Living in Western Australia induces some physiological adaptations of seasonal acclimatisation in the surgical burns team.

Seasonal acclimatization is known to result in adaptations that can improve heat tolerance. Staff who operate on burn injuries are exposed to thermally stressful conditions and seasonal acclimatization may improve their thermoeffector responses during surgery. Therefore, the aim of this study was to assess the physiological and perceptual responses of staff who operate on burn injuries during summer and winter, to determine whether they become acclimatized to the heated operating theater. Eight staff members had physiological and perceptual responses compared during burn surgeries conducted in thermoneutral (CON: 24.1 ± 1.2°C, 45 ± 7% relative humidity [RH]) and heated (HOT: 31.3 ± 1.6°C, 44 ± 7% RH) operating theaters, in summer and winter. Physiological parameters that were assessed included core temperature, heart rate, total sweat loss, sweat rate, and urinary specific gravity. Perceptual responses included ratings of thermal sensation and comfort. In summer, CON compared to winter CON, baseline (85 ± 15 bpm VS 94 ± 18 bpm), mean (84 ± 16 bpm VS 93 ± 18 bpm), and peak HR (94 ± 17 bpm VS 105 ± 19 bpm) were lower (p < 0.05), whereas core temperature was not different between seasons in either condition (p > 0.05). In HOT, ratings of discomfort were higher in summer (15 ± 3) than winter (13 ± 3; p > 0.05), but ratings of thermal sensation and sweat rate were similar between seasons (p > 0.05). The surgical team in burns in Western Australia can obtain some of the physiological adaptations that result from seasonal acclimatization, but not all. That is most likely due to a lower than required amount of outdoor heat exposure in summer, to induce all physiological and perceptual adaptations.

Higher operating theatre temperature during burn surgery increases physiological heat strain, subjective workload, and fatigue of surgical staff.

Raising the ambient temperature of the operating theatre is common practice during burn surgeries to maintain the patient's core body temperature; however, the effects of operating in the heat on cognitive performance, manual dexterity, and perceived workload of surgical staff have not been assessed in a real-world context. Therefore, the aim was to assess the real-time impact of heat during burn surgeries on staff's cognitive function, manual dexterity, and perceptual measures (workload, thermal sensation, thermal comfort, perceived exertion, and fatigue) and physiological parameters (core temperature, heart-rate, fluid loss, and dehydration). Ten burn surgery staff members were assessed in CON (24.0±1.1°C, 45±6% relative humidity [RH]) and HOT (30.8±1.6°C, 39±7% RH) burn surgeries (average 150 min duration). Cognitive performance, manual dexterity, and perceptual measures were recorded pre- and post-surgery, while physiological parameters were recorded throughout surgery. HOT conditions did not significantly affect manual dexterity or cognitive function (p > .05), however HOT resulted in heat strain (increased heart-rate, core temperature, and fluid loss: p < .05), and increased subjective workload, discomfort, perceived exertion, and fatigue compared to CON conditions (p < .05). Cognitive function and manual dexterity were maintained in hot conditions, suggesting that operating in approximately 31°C heat is a safe approach for patient treatment. However, job burnout, which is positively correlated with perceived workload, and the impact of cumulative fatigue on the mental health of surgery staff, must be considered in the context of supporting an effective health workforce.

Physical and perceptual cooling: Improving cognitive function, mood disturbance and time to fatigue in the heat.

