Keeping your cool: possible mechanisms for enhanced exercise performance in the heat with internal cooling methods

Muscle Cooling Before and in the Middle of a Session: There Are Benefits on Subsequent Localized Endurance Performance in a Warm Environment

ABSTRACT

Baláš, J, Kodejška, J, Procházková, A, Knap, R, and Tufano, JJ. Muscle cooling before and in the middle of a session: there are benefits on subsequent localized endurance performance in a warm environment. J Strength Cond Res 38(3): 533-539, 2024-Localized cold-water immersion (CWI) has been shown to facilitate recovery in the middle of a session of exhaustive repeated forearm contractions. However, it has been suggested that these benefits may be attributed to "precooling" the muscle before an activity, as opposed to cooling a previously overheated muscle. Therefore, this study aimed to determine how precooling and mid-cooling affects localized repeated muscular endurance performance in a warm environment. Nineteen subjects completed a familiarization session and 3 laboratory visits, each including 2 exhaustive climbing trials separated by 20 minutes of recovery: PRE CWI (CWI, trial 1; passive sitting [PAS], trial 2); MID CWI (PAS, trial 1; CWI, trial 2); and CONTROL (PAS, trial 1; PAS, trial 2). Climbing trial 1 in PRE CWI was 32 seconds longer than in CONTROL ( p = 0.013; d = 0.46) and 47 seconds longer than in MID CWI ( p = 0.001; d = 0.81). The time of climbing trial 2 after PAS (PRE CWI and CONTROL) was very similar (312 vs. 319 seconds) irrespective of the first trial condition. However, the time of the second trial in MID CWI was 43 seconds longer than in PRE CWI ( p < 0.001; d = 0.63) and 50 seconds longer than in CONTROL ( p < 0.001; d = 0.69). In warm environments, muscle precooling and mid-cooling can prolong localized endurance performance during climbing. However, the effectiveness of mid-cooling may not be as a "recovery strategy" but as a "precooling" strategy to decrease muscle temperature before subsequent performance, delaying the onset of localized heat-induced neuromuscular fatigue.

Ad libitum ice slurry ingestion and half-marathon performance in a hot environment: A study comparing the effects of the amount and moment of ingestion between ice slurry and water at 37 °C

Ice slurry ingestion during prolonged exercises may improve performance in hot environments; however, the ideal amount and timing of ingestion are still uncertain. We determined whether ad libitum ice slurry ingestion influences physiological and perceptual variables and half-marathon performance while comparing the effects of the amount and moment of ingestion between ice slurry and water at 37 °C. Ten trained participants (28 ± 2 years; mean and SD) were required to run two half marathons while consuming either ice slurry (-1 °C; Ad-1) or water (37 °C; 37 CE) ad libitum. They then performed two other half marathons where, during one, they were required to ingest an amount of water equivalent to the amount consumed during the Ad-1 trial (Pro37), and in the other, to ingest ice slurry in the amount consumed during the 37 CE trial (Pro-1). During the half marathons, dry-bulb temperature and relative humidity were controlled at 33.1 ± 0.3 °C and 60 ± 3%, respectively. Ad-1 ingestion (349.6 ± 58.5 g) was 45% less than 37 CE ingestion (635.5 ± 135.8 g). Physical performance, heart rate, perceived exertion, body temperatures, and thermal perception were not influenced by the temperature or amount of beverage ingestion. However, a secondary analysis suggested that lower beverage ingestion was associated with improved performance (Ad-1 + Pro37 vs. 37 CE + Pro-1: -4.0 min, Cohen's d = 0.39), with a significant relationship between lower beverage ingestion and faster running time (b = 0.02, t = 4.01, p < 0.001). In conclusion, ice slurry ingestion does not affect performance or physiological or perceptual variables during a half marathon in a hot environment. Preliminary evidence suggests that lower beverage ingestion (ice slurry or warm water) is associated with improved performance compared to higher ingestion.

Cumulative pre-cooling methods do not enhance cycling performance in tropical climate

The main objective of this study was to investigate the effect of mixed cooling techniques (combination of internal and external strategies, with and without menthol) during warm-up for a time trial in tropical climate. Seven heat-acclimatized trained male road cyclists participated in three experimental sessions consisting of 20-min cycling performances on a velodrome track in ecological hot and humid conditions (Guadeloupe, French West Indies; WBGT: 27.64±0.27°C; relative humidity: 76.43±2.19%), preceded by a standardized 30-min warm-up and the ingestion of cold menthol water (1) with a cooling vest soaked in ice water (ICE-VEST), (2) with a cooling vest soaked in ice menthol water (MEN-VEST), and (3) without a vest (NO-VEST). Cycling performance (total distance, distance traveled per 2-min block), physiological parameters (core body temperature recorded, heart rate) and perceptions (exertion, thermal comfort, thermal sensation) were assessed. No between-condition differences were found for physiological parameters, the total covered distance or the distance traveled per 2-min block. However, distance traveled per 2-min decreased with time (p = 0.03), with no difference between conditions, suggesting a variation in pace during the cycling performance trial (e.g., mean±SD: 1321±48.01m at T2; 1308±46.20m at T8, 1284±78.38m at T14, 1309±76.29m at T20). No between-condition differences were found for perception of exertion, thermal comfort and thermal sensation during the warm-up (11.83±3.34; 2.58±1.02; 4.39±0.94, respectively) and the performance (17.85±0.99; 2.70±1.25; 5.20±1.20, respectively) but the pairwise comparisons within condition revealed a significant increase of TS values from T0 (4.57±1.13) to T20 (6.00±0.58) only in NO-VEST condition (p = 0.04). The absence of modification of thermal sensation at the end of the cycling test under the mixed conditions (ICE-VEST and MEN-VEST) suggests a beneficial effect of wearing a cooling vest on thermal sensation although it had no effect on performance.

Menthol mouth rinsing and performance in elite football referees in the heat: A study protocol for a randomized crossover trial

Background

Within professional European competitions, matches can be played in extreme environmental temperatures, ranging from -5 °C to +30 °C in different countries. Furthermore, the World Cups are usually played in the summer months, when temperatures can exceed 35 °C, increasing physiological stress. Practical and cost-effective cooling strategies may be implemented to help players and referees to cope with exercising in the heat. No study has evaluated the effect of non-thermal internal cooling techniques regarding performance responses on elite football referees, so far. This study aims to analyse the effects of a menthol mouth rinse regarding physical, physiological, and perceptual performance in elite male football referees, during a 90-min football protocol in the heat.

Methods

At least thirteen male football referees will be recruited to perform two intermittent football protocols, separated by no less than 7 days. After passing the eligibility criteria, the participants will be randomly assigned to 1 of 2 beverages: (1) intervention - menthol solution 0.01% and (2) placebo - noncaloric berry-flavored solution, both at room temperature. The beverages will be given before warm-up (pre-cooling) and at the half-time (per-cooling). The trials will follow a randomized counterbalanced crossover design, single blinded, and will take place in indoor facilities, with Wet Bulb Globe Temperature (WBGT) > 30 °C, at the same time of the day to control for circadian variations.

Impact of the project

The results of this study are expected to determine whether mouth rinsing a menthol solution before and during a football exercise protocol performed in the heat will alter perceptual measures and help ease physiological strain and attenuate performance decrements in elite male football referees, comparing to a non-cooling strategy. Thus, we can be closer to defining nutritional strategies of internal cooling that may be an advantage for the performance of the football referees in the heat.

Trial registration

www.ClinicalTrials.gov NCT05632692 registered on 20 November 2022.

Effects of ice slurry ingestion on body temperature and softball pitching performance in a hot environment: a randomized crossover trial

BACKGROUND

Although softball players are often required to play in hot environments, scarce evidence is available regarding the effects of ice slurry ingestion on body temperature and pitching performance in softball pitchers in a hot environment. Thus, this study investigated the effects of ice slurry ingestion before and between innings on body temperature and softball pitching performance in a hot environment.

METHODS

In a randomized crossover design, seven heat-acclimatized amateur softball pitchers (four males and three females) completed simulated softball games consisting of 15 best-effort pitches per inning for seven innings with between-pitch rest intervals of 20 s. Participants were assigned to either a control trial (CON: ingestion of 5.0 g·kg^-1 of cool fluid [9.8 ± 2.2 °C] before simulated softball games and 1.25 g·kg^-1 of cool fluid between inning intervals) or an ice trial (ICE: ingestion of ice slurry [- 1.2 ± 0.1 °C] based on the same timings and doses as the CON). Participants performed both trials in an outdoor ground during the summer season (30.8 ± 2.7 °C, 57.0 ± 7.9% relative humidity).

RESULTS

Ice slurry ingestion before the simulated softball game (pre-cooling) resulted in a greater reduction in rectal temperature compared with cool fluid ingestion (p = 0.021, d = 0.68). No significant differences were observed between the trials in rectal temperature changes during the simulated softball game (p > 0.05). Compared to the CON, heart rate during the game was significantly decreased (p < 0.001, d = 0.43), and handgrip strength during the game was significantly increased (p = 0.001, d = 1.16) in the ICE. Ratings of perceived exertion, thermal comfort, and thermal sensation were improved in the ICE compared to those in the CON (p < 0.05). Ball velocity and pitching accuracy were not affected by ICE.

CONCLUSIONS

Ice slurry ingestion before and between innings reduced thermal, cardiovascular, and perceptual strain. However, it did not affect softball pitching performance compared to cool fluid ingestion.

Cold water immersion of the hand and forearm during half-time improves intermittent exercise performance in the heat

The present study aimed to investigate the effect of cold water immersion of the hand and forearm during half-time (HT) on intermittent exercise performance and thermoregulation by imitating intermittent athletic games in the heat. In a randomized crossover design, 11 physically active men performed the first half (first and second block) and second half (third and fourth block) intermittent cycling exercise protocol, which consisted of a 5-s maximal power pedalling (body weight × 0.075 kp) every minute separated by 25-s of unloaded pedalling and rest (30 s) in the heat (33°C, 50% relative humidity). The two-halves were separated by a 15-min HT. During HT, the participants were assigned to the CON (sedentary resting) or COOL (immersion of hands and forearms in cold water at 15-17°C) condition. The mean power output in the second half was significantly greater (third and fourth block: p < 0.05) in the COOL than in the CON condition. Moreover, there was a significant decrease in the rectal (0.54 ± 0.17°C, p < 0.001) and mean skin (1.86 ± 0.34°C, p < 0.05) temperatures of the COOL condition during HT. Furthermore, the heart rate (16 ± 7 bpm, p < 0.05) and skin blood flow (40.2 ± 10.5%, p < 0.001) decreased at the end of HT in the COOL condition. In the second half, thermal sensation was more comfortable in the COOL condition (p < 0.001). Cold water immersion of the hand and forearm during HT improved physiological and reduced perceived heat stress. Moreover, it prevented a reduction in intermittent exercise performance in the second half.

Effects of internal cooling on physical performance, physiological and perceptional parameters when exercising in the heat: A systematic review with meta-analyses

Background: An elevated core temperature (Tcore) increases the risk of performance impairments and heat-related illness. Internal cooling (IC) has the potential to lower Tcore when exercising in the heat. The aim of the review was to systematically analyze the effects of IC on performance, physiological, and perceptional parameters. Methods: A systematic literature search was performed in the PubMed database on 17 December 2021. Intervention studies were included assessing the effects of IC on performance, physiological, or perceptional outcomes. Data extraction and quality assessment were conducted for the included literature. The standardized mean differences (SMD) and 95% Confidence Intervals (CI) were calculated using the inverse-variance method and a random-effects model. Results: 47 intervention studies involving 486 active subjects (13.7% female; mean age 20-42 years) were included in the meta-analysis. IC resulted in significant positive effects on time to exhaustion [SMD (95% CI) 0.40 (0.13; 0.67), p < 0.01]. IC significantly reduced Tcore [-0.19 (22120.34; -0.05), p < 0.05], sweat rate [-0.20 (-0.34; -0.06), p < 0.01], thermal sensation [-0.17 (-0.33; -0.01), p < 0.05], whereas no effects were found on skin temperature, blood lactate, and thermal comfort (p > 0.05). IC resulted in a borderline significant reduction in time trial performance [0.31 (-0.60; -0.02), p = 0.06], heart rate [-0.13 (-0.27; 0.01), p = 0.06], rate of perceived exertion [-0.16 (-0.31; -0.00), p = 0.05] and borderline increased mean power output [0.22 (0.00; 0.44), p = 0.05]. Discussion: IC has the potential to affect endurance performance and selected physiological and perceptional parameters positively. However, its effectiveness depends on the method used and the time point of administration. Future research should confirm the laboratory-based results in the field setting and involve non-endurance activities and female athletes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022336623.

Performance effects of internal pre- and per-cooling across different exercise and environmental conditions: A systematic review

Exercise in a hot and humid environment may endanger athlete's health and affect physical performance. This systematic review aimed to examine whether internal administration of ice, cold beverages or menthol solutions may be beneficial for physical performance when exercising in different environmental conditions and sports backgrounds. A systematic search was performed in PubMed, Web of Science, Scopus and SPORTDiscus databases, from inception to April 2022, to identify studies meeting the following inclusion criteria: healthy male and female physically active individuals or athletes (aged ≥18 years); an intervention consisting in the internal administration (i.e., ingestion or mouth rinse) of ice slush, ice slurry or crushed ice and/or cold beverages and/or menthol solutions before and/or during exercise; a randomized crossover design with a control or placebo condition; the report of at least one physical performance outcome; and to be written in English. Our search retrieved 2,714 articles in total; after selection, 43 studies were considered, including 472 participants, 408 men and 64 women, aged 18-42 years, with a VO2max ranging from 46.2 to 67.2 mL⋅kg-1⋅min-1. Average ambient temperature and relative humidity during the exercise tasks were 32.4 ± 3.5°C (ranging from 22°C to 38°C) and 50.8 ± 13.4% (varying from 20.0% to 80.0%), respectively. Across the 43 studies, 7 exclusively included a menthol solution mouth rinse, 30 exclusively involved ice slurry/ice slush/crushed ice/cold beverages intake, and 6 examined both the effect of thermal and non-thermal internal techniques in the same protocol. Rinsing a menthol solution (0.01%) improved physical performance during continuous endurance exercise in the heat. Conversely, the ingestion of ice or cold beverages did not seem to consistently increase performance, being more likely to improve performance in continuous endurance trials, especially when consumed during exercises. Co-administration of menthol with or within ice beverages seems to exert a synergistic effect by improving physical performance. Even in environmental conditions that are not extreme, internal cooling strategies may have an ergogenic effect. Further studies exploring both intermittent and outdoor exercise protocols, involving elite male and female athletes and performed under not extreme environmental conditions are warranted. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268197], identifier [CRD42021268197].

