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Whole-body cryotherapy: empirical evidence and theoretical perspectives

Identifieur interne : 001262 ( Pmc/Checkpoint ); précédent : 001261; suivant : 001263

Whole-body cryotherapy: empirical evidence and theoretical perspectives

Auteurs : Chris M. Bleakley [Royaume-Uni] ; François Bieuzen [France] ; Gareth W. Davison [Royaume-Uni] ; Joseph T. Costello [Australie]

Source :

RBID : PMC:3956737

Abstract

Whole-body cryotherapy (WBC) involves short exposures to air temperatures below −100°C. WBC is increasingly accessible to athletes, and is purported to enhance recovery after exercise and facilitate rehabilitation postinjury. Our objective was to review the efficacy and effectiveness of WBC using empirical evidence from controlled trials. We found ten relevant reports; the majority were based on small numbers of active athletes aged less than 35 years. Although WBC produces a large temperature gradient for tissue cooling, the relatively poor thermal conductivity of air prevents significant subcutaneous and core body cooling. There is weak evidence from controlled studies that WBC enhances antioxidant capacity and parasympathetic reactivation, and alters inflammatory pathways relevant to sports recovery. A series of small randomized studies found WBC offers improvements in subjective recovery and muscle soreness following metabolic or mechanical overload, but little benefit towards functional recovery. There is evidence from one study only that WBC may assist rehabilitation for adhesive capsulitis of the shoulder. There were no adverse events associated with WBC; however, studies did not seem to undertake active surveillance of predefined adverse events. Until further research is available, athletes should remain cognizant that less expensive modes of cryotherapy, such as local ice-pack application or cold-water immersion, offer comparable physiological and clinical effects to WBC.


Url:
DOI: 10.2147/OAJSM.S41655
PubMed: 24648779
PubMed Central: 3956737


Affiliations:


