Planning for spectator thermal comfort and health in the face of extreme heat: The Tokyo 2020 Olympic marathons

Effects of adaptation measures to extreme heat throughout medium and high temperature periods, case study at the Osaka expo site

For the Osaka-Kansai Expo, to be held from April to October 2025, it is necessary to manage the exhibition site with consideration for countermeasures against heat in order to make safe and active use of the outdoor space. In this study, we compared meteorological data observed at Expo site on the sea coast, and at the Osaka Meteorological Observatory in the city center to analyze the quantitative relationship between meteorological elements at both locations, calculated thermal environment indices using these meteorological data, and considered the effects of implementing adaptation measures against the heat. The effect of solar radiation shading is predominant in lowering SET* and WBGT. During the medium temperature period, before mid-June and after mid-September, solar radiation shading avoids uncomfortable conditions, and during the high temperature period, from late June to mid-July and mid-August to early September, solar radiation shading, surface cover improvement, and mist spraying reduce the risk of heat stroke. However, during the extremely hot period, from late July to early August, the risk of heat stroke cannot be avoided by any of the adaptation measures to heat.

Thermoregulatory, Cardiovascular and Perceptual Responses of Spectators of a Simulated Football Match in Hot and Humid Environmental Conditions

Major sporting events are often scheduled in thermally challenging environments. The heat stress may impact athletes but also spectators. We examined the thermal, cardiovascular, and perceptual responses of spectators watching a football match in a simulated hot and humid environment. A total of 48 participants (43 ± 9 years; n = 27 participants <50 years and n = 21 participants ≥50 years, n = 21) watched a 90 min football match in addition to a 15 min baseline and 15 min halftime break, seated in an environmental chamber (Tair = 31.9 ± 0.4 °C; RH = 76 ± 4%). Gastrointestinal temperature (Tgi), skin temperature (Tskin), and heart rate (HR) were measured continuously throughout the match. Mean arterial pressure (MAP) and perceptual parameters (i.e., thermal sensation and thermal comfort) were scored every 15 min. Tri (37.3 ± 0.4 °C to 37.4 ± 0.3 °C, p = 0.11), HR (76 ± 15 bpm to 77 ± 14 bpm, p = 0.96) and MAP (97 ± 10 mm Hg to 97 ± 10 mm Hg, p = 0.67) did not change throughout the match. In contrast, an increase in Tskin (32.9 ± 0.8 °C to 35.4 ± 0.3 °C, p < 0.001) was found. Further, 81% of participants reported thermal discomfort and 87% a (slightly) warm thermal sensation at the end of the match. Moreover, the thermal or cardiovascular responses were not affected by age (all p-values > 0.05). Heat stress induced by watching a football match in simulated hot and humid conditions does not result in substantial thermal or cardiovascular strain, whereas a significant perceptual strain was observed.

Effects of different external cooling placements prior to and during exercise on athletic performance in the heat: A systematic review and meta-analysis

Background: Nowadays, many high-profile international sport events are often held in warm or hot environments, hence, it is inevitable for these elite athletes to be prepared for the challenges from the heat. Owing to internal cooling may cause gastrointestinal discomfort to athletes, external cooling technique seems to be a more applicable method to deal with thermal stress. Central cooling mainly refers to head, face, neck and torso cooling, can help to reduce skin temperature and relieve thermal perception. Peripheral cooling mainly refers to four limbs cooling, can help to mitigate metabolic heat from muscular contrac to effectively prevent the accumulation of body heat. Hence, we performed a meta-analysis to assess the effectiveness of different external cooling placements on athletic performance in the heat Methods: A literatures search was conducted using Web of Science, MEDLINE and SPORTDiscus until September 2022. The quality and risk of bias in the studies were independently assessed by two researchers. Results: 1,430 articles were initially identified (Web of Science = 775; MEDLINE = 358; SPORTDiscus = 271; Additional records identified through other sources = 26), 60 articles (82 experiments) met the inclusion criteria and were included in the final analysis, with overall article quality being deemed moderate. Central cooling (SMD = 0.43, 95% CI 0.27 to 0.58, p < 0.001) was most effective in improving athletic performance in the heat, followed by central and peripheral cooling (SMD = 0.38, 95% CI 0.23 to 0.54, p < 0.001), AND peripheral cooling (SMD = 0.32, 95% CI 0.07 to 0.57, p = 0.013). For the cooling-promotion effects on different sports types, the ranking order in central cooling was ETE (exercise to exhaustion), TT (time-trial), EWT (exercise within the fixed time or sets), IS (intermittent sprint); the ranking order in peripheral cooling was EWT, TT, ETE and IS; the ranking order in central and peripheral cooling was ETE, IS, EWT and TT. Conclusion: Central cooling appears to be an more effective intervention to enhance performance in hot conditions through improvements of skin temperature and thermal sensation, compared to other external cooling strategies. The enhancement effects of peripheral cooling require sufficient re-warming, otherwise it will be trivial. Although, central and peripheral cooling seems to retain advantages from central cooling, as many factors may influence the effects of peripheral cooling to offset the positive effects from central cooling, the question about whether central and peripheral cooling method is better than an isolated cooling technique is still uncertain and needs more researchs to explore it.

