title: Optimizing Cold-Water Immersion for Exercise-Induced Hyperthermia: An Evidence-Based Paper.
abstract: Reference: Zhang Y, Davis JK, Casa DJ, Bishop PA. Optimizing cold water immersion for exercise-induced hyperthermia: a meta-analysis. Med Sci Sports Exerc. 2015;47(11):2464-2472. Clinical Questions: Do optimal procedures exist for implementing cold-water immersion (CWI) that yields high cooling rates for hyperthermic individuals?
  
  
  METHODS
  One reviewer performed a literature search using PubMed and Web of Science. Search phrases were cold water immersion, forearm immersion, ice bath, ice water immersion, immersion, AND cooling.
  
  
  METHODS
  Studies were included based on the following criteria: (1) English language, (2) full-length articles published in peer-reviewed journals, (3) healthy adults subjected to exercise-induced hyperthermia, and (4) reporting of core temperature as 1 outcome measure. A total of 19 studies were analyzed.
  
  
  METHODS
  Pre-immersion core temperature, immersion water temperature, ambient temperature, immersion duration, and immersion level were coded a priori for extraction. Data originally reported in graphical form were digitally converted to numeric values. Mean differences comparing the cooling rates of CWI with passive recovery, standard deviation of change from baseline core temperature, and within-subjects r were extracted. Two independent reviewers used the Physiotherapy Evidence Database (PEDro) scale to assess the risk of bias.
  
  
  RESULTS
  Cold-water immersion increased the cooling rate by 0.03°C/min (95% confidence interval [CI] = 0.03, 0.04°C/min) compared with passive recovery. Cooling rates were more effective when the pre-immersion core temperature was ≥38.6°C (P = .023), immersion water temperature was ≤10°C (P = .036), ambient temperature was ≥20°C (P = .013), or immersion duration was ≤10 minutes (P < .001). Cooling rates for torso and limb immersion (mean difference = 0.04°C/min, 95% CI = 0.03, 0.06°C/min) were higher (P = .028) than those for forearm and hand immersion (mean difference = 0.01°C/min, 95% CI = -0.01, 0.04°C/min).
  
  
  CONCLUSIONS
  Hyperthermic individuals were cooled twice as fast by CWI as by passive recovery. Therefore, the former method is the preferred choice when treating patients with exertional heat stroke. Water temperature should be <10°C, with the torso and limbs immersed. Insufficient published evidence supports CWI of the forearms and hands.
authors.affiliation: Department of Applied Medicine and Rehabilitation, Sycamore Center for Wellness and Applied Medicine, Indiana State University, Terre Haute.
authors.forename: Emma A
authors.initials: EA
authors.lastname: Nye
authors.affiliation: Department of Applied Medicine and Rehabilitation, Sycamore Center for Wellness and Applied Medicine, Indiana State University, Terre Haute.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Edler
authors.affiliation: Department of Applied Medicine and Rehabilitation, Sycamore Center for Wellness and Applied Medicine, Indiana State University, Terre Haute.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Eberman
authors.affiliation: Department of Applied Medicine and Rehabilitation, Sycamore Center for Wellness and Applied Medicine, Indiana State University, Terre Haute.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Games
mesh_terms: D001831:Body Temperature / Q000502:physiology*; D003080:Cold Temperature; D015444:Exercise; D005334:Fever / Q000628:therapy*; D005542:Forearm; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007101:Immersion; D013177:Sports; D014867:Water
chemical_list: D014867:Water
keywords: cooling rates; exertional heat stroke; ice bath; ice-water immersion