Strategies for increasing evaporative cooling during simulated desert patrol mission

Limitations associated with thermoregulation and cardiovascular research assessing laborers performing work in the heat

PURPOSE

To quantify the current literature and limitations associated with research examining thermoregulatory and cardiovascular strain in laborers working in the heat.

METHODS

PubMed, SCOPUS, and SPORTDiscus were searched for terms related to the cardiovascular system, heat stress, and physical work. Qualifying studies included adult participants (18-65 years old), a labor-intensive environment or exercise protocol simulating a labor environment, a minimum duration of 120 min of physical work, and environmental heat stress (ambient temperature ≥26.0°C and ≥30% relative humidity). Studies included at least one of the following outcomes: pre- and peak physical work, core temperature, heart rate (HR), systolic blood pressure, diastolic blood pressure, HR variability, and rate pressure product.

RESULTS

Twenty-one out of 1559 potential studies qualified from our search. There was a total of 598 participants (mean = 28 ± 50 participants per study, range = 4-238 participants per study), which included 51 females (8.5%) and 547 males (91.5%). Of the participants, 3.8% had cardiovascular risk factors (diabetes: n = 10; hypertension: n = 13) and 96.2% were characterized as "healthy". Fifty-seven percent of the included studies were performed in a laboratory setting.

CONCLUSIONS

Studies were predominantly in men (91.5%), laboratory settings (57%), and "healthy" individuals (96.2%). To advance equity in protection against occupational heat stress and better inform future heat safety recommendations to protect all workers, future studies must focus on addressing these limitations. Employers, supervisors, and other safety stakeholders should consider these limitations while implementing current heat safety recommendations.

Performance effects of internal pre- and per-cooling across different exercise and environmental conditions: A systematic review

Exercise in a hot and humid environment may endanger athlete's health and affect physical performance. This systematic review aimed to examine whether internal administration of ice, cold beverages or menthol solutions may be beneficial for physical performance when exercising in different environmental conditions and sports backgrounds. A systematic search was performed in PubMed, Web of Science, Scopus and SPORTDiscus databases, from inception to April 2022, to identify studies meeting the following inclusion criteria: healthy male and female physically active individuals or athletes (aged ≥18 years); an intervention consisting in the internal administration (i.e., ingestion or mouth rinse) of ice slush, ice slurry or crushed ice and/or cold beverages and/or menthol solutions before and/or during exercise; a randomized crossover design with a control or placebo condition; the report of at least one physical performance outcome; and to be written in English. Our search retrieved 2,714 articles in total; after selection, 43 studies were considered, including 472 participants, 408 men and 64 women, aged 18-42 years, with a VO2max ranging from 46.2 to 67.2 mL⋅kg-1⋅min-1. Average ambient temperature and relative humidity during the exercise tasks were 32.4 ± 3.5°C (ranging from 22°C to 38°C) and 50.8 ± 13.4% (varying from 20.0% to 80.0%), respectively. Across the 43 studies, 7 exclusively included a menthol solution mouth rinse, 30 exclusively involved ice slurry/ice slush/crushed ice/cold beverages intake, and 6 examined both the effect of thermal and non-thermal internal techniques in the same protocol. Rinsing a menthol solution (0.01%) improved physical performance during continuous endurance exercise in the heat. Conversely, the ingestion of ice or cold beverages did not seem to consistently increase performance, being more likely to improve performance in continuous endurance trials, especially when consumed during exercises. Co-administration of menthol with or within ice beverages seems to exert a synergistic effect by improving physical performance. Even in environmental conditions that are not extreme, internal cooling strategies may have an ergogenic effect. Further studies exploring both intermittent and outdoor exercise protocols, involving elite male and female athletes and performed under not extreme environmental conditions are warranted. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268197], identifier [CRD42021268197].

The Evaluation of Physiological Index Changes and Safety Work of Female Medical Staff With Different Medical Protection Standards in the Ward of COVID-19

Background

Effective personal protective equipment (PPE) contribute to the prevention of COVID-19 infection. However, it is necessary to evaluate the potential risk of different medical protections in the isolation ward of COVID-19.

Objectives

We aimed to explore the dynamics in physiological indexes of medical staff under primary and secondary PPE in the isolation ward of COVID-19 and provide the scientific basis for determining the safe work strategy.

Materials and Methods

In this study, 30 female nurses were selected to simulate medical work under the primary or secondary PPE, respectively. The oral temperature, axillary temperature, heart rate, respiratory rate, blood oxygen saturation, and blood pressure were measured and recorded every 20 min. The subjective adverse symptoms were recorded every 30 min. The blood glucose and weight of the individuals were measured and recorded before and after the trial.

