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Anderson SA, Eichner ER, Bennett S, Boden BP, Colgate B, Courson R, Davis JK, Elkins GA, Judge LW, Krueger M, Kucera KL, Niehoff K, Rooks Y, Tucker JB, Roberts WO. Preventing Exertional Heat Stroke in Football: Time for a Paradigm Shift. Sports Health 2024:19417381241260045. [PMID: 38874455 DOI: 10.1177/19417381241260045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
CONTEXT Among American sports, football has the highest incidence of exertional heat stroke (EHS), despite decades of prevention strategies. Based on recent reports, 100% of high school and college EHS football fatalities occur during conditioning sessions. Linemen are the at-risk population, constituting 97% of football EHS deaths. Linemen heat up faster and cool down slower than other players. EVIDENCE ACQUISITION Case series were identified from organized, supervised football at the youth, high school, and collegiate levels and compiled in the National Registry of Catastrophic Sports Injuries. Sources for event occurrence were media reports and newspaper clippings, autopsy reports, certificates of death, school-sponsored investigations, and published medical literature. Articles were identified through PubMed with search terms "football," "exertional heat stroke," and "prevention." STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 5. RESULTS Football EHS is tied to (1) high-intensity drills and conditioning that is not specific to individual player positions, (2) physical exertion as punishment; (3) failure to modify physical activity for high heat and humidity, (4) failure to recognize early signs and symptoms of EHS, and (5) death when cooling is delayed. CONCLUSION To prevent football EHS, (1) all training and conditioning should be position specific; (2) physical activity should be modified per the heat load; (3) understand that some players have a "do-or-die" mentality that supersedes their personal safety; (4) never use physical exertion as punishment; (5) eliminate conditioning tests, serial sprints, and any reckless drills that are inappropriate for linemen; and (6) consider air-conditioned venues for linemen during hot practices. To prevent EHS, train linemen based on game demands. STRENGTH-OF-RECOMMENDATION TAXONOMY n/a.
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Affiliation(s)
| | - E Randy Eichner
- Oklahoma University Health Science Center, Oklahoma City, Oklahoma
| | - Scott Bennett
- Collegiate Strength and Conditioning Coaches Association, Roanoke, Virginia
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Uniformed Services University, Rockville, Maryland
| | - Bob Colgate
- National Federation of State High School Associations [NFHS], Indianapolis, Indiana
| | - Ron Courson
- University of Georgia Athletic Association, Athens, Georgia
| | - Jon K Davis
- Gatorade Sports Science Institute, Frisco, Texas
| | | | | | - Mike Krueger
- Colorado High School Activities Association, Aurora, Colorado
| | - Kristen L Kucera
- Department of Exercise and Sport Science, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, and National Center for Catastrophic Sport Injury Research [NCCSIR], Chapel Hill, North Carolina
| | | | - Yvette Rooks
- University of Maryland-College Park, College Park, Maryland
| | - James B Tucker
- Syracuse University, Syracuse, New York, Department of Family Medicine, SUNY Upstate Medical University, Syracuse, New York, and St. Joseph's Hospital Health Center, Syracuse, New York
| | - William O Roberts
- American College of Sports Medicine, Indianapolis, Indiana, and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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Mason HM, King JC, Peden AE, Leicht AS, Franklin RC. The impact of extreme heat on mass-gathering sporting events: Implications for Australia and other countries. J Sci Med Sport 2024:S1440-2440(24)00145-2. [PMID: 38796374 DOI: 10.1016/j.jsams.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES As temperatures increase across the globe due to climate change, human exposure to extreme heat is a public health challenge. During sporting events, athletes, officials, spectators, and staff are at risk of heat stress and resulting illness. The objective of this review was to explore the impact of heat on the health outcomes of these groups and the wider health system and discuss implications for outdoor mass-gathering sporting events in Australia. DESIGN A systematic review was undertaken to identify literature published from 2010 to 2023. METHODS Seven databases were searched: Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare, and PsychInfo, for relevant key search terms such as heatwave, heat stress, extreme heat, stadium, arena, sports facilit*, sport, athletic, and Olympic. An inductive thematic analysis was undertaken. Articles were quality checked using Joanna Briggs Institute critical appraisal tools and data were extracted, tabulated, and synthesized. RESULTS Forty papers were included in the final analysis: 17 quantitative, and 23 descriptive and qualitative (including reviews). Health outcomes explored across the literature included exertional heat illness, exertional heat stroke, hyperthermia, and general heat related illness. Six recommendation themes emerged: planning, mitigation strategies, medical, policy, research, and education. CONCLUSIONS The impact of heat on health outcomes during sporting events is significant, and should be considered by individuals, coaches, officials, and organizers before, during, and after mass-gathering sporting events. These findings can inform evidence-based preparedness strategies to protect the health of those attending and competing in mass-gathering sporting events now and into the future.
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Affiliation(s)
- Hannah M Mason
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia
| | - Jemma C King
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia
| | - Amy E Peden
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Australia
| | - Richard C Franklin
- Discipline of Public Health and Tropical Medicine, James Cook University, Australia.
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Pompeo A, Afonso J, Cirillo ELR, Costa JA, Vilaça-Alves J, Garrido N, González-Víllora S, Williams AM, Casanova F. Impact of temperature on physical and cognitive performance in elite female football players during intermittent exercise. Scand J Med Sci Sports 2024; 34:e14646. [PMID: 38700046 DOI: 10.1111/sms.14646] [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: 01/22/2024] [Revised: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
There is limited research on female football players, especially related to their physical and cognitive performance under different climactic conditions. We analyzed the impact of a hot environmental temperature on physical performance and anticipation in elite female football players during a fatigue-inducing intermittent protocol. Elite female players (n = 21) performed the countermovement jump (CMJ) and responded to filmed sequences of offensive play under two distinct environmental temperatures (i.e., mild environment temperature- 20°C and 30% rh versus hot environment temperature- 38°C and 80% rh), interspersed by 1-week interval. Linear mixed models were used. CMJ performance declined following the intermittent protocol on both temperature conditions (p < 0.05). Moreover, there were significant main effects for protocol on CMJ speed (m/s) (p = 0.001; ηp 2 = 0.12), CMJ power (p = 0.002; ηp 2 = 0.11), and CMJ Heightmax (p = 0.002; ηp 2 = 0.12). After performing the intermittent protocol, exposure to a hot temperature caused a greater decline in anticipation accuracy (mild temperature = 64.41% vs. hot temperature = 53.44%; p < 0.001). Our study shows impaired performance in elite female football players following an intermittent protocol under hot compared with mild environmental conditions. We report decreased performance in both CMJ and anticipation performance under hotter conditions. The results reveal that exposure to hot temperatures had a negative effect on the accuracy of their anticipatory behaviors. We consider the implication of the work for research and training interventions.
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Affiliation(s)
- Alberto Pompeo
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
| | - José Afonso
- Centre for Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto, Porto, Portugal
| | - Everton Luis Rodrigues Cirillo
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
- State University of Londrina (UEL)/Sports Science Department, Londrina, Brazil
| | - Júlio A Costa
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
| | - José Vilaça-Alves
- Department of Sport-Sciences, Exercise and Health, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Research Center in Sports, Health, and Human Development (CIDESD), Vila Real, Portugal
| | - Nuno Garrido
- Department of Sport-Sciences, Exercise and Health, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Research Center in Sports, Health, and Human Development (CIDESD), Vila Real, Portugal
| | - Sixto González-Víllora
- Sport and Physical Activity Education Research Group, Faculty of Education, University of Castilla-La Mancha, Albacete, Spain
| | - Andrew Mark Williams
- Department of Healthspan, Resilience, and Performance Group, Institute for Human and Machine Cognition, Pensacola, Florida, USA
| | - Filipe Casanova
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, Lisbon, Portugal
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Yamashita N, Kume M, Satake T, Inoue K, Yoshida T. Subjective perceived risk factors of exertional heat exhaustion-related symptoms in female collegiate athletes in Japan. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02667-9. [PMID: 38598168 DOI: 10.1007/s00484-024-02667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Associations of exertional heat exhaustion (EHE)-related symptoms with lifestyle habits and health factors specific to female athletes, ranked by relative risks from high to low, remain elusive. Addressing this issue would benefit athletes and coaches, ensuring safer practices during summer sports activities. To address this issue, we distributed paper-based questionnaires to seven universities in Japan, and 983 respondents completed our survey. The questionnaires covered various personal characteristics, lifestyle habits, perceived health factors, perceived athletic activity, and EHE-related symptoms. In this retrospective case-control study, we analyzed the relationships of EHE-related symptoms (objective variables) with lifestyle habits, health factors, and athletic activity conditions (explanatory variables) using the partial proportional odds model. The questionnaire responses revealed that perceived dehydration, sickness, loss of appetite, perceived accumulated fatigue, perceived mental stress, lack of ambient wind, and insufficient rest breaks were positively associated with EHE-related symptoms, with relative risks ranging from high to low. Using an air conditioner during sleep and having a sleep duration of ≥ 6 h were associated with a reduced risk of EHE-related symptoms. The study results suggest that female athletes should be allowed to postpone exercise or reduce its intensity and volume based on their perceptions of dehydration, sickness, loss of appetite, accumulated fatigue, and mental stress in summer to prevent heat-related illnesses.
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Affiliation(s)
- Naoyuki Yamashita
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, 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
| | - Keiko Inoue
- Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
| | - Tetsuya Yoshida
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, Japan
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Parsons IT, Snape D, Stacey MJ, Barlow M, O'Hara J, Gall N, Chowienczyk P, Wainwright B, Woods DR. Improvements in Orthostatic Tolerance with Exercise Are Augmented by Heat Acclimation: A Randomized Controlled Trial. Med Sci Sports Exerc 2024; 56:644-654. [PMID: 38079307 DOI: 10.1249/mss.0000000000003355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
INTRODUCTION Heat adaptation is protective against heat illness; however, its role in heat syncope, due to reflex mechanisms, has not been conclusively established. The aim of this study was to evaluate if heat acclimation (HA) was protective against heat syncope and to ascertain underlying physiological mechanisms. METHODS Twenty (15 males, 5 females) endurance-trained athletes were randomized to either 8 d of mixed active and passive HA (HEAT) or climatically temperate exercise (CONTROL). Before, and after, the interventions participants underwent a head up tilt (HUT) with graded lower body negative pressure (LBNP), in a thermal chamber (32.0 ± 0.3°C), continued until presyncope with measurement of cardiovascular parameters. Heat stress tests (HST) were performed to determine physiological and perceptual measures of HA. RESULTS There was a significant increase in orthostatic tolerance (OT), as measured by HUT/LBNP, in the HEAT group (preintervention; 28 ± 9 min, postintervention; 40 ± 7 min) compared with CONTROL (preintervention; 30 ± 8 mins, postintervention; 33 ± 5 min) ( P = 0.01). Heat acclimation resulted in a significantly reduced peak and mean rectal and skin temperature ( P < 0.01), peak heat rate ( P < 0.003), thermal comfort ( P < 0.04), and rating of perceived exertion ( P < 0.02) during HST. There was a significantly increased plasma volume (PV) in the HEAT group in comparison to CONTROL ( P = 0.03). CONCLUSIONS Heat acclimation causes improvements in OT and is likely to be beneficial in patients with heat exacerbated reflex syncope. Heat acclimation-mediated PV expansion is a potential physiological mechanism underlying improved OT.
