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ALKEMADE PUCK, EIJSVOGELS THIJSMH, JANSSEN THOMASWJ, JANSEN KASPARMB, KINGMA BORISRM, DAANEN HEINAM. Upper-Body versus Lower-Body Cooling in Individuals with Paraplegia during Arm-Crank Exercise in the Heat. Med Sci Sports Exerc 2023; 55:2014-2024. [PMID: 37418241 PMCID: PMC10581408 DOI: 10.1249/mss.0000000000003244] [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] [Indexed: 07/08/2023]
Abstract
PURPOSE For wheelchair users with a spinal cord injury, the lower body may be a more convenient cooling site than the upper body. However, it remains unknown if leg cooling reduces thermal strain in these individuals. We compared the impact of upper-body versus lower-body cooling on physiological and perceptual outcomes during submaximal arm-crank exercise under heat stress in individuals with paraplegia. METHODS Twelve male participants with paraplegia (T4-L2, 50% complete lesion) performed a maximal exercise test in temperate conditions, and three heat stress tests (32°C, 40% relative humidity) in which they received upper-body cooling (COOL-UB), lower-body cooling (COOL-LB), or no cooling (CON) in a randomized counterbalanced order. Each heat stress test consisted of four exercise blocks of 15 min at 50% of peak power output, with 3 min of rest in between. Cooling was applied using water-perfused pads, with 14.8-m tubing in both COOL-UB and COOL-LB. RESULTS Gastrointestinal temperature was 0.2°C (95% confidence interval (CI), 0.1°C to 0.3°C) lower during exercise in COOL-UB versus CON (37.5°C ± 0.4°C vs 37.7°C ± 0.3°C, P = 0.009), with no difference between COOL-LB and CON ( P = 1.0). Heart rate was lower in both COOL-UB (-7 bpm; 95% CI, -11 to -3 bpm; P = 0.01) and COOL-LB (-5 bpm; 95% CI, -9 to -1 bpm; P = 0.049) compared with CON. The skin temperature reduction at the cooled skin sites was larger in COOL-LB (-10.8°C ± 1.1°C) than in COOL-UB (-6.7°C ± 1.4°C, P < 0.001), which limited the cooling capacity in COOL-LB. Thermal sensation of the cooled skin sites was improved and overall thermal discomfort was lower in COOL-UB ( P = 0.01 and P = 0.04) but not in COOL-LB ( P = 0.17 and P = 0.59) compared with CON. CONCLUSIONS Upper-body cooling more effectively reduced thermal strain than lower-body cooling in individuals with paraplegia, as it induced greater thermophysiological and perceptual benefits.
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Affiliation(s)
- PUCK ALKEMADE
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
| | - THIJS M. H. EIJSVOGELS
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - THOMAS W. J. JANSSEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
| | - KASPAR M. B. JANSEN
- Department of Design Engineering, Delft University of Technology, Delft, THE NETHERLANDS
| | - BORIS R. M. KINGMA
- Department Human Performance, Unit Defence, Safety and Security, TNO, The Netherlands Organization for Applied Sciences, Soesterberg, THE NETHERLANDS
| | - HEIN A. M. DAANEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
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Gavel EH, Lacroix MA, Goosey-Tolfrey VL, Logan-Sprenger HM. Characterizing the Thermal Demands and Mobility Performance During International Wheelchair Rugby Competition. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:856904. [PMID: 36188931 PMCID: PMC9397831 DOI: 10.3389/fresc.2022.856904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022]
Abstract
Objective To determine the thermoregulatory responses and mobility performance of wheelchair rugby (WCR) players during international competition. Methods Eleven male National Team WCR players volunteered for the study. Testing occurred during a four game series against international competition (temp 24.7 ± 0.7°C, relative humidity 50.1 ± 3.6%), with movement time (MT) and gastrointestinal temperature (Tgi) recorded continuously. Results The mean maximal Tgi was 38.6 ± 0.6°C (37.9-39.7) and did not significantly differ among Low-Class, Mid-Class, and High-Class athletes (p > 0.05). Moreover, there was a strong and significant relationship between minutes (min) played per quarter of the game and change in Tgi (r = 0.36, p = 0.01). Athletes moved a total of 27:43 ± 9:40 min:seconds (s), spent a total of 15:02 ± 8.23 min:s in Zone 1 (53.5%), 8:19 ± 3:20 min:s in Zone 2 (31.7%), and 5:59 ± 1:51 min:s in Zone 3 (21.3%). There were no differences among classification in total movement time (p = 0.169) or for speed in Zone 1, Zone 2, or Zone 3 (p > 0.05). The relationship between peak forward speed and total movement time was strong (p = 0.021, r = 0.68). Conclusion This study demonstrated that the time spent in absolute movement zones is not classification dependent, the change in core temperature is related to movement time per quarter. Furthermore, peak speeds obtained on-court were linked to overall movement time which suggests athletes should warm-up before going on court.
