Osmoregulatory modulation of thermal sweating in humans: reflex effects of drinking

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 4: evolution, thermal adaptation and unsupported theories of thermoregulation

This review is the final contribution to a four-part, historical series on human exercise physiology in thermally stressful conditions. The series opened with reminders of the principles governing heat exchange and an overview of our contemporary understanding of thermoregulation (Part 1). We then reviewed the development of physiological measurements (Part 2) used to reveal the autonomic processes at work during heat and cold stresses. Next, we re-examined thermal-stress tolerance and intolerance, and critiqued the indices of thermal stress and strain (Part 3). Herein, we describe the evolutionary steps that endowed humans with a unique potential to tolerate endurance activity in the heat, and we examine how those attributes can be enhanced during thermal adaptation. The first of our ancestors to qualify as an athlete was Homo erectus, who were hairless, sweating specialists with eccrine sweat glands covering almost their entire body surface. Homo sapiens were skilful behavioural thermoregulators, which preserved their resource-wasteful, autonomic thermoeffectors (shivering and sweating) for more stressful encounters. Following emigration, they regularly experienced heat and cold stress, to which they acclimatised and developed less powerful (habituated) effector responses when those stresses were re-encountered. We critique hypotheses that linked thermoregulatory differences to ancestry. By exploring short-term heat and cold acclimation, we reveal sweat hypersecretion and powerful shivering to be protective, transitional stages en route to more complete thermal adaptation (habituation). To conclude this historical series, we examine some of the concepts and hypotheses of thermoregulation during exercise that did not withstand the tests of time.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 2: physiological measurements

In this, the second of four historical reviews on human thermoregulation during exercise, we examine the research techniques developed by our forebears. We emphasise calorimetry and thermometry, and measurements of vasomotor and sudomotor function. Since its first human use (1899), direct calorimetry has provided the foundation for modern respirometric methods for quantifying metabolic rate, and remains the most precise index of whole-body heat exchange and storage. Its alternative, biophysical modelling, relies upon many, often dubious assumptions. Thermometry, used for >300 y to assess deep-body temperatures, provides only an instantaneous snapshot of the thermal status of tissues in contact with any thermometer. Seemingly unbeknownst to some, thermal time delays at some surrogate sites preclude valid measurements during non-steady state conditions. To assess cutaneous blood flow, immersion plethysmography was introduced (1875), followed by strain-gauge plethysmography (1949) and then laser-Doppler velocimetry (1964). Those techniques allow only local flow measurements, which may not reflect whole-body blood flows. Sudomotor function has been estimated from body-mass losses since the 1600s, but using mass losses to assess evaporation rates requires precise measures of non-evaporated sweat, which are rarely obtained. Hygrometric methods provide data for local sweat rates, but not local evaporation rates, and most local sweat rates cannot be extrapolated to reflect whole-body sweating. The objective of these methodological overviews and critiques is to provide a deeper understanding of how modern measurement techniques were developed, their underlying assumptions, and the strengths and weaknesses of the measurements used for humans exercising and working in thermally challenging conditions.

Heatstroke risk informing system using wearable perspiration ratemeter on users undergoing physical exercise

We constructed an informing system to users for the heatstroke risk using a wearable perspiration ratemeter and the users' thirst responses. The sweating ratemeter was constructed with a capacitive humidity sensor in the ventilated capsule. The timing point for informing heatstroke risk was decided to change from positive to negative on the second derivative of sweating curve. In addition, a wearable self-identification and -information system of thirst response was constructed with a smartphone. To evaluate the validity of wearable apparatus, we aimed to conduct human experiments of 16 healthy subjects with the step up and down physical exercises. The blood and urine samples of the subjects were collected before and after the 30-min physical exercise. The concentrations of TP, Alb, and RBC increased slightly with the exercise. In contrast, the concentrations of vasopressin in all subjects remarkably increased with the exercise. In almost subjects, they identified their thirst response until several min after the informing for heatstroke risk. In conclusion, the wearable ratemeter and self-information system of thirst response were suitable for informing system of heatstroke risk. The validity of timing point for informing heatstroke risk was confirmed with changes in the thirst response and concentrations of vasopressin in blood.

Hypohydration but not Menstrual Phase Influences Pain Perception in Healthy Women

Chronic pain is a pervasive health problem and is associated with tremendous socioeconomic costs. However, current pain treatments are often ineffective due, in part, to the multi-factorial nature of pain. Mild hypohydration was shown to increase experimental pain sensitivity in men, but whether this also occurs in women has not been examined. Fluctuations in ovarian hormones (i.e., 17ß-oestradiol and progesterone) throughout the menstrual cycle may influence a woman's pain sensitivity, as well as hydration levels, suggesting possible interactions between hypohydration and menstrual phase on pain. We investigated the effects of mild hypohydration (HYPO, 24 hr of fluid restriction) on ischaemic pain sensitivity in 14 eumenorrheic women during the early follicular (EF) and mid-luteal (ML) phases of their menstrual cycle. We also examined whether acute water ingestion could reverse the negative effects of hypohydration. Elevated serum osmolality, plasma copeptin, and urine specific gravity indicated mild hypohydration. Compared to euhydration, HYPO reduced pain tolerance (by 34 ± 46 s; P = 0.02, ηp2 = 0.37) and increased ratings of pain intensity (by 0.7 ± 0.7 cm; P = 0.004; ηp2 = 0.55) and unpleasantness (by 0.7 ± 0.9 cm; P = 0.02; ηp2 = 0.40); these results were not influenced by menstrual phase. Water ingestion reduced thirst perception (Visual Analogue Scale, by 2.3 ± 0.9 cm; P < 0.001, ηp2 = 0.88) but did not reduce pain sensitivity. Therefore, hypohydration increases pain sensitivity in women with no influence of menstrual phase.

Revisiting the evaluation of central versus peripheral thermoregulatory control in humans

Human thermoregulatory control is often evaluated through the relationship between thermoeffector output and core or mean body temperature. In addition to providing a general indication of whether a variable of interest alters thermoregulatory control, this relationship is often used to determine how this alteration may occur. This latter interpretation relies upon two parameters of the thermoeffector output-body temperature relationship: the onset threshold and thermosensitivity. Traditionally, changes in the onset threshold and thermosensitivity are interpreted as "central" or "peripheral" modulation of thermoregulatory control, respectively. This mini-review revisits the origins of the thermoeffector output-body temperature relationship and its use to interpret "central" or "peripheral" modulation of thermoregulatory control. Against this background, we discuss the strengths and weaknesses of this approach and highlight that "central" thermoregulatory control reflects the neural control of body temperature whereas "peripheral" thermoregulatory control reflects properties specific to the thermoeffector organs. We highlight studies that employed more direct approaches to investigate the neural control of body temperature and peripheral properties of thermoeffector organs. We conclude by encouraging future investigations interested in studying thermoregulatory control to more directly investigate the component of the thermoeffector loop under investigation.heat; human; skin blood flow; sweat; thermoregulatory.

