Effects of Heat Removal Through the Hand on Metabolism and Performance During Cycling Exercise in the Heat

Effects of palm cooling on thermoregulatory-related and subjective indicators during exercise in a hot environment

Palm cooling is a simple and easily implemented intervention strategy during exercise. We aimed to examine the effects of bilateral palm cooling before and during exercise on thermoregulatory-related and subjective indicators in a hot environment. Ten active men (age: 21 ± 1 years; height 172.2 ± 5.7 cm; weight 67.4 ± 7.2 kg) underwent three experimental trials at the same time of the day, consisting of palm cooling with 12°C (ICE12°C), palm cooling with 0°C (ICE0°C) where vasoconstriction is supposed to occur, and control (CON) trials. After 30 min rest at ambient temperature, participants performed 20 min exercise at 33°C, 60% relative humidity. Rectal temperature, skin temperature, rate of perceived exertion, heart rate, local sweat rate, oxygen uptake, carbon dioxide production, and respiratory exchange ratio did not differ between the trials. Thermal sensation and comfort were lower in the ICE12°C and ICE0°C trials than in the CON trial, but the ICE0°C trial showed a longer duration of cold sensation than the ICE12°C trial. Palm cooling at 12°C and 0°C improved thermal sensation and thermal comfort during exercise in a hot environment, although there was no effect on core body temperature, sweating, and cardiorespiratory function. Bilateral palm cooling at 12°C and 0°C improve subjective indicators during exercise in a hot environment and these effects are slightly greater at 0°C than at 12°C cooling, while having no effect on thermoregulatory-related indicators. These results suggest that bilateral palm cooling at lower temperatures may safely reduce the perception of warmth during exercise in a hot environment.

Performance Benefits of Pre- and Per-cooling on Self-paced Versus Constant Workload Exercise: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVE

Exercise in hot environments impairs endurance performance. Cooling interventions can attenuate the impact of heat stress on performance, but the influence of an exercise protocol on the magnitude of performance benefit remains unknown. This meta-analytical review compared the effects of pre- and per-cooling interventions on performance during self-paced and constant workload exercise in the heat.

METHODS

The study protocol was preregistered at the Open Science Framework ( https://osf.io/wqjb3 ). A systematic literature search was performed in PubMed, Web of Science, and MEDLINE from inception to 9 June, 2023. We included studies that examined the effects of pre- or per-cooling on exercise performance in male individuals under heat stress (> 30 °C) during self-paced or constant workload exercise in cross-over design studies. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized trials.

RESULTS

Fifty-nine studies (n = 563 athletes) were identified from 3300 records, of which 40 (n = 370 athletes) used a self-paced protocol and 19 (n = 193 athletes) used a constant workload protocol. Eighteen studies compared multiple cooling interventions and were included more than once (total n = 86 experiments and n = 832 paired measurements). Sixty-seven experiments used a pre-cooling intervention and 19 used a per-cooling intervention. Average ambient conditions were 34.0 °C [32.3-35.0 °C] and 50.0% [40.0-55.3%] relative humidity. Cooling interventions attenuated the performance decline in hot conditions and were more effective during a constant workload (effect size [ES] = 0.62, 95% confidence interval [CI] 0.44-0.81) compared with self-paced exercise (ES = 0.30, 95% CI 0.18-0.42, p = 0.004). A difference in performance outcomes between protocols was only observed with pre-cooling (ES = 0.74, 95% CI 0.50-0.98 vs ES = 0.29, 95% CI 0.17-0.42, p = 0.001), but not per-cooling (ES = 0.45, 95% CI 0.16-0.74 vs ES = 0.35, 95% CI 0.01-0.70, p = 0.68).

CONCLUSIONS

Cooling interventions attenuated the decline in performance during exercise in the heat, but the magnitude of the effect is dependent on exercise protocol (self-paced vs constant workload) and cooling type (pre- vs per-cooling). Pre-cooling appears to be more effective in attenuating the decline in exercise performance during a constant workload compared with self-paced exercise protocols, whereas no differences were found in the effectiveness of per-cooling.

Effects of different external cooling placements prior to and during exercise on athletic performance in the heat: A systematic review and meta-analysis

