University of Oulu

Valtonen, R.I.P., Hintsala, H.H.E., Kiviniemi, A. et al. Cardiovascular responses to dynamic and static upper-body exercise in a cold environment in coronary artery disease patients. Eur J Appl Physiol 122, 223–232 (2022).

Cardiovascular responses to dynamic and static upper-body exercise in a cold environment in coronary artery disease patients

Saved in:
Author: Valtonen, Rasmus I. P.1,2; Hintsala, Heidi H. E.1,3; Kiviniemi, Antti4;
Organizations: 1Center for Environmental and Respiratory Health Research (CERH), University of Oulu, 5000, 90014, Oulu, Finland
2Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
3Centria University of Applied Sciences, Kokkola, Finland
4Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
5Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, USA
6Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
7Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
8Department of Community Medicine, University of Tromsø, Tromsø, Norway
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.5 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-03-07


Purpose: Upper-body exercise performed in a cold environment may increase cardiovascular strain, which could be detrimental to patients with coronary artery disease (CAD). This study compared cardiovascular responses of CAD patients during graded upper-body dynamic and static exercise in cold and neutral environments.

Methods: 20 patients with stable CAD performed 30 min of progressive dynamic (light, moderate, and heavy rating of perceived exertion) and static (10, 15, 20, 25 and 30% of maximal voluntary contraction) upper body exercise in cold (− 15 °C) and neutral (+ 22 °C) environments. Heart rate (HR), blood pressure (BP) and electrocardiographic (ECG) responses were recorded and rate pressure product (RPP) calculated.

Results: Dynamic-graded upper-body exercise in the cold increased HR by 2.3–4.8% (p = 0.002–0.040), MAP by 3.9–5.9% (p = 0.038–0.454) and RPP by 18.1–24.4% (p = 0.002–0.020) when compared to the neutral environment. Static graded upper-body exercise in the cold resulted in higher MAP (6.3–9.1%; p = 0.000–0.014), lower HR (4.1–7.2%; p = 0.009–0.033), but unaltered RPP compared to a neutral environment. Heavy dynamic exercise resulted in ST depression that was not related to temperature. Otherwise, ECG was largely unaltered during exercise in either thermal condition.

Conclusions: Dynamic- and static-graded upper-body exercise in the cold involves higher cardiovascular strain compared with a neutral environment among patients with stable CAD. However, no marked changes in electric cardiac function were observed. The results support the use of upper-body exercise in the cold in patients with stable CAD.

Trial registration: Clinical trial registration NCT02855905 August 2016.

see all

Series: European journal of applied physiology
ISSN: 1439-6319
ISSN-E: 1439-6327
ISSN-L: 1439-6319
Volume: 122
Issue: 1
Pages: 223 - 232
DOI: 10.1007/s00421-021-04826-x
Type of Publication: A1 Journal article – refereed
Field of Science: 3111 Biomedicine
Funding: Open access funding provided by University of Oulu including Oulu University Hospital. The study was funded through grants from the Finnish Ministry of Education and Culture (TI, RV, HH, AK) (CadColdEx OKM/84/626/2014, OKM/44/626/2015, OKM/31/626/2016, RV, HH, AK) and (ActiCard OKM/54/626/2019, OKM/85/626/2019, OKM/1096/626/2020, RV), Yrjö Jahnsson Foundation (TI, HH), Juho Vainio Foundation (RV).
Copyright information: © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit