Validation and adjustment of the mathematical prediction model for human sweat rate responses to outdoor environmental conditions

Heat: a primer for public health researchers

OBJECTIVES

To provide a primer on the physical characteristics of heat from a biometeorological perspective for those interested in the epidemiology of extreme heat.

STUDY DESIGN

A literature search design was used.

METHODS

A review of the concepts of heat, heat stress and human heat balance was conducted using Web of Sciences, Scopus and PubMed.

RESULTS

Heat, as recognised in the field of human biometeorology, is a complex phenomenon resulting from the synergistic effects of air temperature, humidity and ventilation levels, radiation loads and metabolic activity. Heat should therefore not be conflated with high temperatures. A range of empirical, direct and rational heat stress indices have been developed to assess heat stress.

CONCLUSION

The conceptualisation of heat stress is best described with reference to the human heat balance which describes the various avenues for heat gain to and heat loss from the body. Air temperature alone is seldom the reason for heat stress and thus heat-related health effects.

Sweat rate prediction equations for outdoor exercise with transient solar radiation

We investigated the validity of employing a fuzzy piecewise prediction equation (PW) [Gonzalez et al. J Appl Physiol 107: 379-388, 2009] defined by sweat rate (m(sw), g·m(-2)·h(-1)) = 147 + 1.527·(E(req)) - 0.87·(E(max)), which integrates evaporation required (E(req)) and the maximum evaporative capacity of the environment (E(max)). Heat exchange and physiological responses were determined throughout the trials. Environmental conditions were ambient temperature (T(a)) = 16-26°C, relative humidity (RH) = 51-55%, and wind speed (V) = 0.5-1.5 m/s. Volunteers wore military fatigues [clothing evaporative potential (i(m)/clo) = 0.33] and carried loads (15-31 kg) while marching 14-37 km over variable terrains either at night (N = 77, trials 1-5) or night with increasing daylight (N = 33, trials 6 and 7). PW was modified (Pw,sol) for transient solar radiation (R(sol), W) determined from measured solar loads and verified in trials 6 and 7. PW provided a valid m(sw) prediction during night trials (1-5) matching previous laboratory values and verified by bootstrap correlation (r(bs) of 0.81, SE ± 0.014, SEE = ± 69.2 g·m(-2)·h(-1)). For trials 6 and 7, E(req) and E(max) components included R(sol) applying a modified equation Pw,sol, in which m(sw) = 147 + 1.527·(E(req,sol)) - 0.87·(E(max)). Linear prediction of m(sw) = 0.72·Pw,sol + 135 (N = 33) was validated (R(2) = 0.92; SEE = ±33.8 g·m(-2)·h(-1)) with PW β-coefficients unaltered during field marches between 16°C and 26°C T(a) for m(sw) ≤ 700 g·m(-2)·h(-1). PW was additionally derived for cool laboratory/night conditions (T(a) < 20°C) in which E(req) is low but E(max) is high, as: PW,cool (g·m(-2)·h(-1)) = 350 + 1.527·E(req) - 0.87·E(max). These sweat prediction equations allow valid tools for civilian, sports, and military medicine communities to predict water needs during a variety of heat stress/exercise conditions.

Thermoregulation and endurance running in extinct hominins: Wheeler's models revisited

Thermoregulation is often cited as a potentially important influence on the evolution of hominins, thanks to a highly influential series of papers in the Journal of Human Evolution in the 1980s and 1990s by Peter Wheeler. These papers developed quantitative modeling of heat balance between different potential hominins and their environment. Here, we return to these models, update them in line with new developments and measurements in animal thermal biology, and modify them to represent a running hominin rather than the stationary form considered previously. In particular, we use our modified Wheeler model to investigate thermoregulatory aspects of the evolution of endurance running ability. Our model suggests that for endurance running to be possible, a hominin would need locomotive efficiency, sweating rates, and areas of hairless skin similar to modern humans. We argue that these restrictions suggest that endurance running may have been possible (from a thermoregulatory viewpoint) for Homo erectus, but is unlikely for any earlier hominins.

