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Bandiera D, Racinais S, Garrandes F, Adami PE, Bermon S, Pitsiladis YP, Tessitore A. Heat-related risk at Paris 2024: a proposal for classification and review of International Federations policies. Br J Sports Med 2024; 58:860-869. [PMID: 38950917 DOI: 10.1136/bjsports-2024-108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/03/2024]
Abstract
Several International Federations (IFs) employ specific policies to protect athletes' health from the danger of heat. Most policies rely on the measurement of thermal indices such as the Wet Bulb Globe Temperature (WBGT) to estimate the risk of heat-related illness. This review summarises the policies implemented by the 32 IFs of the 45 sports included in the Paris 2024 Olympic Games. It provides details into the venue type, measured parameters, used thermal indices, measurement procedures, mitigation strategies and specifies whether the policy is a recommendation or a requirement. Additionally, a categorisation of sports' heat stress risk is proposed. Among the 15 sports identified as high, very high or extreme risk, one did not have a heat policy, three did not specify any parameter measurement, one relied on water temperature, two on air temperature and relative humidity, seven on WBGT (six measured on-site and one estimated) and one on the Heat Stress Index. However, indices currently used in sports have been developed for soldiers or workers and may not adequately reflect the thermal strain endured by athletes. Notably, they do not account for the athletes' high metabolic heat production and their level of acclimation. It is, therefore, worthwhile listing the relevance of the thermal indices used by IFs to quantify the risk of heat stress, and in the near future, develop an index adapted to the specific needs of athletes.
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Affiliation(s)
- David Bandiera
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Roma, Italy
- Environmental Stress Unit, CREPS Montpellier-Font Romeu, Montpellier, France
| | - Sebastien Racinais
- Environmental Stress Unit, CREPS Montpellier-Font Romeu, Montpellier, France
- UMR 866 INRAE Université de Montpellier, Montpellier, France
| | | | | | | | - Yannis P Pitsiladis
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Roma, Italy
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, Kowloon, Hong Kong
| | - Antonio Tessitore
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Roma, Italy
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Kerr ZY, Diana JC, Adams WM, Register-Mihalik JK, Nedimyer AK. The initial visibility of updated recommendations on preseason heat safety in high school athletics among United States athletic trainers. PLoS One 2024; 19:e0300669. [PMID: 38517911 PMCID: PMC10959349 DOI: 10.1371/journal.pone.0300669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024] Open
Abstract
Updated recommendations on preseason heat safety in high school (HS) athletics ("2021 Consensus Statements") were published in April 2021. This cross-sectional survey study explored the initial roll-out of the 2021 Consensus Statements, including their visibility among United States HS athletic trainers (ATs) and perceived levels of confidence in implementing them. Recruitment occurred first, from a random selection of ATs from the Board of Certification, Inc., and second, an open invitation via social media. An online cross-sectional questionnaire had participating ATs note whether they had seen the 2021 Consensus Statements. If yes, ATs reported their perceived level of confidence in implementing them (5-point-ordinal scale from "not at all confident" to "very confident); if no, ATs disclosed (open-ended) why they had not yet seen them. Descriptive statistics were calculated for quantitative variables; template analysis identified codes related to visibility of and confidence in implementing 2021 Consensus Statements. Nearly half (45.7%) of 116 responding HS ATs reported having seen at least one 2021 Consensus Statements; 23.3% had reviewed all three. Common reasons among the 63 that had not seen them included: not aware they were published (n = 22), have yet to read them (n = 19), and believed they could not access the journal (n = 10). Of the 53 ATs having seen at least one of the 2021 Consensus Statements, 67.9% (n = 36) were very/fairly confident in implementing them at their HS. Reasons for confidence included their schools ensuring up-to-date EHI prevention and management practices (n = 18) and athletics constituent support (n = 8). This exploratory study observed proportions of surveyed HS ATs that had not seen the 2021 Consensus Statements and were not confident in implementing them. Findings highlight the need to continue improving messaging about access to best-practice recommendations. Further, continued efforts inclusive of active and passive dissemination strategies across all athletics constituents are needed to aid proper implementation.
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Affiliation(s)
- Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jake C. Diana
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - William M. Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, United States of America
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, United States of America
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States of America
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Aliza K. Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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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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Guzman-Echavarria G, Middel A, Vanos J. Beyond heat exposure - new methods to quantify and link personal heat exposure, stress, and strain in diverse populations and climates: The journal Temperature toolbox. Temperature (Austin) 2022; 10:358-378. [PMID: 37554380 PMCID: PMC10405775 DOI: 10.1080/23328940.2022.2149024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022] Open
Abstract
Fine-scale personal heat exposure (PHE) information can help prevent or minimize weather-related deaths, illnesses, and reduced work productivity. Common methods to estimate heat risk do not simultaneously account for the intensity, frequency, and duration of thermal exposures, nor do they include inter-individual factors that modify physiological response. This study demonstrates new whole-body net thermal load estimations to link PHE to heat stress and strain over time. We apply a human-environment heat exchange model to examine how time-varying net thermal loads differ across climate contexts, personal attributes, and spatiotemporal scales. First, we investigate summertime climatic PHE impacts for three US cities: Phoenix, Miami, and New York. Second, we model body morphology and acclimatization for three profiles (middle-aged male/female; female >65 years). Finally, we quantify model sensitivity using representative data at synoptic and micro-scales. For all cases, we compare required and potential evaporative heat losses that can lead to dangerous thermal exposures based on (un)compensable heat stress. Results reveal misclassifications in heat stress or strain due to incomplete environmental data and assumed equivalent physiology and activities between people. Heat strain is most poorly represented by PHE alone for the elderly, non-acclimatized, those engaged in strenuous activities, and when negating solar radiation. Moreover, humid versus dry heat across climates elicits distinct thermal responses from the body. We outline criteria for inclusive PHE evaluations connecting heat exposure, stress, and strain while using physiological-based methods to avoid misclassifications. This work underlines the value of moving from "one-size-fits-all" thermal indices to "fit-for-purpose" approaches using personalized information.
