Age, fitness, and regional blood flow during exercise in the heat

Nourishing Physical Productivity and Performance On a Warming Planet - Challenges and Nutritional Strategies to Mitigate Exertional Heat Stress

PURPOSE OF REVIEW: Climate change is predicted to increase the frequency and severity of exposure to hot environments. This can impair health, physical performance, and productivity for active individuals in occupational and athletic settings. This review summarizes current knowledge and recent advancements in nutritional strategies to minimize the impact of exertional-heat stress (EHS). RECENT FINDINGS: Hydration strategies limiting body mass loss to < 3% during EHS are performance-beneficial in weight-supported activities, although evidence regarding smaller fluid deficits (< 2% body mass loss) and weight-dependent activities is less clear due to a lack of well-designed studies with adequate blinding. Sodium replacement requirements during EHS depends on both sweat losses and the extent of fluid replacement, with quantified sodium replacement only necessary once fluid replacement > 60-80% of losses. Ice ingestion lowers core temperature and may improve thermal comfort and performance outcomes when consumed before, but less so during activity. Prevention and management of gastrointestinal disturbances during EHS should focus on high carbohydrate but low FODMAP availability before and during exercise, frequent provision of carbohydrate and/or protein during exercise, adequate hydration, and body temperature regulation. Evidence for these approaches is lacking in occupational settings. Acute kidney injury is a potential concern resulting from inadequate fluid replacement during and post-EHS, and emerging evidence suggests that repeated exposures may increase the risk of developing chronic kidney disease. Nutritional strategies can help regulate hydration, body temperature, and gastrointestinal status during EHS. Doing so minimizes the impact of EHS on health and safety and optimizes productivity and performance outcomes on a warming planet.

Effects of individual characteristics and local body functions on sweating response: A review

In this study, we conducted a literature review to deepen our understanding of the sweating response of the thermoregulatory system, focusing on the influence of individual characteristics and local body functions. Among the factors related to individual characteristics, improvement in aerobic fitness had a positive effect on the sweating response, whereas aging exerted an inhibitory effect. Short-term artificial acclimation and seasonal heat acclimatization promoted sweating, whereas long-term geographical acclimatization suppressed sweating. Male exhibited higher sweat rates than female when the metabolic heat production was high. Individuals with smaller surface area-to-mass ratios tended to have higher sweat rates than those with larger ratios. Regarding local body functions, sweat distribution in the resting state showed high regional sweat rates in the lower limbs and torso, with higher values in the lower limbs when in the supine position and higher values in the torso when in the seated position. During exercise, the regional sweat rates was high in the torso, whereas the limbs exhibited relatively low sweat rates. These differences in sweat distribution stem from the thermoregulatory potential of each body region, which aims to efficiently regulate body temperature. Local effects have only been examined in the thigh and forearm, with temperature coefficient Q10 ranging from 2 to 5. Only the forehead showed significantly high thermosensitivity among all body regions.

Physiological confounders of renal blood flow measurement

OBJECTIVES

Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI.

METHODS

A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans.

RESULTS

A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement.

CONCLUSION

Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results.

Sports drinks do not increase acute kidney injury risk in males during industrial work in the heat when euhydration is maintained, a randomized crossover trial

Industrial workers regularly perform physical labor under high heat stress, which may place them at risk for dehydration and acute kidney injury. Current guidelines recommend that workers should consume sports drinks to maintain euhydration during work shifts. However, the impact of fructose sweetened sports drinks on acute kidney injury risk is unknown. The purpose of this study was to investigate the effects of sports drink consumption on markers of acute kidney injury following simulated industrial work in the heat. Twenty males completed two matched 2 h simulated industrial work trial visits in a warm and humid environment (30 °C and 55% relative humidity). During and following the bout of simulated work, participants consumed either a commercially available sports drink or a noncaloric placebo. Urine and blood samples, collected pre-, post-, and 16 h post-work were assayed for markers of hydration (plasma/urine osmolality, and urine specific gravity) and acute kidney injury (KIM-1 and NGAL). There were no differences in physiological or perceptual responses to the bout of work (interaction p > 0.05 for all indices), and markers of hydration were similar between trials (interaction p > 0.05 for all indices). KIM-1 (Placebo: Δ Ln 1.18 ± 1.64; Sports drink: Δ Ln 1.49 ± 1.10 pg/mL; groupwide d = 0.89, p < 0.001) and NGAL (Placebo: Δ Ln 0.44 ± 1.11; Sports drink: Δ Ln 0.67 ± 1.22 pg/mL; groupwide d = 0.39, p = 0.03) were elevated pre- to post-work, but there were no differences between trials (interaction p > 0.05). These data provide no evidence that consumption of fructose sweetened sports drinks increases the risk of acute kidney injury during physical work in the heat.

Exercise-induced changes in lower limbs skin temperature against plasma ATP among individuals with various type and level of physical activity

The objective of the study was to examine the lower limbs skin temperature (TSK) changes in response to exhaustive whole-body exercise in trained individuals in reference to changes in plasma adenosine triphosphate (ATP). Eighteen trained participants from distinct sport type ‒ endurance (25.2 ± 4.9 yr) and speed-power (25.8 ± 3.1 yr), and 9 controls (24,9 ± 4,3 yr) ‒ were examined. Lower limbs TSK and plasma ATP measures were applied in parallel in response to incremental treadmill test and during 30-min recovery period. Plasma ATP kinetics were inversely associated to changes in TSK. The first significant decrease in TSK (76-89% of V˙ O2MAX) occurred shortly before a significant plasma ATP increase (86-97% of V˙ O2MAX). During recovery, TSK increased, reaching pre-exercise values (before exercise vs. after 30-min recovery: 31.6 ± 0.4 °C vs. 32.0 ± 0.8 °C, p = 0.855 in endurance; 32.4 ± 0.5 °C vs. 32.9 ± 0.5 °C, p = 0.061 in speed-power; 31.9 ± 0.7 °C vs. 32.4 ± 0.8 °C, p = 0.222 in controls). Plasma ATP concentration did not returned to pre-exercise values in well trained participants (before exercise vs. after 30-min recovery: 699 ± 57 nmol l-1 vs. 854 ± 31 nmol l-1, p < 0.001, η2 = 0.961 and 812 ± 35 nmol l-1 vs. 975 ± 55 nmol l-1, p < 0.001, η2 = 0.974 in endurance and speed-power, respectively), unlike in controls (651 ± 40 nmol l-1 vs. 687 ± 61 nmol·l-1, p = 0.58, η2 = 0.918). The magnitude of TSK and plasma ATP response differed between the groups (p < 0.001, η2 = 0.410 for TSK; p < 0.001, η2 = 0.833 for plasma ATP). We conclude that lower limbs TSK change indirectly corresponds to the reverse course of plasma ATP during incremental exercise and the magnitude of the response depends on the level of physical activity and the associated to it long-term metabolic adaptation.

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.

The Potential of Exercise on Lifestyle and Skin Function: Narrative Review

BACKGROUND

The skin is an important organ of the human body and has moisturizing and barrier functions. Factors such as sunlight and lifestyle significantly affect these skin functions, with sunlight being extremely damaging. The effects of lifestyle habits such as smoking, diet, and sleep have been studied extensively. It has been found that smoking increases the risk of wrinkles, while excessive fat and sugar intake leads to skin aging. Lack of sleep and stress are also dangerous for the skin's barrier function. In recent years, the impact of exercise habits on skin function has been a focus of study. Regular exercise is associated with increased blood flow to the skin, elevated skin temperature, and improved skin moisture. Furthermore, it has been shown to improve skin structure and rejuvenate its appearance, possibly through promoting mitochondrial biosynthesis and affecting hormone secretion. Further research is needed to understand the effects of different amounts and content of exercise on the skin.

OBJECTIVE

This study aims to briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far and introduce the expected effects of exercise on skin function.

METHODS

We conducted a review of the literature using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 with the following keywords: exercise, skin, and life habits.

