Body heat storage during physical activity is lower with hot fluid ingestion under conditions that permit full evaporation

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 2: physiological measurements

In this, the second of four historical reviews on human thermoregulation during exercise, we examine the research techniques developed by our forebears. We emphasise calorimetry and thermometry, and measurements of vasomotor and sudomotor function. Since its first human use (1899), direct calorimetry has provided the foundation for modern respirometric methods for quantifying metabolic rate, and remains the most precise index of whole-body heat exchange and storage. Its alternative, biophysical modelling, relies upon many, often dubious assumptions. Thermometry, used for >300 y to assess deep-body temperatures, provides only an instantaneous snapshot of the thermal status of tissues in contact with any thermometer. Seemingly unbeknownst to some, thermal time delays at some surrogate sites preclude valid measurements during non-steady state conditions. To assess cutaneous blood flow, immersion plethysmography was introduced (1875), followed by strain-gauge plethysmography (1949) and then laser-Doppler velocimetry (1964). Those techniques allow only local flow measurements, which may not reflect whole-body blood flows. Sudomotor function has been estimated from body-mass losses since the 1600s, but using mass losses to assess evaporation rates requires precise measures of non-evaporated sweat, which are rarely obtained. Hygrometric methods provide data for local sweat rates, but not local evaporation rates, and most local sweat rates cannot be extrapolated to reflect whole-body sweating. The objective of these methodological overviews and critiques is to provide a deeper understanding of how modern measurement techniques were developed, their underlying assumptions, and the strengths and weaknesses of the measurements used for humans exercising and working in thermally challenging conditions.

The effects of low and normal dose ice slurry ingestion on endurance capacity and intestinal epithelial injury in the heat

OBJECTIVES

Compare the effects of ice slurry ingestion at low and normal doses on endurance capacity and exertional heat stress-induced gastrointestinal perturbations.

DESIGN

Randomised, cross-over design.

METHODS

Twelve physically active males completed four treadmill running trials, ingesting ice slurry (ICE) or ambient drink (AMB) at 2 g·kg^-1 (Normal; N) or 1 g·kg^-1 (Low; L) doses every 15-min during exercise and 8 g·kg^-1 (N) or 4 g·kg^-1 (L) pre- and post-exercise. Pre-, during and post-exercise serum intestinal fatty-acid binding protein ([I-FABP]) and lipopolysaccharide ([LPS]) concentrations were determined.

RESULTS

Pre-exercise gastrointestinal temperature (T_gi) was lower in L + ICE than L + AMB (p < 0.05), N + ICE than N + AMB (p < 0.001) and N + ICE than L + ICE (p < 0.001). Higher rate of T_gi rise (p < 0.05) and lower estimated sweat rate (p < 0.001) were observed in N + ICE than N + AMB. Rate of T_gi rise was similar at low dose (p = 0.113) despite a lower estimated sweat rate in L + ICE than L+AMB (p < 0.01). Time-to-exhaustion was longer in L + ICE than L + AMB (p < 0.05), but similar between N + ICE and N + AMB (p = 0.142) and L + ICE and N + ICE (p = 0.766). [I-FABP] and [LPS] were similar (p > 0.05).

CONCLUSIONS

L + ICE elicited a lower heat dissipation compensatory effect with similar endurance capacity as N + ICE. Ice slurry conferred no protection against exertional heat stress-induced gastrointestinal perturbations.

Effects of internal cooling on physical performance, physiological and perceptional parameters when exercising in the heat: A systematic review with meta-analyses

Background: An elevated core temperature (Tcore) increases the risk of performance impairments and heat-related illness. Internal cooling (IC) has the potential to lower Tcore when exercising in the heat. The aim of the review was to systematically analyze the effects of IC on performance, physiological, and perceptional parameters. Methods: A systematic literature search was performed in the PubMed database on 17 December 2021. Intervention studies were included assessing the effects of IC on performance, physiological, or perceptional outcomes. Data extraction and quality assessment were conducted for the included literature. The standardized mean differences (SMD) and 95% Confidence Intervals (CI) were calculated using the inverse-variance method and a random-effects model. Results: 47 intervention studies involving 486 active subjects (13.7% female; mean age 20-42 years) were included in the meta-analysis. IC resulted in significant positive effects on time to exhaustion [SMD (95% CI) 0.40 (0.13; 0.67), p < 0.01]. IC significantly reduced Tcore [-0.19 (22120.34; -0.05), p < 0.05], sweat rate [-0.20 (-0.34; -0.06), p < 0.01], thermal sensation [-0.17 (-0.33; -0.01), p < 0.05], whereas no effects were found on skin temperature, blood lactate, and thermal comfort (p > 0.05). IC resulted in a borderline significant reduction in time trial performance [0.31 (-0.60; -0.02), p = 0.06], heart rate [-0.13 (-0.27; 0.01), p = 0.06], rate of perceived exertion [-0.16 (-0.31; -0.00), p = 0.05] and borderline increased mean power output [0.22 (0.00; 0.44), p = 0.05]. Discussion: IC has the potential to affect endurance performance and selected physiological and perceptional parameters positively. However, its effectiveness depends on the method used and the time point of administration. Future research should confirm the laboratory-based results in the field setting and involve non-endurance activities and female athletes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022336623.

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.

The Type of Per-Cooling Strategies Currently Employed by Competitive and Professional Cyclists-Triathletes During Training and Competition Are Condition (Dry vs. Humid) Dependant

Purpose

To investigate cooling strategies employed by athletes (cyclists-triathletes) during training and competition in hot and dry (HD) and hot and humid (HH) conditions.

