A scoping review protocol on brain PaCO2 levels at altitude for stroke airplane transport

How long will it take for your competent? hospital and emergency services to adopt these guidelines when they come out?

Do you prefer your hospital  incompetence NOT KNOWING? OR NOT DOING?

 A scoping review protocol on brain PaCO2 levels at altitude

STUDY PROTOCOL
A scoping review protocol on brain PaCO2
levels at altitude
Hanna TangID1,2☯*, Laurel CharlesworthID1,2,3☯, Manoj Lalu3,4, Brian Dewar3, Risa Shorr5,
Dariush Dowlatshahi1,2,3
1 Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada, 2 Faculty
of Medicine, University of Ottawa, Ottawa, Ontario, Canada, 3 Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada, 4 Department of Anesthesiology and Pain Medicine, Department of Cellular and Molecular
Medicine, University of Ottawa, Ottawa, Ontario, Canada, 5 Learning Services, The Ottawa Hospital, Ottawa,
Ontario, Canada
☯ These authors contributed equally to this work.
* hatang@toh.ca
Abstract                                       
Background
Aeromedical transfer of patients with ischemic stroke to access hyperacute stroke treatment is
becoming increasingly common. Little is known about how rapid changes of altitude and atmo-
spheric pressure can impact cerebral perfusion and ischemic burden. In patients with ischemic
stroke, there is a theoretical possibility that this physiologic response of hypoxia-driven hyper-
ventilation at higher altitude can lead to a relative drop in PaCO2. This would ultimately result in
cerebral vasoconstriction, and therefore worsening of the ischemic burden in patients with
ischemic stroke. Currently, there are no specific recommendations in stroke guidelines for opti-
mizing altitude of aeromedical transportation to minimize the rate of ischemic burden. In this
scoping review, we aim to map the available literature that addressed whether PaCO2 changes
with altitude. This would be the steppingstone for more in-depth analyses into the cerebral auto-
regulatory consequences of high altitude on cerebral ischemia to form future guidelines.
Methods and analysis
We will follow scoping review methods recommended by the Joanna Briggs Institute. Elec-
tronic databases MEDLINE, Embase, Web of Science, and Cochrane Central Register of
Systematic will be systematically searched to identify articles that report on the acute
response of PaCO2 on acute change in altitude. Two independent investigators will perform
duplicate title and abstract screening and full-text review, followed by duplicate data extrac-
tion. We will present quantitative data using descriptive statistics. Key textual information
will be synthesized in a tabular format Simple statistics on the frequency of papers, data will
be presented via histogram.
Ethics and dissemination
This scoping review does not require ethical approval. The results of our scoping review will
be published in academic medical journals and presented at medical conferences. The find-
ings will highlight the current availability of literature on PaCO2 changes with altitude.

Registration

This scoping review protocol has been registered in Open Science Framework (DOI 10.

17605/OSF.IO/UVK83).

Introduction

Aeromedical transfer of patients with ischemic stroke allows access to hyperacute therapies

that are not otherwise geographically available [1, 2]. Since 2018, when the Thrombectomy 6

to 24 Hours after Stroke with a Mismatch between Deficit and Infarct Trial demonstrated a

90-day mortality and recovery benefit with endovascular therapy (EVT) in patients who pres-

ent with acute stroke within 24 hours of onset [3], the treatment window for ischemic stroke

was extended to 24 hours from last seen well. This led to an expansion of catchment areas of

EVT-capable comprehensive stroke centres. To this end, aeromedical transport is increasingly

used worldwide to reduce the overall time to treatment for patients with strokes suspected to

be secondary to a large vessel occlusion [4]. However, little is known about how rapid changes

of altitude and atmospheric pressure can impact cerebral perfusion and ischemic burden.