RESULTS

Exercise augments the total spectrum power density of cutaneous blood perfusion by a factor of approximately 8, and vasodilation demonstrates an enhancement of approximately 1.5-fold. Regular exercise can also mitigate age-related skin changes by promoting mitochondrial biosynthesis. However, not all exercise impacts are positive; for instance, swimming in chlorinated pools may harm the skin barrier function. Hence, the exercise environment should be considered for its potential effects on the skin.

CONCLUSIONS

This review demonstrates that exercise can potentially enhance skin function retention.

Hypohydration attenuates increases in creatinine clearance to oral protein loading and the renal hemodynamic response to exercise pressor reflex

Insufficient hydration is prevalent among free living adults. This study investigated whether hypohydration alters 1) renal functional reserve, 2) the renal hemodynamic response to the exercise pressor reflex, and 3) urine-concentrating ability during oral protein loading. In a block-randomized crossover design, 22 healthy young adults (11 females and 11 males) underwent 24-h fluid deprivation (Hypohydrated) or 24-h normal fluid consumption (Euhydrated). Renal functional reserve was assessed by oral protein loading. Renal hemodynamics during the exercise pressor reflex were assessed via Doppler ultrasound. Urine-concentrating ability was assessed via free water clearance. Creatinine clearance did not differ at 150 min postprotein consumption between conditions [Hypohydrated: 246 mL/min, 95% confidence interval (CI): 212-280; Euhydrated: 231 mL/min, 95% CI: 196-265, P = 0.2691] despite an elevated baseline in Hypohydrated (261 mL/min, 95% CI: 218-303 vs. 143 mL/min, 95% CI: 118-168, P < 0.0001). Renal artery vascular resistance was not different at baseline (P = 0.9290), but increases were attenuated in Hypohydrated versus Euhydrated at the end of handgrip (0.5 mmHg/cm/s, 95% CI: 0.4-0.7 vs. 0.8 mmHg/cm/s 95% CI: 0.6-1.1, P = 0.0203) and end occlusion (0.2 mmHg/cm/s, 95% CI: 0.1-0.3 vs. 0.4 mmHg/cm/s 95% CI: 0.3-0.6, P = 0.0127). There were no differences between conditions in free water clearance at 150 min postprotein (P = 0.3489). These data indicate that hypohydration 1) engages renal functional reserve and attenuates the ability to further increase creatinine clearance, 2) attenuates increases in renal artery vascular resistance to the exercise pressor reflex, and 3) does not further enhance nor impair urine-concentrating ability during oral protein loading.NEW & NOTEWORTHY Insufficient hydration is prevalent among free living adults. This study found that hypohydration induced by 24-h fluid deprivation engaged renal functional reserve and that oral protein loading did not further increase creatinine clearance. Hypohydration also attenuated the ability to increase renal vascular resistance during the exercise pressor reflex. In addition, hypohydration neither enhanced nor impaired urine-concentrating ability during oral protein loading. These data support the importance of mitigating hypohydration in free living adults.

Experimental research in environmentally induced hyperthermic older persons: A systematic quantitative literature review mapping the available evidence

The heat-related health burden is expected to persist and worsen in the coming years due to an aging global population and climate change. Defining the breadth and depth of our understanding of age-related changes in thermoregulation can identify underlying causes and strategies to protect vulnerable individuals from heat. We conducted the first systematic quantitative literature review to provide context to the historical experimental research of healthy older adults - compared to younger adults or unhealthy age matched cases - during exogenous heat strain, focusing on factors that influence thermoregulatory function (e.g. co-morbidities). We identified 4,455 articles, with 147 meeting eligibility criteria. Most studies were conducted in the US (39%), Canada (29%), or Japan (12%), with 71% of the 3,411 participants being male. About 71% of the studies compared younger and older adults, while 34% compared two groups of older adults with and without factors influencing thermoregulation. Key factors included age combined with another factor (23%), underlying biological mechanisms (18%), age independently (15%), influencing health conditions (15%), adaptation potential (12%), environmental conditions (9%), and therapeutic/pharmacological interventions (7%). Our results suggest that controlled experimental research should focus on the age-related changes in thermoregulation in the very old, females, those with overlooked chronic heat-sensitive health conditions (e.g. pulmonary, renal, mental disorders), the impact of multimorbidity, prolonged and cumulative effects of extreme heat, evidence-based policy of control measures (e.g. personal cooling strategies), pharmaceutical interactions, and interventions stimulating protective physiological adaptation. These controlled studies will inform the directions and use of limited resources in ecologically valid fieldwork studies.

Relationship between aerobic fitness and lower limb skin temperature during cycling exercise testing among well-trained athletes and nonathletes: a cross-sectional study

Background

During prolonged physical exercise, the skin plays an important role in thermoregulation by dissipating heat to maintain core temperature. Moreover, thermal variation may be influenced by the physical fitness level of an individual. The aim of the present study was to determine the relationship between aerobic fitness and lower limb skin temperature during graded cycling exercise testing in well-trained athletes and nonathletes.

Methods

Twelve trained athletes (mean ± SD maximal oxygen consumption [VO2max], 52.44 ± 4.5 ml/kg/min) and 12 nonathletes (VO2max, 36.95 ± 4.9 ml/kg/min) participated in this study. The regional skin temperature over the lower limbs was monitored continuously during incremental exercise testing using a thermal camera, and cardio-respiratory parameters were assessed and recorded using a metabolic analyzer (K5, COSMED, Rome, Italy).

Results

The mean skin temperature of athletes at a high intensity of exercise was 27.23 ± 0.3 °C while that of nonathletes was 29.03 ± 0.44 °C, a difference that was statistically significant (p < 0.05). A negative correlation was observed between skin temperature and cardiovascular parameters (VO2max and heart rate) in athletes, while no such correlation was found among nonathletes.

Conclusion

The present study demonstrated a negative correlation between oxygen consumption and lower limb skin temperature in athletes, while the correlation was poor in nonathletes. This suggests that physical fitness level may influence the pattern of alterations in lower limb skin temperature, which supports the hypothesis that athletes exhibit better heat dissipation mechanisms than nonathletes.

Relatively minor influence of individual characteristics on critical wet-bulb globe temperature (WBGT) limits during light activity in young adults (PSU HEAT Project)

Critical environmental limits are temperature-humidity thresholds above which heat balance cannot be maintained for a given metabolic heat production. This study examined the association between individual characteristics [sex, body surface area (AD), aerobic capacity (V̇o2max), and body mass (mb)] and critical environmental limits in young adults at low metabolic rates. Forty-four (20 M/24 F; 23 ± 4 yr) subjects were exposed to progressive heat stress in an environmental chamber at two low net metabolic rates (Mnet); minimal activity (MinAct; Mnet = ∼160 W) and light ambulation (LightAmb; Mnet = ∼260 W). In two hot-dry (HD; ≤25% rh) environments, ambient water vapor pressure (Pa = 12 or 16 mmHg) was held constant and dry-bulb temperature (Tdb) was systematically increased. In two warm-humid (WH; ≥50% rh) environments, Tdb was held constant at 34°C or 36°C, and Pa was systematically increased. The critical wet-bulb globe temperature (WBGTcrit) was determined for each condition. During MinAct, after entry of Mnet into the forward stepwise linear regression model, no individual characteristics were entered into the model for WH (R2adj = 0.01, P = 0.27) or HD environments (R2adj = -0.01, P = 0.44). During LightAmb, only mb was entered into the model for WH environments (R2adj = 0.44, P < 0.001), whereas only V̇o2max was entered for HD environments (R2adj = 0.22; P = 0.002). These data demonstrate negligible importance of individual characteristics on WBGTcrit during low-intensity nonweight-bearing (MinAct) activity with a modest impact of mb and V̇o2max during weight-bearing (LightAmb) activity in extreme thermal environments.NEW & NOTEWORTHY Our laboratory has recently published a series of papers establishing the upper ambient temperature-humidity thresholds for maintaining heat balance, termed critical environmental limits, in young adults. However, no studies have investigated the relative influence of individual characteristics, such as sex, body size, and aerobic fitness, on those environmental limits. Here, we demonstrate the contributions of sex, body mass, body surface area, and maximal aerobic capacity on critical wet-bulb globe temperature (WBGT) limits in young adults.

