Isothermic and fixed intensity heat acclimation methods induce similar heat adaptation following short and long-term timescales

Myths and methodologies: Considerations for evaluating the time course of thermoregulatory adaptation during heat acclimation

Since the early 1900s, repeated heat exposure has been used as a method to induce physiological adaptations that enhance our ability to tolerate heat stress during athletic and occupational pursuits. Much of this work has been dedicated to quantifying the time course of adaptation and identifying the minimum duration of acclimation required to optimise performance or enhance safety. To achieve this, investigators have typically applied classical (constant load) heat acclimation, whereby 60-90 min exercise is performed at the same absolute or relative intensity in a hot environment for 3-24 days, with adaptations evaluated using an identical forcing function test before and after. This approach has provided a foundation from which to develop our understanding of changes in thermoregulatory function, but it has several, frequently overlooked shortcomings, which have resulted in misconceptions concerning the time course of adaptation. It is frequently suggested that most of the thermoregulatory adaptations during heat acclimation occur within a week, but this is an oversimplification and a predictable artefact of the experimental designs used. Consequently, the time course of complete human adaptation to heat remains poorly understood and appears to vary considerably due to numerous individual factors. The purpose of this communication is to highlight the key methodological considerations required when interpreting the existing literature documenting adaptation over time. We also propose potential means by which to improve the way we induce and quantify the magnitude of adaptation to expedite discovery.

Eccentric muscle-damaging exercise in the heat lowers cellular stress prior to and immediately following future exertional heat exposure

Muscle-damaging exercise (e.g., downhill running [DHR]) or heat exposure bouts potentially reduce physiological and/or cellular stress during future exertional heat exposure; however, the true extent of their combined preconditioning effects is unknown. Therefore, this study investigated the effect of muscle-damaging exercise in the heat on reducing physiological and cellular stress during future exertional heat exposure. Ten healthy males (mean ± Standard Definition; age, 23 ± 3 years; body mass, 78.7 ± 11.5 kg; height, 176.9 ± 4.7 cm) completed this study. Participants were randomly assigned into two preconditioning groups: (a) DHR in the heat (ambient temperature [Tamb], 35 °C; relative humidity [RH], 40%) and (b) DHR in thermoneutral (Tamb, 20 °C; RH, 20%). Seven days following DHR, participants performed a 45-min flat run in the heat (FlatHEAT [Tamb, 35 °C; RH, 40%]). During exercise, heart rate and rectal temperature (Trec) were recorded at baseline and every 5-min. Peripheral blood mononuclear cells were isolated to assess heat shock protein 72 (Hsp72) concentration between conditions at baseline, immediately post-DHR, and immediately pre-FlatHEAT and post-FlatHEAT. Mean Trec during FlatHEAT between hot (38.23 ± 0.38 °C) and thermoneutral DHR (38.26 ± 0.38 °C) was not significantly different (P = 0.68), with no mean heart rate differences during FlatHEAT between hot (172 ± 15 beats min-1) and thermoneutral conditions (174 ± 8 beats min-1; P = 0.58). Hsp72 concentration change from baseline to immediately pre-FlatHEAT was significantly lower in hot (-51.4%) compared to thermoneutral (+24.2%; P = 0.025) DHR, with Hsp72 change from baseline to immediately post-FlatHEAT also lower in hot (-52.6%) compared to thermoneutral conditions (+26.3%; P = 0.047). A bout of muscle-damaging exercise in the heat reduces cellular stress levels prior to and immediately following future exertional heat exposure.

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.

Quantifying Exercise Heat Acclimatisation in Athletes and Military Personnel: A Systematic Review and Meta-analysis

BACKGROUND

Athletes and military personnel are often expected to compete and work in hot and/or humid environments, where decrements in performance and an increased risk of exertional heat illness are prevalent. A physiological strategy for reducing the adverse effects of heat stress is to acclimatise to the heat.

OBJECTIVE

The aim of this systematic review was to quantify the effects of relocating to a hotter climate to undergo heat acclimatisation in athletes and military personnel.

ELIGIBILITY CRITERIA

Studies investigating the effects of heat acclimatisation in non-acclimatised athletes and military personnel via relocation to a hot climate for < 6 weeks were included.

DATA SOURCES

MEDLINE, SPORTDiscus, CINAHL Plus with Full Text and Scopus were searched from inception to June 2022.

RISK OF BIAS

A modified version of the McMaster critical review form was utilised independently by two authors to assess the risk of bias.

DATA SYNTHESIS

A Bayesian multi-level meta-analysis was conducted on five outcome measures, including resting core temperature and heart rate, the change in core temperature and heart rate during a heat response test and sweat rate. Wet-bulb globe temperature (WBGT), daily training duration and protocol length were used as predictor variables. Along with posterior means and 90% credible intervals (CrI), the probability of direction (Pd) was calculated.

RESULTS

Eighteen articles from twelve independent studies were included. Fourteen articles (nine studies) provided data for the meta-analyses. Whilst accounting for WBGT, daily training duration and protocol length, population estimates indicated a reduction in resting core temperature and heart rate of - 0.19 °C [90% CrI: - 0.41 to 0.05, Pd = 91%] and - 6 beats·min-1 [90% CrI: - 16 to 5, Pd = 83%], respectively. Furthermore, the rise in core temperature and heart rate during a heat response test were attenuated by - 0.24 °C [90% CrI: - 0.67 to 0.20, Pd = 85%] and - 7 beats·min-1 [90% CrI: - 18 to 4, Pd = 87%]. Changes in sweat rate were conflicting (0.01 L·h-1 [90% CrI: - 0.38 to 0.40, Pd = 53%]), primarily due to two studies demonstrating a reduction in sweat rate following heat acclimatisation.

CONCLUSIONS

Data from athletes and military personnel relocating to a hotter climate were consistent with a reduction in resting core temperature and heart rate, in addition to an attenuated rise in core temperature and heart rate during an exercise-based heat response test. An increase in sweat rate is also attainable, with the extent of these adaptations dependent on WBGT, daily training duration and protocol length.

PROSPERO REGISTRATION

CRD42022337761.

The reliability of a portable steam sauna pod for the whole-body passive heating of humans

INTRODUCTION

Passive heating is receiving increasing attention within human performance and health contexts. A low-cost, portable steam sauna pod may offer an additional tool for those seeking to manipulate physiological (cardiovascular, thermoregulatory and sudomotor) and perceptual responses for improving sporting or health profiles. This study aimed to 1) report the different levels of heat stress and determine the pods' inter-unit reliability, and 2) quantify the reliability of physiological and perceptual responses to passive heating.

METHOD

In part 1, five pods were assessed for temperature and relative humidity (RH) every 5 min across 70 min of heating for each of the 9 settings. In part 2, twelve males (age: 24 ± 4 years) completed two 60 min trials of passive heating (3 × 20 min at 44 °C/99% RH, separated by 1 week). Heart rate (HR), rectal (Trectal) and tympanic temperature (Ttympanic) were recorded every 5 min, thermal comfort (Tcomfort) and sensation (Tsensation) every 10 min, mean arterial pressure (MAP) at each break period and sweat rate (SR) after exiting the pod.