Pre-cooling with ingesting a high-carbohydrate ice slurry on thermoregulatory responses and subcutaneous interstitial fluid glucose during heat exposure

The purpose of this study was to compare the effects of ingesting ice slurries with two different carbohydrate contents on body temperatures and the subcutaneous interstitial fluid glucose level during heat exposure. Seven physically active men underwent one of three interventions: the ingestion of 7.5 g/kg of a control beverage (CON: 26°C), a normal-carbohydrate ice slurry (NCIS: −1°C), or a high-carbohydrate ice slurry (HCIS: −5°C). The participants were monitored for a 120-min period that included 10 min of rest, 25 min of exposure to the experimental cooling intervention (during which the beverage was ingested), and 85 min of seated rest in a climate chamber (36°C, 50% relative humidity). The rectal temperature in the HCIS and NCIS trials was lower than that in the CON trial from 40 to 75 min. The infrared tympanic temperature was also lower in the HCIS and NCIS trials than in the CON trial from 20 to 50 min, whereas the deep thigh or mean skin temperatures were not significantly different among the three groups. From 90 to 120 min, the subcutaneous interstitial fluid glucose level in the NCIS trial was lower than that at 65 min; however, reductions were not seen in the HCIS and CON trials. These findings suggest that both HCIS ingestion and conventional NCIS ingestion were effective cooling strategies for reducing thermal strain, while HCIS ingestion may also enable a higher subcutaneous interstitial fluid glucose level to be maintained, ensuring an adequate supply of required muscle substrates.

Effects of hot and humid environments on thermoregulation and aerobic endurance capacity of Laser sailors

Objectives

The purpose was to investigate the effects of hot and humid environments on thermoregulation and aerobic endurance capacity and whether high skin temperature serves as a more important thermoregulatory factor affecting aerobic exercise capacity.

Methods

A randomized cross-over design was applied to this study, in which nine Laser sailors performed the 6 km rowing test (6 km test) in both a warm (ambient temperature: 23 ± 1.4 °C; relative humidity: 60.5 ± 0.7%; wind speed: 0 km/h; WARM) and hot environment (ambient temperature: 31.8 ± 1.1 °C; relative humidity: 63.5 ± 4.9%; wind speed: 3.5 ± 0.7 km/h; HOT).

Results

The time for completing 6 km test of HOT group was significantly longer than that of WARM group (P = 0.0014). Mean power of 3–4 km, 4–5 km and 5–6 km were significant lower in HOT group (P = 0.014, P = 0.02, P = 0.003). Gastrointestinal temperature and skin temperature were significantly higher in HOT group during the 6 km test (P = 0.016, P = 0.04). Heat storage at 5 min and 15 min of HOT group were significantly higher than that of WARM group (P = 0.0036; P = 0.0018). Heart rate and physiological strain index of HOT group were significantly higher than that of WARM group during the 6 km test (P = 0.01, P < 0.01).

Conclusion

When skin temperature and core temperature both increased, high skin temperature may be the more important thermoregulatory factor that affected the aerobic endurance performance in hot and humid environments. The high skin temperature narrowed the core to skin temperature gradient and skin to ambient temperature gradient, which may result in greater accumulation of heat storage. The greater heat storage led to the lower muscle power output, which contributed to the reduction of the heat production.

A Combination of Ice Ingestion and Head Cooling Enhances Cognitive Performance during Endurance Exercise in the Heat

This study assessed the effectiveness of head cooling during exercise in the heat on cognitive performance, either alone or with ice ingestion. Ten healthy males, non-acclimatized to heat, ran (70% V̇O₂peak) for 2×30 min in heat (35 ± 0.9°C, 68.2 ± 6.9% RH). Participants completed 3 trials: 10 min of head cooling during exercise (HC); precooling with crushed ice (7gikg^-1) and head cooling during exercise (MIX); or no-cooling/control (CON). Working memory was assessed using the automated operation span task (OSPAN) and serial seven test (S7). Following MIX, S7 scores were improved compared to CON (12 ± 9.5, p = 0.004, d = 1.42, 0.34-2.28) and HC (4 ± 5.5, p = 0.048, d = 0.45, -0.47 to 1.3) during exercise. Moderate to large effect sizes were recorded for S7 and OSPAN following MIX and HC compared to CON, suggesting a tendency for improved cognitive performance during exercise in heat. Following precooling (MIX), core body temperature (T_c) and forehead temperature (T_h) were lower compared to baseline (-0.75 ± 0.37°C, p < 0.001; -0.31 ± 0.29°C, p = 0.008, respectively) but not in HC or CON (p > 0.05). Thermal sensation (TS) was lower in MIX and HC compared to CON during exercise (p < 0.05). The reduction in T_c, T_h and TS with MIX may have attenuated the effect of heat and subsequently improved working memory during exercise in heat.

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

In-play optimal cooling for outdoor match-play tennis in the heat

The purpose of this study was to compare the efficacy of four cooling interventions used for reducing physiological and perceptual strain and improving exercise performance during outdoor match-play tennis in the heat. Eight competitive tennis players played four counter-balanced simulated outdoor matches in the heat (WBGT: 28.4-32.5°C) at 24- or 48-h intervals. Each match comprised 3 sets for which the "no-ad" rule was applied to limit duration variability. Players underwent the following cooling interventions: ad libitum fluid ingestion (CON), ad libitum fluid ingestion and ice vest (VEST), total ingestion of approximately 1000 g ice slurry and ice vest (Combined: BINE), or total ingestion of approximately 400 g ice slurry and ice vest (Low-combined: L-BINE). Gastrointestinal temperature was lower in the BINE and the L-BINE trials than in the CON trial at the set-break of set 1, and these differences in gastrointestinal temperature persisted throughout the remainder of the match (p < 0.05). The ratio of moderate-high intensity activity (≥10 km/h) in set 3 was significantly higher in the L-BINE trial than that in the BINE trial (p < 0.05). In the CON and BINE trials, high intensity activity was significantly lower in set 3 compared with set 1 and 2, respectively. Cooling by optimal ice slurry ingestion and ice vest may be a more effective strategy in mitigating the development of heat strain during outdoor match-play tennis in the heat.

Efficacy of ice slurry and carbohydrate-electrolyte solutions for firefighters

OBJECTIVES

To examine the thermoregulatory and fluid-electrolyte responses of firefighters ingesting ice slurry and carbohydrate-electrolyte solutions before and after firefighting operations.

METHODS

Twelve volunteer firefighters put on fireproof clothing and ingested 5 g/kg of beverage in an anteroom at 25°C and 50% relative humidity (RH; pre-ingestion), and then performed 30 minutes of exercise on a cycle ergometer (at 125 W for 10 minutes and then 75 W for 20 minutes) in a room at 35℃ and 50% RH. The participants then returned to the anteroom, removed their fireproof clothing, ingested 20 g/kg of beverage (post-ingestion), and rested for 90 minutes. Three combinations of pre-ingestion and post-ingestion beverages were provided: a 25℃ carbohydrate-electrolyte solution for both (CH condition); 25℃ water for both (W condition); and a -1.7℃ ice slurry pre-exercise and 25℃ carbohydrate-electrolyte solution post-exercise (ICE condition).

RESULTS

The elevation of body temperature during exercise was lower in the ICE condition than in the other conditions. The sweat volume during exercise was lower in the ICE condition than in the other conditions. The serum sodium concentration and serum osmolality were lower in the W condition than in the CH condition.

CONCLUSIONS

The ingestion of ice slurry while firefighters were wearing fireproof clothing before exercise suppressed the elevation of body temperature during exercise. Moreover, the ingestion of carbohydrate-electrolyte solution by firefighters after exercise was useful for recovery from dehydration.

