Prevention of Cold Injuries during Exercise

John W. Castellani, Ph.D., FACSM; Andrew J. Young, Ph.D., FACSM; Michel B. Ducharme, Ph.D.; Gordon G. Giesbrecht, Ph.D.; Ellen Glickman, Ph.D., FACSM; Robert E. Sallis, M.D., FACSM


March 01, 2010

In This Article


Exercise is primarily pursued outside in a variety of environmental extremes, including exercising in cold air and water. Because this topic affects many different people, the ACSM presents an evidence-based review of the state of knowledge on exercising in the cold.

A summary of the evidence statements and their respective evidence category grades are presented in Table 6. Since outcomes-based (development of hypothermia, frostbite, nonfreezing cold injury) research in the cold is limited due to ethical constraints, the majority of the evidence categories are graded based on physiologic end-points. However, this collection of information still enables a recommendation to be made that will aid in preventing cold injuries during exercise.

It is the position of the American College of Sports Medicine that exercise can be safely performed in cold-weather if coaches, athletes, medical personnel, and officials follow a risk management strategy. Successful implementation of this strategy includes asking the following questions: a) how cold is it?; b) what clothing protection is available?, c) who is at risk for a cold-weather injury?, d) what is the health condition of the exerciser?, e) what effective strategies do I have available to mitigate the cold stress and injury risk?, and f) is there a contingency plan in place to deal with changing conditions? Training in cold weather is very important as athletes and coaches can learn strategies to aid in making good decisions. Training for shorter durations and near definitive care and rewarming facilities will aid athletes when the weather is worse than normal. Cold environmental conditions, in most cases, should not be a limiting factor for successfully exercising in athletic competitions, recreational pursuits, leisure activities, and occupational work.

This pronouncement was reviewed for the American College of Sports Medicine by the Pronouncements Committee and by Ira Jacobs, Ph.D., FACSM; Joel B. Mitchell, Ph.D., FACSM; Timothy D. Noakes, M.D., FACSM; Kent B. Pandolf, Ph.D., FACSM; Kenneth W. Rundell, Ph.D., FACSM; and Susan M. Shirreffs, Ph.D., FACSM.