Those who practice Avantouinti after their Sauna should take the precaution of delaying their dip until they have become acclimatized to the outside temperature, because going from 80-100 degrees in the sauna to approximately 0 degrees in freezing water could prove fatal for anybody with heart and circulatory problems, especially as the ambient temperature in Finland during the winter can vary between 1-3 degrees above zero to 25 degrees below, because the thermal dispersal in water is 25 times faster than it is in air, under normal ventilation conditions.

Currently, the number of people in Finland who swim in cold or freezing water (below 10°C) is on the increase. It is estimated that approximately 100,000 Finns (approximately 1 per 100 inhabitants) is in the habit of bathing in cold water in inland pools or in the sea. This practice seems to be spreading ubiquitously throughout the Western world, as evinced by the innumerable clubs that gather together and keep informed those who practice this health-giving sporting activity.

The élitist, and what I would call ‘snobbish’, gentlemen’s régime of bathing in cold water in the Thames during the last century led to the founding of the Highgate Lifebuoys Club in London, and was subsequently emulated all over the world.

It is not just the innumerable people who have pursued this activity for several years who are aware of its beneficial effect, it is enjoyed by anybody who has given it a go and discovered its scientific benefits.

The organism’s response to cold-water bathing has been the subject of much research, mainly geared to the study of the effects of underwater activities or accidental falls into the water during ‘floating’ sports on the water such as sailing and canoeing. As we shall see, these situations furnish information that is useful for the prevention and treatment of emergencies linked to exposure to extreme or prolonged cold, but they are not always applicable to cold water bathing which entails abiding by certain methods and precautions.

Studies devoted to the medical effects of balneation and swimming in cold water and exposure to damp, cold environments have been carried out by qualified medical teams, especially in England and in Germany.

William Keatinge, Professor at the Queen Mary and Westfield College in London has studied the effect of intentional exposure to cold as practiced in Siberia in depth, where it is known as Ivanov Therapy (after a guru who manages to walk naked in the snow for hours). This is based on walking barefoot and bare chested with ‘pauses for meditation’.

Even pregnant women and children who have been accustomed to brief immersions in snow since birth have taken up this practice.

By acclimatizing themselves to the cold, they are able to survive the most adverse climatic conditions with no risk to themselves.

The Russian Medical School has formulated a very interesting indication for cold water baths, which may well be applicable to various situations in the Western world, where stress and depression seem to be on the increase.

Cold water bathing has been proven to help in the treatment of anxiety and depressive neuroses as well as the so-called Chronic Fatigue Syndrome/CFS, which is still associated with conditions of ‘somatization’ caused by anxiety and depression.

In Russia, where this illness is widespread, the cause has been attributed to the psychological trauma suffered by survivors of Chernobyl (Post Chernobyl Syndrome) and it has been successfully treated with cold water baths.

Keatinge notes that the majority of deaths among the elderly in Northern Europe and Great Britain caused by prolonged accidental exposure to cold (e.g. while waiting for public transport) could be avoided by introducing controlled acclimatization techniques such as bathing in cold water.

However, Keatinge also warns of the risks of bathing and swimming in cold water for those who do not practice it regularly and over a lengthy period, especially those people who suffer from or are at risk of ischemic cardiovascular disease (angina and myocardial infarction, Reynaud’s Disease and Reynaud’s Syndrome etc.).

According to Keatinge, apart from the defensive adrenaline energy rush of the body which affects the vasomotor and neuro-endocrinological systems (vasoconstriction, catecholamine and ACTH increase), exposure to the cold for longer than half an hour causes thickening of the blood (increased viscosity) which carries with it a risk of difficult and inadequate perfusion (spraying) of vital organs such as the heart, kidneys and brain, which can lead to ischemic attacks or infarction.

The benefits of bathing in cold water on swimmers who have kept this habit up regularly for years have been scientifically studied by Werner Siems of the Humboldt University of Berlin and his group (at the Herzog Julius Hospital in Bad Harzburg).

They found that these subjects were likely to suffer half as many infectious respiratory diseases (bronchitis, bronchial pneumonia) as those who do not practice this habit.

Some of the beneficial physiological biochemical mechanisms associated with regular bathing in cold water are as follows:

people who swim regularly in cold water produce a greater percentage of a series of substances such as glutathione and other antioxidant enzymes which are capable of neutralizing oxidating reactions connected with cellular aging.

