IOC consensus statement on recommendations and regulations for sport events in the heat

Paris air quality monitoring for the 2024 Olympics and Paralympics: focus on air pollutants and pollen

BACKGROUND

Exposure to air pollution can affect the health of individuals with respiratory disease, but may also impede the health and performance of athletes. This is potentially relevant for people travelling to and competing in the Olympic and Paralympic Games (OPG) in Paris. We describe anticipated air quality in Paris based on historical monitoring data and describe the impact of the process on the development of monitoring strategies for future international sporting events.

METHODS

Air pollutant data for July to September 2020-2023 and pollen data for 2015-2022 were provided by Airparif (particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3)) and RNSA stations in the Paris region. Airparif's street-level numerical modelling provided spatial data for the OPG venues.

RESULTS

The maximum daily mean PM2.5 was 11±6 µg/m3 at traffic stations, below the WHO recommended daily air quality threshold (AQT). Daily NO2 concentrations ranged from 5±3 µg/m3 in rural areas to 17±14 µgm3 in urban areas. Near traffic stations, this rose to 40±24 µg/m3 exceeding the WHO AQT. Both peaked around 06:00 and 20:00 UTC (coordinated universal time). The ambient O3 level exceeded the AQT on 20 days per month and peaked at 14:00 UTC. The main allergenic taxa from June to September was Poaceae (ie, grass pollen variety).

CONCLUSION

Air pollutant levels are expected to be within accepted air quality thresholds at the Paris OPG. However, O3 concentrations may be significantly raised in very hot and clear conditions and grass pollen levels will be high, prompting a need to consider and manage this risk in susceptible individuals.

The impact of extreme heat on mass-gathering sporting events: Implications for Australia and other countries

OBJECTIVES

As temperatures increase across the globe due to climate change, human exposure to extreme heat is a public health challenge. During sporting events, athletes, officials, spectators, and staff are at risk of heat stress and resulting illness. The objective of this review was to explore the impact of heat on the health outcomes of these groups and the wider health system and discuss implications for outdoor mass-gathering sporting events in Australia.

DESIGN

A systematic review was undertaken to identify literature published from 2010 to 2023.

METHODS

Seven databases were searched: Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare, and PsychInfo, for relevant key search terms such as heatwave, heat stress, extreme heat, stadium, arena, sports facilit*, sport, athletic, and Olympic. An inductive thematic analysis was undertaken. Articles were quality checked using Joanna Briggs Institute critical appraisal tools and data were extracted, tabulated, and synthesized.

RESULTS

Forty papers were included in the final analysis: 17 quantitative, and 23 descriptive and qualitative (including reviews). Health outcomes explored across the literature included exertional heat illness, exertional heat stroke, hyperthermia, and general heat related illness. Six recommendation themes emerged: planning, mitigation strategies, medical, policy, research, and education.

CONCLUSIONS

The impact of heat on health outcomes during sporting events is significant, and should be considered by individuals, coaches, officials, and organizers before, during, and after mass-gathering sporting events. These findings can inform evidence-based preparedness strategies to protect the health of those attending and competing in mass-gathering sporting events now and into the future.

Heat-related risk at Paris 2024: a proposal for classification and review of International Federations policies

Several International Federations (IFs) employ specific policies to protect athletes' health from the danger of heat. Most policies rely on the measurement of thermal indices such as the Wet Bulb Globe Temperature (WBGT) to estimate the risk of heat-related illness. This review summarises the policies implemented by the 32 IFs of the 45 sports included in the Paris 2024 Olympic Games. It provides details into the venue type, measured parameters, used thermal indices, measurement procedures, mitigation strategies and specifies whether the policy is a recommendation or a requirement. Additionally, a categorisation of sports' heat stress risk is proposed. Among the 15 sports identified as high, very high or extreme risk, one did not have a heat policy, three did not specify any parameter measurement, one relied on water temperature, two on air temperature and relative humidity, seven on WBGT (six measured on-site and one estimated) and one on the Heat Stress Index. However, indices currently used in sports have been developed for soldiers or workers and may not adequately reflect the thermal strain endured by athletes. Notably, they do not account for the athletes' high metabolic heat production and their level of acclimation. It is, therefore, worthwhile listing the relevance of the thermal indices used by IFs to quantify the risk of heat stress, and in the near future, develop an index adapted to the specific needs of athletes.

