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Hamdan R, Guyotat N, Mahéo P, Bailleux J, Asdrubal J, Gallina X. Contribution of medical resonance imaging in the return to physical activity after exertional rhabdomyolysis a case report. PHYSICIAN SPORTSMED 2024. [PMID: 39258326 DOI: 10.1080/00913847.2024.2403322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/24/2024] [Accepted: 09/09/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Rémy Hamdan
- Department of Vascular Medicine, Macon Hospital Centre, Mâcon, France
| | - Nicolas Guyotat
- Department of Internal Medicine, Macon Hospital Centre, Mâcon, France
| | - Pierre Mahéo
- Department of Cardiology, Macon Hospital Centre, Mâcon, France
| | - Jérôme Bailleux
- Department of Medical Imagery, Macon Hospital Centre, Mâcon, France
- IMADIS, Lyon, France
| | - Jacques Asdrubal
- Department of Emergency Medicine, Macon Hospital Centre, Mâcon, France
| | - Xavier Gallina
- Department of Medical Imagery, Macon Hospital Centre, Mâcon, France
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Zhang Z, Wu X, Zou Z, Shen M, Liu Q, Zhangsun Z, Zhao H, Lei W, Wang Z, Dong Y, Yang Y. Heat stroke: Pathogenesis, diagnosis, and current treatment. Ageing Res Rev 2024; 100:102409. [PMID: 38986844 DOI: 10.1016/j.arr.2024.102409] [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] [Received: 02/05/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Recently, the incidence of heat-related illnesses has exhibited a steadily upward trend, which is closely associated with several environmental factors such as climate change and air pollution. The progression of heat-related illnesses is a continuous process and can progress to the terminal period when it transforms into heat stroke, the most severe form. Heat stroke is markedly by a core body temperature above 40°C and central nervous system dysfunction. Current knowledge suggests that the pathogenesis of heat stroke is complex and varied, including inflammatory response, oxidative stress, cell death, and coagulation dysfunction. This review consolidated recent research progress on the pathophysiology and pathogenesis of heat stroke, with a focus on the related molecular mechanisms. In addition, we reviewed common strategies and sorted out the drugs in various preclinical stages for heat stroke, aiming to offer a comprehensive research roadmap for more in-depth researches into the mechanisms of heat stroke and the reduction in the mortality of heat stroke in the future.
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Affiliation(s)
- Zhe Zhang
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Xiaopeng Wu
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Zheng Zou
- Department of Neurosurgery, The General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang, Liaoning 110016, China
| | - Mingzhi Shen
- Department of General Medicine, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Hainan, 572013, China
| | - Qiong Liu
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Ziyin Zhangsun
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Huadong Zhao
- Department of General Surgery, Tangdu Hospital, The Airforce Medical University, 1 Xinsi Road, Xi'an, 710038, China
| | - Wangrui Lei
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Zheng Wang
- Department of Cardiothoracic Surgery, Central Theater Command General Hospital of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China
| | - Yushu Dong
- Department of Neurosurgery, The General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang, Liaoning 110016, China.
| | - Yang Yang
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China.
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DeHan PJ, Flores SA, Rhodehouse BB, Kaplan JJ, DeGroot DW. Rebound Hyperthermia in Exertional Heat Stroke. Mil Med 2024:usae393. [PMID: 39212949 DOI: 10.1093/milmed/usae393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/24/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Exertional heat stroke (EHS) is a life-threatening condition requiring rapid reversal of hyperthermia to prevent poor health outcomes. Current treatment protocols aim for a cooling rate of 0.15 C/min using various modalities. This case report details a 22-year-old male who, despite initial successful cooling measures, experienced rebound hyperthermia, necessitating the use of endovascular cooling (EVC). The patient collapsed during a 19.3 km (12-mile) ruck march in Fort Moore, Georgia, with an initial core temperature of 41.6ºC. Conventional cooling methods, including ice sheets and chilled intravenous saline, adequately cooled the patient to target temperatures; however, discontinuation of cooling methods resulted in rebound hyperthermia. Endovascular cooling was eventually initiated, resulting in euthermia after 36 hours of continued use. During his hospital admission, the patient was evaluated thoroughly for underlying etiologies contributing to his rebound hyperthermia. This workup did not yield any concerning pathology, except for bilateral foot cellulitis noted on physical examination, which was subsequently managed with antibiotics. Despite initial complications, the patient recovered within 5 days and returned to duty after 2 months. Several case reports have been published regarding the use of EVC in the management of EHS. These reports, however, describe its use in initial management of EHS or in cases where hyperthermia was refractory to other conventional cooling methods. To our knowledge, this is the first report of its kind highlighting its successful implementation in rebound hyperthermia. Early recognition and initiation of cooling measures are critical in EHS cases. Future directions include developing EHS-specific EVC protocols for patients experiencing refractory or rebound hyperthermia.
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Affiliation(s)
- Preston J DeHan
- National Capital Consortium Primary Care Sports Medicine Fellowship, A.T. Augusta Military Medical Center, Fort Belvoir, VA 22060, USA
| | - Shelley A Flores
- Family Medicine Clinic OIC, BG Crawford F. Sams US Army Health Clinic, Sagamihara, Kanagawa 252-0326, Japan
| | - Blair B Rhodehouse
- Martin Army Community Hospital Family Medicine Residency Program; Medical Director, The Army Heat Center, Fort Moore, GA 31905, USA
| | - Joseph J Kaplan
- Department of Emergency Medicine, Martin Army Community Hospital, Fort Moore, GA 31905, USA
| | - David W DeGroot
- The Army Heat Center, Martin Army Community Hospital, Fort Moore, GA 31905, USA
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Périard JD, Wilson MG, Tebeck ST, Stanley J, Girard O. Health status and heat preparation at a UCI World Tour multistage cycling race. J Sci Med Sport 2024:S1440-2440(24)00491-2. [PMID: 39242327 DOI: 10.1016/j.jsams.2024.08.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVES To assess health status and heat preparation of cyclists at the 2019 Tour Down Under and determine the alignment of heat mitigation strategies with current recommendations. DESIGN Cohort study. METHODS Twenty-three (17 % participation rate) male World Tour cyclists from five teams and 10 countries completed a pre-competition questionnaire evaluating exertional heat illness (EHI) history, pre-race health status, and heat mitigation and recovery strategies use. Associations between arrival days pre-competition, years as professional, nationality, team, history of EHI symptoms and diagnosis on heat mitigation and recovery strategy utilisation were assessed. RESULTS 65 % of cyclists reported previously experiencing one or more EHI symptom (cramping: 48 %) and 22 % a diagnosis of heat stroke. In the 10 days preceding the race, 26 % experienced one or more illness symptoms. 65 % trained in the heat (acclimatisation 8-25 days; acclimation: 3-7 days), which was associated with team (P = 0.047, ϕc = 0.61), nationality (P = 0.009, ϕc = 0.86) and EHI symptoms history (P = 0.058, ϕ = 0.43). All cyclists had a hydration plan, with links to team (0.5-1.0 L·h-1, P = 0.043, ϕc = 0.68) and EHI symptom history (1.0-1.5 L·h-1, P = 0.048, ϕ = 0.476). Most had pre-cooling (87 %) and mid-cooling (83 %) strategies, most commonly cold beverages (75 %) and neck collars (78 %), respectively. All cyclists planned on using at least one recovery strategy (massage: 87 %). CONCLUSIONS Our data indicate good alignment with current recommendations for competing in the heat, particularly for hydration, cooling and recovery strategies. Whilst the proportion of cyclists engaging in heat acclimation/acclimatisation is encouraging, greater awareness on adapting and implementing heat training is required.
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Affiliation(s)
- J D Périard
- Research Institute for Sport and Exercise, University of Canberra, Australia.
| | - M G Wilson
- Institute of Sport, Exercise and Health, University College London, UK; Aspetar Orthopaedic and Sports Medicine Hospital, Qatar
| | - S T Tebeck
- Department of Sports Science, South Australian Sports Institute of Sport, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Australia
| | - J Stanley
- Department of Sports Science, South Australian Sports Institute of Sport, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Australia; Australian Cycling Team, Auscycling, Gepps Cross, Australia
| | - O Girard
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Australia
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Segreti A, Celeski M, Guerra E, Crispino SP, Vespasiano F, Buzzelli L, Fossati C, Papalia R, Pigozzi F, Grigioni F. Effects of Environmental Conditions on Athlete's Cardiovascular System. J Clin Med 2024; 13:4961. [PMID: 39201103 PMCID: PMC11355938 DOI: 10.3390/jcm13164961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
Environmental factors such as extreme temperatures, humidity, wind, pollution, altitude, and diving can significantly impact athletes' cardiovascular systems, potentially hindering their performance, particularly in outdoor sports. The urgency of this issue is heightened by the increasing prevalence of climate change and its associated conditions, including fluctuating pollution levels, temperature variations, and the spread of infectious diseases. Despite its critical importance, this topic is often overlooked in sports medicine. This narrative review seeks to address this gap by providing a comprehensive, evidence-based evaluation of how athletes respond to environmental stresses. A thorough assessment of current knowledge is essential to better prepare athletes for competition under environmental stress and to minimize the harmful effects of these factors. Specifically, adaptative strategies and preventative measures are vital to mitigating these environmental influences and ensuring athletes' safety.
