Reassessing the distribution of Burkholderia pseudomallei outside known endemic areas using animal serological screening combined with environmental surveys: The case of Les Saintes (Guadeloupe) and French Guiana.

BACKGROUND: Melioidosis, an emerging infectious disease that affects both humans and animals, is caused by the soil-dwelling bacterium Burkholderia pseudomallei. It is endemic in South and Southeast Asia, and northern Australia, causing an estimated 165,000 human cases annually worldwide. Human cases have been reported in the French West Indies (Martinique and Guadeloupe) since the 1990s. Conversely, no human cases have been reported in French Guiana, a French territory in South America. Our study aimed to investigate whether B. pseudomallei is locally established in Guadeloupe and French Guiana using animals as a proxy. METHODOLOGY/PRINCIPAL FINDINGS: Blood samples were collected from different animals from 56 farms in French Guiana (n = 670) and from two goat farms in Les Saintes (n = 31), part of the Guadeloupe archipelago and tested by enzyme-linked immunosorbent assay (ELISA). In Les Saintes, a serological follow-up was performed, and soil, water and goat rectal swabs were collected and analyzed by culture and PCR. The highest seroprevalence rates (39%) were observed in goats in Les Saintes, followed by horses (24%) and cattle (16%) in French Guiana. In the two goat farms, supplementary analyses detected B. pseudomallei from one goat rectal swab, and a B. pseudomallei strain was isolated from the soil. CONCLUSIONS/SIGNIFICANCE: Our animal serological data suggest the presence of B. pseudomallei in Les Saintes and French Guiana. In Les Saintes, environmental surveys confirmed the endemicity of the bacteria, which is consistent with documented human cases of melioidosis on the island. We did not conduct an environmental survey in French Guiana. Nevertheless, our serological results call for local environmental surveys and a retrospective reassessment of human infections with melioidosis-like symptoms.

Assessment of the Omius™ cooling headband effectiveness during a 70-min submaximal running effort followed by a 5-km time-trial in hot/humid conditions.

Exercise performed under hot/humid conditions can hinder endurance performance. The Omius™ headband (OH) is purported to reduce the perception of heat and improve performance. We examined the impact of OH on selected thermal and cardiovascular functions, subjective perceptions and running performance. Using a randomized crossover protocol, 10 trained male athletes (28 ± 4 years) completed two trials (OH and sham headband (SH), 35.0 ± 0.3 °C, 56 ± 3% relative humidity) comprising 70 min of running (60% V˙O2max) followed by a 5-km running time-trial (TT). Heart rate, perceived exertion and whole-body thermal comfort did not significantly differ between conditions during the submaximal running effort and TT. Rectal temperature was higher with OH (0.11 ± 0.16 °C, p = 0.052) than SH prior to the submaximal running effort, however, no significant differences were observed between conditions regarding the changes in rectal temperature from baseline during the submaximal running effort and TT. Forehead temperature was significantly lower with OH than SH during the submaximal running effort, but no significant differences were observed at the end of the TT. Scores of perceived forehead thermal comfort were only significantly lower with OH than SH during the submaximal running effort. TT performance did not significantly differ between OH (19.8 ± 1.2 min) and SH (20.2 ± 1.0 min). In conclusion, OH improves forehead thermal comfort and reduces forehead temperature but not rectal temperature, heart rate and perceived exertion during, nor 5-km TT performance following, 70 min of submaximal running in the heat.

Isolation of Burkholderia pseudomallei from a goat in New Caledonia: implications for animal and human health monitoring and serological tool comparison.

