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Lackner M, Grossmann F, Perret C, Flueck JL, Hertig-Godeschalk A. Chasing Gold: Heat Acclimation in Elite Handcyclists with Spinal Cord Injury. Int J Sports Med 2024. [PMID: 38885662 DOI: 10.1055/a-2321-1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Thermoregulation is impaired in individuals with a spinal cord lesion (SCI), affecting sweat capacity, heat loss, and core temperature. This can be particularly problematic for athletes with SCI who exercise in hot and humid conditions, like those during the Tokyo 2020 Paralympic Games. Heat acclimation can support optimal preparation for exercise in such challenging environments, but evidence is limited in endurance athletes with SCI. We evaluated whether seven consecutive days of exercise in the heat would result in heat acclimation. Five elite para-cycling athletes with SCI participated (two females, three males, median (Q1-Q3) 35 (31-51) years, four with paraplegia and one with tetraplegia). All tests and training sessions were performed in a heat chamber (30°C and 75% relative humidity). A time-to-exhaustion test was performed on day 1 (pretest) and day 7 (posttest). On days 2-6, athletes trained daily for one hour at 50-60% of individual peak power (PPeak). Comparing pretest and posttest, all athletes increased their body mass loss (p=0.04), sweat rate (p=0.04), and time to exhaustion (p=0.04). Effects varied between athletes for core temperature and heart rate. All athletes appeared to benefit from our heat acclimation protocol, helping to optimize their preparation for the Tokyo 2020 Paralympic Games.
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Affiliation(s)
- Mike Lackner
- Sports Therapy, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Fabian Grossmann
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Claudio Perret
- Neuro-Musculoskeletal Functioning and Mobility, Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Joelle L Flueck
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
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2
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Lôbo ILB, Wanner SP, Guerreiro RDC, Coelho BLP, Coimbra FEDS, Martins MEM, Duarte LCDA, Stieler E, de Mello MT, Silva A. Effects of two external cooling strategies on physiological and perceptual responses of athletes with tetraplegia during and after exercise in the heat. J Therm Biol 2024; 123:103896. [PMID: 38906048 DOI: 10.1016/j.jtherbio.2024.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
Athletes with tetraplegia may experience marked hyperthermia while exercising under environmental heat stress due to their limited ability to dissipate heat through evaporative means. This study investigated the effectiveness of two external cooling strategies (i.e., spraying water onto the body surface or using a cooling vest) on physiological and perceptual variables in tetraplegic athletes during and after an aerobic exercise session in a hot environment. Nine male wheelchair rugby players performed an incremental test to determine their maximum aerobic power output. After that, they were subjected to three experimental trials in a counter-balanced order: control (CON, no body cooling), cooling vest (CV), and water spraying (WS). During these trials, they performed 30 min of a submaximal exercise (at 65% of their maximum aerobic power) inside an environmental chamber set to maintain the dry-bulb temperature at 32 °C. The following variables were recorded at regular intervals during the exercise and for an additional 30 min following the exertion (i.e., post-exercise recovery) with the participants also exposed to 32 °C: body core temperature (TCORE), skin temperature (TSKIN), heart rate (HR), rating of perceived exertion (RPE), thermal comfort (TC), and thermal sensation (TS). While exercising in CON conditions, the tetraplegic athletes had the expected increases in TCORE, TSKIN, HR, RPE, and TC and TS scores. HR, TC, and TS decreased gradually toward pre-exercise values after the exercise, whereas TCORE and TSKIN remained stable at higher values. Using a cooling vest decreased the temperature measured only on the chest and reduced the scores of RPE, TC, and TS during and after exercise but did not influence the other physiological responses of the tetraplegic athletes. In contrast, spraying water onto the athletes' body surface attenuated the exercise-induced increase in TSKIN, led to lower HR values during recovery, and was also associated with better perception during and after exercise. We conclude that water spraying is more effective than the cooling vest in attenuating physiological strain induced by exercise-heat stress. However, although both external cooling strategies do not influence exercise hyperthermia, they improve the athletes' thermal perception and reduce perceived exertion.