Human Bioclimate Analysis for the Paris Olympic Games

Weather and climate conditions can be important and a decision factor for travel plans or outdoor and sport events. It is important to quantify thermal comfort and other related climate factors for different applications and destinations and make the results easily accessible to visitors and sport attendees. This analysis has provided and quantified thermal comfort, heat stress and other climate-related factors. A relevant approach is the visualization of climate thresholds in a Climate-Tourism/Transfer-Information Scheme (CTIS) for the prevailing local climate conditions. The methodology provided here is a possible gold standard of good human biometeorological practices for tourism, recreation and sports, and can be applied for all major events. The information provided on the local climate can be extracted by non-experts such as tourists intending to attend sports events.

Proposed framework for forecasting heat-effects on motor-cognitive performance in the Summer Olympics

Heat strain impairs performance across a broad spectrum of sport disciplines. The impeding effects of hyperthermia and dehydration are often ascribed to compromised cardiovascular and muscular functioning, but expert performance also depends on appropriately tuned sensory, motor and cognitive processes. Considering that hyperthermia has implications for central nervous system (CNS) function and fatigue, it is highly relevant to analyze how heat stress forecasted for the upcoming Olympics may influence athletes. This paper proposes and demonstrates the use of a framework combining expected weather conditions with a heat strain and motor-cognitive model to analyze the impact of heat and associated factors on discipline- and scenario-specific performances during the Tokyo 2021 games. We pinpoint that hyperthermia-induced central fatigue may affect prolonged performances and analyze how hyperthermia may impair complex motor-cognitive performance, especially when accompanied by either moderate dehydration or exposure to severe solar radiation. Interestingly, several short explosive performances may benefit from faster cross-bridge contraction velocities at higher muscle temperatures in sport disciplines with little or no negative heat-effect on CNS fatigue or motor-cognitive performance. In the analyses of scenarios and Olympic sport disciplines, we consider thermal impacts on “motor-cognitive factors” such as decision-making, maximal and fine motor-activation as well as the influence on central fatigue and pacing. From this platform, we also provide perspectives on how athletes and coaches can identify risks for their event and potentially mitigate negative motor-cognitive effects for and optimize performance in the environmental settings projected.

Spatio-Temporal Evolution and Prediction of Tourism Comprehensive Climate Comfort in Henan Province, China

The tourism comprehensive climate comfort index (TCCI) was used to evaluate the tourism climate comfort in Henan Province in the last 61 years, and its future development trend is predicted. The results showed that the temporal variation of the TCCI had a “double peak” type (monthly variation), and an overall comfort improvement trend (interannual variation). The change of tourism climate comfort days was similar to the change of the index, especially in the months with a low comfort level. In space, the distribution of the TCCI gradually increased from northeast to southwest, and the area with a high comfort level also increased over time. Meanwhile, it also showed the spatial distribution of months with a low comfort level, which provides reliable information for tourists to use when choosing tourist destinations across all periods of the year. The TCCI was classified by hierarchical classification, and principal components were extracted to explore the main climate factors controlling different types of TCCIs and the relationship between them, and large-scale atmospheric–oceanic variability. According to the temporal change trend and correlation, the long-term change trend of tourism climate comfort was predicted, which will provide a scientific basis for tourism planners to choose tourist destinations.

