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Callovini A, Fornasiero A, Savoldelli A, Decet M, Skafidas S, Pellegrini B, Bortolan L, Schena F. Independent, additive and interactive effects of acute normobaric hypoxia and cold on submaximal and maximal endurance exercise. Eur J Appl Physiol 2024; 124:1185-1200. [PMID: 37962573 PMCID: PMC10955012 DOI: 10.1007/s00421-023-05343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate the independent and combined effects of hypoxia (FiO2 = 13.5%) and cold (- 20 °C) on physiological and perceptual responses to endurance exercise. METHODS 14 trained male subjects ( V . O2max: 64 ± 5 mL/kg/min) randomly performed a discontinuous maximal incremental test to exhaustion on a motorized treadmill under four environmental conditions: Normothermic-Normoxia (N), Normothermic-Hypoxia (H), Cold-Normoxia (C) and Cold-Hypoxia (CH). Performance and physiological and perceptual responses throughout exercise were evaluated. RESULTS Maximal WorkLoad (WL) and WL at lactate threshold (LT) were reduced in C (- 2.3% and - 3.5%) and H (- 18.0% and - 21.7%) compared to N, with no interactive (p = 0.25 and 0.81) but additive effect in CH (- 21.5% and - 24.6%). Similarly, HRmax and Vemax were reduced in C (- 3.2% and - 14.6%) and H (- 5.0% and - 7%), showing additive effects in CH (- 7.7% and - 16.6%). At LT, additive effect of C (- 2.8%) and H (- 3.8%) on HR reduction in CH (- 5.7%) was maintained, whereas an interactive effect (p = 0.007) of the two stressors combined was noted on Ve (C: - 3.1%, H: + 5.5%, CH: - 10.9%). [La] curve shifted on the left in CH, displaying an interaction effect between the 2 stressors on this parameter. Finally, RPE at LT was exclusively reduced by hypoxia (p < 0.001), whereas TSmax is synergistically reduced by cold and hypoxia (interaction p = 0.047). CONCLUSION If compared to single stress exposure, exercise performance and physiological and perceptual variables undergo additive or synergistic effects when cold and hypoxia are combined. These results provide new insight into human physiological responses to extreme environments.
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Affiliation(s)
- A Callovini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy.
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - A Fornasiero
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - A Savoldelli
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - M Decet
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - S Skafidas
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
| | - B Pellegrini
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - L Bortolan
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - F Schena
- CeRiSM, Sport Mountain and Health Research Centre, University of Verona, Rovereto, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Ojanen T, Pihlainen K, Vaara JP, Kyröläinen H. Physiological and physical performance changes during a 20-day winter military training course and its subsequent 10-day recovery period. Int J Circumpolar Health 2023; 82:2207287. [PMID: 37119213 PMCID: PMC10150620 DOI: 10.1080/22423982.2023.2207287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The present study investigated physiological, mental and physical performance changes during a 20-day winter military training course and the following 10-day recovery period. Fifty-eight (age 19 ± 1 years, height 182 ± 6 cm, body mass 78.5 ± 7.2 kg) male soldiers volunteered. Body composition, serum biomarker levels and performance tests were measured four times during the study. In addition, questionnaires were collected daily for subjective stress and rate of perceived exertion. The course induced significant declines in body (-3.9%, p < 0.05) and fat mass (-31.6%, p < 0.05) as well as in all assessed physical performance variables (-9.2 - -20.2%, p < 0.05), testosterone (-73.7%, p < 0.001) and IGF-1 concentrations (-43.6%, p < 0.001). At the same time, the sex hormone-binding globulin, creatine kinase, and C-reactive protein values increased significantly (46.3-1952.7%, p < 0.05). After the 10-day recovery period, the body composition and hormonal values returned to the baseline (p < 0.05), as did some physical performance variables, such as 2 min sit-ups and the evacuation test (p < 0.05). However, explosive force production in the upper and lower bodies remained unrecovered. The 20-day winter military training caused significant physiological and mental stress, as well as a drastic decline in physical performance even for highly physically fit soldiers, and the 10-day recovery period did not establish full recovery.
