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 optimise performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimise performance is to heat acclimatise. Heat acclimatisation should comprise repeated exercise-heat exposures over 1-2 weeks. In addition, athletes should initiate competition and training in a euhydrated state and minimise dehydration during exercise. Following the development of commercial cooling systems (eg, cooling-vest), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organisers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimising 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.

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 a euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vest), 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.

Adaptations and mechanisms of human heat acclimation: Applications for competitive athletes and sports.

Exercise heat acclimation induces physiological adaptations that improve thermoregulation, attenuate physiological strain, reduce the risk of serious heat illness, and improve aerobic performance in warm-hot environments and potentially in temperate environments. The adaptations include improved sweating, improved skin blood flow, lowered body temperatures, reduced cardiovascular strain, improved fluid balance, altered metabolism, and enhanced cellular protection. The magnitudes of adaptations are determined by the intensity, duration, frequency, and number of heat exposures, as well as the environmental conditions (i.e., dry or humid heat). Evidence is emerging that controlled hyperthermia regimens where a target core temperature is maintained, enable more rapid and complete adaptations relative to the traditional constant work rate exercise heat acclimation regimens. Furthermore, inducing heat acclimation outdoors in a natural field setting may provide more specific adaptations based on direct exposure to the exact environmental and exercise conditions to be encountered during competition. This review initially examines the physiological adaptations associated with heat acclimation induction regimens, and subsequently emphasizes their application to competitive athletes and sports.

Skin temperature modifies the impact of hypohydration on aerobic performance.

This study determined the effects of hypohydration on aerobic performance in compensable [evaporative cooling requirement (E(req)) < maximal evaporative cooling (E(max))] conditions of 10 degrees C [7 degrees C wet bulb globe temperature (WBGT)], 20 degrees C (16 degrees C WBGT), 30 degrees C (22 degrees C WBGT), and 40 degrees C (27 degrees C WBGT) ambient temperature (T(a)). Our hypothesis was that 4% hypohydration would impair aerobic performance to a greater extent with increasing heat stress. Thirty-two men [22 +/- 4 yr old, 45 +/- 8 ml.kg(-1).min(-1) peak O(2) uptake (Vo(2 peak))] were divided into four matched cohorts (n = 8) and tested at one of four T(a) in euhydrated (EU) and hypohydrated (HYPO, -4% body mass) conditions. Subjects completed 30 min of preload exercise (cycle ergometer, 50% Vo(2 peak)) followed by a 15 min self-paced time trial. Time-trial performance (total work, change from EU) was -3% (P = 0.1), -5% (P = 0.06), -12% (P < 0.05), and -23% (P < 0.05) in 10 degrees C, 20 degrees C, 30 degrees C, and 40 degrees C T(a), respectively. During preload exercise, skin temperature (T(sk)) increased by approximately 4 degrees C per 10 degrees C T(a), while core (rectal) temperature (T(re)) values were similar within EU and HYPO conditions across all T(a). A significant relationship (P < 0.05, r = 0.61) was found between T(sk) and the percent decrement in time-trial performance. During preload exercise, hypohydration generally blunted the increases in cardiac output and blood pressure while reducing blood volume over time in 30 degrees C and 40 degrees C T(a). Our conclusions are as follows: 1) hypohydration degrades aerobic performance to a greater extent with increasing heat stress; 2) when T(sk) is >29 degrees C, 4% hypohydration degrades aerobic performance by approximately 1.6% for each additional 1 degrees C T(sk); and 3) cardiovascular strain from high skin blood flow requirements combined with blood volume reductions induced by hypohydration is an important contributor to impaired performance.

Expanded prediction equations of human sweat loss and water needs.