BACKGROUND: Melioidosis is a serious bacterial infection caused by Burkholderia pseudomallei, a gram-negative bacterium commonly found in soil and water. It can affect both humans and animals, and is endemic in regions such as Southeast Asia and Northern Australia. In recent years, there have been reports of an emergence of human melioidosis in other areas, including New Caledonia. RESULTS: During standard laboratory analysis in New Caledonia in 2021, a strain of B. pseudomallei was isolated from a goat. The strain was characterized using both MLST and WGS techniques and was found to cluster with previously described local human strains from the area. In parallel, several serological tests (CFT, ELISA, Luminex (Hcp1, GroEL, BPSS1840), arrays assay and a latex agglutination test) were performed on animals from the farm where the goat originated, and/or from three other neighboring farms. Using two commercial ELISA kits, seropositive animals were found only on the farm where the infected goat originated and tests based on recombinant proteins confirmed the usefulness of the Hcp1 protein for the diagnosis of melioidosis in animals. CONCLUSIONS: Despite the regular reports of human cases, this is the first confirmed case of melioidosis in an animal in New Caledonia. These results confirm the presence of the bacterium in the region and highlight the importance of vigilance for both animal and human health. It is critical that all health partners, including breeders, veterinarians, and biologists, work together to monitor and prevent the spread of the disease.

Work-rest regimens for work in hot environments: A scoping review.

BACKGROUND: To limit exposures to occupational heat stress, leading occupational health and safety organizations recommend work-rest regimens to prevent core temperature from exceeding 38°C or increasing by ≥1°C. This scoping review aims to map existing knowledge of the effects of work-rest regimens in hot environments and to propose recommendations for future research based on identified gaps. METHODS: We performed a search of 10 databases to retrieve studies focused on work-rest regimens under hot conditions. RESULTS: Forty-nine articles were included, of which 35 were experimental studies. Most studies were conducted in laboratory settings, in North America (71%), on healthy young adults, with 94% of the 642 participants being males. Most studies (66%) employed a protocol duration ≤240 min (222 ± 162 min, range: 37-660) and the time-weighted average wet-bulb globe temperature was 27 ± 4°C (range: 18-34). The work-rest regimens implemented were those proposed by the American Conference of Governmental and Industrial Hygiene (20%), National Institute of Occupational Safety and Health (11%), or the Australian Army (3%). The remaining studies (66%) did not mention how the work-rest regimens were derived. Most studies (89%) focused on physical tasks only. Most studies (94%) reported core temperature, whereas only 22% reported physical and/or mental performance outcomes, respectively. Of the 35 experimental studies included, 77% indicated that core temperature exceeded 38°C. CONCLUSIONS: Although work-rest regimens are widely used, few studies have investigated their physiological effectiveness. These studies were mainly short in duration, involved mostly healthy young males, and rarely considered the effect of work-rest regimens beyond heat strain during physical exertion.

Shifting focus: Time to look beyond the classic physiological adaptations associated with human heat acclimation.

Planet Earth is warming at an unprecedented rate and our future is now assured to be shaped by the consequences of more frequent hot days and extreme heat. Humans will need to adapt both behaviorally and physiologically to thrive in a hotter climate. From a physiological perspective, countless studies have shown that human heat acclimation increases thermoeffector output (i.e., sweating and skin blood flow) and lowers cardiovascular strain (i.e., heart rate) during heat stress. However, the mechanisms mediating these adaptations remain understudied. Furthermore, several possible benefits of heat acclimation for other systems and functions involved in maintaining health and performance during heat stress remain to be elucidated. This review summarizes recent advances in human heat acclimation, with emphasis on recent studies that (1) advanced our understanding of the mechanisms mediating improved thermoeffector output and (2) investigated adaptations that go beyond those classically associated with heat acclimation. We highlight that these studies have contributed to a better understanding of the integrated physiological responses underlying human heat acclimation while leaving key unanswered questions that will need to be addressed in the future.

Repeatability of Ad Libitum Water Intake during Repeated 1 h Walking/Jogging Exercise Sessions Conducted under Hot Ambient Conditions.

