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Meade RD, Akerman AP, Notley SR, McGarr GW, McCourt ER, Kirby NV, Costello JT, Cotter JD, Crandall CG, Zanobetti A, Kenny GP. Meta-analysis of heat-induced changes in cardiac function from over 400 laboratory-based heat exposure studies. Nat Commun 2025; 16:2543. [PMID: 40087302 PMCID: PMC11909281 DOI: 10.1038/s41467-025-57868-6] [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: 06/18/2024] [Accepted: 03/03/2025] [Indexed: 03/17/2025] Open
Abstract
Heat waves are associated with increased fatalities from adverse cardiovascular events attributed to the negative effects of heat on cardiac function. However, scientific understanding of acute cardiac adjustments to heat has come primarily from laboratory experiments employing insulated and encapsulated heating modalities, most commonly water-perfused suits. We evaluated whether findings from those studies reflect cardiac responses during more natural exposures to hot ambient conditions simulated in climate-controlled chambers by synthesizing the findings from over 400 laboratory-based heat exposure studies (6858 participant-exposures) published between 1961-2024. Among all included studies, median (interquartile range) elevations in core temperature and heart rate from baseline to end-exposure were 0.9 (0.5-1.3)°C and 27 (15-40) beats/min. Multilevel mixed-effects meta-analyses revealed exacerbated elevations in heart rate, cardiac output, and rate pressure product (estimate of cardiac workload) and blunted falls in systolic pressure in participants heated via encapsulated modalities. Leveraging the large dataset, we also provide empirical estimates of body temperature and cardiovascular responses to a wide range of conditions experienced during heat waves. With rising global temperatures, ecologically-minded physiological research is needed to improve understanding of the effects of heat stress on cardiac responses and further the development of robust climate health models and evidence-based heat-health guidance.
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Affiliation(s)
- Robert D Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Ashley P Akerman
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory W McGarr
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Emma R McCourt
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie V Kirby
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph T Costello
- School of Psychology, Sport & Health Sciences, University of Portsmouth, Portsmouth, United Kingdom
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Su Y, Martinkova A, O'Donnell E, Bailey SJ, Leicht CA. The acute effects of continuous and intermittent whole-body passive heating on cardiovascular disease risk indicators in healthy and young males and females. Eur J Appl Physiol 2025:10.1007/s00421-025-05718-0. [PMID: 39953332 DOI: 10.1007/s00421-025-05718-0] [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: 10/10/2024] [Accepted: 01/15/2025] [Indexed: 02/17/2025]
Abstract
PURPOSE Heat therapy is recognised to promote cardiovascular health, and whilst most recent heat therapy investigations have focussed on continuous heat exposure, traditional sauna use often includes recovery periods. This study compared the acute effects of continuous versus intermittent whole-body heating on cardiovascular function markers in males and females. METHODS Twenty healthy participants (25 ± 3 years; 10 males, 10 females) were exposed to 2 passive heating regimens: continuous heating (CH) for 60 min and intermittent heating (IH) comprised of 3 × 20-min blocks interspersed by 15-min cooling breaks. Skin perfusion, blood pressure (BP), plasma nitrite, interleukins, body temperature, and thermal perceptual responses were assessed. RESULTS Greater increases in rectal temperature (Trec) (CH: 1.2 ± 0.1 °C; IH: 0.5 ± 0.1 °C), skin perfusion, systolic blood pressure (SBP), heart rate (HR), interleukin-6 (IL-6) and plasma nitrite were found in CH compared to IH (p ≤ 0.01), but the thermal perceptual response was more unfavourable during CH (p < 0.01). Females had higher skin perfusion and plasma nitrite concentrations (p ≤ 0.04), but lower brachial and central BP than males in both conditions (p ≤ 0.01). Furthermore, females reached a higher Trec and more unfavourable thermal perception in CH (p ≤ 0.02). CONCLUSION More pronounced cardiovascular responses were associated with higher Trec and discomfort. Females exhibited higher skin perfusion and plasma nitrite concentrations than males and reported less favourable thermal perception in CH, but not in IH.