According to the German researchers, mild oxidative stress triggered by the initial exposure to cold helps to prepare the body to withstand the medium to long term antioxidant stress caused by habitual exposure to the cold.

There is a theory, as yet unproven, that this might help protect the body against cardiac and vascular disease (with medium to long term effect).

Finally, these researchers believe that bathing in cold water, practiced regularly (at least 1-2 times a week) helps to

On-going research seems to suggest convincingly that this would have a significant effect:

• at a neuropsychiatric level, through mood-enhancing psycho neuro endocrinological action in which exposure to light, and solar light in particular, would play a primary synergic role (‘light therapy’)
• at a metabolic level, by modifying thermogenesis and thermoregulation thus affecting both perception of the ambient temperature and calorific consumption, and influencing dietetic supply and demand as well as lipolysis (breakdown of fats).

Cold water swimming: physiological and endocrine metabolic aspects
Environmental conditions refer to water, undulatory motion, climatic environmental conditions (sunshine, wind), relative humidity (%) and rain.

The conditions we would regard as ideal, and that we would be seeking are as follows: brief immersion (from three to fifteen minutes) in sea water in a calm pool with no or very little undulatory motion and little or no wind (under 15 knots) and a water temperature of between 10 and 18 degrees (an average of 14 during the winter season) and fine weather.

The body’s response to ‘cold water’ or rather ‘out of season’ bathing depends on environmental and personal factors.

Individual circumstances, relative to the person taking out of season baths (All Seasons Swimming/ASS), can largely be divided into three categories:

• those who do it habitually, i.e. every day
• those who do it frequently, no more than once or twice a week
• those who do it occasionally (once a month or once a year)

As far as the ‘habituees’ (first category) are concerned, the possibility that they may become truly inured* must be taken into consideration. The incidence of this happening is extremely rare, however, and is regarded as ‘anecdotal’ evidence of CWS (for example: ‘that guy who bathes at Pegli all year round no matter what the weather’).

In all cases a there is a build-up of ‘stress’ which, in the absence of tolerance and adaptation**, will mainly affect the cardiovascular and endocrine systems.

I believe that it would be advisable to consider carrying out a preliminary check of the cardiovascular and endocrine systems in all cases: including the neurovegetative system which is closely involved with the functioning of all the endocrine glands in our bodies as well as the peripheral tissues which, despite not being strictly glandular in their anatomical make-up, release hormonal secretions into the circulation as a whole as well as to localized areas (these are often biologically active polipeptides) such as endorphins.

Given that sudden cold, even in people who are prepared for it (such as athletes who take part in alpine sports), can act as a stimulant for numerous endocrine axes (hypothalamus/ pituitary/ peripheral endocrine glands), I would suggest the need for an accurate preliminary evaluation of the two ‘major systems’:

An evaluation of two other secretional moments should also be considered: namely the ones that release the two hormones produced by the pituitary gland that do not have a particular peripheral target gland:

The first of these hormones (GH/growth hormone), especially in adults in whom, for obvious reasons, it no longer affects body height, sets intense metabolic activity in motion, which can supply an immediate caloric substratum to those who are exposed to low temperatures.

This is caused by the release of fatty acids stored in adipose tissue.

This leads to the wider issue of the beneficial effects of swimming in cold water on obesity, which is not simply an esthetic problem, but is actually one of the greatest medical and health problems of our time.

Prolactin, however, is now regarded as a ‘stress hormone’ in its own right in both females and males, since the numerous everyday stimuli, be they endogenous or exogenous, trigger its release in the same way as the adreno corticotrophin hormone (ACTH).

Any preliminary evaluation should include:

1) the thyroid hormones

Free thyroxine and triiodothyronine (free T4 and T3) as well as the pituitary hormone that regulates their secretion (thyrotropin or TSH).

Evaluation of hematic cortisol, focusing particularly on the circadian rhythm.

Evaluation of dehydroepiandrosterone and its sulphate (DHEA and DHEA sulphate).

At present, this pre-hormone is thought to offer some protection against the signs of aging and is also viewed as a possible physiological inhibitor of the formation of some tumors.

It would, therefore, be interesting to find out more about the most reliable tumor ‘markers’, such as CEA, which is relatively generic (to discover the conditions under which it becomes elevated!!!) and PSA which is, instead, specific to expansive prostate disease. (why are these being mentioned, what have they got to do with bathing and cold water?)