RESULTS

In part 1, setting 9 provided the highest temperature (44.3 ± 0.2 °C) and longest time RH remained stable at 99% (51±7 min). Inter-unit reliability data demonstrated agreement between pods for settings 5-9 (intra-class correlation [ICC] >0.9), but not for settings 1-4 (ICC <0.9). In part 2, between-visits, high correlations, and low typical error of measurement (TEM) and coefficient of variation (CV) were found for Trectal, HR, MAP, SR, and Tcomfort, but not for Ttympanic or Tsensation. A peak Trectal of 38.09 ± 0.30 °C, HR of 124 ± 15 b min-1 and a sweat loss of 0.73 ± 0.33 L were reported. No between-visit differences (p > 0.05) were observed for Trectal, Ttympanic, Tsensation or Tcomfort, however HR (+3 b.min-1) and MAP (+4 mmHg) were greater in visit 1 vs. 2 (p < 0.05).

CONCLUSION

Portable steam sauna pods generate reliable heat stress between-units. The highest setting (44 °C/99% RH) also provides reliable but modest adjustments in physiological and perceptual responses.

Key Exercise Concepts in the Rehabilitation from Severe Burns

This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.

Heat acclimation reduces the effects of whole-body hyperthermia on knee-extensor relaxation rate, but does not affect voluntary torque production

PURPOSE

This study investigated the effects of acute hyperthermia and heat acclimation (HA) on maximal and rapid voluntary torque production, and their neuromuscular determinants.

METHODS

Ten participants completed 10 days of isothermic HA (50 °C, 50% rh) and had their knee-extensor neuromuscular function assessed in normothermic and hyperthermic conditions, pre-, after 5 and after 10 days of HA. Electrically evoked twitch and octet (300 Hz) contractions were delivered at rest. Maximum voluntary torque (MVT), surface electromyography (EMG) normalised to maximal M-wave, and voluntary activation (VA) were assessed during brief maximal isometric voluntary contractions. Rate of torque development (RTD) and normalised EMG were measured during rapid voluntary contractions.

RESULTS

Acute hyperthermia reduced neural drive (EMG at MVT and during rapid voluntary contractions; P < 0.05), increased evoked torques (P < 0.05), and shortened contraction and relaxation rates (P < 0.05). HA lowered resting rectal temperature and heart rate after 10 days (P < 0.05), and increased sweating rate after 5 and 10 days (P < 0.05), no differences were observed between 5 and 10 days. The hyperthermia-induced reduction in twitch half-relaxation was attenuated after 5 and 10 days of HA, but there were no other effects on neuromuscular function either in normothermic or hyperthermic conditions.

CONCLUSION

HA-induced favourable adaptations to the heat after 5 and 10 days of exposure, but there was no measurable benefit on voluntary neuromuscular function in normothermic or hyperthermic conditions. HA did reduce the hyperthermic-induced reduction in twitch half-relaxation time, which may benefit twitch force summation and thus help preserve voluntary torque in hot environmental conditions.

Taking the plunge: When is best for hot water immersion to complement exercise in heat and hypoxia

This investigation assessed the psycho-physiological and performance effects of hot water immersion (HWI) implemented either before or after a repeated-sprint training in hypoxia (RSH) session conducted in the heat. Ten participants completed three RSH trials (3 × 10 × 5-s sprints), conducted at 40°C and simulated altitude of 3000 m. A 30-min monitoring period preceded and followed all exercise sessions. In PRE, the pre-exercise period was HWI, and the post-exercise period was seated rest in temperate conditions. This combination was reversed in POST. In CON, participants were seated in temperate conditions for both periods. Compared to CON, PRE elicited a reduction in power output during each repeated-sprint set (14.8-16.2%, all p < 0.001), and a significantly higher core temperature (Tc) during the pre-exercise period and throughout the exercise session (p < 0.001 and p = 0.025, respectively). In POST, power output and Tc until the end of exercise were similar to CON, with Tc higher at the conclusion of the post-exercise period (p < 0.001). Time across the entire protocol spent ≥38.5°C Tc was significantly longer in PRE (48.1 ± 22.5 min) than POST (31.0 ± 11.3 min, p = 0.05) and CON (15.8 ± 16.3 min, p < 0.001). Employing HWI following RSH conducted in the heat provides effective outcomes regarding physiological strain and cycling performance when compared to pre-exercise or no HWI.

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.

Increased air temperature decreases high-speed, but not total distance, in international field hockey

This study investigated the effect of heat stress on locomotor activity within international field hockey at team, positional and playing-quarter levels. Analysis was conducted on 71 matches played by the Malaysia national men’s team against 24 opponents. Fixtures were assigned to match conditions, based on air temperature [COOL (14 ± 3°C), WARM (24 ± 1°C), HOT (27 ± 1°C), or VHOT (32 ± 2°C), p < 0.001]. Relationships between locomotor metrics and air temperature (AIR), absolute and relative humidity, and wet bulb globe temperature (WBGT) were investigated further using correlation and regression analyses. Increased AIR and WBGT revealed similar correlations (p < 0.01) with intensity metrics; high-speed running (AIR r = −0.51, WBGT r = −0.45), average speed (AIR r = −0.48, WBGT r = −0.46), decelerations (AIR r = −0.41, WBGT r = −0.41), sprinting efforts (AIR r = −0.40, WBGT r = −0.36), and sprinting distance (AIR r = −0.37, WBGT r = −0.29). In comparison to COOL, HOT, and VHOT matches demonstrated reduced high-speed running intensity (−14–17%; p < 0.001), average speed (−5-6%; p < 0.001), sprinting efforts (−17%; p = 0.010) and decelerations per min (−12%; p = 0.008). Interactions were found between match conditions and playing quarter for average speed (+4-7%; p = 0.002) and sprinting distance (+16-36%; p < 0.001), both of which were higher in the fourth quarter in COOL versus WARM, HOT and VHOT. There was an interaction for “low-speed” (p < 0.001), but not for “high-speed” running (p = 0.076) demonstrating the modulating effect of air temperature (particularly >25°C) on pacing within international hockey. These are the first data demonstrating the effect of air temperature on locomotor activity within international men’s hockey, notably that increased air temperature impairs high-intensity activities by 5–15%. Higher air temperatures compromise high-speed running distances between matches in hockey.

Sex differences in adaptation to intermittent post-exercise sauna bathing in trained middle-distance runners

Background

The purpose of this study was to investigate the effect of sex on the efficacy of intermittent post-exercise sauna bathing to induce heat acclimation and improve markers of temperate exercise performance in trained athletes.

Methods

Twenty-six trained runners (16 female; mean ± SD, age 19 ± 1 years, V̇O_2max F: 52.6 ± 6.9 mL⋅kg⁻¹⋅min⁻¹, M: 64.6 ± 2.4 mL⋅kg⁻¹⋅min⁻¹) performed a running heat tolerance test (30 min, 9 km⋅h⁻¹/2% gradient, 40 °C/40%RH; HTT) and temperate (18 °C) exercise tests (maximal aerobic capacity [V̇O_2max] and lactate profile) pre and post 3 weeks of normal exercise training plus 29 ± 1 min post-exercise sauna bathing (101–108 °C) 3 ± 1 times per week.

Results

Females and males exhibited similar reductions (interactions p > 0.05) in peak rectal temperature (− 0.3 °C; p < 0.001), skin temperature (− 0.9 °C; p < 0.001) and heart rate (− 9 beats·min⁻¹; p = 0.001) during the HTT at post- vs pre-intervention. Only females exhibited an increase in active sweat glands on the forearm (measured via modified iodine technique; F: + 57%, p < 0.001; M: + 1%, p = 0.47). Conversely, only males increased forearm blood flow (measured via venous occlusion plethysmography; F: + 31%, p = 0.61; M: + 123%; p < 0.001). Females and males showed similar (interactions p > 0.05) improvements in V̇O_2max (+ 5%; p = 0.02) and running speed at 4 mmol·L⁻¹ blood lactate concentration (+ 0.4 km·h⁻¹; p = 0.001).

