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Tetzlaff EJ, Ioannou LG, O'Connor FK, Kaltsatou A, Ly V, Kenny GP. Practical Considerations for Using Personal Cooling Garments for Heat Stress Management in Physically Demanding Occupations: A Systematic Review and Meta-Analysis Using Realist Evaluation. Am J Ind Med 2025; 68:3-25. [PMID: 39498663 DOI: 10.1002/ajim.23672] [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: 08/15/2024] [Revised: 09/30/2024] [Accepted: 10/04/2024] [Indexed: 11/07/2024]
Abstract
INTRODUCTION Due to rising temperature extremes, workplaces are seeking new solutions, such as using personal cooling garments (PCG) to mitigate and manage workplace heat exposure. This systematic review sought to assess the physiological and perceptual effects of PCGs on workers in standard work clothing performing moderate-to-heavy intensity tasks in hot environments. METHODS A peer-reviewed search strategy was conducted in MEDLINE, Embase, CINAHL, Scopus, Global Health, and Business Source Complete with no language or time limits. A meta-analysis using a realist evaluation framework was then performed to evaluate the effectiveness of the PCGs. RESULTS Thirty-three studies with 764 participants (98% male; average 21 ± 34 participants per study), conducted primarily in a laboratory setting (76%) were included. The studies were 193 ± 190 min in duration and consisted of a moderate-to-heavy work effort of 3.3 ± 1.0 METs in hot ambient conditions (temperature: 35.9 ± 3.3°C, 51.4 ± 12.1% relative humidity, wet bulb globe temperature [WBGT] 31.2 ± 2.6°C). The PCGs (n = 67) facilitated heat exchange through conduction (n = 39), evaporation (n = 4), convection (n = 2), radiation (n = 2), or hybrid combinations (n = 20). Conductive and hybrid PCGs offered the greatest thermoregulatory benefit, whereby core temperature (Tc) and heart rate (HR) reductions were consistently observed (Conductive: Tc: -0.3°C, HR: -12 bpm; Hybrid: Tc:-0.2°C, HR: -10 bpm), while PCGs directed at enhancing evaporative and radiative heat exchange had no or minimal effect on the physiological outcomes assessed (i.e., TC < 0.1°C, HR: < 0.7 bpm). CONCLUSION While the PCGs had a positive overall effect, conductive options offered the most consistent benefit to workers. WBGT, clothing insulation, and duration of wear significantly affected some physiological and perceptual outcomes.
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Affiliation(s)
- Emily J Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Leonidas G Ioannou
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Fergus K O'Connor
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | - Antonia Kaltsatou
- Functional Architecture of Mammals in their Environment Laboratory, School of Exercise Science, University of Thessaly, Karies, Trikala, Greece
| | - Valentina Ly
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Mansouri F, Nia MT, Villar R, Cornish SM, Giesbrecht GG. Upper- vs. Whole-Body Cooling During Exercise with Thermal Protective Clothing in the Heat. Aerosp Med Hum Perform 2024; 95:659-666. [PMID: 39169487 DOI: 10.3357/amhp.6434.2024] [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: 08/23/2024]
Abstract
INTRODUCTION: Firefighters operating in hot environments face challenges from protective garments that restrict heat dissipation, resulting in increased core temperature, thermal discomfort, and performance decline. Cooling vests represent a viable solution. The study aim was to compare effectiveness of the same amount of cooling power to the upper body (UB) or whole body (WB) in alleviating thermoregulatory and physiological stress, enhancing cognitive function, and reducing ratings of thermal discomfort and exertion, during 60 min of exercise in a hot environment (40°C, 40% relative humidity) while wearing firefighter turnout gear.METHODS: Eight healthy individuals (27.5 ± 3 y) participated in three conditions with either no cooling (Control) or active cooling with a liquid perfused shirt (UB cooling), or with a liquid perfused shirt and pants (WB cooling). In each trial, subjects performed three sets of 15 min of stepping (20 steps ⋅ min-1) and 5 min of rest.RESULTS: Both cooling strategies were beneficial compared to having no cooling at all. Subjects could only complete two exercise bouts during Control, but they completed all three bouts with active cooling. WB cooling provided an advantage over UB cooling for core and skin temperature, and thermal comfort and sensation. The advantage in minimizing the increase in core temperature was only evident during the third exercise bout.DISCUSSION: Active cooling is advantageous under these conditions. WB cooling provided some benefits vs UB cooling during heavy intensity exercise; however, it is uncertain whether these benefits would be observed during light-to-moderate exercise, which more likely reflects an actual firefighting scenario.Mansouri F, Talebian Nia M, Villar R, Cornish SM, Giesbrecht GG. Upper- vs. whole-body cooling during exercise with thermal protective clothing in the heat. Aerosp Med Hum Perform. 2024; 95(9):659-666.
