Cold Water Immersion Directly and Mediated by Alleviated Pain to Promote Quality of Life in Indonesian with Gout Arthritis: A Community-based Randomized Controlled Trial

Background: Gout arthritis is an autoinflammatory arthritis that generates chronic long-term pain. Pain impacts physical activities, joint mobility, stress, anxiety, depression, and quality of life. Cold-water immersion therapy reduces inflammation and pain associated with gout arthritis. However, cold-water immersion therapy has not been conducted among people worldwide with gout arthritis. Objective: To investigate the cold-water immersion intervention on pain, joint mobility, physical activity, stress, anxiety, depression, and quality of life among acute gout patients. Methods: A community-based randomized control trial design with two parallel-intervention groups: a cold-water immersion group (20–30°C 20 minutes/day for 4 weeks) and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were recruited using a multi-stage sampling method and were randomly assigned using block randomization. A generalized estimating equation model was used to analyze the results (coef. β) and produce 95% confidence intervals (CIs). A path analysis was used to analyze mediating effects. Results: Significant pain alleviation ( β = −2.06; −2.42), improved joint mobility ( β = 1.20, 1.44), physical activity ( β = 2.05, .59), stress ( β = −1.25; −1.35), anxiety ( β = −.62; −1.37), and quality of life ( β = 5.34; 9.93) were detected after cold-water immersion at the second-week, and were maintained to the fourth-week time point, compared to pre-intervention and the control group. Depression ( β = −1.80) had decreased by the fourth week compared to the pre-test and control group. Cold-water immersion directly mediated alleviation of pain ( β = −.46, p ≤ .001) and to promote the quality of life ( β = .16, p = .01). Conclusions: Cold-water immersion decreased pain, stress, anxiety, and depression, and increased joint mobility, physical activity, and quality of life. It mediated alleviation of pain to increase the quality of life.

Proper Recognition and Management of Exertional Heat Stroke in a High School Cross Country Runner: A Validation Clinical Case Report

A 14-year-old female high school cross country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer (AT) assessed the patient, who presented with difficulty breathing then other signs of EHS (i.e. confusion, agitation). The patient was taken to the medical area, draped with a towel, and a rectal temperature (Tre) of 106.9°F(41.6°C) was obtained. The emergency action plan was activated and emergency medical services (EMS) were called. The patient was submerged in a cold-water immersion tub until EMS arrived (~15 minutes; Tre = 100.1°F; cooling rate: 0.41°F·min−1[0.25°C·min−1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. The patient was not admitted and returned to running without sequelae. Following best practices, AT's in secondary schools can prevent death from EHS by properly recognizing EHS and providing rapid cooling before transport.

The Prevalence of Use of Various Post-Exercise Recovery Methods after Training among Elite Endurance Athletes

There is now compelling evidence of the effectiveness of a range of post-exercise recovery techniques, including extended nights of sleep, cold water immersion, massage, and compression garments. Currently, limited information is available on post-exercise recovery methods used by elite endurance athletes. Therefore, this study investigated the actual methods of recovery used in this group of athletes. Google Forms were used to collect information on the recovery methods used by elite endurance track and field athletes (n = 153, 61.4% men, 38.6% women; average age: 22.7 ± 4.6 years). The most used methods of recovery were sauna bathing (96.7%), massage (86.9%), daytime nap (81.0%), and long night sleep (at least 9h) (61.4%). Recovery methods with proven effectiveness such as cold water immersion and compression garments were rarely used (15.0% and 7.8%, respectively). Overall, recovery methods were used more often when the tiers of the track and field athletes were higher. Massage and sauna bathing were the most used methods of post-exercise recovery among Russian endurance track and field athletes. In most cases, they were used in conjunction with short daytime nap and long night sleep. Higher tier athletes were more likely to use sauna bathing, massage, long night sleep, and daytime nap but not cold water immersion and compression garments as recovery methods; however, all these methods except for cold water immersion were widely used among elite-tier athletes.

Cognitive performance in pain is predicted by effort, not goal desire

Background Pain’s disruptive effects on cognition are well documented. The seminal goal-pursuit account of pain suggests that cognitive disruption is less likely if participants are motivated to attended to a focal goal and not a pain goal. Objectives Existing theory is unclear about the conceptualisation and operationalisation of ‘focal goal’. This study aims to clarify how goals should be conceptualised and further seeks to test the theory of the goal-pursuit account. Methods In a pre-registered laboratory experiment, 56 participants completed an arithmetic task in high-reward/low-reward and pain/control conditions. Pain was induced via cold-water immersion. Results High levels of reported effort exertion predicted cognitive-task performance, whereas desire for rewards did not. Post-hoc analyses further suggest that additional effort in the pain condition compensated for pain’s disruptive effects, but when this extra effort was not exerted, performance deficits were observed in pain, compared to control, conditions. Conclusion Results suggest that ‘motivation’, or commitment to a focal goal, is best understood as effort exertion and not as a positive desire to achieve a goal. These results solidify existing theory and aid researchers in operationalising these constructs.

