51
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Tyler CJ, Reeve T, Hodges GJ, Cheung SS. The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis. Sports Med 2016; 46:1699-1724. [DOI: 10.1007/s40279-016-0538-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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52
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Hoffman MD, Hew-Butler T, Roberts WO, Rogers IR, Rosner MH. Is Postevent Intravenous Hydration an Appropriate Service at Endurance Competitions? Wilderness Environ Med 2016; 27:7-9. [PMID: 26948551 DOI: 10.1016/j.wem.2015.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System and University of California Davis Medical Center, Sacramento, CA
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Ian R Rogers
- Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Perth, Western Australia, Australia
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System,Charlottesville, VA
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53
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Abstract
Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise–heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.
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54
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Walsh NP, Oliver SJ. Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Immunol Cell Biol 2015; 94:132-9. [PMID: 26563736 DOI: 10.1038/icb.2015.99] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Neil P Walsh
- Extremes Research Group, Bangor University Bangor UK
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55
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Lipman GS, Eifling KP, Ellis MA, Gaudio FG, Otten EM, Grissom CK. Wilderness Medical Society practice guidelines for the prevention and treatment of heat-related illness: 2014 update. Wilderness Environ Med 2015; 25:S55-65. [PMID: 25498263 DOI: 10.1016/j.wem.2014.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. We present a review of the classifications, pathophysiology, and evidence-based guidelines for planning and preventive measures as well as best practice recommendations for both field and hospital-based therapeutic management of heat illness. These recommendations are graded on the basis of the quality of supporting evidence, and balance between the benefits and risks or burdens for each modality. This is an updated version of the original WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness published in Wilderness & Environmental Medicine 2013;24(4):351-361.
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Affiliation(s)
- Grant S Lipman
- Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Lipman).
| | - Kurt P Eifling
- Division of Emergency Medicine, Barnes-Jewish Hospital/Washington University School of Medicine, Saint Louis, MO (Dr Eifling)
| | - Mark A Ellis
- Department of Emergency Medicine, Spartanburg Regional Healthcare System, Spartanburg, SC (Dr Eifling)
| | - Flavio G Gaudio
- Division of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY (Dr Gaudio)
| | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH (Dr Otten)
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT (Dr Grissom)
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56
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Racinais S, Alonso JM, Coutts AJ, Flouris AD, Girard O, González-Alonso J, Hausswirth C, Jay O, Lee JKW, Mitchell N, Nassis GP, Nybo L, Pluim BM, Roelands B, Sawka MN, Wingo J, Périard JD. Consensus recommendations on training and competing in the heat. Br J Sports Med 2015; 49:1164-73. [PMID: 26069301 PMCID: PMC4602249 DOI: 10.1136/bjsports-2015-094915] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/05/2022]
Abstract
Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events, for hydration and body cooling opportunities, when competitions are held in the heat.