Background: Nowadays, many high-profile international sport events are often held in warm or hot environments, hence, it is inevitable for these elite athletes to be prepared for the challenges from the heat. Owing to internal cooling may cause gastrointestinal discomfort to athletes, external cooling technique seems to be a more applicable method to deal with thermal stress. Central cooling mainly refers to head, face, neck and torso cooling, can help to reduce skin temperature and relieve thermal perception. Peripheral cooling mainly refers to four limbs cooling, can help to mitigate metabolic heat from muscular contrac to effectively prevent the accumulation of body heat. Hence, we performed a meta-analysis to assess the effectiveness of different external cooling placements on athletic performance in the heat Methods: A literatures search was conducted using Web of Science, MEDLINE and SPORTDiscus until September 2022. The quality and risk of bias in the studies were independently assessed by two researchers. Results: 1,430 articles were initially identified (Web of Science = 775; MEDLINE = 358; SPORTDiscus = 271; Additional records identified through other sources = 26), 60 articles (82 experiments) met the inclusion criteria and were included in the final analysis, with overall article quality being deemed moderate. Central cooling (SMD = 0.43, 95% CI 0.27 to 0.58, p < 0.001) was most effective in improving athletic performance in the heat, followed by central and peripheral cooling (SMD = 0.38, 95% CI 0.23 to 0.54, p < 0.001), AND peripheral cooling (SMD = 0.32, 95% CI 0.07 to 0.57, p = 0.013). For the cooling-promotion effects on different sports types, the ranking order in central cooling was ETE (exercise to exhaustion), TT (time-trial), EWT (exercise within the fixed time or sets), IS (intermittent sprint); the ranking order in peripheral cooling was EWT, TT, ETE and IS; the ranking order in central and peripheral cooling was ETE, IS, EWT and TT. Conclusion: Central cooling appears to be an more effective intervention to enhance performance in hot conditions through improvements of skin temperature and thermal sensation, compared to other external cooling strategies. The enhancement effects of peripheral cooling require sufficient re-warming, otherwise it will be trivial. Although, central and peripheral cooling seems to retain advantages from central cooling, as many factors may influence the effects of peripheral cooling to offset the positive effects from central cooling, the question about whether central and peripheral cooling method is better than an isolated cooling technique is still uncertain and needs more researchs to explore it.

An Ice Vest, but Not Single-Hand Cooling, Is Effective at Reducing Thermo-Physiological Strain During Exercise Recovery in the Heat

Sports limit the length of breaks between halves or periods, placing substantial time constraints on cooling effectiveness. This study investigated the effect of active cooling during both time-limited and prolonged post-exercise recovery in the heat. Ten recreationally-active adults (VO2peak 43.6 ± 7.5 ml·kg-1·min-1) were exposed to thermally-challenging conditions (36°C air temperature, 45% RH) while passively seated for 30 min, cycling for 60 min at 51% VO2peak, and during a seated recovery for 60 min that was broken into two epochs: first 15 min (REC0-15) and total 60 min (REC0-60). Three different cooling techniques were implemented during independent recovery trials: (a) negative-pressure single hand-cooling (~17°C); (b) ice vest; and (c) non-cooling control. Change in rectal temperature (T re), mean skin temperature (T ¯ sk ), heart rate (HR), and thermal sensation (TS), as well as mean body temperature (T ¯ b ), and heat storage (S) were calculated for exercise, REC0-15 and REC0-60. During REC0-15, HR was lowered more with the ice vest (-9 [-15 to -3] bts·min-1, p = 0.002) and single hand-cooling (-7 [-13 to -1] bts·min-1, p = 0.021) compared to a non-cooling control. The ice vest caused a greater change inT ¯ sk compared to no cooling (-1.07 [-2.00 to -0.13]°C, p = 0.021) and single-hand cooling (-1.07 [-2.01 to -0.14]°C, p = 0.020), as well as a greater change in S compared to no cooling (-84 [-132 to -37] W, p < 0.0001) and single-hand cooling (-74 [-125 to -24] W, p = 0.002). Across REC0-60, changes inT ¯ b (-0.38 [-0.69 to -0.07]°C, p = 0.012) andT ¯ sk (-1.62 [-2.56 to -0.68]°C, p < 0.0001) were greater with ice vest compared to no cooling. Furthermore, changes in inT ¯ b (-0.39 [-0.70 to -0.08]°C, p = 0.010) andT ¯ sk (-1.68 [-2.61 to -0.74]°C, p < 0.0001) were greater with the ice vest compared to single-hand cooling. Using an ice vest during time-limited and prolonged recovery in the heat aided in a more effective reduction in thermo-physiological strain compared to both passive cooling as well as a single-hand cooling device.