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Affiliation(s)
- Andrea Segreti
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Roma, Italy; (C.F.); (F.P.)
| | - Mihail Celeski
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Emiliano Guerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy;
| | - Simone Pasquale Crispino
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesca Vespasiano
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Lorenzo Buzzelli
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Roma, Italy; (C.F.); (F.P.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy;
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 15, 00135 Roma, Italy; (C.F.); (F.P.)
| | - Francesco Grigioni
- Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (M.C.); (S.P.C.); (F.V.); (L.B.); (F.G.)
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Yamashita N, Kume M, Satake T, Inoue K, Yoshida T. Subjective perceived risk factors of exertional heat exhaustion-related symptoms in female collegiate athletes in Japan. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1303-1314. [PMID: 38598168 DOI: 10.1007/s00484-024-02667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Associations of exertional heat exhaustion (EHE)-related symptoms with lifestyle habits and health factors specific to female athletes, ranked by relative risks from high to low, remain elusive. Addressing this issue would benefit athletes and coaches, ensuring safer practices during summer sports activities. To address this issue, we distributed paper-based questionnaires to seven universities in Japan, and 983 respondents completed our survey. The questionnaires covered various personal characteristics, lifestyle habits, perceived health factors, perceived athletic activity, and EHE-related symptoms. In this retrospective case-control study, we analyzed the relationships of EHE-related symptoms (objective variables) with lifestyle habits, health factors, and athletic activity conditions (explanatory variables) using the partial proportional odds model. The questionnaire responses revealed that perceived dehydration, sickness, loss of appetite, perceived accumulated fatigue, perceived mental stress, lack of ambient wind, and insufficient rest breaks were positively associated with EHE-related symptoms, with relative risks ranging from high to low. Using an air conditioner during sleep and having a sleep duration of ≥ 6 h were associated with a reduced risk of EHE-related symptoms. The study results suggest that female athletes should be allowed to postpone exercise or reduce its intensity and volume based on their perceptions of dehydration, sickness, loss of appetite, accumulated fatigue, and mental stress in summer to prevent heat-related illnesses.
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Affiliation(s)
- Naoyuki Yamashita
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, Japan.
| | - Masashi Kume
- Department of Food and Nutrition, Kyoto Bunkyo Junior College, Uji, Japan
| | - Toshiyuki Satake
- Faculty of Health Science, Kyoto Koka Women's University, Kyoto, Japan
| | - Keiko Inoue
- Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
| | - Tetsuya Yoshida
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, Japan
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Koo CJ, Hintz C, Butler CR. Return to Duty Following Exertional Heat Stroke: A Review. Mil Med 2024; 189:e1312-e1317. [PMID: 37776525 DOI: 10.1093/milmed/usad388] [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: 05/16/2023] [Revised: 07/28/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Exertional heat stroke (EHS), which presents with extreme hyperthermia and alteration to the central nervous system, disproportionately affects the military, where warfighters are expected to perform in all types of environmental conditions. Because of an incomplete understanding of individualized recovery from EHS, there are several shortcomings with the current guidance on return to duty (RTD) following an EHS. The purpose of this manuscript is to provide an updated literature review of best practices for return to duty following EHS to guide decision making regarding EHS and explore areas of future research for medical staff who work with warfighters. MATERIALS AND METHODS A literature review related to EHS in both athlete and military populations, as well as any existing guidelines for RTD, was conducted using PubMed and Covidence. RESULTS Twenty-one articles were identified for this updated review on EHS and RTD, with recommendations focused during and after an EHS event, as well as the role of heat tolerance testing (HTT). CONCLUSIONS EHS has a high morbidity and mortality rate if not treated rapidly. Because the extent of end-organ damage is dependent on the amount of time that the individual is hyperthermic, rapid diagnosis via rectal thermometry, and efficient cooling methods are imperative to the wellbeing of EHS patients. Following EHS, gradual RTD recommendations within the limits of operational demand should be implemented to reduce the risk for a subsequent heat injury event. While many versions of HTT, most notably the Israeli Defense Force (IDF) protocol, have been created to guide RTD recommendations, a universal assessment for heat tolerance has yet to be adopted. As such, medical personnel should apply a multifactorial approach to ensure safe RTD.
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Affiliation(s)
- Caitlyn J Koo
- F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Courtney Hintz
- Special Warfare Training Wing, Special Warfare Human Performance Support Group, JBSA-Lackland, TX 78236, USA
| | - Cody R Butler
- Special Warfare Training Wing, Special Warfare Human Performance Support Group, JBSA-Lackland, TX 78236, USA
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Giersch GEW, Charkoudian N. Regulation of body temperature and blood pressure in women: Mechanisms and implications for heat illness risk. Exp Physiol 2024. [PMID: 38607298 DOI: 10.1113/ep091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
Increasing global temperatures due to ongoing climate change phenomena have resulted in increased risk of exertional heat illness in otherwise healthy, young individuals who work or play in the heat. With increasing participation of women in athletic, military and industrial activities that involve exertion in the heat, there is a growing need to study female physiology in this context. Mechanisms controlling blood pressure and body temperature have substantial overlap in humans, largely due to autonomic mechanisms which contribute to both. Similarly, illnesses that result from excessive heat exposure can often be traced back to imbalances in one or more of these autonomic mechanisms. In recent years, there has been increased recognition of the importance of sex as a biological variable for basic and applied research in these areas. The goal of this paper is to present an update on the integrative physiology and pathophysiology of responses to heat stress in women (thermoregulation and blood pressure regulation). In this context, it is often the case that differences between sexes are presented as 'advantages' and 'disadvantages' of one sex over the other. In our opinion, this is an over-simplification of the physiology which ignores the nuances and complexities of the integrative physiology of responses to heat exposure and exercise, and their relevance for practical outcomes.
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Affiliation(s)
| | - Nisha Charkoudian
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Herring SA, Kibler WB, Putukian M, Blauwet C, Boyajian-O'Neill LA, Boyd J, Franks RR, Indelicato PA, LeClere LE, Logan C, O'Connor FG, Matuszak J, Roberts WO, Sallis RE. Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update). Curr Sports Med Rep 2024; 23:143-158. [PMID: 38578492 DOI: 10.1249/jsr.0000000000001160] [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: 04/06/2024]
Abstract
ABSTRACT Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.
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Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - W Ben Kibler
- Lexington Clinic, Shoulder Center of Kentucky, Lexington, KY
| | | | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA
| | | | - Joel Boyd
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | - R Rob Franks
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Peter A Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Lance E LeClere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Logan
- Sports Medicine, Colorado Sports Medicine & Orthopaedics, Denver, CO
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jason Matuszak
- Department of Family Medicine, School of Medicine, Excelsior Orthopaedics, University at Buffalo, Buffalo, NY
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
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10
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Herring SA, Kibler WB, Putukian M, Blauwet C, Boyajian-O'Neill LA, Boyd J, Franks RR, Indelicato PA, Leclere LE, Logan C, O'Connor FG, Matuszak J, Roberts WO, Sallis R. Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update). Med Sci Sports Exerc 2024; 56:575-589. [PMID: 38485729 DOI: 10.1249/mss.0000000000003325] [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: 03/19/2024]
Abstract
ABSTRACT Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.
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Affiliation(s)
- Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - W Ben Kibler
- Lexington Clinic, Shoulder Center of Kentucky, Lexington, KY
| | | | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA
| | | | - Joel Boyd
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | - R Rob Franks
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Peter A Indelicato
- Department of Orthopedic Surgery and Sports Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Lance E Leclere
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Logan
- Sports Medicine, Colorado Sports Medicine & Orthopaedics, Denver, CO
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jason Matuszak
- Department of Family Medicine, School of Medicine, Excelsior Orthopaedics, University at Buffalo, Buffalo, NY
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
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11
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Hintz CN, Butler CR. Wearable and ingestible technology to evaluate and prevent exertional heat illness: A narrative review. PM R 2024; 16:398-403. [PMID: 38501700 DOI: 10.1002/pmrj.13155] [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: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 03/20/2024]
Abstract
Exertional heat illness remains a constant threat to the athlete, military service member, and laborer. Recent increases in the number and intensity of environmental heat waves places these populations at an ever increasing risk and can be deadly if not recognized and treated rapidly. For this reason, it is extremely important for medical providers to guide athletes, service members, and laborers in the implementation of awareness, education, and measures to reduce or mitigate the risk of exertional heat illness. Within the past 2 decades, a variety of wearable technology options have become commercially available to track an estimation of core temperature, yet questions continue to emerge as to its use, effectiveness, and practicality in athletics, the military, and the workforce. There is a paucity of data on the accuracy of many of these newer devices in the setting of true heat stroke physiology, and it is important to avoid overreliance on new wearable technology. Further research and improvement of this technology are critical to identify accuracy in the diagnosis and prevention of EHI.