Effect of High Temperature on Walking among Residents of Rural and Urban Communities

PURPOSE

This study aimed to establish the association between high temperature and walking among residents of rural and urban areas.

MATERIALS AND METHODS

This cross-sectional study used data from the Korea Meteorological Administration and the 2018 Community Health Survey to confirm the association between temperature and walking practice. The dependent variable was walking practice. Walking practice was considered if the participants walked for more than 30 minutes a day or more than 5 days a week. The independent variable was the daily maximum temperature (℃) for the preceding 7 days, calculated from the survey date of each participant. A multilevel analysis was conducted to simultaneously consider the individual- and neighborhood-level variables that could affect determining the association between daily maximum temperatures and walking practice.

RESULTS

When the daily maximum temperature increased by 1℃, the odds ratio of walking practice decreased to 0.95 (95% confidence interval 0.94-0.97) in rural areas. In contrast, it decreased to 0.98 (95% confidence interval 0.97-1.00) in urban areas, considering both individual- and neighborhood-level factors. Individual- and neighborhood-level determinants of walking practice in rural areas, including educational attainment, marital status, driving a car, subjective health, depression, and meeting neighbors and friends, were confirmed.

CONCLUSION

This study confirmed that increased temperature led to more decrease in physical activity levels in rural areas than in urban areas. Physical and environmental approaches to avoid heat are needed to maintain and promote physical activity, since temperatures can reduce physical activity during the hot summer months.

Human temperature regulation under heat stress in health, disease, and injury

The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.

Heat exposure limits for young unacclimatized males and females at low and high humidity

Little is known about the separate and combined influences of humidity conditions, sex, and aerobic fitness on heat tolerance in unacclimatized males and females. The purpose of the current study was to describe heat tolerance, in terms of critical WBGT (WBGT_crit), in unacclimatized young males and females in hot-dry (HD) and warm-humid (WH) environments. Eighteen subjects (9 M/9F; 21 ± 2 yr) were tested during exercise at 30% V̇O_2max in a controlled environmental chamber. Progressive heat stress exposures were performed with either (1) constant dry-bulb temperature (T_db) of 34 and 36 °C and increasing ambient water vapor pressure (P_a) (P_crit trials; WH); or (2) constant P_a of 12 and 16 mmHg and increasing T_db (T_crit trials; HD). Chamber T_db and P_a, and subject esophageal temperature (T_es), were continuously monitored throughout each trial. After a 30-min equilibration period, progressive heat stress continued until subject heat balance could no longer be maintained and a clear rise in T_es was observed. Absolute WBGT_crit and WBGT_crit adjusted to a metabolic rate of 300 W (WBGT₃₀₀), and the difference between WBGT_crit and occupational exposure limits (OEL; ΔOEL) was assessed. WBGT_crit, WBGT₃₀₀, and ΔOEL were higher in WH compared to HD (p < 0.0001) for females but were the same between environments for males (p ≥ 0.21). WBGT_crit was higher in females compared to males in WH (p < 0.0001) but was similar between sexes in HD (p = 0.44). When controlling for metabolic rate, WBGT₃₀₀ and ΔOEL were higher in males compared to females in WH and HD (both p < 0.0001). When controlling for sex, V̇O_2max was not associated with WBGT₃₀₀ or ΔOEL for either sex (r ≤ 0.12, p ≥ 0.49). These findings suggest that WBGT_crit is higher in females compared to males in WH, but not HD, conditions. Additionally, the WBGT_crit is lower in females, but not males, in HD compared to WH conditions.

Repository Describing the Anatomical, Physiological, and Biological Changes in an Obese Population to Inform Physiologically Based Pharmacokinetic Models

Background

Obesity is associated with physiological changes that can affect drug pharmacokinetics. Obese individuals are underrepresented in clinical trials, leading to a lack of evidence-based dosing recommendations for many drugs. Physiologically based pharmacokinetic (PBPK) modelling can overcome this limitation but necessitates a detailed description of the population characteristics under investigation.

Objective

The purpose of this study was to develop and verify a repository of the current anatomical, physiological, and biological data of obese individuals, including population variability, to inform a PBPK framework.

Methods

A systematic literature search was performed to collate anatomical, physiological, and biological parameters for obese individuals. Multiple regression analyses were used to derive mathematical equations describing the continuous effect of body mass index (BMI) within the range 18.5–60 kg/m² on system parameters.

Results

In total, 209 studies were included in the database. The literature reported mostly BMI-related changes in organ weight, whereas data on blood flow and biological parameters (i.e. enzyme abundance) were sparse, and hence physiologically plausible assumptions were made when needed. The developed obese population was implemented in Matlab^® and the predicted system parameters obtained from 1000 virtual individuals were in agreement with observed data from an independent validation obese population. Our analysis indicates that a threefold increase in BMI, from 20 to 60 kg/m², leads to an increase in cardiac output (50%), liver weight (100%), kidney weight (60%), both the kidney and liver absolute blood flows (50%), and in total adipose blood flow (160%).

Conclusion

The developed repository provides an updated description of a population with a BMI from 18.5 to 60 kg/m² using continuous physiological changes and their variability for each system parameter. It is a tool that can be implemented in PBPK models to simulate drug pharmacokinetics in obese individuals.

Effects of Yogurt Intake on Cardiovascular Strain during Outdoor Interval Walking Training by Older People in Midsummer: A Randomized Controlled Study

We examined whether post-exercise yogurt intake reduced cardiovascular strain during outdoor interval walking training (IWT) in older people during midsummer. The IWT is a training regimen repeating slow and fast walking at ~40% and ≥70% peak aerobic capacity, respectively, for 3 min each per set, ≥5 sets per day, and ≥4 days/wk. We randomly divided 28 male and 75 female older people (~73 yr), who had performed IWT ≥12 months, into a carbohydrate group (CHO-G) consuming jelly (45 g CHO, 180 kcal) and a yogurt group (YGT-G) consuming a yogurt drink (9.3 g protein, 39 g CHO, 192 kcal) immediately after daily IWT for 56 days while monitoring exercise intensity and heart rate (HR) with portable devices. We analyzed the results in 39 subjects for the CHO-G and 37 subjects for the YGT-G who performed IWT ≥ 4 days/wk, ≥60 min total fast walking/wk, and ≥4 sets of each walk/day. We found that the mean HR for fast walking decreased significantly from the baseline after the 30th day in the YGT-G (p < 0.03), but not in the CHO-G (p = 1.00). There were no significant differences in training achievements between the groups. Thus, post-exercise yogurt intake might reduce cardiovascular strain during outdoor walking training in older people.

