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Kunutsor SK, Lehoczki A, Laukkanen JA. The untapped potential of cold water therapy as part of a lifestyle intervention for promoting healthy aging. GeroScience 2024:10.1007/s11357-024-01295-w. [PMID: 39078461 DOI: 10.1007/s11357-024-01295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
Healthy aging is a crucial goal in aging societies of the western world, with various lifestyle strategies being employed to achieve it. Among these strategies, hydrotherapy stands out for its potential to promote cardiovascular and mental health. Cold water therapy, a hydrotherapy technique, has emerged as a lifestyle strategy with the potential capacity to evoke a wide array of health benefits. This review aims to synthesize the extensive body of research surrounding cold water therapy and its beneficial effects on various health systems as well as the underlying biological mechanisms driving these benefits. We conducted a search for interventional and observational cohort studies from MEDLINE and EMBASE up to July 2024. Deliberate exposure of the body to cold water results in distinct physiological responses that may be linked to several health benefits. Evidence, primarily from small interventional studies, suggests that cold water therapy positively impacts cardiometabolic risk factors, stimulates brown adipose tissue and promotes energy expenditure-potentially reducing the risk of cardiometabolic diseases. It also triggers the release of stress hormones, catecholamines and endorphins, enhancing alertness and elevating mood, which may alleviate mental health conditions. Cold water therapy also reduces inflammation, boosts the immune system, promotes sleep and enhances recovery following exercise. The optimal duration and temperature needed to derive maximal benefits is uncertain but current evidence suggests that short-term exposure and lower temperatures may be more beneficial. Overall, cold water therapy presents a potential lifestyle strategy to enhancing physical and mental well-being, promoting healthy aging and extending the healthspan, but definitive interventional evidence is warranted.
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Affiliation(s)
- Setor K Kunutsor
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R2H 2A6, Canada.
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK.
| | - Andrea Lehoczki
- Department of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Wellbeing Services County of Central Finland, Department of Medicine, Finland District, Jyväskylä, Finland
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Moes MI, Elia A, Gennser M, Keramidas ME. Combined effects of mild hypothermia and nitrous-oxide-induced narcosis on manual and cognitive performance. Am J Physiol Regul Integr Comp Physiol 2024; 326:R197-R209. [PMID: 38189165 PMCID: PMC11283895 DOI: 10.1152/ajpregu.00246.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
Divers are at enhanced risk of suffering from acute cognitive deterioration because of the low ambient temperatures and the narcotic action of inert gases inspired at high pressures. Yet, the behavioral effects of cold and inert gas narcosis have commonly been assessed in isolation and during short-term provocations. We therefore evaluated the interactive influence of mild hypothermia and narcosis engendered by a subanesthetic dose of nitrous oxide (N2O; a normobaric intervention analog of hyperbaric nitrogen) on cognitive function during prolonged iterative exposure. Fourteen men partook in two ∼12-h sessions (separated by ≥4 days), wherein they performed sequentially three 120-min cold (20°C) water immersions (CWIs), while inhaling, in a single-blinded manner, either normal air or a normoxic gas mixture containing 30% N2O. CWIs were separated by a 120-min rewarming in room-air breathing conditions. Before the first CWI and during each CWI, subjects performed a finger dexterity test, and the Spaceflight Cognitive Assessment Tool for Windows (WinSCAT) test assessing aspects of attention, memory, learning, and visuospatial ability. Rectal and skin temperatures were, on average, reduced by ∼1.2 °C and ∼8 °C, respectively (P < 0.001). Cooling per se impaired (P ≤ 0.01) only short-term memory (∼37%) and learning (∼18%); the impairments were limited to the first CWI. N2O also attenuated (P ≤ 0.02) short-term memory (∼37%) and learning (∼35%), but the reductions occurred in all CWIs. Furthermore, N2O invariably compromised finger dexterity, attention, concentration, working memory, and spatial processing (P < 0.05). The present results demonstrate that inert gas narcosis aggravates, in a persistent manner, basic and higher-order cognitive abilities during protracted cold exposure.