At sea level, ventilation is driven by predominantly by arterial pressure of carbon dioxide

(PaCO2) with a secondary ventilatory response to hypoxia with lower arterial pressures of oxy-

gen (PaO2). The partial pressure of oxygen (pO2) decreases at higher altitudes when atmo-

spheric pressure decreases, leading to relative hypoxia; this hypobaric hypoxic environment

causes hypoxia-driven hyperventilation, in an attempt to normalize PaO2 [5, 6]. In patients

with ischemic stroke, there is a theoretical possibility that this physiologic response of hyp-

oxia-driven hyperventilation at higher altitude can lead to a relative drop in PaCO2. There is a

nearly direct linear relationship between PaCO2 and cerebral autoregulation, with hypocarbia

causing vasoconstriction. In the hypobaric hypoxic environment, hypoxia-drive hyperventila-

tion lowers PaCO2 which could lead to decreased cerebral blood flow and therefore worsening

of the ischemic burden in patients with ischemic stroke. Although the use of supplemental

oxygen could mitigate some of the effects of the hypobaric hypoxic environment during aero-

medical transport, there are no current protocols for how this should be implemented, and it

is currently unknown what blood oxygen saturation (spO2) should be targeted. Furthermore,

in patients with concurrent diseases impacting blood oxygenation, supplemental oxygen alone

may not be sufficient to optimize PaO2 and could require modifications in the cabin pressure

and cruising altitude which could delay air transfer.

Currently, there are no specific recommendations in stroke guidelines for optimizing alti-

tude of aeromedical transportation to minimize the rate of ischemic burden [7–11]. However,

before these guidelines can be established, there are some knowledge gaps that will need to be

addressed. The physiologic relationship between PaO2, PaCO2, altitude and cerebral autoregu-

lation during aeromedical transfer is not well known. In this scoping review, we aim to map

the available literature that addresses whether PaCO2 changes with altitude. This scoping

review will provide essential foundational information for future investigations into the cere-

bral autoregulatory consequences of high altitude on cerebral ischemia.

More at link.

Upper Body Strength Predicts Sexual Partner Count in Men and Women

 With your vast need for sex post stroke, your doctor is responsible for you retaining your upper body strength. My left arm hasn't exercised in 18 years, how the hell am I supposed to attract a partner?

All this is why you need to be doing lots of sex, why the hell can't your doctor get you fucking again? In fact you should be doing it in the hospital.

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better

 

Sex after stroke

 

Sex linked to better brain power in older age

Sex: The Ultimate Full Body Workout

 

Better Memory From This Extremely Pleasurable Activity - Sex

 

WHY SEX IS BETTER FOR YOUR BRAIN THAN SUDOKU 

 

Sex linked to better brain power in older age

 

Good News About Sex- It Doesn't Cause a Stroke

 

Sex Does Not Increase Heart Attack Risk - What about stroke?

 

Frequent orgasms may protect against heart attacks

Sex linked to better brain power in older age  (Put this in here twice because it's so important!)

 

An orgasm a day keeps the doctor away!

In case you don't have a partner she could prescribe this.

Electrosex

And the benefits of marijuana for sex here:

Sex, Marijuana and Baby Booms

New study highlights the benefit of touch on mental and physical health

The latest here:

Upper Body Strength Predicts Sexual Partner Count in Men and Women

Summary: A study revealed that both men and women with greater upper body strength report more lifetime sexual partners, challenging the sexual selection hypothesis, which emphasizes male physical competition for mates.

While men’s strength is often linked to evolutionary advantages like hunting and mate competition, the findings also suggest stronger men are more likely to be in long-term relationships, supporting the “provisioning” theory.

Women’s upper body strength, surprisingly, correlated with higher partner counts, though the reasons remain unclear, with theories including assortative mating or reduced dependency on male support.

Key Facts:

• Cross-Gender Pattern: Stronger men and women both report more lifetime sexual partners, defying traditional evolutionary assumptions.
• Provisioning Theory: Stronger men may have been better long-term partners, supporting families through hunting.
• Unexplained Link: Women’s strength correlates with partner count, but the evolutionary basis requires further study.

Source: Washington State University

While many studies have looked at possible evolutionary links between men’s strength and sexual behavior, a Washington State University study included data on women with a surprising result. Women, as well as men, who had greater upper body strength tended to have more lifetime sexual partners compared to their peers.

The study, published in the journal Evolution and Human Behavior, was designed to test evolutionary theories for human sexual dimorphism—namely that in early human history there was likely a reproductive advantage selecting for men’s greater upper body strength.  

Another finding in this study did hint at a reason for that physical difference: men with greater upper body strength were also more likely to to be in long-term relationships.