Rapid saline infusion and/or drinking enhance skin sympathetic nerve activity components reduced by hypovolaemia and hyperosmolality in hyperthermia

KEY POINTS

In hyperthermia, plasma hyperosmolality suppresses both cutaneous vasodilatation and sweating responses and this suppression is removed by oropharyngeal stimulation such as drinking. Hypovolaemia suppresses only cutaneous vasodilatation, which is enhanced by rapid infusion in hyperthermia. Our recent studies suggested that skin sympathetic nerve activity (SSNA) involves components synchronized and non-synchronized with the cardiac cycle, which are associated with an active vasodilator and a sudomotor, respectively. In the present study, plasma hyperosmolality suppressed both components; drinking removed the hyperosmolality-induced suppressions, simultaneously with increases in cutaneous vasodilatation and sweating, while not altering plasma volume and osmolality. Furthermore, a rapid saline infusion increased the synchronized component and cutaneous vasodilatation in hypovolaemic and hyperthermic humans. The results support our idea that SSNA involves an active cutaneous vasodilator and a sudomotor, and that a site where osmolality signals are projected to control thermoregulation is located more superior than the medulla where signals from baroreceptors are projected.

ABSTRACT

We reported that skin sympathetic nerve activity (SSNA) involved components synchronized and non-synchronized with the cardiac cycle; both components increased in hyperthermia and our results suggested that the components are associated with an active vasodilator and a sudomotor, respectively. In the present study, we examined whether the increases in the components in hyperthermia would be suppressed by plasma hyperosmolality simultaneously with suppression of cutaneous vasodilatation and sweating and whether this suppression was released by oropharyngeal stimulation (drinking). Also, effects of a rapid saline infusion on both components and responses of cutaneous vasodilatation and sweating were tested in hypovolaemic and hyperthermic subjects. We found that (1) plasma hyperosmolality suppressed both components in hyperthermia, (2) the suppression was released by drinking 200 mL of water simultaneously with enhanced cutaneous vasodilatation and sweating responses, and (3) a rapid infusion at 1.0 and 0.2 ml min^-1  kg^-1 for the first 10 min and the following 20 min, respectively, increased the synchronized component and cutaneous vasodilatation in diuretic-induced hypovolaemia greater than those in a time control; at 0.1 ml min^-1  kg^-1 for 30 min no greater increases in the non-synchronized component and sweating responses were observed during rapid infusion than in the time control. The results support the idea that SSNA involves components synchronized and non-synchronized with the cardiac cycle, associated with the active cutaneous vasodilator and sudomotor, and a site of osmolality-induced modulation for thermoregulation is located superior to the medulla where signals from baroreceptors are projected.

Impact of 3-day high and low dietary sodium intake on sodium status in response to exertional-heat stress: a double-blind randomized control trial

PURPOSE

To determine the impact of altering dietary sodium intake for 3 days preceding exercise on sweat sodium concentration [Na⁺], and cardiovascular and thermoregulatory variables.

METHODS

Fifteen male endurance athletes (runners n = 8, cyclists n = 7) consumed a low (LNa, 15 mg kg^-1 day^-1) or high (HNa, 100 mg kg^-1 day^-1) sodium diet, or their usual free-living diet [UDiet, 46 (37-56) mg kg^-1 day^-1] for 3 days in a double-blind, randomized cross-over design, collecting excreted urine (UNa) and refraining from exercise. On day 4, they completed 2 h running at 55% [Formula: see text]O_2max or cycling at 55% maximum aerobic power in T_amb 35 °C. Pre- and post-exercise blood samples were collected, and sweat from five sites using absorbent patches along the exercise protocol.

RESULTS

UNa on days 2-3 pre-exercise [mean (95% CI) LNa 16 (12-19) mg kg^-1 day^-1, UDiet 46 (37-56) mg kg^-1 day^-1, HNa 79 (72-85) mg kg^-1 day^-1; p < 0.001] and pre-exercise aldosterone [LNa 240 (193-286) mg kg^-1 day^-1, UDiet 170 (116-224) mg kg^-1 day^-1, HNa 141 (111-171) mg kg^-1 day^-1; p = 0.001] reflected sodium intake as expected. Pre-exercise total body water was greater following HNa compared to LNa (p < 0.05), but not UDiet. Estimated whole-body sweat [Na⁺] following UDiet was 10-11% higher than LNa and 10-12% lower than HNa (p < 0.001), and correlated with pre-exercise aldosterone (1st h r =  - 0.568, 2nd h r =  - 0.675; p < 0.01). Rectal temperature rose more quickly in LNa vs HNa (40-70 min; p < 0.05), but was similar at the conclusion of exercise, and no significant differences in heart rate or perceived exertion were observed.

CONCLUSIONS

Three day altered sodium intake influenced urinary sodium excretion and sweat [Na⁺], and the rise in rectal temperature, but had no effect on perceived exertion during moderate-intensity exercise in hot ambient conditions.

Physiology of sweat gland function: The roles of sweating and sweat composition in human health

The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.

The ergogenic potency of carbohydrate mouth rinse on endurance running performance of dehydrated athletes

PURPOSE

To examine the effect of carbohydrate (CHO) mouth rinsing on endurance running responses and performance in dehydrated individuals.

METHODS

In a double blind, randomised crossover design, 12 well-trained male runners completed 4 running time to exhaustion (TTE) trials at a speed equivalent to 70% of VO_2peak in a thermoneutral condition. Throughout each run, participants mouth rinsed and expectorated every 15 min either 25 mL of 6% CHO or a placebo (PLA) solution for 10 s. The four TTEs consisted of two trials in the euhydrated (EU-CHO and EU-PLA) and two trials in the dehydrated (DY-CHO and DY-PLA) state. Prior to each TTE run, participants were dehydrated via exercise and allowed a passive rest period during which they were fed and either rehydrated equivalent to their body mass deficit (i.e., EU trials) or ingested only 50 mL of water (DY trials).

RESULTS

CHO mouth rinsing significantly improved TTE performance in the DY compared to the EU trials (78.2 ± 4.3 vs. 76.9 ± 3.8 min, P = 0.02). The arousal level of the runners was significantly higher in the DY compared to the EU trials (P = 0.02). There was no significant difference among trials in heart rate, plasma glucose and lactate, and psychological measures.

CONCLUSIONS

CHO mouth rinsing enhanced running performance significantly more when participants were dehydrated vs. euhydrated due to the greater sensitivity of oral receptors related to thirst and central mediated activation. These results show that level of dehydration alters the effect of brain perception with presence of CHO.