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Affiliation(s)
- Maaike I Moes
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Antonis Elia
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Mikael Gennser
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Michail E Keramidas
- Division of Environmental Physiology, Swedish Aerospace Physiology Center, KTH Royal Institute of Technology, Stockholm, Sweden
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Barwood MJ, Eglin C, Hills SP, Johnston N, Massey H, McMorris T, Tipton MJ, Wakabayashi H, Webster L. Habituation of the cold shock response: A systematic review and meta-analysis. J Therm Biol 2024; 119:103775. [PMID: 38211547 DOI: 10.1016/j.jtherbio.2023.103775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
Cold water immersion (CWI) evokes the life-threatening reflex cold shock response (CSR), inducing hyperventilation, increasing cardiac arrhythmias, and increasing drowning risk by impairing safety behaviour. Repeated CWI induces CSR habituation (i.e., diminishing response with same stimulus magnitude) after ∼4 immersions, with variation between studies. We quantified the magnitude and coefficient of variation (CoV) in the CSR in a systematic review and meta-analysis with search terms entered to Medline, SportDiscus, PsychINFO, Pubmed, and Cochrane Central Register. Random effects meta-analyses, including effect sizes (Cohen's d) from 17 eligible groups (k), were conducted for heart rate (HR, n = 145, k = 17), respiratory frequency (fR, n = 73, k = 12), minute ventilation (Ve, n = 106, k = 10) and tidal volume (Vt, n = 46, k=6). All CSR variables habituated (p < 0.001) with large or moderate pooled effect sizes: ΔHR -14 (10) bt. min-1 (d: -1.19); ΔfR -8 (7) br. min-1 (d: -0.78); ΔVe, -21.3 (9.8) L. min-1 (d: -1.64); ΔVt -0.4 (0.3) L -1. Variation was greatest in Ve (control vs comparator immersion: 32.5&24.7%) compared to Vt (11.8&12.1%). Repeated CWI induces CSR habituation potentially reducing drowning risk. We consider the neurophysiological and behavioural consequences.
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Affiliation(s)
- Martin J Barwood
- Faculty of Social and Health Sciences, Leeds Trinity University, Horsforth, UK.
| | - Clare Eglin
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Samuel P Hills
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Nicola Johnston
- Faculty of Social and Health Sciences, Leeds Trinity University, Horsforth, UK
| | - Heather Massey
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Terry McMorris
- Department of Sport and Exercise Science, Institute for Sport, University of Chichester, College Lane, Chichester, West Sussex, UK
| | - Michael J Tipton
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Hitoshi Wakabayashi
- Laboratory of Environmental Ergonomics, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Lisa Webster
- Faculty of Social and Health Sciences, Leeds Trinity University, Horsforth, UK
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Mohsenian S, Kouhnavard B, Nami M, Mehdizadeh A, Seif M, Zamanian Z. Effect of temperature reduction of the prefrontal area on accuracy of visual sustained attention. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:1368-1375. [PMID: 36177972 DOI: 10.1080/10803548.2022.2131116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives. Detection of sensitive signs in many work environments with automated systems (aviation industry, flight safety tower, maritime industry, monitoring in the military industry, etc.) is essential and requires constant visual attention. Therefore, the aim of this study was to investigate the effect of forehead cooling on the accuracy of stable visual attention. Methods. This interventional study was performed on 34 male students. The sampling method was a randomized block design. Subjects were assessed by demographic questionnaire, Snellen chart, Spielberger state-trait anxiety inventory (STAI) and physiological and cognitive measurements. Results. Prefrontal cortex (PFC) cooling caused significant changes in sublingual temperature during four measurements in the intervention group. There were no significant changes in heart rate, diastolic blood pressure and saturation of peripheral oxygen (%SpO2) between the two groups. The critical flicker frequency (CFF) as an indicator of cognitive fatigue showed that cognitive improvement after PFC cooling occurred following a reduction in cognitive fatigue. Conclusions. Considering the importance of choosing non-invasive methods to improve the operator's cognitive skills while performing cognitive tasks in the field of neuroergonomics, it can be concluded that PFC cooling is an effective and safe way to improve some cognitive skills such as visual attention.
