Predicting Temperature Changes During Cold Water Immersion and Exercise Scenarios: Application of a Tissue–Blood Interactive Whole-Body Model

Context: Recommended treatment for exertional heat stroke includes whole-body cold-water immersion (CWI). However, remote locations or monetary or spatial restrictions can challenge the feasibility of CWI. Thus, the development of a modified, portable CWI method would allow for optimal treatment of exertional heat stroke in the presence of these challenges. Objective: To determine the cooling rate of modified CWI (tarp-assisted cooling with oscillation [TACO]) after exertional hyperthermia. Design: Randomized, crossover controlled trial. Setting: Environmental chamber (temperature = 33.4°C ± 0.8°C, relative humidity = 55.7% ± 1.9%). Patients or Other Participants: Sixteen volunteers (9 men, 7 women; age = 26 ± 4.7 years, height = 1.76 ± 0.09 m, mass = 72.5 ± 9.0 kg, body fat = 20.7% ± 7.1%) with no history of compromised thermoregulation. Intervention(s): Participants completed volitional exercise (cycling or treadmill) until they demonstrated a rectal temperature (Tre) ≥39.0°C. After exercise, participants transitioned to a semirecumbent position on a tarp until either Tre reached 38.1°C or 15 minutes had elapsed during the control (no immersion [CON]) or TACO (immersion in 151 L of 2.1°C ± 0.8°C water) treatment. Main Outcome Measure(s): The Tre, heart rate, and blood pressure (reported as mean arterial pressure) were assessed precooling and postcooling. Statistical analyses included repeated-measures analysis of variance with appropriate post hoc t tests and Bonferroni correction. Results: Before cooling, the Tre was not different between conditions (CON: 39.27°C ± 0.26°C, TACO: 39.30°C ± 0.39°C; P = .62; effect size = −0.09; 95% confidence interval [CI] = −0.2, 0.1). At postcooling, the Tre was decreased in the TACO (38.10°C ± 0.16°C) compared with the CON condition (38.74°C ± 0.38°C; P < .001; effect size = 2.27; 95% CI = 0.4, 0.9). The rate of cooling was greater during the TACO (0.14 ± 0.06°C/min) than the CON treatment (0.04°C/min ± 0.02°C/min; t15 = −8.84; P < .001; effect size = 2.21; 95% CI = −0.13, −0.08). These differences occurred despite an insignificant increase in fluid consumption during exercise preceding CON (0.26 ± 0.29 L) versus TACO (0.19 ± 0.26 L; t12 = 1.73; P = .11; effect size = 0.48; 95% CI = −0.02, 0.14) treatment. Decreases in heart rate did not differ between the TACO and CON conditions (t15 = −1.81; P = .09; effect size = 0.45; 95% CI = −22, 2). Mean arterial pressure was greater at postcooling with TACO (84.2 ± 6.6 mm Hg) than with CON (67.0 ± 9.0 mm Hg; P < .001; effect size = 2.25; 95% CI = 13, 21). Conclusions: The TACO treatment provided faster cooling than did the CON treatment. When location, monetary, or spatial restrictions are present, TACO represents an effective alternative to traditional CWI in the emergency treatment of patients with exertional hyperthermia.

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Cooling and Performance Recovery of Trained Athletes: A Meta-Analytical Review

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.8.3.227 ◽

2013 ◽

Vol 8 (3) ◽

pp. 227-242 ◽

Cited By ~ 55

Author(s):

Wigand Poppendieck ◽

Oliver Faude ◽

Melissa Wegmann ◽

Tim Meyer

Keyword(s):