Hydration Is More Important Than Exogenous Carbohydrate Intake During Push-to-the-Finish Cycle Exercise in the Heat

Dehydration ≥2% loss of body mass is associated with reductions in performance capacity, and carbohydrate (CHO)-electrolyte solutions (CES) are often recommended to prevent dehydration and provide a source of exogenous carbohydrate during exercise. It is also well established that performance capacity in the heat is diminished compared to cooler conditions, a response attributable to greater cardiovascular strain caused by high skin and core temperatures. Because hydration status, environmental conditions, and carbohydrate availability interact to influence performance capacity, we sought to determine how these factors affect push-to-the-finish cycling performance. Ten young trained cyclists exercised at a moderate intensity (2.5 W·kg^-1) in a hot-dry condition [40°C, 20% relative humidity (RH)] until dehydration of ~2% body mass. Subjects then consumed either no fluid (NF) or enough fluid (water, WAT; Gatorade®, GAT; or GoodSport™, GS) to replace 75% of lost body mass over 30 min. After a 30-min light-intensity warm-up (1.5 W·kg^-1) in a 35°C, 20% RH environment, subjects then completed a 120-kJ time trial (TT). TT time-to-completion, absolute power, and relative power were significantly improved in WAT (535 ± 214 s, 259 ± 99 W, 3.3 ± 0.9 W·kg^-1), GAT (539 ± 226 s, 260 ± 110 W, 3.3 ± 1.0 W·kg^-1), and GS (534 ± 238 s, 262 ± 105 W, 3.4 ± 1.0 W·kg^-1) compared to NF (631 ± 310 s, 229 ± 96 W, 3.0 ± 0.9 W·kg^-1) all (p < 0.01) with no differences between WAT, GAT, and GS, suggesting that hydration is more important than carbohydrate availability during exercise in the heat. A subset of four subjects returned to the laboratory to repeat the WAT, GAT, and GS treatments to determine if between-beverage differences in time-trial performance were evident with a longer TT in thermoneutral conditions. Following dehydration, the ambient conditions in the environmental chamber were reduced to 21°C and 20% RH and subjects completed a 250-kJ TT. All four subjects improved TT performance in the GS trial (919 ± 353 s, 300 ± 100 W, 3.61 ± 0.86 W·kg^-1) compared to WAT (960 ± 376 s, 283 ± 91 W, 3.43 ± 0.83 W·kg^-1), while three subjects improved TT performance in the GAT trial (946 ± 365 s, 293 ± 103 W, 3.60 ± 0.97 W·kg^-1) compared to WAT, highlighting the importance of carbohydrate availability in cooler conditions as the length of a push-to-the-finish cycling task increases.

Monitoring adaptation of skin tissue oxygenation during cycling ergometer exercise by frequency-domain diffuse optical spectroscopy

In addition to supplying oxygen molecule O2 for metabolic functions during the adaptation to exercise, blood also plays a critical role in heat dissipation for core temperature stabilization. This study investigates the status of hemodynamic oxygenation in the forearm's skin tissue of three participants during a complete ergometer exercise from the resting to exercising, and to recovering conditions using a three-wavelength frequency-domain diffuse reflectance spectroscopy (FD DRS) alongside the monitoring of heartbeat rate and skin temperature. The FD DRS system was synchronized with radiofrequency (RF)-modulated input photon sources and the respective output to extract time-course absorption and scattering coefficients of the skin tissue, which, through the fitting of lambert's law of absorbance, can be used to determine the concentration of oxygenated/deoxygenated hemoglobin molecules, and consequentially, the oxygen saturation of skin tissue and total hemoglobin (THb) concentration. Expressly, a sudden jump in heartbeat rate at the beginning of the exercise, a temporal lag of the rising edge of skin temperature behind that of the THb concentration in the procession of step-wise incremental working intensity, and the uprising of THb in the exhaustion zone in responses to the physiological adaptation to exercise were identified. Finally, conclusive remarks were drawn that the FD DRS system is useful in extracting the hemodynamic properties of forearm skin which is often being neglected in previous exercise physiology studies by DRS-related techniques. The detailed variation of hemodynamic and optical scattering parameters of forearm skin elucidated in the studies can be applied for the analysis of athletes' physiological status, and may be a potential reference for the design of future wearable devices.

Relationship between Skin Temperature Variation and Muscle Damage Markers after a Marathon Performed in a Hot Environmental Condition

This study aimed to assess the effect of a marathon running at a hot environmental temperature on the baseline skin temperature (Tsk) of the posterior day and to analyze the relationship between Tsk response and muscle damage markers variation. The Tsk, creatine kinase, and lactate dehydrogenase of 16 marathon runners were assessed four times before (15 days and 45 min) and after (24 h and 6 days) a marathon in a hot environment (thermal stress index = 28.3 ± 3.3 °C and humidity ~81%). The Tsk of thirteen different body regions of both right and left lower limbs were analyzed. Higher values after the marathon were observed than 45 min before in creatine kinase (174.3 ± 136.4 UI/L < 1159.7 ± 699.7 UI/L, p < 0.01 and large effect size) and lactate dehydrogenase (362.6 ± 99.9 UI/L < 438 ± 115.5 UI/L, p = 0.02 and moderate effect size). Generally, Tsk was higher the day after the marathon than at the other three moments (e.g., rectus femoris region, 6 days before vs. the day after, 95% confidence interval of the difference (0.3, 1.6 °C), p = 0.04 and large effect size). No relationship or correlation was observed between the variation of Tsk and muscle damage markers (p > 0.05). In conclusion, performing a marathon in a hot environmental condition results in a higher Tsk the day after the marathon. This increase in Tsk could be because of the heat generated by the marathon and its subsequent physiological processes (e.g., increase in endothelial nitric oxide, glycogen resynthesis, or increase of systemic hormones), which would be reflected in the Tsk due to the peripheral vasodilation promoted by the hot environment. However, among these processes, muscle damage does not seem to be of great importance due to the lack of an observed relationship between Tsk and muscle damage markers.

The Change in Core Temperature and Sweating Response during Exercise Are Unaffected by Time of Day within the Wake Period

INTRODUCTION

Exercise thermoregulation studies typically control for time of day. The present study assessed whether circadian rhythm independently alters time-dependent changes in core temperature and sweating during exercise at a fixed rate of metabolic heat production (Hprod) during the wake period.

METHODS

Ten men (26 ± 2 yr, 76.6 ± 6.3 kg, 1.95 ± 0.10 m2) cycled for 60 min in three combinations of ambient temperature and Hprod (23°C-7.5 W·kg-1, 33°C-5.5 W·kg-1, and 33°C-7.5 W·kg-1) at two times of day (a.m.: 0800 h, p.m.: 1600 h). Rectal temperature (Tre), local sweat rate, and whole-body sweat losses were measured.

RESULTS

Absolute Tre was lower at baseline in a.m. versus p.m. for all three conditions (a.m.: 36.8°C ± 0.2°C, p.m.: 37.0°C ± 0.2°C, P < 0.01). The ΔTre was not altered by time of day (P > 0.22) and not different at 60 min between a.m. and p.m. for 23°C-7.5 W·kg-1 (a.m.: 0.83°C ± 0.14°C, p.m.: 0.75°C ± 0.20°C; P = 0.20), 33°C-5.5 W·kg-1 (a.m.: 0.51°C ± 0.14°C, p.m.: 0.47°C ± 0.14°C; P = 0.22), and 33°C-7.5 W·kg-1 (a.m.: 0.77°C ± 0.20°C, p.m.: 0.73°C ± 0.21°C; P = 0.80). The change in local sweat rate was unaffected by time of day (P > 0.16) and not different at 60 min in 23°C-7.5 W·kg-1 (a.m.: 0.67 ± 0.20 mg·cm-2·min-1, p.m.: 0.62 ± 0.21 mg·cm-2·min-1; P = 0.55), 33°C-5.5 W·kg-1 (a.m.: 0.59 ± 0.13 mg·cm-2·min-1, p.m.: 0.57 ± 0.12 mg·cm-2·min-1; P = 0.65), and 33°C-7.5 W·kg-1 (a.m.: 0.91 ± 0.19 mg·cm-2·min-1, p.m.: 0.84 ± 0.15 mg·cm-2·min-1; P = 0.33). Whole-body sweat loss was not different between a.m. and p.m. for 23°C-7.5 W·kg-1 (a.m.: 579 ± 72 g, p.m.: 579 ± 96 g; P = 0.99), 33°C-5.5 W·kg-1 (a.m.: 558 ± 48 g, p.m.: 555 ± 83 g; P = 0.89), and 33°C-7.5 W·kg-1 (a.m.: 796 ± 72 g, p.m.: 783 ± 75 g; P = 0.31).

CONCLUSIONS

The change in core temperature and sweating throughout a 60-min exercise bout in 23°C and 33°C were unaffected by circadian rhythm during the wake period when exercise intensity was prescribed to elicit comparable rates of Hprod, suggesting that scheduling thermoregulatory exercise trials for the same time of day is unnecessary.

