Acta Physiol Scand 2005, 183, 117124

Local cold acclimation of the hand impairs thermal responses of the nger without improving hand neuromuscular function
C. L. M. Geurts,1 G. G. Sleivert2 and S. S. Cheung3
1 2 3 Human Performance Laboratory, Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada PacicSport Canadian Sport Centre Victoria, Victoria, BC, Canada Environmental Ergonomics Laboratory, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada

Received 25 February 2004, accepted 2 September 2004 Correspondence: G. G. Sleivert PhD, Director of Sport Science and Medicine, PacicSport Canadian Sport Centre Victoria, 100-4636 Elk Lake Dr Victoria, BC V8Z 5M1, Canada.

Abstract Aim: To investigate the effects of cold acclimation on the thermal response and neuromuscular function of the hand. Methods: Ten healthy subjects [three female, seven male, age (mean SD): 27.9 7.9 years] immersed their right hand in 8 C water for 30 min, 5 days a week for 3 weeks. On the rst and the last day, neuromuscular function of the rst dorsal interosseus (FDI) muscle was tested. Results: There was no signicant change in maximal voluntary contraction strength or evoked contractile characteristics of the FDI after cold acclimation. Minimum nger temperature decreased signicantly from 10.6 1.2 to 9.3 0.8 C after 3 weeks (P < 0.01), with most of the decrease occurring after a single exposure. Mean nger temperature dropped signicantly from 14.2 1.9 to 11.7 1.4 C following cold acclimation (P < 0.05), with 90% of this adaptation occurring after 5 days. Onset time of cold-induced vasodilatation increased from 446 171 to 736 384 s (P < 0.05) and the amplitude decreased from 5.3 3.2 to 2.5 2.1 C (P < 0.05). This was signicantly different from the control group, who immersed their right hand on the rst and last days only. Conclusion: These data suggest that cold acclimation does not enhance hand temperature or function but may put the hands at a greater risk of cold injury when exposed to the cold. Keywords cold acclimation, cold-induced vasodilatation, contractile properties, evoked force, hand, skin temperature.

There are occupations in which manual work has to be performed in a cold environment. Examples include sherman (LeBlanc et al. 1960, 1964), power-line workers that must work outside in winter, and frozen-food processing industry workers (Chiang et al. 1990). While performing these manual tasks, it is not always possible to protect the hands sufciently against the cold because bulky gloves impair manual dexterity (Geng et al. 1997). When exposed to acute cold stress, the body responds with a vasoconstriction of the extremities to maintain the temperature in the core. After a prolonged period of vasoconstriction, a paradoxical vasodilatation usually
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occurs. This cold-induced vasodilatation (CIVD) was rst reported by Lewis (1930) and has long been considered a protective mechanism for cold injury of the ngers (Wilson & Goldman 1970). During a CIVD, there is an increase in blood ow to the hand that warms up the ngers. Ducharme et al. (1991) also showed increased blood circulation in the large vessels of the forearm during CIVD, which increased the temperature of the forearm muscles. It is well known that neuromuscular function is dependent on the temperature of the muscle (Ranatunga et al. 1987), therefore if CIVD increases muscle temperature of the 117

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hand muscles due to an increased blood ow to the extremities, this may have a benecial effect on the neuromuscular function in this region and could conceivably improve manual dexterity (Heus et al. 1995). Repeated exposure to cold stress results in a cold acclimation, described by some as cold adaptation. The literature on cold acclimation is ambiguous regarding the effect of chronic or repeated cold stress on the human body. Studies on people living and working in the cold have shown an increased skin temperature and enhanced blood ow to the extremities while in cold conditions (Miller & Irving 1962, Eagan 1963, LeBlanc et al. 1964, Savourey et al. 1996). Other researchers have shown an enhanced vasoconstriction after cold adaptation, resulting in a decreased skin temperature upon cold exposure (Livingstone 1976, Leftheriotis et al. 1990, Bridgman 1991). There are numerous reasons for this diversity of cold adaptation. The type of cold adaptation is probably dependent upon the various experimental conditions used to develop and test cold adaptation, such as continuous vs. discontinuous exposures, moderate vs. severe cold stress, variations in total exposure time during both adaptation and testing, whole body vs. extremity-only exposure, and air vs. water immersion. The purpose of this study was to investigate the effects of repeated cold-water immersion of the hand on thermoregulation of the hand and on the neuromuscular function of the rst dorsal interosseus (FDI) muscle. In this study, the hand was tested and acclimated in cold water for 30 min to get a complete view on the CIVD response that typically occurs after 10 min of cold stress. Although contact cooling through handling material or tools may impose a greater risk in daily life due to its more intense and rapid cooling effect (Jay & Havenith 2004), acclimation will most likely result from whole hand cooling over a longer period of time. Cold water is the safest and fastest way to cool the periphery without putting the subjects at risk of cold injury. The whole hand was cooled instead of only the nger because in daily life people typically expose their whole hand when working in a cold environment. Because the whole hand was immersed, the cold stress would be larger than with nger-only immersion; therefore, a water temperature of 8 C was chosen to minimize the extreme discomfort and nausea often experienced by subjects. It was hypothesized that repeated cold-water immersion of the hand would enhance the CIVD response and that this would improve neuromuscular function of the FDI muscle.

