This section summarizes the effect of the subsequent exercise, body composition, age, gender, and ethnicity as factors that have an impact on the efficacy of cocoa powder emerging. Later and his colleagues stated that it's possible that the underlying time course of recovery between different exercise stressors is different, and this consequently may influence how recovery strategies could be implemented. Moreover, first, he and his colleagues stated that the optimal water immersion technique and protocol for recovery of performance may depend on the type of exercise that is performed. In line, Stevens and our colleagues concluded that endurance and stretch shortening exercise are most likely more responsible to Coldwater immersion than isolated concentric and eccentric exercise. He shall in college also concluded based on a review of the literature, the cold water immersion is ineffective in reducing exercise induced muscle damage sustained via a single joint eccentric exercise, while on the other hand, cold water immersion seems more effective in treating exercise induced muscle damage incurred with intermittent teams for exercises.

For instance, the muscle maximum voluntary contraction is not ameliorated after isolated single joint contractions, but is improved after cold water immersion following intermittent team sports exercises. A more recent study of poppendieck and colleagues on trained athletes found contrary findings to the study of Halston and colleagues. In their analysis, the performance of the weight bearing activity was enhanced with only 1.9% while the non weight bearing activity showed the benefit of 4%. differences are described to the water immersion technique, also in college also included contrast and hot water immersion techniques, while poppendieck in college only included cold water immersion. poppendieck Wendy and colleagues found that cooling had most considerable effects on intermittent Activity followed by endurance activity, but with a negligible impact on strength activity concerning endurance activities. It has been suggested that cold water immersion is ineffective for high intensity exercise of short duration.

A study from Pfeiffer and colleagues evaluated the benefit of cold water immersion via one kilometer time trial. And another study from bifur and colleagues assess the benefit of cold water immersion via a four kilometer time trial. Only the four kilometer Time Trial provides beneficial effects, which might be caused by the lack of thermal strain from the initial exercise by the enhanced parasympathetic reactivation, which may impact muscular contraction through the effect of oxygen consumption and glucose metabolism. In line with the recommendations made in the review of Stevens and colleagues, the objective of recovery should be established first, and where possible, the cooling protocol should be specific to the desired outcome. For example, cold water emerging used to reduce the thermal strain will likely be shorter duration and for the reduction of secondary exercise induced muscle damage, consideration should be given to the subsequent exercise and the timeframe available.

If whole body endurance performance is required cold water emerging may have a positive impact due to pre cooling effects. However, if maximum efforts are needed, cold water emergent may not be appropriate due to the impact of cold muscle temperature or muscle contraction. On a broader perspective, what are emerging as discussed in the previous chapters can be applied in rehabilitation in medicine recovery as well. Also in these domains, the objective should partly determine the protocol prescribed. Applying What are emerging to treat depressive symptoms should specify a less intense protocol compared to counteract a cartilage flare up knee problem following intense rehab session considering the recovery objective Subsequent exercise are two critical factors that will assist in providing the wanted effects. Similar reasoning accounts for body composition.

Body composition is used to describe the percentages of fat, bone, water and muscle in humans. Because muscle tissue takes up less space in our body than fat tissue. Our body composition as well as our weight determines leanness to people of the same sex and body weight may look completely different because they have a different body composition. Here is where we make a difference between someone who's an ectomorph, an endomorph, or a major more of an ectomorph being lean along an endomorph being big with high body fat and the major Wharf, being muscular with a high metabolism and responsive muscle cells. The body surface area to body mass ratio is considered an employee And variable to maintain thermal homeostasis. This body surface area can be calculated via different formulas.

The most widely used method is the Dubois formula. This formula calculates the body surface area based on body weight and body height. The average body surface area for a human being is 1.7. And more specifically for male 1.9 and female 1.6. A larger body surface to body mass ratio facilitates heat loss, whereas smaller ratio facilitates heat isolation. The body composition of elite athletes differ a lot, as is evidenced in the picture which shows only world champions in their sports, not only between sports but also within sports and within one specific team.

The body composition is very different Zem ski and colleagues for instance assess the body composition characteristics of Elite rugby union athletes and concluded that rugby players so show significantly different distribution patterns of fat mass and lean mass, which may influence their suitability for playing particular positions. Major morphic athletes are likely to present with higher core temperature at rest and following exercise. And one might conclude that therefore a greater dose of whole body cryo would be necessary to account for the higher temperatures in these individuals. In contrast, it may also be concluded the Daya core temperature may create a greater temperature gradient between the body and the court, therefore increasing cooling rate, which would be in line with Newton's law of cooling. Freezing and colleagues assess the cooling rate of the core temperature from people with either a high or a low body surface to lean body mass ratio in different body temperatures during both terminal To a water emergent at 79 degrees Fahrenheit, and cold water emerging at 36 degrees Fahrenheit.