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Affiliation(s)
- Erica H Gavel
- Faculty of Science, Ontario Tech University, Oshawa, ON, Canada.,Canadian Sport Institute Ontario, Toronto, ON, Canada
| | | | - Vicky L Goosey-Tolfrey
- School of Sport, Exercise and Health Sciences, Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, United Kingdom
| | - Heather M Logan-Sprenger
- Faculty of Science, Ontario Tech University, Oshawa, ON, Canada.,Canadian Sport Institute Ontario, Toronto, ON, Canada.,Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
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O'Brien TJ, Lunt KM, Stephenson BT, Goosey-Tolfrey VL. The effect of pre-cooling or per-cooling in athletes with a spinal cord injury: a systematic review and meta-analysis. J Sci Med Sport 2022; 25:606-614. [DOI: 10.1016/j.jsams.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 01/22/2023]
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Ice Slurry Ingestion Lowers Thermoregulatory Strain in Wheelchair Tennis Players During Repeated Sprint Intervals in the Heat. Int J Sports Physiol Perform 2022; 17:1748-1755. [DOI: 10.1123/ijspp.2022-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose: To examine the efficacy of per-cooling via ice slurry ingestion (ICE) in wheelchair tennis players exercising in the heat. Method: Eight wheelchair tennis players undertook sprints (4 sets of 10 × 5 s over 40 min) in a hot environment (∼32 °C), interspersed by 3 boluses of 2.67 g·kg (6.8 g·kg total) ICE or drinking temperate water (control condition). Athletes performed an on-court test of repeated sprint ability (20 × 20 m) in temperate conditions immediately before and 20 minutes after the heat exposure, and time to complete each sprint as well as intermediate times were recorded. Gastrointestinal and weighted mean skin and forehead temperatures were collected throughout the heat exposure, as were thermal sensation, heart rate, and blood lactate concentration. Sweat rate was calculated from body mass changes and fluid/ice intakes. Results: Compared with the control condition, ICE resulted in a significantly lower gastrointestinal temperature (95% CI, 0.11–0.17 °C; P < .001), forehead temperature (0.58–1.06 °C; P < .001), thermal sensation (0.07–0.50 units; P = .017), and sweat rate (0.06–0.46 L·h−1; P = .017). Skin temperature, heart rate, and blood lactate concentration were not significantly different between conditions (P ≥ .598). There was no overall change preheating to postheating (P ≥ .114) or an effect of condition (P ≥ .251) on repeated sprint times. Conclusions: ICE is effective at lowering objective and subjective thermal strain when consumed between sets of repeated wheelchair sprints in the heat. However, ICE has no effect on on-court repeated 20-m sprint performance.
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Skin temperature measurement in individuals with spinal cord injury during and after exercise: Systematic review. J Therm Biol 2021; 105:103146. [DOI: 10.1016/j.jtherbio.2021.103146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
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Grossmann F, Flueck JL, Perret C, Meeusen R, Roelands B. The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies-A Systematic Review. Front Physiol 2021; 12:636997. [PMID: 33868002 PMCID: PMC8049141 DOI: 10.3389/fphys.2021.636997] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: In individuals with a spinal cord injury thermoregulatory mechanisms are fully or partially interrupted. This could lead to exercise-induced hyperthermia in temperate conditions which can be even more distinct in hot conditions. Hyperthermia has been suggested to impair physiological mechanisms in athletes, which could negatively influence physical performance and subjective well-being or cause mild to severe health issues. Objective: The aim was to evaluate the literature on the thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise in temperate and hot conditions taking the effects of cooling techniques and heat acclimation into account. Data sources: Two electronic databases, PubMed and Web of Science were searched. Studies were eligible if they observed the influence of exercise on various thermoregulatory parameters (e.g., core and skin temperature, sweat rate, thermal sensation) in individuals with a spinal cord injury. Results: In total 32 articles were included of which 26 were of strong, 3 of moderate and 3 of weak quality. Individuals with a high lesion level, especially those with a tetraplegia, reached a higher core and skin temperature with a lower sweat rate. The use of cooling techniques before and during exercise can positively affect the burden of the impaired thermoregulatory system in all individuals with a spinal cord injury. Conclusion: Due to the absence of normal thermoregulatory abilities, individuals with a high-level spinal cord injury need special attention when they are exercising in temperate and hot conditions to prevent them from potential heat related issues. The use of cooling techniques can reduce this risk.
