Journal of Thermal Biology 24 (1999) 391±396

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The e€ect of direct and indirect hand heating on ®nger

blood ¯ow and dexterity during cold exposure
Michel B. Ducharme*,1, Dragan Brajkovic1, John Frim1
Human Protection and Performance, Defence and Civil Institute of Environmental Medicine, Toronto, Canada, M3M 3B9

Abstract

1. The aim of this study was to investigate if ®nger temperature or ®nger blood ¯ow is the critical factor for main-
tenance of ®nger dexterity during cold exposure.
2. Subjects were exposed twice to ÿ258C air for 3 h by using a Torso Heating Test (THT) where the torso was
maintained to 428C with a heating vest while the hands were bare, and a Hand Heating Test (HHT) where the
hands were heated with heated gloves.
3. Despite similar ®nger temperatures, ®nger blood ¯ow was eight times lower and ®nger dexterity was decreased in
HHT as compared to THT.
4. It is concluded that ®nger blood ¯ow is the critical factor to maintain ®nger dexterity in the cold.
Crown Copyright # 2000 Published by Elsevier Science Ltd. All rights reserved.

Keywords: Finger dexterity; Finger temperature; Auxiliary heating; Cold exposure; Heating gloves; Torso heating; Comfort of
extremities

1. Introduction auxiliary heating of the hands will result in a signi®-

Maintaining hand dexterity and comfort is a chal-
lenge during exposure to cold, particularly when hand
work is involved. This condition may require removal
of protective mitts in favor of working with thin gloves
or even bare hands. This condition will result in rapid
cooling of the extremities, a lost of manual dexterity
and an increased risk of cold injury.
Auxiliary heating with electrically heated gloves has
been used in the past to maintain hand performance
without real success. Martini et al. (1994) showed that
* Corresponding author.
1
Works for the Department of National Defence.
cant elevation of the skin temperature of the hands to
258C during systemic exposure to cold, but failed to
show any improvement of ®nger dexterity when com-
pared to a condition without auxiliary heating where
the ®nger temperature was 138C. We hypothesized that
the reason for this lack of improvement in perform-
ance may be related to the failure of the auxiliary heat-
ing to elevate blood ¯ow to the hands, despite the
comfortable 258C ®nger skin temperature.
The purpose of this experiment was to compare the
e€ects of heating the hands directly with Electrically
Heated Gloves (EHGs) and heating the hands in-
directly to the same skin temperature by using an
Electrically Heated Vest (EHV), on ®nger blood ¯ow
and dexterity during cold exposure.

