Evaluation and refinement of the environmental stress index for different climatic conditions.

The purpose of this study was to evaluate the recently constructed environmental stress index (ESI) for a large database comprising various climatic conditions. Data analysis of measurements from 19 locations revealed a high correlation between ESI and the wet bulb globe temperature (WBGT) index for each database. Validity from statistical analysis, including optimization procedures, slightly changed the ESI constants as follows: ESI = 0.62Ta - 0.007RH + 0.002SR + 0.0043(Ta x RH) - 0.078(0.1 + SR)(-1) where: Ta = ambient temperature (degrees C); RH = relative humidity (%); and SR = solar radiation (w x m(-2)). The refined ESI and the WBGT index were applied to databases of more than 125,000 measurements for each variable: Ta, RH, SR, black globe temperature (Tg), and wet bulb temperature (Tw). For each database, the ESI was then successfully correlated with the WBGT (P < 0.05, R2 > or = 0.899). We conclude that the refined ESI, which is constructed from fast response and commonly used weather sensors (Ta, RH, SR), is a potential index to serve as an alternative to the WBGT for heat category assessment.

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.

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.

Effects of dehydration, hypohydration, and hyperhydration on tolerance during uncompensable heat stress.

The present study examined the effects of dehydration from prior exercise on subsequent exercise tolerance time (TT) that involved wearing nuclear, biological, and chemical (NBC) protective clothing. It was hypothesised that TT would be reduced in the dehydrated state. Ten men undertook continuous treadmill walking at 4.8 km.h-1 at 35 degrees C and 50% relative humidity, wearing NBC clothing while euhydrated (EU) or dehydrated (D) by 2.3% of body weight. Hydration status had no impact on thermoregulatory or cardiovascular responses during exercise. Also rectal temperature at exhaustion did not differ between EU (38.52 +/- 0.39 degrees C) and D (38.43 +/- 0.45 degrees C). Exercise TT during this uncompensable heat stress was reduced significantly for D (47.7 +/- 15.3 min) compared with EU (59.0 +/- 13.6 min). It was concluded that prior exercise leading to levels of dehydration to 2.3% of body weight, together with subsequent fluid restriction during exposure to uncompensable heat stress, impaired TT while wearing the NBC protective clothing. The integration of these findings together with other comparable studies that have examined the influence of hypo- and hyperhydration on TT while wearing NBC protective clothing revealed that hydration status has less effect on TT as the severity of uncompensable heat stress increases.

Evaluating physiological strain during cold exposure using a new cold strain index.

A cold strain index (CSI) based on core (T(core)) and mean skin temperatures (T(sk)) and capable of indicating cold strain in real time and analyzing existing databases has been developed. This index rates cold strain on a universal scale of 0-10 and is as follows: CSI = 6.67(T(core t) - T(core 0)). (35 - T(core 0))(-1) + 3.33(T(sk (t)) - T(sk 0)). (20 - T(sk 0))(-1), where T(core 0) and T(sk 0) are initial measurements and T(core t) and T(sk t) are simultaneous measurements taken at any time t; when T(core t) > T(core 0), then T(core t) - T(core 0) = 0. CSI was applied to three databases. The first database was obtained from nine men exposed to cold air (7 degrees C, 40% relative humidity) for 120 min during euhydration and two hypohydration conditions achieved by exercise-heat stress-induced sweating or by ingestion of furosemide 12 h before cold exposure. The second database was from eight men exposed to cold air (10 degrees C) immediately on completion of 61 days of strenuous outdoor military training, 48 h later, and after 109 days. The third database was from eight men repeatedly immersed in 20 degrees C water three times in 1 day and during control immersions. CSI significantly differentiated (P < 0.01) between the trials and individually categorized the strain of the subject for two of these three databases. This index has the potential to be widely accepted and used universally.

Can gender differences during exercise-heat stress be assessed by the physiological strain index?

A physiological strain index (PSI) based on rectal temperature (Tre) and heart rate (HR) was recently suggested to evaluate exercise-heat stress. The purpose of this study was to evaluate PSI for gender differences under various combinations of exercise intensity and climate. Two groups of eight men each were formed according to maximal rate of O2 consumption (VO2 max). The first group of men (M) was matched to a group of nine women (W) with similar (P > 0.001) VO2 max (46.1 +/- 2.0 and 43.6 +/- 2.9 ml. kg-1. min-1, respectively). The second group of men (MF) was significantly (P < 0. 001) more fit than M or W with VO2 max of 59.1 +/- 1.8 ml. kg-1. min-1. Subjects completed a matrix of nine experimental combinations consisting of three different exercise intensities for 60 min [low, moderate, and high (300, 500, and 650 W, respectively)] each at three climates (comfortable, hot wet, and hot dry [20 degrees C 50% relative humidity (RH), 35 degrees C 70% RH, and 40 degrees C 35% RH, respectively]). No significant differences (P > 0.05) were found between matched genders (M and W) at the same exposure for sweat rate, relative VO2 max (%VO2 max), and PSI. However, MF had significantly (P < 0.05) lower strain than M and W as reflected by %VO2 max and PSI. In summary, PSI applicability was extended for exercise-heat stress and gender. This index continues to show potential for wide acceptance and application.

