Mike Tipton

Considerations for the measurement of core, skin and mean body temperatures

Despite previous reviews and commentaries, significant misconceptions remain concerning deep-body (core) and skin temperature measurement in humans. Therefore, the authors have assembled the pertinent Laws of Thermodynamics and other first principles that govern physical and physiological heat exchanges. The resulting review is aimed at providing theoretical and empirical justifications for collecting and interpreting these data. The primary emphasis is upon deep-body temperatures, with discussions of intramuscular, subcutaneous, transcutaneous and skin temperatures included. These are all turnover indices resulting from variations in local metabolism, tissue conduction and blood flow. Consequently, inter-site differences and similarities may have no mechanistic relationship unless those sites have similar metabolic rates, are in close proximity and are perfused by the same blood vessels. Therefore, it is proposed that a gold standard deep-body temperature does not exist. Instead, the validity of each measurement must be evaluated relative to ones research objectives, whilst satisfying equilibration and positioning requirements. When using thermometric computations of heat storage, the establishment of steady-state conditions is essential, but for clinically relevant states, targeted temperature monitoring becomes paramount. However, when investigating temperature regulation, the response characteristics of each temperature measurement must match the forcing function applied during experimentation. Thus, during dynamic phases, deep-body temperatures must be measured from sites that track temperature changes in the central blood volume.

‘Autonomic conflict’: a different way to die during cold water immersion?

Abstract  Cold water submersion can induce a high incidence of cardiac arrhythmias in healthy volunteers. Submersion and the release of breath holding can activate two powerful and antagonistic responses: the ‘cold shock response’ and the ‘diving response’. The former involves the activation of a sympathetically driven tachycardia while the latter promotes a parasympathetically mediated bradycardia. We propose that the strong and simultaneous activation of the two limbs of the autonomic nervous system (‘autonomic conflict’) may account for these arrhythmias and may, in some vulnerable individuals, be responsible for deaths that have previously wrongly been ascribed to drowning or hypothermia. In this review, we consider the evidence supporting this claim and also hypothesise that other environmental triggers may induce autonomic conflict and this may be more widely responsible for sudden death in individuals with other predisposing conditions.

Immersion deaths and deterioration in swimming performance in cold water

BACKGROUND General hypothermia (deep body temperature <35 degrees C) has been implicated in immersion-related deaths, but many deaths occur too quickly for it to be involved. We investigated changes in swimming capability in cold water to find out whether such changes could lead to swim failure and drowning. METHODS Ten volunteers undertook three self-paced breaststroke swims in a variable-speed swimming flume, in water at 25 degrees C, 18 degrees C, and 10 degrees C, for a maximum of 90 min. During each swim, we measured oxygen consumption, rectal temperature, swim speed and angle, and stroke rate and length. Swim failure was defined as being unable to keep feet off the bottom of the flume. FINDINGS All ten swimmers completed 90 min swims at 25 degrees C, eight completed swims at 18 degrees C, and five at 10 degrees C. In 10 degrees C water, one swimmer reached swim failure after 61 min and four were withdrawn before 90 min with rectal temperatures of 35 degrees C when they were close to swim failure. Swimming efficiency and length of stroke decreased more and rate of stroke and swim angle increased more in 10 degrees C water than in warmer water. These variables seemed to characterise impending swim failure. INTERPRETATION Impaired performance and initial cardiorespiratory responses to immersion probably represent the major dangers to immersion victims. Consequently, treatment should be aimed at symptoms resulting from near-drowning rather than severe hypothermia.

HUMAN ADAPTATION TO REPEATED COLD IMMERSIONS

1. The present investigation was designed to examine human adaptation to intermittent severe cold exposure and to assess the effect of exercise on any adaptation obtained. 2. Sixteen subjects were divided into two equal groups. Each subject performed ten head‐out immersions; two into thermoneutral water which was then cooled until they shivered vigorously, and eight into water at 15 degrees C for 40 min. During the majority of the 15 degrees C immersions, one group (dynamic group) exercised whilst the other (static group) rested. 3. Results showed that both groups responded to repeated cold immersions with a reduction in their initial responses to cold. The time course of these reductions varied, however, between responses. 4. Only the static group developed a reduced metabolic response to prolonged resting immersion. 5. It is concluded that repeated resting exposure to cold was the more effective way of producing an adaptation. The performance of exercise during repeated exposure to cold prevented the development of an adaptive reduction in the metabolic response to cold during a subsequent resting immersion. In addition, many of the adaptations obtained during repeated resting exposure were overridden or masked during a subsequent exercising immersion.

