090387

The effects of L-Menthol cream and ice-slurry ingestion on exercise at fixed-

intensity.

Abstract

Exercise performance is well-known to be negatively affected by hot conditions due to

increases in whole-body temperature and thermal discomfort. The aim of this study
was to investigate the effects of ice slurry ingestion and or menthol application on
thermoregulatory responses on sub-maximal, fixed-intensity exercise in the heat
Preliminary VO2max testing to establish lactate threshold preceded four additional tests.
Using a randomised counterbalanced crossover, ten recreationally trained males were
assigned to either 1kg of ice slurry (ice), 1kg of ice and menthol face cream (menthol),
just menthol or a control group in a hot environment (35 °C). Core (Tc) and skin (Tsk)
temperature, thermal comfort and sensation, Bla, HR, RPE and gas exchange were
measured. Statistical significance (p ˂ 0.05) occurred between conditions within Tc
(ice vs menthol and control, ice and menthol vs menthol and control), Tsk (ice vs ice
and menthol, menthol and control) and thermal comfort (ice vs menthol, ice and
menthol vs control and menthol vs control). This study suggests ice slurry ingestion
alone and in combination with menthol face cream, act as a significant practical pre-
cooling strategy within hot environments across sub-maximal, fixed intensity exercise.

Introduction
Endurance performance has been well recognised to be negatively affected by hot
conditions (Peiffer & Abbiss, 2011), which is significant for endurance-based athletes
as most major international sporting competitions take place in hot environments. As
expected in the forthcoming 2020 Olympics in Tokyo and 2022 FIFA World cup in
Quarter (Stevens, Taylor & Dascombe, 2017). When exercising in hot environments,
cardiovascular response and whole-body temperature increases as well as thermal
discomfort, perceptions of exertion and can expand the chance of exhaustion, heat
syncope, heat injury, heat stroke and exercise related muscle cramps resulting in
decrements across endurance performance (Casa et al., 2015). In contrast, continued
exposure to hot environments increases submaximal performance, maximal aerobic
capacity (VO2max), thermoregulatory responses and enhances thermal comfort

1
090387

(Sawka, Leon, Montain & Sonna, 2011). For safe exposure to various ambient
temperatures, body temperature is regulated through behavioural responses such as
sweating and autonomic responses such as removing or adding clothing (Schlader et
al., 2013).

In a review by El Helou et al. (2012) it was reported within marathon races, a mean
optimal temperature of ~6°C was ideal, for every 1 °C increase above this temperature
equated to a 0.03% reduction in performance. In addition, when temperatures
exceeded 20 °C there was an average deterioration of ~ 12% - 17% on performance.
These findings coincide with Racinais, Periard, Karslen and Nybo (2015) who found
for every 1 °C rise in ambient temperature past 10 °C resulted in a 0.3% to 0.9%
decrement in performance. These undesirable effects have been shown to worsen as
exercise duration increases, approximately 2% over 6 minutes (Altareki et al., 2009),
7% over 30 minutes (Tatterson, Hahn, Martin & Febbraio, 2000) and 16% over 70
minutes (Racinais et al., 2015). In addition, Galloway and Maughan (1997) found at
higher temperatures (21 °C and 31 °C respectively), when exercising at a fixed
intensity (70% V02 max), decreased time taken to reach fatigue occurred eliciting a
30-minute difference between trials completed.

Numerous strategies have been explored to improve both athlete health and
performance in hot climates (Coris, Ramirez & Van-Durme, 2004). Pre-cooling (PC)
and heat acclimatisation (HA) have both been well researched and proven to amplify
work capacity within heat (Ross et al., 2013). An elevated core temperature (Tc) has
been hypothesised as the main limiting factor on exercise performance in hot
conditions. Improvement on performance has been thought to be helped via PC
methods, by lowering initial Tc and expanding the gap between preliminary Tc and
temperature where degradation of performances occurs, highlighting the significance
of PC strategies.