Environmental challenges facing athletes, stakeholders and spectators at Paris 2024 Olympic and Paralympic Games: an evidence-based review of mitigation strategies and recommendations

The upcoming Paris 2024 Olympic and Paralympic Games could face environmental challenges related to heat, air quality and water quality. These challenges will pose potential threats to athletes and impact thousands of stakeholders and millions of spectators. Recognising the multifaceted nature of these challenges, a range of strategies will be essential for mitigating adverse effects on participants, stakeholders and spectators alike. From personalised interventions for athletes and attendees to comprehensive measures implemented by organisers, a holistic approach is crucial to address these challenges and the possible interplay of heat, air and water quality factors during the event. This evidence-based review highlights various environmental challenges anticipated at Paris 2024, offering strategies applicable to athletes, stakeholders and spectators. Additionally, it provides recommendations for Local Organising Committees and the International Olympic Committee that may be applicable to future Games. In summary, the review offers solutions for consideration by the stakeholders responsible for and affected by the anticipated environmental challenges at Paris 2024.

Using wet-bulb globe temperature meters to examine the effect of heat on various tennis court surfaces

In this study, we evaluated the thermal environments of different tennis courts using wet-bulb globe temperature (WBGT) meters. WBGT meters were installed in an outdoor hard court, sand-filled artificial grass court, and clay court (a softball field), and measurements were taken hourly from 9:00 to 17:00 on weekdays from June 1 to September 21, 2022. The results were compared with data from different courts and the nearest Japan Meteorological Agency station (JMA WBGT) based on the Japan Sports Association's guidelines for exercise to prevent heat stroke. The median WBGT on each court was significantly higher for hard courts at the "Warning" (25 ≤ JMA WBGT < 28) level or above, sand-filled artificial grass courts at the "Severe Warning" (28 ≤ JMA WBGT < 31) level or above, and clay courts at the "Danger" (31 ≤ JMA WBGT) level than the JMA WBGT. Compared with the JMA WBGT, hard and sand-filled artificial grass courts are played on under particularly hot conditions. The results of this study could indicate to tournament organizers and coaches the importance of measuring the WBGT on each court surface from an early stage to prevent heat-related incidents.

The effect of synthetic grass sports surfaces on the thermal environment: A systematic review

There are concerns regarding high surface temperatures on synthetic grass sports surfaces influencing the surrounding thermal environment, potentially increasing heat stress and impacting athlete safety. As such, studies have investigated changes to the thermal environment surrounding synthetic grass surfaces in comparison to both natural grass, and synthetic surfaces with different features, but this body of research has not been systematically reviewed. Therefore, this systematic review aimed to (i) determine if there are differences in the thermal environment surrounding synthetic grass surfaces compared with natural grass surfaces, and (ii) determine if there are differences in the thermal environment between different types of synthetic grass surfaces. A systematic review adhering to the PRISMA guidelines was performed. The eligibility criteria required investigations to report at least one of the following environmental parameters on or directly above both a synthetic surface and a comparator group of either natural grass or an alternative synthetic grass surface used in sport: Air temperature, mean radiant temperature, humidity, wind velocity, unified heat stress indices (i.e. wet-bulb-globe temperature and heat index) and/or surface temperature. Twenty-three studies were identified. The only parameters that were consistently higher on synthetic grass compared to natural grass were the air temperature (range: 0.5-1.2 °C) and surface temperature (range: 9.4-33.7 °C), while the mean radiant temperature, humidity, wind velocity and wet-bulb-globe temperature remained similar or required more data to determine if any differences exist. Synthetic grass surfaces consisting of styrene butadiene rubber infill or a shock pad had increased surface temperatures, whereas surfaces with thermoplastic elastomer infill, Cool climate turf fibres or HydroChill had lower surface temperatures. This systematic review has demonstrated that air and surface temperatures can be increased on synthetic sports surfaces, compared to natural grass surfaces. However, it is uncertain whether the differences are enough to increase an individual's heat stress risk and cause concern for athlete safety. While modifications to the turf infill or fibres can reduce synthetic surface temperatures, the effect of these features on the thermal environment as a whole is unclear. This review was prospectively registered with the Open Science Framework (Open Science Framework registration   https://doi.org/10.17605/OSF.IO/BTKGE ).

