Passive heat acclimation improves skeletal muscle contractility in humans

Resistance Training in the Heat: Mechanisms of Hypertrophy and Performance Enhancement

ABSTRACT

Pryor, JL, Sweet, D, Rosbrook, P, Qiao, J, Hess, HW, and Looney, DP. Resistance training in the heat: Mechanisms of hypertrophy and performance enhancement. J Strength Cond Res 38(7): 1350-1357, 2024-The addition of heat stress to resistance exercise or heated resistance exercise (HRE) is growing in popularity as emerging evidence indicates altered neuromuscular function and an amplification of several mechanistic targets of protein synthesis. Studies demonstrating increased protein synthesis activity have shown temperature-dependent mammalian target of rapamycin phosphorylation, supplemental calcium release, augmented heat shock protein expression, and altered immune and hormone activity. These intriguing observations have largely stemmed from myotube, isolated muscle fiber, or rodent models using passive heating alone or in combination with immobilization or injury models. A growing number of translational studies in humans show comparable results employing local tissue or whole-body heat with and without resistance exercise. While few, these translational studies are immensely valuable as they are most applicable to sport and exercise. As such, this brief narrative review aims to discuss evidence primarily from human HRE studies detailing the neuromuscular, hormonal, and molecular responses to HRE and subsequent strength and hypertrophy adaptations. Much remains unknown in this exciting new area of inquiry from both a mechanistic and functional perspective warranting continued research.

Passive heating-induced changes in muscle contractile function are not further augmented by prolonged exposure in young males experiencing moderate thermal stress

Background: We investigated the impact of 1) passive heating (PH) induced by single and intermittent/prolonged hot-water immersion (HWI) and 2) the duration of PH, on muscle contractile function under the unfatigued state, and during the development of muscle fatigue. Methods: Twelve young males volunteered for this study consisting of two phases: single phase (SP) followed by intermittent/prolonged phase (IPP), with both phases including two conditions (i.e., four trials in total) performed randomly: control passive sitting (CON) and HWI (44-45°C; water up to the waist level). SP-HWI included one continuous 45-min bath (from 15 to 60 min). IPP-HWI included an initial 45-min bath (from 15 to 60 min) followed by eight additional 15-min baths interspaced with 15-min breaks at room temperature between 75 and 300 min. Intramuscular (Tmu; measured in the vastus lateralis muscle) and rectal (Trec) temperatures were determined. Neuromuscular testing (performed in the knee extensors and flexors) was performed at baseline and 60 min later during SP, and at baseline, 60, 90, 150 and 300 min after baseline during IPP. A fatiguing protocol (100 electrical stimulations of the knee extensors) was performed after the last neuromuscular testing of each trial. Results: HWI increased Tmu and Trec to 38°C-38.5°C (p < 0.05) during both SP and IPP. Under the unfatigued state, HWI did not affect electrically induced torques at 20 Hz (P20) and 100 Hz (P100). However, it induced a shift towards a faster contractile profile during both SP and IPP, as evidenced by a decreased P20/P100 ratio (p < 0.05) and an improved muscle relaxation (i.e., reduced half-relaxation time and increased rate of torque relaxation; p < 0.05). Despite a reduced voluntary activation (i.e., -2.63% ± 4.19% after SP-HWI and -5.73% ± 4.31% after IPP-HWI; condition effect: p < 0.001), HWI did not impair maximal isokinetic and isometric contraction torques. During the fatiguing protocol, fatigue index and the changes in muscle contractile properties were larger after HWI than CON conditions (p < 0.05). Finally, none of these parameters were significantly affected by the heating duration. Conclusion: PH induces changes in muscle contractile function which are not augmented by prolonged exposure when thermal stress is moderate.

Cyclooxygenase inhibition does not blunt thermal hyperemia in skeletal muscle of humans

Acute heat exposure increases skeletal muscle blood flow in humans. However, the mechanisms mediating this hyperemic response remain unknown. The cyclooxygenase pathway is active in skeletal muscle, is heat sensitive, and contributes to cutaneous thermal hyperemia in young healthy humans. Therefore, the purpose of this study was to test the hypothesis that cyclooxygenase inhibition would attenuate blood flow in the vastus lateralis muscle during localized heating. Twelve participants (6 women) were studied on two separate occasions: 1) time control (i.e., no ibuprofen); and 2) ingestion of 800 mg ibuprofen, a nonselective cyclooxygenase inhibitor. Experiments were randomized, counter-balanced, and separated by at least 10 days. Pulsed short-wave diathermy was used to induce unilateral deep heating of the vastus lateralis for 90 min, whereas the contralateral leg served as a thermoneutral control. Microdialysis was utilized to bypass the cutaneous circulation and directly measure local blood flow in the vastus lateralis muscle of each leg via the ethanol washout technique. Heat exposure increased muscle temperature and local blood flow (both P < 0.01 vs. baseline). However, the thermal hyperemic response did not differ between control and ibuprofen conditions (P ≥ 0.2). Muscle temperature slightly decreased for the thermoneutral leg (P < 0.01 vs. baseline), yet local blood flow remained relatively unchanged across time for control and ibuprofen conditions (both P ≥ 0.7). Taken together, our data suggest that inhibition of cyclooxygenase-derived vasodilator prostanoids does not blunt thermal hyperemia in skeletal muscle of young healthy humans.NEW & NOTEWORTHY Acute heat exposure increases skeletal muscle blood flow in humans. However, the mechanisms mediating this hyperemic response remain unknown. Using a pharmacological approach combined with microdialysis, we found that thermal hyperemia in the vastus lateralis muscle was well maintained despite the successful inhibition of cyclooxygenase. Our results suggest that cyclooxygenase-derived vasodilator prostanoids do not contribute to thermal hyperemia in skeletal muscle of young healthy humans.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSION

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

Influence of temperature on twitch potentiation following submaximal voluntary contractions in human plantar flexor muscles

This study aimed to clarify the influence of temperature on post-activation twitch potentiation, a possible indicator of fast-twitch fiber activation during a preceding voluntary contraction. Ten healthy males immersed their left lower leg in water of different temperatures (cold: 0°C, neutral: 32-35°C, hot: ~43°C) for 20 min each. In each temperature condition, they performed submaximal (10%-50% of maximal voluntary contraction torque measured before water immersion) and maximal plantar flexions. Immediately after each voluntary contraction, twitch contractions were evoked with supramaximal stimulation of the posterior tibial nerve. The magnitude of twitch potentiation, defined as a percent increase in twitch torque following a voluntary contraction, increased with the intensity of the preceding voluntary contraction. The magnitude of twitch potentiation after the maximal voluntary contraction was smaller in Cold than in the other temperature conditions. However, temperature had no influence on the relative magnitude of twitch potentiation following the submaximal contractions. In addition, there was no difference in electromyographic activity between the gastrocnemius and soleus muscles in any temperature conditions. Collectively, the temperature dependence was not observed when using twitch potentiation or electromyographic amplitude as an indicator of fast-twitch fiber activation during brief submaximal voluntary contractions.

Skeletal muscle oxidative adaptations following localized heat therapy

Repeated heat treatment has been shown to induce oxidative adaptations in cell cultures and rodents, but similar work within human models is scarce. This study investigated the effects of 6 weeks of localized heat therapy on near-infrared spectroscopy-(NIRS) derived indices of muscle oxidative and microvascular function. Twelve physically active participants (8 males and 4 females, age: 34.9 ± 5.9 years, stature: 175 ± 7 cm, body mass: 76.7 ± 13.3 kg) undertook a 6-week intervention, where adhesive heat pads were applied for 8 h/day, 5 days/week, on one calf of each participant, while the contralateral leg acted as control. Prior to and following the intervention, the microvascular function was assessed using NIRS-based methods, where 5 min of popliteal artery occlusion was applied, and the reperfusion (i.e., re-saturation rate, re-saturation amplitude, and hyperemic response) was monitored for 2 min upon release. Participants also performed a 1-min isometric contraction of the plantar flexors (30% maximal voluntary contraction), following which a further 2 min interval was undertaken for the assessment of recovery kinetics. A 20-min time interval was allowed before the assessment protocol was repeated on the contralateral leg. Repeated localized heating of the gastrocnemius did not influence any of the NIRS-derive indices of microvascular or oxidative function (p > 0.05) following 6 weeks of treatment. Our findings indicate that localized heating via the use of adhesive heat pads may not be a potent stimulus for muscle adaptations in physically active humans.