Ice slurry ingestion before and during exercise inhibit the increase in core and deep-forehead temperatures in the second half of the exercise in a hot environment

Many studies have reported that pre-exercise ice slurry ingestion improves exercise performance; however, it may increase the risk of developing heat stroke. Some studies have suggested that pre-exercise ice slurry ingestion accelerates the core temperature increase that occurs during exercise. Therefore, this study aimed to investigate whether the ingestion of ice slurry before and during exercise can inhibit this acceleration. Moreover, we measured the deep-forehead temperature (T_{deep head}) to determine whether ice slurry ingestion before and during exercise can maintain this reduction in brain temperature. Eleven male participants at room temperature (24 °C, 50% relative humidity [RH]) ingested 7.5 g/kg of ice slurry or a thermoneutral sports drink within 30 min. They then exercised for approximately 60 min at 50% of the maximal oxygen uptake in a hot environment (34 °C, 50% RH) while ingesting 1.25 g/kg of ice slurry or a thermoneutral sports drink every 10 min. Rectal temperature (T_re), T_{deep head}, forehead skin temperature, mean skin temperature, heart rate, nude body mass, and urine specific gravity were measured as physiological indices. The rating of perceived exertion, thermal sensation, and thermal comfort were measured at 5-min intervals throughout the experiment. The T_re and T_{deep head} during the second half of the exercise session were significantly reduced after ingestion of the ice slurry before and during exercise (p < 0.05). In addition, the rate of increase in T_re and T_deephead slowed during the second half of the exercise session after the ingestion of the ice slurry before and during exercise (p < 0.05). These results indicate that the increases in T_re and T_{deep head}, reflecting brain temperature in the second half of the exercise session, were significantly inhibited by ice slurry ingestion before and during exercise.

Can taste be ergogenic?

Taste is a homeostatic function that conveys valuable information, such as energy density, readiness to eat, or toxicity of foodstuffs. Taste is not limited to the oral cavity but affects multiple physiological systems. In this review, we outline the ergogenic potential of substances that impart bitter, sweet, hot and cold tastes administered prior to and during exercise performance and whether the ergogenic benefits of taste are attributable to the placebo effect. Carbohydrate mouth rinsing seemingly improves endurance performance, along with a potentially ergogenic effect of oral exposure to both bitter tastants and caffeine although subsequent ingestion of bitter mouth rinses is likely required to enhance performance. Hot and cold tastes may prove beneficial in circumstances where athletes' thermal state may be challenged. Efficacy is not limited to taste, but extends to the stimulation of targeted receptors in the oral cavity and throughout the digestive tract, relaying signals pertaining to energy availability and temperature to appropriate neural centres. Dose, frequency and timing of tastant application likely require personalisation to be most effective, and can be enhanced or confounded by factors that relate to the placebo effect, highlighting taste as a critical factor in designing and administering applied sports science interventions.

Impact of Ice Slurry Ingestion During Break-Times on Repeated-Sprint Exercise in the Heat

The study aimed to investigate the effects of ice slurry ingestion during break times and half-time (HT) on repeated-sprint performance and core temperature in the heat. Seven males performed two different trials as follows: ice slurry (-1°C) or room temperature water ingestion at each break and HT break at 36.5°C, 50% relative humidity. Participants performed 30 sets of 1-min periods of repeated- sprint exercises protocol using a cycling ergometer. Each period consisted of 5 sec of maximal pedaling, 25 sec of pedaling with no workload, and 30 sec of rest; two sets of exercise periods were separated by 10 min of rest. Each break was implemented for 1 min after every 5 sets. The rectal temperature in ice slurry ingestion was significantly lower than that of the room temperature water at 45 set (p=0.04). Total and mean work done was greater in ice slurry ingestion compared to room temperature water ingestion (p < 0.05). These results suggested that ice slurry ingestion during break times and HT break may be an effective cooling strategy to attenuate the rise of core temperature in the second half of exercise and improve the repeated-sprint exercise capacity in the heat.

Enhanced Decision Making and Working Memory During Exercise in the Heat With Crushed Ice Ingestion

PURPOSE

To examine the effects of precooling via crushed ice ingestion on cognitive function during exercise in the heat.

METHODS

Eleven active men ingested either 7 g·kg-1 of crushed ice (ICE) or thermoneutral water (CON) 30 minutes before running 90 minutes on a treadmill at a velocity equivalent to 65% VO2peak in hot and humid conditions (35.0°C [0.5°C], 53.1% [3.9%] relative humidity). Participants completed 3 cognitive tasks to investigate decision making (8-choice reaction time [CRT]), working memory (serial seven [S7]), and executive control (color multisource interference task [cMSIT]) on arrival, after precooling, and after running.

RESULTS

Precooling significantly decreased preexercise core (Tcore) and forehead skin temperature in ICE compared with CON, respectively (Tcore 0.8°C [0.4°C], -0.2°C [0.1°C]; Thead -0.5°C [0.4°C], 0.2°C [0.8°C]; P ≤ .05). Postrun, ICE significantly reduced errors compared with CON for CRT (P ≤ .05; d = 0.90; 90% confidence interval, 0.13-1.60) and S7 (P ≤ .05; d = 1.05; 90% confidence interval, 0.26-1.75). Thermal sensation was lower after precooling with ICE (P ≤ .05), but no significant differences were recorded between conditions for cMSIT errors, skin temperature, heart rate, or ratings of perceived exertion or perceived thirst (P > .05).

CONCLUSIONS

Precooling via ICE maintained cognitive accuracy in decision making and working memory during exercise in the heat. Thus, ICE may have the potential to improve sporting performance by resisting deleterious effects of exercise in a hot and humid environment on cognitive function.

Menthol as an Adjuvant to Help Athletes Cope With a Tropical Climate: Tracks From Heat Experiments With Special Focus on Guadeloupe Investigations

Endurance and prolonged exercise are altered by hot climate. In hot and dry climate, thermoregulation processes, including evapotranspiration, normally maintain a relatively constant body core temperature. In hot and wet climate (usually called “tropical”), the decrease in evapotranspiration efficacy increases the sweating rate, which can rapidly induce severe hypohydration without efficiently reducing core temperature. The negative effects of tropical environment on long-duration exercise have been well documented, with clear demonstrations that they exceed the acclimation possibilities: both acclimated athletes and natives to tropical climate show impaired performances compared with that in neutral climate. New countermeasures, applicable during competitive events, are therefore needed to limit these negative effects. We studied the effects of several countermeasures in outdoor or natural tropical climates and noted that the easiest method to apply is cooling with cold (−1 to 3°C) beverage. Moreover, adding menthol increased the cold sensation induced by the beverage temperature, optimizing the positive effects on performance. We also demonstrated that efficient pre-cooling with cold menthol beverage requires drinking for 1 h instead of 30 min before the exercise. The optimal cooling method seems to be 1 h of cold + menthol pre-cooling ingestion followed by menthol + ice-slurry per-cooling. However, limitations should be noted: (1) the menthol concentration seems to be crucial, with positive effects for a 0.05% solution, whereas higher concentrations need to be explored; and (2) because it acts as a cold adjuvant without decreasing core temperature, menthol can lead to decreased thermoregulatory processes, thus inducing hyperthermia. Last, if menthol is added to cooling processes, athletes should first test them in training conditions for the maximal cooling effect to ensure optimal performance in competition in tropical climate.