Conclusions

Three weeks of post-exercise sauna bathing effectively induces heat acclimation in females and males, though possibly amid different thermoeffector adaptations. Post-exercise sauna bathing is also an effective ergogenic aid for both sexes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-021-00342-6.

The Effect of Medium-Term Sauna-Based Heat Acclimation (MPHA) on Thermophysiological and Plasma Volume Responses to Exercise Performed under Temperate Conditions in Elite Cross-Country Skiers

The influence of a series of ten sauna baths (MPHA) on thermophysiological and selected hematological responses in 14 elite cross-country skiers to a submaximal endurance exercise test performed under thermoneutral environmental conditions was studied. Thermal and physiological variables were measured before and after the exercise test, whereas selected hematological indices were studied before, immediately after, and during recovery after a run, before (T1) and after sauna baths (T2). MPHA did not influence the baseline internal, body, and skin temperatures. There was a decrease in the resting heart rate (HR: p = 0.001) and physiological strain (PSI: p = 0.052) after MPHA and a significant effect of MPHA on systolic blood pressure (p = 0.03), hematological indices, and an exercise effect but no combined effect of treatments and exercise on the tested variables. A positive correlation was reported between PSI and total protein (%ΔTP) in T2 and a negative between plasma volume (%ΔPV) and mean red cellular volume (%ΔMCV) in T1 and T2 in response to exercise and a positive one during recovery. This may suggest that MPHA has a weak influence on body temperatures but causes a moderate decrease in PSI and modifications of plasma volume restoration in response to exercise under temperate conditions in elite athletes.

A 5-day Heat Acclimation Program Improves Heat Stress Indicators While Maintaining Exercise Capacity

ABSTRACT

Wardenaar, FC, Ortega-Santos, CP, Vento, K, Beaumont, JS, Griffin, SC, Johnston, C, and Kavouras, SA. A 5-day heat acclimation program improves heat stress indicators while maintaining exercise capacity. J Strength Cond Res 35(5): 1279-1286, 2021-This study aimed to evaluate whether a daily 60 minutes isothermic biking protocol during a 5-day period could improve physiological heat acclimation and exercise performance capacity in partially acclimated subjects. A quasi-experimental study consisted of an intervention (INT, n = 7) and control (CON, n = 7) group completing 2 12 minutes Cooper tests (pre-CT on day 1 and post-CT on day 7) and a heat stress test (HST, on day 9). INT performed additional intensive exercise 1 hour per day on days 1-5, whereas CON did not. During CTs and HST, core temperature (Tc, telemetric capsule), skin temperature (Tsk, sensors at neck, right shoulder, left hand, and right shin), and heart rate (HR, chest strap) were continuously monitored and baseline, average, peak, and increment were calculated. During the HST, the INT group showed a smaller baseline-peak Tc increment (INT 0.88 ± 0.27 vs. CON 1.64 ± 0.90° C, p = 0.02), a lower HR peak (150.2 ± 12.6 vs. 173.0 ± 16.8 b·min-1, p = 0.02), and lower Tsk peak (36.47 ± 0.62 vs. 36.54 ± 0.46° C, p = 0.04). There was a nonsignificant, but practical difference based on a moderate effect size for change in pre-CT to post-CT performance of nearly +2.7 ± 12.3% in INT and -3.0 ± 8.5% in CON (p = 0.32 and d = 0.51), and HST distance covered resulting in a nonsignificant difference of 464 ± 849 m between INT and CON (p = 0.38 and d = 0.44). In conclusion a short-term 5-day heat acclimation program including 300 minutes of extra exercise resulted in positive physiological adaptions to heat stress, as indicated by lower core temperature and HR in comparison with a control group.

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.

Effects of Heat Acclimation and Acclimatisation on Maximal Aerobic Capacity Compared to Exercise Alone in Both Thermoneutral and Hot Environments: A Meta-Analysis and Meta-Regression

Background

Heat acclimation and acclimatisation (HA) is typically used to enhance tolerance to the heat, thereby improving performance. HA might also confer a positive adaptation to maximal oxygen consumption (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max), although this has been historically debated and requires clarification via meta-analysis.

Objectives

(1) To meta-analyse all studies (with and without control groups) that have investigated the effect of HA on \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max adaptation in thermoneutral or hot environments; (2) Conduct meta-regressions to establish the moderating effect of selected variables on \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max adaptation following HA.

Methods

A search was performed using various databases in May 2020. The studies were screened using search criteria for eligibility. Twenty-eight peer-reviewed articles were identified for inclusion across four separate meta-analyses: (1) Thermoneutral \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max within-participants (pre-to-post HA); (2) Hot \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max within-participants (pre-to-post HA); (3) Thermoneutral \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max measurement; HA vs. control groups; (4) Hot \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max measurement, HA vs. control groups. Meta-regressions were performed for each meta-analysis based on: isothermal vs. iso-intensity programmes, days of heat exposure, HA ambient temperature (°C), heat index, HA session duration (min), ambient thermal load (HA session x ambient temperature), mean mechanical intensity (W) and the post-HA testing period (days).

Results

The meta-analysis of pre–post differences in thermoneutral \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max demonstrated small-to-moderate improvements in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max (Hedges’ g = 0.42, 95% CI 0.24–0.59, P < 0.001), whereas moderate improvements were found for the equivalent analysis of hot \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max changes (Hedges’ g = 0.63, 95% CI 0.26–1.00, P < 0.001), which were positively moderated by the number of days post-testing (P = 0.033, β = 0.172). Meta-analysis of control vs. HA thermoneutral \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max demonstrated a small improvement in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max in HA compared to control (Hedges’ g = 0.30, 95% CI 0.06–0.54, P = 0.014) and this effect was larger for the equivalent hot \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max analysis where a higher (moderate-to-large) improvement in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max was found (Hedges’ g = 0.75, 95% CI 0.22–1.27, P = 0.005), with the number of HA days (P = 0.018; β = 0.291) and the ambient temperature during HA (P = 0.003; β = 0.650) positively moderating this effect.

Conclusion

HA can enhance \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max adaptation in thermoneutral or hot environments, with or without control group consideration, by at least a small and up to a moderate–large amount, with the larger improvements occurring in the heat. Ambient heat, number of induction days and post-testing days can explain some of the changes in hot \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$V{\text{O}}_{2\max }$$\end{document}VO2max adaptation.

Heat acclimation training with intermittent and self-regulated intensity may be used as an alternative to traditional steady state and power-regulated intensity in endurance cyclists

The study aimed to determine the effects of self-regulated and variable intensities sustained during short-term heat acclimation training on cycling performance. Seventeen competitive-level male athletes performed a 20-km cycling time trial before (TT-PRE), immediately after (TT-POST1) and one week after (TT-POST2) a 5-day acclimation training program, including either RPE-regulated intermittent (HA-HIT, N = 9) or fixed and low-intensity (HA-LOW, N = 8) training sessions in the heat (39 °C; 40% relative humidity). Total training volume was 23% lower in HA-HIT compared to HA-LOW. Physiological responses were evaluated during a 40-min fixed-RPE cycling exercise performed before (HST-PRE) and immediately after (HST-POST) heat acclimation. All participants in HA-LOW group tended to improve mean power output from TT-PRE to TT-POST1 (+8.1 ± 5.2%; ES = 0.55 ± 0.23), as well as eight of the nine athletes in HA-HIT group (+4.3 ± 2.0%; ES = 0.29 ± 0.31) without difference between groups, but TT-POST2 results showed that improvements were dissipated one week after. Similar improvements in thermal sensation and lower elevations of core temperature in HST-POST following HA-LOW and HA-HIT training protocols suggest that high intensity and RPE regulated bouts could be an efficient strategy for short term heat acclimation protocols, for example prior to the competition. Furthermore, the modest impact of lowered thermal sensation on cycling performance confirms that perceptual responses of acclimated athletes are dissociated from physiological stress when exercising in the heat.