Blinded and unblinded hypohydration similarly impair cycling time trial performance in the heat in trained cyclists

Knowledge of hydration status may contribute to hypohydration-induced exercise performance decrements; therefore, this study compared blinded and unblinded hypohydration on cycling performance. Fourteen trained, nonheat-acclimated cyclists (age: 25 ± 5 yr; V̇o2peak: 63.3 ± 4.7 ml·kg−1·min−1; cycling experience: 6 ± 3 yr) were pair matched to blinded (B) or unblinded (UB) groups. After familiarization, subjects completed euhydrated (B-EUH; UB-EUH) and hypohydrated (B-HYP; UB-HYP) trials in the heat (31°C); 120-min cycling preload (50% Wpeak) and a time trial (~15 min). During the preload of all trials, 0.2 ml water·kg body mass−1 was ingested every 10 min, with additional water provided during EUH trials to match sweat losses. To blind the B group, a nasogastric tube was inserted in both trials and used to provide water in B-EUH. The preload induced similar ( P = 0.895) changes in body mass between groups (B-EUH: −0.6 ± 0.5%; B-HYP: −3.0 ± 0.5%; UB-EUH: −0.5 ± 0.3%; UB-HYP −3.0 ± 0.3%). All variables responded similarly between B and UB groups ( P ≥ 0.558), except thirst ( P = 0.004). Changes typical of hypohydration (increased heart rate, rating of perceived exertion, gastrointestinal temperature, serum osmolality and thirst, and decreased plasma volume; P ≤ 0.017) were apparent in HYP by 120 min. Time trial performance was similar between groups ( P = 0.710) and slower ( P ≤ 0.013) with HYP for B (B-EUH: 903 ± 89 s; B-HYP: 1,008 ± 121 s; −11.4%) and UB (UB-EUH: 874 ± 108 s; UB-HYP: 967 ± 170 s; −10.1%). Hypohydration of ~3% body mass impairs time trial performance in the heat, regardless of knowledge of hydration status.

NEW & NOTEWORTHY This study demonstrates, for the first time, that knowledge of hydration status does not exacerbate the negative performance consequences of hypohydration when hypohydration is equivalent to ~3% body mass. This is pivotal for the interpretation of the many previous studies that have not blinded subjects to their hydration status and suggests that these previous studies are not likely to be confounded by the overtness of the methods used to induce hypohydration.

Integrating Competing Demands of Osmoregulatory and Thermoregulatory Homeostasis

Mammals are characterized by a stable core body temperature. When maintenance of core temperature is challenged by ambient or internal heat loads, mammals increase blood flow to the skin, sweat and/or pant, or salivate. These thermoregulatory responses enable evaporative cooling at moist surfaces to dissipate body heat. If water losses incurred during evaporative cooling are not replaced, body fluid homeostasis is challenged. This article reviews the way mammals balance thermoregulation and osmoregulation.

Drinking Strategies: Planned Drinking Versus Drinking to Thirst

In humans, thirst tends to be alleviated before complete rehydration is achieved. When sweating rates are high and ad libitum fluid consumption is not sufficient to replace sweat losses, a cumulative loss in body water results. Body mass losses of 2% or greater take time to accumulate. Dehydration of ≥  2% body mass is associated with impaired thermoregulatory function, elevated cardiovascular strain and, in many conditions (e.g., warmer, longer, more intense), impaired aerobic exercise performance. Circumstances where planned drinking is optimal include longer duration activities of >  90 min, particularly in the heat; higher-intensity exercise with high sweat rates; exercise where performance is a concern; and when carbohydrate intake of 1 g/min is desired. Individuals with high sweat rates and/or those concerned with exercise performance should determine sweat rates under conditions (exercise intensity, pace) and environments similar to that anticipated when competing and tailor drinking to prevent body mass losses >  2%. Circumstances where drinking to thirst may be sufficient include short duration exercise of <  1 h to 90 min; exercise in cooler conditions; and lower-intensity exercise. It is recommended to never drink so much that weight is gained.

Plasma hyperosmolality improves tolerance to combined heat stress and central hypovolemia in humans

Heat stress profoundly impairs tolerance to central hypovolemia in humans via a number of mechanisms including heat-induced hypovolemia. However, heat stress also elevates plasma osmolality; the effects of which on tolerance to central hypovolemia remain unknown. This study examined the effect of plasma hyperosmolality on tolerance to central hypovolemia in heat-stressed humans. With the use of a counterbalanced and crossover design, 12 subjects (1 female) received intravenous infusion of either 0.9% iso-osmotic (ISO) or 3.0% hyperosmotic (HYPER) saline. Subjects were subsequently heated until core temperature increased ~1.4°C, after which all subjects underwent progressive lower-body negative pressure (LBNP) to presyncope. Plasma hyperosmolality improved LBNP tolerance (ISO: 288 ± 193 vs.

HYPER

382 ± 145 mmHg × min, P = 0.04). However, no differences in mean arterial pressure (P = 0.10), heart rate (P = 0.09), or muscle sympathetic nerve activity (P = 0.60, n = 6) were observed between conditions. When individual data were assessed, LBNP tolerance improved ≥25% in eight subjects but remained unchanged in the remaining four subjects. In subjects who exhibited improved LBNP tolerance, plasma hyperosmolality resulted in elevated mean arterial pressure (ISO: 62 ± 10 vs.

HYPER

72 ± 9 mmHg, P < 0.01) and a greater increase in heart rate (ISO: +12 ± 24 vs. HYPER: +23 ± 17 beats/min, P = 0.05) before presyncope. No differences in these variables were observed between conditions in subjects that did not improve LBNP tolerance (all P ≥ 0.55). These results suggest that plasma hyperosmolality improves tolerance to central hypovolemia during heat stress in most, but not all, individuals.

Central control of body temperature

Central neural circuits orchestrate the behavioral and autonomic repertoire that maintains body temperature during environmental temperature challenges and alters body temperature during the inflammatory response and behavioral states and in response to declining energy homeostasis. This review summarizes the central nervous system circuit mechanisms controlling the principal thermoeffectors for body temperature regulation: cutaneous vasoconstriction regulating heat loss and shivering and brown adipose tissue for thermogenesis. The activation of these thermoeffectors is regulated by parallel but distinct efferent pathways within the central nervous system that share a common peripheral thermal sensory input. The model for the neural circuit mechanism underlying central thermoregulatory control provides a useful platform for further understanding of the functional organization of central thermoregulation, for elucidating the hypothalamic circuitry and neurotransmitters involved in body temperature regulation, and for the discovery of novel therapeutic approaches to modulating body temperature and energy homeostasis.

Central neural control of thermoregulation and brown adipose tissue

Central neural circuits orchestrate the homeostatic repertoire that maintains body temperature during environmental temperature challenges and alters body temperature during the inflammatory response. This review summarizes the experimental underpinnings of our current model of the CNS pathways controlling the principal thermoeffectors for body temperature regulation: cutaneous vasoconstriction controlling heat loss, and shivering and brown adipose tissue for thermogenesis. The activation of these effectors is regulated by parallel but distinct, effector-specific, core efferent pathways within the CNS that share a common peripheral thermal sensory input. Via the lateral parabrachial nucleus, skin thermal afferent input reaches the hypothalamic preoptic area to inhibit warm-sensitive, inhibitory output neurons which control heat production by inhibiting thermogenesis-promoting neurons in the dorsomedial hypothalamus that project to thermogenesis-controlling premotor neurons in the rostral ventromedial medulla, including the raphe pallidus, that descend to provide the excitation of spinal circuits necessary to drive thermogenic thermal effectors. A distinct population of warm-sensitive preoptic neurons controls heat loss through an inhibitory input to raphe pallidus sympathetic premotor neurons controlling cutaneous vasoconstriction. The model proposed for central thermoregulatory control provides a useful platform for further understanding of the functional organization of central thermoregulation and elucidating the hypothalamic circuitry and neurotransmitters involved in body temperature regulation.

