Can Neck Cooling Improve Performance in Heat? The Evidence

A cold towel around your neck may help you train better in the heat—even if it barely changes your core body temperature. That is the counterintuitive conclusion from the best current synthesis: targeted cooling reliably makes people feel less hot and more comfortable, while its average effect on athletic performance remains possible rather than proven.

This matters because cooling culture often treats cold exposure as a simple plumbing problem: lower body temperature, perform better. Head, face, and neck cooling do not seem to work that way. They may instead change thermal perception enough to affect pacing, effort tolerance, and the willingness to keep pushing when the heat feels punishing.

That is useful, but it is not a license to call a wet towel an ergogenic miracle—or to claim it substitutes for hydration, acclimatization, sensible pacing, or medical care.

The main finding: cooler feelings, uncertain faster times

A 2025 systematic review and multilevel meta-analysis by Stevens et al. combined 63 controlled studies involving 618 participants; 86.6% were male. It included water-perfused devices, phase-change collars and headwear, fans, cold air, ice or gel packs, towels, menthol, and water spraying.

The review found a consistent local effect: cooling the head, face, or neck lowered local skin temperature and improved thermal sensation and thermal comfort. The pooled effects on core temperature, heart rate, and mean skin temperature were negligible. In other words, participants felt cooler, but the intervention did not meaningfully shift systemic thermoregulation on average.

The performance result needs more restraint. The pooled estimate for exercise performance, across self-paced and fixed-intensity protocols, was classified as inconclusive. Its 95% confidence interval ranged from a negligible effect to a medium benefit. It excluded harm, but it did not exclude no effect. A favorable point estimate is not the same as a confirmed population-level benefit.

That uncertainty has practical consequences. Some positive trials may reflect a real performance effect. Others may reflect expectancy effects, small samples, or publication bias, which the authors identified as a concern because null findings can be less likely to reach publication.

Head and neck cooling has strong evidence for making heat feel more tolerable. It has plausible, but unconfirmed, evidence for improving exercise performance.

Perception may be part of the mechanism

The mismatch between perception and physiology is the most interesting result. During hot exercise, how hot you feel can shape whether you back off, how you pace, and how sustainable a given effort seems. If neck cooling makes the session feel less oppressive, an athlete may hold a stronger pace without a meaningful drop in core temperature.

This is a reasonable interpretation of the pooled pattern, not proof of a single mechanism. The meta-analysis did not establish that altered perception caused any observed performance change. It did show that the perceptual effects were consistent while systemic measures were not.

That distinction also limits comparisons with cold plunges and full-body ice baths. Whole-body cooling targets a different physiological exposure. The available evidence does not include a direct meta-analytic comparison of targeted head, face, or neck cooling with cold-water immersion. Claims that one is better than the other would run ahead of the data.

Individual trials point in the same direction—but do not settle the question

Several randomized trials provide encouraging signals in hot conditions. In a counterbalanced crossover trial of 15 male amateur runners, Coelho et al. in 2021 found that head pre-cooling improved 5-km time-trial performance in the heat. That is a relevant, sport-specific result, but one small trial cannot determine the size of the typical effect across athletes and settings.

Yanaoka et al. in 2022 also reported improved cycling time-trial performance in the heat when participants used mixed-method cooling between exercise bouts. Because the protocol combined cooling methods, it cannot isolate the contribution of head or neck cooling itself.

Elite athletes may see less room for improvement. Fenemor et al. in 2024 reported small performance effects from a practical mixed strategy using ice towels and ice slurry in elite team-sport athletes. That result fits a sensible pattern: athletes who are highly trained and heat-adapted may gain less from an intervention that mainly changes thermal discomfort. It does not establish a precise gradient, but it argues against promising the same payoff to every athlete.

Do not sell this as a cognitive enhancer

The cognitive claim is thinner than the performance claim. Stevens et al. could not pool cognitive outcomes because the studies were too heterogeneous and too small to support a reliable combined estimate.

The most directly relevant experiment, Mazalan et al. in 2022, enrolled 10 non-heat-acclimatized men exercising at 70% VO₂max in the heat. Combining head cooling with ice ingestion improved cognitive performance during endurance exercise. The result is interesting, but it cannot tell us whether head cooling alone produced the effect; ice ingestion was part of the intervention. With only 10 participants, it also provides limited statistical weight.

For now, targeted cooling may help someone preserve comfort during hot exercise, and that could matter for attention or decision-making. It has not earned a general claim that it improves cognition at the gym, at a desk, or in ordinary temperatures.

Multiple sclerosis studies show why population and setting matter

Cooling can have larger effects in people with multiple sclerosis (MS), where heat sensitivity is a major clinical issue. Apostolou et al. in 2024 found that head and neck cooling enhanced exercise tolerance in people with MS. This is meaningful clinical evidence for that population, but it should not set expectations for healthy athletes.

A randomized crossover study by Dauksaite et al. in 2024 adds a useful complication. It tested head-neck cooling at an 18°C contact temperature during submaximal exercise under thermoneutral conditions in men with MS and healthy men. The study reported effects on central and peripheral fatigue, motor accuracy, and blood markers of stress. Effects persisting without ambient heat stress complicate a purely heat-dependent perceptual explanation.

There are at least two interpretations: targeted cooling may influence pathways beyond feeling hot, or the MS population's heightened thermosensitivity may sustain effects that healthy athletes would not experience to the same degree. The study cannot resolve that question by itself.

Task design may matter as well. In men with MS, Dauksaite et al. in 2025 found greater motor-performance benefits during unpredictable tasks than during constant, predictable tasks. That finding should stay in its lane: it was shown in MS patients, not healthy players or runners, and needs replication before it informs sport-specific training claims.

What to do with this evidence

If you train or compete in genuine heat, use a cold wet towel, ice pack, cooling cap, cold water on the face, or a neck collar before or during exercise when practical. The 2025 meta-analysis found no cooling modality statistically superior to another. A premium water-perfused device therefore has no demonstrated pooled advantage over a simple cold towel. Your wallet may remain at room temperature.

Set the right expectation: you are likely to feel cooler and more comfortable. You may perform better, especially if you are recreational, unacclimatized, or working in substantial heat, but the average performance effect remains inconclusive. Do not expect targeted cooling to meaningfully lower core temperature or replace hydration and heat-acclimatization practices.

In thermoneutral or cool settings, healthy-athlete evidence is too uncertain to justify buying equipment for performance or cognition. In heat, though, a cheap, portable cooling option is a reasonable experiment because the comfort benefit is well supported and the possible performance upside comes with little drama.