Peripheral sweat gland function is improved with humid heat acclimation

Shifting focus: Time to look beyond the classic physiological adaptations associated with human heat acclimation

Planet Earth is warming at an unprecedented rate and our future is now assured to be shaped by the consequences of more frequent hot days and extreme heat. Humans will need to adapt both behaviorally and physiologically to thrive in a hotter climate. From a physiological perspective, countless studies have shown that human heat acclimation increases thermoeffector output (i.e., sweating and skin blood flow) and lowers cardiovascular strain (i.e., heart rate) during heat stress. However, the mechanisms mediating these adaptations remain understudied. Furthermore, several possible benefits of heat acclimation for other systems and functions involved in maintaining health and performance during heat stress remain to be elucidated. This review summarizes recent advances in human heat acclimation, with emphasis on recent studies that (1) advanced our understanding of the mechanisms mediating improved thermoeffector output and (2) investigated adaptations that go beyond those classically associated with heat acclimation. We highlight that these studies have contributed to a better understanding of the integrated physiological responses underlying human heat acclimation while leaving key unanswered questions that will need to be addressed in the future.

Human temperature regulation under heat stress in health, disease, and injury

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.

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

Sweat rate and sweat composition following active or passive heat re-acclimation: A pilot study

The purpose of this study was to investigate local sweat rate (LSR) and sweat composition before and after active or passive heat re-acclimation (HRA). Fifteen participants completed four standardized heat stress tests (HST): before and after ten days of controlled hyperthermia (CH) heat acclimation (HA), and before and after five days of HRA. Each HST consisted of 35 min of cycling at 1.5W·kg⁻¹ body mass (33°C and 65% relative humidity), followed by a graded exercise test. For HRA, participants were re-exposed to either CH (CH-CH, n = 6), hot water immersion (water temperature ~40°C for 40 min; CH-HWI, n = 5) or control (CH-CON, n = 4). LSR, sweat sodium, chloride, lactate and potassium concentrations were determined on the arm and back. LSR increased following HA (arm +18%; back +41%, P ≤  0.03) and HRA (CH-CH: arm +31%; back +45%; CH-HWI: arm +65%; back +49%; CH-CON arm +11%; back +11%, P ≤ 0.021). Sweat sodium, chloride and lactate decreased following HA (arm 25–34; back 21–27%, P < 0.001) and HRA (CH-CH: arm 26–54%; back 20–43%; CH-HWI: arm 9–49%; back 13–29%; CH-CON: arm 1–3%, back 2–5%, P < 0.001). LSR increases on both skin sites were larger in CH-CH and CH-HWI than CH-CON (P ≤ 0.010), but CH-CH and CH-HWI were not different (P ≥ 0.148). Sweat sodium and chloride conservation was larger in CH-CH than CH-HWI and CH-CON on the arm and back, whilst CH-HWI and CH-CON were not different (P ≥ 0.265). These results suggest that active HRA leads to similar increases in LSR, but more conservation of sweat sodium and chloride than passive HRA.

Abbreviations: ANOVA: Analysis of variance; ATP: Adenosine triphosphate; BSA (m²): Body surface area; CH: Controlled hyperthermia; CH-CH: Heat re-acclimation by controlled hyperthermia; CH-CON: Control group (no heat re-acclimation); CH-HWI: Heat re-acclimation by hot water immersion; CV (%): Coefficient of variation; dt (min): Duration of a stimulus; F: Female; GEE: Generalized estimating equations; HA: Heat acclimation; HRA : Heat re-acclimation; HST: Heat stress test; LSR (mg·cm⁻²·min⁻¹) : Local sweat rate; LOD (mmol·L⁻¹): Limit of detection; M: Male; mx (mg): Mass of x; RH (%): Relative humidity; RT: Recreationally trained; SA (cm²): Surface area; t (min): Time; T: Trained; T_sk (°C): Skin temperature; T_re (°C): Rectal temperature; USG : Urine specific gravity; VO_2peak (mL·kg⁻¹·min⁻¹): Peak oxygen uptake; WBSL (L): Whole-body sweat loss; WBSR (L·h⁻¹): Whole-body sweat rate

