title: Cooling via one hand improves physical performance in heat-sensitive individuals with multiple sclerosis: a preliminary study.
abstract: 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 degrees 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biological Sciences, Stanford University, Stanford, CA 94305, USA. dagrahn@Stanford.edu
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Grahn
authors.forename: Julie Vls
authors.initials: JV
authors.lastname: Murray
authors.forename: H Craig
authors.initials: HC
authors.lastname: Heller
mesh_terms: D000328:Adult; D001831:Body Temperature / Q000502:physiology*; D003080:Cold Temperature; D017679:Cryotherapy / Q000295:instrumentation / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006225:Hand / Q000502:physiology*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000628:therapy*; D010807:Physical Endurance / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology