Cross-adaptation from heat stress to hypoxia: A systematic review and exploratory meta-analysis.

Cross-adaptation (CA) refers to the successful induction of physiological adaptation under one environmental stressor (e.g., heat), to enable subsequent benefit in another (e.g., hypoxia). This systematic review and exploratory meta-analysis investigated the effect of heat acclimation (HA) on physiological, perceptual and physical performance outcome measures during rest, and submaximal and maximal intensity exercise in hypoxia. Database searches in Scopus and MEDLINE were performed. Studies were included when they met the Population, Intervention, Comparison, and Outcome criteria, were of English-language, peer-reviewed, full-text original articles, using human participants. Risk of bias and study quality were assessed using the COnsensus based Standards for the selection of health status Measurement INstruments checklist. Nine studies were included, totalling 79 participants (100 % recreationally trained males). The most common method of HA included fixed-intensity exercise comprising 9 ± 3 sessions, 89 ± 24-min in duration and occurred within 39 ± 2 °C and 32 ± 13 % relative humidity. CA induced a moderate, beneficial effect on physiological measures at rest (oxygen saturation: g = 0.60) and during submaximal exercise (heart rate: g = -0.65, core temperature: g = -0.68 and skin temperature: g = -0.72). A small effect was found for ventilation (g = 0.24) and performance measures (peak power: g = 0.32 and time trial time: g = -0.43) during maximal intensity exercise. No effect was observed for perceptual outcome measures. CA may be appropriate for individuals, such as occupational or military workers, whose access to altitude exposure prior to undertaking submaximal activity in hypoxic conditions is restricted. Methodological variances exist within the current literature, and females and well-trained individuals have yet to be investigated. Future research should focus on these cohorts and explore the mechanistic underpinnings of CA.

A feasibility study of the use of UmbiFlow™ to assess the impact of heat stress on fetoplacental blood flow in field studies.

OBJECTIVE: To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS: This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS: A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS: The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.

Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study.

BACKGROUND: Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS: We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS: Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION: Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING: The Wellcome Trust.

Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa.

Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.

Exercise hyperthermia induces greater changes in gastrointestinal permeability than equivalent passive hyperthermia.

Hyperthermia and exertional heat illness increase gastrointestinal (GI) permeability, although whether the latter is only via hyperthermia is unclear. The aim of this pilot study was to determine whether different changes in GI permeability, characterized by an increased plasma lactulose:rhamnose concentration ratio ([L:R]), occurred in exercise hyperthermia in comparison to equivalent passive hyperthermia. Six healthy adult male participants (age 25 ± 5 years, mass 77.0 ± 6.7 kg, height 181 ± 6 cm, peak oxygen uptake [ V·O2peak ] 48 ± 8 ml.kg-1 .min-1 ) underwent exercise under hot conditions (Ex-Heat) and passive heating during hot water immersion (HWI). Heart rate (HR), rectal temperature (TCORE ), rating of perceived exertion (RPE), and whole-body sweat loss (WBSL) were recorded throughout the trials. The L:R ratio, peak HR, change in HR, and change in RPE were higher in Ex-Heat than HWI, despite no differences in trial duration, peak core temperature or WBSL. L:R was strongly correlated (p < 0.05) with HR peak (r = 0.626) and change in HR (r = 0.615) but no other variable. The greater L:R in Ex-Heat, despite equal TCORE responses to HWI, indicates that increased cardiovascular strain occurred during exercise, and exacerbates hyperthermia-induced GI permeability at the same absolute temperature.

Exercise heat acclimation and post-exercise hot water immersion improve resting and exercise responses to heat stress in the elderly.

