{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:10:02Z","timestamp":1747188602756,"version":"3.40.5"},"reference-count":55,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,4,19]],"date-time":"2019-04-19T00:00:00Z","timestamp":1555632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Experimental Physiology"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>New Findings<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p><jats:bold>What is the central question of this study?<\/jats:bold><\/jats:p>\n<jats:p>Does a delay in cold water immersion treatment affect the cardiac autonomic control of exertionally heat\u2010strained individuals?<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p><jats:bold>What is the main finding and its importance?<\/jats:bold><\/jats:p>\n<jats:p>Cold water immersion is effective for treating exertionally heat\u2010strained individuals even when treatment is commenced with a significant delay. However, that treatment delay leads to only partial\/transient restoration of cardiac autonomic control. Therefore, we recommend that exertional heatstroke patients are continuously monitored for several hours even after core temperature has returned to normal values.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Immediate cold water immersion (CWI) is the gold\u2010standard treatment for exertional heatstroke. In the field, however, treatment is often delayed, primarily owing to a delayed paramedic response and\/or inaccurate diagnosis. We examined the effect of treatment (reduction of rectal temperature to 37.5\u00b0C) delays of 5 (short), 20 (moderate) and 40 (prolonged) min on cardiac autonomic control [as assessed via heart rate variability (HRV)] in eight exertionally heat\u2010strained (40.0\u00b0C rectal temperature) individuals. Eleven HRV indices were computed that have been described commonly in the literature and characterize almost all known domains of the variability and complexity of the cardiopulmonary system. We found that the cardiac autonomic control (as assessed via HRV) of exertionally heat\u2010strained individuals was significantly affected by the amount of time it took for the CWI treatment to be applied. Six out of 11 HRV indices studied, from all variability domains, displayed strong (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.005) time\u00a0\u00d7\u00a0delay interaction effects. Moreover, the number of significantly (<jats:italic>P<\/jats:italic>\u00a0\u2264\u00a00.005) abnormal (i.e. different from the short delay) HRV indices more than doubled (seven\u00a0<jats:italic>versus<\/jats:italic> 15) from the moderate delay to the prolonged delay. Finally, our results demonstrated that a CWI treatment applied with delays of 20 and, primarily, 40\u00a0min did not lead to a full restoration of cardiac autonomic control of exertionally heat\u2010strained individuals. In conclusion, this study supports CWI for treating exertionally heat\u2010strained individuals even when applied with prolonged delay, but it highlights the importance of continued cardiac monitoring of patients who have suffered exertional heatstroke for several hours after restoration of core temperature to normal.<\/jats:p><\/jats:sec>","DOI":"10.1113\/ep087297","type":"journal-article","created":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T10:49:05Z","timestamp":1554115745000},"page":"845-854","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Heart rate variability dynamics during treatment for exertional heat strain when immediate response is not possible"],"prefix":"10.1113","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9823-3915","authenticated-orcid":false,"given":"Andreas D.","family":"Flouris","sequence":"first","affiliation":[{"name":"FAME Laboratory Department of Physical Education and Sport Science University of Thessaly  Trikala 42100 Greece"},{"name":"Human Environmental Physiological Research Unit University of Ottawa  Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian J.","family":"Friesen","sequence":"additional","affiliation":[{"name":"Human Environmental Physiological Research Unit University of Ottawa  Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-5920","authenticated-orcid":false,"given":"Christophe L.","family":"Herry","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program Ottawa Hospital Research Institute  Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J. E.","family":"Seely","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program Ottawa Hospital Research Institute  Ontario Canada"},{"name":"Thoracic Surgery and Critical Care Medicine Ottawa Hospital  Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean R.","family":"Notley","sequence":"additional","affiliation":[{"name":"Human Environmental Physiological Research Unit University of Ottawa  Ottawa ON Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8683-6973","authenticated-orcid":false,"given":"Glen P.","family":"Kenny","sequence":"additional","affiliation":[{"name":"Human Environmental Physiological Research Unit University of Ottawa  Ottawa ON Canada"},{"name":"Clinical Epidemiology Program Ottawa Hospital Research Institute  Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,19]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"17","article-title":"Update: Heat injuries, active component, U.S. Armed Forces, 2014","volume":"22","author":"Armed Forces Health Surveillance Center","year":"2015","journal-title":"Medical Surveillance Monthly Report"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31802fa199"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-017-0189-z"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00874.2001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2011.09.009"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903120500541324"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00176.2016"},{"key":"e_1_2_8_9_1","first-page":"169","volume-title":"Exertional heat illnesses","author":"Casa D. 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