Arm cooling selectively impacts sensorimotor control.

The benefits of cold have long been recognized in sport and medicine. However, it also brings costs, which have more rarely been investigated, notably in terms of sensorimotor control. We hypothesized that, in addition to peripheral effects, cold slows down the processing of proprioceptive cues, which has an impact on both feedback and feedforward control. We therefore compared the performances of participants whose right arm had been immersed in either cold water (arm temperature: 14°C) or lukewarm water (arm temperature: 34°C). In experiment 1, we administered a Fitts's pointing task and performed a kinematic analysis to determine whether sensorimotor control processes were affected by the cold. Results revealed 1) modifications in late kinematic parameters, suggesting changes in the use of proprioceptive feedback, and 2) modifications in early kinematic parameters, suggesting changes in action representations and/or feedforward processes. To explore our hypothesis further, we ran a second experiment in which no physical movement was involved, and thus no peripheral effects. Participants were administrated a hand laterality task, known to involve implicit motor imagery and assess the internal representation of the hand. They were shown left- and right-hand images randomly displayed in different orientations in the picture plane and had to identify as quickly and as accurately as possible whether each image was of the left hand or the right hand. Results revealed slower responses and more errors when participants had to mentally rotate the cooled hand in the extreme orientation of 160°, further suggesting the impact of cold on action representations.NEW & NOTEWORTHY We investigated how arm cooling modulates sensorimotor representations and sensorimotor control. Arm cooling induced changes in early kinematic parameters of pointing, suggesting an impact on feedforward processes or hand representation. Arm cooling induced changes in late kinematic parameters of pointing, suggesting an impact on feedback processes. Arm cooling also affected performance on a hand laterality task, suggesting that action representations were modified.

Effects of repeated cryostimulation exposures on sleep and wellness in healthy young adults.

The aim of this study was to evaluate the effects of daily whole-body cryostimulation (WBC) sessions during 5 consecutive days on wellness and sleep parameters in healthy young men and women. Twenty healthy subjects (9 women; 11 men) aged 23.1 ± 2.6 years old participated in this randomized protocol, with 5 consecutive days with (CRYO) or without WBC (CONT) exposure. Sleep was analyzed over the 5 nights in each condition. Sleep quality and quantity were assessed via actimetry, cerebral activity and questionnaires. Nocturnal heart rate variability (HRV) was also recorded and questionnaires were given to assess wellness and mood. Repeated WBC exposures had a beneficial impact on mood and anxiety. It also improved subjective sleep quality (scored from 3.6 ± 0.5 pre to 3.9 ± 0.3), especially in women. Also, repeated WBC sessions modulated sleep architecture by increasing slow wave sleep duration (+7.3 ± 16.8 min) during the nights without impacting other sleep parameters, nor nocturnal HRV. In conclusion, repeated WBC seems to be an effective strategy to improve slow wave sleep duration in healthy young subjects. The reported psychological improvements may better benefit women than men.

The effects of cold exposure (cold water immersion, whole- and partial- body cryostimulation) on cardiovascular and cardiac autonomic control responses in healthy individuals: A systematic review, meta-analysis and meta-regression.

BACKGROUND: Cryostimulation and cold-water immersion (CWI) have recently gained widespread attention due to their association with changes in cardiovascular and cardiac autonomic control responses. Therefore, the aim of the present systematic review and meta-analysis was to identify the global impact of such cold exposures on cardiovascular and cardiac autonomic activity. METHODS: Three databases (PubMed, Embase, Web-of-Science) were used. Studies were eligible for inclusion if they were conducted on healthy participants using cryostimulation and/or CWI. The outcomes included measurements of blood pressure (BP), heart rate (HR), and heart rate variability (HRV) indices: RR interval (RR), Root mean square of successive RR interval differences (RMSSD), low frequency band (LF), high frequency band (HF), and LF/HF ratio. RESULTS: Among the 27 articles included in our systematic literature review, only 24 were incorporated into the meta-analysis. Our results reveal a significant increase in HRV indices: RMSSD (Standardized mean difference (SMD) = 0.61, p < 0.001), RR (SMD = 0.77, p < 0.001), and HF (SMD = 0.46, p < 0.001), as well as significantly reduced LF (SMD = -0.41, p < 0.001) and LF/HF ratio (SMD = -0.25, p < 0.01), which persisted up to 15 min following cold exposure. Significantly decreased heart rate (SMD = -0.16, p < 0.05), accompanied by slightly increased mean BP (SMD = 0.28, p < 0.001), was also observed. These results seem to depend on individual characteristics and the cooling techniques. CONCLUSION: Our meta-analysis suggests that cryostimulation and/or CWI exposure enhance parasympathetic nervous activity. There is scarce scientific literature regarding the effect of individual characteristics on cold-induced physiological responses.