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Affiliation(s)
- Tommi Ojanen
- Human Performance Division, Finnish Defence Research Agency, Tuusula, Finland
| | - Kai Pihlainen
- Training Division, Defence Command, Helsinki, Finland
| | - Jani P Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - Heikki Kyröläinen
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Chen F, Fu M, Li Y, Shen S, Yang J, Weng W. A numerical tool for assessing human thermal safety and thermal comfort in cold-weather activities. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:377-388. [PMID: 36515728 DOI: 10.1007/s00484-022-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
This paper describes a newly developed software tool to evaluate human thermal safety and thermal comfort in cold-weather activities aimed at guiding users to arrange activity plans and select appropriate clothing ensembles. The software inputs include conditions of activity, environment, human body, and clothing ensemble. It outputs physiological temperatures, cold injury risks, thermal sensations, and thermal comforts in intuitive ways like cloud maps and curves. The software tool is characterized by (1) integration of a thermoregulatory model that predicts human thermophysiological responses under exercise conditions in cold environments, (2) the functions of clothing ensemble database and individual parameter database, (3) the human centric outputs that directly reflect human physiological and mental status, and (4) the user-friendly operation interface and output interface, as well as a wide applicability. The software is validated with human test studies covering ambient temperatures from - 30.6 to 5 °C, clothing ensembles from 1.34 to 3.20 clo, and activity intensities from 2 to 9 Mets. The average prediction RMSEs of core temperature, mean skin temperature, thermal sensation, and thermal comfort are 0.16 °C, 0.45 °C, 0.58, and 1.41, respectively. The software is an advanced expansion to current standards and guidance of cold exposure assessment and a meaningful tool for the fields of occupational health care, cold protection, and environmental ergonomics.
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Affiliation(s)
- Feiyu Chen
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
| | - Ming Fu
- Hefei Institute for Public Safety Research, Tsinghua University, Hefei, 230601, Anhui Province, China.
- Anhui Province Key Laboratory of Human Safety, Hefei, 230601, Anhui Province, China.
| | - Yayun Li
- Hefei Institute for Public Safety Research, Tsinghua University, Hefei, 230601, Anhui Province, China
- Anhui Province Key Laboratory of Human Safety, Hefei, 230601, Anhui Province, China
| | - Shifei Shen
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China.
| | - Jie Yang
- College of Safety Science and Engineering, Xi'an University of Science and Technology, Xi'an, 710054, China
| | - Wenguo Weng
- Institute of Public Safety Research, Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
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Brocherie F, Brito J, Costa JA, Millet GP. Editorial: Evidence to practice: Bridging the gap in environmental challenges (cold, heat, hypoxia) in sport and exercise: Acclimatization/acclimation, training, competitions, recovery, rehabilitation and therapeutic interventions. Front Sports Act Living 2022; 4:1090086. [DOI: 10.3389/fspor.2022.1090086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
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Blokker T, Bucher E, Steiner T, Wehrlin JP. Effect of cold ambient temperature on heat flux, skin temperature, and thermal sensation at different body parts in elite biathletes. Front Sports Act Living 2022; 4:966203. [PMID: 36406769 PMCID: PMC9666787 DOI: 10.3389/fspor.2022.966203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION When exercising in the cold, optimizing thermoregulation is essential to maintain performance. However, no study has investigated thermal parameters with wearable-based measurements in a field setting among elite Nordic skiers. Therefore, this study aimed to assess the thermal response and sensation measured at different body parts during exercise in a cold environment in biathletes. METHODS Thirteen Swiss national team biathletes (6 females, 7 males) performed two skiing bouts in the skating technique on two consecutive days (ambient temperature: -3.74 ± 2.32 °C) at 78 ± 4% of maximal heart rate. Heat flux (HF), core (Tcore) and skin (Tskin) temperature were measured with sensors placed on the thigh, back, anterior and lateral thorax. Thermal sensation (TS) was assessed three times for different body parts: in protective winter clothing, in a race suit before (PRE) and after exercise (POST). RESULTS HF demonstrated differences (p < 0.001) between sensor locations, with the thigh showing the highest heat loss (344 ± 37 kJ/m2), followed by the back (269 ± 6 kJ/m2), the lateral thorax (220 ± 47 kJ/m2), and the anterior thorax (192 ± 37 kJ/m2). Tcore increased (p < 0.001). Tskin decreased for all body parts (p < 0.001). Thigh Tskin decreased more than for other body parts (p < 0.001). From PRE to POST, TS of the hands decreased (p < 0.01). CONCLUSION Biathletes skiing in a race suit at moderate intensity experience significant heat loss and a large drop in Tskin, particularly at the quadriceps muscle. To support the optimal functioning of working muscles, body-part dependent differences in the thermal response should be considered for clothing strategy and for race suit design.