The Importance of Maintaining and Improving a Healthy Gut Microbiota in Athletes as a Preventive Strategy to Improve Heat Tolerance and Acclimatization

Exposure to passive heat (acclimation) and exercise under hot conditions (acclimatization), known as heat acclimation (HA), are methods that athletes include in their routines to promote faster recovery and enhance physiological adaptations and performance under hot conditions. Despite the potential positive effects of HA on health and physical performance in the heat, these stimuli can negatively affect gut health, impairing its functionality and contributing to gut dysbiosis. Blood redistribution to active muscles and peripheral vascularization exist during exercise and HA stimulus, promoting intestinal ischemia. Gastrointestinal ischemia can impair intestinal permeability and aggravate systemic endotoxemia in athletes during exercise. Systemic endotoxemia elevates the immune system as an inflammatory responses in athletes, impairing their adaptive capacity to exercise and their HA tolerance. Better gut microbiota health could benefit exercise performance and heat tolerance in athletes. This article suggests that: (1) the intestinal modifications induced by heat stress (HS), leading to dysbiosis and altered intestinal permeability in athletes, can decrease health, and (2) a previously acquired microbial dysbiosis and/or leaky gut condition in the athlete can negatively exacerbate the systemic effects of HA. Maintaining or improving the healthy gut microbiota in athletes can positively regulate the intestinal permeability, reduce endotoxemic levels, and control the systemic inflammatory response. In conclusion, strategies based on positive daily habits (nutrition, probiotics, hydration, chronoregulation, etc.) and preventing microbial dysbiosis can minimize the potentially undesired effects of applying HA, favoring thermotolerance and performance enhancement in athletes.

Twenty four-hour passive heat and cold exposures did not modify energy intake and appetite but strongly modify food reward

Effects of acute thermal exposures on appetite appear hypothetical in reason of very heterogeneous methodologies. The aim of this study was therefore to clearly define the effects of passive 24-h cold (16°C) and heat (32°C) exposures on appetitive responses compared with a thermoneutral condition (24°C). Twenty-three healthy, young and active male participants realised three sessions (from 13.00) in a laboratory conceived like an apartment dressed with the same outfit (Clo = 1). Three meals composed of three or four cold or warm dishes were served ad libitum to assess energy intake (EI). Leeds Food Preference Questionnaires were used before each meal to assess food reward. Subjective appetite was regularly assessed, and levels of appetitive hormones (acylated ghrelin, glucagon-like peptite-1, leptin and peptide YY) were assessed before and after the last meal (lunch). Contrary to the literature, total EI was not modified by cold or heat exposure (P = 0·120). Accordingly, hunger scores (P = 0·554) were not altered. Levels of acylated ghrelin and leptin were marginally higher during the 16 (P = 0·032) and 32°C (P < 0·023) sessions, respectively. Interestingly, implicit wanting for cold and low-fat foods at 32°C and for warm and high-fat foods at 16°C were increased during the whole exposure (P < 0·024). Moreover, cold entrées were more consumed at 32°C (P < 0·062) and warm main dishes more consumed at 16°C (P < 0·025). Thus, passive cold and hot exposures had limited effects on appetite, and it seems that offering some choice based on food temperature may help individuals to express their specific food preferences and maintain EI.

