BACKGROUND: Precooling (PC) before exercise may help prevent severe hyperthermia and exertional heatstroke (EHS). Before clinicians can advocate PC as an EHS prevention strategy, it must effectively mitigate factors associated with EHS development while not lessening the effectiveness of EHS treatment. Therefore, this study determined if PC affected rectal temperature (Trec), body heat storage, heart rate (HR), ratings of perceived exertion (RPE), thermal sensation, sweat rate, and postexercise cold-water immersion (CWI) Trec cooling rates.METHODS: In this randomized, crossover, counterbalanced study, 12 subjects (6 men, 6 women; age = 22 ± 2 yr; mass = 73.5 ± 7.9 kg; height = 171 ± 7 cm) underwent 15 min of CWI (10.0 ± 0.03°C) in an environmental chamber (38.6 ± 0.6°C; 36 ± 2% humidity). After a 10-min rest, they exercised to a Trec of 39.5°C. Subsequently, they underwent CWI (9.99 ± 0.03°C) until Trec reached 38°C. On control (CON) days, the same procedures occurred without the 15-min PC intervention. Trec, HR, thermal sensation, and RPE were measured at various times before, during, and after exercise.RESULTS: PC lowered body heat storage and Trec by 15.7 ± 15.0 W · m−2 and 0.42 ± 0.40°C, respectively, before exercise. Subjects exercised significantly longer (PC = 66.7 ± 16.3 min, CON = 45.7 ± 9.5 min) and at lower Trec (∼0.5 ± 0.5°C) and HR (∼10 ± 7 bpm) following PC. PC significantly lowered sweat rate (PC = 1.02 ± 0.31 L · h−1, CON = 1.22 ± 0.39 L · h−1), but did not affect RPE or CWI cooling rates (PC = 0.18 ± 0.14°C · min−1; CON = 0.19 ± 0.05°C · min−1). Thermal sensation significantly differed between conditions only at pre-exercise (PC = 3 ± 1, CON = 5 ± 0.5).DISCUSSION: PC delayed severe hyperthermia and mitigated dehydration without affecting thermal perception or cooling rates posthyperthermia. PC may help prevent dangerous hyperthermia in athletes.Wohlfert TM, Miller KC. Precooling, exertional heatstroke risk factors, and postexercise cooling rates. Aerosp Med Hum Perform. 2019; 90(1):12–17.

In four studies, RPE during exercise ranged from 12 ± 2 to 20 ± 3 with no clinically meaningful differences between PC and control trials. Thermal sensation scores ranged from 2 ± 1 to 8 ± 0.5 in control trials and from 2 ± 1 to 7.5 ± 0.5 during PC trials. Clinical Bottom Line: Precooling did not cause clinically-meaningful differences in RPE or TS during exercise. It is unlikely PC would predispose athletes to EHS by altering perceptions of exercise intensity or body core temperature. Strength of Recommendation: None of the reviewed studies (all level 2 studies with PEDro scores ≥5) suggest PC with CWI influences RPE or TS in exercising males.