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Hodgson JR, Chapman L, Pope FD. Amateur runners more influenced than elite runners by temperature and air pollution during the UK's Great North Run half marathon. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 842:156825. [PMID: 35752238 DOI: 10.1016/j.scitotenv.2022.156825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
The short- and long-term impacts of air pollution on human health are well documented and include cardiovascular, neurological, immune system and developmental damage. Additionally, the irritant qualities of air pollutants can cause respiratory and cardiovascular distress. This can be heightened during exercise and especially so for those with respiratory conditions such as asthma. Meteorological conditions have also been shown to adversely impact athletic performance; but research has mostly examined the impact of pollution and meteorology on marathon times or running under laboratory settings. This study focuses on the half marathon distance (13.1 miles/21.1 km) and utilises the Great North Run held in Newcastle-upon-Tyne, England, between 2006 and 2019. Local meteorological (temperature, relative humidity, heat index and wind speed) and air quality (ozone, nitrogen dioxide and PM2.5) data is used in conjunction with finishing times of the quickest and slowest amateur participants, along with the elite field, to determine the extent to which each group is influenced in real-world conditions. Results show that increased temperatures, heat index and ozone concentrations are significantly detrimental to amateur half marathon performances. The elite field meanwhile is influenced by higher ozone concentrations. It is thought that the increased exposure time to the environmental conditions contributes to this greater decrease in performance for the slowest participants. For elite athletes that are performing closer to their maximal capacity (VO2 max), the higher ozone concentrations likely results in respiratory irritation and decreased performance. Nitrogen dioxide and PM2.5 pollution showed no significant relationship with finishing times. These results provide additional insight into the environmental effects on exercise, which is particularly important under the increasing effects climate change and regional air pollution. This study can be used to inform event organisation and start times for both mass participation and major elite events with the aim to reduce heat- and pollution-related incidents.
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Affiliation(s)
- James R Hodgson
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Lee Chapman
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
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Modelling and experimental study of thermo-physiological responses of human exercising in cold environments. J Therm Biol 2022; 109:103316. [DOI: 10.1016/j.jtherbio.2022.103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
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Effects of multiple indoor environmental factors on anaerobic exercise performance. J Therm Biol 2022; 108:103280. [DOI: 10.1016/j.jtherbio.2022.103280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022]
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Impact of a Cold Environment on the Performance of Professional Cyclists: A Pilot Study. Life (Basel) 2021; 11:life11121326. [PMID: 34947857 PMCID: PMC8704244 DOI: 10.3390/life11121326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
The practice of physical activity in a variable climate during the same competition is becoming more and more common due to climate change and increasingly frequent climate disturbances. The main aim of this pilot study was to understand the impact of cold ambient temperature on performance factors during a professional cycling race. Six professional athletes (age = 27 ± 2.7 years; height = 180.86 ± 5.81 cm; weight = 74.09 ± 9.11 kg; % fat mass = 8.01 ± 2.47%; maximum aerobic power (MAP) = 473 ± 26.28 W, undertook ~20 h training each week at the time of the study) participated in the Tour de la Provence under cold environmental conditions (the ambient temperature was 15.6 ± 1.4 °C with a relative humidity of 41 ± 8.5% and the normalized ambient temperature (Tawc) was 7.77 ± 2.04 °C). Body core temperature (Tco) was measured with an ingestible capsule. Heart rate (HR), power, speed, cadence and the elevation gradient were read from the cyclists’ onboard performance monitors. The interaction (multivariate analysis of variance) of the Tawc and the elevation gradient has a significant impact (F(1.5) = 32.2; p < 0.001) on the variables (cadence, power, velocity, core temperature, heart rate) and on each individual. Thus, this pilot study shows that in cold environmental conditions, the athlete’s performance was limited by weather parameters (ambient temperature associated with air velocity) and race characteristics. The interaction of Tawc and elevation gradient significantly influences thermal (Tco), physiological (HR) and performance (power, speed and cadence) factors. Therefore, it is advisable to develop warm-up, hydration and clothing strategies for competitive cycling under cold ambient conditions and to acclimatize to the cold by training in the same conditions to those that may be encountered in competition.
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Castellani JW, Eglin CM, Ikäheimo TM, Montgomery H, Paal P, Tipton MJ. ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise. Curr Sports Med Rep 2021; 20:594-607. [PMID: 34752434 DOI: 10.1249/jsr.0000000000000907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Cold injury can result from exercising at low temperatures and can impair exercise performance or cause lifelong debility or death. This consensus statement provides up-to-date information on the pathogenesis, nature, impacts, prevention, and treatment of the most common cold injuries.
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Affiliation(s)
- John W Castellani
- United States Army Research Institute of Environmental Medicine, Thermal and Mountain Medicine Division, Natick, MA
| | - Clare M Eglin
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
| | | | - Hugh Montgomery
- University College London, Centre for Human Health and Performance, London, United Kingdom
| | - Peter Paal
- Hospitallers Brothers Hospital, Anaesthesiology and Intensive Care Medicine, Salzburg, Austria
| | - Michael J Tipton
- University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, United Kingdom
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Gatterer H, Dünnwald T, Turner R, Csapo R, Schobersberger W, Burtscher M, Faulhaber M, Kennedy MD. Practicing Sport in Cold Environments: Practical Recommendations to Improve Sport Performance and Reduce Negative Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9700. [PMID: 34574624 PMCID: PMC8471173 DOI: 10.3390/ijerph18189700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Although not a barrier to perform sport, cold weather environments (low ambient temperature, high wind speeds, and increased precipitation, i.e., rain/water/snow) may influence sport performance. Despite the obvious requirement for practical recommendations and guidelines to better facilitate training and competition in such cold environments, the current scientific evidence-base is lacking. Nonetheless, this review summarizes the current available knowledge specifically related to the physiological impact of cold exposure, in an attempt to provide practitioners and coaches alike with practical recommendations to minimize any potential negative performance effects, mitigate health issues, and best optimize athlete preparation across various sporting disciplines. Herein, the review is split into sections which explore some of the key physiological effects of cold exposure on performance (i.e., endurance exercise capacity and explosive athletic power), potential health issues (short-term and long-term), and what is currently known with regard to best preparation or mitigation strategies considered to negate the potential negative effects of cold on performance. Specific focus is given to "winter" sports that are usually completed in cold environments and practical recommendations for physical preparation.
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Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy;
| | - Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall i.T., Tirol, Austria and Tirol-Kliniken GmbH, 6020 Innsbruck, Austria; (T.D.); (W.S.)
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy;
| | - Robert Csapo
- Centre for Sport Science and University Sports, University of Vienna, 1010 Vienna, Austria;
| | - Wolfgang Schobersberger
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall i.T., Tirol, Austria and Tirol-Kliniken GmbH, 6020 Innsbruck, Austria; (T.D.); (W.S.)
- Austrian Society for Alpine and High-Altitude Medicine, 6414 Mieming, Austria; (M.B.); (M.F.)
| | - Martin Burtscher
- Austrian Society for Alpine and High-Altitude Medicine, 6414 Mieming, Austria; (M.B.); (M.F.)
- Department of Sport Science, University Innsbruck, 6020 Innsbruck, Austria
| | - Martin Faulhaber
- Austrian Society for Alpine and High-Altitude Medicine, 6414 Mieming, Austria; (M.B.); (M.F.)
- Department of Sport Science, University Innsbruck, 6020 Innsbruck, Austria
| | - Michael D. Kennedy
- Athlete Health Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Sandbakk Ø, Solli GS, Talsnes RK, Holmberg HC. Preparing for the Nordic Skiing Events at the Beijing Olympics in 2022: Evidence-Based Recommendations and Unanswered Questions. JOURNAL OF SCIENCE IN SPORT AND EXERCISE 2021; 3:257-269. [PMID: 38624672 PMCID: PMC8107804 DOI: 10.1007/s42978-021-00113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Abstract
At the 2022 Winter Olympics in Beijing, the XC skiing, biathlon and nordic combined events will be held at altitudes of ~ 1700 m above sea level, possibly in cold environmental conditions and while requiring adjustment to several time zones. However, the ongoing COVID-19 pandemic may lead to sub-optimal preparations. The current commentary provides the following evidence-based recommendations for the Olympic preparations: make sure to have extensive experience of training (> 60 days annually) and competition at or above the altitude of competition (~ 1700 m), to optimize and individualize your strategies for acclimatization and competition. In preparing for the Olympics, 10-14 days at ~ 1700 m seems to optimize performance at this altitude effectively. An alternative strategy involves two-three weeks of training at > 2000 m, followed by 7-10 days of tapering off at ~ 1700 m. During each of the last 3 or 4 days prior to departure, shift your sleeping and eating schedule by 0.5-1 h towards the time zone in Beijing. In addition, we recommend that you arrive in Beijing one day earlier for each hour change in time zone, followed by appropriate timing of exposure to daylight, meals, social contacts, and naps, in combination with a gradual increase in training load. Optimize your own individual procedures for warming-up, as well as for maintaining body temperature during the period between the warm-up and competition, effective treatment of asthma (if necessary) and pacing at ~ 1700 m with cold ambient temperatures. Although we hope that these recommendations will be helpful in preparing for the Beijing Olympics in 2022, there is a clear need for more solid evidence gained through new sophisticated experiments and observational studies.