Precooling via immersion in CO2-enriched water at 25°C decreased core body temperature but did not improve 10-km cycling time trial in the heat

This study compared the effects of precooling via whole-body immersion in 25°C CO2-enriched water (CO2WI), 25°C unenriched water (WI) or no cooling (CON) on 10-km cycling time trial (TT) performance. After 30 min of precooling (CO2WI, CON, WI) in a randomized, crossover manner, 11 male cyclists/triathletes completed 30-min submaximal cycling (65%VO2peak), followed by 10-km TT in the heat (35°C, 65% relative humidity). Average power output and performance time during TT were similar between conditions (p = 0.387 to 0.833). Decreases in core temperature (Tcore) were greater in CO2WI (-0.54 ± 0.25°C) than in CON (-0.32 ± 0.09°C) and WI (-0.29 ± 0.20°C, p = 0.011 to 0.022). Lower Tcore in CO2WI versus CON was observed at 15th min of exercise (p = 0.050). Skin temperature was lower in CO2WI and WI than in CON during the exercise (p < 0.001 to 0.031). Only CO2WI (1029 ± 305 mL) decreased whole-body sweat loss compared with CON (1304 ± 246 mL, p = 0.029). Muscle oxygenation by near-infrared spectroscopy (NIRS), thermal sensation, and thermal comfort were lower in CO2WI and WI versus CON only during precooling (p < 0.001 to 0.041). NIRS-derived blood volume was significantly lower in CO2WI and WI versus CON during exercise (p < 0.001 to 0.022). Heart rate (p = 0.998) and rating of perceived exertion (p = 0.924) did not differ between conditions throughout the experiment. These results suggested that CO2WI maybe more effective than WI for enhanced core body cooling and minimized sweat losses.

Hot water immersion: Maintaining core body temperature above 38.5°C mitigates muscle fatigue

PURPOSE

Hot water immersion (HWI) has gained popularity to promote muscle recovery, despite limited data on the optimal heat dose. The purpose of this study was to compare the responses of two exogenous heat strains on core body temperature, hemodynamic adjustments, and key functional markers of muscle recovery following exercise-induced muscle damage (EIMD).

METHODS

Twenty-eight physically active males completed an individually tailored EIMD protocol immediately followed by one of the following recovery interventions: HWI (40°C, HWI40 ), HWI (41°C, HWI41 ) or warm water immersion (36°C, CON36 ). Gastrointestinal temperature (Tgi ), hemodynamic adjustments (cardiac output [CO], mean arterial pressure [MAP], and systemic vascular resistance [SVR]), pre-frontal cortex deoxyhemoglobin (HHb), ECG-derived respiratory frequency, and subjective perceptual measures were tracked throughout immersion. In addition, functional markers of muscle fatigue (maximal concentric peak torque [Tpeak ]) and muscle damage (late-phase rate of force development [RFD100-200 ]) were measured prior to EIMD (pre-), 24 h (post-24 h), and 48 h (post-48 h) post-EIMD.

RESULTS

By the end of immersion, HWI41 led to significantly higher Tgi values than HWI40 (38.8 ± 0.1 vs. 38.0°C ± 0.6°C, p < 0.001). While MAP was well maintained throughout immersion, only HWI41 led to increased (HHb) (+4.2 ± 1.47 μM; p = 0.005) and respiratory frequency (+4.0 ± 1.21 breath.min-1 ; p = 0.032). Only HWI41 mitigated the decline in RFD100-200 at post-24 h (-7.1 ± 31.8%; p = 0.63) and Tpeak at post-48 h (-3.1 ± 4.3%, p = 1).

CONCLUSION

In physically active males, maintaining a core body temperature of ~25 min within the range of 38.5°C-39°C has been found to be effective in improving muscle recovery, while minimizing the risk of excessive physiological heat strain.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

Compositional Aspects of Beverages Designed to Promote Hydration Before, During, and After Exercise: Concepts Revisited

Hypohydration can impair aerobic performance and deteriorate cognitive function during exercise. To minimize hypohydration, athletes are recommended to commence exercise at least euhydrated, ingest fluids containing sodium during long-duration and/or high-intensity exercise to prevent body mass loss over 2% and maintain elevated plasma osmolality, and rapidly restore and retain fluid and electrolyte homeostasis before a second exercise session. To achieve these goals, the compositions of the fluids consumed are key; however, it remains unclear what can be considered an optimal formulation for a hydration beverage in different settings. While carbohydrate-electrolyte solutions such as sports drinks have been extensively explored as a source of carbohydrates to meet fuel demands during intense and long-duration exercise, these formulas might not be ideal in situations where fluid and electrolyte balance is impaired, such as practicing exercise in the heat. Alternately, hypotonic compositions consisting of moderate to high levels of electrolytes (i.e., ≥45 mmol/L), mainly sodium, combined with low amounts of carbohydrates (i.e., <6%) might be useful to accelerate intestinal water absorption, maintain plasma volume and osmolality during exercise, and improve fluid retention during recovery. Future studies should compare hypotonic formulas and sports drinks in different exercise settings, evaluating different levels of sodium and/or other electrolytes, blends of carbohydrates, and novel ingredients for addressing hydration and rehydration before, during, and after exercise.