Water Intake from the Points of View of Rhazes and Avicenna

Owing to the effect of acute and chronic hypohydration on health and the lethal effects of hyperhydration, an appropriate amount of water intake is important for each individual. Traditional Iranian medicine (TIM) is a holistic system one of whose important parts deals with lifestyles and how to maintain health, including the amount of water intake for every person and the appropriate principles of drinking water. In this study, Avicenna's Canon of Medicine, Rhazes' Benefits of Food and Its Harmfulness, and conventional medical articles were reviewed to evaluate the amount of water intake for each person and the principles of drinking water. TIM has expressed an individualized difference in the amount of water intake in the form of temperament and the relationship between the appropriate time of drinking water with other daily activities. In this view, drinking water at the inappropriate time causes liver and gastrointestinal diseases; it can create the foundation for conducting new studies in the field of appropriate water intake and lifestyle changes to reduce malnutrition complications.

Effect of ice slushy ingestion and cold water immersion on thermoregulatory behavior

Two studies were conducted to examine the effects of ice slushy ingestion (ICE) and cold water immersion (CWI) on thermoregulatory and sweat responses during constant (study 1) and self-paced (study 2) exercise. In study 1, 11 men cycled at 40-50% of peak aerobic power for 60 min (33.2 ± 0.3°C, 45.9 ± 0.5% relative humidity, RH). In study 2, 11 men cycled for 60 min at perceived exertion (RPE) equivalent to 15 (33.9 ± 0.2°C and 42.5 ± 3.9%RH). In both studies, each trial was preceded by 30 min of CWI (~22°C), ICE or no cooling (CON). Rectal temperature (Tre), skin temperature (Tsk), thermal sensation, and sweat responses were measured. In study 1, ICE decreased Tre-Tsk gradient versus CON (p = 0.005) during first 5 min of exercise, while CWI increased Tre-Tsk gradient versus CON and ICE for up to 20 min during the exercise (p<0.05). In study 2, thermal sensation was lower in CWI versus CON and ICE for up to 35-40 min during the exercise (p<0.05). ICE reduced thermal sensation versus CON during the first 20 min of exercise (p<0.05). In study 2, CWI improved mean power output (MPO) by ~8 W, compared with CON only (p = 0.024). In both studies, CWI (p<0.001) and ICE (p = 0.019) delayed sweating by 1-5 min but did not change the body temperature sweating threshold, compared with CON (both p>0.05). Increased Tre-Tsk gradient by CWI improved MPO while ICE reduced Tre but did not confer any ergogenic effect. Both precooling treatments attenuated the thermal efferent signals until a specific body temperature threshold was reached.

Internal precooling decreases forehead and core temperature but does not alter choice reaction time during steady state exercise in hot, humid conditions

This study aimed to determine if precooling via crushed ice ingestion reduces forehead skin temperature (T_head) and core temperature (T_core) during exercise in the heat and whether it has an effect on choice reaction time (CRT). Ten males commenced a 30 min precooling period, ingesting either 7 g kg^-1 of crushed ice (ICE) or room temperature water (CON) prior to cycling 60 min at 55% V̇O_2peak in hot, humid conditions (35.0 ± 0.3 °C, 50.2 ± 2.1% Relative Humidity). The CRT task was completed upon arrival and after the precooling period in the lab, then at 15 min intervals during exercise in the heat. Precooling reduced T_head and T_core to a greater degree in ICE (T_head: -0.8 ± 0.31 °C; T_core: -0.9 ± 0.3 °C) compared with CON (T_head: -0.2 ± 0.3 °C; T_core: -0.2 ± 0.2 °C) (p ≤ 0.001). Choice reaction time performance improved throughout the cycle for both conditions (p ≤ 0.05). Ice ingestion lowered thermal sensation (p = 0.003) and skin temperature (d = 0.88; T_skin), while heart rate, ratings of perceived exertion and thirst were similar between conditions (p > 0.05). Precooling effectively reduced T_head and T_core but did not provide additional improvement in CRT during moderate exercise in the heat. Further investigation is required to determine whether the lower central and peripheral temperature after ice ingestion is beneficial for tasks of greater cognitive effort.

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

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

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

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

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

Ice slurry ingestion during break times attenuates the increase of core temperature in a simulation of physical demand of match-play tennis in the heat

This investigation assessed the effect of ice slurry ingestion compared to that of cold water ingestion during break times on thermal strain and perception in simulated match-play tennis in the heat. Seven male recreational athletes (age = 22 ± 2 yr, height = 1.72 ± 0.08 m, Body mass = 64.8 ± 6.8 kg) performed two trials in a climate chamber, each time completing 4 sets of simulated match-play. During International Tennis Federation-mandated breaks (90-s between odd-numbered games; 120-s between sets), either ice slurry or cold water were ingested. The rectal temperature, forehead skin temperature, heart rate, rating of thermal comfort and total sweat loss were measured. The change in rectal temperature in the ice slurry trial was significantly lower than that in the cold water trial by game 3 of set 3 (p = 0.02). These differences in Δrectal temperature persisted throughout the remainder of the "match" (p < 0.05). Forehead skin temperature, heart rate and rating of thermal comfort were significantly lower in the ice slurry trial than in the cold water trial by the second half of the experiment (p < 0.05). Total sweat loss in ice slurry trial is significantly lower than cold water trial (p = 0.002). These results suggested that ice slurry ingestion was more effective than cold water ingestion in mitigating the development of heat strain during simulated match-play tennis in the heat.

L-Menthol mouth rinse or ice slurry ingestion during the latter stages of exercise in the heat provide a novel stimulus to enhance performance despite elevation in mean body temperature

Purpose

This study investigated the effects of l-menthol mouth rinse and ice slurry ingestion on time to exhaustion, when administered at the latter stages (~ 85%) of baseline exercise duration in the heat (35 °C).

Method

Ten male participants performed four time to exhaustion (TTE) trials on a cycle ergometer at 70% W_max. In a randomized crossover design, (1) placebo-flavored non-calorific mouth rinse, (2) l-menthol mouth rinse (0.01%), or (3) ice ingestion (1.25 g kg⁻¹), was administered at 85% of participants’ baseline TTE. Time to exhaustion, core and skin temperature, heart rate, rating of perceived effort, thermal comfort and thermal sensation were recorded.

Results

From the point of administration at 85% of baseline TTE, exercise time was extended by 1% (placebo, 15 s), 6% (l-menthol, 82 s) and 7% (ice, 108 s), relative to baseline performance (P = 0.036), with no difference between l-menthol and ice (P > 0.05). Core temperature, skin temperature, and heart rate increased with time but did not differ between conditions (P > 0.05). Thermal sensation did not differ significantly but demonstrated a large effect size (P = 0.080; \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\eta _{{\text{p}}}^{2}$$\end{document}ηp2 = 0.260).

Conclusion

These results indicate that both thermally cooling and non-thermally cooling oral stimuli have an equal and immediate behavioral, rather than physiological, influence on exhaustive exercise in the heat.

Practical Cooling Strategies During Continuous Exercise in Hot Environments: A Systematic Review and Meta-Analysis

Background

Performing exercise in thermally stressful environments impairs exercise capacity and performance. Cooling during exercise has the potential to attenuate detrimental increases in body temperature and improve exercise capacity and performance.

Objective

The objective of this review was to assess the effectiveness of practical cooling strategies applied during continuous exercise in hot environments on body temperature, heart rate, whole body sweat production, rating of perceived exertion (RPE), thermal perception and exercise performance.

