Heat acclimation improves heat exercise tolerance and heat dissipation in individuals with extensive skin grafts

Burn survivors with extensive skin grafts have impaired heat dissipation and thus heat tolerance. This study tested the hypothesis that heat acclimation (HA) improves these factors in this population. Thirty-four burn survivors were stratified into highly [>40% body surface area (BSA) grafted, n = 15] and moderately (17-40% BSA grafted, n = 19) grafted groups. Nine healthy nonburned subjects served as controls. Subjects underwent 7 days of HA involving 90 min of exercise at ∼ 50% peak oxygen uptake in 40°C, 30% relative humidity. On days 1 and 7, subjects exercised in the heat at a fixed rate of metabolic heat production. Pre-HA, all controls and 18/19 subjects in the 17-40% group completed 90 min of exercise. Conversely, heat exercise tolerance was lower (P < 0.01) in the > 40% group, with 7/15 subjects not completing 90 min of exercise. Post-HA, heat exercise tolerance was similar between groups (P = 0.39) as all subjects, except one, completed 90 min of exercise. Pre-HA, the magnitude of the increase in internal temperature during exercise occurred sequentially (P ≤ 0.03) according to BSA grafted (>40%: 1.6 ± 0.5°C; 17-40%: 1.2 ± 0.3°C; control: 0.9 ± 0.2°C). HA attenuated (P < 0.01) increases in internal temperature in the control (by 0.2 ± 0.3°C), 17-40% (by 0.3 ± 0.3°C), and > 40% (by 0.3 ± 0.4°C) groups, the magnitude of which was similar between groups (P = 0.42). These data indicate that HA improves heat tolerance and dissipation in burn survivors with grafted skin, and the magnitude of these improvements are not influenced by the extent of skin grafting.

Forearm cutaneous vascular and sudomotor responses to whole body passive heat stress in young smokers

The purpose of this study was to compare smokers and nonsmokers' sudomotor and cutaneous vascular responses to whole body passive heat stress. Nine regularly smoking (SMK: 29 ± 9 yr; 10 ± 6 cigarettes/day) and 13 nonsmoking (N-SMK: 27 ± 8 yr) males were passively heated until core temperature (TC) increased 1.5°C from baseline. Forearm local sweat rate (LSR) via ventilated capsule, sweat gland activation (SGA), sweat gland output (SGO), and cutaneous vasomotor activity via laser-Doppler flowmetry (CVC) were measured as mean body temperature increased (ΔTb) during passive heating using a water-perfused suit. Compared with N-SMK, SMK had a smaller ΔTb at the onset of sweating (0.52 ± 0.19 vs. 0.35 ± 0.14°C, respectively; P = 0.03) and cutaneous vasodilation (0.61 ± 0.21 vs. 0.31 ± 0.12°C, respectively; P < 0.01). Increases in LSR and CVC per °C ΔTb (i.e., sensitivity) were similar in N-SMK and SMK (LSR: 0.63 ± 0.21 vs. 0.60 ± 0.40 Δmg/cm(2)/min/°C ΔTb, respectively, P = 0.81; CVC: 82.5 ± 46.2 vs. 58.9 ± 23.3 Δ%max/°C ΔTb, respectively; P = 0.19). However, the plateau in LSR during whole body heating was higher in N-SMK vs. SMK (1.00 ± 0.13 vs. 0.79 ± 0.26 mg·cm(-2)·min(-1); P = 0.03), which was likely a result of higher SGO (8.94 ± 3.99 vs. 5.94 ± 3.49 μg·gland(-1)·min(-1), respectively; P = 0.08) and not number of SGA (104 ± 7 vs. 121 ± 9 glands/cm(2), respectively; P = 0.58). During whole body passive heat stress, smokers had an earlier onset for forearm sweating and cutaneous vasodilation, but a lower local sweat rate that was likely due to lower sweat output per gland. These data provide insight into local (i.e., forearm) thermoregulatory responses of young smokers during uncompensatory whole body passive heat stress.