Physiological employment standards I. Occupational fitness standards: objectively subjective?

This paper examines the processes involved in the establishment of a minimum occupational fitness standard, with particular reference to the interplay that inevitably occurs between objective measurements and subjective decisions. The areas considered include: the determination of the critical task on which to base a standard; establishing minimum acceptable performance and methods of best practice for the execution of these tasks; determining the physical demands of a task and a reasonable relative workload; producing the final standard. Finally, the impact of the subjective component of the development of an occupational fitness standard on its defensibility is discussed. It is concluded that all standards involve some subjective aspects; the extent of these could be reduced by further research. In the meantime, it would be prudent for those developing standards to detail the rationale, methods and evidence by which subjective decisions were reached, to provide an audit trail for subsequent investigation.

Ventilated vest and tolerance for intermittent exercise in hot, dry conditions with military clothing.

INTRODUCTION Recent research has focused on developing air-ventilated garments to improve evaporative cooling in military settings. This study assessed a ventilated vest (Vest) in hot (45 degrees C), dry (10% RH) ambient conditions over 6 h of rest and exercise. It was hypothesized that the Vest would lower the thermal strain and increase the amount of exercise done by subjects. METHODS Eight healthy heat-acclimated men, wearing combat clothing, body armor, and a 19-kg load in webbing walked on a treadmill at 5 km h(-1) at a 2% incline until rectal temperature (T(rec)) reached 38.5 degrees C. They then rested until T(re) reached 38 degrees C, at which point they recommenced walking. On one occasion the subjects wore a Vest, blowing ambient air around the torso. On the second occasion subjects did not wear the vest (NoVest). Exercise/rest ratio, T(rec), skin temperature (T(sk)), sweat responses, rating of perceived exertion (RPE), and thermal comfort (TC) were measured. RESULTS Subjects wearing theVest exercised for significantly longer (18%; 11 min/h) as a percentage of total exposure time, stopped exercise significantly less often [Mean (SD); NoVest: 3 (2) stops; Vest: 1 (2) stops], and maintained significantly lower skin temperature under the body armor [T(chest): NoVest 37.55 (0.51) degrees C; Vest: 35.33 (1.00) degrees C; T(back): NoVest: 36.85 (0.83) degrees C; Vest: 35.84 (0.88) degrees C]. The Vest provided 28 W of cooling during exercise and 73 W when at rest as estimated by thermometry. CONCLUSION A ventilated vest can provide cooling, and thereby reduce thermal strain and increase exercise done in dry environmental temperatures up to 45 degrees C, without causing skin irritation and discomfort.

Habituation of the initial responses to cold water immersion in humans: a central or peripheral mechanism?

1 The initial respiratory and cardiac responses to cold water immersion are thought to be responsible for a significant number of open water deaths each year. Previous research has demonstrated that the magnitude of these responses can be reduced by repeated immersions in cold waterwhether the site of habituation is central or peripheral. 2 Two groups of subjects undertook two 3 min head‐out immersions in stirred water at 10 °C of the right‐hand side of the body (R). Between these two immersions (3 whole days) the control group (n= 7) were not exposed to cold water, but the habituation group (n= 8) undertook a further six 3 min head‐out immersions in stirred water at 10 °C of the left‐hand side of the body (L). 3 Repeated L immersions reduced (P < 0.01) the heart rate, respiratory frequency and volume responses. During the second R immersion a reduction (P < 0.05) in the magnitude of the responses evoked was seen in the habituation group but not in the control group, despite both groups having identical skin temperature profiles. 4 It is concluded that the mechanisms involved in producing habituation of the initial responses are located more centrally than the peripheral receptors.

