary-adrenal axis, with inhibitory effects on IgA synthesis and/or transcytosis. Consensus exists that reduced levels of saliva SIgA are associated with increased risk of URTI during heavy training. An important question for exercise immunologists remains: how does one measure immune function in a meaningful way? One approach to assessing immune function that extends beyond blood or salivary measures involves challenging study participants with antigenic stimuli and assessing relevant antigen-driven responses including antigen specific cell-mediated delayed type hypersensitivity responses, or circulating antibody responses. Investigators can inject novel antigens such as keyhole limpet haemocyanin (KLH) to assess development of a primary antibody response (albeit only once) or previously seen antigens such as influenza, where the subsequent antibody response reflects a somewhat more variable mixture of primary, secondary and tertiary responses. Using a novel antigen has the advantage that the investigator can identify the effects of exercise stress on the unique cellular events required for a primary response that using a previously seen antigen (e.g. influenza) does not permit. The results of exercise studies using these approaches indicate that an acute bout of intense exercise suppresses antibody production (e.g. anti-KLH Ig) whereas moderate exercise training can restore optimal antibody responses in the face of stressors and ageing. Because immune function is critical to host survival, the system has evolved a large safety net and redundancy such that it is difficult to determine how much immune function must be lost or gained to reveal changes in host disease susceptibility. There are numerous examples where exercise alters measures of immunity by 15-25%. Whether changes of this magnitude are sufficient to alter host defence, disease susceptibility or severity remains debatable. Chronic inflammation is involved in the pathogenesis of insulin resistance, atherosclerosis, neurodegeneration, and tumour growth. Evidence suggests that the prophylactic effect of exercise may, to some extent, be ascribed to the anti-inflammatory effect of regular exercise mediated via a reduction in visceral fat mass and/or by induction of an anti-inflammatory environment with each bout of exercise (e.g. via increases in circulating anti-inflammatory cytokines including interleukin (IL)-1 receptor antagonist and IL-10). To understand the mechanism(s) of the protective, anti-inflammatory effect of exercise fully, we need to focus on the nature of exercise that is most efficient at allieviating the effects of chronic inflammation in disease. The beneficial effects of endurance exercise are well known; however, the antiinflammatory role of strength training exercises are poorly defined. In addition, the independent contribution of an exercise-induced reduction in visceral fat versus other exercise-induced anti-inflammatory mechanisms needs to be understood better. There is consensus that exercise training protects against some types of cancers. Training also enhances aspects of anti-tumour immunity and reduces inflammatory mediators. However, the evidence linking immunological and inflammatory mechanisms, physical activity, and cancer risk reduction remains tentative. (ABSTRACT TRUNCATED)
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In the last years, phototherapy has becoming a promising tool to improve skeletal muscle recovery after exercise, however, it was not compared with other modalities commonly used with this aim. In the present study we compared the short-term effects of cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) with placebo LEDT on biochemical markers related to skeletal muscle recovery after high-intensity exercise. A randomized double-blind placebo-controlled crossover trial was performed with six male young futsal athletes. They were treated with CWIT (5°C of temperature [SD ±1°]), active LEDT (69 LEDs with wavelengths 660/850 nm, 10/30 mW of output power, 30 s of irradiation time per point, and 41.7 J of total energy irradiated per point, total of ten points irradiated) or an identical placebo LEDT 5 min after each of three Wingate cycle tests. Pre-exercise, post-exercise, and post-treatment measurements were taken of blood lactate levels, creatine kinase (CK) activity, and C-reactive protein (CRP) levels. There were no significant differences in the work performed during the three Wingate tests (p > 0.05). All biochemical parameters increased from baseline values (p < 0.05) after the three exercise tests, but only active LEDT decreased blood lactate levels (p = 0.0065) and CK activity (p = 0.0044) significantly after treatment. There were no significant differences in CRP values after treatments. We concluded that treating the leg muscles with LEDT 5 min after the Wingate cycle test seemed to inhibit the expected post-exercise increase in blood lactate levels and CK activity. This suggests that LEDT has better potential than 5 min of CWIT for improving short-term post-exercise recovery.