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Affiliation(s)
| | - Daniel Snape
- Carnegie School of Sport, Leeds Beckett University, Leeds, UNITED KINGDOM
| | - Michael J Stacey
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UNITED KINGDOM
| | - Matthew Barlow
- Carnegie School of Sport, Leeds Beckett University, Leeds, UNITED KINGDOM
| | - John O'Hara
- Carnegie School of Sport, Leeds Beckett University, Leeds, UNITED KINGDOM
| | - Nick Gall
- School of Cardiovascular Medicine and Sciences, King's College London, London, UNITED KINGDOM
| | - Phil Chowienczyk
- School of Cardiovascular Medicine and Sciences, King's College London, London, UNITED KINGDOM
| | - Barney Wainwright
- Carnegie School of Sport, Leeds Beckett University, Leeds, UNITED KINGDOM
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Willcox MJ, Rhodehouse BB, DeGroot DW. Ice Sheet Cooling in the Field Reduces Morbidity in Exertional Heat Stroke. Curr Sports Med Rep 2024; 23:119-123. [PMID: 38578488 DOI: 10.1249/jsr.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- M Justin Willcox
- Department of Family Medicine, Martin Army Community Hospital, Fort Moore, GA
| | - Blair B Rhodehouse
- Department of Family Medicine, Martin Army Community Hospital, Fort Moore, GA
| | - David W DeGroot
- The Army Heat Center, Martin Army Community Hospital, Fort Moore, GA
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Watt S, Chue J, Kocz R. Association of malignant hyperthermia and exertional heat illness in young athletes: An analysis of awareness among clinical and athletic first responders. Saudi J Anaesth 2024; 18:224-230. [PMID: 38654868 PMCID: PMC11033909 DOI: 10.4103/sja.sja_858_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 04/26/2024] Open
Abstract
Background Malignant hyperthermia (MH), a rare inherited condition seen almost exclusively in the perioperative setting, is triggered by volatile anesthetics or an intravenous paralytic drug, succinylcholine. It can, however, occur without any exposure to anesthetic drugs, being associated with heat illness and rhabdomyolysis, thus presenting a little-known risk to young athletes exercising in hot environments. Objective This study aimed to determine the first responder awareness of MH and its association with heat illness in young athletes within athletic and clinical environments. Methods Awareness within the clinical milieu was assessed by an institutional chart review of 3296 charts. The identified heat illness cases were examined for treatment consistent with the management of a suspected episode of MH. Awareness among first responders in an athletic setting was examined by a survey administered to a total of 1,500 coaches and athletic trainers at the high school level along with emergency medical services providers across the United States. Results No treatment consistent with the suspicion of MH was noted among clinical first responders, suggesting a lack of awareness. Survey administration also revealed a limited amount of knowledge of MH and its potential role in heat illness. Conclusion The results point to lack of awareness among pre-hospital and hospital-based first responders of the relationship between MH and heat illness in young athletes. An effort to educate these members of the healthcare community can contribute to an expeditious and life-saving intervention. Clinical Relevance First responders who may interact with a young athlete have low knowledge of MH and its relationship to heat illness. Similar lack of awareness exists among hospital personnel who care for young individuals with heat illness. Educating the first responders about this condition can speed up the time to intervene and save lives.
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Affiliation(s)
- Stacey Watt
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | - James Chue
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Remek Kocz
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
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Hintz C, Presley DM, Butler CR. Heat stroke burden and validity of wearable-derived core temperature estimation during elite military training. PHYSICIAN SPORTSMED 2024; 52:154-159. [PMID: 36919415 DOI: 10.1080/00913847.2023.2190729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Exertional heat stroke (EHS) remains a significant health concern while training in hot environments, prompting the development of noninvasive wearable technology for monitoring estimated core temperature (ECT). The objective of this study was to review the effectiveness of an ECT device during elite military training by providing a case series of individuals who developed EHS. METHODS This is a retrospective study of EHS cases during high-intensity training while wearing the ECT device, Zephyr BioharnessTM. Data was collected from January 2021 through September 2021 at the Air Force Special Warfare Training pipeline in San Antonio, TX. Rectal temperatures of EHS diagnoses, defined by central nervous system (CNS) dysfunction and rectal temperature approaching or >40°C (104°F), were compared to ECT reading via Zephyr BioharnessTM. Incidence rates and psychometric properties were calculated using R package. RESULTS A total of 47,058 daily peak ECT measurements were collected among 1,364 trainees. A total of 499 trainees flagged as potential EHS by Zephyr BioharnessTM reading >39.7°C (103.5°F). The incidence of confirmed EHS was 0.8/1000 person-months. Of the 10 confirmed EHS cases (9 males, 1 female; age = 23.4 ± 2.7 yrs; BMI = 25 ± 2; body fat = 13 ± 5%), 8 trainees had a peak ECT reading below 39.7°C which resulted in a sensitivity of 20%, specificity of 98.9%, positive likelihood ratio (LR) of 18.93 (95% Confidence Interval [CI] 5.5-65.6), and a negative LR of 0.81 (95% CI 0.6-1.1). CONCLUSION ECT had substantial false positive and negative rates. Further studies are needed to validate this technology in other populations, and the algorithm used in this device needs to be refined to better capture the environmental and physical requirements in the special operations population.
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Affiliation(s)
- Courtney Hintz
- Special Warfare Human Performance Support Group, USAF, Lackland AFB, San Antonio, TX, USA
| | | | - Cody R Butler
- Special Warfare Human Performance Support Group, USAF, Lackland AFB, San Antonio, TX, USA
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Miller KC, Amaria NY. Body Bag Cooling with Two Different Water Temperatures for the Treatment of Hyperthermia. Aerosp Med Hum Perform 2024; 95:194-199. [PMID: 38486327 DOI: 10.3357/amhp.6364.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
INTRODUCTION: Exertional heatstroke (EHS) is a life-threatening condition that requires quick recognition and cooling for survival. Experts recommend using cooling modalities that reduce rectal temperature (TREC) faster than 0.16°C/min though rates above 0.08°C/min are considered "acceptable." Hyperthermic individuals treated in body bags filled with ice water (∼3°C) have excellent cooling rates (0.28 ± 0.09°C/min). However, clinicians may not have access to large amounts of ice or ice water when treating EHS victims. The purpose of this study was to determine if using a body bag filled with water near the upper limits of expert recommendations for EHS treatment would produce acceptable (>0.08°C/min) or "ideal (>0.16°C/min)" TREC cooling rates or different nadir values.METHODS: A total of 12 individuals (9 men, 3 women; age: 21 ± 2 yr; mass: 74.6 ± 10.2 kg; height: 179.5 ± 9.6 cm) exercised in the heat until TREC was 39.5°C. They lay supine while 211.4 ± 19.5 L of 10°C (Ten) or 15°C (Fifteen) water was poured into a body bag. Subjects cooled until TREC was 38°C. They exited the body bag and rested in the heat for 10 min.RESULTS: Subjects exercised in similar conditions and for similar durations (Ten = 46.3 ± 8.6 min, Fifteen = 46.2 ± 7.8 min). TREC cooling rates were faster in Ten than Fifteen (Ten = 0.18 ± 0.07°C/min, Fifteen = 0.14 ± 0.09°C/min). TREC nadir was slightly higher in Fifteen (37.3 ± 0.2°C) than Ten (37.1 ± 0.3°C).DISCUSSION: Body bag cooling rates met expert definitions of acceptable (Fifteen) and ideal (Ten) for EHS treatment. This information is valuable for clinicians who do not have access to or the resources for ice water cooling to treat EHS.Miller KC, Amaria NY. Body bag cooling with two different water temperatures for the treatment of hyperthermia. Aerosp Med Hum Perform. 2024; 95(4):194-199.
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Iio Y, Tanaka M, Kozai H, Aoyama Y, Mori Y, Seguchi M, Ito M. Association between the experience of exertional heat illness (EHI) and living conditions of collegiate student athletes. Drug Discov Ther 2024; 18:60-66. [PMID: 38355123 DOI: 10.5582/ddt.2023.01094] [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] [Indexed: 02/16/2024]
Abstract
Exertional heatstroke (EHS), a severe form of exertional heat illness (EHI), is the third leading cause of death in athletes; thus, early detection and prevention of EHI can help prevent EHS, which is a life-threatening condition. This study aimed to clarify the association between the cognizance of experiencing EHI and living conditions and specific EHI symptoms among collegiate athletes. This study was conducted in October 2022 by administering a questionnaire to 237 male collegiate athletes. Of the 215 (90.7%) respondents, 197 (91.6%) provided valid responses; among them, 88 (44.7%) responded they had experienced EHI, while 109 (55.3%) had not. A history of medical examinations due to EHI, having experienced headaches during summer activities, and having read the EHI manual were factors indicating cognizance of EHI. The number of times meals containing a staple food, main dish, and side dish were eaten in a day was a factor in preventing EHI. Early detection of EHI is important for its prevention, and it is important that athletes themselves have knowledge of symptoms and can correctly self-diagnose EHI. Emphasizing the potential of a well-balanced dietary intake has the potential to prevent EHI is crucial.
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Affiliation(s)
- Yoko Iio
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Mamoru Tanaka
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Hana Kozai
- Department of Food and Nutritional Sciences, College of Bioscience and Biotechnology, Chubu University, Aichi, Japan
| | - Yuka Aoyama
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Clinical Engineering, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yukihiro Mori
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Nursing, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Manato Seguchi
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Morihiro Ito
- Graduate School of Life and Health Sciences, Chubu University, Aichi, Japan
- Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
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Barletta JF, Palmieri TL, Toomey SA, Harrod CG, Murthy S, Bailey H. Management of Heat-Related Illness and Injury in the ICU: A Concise Definitive Review. Crit Care Med 2024; 52:362-375. [PMID: 38240487 DOI: 10.1097/ccm.0000000000006170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The increasing frequency of extreme heat events has led to a growing number of heat-related injuries and illnesses in ICUs. The objective of this review was to summarize and critically appraise evidence for the management of heat-related illnesses and injuries for critical care multiprofessionals. DATA SOURCES Ovid Medline, Embase, Cochrane Clinical Trials Register, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov databases were searched from inception through August 2023 for studies reporting on heat-related injury and illness in the setting of the ICU. STUDY SELECTION English-language systematic reviews, narrative reviews, meta-analyses, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed. DATA EXTRACTION Data regarding study methodology, patient population, management strategy, and clinical outcomes were qualitatively assessed. DATA SYNTHESIS Several risk factors and prognostic indicators for patients diagnosed with heat-related illness and injury have been identified and reported in the literature. Effective management of these patients has included various cooling methods and fluid replenishment. Drug therapy is not effective. Multiple organ dysfunction, neurologic injury, and disseminated intravascular coagulation are common complications of heat stroke and must be managed accordingly. Burn injury from contact with hot surfaces or pavement can occur, requiring careful evaluation and possible excision and grafting in severe cases. CONCLUSIONS The prevalence of heat-related illness and injury is increasing, and rapid initiation of appropriate therapies is necessary to optimize outcomes. Additional research is needed to identify effective methods and strategies to achieve rapid cooling, the role of immunomodulators and anticoagulant medications, the use of biomarkers to identify organ failure, and the role of artificial intelligence and precision medicine.