3) growth hormone (GH)

Evaluation of the basal values of the hormone and of its secretional response to physiological stimuli in particular (GHRH, somatostatin, medicinal GH-activators, such as ghrelin, which is a new hormonal GH-stimulator, produced and secreted by adipose tissue and probably capable of strengthening the release of this pituitary hormone and increasing its effect on the release of fatty acids).

Evaluation of the basal levels of this hormone, which is a well-known ‘stress hormone’ even in males and examination of its responses to exposure to hypothalamic factors (TRH, somastostatin) or dopaminergic or antidopaminergic drugs. This could form the basis of a study of interactions with the adrenergic component of the neurovegetative system.

These instruments undoubtedly provide the best means of regulating water temperature with absolute precision. They can be ordered from stores that specialize in precision measuring equipment.

The water temperature should be checked daily, since it can vary by up to between 2 and 3 degrees Centigrade during storms and even where low-level flooding has caused rivers to burst their banks or there are torrents in spate with outlets near the bathing area.

Another important factor that can affect the temperature and quality of the water is the dumping of waste that is not natural in origin (industrial, thermoelectric power stations, waste water and sewage etc.). The geology and lay of the land of the selected area is, therefore, of great relevance.

In the Mediterranean, the temperature falls by about 2 degrees a month from an average 21-25 degrees during the summer period (June, July and August). It reaches a level of about 12-14 degrees C at the end of March and then rises gradually as Spring progresses. Even during the coldest months, it is unusual to find water temperatures of less than 10 degrees C (50F) in many Mediterranean regions (i. e. French and Italian Riviera: (Nice, Cannes, Sanremo, Bordighera).
 

There is much to be said about the ideal temperature for Cold Water Swimming, including the variations in physiological response caused by the physical conditions of the subject at the time, their sensitivity and reactivity but also their enjoyment and stamina.

We would advise CWS on warm, sunny winter days, at least to start with.

The ideal protocol would envisage continuing summer bathing habits, uninterrupted by the onset of autumn. This obviously means that there can be a gradual acclimatization to both the diminishing temperature of the water and the air temperature.

One particular aspect of environmental temperature concerns ventilation.

We explained how even a light breeze can significantly modify heat dispersion (up to 25 times) in winds of over 20 knots.

Bathing in strong winds (above 20 knots) increases the risk of hypothermia or at least of symptoms of cooling (nasal pharyngeal mucositis, otitis, laryngitis and tracheobronchitis) in susceptible people (children, old people and the immunodepressed).

Protocol of ‘habituation’
Reckless immersion of the whole body in water, the famous dive into cold water that forms part of the so-called ‘winter endurance’ sport, often performed in an exhibitionist and theatrical manner by individuals or groups of people seeking publicity, and which sometimes involves acrobatics such as throwing oneself off bridges or steep cliffs can engender appreciation and admiration, but it is not a sporting practice to be recommended in view of the following.

Habituation (acclimatization) is undoubtedly a complex process (involving the autonomous/neurovegetative and central nervous systems as well as a number of highly important organs) requiring progressive periods of time and methods of exposing the body to cold water.

Therefore, our advice would be to immerse the feet and ankles (for 2 minutes) near the waterline, then to move swiftly on to where the water is knee-deep and bend the trunk forwards, keeping the legs completely straight, arms stretched, until the hands are in the water, fingers stretched wide apart, breathing slowly and deeply all the while. On sunny days and when there is little wind (breezes of less than 20 knots), we would recommend maintaining this position for 2-3 minutes (counting slowly up to 100) so that approximately 1/3 of the body’s surface comes into contact with cold water, thus triggering a rapid but not a lightening-fast orthosympathetic (neurovegetative) reaction and consequently a vasomotor response aimed at protecting the vital internal organs.

In addition to the immediate vasomotor orthosympathetic reaction (caused by the adrenal glands releasing adrenalin and noradrenalin), a psychoneuroendocrine adaptive response which renders the next phase, total body immersion, atraumatic (release of ACTH).

This means, in fact, that the adrenergic vasomotor reaction is divided into two stages, thus avoiding any risk of an vasoconstrictive overload of the heart and kidneys.

The body position, with the trunk bent over and the legs straight can be gradually accentuated by working with the breathing, which promotes an atraumatic lengthening of the tendonous mechanisms and the dorsal muscle fascia until the position of maximum flexion is reached, at which point some people will be able to touch the tops of their feet with their hands.

During this phase it is important not to modify the breathing pattern, which should be slow and strong, and involve the abdominal respiratory muscles as much as possible.

