Habituation of the metabolic and ventilatory responses to cold-water immersion in humans

An experiment was undertaken to answer long-standing questions concerning the nature of metabolic habituation in repeatedly cooled humans. It was hypothesised that repeated skin and deep-body cooling would produce such a habituation that would be specific to the magnitude of the cooling experienced, and that skin cooling alone would dampen the cold-shock but not the metabolic response to cold-water immersion. Twenty-one male participants were divided into three groups, each of which completed two experimental immersions in 12°C water, lasting until either rectal temperature fell to 35°C or 90min had elapsed. Between these two immersions, the control group avoided cold exposures, whilst two experimental groups completed five additional immersions (12°C). One experimental group repeatedly immersed for 45min in average, resulting in deep-body (1.18°C) and skin temperature reductions. The immersions in the second experimental group were designed to result only in skin temperature reductions, and lasted only 5min. Only the deep-body cooling group displayed a significantly blunted metabolic response during the second experimental immersion until rectal temperature decreased by 1.18°C, but no habituation was observed when they were cooled further. The skin cooling group showed a significant habituation in the ventilatory response during the initial 5min of the second experimental immersion, but no alteration in the metabolic response. It is concluded that repeated falls of skin and deep-body temperature can habituate the metabolic response, which shows tissue temperature specificity. However, skin temperature cooling only will lower the cold-shock response, but appears not to elicit an alteration in the metabolic response.

Acute anxiety increases the magnitude of the cold shock response before and after habituation

Cold immersion evokes the life-threatening cold shock response (CSR). We hypothesised that anxiety may increase the magnitude of (Study 1), and diminish habituation to (Study 2), the CSR. Study 1: eleven participants completed two 7-min immersions in cold water (15 °C). On one occasion, to induce anxiety, participants were instructed that the water would be 5 °C colder (ANX); it was unchanged. The other immersion was a control (CON). Study 2: ten different participants completed seven, 7-min immersions. Immersions 1-5 induced habituation. Immersions 6 and 7 were counter-balanced to produce anxiety (ANX) or acted as a control (CON). Anxiety (20 cm scale) and cardiorespiratory responses (cardiac frequency [f(c)]), respiratory frequency [f(R)], tidal volume [V(T)], minute ventilation [V(E)]) were measured in both studies. Results of study 1: participants were more anxious in the ANX immersion (mean [SD]; CON 5.3 [3.6] and ANX 8.4 [5.0] cm). f(c) peaked at higher levels in ANX (136.4 [15.0]; CON: 124.0 [17.6] b min(-1)) and was higher pre-immersion and in minutes 3 and 5-7 by 7.2 [2.1] b min(-1). ANX [Formula: see text] was higher pre immersion and in minutes 5-6. Results of study 2: repeated immersion habituated the CSR. Anxiety was greater prior to ANX (CON 1.9 [2.3], ANX 6.6 [4.8] cm). f (c) in ANX was higher prior to immersion and in minutes 1-2, 4-6 cf CON; ANX f (c) was not different to the CSR seen in pre-habituation. f (R) was higher in minute 1 of immersion 1 (cf min 1 CON and ANX) following which it exceeded the CSR in CON. The magnitude and duration of CSR (f(c), V(E)) increased with anxiety. Anxiety diminishes CSR habituation.

'Autonomic conflict': a different way to die during cold water immersion?

Cold water submersion can induce a high incidence of cardiac arrhythmias in healthy volunteers. Submersion and the release of breath holding can activate two powerful and antagonistic responses: the 'cold shock response' and the 'diving response'. The former involves the activation of a sympathetically driven tachycardia while the latter promotes a parasympathetically mediated bradycardia. We propose that the strong and simultaneous activation of the two limbs of the autonomic nervous system ('autonomic conflict') may account for these arrhythmias and may, in some vulnerable individuals, be responsible for deaths that have previously wrongly been ascribed to drowning or hypothermia. In this review, we consider the evidence supporting this claim and also hypothesise that other environmental triggers may induce autonomic conflict and this may be more widely responsible for sudden death in individuals with other predisposing conditions.