University of New Brunswick approved the study protocol in advance. Each subject completed and answered no to all questions on the Physical Activity Readiness Questionnaire (PAR-Q) (CSEP 1998) and provided written informed consent before participating. Seventeen subjects (10 male, seven female, 26.9 6.6 years) were used for the analysis. One female subject withdrew because of intolerance of the cold water. The data of two male subjects were discarded because they did not show a CIVD response during the initial test, dened as an increase in nger temperature of 0.5 C.

Experimental design
All subjects underwent in total four neuromuscular function tests. The rst two were conducted in thermoneutral condition and after 30 min hand cooling and this was repeated 3 weeks later. The subjects were assigned to two groups a priori to avoid time gaps between the initial test and the acclimation trials. The experimental group (EXP; three female, seven male; age 27.9 7.9 years; height 1.76 0.07 m; weight 74.3 10.4 kg) came into the laboratory ve times a week for 3 weeks to immerse their right hand up to the styloid process into 8 C water for 30 min. On the rst and the last day of this cold acclimation period, they underwent a neuromuscular function test. A control group (CON; four female, three male; age of 25.6 4.1 years; height 1.74 0.08 m; weight 70.2 11.4 kg) arrived at the laboratory on the rst and last day only to undergo the neuromuscular function test. The testing took place in September and October 2002 in eastern Canada (average ambient outdoor temperature: 11.8 5.7 C).

Neuromuscular function test

Upon arrival on the rst and the last day of the cold acclimation period, a plastic mould was made for the index nger and forearm. Two insulated ceramic chip thermistors (MA-100; Thermometrics, New York, NY, USA) were placed next to the nail bed of the right index nger (Tif) and on the skin over the FDI muscle (Tfdi). Skin temperature of the index nger was measured and logged every 8 s on a data logger (Smartreader 8 Plus; ACR, Vancouver, BC, Canada) interfaced with a computer to prevent cold injury. Two stimulating electrodes were placed on the ulnar nerve, 4 and 7 cm proximal to the pisiform bone, respectively. The subject was seated with the shoulder abducted and the forearm resting on a stable base. Forearm and hand were immobilized using a plastic mould and straps. The subject was accustomed to the electric current and familiarized to the feeling of tetanic stimulation. The
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Materials and methods Subjects

Twenty volunteers (12 male and eight female) participated in this study. The Ethics Committee of the 118

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current was delivered through supramaximal square wave pulses of 200 ls duration by a constant current stimulator (Digitimer; DS7A, Hertfordshire, UK). The protocol used was similar to that of Geurts et al. (2004) and was conducted as follows: rst, the subject performed an isometric maximal voluntary contraction (MVC) with the index nger. The resulting abduction force was amplied (100) and collected at 1 kHz for 1 later processing (WinDaq Pro+; Dataq, Akron, OH, USA). Thereafter, one evoked twitch, evoked tetanic contractions at 10 and 20 Hz stimulating frequencies, and two voluntary force control trials at 25 and 50% of the MVC, 40 s in duration, were performed. Two minutes of rest separated each neuromuscular test. The plastic mould and stimulating electrodes were removed and the subject was then transferred to the hand cooling station. The right hand was immersed up to the styloid processes for 30 min in circulating 8 C water maintained with a chiller (Polyscience, Niles, IL, USA). After 30 min, the hand was removed from the water, dried off, and the subject was transferred back to the myograph and the neuromuscular testing, with exception of the MVC, was repeated. This process took about 35 min; in this time, the index nger warmed up on average 6.2 2.6 C and the skin above the FDI by 6.1 2.4 C.

