Annals of Biomedical Engineering ( 2008)

DOI: 10.1007/s10439-008-9512-1

Exercise-Associated Thermographic Changes in Young

and Elderly Subjects
JOSÉ J. A. FERREIRA,1 LORENA C. S. MENDONÇA,1 LUIZ A. O. NUNES,2
ANTÔNIO C. C. ANDRADE FILHO,2 JOSÉ R. REBELATTO,1 and TANIA F. SALVINI1
1
Department of Physical Therapy, Federal University of São Carlos, Sao Carlos, SP, Brazil; and 2Physics Institute of São Carlos,
University of São Paulo, Sao Carlos, SP, Brazil
(Received 28 July 2007; accepted 30 April 2008)

Abstract—This study aimed at evaluating the thermographic to Kenny et al.,13 the tissue temperature at any given
changes associated with localized exercise in young and time is determined by the relative rate of heat pro-
elderly subjects. An exercise protocol using 1 kg load was duction and loss. Thus, the localized muscle tempera-
applied during 3 min to the knee flexors of 14 elderly
(67 ± 5 years) and 15 young (23 ± 2 years) healthy sub- ture at any given point is the result of metabolic rate
jects. The posterior thigh’s skin temperature of the exercised differences, heat exchange rate to the neighboring tis-
limb and contralateral limb were measured by infrared sue and by peripheral and deeper blood circulation.
thermography on pre-exercise, immediately post-exercise, Previous reports showed exercise-related tempera-
and during the 10-min period post-exercise. Difference ture changes in both muscle1,6,13,15,16,25 and skin19,23 by
(p < 0.01) between elderly and young subjects was observed
on pre-exercise temperature. Although differences were not direct measurements. This type of measure presumes
observed between pre-exercise and immediately post-exercise that heat production in the muscles occurs uniformly.
temperature in the exercised limb, thermographic profile However, the individually specific characteristics of
displayed heat concentration in exercised areas for both superficial vascularization and asymmetrical position-
groups. Temperature reduction was only observed for the ing of dilated veins may cause misinterpretations in the
young group on the 10-min post-exercise (p < 0.05) in the
exercised limb (30.7 ± 1.7 to 30.3 ± 1.5
C). In contrast, results when one uses contact sensors in the region of
there was a temperature reduction post-exercise (p < 0.01) in these veins.27 Then, temperature measured directly on
the contralateral limb for both groups. These results present the skin or muscle could induce to equivocal inter-
new evidences that elderly and young subjects display similar pretations due to the positioning of the sensors near
capacity of heat production; however, the elderly subjects neighboring warm blood vessels and also because
presented a lower resting temperature and slower heat
dissipation. This work contributes to improve the under- warming up does not occur in a uniform manner
standing about temperature changes in elderly subjects and throughout the entire muscle.14,27
may present implications to the sports and rehabilitation On the other hand, infrared thermography is a non-
programs. invasive procedure that registers the temperature dis-
tribution with a thermal camera that receives and
Keywords—Warm-up, Skin temperature, Infrared thermog- processes the infrared radiation emitted from the sur-
raphy, Aging. face of the body.27 This process has been widely used
to characterize temperature patterns of the body sur-
face in the diagnosis of several diseases, and it could
INTRODUCTION represent a valuable instrument for the analysis of
biological tissues and physiological researches con-
The blood supply for the muscles during the initial
cerning the study of production and dissipation of heat
part of exercise is accompanied by vasoconstriction in
during and after exercise.7,8,27 Infrared thermography
the skin while a vasodilator thermoregulatory response
overcomes limitations observed in other methods that
occurs when the body temperature rises, determining
require physical contact to measure the tempera-
the heat loss through the surface of skin.28 According
ture,27,28 and it could offer indirect hemodynamic
recruitment information of muscle masses during
the process of exercise-related thermal adjustment.17
Address correspondence to José J. A. Ferreira, Department of
The thermal changes that occurred in deep areas of the
Physical Therapy, Federal University of São Carlos, Sao Carlos, SP, body are transferred to the superficial tissue by the
Brazil. Electronic mail: jamacy@gmail.com blood circulation.8,27

 2008 Biomedical Engineering Society

 FERREIRA et al.