Cycling cadence affects heart rate variability

The purpose of this study was to examine the effect different cycling cadences have on heart rate variability (HRV) when exercising at constant power outputs. Sixteen males had ECG and respiratory measurements recorded at rest and during 8, 10 min periods of cycling at four different cadences (40, 60, 80 and 100 revs min(-1)) and two power outputs (0 W (unloaded) and 100 W (loaded)). The cycling periods were performed following a Latin square design. Spectral analyses of R-R intervals by fast Fourier transforms were used to quantify absolute frequency domain HRV indices (ms(2)) during the final 5 min of each bout, which were then log transformed using the natural logarithm (Ln). HRV indices of high frequency (HF) power were reduced when cadence was increased (during unloaded cycling (0 W) log transformed HF power decreased from a mean [SD] of 6.3 [1.4] Ln ms(2) at 40 revs min(-1) to 3.9 [1.3] Ln ms(2) at 100 revs min(-1)). During loaded cycling (at 100 W), the low to high frequency (LF:HF) ratio formed a 'J' shaped curve as cadence increased from 40 revs min(-1) (1.4 [0.4]) to 100 revs min(-1) (1.9 [0.7]), but dipped below the 40 revs min(-1) values during the 60 revs min(-1) 1.1 (0.3) and 80 revs min(-1) 1.2 (0.6) cadence conditions. Cardiac frequency (f(C)) and ventilatory variables were strongly correlated with frequency domain HRV indices (r = -0.80 to -0.95). It is concluded that HRV indices are influenced by both cycling cadence and power output; this is mediated by the f(C) and ventilatory changes that occur as cadence or exercise intensity is increased. Consequently, if HRV is assessed during exercise, both power output/exercise intensity and cadence should be standardized.

A proposed decision-making guide for the search, rescue and resuscitation of submersion (head under) victims based on expert opinion

There is some confusion, and consequent variation in policy, between the agencies responsible for the search, rescue and resuscitation of submersion victims regarding the likelihood of survival following a period of submersion. The aim of this work was to recommend a decision-making guide for such victims. This guidance was arrived at by a review of the relevant literature and specific case studies, and a "consensus" meeting on the topic. The factors found to be important for determining the possibility of prolonged survival underwater were: water temperature; salinity of water; duration of submersion; and age of the victim. Of these, only water temperature and duration are sufficiently clear to form the basis of guidance in this area. It is concluded that if water temperature is warmer than 6°C, survival/resuscitation is extremely unlikely if submerged longer than 30 min. If water temperature is 6°C or below, survival/resuscitation is extremely unlikely if submerged longer than 90 min.

ECG during helicopter underwater escape training

INTRODUCTION

Coincidental stimulation of the sympathetic and parasympathetic nervous system can cause "autonomic conflict" and consequent cardiac arrhythmias. The present study tested the hypotheses that: 1) cardiac arrhythmias would be seen in those undertaking helicopter underwater escape training (HUET); 2) the occurrence of arrhythmias in individuals could be predicted; and 3) the heart rate response to HUET would habituate with repeated runs.

METHODS

There were 26 male volunteers who each undertook 5 HUET submersions into water at 29.5 degrees C, with each run separated by 10 min. Each submersion included a 3-min, 40-s pre-submersion period, a 10-s submersion, and 40-s post-submersion period. Participants wore a three-lead telemetric ECG system beneath an immersion suit and underclothing. Skin temperature was measured in one participant. Each participant undertook tests to establish their autonomic function, including heart rate variability, face immersion, cold pressor test, and aerobic capacity assessment.

RESULTS

The heart rate response to HUET was reduced by the fourth run when compared to the first run. Across all runs, 32 cardiac arrhythmias were identified (25%) in 22 different participants; all but 6 of the arrhythmias occurred just after submersion. Only aerobic fitness appeared inversely associated with the occurrence of arrhythmias.

