The effect of pre-cooling or per-cooling in athletes with a spinal cord injury: a systematic review and meta-analysis

Objectives For individuals with a spinal cord injury (SCI), thermoregulatory challenges presented by the environment are amplified, increasing the risk of exertional heat illness. Thus, this systematic review and meta-analysis aims to quantify the effects of pre- and per-cooling on core temperature (Tc), skin temperature (Tsk) and thermal sensation in participants with SCI and assess the influence of lesion level on the effects of cooling. Design Systematic review with meta-analysis. Methods Out of 2107 potential studies, 17 were identified via the inclusion criteria for a total of 145 research participants. A total of 12 studies were included in the primary analysis of Tc; 9 included in the analysis of Tsk; and 9 included in the analysis of thermal perceptions. 15 experimental conditions were included in the secondary analysis of lesion level on the effects of cooling. Results Cooling reduced Tc (Hedges' g = 0.44; 95% confidence intervals [CI] 0.16, 0.72; p sk (Hedges' g = 1.11; 95% CI 0.56, 1.66; p c to a greater extent than per-cooling (Hedges' g = 0.25) (p = 0.020). The effect of lesion level on the effectiveness of cooling on Tc had a moderate, positive association (r = 0.518, p = 0.048). Conclusion Pre-cooling may reduce Tc to a greater extent than per-cooling during subsequent exercise. Pre-and per-cooling can attenuate the increase in thermal strain in athletes with an SCI. The beneficial effects of cooling are greater in tetraplegic individuals.