Objectives: For individuals with a spinal cord injury, thermoregulatory challenges presented by the environment are amplified, increasing the risk of exertional heat illness. Thus, this systematic review and meta-analysis aims to quantify the effects of pre- and per-cooling on core temperature (Tc), skin temperature (Tsk) and thermal sensation in participants with spinal cord injury and assess the influence of lesion level on the effects of cooling. Design: Systematic review with meta-analysis. Methods: Out of 2107 potential studies, 17 were identified via the inclusion criteria for a total of 145 research participants. A total of 12 studies were included in the primary analysis of Tc; 9 included in the analysis of Tsk; and 9 included in the analysis of thermal perceptions. 15 experimental conditions were included in the secondary analysis of lesion level on the effects of cooling. Results: Cooling reduced Tc (Hedges' g=0.44; 95% confidence intervals 0.16, 0.72; p<0.001), Tsk (Hedges' g=1.11; 95% confidence intervals 0.56, 1.66; p<0.002) and thermal sensation (Hedges' g=0.60; 95% confidence intervals 0.27, 0.93; p<0.001). Subgroup analysis revealed pre-cooling (Hedges' g=0.92), reduced Tc to a greater extent than per-cooling (Hedges' g=0.25; p=0.020). The effect of lesion level on the effectiveness of cooling on Tc had a moderate, positive association (r=0.518, p=0.048). Conclusion: Pre-cooling may reduce Tc to a greater extent than per-cooling during subsequent exercise. Pre- and per-cooling can attenuate the increase in thermal strain in athletes with a spinal cord injury. The beneficial effects of cooling are greater in tetraplegic individuals.
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