CONCLUSIONS

The heart rate response to HUET habituates. HUET produces cardiac arrhythmias; these are asymptomatic and probably of little clinical significance in young, fit individuals. It remains to be seen if this is the case with either an older, less fit cohort of people or in those undertaking longer breath holds in colder water.

Performance of emergency underwater breathing systems in cool (25 degrees C) and cold (12 degrees C) water

INTRODUCTION

The shortfall between breath-hold time on cold-water immersion and the time required to make an underwater escape from a helicopter provides the rationale for emergency underwater breathing systems (EUBS) for passengers flying over cold water. This study compared three types of EUBS: a compressed gas system (CG); a rebreather system (RB); and a hybrid system (H).

METHODS

Each EUBS was examined during water deployment (W(dep)) and over 90 s in cool (25 degrees C) and cold water (12 degrees C) immersion to the neck (Imm) and submersion (Subm). Subjects wore standardized clothing, including dry suit. Measures included: W(dep) time, stay time (Imm and Subm), dyspnea rating, O2 and CO2 remaining in rebreather bags [H and RB (partial pressure mmHg)], and gas volume used (CG).

RESULTS

Mean data show W(dep) was slowest in the H (17.7 s) compared to the RB (10.0 s) and CG (8.1 s). Stay time was greatest in the H (90.0 s) compared to the RB (68.3 s) and CG (87.0 s); stay time in CG was also greater than RB. Dyspnea ratings were greater in RB trials (6.5 cm) compared to the CG (2.4 cm) and H (1.9 cm). Across devices, stay time in cold water was shorter during submersion than immersion (85.9 s vs. 70.1 s). During submersion stay time was shorter in cold compared to cool water (12 degrees C: 62.8 s; 25 degrees C: 77.5 s).

DISCUSSION

The data suggest that the CG and H devices outperformed the RB device, but the H device required longer to deploy.

'Cross-adaptation': habituation to short repeated cold-water immersions affects the response to acute hypoxia in humans

Adaptation to an environmental stressor is usually studied in isolation, yet these stressors are often encountered in combination in the field, an example being cold and hypoxia at altitude. There has been a paucity of research in this area, although work with rodents indicates that habituation to repeated short cold exposures has a cross-adaptive effect during hypoxia. The present study tested the hypothesis that cross-adaptation is also possible with humans. Thirty-two male volunteers were exposed to 10 min bouts of normoxic and hypoxic (FIO2 0.12) rest and exercise (100 W on a recumbent cycle ergometer). These were repeated after a 96 h interval, during which participants completed six, 5 min immersions in either cold (12°C, CW) or thermoneutral water (35°C, TW). Venous blood samples were taken immediately after each bout, for determination of catecholamine concentrations. A three-lead ECG was recorded throughout and the final 5 min of each bout was analysed for heart rate variability using fast fourier transformations (and displayed as log transformed data (ln)). In comparison with the first hypoxic exercise exposure, the second exposure of the CW group resulted in an increased ln high frequency (ln HF) power (P < 0.001) and reduced adrenaline (P < 0.001) and noradrenaline concentrations (P < 0.001). Adrenaline and noradrenaline concentrations were lower in the CW group during the second hypoxic exercise compared to the TW group (P = 0.042 and P = 0.003), but ln HF was not. When separated into hypoxic sensitive and hypoxic insensitive subgroups, ln HF was higher in the hypoxic sensitive CW group during the second hypoxic exercise than in any of the other subgroups. Cold habituation reduced the sympathetic response (indicated by the reduced catecholamine concentrations) and elevated the parasympathetic activity (increased ln HF power) to hypoxic exercise. These data suggest a generic autonomic cross-adaptive effect between cold habituation and exposure to acute hypoxia in humans.