Temperature regulation during exercise in the heat: Insights for the aging athlete

OBJECTIVE

The purpose of this review is to evaluate the currently-available literature regarding the impact of both primary aging and age-related fitness on thermoregulatory function during exercise in the heat. In so doing, we aim to (1) characterize the influence of fitness in mitigating age-related declines in thermoregulation, (2) address the limitations of prior experimental approaches for investigating age-related thermoregulatory impairments, (3) examine to what extent aerobic fitness can be maintained in the aging athlete, and (4) begin to address the specific environmental conditions in which age-related impairments in thermoregulatory function may place highly active older adults at increased risk for heat-related illness and injury and/or limited performance.

DESIGN

Mini-review.

METHODS

Review and synthesis of available information.

RESULTS

The earth's climate is warming, accompanied by a consequently greater frequency and severity of extreme heat events. At the same time, lifespan is increasing and people of all ages are staying increasingly active. Age-related impairments in thermoregulatory function are well-documented, leading to increased heat-related health risks and reduced exercise/athletic performance for older adults in hot environmental conditions. High aerobic fitness improves body temperature regulation during exercise via augmented sweating and improved cardiovascular function, including cardiac output and skin blood flow, in humans of all ages.

CONCLUSIONS

The masters athlete is better suited for exercise/heat-stress compared to his or her less fit peers. However, while age and thermoregulation in general has been studied extensively, research on the most fit older adults, including highly competitive athletes, is generally lacking.

Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging

The kidneys' integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.

Facial Blood Flow Responses to Dynamic Exercise

We reported previously that a static handgrip exercise evoked regional differences in the facial blood flow. The present study examined whether regional differences in facial blood flow are also evoked during dynamic exercise. Facial blood flow was measured by laser speckle flowgraphy during 15 min of cycling exercise at heart rates of 120 bpm, 140 bpm and 160 bpm in 12 subjects. The facial vascular conductance index was calculated from the blood flow and mean arterial pressure. The regional blood flow and conductance index values were determined in the forehead, eyelid, nose, cheek, ear and lip. One-way ANOVA and Tukey's post-hoc test were used to examine effects of exercise intensity and target regions. The blood flow and conductance index in skin areas increased significantly with the exercise intensity. The blood flow and conductance index in the lip increased significantly at 120 bpm and 140 bpm compared to the control, while the values in the lip at 160 bpm did not change from the control values. These results suggest that the blood flow in facial skin areas, not in the lip, responds similarly to dynamic exercise, in contrast to the responses to static exercise.

Individual Responses to Heat Stress: Implications for Hyperthermia and Physical Work Capacity

Background

Extreme heat events are increasing in frequency, severity, and duration. It is well known that heat stress can have a negative impact on occupational health and productivity, particularly during physical work. However, there are no up-to-date reviews on how vulnerability to heat changes as a function of individual characteristics in relation to the risk of hyperthermia and work capacity loss. The objective of this narrative review is to examine the role of individual characteristics on the human heat stress response, specifically in relation to hyperthermia risk and productivity loss in hot workplaces. Finally, we aim to generate practical guidance for industrial hygienists considering our findings. Factors included in the analysis were body mass, body surface area to mass ratio, body fat, aerobic fitness and training, heat adaptation, aging, sex, and chronic health conditions.

Findings

We found the relevance of any factor to be dynamic, based on the work-type (fixed pace or relative to fitness level), work intensity (low, moderate, or heavy work), climate type (humidity, clothing vapor resistance), and variable of interest (risk of hyperthermia or likelihood of productivity loss). Heat adaptation, high aerobic fitness, and having a large body mass are the most protective factors during heat exposure. Primary detrimental factors include low fitness, low body mass, and lack of heat adaptation. Aging beyond 50 years, being female, and diabetes are less impactful negative factors, since their independent effect is quite small in well matched participants. Skin surface area to mass ratio, body composition, hypertension, and cardiovascular disease are not strong independent predictors of the heat stress response.

Conclusion

Understanding how individual factors impact responses to heat stress is necessary for the prediction of heat wave impacts on occupational health and work capacity. The recommendations provided in this report could be utilized to help curtail hyperthermia risk and productivity losses induced by heat.

Psychrometric limits and critical evaporative coefficients for exercising older women

Critical environmental limits are those above which human heat balance cannot be maintained for a given metabolic heat production. These limits, and associated critical evaporative coefficients (K_e') that can be used to model responses in hot environments, have not been determined for older subjects. The present paper graphically characterizes psychrometric limits and environmental isotherms and derives K_e' values for a group of unacclimated older (n = 10; age 62 - 80 yr) women exercising at 30% V̇o_2max. Uniquely, we compare and contrast these data with published data from young, unacclimated and young, heat-acclimated women tested across a four-decade span using the same protocol in the same environmental chamber. These loci are presented graphically on a psychrometric chart (with confidence intervals). Isotherms constructed from biophysical modeling and sweating capacity closely fit the data but underestimated empirically derived data points in hotter, drier environments. Compared with the young (age 19-26 yr) women previously tested, the older women had significantly constrained (lower) critical environmental limits, in part due to lower sweating rates. Age-specific values of the critical evaporative coefficient, K_e', derived by partial calorimetry in the more humid environments (in which skin wettedness approached 1), were likewise lower for the older women (overall mean = 9.1 W·m^-2·mmHg^-1; P < 0.05) vs. unacclimated (15.4 W·m^-2·mmHg^-1) and acclimated (17.0 W·m^-2·mmHg^-1) young women. Constrained psychrometric limits and lower critical evaporative coefficients lend biophysical clarity to decreased abilities of older women for prolonged exercise in the heat.NEW & NOTEWORTHY This study is the first to describe, graphically and quantitatively, critical environmental limits for women between the ages of 62 and 80 yr based on the biophysics of heat exchange. These psychrometric limit lines define combinations of ambient temperature and humidity above which human heat balance cannot be maintained for a given metabolic heat production. These limits, and associated critical evaporative coefficients (K_e'), can be used to model low- to moderate-intensity exercise responses in hot environments and have directly translatable data that can be used for evidence-based policy decisions, to prepare for impending heat events, and for implementation of other safety interventions.

Repository Describing an Aging Population to Inform Physiologically Based Pharmacokinetic Models Considering Anatomical, Physiological, and Biological Age-Dependent Changes

BACKGROUND

Aging is characterized by anatomical, physiological, and biological changes that can impact drug kinetics. The elderly are often excluded from clinical trials and knowledge about drug kinetics and drug-drug interaction magnitudes is sparse. Physiologically based pharmacokinetic modeling can overcome this clinical limitation but detailed descriptions of the population characteristics are essential to adequately inform models.

OBJECTIVE

The objective of this study was to develop and verify a population database for aging Caucasians considering anatomical, physiological, and biological system parameters required to inform a physiologically based pharmacokinetic model that included population variability.

METHODS

A structured literature search was performed to analyze age-dependent changes of system parameters. All collated data were carefully analyzed, and descriptive mathematical equations were derived.

RESULTS

A total of 362 studies were found of which 318 studies were included in the analysis as they reported rich data for anthropometric parameters and specific organs (e.g., liver). Continuous functions could be derived for most system parameters describing a Caucasian population from 20 to 99 years of age with variability. Areas with sparse data were identified such as tissue composition, but knowledge gaps were filled with plausible qualified assumptions. The developed population was implemented in Matlab^® and estimated system parameters from 1000 virtual individuals were in accordance with independent observed data showing the robustness of the developed population.

CONCLUSIONS

The developed repository for aging subjects provides a singular specific source for key system parameters needed for physiologically based pharmacokinetic modeling and can in turn be used to investigate drug kinetics and drug-drug interaction magnitudes in the elderly.

