Head and neck cooling enhance exercise tolerance in individuals with multiple sclerosis

Background: Individuals with Multiple Sclerosis (MS) experience impairments in heat dissipation, compromising core temperature regulation during exercise. Objective: To examine the efficacy of combined head-and-neck cooling as administered via a commercially available cooling cap and neck wrap in mitigating increases in core temperature during exercise. Methods: On separate days, ten (7 females) adults (46.1 +/- 11.6 years) with relapsing-remitting MS performed semi-recumbent cycling consisting of an incremental exercise bout to volitional fatigue in a temperate environment (23 degrees C, 50 % relative humidity) while undergoing head-and-neck cooling using a cooling cap and neck wrap maintained at 10 degrees C (COLD) or 24-26 degrees C (NEUTRAL). Prior to and following a 30-minute post-exercise recovery, functional capacity was assessed by a battery of tests consisting of a 2-minute walk test, Timed 25-Foot Walk test, sit-to-stand test, and Berg Balance Scale. Core (ingestible pill) and skin temperatures were recorded continuously. The level of fatigue was measured with questionnaires. Results: The duration of the incremental exercise test increased with the application of COLD (28.4 +/- 5.1 min) versus NEUTRAL water (vs 20.8 +/- 5.1 min) (p = 0.001) and was paralleled by a significant reduction in body temperatures (similar to 1 degrees C, p < 0.05). The distance covered during the 2-min walk test performed after the incremental exercise test increased with the COLD (176.5 +/- 0.6 m), relative to the NEUTRAL condition (147.7 +/- 43.5 m) (p = 0.01). Fatigue levels did not change between conditions. Conclusion: We show that head-and-neck cooling with cold water effectively enhances exercise tolerance and mitigates increases in core temperature during exercise in individuals with MS.