Methods

Thirty-five athletes completed an online questionnaire on the type, timing, and justification of cooling strategies employed during past training and/or competitions in HD and HH conditions. In addition, 3 athletes also completed a one-to-one follow-up interview.

Results

Comparisons between strategies employed in all conditions were based on N = 14 (40%). Cold-water pouring was the most employed (N = 4; 21%) strategy during training and/or competing in hot conditions. The timing of the strategies employed was based on pitstops only (N = 7; 50%). The justification for strategies employed was based on trial and error (N = 9, 42.85%: N = 10, 47.61%). All athletes rated strategies employed as 1 (“not effective for minimising performance impairments and heat-related illnesses”). Comparisons between HD and HH were based on N = 21 (60%), who employed different strategies based on condition. Cold-water ingestion was the most employed (N = 9, 43%) strategy in HD, whereas a combination of cold-water ingestion and pouring was the most employed (N = 9, 43%) strategy in HH. The timing of strategies employed in the HD split was pre-planned by distance but was modified based on how athletes felt during (N = 8, 38%), and pre-planned by distance and pit stops (N = 8, 38%). The timing of strategies employed in HH was pre-planned based on distance and how athletes felt during (N = 9, 42%). About 57% (N = 12) of the 60% (N = 21) perceived effectiveness in HD and HH as 3 (“Sometimes effective and sometimes not effective”), whereas 43% (N = 9) of the 60% (N = 21) perceived effectiveness in HD and HH as 4 (“Effective for minimising performance impairments”).

Conclusion

Cold-water ingestion is the preferred strategy by athletes in HD compared to a combination of cold-water ingestion and pouring in HH conditions. All strategies were pre-planned and trialled based on distance and how athletes felt during training and/or competition. These strategies were perceived as effective for minimising performance impairments, but not heat-related illnesses. Future studies should evaluate the effectiveness of these cooling strategies on performance and thermoregulatory responses in HD and HH conditions.

Looking ahead of 2021 Tokyo Summer Olympic Games: How Does Humid Heat Affect Endurance Performance? Insight into physiological mechanism and heat-related illness prevention strategies

The combination of high humidity and ambient temperature of the 2021 Tokyo Summer Olympic Game will undoubtfully result in greater physiological strains and thereby downregulates the endurance performance of athletes. Although many research studies have highlighted that the thermoregulatory strain is greater when the environment is hot and humid, no review articles have addressed the thermoregulatory and performance differences between dry and humid heat and such lack of consensuses in this area will lead to increase the risk of heat-related injuries as well as suboptimal preparation. Furthermore, specific strategies to counteract this stressful environment has not been outlined in the current literature. Therefore, the purposes of this review are: 1) to provide a clear evidence that humid heat is more stressful than dry heat for both male and female athletes and therefore the preparation for the Tokyo Summer Olympic should be environmental specific instead of a one size fits all approach; 2) to highlight why female athletes may be facing a disadvantage when performing a prolonged endurance event under high humidity environment and 3) to highlight the potential interventional strategies to reduce thermal strain in hot-humid environment. The summaries of this review are: both male and female should be aware of the environmental condition in Tokyo as humid heat is more stressful than dry heat; Short-term heat acclimation may not elicit proper thermoregulatory adaptations in hot-humid environment; cold water immersion with proper hydration and some potential per-cooling modalities may be beneficial for both male and female athletes in hot-humid environment.

Dynamic brain-body coupling of breath-by-breath O2-CO2 exchange ratio with resting state cerebral hemodynamic fluctuations

BACKGROUND

The origin of low frequency cerebral hemodynamic fluctuations (CHF) in the resting state remains unknown. Breath-by breath O2-CO2 exchange ratio (bER) has been reported to correlate with the cerebrovascular response to brief breath hold challenge at the frequency range of 0.008-0.03Hz in healthy adults. bER is defined as the ratio of the change in the partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration. In this study, we aimed to investigate the contribution of respiratory gas exchange (RGE) metrics (bER, ΔPO2 and ΔPCO2) to low frequency CHF during spontaneous breathing.

METHODS

Twenty-two healthy adults were included. We used transcranial Doppler sonography to evaluate CHF by measuring the changes in cerebral blood flow velocity (ΔCBFv) in bilateral middle cerebral arteries. The regional CHF were mapped with blood oxygenation level dependent (ΔBOLD) signal changes using functional magnetic resonance imaging. Temporal features and frequency characteristics of RGE metrics during spontaneous breathing were examined, and the simultaneous measurements of RGE metrics and CHF (ΔCBFv and ΔBOLD) were studied for their correlation.

RESULTS

We found that the time courses of ΔPO2 and ΔPCO2 were interdependent but not redundant. The oscillations of RGE metrics were coherent with resting state CHF at the frequency range of 0.008-0.03Hz. Both bER and ΔPO2 were superior to ΔPCO2 in association with CHF while CHF could correlate more strongly with bER than with ΔPO2 in some brain regions. Brain regions with the strongest coupling between bER and ΔBOLD overlapped with many areas of default mode network including precuneus and posterior cingulate.

CONCLUSION

Although the physiological mechanisms underlying the strong correlation between bER and CHF are unclear, our findings suggest the contribution of bER to low frequency resting state CHF, providing a novel insight of brain-body interaction via CHF and oscillations of RGE metrics.

Thermoregulatory responses to ice slurry ingestion during low and moderate intensity exercises with restrictive heat loss

OBJECTIVES

We investigated the thermoregulatory responses to ice slurry ingestion during low- and moderate-intensity exercises with restrictive heat loss.