It is important to remember, however, that everybody will do what they can in their own time. Never overexert yourself, because the entire procedure should be carried out in a calm and relaxed manner, better still under the supervision of an instructor.

Complete immersion of the body does not include the neck and head, which lose approximately 50% of the body heat. In this sort of situation it might be a good idea to wear something over the head and neck, like a cap or a scarf made of Neoprene, wool or synthetic fibers (Polartec, Goretex etc.) and to cut the ‘habituation’ phase (fingers splayed and immersed in water for 2-3 minutes) down to one minute (counting slowly up to 30)
 

Dietary and digestive precautions
Extremely detailed guide-lines have been produced by physiologists, sports doctors and nutritionists concerning the optimum time lapse between eating a main meal and bathing so as to lessen the risk of cardiocirculatory collapse (shock); such conditions could be triggered by insufficient blood perfusion of the brain due to the increased demand for blood by the viscera during the digestive process (mainly the stomach and the intestines). However, most people would agree that a 2-3 hour wait is sensible, although probably excessive.

CWS can also be recommended in conjunction with a series of other activities aimed at achieving overall postural re-education, increased muscle power and enhanced flexibility and joint trophism.

We would recommend a series of exercises taken from Yoga and Tae Bo.

Exercises to be performed in water
Four-Leaf Clover Exercises (Tae Bo technique, adapted for water)

1) Extend the right leg out in front as far as possible, moving quickly but not traumatically or suddenly (to avoid tearing a muscle).

The left leg should be kept flexed at buttock height sway gently so as to keep the position of the body as steady as possible.

2) Bend the right leg and bring it back next to the left leg and then extend it sideways (to the right) so as to achieve a lateral extension of almost 90° with respect to the previous projection.

Movements must never be sudden or traumatic, despite the fact that this is exercise should be performed quickly.

Bring back the left leg, keeping it flexed against the left.

3) Extend the right leg behind you as far as you can, but doing the reverse of 1). Then bring back the right leg keeping it flexed against the left.

6) Extend the left leg behind you as far as you can (at 180° with respect to the projection of the right leg in 1).

7) Flex the left leg and bring it back next to the right, then extend it laterally to the left so as to achieve a 370° lateral extension with respect to extension 1).

This is a fast but not traumatic movement (avoid clicking or cracking your kneecap).

8) Flex the left leg and bring it back next to the right one.

9) Extend the left leg in front of you as far as you can quickly but not traumatically or suddenly (to avoid tearing a muscle)

The two legs therefore move in a CLOCKWISE direction – the right leg should point to 12/3/6 o’clock and the left to 6/9/12 o’clock.

This exercise should be repeated 4 more times (making a total set of 5).

The same movements should be repeated immediately, without a break, in an ANTICLOCKWISE direction this time, starting by extending the left leg in front, then to the side and finally behind, completing the circle with the posterior extension of the right leg, then to the side and then in front, the left leg should point to 12/9/6 o’clock and the right to 6/3/12 o’clock. In this case too, the exercise should be repeated 4 times (making a total set of 5).

The sets should be repeated for 5 minutes altogether.

Big toe-hand position
The lack of gravitational pull in the water means that one of the Yoga balancing positions can be assumed with ease. This is the thumb-big toe position of the Sun Salutation, which stretches the flexor and adductor leg and thigh muscles.

Swimming Phase (San Remo Style)
The mode of swimming that we would recommend at this point is one that we have defined ‘San Remo style’.

We recommend keeping the head and neck above water for thermoregulatory reasons (because the head and neck lose significant amounts of heat) but also and especially to avoid bringing the mouth, nose and eyes (sensitive mucous membranes that are more or less open to colonization/infection by microorganisms) into contact with water that might very well be contaminated (biological pollution).

The water in and about large cities may have been polluted suddenly and unexpectedly by breakdowns in the sewage system or environmental accidents (floods) leading to rapid biological and chemical pollution.

The many faults in the sewage system and the vulnerability of the loading and dumping of waste water and sewage into the sea are good reasons for not bringing the mucous membranes into contact with sea water, this is another reason why one swims … with one’s head held high!

It’s not only more dignified but more expedient, even though it might strike children on the beach as bizarre!

San Remo swimming is like swimming freestyle, but without moving the head, which remains erect and facing in a forward direction.

The lower limbs may only be required to make minimal effort, if at all (flippers can be worn).

We would recommend spending approximately 5 minutes on this exercise.

