Accepted Manuscript

JPFSM: Short Review Article

Physiological characteristics of women’s cold constitution and the effects ofexercise

Fumio Yamazaki1,2

1Graduate School of Health and Welfare, and 2Department of Nursing, Faculty of Nursingand Human Nutrition, Yamaguchi Prefectural University, 6-2-1 Sakurabatake,Yamaguchi 753-0021, Japan

Number of Figures: 3

Running title: Cold constitution and exercise

Corresponding author: Fumio Yamazaki, Ph.D.
E-mail: fsone@n.ypu.jp

Abstract About half of young Japanese women have a cold constitution, which heightens
susceptibility to cold syndrome. In recent years, new findings on the physiologicalfeatures of a cold constitution have increased. Cold constitution lowers the quality ofdaily life, so coldness and the related complaints need to be alleviated. Single dynamic
exercise transiently relieves coldness via the warm-up effect. Exercise training decreases
sensitivity to cold under normal temperature conditions and enhances peripheral
cutaneous vasodilatory responses in young women with a cold constitution. This review
provides an overview of the physiological characteristics of women’s cold constitution
and the acute and chronic effects of physical exercise as a countermeasure.
Keywords: aerobic exercise, cold sensitivity, thermal discomfort, skin temperatureタイトル： 女性の冷え性の生理学的特徴と運動の効果

著者名： 山崎文夫 1,2

所属： 1 山口県立大学大学院健康福祉学研究科, 2 山口県立大学看護栄養学部看護学科

抄録： 日本人の若年女性の約半数は, 体調不良に陥りやすい冷え性であるとされる. 近年, 冷
え性の生理学特徴に関する新たな知見が増加しつつある. 冷え性は日常生活の質を低下させるため, 冷えとそれに伴う不定愁訴の緩和が必要である. 単回の動的運動は, ウォームアップ効果
により一過性に冷えを緩和する. 運動トレーニングは, 冷え性の若年女性において, 常温環境下での寒冷に対する感受性を低下させ, 末梢の皮膚血管拡張反応を亢進させる. 本総説では, 女
性の冷え性の生理学的特徴とその対策としての身体運動の急性および慢性の効果について概説する.

1

Introduction

2

Cold-induced physiological responses usually exhibit inter-individual differences,3

even among healthy people. Even at times when most people do not feel cool under4

temperate thermal conditions, women may experience severe coldness of the body,5

especially the lower extremities1-6). A cold constitution with higher sensitivity to cold is

6

called “hi-e-sho” in Japanese, which is more common in women than in men1,2,5). Prior

7

studies have reported that about half of young Japanese women have an aware of cold

8

constitution5,7,8). Women with a cold constitution often feel discomfort due to a severe

9cold sensation in cool environments, have general malaise (such as sleeplessness,10

weariness, and lowered power of concentration), and a tendency to fall ill9,10). Thus, a11

cold constitution lowers the quality of life and heightens susceptibility to cold syndrome.

12

Several strategies have been reported to alleviate cold symptoms: the intake of dietary13

supplements that have a warming effect (capsinoids, ginger, Piper longum L.)11-13), the14intake of multifunctional foods (glucosyl hesperidin, royal jelly)14,15), foot massage16),15

electro-acupuncture therapy17), and abdominal breathing exercises18). In recent years, our16

research group has reported that physical exercise can be a strategy to improve cold

17

symptoms. The practice of daily exercise is recommended for the prevention of lifestyle-18

related diseases19,20), and the effects of exercise can include improving cold constitution.

19

This review first provides an overview of the physiological characteristics of women’s

20

cold constitution, for which new knowledge is increasing. Next, we discuss the currently

21

reported effects of physical exercise on women’s cold constitution.