DESIGN

Randomised, counterbalanced, cross-over design.

METHODS

Following a familiarisation trial, ten physically active males exercised on a motorised treadmill at low-intensity (L; 40% VO_2max) or moderate-intensity (M; 70% VO_2max) for 75-min, in four randomised, counterbalanced trials. Throughout the exercise bout, participants donned a raincoat to restrict heat loss. Participants ingested 2gkg^-1 body mass of ambient water (L+AMB and M+AMB trials) or ice slurry (L+ICE and M+ICE trials) at 15-min intervals during exercise in environmental conditions of T_db, 25.1±0.6°C and RH, 63±5%. Heart rate (HR), gastrointestinal temperature (T_gi), mean weighted skin temperature (T_sk), estimated sweat loss, ratings of perceived exertion (RPE) and thermal sensation (RTS) were recorded.

RESULTS

Compared to L+AMB, participants completed L+ICE trials with lower ΔT_gi (0.8±0.3°C vs 0.6±0.2°C; p=0.03), mean RPE (10±1 vs 9±1; p=0.03) and estimated sweat loss (0.91±0.2L vs 0.78±0.27L; p=0.04). Contrastingly, T_gi (p=0.22), T_sk (p=0.37), HR (p=0.31), RPE (p=0.38) and sweat loss (p=0.17) were similar between M+AMB and M+ICE trials. RTS was similar during both low-intensity (4.9±0.5 vs 4.7±0.3; p=0.10) and moderate-intensity exercise (5.3±0.47 vs 5.0±0.4; p=0.09).

CONCLUSIONS

Per-cooling using ice slurry ingestion marginally reduced thermal strain during low-intensity but not during moderate-intensity exercise. Ice slurry may be an effective and practical heat mitigation strategy during low-intensity exercise such as in occupational and military settings, but a greater volume should be considered to ensure its efficacy.

Cerebrovascular reactivity assessment with O2-CO2 exchange ratio under brief breath hold challenge

BACKGROUND

Hypercapnia during breath holding is believed to be the dominant driver behind the modulation of cerebral blood flow (CBF). However, increasing evidence show that mild hypoxia and mild hypercapnia in breath hold (BH) could work synergistically to enhance CBF response. We hypothesized that breath-by-breath O2-CO2 exchange ratio (bER), defined as the ratio of the change in partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration, would be able to better correlate with the global and regional cerebral hemodynamic responses (CHR) to BH challenge. We aimed to investigate whether bER is a more useful index than end-tidal PCO2 to characterize cerebrovascular reactivity (CVR) under BH challenge.

METHODS

We used transcranial Doppler ultrasound (TCD) to evaluate CHR under BH challenge by measuring cerebral blood flow velocity (CBFv) in the middle cerebral arteries. Regional changes in CHR to BH and exogenous CO2 challenges were mapped with blood oxygenation level dependent (BOLD) signal changes using functional magnetic resonance imaging (fMRI). We correlated respiratory gas exchange (RGE) metrics (bER, ΔPO2, ΔPCO2, end-tidal PCO2 and PO2, and time of breaths) with CHR (CBFv and BOLD) to BH challenge. Temporal features and frequency characteristics of RGE metrics and their coherence with CHR were examined.

RESULTS

CHR to brief BH epochs and free breathing were coupled with both ΔPO2 and ΔPCO2. We found that bER was superior to either ΔPO2 or ΔPCO2 alone in coupling with the changes of CBFv and BOLD signals under breath hold challenge. The regional CVR results derived by regressing BOLD signal changes on bER under BH challenge resembled those derived by regressing BOLD signal changes on end-tidal PCO2 under exogenous CO2 challenge.

CONCLUSION

Our findings provide a novel insight on the potential of using bER to better quantify CVR changes under BH challenge.

Thermal behavior alleviates thermal discomfort during steady-state exercise without affecting whole body heat loss

We tested the hypothesis that thermal behavior resulting in reductions in mean skin temperature alleviates thermal discomfort and mitigates the rise in core temperature during light-intensity exercise. In a 27 ± 0°C, 48 ± 6% relative humidity environment, 12 healthy subjects (6 men, 6 women) completed 60 min of recumbent cycling. In both trials, subjects wore a water-perfused suit top continually perfusing 34 ± 0°C water. In the behavior trial, subjects maintained their upper body thermally comfortable by pressing a button to perfuse cool water (2.2 ± 0.5°C) through the top for 2 min per button press. Metabolic heat production (control: 404 ± 52 W, behavior: 397 ± 65 W; P = 0.44) was similar between trials. Mean skin temperature was reduced in the behavior trial (by -2.1 ± 1.8°C, P < 0.01) because of voluntary reductions in water-perfused top temperature (P < 0.01). Whole body (P = 0.02) and local sweat rates were lower in the behavior trial (P ≤ 0.05). Absolute core temperature was similar (P ≥ 0.30); however, the change in core temperature was greater in the behavior trial after 40 min of exercise (P ≤ 0.03). Partitional calorimetry did not reveal any differences in cumulative heat storage (control: 554 ± 229, behavior: 544 ± 283 kJ; P = 0.90). Thermal behavior alleviated whole body thermal discomfort during exercise (by -1.17 ± 0.40 arbitrary units, P < 0.01). Despite lower evaporative cooling in the behavior trial, similar heat loss was achieved by voluntarily employing convective cooling. Therefore, thermal behavior resulting in large reductions in skin temperature is effective at alleviating thermal discomfort during exercise without affecting whole body heat loss.NEW & NOTEWORTHY This study aimed to determine the effectiveness of thermal behavior in maintaining thermal comfort during exercise by allowing subjects to voluntarily cool their torso and upper limbs with 2°C water throughout a light-intensity exercise protocol. We show that voluntary cooling of the upper body alleviates thermal discomfort while maintaining heat balance through convective rather than evaporative means of heat loss.