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Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, AZ
| | - Tina L Palmieri
- Burn Division, Department of Surgery, Shriners Hospitals for Children Northern California, Sacramento, CA
| | - Shari A Toomey
- Respiratory Department/Sleep Center, Carilion Clinic Children's Hospital, Roanoke, VA
| | | | - Srinivas Murthy
- Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | - Heatherlee Bailey
- Department of Emergency Medicine, Durham Veterans Affairs Medical Center, Durham, NC
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Stearns RL, Hosokawa Y, Belval LN, Martin DG, Huggins RA, Jardine JF, Casa DJ. Exertional Heat Stroke Survival at the Falmouth Road Race: 180 New Cases With Expanded Analysis. J Athl Train 2024; 59:304-309. [PMID: 37655801 PMCID: PMC10976335 DOI: 10.4085/1062-6050-0065.23] [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] [Indexed: 09/02/2023]
Abstract
CONTEXT A high number of exertional heat stroke (EHS) cases occur during the Falmouth Road Race. OBJECTIVES To extend previous analyses of EHS cases during the Falmouth Road Race by assessing or describing (1) EHS and heat exhaustion (HE) incidence rates, (2) EHS outcomes as they relate to survival, (3) the effect of the environment on these outcomes, and (4) how this influences medical provider planning and preparedness. DESIGN Descriptive epidemiologic study. SETTING Falmouth Road Race. PATIENTS OR OTHER PARTICIPANTS Patients with EHS or HE admitted to the medical tent. MAIN OUTCOME MEASURE(S) We obtained 8 years (2012 to 2019) of Falmouth Road Race anonymous EHS and HE medical records. Meteorologic data were collected and analyzed to evaluate the effect of environmental conditions on the heat illness incidence (exertional heat illness [EHI] = EHS + HE). The EHS treatment and outcomes (ie, cooling time, survival, and discharge outcome), number of HE patients, and wet bulb globe temperature (WBGT) for each race were analyzed. RESULTS A total of 180 EHS and 239 HE cases were identified. Overall incidence rates per 1000 participants were 2.07 for EHS and 2.76 for HE. The EHI incidence rate was 4.83 per 1000 participants. Of the 180 EHS cases, 100% survived, and 20% were transported to the emergency department. The WBGT was strongly correlated with the incidence of both EHS (r2 = 0.904, P = .026) and EHI (r2 = 0.912, P = .023). CONCLUSIONS This is the second-largest civilian database of EHS cases reported. When combined with the previous dataset of EHS survivors from this race, it amounts to 454 EHS cases resulting in 100% survival. The WBGT remained a strong predictor of EHS and EHI cases. These findings support 100% survival from EHS when patients over a wide range of ages and sexes are treated with cold-water immersion.
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Affiliation(s)
- Rebecca L. Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | | | - David G. Martin
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Robert A. Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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13
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Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med 2024; 35:112S-127S. [PMID: 38425235 DOI: 10.1177/10806032241227924] [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] [Indexed: 03/02/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
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Affiliation(s)
- Kurt P Eifling
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Flavio G Gaudio
- Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, NY
| | - Charles Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | | | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - August D Martin
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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14
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Flouris AD, Notley SR, Stearns RL, Casa DJ, Kenny GP. Recommended water immersion duration for the field treatment of exertional heat stroke when rectal temperature is unavailable. Eur J Appl Physiol 2024; 124:479-490. [PMID: 37552243 DOI: 10.1007/s00421-023-05290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The recommended treatment for exertional heat stroke is immediate, whole-body immersion in < 10 °C water until rectal temperature (Tre) reaches ≤ 38.6 °C. However, real-time Tre assessment is not always feasible or available in field settings or emergency situations. We defined and validated immersion durations for water temperatures of 2-26 °C for treating exertional heat stroke. METHODS We compiled data for 54 men and 18 women from 7 previous laboratory studies and derived immersion durations for reaching 38.6 °C Tre. The resulting immersion durations were validated against the durations of cold-water immersion used to treat 162 (98 men; 64 women) exertional heat stroke cases at the Falmouth Road Race between 1984 and 2011. RESULTS Age, height, weight, body surface area, body fat, fat mass, lean body mass, and peak oxygen uptake were weakly associated with the cooling time to a safe Tre of 38.6 °C during immersions to 2-26 °C water (R2 range: 0.00-0.16). Using a specificity criterion of 0.9, receiver operating characteristics curve analysis showed that exertional heat stroke patients must be immersed for 11-12 min when water temperature is ≤ 9 °C, and for 18-19 min when water temperature is 10-26 °C (Cohen's Kappa: 0.32-0.75, p < 0.001; diagnostic odds ratio: 8.63-103.27). CONCLUSION The reported immersion durations are effective for > 90% of exertional heat stroke patients with pre-immersion Tre of 39.5-42.8 °C. When available, real-time Tre monitoring is the standard of care to accurately diagnose and treat exertional heat stroke, avoiding adverse health outcomes associated with under- or over-cooling, and for implementing cool-first transport second exertional heat stroke policies.
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Affiliation(s)
- Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Defence Science and Technology Group, Melbourne, VIC, Australia
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Montpetit Hall, 125 University Private, Room 367, Ottawa, ON, K1N 6N5, Canada.
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15
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van de Kerkhof TM, Bongers CCWG, Périard JD, Eijsvogels TMH. Performance Benefits of Pre- and Per-cooling on Self-paced Versus Constant Workload Exercise: A Systematic Review and Meta-analysis. Sports Med 2024; 54:447-471. [PMID: 37803106 PMCID: PMC10933154 DOI: 10.1007/s40279-023-01940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Exercise in hot environments impairs endurance performance. Cooling interventions can attenuate the impact of heat stress on performance, but the influence of an exercise protocol on the magnitude of performance benefit remains unknown. This meta-analytical review compared the effects of pre- and per-cooling interventions on performance during self-paced and constant workload exercise in the heat. METHODS The study protocol was preregistered at the Open Science Framework ( https://osf.io/wqjb3 ). A systematic literature search was performed in PubMed, Web of Science, and MEDLINE from inception to 9 June, 2023. We included studies that examined the effects of pre- or per-cooling on exercise performance in male individuals under heat stress (> 30 °C) during self-paced or constant workload exercise in cross-over design studies. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized trials. RESULTS Fifty-nine studies (n = 563 athletes) were identified from 3300 records, of which 40 (n = 370 athletes) used a self-paced protocol and 19 (n = 193 athletes) used a constant workload protocol. Eighteen studies compared multiple cooling interventions and were included more than once (total n = 86 experiments and n = 832 paired measurements). Sixty-seven experiments used a pre-cooling intervention and 19 used a per-cooling intervention. Average ambient conditions were 34.0 °C [32.3-35.0 °C] and 50.0% [40.0-55.3%] relative humidity. Cooling interventions attenuated the performance decline in hot conditions and were more effective during a constant workload (effect size [ES] = 0.62, 95% confidence interval [CI] 0.44-0.81) compared with self-paced exercise (ES = 0.30, 95% CI 0.18-0.42, p = 0.004). A difference in performance outcomes between protocols was only observed with pre-cooling (ES = 0.74, 95% CI 0.50-0.98 vs ES = 0.29, 95% CI 0.17-0.42, p = 0.001), but not per-cooling (ES = 0.45, 95% CI 0.16-0.74 vs ES = 0.35, 95% CI 0.01-0.70, p = 0.68). CONCLUSIONS Cooling interventions attenuated the decline in performance during exercise in the heat, but the magnitude of the effect is dependent on exercise protocol (self-paced vs constant workload) and cooling type (pre- vs per-cooling). Pre-cooling appears to be more effective in attenuating the decline in exercise performance during a constant workload compared with self-paced exercise protocols, whereas no differences were found in the effectiveness of per-cooling.
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Affiliation(s)
- Tessa M van de Kerkhof
- Department of Physiology (392), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Coen C W G Bongers
- Department of Physiology (392), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- School of Sports and Exercise, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Julien D Périard
- University of Canberra Research Institute for Sport and Exercise, Canberra, ACT, Australia
| | - Thijs M H Eijsvogels
- Department of Physiology (392), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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16
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Stacey MJ, Brett S, Fitchett G, Hill NE, Woods D. What do environment-related illnesses tell us about the character of military medicine and future clinical requirements? BMJ Mil Health 2024; 170:43-46. [PMID: 34686561 DOI: 10.1136/bmjmilitary-2021-001934] [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: 07/01/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Abstract
Extreme environments present medical and occupational challenges that extend beyond generic resuscitation, to formulating bespoke diagnoses and prognoses and embarking on management pathways rarely encountered in civilian practice. Pathophysiological complexity and clinical uncertainty call for military physicians of all kinds to balance intuition with pragmatism, adapting according to the predominant patterns of care required. In an era of smaller operational footprints and less concentrated clinical experience, proposals aimed at improving the systematic care of Service Personnel incapacitated at environmental extremes must not be lost to corporate memory. These general issues are explored in the particular context of thermal stress and metabolic disruption. Specific focus is given to the accounts of military physicians who served on large-scale deployments into the heat of Iraq and Kuwait (Operation TELIC) and Oman (Exercise SAIF SAREEA). Generalisable insights into the enduring character of military medicine and future clinical requirements result.
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Affiliation(s)
- Michael John Stacey
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - S Brett
- Faculty of Medicine, Imperial College London, London, UK
| | - G Fitchett
- Blood Far Forward, British Army HQ, Andover, UK
| | - N E Hill
- Faculty of Medicine, Imperial College London, London, UK
| | - D Woods
- Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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Bultas MW, Oerther S. The Role of the School Nurse in Addressing Climate-Associated Illnesses: Heat. NASN Sch Nurse 2024:1942602X231223158. [PMID: 38193318 DOI: 10.1177/1942602x231223158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Extremely hot or humid days are anticipated to continue, occur more often, and intensify over time. School-age children are especially vulnerable to extreme heat. The primary acute health effects of heat on children can range from heat exhaustion to heatstroke. The purpose of this article is to raise awareness of the impact some acute heat-related illnesses have on school-age children's health and to provide school nurses with information on the signs and symptoms of heat-related illnesses as well as prevention tips to share with parents and school administrators. This is the fifth article in a series meant to inform school nurses about illnesses linked to the climate and provide them with the tools they need to safeguard children' health.
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Affiliation(s)
- Margaret W Bultas
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, MO
| | - Sarah Oerther
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, MO
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18
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Boden BP, Anderson SA, Sheehan FT. Catastrophic Sports Injuries: Causation and Prevention. J Bone Joint Surg Am 2024; 106:62-73. [PMID: 37988459 DOI: 10.2106/jbjs.23.00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.
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Affiliation(s)
- Barry P Boden
- The Orthopaedic Center, The Centers for Advanced Orthopaedics, Rockville, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland
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19
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Danzig RM, Raunig JM, Acholonu CJ. Exertional Heat Illness-From Identifying Heat Rash to Treating Heat Stroke. Pediatr Ann 2024; 53:e17-e21. [PMID: 38194658 DOI: 10.3928/19382359-20231113-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Heat-related illness commonly affects adolescent patients, especially as summer approaches and global temperature extremes worsen. Basic counseling on sunburn prevention can decrease the risk for future malignancies, and rapidly preventing, identifying, and treating heat stroke can prevent severe morbidity and mortality. This article will review the epidemiology of exertional heat-related illness and the variations in presentations and pathology, from heat rash and sunburn to heat exhaustion and heat stroke. By the end of this review clinicians should be able to identify and treat different heat-related illnesses in adolescents and potentially save a life. [Pediatr Ann. 2024;53(1):e17-e21.].
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20
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Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators. Sports Health 2024; 16:58-69. [PMID: 36872595 PMCID: PMC10732114 DOI: 10.1177/19417381231155107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. HYPOTHESIS We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants' zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption. RESULTS Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%). CONCLUSION Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. CLINICAL RELEVANCE Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.