Aims. – Whole body cryotherapy (WBC) at -110 °C has been in use since the eighties, essentially in Northern Europe, for the treatment of rheumatism diseases and also in sports medicine and traumatology. The objective of this work is to measure the effects of a WBC session on skin and core body temperatures, based on the medical protocol that we have been using on sportsmen and sportswomen for nearly two years, on a daily basis.Method. – Eleven sportspersons were included in the study, 10 men and 1 woman. Skin temperatures were measured in various places on the body using a laser thermometer, 5 minutes before the session and then immediately afterwards and 5, 10 and finally 20 minutes later. The core body temperature was measured using an ear thermometer. The cryotherapy session lasted 4 minutes.Results. – On exiting the cold chamber, the lowest temperatures were measured on the shin, with an average value of less than 10 °C. The skin temperatures rose very quickly, but the measured values remained lower than the reference temperatures after 20 minutes. As far as the core body temperature is concerned, we observed a significant decrease, but the value observed was both deferred and transient: 0.63 °C observed after 5 minutes. The difference was no longer significant after 20 minutes.
To investigate the mechanisms of exercise-induced immune perturbations, we measured promising immunomodulatory hormones and cytokines in plasma of 16 male marathon runners before and after a competitive 42.195-km race. Interleukin 1-beta (IL-1β) and interferon gamma (IFN-γ) concentrations remained unchanged after the marathon. The cytokines IL-12, IFN-α and tumour necrosis factor alpha (TNF-α) could not be detected even using highly sensitive specific immunoassays, indicating at least that overshooting responses of these cytokines had not occurred after exercise. As mechanisms for the small changes in these cytokines, we demonstrated for the first time a significant rise in concentrations of inhibitory cytokine IL-10 in addition to the immunosuppressive hormone cortisol, although concentrations of IL-4 and transforming growth factor-beta (TGF-β) were unaffected by the race. Furthermore, concentrations of IL-1 receptor antagonist (IL-1ra) and IL-6, which are negative-feedback inhibitors of cytokine production, increased by more than 100 times. As for humoral mediators of neutrophil mobilization, concentrations of growth hormone (GH), cortisol and granulocyte colony-stimulating factor (G-CSF) increased significantly. In addition, concentrations of neutrophil-priming substances (IL-6, IL-8, G-CSF, GH and prolactin) also increased significantly and the induction of IL-8 and G-CSF with exercise was demonstrated for the first time in the present study. In contrast, IL-2 concentration decreased, by 32%, and this was correlated with the induction of nitric oxide (NO) production. Muscle damage, monitored using changes in concentrations of creatine kinase and myoglobin, was also observed. These results suggested that exercise-induced pathogenesis including previously reported immunosuppression and neutrophil hyper-reactivity might be attributed, at least partly, to the systemic dynamics of the above bioactive substances.
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.
Cold water immersion reduces exercise-induced muscle damage. Benefits may partly arise from a decline in limb blood flow; however, no study has comprehensively investigated the influence of different degrees of cooling undertaken via cold water immersion on limb blood flow responses. To determine the influence of cold (8°C) and cool (22°C) water immersion on lower limb and cutaneous blood flow. Controlled laboratory study. Nine men were placed in a semireclined position and lowered into 8°C or 22°C water to the iliac crest for two 5-minute periods interspersed with 2 minutes of nonimmersion. Rectal and thigh skin temperature, deep and superficial muscle temperature, heart rate, mean arterial pressure, thigh cutaneous blood velocity (laser Doppler), and superficial femoral artery blood flow (duplex ultrasound) were measured during immersion and for 30 minutes after immersion. Indices of vascular conductance were calculated (flux and blood flow/mean arterial pressure). Reductions in rectal temperature (8°C, 0.2° ± 0.1°C; 22°C, 0.1° ± 0.1°C) and thigh skin temperature (8°C, 6.2° ± 0.5°C; 22°C, 3.2° ± 0.2°C) were greater in 8°C water than in 22°C (P < .01). Femoral artery conductance was reduced to a similar extent immediately after immersion (~30%) and 30 minutes after immersion (~40%) under both conditions (P < .01). In contrast, there was less thigh cutaneous vasoconstriction during and after immersion in 8°C water compared with 22°C (P = .01). These data suggest that immersion at both temperatures resulted in similar whole limb blood flow but, paradoxically, more blood was distributed to the skin in the colder water. This suggests that colder temperatures may be associated with reduced muscle blood flow, which could provide an explanation for the benefits of cold water immersion in alleviating exercise-induced muscle damage in sports and athletic contexts. Colder water temperatures may be more effective in the treatment of exercise-induced muscle damage and injury rehabilitation because of greater reductions in muscle blood flow.