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PMC:3956737

Le document en format XML

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</TEI>
<pmc article-type="review-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Open Access J Sports Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Open Access J Sports Med</journal-id>
<journal-id journal-id-type="publisher-id">Open Access Journal of Sports Medicine</journal-id>
<journal-title-group>
<journal-title>Open Access Journal of Sports Medicine</journal-title>
</journal-title-group>
<issn pub-type="epub">1179-1543</issn>
<publisher>
<publisher-name>Dove Medical Press</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">24648779</article-id>
<article-id pub-id-type="pmc">3956737</article-id>
<article-id pub-id-type="doi">10.2147/OAJSM.S41655</article-id>
<article-id pub-id-type="publisher-id">oajsm-5-025</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Review</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Whole-body cryotherapy: empirical evidence and theoretical perspectives</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Bleakley</surname>
<given-names>Chris M</given-names>
</name>
<xref ref-type="aff" rid="af1-oajsm-5-025">1</xref>
<xref ref-type="corresp" rid="c1-oajsm-5-025"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bieuzen</surname>
<given-names>François</given-names>
</name>
<xref ref-type="aff" rid="af2-oajsm-5-025">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Davison</surname>
<given-names>Gareth W</given-names>
</name>
<xref ref-type="aff" rid="af1-oajsm-5-025">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Costello</surname>
<given-names>Joseph T</given-names>
</name>
<xref ref-type="aff" rid="af3-oajsm-5-025">3</xref>
</contrib>
</contrib-group>
<aff id="af1-oajsm-5-025">
<label>1</label>
Sport and Exercise Science Research Institute, Faculty of Life and Health Sciences, University of Ulster, Newtownabbey, Northern Ireland</aff>
<aff id="af2-oajsm-5-025">
<label>2</label>
Research Department, Laboratory of Sport, Expertise and Performance, French National Institute of Sport (INSEP), Paris, France</aff>
<aff id="af3-oajsm-5-025">
<label>3</label>
School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia</aff>
<author-notes>
<corresp id="c1-oajsm-5-025">Correspondence: Chris Bleakley, Ulster Sports Academy, University of Ulster, Newtownabbey, County Antrim, BT370QB, Northern Ireland, Tel +44 28 9036 66025, Email
<email>c.bleakley@ulster.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2014</year>
</pub-date>
<pub-date pub-type="epub">
<day>10</day>
<month>3</month>
<year>2014</year>
</pub-date>
<volume>5</volume>
<fpage>25</fpage>
<lpage>36</lpage>
<permissions>
<copyright-statement>© 2014 Bleakley et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement>
<copyright-year>2014</copyright-year>
<license>
<license-p>The full terms of the License are available at
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p>
</license>
</permissions>
<abstract>
<p>Whole-body cryotherapy (WBC) involves short exposures to air temperatures below −100°C. WBC is increasingly accessible to athletes, and is purported to enhance recovery after exercise and facilitate rehabilitation postinjury. Our objective was to review the efficacy and effectiveness of WBC using empirical evidence from controlled trials. We found ten relevant reports; the majority were based on small numbers of active athletes aged less than 35 years. Although WBC produces a large temperature gradient for tissue cooling, the relatively poor thermal conductivity of air prevents significant subcutaneous and core body cooling. There is weak evidence from controlled studies that WBC enhances antioxidant capacity and parasympathetic reactivation, and alters inflammatory pathways relevant to sports recovery. A series of small randomized studies found WBC offers improvements in subjective recovery and muscle soreness following metabolic or mechanical overload, but little benefit towards functional recovery. There is evidence from one study only that WBC may assist rehabilitation for adhesive capsulitis of the shoulder. There were no adverse events associated with WBC; however, studies did not seem to undertake active surveillance of predefined adverse events. Until further research is available, athletes should remain cognizant that less expensive modes of cryotherapy, such as local ice-pack application or cold-water immersion, offer comparable physiological and clinical effects to WBC.</p>
</abstract>
<kwd-group>
<title>Keywords</title>
<kwd>whole-body cryotherapy</kwd>
<kwd>cooling</kwd>
<kwd>recovery</kwd>
<kwd>muscle damage</kwd>
<kwd>sport</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="f1-oajsm-5-025" position="float">
<label>Figure 1</label>
<caption>
<p>Forest plot of perceived sensation.</p>
<p>
<bold>Abbreviations:</bold>
IV, inverse variance; CI, confidence interval; WBC, whole-body cryotherapy.</p>
</caption>
<graphic xlink:href="oajsm-5-025Fig1"></graphic>
</fig>
<fig id="f2-oajsm-5-025" position="float">
<label>Figure 2</label>
<caption>
<p>Forest plot of performance outcomes.</p>
<p>
<bold>Abbreviations:</bold>
IV, inverse variance CI, confidence interval; WBC, whole-body cryotherapy.</p>
</caption>
<graphic xlink:href="oajsm-5-025Fig2"></graphic>
