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doi:10.1093/fampra/cmi072
Johnson C and Eccles R. Acute cooling of the feet and the onset of common cold symptoms.
Family Practice 2005; 22: 608613.
Background. There is a common folklore that chilling of the body surface causes the develop-
ment of common cold symptoms, but previous clinical research has failed to demonstrate any
effect of cold exposure on susceptibility to infection with common cold viruses.
Objective. This study will test the hypothesis that acute cooling of the feet causes the onset of
common cold symptoms.
Methods. 180 healthy subjects were randomized to receive either a foot chill or control pro-
cedure. All subjects were asked to score common cold symptoms, before and immediately after
608
Acute cooling of the feet and the onset of common cold symptoms 609
vasoconstriction in the nose and upper airways, and this next available procedure at the start of the randomisa-
vasoconstrictor response may inhibit respiratory tion list and subjects with 4 or more colds were assigned
defence and cause the onset of common cold symptoms to the next available procedure at the end of the list.
by converting an asymptomatic viral infection (sub- Ninety subjects were allocated to receive the chill pro-
clinical infection) into a symptomatic viral infection cedure and ninety subjects to receive the control pro-
(clinical infection).11 The novel idea in this hypothesis cedure. If allocated to the chilling procedure, the
was that when common cold viruses are circulating in subject was asked to remove their shoes and socks
the community a proportion of those infected will have and place their feet in a bowl containing 910 litres
sub-clinical infections, and that when any of this sub- of water at a temperature of 10 C for twenty minutes.
group are exposed to chilling of the body surface this The temperature of the cold bath was monitored
could aid conversion of a sub-clinical infection to a clin- (Pen shape digital multi-stem thermometer, Scientific
ical infection. This study was aimed at testing this hypo- Laboratory Supplies Ltd, Wilford Industrial Estate,
thesis, by studying the onset of common cold symptoms Nottingham, UK) and ice was added if necessary to
after acute chilling of healthy asymptomatic subjects, maintain the water temperature at 10 C. If allocated
during the winter, when common cold viruses are cir- to the control procedure the subject was asked to
culating in the community. keep their shoes and socks on and place their feet in
The aims of the study were to determine if acute chil- an empty bowl for twenty minutes. Warm water was not
ling caused: acute onset of common cold symptoms used as a control as it was believed that this stimulus
group giving a maximum difference between the groups test was used to test for differences in the number of
of 20 and a minimum of 10 depending on the distribu- colds reported by the two test groups in their diaries. A
tion of spontaneous colds. Statistical comparisons were subject was deemed to have experienced a cold if they
made between the two experimental groups of subjects; reported they were suffering from a cold on any occa-
chilled and control. The hypotheses were tested at a sion after the test procedures on days 1 + 2 + 3 + 4/5.
0.05 level of significance. The Mann-Whitney test
was used to test for differences in symptom scores
and history of colds incidence. The immediate effects Results
of chilling were studied by comparing the differences
from baseline to immediately after the test procedures Subject demographics
in total symptom scores, between chilled and control 180 subjects were enrolled in the study between
groups. The delayed effects of chilling were studied October 2003 and March 2004, 90 were randomized
by comparing the differences in total symptom scores to the chill procedure, and 90 to the control procedure.
between chilled and control groups over the 4/5 days The flow diagram in Figure 1 shows the flow of parti-
period after the test procedures. Mean total symptom cipants through each stage of the study. The demo-
scores have been used to describe the symptom score graphics of the two test groups are provided in Table 1
data in the text as this descriptive shows a change in the that demonstrates that the test groups were balanced
symptom score, whereas the median does not due to the and there was no significant difference in any of the
Excluded (n=8)
Not meeting inclusion
criteria (n=4)
Refused to participate
Randomised (n=4)
(n=180)
60
Median age 20.0 (1843) 20.0 (1839) P = 0.598 (MW)
subjects
(range)
Male 29 25 P = 0.515
(Chi-squared) 30
Female 61 65
Median colds 2.0 (110) 2.0 (18) P = 0.859 (MW)
per year (range)
0
Control Chilled
MW = Mann Whitney test.
FIGURE 2. Numbers of subjects that reported they were
suffering from a common cold in their diaries during the 4/5
TABLE 2 Immediate effects of chilling days period following control or chill procedures. The
shaded area represents those subjects reporting colds
Baseline Immediately Difference Statistics
after
symptom scores for days 14/5 following the control
Delayed effects of chilling Chilling of the feet in cold water (12 C 1 C) has
A delayed effect of chilling on the incidence of colds been previously reported to cause an intense vasocon-
and symptoms was observed in the 4/5 days following striction of both the cutaneous and upper airway blood
the chill procedure. Significantly more chilled subjects vessels15 and the vasoconstriction of the upper airways
than control subjects reported they were suffering from has been proposed as a mechanism that reduces respir-
colds in the 4/5 days following the test procedures. The atory defence against infection.10,11 When common cold
difference in the incidence of colds between the two test viruses are circulating in the community a proportion of
groups was also supported by a significant difference in subjects will have sub-clinical infections, and chilling of
total symptom scores over the 4/5 days following the these subjects may cause vasoconstriction in the upper
test procedures. Analysis of the symptom scores as airway epithelium and conversion of a sub-clinical to a
dichotomous data also demonstrated a significantly clinical infection. In these cases the subject links the
greater symptom score (more colds) in the chilled causality of the common cold symptoms to the chill
group. The increased incidence of reports of colds and does not realise that they were already infected
and higher symptom scores in the chilled subjects before they caught a cold. Laboratory studies using
compared to the control subjects may be due to several viral challenge and cold exposure do not provide any
factors. evidence that chilling increases susceptibility to the
Belief in the folklore that acute chilling of the body development of common cold symptoms7,8 but these
surface, in some way precipitates a common cold could studies do not mimic the natural exposure to common