University of Oulu

Rasmus I. P. Valtonen, Antti Kiviniemi, Heidi E. Hintsala, Niilo R. I. Ryti, Tuomas Kenttä, Heikki V. Huikuri, Juha Perkiömäki, Craig Crandall, Wouter van Marken Lichtenbelt, Markku Alén, Hannu Rintamäki, Matti Mäntysaari, Arto Hautala, Jouni J. K. Jaakkola, and Tiina M. Ikäheimo, Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease, American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 2018 315:4, R768-R776,

Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease

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Author: Valtonen, Rasmus I. P.1,2; Kiviniemi, Antti3; Hintsala, Heidi E.1,2;
Organizations: 1Center for Environmental and Respiratory Health Research, University of Oulu, Finland
2Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
3Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
4Department of Internal Medicine, University of Texas Southwestern Medical Center and the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
5Department of Human Biology/Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
6Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research, University of Oulu, Finland
7Institute of Biomedicine, Department of Physiology and Biocenter of Oulu, University of Oulu, Oulu, Finland
8Finnish Institute of Occupational Health, Oulu, Finland
9Finnish Defence Forces, Aeromedical Centre, Helsinki, Finland
10Center for Machine Vision and Signal Analysis, University of Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link:
Language: English
Published: American Physiological Society, 2018
Publish Date: 2019-09-28


Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%–70% of max heart rate (HR)] performed at +22°C and −15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions (P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature (P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.

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Series: American journal of physiology. Regulatory, integrative and comparative physiology
ISSN: 0363-6119
ISSN-E: 1522-1490
ISSN-L: 0363-6119
Volume: 315
Issue: 4
Pages: R768 - R776
DOI: 10.1152/ajpregu.00069.2018
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
Funding: The study was funded through grants from the Finnish Ministry of Education and Culture and Yrjö Jahnsson Foundation [Year-round health enhancing exercise and coronary artery disease: a randomized controlled study (CadColdEx)]. A. Kiviniemi received funding from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland and the Paulo Foundation, Espoo, Finland.
Copyright information: © 2018 the American Physiological Society. The final publication is available at