Temperature of Ingested Water during Exercise Does Not Affect Body Heat Storage

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

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.

Effects of internal cooling on physical performance, physiological and perceptional parameters when exercising in the heat: A systematic review with meta-analyses

Background: An elevated core temperature (Tcore) increases the risk of performance impairments and heat-related illness. Internal cooling (IC) has the potential to lower Tcore when exercising in the heat. The aim of the review was to systematically analyze the effects of IC on performance, physiological, and perceptional parameters. Methods: A systematic literature search was performed in the PubMed database on 17 December 2021. Intervention studies were included assessing the effects of IC on performance, physiological, or perceptional outcomes. Data extraction and quality assessment were conducted for the included literature. The standardized mean differences (SMD) and 95% Confidence Intervals (CI) were calculated using the inverse-variance method and a random-effects model. Results: 47 intervention studies involving 486 active subjects (13.7% female; mean age 20-42 years) were included in the meta-analysis. IC resulted in significant positive effects on time to exhaustion [SMD (95% CI) 0.40 (0.13; 0.67), p < 0.01]. IC significantly reduced Tcore [-0.19 (22120.34; -0.05), p < 0.05], sweat rate [-0.20 (-0.34; -0.06), p < 0.01], thermal sensation [-0.17 (-0.33; -0.01), p < 0.05], whereas no effects were found on skin temperature, blood lactate, and thermal comfort (p > 0.05). IC resulted in a borderline significant reduction in time trial performance [0.31 (-0.60; -0.02), p = 0.06], heart rate [-0.13 (-0.27; 0.01), p = 0.06], rate of perceived exertion [-0.16 (-0.31; -0.00), p = 0.05] and borderline increased mean power output [0.22 (0.00; 0.44), p = 0.05]. Discussion: IC has the potential to affect endurance performance and selected physiological and perceptional parameters positively. However, its effectiveness depends on the method used and the time point of administration. Future research should confirm the laboratory-based results in the field setting and involve non-endurance activities and female athletes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022336623.

Performance effects of internal pre- and per-cooling across different exercise and environmental conditions: A systematic review

Exercise in a hot and humid environment may endanger athlete's health and affect physical performance. This systematic review aimed to examine whether internal administration of ice, cold beverages or menthol solutions may be beneficial for physical performance when exercising in different environmental conditions and sports backgrounds. A systematic search was performed in PubMed, Web of Science, Scopus and SPORTDiscus databases, from inception to April 2022, to identify studies meeting the following inclusion criteria: healthy male and female physically active individuals or athletes (aged ≥18 years); an intervention consisting in the internal administration (i.e., ingestion or mouth rinse) of ice slush, ice slurry or crushed ice and/or cold beverages and/or menthol solutions before and/or during exercise; a randomized crossover design with a control or placebo condition; the report of at least one physical performance outcome; and to be written in English. Our search retrieved 2,714 articles in total; after selection, 43 studies were considered, including 472 participants, 408 men and 64 women, aged 18-42 years, with a VO2max ranging from 46.2 to 67.2 mL⋅kg-1⋅min-1. Average ambient temperature and relative humidity during the exercise tasks were 32.4 ± 3.5°C (ranging from 22°C to 38°C) and 50.8 ± 13.4% (varying from 20.0% to 80.0%), respectively. Across the 43 studies, 7 exclusively included a menthol solution mouth rinse, 30 exclusively involved ice slurry/ice slush/crushed ice/cold beverages intake, and 6 examined both the effect of thermal and non-thermal internal techniques in the same protocol. Rinsing a menthol solution (0.01%) improved physical performance during continuous endurance exercise in the heat. Conversely, the ingestion of ice or cold beverages did not seem to consistently increase performance, being more likely to improve performance in continuous endurance trials, especially when consumed during exercises. Co-administration of menthol with or within ice beverages seems to exert a synergistic effect by improving physical performance. Even in environmental conditions that are not extreme, internal cooling strategies may have an ergogenic effect. Further studies exploring both intermittent and outdoor exercise protocols, involving elite male and female athletes and performed under not extreme environmental conditions are warranted. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268197], identifier [CRD42021268197].

Partitional calorimetry

For thermal physiologists, calorimetry is an important methodological tool to assess human heat balance during heat or cold exposures. A whole body direct calorimeter remains the gold standard instrument for assessing human heat balance; however, this equipment is rarely available to most researchers. A more widely accessible substitute is partitional calorimetry, a method by which all components of the conceptual heat balance equation-metabolic heat production, conduction, radiation, convection, and evaporation-are calculated separately based on fundamental properties of energy exchange. Since partitional calorimetry requires relatively inexpensive equipment (vs. direct calorimetry) and can be used over a wider range of experimental conditions (i.e., different physical activities, laboratory or field settings, clothed or seminude), it allows investigators to address a wide range of problems such as predicting human responses to thermal stress, developing climatic exposure limits and fluid replacement guidelines, estimating clothing properties, evaluating cooling/warming interventions, and identifying potential thermoregulatory dysfunction in unique populations. In this Cores of Reproducibility in Physiology (CORP) review, we summarize the fundamental principles underlying the use of partitional calorimetry, present the various methodological and arithmetic requirements, and provide typical examples of its use. Strategies to minimize estimation error of specific heat balance components, as well as the limitations of the method, are also discussed. The goal of this CORP paper is to present a standardized methodology and thus improve the accuracy and reproducibility of research employing partitional calorimetry.

