Cold Water Therapies: Minimizing the Risks

Cold Water Therapies: Minimizing the Risks

Cold Water Immersion (CWI) is a “hot topic” right now. In many countries, there has been an explosion in the number of people undertaking CWI for anecdotally claimed mental and physical health benefits.1 These immersions range from static immersions in ice baths and cold showers at home, to swims and dips in open water. Coupled with this, in 2021 Her Majesty’s Coastguard UK reported a 52% increase in calls associated with swimming and diving and between 2018 and 2021 there was a 79% increase deaths related to open water swimming (34 to 61 deaths) in the UK.2

For tropical animals such as humans, immersion in cold water is stressful and carries a significant risk of respiratory, cardiovascular, and possibly peripheral neurovascular injury. The most dangerous reaction associated with CWI is “cold shock”.3 4 It is triggered by a rapid drop in skin temperature and includes gasping, hyperventilation, release of stress hormones, hypertension and arrhythmias. Loss of breathing control can be a precursor to drowning, and increased work on the heart and circulation can lead to cardiovascular disease. Cardiac arrhythmias are particularly common if cold immersion includes face, apnea, and coactivation of cold shock (sympathetic autonomic nervous system response) and dive response (parasympathetic autonomic nervous system response) – a combination of conflicting inputs to the core called “autonomous conflict”. ‘ ‘.4

We encourage people to enjoy water, but in a responsible way that maximizes potential benefits and minimizes risks. With that in mind, we offer some advice for CWI participants, those evaluating…

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