OBJECTIVES: To investigate the efficacy of heat acclimation (HA) in the young (YEX) and elderly (EEX) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (EHWI). DESIGN: Cross-sectional study. METHOD: Twenty-six participants (YEX: n = 11 aged 22 ±â€¯2 years, EEX:n = 8 aged 68 ±â€¯3 years, EHWI: n = 7 aged 73 ±â€¯3 years) completed two pre-/post-tests, separated by five intervention days. YEX and EEX exercised in hot conditions to raise rectal temperature (Trec) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. EHWI completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg-1 Hprod), and a six-minute walk test (6MWT), all in 35 °C, 50% RH. RESULTS: The HA protocols did not elicit different mean heart rate (HR), Trec, and duration Trec ≥ 38.5 °C (p > 0.05) between YEX, EEX, and EHWI groups. Resting Trec, peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p < 0.05), with no difference between groups. YEX also demonstrated a reduction in resting HR (p < 0.05). No change was observed in peak Trec or HR, vascular conductance, sweat rate, or thermal comfort in any group (p > 0.05). CONCLUSIONS: Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (EEX), and post-exercise HWI (EHWI) are considered viable interventions to prepare the elderly for heat stress.

Heat acclimation improves sweat gland function and lowers sweat sodium concentration in an adult with cystic fibrosis.

We present novel data concerning the time-course of adaptations and potential benefits of heat acclimation for people with cystic fibrosis (pwCF), who are at greater risk of exertional heat illness. A 25-year-old male (genotype: delta-F508 and RH117, forced expiratory volume in 1-second: 77% predicted and baseline sweat [Na+]: 70 mmol·L - 1), who had previously experienced muscle cramping during exercise in ambient heat, underwent 10-sessions of heat acclimation (90-min at 40°C and in 40% relative humidity). Adaptations included; lower resting core temperature (-0.40°C) and heart rate (-6 beats·min-1), plasma volume expansion (+6.0%) and, importantly, increased sweat loss (+370 mL) and sweat gland activity (+12 glands·cm2) with decreased sweat [Na+] (-18 mmol·L - 1). Adaptations were maintained for at least 7-days, with no evidence of cramping during follow-up exercise-heat stress testing. These data suggest pwCF may benefit from heat acclimation to induce sudomotor function improvements, particularly reductions in sweat [Na+], however, further research is required.

A protocol for an observational cohort study of heat strain and its effect on fetal wellbeing in pregnant farmers in The Gambia.

Introduction: Climate change predictions indicate that global temperatures are likely to exceed those seen in the last 200,000 years, rising by around 4°C above pre-industrial levels by 2100 (without effective mitigation of current emission rates). In regions of the world set to experience extreme temperatures, women often work outside in agriculture even during pregnancy. The implications of heat strain in pregnancy on maternal health and pregnancy outcome are not well understood. This protocol describes a study to assess the physiological response of pregnant women to environmental heat stress and the immediate effect this has on fetal wellbeing. Methods and analysis: The study will be performed in West Kiang district, The Gambia; a semi-arid zone in West Africa with daily maximum temperatures ranging from approximately 32 to 40°C. We will recruit 125 pregnant women of all ages who perform agricultural work during their pregnancy. Participants will be followed every two months until delivery. At each study visit fetal growth will be measured by ultrasound scan. During the course of their working day we will take the following measurements: continuous maternal physiological measurements (heart rate, respiratory rate, chest skin temperature and tri-axis accelerometer data); intermittent maternal tympanic core temperature, four point skin temperature, blood pressure; intermittent fetal heart rate and, if eligible, umbilical artery doppler; intermittent environmental measurements of air temperature, humidity, solar radiation and wind speed. Venous blood and urine will be collected at beginning and end of day for biomarkers of heat strain or fetal distress and hydration status.

Heat alleviation strategies for athletic performance: A review and practitioner guidelines.

International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature.

Heat acclimation attenuates the increased sensations of fatigue reported during acute exercise-heat stress.