Existential threats to the Summer Olympic and Paralympic Games? a review of emerging environmental health risks

This review highlights two intersecting environmental phenomena that have significantly impacted the Tokyo Summer Olympic and Paralympic Games: infectious disease outbreaks and anthropogenic climate change. Following systematic searches of five databases and the gray literature, 15 studies were identified that addressed infectious disease and climate-related health risks associated with the Summer Games and similar sports mega-events. Over two decades, infectious disease surveillance at the Summer Games has identified low-level threats from vaccine-preventable illnesses and respiratory conditions. However, the COVID-19 pandemic and expansion of vector-borne diseases represent emerging and existential challenges for cities that host mass gathering sports competitions due to the absence of effective vaccines. Ongoing threats from heat injury among athletes and spectators have also been identified at international sports events from Asia to North America due to a confluence of rising Summer temperatures, urban heat island effects and venue crowding. Projections for the Tokyo Games and beyond suggest that heat injury risks are reaching a dangerous tipping point, which will necessitate relocation or mitigation with long-format and endurance events. Without systematic change to its format or staging location, the Summer Games have the potential to drive deleterious health outcomes for athletes, spectators and host communities.

Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport

The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees' health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology's availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.

A Mixed-Method Approach of Pre-Cooling Enhances High-Intensity Running Performance in the Heat

We investigated whether single or combined methods of pre-cooling could affect high-intensity exercise performance in a hot environment. Seven male athletes were subjected to four experimental conditions for 30 min in a randomised order. The four experimental conditions were: 1) wearing a vest cooled to a temperature of 4 ℃ (Vest), 2) consuming a beverage cooled to a temperature of 4 ℃ (Beverage), 3) simultaneous usage of vest and consumption of beverage (Mix), and 4) the control trial without pre-cooling (CON). Following those experimental conditions, they exercised at a speed of 80% VO₂max until exhaustion in the heat (38.1 ± 0.6 ℃, 55.3 ± 0.3% RH). Heart rate (HR), rectal temperature (T_core), skin temperature (T_skin), sweat loss (SL), urine specific gravity (USG), levels of sodium (Na⁺) and potassium (K⁺), rating of perceived exertion (RPE), thermal sensation (TS), and levels of blood lactic acid ([Bla]) were monitored. Performance was improved using the mixed pre-cooling strategy (648.43 ± 77.53 s, p = 0.016) compared to CON (509.14 ± 54.57 s). T_core after pre-cooling was not different (Mix: 37.01 ± 0.27 ℃, Vest: 37.19 ± 0.33 ℃, Beverage: 37.03 ± 0.35 ℃) in all cooling conditions compared to those of CON (37.31 ±0.29 ℃). A similar T_core values was achieved at exhaustion in all trials (from 38.10 ℃ to 39.00 ℃). No difference in the level of USG was observed between the conditions. Our findings suggest that pre-cooling with a combination of cold vest usage and cold fluid intake can improve performance in the heat.

A comprehensive review of thermal comfort studies in urban open spaces

Urban open spaces provide various benefits to large populations in cities. Since thermally comfortable urban open spaces improve the quality of urban living, an increasing number of studies have been conducted to extend the existing knowledge of outdoor thermal comfort. This paper comprehensively reviews current outdoor thermal comfort studies, including benchmarks, data collection methods, and models of outdoor thermal comfort. Because outdoor thermal comfort is a complex issue influenced by various factors, a conceptual framework is proposed which includes physical, physiological and psychological factors as direct influences; and behavioral, personal, social, cultural factors, as well as thermal history, site, and alliesthesia, as indirect influences. These direct and indirect factors are further decomposed and reviewed, and the interactions among various factors are discussed. This review provides researchers with a systematic and comprehensive understanding of outdoor thermal comfort, and can also guide designers and planners in creating thermally comfortable urban open spaces.