Partial-body cryostimulation does not impact peripheral microvascular responsiveness but reduces muscular metabolic O2 consumption (mV˙O2) at rest.

This study aimed to investigate the effect of partial-body cryostimulation (PBC) on microvascular responsiveness and muscular metabolic O2 consumption rate (mV˙O2). Twenty healthy young adults (ten males and ten females) underwent a post-occlusive reactive hyperemia (PORH) test at the flexor digitorum superficialis area before and after a 3-min PBC session and a 3-min control session. Using near-infrared spectroscopy, occlusion and reperfusion slopes were calculated: oxyhemoglobin ([HbO2]) decrease rate ([HbO2] slope 1), deoxyhaemoglobin ([HHb]) increase rate ([HHb] slope 1), [HbO2] increase rate ([HbO2] slope 2), and [HHb] increase rate ([HHb] slope 2. Using HbO2 kinetics during the occlusion, mV˙O2 was also calculated to characterize myocytes' metabolic O2 consumption. HbO2 slope 1 value was lower after PBC than before PBC (-0.15 ± 0.08 vs -0.24 ± 0.11 s-1; respectively; P < 0.05) in male participants only. A lower [HHb] slope 1 was also observed after PBC compared to before PBC (0.18 ± 0.10 vs 0.24 ± 0.16 s-1; P < 0.05) with no interaction for sex categories. mV˙O2 was significantly lower after PBC than before (pre values 14.75 ± 3.94 vs 18.47 ± 5.73 µMO2Hb.s-1; respectively; P < 0.01) with no interaction between sex categories. No changes in the calculated slope 2 were observed. These findings suggest that a single session of PBC reduces the muscular metabolic O2 needs at rest; however, it does not alter the vascular ability to provide O2 to the myocytes.

Thermoregulation and thermal sensation during whole-body water immersion at different water temperatures in healthy individuals: A scoping review.

BACKGROUND: Severe thermal discomfort may increase risk of drowning due to hypothermia or hyperthermia from prolonged exposure to noxious water temperatures. The importance of using a behavioral thermoregulation model with thermal sensation may predict the thermal load that the human body receives when exposed to various immersive water conditions. However, there is no thermal sensation "gold standard" model specific for water immersion. This scoping review aims to present a comprehensive overview regarding human physiological and behavioral thermoregulation during whole-body water immersion and explore the feasibility for an accepted defined sensation scale for cold and hot water immersion. METHODS: A standard literary search was performed on PubMed, Google Scholar, and SCOPUS. The words "Water Immersion," "Thermoregulation," "Cardiovascular responses" were used either as independent searched terms and MeSH terms (Medical Subject Headings) or in combination with other text words. The inclusion criteria for clinical trials terms to thermoregulatory measurements (core or skin temperature), whole-body immersion, 18-60 years old and healthy individuals. The prementioned data were analyzed narratively to achieve the overall study objective. RESULTS: Twenty-three published articles fulfilled the review inclusion/exclusion criteria (with nine measured behavioral responses). Our outcomes illustrated a homogenous thermal sensation in a variety of water temperatures ranges, that was strongly associated with thermal balance, and observed different thermoregulatory responses. This scoping review highlights the impact of water immersion duration on human thermoneutral zone, thermal comfort zone, and thermal sensation. CONCLUSION: Our findings enlighten the significance of thermal sensation as a health indicator for establishing a behavioral thermal model applicable for water immersion. This scoping review provides insight for the needed development of subjective thermal model of thermal sensation in relation to human thermal physiology specific to immersive water temperature ranges within and outside the thermal neutral and comfort zone.

Whole-body cryostimulation in obesity. A scoping review.

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.

Cooling During Exercise May Induce Benefits Linked to Improved Brain Perfusion.