Methods

Electronic database searches of MEDLINE, SPORTDiscus, Scopus and Physiotherapy Evidence Database (PEDro) were conducted using medical subject headings, indexing terms and keywords. Studies were eligible if participants were defined as ‘healthy’, the exercise task was conducted in an environment ≥25 °C, it used a cooling strategy that would be practical for athletes to use during competition, cooling was applied during a self-paced or fixed-intensity trial, participants exercised continuously, and the study was a randomised controlled trial with the comparator either a thermoneutral equivalent or no cooling. Data for experimental and comparator groups were meta-analysed and expressed as a standardised mean difference and 95 % confidence interval.

Results

Fourteen studies including 135 participants met the eligibility criteria. Confidence intervals for meta-analysed data included beneficial and detrimental effects for cooling during exercise on core temperature, mean skin temperature, heart rate and sweat production during fixed-intensity exercise. Cooling benefited RPE and thermal perception during fixed-intensity exercise and improved self-paced exercise performance.

Conclusion

Cooling during fixed-intensity exercise, particularly before a self-paced exercise trial, improves endurance performance in hot environments by benefiting RPE and thermal perception, but does not appear to attenuate increases in body temperature.

Menthol Use for Performance in Hot Environments

Menthol is a compound of plant origin and has recently been used to aid exercise performance in hot, humid environments. Menthol creates a sensation of coolness when applied to the skin or mucosal surfaces stimulating the cold receptors. In these environments, fatigue is known to be accelerated and feelings of being hot are one of the main contributors to the early onset of fatigue. However, current research indicates that nonthermal perceptual cooling interventions could alter behavior in the heat by reducing thermal perception. This would allow the athlete to feel cooler when exercising at the same work rate in the heat. Menthol has been investigated as an internal and external intervention. Greater benefits have currently been found for internal interventions than external methods. Future research should focus on the mechanisms, dosage, and timing of both internal and external interventions, and the role menthol could play within speed or strength.

The effect of ice slurry ingestion on body temperature and cycling performance in competitive athletes

The effects of pre cooling on endurance performance are widely known. In contrast, the approach of cooling during endurance exercise in combination with pre-exercise cooling has been poorly understood. The purpose of the present study was to determine whether the effects of precooling and cooling during exercise enhance exercise performance compared to the ingestion of a thermo-neutral beverage (20 °C) or precooling alone in cycling performance. This was an experimental study using a randomised crossover design in which 7 cyclists underwent three trials comprising of 45 min steady state cycling (SS) at 70% VO₂ max and a subsequent 10 km time trial (TT) in hot conditions (32 °C, 50% relative humidity). Rectal temperature (T_re), heat storage (HS), heart rate (HR), blood lactate concentration (BLA) and thermal sensation (TS) were measured. The intervention consisted of: (1) ingestion of thermo-neutral beverage before and during SS cycling (TN), (2) ingestion of ice slurry beverage and application of iced towels (precooling) prior to exercise, and then ingestion of thermo-neutral beverage during SS (PRE) and (3) precooling strategy as above plus ice slurry ingestion during SS cycling (PRE + MID). The intake of thermo-neutral or ice slurry beverage (14 g/kg) occurred over 30 min before and every 15 min during SS cycling. There was no significant difference in TT performance between all the conditions (P =0.72). However, PRE and PRE + MID caused a significant decrease in T_re (P < 0.05) from TN during exercise. Accordingly, both precooling and a combination of precooling and mid-cooling during exercise in hot conditions may be a practical and effective way of reducing core temperature. Future studies should investigate longer distance events and timing of ice slurry ingestion.

Topical and Ingested Cooling Methodologies for Endurance Exercise Performance in the Heat

This systematic review and meta-analysis aimed to assess studies which have investigated cooling methodologies, their timing and effects, on endurance exercise performance in trained athletes (Category 3; VO_2max ≥ 55 mL·kg·min⁻¹) in hot environmental conditions (≥28 °C). Meta-analyses were performed to quantify the effects of timings and methods of application, with a narrative review of the evidence also provided. A computer-assisted database search was performed for articles investigating the effects of cooling on endurance performance and accompanying physiological and perceptual responses. A total of 4129 results were screened by title, abstract, and full text, resulting in 10 articles being included for subsequent analyses. A total of 101 participants and 310 observations from 10 studies measuring the effects of differing cooling strategies on endurance exercise performance and accompanying physiological and perceptual responses were included. With respect to time trial performance, cooling was shown to result in small beneficial effects when applied before and throughout the exercise bout (Effect Size: −0.44; −0.69 to −0.18), especially when ingested (−0.39; −0.60 to −0.18). Current evidence suggests that whilst other strategies ameliorate physiological or perceptual responses throughout endurance exercise in hot conditions, ingesting cooling aids before and during exercise provides a small benefit, which is of practical significance to athletes’ time trial performance.

Sports and environmental temperature: From warming-up to heating-up

Most professional and recreational athletes perform pre-conditioning exercises, often collectively termed a 'warm-up' to prepare for a competitive task. The main objective of warming-up is to induce both temperature and non-temperature related responses to optimize performance. These responses include increasing muscle temperature, initiating metabolic and circulatory adjustments, and preparing psychologically for the upcoming task. However, warming-up in hot and/or humid ambient conditions increases thermal and circulatory strain. As a result, this may precipitate neuromuscular and cardiovascular impairments limiting endurance capacity. Preparations for competing in the heat should include an acclimatization regimen. Athletes should also consider cooling interventions to curtail heat gain during the warm-up and minimize dehydration. Indeed, although it forms an important part of the pre-competition preparation in all environmental conditions, the rise in whole-body temperature should be limited in hot environments. This review provides recommendations on how to build an effective warm-up following a 3 stage RAMP model (Raise, Activate and Mobilize, Potentiate), including general and context specific exercises, along with dynamic flexibility work. In addition, this review provides suggestion to manipulate the warm-up to suit the demands of competition in hot environments, along with other strategies to avoid heating-up.

Comparison of the effects of cold water and ice ingestion on endurance cycling capacity in the heat

PURPOSE

The purpose of this study was to examine the effects of pre-cooling and fluid replacement with either crushed ice or cold water.

METHODS

On 2 separate occasions, in a counterbalanced order, 9 recreationally-trained males ingested 1.25 g/kg (80-100 g) of either crushed ice (0.5°C) or cold water (4°C) every 5 min for 30 min before exercise. They also ingested 2.0 g/kg (130-160 g) of the same treatment drink at 15 min, 30 min, and 45 min after the commencement of cycling to exhaustion at 60%VO_2max until voluntary exhaustion in a hot environment (35°C and 30% relative humidity).

RESULTS

The cycling time to exhaustion in the crushed ice trial (50.0 ± 12.2 min) was longer than the cold water trial (42.2 ± 10.1 min; p = 0.02). Although the rectal temperature fell by 0.37°C ± 0.03°C (p = 0.01) at the end of the resting period after the crushed ice ingestion, the rates of rise in rectal temperature during the exercise period were not significantly different between these 2 conditions (crushed ice: 0.23°C ± 0.07°C, 5 min; cold water: 0.22°C ± 0.07°C, 5 min; p = 0.94).

CONCLUSION

Crushed ice ingestion before and during exercise in a hot environment may be a preferred and effective approach for minimizing thermal strain, and for improving endurance performance as compared with cold water ingestion.