0306-4565/00/$ - see front matter Crown Copyright # 2000 Published by Elsevier Science Ltd. All rights reserved.
PII: S 0 3 0 6 - 4 5 6 5 ( 9 9 ) 0 0 0 4 6 - 7
392 M.B. Ducharme et al. / Journal of Thermal Biology 24 (1999) 391±396
2. Methods
Eight, healthy, non-smoking male volunteers with
the following mean2 SD characteristics were recruited:
age 32.82 7.4 years, height 176.4 2 6.3 cm, weight
82.4 2 7.5 kg, and body surface area 1.99 2 0.11. Body
surface area was calculated using the formula of
Dubois and Dubois (1916).
The eight subjects were exposed to one familiariz-
ation test (FT) and two treatment tests: a THT and an
HHT. The tests were done one week apart over a time
period spanning from January to July 1998. Subjects
were exposed to an ambient temperature of ÿ258C
with a wind speed <0.2 m sÿ1 for 3 h during all tests.
2.1. Torso Heating Test
During THT, the torso was heated using an EHV.
The mean heated torso skin temperature under the
- -
EHV (Ttorso) was maintained at 42 2 0.58C. A Ttorso of
42 2 0.58C was chosen because the objective was to
maximally vasodilate the skin without burning the
skin. It has been reported by Hardy (1972) that the
burn threshold for human skin is 458C. Therefore, it
-
was felt that a Ttorso of 428C would be safe, yet warm.
No gloves or Arctic mitts were worn during the entire
3-h exposure. Heavy insulation was worn over the
body which consisted of a three layer Canadian Forces
(CF) Arctic clothing ensemble. The CF Arctic clothing
ensemble consisted of a ¯eece garment (®rst layer), an
uninsulated inner parka and pants (second layer), and
an insulated outer parka and pants (third layer). Long,
cotton underwear was also worn under the ¯eece
pants. Standard CF mukluks, woollen socks, and bala-
clava were also worn. The total insulation of the CF
Arctic clothing ensemble (excluding the long, cotton
underwear) was 3.6 Clo (0.556 m2 k Wÿ1).
1
The EHV consisted of 10 Kapton ¯exible heaters
(Omega Engineering, Stanford, Connecticut, USA)
®xed around the torso and covering a total area of
0.266 m2. The heaters were not in direct contact with
the skin, but inside a ®re resistant pocket made of
1 1
Nomex fabric with Thinsulate insulation on the
outer surface of the heater. Once the heaters were
placed inside the pockets, the pockets were sewn
together to form a vest that covered a total area of
0.366 m2. A tight, short-sleeved lycra body suit which
extended down to the mid-thigh level was worn over
the EHV to optimize the contact between the skin and
the EHV. Preselected voltages were sent by ®ve cur-
rent-limiting power supplies (two model 6030A, 0 to
200 V/0 to 17 A, 1000 W; three model 6034A, 0 to
60 V/0 to 10 A, 200 W; Hewlett Packard) to the ®ve
-
pairs of heaters to achieve a Ttorso of 42 2 0.58C. The
power supplies were controlled by a computer which
allowed the user to input the desired heater power for
each pair of heaters in the EHV. To ensure that the
skin temperature under the heaters did not reach 458C
at any time, the computer turned o€ the heater com-
pletely if skin temperature reached 448C.
2.2. Hand Heating Test
During HHT, subjects wore the EHV, but it was not
powered. EHGs were worn along with Arctic mitts
during the 3 h exposure, except during the dexterity
tests when the hands were bare. The three layer CF
Arctic clothing ensemble was worn over the body. The
EHG heater power was adjusted manually so that the
-
mean ®nger skin temperature (T®ng) was the same as
-
the T®ng established during THT. The EHGs were con-
structed with heating wires covering the ®ngers and
back of the hands and knitted into a tight-®tting,
nylon glove (Rapier Missle Glove, Vacuum Re¯ex Ltd,
Su€olk, UK).
2.3. Finger dexterity tests performed during THT and
HHT
During the 3 h cold exposure, the subjects were
asked to perform either a ri¯e disassembly and assem-
bly test using a Canadian Forces C-7 ri¯e (C-7 test) or
the Purdue Pegboard test (PP test) every 30 min. The
C-7 test was done at time 0, 60, 120, and 180 min. The
PP test was done at time 30, 90, and 150 min. The C-7
and PP tests were also done outside the cold chamber
at an ambient temperature of 258C. The C-7 test pro-
vided an index of gross ®nger dexterity, whereas the
PP test measured ®ne ®nger dexterity.
The C-7 test was chosen because it was representa-
tive of the type of ®nger dexterity task that might be
performed by Canadian soldiers in the ®eld. The C-7
ri¯e consisted of 10 pieces, most of which were made
from metal. The subjects took on average 1 to 2 min
to complete the C-7 test outside the cold chamber.
The PP test is a ®nger dexterity test which has been
shown to be a reliable and valid measure of ®nger dex-
terity (Bass and Stucki, 1951). It consists of assembling
as many four-piece units (a small metal pin, collar and
two washers) into small holes in a 1 min period.
Subjects were asked to perform three trials of the 1 min
test with approximately a 20 to 30 s break between
each trial. An average PP score (in points) was
recorded for the three trials. During the completion of
the three trials, the hands were bare for 4 to 5 min.
Subjects were asked to practice the C-7 and PP tests
prior to entering the cold chamber. During the practice
