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. 2017 Aug;52(8):747-752.
doi: 10.4085/1062-6050-52.5.05. Epub 2017 Jul 17.

Temperate-Water Immersion as a Treatment for Hyperthermic Humans Wearing American Football Uniforms

Kevin C Miller  1 , Tyler Truxton  1 , Blaine Long  1
Affiliations

Temperate-Water Immersion as a Treatment for Hyperthermic Humans Wearing American Football Uniforms

Kevin C Miller et al. J Athl Train. 2017 Aug.

Abstract

Context: Cold-water immersion (CWI; 10°C) can effectively reduce body core temperature even if a hyperthermic human is wearing a full American football uniform (PADS) during treatment. Temperate-water immersion (TWI; 21°C) may be an effective alternative to CWI if resources for the latter (eg, ice) are unavailable.

Objective: To measure rectal temperature (Trec) cooling rates, thermal sensation, and Environmental Symptoms Questionnaire (ESQ) scores of participants wearing PADS or shorts, undergarments, and socks (NOpads) before, during, and after TWI.

Design: Crossover study.

Setting: Laboratory.

Patients or other participants: Thirteen physically active, unacclimatized men (age = 22 ± 2 years, height = 182.3 ± 5.2 cm, mass = 82.5 ± 13.4 kg, body fat = 10% ± 4%, body surface area = 2.04 ± 0.16 m2).

Intervention(s): Participants exercised in the heat (40°C, 50% relative humidity) on 2 days while wearing PADS until Trec reached 39.5°C. Participants then underwent TWI while wearing either NOpads or PADS until Trec reached 38°C. Thermal sensation and ESQ responses were collected at various times before and after exercise.

Main outcome measure(s): Temperate-water immersion duration (minutes), Trec cooling rates (°C/min), thermal sensation, and ESQ scores.

Results: Participants had similar exercise times (NOpads = 38.1 ± 8.1 minutes, PADS = 38.1 ± 8.5 minutes), hypohydration levels (NOpads = 1.1% ± 0.2%, PADS = 1.2% ± 0.2%), and thermal sensation ratings (NOpads = 7.1 ± 0.4, PADS = 7.3 ± 0.4) before TWI. Rectal temperature cooling rates were similar between conditions (NOpads = 0.12°C/min ± 0.05°C/min, PADS = 0.13°C/min ± 0.05°C/min; t12 = 0.82, P = .79). Thermal sensation and ESQ scores were unremarkable between conditions over time.

Conclusions: Temperate-water immersion produced acceptable (ie, >0.08°C/min), though not ideal, cooling rates regardless of whether PADS or NOpads were worn. If a football uniform is difficult to remove or the patient is noncompliant, clinicians should begin water-immersion treatment with the athlete fully equipped. Clinicians should strive to use CWI to treat severe hyperthermia, but when CWI is not feasible, TWI should be the next treatment option because its cooling rate was higher than the rates of other common modalities (eg, ice packs, fanning).

Keywords: Environmental Symptoms Questionnaire; exertional heat stroke; rectal temperature; thermal sensation.

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Figures

Figure 1.
Figure 1.
Rectal temperatures during exercise (left) and temperate-water immersion (right) for participants wearing a full American football uniform or minimal clothing (mean ± standard deviation, n = 13). Data are shown until the shortest exercise and water-immersion durations common to at least 10 of the 13 participants. X-axis error bars indicate the standard deviation for the final times to reach 39.5°C during exercise and 38°C during temperate-water immersion. Abbreviations: NOpads, shorts, undergarments, and socks; PADS, shorts, undergarments, socks, T-shirt, practice jersey, shoulder pads, helmet, game pants, and padding over the thighs, knees, hips, and tailbone.
Figure 2.
Figure 2.
Thermal-sensation scores before, during, and after temperate-water immersion while wearing a full American football uniform or minimal clothing (mean ± standard deviation, n = 13). Scale ratings ranged from 0 (unbearably cold) to 8 (unbearably hot). A score of 4 indicated participants were comfortable. a The pre-exercise score was different than scores at all other times (P < .05). b Postexercise > Trec at 38.75°C and postimmersion (P < .05). Abbreviations: NOpads, shorts, undergarments, and socks; PADS, shorts, undergarments, socks, T-shirt, practice jersey, shoulder pads, helmet, game pants, and padding over the thighs, knees, hips, and tailbone.
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