Physiological responses to incremental exercise in the heat following internal and external precooling

Small Performance Effects of a Practical Mixed-Methods Cooling Strategy in Elite Team Sport Athletes

Purpose: The ingestion of ice slurry and application of ice towels can elicit favorable physiological, perceptual, and performance benefits when used individually; however, the combined use and effectiveness of these practical cooling strategies have not been assessed using a sport-specific performance test, based on actual match demands, in an elite team sport context. Methods: Ten non-heat acclimated elite male rugby sevens athletes undertook two cycling heat response tests (HRT) designed to be specific to the demands of rugby sevens in hot conditions (35°C, 80% rH). In a crossover design, the HRTs were conducted with (COOLING) and without (HOT) the combined use of internal (ice slushy ingestion) and external (application of ice towels to the head, neck, and face) pre- and per-cooling strategies. Physiological, perceptual, and performance variables were monitored throughout each HRT. Results: COOLING resulted in reductions in mean tympanic temperature (-0.4 ± 0.2°C; d = 1.18); mean heart rate (-5 ± 8 bpm; d = 0.53); thermal discomfort (-0.5 ± 0.9 AU; d = 0.48); and thirst sensation (-1.0 ± 1.1 AU; d = 0.61) during the HRT. COOLING also resulted in a small increase in 4-min time trial power output (by 7 ± 33 W, ~3%; d = 0.35) compared to HOT. Discussion: A combination of internal and external pre- and per-cooling strategies can result in a range of small physiological, perceptual, and performance benefits during a rugby sevens specific HRT, compared to undertaking no cooling. Practitioners should include such strategies when performing in hot conditions.

Blood Lactate Responses of Male and Female Players Across an International Rugby Sevens Tournament

PURPOSE

This study investigated within- and between-matches blood lactate (La-) responses across an international Rugby Sevens tournament (5 matches over 2 d) in male and female players.

METHODS

Earlobe blood samples were taken from 25 professional players around matches: before warm-up (PRE), immediately upon finishing match participation (POST), and 30 minutes postmatch (30 min).

RESULTS

POST [La-] (mean [SD], range) for males was 10.3 (3.2; 2.9-20.2) mmol·L-1 and for females was 9.1 (2.3; 3.4-14.6) mmol·L-1. Linear mixed-effects models revealed a decrease in POST [La-] after match 5, compared to match 1. Increased PRE [La-] was found before match 2 (+0.8 [0.6-1.1] mmol·L-1), match 3 (+0.8 [0.5-1.1] mmol·L-1), and match 5 (+0.6 [0.4-0.9] mmol·L-1) compared to match 1 (all P < .001). The [La-] remained elevated at 30 min, compared to PRE (+1.7 [1.4-2.0] mmol·L-1, P < .001), with ∼20% of values persisting >4 mmol·L-1. Higher POST was observed in males compared to females (+1.6 [0.1-3.2] mmol·L-1, P = .042); however, no differences between sexes were found across 30 min or PRE [La-]. No [La-] differences between positions (backs and forwards) were identified.

CONCLUSIONS

Lactate concentrations above 10 mmol·L-1 are required to effectively simulate the anaerobic demands of international Rugby Sevens matches. Practitioners are advised to individualize anaerobic training prescription due to the substantial variability observed within positional groups. Additionally, improving athletes' metabolic recovery capacity through training, nutrition, and recovery interventions may enhance physical preparation for subsequent matches within a day, where incomplete lactate clearance was observed.

The contribution of physical exertion to heat-related illness and death in the Arizona borderlands

Recent studies and reports suggest an increased mortality rate of undocumented border crossers (UBCs) in Arizona is the result of heat extremes and climatic change. Conversely, others have shown that deaths have occurred in cooler environments than in previous years. We hypothesized that human locomotion plays a greater role in heat-related mortality and that such events are not simply the result of exposure. To test our hypothesis, we used a postmortem geographic application of the human heat balance equation for 2,746 UBC deaths between 1990 and 2022 and performed regression and cluster analyses to assess the impacts of ambient temperature and exertion. Results demonstrate exertion having greater explaining power, suggesting that heat-related mortality among UBCs is not simply a function of extreme temperatures, but more so a result of the required physical exertion. Additionally, the power of these variables is not static but changes with place, time, and policy.

