# Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series
## 3 Case Series
### Case 7  
[PERSON], a 61-year-old woman, suffered a SARS-CoV-2 infection in March 2021, after which she was bedridden at home (from 23 March to 11 April) and not hospitalized. She was diagnosed with bilateral interstitial pneumonia secondary to the infection, which was treated for 16 days with deltacortene 150 g/day, amoxicillin 875 mg/twice daily, and paracetamol 500 mg/day. After the acute phase, she experienced chronic fatigue and cough, muscle pain, strong anxiety, reduced salivation, low exercise tolerance, and dyspnea at the slightest effort. The patient complained of significant hand pain due to rheumatoid arthritis, and cervical spine and dorsal spine pain. She also reported shortness of breath and sleep apnea and, in parallel, reduced sleep and quality of life. These symptoms, which were not present before the COVID-19 infection, persisted until the date of admission to our RU (18 January 2022). Since no contraindications were present, we proposed treatment with WBC. The patient's medical history revealed severe obesity, OSAS, mixed dyslipidemia, serum-negative rheumatoid arthritis, non-autoimmune hypothyroidism for about 30 years, and hypertension under good pharmacological control. She also presented altered fasting blood glucose levels and impaired glucose tolerance, generalized anxiety disorder, and an eating disorder. Inflammation and liver dysfunction markers were in a normal range, whereas nutritional and metabolic parameters confirmed a picture of dyslipidemia and an unbalanced glycemic and insulinemic profile (Table 7). Pharmacological therapy was Eutirox 0.1 mg/day; Almarytm 100 mg/day; olmesartan 40 mg/day; Folin 5 mg/day; atorvastatin 10 mg/day; tocilizumab 162 mg/day; Reumaflex 12.5 mg/day. \begin{table}
\begin{tabular}{l l l l} \hline  & & **Admission** & **Discharge** \\ \hline \multirow{8}{*}{**Anthropometry and Body Composition**} & Weight (kg) & 140 & 134.8 \\  & Height (cm) & 189 & 189 \\  & BMI (kg/m\({}^{2}\)) & 39.19 & 37.74 \\  & Waist circumference & 129 & 126 \\  & FM (kg; \%) & 65.4; 47.3 & 60.7; 44.7 \\  & FFM (kg; \%) & 72.9; 52.7 & 75.1; 55.3 \\  & MM (kg; \%) & 50.4; 36.4 & 44.4; 75.1 \\  & ASMM (kg; \%) & 30.7 & 30.6 \\ \hline \multirow{8}{*}{**Hematological Biomarkers**} & ALT (U/L) & 51 & 70 \\  & AST (U/L) & 31 & 44 \\  & GGT (U/L) & 26 & 20 \\  & HBA1C (mmol/mL; \%) & 50; 6.7 & 44; 6.2 \\  & Glucose (mg/dL) & 151 & 117 \\  & Total cholesterol (mg/dL) & 192 & 182 \\  & HDL (mg/dL) & 48 & 39 \\  & LDL (mg/dL) & 122 & 122 \\  & Triglycerides (mg/dL) & 174 & 134 \\  & Ferritin (\(\mu\)g/L) & 639 & 531 \\  & CRP (mg/dL) & 1.1 & 0.1 \\  & ESR (mg/dL) & 20 & 13 \\  & LDH (U/L) & 216 & 193 \\  & D-dimer (\(\mu\)g/L) & 514 & 435 \\ \hline \multirow{8}{*}{**Physical Performance**} & 6 MWT (m) & 510 & 568 \\  & Handgrip strength (kg) & 49.8 & 49.3 \\ \cline{1-1}  & VAS function & 25/100 & 3/100 \\ \cline{1-1}  & EuroQol & 70/100 & 90/100 \\ \cline{1-1}  & MRC dyspnea & 1/5 & 0/5 \\ \hline \end{tabular}
\end{table} 
Table 6: Case 6 admission and discharge parameters. Individual Rehabilitation Program Timeline  
On 18 January 2022, she started physiotherapy and nutritional intervention. WBC started on 21 January 2022. The final evaluation of clinical parameters was 3 February 2022. _Nutritional intervention_: A hypocaloric diet of 1500 kcal/day was started in order to lose 5-10% of the initial weight and to improve the glyco-metabolic status. The diet composition was: 70 g/day of protein (18% of total kcal daily intake), 47.3 g/day of lipids (27%), and 207 g/day (55%) of carbohydrates. _Physiotherapy_: The goal was to obtain weight loss, optimization of ventilatory, improvement in quality of life, muscle function, and strength, and reduction in fatigue-related symptoms secondary to Long COVID. The patient underwent a physiotherapy program with specific techniques (SMARTERehab) [27] aimed at improving posture and motor control, intra-abdominal pressure, rib cage mobility, and correct muscle activation and coordination.