Medical Disclaimer

Absolute Contraindications

Do not begin cold showers or cold-water immersion if any of the following applies. Medical clearance is required before proceeding.

Cardiovascular

• Current chest pain, unexplained shortness of breath, fainting, or palpitations
• Known serious heart disease: recent heart attack, unstable angina, severe coronary artery disease, heart failure, cardiomyopathy, or severe valvular disease
• Known dangerous heart rhythm disorder or a history of serious arrhythmias
• Uncontrolled high blood pressure or recent hypertensive crisis

Respiratory

• Severe asthma or uncontrolled breathing disease, particularly where cold triggers symptoms

Neurological

• Epilepsy or seizure disorder that is not well controlled (risk of loss of consciousness in water)

Vascular & Circulatory

• Severe peripheral vascular disease with poor circulation
• Previous frostbite with ongoing tissue vulnerability
• History of cold urticaria, cold anaphylaxis, or severe cold-induced wheeze
• History of severe hypothermia, or inability to sense temperature correctly
• Severe Raynaud’s disease with tissue injury, ulceration, or severe attacks

Other Absolute Contraindications

• Pregnancy, unless specifically cleared by your clinician
• Any acute illness with fever, vomiting, diarrhoea, or suspected infection — wait until fully recovered

Relative Contraindications

Cold exposure may be possible for people in the following groups, but only after medical clearance and with strict, conservative limits. Do not proceed without professional guidance.

Cardiovascular

• Controlled high blood pressure or a history of hypertension
• Stable heart disease, including treated coronary artery disease
• History of stroke or transient ischaemic attack

Metabolic & Endocrine

• Diabetes, particularly with neuropathy, poor circulation, or a history of foot ulcers
• Thyroid disorders affecting heat production or temperature regulation
• Anaemia or blood disorders that reduce oxygen delivery
• Kidney disease, particularly where blood pressure is unstable
• Eating disorders, very low body weight, or unexplained weight loss

Respiratory

• Asthma or COPD that is controlled but sensitive to cold air or physical stress

Autonomic & Post-Viral

• Autonomic dysfunction, including POTS or significant orthostatic intolerance

Neurological

• Migraine triggered by cold exposure

Psychological & Trauma-Related

• History of panic attacks, severe anxiety, PTSD, or trauma responses triggered by stress or breath restriction

Other

• Current substance withdrawal or use of intoxicants

Medication Considerations

Cold exposure can interact with medication effects on heart rate, blood pressure, temperature regulation, alertness, and heart rhythm. If you take any regular medication, obtain medical clearance before beginning cold exposure.

• Beta-blockers. Can blunt heart rate response and reduce the body’s ability to respond to cold stress.
• Anti-arrhythmic drugs and QT-prolonging drugs. Cold stress can increase arrhythmia risk in susceptible individuals.
• Blood pressure medicines, diuretics, and vasodilators. Cold can alter blood pressure and increase the risk of fainting on exit from cold water.
• Sedatives, sleeping tablets, benzodiazepines, strong pain medicines. Drugs that reduce alertness or slow reaction time require careful consideration.
• Stimulants, including some ADHD medications and high-dose decongestants. Cold exposure already raises adrenaline; additional stimulant load requires care.
• Some antidepressants and antipsychotics. Certain medications can affect temperature regulation or QT interval.
• Some antihistamines. Sedating types can reduce alertness and may impair safe decision-making.
• Some antibiotics with QT risk. Seek clinical advice if taking antibiotics.
• Alcohol and recreational drugs. Do not combine with cold exposure under any circumstances.
• Paracetamol, ibuprofen, or other pain and fever medicines taken regularly. Speak to a clinician before beginning cold exposure. Do not undertake cold immersion when using these medicines to mask symptoms of illness.

Young People Under 18

Couch to Recovery™ is designed for adults. Use by anyone under the age of 18 is not the intended use case for this programme.

All three of the following must be in place before any session begins for anyone under 18:

• Written consent from a parent or legal guardian who has read the full safety guidance.
• Medical clearance from a qualified clinician who knows the young person’s full medical history.
• Adult supervision in the home, particularly during the first sessions and first two weeks.

The programme is not designed for, and is not generally recommended for, anyone under the age of 16. Self-directed use is not appropriate at this age. Where a young person under 18 participates, the parent or legal guardian accepts full responsibility for that decision, for ensuring medical clearance is obtained, and for supervising all sessions.

Pre-Start Screening Checklist

If you answer yes to any of the following, do not proceed without medical clearance.

• Do you have chest pain, palpitations, fainting, or unexplained breathlessness?
• Have you been diagnosed with heart disease, a heart rhythm problem, or uncontrolled high blood pressure?
• Do you have asthma, a seizure disorder, Raynaud’s disease, diabetes with neuropathy, or autonomic dysfunction?
• Are you pregnant?
• Are you currently unwell with fever, infection, vomiting, or diarrhoea?
• Do you take regular medication? If yes, have you obtained medical clearance?
• Are you under the age of 18? If yes, do you have parental consent, medical clearance, and adult supervision in place?

Before Every Session

• Use a non-slip mat and secure your footing before exposure.
• Use a grab rail or stable surface if needed, particularly in early sessions.
• Use a shower chair if you are severely fatigued or unsteady.
• Have someone nearby during your first week if possible.
• Never hold your breath during cold exposure.
• Stop immediately and step out if anything feels wrong.

Legal Disclaimer

The author, publisher, and Couch to Recovery™ programme accept no responsibility or liability for any adverse effects, injuries, or health complications arising from the use or misuse of information contained in this book, programme, or app.

By applying any techniques described, you acknowledge that:

• You do so entirely at your own risk
• You have consulted appropriate medical professionals where relevant
• You accept full responsibility for your choices
• You will not hold any party liable for outcomes

This material is provided for informational and educational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease or medical condition.

If in doubt, do not proceed.

Contact