Use of Gloves to Examine Intermittent Palm Cooling's Impact on Rowing Ergometry

ABSTRACT

O'Brien, IT, Kozerski, AE, Gray, WD, Chen, L, Vargas, LJ, McEnroe, CB, Vanhoover, AC, King, KM, Pantalos, GM, and Caruso, JF. Use of gloves to examine intermittent palm cooling's impact on rowing ergometry. J Strength Cond Res 35(4): 931-940, 2021-The aim of this study was to examine the use of gloves on intermittent palm cooling's impact on rowing ergometry workouts. Our methods had subjects (n = 34) complete 3 rowing ergometer workouts of up to 8 2-minute stages separated by 45- or 60-second rests. They were randomized to one of the following treatments per workout: no palm cooling (NoPC), intermittent palm cooling as they rowed (PCex), or intermittent palm cooling as they rowed and post-exercise (PCex&post). Palm cooling entailed intermittent cold (initial temperature: 8.1° C) application and totaled 10 (PCex) and 20 (PCex&post) minutes, respectively. Workouts began with 8 minutes of rest after which pre-exercise data were obtained, followed by a ten-minute warm-up and the workout, and 20 minutes of post-exercise recovery. Numerous physiological and performance variables were collected before, during, and after workouts, and each was analyzed with either a two- or three-way analysis of variance. Our results include, with a 0.05 alpha and a simple effects post hoc, the distance rowed analysis produced a significant workout effect with PCex, PCex&post > NoPC. There were also significant interworkout differences for heart rate (HR) (NoPC > PCex) and blood lactate concentration (NoPC > PCex, PCex&post). We conclude that lower HRs and blood lactate concentrations from intermittent cooling caused subjects to experience less fatigue during those workouts and enabled more work to be performed. Continued research should identify optimal cooling characteristics to expedite body heat removal. Practical applications suggest that intermittent palm cooling administered with gloves enhance performance by abating physiological markers of fatigue.

Ergogenic and Physiological Outcomes Derived From a Novel Skin Cooling Device

ABSTRACT

Gray, WD, Jett, DM, Cocco, AR, Vanhoover, AC, Colborn, CE, Pantalos, GM, Stumbo, J, Quesada, PM, and Caruso, JF. Ergogenic and physiological outcomes derived from a novel skin cooling device. J Strength Cond Res 35(2): 391-403, 2021-Our study's purpose assessed a cooling headband's ergogenic and physiological impacts. Subjects (15 women and 13 men) completed six visits; the final 3 entailed rowing workouts with the following treatment conditions: no head cooling (NoHC), intermittent head cooling during exercise (HCex), and intermittent head cooling during exercise and post-exercise recovery (HCex&post). Data collection occurred at the following times (a) pre-exercise and post-warm-up, (b) between stages of up to eight 2-minute bouts, and (c) at 5, 10, 15, and 20 minutes post-exercise. In addition to distance rowed, thermal, cardiovascular, perceptual, and metabolic measurements were obtained. Results included a small yet significant intertreatment difference (HCex, HCex&post > NoHC) for distance rowed. Our cardiovascular and metabolic indices exhibited sex and time differences but likely did not contribute to the ergogenic effect. Yet, left hand temperatures (LHT) exhibited significant 2-way and 3-way interactions that were the likely source of the ergogenic effect. Auditory canal temperature (AUDT) results suggest the head is sensitive to heat increases, yet LHT data show headband use evoked significantly greater temperature increases at the hand's palmar surface, indicative of heat transfer. We conclude, and our practical applications suggest, the headband's ergogenic effect was manifested by cold-induced vasodilation at the hand's palmar surface, rather than heat losses through the head.

Comparison of two different cooling systems in alleviating thermal and physiological strain during prolonged exercise in the heat

This study compared the efficacy of an ice vest comprising of water (WATER) or a water-carbon (CARBON) emulsion on thermophysiological responses to strenuous exercise in the heat. Twelve male cyclists completed three 50-minute constant workload trials (55% of peak power output, ambient temperature 30.4 ± 0.6°C) with WATER, CARBON, and without ice vest (CONTROL), respectively. The increase in core body temperature (Tcore) was lower in WATER at 40 (-0.49 ± 0.34 °C) and 50 minutes (-0.48 ± 0.48 °C) and in CARBON at 30 (-0.41 ± 0.48 °C), 40 (-0.54 ± 0.51 °C), and 50 minutes (-0.67 ± 0.62 °C) as compared to CONTROL (p < 0.05, ES > 0.8). While heart rate and blood lactate kinetics did not differ between the conditions, statistical main effects in favour of both WATER and CARBON were found for thermal sensation (condition p < 0.001 and interaction p < 0.01) and rating of perceived exertion (condition p < 0.05). Per-cooling with CARBON and WATER similarly reduced Tcore but not physiological strain during prolonged exercise in the heat. Practitioner Summary: Exercise in the heat is characterised by increases in thermophysiological strain. Both per-cooling with a novel carbon-based and a conventional water-based ice vest were shown to reduce core temperature significantly. However, due to its lower mass, the carbon-based system may be recommended especially for weight-bearing sports.

