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Facebook Twitter Instagram. Search again. And while malnutrition can compromise your immune system, proof that superfoods boost it has been elusive. Cold showers interested us because there have been numerous claims — throughout history and across cultures — about their beneficial effects.

Hippocrates, the father of medicine, prescribed cold baths for his patients. In ancient Roman times, one ritual involved moving through several rooms with increasing temperatures, then ending with a plunge in a cold pool — hence the Latin term frigidarium. You still see practices like this in spas around the world. Athletes take ice baths to reduce local inflammation and soreness and improve injury recovery times.

Two-thirds of the people who took cold showers continued them after the study. A recent study even showed that healthy adults can use those techniques to modulate their immune response when injected with a pathogen, leading to fewer and less severe symptoms. I was approached about coauthoring a book on cold showers — the writer wanted a medical expert on board — but I told him that I wanted to investigate their effect instead.

We instructed our study participants to shower as they normally did — as hot as they wanted, for as long as they wanted — then to make the water as cold as possible for the prescribed amount of time. It was a miracle that we had more than 4, volunteers, about 3, of which we enrolled. But none of our participants had taken them regularly before. They were a mixed group of healthy adults, with no severe heart or respiratory problems.

Some of them were probably inspired by the Iceman stories. Many told us they were afraid the experiment would make them miserable, and in the beginning it did.

The vast majority found it uncomfortable, and some hated it, so they needed resilience to get through the month. As time went on, though, people started adapting and feeling less bothered. That, to me, is the most indicative sign of a beneficial effect — whether physiological or psychological.

Taking a freezing cold shower is not something you do for pleasure. The reduction in sick days was the same across the , , and second groups. A dose response relationship was investigated by varying in the duration of the cold shower.

Between December 7 th and December 30 th , we recruited participants through advertisements and social media. Inclusion, randomization and data collection were all performed via a web based application using surveys only. Written informed consent was obtained from all participants. The study was designed as a pragmatic trial and compliance to the intervention could not be verified. The primary aim was to look at any effect of a routine cold shower and the secondary aim was to look at dose-dependency effects.

The study protocol was approved by our institutional review board based on ethical considerations September 3 rd , Academic Medical Center, Amsterdam, The Netherlands. Being exempt from formal medical ethical review as it was considered non-medical research, this non-clinical trial was not registered in a clinical trial registry before recruitment of the first participant but on June 25th prior to data analysis August 5 th —September 13 th with The Netherlands National Trial Register NTR , approved by the WHO, number NTR The authors confirm that all ongoing and related trials for this intervention are registered.

Participants were adults aged 18—65 without routine experience of hot-to- cold showering who were employed when they entered the study. As no harmful effects of cold showering have previously been reported, the only exclusion criterion was significant comorbidity, including cardiac, pulmonary or any other severe disease. Exclusion criteria were primarily self-assessed. After informed consent, eligible participants were randomized to one of four groups Randomization was performed using computerized random numbers within a custom-made Hypertext Preprocessor PHP scripted web-based application for online surveys, without applying block randomization or stratification methods.

Participants randomized to the intervention groups were instructed to shower as warm and as long as preferred but ending with respectively 30, 60 or 90 seconds showering at the coldest available water temperature. They were instructed to use either the timer provided through a web link for smart phones by the research team, or a timer of their own. In case they could not complete the full period, participants were asked to time the period using a stopwatch.

During the following 60 days January 31 st -March 31 st participants of all three intervention groups were instructed to shower as preferred, i. Participants randomized to the control group were instructed to shower as regular not cold during the full day study period. Data were primarily collected through an online web-based platform and managed in Microsoft Excel In order to provide self-reports, participants were asked to log in three times: at baseline, between 30 and 60 days, and between 90 and days.

Weekly reminder emails were sent to participants who had not yet completed follow-up. Specific missing data were collected by email. All outcomes were self-reported using web based surveys. The primary outcome was illness days and related leave from work during the day study period January to March Sickness absence was considered to be the most objective indirect parameter indicative of illness severity.

Participants were asked to rate the total number of days of absence from their work due to sickness, if possible by verifying with their employer or their agenda. Absence frequency was not measured. Illness days were defined as the total amount of days a participant felt ill including symptoms of cold and flu. If participants rated sickness absence or illness over five days, they were asked for a reason.

The secondary outcomes were time of subjective sickness, quality of life, work productivity, thermal sensation and anxiety. Quality of life was assessed using the Short Form 36 SF , a item patient-reported survey of health.

The Dutch 4-week recall version was used, as adapted and validated by Aaronson et al. Mediation of the mind-body neurosensory pathways were assessed as changes in daily thermal sensation of the body and extremities, respectively expressed as warmer, colder or not different from their habitual daily sensation before the start of the trial.

To explore anxiety, we selected the six questions of the subscale scoring anxiety from the Brief Symptom Inventory. The Dutch version was used, as adapted and validated by De Beurs and Zitman.

At each follow-up moment, participants were asked to report any positive and negative effects. Adverse reactions other than influenza or influenza-related symptoms that were possibly or likely related to hot-to- cold showering were recorded by asking participants for any negative experiences and events as well as reasons to discontinue the intervention.