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Affiliation(s)
- Ingrid Ludimila Bastos Lôbo
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil; Departamento de Ciências do Movimento Humano of the Universidade do Estado de Minas Gerais (DCMH/UEMG), Ibirité, MG, Brazil.
| | - Samuel Penna Wanner
- Laboratório de Fisiologia do Exercício of the Universidade Federal de Minas Gerais (LAFISE/UFMG), Belo Horizonte, MG, Brazil.
| | - Renato de Carvalho Guerreiro
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | - Bruno Lourenço Pinto Coelho
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | | | - Maria Eduarda Machado Martins
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | - Larissa Cristina de Abreu Duarte
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | - Eduardo Stieler
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | - Marco Túlio de Mello
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
| | - Andressa Silva
- Centro de Estudos em Psicobiologia e Exercício of the Universidade Federal de Minas Gerais (CEPE/UFMG), Belo Horizonte, MG, Brazil.
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Puce L, Biz C, Ceylan HI, Bragazzi NL, Formica M, Trabelsi K, Szarpak Ł, Trompetto C, Rossin A, Lanciano NA, Ruggieri P. Adaptive Shooting Disciplines: A Scoping Review of the Literature with Bibliometric Analysis. Healthcare (Basel) 2024; 12:463. [PMID: 38391838 PMCID: PMC10888416 DOI: 10.3390/healthcare12040463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Para-archery and para-shooting, two very popular adaptive shooting disciplines that have earned their place as major official events in the Paralympic Games, share some similarities, as well as distinctive features in terms of rules, physiological requirements, and equipment used. The International Paralympic Committee has a clear responsibility to ensure that all sports within its jurisdiction, including adaptive shooting, can achieve excellence in their respective fields. To achieve this, the conduct of well-designed studies and rigorous research is essential. Although some research has been conducted in this area, a comprehensive and systematic evaluation is still needed. Therefore, the present study aims to provide a thorough review and synthesis of existing research on adaptive shooting disciplines, identify strengths and gaps, and suggest future directions. Arksey and O'Malley's methodology is leveraged and enhanced with bibliometric and policy analyses to review literature on adaptive shooting. Databases like PubMed/MEDLINE, Scopus, Web of Science, OvidSP, and EMBASE were searched, focusing on studies in adaptive shooting disciplines and analysing these findings through a blend of thematic and statistical methods. Twenty-four studies totalling 483 para-athletes (299 para-shooters and 184 para-archers) are included in this scoping review, focusing on a range of aspects, including physiological responses (n = 9), research design and measurement methods for evidence-based classification (n = 6), biopsychosocial aspects (n = 3), development of new methods and technologies (n = 4), kinematic and biomechanical assessment (n = 1), and epidemiology of injuries (n = 1). Seven articles focused exclusively on para-archery, thirteen exclusively on para-shooting, and four on both para-archery and para-shooting. In conclusion, the available literature on adaptive shooting disciplines is still very limited, especially regarding para-archery compared to para-shooting. This highlights the need for further research in many key areas to ensure a better understanding of the different disciplines and to provide appropriate support for para-athletes. Future research in para-archery and para-shooting should focus on technological innovations, biomechanical studies, and psychological support to enhance athlete performance and accessibility. Addressing the imbalance between the two disciplines, along with injury prevention and global participation, can drive the sports towards greater inclusivity and equity for para-athletes worldwide.