Effect of hot water immersion on acute physiological responses following resistance exercise

Purpose: Hot water immersion (HWI) is a strategy theorised to enhance exercise recovery. However, the acute physiological responses to HWI following resistance exercise are yet to be determined. Methods: The effect of HWI on intramuscular temperature (IMT), muscle function, muscle soreness and blood markers of muscle cell disruption and inflammatory processes after resistance exercise was assessed. Sixteen resistance trained males performed resistance exercise, followed by either 10 min HWI at 40°C or 10 min passive recovery (PAS). Results: Post-intervention, the increase in IMT at all depths was greater for HWI compared to PAS, however this difference had disappeared by 1 h post at depths of 1 and 2 cm, and by 2 h post at a depth of 3 cm. There were no differences between groups for muscle function, muscle soreness or any blood markers. Conclusion: These results suggest that HWI is a viable means of heat therapy to support a greater IMT following resistance exercise. Recovery of muscle function and muscle soreness is independent of acute changes in IMT associated with HWI.

The independent effects of local heat application on muscle growth program associated mRNA and protein phosphorylation

The development and maintenance of skeletal muscle is crucial for the support of daily function. Recent evidence suggests that genes coded for proteins associated with the human muscle growth program (myogenic and proteolytic genes) are sensitive to local heat application. Therefore, the purpose of this investigation was to determine the effect of 4 h of local heat application to the vastus lateralis at rest on acute phosphorylation (mTORSer2448, p70-S6K1Thr389, and 4E-BP1Thr47/36) and gene expression changes for proteins associated with the muscle growth program. Intramuscular temperature of the HOT limb was 1.2 ± 0.2 °C higher than CON limb after 4 h of local heating. However, this local heat stimulus did not influence transcription of genes associated with myogenesis (MSTN, p = 0.321; MYF5, p = 0.445; MYF6, p = 0.895; MEF2a, p = 0.809; MYO-G, p = 0.766; MYO-D1, p = 0.118; RPS3, p = 0.321; and RPL-3L, p = 0.577), proteolysis (Atrogin-1, p = 0.573; FOXO3a, p = 0.452; MURF-1, p = 0.284), nor protein phosphorylation (mTORSer2448, p = 0.981; P70-S6K1Thr389, p = 0.583; 4E-BP1Thr37/46, p = 0.238) associated with the muscle growth program. These findings suggest little to no association between the local application of heat, at rest, and the activation of the observed muscle growth program-related markers.

Active Heat Acclimation Does Not Alter Muscle-Tendon Unit Properties

PURPOSE

Heat acclimation (HA) is recommended before competing in hot and humid conditions. HA has also been recently suggested to increase muscle strength, but its effects on human's muscle and tendon mechanical properties are not yet fully understood. This study investigated the effect of active HA on gastrocnemius medialis (GM) muscle-tendon properties.

METHODS

Thirty recreationally active participants performed 13 low-intensity cycling sessions, distributed over a 17-d period in hot (HA = ~38°C, ~58% relative humidity; n = 15) or in temperate environment (CON = ~23°C, ~35% relative humidity; n = 15). Mechanical data and high-frame rate ultrasound images were collected during electrically evoked and voluntary contractions pre- and postintervention. Shear modulus was measured at rest in GM, and vertical jump performance was assessed.

RESULTS

Core temperature decreased from the first to the last session in HA (-0.4°C ± 0.3°C; P = 0.015), while sweat rate increased (+0.4 ± 0.3 L·h -1 ; P = 0.010), suggesting effective HA, whereas no changes were observed in CON (both P ≥ 0.877). Heart rate was higher in HA versus CON and decreased throughout intervention in groups (both P ≤ 0.008), without an interaction effect ( P = 0.733). Muscle-tendon unit properties (i.e., maximal and explosive isometric torque production, contractile properties, voluntary activation, joint and fascicular force-velocity relationship, passive muscle, and active tendon stiffness) and vertical jump performance did not show training ( P ≥ 0.067) or group-training interaction ( P ≥ 0.232) effects.

CONCLUSIONS

Effective active HA does not alter muscle-tendon properties. Preparing hot and humid conditions with active HA can be envisaged in all sporting disciplines without the risk of impairing muscle performance.

Heart Rate and Body Temperature Evolution in an Interval Program of Passive Heat Acclimation at High Temperatures (100 ± 2 °C) in a Sauna

Heat exposure provokes stress on the human body. If it remains constant, it leads to adaptations such as heat acclimation. This study aims to observe the evolution of heart rate (HR), core temperature (Tcore), and skin temperature (Tskin) in an intervallic program of exposure to extreme heat. Twenty-nine healthy male volunteers were divided into a control group (CG; n = 14) and an experimental group (EG; n = 15). EG experienced nine sessions (S) of intervallic exposure to high temperatures (100 ± 2 °C), whereas CG was exposed to ambient temperatures (22 ± 2 °C). HR, Tskin, and Tcore were monitored in S1, 4, 5, 8, and 9. An important increase in HR occurred in the S4 compared to the rest (p < 0.05) in EG. A lower HR was discovered in S8 and S9 compared to S4 and in S9 in relation to S1 (p < 0.05) in EG. EG experiences a gradual decrease in Tcore and Tskin, which was detected throughout the assessments, although it was only significant in the S8 and S9 (p < 0.05). Interval exposure to heat at 100 ± 2 °C elicits stress on the human organism, fundamentally increasing Tcore, Tskin, and FC. This recurring stress in the full program caused a drop in the thermoregulatory response as an adaptation or acclimation to heat.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Increases in muscle temperature by hot water improve muscle contractile function and reduce motor unit discharge rates

PURPOSE

Examine the effects of 42°C hot-water immersion on muscle contraction function and motor unit discharge rates. Voluntary and evoked contraction assessments were examined first with a concomitant increase in the core and muscle temperature, and thereafter with increased muscle temperature but cooled core temperature.

METHODS

Fifteen participants (24.9 ± 5.6 years) performed neuromuscular assessments before, after, and ~15-min after either 90-min of 42°C (hot) or 36°C (control) water immersion. Maximal voluntary contraction (MVC) assessment of knee extension was performed along with surface electromyography (sEMG) (vastus lateralis and medialis [VL, VM]) and voluntary activation level (VAL). Resting evoked twitch was elicited for peak torque and time to peak torque analysis. In addition, the VL and VM motor unit discharge rates (MUDR) were measured.

RESULTS

After hot-water immersion (core temperature ↑1°C; muscle temperature ↑2.4°C), MVC torque and VAL decreased (p < 0.05). The sEMG (VL and VM) and peak twitch torque did not change (p > 0.05), while time to peak torque decreased (p = 0.007). The VL and VM MUDR decreased, showing a time effect, after both water immersion conditions (36 and 42°C) (p > 0.001). Fifteen minutes after the hot-water immersion (core temperature at baseline; muscle temperature ↑1.4°C), MVC torque returned to baseline, but VAL remained lower. The sEMG (VL and VM) remained unchanged. Peak twitch torque increased (p < 0.002) and time to peak torque remained lower (p = 0.028). The MUDR remained lower after both water immersion conditions (p < 0.05).

CONCLUSION

Increased core temperature evoked by 42°C hot-water immersion decreases MVC torque and VAL. However, a passive increase in muscle temperature improved evoked muscle contractile function (i.e., time to peak torque [after] and peak twitch torque [~15 min after]). Moreover, a passive increase in muscle temperature reduced the required MUDR to attain the same torque.