Analysis was conducted using intention to treat principles. For the primary outcome sickness absence days and illness days at 90 days follow-up a negative binomial regression model with log link was performed which was preferred over the Poisson model because of over-dispersion in the count data.

Statistical methods used 2-sided testing. For secondary outcomes this included Kruskal Wallis or Mann-Whitney U tests for non-normal distributed continuous variables and Chi-square tests for categorical variables.

This study investigated the effect of cold showering on health and work: a trial randomizing a hot-to- cold shower for 30, 60, 90 seconds or a control group during 30 consecutive days followed by 60 days of showering cold at their own discretion for the intervention groups. Values are numbers percentages unless stated otherwise. Of the candidates screened for eligibility participants were enrolled Fig 1.

Table 1 shows that baseline characteristics as well as data on primary and secondary outcome measures were similar between the intervention groups and the control group. Results in text and tables are reported in respective order of the groups as 30s cold shower, 60s cold shower, 90s cold shower and control group.

There were no trends between doses towards illness or absenteeism benefit. The only associated parameter of influence in the model was regular physical activity IRR: 0. Median quality of life MCS after 30 days was slightly higher for all intervention groups However, after 90 days significant differences were not observed anymore Table 4. Difference between all interventional groups versus control group Mann-Whitney U.

Twenty serious adverse events were reported, that were all considered unrelated to the intervention. One participant in the 90 seconds intervention group died unexpectedly of occult chronic pulmonary embolism at 56 days follow-up. This occult condition was not diagnosed at the time of enrolment and her medical history included hypertension only. Critical assessment by the team of treating intensive care physicians showed no possible relationship to the hot-to- cold shower.

There were eight participants with a mild pneumonia, two urinary tract infections, two had middle ear infections, one pneumothorax, one glaucoma, two hand wounds, one with multiple rib contusions after a fall, one with concussion and head wound after a fall, one bike and one ski-accident both with multiple minor contusions, distorsions and lacerations.

No related serious adverse events were reported. Other possibly related adverse events included muscle ache or cramps in eight, itch in six, insomnia in four related to cold shower in the evening , dizziness in four, lumbago in two, head ache in one, nose bleeding in one, diarrhea in one, palpitations in one and transient swelling and erythema of three digits of one hand in one participant after the cold shower.

The contrast between the results of both primary outcome parameters is suggestive of the fact that the intensity rather than the duration of symptoms is modulated by the intervention. The duration of the cold shower did not influence outcome as there was no significant difference between intervention groups.

The only secondary outcome that showed a slight beneficial effect—on the short run—was quality of life mental component summary although this was deemed too small to be clinically relevant. The most commonly reported beneficial effect was an increase in perceived energy levels including many reported comparisons to the effect of caffeine.

Other related harmful effects were mild and uncommon. An epidemic is defined as an incidence above this threshold for at least two consecutive weeks. The actual incidence of influenza cases was considerably higher, because only a proportion of the patients with influenza-like symptoms consulted the general practitioner.

At the start of the season, influenza virus A H3N2 dominated, while later in the season, influenza virus B was most prevalent. A part of the circulating influenza A-viruses appeared to mismatch with the influenza A-strain in the vaccine. Other prevalent viruses during the study period included the respiratory syncytial virus RSV , the enterovirus and the rhinovirus. Our search resulted in no randomized controlled trials that assessed health.

One Cochrane review investigated the effect of cold-water immersion for preventing and treating muscle soreness after exercise[ 18 ] and found some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise. The three randomized controlled trials were limited to the subject of cold bathing on athletic performance[ 19 , 20 ] and physiological response. However, there is a lack of data regarding any cumulative clinical effect and relevance for health.

Cold water has been used therapeutically for many centuries and continues using modern technology. Hippocrates, the father of medicine, who added rubbing to cold bathing, was accustomed to use cold water in his treatment of the most serious illnesses. It was initially proposed for the treatment of rheumatic diseases[ 22 ] but is increasingly popularized among athletes for its supposedly beneficial effect on recovery and performance, even though it has not been confirmed in a recent systematic review.

In The Netherlands, there has been an increasing trend for cold bathing over the past few years. Part of this growing popularity is owed to the scientific approach of a health and mindset technique hallmarked by cold-exposure as created by an individual named Wim Hof, nicknamed the Iceman for his ability to remain constant body temperature in extreme cold conditions. The mechanism or explanatory pathway of any therapeutic effects of cold exposure remains unclear. In the acute phase during shivering increases of cortisol and norepinephrine concentrations have been reported but resulted in minimal or no immune modulation.

Longterm hormonal and cytokine effects of such modulation are relatively small and its significance remains unclear as only the early steps of the immune cascade appear to be affected.

The greatest physiological response to cold water exposure was observed during the first 30 seconds and the rapidity suggests that it is initiated by neurogenic pathways rather than circulating hormones.

Another physiological explanatory mechanism is the improvement of fitness level when considering the routine cold shower as frequent engaging physical activity.

Cycling to work was therefore associated with less sickness absence. This is consistent with the findings of Nieman et al. In addition, there are multiple psychological explanatory mechanisms such as expectancies which play a major role for the treatment outcome of a broad variety of immune-mediated conditions.

The aim of this study is to investigate whether such claims are true.