The Specialist:
As director of orthopedic and sports rehab at Mount Sinai Beth Israel, Dr. Robert Gotlin helps promote safe, effective exercise for patients of all ages through the medical fitness program. This is his 25th year of working in the field.

Who’s at risk:
As winter roars into full gear, it’s a good idea to take stock of what you are doing to stay active in the cold weather. “You always have to take Mother Nature seriously when you exercise, but cold weather presents a particular challenge — the need to dress appropriately, so your body is warm enough to prevent frostbite, but also in a way that allows your body to cool down, by sweating, without becoming overly cooled,” Gotlin says. “The cold weather also places additional stresses on the cardiovascular and pulmonary systems, which is why you so often hear about relatively healthy 50-year-old men having heart attacks while they’re out shoveling snow.”

Doctors have developed a four-point checklist for exercise safety. “Before exercise, you need to address what you’re doing, how you’re doing it, how you’re dressed, and if you’re medically able,” Gotlin says. “My advice is to address with your health provider whether or not going out in the cold is a challenge for you.”

Cold weather has specific physiologic effects on the body that are nothing to mess around with.

“Being out in the cold causes blood vessels to constrict, which places extra strain on the heart and makes it more difficult to regulate blood pressure,” Gotlin says. “This additional stress on the cardiovascular system makes doing a warm-up much more important in the cold than the warm weather. So be sure to do a little stretching and get the blood flow going before you start full force.”

Even seemingly-unrelated health problems can make you more susceptible to cold injury.

“If you have any diabetes or any respiratory or cardiovascular problems, you need to take extra care to layer smartly to keep the body temperature up,” Gotlin says. “You also need to be sure to have any medications on hand. For instance, if you have diabetes, you need to carry jelly beans or a sugar packet to keep your glucose level up should it decline with the exercise. And if you are a cardiac patient, you may need to have nitroglycerine with you to treat chest pain.”

Frostbite can occur in a matter of minutes, so it’s vital to be prepared. “To prevent frostbite, you need to take special care of the head, hands and feet,” Gotlin says. “It’s also important to know the warning signs that you are becoming dangerously cold. When the body is overly cold but stops shivering, that means it is shutting down and you need to warm up immediately.” Once you’ve stopped shivering, you should call 911 if you experience chest pain, shortness of breath or dizziness.

Even though it’s harder to get motivated during the dark days of winter, it’s crucial to stay active. “Exercise has to be a way of life — it helps you fight disease, be stable and strong,” says Gotlin. “You need to find something you can do, will do and want to do, and find a way to keep doing it in the winter.”

Signs and symptoms:
The body has a pretty straightforward cascade of symptoms that communicate it is becoming overly cold.

“The sequence of events is that first you feel cold, then you begin shivering, then you feel pins and needles in your hands and feet,” Gotlin says. “This is your body’s way of telling you it’s not getting the blood flow it needs because of the cold. When you are still cold but stop shivering, that can be a sign your condition is worsening.”

A second set of symptoms convey that you’re at imminent risk of a heart attack. “In the context of extreme cold, chest pain, shortness of breath and abdominal cramping can be signs that you’re at risk of cardiac arrest,” says Gotlin. “If you experience these symptoms, you should consider it an emergency that you get out of the cold and into the warm. Call 911.”

Dehydration doesn’t just happen in warm weather. In the winter, it’s easy to get dehydrated without realizing it. “The typical signs of dehydration are that you get thirsty, sweaty and red in the face,” Gotlin says. “But when you’re out in the cold, you’re not noticeably sweating, your face is already red and you often get distracted and don’t notice that you’re thirsty.” Plan to drink water every 15-20 minutes when you’re outside — even in frigid temperatures.

Traditional treatment:
The key to safe winter activities is prevention. “Exercising in the cold is all about preparation and paying attention to how your body is reacting,” Gotlin says. “You want to wear the proper layers of clothing. You want to let the body sweat, because that’s how it drops its internal temperature, but then you need to protect against getting too cold.” And don’t stay outside too long.

Watch your body for warning signs that it is beginning to struggle. “Pay attention to your breathing rate. If you can’t speak sentences without getting short of breath, that’s a sign you;re overdoing it,” says Gotlin. “Shivering is one of the ways your body protects itself, so if you’re cold and stop shivering, get moving or get inside pronto. Of course you also want to watch for the emergency symptoms of chest pain, shortness of breath and dizziness.”

If you notice that you’re getting overly cold, the solution is common sense: you need to find a way to warm up. “At that point the treatment is getting the blood flow going, staying in constant motion, rubbing cold parts to get blood flowing and getting inside before long,” Gotlin says. “Hydration and getting a good meal will also help your body recover.”

With good preparation, you can stick with your favorite activities during the winter months. “The body is one of the greatest computers we know in terms of adapting to environments,” Gotlin says. “We can do almost anything at different temperatures, but we need to be prepared and be observant.”

Research breakthroughs:
Modern technology can help. “There are better and better wearable devices like Fitbits. And in the future, these devices will be more adaptable to climate conditions,” Gotlin says. “I don’t think it will be that long before your device will have service markers for external and body temperature, including ways to let you know if you’re overheated or underheated.”

Questions for your doctor:
If you’re thinking of trying out a new exercise routine that you haven’t tried in the winter, think preventively and ask, “Am I physically able to do this activity in the cold?” A good follow-up is, “Are there any extra precautions I should take before I exercise?” And “What is the right warm-up for me?” “Exercising is a very beneficial activity to improve health and well-being,” Gotlin says. “However, in the cold weather, you need to be sure to be prepared and follow a smart exercise plan tailored to your health.”

What you can do:
Get informed. For handy tips on staying fit and staying safe during the winter, check out the city’s Department of Health website ( Another good resource is Mount Sinai ( and its Transition to Fitness Program.

Keep moving all year-round. Exercise needs to a year-round habit, and it’s especially crucial for supporting your immunity during winter flu season. Talk to your doctor about how to exercise safely all year long.

Dress and eat smart. Be sure to dress appropriately, so your body can cool down without becoming overly cooled. And because you burn a lot more calories in the cold, be sure to have proper fluid and calorie intake, before and after workout.

Be alert for red flags. Shivering is actually a healthy reminder to get moving, even just by stamping your foot and rubbing hands. The danger zone is when you stop shivering. At that point, the signs of an emergency are chest tightness, shortness of breath and dizziness. They merit a call to 911.

Drink plenty of fluids — except alcohol. You need to stay hydrated to support circulation. However, drinking alcohol will not only dehydrate you, it can mask the warning signs of cold injury. Gotlin says: “Don’t drink outside in extreme cold.”

By the numbers:
— Winter cold kills twice as many people as summer heat.
— 53% of heart attacks occur in winter months.
— Hypothermia can occur even at temperatures above 40 degrees if the person is damp.
— About 2,000 Americans a year die from weather-related injuries.


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