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Otani H, Goto T, Kobayashi Y, Goto H, Hosokawa Y, Tokizawa K, Shirato M. The fan cooling vest use reduces thermal and perceptual strain during outdoor exercise in the heat on a sunny summer day. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1625-1635. [PMID: 38771319 DOI: 10.1007/s00484-024-02690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
The fan cooling vest is coming into very common use by Japanese outdoor manual workers. We examined that to what extent using this vest reduces thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Ten male baseball players in high school conducted two baseball training sessions for 2-h with (VEST) or without (CON) a commercially available fan cooling vest on a baseball uniform. These sessions commenced at 10 a.m. on separate days in early August. The fan airflow rate attached the vest was 62 L·s-1. Neither ambient temperature (Mean ± SD: VEST 31.9 ± 0.2°C; CON 31.8 ± 0.7°C), wet-bulb globe temperature (VEST 31.2 ± 0.4°C; CON 31.4 ± 0.5°C) nor solar radiation (VEST 1008 ± 136 W·m-2; CON 1042 ± 66 W·m-2) was different between trials. Mean skin temperature (VEST 34.5 ± 1.1°C; CON 35.1 ± 1.4°C), infrared tympanic temperature (VEST 38.9 ± 0.9°C; CON 39.2 ± 1.2°C), heart rate (VEST 127 ± 31 bpm; CON 139 ± 33 bpm), body heat storage (VEST 140 ± 34 W·m-2; CON 160 ± 22 W·m-2), thermal sensation (- 4-4: VEST 0 ± 2; CON 3 ± 1) and rating of perceived exertion (6-20: VEST 11 ± 2; CON 14 ± 2) were lower in VEST than CON (all P < 0.05). Total distance measured with a global positioning system (VEST 3704 ± 293 m; CON 3936 ± 501 m) and body fluid variables were not different between trials. This study indicates that the fan cooling vest use can reduce thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Cooling with this vest would be effective to mitigate thermal risks and perceptual stress in athletes and sports participants under such settings.
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Affiliation(s)
- Hidenori Otani
- Faculty of Health Care Sciences, Himeji Dokkyo University, 7-2-1 Kamiono, Himeji, Hyogo, 670-8524, Japan.
| | - Takayuki Goto
- National Institute of Technology, Akashi College, Uozumi-Cho, 679-3 Nishioka, Akashi, Hyogo, 674-0084, Japan
| | - Yuki Kobayashi
- National Institute of Technology, Akashi College, Uozumi-Cho, 679-3 Nishioka, Akashi, Hyogo, 674-0084, Japan
| | - Heita Goto
- Kyushu Kyoritsu University, 1-8 Jiyugaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8585, Japan
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1164, Japan
| | - Ken Tokizawa
- National Institute of Occupational Safety and Health, 1-4-6 Umezono, Kiyose, Tokyo, 204-0024, Japan
| | - Minayuki Shirato
- Meiji Gakuin University, 1-2-37 Shiroganedai, Minato-Ku, Tokyo, 108-8636, Japan
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Del Ferraro S, Falcone T, Morabito M, Bonafede M, Marinaccio A, Gao C, Molinaro V. Mitigating heat effects in the workplace with a ventilation jacket: Simulations of the whole-body and local human thermophysiological response with a sweating thermal manikin in a warm-dry environment. J Therm Biol 2024; 119:103772. [PMID: 38145612 DOI: 10.1016/j.jtherbio.2023.103772] [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: 06/21/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023]
Abstract
Climate change is increasingly affecting human well-being and will inevitably impact on occupational sectors in terms of costs, productivity, workers' health and injuries. Among the cooling garment developed to reduce heat strain, the ventilation jacket could be considered for possible use in workplaces, as it is wearable without limiting the user's mobility and autonomy. In this study, simulations with a sweating manikin are carried out to investigate the effects of a short-sleeved ventilation jacket on human thermophysiological responses in a warm-dry scenario. Simulations were performed in a climatic chamber (air temperature = 30.1 °C; air velocity = 0.29 