Fluid consumption and sweating in National Football League and collegiate football players with different access to fluids during practice

CONTEXT

Considerable controversy regarding fluid replacement during exercise currently exists.

OBJECTIVE

To compare fluid turnover between National Football League (NFL) players who have constant fluid access and collegiate football players who replace fluids during water breaks in practices.

DESIGN

Observational study.

SETTING

Respective preseason training camps of 1 National Collegiate Athletic Association Division II (DII) football team and 1 NFL football team. Both morning and afternoon practices for DII players were 2.25 hours in length, and NFL players practiced for 2.25 hours in the morning and 1 hour in the afternoon. Environmental conditions did not differ.

PATIENTS OR OTHER PARTICIPANTS

Eight NFL players (4 linemen, 4 backs) and 8 physically matched DII players (4 linemen, 4 backs) participated.

INTERVENTION(S)

All players drank fluids only from their predetermined individual containers. The NFL players could consume both water and sports drinks, and the DII players could only consume water.

MAIN OUTCOME MEASURE(S)

We measured fluid consumption, sweat rate, total sweat loss, and percentage of sweat loss replaced. Sweat rate was calculated as change in mass adjusted for fluids consumed and urine produced.

RESULTS

Mean sweat rate was not different between NFL (2.1 +/- 0.25 L/h) and DII (1.8 +/- 0.15 L/h) players (F(1,12) = 2, P = .18) but was different between linemen (2.3 +/- 0.2 L/h) and backs (1.6 +/- 0.2 L/h) (t(14) = 3.14, P = .007). We found no differences between NFL and DII players in terms of percentage of weight loss (t(7) = -0.03, P = .98) or rate of fluid consumption (t(7) = -0.76, P = .47). Daily sweat loss was greater in DII (8.0 +/- 2.0 L) than in NFL (6.4 +/- 2.1 L) players (t(7) = -3, P = .02), and fluid consumed was also greater in DII (5.0 +/- 1.5 L) than in NFL (4.0 +/- 1.1 L) players (t(7) = -2.8, P = .026). We found a correlation between sweat loss and fluids consumed (r = 0.79, P < .001).

CONCLUSIONS

During preseason practices, the DII players drinking water at water breaks replaced the same volume of fluid (66% of weight lost) as NFL players with constant access to both water and sports drinks.

Expanded prediction equations of human sweat loss and water needs

The Institute of Medicine expressed a need for improved sweating rate (ṁsw) prediction models that calculate hourly and daily water needs based on metabolic rate, clothing, and environment. More than 25 years ago, the original Shapiro prediction equation (OSE) was formulated as ṁsw (g·m−2·h−1) = 27.9· Ereq·( Emax)−0.455, where Ereq is required evaporative heat loss and Emax is maximum evaporative power of the environment; OSE was developed for a limited set of environments, exposures times, and clothing systems. Recent evidence shows that OSE often overpredicts fluid needs. Our study developed a corrected OSE and a new ṁsw prediction equation by using independent data sets from a wide range of environmental conditions, metabolic rates (rest to ≤450 W/m2), and variable exercise durations. Whole body sweat losses were carefully measured in 101 volunteers (80 males and 21 females; >500 observations) by using a variety of metabolic rates over a range of environmental conditions (ambient temperature, 15–46°C; water vapor pressure, 0.27–4.45 kPa; wind speed, 0.4–2.5 m/s), clothing, and equipment combinations and durations (2–8 h). Data are expressed as grams per square meter per hour and were analyzed using fuzzy piecewise regression. OSE overpredicted sweating rates ( P < 0.003) compared with observed ṁsw. Both the correction equation (OSEC), ṁsw = 147·exp (0.0012·OSE), and a new piecewise (PW) equation, ṁsw = 147 + 1.527· Ereq − 0.87· Emax were derived, compared with OSE, and then cross-validated against independent data (21 males and 9 females; >200 observations). OSEC and PW were more accurate predictors of sweating rate (58 and 65% more accurate, P < 0.01) and produced minimal error (standard error estimate < 100 g·m−2·h−1) for conditions both within and outside the original OSE domain of validity. The new equations provide for more accurate sweat predictions over a broader range of conditions with applications to public health, military, occupational, and sports medicine settings.