Plasma hyperosmolality attenuates skin sympathetic nerve activity during passive heat stress in humans

KEY POINTS

Plasma hyperosmolality delays the onset for sweat production and cutaneous vasodilatation during heat stress in humans; however, the mechanism by which hyperosmolality exerts this effect remains unknown. This study examined if plasma hyperosmolality exerts a central and/or peripheral modulation of thermoregulatory function in humans. The main findings are that plasma hyperosmolality delays the increase in skin sympathetic nerve activity during whole-body passive heat stress in humans. In contrast, local intradermal infusion of hyperosmotic saline did not affect sweating or cutaneous vasodilatation. These results suggest that plasma hyperosmolality delays the onset threshold for sweating and cutaneous vasodilatation by inhibiting efferent thermoregulatory activity in humans.

ABSTRACT

In humans, plasma hyperosmolality delays the onset of sweating and cutaneous vasodilatation during heat stress. However, it remains unknown if hyperosmolality exerts this effect through a central (i.e. CNS) and/or peripheral (i.e. effector organ) modulation of thermoregulatory activity. We examined if intravenous infusion of hyperosmotic saline affects skin sympathetic nerve activity (SSNA) during whole-body passive heating in healthy humans. Furthermore, we examined if local intradermal infusion of hyperosmotic saline affects sweating and cutaneous vasodilatation during passive heating. Following intravenous infusion of either 0.9% (ISO) or 3.0% (HYPER) NaCl saline, 12 subjects were passively heated until core temperature increased by ∼0.6°C. During each condition, sweating and cutaneous vascular conductance were measured over two intradermal microdialysis probes, one perfused with ISO saline and the other with HYPER saline. Intravenous infusion of HYPER saline increased plasma osmolality (294 ± 3 to 316 ± 5 mOsm kg(-1) H2O, P ≤ 0.01), which remained greater than ISO throughout heating. Plasma hyperosmolality delayed the mean body temperature onset of sweating (+1.24 ± 0.18 vs. +1.60 ± 0.18°C, P ≤ 0.01) and cutaneous vasodilatation (+1.15 ± 0.18 vs. +1.53 ± 0.22°C, P ≤ 0.01), and attenuated the increase in SSNA during heating (+147 ± 178 vs. +427 ± 281%, P ≤ 0.01). Intradermal infusion of HYPER saline increased baseline cutaneous vascular conductance (P ≤ 0.01), which did not increase further during the subsequent heating period (P = 0.11). In contrast, intradermal infusion of HYPER saline did not affect sweating (P = 0.99). These results provide direct evidence that plasma hyperosmolality exerts a central modulatory effect governing efferent thermoregulatory activity in humans.

Roux-en-Y gastric bypass does not affect daily water intake or the drinking response to dipsogenic stimuli in rats

Bariatric surgery is currently the most effective treatment for severe obesity, and Roux-en-Y gastric bypass (RYGB) is the most common approach in the United States and worldwide. Many studies have documented the changes in body weight, food intake, and glycemic control associated with the procedure. Although dehydration is commonly listed as a postoperative complication, little focus has been directed to testing the response to dipsogenic treatments after RYGB. Accordingly, we used a rat model of RYGB to test for procedure-induced changes in daily water intake and in the response to three dipsogenic treatments: central administration of ANG II, peripheral injection of hypertonic saline, and overnight water deprivation. We did not find any systematic differences in daily water intake of sham-operated and RYGB rats, nor did we find any differences in the response to the dipsogenic treatments. The results of these experiments suggest that RYGB does not impair thirst responses and does not enhance any satiating effect of water intake. Furthermore, these data support the current view that feedback from the stomach is unnecessary for the termination of drinking behavior and are consistent with a role of orosensory or postgastric feedback.

Characterization of the effects of the vasopressin V2 receptor on sweating, fluid balance, and performance during exercise

A regulatory effect of arginine vasopressin (AVP) on sweat water conservation has been hypothesized but not definitively evaluated. AVP-mediated insertion of sweat and salivary gland aquaporin-5 (AQP5) water channels through activation of the vasopressin type 2 receptor (V2R) remains an attractive, yet unexplored, mechanism that could result in a more concentrated sweat with resultant decreased water loss. Ten runners participated in a double-blind randomized control treadmill trial under three separate pharmacological conditions: a placebo, V2R agonist (0.2 mg desmopressin), or V2R antagonist (30 mg tolvaptan). After a familiarization trial, runners ran for 60 min at 60% of peak speed followed by a performance trial to volitional exhaustion. Outcome variables were collected at three exercise time points: baseline, after the steady-state run, and after the performance run. Body weight losses were <2% across all three trials. Significant pharmacological condition effects were noted for urine osmolality [F = 84.98; P < 0.0001] and urine sodium concentration ([Na(+)]) [F = 38.9; P < 0.0001], which verified both pharmacological activation and inhibition of the V2R at the kidney collecting duct. Plasma osmolality and [Na(+)] demonstrated significant exercise (F = 26.0 and F = 11.1; P < 0.0001) and condition (F = 5.1 and F = 3.8; P < 0.05) effects (osmolality and [Na(+)], respectively). No significant exercise or condition effects were noted for either sweat or salivary [Na(+)]. Significant exercise effects were noted for plasma [AVP] (F = 22.3; P < 0.0001), peak core temperature (F = 103.3; P < 0.0001), percent body weight change (F = 6.3; P = 0.02), plasma volume change (F = 21.8; P < 0.0001), and thirst rating (F = 78.2; P < 0.0001). Performance time was not altered between conditions (P = 0.80). In summary, AVP acting at V2R does not appear to regulate water losses from body fluids other than renal excretion during exercise.