Psychological skills training improves exercise performance in the heat

INTRODUCTION

Fatigue occurs earlier when working at corresponding exercise intensities in hot compared with cool conditions. Psychological skills training (PST) can modify the responses evoked by thermal stimuli such as the respiratory responses on immersion to cold water. This study tested the hypothesis that a 4-d PST package would significantly increase the distance covered during 90 min of running in the heat.

METHOD

Eighteen subjects completed three maximal-effort runs (R1, R2, R3) of 90 min in the heat (30 degrees C; 40% RH). After R2, subjects were matched and randomly allocated to either a control group (CG) or psychological skills group (PSG). Between R2 and R3, the CG (N = 8) continued their normal activities, and the PSG (N = 10) received PST to help them tolerate unpleasant sensations arising from exercising in the heat, and to suppress the temptation to lower their work intensity. Key measures include distance covered, .VO2, skin (T(sk)) and aural temperature (T(au)), RPE, sweat production and evaporation, interleukin-6 (IL-6), and prolactin (PRL) in whole blood.

RESULTS

The distances covered in the CG did not differ between runs. In the PSG, there were no differences in the distance run between R1 and R2, but they ran significantly farther in R3 (8%; 1.15 km); there were no between-group differences. There were no significant differences between R1 and R3 in peak T(au), T(sk), sweat volumes, IL-6, and PRL (P > 0.05) in either group.

CONCLUSION

PST suppressed the temptation to reduce exercise intensity during R3. It is concluded that PST can improve running performance in the heat. The precise mechanisms underpinning these improvements are unclear; however, their implications for unblinded experimental design are not.

Breath-hold time during cold water immersion: effects of habituation with psychological training

INTRODUCTION

The loss of the conscious control of respiration on whole body cold water immersion (CWI) can result in the aspiration of water and drowning. Repeated CWI reduces the respiratory drive evoked by CWI and should prolong breath-hold time on CWI (BHmax(CWI)). Psychological skills training (PST) can also increase BHmax(CWI) by improving the ability of individuals to consciously suppress the drive to breathe. This study tested the hypothesis that combining PST and repeated CWI would extend BHmax(CWI) beyond that seen following only repeated CWI.

METHODS

There were 20 male subjects who completed two 2.5-min, head-out breath-hold CWI (BH1 and BH2) in water at 12 degrees C. Following BH1, subjects were matched on BHmax(CWI) and allocated to a habituation (HAB) group or a habituation plus PST group (H+PST). Between BH1 and BH2 both experimental groups undertook five 2.5-min CWI on separate days, during which they breathed freely. The H+PST also received psychological training to help tolerate cold and suppress the drive to breathe on immersion to extend BHmax(CWI).

RESULTS

During BH1, mean BHmax(CWI) (+/- SD) in the HAB group was 22.00 (10.33) s and 22.38 (10.65) s in the H+PST. After the five free-breathing CWI, both groups had a longer BHmax(CWI) in BH2. The HAB group improved by 14.13 (20.21) s, an increase of 73%. H+PST improved by 26.86 (24.70) s, a 120% increase. No significant differences were identified between the groups.

CONCLUSION

Habituation significantly increases BHmax on CWI, the addition of PST did not result in statistically significant improvements in BHmax(CWI), but may have practical significance.

The influence of acute and 23 days of intermittent hypoxic exposures on the exercise-induced forehead sweating response