“People have assumptions about men’s sexual behavior and how that’s related to evolution. Besides acquiring more sexual partners, establishing long-term relationships was likely also important for men in evolutionary history,” said lead author Caroline Smith, a recent WSU Ph.D. graduate in anthropology.

For this study, Smith and her advising professor, WSU evolutionary anthropologist Ed Hagen, analyzed data on 4,316 U.S. adults from 2013-2014 from the National Health and Nutrition Examination Survey conducted by the Centers for Disease Control and Prevention.

They primarily used grip strength, a common measure to approximate upper body strength, and compared it to participants’ survey responses about their sexual behavior.

The findings present a mixed picture, the authors said.

There are several hypotheses around why men have greater upper body strength. One popular theory, known as the sexual selection hypothesis, is based on competition: that like other primates, human males competed against each other for access to mates so needed to be physically formidable to pass their genes on.

This theory predicts little relationship between women’s strength and their mating success.

“Men are stronger than women, on average, and men report more lifetime partners than women, but men and women are on the same regression line,” said Hagen.

“Regardless of whether they’re males or females, stronger individuals have more lifetime sexual partners. That was a surprising finding and somewhat contrary to the sexual selection hypothesis.”

On the other hand, this study’s finding about long-term partners seems to support another theory based on “provisioning.”

Since human babies require a lot of care and resources, particularly from women during pregnancy and lactation, men were more desirable as partners when they could provide meat through hunting, which for hundreds of thousands of years before the modern era required upper body strength.

The stronger human males, who also stuck around and helped provide more food resources to those children as they grew, also would better ensure their survival.

While there are theories for men’s strength in relation to reproductive success, there are not so many for women’s strength, in part because women are not often included in these types of studies.

There was not an obvious explanation in this study’s data why women with greater upper body strength also had greater number of lifetime partners. The researchers controlled for many variables, including general health and testosterone levels, but the connection still held.

They did cite a few potential theories, including that it is due to “assortative mating,” meaning physically stronger people tend to partner with each other more frequently. It could also be that women who are physically stronger require less male investment or feel like they can take more risks.

Ultimately, more studies involving women would be needed to uncover more evidence for the reasons behind this connection as well as a better understanding of human evolution in general.

“I believe it’s important to continually test our theories, especially by expanding our research questions to include women,” said Smith.

About this relationship and evolutionary neuroscience research news

Author: William Ferguson
Source: Washington State University
Contact: William Ferguson – Washington State University
Image: The image is credited to Neuroscience News

Original Research: Closed access.
“Strength, mating success, and immune and nutritional costs in a population sample of US women and men: A registered report” by Ed Hagen et al. Evolution and Human Behavior

Turning everyday objects into tools for recovery

 With any competence at all in the stroke medical world, this would be turned into protocols and delivered to all 10 million yearly stroke survivors! But since there is NO leadership and NO strategy, NOTHING WILL OCCUR! That is how fucking incompetent your stroke medical 'professionals' are! Nothing here works for patients with spasticity.

Turning everyday objects into tools for recovery

When people recover from a stroke, they often start by doing exercises in a clinic. But once they go home, they need to keep exercising to keep their hands and wrists functional. These exercises can feel boring and hard to stick to. Many people skip the recommended 30 minutes of daily exercises, which slows down or reverses their recovery. But what if brushing your teeth or drinking your morning coffee could help you get better?

At the University of Twente, researchers Juliet Haarman, Kostas Nizamis, Emiel Harmsen and Armağan Karahanoğlu have come up with a creative idea: use everyday objects as tools to help people recover. This transforms ordinary household objects into smart hand-training objects.

"We started in 2019 with a focus on wearable robotics," says Haarman, "but we quickly realised we could make it easier by using things people already have at home." This approach focuses on hand rehabilitation, particularly for stroke patients who need to maintain or regain wrist movement. The researchers partnered with Roessingh Research and Development, Roessingh Rehabilitation Centre, Hankamp Rehab, ZGT, and Saxion University to co-develop these tools with patients and physiotherapists.

From toothbrush to coffee cup

The team looked at everyday items like your toothbrush, a placemat or coffee cup to see how they could double as exercise tools. "We asked patients and experts what objects would be easiest to use," the researchers explained. The goal was to make tools that are helpful but not frustrating.