Technology Innovation and Guardrails in Elite Sport: The Future is Now

A growing number of companies are developing or using wearable sensor technologies that can monitor, analyse and transmit data from humans in real time that can be used by the sporting, biomedical and media industries. To explore this phenomenon, we describe and review two high-profile sporting events where innovations in wearable technologies were trialled: the Tokyo 2020 Summer Olympic Games (Tokyo 2020, Japan) and the 2022 adidas Road to Records (Germany). These two major sporting events were the first time academic and industry partners came together to implement real-time wearable solutions during major competition, to protect the health of athletes competing in hot and humid environments, as well as to better understand how these metrics can be used moving forwards. Despite the undoubted benefits of such wearables, there are well-founded concerns regarding their use including: (1) limited evidence quantifying the potential beneficial effects of analysing specific parameters, (2) the quality of hardware and provided data, (3) information overload, (4) data security and (5) exaggerated marketing claims. Employment and sporting rules and regulations also need to evolve to facilitate the use of wearable devices. There is also the potential to obtain real-time data that will oblige medical personnel to make crucial decisions around whether their athletes should continue competing or withdraw for health reasons. To protect athletes, the urgent need is to overcome these ethical/data protection concerns and develop wearable technologies that are backed by quality science. The fields of sport and exercise science and medicine provide an excellent platform to understand the impact of wearable sensors on performance, wellness, health, and disease.

Cognitive Function among Young Women's Football Players in the Summer Heat

Recently, there has been a growing focus on studies related to women's football. However, the cognitive function of female football players has not been extensively characterized. Thus, we explored how the cognitive function of female football players was altered during a series of matches in summer and examined day-to-day variations in cognitive function with regard to dehydration status. Resting cognitive function was assessed from 17 young women football players during the Japan Club Youth Women's football tournament, which spanned eight consecutive days. Cognitive function initially improved, with this improvement sustained throughout the tournament. It is worth noting that ten participants experienced symptoms of dehydration at least once during the tournament; however, these symptoms were not found to be linked to impaired cognitive function, suggesting that resting cognitive function remains unaffected during summer matches, even in the presence of dehydration symptoms.

Protective guidelines and mitigation strategies for hot conditions in professional football: starting 11 Hot Tips for consideration

Elevated heat, humidity and solar load combined with low air movement independently and additively impair performance, increase the perception of effort and the risk of heat-related illnesses. For the specific context of professional football, the Fédération Internationale de Football Association (FIFA) heat guidelines are often used as the default policy. Still, these seem less protective than guidelines in other sports or from countries traditionally exposed to extreme hot conditions. Following several high-profile international and continental competitions played in hot conditions (eg, 2014 FIFA World Cup Brazil), a series of cross-sectional studies showed that national team players and their managers unanimously mentioned that the hot and humid conditions during these matches made it difficult as a team to perform. Such a concern is likely to be relevant for the upcoming 2026 FIFA World Cup that will be held in the traditional June-July window across 16 host cities in Canada, Mexico and USA. Therefore, to better protect players' health and performance during training and match play in hot conditions, we present our starting 11 Hot Tips that should be considered and facilitated by governing bodies, competition organisers, clubs, staff members and players.

