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We read with interest the recent review by Bleakley and Davison (BJSM vol 44: 179-187), which described the physiological and biochemical responses to cold water immersion (CWI) after exercise. The authors examined some of the acute cardiovascular responses that occur with CWI, such as changes in heart rate, blood pressure and cerebral blood flow. We noted, however, that they did not address the effec...
We read with interest the recent review by Bleakley and Davison (BJSM vol 44: 179-187), which described the physiological and biochemical responses to cold water immersion (CWI) after exercise. The authors examined some of the acute cardiovascular responses that occur with CWI, such as changes in heart rate, blood pressure and cerebral blood flow. We noted, however, that they did not address the effects of CWI on heart rate variability (HRV), which provides an indication of cardiac autonomic nervous system (ANS) activity. Exercise increases cardiac sympathetic activity and reduces cardiac parasympathetic activity. But when multiple bouts of high-intensity exercise are performed without adequate recovery, the return of cardiac parasympathetic activity to resting levels is diminished[4, 5, 6]. There is evidence to suggest however, that CWI quickens the (post-exercise) return of cardiac ANS activity to pre-exercise levels, which may be indicative of an improved recovery state.
Water immersion on its own alters cardiac ANS activity. In thermoneutral water immersion, hydrostatic pressure is the primary factor that induces a mild compression of the peripheral vasculature, thereby increasing venous return and baroreceptor loading, ultimately increasing cardiac parasympathetic activity. For example, cardiac and vasomotor sympathetic activity was suppressed , while cardiac parasympathetic activity was elevated [8,10] during thermoneutral water (30 - 34.5 degrees C) immersion and further elevated during cool water (26 - 27 deg C) immersion compared with sitting out of the water. Collectively, these findings indicate that water immersion increases cardiac parasympathetic activity, and the effect is augmented with the addition of a cold stimulus[9, 12].
Extending the findings of Mourot et al. at rest (i.e., without exercise), Al Haddad et al. observed a greater increase in cardiac parasympathetic activity after immersion in cold (14 - 15 deg C) compared with warm (33 - 34 deg C) water following submaximal exercise. Thus, CWI (at ~14 deg C) provides a moderate cold stimulus that likely has an additive effect on the hydrostatic pressure, increasing peripheral vasoconstriction[7, 13], and also stimulating cold receptors in the skin, subcutaneous tissue and veins. Together, these responses likely augment cardiac parasympathetic stimulation.
In an applied setting with athletes, Buchheit et al. and Parouty et al. observed that 5 min of CWI during recovery between two supramaximal exercise bouts helped to restore cardiac parasympathetic activity. This response however, was not associated with improved 1-km cycling performance, and was detrimental to repeated 100-m sprint swimming times. Currently, limited data exists on the relationship between parasympathetic activity and athletic performance; however, it appears that improved/faster post-exercise parasympathetic reactivation does not necessarily translate into better high-intensity exercise performance. Further study exclusively manipulating cardiac autonomic activity before exercise (e.g., through pharmacological means) might help clarify this question. Exercise performance in such short events (1 min) may be more closely related to the efficiency of the neuromuscular and anaerobic systems, with the cardiovascular and autonomic systems playing only minor roles. Furthermore, the increased parasympathetic background before a repeated high-intensity effort might compromise cardio-acceleration at exercise onset, limiting oxygen delivery and therefore performance. Greater parasympathetic activity before exercise may be beneficial for longer events, when a blunted increase in heart rate together with the increased plasma volume as a consequence of fluid shift after immersion can prevent excessive myocardial work and therefore maintain prolonged aerobic performance. Future work could address this concept.
To date, no study has examined the effect of CWI during consecutive days of exercise on cardiac ANS activity, however, CWI following exercise sessions, particularly high-intensity exercise, may help restore/maintain cardiac parasympathetic activity during consecutive days of training. A concurrent reduction in cardiac sympathetic and increase in parasympathetic activity may be related to perceptions of less stress[17, 18], and greater well-being or - - recovery [4, 15]. Together, these observations may also be associated with improved sleep quality (personal observations), thereby reducing the period required for full recovery. Finally, the recent findings by Lung et al. also suggest that repeated CWI might accelerate acclimation to altitude by reducing sympathetic responses to hypoxic exposure, which could be of interest for sea-level athletes travelling to and competing at altitude. This cross-adaptive response highlights further potential benefits of CWI for athletes competing in various environments, and warrants future research.
In summary, in addition to the numerous physiological effects of CWI described by Bleakley and Davison (BJSM vol 44: 179-187), the clear alterations of HRV and cardiac autonomic activity are also important to consider. The effects of CWI on cardiac parasympathetic activity and associated perceptions of recovery suggest that CWI may be most effective when used after the final session of the day, or at the end of the day, which could improve an athletes overall recovery process (i.e., perceived well-being and sleep quality). The effect of CWI on training program adaptation and recovery requires further investigation.
Authors and affiliations
Jamie Stanley1,2, Paul B. Laursen3,4, Jonathan M. Peake1,2, Martin Buchheit5
1The University of Queensland, School of Human Movement Studies, Brisbane, Australia
2Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Brisbane, Australia
3New Zealand Academy of Sport North Island, Auckland, New Zealand
4School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
5Physiology Unit, Sport Science Department, Aspire, Academy for Sports Excellence, Doha, Qatar
Address for correspondence:
Jamie Stanley, School of Human Movement Studies, The University of Queensland, Brisbane, Queensland 4072, Australia; E-mail: email@example.com; Tel: +61 7 3365 6482; Fax: +61 7 3365 6877.
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