Take the toothbrush, for instance. To train wrist rotation, the team developed a brush that rotates while in use. "The toothbrush stimulates you to make a few wrist rotations, turning your brushing routine into a mini wrist workout. It is a form of training that facilitates the use of patients’ affected hand and wrist." Similarly, colourful LEDs in a placemat encourage patients to perform specific hand movements by dancing around like little fairies showing you exactly where to place your cup.

The toothbrush is way too small for my left hand fingers to get a grasp on.

Human-centred design

A previous version of the placemat which – a large wooden block with small LED screens – showed smiley faces when the cup was placed correctly. “But making it too much like a game had downsides. People got bored of the game after a while. Therefore, we redesigned it to be more subtle, so it doesn’t interrupt the drinking activity itself."

The coffee cup design evolved after initial feedback. Early versions required squeezing a glass cup with lights to give feedback, but users found it unnatural and worried the glass might break. "We switched to a stainless steel cup and made the gripping movements feel more natural." These changes show how important it is to listen to user feedback.

I can't get my fingers open enough without using my right hand to pull them open, and that would entail turning the cup sideways thus spilling the coffee! Doing it with an empty cup still wouldn't work, filling it after that would still spill since spasticity turns the wrist sideways.

Testing in real homes

The researchers soon start with small trials with stroke patients at home. Over a period of four weeks, they will track how often people use the tools and for how long. "Our first goal is to see if people actually use these objects. Once we know that, we can test if they work as well as traditional exercises."

The potential impact of these tools extends beyond the lab. The researchers hope to create a wide range of tools for different people. "For example, someone who cooks a lot might use a spatula for exercises, while a computer user might benefit from a special mouse.” By making recovery part of daily life, these tools could make it easier and more enjoyable for patients to stick to their routines.

You have a ways to go to get survivors with spasticity recovering

A new way to heal

So, what if your morning coffee or brushing your teeth could help you heal after a stroke? Thanks to these innovative researchers, it’s not just a possibility, it’s becoming a reality. These tools have the potential to transform rehabilitation, making it an intuitive and integral part of life, and bringing hope to countless patients worldwide.

Mount Holly Rehab First in US to be Certified in Stroke Rehabilitation

 NOT GOOD ENOUGH! Refers to 'care' NOT RECOVERY! Business 101 would never allow you to specify 'processes' in your goals and objectives; ONLY RESULTS! You'd be fired in no time trying to pull that over your director.  The board of directors here is completely incompetent!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! And what is your definition of competence in stroke? Swearing at me is allowed, I'll return the favor. Don't even attempt to use the tyranny of low expectations as an answer.

Mount Holly Rehab First in US to be Certified in Stroke Rehabilitation

Mount Holly Rehabilitation & Healthcare Center in Lumberton is the first skilled nursing facility in the United States to earn the Skilled Nursing Facility Stroke Rehabilitation Certification offered by the American Heart Association®. Located at 62 Richmond Avenue, Mount Holly Rehab provides post-hospital care, short-term rehab and long-term residential care.

The certification provides a framework for evaluating skilled nursing facilities against rigorous science-based requirements for stroke rehabilitation, including program management, patient and caregiver education and support, care coordination, clinical management and quality improvement.

Mount Holly’s Stroke Recovery Program is the first specialized subacute care(NOT RECOVERY!) offering of its kind for the region. Under the direction of Tracey Harris, MD, stroke rehabilitation services are tailored to meet the specific needs and goals of an individual, dependent on how they have been impacted by a stroke. The program aims to help restore physical function and the ability to perform daily activities, gain strength and endurance, improve balance and mobility, manage pain and spasticity, overcome speech and communication deficits, and develop new cognitive strategies.

“When there are evidence-based processes during every phase of care(NOT RECOVERY!), patients have the best opportunity for positive outcomes,” said Pamela Duncan, PhD, PT, FAPTA, FAHA, volunteer chair of the American Heart Association’s Skilled Nursing Facility Stroke Rehabilitation Certification Oversight Workgroup. “Participation in this certification benefits the patient and the facility by standardizing care(NOT RECOVERY!), helping patients and their loved ones choose a facility that follows important best practices.”