Post-exercise, passive heat acclimation with sauna or hot-water immersion provide comparable adaptations to performance in the heat in a military context

To mitigate the effects of heat during operations in hot environments, military personnel will likely benefit from heat acclimation (HA) conducted prior to deployment. Using post-exercise, passive heating, 25 participants completed a 5 d HA regime in sauna (70 °C, 18% RH) or hot-water immersion (HWI) (40 °C) for ≤40 min, preceded and followed by a heat stress test (1-h walking at 5 km.h^-1 in 33 °C, 77% RH in military uniform (20 kg) before an incremental ramp to exhaustion). Fifteen completed both regimes in a randomised, cross-over manner. While performance did not significantly improve (+14%, [-1, 29], p = .079), beneficial adaptations were observed for mean exercising core temperature (-0.2 °C, [-0.2, -0.2], p <.001), skin temperature (-0.2 °C, [-0.2, -0.2], p = 035) and heart rate (-8 bpm, [-6, -10], p<.001) in both conditions. Post-exercise, passive HA of either modality may benefit military units operating in the heat.Practitioner summary: Strategies are required to prevent health and performance impairments during military operations upon arrival in hot environments. Using a randomised, cross-over design, participants completed five-day passive, post-exercise heat acclimation using sauna or hot-water immersion. Both regimes elicited beneficial albeit modest heat adaptations.Abbreviations: HA: heat acclimation; HST: heat stress test; HWI: hot-water immersion; RH: relative humidity.

Skeletal muscle angiogenic, regulatory, and heat shock protein responses to prolonged passive hyperthermia of the human lower limb

Passive hyperthermia induces a range of physiological responses including augmenting skeletal muscle mRNA expression. This experiment aimed to examine gene and protein responses to prolonged passive leg hyperthermia. Seven young participants underwent 3 h of resting unilateral leg heating (HEAT) followed by a further 3 h of rest, with the contralateral leg serving as an unheated control (CONT). Muscle biopsies were taken at baseline (0 h), and at 1.5, 3, 4, and 6 h in HEAT and 0 and 6 h in CONT to assess changes in selected mRNA expression via qRT-PCR, and HSP72 and VEGFα concentration via ELISA. Muscle temperature (T_m) increased in HEAT plateauing from 1.5 to 3 h (+3.5 ± 1.5°C from 34.2 ± 1.2°C baseline value; P < 0.001), returning to baseline at 6 h. No change occurred in CONT. Endothelial nitric oxide synthase (eNOS), Forkhead box O1 (FOXO-1), Hsp72, and VEGFα mRNA increased in HEAT (P < 0.05); however, post hoc analysis identified that only Hsp72 mRNA statistically increased (at 4 h vs. baseline). When peak change during HEAT was calculated angiopoietin 2 (ANGPT-2) decreased (-0.4 ± 0.2-fold), and C-C motif chemokine ligand 2 (CCL2) (+2.9 ± 1.6-fold), FOXO-1 (+6.2 ± 4.4-fold), Hsp27 (+2.9 ± 1.7-fold), Hsp72 (+8.5 ± 3.5-fold), Hsp90α (+4.6 ± 3.7-fold), and VEGFα (+5.9 ± 3.1-fold) increased from baseline (all P < 0.05). At 6 h T_m were not different between limbs (P = 0.582; CONT = 32.5 ± 1.6°C, HEAT = 34.3 ± 1.2°C), and only ANGPT-2 (P = 0.031; -1.3 ± 1.4-fold) and VEGFα (P = 0.030; 1.1 ± 1.2-fold) differed between HEAT and CONT. No change in VEGFα or HSP72 protein concentration were observed over time; however, peak change in VEGFα did increase (P < 0.05) in HEAT (+140 ± 184 pg·mL^-1) versus CONT (+7 ± 86 pg·mL^-1). Passive hyperthermia transiently augmented ANGPT-2, CCL2, eNOS, FOXO-1, Hsp27, Hsp72, Hsp90α and VEGFα mRNA, and VEGFα protein.

New developments in translational microcirculatory research

Microvascular disease plays a critical role in systemic end-organ dysfunction, and treatment of microvascular pathologies may greatly reduce cardiovascular morbidity and mortality. The Call for Papers collection: New Developments in Translational Microcirculatory Research highlights key advances in our understanding of the role of microvessels in the development of chronic diseases as well as therapeutic strategies to enhance microvascular function. This Mini Review provides a concise summary of these advances and draws from other relevant research to provide the most up-to-date information on the influence of cutaneous, cerebrovascular, coronary, and peripheral microcirculation on the pathophysiology of obesity, hypertension, cardiovascular aging, peripheral artery disease, and cognitive impairment. In addition to these disease- and location-dependent research articles, this Call for Papers includes state-of-the-art reviews on coronary endothelial function and assessment of microvascular health in different organ systems, with an additional focus on establishing rigor and new advances in clinical trial design. These articles, combined with original research evaluating cellular, exosomal, pharmaceutical, exercise, heat, and dietary interventional therapies, establish the groundwork for translating microcirculatory research from bench to bedside. Although numerous studies in this collection are focused on human microcirculation, most used robust preclinical models to probe mechanisms of pathophysiology and interventional benefits. Future work focused on translating these findings to humans are necessary for finding clinical strategies to prevent and treat microvascular dysfunction.

Local passive heating administered during recovery impairs subsequent isokinetic knee extension exercise performance

BACKGROUND: Passive heating has attracted attention as a potentially promising recovery modality in sports. However, investigations of passive heating have yielded only inconsistent results for exercise performance. OBJECTIVE: To investigate the acute effects of local passive heating administered between repeated bouts of isokinetic exercise. METHODS: The experiment was a randomized crossover study. There was a total of three visits including a familiarization visit. During the remaining two visits, eleven healthy men performed three bouts of nine sets of isokinetic knee extensions using their dominant single-leg (30 repetitions/set, 180∘/sec). A 15 min recovery, during which a local passive heating pad at control (CON) or heating (HT) was applied to the rectus femoris, was afforded after the 3rd and 6th sets (Recovery 1 and 2). Isokinetic exercise performance, as assessed by peak torque, total work, and average power was analyzed using two-way repeated-measures ANOVA. RESULTS: Following Recovery 1 and 2, isokinetic exercise performance, as assessed by peak torque, total work, and average power was reduced in Set 4 (p< 0.001, p< 0.001, p= 0.080) and Set 7 (p< 0.001, p< 0.001, p= 0.009) in the HT group relative to the CON group. Electromyography analysis revealed that signal amplitude was lower in the HT group in Set 4 (p< 0.001) subsequent to Recovery 1, and that firing frequency was higher in Set 7 (p= 0.002) in the HT group after Recovery 2. Furthermore, EMG time-frequency maps from one representative participant showed that following Recovery 1 and 2 peak energy decreased during the first five repetitions in Set 4 and 7. CONCLUSIONS: Local passive heating administered during recovery decreased subsequent performance of isokinetic knee extensors, muscle activation ability and increased firing frequency maintaining force output. Therefore, local passive heating is not an appropriate acute recovery strategy for isokinetic exercises.

Acute Effect of Exposure to Extreme Heat (100 ± 3 °C) on Lower Limb Maximal Resistance Strength

The aim of this study was to evaluate the acute effect of a single dry sauna bath lasting twelve minutes on the indirect determination of the one maximum repetition (1RM) leg press among trained and untrained participants. Thirty young men participated in the study, a trained group (TG; n = 15; age: 20.97 ± 0.44 years) and an untrained group (UG; n = 15; age: 21.03 ± 0.11 years). Subjects in the TG had performed resistance training for at least two years before the beginning of the experiment. All participants performed two indirect tests of their one maximum repetition leg press on two different days, with a rest period of three weeks between tests. Additionally, anthropometric, body composition, blood pressure, body temperature, and rated perceived exertion were evaluated. On the second testing day, all of the participants took a dry sauna bath lasting 12 min immediately before performing the leg press test. In the second evaluation (pre-heating in the sauna), the UG experienced increases in absolute RM (178.48 ± 56.66 to 217.60 ± 59.18 kg; p < 0.05; R = 0.798), relative RM (2.65 ± 0.61 to 3.24 ± 0.58 kg·g body mass^-1; p < 0.05; R = 0.798), and muscular RM (5.64 ± 1.20 to 6.77 ± 1.14 kg·kg muscle mass^-1; p < 0.05; R = 0.797). The TG also increased their values on the second day in absolute RM (284.96 ± 62.41 to 314.92 ± 1.04 kg; p < 0.01; R = 0.886), in relative RM (3.61 ± 0.88 to 3.99 ± 1.85 kg*kg body mass^-1; p < 0.01; R = 0.886), and muscular RM (7.83 ± 1.69 to 8.69 ± 1.85 kg·kg muscle mass^-1; p < 0.01; R = 0.854). A passive, extreme-heat sauna bath lasting 12 min taken immediately before a relative maximum repetition test seems to provoke clear positive responses for the development of strength.