Continuous forearm cooling attenuates gastrointestinal temperature increase during cycling

Hot environmental conditions can challenge thermoregulation resulting in exacerbated heat strain. This study evaluated the influence of continuous inner forearm cooling on gastrointestinal temperature (T_GI) and physiological responses to exercise in hot (30°C) and humid (relative humidity: 70%) conditions. Eleven trained cyclists (seven male age: 37±12 years; four female age: 41±15 years; mean±standard deviation) performed two experimental trials, cycling at 66% of their self-reported functional threshold power (average work rate over an hour of maximum effort cycling; 175±34W) for 45 minutes in an environmental chamber. One trial employed continuous inner forearm cooling (COOL) with 5°C water passing through aluminum heat exchangers, while the other had no cooling (CONTROL). Heat was removed from the body at an average rate of 30.3±6.6W during the COOL trial resulting in an attenuation of T_GI rise (CONTROL: 2.46±0.70, COOL: 2.03±0.63°C·h^-1; p=0.002). The change in heart rate from the 10th minute to the end of exercise, as an indicator of cardiovascular drift, was reduced (CONTROL: 20±7, COOL: 17±6beats·min^-1; p=0.050) and end-exercise thermal comfort was improved in the COOL trial with a trend for reduced rating of perceived exertion (p=0.055). Findings suggest that continuous cooling of the inner forearms can attenuate the rise of T_GI and help mitigate the risk of heat injury during exercise in hot and humid conditions.

Per-Cooling (Using Cooling Systems during Physical Exercise) Enhances Physical and Cognitive Performances in Hot Environments. A Narrative Review

There are many important sport events that are organized in environments with a very hot ambient temperature (Summer Olympics, FIFA World Cup, Tour de France, etc.) and in hot locations (e.g., Qatar). Additionally, in the context of global warming and heat wave periods, athletes are often subjected to hot ambient temperatures. It is known that exercising in the heat induces disturbances that may provoke premature fatigue and negatively affects overall performance in both endurance and high intensity exercises. Deterioration in several cognitive functions may also occur, and individuals may be at risk for heat illnesses. To train, perform, work and recover and in a safe and effective way, cooling strategies have been proposed and have been routinely applied before, during and after exercise. However, there is a limited understanding of the influences of per-cooling on performance, and it is the subject of the present review. This work examines the influences of per-cooling of different areas of the body on performance in terms of intense short-term exercises ("anaerobic" exercises), endurance exercises ("aerobic" exercises), and cognitive functioning and provides detailed strategies that can be applied when individuals train and/or perform in high ambient temperatures.

Hand and torso pre-cooling does not enhance subsequent high-intensity cycling or cognitive performance in heat

The purpose of this study was to compare the separate and combined effects of two practical cooling methods (hand and torso) used prior to exercise on subsequent high-intensity cycling performance in heat. Ten trained male cyclists (V̇O2peak: 65.7 ± 10.7 ml.kg-1.min-1) performed four experimental trials (randomised within-subjects design) involving 30-min of pre-cooling (20-min seated; PRE-COOL, 10 min warm-up; PRE-COOL+WUP), while using a: (1) hand-cooling glove (CG); (2) cooling jacket (CJ); (3) both CG and CJ (CG+J); or (4) no-cooling (NC) control, followed by a cycling race simulation protocol (all performed in 35.0 ± 0.6°C and 56.6 ± 4.5% RH). During the 30-min of pre-cooling, no reductions in core (Tc) or mean skin temperature (Tsk) occurred; however, Tsk remained lower in the CJ and CG+J trials compared to NC and CG (p = 0.002-0.040, d= 0.55-1.01). Thermal sensation ratings also indicated that participants felt "hotter" during NC compared to all other trials during both PRE-COOL and PRE-COOL+WUP (p = 0.001-0.015, d= 1.0-2.19), plus the early stages of exercise (sets 1-2; p = 0.005-0.050, d= 0.56-1.22). Following cooling, no differences were found for absolute Tc and Tsk responses between trials over the entire exercise protocol (p > 0.05). Exercise and cognitive (working memory) performance also did not differ between trials (p = 0.843); however, cognitive performance improved over time in all trials (p < 0.001). In summary, pre-cooling (20-min seated and 10-min warm-up) in heat did not improve subsequent high-intensity cycling performance, cognitive responses and associated thermoregulatory strain (Tc and Tsk) compared to control.

Practical Cooling Strategies During Continuous Exercise in Hot Environments: A Systematic Review and Meta-Analysis

Background

Performing exercise in thermally stressful environments impairs exercise capacity and performance. Cooling during exercise has the potential to attenuate detrimental increases in body temperature and improve exercise capacity and performance.

Objective

The objective of this review was to assess the effectiveness of practical cooling strategies applied during continuous exercise in hot environments on body temperature, heart rate, whole body sweat production, rating of perceived exertion (RPE), thermal perception and exercise performance.

Methods

Electronic database searches of MEDLINE, SPORTDiscus, Scopus and Physiotherapy Evidence Database (PEDro) were conducted using medical subject headings, indexing terms and keywords. Studies were eligible if participants were defined as ‘healthy’, the exercise task was conducted in an environment ≥25 °C, it used a cooling strategy that would be practical for athletes to use during competition, cooling was applied during a self-paced or fixed-intensity trial, participants exercised continuously, and the study was a randomised controlled trial with the comparator either a thermoneutral equivalent or no cooling. Data for experimental and comparator groups were meta-analysed and expressed as a standardised mean difference and 95 % confidence interval.