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Affiliation(s)
- Yunuo Su
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Adela Martinkova
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Emma O'Donnell
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Christof A Leicht
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
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Cheng JL, Pizzola CA, Mattook KC, Noguchi KS, Armstrong CM, Bagri GK, Macdonald MJ. Effects of Lower Limb Heat Therapy, Exercise Training, or a Combined Intervention on Vascular Function: A Randomized Controlled Trial. Med Sci Sports Exerc 2025; 57:94-105. [PMID: 39283227 DOI: 10.1249/mss.0000000000003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
PURPOSE The purpose of this study is to compare the effects of 8 wk of no intervention (CON), lower limb heat therapy (HEAT), moderate-intensity exercise training (EX), or combined training and therapy (HEATEX) in young, healthy recreationally active adults. METHODS Sixty participants (23 ± 3 yr, 30 females) were randomly allocated into CON ( n = 15), HEAT ( n = 15), EX ( n = 14), or HEATEX ( n = 16). The primary outcome was vascular function, assessed through brachial artery flow-mediated dilation tests. Secondary measures included arterial stiffness (pulse wave velocity), cardiorespiratory fitness (V̇O 2peak ), body composition, and quadriceps muscle strength. RESULTS There were no differences in brachial artery flow-mediated dilation between the groups before and after the interventions (all P > 0.05). Both interventions with a heating component were associated with within-group reductions in carotid-femoral pulse wave, and increase in absolute and relative V̇O 2peak after 8 wk (HEAT: ∆-0.27 [-0.53, -0.02] m s -1 , ∆0.18 [0.06, 0.29] L·min -1 , ∆2.18 [0.60, 3.76] mL·kg -1 ·min -1 , respectively; HEATEX: ∆-0.33 [-0.58, -0.09], ∆0.21 [0.11, 0.32] L·min -1 , ∆2.59 [1.06, 4.12] mL·kg -1 ·min -1 , respectively), but no between-group differences were observed ( P = 0.25, P = 0.21, and P = 0.55, respectively). There was also a within-group decrease in body fat percentage with EX (∆-1.37 [-2.45, -0.29] %), but no changes in leg strength in any of the groups ( P = 0.79). CONCLUSIONS This randomized controlled trial is the first to examine the efficacy of lower limb heating against traditionally prescribed exercise training. In our young cohort, 8 wk of training and/or therapy was insufficient to improve vascular function. More intense protocols and longer interventions involving lower limb heating may be required to elicit improvements in health outcomes.
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Affiliation(s)
- Jem L Cheng
- Department of Kinesiology, McMaster University, Hamilton, Ontario, CANADA
| | | | - Keira C Mattook
- Department of Kinesiology, McMaster University, Hamilton, Ontario, CANADA
| | - Kenneth S Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, CANADA
| | - Calvin M Armstrong
- Department of Kinesiology, McMaster University, Hamilton, Ontario, CANADA
| | - Gurleen K Bagri
- Department of Kinesiology, McMaster University, Hamilton, Ontario, CANADA
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4
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Su Y, O’Donnell E, Hoekstra SP, Leicht CA. Facial cooling improves thermal perceptions and maintains the interleukin-6 response during passive heating: A sex comparison. Temperature (Austin) 2024; 12:40-54. [PMID: 40041158 PMCID: PMC11875509 DOI: 10.1080/23328940.2024.2406730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 03/06/2025] Open
Abstract
Passively elevating body temperature can trigger a potentially beneficial acute inflammatory response. However, heat therapy often causes discomfort and negative thermal perceptions, particularly in females who generally have lower heat tolerance than males. This study aimed to evaluate the impact of facial cooling on thermal comfort and interleukin-6 concentration in response to 60 minutes of dry heat exposure, and to investigate sex differences in physiological responses and perceptions. 22 healthy young adults (10 females, 12 males; age: 24.4 ± 3.3 years) completed three trials in randomized order using a dry sauna device: 1) Hyperthermia (71.1 ± 1.9°C; HEAT), 2) Hyperthermia with facial cooling via fans (71.1 ± 3.0°C; FAN), and 3) Normothermia (27.0 ± 0.9°C; CON). Blood samples to determine interleukin-6 (IL-6) plasma concentration were collected before and after exposure; basic affect and thermal comfort, rectal and skin temperature were assessed throughout the intervention. Rectal temperature following HEAT (38.0 ± 0.3°C) and FAN (37.8 ± 0.3°C) did not differ between males and females (p = 0.57). Females had higher forehead skin temperatures than males (p ≤ 0.019). Thermal comfort remained more positive in FAN compared to HEAT (p ≤ 0.002). Females felt more thermal discomfort than males in HEAT (p ≤ 0.03), but not in FAN (p = 0.28). The increase in IL-6 plasma concentration was similar between HEAT and FAN (p = 1.00), and higher than CON (p ≤ 0.02); there was no difference between males and females (p = 0.69). This study showed that facial cooling alleviated the thermal discomfort during heat exposure, particularly benefitted females, and did not impede the acute IL-6 response.