Is the Cooling Vest an Ergogenic Tool for Physically Active Individuals? Assessment of Perceptual Response, Thermo-Physiological Behavior, and Sports Performance: A Systematic Review and Meta-Analysis

Exercise capacity is limited by environmental heat stress because thermoregulatory systems are altered and cannot prevent the elevation of body temperature due to a complex interplay of physiological, physical, and perceptual alterations. Cooling is an effective strategy to attenuate the temperature rise. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PEDro scale for assessing methodological quality, we systematically reviewed studies indexed in Medline, Web of Science, EMBASE, Science Direct, Sportdiscus, and Scopus, to evaluate the effects of the cooling vest (CVs) on perceptual response, physiological behavior, and sports performance in adult physical activity practitioners under heat stress conditions. Among the 711 studies identified in the search, 10 studies for the systematic review and eight for the meta-analysis met the inclusion and exclusion criteria. Overall, the use of CVs showed improvements in certain sports performance indicators, being significant (p < 0.05) in test time and substantial in peak power that could be influenced directly by the significant reduction (p < 0.05) in skin temperature and indirectly by the significant improvement (p < 0.05) in thermal and exertional perceptual responses, without the involvement of core temperature. In conclusion, the use of CVs is a cooling technique that influences perceptual response, thermo-physiological behavior, and sports performance. However, further studies are needed to elucidate the relevance of its application to CVs.

Effects of different external cooling placements prior to and during exercise on athletic performance in the heat: A systematic review and meta-analysis

Background: Nowadays, many high-profile international sport events are often held in warm or hot environments, hence, it is inevitable for these elite athletes to be prepared for the challenges from the heat. Owing to internal cooling may cause gastrointestinal discomfort to athletes, external cooling technique seems to be a more applicable method to deal with thermal stress. Central cooling mainly refers to head, face, neck and torso cooling, can help to reduce skin temperature and relieve thermal perception. Peripheral cooling mainly refers to four limbs cooling, can help to mitigate metabolic heat from muscular contrac to effectively prevent the accumulation of body heat. Hence, we performed a meta-analysis to assess the effectiveness of different external cooling placements on athletic performance in the heat Methods: A literatures search was conducted using Web of Science, MEDLINE and SPORTDiscus until September 2022. The quality and risk of bias in the studies were independently assessed by two researchers. Results: 1,430 articles were initially identified (Web of Science = 775; MEDLINE = 358; SPORTDiscus = 271; Additional records identified through other sources = 26), 60 articles (82 experiments) met the inclusion criteria and were included in the final analysis, with overall article quality being deemed moderate. Central cooling (SMD = 0.43, 95% CI 0.27 to 0.58, p < 0.001) was most effective in improving athletic performance in the heat, followed by central and peripheral cooling (SMD = 0.38, 95% CI 0.23 to 0.54, p < 0.001), AND peripheral cooling (SMD = 0.32, 95% CI 0.07 to 0.57, p = 0.013). For the cooling-promotion effects on different sports types, the ranking order in central cooling was ETE (exercise to exhaustion), TT (time-trial), EWT (exercise within the fixed time or sets), IS (intermittent sprint); the ranking order in peripheral cooling was EWT, TT, ETE and IS; the ranking order in central and peripheral cooling was ETE, IS, EWT and TT. Conclusion: Central cooling appears to be an more effective intervention to enhance performance in hot conditions through improvements of skin temperature and thermal sensation, compared to other external cooling strategies. The enhancement effects of peripheral cooling require sufficient re-warming, otherwise it will be trivial. Although, central and peripheral cooling seems to retain advantages from central cooling, as many factors may influence the effects of peripheral cooling to offset the positive effects from central cooling, the question about whether central and peripheral cooling method is better than an isolated cooling technique is still uncertain and needs more researchs to explore it.