Results

Fourteen studies including 135 participants met the eligibility criteria. Confidence intervals for meta-analysed data included beneficial and detrimental effects for cooling during exercise on core temperature, mean skin temperature, heart rate and sweat production during fixed-intensity exercise. Cooling benefited RPE and thermal perception during fixed-intensity exercise and improved self-paced exercise performance.

Conclusion

Cooling during fixed-intensity exercise, particularly before a self-paced exercise trial, improves endurance performance in hot environments by benefiting RPE and thermal perception, but does not appear to attenuate increases in body temperature.

Effect of wrist cooling on aerobic and anaerobic performance in elite sportsmen

BACKGROUND

Body cooling has been used to increase sporting performance and enhance recovery. Several studies have reported improvement in exercise capacities using forearm and hand cooling or only hand cooling. Wrist cooling has emerged as a portable light weight solution for precooling prior to sporting activity. The Astrand test for aerobic performance and the Wingate test for anaerobic performance are reliable and accurate tests for performance assessment. This study conducted on elite Indian athletes analyses the effects of wrist precooling on aerobic and anaerobic performance as tested by the Astrand test and the Wingate test before and after wrist precooling.

METHODS

67 elite sportsmen were administered Wingate and Astrand test under standardised conditions with and without wrist precooling using a wrist cooling device (dhamaSPORT). Paired t-test was applied to study effect on aerobic [VO2 (ml/min/kg)] and anaerobic performance [peak power (W/kg) and average power (W/kg)] and Cohen's d was used to calculate effect size of wrist precooling.

RESULTS

After wrist precooling, significant increase of 0.22 (p = 0.014, 95% CI: 0.047, 0.398) in peak power (W/kg) and 0.22 (p < 0.0001, 95% CI: 0.142, 0.291) was observed in average power (W/kg). Although, an increase of 1.38 (p = 0.097, 95% CI: -0.225, 3.012) was observed in VO2 (ml/min/kg), wrist precooling was not significantly effective in aerobic performance. Wrist cooling effect size was smaller in VO2 (Cohen's d = 0.21), peak power (Cohen's d = 0.31) and it was larger in average power (Cohen's d = 0.71).

CONCLUSION

Results show wrist precooling significantly improves anaerobic than aerobic performance of elite sportsmen.

Thermoregulatory and Perceptual Effects of a Percooling Garment Worn Underneath an American Football Uniform

Keen, ML, Miller, KC, and Zuhl, MN. Thermoregulatory and perceptual effects of a percooling garment worn underneath an American football uniform. J Strength Cond Res 31(11): 2983-2991, 2017-American football athletes are at the highest risk of developing exertional heat illness (EHI). We investigated whether percooling (i.e., cooling during exercise) garments affected perceptual or physiological variables in individuals exercising in the heat while wearing football uniforms. Twelve male participants (age = 24 ± 4 year, mass = 80.1 ± 8.5 kg, height = 182.5 ± 10.4 cm) completed this cross-over, counterbalanced study. On day 1, we measured peak oxygen consumption (V[Combining Dot Above]O2). On days 2 and 3, participants wore percooling garments with (ICE) or without (CON) ice packs over the femoral and brachial arteries. They donned a football uniform and completed 3, 20-minute bouts of treadmill exercise at ∼50% of peak V[Combining Dot Above]O2 (∼33° C, ∼42% relative humidity) followed by a 10-minute rest period. Ice packs were replaced every 20 minutes. Rating of perceived exertion (RPE), thermal sensation, and thirst sensation were measured before and after each exercise bout. Environmental symptoms questionnaire (ESQ) responses and urine specific gravity (Usg) were measured pretesting and after the last exercise bout. V[Combining Dot Above]O2, change in heart rate (ΔHR), and change in rectal temperature (ΔTrec) were measured every 5 minutes. Sweat rate, sweat volume, and percent hypohydration were calculated. No interactions (F17,187 ≤ 1.6, p ≥ 0.1) or main effect of cooling condition (F1,11 ≤ 1.4, p ≥ 0.26) occurred for ΔTrec, ΔHR, thermal sensation, thirst, RPE, ESQ, or Usg. No differences between conditions occurred for sweat volume, sweat rate, or percent hypohydration (t11 ≤ 0.7, p ≥ 0.25). V[Combining Dot Above]O2 differed between conditions over time (F15,165 = 3.3, p < 0.001); ICE was lower than CON at 30, 55, and 70 minutes (p ≤ 0.05). It is unlikely that these garments would prevent EHI or minimize dehydration in football athletes.

Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations

Exercise-induced increases in core body temperature could negative impact performance and may lead to development of heat-related illnesses. The use of cooling techniques prior (pre-cooling), during (per-cooling) or directly after (post-cooling) exercise may limit the increase in core body temperature and therefore improve exercise performance. The aim of the present review is to provide a comprehensive overview of current scientific knowledge in the field of pre-cooling, per-cooling and post-cooling. Based on existing studies, we will discuss 1) the effectiveness of cooling interventions, 2) the underlying physiological mechanisms and 3) practical considerations regarding the use of different cooling techniques. Furthermore, we tried to identify the optimal cooling technique and compared whether cooling-induced performance benefits are different between cool, moderate and hot ambient conditions. This article provides researchers, physicians, athletes and coaches with important information regarding the implementation of cooling techniques to maintain exercise performance and to successfully compete in thermally stressful conditions.

Effect of hand cooling on body temperature, cardiovascular and perceptual responses during recumbent cycling in a hot environment

The purpose of this study was to quantify physiological and perceptual responses to hand immersion in water during recumbent cycling in a hot environment. Seven physically active males (body mass 79.8 ± 6.3 kg; stature 182 ± 5 cm; age 23 ± 3 years) immersed their hands in 8, 14 and 34°C water whilst cycling at an intensity (W) equivalent to 50% [Formula: see text]O_2peak for 60 min in an environmental chamber (35°C, 50% relative humidity). 8 and 14°C water attenuated an increase in body temperature, and lowered cardiorespiratory and skin blood flow demands. These effects were considered to be practically beneficial (standardised effect size > 0.20). There was a tendency for 8 and 14°C to extend exercise duration versus 34°C (>7%). Heart rate, intestinal, mean skin and mean body temperature were less in 8°C compared to 14°C; these differences were considered practically beneficial. Augmented heat loss at the palm-water surface might enable cooler blood to return to the body and limit physiological strain. These findings provide a mechanistic basis for continuous hand cooling and indicate that endurance exercise in hot environments could be improved using this method. Future research should investigate its effectiveness during cycling and running performance.

Effect of body cooling on subsequent aerobic and anaerobic exercise performance: a systematic review

Body cooling has become common in athletics, with numerous studies looking at different cooling modalities and different types of exercise. A search of the literature revealed 14 studies that measured performance following cooling intervention and had acceptable protocols for exercise and performance measures. These studies were objectively analyzed with the Physiotherapy Evidence Database (PEDro) scale, and 13 of the studies were included in this review. These studies revealed that body cooling by various modalities had consistent and greater impact on aerobic exercise performance (mean increase in performance = 4.25%) compared to anaerobic (mean increase in performance = 0.66%). Different cooling modalities, and cooling during different points during an exercise protocol, had extremely varied results. In conclusion, body cooling seems to have a positive effect on aerobic performance, although the impact on anaerobic performance may vary and often does not provide the same positive effect.

Palm cooling does not reduce heat strain during exercise in a hot, dry environment

To compare the effectiveness of the rapid thermal exchange device (RTX) in slowing the development of hyperthermia and associated symptoms among hand immersed in water bath (WB), water-perfused vest (WPV), and no cooling condition (NC). Ten subjects performed 4 heat stress trials. The protocol consisted of 2 bouts of treadmill walking, separated by a cooling-rehydration period. The times to reach the predetermined rectal temperature in the first (38.5 degrees C) and second bouts (39 degrees C) were not different among RTX, NC, and WB, but was longer for the WPV in both bouts (p<0.05). Heat storage was significantly lower for WPV only in the first bout vs. the other conditions (p<0.05). Heart rate (HR) was not different at 10, 20, and 30 min during the first bout among RTX, NC, and WB, but was lower for WPV (p<0.05). HR was not different among conditions during the second bout. The RTX was not effective in slowing the development of hyperthermia.

Heat loss through the glabrous skin surfaces of heavily insulated, heat-stressed individuals

Insulation reduces heat exchange between a body and the environment. Glabrous (nonhairy) skin surfaces (palms of the hands, soles of the feet, face, and ears) constitute a small percentage of total body surface area but contain specialized vascular structures that facilitate heat loss. We have previously reported that cooling the glabrous skin surfaces is effective in alleviating heat stress and that the application of local subatmospheric pressure enhances the effect. In this paper, we compare the effects of cooling multiple glabrous skin surfaces with and without vacuum on thermal recovery in heavily insulated heat-stressed individuals. Esophageal temperatures (T(es)) and heart rates were monitored throughout the trials. Water loss was determined from pre- and post-trial nude weights. Treadmill exercise (5.6 km/h, 9-16% slope, and 25-45 min duration) in a hot environment (41.5 degrees C, 20-30% relative humidity) while wearing insulating pants and jackets was used to induce heat stress (T(es)>or=39 degrees C). For postexercise recovery, the subjects donned additional insulation (a balaclava, winter gloves, and impermeable boot covers) and rested in the hot environment for 60 min. Postexercise cooling treatments included control (no cooling) or the application of a 10 degrees C closed water circulating system to (a) the hand(s) with or without application of a local subatmospheric pressure, (b) the face, (c) the feet, or (d) multiple glabrous skin regions. Following exercise induction of heat stress in heavily insulated subjects, the rate of recovery of T(es) was 0.4+/-0.2 degrees C/h(n=12), but with application of cooling to one hand, the rate was 0.8+/-0.3 degrees C/h(n=12), and with one hand cooling with subatmospheric pressure, the rate was 1.0+/-0.2 degrees C/h(n=12). Cooling alone yielded two responses, one resembling that of cooling with subatmospheric pressure (n=8) and one resembling that of no cooling (n=4). The effect of treating multiple surfaces was additive (no cooling, DeltaT(es)=-0.4+/-0.2 degrees C; one hand, -0.9+/-0.3 degrees C; face, -1.0+/-0.3 degrees C; two hands, -1.3+/-0.1 degrees C; two feet, -1.3+/-0.3 degrees C; and face, feet, and hands, -1.6+/-0.2 degrees C). Cooling treatments had a similar effect on water loss and final resting heart rate. In heat-stressed resting subjects, cooling the glabrous skin regions was effective in lowering T(es). Under this protocol, the application of local subatmospheric pressure did not significantly increase heat transfer per se but, presumably, increased the likelihood of an effect.