Wet bulb globe temperature (WBGT)--to what extent is GT essential?

BACKGROUND: Industrial and military safety personnel often require an easy, quick and accurate assessment of heat stress as a potential risk. The widely used WBGT index to evaluate heat stress is cumbersome and suited for a fixed site station rather than a mobile situation. Recently, a modified discomfort index (MDI) compiled from ambient temperature (Ta) and wet bulb temperature (Tw) was suggested to evaluate heat stress. HYPOTHESIS: Validation of the simple and easy-to-operate MDI on an independent database can determine whether this index is able to serve as a reliable and valid alternative to WBGT. METHODS: Four separate database sets obtained from the Marine Corps Training Site on Parris Island, SC, served to validate this index. Hourly weather measurements were collected daily during 4 yr, representing a wide range of environmental conditions. RESULTS: The MDI validity was tested vs. the WBGT index. A highly significant correlation coefficient (r) greater than 0.95 (p < 0.001) was found in each of the four database sets. CONCLUSIONS: The simply constructed and user friendly MDI is easier to calculate and use than WBGT, and it has the potential to serve as an attractive alternative to the WBGT index in assessing heat stress.

The physiological strain index applied to heat-stressed rats.

A physiological strain index (PSI) based on heart rate (HR) and rectal temperature (Tre) was recently suggested to evaluate exercise-heat stress in humans. The purpose of this study was to adjust PSI for rats and to evaluate this index at different levels of heat acclimation and training. The corrections of HR and Tre to modify the index for rats are as follows: PSI = 5 (Tre t - Tre 0). (41.5 - Tre 0)-1 + 5 (HRt - HR0). (550 - HR0)-1, where HRt and Tre t are simultaneous measurements taken at any time during the exposure and HR0 and Tre 0 are the initial measurements. The adjusted PSI was applied to five groups (n = 11-14 per group) of acclimated rats (control and 2, 5, 10, and 30 days) exposed for 70 min to a hot climate [40 degrees C, 20% relative humidity (RH)]. A separate database representing two groups of acclimated or trained rats was also used and involved 20 min of low-intensity exercise (O2 consumption approximately 50 ml. min-1. kg-1) at three different climates: normothermic (24 degrees C, 40% RH), hot-wet (35 degrees C, 70% RH), and hot-dry (40 degrees C, 20% RH). In normothermia, rats also performed moderate exercise (O2 consumption approximately 60 ml. min-1. kg-1). The adjusted PSI differentiated among acclimation levels and significantly discriminated among all exposures during low-intensity exercise (P < 0.05). Furthermore, this index was able to assess the individual roles played by heat acclimation and exercise training.

Evaluation of different levels of hydration using a new physiological strain index.

A physiological strain index (PSI), based on rectal temperature (Tre) and heart rate (HR), was recently suggested for evaluating heat stress. The purpose of this study was to evaluate the PSI for different combinations of hydration level and exercise intensity. This index was applied to two databases. The first database was obtained from eight endurance-trained men dehydrated to four different levels (1.1, 2.3, 3.4, and 4.2% of body wt) during 120 min of cycling at a power output of 62-67% maximum O2 consumption (VO2 max) in the heat [33 degrees C and 50% relative humidity (RH)]. The second database was obtained from nine men performing exercise in the heat (30 degrees C and 50% RH) for 50 min. These subjects completed a matrix of nine trials of exercise on a treadmill at three exercise intensities (25, 45, and 65% VO2 max) and three hydration levels (euhydration and hypohydration at 3 and 5% of body wt). Tre, HR, esophageal temperature (Tes), and local sweating rate were measured. PSI (obtained from either Tre or Tes) significantly (P < 0.05) differentiated among all exposures in both databases categorized by exercise intensity and hydration level, and we assessed the strain on a scale ranging from 0 to 10. Therefore, PSI applicability was extended for heat strain associated with hypohydration and continues to provide the potential to be universally accepted.