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.

The Impact of a Natural Olive-Derived Phytocomplex (OliPhenolia®) on Exercise-Induced Oxidative Stress in Healthy Adults

The role of natural polyphenols in reducing oxidative stress and/or supporting antioxidant mechanisms, particularly relating to exercise, is of high interest. The aim of this study was to investigate OliPhenolia® (OliP), a biodynamic and organic olive fruit water phytocomplex, rich in hydroxytyrosol (HT), for the first time within an exercise domain. HT bioavailability from OliP was assessed in fifteen healthy volunteers in a randomized, double-blind, placebo controlled cross-over design (age: 30 ± 2 yrs; body mass: 76.7 ± 3.9 kg; height: 1.77 ± 0.02 m), followed by a separate randomized, double-blinded, cohort trial investigating the short-term impact of OliP consumption (2 × 28 mL∙d−1 of OliP or placebo (PL) for 16-days) on markers of oxidative stress in twenty-nine recreationally active participants (42 ± 2 yrs; 71.1 ± 2.1 kg; 1.76 ± 0.02 m). In response to a single 28 mL OliP bolus, plasma HT peaked at 1 h (38.31 ± 4.76 ng∙mL−1), remaining significantly elevated (p < 0.001) until 4 h. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and HT were assessed at rest and immediately following exercise (50 min at ~75% V˙O2max then 10 min intermittent efforts) and at 1 and 24 h post-exercise, before and after the 16-day supplementation protocol. Plasma HT under resting conditions was not detected pre-intervention, but increased to 6.3 ± 1.6 ng·mL−1 following OliP only (p < 0.001). OliP demonstrated modest antioxidant effects based on reduced SOD activity post-exercise (p = 0.016) and at 24 h (p ≤ 0.046), and increased GSH immediately post-exercise (p = 0.009) compared with PL. No differences were reported for MDA and CAT activity in response to the exercise protocol between conditions. The phenolic compounds within OliP, including HT, may have specific antioxidant benefits supporting acute exercise recovery. Further research is warranted to explore the impact of OliP following longer-term exercise training, and clinical domains pertinent to reduced oxidative stress.

Effects of mixed-cooling strategies on executive functions in simulated tennis in hot and humid conditions

This study aimed to investigate the effects of mixed-cooling strategies, which combines external (cooling vest + neck cooled collar) and internal cooling (cold sports drink ingestion) on measures of executive function during simulated tennis in hot/humid conditions. In a counterbalanced design (randomised order), eight males undertook two trials [one with the mixed-cooling strategy, (MCOOL condition) and another without (CON condition)] in a climate chamber (36.5°C, 50% relative humidity). All subjects completed an intermittent treadmill protocol simulating a three-set tennis match with a 90-second break during odd-numbered games and 120-second breaks between sets, in accordance with the activity profile and International Tennis Federation rules. The mixed-cooling strategies were adopted before test and break time during the simulated tennis match. Stroop task, 2-back task, More-odd shifting task, gastrointestinal temperature (Tgi), skin temperature, blood lactic acid (BLA), heart rate, urine specific gravity (USG), sweat rate (SR), thermal sensation (TS) and perceived exertion (RPE) were measured. Results showed that the mean exercise time was longer in the MCOOL condition than in the CON condition. The SR was greater in CON trial compared with that in MCOOL trial. Results of two-way analysis of variance with repeated measures revealed that time×condition interactions were significant in BLA, Stroop response time, and switch cost of the more-odd shifting task. There were main effects of condition for Tgi, HR, TS, RPE, BLA, Stroop response time, and switch cost of the more-odd shifting task. In a hot/wet environment, pre- and intermittent mixed-cooling strategies can significantly improve exercise time and measures of executive function of tennis players in a simulated tennis match.

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].