Effects of three-exercise sessions in the heat on endurance cycling performance

PURPOSE

To investigate the effects of a very short-term acclimation protocol (VSTAP) on performance, physiological and perceptual responses to exercise in the heat.

METHODS

12 trained male cyclists (age 31.2 ± 7; weight 71.3 ± 7 kg, VO_2max: 58.4 ± 3.7 mL/kg/min) randomly performed two Time to Exhaustion Tests (TTE) at 75% of normothermic peak power output (PPO), one in normothermia (N,18°C-50% RH) and one in the heat (H,35°C-50% RH), before and after a VSTAP intervention, consisting of 3 days-90 min exercise (10min at 30% of PPO+80 min at 50% of PPO) in H (≈4.5h of heat exposure). Performance time of TTEs and physiological and perceptual variables of both TTEs and training sessions (T1, T2 and T3) were evaluated.

RESULTS

Magnitude Based Inferences (MBI) revealed 92/6/1% and 62/27/11% chances of positive/trivial/negative effects of VSTAP of improving performance in H (+17%) and in N (+9%), respectively. Heart Rate (HR) decreased from T1 to T3 (p < 0.001) and T2 to T3 (p < 0.001), whereas Tympanic Temperature (TyT) decreased from T1 to T2 (p = 0.047) and from T1 to T3 (p = 0.007). Furthermore, despite the increased tolerance to target Power Output (PO) throughout training sessions, RPE decreased from T1 to T3 (p = 0.032).

CONCLUSIONS

The VSTAP determined meaningful physiological (i.e. decreased HR and TyT) and perceptual (i.e. decreased RPE) adaptations to submaximal exercise. Furthermore, showing good chances to improve performance in the heat, it represents a valid acclimation strategy to be implemented when no longer acclimation period is possible. Finally, no cross-over effect of the VSTAP on performance in temperate conditions was detected.

Additional Clothing Increases Heat Load in Elite Female Rugby Sevens Players

PURPOSE

To determine whether elite female rugby sevens players are exposed to core temperatures (Tc) during training in the heat that replicate the temperate match demands previously reported and to investigate whether additional clothing worn during a hot training session meaningfully increases the heat load experienced.

METHODS

A randomized parallel-group study design was employed, with all players completing the same approximately 70-minute training session (27.5°C-34.8°C wet bulb globe temperature) and wearing a standardized training ensemble (synthetic rugby shorts and training tee [control (CON); n = 8]) or additional clothing (standardized training ensemble plus compression garments and full tracksuit [additional clothing (AC); n = 6]). Groupwise differences in Tc, sweat rate, GPS-measured external locomotive output, rating of perceived exertion, and perceptual thermal load were compared.

RESULTS

Mean (P = .006, ηp2=.88) and peak (P < .001, ηp2=.97) Tc were higher in AC compared with CON during the training session. There were no differences in external load (F4,9 = 0.155, P = .956, Wilks Λ = 0.935, ηp2=.06) or sweat rate (P = .054, Cohen d = 1.09). A higher rating of perceived exertion (P = .016, Cohen d = 1.49) was observed in AC compared with CON. No exertional-heat-illness symptomology was reported in either group.

CONCLUSIONS

Player Tc is similar between training performed in hot environments and match play in temperate conditions when involved for >6 minutes. Additional clothing is a viable and effective method to increase heat strain in female rugby sevens players without compromising training specificity or external locomotive capacity.

Individual characteristics associated with the magnitude of heat acclimation adaptations

Purpose

The magnitude of heat acclimation (HA) adaptations varies largely among individuals, but it remains unclear what factors influence this variability. This study compared individual characteristics related to fitness status and body dimensions of low-, medium-, and high responders to HA.

Methods

Twenty-four participants (9 female, 15 male; maximum oxygen uptake [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{V}}$$\end{document}V˙O_2peak,kg] 52 ± 9 mL kg⁻¹ min⁻¹) completed 10 daily controlled-hyperthermia HA sessions. Adaptations were evaluated by heat stress tests (HST; 35 min cycling 1.5 W  kg⁻¹; 33 °C, 65% relative humidity) pre- and post-HA. Low-, medium-, and high responder groups were determined based on tertiles (n = 8) of individual adaptations for resting rectal temperature (T_re), exercise-induced T_re rise (ΔT_re), whole-body sweat rate (WBSR), and heart rate (HR).

Results

Body dimensions (p > 0.3) and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{V}}$$\end{document}V˙O_2peak,kg (p > 0.052) did not differentiate low-, medium-, and high responders for resting T_re or ΔT_re. High WBSR responders had a larger body mass and lower body surface area-to-mass ratio than low responders (83.0 ± 9.3 vs 67.5 ± 7.3 kg; 249 ± 12 vs 274 ± 15 cm² kg⁻¹, respectively; p < 0.005). Conversely, high HR responders had a smaller body mass than low responders (69.2 ± 6.8 vs 83.4 ± 9.4 kg; p = 0.02). \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{V}}$$\end{document}V˙O_2peak,kg did not differ among levels of responsiveness for WBSR and HR (p > 0.3).

Conclusion

Individual body dimensions influenced the magnitude of sudomotor and cardiovascular adaptive responses, but did not differentiate T_re adaptations to HA. The influence of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot{{V}}$$\end{document}V˙O_2peak,kg on the magnitude of adaptations was limited.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-021-04626-3.

The effects of local versus systemic passive heating on the acute inflammatory, vascular and glycaemic response

The aim of this study was to compare the acute cardiometabolic and perceptual responses between local and whole-body passive heating. Using a water-perfused suit, 10 recreationally active males underwent three 90 min conditions: heating of the legs with upper-body cooling (LBH), whole-body heating (WBH) and exposure to a thermoneutral temperature (CON). Blood samples were collected before and up to 3 h post-session to assess inflammatory markers, while a 2 h oral glucose tolerance test was initiated 1 h post-session. Femoral artery blood flow and perceptual responses were recorded at regular intervals. The interleukin (IL)-6 incremental area under the curve (iAUC) was higher for LBH (1096 ± 851 pg/mL × 270 min) and WBH (833 ± 476 pg/mL × 270 min) compared with CON (565 ± 325 pg/mL × 270 min; p < 0.047). Glucose concentrations were higher after WBH compared with LBH and CON (p < 0.046). Femoral artery blood flow was higher at the end of WBH (1713 ± 409 mL/min) compared with LBH (943 ± 349 mL/min; p < 0.001), and higher in LBH than CON (661 ± 222 mL/min; p = 0.002). Affect and thermal comfort were more negative during WBH compared with LBH and CON (p < 0.010). In conclusion, local passive heating elevated blood flow and the IL-6 iAUC. However, while resulting in more positive perceptual responses, the majority of the included cardiometabolic markers were attenuated compared with WBH.

Novelty: The increase in the IL-6 iAUC in response to passive heating is not reduced by upper-body cooling. Upper-body cooling attenuates the plasma nitrite, IL-1ra and femoral artery blood flow response to passive heating. Upper-body cooling leads to more positive perceptual responses to passive heating.

