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Report for CET Cryotherapy

January 2009

Dr. C.M Bleakley; Prof. S.M McDonough
Health and Rehabilitation Sciences Research Institute
University of Ulster

A Randomised Controlled Pilot Study of the Physiological Effect
of Cold Water Immersion using Healthy Human Subjects

1.Background:

1.1 The increasing competitiveness of elite level sport has meant that athletes are continually striving to develop their sporting performance and physical capacity. This can often lead to athletes subjecting themselves to rigorous training schedules and high volumes of physical activity throughout a competitive season.

1.2 It is now commonplace for athletes to employ various recovery strategies after exercise. Recently, cryotherapy immersion and ‘ice baths’ have become a popular strategy, however much of this may be due to anecdotal evidence.

1.3 In particular, the exact physiological rationale for cold water immersion is still unclear and few studies have assessed the associated peripheral and central effects.

2 Objectives:

2.1 To study the effects of cold water immersion on heart rate, blood pressure, skin temperature, core temperature and subjective tolerance.

2.2 To compare the effects of cold water immersion in two different water temperatures, applied with and without turbulence.

3.Study design:

A double blind randomised controlled trial design was used. N=20 healthy subjects were recruited from the staff and student population at the University of Ulster. Group allocation was concealed using sequentially numbered opaque sealed envelopes.

4 Intervention:

After a period of acclimatization, all participants were immersed in a cryotherapy bath (CET Cryotherapy Ltd) for a 5 minute period up to waist level. They were randomized to one of the following conditions:

1. Immersion in ice bath (2ºC) with water turbulence (n=5)
2. Immersion in ice bath (2ºC) without water turbulence (n=5)
3. Immersion in ice bath (10ºC) with water turbulence (n=5)
4. Immersion in ice bath (10ºC) with out water turbulence (n=5)

5 Outcomes:

Heart rates (HR), blood pressure (BP), subjective pain response (McGill pain questionnaire) were recorded. In addition, the Vital Sense telemetric physiological monitoring system (Minimitter Co. Inc, Bend, OR) were used to assess skin temperature (foot dorsum, anterior thigh) and core temperature.

6 Executive summary of results
6.1 Our initial review of the evidence base in this area showed that few research studies have adequately measured changes to skin temperature during cold water immersion (CWI).

6.2 Based on the most up to date clinical evidence, the optimal recommended skin temperature reduction for treating soft tissue injuries of elite athletes is between 10ºC and 14ºC (References I, II, III & IV).

6.3 Our research noted that these temperature reductions could be readily achieved after a 5 minute immersion (to waist level) in the CET Cryotherapy Spa [Cryo Spa]. Furthermore, skin cooling to therapeutic levels was enhanced by using the in-built jets on the Cryo Spa, to create water turbulence.

6.4 Immersion at 2ºC with water turbulence resulted in the largest skin temperature reductions, followed by immersion in 2ºC without water turbulence.

6.5 We found no adverse events or side effects associated with using the CET Cryo Spa.

6.6 There were no clinically significant differences between groups for key outcome and demographic data at baseline. There were no adverse events or side effects associated with any of the immersion interventions. In all but one subject, there were marginal increases in core temperature during immersion. All the changes in core temperature reported during the study were clinically insignificant.

6. Graph 3
Typical skin temperature reduction (each minute) during immersion in 2 ºC

7. Graph
CET: values for 2ºC with turbulence.
*Approximate value extracted from original study graph.

8. References.

· Chesterton LS et al. Skin temperature response to cryotherapy. Arch Phys Med Rehabil. 2002; 83(4): 543-9.
· Kanlayanaphotporn R & Janwantanakul P. Comparison of skin surface temperature during the application of various cryotherapy modalities. Arch Phys Med Rehabil. 2005; 86(7): 1411-5.
· Kennet J et al. Cooling efficiency of 4 common cryotherapeutic agents. J Athl Train. 2007; 42(3): 343-8.
· Palmieri R et al. Peripheral ankle cooling and core body temperature. J Athl Train. 2006; 41(2): 185-8.