Mount Holly’s multidisciplinary services include physical, occupational and speech therapies. The center’s therapy gym features state-of-the-art equipment and technology to support the unique needs of stroke survivors, including the LiteGait® support system and Synchrony Dysphagia Solutions by ACP®, among others.

Board certified in Physical Medicine and Rehabilitation (PM&R), Dr. Harris has more than 30 years of medical experience. She is affiliated with Virtua Medical Group.

The Association’s certification ensures stroke rehabilitation care(NOT RECOVERY!) is coordinated from pre-admission through working with the skilled nursing facility to discharge. “After experiencing a stroke, patients need high-quality care(NOT RECOVERY!) that follows evidence-based guidelines, giving them the best chance at faster and more effective recovery,” said Kate Bauer, regional director of market development at Marquis Health Consulting Services, which supports Mount Holly.

“At Mount Holly, the team aims to be trailblazers and continues to use innovative methods to give its patients recovering from stroke the best care(NOT RECOVERY!),” Bauer added. “The American Heart Association has armed the center with additional tools and recognized its success – it is an honor to have Mount Holly’s processes and efforts recognized in this way.”

Former Purdue men’s basketball coach Gene Keady suffers stroke

 

I don't know why doctors prognosticate complete recovery when they have absolutely NO FUCKING CLUE AS TO RECOVERY. They don't do objective damage diagnosis, they have no rehab protocols at all. THEY KNOW NOTHING ABOUT STROKE AT ALL!

Mercury astronaut Scott Carpenter suffers stroke; full recovery expected

Oops! 

 Scott Carpenter - Obituary 

The latest here:

Former Purdue men’s basketball coach Gene Keady suffers stroke

NDIANAPOLIS — Former Purdue men’s basketball coach Gene Keady suffered a stroke last week.

In a post on X, the Boilermaker men’s hoops program confirmed Keady “suffered a small stroke and was taken to the hospital for evaluation.” Keady has since been transferred to a rehab facility and expected to make a full recovery.

Keady coached at Purdue for 25 years from 1980-2005. He is the winningest coach in the history of the Boilermaker men’s basketball program.

Purdue went 512-270 with Keady at the helm. The Boilermakers won six Big Ten titles and qualified for the NCAA Tournament 17 times under Keady.

Keady, now 88 years old, retired in 2005. He was succeeded by Matt Painter, who is now the second-winningest coach in Purdue men’s hoops history with a 472-208 record.

 I always did, it allowed me to get to a higher speed, but then I haven't done treadmills in over a decade. I now consider them to be vastly inferior to overground walking. You get no perturbations from treadmills. Overground greatly increases your balance ability.

Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds

• Monica Biggio,
• Costanza Iester,
• Davide Cattaneo,
• Simone Cutini,
• Ambra Bisio,
• Ludovico Pedullà,
• Alessandro Torchio,
• Marco Bove &
• Laura Bonzano 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 5 (2025) Cite this article

• Metrics details

Abstract

Background

Treadmill-based gait training is part of rehabilitation programs focused on walking abilities. The use of handrails embedded in treadmill systems is debated, and current literature only explores the issue from a behavioral perspective.

Methods

We examined the cortical correlates of treadmill walking in healthy participants using functional near-infrared spectroscopy. We investigated whether the utilization of treadmill handrails at varying walking speeds could affect cortical activation associated with the task, and we evaluated potential differences in task-based functional connectivity across the various walking conditions.

Results

Significant differences in cortical activation were found between the two walking speeds (3 and 5 km/h) in the unsupported condition; these differences were reduced when using the handrails. Specifically, cortical activation was significantly higher when the participants swung their arms freely while walking at a speed of 5 compared to 3 km/h in several Brodmann’s Areas (BA): left BA10, BA3 and BA39, and right BA10, BA9, BA8, BA3, and BA40. No significant differences were found when participants were holding onto the handrails. A significant difference was found in the left BA40 between the two speeds, regardless of whether the participants were holding onto the handrails. Furthermore, at the higher speed and without the use of handrails, a wider pattern of task-based functional connectivity was observed, with significantly stronger connectivity between the left BA10 and BA40.

Conclusions

We suggest that speed and handrails use play a role in walking cortical activity patterns, therefore they are key ingredients to take into account when planning a rehabilitation program.

