Effect of cold water immersion on exercise induced-inflammation

Document Type: Original Article

Authors

Department of Exercise physiology, Marvdasht branch, Islamic Azad University, Marvdasht, Iran

Abstract

Introduction: Immersion in cold water has been used as a therapeutic treatment for restoring physical activity and mental health. The effect of this method on reduction of exercise induced-inflammation is not well known. The aim of this study was to investigate the effect of cold water immersion on CRP levels after an exhaustive aerobic training.
Material & Methods: 20 male table tennis athletes were participated in this study as the subjects. The subjects were divided into the passive recovery (n=10) or cold water immersion (n=10) groups. All the subjects were performed the Bruce test protocol as the exhaustive aerobic training. Blood CRP was measured at three times: before and immediately after the exhaustive aerobic training and after the recovery strategies.
Results: The results showed that the CRP levels increased immediately after the exhaustive aerobic training in the two groups (P<0.05). Blood CRP levels decreased after 15 min passive recovery and cold water immersion compare to after the exhaustive aerobic training (P<0.05). Bonferroni Post hoc test indicates that no significant differences were observed between two types of recovery.
Conclusions: The results suggested that no significant differences are exist between the passive recovery and cold water immersion on reduction of exercise-induce inflammation; thus these two strategies are well for CRP reduction after intensive exercise.

Keywords


Introduction

Unaccustomed and high-intensity exercise may result in significant damage to skeletal muscle and cause delayed onset muscle soreness and inflammation in both recreational and elite athletes (1). CRP is a commonly used marker of systemic inflammation (2) that has also been used to investigate the level of inflammation post-exercise (3,4). A large amount of therapeutic modalities are used after sports activities to improve skeletal muscle recovery, the most commonly used modalities are: active recovery (5,6), cold water (cryotherapy) (7), massage (8), contrast heat therapy (use of hot and cold water immersion) (9-11), hydrotherapy (12), stretching (13), and electric stimulation (14). However, the scientific evidence behind these modalities is limited.

Water immersion is the one of recovery strategies that gaining popularity among athletes. Immersion in hot and/or cold water has been used as a therapeutic treatment for restoring physical and mental health (15). After training or games some athletes may spend up to 20 minutes using water immersion to enhance recovery (16). In this method, the pressure of water on the body causes a redistribution of body fluid with increasing levels of immersion increasing the hydrostatic pressure on the body (17). Fluid shifts due to immersion appear to increase cardiac output and muscle blood flow, and reduce peripheral resistance increasing blood lactate recovery without a subject expending the energy required during active recovery (18).

Cold water immersion therapy is a modality that uses immersion of a body part in water with temperature below 15°C (19). Cold water immersion may have modulated inflammation and cellular stress after high-intensity and exhaustive exercise. There exists a long-standing belief that by reducing temperature and blood flow in skeletal muscle, cryotherapy such as icing or cold water immersion reduces the metabolic rate of and/or inflammation in tissues within and around the injured site in skeletal muscle (20). This supposedly protects neighboring cells against ischaemia after injury, which is thought to reduce the risk of secondary cell injury or death (21). Animal studies demonstrate the effectiveness of ice massage (22,23) or local infusion of cold saline (24,25) for reducing inflammation in muscle following injury. However, a little research have examined whether cold water immersion reduces inflammation after an exhaustive exercise. Leal Junior et al. (2011), for instance, reported that light emitting diode therapy has better potential than 5 min of cold water immersion for improving short-term post-exercise recovery. They found that creatine kinase (CK) activity and CRP level had no significant changes after the cold water immersion. We hypothesized that cold water immersion would more attenuate CRP level as the inflammatory marker after an exhaustive aerobic training compare to the passive recovery. Thus the purpose of present study was to examine the effect of cold water immersion on CRP levels after an exhaustive aerobic training.

 

Materials and methods

Subjects

20 male table tennis athletes, age (20.4 ± 3.4 year), height (174.4 ± 4.5 cm), weight (68.1 ± 9.0 kg) and BMI (22.3 ± 2.6 kg/m2) were participated in this study as the subjects. The subjects were given both verbal and written instructions outlining the experimental procedure, and written informed consent was obtained. The subjects were divided into the passive recovery (n=10) or cold water immersion (n=10) groups. Participants were all familiar with exhaustive exercise training. All participants enrolled in the Bruce test protocol; then each group started its own recovery for 15 minutes.

