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Labat T1,2, Baudry M2,3
1Pôle Kiné Chenel, Franconville, France, 2In EBP We Trust, Paris, France, 3Private Practioner, Paris, France
Background: Whole-body cryotherapy (WBC) involves a single or repeated exposure(s) to extremely cold dry air (below -100 °C). The first WBC chamber was built in Japan in the late 1970s, initially intended for use in a clinical setting to treat patients with rheumatic diseases as a symptomatic treatment. In sports medicine, WBC has been investigated as a post-exercise intervention. But cryotherapy is still used empirically in a wide range of conditions, based on physiological effects.
Purpose: To determine and summarize the clinical effects of whole-body cryotherapy based on the results and conclusions of existing systematic reviews.
Methods: An electronic search was conducted in MEDLINE, EMBASE, Cochrane Library (CDSR), CINAHL and Physiotherapy Evidence Database (PEDro), according to the PRISMA statement. The search strategy included only terms relating to or describing the intervention (MeSH and text word), based on the Cochrane Highly Sensitive Search Strategy. We also searched in the reference lists of articles, review registers, unpublished trials, conference proceedings and hand-searched journals. The searches were running between Avril and June 2018.
We aimed to include systematic reviews that compared the use of WBC with other controlled condition. Our prespecified outcomes were clinical effects (patient-relevant outcomes) and adverse effects. Two review authors independently screened search results, selected studies, assessed risk of bias and extracted data. We assessed the risk of bias with R-AMSTAR scale.
Results: Five systematic reviews with or without meta-analysis published between 2013 and 2017 were included, gathering a total of 12 randomized control trials about WBC. Four were focused on the effect of post-exercise cryotherapy on recovery characteristics. One was about the therapeutic effect of cryotherapy for inflammatory rheumatic diseases. The reviews were heterogeneous, including the population, intervention and outcomes. All but one of these have been design features that carried a high risk of bias classified as “low” to “very low” quality based on the R-ASMATR scale. One was classified as “good” quality.
The four reviews provided some evidence that WBC may reduce muscle soreness (pain at rest) after exercise, but no difference on subjective recovery. One review gave no evidence for VAS and DAS28 in inflammatory rheumatic diseases (no between-group effect size). None of the reviews reported surveillance of adverse events.
Conclusion(s): There is insufficient evidence to determine whether whole-body cryotherapy improves recovery characteristics after exercise. There is no evidence on the use of this intervention in inflammatory rheumatic diseases. The lack of evidence on adverse events is important. No more systematic review is required, but further high-quality and well-reported research in this area is needed.
Implications: There is currently insufficient evidence to support the use of whole-body cryotherapy after exercise and no evidence in inflammatory rheumatic diseases, given the results and the safety concerns relating to single or repeated exposure to extreme temperature.
Keywords: Whole Body Cryotherapy, Clinical Effects, Systematic Review
Funding acknowledgements: The authors have not declared a specific grant for this research from any funding agency or not-for-profit sectors.
Purpose: To determine and summarize the clinical effects of whole-body cryotherapy based on the results and conclusions of existing systematic reviews.
Methods: An electronic search was conducted in MEDLINE, EMBASE, Cochrane Library (CDSR), CINAHL and Physiotherapy Evidence Database (PEDro), according to the PRISMA statement. The search strategy included only terms relating to or describing the intervention (MeSH and text word), based on the Cochrane Highly Sensitive Search Strategy. We also searched in the reference lists of articles, review registers, unpublished trials, conference proceedings and hand-searched journals. The searches were running between Avril and June 2018.
We aimed to include systematic reviews that compared the use of WBC with other controlled condition. Our prespecified outcomes were clinical effects (patient-relevant outcomes) and adverse effects. Two review authors independently screened search results, selected studies, assessed risk of bias and extracted data. We assessed the risk of bias with R-AMSTAR scale.
Results: Five systematic reviews with or without meta-analysis published between 2013 and 2017 were included, gathering a total of 12 randomized control trials about WBC. Four were focused on the effect of post-exercise cryotherapy on recovery characteristics. One was about the therapeutic effect of cryotherapy for inflammatory rheumatic diseases. The reviews were heterogeneous, including the population, intervention and outcomes. All but one of these have been design features that carried a high risk of bias classified as “low” to “very low” quality based on the R-ASMATR scale. One was classified as “good” quality.
The four reviews provided some evidence that WBC may reduce muscle soreness (pain at rest) after exercise, but no difference on subjective recovery. One review gave no evidence for VAS and DAS28 in inflammatory rheumatic diseases (no between-group effect size). None of the reviews reported surveillance of adverse events.
Conclusion(s): There is insufficient evidence to determine whether whole-body cryotherapy improves recovery characteristics after exercise. There is no evidence on the use of this intervention in inflammatory rheumatic diseases. The lack of evidence on adverse events is important. No more systematic review is required, but further high-quality and well-reported research in this area is needed.
Implications: There is currently insufficient evidence to support the use of whole-body cryotherapy after exercise and no evidence in inflammatory rheumatic diseases, given the results and the safety concerns relating to single or repeated exposure to extreme temperature.
Keywords: Whole Body Cryotherapy, Clinical Effects, Systematic Review
Funding acknowledgements: The authors have not declared a specific grant for this research from any funding agency or not-for-profit sectors.
Topic: Sport & sports injuries; Sport & sports injuries; Rheumatology
Ethics approval required: No
Institution: None
Ethics committee: None
Reason not required: This is a systematic review of the literature
All authors, affiliations and abstracts have been published as submitted.