Background

Gait abnormalities during old age and as a result of neurological diseases are very debilitating and can increase the risk of falls [1], negatively affect independence and quality of life [2], and increase health care costs [3]. For this reason, walking abilities are often considered a primary focus for rehabilitation programs.

To create controlled setups in rehabilitation, several studies recommend treadmill-based gait training paradigms [4], and body weight support systems are allowed in order to minimize the delay in starting gait training for neurological patients and to increase safety without the use of walking aids [5]. The use of handrails embedded in treadmill systems helps to stabilize the body by increasing afferent somatosensory signals through haptic contact with the handrails [6,7,8].

Some controversial results have been reported in the literature on the use of treadmill handrails during rehabilitation. First of all, it should be considered that holding the hands onto the handrails of the treadmill might not imply a representative walking pattern, in terms of an ecological perspective, since it encourages bad posture and prevents the natural stride [9,10,11]. It has been reported that supporting on the handrails lightens the workload since it requires less muscular activation without resulting in substantial neuromuscular re-organization. In fact, it increases the base of support, resulting in greater stability, reduces uncertainty leading to a better balance, and improves ability to generate corrective forces to compensate for perturbations [12]. Also, handrail use during treadmill walking in a split-belt adaptation training reduced locomotor learning in healthy young subjects, suggesting that this balance support may ease, or alter the task demand [6].

It has been shown that the effect of gait rehabilitation can be improved by holding handrails [13], especially when participants used a firm rather than a light touch on the handrails [12]. It should be noted, however, that Bello and colleagues attributed the improvements seen during the rehabilitation of patients with Parkinson’s disease to the belts used in combination with the treadmill, instead of the handrails themselves [14].

Nevertheless, all these studies explored the issue from a behavioral perspective. To our knowledge, the effects of holding handrails during treadmill walking have never been investigated with neuroimaging techniques.

In general, in order to propose effective rehabilitation paradigms, it is necessary to reach a better understanding of the mechanisms underlying the gait under various conditions [15]. Walking has long been regarded as predominantly automatic process, however functional magnetic resonance imaging (fMRI) studies based on motor imagery of gait have demonstrated a cortical control even during simple walking processes in healthy elderly, pathological subjects, as well as healthy young individuals [16,17,18]. The areas mainly involved in gait are the prefrontal cortex, supplementary motor, premotor and primary motor areas, sensorimotor areas; their activity has been found to be modulated by task demand [17, 19]. Bakker and colleagues asked their participants to (visually) imagine a normal gait or a precision gait over a narrower path, finding an increased cortical activity in cortical structures outside primary motor regions during the harder task, thus emphasizing greater cortical activity when an increased postural control is required [16].

Portable neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), led to identify cortical activation patterns and locomotor networks involved in walking, providing new insight into cortical control of actual human locomotion [20,21,22]. In fact, this technique made it possible to study walking during its actual performance and to modulate the difficulty of the task [19], the somatosensory feedback from different peripheral stimuli [23], or to assess the difference between walking and running [24].

In this vein, we investigated the cortical correlates of treadmill walking by means of fNIRS in a group of healthy participants. We were interested in understanding whether the use of treadmill handrails, at different walking speeds, could modulate cortical activation related to the task. Specifically, we carried on an fNIRS study while walking on a treadmill at two different speeds (3 and 5 km/h - lower or equal with respect to the spontaneous walking speed of young healthy subjects [25]), with or without holding onto the handrails. Furthermore, one published study based on fMRI showed that individuals with faster gait speed have stronger resting-state functional connectivity (FC) within the frontoparietal control network, and that gait variability is correlated with between-network functional connectivity [26]. As a step forward, here using fNIRS we were able to assess possible differences in task-based FC among the task conditions during walking to better understand how task performance modulated the connectivity between cortical regions, providing a more comprehensive view of cortical function beyond isolated regional activity.

It has been reported that, during comfortable walking, lower extremity muscle activity had a strong correlation with cortical activation [27]. Therefore, we expected to find differences in cortical activation between the two walking speeds in the unsupported condition. Given that walking with handrails can lighten the workload of walking requiring less muscular activation [12], we hypothesized that this condition would be associated with a reduced brain resource demand and that the use of the handrails could mitigate the differences in cortical activity due to the walking speed.