Impairments to Thermoregulation in the Elderly During Heat Exposure Events

Heat waves represent a public health risk to elderly people, and typically result in an increased rate of hospital admissions and deaths. Studies of thermoregulation in this cohort have generally focused on single elements such as sweating capacity. Sweating capacity and skin blood flow reduce with age, reducing ability to dissipate heat. Perception of effort during heat exposure is emerging as an area that needs further investigation as the elderly appear to lack the ability to adequately perceive increased physiological strain during heat exposure. The role of the gut and endotoxemia in heat stress has received attention in young adults, while the elderly population has been neglected. This shortcoming offers another potential avenue for identifying effective integrated health interventions to reduce heat illnesses. Increasing numbers of elderly individuals in populations worldwide are likely to increase the incidence of heat wave-induced deaths if adequate interventions are not developed, evaluated, and implemented. In this narrative-style review we identify and discuss health-related interventions for reducing the impact of heat illnesses in the elderly.

Renal and segmental artery hemodynamics during whole body passive heating and cooling recovery

High environmental temperatures are associated with increased risk of acute kidney injury, which may be related to reductions in renal blood flow. The susceptibility of the kidneys may be increased because of heat stress-induced changes in renal vascular resistance (RVR) to sympathetic activation. We tested the hypotheses that, compared with normothermia, increases in RVR during the cold pressor test (CPT, a sympathoexcitatory maneuver) are attenuated during passive heating and exacerbated after cooling recovery. Twenty-four healthy adults (22 ± 2 yr; 12 women, 12 men) completed CPTs at normothermic baseline, after passive heating to a rise in core temperature of ~1.2°C, and after cooling recovery when core temperature returned to ~0.2°C above normothermic baseline. Blood velocity was measured by Doppler ultrasound in the distal segment of the right renal artery (Renal, n = 24 during thermal stress, n = 12 during CPTs) or the middle portion of a segmental artery (Segmental, n = 12). RVR was calculated as mean arterial pressure divided by renal or segmental blood velocity. RVR increased at the end of CPT during normothermic baseline in both arteries (Renal: by 1.0 ± 1.0 mmHg·cm−1·s, Segmental: by 2.2 ± 1.2 mmHg·cm−1·s, P ≤ 0.03), and these increases were abolished with passive heating ( P ≥ 0.76). At the end of cooling recovery, RVR in both arteries to the CPT was restored to that of normothermic baseline ( P ≤ 0.17). These data show that increases in RVR to sympathetic activation during passive heating are attenuated and return to that of normothermic baseline after cooling recovery.

NEW & NOTEWORTHY Our data indicate that increases in renal vascular resistance to the cold pressor test (i.e., sympathetic activation) are attenuated during passive heating, but at the end of cooling recovery this response returns to that of normothermic baseline. Importantly, hemodynamic responses were assessed in arteries going to (renal artery) and within (segmental artery) the kidney, which has not been previously examined in the same study during thermal and/or sympathetic stressors.

The Potential for Renal Injury Elicited by Physical Work in the Heat

An epidemic of chronic kidney disease (CKD) is occurring in laborers who undertake physical work in hot conditions. Rodent data indicate that heat exposure causes kidney injury, and when this injury is regularly repeated it can elicit CKD. Studies in humans demonstrate that a single bout of exercise in the heat increases biomarkers of acute kidney injury (AKI). Elevations in AKI biomarkers in this context likely reflect an increased susceptibility of the kidneys to AKI. Data largely derived from animal models indicate that the mechanism(s) by which exercise in the heat may increase the risk of AKI is multifactorial. For instance, heat-related reductions in renal blood flow may provoke heterogenous intrarenal blood flow. This can promote localized ischemia, hypoxemia and ATP depletion in renal tubular cells, which could be exacerbated by increased sodium reabsorption. Heightened fructokinase pathway activity likely exacerbates ATP depletion occurring secondary to intrarenal fructose production and hyperuricemia. Collectively, these responses can promote inflammation and oxidative stress, thereby increasing the risk of AKI. Equivalent mechanistic evidence in humans is lacking. Such an understanding could inform the development of countermeasures to safeguard the renal health of laborers who regularly engage in physical work in hot environments.

The Dynamic and Correlation of Skin Temperature and Cardiorespiratory Fitness in Male Endurance Runners

During endurance exercise, skin temperature (Tsk) plays a fundamental role in thermoregulatory processes. Environmental temperature is the biggest determinant of the Tsk. During exercise, the response of the skin temperature might be influenced by aerobic fitness (VO_2peak). The aim of this study was to analyze and compare the dynamic of Tsk in high (HF) and moderately (MF) fit endurance runners during a progressive maximal stress test. Seventy-nine male endurance runners were classified into HF (n = 35; VO_2peak = 56.62 ± 4.31 mL/kg/min) and MF (n = 44; VO_2peak = 47.86 ± 5.29 mL/kg/min) groups. Tsk and cardiovascular data were continuously monitored during an incremental exercise, followed by a recovery period of five minutes. Results revealed that the MF group exhibited lower VO_2peak, Speed_peak, ventilation (VE), muscle mass %, and higher BMI and fat mass % than the HF group (all p < 0.001). HF had significantly higher Tsk at baseline, and at 60% and 70% of peak workload (all p < 0.05). Tsk_peak correlated with age, fat mass %, muscle mass %, VO_2peak, Speed_peak, HR and VE (all p < 0.05). These findings indicate that VO_2peak was positively associated with increased Tsk during incremental exercise in male endurance runners.

Health Risks and Interventions in Exertional Heat Stress

BACKGROUND

With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses.

METHODS

A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included.

RESULTS

Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes.

CONCLUSION

Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.

[Epidemiology and prevention of heat-related adverse health effects on elderly people]

Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States have developed recommendations for heat action plans, in which the medical profession should also participate in the prevention of heat-related damage to health. Physicians and their team should first become acquainted with the topic. In addition, they should inform patients at risk and their relatives of the risks and preventive measures. In the summer a critical check of drugs is also needed because medications impair cooling mechanisms in heat waves, the pharmacokinetics can change and unwanted side effects of drugs occur more frequently. Lastly, due to their central position in the healthcare system, physicians should participate in the coordination of a good nursing care and intensification of social contacts during heat waves.

Interactive effects of age and hydration state on human thermoregulatory function during exercise in hot-dry conditions

AIM

Ageing and hypohydration independently attenuate heat dissipation during exercise; however, the interactive effects of these factors remain unclear. We assessed the hypothesis that ageing suppresses hypohydration-induced reductions in whole-body heat loss during exercise in the heat.

METHODS

On two occasions, eight young (mean [SD]: 24 [4] years) and eight middle-aged (59 [5] years) men performed 30-minute bouts of light (heat production of 175 W m^-2 ) and moderate (275 W m^-2 ) cycling (separated by 15-minute rest) in the heat (40°C, 15% relative humidity) when euhydrated and hypohydrated (~4% reduction in body mass). Heat production and whole-body net heat exchange (evaporative heat loss + dry heat gain) were measured via indirect and direct calorimetry (respectively) and heat storage was calculated via their temporal summation.

RESULTS

Net heat exchange was reduced, while heat storage was elevated, in the middle-aged men during moderate exercise when euhydrated (both P ≤ 0.01). In the young, evaporative heat loss was attenuated in the hypohydrated vs euhydrated condition during light (199 ± 6 vs 211 ± 10 W m^-2 ; P ≤ 0.01) and moderate (287 ± 15 vs 307 ± 13 W m^-2 ; P ≤ 0.01) exercise, but was similar in the middle-aged men, averaging 223 ± 6 and 299 ± 15 W m^-2 , respectively, across conditions (both P ≥ 0.32). Heat storage was thereby exacerbated by hypohydration in the young (both P < 0.01) but not the middle-aged (both P ≥ 0.32) during both exercise bouts and, as a result, was similar between groups when hypohydrated (both P ≥ 0.50).

CONCLUSION

Hypohydration attenuates heat loss via sweating in young but not middle-aged men, indicating that ageing impairs one's ability to mitigate further sweat-induced fluid loss during hypohydration.