Potential role of passively increased muscle temperature on contractile function

Declines in muscle force, power, and contractile function can be observed in older adults, clinical populations, inactive individuals, and injured athletes. Passive heating exposure (e.g., hot baths, sauna, or heated garments) has been used for health purposes, including skeletal muscle treatment. An acute increase in muscle temperature by passive heating can increase the voluntary rate of force development and electrically evoked contraction properties (i.e., time to peak twitch torque, half-relation time, and electromechanical delay). The improvements in the rate of force development and evoked contraction assessments with increased muscle temperature after passive heating reveal peripheral mechanisms’ potential role in enhancing muscle contraction. This review aimed to summarise, discuss, and highlight the potential role of an acute passive heating stimulus on skeletal muscle cells to improve contractile function. These mechanisms include increased calcium kinetics (release/reuptake), calcium sensitivity, and increased intramuscular fluid.

Faster early rate of force development in a warmer muscle: an in vivo exploration of fascicle dynamics and muscle-tendon mechanical properties

While heat exposure has been shown to increase the rate of force development (RFD), the underlying processes remain unknown. This study investigated the effect of heat on gastrocnemius medialis (GM) muscle-tendon properties and interactions. Sixteen participants performed electrically-evoked and voluntary contractions combined with ultrafast ultrasound under thermoneutral (CON: 26°C, core temperature 37.0±0.3°C, muscle temperature 34.0±1.1°C) and passive heat exposure (HOT: 47°C, core temperature 38.4±0.3°C, muscle temperature 37.0±0.8°C) conditions. Maximal voluntary force was unchanged while voluntary activation decreased (-4.6±8.7%, P=0.038) in HOT. Heat exposure increased RFD before 100 ms from contraction onset (+48.2±62.7%; P=0.013), without further changes after 100 ms. GM fascicle dynamics during electrically-evoked and voluntary contractions remained unchanged between conditions. Joint velocity at a given force was higher in HOT (+7.1±6.6%; P=0.004), while the fascicle force-velocity relationship was unchanged. Passive muscle stiffness and active tendon stiffness were lower in HOT than CON (P≤0.030). This study showed that heat-induced increases in early RFD may not be attributed to changes in contractile properties. Late RFD was unaltered, probably explained by decreased soft tissues' stiffness in heat. Investigations are required to explore the possible influence of neural drive and motor unit recruitment in the enhancement of explosive strength elicited by heat exposure.

The Heat Shock Connection: Skeletal Muscle Hypertrophy and Atrophy

Skeletal muscle is an integral tissue system that plays a crucial role in the physical function of all vertebrates and is a key target for maintaining or improving health and performance across the lifespan. Based largely on cellular and animal models, there is some evidence that various forms of heat stress with or without resistance exercise may enhance skeletal muscle growth or reduce its loss. It is not clear whether these stimuli are similarly effective in humans or meaningful in comparison to exercise alone across various heating methodologies. Furthermore, the magnitude by which heat stress may influence whole body thermoregulatory responses and the connection to skeletal muscle adaptation remains ambiguous. Finally, the underlying mechanisms, which may include interaction between relevant heat shock proteins and intracellular hypertrophy and atrophy related factors, remain unclear. In this narrative mini-review we examine the relevant literature regarding heat stress alone or in combination with resistance exercise emphasizing skeletal muscle hypertrophy and atrophy across cellular and animal models, as well as human investigations. Additionally, we present working mechanistic theories for heat shock protein mediated signaling effects regarding hypertrophy and atrophy related signaling processes. Importantly, continued research is necessary to determine the practical effects and mechanisms of heat stress with and without resistance exercise on skeletal muscle function via growth and maintenance.

Impact of climatic conditions projected at the World Cup in Qatar 2022 on repeated maximal efforts in soccer players

This study aimed to investigate the relationship between the climatic conditions predicted for the 2022 FIFA World Cup in Qatar and the capacity for repeated maximum effort (RSA), of soccer players. Twenty-four semi-professional soccer players participated in the study. The exercise test consisted of ten 6-second maximal efforts on a cycloergometer. A 90-second passive rest interval was used. Mechanical parameters were recorded in each repetition, and biochemical parameters at rest and even repetitions. The test was performed in a Weiss Technik WK-26 climate chamber under two different conditions: (1) thermoneutral (TNC - 20.5 °C; 58.7% humidity); (2) predicted for the 2022 World Cup in Qatar (QSC - 28.5 ± 1.92 °C; 58.7 ± 8.64% humidity). Significantly higher mean maximum power values were recorded in the second repetition under QSC conditions (1731,8 ± 214,4 W) (p = 0.025). A significantly longer time to reach maximum power was also recorded under TNC conditions compared to QSC conditions in repetition 2 (1,32 ± 0,33 s), (1,05 ± 0,29 s) (p = 0.016) and 6 (1,41 ± 0,48 s), (1,17 ± 0,25) (p = 0.036). There was a significantly higher rate of power loss, between repetition 2 (p = 0.023) and 4 (p = 0.043) under QSC conditions, compared to TNC. Considering the biochemical parameters, a significantly higher pO2 concentration was registered under QSC conditions in the 10th repetition (p = 0.006). The ambient temperature during exercise should be taken into account to determine the anaerobic exercise capacity of the athletes. At higher temperatures, there is a greater capacity for maximal effort, in terms of maximal power achieved, but with a greater decrease in performance.

Effects of 24 h Compression Interventions with Different Garments on Recovery Markers during Running

Compression and temperature manipulation are discussed as strategies to improve performance markers and recovery in sports. Here, we investigate the effects of compression stockings made with fabric, either combined or not with heating and cooling substances, on variables related to running performance and recovery. Ten trained runners (mean ± standard deviation age 45 ± 9 years old, body mass 69 ± 7 kg, height 166 ± 4 cm) with no experience of using compression garments performed an intense running session of 10 km, then wore a stocking for 24 h (randomized; without compression, compression, compression with camphor, and compression with menthol), and were evaluated on the following day, after running 5 km. The different types of compression stockings used 24 h before exercise did not affect running kinematics (p > 0.14), skin temperature (p > 0.05), heart rate (p > 0.12; mean value of maximal heart rate 156 bpm), comfort perception (p = 0.13; mean value of 7/10 points), or perception of recovery (p = 0.13; mean value of 7/10 points). In general, there were no effects of 24 h pre-exercise lower leg compression, including those treated with menthol and camphor applications on running kinematics, skin temperature, heart rate, or recovery perception in athletes undertaking consecutive running exercises.

Thermotherapy Effects on Healthy and Type 2 Diabetes Human Skeletal Muscle Myoblast Cell Lines

Diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels with associated disordered carbohydrate and lipid metabolism. Type 2 diabetes (T2D) specifically has been shown to cause a decrease in skeletal muscle mass due to oxidative stress. This study investigated a treatment option for T2D through thermotherapy on healthy (HSMM) and T2D (D-HSMM) human skeletal muscle cells. The goals were to determine the effects of thermotherapy, long-term (chronic) and short-term (acute), on HSMM and D-HSMM cell viabilities and oxidative stress. HSMM and D-HSMM cells were grown to confluency, harvested, and counted to determine density. Acute and chronic heat treatments were applied to both cell lines. The chronic treatment consisted of a 30-minute exposure to 40°C, three times a week for three weeks; the acute treatment was a one-time exposure. Oxidative stress assays and cell viabilities were tested 24 hours after heat treatments. Results indicated no significant effect on the cell viability of HSMM and D-HSMM cells. The acute treatment had a significant increase (p ≤ 0.05) of MDA concentration compared to the chronic treatment. The chronic treatment had a significant increase (p ≤ 0.05) in catalase activity compared to the acute treatment. The SOD activity had no significant change (p > 0.05) between the chronic and acute treatments. In conclusion, acute thermotherapy may not be beneficial for skeletal muscle cells due to the observed increase in oxidative stress, especially in the D-HSMM cells.