For the temperature data, a two-sample t-test was used to compare the difference between pre- and posttest values across the experimental and control group. The subjects were assigned to the experimental and control group a priori, which resulted in a difference in the pre-test temperature. Therefore, the different scores of the pre- and post-tests were used for analysis. Additional analysis was performed on the acclimation data. A one-way analysis of variance (anova) with repeated measurements (time, four levels) was performed on day 1, 6, 11 and 15. When a main effect was detected, Bonferroni post-hoc tests were applied to determine signicant differences between the days. For the neuromuscular data, a two-way anova (group time) with repeated measures on one factor (time, consisting of four levels: pre-cold, pre-warm, post-cold and post-warm) was used to test for differences in responses between groups and across time. For all statistics, type 1 error was protected at the 5% level. All data are reported as mean SD.

Results Thermoregulatory data

For the EXP group, minimum nger temperature decreased from 10.6 1.2 to 9.3 0.8 C after 3 weeks of cold acclimation. The difference between the pre- and post-test was signicantly different (P < 0.01) from that of the control group (9.2 0.5 C before, 9.3 0.8 C after). The time-course of the minimum temperature response is shown in Figure 1. Time-course analysis showed that the modelled minimum nger temperature was completely adapted after a single exposure. Analysis of variance conrmed a signicant time effect and post-hoc comparisons revealed that the cold acclimation response occurred between days 1 and 6 (P 0.02).

Data analysis
The onset time of the CIVD was dened as the time from hand entry until the skin temperature of the index nger rst started to rise for more than 0.5 C and the amplitude of the CIVD was dened as the apex of the CIVD minus the nadir of the CIVD. The minimum skin temperature of the index nger (Tif min) and the average temperature of the index nger (Tif mean) during the 30 min water immersion were averaged over the 10 experimental subjects and plotted vs. acclimation day and then tted with a simple exponential function [y a + b exp()x/c)] (Gill & Sleivert 2001). The following characteristics were calculated from the evoked force measurements. Peak twitch force (PTF) was dened as the peak amplitude of the force signal. Time to peak force (TTP) was dened as the delay between the stimulus and the peak amplitude. The half relaxation time (1/2RT) was dened as the time between the PTF and the point at which the peak force was reduced to half its size. To determine the degree of fusion in the tetanic forces at 10 and 20 Hz, an epoch of 200 ms was taken at peak force and the coefcient of variation (CV) was calculated by dividing the standard deviation by the mean force of this epoch. The CV of the submaximal voluntary forces were calculated in a similar manner by using an epoch of 1 s after 20 s. High CV represent poorer force control.
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Figure 1 Minimum index nger temperature [mean (SD)] during cold water immersion of the EXP group (open circles) over the course of 15 days, and pre and post values of the CON group (lled circles). *Signicantly different from day 1: P < 0.05 (repeated measures on day 1, 6, 11 and 15).

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The mean nger temperature over the 30-min immersion signicantly dropped from 14.2 1.9 C before to 11.7 1.4 C after cold acclimation (P < 0.05), compared with that of the control group (12.1 1.5 C before, 11.5 1.3 C after). The time-course analysis shown in Figure 2 reveals that after a single exposure, 67% of the acclimation in mean nger temperature had occurred, and 99% of cold acclimation was reached by day 5. Analysis of variance conrmed a signicant time effect and post-hoc comparisons revealed that the cold acclimation response occurred between days 1 and 6 (P < 0.01). The onset time for CIVD increased from 446 172 s before to 736 385 s after acclimation in the EXP group and the difference between pre- and post-test was signicantly different (P < 0.05) from that of the CON group (534 263 s before, 573 247 s after). Timecourse analysis shown in Figure 3 reveals that 92% of the acclimation had occurred by day 5. The amplitude of CIVD decreased from 5.3 3.2 C before to 2.5 2.1 C after acclimation, which was signicantly different (P < 0.05) from the control group