PC has been the subject of numerous research (Siegal & Laursen, 2012), which have
found positive effects on endurance performance in hot environments. Using external
or internal strategies have been shown throughout exercise at fixed intensities, reduce
thermal strain and enhance performance (Siegel et al., 2010). However, it has been
noted the impracticality of most cooling methods, particularly during competition, such
2
090387

as; mechanically circulated cold water and heavy ice vests. In addition to cooling
garments, alternative approaches have been explored such as ingestion of ice and/or
cold fluids (ice slurry) (Tyler, Sunderland & Cheung, 2015). The melting (enthalpy of
fusion) of ice to water involves a huge handover of heat energy into the system. It has
been reported that transfer of ice to water can cause lower intramuscular and skin
surface temperatures. Hence, once ice is consumed, surrounding tissues transfer heat
energy into the slurry mix, as opposed to storing it in the body, dropping Tc (Merrick,
Jutte & Smith, 2003). Several studies investigated the effects of ice ingestion on
endurance performance (Siegel et al., 2012), with a common outcome theme
highlighting an improvement on performance across time and power output, however,
results were not deemed statistically significant.

Traditionally menthol, used as a mouth rinse, has shown significant ergogenic effects
on endurance performance within hot environments (Tran-Trong et al., 2015). It is
believed menthol works to aid sensations of freshness and coolness via a stimulus on
the trigeminal nerve and an agonist towards the TRPM8 channel (Patel, Ishiuji &
Yosipovitch, 2007), which works as a temperature sensor of cold. Giving menthols
ability to provide a perceptual cooling effect, the potential for it to aid performance in
hot conditions could prove useful as a PC strategy. Limited research has identified the
positives of external application of menthol to the face or body, however, Schlader,
Simmons, Stannard & Mundel (2011) found in endurance performance an
improvement occurred on time to exhaustion and total work, as well as improved
comfort and cooler thermal sensation. However, volume of research within this area
fails to come to a definitive conclusion as to whether external menthol application has
significant positive effects on endurance performance.

Therefore, the aim of this study was to assess the ergogenic effect of menthol face
cream and ice slurry ingestion as a PC intervention on thermoregulatory responses
and sub-maximal exercise performance at a fixed intensity in the heat. We
hypothesised that ice ingestion would significantly lower Tc and menthol would
significantly enhance thermal comfort and thermal sensation. Resulting in an easier
ability to sustain sub-maximal performance.

3
090387

Method

Participants

Ten recreationally trained males (Age: 27 ± 5 years; Height: 1.80 ± 0.08 meters; Mass:
77.8 ± 8.0 kilograms) volunteered for this study. All subjects provided written informed
consent to take part in this study and had no history of heat related illness and were
free from injury. The study procedures were approved by the St Mary’s University
ethics committee.

Preliminary testing

Initially subject’s height and weight were recorded, a heart rate monitor fitted and
ambient temperature (°C), humidity (%) and barometric pressure (mmHg) were all
noted. After a thorough check of the required number of Douglas bags, participants
were instructed and familiarised with the setup of the cycle ergometer (Mechanically
Braked Cycle Ergometer, Monark Exercise AB, Ergomedic 824E, Varberg, Sweeden)
and the procedures of a maximal oxygen uptake test.

Preceding the test, a 4-minute warm-up was utilised at 80rpm at 120W. The test
continued until participants reached volitional fatigue via incremental work stages of
4-minutes. During the last 60 seconds of each stage gas samples were collected via
the Douglas bags. Heart rate, RPE and blood lactate samples were collected during
the 60 second rest interval and a work rate increment of 24 W (equivalent to 0.3 kg)
was applied. Participants VO2max and lactate threshold (LT) were calculated, including
power output at the LT and VO2max.

Procedure

Using a randomised counterbalanced cross-over procedure, participants were

assigned to one of four conditions that were carried out over a four-week period; ice
slurry, menthol, ice and menthol and a control.

4
090387

Participants were instructed to avoid caffeine 12 hours prior to testing and no fluids
taken throughout the trial. Prior to entering the heat chamber (temperature at 35°C
and 40-50% humidity), body mass was measured wearing only shorts (and again post
exercise) then skin thermistors (Edale CD Thermister Thermometer, Edale
Instruments Ld, Cambirdge, UK) and a rectal probe were fitted. Once in the chamber
participants set up the ergometer to the same specification as the preliminary test.
Subjects spent 45 minutes in the chamber prior to commencement, in which time heart
rate, resting whole-body thermal comfort (Bedford scale), whole-body thermal
sensation (ASHRAE scale), facial thermal perception, gas exchange measurements,
blood lactate and respiratory rate were recorded. All these measurements plus RPE
were measured every 5-minutes throughout the test (baseline, 5, 10, 15 and 20
minutes), at which participants were cycling at LT at a fixed cadence.