Heat Reacclimation Using Exercise or Hot Water Immersion

INTRODUCTION

The aim of this study was to compare the effectiveness of exercise versus hot water immersion heat reacclimation (HRA) protocols.

METHODS

Twenty-four participants completed a heat stress test (HST; 33°C, 65% RH), which involved cycling at a power output equivalent to 1.5 W·kg-1 for 35 min whereby thermophysiological variables were measured. This was followed by a graded exercise test until exhaustion. HST1 was before a 10-d controlled hyperthermia (CH) heat acclimation (HA) protocol and HST2 immediately after. Participants completed HST3 after a 28-d decay period without heat exposure and were then separated into three groups to complete a 5-d HRA protocol: a control group (CH-CON, n = 8); a hot water immersion group (CH-HWI, n = 8), and a controlled hyperthermia group (CH-CH, n = 8). This was followed by HST4.

RESULTS

Compared with HST1, time to exhaustion and thermal comfort improved; resting rectal temperature (Tre), end of exercise Tre, and mean skin temperature (Tsk) were lower; and whole body sweat rate (WBSR) was greater in HST2 for all groups (P < 0.05). After a 28-d decay, only WBSR, time to exhaustion, and mean Tsk returned to pre-HA values. Of these decayed variables, only WBSR was reinstated after HRA; the improvement was observed in both the CH-CH and the CH-HWI groups (P < 0.05).

CONCLUSION

The data suggest that HRA protocol may not be necessary for cardiovascular and thermal adaptations within a 28-d decay period, as long as a 10-d CH-HA protocol has successfully induced these physiological adaptations. For sweat adaptations, a 5-d CH or HWI-HRA protocol can reinstate the lost adaptations.

Short-term heat acclimation preserves knee extensor torque but does not improve 20 km self-paced cycling performance in the heat

Purpose

This study investigated the effect of 5 days of heat acclimation training on neuromuscular function, intestinal damage, and 20 km cycling (20TT) performance in the heat.

Methods

Eight recreationally trained males completed two 5-day training blocks (cycling 60 min day⁻¹ at 50% peak power output) in a counter-balanced, cross-over design, with a 20TT completed before and after each block. Training was conducted in hot (HA: 34.9 ± 0.7 °C, 53 ± 4% relative humidity) or temperate (CON: 22.2 ± 2.6 °C, 65 ± 8% relative humidity) environment. All 20TTs were completed in the heat (35.1 ± 0.5 °C, 51 ± 4% relative humidity). Neuromuscular assessment of knee extensors (5 × 5 s maximum voluntary contraction; MVC) was completed before and after each 20TT and on the first and last days of each training block.

Results

MVC torque was statistically higher after 5 days of HA training compared to CON (mean difference = 14 N m [95% confidence interval; 6, 23]; p < 0.001; d = 0.77). However, 20TT performance after 5 days of HA training was not statistically different to CON, with a between-conditions mean difference in the completion time of 68 s [95% confidence interval; − 9, 145] (p = 0.076; d = 0.35).

Conclusion

Short-term heat acclimation training may increase knee extensor strength without changes in central fatigue or intestinal damage. Nevertheless, it is insufficient to improve 20 km self-paced cycling performance in the heat compared to workload-matched training in a temperate environment. These data suggest that recreationally trained athletes gain no worthwhile performance advantage from short-term heat-training before competing in the heat.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-021-04744-y.

Effect of Handgrip Training in Extreme Heat on the Development of Handgrip Maximal Isometric Strength among Young Males

The aim of this study was to evaluate the acute and adaptive effects of passive extreme heat (100 ± 3 °C) exposition in combination with a strength training protocol on maximal isometric handgrip strength. Fifty-four untrained male university students participated in this investigation. Twenty-nine formed the control group (NG) and 25 the heat-exposed group (HG). All the participants performed a 3-week isotonic handgrip strength training program twice a week with a training volume of 10 series of 10 repetitions with 45-s rest between series, per session. All the subjects only trained their right hand, leaving their left hand untrained. HG performed the same training protocol in hot (100 ± 3 °C) conditions in a dry sauna. Maximal isometric handgrip strength was evaluated each training day before and after the session. NG participants did not experience any modifications in either hand by the end of the study while HG increased maximal strength values in both hands (p < 0.05), decreased the difference between hands (p < 0.05), and recorded higher values than the controls in the trained (p < 0.05) and untrained (p < 0.01) hands after the intervention period. These changes were not accompanied by any modification in body composition in either group. The performance of a unilateral isotonic handgrip strength program in hot conditions during the three weeks induced an increase in maximal isometric handgrip strength in both hands without modifications to bodyweight or absolute body composition.

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.

The Role of Skeletal Muscles in Exertional Heat Stroke Pathophysiology

The active participation of skeletal muscles is a unique characteristic of exertional heat stroke. Nevertheless, the only well-documented link between skeletal muscle activities and exertional heat stroke pathophysiology is the extensive muscle damage (e. g., rhabdomyolysis) and subsequent leakage of intramuscular content into the circulation of exertional heat stroke victims. Here, we will present and discuss rarely explored roles of skeletal muscles in the context of exertional heat stroke pathophysiology and recovery. This includes an overview of heat production that contributes to severe hyperthermia and the synthesis and secretion of bioactive molecules, such as cytokines, chemokines and acute phase proteins. These molecules can alter the overall inflammatory status from pro- to anti-inflammatory, affecting other organ systems and influencing recovery. The activation of innate immunity can determine whether a victim is ready to return to physical activity or experiences a prolonged convalescence. We also provide a brief discussion on whether heat acclimation can shift skeletal muscle secretory phenotype to prevent or aid recovery from exertional heat stroke. We conclude that skeletal muscles should be considered as a key organ system in exertional heat stroke pathophysiology.

Hyperthermia reduces electromechanical delay via accelerated electrochemical processes

The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (D_m; i.e., delay between stimulation and muscle fascicle motion), and mechanical (T_m; i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26°C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50°C, 18% relative humidity, after ∼127 min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0 ± 0.6°C in HOT vs. 34.0 ± 0.8°C in CON (P < 0.001). EMD was shorter (9.4 ± 0.8 ms) in HOT than in CON (10.8 ± 0.6 ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0 ± 0.8 ms vs. 5.5 ± 0.9 ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance.NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5°C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.

Six weeks of localized heat therapy does not affect muscle mass, strength and contractile properties in healthy active humans

PURPOSE

Animal and human studies have shown that repeated heating may induce skeletal muscle adaptations, increasing muscle strength. The aim of this study is to investigate the effect of 6 weeks of localized heating on skeletal muscle strength, volume and contractile properties in healthy humans.

METHODS

Fifteen active participants (8 males/7 females, 35 ± 6 years, 70 ± 14 kg, 173 ± 7 cm, average training of 87 min per week) were subjected to 6 weeks of single-leg heat therapy. Heat pads were applied for 8 h/day, 5 days/week, on one randomly selected calf of each participant, while the contralateral leg acted as control. The heat pads increased muscle temperature by 4.6 ± 1.2 °C (p < 0.001). Every 2 weeks, participants were tested for morphological (MRI), architectural (ultrasound), contractile (electrically evoked twitch), and force (isometric and isokinetic) adaptations.

RESULTS

Repeated localized heating did not affect the cross-sectional area (p = 0.873) or pennation angle (p = 0.345) of the gastrocnemius muscles; did not change the evoked peak twitch amplitude (p = 0.574) or rate of torque development (p = 0.770) of the plantar flexors; and did not change maximal voluntary isometric (p = 0.214) or isokinetic (p = 0.973) plantar flexor torque.

