Exertional fatigue, sleep loss, and negative energy balance increase susceptibility to hypothermia

Temperature fluctuation and acute myocardial infarction in Beijing: an extended analysis of temperature ranges and differences

Purpose

Few studies examined the relationship between temperature fluctuation metrics and acute myocardial infarction (AMI) hospitalizations within a single cohort. We aimed to expand knowledge on two basic measures: temperature range and difference.

Methods

We conducted a time-series analysis on the correlations between temperature range (TR), daily mean temperature differences (DTDmean), and daily mean-maximum/minimum temperature differences (TDmax/min) and AMI hospitalizations, using data between 2013 and 2016 in Beijing, China. The effects of TRn and DTDmeann over n-day intervals were compared, respectively. Subgroup analysis by age and sex was performed.

Results

A total of 81,029 AMI hospitalizations were included. TR1, TDmax, and TDmin were associated with AMI in J-shaped patterns. DTDmean1 was related to AMI in a U-shaped pattern. These correlations weakened for TR and DTDmean with longer exposure intervals. Extremely low (1st percentile) and high (5°C) DTDmean1 generated cumulative relative risk (CRR) of 2.73 (95% CI: 1.56-4.79) and 2.15 (95% CI: 1.54-3.01). Extremely high TR1, TDmax, and TDmin (99th percentile) correlated with CRR of 2.00 (95% CI: 1.73-2.85), 1.71 (95% CI: 1.40-2.09), and 2.73 (95% CI: 2.04-3.66), respectively. Those aged 20-64 had higher risks with large TR1, TDmax, and TDmin, while older individuals were more affected by negative DTDmean1. DTDmean1 was associated with a higher AMI risk in females.

Conclusion

Temperature fluctuations were linked to increased AMI hospitalizations, with low-temperature extremes having a more pronounced effect. Females and the older adult were more susceptible to daily mean temperature variations, while younger individuals were more affected by larger temperature ranges.

Impact of a Cold Environment on the Performance of Professional Cyclists: A Pilot Study

The practice of physical activity in a variable climate during the same competition is becoming more and more common due to climate change and increasingly frequent climate disturbances. The main aim of this pilot study was to understand the impact of cold ambient temperature on performance factors during a professional cycling race. Six professional athletes (age = 27 ± 2.7 years; height = 180.86 ± 5.81 cm; weight = 74.09 ± 9.11 kg; % fat mass = 8.01 ± 2.47%; maximum aerobic power (MAP) = 473 ± 26.28 W, undertook ~20 h training each week at the time of the study) participated in the Tour de la Provence under cold environmental conditions (the ambient temperature was 15.6 ± 1.4 °C with a relative humidity of 41 ± 8.5% and the normalized ambient temperature (T_awc) was 7.77 ± 2.04 °C). Body core temperature (T_co) was measured with an ingestible capsule. Heart rate (HR), power, speed, cadence and the elevation gradient were read from the cyclists’ onboard performance monitors. The interaction (multivariate analysis of variance) of the T_awc and the elevation gradient has a significant impact (F(1.5) = 32.2; p < 0.001) on the variables (cadence, power, velocity, core temperature, heart rate) and on each individual. Thus, this pilot study shows that in cold environmental conditions, the athlete’s performance was limited by weather parameters (ambient temperature associated with air velocity) and race characteristics. The interaction of T_awc and elevation gradient significantly influences thermal (T_co), physiological (HR) and performance (power, speed and cadence) factors. Therefore, it is advisable to develop warm-up, hydration and clothing strategies for competitive cycling under cold ambient conditions and to acclimatize to the cold by training in the same conditions to those that may be encountered in competition.

Human cold habituation: Physiology, timeline, and modifiers

Habituation is an adaptation seen in many organisms, defined by a reduction in the response to repeated stimuli. Evolutionarily, habituation is thought to benefit the organism by allowing conservation of metabolic resources otherwise spent on sub-lethal provocations including repeated cold exposure. Hypermetabolic and/or insulative adaptations may occur after prolonged and severe cold exposures, resulting in enhanced cold defense mechanisms such as increased thermogenesis and peripheral vasoconstriction, respectively. Habituation occurs prior to these adaptations in response to short duration mild cold exposures, and, perhaps counterintuitively, elicits a reduction in cold defense mechanisms demonstrated through higher skin temperatures, attenuated shivering, and reduced cold sensations. These habituated responses likely serve to preserve peripheral tissue temperature and conserve energy during non-life threatening cold stress. The purpose of this review is to define habituation in general terms, present evidence for the response in non-human species, and provide an up-to-date, critical examination of past studies and the potential physiological mechanisms underlying human cold habituation. Our aim is to stimulate interest in this area of study and promote further experiments to understand this physiological adaptation.

Negative energy balance during military training: The role of contextual limitations

During multiday training exercises, soldiers almost systematically face a moderate-to-large energy deficit, affecting their body mass and composition and potentially their physical and cognitive performance. Such energy deficits are explained by their inability to increase their energy intake during these highly demanding periods. With the exception of certain scenarios in which rations are voluntarily undersized to maximize the constraints, the energy content of the rations are often sufficient to maintain a neutral energy balance, suggesting that other limitations are responsible for such voluntary and/or spontaneous underconsumption. In this review, the overall aim was to present an overview of the impact of military training on energy balance, a context that stands out by its summation of specific limitations that interfere with energy intake. We first explore the impact of military training on the various components of energy balance (intake and expenditure) and body mass loss. Then, the role of the dimensioning of the rations (total energy content above or below energy expenditure) on energy deficits are addressed. Finally, the potential limitations inherent to military training (training characteristics, food characteristics, timing and context of eating, and the soldiers' attitude) are discussed to identify potential strategies to spontaneously increase energy intake and thus limit the energy deficit.

Short-term sleep deprivation and human thermoregulatory function during thermal challenges

NEW FINDINGS

What is the topic of this review? It is generally accepted that sleep deprivation constitutes a predisposing factor to the development of thermal injury. This review summarizes the available human-based evidence on the impact of sleep loss on autonomic and behavioural thermoeffectors during acute exposure to low and high ambient temperatures. What advances does it highlight? Limited to moderate evidence suggests that sleep deprivation per se impairs thermoregulatory defence mechanisms during exposure to thermal extremes. Future research is required to establish whether inadequate sleep enhances the risk for cold- and heat-related illnesses.

ABSTRACT

Relatively short periods of inadequate sleep provoke physiological and psychological perturbations, typically leading to functional impairments and degradation in performance. It is commonly accepted that sleep deprivation also disturbs thermal homeostasis, plausibly enhancing susceptibility to cold- and heat-related illnesses. Herein, we summarize the current state of human-based evidence on the impact of short-term (i.e., ≤4 nights) sleep deprivation on autonomic and behavioural thermoeffectors during acute exposure to low and high ambient temperatures. The purpose of this brief narrative review is to highlight knowledge gaps in the area and stimulate future research to investigate whether sleep deprivation constitutes a predisposing factor for the development of thermal injuries.

Examining the benefits of cold exposure as a therapeutic strategy for obesity and type 2 diabetes

The pathogenesis of metabolic diseases such as obesity and type 2 diabetes are characterized by a progressive dysregulation in energy partitioning, often leading to end-organ complications. One emerging approach proposed to target this metabolic dysregulation is the application of mild cold exposure. In healthy individuals, cold exposure can increase energy expenditure and whole body glucose and fatty acid utilization. Repeated exposures can lower fasting glucose and insulin levels and improve dietary fatty acid handling, even in healthy individuals. Despite its apparent therapeutic potential, little is known regarding the effects of cold exposure in populations for which this stimulation could benefit the most. The few studies available have shown that both acute and repeated exposures to the cold can improve insulin sensitivity and reduce fasting glycemia in individuals with type 2 diabetes. However, critical gaps remain in understanding the prolonged effects of repeated cold exposures on glucose regulation and whole body insulin sensitivity in individuals with metabolic syndrome. Much of the metabolic benefits appear to be attributable to the recruitment of shivering skeletal muscles. However, further work is required to determine whether the broader recruitment of skeletal muscles observed during cold exposure can confer metabolic benefits that surpass what has been historically observed from endurance exercise. In addition, although cold exposure offers unique cardiovascular responses for a physiological stimulus that increases energy expenditure, further work is required to determine how acute and repeated cold exposure can impact cardiovascular responses and myocardial function across a broader scope of individuals.

Shivering in the Pleistocene. Human adaptations to cold exposure in Western Europe from MIS 14 to MIS 11

During the mid-Middle Pleistocene MIS 14 to MIS 11, humans spread through Western Europe from the Mediterranean peninsulas to the sub-Arctic region, and they did so not only during the warm periods but also during the glacial stages. In doing so, they were exposed to harsh environmental conditions, including low or extremely low temperatures. Here we review the distribution of archeological assemblages in Western Europe from MIS 14 to MIS 11 and obtain estimates of the climatic conditions at those localities. Estimates of the mean annual temperature, mean winter and summer temperatures, and the lowest temperature of the coldest month for each locality were obtained from the Oscillayers database. Our results show that hominins endured cold exposure not only during the glacial stages but also during the interglacials, with winter temperatures below 0 °C at many localities. The efficacy of the main physiological and behavioral adaptations that might have been used by the Middle Pleistocene hominins to cope with low temperatures is evaluated using a simple heat-loss model. Our results suggest that physiological and anatomical adaptations alone, such as increasing basal metabolic rate and subcutaneous adipose tissue, were not enough to tolerate the low winter temperatures of Western Europe, even during the MIS 13 and MIS 11 interglacials. In contrast, the use of a simple fur bed cover appears to have been an extremely effective response to low temperatures. We suggest that advanced fire production and control technology were not necessary for the colonization of northern Europe during MIS 14 and MIS 12. We propose that Middle Pleistocene European populations were able to endure the low temperatures of those glacial stages combining anatomical and physiological adaptations with behavioral responses, such as the use of shelter and simple fur clothes.

Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation

Since its publication in 1950, the Biology of Human Starvation, which describes the classic longitudinal Minnesota Experiment of semistarvation and refeeding in healthy young men, has been the undisputed source of scientific reference about the impact of long-term food deprivation on human physiology and behavior. It has been a guide in developing famine and refugee relief programs for international agencies, in exploring the effects of food deprivation on the cognitive and social functioning of those with anorexia nervosa and bulimia nervosa, and in gaining insights into metabolic adaptations that undermine obesity therapy and cachexia rehabilitation. In more recent decades, the application of a systems approach to the analysis of its data on longitudinal changes in body composition, basal metabolic rate, and food intake during the 24 weeks of semistarvation and 20 weeks of refeeding has provided rare insights into the multitude of control systems that govern the regulation of body composition during weight regain. These have underscored an internal (autoregulatory) control of lean-fat partitioning (highly sensitive to initial adiposity), which operates during weight loss and weight regain and revealed the existence of feedback loops between changes in body composition and the control of food intake and adaptive thermogenesis for the purpose of accelerating the recovery of fat mass and fat-free mass. This paper highlights the general features and design of this grueling experiment of simulated famine that has allowed the unmasking of fundamental control systems in human body composition autoregulation. The integration of its outcomes constitutes the "famine reactions" that drive the normal physiology of weight regain and obesity relapse and provides a mechanistic "autoregulation-based" explanation of how dieting and weight cycling, transition to sedentarity, or developmental programming may predispose to obesity. It also provides a system physiology framework for research toward elucidating proteinstatic and adipostatic mechanisms that control hunger-appetite and adaptive thermogenesis, with major implications for a better understanding (and management) of cachexia, obesity, and cardiometabolic diseases.

Seasonal Trends for Environmental Illness Incidence in the U.S. Army

INTRODUCTION

The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The "heat season", when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the "cold season" is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations.

METHODS

The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons.

RESULTS

Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the "heat season" of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons.

CONCLUSIONS

The present study indicates that the traditional heat season definition should be revised to begin  ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations.

Hypoxia gradually augments metabolic and thermoperceptual responsiveness to repeated whole-body cold stress in humans

New Findings

What is the central question of this study?

In male lowlanders, does hypoxia modulate thermoregulatory effector responses during repeated whole‐body cold stress encountered in a single day?

What is the main finding and its importance?

A ∼10 h sustained exposure to hypoxia appears to mediate a gradual upregulation of endogenous heat production, preventing the progressive hypothermic response prompted by serial cold stimuli. Also, hypoxia progressively degrades mood, and compounds the perceived thermal discomfort, and sensations of fatigue and coldness.

Abstract

We examined whether hypoxia would modulate thermoeffector responses during repeated cold stress encountered in a single day. Eleven men completed two ∼10 h sessions, while breathing, in normobaria, either normoxia or hypoxia (PO2: 12 kPa). During each session, subjects underwent sequentially three 120 min immersions to the chest in 20°C water (CWI), interspersed by 120 min rewarming. In normoxia, the final drop in rectal temperature (T_rec) was greater in the third (∼1.2°C) than in the first and second (∼0.9°C) CWIs (P < 0.05). The first hypoxic CWI augmented the T_rec fall (∼1.2°C; P = 0.002), but the drop in T_rec did not vary between the three hypoxic CWIs (P = 0.99). In normoxia, the metabolic heat production (M˙) was greater during the first half of the third CWI than during the corresponding part of the first CWI (P = 0.02); yet the difference was blunted during the second half of the CWIs (P = 0.89). In hypoxia, by contrast, the increase in M˙ was augmented by ∼25% throughout the third CWI (P < 0.01). Regardless of the breathing condition, the cold‐induced elevation in mean arterial pressure was blunted in the second and third CWI (P < 0.05). Hypoxia aggravated the sensation of coldness (P = 0.05) and thermal discomfort (P = 0.04) during the second half of the third CWI. The present findings therefore demonstrate that prolonged hypoxia mediates, in a gradual manner, metabolic and thermoperceptual sensitization to repeated cold stress.