(3.0 3.0 C before, 3.0 2.9 C after). The timecourse of the amplitude change is displayed in Figure 4. In addition, the skin temperature of the index nger after 10 min of cold water immersion was signicantly decreased from 12.3 2.2 C before to 10.6 2.0 C after acclimation in the EXP group (P < 0.04) compared with the control group (10.5 1.3 before, 11.6 2.2 C after). An overview of all the temperature data is shown in Table 1. Comparison of the temperature data of EXP and CON group combined for the pre-acclimation test revealed no signicant difference between the male subjects and females subjects for the index nger temperature. Only the onset time of the CIVD was signicantly later in the group of male subjects (P < 0.04). After 30 min of cold water immersion, the hand was quickly placed in the hand myograph and strapped in. As soon as the hand was out of the water, the hand warmed up. Although nger and FDI temperature increased on average 6.2 2.6 and 6.0 2.4 C, respectively, both Tif and Tfdi were signicantly colder during the cold condition compared with the warm condition (P < 0.01). During the neuromuscular testing, the Tfdi in the warm condition was 32.6 2.8 C before and 30.7 2.4 C after cold acclimation. In the cold condition, the Tfdi was 18.8 2.8 C before and 17.6 3.4 C after cold acclimation. The Tif was 30.4 3.9 C before and 27.0 3.7 C after cold acclimation in the warm condition and 19.2 3.2 and 15.7 2.7 C after cold acclimation in the cold condition. These differences were not signicantly different between groups.

Figure 2 Average index nger temperature over 30 min cold water immersion [mean (SD)] of the EXP group (open circles) over the course of 15 days and pre and post values of the CON group (lled circles). *Signicantly different from day 1: P < 0.05 (repeated measures on day 1, 6, 11 and 15).

Neuromuscular data
Maximal voluntary contraction was not signicantly different between groups after acclimation and averaged 54.5 21.8 n before and 59.5 22.0 n after cold for

Figure 3 Onset time for the CIVD [mean (SD)] of the EXP group (open circles) over the course of 15 days of cold acclimation and the pre and post values of the CON group (lled circles). *Signicantly different from day 1: P < 0.05.

Figure 4 Amplitude of the CIVD [mean (SD)] of the EXP group (lled circles) over the course of 15 days, and the pre and post values of the CON group (lled circles). *Signicantly different from day 1: P < 0.05. 2005 Scandinavian Physiological Society

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Acta Physiol Scand 2005, 183, 117124 Table 1 Temperature responses before and after cold acclimation and the difference score for the experimental and control group

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Post Difference (pre ) post) 3.4 3.0 0.8 0.8 1.4 1.3 3.2 2.4 384.9 247 2.1 2.9 2.0 2.2 4.5 0.9 1.3 )0.1 2.5 0.6 4.0 0.6 )290 )40 2.8 0.0 1.7 )1.1 4.0 4.5 1.0 0.6* 1.8 1.7* 5.0 2.2* 325 129* 3.6 1.2* 1.9 2.6*

Group Tif at entry (C) Tif Tif Tif

min

Pre 31.9 28.3 10.6 9.2 14.2 12.1 16.5 13.4 446.4 533.7 5.3 3.0 12.3 10.5 3.0 3.2 1.2 0.5 1.9 1.5 3.9 2.9 171.7 263.2 3.2 3.0 2.2 1.2

(C) (C) (C)

mean

max

Onset time (s) Amplitude (C) Tif (after 10 min) (C)

Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con

27.4 27.3 9.3 9.3 11.7 11.5 12.5 12.8 736 573.7 2.5 3.0 10.6 11.6

Tif, skin temperature of index nger; Entry, nger temperature before water immersion; Min, minimum temperature during 30-min immersion; Mean, average temperature during 30-min immersion; Max, maximum temperature after the minimum temperature; Onset time, onset time of CIVD. Amplitude is Tif max ) Tif min. *Signicant difference between experimental and control group on difference score (P < 0.05).

the groups combined. An overview of the neuromuscular data is shown in Table 2. There was a signicant difference between the muscle characteristics in the warm and cold conditions, but there were no signicant changes in neuromuscular function of the FDI as a result of cold acclimation. The degree of fusion was higher (as observed by the smaller CV) in the voluntary force control trials than in the evoked tetanic contractions, but there was no effect of either thermal condition or cold acclimation. There was no signicant effect of cold acclimation on any neuromuscular parameters measured in this study.