The effect of acute and 23 days of intermittent exposures to normobaric hypoxia on the forehead sweating response during steady-state exercise was investigated. Eight endurance athletes slept in a normobaric hypoxic room for a minimum of 8 h per day at a simulated altitude equivalent to 2,700 m for 23 days (sleep high-train low regimen). Peak oxygen uptake (VO2(peak)) and peak work rate (WR(peak)) were determined under normoxic (20.9%O(2)) and hypoxic (13.5%O(2)) conditions prior to (pre-IHE), and immediately after (post-IHE) the intermittent hypoxic exposures (IHE). Also, each subject performed three 30-min cycle-ergometry bouts: (1) normoxic exercise at 50% WR(peak) attained in normoxia (control trial; CT); (2) hypoxic exercise at 50% WR(peak) attained in hypoxia (hypoxic relative trial; HRT) and (3) hypoxic exercise at the same absolute work rate as in CT (hypoxic absolute trial; HAT). Exposure to hypoxia induced a 33 and 37% decrease (P < 0.001) in (VO2(peak)) pre-IHE and post-IHE, respectively. Despite similar relative oxygen uptake during HAT pre-IHE and post-IHE, the ratings of perceived whole-body exertion decreased substantially (P < 0.05) post-IHE. Pre-IHE the sweat secretion on the forehead (m(sw)f) was greater (P < 0.01) in the HAT (2.60 (0.80) mg cm(-2) min(-1)) compared to the other two trials (CT = 1.87 (1.09) mg cm(-2) min(-1); HRT = 1.57 (0.82) mg cm(-2) min(-1)) despite a similar exercise-induced elevation in body temperatures, resulting in an augmented (P < 0.01) gain of the sweating response (m(sw)f/Delta T(re)). The augmented (m(sw)f) and m(sw)f/Delta T(re) during the HAT were no longer evident post-IHE. Thus, it appears that exercise sweating on the forehead is potentiated by acute exposure to hypoxia, an effect which can be abolished by 23 days of intermittent hypoxic exposures.

Breath-hold performance during cold water immersion: effects of psychological skills training

INTRODUCTION

Accidental cold water immersion (CWI) is a significant cause of death, particularly in those who are immersed in rough water or forcibly submerged such as in a ditched and inverted helicopter. The marked reduction in maximal breath-hold time associated with CWI, part of the 'cold shock' response, significantly increases the risk of drowning. However, the response is highly variable between subjects. This experiment tested the hypothesis that part of this variability is due to psychological factors.

METHODS

There were 32 subjects who completed 2 2.5-min, head-out immersions in 11 degrees C water, separated by 7 d. Between immersions, subjects were matched on initial maximum breath-hold time on immersion (BHwater) and allocated to either a psychological intervention group (PIG) or control group (CG). PIG (n=16) subjects each undertook a psychological skills intervention comprising 4 interlinked training sessions covering goal-setting, arousal regulation, mental imagery, and positive self-talk; CG (n=16) continued normal daily activity.

RESULTS

Psychological intervention significantly increased BHwater on immersion in the PIG vs. the CG [mean (SD); CG BHwater immersion 1:24.01 (6.72) s; immersion 2: 21.34 (16.31) s; PIG: BHwater immersion 1: 24.66 (14.60) s; immersion 2: 44.25 (31.63) s]. The difference in maximum voluntary BHwater between immersion 1 and 2 in the PIG averaged 19.59 s, equating to an 80% increase following psychological intervention.

CONCLUSION

Psychological influences may account for a significant amount of the variability in the respiratory responses during CWI, and may be a key factor in determining the chances of survival following accidental immersion.

Can firefighter instructors perform a simulated rescue after a live fire training exercise?

Two studies were undertaken to determine whether firefighter instructors are capable of performing a simulated rescue task after undertaking a live fire training exercise (LFTE) lasting approximately 40 min. In the first study, ten instructors performed two simulated rescue tasks in air at 19 degrees C, involving dragging an 81-kg dummy for 15 m along a corridor and down two flights of stairs. The first rescue acted as a control (Rcontrol) and was conducted when they were euhydrated and normothermic. The second task was undertaken 10.4 (3.3) min [mean (SD)] after a LFTE resulting in an average rectal temperature of 38.1 (0.4) degrees C (Rhot). All instructors were able to successfully complete Rcontrol and Rhot in 90.1 (28.6) s and 78.7 (15.6) s respectively. Heart rate (HR) and rating of perceived exertion (RPE) were higher after the LFTE [162 (16) beats min(-1) versus 180 (15) beats min(-1); and 13.3 (2.4) versus 15.7 (2.1), respectively, P<0.001]. In the second study, six instructors (one instructor participated twice giving seven trials) undertook a simulated rescue task in 16 degrees C involving dragging an 85-kg dummy along a flat surface 79 (65) s after a LFTE that increased rectal temperature to 38.3 (0.7) degrees C. On six occasions the instructor was able to successfully complete the full 30-m drag in 41.7 (6.9) s and one instructor dragged the dummy for 20 m before stopping through exhaustion. HR during the rescue task reached 173 (19) beats min(-1) and RPE was 16.3 (2.4). In conclusion, most of the instructors were able to perform a rescue task after the LFTE, however they were close to their physical limit.