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Affiliation(s)
- Fabian Grossmann
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, United Kingdom
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Mneimneh F, Moussalem C, Ghaddar N, Ghali K, Omeis I. Experimental study on the effectiveness of the PCM cooling vest in persons with paraplegia of varying levels. J Therm Biol 2020; 91:102634. [PMID: 32716876 DOI: 10.1016/j.jtherbio.2020.102634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
Persons with paraplegia (PA) from thoracic spinal cord injury (T1-T12) are prone to thermal stress during exercise due to impaired thermoregulation. This study evaluates the effectiveness of phase change material (PCM) cooling vests on persons with PA of different levels of injury during exercise in hot exposure. Sixteen participants were recruited and divided to three groups based on injury level; high-thoracic T1-T3, mid-thoracic T4-T8, and low thoracic T9-T12 to perform a 30-min arm-crank exercise at a 30 °C room condition. Two types of PCM vests at melting temperature of 20 °C were tested: i) V1 with PCM covering the trunk of 3.4 kg overall vest mass and ii) V2 with PCM covering chest and upper back of 2.17 kg overall vest mass. High thoracic and low-thoracic groups performed NV and V1 tests; whereas, mid-thoracic group performed NV, V1, and V2 tests. Heart rate, core, and skin temperatures were monitored during 15-min preconditioning, 30-min exercise, and 15-min recovery. In addition, thermal comfort, sensation, skin wettedness, and perceived exertion were recorded during exercise only. The main findings were that the effectiveness of the cooling vest was dependent on injury level and portion of sensate skin of trunk covered by the PCM packets. Rise in core temperature (ΔTcr) was reduced significantly for the low-thoracic group during exercise and recovery (ΔTcr=0.41°C, 0.26°C for NV and V1; respectively, p<0.05). For the mid-thoracic group, both V1 (p = 0.001) and V2 (p = 0.008) were effective in reducing ΔTcr compared to the NV test at the end of the recovery period (0.74°C,0.42°C,0.56°C, for NV, V1 and V2; respectively). For the high-thoracic group, V1 was not effective in reducing core temperature (p>0.05). For the mid-thoracic group, V2 at 36% lower mass significantly improved thermal comfort (p = 0.0004) compared to the NV test and was as effective compared to V1 in reducing core temperature.
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Affiliation(s)
- Farah Mneimneh
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Charbel Moussalem
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
| | - Nesreen Ghaddar
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon.
| | - Kamel Ghali
- Mechanical Engineering Department, American University of Beirut, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Ibrahim Omeis
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh Beirut, 1107 2020, Beirut, Lebanon
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9
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Bernardi M, Fedullo AL, Bernardi E, Munzi D, Peluso I, Myers J, Lista FR, Sciarra T. Diet in neurogenic bowel management: A viewpoint on spinal cord injury. World J Gastroenterol 2020; 26:2479-2497. [PMID: 32523306 PMCID: PMC7265150 DOI: 10.3748/wjg.v26.i20.2479] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.
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Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome 00185, Italy
- Italian Paralympic Committee, Rome 00191, Italy
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Anna Lucia Fedullo
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Elisabetta Bernardi
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari 70121, Italy
| | - Diego Munzi
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome 00178, Italy
| | - Jonathan Myers
- VA Palo Alto Health Care System and Stanford University, Cardiology Division, Palo Alto, CA 94025, United States
| | | | - Tommaso Sciarra
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
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Douzi W, Dupuy O, Theurot D, Smolander J, Dugué B. Per-Cooling (Using Cooling Systems during Physical Exercise) Enhances Physical and Cognitive Performances in Hot Environments. A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1031. [PMID: 32041228 PMCID: PMC7036802 DOI: 10.3390/ijerph17031031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
There are many important sport events that are organized in environments with a very hot ambient temperature (Summer Olympics, FIFA World Cup, Tour de France, etc.) and in hot locations (e.g., Qatar). Additionally, in the context of global warming and heat wave periods, athletes are often subjected to hot ambient temperatures. It is known that exercising in the heat induces disturbances that may provoke premature fatigue and negatively affects overall performance in both endurance and high intensity exercises. Deterioration in several cognitive functions may also occur, and individuals may be at risk for heat illnesses. To train, perform, work and recover and in a safe and effective way, cooling strategies have been proposed and have been routinely applied before, during and after exercise. However, there is a limited understanding of the influences of per-cooling on performance, and it is the subject of the present review. This work examines the influences of per-cooling of different areas of the body on performance in terms of intense short-term exercises ("anaerobic" exercises), endurance exercises ("aerobic" exercises), and cognitive functioning and provides detailed strategies that can be applied when individuals train and/or perform in high ambient temperatures.
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Affiliation(s)
| | | | | | | | - Benoit Dugué
- University of Poitiers, Laboratoire Mobilité Vieillissement Exercice (MOVE)-EA6314, Faculty of Sport Sciences, 8 Allée Jean Monnet, 86000 Poitiers, France; (W.D.); (O.D.); (D.T.); (J.S.)