Aerobic but not thermoregulatory gains following a 10-day moderate-intensity training protocol are fitness level dependent: A cross-adaptation perspective

Moderate‐intensity exercise sessions are incorporated into heat‐acclimation and hypoxic‐training protocols to improve performance in hot and hypoxic environments, respectively. Consequently, a training effect might contribute to aerobic performance gains, at least in less fit participants. To explore the interaction between fitness level and a training stimulus commonly applied during acclimation protocols, we recruited 10 young males of a higher (more fit‐MF, peak aerobic power [VO_2peak]: 57.9 [6.2] ml·kg⁻¹·min⁻¹) and 10 of a lower (less fit‐LF, VO_2peak: 41.7 [5.0] ml·kg⁻¹·min⁻¹) fitness level. They underwent 10 daily exercise sessions (60 min@50% peak power output [W_peak]) in thermoneutral conditions. The participants performed exercise testing on a cycle ergometer before and after the training period in normoxic (NOR), hypoxic (13.5% F_iO₂; HYP), and hot (35°C, 50% RH; HE) conditions in a randomized and counterbalanced order. Each test consisted of two stages; a steady‐state exercise (30 min@40% NOR W_peak to evaluate thermoregulatory function) followed by incremental exercise to exhaustion. VO_2peak increased by 9.2 (8.5)% (p = .024) and 10.2 (15.4)% (p = .037) only in the LF group in NOR and HE, respectively. W_peak increases were correlated with baseline values in NOR (r = −.58, p = .010) and HYP (r = −.52, p = .018). MF individuals improved gross mechanical efficiency in HYP. Peak sweat rate increased in both groups in HE, whereas MF participants activated the forehead sweating response at lower rectal temperatures post‐training. In conclusion, an increase in VO_2peak but not mechanical efficiency seems probable in LF males after a 10‐day moderate‐exercise training protocol.

Methods for improving thermal tolerance in military personnel prior to deployment

Acute exposure to heat, such as that experienced by people arriving into a hotter or more humid environment, can compromise physical and cognitive performance as well as health. In military contexts heat stress is exacerbated by the combination of protective clothing, carried loads, and unique activity profiles, making them susceptible to heat illnesses. As the operational environment is dynamic and unpredictable, strategies to minimize the effects of heat should be planned and conducted prior to deployment. This review explores how heat acclimation (HA) prior to deployment may attenuate the effects of heat by initiating physiological and behavioural adaptations to more efficiently and effectively protect thermal homeostasis, thereby improving performance and reducing heat illness risk. HA usually requires access to heat chamber facilities and takes weeks to conduct, which can often make it impractical and infeasible, especially if there are other training requirements and expectations. Recent research in athletic populations has produced protocols that are more feasible and accessible by reducing the time taken to induce adaptations, as well as exploring new methods such as passive HA. These protocols use shorter HA periods or minimise additional training requirements respectively, while still invoking key physiological adaptations, such as lowered core temperature, reduced heart rate and increased sweat rate at a given intensity. For deployments of special units at short notice (< 1 day) it might be optimal to use heat re-acclimation to maintain an elevated baseline of heat tolerance for long periods in anticipation of such an event. Methods practical for military groups are yet to be fully understood, therefore further investigation into the effectiveness of HA methods is required to establish the most effective and feasible approach to implement them within military groups.

Sex differences in the physiological adaptations to heat acclimation: a state-of-the-art review

Over the last few decades, females have significantly increased their participation in athletic competitions and occupations (e.g. military, firefighters) in hot and thermally challenging environments. Heat acclimation, which involves repeated passive or active heat exposures that lead to physiological adaptations, is a tool commonly used to optimize performance in the heat. However, the scientific community's understanding of adaptations to heat acclimation are largely based on male data, complicating the generalizability to female populations. Though limited, current evidence suggests that females may require a greater number of heat acclimation sessions or greater thermal stress to achieve the same magnitude of physiological adaptations as males. The underlying mechanisms explaining the temporal sex differences in the physiological adaptations to heat acclimation are currently unclear. Therefore, the aims of this state-of-the-art review are to: (i) present a brief yet comprehensive synthesis of the current female and sex difference literature, (ii) highlight sex-dependent (e.g. anthropometric, menstrual cycle) and sex-independent factors (e.g. environmental conditions, fitness) influencing the physiological and performance adaptations to heat acclimation, and (iii) address key avenues for future research.

Individual Responses to Heat Stress: Implications for Hyperthermia and Physical Work Capacity

Background

Extreme heat events are increasing in frequency, severity, and duration. It is well known that heat stress can have a negative impact on occupational health and productivity, particularly during physical work. However, there are no up-to-date reviews on how vulnerability to heat changes as a function of individual characteristics in relation to the risk of hyperthermia and work capacity loss. The objective of this narrative review is to examine the role of individual characteristics on the human heat stress response, specifically in relation to hyperthermia risk and productivity loss in hot workplaces. Finally, we aim to generate practical guidance for industrial hygienists considering our findings. Factors included in the analysis were body mass, body surface area to mass ratio, body fat, aerobic fitness and training, heat adaptation, aging, sex, and chronic health conditions.

Findings

We found the relevance of any factor to be dynamic, based on the work-type (fixed pace or relative to fitness level), work intensity (low, moderate, or heavy work), climate type (humidity, clothing vapor resistance), and variable of interest (risk of hyperthermia or likelihood of productivity loss). Heat adaptation, high aerobic fitness, and having a large body mass are the most protective factors during heat exposure. Primary detrimental factors include low fitness, low body mass, and lack of heat adaptation. Aging beyond 50 years, being female, and diabetes are less impactful negative factors, since their independent effect is quite small in well matched participants. Skin surface area to mass ratio, body composition, hypertension, and cardiovascular disease are not strong independent predictors of the heat stress response.

Conclusion

Understanding how individual factors impact responses to heat stress is necessary for the prediction of heat wave impacts on occupational health and work capacity. The recommendations provided in this report could be utilized to help curtail hyperthermia risk and productivity losses induced by heat.

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.

Effectiveness of Short-Term Heat Acclimation on Intermittent Sprint Performance With Moderately Trained Females Controlling for Menstrual Cycle Phase

Introduction

Investigate the effectiveness of short-term heat acclimation (STHA), over 5-days (permissive dehydration), on an intermittent sprint exercise protocol (HST) with females. Controlling for menstrual cycle phase.

Materials and Methods

Ten, moderately trained, females (Mean [SD]; age 22.6 [2.7] y; stature 165.3 [6.2] cm; body mass 61.5 [8.7] kg; V.⁢O2⁢peak 43.9 [8.6] mL⋅kg^–1⋅min^–1) participated. The HST (31.0°C; 50%RH) was 9 × 5 min (45-min) of intermittent exercise, based on exercise intensities of female soccer players, using a motorized treadmill and Wattbike. Participants completed HST1 vs. HST2 as a control (C) trial. Followed by 90 min, STHA (no fluid intake), for five consecutive days in 39.5°C; 60%RH, using controlled-hyperthermia (∼rectal temperature [T_re] 38.5°C). The HST3 occurred within 1 week after STHA. The HST2 vs HST3 trials were in the luteal phase, using self-reported menstrual questionnaire and plasma 17β-estradiol.

Results

Pre (HST2) vs post (HST3) STHA there was a reduction at 45-min in T_re by 0.20°C (95%CI −0.30 to −0.10°C; d = 0.77); T¯s⁢k (−0.50; −0.90 to −0.10°C; d = 0.80); and T¯b (−0.25; −0.35 to −0.15°C; d = 0.92). Cardiac frequency reduced at 45-min (−8; −16 to −1 b⋅min^–1; d = 1.11) and %PV increased (7.0; −0.4 to 14.5%: d = 1.27). Mean power output increased across all nine maximal sprints by 56W (−26 to 139W; d = 0.69; n = 9). There was limited difference (P > 0.05) for these measures in HST1 vs HST2 C trial.