Human temperature regulation during cycling with moderate leg ischaemia

The effect of graded ischaemia in the legs on the regulation of body temperature during steady-state exercise was investigated in seven healthy males. It was hypothesised that graded ischaemia in the working muscles increases heat storage within the muscles, which in turn potentiates sweat secretion during exercise. Blood perfusion in the working muscles was reduced by applying a supra-atmospheric pressure (+6.6 kPa) around the legs, which reduced maximal working capacity by 29%. Each subject conducted three separate test trials comprising 30 min of steady-state cycling in a supine position. Exercise with unrestricted blood flow (Control trial) was compared to ischaemic exercise conducted at an identical relative work rate (Relative trial), as well as at an identical absolute work rate (Absolute trial); the latter corresponding to a 20% increase in relative workload. The average (SD) increases in both the rectal and oesophageal temperatures during steady-state cycling was 0.3 (0.2) degrees C and did not significantly differ between the three trials. The increase in muscle temperature was similar in the Control (2.7 (0.3) degrees C) and Absolute (2.4 (0.7) degrees C) trials, but was substantially lower (P < 0.01) in the Relative trial (1.4 (0.8) degrees C). Ischaemia potentiated (P < 0.01) sweating on the forehead in the Absolute trial (24.2 (7.3) g m(-2) min(-1)) compared to the Control trial (13.4 (6.2) g m(-2) min(-1)), concomitant with an attenuated (P < 0.05) vasodilatation in the skin during exercise. It is concluded that graded ischaemia in working muscles potentiates the exercise sweating response and attenuates vasodilatation in the skin initiated by increased core temperature, effects which may be attributed to an augmented muscle metaboreflex.

Human thermoregulatory function during exercise and immersion after 35 days of horizontal bed-rest and recovery

The present study evaluated the effect of 35 days of experimental horizontal bed-rest on exercise and immersion thermoregulatory function. Fifteen healthy male volunteers were assigned to either a Control (n = 5) or Bed-rest (n = 10) group. Thermoregulatory function was evaluated during a 30-min bout of submaximal exercise on a cycle ergometer, followed immediately by a 100-min immersion in 28 degrees C water. For the Bed-rest group, exercise and immersion thermoregulatory responses observed post-bed-rest were compared with those after a 5 week supervised active recovery period. In both trials, the absolute work load during the exercise portion of the test was identical. During the exercise and immersion, we recorded skin temperature, rectal temperature, the difference in temperature between the forearm and third digit of the right hand (DeltaT(forearm-fingertip))--an index of skin blood flow, sweating rate from the forehead, oxygen uptake and heart rate at minute intervals. Subjects provided ratings of temperature perception and thermal comfort at 5-min intervals. Exercise thermoregulatory responses after bed-rest and recovery were similar. Subjective ratings of temperature perception and thermal comfort during immersion indicated that subjects perceived similar combinations of Tsk and Tre to be warmer and thermally less uncomfortable after bed-rest. The average (SD) exercise-induced increase in Tre relative to resting values was not significantly different between the Post-bed-rest (0.4 (0.2) degrees C) and Recovery (0.5 (0.2) degrees C) trials. During the post-exercise immersion, the decrease in Tre, relative to resting values, was significantly (P < 0.05) greater in the Post-bed-rest trial (0.9 (0.5) degrees C) than after recovery (0.4 (0.3) degrees C). DeltaT(forearm-fingertip) was 5.2 (0.9) degrees C and 5.8 (1.0) degrees C at the end of the post-bed-rest and recovery immersions, respectively. The gain of the shivering response (increase in VO(2) relative to the decrease in Tre; VO(2)/Tre) was 1.19 l min(-1) degrees C(-1) in the Recovery trial, and was significantly attenuated to 0.51 l min(-1) degrees C(-1) in the Post-bed-rest trial. The greater cooling rate observed in the post-bed-rest trial is attributed to the greater heat loss and reduced heat production. The former is the result of attenuated cold-induced vasoconstriction and enhanced sweating rate, and the latter a result of a lower shivering VO(2) response.

