# Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series
## 3 Case Series
### Case 6  
[PERSON], a 48-year-old man, suffered from a SARS-CoV-2 infection in March 2020. Due to the worsening of clinical conditions and respiratory capacity, he was admitted to the ICU where he was intubated and mechanically ventilated. He was hospitalized there for 15 days and discharged after a negative swab. He was then bedridden for about 2 months. During the SARS-CoV-2 infection he also developed type 2 diabetes mellitus. He was admitted \begin{table}
\begin{tabular}{l l l l} \hline \hline  & & **Admission** & **Discharge** \\ \hline \multirow{8}{*}{**Physical Performance**} & ESR (mg/dL) & 56 & 35 \\  & LDH (U/L) & 178 & 159 \\  & D-dimer (ug/L) & 798 & 478 \\  & Fibrinogen (mg/dL) & 453 & 340 \\ \hline \multirow{8}{*}{**Physical Performance**} & Handgrip strength (kg) & 16.6 & 16.2 \\  & TUG (s) & 10.5 & 8.7 \\  & FIM scale & 124/126 & 124/126 \\  & VAS function & 49/100 & 29/100 \\  & EuroQol & 60/100 & 80/100 \\  & MRC dyspnea & 3/5 & 2/5 \\ \hline
**Pain** & Vas pain & 50/100 & 28/100 \\ \hline \multirow{4}{*}{**Trunk Range of Motion**} & Extension \({}^{\circ}\) & 10 & 15 \\  & Flexion \({}^{\circ}\) & 50 & 80 \\ \cline{1-1}  & Left lateral bending \({}^{\circ}\) & 15 & 15 \\ \cline{1-1}  & Right lateral bending \({}^{\circ}\) & 15 & 15 \\ \hline \hline \end{tabular}
\end{table} 
Table 5: _Cont._to our RU on 7 January 2022. At admission, his body weight and height were 140 kg and 189 cm, respectively, with a BMI of 39.19 kg/m\({}^{2}\); thus, presenting a severe obesity condition. He also presented with chronic low back pain, medial knee pain, and OSAS, which was treated with C-PAP and oxygen therapy (2 L/min). He was experiencing dyspnea from the slightest effort, persistent asthenia, generalized fatigue, low tolerance to effort, poor quality of sleep, retrograde amnesia, and anemia. Polysomnography revealed 90 apneas per night. The patient was also reporting deterioration of mood and sleep, daytime sleepiness, and difficulty in performing basic daily activities, especially in the morning hours. The patient's body composition, assessed with a body impedance analysis (BIA), was: FM = 65.4 kg (47.3%); FFM = 72.9 kg; (52.7%); MM = 50.4 kg (36.4%); and ASMM 30.7 kg. The patient was admitted to undergo a metabolic, nutritional, motor, and respiratory rehabilitation program. Hematological biomarkers showed elevated values of the main inflammation markers. Liver dysfunction markers and the lipidic profile were in a normal range. The glucidic profile was compatible with the diagnosis of DMT2. Pharmacological therapy consisted of metformin 500 mg/day. Individual Rehabilitation Program Timeline  
On 10 January 2022, he started physiotherapy and nutritional intervention. WBC started on 13 January 2022. The final evaluation of clinical parameters was on 2 February 2022. _Nutritional intervention_: A hypocaloric diet of 1800 kcal/day was started in order to lose 5-10% of the initial weight and to improve glyco-metabolic compensation. The diet composition was: 94.3 g/day of protein (20% of total kcal daily intake), 50.7 g/day of lipids (25%), and 255 g/day (55%) of carbohydrates, and, after discharge from the hospital, the patient was advised to continue with the same diet also at home. _Physiotherapy_: The patient was reporting daily asthenia and dyspnea with minimal effort. Overall, the patient was showing the ability to cope with basic daily activities, but with pain in the lower back and in the lower limbs. During the first week, the physiotherapy sessions consisted of manual therapy and 20 min of body weight exercise with prolonged recovery times. In weeks two and three, he continued body weight muscle strengthening exercises, with the secondary aim of learning exercises to be performed independently at home after discharge. Initially, it was aimed at the correct execution of the movement, with recovery times dilated to avoid overexertion. In week three, recovery times shortened considerably.