Athletes exercising in heat stress experience increased perceived fatigue acutely, however it is unknown whether heat acclimation (HA) reduces the magnitude of this perceptual response and whether different HA protocols influence the response. This study investigated sensations of fatigue following; acute exercise-heat stress; short- (5-sessions) and medium-term (10-sessions) HA; and between once- (ODHA) and twice-daily HA (TDHA) protocols. Twenty male participants (peak oxygen uptake: 3.75 ± 0.47 L·min-1) completed 10 sessions (60-min cycling at ~2 W·kg-1, 45°C/20% relative humidity) of ODHA (n = 10) or non-consecutive TDHA (n = 10). Sensations of fatigue (General, Physical, Emotional, Mental, Vigor and Total Fatigue) were assessed using the multi-dimensional fatigue scale inventory-short form pre and post session 1, 5 and 10. Heat adaptation was induced following ODHA and TDHA, with reductions in resting rectal temperature and heart rate, and increased plasma volume and sweat rate (P < 0.05). General, Physical and Total Fatigue increased from pre-to-post for session 1 within both groups (P < 0.05). Increases in General, Physical and Total Fatigue were attenuated in session 5 and 10 vs. session 1 of ODHA (P < 0.05). This change only occurred at session 10 of TDHA (P < 0.05). Whilst comparative heat adaptations followed ODHA and TDHA, perceived fatigue is prolonged within TDHA. ABBREVIATIONS: ∆: Change; ANOVA: Analysis of variance; HA: Heat acclimation; HR: Heart rate; IL-6: Interleukin-6; MFS-SF: Multi-dimensional fatigue symptom inventory-short form (MFSI-SF); MTHA: Medium-term heat acclimation; Na+: Sodium; ODHA: Once daily heat acclimation; PV: Plasma volume; RH: Relative humidity; RPE: Rating of perceived exertion; SD: Standard deviation; SE: Standard error of the slope coefficient or intercept; SEE : Standard error of the estimate for the regression equation; STHA: Short-term heat acclimation; TDHA: Twice daily heat acclimation; TC: Thermal Comfort; Tre: Rectal temperature; TSS: Thermal sensation; V̇O2peak: Peak oxygen uptake; WBSL: whole-body sweat loss.

Altitude training in endurance running: perceptions of elite athletes and support staff.

This study sought to establish perceptions of elite endurance athletes on the role and worth of altitude training. Elite British endurance runners were surveyed to identify the altitude and hypoxic training methods utilised, along with reasons for use, and any situational, cultural and behaviour factors influencing these. Prior to the 2012 Olympics Games, 39 athletes and 20 support staff (coaches/practitioners) completed an internet-based survey to establish differences between current practices and the accepted "best-practice". Almost all of the athletes (98%) and support staff (95%) surveyed had utilised altitude and hypoxic training, or had advised it to athletes. 75% of athletes believed altitude and hypoxia to be a "very important" factor in their training regime, with 50% of support staff believing the same. Athletes and support staff were in agreement of the methods of altitude training utilised (i.e. 'hypoxic dose' and strategy), with camps lasting 3-4 weeks at 1,500-2,500 m being the most popular. Athletes and support staff are utilising altitude and hypoxic training methods in a manner agreeing with research-based suggestions. The survey identified a number of specific challenges and priorities, which could provide scope to optimise future altitude training methods for endurance performance in these elite groups.

A comparison of two global positioning system devices for team-sport running protocols.

The comparability and reliability of global positioning system (GPS) devices during running protocols associated with team-sports was investigated. Fourteen moderately-trained males completed 690 m of straight-line movements, a 570 m change of direction (COD) course and a 642.5 m team-sport simulated circuit (TSSC); on two occasions. Participants wore a FieldWiz GPS device and a Catapult MinimaxX S4 10-Hz GPS device. Typical error of measurement (TE) and coefficient of variation (CV%) were calculated between GPS devices, for the variables of total distance and peak speed. Reliability comparisons were made within FieldWiz GPS devices, between sessions. Small TE were observed between FieldWiz and Catapult GPS devices for total distance and peak speed during straight-line (16.9 m [2%], 1.2 km·h-1 [4%]), COD (31.8 m [6%], 0.4 km·h-1 [2%]) and TSSC protocols (12.9 m [2%], 0.5 km·h-1 [2%]), respectively, with no significant mean bias (p > 0.05). Small TE were also observed for the FieldWiz GPS device between sessions (p > 0.05) for straight-line (9.6 m [1%], 0.2 km·h-1 [1%]), COD (12.8 m [2%], 0.2 km·h-1 [1%]) and TSSC protocols (6.9 m [1%], 0.6 km·h-1 [2%]), respectively. Data from the FieldWiz GPS device appears comparable to established devices and reliable across a range of movement patterns associated with team-sports.

Once- and twice-daily heat acclimation confer similar heat adaptations, inflammatory responses and exercise tolerance improvements.

