# Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series
## 3 Case Series
### Case 3
\begin{table}
\begin{tabular}{l l l l} \hline  & & **Admission** & **Discharge** \\ \hline \multirow{8}{*}{**Anthropometry and Body Composition**} & Weight (kg) & 136.4 & 130.8 \\  & Height (cm) & 182 & 182 \\  & BMI (kg/m\({}^{2}\)) & 41.18 & 39.49 \\  & Waist circumference & 138 & 127 \\  & FM (kg; \%) & 76.9; 56.4 & 74.4; 56.5 \\  & FFM (kg; \%) & 59.5; 43.6 & 57.2; 43.5 \\  & MM (kg; \%) & 33.1; 24.3 & 31.2; 23.7 \\  & ASMM (kg; \%) & 27.6 & 25 \\ \hline \multirow{8}{*}{**Hematological Biomarkers**} & ALT (U/L) & 16 & 16 \\  & GGT (U/L) & 12 & 11 \\  & HBA1C (mmol/mL; \%) & 37; 5.5 & 37; 5.5 \\ \cline{1-1}  & Glucose (mg/dL) & 95 & 98 \\ \cline{1-1}  & HDL (mg/dL) & 42 & 45 \\ \cline{1-1}  & LDL (mg/dL) & 114 & 112 \\ \cline{1-1}  & Triglycerides (mg/dL) & 220 & 179 \\ \hline \multirow{8}{*}{**Physical Performance**} & Handgrip strength (kg) & 15 & 15.6 \\ \cline{1-1}  & TUG (s) & 8 & 7 \\ \cline{1-1}  & FIM scale & 105/126 & 119/126 \\ \cline{1-1}  & VAS function & 50/100 & 18/100 \\ \cline{1-1}  & EuroQol & 50/100 & 75/100 \\ \cline{1-1}  & MRC dyspnea & 4/5 & 2/5 \\ \hline
**Pain** & VAS Pain & 100/100 & 57/100 \\ \hline \multirow{8}{*}{**Trunk Range of Motion**} & Extension \({}^{\circ}\) & 20 & 20 \\ \cline{1-1}  & Flexion \({}^{\circ}\) & 60 & 60 \\ \cline{1-1}  & Left lateral bending \({}^{\circ}\) & 30 & 25 \\ \cline{1-1}  & Right lateral bending \({}^{\circ}\) & 30 & 30 \\ \hline \end{tabular}
\end{table} 
Table 3: Case 3 admission and discharge parameters. _Nutritional intervention_: A hypocaloric diet of 1650 kcal/day was started to lose 5-10% of the initial weight. The diet composition was: 75 g/day of protein (18% of total kcal daily intake), 45 g/day of lipids (24%), and 240 g/day (58%) of carbohydrates. _Physiotherapy_: The goal was to obtain an improvement in respiratory capacity, tolerance to effort, and independence, and a reduction in general pain. In the first week of physiotherapy, initial physical activity therapy consisted of decompression techniques while lying down, and progressive proprioceptive exercises while seated were introduced later. After 2 weeks, we implemented progressive body weight exercises using barbells and exercise balls to train the major muscle groups of the lower and upper limbs and core. The rehabilitation program also included respiratory physiotherapy, consisting of several motor control exercises performed while lying, sitting, and standing, with the aim of increasing thoracic mobility, improving posture, improving lumbar-pelvic muscles' coordination, improving diaphragmatic action, and reducing the respiratory accessory muscles co-contraction [27]. _WBC_: The patient underwent a total of 12 WBC sessions over 3 weeks. The average reduction in skin temperature recorded was 13.09 \(\pm\) 4.26 \({}^{\circ}\)C degrees, with a maximum delta value of 21.5 \({}^{\circ}\)C between pre-and post-session temperature, at the level of the popliteal fossa after the 9 th treatment (the lowest temperature registered was 12.2 \({}^{\circ}\)C). No adverse events occurred. _Final assessment_: Despite her weight loss, the patient's metabolic parameters did not vary considerably. On the other hand, she reported noticeable improvements in physical performance and respiratory capacity (Table 3). In fact, dyspnea was absent in all basic activities of daily living, and she was able to walk 20 min without reporting shortness of breath. A moderate perception of fatigue was still present only while walking uphill or climbing stairs. She was very enthusiastic about the WBC protocol, reporting improved quality of sleep and quality of life, and a reduction in functional and general pain and muscle fatigue.