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Affiliation(s)
- S Racinais
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - J M Alonso
- Sports Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Medical and Anti-doping Commission, International Association of Athletics Federations (IAAF), Montecarlo, Monaco
| | - A J Coutts
- Sport and Exercise Discipline Group, University of Technology Sydney (UTS), Australia
| | - A D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - O Girard
- Department of Physiology, Faculty of Biology and Medicine, ISSUL, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - J González-Alonso
- Department of Life Sciences, Centre for Sports Medicine and Human Performance, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - C Hausswirth
- Research Department, Laboratory of Sport, Expertise and Performance, French National Institute of Sport (INSEP), Paris, France
| | - O Jay
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - J K W Lee
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - N Mitchell
- British Cycling and 'Sky Pro Cycling', National Cycling Centre, Manchester, UK
| | - G P Nassis
- National Sports Medicine Programme, Excellence in Football Project, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - L Nybo
- Department of Nutrition, Exercise and Sport, Section of Human Physiology, University of Copenhagen, Copenhagen, Denmark
| | - B M Pluim
- Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amersfoort, The Netherlands
| | - B Roelands
- Department of Human Physiology, Vrije Universiteit Brussel, Brussels, Belgium
| | - M N Sawka
- School of Applied Physiology, College of Science, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - J Wingo
- Department of Kinesiology, University of Alabama, Tuscaloosa, USA
| | - J D Périard
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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57
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Cheung SS, McGarr GW, Mallette MM, Wallace PJ, Watson CL, Kim IM, Greenway MJ. Separate and combined effects of dehydration and thirst sensation on exercise performance in the heat. Scand J Med Sci Sports 2015; 25 Suppl 1:104-11. [DOI: 10.1111/sms.12343] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S. S. Cheung
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - G. W. McGarr
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - M. M. Mallette
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - P. J. Wallace
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - C. L. Watson
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - I. M. Kim
- Environmental Ergonomics Laboratory; Department of Kinesiology; Brock University; St. Catharines Canada
| | - M. J. Greenway
- Niagara Regional Campus; Michael G. DeGroote School of Medicine, McMaster University; Hamilton Canada
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58
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Racinais S, Alonso JM, Coutts AJ, Flouris AD, Girard O, González-Alonso J, Hausswirth C, Jay O, Lee JKW, Mitchell N, Nassis GP, Nybo L, Pluim BM, Roelands B, Sawka MN, Wingo JE, Périard JD. Consensus recommendations on training and competing in the heat. Scand J Med Sci Sports 2015; 25 Suppl 1:6-19. [DOI: 10.1111/sms.12467] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- S. Racinais
- Athlete Health and Performance Research Centre; Aspetar; Qatar Orthopaedic and Sports Medicine Hospital; Doha Qatar
| | - J. M. Alonso
- Sports Medicine Department; Aspetar Orthopaedic and Sports Medicine Hospital; Doha Qatar
- Medical and Anti-doping Commission; International Association of Athletics Federations (IAAF); Montecarlo Monaco
| | - A. J. Coutts
- Sport and Exercise Discipline Group; University of Technology Sydney (UTS); Lindfield New South Wales Australia
| | - A. D. Flouris
- FAME Laboratory; Department of Physical Education and Sport Science; University of Thessaly; Trikala Greece
| | - O. Girard
- ISSUL; Institute of Sport Sciences; Department of Physiology; Faculty of Biology and Medicine; University of Lausanne; Lausanne Switzerland
| | - J. González-Alonso
- Centre for Sports Medicine and Human Performance; Department of Life Sciences; College of Health and Life Sciences; Brunel University London; Uxbridge UK
| | - C. Hausswirth
- French National Institute of Sport (INSEP); Research Department; Laboratory of Sport, Expertise and Performance; Paris France
| | - O. Jay
- Discipline of Exercise and Sport Science; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
| | - J. K. W. Lee
- Defence Medical and Environmental Research Institute; DSO National Laboratories; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
- Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore
| | - N. Mitchell
- British Cycling and “Sky Pro Cycling”; National Cycling Centre; Manchester UK
| | - G. P. Nassis
- National Sports Medicine Programme; Excellence in Football Project; Aspetar; Qatar Orthopaedic and Sports Medicine Hospital; Doha Qatar
| | - L. Nybo
- Department of Nutrition, Exercise and Sport; Section of Human Physiology; University of Copenhagen; Copenhagen Denmark
| | - B. M. Pluim
- Medical Department; Royal Netherlands Lawn Tennis Association (KNLTB); Amersfoort The Netherlands