Effect of the timing of ice slurry ingestion for precooling on endurance exercise capacity in a warm environment

It has been demonstrated that precooling with ice slurry ingestion enhances endurance exercise capacity in the heat. However, no studies have yet evaluated the optimal timing of ice slurry ingestion for precooling. This study aimed to investigate the effects of varying the timing of ice slurry ingestion for precooling on endurance exercise capacity in a warm environment. Ten active male participants completed 3 experimental cycling trials to exhaustion at 55% peak power output (PPO) after 15min of warm-up at 30% PPO at 30°C and 80% relative humidity. Three experimental conditions were set: no ice slurry ingestion (CON), pre-warm-up ice slurry ingestion (-1°C; 7.5gkg^-1) (PRE), and post-warm-up ice slurry ingestion (POST). Rectal and mean skin temperatures at the beginning of exercise in the POST condition (37.1±0.2°C, 33.8±0.9°C, respectively) were lower than those in the CON (37.5±0.3°C; P<0.001, 34.8±0.8°C; P<0.01, respectively) and PRE (37.4±0.2°C; P<0.01, 34.6±0.7°C; P<0.01, respectively) conditions. These reductions increased heat storage capacity and resulted in improved exercise capacity in the POST condition (60.2±8.7min) compared to that in the CON (52.0±11.9min; effect size [ES]=0.78) and PRE (56.9±10.4min; ES=0.34) conditions. Ice slurry ingestion after warm-up effectively reduced both rectal and skin temperatures and increased cycling time to exhaustion in a warm environment. Timing ice slurry ingestion to occur after warm-up may be effective for precooling in a warm environment.

Ice ingestion with a long rest interval increases the endurance exercise capacity and reduces the core temperature in the heat

Background

The timing in which ice before exercise should be ingested plays an important role in optimizing its success. However, the effects of differences in the timing of ice ingestion before exercise on cycling capacity, and thermoregulation has not been studied. The aim of the present study was to assess the effect of length of time after ice ingestion on endurance exercise capacity in the heat.

Methods

Seven males ingested 1.25 g kg body mass⁻¹ of ice (0.5 °C) or cold water (4 °C) every 5 min, six times. Under three separate conditions after ice or water ingestion ([1] taking 20 min rest after ice ingestion, [2] taking 5 min rest after ice ingestion, and [3] taking 5 min rest after cold water ingestion), seven physically active male cyclists exercised at 65% of their maximal oxygen uptake to exhaustion in the heat (35 °C, 30% relative humidity).

Results

Participants cycled significantly longer following both ice ingestion with a long rest interval (46.0 ± 7.7 min) and that with a short rest interval (38.7 ± 5.7 min) than cold water ingestion (32.3 ± 3.2 min; both p < 0.05), and the time to exhaustion was 16% (p < 0.05) longer for ice ingestion with a long rest interval than that with a short rest interval. Ice ingestion with a long rest interval (−0.55 ± 0.07 °C; both p < 0.05) allowed for a greater drop in the core temperature than both ice ingestion with a short rest interval (−0.36 ± 0.16 °C) and cold water ingestion (−0.11 ± 0.14 °C). Heat storage under condition of ice ingestion with a long rest interval during the pre-exercise period was significantly lower than that observed with a short rest interval (−4.98 ± 2.50 W m⁻²; p < 0.05) and cold water ingestion (2.86 ± 4.44 W m⁻²).

Conclusions

Therefore, internal pre-cooling by ice ingestion with a long rest interval had the greatest benefit on exercise capacity in the heat, which is suggested to be driven by a reduced rectal temperature and heat storage before the start of exercise.

Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations

Exercise-induced increases in core body temperature could negative impact performance and may lead to development of heat-related illnesses. The use of cooling techniques prior (pre-cooling), during (per-cooling) or directly after (post-cooling) exercise may limit the increase in core body temperature and therefore improve exercise performance. The aim of the present review is to provide a comprehensive overview of current scientific knowledge in the field of pre-cooling, per-cooling and post-cooling. Based on existing studies, we will discuss 1) the effectiveness of cooling interventions, 2) the underlying physiological mechanisms and 3) practical considerations regarding the use of different cooling techniques. Furthermore, we tried to identify the optimal cooling technique and compared whether cooling-induced performance benefits are different between cool, moderate and hot ambient conditions. This article provides researchers, physicians, athletes and coaches with important information regarding the implementation of cooling techniques to maintain exercise performance and to successfully compete in thermally stressful conditions.

Evidence of viscerally-mediated cold-defence thermoeffector responses in man

KEY POINTS

Visceral thermoreceptors that modify thermoregulatory responses are widely accepted in animal but not human thermoregulation models. Recently, we have provided evidence of viscerally-mediated sweating alterations in humans during exercise brought about by warm and cool fluid ingestion. In the present study, we characterize the modification of shivering and whole-body thermal sensation during cold stress following the administration of a graded thermal stimuli delivered to the stomach via fluid ingestion at 52, 37, 22 and 7°C. Despite no differences in core and skin temperature, fluid ingestion at 52°C rapidly decreased shivering and sensations of cold compared to 37°C, whereas fluid ingestion at 22 and 7°C led to equivalent increases in these responses. Warm and cold fluid ingestion independently modifies cold defence thermoeffector responses, supporting the presence of visceral thermoreceptors in humans. However, the cold-defence thermoeffector response patterns differed from previously identified hot-defence thermoeffectors.

ABSTRACT

Sudomotor activity is modified by both warm and cold fluid ingestion during heat stress, independently of differences in core and skin temperatures, suggesting independent viscerally-mediated modification of thermoeffectors. The present study aimed to determine whether visceral thermoreceptors modify shivering responses to cold stress. Ten males (mean ± SD: age 27 ± 5 years; height 1.73 ± 0.06 m, weight 78.4 ± 10.7 kg) underwent whole-body cooling via a water perfusion suit at 5°C, on four occasions, to induce a steady-state shivering response, at which point two aliquots of 1.5 ml kg^-1 (SML) and 3.0 ml kg^-1 (LRG), separated by 20 min, of water at 7, 22, 37 or 52°C were ingested. Rectal, mean skin and mean body temperature (T_b ), electromyographic activity (EMG), metabolic rate (M) and whole-body thermal sensation on a visual analogue scale (WBTS) ranging from 0 mm (very cold) to 200 mm (very hot) were all measured throughout. T_b was not different between all fluid temperatures following SML fluid ingestion (7°C: 35.7 ± 0.5°C; 22°C: 35.6 ± 0.5°C; 37°C: 35.5 ± 0.4°C; 52°C: 35.5 ± 0.4°C; P = 0.27) or LRG fluid ingestion (7°C: 35.3 ± 0.6°C; 22°C: 35.3 ± 0.5°C; 37°C: 35.2 ± 0.5°C; 52°C: 35.3 ± 0.5°C; P = 0.99). With SML fluid ingestion, greater metabolic rates and cooler thermal sensations were observed with ingestion at 7°C (M: 179 ± 55 W, WBTS: 29 ± 21 mm) compared to 52°C (M: 164 ± 34 W, WBTS: 51 ± 28 mm; all P < 0.05). With LRG ingestion, compared to shivering and thermal sensations with ingestion at 37°C (M: 215 ± 47 W, EMG: 3.9 ± 2.5% MVC, WBTS: 33 ± 2 mm), values were different (all P < 0.05) following ingestion at 7°C (M: 269 ± 77 W, EMG: 5.5 ± 0.9% MVC, WBTS: 14 ± 12 mm), 22°C (M: 270 ± 86 W, EMG: 5.6 ± 1.0% MVC, WBTS: 18 ± 19 mm) and 52°C (M: 179 ± 34 W, EMG: 3.3 ± 2.1% MVC, WBTS: 53 ± 28 mm). In conclusion, fluid ingestion at 52°C decreased shivering and the sensation of coolness, whereas fluid ingestion at 22 and 7°C increased shivering and sensations of coolness to similar levels, independently of core and skin temperature.

