Hydration and thermal strain during tennis in the heat

The impact of extreme heat on mass-gathering sporting events: Implications for Australia and other countries

OBJECTIVES

As temperatures increase across the globe due to climate change, human exposure to extreme heat is a public health challenge. During sporting events, athletes, officials, spectators, and staff are at risk of heat stress and resulting illness. The objective of this review was to explore the impact of heat on the health outcomes of these groups and the wider health system and discuss implications for outdoor mass-gathering sporting events in Australia.

DESIGN

A systematic review was undertaken to identify literature published from 2010 to 2023.

METHODS

Seven databases were searched: Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare, and PsychInfo, for relevant key search terms such as heatwave, heat stress, extreme heat, stadium, arena, sports facilit*, sport, athletic, and Olympic. An inductive thematic analysis was undertaken. Articles were quality checked using Joanna Briggs Institute critical appraisal tools and data were extracted, tabulated, and synthesized.

RESULTS

Forty papers were included in the final analysis: 17 quantitative, and 23 descriptive and qualitative (including reviews). Health outcomes explored across the literature included exertional heat illness, exertional heat stroke, hyperthermia, and general heat related illness. Six recommendation themes emerged: planning, mitigation strategies, medical, policy, research, and education.

CONCLUSIONS

The impact of heat on health outcomes during sporting events is significant, and should be considered by individuals, coaches, officials, and organizers before, during, and after mass-gathering sporting events. These findings can inform evidence-based preparedness strategies to protect the health of those attending and competing in mass-gathering sporting events now and into the future.

IOC consensus statement on recommendations and regulations for sport events in the heat

This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes' behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

Effects of mixed-cooling strategies on executive functions in simulated tennis in hot and humid conditions

This study aimed to investigate the effects of mixed-cooling strategies, which combines external (cooling vest + neck cooled collar) and internal cooling (cold sports drink ingestion) on measures of executive function during simulated tennis in hot/humid conditions. In a counterbalanced design (randomised order), eight males undertook two trials [one with the mixed-cooling strategy, (MCOOL condition) and another without (CON condition)] in a climate chamber (36.5°C, 50% relative humidity). All subjects completed an intermittent treadmill protocol simulating a three-set tennis match with a 90-second break during odd-numbered games and 120-second breaks between sets, in accordance with the activity profile and International Tennis Federation rules. The mixed-cooling strategies were adopted before test and break time during the simulated tennis match. Stroop task, 2-back task, More-odd shifting task, gastrointestinal temperature (Tgi), skin temperature, blood lactic acid (BLA), heart rate, urine specific gravity (USG), sweat rate (SR), thermal sensation (TS) and perceived exertion (RPE) were measured. Results showed that the mean exercise time was longer in the MCOOL condition than in the CON condition. The SR was greater in CON trial compared with that in MCOOL trial. Results of two-way analysis of variance with repeated measures revealed that time×condition interactions were significant in BLA, Stroop response time, and switch cost of the more-odd shifting task. There were main effects of condition for Tgi, HR, TS, RPE, BLA, Stroop response time, and switch cost of the more-odd shifting task. In a hot/wet environment, pre- and intermittent mixed-cooling strategies can significantly improve exercise time and measures of executive function of tennis players in a simulated tennis match.

Children's water intake and hydration: a public health issue

Optimal hydration is required for all physiologic functions and cognition. Children, especially younger ones, are particularly susceptible to dehydration, given their physiological specificities, in particular, their renal immaturity and relatively large skin surface in early life, but also their dependence on adults and their greater propensity to develop digestive diseases leading to fluid losses. Mild dehydration consequences are dominated by their impact on cognitive functions, whereas more severe dehydration may endanger the health outcome. Studies on this subject in children are scarce; in particular, the long-term consequence on renal function remains questionable. This review considers how children's water intake including fluid intake and water content of food, are worrying. The findings show that, worldwide, most children do not meet adequate water intake recommendations. The main problems likely to explain insufficient water intake are access to safe water, availability of drinking water at school, and healthy-hydration education, which are all points that need to be improved within health policy.