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Affiliation(s)
- Yunuo Su
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma O’Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Sven. P. Hoekstra
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Christof A. Leicht
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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5
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Park CY. The 2018 Heat Wave's Impact on the Mortality of Older People in Seoul, South Korea. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:478-496. [PMID: 38593089 DOI: 10.1080/19371918.2024.2340082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Few studies on social welfare in South Korea have examined the effects of climate change, especially heat waves on vulnerable populations. The present study aims to investigate how heat waves affect vulnerable populations. This study utilized a cross-sectional study design, using the daily heat index and heat-related mortality data for Seoul, South Korea, in summer 2018. The research used micro-raw data of deaths caused by hypertensive, ischemic heart, and cerebrovascular diseases, as well as heat index data. An effect was observed for the heat index on mortality for individuals over 65 years of age, men, people with spouses, and those ages 75-79 years.
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Affiliation(s)
- Chi-Yong Park
- Department of Social Welfare, Sungkyunkwan University, Seoul, South Korea
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6
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Mirsanei Z, Asemani Y, Derakhshanjazari M, Gharibi V, Norouzi P, Mahdavi S, Cousins R. The influence of occupational heat stress on serum inflammatory cytokines among traditional bakery workers in Iran. PLoS One 2024; 19:e0302847. [PMID: 38709796 PMCID: PMC11073666 DOI: 10.1371/journal.pone.0302847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Heat exposure exceeding the ISO7243:1989 standard limit can contribute to health problems among employees in a variety of workplaces. Ignoring heat standard requirements in hot working conditions such as bakeries results in physiologic and health problems, as well as an elevated risk of later illnesses. In this analytical case-control study, the serum levels of four inflammatory factors (interleukin-1 beta, interleukin-6, tumor necrosis factor-α, and C-reactive protein) were assessed using an enzyme-linked immunosorbent assay. 105 male artisan bakers (in four job classifications in bakeries and staff) were compared based on demographic characteristics and inflammatory factors. The findings of the study showed correlations between serum interleukin-1β, interleukin-6, and C-reactive protein levels and thermal exposure in the occupational environment and employment type. Moreover, some differences in serum level of interleukin-1β and job type were observed. Heat overexposure affected the increase of interleukin-1β and C-reactive protein secretion. As a result of years of working in high-temperature conditions, inflammation can lead to subsequent diseases in workers. To protect their health from this occupational hazard, additional safeguards are needed. Our recommendations could also be applied to overly hot work environments that may cause heat stress in workers.
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Affiliation(s)
- Zahra Mirsanei
- Department of Immunology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahya Asemani
- Department of Immunology, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Derakhshanjazari
- Department of Occupational Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Vahid Gharibi
- Department of Occupational Health and Safety Engineering, School of Public Health, Arak University of Medical Sciences, Arak, Iran
| | - Pirasteh Norouzi
- Department of Physiology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sepideh Mahdavi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom
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7
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Requia WJ, Jablinski Castelhano F, Moore J, Maria Damasceno da Silva R, Andreotti Dias M. Thermal stress and hospital admissions for cardiorespiratory disease in Brazil. ENVIRONMENT INTERNATIONAL 2024; 187:108694. [PMID: 38688235 DOI: 10.1016/j.envint.2024.108694] [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: 12/14/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