CAERvest® - a novel endothermic hypothermic device for core temperature cooling: safety and efficacy testing

INTRODUCTION

Cooling of the body is used to treat hyperthermic individuals with heatstroke or to depress core temperature below normal for neuroprotection. A novel, chemically activated, unpowered cooling device, CAERvest®, was investigated for safety and efficacy.

METHODS

Eight healthy male participants (body mass 79.9 ± 1.9 kg and body fat percentage 16.1 ± 3.8%) visited the laboratory (20 °C, 40% relative humidity) on four occasions. Following 30-min rest, physiological and perceptual measures were recorded. Participants were then fitted with the CAERvest® proof of concept (PoC) or prototype 1 (P1), 2 (P2) or 3 (P3) for 60 min. Temperature, cardiovascular and perceptual measures were recorded every 5 min. After cooling, the CAERvest® was removed and the torso checked for cold-related injuries.

RESULTS

Temperature measures significantly (p < 0.05) reduced pre to post in all trials. Larger reductions in core and skin temperatures were observed for PoC (-0.36 ± 0.18 and -1.55 ± 0.97 °C) and P3 (-0.36 ± 0.22 and -2.47 ± 0.82 °C), compared with P1 and P2. No signs of cold-related injury were observed at any stage.

CONCLUSION

This study demonstrates that the CAERvest® is an effective device for reducing body temperature in healthy normothermic individuals without presence of cold injury. Further research in healthy and clinical populations is warranted.

Ice Slurry Ingestion Leads to a Lower Net Heat Loss during Exercise in the Heat

PURPOSE

To compare the reductions in evaporative heat loss from the skin (Esk) to internal heat loss (Hfluid) induced by ice slurry (ICE) ingestion relative to 37 °C fluid and the accompanying body temperature and local thermoeffector responses during exercise in warm, dry conditions (33.5 °C ± 1.4 °C; 23.7% ± 2.6% relative humidity [RH]).

METHODS

Nine men cycled at approximately 55% VO2peak for 75 min and ingested 3.2 mL · kg(-1) aliquots of 37 °C fluid or ICE after 15, 30, and 45 min of exercise. Metabolic heat production (M-W), rectal temperature (Tre), mean skin temperature (Tsk), whole-body sweat loss (WBSL), local sweat rate (LSR), and skin blood flow (SkBF) were measured throughout. Net heat loss (HLnet) and heat storage (S) were estimated using partitional calorimetry.

RESULTS

Relative to the 37 °C trial, M-W was similar (P = 0.81) with ICE ingestion; however, the 200 ± 20 kJ greater Hfluid (P < 0.001) with ICE ingestion was overcompensated by a 381 ± 199-kJ lower Esk (P < 0.001). Net heat loss (HLnet) was consequently 131 ± 120 kJ lower (P = 0.01) and S was greater (P = 0.05) with ICE ingestion compared with 37 °C fluid ingestion. Concurrently, LSR and WBSL were lower by 0.16 ± 0.14 mg · min(-1) · cm(-2) (P < 0.01) and 191 ± 122 g (P < 0.001), respectively, and SkBF tended to be lower (P = 0.06) by 5.4%maxAU ± 13.4%maxAU in the ICE trial. Changes in Tre and Tsk were similar throughout exercise with ICE compared to 37 °C fluid ingestion.

CONCLUSIONS

Relative to 37 °C, ICE ingestion caused disproportionately greater reductions in Esk relative to Hfluid, resulting in a lower HLnet and greater S. Mechanistically, LSR and possibly SkBF were suppressed independently of Tre or Tsk, reaffirming the concept of human abdominal thermoreception. From a heat balance perspective, recommendations for ICE ingestion during exercise in warm, dry conditions should be reconsidered.

Effects of Intermittent Neck Cooling During Repeated Bouts of High-Intensity Exercise

The purpose of this investigation was to determine the influence of intermittent neck cooling during exercise bouts designed to mimic combat sport competitions. Participants (n = 13, age = 25.3 ± 5.0 year height = 176.9 ± 7.5 cm, mass = 79.3 ± 9.0 kg, body fat = 11.8% ± 3.1%) performed three trials on a cycle ergometer. Each trial consisted of two, 5-min high-intensity exercise (HEX) intervals (HEX1 and HEX2—20 s at 50% peak power, followed by 15 s of rest), and a time to exhaustion (TTE) test. One-minute rest intervals were given between each round (RI1 and RI2), during which researchers treated the participant’s posterior neck with either (1) wet-ice (ICE); (2) menthol spray (SPRAY); or (3) no treatment (CON). Neck (T_NECK) and chest (T_CHEST) skin temperatures were significantly lower following RI1 with ICE (vs. SPRAY). Thermal sensation decreased with ICE compared to CON following RI1, RI2, TTE, and a 2-min recovery. Rating of perceived exertion was also lower with ICE following HEX2 (vs. CON) and after RI2 (vs. SPRAY). Treatment did not influence TTE (68.9 ± 18.9s). The ability of intermittent ICE to attenuate neck and chest skin temperature rises during the initial HEX stages likely explains why participants felt cooler and less exerted during equivalent HEX bouts. These data suggest intermittent ICE improves perceptual stress during short, repeated bouts of vigorous exercise.

Comparison of Gastrointestinal and Rectal Temperatures During Recovery After a Warm-Weather Road Race

CONTEXT

It has been well established that gastrointestinal temperature (TGI) tracks closely with rectal temperature (TREC) during exercise. However, the field use of TGI pills is still being examined, and little is known about how measurements obtained using these devices compare during recovery after exercise in warm weather.

OBJECTIVE

To compare TGI and TREC in runners who completed an 11.3-km warm-weather road race and determine if runners with higher TGI and TREC present with greater passive cooling rates during recovery.

DESIGN

Cross-sectional study.

SETTING

Field.

PATIENTS OR OTHER PARTICIPANTS

Thirty recreationally active runners (15 men, 15 women; age = 39 ± 11 years, weight = 68.3 ± 11.7 kg, body fat = 19.2% ± 5.0%).

MAIN OUTCOME MEASURE(S)

The TGI and TREC were obtained immediately after the race and during a 20-minute passive rest at the 2014 Falmouth Road Race (heat index = 26.2°C ± 0.9°C). Temperatures were taken every 2 minutes during passive rest. The main dependent variables were mean bias and limits of agreement for TGI and TREC, using Bland-Altman analysis, and the 20-minute passive cooling rates for TGI and TREC.

RESULTS

No differences were evident between TGI and TREC throughout passive rest (P = .542). The passive cooling rates for TGI and TREC were 0.046 ± 0.031°C·min(-1) and 0.060 ± 0.036°C·min(-1), respectively. Runners with higher TGI and TREC at the start of cooling had higher cooling rates (R = 0.682, P < .001 and R = 0.54, P = .001, respectively). The mean bias of TGI during the 20-minute passive rest was -0.06°C ± 0.56°C with 95% limits of agreement of ±1.09°C.

CONCLUSIONS

After participants completed a warm-weather road race, TGI provided a valid measure of body temperature compared with the criterion measure of TREC. Therefore, TGI may be a viable option for monitoring postexercise-induced hyperthermia, if the pill is administered prophylactically.

Consensus Recommendations on Training and Competing in the Heat

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise–heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat.