Adaptations and mechanisms of human heat acclimation: Applications for competitive athletes and sports

Adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit

Background

While active heat acclimation strategies have been robustly explored, not many studies highlighted passive heat acclimation strategies. Particularly, little evidence demonstrated advantages of utilizing a water-perfused suit as a passive heating strategy. This study aimed to explore heat adaptive changes in physiological and perceptual responses during 10-day heat acclimation training using a water-perfused suit.

Methods

Nineteen young males were divided into three experimental groups: exercise condition (N = 6, HA_EXE, 1-h exercise at 6 km h⁻¹ followed by 1-h rest in a sitting position), exercise and passive heating condition (N = 6, HA_EXE+SUIT, 1-h exercise at 6 km h⁻¹ followed 1-h passive heating in a sitting position), and passive heating condition (N = 7, HA_SUIT, 2-h passive heating in a sitting position). All heating programs were conducted for 10 consecutive days in a climatic chamber maintained at 33 °C with 60% relative humidity. The passive heating was conducted using a newly developed water-perfused suit with 44 °C water.

Results

Greater whole-body sweat rate and alleviated perceptual strain were found in HA_SUIT and HA_EXE+SUIT after 5 and/or 10 days (P < 0.05) but not in the exercise-only condition (HA_EXE). Lower rectal temperature and heart rate were found in all conditions after the training (P < 0.05). Heat adaptive changes appeared earlier in HA_SUIT except for sweat responses.

Conclusions

For heat acclimation in hot humid environments, passive and post-exercise heat acclimation training using the suit (water inflow temperature 44 °C) were more effective than the mild exercise (1-h walking at 6 km h⁻¹). This form of passive heating (HA_SUIT) may be an especially effective strategy for the elderly and the disabled who are not able to exercise in hot environments.

Mouse Thermoregulation: Introducing the Concept of the Thermoneutral Point

Human and mouse thermal physiology differ due to dissimilar body sizes. Unexpectedly, in mice we found no ambient temperature zone where both metabolic rate and body temperature were constant. Body temperature began increasing once cold-induced thermogenesis was no longer required. This result reproduced in male, female, C57BL/6J, 129, chow-fed, diet-induced obese, and ob/ob mice as well as Trpv1-/-;Trpm8-/-;Trpa1-/- mice lacking thermal sensory channels. During the resting-light phase, the energy expenditure minimum spanned ∼4°C of ambient temperature, whereas in the active-dark phase it approximated a point. We propose the concept of a thermoneutral point (TNP), a discrete ambient temperature below which energy expenditure increases and above which body temperature increases. Humans do not have a TNP. As studied, the mouse TNP is ∼29°C in light phase and ∼33°C in dark phase. These observations inform how thermoneutrality is defined and how mice are used to model human energy physiology and drug development.

Novel Acclimatization and Acclimation Strategies for Hot Climates

Exercising in hot, humid temperatures increases the risk for heat-related illnesses, ranging from mild heat edema to severe heat stroke. With increasing globalization in the world of sports, athletes are sometimes expected to compete in unforgiving conditions that expose them to these risks. In an effort to improve exercise capacity and reduce the risk of serious heat injury, many athletes are recommended to undergo heat acclimatization program prior to competing in climates with elevated average temperature. This article will look at current recommendations as well as studies on differing techniques for acclimatization and acclimation, with hopes to provide guidance for the modern-day clinician and athletes.

Sex differences in the response to oxidative and proteolytic stress

Sex differences in diseases involving oxidative and proteolytic stress are common, including greater ischemic heart disease, Parkinson disease and stroke in men, and greater Alzheimer disease in women. Sex differences are also observed in stress response of cells and tissues, where female cells are generally more resistant to heat and oxidative stress-induced cell death. Studies implicate beneficial effects of estrogen, as well as cell-autonomous effects including superior mitochondrial function and increased expression of stress response genes in female cells relative to male cells. The p53 and forkhead box (FOX)-family genes, heat shock proteins (HSPs), and the apoptosis and autophagy pathways appear particularly important in mediating sex differences in stress response.

Regional differences in exertional heat illness rates among Georgia USA high school football players

Many high school associations in recent years are developing policies to improve player safety regarding exertional heat illnesses (EHIs). A question is whether states with diverse climates need multiple sets of guidelines with different activity modification thresholds. We examine this question in the state of Georgia, which has a diverse climate. Our study leverages a multi-year dataset of exertional heat illnesses (EHIs) among high school football players to test the hypothesis that EHI rates under similar wet bulb globe temperatures (WBGTs) will be greater among athletes in the cooler, northern region versus warmer, southern region of the state. The focus of this study is on a 3-year period (2012-2014) when uniform heat safety polices, including acclimatization and activity modification guidelines, were implemented across the state. Results show that athletes in the northern region acclimatize to cooler conditions. Almost 68% of practices have WBGTs < 27.8 °C (82 °F) compared to the southern region where athletes receive many times the exposures to hotter WBGTs in the 27.8-30.5 °C and 30.6-32.2 °C categories. In the post-acclimatization period, we observed statistically significantly (p < .05) greater EHI rates among athletes in the northern region of the state, even when controlling for meteorological conditions. Our findings suggest that differential acclimatization between football players in the northern and southern regions of the state is impacting EHI rates and that regional heat safety guidelines may be needed in Georgia and other states with similarly diverse climates.

A retrospective analysis to determine if exercise training-induced thermoregulatory adaptations are mediated by increased fitness or heat acclimation

NEW FINDINGS

What is the central question of this study? Are fitness-related improvements in thermoregulatory responses during uncompensable heat stress mediated by aerobic capacity V ̇ O 2 max or is it the partial heat acclimation associated with training? What is the main finding and its importance? During uncompensable heat stress, individuals with high and low V ̇ O 2 max displayed similar sweating and core temperature responses whereas exercise training in previously untrained individuals resulted in a greater sweat rate and a smaller rise in core temperature. These observations suggest that it is training, not V ̇ O 2 max per se, that mediates thermoregulatory improvements during uncompensable heat stress.

ABSTRACT

It remains unclear whether aerobic fitness, as defined by the maximum rate of oxygen consumption V ̇ O 2 max , independently improves heat dissipation in uncompensable environments, or whether the thermoregulatory adaptations associated with heat acclimation are due to repeated bouts of exercise-induced heat stress during regular aerobic training. The present analysis sought to determine if V ̇ O 2 max independently influences thermoregulatory sweating, maximum skin wettedness (ω_max ) and the change in rectal temperature (ΔT_re ) during 60 min of exercise in an uncompensable environment (37.0 ± 0.8°C, 4.0 ± 0.2 kPa, 64 ± 3% relative humidity) at a fixed rate of heat production per unit mass (6 W kg^-1 ). Retrospective analyses were performed on 22 participants (3 groups), aerobically unfit (UF; n = 7; V ̇ O 2 max : 41.7 ± 9.4 ml kg^-1  min^-1 ), aerobically fit (F; n = 7; V ̇ O 2 max : 55.6 ± 4.3 ml kg^-1  min^-1 ; P < 0.01) and aerobically unfit (n = 8) individuals, before (pre; V ̇ O 2 max : 45.8 ± 11.6 ml kg^-1  min^-1 ) and after (post; V ̇ O 2 max : 52.0 ± 11.1 ml kg^-1  min^-1 ; P < 0.001) an 8-week training intervention. ω_max was similar between UF (0.74 ± 0.09) and F (0.78 ± 0.08, P = 0.22). However, ω_max was greater post- (0.84 ± 0.08) compared to pre- (0.72 ± 0.06, P = 0.02) training. During exercise, mean local sweat rate (forearm and upper-back) was greater post- (1.24 ± 0.20 mg cm^-2  min^-1 ) compared to pre- (1.04 ± 0.25 mg cm^-2  min^-1 , P < 0.01) training, but similar between UF (0.94 ± 0.31 mg cm^-2  min^-1 , P = 0.90) and F (1.02 ± 0.30 mg cm^-2  min^-1 ). The ΔT_re at 60 min of exercise was greater pre- (1.13 ± 0.16°C, P < 0.01) compared to post- (0.96 ± 0.14°C) training, but similar between UF (0.85 ± 0.29°C, P = 0.22) and F (0.95 ± 0.22°C). Taken together, aerobic training, not V ̇ O 2 max per se, confers an increased ω_max , greater sweat rate, and smaller rise in core temperature during uncompensable heat stress in fit individuals.