The aim of this study was to evaluate the impact of using a cooling vest during physical exercise (per-cooling) in humid and temperate conditions (≈22°C, ≈80% relative humidity) on perceptual and physiological responses (tissue oxygenation and heart rate). 20 physically active men performed twice a 30-min cycling exercise at 70% of their theoretical maximum heart rate while using an activated (experimental condition) and a deactivated (control condition) cooling system in a randomized crossover study. Heart rate and tissue (cerebral and muscular) oxygenation were continuously measured during exercise and recovery, and skin temperature was measured every 10 min. Perception of temperature, humidity and comfort were assessed at the end of the recovery period. Results showed a decrease in trunk skin temperature (p<0.05), a faster heart rate recovery and an increase in the concentration of total hemoglobin at the brain level (p<0.05) compared with control condition. Moreover, an improved subjective rating of thermal sensations, wetness and comfort compared to control values (p<0.05) was noted. In conclusion, wearing a cooling vest during submaximal exercise improves perceptual and physiological responses in humid temperate conditions, which may be due to a better blood perfusion at the brain level and a better parasympathetic reactivation.

The use of whole-body cryotherapy: time- and dose-response investigation on circulating blood catecholamines and heart rate variability.

PURPOSE: A predominance of parasympathetic drive is observed following cold exposure. Such modulation of the autonomic nervous system (ANS) is associated with faster post-exercise recovery. Within this context, whole-body cryotherapy (WBC) has been spreading in sport medicine, though the optimal temperature and frequency are unclear. The aim of this study was to examine the effects of different cryotherapy conditions on the sympathovagal balance. METHODS: Forty healthy males were randomly assigned into five different groups (- 110 °C, - 60 °C, - 10 °C, control temperature [≃ 24 °C]) and undertook 5 WBC sessions over 5 consecutive days. Cardiac autonomic activity was assessed through heart rate variability (HRV) using power density of high frequency (HF), root-mean square difference of successive R-R intervals (RMSSD) and sympathovagal balance (LF/HF). Systemic sympathetic activity was assessed via circulating blood catecholamines. RESULTS: Mean weekly RMSSD (pre: 48 ± 22 ms, post: 68 ± 29 ms) and HF (pre: 607 ± 692 ms2, post: 1271 ± 1180 ms2) increased (p < 0.05) from pre to post WBC, only in the - 110 °C condition. A rise in plasma norepinephrine was found after the first - 110 °C WBC session only (pre: 173 ± 98, post: 352 ± 231 ng L-1, p < 0.01); whereas, it was not significant after the 5th session (pre: 161 ± 120, post: 293 ± 245 ng L-1, p = 0.15). CONCLUSION: These results suggest that one - 110 °C WBC exposure is required to stimulate the ANS. After five daily exposures, a lower autonomic response was recorded compared to day one, therefore suggesting the development of physiological habituation to WBC.

Cooling during exercise enhances performances, but the cooled body areas matter: A systematic review with meta-analyses.

INTRODUCTION: Hyperthermia during exercise induces central and peripheral fatigue and impairs physical performance. To facilitate heat loss and optimize performance, athletes can hasten body cooling prior (pre-cooling) or during (per-cooling) exercise. However, it is unclear whether per-cooling effect is the same on 'aerobic' and 'anaerobic' types of exercise (duration <75 and >76 seconds, respectively, according to Gastin [Sports Med 2001;31:725-741]) and whether the body area that is cooled makes a difference. METHODS: A literature search led to the identification of 1582 potential studies. Included studies had to include physical exercise with sufficient details on the type, duration, intensity, and provide valid performance measures and a cooling intervention administered during exercise with sufficient details on the type and site of application. RESULTS: Forty-five studies were included. Per-cooling provides a performance benefit during 'aerobic' (standardized mean difference (SMD) of 0.60, P < .001) and 'anaerobic' exercises (SMD = 0.27, P < .02). The effects were greater during aerobic compared to anaerobic exercises (P < .01). Internal cooling (cold fluid ingestion such as cold water and ice slurry/menthol beverage) and external cooling (face, neck, and torso) provide the greatest performance benefit for 'aerobic' performance with a moderate to large effect (0.46 < SMD < 1.24). For 'anaerobic' exercises, wearing a whole-body cooling garment is the best way to enhance exercise performance (SMD = 0.39, P < .01). CONCLUSION: Per-cooling improves 'aerobic' and 'anaerobic' exercise performance with a greater benefit for 'aerobic' exercise. The magnitude of the effect depends on the type and site of the cooling application.

What everybody should know about postural changes.