Combination of whole body cryotherapy with static stretching exercises reduces fatigue and improves functioning of the autonomic nervous system in Chronic Fatigue Syndrome

BACKGROUND

The aim of this study was to explore the tolerability and effect of static stretching (SS) and whole body cryotherapy (WBC) upon fatigue, daytime sleepiness, cognitive functioning and objective and subjective autonomic nervous system functioning in those with Chronic Fatigue Syndrome (CFS) compared to a control population.

METHODS

Thirty-two CFS and eighteen healthy controls (HC) participated in 2 weeks of a SS + WBC programme. This programme was composed of five sessions per week, 10 sessions in total.

RESULTS

A significant decrease in fatigue was noted in the CFS group in response to SS + WBC. Some domains of cognitive functioning (speed of processing visual information and set-shifting) also improved in response to SS + WBC in both CFS and HC groups. Our study has confirmed that WBC is well tolerated by those with CFS and leads to symptomatic improvements associated with changes in cardiovascular and autonomic function.

CONCLUSIONS

Given the preliminary data showing the beneficial effect of cryotherapy, its relative ease of application, good tolerability, and proven safety, therapy with cold exposure appears to be an approach worth attention. Further studies of cryotherapy as a potential treatment in CFS is important in the light of the lack of effective therapeutic options for these common and often disabling symptoms.

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.

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.

Exercise hyperthermia induces greater changes in gastrointestinal permeability than equivalent passive hyperthermia

Hyperthermia and exertional heat illness increase gastrointestinal (GI) permeability, although whether the latter is only via hyperthermia is unclear. The aim of this pilot study was to determine whether different changes in GI permeability, characterized by an increased plasma lactulose:rhamnose concentration ratio ([L:R]), occurred in exercise hyperthermia in comparison to equivalent passive hyperthermia. Six healthy adult male participants (age 25 ± 5 years, mass 77.0 ± 6.7 kg, height 181 ± 6 cm, peak oxygen uptake [ V · O 2 peak ] 48 ± 8 ml.kg-1 .min-1 ) underwent exercise under hot conditions (Ex-Heat) and passive heating during hot water immersion (HWI). Heart rate (HR), rectal temperature (TCORE ), rating of perceived exertion (RPE), and whole-body sweat loss (WBSL) were recorded throughout the trials. The L:R ratio, peak HR, change in HR, and change in RPE were higher in Ex-Heat than HWI, despite no differences in trial duration, peak core temperature or WBSL. L:R was strongly correlated (p < 0.05) with HR peak (r = 0.626) and change in HR (r = 0.615) but no other variable. The greater L:R in Ex-Heat, despite equal TCORE responses to HWI, indicates that increased cardiovascular strain occurred during exercise, and exacerbates hyperthermia-induced GI permeability at the same absolute temperature.

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.

A Mixed-Method Approach of Pre-Cooling Enhances High-Intensity Running Performance in the Heat

We investigated whether single or combined methods of pre-cooling could affect high-intensity exercise performance in a hot environment. Seven male athletes were subjected to four experimental conditions for 30 min in a randomised order. The four experimental conditions were: 1) wearing a vest cooled to a temperature of 4 ℃ (Vest), 2) consuming a beverage cooled to a temperature of 4 ℃ (Beverage), 3) simultaneous usage of vest and consumption of beverage (Mix), and 4) the control trial without pre-cooling (CON). Following those experimental conditions, they exercised at a speed of 80% VO₂max until exhaustion in the heat (38.1 ± 0.6 ℃, 55.3 ± 0.3% RH). Heart rate (HR), rectal temperature (T_core), skin temperature (T_skin), sweat loss (SL), urine specific gravity (USG), levels of sodium (Na⁺) and potassium (K⁺), rating of perceived exertion (RPE), thermal sensation (TS), and levels of blood lactic acid ([Bla]) were monitored. Performance was improved using the mixed pre-cooling strategy (648.43 ± 77.53 s, p = 0.016) compared to CON (509.14 ± 54.57 s). T_core after pre-cooling was not different (Mix: 37.01 ± 0.27 ℃, Vest: 37.19 ± 0.33 ℃, Beverage: 37.03 ± 0.35 ℃) in all cooling conditions compared to those of CON (37.31 ±0.29 ℃). A similar T_core values was achieved at exhaustion in all trials (from 38.10 ℃ to 39.00 ℃). No difference in the level of USG was observed between the conditions. Our findings suggest that pre-cooling with a combination of cold vest usage and cold fluid intake can improve performance in the heat.