Time course of heat acclimation and its decay.

More is known about the time course for the acquisition of human heat acclimation during exercise than its decay or loss. Pioneering research in the 1940s led to our early understanding of the heat acclimation process and its subsequent decay with further knowledge concerning the associated physiological mechanisms in later years. For both hot-dry and hot-humid environments, nearly complete exercise-heat acclimation occurs after 7 to 10 days of exposure. However, about two-thirds to 75% of the physiological adjustments and improvements in performance are seen in 4 to 6 days. Individuals with high levels of aerobic fitness are partially but not fully acclimated to the heat. Most of the early studies on decay or loss of heat acclimation are flawed by very small samples, incomplete heat acclimation or inappropriate measurements. Nevertheless, these studies are pioneering in a sense because they indicate that the retention of heat acclimation is quite variable between individuals and environments. Retention of the benefits of heat acclimation appears to remain longer for dry compared to humid heat. High levels of aerobic fitness seem associated with greater retention of heat acclimation. Further well-designed and definitive studies on decay or loss of heat acclimation appear necessary.

A physiological strain index to evaluate heat stress.

A physiological strain index (PSI), based on rectal temperature (Tre) and heart rate (HR), capable of indicating heat strain online and analyzing existing databases, has been developed. The index rates the physiological strain on a universal scale of 0-10. It was assumed that the maximal Tre and HR rise during exposure to exercise heat stress from normothermia to hyperthermia was 3 degrees C (36.5-39.5 degrees C) and 120 beats/min (60-180 beats/min), respectively. Tre and HR were assigned the same weight functions as follows: PSI = 5(Tret - Tre0) . (39.5 - Tre0)-1 + 5(HRt - HR0) . (180 - HR0)-1, where Tret and HRt are simultaneous measurements taken at any time during the exposure and Tre0 and HR0 are the initial measurements. PSI was applied to data obtained from 100 men performing exercise in the heat (40 degrees C, 40% relative humidity; 1.34 m/s at a 2% grade) for 120 min. A separate database representing seven men wearing protective clothing and exercising in hot-dry and hot-wet environmental conditions was applied to test the validity of the present index. PSI differentiated significantly (P < 0.05) between the two climates. This index has the potential to be widely accepted and to serve universally after extending its validity to women and other age groups.

Human thermoregulatory responses during serial cold-water immersions.

This study examined whether serial cold-water immersions over a 10-h period would lead to fatigue of shivering and vasoconstriction. Eight men were immersed (2 h) in 20 degrees C water three times (0700, 1100, and 1500) in 1 day (Repeat). This trial was compared with single immersions (Control) conducted at the same times of day. Before Repeat exposures at 1100 and 1500, rewarming was employed to standardize initial rectal temperature. The following observations were made in the Repeat relative to the Control trial: 1) rectal temperature was lower and heat debt was higher (P < 0.05) at 1100; 2) metabolic heat production was lower (P < 0.05) at 1100 and 1500; 3) subjects perceived the Repeat trial as warmer at 1100. These data suggest that repeated cold exposures may impair the ability to maintain normal body temperature because of a blunting of metabolic heat production, perhaps reflecting a fatigue mechanism. An alternative explanation is that shivering habituation develops rapidly during serially repeated cold exposures.

Hyperhydration: tolerance and cardiovascular effects during uncompensable exercise-heat stress.

This study examined the efficacy of glycerol and water hyperhydration (1 h before exercise) on tolerance and cardiovascular strain during uncompensable exercise-heat stress. The approach was to determine whether 1-h preexercise hyperhydration (29.1 ml H2O/kg lean body mass with or without 1.2 g/kg lean body mass of glycerol) provided a physiological advantage over euhydration. Eight heat-acclimated men completed three trials (control euhydration before exercise, and glycerol and water hyperhydrations) consisting of treadmill exercise-heat stress (ratio of evaporative heat loss required to maximal capacity of climate = 416). During exercise ( approximately 55% maximal O2 uptake), there was no difference between glycerol and water hyperhydration methods for increasing (P < 0.05) total body water. Glycerol hyperhydration endurance time (33. 8 +/- 3.0 min) was longer (P < 0.05) than for control (29.5 +/- 3.5 min), but was not different (P > 0.05) from that of water hyperhydration (31.3 +/- 3.1 min). Hyperhydration did not alter (P > 0.05) core temperature, whole body sweating rate, cardiac output, blood pressure, total peripheral resistance, or core temperature tolerance. Exhaustion from heat strain occurred at similar core and skin temperatures and heart rates in each trial. Symptoms at exhaustion included syncope and ataxia, fatigue, dyspnea, and muscle cramps (n = 11, 10, 2, and 1 cases, respectively). We conclude that 1-h preexercise glycerol hyperhydration provides no meaningful physiological advantage over water hyperhydration and that hyperhydration per se only provides the advantage (over euhydration) of delaying hypohydration during uncompensble exercise-heat stress.