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Affiliation(s)
- Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy
| | - Halil Ibrahim Ceylan
- Physical Education and Sports Teaching Department, Kazim Karabekir Faculty of Education, Ataturk University, Erzurum 25030, Turkey
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Matteo Formica
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Khaled Trabelsi
- Institut Supérieur du Sport et de l'Éducation Physique de Sfax, University of Sfax, Sfax 3000, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Łukasz Szarpak
- Department of Clinical Research and Development, LUXMED Group, 02-676 Warsaw, Poland
- Institute of Research Outcomes, Maria Sklodowska-Curie Medical Academy, 03-211 Warsaw, Poland
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandro Rossin
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy
| | - Nicola Antonio Lanciano
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy
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4
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Alkemade P, Daanen HAM, Janssen TWJ, Broad E, Goosey-Tolfrey VL, Ibusuki T, Kneepkens H, Périard JD, Eijsvogels TMH. Heat preparedness and exertional heat illness in Paralympic athletes: A Tokyo 2020 survey. Temperature (Austin) 2022; 10:264-275. [PMID: 37332304 PMCID: PMC10274519 DOI: 10.1080/23328940.2022.2147364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
Paralympic athletes may be at increased risk for exertional heat illness (EHI) due to reduced thermoregulatory ability as a consequence of their impairment. This study investigated the occurrence of heat-stress related symptoms and EHI, and the use of heat mitigation strategies in Paralympic athletes, both in relation to the Tokyo 2020 Paralympic Games and previous events. Paralympic athletes competing in Tokyo 2020 were invited to complete an online survey five weeks prior to the Paralympics and up to eight weeks after the Games. 107 athletes (30 [24-38] years, 52% female, 20 nationalities, 21 sports) completed the survey. 57% of respondents had previously experienced heat-stress related symptoms, while 9% had been medically diagnosed with EHI. In Tokyo, 21% experienced at least one heat-stress related symptom, while none reported an EHI. The most common symptom and EHI were, respectively, dizziness and dehydration. In preparation for Tokyo, 58% of respondents used a heat acclimation strategy, most commonly heat acclimatization, which was more than in preparation for previous events (45%; P = 0.007). Cooling strategies were used by 77% of athletes in Tokyo, compared to 66% during past events (P = 0.18). Cold towels and packs were used most commonly. Respondents reported no medically-diagnosed EHIs during the Tokyo 2020 Paralympic Games, despite the hot and humid conditions in the first seven days of competition. Heat acclimation and cooling strategies were used by the majority of athletes, with heat acclimation being adopted more often than for previous competitions.
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Affiliation(s)
- Puck Alkemade
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Hein A. M. Daanen
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Thomas W. J. Janssen
- Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Victoria L. Goosey-Tolfrey
- Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LeicestershireLE11 3TU, UK
| | - Tatsuru Ibusuki
- Department of Rehabilitation Medicine, Akeno Central Hospital, Oita, Japan
| | - Hiske Kneepkens
- Sport Medisch Centrum Papendal, NOC*NSF, Arnhem, The Netherlands
| | - Julien D. Périard
- University of Canberra Research Institute for Sport and Exercise, Bruce, New south wales, Australia
| | - Thijs M. H. Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev 2022; 102:1907-1989. [PMID: 35679471 PMCID: PMC9394784 DOI: 10.1152/physrev.00047.2021] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022] Open
Abstract
The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.
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Affiliation(s)
- Matthew N Cramer
- Defence Research and Development Canada-Toronto Research Centre, Toronto, Ontario, Canada
| | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Quebec, Canada
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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Gee CM, Lacroix MA, Stellingwerff T, Gavel EH, Logan-Sprenger HM, West CR. Physiological Considerations to Support Podium Performance in Para-Athletes. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:732342. [PMID: 36188768 PMCID: PMC9397986 DOI: 10.3389/fresc.2021.732342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022]
Abstract
The twenty-first century has seen an increase in para-sport participation and the number of research publications on para-sport and the para-athlete. Unfortunately, the majority of publications are case reports/case series or study single impairment types in isolation. Indeed, an overview of how each International Paralympic Committee classifiable impairment type impact athlete physiology, health, and performance has not been forthcoming in the literature. This can make it challenging for practitioners to appropriately support para-athletes and implement evidence-based research in their daily practice. Moreover, the lack of a cohesive publication that reviews all classifiable impairment types through a physiological lens can make it challenging for researchers new to the field to gain an understanding of unique physiological challenges facing para-athletes and to appreciate the nuances of how various impairment types differentially impact para-athlete physiology. As such, the purpose of this review is to (1) summarize how International Paralympic Committee classifiable impairments alter the normal physiological responses to exercise; (2) provide an overview of "quick win" physiological interventions targeted toward specific para-athlete populations; (3) discuss unique practical considerations for the para-sport practitioner; (4) discuss research gaps and highlight areas for future research and innovation, and (5) provide suggestions for knowledge translation and knowledge sharing strategies to advance the field of para-sport research and its application by para-sport practitioners.