The elderly's physiological and perceptual responses to cooling during simulated activities of daily living in UK summer climatic conditions

OBJECTIVES

The elderly are the most at-risk population for heat-related illness and mortality during the periods of hot weather. However, evidence-based elderly-specific cooling strategies to prevent heat-illness are limited. The aim of this investigation was to quantify the elderly's physiological and perceptual responses to cooling through cold water ingestion (COLD) or an L-menthol mouth rinse (MENT) during simulated activities of daily living in UK summer climatic conditions.

STUDY DESIGN

Randomised, controlled repeated measures research design.

METHODS

A total of ten participants (men n = 7, women n = 3: age; 69 ± 3 yrs, height; 168 ± 10 cm, body mass; 68.88 ± 13.72 kg) completed one preliminary and three experimental trials; control (CON), COLD and MENT. Experimental trials consisted of 40 min rest followed by 30 min of cycling exercise at 6 metabolic equivalents and a 6-min walk test (6MWT), within a 35 °C, 50% relative humidity environment. Experimental interventions (every 10 min); cold water (4 °C) ingestion (total of 1.5L) or menthol (5 ml mouth swill for 5 s, menthol concentration of 0.01%).

RESULTS

Peak rectal temperature (T_re) was significantly (P < 0.05) lower in COLD compared with CON (-0.34 ± 0.16 °C) and MENT (-0.36 ± 0.20 °C). End exercise heart rate (HR) decreased in COLD compared with CON (-7 ± 9 b min^-1) and MENT (-6 ± 7 b min^-1). There was no difference in end exercise thermal sensation (TS) (CON; 6.1 ± 0.4, COLD; 6.0 ± 0.4, MENT; 6.4 ± 0.6) or thermal comfort (TC) (CON; 4 ± 1, COLD; 4 ± 1, MENT; 4 ± 1) between trials. The participants walked significantly further during the COLD 6MWT compared with CON (40 m ± 40 m) and MENT (40 m ± 30 m). There was reduced physiological strain in the COLD 6MWT compared with CON (T_re; -0.21 ± 0.24 °C, HR; -7 ± 8 b min^-1) and MENT (T_re; -0.23 ± 0.24 °C, HR; -4 ± 7 b min^-1).

CONCLUSION

The elderly have reduced physiological strain (T_re and HR) during activities of daily living and a 6MWT in hot UK climatic conditions, when they drink cold water. Furthermore, the elderly's perception (TS and TC) of the hot environment did not differ from CON at the end of exercise with COLD or MENT interventions. Menthol provided neither perceptual benefit to exercise in the heat nor functional gain. The TS data indicate that elderly may be at increased risk of heat illness, due to not feeling hot and uncomfortable enough to implement physiological strain reducing strategies such as cold-water ingestion.

Comparison of two different cooling systems in alleviating thermal and physiological strain during prolonged exercise in the heat

This study compared the efficacy of an ice vest comprising of water (WATER) or a water-carbon (CARBON) emulsion on thermophysiological responses to strenuous exercise in the heat. Twelve male cyclists completed three 50-minute constant workload trials (55% of peak power output, ambient temperature 30.4 ± 0.6°C) with WATER, CARBON, and without ice vest (CONTROL), respectively. The increase in core body temperature (Tcore) was lower in WATER at 40 (-0.49 ± 0.34 °C) and 50 minutes (-0.48 ± 0.48 °C) and in CARBON at 30 (-0.41 ± 0.48 °C), 40 (-0.54 ± 0.51 °C), and 50 minutes (-0.67 ± 0.62 °C) as compared to CONTROL (p < 0.05, ES > 0.8). While heart rate and blood lactate kinetics did not differ between the conditions, statistical main effects in favour of both WATER and CARBON were found for thermal sensation (condition p < 0.001 and interaction p < 0.01) and rating of perceived exertion (condition p < 0.05). Per-cooling with CARBON and WATER similarly reduced Tcore but not physiological strain during prolonged exercise in the heat. Practitioner Summary: Exercise in the heat is characterised by increases in thermophysiological strain. Both per-cooling with a novel carbon-based and a conventional water-based ice vest were shown to reduce core temperature significantly. However, due to its lower mass, the carbon-based system may be recommended especially for weight-bearing sports.