Posture changes have been known for a long time to influence the concentration of many analytes in blood especially macromolecules. It is very clear that when someone switches from supine to sitting or standing or from sitting to standing a hemoconcentration is induced. Similarly, when someone switches from standing to sitting or lying a hemodilution occurs. In the context of clinical chemistry, rules have been issued to buffer the impact of postural changes close to the blood specimen collection (e.g. 15 min of seated rest before the blood puncture). A big work has then been performed to educate the personnel concerned by blood specimen collection (medical doctors, nurses, phlebotomists, pharmacists, clinical researchers, scientists, etc.) through professional training to standardize the puncture and the collection procedures. Official procedures and guidelines have been published. Nevertheless, there is still a long way to go and too often standardization of posture before the blood collection is not properly performed. Maybe, this relative failure could be overcome by using new strategies in forwarding the message on the impact of posture changes in the outcome of blood tests and the importance of controlling this factor when blood specimens are taken. Some possible actions are presented concerning the improvement of the education of medical and paramedical personnel especially during their primary training, and also to educate the patients and the whole population in general.

Validation of a new whole-body cryotherapy chamber based on forced convection.

Whole-body cryotherapy (WBC) and partial-body cryotherapy (PBC) are two methods of cold exposure (from -110 to -195°C according to the manufacturers). However, temperature measurement in the cold chamber during a PBC exposure revealed temperatures ranging from -25 to -50°C next to the skin of the subjects (using isolating layer placed between the sensor and the skin). This discrepancy is due to the human body heat transfer. Moreover, on the surface of the body, an air layer called the boundary layer is created during the exposure and limits heat transfer from the body to the cabin air. Incorporating forced convection in a chamber with a participant inside could reduce this boundary layer. The aim of this study was to explore the use of a new WBC technology based on forced convection (frontal unilateral wind) through the measurement of skin temperature. Fifteen individuals performed a 3-min WBC exposure at -40°C with an average wind speed of 2.3ms-1. The subjects wore a headband, a surgical mask, underwear, gloves and slippers. The skin temperature of the participants was measured with a thermal camera just before exposure, just after exposure and at 1, 3, 5, 10, 15 and 20min after exposure. Mean skin temperature significantly dropped by 11°C just after exposure (p<0.001) and then significantly increased during the 20-min post exposure period (p<0.001). No critically low skin temperature was observed at the end of the cold exposure. This decrease was greater than the mean decreases in all the cryosauna devices with reported exposures between -140°C and -160°C and those in two other WBC devices with reported exposures between -60°C and -110°C. The use of this new technology provides the ability to reach decreases in skin temperature similar to other technologies. The new chamber is suitable and relevant for use as a WBC device.

Whole- and partial-body cryostimulation/cryotherapy: Current technologies and practical applications.

Cold therapy is commonly used as a method to relieve pain and inflammation. This review focuses primarily on two methods of cold therapy that have received recent attention: whole-body cryotherapy and partial-body cryotherapy. These methods are used to induce physiological and psychological benefits in humans in the context of medicine, health and sports. The subjects experiencing cryotherapy are dressed in minimal clothing and are exposed to very cold air (at -110°C or less) for 1-4min. Despite the increasing scientific interest in these methods, there is a lack of information about the technologies used. Moreover, there is no existing reference concerning exposure protocols and the relationship between temperature, duration, number of repetitions and the treatments' desired effects. The aim of this review is to compare whole- and partial-body cryotherapy effects (especially on skin temperature) and to classify the protocols for exposure according to the desired effects. This review emphasises 1) the lack of information concerning the actual temperatures inside the cabin or chamber during exposure and 2) the heterogeneity among the exposure protocols that have been reported in the scientific literature. This review will be valuable and relevant to health professionals endeavouring to optimize the cold treatments offered to patients and producers of cryotherapy apparatus striving to create more efficient devices that meet market requirements.

Impact of regular cold exposure on electrical skin resistance in patients with joint degenerative diseases.

OBJECTIVE: Common features in chronic inflammatory disease patients (CIDP) are inflammation, mental stress (MS), and autonomic nervous system imbalance. Whole-body cryotherapy (WBC) exposure and regular physical exercise are known to regulate these features. In this study, we assessed the impact of regular physical exercise and the use of WBC exposure in CIDP on the level of electrical skin resistance (SR) to evaluate the skin sympathetic nervous activity and and estimate MS levels. METHODS: SR was evaluated before and after a 10-day-period of daily physical exercise preceded or not by WBC (3 min at -110°C) in two groups of 134 CIDP (WBC vs. non-WBC groups). RESULTS: At baseline, the number of severe MS patients was similar in both groups. However, after the training period, the number of severe MS patients significantly decreased in the WBC group, only. An increase in SR (a decrease in stress level) was noted in the WBC group only, and such increase was higher in men than in women and in patients younger than 60 versus patients older than 60 years old. CONCLUSION: The use of daily WBC combined with physical exercise induced physiological adaptations and lowered the sympathetic nervous activity that may reflect a reduced level of MS in CIDP. These adaptations seem to depend on gender and age.