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Affiliation(s)
- Sajjad Mohsenian
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Nami
- Faculty of Neuroscience, Shiraz University of Medical Sciences, Iran
| | | | - Mojgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Wallace PJ, Gagnon DD, Hartley GL, Taber MJ, Cheung SS. Effects of skin and mild core cooling on cognitive function in cold air in men. Physiol Rep 2023; 11:e15893. [PMID: 38114071 PMCID: PMC10730300 DOI: 10.14814/phy2.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study tested the effects of skin and core cooling on cognitive function in 0°C cold air. Ten males completed a randomized, repeated measures study consisting of four environmental conditions: (i) 30 min of exposure to 22°C thermoneutral air (TN), (ii) 15 min to 0°C cold air which cooled skin temperature to ~27°C (CS), (iii) 0°C cold air exposure causing mild core cooling of ∆-0.3°C from baseline (C-0.3°C) and (iv) 0°C cold air exposure causing mild core cooling of ∆-0.8°C from baseline (C-0.8°C). Cognitive function (reaction time [ms] and errors made [#]) were tested using a simple reaction test, a two-six item working memory capacity task, and vertical flanker task to assess executive function. There were no condition effects (all p > 0.05) for number of errors made on any task. There were no significant differences in reaction time relative to TN for the vertical flanker and item working memory capacity task. However, simple reaction time was slower in C-0.3°C (297 ± 33 ms) and C-0.8°C (296 ± 41 ms) compared to CS (267 ± 26 ms) but not TN (274 ± 38). Despite small changes in simple reaction time (~30 ms), executive function and working memory was maintained in 0°C cold air with up to ∆-0.8°C reduction in core temperature.
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Affiliation(s)
- Phillip J. Wallace
- Environmental Ergonomics Laboratory, Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
| | - Dominique D. Gagnon
- Faculty of Sports and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Clinic for Sports and Exercise Medicine, Department of Sports and Exercise Medicine, Faculty of MedicineUniversity of Helsinki MäkelänkatuHelsinkiFinland
- School of Kinesiology and Health SciencesLaurentian UniversitySudburyOntarioCanada
| | - Geoffrey L. Hartley
- Department of Physical and Health EducationNipissing UniversityNorth BayOntarioCanada
| | - Michael J. Taber
- Environmental Ergonomics Laboratory, Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
- NM Consulting Inc.St. CatharinesOntarioCanada
| | - Stephen S. Cheung
- Environmental Ergonomics Laboratory, Department of KinesiologyBrock UniversitySt. CatharinesOntarioCanada
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Briganti GL, Chesini G, Tarditi D, Serli D, Capodici A. Effects of cold water exposure on stress, cardiovascular, and psychological variables. Acta Physiol (Oxf) 2023; 239:e14056. [PMID: 37840386 DOI: 10.1111/apha.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Giovanni Leonardo Briganti
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulia Chesini
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Tarditi
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Serli
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Capodici
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Zwaag J, Timmerman H, Pickkers P, Kox M. Modulation of Pain Sensitivity by a Hyperventilatory Breathing Exercise and Cold Exposure Training. J Pain Res 2023; 16:1979-1991. [PMID: 37333948 PMCID: PMC10276601 DOI: 10.2147/jpr.s400408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Background Evidence indicates that healthy individuals who follow a training program comprised hyperventilatory breathing exercises and cold exposure can voluntarily activate their sympathetic nervous system and attenuate their systemic inflammatory response during experimental endotoxemia (intravenous administration of bacterial endotoxin). Furthermore, trained participants reported less endotoxemia-induced flu-like symptoms. However, it remained to be determined whether the effects on symptoms are due to the mitigated inflammatory response or involve direct analgesic effects of (elements of) the training program. Methods In the present study, we used Nijmegen-Aalborg Screening Quantitative sensory testing (NASQ) to objectively map pain sensitivity using non-invasive stimuli to address this question. First, NASQ parameters were evaluated in 20 healthy volunteers before, during, and after the conduct of the hyperventilatory breathing exercise. Second, NASQ measurements were performed before and after 48 healthy volunteers followed different modalities of the training program: breathing exercise training, cold exposure training, the combination of both, or no training. Lastly, NASQ measurements were performed in these 48 subjects during experimental endotoxemia. Results Electrical pain detection thresholds increased during the breathing exercise (p = 0.001) as well as four hours afterwards (p = 0.03). Furthermore, cold exposure training resulted in lower VAS scores during hand immersion in ice water (p < 0.001). Systemic inflammation induced by administration of endotoxin nullified the decreased pain perception during the ice water test in subjects trained in cold exposure. Conclusion A hyperventilatory breathing exercise decreases pain perception induced by an electrical stimulus. Furthermore, cold exposure training may decrease pain perception induced by hand immersion in ice water.
