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      Exercise in the Cold : Preventing and Managing Hypothermia and Frostbite Injury

      research-article
      , MD * ,
      Sports Health
      SAGE Publications
      frostbite, hypothermia, event medicine, injury prevention

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          Abstract

          Context:

          Hypothermia and frostbite injuries occur in cold weather activities and sporting events.

          Evidence Acquisition:

          A PubMed search was used to identify original research and review articles related to cold, frostbite, and hypothermia. Inclusion was based on their relevance to prevention and treatment of cold-related injuries in sports and outdoor activities. Dates of review articles were limited to those published after 2010. No date limit was set for the most recent consensus statements or original research.

          Study Design:

          Clinical review.

          Level of Evidence:

          Level 5.

          Results:

          Frostbite and hypothermia are well-documented entities with good prevention strategies and prehospital treatment recommendations that have changed very little with time. A layered approach to clothing is the best way to prevent injury and respond to weather changes. Each athlete, defined as a participant in a cold weather sport or activity, will respond to cold differently depending on anthropometric measurements and underlying medical risk factors. An understanding of wind-chill temperatures, wetness, and the weather forecast allows athletes and event coordinators to properly respond to changing weather conditions. At the first sign of a freezing cold injury, ensure warm, dry clothes and move to a protected environment.

          Conclusion:

          Cold injuries can be prevented, and cold weather activities are safe with proper education, preparation, and response to changing weather conditions or injury.

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          Most cited references19

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          Measurement and prediction of peak shivering intensity in humans.

          Prediction equations of shivering metabolism are critical to the development of models of thermoregulation during cold exposure. Although the intensity of maximal shivering has not yet been predicted, a peak shivering metabolic rate (Shivpeak) of five times the resting metabolic rate has been reported. A group of 15 subjects (including 4 women) [mean age 24.7 (SD 6) years, mean body mass 72.1 (SD 12) kg, mean height 1.76 (SD 0.1) m, mean body fat 22.3 (SD 7)% and mean maximal oxygen uptake (VO2max) 53.2 (SD 9) ml O2.kg-1.min-1] participated in the present study to measure and predict Shivpeak. The subjects were initially immersed in water at 8 degrees C for up to 70 min. Water temperature was then gradually increased at 0.8 degree C.min-1 to a value of 20 degrees C, which it was expected would increase shivering heat production based on the knowledge that peripheral cold receptors fire maximally at approximately this temperature. This, in combination with the relatively low core temperature at the time this water temperature was reached, was hypothesized would stimulate Shivpeak. Prior to warming the water from 8 to 20 degrees C, the oxygen consumption was 15.1 (SD 5.5) ml.kg-1.min-1 at core temperatures of approximately 35 degrees C. After the water temperature had risen to 20 degrees C, the observed Shivpeak was 22.1 (SD 4.2) ml O2.kg-1.min-1 at core and mean skin temperatures of 35.2 (SD 0.9) and 22.1 (SD 2.2) degrees C, respectively. The Shivpeak corresponded to 4.9 (SD 0.8) times the resting metabolism and 41.7 (SD 5.1)% of VO2max. The best fit equation predicting Shivpeak was Shivpeak (ml O2.kg-1.min-1) = 30.5 + 0.348 x VO2max (ml O2.kg-1.min-1) - 0.909 x body mass index (kg.m-2) - 0.233 x age (years); (P = 0.0001; r2 = 0.872).
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            Frostbite: incidence and predisposing factors in mountaineers.

            Frostbite, the most common cold injury, occurs in mountaineers, a major group at risk, more often than in the general population. To describe the incidence of frostbite and the situations associated with it in mountaineering, emphasising factors that can be modified to decrease its frequency and severity. In this cross sectional, questionnaire based study, 637 mountaineers were asked if they had suffered any frostbite injuries during the preceding two years and to provide the personal and circumstantial details. The mean incidence was 366/1000 population per year. Grade 1 injury (83.0%) and hands (26.4%) and feet (24.1%) involvement were most common. There was a significant relation between lack of proper equipment (odds ratio 14.3) or guide (p<0.001) and the injury. Inappropriate clothing, lack or incorrect use of equipment, and lack of knowledge of how to deal with cold and severe weather were claimed to be the main reasons for the injury. In high altitude and winter expeditions, mountaineers should wear appropriate clothing, have the necessary equipment such as quality boots and mittens, use a competent guide, and have training on how to tackle cold weather. They should also avoid wet clothing, windy terrains, and should never remain in the same position for long periods to reduce the risk of cold injuries.
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              American College of Sports Medicine position stand: prevention of cold injuries during exercise.

              It is the position of the American College of Sports Medicine that exercise can be performed safely in most cold-weather environments without incurring cold-weather injuries. The key to prevention is use of a comprehensive risk management strategy that: a) identifies/assesses the cold hazard; b) identifies/assesses contributing factors for cold-weather injuries; c) develops controls to mitigate cold stress/strain; d) implements controls into formal plans; and e) utilizes administrative oversight to ensure controls are enforced or modified. The American College of Sports Medicine recommends that: 1) coaches/athletes/medical personnel know the signs/symptoms and risk factors for hypothermia, frostbite, and non-freezing cold injuries, identify individuals susceptible to cold injuries, and have the latest up-to-date information about current and future weather conditions before conducting training sessions or competitions; 2) cold-weather clothing be chosen based on each individual's requirements and that standardized clothing ensembles not be mandated for entire groups; 3) the wind-chill temperature index be used to estimate the relative risk of frostbite and that heightened surveillance of exercisers be used at wind-chill temperatures below -27 degrees C (-18 degrees F); and 4) individuals with asthma and cardiovascular disease can exercise in cold environments, but should be monitored closely.
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                Author and article information

                Journal
                Sports Health
                Sports Health
                SPH
                spsph
                Sports Health
                SAGE Publications (Sage CA: Los Angeles, CA )
                1941-7381
                1941-0921
                8 February 2016
                March 2016
                1 March 2017
                : 8
                : 2
                : 133-139
                Affiliations
                []Activity, Sports and Exercise Medicine Department, Group Health Cooperative, Everett, Washington
                Author notes
                [*] [* ]Jessie Fudge, MD, Activity, Sports and Exercise Medicine Department, Group Health Cooperative, 2930 Maple Street, Everett, WA 98201 (email: fudge.j@ 123456ghc.org ).
                Article
                10.1177_1941738116630542
                10.1177/1941738116630542
                4789935
                26857732
                d3c501e2-b88e-4865-a121-82c4aa1f18ab
                © 2016 The Author(s)
                History
                Categories
                Focus Topic: Wilderness/Extreme Athlete
                Custom metadata
                March/April 2016

                Sports medicine
                frostbite,hypothermia,event medicine,injury prevention
                Sports medicine
                frostbite, hypothermia, event medicine, injury prevention

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