Evidence that transient changes in sudomotor output with cold and warm fluid ingestion are independently modulated by abdominal, but not oral thermoreceptors

Two studies were performed to 1) characterize changes in local sweat rate (LSR) following fluid ingestion of different temperatures during exercise, and 2) identify the potential location of thermoreceptors along the gastrointestinal tract that independently modify sudomotor activity. In study 1, 12 men cycled at 50% Vo2peak for 75 min while ingesting 3.2 ml/kg of 1.5°C, 37°C, or 50°C fluid 5 min before exercise; and after 15, 30, and 45-min of exercise. In study 2, 8 men cycled at 50% Vo2peak for 75 min while 3.2 ml/kg of 1.5°C or 50°C fluid was delivered directly into the stomach via a nasogastric tube (NG trials) or was mouth-swilled only (SW trials) after 15, 30, and 45 min of exercise. Rectal (Tre), aural canal (Tau), and mean skin temperature (Tsk); and LSR on the forehead, upper-back, and forearm were measured. In study 1, Tre, Tau, and Tsk were identical between trials, but after each ingestion, LSR was significantly suppressed at all sites with 1.5°C fluid and was elevated with 50°C fluid compared with 37°C fluid (P < 0.001). The peak difference in mean LSR between 1.5°C and 50°C fluid after ingestion was 0.29 ± 0.06 mg·min(-1)·cm(-2). In study 2, LSR was similar between 1.5°C and 50°C fluids with SW trials (P = 0.738), but lower at all sites with 1.5°C fluid in NG trials (P < 0.001) despite no concurrent differences in Tre, Tau, and Tsk. These data demonstrate that 1) LSR is transiently altered by cold and warm fluid ingestion despite similar core and skin temperatures; and 2) thermoreceptors that independently and acutely modulate sudomotor output during fluid ingestion probably reside within the abdominal area, but not the mouth.

Osmoreceptors do not exhibit a sex-dependent modulation of forearm skin blood flow and sweating

Studies show that increases in plasma osmolality result in a delayed onset threshold of thermoeffector responses. However, it remains unclear if there are sex-related differences in the osmotically induced changes in both sweating and cutaneous vascular conductance (CVC). Nine young men and nine young women were passively heated (water-perfused suit) to 1.5°C above baseline esophageal temperature while in an isosmotic (0.9% NaCl saline infusion) (ISO) and hyperosmotic (3% NaCl saline infusion) (HYP) state. Forearm sweat rate (ventilated capsule), skin blood flow (laser-Doppler), esophageal temperature and skin temperature were continuously recorded. Sweat gland output (SGO) on the forearm was calculated from the number of heat activated sweat glands (modified iodine-paper technique) at the end of heating. The onset threshold and thermosensitivity of sweating and CVC were determined using the linear portion of each response plotted against mean body temperature and analyzed using segmented regression analysis. We show that the osmotically induced delay in the onset threshold of sweating and CVC is similar between males and females. Although the thermosensitivity of CVC was similar between sexes (P = 0.601), the thermosensitivity of sweating was consistently lower in females compared to males (P = 0.018). The lower thermosensitivity in sudomotor response of females was accompanied by a lower SGO (P = 0.003), albeit similar sweat gland activation to males (P = 0.644). We conclude that sex-related differences in thermoeffector activity are independent of osmoreceptor activation. Therefore, osmoreceptors do not exhibit sex-related differences in the modulation of CVC and sweating responses during heat stress.

Mild dehydration and cycling performance during 5-kilometer hill climbing

CONTEXT

Hydration has been shown to be an important factor in performance; however, the effects of mild dehydration during intense cycling are not clear.

OBJECTIVE

To determine the influence of mild dehydration on cycling performance during an outdoor climbing trial in the heat (ambient temperature = 29.0°C ± 2.2°C).

DESIGN

Crossover study.

SETTING

Outdoor.

PATIENTS OR OTHER PARTICIPANTS

Ten well-trained, male endurance cyclists (age = 28 ± 5 years, height = 182 ± 0.4 cm, mass = 73 ± 4 kg, maximal oxygen uptake = 56 ± 9 mL·min(-1)·kg(-1), body fat = 23% ± 2%, maximal power = 354 ± 48 W).

INTERVENTION(S)

Participants completed 1 hour of steady-state cycling with or without drinking to achieve the desired pre-exercise hydration level before 5-km hill-climbing cycling. Participants started the 5-km ride either euhydrated (EUH) or dehydrated by -1% of body mass (DEH).

MAIN OUTCOME MEASURE(S)

Performance time, core temperature, sweat rate, sweat sensitivity, and rating of perceived exertion (RPE).

RESULTS

Participants completed the 5-km ride 5.8% faster in the EUH (16.6 ± 2.3 minutes) than DEH (17.6 ± 2.9 minutes) trial (t1 = 10.221, P = .001). Postexercise body mass was -1.4% ± 0.3% for the EUH trial and -2.2% ± 0.2% for the DEH trial (t1 = 191.384, P < .001). Core temperature after the climb was greater during the DEH (39.2°C ± 0.3°C) than EUH (38.8°C ± 0.2°C) trial (t1 = 8.04, P = .005). Sweat rate was lower during the DEH (0.44 ± 0.16 mg·m(-2)·s(-1)) than EUH (0.51 ± 0.16 mg·m(-2)·s(-1)) trial (t8 = 2.703, P = .03). Sweat sensitivity was lower during the DEH (72.6 ± 32 g·°C(-1)·min(-1)) than EUH (102.6 ± 54.2 g·°C(-1)·min(-1)) trial (t8 = 3.072, P = .02). Lastly, RPE after the exercise performance test was higher for the DEH (19.0 ± 1.0) than EUH (17.0 ± 1.0) participants (t9 = -3.36, P = .008).

CONCLUSIONS

We found mild dehydration decreased cycling performance during a 5-km outdoor hill course, probably due to greater heat strain and greater perceived intensity.

Sex differences in thermoeffector responses during exercise at fixed requirements for heat loss

To assess potential mechanisms responsible for the lower sudomotor thermosensitivity in women during exercise, we examined sex differences in sudomotor function and skin blood flow (SkBF) during exercise performed at progressive increases in the requirement for heat loss. Eight men and eight women cycled at rates of metabolic heat production of 200, 250, and 300 W/m(2) of body surface area, with each rate being performed sequentially for 30 min. The protocol was performed in a direct calorimeter to measure evaporative heat loss (EHL) and in a thermal chamber to measure local sweat rate (LSR) (ventilated capsule), SkBF (laser-Doppler), sweat gland activation (modified iodine-paper technique), and sweat gland output (SGO) on the back, chest, and forearm. Despite a similar requirement for heat loss between the sexes, significantly lower increases in EHL and LSR were observed in women (P ≤ 0.001). Sex differences in EHL and LSR were not consistently observed during the first and second exercise periods, whereas EHL (348 ± 13 vs. 307 ± 9 W/m(2)) and LSR on the back (1.61 ± 0.07 vs. 1.20 ± 0.09 mg · min(-1) · cm(-2)), chest (1.33 ± 0.06 vs. 1.08 ± 0.09 mg · min(-1) · cm(-2)), and forearm (1.53 ± 0.07 vs. 1.20 ± 0.06 mg · min(-1) · cm(-2), men vs. women) became significantly greater in men during the last exercise period (P < 0.05). At each site, differences in LSR were solely due to a greater SGO in men, as opposed to differences in sweat gland activation. In contrast, no sex differences in SkBF were observed throughout the exercise period. The present study demonstrates that sex differences in sudomotor function are only evidenced beyond a certain requirement for heat loss, solely through differences in SGO. In contrast, the lower EHL and LSR in women are not paralleled by a lower SkBF response.