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Griggs KE, Havenith G, Price MJ, Goosey-Tolfrey VL. Evaporative heat loss insufficient to attain heat balance at rest in individuals with a spinal cord injury at high ambient temperature. J Appl Physiol (1985) 2019; 127:995-1004. [DOI: 10.1152/japplphysiol.00893.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to determine whether climatic limits for achieving heat balance at rest are affected by spinal cord injury (SCI). Twenty-three men [8 able-bodied (AB), 8 with paraplegia (PP), and 7 with tetraplegia (TP)] rested in 37°C and 20% relative humidity (RH) for 20 min. With the ambient temperature held constant, RH was increased by 5% every 7 min, until gastrointestinal temperature (Tgi) showed a clear inflection or increased by >1°C. Tgi, skin temperatures, perceptual responses, and metabolic energy expenditure were measured throughout. Metabolic heat production [AB: 123 (21) W, PP: 111 (15) W, TP: 103 (29) W; means (SD)] and required rate of evaporative cooling for heat balance [Ereq; AB: 113 (20) W, PP: 107 (17) W, TP: 106 (29) W] were similar between groups ( P = 0.22 and P = 0.79). Compared with AB, greater increases in Tgi were observed in TP ( P = 0.01), with notable increases in mean skin temperature (Tsk) for TP and PP ( P = 0.01). A Tgi inflection point was demonstrated by seven AB, only three of eight PP, and no TP. Despite metabolic heat production (and Ereq) being similar between groups, evaporative heat loss was not large enough to obtain heat balance in TP, linked to a shortfall in evaporative cooling potential. Although PP possess a greater sweating capacity, the continual increase in Tgi and Tsk in most PP, although lower than for TP, implies that latent heat loss for PP is also insufficient to attain heat balance. NEW & NOTEWORTHY In the absence of convective heat loss, at temperatures around 37°C evaporative heat loss is insufficient to attain heat balance at rest in individuals with paraplegia and tetraplegia. This finding was directly linked to a shortfall in evaporative cooling potential compared with required evaporative cooling. In this environment, individuals with both paraplegia and tetraplegia cannot subjectively determine the magnitude of their thermal strain; thus perceptual responses should not be relied upon for this population group.
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Affiliation(s)
- K. E. Griggs
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - G. Havenith
- Environmental Ergonomics Research Centre, Design School, Loughborough University, Loughborough, United Kingdom
| | - M. J. Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - V. L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Douzi W, Dugué B, Vinches L, Al Sayed C, Hallé S, Bosquet L, Dupuy O. Cooling during exercise enhances performances, but the cooled body areas matter: A systematic review with meta‐analyses. Scand J Med Sci Sports 2019; 29:1660-1676. [DOI: 10.1111/sms.13521] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Wafa Douzi
- Laboratoire Mobilité Vieillissement Exercice (MOVE)‐EA6314, Faculty of Sport Sciences University of Poitiers Poitiers France
| | - Benoit Dugué
- Laboratoire Mobilité Vieillissement Exercice (MOVE)‐EA6314, Faculty of Sport Sciences University of Poitiers Poitiers France
| | - Ludwig Vinches
- Department of Mechanical Engineering ‐ Ecole de Technologie Supérieure Montréal QC Canada
| | - Chady Al Sayed
- Department of Mechanical Engineering ‐ Ecole de Technologie Supérieure Montréal QC Canada
| | - Stéphane Hallé
- Department of Mechanical Engineering ‐ Ecole de Technologie Supérieure Montréal QC Canada
| | - Laurent Bosquet
- Laboratoire Mobilité Vieillissement Exercice (MOVE)‐EA6314, Faculty of Sport Sciences University of Poitiers Poitiers France
| | - Olivier Dupuy
- Laboratoire Mobilité Vieillissement Exercice (MOVE)‐EA6314, Faculty of Sport Sciences University of Poitiers Poitiers France
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Griggs KE, Stephenson BT, Price MJ, Goosey-Tolfrey VL. Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020. Temperature (Austin) 2019; 7:37-57. [PMID: 32166104 PMCID: PMC7053936 DOI: 10.1080/23328940.2019.1617030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
Abstract
International sporting competitions, including the Paralympic Games, are increasingly being held in hot and/or humid environmental conditions. Thus, a greater emphasis is being placed on preparing athletes for the potentially challenging environmental conditions of the host cities, such as the upcoming Games in Tokyo in 2020. However, evidence-based practices are limited for the impairment groups that are eligible to compete in Paralympic sport. This review aims to provide an overview of heat-related issues for Paralympic athletes alongside current recommendations to reduce thermal strain and technological advancements in the lead up to the Tokyo 2020 Paralympic Games. When competing in challenging environmental conditions, a number of factors may contribute to an athlete's predisposition to heightened thermal strain. These include the characteristics of the sport itself (type, intensity, duration, modality, and environmental conditions), the complexity and severity of the impairment and classification of the athlete. For heat vulnerable Paralympic athletes, strategies such as the implementation of cooling methods and heat acclimation can be used to combat the increase in heat strain. At an organizational level, regulations and specific heat policies should be considered for several Paralympic sports. Both the utilization of individual strategies and specific heat health policies should be employed to ensure that Paralympics athletes' health and sporting performance are not negatively affected during the competition in the heat at the Tokyo 2020 Paralympic Games.