The growing body of scientific literature underscores the intricate relationship between meteorological conditions and human health, particularly in the context of extreme temperatures. However, conventional temperature-centric approaches often fall short in capturing the complexity of thermal stress experienced by individuals. Temperature alone, as a metric, fails to encompass the entirety of the thermal stress individuals face, necessitating a more nuanced understanding. In response to this limitation, climatologists have devised thermal indices-composite measures meticulously crafted to reflect the intricate interplay of meteorological factors influencing human perception of temperature. Recognizing the inadequacy of simplistic temperature-focused methodologies, our study aims to address the multifaceted nature of thermal stress. In this study, we explored the association between thermal indices and hospital admissions for circulatory and respiratory diseases in Brazil. We used an extensive dataset spanning 11 years (2008-2018) from the Brazilian Ministry of Health, encompassing a total of 23,791,093 hospitalizations for circulatory and respiratory diseases. We considered four distinct thermal indices-Discomfort Index (DI), Net Effective Temperature (NET), Humidex (H), and Heat Index (HI). We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by time-varying confounders. In the second stage, we applied meta-analysis with random effects to estimate the national relative risk (RR). Our findings suggest robust variations among the thermal indices under examination. These variations underscore the intricate nature of associations between temperature and health, with each index capturing distinct aspects of thermal conditions. Our results indicate that extreme thermal conditions, both at the low and high ends, are associated with increased risks of hospital admissions. The diverse impact observed among different indices emphasizes the complex interplay between various meteorological factors and their specific physiological consequences. This underscores the necessity for a comprehensive comprehension of temperature metrics to guide precise public health interventions, recognizing the multifaceted nature of temperature-health relationships.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
| | | | - Julia Moore
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Reizane Maria Damasceno da Silva
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Mariana Andreotti Dias
- Demography Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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8
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Su Y, Hoekstra SP, Leicht CA. Hot water immersion is associated with higher thermal comfort than dry passive heating for a similar rise in rectal temperature and plasma interleukin-6 concentration. Eur J Appl Physiol 2024; 124:1109-1119. [PMID: 37870668 PMCID: PMC10954860 DOI: 10.1007/s00421-023-05336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To compare the perceptual responses and interleukin-6 (IL-6) concentration following rectal temperature-matched dry heat exposure (DH) and hot water immersion (HWI). METHODS Twelve healthy young adults (BMI 23.5 ± 3.6 kg/m2; age: 25.8 ± 5.7 years) underwent 3 trials in randomised order: DH (air temperature 68.9 °C), HWI (water temperature 37.5 °C), and thermoneutral dry exposure (CON, air temperature 27.3 °C). Blood samples to determine IL-6 plasma concentration were collected; basic affect and thermal comfort, rectal and skin temperature (Tskin) were assessed throughout the intervention. RESULTS Rectal temperature (Trec) did not differ between DH (end temperature 38.0 ± 0.4 °C) and HWI (37.9 ± 0.2 °C, P = 0.16), but was higher compared with CON (37.0 ± 0.3 °C; P ≤ 0.004). Plasma IL-6 concentration was similar after DH (pre to post: 0.8 ± 0.5 to 1.4 ± 1.5 pg·ml-1) and HWI (0.5 ± 0.2 to 0.9 ± 0.6 pg·ml-1; P = 0.46), but higher compared with CON (0.6 ± 0.5 to 0.6 ± 0.4 pg·ml-1; P = 0.01). At the end of the intervention, basic affect and thermal comfort were most unfavourable during DH (Basic affect; DH: - 0.7 ± 2.9, HWI: 0.8 ± 1.9, CON 1.9 ± 1.9, P ≤ 0.004; Thermal comfort; 2.6 ± 0.8, HWI: 1.4 ± 0.9 and CON: 0.2 ± 0.4; P ≤ 0.004). Mean Tskin was highest for DH, followed by HWI, and lowest for CON (DH: 38.5 ± 1.3 °C, HWI: 36.2 ± 0.5 °C, CON: 31.6 ± 0.7 °C, P < 0.001). CONCLUSION The IL-6 response did not differ between DH and HWI when matched for the elevation in Trec. However, thermal comfort was lower during DH compared to HWI, which may be related to the higher Tskin during DH.
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Affiliation(s)
- Yunuo Su
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Sven P Hoekstra
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Christof A Leicht
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
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9
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Requia WJ, Vicedo-Cabrera AM, de Schrijver E, Amini H. Low ambient temperature and hospitalization for cardiorespiratory diseases in Brazil. ENVIRONMENTAL RESEARCH 2023; 231:116231. [PMID: 37245579 DOI: 10.1016/j.envres.2023.116231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15-45, 46-65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Brazil.