They found that people with a low body surface to lean body mass ratio ever reduced core cooling rate and take longer to cool than those with a high ratio. The influence of body composition and thermal and physiological outcomes following water emerging has been the topic in other studies as well, like in the study from Stevens and colleagues. In their study, the low fat group had significantly lower core temperatures after 15 minutes emerging in 59 degrees Fahrenheit compared to the high fat group at all different time points. Low fat groups illustrated the core temperature reduction of 0.5 degrees Fahrenheit per minute, while the high fat group showed the core temperature of only 0.2 degrees Fahrenheit per minute. No differences were found between groups into hot water condition. Muscle temperature is also significantly more effective.

In the low fat groups compared to the high fat groups, as shown in the same study from Stevens and colleagues, the muscle temperature in cold water with water of 59 degrees Fahrenheit for 15 minutes dropped by maximum 15.5 degrees Fahrenheit in the low fat group, compared to only 9.2 degrees Fahrenheit in the high fat group, with no differences in cooling rate in the hot water condition with water of hundred degrees Fahrenheit. It was also found that individuals with a higher muscle mass take longer to leave warm skin temperature following cold water immersion is less affected by differences in body composition. different studies from Stevens and colleagues consistently found that there were no significant differences in skin temperature responses between low and high fat groups following cold water immersion. Like skin temperature blood flow is also not affected by a variation in body composition following water emergent, well thermal sensation significantly lower in low fat groups compared to high fat groups.

Adolescence and elderly have lower subcutaneous fat and a larger body surface area to body mass ratio, resulting in quicker heat loss compared to athletes within the age range between 18 and 35. The elderly also experience diminished autonomic function, including reduced skin blood flow responsiveness to cold exposure, decreased sweating, and less stable temperature regulation, predisposing thermo regulatory insufficiency, which may lead to MP reactions to cold water emergent. Hypothetically young athletes and elderly therefore need less intense cold and hot water emerging protocols to impact skin, core and muscle temperatures. As research is mainly focusing on male volunteers between 18 and 30 years due to the high accessibility and potential lower risk involved, it would be beneficial for future research to start including young And older volunteers to establish the effects following cold water immersion as well. Compared to male athletes, female athletes tend to have more body fat, thicker layers of subcutaneous fat, and a large body surface area to body mass ratio.

Therefore, women tend to go to a greater extent, which is confirmed by an unpublished study from our own research group. In this study, which is currently considered for publication, we compare the group of 12 male and female recreational athletes after an exhaustive exercise protocol, and a similar cold water immersion strategy 12 minutes emerging at 50 degrees Fahrenheit to enhance acute recovery outcomes. Preliminary results show that female athletes illustrated the better power recovery measured by squat jump height compared to males, with the difference significantly correlating to the difference in body surface area to body mass ratio. In the graph shown the body section surface area to body mass on the x axis and the power decline in percentage is shown. A larger ratio is significantly correlated with a lower power decline. Female thermal regulatory responses and thermal sensitivity are also influenced by the menstrual cycle, where during the luteal phase, core temperature and skin temperature are higher than during the follicular phase.

Emissivity is strongly related with a difference in adipose tissue height, weight and body surface area, explaining variances in responses in skin, muscle and core temperature follow cold water emergent. Next, maily and colleagues found that individuals of African descent have a higher sensitivity to call vertical Caucasian or Asian individuals illustrated by a more pronounced facial constriction response to cold water in 46 degrees Fahrenheit. Individuals of African descent are more sensitive to cold Compared to Asian and Caucasian, and Asian are more sensitive to cold than Caucasian, therefore individuals with a difference in ethnicity, irrespective of their body composition should be treated differently when prescribing a water emerging protocol. It is therefore recommended to use a higher water temperature for an athlete of African descent to be tolerate, and a step by step process should be prescribed for the African athlete is immersed as first only partial for a short time in less cold water and overtime progressed to full body longer and colder protocols.

Using higher water temperatures might imply longer emergent times to become the same effects. Next to subsequent exercise, body composition, age, gender, and ethnicity. Other factors like water emergent technique, emergent position, and responsiveness have an impact on the efficacy of cold water emergent as well. However, these factors are not within the scope of this course. Also muscle adaptation and athletes compliance are important variables to consider when implementing what are emerging. In the next section we will take it all together and provide general guidelines to integrate and optimize the use of Coldwater immersion in sports practice.