</fig>
<table-wrap id="t1-oajsm-5-025" position="float">
<label>Table 1</label>
<caption>
<p>Study characteristics</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" rowspan="2" colspan="1">Study design</th>
<th align="left" valign="top" rowspan="2" colspan="1">Participants</th>
<th align="left" valign="top" rowspan="2" colspan="1">WBC (control)</th>
<th colspan="3" align="left" valign="top" rowspan="1">Outcomes
<hr></hr>
</th>
</tr>
<tr>
<th align="left" valign="top" rowspan="1" colspan="1">Higher values in WBC (vs control)</th>
<th align="left" valign="top" rowspan="1" colspan="1">Lower values in WBC (vs control)</th>
<th align="left" valign="top" rowspan="1" colspan="1">No between-group differences</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Mila-Kierzenkowska et al
<xref rid="b5-oajsm-5-025" ref-type="bibr">5</xref>
<break></break>
Crossover study (4-month washout)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 Olympic-level kayakers undertaking a 10-day training cycle (all female, mean age 23.9±3.2 years) Cointerventions
<break></break>
Antioxidant supplementation</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 exposed to −120°C to −140°C for 3 minutes; 20 sessions in total: twice per day over a 10-day period (n=9 no WBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Catalase TBARS</td>
<td align="left" valign="top" rowspan="1" colspan="1">Superoxide dismutase Glutathione peroxidase</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Hausswirth et al
<xref rid="b6-oajsm-5-025" ref-type="bibr">6</xref>
<break></break>
Randomized crossover study (3-week washout)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 well-trained runners undertaking a simulated 48-minute trail run (all male, mean age 31.8±6.5 years)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 exposed to −110°C for 3 minutes; 3 sessions in total: immediately, 24, and 48 hours postexercise (n=9 seated rest)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Strength</td>
<td align="left" valign="top" rowspan="1" colspan="1">Pain Tiredness</td>
<td align="left" valign="top" rowspan="1" colspan="1">Creatine kinase</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Pournot et al
<xref rid="b7-oajsm-5-025" ref-type="bibr">7</xref>
<break></break>
Randomized crossover study (3-week washout)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=11 trained runners undertaking a simulated 48-minute trail run (all male, mean age 31.8±6.5 years)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=11 exposed to −110°C for 3 minutes; 4 sessions in total: immediately, 24, 48, and 72 hours postexercise
<break></break>
(n=11 seated rest)</td>
<td align="left" valign="top" rowspan="1" colspan="1">IL-1ra</td>
<td align="left" valign="top" rowspan="1" colspan="1">CRP</td>
<td align="left" valign="top" rowspan="1" colspan="1">IL-1β
<break></break>
IL-6
<break></break>
IL-10
<break></break>
TNFα
<break></break>
Leukocyte count</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Ziemann et al
<xref rid="b8-oajsm-5-025" ref-type="bibr">8</xref>
<break></break>
Randomized controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=12 professional male tennis players undertaking moderate-intensity training for 5 days (all male, mean age 20±2 years control, 23±3 years WBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=6 exposed to −120°C for 3 minutes; 10 sessions in total: twice per day over 5 days (n=6 no WBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">IL-6
<break></break>
Tennis-stroke effectiveness</td>
<td align="left" valign="top" rowspan="1" colspan="1">TNFα</td>
<td align="left" valign="top" rowspan="1" colspan="1">Creatine kinase
<break></break>
Leukocyte count
<break></break>
Cortisol
<break></break>
Testosterone</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Miller et al
<xref rid="b9-oajsm-5-025" ref-type="bibr">9</xref>
<break></break>
Controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=94 healthy participants (46 male, 48 female, mean age 37.5±3.1 years WBC, 37.9±2.1 years control)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=46 exposed to −130°C for 3 minutes; 10 sessions in total: 1 session per day over 10 days (n=48 no WBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Total antioxidant status
<break></break>
Superoxide dismutase
<break></break>
Uric acid
<break></break>
TBARS</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Costello et al
<xref rid="b10-oajsm-5-025" ref-type="bibr">10</xref>
<break></break>
Randomized controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=36 healthy participants (24 male, 12 female, mean age 20.8±1.2 years)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=16 exposed to −110°C for 3 minutes; 2 sessions in a single day, 2 hours apart (n=16 exposed to 15°C)</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">Joint positional sense
<xref ref-type="table-fn" rid="tfn1-oajsm-5-025">a</xref>
MVIC</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Costello et al
<xref rid="b10-oajsm-5-025" ref-type="bibr">10</xref>
<break></break>