This study investigated the effects of menthol swilling and crushed ice ingestion on cognitive function, total mood disturbance (TMD), and time to fatigue (TTF). Twelve male long-distance runners completed three counterbalanced running trials (3 × 30 minutes at 65% VO2peak and a TTF run at 100% VO2peak ) in hot, humid conditions (35.3 ± 0.3°C, 59.2 ± 2.5% relative humidity). Trials consisted of precooling with crushed ice ingestion and mid-cooling by menthol swilling (MIX), precooling with water ingestion and mid-cooling by menthol swilling (MENTH), and control (CON). Swilling with either 25 mL of menthol solution or placebo occurred upon entry to the heat, at 15-minute intervals during the run and prior to the TTF run. Core temperature, forehead skin temperature, tympanic temperature, perceived thermal sensation, and TMD were significantly lower with MIX compared with MENTH and CON (P < .05). Thirst was satiated in MIX compared with CON; however, MENTH did not have a significant effect. After 90 minutes of running and post-TTF run, fewer errors occurred in the executive control task (P < .05), as well as decision-making and working memory (P > .05; d = 0.5-0.79) between MIX and CON; however, MENTH had no effect compared with CON. The TTF run was significantly longer with MENTH (34.38%; P = .02) and MIX (39.06%; P = .001) compared with CON, with no difference between MENTH and MIX (P = .618). The physical reduction in core and internal head temperature seen with crushed ice ingestion may lead to improvements in cognitive function; however, both MENTH and MIX were sufficient for improving exercise performance.

Caffeine Ingestion Improves Repeated Freestyle Sprints in Elite Male Swimmers.

The purpose of this investigation was to determine the efficacy of a moderate dose of caffeine to improve repeat-sprint performance in elite freestyle sprinters. Nine highly trained male swimmers performed 6 x 75 m freestyle sprints on two occasions 1-h after consuming either 3 mg·kg-1 caffeine (CAF), or placebo, in a cross-over manner. Capillary blood samples for the analysis of blood lactate concentration and pH were collected after the 1st, 3rd, and 5th sprint, while heart rate and perceived exertion (RPE) were collected after every sprint. There was a moderate effect for improved mean sprint time in the CAF condition (0.52 s; 1.3%; d = 0.50). When assessed individually, there was a large effect for improved performance in sprints 3 (1.00 s; 2.5%; d = 1.02) and 4 (0.84 s; 2.1%; d = 0.84) in CAF compared to placebo, with worthwhile performance improvement found for each of the first 5 sprints. There was a significant treatment effect for higher blood lactate concentration for CAF (p = 0.029), and a significant treatment*time effect for reduced pH in the CAF condition (p = 0.004). Mean heart rate (167 ± 9 bpm vs 169 ± 7 bpm) and RPE (17 ± 1 vs 17 ± 1) were not different between placebo and CAF trials, respectively. This investigation is the first to demonstrate enhanced repeat-sprint ability in swimmers following acute caffeine ingestion. It appears likely that the combination of a moderate dose of caffeine (3-6 mg·kg-1) with trained athletes is most likely to enhance repeat-sprint ability in various athletic populations; however, the exact mechanism(s) for an improved repeat-sprint ability following acute caffeine ingestion remain unknown.

Interleukin-6 and Hepcidin Levels during Hormone-Deplete and Hormone-Replete Phases of an Oral Contraceptive Cycle: A Pilot Study.

BACKGROUND: In the past, elevated estradiol levels were reported to downregulate the iron regulatory hormone hepcidin, thereby potentially improving iron metabolism. As estrogen plays a role in regulating the menstrual cycle and can influence the cytokine interleukin-6 (IL-6; a hepcidin up-regulator), this investigation examined the effects of estradiol supplementation achieved by the use of a monophasic oral contraceptive pill (OCP) on IL-6, hepcidin levels and iron status during the hormone-deplete versus hormone-replete phases within an oral contraceptive cycle (OCC). METHODS: Fifteen healthy female OCP users were recruited and provided a venous blood sample on 2 separate mornings during a 28-day period. These included (a) days 2-4 of the OCC, representing a hormone-free withdrawal period (WD); (b) days 12-14 of the OCC, representing the end of the first week of active hormone therapy (AHT). RESULTS: IL-6 and hepcidin levels were not significantly different at WD and AHT. Serum ferritin was significantly higher (p = 0.039) during AHT as compared to WD. CONCLUSIONS: Fluctuations in OCP hormones (estradiol and/or progestogen) had no effect on basal IL-6 and hepcidin levels in young women. Nevertheless, elevated ferritin levels recorded during AHT may indicate that OCP hormones can positively influence iron stores within an OCC despite unchanged hepcidin levels.

