Abstract
What is the central question of this study? Does recreational cold exposure result in cold sensitivity and is this associated with endothelial dysfunction and impaired sensory thermal thresholds? What is the main finding and its importance? Previous cold exposure was correlated with cold sensitivity of the foot, which might indicate the development of a subclinical non-freezing cold injury. Endothelial function and thermal detection were not impaired in cold-sensitive individuals; therefore, further research is required to understand the pathophysiology of subclinical and clinical forms of non-freezing cold injury. In this study, we investigated whether cold-sensitive (CS) individuals, who rewarm more slowly after a mild cold challenge, have impaired endothelial function and sensory thermal thresholds (STTs) and whether this is related to reported cold exposure. Twenty-seven participants with varying previous cold exposure undertook three tests: an STT test, i.e. determination of warm and cold STTs of the fingers and dorsal foot; an endothelial function test, i.e. measurement of cutaneous vascular conductance (CVC) during iontophoresis of ACh on the forearm, finger and foot; and a CS test, involving immersion of a foot for 2min in water at 15°C followed by 10min of rewarming in air at 30°C. Toe skin temperature (Tsk ) measured during the CS test was used to form a CS group (<32°C before and 5min after immersion) and an otherwise closely matched control group [Tsk >32°C; n=9 (four women) for both groups]. A moderate relationship was found between cold exposure ranking and Tsk rewarming (r=0.408, P=0.035, n=27) but not STT or endothelial function. The Tsk and blood flow were lower in CS compared with control subjects before and after foot immersion [Tsk , mean (SD): 30.3(0.9) versus 34.8(0.8) and 27.9(0.8) versus 34.3(0.8)°C, P<0.001; and CVC: 1.08(0.79) versus 3.82(1.21) and 0.79(0.52) versus 3.45(1.07)fluxmmHg-1 , n=9, P<0.001, respectively]. However, no physiologically significant differences were observed between groups for endothelial function or STT. A moderate correlation between previous cold exposure and toe Tsk rewarming after foot immersion was observed; however, CS was not associated with impaired endothelial function or reduced thermal detection.
Highlights
Non-freezing cold injury (NFCI) is caused by prolonged exposure to cold and often wet conditions (Kuht, Woods, & Hollis, 2019; Ungley & Blackwood, 1942)
Mean toe skin temperature was significantly lower in CS compared with control subjects (F1,48 = 151.8, P < 0.001; Figure 1a) before immersion and at 5 and 10 min of rewarming, but not immediately after foot immersion (P = 0.1038, d = 1.41), there was a large effect size
No difference in mean finger skin temperature or thumb cutaneous vascular conductance (CVC) was observed between groups (F1,16 = 2.69, P = 0.121 and F1,16 = 2.05, P = 0.172, respectively) during the hand cold-sensitivity test (CST) (Figure 2)
Summary
Non-freezing cold injury (NFCI) is caused by prolonged exposure to cold and often wet conditions (Kuht, Woods, & Hollis, 2019; Ungley & Blackwood, 1942). Stage 4, the chronic state, is characterized by cold sensitivity (reduced skin blood flow in thermoneutral ambient temperatures and poor rewarming after a cold challenge; Eglin, Golden, & Tipton, 2013), numbness, hyperhidrosis and persistent pain (Ungley et al, 1945) These symptoms may last for many years and can have life-changing consequences for the individual. Individuals of African or Caribbean origin, who are more susceptible to NFCI than their Caucasian counterparts (Burgess & Macfarlane, 2009), have been shown to have a reduced vasodilatory response to ACh (Maley, House, Tipton, & Eglin, 2015) These studies indicate that the underlying mechanism of the cold sensitivity associated with NFCI is endothelial dysfunction. Endothelial function and thermal detection were not impaired in cold-sensitive individuals; further research is required to understand the pathophysiology of subclinical and clinical forms of non-freezing cold injury
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