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Effect Sizes ◽

Whole Body ◽

Intensive Training ◽

Positive Effects ◽

Performance Recovery ◽

And Performance ◽

Whole Body Cooling

Purpose:Cooling after exercise has been investigated as a method to improve recovery during intensive training or competition periods. As many studies have included untrained subjects, the transfer of those results to trained athletes is questionable.Methods:Therefore, the authors conducted a literature search and located 21 peer-reviewed randomized controlled trials addressing the effects of cooling on performance recovery in trained athletes.Results:For all studies, the effect of cooling on performance was determined and effect sizes (Hedges’ g) were calculated. Regarding performance measurement, the largest average effect size was found for sprint performance (2.6%, g = 0.69), while for endurance parameters (2.6%, g = 0.19), jump (3.0%, g = 0.15), and strength (1.8%, g = 0.10), effect sizes were smaller. The effects were most pronounced when performance was evaluated 96 h after exercise (4.3%, g = 1.03). Regarding the exercise used to induce fatigue, effects after endurance training (2.4%, g = 0.35) were larger than after strength-based exercise (2.4%, g = 0.11). Cold-water immersion (2.9%, g = 0.34) and cryogenic chambers (3.8%, g = 0.25) seem to be more beneficial with respect to performance than cooling packs (−1.4%, g= −0.07). For cold-water application, whole-body immersion (5.1%, g = 0.62) was significantly more effective than immersing only the legs or arms (1.1%, g = 0.10).Conclusions:In summary, the average effects of cooling on recovery of trained athletes were rather small (2.4%, g = 0.28). However, under appropriate conditions (whole-body cooling, recovery from sprint exercise), postexercise cooling seems to have positive effects that are large enough to be relevant for competitive athletes.

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Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review

Journal of Athletic Training ◽

10.4085/1062-6050-44.1.84 ◽

2009 ◽

Vol 44 (1) ◽

pp. 84-93 ◽

Cited By ~ 105

Author(s):

Brendon P. McDermott ◽

Douglas J. Casa ◽

Matthew S. Ganio ◽

Rebecca M. Lopez ◽

Susan W. Yeargin ◽

...

Keyword(s):

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Whole Body ◽

Original Research ◽

Induced Hyperthermia ◽

Body Cooling ◽

Exercise Induced ◽

Whole Body Cooling ◽

Ice Water

Abstract Objective: To assess existing original research addressing the efficiency of whole-body cooling modalities in the treatment of exertional hyperthermia. Data Sources: During April 2007, we searched MEDLINE, EMBASE, Scopus, SportDiscus, CINAHL, and Cochrane Reviews databases as well as ProQuest for theses and dissertations to identify research studies evaluating whole-body cooling treatments without limits. Key words were cooling, cryotherapy, water immersion, cold-water immersion, ice-water immersion, icing, fanning, bath, baths, cooling modality, heat illness, heat illnesses, exertional heatstroke, exertional heat stroke, heat exhaustion, hyperthermia, hyperthermic, hyperpyrexia, exercise, exertion, running, football, military, runners, marathoner, physical activity, marathoning, soccer, and tennis. Data Synthesis: Two independent reviewers graded each study on the Physiotherapy Evidence Database (PEDro) scale. Seven of 89 research articles met all inclusion criteria and a minimum score of 4 out of 10 on the PEDro scale. Conclusions: After an extensive and critical review of the available research on whole-body cooling for the treatment of exertional hyperthermia, we concluded that ice-water immersion provides the most efficient cooling. Further research comparing whole-body cooling modalities is needed to identify other acceptable means. When ice-water immersion is not possible, continual dousing with water combined with fanning the patient is an alternative method until more advanced cooling means can be used. Until future investigators identify other acceptable whole-body cooling modalities for exercise-induced hyperthermia, ice-water immersion and cold-water immersion are the methods proven to have the fastest cooling rates.

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Chemically Activated Cooling Vest’s Effect on Cooling Rate Following Exercise-Induced Hyperthermia: A Randomized Counter-Balanced Crossover Study

Medicina ◽

10.3390/medicina56100539 ◽

2020 ◽

Vol 56 (10) ◽

pp. 539

Author(s):

Yuri Hosokawa ◽

Luke N. Belval ◽

William M. Adams ◽

Lesley W. Vandermark ◽

Douglas J. Casa

Keyword(s):

Cooling Rate ◽

Body Mass ◽

Cold Water ◽

Water Immersion ◽

Heat Stroke ◽

Cooling Capacity ◽

Cold Water Immersion ◽

Whole Body ◽

Climatic Chamber ◽

Exercise Induced

Background and objectives: Exertional heat stroke (EHS) is a potentially lethal, hyperthermic condition that warrants immediate cooling to optimize the patient outcome. The study aimed to examine if a portable cooling vest meets the established cooling criteria (0.15 °C·min−1 or greater) for EHS treatment. It was hypothesized that a cooling vest will not meet the established cooling criteria for EHS treatment. Materials and Methods: Fourteen recreationally active participants (mean ± SD; male, n = 8; age, 25 ± 4 years; body mass, 86.7 ± 10.5 kg; body fat, 16.5 ± 5.2%; body surface area, 2.06 ± 0.15 m2. female, n = 6; 22 ± 2 years; 61.3 ± 6.7 kg; 22.8 ± 4.4%; 1.66 ± 0.11 m2) exercised on a motorized treadmill in a hot climatic chamber (ambient temperature 39.8 ± 1.9 °C, relative humidity 37.4 ± 6.9%) until they reached rectal temperature (TRE) >39 °C (mean TRE, 39.59 ± 0.38 °C). Following exercise, participants were cooled using either a cooling vest (VEST) or passive rest (PASS) in the climatic chamber until TRE reached 38.25 °C. Trials were assigned using randomized, counter-balanced crossover design. Results: There was a main effect of cooling modality type on cooling rates (F[1, 24] = 10.46, p < 0.01, η2p = 0.30), with a greater cooling rate observed in VEST (0.06 ± 0.02 °C·min−1) than PASS (0.04 ± 0.01 °C·min−1) (MD = 0.02, 95% CI = [0.01, 0.03]). There were also main effects of sex (F[1, 24] = 5.97, p = 0.02, η2p = 0.20) and cooling modality type (F[1, 24] = 4.38, p = 0.047, η2p = 0.15) on cooling duration, with a faster cooling time in female (26.9 min) than male participants (42.2 min) (MD = 15.3 min, 95% CI = [2.4, 28.2]) and faster cooling duration in VEST than PASS (MD = 13.1 min, 95% CI = [0.2, 26.0]). An increased body mass was associated with a decreased cooling rate in PASS (r = −0.580, p = 0.03); however, this association was not significant in vest (r = −0.252, p = 0.39). Conclusions: Although VEST exhibited a greater cooling capacity than PASS, VEST was far below an acceptable cooling rate for EHS treatment. VEST should not replace immediate whole-body cold-water immersion when EHS is suspected.

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Effect of the Depth of Cold Water Immersion on Sleep Architecture and Recovery Among Well-Trained Male Endurance Runners

Frontiers in Sports and Active Living ◽

10.3389/fspor.2021.659990 ◽

2021 ◽

Vol 3 ◽

Author(s):

Maxime Chauvineau ◽

Florane Pasquier ◽

Vincent Guyot ◽

Anis Aloulou ◽

Mathieu Nedelec

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Muscle Damage ◽

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Sleep Architecture ◽

Whole Body ◽

Partial Body ◽

Endurance Runners

Introduction: The aim of the present study was to investigate the effect of the depth of cold water immersion (CWI) (whole-body with head immersed and partial-body CWI) after high-intensity, intermittent running exercise on sleep architecture and recovery kinetics among well-trained runners.Methods: In a randomized, counterbalanced order, 12 well-trained male endurance runners (V.O2max = 66.0 ± 3.9 ml·min−1·kg−1) performed a simulated trail (≈18:00) on a motorized treadmill followed by CWI (13.3 ± 0.2°C) for 10 min: whole-body immersion including the head (WHOLE; n = 12), partial-body immersion up to the iliac crest (PARTIAL; n = 12), and, finally, an out-of-water control condition (CONT; n = 10). Markers of fatigue and muscle damage—maximal voluntary isometric contraction (MVIC), countermovement jump (CMJ), plasma creatine kinase [CK], and subjective ratings—were recorded until 48 h after the simulated trail. After each condition, nocturnal core body temperature (Tcore) was measured, whereas sleep and heart rate variability were assessed using polysomnography.Results: There was a lower Tcore induced by WHOLE than CONT from the end of immersion to 80 min after the start of immersion (p < 0.05). Slow-wave sleep (SWS) proportion was higher (p < 0.05) during the first 180 min of the night in WHOLE compared with PARTIAL. WHOLE and PARTIAL induced a significant (p < 0.05) decrease in arousal for the duration of the night compared with CONT, while only WHOLE decreased limb movements compared with CONT (p < 0.01) for the duration of the night. Heart rate variability analysis showed a significant reduction (p < 0.05) in RMSSD, low frequency (LF), and high frequency (HF) in WHOLE compared with both PARTIAL and CONT during the first sequence of SWS. No differences between conditions were observed for any markers of fatigue and muscle damage (p > 0.05) throughout the 48-h recovery period.Conclusion: WHOLE reduced arousal and limb movement and enhanced SWS proportion during the first part of the night, which may be particularly useful in the athlete's recovery process after exercise. Future studies are, however, required to assess whether such positive sleep outcomes may result in overall recovery optimization.