m/s; relative humidity = 30.0 %), considering two constant levels of metabolic rate M (M1 = 2.4 MET; M2 = 3.2 MET), a sequence of these two (Work), and three levels of fan velocities (lf = 0; lf=2; lf=4). The results revealed a more evident impact on the mean skin temperature (Tsk) compared to the rectal temperature (Tre), with significant decreases (compared to fan-off) at all M levels, for Tsk from the beginning and for Tre from the 61st minute. Skin temperatures of the torso zones decreased significantly (compared to fan-off) at all M levels, and a greater drop was registered for the Back. The fans at the highest level (lf=4) were significantly effective in improving whole-body and local thermal sensations when compared to fan-off, at all M levels. At the intermediate level (lf=2), the statistical significance varied with thermal zone, M and time interval considered. The results of the simulations also showed that the Lower Torso needs to be monitored at M2 level, as the drop in skin temperature could lead to local overcooling and thermal discomfort. Simulations showed the potential effectiveness of the ventilation jacket, but human trials are needed to verify its cooling power in real working conditions.
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Affiliation(s)
- Simona Del Ferraro
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
| | - Tiziana Falcone
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
| | - Marco Morabito
- Institute of BioEconomy (IBE), National Research Council, Via Madonna Del Piano 10, 50019, Sesto Fiorentino, FI, Italy; Centre of Bioclimatology, University of Florence, Piazzale Delle Cascine 18, 50144, Florence, Italy.
| | - Michela Bonafede
- Laboratory of Occupational and Environmental Epidemiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Stefano Gradi 55, 00143, Rome, Italy.
| | - Alessandro Marinaccio
- Laboratory of Occupational and Environmental Epidemiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Stefano Gradi 55, 00143, Rome, Italy.
| | - Chuansi Gao
- Aerosol and Climate Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Sölvegatan 26, Lund, Sweden.
| | - Vincenzo Molinaro
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
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Naito T, Saito T, Ohhashi M, Hayashi S. Recovery with a fan-cooling jacket after exposure to high solar radiation during exercise in hot outdoor environments. Front Sports Act Living 2023; 5:1106882. [PMID: 36860733 PMCID: PMC9968796 DOI: 10.3389/fspor.2023.1106882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
The study aimed to investigate the effect of body cooling with a fan-cooling jacket on body temperature responses during recovery after exercise when exposed to high solar radiation in a hot outdoor environment. Nine males cycled using ergometer until their rectal temperature increased to 38.50 °C in hot outdoor environments, followed by body cooling recovery in warm indoor environments. Subjects repeatedly performed the cycling exercise protocol, which consisted of one set of 5 min at a load of 1.5 watt/kg body weight and 15 min at a load of 2.0 watt/kg body weight at 60 rpm. Body cooling recovery consisted of cold water ingestion (10°C: CON) or cold water ingestion + wearing a fan-cooling jacket (FAN) until the rectal temperature decreased to 37.75°C. The time for the rectal temperature to reach 38.5°C did not differ between the two trials. The rate of decrease in rectal temperature at recovery tended to be higher in FAN trial than in CON trial (P = 0.082). The rate of decrease in tympanic temperature was higher in FAN trials than in CON trials (P = 0.002). The rate of decrease in mean skin temperature at the first 20 min of recovery was higher in FAN than in CON trial (P = 0.013). Body cooling recovery with a fan-cooling jacket in addition to cold water ingestion may be effective in reducing elevated tympanic and skin temperatures after exercise in the heat under a clear sky, but may be difficult to decrease rectal temperature.