Comparison of Thermal Comfort between Sapporo and Tokyo—The Case of the Olympics 2020

Weather and climate conditions can be decisive regarding travel plans or outdoor events, especially for sport events. The Olympic Games 2020, postponed to 2021, will take place in Tokyo at a time which is considered to be the hottest and most humid time of the year. However, a part of the athletic competitions is relocated to the northern city Sapporo. Therefore, it is important to quantify thermal comfort for different occasions and destinations and make the results accessible to visitors and sport attendees. The following analysis will quantify and compare thermal comfort and heat stress between Sapporo and Tokyo using thermal indices like the Physiologically Equivalent Temperature and the modified Physiologically Equivalent Temperature (PET and mPET). The results reveal different precipitation patterns for the cities. While a higher precipitation rate appears in Sapporo during winter, the precipitation rate is higher in Tokyo during summer. PET and mPET exhibit a greater probability of heat stress conditions in Tokyo during the Olympic Games, whereas Sapporo has more moderate values for the same period. The Climate-Tourism/Transfer-Information-Scheme (CTIS) integrates and simplifies climate information and makes them comprehensible for non-specialists. The CTIS of Tokyo illustrates lower suitable conditions for “Heat stress”, “Sunny days” and “Sultriness”. Transferring parts of the athletics competition to a northern city is thus more convenient for athletes, staff members and spectators. Hence, heat stress can be avoided and an acceptable outdoor stay is ensured. Overall, this quantification and comparison of the thermal conditions in Sapporo and Tokyo reveal limitations but also possibilities for the organizers of the Olympic Games. Furthermore it can be used to raise awareness for promoting or arranging countermeasures and heat mitigation at specific events and destinations, if necessary.

The Natural Environmental Factors Influencing the Spatial Distribution of Marathon Event: A Case Study from China

PURPOSE

The purpose of this study was to investigate the influence of natural environmental factors on the spatial distribution of marathon events in China, and to identify the suitable natural environmental factors for the marathon events.

METHODS

Geographic information system (GIS) spatial analysis tools were used to perform coupling analysis, e.g. overlap, neighborhood, intersection and buffer for terrain, climate, air quality, mountains and water resources with 342 marathon events held in China in 2018.

RESULTS

The results indicate that the spatial distribution of marathon events in China is negatively correlated with the elevation of the terrain (plain > hill > plateau > mountain > basin); climate (subtropical monsoon climate > temperate monsoon climate > temperate continental climate > tropical monsoon climate > plateau alpine climate), air quality (level 3 > level 2 > level 4 > level 1). Results indicate that buffer zones can protect water resources: there are 24 items in the buffer zone of river 0.5 km and lake 1 km, 131 items in the buffer zone of river 3 km and lake 5 km, 191 items in the buffer zone of river 5 km and lake 10 km, 298 items in the buffer zone of river 10 km and lake 20 km. Results indicate for mountain range buffer: 13 items in the 20 km buffer and 39 items in the 50 km buffer.

CONCLUSIONS

Marathon events are more likely to be held on the third rung of China's topography where a city has a typical landform (plains, basins, hills, or mountain) with good climate and air quality. Meanwhile a city with water and mountain resources for recreational events such as cross-country or obstacle course are essential. The contribution of this study is to systematically and intuitively reflect the influence of natural environment factors on the distribution of marathon events in China, and to provide evidence for the medium and long-term planning of marathon events in China, the selection of venues for different types of marathon events and how to attract participants.

A multi-scalar climatological analysis in preparation for extreme heat at the Tokyo 2020 Olympic and Paralympic Games

Extreme heat can be harmful to human health and negatively affect athletic performance. The Tokyo Olympic and Paralympic Games are predicted to be the most oppressively hot Olympics on record. An interdisciplinary multi-scale perspective is provided concerning extreme heat in Tokyo-from planetary atmospheric dynamics, including El Niño Southern Oscillation (ENSO), to fine-scale urban temperatures-as relevant for heat preparedness efforts by sport, time of day, and venue. We utilize stochastic methods to link daytime average wet bulb globe temperature (WBGT) levels in Tokyo in August (from meteorological reanalysis data) with large-scale atmospheric dynamics and regional flows from 1981 to 2016. Further, we employ a mesonet of Tokyo weather stations (2009-2018) to interpolate the spatiotemporal variability in near-surface air temperatures at outdoor venues. Using principal component analysis, two planetary (ENSO) regions in the Pacific Ocean explain 70% of the variance in Tokyo's August daytime WBGT across 35 years, varying by 3.95°C WGBT from the coolest to warmest quartile. The 10-year average daytime and maximum intra-urban air temperatures vary minimally across Tokyo (<1.2°C and 1.7°C, respectively), and less between venues (0.6-0.7°C), with numerous events planned for the hottest daytime period (1200-1500 hr). For instance, 45% and 38% of the Olympic and Paralympic road cycling events (long duration and intense) occur midday. Climatologically, Tokyo will present oppressive weather conditions, and March-May 2020 is the critical observation period to predict potential anomalous late-summer WBGT in Tokyo. Proactive climate assessment of expected conditions can be leveraged for heat preparedness across the Game's period.