In Shackleton's trails: Central and local thermoadaptive modifications to cold and hypoxia after a man-hauling expedition on the Antarctic Plateau

Cold and hypoxia constitute the main environmental stressors encountered on the Antarctic Plateau. Hence, we examined whether central and/or peripheral acclimatisation to the combined stressors of cold and hypoxia would be developed in four men following an 11-day man-hauling expedition on this polar region. Before and after the journey, participants performed a static whole-body immersion in 21 °C water, during which they were breathing a hypoxic gas (partial pressure of inspired O₂: ~97 mmHg). To evaluate their local responses to cold, participants also immersed the hand into 8 °C water for 30 min, while they were whole-body immersed and mildly hypothermic [i.e. 0.5 °C fall in rectal temperature (T_rec) from individual pre-immersion values]. T_rec and skin temperature (T_sk), skin blood flux, and oxygen uptake (reflecting shivering thermogenesis) were monitored throughout. The polar expedition accelerated by ~14 min the drop in T_rec [final mean (95% confidence interval) changes in T_rec: Before = -0.94 (0.15) °C, After: - 1.17 (0.23) °C]. The shivering onset threshold [Before: 19 (22) min, After: 25 (19) min] and gain [Before: - 4.19 (3.95) mL min^-1 kg^-1, After: - 1.70 (1.21) mL min^-1 kg^-1] were suppressed by the expedition. T_sk did not differ between trials. The development of a greater post-expedition hypothermic state did not compromise finger circulation during the hand-cooling phase. Present findings indicate therefore that a hypothermic pattern of cold acclimatisation, as investigated in hypoxia, was developed following a short-term expedition on the South Polar Plateau; an adaptive response that is characterised mainly by suppressed shivering thermogenesis, and partly by blunted cutaneous vasoconstriction.

Skin temperature, sleep, and vigilance

A large number of studies have shown a close association between the 24-hour rhythms in core body temperature and sleep propensity. More recently, studies have have begun to elucidate an intriguing association of sleep with skin temperature as well. The present chapter addresses the association of sleep and alertness with skin temperature. It discusses whether the association could reflect common underlying drivers of both sleep propensity and skin vasodilation; whether it could reflect efferents of sleep-regulating brain circuits to thermoregulatory circuits; and whether skin temperature could provide afferent input to sleep-regulating brain circuits. Sleep regulation and concomitant changes in skin temperature are systematically discussed and three parallel factors suggested: a circadian clock mechanism, a homeostatic hourglass mechanism, and a third set of sleep-permissive and wake-promoting factors that gate the effectiveness of signals from the clock and hourglass in the actual induction of sleep or maintenance of alert wakefulness. The chapter moreover discusses how the association between skin temperature and arousal can change with sleep deprivation and insomnia. Finally it addresses whether the promising laboratory findings on the effects of skin temperature manipulations on vigilance can be applied to improve sleep in everyday life.

Shivering and nonshivering thermogenesis in skeletal muscles

Humans have inherited complex neural circuits which drive behavioral, somatic, and autonomic thermoregulatory responses to defend their body temperature. While they are well adapted to dissipate heat in warm climates, they have a reduced capacity to preserve it in cold environments. Consequently, heat production is critical to defending their core temperature. As in other large mammals, skeletal muscles are the primary source of heat production recruited in cold-exposed humans. This is achieved voluntarily in the form of contractions from exercising muscles or involuntarily in the form of contractions from shivering muscles and the recruitment of nonshivering mechanisms. This review describes our current understanding of shivering and nonshivering thermogenesis in skeletal muscles, from the neural circuitry driving their recruitment to the metabolic substrates that fuel them. The presence of these heat-producing mechanisms can be measured in vivo by combining indirect respiratory calorimetry with electromyography or biomedical imaging modalities. Indeed, much of what is known regarding shivering in humans and other animal models stems from studies performed using these methods combined with in situ and in vivo neurologic techniques. More recent investigations have focused on understanding the metabolic processes that produce the heat from both contracting and noncontracting mechanisms. With the growing interest in the potential therapeutic benefits of shivering and nonshivering skeletal muscle to counter the effects of neuromuscular, cardiovascular, and metabolic diseases, we expect this field to continue its growth in the coming years.

Cardiovascular and thermal strain during 3-4 days of a metabolically demanding cold-weather military operation

BACKGROUND

Cardiovascular (CV) and thermal responses to metabolically demanding multi-day military operations in extreme cold-weather environments are not well described. Characterization of these operations will provide greater insights into possible performance capabilities and cold injury risk.

METHODS

Soldiers from two cold-weather field training exercises (FTX) were studied during 3-day (study 1, n = 18, age: 20 ± 1 year, height: 182 ± 7 cm, mass: 82 ± 9 kg) and 4-day (study 2, n = 10, age: 20 ± 1 year, height: 182 ± 6 cm, mass: 80.7 ± 8.3 kg) ski marches in the Arctic. Ambient temperature ranged from -18 to -4 °C during both studies. Total daily energy expenditure (TDEE, from doubly labeled water), heart rate (HR), deep body (T_pill), and torso (T_torso) skin temperature (obtained in studies 1 and 2) as well as finger (T_fing), toe (T_toe), wrist, and calf temperatures (study 2) were measured.

RESULTS

TDEE was 6821 ± 578 kcal day^-1 and 6394 ± 544 for study 1 and study 2, respectively. Mean HR ranged from 120 to 140 bpm and mean T_pill ranged between 37.5 and 38.0 °C during skiing in both studies. At rest, mean T_pill ranged from 36.0 to 36.5 °C, (lowest value recorded was 35.5 °C). Mean T_fing ranged from 32 to 35 °C during exercise and dropped to 15 °C during rest, with some T_fing values as low as 6-10 °C. T_toe was above 30 °C during skiing but dropped to 15-20 °C during rest.

CONCLUSIONS

Daily energy expenditures were among the highest observed for a military training exercise, with moderate exercise intensity levels (~65% age-predicted maximal HR) observed. The short-term cold-weather training did not elicit high CV and T_pill strain. T_fing and T_toe were also well maintained while skiing, but decreased to values associated with thermal discomfort at rest.

Two Days of Calorie Deprivation Induced by Underfeeding and Aerobic Exercise Degrades Mood and Lowers Interstitial Glucose but Does Not Impair Cognitive Function in Young Adults

BACKGROUND

In studies assessing the effects of acute undernutrition on cognitive function, volunteers are sedentary and findings are equivocal, even though glucose concentrations fall substantially. However, military personnel and endurance athletes often are underfed when physical demands, and consequently energy expenditure, are substantial.

OBJECTIVE

The objective of this study was to determine whether 2 d of near-total calorie deprivation combined with aerobic exercise degraded cognitive performance and mood.