Hydration Status over 24-H Is Not Affected by Ingested Beverage Composition

OBJECTIVE

To investigate the 24-h hydration status of healthy, free-living, adult males when given various combinations of different beverage types.

METHODS

Thirty-four healthy adult males participated in a randomized, repeated-measures design in which they consumed: water only (treatment A), water+cola (treatment B), water+diet cola (treatment C), or water+cola+diet cola+orange juice (treatment D) over a sedentary 24-h period across four weeks of testing. Volumes of fluid were split evenly between beverages within each treatment, and when accounting for food moisture content and metabolic water production, total fluid intake from all sources was equal to 35 ± 1 ml/kg body mass. Urine was collected over the 24-h intervention period and analyzed for osmolality (Uosm), volume (Uvol) and specific gravity (USG). Serum osmolality (Sosm) and total body water (TBW) via bioelectrical impedance were measured after the 24-h intervention.

RESULTS

24-h hydration status was not different between treatments A, B, C, and D when assessed via Uosm (590 ± 179; 616 ± 242; 559 ± 196; 633 ± 222 mOsm/kg, respectively) and Uvol (1549 ± 594; 1443 ± 576; 1690 ± 668; 1440 ± 566 ml) (all p > 0.05). A -difference in 24-h USG was observed between treatments A vs. D (1.016 ± 0.005 vs. 1.018 ± 0.007; p = 0.049). There were no differences between treatments at the end of the 24-h with regard to Sosm (291 ± 4; 293 ± 5; 292 ± 5; 293 ± 5 mOsm/kg, respectively) and TBW (43.9 ± 5.9; 43.8 ± 6.0; 43.7 ± 6.1; 43.8 ± 6.0 kg) (all p > 0.05).

CONCLUSIONS

Regardless of the beverage combination consumed, there were no differences in providing adequate hydration over a 24-h period in free-living, healthy adult males. This confirms that beverages of varying composition are equally effective in hydrating the body.

Drinking to thirst versus drinking ad libitum during road cycling

CONTEXT

The sensation of thirst is different from the complex behavior of drinking ad libitum. Rehydration recommendations to athletes differ, depending on the source, yet no previous researchers have systematically compared drinking to thirst (D(TT)) versus ad libitum drinking behavior (D(AL)).

OBJECTIVE

To compare 2 groups of trained cyclists (D(TT) and D(AL)) who had similar physical characteristics and training programs (P > .05). The D(TT) group (n = 12, age = 47 ± 7 years) drank only when thirsty, whereas the D(AL) group (n = 12, age = 44 ± 7 years) consumed fluid ad libitum (ie, whenever and in whatever volume desired).

DESIGN

Cohort study.

SETTING

Road cycling (164 km) in the heat (36.1 °C ± 6.5 °C).

PATIENTS OR OTHER PARTICIPANTS

Ultraendurance cyclists (4 women, 20 men).

INTERVENTION(S)

We recorded measurements 1 day before the event, on event day before the start, at 3 roadside aid stations, at the finish line, and 1 day after the event.

MAIN OUTCOME MEASURE(S)

Body mass, urinary hydration indices, and food and fluids consumed.

RESULTS

No between-groups differences were seen on event day for total exercise time (DTT = 6.69 ± 0.89 hours, DAL = 6.66 ± 0.77 hours), urinary indices (specific gravity, color), body mass change (D(TT) = -2.22% ± 1.73%, DAL = -2.29% ± 1.62%), fluid intake (D(TT) = 5.63 ± 2.59 L/6.7 h, D(AL) = 6.04 ± 2.37 L/6.7 h), dietary energy intake, macronutrient intake, ratings of thirst (D(TT) start = 2 ± 1, D(TT) finish = 6 ± 1, DAL start = 2 ± 1, D(AL) finish = 6 ± 1), pain, perceived exertion, or thermal sensation. Total fluid intake on recovery day +1 was the primary significant difference (D(AL) = 5.13 ± 1.87 L/24 h, D(TT) = 3.13 ± 1.53 L/24 h, t18 = 2.59, P = .02).