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Affiliation(s)
| | - William M. Adams
- Division of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado
| | - Kelly A. Coleman
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, Connecticut
| | - Rebecca M. Lopez
- University of South Florida, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, Tampa, Florida
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Ashley CD, Lopez RM, Tritsch AJ. Football Practices in Hot Environments Impact Subsequent Days' Hydration. J Strength Cond Res 2024; 38:90-96. [PMID: 37815236 DOI: 10.1519/jsc.0000000000004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT Ashley, CD, Lopez, RM, and Tritsch, AJ. Football practices in hot environments impact subsequent days' hydration. J Strength Cond Res 38(1): 90-96, 2024-The impact of proper hydration to prevent exertional heat illness in American football has not been evaluated during high school preseason football practices in a hot environment (wet-bulb globe temperature = 31.3 ± 1.8° C). The purposes of this study were to examine the accuracy of urinary hydration measures to assess body mass (BM) changes and to examine carryover effects of consecutive practices by comparing postpractice with the next prepractice values. Before and after each of 7 outdoor practices, 31 male high school football players (age = 16 ± 1 years, height = 181.2 ± 12.0 cm, BM = 85.7 ± 19.1 kg, body mass index = 20.8 ± 1.8) provided a urine sample and were weighed to assess hydration. Sensitivity and specificity of urine color (Ucol) and urine-specific gravity (USG) to determine BM changes were determined using receiver operating characteristic (ROC) analysis. Paired samples t -tests assessed carryover effects between practices. Repeated-measures analysis of variance assessed carryover effects across practices. Significance was set at p < 0.05. Sensitivity and specificity for using Ucol or USG to determine BM changes was not significant. For Ucol, there was a carryover effect from practice numbers 2 to 3, 6 to 7 am , 7 am to 7 pm ( p < 0.001 for all), and 10 to 11 ( p = 0.004); most with less than 24 hours between practices. The %BM loss (%BML) was significantly greater ( p = 0.001 to 0.024) after 2-a-day practices. Effects of previous days' exercise in the heat, as evidenced by higher Ucol and %BL, are greater after 2-a-day practices, which occurred on later practice days. Athletes must replenish fluids during and between practices to remain euhydrated.
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Affiliation(s)
- Candi D Ashley
- Department of Educational and Psychological Studies, University of South Florida, Tampa, Florida; and
| | - Rebecca M Lopez
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa, Florida
| | - Amanda J Tritsch
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa, Florida
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22
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Verdegaal ELJMM, Howarth GS, McWhorter TJ, Delesalle CJG. Thermoregulation during Field Exercise in Horses Using Skin Temperature Monitoring. Animals (Basel) 2023; 14:136. [PMID: 38200867 PMCID: PMC10777899 DOI: 10.3390/ani14010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Hyperthermia and exertional heat illness (EHI) are performance and welfare issues for all exercising horses. Monitoring the thermoregulatory response allows for early recognition of metabolic heat accumulation during exercise and the possibility of taking prompt and effective preventative measures to avoid a further increase in core body temperature (Tc) leading to hyperthermia. Skin temperature (Tsk) monitoring is most used as a non-invasive tool to assess the thermoregulatory response pre- and post-exercise, particularly employing infrared thermographic equipment. However, only a few studies have used thermography to monitor skin temperature continuously during exercise. This commentary provides an overview of studies investigating surface skin temperature mainly by infrared thermography (IRT) during exercise. The scientific evidence, including methodologies, applications, and challenges associated with (continuous) skin temperature monitoring in horses during field exercise, is discussed. The commentary highlights that, while monitoring Tsk is straightforward, continuous Tsk alone does not always reliably estimate Tc evolvement during field exercise. In addition, inter-individual differences in thermoregulation need to be recognized and accounted for to optimize individual wellbeing. With the ongoing development and application of advanced wearable monitoring technology, there may be future advances in equipment and modeling for timely intervention with horses at hyperthermic risk to improve their welfare. However, at this point, infrared thermographic assessment of Tsk should always be used in conjunction with other clinical assessments and veterinary examinations for a reliable monitoring of the welfare of the horse.
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Affiliation(s)
- Elisabeth-Lidwien J. M. M. Verdegaal
- Thermoregulation Research Group, Equine Health and Performance Centre, University of Adelaide, Roseworthy, SA 5116, Australia; (G.S.H.); (T.J.M.); (C.J.G.D.)
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Roseworthy, SA 5371, Australia
- Research Group of Comparative Physiology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Gordon S. Howarth
- Thermoregulation Research Group, Equine Health and Performance Centre, University of Adelaide, Roseworthy, SA 5116, Australia; (G.S.H.); (T.J.M.); (C.J.G.D.)
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Roseworthy, SA 5371, Australia
| | - Todd J. McWhorter
- Thermoregulation Research Group, Equine Health and Performance Centre, University of Adelaide, Roseworthy, SA 5116, Australia; (G.S.H.); (T.J.M.); (C.J.G.D.)
- School of Animal and Veterinary Sciences, Roseworthy Campus, University of Adelaide, Roseworthy, SA 5371, Australia
| | - Catherine J. G. Delesalle
- Thermoregulation Research Group, Equine Health and Performance Centre, University of Adelaide, Roseworthy, SA 5116, Australia; (G.S.H.); (T.J.M.); (C.J.G.D.)
- Research Group of Comparative Physiology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
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23
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McDermott BP, Atkins WC. Response on: Whole-body cooling effectiveness of cold intravenous saline following exercise hyperthermia. Am J Emerg Med 2023; 74:165-166. [PMID: 37793950 DOI: 10.1016/j.ajem.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Brendon P McDermott
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, United States of America.
| | - Whitley C Atkins
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, United States of America; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, United States of America.
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24
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Masoud AA, Alansare AB, Finch AE. Physiological effects of exercise in heat while wearing a polyester versus cotton T-shirt in physically active men with obesity: a pilot study. J Sports Med Phys Fitness 2023; 63:1358-1365. [PMID: 37721720 DOI: 10.23736/s0022-4707.23.15164-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Obesity may impair evaporation especially during exercising in heat. Polyester sportwear is proposed to improve the evaporation but its effectiveness remains overlooked. We investigated physiological effects of exercise in heat while wearing a polyester versus cotton T-shirt on thermoregulation, perspiration, and cardiovascular regulations. METHODS Physically active men with obesity (N.=7; 21.7±1.7 years old; VO2peak 36.8±8.7 mL/kg/min; body fat percentage 34.7±4.3%) performed two randomized, crossover walking sessions for 30 mins (27 °C; 12% relative humidity) while wearing a polyester or cotton T-shirt, separated by a 7-day wash out period. Thermoregulation was assessed by measuring tympanic, torso (back and chest), and peripheral (forehead and forearm) skin temperatures. Perspiration rate was estimated as the difference in body weight (pre minus post walking). Heart rate was measured by a Polar heart rate monitor. Systolic and diastolic blood pressure were measured by a sphygmomanometer. All measurements were performed pre, during, and post each session. Two-way ANOVA examined main effects of time, fabric type, and their interactions on the study's outcomes. RESULTS Back and chest temperatures increased (∆=1.6 °C and 0.9 °C, respectively) while forehead and forearm temperatures decreased (∆=-0.5 °C and -1.6 °C, respectively) over time (P<0.05 for all). Only forehead temperature had an interaction effect for time by fabric type where greater decrease was observed during the polyester T-shirt session compared to the cotton T-shirt session (∆=-0.1 vs. -0.8 °C; P=0.016). Heart rate (∆=27.8 beat/min) and systolic blood pressure (∆=7.5 mmHg) increased while diastolic blood pressure (∆=-5.0 mmHg) decreased over time (P<0.05 for all). No difference observed for perspiratory rate (P>0.05). CONCLUSIONS The current findings do not support the superiority of polyester or cotton sportwear for better thermoregulatory, perspiratory, and cardiovascular regulations in physically active men with obesity. Future research should examine the effectiveness of other alternative fabrics of sportwear for better physiological responses when exercising in the heat, particularly in adults with obesity.
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Affiliation(s)
- Abdulaziz A Masoud
- Department of Physical Education, College of Education, Jazan University, Jazan, Saudi Arabia
- University of New Mexico, Department of Health Exercise and Sport Sciences, Albuquerque, NM, USA
| | - Abdullah B Alansare
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia -
| | - Alfred E Finch
- Department of Kinesiology, Recreation, and Sport, College of Health and Human Services, Indiana State University, Terre Haute, IN, USA
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Willmott AGB, James CA, Hayes M, Maxwell NS, Roberts J, Gibson OR. The reliability of a portable steam sauna pod for the whole-body passive heating of humans. J Therm Biol 2023; 118:103743. [PMID: 37979477 DOI: 10.1016/j.jtherbio.2023.103743] [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: 06/23/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Passive heating is receiving increasing attention within human performance and health contexts. A low-cost, portable steam sauna pod may offer an additional tool for those seeking to manipulate physiological (cardiovascular, thermoregulatory and sudomotor) and perceptual responses for improving sporting or health profiles. This study aimed to 1) report the different levels of heat stress and determine the pods' inter-unit reliability, and 2) quantify the reliability of physiological and perceptual responses to passive heating. METHOD In part 1, five pods were assessed for temperature and relative humidity (RH) every 5 min across 70 min of heating for each of the 9 settings. In part 2, twelve males (age: 24 ± 4 years) completed two 60 min trials of passive heating (3 × 20 min at 44 °C/99% RH, separated by 1 week). Heart rate (HR), rectal (Trectal) and tympanic temperature (Ttympanic) were recorded every 5 min, thermal comfort (Tcomfort) and sensation (Tsensation) every 10 min, mean arterial pressure (MAP) at each break period and sweat rate (SR) after exiting the pod. RESULTS In part 1, setting 9 provided the highest temperature (44.3 ± 0.2 °C) and longest time RH remained stable at 99% (51±7 min). Inter-unit reliability data demonstrated agreement between pods for settings 5-9 (intra-class correlation [ICC] >0.9), but not for settings 1-4 (ICC <0.9). In part 2, between-visits, high correlations, and low typical error of measurement (TEM) and coefficient of variation (CV) were found for Trectal, HR, MAP, SR, and Tcomfort, but not for Ttympanic or Tsensation. A peak Trectal of 38.09 ± 0.30 °C, HR of 124 ± 15 b min-1 and a sweat loss of 0.73 ± 0.33 L were reported. No between-visit differences (p > 0.05) were observed for Trectal, Ttympanic, Tsensation or Tcomfort, however HR (+3 b.min-1) and MAP (+4 mmHg) were greater in visit 1 vs. 2 (p < 0.05). CONCLUSION Portable steam sauna pods generate reliable heat stress between-units. The highest setting (44 °C/99% RH) also provides reliable but modest adjustments in physiological and perceptual responses.
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Affiliation(s)
- A G B Willmott
- Cambridge Centre for Sport and Exercise Sciences (CCSES), Anglia Ruskin University, Cambridge, UK; Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK.
| | - C A James
- Hong Kong Sports Institute (HKSI), Hong Kong; Department of Sport, Physical Education and Health, Hong Kong Baptist University. Kowloon Tong, Hong Kong
| | - M Hayes
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - N S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - J Roberts
- Cambridge Centre for Sport and Exercise Sciences (CCSES), Anglia Ruskin University, Cambridge, UK
| | - O R Gibson
- Centre for Physical Activity in Health and Disease (CHPAD), Division of Sport, Health and Exercise Sciences, Brunel University London, Uxbridge, UK
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Cusack B, Cash M, Tuohy K, Brady-Olympia J, Olympia RP. Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers: Compliance With Emergency Medicine and Athletic Trainer Evidence-Based Guidelines. Pediatr Emerg Care 2023; 39:945-952. [PMID: 38019713 DOI: 10.1097/pec.0000000000003073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. METHODS A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. RESULTS Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. CONCLUSIONS Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.