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Whole-body active heating does not preserve finger temperature or manual dexterity during cold-water immersion

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2020.11 ◽

2020 ◽

pp. 253-260

Author(s):

Courtney E. Wheelock ◽

Hayden W. Hess ◽

Zachary J. Schlader ◽

Blair D. Johnson ◽

David Hostler ◽

...

Keyword(s):

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Manual Dexterity ◽

Whole Body ◽

Finger Temperature ◽

Thermal Thresholds ◽

Increased Risk ◽

Core Body ◽

Skin Temperatures

Background: Cold-water immersion impairs manual dexterity when finger temperature is below 15˚C. This exposes divers to increased risk of error. We hypothesized that whole-body active heating would maintain finger temperatures and dexterity during cold-water immersion. Methods: Twelve subjects (six males) (22±2 years old; BMI 23.9±2.5; body fat 16±6%) completed 60-minute head-out water immersion (HOWI) wearing a 7mm wetsuit and 3mm gloves in thermoneutral water (TN 25˚C) and cold water (CW 10˚C)while wearing a water-perfused suit (WP) with 37˚C water circulated over the torso, arms, and legs. Gross (Minnesota Manual Dexterity Test [MMDT]) and fine (modified Purdue Pegboard [PPT]) dexterity were assessed before, during and after immersion. Core body and skin temperatures were recorded every 10 minutes. Results: MMDT (TN -25±14%; CW -72±23%; WP -67±29%; p<0.05) and PPT (TN -16±9%; CW: -45±10%; WP: -38±13%; p<0.05) performance decreased during immersion. MMDT and PPT did not differ between CW and WP. Immediately following immersion gross dexterity was recovered in all conditions. Post-immersion fine dexterity was still impaired in CW (p<0.01), but not WP or TN. Core and skin temperatures decreased during immersion in CW and WP (p<0.05) but did not differ between CW and WP. Conclusions: Manual dexterity decreased during immersion. Dexterity was further impaired during cold-water immersion and was not maintained by water perfusion active heating. Warm water perfusion did not maintain finger temperature above 15˚C but hand temperature remained above these limits, suggesting a need to reassess thermal thresholds for working divers in cold-water conditions.

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Seven days of cold acclimation substantially reduces shivering intensity and increases nonshivering thermogenesis in adult humans

Journal of Applied Physiology ◽

10.1152/japplphysiol.01133.2018 ◽

2019 ◽

Vol 126 (6) ◽

pp. 1598-1606 ◽

Cited By ~ 6

Author(s):

Kyle Gordon ◽

Denis P. Blondin ◽

Brian J. Friesen ◽

Hans Christian Tingelstad ◽

Glen P. Kenny ◽

...