Conditions requiring ice slurry ingestion, 1 kg was ingested in two 500g doses 30-
minutes prior to exercise, with 15 minutes to consume each. For conditions that
required menthol, a face cream was applied to subjects 10-minutes pre-exercise.

Data analysis

Data extracted from the Douglas bags were examined using a high flow gas analyser
and gas meter, then compiled on a Microsoft excel document labelled ‘expired air
analysis’. Data accumulated from this document, along with all other recorded
measurements, were collated onto a separate excel spreadsheet for all participants.

Statistical analysis

A 2-way analysis of variance (ANOVA) for repeated measures was implemented to

test for differences between conditions across multiple variables. If sphericity was
violated, then a Greenhouse-Geisser was evaluated. When significance was
identified, differences between conditions were delineated using a post hoc pair-wise
comparison with Bonferroni adjustment (statistical significance was accepted at ˂

5
090387

0.05). All data is presented as means ± standard deviation. Statistical analysis was
achieved using IBM SPSS (Version 24, IBM Corp: Armonk, NY).

Results

Core (Tc) and skin (Tsk) temperature

Figure 2 demonstrates the mean Tc across all four conditions at each time point. A
repeated measures ANOVA determined statistical significance and sphericity between
time and condition (F(12) = 1.486, p ˂ 0.05). A Pairwise comparison table was
analysed after using a Post hoc Bonferroni adjustment and revealed significant
differences occurred at baseline, 5-minutes and 10-minutes between ice vs menthol
(p ˂ 0.05), ice vs control (p ˂ 0.05), ice and menthol vs menthol (p ˂ 0.05) and ice and
menthol vs control (p ˂ 0.05). Also, between ice vs menthol (p ˂ 0.05) and ice vs
control (p ˂ 0.05) at 15 and 20-minutes.

38.4

38.2
Mean Core Temperature (°C)

38

37.8

37.6

37.4

37.2

37

36.8
Base 5min 10min 15min 20min

Ice Slurry Ice Slurry & Menthol Menthol Control

6
090387

*indicates significant difference between ice vs menthol and ice vs control conditions.
+indicates significant difference between ice and menthol vs menthol and ice and
menthol vs control.

Figure 2. Mean Tc across all conditions at each time point.

Figure 3 illustrates mean Tsk across all four conditions at each time period. A repeated
measures ANOVA determined statistical significance and sphericity between time and
condition (F(12) = 4.390, p ˂ 0.05). A Pairwise comparison table was analysed after
using a Post hoc Bonferroni adjustment and revealed significant differences occurred
at baseline between ice vs ice and menthol (p ˂ 0.05), ice vs menthol (p ˂ 0.05) and
ice vs control (p ˂ 0.05).

37

36.5
Mean Skin Temperature (°C)

36

35.5

35

34.5

34
Base 5min 10min 15min 20min

Ice Slurry Ice Slurry & Menthol Menthol Control

*indicates significant difference between ice vs ice and menthol, ice vs menthol and
ice vs control.

Figure 3. Mean Tsk across all conditions at each time point.

Ratings of thermal comfort, thermal sensation and perceived exertion

7
090387

Figure 4 displays the mean rating of thermal comfort across all four conditions at each
time point. A repeated measures ANOVA with a Greenhouse-Geisser correction
determined statistical significance between time and condition (F(3.049) = 3.186, p ˂
0.05). A Pairwise comparison table was analysed after using a Post hoc Bonferroni
adjustment and revealed significant differences occurred at baseline between ice vs
menthol (p ˂ 0.05), ice and menthol vs control (p ˂ 0.05), and in addition to baseline,
at 5-minites between menthol vs control (p ˂ 0.05).

0.7

0.2
Rating of Thermal Comfort

Base 5min 10min 15min 20min

-0.3

-0.8

-1.3

-1.8

-2.3

-2.8
Ice Slurry Ice Slurry & Menthol Menthol Control

*indicates significant difference between ice vs menthol. +indicates significant

difference between ice and menthol vs control. #indicates significant difference
between menthol vs control.

Figure 4. Ratings of thermal comfort across all conditions at each time point.