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Affiliation(s)
- Bryan Cusack
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
| | - Morgan Cash
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
| | - Kyle Tuohy
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA
| | - Jodi Brady-Olympia
- From the Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
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Oki K, Ward JA, Ward SM, Plamper ML, Henderson CG, Mayer TA, Caldwell AR, Leon LR. Vancomycin modestly attenuates symptom severity during onset of and recovery from exertional heat stroke in mice. J Appl Physiol (1985) 2023; 135:1348-1359. [PMID: 37881848 PMCID: PMC10979831 DOI: 10.1152/japplphysiol.00368.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Increased intestinal permeability during exertion and subsequent leakage of bacteria into circulation is hypothesized to accelerate exertional heat stroke (EHS) onset and/or exacerbate EHS severity. To provide proof of concept for this theory, we targeted intestinal microbiota via antibiotic prophylaxis and determined whether vancomycin would delay EHS onset and/or mitigate EHS severity and mortality rates using a mouse model of EHS. Mice were 1) designated as EHS or Exercise Control (ExC) and 2) given 7 days of vancomycin (VEHS, VExC) or untreated water (EHS, ExC) before EHS/Exercise. Following EHS/ExC, mice were euthanized immediately (0 h) or returned to their home cage (25°C) and euthanized after 3 h or 24 h. VEHS mice exhibited reduced abundance and altered composition of fecal bacteria (with notable decreases in genera within orders Clostridiales and Bacteroidales); increased water consumption, lower core temperature (TC) before and during heating (TCMax), lower circulating markers of organ damage and inflammation at 24 h; and reduced hepatic activation of stress pathways at 0 and 3 h compared with EHS mice. Vancomycin-induced alterations to the intestinal microbiota likely influenced EHS outcomes, but it is unconfirmed whether this is due to attenuated bacterial leakage into circulation or other (in)direct effects on physiology and behavior (e.g., decreased TC, increased water consumption). To our knowledge, this is the first study quantitating antibiotic effects in conscious/unanesthetized, exertional HS animals.NEW & NOTEWORTHY Vancomycin prophylaxis lowered core temperature before and during EHS, mitigated EHS-associated rise of hepatic biomarkers and cytokines/chemokines in circulation (particularly at 24 h), and corresponded to inhibited phosphorylation of hepatic c-Jun NH2-terminal kinase on Threonine 183/Tyrosine 185 at 0 and 3 h in conscious, unanesthetized mice. However, vancomycin also induced cecal enlargement suggesting its off-target effects could limit its utility against EHS.
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Affiliation(s)
- Kentaro Oki
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Jermaine A Ward
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Shauna M Ward
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Mark L Plamper
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Chloe G Henderson
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Oak Ridge Institute of Science and Education, Oak Ridge, Tennessee, United States
| | - Thomas A Mayer
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Aaron R Caldwell
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Oak Ridge Institute of Science and Education, Oak Ridge, Tennessee, United States
| | - Lisa R Leon
- Thermal and Mountain Medicine Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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Pryor RR, Haboian K, Fitts T, Stooks JJ. Tarp-Assisted Cooling for Exertional Heat Stroke Treatment in Wildland Firefighting. Wilderness Environ Med 2023; 34:490-497. [PMID: 37748988 DOI: 10.1016/j.wem.2023.08.002] [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: 06/06/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Exertional heat stroke is a life-threatening emergency necessitating immediate treatment with rapid body cooling. A field-expedient alternative may be tarp-assisted cooling, requiring only water and a tarp. The objective of this study was to compare core temperature (Tc) cooling rates of tarp-assisted cooling using the limited resources available to a wildland firefighter and the current standard care provided in wilderness settings. METHODS This cross-over, randomized control trial of 17 healthy individuals consisted of exercise in a 42±1°C, 32±4% relative humidity environment while wearing wildland firefighter attire, followed by cooling. Body cooling consisted of either pouring 11 L of 25±1°C water over the torso while lying supine on a tarp configured to hold water close to the individual (Tarp) or dousing the water on the participant followed by lying supine with a light breeze, current standard care in the wilderness (Current Care). Cooling occurred until Tc reached 38°C. RESULTS Participants walked until a similar Tc was achieved in Tarp (39.59±0.04°C) and Current Care (39.55±0.22°C; P=0.36). Core temperature cooling rate was not different between Tarp (0.076±0.042°C·min-1) and Current Care (0.088±0.046°C·min-1; P=0.41). CONCLUSIONS In hyperthermic individuals, Tarp did not provide a faster cooling rate compared to the current exertional heat stroke care provided in the wilderness, and both provided a slower cooling rate than that provided by the traditional method of cold water immersion (>0.20°C·min-1) to treat exertional heat stroke patients.
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Affiliation(s)
- Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY.
| | - Kara Haboian
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Triniti Fitts
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Jocelyn J Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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Kelly MR, Emerson DM, McDermott BP, Atkins WC, Butts CL, Laursen RM, Troyanos C, Duckett A, Siedlik J. Gastrointestinal cell injury and perceived symptoms after running the Boston Marathon. Front Physiol 2023; 14:1268306. [PMID: 37908334 PMCID: PMC10615131 DOI: 10.3389/fphys.2023.1268306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Abstract
Gastrointestinal (GI) disturbances are a prevalent cause of marathon related complaints, and in extreme cases can promote life-threatening conditions such as exertional heat stroke. Our aim was to study intestinal cell injury [via intestinal fatty acid binding protein (I-FABP)] and perceived GI distress symptoms among marathon runners. We also examined potential risk factors (e.g., inadequate sleep) that could exacerbate GI disturbances in healthy, trained endurance runners. This was a parallel mixed-methods study design. 2019 Boston Marathon participants were recruited via email and subjects completed surveys before the race describing demographics and training history. Participants completed a GI questionnaire to assess presence and severity of symptoms, a survey regarding risk factors (e.g., recent illness, medications) that could promote GI disturbances, and provided a urine sample at three time points (immediately pre-race, post-race, and 24-h post-race). Due to weather, blood samples were only collected immediately and 24-h post-race. A total of 40 runners (males: n = 19, age = 44.9 ± 10.8 years; females: n = 21, age = 44.8 ± 10.6 years) completed this study. I-FABP significantly decreased from post-race (3367.5 ± 2633.5 pg/mL) to 24-h post-race (1657.3 ± 950.7 pg/mL, t (39) = -4.228, p < .001, d = -.669). There was a significant difference in overall GI symptom scores across the three time points (F (2, 39) = 41.37, p < .001). The highest average score occurred post-race (.84 ± .68), compared to pre-race (.09 ± .12) and 24-h post-race (.44 ± .28). Post-race I-FABP (r = .31, p = .048) and post-race urine specific gravity (r = .33, p = .041) were significantly correlated with post-race GI symptom scores. Our study provides further support to the individualized nature of GI disturbances, with participants experiencing a wide range of risk factors that can influence the extent of GI damage and perceived symptoms during and after exercise.
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Affiliation(s)
- Melani R. Kelly
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, United States
- Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, UT, United States
| | - Dawn M. Emerson
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, United States
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Brendon P. McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Whitley C. Atkins
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, United States
| | - Cory L. Butts
- Department of Exercise and Nutrition Sciences, Weber State University, Ogden, UT, United States
| | - R. Mark Laursen
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | | | - Andrew Duckett
- Department of Athletics, Boston University, Boston, MA, United States
| | - Jacob Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, United States
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ALKEMADE PUCK, DE KORTE JOHANNUSQ, BONGERS COENCWG, DAANEN HEINAM, HOPMAN MARIATE, JANSSEN THOMASWJ, EIJSVOGELS THIJSMH. Humid Heat Equally Impairs Maximal Exercise Performance in Elite Para-Athletes and Able-Bodied Athletes. Med Sci Sports Exerc 2023; 55:1835-1844. [PMID: 37227231 PMCID: PMC10487364 DOI: 10.1249/mss.0000000000003222] [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] [Indexed: 05/26/2023]
Abstract
PURPOSE This study aimed to compare the impact of hot-humid environmental conditions on performance outcomes, thermoregulatory responses, and thermal perception during exercise between elite para- and able-bodied (AB) athletes. METHODS Twenty elite para-athletes (para-cycling and wheelchair tennis) and 20 elite AB athletes (road cycling, mountain biking, beach volleyball) performed an incremental exercise test in a temperate environment (mean ± SD, 15.2°C ± 1.2°C; relative humidity, 54% ± 7%) and a hot-humid environment (31.9°C ± 1.6°C, 72% ± 5%). Exercise tests started with a 20-min warm-up at 70% of maximal heart rate, after which power output increased by 5% every 3 min until volitional exhaustion. RESULTS Time to exhaustion was shorter in hot-humid versus temperate conditions, with equal performance loss for para- and AB athletes (median (interquartile range), 26% (20%-31%) vs 27% (19%-32%); P = 0.80). AB athletes demonstrated larger exercise-induced increases in gastrointestinal temperature (T gi ) in hot-humid versus temperate conditions (2.2 ± 0.7 vs 1.7 ± 0.5, P < 0.001), whereas T gi responses in para-athletes were similar between conditions (1.3 ± 0.6 vs 1.3 ± 0.4, P = 0.74). Para- and AB athletes showed similar elevations in peak skin temperature ( P = 0.94), heart rate ( P = 0.67), and thermal sensation score ( P = 0.64) in hot-humid versus temperate conditions. CONCLUSIONS Elite para-athletes and AB athletes demonstrated similar performance decrements during exercise in hot-humid versus temperate conditions, whereas T gi elevations were markedly lower in para-athletes. We observed large interindividual variation within both groups, suggesting that in both para- and AB athletes, personalized heat mitigation plans should be developed based on individual thermal testing.
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Affiliation(s)
- PUCK ALKEMADE
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
| | - JOHANNUS Q. DE KORTE
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - COEN C. W. G. BONGERS
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - HEIN A. M. DAANEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
| | - MARIA T. E. HOPMAN
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - THOMAS W. J. JANSSEN
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, THE NETHERLANDS
- Amsterdam Institute of Sport Science, Amsterdam, THE NETHERLANDS
| | - THIJS M. H. EIJSVOGELS
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
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Singh G, Bennett KJ, Taylor L, Stevens CJ. Core body temperature responses during competitive sporting events: A narrative review. Biol Sport 2023; 40:1003-1017. [PMID: 37867748 PMCID: PMC10588574 DOI: 10.5114/biolsport.2023.124842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/12/2022] [Accepted: 11/26/2022] [Indexed: 10/24/2023] Open
Abstract
Due to the lack of research in real-world sports competitions, the International Olympic Committee, in 2012, called for data characterising athletes' sport and event-specific thermal profiles. Studies clearly demonstrate that elite athletes often attain a core body temperature (Tc) ≥ 40°C without heat-related medical issues during competition. However, practitioners, researchers and ethical review boards continue to cite a Tc ≥ 40°C (and lower) as a threshold where athlete health is impacted (an assumption from laboratory studies). Therefore, this narrative review aims to: (i) summarise and review published data on Tc responses during competitive sport and identify key considerations for practitioners; (ii) establish the incidence of athletes experiencing a Tc ≥ 40°C in competitive sport alongside the incidence of heat illness/heat stroke (EHI/EHS) symptoms; and (iii) discuss the evolution of Tc measurement during competition. The Tc response is primarily based on the physical demands of the sport, environmental conditions, competitive level, and athlete disability. In the reviewed research, 11.9% of athletes presented a Tc ≥ 40°C, with only 2.8% of these experiencing EHI/EHS symptoms, whilst a high Tc ≥ 40°C (n = 172; Tc range 40-41.5°C) occurred across a range of sports and environmental conditions (including some temperate environments). Endurance athletes experienced a Tc ≥ 40°C more than intermittent athletes, but EHI/EHS was similar. This review demonstrates that a Tc ≥ 40°C is not a consistently meaningful risk factor of EHI/EHS symptomology in this sample; therefore, Tc monitoring alongside secondary measures (i.e. general cognitive disturbance and gait disruption) should be incorporated to reduce heat-related injuries during competition.