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Evan de Schrijver
- Institute of Social and Preventive Medicine, Oeschger Center for Climate Change Research, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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10
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Requia WJ, Vicedo-Cabrera AM, de Schrijver E, Amini H, Gasparrini A. Association of high ambient temperature with daily hospitalization for cardiorespiratory diseases in Brazil: A national time-series study between 2008 and 2018. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 331:121851. [PMID: 37211231 DOI: 10.1016/j.envpol.2023.121851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
Further research is needed to examine the nationwide impact of temperature on health in Brazil, a region with particular challenges related to climate conditions, environmental characteristics, and health equity. To address this gap, in this study, we looked at the relationship between high ambient temperature and hospital admissions for circulatory and respiratory diseases in 5572 Brazilian municipalities between 2008 and 2018. We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by PM2.5, O3, relative humidity, and time-varying confounders. We estimated relative risks (RRs) of the association of heat (percentile 99th) with hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. In the second stage, we applied meta-analysis with random effects to estimate the national RR. Our study population includes 23,791,093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. The robustness of the RR and the effect size varied significantly by region, sex, age group, and health outcome. Overall, our findings suggest that i) respiratory admissions had the highest RR, while circulatory admissions had inconsistent or null RR in several subgroup analyses; ii) there was a large difference in the cumulative risk ratio across regions; and iii) overall, women and the elderly population experienced the greatest impact from heat exposure. The pooled national results for the whole population (all ages and sex) suggest a relative risk of 1.29 (95% CI: 1.26; 1.32) associated with respiratory admissions. In contrast, national meta-analysis for circulatory admissions suggested robust positive associations only for people aged 15-45, 46-65, >65 years old; for men aged 15-45 years old; and women aged 15-45 and 46-65 years old. Our findings are essential for the body of scientific evidence that has assisted policymakers to promote health equity and to create adaptive measures and mitigations.
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Affiliation(s)
- Weeberb J Requia
- School of Public Policy and Government, Fundação Getúlio Vargas Brasília, Distrito Federal, Brazil.
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Evan de Schrijver
- Institute of Social and Preventive Medicine, University of Bern, Oeschger Center for Climate Change Research, University of Bern, Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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11
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Koch Esteves N, Gibson OR, Khir AW, González‐Alonso J. Regional thermal hyperemia in the human leg: Evidence of the importance of thermosensitive mechanisms in the control of the peripheral circulation. Physiol Rep 2021; 9:e14953. [PMID: 34350727 PMCID: PMC8339537 DOI: 10.14814/phy2.14953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 02/04/2023] Open
Abstract
Hyperthermia is thought to increase limb blood flow through the activation of thermosensitive mechanisms within the limb vasculature, but the precise vascular locus in which hyperthermia modulates perfusion remains elusive. We tested the hypothesis that local temperature-sensitive mechanisms alter limb hemodynamics by regulating microvascular blood flow. Temperature and oxygenation profiles and leg hemodynamics of the common (CFA), superficial (SFA) and profunda (PFA) femoral arteries, and popliteal artery (POA) of the experimental and control legs were measured in healthy participants during: (1) 3 h of whole leg heating (WLH) followed by 3 h of recovery (n = 9); (2) 1 h of upper leg heating (ULH) followed by 30 min of cooling and 1 h ULH bout (n = 8); and (3) 1 h of lower leg heating (LLH) (n = 8). WLH increased experimental leg temperature by 4.2 ± 1.2ºC and blood flow in CFA, SFA, PFA, and POA by ≥3-fold, while the core temperature essentially remained stable. Upper and lower leg blood flow increased exponentially in response to leg temperature and then declined during recovery. ULH and LLH similarly increased the corresponding segmental leg temperature, blood flow, and tissue oxygenation without affecting these responses in the non-heated leg segment, or perfusion pressure and conduit artery diameter across all vessels. Findings demonstrate that whole leg hyperthermia induces profound and sustained elevations in upper and lower limb blood flow and that segmental hyperthermia matches the regional thermal hyperemia without causing thermal or hemodynamic alterations in the non-heated limb segment. These observations support the notion that heat-activated thermosensitive mechanisms in microcirculation regulate limb tissue perfusion during hyperthermia.