Improved neural control of body temperature following heat acclimation in humans

KEY POINTS

With the advent of more frequent extreme heat events, adaptability to hot environments will be crucial for the survival of many species, including humans. However, the mechanisms that mediate human heat adaptation have remained elusive. We tested the hypothesis that heat acclimation improves the neural control of body temperature. Skin sympathetic nerve activity, comprising the efferent neural signal that activates heat loss thermoeffectors, was measured in healthy adults exposed to passive heat stress before and after a 7 day heat acclimation protocol. Heat acclimation reduced the activation threshold for skin sympathetic nerve activity, leading to an earlier activation of cutaneous vasodilatation and sweat production. These findings demonstrate that heat acclimation improves the neural control of body temperature in humans.

ABSTRACT

Heat acclimation improves autonomic temperature regulation in humans. However, the mechanisms that mediate human heat adaptation remain poorly understood. The present study tested the hypothesis that heat acclimation improves the neural control of body temperature. Body temperatures, skin sympathetic nerve activity, cutaneous vasodilatation, and sweat production were measured in 14 healthy adults (nine men and five women, aged 27 ± 5 years) during passive heat stress performed before and after a 7 day heat acclimation protocol. Heat acclimation increased whole-body sweat rate [+0.54 L h^-1 (0.32, 0.75), P < 0.01] and reduced resting core temperature [-0.29°C (-0.40, -0.18), P < 0.01]. During passive heat stress, the change in mean body temperature required to activate skin sympathetic nerve activity was reduced [-0.21°C (-0.34, -0.08), P < 0.01] following heat acclimation. The earlier activation of skin sympathetic nerve activity resulted in lower activation thresholds for cutaneous vasodilatation [-0.18°C (-0.35, -0.01), P = 0.04] and local sweat rate [-0.13°C (-0.24, -0.01), P = 0.03]. These results demonstrate that heat acclimation leads to an earlier activation of the neural efferent outflow that activates the heat loss thermoeffectors of cutaneous vasodilatation and sweating.

Sweating as a heat loss thermoeffector

In humans, sweating is the most powerful autonomic thermoeffector. The evaporation of sweat provides by far the greatest potential for heat loss and it represents the only means of heat loss when air temperature exceeds skin temperature. Sweat production results from the integration of afferent neural information from peripheral and central thermoreceptors which leads to an increase in skin sympathetic nerve activity. At the neuroglandular junction, acetylcholine is released and binds to muscarinic receptors which stimulate the secretion of a primary fluid by the secretory coil of eccrine glands. The primary fluid subsequently travels through a duct where ions are reabsorbed. The end result is the expulsion of hypotonic sweat on to the skin surface. Sweating increases in proportion with the intensity of the thermal challenge in an attempt of the body to attain heat balance and maintain a stable internal body temperature. The control of sweating can be modified by biophysical factors, heat acclimation, dehydration, and nonthermal factors. The purpose of this article is to review the role of sweating as a heat loss thermoeffector in humans.

The change in metabolic heat production is a primary mediator of heat acclimation in adults

PURPOSE

This study examined whether heat acclimation (HA) results in either predominate improvements in heat dissipation or reduced endogenous heat production via individual components of the human heat balance equation.

METHODS

Twelve healthy inactive subjects (5 females, mean ± SD): age 28 ± 6y, 77.9 ± 2kg), completed a 10-day HA (42°C, 28% RH) hyperthermia clamp (90min/day exercise, ∆1.5°C in rectal temperature (T_re)) and control workload matched (CON: 23°C, 42% RH) protocols in a counterbalanced design separated by at least 2 mo. Pre-and post-HA were matched for external work rate (EX_WR; day 1 and day 10 first 30min at 118 ± 29W, last 60min at 11 ± 5W); and metabolic heat production (H_prod; day 1 and day 9, first 30min at 296 ± 26Wm^-2, last 60min 187 ± 33Wm-2).