Figure 5 shows the mean rating of thermal sensation across all four conditions at each
time period. A repeated measures ANOVA with a Greenhouse-Geisser correction
determined statistical significance between time and condition (F(3.470) = 2.866, p ˂
0.05). A Pairwise comparison table was analysed after using a Post hoc Bonferroni
adjustment and revealed no significant differences occurred between any of the
conditions at any timepoint.

8
090387

0
Base 5min 10min 15min 20min

-0.5
Rating of Thermal Sensation

-1

-1.5

-2

-2.5

-3

Ice Slurry Ice Slurry & Menthol Menthol Control

Figure 5. Ratings of thermal sensation across all conditions at each time point.

Figure 6 demonstrates mean RPE values across all four conditions at each time point
were also analysed. A repeated measures ANOVA determined statistical significance
and sphericity between time and condition (F(12) = 1.829, p ˂ 0.05). A Pairwise
comparison table was analysed after using a Post hoc Bonferroni adjustment and
revealed significant differences occurred only at 10-minutes between ice and control
(p ˂ 0.05).

9
090387

17
Rate of Perceived Exertion (RPE)

15

13

11

5
Base 5min 10min 15min 20min

Ice Slurry Ice Slurry & Menthol Menthol Control

*indicates significant difference between ice vs control.

Figure 6. Rate of perceived exertion (RPE) across all conditions at each time point.

Discussion

Endurance performance has been well noted to be affected within hot climates.
Currently, PC interventions have been investigated to battle the negative effects
associated. However, common strategies have been deemed impractical. The aim of
this study was to evaluate the thermoregulatory effects of ice slurry and/or menthol
cream as a PC intervention on sub-maximal exercise performance in a hot
environment. In this study, we measured various thermoregulatory responses on heat-
induced exercise to identify the effectiveness of different PC strategies. Across
different time points we identified Tc as being significantly affected by ice ingestion.
Ice ingestion has been recently employed due to it practicality over alternative cooling
methods such as; heavy ice vests and circulated cold water.

Cooling the core without a simultaneous reduction in Tsk could possibly lead to sub-
par performance (Stanley, Leveritt & Peake, 2010). However, ingestion of ice has been
shown to have little to no effect on Tsk (Siegal et al., 2012), potentially due to a

10
090387

reduced Tc to Tsk ratio post-ingestion, thus possibly dampening the capability of

transferring heat to the environment. However, results from this study show that ice
elicited significant differences on Tc and Tsk throughout the trials taken. Which would
suggest ice slurry PC methods to be highly beneficial, as Tc has been suggested as
the main limiting factor (Tyler et al., 2015).

Prolonged exercise in hot environments pose a larger threat on thermal homeostasis,

and is not uncommon to see Tc above 40°C. However, Tc following endurance
exercise has been shown to range from 37.5°C to 40+°C (Bogerd et al., 2010),
highlighting a thermal strain ranging between mild and extreme. Burdon et al. (2013)
found ice slurry resulted in lower Tc at the end of exercise by 0.1 – 0.2°C in hot
conditions, which coincides with results found in this study at the final time point
between ice slurry (38.0°C) and the control trial (38.4°C). In contrast, Siegel et al.
(2010) found that the pre-cooled group elicited significantly greater Tc at the end of
exercise due to a larger metabolic heat load because of a cooling effect on the brain
and/or effect on afferent core temperature nerves (Gleeson, 1998), thus altering
perception. However, these studies looked at exercise to exhaustion as opposed to at
a fixed intensity, which would resolve the conflict in Tc findings.

As Tc has been previously mentioned as the largest limiting factor on performance,

PC allows participants to begin exercise at a reduced Tc and effect the rate at which
Tc rises. This agrees with our findings as at baseline, Tc of 37.0°C vs 37.5°C (pre-
cooled and control group respectively) were present and remained consistent
throughout the exercise period, most significantly via ice slurry ingestion. Interestingly,
Bogerd et al. (2010) found Tc reduction was non-existent at the start of exercise but
began happening during the early part of exercise, potentially due to an initial
vasoconstriction on the peripheral blood vessels and rearrangement of blood to the
core (after drop phenomenon) (Webb, 1986). However, Mitchell, McFarlin and Dugas
(2003) agree with our findings, who found PC via ice ingestion had a prolonged effect
on Tc throughout exercise in the heat.

