Calf muscle stimulation with the Veinoplus device results in a significant increase in lower limb inflow without generating limb ischemia or pain in patients with peripheral artery disease

OBJECTIVE: Increase in arterial inflow to the lower limbs is important to obtain functional improvement in peripheral artery disease (PAD) patients with claudication. The aim of this study was to assess the effect of electrical stimulation of calf muscles on arterial inflow and tissue oxygen content in PAD in the area of stimulation.METHODS: Fifteen adult patients [mean (standard deviation) age, 62 (12 ) years; height, 165 (8)cm; weight, 76 (13) kg; lowest ankle-brachial index 0.66 (0.19)] with stable arterial claudication were recruited. All patients performed a treadmill test (3.2 km/h, 10% slope) associated with a transcutaneous oximetry test expressed as decrease from rest of oxygen pressure (DROP) index values (calf changes minus chest changes from rest) with a maximum walking distance (median [25th/75th percentiles]) of 295 [133-881] m. The DROP index on the symptomatic side was -25 [-18/-34] mm Hg. On another day the patients underwent electrical stimulation in the seated position on the leg that was the most symptomatic on the treadmill. After resting values were recorded, the gastrocnemius was stimulated for 20minutes at increasing contraction rates at 5-minute steps of 60, 75, 86, and 100bpm on the most symptomatic side. Arterial blood inflow with duplex Doppler ultrasound scanning of the femoral artery, DROP transcutaneous oxygen pressure value, and oxygen concentration (O2Hb) from the near-infrared spectroscopic signal of the calf were recorded on both sides. Patients were instructed to report eventual contraction-induced pain in the stimulated calf. Results are given as mean (standard deviation) or median [25th/75th percentiles] according to distribution, and the level of statistical significance was set at P < .05 on two-tailed tests. RESULTS: Lower limb inflow (mL/min) was 64 [48/86] vs 63 [57/81] (P> .05) before stimulation, 123 [75/156] vs 57 [44/92] (P < .01) at 60bpm, 127 [91/207] vs 49 [43/68] (P < .01) at 75bpm, 140 [84/200] vs 57 [45/71] (P < .01) at 86bpm, and 154 [86/185] vs 55 [46/94] (P < .01) at 100bpm on the stimulated vs nonstimulated limb, respectively. No apparent decrease or significant leg difference was observed in DROP index or O2Hb values. None of the patients reported contraction-induced pain in the leg. CONCLUSIONS: Electrical stimulation of calf muscle with the Veinoplus device results in a significant increase of arterial inflow without measurable muscle ischemia or pain. Potential use of this device as an adjuvant treatment to improve walking capacity in PAD patients remains to be evaluated

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

Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi Exposures following Severe Exercise

The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory

Whole-body cryotherapy: empirical evidence and theoretical perspectives

Chris M Bleakley,1 Fran&ccedil;ois Bieuzen,2 Gareth W Davison,1 Joseph T Costello3 1Sport and Exercise Science Research Institute, Faculty of Life and Health Sciences, University of Ulster, Newtownabbey, Northern Ireland; 2Research Department, Laboratory of Sport, Expertise and Performance, French National Institute of Sport (INSEP), Paris, France; 3School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia Abstract: Whole-body cryotherapy (WBC) involves short exposures to air temperatures below &ndash;100&deg;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. Keywords: whole-body cryotherapy, cooling, recovery, muscle damage, spor

Short term eVects of various water immersions on recovery from exhaustive intermittent exercise

In order to investigate the effectiveness of diVerent techniques of water immersion recovery on maximal strength, power and the post-exercise inflammatory response in elite athletes, 41 highly trained (Football, Rugby, Volleyball) male subjects (age = 21.5 ± 4.6 years, mass = 73.1 ± 9.7 kg and height = 176.7 ± 9.7 cm) performed 20 min of exhaustive, intermittent exercise followed by a 15 min recovery intervention. The recovery intervention consisted of diVerent water immersion techniques, including: Temperate water immersion (36°C; TWI), cold water immersion (10°C; CWI), contrast water temperature (10-42°C; CWT) and a passive recovery (PAS). Performances during a maximal 30-s rowing test (P30 s), a maximal vertical countermovement jump (CMJ) and a maximal isometric voluntary contraction (MVC) of the knee extensor muscles were measured at rest (Pre-exercise), immediately after the exercise (Post-exercise), 1 h after (Post 1 h) and 24 h later (Post 24 h). Leukocyte proWle and venous blood markers of muscle damage (creatine kinase (CK) and lactate dehydrogenase (LDH)) were also measured Preexercise, Post 1 h and Post 24 h. A signiWcant time eVect was observed to indicate a reduction in performance (Pre-exercise vs. Post-exercise) following the exercise bout in all conditions (P < 0.05). Indeed, at 1 h post exercise, a signiWcant improvement in MVC and P30 s was respectively observed in the CWI and CWT groups compared to pre-exercise. Further, for the CWI group, this result was associated with a comparative blunting of the rise in total number of leucocytes at 1 h post and of plasma concentration of CK at 24 h post. The results indicate that the practice of cold water immersion and contrast water therapy are more eVective immersion modalities to promote a faster acute recovery of maximal anaerobic performances (MVC and 30" all-out respectively) after an intermittent exhaustive exercise. These results may be explained by the suppression of plasma concentrations of markers of inXammation and damage, suggesting reduced passive leakage from disrupted skeletal muscle, which may result in the increase in force production during ensuing bouts of exercise. © Springer-Verlag 2010

Postexercise cooling interventions and the effects on exercise-induced heat stress in a temperate environment

The aim of this study was to examine the effects of cool water immersion (20 °C; CWI) while wearing a cooling jacket (Cryovest;V) and a passive control (PAS) as recovery methods on physiological and thermoregulatory responses between 2 exercise bouts in temperate conditions. Nine well-trained male cyclists performed 2 successive bouts of 45 min of endurance cycling exercise in a temperate environment (20 °C) separated by 25 min of the respective recovery interventions. Capillary blood samples were obtained to measure lactate (La -), sodium (Na +), bicarbonate (HCO3 -) concentrations and pH, whilst body mass loss (BML), core temperature (T core), skin temperature (T skin), heart rate (HR), oxygen uptake, and minute ventilation were measured before (Pre), immediately after the first exercise bout (Ex1), the recovery (R), and after the second exercise bout (Ex2). V and CWI both resulted in a reduction of T skin at R (-2.1 ± 0.01 °C and -11.6 ± 0.01 °C, respectively, p 0.05), V attenuated the rise in HR, minute ventilation, and oxygen uptake from Ex1 to Ex2, while T core and T skin were significantly lower following the second session (p < 0.05). Further, CWI was also beneficial in lowering T core, T skin, and BML, while a rise in Na + was observed following Ex2 (p < 0.05). Overall results indicate that cooling interventions (V and CWI) following exercise in a temperate environment provide a reduction in thermal strain during ensuing exercise bouts

Load in sport and risk of illness: ReFORM synthesis of the IOC Consensus Statement

editorial reviewe

La traduction et la synthèse des positions de consensus du CIO: la première mission de ReFORM pour une meilleure diffusion des connaissances vers la francophonie

editorial reviewe