Human adaptation to cold may occur through acclimatization or acclimation and includes genetic, physiologic, morphological or behavioural responses. It has been studied in indigenous populations, during polar or ski expeditions, sporting activities, military training, in urban people, or under controlled conditions involving exposures to cold air or water. Although divergent results exist between the studies, the main cold adaptation responses are either insulative (circulatory adjustments, increase of fat layer) or metabolic (shivering or nonshivering thermogenesis) and may be positive (enhanced) or negative (blunted). The pattern of cold adaptation is dependent on the type (air, water) and intensity (continuous, intermittent) of the cold exposure. In addition, several individual factors like age, sex, body composition, exercise, diet, fitness and health modify the responses to cold. Habituation of thermal sensations to cold develops first, followed by cardiovascular, metabolic and endocrinological responses. If the repeated cold stimulus is discontinued, adaptation will gradually disappear. The functional significance of physiological cold adaptation is unclear, and some of the responses can even be harmful and predispose to cold injuries. The article summarises recent research information concerning with the thermoregulatory responses related to repeated exposures to cold (air or water), and also discusses the determinants of cold adaptation, as well as its functional significance.