METHODS

A double-blind, placebo-controlled, crossover design was used. Twenty-three volunteers [17 men (mean ± SD age: 20.5 ± 0.7 y) and 6 women (mean ± SD age: 23.3 ± 1.4 y); mean ± SD body mass index (in kg/m²): 25 ± 3] participated for 68 h, including a 51-h inpatient phase in a calorie-deprived or fully fed state during which behavioral testing was conducted and interstitial glucose was monitored continuously. Mood and cognitive performance, including psychomotor and visual vigilance, visual match-to-sample, repeated acquisition (motor learning), N-back (working memory), and grammatical reasoning, were repeatedly assessed. During each condition, individual daily energy intake and expenditure were controlled. During calorie deprivation, volunteers consumed 266 ± 61 kcal/d; during full feeding, they consumed 3935 ± 769 kcal/d. Participants engaged in identical exercise sessions for 4 h/d at 40-65% of peak volume of oxygen uptake attained.

RESULTS

Calorie deprivation did not affect any aspect of cognitive performance, but produced robust effects on mood measured by the Profile of Mood States, including increased tension (P < 0.001), fatigue (P < 0.001), and total mood disturbance (from -0.80 ± 5.1 to 20.1 ± 6.1; P < 0.001), and decreased vigor (P = 0.002), as indicated by treatment × trial (time) effects on ANOVA. Interstitial glucose concentrations were lower during calorie deprivation than in the fully fed condition (P = 0.002, treatment × trial interaction) and declined to 61 mg/dL by the end of the treatment condition.

CONCLUSION

In healthy young men and women, 2 d of severe calorie deprivation in combination with substantial aerobic exercise adversely affects multiple aspects of mood, but not cognition, in spite of substantial reductions in interstitial glucose concentrations. This trial was registered at clinicaltrials.gov as NCT01603550.

Passive and active roles of fat-free mass in the control of energy intake and body composition regulation

While putative feedback signals arising from adipose tissue are commonly assumed to provide the molecular links between the body's long-term energy requirements and energy intake, the available evidence suggests that the lean body or fat-free mass (FFM) also plays a role in the drive to eat. A distinction must, however, be made between a 'passive' role of FFM in driving energy intake, which is likely to be mediated by 'energy-sensing' mechanisms that translate FFM-induced energy requirements to energy intake, and a more 'active' role of FFM in the drive to eat through feedback signaling between FFM deficit and energy intake. Consequently, a loss of FFM that results from dieting or sedentarity should be viewed as a risk factor for weight regain and increased fatness not only because of the impact of the FFM deficit in lowering the maintenance energy requirement but also because of the body's attempt to restore FFM by overeating-a phenomenon referred to as 'collateral fattening'. A better understanding of these passive and active roles of FFM in the control of energy intake will necessitate the elucidation of peripheral signals and energy-sensing mechanisms that drive hunger and appetite, with implications for both obesity prevention and its management.

Cold-induced thermogenesis in humans

A basic property of endothermic thermoregulation is the ability to generate heat by increasing metabolism in response to cold ambient temperatures to maintain a stable core body temperature. This process, known as cold-induced thermogenesis (CIT), has been measured in humans as early as 1780 by Antoine Lavoisier, but has found renewed interest because of the recent 'rediscovery' of thermogenic, cold-activated brown adipose tissue (BAT) in adult humans. In this review, we summarize some of the key findings of the work involving CIT over the past two centuries and highlight some of the seminal studies focused on this topic. There has been a substantial range of variability in the reported CIT in these studies, from 0 to 280% above basal metabolism. We identify and discuss several potential sources of this variability, including both methodological (measurement device, cold exposure temperature and duration) and biological (age and body composition of subject population) discrepancies. These factors should be considered when measuring CIT going forward to better assess whether BAT or other thermogenic organs are viable targets to combat chronic positive energy balance based on their relative capacities to elevate human metabolism.

Moving in extreme environments: extreme loading; carriage versus distance

This review addresses human capacity for movement in the context of extreme loading and with it the combined effects of metabolic, biomechanical and gravitational stress on the human body. This topic encompasses extreme duration, as occurs in ultra-endurance competitions (e.g. adventure racing and transcontinental races) and expeditions (e.g. polar crossings), to the more gravitationally limited load carriage (e.g. in the military context). Juxtaposed to these circumstances is the extreme metabolic and mechanical unloading associated with space travel, prolonged bedrest and sedentary lifestyle, which may be at least as problematic, and are therefore included as a reference, e.g. when considering exposure, dangers and (mal)adaptations. As per the other reviews in this series, we describe the nature of the stress and the associated consequences; illustrate relevant regulations, including why and how they are set; present the pros and cons for self versus prescribed acute and chronic exposure; describe humans' (mal)adaptations; and finally suggest future directions for practice and research. In summary, we describe adaptation patterns that are often U or J shaped and that over time minimal or no load carriage decreases the global load carrying capacity and eventually leads to severe adverse effects and manifest disease under minimal absolute but high relative loads. We advocate that further understanding of load carrying capacity and the inherent mechanisms leading to adverse effects may advantageously be studied in this perspective. With improved access to insightful and portable technologies, there are some exciting possibilities to explore these questions in this context.

Altered metabolic homeostasis is associated with appetite regulation during and following 48-h of severe energy deprivation in adults

BACKGROUND

Military personnel frequently endure intermittent periods of severe energy deficit which can compromise health and performance. Physiologic factors contributing to underconsumption, and the subsequent drive to overeat, are not fully characterized. This study aimed to identify associations between appetite, metabolic homeostasis and endocrine responses during and following severe, short-term energy deprivation.

METHODS

Twenty-three young adults (17M/6F, 21±3years, BMI 25±3kg/m(2)) participated in a randomized, controlled, crossover trial. During separate 48-h periods, participants increased habitual energy expenditure by 1647±345kcal/d (mean±SD) through prescribed exercise at 40-65% VO2peak, and consumed provided isovolumetric diets designed to maintain energy balance at the elevated energy expenditure (EB; 36±93kcal/d energy deficit) or to produce a severe energy deficit (ED; 3681±716kcal/d energy deficit). Appetite, markers of metabolic homeostasis and endocrine mediators of appetite and substrate availability were periodically measured. Ad libitum energy intake was measured over 36h following both experimental periods.

RESULTS

Appetite increased during ED and was greater than during EB despite maintenance of diet volume (P=0.004). Ad libitum energy intake was 907kcal/36h [95% CI: 321, 1493kcal/36h, P=0.004] higher following ED compared to following EB. Serum beta-hydroxybutyrate, free fatty acids, branched-chain amino acids, dehydroepiandrosterone-sulfate (DHEA-S) and cortisol concentrations were higher (P<0.001 for all), whereas whole-body protein balance was more negative (P<0.001), and serum glucose, insulin, and leptin concentrations were lower (P<0.001 for all) during ED relative to during EB. Cortisol concentrations, but not any other hormone or metabolic substrate, were inversely associated with satiety during EB (R(2)=0.23, P=0.04). In contrast, serum glucose and DHEA-S concentrations were inversely associated with satiety during ED (R(2)=0.68, P<0.001). No associations between physiologic variables measured during EB and ad libitum energy intake following EB were observed. However, serum leptin and net protein balance measured during ED were inversely associated with ad libitum energy intake following ED (R(2)=0.48, P=0.01).