Few studies have examined the alterations of Temperature Measurements

thermographic patterns after exercise2,17,18,26–28 and
The subjects were instructed to eat 2 h before the
none of them assessed the possible thermographic
assessment and to refrain from drinking alcohol nor
profile changes associated to localized exercise in
practice any kind of vigorous physical exercise 24 h
elderly subjects. It is well known that aging is related to
prior to the evaluation. Also, they were recommended
muscle mass loss and metabolism reduction, which
not to apply hydrating lotion or any similar product on
limits heat production and thermoregulatory adjust-
the lower limbs.
ments.5,10,12 Although there are several studies about
The temperature of the posterior surface of the thighs
the effect of strength training and endurance in the
was assessed by means of the infrared (IR) thermogra-
elderly, possible differences in the thermogenic
phy procedure, according to the thermal image acqui-
response associated to localized exercises in young and
sition criteria described by Ring and Ammer.24 A
elderly subjects are still not clarified.
thermographic IR-camera was used operating near
The hypothesis of this study is that differences exist
5 lm region (spectral response = 3.5–6.5 lm). The
in the magnitude of the thermal response associated to
camera was designed as an optic-mechanical scanner
exercise between young and elderly subjects. Further-
with a single-element liquid nitrogen-cooled HgCdTe
more, the thermographic changes associated to the
sensor PV6-150 (Fermionics Opto-Technology-USA).
localized exercise were assessed by infrared thermog-
The optical system consists of line and frame scanning
raphy in both young and elderly subjects.
mirrors mounted in front of a lens which concentrates
radiation on the sensor. The motion of the frame and
line scanning mirrors is mutually synchronized to
MATERIAL AND METHODS ensure a high repeatability of geometry of the suc-
cessive frames. The camera allowed the capture of 20
Subjects
thermographic images/min with a spatial resolution
Twenty-nine volunteers were recruited (14 elderly of 5 mm and sensibility of 0.1
C (measuring range:
and 15 young subjects). The elderly group was com- 10–40
C; focusing range: 0.25 m to infinite; field of
posed of 12 women and 2 men [67 ± 5 years; view: 30
· 30
) under controlled conditions of tem-
158 ± 7.6 cm; 67.4 ± 7.9 kg; and 26.8 ± 2.5 kg/m2 perature (22–24
C) and air humidity (<50%). The
of body mass index (BMI)]. The young group was IR-camera is connected with any IBM-compatible
composed of 10 women and 5 men (23 ± 2 years; desktop computer by a homemade interface and
168 ± 10.5 cm; 63.3 ± 13 kg; and 22.1 ± 2.3 kg/m2 software.
of BMI). A difficulty was encountered when attempt- As regards to the calibration procedure, a black
ing to form paired groups as regards to BMI and body was created with controlled temperature and
gender due to the volunteers’ age level difference. precision of 0.02
C by means of a thermistor PT-100
However, an intragroup statistical analysis (indepen- (Telemeter Electronic, Donauworth, Germany). The
dent Student’s t-test) to subgroups with BMI differ- camera presented an automatic drift removing system
ence of 4 kg/m2 did not detect temperature significant (drift < 0.1
C) in accordance with the temperature
differences (p > 0.05). The inclusion criteria were as variation of the exam room. As the subject was
followed: subjects should be 60–80 years of age (elderly maintained in a steady orthostatic position during the
group) and 18–30 years of age (young group). All image acquisitions, a drift-shift effect correction was
subjects were considered active and healthy, and pre- not necessary. Both the camera and the respective
sented a medical statement confirming that their image processing software were developed by the São
physical health was appropriate to the physical activity Carlos Physics Institute of the University of São Paulo
level of the exercise protocol they would enrol. Sub- (USP), SP, Brazil.
jects were also classified as active by indicating their Regarding the application of the thermography,
involvement in light to moderate physical activities the subjects were dressed in shorts, which allowed the
with the duration of 1 h, three times per week, for at complete exposure of the posterior region of the
least 1 year. As exclusion criteria the following aspects lower limbs. Prior to starting the temperature
were considered for both groups: smokers; the pres- recordings, the subjects remained in the standing
ence of musculoskeletal disorders; prior surgery and position during 10 min in the examination room with
pain symptom in the lower limbs; cardiac and vascular the purpose of acclimatizing to the room temperature
detriment or any other disease that could alter body (thermalization).
temperature. This study was approved by the Univer- The camera was maintained at a distance of 2.34 m
sity Ethics Committee in accordance with Helsinki from the subject and at a height of 36 cm from the
Declaration for Human Research. floor. This camera distance and height allowed
 Thermography and Exercise