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Affiliation(s)
- Gurpreet Singh
- Physical Activity, Sport, and Exercise Research Theme, Faculty of Health, Southern Cross University, Australia
| | - Kyle J.M. Bennett
- Physical Activity, Sport, and Exercise Research Theme, Faculty of Health, Southern Cross University, Australia
| | - Lee Taylor
- Loughborough University, School of Sport, Exercise and Health Sciences, Loughborough, UK
- University of Technology, Sydney (UTS), Human Performance Research Centre, Sydney, Australia
- University of Technology Sydney (UTS), Sport & Exercise Discipline Group, Faculty of Health, Sydney, Australia
| | - Christopher J. Stevens
- Physical Activity, Sport, and Exercise Research Theme, Faculty of Health, Southern Cross University, Australia
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O'Reilly M, Hu YWE, Gruber J, Jones DM, Daniel A, Marra J, Fraser JJ. Consistency and applicability of return to function guidelines in tactical-athletes with exertional heat illness. A systematic review. PHYSICIAN SPORTSMED 2023; 51:482-491. [PMID: 36239088 DOI: 10.1080/00913847.2022.2135973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. METHODS Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. RESULTS Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. CONCLUSIONS This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI .
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Affiliation(s)
- Matthew O'Reilly
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center San Diego, San Diego, CA, USA
| | - Yao-Wen Eliot Hu
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Jonathan Gruber
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- United States Navy Medicine Readiness and Training Unit, Naval Medical Center Camp Lejeune, Jacksonville, NC, USA
| | - Douglas M Jones
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
| | - Arthur Daniel
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - Janelle Marra
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- 17th Combat Logistics Regiment, 1st Marine Logistics Group, Camp Pendleton, CA, USA
| | - John J Fraser
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
- Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA, USA
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McDermott BP, Atkins WC. Whole-body cooling effectiveness of cold intravenous saline following exercise hyperthermia: a randomized trial. Am J Emerg Med 2023; 72:188-192. [PMID: 37562177 DOI: 10.1016/j.ajem.2023.07.053] [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: 07/07/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION In some athletic, occupational, military and emergency settings, cold intravenous (IV) fluids are used to facilitate whole-body cooling in an effort to treat heat illness. This treatment has anecdotal support, but currently lacks evidence supporting it as a whole-body cooling modality. Other modalities may offer superior cooling rates, and thus, patient outcomes following treatment. We sought to evaluate cooling rates of cold-IV normal saline immediately following exercise-induced hyperthermia. METHODS Eight healthy participants (3 females; 25 ± 2y; 72.9 ± 10.9 kg) completed 2 trials in random order. Prior to exercise, participants provided a small urine sample to confirm hydration status via urine specific gravity. Wet bulb globe temperature (WBGT) was assessed throughout trials. In both trials, participants exercised outdoors until rectal temperature (Tre) reached ∼38.9 °C, or volitional exhaustion, and then were cooled. In cooling, participants received either cold-IV (∼5 °C 0.9% NaCl fluids) or no treatment (sat in the shade; passive). Throughout exercise and treatment, Tre and heart rate (HR) were monitored. During exercise and every 10 min throughout cooling, participants were asked to assess thermal sensation. RESULTS Hydration status (P = .847) was not significantly different prior to exercise between trials. WBGT throughout was not different between trials (P = .426). Maximum Tre reached was not different between cold-IV (38.88 ± 0.30 °C) and passive cooling (38.76 ± 0.28 °C) trials (P = .184). Mean cooling rate for cold-IV (0.039 ± 0.005 °C·min-1) was significantly greater than for passive cooling (0.028 ± 0.005 °C·min-1; P = .002). Tre throughout cooling was not different between trials (P = .707), but did decrease throughout (P = .008), regardless of trial. HR was decreased over time (P < .001), but cold-IV and passive cooling were not different throughout HR recovery (P = .141). Thermal sensation decreased throughout cooling (P < .001), but was not different between trials (p = .278). CONCLUSION Emergency medical personnel should adopt treatment protocols that employ documented effective treatments for exertional heat stroke. In isolation, our data casts significant doubt for the use of cold-IV saline infusion for whole-body cooling of hyperthermic individuals.
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Affiliation(s)
- Brendon P McDermott
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, USA.
| | - Whitley C Atkins
- Exercise Science Research Center, University of Arkansas, Fayetteville, AR, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.
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Casa DJ, Szymanski MR, Jardine JF, Stearns RL, Adams WM, Eason CM, Hosokawa Y, Huggins RA, Lopez RM, McDermott BP, Miller KC, Nolan JK, Pryor RR, Scarneo-Miller SE, Vandermark LW. Letter on the 2023 ACSM Expert Consensus Statement on Exertional Heat Illness. Curr Sports Med Rep 2023; 22:336-337. [PMID: 37678353 DOI: 10.1249/jsr.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Michael R Szymanski
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - John F Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | | | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University. Tokorozawa, Saitama, Japan
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Brendon P McDermott
- Exercise Science Research Center, College of Education and Health Professions, University of Arkansas, Fayetteville, AR
| | - Kevin C Miller
- Texas State University, Department of Health and Human Performance, San Marcos, TX
| | - Julie K Nolan
- Athletic Training Education Program, Sacred Heart University, Fairfield, CT
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | | | - Lesley W Vandermark
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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Chen L, Xu S, Yang X, Zhao J, Zhang Y, Feng X. Association between cooling temperature and outcomes of patients with heat stroke. Intern Emerg Med 2023; 18:1831-1842. [PMID: 37133728 PMCID: PMC10504196 DOI: 10.1007/s11739-023-03291-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
This study explored the relationship between body temperature and adverse outcomes in patients with heat stroke to identify the optimal target body temperature within the first 24 h. This retrospective, multicentre study enrolled 143 patients admitted to the emergency department and diagnosed with heat stroke. The primary outcome was the in-hospital mortality rate, while secondary outcomes included the presence and number of damaged organs and neurological sequelae at discharge. A body temperature curve was built using a generalized additive mixed model, and the association between body temperatures and outcomes was established by logistic regression. The threshold and saturation effects were used to explore the targeted body temperature management. Cases were divided into the surviving and non-surviving groups. The cooling rate within the first 2 h was significantly higher in the survival group than the non-survival group (β: 0.47; 95% confidence interval [CI]: 0.09-0.84; P = 0.014), while the non-survival group exhibited a lower body temperature within 24 h (β: - 0.06; 95% CI: - 0.08 to - 0.03; P ≤ 0.001). Body temperature after 2 h (odds ratio [OR]: 2.27; 95% CI: 1.14-4.50; P = 0.019) and lowest temperature within 24 h (OR: 0.18; 95% CI: 0.06-0.55; P = 0.003) were significantly related to in-hospital mortality rate. When the body temperature at 0.5 h was 38.5-40.0 °C, the number of damaged organs was at its lowest. In patients with heat stroke, both hyperthermia and hypothermia were associated with adverse outcomes. Hence, an accurate body temperature management is required during the early stages of care.
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Affiliation(s)
- Lan Chen
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Shuying Xu
- Emergency Department, Dongyang People's Hospital, Dongyang, Zhejiang Province, China
| | - Xiaoling Yang
- Emergency Department, Lanxi People's Hospital, Lanxi, Zhejiang Province, China
| | - Junlu Zhao
- Emergency Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China
| | - Xiuqin Feng
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, 310009, Zhejiang, China.
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Bennett S, Tiollier E, Guibert E, Morales-Artacho A, Lalire P, Owens DJ, Morton JP, Brocherie F, Louis J. Environmental heat stress offsets adaptation associated with carbohydrate periodization in trained male triathletes. Scand J Med Sci Sports 2023; 33:1677-1689. [PMID: 37322619 DOI: 10.1111/sms.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Carbohydrate (CHO) intake periodization via the sleep low train low (SL-TL) diet-exercise model increases fat oxidation during exercise and may enhance endurance-training adaptation and performance. Conversely, training under environmental heat stress increases CHO oxidation, but the potential of combined SL-TL and heat stress to enhance metabolic and performance outcomes is unknown. METHODS Twenty-three endurance-trained males were randomly assigned to either control (n = 7, CON), SL-TL (n = 8, SLTemp ) or SL-TL + heat stress (n = 8, SLHeat ) groups and prescribed identical 2-week cycling training interventions. CON and SLTemp completed all sessions at 20°C, but SLHeat at 35°C. All groups consumed matched CHO intake (6 g·kg-1 ·day-1 ) but timed differently to promote low CHO availability overnight and during morning exercise in both SL groups. Submaximal substrate utilization was assessed (at 20°C), and 30-min performance tests (at 20 and 35°C) were performed Pre-, Post-, and 1-week post-intervention (Post+1). RESULTS SLTemp improved fat oxidation rates at 60% MAP (~66% VO2peak ) at Post+1 compared with CON (p < 0.01). Compared with SLTemp , fat oxidation rates were significantly lower in SLHeat at Post (p = 0.02) and Post+1 (p < 0.05). Compared with CON, performance was improved at Post in SLTemp in temperate conditions. Performance was not different between any groups or time points in hot conditions. CONCLUSION SL-TL enhanced metabolic adaptation and performance compared with CON and combined SL-TL and heat stress. Additional environmental heat stress may impair positive adaptations associated with SL-TL.
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Affiliation(s)
- Samuel Bennett
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Eve Tiollier
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Elodie Guibert
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Antonio Morales-Artacho
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Paul Lalire
- French Triathlon Federation (FFTri), Saint-Denis, France
| | - Daniel J Owens
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
| | - James P Morton
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
| | - Franck Brocherie
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Julien Louis
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
- Laboratory Sport, Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
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37
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Adams WM, Hosokawa Y, Scarneo-Miller SE, Belval LN. Enhancing exertional heat stroke patient care: where are we now and where do we need to go? Br J Sports Med 2023:bjsports-2023-106713. [PMID: 37344155 DOI: 10.1136/bjsports-2023-106713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Affiliation(s)
- William M Adams
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
- US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
- School of Sport, Exercise and Health Science, Loughborough University, Leicestershire, UK
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Luke N Belval
- Naval Submarine Medical Research Laboratory, Groton, Connecticut, USA
- Leidos Inc, Reston, Virginia, USA
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Jolicoeur Desroches A, Naulleau C, Deshayes TA, Pancrate T, Goulet EDB. CORE™ wearable sensor: Comparison against gastrointestinal temperature during cold water ingestion and a 5 km running time-trial. J Therm Biol 2023; 115:103622. [PMID: 37352596 DOI: 10.1016/j.jtherbio.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
Five km running time-trials (TT) are associated with rapid and significant increases in core body temperature (TC). For such races, real-time feedback from pre-exercise and exercise TC may be helpful in the design of an optimal pacing strategy aimed at limiting the possibility of developing heat-related illnesses. This study compared measurements of TC obtained with a wearable device, the CORE™, to those of a gastrointestinal pill (GI pill), during cold water ingestion and a 5 km running TT. Twelve participants (25 ± 4 yrs) ingested 7.5 mL/kg fat-free mass of 4 °C water over the first 5 min of a 120 min sitting period, after which they completed a 5 km running TT at 30 °C, 50% relative humidity. A TC difference > ± 0.25 °C between sensors was deemed clinically unacceptable. Prior to water ingestion, the CORE-derived TC was 0.49 ± 0.25 °C lower than the GI pill. The CORE was irresponsive to the 0.26 ± 0.22 °C peak decline in TC captured with the GI pill 40 min following water ingestion. Prior to the TT, TC was 0.30 ± 0.25 °C lower with the CORE than the GI pill. During the TT, the CORE underestimated the rate of increase in TC by 0.0125 ± 0.019 °C/min compared with the GI pill, and mean absolute difference in TC between sensors was of 0.47 ± 0.34 °C. In conclusion, the CORE does not capture the cooling effect of cold water ingestion and provides a clinically relevant underestimation of TC during a 5 km running TT in the heat.
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Affiliation(s)
| | - Catherine Naulleau
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada; Institut National du Sport du Québec, Montréal, Québec, Canada
| | - Thomas A Deshayes
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada; Research Centre on Aging, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Timothée Pancrate
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Eric D B Goulet
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada; Research Centre on Aging, University of Sherbrooke, Sherbrooke, Québec, Canada.