Partitional calorimetry

For thermal physiologists, calorimetry is an important methodological tool to assess human heat balance during heat or cold exposures. A whole body direct calorimeter remains the gold standard instrument for assessing human heat balance; however, this equipment is rarely available to most researchers. A more widely accessible substitute is partitional calorimetry, a method by which all components of the conceptual heat balance equation-metabolic heat production, conduction, radiation, convection, and evaporation-are calculated separately based on fundamental properties of energy exchange. Since partitional calorimetry requires relatively inexpensive equipment (vs. direct calorimetry) and can be used over a wider range of experimental conditions (i.e., different physical activities, laboratory or field settings, clothed or seminude), it allows investigators to address a wide range of problems such as predicting human responses to thermal stress, developing climatic exposure limits and fluid replacement guidelines, estimating clothing properties, evaluating cooling/warming interventions, and identifying potential thermoregulatory dysfunction in unique populations. In this Cores of Reproducibility in Physiology (CORP) review, we summarize the fundamental principles underlying the use of partitional calorimetry, present the various methodological and arithmetic requirements, and provide typical examples of its use. Strategies to minimize estimation error of specific heat balance components, as well as the limitations of the method, are also discussed. The goal of this CORP paper is to present a standardized methodology and thus improve the accuracy and reproducibility of research employing partitional calorimetry.

Does Cold Water or Ice Slurry Ingestion During Exercise Elicit a Net Body Cooling Effect in the Heat?

Cold water or ice slurry ingestion during exercise seems to be an effective and practical means to improve endurance exercise performance in the heat. However, transient reductions in sweating appear to decrease the potential for evaporative heat loss from the skin by a magnitude that at least negates the additional internal heat loss as a cold ingested fluid warms up to equilibrate with body temperature; thus explaining equivalent core temperatures during exercise at a fixed heat production irrespective of the ingested fluid temperature. Internal heat transfer with cold fluid/ice is always 100% efficient; therefore, when a decrement occurs in the efficiency that sweat evaporates from the skin surface (i.e. sweating efficiency), a net cooling effect should begin to develop. Using established relationships between activity, climate and sweating efficiency, the boundary conditions beyond which cold ingested fluids are beneficial in terms of increasing net heat loss can be calculated. These conditions are warmer and more humid for cycling relative to running by virtue of the greater skin surface airflow, which promotes evaporation, for a given metabolic heat production and thus sweat rate. Within these boundary conditions, athletes should ingest fluids at the temperature they find most palatable, which likely varies from athlete to athlete, and therefore best maintain hydration status. The cooling benefits of cold fluid/ice ingestion during exercise are likely disproportionately greater for athletes with physiological disruptions to sweating, such as those with a spinal cord injury or burn injuries, as their capacity for skin surface evaporative heat loss is much lower; however, more research examining these groups is needed.

Temperature of water ingested before exercise alters the onset of physiological heat loss responses

This study sought to determine whether the temperature of water ingested before exercise alters the onset threshold and subsequent thermosensitivity of local vasomotor and sudomotor responses after exercise begins. Twenty men [24 (SD 4) yr of age, 75.8 (SD 8.1) kg body mass, 52.3 (SD 7.7) ml·min^-1·kg^-1 peak O₂ consumption (V̇o_2peak)] ingested 1.5°C, 37°C, or 50°C water (3.2 ml/kg), rested for 5 min, and then cycled at 50% V̇o_2peak for 15 min at 23.0 (SD 0.9) °C and 32 (SD 10) % relative humidity. Mean body temperature (T_b), local sweat rate (LSR), and skin blood flow (SBF) were measured. In a subset of eight men [25 (SD 5) yr of age, 78.6 (SD 8.3) kg body mass, 48.9 (SD 11.1) ml·min^-1·kg^-1 V̇o_2peak], blood pressure was measured and cutaneous vascular conductance (CVC) was determined. The change in T_b was greater at the onset of LSR measurement with ingestion of 1.5°C than 50°C water [ΔT_b = 0.19 (SD 0.15) vs. 0.11 (SD 0.12) °C, P = 0.04], but not 37°C water [ΔT_b = 0.14 (SD 0.14) °C, P = 0.23], but did not differ between trials for SBF measurement [ΔT_b = 0.18 (SD 0.15) °C, 0.11 (SD 0.13) °C, and 0.09 (SD 0.09) °C with 1.5°C, 37°C, and 50°C water, respectively, P = 0.07]. Conversely, the thermosensitivity of LSR and SBF was not different [LSR = 1.11 (SD 0.75), 1.11 (SD 0.75), and 1.34 (SD 1.11) mg·min^-1·cm^-2·°C^-1 with 1.5°C, 37°C, and 50°C ingested water, respectively ( P = 0.46); SBF = 717 (SD 882), 517 (SD 606), and 857 (SD 904) %baseline arbitrary units (AU)/°C with 1.5°C, 37°C, and 50°C ingested water, respectively ( P = 0.95)]. After 15 min of exercise, LSR and SBF were greater with ingestion of 50°C than 1.5°C water [LSR = 0.40 (SD 0.17) vs. 0.31 (SD 0.19) mg·min^-1·cm^-2 ( P = 0.02); SBF = 407 (SD 149) vs. 279 (SD 117) %baseline AU ( P < 0.001)], but not 37°C water [LSR = 0.50 (SD 0.22) mg·min^-1·cm^-2; SBF = 324 (SD 169) %baseline AU]. CVC was statistically unaffected [275 (SD 81), 340 (SD 114), and 384 (SD 160) %baseline CVC with 1.5°C, 37°C, and 50°C ingested water, respectively, P = 0.30]. Collectively, these results support the concept that visceral thermoreceptors modify the central drive for thermoeffector responses.