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Affiliation(s)
- Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro Strøm Solli
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Physical Education, Nord University, Bodø, Norway
| | - Rune Kjøsen Talsnes
- Department of Sports Science and Physical Education, Nord University, Bodø, Norway
- Meråker High School, Trøndelag County Council, Steinkjer, Norway
| | - Hans-Christer Holmberg
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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A heat and moisture-exchanging mask impairs self-paced maximal running performance in a sub-zero environment. Eur J Appl Physiol 2021; 121:1979-1992. [PMID: 33782715 PMCID: PMC8192396 DOI: 10.1007/s00421-021-04666-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/16/2021] [Indexed: 12/05/2022]
Abstract
Purpose Heat-and-moisture-exchanging devices (HME) are commonly used by endurance athletes during training in sub-zero environments, but their effects on performance are unknown. We investigated the influence of HME usage on running performance at − 15 °C. Methods Twenty-three healthy adults (15 male, 8 female; age 18–53 years; \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}{\text O}_{2peak}$$\end{document}V˙O2peak men 56 ± 7, women 50 ± 4 mL·kg−1·min−1) performed two treadmill exercise tests with and without a mask-style HME in a randomised, crossover design. Participants performed a 30-min submaximal warm-up (SUB), followed by a 4-min maximal, self-paced running time-trial (TT). Heart rate (HR), respiratory frequency (fR), and thoracic area skin temperature (Tsk) were monitored using a chest-strap device; muscle oxygenation (SmO2) and deoxyhaemoglobin concentration ([HHb]) were derived from near-infra-red-spectroscopy sensors on m. vastus lateralis; blood lactate was measured 2 min before and after the TT. Results HME usage reduced distance covered in the TT by 1.4%, despite similar perceived exertion, HR, fR, and lactate accumulation. The magnitude of the negative effect of the HME on performance was positively associated with body mass (r2 = 0.22). SmO2 and [HHb] were 3.1% lower and 0.35 arb. unit higher, respectively, during the TT with HME, and Tsk was 0.66 °C higher during the HME TT in men. HR (+ 2.7 beats·min−1) and Tsk (+ 0.34 °C) were higher during SUB with HME. In the male participants, SmO2 was 3.8% lower and [HHb] 0.42 arb. unit higher during SUB with HME. Conclusion Our findings suggest that HME usage impairs maximal running performance and increases the physiological demands of submaximal exercise.
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Yang C, Xu Y, Yang Y, Xiao S, Fu W. Effectiveness of Using Compression Garments in Winter Racing Sports: A Narrative Review. Front Physiol 2020; 11:970. [PMID: 32848885 PMCID: PMC7417664 DOI: 10.3389/fphys.2020.00970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/16/2020] [Indexed: 01/03/2023] Open
Abstract
Nowadays, compression garments (CGs) are widely used in winter racing sports, such as speed skating, short-track speed skating, alpine skiing, and cross-country skiing. However, the effect of wearing CGs on athletic performance in these specific sports is still not fully examined. Thus, the aim of this narrative review is to summarize the research and application of CGs in winter racing sports and to discuss how the CGs help athletes improve their performance in an integrative manner (i.e., physiology, aerodynamics, and biomechanics). A total of 18 experimental studies dedicated to CGs in winter racing sports were identified from the peer-review scientific literature. The main findings are as follows. (1) Currently, CG studies have mainly focused on drag reduction, metabolism, muscle function, strength performance, and fatigue recovery. (2) The results of most studies conducted in wind tunnels showed that, for cylindrical structures similar to the human body, clothing with rough surfaces can reduce air drag. Notably, the effect of CGs on drag reduction in real competition has not been fully explored in the literature. (3) Compression can reduce muscle vibrations at high impact and help athletes control the center of pressure movement, a function that is important for alpine skiing. Future studies are needed to improve current understanding of the effects of compression clothing microstructure on drag reduction and their stretching in different parts of the body. Furthermore, the design of experimental protocol must be consistent with those during the competition, thus providing a full discussion on energy metabolism, fatigue, and recovery affected by CGs.
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Affiliation(s)
- Chenhao Yang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yongxin Xu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yang Yang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Songlin Xiao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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15
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Hanstock HG, Ainegren M, Stenfors N. Exercise in Sub-zero Temperatures and Airway Health: Implications for Athletes With Special Focus on Heat-and-Moisture-Exchanging Breathing Devices. Front Sports Act Living 2020; 2:34. [PMID: 33345026 PMCID: PMC7739679 DOI: 10.3389/fspor.2020.00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Asthma is highly prevalent among winter endurance athletes. This "occupational disease" of cross-country skiers, among others, was acknowledged during the 1990s, with the pathogenesis attributed to repeated and prolonged exposure to cold, dry air combined with high rates of ventilation during exercise. Nevertheless, more than 25 years later, the prevalence of asthma among Scandinavian cross-country skiers is unchanged, and prevention remains a primary concern for sports physicians. Heat-and-moisture-exchanging breathing devices (HMEs) prevent exercise-induced bronchoconstriction in subjects with pre-existing disease and may have potential as a preventative intervention for healthy athletes undertaking training and competition in winter endurance sports. Herein we firstly provide an overview of the influence of temperature and humidity on airway health and the implications for athletes training and competing in sub-zero temperatures. We thereafter describe the properties and effects of HMEs, identify gaps in current understanding, and suggest avenues for future research.