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Affiliation(s)
| | | | - Trent Stellingwerff
- Athletics Canada, Ottawa, ON, Canada
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
| | - Erica H. Gavel
- Canadian Sport Institute-Ontario, Toronto, ON, Canada
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Heather M. Logan-Sprenger
- Canadian Sport Institute-Ontario, Toronto, ON, Canada
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Christopher R. West
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
- Faculty of Medicine, International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, University of British Columbia, Kelowna, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
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Gee CM, Lacroix MA, Pethick WA, Côté P, Stellingwerff T, West CR. Cardiovascular responses to heat acclimatisation in athletes with spinal cord injury. J Sci Med Sport 2021; 24:756-762. [DOI: 10.1016/j.jsams.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/07/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
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8
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Grossmann F, Flueck JL, Perret C, Meeusen R, Roelands B. The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies-A Systematic Review. Front Physiol 2021; 12:636997. [PMID: 33868002 PMCID: PMC8049141 DOI: 10.3389/fphys.2021.636997] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: In individuals with a spinal cord injury thermoregulatory mechanisms are fully or partially interrupted. This could lead to exercise-induced hyperthermia in temperate conditions which can be even more distinct in hot conditions. Hyperthermia has been suggested to impair physiological mechanisms in athletes, which could negatively influence physical performance and subjective well-being or cause mild to severe health issues. Objective: The aim was to evaluate the literature on the thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise in temperate and hot conditions taking the effects of cooling techniques and heat acclimation into account. Data sources: Two electronic databases, PubMed and Web of Science were searched. Studies were eligible if they observed the influence of exercise on various thermoregulatory parameters (e.g., core and skin temperature, sweat rate, thermal sensation) in individuals with a spinal cord injury. Results: In total 32 articles were included of which 26 were of strong, 3 of moderate and 3 of weak quality. Individuals with a high lesion level, especially those with a tetraplegia, reached a higher core and skin temperature with a lower sweat rate. The use of cooling techniques before and during exercise can positively affect the burden of the impaired thermoregulatory system in all individuals with a spinal cord injury. Conclusion: Due to the absence of normal thermoregulatory abilities, individuals with a high-level spinal cord injury need special attention when they are exercising in temperate and hot conditions to prevent them from potential heat related issues. The use of cooling techniques can reduce this risk.
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Affiliation(s)
- Fabian Grossmann
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, United Kingdom
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Stephenson BT, Tolfrey K, Goosey-Tolfrey VL. Mixed Active and Passive, Heart Rate-Controlled Heat Acclimation Is Effective for Paralympic and Able-Bodied Triathletes. Front Physiol 2019; 10:1214. [PMID: 31616314 PMCID: PMC6763681 DOI: 10.3389/fphys.2019.01214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/06/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ben T Stephenson
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,Physiology, English Institute of Sport, Loughborough Performance Centre, Loughborough University, Loughborough, United Kingdom
| | - Keith Tolfrey
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Victoria L Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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10
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Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin) 2019; 6:211-259. [PMID: 31608304 PMCID: PMC6773238 DOI: 10.1080/23328940.2019.1632145] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.