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Affiliation(s)
- Courtney N Hintz
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
| | - Cody R Butler
- Special Warfare Human Performance Support Group, USAF, San Antonio, Texas, USA
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12
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Hintz C, Presley DM, Butler CR. Heat stroke burden and validity of wearable-derived core temperature estimation during elite military training. PHYSICIAN SPORTSMED 2024; 52:154-159. [PMID: 36919415 DOI: 10.1080/00913847.2023.2190729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Exertional heat stroke (EHS) remains a significant health concern while training in hot environments, prompting the development of noninvasive wearable technology for monitoring estimated core temperature (ECT). The objective of this study was to review the effectiveness of an ECT device during elite military training by providing a case series of individuals who developed EHS. METHODS This is a retrospective study of EHS cases during high-intensity training while wearing the ECT device, Zephyr BioharnessTM. Data was collected from January 2021 through September 2021 at the Air Force Special Warfare Training pipeline in San Antonio, TX. Rectal temperatures of EHS diagnoses, defined by central nervous system (CNS) dysfunction and rectal temperature approaching or >40°C (104°F), were compared to ECT reading via Zephyr BioharnessTM. Incidence rates and psychometric properties were calculated using R package. RESULTS A total of 47,058 daily peak ECT measurements were collected among 1,364 trainees. A total of 499 trainees flagged as potential EHS by Zephyr BioharnessTM reading >39.7°C (103.5°F). The incidence of confirmed EHS was 0.8/1000 person-months. Of the 10 confirmed EHS cases (9 males, 1 female; age = 23.4 ± 2.7 yrs; BMI = 25 ± 2; body fat = 13 ± 5%), 8 trainees had a peak ECT reading below 39.7°C which resulted in a sensitivity of 20%, specificity of 98.9%, positive likelihood ratio (LR) of 18.93 (95% Confidence Interval [CI] 5.5-65.6), and a negative LR of 0.81 (95% CI 0.6-1.1). CONCLUSION ECT had substantial false positive and negative rates. Further studies are needed to validate this technology in other populations, and the algorithm used in this device needs to be refined to better capture the environmental and physical requirements in the special operations population.
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Affiliation(s)
- Courtney Hintz
- Special Warfare Human Performance Support Group, USAF, Lackland AFB, San Antonio, TX, USA
| | | | - Cody R Butler
- Special Warfare Human Performance Support Group, USAF, Lackland AFB, San Antonio, TX, USA
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Taylor KM, Giersch GEW, Caldwell AR, Epstein Y, Charkoudian N. Relation of body surface area-to-mass ratio to risk of exertional heat stroke in healthy men and women. J Appl Physiol (1985) 2024; 136:549-554. [PMID: 38234291 PMCID: PMC11219003 DOI: 10.1152/japplphysiol.00597.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
Risk of exertional heat stroke (EHS) is an ongoing challenge for United States military personnel, for athletes and for individuals with occupational stressors that involve prolonged activity in hot environments. Higher body mass index (BMI) is significantly associated with increased risk for EHS in activity duty U.S. Soldiers. During exercise, heat is generated primarily by contracting skeletal muscle (and other metabolically active body mass) and dissipated based on body surface area (BSA). Thus, in compensable environments, a higher BSA·mass-1 may be a benefit to heat dissipation and decrease the risk of EHS. The purpose of the present analysis was to test the hypothesis that BSA·mass-1 ratio is an important biophysical characteristic contributing to the risk of EHS. We employed a matched case-control approach, where each individual with a diagnosis of EHS was matched to five controls who were never diagnosed with EHS but were in the same unit and had the same job title. We used a multivariate conditional logistic regression model including variables of BSA·mass-1, sex, age, military rank, and race. BSA·mass-1 significantly predicted EHS risk (P = 0.006), such that people with higher BSA·mass-1 were at lower risk of developing EHS when controlling for other potential factors such as age and race. This relationship persisted after adjustment for other anthropometric measures of body size including weight, BMI, and BSA. These data suggest that biophysical factors play an important role in EHS risk, particularly in a healthy military-aged cohort of men and women.NEW & NOTEWORTHY With the impacts of climate change yielding higher average ambient temperatures over time, the incidence of EHS for individuals participating in outdoor activities may consequently increase. With the larger sample size in this study compared with prior research in this field, we were able to use various methods that had not been applied before. For example, we were able to mutually adjust for different measurements of body size to understand which metric had the highest association with EHS risk. Understanding factors that may be modifiable may be important for developing interventions to counteract the increased risk of EHS associated with climate change.
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Affiliation(s)
- Kathryn M Taylor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Aaron R Caldwell
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Yoram Epstein
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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Lin QW, Zhong LC, He LP, Zeng QB, Zhang W, Song Q, Song JC. A newly proposed heatstroke-induced coagulopathy score in patients with heat illness: A multicenter retrospective study in China. Chin J Traumatol 2024; 27:83-90. [PMID: 37625936 DOI: 10.1016/j.cjtee.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC. METHODS This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0. RESULTS The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (OR = 1.681, 95% CI 1.291 - 2.189, p < 0.001), prothrombin time (OR = 1.427, 95% CI 1.175 - 1.733, p < 0.001) and D-dimer (OR = 1.242, 95% CI 1.049 - 1.471, p = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (r = 0.8848, p < 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (p < 0.05). CONCLUSIONS The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.
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Affiliation(s)
- Qing-Wei Lin
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Lin-Cui Zhong
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Long-Ping He
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Qing-Bo Zeng
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China
| | - Wei Zhang
- Department of Emergency Medicine, The 900th Hospital of Chinese PLA Logistic Support Forces, Fuzhou, 350000, China
| | - Qing Song
- Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, Hainan Province, China
| | - Jing-Chun Song
- Department of Critical Care Medicine, The 908th Hospital of Chinese PLA Logistic Support Forces, Nanchang, 360104, Jiangsu Province, China.
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Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med 2024; 35:112S-127S. [PMID: 38425235 DOI: 10.1177/10806032241227924] [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] [Indexed: 03/02/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
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Affiliation(s)
- Kurt P Eifling
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Flavio G Gaudio
- Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, NY
| | - Charles Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | | | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - August D Martin
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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16
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Obeagu EI, Obeagu GU. Implications of climatic change on sickle cell anemia: A review. Medicine (Baltimore) 2024; 103:e37127. [PMID: 38335412 PMCID: PMC10860944 DOI: 10.1097/md.0000000000037127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin, causing red blood cells to assume a sickle shape, leading to various complications. Climate change has emerged as a significant global challenge, influencing environmental conditions worldwide. This paper explores the implications of climatic variations on the prevalence, management, and outcomes of SCA. Climate change affects weather patterns, leading to altered temperatures, increased frequency of extreme weather events, and variations in humidity levels. These changes can have a profound impact on individuals living with SCA. High temperatures exacerbate the symptoms of SCA, potentially triggering painful vaso-occlusive crises due to dehydration and increased blood viscosity. Conversely, cold temperatures may induce vaso-occlusion by causing blood vessels to constrict. Changes in rainfall patterns might also affect water accessibility, which is crucial for maintaining adequate hydration, particularly in regions prone to droughts. The management of SCA is multifaceted, involving regular medical care, hydration, and avoiding triggers that could precipitate a crisis. Adverse weather events and natural disasters can disrupt healthcare infrastructure and access to essential medications and resources for SCA patients, especially in vulnerable communities. To mitigate the implications of climatic change on SCA, interdisciplinary strategies are essential. These strategies may include enhancing healthcare systems' resilience to climate-related disruptions, implementing adaptive measures to address changing environmental conditions, and promoting public awareness and education on managing SCA amidst climate variability. In conclusion, climatic variations pose significant challenges for individuals with SCA, affecting the prevalence, management, and outcomes of the disease.
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Finch CF, Huang SS, Gamage P. Mitigating the risk of heat-related injury. Inj Prev 2024; 30:1-2. [PMID: 38272702 DOI: 10.1136/ip-2023-045196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Caroline F Finch
- Chancellery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Songshan Sam Huang
- School of Business and Law, Edith Cowan University, Joondalup, Western Australia, Australia
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [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] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Rony MKK, Alamgir HM. High temperatures on mental health: Recognizing the association and the need for proactive strategies-A perspective. Health Sci Rep 2023; 6:e1729. [PMID: 38059052 PMCID: PMC10696165 DOI: 10.1002/hsr2.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background and Aims The influence of temperature on various aspects of daily life is often underestimated, and its effects on mental health are not widely recognized. Understanding and addressing the relationship between temperature and mental well-being is crucial in the context of climate change and rising global temperatures. This perspective aimed to investigate the effects of high temperatures on mental health and identify proactive strategies to mitigate these effects. Methods This perspective adopted a twofold approach, including a comprehensive literature review and socioecological framework. The literature review involved extensive searches across Google Scholar, PubMed, and Scopus to identify relevant, peer-reviewed articles, and reports from diverse disciplines. Results The perspective emphasized the significance of recognizing heat stress and its consequences on mental well-being. Chronic heat stress can lead to increased stress, anxiety, and cognitive impairment. Vulnerable populations include, the very young, older adults, and individuals with pre-existing mental health conditions. Socioeconomic factors can further exacerbate vulnerability, highlighting the need for tailored strategies to manage mental health challenges during high temperatures. Additionally, the article identified and discussed proactive coping strategies to minimize both the psychological and physical impacts of heat stress. Mindfulness, stress management techniques, and therapy are suggested as effective means for individuals to manage psychological distress. Conclusion Implementing preventive measures are essential steps in promoting mental wellness in high temperatures. Proactive strategies by addressing the physiological and psychological effects of heat and considering the specific needs of vulnerable populations can help individuals and communities navigate the challenges posed by rising temperatures and promote resilience and preserve their mental well-being.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Department of Public HealthBangladesh Open UniversityGazipurBangladesh
- Department of Institute of Social Welfare and ResearchUniversity of DhakaDhakaBangladesh
| | - Hasnat M. Alamgir
- Department of Career & Professional Development Services (CPDS)Southeast UniversityDhakaBangladesh
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20
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Deshayes TA, Périard JD. Regular physical activity across the lifespan to build resilience against rising global temperatures. EBioMedicine 2023; 96:104793. [PMID: 37689024 PMCID: PMC10498184 DOI: 10.1016/j.ebiom.2023.104793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023] Open
Abstract
Population aging, high prevalence of non-communicable diseases, physical inactivity, and rising global temperatures are some of the most pressing issues in public health of the current century. Such trends suggest that individuals increasingly less equipped to tolerate heat will be increasingly exposed to it, which from a public health perspective is alarming. Nonetheless, future impacts of extreme heat events will depend not only on the magnitude of climate change, but on our ability to adapt by becoming less sensitive and vulnerable. Although physical activity's role in mitigating climate change has received attention, its potential contribution to climate change adaptation and resilience remains largely unaddressed. Accordingly, in this viewpoint, we discuss how regular physical activity throughout life could have an important contribution to adapting to rising global temperatures, allowing to be better equipped to cope with heat-related health hazards and increasing individual and community resilience. This viewpoint constitutes a call for more research into the contribution that physical activity can have in adapting to rising global temperatures and, more broadly, to climate change.
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Affiliation(s)
- Thomas A Deshayes
- Montreal Heart Institute, Montréal, Canada; School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Canada.
| | - Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
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21
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O'Reilly M, Hu YWE, Gruber J, Jones DM, Daniel A, Marra J, Fraser JJ. Consistency and applicability of return to function guidelines in tactical-athletes with exertional heat illness. A systematic review. PHYSICIAN SPORTSMED 2023; 51:482-491. [PMID: 36239088 DOI: 10.1080/00913847.2022.2135973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. METHODS Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. RESULTS Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. CONCLUSIONS This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI .
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Affiliation(s)
- Matthew O'Reilly
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center San Diego, San Diego, CA, USA
| | - Yao-Wen Eliot Hu
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Jonathan Gruber
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center Camp Lejeune, Jacksonville, NC, USA
| | - Douglas M Jones
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Arthur Daniel
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Janelle Marra
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- 17th Combat Logistics Regiment, 1st Marine Logistics Group, Camp Pendleton, CA, USA
| | - John J Fraser
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
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Gagnon D, Bartlett AA, Deshayes TA, Vanzella LM, Marzolini S, Oh P. Exercise for Cardiac Rehabilitation in a Warming Climate. Can J Cardiol 2023; 39:1268-1271. [PMID: 36806688 DOI: 10.1016/j.cjca.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Daniel Gagnon
- Montréal Heart Institute, Montréal, Québec, Canada; School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Québec, Canada; Department of Pharmacology and Physiology, Université de Montréal, Montréal, Québec, Canada.
| | - Audrey-Ann Bartlett
- Montréal Heart Institute, Montréal, Québec, Canada; School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Québec, Canada
| | - Thomas A Deshayes
- Montréal Heart Institute, Montréal, Québec, Canada; School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Québec, Canada
| | - Laís Manata Vanzella
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
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Maher JD, Weiss L. Development and Implementation of an Emergency Action Plan in Football. HSS J 2023; 19:358-364. [PMID: 37435130 PMCID: PMC10331272 DOI: 10.1177/15563316231165498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 07/13/2023]
Abstract
Although uncommon, life-threatening injuries and illnesses do occur in American football, and the emergency response team must be ready to act when an emergency arises during training, practice, or competition. An emergency action plan (EAP) is central to the care of an athlete with a suspected life-threatening injury or illness. This set of step-by-step instructions on how the emergency response team will act during an emergency details the members of the team and their roles, plus information on emergency equipment, procedures at each venue, and the transportation of a player to the hospital. The emergency response team should keep the EAP up-to-date and rehearse annually.
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Affiliation(s)
| | - Leigh Weiss
- New York Football Giants, East Rutherford, NJ, USA
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Gaskell SK, Henningsen K, Young P, Gill P, Muir J, Henry R, Costa RJS. The Impact of a 24-h Low and High Fermentable Oligo- Di- Mono-Saccharides and Polyol (FODMAP) Diet on Plasma Bacterial Profile in Response to Exertional-Heat Stress. Nutrients 2023; 15:3376. [PMID: 37571312 PMCID: PMC10420669 DOI: 10.3390/nu15153376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Exertional-heat stress (EHS) compromises intestinal epithelial integrity, potentially leading to the translocation of pathogenic agents into circulation. This study aimed to explore the impact of EHS on the systemic circulatory bacterial profile and to determine the impact of a short-term low (LFOD) and high (HFOD) fermentable oligo- di- mono-saccharide and polyol dietary intervention before EHS on this profile. Using a double-blind randomized cross-over design, thirteen endurance runners (n = 8 males, n = 5 females), with a history of exercise-associated gastrointestinal symptoms (Ex-GIS), consumed a 24 h LFOD and HFOD before 2 h running at 60% V.O2max in 35.6 °C. Blood and fecal samples were collected pre-EHS to determine plasma microbial DNA concentration, and sample bacteria and short chain fatty acid (SCFA) profiles by fluorometer quantification, 16S rRNA amplicon gene sequencing, and gas chromatography, respectively. Blood samples were also collected post-EHS to determine changes in plasma bacteria. EHS increased plasma microbial DNA similarly in both FODMAP trials (0.019 ng·μL-1 to 0.082 ng·μL-1) (p < 0.01). Similar pre- to post-EHS increases in plasma Proteobacteria (+1.6%) and Firmicutes (+0.6%) phyla relative abundance were observed in both FODMAP trials. This included increases in several Proteobacteria genus (Delftia and Serratia) groups. LFOD presented higher fecal Firmicutes (74%) and lower Bacteroidota (10%) relative abundance pre-EHS, as a result of an increase in Ruminococcaceae and Lachnospiraceae family and respective genus groups, compared with HFOD (64% and 25%, respectively). Pre-EHS plasma total SCFA (p = 0.040) and acetate (p = 0.036) concentrations were higher for HFOD (188 and 178 μmol·L-1, respectively) vs. LFOD (163 and 153 μmol·L-1, respectively). Pre-EHS total fecal SCFA concentration (119 and 74 μmol·g-1; p < 0.001), including acetate (74 and 45 μmol·g-1; p = 0.001), butyrate (22 and 13 μmol·g-1; p = 0.002), and propionate (20 and 13 μmol·g-1; p = 0.011), were higher on HFOD vs LFOD, respectively. EHS causes the translocation of whole bacteria into systemic circulation and alterations to the plasma bacterial profile, but the FODMAP content of a 24 h diet beforehand does not alter this outcome.