RESULTS

When Pre- and post- HA was matched for H_prod, there was no difference during the first 30 or last 60min of exercise for metabolic energy expenditure (MEE 363 ± 70/ 195 ± 32Wm^-2), H_prod (296 ± 67/ 187 ± 33Wm^-2) or T_re (∆2.1 ± 0.5°C). When pre- and post-HA was EX_WR equivalent, HA significantly attenuated MEE during the first 30 and last 60min (303 ± 49/ 174 ± 35Wm^-2), H_prod (241 ± 44/ 168 ± 33, W·m^-2), and ∆T_re (∆1.3 ± 0.4°C) (each P < 0.0001). When ∆T_re, ∆T_sk, ∆T_b were each normalized per 100W H_prod, no differences were found for any pre-to post-HA comparison. Heat loss required (E_req) to maintain steady state internal temperature (E_req = 220 ± 32Wm^-2), maximal capacity of the climate for evaporative heat loss (E_max = 266 ± 56Wm^-2), evaporative heat loss from skin (E_sk = 207 ± 38Wm^-2) or skin wettedness (E_req/E_max = 0.88 ± 0.23Wm^-2) were not different among each condition during the last 60min.

CONCLUSION

The mechanisms that underlie heat acclimation are not wholly attributed to heat dissipation enhancements per se, but are significantly influenced by metabolic heat production alterations under uncompensable heat stress environments.

Ten days of repeated local forearm heating does not affect cutaneous vascular function

The aim of the present study was to determine whether 10 days of repeated local heating could induce peripheral adaptations in the cutaneous vasculature and to investigate potential mechanisms of adaptation. We also assessed maximal forearm blood flow to determine whether repeated local heating affects maximal dilator capacity. Before and after 10 days of heat training consisting of 1-h exposures of the forearm to 42°C water or 32°C water (control) in the contralateral arm (randomized and counterbalanced), we assessed hyperemia to rapid local heating of the skin (n = 14 recreationally active young subjects). In addition, sequential doses of acetylcholine (ACh, 1 and 10 mM) were infused in a subset of subjects (n = 7) via microdialysis to study potential nonthermal microvascular adaptations following 10 days of repeated forearm heat training. Skin blood flow was assessed using laser-Doppler flowmetry, and cutaneous vascular conductance (CVC) was calculated as laser-Doppler red blood cell flux divided by mean arterial pressure. Maximal cutaneous vasodilation was achieved by heating the arm in a water-spray device for 45 min and assessed using venous occlusion plethysmography. Forearm vascular conductance (FVC) was calculated as forearm blood flow divided by mean arterial pressure. Repeated forearm heating did not increase plateau percent maximal CVC (CVC_max) responses to local heating (89 ± 3 vs. 89 ± 2% CVC_max, P = 0.19), 1 mM ACh (43 ± 9 vs. 53 ± 7% CVC_max, P = 0.76), or 10 mM ACh (61 ± 9 vs. 85 ± 7% CVC_max, P = 0.37, by 2-way repeated-measures ANOVA). There was a main effect of time at 10 mM ACh (P = 0.03). Maximal FVC remained unchanged (0.12 ± 0.02 vs. 0.14 ± 0.02 FVC, P = 0.30). No differences were observed in the control arm. Ten days of repeated forearm heating in recreationally active young adults did not improve the microvascular responsiveness to ACh or local heating.NEW & NOTEWORTHY We show for the first time that 10 days of repeated forearm heating is not sufficient to improve cutaneous vascular responsiveness in recreationally active young adults. In addition, this is the first study to investigate cutaneous cholinergic sensitivity and forearm blood flow following repeated local heat exposure. Our data add to the limited studies regarding repeated local heating of the cutaneous vasculature.