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Affiliation(s)
- Lindsay B Baker
- Gatorade Sports Science Institute, PepsiCo R&D Physiology and Life Sciences, Barrington, IL, USA
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11
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Griggs KE, Stephenson BT, Price MJ, Goosey-Tolfrey VL. Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020. Temperature (Austin) 2019; 7:37-57. [PMID: 32166104 PMCID: PMC7053936 DOI: 10.1080/23328940.2019.1617030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Katy E. Griggs
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ben T. Stephenson
- Loughborough Performance Centre, English Institute of Sport, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael J. Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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12
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Casadio JR, Kilding AE, Cotter JD, Laursen PB. From Lab to Real World: Heat Acclimation Considerations for Elite Athletes. Sports Med 2018; 47:1467-1476. [PMID: 28035584 DOI: 10.1007/s40279-016-0668-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As major sporting events are often held in hot environments, increased interest in ways of optimally heat acclimating athletes to maximise performance has emerged. Heat acclimation involves repeated exercise sessions in hot conditions that induce physiological and thermoregulatory adaptations that attenuate heat-induced performance impairments. Current evidence-based guidelines for heat acclimation are clear, but the application of these recommendations is not always aligned with the time commitments and training priorities of elite athletes. Alternative forms of heat acclimation investigated include hot water immersion and sauna bathing, yet uncertainty remains around the efficacy of these methods for reducing heat-induced performance impairments, as well as how this form of heat stress may add to an athlete's overall training load. An understanding of how to optimally prescribe and periodise heat acclimation based on the performance determinants of a given event is limited, as is knowledge of how heat acclimation may affect the quality of concurrent training sessions. Finally, differences in individual athlete responses to heat acclimation need to be considered. This article addresses alternative methods of heat acclimation and heat exposure, explores gaps in literature around understanding the real world application of heat acclimation for athletes, and highlights specific athlete considerations for practitioners.
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Affiliation(s)
- Julia R Casadio
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand.
- High Performance Sport New Zealand, PO Box 302 563, North Harbour, Auckland, 0751, New Zealand.
| | - Andrew E Kilding
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Paul B Laursen
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
- High Performance Sport New Zealand, PO Box 302 563, North Harbour, Auckland, 0751, New Zealand
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13
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Baumgart JK, Brurok B, Sandbakk Ø. Peak oxygen uptake in Paralympic sitting sports: A systematic literature review, meta- and pooled-data analysis. PLoS One 2018; 13:e0192903. [PMID: 29474386 PMCID: PMC5825058 DOI: 10.1371/journal.pone.0192903] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Peak oxygen uptake (VO2peak) in Paralympic sitting sports athletes represents their maximal ability to deliver energy aerobically in an upper-body mode, with values being influenced by sex, disability-related physiological limitations, sport-specific demands, training status and how they are tested. Objectives To identify VO2peak values in Paralympic sitting sports, examine between-sports differences and within-sports variations in VO2peak and determine the influence of sex, age, body-mass, disability and test-mode on VO2peak. Design Systematic literature review and meta-analysis. Data sources PubMed, CINAHL, SPORTDiscusTM and EMBASE were systematically searched in October 2016 using relevant medical subject headings, keywords and a Boolean. Eligibility criteria Studies that assessed VO2peak values in sitting sports athletes with a disability in a laboratory setting were included. Data synthesis Data was extracted and pooled in the different sports disciplines, weighted by the Dersimonian and Laird random effects approach. Quality of the included studies was assessed with a modified version of the Downs and Black checklist by two independent reviewers. Meta-regression and pooled-data multiple regression analyses were performed to assess the influence of sex, age, body-mass, disability, test mode and study quality on VO2peak. Results Of 6542 retrieved articles, 57 studies reporting VO2peak values in 14 different sitting sports were included in this review. VO2peak values from 771 athletes were used in the data analysis, of which 30% participated in wheelchair basketball, 27% in wheelchair racing, 15% in wheelchair rugby and the remaining 28% in the 11 other disciplines. Fifty-six percent of the athletes had a spinal cord injury and 87% were men. Sports-discipline-averaged VO2peak values ranged from 2.9 L∙min-1 and 45.6 mL∙kg-1∙min-1 in Nordic sit skiing to 1.4 L∙min-1 and 17.3 mL∙kg-1∙min-1 in shooting and 1.3 L∙min-1 and 18.9 mL∙kg-1∙min-1 in wheelchair rugby. Large within-sports variation was found in sports with few included studies and corresponding low sample sizes. The meta-regression and pooled-data multiple regression analyses showed that being a man, having an amputation, not being tetraplegic, testing in a wheelchair ergometer and treadmill mode, were found to be favorable for high absolute and body-mass normalized VO2peak values. Furthermore, high body mass was favourable for high absolute VO2peak values and low body mass for high body-mass normalized VO2peak values. Conclusion The highest VO2peak values were found in Nordic sit skiing, an endurance sport with continuously high physical efforts, and the lowest values in shooting, a sport with low levels of displacement, and in wheelchair rugby where mainly athletes with tetraplegia compete. However, VO2peak values need to be interpreted carefully in sports-disciplines with few included studies and large within-sports variation. Future studies should include detailed information on training status, sex, age, test mode, as well as the type and extent of disability in order to more precisely evaluate the effect of these factors on VO2peak.
