Table 6.

Thermoregulatory responses using cooling techniques.

Study	Sample	Climate	Intervention/Exposure	Duration	Thermal measurement	Methodological characteristics	Outcome
Armstrong et al. (1995)	6 PA (C6-T12)	32.9 ± 0.1°C 75 ± 3% rh	30′ WC on stationary roller @ self-selected 10 km pace (67-70% VO2 peak) DUR with headpiece or DUR with IV	20-25′ rest in heat 30′ exercise	Tre Tau Tsk Sweat rate ThS	RCT cross-over	No differences between tests in Tre, Tau, Tsk, sweat rate, ThS
Bongers et al. (2016)	10 M, PA (T4-T12)	25.4 ± 0.4°C 41.0 ± 8.4% rh	45′ arm cranking @ 50% peak power with DUR with IV	10′ rest in heat 10′ WU 45′ test 5′ cool down 10′ rest in heat	Tin Tsk Fluid loss ThS	RCT cross-over	Tin no between test differences Tsk mean ↓ with IV ThS ↓ with IV Fluid loss: no differences between tests
Griggs et al. (2017a)	1 F, TP 7 M, TP (C5-C7)	20.2 ± 0.2°C 33.0 ± 3.1% rh	4x 15′ intermittent sprint protocol 4x 15′ with different sprint bouts in 3 conditions No cooling PRE with IV (incl. during WU) PRE with IV and DUR with WS	15′ rest 20′ WU 4x 15′ exercise with 2′/5′/2′ rest in between	Tin Tsk ThS Fluid loss	RCT cross-over	ΔTin ↓ in PRE/DUR condition Tsk mean ↓ in PRE/DUR condition No differences between tests in ThS,fluid loss
Hagobian et al. (2004)	6 M, SCI (C5-T5) 6 M, AB	31.8 ± 0.2°C 26 ± 1% rh	45′ arm cranking @ 66 ± 5% VO2peak DUR with foot cooling	30′ rest in heat 10′ rest in heat (baseline) 45′ exercise 30′ passive recovery	Ty Tsk	RCT cross- over	ΔTy ↑ in non-cooling ΔTy ↑ in cooling compared to AB Tsk face ↑ in SCI Tsk back ↑ in SCI
Pritchett et al. (2010)	3 M, PA (T3-L1) 4 F, PA (T3-L1)	22 ± 1°C 45-50 ± 0.1% rh	Incremental stage test 7′/stage; start 30 W, increment 20 W, till Tes rose more 0.2°C/min or 90 W DUR with WS	7′ each stage 1′ in-between passive recovery	Teso Tre Tsk ThS	RCT cross-over	No differences between tests in in Tre, Tsk, ThS, Teso
Trbovich (2019)	1 TP 1 PA 1 AB	75°F control 90°F hot	30′ WC treadmill 5 different conditions: control, hot, hot with IV, hot with WS, hot with ice slurry	10′ rest 30′ treadmill	Tin	RCT cross-over	All three cooling interventions mitigated the rise in Tin in TP WS and ice slurry mitigated the rise in PA
Trbovich et al. (2014)	6 TP (C5-C7) 5 PA, (T3-T5) 6 PA, (T7-T12) 19 AB	21.1–23.9°C	Playing WC basketball or rugby DUR with IV Without cooling	20′ rest 60′ exercise	Tin	RCT cross-over	Tin ↑ in TP than PA, AB No between test differences in Tin for any group or condition
Trbovich et al. (2019)	7 TP (C5-C7) 4 PA (T4–L1) 16 AB	19-22°C 55-60% rh	90′ intermittent sprint exercise under two conditions DUR with WS application every 15′ without cooling TP played WC rugby PP played WC basketball	15′ WU 60-90′ WC basketball or rugby	Tin	RCT cross-over	ΔTin ↑ in TP than PA, AB ΔTin ↓ in TP with WS
Webborn et al. (2005)	8 M, TP (C5-C7)	32.0 ± 0.1°C 50.0 ± 0.1% rh	14x 2′ intermittent sprint protocol arm cranking PRE with IV DUR with IV	15′ rest in temperate 20′ IV or rest in thermal neutral 7′ WU 14x 2′ exercise	Tin Tsk ThS	RCT cross-over	Tin ↑ without cooling ΔTin ↓ lower in DUR than other conditions Tsk ↓ with DUR than control ThS no differences between tests
Webborn et al. (2010)	8 M, TP (C5-C7)	32.0 ± 0.1°C 50.0 ± 0.1% rh	30x 2′ intermittent sprint protocol arm cranking PRE with IV DUR with IV	15′ rest in thermal neutral 20′ IV or rest in thermal neutral 7′ WU Up to 30x 2′ exercise	Tc Tsk Performance	RCT cross-over	Tin ↑ without cooling Tsk ↓ with DUR than control Performance ↑ with PRE than control Performance ↑ with DUR than PRE

M, male; F, female; AB, able-bodied; PA, paraplegic; TP, tetraplegic; SCI, spinal cord injury; C, cervical; T, thoracic; L, lumbar; WC, wheelchair; °C, degree Celsius; °F, degree Fahrenheit; rh, relative humidity; WU, warm-up; T_re, rectal temperature; T_eso, esophageal temperature; T_sk, skin temperature; T_int, intestinal temperature; T_y, tympanic temperature; T_au, aural temperature; ThS, thermal sensation; HR, heart rate; RCT, randomized controlled trial; nRnCT, non-randomized non-controlled trial; W, watt; P_max = maximal power output; ↑ = higher; → = indifferent; ↓ = lower; DUR = cooling during exercise; PRE = cooling before exercise; IV = ice vest/cooling vest; WS = water spray.