# Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series
## 3 Case Series
### Case 2  
[PERSON], a 53-year-old woman, was admitted to our RU for PCC on 17 August 2021 after a SARS-CoV-2 infection on 20 November 2020, for which no hospitalization was needed. In the months following the infection, she experienced persistent generalized fatigue and widespread musculoskeletal pain, hindering her capacity to cope with the full range of activities of daily living. She was eventually referred by her family doctor for a rehabilitation program aimed at restoring her capacities. At admission, her body weight and height were 89.6 kg and 1.64 m, respectively, with a BMI of 33.31 kg/m\({}^{2}\) and a waist circumference of 111 cm. In the last 5 years, she suffered from type 2 diabetes mellitus, which was treated with metformin, and hypertension, which was under pharmacological control. Binge eating and bipolar disorders were also present. At admission, the patient was complaining of low back pain radiating to the left foot, and a reduction in global functioning and independence in daily living activities. She was able to stand and walk independently for short/medium distances, but with the onset of pain and early fatigue. Reduced flexibility limited her ability to kneel, bend forward, and pick up objects from the floor. Body composition as assessed by a body impedance analysis (BIA) was: FM = 44 kg (49.1%); FFM = 45.6 kg (50.9%); and MM = 26.4 kg (29.5%). Hematological biomarkers showed unbalanced lipidic and glucidic profiles (Table 2). Pharmacological therapy consisted of: cholecalciferol 25,000 IU/week, omeprozole 400 mg/day, metformin 1000 mg/day, Triatec 5 mg/day, Empagliflozin 250 mg/day, Resilient 83 mg/day, Pregabalin 75 mg/day, and Felson 15 mg/day. \begin{table}
\begin{tabular}{l l l l}  & & **Admission** & **Discharge** \\ \hline \multirow{8}{*}{**Anthropometry and Body Composition**} & Weight (kg) & 89.6 & 85 \\  & Height (cm) & 164 & 164 \\  & BMI (kg/m\({}^{2}\)) & 33.31 & 31.6 \\  & Waist circumference & 111 & 105 \\  & FM (kg; \%) & 44; 49.1 & 39.9; 46.3 \\  & FFM (kg; \%) & 45.6; 50.9 & 46.3; 53.7 \\  & MM (kg; \%) & 26.4; 29.5 & 28; 32.5 \\  & ASMM (kg; \%) & 17.7 & 18 \\ \end{tabular}
\end{table} 
Table 2: Case 2 admission and discharge parameters. Individual Rehabilitation Program Timeline  
On 26 August 2021, she started physiotherapy and nutritional intervention. WBC started on 9 September. The final evaluation of clinical parameters was on 22 September 2021. _Nutritional intervention_: The patient was put on a hypocaloric diet of 1450 kcal/day to lose 5-10% of the initial weight. The diet composition was: 75 g/day of protein (21% of total kcal daily intake), 44 g/day of lipids (27%), and 188 g/day (52%) of carbohydrates. _Physiotherapy_: Physiotherapy included postural physiotherapy, consisting of several motor control exercises performed while lying, sitting, and standing. The purpose for the patient was to increase thoracic mobility, improve posture, improve lumbar-pelvic muscles' coordination, improve diaphragmatic action, and reduce the respiratory accessory muscles co-contraction. In the first week of physiotherapy, physical activity consisted of decompression techniques while lying down, and progressive proprioceptive exercises while seated were introduced later. After 2 weeks, the program was implemented with progressive body weight exercises using barbells and exercise balls to train the major muscle groups of the lower and upper limbs and core. _WBC_: The patient underwent a total of 10 WBC sessions over two weeks. The average reduction in skin temperature recorded was 10.3 \(\pm\) 5.7 \({}^{\circ}\)C degrees with a maximum delta value of 24.3 \({}^{\circ}\)C between pre-and post-session temperature. The lowest temperature recorded was 9.2 \({}^{\circ}\)C, after the 9 th cryostimulation session, at the level of the popliteal fossa. No adverse events were recorded. _Final assessment_: The patient showed markedly improved metabolic parameters, physical performance, and strength, and had reduced functional and general pain.