adequate capture of all subjects’ lower limbs, despite of thigh. This area was identified by visual inspection of
limb length differences. The first measurement was the image exhibited in the monitor screen in an equi-
performed after 10 min of thermalization, on the pre- distant position between the knee and superior limits of
exercise condition. Only then the subjects were sub- the thigh and between lateral and medial limits of the
mitted to the exercises. Dominant lower limb was thigh from each subject (Fig. 1c). It was decided not to
defined as the limb preferentially utilized to kick a ball. place any marker around the area of interest to avoid
All subjects were right-limb dominant and they were temperature shift by conduction or any other interfer-
then asked to perform the exercise with their right ence. Moreover, the utilization of the calculated tem-
lower limb. perature average upon the area in study minimizes
Six thermographic images were taken immediately positioning errors. The localization of the area and the
post-exercise with the subject and the camera posi- reading of the respective measures were performed by
tioned as previously described. The post-exercise two independent examiners presenting no significant
images were captured with an interval of 2 min differences (independent Student’s t-test, p > 0.05).
between them: the first one was obtained immedi-
ately post-exercise (0¢) and then 2, 4, 6, 8, and 10 min
Warm-Up Exercise
subsequently. Interval between measures was defined
in a prior pilot study where the minimum period The subjects were previously oriented about the
needed to detect post-exercise temperature changes exercise procedures. During the exercises, the subjects
was identified. were maintained in a standing position with their ver-
The temperature average was calculated with the tebral column aligned and the pelvis retroverted in
processing software utilizing a rectangular area order to rectify the lumbar lordosis. Two fixed lateral
(36 · 36 pixels) positioned in the center of the posterior supports were used to support the hands, providing

FIGURE 1. Posterior view of the limbs. Thermograms of a young subject (a, b, c, d). The right limb was the exercised one: (a) pre-
exercise; (b) (0¢) = immediately after exercise; (c) 2 min post-exercise; (d) 4 min post-exercise. Dashed lines demark the knee and
superior limit of the thigh; rectangle = area of the temperature measurement; R = right and L = left.
 FERREIRA et al.

