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Otani H, Goto T, Kobayashi Y, Goto H, Hosokawa Y, Tokizawa K, Shirato M. The fan cooling vest use reduces thermal and perceptual strain during outdoor exercise in the heat on a sunny summer day. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1625-1635. [PMID: 38771319 DOI: 10.1007/s00484-024-02690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
The fan cooling vest is coming into very common use by Japanese outdoor manual workers. We examined that to what extent using this vest reduces thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Ten male baseball players in high school conducted two baseball training sessions for 2-h with (VEST) or without (CON) a commercially available fan cooling vest on a baseball uniform. These sessions commenced at 10 a.m. on separate days in early August. The fan airflow rate attached the vest was 62 L·s-1. Neither ambient temperature (Mean ± SD: VEST 31.9 ± 0.2°C; CON 31.8 ± 0.7°C), wet-bulb globe temperature (VEST 31.2 ± 0.4°C; CON 31.4 ± 0.5°C) nor solar radiation (VEST 1008 ± 136 W·m-2; CON 1042 ± 66 W·m-2) was different between trials. Mean skin temperature (VEST 34.5 ± 1.1°C; CON 35.1 ± 1.4°C), infrared tympanic temperature (VEST 38.9 ± 0.9°C; CON 39.2 ± 1.2°C), heart rate (VEST 127 ± 31 bpm; CON 139 ± 33 bpm), body heat storage (VEST 140 ± 34 W·m-2; CON 160 ± 22 W·m-2), thermal sensation (- 4-4: VEST 0 ± 2; CON 3 ± 1) and rating of perceived exertion (6-20: VEST 11 ± 2; CON 14 ± 2) were lower in VEST than CON (all P < 0.05). Total distance measured with a global positioning system (VEST 3704 ± 293 m; CON 3936 ± 501 m) and body fluid variables were not different between trials. This study indicates that the fan cooling vest use can reduce thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Cooling with this vest would be effective to mitigate thermal risks and perceptual stress in athletes and sports participants under such settings.
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Affiliation(s)
- Hidenori Otani
- Faculty of Health Care Sciences, Himeji Dokkyo University, 7-2-1 Kamiono, Himeji, Hyogo, 670-8524, Japan.
| | - Takayuki Goto
- National Institute of Technology, Akashi College, Uozumi-Cho, 679-3 Nishioka, Akashi, Hyogo, 674-0084, Japan
| | - Yuki Kobayashi
- National Institute of Technology, Akashi College, Uozumi-Cho, 679-3 Nishioka, Akashi, Hyogo, 674-0084, Japan
| | - Heita Goto
- Kyushu Kyoritsu University, 1-8 Jiyugaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8585, Japan
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1164, Japan
| | - Ken Tokizawa
- National Institute of Occupational Safety and Health, 1-4-6 Umezono, Kiyose, Tokyo, 204-0024, Japan
| | - Minayuki Shirato
- Meiji Gakuin University, 1-2-37 Shiroganedai, Minato-Ku, Tokyo, 108-8636, Japan
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Del Ferraro S, Falcone T, Morabito M, Bonafede M, Marinaccio A, Gao C, Molinaro V. Mitigating heat effects in the workplace with a ventilation jacket: Simulations of the whole-body and local human thermophysiological response with a sweating thermal manikin in a warm-dry environment. J Therm Biol 2024; 119:103772. [PMID: 38145612 DOI: 10.1016/j.jtherbio.2023.103772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023]
Abstract
Climate change is increasingly affecting human well-being and will inevitably impact on occupational sectors in terms of costs, productivity, workers' health and injuries. Among the cooling garment developed to reduce heat strain, the ventilation jacket could be considered for possible use in workplaces, as it is wearable without limiting the user's mobility and autonomy. In this study, simulations with a sweating manikin are carried out to investigate the effects of a short-sleeved ventilation jacket on human thermophysiological responses in a warm-dry scenario. Simulations were performed in a climatic chamber (air temperature = 30.1 °C; air velocity = 0.29 m/s; relative humidity = 30.0 %), considering two constant levels of metabolic rate M (M1 = 2.4 MET; M2 = 3.2 MET), a sequence of these two (Work), and three levels of fan velocities (lf = 0; lf=2; lf=4). The results revealed a more evident impact on the mean skin temperature (Tsk) compared to the rectal temperature (Tre), with significant decreases (compared to fan-off) at all M levels, for Tsk from the beginning and for Tre from the 61st minute. Skin temperatures of the torso zones decreased significantly (compared to fan-off) at all M levels, and a greater drop was registered for the Back. The fans at the highest level (lf=4) were significantly effective in improving whole-body and local thermal sensations when compared to fan-off, at all M levels. At the intermediate level (lf=2), the statistical significance varied with thermal zone, M and time interval considered. The results of the simulations also showed that the Lower Torso needs to be monitored at M2 level, as the drop in skin temperature could lead to local overcooling and thermal discomfort. Simulations showed the potential effectiveness of the ventilation jacket, but human trials are needed to verify its cooling power in real working conditions.