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Affiliation(s)
- Helen G Hanstock
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Mats Ainegren
- Sports Tech Research Centre, Department of Quality Management and Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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16
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17
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Renberg J, Christiansen MT, Wiggen ØN, Roeleveld K, Bardal EM, Reinertsen RE. Metabolic rate and muscle activation level when wearing state-of-the-art cold-weather protective clothing during level and inclined walking. APPLIED ERGONOMICS 2020; 82:102956. [PMID: 31542574 DOI: 10.1016/j.apergo.2019.102956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 07/18/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
Use of cold-weather personal protective clothing (PPC) in cold climates is essential but can add metabolic cost to the wearer. This study measured the effect of wearing state-of-the-art PPC and personal protective equipment (PPE), with the possible effect of clothing layers and fit, on physiological responses including metabolic rate (MR) and muscle activation level. 19 male participants (80.2 ± 5.9 kg, 181.5 ± 5.1 cm) wore five different clothing ensembles during level (0°) and inclined (6°) walking. Compared to a base layer ensemble (388.7 ± 42.7 W/737.8 ± 57.9 W), wearing a 3-layer PPC ensemble (421.5 ± 44.7 W/811.7 ± 69.2 W) significantly increased MR, and adding PPE (458.3 ± 59.8 W/864.5 ± 71.2 W) further increased MR during level/inclined walking. Independent of the extra weight, adding a middle layer between base layer and outer clothing significantly increased MR during inclined walking only, and no effect of oversized outer clothing was measured.
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Affiliation(s)
- Julie Renberg
- SINTEF Digital, Department of Health Research, P.O. Box 4760, Torgarden, N-7465, Trondheim, Norway; Norwegian University of Science and Technology, Department of Biology, NTNU, Faculty of Natural Sciences, NO-7491, Trondheim, Norway.
| | - Maren Trones Christiansen
- Norwegian University of Science and Technology, Department of Biology, NTNU, Faculty of Natural Sciences, NO-7491, Trondheim, Norway.
| | - Øystein Nordrum Wiggen
- SINTEF Digital, Department of Health Research, P.O. Box 4760, Torgarden, N-7465, Trondheim, Norway.
| | - Karin Roeleveld
- Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Heath Sciences, NO-7491, Trondheim, Norway.
| | - Ellen Marie Bardal
- Norwegian University of Science and Technology, Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Heath Sciences, NO-7491, Trondheim, Norway.
| | - Randi Eidsmo Reinertsen
- SINTEF Digital, Department of Health Research, P.O. Box 4760, Torgarden, N-7465, Trondheim, Norway; Norwegian University of Science and Technology, Department of Biology, NTNU, Faculty of Natural Sciences, NO-7491, Trondheim, Norway.
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18
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O Sullivan IJ, Johnson MI, Hind K, Breen S, Francis P. Are changes in running economy associated with changes in performance in runners? A systematic review and meta-analysis. J Sports Sci 2019; 37:1521-1533. [PMID: 30810467 DOI: 10.1080/02640414.2019.1575177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Improvements in running economy (RE) are thought to lead to improvements in running performance (P). Multiple interventions have been designed with the aim of improving RE in middle and long-distance runners. The aim of this study was to assess the effect of interventions of at least 2-weeks' duration on RE and P and to determine whether there is a relationship between changes in RE (ΔRE) and changes in running performance (ΔP). A database search was carried out in Web of Science, Scopus and SPORTDiscus. In accordance with a PRISMA checklist 10 studies reporting 12 comparisons between interventions and controls were included in the review. There was no correlation between percentage ΔRE and percentage ΔP (r = 0.46, P = 0.936, 12 comparisons). There was a low risk of reporting bias but an unclear risk of bias for other items. Meta-analyses found no statistically significant differences between interventions and controls for RE (SMD (95% CI) = -0.37 (-1.43, 0.69), 204 participants, p = 0.49) or for P (SMD (95% CI) = -0.65 (-26.02, 24.72, 204 participants, p = 0.99). There is a need for studies of greater statistical power, methodological quality, duration and homogeneity of intervention and population. Standardised measures of performance and greater control over non-intervention training are also required.