Divergent roles of plasma osmolality and the baroreflex on sweating and skin blood flow

Plasma hyperosmolality and baroreceptor unloading have been shown to independently influence the heat loss responses of sweating and cutaneous vasodilation. However, their combined effects remain unresolved. On four separate occasions, eight males were passively heated with a liquid-conditioned suit to 1.0°C above baseline core temperature during a resting isosmotic state (infusion of 0.9% NaCl saline) with (LBNP) and without (CON) application of lower-body negative pressure (−40 cmH2O) and during a hyperosmotic state (infusion of 3.0% NaCl saline) with (LBNP + HYP) and without (HYP) application of lower-body negative pressure. Forearm sweat rate (ventilated capsule) and skin blood flow (laser-Doppler), as well as core (esophageal) and mean skin temperatures, were measured continuously. Plasma osmolality increased by ∼10 mosmol/kgH2O during HYP and HYP + LBNP conditions, whereas it remained unchanged during CON and LBNP ( P ≤ 0.05). The change in mean body temperature (0.8 × core temperature + 0.2 × mean skin temperature) at the onset threshold for increases in cutaneous vascular conductance (CVC) was significantly greater during LBNP (0.56 ± 0.24°C) and HYP (0.69 ± 0.36°C) conditions compared with CON (0.28 ± 0.23°C, P ≤ 0.05). Additionally, the onset threshold for CVC during LBNP + HYP (0.88 ± 0.33°C) was significantly greater than CON and LBNP conditions ( P ≤ 0.05). In contrast, onset thresholds for sweating were not different during LBNP (0.50 ± 0.18°C) compared with CON (0.46 ± 0.26°C, P = 0.950) but were elevated ( P ≤ 0.05) similarly during HYP (0.91 ± 0.37°C) and LBNP + HYP (0.94 ± 0.40°C). Our findings show an additive effect of hyperosmolality and baroreceptor unloading on the onset threshold for increases in CVC during whole body heat stress. In contrast, the onset threshold for sweating during heat stress was only elevated by hyperosmolality with no effect of the baroreflex.

Central neural pathways for thermoregulation

Central neural circuits orchestrate a homeostatic repertoire to maintain body temperature during environmental temperature challenges and to alter body temperature during the inflammatory response. This review summarizes the functional organization of the neural pathways through which cutaneous thermal receptors alter thermoregulatory effectors: the cutaneous circulation for heat loss, the brown adipose tissue, skeletal muscle and heart for thermogenesis and species-dependent mechanisms (sweating, panting and saliva spreading) for evaporative heat loss. These effectors are regulated by parallel but distinct, effector-specific neural pathways that share a common peripheral thermal sensory input. The thermal afferent circuits include cutaneous thermal receptors, spinal dorsal horn neurons and lateral parabrachial nucleus neurons projecting to the preoptic area to influence warm-sensitive, inhibitory output neurons which control thermogenesis-promoting neurons in the dorsomedial hypothalamus that project to premotor neurons in the rostral ventromedial medulla, including the raphe pallidus, that descend to provide the excitation necessary to drive thermogenic thermal effectors. A distinct population of warm-sensitive preoptic neurons controls heat loss through an inhibitory input to raphe pallidus neurons controlling cutaneous vasoconstriction.

Arginine vasopressin, fluid balance and exercise: is exercise-associated hyponatraemia a disorder of arginine vasopressin secretion?

The ability of the human body to regulate plasma osmolality (POsm) within a very narrow and well defined physiological range underscores the vital importance of preserving water and sodium balance at rest and during exercise. The principle endocrine regulator of whole body fluid homeostasis is the posterior pituitary hormone, arginine vasopressin (AVP). Inappropriate AVP secretion may perpetuate either slow or rapid violation of these biological boundaries, thereby promoting pathophysiology, morbidity and occasional mortality. In the resting state, AVP secretion is primarily regulated by changes in POsm (osmotic regulation). The osmotic regulation of AVP secretion during exercise, however, may possibly be enhanced or overridden by many potential non-osmotic factors concurrently stimulated during physical activity, particularly during competition. The prevalence of these highly volatile non-osmotic AVP stimuli during strenuous or prolonged physical activity may reflect a teleological mechanism to promote water conservation during exercise. However, non-osmotic AVP secretion, combined with high fluid availability plus sustained fluid intake (exceeding fluid output), has been hypothesized to lead to an increase in both the incidence and related deaths from exercise-associated hyponatraemia (EAH) in lay and military populations. Inappropriately, high plasma AVP concentrations ([AVP](p)) associated with low blood sodium concentrations facilitate fluid retention and sodium loss, thereby possibly reconciling both the water intoxication and sodium loss theories of hyponatraemia that are currently under debate. Therefore, given the potential for a variety of exercise-induced non-osmotic stimuli for AVP secretion, hydration strategies must be flexible, individualized and open to change during competitive events to prevent the occurrence of rare, but life-threatening, EAH. This review focuses on the potential osmotic and non-osmotic stimuli to AVP secretion that may affect fluid homeostasis during physical activity. Recent laboratory and field data support: (i) stimulatory effects of exercise intensity and duration on [AVP](p); (ii) possible relationships between changes in POsm with changes in both sweat and urinary osmolality; (iii) alterations in the AVP osmoregulatory set-point by sex steroid hormones; (iv) differences in [AVP](p) in trained versus untrained athletes; and (v) potential inter-relationships between AVP and classical (aldosterone, atrial natriuretic peptide) and non-classical (oxytocin, interleukin-6) endocrine mediators. The review concludes with a hypothesis on how sustained fluid intakes beyond the capacity for fluid loss might possibly facilitate the development of hyponatraemia if exercise-induced non-osmotic stimuli override 'normal' osmotic suppression of AVP when hypo-osmolality exists.

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.

Mechanisms and controllers of eccrine sweating in humans

Human body temperature is regulated within a very narrow range. When exposed to hyperthermic conditions, via environmental factors and/or increased metabolism, heat dissipation becomes vital for survival. In humans, the primary mechanism of heat dissipation, particularly when ambient temperature is higher than skin temperature, is evaporative heat loss secondary to sweat secretion from eccrine glands. While the primary controller of sweating is the integration between internal and skin temperatures, a number of non-thermal factors modulate the sweating response. In addition to summarizing the current understanding of the neural pathways from the brain to the sweat gland, as well as responses at the sweat gland, this review will highlight findings pertaining to studies of proposed non-thermal modifiers of sweating, namely, exercise, baroreceptor loading state, and body fluid status. Information from these studies not only provides important insight pertaining to the basic mechanisms of sweating, but also perhaps could be useful towards a greater understanding of potential mechanisms and consequences of disease states as well as aging in altering sweating responses and thus temperature regulation.