Evaluation of the limits to accurate sweat loss prediction during prolonged exercise

Sweat prediction equations are often used outside their boundaries to estimate fluid requirements and generate guidance. The limitations associated with these generalized predictions have not been characterized. The purposes of this study were to: (1) evaluate the accuracy of a widely used sweat prediction equation (SHAP) when widening it's boundaries to include cooler environments (2 h) and very prolonged exercise (8 h), (2) determine the independent impact of holding skin temperature constant (SHAP36), and (3) describe how adjustments for non-sweat losses (NSL) and clothing saturation dynamics affect prediction accuracy. Water balance was measured in 39 volunteers during 15 trials that included intermittent treadmill walking for 2 h (300-600 W, 15-30 degrees C; n=21) or 8 h (300-420 W, 20-40 degrees C; n=18). Equation accuracy was assessed by comparing actual and predicted sweating rates (211 observations) using least-squares regression. Mean and 95% confidence intervals for group differences were compared against a zone of indifference (+/-0.125 l/h). Sweating rate variance accounted for by SHAP and SHAP36 was always high (r2>0.70), while the standard error of the estimate was small and uniform around the line of best fit. SHAP errors were >0.125 l/h during 2 and 8 h of exercise. SHAP36 errors were <0.125 l/h for 2 h conditions but were higher at 8 h in three of the six warmest trials. Adjustments for NSL and clothing saturation dynamics help explain SHAP errors at 2 and 8 h, respectively. These results provide a basis for future development of accurate algorithms with broader utility.

The effects of solar radiation on thermal comfort

The aim of this study was to investigate the relationship between simulated solar radiation and thermal comfort. Three studies investigated the effects of (1) the intensity of direct simulated solar radiation, (2) spectral content of simulated solar radiation and (3) glazing type on human thermal sensation responses. Eight male subjects were exposed in each of the three studies. In Study 1, subjects were exposed to four levels of simulated solar radiation: 0, 200, 400 and 600 Wm(-2). In Study 2, subjects were exposed to simulated solar radiation with four different spectral contents, each with a total intensity of 400 Wm(-2) on the subject. In Study 3, subjects were exposed through glass to radiation caused by 1,000 Wm(-2) of simulated solar radiation on the exterior surface of four different glazing types. The environment was otherwise thermally neutral where there was no direct radiation, predicted mean vote (PMV)=0+/-0.5, [International Standards Organisation (ISO) standard 7730]. Ratings of thermal sensation, comfort, stickiness and preference and measures of mean skin temperature (t(sk)) were taken. Increase in the total intensity of simulated solar radiation rather than the specific wavelength of the radiation is the critical factor affecting thermal comfort. Thermal sensation votes showed that there was a sensation scale increase of 1 scale unit for each increase of direct radiation of around 200 Wm(-2). The specific spectral content of the radiation has no direct effect on thermal sensation. The results contribute to models for determining the effects of solar radiation on thermal comfort in vehicles, buildings and outdoors.

Physiologic tolerance to uncompensable heat: intermittent exercise, field vs laboratory

PURPOSE

This study determined whether exercise (30 min)-rest (10 min) cycles alter physiologic tolerance to uncompensable heat stress (UCHS) when outdoors in the desert. In addition, the relationship between core temperature and exhaustion from heat strain previously established in laboratory studies was compared with field studies.