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Affiliation(s)
- Nuno Koch Esteves
- Centre for Human Performance, Exercise and RehabilitationCollege of Health, Medicine and Life SciencesBrunel University LondonUxbridgeUK
| | - Oliver R. Gibson
- Centre for Human Performance, Exercise and RehabilitationCollege of Health, Medicine and Life SciencesBrunel University LondonUxbridgeUK
- Division of Sport, Health and Exercise SciencesDepartment of Life SciencesCollege of Health, Medicine and Life SciencesBrunel University LondonUxbridgeUK
| | - Ashraf W. Khir
- Department of Mechanical and Aerospace EngineeringCollege of Engineering, Design and Physical SciencesBrunel University LondonUxbridgeUK
| | - José González‐Alonso
- Centre for Human Performance, Exercise and RehabilitationCollege of Health, Medicine and Life SciencesBrunel University LondonUxbridgeUK
- Division of Sport, Health and Exercise SciencesDepartment of Life SciencesCollege of Health, Medicine and Life SciencesBrunel University LondonUxbridgeUK
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12
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Local cooling during hot water immersion improves perceptions without inhibiting the acute interleukin-6 response. Eur J Appl Physiol 2021; 121:1581-1591. [PMID: 33646422 PMCID: PMC8144146 DOI: 10.1007/s00421-021-04616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/04/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Passive elevation of body temperature can induce an acute inflammatory response that has been proposed to be beneficial; however, it can be perceived as uncomfortable. Here, we investigate whether local cooling of the upper body during hot water immersion can improve perception without inhibiting the interleukin-6 (IL-6) response. METHODS Nine healthy male participants (age: 22 ± 1 years, body mass: 83.4 ± 9.4 kg) were immersed up to the waist for three 60-min water immersion conditions: 42 °C hot water immersion (HWI), 42 °C HWI with simultaneous upper-body cooling using a fan (FAN), and 36 °C thermoneutral water immersion (CON). Blood samples to determine IL-6 plasma concentration were collected pre- and post-water immersion; basic affect and thermal comfort were assessed throughout the intervention. RESULTS Plasma IL-6 concentration was higher for HWI and FAN when compared with CON (P < 0.01) and did not differ between HWI and FAN (P = 0.22; pre to post, HWI: 1.0 ± 0.6 to 1.5 ± 0.7 pg·ml-1, FAN: 0.7 ± 0.5 to 1.1 ± 0.5 pg·ml-1, CON: 0.5 ± 0.2 to 0.5 ± 0.2 pg·ml-1). At the end of immersion, basic affect was lowest for HWI (HWI: - 1.8 ± 2.0, FAN: 0.2 ± 1.6, CON 1.0 ± 2.1, P < 0.02); thermal comfort for HWI was in the uncomfortable range (3.0 ± 1.0, P < 0.01 when compared with FAN and CON), whereas FAN (0.7 ± 0.7) and CON (-0.2 ± 0.7) were in the comfortable range. CONCLUSION Local cooling of the upper body during hot water immersion improves basic affect and thermal comfort without inhibiting the acute IL-6 response.
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Gharibi V, Khanjani N, Heidari H, Ebrahimi MH, Hosseinabadi MB. The effect of heat stress on hematological parameters and oxidative stress among bakery workers. Toxicol Ind Health 2020; 36:1-10. [PMID: 31934822 DOI: 10.1177/0748233719899824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Heat stress causes physiological changes, and changes in hematological parameters and hormonal levels in the human body, known as thermal strain. This study was conducted to determine the effect of exposure to heat stress on hematological parameters and oxidative stress in the bakers of Shahroud City, Iran. A total of 163 bakery workers (exposed group) and 135 office workers (unexposed group) with a minimum of 1-year working experience were selected. Exposure to heat stress was measured using ISO-7243 criteria on the hottest days of the year (late July and August). Wet-bulb globe temperature (WBGT) was calculated based on indoor environments. Oxidative stress indices including malondialdehyde (MDA), nitric oxide (NO), total antioxidant capacity (TAC) in the bakers' and office workers' serum and hematological parameters were measured. Statistical analysis was done through independent t-test, and multivariate linear regression using SPSS v24. Analysis of hematological parameters showed that about 70% and 68% of the bakers had abnormal mean cell volume (MCV) and white blood cell (WBC) count, respectively, while only around 12% of them had abnormal mean cell hemoglobin concentration (MCHC). The counts of red blood cells (RBC), WBC, lymphocytes (LYM), and MCV showed significant differences in different occupational groups (p < 0.05). The levels of MDA and NO were significantly higher in bakers with WBGT more than the threshold value (p < 0.05). The WBGT index for assessing heat stress can be used as a predictor variable for MDA and NO levels. In addition, heat stress exposure could be a risk factor for abnormal WBC, RBC, LYM, and MCV.