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Affiliation(s)
- Stephanie K. Gaskell
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Kayla Henningsen
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Pascale Young
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
| | - Paul Gill
- Department of Gastroenterology, Monash University, Melbourne, VIC 3004, Australia; (P.G.); (J.M.)
| | - Jane Muir
- Department of Gastroenterology, Monash University, Melbourne, VIC 3004, Australia; (P.G.); (J.M.)
| | - Rebekah Henry
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia;
- Department of Civil Engineering, Monash University, Clayton, VIC 3168, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition Dietetics & Food, Monash University, Notting Hill, VIC 3168, Australia; (S.K.G.); (K.H.); (P.Y.)
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Gouttebarge V, Duffield R, den Hollander S, Maughan R. Protective guidelines and mitigation strategies for hot conditions in professional football: starting 11 Hot Tips for consideration. BMJ Open Sport Exerc Med 2023; 9:e001608. [PMID: 37492782 PMCID: PMC10364156 DOI: 10.1136/bmjsem-2023-001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Elevated heat, humidity and solar load combined with low air movement independently and additively impair performance, increase the perception of effort and the risk of heat-related illnesses. For the specific context of professional football, the Fédération Internationale de Football Association (FIFA) heat guidelines are often used as the default policy. Still, these seem less protective than guidelines in other sports or from countries traditionally exposed to extreme hot conditions. Following several high-profile international and continental competitions played in hot conditions (eg, 2014 FIFA World Cup Brazil), a series of cross-sectional studies showed that national team players and their managers unanimously mentioned that the hot and humid conditions during these matches made it difficult as a team to perform. Such a concern is likely to be relevant for the upcoming 2026 FIFA World Cup that will be held in the traditional June-July window across 16 host cities in Canada, Mexico and USA. Therefore, to better protect players' health and performance during training and match play in hot conditions, we present our starting 11 Hot Tips that should be considered and facilitated by governing bodies, competition organisers, clubs, staff members and players.
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Affiliation(s)
- Vincent Gouttebarge
- Football Players Worldwide (FIFPRO), Hoofddorp, Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, Netherlands
- Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Rob Duffield
- School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ron Maughan
- School of Medicine, St Andrews University, St Andrews, UK
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Caraway JJ, Shepard J, Hintz C, Butler CR. Management of a Special Warfare Trainee With Repeat Exertional Heat Stroke: A Case Study. J Sport Rehabil 2023:1-6. [PMID: 37290772 DOI: 10.1123/jsr.2022-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear. CASE PRESENTATION This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4 weeks of a stepwise recovery after an initial EHS. MANAGEMENT AND OUTCOMES After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines. CONCLUSIONS In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS.
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Affiliation(s)
- J Joseph Caraway
- School of Medicine, Uniformed Services University, Bethesda, MD,USA
| | - Julius Shepard
- School of Medicine, Uniformed Services University, Bethesda, MD,USA
| | - Courtney Hintz
- Special Warfare Human Performance Support Group, Lackland, TX,USA
| | - Cody R Butler
- Special Warfare Human Performance Support Group, Lackland, TX,USA
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Henningsen K, Mika A, Alcock R, Gaskell SK, Parr A, Rauch C, Russo I, Snipe RMJ, Costa RJS. The increase in core body temperature in response to exertional-heat stress can predict exercise-induced gastrointestinal syndrome. Temperature (Austin) 2023; 11:72-91. [PMID: 38577295 PMCID: PMC10989703 DOI: 10.1080/23328940.2023.2213625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 04/06/2024] Open
Abstract
Utilizing metadata from existing exertional and exertional-heat stress studies, the study aimed to determine if the exercise-associated increase in core body temperature can predict the change in exercise-induced gastrointestinal syndrome (EIGS) biomarkers and exercise-associated gastrointestinal symptoms (Ex-GIS). Endurance-trained individuals completed 2 h of running exercise in temperate (21.2-30.0°C) to hot (35.0-37.2°C) ambient conditions (n = 132 trials). Blood samples were collected pre- and post-exercise to determine the change in gastrointestinal integrity biomarkers and systemic inflammatory cytokines. Physiological and thermoregulatory strain variables were assessed every 10-15 min during exercise. The strength of the linear relationship between maximal (M-Tre) and change (Δ Tre) in rectal temperature and EIGS variables was determined via Spearman's rank correlation coefficients. While the strength of prediction was determined via simple and multiple linear regression analyses dependent on screened EIGS and Ex-GIS confounding factors. Significant positive correlations between Tre maximum (M-Tre) and change (Δ Tre) with I-FABP (rs = 0.434, p < 0.001; and rs = 0.305, p < 0.001; respectively), sCD14 (rs = 0.358, p < 0.001; and rs = 0.362, p < 0.001), systemic inflammatory response profile (SIR-Profile) (p < 0.001), and total Ex-GIS (p < 0.05) were observed. M-Tre and Δ Tre significantly predicted (adjusted R2) magnitude of change in I-FABP (R2(2,123)=0.164, p < 0.001; and R2(2,119)=0.058, p = 0.011; respectively), sCD14 (R2(2,81)=0.249, p < 0.001; and R2(2,77)=0.214, p < 0.001), SIR-Profile (p < 0.001), and total Ex-GIS (p < 0.05). Strong to weak correlations were observed between M-Tre and Δ Tre with plasma concentrations of I-FABP, sCD14, SIR-Profile, and Ex-GIS in response to exercise. M-Tre and Δ Tre can predict the magnitude of these EIGS variables and Ex-GIS in response to exercise.
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Affiliation(s)
- Kayla Henningsen
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alice Mika
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rebekah Alcock
- Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria, Australia
| | - Stephanie K. Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alexandra Parr
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Christopher Rauch
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Isabela Russo
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rhiannon M. J. Snipe
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
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Kruijt N, van den Bersselaar LR, Hopman MTE, Snoeck MMJ, van Rijswick M, Wiggers TGH, Jungbluth H, Bongers CCWG, Voermans NC. Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms. SPORTS MEDICINE - OPEN 2023; 9:33. [PMID: 37204519 DOI: 10.1186/s40798-023-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. METHODS We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients' perspective on these outcomes. RESULTS Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. CONCLUSION Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - L R van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M van Rijswick
- Department of Exercise Medicine and Exercise Physiology, Royal Dutch Army, Utrecht, The Netherlands
| | - T G H Wiggers
- Department of Sports Medicine, Anna Hospital, Geldrop, The Netherlands
| | - H Jungbluth
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - C C W G Bongers
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
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Patel J, Boyer N, Mensah K, Haider S, Gibson O, Martin D, Walter E. Critical illness aspects of heatstroke: A hot topic. J Intensive Care Soc 2023; 24:206-214. [PMID: 37260431 PMCID: PMC10227888 DOI: 10.1177/17511437221148922] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Heatstroke represents the most severe end of the heat illness spectrum, and is increasingly seen in those undergoing exercise or exertion ('exertional heatstroke') and those exposed to high ambient temperatures, for example in heatwaves ('classical heatstroke'). Both forms may be associated with significant thermal injury, leading to organ dysfunction and the need for admission to an intensive care unit. The process may be exacerbated by translocation of bacteria or endotoxin through an intestinal wall rendered more permeable by the hyperthermia. This narrative review highlights the importance of early diagnosis, rapid cooling and effective management of complications. It discusses the incidence, clinical features and treatment of heatstroke, and discusses the possible role of intestinal permeability and advances in follow-up and recovery of this condition. Optimum treatment involves an integrated input from prehospital, emergency department and critical care teams, along with follow-up by rehabilitation teams and, if appropriate, sports or clinical physiologists.
