Cold stimulation and exercise are two independent stimulus variables, each yielding unique impacts on human health. However, in many cases, individuals often encounter both factors simultaneously, particularly in colder regions where outdoor physical activity is prevalent. Despite numerous studies exploring the effects of cold exposure and exercise independently, only a limited number of comprehensive reviews have evaluated their combined influence on health. This review aims to bridge this gap by meticulously examining the potential benefits and detriments of both cold stimulation and exercise on human health. Specifically, the review focuses on their impacts on cardiovascular, respiratory, and immune function, as well as the favorable effects of moderate exercise on the human body. While evidence suggests that cold exposure can enhance health outcomes in certain disease contexts, it also poses risks, particularly for vulnerable populations. Furthermore, while moderate exercise is generally beneficial, engaging in physical activity in cold weather conditions can increase the risk of hypothermia, frostbite, and other cold-related injuries. Consequently, there is an urgent need to develop safe and effective guidelines for exercising in cold weather, particularly for individuals living in colder regions. This review emphasizes the necessity for further research on the combined effects of cold stimulation and exercise, with the goal of informing public health policies and guidelines for physical activity in cold weather conditions.

  Background  Non-optimal temperatures contribute substantially to ischemic heart disease (IHD) risk; however, comparative trends and determinants of the dual burdens associated with heat and cold exposure remain poorly understood, especially in China. This study compared the temperature-attributable burden of IHD in China with global and Socio-Demographic Index (SDI)-stratified patterns from 1990 to 2021 to identify major disparities.  Methods  Using data from the Global Burden of Disease 2021 study, we analyzed trends in temperature-attributable IHD trends via decomposition analysis, Joinpoint regression, and age-period-cohort modeling. Future trends through 2031 were projected using a Bayesian model.  Results  Globally, the age-standardized mortality rate (ASMR) attributable to non-optimal temperatures declined by 30.09%, primarily driven by reductions in the low-temperature burden. However, these improvements were largely confined to high-SDI regions, while lower-SDI regions experienced stagnant or worsening trends. In contrast, China demonstrated a 15.65% increase in overall ASMR, driven by a dual burden characterized by a marked rise in heat-related ASMR (+64.15%) and a concurrent increase in cold-related ASMR (+12.18%). Decomposition analysis identified fundamentally different driving forces between global and Chinese trends. Globally, epidemiological improvements exerted a strong protective effect (-256.56%), whereas in China, these factors contributed to an increase in per-capita risk (+169.82%). Projections to 2031 suggest these disparities are likely to persist.  Conclusion  China is facing a compounding IHD crisis driven by the combined impacts of both heat and cold exposure, representing a risk profile that differs fundamentally from global patterns. These findings highlight the urgent need for a paradigm shift toward tailored, dual-target public health strategies capable of simultaneously mitigating the adverse cardiovascular effects of both temperature extremes in vulnerable populations.