Does erythrocyte infusion improve 3.2-km run performance at high altitude?

The effects of autologous erythrocyte infusion on improving exercise performance at high altitude have not previously been studied. The effects of erythrocyte infusion on 3.2-km (2-mile) run performance were evaluated during 3 days (HA3) and 14 days (HA14) exposure to high altitude (4300 m) in erythrocyte-infused (ER) and control (CON) subjects that were initially matched (P>0.05; n = 8 in each group) for age, body size and aerobic fitness. After sea-level runs (SL; 50 m), unacclimated-male subjects received either 700 ml of saline and autologous erythrocytes (42% hematocrit; ER) or saline alone (CON). The 3.2-km run times (min:s) did not differ (P>0.05) between groups at SL [mean (SEM) ER, 13:14 (00:19); CON, 13:39 (00:32)] or during HA3 [ER, 19:02 (00:18); CON, 19:44 (00:43)] and HA14 [ER, 17:44 (00:27); CON, 18:45 (00:55)] but times were slower (P<0.05) when comparing HA3 or HA14 to SL. Heart rates (HR) did not differ between groups at SL [ER, 188 (3) beats x min(-1); CON, 191 (3) beats x min(-1)], or during HA3 [ER, 170 (4) beats x min(-1); CON, 178 (4) beats x min(-1)] and HA14 [ER, 162 (6) beats x min(-1); CON, 169 (5) beats x min(-1)], but HR were lower (P<0.05) when comparing HA3 or HA14 to SL. Ratings of perceived exertion (local, central, and overall ratings) did not differ between groups at SL, HA3 or HA14, but local ratings were higher (P<0.05) at HA3 and HA14 compared to SL, and overall ratings were higher for HA3 than SL. Analysis of covariance (adjusted for SL group run times) revealed (min:s) 00:14 (HA3) and 00:28 (HA14) mean improvement tendencies (P>0.05) for ER compared to CON. Thus, no significant improvements in 3.2-km run performance were associated with erythrocyte infusion, although the ER group showed a tendency to run slightly faster at high altitude.

Simulation of a cold-stressed finger including the effects of wind, gloves, and cold-induced vasodilatation.

The thermal response of fingers exposed to cold weather conditions has been simulated. Energy balance equations were formulated, in a former study, for the tissue layers and the arterial, venous, and capillary blood vessels. The equations were solved by a finite difference scheme using the Thomas algorithm and the method of alternating directions. At this stage of development the model does not include any autonomic control functions. Model simulations assumed an electrical heating element to be embedded in the glove layers applied on the finger. A 1.3 W power input was calculated for maintaining finger temperatures at their pre-cold exposure level in a 0 degree C environment. Alternate assumptions of nutritional (low) and basal (high) blood flows in the finger demonstrated the dominance of this factor in maintaining finger temperatures at comfortable levels. Simulated exposures to still and windy air, at 4.17 m/s (15 km/h), indicated the profound chilling effects of wind on fingers in cold environments. Finally, the effects of variable blood flow in the finger, known as "cold-induced vasodilatation," were also investigated. Blood flow variations were assumed to be represented by periodic, symmetric triangular waves allowing for gradual opening-closing cycles of blood supply to the tip of the finger. Results of this part of the simulation were compared with measured records of bare finger temperatures. Good conformity was obtained for a plausible pattern of change in blood flow, which was assumed to be provided in its entirety to the tip of the finger alone.

Hyperhydration: thermoregulatory effects during compensable exercise-heat stress.

This study examined the effects of hyperhydration on thermoregulatory responses during compensable exercise-heat stress. The general approach was to determine whether 1-h preexercise hyperhydration [29. 1 ml/kg lean body mass; with or without glycerol (1.2 g/kg lean body mass)] would improve sweating responses and reduce core temperature during exercise. During these experiments, the evaporative heat loss required (Ereq = 293 W/m2) to maintain steady-state core temperature was less than the maximal capacity (Emax = 462 W/m2) of the climate for evaporative heat loss (Ereq/Emax = 63%). Eight heat-acclimated men completed five trials: euhydration, glycerol hyperhydration, and water hyperhydration both with and without rehydration (replace sweat loss during exercise). During exercise in the heat (35 degrees C, 45% relative humidity), there was no difference between hyperhydration methods for increasing total body water (approximately 1.5 liters). Compared with euhydration, hyperhydration did not alter core temperature, skin temperature, whole body sweating rate, local sweating rate, sweating threshold temperature, sweating sensitivity, or heart rate responses. Similarly, no difference was found between water and glycerol hyperhydration for these physiological responses. These data demonstrate that hyperhydration provides no thermoregulatory advantage over the maintenance of euhydration during compensable exercise-heat stress.