This experiment aimed to investigate the efficacy of twice-daily, nonconsecutive heat acclimation (TDHA) in comparison to once-daily heat acclimation (ODHA) and work matched once- or twice-daily temperate exercise (ODTEMP, TDTEMP) for inducing heat adaptations, improved exercise tolerance, and cytokine (immune) responses. Forty males, matched biophysically and for aerobic capacity, were assigned to ODHA, TDHA, ODTEMP, or TDTEMP. Participants completed a cycling-graded exercise test, heat acclimation state test, and a time to task failure (TTTF) at 80% peak power output in temperate (TTTFTEMP : 22°C/40% RH) and hot conditions (TTTFHOT : 38°C/20% RH), before and after 10-sessions (60 min of cycling at ~2 W·kg-1 ) in 45°C/20% RH (ODHA and TDHA) or 22°C/40% RH (ODTEMP or TDTEMP). Plasma IL-6, TNF-α, and cortisol were measured pre- and postsessions 1, 5, and 10. ODHA and TDHA induced equivalent heat adaptations (P < 0.05) (resting rectal temperature [-0.28 ± 0.22, -0.28 ± 0.19°C], heart rate [-10 ± 3, -10 ± 4 b·min-1 ], and plasma volume expansion [+10.1 ± 5.6, +8.5 ± 3.1%]) and improved heat acclimation state (sweat set point [-0.22 ± 0.18, -0.22 ± 0.14°C] and gain [+0.14 ± 0.10, +0.15 ± 0.07 g·sec-1 ·°C-1 ]). TTTFHOT increased (P < 0.001) following ODHA (+25 ± 4%) and TDHA (+24 ± 10%), but not ODTEMP (+5 ± 14%) or TDTEMP (+5 ± 17%). TTTFTEMP did not improve (P > 0.05) following ODHA (+14 ± 4%), TDHA (14 ± 8%), ODTEMP (9 ± 10%) or TDTEMP (8 ± 13%). Acute (P < 0.05) but no chronic (P > 0.05) increases were observed in IL-6, TNF-α, or cortisol during ODHA and TDHA, or ODTEMP and TDTEMP. Once- and twice-daily heat acclimation conferred similar magnitudes of heat adaptation and exercise tolerance improvements, without differentially altering immune function, thus nonconsecutive TDHA provides an effective, logistically flexible method of HA, benefitting individuals preparing for exercise-heat stress.

Physiological and perceptual responses to exercising in restrictive heat loss attire with use of an upper-body sauna suit in temperate and hot conditions.

The aim of this experiment was to quantify physiological and perceptual responses to exercise with and without restrictive heat loss attire in hot and temperate conditions. Ten moderately-trained individuals (mass; 69.44±7.50 kg, body fat; 19.7±7.6%) cycled for 30-mins (15-mins at 2 W.kg-1 then 15-mins at 1 W.kg-1) under four experimental conditions; temperate (TEMP, 22°C/45%), hot (HOT, 45°C/20%) and, temperate (TEMPSUIT, 22°C/45%) and hot (HOTSUIT, 45°C/20%) whilst wearing an upper-body "sauna suit". Core temperature changes were higher (P<0.05) in TEMPSUIT (+1.7±0.4°C.hr-1), HOT (+1.9±0.5°C.hr-1) and HOTSUIT (+2.3±0.5°C.hr-1) than TEMP (+1.3±0.3°C.hr-1). Skin temperature was higher (P<0.05) in HOT (36.53±0.93°C) and HOTSUIT (37.68±0.68°C) than TEMP (33.50±1.77°C) and TEMPSUIT (33.41±0.70°C). Sweat rate was greater (P<0.05) in TEMPSUIT (0.89±0.24 L.hr-1), HOT (1.14±0.48 L.hr-1) and HOTSUIT (1.51±0.52 L.hr-1) than TEMP (0.56±0.27 L.hr-1). Peak heart rate was higher (P<0.05) in TEMPSUIT (155±23 b.min-1), HOT (163±18 b.min-1) and HOTSUIT (171±18 b.min-1) than TEMP (151±20 b.min-1). Thermal sensation and perceived exertion were greater (P<0.05) in TEMPSUIT (5.8±0.5 and 14±1), HOT (6.4±0.5 and 15±1) and HOTSUIT (7.1±0.5 and 16±1) than TEMP (5.3±0.5 and 14±1). Exercising in an upper-body sauna suit within temperate conditions induces a greater physiological strain and evokes larger sweat losses compared to exercising in the same conditions, without restricting heat loss. In hot conditions, wearing a sauna suit increases physiological and perceptual strain further, which may accelerate the stimuli for heat adaptation and improve HA efficiency.