Efficacy of Heat Mitigation Strategies on Core Temperature and Endurance Exercise: A Meta-Analysis

Background: A majority of high profile international sporting events, including the coming 2020 Tokyo Olympics, are held in warm and humid conditions. When exercising in the heat, the rapid rise of body core temperature (T_c) often results in an impairment of exercise capacity and performance. As such, heat mitigation strategies such as aerobic fitness (AF), heat acclimation/acclimatization (HA), pre-exercise cooling (PC) and fluid ingestion (FI) can be introduced to counteract the debilitating effects of heat strain. We performed a meta-analysis to evaluate the effectiveness of these mitigation strategies using magnitude-based inferences.

Methods: A computer-based literature search was performed up to 24 July 2018 using the electronic databases: PubMed, SPORTDiscus and Google Scholar. After applying a set of inclusion and exclusion criteria, a total of 118 studies were selected for evaluation. Each study was assessed according to the intervention's ability to lower T_c before exercise, attenuate the rise of T_c during exercise, extend T_c at the end of exercise and improve endurance. Weighted averages of Hedges' g were calculated for each strategy.

Results: PC (g = 1.01) was most effective in lowering T_c before exercise, followed by HA (g = 0.72), AF (g = 0.65), and FI (g = 0.11). FI (g = 0.70) was most effective in attenuating the rate of rise of T_c, followed by HA (g = 0.35), AF (g = −0.03) and PC (g = −0.46). In extending T_c at the end of exercise, AF (g = 1.11) was most influential, followed by HA (g = −0.28), PC (g = −0.29) and FI (g = −0.50). In combination, AF (g = 0.45) was most effective at favorably altering T_c, followed by HA (g = 0.42), PC (g = 0.11) and FI (g = 0.09). AF (1.01) was also found to be most effective in improving endurance, followed by HA (0.19), FI (−0.16) and PC (−0.20).

Conclusion: AF was found to be the most effective in terms of a strategy's ability to favorably alter T_c, followed by HA, PC and lastly, FI. Interestingly, a similar ranking was observed in improving endurance, with AF being the most effective, followed by HA, FI, and PC. Knowledge gained from this meta-analysis will be useful in allowing athletes, coaches and sport scientists to make informed decisions when employing heat mitigation strategies during competitions in hot environments.

Aging and Thermoregulatory Control: The Clinical Implications of Exercising under Heat Stress in Older Individuals

Climate change is predicted to bring about a greater variability in weather patterns with an increase in extreme weather events such as sustained heat waves. This change may have a direct impact on population health since heat waves can exceed the physiological limit of compensability of vulnerable individuals. Indeed, many clinical reports suggest that individuals over the age of 60 years are consistently the most vulnerable, experiencing significantly greater adverse heat-related health outcomes than any other age cohort during environmental heat exposure. There is now evidence that aging is associated with an attenuated physiological ability to dissipate heat and that the risk of heat-related illness in these individuals is elevated, particularly when performing physical activity in the heat. The purpose of this review is to discuss mechanisms of thermoregulatory control and the factors that may increase the risk of heat-related illness in older individuals. An understanding of the mechanisms responsible for impaired thermoregulation in this population is of particular importance, given the current and projected increase in frequency and intensity of heat waves, as well as the promotion of regular exercise as a means of improving health-related quality of life and morbidity and mortality. As such, the clinical implications of this work in this population will be discussed.

Futility of current urine salbutamol doping control

Aims

Salbutamol is used in the management of obstructive bronchospasm, including that of some elite athletes. It is claimed that high salbutamol (oral) doses may also have an anabolic effect. Therefore, inhalation of salbutamol is restricted by the World Anti‐Doping Agency (WADA) to a maximal daily dose. Urine is tested for violations, but recent cases have resulted in a debate regarding the validity of this approach. It was our aim to determine whether current approaches are sufficiently able to differentiate approved usage from violations.

Methods

We extracted pharmacokinetic parameters from literature for salbutamol and its sulphated metabolite. From these parameters, a semi‐physiological pharmacokinetic model of inhaled and orally administered salbutamol was synthesized, validated against literature data, and used to perform clinical trial simulations (n = 1000) of possible urine concentrations over time resulting from WADA‐allowed and oral unacceptable dosages.

Results

The synthesized model was able to predict the literature data well. Simulations showed a very large range of salbutamol concentrations, with a significant portion of virtual subjects (15.4%) exceeding the WADA threshold limit of 1000 ng ml⁻¹ at 1 h post‐dose.

Conclusions

The observed large variability in urine concentrations indicates that determining the administered dose from a single untimed urine sample is not feasible. The current threshold inadvertently leads to incorrect assumptions of violation, whereas many violations will go unnoticed, especially when samples are taken long after drug administration. These issues, combined with the dubious assertion of its anabolic effect, leads us to conclude that the large effort involved in testing should be reconsidered.

Relationship between maximum oxygen uptake and peripheral vasoconstriction in a cold environment

Background

Various individual characteristics affect environmental adaptability of a human. The present study evaluates the relationship between physical fitness and peripheral vasoconstriction in a cold environment.

Methods

Seven healthy male students (aged 22.0 years) participated in this study. Cold exposure tests consisted of supine rest for 60 min at 28 °C followed by 90 min at 10 °C. Rectal and skin temperatures at seven sites, oxygen consumption, and the diameter of a finger vein were measured during the experiment. Metabolic heat production, skin heat conductance, and the rate of vasoconstriction were calculated. Individual maximum oxygen consumption, a direct index of aerobic fitness, was measured on the day following the cold exposure test.

Results

Decreases in temperature of the hand negatively correlated with the changes in rectal temperature. Maximum oxygen consumption and the rate of vasoconstriction are positively correlated. Furthermore, pairs of the following three factors are also significantly correlated: rate of metabolic heat production, skin heat conductance, and the rate of vasoconstriction.

Conclusion

The results of this study suggested that the capacity for peripheral vasoconstriction can be improved by physical exercise. Furthermore, when exposed to a cold environment, fitter individuals could maintain metabolic heat production at the resting metabolic level of a thermoneutral condition, as they correspondingly lost less heat.

Development of a Whole-Body Physiologically Based Pharmacokinetic Approach to Assess the Pharmacokinetics of Drugs in Elderly Individuals

Background

Because of the vulnerability and frailty of elderly adults, clinical drug development has traditionally been biased towards young and middle-aged adults. Recent efforts have begun to incorporate data from paediatric investigations. Nevertheless, the elderly often remain underrepresented in clinical trials, even though persons aged 65 years and older receive the majority of drug prescriptions. Consequently, a knowledge gap exists with regard to pharmacokinetic (PK) and pharmacodynamic (PD) responses in elderly subjects, leaving the safety and efficacy of medicines for this population unclear.

Objectives

The goal of this study was to extend a physiologically based pharmacokinetic (PBPK) model for adults to encompass the full course of healthy aging through to the age of 100 years, to support dose selection and improve pharmacotherapy for the elderly age group.

Methods

For parameterization of the PBPK model for healthy aging individuals, the literature was scanned for anthropometric and physiological data, which were consolidated and incorporated into the PBPK software PK-Sim^®. Age-related changes that occur from 65 to 100 years of age were the main focus of this work. For a sound and continuous description of an aging human, data on anatomical and physiological changes ranging from early adulthood to old age were included. The capability of the PBPK approach to predict distribution and elimination of drugs was verified using the test compounds morphine and furosemide, administered intravenously. Both are cleared by a single elimination pathway. PK parameters for the two compounds in younger adults and elderly individuals were obtained from the literature. Matching virtual populations—with regard to age, sex, anthropometric measures and dosage—were generated. Profiles of plasma drug concentrations over time, volume of distribution at steady state (V_ss) values and elimination half-life (t_½) values from the literature were compared with those predicted by PBPK simulations for both younger adults and the elderly.

Results

For most organs, the age-dependent information gathered in the extensive literature analysis was dense. In contrast, with respect to blood flow, the literature study produced only sparse data for several tissues, and in these cases, linear regression was required to capture the entire elderly age range. On the basis of age-informed physiology, the predicted PK profiles described age-associated trends well. The root mean squared prediction error for the prediction of plasma concentrations of furosemide and morphine in the elderly were improved by 32 and 49 %, respectively, by use of age-informed physiology. The majority of the individual V_ss and t_½ values for the two model compounds, furosemide and morphine, were well predicted in the elderly population, except for long furosemide half-lifes.