Hydration Status of Junior Tennis Players and the Difference after a Lecture on Its Practice

Dehydration reduces exercise performance and causes heat-related illness. However, the fact that dehydration is a serious sports injury is often forgotten, especially among junior tennis players, who engage in tennis matches alone without receiving advice from others. Our objective was to investigate the hydration status of junior tennis players and the difference after attending a lecture on the importance of hydration. In total, 157 junior tennis players attending a training camp participated in this study. The duration of the camp was two days, and a lecture was organized on the first night to educate the players about hydration using a body mass scale. Body mass (BM) was measured immediately before and after practice on the first and second day. The water loss rate (WLR) was calculated by dividing the loss in BM during practice by the BM before practice. In total, 34.4% of players had attended a lecture on hydration in the past. These players had a lower WLR than those who had not, but the difference was not significant. The WLR was significantly lower after attending our lecture than that before. This study suggests that a lecture on hydration could immediately improve the hydration status of the junior tennis players; however, this effect may not be lasting. They may need help from their coaches and parents to implement what they have learned in lecture.

In-play optimal cooling for outdoor match-play tennis in the heat

The purpose of this study was to compare the efficacy of four cooling interventions used for reducing physiological and perceptual strain and improving exercise performance during outdoor match-play tennis in the heat. Eight competitive tennis players played four counter-balanced simulated outdoor matches in the heat (WBGT: 28.4-32.5°C) at 24- or 48-h intervals. Each match comprised 3 sets for which the "no-ad" rule was applied to limit duration variability. Players underwent the following cooling interventions: ad libitum fluid ingestion (CON), ad libitum fluid ingestion and ice vest (VEST), total ingestion of approximately 1000 g ice slurry and ice vest (Combined: BINE), or total ingestion of approximately 400 g ice slurry and ice vest (Low-combined: L-BINE). Gastrointestinal temperature was lower in the BINE and the L-BINE trials than in the CON trial at the set-break of set 1, and these differences in gastrointestinal temperature persisted throughout the remainder of the match (p < 0.05). The ratio of moderate-high intensity activity (≥10 km/h) in set 3 was significantly higher in the L-BINE trial than that in the BINE trial (p < 0.05). In the CON and BINE trials, high intensity activity was significantly lower in set 3 compared with set 1 and 2, respectively. Cooling by optimal ice slurry ingestion and ice vest may be a more effective strategy in mitigating the development of heat strain during outdoor match-play tennis in the heat.

Effects of in-play cooling during simulated tennis match play in the heat on performance, physiological and perceptual measures

BACKGROUND

The aim of this crossover study was to investigate whether a cooling intervention during simulated tennis match play in the heat could affect players' performance, physiology, perception of effort, and well-being.

METHODS

Eight competitive male tennis players performed two testing sessions of 45-minute simulated tennis match play on a hard court at 31.8±2.1°C and 48.5±9.6% relative humidity. During change-of-end breaks, the cooling interventions (COL) consisted of cold-water ingestion (ad libitum) and an electric fan facing the players at a distance of 1 m combined with an ice-filled damp towel around the neck and on the thighs or no cooling (CON) were applied. Measures of performance, heart rate, blood lactate concentration, tympanic and local skin temperature, sweat loss, perceived exertion, and thermal sensation as well as ratings of recovery were recorded in both sessions.

RESULTS

Paired-samples t-tests showed no significant differences (P>0.05) in any of the measures between COL and CON. Effect size (ES) calculations indicated moderate evidence that COL was beneficial to local skin temperature (ES=-0.95) and thermal sensation (ES=-0.77). At the individual level, a positive response to COL was found in some players for heart rate, local skin temperature, thermal sensation, and ratings of recovery.

