Cooling effectiveness of a modified cold-water immersion method after exercise-induced hyperthermia


Context: Recommended treatment for exertional heat stroke includes whole-body cold-water immersion (CWI). However, remote locations or monetary or spatial restrictions can challenge the feasibility of CWI. Thus, the development of a modified, portable CWI method would allow for optimal treatment of exertional heat stroke in the presence of these challenges.

Objective: To determine the cooling rate of modified CWI (tarp-assisted cooling with oscillation [TACO]) after exertional hyperthermia.

Design: Randomized, crossover controlled trial. Setting: Environmental chamber (temperature = 33.4°C ± 0.8°C, relative humidity = 55.7% ± 1.9%).

Patients or Other Participants: Sixteen volunteers (9 men, 7 women; age=26 ± 4.7 years, height=1.76 ± 0.09 m, mass= 72.5 ± 9.0 kg, body fat = 20.7% ± 7.1%) with no history of compromised thermoregulation.

Intervention(s): Participants completed volitional exercise (cycling or treadmill) until they demonstrated a rectal temperature (Tre)-39.0°C. After exercise, participants transitioned to a semirecumbent position on a tarp until either Tre reached 38.1°C or 15 minutes had elapsed during the control (no immersion [CON]) or TACO (immersion in 151 L of 2.1°C ± 0.8°C water) treatment.

Main Outcome Measure(s): The Tre, heart rate, and blood pressure (reported as mean arterial pressure) were assessed precooling and postcooling. Statistical analyses included repeated-measures analysis of variance with appropriate post hoc t tests and Bonferroni correction.

Results: Before cooling, the Tre was not different between conditions (CON: 39.27°C ± 0.26°C, TACO: 39.30°C ± 0.39°C; P=.62; effect size=-0.09; 95% confidence interval [CI]=-0.2, 0.1). At postcooling, the Tre was decreased in the TACO (38.10°C ± 0.16°C) compared with the CON condition (38.74°C ± 0.38°C; P <.001; effect size = 2.27; 95% CI = 0.4, 0.9). The rate of cooling was greater during the TACO (0.14 ± 0.06°C/ min) than the CON treatment (0.04°C/min ± 0.02°C/min; t15 =-8.84; P <.001; effect size = 2.21; 95% CI =-0.13,-0.08). These differences occurred despite an insignificant increase in fluid consumption during exercise preceding CON (0.26 ± 0.29 L) versus TACO (0.19 ± 0.26 L; t12=1.73; P=.11; effect size= 0.48; 95% CI =-0.02, 0.14) treatment. Decreases in heart rate did not differ between the TACO and CON conditions (t15 =-1.81; P = .09; effect size = 0.45; 95% CI =-22, 2). Mean arterial pressure was greater at postcooling with TACO (84.2 ± 6.6 mm Hg) than with CON (67.0 ± 9.0 mm Hg; P <.001; effect size = 2.25; 95% CI = 13, 21).

Conclusions: The TACO treatment provided faster cooling than did the CON treatment. When location, monetary, or spatial restrictions are present, TACO represents an effective alternative to traditional CWI in the emergency treatment of patients with exertional hyperthermia.

Document Type





Exertional heat stroke, Heat illness, Heat strain, Tarp-assisted cooling

Publication Date


Journal Title

Journal of Athletic Training