sessions subjects wore the same upper body layers of
CF Arctic clothing they wore inside the cold chamber.
In addition, the balaclava and parka hood were worn
so that any possible restrictions in vision which
occurred in the cold chamber as a result of wearing
 M.B. Ducharme et al. / Journal of Thermal Biology 24 (1999) 391±396
the balaclava could be duplicated during the practice
session. The lower half of the CF Arctic ensemble was
not worn during the practice sessions because it was
hypothesized that any decrease in dexterity test per-
formance caused by restrictions in the Arctic clothing
would be limited to the clothing worn on the upper-
half of the body. The subjects practiced the ®nger dex-
terity tests until a plateau in performance was
observed. An average of the two best PP test scores
and two best C-7 test scores were recorded.
2.4. Familiarization Test
FT was done prior to THT or HHT. The purpose of
FT was four-fold. First, it allowed the subject to
become familiar with the equipment and the pro-
cedures that were used during THT and HHT. Second,
it provided an opportunity to establish the EHV heater
-
power values required to maintain Ttorso at 42 2 0.58C.
Third, it provided an opportunity to establish the ap-
proximate heater power required during the EHG
tests. Fourth, it gave the subjects an opportunity to
practice the dexterity tests in the cold. During the hea-
ter power titration test, the subjects were fully dressed
with all sensors, heaters and all three layers of the CF
Arctic clothing. During the ®rst 60 min in the cold
chamber, the hands were bare and the EHV was
turned on. From time 60 to 120 min, the EHV was
turned o€ and EHGs and Arctic mitts were worn. The
-
EHG heater power was gradually increased until T®ng
-
reached the same T®ng that was achieved during the
-
60 min of torso heating, at which point T®ng was main-
tained at this temperature by manually adjusting the
heater power.
2.5. Physiological variables measured during all tests
- -
T®ng was measured using a thermistor (YSI 44004
series; Yellow Springs Instruments, Yellow Springs,
Ohio, USA). The probe was placed on the `ring' ®nger
of each hand on the volar side of the tip of the ®nger.
- -
Measurements of T®ng were made ®ve times per minute
over the course of 3 h using a data acquisition system
(model 3497A data acquisition/control unit; Hewlett
Packard). An average value was printed out each min-
ute.
Finger blood ¯ow (Q _ ) was measured using a
fing
780 nm laser Doppler ¯owmeter probe (PF4001 Laser
Doppler Flowmeter, Perimed, Stockholm, Sweden). A
blood ¯ow probe was placed next to each ®nger tem-
perature thermistor. The unit of measurement used to
represent the skin blood ¯ow is the perfusion unit
(PU), a relative unit of blood ¯ow. A calibration stan-
dard is used to adjust the laser Doppler ¯owmeter
readings to coincide with the readings obtained with a
_
motility standard. Q fing was measured 15 times per
393
_
minute for 3 h and an average Q fing was taken every
minute.
2.6. Statistical analyses
A two-way ANOVA for repeated measures with
heating condition and time as the independent vari-
ables was used to compare conditions THT and HHT
- _ , PP score and
for the dependent measures T®ng, Q fing
C-7 ri¯e time. Results were considered statistically sig-
ni®cant at p R 0.05 (using the Greenhouse±Geisser
adjustment for repeated measures). If a signi®cant
`treatment  time' interaction existed, a contrast test
was performed every 5 min from t0 to t180 min to
determine the time at which a signi®cant di€erence
existed between THT and HHT.
3. Results
- _
The T®ng and Q fing data during THT and HHT were
presented for each min during the time period t0 to
t180 min. The C-7 ri¯e times were presented for times
t0, t60, t120, and t180 min and included the C-7 ri¯e
times outside the cold chamber (labeled `room' on the
graphs). The PP scores were presented for times t30,
t90, and t150 min and also included PP scores outside
the cold chamber. All data is presented as a
mean 2 SE for an n of 8.
3.1. Mean ®nger temperature
Fig. 1 shows that there was no signi®cant di€erence
-
in T®ng between THT and HHT from t0 to t180 min
between each dexterity test. This similarity in T®ng
should be observed because the objective of the proto-
-
col was to maintain the T®ng during HHT at the same
-
T®ng that resulted from heating the torso during THT.
During THT and HHT, T®ng remained stable at
31.2 2 1.28C and 31.02 1.18C, respectively, from t0 to
t180 min after the ®ngers rewarmed after each dexterity
test. During the THT C-7 tests from t0 to t180 min,
-
T®ng decreased to a value between 23 and 268C,
whereas during the THT PP tests from t0 to t180 min,
-
T®ng decreased to value between 26 and 308C. During
-
the HHT C-7 tests from t0 to t180 min, T®ng decreased
to a value between 18 and 268C, whereas during the
-
HHT PP tests from t0 to t180 min, T®ng decreased to
value between 15 and 188C. After completing the THT
dexterity tests, the ®ngers warmed up to a stable
-
T®ng r 298C within 0 to 7 min, whereas during the
HHT dexterity tests, the ®ngers warmed up to a stable
-
and comfortable T®ng r 298C within 4 to 9 min.
394 M.B. Ducharme et al. / Journal of Thermal Biology 24 (1999) 391±396