CONCLUSION

These findings suggest that changes in metabolic homeostasis during energy deprivation modulate appetite independent of reductions in diet volume. Following energy deprivation, physiologic signals of adipose and lean tissue loss may drive restoration of energy balance.

CLINICAL TRIALS REGISTRATION

www.clinicaltrials.gov #NCT01603550.

Oxidative fuel selection and shivering thermogenesis during a 12- and 24-h cold-survival simulation

Because the majority of cold exposure studies are constrained to short-term durations of several hours, the long-term metabolic demands of cold exposure, such as during survival situations, remain largely unknown. The present study provides the first estimates of thermogenic rate, oxidative fuel selection, and muscle recruitment during a 24-h cold-survival simulation. Using combined indirect calorimetry and electrophysiological and isotopic methods, changes in muscle glycogen, total carbohydrate, lipid, protein oxidation, muscle recruitment, and whole body thermogenic rate were determined in underfed and noncold-acclimatized men during a simulated accidental exposure to 7.5 °C for 12 to 24 h. In noncold-acclimatized healthy men, cold exposure induced a decrease of ∼0.8 °C in core temperature and a decrease of ∼6.1 °C in mean skin temperature (range, 5.4-6.9 °C). Results showed that total heat production increased by approximately 1.3- to 1.5-fold in the cold and remained constant throughout cold exposure. Interestingly, this constant rise in Ḣprod and shivering intensity was accompanied by a large modification in fuel selection that occurred between 6 and 12 h; total carbohydrate oxidation decreased by 2.4-fold, and lipid oxidation doubled progressively from baseline to 24 h. Clearly, such changes in fuel selection dramatically reduces the utilization of limited muscle glycogen reserves, thus extending the predicted time to muscle glycogen depletion to as much as 15 days rather than the previous estimates of approximately 30-40 h. Further research is needed to determine whether this would also be the case under different nutritional and/or colder conditions.

Cold Stress Effects on Exposure Tolerance and Exercise Performance

Cold weather can have deleterious effects on health, tolerance, and performance. This paper will review the physiological responses and external factors that impact cold tolerance and physical performance. Tolerance is defined as the ability to withstand cold stress with minimal changes in physiological strain. Physiological and pathophysiological responses to short-term (cold shock) and long-term cold water and air exposure are presented. Factors (habituation, anthropometry, sex, race, and fitness) that influence cold tolerance are also reviewed. The impact of cold exposure on physical performance, especially aerobic performance, has not been thoroughly studied. The few studies that have been done suggest that aerobic performance is degraded in cold environments. Potential physiological mechanisms (decreases in deep body and muscle temperature, cardiovascular, and metabolism) are discussed. Likewise, strength and power are also degraded during cold exposure, primarily through a decline in muscle temperature. The review also discusses the concept of thermoregulatory fatigue, a reduction in the thermal effector responses of shivering and vasoconstriction, as a result of multistressor factors, including exhaustive exercise.

Maintaining thermogenesis in cold exposed humans: relying on multiple metabolic pathways

In cold exposed humans, increasing thermogenic rate is essential to prevent decreases in core temperature. This review describes the metabolic requirements of thermogenic pathways, mainly shivering thermogenesis, the largest contributor of heat. Research has shown that thermogenesis is sustained from a combination of carbohydrates, lipids, and proteins. The mixture of fuels is influenced by shivering intensity and pattern as well as by modifications in energy reserves and nutritional status. To date, there are no indications that differences in the types of fuel being used can alter shivering and overall heat production. We also bring forth the potential contribution of nonshivering thermogenesis in adult humans via the activation of brown adipose tissue (BAT) and explore some means to stimulate the activity of this highly thermogenic tissue. Clearly, the potential role of BAT, especially in young lean adults, can no longer be ignored. However, much work remains to clearly identify the quantitative nature of this tissue's contribution to total thermogenic rate and influence on shivering thermogenesis. Identifying ways to potentiate the effects of BAT via cold acclimation and/or the ingestion of compounds that stimulate the thermogenic process may have important implications in cold endurance and survival.

How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery

Whether dieting makes people fatter has been a subject of considerable controversy over the past 30 years. More recent analysis of several prospective studies suggest, however, that it is dieting to lose weight in people who are in the healthy normal range of body weight, rather than in those who are overweight or obese, that most strongly and consistently predict future weight gain. This paper analyses the ongoing arguments in the debate about whether repeated dieting to lose weight in normal-weight people represents unsuccessful attempts to counter genetic and familial predispositions to obesity, a psychosocial reaction to the fear of fatness or that dieting per se confers risks for fatness and hence a contributing factor to the obesity epidemic. In addressing the biological plausibility that dieting predisposes the lean (rather than the overweight or obese) to regaining more body fat than what had been lost (i.e. fat overshooting), it integrates the results derived from the re-analysis of body composition data on fat mass and fat-free mass (FFM) losses and recoveries from human studies of experimental energy restriction and refeeding. These suggest that feedback signals from the depletion of both fat mass (i.e. adipostats) and FFM (i.e. proteinstats) contribute to weight regain through the modulation of energy intake and adaptive thermogenesis, and that a faster rate of fat recovery relative to FFM recovery (i.e. preferential catch-up fat) is a central outcome of body composition autoregulation in lean individuals. Such a temporal desynchronization in the restoration of the body's fat vs. FFM results in a state of hyperphagia that persists beyond complete recovery of fat mass and interestingly until FFM is fully recovered. However, as this completion of FFM recovery is also accompanied by fat deposition, excess fat accumulates. In other words, fat overshooting is a prerequisite to allow complete recovery of FFM. This confers biological plausibility for post-dieting fat overshooting - which through repeated dieting and weight cycling would increase the risks for trajectories from leanness to fatness. Given the increasing prevalence of dieting in normal-weight female and male among young adults, adolescents and even children who perceive themselves as too fat (due to media, family and societal pressures), together with the high prevalence of dieting for optimizing performance among athletes in weight-sensitive sports, the notion that dieting and weight cycling may be predisposing a substantial proportion of the population to weight gain and obesity deserves greater scientific scrutiny.

Web-based hypothermia information: a critical assessment of Internet resources and a comparison to peer-reviewed literature

AIMS

Hypothermia is a medical condition characterized by a drop in core body temperature, and it is a considerable source of winter weather-related vulnerability in mid-/high-latitude areas. Heat vulnerability research, including assessments of internet-based resources, is more thoroughly represented in the peer-reviewed literature than cold-related vulnerability research. This study was undertaken to summarize available web-based hypothermia information, and then determine its scientific validity compared to the peer-reviewed literature.