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Affiliation(s)
- Katy E. Griggs
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ben T. Stephenson
- Loughborough Performance Centre, English Institute of Sport, Loughborough University, Loughborough, UK
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael J. Price
- School of Life Sciences, Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Trbovich MB, Handrakis JP, Kumar NS, Price MJ. Impact of passive heat stress on persons with spinal cord injury: Implications for Olympic spectators. Temperature (Austin) 2019; 7:114-128. [PMID: 33015240 PMCID: PMC7518736 DOI: 10.1080/23328940.2019.1631730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/26/2023] Open
Abstract
Environmental heat stress can negatively impact health, work capacity, and athletic performance and potentially to lead to life-threatening consequences if not mitigated. With the upcoming Toyko Olympic games to be held during anticipated warm ambient temperatures (up to 29°C), and with spectators potentially spending long durations of time outdoors, certain populations of persons with impaired thermoregulatory capacity will be at higher risk of heat-related illness from passive heat stress. Persons with spinal cord injury (SCI) are one of these groups as a result of a decentralized sympathetic nervous system, which leaves them with impairment in convective and evaporative cooling via vasodilation and sweating, respectively. This review summarizes (1) thermoregulatory physiological responses of persons with SCI under passive heat stress: the effect of level and completeness of injury; (2) the impact of passive heat stress on quality of life (QOL), outdoor participation, behavioral thermoregulation, and cognition; (3) recommendations and education for clinicians providing health care for persons with SCI; and (4) suggestions of future directions for exploring the gaps in the literature on passive heat stress in persons with SCI. This article aims to equip consumers with SCI and health-care professionals with the most up-to-date knowledge on passive heat stress responses in persons with SCI, so that their attendance at the Olympic games can be done with maximal safety and enjoyment.
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Affiliation(s)
- Michelle B. Trbovich
- Department of Rehabilitation Medicine, UT Health Science Center at San Antonio, San Antonio, TX, USA
- Spinal cord injury center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
- New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY, USA
| | - Nina S. Kumar
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, NY, USA
| | - Mike J. Price
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Trbovich M, Koek W, Ortega C. Efficacy of water spray for evaporative cooling in athletes with spinal cord injury. Spinal Cord Ser Cases 2019; 5:51. [PMID: 31632709 PMCID: PMC6786376 DOI: 10.1038/s41394-019-0194-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 01/01/2023] Open
Abstract
Study design Interventional crossover study. Objective Spinal cord injury (SCI) disrupts afferent input to the hypothalamus and impairs efferent vaso- and sudomotor output, especially in lesions above the sympathetic chain (T1-L2). In consequence, persons with SCI under heat stress experience impairment in the ability to dissipate heat proportional to the lesion level. Thermoregulatory dysfunction places an individual at high risk of hyperthermia, which can be life threatening, especially for athletes with SCI during exercise. Current evidence on therapeutic cooling techniques in athletes with SCI is limited, but basic physiologic and research data suggest water spray (WS) might be efficacious, particularly in athletes with tetraplegia (TP), who are most impaired in thermoregulation. The aim of this study was to evaluate the effect of WS on core temperature (Tc) during exercise in athletes with SCI. Setting Texas, USA. Methods Eleven individuals with SCI: seven with TP, four with paraplegia (PP); and sixteen able-bodied (AB) controls underwent a wheelchair intermittent sprint exercise for 90 min under two conditions: (1) WS application every 15 min and (2) control (C), without WS. Tc was measured every 15 min and was analyzed for the effect of group (TP, PP, and AB) and time. Change in Tc (ΔTc) was also compared between groups. Results ΔTc was significantly higher in TP vs. PP (p < 0.0001) and TP vs. AB (p < 0.0001) groups under C treatment. WS significantly attenuated ΔTc in TP (p = 0.001), but did not change ΔTc in PP or AB. Conclusion WS effectively attenuated Tc elevation during exercise in athletes with TP. Sponsorship Texas chapter of the Paralyzed Veterans of America.
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Affiliation(s)
- Michelle Trbovich
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Wouter Koek
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Catherine Ortega
- School of Health Professions, Physical Therapy Department, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
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Trbovich M. Efficacy of Various Cooling Techniques During Exercise in Persons With Spinal Cord Injury: A Pilot Crossover Intervention Study. Top Spinal Cord Inj Rehabil 2019; 25:74-82. [PMID: 30774291 DOI: 10.1310/sci2501-74] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Decentralization of the sympathetic nervous system in persons with spinal cord injury (SCI) results in impaired vasomotor and sudomotor activity and, subsequently, impaired thermoregulatory capacity during exercise in the heat. Hyperthermia can be life-threatening and, as such, cooling interventions are needed to prevent this sequela. Objectives: To measure change in core temperature (ΔTC) over time during exercise in normothermic and high ambient heat conditions to compare thermoregulatory capacity in persons with varying degrees of intact vasomotor and sudomotor activity and to determine the efficacy of three cooling interventions in mitigating TC rise. Methods: Three persons participated: a 51-year-old with complete (AIS A) tetraplegia (TP), a 32-year-old with AIS A paraplegia (PP), and a 40-year-old without SCI (AB). Each exercised for 30 minutes on a wheelchair treadmill propelled at 30 revolutions per minute under five different conditions: (1) cool (C) = 75°F without cooling, (2) hot (H) = 90°F without cooling, (3) 90°F with cooling vest (CV), (4) 90°F with water spray (WS), and (5) 90°F with ice slurry ingestion (IS). ΔTC was compared for all conditions in all participants. Results: ΔTC in the C and H conditions was proportional to the neurological level of injury, with Tc rising highest in the TP followed by the PP then AB. WS was most efficacious at mitigating rise in TC followed by IS and CV in TP and PP. None of the cooling interventions provided an added TC cooling effect in AB. Conclusion: WS was most efficacious at mitigating rise in TC in TP>PP during exercise in the heat and should be studied in a larger SCI population.