Local versus whole-body sweating adaptations following 14 days of traditional heat acclimation

The purpose of this study was to examine if local changes in sweat rate following 14 days of heat acclimation reflect those that occur at the whole-body level. Both prior to and following a 14-day traditional heat acclimation protocol, 10 males exercised in the heat (35 °C, ∼20% relative humidity) at increasing rates of heat production equal to 300 (Ex1), 350 (Ex2), and 400 (Ex3) W·m−2. A 10-min recovery period followed Ex1, while a 20-min recovery period separated Ex2 and Ex3. The exercise protocol was performed in a direct calorimeter to measure whole-body sweat rate and, on a separate day, in a thermal chamber to measure local sweat rate (LSR), sweat gland activation (SGA), and sweat gland output (SGO) on the upper back, chest, and mid-anterior forearm. Post-acclimation, whole-body sweat rate was greater during each exercise bout (Ex1: 14.3 ± 0.9; Ex2: 17.3 ± 1.2; Ex3: 19.4 ± 1.3 g·min−1, all p ≤ 0.05) relative to pre-acclimation (Ex1: 13.1 ± 0.6; Ex2: 15.4 ± 0.8; Ex3: 16.5 ± 1.3 g·min−1). In contrast, only LSR on the forearm increased with acclimation, and this increase was only observed during Ex2 (Post: 1.32 ± 0.33 vs. Pre: 1.06 ± 0.22 mg·min−1·cm−2, p = 0.03) and Ex3 (Post: 1.47 ± 0.41 vs. Pre: 1.17 ± 0.23 mg·min−1·cm−2, p = 0.05). The greater forearm LSR post-acclimation was due to an increase in SGO, as no changes in SGA were observed. Overall, these data demonstrate marked regional variability in the effect of heat acclimation on LSR, such that not all local measurements of sweat rate reflect the improvements observed at the whole-body level.

Changes of brain monoamine levels and physiological indexes during heat acclimation in rats

Brain monoamines, such as noradrenaline (NA), dopamine (DA), and serotonin (5-HT), regulate many important physiological functions including thermoregulation. The purpose of this study was to clarify changes in NA, DA, and 5-HT levels in several brain regions in response to heat acclimation while also recording body temperature (Tb), heart rate (HR), and locomotor activity (Act). Rats were exposed to a heated environment (32°C) for 3h (3H), 1 day (1D), 7 days, 14 days (14D), 21 days, or 28 days (28D). After heat exposure, each of the following brain regions were immediately extracted and homogenized: the caudate putamen (CPu), preoptic area (PO), dorsomedial hypothalamus (DMH), frontal cortex (FC), and hippocampus (Hip). NA, DA, and 5-HT levels in the extract were measured by high performance liquid chromatography. Although Tb increased immediately after heat exposure, it decreased about 14D later. HR was maintained at a low level throughout heat exposure, and Act tended to increase near the end of heat exposure. After 3H, we observed a marked increase in NA level in the CPu. Although this response vanished after 1D, the level increased again after 28D. DA level in the CPu decreased significantly from 1D to 28D. 5-HT level in the PO and DMH decreased from 1D to 14D. It returned to control levels after 28D with increment of DA level. 5-HT level in the FC decreased at the start of heat exposure, but recovered after 28D; a time point at which DA level also increased. Monoamine levels in the Hip were unchanged after early heat exposure, but both 5-HT and DA levels increased after 28D. These results provide definitive evidence of changes in monoamines in individual brain regions involved in thermoregulation and behavioral, cognitive, and memory function during both acute and chronic heat exposure.