CONCLUSIONS

Observations on event day indicated that drinking to thirst and drinking ad libitum resulted in similar physiologic and perceptual outcomes. This suggests that specific instructions to "drink to thirst" were unnecessary. Indeed, if athletes drink ad libitum, they can focus on training and competition rather than being distracted by ongoing evaluation of thirst sensations.

Forehead versus forearm skin vascular responses at presyncope in humans

Facial pallor is commonly observed at presyncope in humans, suggestive of reductions in facial skin blood flow (SkBF). Yet, cutaneous vasoconstriction is usually minimal at presyncope when measured at the forearm. We tested the hypothesis that reductions in forehead SkBF at presyncope are greater than in the forearm. Forehead and forearm SkBF (laser-Doppler) and blood pressure (Finometer or radial artery catheterization) were measured during lower body negative pressure (LBNP) to presyncope in 11 normothermic and 13 heat-stressed subjects (intestinal temperature increased ∼1.4°C). LBNP reduced mean arterial pressure from 91 ± 5 to 57 ± 7 mmHg during normothermia (P ≤ 0.001) and from 82 ± 5 to 57 ± 7 mmHg during heat stress (P ≤ 0.001). During normothermia, LBNP decreased forehead SkBF 55 ± 14% compared with 24 ± 11% at the forearm (P = 0.002), while during heat stress LBNP decreased forehead SkBF 39 ± 11% compared with 28 ± 8% in the forearm (P = 0.007). In both conditions, most (≥68%) of the decreases in SkBF were due to decreases in blood pressure. However, a greater contribution of actively mediated reductions in SkBF was observed at the forehead, relative to the forearm during normothermia (32 ± 13% vs. 11 ± 11%, P = 0.031) and heat stress (30 ± 13% vs. 10 ± 13%, P = 0.004). These data suggest that facial pallor at presyncope is due to a combination of passive decreases in forehead SkBF secondary to reductions in blood pressure and to active decreases in SkBF, the latter of which are relatively greater than in the forearm.

Effect of air-filled vest on exercise-heat strain when wearing ballistic protection

OBJECTIVES

The purpose was to determine if an air-filled vest worn under ballistic protection reduces physiological strain during exercise in the heat either while wearing a tactical military (TM) protective vest or a law enforcement (LE) concealable vest.

METHODS

Sixteen men (24.5±3.9 years; 179.5±5.6 cm; 84.6±12.3kg) performed either two or four trials of treadmill walking (1.34 m s(-1); 2% grade) over 120 min in a hot, dry environment (37°C, 30% relative humidity, wind speed 3.5 m s(-1)). Participants completed trials wearing a TM or LE, with either the air-filled vest (TMa; LEa) or no vest (TMc; LEc) in random order. During trials, participants wore Army Combat Uniform pants. Physiological variables measured every 5min included gastrointestinal temperature (T GI), mean skin temperature (T sk), and heart rate (HR). Sweat rate (SR) was calculated based on fluid intake and body mass measures.

RESULTS

In the tactical trial (TMa versus TMc), no differences in final T GI (38.2±0.4 versus 38.3±0.4°C), T sk (35.0±0.9 versus 35.0±1.0°C), HR (142±19 versus 143±23 bpm) existed (P>0.05). In the LE trials (LEa versus LEc), no differences in final T GI (38.0±0.4 versus 38.1±0.3°C), T sk (35.3±1.1 versus 35.6±0.9°C), HR (132±20 versus 135±20 bpm) existed (P>0.05). Despite slightly higher SR, there was no statistical difference in TM (1.15±1.13 versus 1.54±0.46 l h(-1); P=0.10) or in LE (1.39±0.52 versus 1.37±0.18 l h(-1); P=0.35) during trials.