Short-Term Heat Acclimation and Precooling, Independently and Combined, Improve 5-km Time Trial Performance in the Heat.

James, CA, Richardson, AJ, Watt, PW, Willmott, AGB, Gibson, OR, and Maxwell, NS. Short-term heat acclimation and precooling, independently and combined, improve 5-km time trial performance in the heat. J Strength Cond Res 32(5): 1366-1375, 2018-Following heat acclimation (HA), endurance running performance remains impaired in hot vs. temperate conditions. Combining HA with precooling (PC) demonstrates no additive benefit in intermittent sprint, or continuous cycling exercise protocols, during which heat strain may be less severe compared to endurance running. This study investigated the effect of short-term HA (STHA) combined with mixed methods PC, on endurance running performance and directly compared PC and HA. Nine amateur trained runners completed 5-km treadmill time trials (TTs) in the heat (32° C, 60% relative humidity) under 4 conditions; no intervention (CON), PC, short-term HA (5 days-HA) and STHA with PC (HA + PC). Mean (±SD) performance times were; CON 1,476 (173) seconds, PC 1,421 (146) seconds, HA 1,378 (116) seconds and HA + PC 1,373 (121) seconds. This equated to the following improvements versus CON; PC -3.7%, HA -6.6% and HA + PC -7.0%. Statistical differences were only observed between HA and CON (p = 0.004, d = 0.68, 95% CI [-0.27 to 1.63]) however, similar effect sizes were observed for HA + PC vs. CON (d = 0.70, 95% CI [-0.25 to 1.65]), with smaller effects between PC vs. CON (d = 0.34, 95% CI [-0.59 to 1.27]), HA vs. PC (d = 0.33, 95% CI [-0.60 to 1.26]) and HA + PC vs. PC (d = 0.36, 95% CI [-0.57 to 1.29]). Pilot testing revealed a TT typical error of 16 seconds (1.2%). Precooling offered no further benefit to performance in the acclimated individual, despite modest alleviation of physiological strain. Maintenance of running speed in HA + PC, despite reduced physiological strain, may indicate an inappropriate pacing strategy therefore, further familiarization is recommended to optimize a combined strategy. Finally, these data indicate HA, achieved through cycle training, yields a larger ergogenic effect than PC on 5-km running performance in the heat, although PC remains beneficial when HA is not possible.

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.

Sauna exposure immediately prior to short-term heat acclimation accelerates phenotypic adaptation in females.

OBJECTIVES: Investigate whether a sauna exposure prior to short-term heat acclimation (HA) accelerates phenotypic adaptation in females. DESIGN: Randomised, repeated measures, cross-over trial. METHODS: Nine females performed two 5-d HA interventions (controlled hyperthermia Tre≥38.5°C), separated by 7-wk, during the follicular phase of the menstrual cycle confirmed by plasma concentrations of 17-ß estradiol and progesterone. Prior to each 90-min HA session participants sat for 20-min in either a temperate environment (20°C, 40% RH; HAtemp) wearing shorts and sports bra or a hot environment (50°C, 30% RH) wearing a sauna suit to replicate sauna conditions (HAsauna). Participants performed a running heat tolerance test (RHTT) 24-h pre and 24-h post HA. RESULTS: Mean heart rate (HR) (85±4 vs. 68±5 bpm, p≤0.001), sweat rate (0.4±0.2 vs. 0.0±0.0Lh-1, p≤0.001), and thermal sensation (6±0 vs. 5±1, p=0.050) were higher during the sauna compared to temperate exposure. Resting rectal temperature (Tre) (-0.28±0.16°C), peak Tre (-0.42±0.22°C), resting HR (-10±4 bpm), peak HR (-12±7 bpm), Tre at sweating onset (-0.29±0.17°C) (p≤0.001), thermal sensation (-0.5±0.5; p=0.002), and perceived exertion (-3±2; p≤0.001) reduced during the RHTT, following HAsauna; but not HAtemp. Plasma volume expansion was greater following HAsauna (HAsauna, 9±7%; HAtemp, 1±5%; p=0.013). Sweat rate (p≤0.001) increased and sweat NaCl (p=0.006) reduced during the RHTT following HAsauna and HAtemp. CONCLUSIONS: This novel strategy initiated HA with an attenuation of thermoregulatory, cardiovascular, and perceptual strain in females due to a measurably greater strain in the sauna compared to temperate exposure when adopted prior to STHA.