Discussion

Short-term heat acclimation (5-days) using controlled-hyperthermia, leads to physiological adaptation during intermittent exercise in the heat, in moderately trained females when controlling for menstrual cycle phase.

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.

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.

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.

No ergogenic effects of a 10-day combined heat and hypoxic acclimation on aerobic performance in normoxic thermoneutral or hot conditions

PURPOSE

Hypoxic acclimation enhances convective oxygen delivery to the muscles. Heat acclimation-elicited thermoregulatory benefits have been suggested not to be negated by adding daily exposure to hypoxia. Whether concomitant acclimation to both heat and hypoxia offers a synergistic enhancement of aerobic performance in thermoneutral or hot conditions remains unresolved.

METHODS

Eight young males ([Formula: see text]: 51.6 ± 4.6 mL min^-1 kg^-1) underwent a 10-day normobaric hypoxic confinement (F_iO₂ = 0.14) interspersed with daily 90-min normoxic controlled hyperthermia (target rectal temperature: 38.5 °C) exercise sessions. Prior to, and following the confinement, the participants conducted a 30-min steady-state exercise followed by incremental exercise to exhaustion on a cycle ergometer in thermoneutral normoxic (NOR), thermoneutral hypoxic (F_iO₂ = 0.14; HYP) and hot (35 °C, 50% relative humidity; HE) conditions in a randomized and counterbalanced order. The steady-state exercise was performed at 40% NOR peak power output (W_peak) to evaluate thermoregulatory function. Blood samples were obtained from an antecubital vein before, on days 1 and 10, and the first day post-acclimation.

RESULTS

[Formula: see text] and ventilatory thresholds were not modified in any environment following acclimation. W_peak increased by 6.3 ± 3.4% in NOR and 4.0 ± 4.9% in HE, respectively. The magnitude and gain of the forehead sweating response were augmented in HE post-acclimation. EPO increased from baseline (17.8 ± 7.0 mIU mL^-1) by 10.7 ± 8.8 mIU mL^-1 on day 1 but returned to baseline levels by day 10 (15.7 ± 5.9 mIU mL^-1).

DISCUSSION

A 10-day combined heat and hypoxic acclimation conferred only minor benefits in aerobic performance and thermoregulation in thermoneutral or hot conditions. Thus, adoption of such a protocol does not seem warranted.

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 acclimation attenuates the increased sensations of fatigue reported during acute exercise-heat stress

Athletes exercising in heat stress experience increased perceived fatigue acutely, however it is unknown whether heat acclimation (HA) reduces the magnitude of this perceptual response and whether different HA protocols influence the response. This study investigated sensations of fatigue following; acute exercise-heat stress; short- (5-sessions) and medium-term (10-sessions) HA; and between once- (ODHA) and twice-daily HA (TDHA) protocols. Twenty male participants (peak oxygen uptake: 3.75 ± 0.47 L·min-1) completed 10 sessions (60-min cycling at ~2 W·kg-1, 45°C/20% relative humidity) of ODHA (n = 10) or non-consecutive TDHA (n = 10). Sensations of fatigue (General, Physical, Emotional, Mental, Vigor and Total Fatigue) were assessed using the multi-dimensional fatigue scale inventory-short form pre and post session 1, 5 and 10. Heat adaptation was induced following ODHA and TDHA, with reductions in resting rectal temperature and heart rate, and increased plasma volume and sweat rate (P < 0.05). General, Physical and Total Fatigue increased from pre-to-post for session 1 within both groups (P < 0.05). Increases in General, Physical and Total Fatigue were attenuated in session 5 and 10 vs. session 1 of ODHA (P < 0.05). This change only occurred at session 10 of TDHA (P < 0.05). Whilst comparative heat adaptations followed ODHA and TDHA, perceived fatigue is prolonged within TDHA.

ABBREVIATIONS

∆: Change; ANOVA: Analysis of variance; HA: Heat acclimation; HR: Heart rate; IL-6: Interleukin-6; MFS-SF: Multi-dimensional fatigue symptom inventory-short form (MFSI-SF); MTHA: Medium-term heat acclimation; Na+: Sodium; ODHA: Once daily heat acclimation; PV: Plasma volume; RH: Relative humidity; RPE: Rating of perceived exertion; SD: Standard deviation; SE: Standard error of the slope coefficient or intercept; SEE : Standard error of the estimate for the regression equation; STHA: Short-term heat acclimation; TDHA: Twice daily heat acclimation; TC: Thermal Comfort; Tre: Rectal temperature; TSS: Thermal sensation; V̇O2peak: Peak oxygen uptake; WBSL: whole-body sweat loss.

The time course of adaptations in thermoneutral maximal oxygen consumption following heat acclimation

PURPOSE

This study investigated the effects of a 10-day heat acclimation (HA) programme on the time course of changes in thermoneutral maximal oxygen uptake ([Formula: see text]O_2max) during and up to 10 days post-HA.

METHODS

Twenty-two male cyclists were assigned to a HA or control (Con) training group following baseline ramp tests of thermoneutral [Formula: see text]O_2max. Ten days of fixed-intensity (50% baseline [Formula: see text]O_2max) indoor cycling was performed in either ~ 38.0 °C (HA) or ~ 20 °C (Con). [Formula: see text]O_2max was re-tested on HA days 5, 10 and post-HA days 1, 2, 3, 4, 5 and 10.

RESULTS

[Formula: see text]O_2max initially declined across time in both groups during training (P < 0.05), before increasing in the post-HA period in both groups (P < 0.05). However, [Formula: see text]O_2max was higher than control by post-HA day 4 in the HA group (P = 0.046).

CONCLUSIONS

The non-linear time course of [Formula: see text]O_2max adaptation suggests that post-testing should be performed 96-h post-training to identify the maximal change for most individuals. In preparation for training or testing, athletes can augment their aerobic power in thermoneutral environments by performing 10 days HA, but the full effects will manifest at varying stages of the post-HA period.

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.

Efficacy of Heat Mitigation Strategies on Core Temperature and Endurance Exercise: A Meta-Analysis

Background: A majority of high profile international sporting events, including the coming 2020 Tokyo Olympics, are held in warm and humid conditions. When exercising in the heat, the rapid rise of body core temperature (T_c) often results in an impairment of exercise capacity and performance. As such, heat mitigation strategies such as aerobic fitness (AF), heat acclimation/acclimatization (HA), pre-exercise cooling (PC) and fluid ingestion (FI) can be introduced to counteract the debilitating effects of heat strain. We performed a meta-analysis to evaluate the effectiveness of these mitigation strategies using magnitude-based inferences.

Methods: A computer-based literature search was performed up to 24 July 2018 using the electronic databases: PubMed, SPORTDiscus and Google Scholar. After applying a set of inclusion and exclusion criteria, a total of 118 studies were selected for evaluation. Each study was assessed according to the intervention's ability to lower T_c before exercise, attenuate the rise of T_c during exercise, extend T_c at the end of exercise and improve endurance. Weighted averages of Hedges' g were calculated for each strategy.