The effect of hot and cold drinks on thermoregulation, perception, and performance: the role of the gut in thermoreception

PURPOSE

Hot compared to cold drinks alter sweating responses during very low intensity exercise in temperate conditions. The thermoregulatory, perceptual, and performance effects of hot compared to cold drinks in hot, dry conditions during high-intensity exercise have not been examined.

METHOD

Ten participants [mean ± SD characteristics age 25 ± 5 years, height 1.81 ± 0.07 m, body mass 73.5 ± 10.6 kg, maximal power output (P_Max) 350 ± 41 W] completed two conditions, where they drank four boluses (ingested at - 9, 15, 30, and 45 min, respectively) of 3.2 mL kg^- 1 (~ 960 mL total) of either a COLD (5.3 °C) or a HOT drink (49.0 °C), which were contrasted to a no-drink CONTROL. They cycled for 60-min [55% P_Max in hot (34.4 °C) dry (34% RH)] ambient conditions followed by a test to exhaustion (TTE; 80% P_Max). The thermoregulatory, performance, and perceptual implications of drink temperature were measured.

RESULTS

TTE was worse in the CONTROL (170 ± 132 s) than the COLD drink (371 ± 272 s; p = 0.021) and HOT drink conditions (367 ± 301 s; p = 0.038) which were not different (p = 0.965). Sweat responses [i.e., reflex changes in mean skin temperature (T_msk) and galvanic skin conductance] indicated transient reductions in sweating response after COLD drink ingestion. The COLD drink improved thermal comfort beyond the transient changes in sweating.

CONCLUSION

Only COLD drink ingestion changed thermoregulation, but improved perceptual response. Accordingly, we conclude a role for gut thermoreception in thermal perception during exercise in hot, dry conditions.

Individual differences in normal body temperature: longitudinal big data analysis of patient records

OBJECTIVE

To estimate individual level body temperature and to correlate it with other measures of physiology and health.

DESIGN

Observational cohort study.

SETTING

Outpatient clinics of a large academic hospital, 2009-14.

PARTICIPANTS

35 488 patients who neither received a diagnosis for infections nor were prescribed antibiotics, in whom temperature was expected to be within normal limits.

MAIN OUTCOME MEASURES

Baseline temperatures at individual level, estimated using random effects regression and controlling for ambient conditions at the time of measurement, body site, and time factors. Baseline temperatures were correlated with demographics, medical comorbidities, vital signs, and subsequent one year mortality.

RESULTS

In a diverse cohort of 35 488 patients (mean age 52.9 years, 64% women, 41% non-white race) with 243 506 temperature measurements, mean temperature was 36.6°C (95% range 35.7-37.3°C, 99% range 35.3-37.7°C). Several demographic factors were linked to individual level temperature, with older people the coolest (-0.021°C for every decade, P<0.001) and African-American women the hottest (versus white men: 0.052°C, P<0.001). Several comorbidities were linked to lower temperature (eg, hypothyroidism: -0.013°C, P=0.01) or higher temperature (eg, cancer: 0.020, P<0.001), as were physiological measurements (eg, body mass index: 0.002 per m/kg², P<0.001). Overall, measured factors collectively explained only 8.2% of individual temperature variation. Despite this, unexplained temperature variation was a significant predictor of subsequent mortality: controlling for all measured factors, an increase of 0.149°C (1 SD of individual temperature in the data) was linked to 8.4% higher one year mortality (P=0.014).

CONCLUSIONS

Individuals' baseline temperatures showed meaningful variation that was not due solely to measurement error or environmental factors. Baseline temperatures correlated with demographics, comorbid conditions, and physiology, but these factors explained only a small part of individual temperature variation. Unexplained variation in baseline temperature, however, strongly predicted mortality.

Sports and environmental temperature: From warming-up to heating-up

Most professional and recreational athletes perform pre-conditioning exercises, often collectively termed a 'warm-up' to prepare for a competitive task. The main objective of warming-up is to induce both temperature and non-temperature related responses to optimize performance. These responses include increasing muscle temperature, initiating metabolic and circulatory adjustments, and preparing psychologically for the upcoming task. However, warming-up in hot and/or humid ambient conditions increases thermal and circulatory strain. As a result, this may precipitate neuromuscular and cardiovascular impairments limiting endurance capacity. Preparations for competing in the heat should include an acclimatization regimen. Athletes should also consider cooling interventions to curtail heat gain during the warm-up and minimize dehydration. Indeed, although it forms an important part of the pre-competition preparation in all environmental conditions, the rise in whole-body temperature should be limited in hot environments. This review provides recommendations on how to build an effective warm-up following a 3 stage RAMP model (Raise, Activate and Mobilize, Potentiate), including general and context specific exercises, along with dynamic flexibility work. In addition, this review provides suggestion to manipulate the warm-up to suit the demands of competition in hot environments, along with other strategies to avoid heating-up.