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Dutton RA. Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies. Curr Sports Med Rep 2019; 18:9-16. [PMID: 30624329 DOI: 10.1249/jsr.0000000000000560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.
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Affiliation(s)
- Rebecca A Dutton
- University of New Mexico, Department of Orthopaedics and Rehabilitation
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Walter M, Krassioukov AV. Autonomic Nervous System in Paralympic Athletes with Spinal Cord Injury. Phys Med Rehabil Clin N Am 2018; 29:245-266. [PMID: 29627087 DOI: 10.1016/j.pmr.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Individuals sustaining a spinal cord injury (SCI) frequently suffer from sensorimotor and autonomic impairment. Damage to the autonomic nervous system results in cardiovascular, respiratory, bladder, bowel, and sexual dysfunctions, as well as temperature dysregulation. These complications not only impede quality of life, but also affect athletic performance of individuals with SCI. This article summarizes existing evidence on how damage to the spinal cord affects the autonomic nervous system and impacts the performance in athletes with SCI. Also discussed are frequently used performance-enhancing strategies, with a special focus on their legal aspect and implication on the athletes' health.
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Affiliation(s)
- Matthias Walter
- Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Andrei V Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre, University of British Columbia, GF Strong Rehabilitation Centre, Vancouver Coastal Health, 818 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada.
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Price MJ, Trbovich M. Thermoregulation following spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2018; 157:799-820. [DOI: 10.1016/b978-0-444-64074-1.00050-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Griggs KE, Havenith G, Paulson TAW, J Price M, Goosey-Tolfrey VL. Effects of cooling before and during simulated match play on thermoregulatory responses of athletes with tetraplegia. J Sci Med Sport 2017; 20:819-824. [PMID: 28389216 DOI: 10.1016/j.jsams.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/02/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Athletes with high level spinal cord injuries (tetraplegia) are under greater thermal strain during exercise than the able-bodied. The purpose of this study was to investigate the effectiveness of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays in athletes with tetraplegia. DESIGN Counter-balanced, cross-over design. METHODS Eight wheelchair rugby players with tetraplegia completed a 60min intermittent sprint protocol (ISP) on a wheelchair ergometer in 20.2°C±0.2°C and 33.0%±3.1% relative humidity. The ISP was conducted on three occasions; no cooling (NC), pre-cooling with an ice vest (P) and pre-cooling with an ice vest and water sprays between quarters (PW). Gastrointestinal (Tgi) temperature, mean skin temperature (Tsk) and perceptual responses were measured throughout. RESULTS At the end of pre-cooling, the change in Tgi was not significantly different between conditions (P>0.05) but the change in Tsk was significantly greater in P and PW compared to NC (P<0.001). The change in Tgi over the ISP was significantly lower in PW and P compared to NC (P<0.05), whilst the change in Tsk was lower in PW compared to P and NC (P<0.05). Cooling had no effect on performance or perceptual responses (P>0.05). CONCLUSIONS Water spraying between quarters combined with pre-cooling using an ice vest lowers thermal strain to a greater degree than pre-cooling only in athletes with tetraplegia, but has no effect on simulated wheelchair rugby performance or perceptual responses.
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Affiliation(s)
- Katy E Griggs
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Design School, Loughborough University, UK
| | - Thomas A W Paulson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK
| | - Michael J Price
- Department of Biomolecular and Sports Science, Coventry University, UK
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, UK.
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Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia. Phys Ther 2016; 96:650-8. [PMID: 26472295 DOI: 10.2522/ptj.20150266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with spinal cord injury (SCI) have an altered afferent input to the thermoregulatory center, resulting in a reduced efferent response (vasomotor control and sweating capacity) below the level of the lesion. Consequently, core body temperature rises more rapidly during exercise in individuals with SCI compared with people who are able-bodied. Cooling strategies may reduce the thermophysiological strain in SCI. OBJECTIVE The aim of this study was to examine the effects of a cooling vest on the core body temperature response of people with a thoracic SCI during submaximal exercise. METHODS Ten men (mean age=44 years, SD=11) with a thoracic lesion (T4-T5 or below) participated in this randomized crossover study. Participants performed two 45-minute exercise bouts at 50% maximal workload (ambient temperature 25°C), with participants randomized to a group wearing a cooling vest or a group wearing no vest (separate days). Core body temperature and skin temperature were continuously measured, and thermal sensation was assessed every 3 minutes. RESULTS Exercise resulted in an increased core body temperature, skin temperature, and thermal sensation, whereas cooling did not affect core body temperature. The cooling vest effectively decreased skin temperature, increased the core-to-trunk skin temperature gradient, and tended to lower thermal sensation compared with the control condition. LIMITATIONS The lack of differences in core body temperature among conditions may be a result of the relative moderate ambient temperature in which the exercise was performed. CONCLUSIONS Despite effectively lowering skin temperature and increasing the core-to-trunk skin temperature gradient, there was no impact of the cooling vest on the exercise-induced increase in core body temperature in men with low thoracic SCI.