METHODS

This research takes a similar approach used by Hajat et al. for web-based heat vulnerability research, and utilizes this framework to assess hypothermia information found on the internet. Hypothermia-related search terms were used to obtain websites containing hypothermia information, and PubMed (medical literature search engine) and Google Scholar were used to identify peer-reviewed hypothermia literature. The internet information was aggregated into categories (vulnerable populations, symptoms, prevention), which were then compared to the hypothermia literature to determine the scientific validity of the web-based guidance. The internet information was assigned a Strength of Recommendation Taxonomy (SORT) grade (developed by the American Academy of Family Practitioners) of A, B, or C based on the peer-reviewed evidence.

RESULTS

Overall, 25 different pieces of guidance within the three categories were identified on 49 websites. Guidance concerning hypothermia symptoms most frequently appeared on websites, with six symptoms appearing on 50% or greater of websites. No piece of guidance within the vulnerable population categories appeared on greater than 60% of the websites, and prevention-related guidance was characterized by varied SORT grades.

CONCLUSIONS

Hypothermia information on the internet was not entirely congruent with the information within the peer-reviewed medical literature. Several suggestions for improving web-based hypothermia resources include clearly listing sources for users to see and eliminating guidance with lower SORT grades and replacing with evidence-based information.

Limits to sustained energy intake. XX. Body temperatures and physical activity of female mice during lactation

Lactating animals consume greater amounts of food than non-reproductive animals, but energy intake appears to be limited in late lactation. The heat dissipation limit theory suggests that the food intake of lactating mice is limited by the capacity of the mother to dissipate heat. Lactating mice should therefore have high body temperatures (Tb), and changes in energy intake during lactation should be reflected by variation in Tb. To investigate these predictions, 26 mice (Mus musculus) were monitored daily throughout lactation for food intake, body mass, litter size and litter mass. After weaning, 21 days postpartum, maternal food intake and body mass were monitored for another 10 days. Maternal activity and Tb were recorded every minute for 23 h a day using implanted transmitters (vital view). Energy intake increased to a plateau in late lactation (days 13-17). Daily gain in pup mass declined during this same period, suggesting a limit on maternal energy intake. Litter size and litter mass were positively related to maternal energy intake and body mass. Activity levels were constantly low, and mice with the largest increase in energy intake at peak lactation had the lowest activity. Tb rose sharply after parturition and the circadian rhythm became compressed within a small range. Tb during the light period increased considerably (1.1 ° C higher than in baseline), and lactating mice faced chronic hyperthermia, despite their activity levels in lactation being approximately halved. Average Tb increased in relation to energy intake as lactation progressed, but there was no relationship between litter size or litter mass and the mean Tb at peak lactation. These data are consistent with the heat dissipation limit theory, which suggests performance in late lactation is constrained by the ability to dissipate body heat.

Three nights of sleep deprivation does not alter thermal strain during exercise in the heat

PURPOSE

Individuals exposed to total sleep deprivation may experience an increased risk of impaired thermoregulation and physiological strain during prolonged physical activity in the heat. However, little is known of the impact of more relevant partial sleep deprivation (PSD). This randomized counterbalanced study investigated the effect of PSD on thermal strain during an exercise-heat stress.

METHODS

Ten healthy individuals performed two stress tests (45 min running, 70 % [Formula: see text] 33 °C, 40 % RH). Each trial followed three nights of controlled sleep: normal [479 (SD 2) min sleep night(-1); Norm] and PSD [116 (SD 4) min sleep night(-1)]. Energy balance and hydration state were controlled throughout the trials. Rectal temperatures (T re), mean skin temperature ([Formula: see text]), heart rate (HR), RPE, and thermal sensations (TS) were measured at regular intervals during each heat stress trial.

RESULTS

There was a significant main effect of time (P < 0.05) for all of these variables. However, no differences (P > 0.05) were observed between PSD and Norm, respectively, for T re [39.0 (0.5) vs. 39.1 (0.5) °C], [Formula: see text], [36.1 (0.6) vs. 36.0 (0.7) °C] and HR [181 (13) vs. 182 (13) beats min(-1))] at the end of exercise-heat stress. There were no differences (P > 0.05) in [Formula: see text], PSI, RPE, TS and whole-body sweat rate between PSD versus Norm.

CONCLUSION

Since greater physiological strain during exercise-heat stress did not follow three nights of PSD, it appears that sleep loss may have minimal impact upon thermal strain during exercise in the heat, at least as evaluated within this experiment.

Cold hands, warm feet: sleep deprivation disrupts thermoregulation and its association with vigilance

STUDY OBJECTIVES

Vigilance is affected by induced and spontaneous skin temperature fluctuations. Whereas sleep deprivation strongly affects vigilance, no previous study examined in detail its effect on human skin temperature fluctuations and their association with vigilance.

DESIGN

In a repeated-measures constant routine design, skin temperatures were assessed continuously from 14 locations while performance was assessed using a reaction time task, including eyes-open video monitoring, performed five times a day for 2 days, after a normal sleep or sleep deprivation night.

SETTING

Participants were seated in a dimly lit, temperature-controlled laboratory.

PATIENTS OR PARTICIPANTS

Eight healthy young adults (five males, age 22.0 ± 1.8 yr (mean ± standard deviation)).

INTERVENTION

One night of sleep deprivation.

MEASUREMENTS AND RESULTS

Mixed-effect regression models were used to evaluate the effect of sleep deprivation on skin temperature gradients of the upper (ear-mastoid), middle (hand-arm), and lower (foot-leg) body, and on the association between fluctuations in performance and in temperature gradients. Sleep deprivation induced a marked dissociation of thermoregulatory skin temperature gradients, indicative of attenuated heat loss from the hands co-occurring with enhanced heat loss from the feet. Sleep deprivation moreover attenuated the association between fluctuations in performance and temperature gradients; the association was best preserved for the upper body gradient.

CONCLUSIONS

Sleep deprivation disrupts coordination of fluctuations in thermoregulatory skin temperature gradients. The dissociation of middle and lower body temperature gradients may therefore be evaluated as a marker for sleep debt, and the upper body gradient as a possible aid in vigilance assessment when sleep debt is unknown. Importantly, our findings suggest that sleep deprivation affects the coordination between skin blood flow fluctuations and the baroreceptor-mediated cardiovascular regulation that prevents venous pooling of blood in the lower limbs when there is the orthostatic challenge of an upright posture.

HEAT TRANSFER MODEL FOR PREDICTING SURVIVAL TIME IN COLD WATER IMMERSION

In the present paper a heat transfer (HT) model to estimate survival time of individual stranded in cold water such as at sea is proposed. The HT model was derived based on the assumption that the body specific heat capacity and thermal conductance are not time dependent. The solution to the HT model simulates expected survival time as a function of water temperature, metabolism rate, skin, muscle and fat thickness, insulation thermal conductivity and thickness, height and weight of the subject. Although, these predictions must be considered approximate due to the complex nature of the variables involved, the proposed HT model can be employed to determine supplemental body insulation such as personal protective clothing to meet a predefined survival time in any given water temperature. In particular, the results obtained are useful as a decision aid in search and rescue mission in predicting survival time for shipwreck victims at sea.