CONCLUSION

When participants exercised with a TM or LE while wearing the air-filled vest, there were no thermoregulatory and physiological differences compared to control trials. In our testing conditions, the air-filled device had little effect on physiological responses during prolonged mild exercise in the heat.

Effective body water and body mass changes during summer ultra-endurance road cycling

Because body mass change (ΔMb) does not represent all water losses and gains, the present field investigation determined if (a) ΔMb equalled the net effective body water change during ultra-endurance exercise and (b) ground speed and exercise duration influenced these variables. Thirty-two male cyclists (age range, 35-52 years) completed a 164-km event in a hot environment, were retrospectively triplet matched and placed into one of three groups based on exercise duration (4.8, 6.3, 9.6 h). Net effective body water loss was computed from measurements (body mass, total fluid intake and urine excreted) and calculations (water evolved and mass loss due to substrate oxidation, solid food mass and sweat loss), including (ΔEBWgly) and excluding (ΔEBW) water bound to glycogen. With all cyclists combined, the mean ΔMb (i.e. loss) was greater than that of ΔEBWgly by 1200 ± 200 g (P = 1.4 × 10(-18)), was similar to ΔEBW (difference, 0 ± 200 g; P = .21) and was strongly correlated with both (R(2) = .98). Analysis of equivalence indicated that ΔMb was not equivalent to ΔEBWgly, but was equivalent to ΔEBW. Due to measurement complexity, we concluded that (a) athletes will not calculate the effective body water calculations routinely and (b) body mass change remains a useful field-expedient estimate of net effective body water change.

Novel hydration assessment techniques employing thirst and a water intake challenge in healthy men

Exploring novel hydration indices is important because no human biomarker has been shown to be incontrovertibly valid in all life situations. The present investigation was designed to identify inexpensive, nontechnical methods to use when self-assessing hydration status. This investigation evaluated the validity and efficacy of 2 novel techniques (i.e., thirst sensation and urine volume) to assess hydration state of 29 active men (mean ± SD; age, 23 ± 4 years; body mass, 76.02 ± 11.94 kg) at rest. Eight combinations of 4 water challenges (4.8, 9.3, 11.0, or 14 mL·kg−1) and 2 hydration states (mildly hypohydrated (HY), –2.0%; euhydrated (EU), –0.2% body mass) were employed. First, thirst was linearly related to body water loss, and ratings of thirst distinguished HY from EU (p < 0.001) subsequent to 19 h of controlled food and fluid intake. Second, measurements of urine volume 60 min after consuming a water bolus (11.0 or 14 mL·kg−1) were strongly and inversely correlated with entering hydration state, assessed by urine specific gravity (r2 = 0.76, p < 0.0001) and urine osmolality (r2 = 0.77, p < 0.0001). We concluded that healthy men can employ simple measurements of morning thirst sensation and urine volume to identify the presence of mild hypohydration and to guide fluid replacement. These 2 techniques are relevant because HY (–2% body mass) is the approximate threshold for the onset of thirst, reduced endurance exercise performance, and decrements of working memory and mood.

Effect of human skin grafts on whole-body heat loss during exercise heat stress: a case report

When exposed to heat stress, increases in cutaneous blood flow and sweating in well-healed grafted skin are severely attenuated, which could impair whole-body heat loss if skin grafts cover a large portion of total body surface area (TBSA). It is unknown to what extent whole-body heat loss is impaired when skin grafts cover a significant (eg, >50%) proportion of TBSA. The authors examined whole-body heat exchange during and after 60 min of cycling exercise in the heat (35°C; 25% relative humidity), at a fixed rate of metabolic heat production (~400 W) in a woman (age, 36 years; mass, 78.2 kg) with well-healed (17+ years) skin grafts covering 75% of TBSA. Her responses were compared with two noninjured control subjects. Whole-body evaporative and dry heat exchange were measured by direct calorimetry. While exercising in the same ambient conditions and at the same rate of heat production, relative evaporative heat loss of nongrafted skin in the grafted subject (ie, evaporative heat loss per m) was nearly twice that of the control subjects. However, total rate of evaporative heat loss reached only 59% of the amount required for heat balance in the skin-grafted subject compared with 92 ± 3% in controls. Thus, the increase in core temperature was 2-fold greater for the grafted (1.22°C) vs control (0.61 ± 0.19°C) individuals. This case study demonstrates that a large area of grafted skin greatly diminishes maximum evaporative heat loss during exercise in the heat, making a compensable environment for control subjects uncompensable for skin-grafted individuals.