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Affiliation(s)
- Claudio Perret
- Institute of Sports Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
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23
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Abstract
Cooling strategies that help prevent a reduction in exercise capacity whilst exercising in the heat have received considerable research interest over the past 3 decades, especially in the lead up to a relatively hot Olympic and Paralympic Games. Progressing into the next Olympic/Paralympic cycle, the host, Rio de Janeiro, could again present an environmental challenge for competing athletes. Despite the interest and vast array of research into cooling strategies for the able-bodied athlete, less is known regarding the application of these cooling strategies in the thermoregulatory impaired spinal cord injured (SCI) athletic population. Individuals with a spinal cord injury (SCI) have a reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the level of the spinal cord lesion. The magnitude of this thermoregulatory impairment is proportional to the level of the lesion. For instance, individuals with high-level lesions (tetraplegia) are at a greater risk of heat illness than individuals with lower-level lesions (paraplegia) at a given exercise intensity. Therefore, cooling strategies may be highly beneficial in this population group, even in moderate ambient conditions (~21 °C). This review was undertaken to examine the scientific literature that addresses the application of cooling strategies in individuals with an SCI. Each method is discussed in regards to the practical issues associated with the method and the potential underlying mechanism. For instance, site-specific cooling would be more suitable for an athlete with an SCI than whole body water immersion, due to the practical difficulties of administering this method in this population group. From the studies reviewed, wearing an ice vest during intermittent sprint exercise has been shown to decrease thermal strain and improve performance. These garments have also been shown to be effective during exercise in the able-bodied. Drawing on additional findings from the able-bodied literature, the combination of methods used prior to and during exercise and/or during rest periods/half-time may increase the effectiveness of a strategy. However, due to the paucity of research involving athletes with an SCI, it is difficult to establish an optimal cooling strategy. Future studies are needed to ensure that research outcomes can be translated into meaningful performance enhancements by investigating cooling strategies under the constraints of actual competition. Cooling strategies that meet the demands of intermittent wheelchair sports need to be identified, with particular attention to the logistics of the sport.
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Krassioukov A, West C. The role of autonomic function on sport performance in athletes with spinal cord injury. PM R 2015; 6:S58-65. [PMID: 25134753 DOI: 10.1016/j.pmrj.2014.05.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/05/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
Devastating paralysis, autonomic dysfunction, and abnormal cardiovascular control present significant hemodynamic challenges to individuals with spinal cord injury (SCI), especially during exercise. In general, resting arterial pressure after SCI is lower than with able-bodied individuals and is commonly associated with persistent orthostatic intolerance along with transient episodes of life-threatening hypertension, known as "autonomic dysreflexia." During exercise, the loss of central and reflexive cardiovascular control attenuates maximal heart rate and impairs blood pressure regulation and blood redistribution, which ultimately reduces venous return, stroke volume, and cardiac output. Thermoregulation also is severely compromised in high-lesion SCI, a problem that is compounded when competing in hot and humid conditions. There is some evidence that enhancing venous return via lower body positive pressure or abdominal binding improves exercise performance, as do cooling strategies. Athletes with SCI also have been documented to self-induce autonomic dysreflexia before competition with a view of increasing blood pressure and improving their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympics Committee. This article addresses the complex issue of how the autonomic nervous system affects sports performance in athletes with SCI, with a specific focus on the potential debilitating effects of deranged cardiovascular control.
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Affiliation(s)
- Andrei Krassioukov
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada∗; International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada(†).
| | - Christopher West
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada∗
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Chan AP, Song W, Yang Y. Meta-analysis of the effects of microclimate cooling systems on human performance under thermal stressful environments: Potential applications to occupational workers. J Therm Biol 2015; 49-50:16-32. [DOI: 10.1016/j.jtherbio.2015.01.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
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Trbovich M, Ortega C, Schroeder J, Fredrickson M. Effect of a cooling vest on core temperature in athletes with and without spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:70-80. [PMID: 24574824 DOI: 10.1310/sci2001-70] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND It is well accepted that persons with spinal cord injury (SCI) have impaired ability to regulate core temperature due to impaired vasomotor and sudomotor activity below their level of injury. Impaired heat dissipation puts SCI athletes at great risk of exercise-induced hyperthermia (EIH) (>37.8°C). There is minimal evidence for efficacy of any specific cooling method in SCI athletes in a thermoneutral sport-specific setting. OBJECTIVE To evaluate the extent of EIH in persons with and without SCI and subsequently examine the effect of a cooling vest to attenuate rise in core body temperature (Tc). METHODS SCI (n = 17) and able-bodied (AB; n = 19) athletes participated in a 60-minute intermittent sprinting exercise in a thermoneutral (21.1°C-23.9°C) environment. Participants were separated according to their level of injury: tetraplegia defined as above T1 (TP; n = 6), high paraplegia defined as T5 through T1 (HP; n = 5), low paraplegia defined as T6 and below (LP; n = 6), and AB (n = 19). Tc was recorded at 15-minute intervals using an ingestible thermometer pill. This protocol was completed with a cooling vest (V) and without a cooling vest (NV). RESULTS All SCI and most AB athletes experienced EIH. After 60 minutes, Tc of TP athletes was significantly increased compared to HP (P = .03) and AB athletes (P = .007). There was no significant effect of the vest on Tc over time for any group. CONCLUSIONS TP athletes have the highest risk of exercise-induced hyperthermia. The cooling vest does not significantly attenuate rise in Tc in SCI or AB athletes.
