Head, facial and neck cooling as per-cooling modalities to improve exercise performance in the heat: A narrative review and practical applications

It has been well established that athletic performance is greatly affected by environmental heat. Numerous studies have attempted to find reliable cooling strategies to improve athletic performance while exercising in the heat. Whole-body pre-cooling has been found to enhance endurance performance in both dry and humid heat. Nevertheless, positive physiological alternations induced by pre-cooling gradually disappear during exercise. Hence, there is a great need to find effective per-cooling strategies to improve athletic performance in the heat. Unfortunately, its impractical to adopt pre-cooling approaches as a per-cooling modality to improve athletic performance due to inherent issues of practicality. Thus, a narrative review was conducted to examine the impact of head, neck and facial cooling on athletic performance in the heat. Based on current evidences, head, neck and facial cooling could greatly decrease local skin temperature at those areas where cooling was applied and thereby, local perceptual sensations were greatly enhanced. Neck cooling during exercise is found effective to improve athletic performance for both endurance and team sports athletes in the heat. Besides, neck cooling is preferred over the head, facial & combined head/facial & neck cooling for both endurance and team sport athletes in the heat from a practical application viewpoint. Research is lacking on the systematically selection of per-cooling modalities to improve athletic performance based on environmental conditions and nature of the sports activity. In addition, powerful but portable head, neck and facial cooling systems are urgently required to help athletes improving performance in the heat. Key pointsO_LINeck cooling during exercise is effective to enhance endurance performance for endurance athletes in the heat. C_LIO_LINeck cooling during exercise could improve repeated sprint performance for team sport athletes in the heat. C_LIO_LIHead, neck & facial cooling could largely reduce local skin temperature and thereby improving local perceptual responses. C_LIO_LINeck cooling is preferred over the head, facial & combined head/facial & neck cooling for both endurance and team sport athletes. C_LIO_LIIts challenging to adopt facial or head cooling to cool athletes during exercise due to inherent issues of practicality. C_LI