Long Term Adaptation to Heat Stress: Shifts in the Minimum Mortality Temperature in the Netherlands

It is essentially unknown how humans adapt or will adapt to heat stress caused by climate change over a long-term interval. A possible indicator of adaptation may be the minimum mortality temperature (MMT), which is defined as the mean daily temperature at which the lowest mortality occurs. Another possible indicator may be the heat sensitivity, i.e., the percentage change in mortality per 1°C above the MMT threshold, or heat attributable fraction (AF), i.e., the percentage relative excess mortality above MMT. We estimated MMT and heat sensitivity/AF over a period of 23 years for older adults (≥65 years) in the Netherlands using three commonly used methods. These methods are segmented Poisson regression (SEG), constrained segmented distributed lag models (CSDL), and distributed lag non-linear models (DLNM). The mean ambient temperature increased by 0.03°C/year over the 23 year period. The calculated mean MMT over the 23-year period differed considerably between methods [16.4 ± 1.2°C (SE) (SEG), 18.9 ± 0.5°C (CSDL), and 15.3 ± 0.4°C DLNM]. MMT increased during the observed period according to CSDL (0.11 ± 0.05°C/year) and DLNM (0.15 ± 0.02°C/year), but not with SEG. The heat sensitivity, however, decreased for the latter method (0.06%/°C/year) and did not change for CSDL. Heat AF was calculated for the DLNM method and decreased with 0.07%/year. Based on these results we conclude that the susceptibility of humans to heat decreases over time, regardless which method was used, because human adaptation is shown by either an increase in MMT (CSDL and DLNM) or a decrease in heat sensitivity for unchanged MMT (SEG). Future studies should focus on what factors (e.g., physiological, behavioral, technological, or infrastructural adaptations) influence human adaptation the most, so it can be promoted through adaptation policies. Furthermore, future studies should keep in mind that the employed method influences the calculated MMT, which hampers comparability between studies.

Acute Kidney Injury Biomarker Responses to Short-Term Heat Acclimation

The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot (n = 12, 40 °C, 40% relative humidity) or mild (n = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90–120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL⁻¹ or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL⁻¹) and PostHA (0.39 ± 0.20 mg·dL⁻¹), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL⁻¹, 0.08 ± 0.06 mg·dL⁻¹, p ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA (n = 9, 75%), with fewer participants with CLINICAL PostHA (n = 7, 58%, p = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.

Per-Cooling (Using Cooling Systems during Physical Exercise) Enhances Physical and Cognitive Performances in Hot Environments. A Narrative Review

There are many important sport events that are organized in environments with a very hot ambient temperature (Summer Olympics, FIFA World Cup, Tour de France, etc.) and in hot locations (e.g., Qatar). Additionally, in the context of global warming and heat wave periods, athletes are often subjected to hot ambient temperatures. It is known that exercising in the heat induces disturbances that may provoke premature fatigue and negatively affects overall performance in both endurance and high intensity exercises. Deterioration in several cognitive functions may also occur, and individuals may be at risk for heat illnesses. To train, perform, work and recover and in a safe and effective way, cooling strategies have been proposed and have been routinely applied before, during and after exercise. However, there is a limited understanding of the influences of per-cooling on performance, and it is the subject of the present review. This work examines the influences of per-cooling of different areas of the body on performance in terms of intense short-term exercises ("anaerobic" exercises), endurance exercises ("aerobic" exercises), and cognitive functioning and provides detailed strategies that can be applied when individuals train and/or perform in high ambient temperatures.

High Thermoregulatory Strain During Competitive Paratriathlon Racing in the Heat

Purpose: Paratriathletes may display impairments in autonomic (sudomotor and/or vasomotor function) or behavioral (drinking and/or pacing of effort) thermoregulation. As such, this study aimed to describe the thermoregulatory profile of athletes competing in the heat. Methods: Core temperature (Tc) was recorded at 30-second intervals in 28 mixed-impairment paratriathletes during competition in a hot environment (air temperature = 33°C, relative humidity = 35%–41%, and water temperature = 25°C–27°C), via an ingestible temperature sensor (BodyCap e-Celsius). Furthermore, in a subset of 9 athletes, skin temperature was measured. Athletes’ wetsuit use was noted while heat illness symptoms were self-reported postrace. Results: In total, 22 athletes displayed a Tc ≥ 39.5°C with 8 athletes ≥40.0°C. There were increases across the average Tc for swim, bike, and run sections (P ≤ .016). There was no change in skin temperature during the race (P ≥ .086). Visually impaired athletes displayed a significantly greater Tc during the run section than athletes in a wheelchair (P ≤ .021). Athletes wearing a wetsuit (57% athletes) had a greater Tc when swimming (P ≤ .032), whereas those reporting heat illness symptoms (57% athletes) displayed a greater Tc at various time points (P ≤ .046). Conclusions: Paratriathletes face significant thermal strain during competition in the heat, as evidenced by high Tc, relative to previous research in able-bodied athletes and a high incidence of self-reported heat illness symptomatology. Differences in the Tc profile exist depending on athletes’ race category and wetsuit use.

The Influence of Heat Acclimation and Hypohydration on Post-Weight-Loss Exercise Performance

PURPOSE

To examine the influence of fluid intake on heat acclimation and the subsequent effects on exercise performance following acute hypohydration.

METHODS

Participants were randomly assigned to 1 of 2 groups, either able to consume water ad libitum (n = 10; age 23 [3] y, height 1.81 [0.09] m, body mass 87 [13] kg; HAW) or not allowed fluid (n = 10; age 26 [5] y, height 1.76 [0.05] m, body mass 79 [10] kg; HANW) throughout 12 × 1.5-h passive heat-acclimation sessions. Experimental trials were completed on 2 occasions before (2 baseline trials) and 1 following the heat-acclimation sessions. These sessions involved 3 h of passive heating (45°C, 38% relative humidity) to induce hypohydration followed by 3 h of ad libitum food and fluid intake after which participants performed a repeat sled-push test to assess physical performance. Urine and blood samples were collected before, immediately, and 3 h following hypohydration to assess hydration status. Mood was also assessed at the same time points.

RESULTS

No meaningful differences in physiological or performance variables were observed between HANW and HAW at any time point. Using pooled data, mean sprint speed was significantly (P < .001) faster following heat acclimation (4.6 [0.7] s compared with 5.1 [0.8] s). Furthermore, heat acclimation appeared to improve mood following hypohydration.

CONCLUSIONS

Results suggest that passive heat-acclimation protocols may be effective at improving short-duration repeat-effort performance following acute hypohydration.

Heat Acclimation Does Not Modify Q 10 and Thermal Cardiac Reactivity

Heat acclimation (HA) is an essential modifier of physiological strain when working or exercising in the heat. It is unknown whether HA influences the increase of energy expenditure (Q ₁₀ effect) or heart rate (thermal cardiac reactivity TCR) due to increased body temperature. Therefore, we studied these effects using a heat strain database of climatic chamber experiments performed by five semi-nude young males in either non-acclimated or acclimated state. Measured oxygen consumption rate (VO₂), heart rate (HR), and rectal temperature (T _re) averaged over the third hour of exposure were obtained from 273 trials in total. While workload (walking 4 km/h on level) was constant, heat stress conditions varied widely with air temperature 25-55°C, vapor pressure 0.5-5.3 kPa, and air velocity 0.3-2 m/s. HA was induced by repeated heat exposures over a minimum of 3 weeks. Non-acclimated experiments took place in wintertime with a maximum of two exposures per week. The influence of T _re and HA on VO₂ and HR was analyzed separately with mixed model ANCOVA. Rising T _re significantly (p < 0.01) increased both VO₂ (by about 7% per degree increase of T _re) and HR (by 39-41 bpm per degree T _re); neither slope nor intercept depended significantly on HA (p > 0.4). The effects of T _re in this study agree with former outcomes for VO₂ (7%/°C increase corresponding to Q ₁₀ = 2) and for HR (TCR of 33 bpm/°C in ISO 9886). Our results indicate that both relations are independent of HA with implications for heat stress assessment at workplaces and for modeling heat balance.