22
23

Physiological characteristics of a cold constitution

24

Core temperature and metabolic rate

25

The resting core body temperature of people with a cold constitution is within the26

normal range21,22); thus, its physiological properties are different from hypothermia,

27

which causes a decrease in core body temperature. However, the resting metabolic rate

28

of people with a cold constitution is lower than normal people; thus, they have a poor

29

ability to increase the metabolic rate during exposure to cold, because of lower non-

30

shivering thermogenesis21,22). A previous study reported lower serum thyroxine (T4)31levels in people with a cold constitution than in normal people; however, there were no32

significant differences between both groups in plasma epinephrine and cortisol levels21).

33

Okada et al.23) reported a low level of free triiodothyronine (T3) in women with a cold

34

constitution. Low thyroid function in people with a cold constitution is responsible for35

the low metabolic rate during normothermia and mild cold exposure21,23). Prior studies

36

demonstrated the existence of metabolically active brown adipose tissue (BAT) in adult37

humans, and inter-individual differences after cold exposure24,25). Low BAT activity in38

individuals with a cold constitution is suggested as a potential reason for the different

39

metabolic responses during mild cold exposure22). Greater cutaneous vasoconstrictor

40

sensitivity in individuals with a cold constitution is an adaptive characteristic for41

preventing possible hypothermia caused by low thermogenesis during exposure to a cold

42

environment or almost normal temperature environment22).

43
44(Insert Fig.1)

45
46

Temperature sensory function

47

The Fig. 1 shows the main physiological features of people with a cold constitution

48

and signaling pathways for cold sensation and cutaneous vasoconstriction response. Cool49

stimulation of the skin is transmitted by cutaneous cold receptors in sensory nerve endings

50

to the cerebral cortex, and the limbic system, resulting in cold sensation and discomfort,

51

respectively26,27). People with a cold constitution have a strong sensation of cold and skin52

vasoconstriction due to the high sensitivity of these signaling pathways22). The higher

53

thermal sensitivity to cold in people with a cold constitution is mainly due to: 1) greater

54

activity in somatosensory neurons in the cerebral cortex at a given peripheral

55

thermosensitive input, 2) greater thermosensitive neural activity in the afferent pathways

56

from skin to cerebral cortex and limbic system, or 3) greater thermoreceptor excitation in57

the cutaneous endings of somatosensory neurons at a similar temperature22). A previous

58

study reported that the number of cold and warm spots of the skin of the dorsal foot were59

not significantly different between a cold constitution group and a normal group28); thus,

60

higher receptor density in the skin may be not responsible for the higher thermal

61

sensitivity to cold. Cold receptors in the skin express TRPM8 (melastatin 8) cation

62

channels, which generate receptor potentials upon cooling stimuli or menthol29). Non-63

cold-sensitive individuals experience increased cold sensitivity to menthol administration64

to the skin of the lower extremities, but this is less likely to occur in cold-sensitive

65

individuals, suggesting paradoxical desensitization to cold receptor function30).

66

Individuals with a cold constitution, characterized by often cold peripheral extremities,

67

may adapt their temperature sensory function at the cold receptor level to reduce daily

68

thermal discomfort.

69
70

Brain activity

71

Electroencephalography (EEG) is a noninvasive method of assessing brain function. EEG

72recordings with closed eyes during whole-body cooling have shown that brain activity is73

more enhanced in cold sensitive individuals31-33). That is, the cold sensitive individuals

74

showed fewer 8-10 Hz EEGs (low-frequency alpha waves) and more 13-30 Hz EEGs

75

(beta waves) than non-cold sensitive individuals; however, this was not found with open76

eyes31-33). It is thought that higher frequencies of EEG manifest discomfort symptoms in

77

response to cold32,33). These brain activity characteristics also represent physiological78

characteristics of sensitivity to cold. There is limited information on the brain function

79

for individuals with a cold constitution; therefore, further study is warranted for

80

elucidating the characteristics.