 

Intensive Exercise

The Bruce test protocol was used as the exhaustive exercise training. This test includes 7 phases. This test is done on the treadmill and started with low intensity; every 3 minutes. The speed and the gradient (slope) of the device increased up to the level in which the subject could not perform the test anymore and became totally exhausted.

 

Passive recovery

The subjects in the passive recovery group were performed nothing out of the ordinary after the intensive exercise for 15 min.

 

Cold Water Immersion

The most popular cold water immersion temperature was between 10°C and 15°C (26). But in this study we selected 12°C for cold water immersion recovery. The participants of cold water immersion were immersed in the water up to Manubrium Sterni for 15 min.

 

CRP measurement

The CRP level was measured for all subjects in 3 phases of before the test, immediately after the test and immediately after the recovery strategies. CRP levels were determined in duplicate via an enzyme-linked immunosorbent assay (ELISA) kits (Diagnostics Biochem Canada, Inc). The intra and inter-assay coefficients of variation for hs-CRP were <5.7% and a sensitivity of 10 ng/ml.

 

Statistical analysis

All experimental and calculated values are presented as a mean ± standard deviation. The repeated measures analysis of variance test is utilized to investigate the changes of variable means. The Bonferroni post hoc test is applied for the significant variation. The significance level was set at P

 

Results

The data on CRP concentration at baseline, after Bruce test and after 15 min recovery are presented in the figure 1. The results demonstrated that CRP level was increased significantly immediately after the Bruce test compared to the baseline and it was reduces significantly after the passive recovery (P<0.05). On the hand, as shown in the figure 1, CRP level was increased significantly immediately after the Bruce test compared to the baseline and it was reduces significantly after the 15 min cold water immersion (P<0.05).

No significant differences were observed between passive recovery and cold water immersion to reduce the CRP levels.

 

 

Fig 1. CRP level variations after passive recovery and cold water immersion

 

*Significant difference with baseline (P<0.05).

† Significant difference with after Bruce test (P<0.05).


 

Discussion

The effect of cold water immersion on CRP levels after an exhaustive aerobic training was examined in the present study. Exercise stimulated muscular inflammation and CRP level was increased after the exhaustive exercise training. Although CRP level was reduces significantly after passive recovery and cold water immersion, but contrary to our hypothesis, these responses did not differ substantially between cold water immersion and passive recovery. Previous studies indicated that regular application of cold water immersion attenuated long-term muscle adaptation compared with active recovery (27).

Animal studies have demonstrated that icing (28) or infusing cold saline (24,25) into injured muscle of rats reduces leucocyte rolling and adhesion, and neutrophil infiltration and activation. By contrast, another study found that cold water immersion did not reduce leucocyte counts in muscle of rats after exercise (29). Icing reduces and/or delays macrophage infiltration in rat muscle after muscle injury (22,23).

The effects of ice massage (30), cold water immersion (31,32), or exposure to −30°C air (33) on systemic inflammatory responses to intense eccentric exercise or resistance exercise are variable and are relatively minor. In line with our results, Minett et al. (2014) also reported that cold water immersion reduces inflammation markers after intermittent-sprint exercise in the heat (34). However, Peake et al. (2017) noted that cold water immersion is no more effective than active recovery for minimizing the inflammatory and stress responses in muscle after resistance exercise (20). This difference could be related to difference in the temperature of cold water, exercise protocol that performed for induced inflammation and inflammatory markers that measured in these studies.

The Primary concept behind the cold water immersion is in reducing the painful feeling that depends on delayed onset muscle soreness that occurs with damage of muscle fibers and causes to decrease of muscle pain and increases the speed of recovery time (35). This kind of recovery causes the contraction of blood vessels, depletion of waste product such as lactate acid  to the  tissues that are not involved in pain, reduces the metabolic activity and delaying of physiological processes, reduces the inflation and finally reduces the tissues' disability that these items are of benefits of cold water immersion. Cold water immersion may cause a reduction in pain through several possible mechanisms, namely the inhibition of nociceptors, reduction in metabolic enzyme activity, reduction in muscle spasms or an altered nerve conduction velocity (36,37). Moreover, Cold water immersion leads to the reduction of heart rate compare to the warm water immersion. Compared with the active recovery and passive recovery, cold-water immersion significantly lowered temperature after the recovery phase (38). Exposure to a cold-water immersion intervention can rapidly decrease muscle temperature and muscular force output (39). Water immersion methods cause's athletes to feel more relaxed and this issue can happen due to the floating force that is oppose of gravity and supports the part of body weight that is floating in water. This force causes lightness and weightlessness feeling. Also during water immersion neuromuscular responses reduce. As a result general comfort and a reduction in fatigue would be felt after exercise. Various methods of water immersion cause the complete comfort in muscles and a reduction in tension and anxiety (40).