The Institute of Medicine expressed a need for improved sweating rate (msw) prediction models that calculate hourly and daily water needs based on metabolic rate, clothing, and environment. More than 25 years ago, the original Shapiro prediction equation (OSE) was formulated as msw (g.m(-2).h(-1))=27.9.Ereq.(Emax)(-0.455), where Ereq is required evaporative heat loss and Emax is maximum evaporative power of the environment; OSE was developed for a limited set of environments, exposures times, and clothing systems. Recent evidence shows that OSE often overpredicts fluid needs. Our study developed a corrected OSE and a new msw prediction equation by using independent data sets from a wide range of environmental conditions, metabolic rates (rest to 500 observations) by using a variety of metabolic rates over a range of environmental conditions (ambient temperature, 15-46 degrees C; water vapor pressure, 0.27-4.45 kPa; wind speed, 0.4-2.5 m/s), clothing, and equipment combinations and durations (2-8 h). Data are expressed as grams per square meter per hour and were analyzed using fuzzy piecewise regression. OSE overpredicted sweating rates (P<0.003) compared with observed msw. Both the correction equation (OSEC), msw=147.exp (0.0012.OSE), and a new piecewise (PW) equation, msw=147+1.527.Ereq-0.87.Emax were derived, compared with OSE, and then cross-validated against independent data (21 males and 9 females; >200 observations). OSEC and PW were more accurate predictors of sweating rate (58 and 65% more accurate, P<0.01) and produced minimal error (standard error estimate<100 g.m(-2).h(-1)) for conditions both within and outside the original OSE domain of validity. The new equations provide for more accurate sweat predictions over a broader range of conditions with applications to public health, military, occupational, and sports medicine settings.

Exercise associated hyponatraemia: quantitative analysis to understand the aetiology.

BACKGROUND: The development of symptomatic hyponatraemia consequent on participation in marathon and ultraendurance races has led to questions about its aetiology and prevention. OBJECTIVES: To evaluate: (a) the assertion that sweat sodium losses cannot contribute to the development of hyponatraemia during endurance exercise; (b) the adequacy of fluid replacement recommendations issued by the International Marathon Medical Directors Association (IMMDA) for races of 42 km or longer; (c) the effectiveness of commercial sports drinks, compared with water, for attenuating plasma sodium reductions. METHODS: A mathematical model was used to predict the effects of different drinking behaviours on hydration status and plasma sodium concentration when body mass, body composition, running speed, weather conditions, and sweat sodium concentration were systematically varied. RESULTS: Fluid intake at rates that exceed sweating rate is predicted to be the primary cause of hyponatraemia. However, the model predicts that runners secreting relatively salty sweat can finish ultraendurance exercise both dehydrated and hyponatraemic. Electrolyte-containing beverages are predicted to delay the development of hyponatraemia. The predictions suggest that the IMMDA fluid intake recommendations adequately sustain hydration over the 42 km distance if qualifiers-for example, running pace, body size-are followed. CONCLUSIONS: Actions to prevent hyponatraemia should focus on minimising overdrinking relative to sweating rate and attenuating salt depletion in those who excrete salty sweat. This simulation demonstrates the complexity of defining fluid and electrolyte consumption rates during athletic competition.

Bioelectrical impedance to estimate changes in hydration status.

Bioelectrical impedance analysis (BIA) has been suggested as a simple, rapid method to assess changes in hydration status. BIA measures the electrical impedance to a low amperage current that is affected by both water and electrolyte content of the body. While BIA can reliably estimate total body water and body density in euhydrated individuals under standardized clinical conditions, changes in fluid and electrolyte content can independently alter bioimpedance measurements. Because hydration changes typically involve concomitant changes in fluid and electrolyte content, the interpretation of a change in bioimpedance will often be confounded. This paper examines the assumptions underlying estimations of total body water from BIA and addresses the factors known to influence bioimpedance independently from actual change in total body water. The results indicate that current BIA methodology may not provide valid estimates of total body water when hydration state is altered.

Cold strain index applied to exercising men in cold-wet conditions.

A cold strain index (CSI) based on rectal (T(re)) and mean skin temperatures ((sk)) using data from seminude resting subjects has been proposed (Moran DS, Castellani JW, O'Brien C, Young AJ, and Pandolf KB. Am J Physiol Regulatory Integrative Comp Physiol 277: R556-R564, 1999). The current study determined whether CSI could provide meaningful data for clothed subjects exercising in the cold with compromised insulation. Ten men exercised in cold-wet conditions (CW) for 6 h before (D0) and after 3 days of exhaustive exercise (D3). Each hour of CW consisted of 10 min of standing in rain (5.4 cm/h, 5 degrees C air) followed by 45 min of walking (1.34 m/s, 5.4 m/s wind, 5 degrees C air). The change in T(re) across time was greater (P < 0.05) on D3 than on D0, and the change in (sk) was less (P < 0.05) on D3 than on D0. Although CSI increased across time, the index at the end of both trials (D3 = 4.6 +/- 0.6; D0 = 4.2 +/- 0.8) was similar (P > 0.05). Thus, while (sk) was 1.3 degrees C higher (P < 0.05) and T(re) was 0.3 degrees C lower (P < 0.05) on D3 than on D0, CSI did not discriminate the greater heat loss that occurred on D3. These findings indicate that when vasoconstrictor responses to cold are altered, such as after exhaustive exercise, CSI does not adequately quantify the different physiological strain between treatments. CSI may be useful for indicating increased strain across time, but its utility as a marker of strain between different treatments or studies is uncertain because no independent measure of strain has been used to determine to what extent CSI is a valid and reliable measure of strain.