CONCLUSIONS

A likely inability of COL to improve players' performance or reduce thermal strain during tennis match play in hot humid conditions was found at the group level. However, some players may be more likely to benefit from COL. Therefore, the use of COL should be individualized.

Yogurt Drink Effectively Rehydrates Athletes After a Strenuous Exercise Session

Dehydration and electrolyte imbalance as a result of prolonged strenuous exercise leads to poor thermoregulation and impaired muscle performance. Thus, appropriate rehydration during and after exercise with a solution that has a balanced combination of nutrients including electrolytes, carbohydrates and proteins is crucial in preventing the side effects of dehydration. Yogurt drink as a traditional drink with an appropriate nutritious content could be used as an alternative to expensive commercially available drinks for rehydrating athletes after long exercises in warm and humid environments and in developing countries. In this cross-over trial we examined the rehydration potential of yogurt drink in comparison to water and a commercial drink after a strenuous exercise (cycling) session in a hot and humid environment. Blood measurements included blood osmolality, serum glucose, hematocrit and serum electrolytes. Urine measurements included urine volume, osmolality and electrolyte concentrations. The results showed that early after rehydration Yogurt drink compared to water significantly increased urine sodium (mmol/L) (138.8 ± 93.4 vs. 90.0 ± 50.7, P < 0.01), urine potassium (mmol/L) (105.6 ± 55.1 vs. 35.8 ± 22.0, P < 0.05) and urine chloride (mmol/L) (113.2 ± 28.4 vs. 35.8 ± 25.1 P < 0.01). This degree of improvement was the same as with the commercial drink for urine sodium, potassium, and chloride. Yogurt drink prevented dehydration-induced changes in the blood as it stabilized the hematocrit and serum sodium, potassium and osmolality within the normal range after exercise. Finally, our results indicated that yogurt drink, as a natural and affordable rehydration option, can be considered to restore fluid and electrolyte losses after strenuous exercises in hot and humid environments.

Ice slurry ingestion during break times attenuates the increase of core temperature in a simulation of physical demand of match-play tennis in the heat

This investigation assessed the effect of ice slurry ingestion compared to that of cold water ingestion during break times on thermal strain and perception in simulated match-play tennis in the heat. Seven male recreational athletes (age = 22 ± 2 yr, height = 1.72 ± 0.08 m, Body mass = 64.8 ± 6.8 kg) performed two trials in a climate chamber, each time completing 4 sets of simulated match-play. During International Tennis Federation-mandated breaks (90-s between odd-numbered games; 120-s between sets), either ice slurry or cold water were ingested. The rectal temperature, forehead skin temperature, heart rate, rating of thermal comfort and total sweat loss were measured. The change in rectal temperature in the ice slurry trial was significantly lower than that in the cold water trial by game 3 of set 3 (p = 0.02). These differences in Δrectal temperature persisted throughout the remainder of the "match" (p < 0.05). Forehead skin temperature, heart rate and rating of thermal comfort were significantly lower in the ice slurry trial than in the cold water trial by the second half of the experiment (p < 0.05). Total sweat loss in ice slurry trial is significantly lower than cold water trial (p = 0.002). These results suggested that ice slurry ingestion was more effective than cold water ingestion in mitigating the development of heat strain during simulated match-play tennis in the heat.

Role of Functional Beverages on Sport Performance and Recovery

Functional beverages represent a palatable and efficient way to hydrate and reintegrate electrolytes, carbohydrates, and other nutrients employed and/or lost during physical training and/or competitions. Bodily hydration during sporting activity is one of the best indicators of health in athletes and can be a limiting factor for sport performance. Indeed, dehydration strongly decreases athletic performance until it is a risk to health. As for other nutrients, each of them is reported to support athletes' needs both during the physical activity and/or in the post-workout. In this study, we review the current knowledge of macronutrient-enriched functional beverages in sport taking into account the athletes' health, sports performance, and recovery.