It is advisable to alternate brief bouts of backstroke and San Remo swimming for a total time of 10 minutes.

Getting out of the water, drying the body and recuperation of heat
We recommend acquiring a heavy, hooded robe that can be worn both before and after CWS, especially if there is noticeable environmental ventilation.

This is to protect the head and neck, which should not be wet, but would benefit from being protected from the wind because of their high propensity towards heat loss. Therefore, it is best to put the robe on straight after bathing and go into a warm, dry room (23°C ideally), and then dry off with terry and cotton towels and change out of the wet bathing suit immediately.

The ambient temperature in the place where one intends to spend the minutes after bathing is of vital importance. If this is out of doors and the temperature is less than 20°C, it would be a good idea to put on a pair of woolen tights under a pair of trousers or fleecy track suit pants. Woolen underclothes rather than cotton are always preferable for the body (singlet or T-shirt).

The outer layer could be a sailor-type (water-repellent) sweater with a high neck, a jacket or heavy sweater made of wool or fleece.

If, however, one intends to remain in a place where the temperature is over 21°C. (23° for example), then clothing can be made of light wool or nylon or cotton as long as …. there is no onset of shivering and if, after consuming a hot infusion (heartily recommended), all feelings of cold have vanished. If trembling sets in or there is a strong feeling of cold, it would be advisable to put on a padded jacket.

The wearing of woolen tights (ski type), or alternatively long woolen stockings, together with comfortable shoes (even trainers or sneakers) is imperative.

Once CWS has become habitual (no less than two swims a week) and the benefits obtained and people feel inclined to stay longer in the water (well-being and satisfaction prolong the length of stay in the water) over-confidence can lead to latent symptoms of hypothermia (shivering while drying off and getting dressed, a persistent feeling of cold, slurred speech).

If symptoms persist even after a hot drink (tea, for example) and in all cases where the person is confident enough to spend an energetic and prolonged period in the water, even without exhibiting these symptoms, a supplementary program of heat production or recuperation should be embarked on (as a preventative measure) which we suggest might include the following activities:

Sun Salutation (Yoga)

Skipping with a Rope (no less than 5 sets of 50 jumps each)

Knee bends (flexing the legs) (no less than 3 sets of 50 bends each)

Running (jogging) for no less than 20 minutes.

One or more of the above can, and in symptomatic cases (persistent feeling of cold, and shivering), should be carried out until a state of well-being and acclimatization to the surrounding environment are achieved.

The sense of gratification that ‘out of season bathing’ can bring
It is pointless to pretend that all those who take part in this activity do not think of themselves more along the lines of heroes than martyrs and as such, in their heart of hearts, what they would really like, narcissistically-speaking, is to find an admiring audience cheering them on, ready to congratulate them when they come out of the water.

The fact that this is seldom the case is due to nothing more than the discretion and good manners of the on-lookers, it is not a question of their not genuinely admiring the admittedly out-of-the-ordinary activity that cold water swimming undoubtedly is.

Often it falls to friends and fellow cold water swimmers to congratulate beginners after completing their “trial”; there may well be a certain amount of juvenile banter which eventually takes the shine off the novice’s expectations of glory.

The profound feeling of well-being that is achieved after the first few minutes’ “suffering” in the water is more than enough to compensate for any spectatorly lack of interest in the accomplishment, leading to an increasing wish to swim ‘in private’ (away from curious and indiscreet eyes).

Should anybody actually come forward with congratulations at that point, the satisfaction turns into real joy (try it and see!!).

AWS Protocol in brief
In a nutshell, the protocol of AWS and a break-down of the timing for the various different stages is as follows:

a) preliminary preparation
        - immersion of feet alone (2 minutes)
        - immersion of feet and splayed hands (3 minutes)
b) complete immersion excluding the head (instantaneous)
c) acclimatization phase (backstroke) with short, frequent movements (5 minutes)
d) exercise phase (Tae Bo, Acquarobics and Yoga) (5 minutes)
e) swimming phase (alternating San Remo style and backstroke) (5 minutes)
 

Total immersion 15 minutes (the length of time can be increased gradually up to 50%)

Total time spent in the water 20 minutes (including the time spent on the preliminary phase)

This period represents half of the minimum time it takes a middle-aged person to start displaying the first signs of hypothermia in water at a temperature of 10° (note the rule of 50: at 50 years of age, in water at 50°F/10C for 50 minutes there is a risk of hypothermia).