Plasma hyperosmolality elevates the internal temperature threshold for active thermoregulatory vasodilation during heat stress in humans

Plasma hyperosmolality delays the response in skin blood flow to heat stress by elevating the internal temperature threshold for cutaneous vasodilation. This elevation could be because of a delayed onset of cutaneous active vasodilation and/or to persistent cutaneous active vasoconstriction. Seven healthy men were infused with either hypertonic (3% NaCl) or isotonic (0.9% NaCl) saline and passively heated by immersing their lower legs in 42 degrees C water for 60 min (room temperature, 28 degrees C; relative humidity, 40%). Skin blood flow was monitored via laser-Doppler flowmetry at sites pretreated with bretylium tosylate (BT) to block sympathetic vasoconstriction selectively and at adjacent control sites. Plasma osmolality was increased by approximately 13 mosmol/kgH(2)O following hypertonic saline infusion and was unchanged following isotonic saline infusion. The esophageal temperature (T(es)) threshold for cutaneous vasodilation at untreated sites was significantly elevated in the hyperosmotic state (37.73 +/- 0.11 degrees C) relative to the isosmotic state (36.63 +/- 0.12 degrees C, P < 0.001). A similar elevation of the T(es) threshold for cutaneous vasodilation was observed between osmotic conditions at the BT-treated sites (37.74 +/- 0.18 vs. 36.67 +/- 0.07 degrees C, P < 0.001) as well as sweating. These results suggest that the hyperosmotically induced elevation of the internal temperature threshold for cutaneous vasodilation is due primarily to an elevation in the internal temperature threshold for the onset of active vasodilation, and not to an enhancement of vasoconstrictor activity.

Drinking-induced thermoregulatory panting in rehydrated sheep: influences of oropharyngeal/esophageal signals, core temperature, and thirst satiety

Dehydrated mammals conserve body water by reducing thermoregulatory evaporative cooling responses e.g., panting and sweating. Increased core temperature (Tc) may result. Following rehydration and correction of fluid deficits, panting and sweating commence. We investigated the role of oropharyngeal/esophageal, postabsorptive and thermal signals in the panting response, and reduced Tc that occurs when unshorn sheep drink water following water deprivation for 2 days (ambient temperature 20°C). Ingestion of water (at body temperature) resulted in increased respiratory rate (panting) and reduced Tc within 4 min that persisted for at least 90 min. Initially, a similar panting response and reduced Tc occurred following rehydration by drinking isotonic saline solution, but panting was not sustained after 20 min, and Tc began to rise again. Rehydration by intraruminal administration of water, without any drinking, resulted in delayed panting and fall in Tc. Intraruminal infusion of saline was ineffective. Rehydration by drinking cool water (20°C) resulted in a rapid fall in Tc without increased panting. Shorn sheep had lower basal Tc that did not increase during 2 days of water deprivation, and they did not pant on rehydration by drinking water. Our results indicate that signals from the oropharyngeal and/or esophageal region associated with the act of drinking play a crucial role in the initial 20–30 min of the panting response to rehydration. Postabsorptive factors most likely reduced plasma tonicity and cause continued panting and further reduction in Tc. Tc also influences rehydration-induced panting. It occurs only if sheep incur a heat load during bodily dehydration.

Acute changes in arginine vasopressin, sweat, urine and serum sodium concentrations in exercising humans: does a coordinated homeostatic relationship exist?

The parallel response of sweat rate and urine production to changes in plasma osmolality and volume support a role for arginine vasopressin (AVP) as the main endocrine regulator of both excretions. A maximal test to exhaustion and a steady-state run on a motorised treadmill were both completed by 10 moderately trained runners, 1 week apart. Sweat, urine and serum sodium concentrations ([Na+]) were evaluated in association with the plasma concentrations of cytokines, neurohypophyseal and natriuretic peptides, and adrenal steroid hormones. When data from both the high-intensity and steady-state runs were combined, significant linear correlations were noted between: sweat [Na+] versus postexercise urine [Na+] (r=0.80; p<0.001), postexercise serum [Na+] versus both postexercise urine [Na+] (r=0.56; p<0.05) and sweat [Na+] (r=0.64; p<0.01) and postexercise urine [Na+] versus postexercise plasma arginine vasopressin concentration ([AVP](P)) (r=0.48; p<0.05). A significant positive correlation was noted between postexercise [AVP](P) and sweat [Na+] during the steady-state condition only (r=0.66; p<0.05). These correlations suggest that changes in serum [Na+] during exercise may evoke corresponding changes in sweat and urine [Na+], which are likely regulated coordinately by changes in [AVP](P) to preserve body fluid homeostasis.

Neural control and mechanisms of eccrine sweating during heat stress and exercise

In humans, evaporative heat loss from eccrine sweat glands is critical for thermoregulation during exercise and/or exposure to hot environmental conditions, particularly when environmental temperature is greater than skin temperature. Since the time of the ancient Greeks, the significance of sweating has been recognized, whereas our understanding of the mechanisms and controllers of sweating has largely developed during the past century. This review initially focuses on the basic mechanisms of eccrine sweat secretion during heat stress and/or exercise along with a review of the primary controllers of thermoregulatory sweating (i.e., internal and skin temperatures). This is followed by a review of key nonthermal factors associated with prolonged heat stress and exercise that have been proposed to modulate the sweating response. Finally, mechanisms pertaining to the effects of heat acclimation and microgravity exposure are presented.

Heat illness during working and preventive considerations from body fluid homeostasis

The purposes of this review are to show pathophysiological mechanisms for heat illness during working in a hot environment and accordingly provide some preventive considerations from a viewpoint of body fluid homeostasis. The incidence of the heat illness is closely associated with body temperature regulation, which is much affected by body fluid state in humans. Heat generated by contracting muscles during working increases body temperature, which, in a feedback manner, drives heat-dissipation mechanisms of skin blood flow and sweating to prevent a rise in body temperature. However, the impairment of heat-dissipation mechanisms caused by hard work in hot, humid, and dehydrated conditions accelerates the increase in body temperature, and, if not properly treated, leads to heat illness. First, we overviewed thermoregulation during working (exercising) in a hot environment, describe the effects of dehydration on skin blood flow and sweating, and then explained how they contributes to the progression toward heat illness. Second, we described the advantageous effects of blood volume expansion after heat acclimatization on temperature regulation during exercise as well as those of restitution from dehydration by supplementation of carbohydrate-electrolyte solution. Finally, we described that the deteriorated thermoregulation in the elderly is closely associated with the impaired body fluid regulation and that blood volume expansion by exercise training with protein supplementation improves thermoregulation.