Effects of Cool-Down Exercise and Cold-Water Immersion Ther-apy on Basic Fitness and Sport-Specific Skills among Korean College Soccer Players

Background: We aimed to examine the effects of cool-down exercise and cold-water immersion therapy on agility, speed, power, balance, and sport-specific skill performance in college soccer players, and to provide baseline data for the development of effective recovery programs. Methods: In August 2020, 21 male college soccer players in Seoul, Korea, were randomly divided into the following groups: control group (CG, n=7), cool-down exercise group (CDG, n=7), and cool-down exercise plus cold-water immersion group (CDCWG, n=7). Agility, speed, power, balance, and sport-specific skill performance were assessed before and after the intervention. Results: No significant differences in Southeast Missouri (SEMO) Agility Test, 20-m sprint test, vertical jump test, or Y-balance test (right) were observed among the groups; however, there was a significant effect of time (P<0.05) and a significant time × group interaction (P<0.05). Significant effects of time (P<0.001), group (P=0.043), and a time × group interaction (P=0.009) were observed in the Y-balance test (left). There were no between-group differences in the 22-m dribble test, shooting test (left), or shooting test (right); however, there were significant effects of time (P<0.05) and significant time × group interactions (P<0.05). No significant effects of group or time × group interactions were observed for the kicking test (left or right); however, there were significant effects of time (P<0.001). Conclusion: Addition of cold-water immersion therapy to a recovery program including cool-down exercise can promote recovery of basic and sport-specific abilities among college soccer players.

Influencia del masaje ZNAR y la inmersión en agua fría en el proceso inflamatorio, Creatin Kinasa y percepción al dolor muscular en jugadores de voleibol (Influence of ZNAR massage and cold water immersion on the inflammatory process, Creatine Kinase and

Las estrategias que aminoren el dolor, la inflamación y el daño muscular provocados por la actividad física de alta intensidad en atletas son de interés en la recuperación deportiva, por lo que el objetivo del estudio fue conocer el efecto del masaje ZNAR y la inmersión en agua fría a 10° sobre el proceso inflamatorio a través de la interleucina 6 (IL-6), interleucina 10 (IL-10), el factor de necrosis tumoral Alpha (TNF-α), el daño muscular mediante la Creatin Kinasa (CK) y la percepción al dolor muscular a través de la escala visual análoga de dolor (EVA) en jugadores de voleibol. Participaron 19 atletas divididos en un grupo control y un grupo experimental, sometidos a dos protocolos de recuperación (masaje ZNAR e inmersión en agua fría) posterior a un test de inducción a la fatiga. Se cuantifico la IL-6, IL-10, TNF, CK y EVA. Los resultados mostraron cambios significativos (p < .05) en las tomas de recuperación en el comportamiento del proceso inflamatorio, la CK y la percepción al dolor muscular con ambos métodos de recuperación. Conclusión, el Masaje ZNAR favorece a la recuperación de la IL-6 y la IL-10 además de la disminución de la CK y la percepción al dolor muscular. Abstract: The strategies that reduce pain, inflammation and muscle damage caused by high intensity activity in athletes are of interest in sports recovery, the objective of the study was to know the effect of ZNAR massage and cold water immersion at 10 ° on the inflammatory process through interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor Alpha (TNF-α), muscle damage through Creatine Kinase (CK) and the perception of muscle pain through the visual analoge scale (VAS) in volleyball players. 19 athletes were divided into a control group and an experimental group, submitted to two recovery protocols (ZNAR massage and cold water immersion) after a fatigue induction test. IL-6, IL-10, TNF, CK and EVA were quantified. The results showed significant changes (p < .05) in the recovery shots in the behavior of the inflammatory process, the CK and the perception of muscle pain with both recovery methods. Conclusion, the ZNAR Massage favors the recovery of IL-6 and IL-10 in addition to the decrease in CK and the perception of muscle pain

Athlete, coach and practitioner knowledge and perceptions of post-exercise cold-water immersion for recovery: a qualitative and quantitative exploration

This survey sought to establish current use, knowledge and perceptions of cold-water immersion (CWI) when used for recovery. 111 athletes, coaches and support practitioners completed the anonymous online survey, answering questions about their current CWI protocols, perceptions of benefits associated with CWI and knowledge of controlling mechanisms. Respondents were largely involved in elite sport at international, national and club level, with many having used CWI previously (86%) and finding its use beneficial for recovery (78%). Protocols differed, with the duration of immersion one aspect that failed to align with recommendations in the scientific literature. Whilst many respondents were aware of benefits associated with CWI, there remains some confusion. There also seems to be a gap in mechanistic knowledge, where respondents are aware of benefits associated with CWI, but failed to identify the underlying mechanisms. This identifies the need for an improved method of knowledge transfer between scientific and applied practice communities. Moreover, data herein emphasises the important role of the ‘support practitioner’ as respondents in this role tended to favour CWI protocols more aligned to recommendations within the literature. With a significant number of respondents claiming they were made aware of CWI for recovery through a colleague (43%), the importance of knowledge transfer and context being appropriately applied to data is as important as ever. With the firm belief that CWI is useful for recovery in sport, the focus should now be on investigating the psychophysiological interaction and correct use of this methodology.