The effects and mechanisms of PC on performance may also possess a

psychophysiological element. Thermal comfort and thermal sensation improvement
are typical responses during cooling and have been noted in addition to improved

11
 090387

performance (Schulze et al., 2015). However, findings within this study found across
all conditions, no effect in thermal sensation was present. These findings contrast with
Schlader et al. (2011) who found the application of menthol gel decreased thermal
sensation and improved performance. Interestingly, Ansley et al. (2008) found by
specifically cooling the head, lead to a considerable performance improvement
possibly because of a larger quantity of cold sensitive afferents located there (Cotter
& Taylor, 2005). Yet, this study also employed a menthol cream applied to the face
and no such effect occurred on thermal sensation, however, thermal comfort was
found to be significantly reduced when menthol was applied in contrast to the control
trial. RPE has also been shown to be reduced during endurance performance (Ansley
et al., 2008), these changes decrease perception for overall exercise and thermal
strain. However, this study found menthol to have no effect on RPE across any time
period, this could be attributed to menthol causing a false sense of perceived exertion
and thermal perception, consequently causing the participant to push themselves
harder, thus resulting in a similar RPE.

In conclusion, the present study suggests that ice slurry ingestion was significantly
able to reduce Tc throughout exercise, and menthol when externally applied, can
significantly reduce thermal comfort. Therefore, ice slurry ingestion and/or menthol
application could serve as a practical PC strategy on fixed sub-maximal intensity
exercise in the heat.

Reference List

Altareki, N., Drust, B., Atkinson, G., Cable, T., & Gregson, W. (2009). Effects of environmental
heat stress (35 degrees C) with simulated air movement on the thermoregulatory
responses during a 4 km cycling time-trial. International Journal of Sports Medicine,
30, (1), 9-15.

Ansley, L., Marvin, G., Sharma, A., Kendall, M. J., Jones, D. A., & Bridge, M. W. (2008). The
effects of head cooling on endurance and neuroendocrine responses to exercise in
warm condition. Physiological Research, 57, (6), 863-872.

12
 090387

Bogerd, N., Perret, C., Bogerd, C. P., Rossu, R. M., & Daanen, H. A. (2010). The effect of
pre-cooling intensity on cooling efficiency and exercise performance. Journal of Sports
Sciences, 28, (7), 771-779.

Burdon, C. A., Hoon, M. W., Johnson, N. A., Chapman, P. G., & O’Connor, H. T. (2013). The
effect of ice slushy ingestion and mouthwash on thermoregulation and endurance
performance in the heat. International Journal of Sports Nutrition and Exercise
Metabolism, 23, (5), 458-469.

Casa, D. J., DeMartini, J. K., Bergeron, M. F., Csillan, D., Eichner, E. R., Lopez, R. M.,
Ferrara, M. S., Miller, K. C., O’Connor, F., Sawka, M. N., & Yeargin, S. W. (2015).
National athletic trainer’s association position statement: Exertional heat illness.
Journal of Athletic Training, 50, (9), 986-1000.

Coris, E. E., Ramirez, A. M., & Van-Durme, D. J. (2004). Heat illness in athletes. Sports
Medicine, 34, (1), 9-16.

Cotter, J. D., & Taylor, N. A. (2005). The distribution of cutaneous sudomotor and alliesthesial
thermosensitivity in mildly heat-stressed humans: an open-loop approach. The Journal
of Physiology, 565, (1), 335-345.

El Helou, N., Tfflet, M., Berthelot, G., Tolaini, J., Marc, A., Guillaume, M., Hausswirth, C., &
Toussaint, J. F. (2012). Impact of environmental parameters on marathon running
performance. PLoS One, 7, (5), 37407.

Galloway, S. D., & Maughan, R. J. (1997). Effects of ambient temperature on the capacity to
perform prolonged cycle exercise exercise in man. Medicine and Science in Sport and
Exercise, 29, (9), 1240-1249.

Gleeson, M. (1998). Temperature regulation during exercise. International Journal of Sports

Medicine, 19, S96-9.

13
 090387

Merrick, M. A., Jutte, L. S., & Smith, M. E. (2003). Cold modalities with different
thermodynamic properties produce different surface and intramuscular temperatures.
Journal of Athletic Training, 38, (1), 28-33.