Permanence of the habituation of the initial responses to cold-water immersion in humans

Abstract Sudden immersion in cold water initiates an inspiratory gasp response followed by uncontrollable hyperventilation and tachycardia. It is known that this response, termed the “cold shock” response, can be attenuated following repeated immersion. In the present investigation we examined how long this habituation lasts. Twelve healthy male volunteers participated in the experiment, they were divided into a control (C) group (n=4), and a habituation (H) group (n=8). In October, each subject undertook two 3-min head-out seated immersions into stirred water at 10 °C wearing swimming trunks. These immersions took place at the same time of day, with 4 days separating the two immersions. In the intervening period, the C group were not exposed to cold water, while the H group undertook six, 3-min head-out immersions in water at 15 °C. Two months (December), 4 months (February), 7 months (May) and 14 months (January) after their first immersion, all subjects undertook another 3-min head-out immersion in water at 10 °C. The H group showed a reduction in respiratory frequency (47 to 24 breaths · min−1), inspiratory minute volume (72.2 to 31.3 l · min−1) and heart rate (128 to 109 beats · min−1) during the first 30 s of immersion on day 5 compared to day 1. Seven months later these responses were still significantly reduced compared to day 1. After 14 months, heart rate remained attenuated but respiratory frequency and inspiratory minute volume had returned towards pre-habituation levels. The responses of the C group during the first 30 s of immersion were not altered. Both groups showed an attenuation in the responses during the remaining 150 s of immersion following repeated immersions. It is concluded that repeated immersions in cold water result in a long-lasting (7–14 months) reduction in the magnitude of the cold shock response. Less frequent immersions produced a decrease in the duration, but not the magnitude of the response.

Cutaneous thermal thresholds—the reproducibility of their measurements and the effect of gender

The present study evaluated the reproducibility of measurements of the forearm thresholds for warm (WT) and cold (CT) sensation, and their dependence on gender. The Middlesex Thermal Testing System was used for this purpose. CT did not differ between the five consecutive trials, whereas WT fell significantly. A minimum of two trial tests are therefore recommended prior to the assessment of WT. Furthermore, CT and WT were induced by significantly smaller skin temperature changes (lower thresholds) in females as compared to males. Should this gender specific difference in thermosensitivity also be observed in other skin regions, then females would be more sensitive to thermal stimulation than males.

Temperature dependence of habituation of the initial responses to cold-water immersion

Abstract The initial responses to cold-water immersion, evoked by stimulation of peripheral cold receptors, include tachycardia, a reflex inspiratory gasp and uncontrollable hyperventilation. When immersed naked, the maximum responses are initiated in water at 10°C, with smaller responses being observed following immersion in water at 15°C. Habituation of the initial responses can be achieved following repeated immersions, but the specificity of this response with regard to water temperature is not known. Thirteen healthy male volunteers were divided into a control (C) group (n = 5) and a habituation (H) group (n = 8). Each subject undertook two 3-min head-out immersions in water at 10°C wearing swimming trunks. These immersions took place at a corresponding time of day with 4 days separating the two immersions. In the intervening period the C group were not exposed to cold water, while the H group undertook another six, 3-min, head-out immersions in water at 15°C. Respiratory rate (fR), inspiratory minute volume (V˙I) and heart rate (fH) were measured continuously throughout each immersion. Following repeated immersions in water at 15°C, the fR, V˙I and fH responses of the H group over the first 30 s of immersion were reduced (P < 0.01) from 33.3 breaths · min−1, 50.5 l · min−1 and 114 beats · min−1 respectively, to 19.8 breaths · min−1, 26.4 l · min−1 and 98 beats · min−1, respectively. In water at 10°C these responses were reduced (P < 0.01) from 47.3 breaths · min−1, 67.6 l · min−1 and 128 beats · min−1 to 24.0 breaths · min−1, 29.5 l · min−1 and 109 beats · min−1, respectively over a corresponding period of immersion. Similar reductions were observed during the last 2.5 min of immersions. The initial responses of the C group were unchanged. It is concluded that habituation of the cold shock response can be achieved by immersion in warmer water than that for which protection is required. This suggests that repeated submaximal stimulation of the cutaneous cold receptors is sufficient to attenuate the responses to more maximal stimulation.