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Affiliation(s)
- Julia Kathrin Baumgart
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- * E-mail:
| | - Berit Brurok
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav’s University Hospital, Trondheim, Norway
| | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
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14
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Abstract
Spinal cord injury results in physiologic adaptations affecting heat production (reduced muscle mass) and heat dissipation (blood redistribution and reduced sweating capacity below the level of lesion). However, it is the balance between these factors which determines whether heat balance is achieved. Core temperature estimates are generally consistent with those for the able-bodied, with cooler values reported in some instances. More notable differences are demonstrated through cooler lower-body skin temperatures at rest and a loss of anticipatory control during exposure to heat and cold when compared to the able-bodied. During exercise in cool conditions persons with paraplegia demonstrate similar body temperature responses as for the able-bodied but retain heat during recovery. Persons with tetraplegia demonstrate continual increases in core temperature and thus thermal imbalance along with greater heat retention. During exercise in the heat, athletes with paraplegia appear to be able to regulate body temperature to a similar extent as the able-bodied. Those with tetraplegia again show thermal imbalance but to a much greater extent than in the cold. Future work should focus upon specific sweating responses and adaptations following spinal cord injury, the effects of completeness of lesion, perceptual responses to environmental challenges, and how these translate to undertaking activities of daily living.
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Affiliation(s)
- Mike J Price
- School of Life Sciences, Coventry University, Coventry, United Kingdom.
| | - Michelle Trbovich
- Spinal Cord Injury Unit, San Antonio Veterans Hospital, San Antonio, TX, United States
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15
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Handrakis JP, Ni Guan Z, Nulty JW, Tascione O, Rosado-Rivera D, White D, Bang C, Spungen AM, Bauman WA. Effect of Heat Exposure on Cognition in Persons with Tetraplegia. J Neurotrauma 2017; 34:3372-3380. [PMID: 28462685 DOI: 10.1089/neu.2016.4850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Individuals with cervical spinal cord injury (SCI) have impaired thermoregulatory mechanisms attributed to interruption of motor, sensory, and autonomic neuropathways. To determine the effects of heat exposure on core body temperature (Tcore) and cognitive performance in persons with tetraplegia, 8 individuals with chronic tetraplegia (C3-C7, American Spinal Cord Injury Association Impairment Scale A-B) and 9 able-bodied controls were acclimated to 27°C at baseline (BL) before being exposed to 35°C for up to 120 min (Heat Challenge). Rectal temperature (Tcore), distal skin temperatures (Tskavg), sweat rate (QSavg), microvascular skin perfusion (LDFavg), and plasma norepinephrine (NE) were measured. Cognitive performance was assessed using Stroop Color and Word and Wechsler Adult Intelligence Scale-Fourth Edition Digit Span tests at BL and at the end of Heat Challenge. After Heat Challenge, Tcore increased 0.78 ± 0.18°C (p < 0.001) in tetraplegics after an average of 118 ± 5 min. Tcore did not change in controls after 120 min. The increase in QSavg was larger in controls than in tetraplegics (946 ± 672% vs. 51 ± 12%; p = 0.007, respectively). LDFavg increased only in controls (109 ± 93%; p = 0.008). Tskavg appeared to increase less in tetraplegics than in controls. Plasma NE levels remained lower in tetraplegics compared to controls after Heat Challenge (86 ± 64 vs. 297 ± 84 pg/mL, respectively; p < 0.001). Stroop Color, Interference, and WAIS-IV Sequence scores increased only in tetraplegics (19.4 ± 17.2%; p < 0.05, 8.3 ± 5.9%; p < 0.05, 29.1 ± 27.4%; p < 0.05, respectively). Dysfunctional thermoregulatory mechanisms in the tetraplegic group allowed Tcore to rise from subnormal levels to normothermia during heat exposure. Normothermia was associated with improvements in attention, working memory, and executive function.