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

Exercise heat acclimation induces physiological adaptations that improve thermoregulation, attenuate physiological strain, reduce the risk of serious heat illness, and improve aerobic performance in warm-hot environments and potentially in temperate environments. The adaptations include improved sweating, improved skin blood flow, lowered body temperatures, reduced cardiovascular strain, improved fluid balance, altered metabolism, and enhanced cellular protection. The magnitudes of adaptations are determined by the intensity, duration, frequency, and number of heat exposures, as well as the environmental conditions (i.e., dry or humid heat). Evidence is emerging that controlled hyperthermia regimens where a target core temperature is maintained, enable more rapid and complete adaptations relative to the traditional constant work rate exercise heat acclimation regimens. Furthermore, inducing heat acclimation outdoors in a natural field setting may provide more specific adaptations based on direct exposure to the exact environmental and exercise conditions to be encountered during competition. This review initially examines the physiological adaptations associated with heat acclimation induction regimens, and subsequently emphasizes their application to competitive athletes and sports.

Heat acclimation improves heat exercise tolerance and heat dissipation in individuals with extensive skin grafts

Burn survivors with extensive skin grafts have impaired heat dissipation and thus heat tolerance. This study tested the hypothesis that heat acclimation (HA) improves these factors in this population. Thirty-four burn survivors were stratified into highly [>40% body surface area (BSA) grafted, n = 15] and moderately (17-40% BSA grafted, n = 19) grafted groups. Nine healthy nonburned subjects served as controls. Subjects underwent 7 days of HA involving 90 min of exercise at ∼ 50% peak oxygen uptake in 40°C, 30% relative humidity. On days 1 and 7, subjects exercised in the heat at a fixed rate of metabolic heat production. Pre-HA, all controls and 18/19 subjects in the 17-40% group completed 90 min of exercise. Conversely, heat exercise tolerance was lower (P < 0.01) in the > 40% group, with 7/15 subjects not completing 90 min of exercise. Post-HA, heat exercise tolerance was similar between groups (P = 0.39) as all subjects, except one, completed 90 min of exercise. Pre-HA, the magnitude of the increase in internal temperature during exercise occurred sequentially (P ≤ 0.03) according to BSA grafted (>40%: 1.6 ± 0.5°C; 17-40%: 1.2 ± 0.3°C; control: 0.9 ± 0.2°C). HA attenuated (P < 0.01) increases in internal temperature in the control (by 0.2 ± 0.3°C), 17-40% (by 0.3 ± 0.3°C), and > 40% (by 0.3 ± 0.4°C) groups, the magnitude of which was similar between groups (P = 0.42). These data indicate that HA improves heat tolerance and dissipation in burn survivors with grafted skin, and the magnitude of these improvements are not influenced by the extent of skin grafting.

Lactate in human sweat: a critical review of research to the present day

This review provides a critical overview of the literature published in the area of lactate in human sweat between 1934 and the present. The first section summarizes the relevant pieces of literature, the second evaluates the literature across a range of topics and the third presents potential applications for sweat lactate measurements. Key factors that may affect sweat lactate are discussed in detail in the second section of this review. Both acetylcholine and catecholamine hormonal signals can trigger sweating independently of one another; differences in sweat output and lactate concentrations are compared. The primary triggers for sweating, exercise and heat are also compared, with exercise-induced sweating being further examined with respect to the exercise intensity. This review examines the significant variations in sweat lactate between bodily sites as well the relationship to physiological parameters such as gender, age and physical fitness, along with the effect of climate adaptation on sweat lactate concentrations.

Blocking the beta-adrenergic system does not affect sweat gland function during heat acclimation

The purpose of the current study was to test the hypothesis that the beta-adrenergic innervation of the human eccrine sweat gland facilitates greater sweat production following heat acclimation. Eight healthy subjects (mean ± SD age: 25.1 ± 4.1 years, weight: 79.0 ± 16.1 kg, and VO(2)max: 48.5 ± 8.0 ml/kg/min) underwent active heat acclimation by walking at 40% of their VO(2)max for 8 days (90 min a day) in an environmental chamber (35.3 ± 0.8°C and 40.2 ± 2.1% rH). To test the hypothesis, the adrenergic component of sweat gland innervation was inhibited by continuously administering a 0.5% solution of the beta-adrenergic antagonist propranolol via iontophoresis to a 5 cm(2) area of one forearm during each 90-min exercise bout. The opposing control forearm underwent iontophoresis with a saline solution. Following heat acclimation, mean sweat rate in the inhibited and control forearm was 0.47 ± 0.30 mg/cm(2)/min and 0.44 ± 0.25mg/cm(2)/min, respectively. Findings of the current study fail to support the hypothesis that adrenergic innervation facilitates human eccrine sweat gland function during heat acclimation, as no significant differences in sweating were observed. In light of the above, the physiological significance of the dual cholinergic and adrenergic innervation of the eccrine sweat gland has yet to be determined.