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Affiliation(s)
- Jesal Patel
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Naomi Boyer
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Kwabena Mensah
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Syeda Haider
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
| | - Oliver Gibson
- Division of Sport, Health and Exercise
Sciences, Brunel University, London, UK
| | - Daniel Martin
- Department of Intensive Care, Derriford
Hospital, Plymouth, UK
- Peninsula Medical School, University of
Plymouth, UK
| | - Edward Walter
- Department of Intensive Care, Royal
Surrey County Hospital, Guildford, UK
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Yeargin S, Hirschhorn R, Grundstein A, Arango D, Graham A, Krebs A, Turner S. Variations of wet-bulb globe temperature across high school athletics in South Carolina. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:735-744. [PMID: 37002402 DOI: 10.1007/s00484-023-02449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 05/09/2023]
Abstract
The purpose was to describe wet bulb globe temperature (WBGT) throughout a high school fall athletic season (August to November) after a state-wide mandate requiring schools to use a WBGT-guided activity modification table with categories (AMTC). A cross-sectional research design utilized 30 South Carolina high schools. The independent variables were region (upstate, midlands, and coastal), sport (football, tennis, cross-country), month, start times (7-10 am, 10 am-3 pm, 3-6 pm, and 6-9 pm), and event type (practice, competition). Dependent variables were event frequency, average WBGT, and AMTC. Practice WBGT was 78.7 ± 8.2 °F (range: 34.7 to 99.0 °F). A significant difference for WBGT across month (F6, 904.7 = 385.07, P < 0.001) existed, with early September hotter than all other months (84.8 °F ± 3.8, P < 0.001). Every month had practices in each AMTC, until early November. Most events (64.6%, n = 1986) did not change AMTC; however, 9.1% (n = 281) changed to a hotter category. The 10 am-3 pm start time was significantly hotter than all other time frames (83.0 °F ± 7.2, P < 0.05). Tennis experienced hotter practices (79.9 °F ± 6.9) than football (78.4 °F ± 8.5; P < 0.001) and cross country (78.2 °F ± 8.8, P < 0.001). Schools in the Midlands experienced hotter practices (80.1 °F ± 7.8) than upstate (P < 0.001) and coastal schools (P = 0.005). Competition WBGT was significantly cooler than practices (72.3 ± 10.5 °F, t = 12.04, P < 0.001) and differed across sports (F2, 20.78 = 18.39, P < .001). Both cross-country (P = 0.003) and tennis (P < 0.001) were hotter than football. Schools should continuously monitor WBGT throughout practices and until November to optimize AMTC use. Risk mitigation strategies are needed for sports other than football to decrease the risk of exertional heat illnesses.
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Affiliation(s)
- Susan Yeargin
- Exercise Science Department, University of South Carolina, Columbia, SC, USA.
| | - Rebecca Hirschhorn
- School of Kinesiology, Louisana State University, Baton Rouge, Louisana, USA
| | | | - Dylan Arango
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Adam Graham
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Amy Krebs
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Sydney Turner
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
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31
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Hornsby H. Black Flag Collapse. Curr Sports Med Rep 2023; 22:111-112. [PMID: 37036456 DOI: 10.1249/jsr.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Hannah Hornsby
- National Capital Consortium Sports Medicine Fellowship, Fort Belvoir, Virginia
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32
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Roberts WO, O'Connor FG. Exertional Heat Illness Consensus Response. Curr Sports Med Rep 2023; 22:150. [PMID: 37036464 DOI: 10.1249/jsr.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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DeHan PJ, Warren KC, Buchanan BK, DeGroot DW. Gastrointestinal Associated Exertional Heat Stroke. Curr Sports Med Rep 2023; 22:117-119. [PMID: 37036459 DOI: 10.1249/jsr.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Preston J DeHan
- Martin Army Community Hospital Family Medicine Residency Program; Fort Benning, GA
| | - Kyle C Warren
- Martin Army Community Hospital Family Medicine Residency Program; Fort Benning, GA
| | - Benjamin K Buchanan
- Department of Family Medicine Uniformed Services University of the Health Sciences; Core Faculty, Martin Army Community Hospital Family Medicine Residency Program; Deputy Director, The Army Heat Center, Fort Benning, GA
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Miller KC, Launstein ED, Glovatsky RM. Rectal Temperature Cooling Using 2 Cold-Water Immersion Preparation Strategies. J Athl Train 2023; 58:355-360. [PMID: 36094578 PMCID: PMC11215638 DOI: 10.4085/1062-6050-0248.22] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Cold-water immersion (CWI) is essential to treat patients with exertional heatstroke (EHS). Experts recommend that patients with EHS be immersed in water between 1.7°C and 15°C within 30 minutes of collapse. Some clinicians fill cooling tubs several hours before exercise, keep the tub in hot conditions, and then add ice in the event of an EHS emergency. No data exist on whether adding ice to water at the time of treatment is as effective as keeping water in the recommended range. OBJECTIVES To (1) compare the cooling rates of individuals immersed in a water bath kept at 10°C (CON) or 17°C water with 75.7 L (20 gal) of ice added to it immediately upon immersion (ICE) and (2) examine perceptual responses before, during, and after cooling. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve individuals (7 men, 5 women; age = 22 ± 2 years, height = 176.0 ± 12.8 cm, mass = 74.5 ± 10.6 kg). INTERVENTIONS Participants exercised in the heat until rectal temperature was 39.5°C. They then immersed themselves in CON (initial water volume = 681 ± 7.6 L, 10.0°C ± 0.03°C) or ICE (initial water volume = 605.7 ± 7.6 L water at 17.0°C ± 0.03°C with 75.7 L ice) until rectal temperature was 38°C. Thermal sensation and environmental symptoms questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. MAIN OUTCOME MEASURE(S) Rectal temperature cooling rates, thermal sensation, ESQ responses. RESULTS Participants exercised for similar durations (CON = 39.6 ± 18.2 minutes, ICE = 38.8 ± 14.3 minutes, Z11 = 0.94, P = .38) and had similar thermal sensation and ESQ scores immediately postexercise each day (P values > .05). They cooled quickly and at similar rates in both conditions (CON = 0.20°C ± 0.06°C/min, ICE = 0.21°C ± 0.12°C/min, t12 = 0.72, P = .49). Perception data were similar between conditions during and after cooling (P < .05). CONCLUSIONS Clinicians can cool patients with EHS quickly by adding ice to water that has warmed to above expert recommendations. Adding ice to a water bath at the time of EHS emergencies could save time, energy, and resources instead of always maintaining water bath temperatures within expert-recommended ranges.
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Affiliation(s)
- Kevin C. Miller
- Department of Health and Human Performance, Texas State University, San Marcos
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Rivera-Brown AM, Correa JJ, Micheo WF. Return-to-Competition Progression After Exertional Heat Stroke in an Adolescent Runner: A Case Report. J Athl Train 2023; 58:349-354. [PMID: 35622950 PMCID: PMC11215635 DOI: 10.4085/1062-6050-0583.21] [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] [Indexed: 11/09/2022]
Abstract
A 14-year-old runner indigenous to the tropics collapsed during his first 10-km race in a hot and humid climate. Dizziness, stumbling, and loss of consciousness were symptoms of exertional heat stroke. Two days postcollapse, blood tests revealed elevated hepatic transaminases consistent with hepatic injury. We discuss the return-to-competition progression, which included a gradual increase in exercise duration, initially in a cool and then in a tropical climate, and 2 field-based (wet-bulb globe temperature > 29.0°C) running evaluations that simulated the environmental conditions and training intensity the athlete would encounter in his sport. The thermoregulatory results guided the training progression, his tolerance to running in the heat improved, blood values normalized, and he was cleared to compete in a tropical climate. This exploration case report presents a novel field-based protocol that replicates the physiological demands of training in the tropics to evaluate thermoregulatory responses during exercise-heat stress in young runners after exertional heat stroke to facilitate a safe return to competition.
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Affiliation(s)
- Anita M. Rivera-Brown
- Department of Physical Medicine, Rehabilitation and Sports Medicine, Center for Sports Health and Exercise Sciences, San Juan
- Department of Physiology, University of Puerto Rico, School of Medicine, San Juan
| | - José J. Correa
- Department of Physical Medicine, Rehabilitation and Sports Medicine, Center for Sports Health and Exercise Sciences, San Juan
| | - William F. Micheo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, Center for Sports Health and Exercise Sciences, San Juan
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Nye NS, Grubic T, Kim M, O'Connor F, Deuster PA. Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes. J Athl Train 2023; 58:232-243. [PMID: 35724358 PMCID: PMC10176841 DOI: 10.4085/1062-6050-0400.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Facing pressure to train for victory, warfighters and athletes encounter numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTPs) signifies universal processes designed to prevent unnecessary bodily harm, including injury, illness, and death, during physical training programs. Although no formal guidelines exist for collectively implementing a defined set of UTPs to address a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to preventing sudden death during high school sports and collegiate conditioning sessions. A long list of critical topics must be considered as UTPs, including physical fitness factors, transition-period accommodation, hydration, environmental factors and acclimatization, appropriate recovery, use of medications and dietary supplements, and importantly, leadership. In this article, we outline in detail, with corresponding Strength of Recommendation Taxonomy ratings, what should be considered universal recommendations to minimize the risk of warfighters and athletes coming to harm when participating in group physical activities.