Discussion
The unique aspect of this study was the time-course data of local acclimation of the hand, coupled with the prolonged immersion time and the neuromuscular tests performed before and after local cold acclimation. We found that immersing one hand repeatedly in cold water resulted in an enhanced vasoconstriction and a blunted CIVD response, with the majority of the acclimation occurring within the rst week of cold water immersion. Most researchers who have reported a decrease in skin temperature after cold acclimatization tested their subjects during whole body cooling in air (Young et al. 1986, Savourey et al. 1996, OBrien et al. 2000) or their subjects underwent a whole body cold exposure during the acclimatization period (Paik et al. 1972, Livingstone 1976, Bridgman 1991, Savourey et al. 1992). However, a lower core body temperature can
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directly impair the CIVD response (Daanen et al. 1997). In this study, the subjects were only subjected to local hand cooling while sitting in a thermoneutral room (ambient temperature 23.0 1.6 C). This is similar to the exposures used in other studies using imposed repeated local cooling of the periphery, but other studies using this exposure regime on their subjects found higher skin temperatures of the hand in the adapted group (Adams & Smith 1962, Eagan 1963). The results in this study were therefore unexpected. An enhanced vasoconstriction resulting in colder hands may be expected to impair neuromuscular function, as temperature is an important modulator of the contractile function of skeletal muscle (Davies & Young 1983, De Ruiter et al. 1999). In the present study, a signicant impairment in contractile characteristics between the warm and cold condition was observed and no benecial adaptations in neuromuscular function were found after cold acclimation. Previous research by Geurts et al. (2004) reported that a decrease in Tfdi of 10.2 C resulted in an increase in TTP and 1/2RT of 58 and 63 ms, respectively. A larger change in temperature response in the hand and nger may be needed to see signicant changes in neuromuscular function after acclimation. During cold water immersion, the nger temperature was signicantly lower after cold acclimation. The skin temperature above the FDI was, however, less affected and this decrease was not signicantly different between groups. The skin temperature directly above the FDI is closely related to the muscle temperature of the FDI 121

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Cold Post 20.5 23.5 1.3 1.2 19 12 18 13 5.3 4.8 1.0 1.3 9.4 14.9 0.9 0.5 1.0 0.9 1.2 2.0 61.2 58.3 2.5 1.8 145 138 72 63 11.7 8.6 2.5 4.6 30.8 27.1 1.2 1.1 1.8 3.5 4.2 3.5 16.4 27.7 0.8 0.8 14 17 20 15 10.0 7.4 1.0 3.5 10.8 13.7 0.6 0.6 1.3 2.4 7.7 3.2 Pre 2.0 1.6 231 223 173 179 20.5 15.9 1.4 2.0 33.7 27.7 1.1 1.0 1.8 2.6 2.7 2.8 1.2 1.5 27 31 46 56 7.6 11.5 0.6 1.0 10.1 16.0 0.7 0.7 1.8 2.5 1.7 1.6 Post 1.2 0.8 268 269 174 162 15.5 11.1 1.6 2.3 24.8 21.1 1.0 1.2 1.5 2.2 2.2 2.2 1.2 0.3 48 103 55 5.2 8.6 4.6 0.7 0.9 7.2 6.2 0.6 0.7 0.5 1.5 1.1 1.2

Acta Physiol Scand 2005, 183, 117124 Table 2 An overview of the neuromuscular data (mean SD) from the warm (31.6 2.7 C) and cold test (18.2 3.1 C) for the experimental and control group

Warm Group MVC (n) PTF (n) TTP (ms) 1/2RT (ms) Fmax 10 Hz (n) CV 10 Hz (%) Fmax 20 Hz (n) CV 20 Hz (%) CV25%MVC (10)2 %) CV50%MVC (10)2 %) Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Exp Con Pre 55.1 54.3 2.8 2.3 142 136 78 69 10.9 9.6 2.6 1.9 32.3 30.0 1.6 1.0 1.7 2.2 1.8 2.7

MVC, maximal voluntary contraction; PFT, peak twitch force; TTP, time to peak force; 1/2RT, half relaxation time; Fmax 10 Hz, maximum force at 10 Hz stimulating frequency; CV 10 Hz, SD/mean of 200 ms epoch of force response at 10 Hz; Fmax 20 Hz, maximum force at 20 Hz stimulating frequency; CV 20 Hz, SD/mean of 200 ms epoch of force response at 20 Hz.