| | - B. Roelands
- Department of Human Physiology; Vrije Universiteit Brussel; Brussels Belgium
| | - M. N. Sawka
- School of Applied Physiology; College of Science; Georgia Institute of Technology; Atlanta Georgia USA
| | - J. E. Wingo
- Department of Kinesiology; University of Alabama; Tuscaloosa Alabama USA
| | - J. D. Périard
- Athlete Health and Performance Research Centre; Aspetar; Qatar Orthopaedic and Sports Medicine Hospital; Doha Qatar
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59
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Cotter JD, Thornton SN, Lee JK, Laursen PB. Are we being drowned in hydration advice? Thirsty for more? EXTREME PHYSIOLOGY & MEDICINE 2014; 3:18. [PMID: 25356197 PMCID: PMC4212586 DOI: 10.1186/2046-7648-3-18] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 12/29/2022]
Abstract
Hydration pertains simplistically to body water volume. Functionally, however, hydration is one aspect of fluid regulation that is far more complex, as it involves the homeostatic regulation of total body fluid volume, composition and distribution. Deliberate or pathological alteration of these regulated factors can be disabling or fatal, whereas they are impacted by exercise and by all environmental stressors (e.g. heat, immersion, gravity) both acutely and chronically. For example, dehydration during exercising and environmental heat stress reduces water volume more than electrolyte content, causing hyperosmotic hypohydration. If exercise continues for many hours with access to food and water, composition returns to normal but extracellular volume increases well above baseline (if exercising upright and at low altitude). Repeating bouts of exercise or heat stress does likewise. Dehydration due to physical activity or environmental heat is a routine fluid-regulatory stress. How to gauge such dehydration and - more importantly-what to do about it, are contested heavily within sports medicine and nutrition. Drinking to limit changes in body mass is commonly advocated (to maintain ≤2% reduction), rather than relying on behavioural cues (mainly thirst) because the latter has been deemed too insensitive. This review, as part of the series on moving in extreme environments, critiques the validity, problems and merits of externally versus autonomously controlled fluid-regulatory behaviours, both acutely and chronically. Our contention is that externally advocated hydration policies (especially based on change in body mass with exercise in healthy individuals) have limited merit and are extrapolated and imposed too widely upon society, at the expense of autonomy. More research is warranted to examine whether ad libitum versus avid drinking is beneficial, detrimental or neither in: acute settings; adapting for obligatory dehydration (e.g. elite endurance competition in the heat), and; development of chronic diseases that are associated with an extreme lack of environmental stress.
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Affiliation(s)
- James David Cotter
- Exercise and Environmental Physiology, School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Simon N Thornton
- Faculté de Médecine, Université de Lorraine, U 1116 -INSERM-UL, 9, Avenue de la forêt de Haye, CS50-184 - 54505 VANDŒUVRE, Les Nancy cedex, France
| | - Jason Kw Lee
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Paul B Laursen
- High Performance Sport New Zealand, Auckland, New Zealand ; Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
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60
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Lipman GS, Eifling KP, Ellis MA, Gaudio FG, Otten EM, Grissom CK. The Importance of Keeping Cool: Reply Regarding the Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Heat-Related Illness. Wilderness Environ Med 2014; 25:247-9. [DOI: 10.1016/j.wem.2014.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 01/23/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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61
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Garrett A, Goosens N, Rehrer N, Patterson M, Harrison J, Sammut I, Cotter J. Short-term heat acclimation is effective and may be enhanced rather than impaired by dehydration. Am J Hum Biol 2014; 26:311-20. [DOI: 10.1002/ajhb.22509] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- A.T. Garrett
- School of Physical Education; Sport and Exercise Sciences, University of Otago; Dunedin New Zealand
- Department of Sport; Health and Exercise Science, University of Hull; United Kingdom
| | - N.G. Goosens
- School of Physical Education; Sport and Exercise Sciences, University of Otago; Dunedin New Zealand
| | - N.J. Rehrer
- School of Physical Education; Sport and Exercise Sciences, University of Otago; Dunedin New Zealand
| | - M.J. Patterson
- Defence Science Technology Organisation (DSTO); Melbourne Australia
| | - J. Harrison
- School of Pharmacology and Toxicology; University of Otago; Dunedin New Zealand
| | - I. Sammut
- School of Pharmacology and Toxicology; University of Otago; Dunedin New Zealand
| | - J.D. Cotter
- School of Physical Education; Sport and Exercise Sciences, University of Otago; Dunedin New Zealand
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