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Affiliation(s)
| | - Tyler Grubic
- Aviation Survival Training Center, NAS Patuxent River, MD
| | - Michael Kim
- Sports Medicine Clinic, Fort Belvoir Community Hospital, VA
| | | | - Patricia A. Deuster
- USU/MEM Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Silver Spring, MD
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Li F, Deng J, He Q, Zhong Y. ZBP1 and heatstroke. Front Immunol 2023; 14:1091766. [PMID: 36845119 PMCID: PMC9950778 DOI: 10.3389/fimmu.2023.1091766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Heatstroke, which is associated with circulatory failure and multiple organ dysfunction, is a heat stress-induced life-threatening condition characterized by a raised core body temperature and central nervous system dysfunction. As global warming continues to worsen, heatstroke is expected to become the leading cause of death globally. Despite the severity of this condition, the detailed mechanisms that underlie the pathogenesis of heatstroke still remain largely unknown. Z-DNA-binding protein 1 (ZBP1), also referred to as DNA-dependent activator of IFN-regulatory factors (DAI) and DLM-1, was initially identified as a tumor-associated and interferon (IFN)-inducible protein, but has recently been reported to be a Z-nucleic acid sensor that regulates cell death and inflammation; however, its biological function is not yet fully understood. In the present study, a brief review of the main regulators is presented, in which the Z-nucleic acid sensor ZBP1 was identified to be a significant factor in regulating the pathological characteristics of heatstroke through ZBP1-dependent signaling. Thus, the lethal mechanism of heatstroke is revealed, in addition to a second function of ZBP1 other than as a nucleic acid sensor.
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Affiliation(s)
- Fanglin Li
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Jiayi Deng
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiuli He
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China,*Correspondence: Qiuli He, ; Yanjun Zhong,
| | - Yanjun Zhong
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Qiuli He, ; Yanjun Zhong,
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An Overview of Exertional Heat Illness in Thoroughbred Racehorses: Pathophysiology, Diagnosis, and Treatment Rationale. Animals (Basel) 2023; 13:ani13040610. [PMID: 36830397 PMCID: PMC9951674 DOI: 10.3390/ani13040610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Exertional heat illness (EHI) is a complex medical disease. The thoroughbred (TB) racehorse is at considerable risk because of the intensity of its exercise activity and its high rate of metabolic heat production. The pathophysiology of EHI can combine aspects of both the heat toxicity pathway and the heat sepsis or endotoxemic pathway. Treatment regimes depend upon the detection of earliest clinical signs, rapid assessment, aggressive cooling and judicious use of ancillary medications. Ice-cold water provides the most rapid cooling, consistent with the need to lower core body temperature before tissue damage occurs. Research into EHI/HS by inducing the condition experimentally is ethically unjustifiable. Consequently, leading researchers in the human field have conceded that "most of our knowledge has been gained from anecdotal incidents, gathered from military personnel and athletes who have collapsed during or following physical activity, and that retrospective and case studies have provided important evidence regarding recognition and treatment of EHI". The authors' review into EHI shares that perspective, and the recommendations made herein are based on observations of heat-affected racehorses at the racetrack and their response, or lack of response, to treatment. From 2014 to 2018, 73 race meetings were attended, and of the 4809 individual starters, signs of EHI were recorded in 457. That observational study formed the basis for a series of articles which have been published under the title, 'EHI in Thoroughbred racehorses in eastern Australia', and forms the background for this review.
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DeGroot DW, Henderson KN, O'Connor FG. Cooling Modality Effectiveness and Mortality Associate With Prehospital Care of Exertional Heat Stroke Casualities. J Emerg Med 2023; 64:175-180. [PMID: 36806435 DOI: 10.1016/j.jemermed.2022.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Cold-water immersion is the gold standard for field treatment of an exertional heat stroke (EHS) casualty. Practical limitations may preclude this method and ice sheets (bed linens soaked in ice water) have emerged as a viable alternative. Laboratory studies suggest that this is an inferior method; however, the magnitude of hyperthermia is limited and may underestimate the cooling rate in EHS casualties. OBJECTIVE Our aim was to determine the prehospital core cooling rate, need for continued cooling on arrival to the emergency department, and mortality rate associated with ice sheet use. METHODS De-identified retrospective data were obtained from emergency medical services (EMS) and included presence or absence of altered mental status, cooling measures applied prior to EMS arrival, and time and core temperature (Tc; rectal) on-scene and on hospital arrival. Cooling rate was calculated from time and temperature data. Mortality data were obtained from the U.S. Army Combat Readiness Center. RESULTS There were 462 casualties that met inclusion criteria. The cooling rate for the entire sample was 0.07°C ± 0.08°C · min-1. EHS casualties with an observed initial Tc < 39°C had an en route cooling rate of 0.03°C ± 0.04°C · min-1 vs. initial Tc ≥ 39°C cooling rate of 0.16°C ± 0.08°C · min-1. There was one fatality due to EHS, for a mortality rate of 0.20% (95% CI 0.01-1.20%). CONCLUSIONS The cooling rate in EHS casualties with initial Tc ≥ 39°C was approximately double that reported in laboratory studies. The observed mortality rate was comparable with casualties treated with cold-water immersion. Our data suggest that ice sheets provide a viable alternative when practical constraints preclude cold-water immersion.
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Affiliation(s)
- David W DeGroot
- The Army Heat Center, Martin Army Community Hospital, Fort Benning, Georgia
| | - Kaemmer N Henderson
- Oak Ridge Institute for Science and Engineering (in support of The Army Heat Center), Martin Army Community Hospital, Fort Benning, Georgia
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
Heat tolerance testing (HTT) has been developed to assess readiness for work or exercise in the heat based on thermoregulation during exertion. Although the Israeli Defense Forces protocol has been the most widely used and referenced, other protocols and variables considered in the interpretation of the testing are emerging. Our purpose was to summarize the role of HTT after exertional heat stroke; assess the validity of HTT; and provide a review of best-practice recommendations to guide clinicians, coaches, and researchers in the performance, interpretation, and future direction of HTT. We also offer the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.
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Affiliation(s)
- Cody Butler
- Special Warfare Human Performance Squadron, Lackland Air Force Base, Texas
| | | | - Michelle Bruneau
- Sports Optimization and Rehabilitation Laboratory, Department of Kinesiology, University of Connecticut, Storrs
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Giersch GEW, Taylor KM, Caldwell AR, Charkoudian N. Body mass index, but not sex, influences exertional heat stroke risk in young healthy men and women. Am J Physiol Regul Integr Comp Physiol 2023; 324:R15-R19. [PMID: 36342147 DOI: 10.1152/ajpregu.00168.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Exertional heat stroke (EHS) remains a persistent threat for individuals working or playing in the heat, including athletes and military and emergency service personnel. However, influence of biological sex and/or body mass index (BMI) on the risk of EHS remain poorly understood. The purpose of this study was to retrospectively assess the influence of sex and BMI on risk of EHS in the active-duty US Army. We analyzed data from 2016 to 2021, using a matched case-control approach, where each individual with a diagnosis of EHS was matched to five controls based on calendar time, unit ID, and job category, to capture control individuals who were matched to EHS events by location, time, and activity. We used a multivariate logistic regression model mutually adjusted for sex, BMI, and age to compare 745 (n = 61 F) individuals (26 ± 7 yr) with a diagnosed EHS to 4,290 (n = 384 F) case controls (25 ± 5 yr). Group average BMI were similar: 26.6 ± 3.1 (EHS) and 26.5 ± 3.6 kg/m2 (CON). BMI was significantly (P < 0.0001) associated with higher risk of EHS with a 3% increase in risk of EHS for every unit increase in BMI. Notably, sex was not associated with any difference in risk for EHS (P = 0.54). These data suggest that young healthy people with higher BMI have significantly higher risk of EHS, but, contrary to what some have proposed, this risk was not higher in young women.
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Affiliation(s)
- Gabrielle E W Giersch
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Kathryn M Taylor
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Aaron R Caldwell
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Biomarkers for warfighter safety and performance in hot and cold environments. J Sci Med Sport 2022:S1440-2440(22)00503-5. [PMID: 36623995 DOI: 10.1016/j.jsams.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (Tc) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction - the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and Tc. Non-invasive methods for real-time estimation of Tc have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.