Hyponatremia associated with exercise: risk factors and pathogenesis.

Exercise-related hyponatremia is an infrequent but potentially life-threatening accompaniment of prolonged exercise. This condition results from sodium losses in sweat, excessive water intake, or both. We review the risk factors for development of this condition and discuss evidence that there is a population at increased risk of hyponatremia during prolonged exercise.

Hyponatremia associated with overhydration in U.S. Army trainees.

This report describes a series of hyponatremia hospitalizations associated with heat-related injuries and apparent over-hydration. Data from the U.S. Army Inpatient Data System were used to identify all hospitalizations for hyposmolality/hyponatremia from 1996 and 1997. Admissions were considered as probable cases of overhydration hyponatremia if this was the only, or primary, diagnosis or if it was associated with any heat-related diagnosis. Seventeen medical records were identified, and the events leading to hospitalization were analyzed. The average serum sodium level was 122 +/- 5 mmol/L (range, 115-130 mmol/L). All 17 patients were soldiers attending training schools. Seventy-seven percent of hyponatremia cases occurred in the first 4 weeks of training. Nine patients had water intake rates equal to or exceeding 2 quarts per hour. Most patients were in good health before developing hyponatremia. The most common symptoms were mental status changes (88%), emesis (65%), nausea (53%), and seizures (31%). In 5 of 6 cases in which extensive history was known, soldiers drank excess amounts of water before developing symptoms and as part of field treatment. The authors conclude that hyponatremia resulted from too aggressive fluid replacement practices for soldiers in training status. The fluid replacement policy was revised with consideration given to both climatic heat stress and physical activity levels. Field medical policy should recognize the possibility of overhydration. Specific evacuation criteria should be established for exertional illness.

Heat strain evaluation of chemical protective garments.

BACKGROUND: The purpose of this study was to compare thermoregulatory and subjective responses of 12 test subjects (10 male, 2 female) wearing 5 different Joint Service Lightweight Integrated Suit Technology (JSLIST) prototype and 3 different currently fielded control chemical/ biological (CB) protective overgarments. METHODS: The overgarments were compared while subjects attempted to complete 100 min of moderate exercise (400 W) in an environmental chamber (35 degrees C/50% rh). Rectal temperature (Tre), skin temperature, heart rate, sweating rate, and test time, as well as subjective symptoms of heat illness were measured. Data were analyzed for times earlier than 100 min because subjects were not usually able to complete the 100-min trials. RESULTS: At 50 min, of the 3 controls, the Army/Air Force Battledress Overgarment (BDO) imposed significantly greater heat strain (indicated by Tre 37.90 degrees C) than the Marine Saratoga (SAR) (Tre 37.68 degrees C) and Navy Chemical Protective Overgarment (CPO) (Tre 37.69 degrees C). The JSLIST prototype garments imposed heat strain (50 min Tre 37.73-37.86 degrees C) as well as subjective perception of heat strain, that ranged between the warmest and coolest controls. CONCLUSIONS: In the environmental and exercise test conditions of this study, we did not find the five JSLIST overgarments to be consistently different from one another. Subjects in the control garments were and felt generally warmer (BDO) or cooler (SAR, CPO) than in the JSLIST prototype garments.

Hydration effects on thermoregulation and performance in the heat.