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Affiliation(s)
- John P Handrakis
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York.,5 New York Institute of Technology , Department of Physical Therapy, School of Health Professions, Old Westbury, New York
| | - Zhen Ni Guan
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York.,5 New York Institute of Technology , Department of Physical Therapy, School of Health Professions, Old Westbury, New York
| | - John W Nulty
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York.,5 New York Institute of Technology , Department of Physical Therapy, School of Health Professions, Old Westbury, New York
| | - Oriana Tascione
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York
| | - Dwindally Rosado-Rivera
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York
| | - Daniel White
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York
| | - Charlene Bang
- 2 Medical Service, James J. Peters VA Medical Center , Bronx, New York.,3 Department of Medicine, The Icahn School of Medicine at Mount Sinai , New York, New York
| | - Ann M Spungen
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York.,2 Medical Service, James J. Peters VA Medical Center , Bronx, New York.,3 Department of Medicine, The Icahn School of Medicine at Mount Sinai , New York, New York.,4 Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai , New York, New York
| | - William A Bauman
- 1 VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York.,2 Medical Service, James J. Peters VA Medical Center , Bronx, New York.,3 Department of Medicine, The Icahn School of Medicine at Mount Sinai , New York, New York.,4 Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai , New York, New York
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16
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Trbovich MB, Kiratli JB, Price MJ. The effects of a heat acclimation protocol in persons with spinal cord injury. J Therm Biol 2016; 62:56-62. [DOI: 10.1016/j.jtherbio.2016.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
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17
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Price MJ. Preparation of Paralympic Athletes; Environmental Concerns and Heat Acclimation. Front Physiol 2016; 6:415. [PMID: 26834641 PMCID: PMC4712300 DOI: 10.3389/fphys.2015.00415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/17/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mike J Price
- Faculty of Health and Life Sciences, School of Life Sciences, Applied Biology and Exercise Science Research Centre, Coventry University Coventry, UK
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18
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Abstract
Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport.
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Girard O. Thermoregulation in wheelchair tennis-How to manage heat stress? Front Physiol 2015; 6:175. [PMID: 26082724 PMCID: PMC4451356 DOI: 10.3389/fphys.2015.00175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/22/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Girard
- Department of Physiology, Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne Lausanne, Switzerland
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20
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Gibson OR, Mee JA, Taylor L, Tuttle JA, Watt PW, Maxwell NS. Isothermic and fixed-intensity heat acclimation methods elicit equal increases in Hsp72 mRNA. Scand J Med Sci Sports 2015; 25 Suppl 1:259-68. [DOI: 10.1111/sms.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- O. R. Gibson
- Centre for Sport and Exercise Science and Medicine (SESAME); Welkin Human Performance Laboratories; University of Brighton; Eastbourne UK
| | - J. A. Mee
- Centre for Sport and Exercise Science and Medicine (SESAME); Welkin Human Performance Laboratories; University of Brighton; Eastbourne UK
| | - L. Taylor
- Muscle Cellular and Molecular Physiology (MCMP) and Applied Sport and Exercise Science (ASEP) Research Groups; Department of Sport Science and Physical Activity; Institute of Sport and Physical Activity Research (ISPAR); University of Bedfordshire; Brighton UK
| | - J. A. Tuttle
- Muscle Cellular and Molecular Physiology (MCMP) and Applied Sport and Exercise Science (ASEP) Research Groups; Department of Sport Science and Physical Activity; Institute of Sport and Physical Activity Research (ISPAR); University of Bedfordshire; Brighton UK
| | - P. W. Watt
- Centre for Sport and Exercise Science and Medicine (SESAME); Welkin Human Performance Laboratories; University of Brighton; Eastbourne UK
| | - N. S. Maxwell
- Centre for Sport and Exercise Science and Medicine (SESAME); Welkin Human Performance Laboratories; University of Brighton; Eastbourne UK
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