Randomized controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=18 participants (4 female, 14 male, mean age 21.2±2.1 years) undertaking 100 high-force maximal eccentric contractions of the left knee extensors</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 exposed to −110°C for 3 minutes; 2 sessions in a single day, 2 hours apart (n=9 exposed to 15°C)</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">MVIC
<break></break>
Pain
<break></break>
Peak power output</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Fonda and Sarabon
<xref rid="b11-oajsm-5-025" ref-type="bibr">11</xref>
<break></break>
Randomized crossover (10-week washout)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=11 participants (all male, mean age 26.9±3.8 years) undertaking high-load and eccentric lower-limb exercises</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=11 exposed to −140°C to −195°C for 3 minutes; 6 sessions in total: 1 per day over 6 days (n=11 no WBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">Pain at rest
<break></break>
Pain on squat</td>
<td align="left" valign="top" rowspan="1" colspan="1">Creatine kinase
<break></break>
Lactate dehydrogenase
<break></break>
Aspartate aminotransferase
<break></break>
Performance
<xref ref-type="table-fn" rid="tfn2-oajsm-5-025">b</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Hausswirth et al
<xref rid="b12-oajsm-5-025" ref-type="bibr">12</xref>
<break></break>
Controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=40 healthy participants (all male; mean age 33.9±12.3 years control, 34.6±11.5 years WBC, 33.3±13.8 years PBC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=15 exposed to −110°C WBC for 3 minutes; n=15 exposed to −160°C PBC for 3 minutes; (n=10 seated rest)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Norepinephrine Dopamine (WBC) Heart-rate variability</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">Epinephrine
<break></break>
Dopamine (PBC)</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Ma et al
<xref rid="b13-oajsm-5-025" ref-type="bibr">13</xref>
<break></break>
Randomized controlled trial</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=30 participants with adhesive capsulitis of the shoulder joint (24 female, 6 male, mean age 57.2±6.6 years)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=15 exposed to −110°C for 4 minutes; 24 sessions in total: 2 sessions per day, 3 times per week over 4 weeks plus standard physiotherapy treatment (n=15 standard physiotherapy treatment only)</td>
<td align="left" valign="top" rowspan="1" colspan="1">ROM Function</td>
<td align="left" valign="top" rowspan="1" colspan="1">Pain</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">Schall et al
<xref rid="b14-oajsm-5-025" ref-type="bibr">14</xref>
<break></break>
Randomized crossover (1-week washout)</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=11 participants (all female, mean age 20.3±1.8 years) undertaking a 3-minute-maximum swimming exercise bout</td>
<td align="left" valign="top" rowspan="1" colspan="1">n=9 exposed to −110°C for 3 minutes; 1 session immediately after exercise (n=9 30 minutes of passive recovery)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Indices of heart-rate variability Metabolic recovery (lactate VO
<sub>2</sub>
peak) Subjective recovery</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">Performance (subjective judging in synchronized swimming)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<bold>Notes:</bold>
</p>
</fn>
<fn id="tfn1-oajsm-5-025">
<label>a</label>
<p>Absolute, relative, and variable error</p>
</fn>
<fn id="tfn2-oajsm-5-025">
<label>b</label>
<p>countermovement jump, power, strength.</p>
</fn>
<fn id="tfn3-oajsm-5-025">
<p>
<bold>Abbreviations:</bold>
WBC, whole-body cryotherapy; vs, versus; TBARS, thiobarbituric acid reactive substances; IL, interleukin; ra, receptor antagonist; CRP, C-reactive protein; TNF, tumor necrosis factor; MVIC, maximum voluntary isometric contraction; PBC, partial body cryotherapy; ROM, range of movement.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t2-oajsm-5-025" position="float">
<label>Table 2</label>
<caption>
<p>Tissue-temperature reductions by cooling modalities</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="top" rowspan="1" colspan="1">Ice pack (10 minutes)</th>
<th align="left" valign="top" rowspan="1" colspan="1">CWI (4–5 minutes, 8°C–10°C)</th>
<th align="left" valign="top" rowspan="1" colspan="1">WBC (3 minutes)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top" rowspan="7" colspan="1">Skin temperature</td>
<td align="left" valign="top" rowspan="1" colspan="1">18
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b15-oajsm-5-025" ref-type="bibr">15</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">6.2 (0.5)
<xref rid="b24-oajsm-5-025" ref-type="bibr">24</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">3.5–8.7
<xref rid="b27-oajsm-5-025" ref-type="bibr">27</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="tfn4-oajsm-5-025">a</xref>
,
<xref rid="b16-oajsm-5-025" ref-type="bibr">16</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">8.4 (0.7)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">6.7
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b28-oajsm-5-025" ref-type="bibr">28</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b17-oajsm-5-025" ref-type="bibr">17</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">9.0 (0.8)
