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Journal of Athletic Training · 2008

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Thomas A. Cappaert, Jennifer A. Stone, John W. Castellani, Bentley Andrew Krause, Daniel Smith, Bradford A. Stephens

National Athletic Trainers' Association Position Statement: Environmental Cold Injuries

National Athletic Trainers' Association. 43(6). 640-658.

Study type
Professional position statement
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Full text reviewed

Cold-weather safety is not just about whether the air is below freezing. The guidance describes immersion foot, a nonfreezing injury associated with prolonged cold and wet exposure, at temperatures around 0–18°C, or 32–65°F. Persistently wet socks or footwear are a common part of that exposure. The authors also address hypothermia, when the body becomes dangerously cold, and frostbite, when tissue freezes. These are different problems, not interchangeable names for feeling chilly. Their shared prevention message is to consider wetness, wind, clothing, exposure time, and personal vulnerability together during outdoor activity.

The recommendations explain how to reduce risk and recognize problems, but they do not establish one safe temperature for every person or activity. A weather reading alone leaves out how quickly someone is losing heat and whether they can stay dry. Many recommendations rely on expert judgment and physiological evidence because large controlled studies deliberately exposing people to cold injury would be difficult or unethical.

How Does This Show Up in Real Life?

A wet outdoor session can require a different plan from a dry outing at the same temperature. The statement recommends clothing layers that move moisture away from the skin, provide insulation, and offer protection from wind and water. It also emphasizes adjusting clothing and activity as conditions change, rather than assuming that wearing the warmest possible outfit solves everything. The practical question is whether the clothing can keep doing its job throughout the outing, including when sweat or rain makes it wet. Access to shelter, replacement dry clothing, and opportunities to warm up belong in that decision. These are prevention recommendations for cold exposure, not evidence that a particular garment makes prolonged exposure safe. They also are not a treatment guide for someone who already has a suspected cold injury.

Evidence strength varies across the recommendations, and findings from particular outdoor groups do not establish identical protection for everyone. Conditions, clothing, exertion, and individual responses interact. The statement does not quantify how much a complete prevention plan reduces injury in ordinary community exercise. Its practical guidance therefore needs judgment rather than being treated as a tested guarantee.

Why We Cite It

Alpekin can use the discussion of personal risk when designing questions that precede an outdoor activity plan. A history of cold injury or a condition affecting temperature regulation can matter even when someone is experienced and fit. This adds a concrete reason for personalization beyond choosing an activity level or matching a schedule.

The useful takeaway is to plan for changing exposure, not just a forecast number. This paper supports a more complete prevention conversation. It cannot turn an equipment checklist into proof that an outing is safe, or replace assessment when cold injury is suspected.

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