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

McDermott, Brendon P.; Casa, Douglas J.; Ganio, Matthew S.; Lopez, Rebecca M.; Yeargin, Susan W.; Armstrong, Lawrence E.; Maresh, Carl M.

doi:10.4085/1062-6050-44.1.84

Cited by 181 publications

(194 citation statements)

References 21 publications

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“…3,12,13,16 We demonstrated that the CS treatment produced faster cooling rates than no treatment; however, the rate of cooling was slower than that produced by currently recommended techniques. 3 We analyzed temperature responses to the treatment protocols using both T re throughout treatment and overall cooling rates. The rates of cooling during each protocol allowed for a more robust analysis as they incorporated changes in T re , thereby reducing variability.…”

Section: Discussionmentioning

confidence: 76%

“…The most severe exertional heat illness is exertional heat stroke (EHS), characterized by a core temperature above 408C and concomitant central nervous system dysfunction. [1][2][3][4][5] Early recognition and treatment of EHS yields the best possible patient outcomes. 6 Decreasing core temperature below 408C as quickly as possible reduces the likelihood of organ damage and concomitantly increases the rate of survival.…”

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confidence: 99%

“…1,9,10 Cooling rates of EHS patients using CWI (0.228C/ min) 5 demonstrate consistency with those reported in hyperthermic research participants (0.198C/min). 3 Unfortunately, a large tub for CWI may not be available at all facilities due to monetary or spatial restrictions. Most athletic venues, however, have water access via a hose or an adjacent locker room with showers.…”

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confidence: 99%

“…Even with the addition of fanning or an intravenous fluid infusion, cooling rates varied considerably from acceptable (0.088C/min-0.158C/min) to unacceptable (,0.088C/min). 3 In a single publication, 13 altering the coverage of the patient with water while fanning resulted in cooling rates ranging from 0.088C/min to 0.278C/min. Given these varied patient responses, continued investigation is needed.…”

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confidence: 99%

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Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Butts

McDermott

Buening

et al. 2016

Journal of Athletic Training

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Context: Exercise conducted in hot, humid environments increases the risk for exertional heat stroke (EHS). The current recommended treatment of EHS is cold-water immersion; however, limitations may require the use of alternative resources such as a cold shower (CS) or dousing with a hose to cool EHS patients.Objective: To investigate the cooling effectiveness of a CS after exercise-induced hyperthermia.Design: Randomized, crossover controlled study. Setting: Environmental chamber (temperature ¼ 33.48C 6 2.18C; relative humidity ¼ 27.1% 6 1.4%).Patients or Other Participants: Seventeen participants (10 male, 7 female; height ¼ 1.75 6 0.07 m, body mass ¼ 70.4 6 8.7 kg, body surface area ¼ 1.85 6 0.13 m 2 , age range ¼ 19-35 years) volunteered.Intervention(s): On 2 occasions, participants completed matched-intensity volitional exercise on an ergometer or treadmill to elevate rectal temperature to 398C or until participant fatigue prevented continuation (reaching at least 38.58C). They were then either treated with a CS (20.88C 6 0.808C) or seated in the chamber (control [CON] condition) for 15 minutes.Main Outcome Measure(s): Rectal temperature, calculated cooling rate, heart rate, and perceptual measures (thermal sensation and perceived muscle pain).Results: The rectal temperature (P¼ .98), heart rate (P¼ .85), thermal sensation (P ¼ .69), and muscle pain (P ¼ .31) were not different during exercise for the CS and CON trials (P . .05). Overall, the cooling rate was faster during CS (0.078C/min 6 0.038C/min) than during CON (0.048C/min 6 0.038C/min; t 16 ¼ 2.77, P ¼ .01). Heart-rate changes were greater during CS (45 6 20 beats per minute) compared with CON (27 6 10 beats per minute; t 16 ¼ 3.32, P ¼ .004). Thermal sensation was reduced to a greater extent with CS than with CON (F 3,45 ¼ 41.12, P , .001).Conclusions: Although the CS facilitated cooling rates faster than no treatment, clinicians should continue to advocate for accepted cooling modalities and use CS only if no other validated means of cooling are available.Key Words: heat stress, exertional heat illness, whole-body cooling, water dousing Key PointsThe use of a cold shower to treat exertional hyperthermia was more effective than no treatment. The cooling rates elicited via the cold shower technique were deemed unacceptable when compared with the goldstandard treatment of cold-water immersion. Clinicians should continue to advocate for appropriate cold-water immersion resources. However, if cold-water immersion is not available, the cold shower technique should be used to treat patients with exertional heat illness as a last resort.

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Section: Discussionmentioning

confidence: 76%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Butts

McDermott

Buening

et al. 2016

Journal of Athletic Training

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“…Although some debate exists concerning the safest and most effective method of cooling the athlete, most studies indicate that water bath immersion produces the fastest decrease in core temperature [31]. Controversy also exists concerning the most appropriate temperature of the water bath [32].…”

Section: Exertional Heatstrokementioning

confidence: 99%

Collapsed athlete – atraumatic

Wen

2014

Curr Rev Musculoskelet Med

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There are several potential causes for an athlete to collapse without trauma on the playing or practice field. Fortunately, most of the time the etiology is benign and recovery is rapid and uneventful. However, when faced with a collapsed athlete, medical personnel need to be prepared for life-threatening conditions until these conditions are ruled out. The most common cause of atraumatic sudden death in athletes is cardiac arrest, usually because of a variety of underlying cardiac conditions. Immediate initiation of CPR with rapid AED use can be the key to survival. Rectal temperature can detect possible heat stroke with need for immediate cooling instituted prior to athlete transport. Exertional hyponatremia is another cause of life-threatening collapse in prolonged endurance events such as marathons and triathlons.

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Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

Bleakley

McDonough

Gardner

et al. 2012

Cochrane Database of Systematic Reviews

116

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BACKGROUND: Many strategies are in use with the intention of preventing or minimizing delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15 °C, is currently one of the most popular interventional strategies used after exercise. OBJECTIVES: To determine the effects of cold-water immersion in the management of muscle soreness after exercise. SEARCH METHODS: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), Medline, Embase, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts. In November 2011, we updated the searches of Central (2011, Issue 4), Medline (up to November Week 3 2011), Embase (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications. SELECTION CRITERIA: Randomized and quasi-randomized trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warmwater immersion, active recovery, compression, or a different duration/ dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms). DATA COLLECTION AND ANALYSIS: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model. MAIN RESULTS: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events. Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardized mean difference, SMD-0.55, 95% CI-0.84 to-0.27; 10 trials), 48 hour (SMD-0.66, 95% CI-0.97 to-0.35; 8 trials), 72 hour (SMD-0.93; 95% CI-1.36 to-0.51; 4 trials) and 96 hour (SMD-0.58; 95% CI-1.00 to-0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running-based exercises showed significantly larger effects in favour of coldwater immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD-1.70; 95% CI-2.49 to-0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery...

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

Cited by 181 publications

References 21 publications

Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia

Collapsed athlete – atraumatic

Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

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