Telemedicine in Sports under Extreme Conditions: Data Transmission, Remote Medical Consultations, and Diagnostic Imaging

Telemedical technologies provide significant benefits in sports for performance monitoring and early recognition of many medical issues, especially when sports are practised outside a regulated playing field, where participants are exposed to rapidly changing environmental conditions or specialised medical assistance is unavailable. We provide a review of the medical literature on the use of telemedicine in adventure and extreme sports. Out of 2715 unique sport citations from 4 scientific databases 16 papers met the criteria, which included all research papers exploring the use of telemedicine for monitoring performance and health status in extreme environments. Their quality was assessed by a double-anonymised review with a specifically designed four-item scoring system. Telemedicine was used in high-mountain sports (37.5%; n = 6), winter sports (18.7%; n = 3), water sports (25%; n = 4), and long-distance land sports (18.7%; n = 3). Telemedicine was used for data transfer, teleconsulting, and the execution of remote-controlled procedures, including imaging diagnostics. Telemedical technologies were also used to diagnose and treat sport-related and environmentally impacted injuries, including emergencies in three extreme conditions: high mountains, ultraendurance activities, and in/under the water. By highlighting sport-specific movement patterns or physiological and pathological responses in extreme climatic conditions and environments, telemedicine may result in better preparation and development of strategies for an in-depth understanding of the stress of the metabolic, cardiorespiratory, biomechanical, or neuromuscular system, potentially resulting in performance improvement and injury prevention.

Heat Preparation and Knowledge at the World Athletics Race Walking Team Championships Muscat 2022

PURPOSE

To assess elite racewalkers' preparation strategies, knowledge, and general practices for competition in the heat and their health status during the World Athletics Race Walking Teams Championships (WRW) Muscat 2022.

METHODS

Sixty-six elite racewalkers (male: n = 42; mean age = 25.8 y) completed an online survey prior to WRW Muscat 2022. Athletes were grouped by sex (males vs females) and climate (self-reported) they live/trained in (hot vs temperate/cold), with differences/relationships between groups assessed. Relationships between ranking (medalist/top 10 vs nonmedalist/nontop 10) and precompetition use of heat acclimation/acclimatization (HA) were assessed.

RESULTS

All surveyed medalists (n = 4) implemented, and top 10 finishers were more likely to report using (P = .049; OR = 0.25; 95% CI, 0.06%-1%), HA before the championships. Forty-three percent of athletes did not complete specific HA training. Females (8% [males 31%]) were less likely to have measured core temperature (P = .049; OR = 0.2; 95% CI, 0.041-0.99) and more likely to not know expected conditions in Muscat (42% vs 14%; P = .016; OR = 4.3; 95% CI, 1%-14%) or what wet bulb globe temperature is (83% vs 55%; P = .024; OR = 4.1; 95% CI, 1%-14%).

CONCLUSIONS

Athletes who implemented HA before the championships tended to place better than those who did not. Forty-three percent of athletes did not prepare for the expected hot conditions at the WRW Muscat 2022, primarily attributed to challenges in accessing and/or cost of equipment/facilities for HA strategies. Further efforts to bridge the gap between research and practice in this elite sport are needed, particularly in female athletes.

Development of an Instrument to Evaluate the Intake of Liquids, Food and Supplements in Endurance Competitions: Nutritional Intake Questionnaire for Endurance Competitions-NIQEC

BACKGROUND

In the last few years endurance sports have experienced a great increase in the number of competitions and participants. Dietary-nutritional planning is key for performing well during such competitions. To date, there is no questionnaire expressly developed to be able to analyze the consumption of liquids, foods, and supplements, as well as gastrointestinal problems in these events. This study describes the development of the Nutritional Intake Questionnaire for Endurance Competitions (NIQEC).

METHODS

The study was composed in the following phases: (1) Bibliographic search for the most important nutrients, (2) focus groups (17 dietitian-nutritionists and 15 experienced athletes) and generation of items, (3) Delphi surveys, and (4) cognitive interviews.

RESULTS

After an initial shaping of the questionnaire with the items that emerged in the focus groups, their relevance was evaluated by means of the Delphi survey, which showed more than 80% approval for most items. Finally, the cognitive interviews indicated that the questionnaire was simple and complete for its purpose. The final NIQEC (n = 50 items) was divided in 5 sections: Demographic data; sports data; consumption of liquids, food and supplements before, during, and after the competition; gastrointestinal complaints, and dietary-nutritional planning for the competition.

CONCLUSIONS

The NICEQ is a useful tool that allows collecting information from participants on sociodemographic factors and gastrointestinal complaints, and estimating the intake of liquid, food, and supplements, for endurance competitions.