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Armstrong LE, Johnson EC, Adams WM, Jardine JF. Hyperthermia and Exertional Heatstroke During Running, Cycling, Open Water Swimming, and Triathlon Events. Open Access J Sports Med 2024; 15:111-127. [PMID: 39345935 PMCID: PMC11438465 DOI: 10.2147/oajsm.s482959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 09/06/2024] [Indexed: 10/01/2024] Open
Abstract
Few previous epidemiological studies, sports medicine position statements, and expert panel consensus reports have evaluated the similarities and differences of hyperthermia and exertional heatstroke (EHS) during endurance running, cycling, open water swimming, and triathlon competitions. Accordingly, we conducted manual online searches of the PubMed and Google Scholar databases using pre-defined inclusion criteria. The initial manual screenings of 1192 article titles and abstracts, and subsequent reviews of full-length pdf versions identified 80 articles that were acceptable for inclusion. These articles indicated that event medical teams recognized hyperthermia and EHS in the majority of running and triathlon field studies (range, 58.8 to 85.7%), whereas few reports of hyperthermia and EHS appeared in cycling and open water swimming field studies (range, 0 to 20%). Sports medicine position statements and consensus reports also exhibited these event-specific differences. Thus, we proposed mechanisms that involved physiological effector responses (sweating, increased skin blood flow) and biophysical heat transfer to the environment (evaporation, convection, radiation, and conduction). We anticipate that the above information will help race directors to distribute pre-race safety advice to athletes and will assist medical directors to better allocate medical resources (eg, staff number and skill sets, medical equipment) and optimize the management of hyperthermia and EHS.
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Affiliation(s)
- Lawrence E Armstrong
- Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Evan C Johnson
- Division of Kinesiology & Health, University of Wyoming, Laramie, WY, USA
| | - William M Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, USA
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
- School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine (NCSEM), Loughborough, UK
| | - John F Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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2
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Mougin L, Bougault V, Racinais S, Mountjoy ML, Stephenson B, Carter S, James LJ, Mears SA, Taylor L. Environmental challenges facing athletes, stakeholders and spectators at Paris 2024 Olympic and Paralympic Games: an evidence-based review of mitigation strategies and recommendations. Br J Sports Med 2024; 58:870-881. [PMID: 38955507 DOI: 10.1136/bjsports-2024-108281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
The upcoming Paris 2024 Olympic and Paralympic Games could face environmental challenges related to heat, air quality and water quality. These challenges will pose potential threats to athletes and impact thousands of stakeholders and millions of spectators. Recognising the multifaceted nature of these challenges, a range of strategies will be essential for mitigating adverse effects on participants, stakeholders and spectators alike. From personalised interventions for athletes and attendees to comprehensive measures implemented by organisers, a holistic approach is crucial to address these challenges and the possible interplay of heat, air and water quality factors during the event. This evidence-based review highlights various environmental challenges anticipated at Paris 2024, offering strategies applicable to athletes, stakeholders and spectators. Additionally, it provides recommendations for Local Organising Committees and the International Olympic Committee that may be applicable to future Games. In summary, the review offers solutions for consideration by the stakeholders responsible for and affected by the anticipated environmental challenges at Paris 2024.
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Affiliation(s)
- Loïs Mougin
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | | | - Sébastien Racinais
- Environmental Stress Unit, CREPS Montpellier Font-Romeu, Montpellier, France
- DMEM, UMR 866 INRAE / University of Montpellier, Montpellier, France
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ben Stephenson
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- UK Sports Institute, Loughborough, UK
| | - Sarah Carter
- Faculty of Health, Exercise and Sports Science, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lewis J James
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Stephen A Mears
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Lee Taylor
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- University of Technology Sydney, Sydney, New South Wales, Australia
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Martin DG, Eason CM, Huggins RA, Tuff B, Casa DJ. Emergency Medical Planning for an Ultramarathon Open Water Swim: A Case Review of "Swim Tuff". Curr Sports Med Rep 2024; 23:216-221. [PMID: 38838684 DOI: 10.1249/jsr.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT Ultramarathon open water swimming (OWS) events are one of the toughest endurance challenges in the world. The sport has gained notoriety with athletes swimming across the English Channel, Diana Nyad swimming from Cuba to Florida, and the 5- and 10-km OWS in the Olympic schedule. The athletes who participate are exposed to dangerous conditions that expose risks inherent to the sport. The optimal time to prepare for an emergency is before it happens. The aim of this paper is to present an emergency action plan (EAP) designed for the "Swim Tuff" event, a record-breaking ultramarathon swim that took place in Rhode Island, United States. This article identifies an overview of Swim Tuff, the challenges experienced, and how the team designed and implemented risk mitigation strategies. The professionals looking over athletes completing an OWS should be educated and aware of the unique circumstances inherent to the sport.
