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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [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: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Alwaleed A, Jamal A. Self-inflicted finger cold injury leading to amputation: Report of a case. Clin Pract 2020; 10:1217. [PMID: 32952983 PMCID: PMC7482180 DOI: 10.4081/cp.2020.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
A cold injury can result in devastating outcomes, leading to significant morbidity and loss of distal extremities. Amputations are common after severe frostbite injuries with delayed presentation, often mediated by post-injury arterial thrombosis. Ischemic injuries are managed according to the ischemia time. The most controversial aspect of treating a salvage injury is the time of surgical intervention, which used to be based on the previous management dogma freeze in January, amputate in July. Recently, the paradigm has shifted to early surgical management if the level of viability of the deep structure can be ascertained using 99mTc pertechnetate scintigraphy (99mTc bone scans). We present a case of a finger amputation resulting from a cold injury secondary to a crush injury.
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Affiliation(s)
- Alammar Alwaleed
- Department of Plastic Surgery Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Almadani Jamal
- Department of Plastic Surgery Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Gorjanc J, Morrison SA, McDonnell AC, Mekjavic PJ, Blagus R, Mekjavic IB. Ski-Everest (8848 m) Expedition: Digit Skin Temperature Responses to Cold Immersion May Reflect Susceptibility to Cold Injury. Wilderness Environ Med 2019; 30:141-149. [PMID: 30979538 DOI: 10.1016/j.wem.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/01/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We tested the hypothesis that individual susceptibility to freezing cold injury might be reflected in an attenuated cold-induced vasodilatation (CIVD) response by comparing the CIVD responses of an elite alpinist with a history of freezing cold injury in the feet (case alpinist) with those of an age- and ability- matched noninjured alpinists control group (controls). According to this hypothesis, the vasomotor responses to a CIVD test of the case alpinist would represent a pathophysiological response when compared with the normal physiological response of a noninjured cohort. METHODS The case alpinist and the controls in the cohort group conducted a cold water immersion test comprising sequential immersion of a hand and foot for 5 min in 35°C water, followed by a 30-min immersion in 8°C water and a 10-min recovery period in room air. During this test we monitored the finger and toe skin temperatures. RESULTS The case alpinist had a significantly attenuated CIVD response and a lower skin temperature in all injured and noninjured digits during immersion (∼2°C lower than in the control group) and an attenuated recovery of finger skin temperatures (∼6°C lower than in the control group). CONCLUSIONS The attenuated CIVD response of the case alpinist may reflect a previously unrecognized enhanced susceptibility to frostbite. In addition to the poor vasomotor response observed in the injured toes, he also exhibited a poor vasomotor response in his noninjured fingers. The results of the present study indicate that a test of vasomotor activity during thermal stress may identify individuals predisposed to cold injury.
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Affiliation(s)
- Jurij Gorjanc
- Department of Surgery, Hospital of the Brothers of St. John of God, St.Veit/Glan, Austria.
| | | | - Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | | | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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Gorjanc J, Morrison SA, McDonnell AC, Mekjavic IB. Koroška 8000 Himalayan expedition: digit responses to cold stress following ascent to Broadpeak (Pakistan, 8051 m). Eur J Appl Physiol 2018; 118:1589-1597. [PMID: 29797057 DOI: 10.1007/s00421-018-3890-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Cold-induced vasodilatation (CIVD) is a peripheral blood flow response, observed in both the hands and feet. Exercise has been shown to enhance the response, specifically by increasing mean skin temperatures (Tsk), in part due to the increased number of CIVD waves. In contrast, hypobaric hypoxia has been suggested to impair digit skin temperature responses, particularly during subsequent hand rewarming following the cold stimulus. This study examined the combined effect of exercise and hypobaric hypoxia on the CIVD response. We compared the CIVD responses in the digits of both the hands and feet of a team of alpinists (N = 5) before and after a 35-day Himalayan expedition to Broadpeak, Pakistan (8051 m). METHODS Five elite alpinists participated in hand and foot cold water immersion tests 20 days before and immediately upon return from their expedition. RESULTS The alpinists summited successfully without supplemental oxygen. Post-expedition, all alpinists demonstrated higher minimum Tsk in their hands (pre: 9.9 ± 1.1, post: 10.1 ± 0.7 °C, p = 0.031). Four alpinists had either greater CIVD waves, and, consequently, higher mean Tsk in their hands, or higher recovery temperatures (pre: 26.0 ± 5.5 °C post: 31.0 ± 4.1 °C, p = 0.052), or faster rewarming rate (pre: 2.6 ± 0.5 °C min-1 post: 3.1 ± 0.4 °C min-1,p = 0.052). In the feet, the responses varied: 1/5 had higher wave amplitudes and 1/5 had higher passive recovery temperatures, whereas 3/5 had lower mean toe temperatures during cold exposure. CONCLUSIONS The results of the cold stress test suggest after a 35-day Himalayan expedition, alpinists experienced a slight cold adaptation of the hands, but not the feet.