Evidence of viscerally-mediated cold-defence thermoeffector responses in man

KEY POINTS

Visceral thermoreceptors that modify thermoregulatory responses are widely accepted in animal but not human thermoregulation models. Recently, we have provided evidence of viscerally-mediated sweating alterations in humans during exercise brought about by warm and cool fluid ingestion. In the present study, we characterize the modification of shivering and whole-body thermal sensation during cold stress following the administration of a graded thermal stimuli delivered to the stomach via fluid ingestion at 52, 37, 22 and 7°C. Despite no differences in core and skin temperature, fluid ingestion at 52°C rapidly decreased shivering and sensations of cold compared to 37°C, whereas fluid ingestion at 22 and 7°C led to equivalent increases in these responses. Warm and cold fluid ingestion independently modifies cold defence thermoeffector responses, supporting the presence of visceral thermoreceptors in humans. However, the cold-defence thermoeffector response patterns differed from previously identified hot-defence thermoeffectors.

ABSTRACT

Sudomotor activity is modified by both warm and cold fluid ingestion during heat stress, independently of differences in core and skin temperatures, suggesting independent viscerally-mediated modification of thermoeffectors. The present study aimed to determine whether visceral thermoreceptors modify shivering responses to cold stress. Ten males (mean ± SD: age 27 ± 5 years; height 1.73 ± 0.06 m, weight 78.4 ± 10.7 kg) underwent whole-body cooling via a water perfusion suit at 5°C, on four occasions, to induce a steady-state shivering response, at which point two aliquots of 1.5 ml kg^-1 (SML) and 3.0 ml kg^-1 (LRG), separated by 20 min, of water at 7, 22, 37 or 52°C were ingested. Rectal, mean skin and mean body temperature (T_b ), electromyographic activity (EMG), metabolic rate (M) and whole-body thermal sensation on a visual analogue scale (WBTS) ranging from 0 mm (very cold) to 200 mm (very hot) were all measured throughout. T_b was not different between all fluid temperatures following SML fluid ingestion (7°C: 35.7 ± 0.5°C; 22°C: 35.6 ± 0.5°C; 37°C: 35.5 ± 0.4°C; 52°C: 35.5 ± 0.4°C; P = 0.27) or LRG fluid ingestion (7°C: 35.3 ± 0.6°C; 22°C: 35.3 ± 0.5°C; 37°C: 35.2 ± 0.5°C; 52°C: 35.3 ± 0.5°C; P = 0.99). With SML fluid ingestion, greater metabolic rates and cooler thermal sensations were observed with ingestion at 7°C (M: 179 ± 55 W, WBTS: 29 ± 21 mm) compared to 52°C (M: 164 ± 34 W, WBTS: 51 ± 28 mm; all P < 0.05). With LRG ingestion, compared to shivering and thermal sensations with ingestion at 37°C (M: 215 ± 47 W, EMG: 3.9 ± 2.5% MVC, WBTS: 33 ± 2 mm), values were different (all P < 0.05) following ingestion at 7°C (M: 269 ± 77 W, EMG: 5.5 ± 0.9% MVC, WBTS: 14 ± 12 mm), 22°C (M: 270 ± 86 W, EMG: 5.6 ± 1.0% MVC, WBTS: 18 ± 19 mm) and 52°C (M: 179 ± 34 W, EMG: 3.3 ± 2.1% MVC, WBTS: 53 ± 28 mm). In conclusion, fluid ingestion at 52°C decreased shivering and the sensation of coolness, whereas fluid ingestion at 22 and 7°C increased shivering and sensations of coolness to similar levels, independently of core and skin temperature.

Ice Slurry Ingestion Leads to a Lower Net Heat Loss during Exercise in the Heat

PURPOSE

To compare the reductions in evaporative heat loss from the skin (Esk) to internal heat loss (Hfluid) induced by ice slurry (ICE) ingestion relative to 37 °C fluid and the accompanying body temperature and local thermoeffector responses during exercise in warm, dry conditions (33.5 °C ± 1.4 °C; 23.7% ± 2.6% relative humidity [RH]).

METHODS

Nine men cycled at approximately 55% VO2peak for 75 min and ingested 3.2 mL · kg(-1) aliquots of 37 °C fluid or ICE after 15, 30, and 45 min of exercise. Metabolic heat production (M-W), rectal temperature (Tre), mean skin temperature (Tsk), whole-body sweat loss (WBSL), local sweat rate (LSR), and skin blood flow (SkBF) were measured throughout. Net heat loss (HLnet) and heat storage (S) were estimated using partitional calorimetry.

RESULTS

Relative to the 37 °C trial, M-W was similar (P = 0.81) with ICE ingestion; however, the 200 ± 20 kJ greater Hfluid (P < 0.001) with ICE ingestion was overcompensated by a 381 ± 199-kJ lower Esk (P < 0.001). Net heat loss (HLnet) was consequently 131 ± 120 kJ lower (P = 0.01) and S was greater (P = 0.05) with ICE ingestion compared with 37 °C fluid ingestion. Concurrently, LSR and WBSL were lower by 0.16 ± 0.14 mg · min(-1) · cm(-2) (P < 0.01) and 191 ± 122 g (P < 0.001), respectively, and SkBF tended to be lower (P = 0.06) by 5.4%maxAU ± 13.4%maxAU in the ICE trial. Changes in Tre and Tsk were similar throughout exercise with ICE compared to 37 °C fluid ingestion.

