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Meta-Analysis
. 2015 Sep 18;2015(9):CD010789.
doi: 10.1002/14651858.CD010789.pub2.

Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults

Joseph T Costello  1 , Philip R A Baker, Geoffrey M Minett, Francois Bieuzen, Ian B Stewart, Chris Bleakley
Affiliations
Meta-Analysis

Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults

Joseph T Costello et al. Cochrane Database Syst Rev. .

Abstract

Background: Recovery strategies are often used with the intention of preventing or minimising muscle soreness after exercise. Whole-body cryotherapy, which involves a single or repeated exposure(s) to extremely cold dry air (below -100 °C) in a specialised chamber or cabin for two to four minutes per exposure, is currently being advocated as an effective intervention to reduce muscle soreness after exercise.

Objectives: To assess the effects (benefits and harms) of whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, the British Nursing Index and the Physiotherapy Evidence Database. We also searched the reference lists of articles, trial registers and conference proceedings, handsearched journals and contacted experts.The searches were run in August 2015.

Selection criteria: We aimed to include randomised and quasi-randomised trials that compared the use of whole-body cryotherapy (WBC) versus a passive or control intervention (rest, no treatment or placebo treatment) or active interventions including cold or contrast water immersion, active recovery and infrared therapy for preventing or treating muscle soreness after exercise in adults. We also aimed to include randomised trials that compared different durations or dosages of WBC. Our prespecified primary outcomes were muscle soreness, subjective recovery (e.g. tiredness, well-being) and adverse effects.

Data collection and analysis: Two review authors independently screened search results, selected studies, assessed risk of bias and extracted and cross-checked data. Where appropriate, we pooled results of comparable trials. The random-effects model was used for pooling where there was substantial heterogeneity. We assessed the quality of the evidence using GRADE.

Main results: Four laboratory-based randomised controlled trials were included. These reported results for 64 physically active predominantly young adults (mean age 23 years). All but four participants were male. Two trials were parallel group trials (44 participants) and two were cross-over trials (20 participants). The trials were heterogeneous, including the type, temperature, duration and frequency of WBC, and the type of preceding exercise. None of the trials reported active surveillance of predefined adverse events. All four trials had design features that carried a high risk of bias, potentially limiting the reliability of their findings. The evidence for all outcomes was classified as 'very low' quality based on the GRADE criteria.Two comparisons were tested: WBC versus control (rest or no WBC), tested in four studies; and WBC versus far-infrared therapy, also tested in one study. No studies compared WBC with other active interventions, such as cold water immersion, or different types and applications of WBC.All four trials compared WBC with rest or no WBC. There was very low quality evidence for lower self-reported muscle soreness (pain at rest) scores after WBC at 1 hour (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -1.42 to -0.12; 20 participants, 2 cross-over trials); 24 hours (SMD -0.57, 95% CI -1.48 to 0.33) and 48 hours (SMD -0.58, 95% CI -1.37 to 0.21), both with 38 participants, 2 cross-over studies, 1 parallel group study; and 72 hours (SMD -0.65, 95% CI -2.54 to 1.24; 29 participants, 1 cross-over study, 1 parallel group study). Of note is that the 95% CIs also included either no between-group differences or a benefit in favour of the control group. One small cross-over trial (9 participants) found no difference in tiredness but better well-being after WBC at 24 hours post exercise. There was no report of adverse events.One small cross-over trial involving nine well-trained runners provided very low quality evidence of lower levels of muscle soreness after WBC, when compared with infrared therapy, at 1 hour follow-up, but not at 24 or 48 hours. The same trial found no difference in well-being but less tiredness after WBC at 24 hours post exercise. There was no report of adverse events.

Authors' conclusions: There is insufficient evidence to determine whether whole-body cryotherapy (WBC) reduces self-reported muscle soreness, or improves subjective recovery, after exercise compared with passive rest or no WBC in physically active young adult males. There is no evidence on the use of this intervention in females or elite athletes. The lack of evidence on adverse events is important given that the exposure to extreme temperature presents a potential hazard. Further high-quality, well-reported research in this area is required and must provide detailed reporting of adverse events.

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Conflict of interest statement

Joseph Costello (Costello 2012a) and François Bieuzen (Hausswirth 2011; Pournot 2011) co‐authored studies that are included in this review. Decisions on inclusion of these studies, the risk of bias assessment and data extraction of these studies were undertaken by other review authors (IBS, PRAB, CB and GMM), who had no involvement in the studies.

Figures

1
1
Logic Model describing the potential benefits and adverse effects of whole‐body cryotherapy
2
2
Study flow diagram
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
5
5
Forest plot of comparison: Whole‐body cryotherapy (WBC) versus passive (no WBC intervention/rest), outcome: 1.2 Pain ‐ random effects analysis (muscle soreness at rest: VAS).
1.1
1.1. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 1 Pain (muscle soreness at rest: VAS).
1.2
1.2. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 2 Pain ‐ random effects analysis (muscle soreness at rest: VAS).
1.3
1.3. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 3 Subgroup analysis. Study design: Pain at 24 hours (muscle soreness at rest: VAS).
1.4
1.4. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 4 Pain (muscle soreness on movement: cm).
1.5
1.5. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 5 Tiredness (0 [no tiredness] to 100 [maximum tiredness]).
1.6
1.6. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 6 Well‐being (0 [worst well‐being] to 100 [optimal well‐being]).
1.7
1.7. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 7 Strength (% of baseline).
1.8
1.8. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 8 Subgroup analysis. Study design: Strength at 72 hour (% of baseline).
1.9
1.9. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 9 Power (jump height: centimetres).
1.10
1.10. Analysis
Comparison 1 Whole‐body cryotherapy (WBC) versus control (no WBC or passive rest), Outcome 10 Power (cycle ergometer: % of baseline).
2.1
2.1. Analysis
Comparison 2 Whole‐body cryotherapy (WBC) versus far infrared therapy, Outcome 1 Pain (muscle soreness at rest: VAS).
2.2
2.2. Analysis
Comparison 2 Whole‐body cryotherapy (WBC) versus far infrared therapy, Outcome 2 Tiredness (0 [no tiredness] to 100 [maximum tiredness]).
2.3
2.3. Analysis
Comparison 2 Whole‐body cryotherapy (WBC) versus far infrared therapy, Outcome 3 Well‐being (0 [worst well‐being] to 100 [optimal well‐being]).
2.4
2.4. Analysis
Comparison 2 Whole‐body cryotherapy (WBC) versus far infrared therapy, Outcome 4 Strength (% of baseline).
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