METHODS

Twelve men completed four trials: moderate intensity continuous exercise (MC), moderate intensity exercise with intermittent rest (MI), hard intensity continuous exercise (HC), and hard intensity exercise with intermittent rest (HI). UCHS was achieved by wearing protective clothing and exercising (estimated at 420 W or 610 W) outdoors in desert heat.

RESULTS

Heat Stress Index values were 200%, 181%, 417%, and 283% for MC, MI, HC, and HI, respectively. Exhaustion from heat strain occurred in 36 of 48 trials. Core temperatures at exhaustion averaged 38.6 +/- 0.5 degrees, 38.9 +/- 0.6 degrees, 38.9 +/- 0.7 degrees, and 39.0 +/- 0.7 degrees C for MC, MI, HC, and HI, respectively. Core temperature at exhaustion was not altered (P > 0.05) by exercise intensity or exercise-rest cycles and 50% of subjects incurred exhaustion at core temperature of 39.4 degrees C. These field data were compared with laboratory and field data collected over the past 35 years. Aggregate data for 747 laboratory and 131 field trials indicated that 50% of subjects incurred exhaustion at core temperatures of 38.6 degrees and 39.5 degrees C, respectively. When heat intolerant subjects (exhaustion < 38.3 degrees C core temperature) were removed from the analysis, subjects from laboratory studies (who underwent short-term acclimation) still demonstrated less (0.8 degrees C) physiological tolerance than those from field studies (who underwent long-term acclimatization).

CONCLUSION

Exercise-rest cycles did not alter physiologic tolerance to UCHS. In addition, subjects from field studies demonstrate greater physiologic tolerance than subjects from laboratory studies.

Water and electrolyte requirements for exercise

Exercise performance can be compromised by a body water deficit, particularly when exercise is performed in hot climates. It is recommended that individuals begin exercise when adequately hydrated. This can be facilitated by drinking 400 mL to 600 mL of fluid 2 hours before beginning exercise and drinking sufficient fluid during exercise to prevent dehydration from exceeding 2% body weight. A practical recommendation is to drink small amounts of fluid (150-300 mL) every 15 to 20 minutes of exercise, varying the volume depending on sweating rate. Core temperature, heart rate, and perceived effort remain lowest when fluid replacement comes closest to matching the rate of sweat loss. During exercise lasting less than 90 minutes, water alone is sufficient for fluid replacement. During prolonged exercise lasting longer than 90 minutes, commercially available carbohydrate electrolyte beverages should be considered to provide an exogenous carbohydrate source to sustain carbohydrate oxidation and endurance performance. Electrolyte supplementation is generally not necessary because dietary intake is adequate to offset electrolytes lost in sweat and urine; however, during initial days of hot-weather training or when meals are not calorically adequate, supplemental salt intake may be indicated to sustain sodium balance.

Heat strain models applicable for protective clothing systems: comparison of core temperature response

Core temperature (Tc) output comparisons were analyzed from thermal models applicable to persons wearing protective clothing. The two models evaluated were the United States (US) Army Research Institute of Environmental Medicine (USARIEM) heat strain experimental model and the United Kingdom (UK) Loughborough (LUT25) model. Data were derived from collaborative heat-acclimation studies conducted by three organizations and included an intermittent-work protocol (Canada) and a continuous-exercise/heat stress protocol (UK and US). Volunteers from the US and the UK were exposed to a standard exercise/heat stress protocol (ambient temperature 35 degrees C/50% relative humidity, wind speed 1 m/s, level treadmill speed 1.34 m/s). Canadian Forces volunteers did an intermittent-work protocol (15 min moderate work/15 min rest at ambient temperature of 40 degrees C/30% relative humidity, wind speed approximately 0.4 m/s). Each model reliably predicted Tc responses (within the margin of error determined by 1 root mean square deviation) during work in the heat with protective clothing. Models that are analytically similar to the classic Stolwijk-Hardy model serve as robust operational tools for prediction of physiological heat strain when modified to incorporate clothing heat-exchange factors.