By Kim Loeffler, MS

Staying physically active year-round remains a cornerstone of cardiopulmonary rehabilitation and long-term health. However, winter weather introduces added challenges for patients with heart and lung disease. The combination of cold outdoor air, increased infection exposure, and reduced physical activity creates a “perfect storm” for worsening respiratory symptoms. Many patients experience decreased exercise tolerance, increased fatigue, and heightened anxiety related to breathlessness during the winter. Reduced activity levels can lead to deconditioning, further impairing functional capacity and quality of life. Understanding how cold air affects the heart and lungs, recognizing potential risks, and implementing practical precautions are essential for safe participation during winter exercise.

How Cold Air Affects Your Heart and Lungs

Cold weather places additional stress on both the heart and lungs, even before exercise begins.  Cold air causes blood vessels to constrict in an effort to maintain core temperature, which increases blood pressure and cardiac workload.¹ For patients with ischemic heart disease, this added stress can reduce oxygen supply while increasing demand, raising the risk of chest discomfort, shortness of breath, or abnormal heart rhythms.^1,2

At the same time, cold, dry air stresses the respiratory system. The lungs must rapidly warm and humidify inhaled air, which can irritate the airway lining and trigger airway narrowing. This response may lead to coughing, wheezing, chest tightness, or shortness of breath, particularly in patients with asthma, chronic obstructive pulmonary disease (COPD), or other chronic lung conditions.³  Cold air also increases mucus thickness and slows the lungs’ natural clearance mechanisms, raising the risk of respiratory infections and exacerbations.

Risk of Cold Exposure

Cold-related symptoms can affect the heart and lungs in several common scenarios. Even a single bout of unprotected cold-weather activity can trigger acute symptoms such as chest pain and sudden shortness of breath, particularly in patients with limited cardiovascular or pulmonary reserve.^1,4  While some physiologic adaptation may occur with regular cold-weather exercise, repeated exposure without appropriate precautions can place cumulative stress on the heart and lungs. Over time, this may lead to more frequent respiratory symptoms, increased reliance on rescue medications, and longer recovery periods following activity.⁵

Importantly, these effects are not limited to exercise. Simply standing or sitting outdoors in cold conditions — such as watching a sporting event or waiting for transportation — can increase cardiac workload and provoke airway symptoms, especially in older adults and those with underlying cardiopulmonary disease.⁶

Understanding that both physical activity and sedentary cold exposure can place meaningful stress on the heart and lungs highlights the importance of preparation and proactive symptom management during the winter months.

Winter Exercise Precautions

Advanced planning is one of the most effective ways to reduce risk. Before exercising outdoors in winter, cardiopulmonary patients should be encouraged to:

• Check temperature, wind chill, and weather conditions
• Dress in layers that can be adjusted as body temperature changes
• Cover the mouth and nose with a scarf, gaiter, or mask to warm inhaled air
• Allow extra time for a gradual warm-up
• Take prescribed medications as directed
• Consider indoor exercise options during extreme cold or high winds
• Wear footwear with good traction to reduce fall risk on icy or uneven surfaces

Listening to Your Body

Paying attention to how the body feels is essential.^7,8 Symptoms should never be ignored or “pushed through” in cold conditions. Patients should stop activity immediately and seek warmth if they experience the following symptoms:

• Chest pain, pressure, or tightness
• New or worsening shortness of breath
• Wheezing or persistent coughing
• Dizziness or lightheadedness
• Palpitations or irregular heartbeat
• Unusual or excessive fatigue

What to Do If Symptoms Occur

Early recognition and prompt response can prevent more serious complications.^7,8 If symptoms develop during cold exposure or exercise, patients should:

1. Stop activity immediately and move to a warm environment.
2. Use prescribed rescue medications, if indicated.
3. Rest until symptoms are fully resolved.
4. Seek medical evaluation if symptoms are severe, persistent, or unusual.

Recurrent winter-related symptoms should signal the need to adjust exercise routines and implement additional cold-weather strategies.

Key Takeaways

Cold weather does not mean physical activity should stop. With education, preparation, and flexibility, cardiopulmonary rehabilitation patients can remain active throughout the winter months. Simple precautions — such as dressing appropriately, warming up gradually, protecting the airways, proper pacing, and choosing indoor options when conditions warrant — can significantly reduce risk while supporting long-term heart and lung health.

Kim Loeffler holds a master’s degree in clinical exercise physiology from Northeastern University and brings experience in research, cardiac rehabilitation, and pulmonary rehabilitation. She competed professionally as an Ironman triathlete for 11 years, combining elite-level athletic experience with clinical expertise. Her work focuses on helping patients improve and maintain heart and lung health through safe, effective exercise.

REFERENCES

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2. Houdas Y, Deklunder G, Lecroart JL. Cold exposure and ischemic heart disease. Int J Sports Med. 1992 Oct;13 Suppl 1:S179-81. doi: 10.1055/s-2007-1024632. PMID: 1483767.
3. Donaldson GC, et al. Effect of temperature on lung function and exacerbations in COPD. Thorax. 1999;54(4):302–307. doi: 10.1034/j.1399-3003.1999.13d25.x
4. Koskela HO. Cold air–provoked respiratory symptoms: the mechanisms and management. Int J Circumpolar Health. 2007;66(2):91–100. doi: 10.3402/ijch.v66i2.18237
5. Tseng CM, Chen YT, Ou SM, Hsiao YH, Li SY, Wang SJ, Yang AC, Chen TJ, Perng DW. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: a nationwide study. PLoS One. 2013;8(3):e57066. doi: 10.1371/journal.pone.0057066. Epub 2013 Mar 15. PMID: 23554858; PMCID: PMC3598847.
6. Eklund LM, Sköndal Å, Tufvesson E, Sjöström R, Söderström L, Hanstock HG, Sandström T, Stenfors N. Cold air exposure at - 15 °C induces more airway symptoms and epithelial stress during heavy exercise than rest without aggravated airway constriction. Eur J Appl Physiol. 2022 Dec;122(12):2533-2544. doi: 10.1007/s00421-022-05004-3. Epub 2022 Sep 2. PMID: 36053365; PMCID: PMC9613713.
7. AACVPR. Guidelines for Pulmonary Rehabilitation Programs. Latest edition. https://us.humankinetics.com/products/guidelines-for-pulmonary-rehabilitation-programs-5th-edition-with-web-resource
8. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 2022.