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Affiliation(s)
- Ian J O Sullivan
- a Musculoskeletal Health Research Group, School of Clinical and Applied Science , Leeds Beckett University , Leeds , UK
| | - Mark I Johnson
- b Centre for Pain Research, Leeds Beckett University, School of Clinical and Applied Science , Leeds Beckett University , Leeds , UK
| | - Karen Hind
- c Research Institute for Sport, Physical Activity and Leisure , Leeds Beckett University , Leeds , UK
| | - Sarah Breen
- d School of Health and Human Performance , Northern Michigan University , Marquette , MI , USA
| | - Peter Francis
- a Musculoskeletal Health Research Group, School of Clinical and Applied Science , Leeds Beckett University , Leeds , UK
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19
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MacRae BA, Annaheim S, Spengler CM, Rossi RM. Skin Temperature Measurement Using Contact Thermometry: A Systematic Review of Setup Variables and Their Effects on Measured Values. Front Physiol 2018. [PMID: 29441024 DOI: 10.3389/fphys.2018.00029, 10.3389/fpls.2018.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Skin temperature (Tskin) is commonly measured using Tskin sensors affixed directly to the skin surface, although the influence of setup variables on the measured outcome requires clarification. Objectives: The two distinct objectives of this systematic review were (1) to examine measurements from contact Tskin sensors considering equilibrium temperature and temperature disturbance, sensor attachments, pressure, environmental temperature, and sensor type, and (2) to characterise the contact Tskin sensors used, conditions of use, and subsequent reporting in studies investigating sports, exercise, and other physical activity. Data sources and study selection: For the measurement comparison objective, Ovid Medline and Scopus were used (1960 to July 2016) and studies comparing contact Tskin sensor measurements in vivo or using appropriate physical models were included. For the survey of use, Ovid Medline was used (2011 to July 2016) and studies using contact temperature sensors for the measurement of human Tskinin vivo during sport, exercise, and other physical activity were included. Study appraisal and synthesis methods: For measurement comparisons, assessments of risk of bias were made according to an adapted version of the Cochrane Collaboration's risk of bias tool. Comparisons of temperature measurements were expressed, where possible, as mean difference and 95% limits of agreement (LoA). Meta-analyses were not performed due to the lack of a common reference condition. For the survey of use, extracted information was summarised in text and tabular form. Results: For measurement comparisons, 21 studies were included. Results from these studies indicated minor (<0.5°C) to practically meaningful (>0.5°C) measurement bias within the subgroups of attachment type, applied pressure, environmental conditions, and sensor type. The 95% LoA were often within 1.0°C for in vivo studies and 0.5°C for physical models. For the survey of use, 172 studies were included. Details about Tskin sensor setup were often poorly reported and, from those reporting setup information, it was evident that setups widely varied in terms of type of sensors, attachments, and locations used. Conclusions: Setup variables and conditions of use can influence the measured temperature from contact Tskin sensors and thus key setup variables need to be appropriately considered and consistently reported.
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Affiliation(s)
- Braid A MacRae
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland.,Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Simon Annaheim
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - René M Rossi
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
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20
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MacRae BA, Annaheim S, Spengler CM, Rossi RM. Skin Temperature Measurement Using Contact Thermometry: A Systematic Review of Setup Variables and Their Effects on Measured Values. Front Physiol 2018; 9:29. [PMID: 29441024 PMCID: PMC5797625 DOI: 10.3389/fphys.2018.00029] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Skin temperature (Tskin) is commonly measured using Tskin sensors affixed directly to the skin surface, although the influence of setup variables on the measured outcome requires clarification. Objectives: The two distinct objectives of this systematic review were (1) to examine measurements from contact Tskin sensors considering equilibrium temperature and temperature disturbance, sensor attachments, pressure, environmental temperature, and sensor type, and (2) to characterise the contact Tskin sensors used, conditions of use, and subsequent reporting in studies investigating sports, exercise, and other physical activity. Data sources and study selection: For the measurement comparison objective, Ovid Medline and Scopus were used (1960 to July 2016) and studies comparing contact Tskin sensor measurements in vivo or using appropriate physical models were included. For the survey of use, Ovid Medline was used (2011 to July 2016) and studies using contact temperature sensors for the measurement of human Tskinin vivo during sport, exercise, and other physical activity were included. Study appraisal and synthesis methods: For measurement comparisons, assessments of risk of bias were made according to an adapted version of the Cochrane Collaboration's risk of bias tool. Comparisons of temperature measurements were expressed, where possible, as mean difference and 95% limits of agreement (LoA). Meta-analyses were not performed due to the lack of a common reference condition. For the survey of use, extracted information was summarised in text and tabular form. Results: For measurement comparisons, 21 studies were included. Results from these studies indicated minor (<0.5°C) to practically meaningful (>0.5°C) measurement bias within the subgroups of attachment type, applied pressure, environmental conditions, and sensor type. The 95% LoA were often within 1.0°C for in vivo studies and 0.5°C for physical models. For the survey of use, 172 studies were included. Details about Tskin sensor setup were often poorly reported and, from those reporting setup information, it was evident that setups widely varied in terms of type of sensors, attachments, and locations used. Conclusions: Setup variables and conditions of use can influence the measured temperature from contact Tskin sensors and thus key setup variables need to be appropriately considered and consistently reported.