Keyword(s):

Cold Acclimation ◽

Core Temperature ◽

Heat Production ◽

Cold Exposure ◽

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Metabolic Changes ◽

Whole Body ◽

Nonshivering Thermogenesis

Daily compensable cold exposure in humans reduces shivering by ~20% without changing total heat production, partly by increasing brown adipose tissue thermogenic capacity and activity. Although acclimation and acclimatization studies have long suggested that daily reductions in core temperature are essential to elicit significant metabolic changes in response to repeated cold exposure, this has never directly been demonstrated. The aim of the present study is to determine whether daily cold-water immersion, resulting in a significant fall in core temperature, can further reduce shivering intensity during mild acute cold exposure. Seven men underwent 1 h of daily cold-water immersion (14°C) for seven consecutive days. Immediately before and following the acclimation protocol, participants underwent a mild cold exposure using a novel skin temperature clamping cold exposure protocol to elicit the same thermogenic rate between trials. Metabolic heat production, shivering intensity, muscle recruitment pattern, and thermal sensation were measured throughout these experimental sessions. Uncompensable cold acclimation reduced total shivering intensity by 36% ( P = 0.003), without affecting whole body heat production, double what was previously shown from a 4-wk mild acclimation. This implies that nonshivering thermogenesis increased to supplement the reduction in the thermogenic contribution of shivering. As fuel selection did not change following the 7-day cold acclimation, we suggest that the nonshivering mechanism recruited must rely on a similar fuel mixture to produce this heat. The more significant reductions in shivering intensity compared with a longer mild cold acclimation suggest important differential metabolic responses, resulting from an uncompensable compared with compensable cold acclimation. NEW & NOTEWORTHY Several decades of research have been dedicated to reducing the presence of shivering during cold exposure. The present study aims to determine whether as little as seven consecutive days of cold-water immersion is sufficient to reduce shivering and increase nonshivering thermogenesis. We provide evidence that whole body nonshivering thermogenesis can be increased to offset a reduction in shivering activity to maintain endogenous heat production. This demonstrates that short, but intense cold stimulation can elicit rapid metabolic changes in humans, thereby improving our comfort and ability to perform various motor tasks in the cold. Further research is required to determine the nonshivering processes that are upregulated within this short time period.

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Recovery From Exercise-Induced Muscle Damage: Cold-Water Immersion Versus Whole-Body Cryotherapy

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2016-0186 ◽

2017 ◽

Vol 12 (3) ◽

pp. 402-409 ◽

Cited By ~ 18

Author(s):

Abd-Elbasset Abaïdia ◽

Julien Lamblin ◽

Barthélémy Delecroix ◽

Cédric Leduc ◽

Alan McCall ◽

...

Keyword(s):

Muscle Damage ◽

Cold Water ◽

Water Immersion ◽

Cold Water Immersion ◽

Whole Body ◽

Countermovement Jump ◽

Jump Performance ◽

Physically Active ◽

Exercise Induced ◽

Whole Body Cryotherapy

Purpose:To compare the effects of cold-water immersion (CWI) and whole-body cryotherapy (WBC) on recovery kinetics after exercise-induced muscle damage.Methods:Ten physically active men performed single-leg hamstring eccentric exercise comprising 5 sets of 15 repetitions. Immediately postexercise, subjects were exposed in a randomized crossover design to CWI (10 min at 10°C) or WBC (3 min at –110°C) recovery. Creatine kinase concentrations, knee-flexor eccentric (60°/s) and posterior lower-limb isometric (60°) strength, single-leg and 2-leg countermovement jumps, muscle soreness, and perception of recovery were measured. The tests were performed before and immediately, 24, 48, and 72 h after exercise.Results:Results showed a very likely moderate effect in favor of CWI for single-leg (effect size [ES] = 0.63; 90% confidence interval [CI] = –0.13 to 1.38) and 2-leg countermovement jump (ES = 0.68; 90% CI = –0.08 to 1.43) 72 h after exercise. Soreness was moderately lower 48 h after exercise after CWI (ES = –0.68; 90% CI = –1.44 to 0.07). Perception of recovery was moderately enhanced 24 h after exercise for CWI (ES = –0.62; 90% CI = –1.38 to 0.13). Trivial and small effects of condition were found for the other outcomes.Conclusions:CWI was more effective than WBC in accelerating recovery kinetics for countermovement-jump performance at 72 h postexercise. CWI also demonstrated lower soreness and higher perceived recovery levels across 24–48 h postexercise.

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