CONCLUSIONS

Relative to 37 °C, ICE ingestion caused disproportionately greater reductions in Esk relative to Hfluid, resulting in a lower HLnet and greater S. Mechanistically, LSR and possibly SkBF were suppressed independently of Tre or Tsk, reaffirming the concept of human abdominal thermoreception. From a heat balance perspective, recommendations for ICE ingestion during exercise in warm, dry conditions should be reconsidered.

Occupational heat stress in Australian workplaces

The aim of this review was to summarize the current state of knowledge on heat stress risk within typical Australian occupational settings. We assessed identified occupations (mining, agriculture, construction, emergency services) for heat production and heat loss potential, and resultant levels of physiological heat strain. A total of 29 reports were identified that assessed in-situ work settings in Northern Territory, South Australia, Western Australia, Queensland, New South Wales and Victoria, that measured physiological responses and characterized the thermal environment. Despite workers across all industries being regularly exposed to high ambient temperatures (32-42°C) often coupled with high absolute humidity (max: 33 hPa), physiological strain is generally low in terms of core temperature (<38°C) and dehydration (<1 % reduction in mass) by virtue of the low energy demands of many tasks, and self-regulated pacing of work possible in most jobs. Heat stress risk is higher in specific jobs in agriculture (e.g. sheep shearing), deep underground mining, and emergency services (e.g., search/rescue and bushfire fighting). Heat strain was greatest in military-related activities, particularly externally-paced marching with carried loads which resulted in core temperatures often exceeding 39.5°C despite being carried out in cooler environments. The principal driver of core temperature elevations in most jobs is the rate of metabolic heat production. A standardized approach to evaluating the risk of occupational heat strain in Australian workplaces is recommended defining the individual parameters that alter human heat balance. Future research should also more closely examine female workers and occupational activities within the forestry and agriculture/horticulture sector.

Consensus Recommendations on Training and Competing in the Heat

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise–heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.

Temperature of Ingested Water during Exercise Does Not Affect Body Heat Storage

PURPOSE

The objective of this study was to examine the effect of ingested water temperature on heat balance during exercise as assessed by direct calorimetry.

METHODS

Ten healthy males (25 ± 4 yr) cycled at 50% V˙O2peak (equivalent rate of metabolic heat production (M-W) of 523 ± 84 W) for 75 min under thermocomfortable conditions (25°C, 25% relative humidity) while consuming either hot (50°C) or cold (1.5°C) water. Four 3.2 mL·kg⁻¹ boluses of hot or cold water were consumed 5 min before and at 15, 30, and 45 min after the onset of exercise. Total heat loss (HL = evaporative heat loss (HE) ± dry heat exchange (HD)) and M-W were measured by direct and indirect calorimetry, respectively. Change in body heat content (ΔHb) was calculated as the temporal summation of M-W and HL and adjusted for changes in heat transfer from the ingested fluid (Hfluid).

RESULTS

The absolute difference for HL (209 ± 81 kJ) was similar to the absolute difference of Hfluid (204 ± 36 kJ) between conditions (P = 0.785). Furthermore, the difference in HL was primarily explained by the corresponding changes in HE (hot: 1538 ± 393 kJ; cold: 1358 ± 330 kJ) because HD was found to be similar between conditions (P = 0.220). Consequently, no difference in ΔHb was observed between the hot (364 ± 152 kJ) and cold (363 ± 134 kJ) conditions (P = 0.971) during exercise.

CONCLUSION

We show that ingestion of hot water elicits a greater HL relative to cold water ingestion during exercise. However, this response was only compensated for the heat of the ingested fluid as evidenced by similar ΔHb between conditions. Therefore, our findings indicate that relative to cold water ingestion, consuming hot water does not provide a thermoregulatory advantage. Both hot and cold water ingestion results in the same amount of heat stored during prolonged moderate-intensity exercise.

The role of fluid temperature and form on endurance performance in the heat

Exercising in the heat often results in an excessive increase in body core temperature, which can be detrimental to health and endurance performance. Research in recent years has shifted toward the optimum temperature at which drinks should be ingested. The ingestion of cold drinks can reduce body core temperature before exercise but less so during exercise. Temperature of drinks does not seem to have an effect on the rate of gastric emptying and intestinal absorption. Manipulating the specific heat capacity of a solution can further induce a greater heat sink. Ingestion of ice slurry exploits the additional energy required to convert the solution from ice to water (enthalpy of fusion). Body core temperature is occasionally observed to be higher at the point of exhaustion with the ingestion of ice slurry. There is growing evidence to suggest that ingesting ice slurry is an effective and practical strategy to prevent excessive rise of body core temperature and improve endurance performance. This information is especially important when only a fixed amount of fluid is allowed to be carried, often seen in some ultra-endurance events and military operations. Future studies should evaluate the efficacy of ice slurry in various exercise and environmental conditions.

Consensus recommendations on training and competing in the heat

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events, for hydration and body cooling opportunities, when competitions are held in the heat.