CONCLUSION

Whereas previous studies have observed improved skeletal muscle function following whole-body and localized heating in active and immobilized humans, respectively, the current data suggested that localized heating may not be a potent stimulus for muscle adaptations in active humans.

Short-Term Repeated-Sprint Training in Hot and Cool Conditions Similarly Benefits Performance in Team-Sport Athletes

This study compared the performance and physiological adaptations of short-term repeated-sprint training in HOT [40°C and 40% relative humidity (RH)] and COOL (20°C and 40% RH) conditions in team-sport athletes. Twenty-five trained males completed five training sessions of 60 min over 7 days in HOT (n = 13) or COOL (n = 12) conditions, consisting of a submaximal warm-up and four sets of maximal sprints. Before and after the intervention, intermittent shuttle running performance was assessed in cool and repeated-sprint ability in hot conditions; the latter preceded and followed by neuromuscular function testing. During the repeated-sprint training sessions, skin (~8.4°C) and core (~0.17°C) temperatures were higher in HOT than COOL (p < 0.05) conditions. Shuttle running distance increased after both interventions (p < 0.001), with a non-significant (p = 0.131) but larger effect in HOT (315 m, d = 1.18) than COOL (207 m, d = 0.51) conditions. Mean (~7%, p < 0.001) and peak (~5%, p < 0.05) power during repeated-sprinting increased following both interventions, whereas peak twitch force before the repeated-sprint assessment was ~10% lower after the interventions (p = 0.001). Heart rate during the repeated-sprint warm-up was reduced (~6 beats.min^-1) following both interventions (p < 0.01). Rectal temperature was ~0.14°C lower throughout the repeated-sprint assessment after the interventions (p < 0.001), with larger effects in HOT than COOL during the warm-up (p = 0.082; d = -0.53 vs. d = -0.15) and repeated-sprints (p = 0.081; d = -0.54 vs. d = -0.02). Skin temperature (p = 0.004, d = -1.11) and thermal sensation (p = 0.015, d = -0.93) were lower during the repeated-sprints after training in HOT than COOL. Sweat rate increased (0.2 L.h^-1) only after training in HOT (p = 0.027; d = 0.72). The intensive nature of brief repeated-sprint training induces similar improvements in repeated-sprint cycling ability in hot conditions and intermittent running performance in cool conditions, along with analogous physiological adaptations, irrespective of the environmental conditions in which training is undertaken.

Skeletal Muscle Signaling Following Whole-Body and Localized Heat Exposure in Humans

This study identified the changes in hypertrophy/atrophy and mitochondrial-related signaling in human skeletal muscle following whole-body (WB) and localized single leg (SL) heat treatment. Nine active male participants were administered either 60 min of passive WB (44–50°C, 50% humidity) or SL (water-perfused suit at 49.5 ± 1.4°C) heat treatment at least 1 week apart in a counterbalanced order. The untreated leg during SL was considered as control (CON). Core, skin, and quadriceps muscle temperature were monitored throughout the experimental trials. Muscle microbiopsy samples were obtained prior to (PRE), and 30 min and 3 h post (POST) following heat treatment. Muscle temperature increased with time (p < 0.0001) in both WB and SL, with no differences between conditions (38.8 ± 0.5°C vs. 38.1 ± 0.6°C, p = 0.065). Core temperature increased only following WB, and was significantly higher compared with SL (39.1 ± 0.3°C vs. 37.1 ± 0.1, p < 0.0001). Compared with PRE, WB up-regulated the phosphorylation status of the majority of the Akt/mTOR pathway (Akt, mTOR, S6K1, rpS6, and p-eIF4E; p ≤ 0.050), with the exception of 4EBP1 (p = 0.139). WB also increased the mRNA of HSPs 72, 90, and 25 (all p < 0.021), and increased or tended to increase the phosphorylation of FOXO1 (p = 0.066) and FOXO3a (p = 0.038). In addition, most (NRF1, NRF2, COX2, and COX4-I2; all p ≤ 0.050), but not all (CS, Cyt c, and COX4-I1; p > 0.441) mRNA content indicative of mitochondrial biogenesis were increased following WB, with no changes evident in these parameters in SL or CON (all p > 0.090). These results indicate that 1 h of WB heat treatment enhanced anabolic (Akt/mTOR), mitochondrial, and cyto-protective signaling (HSP), with a concomitant possible inhibition of FOXO transcription factors.

High Thermoregulatory Strain During Competitive Paratriathlon Racing in the Heat

Purpose: Paratriathletes may display impairments in autonomic (sudomotor and/or vasomotor function) or behavioral (drinking and/or pacing of effort) thermoregulation. As such, this study aimed to describe the thermoregulatory profile of athletes competing in the heat. Methods: Core temperature (Tc) was recorded at 30-second intervals in 28 mixed-impairment paratriathletes during competition in a hot environment (air temperature = 33°C, relative humidity = 35%–41%, and water temperature = 25°C–27°C), via an ingestible temperature sensor (BodyCap e-Celsius). Furthermore, in a subset of 9 athletes, skin temperature was measured. Athletes’ wetsuit use was noted while heat illness symptoms were self-reported postrace. Results: In total, 22 athletes displayed a Tc ≥ 39.5°C with 8 athletes ≥40.0°C. There were increases across the average Tc for swim, bike, and run sections (P ≤ .016). There was no change in skin temperature during the race (P ≥ .086). Visually impaired athletes displayed a significantly greater Tc during the run section than athletes in a wheelchair (P ≤ .021). Athletes wearing a wetsuit (57% athletes) had a greater Tc when swimming (P ≤ .032), whereas those reporting heat illness symptoms (57% athletes) displayed a greater Tc at various time points (P ≤ .046). Conclusions: Paratriathletes face significant thermal strain during competition in the heat, as evidenced by high Tc, relative to previous research in able-bodied athletes and a high incidence of self-reported heat illness symptomatology. Differences in the Tc profile exist depending on athletes’ race category and wetsuit use.

Effects of repeated local heat therapy on skeletal muscle structure and function in humans

The purpose of the present study was to examine the effects of repeated exposure to local heat therapy (HT) on skeletal muscle function, myofiber morphology, capillarization, and mitochondrial content in humans. Twelve young adults (23.6 ± 4.8 yr, body mass index 24.9 ± 3.0 kg/m²) had one randomly selected thigh treated with HT (garment perfused with water at ~52°C) for 8 consecutive weeks (90 min, 5 days/wk) while the opposite thigh served as a control. Biopsies were obtained from the vastus lateralis muscle before and after 4 and 8 wk of treatment. Knee extensor strength and fatigue resistance were also assessed using isokinetic dynamometry. The changes in peak isokinetic torque were higher (P = 0.007) in the thigh exposed to HT than in the control thigh at weeks 4 (control 4.2 ± 13.1 Nm vs. HT 9.1 ± 16.1 Nm) and 8 (control 1.8 ± 9.7 Nm vs. HT 7.8 ± 10.2 Nm). Exposure to HT averted a temporal decline in capillarization around type II fibers (P < 0.05), but had no effect on capillarization indexes in type I fibers. The content of endothelial nitric oxide synthase was ~18% and 35% higher in the thigh exposed to HT at 4 and 8 wk, respectively (P = 0.003). Similarly, HT increased the content of small heat shock proteins HSPB5 (P = 0.007) and HSPB1 (P = 0.009). There were no differences between thighs for the changes in fiber cross-sectional area and mitochondrial content. These results indicate that exposure to local HT for 8 wk promotes a proangiogenic environment and enhances muscle strength but does not affect mitochondrial content in humans.NEW & NOTEWORTHY We demonstrate that repeated application of heat therapy to the thigh with a garment perfused with warm water enhances the strength of knee extensors and influences muscle capillarization in parallel with increases in the content of endothelial nitric oxide synthase and small heat shock proteins. This practical method of passive heat stress may be a feasible tool to treat conditions associated with capillary rarefaction and muscle weakness.