Does Cold Water or Ice Slurry Ingestion During Exercise Elicit a Net Body Cooling Effect in the Heat?

Cold water or ice slurry ingestion during exercise seems to be an effective and practical means to improve endurance exercise performance in the heat. However, transient reductions in sweating appear to decrease the potential for evaporative heat loss from the skin by a magnitude that at least negates the additional internal heat loss as a cold ingested fluid warms up to equilibrate with body temperature; thus explaining equivalent core temperatures during exercise at a fixed heat production irrespective of the ingested fluid temperature. Internal heat transfer with cold fluid/ice is always 100% efficient; therefore, when a decrement occurs in the efficiency that sweat evaporates from the skin surface (i.e. sweating efficiency), a net cooling effect should begin to develop. Using established relationships between activity, climate and sweating efficiency, the boundary conditions beyond which cold ingested fluids are beneficial in terms of increasing net heat loss can be calculated. These conditions are warmer and more humid for cycling relative to running by virtue of the greater skin surface airflow, which promotes evaporation, for a given metabolic heat production and thus sweat rate. Within these boundary conditions, athletes should ingest fluids at the temperature they find most palatable, which likely varies from athlete to athlete, and therefore best maintain hydration status. The cooling benefits of cold fluid/ice ingestion during exercise are likely disproportionately greater for athletes with physiological disruptions to sweating, such as those with a spinal cord injury or burn injuries, as their capacity for skin surface evaporative heat loss is much lower; however, more research examining these groups is needed.

Temperature of water ingested before exercise alters the onset of physiological heat loss responses

This study sought to determine whether the temperature of water ingested before exercise alters the onset threshold and subsequent thermosensitivity of local vasomotor and sudomotor responses after exercise begins. Twenty men [24 (SD 4) yr of age, 75.8 (SD 8.1) kg body mass, 52.3 (SD 7.7) ml·min^-1·kg^-1 peak O₂ consumption (V̇o_2peak)] ingested 1.5°C, 37°C, or 50°C water (3.2 ml/kg), rested for 5 min, and then cycled at 50% V̇o_2peak for 15 min at 23.0 (SD 0.9) °C and 32 (SD 10) % relative humidity. Mean body temperature (T_b), local sweat rate (LSR), and skin blood flow (SBF) were measured. In a subset of eight men [25 (SD 5) yr of age, 78.6 (SD 8.3) kg body mass, 48.9 (SD 11.1) ml·min^-1·kg^-1 V̇o_2peak], blood pressure was measured and cutaneous vascular conductance (CVC) was determined. The change in T_b was greater at the onset of LSR measurement with ingestion of 1.5°C than 50°C water [ΔT_b = 0.19 (SD 0.15) vs. 0.11 (SD 0.12) °C, P = 0.04], but not 37°C water [ΔT_b = 0.14 (SD 0.14) °C, P = 0.23], but did not differ between trials for SBF measurement [ΔT_b = 0.18 (SD 0.15) °C, 0.11 (SD 0.13) °C, and 0.09 (SD 0.09) °C with 1.5°C, 37°C, and 50°C water, respectively, P = 0.07]. Conversely, the thermosensitivity of LSR and SBF was not different [LSR = 1.11 (SD 0.75), 1.11 (SD 0.75), and 1.34 (SD 1.11) mg·min^-1·cm^-2·°C^-1 with 1.5°C, 37°C, and 50°C ingested water, respectively ( P = 0.46); SBF = 717 (SD 882), 517 (SD 606), and 857 (SD 904) %baseline arbitrary units (AU)/°C with 1.5°C, 37°C, and 50°C ingested water, respectively ( P = 0.95)]. After 15 min of exercise, LSR and SBF were greater with ingestion of 50°C than 1.5°C water [LSR = 0.40 (SD 0.17) vs. 0.31 (SD 0.19) mg·min^-1·cm^-2 ( P = 0.02); SBF = 407 (SD 149) vs. 279 (SD 117) %baseline AU ( P < 0.001)], but not 37°C water [LSR = 0.50 (SD 0.22) mg·min^-1·cm^-2; SBF = 324 (SD 169) %baseline AU]. CVC was statistically unaffected [275 (SD 81), 340 (SD 114), and 384 (SD 160) %baseline CVC with 1.5°C, 37°C, and 50°C ingested water, respectively, P = 0.30]. Collectively, these results support the concept that visceral thermoreceptors modify the central drive for thermoeffector responses.

The effect of hot and cold drinks on thermoregulation, perception, and performance: the role of the gut in thermoreception

PURPOSE

Hot compared to cold drinks alter sweating responses during very low intensity exercise in temperate conditions. The thermoregulatory, perceptual, and performance effects of hot compared to cold drinks in hot, dry conditions during high-intensity exercise have not been examined.

