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

Rasmus I. P. Valtonen, Antti Kiviniemi, Heidi E. Hintsala, Niilo R. I. Ryti, Tuomas Kentta, Heikki V. Huikuri, Juha Perkiomaki, Craig Crandall, Wouter van Marken Lichtenbelt, Markku Alen, Hannu Rintamaki, Matti Mantysaari, Arto Hautala, Jouni J. K. Jaakkola, Tiina M. Ikaheimo*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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 degrees C and -15 degrees 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 ( 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.

Original languageEnglish
Pages (from-to)R768-R776
Number of pages9
JournalAmerican Journal of Physiology-regulatory Integrative and Comparative Physiology
Issue number4
Publication statusPublished - Oct 2018


  • cold temperature
  • coronary artery disease
  • exercise
  • MEN


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