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Affiliation(s)
- Simona Del Ferraro
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
| | - Tiziana Falcone
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
| | - Marco Morabito
- Institute of BioEconomy (IBE), National Research Council, Via Madonna Del Piano 10, 50019, Sesto Fiorentino, FI, Italy; Centre of Bioclimatology, University of Florence, Piazzale Delle Cascine 18, 50144, Florence, Italy.
| | - Michela Bonafede
- Laboratory of Occupational and Environmental Epidemiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Stefano Gradi 55, 00143, Rome, Italy.
| | - Alessandro Marinaccio
- Laboratory of Occupational and Environmental Epidemiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Stefano Gradi 55, 00143, Rome, Italy.
| | - Chuansi Gao
- Aerosol and Climate Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Sölvegatan 26, Lund, Sweden.
| | - Vincenzo Molinaro
- Laboratory of Ergonomics and Physiology, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy.
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Ding Y, Zhang Z, Chen Z. Effect of local ventilation temperature and speed under garments on the thermal response of humans at different metabolic rates. APPLIED ERGONOMICS 2023; 113:104102. [PMID: 37506619 DOI: 10.1016/j.apergo.2023.104102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Ventilation under garments is one of the effective solutions to alleviate heat stress in the human body, but ventilation preferences and cooling effects in different body segments at different metabolic rates are not thoroughly studied. Eighteen participants performed three metabolic intensities of cycling exercise at 30 °C, RH 35%, where five body segments underwent adjustable ventilation. The ventilation preferences, psychological and physiological responses, and energy consumption were analyzed. The preferred ventilation temperature was approximately 24.5 ± 1.9 °C and the preferred ventilation speed was 1.56 ± 0.29-1.68 ± 0.27 m s-1. At low and moderate metabolic intensities, the five body segments preferred similar ventilation temperatures. At high metabolic intensity, the back preferred lower ventilation temperatures and higher ventilation speeds than the lower limbs. Additionally, the lower back and chest are considered optimal ventilation body segments to achieve higher overall thermal comfort. This study contributes to the optimization of personal ventilated cooling garments for different metabolism scenarios.
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Affiliation(s)
- Yifan Ding
- College of Fashion and Design, Donghua University, 1882 West Yan'an Road, Changning District, Shanghai, 200051, China.
| | - Zhaohua Zhang
- College of Fashion and Design, Donghua University, 1882 West Yan'an Road, Changning District, Shanghai, 200051, China; Key Laboratory of Clothing Design & Technology (Donghua University), Ministry of Education, West Yan'an Road, Changning District, Shanghai, 200051, China.
| | - Zhirui Chen
- College of Fashion and Design, Donghua University, 1882 West Yan'an Road, Changning District, Shanghai, 200051, China.
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Yamashita N, Kume M, Satake T, Yoshida T. Subjective perceived risk factors of exertional heat exhaustion-related symptoms in male collegiate athletes in Japan: a case-control study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:649-659. [PMID: 36840761 DOI: 10.1007/s00484-023-02442-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to investigate associations between lifestyle habits, health factors, athletic activity conditions, and exertional heat exhaustion (EHE)-related symptoms among male college athletes in Japan based on a self-completed questionnaire. The paper-based questionnaires were distributed to 11 universities in Japan, and 2006 respondents completed the survey. Data of personal characteristics (age, body mass), lifestyle habits (sleep duration, use of air-conditioner while sleeping, and practice duration), perceived health factors (loss of appetite, sleep deprivation, sickness, dehydration, accumulated fatigue, and mental stress), perceived athletic activity (insufficient rest breaks, high ambient temperature, excessive humidity, strong solar radiation, lack of ambient wind, and clothing discomfort), and EHE-related symptoms (dizziness, headaches, nausea, and malaise) were collected. The association between lifestyle habits, health factors, athletic activity conditions (explanatory variables), and EHE-related symptoms (objective variables) was analyzed using the partial-proportional odds model. "Perceived dehydration" (odds ratios [ORs] 1.70-2.31, p < 0.002)," "sickness" (ORs 1.35-1.76), p < 0.001), "perceived accumulated fatigue" (ORs 1.13-1.31, p ≤ 0.001), "perceived mental stress" (ORs 1.17-1.31, p < 0.019), "lack of ambient wind" (ORs 1.12-1.19, p < 0.022), "loss of appetite" (ORs 1.16-1.23, p < 0.037), and "sleep deprivation" (ORs 1.15-1.17, p < 0.025) were positively associated with EHE-related symptoms, whereas "using an air conditioner during sleeping" (ORs 0.91, p = 0.047) during summer seasons was negatively associated. These findings suggest that athletes should be allowed to postpone or downregulate exercise intensity and/or volume based on their perceptions of dehydration, sickness, accumulated fatigue, mental stress, loss of appetite, and/or sleep deprivation in the summer to prevent heat illness.