Transient cutaneous vasodilatation and hypotension after drinking in dehydrated and exercising men

We examined whether oropharyngeal stimulation by drinking released the dehydration-induced suppression of cutaneous vasodilatation and decreased mean arterial pressure (MAP) in exercising subjects, and assessed the effects of hypovolaemia or hyperosmolality alone on these responses. Seven young males underwent four hydration conditions. These were two normal plasma volume (PV) trials: normal plasma osmolality (P(osmol), control trial) and hyperosmolality (DeltaP(osmol) = +11 mosmol (kg H(2)O)(-1)); and two low PV trials: isosmolality (DeltaPV = -310 ml) and hyperosmolality (DeltaPV = -345 ml; DeltaP(osmol) = +9 mosmol (kg H(2)O)(-1)), attained by combined treatment with furosemide (frusemide), hypertonic saline and/or 24 h water restriction. In each trial, the subjects exercised at 60% peak aerobic power for approximately 50 min at 30 degrees C atmospheric temperature and 50% relative humidity. When oesophageal temperature (T(oes)) reached a plateau after approximately 30 min of exercise, the subjects drank 200 ml water at 37.5 degrees C within a minute. Before drinking, forearm vascular conductance (FVC), calculated as forearm blood flow divided by MAP, was lowered by 20-40% in hypovolaemia, hyperosmolality, or both, compared with that in the control trial, despite increased T(oes). After drinking, FVC increased by approximately 20% compared with that before drinking (P < 0.05) in both hyperosmotic trials, but it was greater in normovolaemia than in hypovolaemia (P < 0.05). However, no increases occurred in either isosmotic trial. MAP fell by 4-8 mmHg in both hyperosmotic trials (P < 0.05) after drinking, but more rapidly in normovolaemia than in hypovolaemia. PV and P(osmol) did not change during this period. Thus, oropharyngeal stimulation by drinking released the dehydration-induced suppression of cutaneous vasodilatation and reduced MAP during exercise, and this was accelerated when PV was restored.

Lesions of the anteroventral third ventricle region (AV3V) disrupt cardiovascular responses to an elevation in core temperature

Blood flow is redistributed from the viscera to the periphery during periods of heat stress to maximize heat loss. The heat-induced redistribution of blood flow is strongly influenced by nonthermal inputs such as hydration status. At present, little is known about where thermal and nonthermal information is integrated to generate an appropriate effector response. Recently, the periventricular tissue that surrounds the anteroventral third ventricle (AV3V) has been implicated in the integration of thermal and osmotic information. The purpose of the present study was to determine the effects of electrolytic lesions of the AV3V on the cardiovascular response to a passive heat stress in unanesthetized, free-moving male Sprague-Dawley rats. Core temperature was elevated at a constant rate of approximately 0.03 degrees C/min in sham- and AV3V-lesion rats using an infrared heat lamp. Changes in mesenteric and hindquarter vascular resistance were determined using Doppler flow probes, and heat-induced salivation was estimated using the spit-print technique. The rise in mean arterial pressure (MAP), heart rate (HR), and mesenteric resistance in response to elevations in core temperature were all attenuated in AV3V-lesion rats; however, hindquarter resistance was unaffected. Heat-induced salivation was also diminished. In addition, AV3V-lesion rats were more affected by the novelty of the experimental environment, resulting in a higher basal core temperature, HR, and MAP. These results indicate that AV3V lesions disrupt the cardiovascular and salivatory response to a passive heat stress in rats and produce an exaggerated stress-induced fever triggered by a novel environment.

Reduced thirst in old, thermally dehydrated rats

Water intake and blood parameters of young (7-month) and old (23-month) male Brown Norway rats were assessed following a period of thermal dehydration. Rats of both ages were randomly assigned to one of three groups: (1) Unheated-blood sample, (2) Heated-blood sample, and (3) Heated-water intake. The colonic temperature of heated rats was raised at the rate of 0.05 degrees C/min for 1 h using an infrared heat lamp. Water intake was then measured over the following 2 h. The heating protocol resulted in a similar level of dehydration in both young and old rats; however, plasma osmolality and sodium concentration increased to a significant extent only in the young rats. Old rats drank significantly less water at all time points during the 2 h following the heat stress. While neither group replaced the water lost as a result of the thermal dehydration, the young rats did rehydrate to a greater extent. These results suggest that the diminished level of rehydration in aged rats, following a thermal dehydration, is due to an attenuated rise in plasma osmolality.

Baroreceptor modulation of active cutaneous vasodilation during dynamic exercise in humans

The hypothesis that baroreceptor unloading during dynamic limits cutaneous vasodilation by withdrawal of active vasodilator activity was tested in seven human subjects. Increases in forearm skin blood flow (laser-Doppler velocimetry) at skin sites with (control) and without alpha-adrenergic vasoconstrictor activity (vasodilator only) and in arterial blood pressure (noninvasive) were measured and used to calculate cutaneous vascular conductance (CVC). Subjects performed two similar dynamic exercise (119 +/- 8 W) protocols with and without baroreceptor unloading induced by application of -40 mmHg lower body negative pressure (LBNP). The LBNP condition was reversed (i.e., either removed or applied) after 15 min while exercise continued for an additional 15 min. During exercise without LBNP, the increase in body core temperature (esophageal temperature) required to elicit active cutaneous vasodilation averaged 0.25 +/- 0.08 and 0.31 +/- 0.10 degrees C (SE) at control and vasodilator-only skin sites, respectively, and increased to 0.44 +/- 0.10 and 0.50 +/- 0.10 degrees C (P < 0.05 compared with without LBNP) during exercise with LBNP. During exercise baroreceptor unloading delayed the onset of cutaneous vasodilation and limited peak CVC at vasodilator-only skin sites. These data support the hypothesis that during exercise baroreceptor unloading modulates active cutaneous vasodilation.

Relationship of osmotic inhibition in thermoregulatory responses and sweat sodium concentration in humans

Heat acclimatization improves thermoregulatory responses to heat stress and decreases sweat sodium concentration ([Na(+)](sweat)). The reduced [Na(+)](sweat) results in a larger increase in plasma osmolality (P(osmol)) at a given amount of sweat output. The increase in P(osmol) inhibits thermoregulatory responses to increased body core temperature. Therefore, we hypothesized that the inhibitory effect of plasma hyperosmolality on the thermoregulatory responses to heat stress should be attenuated with the reduction of [Na(+)](sweat) due to heat acclimatization. Eleven subjects (9 male and 2 female) were passively heated by immersing their lower legs into water at 42 degrees C (room temperature 28 degrees C and relative humidity 30%) for 50 min following isotonic or hypertonic saline infusion. We determined the increase in the esophageal temperature (T(es)) required to elicit sweating and cutaneous vasodilation (CVD) (DeltaT(es) thresholds for sweating and CVD, respectively) in each condition and calculated the elevation of the T(es) thresholds per unit increase in P(osmol) as the osmotic inhibition of sweating and CVD. The osmotic shift in the DeltaT(es) thresholds for both sweating and CVD correlated linearly with [Na(+)](sweat) (r = 0.858 and r = 0.628, respectively). Thus subjects with a lower [Na(+)](sweat) showed a smaller osmotic elevation of the DeltaT(es) thresholds for sweating and CVD. These results suggest the possibility that heat acclimatization attenuates osmotic inhibition of thermoregulatory responses as well as reducing [Na(+)](sweat).