Results

The results indicated that the median trial persistence time in the participants with moderate-intensity work wearing the secondary PPE (70.0 min) was much lower than that with moderate-intensity work wearing the primary PPE (180 min) and with light-intensity work wearing the primary PPE (110 min; p < 0.05). Importantly, the heart rate, oral/axillary temperature, and respiratory rate of physiological indexes of the participants under moderate-intensity work wearing the secondary PPE increased significantly faster than the primary PPE (p < 0.001), while blood oxygen saturation decreased significantly faster than the primary PPE (p < 0.001). In addition, the proportions of subjective adverse symptoms (such as dry mouth, dizziness, palpitations, and anhelation) were much higher than primary PPE (p < 0.001). The average sweat volume and blood glucose consumption of participants under moderate-intensity work wearing primary PPE were higher than secondary PPE (p < 0.001).

Conclusion

The combination of an exacerbated workload and secondary PPE worn by COVID-19 healthcare workers increases the change in physiological indicators, and in some cases the adverse symptoms, which can affect and even suspend their medical work. For any medical institution, there is room for improvement in terms of bioethics of a "Job Well Done" to reduce the risks of medical activities under secondary PPE.

Heat Strain and Use of Heat Mitigation Strategies among COVID-19 Healthcare Workers Wearing Personal Protective Equipment-A Retrospective Study

The combination of an exacerbated workload and impermeable nature of the personal protective equipment (PPE) worn by COVID-19 healthcare workers increases heat strain. We aimed to compare the prevalence of heat strain symptoms before (routine care without PPE) versus during the COVID-19 pandemic (COVID-19 care with PPE), identify risk factors associated with experiencing heat strain, and evaluate the access to and use of heat mitigation strategies. Dutch healthcare workers (n = 791) working at COVID-19 wards for ≥1 week, completed an online questionnaire to assess personal characteristics, heat strain symptoms before and during the COVID-19 pandemic, and the access to and use of heat mitigation strategies. Healthcare workers experienced ~25× more often heat strain symptoms during medical duties with PPE (93% of healthcare workers) compared to without PPE (30% of healthcare workers; OR = 25.57 (95% CI = 18.17-35.98)). Female healthcare workers and those with an age <40 years were most affected by heat strain, whereas exposure time and sports activity level were not significantly associated with heat strain prevalence. Cold drinks and ice slurry ingestion were the most frequently used heat mitigation strategies and were available in 63.5% and 30.1% of participants, respectively. Our findings indicate that heat strain is a major challenge for COVID-19 healthcare workers, and heat mitigations strategies are often used to counteract heat strain.

Commercially available carbohydrate drink with menthol fails to improve thermal perception or cycling exercise capacity in males

The purpose of this double-blinded, crossover randomized and counterbalanced study was to compare the effects of ingesting a tepid commercially available carbohydrate-menthol-containing sports drink (menthol) and an isocaloric carbohydrate-containing sports drink (placebo) on thermal perception and cycling endurance capacity "in a simulated home virtual cycling environment". It was hypothesized that the addition of menthol would improve indicators of thermal perception and improve endurance exercise capacity. Twelve healthy, endurance-trained males (age 29 ± 5 years, height 181 ± 6 cm, body mass 79 ± 2 kg and V̇O₂max 57.3 ± 6.4 mL kg^-1 min^-1) completed two experimental trials on a stationary bicycle without external air flow. Each trial consisted of (1) cycling for 60 min at 90% of the first ventilatory threshold while receiving a fixed amount of menthol or placebo every 10 min followed immediately by (2) cycling until volitional exhaustion (TTE) at 105% of the intensity corresponding to the respiratory compensation point. TTE did not differ between both conditions (541 ± 177 and 566 ± 150 s for menthol and placebo; p > 0.05) and neither did ratings of perceived thermal comfort or thermal sensation (p > 0.05). Also, the rectal temperature at the end of TTE was comparable between menthol and placebo trials (38.7 ± 0.2°C and 38.7 ± 0.3°C, respectively; p > 0.05). The present results demonstrate that the addition of menthol to commercially available sports drink does not improve thermal comfort or endurance exercise capacity during ∼65 min of intense virtual cycling.