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Affiliation(s)
- David G Martin
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
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Karunakaran E, Battarbee R, Tait S, Brentan BM, Berney C, Grinham J, Herrero MA, Omolo R, Douterelo I. Integrating molecular microbial methods to improve faecal pollution management in rivers with designated bathing waters. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168565. [PMID: 37979848 DOI: 10.1016/j.scitotenv.2023.168565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023]
Abstract
Rivers are at risk from a variety of pollution sources. Faecal pollution is of particular concern since it disperses pathogenic microorganisms in the aquatic environment. Currently, faecal pollution levels in rivers is monitored using faecal indicator bacteria (FIB) that do not offer information about pollution sources and associated risks. This study used a combined molecular approach, along with measurements of water quality, to gain information on pollution sources, and risk levels, in a newly designated recreational bathing site in the River Wharfe (UK). Physico-chemical parameters were monitored in situ, with water quality multiparameter monitoring sondes installed during the 2021 bathing season. The molecular approach was based on quantitative PCR (qPCR)-aided Microbial Source Tracking (MST) and 16S rRNA gene metabarcoding to obtain a fingerprint of bacterial communities and identify potential bioindicators. The analysis from the water quality sondes showed that ammonium was the main parameter determining the distribution of FIB values. Lower faecal pollution levels were detected in the main river when compared to tributaries, except for samples in the river located downstream of a wastewater treatment plant. The faecal pollution type (anthropogenic vs. zoogenic) changed the diversity and the structure of bacterial communities, giving a distinctive fingerprint that can be used to inform source. DNA-based methods showed that the presence of human-derived bacteria was associated with Escherichia coli spikes, coinciding with higher bacterial diversity and the presence of potential pathogenic bacteria mainly of the genus Mycobacterium, Aeromonas and Clostridium. Samples collected after a heavy rainfall event were associated with an increase in Bacteroidales, which are markers of faecal pollution, including Bacteroides graminisolvens, a ruminant marker associated with surface run-off from agricultural sources. The combined use of qPCR and 16S rRNA sequencing was able to identify pollution sources, and novel bacterial indicators, thereby aiding decision-making and management strategies in recreational bathing rivers.
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Affiliation(s)
- Esther Karunakaran
- Department of Chemical and Biological Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Rick Battarbee
- Environmental Change Research Centre, University College London, London WC1E 6BT, UK; Addingham Environment Group, Addingham, West Yorkshire LS29 0PD, UK
| | - Simon Tait
- Department of Civil and Structural Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Bruno Melo Brentan
- Hydraulic Engineering and Water Resource Department, Federal University of Minas Gerais, Belo Horizonte 31270, Brazil
| | - Cathal Berney
- Addingham Environment Group, Addingham, West Yorkshire LS29 0PD, UK
| | - James Grinham
- Department of Chemical and Biological Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Maria Angeles Herrero
- Department of Civil and Structural Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Ronex Omolo
- Department of Civil and Structural Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Isabel Douterelo
- Department of Civil and Structural Engineering, University of Sheffield, Sheffield S1 3JD, UK.
