运动员全身冷疗。
Whole-body cryotherapy in athletes.
机构信息
IRCCS Galeazzi, School of Medicine, University of Milan, Milan, Italy.
出版信息
Sports Med. 2010 Jun 1;40(6):509-17. doi: 10.2165/11531940-000000000-00000.
Cold therapy is commonly used as a procedure to relieve pain symptoms, particularly in inflammatory diseases, injuries and overuse symptoms. A peculiar form of cold therapy (or stimulation) was proposed 30 years ago for the treatment of rheumatic diseases. The therapy, called whole-body cryotherapy (WBC), consists of exposure to very cold air that is maintained at -110 degrees C to -140 degrees C in special temperature-controlled cryochambers, generally for 2 minutes. WBC is used to relieve pain and inflammatory symptoms caused by numerous disorders, particularly those associated with rheumatic conditions, and is recommended for the treatment of arthritis, fibromyalgia and ankylosing spondylitis. In sports medicine, WBC has gained wider acceptance as a method to improve recovery from muscle injury. Unfortunately, there are few papers concerning the application of the treatment on athletes. The study of possible enhancement of recovery from injuries and possible modification of physiological parameters, taking into consideration the limits imposed by antidoping rules, is crucial for athletes and sports physicians for judging the real benefits and/or limits of WBC. According to the available literature, WBC is not harmful or detrimental in healthy subjects. The treatment does not enhance bone marrow production and could reduce the sport-induced haemolysis. WBC induces oxidative stress, but at a low level. Repeated treatments are apparently not able to induce cumulative effects; on the contrary, adaptive changes on antioxidant status are elicited--the adaptation is evident where WBC precedes or accompanies intense training. WBC is not characterized by modifications of immunological markers and leukocytes, and it seems to not be harmful to the immunological system. The WBC effect is probably linked to the modifications of immunological molecules having paracrine effects, and not to systemic immunological functions. In fact, there is an increase in anti-inflammatory cytokine interleukin (IL)-10, and a decrease in proinflammatory cytokine IL-2 and chemokine IL-8. Moreover, the decrease in intercellular adhesion molecule-1 supported the anti-inflammatory response. Lysosomal membranes are stabilized by WBC, reducing potential negative effects on proteins of lysosomal enzymes. The cold stimulation shows positive effects on the muscular enzymes creatine kinase and lactate dehydrogenase, and it should be considered a procedure that facilitates athletes' recovery. Cardiac markers troponin I and high-sensitivity C-reactive protein, parameters linked to damage and necrosis of cardiac muscular tissue, but also to tissue repair, were unchanged, demonstrating that there was no damage, even minimal, in the heart during the treatment. N-Terminal pro B-type natriuretic peptide (NT-proBNP), a parameter linked to heart failure and ventricular power decrease, showed an increase, due to cold stress. However, the NT-proBNP concentrations observed after WBC were lower than those measured after a heavy training session, suggesting that the treatment limits the increase of the parameter that is typical of physical exercise. WBC did not stimulate the pituitary-adrenal cortex axis: the hormonal modifications are linked mainly to the body's adaptation to the stress, shown by an increase of noradrenaline (norepinephrine). We conclude that WBC is not harmful and does not induce general or specific negative effects in athletes. The treatment does not induce modifications of biochemical and haematological parameters, which could be suspected in athletes who may be cheating. The published data are generally not controversial, but further studies are necessary to confirm the present observations.
冷疗通常被用作缓解疼痛症状的一种方法,特别是在炎症性疾病、损伤和过度使用症状中。30 年前,人们提出了一种特殊形式的冷疗(或刺激)来治疗风湿性疾病。这种疗法称为全身冷冻疗法(WBC),包括暴露在极冷的空气中,这些空气在特殊的温度控制的冷冻室中保持在-110 度至-140 度之间,通常持续 2 分钟。WBC 用于缓解由多种疾病引起的疼痛和炎症症状,特别是与风湿状况相关的疾病,并且被推荐用于关节炎、纤维肌痛和强直性脊柱炎的治疗。在运动医学中,WBC 作为一种从肌肉损伤中恢复的方法得到了更广泛的接受。不幸的是,关于运动员应用该治疗的论文很少。考虑到反兴奋剂规则的限制,研究损伤恢复的可能增强和生理参数的可能改变对于运动员和运动医生来说至关重要,以便判断 WBC 的真正益处和/或限制。根据现有文献,WBC 在健康受试者中没有危害或不利影响。该治疗不会增强骨髓生成,并且可能会减少运动引起的溶血。WBC 会引起氧化应激,但程度较低。重复治疗显然不会引起累积效应;相反,会引起抗氧化状态的适应性变化——在 WBC 先于或伴随剧烈训练时,这种适应是明显的。WBC 不会引起免疫标记物和白细胞的改变,并且似乎对免疫系统没有危害。WBC 的作用可能与具有旁分泌作用的免疫分子的改变有关,而不是与全身免疫功能有关。事实上,抗炎细胞因子白细胞介素(IL)-10 增加,促炎细胞因子白细胞介素(IL)-2 和趋化因子白细胞介素(IL)-8 减少。此外,细胞间黏附分子-1 的减少支持抗炎反应。溶酶体膜通过 WBC 稳定,减少潜在的对溶酶体酶蛋白的负面影响。冷刺激对肌酸激酶和乳酸脱氢酶等肌肉酶有积极影响,应被视为促进运动员恢复的一种方法。心肌标志物肌钙蛋白 I 和高敏 C 反应蛋白与心肌组织损伤和坏死以及组织修复有关,但也与组织修复有关,这些标志物在治疗过程中没有变化,表明心脏没有受到损伤,即使是最小的损伤。N-末端脑利钠肽前体(NT-proBNP)是与心力衰竭和心室动力下降相关的参数,由于冷应激而增加。然而,WBC 后观察到的 NT-proBNP 浓度低于剧烈训练后测量的浓度,这表明该治疗限制了与运动典型的参数的增加。WBC 没有刺激垂体-肾上腺皮质轴:激素的改变主要与身体对压力的适应有关,表现为去甲肾上腺素(去甲肾上腺素)的增加。我们得出的结论是,WBC 对运动员没有危害,也不会引起一般或特定的负面影响。该治疗不会引起生化和血液学参数的改变,这些参数可能会在可能作弊的运动员中引起怀疑。已发表的数据通常没有争议,但需要进一步的研究来证实目前的观察结果。