 

Conclusion

According to results of this study, no significant differences are exist between the passive recovery and cold water immersion on reduction of exercise-induce inflammation; thus these two strategies are well for CRP reduction after intensive exercise. But according to the aforementioned benefits of cold water immersion specially the creating of mental vitality, it seems that this method could be a beneficial method for athletes as one of the suitable types of recovery; because methods of water immersion after activity due to natural muscles' massage, increasing of stretch and relaxation of body and mental, and reduction of neuromuscular fatigue is generally one of the best methods for professional athletes after exercises or competitions.

 

Acknowledgment

We would like to thank and acknowledge the all subjects whom cooperated in this investigation.

 

Conflict of interests: No conflict of interests amongst authors.

References

1. Pyne DB. Exercise-induced muscle damage and inflammation: a review. Aust J Sci Med Sport 1994; 26: 49-58.

2. Malm C, Sjodin TL, Sjoberg B, Lenkei R, Renstrom P, Lundberg IE, et al. Leukocytes, cytokines, growth factors and hormones in human skeletal muscle and blood after uphill or downhill running. J Physiol 2004; 556:983-1000.

3. Peake JM, Nosaka K, Muthalib M, Suzuki K. Systemic inflammatory responses to maximal versus submaximal lengthening contractions of the elbow flexors. Exerc Immunol Rev 2006; 12:72-85.

4. Milias GA, Nomikos T, Fragopoulou E, Athanasopoulos S, Antonopoulou S. Effects of eccentric exercise-induced muscle injury on blood levels of platelet activating factor (PAF) and other inflammatory markers. Eur J Appl Physiol 2005; 95:504-513.

5. Ahmaidi S, Granier P, Taoutaou Z, Mercier J, Dubouchaud H, Prefaut C. Effects of active recovery on plasma lactate and anaerobic power following repeated intensive exercise. Med Sci Sports Exerc 1996; 28: 450-456.

6. Baldari C, Videira M, Madeira F, Sergio J, Guidetti L. Lactate removal during active recovery related to the individual anaerobic and ventilatory thresholds in soccer players. Eur J Appl Physiol 2004; 93: 224-230.

7. Howatson G, Goodall S, Someren KA. The influence of cold water immersions on adaptation following a single bout of damaging exercise. Eur J Appl Physiol 2009; 105: 615-621.

8. Martin NA, Zoeller RF, Robertson RJ, Lephart SM. The comparative effects of sports massage, active recovery, and rest in promoting blood lactate clearance after supramaximal leg exercise. J Athl Train 1998; 33: 30-35.

9. Gill ND, Beaven CM, Cook C. Effectiveness of post-match recovery strategies in rugby players. Br J Sports Med 2006; 40: 260-263.

10. Coffey V, Leveritt M, Gill N. Effect of recovery modality on 4-hour repeated treadmill running performance and changes in physiological variables. J Sci Med Sport 2004; 7: 1-10.

11. Dowzer CN, Reilly T, Cable NT. Effects of deep and shallow water running on spinal shrinkage. Br J Sports Med 1998; 32: 44-48.

12. Mokayef M, Shahini P. Comparison of contrast water immersion, active recovery and passive recovery on blood lactate and CRP levels in table tennis players. J Physic Act Horm 2017; 1: 17-28.

13. Barnett A. Using recovery modalities between training sessions in elite athletes: does it help? Sports Med 2006; 36: 781-796.

14. Lattier G, Millet GY, Martin A, Martin V. Fatigue and recovery after high-intensity exercise. Part II: Recovery interventions. Int J Sports Med 2004; 25: 509-515.

15. Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S. Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 2005; 25: 220-224.

16. Cochrane DJ. Alternating hot and cold water immersion for athlete recovery: a review. Physic Therap Sport 2004; 5: 26-32.

17. Farhi LE, Linnarsson D. Cardiopulmonary readjustments during graded immersion in water at 35 degrees C. Respir Physiol 1977; 30: 35-50.

18. Nakamura K, Takahashi H, Shimai S, Tanaka M. Effects of immersion in tepid bath water on recovery from fatigue after submaximal exercise in man. Ergonomics 1996; 39: 257-266.

19. Leal Junior EC, de Godoi V, Mancalossi JL, Rossi RP, De Marchi T, Parente M, et al. Comparison between cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) in short-term skeletal muscle recovery after high-intensity exercise in athletes-preliminary results. Lasers Med Sci 2011; 26: 493-501.