During exercise, sweat output often exceeds water intake, producing a water deficit or hypohydration. The water deficit lowers both intracellular and extracellular fluid volumes, and causes a hypotonic-hypovolemia of the blood. Aerobic exercise tasks are likely to be adversely effected by hypohydration (even in the absence of heat strain), with the potential affect being greater in hot environments. Hypohydration increases heat storage by reducing sweating rate and skin blood flow responses for a given core temperature. Hypertonicity and hypovolemia both contribute to reduced heat loss and increased heat storage. In addition, hypovolemia and the displacement of blood to the skin make it difficult to maintain central venous pressure and thus cardiac output to simultaneously support metabolism and thermoregulation. Hyperhydration provides no advantages over euhydration regarding thermoregulation and exercise performance in the heat.

Physiologic tolerance to uncompensable heat: intermittent exercise, field vs laboratory.

PURPOSE: This study determined whether exercise (30 min)-rest (10 min) cycles alter physiologic tolerance to uncompensable heat stress (UCHS) when outdoors in the desert. In addition, the relationship between core temperature and exhaustion from heat strain previously established in laboratory studies was compared with field studies. METHODS: Twelve men completed four trials: moderate intensity continuous exercise (MC), moderate intensity exercise with intermittent rest (MI), hard intensity continuous exercise (HC), and hard intensity exercise with intermittent rest (HI). UCHS was achieved by wearing protective clothing and exercising (estimated at 420 W or 610 W) outdoors in desert heat. RESULTS: Heat Stress Index values were 200%, 181%, 417%, and 283% for MC, MI, HC, and HI, respectively. Exhaustion from heat strain occurred in 36 of 48 trials. Core temperatures at exhaustion averaged 38.6 +/- 0.5 degrees, 38.9 +/- 0.6 degrees, 38.9 +/- 0.7 degrees, and 39.0 +/- 0.7 degrees C for MC, MI, HC, and HI, respectively. Core temperature at exhaustion was not altered (P > 0.05) by exercise intensity or exercise-rest cycles and 50% of subjects incurred exhaustion at core temperature of 39.4 degrees C. These field data were compared with laboratory and field data collected over the past 35 years. Aggregate data for 747 laboratory and 131 field trials indicated that 50% of subjects incurred exhaustion at core temperatures of 38.6 degrees and 39.5 degrees C, respectively. When heat intolerant subjects (exhaustion < 38.3 degrees C core temperature) were removed from the analysis, subjects from laboratory studies (who underwent short-term acclimation) still demonstrated less (0.8 degrees C) physiological tolerance than those from field studies (who underwent long-term acclimatization). CONCLUSION: Exercise-rest cycles did not alter physiologic tolerance to UCHS. In addition, subjects from field studies demonstrate greater physiologic tolerance than subjects from laboratory studies.

Heat strain imposed by toxic agent protective systems.

This study evaluated physiological heat strain from two developmental toxic agent protective systems compared with the standard Toxicological Agent Protective (TAP) suit during exercise-heat stress. Eight subjects (six men, two women) completed three experimental trials, at 38 degrees C, 30% rh, wearing: 1) Self Contained Toxic Environment Protective Outfit (STEPO) with rebreather (STEPO-R); 2) STEPO with tether (STEPO-T) or 3) the standard TAP. The STEPO systems provided effective body cooling of: STEPO-R, 200 +/- 36 W; and STEPO-T, 186 +/- 59 W. TAP had no cooling. All experimental trials used treadmill walking at 0.89 m x s(-1), 0% grade at exercise/rest cycles of 20/10 min for 240 min. Metabolic rates for the treatments were: STEPO-R, 298 +/- 26 W; STEPO-T, 299 +/- 34 W; and TAP, 222 +/- 40 W. Rate of heat storage was less (p < 0.05) in STEPO-R (37 +/- 8 W x m(-2)) and STEPO-T (38 +/- 12 W x m(-2)) than in TAP (77 +/- 15 W x m(-2)). Sweating rate was less (p < 0.05) in STEPO-T (10.0 +/- 4.8 g x min(-1)) than in TAP (23.8 x 11.4 g x min(-1)). There was no difference between STEPO-R (12.3 +/- 5.6 g min(-1)) and the other two uniform systems. Subjects did not complete targeted exposure times of 240 min. Exposure time was longer (p < 0.05) in STEPO-R (83 +/- 22 min) and STEPO-T (106 +/- 39 min) than in TAP (46 +/- 10 min). Predicted time to 39.0 degrees C was less (p < 0.05) in TAP (69 +/- 20 min) than in either STEPO-R (226 +/- 124 min) or STEPO-T (244 +/- 170 min). The results of this study show that cooling in STEPO significantly reduced heat storage relative to TAP. The new generation toxic cleanup uniform systems effectively reduced heat stress and increased work capabilities compared with the standard TAP suit.