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Affiliation(s)
- Michelle Trbovich
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas ; Spinal Cord Injury Service, Audie L. Murphy Veteran's Administration Hospital , San Antonio, Texas
| | - Catherine Ortega
- Department of Physical Therapy, University of Texas Health Science Center at San Antonio , Texas
| | - James Schroeder
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas
| | - Mark Fredrickson
- Department of PM&R, University of Texas Health Science Center at San Antonio , Texas ; Spinal Cord Injury Service, Audie L. Murphy Veteran's Administration Hospital , San Antonio, Texas
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The impact of a phase-change cooling vest on heat strain and the effect of different cooling pack melting temperatures. Eur J Appl Physiol 2012; 113:1223-31. [PMID: 23160652 DOI: 10.1007/s00421-012-2534-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
Cooling vests (CV) are often used to reduce heat strain. CVs have traditionally used ice as the coolant, although other phase-change materials (PCM) that melt at warmer temperatures have been used in an attempt to enhance cooling by avoiding vasoconstriction, which supposedly occurs when ice CVs are used. This study assessed the effectiveness of four CVs that melted at 0, 10, 20 and 30 °C (CV₀, CV₁₀, CV₂₀, and CV₃₀) when worn by 10 male volunteers exercising and then recovering in 40 °C air whilst wearing fire-fighting clothing. When compared with a non-cooling control condition (CON), only the CV₀ and CV₁₀ vests provided cooling during exercise (40 and 29 W, respectively), whereas all CVs provided cooling during resting recovery (CV₀ 69 W, CV₁₀ 66 W, CV₂₀ 55 W and CV₃₀ 29 W) (P < 0.05). In all conditions, skin blood flow increased when exercising and reduced during recovery, but was lower in the CV₀ and CV₁₀ conditions compared with control during exercise (observed power 0.709) (P < 0.05), but not during resting recovery (observed power only 0.55). The participants preferred the CV₁₀ to the CV₀, which caused temporary erythema to underlying skin, although this resolved overnight after each occurrence. Consequently, a cooling vest melting at 10 °C would seem to be the most appropriate choice for cooling during combined work and rest periods, although possibly an ice-vest (CV₀) may also be appropriate if more insulation was worn between the cooling packs and the skin than used in this study.
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Abstract
Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.
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Affiliation(s)
- Nick Webborn
- Centre for Sport Research, Chelsea School of Sport, University of Brighton, Eastbourne, UK.
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Partial heat acclimation of athletes with spinal cord lesion. Eur J Appl Physiol 2012; 113:109-15. [PMID: 22592455 DOI: 10.1007/s00421-012-2417-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
Heat acclimation (HA) can improve thermoregulatory stability in able-bodied athletes in part by an enhanced sweat response. Athletes with spinal cord lesion are unable to sweat below the lesion and it is unknown if they can HA. Five paralympic shooting athletes with spinal cord lesion completed seven consecutive days HA in hot conditions (33.4 ± 0.6 °C, 64.8 ± 3.7 %rh). Each HA session consisted of 20 min arm crank exercise at 50 % [Formula: see text] followed by 40 min rest, or simulated shooting. Aural temperature (T (aur)) was recorded throughout. Body mass was assessed before and after each session and a sweat collection swab was fixed to T12 of the spine. Fingertip whole blood was sampled at rest on days 1 and 7 for estimation of the change in plasma volume. Resting T (aur) declined from 36.3 ± 0.2 °C on day 1 to 36.0 ± 0.2 °C by day 6 (P < 0.05). During the HA sessions mean, T (aur) declined from 37.2 ± 0.2 °C on day 1, to 36.7 ± 0.3 °C on day 7 (P < 0.05). Plasma volume increased from day 1 by 1.5 ± 0.6 % on day 7 (P < 0.05). No sweat secretion was detected or changes in body mass observed from any participant. Repeated hyperthermia combined with limited evaporative heat loss was sufficient to increase plasma volume, probably by alterations in fluid regulatory hormones. In conclusion, we found that although no sweat response was observed, athletes with spinal cord lesion could partially HA.
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