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Like all mammals, humans are homeothermic—in other words, body systems are designed to operate effectively and safely within a narrow range of temperatures. Under resting conditions, a person can achieve thermal equilibrium at environmental temperatures as low as 5±C simply by increasing the amount of clothing that is worn. However, problems become more likely when exercising in cold air or cold water. Effects of cold exposure may be general or local. Moderate general cooling can have an adverse impact on tissue viscosity and thus physical performance, and there are dangers to health if a measure of deep-body temperature, such as the rectal temperature, drops below 95.0±F (35.0±C). Local temperatures at the skin surface can drop substantially lower, but tissue damage results as the cells reach freezing point.

Specific issues to be discussed in this article include the safety of cold environments, potential impacts of cold exposure on performance and health, local and general dangers of cold exposure, and prevention and treatment of cold stress.

Assessing the Safety of a Cold Environment

Cold Air

The severity of cold air exposure, expressed as the corrected effective temperature, depends on the wind velocity (or the effective wind velocity, adjusted for the individual's speed of movement), the temperature recorded by a wet bulb thermometer, and the temperature recorded by a globe thermometer (which allows for radiant heating from sunlight). Values can be calculated fairly simply, using nomograms published by the American Society of Heating, Refrigerating and Air Conditioning Engineers, and limits can be specified below which it is wise to cancel events such as a cross-country ski run, where competitors will face the adverse environment for a long period.

A simple example illustrates the likelihood that a person will have difficulty in regulating body temperature. Given a typical skin temperature of 35±C, an air temperature of 0±C, and a wind speed of only 5 m/s, the convective heat loss in normal clothing is about 75 kJ/min, more than twice the likely heat production when engaged in walking in the hills at an oxygen consumption of 2 L/min. Thus, unless additional clothing is provided, a progressive chilling of the body will occur.

The effectiveness of thermal protection depends greatly on the film of still air in immediate contact with the skin and additional air trapped within the clothing. These barriers are readily displaced by the wind, unless the outer garment is windproof. The still air is equally displaced by body movement, particularly in downhill skiing or cycling. Insulation is greatly degraded if the clothing becomes saturated with water, whether externally (from rain or snow) or internally (from sweating).

Cold Water

Cooling occurs much more quickly in water than in air because the rate of heat convection is greater in water. Thus, a temperature of 18±C may be thermally neutral for a person who is exercising in still air, but the thermally neutral temperature in water is around 29±C for a distance swimmer and may be as high as 33±C to 35±C for a sailor whose craft has capsized. Heat loss is particularly rapid in divers who are using heliox gas mixtures, as helium has a high thermal conductivity.

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