weight bearing during one-leg body-weight stand. The with repeated measurements. When a significant F-value
warm-up exercise was performed by the right lower limb was observed, a post hoc Tukey/Kramer’s test was
and consisted of isotonic exercises of knee extension and applied to identify the differences. The independent
flexion with a 1 kg weight resistance placed just above Student’s t-test was utilized to analyze BMI and to
the ankle with a shin pad with Velcro straps. The sub- compare the inter-examiner temperature measures. The
jects were instructed to exercise continually during 1997 version of GB-Stat Pack School Software was used
3 min within their full range of motion of knee extension for all calculations and statistical analysis, and a 5%
and flexion. Exercises were performed at a rate of significance level (p < 0.05) was considered. To analyze
20 repetitions/min, timed with a digital metronome the variation of temperature in function of time, the dif-
(Quick Time QT-5, Quartz Metronome, China). The ference of temperature was calculated from each mea-
heart rate (HR) was monitored by a digital heart rate surement relative to the period immediately beforehand.
monitor (POLAR, model A1, Finland). The exercises
would be interrupted if the subject reported pain, cramp,
incapacity to complete the movements or if HR during RESULTS
exercise was greater than [HRrest + 0.5(HRreserve)],
where [HRrest = HR during rest, 0.5 corresponds to the Intensity of Exercise
percentage of 50%, and HRreserve = HRmax - HRrest, The exercise intensity was very low considering the
in which HRmax = 220 - age, with 220 being a percentage of HRreserve reached by the subjects after
constant].3,11 The interruption criterion was created to the exercise. Even so, the percentage of HRreserve
guarantee a low-intensity exercise and it was not utilized reached by the elderly (23.4 ± 10.3%) was greater
during the study once the subjects did not exceed (p < 0.01) than the percentage reached by the young
HRrest + 0.5(HRreserve). adults (14.8 ± 7.6%). However, as observed in
Table 1, the heart rate variation between the per-
Results Analysis formed measures during rest and by the end of the
exercise was similar to both groups (p > 0.05).
The results were tested for normality (Shapiro–Wilk
test) and homogeneity of the variances (Levene’s test).
ANOVA two-way was used to compare temperature Temperature Pre-Exercise
between exercised and contralateral limbs within each There was no difference in temperature between the
group for pre- and post-exercise. ANOVA three-way was right and left limbs for both elderly and young groups
used to compare the temperature of each limb of the before the exercise. However, the young subjects limb’s
elderly with that of the young subjects (inter-group) pre- temperature was higher compared to the elderly
and post-exercise (2 groups · 2 limbs · 2 conditions) subjects limbs (Table 2).

TABLE 1. Age (years), HR (bpm) pre- and post-exercise for elderly and young subjects.

Elderly Young

Subjects Age HR-pre HR-post Subjects Age HR-pre HR-post

1 65 70 79 1 25 79 104
2 70 75 88 2 24 99 107
3 70 88 110 3 20 86 102
4 68 93 110 4 23 82 98
5 62 82 93 5 23 77 98
6 72 74 107 6 23 85 86
7 67 77 89 7 18 84 90
8 64 87 103 8 22 77 110
9 61 74 79 9 24 90 100
10 66 110 124 10 26 77 94
11 61 87 102 11 22 85 116
12 60 71 97 12 24 84 99
13 71 86 102 13 25 80 107
14 78 74 90 14 24 74 88
15 27 82 97
Mean ± SD 66.8 ± 5.1 82 ± 10.9 98.1 ± 12.7 23.3 ± 2.2 82.7 ± 6.2 99.7 ± 8.3

HR-pre = heart rate pre-exercise; HR-post = heart rate post-exercise; bpm = beating per minute.
 Thermography and Exercise

TABLE 2. Pre- and post-exercise thigh temperature (
C) for elderly and young subjects.

Post-exercise

Limbs Pre-exercise 0¢ 2¢ 4¢ 6¢ 8¢ 10¢

Elderly (n = 14)
Exercised 28.9 ± 1.8* 28.9 ± 1.9** 29 ± 1.8** 29 ± 1.8** 28.9 ± 1.7** 28.9 ± 1.7** 28.8 ± 1.6**
contralateral 28.8 ± 1.8* 28.3 ± 1.9  28.2 ± 1.8  28.1 ± 1.7  28.0 ± 1.7  27.9 ± 1.7  27.8 ± 1.6 
Young (n = 15)
Exercised 30.4 ± 1.5* 30.7 ± 1.7** 30.8 ± 1.5** 30.6 ± 1.5** 30.5 ± 1.5** 30.5 ± 1.5** 30.3 ± 1.5à**
contralateral 30.5 ± 1.6* 30.0 ± 1.7  29.8 ± 1.6  29.7 ± 1.5  29.6 ± 1.5  29.5 ± 1.5  29.4 ± 1.4 

0¢, 2¢, 4¢, 6¢, 8¢, and 10¢ = min post-exercise, values are mean ± SD.
* Difference intergroups (p < 0.01).
** Difference interlimbs (p < 0.01).
  Difference intragroup compared to pre-exercise (p < 0.01).
à Difference intragroup compared to 0¢ (p < 0.05).