Per-Cooling (Using Cooling Systems during Physical Exercise) Enhances Physical and Cognitive Performances in Hot Environments. A Narrative Review

There are many important sport events that are organized in environments with a very hot ambient temperature (Summer Olympics, FIFA World Cup, Tour de France, etc.) and in hot locations (e.g., Qatar). Additionally, in the context of global warming and heat wave periods, athletes are often subjected to hot ambient temperatures. It is known that exercising in the heat induces disturbances that may provoke premature fatigue and negatively affects overall performance in both endurance and high intensity exercises. Deterioration in several cognitive functions may also occur, and individuals may be at risk for heat illnesses. To train, perform, work and recover and in a safe and effective way, cooling strategies have been proposed and have been routinely applied before, during and after exercise. However, there is a limited understanding of the influences of per-cooling on performance, and it is the subject of the present review. This work examines the influences of per-cooling of different areas of the body on performance in terms of intense short-term exercises ("anaerobic" exercises), endurance exercises ("aerobic" exercises), and cognitive functioning and provides detailed strategies that can be applied when individuals train and/or perform in high ambient temperatures.

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.

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.

Short-Term Heat Acclimation and Precooling, Independently and Combined, Improve 5-km Time Trial Performance in the Heat

James, CA, Richardson, AJ, Watt, PW, Willmott, AGB, Gibson, OR, and Maxwell, NS. Short-term heat acclimation and precooling, independently and combined, improve 5-km time trial performance in the heat. J Strength Cond Res 32(5): 1366-1375, 2018-Following heat acclimation (HA), endurance running performance remains impaired in hot vs. temperate conditions. Combining HA with precooling (PC) demonstrates no additive benefit in intermittent sprint, or continuous cycling exercise protocols, during which heat strain may be less severe compared to endurance running. This study investigated the effect of short-term HA (STHA) combined with mixed methods PC, on endurance running performance and directly compared PC and HA. Nine amateur trained runners completed 5-km treadmill time trials (TTs) in the heat (32° C, 60% relative humidity) under 4 conditions; no intervention (CON), PC, short-term HA (5 days-HA) and STHA with PC (HA + PC). Mean (±SD) performance times were; CON 1,476 (173) seconds, PC 1,421 (146) seconds, HA 1,378 (116) seconds and HA + PC 1,373 (121) seconds. This equated to the following improvements versus CON; PC -3.7%, HA -6.6% and HA + PC -7.0%. Statistical differences were only observed between HA and CON (p = 0.004, d = 0.68, 95% CI [-0.27 to 1.63]) however, similar effect sizes were observed for HA + PC vs. CON (d = 0.70, 95% CI [-0.25 to 1.65]), with smaller effects between PC vs. CON (d = 0.34, 95% CI [-0.59 to 1.27]), HA vs. PC (d = 0.33, 95% CI [-0.60 to 1.26]) and HA + PC vs. PC (d = 0.36, 95% CI [-0.57 to 1.29]). Pilot testing revealed a TT typical error of 16 seconds (1.2%). Precooling offered no further benefit to performance in the acclimated individual, despite modest alleviation of physiological strain. Maintenance of running speed in HA + PC, despite reduced physiological strain, may indicate an inappropriate pacing strategy therefore, further familiarization is recommended to optimize a combined strategy. Finally, these data indicate HA, achieved through cycle training, yields a larger ergogenic effect than PC on 5-km running performance in the heat, although PC remains beneficial when HA is not possible.