How dieting makes some fatter: from a perspective of human body composition autoregulation

Dieting makes you fat - the title of a book published in 1983 - embodies the notion that dieting to control body weight predisposes the individual to acquire even more body fat. While this notion is controversial, its debate underscores the large gap that exists in our understanding of basic physiological laws that govern the regulation of human body composition. A striking example is the key role attributed to adipokines as feedback signals between adipose tissue depletion and compensatory increases in food intake. Yet, the relative importance of fat depletion per se as a determinant of post-dieting hyperphagia is unknown. On the other hand, the question of whether the depletion of lean tissues can provide feedback signals on the hunger-appetite drive is rarely invoked, despite evidence that food intake during growth is dominated by the impetus for lean tissue deposition, amidst proposals for the existence of protein-static mechanisms for the regulation of growth and maintenance of lean body mass. In fact, a feedback loop between fat depletion and food intake cannot explain why human subjects recovering from starvation continue to overeat well after body fat has been restored to pre-starvation values, thereby contributing to 'fat overshooting'. In addressing the plausibility and mechanistic basis by which dieting may predispose to increased fatness, this paper integrates the results derived from re-analysis of classic longitudinal studies of human starvation and refeeding. These suggest that feedback signals from both fat and lean tissues contribute to recovering body weight through effects on energy intake and thermogenesis, and that a faster rate of fat recovery relative to lean tissue recovery is a central outcome of body composition autoregulation that drives fat overshooting. A main implication of these findings is that the risk of becoming fatter in response to dieting is greater in lean than in obese individuals.

100 Years Since Scott Reached the Pole: A Century of Learning About the Physiological Demands of Antarctica

The 1910–1913 Terra Nova Expedition to the Antarctic, led by Captain Robert Falcon Scott, was a venture of science and discovery. It is also a well-known story of heroism and tragedy since his quest to reach the South Pole and conduct research en route, while successful was also fateful. Although Scott and his four companions hauled their sledges to the Pole, they died on their return journey either directly or indirectly from the extreme physiological stresses they experienced. One hundred years on, our understanding of such stresses caused by Antarctic extremes and how the body reacts to severe exercise, malnutrition, hypothermia, high altitude, and sleep deprivation has greatly advanced. On the centenary of Scott's expedition to the bottom of the Earth, there is still controversy surrounding whether the deaths of those five men could have, or should have, been avoided. This paper reviews present-day knowledge related to the physiology of sustained man-hauling in Antarctica and contrasts this with the comparative ignorance about these issues around the turn of the 20th century. It closes by considering whether, with modern understanding about the effects of such a scenario on the human condition, Scott could have prepared and managed his team differently and so survived the epic 1,600-mile journey. The conclusion is that by carrying rations with a different composition of macromolecules, enabling greater calorific intake at similar overall weight, Scott might have secured the lives of some of the party, and it is also possible that enhanced levels of vitamin C in his rations, albeit difficult to achieve in 1911, could have significantly improved their survival chances. Nevertheless, even with today's knowledge, a repeat attempt at his expedition would by no means be bound to succeed.

Effects of two glucose ingestion rates on substrate utilization during moderate-intensity shivering

Although the importance of food consumption to survive in the cold is well established, most shivering studies have focused on fuel selection in fasting subjects. Therefore, the aim of the present study was to provide the first estimates of exogenous glucose as well as liver and muscle glycogen oxidation rates of non-cold acclimatized men (n = 6) ingesting glucose in trace amounts (Control; C), and at rates of 400 mg min(-1) (Low Glucose; LG), and 800 mg min(-1) (High Glucose; HG) during moderate-intensity shivering (~3 times resting metabolic rate or ~20% VO(2max)) using indirect calorimetry and stable isotope methodologies. Exogenous glucose oxidation peaked at ~200 mg min(-1) at the lowest glucose ingestion rate (~400 mg min(-1)). In addition, glucose ingestion increased the contribution of plasma glucose to total heat production by ~50% but did not change the role played by muscle glycogen (~27% of heat production for control condition and ~23-28% for LG and HG). Instead, the contribution of liver-derived glucose to total heat production was reduced by 40-60% in LG and HG, respectively. In conclusion, glucose ingestion even at low rates contributes a significant proportion of total heat production during moderate intensity shivering and reduces the utilization of liver-derived glucose but not muscle glycogen.

National Athletic Trainers' Association position statement: environmental cold injuries

OBJECTIVE

To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.

BACKGROUND

Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk.

RECOMMENDATIONS

These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.

Environmental issues for team physicians

As outdoor sports continue to gain popularity, understanding the environmental factors that may influence athletes is becoming a more important aspect of medical care for team physicians. Temperature, ultraviolet light, lightning, and altitude are some of the most common elements that cause illness. Understanding how to prevent, diagnose, and promptly treat conditions caused by environmental factors is essential to optimizing athletic performance in outdoor sports and avoiding morbidity.

Evaluation of two cold thermoregulatory models for prediction of core temperature during exercise in cold water

Cold thermoregulatory models (CTM) have primarily been developed to predict core temperature (T(core)) responses during sedentary immersion. Few studies have examined their efficacy to predict T(core) during exercise cold exposure. The purpose of this study was to compare observed T(core) responses during exercise in cold water with the predicted T(core) from a three-cylinder (3-CTM) and a six-cylinder (6-CTM) model, adjusted to include heat production from exercise. A matrix of two metabolic rates (0.44 and 0.88 m/s walking), two water temperatures (10 and 15 degrees C), and two immersion depths (chest and waist) were used to elicit different rates of T(core) changes. Root mean square deviation (RMSD) and nonparametric Bland-Altman tests were used to test for acceptable model predictions. Using the RMSD criterion, the 3-CTM did not fit the observed data in any trial, whereas the 6-CTM fit the data (RMSD less than standard deviation) in four of eight trials. In general, the 3-CTM predicted a rapid decline in core temperature followed by a plateau. For the 6-CTM, the predicted T(core) appeared relatively tight during the early part of immersion, but was much lower during the latter portions of immersion, accounting for the nonagreement between RMSD and SD values. The 6-CTM was rerun with no adjustment for exercise metabolism, and core temperature and heat loss predictions were tighter. In summary, this study demonstrated that both thermoregulatory models designed for sedentary cold exposure, currently, cannot be extended for use during partial immersion exercise in cold water. Algorithms need to be developed to better predict heat loss during exercise in cold water.

Exertional fatigue and cold exposure: mechanisms of hiker's hypothermia

Participants in prolonged, physically demanding activities in cold weather are at risk of a condition known as “hiker's hypothermia”. During exposure to cold weather, the increased gradient favoring body heat loss to the environment must be balanced by physiological responses, clothing, and behavioral strategies that conserve body heat stores, or else body temperature will decline. The primary human physiological responses elicited by cold exposure are shivering and peripheral vasoconstriction. Shivering increases thermogenesis and replaces body heat losses, while peripheral vasoconstriction improves thermal insulation of the body and retards the rate of heat loss. A body of scientific literature supports the concept that prolonged and (or) repeated cold exposure, fatigue induced by sustained physical exertion, or both together can impair shivering and vasoconstrictor response to cold. The mechanisms accounting for this thermoregulatory impairment are not clear, but the possibility that changes in blood glucose availability or sympathetic responsiveness to cold due to exertion and fatigue merit further research.