Contribution of central versus sweat gland mechanisms to the seasonal change of sweating function in young sedentary males and females

In summer and winter, young, sedentary male (N = 5) and female (N = 7) subjects were exposed to heat in a climate chamber in which ambient temperature (Ta) was raised continuously from 30 to 42°C at a rate of 0.1°C min(-1) at a relative humidity of 40%. Sweat rates (SR) were measured continuously on forearm, chest and forehead together with tympanic temperature (Tty), mean skin temperature (⁻Ts) and mean body temperature ⁻Tb. The rate of sweat expulsions (Fsw) was obtained as an indicator of central sudomotor activity. Tty and ⁻Tb were significantly lower during summer compared with winter in males; SR was not significantly different between summer and winter in males, but was significantly higher during summer in females; SR during winter was higher in males compared with females. The regression line relating Fsw to ⁻Tb shifted significantly from winter to summer in males and females, but the magnitude of the shift was not significantly different between the two subject groups. The regression line relating SR to Fsw was steepened significantly from winter to summer in males and females, and the change in the slope was significantly greater in females than in males. Females showed a lower slope in winter and a similar slope in summer compared to males. It was concluded that sweating function was improved during summer mediated by central sudomotor and sweat gland mechanisms in males and females, and, although the change of sweat gland function from winter to summer was greater in females as compared with males, the level of increased sweat gland function during summer was similar between the two subject groups.

Heat acclimation improves cutaneous vascular function and sweating in trained cyclists

The aim of this study was to explore heat acclimation effects on cutaneous vascular responses and sweating to local ACh infusions and local heating. We also sought to examine whether heat acclimation altered maximal skin blood flow. ACh (1, 10, and 100 mM) was infused in 20 highly trained cyclists via microdialysis before and after a 10-day heat acclimation program [two 45-min exercise bouts at 50% maximal O(2) uptake (Vo(2max)) in 40°C (n = 12)] or control conditions [two 45-min exercise bouts at 50% Vo(2max) in 13°C (n = 8)]. Skin blood flow was monitored via laser-Doppler flowmetry (LDF), and cutaneous vascular conductance (CVC) was calculated as LDF ÷ mean arterial pressure. Sweat rate was measured by resistance hygrometry. Maximal brachial artery blood flow (forearm blood flow) was obtained by heating the contralateral forearm in a water spray device and measured by Doppler ultrasound. Heat acclimation increased %CVC(max) responses to 1, 10, and 100 mM ACh (43.5 ± 3.4 vs. 52.6 ± 2.6% CVC(max), 67.7 ± 3.4 vs. 78.0 ± 3.0% CVC(max), and 81.0 ± 3.8 vs. 88.5 ± 1.1% CVC(max), respectively, all P < 0.05). Maximal forearm blood flow remained unchanged after heat acclimation (290.9 ± 12.7 vs. 269.9 ± 23.6 ml/min). The experimental group showed significant increases in sweating responses to 10 and 100 mM ACh (0.21 ± 0.03 vs. 0.31 ± 0.03 mg·cm(-2)·min(-1) and 0.45 ± 0.05 vs. 0.67 ± 0.06 mg·cm(-2)·min(-1), respectively, all P < 0.05), but not to 1 mM ACh (0.13 ± 0.02 vs. 0.18 ± 0.02 mg·cm(-2)·min(-1), P = 0.147). No differences in any of the variables were found in the control group. Heat acclimation in highly trained subjects induced local adaptations within the skin microcirculation and sweat gland apparatus. Furthermore, maximal skin blood flow was not altered by heat acclimation, demonstrating that the observed changes were attributable to improvement in cutaneous vascular function and not to structural changes that limit maximal vasodilator capacity.

