Effects of a Reduction in Environmental Temperature on the Circulatory Response to Exercise in Man

Se, Epstein; Stampfer, Morris; Gd, Beiser; Re, Goldstein; Braunwald, Eugene

doi:10.1056/nejm196901022800102

Cited by 96 publications

(41 citation statements)

References 14 publications

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“…Early studies attributed cold-induced angina to sympathetic activation, resulting in increased peripheral vascular resistance and blood pressure, and leading to a greater cardiac workload (increased rate-pressure product) for any given exercise intensity (1,10). In the present study, we did not find any significant difference in heart rate or rate-pressure product at any time point between the exercise tests performed at +20°C and at -20°C.…”

Section: Discussioncontrasting

confidence: 62%

“…The potentially conflicting results regarding hemodynamic responses to cold may be explained by several factors. First, various cold stimuli have been used, including environmental cold (1,3,10,11,13,14), cold air inhalation (9,12,15), regional cutaneous cold exposure (cold pressure test) (2,8,16,17) or a combination of the above (16,17). It is now understood that the cold pressure test cannot be used to simulate hemodynamic responses during exercise in cold weather because exercise abolishes the abnormal increase in coronary resistance induced by the cold pressure test in CAD patients (18).…”

Section: Discussionmentioning

confidence: 99%

“…xposure to cold temperature has been shown to precipitate angina pectoris in approximately 40% of patients with symptomatic coronary artery disease (CAD) (1)(2)(3). In addition, emerging data suggest that extreme cold is associated with an increased risk of myocardial infarction and sudden cardiac death (4,5).…”

mentioning

confidence: 99%

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Exposure to extreme cold lowers the ischemic threshold in coronary artery disease patients

Meyer

Guiraud

Curnier

et al. 2010

Canadian Journal of Cardiology

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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Exposure to extreme cold lowers the ischemic threshold in coronary artery disease patients

Meyer

Guiraud

Curnier

et al. 2010

Canadian Journal of Cardiology

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“…While there is no direct evidence to confirm this, other studies using exercise in conjunction with whole body cold exposure have reported similar findings in patients with coronary artery disease. Specifically, submaximal exercise performance (7), time to ischemia (33,41), and O 2 demand (7,16,33) were higher when exercise was performed in a cold environmental chamber. To our knowledge, the present study is the first to demonstrate that the cold ϩ grip protocol causes an augmented RPP response and an attenuated CBV response in young healthy subjects.…”

Section: Discussionmentioning

confidence: 98%

Effect of cold air inhalation and isometric exercise on coronary blood flow and myocardial function in humans

Muller

Gao

Drew

et al. 2011

Journal of Applied Physiology

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Muller MD, Gao Z, Drew RC, Herr MD, Leuenberger UA, Sinoway LI. Effect of cold air inhalation and isometric exercise on coronary blood flow and myocardial function in humans. J Appl Physiol 111: 1694 -1702, 2011. First published September 22, 2011 doi:10.1152/japplphysiol.00909.2011.-The effects of cold air inhalation and isometric exercise on coronary blood flow are currently unknown, despite the fact that both cold air and acute exertion trigger angina in clinical populations. In this study, we used transthoracic Doppler echocardiography to measure coronary blood flow velocity (CBV; left anterior descending coronary artery) and myocardial function during cold air inhalation and handgrip exercise. Ten young healthy subjects underwent the following protocols: 5 min of inhaling cold air (cold air protocol), 5 min of inhaling thermoneutral air (sham protocol), 2 min of isometric handgrip at 30% of maximal voluntary contraction (grip protocol), and 5 min of isometric handgrip at 30% maximal voluntary contraction while breathing cold air (cold ϩ grip protocol). Heart rate, blood pressure, inspired air temperature, CBV, myocardial function (tissue Doppler imaging), O2 saturation, and pulmonary function were measured. The rate-pressure product (RPP) was used as an index of myocardial O2 demand, whereas CBV was used as an index of myocardial O2 supply. Compared with the sham protocol, the cold air protocol caused a significantly higher RPP, but there was a significant reduction in CBV. The cold ϩ grip protocol caused a significantly greater increase in RPP compared with the grip protocol (P ϭ 0.045), but the increase in CBV was significantly less (P ϭ 0.039). However, myocardial function was not impaired during the cold ϩ grip protocol relative to the grip protocol alone. Collectively, these data indicate that there is a supply-demand mismatch in the coronary vascular bed when cold ambient air is breathed during acute exertion but myocardial function is preserved, suggesting an adequate redistribution of blood flow. blood pressure; sympathetic nervous system; oxygen consumption; handgrip EXPOSURE TO COLD TEMPERATURES causes many physiological adjustments, most of which help prevent a fall in core body temperature. Specifically, peripheral vasoconstriction and shivering both raise blood pressure and effectively increase the work of the heart. These are known triggers of angina in clinical populations (33). Cardiac death is highest in the winter months, even in people who spend little time outdoors (45,54). While the effects of lowered skin temperature on cardiovascular function have been extensively studied (10,29,59,60), other mechanisms likely play a role in this process.Physical perturbation of the oropharynx and larynx elevates blood pressure in clinical settings (18,34), and laryngeal cold receptors have been identified in animals (38, 51). Previous studies (26,28,35,37) have shown that blood pressure, heart rate, and/or muscle sympathetic nerve activity are increased with cold air breathing in healthy humans. Acu...

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“…This increased stress is in contrast to the demands of rest and exercise in warm environments. 108,109 Therefore, individuals with diminished cardiovascular system function should be cautious when exercising in the cold and should be monitored closely for symptoms associated with a myocardial infarction.…”

Section: Predisposing Medical Conditionsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Environmental Cold Injuries

Cappaert

Stone²,

Castellani

et al. 2008

Journal of Athletic Training

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Objective: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.Background: Individuals engaged in sport-related or workrelated physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk.Recommendations: These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.

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Effects of a Reduction in Environmental Temperature on the Circulatory Response to Exercise in Man

Cited by 96 publications

References 14 publications

Exposure to extreme cold lowers the ischemic threshold in coronary artery disease patients

Exposure to extreme cold lowers the ischemic threshold in coronary artery disease patients

Effect of cold air inhalation and isometric exercise on coronary blood flow and myocardial function in humans

National Athletic Trainers' Association Position Statement: Environmental Cold Injuries

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