Winter sports athletes: long-term effects of cold air exposure

Abstract

Athletes such as skaters and skiers inhale large volumes of cold air during exercise and shift from nasal to mouth breathing. Endurance athletes, like cross-country skiers, perform at 80% or more of their maximal oxygen consumption and have minute ventilations in excess of 100 l/min. Cold air is always dry, and endurance exercise results in loss of water and heat from the lower respiratory tract. In addition, athletes can be exposed to indoor and outdoor pollutants during the competitive season and during all-year training. Hyperpnoea with cold dry air represents a significant environmental stress to the airways. Winter athletes have a high prevalence of respiratory symptoms and airway hyper-responsiveness to methacholine and hyperpnoea. The acute effects of exercise in cold air are neutrophil influx as demonstrated in lavage fluid and airway epithelial damage as demonstrated by bronchoscopy. Upregulation of pro-inflammatory cytokines has been observed in horses. Chronic endurance training damages the epithelium of the small airways in mice. Airway inflammation has been observed on bronchoscopy of cross-country skiers and in dogs after a 1100-mile endurance race in Alaska. Neutrophilic and lymphocytic inflammation with remodelling is present in bronchial biopsies from skiers. Repeated peripheral airway hyperpnoea with dry air causes inflammation and remodelling in dogs. As it is currently unknown if these airway changes are reversible upon cessation of exposure, preventive measures to diminish exposure of the lower airways to cold air should be instituted by all winter sports athletes.

Sports injuries and illnesses during the 2015 Winter European Youth Olympic Festival

“…In contrast, comparing the traditional summer Olympic Games in London 20125 and winter Olympic Games in Sochi 2014,4 no differences within injury frequency (11% vs 12%) or within illness frequency (7% vs 8%) are apparent. Compared to the S-EYOF, the higher prevalence of illnesses among W-EYOF athletes might be due to competing mainly outdoors in a cold environment where the inhalation of large volumes of cold air during training and competition can diminish the defence of the respiratory system and thus enhance susceptibility to respiratory infections 10. Thus, among winter sport athletes, the most important prophylactic intervention may be prevention of exposure which should be carefully considered by athletes and coaches 11.…”

Sport injuries and illnesses during the first Winter Youth Olympic Games 2012 in Innsbruck, Austria

“…Similar to the 2010 Vancouver Olympic Games,8 the respiratory system was the predominant illness location (61%) during IYOG and about 50% of illnesses were caused by infections. This may be related to the inhalation of large volumes of cold air, during exercise and competition in certain winter sports athletes,21 and the strenuous physical exertion can diminish the defence and thus enhance susceptibility to respiratory infections. Prevention of exposure is the most important prophylactic measure and this should be carefully considered by athletes and coaches 22.…”

Climate, vocal folds, and tonal languages: Connecting the physiological and geographic dots

“…Oral breathing, even of nondry air, promotes the desiccation of the vocal tract and the evaporation of the airway surface liquid of the vocal cords, and the latter has been shown to yield a variety of difficulties vis-à-vis precise phonation (14). The effects of breathing cold air on the vocal tract and the larynx have been supported by numerous studies of those active outdoors in frigid contexts (28,29). These effects are not easily compensated for, and factors such as laryngitis and xerostomia (dry mouth) are recurrent among human populations in very cold regions (28).…”