Sex-related differences in sweat gland cholinergic sensitivity exist irrespective of differences in aerobic capacity

Mechanisms accounting for sex-related differences in the sweat response remain to be elucidated. In the present study, we focused on differences in sweat gland cholinergic sensitivity between males and females. Since, males usually possess higher aerobic capacity than females, we investigated sweating in males and females grouped according to aerobic capacity (.VO(2peak)). Forty-four subjects were assigned to four groups: males with higher (MH) and lower (ML), and females with higher (FH) and lower (FL) .VO(2peak). Forearm sweating was induced by iontophoretic administration (1.5 mA, 60 muA cm(-2), 5 min) of pure water or varying concentrations of pilocarpine hydrochloride (0.125, 0.250, 0.5, 1.0 and 2.0%). Local sweat rate (absorbent paper) and the number of activated sweat glands (iodine impregnated paper) were computed. Maximal pilocarpine-induced sweat rate (SR(max)) and the pilocarpine concentration which elicited 50% of maximal sweating response (K (m)) were calculated. Sweat rate and active gland density increased in response to greater doses of pilocarpine (p < 0.05). Inter-group differences were evident: SR(max) was greatest for MH and lowest for FL (p < 0.05), but no significant differences were observed between ML and FH (p = 0.24). Higher SR(max) were observed, within-sex, for those with greater aerobic capacity (p < 0.05). Furthermore, males' K (m) values were higher than females', indicating greater sweat gland affinity for pilocarpine even for groups having similar aerobic capacity (p < 0.05). In summary, we confirmed that the human sudomotor response is affected by aerobic capacity but, also, that sex-related differences in sweat gland cholinergic sensitivity exist and are not necessarily associated with the typical differences in .VO(2peak) observed between sexes.

Is active sweating during heat acclimation required for improvements in peripheral sweat gland function?

We investigated whether the eccrine sweat glands must actively produce sweat during heat acclimation if they are to adapt and increase their capacity to sweat. Eight volunteers received intradermal injections of BOTOX, to prevent neural stimulation and sweat production of the sweat glands during heat acclimation, and saline injections as a control in the contralateral forearm. Subjects performed 90 min of moderate-intensity exercise in the heat (35 degrees C, 40% relative humidity) on 10 consecutive days. Heat acclimation decreased end-exercise heart rate (156 +/- 22 vs. 138 +/- 17 beats/min; P = 0.0001) and rectal temperature (38.2 +/- 0.3 vs. 37.9 +/- 0.3 degrees C; P = 0.0003) and increased whole body sweat rate (0.70 +/- 0.29 vs. 1.06 +/- 0.50 l/h; P = 0.030). During heat acclimation, there was no measurable sweating in the BOTOX-treated forearm, but the control forearm sweat rate during exercise increased 40% over the 10 days (P = 0.040). Peripheral sweat gland function was assessed using pilocarpine iontophoresis before and after heat acclimation. Before heat acclimation, the pilocarpine-induced sweat rate of the control and BOTOX-injected forearms did not differ (0.65 +/- 0.20 vs. 0.66 +/- 0.22 mg x cm(-2) x min(-1)). However, following heat acclimation, the pilocarpine-induced sweat rate in the control arm increased 18% to 0.77 +/- 0.21 mg x cm(-2) x min(-1) (P = 0.021) but decreased 52% to 0.32 +/- 0.18 mg x cm(-2) x min(-1) (P < 0.001) in the BOTOX-treated arm. Using complete chemodenervation of the sweat glands, coupled with direct cholinergic stimulation via pilocarpine iontophoresis, we demonstrated that sweat glands must be active during heat acclimation if they are to adapt and increase their capacity to sweat.