<xref rid="b26-oajsm-5-025" ref-type="bibr">26</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">8.1 (0.4)
<xref ref-type="table-fn" rid="tfn6-oajsm-5-025">c</xref>
,
<xref rid="b12-oajsm-5-025" ref-type="bibr">12</xref>
</td>
</tr>
<tr>
<td colspan="2" align="left" valign="top" rowspan="1">20
<xref rid="b18-oajsm-5-025" ref-type="bibr">18</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">12.1 (1.0)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
</tr>
<tr>
<td colspan="2" align="left" valign="top" rowspan="1">22
<xref ref-type="table-fn" rid="tfn4-oajsm-5-025">a</xref>
,
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b19-oajsm-5-025" ref-type="bibr">19</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">10.3 (0.6)
<xref rid="b26-oajsm-5-025" ref-type="bibr">26</xref>
</td>
</tr>
<tr>
<td colspan="2" align="left" valign="top" rowspan="1">25.7–26.4
<xref rid="b20-oajsm-5-025" ref-type="bibr">20</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">13.7 (0.7)
<xref rid="b12-oajsm-5-025" ref-type="bibr">12</xref>
</td>
</tr>
<tr>
<td colspan="2" align="left" valign="top" rowspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">19.4
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b29-oajsm-5-025" ref-type="bibr">29</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="5" colspan="1">Intramuscular temperature (2 cm depth)</td>
<td align="left" valign="top" rowspan="1" colspan="1">1.76 (1.37)
<xref rid="b21-oajsm-5-025" ref-type="bibr">21</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1.7 (0.9)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1.2 (0.7)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
</tr>
<tr>
<td colspan="3" align="left" valign="top" rowspan="1">2.0
<xref ref-type="table-fn" rid="tfn4-oajsm-5-025">a</xref>
,
<xref rid="b16-oajsm-5-025" ref-type="bibr">16</xref>
</td>
</tr>
<tr>
<td colspan="3" align="left" valign="top" rowspan="1">2.0
<xref ref-type="table-fn" rid="tfn4-oajsm-5-025">a</xref>
,
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b19-oajsm-5-025" ref-type="bibr">19</xref>
</td>
</tr>
<tr>
<td colspan="3" align="left" valign="top" rowspan="1">2.7
<xref ref-type="table-fn" rid="tfn5-oajsm-5-025">b</xref>
,
<xref rid="b15-oajsm-5-025" ref-type="bibr">15</xref>
</td>
</tr>
<tr>
<td colspan="3" align="left" valign="top" rowspan="1">−3.88 (1.83)
<xref rid="b22-oajsm-5-025" ref-type="bibr">22</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="2" colspan="1">Core temperature</td>
<td align="left" valign="top" rowspan="1" colspan="1">0
<xref ref-type="table-fn" rid="tfn4-oajsm-5-025">a</xref>
,
<xref rid="b16-oajsm-5-025" ref-type="bibr">16</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.2 (0.1)
<xref rid="b24-oajsm-5-025" ref-type="bibr">24</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">0
<xref rid="b29-oajsm-5-025" ref-type="bibr">29</xref>
</td>
</tr>
<tr>
<td align="left" valign="top" rowspan="1" colspan="1">0
<xref rid="b23-oajsm-5-025" ref-type="bibr">23</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.4 (0.2)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.3 (0.2)
<xref rid="b25-oajsm-5-025" ref-type="bibr">25</xref>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<bold>Notes:</bold>
</p>
</fn>
<fn id="tfn4-oajsm-5-025">
<label>a</label>
<p>Data extracted from graphs with permission:
<italic>Arch Phys Med Rehabil</italic>
, 2001;82, Jutte LS, Merrick MA, Ingersoll CD, Edwards JE. The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming. 845–850.
<xref rid="b16-oajsm-5-025" ref-type="bibr">16</xref>
© 2001 with permission from Elsevier; and Merrick MA, Jutte LS, Smith ME. Cold modalities with different thermodynamic properties produce different surface and intramuscular temperatures.
<italic>J Athl Train</italic>
. 2003;38:28–33.
<xref rid="b19-oajsm-5-025" ref-type="bibr">19</xref>
</p>
</fn>
<fn id="tfn5-oajsm-5-025">
<label>b</label>
<p>standard deviation not available.</p>
</fn>
<fn id="tfn6-oajsm-5-025">
<label>c</label>
<p>PBC. All values are degrees celsius (means ± standard deviation).</p>
</fn>
<fn id="tfn7-oajsm-5-025">
<p>
<bold>Abbreviations:</bold>
CWI, cold-water immersion; WBC, whole-body cryotherapy; PBC, partial body cryotherapy (head out).</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Australie</li>
<li>France</li>
<li>Royaume-Uni</li>
</country>
<region>
<li>Irlande du Nord</li>
<li>Île-de-France</li>
</region>
<settlement>
<li>Paris</li>
</settlement>
</list>
<tree>
<country name="Royaume-Uni">
<region name="Irlande du Nord">
<name sortKey="Bleakley, Chris M" sort="Bleakley, Chris M" uniqKey="Bleakley C" first="Chris M" last="Bleakley">Chris M. Bleakley</name>
</region>
<name sortKey="Davison, Gareth W" sort="Davison, Gareth W" uniqKey="Davison G" first="Gareth W" last="Davison">Gareth W. Davison</name>
</country>
<country name="France">
<region name="Île-de-France">
<name sortKey="Bieuzen, Francois" sort="Bieuzen, Francois" uniqKey="Bieuzen F" first="François" last="Bieuzen">François Bieuzen</name>
</region>
</country>
<country name="Australie">
<noRegion>
<name sortKey="Costello, Joseph T" sort="Costello, Joseph T" uniqKey="Costello J" first="Joseph T" last="Costello">Joseph T. Costello</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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