A drinking strategy aiming to replace a given percentage of the sweat losses incurred during exercise should result in reproducible fluid intake volume and, hence, fluid balance from one exercise session to the other performed under similar scenarios. Whether this may also be the case with ad libitum drinking during exercise is unclear. We characterized the repeatability of ad libitum water intake during repeated 1 h exercise sessions and examined its effect over time on fluid balance and selected physiological functions and perceptual sensations. Twelve (3 women) healthy individuals participated in this study. At weekly intervals, they completed four 2 × 30 min walking/jogging exercise bouts (55% V˙O2max, 40 °C, 20-30% relative humidity) interspersed by a 3 min recovery period. During exercise, participants consumed water (20 °C) ad libitum. There were no significant differences among the four exercise sessions for absolute water intake volume (~1000 mL·h-1), percent body mass loss (~0.4%), sweat rate (~1300 mL·h-1) and percent of sweat loss replaced by water intake (~80%). Heart rate, rectal temperature, and perceived thirst and heat stress did not differ significantly between the first and fourth exercise sessions. Perceived exertion was significantly lower during the fourth vs. the first exercise session, but the difference was trivial (<1 arbitrary unit). In conclusion, ad libitum water intake during four successive identical 1 h walking/jogging sessions conducted in the heat will result in similar water intake volumes and perturbations in fluid balance, heart rate, rectal temperature, and perceived thirst, heat stress and exertion.

Regular physical activity across the lifespan to build resilience against rising global temperatures.

Population aging, high prevalence of non-communicable diseases, physical inactivity, and rising global temperatures are some of the most pressing issues in public health of the current century. Such trends suggest that individuals increasingly less equipped to tolerate heat will be increasingly exposed to it, which from a public health perspective is alarming. Nonetheless, future impacts of extreme heat events will depend not only on the magnitude of climate change, but on our ability to adapt by becoming less sensitive and vulnerable. Although physical activity's role in mitigating climate change has received attention, its potential contribution to climate change adaptation and resilience remains largely unaddressed. Accordingly, in this viewpoint, we discuss how regular physical activity throughout life could have an important contribution to adapting to rising global temperatures, allowing to be better equipped to cope with heat-related health hazards and increasing individual and community resilience. This viewpoint constitutes a call for more research into the contribution that physical activity can have in adapting to rising global temperatures and, more broadly, to climate change.

Effect of electric fan use in isolation or combined with ice slurry/cold water ingestion and lower-leg immersion in young men during intermittent physical activity in hot-humid conditions.

Using a randomized crossover protocol, 10 young men completed four 180 min exposures (38 °C, 60% relative humidity), alternating between 30 min of walking and 30 min of sitting where fluid or ice slurry were served. Participants underwent four trials: (i) 5 mL·kg body mass-1 of 20 °C water (CON); (ii) 5 mL·kg body mass-1 of 20 °C water + fan at 4 m·s-1 (FAN); (iii) fan + 3 mL·kg body mass-1 of ice slurry + 2 mL·kg body mass-1 of 4 °C water (FAN + ISCW); and (iv) FAN + ISCW + lower-leg immersion in 20 °C water (FAN + ISCW + LLI). Sweat and body mass losses were higher with FAN than CON, FAN + ISCW, and FAN + ISCW + LLI. Mean and peak changes in Δrectal temperature, heart rate, and perceived heat and thirst from baseline were not statistically and practically different between FAN and CON. FAN + ISCW + LLI decreased sweat loss compared with FAN + ISCW and mean and peak changes in Δrectal temperature, heart rate, and perceived thirst compared with CON. FAN + ISCW + LLI also attenuated the changes in Δrectal temperature (peak) and thirst (mean and peak) compared with FAN. In conclusion, FAN slightly exacerbates fluid loss but does not attenuate the changes in Δrectal temperature, heart rate, and perceived heat and thirst during intermittent physical activity in hot-humid conditions. However, coupling ISCW or ISCW + LLI with the use of a fan attenuates the increase in these outcomes compared with no intervention and to a greater extent for rectal temperature and thirst when fan is coupled with ISCW + LLI than when it is used in isolation.

CORE™ wearable sensor: Comparison against gastrointestinal temperature during cold water ingestion and a 5 km running time-trial.

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.

Effect of Glycerol-Induced Hyperhydration on a 5-kilometer Running Time-Trial Performance in the Heat in Recreationally Active Individuals.