Evaluating safety risks of whole-body cryotherapy/cryostimulation (WBC): a scoping review from an international consortium.

Over the two last decades, whole-body cryotherapy/cryostimulation (WBC) has emerged as an exciting non-pharmacological treatment influencing inflammatory events at a cellular and physiological level, which can result in improved sleep quality, faster neuromuscular recovery after high-intensity exercise, and chronic pain relief for patients suffering different types of diseases (fibromyalgia, rheumatism, arthritis). Some evidence even suggests that WBC has benefits on mental health (depression, anxiety disorders) and cognitive functions in both adults and older adults, due to increased circulating BDNF levels. Recently, some safety concerns have been expressed by influential public health authorities (e.g., FDA, INSERM) based on reports from patients who developed adverse events upon or following WBC treatment. However, part of the data used to support these claims involved individuals whose entire body (except head) was exposed to extreme cold vaporized liquid nitrogen while standing in a narrow bathtub. Such a procedure is known as partial-body cryotherapy (PBC), and is often erroneously mistaken to be whole-body cryotherapy. Although having similarities in terms of naming and pursued aims, these two approaches are fundamentally different. The present article reviews the available literature on the main safety concerns associated with the use of true whole-body cryotherapy. English- and French-language reports of empirical studies including case reports, case series, and randomized controlled trials (RCTs) were identified through searches of PubMed, Scopus, Cochrane, and Web of Science electronic databases. Five case reports and two RCTs were included for a total of 16 documented adverse events (AEs). A critical in-depth evaluation of these AEs (type, severity, context of onset, participant's medical background, follow-up) is proposed and used to illustrate that WBC-related safety risks are within acceptable limits and can be proactively prevented by adhering to existing recommendations, contraindications, and commonsense guidelines.

Dry-land strength training vs. electrical stimulation in sprint swimming performance.

This study was undertaken to compare the effects of dry-land strength training vs. an electrical stimulation program on swimmers. Twenty-four national-level swimmers were randomly assigned to 3 groups: the dry-land strength training program (S), the electrical stimulation training program (ES), and the control (C) group. The training program lasted 4 weeks. The subjects were evaluated before the training, at the end of the training program, and 4 weeks later. The outcome values ascertained were peak torque during arm extension at different velocities (from -60 to 180°·s(-1)) using an isokinetic dynamometer and performance, stroke rate, and stroke length during a 50-m front crawl. A significant increase in swimming velocity and peak torque was observed for both S and ES at the end of the training and 4 weeks later. Stroke length increased in the S group but not in the ES group. However, no significant differences in swimming velocity between S and ES groups were observed. No significant changes occurred in the C group. Programs combining swimming training with dry-land strength or electrical stimulation programs led to a similar gain in sprint performance and were more efficient than swimming alone.

Evaluation of a Hybrid Cardiovascular Rehabilitation Program in Acute Coronary Syndrome Low-Risk Patients Organised in Both Cardiac Rehabilitation and Sport Centres: A Model Feasibility Study.

The aim of the study was to investigate the efficiency, the feasibility, and the safety of a hybrid cardiovascular rehabilitation program in low-risk acute coronary syndrome (ACS) patients. Sixty low-risk patients with stable clinical status who experienced an ACS in the previous 3 months were included in a 3-week rehabilitation program. The patients were randomized either to a group performing the rehabilitation totally in a rehabilitation centre or partially (only the first 5 days) and then in sport centres equipped for supervised adapted physical activities. The sport centres were located in the vicinity of the patient's home. Both rehabilitation programs entailed endurance and resistance training and educational therapy. Before and after rehabilitation, cardiorespiratory functions were measured. Similar and significant improvements in peak V.O2 and power output were seen in patients after both types of rehabilitation (p < 0.05). No particular complications were associated with both of our programs. We conclude that a hybrid rehabilitation program in low-risk ACS patients is feasible, safe, and as beneficial as a traditional program organised in a rehabilitation centre, at least in a short-term. A longitudinal follow-up should nevertheless be organised to examine the long-term impacts of this hybrid rehabilitation program.