Heat Strain with Two Different Ventilation Vests During a Simulated 3-Hour Helicopter Desert Mission

BACKGROUND: The study investigated the heat strain of personnel operating in the rear cabin of a helicopter during desert-climate missions, and to what extent the strain can be mitigated by use of battery-driven ventilation vests.METHODS: Eight men undertook 3-h simulated flight missions in desert conditions (45C, 10% humidity, solar radiation). Each subject participated in three conditions wearing helicopter flight equipment, including body armor, and either: a ventilation vest with a 3-dimensional mesh (Vent-1), a ventilation vest with a foam sheet incorporating channels to direct the air flow (Vent-2), or a T-shirt (NoVent); each mission comprised a 10-min walk, followed by sitting for 30 min, kneeling on a vibration platform for 2 h, and finally 30 min of sitting. Core temperature, heart rate, skin temperatures and heat flux, oxygen uptake, sweating rate, and subjective ratings were recorded. Evaporative capacity and thermal resistance of the garments were determined using a thermal manikin.RESULTS: All subjects completed the NoVent and Vent-1 conditions, whereas in the Vent-2 condition, one subject finished prematurely due to heat exhaustion. The increase in core temperature was significantly (P 0.01) greater in Novent (0.93C) and Vent-2 (0.88C) than in Vent-1 (0.61C). Evaporative capacity was significantly higher for Vent-1 (7.8 g min¹) than for NoVent (4.1 g min¹) and Vent-2 (4.4 g min¹).DISCUSSION: Helicopter personnel may be at risk of heat exhaustion during desert missions. The risk can be reduced by use of a ventilation vest. However, the cooling efficacy of ventilation vests differs substantially depending on their design and ventilation concept.Grönkvist M, Mekjavic I, Ciuha U, Eiken O. Heat strain with two different ventilation vests during a simulated 3-hour helicopter desert mission. Aerosp Med Hum Perform. 2021; 92(4):248256.

Effects of air-perfused rucksack on physiological and perceptual strain during low-intensity exercise in a hot environment

The upcoming Tokyo Olympic and Paralympic Games may be held amid extremely high wet-bulb globe temperature conditions. Many studies have focused on countermeasures to prevent the reduction in exercise performance in the heat. However, cooling strategies for managing heat stress of staff and spectators remain poorly understood. The present study investigated the effects of a lightweight fan cooling device, namely a commercially available air-perfused rucksack, on physiological and perceptual responses during low-intensity exercise in a hot environment. Ten males walked (5.5 km/h, 2.0% gradient) for 60 min in hot conditions (35°C, 50% relative humidity). All participants performed two trials with and without the air-perfused rucksack, respectively. Air was blown onto the upper back and neck via two fans attached on either side of the rucksack. Rectal temperature, neck skin temperature, heart rate, and physiological strain index were significantly lower during walking (P < 0.05) with the rucksack. Additionally, the ratings of perceived exertion, thermal sensation, and thermal comfort were significantly lower (P < 0.05) with the rucksack. These data suggest that the air-perfused rucksack may be effective for managing heat stress of staff and spectators at the Tokyo Olympic and Paralympic Games.

Abbreviations

CON: control trial; ES: effect sizes; FAN: fan cooling trial; HR: heart rate; _mT_sk: mean skin temperature; pre: pre-exercise; PSI: physiological strain index; RPE: rating of perceived exertion; SD: standard deviation; TC: thermal comfort; T_neck: neck skin temperature; T_re: rectal temperature; TS: thermal sensation.

Cooling During Exercise May Induce Benefits Linked to Improved Brain Perfusion

The aim of this study was to evaluate the impact of using a cooling vest during physical exercise (per-cooling) in humid and temperate conditions (≈22°C, ≈80% relative humidity) on perceptual and physiological responses (tissue oxygenation and heart rate). 20 physically active men performed twice a 30-min cycling exercise at 70% of their theoretical maximum heart rate while using an activated (experimental condition) and a deactivated (control condition) cooling system in a randomized crossover study. Heart rate and tissue (cerebral and muscular) oxygenation were continuously measured during exercise and recovery, and skin temperature was measured every 10 min. Perception of temperature, humidity and comfort were assessed at the end of the recovery period. Results showed a decrease in trunk skin temperature (p<0.05), a faster heart rate recovery and an increase in the concentration of total hemoglobin at the brain level (p<0.05) compared with control condition. Moreover, an improved subjective rating of thermal sensations, wetness and comfort compared to control values (p<0.05) was noted. In conclusion, wearing a cooling vest during submaximal exercise improves perceptual and physiological responses in humid temperate conditions, which may be due to a better blood perfusion at the brain level and a better parasympathetic reactivation.

