IIR working group releases position paper on contraindications to Whole-Body Cryostimulation (WBC)

Whole-Body Cryostimulation (WBC) is a treatment that involves short exposures of the entire body (including the head) to very cold and dry air in specially adapted cryochambers. It was originally developed for treating symptoms in patients with rheumatic conditions and it has been widely used mostly in sports medicine for muscle injury and recovery after physical exercise and training.

 

Given the expanding medical applications of whole-body cryostimulation (WBC), the IIR Working Group on Whole-Body Cryostimulation deemed it necessary to revise the existing contraindications. This update was based on a systematic review of the latest scientific evidence and a Delphi¹ consensus procedure involving recognised experts in the field.

 

Members of the IIR working group (P. Capodaglio, B. Dugue, R. Bouzigon, G. Lombardi, E. Miller and E. Ziemann) selected an international multidisciplinary panel of experts, which included recognised experts in WBC, distinguished European Rehabilitation specialists, prominent specialists in cardiology, neurology, endocrinology, oncology and clinical nutrition.

 

Accurate medical assessment, critical appraisal and screening remain mandatory before WBC prescription. In prescribing WBC, appropriate exposure parameters, in terms of session length or chamber temperature, should be observed to avoid risks.

 

The contraindications hereby proposed are meant to guide the initial medical screening (see table). However, the decision to include a patient in WBC treatment should be based on a careful and comprehensive medical assessment of the presence of combined subclinical risk factors. Therefore, medical warnings about possible combined risk factors should be present and WBC prescription should be guided by precautionary criteria about possible association of risk factors not necessarily included in the list of contraindications.

 

Temporary contraindications, such as general malaise, can be postponed until the patient has recovered. For subjective contraindications such as claustrophobia and sensitivity to cold, the clinician should use clinical judgement to assess whether the WBC session can be performed after medical suasion and under supervision.

 

¹ The Delphi method consists of the search for a common consensus among a group of experts on a specific topic. It is a well-known method for determining a consensus opinion among subject matter experts to respond to a research question.

 

A comprehensive review of contraindications to WBC

 

Table. A comprehensive review of contraindications to WBC reported in the literature reviewed (up to 28 February 2023)

Absolute contraindications due to transitory conditions
Current infections	Anaemia (severe)	Abrasion Injuries
Blood pressure	Dehydration	Open wounds
Fever	Pregnancy	Emaciation/cachexia
Drug abuse	Addictions	Unable to maintain standing position
Hypothermia	Alcohol abuse
Subjective absolute contraindications
Cold intolerance	Cold sensitivity	Claustrophobia
Cardiological diseases
(Unstable) coronary artery disease	Hypertension (uncontrolled/unstable/untreated)	Myocardial infarction (acute or recent)
(Unstable) Angina pectoris	(History of) Arrhythmias (acute or severe)	Acute cardiovascular diseases
Valvopathies (stenosis, insufficiency)	Pacemaker
Vascular conditions
(Recent history or acute) venous thromboembolic events	Peripheral arterial disease (stage 3–4)	Local blood flow disorders (ischemia, stasis thrombosis, embolism)
Metabolic/endocrine disorders
Hypothyroidism	Uncontrolled diabetes
Rheumatological/Immunological diseases
Any form of active vasculitis	Raynaud’s syndrome	Clotting diseases
Cryoglobulinemia
Respiratory conditions
(Acute) respiratory infection/disease	Bronchospasm (cold induced)	Chronic respiratory insufficiency
Asthma (cold induced)	(Symptomatic) lung disease	Chronic obstructive pulmonary disease
Neurological diseases
Disorder of autonomic/sympathetic nervous system	(Acute or recent) Stroke	Epilepsy
Polyneuropathies	Cognitive disturbances
Psychiatric diseases
Psychosis	Mental disorder	Anxiety
Renal/urinary diseases
Acute and chronic renal diseases	Urinary infections
Neoplastic diseases
Active cancer
Dermatological diseases
Ulcers	Purulent/gangrenous skin changes	Hyperhidrosis

 

For more information, the complete study is available in open access on FRIDOC and in Frontiers in Rehabilitation Sciences.

 

 

 

 

Source

Capodaglio P., Alito A., Dugue B.M., Bouzigon R., Lombardi G., Miller E.D., Verme F., Modaffari G., Piterà P., Ziemann E. and Fontana J.M. (2025). Contraindications to Whole-Body Cryostimulation (WBC). A position paper from the WBC Working Group of the International Institute of Refrigeration and the multidisciplinary expert panel. Front. Rehabil. Sci. 6:1567402. doi: 10.3389/fresc.2025.1567402