Effect of repeat-sprint training in hypoxia on post-exercise interleukin-6 and F2-isoprostanes.

This investigation examined the oxidative stress (F2-Isoprostane; F2-IsoP) and inflammatory (interleukin-6; IL-6) responses to repeat-sprint training in hypoxia (RSH). Ten trained male team sport athletes performed 3(sets)*9(repetitions)*5 s cycling sprints in simulated altitude (3000 m) and sea-level conditions. Mean and peak sprint power output (MPO and PPO) were recorded, and blood samples were collected pre-exercise, and again at 8 and 60 min post-exercise. Both MPO and PPO were significantly reduced in hypoxia (compared to sea-level) in the second (MPO: 855 ± 89 vs. 739 ± 95 W, p = .006; PPO: 1024 ± 114 vs. 895 ± 112 W, p = .010) and third (MPO: 819 ± 105 vs. 686 ± 83 W, p = .008; PPO: 985 ± 125 vs. 834 ± 99 W, p = .008) sets, respectively. IL-6 was significantly increased from pre- to 1 h post-exercise in both hypoxia (0.7 ± 0.2 vs. 2.4 ± 1.4 pg/mL, p = .004) and sea-level conditions (0.7 ± 0.2 vs. 1.6 ± 0.3 pg/mL, p < .001), with a large effect (d = 0.80) suggesting higher IL-6 levels of post-hypoxia. F2-IsoP was significantly lower 1 h post-exercise in both the hypoxic (p = .005) and sea-level (p = .002) conditions, with no differences between trials. While hypoxia can impact on exercise intensity and may result in greater post-exercise inflammation, it appears to have little effect on oxidative stress. These results indicate that team sport organisations with ready access to hypoxic training facilities could confidently administer RSH without significantly increasing the post-exercise inflammatory or oxidative stress response.

Oral contraception does not alter typical post-exercise interleukin-6 and hepcidin levels in females.

OBJECTIVES: The post-exercise interleukin-6 (IL-6) and hepcidin response was investigated during the hormone-deplete and hormone-replete phases of an estradiol and progestogen regulated oral contraceptive cycle (OCC). DESIGN: Counterbalanced, repeated measures cross-over study. METHODS: Ten active female monophasic oral contraceptive pill (OCP) users completed two 40 min treadmill running trials at 75% of their pre-determined peak oxygen uptake velocity (vVO2peak). These trials were randomly performed in two specific phases of the OCC: (a) Day 2-4, representing a hormone-free withdrawal period (D-0); (b) Day 12-14, representing the end of the first week of active hormone therapy (D+7). Venous blood samples were drawn pre-, post- and 3h post-exercise. RESULTS: In both trials, serum IL-6 was significantly elevated (p<0.05) immediately post-exercise, while serum hepcidin was significantly elevated (p<0.05) 3h post-exercise, with no significant differences recorded between trials. CONCLUSIONS: These findings suggest that exercise performed during the different phases (D-0 vs. D+7) of a monophasic OCP regulated cycle does not alter exercise induced IL-6 or hepcidin production. As such, future studies looking to investigate similar variables post-exercise, may not need to 'control' for different phases of the OCC, provided participants are current monophasic OCP users.

Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production.

The trace element iron plays a number of crucial physiological roles within the body. Despite its importance, iron deficiency remains a common problem among athletes. As an individual's iron stores become depleted, it can affect their well-being and athletic capacity. Recently, altered iron metabolism in athletes has been attributed to postexercise increases in the iron regulatory hormone hepcidin, which has been reported to be upregulated by exercise-induced increases in the inflammatory cytokine interleukin-6. As such, when hepcidin levels are elevated, iron absorption and recycling may be compromised. To date, however, most studies have explored the acute postexercise hepcidin response, with limited research seeking to minimize/attenuate these increases. This review summarizes the current knowledge regarding the postexercise hepcidin response under a variety of exercise scenarios and highlights potential areas for future research-such as: a) the use of hormones though the female oral contraceptive pill to manipulate the postexercise hepcidin response, b) comparing the use of different exercise modes (e.g., cycling vs. running) on hepcidin regulation.

