Inherent variability in heat-stress decision rules

Screening criteria for increased susceptibility to heat stress during work or leisure in hot environments in healthy individuals aged 31-70 years

Population aging and global warming generate important public health risks, as older adults have increased susceptibility to heat stress (SHS). We defined and validated sex-specific screening criteria for SHS during work and leisure activities in hot environments in individuals aged 31-70 years using age, anthropometry, and cardiorespiratory fitness. A total of 123 males and 44 females [44 ± 14 years; 22.9 ± 7.4% body fat; 40.3 ± 8.6 peak oxygen uptake (mlO2/kg/min)] participated, separated into the Analysis (n = 111) and Validation (n = 56) groups. Within these groups, participants were categorized into YOUNG (19-30 years; n = 47) and OLDER (31-70 years; n = 120). All participants performed exercise in the heat inside a direct calorimeter. Screening criteria for OLDER participants were defined from the Analysis group and were cross-validated in the Validation group. Results showed that 30% of OLDER individuals in the Analysis group were screened as SHS positive. A total of 274 statistically valid (p < 0.05) criteria were identified suggesting that OLDER participants were at risk for SHS when demonstrating two or more of the following (males/females): age ≥ 53.0/55.8 years; body mass index ≥29.5/25.7 kg/m2; body fat percentage ≥ 28.8/34.9; body surface area ≤2.0/1.7 m2; peak oxygen uptake ≤48.3/41.4 mlO2/kg fat free mass/min. In the Validation group, McNemar χ2 comparisons confirmed acceptable validity for the developed criteria. We conclude that the developed criteria can effectively screen individuals 31-70 years who are at risk for SHS during work and leisure activities in hot environments and can provide simple and effective means to mitigate the public health risks caused by heat exposure.

Wet-bulb globe temperature (WBGT)--its history and its limitations

Wet-bulb globe temperature (WBGT) is nowadays the most widely used index of heat stress, yet many users appear to be unaware of its history and its limitations. HISTORY OF WBGT: WBGT was invented and first used during the 1950s as one element in a successful campaign to control serious outbreaks of heat illness in training camps of the United States Army and Marine Corps. Control measures based on air temperature and humidity, and applied to all trainees alike, had proved effective but had entailed excessive compliance costs in the form of lost training time. New control measures introduced in 1956 further reduced heat illness and also lost fewer training hours. Crucial innovations were (1) replacing the temperature and humidity measurements with WBGT, which additionally responds to sun and wind, (2) using epidemiologic analyses of casualty records to identify hazardous levels of WBGT and vulnerable trainees, and (3) protecting the most vulnerable trainees by suspending drill at lower levels of WBGT, and by improving their heat tolerance in special conditioning platoons. This campaign has considerable relevance to the prevention of heat illness in sport. LIMITATIONS OF WBGT: WBGT's most serious limitation is that environments at a given level of the index are more stressful when the evaporation of sweat is restricted (by high humidity or low air movement) than when evaporation is free. As with all indices that integrate elements of the thermal environment, interpretation of the observed levels of WBGT requires careful evaluation of people's activity, clothing, and many other factors, all of which can introduce large errors into any predictions of adverse effects. Moreover, the accuracy of WBGT is being eroded by measurement errors associated with the omission of the globe temperature, with non-standard instrumentation, and with unsatisfactory calibration procedures. Because of the above limitations WBGT can provide only a general guide to the likelihood of adverse effects of heat. A much clearer assessment can be obtained by measuring the individual elements of the thermal environment, and using those measurements to estimate the requirement for evaporative cooling, the likelihood of achieving it, and more accurate and comprehensive indices of heat stress.