Heat strain models applicable for protective clothing systems: comparison of core temperature response.

Core temperature (Tc) output comparisons were analyzed from thermal models applicable to persons wearing protective clothing. The two models evaluated were the United States (US) Army Research Institute of Environmental Medicine (USARIEM) heat strain experimental model and the United Kingdom (UK) Loughborough (LUT25) model. Data were derived from collaborative heat-acclimation studies conducted by three organizations and included an intermittent-work protocol (Canada) and a continuous-exercise/heat stress protocol (UK and US). Volunteers from the US and the UK were exposed to a standard exercise/heat stress protocol (ambient temperature 35 degrees C/50% relative humidity, wind speed 1 m/s, level treadmill speed 1.34 m/s). Canadian Forces volunteers did an intermittent-work protocol (15 min moderate work/15 min rest at ambient temperature of 40 degrees C/30% relative humidity, wind speed approximately 0.4 m/s). Each model reliably predicted Tc responses (within the margin of error determined by 1 root mean square deviation) during work in the heat with protective clothing. Models that are analytically similar to the classic Stolwijk-Hardy model serve as robust operational tools for prediction of physiological heat strain when modified to incorporate clothing heat-exchange factors.

Numerical analysis of an extremity in a cold environment including countercurrent arterio-venous heat exchange.

A model of the thermal behavior of an extremity, e.g., a finger, is presented. The model includes the effects of heat conduction, metabolic heat generation, heat transport by blood perfusion, heat exchange between the tissue and the large blood vessels, and arterio-venous heat exchange. Heat exchange with the environment through a layer of thermal insulation, depicting thermal handwear, is also considered. The tissue is subdivided into four concentric layers simulating, from the center outward, core, muscle, fat, and skin. Differential heat balance equations are formulated for the tissue and for the major artery and the major vein traversing the finger. These coupled equations are solved numerically by a finite-difference, alternating direction method employing a Thomas algorithm. The numerical scheme was extensively tested for its stability and convergence. This paper presents the model equations and results of the convergence tests, and shows plots of blood and tissue temperatures along the axis of the model for combinations of parameters including the effect of countercurrent heat exchange between the artery and the vein.

Thermal and metabolic responses to cold-water immersion at knee, hip, and shoulder levels.

To examine the effect of cold-water immersion at different depths on thermal and metabolic responses, eight men (25 yr old, 16% body fat) attempted 12 tests: immersed to the knee (K), hip (H), and shoulder (Sh) in 15 and 25 degrees C water during both rest (R) or leg cycling [35% peak oxygen uptake; (E)] for up to 135 min. At 15 degrees C, rectal (Tre) and esophageal temperatures (Tes) between R and E were not different in Sh and H groups (P > 0.05), whereas both in K group were higher during E than R (P < 0.05). At 25 degrees C, Tre was higher (P < 0.05) during E than R at all depths, whereas Tes during E was higher than during R in H and K groups. Tre remained at control levels in K-E at 15 degrees C, K-E at 25 degrees C, and in H-E groups at 25 degrees C, whereas Tes remained unchanged in K-E at 15 degrees C, in K-R at 15 degrees C, and in all 25 degrees C conditions (P > 0.05). During R and E, the magnitude of Tre change was greater (P < 0.05) than the magnitude of Tes change in Sh and H groups, whereas it was not different in the K group (P > 0.05). Total heat flow was progressive with water depth. During R at 15 and 25 degrees C, heat production was not increased in K and H groups from control level (P > 0.05) but it did increase in Sh group (P < 0.05). The increase in heat production during E compared with R was smaller (P < 0.05) in Sh (121 +/- 7 W/m2 at 15 degrees C and 97 +/- 6 W/m2 at 25 degrees C) than in H (156 +/- 6 and 126 +/- 5 W/m2, respectively) and K groups (155 +/- 4 and 165 +/- 6 W/m2, respectively). These data suggest that Tre and Tes respond differently during partial cold-water immersion. In addition, water levels above knee in 15 degrees C and above hip in 25 degrees C cause depression of internal temperatures mainly due to insufficient heat production offsetting heat loss even during light exercise.