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Oliver DM, McDougall CW, Robertson T, Grant B, Hanley N, Quilliam RS. Self-reported benefits and risks of open water swimming to health, wellbeing and the environment: Cross-sectional evidence from a survey of Scottish swimmers. PLoS One 2023; 18:e0290834. [PMID: 37639394 PMCID: PMC10461842 DOI: 10.1371/journal.pone.0290834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Engaging with natural environments benefits human health by providing opportunities for social interactions, enhancing mental wellbeing and enabling outdoor spaces for physical exercise. Open water swimming has seen a rapid increase in popularity, partly due to the physical health benefits it can provide but also with the growing interest in (re)connecting with nature for environment-health interactions. Using a national-scale online survey of 717 open water swimmers, the aim of this study was to investigate patterns and trends in the perceived benefits and risks of open water swimming to both public health and the environment; and to understand whether these perceived risks and benefits vary across different typologies of swimmers and open water, or 'blue space', environments. Strong associations were found between the most important self-reported benefit associated with open water swimming and both participant age and the categorisation of their typical swim style. All but one of the age-groups surveyed perceived mental wellbeing benefits to be the most important benefit of open water swimming; whilst those aged over 65 identified physical rather than mental wellbeing benefits to be the most important outcome. Participants who preferred lake swimming reported greater concern regarding possible environmental damage caused by the increasing popularity of open water swimming compared to those engaging in river or sea swimming. However, the majority of participants perceived the risks to the environment from open water swimming to be minimal. Our study adds to the growing evidence that open water swimming is perceived by participants as benefitting their mental and physical wellbeing. Improved understanding of the benefits and risks of engaging with blue spaces used for open water swimming can contribute to co-designed policy development to promote safer, healthier and more sustainable outdoor recreation opportunities associated with this increasingly popular outdoor pursuit.
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Affiliation(s)
- David M. Oliver
- Biological and Environmental Sciences, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Craig W. McDougall
- Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Tony Robertson
- Biological and Environmental Sciences, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Blair Grant
- Biological and Environmental Sciences, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Nick Hanley
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Richard S. Quilliam
- Biological and Environmental Sciences, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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Ffrench R, Smith MD, Henderson E. Case of transient global amnesia-like syndrome after recreational cold-water swimming. BMJ Case Rep 2023; 16:e253125. [PMID: 37369527 PMCID: PMC10410986 DOI: 10.1136/bcr-2022-253125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
We document a case of a transient global amnesia (TGA)-like syndrome following open water swimming. This case was atypical for TGA, in that symptoms were prolonged and ischaemic infarct was considered within the differential. MRI did not demonstrate any changes associated with acute ischaemia although did show a mild degree of small vessel change. With amnesia taking greater than 24 hours to resolve, we have labelled this case to be a TGA-like syndrome, provoked by the commonly reported TGA precipitant of cold water immersion. The possibility of a tiny, strategic infarct causing these symptoms was considered and antiplatelet therapy commenced.
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Affiliation(s)
- Ruby Ffrench
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Matthew D Smith
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Henderson
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
- Population Health Sciences, University of Bristol, Bristol, UK
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Murphy M, Polston K, Carroll M, Alm J. Heat Injury in Open-Water Swimming: A Narrative Review. Curr Sports Med Rep 2021; 20:193-198. [PMID: 33790192 DOI: 10.1249/jsr.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Swimming is one of the most popular sports in the world with open-water swimming (OWS) gaining more and more prominence since being featured in the Federation Internationale De Natation World Aquatics Championships in 1992 and the Olympic Games in 2000. The aim of this review is to analyze the existing literature on heat injury in OWS. Relevant literature was located via computer-generated citations during November of 2020 through online computer searches of multiple major databases. Athletes participating in OWS are exposed to environmental conditions that place them at risk for unique medical conditions such as heat injury. Clinicians providing care for OWS athletes should be educated and trained to recognize these conditions and minimize risks to optimize athlete safety. This article identifies medical challenges related to heat injury in OWS while investigating water temperature recommendations, physiological effects of hyperthermia, risk mitigation strategies, and treatment measures.
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Manolis AS, Manolis SA, Manolis AA, Manolis TA, Apostolaki N, Melita H. Winter Swimming. Curr Sports Med Rep 2019; 18:401-415. [DOI: 10.1249/jsr.0000000000000653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Open Water Swimming. Curr Sports Med Rep 2019; 18:247. [DOI: 10.1249/jsr.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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