METHOD

Ten participants [mean ± SD characteristics age 25 ± 5 years, height 1.81 ± 0.07 m, body mass 73.5 ± 10.6 kg, maximal power output (P_Max) 350 ± 41 W] completed two conditions, where they drank four boluses (ingested at - 9, 15, 30, and 45 min, respectively) of 3.2 mL kg^- 1 (~ 960 mL total) of either a COLD (5.3 °C) or a HOT drink (49.0 °C), which were contrasted to a no-drink CONTROL. They cycled for 60-min [55% P_Max in hot (34.4 °C) dry (34% RH)] ambient conditions followed by a test to exhaustion (TTE; 80% P_Max). The thermoregulatory, performance, and perceptual implications of drink temperature were measured.

RESULTS

TTE was worse in the CONTROL (170 ± 132 s) than the COLD drink (371 ± 272 s; p = 0.021) and HOT drink conditions (367 ± 301 s; p = 0.038) which were not different (p = 0.965). Sweat responses [i.e., reflex changes in mean skin temperature (T_msk) and galvanic skin conductance] indicated transient reductions in sweating response after COLD drink ingestion. The COLD drink improved thermal comfort beyond the transient changes in sweating.

CONCLUSION

Only COLD drink ingestion changed thermoregulation, but improved perceptual response. Accordingly, we conclude a role for gut thermoreception in thermal perception during exercise in hot, dry conditions.

Ice Slurry Ingestion Leads to a Lower Net Heat Loss during Exercise in the Heat

PURPOSE

To compare the reductions in evaporative heat loss from the skin (Esk) to internal heat loss (Hfluid) induced by ice slurry (ICE) ingestion relative to 37 °C fluid and the accompanying body temperature and local thermoeffector responses during exercise in warm, dry conditions (33.5 °C ± 1.4 °C; 23.7% ± 2.6% relative humidity [RH]).

METHODS

Nine men cycled at approximately 55% VO2peak for 75 min and ingested 3.2 mL · kg(-1) aliquots of 37 °C fluid or ICE after 15, 30, and 45 min of exercise. Metabolic heat production (M-W), rectal temperature (Tre), mean skin temperature (Tsk), whole-body sweat loss (WBSL), local sweat rate (LSR), and skin blood flow (SkBF) were measured throughout. Net heat loss (HLnet) and heat storage (S) were estimated using partitional calorimetry.

RESULTS

Relative to the 37 °C trial, M-W was similar (P = 0.81) with ICE ingestion; however, the 200 ± 20 kJ greater Hfluid (P < 0.001) with ICE ingestion was overcompensated by a 381 ± 199-kJ lower Esk (P < 0.001). Net heat loss (HLnet) was consequently 131 ± 120 kJ lower (P = 0.01) and S was greater (P = 0.05) with ICE ingestion compared with 37 °C fluid ingestion. Concurrently, LSR and WBSL were lower by 0.16 ± 0.14 mg · min(-1) · cm(-2) (P < 0.01) and 191 ± 122 g (P < 0.001), respectively, and SkBF tended to be lower (P = 0.06) by 5.4%maxAU ± 13.4%maxAU in the ICE trial. Changes in Tre and Tsk were similar throughout exercise with ICE compared to 37 °C fluid ingestion.

CONCLUSIONS

Relative to 37 °C, ICE ingestion caused disproportionately greater reductions in Esk relative to Hfluid, resulting in a lower HLnet and greater S. Mechanistically, LSR and possibly SkBF were suppressed independently of Tre or Tsk, reaffirming the concept of human abdominal thermoreception. From a heat balance perspective, recommendations for ICE ingestion during exercise in warm, dry conditions should be reconsidered.

Occupational heat stress in Australian workplaces

The aim of this review was to summarize the current state of knowledge on heat stress risk within typical Australian occupational settings. We assessed identified occupations (mining, agriculture, construction, emergency services) for heat production and heat loss potential, and resultant levels of physiological heat strain. A total of 29 reports were identified that assessed in-situ work settings in Northern Territory, South Australia, Western Australia, Queensland, New South Wales and Victoria, that measured physiological responses and characterized the thermal environment. Despite workers across all industries being regularly exposed to high ambient temperatures (32-42°C) often coupled with high absolute humidity (max: 33 hPa), physiological strain is generally low in terms of core temperature (<38°C) and dehydration (<1 % reduction in mass) by virtue of the low energy demands of many tasks, and self-regulated pacing of work possible in most jobs. Heat stress risk is higher in specific jobs in agriculture (e.g. sheep shearing), deep underground mining, and emergency services (e.g., search/rescue and bushfire fighting). Heat strain was greatest in military-related activities, particularly externally-paced marching with carried loads which resulted in core temperatures often exceeding 39.5°C despite being carried out in cooler environments. The principal driver of core temperature elevations in most jobs is the rate of metabolic heat production. A standardized approach to evaluating the risk of occupational heat strain in Australian workplaces is recommended defining the individual parameters that alter human heat balance. Future research should also more closely examine female workers and occupational activities within the forestry and agriculture/horticulture sector.