Temperature Post-Exercise the contralateral limbs of both groups, an intensive

negative temperature variation occurred immediately
Exercised Limb
post-exercise (0¢ min), which stabilized at the 2 min
There was no difference between the temperature post-exercise (Fig. 2b).
measurements of the exercised limb after exercise for
both elderly and young subjects when compared to the
pre-exercise temperature. However, post-exercise tem- DISCUSSION
perature was greater in the exercised limb (p < 0.01)
when compared to the contralateral limb for both This study presents new evidences that heat dissi-
groups (Table 2). Moreover, there was a similar pat- pation after localized exercise is slower in the elderly
tern of higher temperature concentration on the exer- compared to the young subjects. Our results showed
cised limbs after exercise (Fig. 1). It was interesting to that only the young subject group presented a
note that only the exercised limb of the young subjects decreased skin temperature in the exercised limb after
displayed a decreased (p < 0.05) temperature on the exercise. This finding is supported by the studies
10-min post-exercise period (Table 2). accomplished by Petrofsky et al.20 and Inbar et al.,10
where the authors verified a greater difficulty presented
Contralateral Limb by the elderly subjects in dissipate heat through the
skin. Such alterations were attributed to blood flow
The temperature of the contralateral limbs decreased
limitations9,20,22 associated to the skin microvessels’
(p < 0.01) for both young and elderly subjects compared
slower recruitment and filling process observed in
to pre-exercise levels (Table 2). The cooling of the con-
elderly subjects.21
tralateral limb can also be observed in the thermograms
Our results also indicate that infrared thermography
of young subjects (Fig. 1).
is capable of detecting different thermal responses
associated to localized low-intensity exercise. The
Temperature Variation
higher temperature concentration on the exercised area
The exercised limbs of elderly and young subjects is probably a consequence of the heat transfer from the
displayed temperature variation differences (Fig. 2). exercised muscles to the thigh skin. This data is in
The young subjects presented a positive temperature agreement with the results of other studies performed
variation in the exercised limb immediately post- with young subjects.1,26,27 In contrast, a decreased skin
exercise (0 min), which was followed by a negative temperature on the exercised limb followed by recov-
variation until the 4th min post-exercise, reaching a ery and stabilization period has been reported else-
relative stability after that. The exercised limb of the where.17,18,28 Zontak et al.28 suggested that increasing
elderly subjects also presented an initial positive vari- hemodynamic requirements, such as an exercise with
ation in the immediately post-exercise period (0¢ min); progressive load, presents a dominant skin vasocon-
however, the negative variation presented a longer strictor stimulus capable of suppressing the thermo-
delay (6 min), reaching a relative stability after that. regulation. However, the type and exercise load
Thus, the temperature variation in the exercised limb observed in these mentioned studies were fairly
seems to be smaller and slower in the elderly subjects different from the ones utilized in the study here
compared to the young group (Fig. 2a). As regards to presented.
 FERREIRA et al.

FIGURE 2. Temperature variation of young and elderly subjects after knee flexion exercise. (a) Exercised limb; (b) contralateral
limb. Each point in the graph is the temperature difference in relation to the instance immediately before. At instance 0, the
difference was calculated in relation to pre-exercise temperature.

On the other hand, the decreased temperature interesting to verify in the present study a similar
identified in the contralateral limb is possibly related to thermographic pattern in both young and elderly sub-
the mechanism described by Vainer, in which skin jects. Based on the experimental conditions used here, it
vasoconstriction allowed to address a larger blood flow indicates that heat production and hemodynamic
to the metabolically active muscle mass.27 It was recruitment mechanisms are not altered with aging
 Thermography and Exercise

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