81
82

Blood flow and temperature in skin83

In general, cutaneous vasoconstriction occurs via reflexes and local controlling84

mechanisms to decrease heat dissipation from the skin when exposed to cold85

environments (Fig. 1). In women with a cold constitution, peripheral skin86

vasoconstriction occurs even under normal temperature conditions34). In previous studies,87

when the room temperature was gradually decreased from a somewhat warm temperature88(29.5°C) to a cool temperature (23.5°C), vasoconstrictor sensitivity in the dorsal foot, but

89

not in the forearm and calf, was greater in cold sensitive subjects than in normal control

90

subjects21,22). The cold sensitive subjects also showed greater vasoconstrictor responses

91

in the dorsal foot22,34), but not in the calf22) during local skin cooling and the iontophoretic

92

application of norepinephrine. These findings suggest that cold sensitive subjects possess

93

a specific blood flow-controlling system in the peripheral pathway that is characterized

94

by higher adrenergic sensitivity for greater cutaneous vasoconstriction in the distal

95

portion of the lower extremities during cold exposure. Differences in the sensitivity of96

these receptors also cause site differences, with stronger vasoconstrictive responses

97

occurring in the peripheral regions of the extremities22). Previous studies reported that98

increased thermal sensitivity of the body to cold and decreased skin temperature in99

peripheral extremities, such as the feet and fingers, during cold exposure contribute to the100

severe cold sensation in women with a cold constitution21,22).

101
102

The main physiological characteristics of people with a cold constitution aresummarized in Fig. 1.

103
104

Effects of exercise on a cold constitution

105

Acute effects

106

Exercise is a means of both behavioral and autonomic thermoregulation to keep the

107

body warm in a normal air temperature condition. In order to clarify the acute effects of108

dynamic exercise on the temperature sensory function of cold-sensitive women, young

109

adult females with an awareness of a cold constitution were divided into two groups: an

110exercise condition in which cycle exercise with a light-to-moderate intensity for 15 min

111

was performed, and a control condition in which rest without exercise was maintained35).

112

Cooling tests in which the hand was immersed in cool water at 15°C were carried out

113

before exercise, immediately after exercise, and 30 min after exercise. The sensitivity of114

the cold sensory function was evaluated based on changes in skin temperature, thermal

115

sensation, and comfort in the hand. Cold sensation and thermal discomfort during hand116

cooling were reduced by the significant increase in core body temperature after exercise.

117

The exercise condition did not alter the sensitivity of cold sensation but reduced the118

sensitivity of thermal discomfort. A warm feeling increased in the trunk portion

119

immediately after exercise; however, cold feeling in the foot was decreased 30 min after120

exercise. These findings suggest that thermal sensation is site-dependent and influenced

121

by increases in core and skin temperatures after exercise (Fig. 2). Furthermore, the122

sensitivity to cold-induced discomfort is temporarily suppressed without affecting the123

sensitivity to cold sensation.

124
125

(Insert Fig. 2)

126
127

Next, we determined the acute effects of exercise on EEG activity in women with a128

cold constitution36). Cold-sensitive and normal young women performed cycle exercise

129with a light-to-moderate intensity for 15 min with the eye closure at a room temperature130of 25°C. Before initiating exercise, cold sensation in the extremities of limbs was higher131

in cold sensitive subjects than control subjects. Significant increases in core and skin132

temperatures immediately after exercise were found in participants with reduced cold

133

sensation. EEG alpha wave power was consistently lower in the cold-sensitive subjects

134

than the control subjects throughout the experiments; however, no changes in spectral

135

power by performing exercise were found. Beta wave power was increased during

136

exercise at moderate intensity (~60% of maximum), which promptly returned to pre-137

exercise levels after exercise. These findings suggest that performing a single dynamic

138

exercise transiently inhibits cold sensation due to thermal effects of exercise without

139

altering alpha wave and beta wave power during rest under normal temperature conditions.

140

Thus, the lower alpha wave power in the cold-sensitive women was independent of cold141

sensation itself.