Could Heat Therapy Be an Effective Treatment for Alzheimer's and Parkinson's Diseases? A Narrative Review

Neurodegenerative diseases involve the progressive deterioration of structures within the central nervous system responsible for motor control, cognition, and autonomic function. Alzheimer's disease and Parkinson's disease are among the most common neurodegenerative disease and have an increasing prevalence over the age of 50. Central in the pathophysiology of these neurodegenerative diseases is the loss of protein homeostasis, resulting in misfolding and aggregation of damaged proteins. An element of the protein homeostasis network that prevents the dysregulation associated with neurodegeneration is the role of molecular chaperones. Heat shock proteins (HSPs) are chaperones that regulate the aggregation and disaggregation of proteins in intracellular and extracellular spaces, and evidence supports their protective effect against protein aggregation common to neurodegenerative diseases. Consequently, upregulation of HSPs, such as HSP70, may be a target for therapeutic intervention for protection against neurodegeneration. A novel therapeutic intervention to increase the expression of HSP may be found in heat therapy and/or heat acclimation. In healthy populations, these interventions have been shown to increase HSP expression. Elevated HSP may have central therapeutic effects, preventing or reducing the toxicity of protein aggregation, and/or peripherally by enhancing neuromuscular function. Broader physiological responses to heat therapy have also been identified and include improvements in muscle function, cerebral blood flow, and markers of metabolic health. These outcomes may also have a significant benefit for people with neurodegenerative disease. While there is limited research into body warming in patient populations, regular passive heating (sauna bathing) has been associated with a reduced risk of developing neurodegenerative disease. Therefore, the emerging evidence is compelling and warrants further investigation of the potential benefits of heat acclimation and passive heat therapy for sufferers of neurodegenerative diseases.

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.

Heat-induced hypervolemia: Does the mode of acclimation matter and what are the implications for performance at Tokyo 2020?

Tokyo 2020 will likely be the most heat stressful Olympics to date, so preparation to mitigate the effects of humid heat will be essential for performance in several of the 33 sports. One key consideration is heat acclimation (HA); the repeated exposure to heat to elicit physiological and psychophysical adaptations that improve tolerance and exercise performance in the heat. Heat can be imposed in various ways, including exercise in the heat, hot water immersion, or passive exposure to hot air (e.g., sauna). The physical requirements of each sport will determine the impact that the heat has on performance, and the adaptations required from HA to mitigate these effects. This review focuses on one key adaptation, plasma volume expansion (PVE), and how the mode of HA may affect the kinetics of adaptation. PVE constitutes a primary HA-mediated adaptation and contributes to functional adaptations (e.g., lower heart rate and increased heat loss capacity), which may be particularly important in athletes of "sub-elite" cardiorespiratory fitness (e.g., team sports), alongside athletes of prolonged endurance events. This review: i) highlights the ability of exercise in the heat, hot-water immersion, and passive hot air to expand PV, providing the first quantitative assessment of the efficacy of different heating modes; ii) discusses how this may apply to athletes at Tokyo 2020; and iii) provides recommendations regarding the protocol of HA and the prospect for achieving PVE (and the related outcomes).

The effects of lower body passive heating combined with mixed-method cooling during half-time on second-half intermittent sprint performance in the heat

PURPOSE

This study examined the effects of combined cooling and lower body heat maintenance during half-time on second-half intermittent sprint performances.

METHODS

In a repeated measures design, nine males completed four intermittent cycling trials (32.1 ± 0.3 °C and 55.3 ± 3.7% relative humidity), with either one of the following half-time recovery interventions; mixed-method cooling (ice vest, ice slushy and hand cooling; COOL), lower body passive heating (HEAT), combined HEAT and COOL (COMB) and control (CON). Peak and mean power output (PPO and MPO), rectal (T_re), estimated muscle (T_es-Mus) and skin (T_SK) temperatures were monitored throughout exercise.

RESULTS

During half-time, the decrease in T_re was substantially greater in COOL and COMB compared with CON and HEAT, whereas declines in T_es-Mus within HEAT and COMB were substantially attenuated compared with CON and COOL. The decrease in T_SK was most pronounced in COOL compared with CON, HEAT and COMB. During second-half, COMB and HEAT resulted in a larger decrease in PPO and MPO during the initial stages of the second-half when compared to CON. In addition, COOL resulted in an attenuated decrease in PPO and MPO compared to COMB in the latter stages of second-half.

CONCLUSION

The maintenance of T_es-Mus following half-time was detrimental to prolonged intermittent sprint performance in the heat, even when used together with cooling.

Heat Acclimation Decay and Re-Induction: A Systematic Review and Meta-Analysis

Background

Although the acquisition of heat acclimation (HA) is well-documented, less is known about HA decay (HAD) and heat re-acclimation (HRA). The available literature suggests 1 day of HA is lost following 2 days of HAD. Understanding this relationship has the potential to impact upon the manner in which athletes prepare for major competitions, as a HA regimen may be disruptive during final preparations (i.e., taper).

Objective

The aim of this systematic review and meta-analysis was to determine the rate of HAD and HRA in three of the main physiological adaptations occurring during HA: heart rate (HR), core temperature (T_c), and sweat rate (SR).

Data Sources

Data for this systematic review were retrieved from Scopus and critical review of the cited references.

Study Selection

Studies were included when they met the following criteria: HA, HAD, and HRA (when available) were quantified in terms of exposure and duration. HA had to be for at least 5 days and HAD for at least 7 days for longitudinal studies. HR, T_c, or SR had to be monitored in human participants.

Study Appraisal

The level of bias in each study was assessed using the McMaster critical review form. Multiple linear regression techniques were used to determine the dependency of HAD in HR, T_c, and SR from the number of HA and HAD days, daily HA exposure duration, and intensity.

Results

Twelve studies met the criteria and were systematically reviewed. HAD was quantified as a percentage change relative to HA (0% = HA, 100% = unacclimated state). Adaptations in end-exercise HR decreased by 2.3% (P < 0.001) for every day of HAD. For end-exercise T_c, the daily decrease was 2.6% (P < 0.01). The adaptations in T_c during the HA period were more sustainable when the daily heat exposure duration was increased and heat exposure intensity decreased. The decay in SR was not related to the number of decay days. However, protracted HA-regimens seem to induce longer-lasting adaptations in SR. High heat exposure intensities during HA seem to evoke more sustained adaptations in SR than lower heat stress. Only eight studies investigated HRA. HRA was 8–12 times faster than HAD at inducing adaptations in HR and T_c, but no differences could be established for SR.

Limitations

The available studies lacked standardization in the protocols for HA and HAD.

Conclusions

HAD and HRA differ considerably between physiological systems. Five or more HA days are sufficient to cause adaptations in HR and T_c; however, extending the daily heat exposure duration enhances T_c adaptations. For every decay day, ~ 2.5% of the adaptations in HR and T_c are lost. For SR, longer HA periods are related to better adaptations. High heat exposure intensities seem beneficial for adaptations in SR, but not in T_c. HRA induces adaptations in HR and T_c at a faster rate than HA. HRA may thus provide a practical and less disruptive means of maintaining and optimizing HA prior to competition.

Effects of heat and cold on health, with special reference to Finnish sauna bathing

Environmental stress such as extremely warm or cold temperature is often considered a challenge to human health and body homeostasis. However, the human body can adapt relatively well to heat and cold environments, and recent studies have also elucidated that particularly heat stress might be even highly beneficial for human health. Consequently, the aim of the present brief review is first to discuss general cardiovascular and other responses to acute heat stress, followed by a review of beneficial effects of Finnish sauna bathing on general and cardiovascular health and mortality as well as dementia and Alzheimer's disease risk. Plausible mechanisms included are improved endothelial and microvascular function, reduced blood pressure and arterial stiffness, and possibly increased angiogenesis in humans, which are likely to mediate the health benefits of sauna bathing. In addition to heat exposure with physiological adaptations, cold stress-induced physiological responses and brown fat activation on health are also discussed. This is important to take into consideration, as sauna bathing is frequently associated with cooling periods in cold(er) environments, but their combination remains poorly investigated. We finally propose, therefore, that possible additive effects of heat- and cold-stress-induced adaptations and effects on health would be worthy of further investigation.

