# Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series
## 3 Case Series
### Case 5  
[PERSON], a 62-year-old woman, was hospitalized in November 2020 with respiratory failure and bilateral interstitial pneumonia due to SARS-CoV-2 infection. During her acute hospitalization, she underwent 6-h C-PAP ventilation cycles, day and night, for 2 weeks and was discharged after 15 days, with indication to continue C-PAP treatment at home only during night hours. She was admitted to our RU on 13 December 2021. At admission, she was reporting PCC, consisting of daytime sleepiness and asthenia, chronic fatigue and dyspnea at minimal effort, deterioration in sleep quality, and depression. The patient's body weight and height were 88.5 kg and 150 cm, respectively, with a BMI of 39.33 kg/m\({}^{2}\) and a waist circumference of 110 cm. The patient's body composition, assessed with a BIA, was: FM = 45.6 kg; (51.5 %); FFM = 42.9 kg; (48.5%); and MM = 20.9 kg (23.6%). The patient's medical history revealed that she had type 2 diabetes mellitus, severe obesity, hypertension under pharmacological control, an eating disorder, depression treated with fluoxetine, sequelae of L5-S1 stabilization surgery, and obstructive sleep apnea syndrome treated with BiPAP therapy. Given the absence of contraindications, we proposed the patient complete a cycle of WBC. Hematological biomarkers showed elevated values of the main inflammation markers on admission; liver dysfunction markers and nutritional and metabolic parameters were indeed in a suboptimal range (Table 5). Pharmacological therapy was: telmisartan 40 mg/day; tapentadol 25 mg/day; pantoprazole 40 mg/day; nebivolol 5 mg/day; furosemide 25 mg/day; metformin 500 mg/day; fluoxetine 20 mg/day; atorvastatin 10 mg/day; promipexole 0.18 mg/day; and dualglutude 1.5 mg/day. \begin{table}
\begin{tabular}{l l l l} \hline  & & **Admission** & **Discharge** \\ \hline \multirow{8}{*}{**Anthropometry and Body Composition**} & Weight (kg) & 88.5 & 85.4 \\  & Height (cm) & 150 & 150 \\  & BMI (kg/m\({}^{2}\)) & 39.33 & 37.96 \\  & Waist circumference & 110 & 110 \\  & FM (kg: \%) & 45.6; 51.5 & 39.7; 46.2 \\  & FFM (kg: \%) & 42.9; 48.5 & 46.3; 53.8 \\  & MM (kg: \%) & 20.9; 23.6 & 28.5; 33.1 \\  & ASMM (kg: \%) & 22.3 & 17.6 \\ \hline \multirow{8}{*}{** Hematological Biomarkers**} & ALT (U/L) & 14 & 8 \\  & AST (U/L) & 13 & 11 \\  & GGT (U/L) & 16 & 13 \\  & HBA1C (mmol/mL; \%) & 39; 5.7 & 35; 5.4 \\  & Glucose (mg/dL) & 80 & 82 \\  & Insulin (mU/L) & 13 & 18.9 \\  & Total cholesterol (mg/dL) & 170 & 131 \\  & HDL (mg/dL) & 49 & 42 \\  & LDL (mg/dL) & 103 & 76 \\  & Triglycerides (mg/dL) & 141 & 94 \\  & Ferritin (ug/L) & 35 & 41 \\  & CRP (mg/dL) & 0.9 & 0.7 \\ \hline \end{tabular}
\end{table} 
Table 5: Case 5 Admission and discharge parameters. Individual Rehabilitation Program Timeline  
On 14 December 2021, she started physiotherapy and nutritional intervention. WBC started on 16 December 2021. The final evaluation of clinical parameters was on 10 January 2022. _Nutritional intervention_: A hypocaloric diet of 1350 kcal/day was started in order to lose 5-10% of the initial weight and to improve glyco-metabolic compensation. The diet composition was: 66 g/day of protein (19% of total kcal daily intake), 43 g/day of lipids (29%), and 176 g/day (52%) of carbohydrates, and, after discharge from the hospital, the patient was advised to continue with the same diet also at home. _Physiotherapy_: The physiotherapist reported several physical therapy sessions were missed because the patient was reporting excessive fatigue and sleepiness during the day. The physical exercise program was therefore inconsistent. Progressive body weight exercises were carried out to strengthen the lower limbs and the spinal muscles. We proposed WBC as an alternative treatment to exercise since this treatment requires less drive, motivation, and active involvement in physical effort. _WBC_: The patient underwent a total of 10 WBC sessions over two weeks.