More at ink.

NOW IS THE TIME TO BUILD BROWN FAT

 Of course your competent? doctor has already informed you of the benefits of cold showers and coffee! You did do cold showers in the hospital, right? And your doctor managed to install a 24 hour coffee station, right? NO? So, you DON'T have a functioning stroke doctor, do you?

cold shower (7 posts to January 2017)

coffee (340 posts to February 2012)

NOW IS THE TIME TO BUILD BROWN FAT

We turn the heating off at night, in our house. Manually.  And I’m an early riser. Which means that when I wake up – usually around 6am, often earlier – it’s both dark and very cold. Our house is old, with single glazed windows, so any residual heat from the previous day has invariably escaped by this time. Naturally it’s tempting to linger under the duvet. But I spent my formative years in a house without central heating, run by frugal parents who told us to put on more clothes. So I get up and shiver my way to the bathroom for my cold shower.

I’m no Wim Hof: I can honestly say that I dread that first blast of cold water. Especially when the bathroom feels like an ice box. But I feel great afterwards, fully awake and alive. And on the days when I really dread it (not enough sleep, bathroom colder than normal), I also remind myself about Brown Fat. Medically known as Brown Adipose Tissue (BAT), brown fat stores energy, burns calories, regulates blood sugar and insulin levels. It may do many other magically life-enhancing things. Indeed, researchers are desperately trying to concoct a pharmaceutical version of Brown Fat, because it appears to protect against obesity, heart disease, cancer, T2 diabetes and Alzheimer’s. Importantly, Brown Fat gobbles up the more dangerous, artery-clogging  White Fat.

At its simplest, Brown Fat exists to produce heat – and so keep us alive. Babies are born wrapped in a generous cloak of it, enabling them to stay alive for a little longer (presumably in the event that Mum was subsequently eaten by a tiger.)  It starts working before shivering sets in, producing warmth by breaking down glucose and fat molecules.

Which is why cold is the very best activator of Brown Fat. Cold showers aren’t the only way – I have a chapter in 52 Ways to Walk on how a wintry stroll activates the stuff, but you could also try keeping the thermostat down for short periods. Exercise also helps activate it, as does drinking coffee. Eating the right diet is important too – plenty of healthy fats, and sufficient iron.  Brown Fat is chock full of iron-laden mitochondria which is why it has a brown colour. Apples and herbs might help (see below).

An abundance of Brown Fat is thought to be one of the reasons that very old people (think centenarians) are always thin, and why longevity researchers consistently cite lean-ness as one of the strongest predictors of healthy longevity.  As we age, it’s unclear whether we lose or gain Brown Fat. Studies have found different outcomes. But one thing is clear: having plentiful supplies could help us all age well.

Just before Christmas, a new study of Brown Fat was published.  This study – from Rutgers New Jersey Medical School in the US – found that having more brown fat made it easier to exercise.  Which is to say that, not only might exercise activate Brown Fat, but that having plentiful brown fat might also make it easier to exercise.  This study was done in mice, but could it also apply to humans? The researchers confidently asserted that, yes, it could, noting that Brown Fat ‘enhances healthful aging.’

Here are a few tips on how to increase your own Brown Fat supplies:

Go for a regular wild swim

Take a cold shower or ice bath. The Cleveland Clinic suggests twice a week.

Go for a walk and expose your neck to the air for a few minutes.  Brown Fat collects around the neck, shoulders and chest.

Turn the thermostat down every now and then. You want to be feeling a little cool, not violently shivering.

Nor does it need to be bracingly cold – some studies suggest two hours of exposure to 66°F (19°C) is all that’s required.

Eat apples, specifically their peel, and other foods containing Ursolic Acid. A handful of studies suggest that this plant-derived phytochemical prompts the production of Brown Fat.

The herbs, rosemary, holy basil and sage are particularly rich in Ursolic acid. In fact many herbs – oregano, thyme etc – contain lots of Ursolic acid, so use them liberally in your cooking. This recipe  from our recipe archive is particularly herb-dense.  I’m quoting from Examine.com here: ’Although the science is preliminary, [ursolic acid] seems to reduce fat accumulation and increase muscle mass gain when in a fed state, and to induce fat burning and preserve muscle mass when in a fasted state.’