Practical pre-cooling methods for occupational heat exposure

This study aimed to identify a pre-cooling method to reduce the physiological and perceptual strain, and the inflammatory response, experienced by individuals who wear personal protective equipment. Eleven males (age 20 ± 2 years, weight 75.8 ± 9.3 kg, height 177.1 ± 5.0 cm) completed 15min pre-cooling (phase change vest [PCV], forearm cooling [ARM], ice slurry consumption [ICE], or a no cooling control [CON]) and 45min intermittent walk (4  km h^-1, 1% gradient) in 49.5 ± 0.6 °C and 15.4 ± 1.0% RH, whilst wearing firefighter ensemble. ICE reduced rectal temperature (T_re) before heat exposure compared to CON (ΔT_re: 0.24 ± 0.09 °C, p < 0.001, d = 0.38) and during exercise compared to CON, ARM, and PCV (p = 0.026, η_p² = 0.145). Thermal sensation was reduced in ICE and ARM vs. CON (p = 0.018, η_p² = 0.150). Interleukin-6 was not affected by pre-cooling (p = 0.648, η_p² = 0.032). It is recommended that those wearing protective equipment consume 500 ml of ice slurry 15min prior to work to reduce physiological and perceptual strain.

Internal and external cooling methods and their effect on body temperature, thermal perception and dexterity

Objective

The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity.

Methods

Ten male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34°C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV₀), phase change cooling vest melting at 14°C (CV₁₄), evaporative cooling vest (CV_EV), arm immersion in 10°C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout.

Results

Compared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P<0.05), though CV₀ resulted in the lowest skin temperature versus other cooling methods. Participants felt cooler with CV₀, CV₁₄, WPS, AI and SL (P<0.05). AI significantly impaired Purdue pegboard performance (P = 0.001), but did not affect grip or pinch strength (P>0.05).

Conclusion

The present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.

Effects of skin surface cooling before exercise on lactate accumulation in cool environment

PURPOSE

We assessed whether plasma lactate accumulation increased and the lactate threshold (LT) declined when the skin temperature was lowered by whole body skin surface cooling before exercise in cool, but not temperate, conditions, and whether the lowered LT was associated with sympathetic activation or lowered plasma volume (PV) by cold-induced diuresis.

METHODS

Ten healthy subjects performed a graded maximal cycling exercise after pre-conditioning under three different conditions for 60 min. Ambient temperature (using an artificial climatic chamber) and water temperature in a water-perfusion suit controlled at 25 and 34 °C in temperate-neutral (Temp-Neut); 25 and 10 °C in temperate-cool (Temp-Cool); and at 10 and 10 °C in cool-cool (Cool-Cool) conditions, respectively. Esophageal (T_es) and skin temperatures were measured; plasma lactate ([Lac]_p) and noradrenaline concentrations ([Norad]_p), and relative change in PV (%ΔPV) were determined before and after pre-conditioning and during exercise, and LT was determined.

RESULTS

After pre-conditioning, T_es was not different among trials, whereas the mean skin temperature was lower in Cool-Cool and Temp-Cool than in Temp-Neut (P < 0.001). During exercise, [Lac]_p and [Norad]_p were higher (P = 0.009 and P < 0.001, respectively) and LT was lower (P = 0.013) in Cool-Cool than in the other trials. The %ΔPV was not different among trials. LT was correlated with [Norad]_p during exercise (R = 0.50, P = 0.005).

CONCLUSIONS

Whole body skin surface cooling before exercise increases lactate accumulation and decreases LT with sympathetic activation when exercise is performed in a cool, but not in a temperate, environment.