Mitchell, J. B., McFarlin, B. K., & Dugas, J. P. (2003). The effect of pre-exercise cooling on
high intensity running performance in the heat. International Journal of Sports
Medicine, 24, (2), 118-124.

Patel, T., Ishiuji, Y., & Yosipovitch, G. (2007). Menthol: a refreshing look at this ancient
compound. Journal of the American Academy of Dermatology, 57, (5), 873-878.

Peiffer, J. J., & Abbiss, C. R. (2011). Influence of environmental temperature on 40km cycling
time-trial performance. International Journal of Sports Physiology and Performance,
6, (2), 208-220.

Racinais, S., Periard, J. D., Karslen, A., & Nybo, L. (2015). Effect of heat and heat
acclimatization on cycling time trial performance and pacing. Medicine and Science in
Sports and Exercise, 47, (3), 601-606.

Ross, M., Abbiss, C., Laursen, P., Martin, D., & Burke, L. (2013). Precooling methods and
their effects on athletic performance. Sports Medicine, 43, (3), 207-225.

Sawka, M. N., Leon, L. R., Montain, S. J., & Sonna, L. A. (2011). Integrated physiological
mechanisms of exercise performance, adaptation and maladaptation to heat stress.
Comprehensive Physiology, 1, (4), 1883-1928.

Schlader, Z. J., Perry, B. G., Jusoh, M. R. C., Hodges, L. D., Stannard, S. R., & Mundel, T.
(2013). Human temperature regulation when given the opportunity to behave.
European Journal of Applied Physiology, 113, (5), 1291-1301.

14
 090387

Schlader, Z. J., Simmons, S. E., Stannard, S.R., & Mundel, T. (2011). The independent roles
of temperature and thermal perception in the control of human thermoregulatory
behaviour. Physiology and Behaviour, 103, (2), 217-224.

Schulze, E., Daanen, H. A., Levels, K., Casadio, J. R., Plews, D. J., Kilding, A. E., Siegel, R.,
& Laurswn, P. B. (2015). Effect of thermal state and thermal comfort on cycling
performance in the heat. International Journal of Sports Physiology and Performance,
10, (5), 655-663.

Siegel, R., & Laursen, P. B. (2012). Keeping your cool: possible mechanisms for enhanced
exercise performance in the heat with internal cooling methods. Sports Medicine, 42,
(2), 89-98.

Siegel, R., Mate, J., Brearley, M. B., Watson, G., Nosaka, K., & Laursen, P. B. (2010). Ice
slurry ingestion increases core temperature capacity and running time in the heat.
Medicine and Science in Sports and Exercise, 42, (4), 717-725.

Siegel, R., Mate, J., Watson, G., Noska, K., & Laursen, P. B. (2012). Pre-cooling with ice
slurry ingestion leads to similar run times to exhaustion in the heat as cold water
immersion. Journal of Sports Sciences, 30, (2), 155-165.

Stanley, J., Leveritt, M., & Peake, J. M. (2010). Thermoregulatory responses to ice-slush
beverage ingestion and exercise in the heat. European Journal of Applied Physiology,
110, (6), 1163-1173.

Stevens, C. J., Taylor, L., & Dascombe, B. J. (2017). Cooling during exercise: An overlooked
strategy for enhancing endurance performance in the heat. Sports Medicine, 47, (5),
829-841.

Tatterson, A. J., Hahn, A. G., Martin, D. T., & Febbraio, M. A. (2000). Effects of heat stress
on physiological responses and exercise performance in elite cyclists. Journal of
Science and Medicine in Sport, 3, (2), 186-193.

15
 090387

Tran-Trong, T., Riera, F., Rinaldi, K., Briki, W., & Hue, O. (2015). Ingestion of a cold
temperature/menthol beverage increases oudorr exercise performance in a hot, humid
environment. PLoS One, 10, (4), 0123815.

Tyler, C. J., Sunderland, C., & Cheung, S. S. (2015). The effect of cooling prior to and during
exercise on exercise performance and capacity in the heat: a meta-analysis. British
Journal of Sports Medicine, 49, (1), 7-13.

Webb, P. (1986). Afterdrop of body temperature during rewarming: an alternative

explanation. Journal of Applied Physiology, 60, (2), 385-390.

16