Effect of exercise modality and intensity on post-exercise interleukin-6 and hepcidin levels.

The effect of exercise modality and intensity on Interleukin-6 (IL-6), iron status, and hepcidin levels was investigated. Ten trained male triathletes performed 4 exercise trials including low-intensity continuous running (L-R), low-intensity continuous cycling (L-C), high-intensity interval running (H-R), and high-intensity interval cycling (H-C). Both L-R and L-C consisted of 40 min continuous exercise performed at 65% of peak running velocity (vVO2peak) and cycling power output (pVO2peak), while H-R and H-C consisted of 8 × 3-min intervals performed at 85% vVO2peak and pVO2peak. Venous blood samples were drawn pre-, post-, and 3 hr postexercise. Significant increases in postexercise IL-6 were seen within each trial (p < .05) and were significantly greater in H-R than L-R (p < .05). Hepcidin levels were significantly elevated at 3 hr postexercise within each trial (p < .05). Serum iron levels were significantly elevated (p < .05) immediately postexercise in all trials except L-C. These results suggest that, regardless of exercise mode or intensity, postexercise increases in IL-6 may be expected, likely influencing a subsequent elevation in hepcidin. Regardless, the lack of change in postexercise serum iron levels in L-C may indicate that reduced hemolysis occurs during weight-supported, low-intensity activity.

Effect of supplemental oxygen on post-exercise inflammatory response and oxidative stress.

This investigation explored the influence of supplemental oxygen administered during the recovery periods of an interval-based running session on the post-exercise markers of reactive oxygen species (ROS) and inflammation. Ten well-trained male endurance athletes completed two sessions of 10 × 3 min running intervals at 85 % of the maximal oxygen consumption velocity (vVO(2)peak) on a motorised treadmill. A 90-s recovery period was given between each interval, during which time the participants were administered either a hyperoxic (HYP) (Fraction of Inspired Oxygen (FIO2) 99.5 %) or normoxic (NORM) (FIO2 21 %) gas, in a randomized, single-blind fashion. Pulse oximetry (SpO(2)), heart rate (HR), blood lactate (BLa), perceived exertion (RPE), and perceived recovery (TQRper) were recorded during each trial. Venous blood samples were taken pre-exercise, post-exercise and 1 h post-exercise to measure Interleukin-6 (IL-6) and Isoprostanes (F2-IsoP). The S(p)O(2) was significantly lower than baseline following all interval repetitions in both experimental trials (p < 0.05). The S(p)O(2) recovery time was significantly quicker in the HYP when compared to the NORM (p < 0.05), with a trend for improved perceptual recovery. The IL-6 and F2-IsoP were significantly elevated immediately post-exercise, but had significantly decreased by 1 h post-exercise in both trials (p < 0.05). There were no differences in IL-6 or F2-IsoP levels between trials. Supplemental oxygen provided during the recovery periods of interval based exercise improves the recovery time of SPO(2) but has no effect on post-exercise ROS or inflammatory responses.

Relationship between inflammatory cytokines and self-report measures of training overload.

It has been purported that inflammatory cytokines may be responsible for the aetiology of overtraining. The aim of the present study was to investigate the relationship between self-reported measures of overtraining and inflammatory cytokines. Eight elite male rowers were monitored in their natural training environment for 8 weeks prior to the 2007 Rowing World Championships. During this period of intense endurance training, self-report measures of overtraining and inflammatory cytokines (Interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12p70, and Tumor Necrosis Factor (TNF)-alpha) were assessed fortnightly. Consistent with previous findings, proinflammatory cytokines IL-1beta and TNF-alpha were significantly associated (p

Impact of training on changes in perceived stress and cytokine production.