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Affiliation(s)
- Gisel Guzman-Echavarria
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, USA
| | - Ariane Middel
- School of Arts, Media and Engineering, Arizona State University, Tempe, AZ, USA
- School of Computing and Augmented Intelligence, Arizona State University,Tempe, AZ, USA
| | - Jennifer Vanos
- School of Sustainability, Arizona State University, Tempe, AZ, USA
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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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Roberts WO, Armstrong LE, Sawka MN, Yeargin SW, Heled Y, O'Connor FG. ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. Curr Sports Med Rep 2021; 20:470-484. [PMID: 34524191 DOI: 10.1249/jsr.0000000000000878] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.
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Affiliation(s)
- William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
| | | | - Michael N Sawka
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Yuval Heled
- Clinical and Integrative Physiology Unit, Heller Institute of Medical Research, Sheba Medical Center, ISRAEL
| | - Francis G O'Connor
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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Adams WM, Hosokawa Y, Casa DJ, Périard JD, Racinais S, Wingo JE, Yeargin SW, Scarneo-Miller SE, Kerr ZY, Belval LN, Alosa D, Csillan D, LaBella C, Walker L. Roundtable on Preseason Heat Safety in Secondary School Athletics: Heat Acclimatization. J Athl Train 2021; 56:352-361. [PMID: 33878177 DOI: 10.4085/1062-6050-596-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics. DATA SOURCES An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed. CONCLUSIONS A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.
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Affiliation(s)
- William M Adams
- Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | - Sebastien Racinais
- Research and Scientific Support Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
| | | | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas
| | - Denise Alosa
- Athletic Medicine, South Burlington School District, Burlington, VT.,College of Nursing and Health Science, University of Vermont, Burlington
| | - David Csillan
- Department of Physical Therapy, Princeton Orthopedic Associates, NJ
| | - Cynthia LaBella
- Department of Pediatrics, Northwestern University Feinberg School of Medicine Institute for Sports Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, IL
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Vanos JK, Rykaczewski K, Middel A, Vecellio DJ, Brown RD, Gillespie TJ. Improved methods for estimating mean radiant temperature in hot and sunny outdoor settings. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:967-983. [PMID: 33909138 DOI: 10.1007/s00484-021-02131-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Thermal comfort research has utilized various sensors and models to estimate the mean radiant temperature (MRT) experienced by a human, including the standard black globe thermometer (SGT), acrylic globe thermometers (AGT), and cylindrical radiation thermometers (CRT). Rather than directly measuring radiation, a temperature is measured in the center of these low-cost sensors that can be related to MRT after theoretically accounting for convection. However, these sensors have not been systematically tested under long-term hot and clear conditions. Further, under variable weather conditions, many issues can arise due to slow response times, shape, inaccuracies in material properties and assumptions, and color (albedo, emissivity) inconsistencies. Here, we assess the performance of MRT produced by various heat transfer models, with and without new average surface temperature ([Formula: see text]) correction factors, using five instruments-the SGT (15 cm, black), tan and black CRTs, gray and black 38 mm AGTs-compared to 3D integral radiation measurements. Measurements were taken on an unobscured roof throughout summer-to-early-fall months in Tempe, Arizona, examining 58 full-sun days. Deviations without correcting for asymmetrical surface heating-found to be the main cause of errors-reached ± 15-20 °C MRT. By accounting for asymmetric heating through [Formula: see text] calculations, new corrective algorithms were derived for the low-cost sensor models. Results show significant improvements in the estimated MRT error for each sensor (i.e., ∆MRTmodel - IRM) when applying the [Formula: see text] corrections. The tan MRTCRT improved from 1.9 ± 6.2 to -0.1 ± 4.4 °C, while the gray AGT and SGT showed improvements from -1.6 ± 7.2 to -0.4 ± 6.3 °C and - 6.6 ± 6.4 to - 0.03 ± 5.7 °C, respectively. The new corrections also eliminated dependence on other meteorological factors (zenith, wind speed). From these results, we provide three simple equations for CRT, AGT, and SGT correction for future research use under warm-hot and clear conditions. This study is the most comprehensive empirical assessment of various low-cost instruments with broad applicability in urban climate and biometeorological research.
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Affiliation(s)
- Jennifer K Vanos
- School of Sustainability, Arizona State University, Tempe, AZ, USA.
| | - Konrad Rykaczewski
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA
| | - Ariane Middel
- School of Arts, Media and Engineering, Herberger Institute for Design and the Arts, Arizona State University, Tempe, AZ, USA
| | - Daniel J Vecellio
- Department of Geography, Texas A&M University, College Station, TX, USA
| | - Robert D Brown
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Terry J Gillespie
- School of Environmental Sciences, University of Guelph, Guelph, Ontario, Canada
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Adams WM, Hosokawa Y, Casa DJ. Preseason Heat Safety in Secondary School Athletics. J Athl Train 2021; 56:349-351. [PMID: 33878176 DOI: 10.4085/1062-6050-430-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- William M Adams
- Hydration, Environment and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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