Heat acclimation-induced intracellular HSP70 in humans: a meta-analysis

Heat acclimation (HA) in humans promotes thermoregulatory adaptations that support management of core temperature in hot environments and reduces the likelihood of heat related illness. Another adaptation to HA is thermotolerance through induction of the heat shock protein (HSP) stress system, which provides protection against thermal insult. However, whether or not HA leads to upregulation of the intracellular HSP system, namely intracellular HSP70 (HSP70), is unclear in humans. Therefore, the purposes of this meta-analysis were to determine if HA leads to HSP70 induction among humans and to evaluate how methodological differences among HA studies influence findings regarding HA-induced HSP70 accumulation. Several databases were searched to identify studies that measured HSP70 (protein and mRNA) changes in response to HA among humans. The effect of HA on HSP70 was analyzed. Differences in the effect of HA were assessed between protein and mRNA. The moderating effect of several independent variables (HA frequency, HA duration, core temperature, exercise intensity) on HSP70 was also evaluated. Data were extracted from 12 studies including 118 participants (mean age 24 years, 98% male). There was a significant effect of HA on HSP70 expression, g = 0.97 (95% CI, 0.08-1.89). The effect of HA was different between subgroups (protein vs. mRNA), g = 1.51 (95% CI, 0.71-2.31), and g = - 0.39 (95% CI, - 1.36), respectively. The frequency of HA (in days) moderated HSP70 protein expression. There was a significant effect of heat acclimation on HSP70 induction in humans. The only factor among identified studies that may moderate this response was the frequency (number of days) of heat exposure.

Differing Physiological Adaptations Induced by Dry and Humid Short-Term Heat Acclimation

PURPOSE

To investigate the effect of a 5-day short-term heat acclimation (STHA) protocol in dry (43°C and 20% relative humidity) or humid (32°C and 80% relative humidity) environmental conditions on endurance cycling performance in temperate conditions (21°C).

METHODS

In a randomized, cross-over design, 11 cyclists completed each of the two 5-day blocks of STHA matched for heat index (44°C) and total exposure time (480 min), separated by 30 days. Pre- and post-STHA temperate endurance performance (4-min mean maximal power, lactate threshold 1 and 2) was assessed; in addition, a heat stress test was used to assess individual levels of heat adaptation.

RESULTS

Differences in endurance performance were unclear. Following dry STHA, gross mechanical efficiency was likely reduced (between-condition effect size dry vs humid -0.59; 90% confidence interval, -1.05 to -0.15), oxygen uptake was likely increased for a given workload (0.64 [0.14 to 1.07]), and energy expenditure likely increased (0.59 [0.17 to 1.03]). Plasma volume expansion at day 5 of acclimation was similar (within-condition outcome 4.6% [6.3%] and 5.3% [5.1%] dry and humid, respectively) but was retained for 3 to 4 days longer after the final humid STHA exposure (-0.2% [8.1%] and 4.5% [4.2%] dry and humid, respectively). Sweat rate was very likely increased during dry STHA (0.57 [0.25 to 0.89]) and possibly increased (0.18 [-0.15 to 0.50]) during humid STHA.

CONCLUSION

STHA induced divergent adaptations between dry and humid conditions, but did not result in differences in temperate endurance performance.

Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance

The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.

Performance Changes Following Heat Acclimation and the Factors That Influence These Changes: Meta-Analysis and Meta-Regression

Heat acclimation (HA) is the process of intentional and consistent exercise in the heat that results in positive physiological adaptations, which can improve exercise performance both in the heat and thermoneutral conditions. Previous research has indicated the many performance benefits of HA, however, a meta-analysis examining the magnitude of different types of performance improvement is absent. Additionally, there are several methodological discrepancies in the literature that could lead to increased variability in performance improvement following HA and no previous study has examined the impact of moderators on performance improvement following HA. Therefore, the aim of this study was two-fold; (1) to perform a meta-analysis to examine the magnitude of changes in performance following HA in maximal oxygen consumption (VO2max), time to exhaustion, time trial, mean power, and peak power tests; (2) to determine the impact of moderators on results of these performance tests. Thirty-five studies met the inclusion/exclusion criteria with 23 studies that assessed VO2max (n = 204), 24 studies that assessed time to exhaustion (n = 232), 10 studies that performed time trials (n = 101), 7 studies that assessed mean power (n = 67), and 10 papers that assessed peak power (n = 88). Data are reported as Hedge's g effect size (ES), and 95% confidence intervals (95% CI). Statistical significance was set to p < 0.05, a priori. The magnitude of change following HA was analyzed, with time to exhaustion demonstrating the largest performance enhancement (ES [95% CI], 0.86 [0.71, 1.01]), followed by time trial (0.49 [0.26, 0.71]), mean power (0.37 [0.05, 0.68]), VO2max (0.30 [0.07, 0.53]), and peak power (0.29 [0.09, 0.48]) (p < 0.05). When all of the covariates were analyzed as individual models, induction method, fitness level, heat index in time to exhaustion (coefficient [95% CI]; induction method, -0.69 [-1.01, -0.37], p < 0.001; fitness level, 0.04 [0.02, 0.06], p < 0.001; heat index, 0.04 [0.02, 0.07], p < 0.0001) and induction length in mean power (coefficient [95% CI]; induction length 0.15 [0.05, 0.25], p = 0.002) significantly impacted the magnitude of change. Sport scientists and researchers can use the findings from this meta-analysis to customize HA induction. For time to exhaustion improvements, HA implementation should focus on induction method and baseline fitness, while the training and recovery balance could lead to optimal time trial performance.

Health complaints and heat stress prevention strategies during taper as predictors of peaked athletic performance at the 2015 World Athletics Championship in hot conditions

OBJECTIVES

To investigate whether self-reported health complaints and choice of heat stress prevention strategies during the taper predicted peaking at an athletics championship in hot conditions.

DESIGN

Cohort study.

METHODS

Data on health and heat stress prevention were collected before the 2015 World Athletics Championship in Beijing, China. Peaking was defined using the athlete's pre-competition ranking and final competition rank. Baseline and endpoint data were fitted into multiple logic regression models.

RESULTS

Two hundred forty-five (29%) of 841 eligible athletes participated. Both sprint/power (Odds ratio (OR) 0.33 (95% Confidence interval (CI) 0.11 to 0.94), P=0.038) and endurance/combined events (OR 0.38 (95% CI 0.14 to 1.00), P=0.049) athletes having sustained concern-causing health complaints during the taper were less likely to peak. Endurance/combined events athletes who chose pre-cooling to mitigate heat stress were less likely to peak (OR 0.35 (95% CI 0.15 to 0.80), P=0.013), while sprint/power athletes reporting a sudden-onset injury complaint during the taper displayed increased peaking (OR 4.47 (95% CI 1.28 to 15.59), P=0.019).

CONCLUSIONS

Health complaints that caused the athlete concern during the taper were predictive of failure to peak at a major athletics competition. Sprint/power athletes who experienced an acute injury symptom during the taper appeared to benefit from rest. Pre-cooling strategies seem to require further validation during real-world endurance/combined events. It appears that athletics athletes' self-reported health should be monitored during the taper, concerns addressed, and heat stress prevention strategies individually tested before championships in hot conditions.

Short-term isothermic heat acclimation elicits beneficial adaptations but medium-term elicits a more complete adaptation

Purpose

To investigate the effects of 60 min daily, short-term (STHA) and medium-term (MTHA) isothermic heat acclimation (HA) on the physiological and perceptual responses to exercise heat stress.

Methods

Sixteen, ultra-endurance runners (female = 3) visited the laboratory on 13 occasions. A 45 min sub-maximal (40% W_max) cycling heat stress test (HST) was completed in the heat (40 °C, 50% relative humidity) on the first (HST_PRE), seventh (HST_STHA) and thirteenth (HST_MTHA) visit. Participants completed 5 consecutive days of a 60 min isothermic HA protocol (target T_re 38.5 °C) between HST_PRE and HST_STHA and 5 more between HST_STHA and HST_MTHA. Heart rate (HR), rectal (T_re), skin (T_sk) and mean body temperature (T_body), perceived exertion (RPE), thermal comfort (TC) and sensation (TS) were recorded every 5 min. During HSTs, cortisol was measured pre and post and expired air was collected at 15, 30 and 45 min.

Results

At rest, T_re and T_body were lower in HST_STHA and HST_MTHA compared to HST_PRE, but resting HR was not different between trials. Mean exercising T_re, T_sk, T_body, and HR were lower in both HST_STHA and HST_MTHA compared to HST_PRE. There were no differences between HST_STHA and HST_MTHA. Perceptual measurements were lowered by HA and further reduced during HST_MTHA.

Conclusion

A 60 min a day isothermic STHA was successful at reducing physiological and perceptual strain experienced when exercising in the heat; however, MTHA offered a more complete adaptation.

How Does a Delay Between Temperate Running Exercise and Hot-Water Immersion Alter the Acute Thermoregulatory Response and Heat-Load?

Hot-water immersion following exercise in a temperate environment can elicit heat acclimation in endurance-trained individuals. However, a delay between exercise cessation and immersion is likely a common occurrence in practice. Precisely how such a delay potentially alters hot-water immersion mediated acute physiological responses (e.g., total heat-load) remains unexplored. Such data would aid in optimizing prescription of post-exercise hot-water immersion in cool environments, relative to heat acclimation goals. Twelve male recreational runners (mean ± SD; age: 38 ± 13 years, height: 180 ± 7 cm, body mass: 81 ± 13.7 kg, body fat: 13.9 ± 3.5%) completed three separate 40-min treadmill runs (18°C), followed by either a 10 min (10M), 1 h (1H), or 8 h (8H) delay, prior to a 30-min hot-water immersion (39°C), with a randomized crossover design. Core and skin temperatures, heart rate, sweat, and perceptual responses were measured across the trials. Mean core temperature during immersion was significantly lower in 1H (37.39 ± 0.30°C) compared to 10M (37.83 ± 0.24°C; p = 0.0032) and 8H (37.74 ± 0.19°C; p = 0.0140). Mean skin temperature was significantly higher in 8H (32.70 ± 0.41°C) compared to 10M (31.93 ± 0.60°C; p = 0.0042) at the end of the hot-water immersion. Mean and maximal heart rates were also higher during immersion in 10M compared to 1H and 8H (p < 0.05), despite no significant differences in the sweat or perceptual responses. The shortest delay between exercise and immersion (10M) provoked the greatest heat-load during immersion. However, performing the hot-water immersion in the afternoon (8H), which coincided with peak circadian body temperature, provided a larger heat-load stimulus than the 1 h delay (1H).

Heat Stress Challenges in Marathon vs. Ultra-Endurance Running

Several studies have investigated the effect of hot and humid ambient conditions on running exercise up to the marathon. However, studies on exercise longer than marathon are sparse. Events exceeding 6 h can be defined as ultra-endurance and have variable characteristics (e.g., distance, elevation profile, technical difficulty, altitude, night running) making hazardous the transposition of the current knowledge obtained in marathon to ultra-endurance running. Thus, the aim of this manuscript was to discuss the potential differences between marathon and ultra-endurance running in terms of heat stress challenges. The high running intensity (especially for the fastest runners), the urban context with high albedo effect materials, and the hot self-generated microclimate in mass-participation events (especially for the average to slow runners) are specific risk factors associated with marathon running in hot environments. Uphill running/walking (sometimes with poles), exotic destination with long-haul travel, desert environment and the necessity to sustain thermoregulatory and sweating responses for several days are risk factors more specific to ultra-endurance running. These differences call for specific research on the effect of hot ambient conditions in ultra-endurance disciplines to create appropriate recommendations.

Effect of Thirst-Driven Fluid Intake on 1 H Cycling Time-Trial Performance in Trained Endurance Athletes

A meta-analysis demonstrated that programmed fluid intake (PFI) aimed at fully replacing sweat losses during a 1 h high-intensity cycling exercise impairs performance compared with no fluid intake (NFI). It was reported that thirst-driven fluid intake (TDFI) may optimize cycling performance, compared with when fluid is consumed more than thirst dictates. However, how TDFI, compared with PFI and NFI, impacts performance during a 1 h cycling time-trial performance remains unknown. The aim of this study was to compare the effect of NFI, TDFI and PFI on 1 h cycling time-trial performance. Using a randomized, crossover and counterbalanced protocol, 9 (7 males and 2 females) trained endurance athletes (30 ± 9 years; Peak V · O₂∶ 59 ± 8 mL·kg^-1·min^-1) completed three 1 h cycling time-trials (30 °C, 50% RH) with either NFI, TDFI or PFI designed to maintain body mass (BM) at ~0.5% of pre-exercise BM. Body mass loss reached 2.9 ± 0.4, 2.2 ± 0.3 and 0.6 ± 0.2% with NFI, TDFI and PFI, respectively. Heart rate, rectal and mean skin temperatures and ratings of perceived exertion and of abdominal discomfort diverged marginally among trials. Mean distance completed (NFI: 35.6 ± 1.9 km; TDFI: 35.8 ± 2.0; PFI: 35.7 ± 2.0) and, hence, average power output maintained during the time-trials did not significantly differ among trials, and the impact of both PFI and TDFI vs. NFI was deemed trivial or unclear. These findings indicate that neither PFI nor TDFI are likely to offer any advantage over NFI during a 1 h cycling time-trial.

Heat alleviation strategies for athletic performance: A review and practitioner guidelines

International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature.

The Use of Technology to Protect the Health of Athletes During Sporting Competitions in the Heat

During the 2019 IAAF World Championships in Athletics in Doha and the 2020 Olympic Games in Tokyo, minimum daily temperatures are expected to be in excess of 30°C. Due to the metabolic demands of the sporting events and the high environmental temperatures, the risk of exertional heat stroke (EHS) is high. Careful planning by event organizers are needed to ensure that athletes are protected from irreversible long-term health damage, or even death during sporting competitions in the heat. Efforts typically have included standard medical plans, equipment, protocols, and expert medical teams. In addition, the importance of responding quickly to a hyperthermic athlete cannot be understated, as minimizing treatment time will greatly improve the chances of full recovery. Treatment time can be minimized by notifying medical personnel about the health status of the athlete and the extent of any pre-competition heat acclimatization. Technology that allows the live transmission of physiological, biomechanical, and performance data to alert medical personnel of potential indicators of EHS should be considered. Real time monitoring ecosystems need to be developed that integrate information from numerous sensors such as core temperature-monitoring “pills” to relay information on how an athlete is coping with competing in intense heat. Medical/support staff would be alerted if an athlete's responses were indicating signs of heat stress or EHS signs and the athlete could be withdrawn under exceptional circumstances. This technology can also help provide more rapid, accurate and dignified temperature assessment at the road/track side in medical emergencies.

Translating Science Into Practice: The Perspective of the Doha 2019 IAAF World Championships in the Heat

Hot and humid ambient conditions may play a major role during the endurance events of the 2019 IAAF world championships, the 2020 summer Olympics and many other sports events. Here, various countermeasures with scientific evidence are put in perspective of their practical application. This manuscript is not a comprehensive review, but rather a set of applied recommendations built upon sound scientific reasoning and experience with elite athletes. The primary recommendation for an athlete who will be competing in the heat, will be to train in the heat. This acclimatization phase should last for 2 weeks and be programmed to accommodate the taper and travel requirements. Despite extensive laboratory-based research, hydration strategies within athletics are generally dictated by the race characteristics. The main opportunities for hydration are during the preparation and recovery phases. In competition, depending on thirst, feeling, and energy requirements, water may be ingested or poured. The athletes should also adapt their warm-up routines to the environmental conditions, as it may do more harm than good. Avoiding harm includes limiting unnecessary heat exposure before the event, warming-up with cooling aids such as ice-vest or cold/iced drinks, and avoiding clothing or accessories limiting sweat evaporation. From a medical perspective, exertional heat stroke should be considered immediately when an athlete collapses or struggles during exercise in the heat with central nervous system disorders. Once a rectal temperature >40.5°C is confirmed, cooling (via cold water immersion) should be undertaken as soon as possible (cool first/transport second).

Mixed Active and Passive, Heart Rate-Controlled Heat Acclimation Is Effective for Paralympic and Able-Bodied Triathletes

Purpose: The aims of this study are to explore the effectiveness of mixed active and passive heat acclimation (HA), controlling the relative intensity of exercise by heart rate (HR) in paratriathletes (PARA), and to determine the adaptation differences to able-bodied (AB) triathletes.

Methods: Seven elite paratriathletes and 13 AB triathletes undertook an 8-day HA intervention consisting of five HR-controlled sessions and three passive heat exposures (35°C, 63% relative humidity). On the first and last days of HA, heat stress tests were conducted, whereby thermoregulatory changes were recorded during at a fixed, submaximal workload. The AB group undertook 20 km cycling time trials pre- and post-HA with performance compared to an AB, non-acclimated control group.

Results: During the heat stress test, HA lowered core temperature (PARA: 0.27 ± 0.32°C; AB: 0.28 ± 0.34°C), blood lactate concentration (PARA: 0.23 ± 0.15 mmol l⁻¹; AB: 0.38 ± 0.31 mmol l⁻¹) with concomitant plasma volume expansion (PARA: 12.7 ± 10.6%; AB: 6.2 ± 7.7%; p ≤ 0.047). In the AB group, a lower skin temperature (0.19 ± 0.44°C) and HR (5 ± 6 bpm) with a greater sweat rate (0.17 ± 0.25 L h⁻¹) were evident post-HA (p ≤ 0.045), but this was not present for the PARA group (p ≥ 0.177). The AB group improved their performance by an extent greater than the smallest worthwhile change based on the normal variation present with no HA (4.5 vs. 3.7%).

Conclusions: Paratriathletes are capable of displaying partial HA, albeit not to same extent as AB triathletes. The HA protocol was effective at stimulating thermoregulatory adaptations with performance changes noted in AB triathletes.

Heat-induced hypervolemia: Does the mode of acclimation matter and what are the implications for performance at Tokyo 2020?

Tokyo 2020 will likely be the most heat stressful Olympics to date, so preparation to mitigate the effects of humid heat will be essential for performance in several of the 33 sports. One key consideration is heat acclimation (HA); the repeated exposure to heat to elicit physiological and psychophysical adaptations that improve tolerance and exercise performance in the heat. Heat can be imposed in various ways, including exercise in the heat, hot water immersion, or passive exposure to hot air (e.g., sauna). The physical requirements of each sport will determine the impact that the heat has on performance, and the adaptations required from HA to mitigate these effects. This review focuses on one key adaptation, plasma volume expansion (PVE), and how the mode of HA may affect the kinetics of adaptation. PVE constitutes a primary HA-mediated adaptation and contributes to functional adaptations (e.g., lower heart rate and increased heat loss capacity), which may be particularly important in athletes of "sub-elite" cardiorespiratory fitness (e.g., team sports), alongside athletes of prolonged endurance events. This review: i) highlights the ability of exercise in the heat, hot-water immersion, and passive hot air to expand PV, providing the first quantitative assessment of the efficacy of different heating modes; ii) discusses how this may apply to athletes at Tokyo 2020; and iii) provides recommendations regarding the protocol of HA and the prospect for achieving PVE (and the related outcomes).

Dietary reference values for chloride

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) has derived dietary reference values (DRVs) for chloride. There are no appropriate biomarkers of chloride status, no balance studies and no adequate evidence on the relationship between chloride intake and health outcomes that can be used to set DRVs for chloride. There is a close relationship between sodium and chloride balances in the body. Sodium chloride is the main source of both electrolytes in European diets and similar urinary excretion levels of sodium and chloride (on a molar basis) are typically observed in Western populations. Hence, the Panel considered that reference values for chloride can be set at values equimolar to the reference values for sodium for all population groups, and are as follows: 1.7 g/day for children aged 1-3 years, 2.0 g/day for children aged 4-6 years, 2.6 g/day for children aged 7-10 years, 3.1 g/day for children aged 11-17 years and 3.1 g/day for adults including pregnant and lactating women. Consistent with the reference values for sodium, these levels of chloride intake are considered to be safe and adequate for the general EU population, under the consideration that the main dietary source of chloride intake is sodium chloride. For infants aged 7-11 months, an adequate intake of 0.3 g/day is set.

Post-exercise Hot Water Immersion Elicits Heat Acclimation Adaptations That Are Retained for at Least Two Weeks

Heat acclimation by post-exercise hot water immersion (HWI) on six consecutive days reduces thermal strain and improves exercise performance during heat stress. However, the retention of adaptations by this method remains unknown. Typically, adaptations to short-term, exercise-heat-acclimation (<7 heat exposures) decay rapidly and are lost within 2 weeks. Short-term protocols should therefore be completed within 2 weeks of relocating to the heat; potentially compromising pre-competition/deployment training. To establish whether adaptations from post-exercise HWI are retained for up to 2 weeks, participants completed a 40-min treadmill run at 65% _max in the heat (33°C, 40% RH) before (PRE) and 24 h after (POST) the HWI intervention (n = 13) and then at 1 week (WK 1) and 2 weeks (WK 2) after the HWI intervention (n = 9). Heat acclimation involved a 40-min treadmill run (65% _max) on six consecutive days in temperate conditions (20°C), followed by ≤40 min HWI (40°C). Post-exercise HWI induced heat acclimation adaptations that were retained for at least 2 weeks, evidenced by reductions from PRE to WK 2 in: resting rectal core temperature (T _re, -0.36 ± 0.25°C), T _re at sweating onset (-0.26 ± 0.24°C), and end-exercise T _re (-0.36 ± 0.37°C). Furthermore, mean skin temperature (T _sk) (-0.77 ± 0.70°C), heart rate (-14 ± 10 beats⋅min^-1), rating of perceived exertion (-1 ± 2), and thermal sensation (-1 ± 1) were reduced from PRE to WK 2 (P < 0.05). However, PRE to POST changes in total hemoglobin mass, blood volume, plasma volume, the drive for sweating onset, sweating sensitivity and whole body sweating rate did not reach significance (P > 0.05). As such, the reduction in thermal strain during exercise-heat stress appears likely due to the reduction in resting T _re evident at POST, WK 1, and WK 2. In summary, 6 days of post-exercise HWI is an effective, practical and accessible heat acclimation strategy that induces adaptations, which are retained for at least 2 weeks. Therefore, post-exercise HWI can be completed during an athlete's pre-taper phase and does not suffer from the same practical limitations as short-term, exercise-heat-acclimation.

Post-exercise Hot Water Immersion Elicits Heat Acclimation Adaptations That Are Retained for at Least Two Weeks

Heat acclimation by post-exercise hot water immersion (HWI) on six consecutive days reduces thermal strain and improves exercise performance during heat stress. However, the retention of adaptations by this method remains unknown. Typically, adaptations to short-term, exercise-heat-acclimation (<7 heat exposures) decay rapidly and are lost within 2 weeks. Short-term protocols should therefore be completed within 2 weeks of relocating to the heat; potentially compromising pre-competition/deployment training. To establish whether adaptations from post-exercise HWI are retained for up to 2 weeks, participants completed a 40-min treadmill run at 65% _max in the heat (33°C, 40% RH) before (PRE) and 24 h after (POST) the HWI intervention (n = 13) and then at 1 week (WK 1) and 2 weeks (WK 2) after the HWI intervention (n = 9). Heat acclimation involved a 40-min treadmill run (65% _max) on six consecutive days in temperate conditions (20°C), followed by ≤40 min HWI (40°C). Post-exercise HWI induced heat acclimation adaptations that were retained for at least 2 weeks, evidenced by reductions from PRE to WK 2 in: resting rectal core temperature (T _re, -0.36 ± 0.25°C), T _re at sweating onset (-0.26 ± 0.24°C), and end-exercise T _re (-0.36 ± 0.37°C). Furthermore, mean skin temperature (T _sk) (-0.77 ± 0.70°C), heart rate (-14 ± 10 beats⋅min^-1), rating of perceived exertion (-1 ± 2), and thermal sensation (-1 ± 1) were reduced from PRE to WK 2 (P < 0.05). However, PRE to POST changes in total hemoglobin mass, blood volume, plasma volume, the drive for sweating onset, sweating sensitivity and whole body sweating rate did not reach significance (P > 0.05). As such, the reduction in thermal strain during exercise-heat stress appears likely due to the reduction in resting T _re evident at POST, WK 1, and WK 2. In summary, 6 days of post-exercise HWI is an effective, practical and accessible heat acclimation strategy that induces adaptations, which are retained for at least 2 weeks. Therefore, post-exercise HWI can be completed during an athlete's pre-taper phase and does not suffer from the same practical limitations as short-term, exercise-heat-acclimation.

Post-exercise Hot Water Immersion Elicits Heat Acclimation Adaptations That Are Retained for at Least Two Weeks

Heat acclimation by post-exercise hot water immersion (HWI) on six consecutive days reduces thermal strain and improves exercise performance during heat stress. However, the retention of adaptations by this method remains unknown. Typically, adaptations to short-term, exercise-heat-acclimation (<7 heat exposures) decay rapidly and are lost within 2 weeks. Short-term protocols should therefore be completed within 2 weeks of relocating to the heat; potentially compromising pre-competition/deployment training. To establish whether adaptations from post-exercise HWI are retained for up to 2 weeks, participants completed a 40-min treadmill run at 65% _max in the heat (33°C, 40% RH) before (PRE) and 24 h after (POST) the HWI intervention (n = 13) and then at 1 week (WK 1) and 2 weeks (WK 2) after the HWI intervention (n = 9). Heat acclimation involved a 40-min treadmill run (65% _max) on six consecutive days in temperate conditions (20°C), followed by ≤40 min HWI (40°C). Post-exercise HWI induced heat acclimation adaptations that were retained for at least 2 weeks, evidenced by reductions from PRE to WK 2 in: resting rectal core temperature (T _re, -0.36 ± 0.25°C), T _re at sweating onset (-0.26 ± 0.24°C), and end-exercise T _re (-0.36 ± 0.37°C). Furthermore, mean skin temperature (T _sk) (-0.77 ± 0.70°C), heart rate (-14 ± 10 beats⋅min^-1), rating of perceived exertion (-1 ± 2), and thermal sensation (-1 ± 1) were reduced from PRE to WK 2 (P < 0.05). However, PRE to POST changes in total hemoglobin mass, blood volume, plasma volume, the drive for sweating onset, sweating sensitivity and whole body sweating rate did not reach significance (P > 0.05). As such, the reduction in thermal strain during exercise-heat stress appears likely due to the reduction in resting T _re evident at POST, WK 1, and WK 2. In summary, 6 days of post-exercise HWI is an effective, practical and accessible heat acclimation strategy that induces adaptations, which are retained for at least 2 weeks. Therefore, post-exercise HWI can be completed during an athlete's pre-taper phase and does not suffer from the same practical limitations as short-term, exercise-heat-acclimation.

Thermoregulatory adaptations with progressive heat acclimation are predominantly evident in uncompensable, but not compensable, conditions

This study assessed whether, notwithstanding lower resting absolute core temperatures, alterations in time-dependent changes in thermoregulatory responses following partial and complete heat acclimation (HA) are only evident during uncompensable heat stress. Eight untrained individuals underwent 8 wk of aerobic training (i.e., partial HA) followed by 6 days of HA in 38°C/65% relative humidity (RH) (i.e., complete HA). On separate days, esophageal temperature (T_es), arm (LSR_arm), and back (LSR_back) sweat rate, and whole body sweat rate (WBSR) were measured during a 45-min compensable (37°C/30% RH) and 60-min uncompensable (37°C/60% RH) heat stress trial pre-training (PRE-TRN), post-training (POST-TRN), and post-heat acclimation (POST-HA). For compensable heat stress trials, resting T_es was lower POST-TRN (36.74 ± 0.27°C, P = 0.05) and POST-HA (36.60 ± 0.27°C, P = 0.001) compared with PRE-TRN (36.99 ± 0.19°C); however, ΔT_es was similar in all trials (PRE-TRN:0.40 ± 0.23°C; POST-TRN:0.42 ± 0.20°C; POST-HA:0.43 ± 0.12°C, P = 0.97). While LSR_back was unaltered by HA (P = 0.94), end-exercise LSR_arm was higher POST-TRN (0.70 ± 0.14 mg·cm^-2·min^-1, P < 0.001) and POST-HA (0.75 ± 0.16 mg·cm^-2·min^-1, P < 0.001) compared with PRE-TRN (0.61 ± 0.15 mg·cm^-2·min^-1). Despite matched evaporative heat balance requirements, steady-state WBSR (31st-45th min) was greater POST-TRN (12.7 ± 1.0 g/min, P = 0.02) and POST-HA (12.9 ± 0.8 g/min, P = 0.004), compared with PRE-TRN (11.7 ± 0.9 g/min). For uncompensable heat stress trials, resting T_es was lower POST-TRN (36.77 ± 0.22°C, P = 0.05) and POST-HA (36.62 ± 0.15°C, P = 0.03) compared with PRE-TRN (36.86 ± 0.24°C). But ΔT_es was smaller POST-TRN (0.77 ± 0.19°C, P = 0.05) and POST-HA (0.75 ± 0.15°C, P = 0.04) compared with PRE-TRN (1.10 ± 0.32°C). LSR_back and LSR_arm increased with HA (P < 0.007), supporting the greater WBSR with HA (POST-TRN:14.4 ± 2.4 g/min, P < 0.001; POST-HA:16.8 ± 2.8 g/min, P < 0.001) compared with PRE-TRN (12.7 ± 3.2 g/min). In conclusion, the thermal benefits of HA are primarily evident when conditions challenge the physiological capacity to dissipate heat.NEW & NOTEWORTHY We demonstrate that neither partial nor complete heat acclimation alters the change in core temperature during compensable heat stress compared with an unacclimated state, despite a marginally greater whole body sweat rate. However, the greater local and whole body sweat rate with partial and complete heat acclimation reduced the rise in core temperature during 60 min of uncompensable heat stress compared with an unacclimated state, suggesting the improvements in heat dissipation associated with heat acclimation are best observed when the upper physiological limits for evaporative heat loss are challenged.

The Dynamic and Correlation of Skin Temperature and Cardiorespiratory Fitness in Male Endurance Runners

During endurance exercise, skin temperature (Tsk) plays a fundamental role in thermoregulatory processes. Environmental temperature is the biggest determinant of the Tsk. During exercise, the response of the skin temperature might be influenced by aerobic fitness (VO_2peak). The aim of this study was to analyze and compare the dynamic of Tsk in high (HF) and moderately (MF) fit endurance runners during a progressive maximal stress test. Seventy-nine male endurance runners were classified into HF (n = 35; VO_2peak = 56.62 ± 4.31 mL/kg/min) and MF (n = 44; VO_2peak = 47.86 ± 5.29 mL/kg/min) groups. Tsk and cardiovascular data were continuously monitored during an incremental exercise, followed by a recovery period of five minutes. Results revealed that the MF group exhibited lower VO_2peak, Speed_peak, ventilation (VE), muscle mass %, and higher BMI and fat mass % than the HF group (all p < 0.001). HF had significantly higher Tsk at baseline, and at 60% and 70% of peak workload (all p < 0.05). Tsk_peak correlated with age, fat mass %, muscle mass %, VO_2peak, Speed_peak, HR and VE (all p < 0.05). These findings indicate that VO_2peak was positively associated with increased Tsk during incremental exercise in male endurance runners.

Health Risks and Interventions in Exertional Heat Stress

BACKGROUND

With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses.

METHODS

A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included.

RESULTS

Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes.

CONCLUSION

Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.

Diversity and evolution of human eccrine sweat gland density

The human eccrine sweat gland is central to the evolution of the human genus, permitting an enormous thermoregulatory sweating capacity that was essential to the human niche of high physical activity in open, hot, semi-arid environments. Despite a century of research inventorying the structure and function of eccrine glands and the physiological responses of human heat acclimation, we do not have a clear understanding of how intraspecific differences in eccrine density affect thermoregulation. Similarly, existing data does not comprehensively catalogue modern human diversity in this trait, nor do we understand the relative influences of evolutionary forces and phenotypic plasticity in shaping this diversity.

Wireless measurement of rectal temperature during exercise: Comparing an ingestible thermometric telemetric pill used as a suppository against a conventional rectal probe

Wireless measurement of rectal temperature during exercise may circumvent some limitations associated with the use of a conventional wired probe. We determined, for the first time, whether temperatures provided in vivo by wireless ingestible thermometric telemetric pills and a rectal probe compare favorably under conditions producing slow and rapid increases and decreases in rectal temperature. While wearing a rectal probe linked to a wireless ingestible thermometric telemetric pill, 13 participants completed the following phases: 1) 30 min sitting; 2) 45 min passive heat exposure (40-42 °C); 3) 45 min sitting while ingesting 7.5 g of ice slurry · kg body mass^-1; 4) running exercise (38 °C) at 68% V˙O_2max until a 39.5 °C increase in rectal probe temperature and; 5) cold-water (10 °C) immersion until a 1.5 °C decrease in rectal probe temperature. Acceptable differences between devices were taken as ≤ 0.3 °C. Mean differences within phases were all < 0.3 °C, whereas 95% limits of agreement ranged from ±0.2 °C to ±0.4 °C, coefficient of variations from ±0.3% to ±0.6% and typical error of measurements from ±0.1 °C to ±0.2°. Of the 14881 rectal temperature values measured over the experiment with the wireless ingestible thermometric telemetric pills and rectal probe, 91% of the differences between devices were found to be ≤ 0.3 °C. Results suggest that rectal temperatures provided by a wireless ingestible thermometric telemetric pill used as a suppository agree with those of a conventional wired probe. Hence, rectal temperature can reliably be measured using a wireless ingestible thermometric telemetric pill as a suppository.

Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020

International sporting competitions, including the Paralympic Games, are increasingly being held in hot and/or humid environmental conditions. Thus, a greater emphasis is being placed on preparing athletes for the potentially challenging environmental conditions of the host cities, such as the upcoming Games in Tokyo in 2020. However, evidence-based practices are limited for the impairment groups that are eligible to compete in Paralympic sport. This review aims to provide an overview of heat-related issues for Paralympic athletes alongside current recommendations to reduce thermal strain and technological advancements in the lead up to the Tokyo 2020 Paralympic Games. When competing in challenging environmental conditions, a number of factors may contribute to an athlete's predisposition to heightened thermal strain. These include the characteristics of the sport itself (type, intensity, duration, modality, and environmental conditions), the complexity and severity of the impairment and classification of the athlete. For heat vulnerable Paralympic athletes, strategies such as the implementation of cooling methods and heat acclimation can be used to combat the increase in heat strain. At an organizational level, regulations and specific heat policies should be considered for several Paralympic sports. Both the utilization of individual strategies and specific heat health policies should be employed to ensure that Paralympics athletes' health and sporting performance are not negatively affected during the competition in the heat at the Tokyo 2020 Paralympic Games.

The Effect of a Resistance Training Session on Physiological and Thermoregulatory Measures of Sub-maximal Running Performance in the Heat in Heat-Acclimatized Men

BACKGROUND

The current study examined the acute effects of a lower body resistance training (RT) session on physiological and thermoregulatory measures during a sub-maximal running protocol in the heat in heat-acclimatized men. Ten resistance-untrained men (age 27.4 ± 4.1 years; height 1.78 ± 0.06 m; body mass 76.8 ± 9.9 kg; peak oxygen uptake 48.2 ± 7.0 mL kg^-1 min^-1) undertook a high-intensity RT session at six-repetition maximum. Indirect muscle damage markers (i.e., creatine kinase [CK], delayed-onset muscle soreness [DOMS], and countermovement jump [CMJ]) were collected prior to, immediately post and 24 and 48 h after the RT session. The sub-maximal running protocol was performed at 70% of the ventilatory threshold, which was conducted prior to and 24 and 48 h following the RT session to obtain physiological and thermoregulatory measures.

RESULTS

The RT session exhibited significant increases in DOMS (p < 0.05; effect size [ES]: 1.41-10.53), whilst reduced CMJ (p < 0.05; ES: - 0.79-1.41) for 48 h post-exercise. There were no differences in CK (p > 0.05), although increased with moderate to large ES (0.71-1.12) for 48 h post-exercise. The physiological cost of running was increased for up to 48 h post-exercise (p < 0.05) with moderate to large ES (0.50-0.84), although no differences were shown in thermoregulatory measures (p > 0.05) with small ES (0.33).

CONCLUSION

These results demonstrate that a RT session impairs sub-maximal running performance for several days post-exercise, although thermoregulatory measures are unperturbed despite elevated muscle damage indicators in heat-acclimatized, resistance untrained men. Accordingly, whilst a RT session may not increase susceptibility to heat-related injuries in heat-acclimatized men during sub-maximal running in the heat, endurance sessions should be undertaken with caution for at least 48 h post-exercise following the initial RT session in resistance untrained men.

Performance and cardiac evaluation before and after a 3-week training camp for 400-meter sprinters - An observational, non-randomized study

Objective

To study the performance and cardiovascular function after a 3-week training camp in athletes competing in an anaerobically dominant sport.

Methods

Twenty-three competitive 400-m athletes were enrolled in this non-randomized study, 17 took part in a 3-week training camp in South-Africa (intervention), but one declined follow-up assessment, while 6 pursued in-door winter training in Sweden and served as controls. Electrocardiography, transthoracic echocardiography, blood test analyses, maximal exercise tolerance test, and a 300-m sprint test with lactate measurements ([La]peak) were performed before and after the training camp period.

Results

At baseline, there were no clinically significant pathological findings in any measurements. The training period resulted in improved 300m-sprint performance [n = 16; running time 36.71 (1.39) vs. 35.98 (1.13) s; p<0.01] and higher peak lactate values. Despite 48% more training sessions than performed on home ground (n = 6), myocardial biomarkers decreased significantly (NT-pro BNP -38%; p<0.05, troponin T -16%; p<0.05). Furthermore, resting heart rate (-7%; p<0.01) and left ventricular systolic and diastolic volumes decreased -6% (p<0.01) and -10% (p<0.05), respectively.

Conclusions

Intense physical activity at training camp improved the performance level, likely due to improved anaerobic capacity indicated by higher [La]peak. There were no clinically significant adverse cardiac changes after this period of predominantly anaerobic training.

Nine-, but Not Four-Days Heat Acclimation Improves Self-Paced Endurance Performance in Females

Although emerging as a cost and time efficient way to prepare for competition in the heat, recent evidence indicates that "short-term" heat acclimation (<7 days) may not be sufficient for females to adapt to repeated heat stress. Furthermore, self-paced performance following either short-term, or longer (>7 days) heat acclimation has not been examined in a female cohort. Therefore, the aim of this study was to investigate self-paced endurance performance in hot conditions following 4- and 9-days of a high-intensity isothermic heat acclimation protocol in a female cohort. Eight female endurance athletes (mean ± SD, age 27 ± 5 years, mass 61 ± 5 kg, VO2peak 47 ± 6 ml⋅kg⋅min-1) performed 15-min self-paced cycling time trials in hot conditions (35°C, 30%RH) before (HTT1), and after 4-days (HTT2), and 9-days (HTT3) isothermic heat acclimation (HA, with power output manipulated to increase and maintain rectal temperature (T rec) at ∼38.5°C for 90-min cycling in 40°C, 30%RH) with permissive dehydration. There were no significant changes in distance cycled (p = 0.47), mean power output (p = 0.55) or cycling speed (p = 0.44) following 4-days HA (i.e., from HTT1 to HTT2). Distance cycled (+3.2%, p = 0.01; +1.8%, p = 0.04), mean power output (+8.1%, p = 0.01; +4.8%, p = 0.05) and cycling speed (+3.0%, p = 0.01; +1.6%, p = 0.05) were significantly greater in HTT3 than in HTT1 and HTT2, respectively. There was an increase in the number of active sweat glands per cm2 in HTT3 as compared to HTT1 (+32%; p = 0.02) and HTT2 (+22%; p < 0.01), whereas thermal sensation immediately before HTT3 decreased ("Slightly Warm," p = 0.03) compared to ratings taken before HTT1 ("Warm") in 35°C, 30%RH. Four-days HA was insufficient to improve performance in the heat in females as observed following 9-days HA.

Ambient Conditions Prior to Tokyo 2020 Olympic and Paralympic Games: Considerations for Acclimation or Acclimatization Strategies

The Tokyo Olympics and Paralympic games in 2020 will be held in hot and humid conditions. Heat acclimation (in a climatic chamber) or heat acclimatization (natural environment) is essential to prepare the (endurance) athletes and reduce the performance loss associated with work in the heat. Based on the 1990-2018 hourly meteorological data of Tokyo and the derived wet bulb globe temperature (WBGT) (Liljegren method), Heat Index and Humidex, it is shown that the circumstances prior to the games are likely not sufficiently hot to fully adapt to the heat. For instance, the WBGT 2 weeks prior to the games at the hottest moment of the day (13:00 h) is 26.4 ± 2.9°C and 28.6 ± 2.8°C during the games. These values include correction for global warming. The daily variation in thermal strain indices during the Tokyo Olympics (WBGT varying by 4°C between the early morning and the early afternoon) implies that the time of day of the event has a considerable impact on heat strain. The Paralympics heat strain is about 1.5°C WBGT lower than the Olympics, but may still impose considerable heat strain since the Paralympic athletes often have a reduced ability to thermoregulate. It is therefore recommended to acclimate about 1 month prior to the Olympics under controlled conditions set to the worst-case Tokyo climate and re-acclimatize in Japan or surroundings just prior to the Olympics.

Exertional Heat Stroke within Secondary School Athletics

Exertional heat stroke (EHS) remains one of the leading causes of sudden death in sport despite clear evidence showing 100% survivability with the proper standards of care in place and utilized. Of particular concern are student athletes competing at the secondary school level, where the extent of appropriate health care services remains suboptimal compared with organized athletics at the collegiate level and higher. While rapid recognition and rapid treatment of EHS ensures survival, the adoption and implementation of these lifesaving steps within secondary school athletics warrant further discussion within the sports medicine community. Establishing proper policies regarding the prevention and care of EHS coupled with utilizing an interdisciplinary care approach is essential for 1) minimizing risk and 2) guaranteeing optimal outcomes for the patient.

Planning for spectator thermal comfort and health in the face of extreme heat: The Tokyo 2020 Olympic marathons

The 2020 Olympic Games marathon will be run through the streets of Tokyo on the mornings of August 2nd and 9th, a time of year that is typically hot, sunny, and humid. Few studies have assessed the potential impact of extreme heat along the marathon course to understand the multiple factors (e.g., radiation, wind flow) affecting human thermal comfort (TC) as influenced by urban design and vegetation. The current research establishes a baseline of microclimate conditions and scenarios to estimate the projected TC along the marathon route for spectators. Mobile microclimate data (air and surface temperatures, solar radiation, humidity, wind speed) were collected along the marathon course over 15 periods in the summer of 2016 and aligned with sky view factors (SVF). Human energy budget modeling was applied to provide spatially-explicit heat budget and TC information along the route. Conditions are expected to create the most discomfort along open, sun-exposed locations, with ~50% of the area along the second half of the course resulting in 'Hot' (budget > 200 W m^-2) or 'Very hot' (budget > 295 W m^-2) conditions. The heat strain index frequently rises above 80% in these locations, with high humidity and low wind flow exacerbating discomfort. Buildings and trees producing a low SVF over roads and sidewalks protect spectators from the morning radiant heat, but such locations should be balanced with wind flow to optimize comfort. The modeling and spatial information can aid in preparing for and mitigating heat stress during the Olympics. Potential solutions can be implemented in collaboration with local organizers and government. This 'research through design' strategy can aid in preparing for and mitigating heat illness during the Olympics. Knowledge gained can be extended to other areas of Tokyo to reduce urban heat, and further provide targeted guidance for effective environmental cooling techniques for human health.

Special Environments: Altitude and Heat

High-level athletes are always looking at ways to maximize training adaptations for competition performance, and using altered environmental conditions to achieve this outcome has become increasingly popular by elite athletes. Furthermore, a series of potential nutrition and hydration interventions may also optimize the adaptation to altered environments. Altitude training was first used to prepare for competition at altitude, and it still is today; however, more often now, elite athletes embark on a series of altitude training camps to try to improve sea-level performance. Similarly, the use of heat acclimation/acclimatization to optimize performance in hot/humid environmental conditions is a common practice by high-level athletes and is well supported in the scientific literature. More recently, the use of heat training to improve exercise capacity in temperate environments has been investigated and appears to have positive outcomes. This consensus statement will detail the use of both heat and altitude training interventions to optimize performance capacities in elite athletes in both normal environmental conditions and extreme conditions (hot and/or high), with a focus on the importance of nutritional strategies required in these extreme environmental conditions to maximize adaptations conducive to competitive performance enhancement.

Heat Acclimation Does Not Protect Trained Males from Hyperthermia-Induced Impairments in Complex Task Performance

This study evaluated if adaptation to environmental heat stress can counteract the negative effects of hyperthermia on complex motor performance. Thirteen healthy, trained males completed 28 days of heat acclimation with 1 h daily exercise exposure to environmental heat (39.4 ± 0.3 °C and 27.0 ± 1.0% relative humidity). Following comprehensive familiarization, the participants completed motor-cognitive testing before acclimation, as well as after 14 and 28 days of training in the heat. On all three occasions, the participants were tested, at baseline (after ~15 min passive heat exposure) and following exercise-induced hyperthermia which provoked an increase in core temperature of 2.8 ± 0.1 °C (similar across days). Both cognitively dominated test scores and motor performance were maintained during passive heat exposure (no reduction or difference between day 0, 14, and 28 compared to cool conditions). In contrast, complex motor task performance was significantly reduced in hyperthermic conditions by 9.4 ± 3.4% at day 0; 15.1 ± 5.0% at day 14, and 13.0 ± 4.8% at day 28 (all p < 0.05 compared to baseline but not different across days). These results let us conclude that heat acclimation cannot protect trained males from being negatively affected by hyperthermia when they perform complex tasks relying on a combination of cognitive performance and motor function.

Efficacy of Hot Yoga as a Heat Stress Technique for Enhancing Plasma Volume and Cardiovascular Performance in Elite Female Field Hockey Players

Perrotta, AS, White, MD, Koehle, MS, Taunton, JE, and Warburton, DER. Efficacy of hot yoga as a heat stress technique for enhancing plasma volume and cardiovascular performance in elite female field hockey players. J Strength Cond Res 32(10): 2878-2887, 2018-This investigation examined the efficacy of hot yoga as an alternative heat stress technique for enhancing plasma volume percentage (PV%) and cardiovascular performance. Ten international caliber female field hockey players completed six 60-minute hot yoga sessions using permissive dehydration over 6 days, followed by a 6-day national team camp. Changes in PV% were examined throughout the intervention and postintervention period. A graded maximal exercise test was performed in a thermoneutral environment (23.2 ± 1.0° C) 24 hours before and 24 hours after intervention. Six days of hot yoga initiated a moderate state of hypovolemia (PV% = -3.5%, 90% confidence limit [CL] [-6.9 to -0.13]), trivial improvements in maximal aerobic power (V[Combining Dot Above]O2max) (effect size [ES] = 0.06, 90% CL [-0.16 to 0.28]), and run time to exhaustion (ES = 0.11, 90% CL [-0.07 to 0.29]). Small meaningful improvements were observed in running speed (km·h) at ventilatory threshold (VT1) (ES = 0.34, 90% CL [-0.08 to 0.76]), VT2 (ES = 0.53, 90% CL [-0.05 to 1.1]), along with adaptations in the respiratory exchange ratio during high-intensity exercise (ES = -0.25, 90% CL [-0.62 to 0.12]). A large plasma volume expansion transpired 72 hours after intervention (PV% = 5.0%, 90% CL [1.3-8.7]) that contracted to a small expansion after 6 days (PV% = 1.6%, 90% CL [-1.0 to 4.2]). This investigation provides practitioners an alternative heat stress technique conducive for team sport, involving minimal exercise stress that can preserve maximal cardiovascular performance over periodized rest weeks within the yearly training plan. Furthermore, improvements in submaximal performance and a delayed hypervolemic response may provide a performance-enhancing effect when entering a 6-day competition period.