Fig. 1. Mean ®nger skin temperature during THT and HHT from t0 to t180 min (mean2SE for n = 8). There was no signi®cant
di€erence ( p > 0.05) between THT and HHT from t0 to t180 min between dexterity tests.

3.2. Mean ®nger blood ¯ow 3.4. Purdue Pegboard score

Fig. 2 shows that Q _

fing was signi®cantly higher
during THT from t17 to t180 when compared to HHT
during the same time period. During THT, Q _
fing
decreased from 2392 22 PU to 1852 29 PU from t5

to t180 min, whereas during HHT, Q_ fing decreased from
2022 19 PU to 24 2 9 PU from t5 to t180 min.
3.3. C-7 Ri¯e test time
Fig. 4 shows that there was no signi®cant di€erence
in the PP score between the practice sessions done out-
side the cold chamber at `room' temperature (258C)
and the PP test at t0 during THT and HHT. In ad-
dition, there was no signi®cant di€erence in the PP
score between THT and HHT at t30; however, the PP
scores at t90 and t150 were signi®cantly lower during
HHT when compared to THT.

Fig. 3 shows that there was no signi®cant di€erence

in C-7 test time between the practice sessions done out-
side the cold chamber at `room' temperature (258C)
and the C-7 test at t0 during THT and HHT. In ad-
dition, there was no signi®cant di€erence in C-7 test
time between THT and HHT from t0 to t120 min; how-
ever the C-7 test time at t180 was signi®cantly lower
during THT when compared to HHT.
4. Discussion
The results of the present study show that despite
maintaining ®nger temperature at the same comforta-
ble value of 318C during exposure to cold by using
two di€erent auxiliary heating approaches (see Fig. 1),
THT maintained a skin ®nger blood ¯ow (185 2 29


Fig. 2. Mean ®nger skin blood ¯ow during THT and HHT from t0 to t180 min (mean2SE for n = 8). Speci®es time of ®rst sig-
ni®cant di€erence ( p R 0.05) between THT and HHT.
 M.B. Ducharme et al. / Journal of Thermal Biology 24 (1999) 391±396 395


Fig. 3. C-7 ri¯e test time during THT and HHT from t0 to t180 min (mean2SE for n = 8). Speci®es signi®cant di€erence


Fig. 4. Purdue Pegboard score during THT and HHT from t30 to t150 min (mean2SE for n = 8). Speci®es signi®cant di€erence
( p R 0.05) between THT and HHT.

PU) nearly eight times larger than HHT (24 2 9 PU;
see Fig. 2). In a previous study, Ducharme et al.
(1995) and Brajkovic et al. (1998) showed that when
®nger temperature reached an uncomfortable value of
138C, the skin ®nger blood ¯ow was approximately 25
PU and the ®ngers were vasoconstricted. This level of
perfusion is virtually the same as in the present study
during the HHT auxiliary heating, which let us con-
cluded that HHT can maintain the skin temperature of
the ®ngers comfortable during cold exposure but is
keeping the ®ngers vasoconstricted. As opposed to
HHT, THT can maintain the ®ngers comfortable by
increasing the skin perfusion, probably through the
opening of the arterio-venous anastomosis.
Keeping the temperature of the hands and ®ngers
comfortable with the THT auxiliary heating allowed
the subjects to maintain their ®nger dexterity during
the full cold exposure period while their bare hands
were exposed to ÿ258C. In contrast, keeping the tem-
perature of the hands and ®ngers comfortable with the
HHT auxiliary heating induced a progressive and sig-
ni®cant decrement of the ®nger dexterity as re¯ected
by the two dexterity tests performed during the cold
exposure. These results support the observations of
Martini et al. (1994), which showed that despite an el-
evated skin temperature of the hands to 258C, direct
auxiliary heating failed to maintain ®nger dexterity
during systemic cold exposure.
Keeping the hands and ®ngers at a comfortable tem-
perature during exposure to cold is not sucient to
assure the maintenance of ®nger and manual dexterity.
It is required that the blood ¯ow to the hands and ®n-
gers be sucient for their proper function.
It is concluded that direct hand heating, while keep-
ing the ®nger comfortable, maintains ®nger vasocon-
striction and causes a decrease of ®nger dexterity. In
contrast, indirect hand heating using torso auxiliary
heating keeps comfortable temperature on the extremi-
396 M.B. Ducharme et al. / Journal of Thermal Biology 24 (1999) 391±396
ties, maintains a high level of blood perfusion and
keeps a constant ®nger dexterity during a 3-h cold ex-
posure at ÿ258C.
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