Whole-body cryotherapy (WBC), a form of cold therapy involving exposure to extremely cold, dry air, is gaining popularity as a potential therapy to reduce pain and inflammation in individuals with autoimmune diseases, as well as among competitive athletes, and for use in sports medicine.

Yet, despite its growing notoriety, WBC has yet to be approved by the FDA for medical use.

 

How does WBC work?

There are two common ways to administer WBC, according to an article published in Current Sports Medicine Report.

Patel K, Bakshi N, Freehill MT, et al.Whole-body cryotherapy in sports medicine. Curr Sports Med Rep. 2019;18(4):136–140.

 

In the first, the individual stands in a chamber that is open at the top. This results in the exposure of the torso and lower body to cold temperatures while the head remains at normal room temperature.

With the second type, an individual or a group sits in a chamber filled with cool air, exposing the entire body (along with the head) to cold temperatures.

WBC takes place in humidity and temperature-controlled cryo chambers that are maintained at -110°C to -140°C. Before entering a cryo chamber, individuals need to undergo 30 to 60 seconds of temperature adaptation at -60°C. They also need to wear minimal clothing to avoid injury from frostbite.

A WBC participant whose head is inside the chamber must wear a surgical mask to avoid humid air exhalation. Sweat removal is also required before entering the chamber to prevent skin burning and necrosis. It’s recommended that WBC recipients move their legs and fingers, and avoid holding their breath, while inside the chamber.

 

What does WBC do?

Although the exact mechanism is unknown, the Current Sports Medicine Report authors wrote that WBC could reduce inflammation, improve bone health, and reduce muscle pain and injury, as well as improve recovery following exercise.

The researchers found that WBC can reduce inflammation by increasing the levels of anti-inflammatory interleukins along with decreasing the secretion of proinflammatory signaling molecules.

According to the research, WBC works by reducing oxidative stress, a reaction that happens during muscle breakdown in exercise as well as during inflammatory processes. Strenuous exercise results in muscle breakdown which produces reactive oxygen species (oxidants) that are released into the intercellular space, further inducing muscle damage.

This most commonly presents as muscle soreness after exercise.

WBC is capable of reducing muscle injury and pain by decreasing catabolic muscle activity (muscle breakdown due to oxidative stress). It can also decrease serum creatine kinase levels that increase due to overtraining and excessive physical workload.

Studies have shown that WBC may have the potential to decrease bone resorption as well as increase bone mineral density, according to the Current Sports Medicine Report research. This can be important for individuals with bone density metabolism disorders such as osteoporosis.

As a result, WBC may have the potential to lead to performance and functional recovery following high-intensity exercises by improving muscle soreness, fatigue, and strength.

 

Potential mental health benefits

 

Another potential therapeutic advantage of WBC is helping to improve symptoms associated with mental health disorders such as depression and anxiety; however, this has not been fully proven.

But research published in Complementary Therapies in Medicine found that WBC can improve mood enhancement by having an impact on circadian rhythms by inducing the quality and duration of sleep.

Doets JJR, Topper M, Nugterb AM. A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems. Complementary Therapies in Medicine. 2021;63:102783.

 

In addition, WBC can potentially have an improvement on exercise, which is shown to have a positive enhancement on sleep cycles, an important aspect of mental health.

 

Side effects of WBC

The use of WBC can lead to some serious side effects when proper precautions are not taken. According to the Current Sports Medicine Report article, these could include:

• Skin problems such as burns and frostbites

• Eye injury

• Asphyxiation and loss of consciousness

• Cardiovascular diseases

• Hypertension

• Respiratory and blood flow disorders

• Claustrophobia

 

WBC prevalence, FDA status

Although not an FDA-approved treatment, WBC is becoming increasingly popular among athletes who undergo extreme exercise and training, according to an article published in Open Access Journal of Sports Medicine.

Bleakley CM, Bieuzen F, Davison GW, et al. Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access J Sports Med. 2014;5:25–36.

However, the specific number of people using it for these purposes is still unknown.

 

WBC can be initiated within 0 to 24 hours following exercise, the authors wrote. It can either be repeated multiple times within the same day or several times over many weeks.

The FDA has not approved WBC to treat medical conditions, including exercise-induced stress, since very little evidence is available concerning its effectiveness and safety, as detailed in an FDA article.

Whole body cryotherapy (WBC): A "cool" trend that lacks evidence, poses risks. US Food & Drug Administration. Updated July 5, 2016.

 

The authors added that it’s not known what physiological changes happen to the body when individuals stay inside the chamber for 2 to 4 minutes. The FDA was also concerned about the worsening of medical conditions for certain people.

In the FDA article, Aron Yustein, MD, a medical officer in the FDA’s Center for Devices and Radiological Health, recommended that individuals should first discuss WBC with their doctors if they’re using it or considering doing so.

 

Similar treatments

There are options for individuals seeking cold therapies besides WBC. An article published by the European Journal of Applied Physiology listed additional such therapies that can be used to improve post-exercise recovery and for health purposes:

Allan R, Malone J, Alexander J, et al.Cold for centuries: a brief history of cryotherapies to improve health, injury and post-exercise recovery. Eur J Appl Physiol. 2022;122(5):1153–1162.

 

• Cold water immersion—taking a dip in very cold water (10°C to 15°C) for 10 to 15 minutes. Immediate immersion of the entire body is preferable to delayed immersion. The depth of water, however, does not play any significant role.

• Ice application—a traditional form of cryotherapy using crushed ice, ice packs, and ice massages to help reduce pain and inflammation in an injured area.

However, patients may prefer the extreme nature of WBC over such treatments since it’s believed that its low temperatures shorten recovery times, the European Journal of Applied Physiology research found.