(Ranatunga et al. 1987). To our knowledge it is not known if this relationship would change with repeated cold water immersion of the hand. It is possible that cold acclimation results in a more severe cutaneous vasoconstriction (Paik et al. 1972), causing the skin to act more as an insulating layer over the FDI muscle. As the skin above the FDI muscle is thin, we think this effect, if present, will be negligible, and that the skin temperature can be used as an indication of the muscle temperature. Cold acclimation did not affect FDI temperature and therefore it is not surprising that cold acclimation did not affect neuromuscular function. This also suggests that focusing on changes in nger thermal responses may not be appropriate when investigating manual dexterity or neuromuscular function of the hand as a whole during cold exposure. The longer cold exposure duration in the present study than in typical studies on hand immersion, in combination with whole-hand vs. single nger immersion, may have had an effect on the study outcome. The majority of studies on peripheral cold adaptation immersed hands for a relatively brief period of 515 min (LeBlanc et al. 1960, Adams & Smith 1962, Nelms & Soper 1962, Eagan 1963, Savourey et al. 1996), in contrast to the 30 min exposure utilized in the present study. Upon closer examination of the values of 122

Tif min after 10 min and Tif min, it was found that there was a signicant decrease in skin temperature in the nal 20 min of exposure. It is possible that the extended duration of cold exposure in the present protocol precipitated the insulative adaptation that was observed, and in the other studies the duration of exposure was insufcient to fully maximize the vasoconstrictive response. Contact cooling can be expected to play a role in the cooling of the hand when working in a cold environment. Depending on the materials handled and contact force, contact cooling is a more rapid and local cooling than whole hand cooling (Jay & Havenith 2004). It may be expected that in contact cooling only the local skin will be cooled (Chen et al. 1996) and that the muscles, mostly located on the dorsum of the hand will be less affected. The local skin temperature in this case will determine the contact time, and thus cooling, in such situations. Another interesting nding of the present study was that the time-course analysis showed that the modelled minimal nger temperature during the 30 min immersion decreased after only one single exposure. Cold acclimation outside the laboratory was not expected as the testing was conducted in September and October with outside temperatures of 1018 C. Vasoconstriction can be inuenced by mental stress (Halperin et al.
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1983) as well as physical stress (Adams & Smith 1962). Noradrenaline release is increased during psychological stress and enhances vasoconstriction. It is possible that the cold stress experienced in the rst day caused an additional mental stress on the second day resulting in an enhanced vasoconstriction. Anticipation of the cold water may have caused the small change in temperature response observed in the control group, resulting in a small decrease in mean Tif and amplitude as well as a slight delay in onset of the CIVD. These changes were substantially smaller than those observed in the experimental group, and we would not expect the mental stress of cold exposure to endure with the repeated cold immersions experienced in the experimental group. There was an uneven distribution of males and females in the experimental and control group and this may have caused differences between the two groups in the pre-acclimation tests. Bartelink et al. (1993) found lower index nger temperatures for females compared with males and an enhanced vascular reactivity in women, resulting in enhanced vasoconstriction and thus lower temperatures. Female core temperature uctuates within the menstrual cycle with the highest core temperatures during the luteal phase, with a difference up to 0.59 C (Hessemer & Bruck 1985) when tested at 03:00 h at the middle of the luteal phase. Jay & 2 Havenith (2004) found that hand/nger size had a greater predictive power than sex. However, we did not nd a signicant difference in index nger temperatures in the initial test between the male and female subjects in this study. Only the onset time of the CIVD was signicantly later in males compared with the females. It has been previously reported that thermal sensation is rapidly habituated with cold exposure (Leppaluoto et al. 2001). In addition, pain sensation is less in coldadapted individuals (Budd et al. 1993). This was also reported in the older literature on Inuits (Brown & Page 1952), shers (LeBlanc et al. 1960) and sh lleters (Nelms & Soper 1962). Unfortunately, thermal sensation was not measured in this study; however, subjective complaints indicated that the subjects did experience less pain and cold at the end of the acclimation period. Sawada et al. (2000) concluded that subjective judgements may not be reliable indicators for monitoring the risk of progressive tissue cooling and frostbite formation. If the ngers are getting colder after cold acclimation but the subjects experience less pain or feel less cold, cold acclimation could potentially put someone at greater risk of cold injury. In summary, unlike the majority of prior research, repeated and prolonged cold water immersion of the hand with the present protocol resulted in an attenuated CIVD response of the ngers but no adaptive responses in FDI temperature or neuromuscular function. The rapid reduction in CIVD, after only a single cold
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exposure of the hands, could potentiate the risk of cold injury during subsequent cold exposure.
We would like to thank the subjects for their enthusiastic participation. The study was supported by a Discovery Grant (Cheung and Sleivert) from the Natural Sciences and Engineering Research Council of Canada (NSERC). C. Geurts was supported by a NSERC PGS-B Scholarship.

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