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Affiliation(s)
- Braid A. MacRae
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Simon Annaheim
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Christina M. Spengler
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - René M. Rossi
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
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21
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Hinde K, Lloyd R, Low C, Cooke C. The effect of temperature, gradient, and load carriage on oxygen consumption, posture, and gait characteristics. Eur J Appl Physiol 2017; 117:417-430. [PMID: 28154976 PMCID: PMC5346415 DOI: 10.1007/s00421-016-3531-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/29/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this experiment was to evaluate the effect of load carriage in a range of temperatures to establish the interaction between cold exposure, the magnitude of change from unloaded to loaded walking and gradient. METHODS Eleven participants (19-27 years) provided written informed consent before performing six randomly ordered walking trials in six temperatures (20, 10, 5, 0, -5, and -10 °C). Trials involved two unloaded walking bouts before and after loaded walking (18.2 kg) at 4 km · h-1, on 0 and 10% gradients in 4 min bouts. RESULTS The change in absolute oxygen consumption (V̇O2) from the first unloaded bout to loaded walking was similar across all six temperatures. When repeating the second unloaded bout, V̇O2 at both -5 and -10 °C was greater compared to the first. At -10 °C, V̇O2 was increased from 1.60 ± 0.30 to 1.89 ± 0.51 L · min-1. Regardless of temperature, gradient had a greater effect on V̇O2 and heart rate (HR) than backpack load. HR was unaffected by temperature. Stride length (SL) decreased with decreasing temperature, but trunk forward lean was greater during cold exposure. CONCLUSION Decreased ambient temperature did not influence the magnitude of change in V̇O2 from unloaded to loaded walking. However, in cold temperatures, V̇O2 was significantly higher than in warm conditions. The increased V̇O2 in colder temperatures at the same exercise intensity is predicted to ultimately lead to earlier onset of fatigue and cessation of exercise. These results highlight the need to consider both appropriate clothing and fitness during cold exposure.
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Affiliation(s)
- Katrina Hinde
- Leeds Beckett University, Headingley Campus, Leeds, West Yorkshire, LS6 3QS, UK.
| | - Ray Lloyd
- Leeds Trinity University, Brownberrie Lane, Horsforth, Leeds, LS18 5HD, UK
| | - Chris Low
- Leeds Beckett University, Headingley Campus, Leeds, West Yorkshire, LS6 3QS, UK
| | - Carlton Cooke
- Leeds Trinity University, Brownberrie Lane, Horsforth, Leeds, LS18 5HD, UK
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22
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Castellani JW, Tipton MJ. Cold Stress Effects on Exposure Tolerance and Exercise Performance. Compr Physiol 2015; 6:443-69. [PMID: 26756639 DOI: 10.1002/cphy.c140081] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cold weather can have deleterious effects on health, tolerance, and performance. This paper will review the physiological responses and external factors that impact cold tolerance and physical performance. Tolerance is defined as the ability to withstand cold stress with minimal changes in physiological strain. Physiological and pathophysiological responses to short-term (cold shock) and long-term cold water and air exposure are presented. Factors (habituation, anthropometry, sex, race, and fitness) that influence cold tolerance are also reviewed. The impact of cold exposure on physical performance, especially aerobic performance, has not been thoroughly studied. The few studies that have been done suggest that aerobic performance is degraded in cold environments. Potential physiological mechanisms (decreases in deep body and muscle temperature, cardiovascular, and metabolism) are discussed. Likewise, strength and power are also degraded during cold exposure, primarily through a decline in muscle temperature. The review also discusses the concept of thermoregulatory fatigue, a reduction in the thermal effector responses of shivering and vasoconstriction, as a result of multistressor factors, including exhaustive exercise.
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Affiliation(s)
- John W Castellani
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Michael J Tipton
- Extreme Environments Laboratory, Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, Hampshire, England, United Kingdom
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23
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Renberg J, Sandsund M, Wiggen ØN, Reinertsen RE. Effect of ambient temperature on female endurance performance. J Therm Biol 2014; 45:9-14. [DOI: 10.1016/j.jtherbio.2014.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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