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Affiliation(s)
- Vahid Gharibi
- School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.,Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Khanjani
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Heidari
- Department of Occupational Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Hossein Ebrahimi
- Environmental and Occupational Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
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León J, Sáenz JM, Artacho-Cordón F, Fernández MF, Martin-Olmedo P, Salamanca-Fernández E, Gómez-Peña C, Olea N, Arrebola JP. Contribution of sociodemographic, occupational, lifestyle and dietary characteristics to the oxidative stress microenvironment in adipose tissue. ENVIRONMENTAL RESEARCH 2019; 175:52-62. [PMID: 31102949 DOI: 10.1016/j.envres.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 05/20/2023]
Abstract
The present study was conceived on the basis of the few previous reports suggesting a potential relevance of the oxidative stress microenvironment in the adipose tissue, a biological matrix which is closely related to the development of several chronic pathologies. Thus, our aim was to describe the levels of enzymatic and non-enzymatic antioxidants and markers of oxidative damage in adipose tissue samples from a Spanish cohort, as well as their main sociodemographic, lifestyle, and dietary predictors. The study was conducted in a subsample (n = 271 adults) of GraMo cohort, recruited in Granada (Southern Spain). A face-to-face questionnaire was used to gather data regarding sociodemographic characteristics, lifestyle, dietary habits, health status, and perceived exposure to chemicals. We analyzed adipose tissue levels of lipid peroxidation (TBARS), total superoxide dismutase (SOD) activity, heme oxygenase-1 (HO-1) activity, and glutathione cycle biomarkers. Potential predictors of oxidative stress markers were assessed using stepwise multivariable linear regression analyses. SOD and TBARS levels were mainly related to sociodemographic and occupational characteristics, while the components of the glutathione cycle and HO-1 were predominantly associated with dietary habits. Men showed significantly lower levels of oxidative stress levels than women. In the regression models including only women, the use of oral contraceptive and hormonal therapy was associated with lower levels of oxidative stress, while the number of children was positively associated with increased oxidative biomarkers. Our results suggest that adipose tissue is potentially important matrix for the assessment of oxidative stress, which can be affected by specific environmental factors. These findings might be relevant for public health.
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Affiliation(s)
- Josefa León
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario San Cecilio de Granada, Spain; CIBER en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - José M Sáenz
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; University of Granada, Radiology and Physical Medicine Department, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Mariana F Fernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; University of Granada, Radiology and Physical Medicine Department, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Piedad Martin-Olmedo
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Escuela Andaluza de Salud Pública, Granada, Spain
| | - Elena Salamanca-Fernández
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Escuela Andaluza de Salud Pública, Granada, Spain
| | - Celia Gómez-Peña
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Unidad de Gestión Clínica de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain
| | - Nicolás Olea
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; University of Granada, Radiology and Physical Medicine Department, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Unidad de Gestión Clínica de Medicina Nuclear, Hospital Universitario San Cecilio de Granada, Granada, Spain
| | - Juan P Arrebola
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; University of Granada, Department of Preventive Medicine and Public Health, Spain.
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15
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Zhao Q, Li S, Coelho MSZS, Saldiva PHN, Hu K, Arblaster JM, Nicholls N, Huxley RR, Abramson MJ, Guo Y. Geographic, Demographic, and Temporal Variations in the Association between Heat Exposure and Hospitalization in Brazil: A Nationwide Study between 2000 and 2015. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:17001. [PMID: 30620212 PMCID: PMC6371650 DOI: 10.1289/ehp3889] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Limited evidence is available regarding the association between heat exposure and morbidity in Brazil and how the effect of heat exposure on health outcomes may change over time. OBJECTIVES This study sought to quantify the geographic, demographic and temporal variations in the heat–hospitalization association in Brazil from 2000–2015. METHODS Data on hospitalization and meteorological conditions were collected from 1,814 cities during the 2000–2015 hot seasons. Quasi-Poisson regression with constrained lag model was applied to examine city-specific estimates, which were then pooled at the regional and national levels using random-effect meta-analyses. Stratified analyses were performed by sex, 10 age groups, and 11 cause categories. Meta-regression was used