Hypercoagulability in response to elevated body temperature and central hypovolemia

BACKGROUND

Coagulation abnormalities contribute to poor outcomes in critically ill patients. In trauma patients exposed to a hot environment, a systemic inflammatory response syndrome, elevated body temperature, and reduced central blood volume occur in parallel with changes in hemostasis and endothelial damage. The objective of this study was to evaluate whether experimentally elevated body temperature and reduced central blood volume (CBV) per se affects hemostasis and endothelial activation.

METHODS

Eleven healthy volunteers were subjected to heat stress, sufficient to elevate core temperature, and progressive reductions in CBV by lower body negative pressure (LBNP). Changes in hemostasis were evaluated by whole blood haemostatic assays, standard hematologic tests and by plasma biomarkers of coagulation and endothelial activation/disruption.

RESULTS

Elevated body temperature and decreased CBV resulted in coagulation activation evidenced by shortened activated partial tromboplastin time (-9% [IQR -7; -4]), thrombelastography: reduced reaction time (-15% [-24; -4]) and increased maximum amplitude (+4% (2; 6)), all P < 0.05. Increased fibrinolysis was documented by elevation of D-dimer (+53% (12; 59), P = 0.016). Plasma adrenaline and noradrenaline increased 198% (83; 346) and 234% (174; 363) respectively (P = 0.006 and P = 0.003).

CONCLUSIONS

This experiment revealed emerging hypercoagulability in response to elevated body temperature and decreased CBV, whereas no effect on the endothelium was observed. We hypothesize that elevated body temperature and reduced CBV contributes to hypercoagulability, possibly due to moderate sympathetic activation, in critically ill patients and speculate that normalization of body temperature and CBV may attenuate this hypercoagulable response.

Heat stress does not augment ventilatory responses to presyncopal limited lower body negative pressure

Simulated haemorrhage, e.g. lower body negative pressure (LBNP), reduces central blood volume and mean arterial pressure, while ventilation increases. Passive whole-body heat stress likewise increases ventilation. The objective of this project was to test the hypothesis that ventilatory responses to reductions in central blood volume and arterial pressure during simulated haemorrhage are enhanced when individuals are heat stressed rather than normothermic. Eight healthy men (34 ± 9 years old, 176 ± 6 cm tall and 80.2 ± 4.2 kg body weight) underwent a simulated haemorrhagic challenge via LBNP until presyncope on two separate occasions, namely normothermic control and whole-body heat-stress trials. Baseline ventilation and core and mean skin temperatures were not different between trials (all P > 0.05). Prior to LBNP, heat stress increased core (from 36.8 ± 0.2 to 38.2 ± 0.2°C, P < 0.05) and mean skin temperatures (from 33.9 ± 0.5 to 38.1 ± 0.6°C, P < 0.05), as well as minute ventilation (from 8.01 ± 2.63 to 13.68 ± 6.68 l min(-1), P < 0.01). At presyncope, mean arterial pressure and middle cerebral artery blood velocity decreased in both trials (P < 0.05). At presyncope, ventilation increased to 23.22 ± 6.78 (P < 0.01) and 25.88 ± 10.16 l min(-1) (P < 0.01) in the normothermic and hyperthermic trials, respectively; however, neither the increase in ventilation from the pre-LBNP period nor the absolute ventilation was different between normothermic and hyperthermic trials (P > 0.05). These data suggest that the increase in ventilation during simulated haemorrhage induced via LBNP is not altered in heat-stressed humans.