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Affiliation(s)
- Jurij Gorjanc
- St. John of God Hospital, Spitalgasse 26, 9300, St. Veit/Glan, Austria.
| | - Shawnda A Morrison
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia
| | - Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Jamova 39, 1000, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Jamova 39, 1000, Ljubljana, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
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Gorjanc J, Morrison SA, Blagus R, Mekjavic IB. Cold Susceptibility of Digit Stumps Resulting from Amputation After Freezing Cold Injury in Elite Alpinists. High Alt Med Biol 2018; 19:185-192. [PMID: 29608373 DOI: 10.1089/ham.2017.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gorjanc, Jurij, Shawnda A. Morrison, Rok Blagus, and Igor B. Mekjavic. Cold susceptibility of digit stumps resulting from amputation after freezing cold injury in elite alpinists. High Alt Med Biol. 19:185-192, 2018. AIM The aim of the study was to assess whether previous freezing cold injury in fingers and/or toes might predispose alpinists to greater risk of further freezing cold injury, primarily due to a greater vasoconstrictor response to cold, resulting in a lower perfusion, reflected in lower skin temperature. METHODS Ten elite alpinists (N = 10; 8 male and 2 female) with amputations after freezing cold injury participated in a cold-water (8°C) immersion stress test of the hands and feet. Digit skin temperatures of amputated digits, their noninjured counterparts, noninjured digits of the affected side and noninjured digits of the corresponding side were measured. The skin temperatures were compared during three consecutive phases of the cold stress test: prewarming, cold water immersion, and passive heating. RESULTS Amputated toes cooled much faster compared to their uninjured counterparts (n = 26, p < 0.001), and attained lower skin temperatures during the cold exposure test (n = 26, p < 0.001). Higher cooling rate was observed in all the toes on the injured limb compared with the toes on the uninjured limb (n = 40, p < 0.001). In contrast to the toes, the fingers on the injured limb after freezing cold injury were warmer during cooling phase compared to uninjured fingers (n = 15, p < 0.001). CONCLUSIONS The lower digit temperatures observed in affected toe stumps during the cold stress test compared to the nonamputated toes may indicate a heightened risk of future freezing cold injury with subsequent cold exposures, as a consequence of less perfusion, reflected in the lower skin temperature. This relationship was not confirmed in the fingers.
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Affiliation(s)
| | | | - Rok Blagus
- 3 Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana , Ljubljana, Slovenia
| | - Igor B Mekjavic
- 4 Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute , Ljubljana, Slovenia .,5 Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia, Canada
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Morrison SA, Gorjanc J, Eiken O, Mekjavic IB. Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in Elite Alpinists. Wilderness Environ Med 2015; 26:295-304. [PMID: 25754904 DOI: 10.1016/j.wem.2014.12.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/17/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess whether previous freezing cold injuries (FCI) would affect digit skin temperatures and rewarming rates during a follow-up cold stress test protocol. DESIGN Nonrandomized control trial. METHODS Twenty elite alpinists participated; alpinists with previous FCI requiring digit amputations (injured, INJ: n = 10 total, n = 8 male) were compared with ability-matched, uninjured alpinists (control, CON: n = 10, all male). Digit skin temperature was measured using infrared thermography as an index of peripheral digit perfusion after a cold stress test, which consisted of 30 minutes of immersion in 8°C water. RESULTS The INJ alpinists' injured toes were warmer (approximately 6%) than their uninjured toes immediately after cold immersion (95% CI, 0.01°C to 1.00°C; P = .05); there were no differences between the rates of rewarming of injured and uninjured toes (INJ, 0.5° ± 0.1°C/min; CON, 0.7° ± 0.3°C/min; P = .16). Although the INJ alpinists had colder injured fingers immediately after the 35°C warm bath compared with their own uninjured fingers (32.2° ± 2.0°C vs 34.5° ± 0.5°C; P = .02), there were no differences observed between the rates of rewarming of injured and uninjured fingers after cold exposure (INJ, 1.1° ± 0.2°C/min; CON, 1.3° ± 0.5°C/min; P = .22). CONCLUSIONS Even after FCI that requires digit amputation, there is no evidence of different tissue rates of rewarming between the injured and uninjured fingers or toes of elite alpinists.
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Affiliation(s)
- Shawnda A Morrison
- Environmental Physiology and Ergonomics Laboratory, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia (Drs Morrison and Mekjavic).
| | - Jurij Gorjanc
- Department of Surgery, Hospital of the Brothers of St. John of God, St.Veit/Glan, Austria (Dr Gorjanc)
| | - Ola Eiken
- Department of Environmental Physiology, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden (Dr Eiken)
| | - Igor B Mekjavic
- Environmental Physiology and Ergonomics Laboratory, Department of Automation, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia (Drs Morrison and Mekjavic)
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Cheung SS. Responses of the hands and feet to cold exposure. Temperature (Austin) 2015; 2:105-20. [PMID: 27227009 PMCID: PMC4843861 DOI: 10.1080/23328940.2015.1008890] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
An initial response to whole-body or local exposure of the extremities to cold is a strong vasoconstriction, leading to a rapid decrease in hand and foot temperature. This impairs tactile sensitivity, manual dexterity, and muscle contractile characteristics while increasing pain and sympathetic drive, decreasing gross motor function, occupational performance, and survival. A paradoxical and cyclical vasodilatation often occurs in the fingers, toes, and face, and this has been termed the hunting response or cold-induced vasodilatation (CIVD). Despite being described almost a century ago, the mechanisms of CIVD are still disputed; research in this area has remained largely descriptive in nature. Recent research into CIVD has brought increased standardization of methodology along with new knowledge about the impact of mediating factors such as hypoxia and physical fitness. Increasing mechanistic analysis of CIVD has also emerged along with improved modeling and prediction of CIVD responses. The present review will survey work conducted during this century on CIVD, its potential mechanisms and modeling, and also the broader context of manual function in cold conditions.
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Affiliation(s)
- Stephen S Cheung
- Environmental Ergonomics Laboratory; Department of Kinesiology ; Brock University; St. Catharines , Canada
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