Cold-Water Immersion for Heat Stress in Older Adults

Overseen By Rachel Cottle, MS

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Penn State University

Must not be taking: Antiepileptics, Methotrexate

Disqualifiers: Chron's, Diverticulitis, Tobacco, others

Compensation: Varies

Number of Visits: 5

Duration: 6-7 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores methods to help older adults stay cool in increasingly common hot weather. It will test whether dipping hands and forearms in cold water (intermittent cold-water hand and forearm immersion) can reduce body temperature during heat stress. The trial will also examine if folic acid (a type of vitamin) can improve blood flow and aid in cooling. People aged 65 and older who speak English and do not have conditions like tobacco use or certain heart risks might be suitable candidates. As an unphased study, this trial offers participants the chance to contribute to innovative research that could enhance comfort and health during heat waves.

Will I have to stop taking my current medications?

The trial requires that you do not take antiepileptic or antiseizure medications, or methotrexate. If you are on these medications, you would need to stop taking them to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that older adults can safely use intermittent cold-water immersion for their hands and forearms. This method helps cool the body and reduces heart strain during hot weather. Importantly, studies have not identified any major safety issues or side effects.

Taking 5 mg of folic acid daily is also considered safe and offers other health benefits. It can improve blood flow, which may be especially helpful in hot conditions.

Overall, both methods appear safe and could help older adults manage heat stress. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Cold-Water Immersion trial for heat stress in older adults because it explores a non-invasive and accessible method to manage heat stress. Unlike other treatments that may involve medication or more complex interventions, this method uses intermittent cold-water immersion of the hands and forearms, which could offer a simple, cost-effective way to cool the body. This approach is particularly promising for older adults, who are more vulnerable to heat stress and may benefit from an easy-to-implement strategy. By focusing on physical cooling rather than chemical or pharmaceutical interventions, this method could provide a safer alternative with fewer side effects.

What evidence suggests that this trial's treatments could be effective for heat stress in older adults?

Research shows that dipping the hand and forearm in cold water can help older adults cool down during hot weather. Studies have found that this method can lower body temperature increases and reduce stress on the heart and blood vessels. This is crucial because older adults often struggle to cool down naturally in the heat. In this trial, participants will receive either intermittent cold-water hand and forearm immersion or folic acid supplementation. Folic acid has been shown to improve blood flow in older adults, which might also help them cope with heat better. Both treatments have shown promising results in making hot weather more manageable for older people. ^{1 2 5 6 7}

Who Is on the Research Team?

W. Larry Kenney, Ph.D.

Principal Investigator

The Pennsylvania State University

Are You a Good Fit for This Trial?

This trial is for older adults who may struggle with body cooling due to aging. It's designed to test if dipping hands and forearms in cold water intermittently can help them stay cool in warm conditions.

Inclusion Criteria

English proficiency

I am 65 years old or older.

Exclusion Criteria

Tobacco use

I am currently taking Methotrexate.

I have a history of Crohn's disease or similar bowel conditions.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Treatment

Participants undergo 4 experimental trials, 2 with folic acid supplementation and 2 with placebo, with intermittent hand and forearm cold-water immersion

6-7 weeks

4 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Intermittent cold-water hand and forearm immersion

Trial Overview The study tests a potential cooling method involving intermittent cold-water hand and forearm immersion compared to not using this strategy at all, aiming to see if it helps manage core temperature during heat stress.

How Is the Trial Designed?

Group I: Folic acid supplementation Experimental Treatment 2 Interventions

5 mg/day folic acid for 6-7 weeks

Group II: Control Placebo Group 2 Interventions

Cellulose placebo tablet for 6-7 weeks

Who Is Running the Clinical Trial?

Penn State University

Lead Sponsor

Trials

380

Recruited

131,000+

Published Research Related to This Trial

In a study involving 17 male volunteers from different ethnic backgrounds, localized cold stress from foot immersion in 10°C water caused an immediate drop in finger temperature across all groups, but recovery rates varied significantly.

Inuit subjects showed the fastest recovery of finger temperature after cold exposure, while Caucasians and Orientals had slower recovery rates, indicating potential differences in cold tolerance among ethnic groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of a local cold stress on peripheral temperatures of Inuit, Oriental, and Caucasian subjects. Livingstone, SD., Grayson, J., Reed, LD., et al.[2022]

Hand immersion in cool water (25°C and 10°C) significantly reduced core and skin temperatures in men wearing impermeable NBC clothing, compared to no immersion, during rest periods in a warm environment (30°C).

This technique extended the total work time of subjects by 10-20 minutes, suggesting that hand immersion can effectively reduce heat stress when normal heat loss methods are limited.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of hand immersion on body temperature when wearing impermeable clothing. Allsopp, AJ., Poole, KA.[2008]

Hand immersion in cold water significantly reduces physiological strain during exercise in hot conditions, as shown by a study with 17 heat-acclimated subjects wearing protective garments, where it lowered average rectal temperature by nearly 0.5 degrees Celsius during rest periods.

This method also improved overall tolerance to heat stress, allowing all participants to complete the exercise session with hand immersion, compared to only 12 out of 17 in the control group, indicating it is a practical and effective strategy for enhancing performance in extreme conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hand immersion in cold water alleviating physiological strain and increasing tolerance to uncompensable heat stress. Khomenok, GA., Hadid, A., Preiss-Bloom, O., et al.[2021]

Maximal voluntary grip strength (MVGS) significantly decreased by 16% after immersing the hand and 13% after immersing the forearm in cold water (5 degrees C), with most reductions occurring in the first 2 minutes.