Is oral temperature an accurate measurement of deep body temperature? A systematic review

CONTEXT

Oral temperature might not be a valid method to assess core body temperature. However, many clinicians, including athletic trainers, use it rather than criterion standard methods, such as rectal thermometry.

OBJECTIVE

To critically evaluate original research addressing the validity of using oral temperature as a measurement of core body temperature during periods of rest and changing core temperature.

DATA SOURCES

In July 2010, we searched the electronic databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTDiscus, Academic Search Premier, and the Cochrane Library for the following concepts: core body temperature, oral, and thermometers. Controlled vocabulary was used, when available, as well as key words and variations of those key words. The search was limited to articles focusing on temperature readings and studies involving human participants.

DATA SYNTHESIS

Original research was reviewed using the Physiotherapy Evidence Database (PEDro). Sixteen studies met the inclusion criteria and subsequently were evaluated by 2 independent reviewers. All 16 were included in the review because they met the minimal PEDro score of 4 points (of 10 possible points), with all but 2 scoring 5 points. A critical review of these studies indicated a disparity between oral and criterion standard temperature methods (eg, rectal and esophageal) specifically as the temperature increased. The difference was -0.50°C ± 0.31°C at rest and -0.58°C ± 0.75°C during a nonsteady state.

CONCLUSIONS

Evidence suggests that, regardless of whether the assessment is recorded at rest or during periods of changing core temperature, oral temperature is an unsuitable diagnostic tool for determining body temperature because many measures demonstrated differences greater than the predetermined validity threshold of 0.27°C (0.5°F). In addition, the differences were greatest at the highest rectal temperatures. Oral temperature cannot accurately reflect core body temperature, probably because it is influenced by factors such as ambient air temperature, probe placement, and ingestion of fluids. Any reliance on oral temperature in an emergency, such as exertional heat stroke, might grossly underestimate temperature and delay proper diagnosis and treatment.

Pulmonary artery and intestinal temperatures during heat stress and cooling

PURPOSE

In humans, whole body heating and cooling are used to address physiological questions where core temperature is central to the investigated hypotheses. Core temperature can be measured in various locations throughout the human body. The measurement of intestinal temperature is increasingly used in laboratory settings as well as in athletics. However, it is unknown whether intestinal temperature accurately tracks pulmonary artery blood temperature, the gold standard, during thermal stimuli in resting humans, which is the investigated hypothesis.

METHODS

This study compared pulmonary artery blood temperature (via thermistor in a pulmonary artery catheter) with intestinal temperature (telemetry pill) during whole body heat stress (n = 8), followed by whole body cooling in healthy humans (mean ± SD; age = 24 ± 3 yr, height = 183 ± 8 cm, mass = 78.1 ± 8.2 kg). Heat stress and subsequent cooling were performed by perfusing warm followed by cold water through a tube-lined suit worn by each subject.

RESULTS

Before heat stress, blood temperature (36.69°C ± 0.25°C) was less than intestinal temperature (36.96°C ± 0.21°C, P = 0.004). The increase in blood temperature after 20 min of heat stress was greater than the intestinal temperature (0.70 ± 0.24 vs 0.47 ± 0.18, P = 0.001). However, the increase in temperatures at the end of heat stress was similar between sites (blood Δ = 1.32°C ± 0.20°C vs intestinal Δ = 1.21°C ± 0.36°C, P = 0.30). Subsequent cooling decreased blood temperature (Δ = -1.03°C ± 0.34°C) to a greater extent than intestinal temperature (Δ = -0.41°C ± 0.30°C, P = 0.04).

CONCLUSIONS

In response to the applied thermal provocations, early temperature changes in the intestine are less than the temperature changes in pulmonary artery blood.