1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling-A Preliminary Investigation.

In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.

Relevance of water gymnastics in rehabilitation programs in patients with chronic heart failure or coronary artery disease with normal left ventricular function.

BACKGROUND: Exercise training is included in cardiac rehabilitation programs to enhance physical capacity and cardiovascular function. Among the existing rehabilitation programs, exercises in water are increasingly prescribed. However, it has been questioned whether exercises in water are safe and relevant in patients with stable chronic heart failure (CHF), coronary artery disease (CAD) with normal systolic left ventricular function. The goal was to assess whether a rehabilitation program, including water-based gymnastic exercises, is safe and induces at least similar benefits as a traditional land-based training. METHODS AND RESULTS: Twenty-four male CAD patients and 24 male CHF patients with stable clinical status participated in a 3-week rehabilitation. They were randomized to either a group performing the training program totally on land (CADl, CHFl; endurance + callisthenic exercises) or partly in water (CADw, CHFw; land endurance + water callisthenic exercises). Before and after rehabilitation, left ventricular systolic and cardiorespiratory functions, hemodynamic variables and autonomic nervous activities were measured. No particular complications were associated with both of our programs. At rest, significant improvements were seen in CHF patients after both types of rehabilitation (increases in stroke volume and left ventricular ejection fraction [LVEF]) as well as a decrease in heart rate (HR) and in diastolic arterial pressure. Significant increases in peaks VO(2), HR, and power output were observed in all patients after rehabilitation in exercise test. The increase in LVEF at rest, in HR and power output at the exercise peak were slightly higher in CHFw than in CHFl. CONCLUSIONS: Altogether, both land and water-based programs were well tolerated and triggered improvements in cardiorespiratory function.

Impact of acute partial-body cryostimulation on cognitive performance, cerebral oxygenation, and cardiac autonomic activity.

We assessed the effects of a 3-min partial-body cryostimulation (PBC) exposure-where the whole body is exposed to extreme cold, except the head-on cognitive inhibition performance and the possible implications of parasympathetic cardiac control and cerebral oxygenation. In a randomized controlled counterbalanced cross-over design, eighteen healthy young adults (nine males and nine females) completed a cognitive Stroop task before and after one single session of PBC (3-min exposure at - 150 °C cold air) and a control condition (3 min at room temperature, 20 °C). During the cognitive task, heart rate variability (HRV) and cerebral oxygenation of the prefrontal cortex were measured using heart rate monitoring and near-infrared spectroscopy methods. We also recorded the cerebral oxygenation during the PBC session. Stroop performance after PBC exposure was enhanced (562.0 ± 40.2 ms) compared to pre-PBC (602.0 ± 56.4 ms; P < 0.042) in males only, accompanied by an increase (P < 0.05) in HRV indices of parasympathetic tone, in greater proportion in males compared to females. During PBC, cerebral oxygenation decreased in a similar proportion in males and females but the cerebral extraction (deoxyhemoglobin: ΔHHb) remained higher after exposure in males, only. These data demonstrate that a single PBC session enhances the cognitive inhibition performance on a Stroop task in males, partly mediated by a greater parasympathetic cardiac control and greater cerebral oxygenation. The effects of PBC on cognitive function seem different in females, possibly explained by a different sensitivity to cold stimulation.

Cryostimulation for Post-exercise Recovery in Athletes: A Consensus and Position Paper.

Recovery after exercise is a crucial key in preventing muscle injuries and in speeding up the processes to return to homeostasis level. There are several ways of developing a recovery strategy with the use of different kinds of traditional and up-to-date techniques. The use of cold has traditionally been used after physical exercise for recovery purposes. In recent years, the use of whole-body cryotherapy/cryostimulation (WBC; an extreme cold stimulation lasting 1-4 min and given in a cold room at a temperature comprised from -60 to -195°C) has been tremendously increased for such purposes. However, there are controversies about the benefits that the use of this technique may provide. Therefore, the main objectives of this paper are to describe what is whole body cryotherapy/cryostimulation, review and debate the benefits that its use may provide, present practical considerations and applications, and emphasize the need of customization depending on the context, the purpose, and the subject's characteristics. This review is written by international experts from the working group on WBC from the International Institute of Refrigeration.