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Galan-Lopez N, Esh CJ, Leal DV, Gandini S, Lucas R, Garrandes F, Bermon S, Adami PE, Kajeniene A, Hosokawa Y, Chrismas BCR, Stevens CJ, Taylor L. Heat Preparation and Knowledge at the World Athletics Race Walking Team Championships Muscat 2022. Int J Sports Physiol Perform 2023:1-12. [PMID: 37279899 DOI: 10.1123/ijspp.2022-0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To assess elite racewalkers' preparation strategies, knowledge, and general practices for competition in the heat and their health status during the World Athletics Race Walking Teams Championships (WRW) Muscat 2022. METHODS Sixty-six elite racewalkers (male: n = 42; mean age = 25.8 y) completed an online survey prior to WRW Muscat 2022. Athletes were grouped by sex (males vs females) and climate (self-reported) they live/trained in (hot vs temperate/cold), with differences/relationships between groups assessed. Relationships between ranking (medalist/top 10 vs nonmedalist/nontop 10) and precompetition use of heat acclimation/acclimatization (HA) were assessed. RESULTS All surveyed medalists (n = 4) implemented, and top 10 finishers were more likely to report using (P = .049; OR = 0.25; 95% CI, 0.06%-1%), HA before the championships. Forty-three percent of athletes did not complete specific HA training. Females (8% [males 31%]) were less likely to have measured core temperature (P = .049; OR = 0.2; 95% CI, 0.041-0.99) and more likely to not know expected conditions in Muscat (42% vs 14%; P = .016; OR = 4.3; 95% CI, 1%-14%) or what wet bulb globe temperature is (83% vs 55%; P = .024; OR = 4.1; 95% CI, 1%-14%). CONCLUSIONS Athletes who implemented HA before the championships tended to place better than those who did not. Forty-three percent of athletes did not prepare for the expected hot conditions at the WRW Muscat 2022, primarily attributed to challenges in accessing and/or cost of equipment/facilities for HA strategies. Further efforts to bridge the gap between research and practice in this elite sport are needed, particularly in female athletes.
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Affiliation(s)
- Natalia Galan-Lopez
- School of Sport, Exercise and Health Sciences, National Center for Sport and Exercise Medicine (NCSEM), Loughborough University, Loughborough,United Kingdom
| | - Chris J Esh
- School of Sport, Exercise and Health Sciences, National Center for Sport and Exercise Medicine (NCSEM), Loughborough University, Loughborough,United Kingdom
- Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha,Qatar
| | - Diogo Vaz Leal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia,Portugal
| | - Silvia Gandini
- Centro Studi-Federazione Italiana di Atletica Leggera, Rome,Italy
| | | | - Frederic Garrandes
- Health and Science Department, World Athletics, Monaco
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice,France
| | - Stephane Bermon
- Health and Science Department, World Athletics, Monaco
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice,France
| | - Paolo Emilio Adami
- Health and Science Department, World Athletics, Monaco
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice,France
| | - Alma Kajeniene
- Department of Sports Medicine, Lithuanian University of Health Sciences, Kaunas,Lithuania
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Shinjuku-ku,Japan
| | | | - Christopher J Stevens
- Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, Coffs Harbour, NSW,Australia
| | - Lee Taylor
- School of Sport, Exercise and Health Sciences, National Center for Sport and Exercise Medicine (NCSEM), Loughborough University, Loughborough,United Kingdom
- Sport and Exercise Discipline Group, Faculty of Health, University of Technology Sydney, Moore Park, NSW,Australia
- Human Performance Research Center, University of Technology Sydney (UTS), Sydney, NSW,Australia
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40
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Wang X, Shang X, Li X, Liu S, Lai B, Ma L, Sun Y, Ma L, Ning B, Li Y, Wang Q. Phase-change material cooling blanket: A feasible cooling choice during transport after exercise-induced hyperthermia. J Therm Biol 2023; 114:103576. [PMID: 37344017 DOI: 10.1016/j.jtherbio.2023.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Exercise-induced hyperthermia preceding the onset of exertional heatstroke requires a rapid reduction in the body core temperature (Tcore) to ensure safety. In recent years, phase-change material (PCM) cooling devices have been increasingly used for rapid cooling after hyperthermia due to their superior capacity for heat absorption. OBJECTIVES This study aimed to evaluate the cooling performance and effectiveness of a PCM cooling blanket on heart rate (HR) and heart rate variability (HRV) recovery after exercise-induced hyperthermia. DESIGN Randomized cross-over. METHODS The study participants were 12 male volunteers who were engaged in professional training and completed an endurance exercise for approximately 30 min in a hot and humid environment (temperature ≈ 30 °C; relative humidity ≈ 66%). The participants underwent a 30-min cooling trial after exercise, receiving either treatment with a PCM cooling blanket (PCM group) or natural cooling (CON group). The Tcore, HR, and HRV time-domain indices were used for analysis. RESULTS The Tcore values were significantly lower in the PCM group during cooling. Reductions in the Tcore from precooling to 20 min of cooling were significantly greater in the PCM group than in the CON group. The HR in the PCM group was lower than that recorded in the CON group at 10 and 20 min of cooling. The reduction in HR during cooling from precooling was also significantly greater in the PCM group. HRV time-domain indices during cooling in the PCM group were significantly lower compared with the CON group while elevations in some HRV time-domain indices from precooling to postcooling were significantly greater in the PCM group than in the CON group. CONCLUSIONS The PCM cooling blanket had good cooling performance and the ability to hasten recovery of both HR and HRV. It may serve as a feasible cooling choice during transport after exercise-induced hyperthermia.
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Affiliation(s)
- Xin Wang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xueyi Shang
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Xin Li
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Shuyuan Liu
- Emergency Department, The Sixth Medical Center of Chinese PLA General Hospital, No.6 of Fucheng Road, Beijing, 100048, China
| | - Bin Lai
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lizhi Ma
- Department of Medical Risk Management, The Third Medical Center of Chinese PLA General Hospital, No. 69 of Yongding Road, Beijing, 100039, China
| | - Ying Sun
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Lan Ma
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China
| | - Bo Ning
- Department of Intensive Care Unit, Air Force Medical Center of China, No.30 of Fucheng Road, Beijing, 100142, China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, No.8 of East Street, Beijing, 100071, China
| | - Qian Wang
- Department of Emergency Medicine, The Third Medical Center of Chinese PLA General Hospital, No.69 of Yongding Road, Beijing, 100039, China.
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Yeargin S, Hirschhorn R, Grundstein A, Arango D, Graham A, Krebs A, Turner S. Variations of wet-bulb globe temperature across high school athletics in South Carolina. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023; 67:735-744. [PMID: 37002402 DOI: 10.1007/s00484-023-02449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 05/09/2023]
Abstract
The purpose was to describe wet bulb globe temperature (WBGT) throughout a high school fall athletic season (August to November) after a state-wide mandate requiring schools to use a WBGT-guided activity modification table with categories (AMTC). A cross-sectional research design utilized 30 South Carolina high schools. The independent variables were region (upstate, midlands, and coastal), sport (football, tennis, cross-country), month, start times (7-10 am, 10 am-3 pm, 3-6 pm, and 6-9 pm), and event type (practice, competition). Dependent variables were event frequency, average WBGT, and AMTC. Practice WBGT was 78.7 ± 8.2 °F (range: 34.7 to 99.0 °F). A significant difference for WBGT across month (F6, 904.7 = 385.07, P < 0.001) existed, with early September hotter than all other months (84.8 °F ± 3.8, P < 0.001). Every month had practices in each AMTC, until early November. Most events (64.6%, n = 1986) did not change AMTC; however, 9.1% (n = 281) changed to a hotter category. The 10 am-3 pm start time was significantly hotter than all other time frames (83.0 °F ± 7.2, P < 0.05). Tennis experienced hotter practices (79.9 °F ± 6.9) than football (78.4 °F ± 8.5; P < 0.001) and cross country (78.2 °F ± 8.8, P < 0.001). Schools in the Midlands experienced hotter practices (80.1 °F ± 7.8) than upstate (P < 0.001) and coastal schools (P = 0.005). Competition WBGT was significantly cooler than practices (72.3 ± 10.5 °F, t = 12.04, P < 0.001) and differed across sports (F2, 20.78 = 18.39, P < .001). Both cross-country (P = 0.003) and tennis (P < 0.001) were hotter than football. Schools should continuously monitor WBGT throughout practices and until November to optimize AMTC use. Risk mitigation strategies are needed for sports other than football to decrease the risk of exertional heat illnesses.
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Affiliation(s)
- Susan Yeargin
- Exercise Science Department, University of South Carolina, Columbia, SC, USA.
| | - Rebecca Hirschhorn
- School of Kinesiology, Louisana State University, Baton Rouge, Louisana, USA
| | | | - Dylan Arango
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Adam Graham
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Amy Krebs
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
| | - Sydney Turner
- Exercise Science Department, University of South Carolina, Columbia, SC, USA
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Alhadad SB, Chua MCY, Lee JKW, Low ICC. The effects of low and normal dose ice slurry ingestion on endurance capacity and intestinal epithelial injury in the heat. J Sci Med Sport 2023:S1440-2440(23)00078-6. [PMID: 37179242 DOI: 10.1016/j.jsams.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Compare the effects of ice slurry ingestion at low and normal doses on endurance capacity and exertional heat stress-induced gastrointestinal perturbations. DESIGN Randomised, cross-over design. METHODS Twelve physically active males completed four treadmill running trials, ingesting ice slurry (ICE) or ambient drink (AMB) at 2 g·kg-1 (Normal; N) or 1 g·kg-1 (Low; L) doses every 15-min during exercise and 8 g·kg-1 (N) or 4 g·kg-1 (L) pre- and post-exercise. Pre-, during and post-exercise serum intestinal fatty-acid binding protein ([I-FABP]) and lipopolysaccharide ([LPS]) concentrations were determined. RESULTS Pre-exercise gastrointestinal temperature (Tgi) was lower in L + ICE than L + AMB (p < 0.05), N + ICE than N + AMB (p < 0.001) and N + ICE than L + ICE (p < 0.001). Higher rate of Tgi rise (p < 0.05) and lower estimated sweat rate (p < 0.001) were observed in N + ICE than N + AMB. Rate of Tgi rise was similar at low dose (p = 0.113) despite a lower estimated sweat rate in L + ICE than L+AMB (p < 0.01). Time-to-exhaustion was longer in L + ICE than L + AMB (p < 0.05), but similar between N + ICE and N + AMB (p = 0.142) and L + ICE and N + ICE (p = 0.766). [I-FABP] and [LPS] were similar (p > 0.05). CONCLUSIONS L + ICE elicited a lower heat dissipation compensatory effect with similar endurance capacity as N + ICE. Ice slurry conferred no protection against exertional heat stress-induced gastrointestinal perturbations.