Evidence-Based Landscape Architecture for Human Health and Well-Being

More than 80% of the people in the USA and Canada live in cities. Urban development replaces natural environments with built environments resulting in limited access to outdoor environments which are critical to human health and well-being. In addition, many urban open spaces are unused because of poor design. This paper describes case studies where traditional landscape architectural design approaches would have compromised design success, while evidence-based landscape architecture (EBLA) resulted in a successful product. Examples range from school-yard design that provides safe levels of solar radiation for children, to neighborhood parks and sidewalks that encourage people to walk and enjoy nearby nature. Common characteristics for integrating EBLA into private, public, and academic landscape architecture practice are outlined along with a discussion of some of the opportunities and barriers to implementation.

Impact of Ambient Temperature and Relative Humidity on the Incidence of Hand-Foot-Mouth Disease in Wuhan, China

Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "M" shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted "V" shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.

Impact of Ambient Temperature and Relative Humidity on the Incidence of Hand-Foot-Mouth Disease in Wuhan, China

Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "M" shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted "V" shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.

A time series analysis of the relationship between apparent temperature, air pollutants and ischemic stroke in Madrid, Spain

The understanding of the role of environment on the pathogenesis of stroke is gaining importance in the context of climate change. This study analyzes the temporal pattern of ischemic stroke (IS) in Madrid, Spain, during a 13-year period (2001-2013), and the relationship between ischemic stroke (admissions and deaths) incidence and environmental factors on a daily scale by using a quasi-Poisson regression model. To assess potential delayed and non-linear effects of air pollutants and Apparent Temperature (AT), a biometeorological index which represents human thermal comfort on IS, a lag non-linear model was fitted in a generalized additive model. The mortality rate followed a downward trend over the studied period, however admission rates progressively increased. Our results show that both increases and decreases in AT had a marked relationship with IS deaths, while hospital admissions were only associated with low AT. When analyzing the cumulative effects (for lag 0-14 days), with an AT of 1.7 °C (percentile 5%) a RR of 1.20 (95% CI, 1.05-1.37) for IS mortality and a RR of 1.09 (95% CI, 0.91-1.29) for morbidity is estimated. Concerning gender differences, men show higher risks of mortality in low temperatures and women in high temperatures. No significant relationship was found between air pollutant concentrations and IS morbi-mortality, but this result must be interpreted with caution, since there are strong spatial fluctuations of the former between nearby geographical areas that make it difficult to perform correlation analyses.

Biologically effective solar ultraviolet exposures and the potential skin cancer risk for individual gold medalists of the 2020 Tokyo Summer Olympic Games

Personal solar ultraviolet radiation exposure models were developed for 144 Olympic events scheduled outdoors from across the 33 sport disciplines that will compete in Tokyo between 24 July and 9 August 2020. Ambient exposure models were developed from existing atmospheric parameters measured over Tokyo (35.7°N 139.7°E) and were used to weight erythemally effective solar ultraviolet exposure to gold medalists, taking into account body posture and expected protection by competitor's clothing which was assessed in comparison to respective medalists of the 2016 Rio Olympics. Individual exposure models consider the ultraviolet surface albedo (lawn, concrete, water or sand) and timing of daily events held within Olympic venues. Exposure assessments are presented, including assessments of all preliminary rounds and qualifiers. Within scheduled outdoor events, we award first place (representing the highest and most harmful UV exposure) to the women's tennis singles (1680 J/m²), second to men's golf (1530 J/m²) and third to the men's cycling road race (941 J/m²) for the highest expected erythemally effective solar ultraviolet radiation exposures of the 2020 Tokyo Games. The highest expected solar ultraviolet exposures for nations expected to win greater than three gold medals among the outdoor events were found to occur in athletes from Kenya followed closely by the United States and Hungary. Gold medalists from South Korea were found to demonstrate the highest level of sun protection due to clothing at the 2016 Rio Games, and are thus expected to receive the greatest relative reduction in erythemally effective exposure during the 2020 Tokyo Games.