Motion sickness decreases arterial pressure and therefore acceleration tolerance

BACKGROUND

Motion sickness is a common aeromedical problem that may occur in pilots exposed to increased gravitoinertial load in the head-to-foot direction (+Gz). Since motion sickness may affect autonomic nervous functions including cardiovascular control, it was hypothesized that it might interfere with cardiovascular responses to high +Gz, thereby decreasing G tolerance.

METHODS

G tolerance and cardiovascular responses to increased G load were studied in nine subjects in a centrifuge environment under two conditions. In the motion sickness condition, the subject was exposed to a motion sickness provocation (MSP) comprising repeated rapid changes in G load in combination with a regimen of head movements. In the control condition the subject was exposed to similar cumulative G-time stress, but without the MSP. Mean arterial pressure (MAP) was measured. An index of peripheral vascular resistance was achieved by measuring the difference in skin temperature between the forearm and fingertip (deltaT(forearm-fingertip)).

RESULTS

MSP decreased gradual-onset rate G tolerance from 5.1 +/- 1.0 G (mean +/- SD) to 4.6 +/- 0.9 G. There was no change in gradual-onset rate G tolerance in the control condition. Rapid-onset rate G tolerance was lower in the motion sickness (2.9 +/- 0.5 G) than in the control (3.4 +/- 0.3 G) condition. MSP reduced MAP by 11 mmHg and deltaT(forearm-fingertip) by 4.2 +/- 4.1 degrees C. In the control condition MAP and deltaT(forearm-fingertip) were unaffected.

CONCLUSIONS

Motion sickness may reduce the arterial pressure response to the extent that the capacity of an individual to withstand increased G loads in the head-to-foot direction is significantly diminished.

Moderate hypoxia does not affect the zone of thermal comfort in humans

The zone of thermal comfort was determined during normoxia and hypoxia in 15 healthy normothermic young subjects. Subjects dressed only in shorts/shorts and bikini top donned a water-perfused suit and assumed a supine position on a bench. The ambient temperature was maintained at a mean (SD) of 25.7 (0.3) degrees C. The thermal comfort zone was determined by increasing the temperature of the water perfusing the suit from cool to warm. During the heating process, subjects were instructed to report when their perception of the thermal stimulus provided by the suit changed from unpleasant to pleasant, and again from pleasant to unpleasant. The boundaries of the thermal comfort zone were assumed to be the temperatures of the water perfusing the suit at the time the subjects reported a change in the affective component of their thermal perception. In normoxia, subjects inspired room air and in hypoxia a gas mixture containing 10% O(2) in N(2). Tympanic temperature was similar in the normoxia and hypoxia conditions (P>0.05). The average (SD) lower and upper limits of the thermal comfort zone were 30.5 (1.5) and 34.7 (3.3) degrees C, respectively, during normoxia, and 30.5 (1.7) and 35.1 (3.4) degrees C, respectively, during hypoxia. No significant differences were observed between the normoxia and hypoxia conditions (P>0.05). Also, no gender-related differences were observed in the characteristics of the thermal comfort zone. The results of the present study indicate that acute hypoxic exposure simulated in the present study does not affect the zone of thermal comfort in humans.