Mild evaporative cooling applied to the torso provides thermoregulatory benefits during running in the heat

We investigated the effects of mild evaporative cooling applied to the torso, before or during running in the heat. Nine male participants performed three trials: control-no cooling (CTR), pre-exercise cooling (PRE-COOL), and during-exercise cooling (COOL). Trials consisted of 10-min neutral exposure and 50-min heat exposure (30 °C; 44% humidity), during which a 30-min running protocol (70% VO2max ) was performed. An evaporative cooling t-shirt was worn before the heat exposure (PRE-COOL) or 15 min after the exercise was started (COOL). PRE-COOL significantly lowered local skin temperature (Tsk ) (up to -5.3 ± 0.3 °C) (P < 0.001), mean Tsk (up to -2 ± 0.1 °C) (P < 0.001), sweat losses (-143 ± 40 g) (P = 0.002), and improved thermal comfort (P = 0.001). COOL suddenly lowered local Tsk (up to -3.8 ± 0.2 °C) (P < 0.001), mean Tsk (up to -1 ± 0.1 °C) (P < 0.001), heart rate (up to -11 ± 2 bpm) (P = 0.03), perceived exertion (P = 0.001), and improved thermal comfort (P = 0.001). We conclude that the mild evaporative cooling provided significant thermoregulatory benefits during exercise in the heat. However, the timing of application was critical in inducing different thermoregulatory responses. These findings provide novel insights on the thermoregulatory role of Tsk during exercise in the heat.

Thermometry, calorimetry, and mean body temperature during heat stress

Heat balance in humans is maintained at near constant levels through the adjustment of physiological mechanisms that attain a balance between the heat produced within the body and the heat lost to the environment. Heat balance is easily disturbed during changes in metabolic heat production due to physical activity and/or exposure to a warmer environment. Under such conditions, elevations of skin blood flow and sweating occur via a hypothalamic negative feedback loop to maintain an enhanced rate of dry and evaporative heat loss. Body heat storage and changes in core temperature are a direct result of a thermal imbalance between the rate of heat production and the rate of total heat dissipation to the surrounding environment. The derivation of the change in body heat content is of fundamental importance to the physiologist assessing the exposure of the human body to environmental conditions that result in thermal imbalance. It is generally accepted that the concurrent measurement of the total heat generated by the body and the total heat dissipated to the ambient environment is the most accurate means whereby the change in body heat content can be attained. However, in the absence of calorimetric methods, thermometry is often used to estimate the change in body heat content. This review examines heat exchange during challenges to heat balance associated with progressive elevations in environmental heat load and metabolic rate during exercise. Further, we evaluate the physiological responses associated with heat stress and discuss the thermal and nonthermal influences on the body's ability to dissipate heat from a heat balance perspective.

Cardiovascular and metabolic responses to tap water ingestion in young humans: does the water temperature matter?

AIM

Drinking water induces short-term cardiovascular and metabolic changes. These effects are considered to be triggered by gastric distension and osmotic factors, but little is known about the influence of water temperature.

METHODS

We determined, in a randomized crossover study, the acute cardiovascular and metabolic responses to 500 mL of tap water at 3 °C (cold), 22 °C (room) and 37 °C (body) in 12 young humans to ascertain an effect of water temperature. We measured continuous beat-to-beat haemodynamics, skin blood flux with laser-Doppler flowmetry and resting energy expenditure by indirect calorimetry starting with a 30-min baseline followed by a 4-min drink period and a subsequent 90-min post-drink observation.

RESULTS

Ingestion of cold- and room-tempered water led to decreased heart rate (P < 0.01) and double product (P < 0.01), and increased stroke volume (P < 0.05); these effects were not observed with body-tempered water. Drinking cold- and room-, but not body-tempered water, led to increased high frequency power of heart rate variability (P < 0.05) and baroreflex sensitivity (P < 0.05). Cold- and room-tempered water increased energy expenditure over 90 min by 2.9% (P < 0.05) and 2.3% (ns), respectively, accompanied by a diminished skin blood flux (P < 0.01), thereby suggesting that both small increases in heat production together with decreased heat loss contribute to warming up the ingested water to intra-abdominal temperature levels.

CONCLUSIONS

Overall, ingestion of cold- and room-, but not body-tempered water reduced the workload to the heart through a reduction in heart rate and double product which could be mediated by an augmented cardiac vagal tone.

Evidence that transient changes in sudomotor output with cold and warm fluid ingestion are independently modulated by abdominal, but not oral thermoreceptors

Two studies were performed to 1) characterize changes in local sweat rate (LSR) following fluid ingestion of different temperatures during exercise, and 2) identify the potential location of thermoreceptors along the gastrointestinal tract that independently modify sudomotor activity. In study 1, 12 men cycled at 50% Vo2peak for 75 min while ingesting 3.2 ml/kg of 1.5°C, 37°C, or 50°C fluid 5 min before exercise; and after 15, 30, and 45-min of exercise. In study 2, 8 men cycled at 50% Vo2peak for 75 min while 3.2 ml/kg of 1.5°C or 50°C fluid was delivered directly into the stomach via a nasogastric tube (NG trials) or was mouth-swilled only (SW trials) after 15, 30, and 45 min of exercise. Rectal (Tre), aural canal (Tau), and mean skin temperature (Tsk); and LSR on the forehead, upper-back, and forearm were measured. In study 1, Tre, Tau, and Tsk were identical between trials, but after each ingestion, LSR was significantly suppressed at all sites with 1.5°C fluid and was elevated with 50°C fluid compared with 37°C fluid (P < 0.001). The peak difference in mean LSR between 1.5°C and 50°C fluid after ingestion was 0.29 ± 0.06 mg·min(-1)·cm(-2). In study 2, LSR was similar between 1.5°C and 50°C fluids with SW trials (P = 0.738), but lower at all sites with 1.5°C fluid in NG trials (P < 0.001) despite no concurrent differences in Tre, Tau, and Tsk. These data demonstrate that 1) LSR is transiently altered by cold and warm fluid ingestion despite similar core and skin temperatures; and 2) thermoreceptors that independently and acutely modulate sudomotor output during fluid ingestion probably reside within the abdominal area, but not the mouth.