Maximal oxygen consumption (V˙O2max) is a major determinant of 5-km running time-trial (TT) performance. Glycerol-induced hyperhydration (GIH) could improve V˙O2max in recreationally active persons through an optimal increase in plasma volume. Moreover, ingestion of a large bolus of cold fluid before exercise could decrease thermal stress during exercise, potentially contributing to improved performance. We determined the effect of GIH on 5-km running TT performance in 10 recreationally active individuals (age: 24 ± 4 years; V˙O2max: 48 ± 3 mL/kg/min). Using a randomized and counterbalanced protocol, participants underwent two, 120-min hydration protocols where they ingested a 1) 30 mL/kg fat-free mass (FFM) of cold water (~4 °C) with an artificial sweetener + 1.4 g glycerol/kg FFM over the first 60 min (GIH) or 2) 7.5 mL/kg FFM of cold water with an artificial sweetener over the first 20 min (EUH). Following GIH and EUH, participants underwent a 5-km running TT at 30 °C and 50% relative humidity. After 120 min, GIH was associated with significantly greater fluid retention (846 ± 415 mL) and plasma volume changes (10.1 ± 8.4%) than EUH, but gastrointestinal (GI) temperature did not differ. During exercise, 5-km running TT performance (GIH: 22.95 ± 2.62; EUH: 22.52 ± 2.74 min), as well as heart rate, GI temperature and perceived exertion did not significantly differ between conditions. This study demonstrates that the additional body water and plasma volume gains provided by GIH do not improve 5-km running TT performance in the heat in recreationally active individuals.

Impact of dehydration on perceived exertion during endurance exercise: A systematic review with meta-analysis.

Background: Understanding the impact of stressors on the rating of perceived exertion (RPE) is relevant from a performance and exercise adherence/participation standpoint. Athletes and recreationally active individuals dehydrate during exercise. No attempt has been made to systematically determine the impact of exercise-induced dehydration (EID) on RPE. Objective: The present meta-analysis aimed to determine the effect of EID on RPE during endurance exercise and examine the moderating effect of potential confounders. Data analyses: Performed on raw RPE values using random-effects models weighted mean effect summaries and meta-regressions with robust standard errors, and with a practical meaningful effect set at 1 point difference between euhydration (EUH) and EID. Only controlled crossover studies measuring RPE with a Borg scale in healthy adults performing ≥30 min of continuous endurance exercise while dehydrating or drinking to maintain EUH were included. Results: Sixteen studies were included, representing 147 individuals. Mean body mass loss with EUH was 0.5 ± 0.4%, compared to 2.3 ± 0.5% with EID (range 1.7-3.1%). Within an EID of 0.5-3% body mass, a maximum difference in RPE of 0.81 points (95% CI: 0.36-1.27) was observed between conditions. A meta-regression revealed that RPE increases by 0.21 points for each 1% increase in EID (95% CI: 0.12-0.31). Humidity, ambient temperature and aerobic capacity did not alter the relationship between EID and RPE. Conclusion: Therefore, the effect of EID on RPE is unlikely to be practically meaningful until a body mass loss of at least 3%.

Effect of Pre-Exercise Caffeine Intake on Endurance Performance and Core Temperature Regulation During Exercise in the Heat: A Systematic Review with Meta-Analysis.

BACKGROUND: Heat is associated with physiological strain and endurance performance (EP) impairments. Studies have investigated the impact of caffeine intake upon EP and core temperature (CT) in the heat, but results are conflicting. There is a need to systematically determine the impact of pre-exercise caffeine intake in the heat. OBJECTIVE: To use a meta-analytical approach to determine the effect of pre-exercise caffeine intake on EP and CT in the heat. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Four databases and cross-referencing. DATA ANALYSIS: Weighted mean effect summaries using robust variance random-effects models for EP and CT, as well as robust variance meta-regressions to explore confounders. STUDY SELECTION: Placebo-controlled, randomized studies in adults (≥ 18 years old) with caffeine intake at least 30 min before endurance exercise ≥ 30 min, performed in ambient conditions ≥ 27 °C. RESULTS: Respectively six and 12 studies examined caffeine's impact on EP and CT, representing 52 and 205 endurance-trained individuals. On average, 6 mg/kg body mass of caffeine were taken 1 h before exercises of ~ 70 min conducted at 34 °C and 47% relative humidity. Caffeine supplementation non-significantly improved EP by 2.1 ± 0.8% (95% CI - 0.7 to 4.8) and significantly increased the rate of change in CT by 0.10 ± 0.03 °C/h (95% CI 0.02 to 0.19), compared with the ingestion of a placebo. CONCLUSION: Caffeine ingestion of 6 mg/kg body mass ~ 1 h before exercise in the heat may provide a worthwhile improvement in EP, is unlikely to be deleterious to EP, and trivially increases the rate of change in CT.