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Affiliation(s)
- Takashi Naito
- Faculty of Law, Hokkai-Gakuen University, Sapporo, Japan,Correspondence: Takashi Naito
| | - Tatsuya Saito
- Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Sotaro Hayashi
- Faculty of Urban Management, Fukuyama City University, Fukuyama, Japan
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Inoue D, Nagano C, Tabuchi S, Endo Y, Hashimoto K, Tanaka H, Nakayama M, Hibino H, Morizane S, Inoue J, Horie S. Partial cooling of the upper body with a water-cooled vest in an environment exceeding body temperature. J Occup Health 2023; 65:e12396. [PMID: 37024445 PMCID: PMC10079649 DOI: 10.1002/1348-9585.12396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of water-cooled clothing that continuously cools restricted body areas to suppress body temperature increase as an anti-heatstroke measure for workers in hot environments that exceed body temperature. METHODS Ten healthy men were placed in Room A (air temperature: 25°C, relative humidity: 50%) for 15 min. They were then transferred to Room B (air temperature: 40°C, relative humidity: 50%), where they rested for 10 min, then put on cooling clothing, and again rested for 15 min (the control group rested for 25 min). They then performed intense ergometer exercise for 40 min at 40% maximal oxygen consumption after which they rested for 10 min. The three trial conditions were CON (long-sleeved summer work clothes), VEST (cooling vest), and P-VEST (partial cooling vest). In VEST and P-VEST, water-cooled clothing continuously recirculated with 10°C water was used to cool the upper body. In P-VEST, only the neck, axillae, and heart areas were in contact with the cooled clothing. The measured indices were the rectal, esophageal, and external auditory canal temperatures; heart rate; estimated sweat volume; and subjective evaluations. RESULTS Compared with the CON condition, the rectal, esophageal, and external auditory canal temperatures and the heart rate were significantly lower and the subjective indices were decreased in the VEST and P-VEST conditions. CONCLUSIONS Partial cooling showed a body cooling effect similar to that of whole upper body cooling. Partial body cooling promoted the heat dissipation, suggesting that partial cooling is efficient for maintaining body cooling in hot environments.
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Affiliation(s)
- Daisuke Inoue
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Chikage Nagano
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Shota Tabuchi
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Yukimi Endo
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Kahori Hashimoto
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Hiroyuki Tanaka
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Masashi Nakayama
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Hiroyuki Hibino
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Shuhei Morizane
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Jinro Inoue
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
| | - Seichi Horie
- Department of Health Policy and ManagementInstitute of Industrial Ecological Sciences, University of Occupational and Environmental HealthFukuokaJapan
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Sekoguchi S, Ando H, Ikegami K, Yoshitake H, Nagano C, Ogami A. Application of tight-fitting half-facepiece breath-response powered air-purifying respirator for internal body cooling in occupational environment. PLoS One 2022; 17:e0266534. [PMID: 35385522 PMCID: PMC8986019 DOI: 10.1371/journal.pone.0266534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
In dust-generating scenarios in occupational environments, it is important to take measures to prevent not only pneumoconiosis, but also heatstroke. The aim of this study was to verify whether using a tight-fitting half-facepiece breath-response powered air-purifying respirator (PAPR) in combination with a self-produced cooling device could abate the deep body temperature while performing activities. We conducted a crossover study involving 10 subjects. The subjects were subjected to three conditions: wearing a PAPR equipped with a cooling device, PAPR, or a replaceable particulate respirator. During the experiment, the rectal temperature of the subjects was measured, along with the temperature near the PAPR inlet in container with the cooling device when the PAPR equipped with the cooling device was worn. The subjects rested in a cold chamber set at a dry-bulb temperature of 28°C and relative humidity of 45% for 20 min. Then, they moved to a hot chamber set to a dry-bulb temperature of 36°C (with the same relative humidity) in 5 min and exercised on a cycle ergometer for 30 min. After that, the subjects moved to the cold chamber for 5 min and rested for 20 min. Notably, the air inhaled by the subjects wearing PAPR equipped with the cooling device was approximately 10°C cooler than the ambient air. Furthermore, 35 min after the initiation of the experiment (after the middle of the exercise period), the rectal temperature of the participants wearing the PAPR equipped with the cooling device was lower than of those wearing PAPR or replaceable particulate respirators (p <0.05). Thus, we could deduce that the self-produced cooling device was useful in abating deep body temperature. PAPR is useful for its potential applications in hot occupational environments and can save lives in working environments where heat stress can result in major medical complications.
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Affiliation(s)
- Shingo Sekoguchi
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hajime Ando
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kazunori Ikegami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hidetaka Yoshitake
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Chikage Nagano
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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