Thermoregulation during cold exposure after several days of exhaustive exercise.

This study examined the hypothesis that several days of exhaustive exercise would impair thermoregulatory effector responses to cold exposure, leading to an accentuated core temperature reduction compared with exposure of the same individual to cold in a rested condition. Thirteen men (10 experimental and 3 control) performed a cold-wet walk (CW) for up to 6 h (6 rest-work cycles, each 1 h in duration) in 5 degrees C air on three occasions. One cycle of CW consisted of 10 min of standing in the rain (5.4 cm/h) followed by 45 min of walking (1.34 m/s, 5.4 m/s wind). Clothing was water saturated at the start of each walking period (0.75 clo vs. 1.1 clo when dry). The initial CW trial (day 0) was performed (afternoon) with subjects rested before initiation of exercise-cold exposure. During the next 7 days, exhaustive exercise (aerobic, anaerobic, resistive) was performed for 4 h each morning. Two subsequent CW trials were performed on the afternoon of days 3 and 7, approximately 2.5 h after cessation of fatiguing exercise. For controls, no exhaustive exercise was performed on any day. Thermoregulatory responses and body temperature during CW were not different on days 0, 3, and 7 in the controls. In the experimental group, mean skin temperature was higher (P < 0.05) during CW on days 3 and 7 than on day 0. Rectal temperature was lower (P < 0.05) and the change in rectal temperature was greater (P < 0.05) during the 6th h of CW on day 3. Metabolic heat production during CW was similar among trials. Warmer skin temperatures during CW after days 3 and 7 indicate that vasoconstrictor responses to cold, but not shivering responses, are impaired after multiple days of severe physical exertion. These findings suggest that susceptibility to hypothermia is increased by exertional fatigue.

Hyperhydration and glycerol: thermoregulatory effects during exercise in hot climates.

Hyperhydration or increasing body water content above normal (euhydration) level was thought to have some benefit during exercise heat-stress; however, attempts to overdrink have been minimized by a rapid diuretic response. The perception that hyperhydration might be beneficial for exercise performance and for thermoregulation arose from the adverse consequences of hypohydration. Many studies had examined the effects of hyperhydration on thermoregulation in the heat; however, most of them suffer from design problems that confound their results. The design problems included control conditions not representing euhydration but hypohydration, control conditions not adequately described, cold fluid ingestion that reduced core temperature, and/or changing heat acclimation status. Several investigators reported lower core temperatures during exercise after hyperhydration, while other studies do not. Some investigators reported higher sweating rates with hyperhydration, while other studies do not. Recent research that controlled for these confounding variables reported that hyperhydration (water or glycerol) did not alter core temperature, skin temperature, whole body sweating rate, local sweating rate, sweating threshold temperature, sweating sensitivity, or heart rate responses compared to euhydration trial. If euhydration is maintained during exercise-heat stress then hyperhydration appears to have no meaningful advantage.

Fluid and electrolyte supplementation for exercise heat stress.

During exercise in the heat, sweat output often exceeds water intake, resulting in a body water deficit (hypohydration) and electrolyte losses. Because daily water losses can be substantial, persons need to emphasize drinking during exercise as well as at meals. For persons consuming a normal diet, electrolyte supplementation is not warranted except perhaps during the first few days of heat exposure. Aerobic exercise is likely to be adversely affected by heat stress and hypohydration; the warmer the climate the greater the potential for performance decrements. Hypohydration increases heat storage and reduces a person's ability to tolerate heat strain. The increased heat storage is mediated by a lower sweating rate (evaporative heat loss) and reduced skin blood flow (dry heat loss) for a given core temperature. Heat-acclimated persons need to pay particular attention to fluid replacement because heat acclimation increases sweat losses, and hypohydration negates the thermoregulatory advantages conferred by acclimation. It has been suggested that hyperhydration (increased total body water) may reduce physiologic strain during exercise heat stress, but data supporting that notion are not robust. Research is recommended for 3 populations with fluid and electrolyte balance problems: older adults, cystic fibrosis patients, and persons with spinal cord injuries.