Defining the determinants of endurance running performance in the heat.

In cool conditions, physiologic markers accurately predict endurance performance, but it is unclear whether thermal strain and perceived thermal strain modify the strength of these relationships. This study examined the relationships between traditional determinants of endurance performance and time to complete a 5-km time trial in the heat. Seventeen club runners completed graded exercise tests (GXT) in hot (GXTHOT; 32°C, 60% RH, 27.2°C WBGT) and cool conditions (GXTCOOL; 13°C, 50% RH, 9.3°C WBGT) to determine maximal oxygen uptake (V̇O2max), running economy (RE), velocity at V̇O2max (vV̇O2max), and running speeds corresponding to the lactate threshold (LT, 2 mmol.l-1) and lactate turnpoint (LTP, 4 mmol.l-1). Simultaneous multiple linear regression was used to predict 5 km time, using these determinants, indicating neither GXTHOT (R2 = 0.72) nor GXTCOOL (R2 = 0.86) predicted performance in the heat as strongly has previously been reported in cool conditions. vV̇O2max was the strongest individual predictor of performance, both when assessed in GXTHOT (r = -0.83) and GXTCOOL (r = -0.90). The GXTs revealed the following correlations for individual predictors in GXTHOT; V̇O2maxr = -0.7, RE r = 0.36, LT r = -0.77, LTP r = -0.78 and in GXTCOOL; V̇O2maxr = -0.67, RE r = 0.62, LT r = -0.79, LTP r = -0.8. These data indicate (i) GXTHOT does not predict 5 km running performance in the heat as strongly as a GXTCOOL, (ii) as in cool conditions, vV̇O2max may best predict running performance in the heat.

Cross-Adaptation: Heat and Cold Adaptation to Improve Physiological and Cellular Responses to Hypoxia.

To prepare for extremes of heat, cold or low partial pressures of oxygen (O2), humans can undertake a period of acclimation or acclimatization to induce environment-specific adaptations, e.g. heat acclimation (HA), cold acclimation (CA), or altitude training. While these strategies are effective, they are not always feasible due to logistical impracticalities. Cross-adaptation is a term used to describe the phenomenon whereby alternative environmental interventions, e.g. HA or CA, may be a beneficial alternative to altitude interventions, providing physiological stress and inducing adaptations observable at altitude. HA can attenuate physiological strain at rest and during moderate-intensity exercise at altitude via adaptations allied to improved O2 delivery to metabolically active tissue, likely following increases in plasma volume and reductions in body temperature. CA appears to improve physiological responses to altitude by attenuating the autonomic response to altitude. While no cross-acclimation-derived exercise performance/capacity data have been measured following CA, post-HA improvements in performance underpinned by aerobic metabolism, and therefore dependent on O2 delivery at altitude, are likely. At a cellular level, heat shock protein responses to altitude are attenuated by prior HA, suggesting that an attenuation of the cellular stress response and therefore a reduced disruption to homeostasis at altitude has occurred. This process is known as cross-tolerance. The effects of CA on markers of cross-tolerance is an area requiring further investigation. Because much of the evidence relating to cross-adaptation to altitude has examined the benefits at moderate to high altitudes, future research examining responses at lower altitudes should be conducted, given that these environments are more frequently visited by athletes and workers. Mechanistic work to identify the specific physiological and cellular pathways responsible for cross-adaptation between heat and altitude, and between cold and altitude, is warranted, as is exploration of benefits across different populations and physical activity profiles.