142
143

Chronic effects

144

To investigate the relationship between a cold constitution and exercise habits, earlier

145

studies37,38) compared the percentage of persons with symptoms of a cold constitution in

146

subjects with and without exercise habits. In a questionnaire survey using the Internet of147

6,729 patients, many subjects with an awareness of a cold constitution did little exercise37).

148

Tsuyushige et al.38) reported that symptoms of a cold constitution were milder in subjects

149

performing intense physical exercise on a daily basis compared to subjects without an

150

exercise habit in a survey involving healthy female university students.

151

A longitudinal study reported that the chronic effects of dynamic exercise, consisting152of a light combination exercise training (aerobic and resistance training) for 3 months,

153

were negation of symptoms related to coldness of the body with increased muscle strength154

in the trunk and lower limbs39). A walking exercise intervention for 4 weeks mitigated155

coldness in the distal portion of the extremities via a reduction in cold sensation at normal

156

body temperature in young women who had a cold constitution40). Thus, the elevation of157

body temperature and skin vasodilation of the distal portions of the extremities that occurs

158

during daily aerobic exercise may contribute to reduced cold sensitivity. Moreover, a159

shorter term (2 weeks) aerobic exercise intervention increased overall and foot warmth160

and comfort in cold-sensitive young women (Fig. 3)41). The alleviations of cold sensitivity

161

symptoms were associated with greater pre-sleep alpha wave power and improved

162

subjective sleep quality with a shorter mid-awake time and a longer deep sleep time41).

163

The habitual exercise-induced increase in alpha wave power at rest may reflect reduced164

sensitivity to cold sensation and/or thermal discomfort in the brain.

165
166

(Insert Fig. 3)

167
168

To summarize the effects of exercise on women’s cold constitution: 1) coldness was

169transiently alleviated in a body site-dependent and time-dependent manner due to the170thermogenic effects of exercise, and 2) cold symptoms in the peripheral extremities at

171

rest were improved after at least 2 weeks of aerobic exercise training.

172

173

Acknowledgements

174

The authors thank Ms. Ayane Nakano, Ms. Mizuho Momose and Ms. Hinako

175

Morikawa to collect the research materials. This review was supported by JSPS

176

KAKENHI Grant Number JP22K11682 and Yamaguchi Prefectural University Joint

177

Research Promotion Program.

178
179
180
181

Conflict of Interests
The authors declare that they have no conflict of interests.

182

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Fig. 1 Signal transduction pathways of cold sensation and cutaneous vasoconstriction
and physiological characteristics of cold constitution. The main physiologicalcharacteristics of people with a cold constitution under normothermic conditions
are: 1) low resting metabolic rate, 2) high sensitivity of cold sensory function, 3)high cerebral nerve activity expressed as low alpha wave power, 4) desensitizationof cutaneous cold receptor function in the lower limbs, 5) high sensitivity of reflex
and local skin vasoconstriction in the distal portion of the peripheral extremities,6) high sensitivity of adrenergic receptor function in the skin of the lower limbs,
7) strong skin vasoconstriction of the distal parts of limbs, and 8) low skintemperature of the extremities. Aerobic exercise acts on the physiologicalmechanisms of cold constitution and alleviates cold symptoms through central andperipheral pathways.

Fig. 2 Changes in thermal sensation of each body part in young women with a cold
constitution35). In exercise experiment (upper panel), the measurements were
performed 10 min before the start of cycle exercise for a total of 15 min(Baseline), immediately after exercise (Test 2), and 30 min after the end of
exercise (Test 3). In control experiment (lower panel), the subjects maintained at
rest without exercising. * p < 0.05 vs Baseline, † p < 0.05 vs Control condition.

Fig. 3 Changes in thermal sensation and thermal comfort in the whole-body and feetwith 2-week exercise or time-controlled interventions in young women with acold constitution41). The measurements were performed during rest in a roomat 18°C. * p < 0.05 vs Before, † p < 0.05 vs. Control