Maximizing Cellular Adaptation to Endurance Exercise in Skeletal Muscle

The application of molecular techniques to exercise biology has provided novel insight into the complexity and breadth of intracellular signaling networks involved in response to endurance-based exercise. Here we discuss several strategies that have high uptake by athletes and, on mechanistic grounds, have the potential to promote cellular adaptation to endurance training in skeletal muscle. Such approaches are based on the underlying premise that imposing a greater metabolic load and provoking extreme perturbations in cellular homeostasis will augment acute exercise responses that, when repeated over months and years, will amplify training adaptation.

Physiological and perceptual responses to exercising in restrictive heat loss attire with use of an upper-body sauna suit in temperate and hot conditions

The aim of this experiment was to quantify physiological and perceptual responses to exercise with and without restrictive heat loss attire in hot and temperate conditions. Ten moderately-trained individuals (mass; 69.44±7.50 kg, body fat; 19.7±7.6%) cycled for 30-mins (15-mins at 2 W.kg^-1 then 15-mins at 1 W.kg^-1) under four experimental conditions; temperate (TEMP, 22°C/45%), hot (HOT, 45°C/20%) and, temperate (TEMP_SUIT, 22°C/45%) and hot (HOT_SUIT, 45°C/20%) whilst wearing an upper-body "sauna suit". Core temperature changes were higher (P<0.05) in TEMP_SUIT (+1.7±0.4°C.hr^-1), HOT (+1.9±0.5°C.hr^-1) and HOT_SUIT (+2.3±0.5°C.hr^-1) than TEMP (+1.3±0.3°C.hr^-1). Skin temperature was higher (P<0.05) in HOT (36.53±0.93°C) and HOT_SUIT (37.68±0.68°C) than TEMP (33.50±1.77°C) and TEMP_SUIT (33.41±0.70°C). Sweat rate was greater (P<0.05) in TEMP_SUIT (0.89±0.24 L.hr^-1), HOT (1.14±0.48 L.hr^-1) and HOT_SUIT (1.51±0.52 L.hr^-1) than TEMP (0.56±0.27 L.hr^-1). Peak heart rate was higher (P<0.05) in TEMP_SUIT (155±23 b.min^-1), HOT (163±18 b.min^-1) and HOT_SUIT (171±18 b.min^-1) than TEMP (151±20 b.min^-1). Thermal sensation and perceived exertion were greater (P<0.05) in TEMP_SUIT (5.8±0.5 and 14±1), HOT (6.4±0.5 and 15±1) and HOT_SUIT (7.1±0.5 and 16±1) than TEMP (5.3±0.5 and 14±1). Exercising in an upper-body sauna suit within temperate conditions induces a greater physiological strain and evokes larger sweat losses compared to exercising in the same conditions, without restricting heat loss. In hot conditions, wearing a sauna suit increases physiological and perceptual strain further, which may accelerate the stimuli for heat adaptation and improve HA efficiency.

No clear benefit of muscle heating on hypertrophy and strength with resistance training

Heat is a major stressor during exercise, though its value in driving adaptation is not well understood. Muscle heating can upregulate pathways facilitating protein synthesis and could thereby enhance effects of exercise training, however, few studies have investigated this possibility. We examined whether heating active muscle during resistance training differentially affected physical and functional adaptations. Within a randomised contralateral-limb control study, ten healthy, resistance-untrained individuals (21 ± 3 y; 5 female) completed 30 sessions of progressive resistance training (12 weeks), performing 4 × 8 unilateral knee extensions at 70% of 1RM. One randomly-allocated thigh was heated during, and for 20 min after, each session using an electric pad eliciting muscle temperatures of >38 °C (HOT); the contralateral limb remained unheated (CON). Training intensity was progressed using 4-weekly strength assessments. Quadricep lean mass (measured using DXA) increased by 15 ± 7% in HOT (p = 0.00) and 15 ± 6% in CON (p = 0.00); the difference being trivial (p = 0.94). Peak isokinetic torque at 90°.s^-1 increased by 30 ± 25% (HOT; p = 0.00) and 34 ± 33% (CON; p = 0.01), with no difference (p = 0.84) between limbs. Rate of torque development increased ∼40%, with no difference between limbs (p = 0.73). The increase in 3-RM strength was also similar in HOT (75 ± 16%) and CON (71 ± 14%; p = 0.80 for difference). No differences in mass or strength changes were evident between sexes. In conclusion, supplemental heating of active muscle during and after each bout of resistance training showed no clear positive (or negative) effect on training-induced hypertrophy or function.

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.

Plasticity of Performance Curves Can Buffer Reaction Rates from Body Temperature Variation in Active Endotherms

Endotherms regulate their core body temperature by adjusting metabolic heat production and insulation. Endothermic body temperatures are therefore relatively stable compared to external temperatures. The thermal sensitivity of biochemical reaction rates is thought to have co-evolved with body temperature regulation so that optimal reaction rates occur at the regulated body temperature. However, recent data show that core body temperatures even of non-torpid endotherms fluctuate considerably. Additionally, peripheral temperatures can be considerably lower and more variable than core body temperatures. Here we discuss whether published data support the hypothesis that thermal performance curves of physiological reaction rates are plastic so that performance is maintained despite variable body temperatures within active (non-torpid) endotherms, and we explore mechanisms that confer plasticity. There is evidence that thermal performance curves in tissues that experience thermal fluctuations can be plastic, although this question remains relatively unexplored for endotherms. Mechanisms that alter thermal responses locally at the tissue level include transient potential receptor ion channels (TRPV and TRPM) and the AMP-activated protein kinase (AMPK) both of which can influence metabolism and energy expenditure. Additionally, the thermal sensitivity of processes that cause post-transcriptional RNA degradation can promote the relative expression of cold-responsive genes. Endotherms can respond to environmental fluctuations similarly to ectotherms, and thermal plasticity complements core body temperature regulation to increase whole-organism performance. Thermal plasticity is ancestral to endothermic thermoregulation, but it has not lost its selective advantage so that modern endotherms are a physiological composite of ancestral ectothermic and derived endothermic traits.

Heat Acclimation-Mediated Cross-Tolerance: Origins in within-Life Epigenetics?

The primary outcome of heat acclimation is increased thermotolerance, which stems from enhancement of innate cytoprotective pathways. These pathways produce “ON CALL” molecules that can combat stressors to which the body has never been exposed, via cross-tolerance mechanisms (heat acclimation-mediated cross-tolerance—HACT). The foundation of HACT lies in the sharing of generic stress signaling, combined with tissue/organ- specific protective responses. HACT becomes apparent when acclimatory homeostasis is achieved, lasts for several weeks, and has a memory. HACT differs from other forms of temporal protective mechanisms activated by exposure to lower “doses” of the stressor, which induce adaptation to higher “doses” of the same/different stressor; e.g., preconditioning, hormesis. These terms have been adopted by biochemists, toxicologists, and physiologists to describe the rapid cellular strategies ensuring homeostasis. HACT employs two major protective avenues: constitutive injury attenuation and abrupt post-insult release of help signals enhanced by acclimation. To date, the injury-attenuating features seen in all organs studied include fast-responding, enlarged cytoprotective reserves with HSPs, anti-oxidative, anti-apoptotic molecules, and HIF-1α nuclear and mitochondrial target gene products. Using cardiac ischemia and brain hypoxia models as a guide to the broader framework of phenotypic plasticity, HACT is enabled by a metabolic shift induced by HIF-1α and there are less injuries caused by Ca⁺² overload, via channel or complex-protein remodeling, or decreased channel abundance. Epigenetic markers such as post-translational histone modification and altered levels of chromatin modifiers during acclimation and its decline suggest that dynamic epigenetic mechanisms controlling gene expression induce HACT and acclimation memory, to enable the rapid return of the protected phenotype. In this review the link between in vivo physiological evidence and the associated cellular and molecular mechanisms leading to HACT and its difference from short-acting cross-tolerance strategies will be discussed.