Cognitive Performance Before and Following Habituation to Exercise-Induced Hypohydration of 2 and 4% Body Mass in Physically Active Individuals.

We investigated the effect of repeated exposures to hypohydration upon cognitive performance. In a randomized crossover design, ten physically active adults completed two 4-week training blocks, one where they maintained euhydration (EUH) and the other where they were water-restricted (DEH) during walking/running at 55% V.O2max, 40 °C. Three sessions per week were performed: (1) 1 h of exercise, (2) exercise until 2% or (3) 4% of body mass has been lost or replaced. Limited to the first and fourth training week, a 12 min walking/running time-trial was completed following the 2 and 4% exercise bouts. Trail making, the Wisconsin card sort, the Stop signal task, Simple visual reaction time and Corsi block-tapping tests were performed immediately following the time-trials. Body mass loss was maintained < 1% with EUH and reached 2.7 and 4.7% with DEH following the time-trials. Except for a lower percentage of correct responses (% accuracy) during the Wisconsin card sort test (p < 0.05) with DEH compared to EUH, no statistically significant decline in cognitive performance was induced by low and moderate levels of hypohydration. Compared to week 1, no statistical differences in cognitive responses were observed after repeated exposures to hypohydration (all p > 0.05). From a practical perspective, the gains in cognitive performance following training to DEH were mostly unclear, but under certain circumstances, were greater than when EUH was maintained. Based on the battery of cognitive tests used in the current study, we conclude that whether physically active individuals are habituated or not to its effect, exercise-induced hypohydration of 2 and 4% has, in general, no or unclear impact on cognitive performance immediately following exercise. These results encourage further research in this area.

Molecular characterization of Burkholderia mallei strains isolated from horses in Brazil (2014-2017).

Glanders is an infectious zoonosis caused by Burkholderia (B.) mallei that mainly affects equids. The objective of this work was to provide additional knowledge on the diversity of the strains circulating in Brazil. Six Burkholderia mallei isolates obtained during necropsies of glanderous horses between 2014 and 2017 in two different states (Pernambuco and Alagoas) were analyzed by polymerase chain reaction-high-resolution melting (PCR-HRM). While four strains (9902 RSC, BM_campo 1, BM_campo 3 and UFAL2) clustered in the L3B2 branch, which already includes the Brazilian 16-2438_BM#8 strain, two strains (BM_campo 2.1 and BM_campo 2.2) clustered within the L3B3sB3 branch, which mostly includes older isolates, from Europe and the Middle East. Whole genome sequencing of two of these strains (UFAL2 and BM_campo 2.1), belonging to different branches, confirmed the HRM typing results and refined the links between the strains, including the description of the L3B3Sb3Gp1SbGp1 genotype, never reported so far for contemporary strains. These results suggest different glanders introduction events in Brazil, including a potential link with strains of European origin, related to colonization or trade.

Impact of Repeated Acute Exposures to Low and Moderate Exercise-Induced Hypohydration on Physiological and Subjective Responses and Endurance Performance.

This study aimed to examine whether repeated exposures to low (2%) and moderate (4%) exercise-induced hypohydration may reverse the potentially deleterious effect of hypohydration on endurance performance. Using a randomized crossover protocol, ten volunteers (23 years, V˙O2max: 54 mL∙kg-1∙min-1) completed two 4-week training blocks interspersed by a 5-week washout period. During one block, participants replaced all fluid losses (EUH) while in the other they were fluid restricted (DEH). Participants completed three exercise sessions per week (walking/running, 55% V˙O2max, 40 °C): (1) 1 h while fluid restricted or drinking ad libitum, (2) until 2 and (3) 4% of body mass has been lost or replaced. During the first and the fourth week of each training block, participants completed a 12 min time-trial immediately after 2% and 4% body mass loss has been reached. Exercise duration and distance completed (14.1 ± 2.7 vs. 6.9 ± 1.5 km) during the fixed-intensity exercise bouts were greater in the 4 compared to the 2% condition (p < 0.01) with no difference between DEH and EUH. During the first week, heart rate, rectal temperature and perceived exertion were higher (p < 0.05) with DEH than EUH, and training did not change these outcomes. Exercise-induced hypohydration of 2% and 4% body mass impaired time-trial performance in a practical manner both at the start and end of the training block. In conclusion, exercise-induced hypohydration of 2% and 4% body mass impairs 12 min walking/running time-trial, and repeated exposures to these hypohydration levels cannot reverse the impairment in performance.

Provision of instructions to drink ad libitum or according to thirst sensation: impact during 120 km of cycling in the heat in men.

The terms drinking to thirst and ad libitum drinking are used interchangeably, but should they? We investigated the differences in how athletes consumed fluids during exercise when instructed to drink according to thirst or ad libitum. Using a randomized, crossover, and counterbalanced design, 10 males (27 ± 4 y) cycled 120 km (48 ± 4% of peak power, 33 °C, 40% relative humidity) on 2 occasions, while drinking water according to thirst or ad libitum. Participants covered the cycling trials in 222 ± 11 min (p = 0.29). Although the body mass loss at the end of exercise and total volume of water consumed were similar between trials, thirst perception before each sip and the volume consumed per sip were significantly higher with thirst than ad libitum drinking, whereas the total number of sips was significantly lower with thirst than ad libitum drinking. Perceived exertion, rectal temperature, and heart rate were all significantly higher with thirst than ad libitum drinking, but the difference was trivial. In conclusion, thirst and ad libitum drinking are associated with different drinking patterns, but equally maintain fluid balance during prolonged exercise. The terms drinking to thirst and ad libitum drinking can be used interchangeably to guide fluid intake during prolonged exercise. Novelty: Both strategies are associated with different patterns of fluid ingestion during prolonged exercise, but are equally effective in maintaining fluid balance. Perceived exertion, rectal temperature, and heart rate are regulated dissimilarly by thirst and ad libitum drinking, but the difference is trivial.

Feasibility of an Intradialytic Combined Exercise Program Targeting Older Adults With End-Stage Renal Disease.

Intradialytic exercise is feasible and yields substantial clinical benefits in middle-aged patients. However, evidence is scarce in older hemodialysis patients. OBJECTIVE: To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. METHODS: Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). RESULTS: About 79% of the screened patients agreed to participate (n = 25, 73 [66-77] years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-s sit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). CONCLUSION: Supervised intradialytic exercise seems safe and beneficial in older patients.

Programmed vs. Thirst-Driven Drinking during Prolonged Cycling in a Warm Environment.

We compared the effect of programmed (PFI) and thirst-driven (TDFI) fluid intake on prolonged cycling performance and exercise associated muscle cramps (EAMC). Eight male endurance athletes (26 ± 6 years) completed two trials consisting of 5 h of cycling at 61% V˙O2peak followed by a 20 km time-trial (TT) in a randomized crossover sequence at 30 °C, 35% relative humidity. EAMC was assessed after the TT with maximal voluntary isometric contractions of the shortened right plantar flexors. Water intake was either programmed to limit body mass loss to 1% (PFI) or consumed based on perceived thirst (TDFI). Body mass loss reached 1.5 ± 1.0% for PFI and 2.5 ± 0.9% for TDFI (p = 0.10). Power output during the 20 km TT was higher (p < 0.05) for PFI (278 ± 41 W) than TDFI (263 ± 39 W), but the total performance time, including the breaks to urinate, was similar (p = 0.48) between conditions. The prevalence of EAMC of the plantar flexors was similar between the drinking conditions. Cyclists competing in the heat for over 5 h may benefit from PFI aiming to limit body mass loss to <2% when a high intensity effort is required in the later phase of the race and when time lost for urination is not a consideration.