Results: PC (g = 1.01) was most effective in lowering T_c before exercise, followed by HA (g = 0.72), AF (g = 0.65), and FI (g = 0.11). FI (g = 0.70) was most effective in attenuating the rate of rise of T_c, followed by HA (g = 0.35), AF (g = −0.03) and PC (g = −0.46). In extending T_c at the end of exercise, AF (g = 1.11) was most influential, followed by HA (g = −0.28), PC (g = −0.29) and FI (g = −0.50). In combination, AF (g = 0.45) was most effective at favorably altering T_c, followed by HA (g = 0.42), PC (g = 0.11) and FI (g = 0.09). AF (1.01) was also found to be most effective in improving endurance, followed by HA (0.19), FI (−0.16) and PC (−0.20).

Conclusion: AF was found to be the most effective in terms of a strategy's ability to favorably alter T_c, followed by HA, PC and lastly, FI. Interestingly, a similar ranking was observed in improving endurance, with AF being the most effective, followed by HA, FI, and PC. Knowledge gained from this meta-analysis will be useful in allowing athletes, coaches and sport scientists to make informed decisions when employing heat mitigation strategies during competitions in hot environments.

Intermittent sprint performance in the heat is not altered by augmenting thermal perception via L-menthol or capsaicin mouth rinses

Purpose

Cooling sensations elicited by mouth rinsing with L-menthol have been reported as ergogenic. Presently, responses to L-menthol mouth rinsing during intermittent sprint performance (ISP) in the heat are unknown and the impact of increased thermal perception on ISP via capsaicin has also not been quantified. This experiment aimed to identify whether eliciting cooling/warming sensations via L-menthol/capsaicin would alter ISP in the heat.

Method

Fourteen participants (mass = 72 ± 9 kg, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\dot {V}{{\text{O}}_{2{\text{peak}}}}$$\end{document}V˙O2peak = 3.30 ± 0.90 L min⁻¹), undertook four experimental trials, involving 40 min of ISP in hot conditions (40.2 ± 0.6 °C, 42 ± 2% R.H.) with mouth rinsing (25 mL, 6 s) at the protocol onset, and every 10 min thereafter. Cooling (0.01% L-menthol; MEN), warming (0.2% capsaicin; CAP), placebo (0.3 sham-CHO; PLA), and control (water; CON) mouth rinses were utilized. Performance was quantified via power (PP) and work done (WD) during sprints. Heart rate (HR), core (T_rec) and skin (T_skin) temperature, perceived exertion (RPE), thermal sensation (T_sens), and comfort (T_com) were measured at 10 min intervals. Sweat rate (whole-body sweat rate) was calculated from ∆mass.

Result

PP reduced over time (P < 0.05); however, no change was observed between trials for PP or WD (P > 0.05). T_com increased over time and was lower in MEN (2.7 ± 1.1; P < 0.05) with no difference between CAP (3.1 ± 1.2), PLA (3.2 ± 1.3) and CON (3.1 ± 1.3). RPE, T_sens HR, T_rec, and T_skin increased over time (P < 0.05) with no between trial differences (P > 0.05).

Conclusion

Despite improved thermal comfort via L-menthol, ISP did not improve. Capsaicin did not alter thermal perception or ISP. The reduction in ISP over time in hot conditions is not influenced by thermal perception.

Electronic supplementary material

The online version of this article (10.1007/s00421-018-4055-0) contains supplementary material, which is available to authorized users.

Passive Heating: Reviewing Practical Heat Acclimation Strategies for Endurance Athletes

Heat acclimation protocols—both active and passive—have been employed by athletes in an effort to attenuate the detrimental effects of heat stress on physical capacities and sports performance. Active strategies have been extensively reviewed, but have various practical and economic limitations. The purpose of this review was therefore to provide an overview of the passive strategies that have received less attention, yet may be more practical or economically viable; recommendations for athletes are also provided. With a systematic search of the relevant databases ending in June 2018, 16 articles on passive heat acclimation that met the inclusion criteria were included in the review. The review highlighted that passive heat acclimation strategies can successfully induce heat adaptations, evident by reports of improved exercise performance, thermoregulatory, cardiovascular, and perceptual responses accompanying such interventions. Based on the review it is apparent that the use of sauna, hot-water immersion and environmental chambers may be used to provide heat stress under passive conditions, for the purpose of acclimation. To maximize the thermoregulatory-adaptive responses, exercise bouts should be employed prior to passive heat stress, rather than passive heating alone, with a minimal delay between exercise and the application of heat stress. Heating bouts should have a minimum duration of 30 min per session and be employed on consecutive days, when possible, with a minimum of 6–7 exposures to induce adaptation. This review identified that information regarding the magnitude of performance changes that can occur, as well as the perceptual responses to passive heating protocols is limited. Future research should investigate the use of passive heat exposures before and/or after repeated heat training sessions, to assess if a further boost to heat adaptation can be achieved with this strategy.

Post-exercise Hot Water Immersion Elicits Heat Acclimation Adaptations in Endurance Trained and Recreationally Active Individuals

Hot water immersion (HWI) after exercise on 6 consecutive days in temperate conditions has been shown to provide heat acclimation adaptations in a recreationally active population. Endurance athletes experience frequent, sustained elevations in body temperature during training and competition; as a consequence, endurance athletes are considered to be partially heat acclimatized. It is therefore important to understand the extent to which endurance trained individuals may benefit from heat acclimation by post-exercise HWI. To this end, we compared the responses of eight endurance trained and eight recreationally active males (habitual weekly endurance exercise: 9 h vs. 3 h) to a 6-day intervention involving a daily treadmill run for 40 min (65% O_2max) in temperate conditions followed immediately by HWI (≤40 min, 40°C). Before (PRE) and after the intervention (POST), hallmark heat acclimation adaptations were assessed during a 40-min treadmill run at 65% O_2max in the heat (33°C, 40% RH). The 6 day, post-exercise HWI intervention induced heat acclimation adaptations in both endurance trained and recreationally active individuals. Training status did not significantly influence the magnitude of heat acclimation adaptations from PRE to POST (interactions P > 0.05) for: the reduction in end-exercise rectal core temperature (T _re, mean, endurance trained -0.36°C; recreationally active -0.47°C); the reduction in resting T _re (endurance trained -0.17°C; recreationally active -0.23°C); the reduction in T _re at sweating onset (endurance trained -0.22°C; recreationally active -0.23°C); and, the reduction in mean skin temperature (endurance trained -0.67°C; recreationally active -0.75°C: PRE to POST P < 0.01). Furthermore, training status did not significantly influence the observed reductions in mean O₂, mean metabolic energy expenditure, end-exercise physiological strain index, perceived exertion or thermal sensation (PRE to POST P < 0.05). Only end-exercise heart rate was influenced by training status (P < 0.01, interaction); whereby, recreationally active but not endurance trained individuals experienced a significant reduction in end-exercise heart rate from PRE to POST (P < 0.01). In summary, these findings demonstrate that post-exercise HWI presents a practical strategy to reduce thermal strain during exercise-heat-stress in endurance trained and recreationally active individuals.

Reliability of a wearable sweat rate monitor and routine sweat analysis techniques under heat stress in females

INTRODUCTION

The aim of the study was to evaluate the reliability of five different sweat analysis techniques which measure; whole body sweat rate [WBSR], local sweat rate [LSR] (via technical absorbent [TA] method and KuduSmart^® monitor), sweat conductivity [SC] and sweat gland activation [SGA] in a female population when exercising moderately under heat stress.