Alpine climbing: injuries and illness

Alpine climbing is a sport whose participants are at risk for a variety of injuries and illnesses. Climbers are venturing into the mountains and attempting routes with ever-increasing difficulty, and it is important to understand the injury and illness concerns of alpine climbers better. Alpine climbers are prone to injuries common to traditional mountaineers and more specialized sport rock climbers. Falls while climbing represent one of the more common causes of serious injury, although acute and chronic musculoskeletal injuries of the hands and extremities are also frequent afflictions. Alpine climbers are at risk for injuries and illness because of the mountain environment where they participate in their sport. Proper preparation for the cold is imperative to prevent frostbite and hypothermia. Worsening symptoms of headache or respiratory symptoms should always alert the alpine climber to possible altitude illness. Understanding the injuries common to the sport can allow providers to deliver the best medical care.

Field studies of exercise and food deprivation

PURPOSE OF REVIEW

The increase in obesity in developed societies drives interest in the interplay of energy intake, metabolic energy expenditure, and body energy stores. A better understanding of energy management in physically active and undernourished humans should help guide strategies to manage obesity safely and effectively. This review focuses on field studies of men and women engaged in prolonged strenuous activities, ranging from ranger training to extreme expeditions.

RECENT FINDINGS

Although scientifically unconventional and limited, field studies of exercise and food deprivation have yielded interesting findings: 4-5% body fat is the normal lower limit to fat reserves in physically active underfed young adult men, and in response to exercise and underfeeding, women used more fat mass and less fat-free mass to meet metabolic fuel requirements.

SUMMARY

Field studies have shown that fat energy reserves in young adult men can be estimated as percentage body fat minus 5%, and initial body fat mass has a significant positive influence on fat oxidation rates per kilogram of fat-free mass during rapid weight loss associated with underfeeding and exercise. Data logging pedometers, activity monitors, global positioning systems, and wireless body and personal-area networks promise to make it easier to study and care for free-living humans.

Energy Expenditure in Men and Women during 54 h of Exercise and Caloric Deprivation

Fifty U.S. Marine recruits (30 men, 20 women) were studied during a physically intense, energy intake-restricted, winter-time 54-h field training exercise (FEX) at Parris Island Marine Corps Recruit Depot. Men and women completed the same physical tasks.

PURPOSE

To characterize and compare the total energy expenditure (TEE) and core temperature responses in men and women working almost continuously for 2.25 d in an outdoor environment while developing a substantial energy deficit.

METHODS

TEE was measured using doubly labeled water (D(2)O(18)). Energy intake was estimated using beverage diaries and collecting ration wrappers saved by each volunteer and adding the known caloric value of each food item consumed. Core temperature was measured using an ingested thermometer pill. Physical activity level (PAL) was calculated by dividing TEE by the calculated basal metabolic rate.

RESULTS

TEE was higher (P < 0.001) for the men (25.7 MJ.d(-1)) than women (19.8 MJ.d(-1)), but there were no differences between men and women in TEE normalized to body mass (men, 0.35 +/- 0.05 MJ.d(-1).kg(-1); women, 0.34 +/- 0.06 MJ.d(-).kg(-1)), corrected body mass (men, 0.29 +/- 0.04 MJ.d(-1).kg(-1) corrected body mass; women, 0.27 +/- 0.04 MJ.d(-1).kg(-1) corrected body mass), fat-free mass (men, 0.41 +/- 0.07 MJ.d(-1).kg(-1) FFM; women, 0.46 +/- 0.07 MJ.d(-1).kg(-1) FFM), or corrected fat-free mass (men, 0.30 +/- 0.05 MJ.d(-1).kg corrected body mass; women, 0.30 +/- 0.04 0.30 +/- 0.05 MJ.d(-1).kg(-1) corrected body mass). PAL was the same for men (3.4 +/- 0.5) and women (3.3 +/- 0.4). Energy intakes were higher (P < 0.05) in men (6.0 +/- 2.0 MJ.d(-1)) than women (4.8 +/- 1.8 MJ.d(-1)). The average minimum core temperature was 36.0 +/- 0.4 degrees C, and the mean maximum core temperature was 38.5 +/- 0.3 degrees C.

CONCLUSIONS

For both men and women, total energy expenditures were among the highest observed for a military FEX. TEE, when normalized or corrected to body mass and fat-free mass, and PAL were the same for men and women.

Mechanisms and functions of coupling between sleep and temperature rhythms

Energy metabolism is strongly linked to the circadian rhythms in sleep and body temperature. Both heat production and heat loss show a circadian modulation. Sleep preferably occurs during the circadian phase of decreased heat production and increased heat loss, the latter due to a profound increase in skin blood flow and, consequently, skin warming. The coupling of these rhythms may differ depending on whether they are assessed in experimental laboratory studies or in habitual sleeping conditions. In habitual sleeping conditions, skin blood flow is for a prolonged time increased to a level hardly ever seen during wakefulness. Possible mechanisms linking the rhythms in sleep and core body and skin temperature are discussed, with a focus on causal effects of changes in core and skin temperature on sleep regulation. It is shown that changes in skin temperature rather than in core temperature causally affect sleep propensity. Contrary to earlier suggestions of a functional role of sleep in heat loss, it is argued that sleep facilitates a condition of increased skin blood flow during a prolonged circadian phase, yet limits heat loss and the risk of hypothermia. Sleep-related behavior including the creation of an isolated microclimate of high temperature by means of warm clothing and bedding in humans and the curling up, huddling and cuddling in animals all help limit heat loss The increase in skin blood flow that characterizes the sleeping period may thus not primarily reflect a thermoregulatory drive. There is indirect support for an alternative role of the prolonged period of increased skin blood flow: it may support maintenance of the skin as a primary barrier in host defense.

Effect of rapid-eye-movement sleep deprivation on rat hypothalamic prostaglandins

In this study, we investigated thyroid hormones, thyroid stimulating hormone (TSH), prostaglandin D(2) (PGD(2)) and prostaglandin E(2) (PGE(2)) levels in rapid-eye-movement (REM) sleep-deprived rats compared with controls. The aim of the present study was to detect the effect of REM sleep deprivation (RSD) especially on hypothalamic prostaglandin levels. Twenty-seven male rats were randomly assigned in three groups as dry cage control, yoked control, and RSD. RSD rats were sleep deprived for 10 consecutive days. At the end of 10th day all rats were sacrificed for measurement. Our results indicated that total triiodothyronine (T(3)) and thyroxine (T(4)) decreased in the RSD group while there was no change in TSH. We also measured hypothalamic PGD(2) and PGE(2) levels, but we could not find any significant change between groups.