#132 - AMA #16: Exploring hot and cold therapy
In this AMA, Peter Attia and Bob Kaplan, his head of research, conduct a deep dive into the evidence behind hot and cold therapies. They evaluate the safety, efficacy, and opportunity costs of various protocols, with Peter ultimately considering dry sauna for longevity.
Deep Dive Analysis
7 Topic Outline
Introduction to AMA 16: Hot and Cold Therapy Deep Dive
Peter's Personal Experience with Stress and Physical Pain
Strategies for Adjusting to Time Zone Changes and Jet Lag
Overview of Hot and Cold Therapy Literature and Evidence Quality
Examining Cold Therapy for Delayed Onset Muscle Soreness (DOMS)
Challenges in Studying Cold Therapy and the Placebo Effect
Balancing Cold Therapy Benefits with Muscle Adaptation Concerns
2 Key Concepts
Delayed Onset Muscle Soreness (DOMS)
DOMS is the pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise. Cold therapy, such as ice baths, has shown evidence in reducing DOMS, particularly when applied 24 to 72 hours post-exercise.
Inflammatory Response to Exercise
Exercise creates micro-injuries to muscle tissue, which triggers an inflammatory response. This inflammation is not always negative; it's part of a healing and adaptation process that can lead to muscle hypertrophy and improved performance. Blunting this response too much, for example with immediate cold therapy, might be detrimental to strength and adaptation.
5 Questions Answered
Stress can manifest as physical pain, such as Peter's experience with his QLs (quadratus lumborum muscles) firing up, which resolved almost overnight once the stressful event (moving) was over. This suggests a direct link between psychological stress and physical discomfort, though the mechanistic explanation is not fully understood.
To adjust to a new time zone, proactively shift your sleep schedule by about 15 minutes a day in the direction of the new time zone for a couple of weeks before travel. On the day of travel, force yourself to wake up extremely early local time to align with the destination's morning, making it easier to go to bed at the appropriate time there and avoid a vicious cycle of poor sleep.
The evidence for cold therapy benefits, such as improving mental health or immune enhancement, is very weak. For example, a claim about mental health benefits was supported by only one case report of a single individual who engaged in open water swimming, making it difficult to discern if the benefit was from cold or exercise.
Yes, there is evidence that cold therapy, such as ice baths, can reduce delayed onset muscle soreness (DOMS). This benefit was identified early in the research on cold therapy and is considered one of its more reliable applications.
The greatest benefits of cold therapy for muscle soreness seem to occur when treated 24 to 72 hours post-exercise. Conversely, it's generally recommended that cold treatment should not be administered in the first hour post-exercise, especially if the goal is performance and recovery, as it might be detrimental to strength and adaptation.
6 Actionable Insights
1. Exercise for Mental Health
Engage in significant daily exercise, such as two hours a day, as the endorphin high from substantial physical activity can potentially overcome or significantly alleviate symptoms of dysthymia and general feelings of malaise.
2. Proactive Eastward Jet Lag Adjustment
When traveling eastward, proactively adjust your sleep schedule by gradually ratcheting it back (e.g., 2.5 hours over two weeks). On the day of travel, wake up extremely early (e.g., 3 AM local time to match 8 AM destination time) and force yourself awake to make it easier to go to bed at a reasonable time in your destination.
3. Gradual Sleep Schedule Adjustment
When facing a significant time zone or schedule change, gradually adjust bedtime and wake-up time by about 15 minutes a day in the weeks leading up to the change. This proactive approach helps acclimate to the new schedule and makes the transition easier for individuals, especially children.
4. Optimal Cold Therapy Timing
If using cold therapy to reduce delayed onset muscle soreness (DOMS), apply it 24 to 72 hours post-exercise. Avoid administering cold therapy in the first hour post-exercise, as it might be detrimental to strength and interfere with the muscle adaptation process.
5. Cold Therapy for Muscle Soreness
Utilize cold therapy, such as ice baths, to reduce delayed onset muscle soreness (DOMS) after intense exercise. This can be a valuable tool for recovery, especially during periods of multiple hard training sessions.
6. Embrace the Placebo Effect
Be open to and accept the placebo effect if it genuinely helps you feel better or perform better. If a treatment or intervention provides a perceived benefit, even if partly due to placebo, it can still contribute positively to your well-being or performance.
3 Key Quotes
It's such a cliche to say we hold stress in our body, but we do. I can't actually mechanistically explain what it is about stress and why higher levels of cortisol or catecholamines or things like that would actually lead to physical pain in my body, but there's no question about it.
Peter Attia
Shut up legs. Just shut up legs. You're not allowed to be talking right now. It doesn't matter how much you're screaming. Just shut up.
Jens Voigt (quoted by Peter Attia)
If the placebo effect is going to make me feel like my legs are better, then so be it.
Peter Attia
1 Protocols
Jet Lag Acclimation Protocol
Peter Attia- Two weeks prior to travel, gradually adjust sleep schedule by bumping bedtime and wake-up time by about 15 minutes a day in the direction of the destination's time zone.
- On the day of travel, wake up extremely early (e.g., 3 AM local time) to functionally align with the destination's morning (e.g., 8 AM destination time).
- Force yourself awake to make it easier to go to bed at the appropriate time in the new destination, preventing a cycle of difficulty falling asleep and waking up.