A new hand-cooling device to enhance firefighter heat strain recovery

This study tested a new portable cooling device for fire fighting recovery. Participants (N = 8) walked and did arm curls (time-weighted VO(2): 1.6 L x min(-1) on a treadmill for 40 min in a heated chamber (wet bulb globe temperature: 33.7 degrees C; relative humidity: 40-45%) while wearing firefighter turn-out gear and self-contained breathing apparatus (SCBA). Immediately on finishing exercise, participants recovered for 40 min with either a hand-cooling device or seated passive recovery at an ambient temperature of 22 degrees C, 35% RH in a repeated-measures counterbalanced design. The cooling device had little impact on recovery during the first 30 min; however, compared with passive cooling, the cooling device resulted in significantly lower rectal temperature (T(re)) during the last 10 min. Relative to starting T(re) of the recovery period, Delta T(re) at 35 min had fallen 0.51 +/- 0.19 degrees C (passive) and 0.76 +/- 0.30 degrees C (active) (p = 0.03); and at 40 min Delta T(re) had fallen 0.63 +/- 0.17 degrees C (passive) and 0.88 +/- 0.31 degrees C (active) (p = 0.03). Cooling capacity of the device calculated from Delta T(re) over the whole recovery period averaged about 144% of passive. Reductions in heat storage enhance worker safety and performance in hot environments.

The effectiveness of hand cooling at reducing exercise-induced hyperthermia and improving distance-race performance in wheelchair and able-bodied athletes

The purpose of this study was to examine the effectiveness of reducing core temperature in postexercise hyperthermic subjects and to assess if hand cooling (HC) improves subsequent timed distance performance. Following a detailed measurement check on the use of insulated auditory canal temperature (Tac), eight wheelchair (WA) athletes and seven male able-bodied (AB) athletes performed two testing sessions, comprising a 60-min exercise protocol and 10-min recovery period, followed by a performance trial (1 km and 3 km for WA and AB, respectively) at 30.8°C (SD 0.2) and 60.6% (SD 0.2) relative humidity. In a counterbalanced order, HC and a no-cooling condition was administered during the 10-min recovery period before the performance trial. Nonsignificant condition × time interactions for both WA ( F15,75 = 1.5, P = 0.14) and AB ( F15,90 = 1.2, P = 0.32) confirmed that the exercise-induced changes (Δ) in Tac were similar before each intervention. However, the exercise-induced increase was evidently greater in AB compared with WA (2.0 vs. 1.3°C change, respectively). HC produced ΔTac of −0.4°C (SD 0.4) and −1.2°C (SD 0.2) in comparison (WA and AB, respectively), and simple-effects analyses suggested that the reductions in Tac were noteworthy after 4 min of HC. HC had an impact on improving AB performances by −4.0 s (SD 11.5) ( P < 0.05) and WA by −20.5 s (SD 24.2) ( P > 0.05). In conclusion, extraction of heat through the hands was effective in lowering Tac in both groups and improving 3-km performance in the AB athletes and trends toward positive gains for the 1-km performance times of the WA group.

Cooling via one hand improves physical performance in heat-sensitive individuals with multiple sclerosis: a preliminary study

Background

Many individuals afflicted with multiple sclerosis (MS) experience a transient worsening of symptoms when body temperature increases due to ambient conditions or physical activity. Resulting symptom exacerbations can limit performance. We hypothesized that extraction of heat from the body through the subcutaneous retia venosa that underlie the palmar surfaces of the hands would reduce exercise-related heat stress and thereby increase the physical performance capacity of heat-sensitive individuals with MS.