Data on training of competitive athletes and the inflammatory response, and, more specifically, the utility of psychological inventories to monitor this response in regards to overreaching is limited. The aim of the present study was to investigate the association of the Perceived Stress Scale (PSS) and inflammatory markers in elite rowers. Eight rowers (males n = 4; females n = 4) were monitored over an 8-week training period, comprising 12 sessions each week and training an average 3.11 h.d(-1). Training volume was periodized weekly while intensity was maintained throughout the study. Perceived stress was measured weekly pretraining, and capillary blood samples (500 microL) were taken post-training. Significant associations between perceived stress and cytokines interleukin-6 (p < .05) and tumor necrosis factor alpha (p < .05) were observed. While further investigation of the role of cytokines in the overtraining process is required, these data provide preliminary support for an association between perceived stress and the inflammatory responses to training.

Cumulative effects of consecutive running sessions on hemolysis, inflammation and hepcidin activity.

The effect of two running sessions completed within a 12-h period on hemolysis, inflammation, and hepcidin activity in endurance athletes was investigated. Ten males completed two experimental trials in a randomized, counterbalanced order. The two trials included (a) a one-running-session trial (T1) including 10 x 1 km interval repeats (90% peak VO2 velocity), and (b) a two-running-session trial (T2), comprising a continuous 10-km run (70% peak VO2 velocity), and a 10 x 1 km interval run (90% peak VO2 velocity) completed 12 h later. Interleukin-6 (IL-6), free hemoglobin (Hb), haptoglobin (Hp), iron, ferritin, and hepcidin were assessed post-exercise. After the T1 and T2 interval runs, free Hb was significantly increased and Hp significantly decreased (p

Effects of exercise on hepcidin response and iron metabolism during recovery.

Urinary hepcidin, inflammation, and iron metabolism were examined during the 24 hr after exercise. Eight moderately trained athletes (6 men, 2 women) completed a 60-min running trial (15-min warm-up at 75-80% HR(peak) + 45 min at 85-90% HR(peak)) and a 60-min trial of seated rest in a randomized, crossover design. Venous blood and urine samples were collected pretrial, immediately posttrial, and at 3, 6, and 24 hr posttrial. Samples were analyzed for interleukin-6 (IL-6), C-reactive protein (CRP), serum iron, serum ferritin, and urinary hepcidin. The immediate postrun levels of IL-6 and 24-hr postrun levels of CRP were significantly increased from baseline (6.9 and 2.6 times greater, respectively) and when compared with the rest trial (p < or = .05). Hepcidin levels in the run trial after 3, 6, and 24 hr of recovery were significantly greater (1.7-3.1 times) than the pre- and immediate postrun levels (p < or = .05). This outcome was consistent in all participants, despite marked variation in the magnitude of rise. In addition, the 3-hr postrun levels of hepcidin were significantly greater than at 3 hr in the rest trial (3.0 times greater, p < or = .05). Hepcidin levels continued to increase at 6 hr postrun but failed to significantly differ from the rest trial (p = .071), possibly because of diurnal influence. Finally, serum iron levels were significantly increased immediately postrun (1.3 times, p < or = .05). The authors concluded that high-intensity exercise was responsible for a significant increase in hepcidin levels subsequent to a significant increase in IL-6 and serum iron.

Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones.

Iron is utilised by the body for oxygen transport and energy production, and is therefore essential to athletic performance. Commonly, athletes are diagnosed as iron deficient, however, contrasting evidence exists as to the severity of deficiency and the effect on performance. Iron losses can result from a host of mechanisms during exercise such as hemolysis, hematuria, sweating and gastrointestinal bleeding. Additionally, recent research investigating the anemia of inflammation during states of chronic disease has allowed us to draw some comparisons between unhealthy populations and athletes. The acute-phase response is a well-recognised reaction to both exercise and disease. Elevated cytokine levels from such a response have been shown to increase the liver production of the hormone Hepcidin. Hepcidin up-regulation has a negative impact on the iron transport and absorption channels within the body, and may explain a potential new mechanism behind iron deficiency in athletes. This review will attempt to explore the current literature that exits in this new area of iron metabolism and exercise.