Eat plenty of good fats – avocados, nuts and seeds, for example.

Make sure you’re getting enough iron from food like meat, seafood, whole grains, leafy vegetables and beans. Sufficient iron will keep your fat cells healthy.

Drink caffeine – according to a 2019 study, caffeine activated Brown Fat.

Of course, we need more research.  The problem with cold exposure research is that most people don’t want to be part of it, or can’t maintain it.  So the bulk of the research still involves mice.  However, there are enough studies of human tissue to suggest that plentiful brown fat won’t hurt us – and may keep us healthier and happier for longer.  Or you can follow the advice of longevity guru, Peter Attia, who says it’s irrelevant whether ice baths and cold showers make you live any longer – what’s important is how they make you feel… better… now!

Interestingly, another cold therapy study crossed my desk recently.  According to this report, five minutes of cryotherapy resulted in an increase in slow-wave sleep, as well as improvements in mood and reductions in anxiety.  In this experiment, men and women spent five minutes a day in a cryostimulation chamber, chilling their bodies to -90C. Cold didn’t help them fall asleep more quickly and it had no effect on REM sleep, but deep slow wave sleep increased by an average of 7.3 minutes per night, with men and women responding differently. ‘The benefits were particularly noticeable for women’, noted the researchers.

Most of us don’t have access to cryostimulation chambers. And five minutes in a cold shower seems a long time, even by my standards.  I suspect there are easier ways to get that extra 7.3 minutes of deep sleep (a good long walk does it for me). But I mention it, just in case!

Perhaps more importantly, cold exposure activates immunity. We first wrote about this in our book The Age-Well Project.  Since my conversion to daily cold showers, several years back, I’ve barely had a cold. In the last year (during which I increased the duration of my shower to a good two minutes every morning), I’ve not had a single cough, cold, sniffle.  Studies published last year have continued to unpick why cold improves immunity.  It’s still a little hazy but a 2024 study of Egyptian adults found that those who cold showered had considerably higher levels of immunoglobulin, and more immune-boosting (and anti-cancer) T-cells.  The researchers concluded that ‘Regular cold shower exposure appears to enhance humoral and cell-mediated immunity.’  They proposed that cold induces physiological adaptations that prime the immune response, thereby boosting immunity. This makes evolutionary sense: faced with potentially debilitating or fatal cold, the body must do all it can to stay alive.

I think what I’m saying is this: it may be cold out there, icy water (or air in my house) may feel deeply uncomfortable, but please don’t spend the winter months locked up in your centrally-heated house. Embrace the (healing) cold!

Within reason, of course. And if you’re new to cold showers or wild swimming (or even exposing yourself to the cool), always check with your doctor first and start very, very slowly.

And for anyone who remains unconvinced, I’ll leave the final word to a group of scientists who, after examining all the evidence of previous studies, wrote:

“Deliberate exposure of the body to cold water results in distinct physiological responses that may be linked to several health benefits. Evidence, primarily from small interventional studies, suggests that cold water therapy positively impacts cardiometabolic risk factors, stimulates brown adipose tissue and promotes energy expenditure, potentially reducing the risk of cardiometabolic diseases. It also triggers the release of stress hormones, catecholamines and endorphins, enhancing alertness and elevating mood, which may alleviate mental health conditions. Cold water therapy also reduces inflammation, boosts the immune system, promotes sleep and enhances recovery following exercise. The optimal duration and temperature needed to derive maximal benefits is uncertain but current evidence suggests that short-term exposure and lower temperatures may be more beneficial. Overall, cold water therapy presents a potential lifestyle strategy to enhancing physical and mental well-being, promoting healthy aging and extending healthspan.”

If you’ve been enjoying these wintry months (apologies to our readers Down Under), please do share any tips for making the most of this season.  And let’s not forget that these cold snaps should be relished for other reasons too. With rising temperatures and continued climate crisis, it’s possible (God forbid) that our children will never see snow, or experience the wintry glitter and sparkle of frost, or feel their cheeks nipped pink by an icy wind. It’s a horrible thought, but let it spur you on and out – enjoy it while you can.

And if you know anyone who might be interested in the contents of this blog post, please pass it on.   We would be delighted!

Annabel