Impact of muscle injury and accompanying inflammatory response on thermoregulation during exercise in the heat.

This study examined whether muscle injury and the accompanying inflammatory responses alter thermoregulation during subsequent exercise-heat stress. Sixteen subjects performed 50 min of treadmill exercise (45-50% maximal O(2) consumption) in a hot room (40 degrees C, 20% relative humidity) before and at select times after eccentric upper body (UBE) and/or eccentric lower body (LBE) exercise. In experiment 1, eight subjects performed treadmill exercise before and 6, 25, and 30 h after UBE and then 6, 25, and 30 h after LBE. In experiment 2, eight subjects performed treadmill exercise before and 2, 7, and 26 h after LBE only. UBE and LBE produced marked soreness and significantly elevated creatine kinase levels (P < 0.05), but only LBE increased (P < 0.05) interleukin-6 levels. In experiment 1, core temperatures before and during exercise-heat stress were similar for control and after UBE, but some evidence for higher core temperatures was found after LBE. In experiment 2, core temperatures during exercise-heat stress were 0.2-0.3 degrees C (P < 0.05) above control values at 2 and 7 h after LBE. The added thermal strain after LBE (P < 0.05) was associated with higher metabolic rate (r = 0.70 and 0.68 at 2 and 6-7 h, respectively) but was not related (P > 0.05) to muscle soreness (r = 0.47 at 6-7 h), plasma interleukin-6 (r = 0.35 at 6-7 h), or peak creatine kinase levels (r = 0.22). Local sweating responses (threshold core temperature and slope) were not altered by UBE or LBE. The results suggest that profuse muscle injury can increase body core temperature during exercise-heat stress and that the added heat storage cannot be attributed solely to increased heat production.

Role of core temperature as a stimulus for cold acclimation during repeated immersion in 20 degrees C water.

The relative importance of skin vs. core temperature for stimulating cold acclimation (CA) was examined by 5 wk of daily 1-h water immersions (20 degrees C) in resting (RG) and exercising (EG) subjects. Rectal temperature fell (0.8 degrees C; P < 0.05) during immersion only in RG. Skin temperature fell (P < 0.05) similarly in both groups. Physiological responses during cold-air exposure (90 min, 5 degrees C) were assessed before and after CA. Body temperatures and metabolic heat production were similar in both groups with no change due to CA. Cardiac output was lower (P < 0.05) in both groups post-CA (10.4 +/- 1.2 l/min) than pre-CA (12.2 +/- 1. 0 l/min), but mean arterial pressure was unchanged (pre-CA 107 +/- 2 mmHg, post-CA 101 +/- 2 mmHg). The increase in norepinephrine was greater (P < 0.05) post-CA (954 +/- 358 pg/ml) compared with pre-CA (1,577 +/- 716 pg/ml) for RG, but CA had no effect on the increase in norepinephrine for EG (pre-CA 1,288 +/- 438 pg/ml, post-CA 1,074 +/- 279 pg/ml). Skin temperature reduction alone may be a sufficient stimulus during CA for increased vasoconstrictor response, but core temperature reduction appears necessary to enhance sympathetic activation during cold exposure.

Physiological problems associated with wearing NBC protective clothing during cold weather.

This report considers how thermal balance of soldiers wearing nuclear, biological and chemical (NBC) protective clothing in combination with the Extreme Cold Weather Clothing System (ECWCS) is affected during work in cold weather. A review of published reports concerning physiological consequences of wearing NBC protective clothing during cold exposure was completed. The findings reported in the experimental literature were too limited to adequately forecast the effects of adding NBC clothing to ECWCS. To remedy the information gap, simulation modeling was employed to predict body temperature changes during alternating bouts of exercise and rest throughout 8 h of exposure to three different severely cold conditions. Published findings indicate that NBC protective clothing may inadequately protect against hand and finger cooling, especially during rest following strenuous activity. No evidence substantiates suggestions that wearing NBC protective masks increases susceptibility to facial frostbite. Collectively, the limited experimental work and the results of simulation modeling argue against any increased risk of hypothermia associated with wearing NBC protective clothing while working in the cold. However, wearing NBC protective clothing during strenuous activity in cold weather may increase the risk of hyperthermia, and cause sweat accumulation in clothing which may compromise insulation and increase the risk of hypothermia during subsequent periods of inactivity.