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Affiliation(s)
- Naoyuki Yamashita
- Faculty of Arts and Sciences, Kyoto Institute of Technology, 1 Hashikamicho Matsugasaki Sakyoku, Kyoto, 606-8585, Japan.
| | - Masashi Kume
- Department of Food and Nutrition, Kyoto Bunkyo Junior College, Uji, Japan
| | - Toshiyuki Satake
- Faculty of Health Science, Kyoto Koka Women's University, Kyoto, Japan
| | - Tetsuya Yoshida
- Faculty of Arts and Sciences, Kyoto Institute of Technology, 1 Hashikamicho Matsugasaki Sakyoku, Kyoto, 606-8585, Japan
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Naito T, Saito T, Ohhashi M, Hayashi S. Recovery with a fan-cooling jacket after exposure to high solar radiation during exercise in hot outdoor environments. Front Sports Act Living 2023; 5:1106882. [PMID: 36860733 PMCID: PMC9968796 DOI: 10.3389/fspor.2023.1106882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
The study aimed to investigate the effect of body cooling with a fan-cooling jacket on body temperature responses during recovery after exercise when exposed to high solar radiation in a hot outdoor environment. Nine males cycled using ergometer until their rectal temperature increased to 38.50 °C in hot outdoor environments, followed by body cooling recovery in warm indoor environments. Subjects repeatedly performed the cycling exercise protocol, which consisted of one set of 5 min at a load of 1.5 watt/kg body weight and 15 min at a load of 2.0 watt/kg body weight at 60 rpm. Body cooling recovery consisted of cold water ingestion (10°C: CON) or cold water ingestion + wearing a fan-cooling jacket (FAN) until the rectal temperature decreased to 37.75°C. The time for the rectal temperature to reach 38.5°C did not differ between the two trials. The rate of decrease in rectal temperature at recovery tended to be higher in FAN trial than in CON trial (P = 0.082). The rate of decrease in tympanic temperature was higher in FAN trials than in CON trials (P = 0.002). The rate of decrease in mean skin temperature at the first 20 min of recovery was higher in FAN than in CON trial (P = 0.013). Body cooling recovery with a fan-cooling jacket in addition to cold water ingestion may be effective in reducing elevated tympanic and skin temperatures after exercise in the heat under a clear sky, but may be difficult to decrease rectal temperature.
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Affiliation(s)
- Takashi Naito
- Faculty of Law, Hokkai-Gakuen University, Sapporo, Japan,Correspondence: Takashi Naito
| | - Tatsuya Saito
- Faculty of Medicine, Tottori University, Tottori, Japan
| | | | - Sotaro Hayashi
- Faculty of Urban Management, Fukuyama City University, Fukuyama, Japan
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Mori K, Nagano C, Fukuzawa K, Hoshuyama N, Tanaka R, Nishi K, Hashimoto K, Horie S. Mitigation of heat strain by wearing a long-sleeve fan-attached jacket in a hot or humid environment. J Occup Health 2022; 64:e12323. [PMID: 35384178 PMCID: PMC9176717 DOI: 10.1002/1348-9585.12323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives This study examined whether a fan‐attached jacket (FAJ) may mitigate the heat strain in hot or humid environment. Methods Nine healthy men engaged in 60‐min sessions on a bicycle ergometer (4 metabolic equivalents [METs] workload) in hot‐dry (40°C and 30% relative humidity) and warm‐humid (30°C and 85% relative humidity) environments. Both are equivalent to an approximately 29°C wet‐bulb globe temperature. The experiment was repeated—once wearing an ordinal jacket (control condition) and once wearing a long‐sleeve FAJ that transfers ambient air at a flow rate of 12 L/s (FAJ condition)—in both environments. Results Increases in core temperatures in hot‐dry environment were not statistically different between control and FAJ; however, that in the warm‐humid environment were significantly different between control and FAJ (0.96 ± 0.10°C and 0.71 ± 0.11°C in rectal temperature, P < .0001; and 0.94 ± 0.09°C and 0.61 ± 0.09°C in esophageal temperature, P < .0001). Changes in heart rate were different between control and FAJ in both environments (62 ± 3 bpm and 47 ± 7 bpm, P < .0001 in hot‐dry environment; and 61 ± 3 bpm and 46 ± 5 bpm, P < .0001 in the warm‐humid environment) and decrease of %weight change was different in hot‐dry environment (1.59 ± 0.12% and 1.25 ± 0.05%, P = .0039), but not in the warm‐humid environment. Conclusions Wearing a FAJ may mitigate heat strain both in hot or humid environments.