Methods

Ten ambulatory MS patients completed one or more randomized paired trials of walking on a treadmill in a temperate environment with and without cooling. Stop criteria were symptom exacerbation and subjective fatigue. The cooling treatment entailed inserting one hand into a rigid chamber through an elastic sleeve that formed an airtight seal around the wrist. A small vacuum pump created a -40 mm Hg subatmospheric pressure enviinside the chamber where the palmar surface of the hand rested on a metal surface maintained at 18–22°C. During the treatment trials, the device was suspended from above the treadmill on a bungee cord so the subjects could comfortably keep a hand in the device without having to bear its weight while walking on the treadmill.

Results

When the trials were grouped by treatment only, cooling treatment increased exercise durations by 33% (43.6 ± 17.1 min with treatment vs. 32.8 ± 10.9 min. without treatment, mean ± SD, p < 5.0·10^-6, paired t-test, n = 26). When the average values were calculated for the subjects who performed multiple trials before the treatment group results were compared, cooling treatment increased exercise duration by 35% (42.8 ± 16.4 min with treatment vs. 31.7 ± 9.8 min. without treatment, mean ± SD, p < 0.003, paired t-test, n = 10).

Conclusion

These preliminary results suggest that utilization of the heat transfer capacity of the non-hairy skin surfaces can enable temperature-sensitive individuals with MS to extend participation in day-to-day physical activities despite thermally stressful conditions. However, systematic longitudinal studies in larger cohorts of MS patients with specific deficits and levels of disability conducted under a variety of test conditions are needed to confirm these preliminary findings.

Heat exposure control using non-refrigerated water in Brazilian steel factory workers

To test an economically reasonable method to reduce thermal stress, we performed an alternated intervention-control study on 2 groups of 8 male steel workers performing the same jobs, using 2 l of water at ambient temperature (23.5 degrees C +/- 1.4), poured on the head and hands. Each group participated for 2 d as control and 2 d as intervention during 4 consecutive summer days in Brazil, 5 h per shift per day. Testing was done by: 1) recording of temperature by thermistors placed on the external ear canal through earplug, skin (chest, upper arm, inner thigh, outer calf) and clothes; 2) recording of heart rate; and 3) Wet Bulb Globe Temperature recording. The intervention was held hourly, when body weight and water intake were evaluated. Symptoms and subjective sensations were evaluated in the beginning and at the end of each shift. No differences were observed in external ear canal and skin temperatures. Subjective thermal sensation (p = 0.018), sweat perception (p = 0.043), and tiredness (p = 0.028) presented positive statistically significant results when comparing intervention to control measurements. In conclusion, our results could not provide evidence that the proposed method cools the analyzed temperatures, although the subjective evaluation suggests a decrease in the head skin temperature, which could be a useful comfort measure.

Thermoregulation in elite athletes

PURPOSE OF REVIEW

Exercise causes body temperature to rise and the resulting heat stored becomes a factor limiting exercise performance in hot conditions. Loss of heat by evaporative processes leads to hypohydration which itself can eventually impair performance. This review focuses on thermoregulatory and behavioural processes during sustained exercise in the heat.

RECENT FINDINGS

Several studies have implicated cerebral mechanisms in eschewing fatigue due to heat stress. Acclimatization improves performance by affecting heat loss mechanisms, implicating peripheral and central processes. Pharmacological methods of increasing heat tolerance are unacceptable strategies for the athlete, but appropriate precooling measures are effective.

SUMMARY

This review highlights the combination of physiological processes that converge in heat stress during extended exercise. Pharmacological ergogenic aids are discouraged due to likely side effects in cerebral function whereas behavioural measures, including precooling the body, have practical support.

Heat extraction through the palm of one hand improves aerobic exercise endurance in a hot environment

In situations where the accumulation of internal heat limits physical performance, enhanced heat extraction from the body should improve performance capacity. The combined application of local subatmospheric pressure (35–45 mmHg) to an entire hand (to increase blood volume) and a heat sink (18–22°C) to the palmar surface were used to draw heat out of the circulating blood. Subjects walked uphill (5.63 km/h) on a treadmill in a 40°C environment. Slopes of the treadmill were held constant during paired experimental trials (with and without the device). Heat extraction attenuated the rate of esophageal temperature rise during exercise (2.1 ± 0.4° and 2.9 ± 0.5°C/h, mean ± SE, with and without the device, respectively; n = 8) and increased exercise duration (46.1 ± 3.4 and 32.3 ± 1.7 min with and without the device, respectively; n = 18). Hand cooling alone had little effect on exercise duration (34.1 ± 3.0, 38.0 ± 3.5, and 57.0 ± 6.4 min, for control, cooling only, and cooling, and subatmospheric pressure, respectively; n = 6). In a longer term study, nine subjects participated in two or four trials per week for 8 wk. The individual workloads (treadmill slope) were varied weekly. Use of the device had a beneficial effect on exercise endurance at all workloads, but the benefit proportionally decreased at higher workloads. It is concluded that heat can be efficiently removed from the body by using the described technology and that such treatment can provide a substantial performance benefit in thermally stressful conditions.