20. Peake JM, Roberts LA, Figueiredo VC, Egner I, Krog S, Aas SN, et al. The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. J Physiol 2017; 595: 695-711.

21. Bleakley C, Glasgow P, Phillips N, Hanna L, Callaghan M, Davison G, et al. Management of acute soft tissue injury using protection rest ice compression and elevation: Recommendations from the Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSM). Association of chartered physiotherapists in sports and exercise medicine, Sheffield. 2010.

Available at: http://www. physiosinsport.org/media/wysiwyg/ACPSM_Physio_Price_A4.pdf.

22. Takagi R, Fujita N, Arakawa T, Kawada S, Ishii N, Miki A. Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. J Appl Physiol 2011; 110: 382-388.

23. Vieira Ramos G, Pinheiro C, Messa S, Delfino G, de Cassia Marqueti R, de Fatima Salvini T et al. Cryotherapy reduces inflammatory response without altering muscle regeneration process and extracellular matrix remodeling of rat muscle. Sci Rep 2016; 6: 18525.

24. Lee H, Natsui H, Akimoto T, Yanagi K, Oshshima N, Kono I. Effects of cryotherapy after contusion using real-time intravital microscopy. Med Sci Sports Exerc 2005; 37: 1093-1098.

25. Schaser KD, Disch AC, Stover JF, Lauffer A, Bail HJ, Mittlmeier T. Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. Am J Sports Med 2007; 35: 93-102.

26. Esfarjani F, Rezaee Z, Marandi SM. Which temperature during the water immersion recovery is the best after a sprint swimming. World Appl Scis J 2012; 16:1403-1408.

27. Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, et al. Post-exercise cold water immersion attenuates acute anabolic signaling and long-term adaptations in muscle to strength training. J Physiol 2015; 593: 4285-4301.

28. Puntel GO, Carvalho NR, Amaral GP, Lobato LD, Silveira SO, Daubermann MF, et al. Therapeutic cold: An effective kind to modulate the oxidative damage resulting of a skeletal muscle contusion. Free Radic Res 2011; 45: 125-138.

29. Camargo MZ, Siqueira CP, Preti MC, Nakamura FY, de Lima FM, Dias IF, et al. Effects of light emitting diode (LED) therapy and cold water immersion therapy on exercise-induced muscle damage in rats. Lasers Med Sci 2012; 27: 1051-1058.

30. Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, et al. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res 2013; 27: 1354-1361.

31. Roberts LA, Nosaka K, Coombes JS, Peake JM. Cold water immersion enhances recovery of submaximal muscle function after resistance exercise. Am J Physiol Regul Integr Comp Physiol 2014; 307: R998-R1008.

32. Gonzalez AM, Fragala MS, Jajtner AR, Townsend JR, Wells AJ, Beyer KS, et al. Effects of β-hydroxy-β-methylbutyrate free acid and cold water immersion on expression of CR3 and MIP-1β following resistance exercise. Am J Physiol Regul Integr Comp Physiol 2014; 306: R483-R489.

33. Guilhem G, Hug F, Couturier A, Regnault S, Bournat L, Filliard JR, et al. Effects of air‐pulsed cryotherapy on neuromuscular recovery subsequent to exercise‐induced muscle damage. Am J Sports Med 2013; 41: 1942-1951.

34. Minett GM, Duffield R, Billaut F, Cannon J, Portus MR, Marino FE. Cold-water immersion decreases cerebral oxygenation but improves recovery after intermittent-sprint exercise in the heat. Scand J Med Sci Sports 2014; 24: 656-666.

35. Airaksinen S, Jokilehto T, Råbergh CM, Nikinmaa M. Heat- and cold-inducible regulation of HSP70 expression in zebrafish ZF4 cells. Comp Biochem Physiol B Biochem Mol Biol 2003; 136: 275-282.

36. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 2007; 41: 365-369.

37. Crowe MJ, O'Connor D, Rudd D. Cold water recovery reduces anaerobic performance. Int J Sports Med 2007; 28: 994-998.

38. Bergh U, Ekblom B. Influence of muscle temperature on maximal muscle strength and power output in human skeletal muscles. Acta Physiol Scand 1979; 107: 33-37.

39. Wallman KE, Morton AR, Goodman C, Grove R, Guilfoyle AM. Randomized controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust 2004; 180: 444-448.

40. Wilcock IM, Cronin JB, Hing WA. Physiological response to water immersion. Sports Med 2006; 36: 747-765.