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Affiliation(s)
- Jelle Zwaag
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans Timmerman
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Pain Center, Groningen, the Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands
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The Effect of Cold Exposure on Cognitive Performance in Healthy Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189725. [PMID: 34574649 PMCID: PMC8470111 DOI: 10.3390/ijerph18189725] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 01/08/2023]
Abstract
Several aspects of cognition can be affected after cold exposure, but contradictory results have been reported regarding affected cognitive domains. The aim of the current systematic review was to evaluate the effects of specific cold exposure on cognitive performance in healthy subjects. A systematic search was performed using MEDLINE (through PubMed), EMBASE (Scopus) and PsycINFO databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were healthy subjects exposed to a cold environment (either simulated or not) and cognitive performance related to cold exposure with an experimental design. The literature search identified 18 studies, eight studies investigated the effect of cold air exposure and ten the effect of cold water immersion on cognitive performance of healthy subjects. There were several differences among the studies (environmental temperature reached, time of exposure, timing, and type of cognitive test administration). Cold exposure induced in most of the experimental settings (15 of 18) an impairment of CP even before accidental hypothermia was established. The most investigated and affected cognitive domains were attention and processing speed, executive function, and memory. Gender differences and effects of repeated exposure and possible acclimation on cognitive performance need further studies to be confirmed.
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Impact of acute partial-body cryostimulation on cognitive performance, cerebral oxygenation, and cardiac autonomic activity. Sci Rep 2021; 11:7793. [PMID: 33833278 PMCID: PMC8032750 DOI: 10.1038/s41598-021-87089-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
We assessed the effects of a 3-min partial-body cryostimulation (PBC) exposure—where the whole body is exposed to extreme cold, except the head—on cognitive inhibition performance and the possible implications of parasympathetic cardiac control and cerebral oxygenation. In a randomized controlled counterbalanced cross-over design, eighteen healthy young adults (nine males and nine females) completed a cognitive Stroop task before and after one single session of PBC (3-min exposure at − 150 °C cold air) and a control condition (3 min at room temperature, 20 °C). During the cognitive task, heart rate variability (HRV) and cerebral oxygenation of the prefrontal cortex were measured using heart rate monitoring and near-infrared spectroscopy methods. We also recorded the cerebral oxygenation during the PBC session. Stroop performance after PBC exposure was enhanced (562.0 ± 40.2 ms) compared to pre-PBC (602.0 ± 56.4 ms; P < 0.042) in males only, accompanied by an increase (P < 0.05) in HRV indices of parasympathetic tone, in greater proportion in males compared to females. During PBC, cerebral oxygenation decreased in a similar proportion in males and females but the cerebral extraction (deoxyhemoglobin: ΔHHb) remained higher after exposure in males, only. These data demonstrate that a single PBC session enhances the cognitive inhibition performance on a Stroop task in males, partly mediated by a greater parasympathetic cardiac control and greater cerebral oxygenation. The effects of PBC on cognitive function seem different in females, possibly explained by a different sensitivity to cold stimulation.
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