Summary • Exposure to cold conditions can have adverse effects for the athlete, both physiological and pathological. • Physiological responses include bronchial spasm, an increase of heart rate and blood pressure, a slowing of nerve conduction, an increase of tissue viscosity, and a stimulation of metabolism, with many of these changes causing some impairment of endurance performance. • Pathological consequences include an increased risk of musculo-skeletal injuries, a loss of manual dexterity and coordination, and a potential for anginal pain, bronchospasm, chilblains, frost bite, and general hypothermia. • Reversible effects of cold upon the airways, the cardiovascular system, the nervous system and metabolism have some adverse effects upon endurance performance, with little possibility of acclimation through repeated cold exposure. • There is potential for reversible physiological responses to progress to dangerous pathologies, particularly severe frostbite that can lead to local gangrene, and general hypothermia that can lead to death. • Such dangers can be largely avoided by a careful monitoring of effective temperature and an appropriate choice of protective clothing. • Much of the deterioration of physical performance seen in a cold environment can be countered by increasing the duration of the pre-event warm-up. • Bronchospasm is a common complaint among athletes when exercising in the cold; it can be countered by wearing a facial mask and (in consultation with a physician) by the intranasal administration of selective beta-2 adrenergic agonists as permitted by doping control agencies. • Cold pathologies are more easily prevented than treated; thus, event organizers must monitor carefully both effective environmental temperatures, and the competitors` choice of appropriate weather, wind and waterproof clothing. • Athletes who develop deep, hemorrhagic frostbite or a general hypothermia where the body temperature has fallen below 35°C require immediate re-warming and admission to a hospital emergency department.
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