Repeated cold showers as a method of habituating humans to the initial responses to cold water immersion

The hypothesis that the initial responses to cold water immersion could be attenuated by repeated cold showers was tested. Eighteen (13 men, 5 women) non-habituated subjects undertook two 3-min head-out seated immersions into stirred water at 10 degrees C wearing swim wear. The immersions were separated by 4 days during which time they took six cold showers. The subjects were randomly split into three groups with different showering regimes: 3 min at 10 degrees C on the back (10B); 3 min at 15 degrees C on the back (15B); and 30 s at 10 degrees C on the back followed by 30 s on the front (10BF). Over the first 30 s of immersion respiratory frequency ( f (R)) was reduced by 21% in groups 10B and 10BF from 54 (14) to 44 (16) breaths.min(-1) ( P <0.05), and 33 (8) to 26 (10) breaths.min(-1) ( P <0.05) respectively, following repeated showers. Group 15B showed no change in f (R). The tachycardia induced on immersion in water at 10 degrees C was not reduced by repeated showers except in group 15B during the last 150 s [from 119 (23) to 105 (25) beats.min(-1), P <0.05]. Repeated showering in water at 10 degrees C reduced the respiratory drive (as measured by f (R)) during head-out immersion in water at the same temperature. No such habituation was observed with repeated showers in warmer water (15 degrees C). It is concluded that when the body surface area cooled is the same, the rate of change of skin temperature is an important factor in determining the degree of habituation produced.

Hypoxia increases the cutaneous threshold for the sensation of cold

Cutaneous temperature sensitivity was tested in 13 male subjects prior to, during and after they breathed either a hypocapnic hypoxic (HH), or a normocapnic hypoxic (NH) breathing mixture containing 10% oxygen in nitrogen. Normocapnia was maintained by adding carbon dioxide to the inspired gas mixture. Cutaneous thresholds for thermal sensation were determined by a thermosensitivity testing device positioned on the plantar side of the first two toes on one leg. Heart rate, haemoglobin saturation, skin temperature at four sites (arm, chest, thigh, calf) and adapting temperature of the skin (T(ad); degrees centigrade), i.e. the temperature of the toe skin preceding a thermosensitivity test, were measured at minute intervals. Tympanic temperature (T(ty); degrees centigrade) was measured prior to the initial normoxic thermosensitivity test, during the hypoxic exposure and after the completion of the final normoxic thermosensitivity test. End-tidal carbon dioxide fraction and minute inspiratory volume were measured continuously during the hypoxic exposure. Ambient temperature, T(ty), T(ad) and mean skin temperature remained similar in both experimental conditions. Cutaneous sensitivity to cold decreased during both HH (P<0.001) and NH conditions (P<0.001) as compared with the tests undertaken pre- and post-hypoxia. No similar effect was observed for cutaneous sensitivity to warmth. The results of the present study suggest that sensitivity to cold decreases during the hypoxic exposure due to the effects associated with hypoxia rather than hypocapnia. Such alteration in thermal perception may affect the individual's perception of thermal comfort and consequently attenuate thermoregulatory behaviour during cold exposure at altitude.

Human physiological responses to cold exposure

Thermal energy is transferred within and between bodies via several avenues, but for most unprotected human cold exposures, particularly during immersion, convective heat loss dominates. Lower tissue temperatures stimulate thermoreceptors, and the resultant afferent flow elicits autonomic homoeostatic responses (thermogenesis and vasoconstriction) that regulate body temperature within a narrow range. The most powerful effector responses occur when both superficial and deep thermoreceptors are cooled simultaneously, but thermoeffector activation can also occur as a result of peripheral cooling alone. The responses to cold, and the hazards associated with cold exposure, are moderated by factors which influence heat production and heat loss, including the severity and duration of cold stimuli, accompanying exercise, the magnitude of the metabolic response, and individual characteristics such as body composition, age, and gender. Cold stress can quickly overwhelm human thermoregulation with consequences ranging from impaired performance to death. This review provides a comprehensive overview of the human physiological responses to acute cold exposure.