to examine the temporal change in estimates of heat effect from 2000 to 2015. RESULTS For every 5°C increase in daily mean temperature during the 2000–2015 hot seasons, the estimated risk of hospitalization over lag 0-7 d rose by 4.0% [95% confidence interval (CI): 3.7%, 4.3%] nationwide. Estimated 6.2% [95% empirical CI (eCI): 3.3%, 9.1%] of hospitalizations were attributable to heat exposure, equating to 132 cases (95% eCI: 69%, 192%) per 100,000 residents. The attributable rate was greatest in children [Formula: see text] and was highest for hospitalizations due to infectious and parasitic diseases. Women of reproductive age and those [Formula: see text] had higher heat burden than men. The attributable burden was greatest for cities in the central west and the inland of the northeast; lowest in the north and eastern coast. Over the 16-y period, the estimated heat effects declined insignificantly at the national level. CONCLUSIONS In Brazil's hot seasons, 6% of hospitalizations were estimated to be attributed to heat exposure. As there was no evidence indicating that thermal adaptation had occurred at the national level, the burden of hospitalization associated with heat exposure in Brazil is likely to increase in the context of global warming. https://doi.org/10.1289/EHP3889.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Paulo H N Saldiva
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | - Kejia Hu
- Institute of Island and Coastal Ecosystems, Ocean College, Zhejiang University, Zhoushan, China
| | - Julie M Arblaster
- School of Earth, Atmosphere and Environment, Monash University, Melbourne, Australia
- Centre of Excellence for Climate Extremes, Australian Research Council, Sydney, Australia
| | - Neville Nicholls
- School of Earth, Atmosphere and Environment, Monash University, Melbourne, Australia
| | - Rachel R Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Effects of Environmental Heat and Antioxidant Ingestion on Blood Markers of Oxidative Stress in Professional Firefighters Performing Structural Fire Exercises. J Occup Environ Med 2018; 60:e595-e601. [DOI: 10.1097/jom.0000000000001452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Short-term effects of Finnish sauna bathing on blood-based markers of cardiovascular function in non-naive sauna users. Heart Vessels 2018; 33:1515-1524. [PMID: 29971466 PMCID: PMC6267405 DOI: 10.1007/s00380-018-1202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/15/2018] [Indexed: 12/15/2022]
Abstract
Emerging evidence suggests that sauna bathing is associated with reduced risk of cardiovascular and all-cause mortality events. However, the biochemical pathways by which sauna bathing might confer its effects on cardiovascular function are not certain. We aimed to study the acute effects of Finnish sauna bathing on various blood-based cardiovascular biomarkers. The study included 102 non-naive sauna users (54% male) with mean age of 51.9 years, who had at least one cardiovascular risk factor. Participants underwent a 30-min single sauna session (mean temperature, 73 °C). Biochemical profiling was conducted before, immediately after sauna and 30-min post-sauna. Overall median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (n = 20 participants) was 46.0 ng/L before sauna exposure, which increased to 50.5 ng/l immediately after sauna (median change, + 12.00%; p < 0.001) and remained persistent at 30-min post-sauna (median change from pre-sauna to post-30-min sauna, + 13.93%; p < 0.001). The changes were more evident in males compared with females. There were no significant changes in overall levels of high sensitivity C-reactive protein, creatine kinase, high sensitivity troponin I, and creatine kinase-MBm. However, levels of creatine kinase increased in males (median change immediately after sauna, + 2.99%; p = 0.024). Levels of NT-proBNP increased after sauna exposure. The increase in levels of creatine kinase was more evident in males. Long-term interventional studies are warranted to evaluate if these biomarkers are involved in pathways underlying the associations of sauna bathing with cardiovascular outcomes.
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18
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Effect of passive heat stress and exercise in the heat on arterial stiffness. Eur J Appl Physiol 2017; 117:1679-1687. [DOI: 10.1007/s00421-017-3658-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
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Caldwell AR, Tucker MA, Burchfield J, Moyen NE, Satterfield AZ, Six A, McDermott BP, Mulvenon SW, Ganio MS. Hydration status influences the measurement of arterial stiffness. Clin Physiol Funct Imaging 2017; 38:447-454. [DOI: 10.1111/cpf.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron R. Caldwell
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Matthew A. Tucker
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Jenna Burchfield
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Nicole E. Moyen
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Alf Z. Satterfield
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Ashley Six
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Brendon P. McDermott
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Sean W. Mulvenon
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
| | - Matthew S. Ganio
- Human Performance Laboratory; College of Education and Health Professionals; University of Arkansas; Fayetteville AR USA
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