Wearing a protective glove after unprotected hand cooling also led to a significant 14% reduction in MVGS, indicating that both hand and forearm protection are crucial for maintaining grip strength after cold exposure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of cold immersion and hand protection on grip strength. Vincent, MJ., Tipton, MJ.[2008]

In a study involving six subjects, immersion of the forearm in 15°C water for 3 hours revealed cyclic fluctuations in muscle temperature, with the first increase occurring after 75 minutes and averaging a cycle duration of 36 minutes.

The maximum muscle temperature increase ranged from 0.4°C to 1.0°C and was linked to the forearm's circumference, suggesting that muscle blood vessels play a significant role in cold-induced vasodilation, while skin temperature and heat loss remained unchanged.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cyclic intramuscular temperature fluctuations in the human forearm during cold-water immersion. Ducharme, MB., VanHelder, WP., Radomski, MW.[2019]

Cold-stress tests, which measure finger skin temperature, are important for diagnosing vascular disorders related to hand-arm vibration syndrome, but there is significant variability in test conditions across different studies.

Standardization efforts are needed, as factors like water temperature (ranging from 0 to 15 degrees C), immersion time (0.5 to 20 minutes), and environmental conditions can greatly affect the diagnostic value of these tests, with a preference for higher water temperatures and shorter immersion times to reduce patient discomfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cold-stress tests involving finger skin temperature measurement for evaluation of vascular disorders in hand-arm vibration syndrome: review of the literature. Harada, N.[2019]

Cold water immersion of the hands and forearms during half-time significantly improved intermittent cycling performance in the heat, with participants showing greater power output in the second half compared to those who rested.

This cooling method also effectively reduced body temperature and heart rate, leading to a more comfortable thermal sensation, which suggests it can enhance exercise performance and comfort in hot conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cold water immersion of the hand and forearm during half-time improves intermittent exercise performance in the heat. Iwahashi, M., Chaen, Y., Yanaoka, T., et al.[2023]

Cold-stress tests, particularly using a 10°C water immersion for 10 minutes, have been widely accepted in Japan for diagnosing hand-arm vibration syndrome, focusing on measuring finger-skin temperature.

There is a need for standardization of the cold-stress test methods and environmental factors to improve the reliability and diagnostic significance of the results in epidemiological studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A minireview of studies conducted in japan using finger-skin temperature during cold-stress tests for the diagnosis of hand-arm vibration syndrome. Harada, N., Yoshimura, M., Laskar, MS.[2019]

Cold water immersion (CWI) at temperatures of 10-15°C for 5-15 minutes is shown to effectively enhance recovery of performance in athletes, making it a popular choice for minimizing fatigue after exercise.

Contrast water therapy (CWT), which alternates between cold and hot water, may also aid recovery, but its effectiveness depends on equal time spent in both temperatures and short immersion durations, with no clear dose-response relationship established.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Water immersion recovery for athletes: effect on exercise performance and practical recommendations. Versey, NG., Halson, SL., Dawson, BT.[2022]

Using natural rubber gloves during cold water immersion significantly increased finger skin temperature and reduced hand pain compared to bare hands and polyethylene gloves, indicating better thermal protection.

Polyethylene gloves also provided some benefit by reducing pain compared to bare hands, suggesting they can be a suitable alternative for minimizing discomfort during immersion tests.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of waterproof covering on finger skin temperature and hand pain during immersion test for diagnosing hand-arm vibration syndrome. Suizu, K., Inoue, M., Fujimura, T., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10285063/

Cold water immersion of the hand and forearm during half ... Cold water immersion of the hand and forearm during HT improved physiological and reduced perceived heat stress. Moreover, it prevented a ...

2. journals.physiology.org journals.physiology.org/doi/abs/10.1152/physiol.2025.40.S1.1155

Intermittent Hand and Forearm Cool Water Immersion ... Intermittent Hand and Forearm Cool Water Immersion Reduces Thermal and Cardiovascular Strain in Older Adults during Uncompensable Heat Stress ( ...

3. physoc.onlinelibrary.wiley.com physoc.onlinelibrary.wiley.com/doi/full/10.1113/EP092789

Intermittent hand and forearm immersion in 20°C water ... These data suggest that intermittent H+F water immersion effectively attenuates thermal and cardiovascular strain for older adults at rest during heat stress.

4. sciencedirect.com sciencedirect.com/science/article/pii/S030645652400144X

The effects of cold water immersion and partial body ... This study investigated the effects of cold water immersion (CWI) and partial body cryotherapy (PBC) applied within a 15-min post-exercise recovery period.

5. researchgate.net researchgate.net/publication/393465701_Intermittent_hand_and_forearm_immersion_in_20C_water_attenuates_thermal_cardiovascular_and_perceptual_strain_in_older_adults_during_heat_stress

(PDF) Intermittent hand and forearm immersion in 20°C ... These data suggest that intermittent H+F water immersion effectively attenuates thermal and cardiovascular strain for older adults at rest during heat stress.

6. physoc.onlinelibrary.wiley.com physoc.onlinelibrary.wiley.com/doi/10.1113/EP092789

Intermittent hand and forearm immersion in 20°C water ... Intermittent hand and forearm immersion in 20°C water attenuates thermal, cardiovascular, and perceptual strain in older adults during heat ...

7. annemergmed.com annemergmed.com/article/S0196-0644(24)00407-4/fulltext

Heat Stroke Management Updates The cold-water immersion protocol involves placing a patient suffering from suspected heat stroke in a body bag filled with a slurry of ice ...