Conclusion

The results of this study support the feasibility of using a knowledge-driven PBPK aging model that includes the elderly to predict PK alterations throughout the entire course of aging, and thus to optimize drug therapy in elderly individuals. These results indicate that pharmacotherapy and safety-related control of geriatric drug therapy regimens may be greatly facilitated by the information gained from PBPK predictions.

Electronic supplementary material

The online version of this article (doi:10.1007/s40262-016-0422-3) contains supplementary material, which is available to authorized users.

Renal sympathetic nerve, blood flow, and epithelial transport responses to thermal stress

Thermal stress is a profound sympathetic stress in humans; kidney responses involve altered renal sympathetic nerve activity (RSNA), renal blood flow, and renal epithelial transport. During mild cold stress, RSNA spectral power but not total activity is altered, renal blood flow is maintained or decreased, and epithelial transport is altered consistent with a sympathetic stress coupled with central volume loaded state. Hypothermia decreases RSNA, renal blood flow, and epithelial transport. During mild heat stress, RSNA is increased, renal blood flow is decreased, and epithelial transport is increased consistent with a sympathetic stress coupled with a central volume unloaded state. Hyperthermia extends these directional changes, until heat illness results. Because kidney responses are very difficult to study in humans in vivo, this review describes and qualitatively evaluates an in vivo human skin model of sympathetically regulated epithelial tissue compared to that of the nephron. This model utilizes skin responses to thermal stress, involving 1) increased skin sympathetic nerve activity (SSNA), decreased skin blood flow, and suppressed eccrine epithelial transport during cold stress; and 2) increased SSNA, skin blood flow, and eccrine epithelial transport during heat stress. This model appears to mimic aspects of the renal responses. Investigations of skin responses, which parallel certain renal responses, may aid understanding of epithelial-sympathetic nervous system interactions during cold and heat stress.

Investigation of Factors Affecting Body Temperature Changes During Routine Clinical Head Magnetic Resonance Imaging

BACKGROUND

Pulsed radiofrequency (RF) magnetic fields, required to produce magnetic resonance imaging (MRI) signals from tissue during the MRI procedure have been shown to heat tissues.

OBJECTIVES

To investigate the relationship between body temperature rise and the RF power deposited during routine clinical MRI procedures, and to determine the correlation between this effect and the body's physiological response.

PATIENTS AND METHODS

We investigated 69 patients from the Korean national cancer center to identify the main factors that contribute to an increase in body temperature (external factors and the body's response) during a clinical brain MRI. A routine protocol sequence of MRI scans (1.5 T and 3.0 T) was performed. The patient's tympanic temperature was recorded before and immediately after the MRI procedure and compared with changes in variables related to the body's physiological response to heat.

RESULTS

Our investigation of the physiological response to RF heating indicated a link between increasing age and body temperature. A higher increase in body temperature was observed in older patients after a 3.0-T MRI (r = 0.07, P = 0.29 for 1.5-T MRI; r = 0.45, P = 0.002 for 3.0-T MRI). The relationship between age and body heat was related to the heart rate (HR) and changes in HR during the MRI procedure; a higher RF power combined with a reduction in HR resulted in an increase in body temperature.

CONCLUSION

A higher magnetic field strength and a decrease in the HR resulted in an increase in body temperature during the MRI procedure.

The effect of exercise training on cutaneous microvascular reactivity: A systematic review and meta-analysis

OBJECTIVES

This study aimed to review the efficacy of exercise training for improving cutaneous microvascular reactivity in response to local stimulus in human adults.

DESIGN

Systematic review with meta-analysis.

METHODS

A systematic search of Medline, Cinahl, AMED, Web of Science, Scopus, and Embase was conducted up to June 2015. Included studies were controlled trials assessing the effect of an exercise training intervention on cutaneous microvascular reactivity as instigated by local stimulus such as local heating, iontophoresis and post-occlusive reactive hyperaemia. Studies where the control was only measured at baseline or which included participants with vasospastic disorders were excluded. Two authors independently reviewed and selected relevant controlled trials and extracted data. Quality was assessed using the Downs and Black checklist.

RESULTS

Seven trials were included, with six showing a benefit of exercise training but only two reaching statistical significance with effect size ranging from -0.14 to 1.03. The meta-analysis revealed that aerobic exercise had a moderate statistically significant effect on improving cutaneous microvascular reactivity (effect size (ES)=0.43, 95% CI: 0.08-0.78, p=0.015).

CONCLUSIONS

Individual studies employing an exercise training intervention have tended to have small sample sizes and hence lacked sufficient power to detect clinically meaningful benefits to cutaneous microvascular reactivity. Pooled analysis revealed a clear benefit of exercise training on improving cutaneous microvascular reactivity in older and previously inactive adult cohorts. Exercise training may provide a cost-effective option for improving cutaneous microvascular reactivity in adults and may be of benefit to those with cardiovascular disease and metabolic disorders such as diabetes.

Brain Temperature in Spontaneously Hypertensive Rats during Physical Exercise in Temperate and Warm Environments

This study aimed to evaluate brain temperature (Tbrain) changes in spontaneously hypertensive rats (SHRs) subjected to two different physical exercise protocols in temperate or warm environments. We also investigated whether hypertension affects the kinetics of exercise-induced increases in Tbrain relative to the kinetics of abdominal temperature (Tabd) increases. Male 16-week-old normotensive Wistar rats (NWRs) and SHRs were implanted with an abdominal temperature sensor and a guide cannula in the frontal cortex to enable the insertion of a thermistor to measure Tbrain. Next, the animals were subjected to incremental-speed (initial speed of 10 m/min; speed was increased by 1 m/min every 3 min) or constant-speed (60% of the maximum speed) treadmill running until they were fatigued in a temperate (25°C) or warm (32°C) environment. Tbrain, Tabd and tail skin temperature were measured every min throughout the exercise trials. During incremental and constant exercise at 25°C and 32°C, the SHR group exhibited greater increases in Tbrain and Tabd relative to the NWR group. Irrespective of the environment, the heat loss threshold was attained at higher temperatures (either Tbrain or Tabd) in the SHRs. Moreover, the brain-abdominal temperature differential was lower at 32°C in the SHRs than in the NWRs during treadmill running. Overall, we conclude that SHRs exhibit enhanced brain hyperthermia during exercise and that hypertension influences the kinetics of the Tbrain relative to the Tabd increases, particularly during exercise in a warm environment.

The Gastrointestinal Circulation: Physiology and Pathophysiology

The gastrointestinal (GI) circulation receives a large fraction of cardiac output and this increases following ingestion of a meal. While blood flow regulation is not the intense phenomenon noted in other vascular beds, the combined responses of blood flow, and capillary oxygen exchange help ensure a level of tissue oxygenation that is commensurate with organ metabolism and function. This is evidenced in the vascular responses of the stomach to increased acid production and in intestine during periods of enhanced nutrient absorption. Complimenting the metabolic vasoregulation is a strong myogenic response that contributes to basal vascular tone and to the responses elicited by changes in intravascular pressure. The GI circulation also contributes to a mucosal defense mechanism that protects against excessive damage to the epithelial lining following ingestion of toxins and/or noxious agents. Profound reductions in GI blood flow are evidenced in certain physiological (strenuous exercise) and pathological (hemorrhage) conditions, while some disease states (e.g., chronic portal hypertension) are associated with a hyperdynamic circulation. The sacrificial nature of GI blood flow is essential for ensuring adequate perfusion of vital organs during periods of whole body stress. The restoration of blood flow (reperfusion) to GI organs following ischemia elicits an exaggerated tissue injury response that reflects the potential of this organ system to generate reactive oxygen species and to mount an inflammatory response. Human and animal studies of inflammatory bowel disease have also revealed a contribution of the vasculature to the initiation and perpetuation of the tissue inflammation and associated injury response.