Steps Towards Comprehensive Heat Communication in the Frame of a Heat Health Warning System in Slovenia

Occupational heat stress has an important negative impact on the well-being, health and productivity of workers and should; therefore, be recognized as a public health issue in Europe. There is no comprehensive heat health warning system in Slovenia combining public health measures with meteorological forecasts. The aim of this research was to provide insight into the development of such a system in Slovenia, turning the communication from the current meteoalarm into a broader system that has more information for different social groups. To achieve this goal, the following steps were used: Analysis of summer temperatures and issued meteoalarms, a survey of the general knowledge about heat among the public, organization and management of two stakeholder symposia, and a final survey on workers' opinions on heat stress and measures, supplemented by interviews with employers. Summer average daily temperature distributions in Slovenia changed during the investigated period (1961-2019) and the mean values increased over time by 2-3 °C. Additionally, the number of days with fulfilled yellow (potentially dangerous) and especially orange (dangerous) meteoalarm conditions increased significantly after 1990. The survey of the general public about heat stress and warnings showed that efforts to raise awareness of heat issues need to be intensified and that public health measures should effectively target vulnerable groups. Stakeholder symposia and further surveys have shown that awareness and understanding of the negative effects of heat stress on health and productivity are still quite low, so effective ways of disseminating information to different sectors while striking the best balance between efficiency, feasibility and economic cost have to be found.

Impacts of cooling intervention on the heat strain attenuation of construction workers

This study aimed to evaluate the effectiveness and practicality of a cooling intervention with a newly designed cooling vest on heat strain attenuation in the construction industry. Fourteen construction workers volunteered to participate in the field study. Each participant took part in two trials, i.e., cooling and control. Construction work included morning and afternoon sessions. Cooling intervention was implemented for 15 and 30 min during the morning and afternoon rest periods, respectively, between repeated bouts of work. Micrometeorological (wet-bulb globe temperature [WBGT]), physiological (tympanic temperature and heart rate), and perceptual (ratings of perceived exertion [RPE] and thermal sensation) measurements were taken during the test. Heat strain indices, including physiological strain index (PSI_HR) and perceptual strain index (PeSI), were estimated accordingly. During the study, construction workers were exposed to a hot environment with a mean WBGT of 31.56 ± 1.87 °C. Compared with the control, physiological and perceptual strain were significantly reduced in the cooling condition during rest and subsequent work periods (p < 0.05; d = 0.24-1.07, small to large cooling effect). Cooling intervention significantly alleviates heat strain in the construction industry. The effectiveness and practicality of a proposed cooling intervention were tested in a field study. Results provide a reference for setting guidelines and promoting application on a range of construction sites.

The Effect of Low Ambient Relative Humidity on Physical Performance and Perceptual Responses during Load Carriage

Introduction: The study evaluated the effect of low ambient relative humidity on physical performance and perceptual responses during load carriage in a hot environment.

Methods: Ten heat-unacclimatized male subjects participated in three 130-min trials, during which they walked on a treadmill, carrying a load of ~35 kg, at a speed of 3.2 km.h⁻¹, with an incident wind at the same velocity and ambient temperature at 45°C. Each trial commenced with a 10-min baseline at 20°C and 50% relative humidity (RH), the subjects transferred to a climatic chamber and commenced their simulated hike, comprising two 50-min walks separated by a 20-min rest period. In two, full protective equipment (FP) trials, RH was 10% (partial pressure of water vapor, p_H2O = 7.2 mmHg) in one (FP10), and 20% (p_H2O = 14.4 mmHg; FP20) in the other. In the control trial, subjects were semi-nude (SN) and carried the equipment in their backpacks; RH was 20%. Measurements included oxygen uptake, ventilation, heart rate, rectal and skin temperatures, heat flux, temperature perception, and thermal comfort.

Results: In FP20, four subjects terminated the trial prematurely due to signs of heat exhaustion; there were no such signs in FP10 or SN. Upon completion of the trials, pulmonary ventilation, heart rate, and rectal temperature were lower in FP10 (33 ± 5 l/min; 128 ± 21 bpm; 38.2 ± 0.4°C) and SN (34 ± 4 l/min; 113 ± 18 bpm; 38.1 ± 0.4°C than in FP20 (39 ± 8 l/min; 145 ± 12 bpm; 38.6 ± 0.4°C). Evaporation was significantly greater in the SN compared to FP10 and FP20 trials. FP10 was rated thermally more comfortable than FP20.

Conclusion: A lower ambient partial pressure of water vapor, reflected in a lower ambient relative humidity, improved cardiorespiratory, thermoregulatory, and perceptual responses during load carriage.