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Affiliation(s)
- Kimiyo Mori
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chikage Nagano
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kimie Fukuzawa
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Natsuko Hoshuyama
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Riho Tanaka
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kento Nishi
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kahori Hashimoto
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Seichi Horie
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Sekoguchi S, Ando H, Ikegami K, Yoshitake H, Nagano C, Ogami A. Application of tight-fitting half-facepiece breath-response powered air-purifying respirator for internal body cooling in occupational environment. PLoS One 2022; 17:e0266534. [PMID: 35385522 PMCID: PMC8986019 DOI: 10.1371/journal.pone.0266534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
In dust-generating scenarios in occupational environments, it is important to take measures to prevent not only pneumoconiosis, but also heatstroke. The aim of this study was to verify whether using a tight-fitting half-facepiece breath-response powered air-purifying respirator (PAPR) in combination with a self-produced cooling device could abate the deep body temperature while performing activities. We conducted a crossover study involving 10 subjects. The subjects were subjected to three conditions: wearing a PAPR equipped with a cooling device, PAPR, or a replaceable particulate respirator. During the experiment, the rectal temperature of the subjects was measured, along with the temperature near the PAPR inlet in container with the cooling device when the PAPR equipped with the cooling device was worn. The subjects rested in a cold chamber set at a dry-bulb temperature of 28°C and relative humidity of 45% for 20 min. Then, they moved to a hot chamber set to a dry-bulb temperature of 36°C (with the same relative humidity) in 5 min and exercised on a cycle ergometer for 30 min. After that, the subjects moved to the cold chamber for 5 min and rested for 20 min. Notably, the air inhaled by the subjects wearing PAPR equipped with the cooling device was approximately 10°C cooler than the ambient air. Furthermore, 35 min after the initiation of the experiment (after the middle of the exercise period), the rectal temperature of the participants wearing the PAPR equipped with the cooling device was lower than of those wearing PAPR or replaceable particulate respirators (p <0.05). Thus, we could deduce that the self-produced cooling device was useful in abating deep body temperature. PAPR is useful for its potential applications in hot occupational environments and can save lives in working environments where heat stress can result in major medical complications.
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Affiliation(s)
- Shingo Sekoguchi
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hajime Ando
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kazunori Ikegami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hidetaka Yoshitake
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Chikage Nagano
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Hashimoto K, Horie S, Nagano C, Hibino H, Mori K, Fukuzawa K, Nakayama M, Tanaka H, Inoue J. A fan-attached jacket worn in an environment exceeding body temperature suppresses an increase in core temperature. Sci Rep 2021; 11:21269. [PMID: 34711896 PMCID: PMC8553827 DOI: 10.1038/s41598-021-00655-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022] Open
Abstract
We examined whether blowing hot air above body temperature under work clothing may suppress core temperature. Nine Japanese men engaged in two 30-min bicycle ergometer sessions at a workload of 40% VO2max at 40 °C and 50% relative humidity. The experiment was conducted without wearing any cooling apparatus (CON), wearing a cooling vest that circulated 10.0 °C water (VEST), and wearing a fan-attached jacket that transferred ambient air underneath the jacket at a rate of 30 L/s (FAN). The VEST and FAN conditions suppressed the increases of rectal temperature (CON, VEST, FAN; 38.01 ± 0.19 °C, 37.72 ± 0.12 °C (p = 0.0076), 37.54 ± 0.19 °C (p = 0.0023), respectively), esophageal temperature (38.22 ± 0.30 °C, 37.55 ± 0.18 °C (p = 0.0039), 37.54 ± 0.21 °C (p = 0.0039), respectively), and heart rate (157.3 ± 9.8 bpm, 136.9 ± 8.9 bpm, (p = 0.0042), 137.5 ± 6.5 bpm (p = 0.0023), respectively). Two conditions also reduced the estimated amount of sweating and improved various subjective evaluations. Even in the 40 °C and 50% relative humidity environment, we may recommend wearing a fan-attached jacket because the heat dissipation through evaporation exceeded the heat convection from the hot ambient air.
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Affiliation(s)
- Kahori Hashimoto
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Seichi Horie
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Chikage Nagano
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Hiroyuki Hibino
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kimiyo Mori
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kimie Fukuzawa
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masashi Nakayama
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Hiroyuki Tanaka
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Jinro Inoue
- Department of Health Policy and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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