Cold therapy for parkinson disease
Evidence review
Overview
Whole-body cryotherapy (2 minutes of extreme cold air in a chamber) has been tested in two small uncontrolled Italian pilot studies of people with Parkinson disease. After 10 sessions, one study reported lower cortisol and improved anxiety, depression, fatigue and sleepiness scores; the other reported increased heart rate variability with stable blood pressure. There are no controlled trials, motor symptoms were not the primary outcome, and cold-water immersion has not been studied.
Key findings
- 10 WBC sessions, 14 patients: lower cortisol and improved anxiety, depression, fatigue and sleepiness scores (p<0.05 for most) (Piterà 2026)
- 10 WBC sessions, 13 completers: increased RMSSD and high-frequency HRV, stable blood pressure (Piterà 2024)
Every study we reviewed
1 found benefit · 1 mixed results
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 5 studies on parkinson disease, across all heat and cold therapies, including case reports and older work not graded here.
Effects of Whole-Body Cryostimulation on Stress Biomarkers and Psychological Well-Being in Parkinson's Disease: A Pilot Study.
Piterà P et al. J Clin Med. 2026. PubMed 41753288 · DOI · Free full text
- Who
- patients with idiopathic Parkinson disease
- What
- whole-body cryotherapy chamber (WBC; cold air, not water immersion), 10 sessions over 2 weeks
- Protocol
- -166 °F · 2 min · 5/wk · 2 wk
- Measured
- serum cortisol and serotonin; anxiety (STAI), depression (BDI), fatigue (FSS), sleep quality, daytime sleepiness (ESS)
- Result
- Serum cortisol fell and serotonin rose; anxiety, depression, fatigue and sleepiness scores improved (p<0.05 for most scales). Sessions were safe and well tolerated.
- Limitations
- uncontrolled; small; short follow-up; effect sizes not given in abstract
Autonomic Modulation in Parkinson's Disease Using Whole-Body Cryostimulation: A Pilot Study.
Piterà P et al. Biomedicines. 2024. PubMed 39595033 · DOI · Free full text
- Who
- patients with mild-to-moderate Parkinson disease (13 completed; mean age 64.5, disease duration 5.4 years)
- What
- whole-body cryotherapy chamber (WBC; cold air, not water immersion), 10 sessions over 5 consecutive days
- Protocol
- 10 sessions in 5 days/wk · 1 wk
- Measured
- heart rate variability and blood catecholamines
- Result
- RR intervals, RMSSD and high-frequency power increased, indicating greater parasympathetic activity; blood pressure remained stable.
- Limitations
- uncontrolled; 4 of 17 did not complete; physiological outcomes only
Protocols used in the studies
Whole-body cryotherapy chamber at -166 F (-110 C) for 2 minutes, 10 sessions over 5 days to 2 weeks, in an inpatient rehabilitation setting. No cold-water immersion protocol has been studied.
What is still unknown
Controlled trials; effects on motor symptoms; durability; whether cold-water immersion has similar effects; safety in patients with orthostatic hypotension.
Safety
Cautions for cold therapy in this condition
- Blood pressure remained stable during WBC in Parkinson disease (PMID 39595033), but cold-water immersion produces a cold shock response with a blood pressure surge (PMID 2691172) and has not been studied in this population.
- Rigidity, slowed movement and balance impairment make entry and exit from cold water hazardous; supervision is needed. See general cold safety entry.
For clinicians
Suggested rationale
Two small uncontrolled pilot studies (Piterà 2024; Piterà 2026) reported improved non-motor symptoms and greater parasympathetic activity after 10 whole-body cryotherapy sessions in Parkinson disease; controlled trials are lacking and the findings do not extend to cold-water immersion.
Suggested wording only. The treating clinician decides whether it reflects their clinical judgment for this patient.
Typical ICD-10 codes: G20. Examples only; the clinician assigns the code.
What a letter of medical necessity should containWho can write it: physicians, NPs, PAs and others