Effect of the timing of ice slurry ingestion for precooling on endurance exercise capacity in a warm environment

It has been demonstrated that precooling with ice slurry ingestion enhances endurance exercise capacity in the heat. However, no studies have yet evaluated the optimal timing of ice slurry ingestion for precooling. This study aimed to investigate the effects of varying the timing of ice slurry ingestion for precooling on endurance exercise capacity in a warm environment. Ten active male participants completed 3 experimental cycling trials to exhaustion at 55% peak power output (PPO) after 15min of warm-up at 30% PPO at 30°C and 80% relative humidity. Three experimental conditions were set: no ice slurry ingestion (CON), pre-warm-up ice slurry ingestion (-1°C; 7.5gkg^-1) (PRE), and post-warm-up ice slurry ingestion (POST). Rectal and mean skin temperatures at the beginning of exercise in the POST condition (37.1±0.2°C, 33.8±0.9°C, respectively) were lower than those in the CON (37.5±0.3°C; P<0.001, 34.8±0.8°C; P<0.01, respectively) and PRE (37.4±0.2°C; P<0.01, 34.6±0.7°C; P<0.01, respectively) conditions. These reductions increased heat storage capacity and resulted in improved exercise capacity in the POST condition (60.2±8.7min) compared to that in the CON (52.0±11.9min; effect size [ES]=0.78) and PRE (56.9±10.4min; ES=0.34) conditions. Ice slurry ingestion after warm-up effectively reduced both rectal and skin temperatures and increased cycling time to exhaustion in a warm environment. Timing ice slurry ingestion to occur after warm-up may be effective for precooling in a warm environment.

Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations

Exercise-induced increases in core body temperature could negative impact performance and may lead to development of heat-related illnesses. The use of cooling techniques prior (pre-cooling), during (per-cooling) or directly after (post-cooling) exercise may limit the increase in core body temperature and therefore improve exercise performance. The aim of the present review is to provide a comprehensive overview of current scientific knowledge in the field of pre-cooling, per-cooling and post-cooling. Based on existing studies, we will discuss 1) the effectiveness of cooling interventions, 2) the underlying physiological mechanisms and 3) practical considerations regarding the use of different cooling techniques. Furthermore, we tried to identify the optimal cooling technique and compared whether cooling-induced performance benefits are different between cool, moderate and hot ambient conditions. This article provides researchers, physicians, athletes and coaches with important information regarding the implementation of cooling techniques to maintain exercise performance and to successfully compete in thermally stressful conditions.

Ischaemic preconditioning does not alter the determinants of endurance running performance in the heat

PURPOSE

Ischaemic preconditioning (IP) has been shown to be ergogenic for endurance performance in normothermic conditions and alleviate physiological strain under hypoxia, potentially through haemodynamic and/or metabolic mechanisms. Exertional hyperthermia is characterised by competition for blood flow between the muscles and skin, an enhanced metabolic strain and impaired endurance performance. This study investigated the effect of IP on the determinants of endurance performance, through an incremental exercise test in the heat.

METHOD

Eleven males completed two graded exercise tests in the heat (32 °C, 62 % RH) until volitional exhaustion, preceded by IP (4 × 5 min 220 mmHg bilateral upper leg occlusion) or a control (CON) condition (4 × 5-min 50 mmHg bilateral).

RESULT

IP did not improve running speeds at fixed blood lactate concentrations of 2 and 4 mMol L(-1) (p = 0.828), or affect blood glucose concentration throughout the trial [mean (±SD); CON 5.03 (0.94) mMol L(-1), IP 5.47 (1.38) mMol L(-1), p = 0.260). There was no difference in [Formula: see text]O2max [CON 55.5 (3.7) mL kg(-1) min(-1), IP 56.0 (2.6) mL kg(-1) min(-1), p = 0.436], average running economy [CON 222.3 (18.0) mL kg(-1) km(-1), IP 218.9 (16.5) mL kg(-1) km(-1), p = 0.125], or total running time during graded exercise [CON 347 (42) s, IP 379 (68) s, p = 0.166]. The IP procedure did not change muscle temperature [CON ∆ = 0.55 (0.57) °C, IP ∆ = 0.78 (0.85) °C, p = 0.568], but did reduce T CORE during exercise (~-0.1 °C, p = 0.001).

CONCLUSION

The novel application of IP prior to exercise in the heat does not enhance the determinants of endurance performance. For events where IP appears ergogenic, muscle warming strategies are unnecessary as IP does not influence deep muscle temperature.