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Affiliation(s)
- Sharifah B Alhadad
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Melissa C Y Chua
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jason K W Lee
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Institute for Digital Medicine, National University of Singapore, Singapore
| | - Ivan C C Low
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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43
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Song Y, Zhang F, Lin G, Wang X, He L, Li Y, Zhai Y, Zhang N, Ma G. A Study of the Fluid Intake, Hydration Status, and Health Effects among Pregnant Women in Their Second Trimester in China: A Cross-Sectional Study. Nutrients 2023; 15:nu15071739. [PMID: 37049579 PMCID: PMC10096982 DOI: 10.3390/nu15071739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The fluid intake and hydration status during pregnancy may influence the health outcomes of both the mother and the fetus. However, there are few studies related to this. The aim of the present study was to investigate fluid intake behaviors among pregnant women in their second trimester, to evaluate their hydration status and pregnancy complications, and to further explore the association of fluid intake and the amniotic fluid index (AFI). Participants’ total fluid intake (TFI) levels were determined using a 7-day 24 h fluid intake questionnaire. The levels of water intake from food were not recorded or measured. Morning urine samples were collected, and both urine osmolality levels and urine specific gravity (USG) were tested to evaluate their hydration status. Fasting blood samples were also collected and measured for osmolality and complete blood count (CBC). A total of 324 participants completed the study. They were divided into four groups based on quartiles of TFI, including participants with lower (LFI1 and LFI2) and higher (HFI1 and HFI2) fluid intake levels. The median TFI was 1485 mL, and the median values of the four groups with different TFI levels were 1348, 1449, 1530, and 1609 mL, respectively. Only 3.4% of the participants attained the recommended value following an adequate water intake (1.7 L) level for pregnant women in China. Plain water was the main TFI resource (78.8~100.00%), and differences in the plain water intake levels among the four groups were evident (χ2 = 222.027, p < 0.05). The urine osmolality decreased sequentially with increasing TFI values from the LFI1 to HFI2 group, and significant differences in the urine osmolality levels among the four groups were evident (p < 0.05). Meanwhile, the percentage of dehydrated participants decreased from 26.8% in the LFI1 group to 0.0% in the HFI2 group (χ2 = 131.241, p < 0.05). Participants with higher TFI values had higher AFI values (χ2 = 58.386, all p < 0.05), and moderate-intensity correlations were found between TFI and urine osmolality, hydration status, and AFI (all p < 0.05). A large proportion of the participants had insufficient TFIs during the second trimester of pregnancy, and a proportion of the participants were dehydrated. The preliminary analysis showed that the AFI was correlated with the TFI during the second trimester of pregnancy. A sufficient TFI is necessary for pregnant women to improve their hydration status and may have effects on their health. The results can provide appropriate scientific references for the development of beneficial recommendations concerning adequate water intake levels for pregnant women in China.
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Affiliation(s)
- Yongye Song
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Fan Zhang
- International School of Public Health and One Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China
| | - Guotian Lin
- International School of Public Health and One Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China
| | - Xing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Limin He
- International School of Public Health and One Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China
| | - Yanchuan Li
- International School of Public Health and One Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China
| | - Yufei Zhai
- International School of Public Health and One Health, Hainan Medical University, 3 Xue Yuan Road, Longhua District, Haikou 571199, China
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Morrissey MC, Langan SP, Brewer GJ, Struder JF, Navarro JS, Nye MN, Casa DJ. Limitations associated with thermoregulation and cardiovascular research assessing laborers performing work in the heat. Am J Ind Med 2023; 66:267-280. [PMID: 36748881 DOI: 10.1002/ajim.23462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To quantify the current literature and limitations associated with research examining thermoregulatory and cardiovascular strain in laborers working in the heat. METHODS PubMed, SCOPUS, and SPORTDiscus were searched for terms related to the cardiovascular system, heat stress, and physical work. Qualifying studies included adult participants (18-65 years old), a labor-intensive environment or exercise protocol simulating a labor environment, a minimum duration of 120 min of physical work, and environmental heat stress (ambient temperature ≥26.0°C and ≥30% relative humidity). Studies included at least one of the following outcomes: pre- and peak physical work, core temperature, heart rate (HR), systolic blood pressure, diastolic blood pressure, HR variability, and rate pressure product. RESULTS Twenty-one out of 1559 potential studies qualified from our search. There was a total of 598 participants (mean = 28 ± 50 participants per study, range = 4-238 participants per study), which included 51 females (8.5%) and 547 males (91.5%). Of the participants, 3.8% had cardiovascular risk factors (diabetes: n = 10; hypertension: n = 13) and 96.2% were characterized as "healthy". Fifty-seven percent of the included studies were performed in a laboratory setting. CONCLUSIONS Studies were predominantly in men (91.5%), laboratory settings (57%), and "healthy" individuals (96.2%). To advance equity in protection against occupational heat stress and better inform future heat safety recommendations to protect all workers, future studies must focus on addressing these limitations. Employers, supervisors, and other safety stakeholders should consider these limitations while implementing current heat safety recommendations.
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Affiliation(s)
| | - Sean P Langan
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Gabrielle J Brewer
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Jeb F Struder
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - John S Navarro
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Megan N Nye
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
| | - Douglas J Casa
- Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
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DeHan PJ, Warren KC, Buchanan BK, DeGroot DW. Gastrointestinal Associated Exertional Heat Stroke. Curr Sports Med Rep 2023; 22:117-119. [PMID: 37036459 DOI: 10.1249/jsr.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Preston J DeHan
- Martin Army Community Hospital Family Medicine Residency Program; Fort Benning, GA
| | - Kyle C Warren
- Martin Army Community Hospital Family Medicine Residency Program; Fort Benning, GA
| | - Benjamin K Buchanan
- Department of Family Medicine Uniformed Services University of the Health Sciences; Core Faculty, Martin Army Community Hospital Family Medicine Residency Program; Deputy Director, The Army Heat Center, Fort Benning, GA
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46
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Wallum M, Whipple T, Peterson A. Wrestling with Heat Illness: Acquired Idiopathic Generalized Anhidrosis in the Pediatric Athlete. Curr Sports Med Rep 2023; 22:113-114. [PMID: 37036457 DOI: 10.1249/jsr.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Michael Wallum
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Terese Whipple
- Department of Emergency Medicine, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew Peterson
- Department of Pediatrics, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
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47
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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: 0] [Impact Index Per Article: 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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Ebisuda Y, Mukai K, Takahashi Y, Ohmura H. Effect of high ambient temperature on physiological responses during incremental exercise in Thoroughbred horses. COMPARATIVE EXERCISE PHYSIOLOGY 2023. [DOI: 10.3920/cep220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Several reports have suggested that the risk of exertional heat illness (EHI) in Thoroughbred racehorses increases in high ambient temperatures. Heat dissipation in horses during exercise becomes less efficient when the body temperature and ambient temperature are close. Therefore, we hypothesised that exercise at 40 °C may increase body temperature, oxygen consumption, and cardiac output during incremental exercise tests compared to 20 and 30 °C. Six trained Thoroughbred horses were studied in a randomised, crossover design at three ambient temperatures with a 6-day washout period. Using a 3% inclined treadmill, horses performed incremental exercise tests at 1.7, 3.5, 6, 8, and 10 m/s for 90 s at ambient temperatures of 20, 30, and 40 °C. The effects of ambient temperature at 10 m/s on physiological variables were analysed using mixed models (P<0.05). Pulmonary arterial temperature and rectal temperature at 40 °C were higher than those at 20 °C (P<0.001) and 30 °C (P<0.001). Similarly, oxygen consumption (vs 20 °C, P=0.009; vs 30 °C, P=0.006) and cardiac output (vs 20 °C, P=0.001; vs 30 °C, P=0.001) at 40 °C were higher than those at 20 and 30 °C. Arterial O2 partial pressure, O2 saturation, and pH at 40 °C were lower than those at 20 and 30 °C. Arterial CO2 partial pressure at 40 °C was higher than that at 20 and 30 °C. No differences were observed in arterial-mixed venous O2 concentration difference (P=0.391) and plasma lactate concentration (P=0.134) at different ambient temperatures. These results indicate that exercise at 40 °C causes excessive high body temperature, decreased running economy, and increased cardiac output compared to exercise at 20 and 30 °C. We strongly suggest that trainers and veterinarians should anticipate the occurrence of increased thermal stresses when ambient temperature is extremely high even in dry conditions and prepare to mitigate the risk of EHI from the perspective of equine welfare.
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Affiliation(s)
- Y. Ebisuda
- Sports Science Division, Equine Research Institute, Japan Racing Association, Shiba1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | - K. Mukai
- Sports Science Division, Equine Research Institute, Japan Racing Association, Shiba1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | - Y. Takahashi
- Sports Science Division, Equine Research Institute, Japan Racing Association, Shiba1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | - H. Ohmura
- Sports Science Division, Equine Research Institute, Japan Racing Association, Shiba1400-4, Shimotsuke, Tochigi 329-0412, Japan
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Klöwer M, Edouard P, Niess AM, Racinais S, Pitsiladis YP, Pappenberger F, Hollander K. Forecasting feels-like temperatures as a strategy to reduce heat illnesses during sport events. Br J Sports Med 2023; 57:559-561. [PMID: 36882307 DOI: 10.1136/bjsports-2022-106413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Milan Klöwer
- Atmospheric, Oceanic, and Planetary Physics, University of Oxford, Oxford, UK
- Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Pascal Edouard
- Inter-university Laboratory of Human Movement Biology (EA 7424), Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Saint-Etienne, France
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France
| | - Andreas M Niess
- Department of Sports Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Sebastien Racinais
- Research and Scientific Support, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Karsten Hollander
- IInstitute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Miller KC, Amaria NY. Excellent Rectal Temperature Cooling Rates in the Polar Life Pod Consistent With Stationary Tubs. J Athl Train 2023; 58:244-251. [PMID: 35192711 PMCID: PMC10176839 DOI: 10.4085/1062-6050-0732.21] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Several tools exist to reduce rectal temperature (TREC) quickly for patients experiencing exertional heatstroke (EHS). Stationary tubs effectively treat EHS but are bulky and impractical in some situations. More portable cold-water immersion techniques, such as tarp-assisted cooling with oscillation, are gaining popularity because of their benefits (eg, less water needed, portability). The Polar Life Pod (PLP) may be another portable way to reduce TREC, but few researchers have examined its effectiveness. OBJECTIVES To determine whether the PLP and stationary tub reduced TREC at acceptable or ideal rates, whether TREC cooling rates differed by method, and how participants felt before, during, and after cooling. DESIGN Randomized crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Thirteen individuals (8 men, 5 women; age = 21 ± 2 years, mass = 73.99 ± 11.24 kg, height = 176.2 ± 11.1 cm). INTERVENTION(S) Participants exercised in the heat until TREC was 39.5°C. They immersed themselves in either the PLP (202.7 ± 23.8 L, 3.2 ± 0.6°C) or a stationary tub (567.8 ± 7.6 L, 15.0 ± 0.1°C) until TREC was 38°C. Thermal sensation and environmental symptom questionnaire (ESQ) responses were recorded before, during, and after exercise and cooling. MAIN OUTCOME MEASURE(S) Rectal temperature cooling rates, thermal sensation, and ESQ responses. RESULTS Participants had similar exercise durations (PLP = 41.6 ± 6.9 minutes, tub = 42.2 ± 9.3 minutes, t12 = 0.5, P = .31), thermal sensation scores (PLP = 7.0 ± 0.5, tub = 7.0 ± 0.5, P > .05), and ESQ scores (PLP = 25 ± 13, tub = 29 ± 14, P > .05) immediately postexercise each day. Although TREC cooling rates were excellent in both conditions, the PLP cooled faster than the stationary tub (PLP = 0.28 ± 0.09°C/min, tub = 0.20 ± 0.09°C/min, t12 = 2.5, P = .01). Thermal sensation in the PLP condition was lower than that in the tub condition halfway through cooling (PLP = 1 ± 1, tub = 2 ± 1, P < .05) and postcooling (PLP = 2 ± 1, tub = 3 ± 1, P < .05). The ESQ scores were higher for PLP than for the stationary tub postcooling (PLP = 25 ± 14, tub = 12 ± 9, P < .05). CONCLUSIONS The PLP and the stationary tub cooled individuals with hyperthermia at ideal rates for treating patients with EHS (ie, >0.16°C/min). The PLP may be an effective tool for treating EHS when limited water volumes and portability are concerns. Clinicians should have rewarming tools and strategies (eg, heating blankets) available to improve patients' comfort after PLP use.
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Affiliation(s)
- Kevin C. Miller
- Department of Health and Human Performance, Texas State University, San Marcos
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