METHODS

Fourteen females (age; 26 ± 7 years, body mass; 66.5 ± 7.6 kg, height; 167.1 ± 6.4 cm) completed a preliminary threshold walking test (to determine exercise intensity) and two main trials, separated by 2 days. Main trials consisted of 30-min seated rest in the environmental chamber (35 °C, 50% relative humidity) in an upper body sauna-suit, before its removal, and walking at a moderate intensity (4 metabolic equivalents) for 30-min (speeds ranged from 4.8 to 6.5 km h^-1). WBSR was measured via nude mass pre and post exercise. The TA and Tegaderm patches (for sweat sodium chloride) were placed on the back, forearm and chest for the entire 60-min, replicated for all participants for both trials. SGA was assessed following the 60-min trial and the KuduSmart® monitor was placed on the left arm for the 30-min of exercise.

RESULTS

WBSR, LSR methods and SC demonstrated no difference between trials (p > 0.05), good agreement (within limits), strong correlations (r ≥ 0.88) and low typical error of measurements [TEM] (< 0.04 L min^-1, 0.13 mg min^-1 cm^-2 and 8 mmol L^-1, respectively). SGA method showed moderate intra-class correlation (r = 0.80), with high TEM (5 glands) and large limits of agreement.

CONCLUSION

Sudomotor function is reliable, as demonstrated by good reliability, small TEM and strong correlations. The use of these sweat techniques is appropriate and practical in females who are exercising at moderate intensity under heat stress, and so, may aid future interventions. SGA shows larger variation and should be used with caution.

Post-exercise Hot Water Immersion Elicits Heat Acclimation Adaptations in Endurance Trained and Recreationally Active Individuals

Hot water immersion (HWI) after exercise on 6 consecutive days in temperate conditions has been shown to provide heat acclimation adaptations in a recreationally active population. Endurance athletes experience frequent, sustained elevations in body temperature during training and competition; as a consequence, endurance athletes are considered to be partially heat acclimatized. It is therefore important to understand the extent to which endurance trained individuals may benefit from heat acclimation by post-exercise HWI. To this end, we compared the responses of eight endurance trained and eight recreationally active males (habitual weekly endurance exercise: 9 h vs. 3 h) to a 6-day intervention involving a daily treadmill run for 40 min (65% O_2max) in temperate conditions followed immediately by HWI (≤40 min, 40°C). Before (PRE) and after the intervention (POST), hallmark heat acclimation adaptations were assessed during a 40-min treadmill run at 65% O_2max in the heat (33°C, 40% RH). The 6 day, post-exercise HWI intervention induced heat acclimation adaptations in both endurance trained and recreationally active individuals. Training status did not significantly influence the magnitude of heat acclimation adaptations from PRE to POST (interactions P > 0.05) for: the reduction in end-exercise rectal core temperature (T_re, mean, endurance trained -0.36°C; recreationally active -0.47°C); the reduction in resting T_re (endurance trained -0.17°C; recreationally active -0.23°C); the reduction in T_re at sweating onset (endurance trained -0.22°C; recreationally active -0.23°C); and, the reduction in mean skin temperature (endurance trained -0.67°C; recreationally active -0.75°C: PRE to POST P < 0.01). Furthermore, training status did not significantly influence the observed reductions in mean O₂, mean metabolic energy expenditure, end-exercise physiological strain index, perceived exertion or thermal sensation (PRE to POST P < 0.05). Only end-exercise heart rate was influenced by training status (P < 0.01, interaction); whereby, recreationally active but not endurance trained individuals experienced a significant reduction in end-exercise heart rate from PRE to POST (P < 0.01). In summary, these findings demonstrate that post-exercise HWI presents a practical strategy to reduce thermal strain during exercise-heat-stress in endurance trained and recreationally active individuals.

A new occupational heat tolerance test: A feasibility study

Heat tolerance tests identify those susceptible to heat illnesses and monitor heat adaptations. Currently, tolerance tests do not replicate the uncompensable heat strain environments experienced in some occupations. In addition, tests can take up to 2 h to complete, and cannot offer intra and inter individual comparisons, due to the use of a fixed exercise intensity. This study aimed to assess the validity and reliability of a new heat occupational tolerance test (HOTT: 40 min at 6 W kg^-1 metabolic heat production, 50 °C 10% RH, in protective clothing) to the standard heat tolerance test (HTT: 2 h walk at 5 km h^-1 1% gradient, 40 °C 40% RH, in shorts and t-shirt). Eighteen participants (age: 21 ± 3 yrs, body mass: 81.3 ± 5.9 kg) completed trials to assess the validity and/or reliability of the HOTT. Peak rectal temperature (T_re) displayed strong agreement and low measurement error (0.19 °C) between HTT (38.7 ± 0.4 °C) and HOTT (38.6 ± 0.4 °C). Strong agreement was also displayed for physiological and perceptual measures between the two HOTT trials, including peak T_re (38.5 ± 0.4 °C vs. 38.5 ± 0.4 °C) and peak heart rate (182 ± 20 b min^-1 vs. 182 ± 21 b min^-1). The HOTT is the first tolerance test that assesses individuals' responses whilst wearing protective clothing in high temperatures. It can consistently identify individuals' levels of heat tolerance within a reduced time frame. In addition, it allows for participant monitoring over time and comparisons between individuals to be made. A continuum based approach is recommended when assessing individuals' responses to the HOTT.

Once- and twice-daily heat acclimation confer similar heat adaptations, inflammatory responses and exercise tolerance improvements

This experiment aimed to investigate the efficacy of twice-daily, nonconsecutive heat acclimation (TDHA) in comparison to once-daily heat acclimation (ODHA) and work matched once- or twice-daily temperate exercise (ODTEMP, TDTEMP) for inducing heat adaptations, improved exercise tolerance, and cytokine (immune) responses. Forty males, matched biophysically and for aerobic capacity, were assigned to ODHA, TDHA, ODTEMP, or TDTEMP. Participants completed a cycling-graded exercise test, heat acclimation state test, and a time to task failure (TTTF) at 80% peak power output in temperate (TTTFTEMP : 22°C/40% RH) and hot conditions (TTTFHOT : 38°C/20% RH), before and after 10-sessions (60 min of cycling at ~2 W·kg-1 ) in 45°C/20% RH (ODHA and TDHA) or 22°C/40% RH (ODTEMP or TDTEMP). Plasma IL-6, TNF-α, and cortisol were measured pre- and postsessions 1, 5, and 10. ODHA and TDHA induced equivalent heat adaptations (P < 0.05) (resting rectal temperature [-0.28 ± 0.22, -0.28 ± 0.19°C], heart rate [-10 ± 3, -10 ± 4 b·min-1 ], and plasma volume expansion [+10.1 ± 5.6, +8.5 ± 3.1%]) and improved heat acclimation state (sweat set point [-0.22 ± 0.18, -0.22 ± 0.14°C] and gain [+0.14 ± 0.10, +0.15 ± 0.07 g·sec-1 ·°C-1 ]). TTTFHOT increased (P < 0.001) following ODHA (+25 ± 4%) and TDHA (+24 ± 10%), but not ODTEMP (+5 ± 14%) or TDTEMP (+5 ± 17%). TTTFTEMP did not improve (P > 0.05) following ODHA (+14 ± 4%), TDHA (14 ± 8%), ODTEMP (9 ± 10%) or TDTEMP (8 ± 13%). Acute (P < 0.05) but no chronic (P > 0.05) increases were observed in IL-6, TNF-α, or cortisol during ODHA and TDHA, or ODTEMP and TDTEMP. Once- and twice-daily heat acclimation conferred similar magnitudes of heat adaptation and exercise tolerance improvements, without differentially altering immune function, thus nonconsecutive TDHA provides an effective, logistically flexible method of HA, benefitting individuals preparing for exercise-heat stress.