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Brownlow MA, Mizzi JX. Pathophysiology of exertional heat illness in the Thoroughbred racehorse: Broadening perspective to include an exercise‐induced gastrointestinal syndrome in which endotoxaemia and systemic inflammation may contribute to the condition. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - James Xavier Mizzi
- Department of Regulation, Welfare and Biosecurity Policy The Hong Kong Jockey Club, Sha Tin Racecourse Sha Tin Hong Kong
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Alzahrani JM, Murray KO, Gambino BJ, Garcia CK, Sheikh LH, Cusack KJ, Laitano O, Clanton TL. Neuromotor deficits and altered physiological responses to repeated exertional heat stroke exposures in mice. Am J Physiol Regul Integr Comp Physiol 2022; 323:R951-R961. [PMID: 36279505 PMCID: PMC9722251 DOI: 10.1152/ajpregu.00152.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022]
Abstract
Exertional heat stroke (EHS) is a life-threatening illness that can lead to negative health outcomes. Using a "severe" preclinical mouse model of EHS, we tested the hypotheses that one EHS exposure results in altered susceptibility to a subsequent EHS and reduced neuromotor performance. Female C57BL/6 mice underwent two protocols, 2 wk apart, either an EHS trial (EHS) or a sham exercise control trial (EXC). For EHS, mice ran in a forced running wheel at 37.5°C/40% relative humidity until loss of consciousness, followed by a slow cooling protocol (2 h recovery at 37.5°C). EXC mice exercised equally but in ∼22°C. Mice were randomized into three groups: 1) EXC-EXC (two consecutive EXC, n = 6, 2) EHS-EXC (EHS followed by EXC, n = 5), and 3) EHS-EHS (repeated EHS, n = 9). Mice underwent noninvasive neuromotor and behavioral tests during recovery and isolated soleus force measurements at the end of recovery. At the first EHS, mice reached average peak core temperatures (Tc,max) of 42.4°C, (46% mortality). On the second EHS, average Tc,max was reduced by ∼0.7°C (P < 0.05; mortality 18%). After the first EHS, both EHS-EX and EHS-EHS showed significant reductions in maximum strength (24 h and 1 wk post). After the second EHS, strength, horizontal rotation, hindlimb tone, suspended hindlimb splay, trunk curl, and provoked biting continued to decline in the EHS-EHS group. In conclusion, exposure to a second EHS after 2 wk leads to increased exercise times in the heat, symptom limitation at a lower Tc,max, and greater deficits in neuromotor and behavioral function during recovery.
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Affiliation(s)
- Jamal M Alzahrani
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Kevin O Murray
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Bryce J Gambino
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Christian K Garcia
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Laila H Sheikh
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Kevin J Cusack
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
| | - Thomas L Clanton
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, Florida
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Hutchins KP, Minett GM, Stewart IB. Treating exertional heat stroke: Limited understanding of the female response to cold water immersion. Front Physiol 2022; 13:1055810. [PMID: 36505067 PMCID: PMC9732943 DOI: 10.3389/fphys.2022.1055810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
According to an expansive body of research and best practice statements, whole-body cold water immersion is the gold standard treatment for exertional heat stroke. However, as this founding evidence was predominantly drawn from males, the current guidelines for treatment are being applied to women without validation. Given the recognised differences in thermal responses experienced by men and women, all-encompassing exertional heat stroke treatment advice may not effectively protect both sexes. In fact, recent evidence suggests that hyperthermic women cool faster than hyperthermic men during cold water immersion. This raises the question of whether overcooling is risked if the present guidelines are followed. The current mini-review examined the literature on women's response to cold water immersion as a treatment for exertional heat stroke and aimed to clarify whether the current guidelines have appropriately considered research investigating women. The potential implications of applying these guidelines to women were also discussed.
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Affiliation(s)
- Cecilia Sorensen
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
| | - Jeremy Hess
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
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Périard JD, DeGroot D, Jay O. Exertional heat stroke in sport and the military: epidemiology and mitigation. Exp Physiol 2022; 107:1111-1121. [PMID: 36039024 PMCID: PMC9826288 DOI: 10.1113/ep090686] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
NEW FINDINGS What is the topic of this review? Exertional heat stroke epidemiology in sport and military settings, along with common risk factors and strategies and policies designed to mitigate its occurrence. What advances does it highlight? Individual susceptibility to exertional heat stroke risk is dependent on the interaction of intrinsic and extrinsic factors. Heat policies in sport should assess environmental conditions, as well as the characteristics of the athlete, clothing/equipment worn and activity level of the sport. Exertional heat stroke risk reduction in the military should account for factors specific to training and personnel. ABSTRACT Exertional heat illness occurs along a continuum, developing from the relatively mild condition of muscle cramps, to heat exhaustion, and in some cases to the life-threatening condition of heat stroke. The development of exertional heat stroke (EHS) is associated with an increase in core temperature stemming from inadequate heat dissipation to offset the rate of metabolically generated heat. Susceptibility to EHS is linked to the interaction of several factors including environmental conditions, individual characteristics, health conditions, medication and drug use, behavioural responses, and sport/organisational requirements. Two settings in which EHS is commonly observed are competitive sport and the military. In sport, the exact prevalence of EHS is unclear due to inconsistent exertional heat illness terminology, diagnostic criteria and data reporting. In contrast, exertional heat illness surveillance in the military is facilitated by standardised case definitions, a requirement to report all heat illness cases and a centralised medical record repository. To mitigate EHS risk, several strategies can be implemented by athletes and military personnel, including heat acclimation, ensuring adequate hydration, cold-water immersion and mandated work-to-rest ratios. Organisations may also consider developing sport or military task-specific heat stress policies that account for the evaporative heat loss requirement of participants, relative to the evaporative capacity of the environment. This review examines the epidemiology of EHS along with the strategies and policies designed to reduce its occurrence in sport and military settings. We highlight the nuances of identifying individuals at risk of EHS and summarise the benefits and shortcomings of various mitigation strategies.
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Affiliation(s)
- Julien D. Périard
- Research Institute for Sport and ExerciseUniversity of CanberraCanberraAustralia
| | - David DeGroot
- Army Heat CenterMartin Army Community HospitalFort BenningGAUSA
| | - Ollie Jay
- Thermal Ergonomics LaboratoryHeat and Health Research IncubatorFaculty of Medicine and HealthUniversity of SydneyCamperdownAustralia
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Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev 2022; 102:1907-1989. [PMID: 35679471 PMCID: PMC9394784 DOI: 10.1152/physrev.00047.2021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Matthew N Cramer
- Defence Research and Development Canada-Toronto Research Centre, Toronto, Ontario, Canada
| | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Quebec, Canada
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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Lee JKW, Tan B, Ogden HB, Chapman S, Sawka MN. Exertional heat stroke: nutritional considerations. Exp Physiol 2022; 107:1122-1135. [PMID: 35521757 PMCID: PMC9790308 DOI: 10.1113/ep090149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the topic of this review? The potential role of nutrition in exertional heat stroke. What advances does it highlight? Certain nutritional and dietary strategies used by athletes and workers may exert a protective effect the pathophysiological processes of exertional heat stroke, whereas others may be detrimental. While current evidence suggests that some of these practices may be leveraged as a potential countermeasure to exertional heat stroke, further research on injury-related outcomes in humans is required. ABSTRACT Exertional heat stroke (EHS) is a life-threatening illness and an enduring problem among athletes, military servicemen and -women, and occupational labourers who regularly perform strenuous activity, often under hot and humid conditions or when wearing personal protective equipment. Risk factors for EHS and mitigation strategies have generally focused on the environment, health status, clothing, heat acclimatization and aerobic conditioning, but the potential role of nutrition is largely underexplored. Various nutritional and dietary strategies have shown beneficial effects on exercise performance and health and are widely used by athletes and other physically active populations. There is also evidence that some of these practices may dampen the pathophysiological features of EHS, suggesting possible protection or abatement of injury severity. Promising candidates include carbohydrate ingestion, appropriate fluid intake and glutamine supplementation. Conversely, some nutritional factors and low energy availability may facilitate the development of EHS, and individuals should be cognizant of these. Therefore, the aims of this review are to present an overview of EHS along with its mechanisms and pathophysiology, discuss how selected nutritional considerations may influence EHS risk focusing on their impact on the key pathophysiological processes of EHS, and provide recommendations for future research. With climate change expected to increase EHS risk and incidence in the coming years, further investigation on how diet and nutrition may be optimized to protect against EHS would be highly beneficial.
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Affiliation(s)
- Jason K. W. Lee
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Heat Resilience and Performance Centre, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Physiology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,N.1 Institute for HealthNational University of SingaporeSingapore,Global Asia InstituteNational University of SingaporeSingapore,Institute for Digital MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore,Singapore Institute for Clinical SciencesAgency for Science, Technology and Research (A*STAR)Singapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Beverly Tan
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Henry B. Ogden
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Department of Sport, Health and WellbeingPlymouth Marjon UniversityPlymouthUK
| | - Shaun Chapman
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Cambridge Centre for Sport and Exercise SciencesSchool of Psychology and Sport ScienceAnglia Ruskin UniversityCambridgeUK
| | - Michael N. Sawka
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGAUSA
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McKenna Z, Houck J, Ducharme J, Li Z, Berkemeier Q, Fennel Z, Wells A, Mermier C, Deyhle M, Laitano O, Amorim F. The effect of prolonged interval and continuous exercise in the heat on circulatory markers of intestinal barrier integrity. Eur J Appl Physiol 2022; 122:2651-2659. [DOI: 10.1007/s00421-022-05049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/09/2022] [Indexed: 11/03/2022]
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