title: The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The aim of this study was to determine the cumulative effect of a routine (hot-to-) cold shower on sickness, quality of life and work productivity.
  
  
  METHODS
  Between January and March 2015, 3018 participants between 18 and 65 years without severe comorbidity and no routine experience of cold showering were randomized (1:1:1:1) to a (hot-to-) cold shower for 30, 60, 90 seconds or a control group during 30 consecutive days followed by 60 days of showering cold at their own discretion for the intervention groups. The primary outcome was illness days and related sickness absence from work. Secondary outcomes were quality of life, work productivity, anxiety, thermal sensation and adverse reactions.
  
  
  RESULTS
  79% of participants in the interventions groups completed the 30 consecutive days protocol. A negative binomial regression model showed a 29% reduction in sickness absence for (hot-to-) cold shower regimen compared to the control group (incident rate ratio: 0.71, P = 0.003). For illness days there was no significant group effect. No related serious advents events were reported.
  
  
  CONCLUSIONS
  A routine (hot-to-) cold shower resulted in a statistical reduction of self-reported sickness absence but not illness days in adults without severe comorbidity.
  
  
  BACKGROUND
  Netherlands National Trial Register NTR5183.
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Geert A
authors.identifier: http://orcid.org/0000-0003-0301-3512
authors.initials: GA
authors.lastname: Buijze
authors.affiliation: Department of Orthopaedic Surgery, Medical Center Slotervaart, Amsterdam, The Netherlands.
authors.forename: Inger N
authors.initials: IN
authors.lastname: Sierevelt
authors.affiliation: Risk Management, Achmea, Zeist, The Netherlands.
authors.forename: Bas C J M
authors.initials: BC
authors.lastname: van der Heijden
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel G
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Department Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Monique H W
authors.initials: MH
authors.lastname: Frings-Dresen
mesh_terms: D000328:Adult; D001494:Baths; D003080:Cold Temperature; D004651:Employment; D005260:Female; D006304:Health Status; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged