Sex differences in thermophysiological responses of elderly to low-intensity exercise during uncompensable heat strain.

PURPOSE: The rising frequency of extreme heat events poses an escalating threat of heat-related illnesses and fatalities, placing an additional strain on global healthcare systems. Whether the risk of heat-related issues is sex specific, particularly among the elderly, remains uncertain. METHODS: 16 men and 15 women of similar age (69 ± 5 years) were exposed to an air temperature of 39.1 ± 0.3 °C and a relative humidity (RH) of 25.1 ± 1.9%, during 20 min of seated rest and at least 40 min of low-intensity (10 W) cycling exercise. RH was gradually increased by 2% every 5 min starting at minute 30. We measured sweat rate, heart rate, thermal sensation, and the rise in gastrointestinal temperature (Tgi) and skin temperature (Tsk). RESULTS: Tgi consistently increased from minute 30 to 60, with no significant difference between females and males (0.012 ± 0.004 °C/min vs. 0.011 ± 0.005 °C/min; p = 0.64). Similarly, Tsk increase did not differ between females and males (0.044 ± 0.007 °C/min vs. 0.038 ± 0.011 °C/min; p = 0.07). Females exhibited lower sweat rates than males (0.29 ± 0.06 vs. 0.45 ± 0.14 mg/m2/min; p < 0.001) in particular at relative humidities exceeding 30%. No sex differences in heart rate and thermal sensation were observed. CONCLUSION: Elderly females exhibit significantly lower sweat rates than their male counterparts during low-intensity exercise at ambient temperatures of 39 °C when humidity exceeds 30%. However, both elderly males and females demonstrate a comparable rise in core temperature, skin temperature, and mean body temperature, indicating similar health-related risks associated with heat exposure.

No large effects on cognitive performance in high versus low solar green-flag WBGT conditions.

Excessive solar radiation negatively affects cognitive performance. Occupational guidelines typically combine environmental components into one value, such as wet-bulb globe temperature (WBGT). Here, we evaluated cognitive performance in two similar 28.6 °C WBGT-effective (WBGTeff) that were designed differently; using high or low levels of solar radiation. Eight soldiers were exposed to a virtual-reality environment in a climate chamber set to high (900 Wm-2) or low solar radiation conditions (300 Wm-2). Soldiers walked 3 x 30 min at 5 kmh-1. Cognitive performance was evaluated using a virtual-reality scenario and a computerised test battery. There was no statistically significant effect of condition on the cognitive tasks (p > 0.05). Associations were found between mean body temperature (Tb) and visual detection (P ≤ 0.01). Differences in solar radiation with similar WBGTeff (28.6 °C) do not cause large systematic differences in cognitive performance. Certain aspects of cognitive performance (i.e. response inhibition) seem to be partly associated with Tb rather than solar radiation.Practitioner summary: Cognitive performance was evaluated in two similar WBGT conditions that were designed differently; using high or low levels of solar radiation. Differences in solar radiation with similar WBGT do not cause systematic differences in cognitive performance. Certain aspects of cognition were partly associated with mean body temperature rather than solar radiation.

Validating an advanced smartphone application for thermal advising in cold environments.

The ClimApp smartphone application was developed to merge meteorological forecast data with personal information for individualized and improved thermal warning during heat and cold stress and for indoor comfort in buildings. For cold environments, ClimApp predicts the personal thermal stress and strain by the use of the Insulation REQuired model that combines weather and personal physiological data with additional consideration of the Wind Chill index based on the local weather forecast. In this study, we validated the individualized ClimApp index relative to measurements and compared it with the Universal Temperature Climate Index (UTCI). To this aim, 55 participants (27 females) were exposed to at least 1 h in an outdoor environment of 10 °C or below (average 1.4 °C air temperature, 74.9% relative humidity, and 4.7 m/s air velocity) inputting their activity level and clothing insulation as instructed by ClimApp. The UTCI and ClimApp indices were calculated and compared to the participants' perceived thermal sensation. The ClimApp index root mean square deviation (RMSD) was below the standard deviation of the perceived thermal sensation which indicates a valid prediction and the UTCI RMSD was higher than the standard deviation which indicates an invalid prediction. The correlation of ClimApp and UTCI to the perceived thermal sensation was statistically significant for both models.

Effects of heat load and hypobaric hypoxia on cognitive performance: a combined stressor approach.

This study investigates how cognitive performance is affected by the combination of two stressors that are operationally relevant for helicopter pilots: heat load and hypobaric hypoxia. Fifteen participants were exposed to (1) no stressors, (2) heat load, (3) hypobaric hypoxia, and (4) combined heat load and hypobaric hypoxia. Hypobaric hypoxia (13,000 ft) was achieved in a hypobaric chamber. Heat load was induced by increasing ambient temperature to ∼28 °C. Cognitive performance was measured using two multitasks, and a vigilance task. Subjective and physiological data (oxygen saturation, heart rate, core- and skin temperature) were also collected. Mainly heat load caused cognitive performance decline. This can be explained by high subjective heat load and increased skin temperature, which takes away cognitive resources from the tasks. Only the arithmetic subtask was sensitive to hypobaric hypoxia, whereby hypobaric hypoxia caused a further performance decline in addition to the decline caused by heat load.Practitioner summary: Little is known about how multiple environmental stressors interact. This study investigates the combined effects of heat load and hypobaric hypoxia on cognitive performance. An additive effect of heat load and hypobaric hypoxia was found on a arithmetic task, which may be attributed to independent underlying mechanisms.

Effect of local skin blood flow during light and medium activities on local skin temperature predictions.

The quality of local skin temperature prediction by thermophysiological models depends on the local skin blood flow (SBF) control functions. These equations were derived for low activity levels (0.8-1met) and mostly in sitting or supine position. This study validates and discusses the prediction of foot SBF during activities of 1-3met in male and females, and the effect on the foot skin temperature prediction (ΔTskin,foot) using the thermophysiological simulation model ThermoSEM. The SBF at the foot was measured for ten male and ten female human subjects at baseline and during three activities (sitting, walking at 1km/h, preferred walking around 3km/h). Additional measurements included the energy expenditure, local skin temperatures (Tskin,loc), environmental conditions and body composition. Measured, normalized foot SBF is 2-8 times higher than the simulated SBF during walking sessions. Also, SBF increases are significantly higher in females vs. males (preferred walking: 4.8±1.5 versus 2.7±1.4, P < 0.05). The quality of ΔTskin,foot using the simulated foot SBF is poor (median deviation is -4.8°C, maximumumdeviationis-6°C). Using the measured SBF in ThermoSEM results in an improved local skin temperature prediction (new maximum deviation is -3.3°C). From these data a new SBF model was developed that includes the walking activity level and gender, and improves SBF prediction and ΔTskin,foot of the thermophysiological model. Accurate SBF and local skin temperature predictions are beneficial in optimizing thermal comfort simulations in the built environment, and might also be applied in sport science or patient's temperature management.

Modelling hand skin temperature in relation to body composition.

Skin temperature is a challenging parameter to predict due to the complex interaction of physical and physiological variations. Previous studies concerning the correlation of regional physiological characteristics and body composition showed that obese people have higher hand skin temperature compared to the normal weight people. To predict hand skin temperature in a different environment, a two-node hand thermophysiological model was developed and validated with published experimental data. In addition, a sensitivity analysis was performed which showed that the variations in skin blood flow and blood temperature are most influential on hand skin temperature. The hand model was applied to simulate the hand skin temperature of the obese and normal weight subgroup in different ambient conditions. Higher skin blood flow and blood temperature were used in the simulation of obese people. The results showed a good agreement with experimental data from the literature, with the maximum difference of 0.31°C. If the difference between blood flow and blood temperature of obese and normal weight people was not taken into account, the hand skin temperature of obese people was predicted with an average deviation of 1.42°C. In conclusion, when modelling hand skin temperatures, it should be considered that regional skin temperature distribution differs in obese and normal weight people.

Incorporating neurophysiological concepts in mathematical thermoregulation models.

Skin blood flow (SBF) is a key player in human thermoregulation during mild thermal challenges. Various numerical models of SBF regulation exist. However, none explicitly incorporates the neurophysiology of thermal reception. This study tested a new SBF model that is in line with experimental data on thermal reception and the neurophysiological pathways involved in thermoregulatory SBF control. Additionally, a numerical thermoregulation model was used as a platform to test the function of the neurophysiological SBF model for skin temperature simulation. The prediction-error of the SBF-model was quantified by root-mean-squared-residual (RMSR) between simulations and experimental measurement data. Measurement data consisted of SBF (abdomen, forearm, hand), core and skin temperature recordings of young males during three transient thermal challenges (1 development and 2 validation). Additionally, ThermoSEM, a thermoregulation model, was used to simulate body temperatures using the new neurophysiological SBF-model. The RMSR between simulated and measured mean skin temperature was used to validate the model. The neurophysiological model predicted SBF with an accuracy of RMSR < 0.27. Tskin simulation results were within 0.37 °C of the measured mean skin temperature. This study shows that (1) thermal reception and neurophysiological pathways involved in thermoregulatory SBF control can be captured in a mathematical model, and (2) human thermoregulation models can be equipped with SBF control functions that are based on neurophysiology without loss of performance. The neurophysiological approach in modelling thermoregulation is favourable over engineering approaches because it is more in line with the underlying physiology.

We are all exposed, but some are more exposed than others.

This paper defines functional cold exposure zones that illustrate whether a person is at risk of developing physical performance loss or cold weather injuries. Individual variation in body characteristics, activity level, clothing and protective equipment all contribute to variation in the effective exposure. Nevertheless, with the right education, training, and cold-adapted behaviours the exposure differences might not necessarily lead to increased risk for cold injury. To support the preparation process for cold weather operations, this paper presents a biophysical analysis explaining how much cold exposure risk can vary between individuals in the same environment. The results suggest that smaller persons are prone to be underdressed for moderate activity levels and larger persons are prone to be overdressed. The consequences of these discrepancies place people at different risks for performance loss or cold weather injuries. Nonetheless, even if all are well-dressed at the whole-body level, variation in hand morphology is also expected to influence hand skin temperatures that can be maintained; with smaller hands being more prone to reach skin temperatures associated with dexterity loss or cold weather injuries. In conclusion, this work focusses on bringing cold science to the Arctic warrior, establishing that combating cold stress is not a one size fits all approach.

Biomarkers for warfighter safety and performance in hot and cold environments.

Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (Tc) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction - the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and Tc. Non-invasive methods for real-time estimation of Tc have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.

Introduction: Training is more important than technology (for performance in the cold).

After more than 50 years of studying soldiers in the cold, we are well past the phase of defining the unique problems; the research requirements are known but the solutions have been slow in coming. This requires iterative testing of proposed lab-based solutions with soldiers in the real environment. Representing a renewed effort to produce and implement solutions to human biomedical challenges in Arctic operations, this journal supplement highlights presentations from a three-day NATO Human Factors and Medicine panel-sponsored symposium in Washington DC in October 2022. While technology can certainly aid soldiers in extreme environments, it is ultimately training that is the most important factor for ensuring optimal performance and survival. By investing in the development of specialized Arctic forces training and implementing new solutions to protect their health and performance, we can ensure success in the coldest and harshest of environments.

Upper-Body versus Lower-Body Cooling in Individuals with Paraplegia during Arm-Crank Exercise in the Heat.

PURPOSE: For wheelchair users with a spinal cord injury, the lower body may be a more convenient cooling site than the upper body. However, it remains unknown if leg cooling reduces thermal strain in these individuals. We compared the impact of upper-body versus lower-body cooling on physiological and perceptual outcomes during submaximal arm-crank exercise under heat stress in individuals with paraplegia. METHODS: Twelve male participants with paraplegia (T4-L2, 50% complete lesion) performed a maximal exercise test in temperate conditions, and three heat stress tests (32°C, 40% relative humidity) in which they received upper-body cooling (COOL-UB), lower-body cooling (COOL-LB), or no cooling (CON) in a randomized counterbalanced order. Each heat stress test consisted of four exercise blocks of 15 min at 50% of peak power output, with 3 min of rest in between. Cooling was applied using water-perfused pads, with 14.8-m tubing in both COOL-UB and COOL-LB. RESULTS: Gastrointestinal temperature was 0.2°C (95% confidence interval (CI), 0.1°C to 0.3°C) lower during exercise in COOL-UB versus CON (37.5°C ± 0.4°C vs 37.7°C ± 0.3°C, P = 0.009), with no difference between COOL-LB and CON ( P = 1.0). Heart rate was lower in both COOL-UB (-7 bpm; 95% CI, -11 to -3 bpm; P = 0.01) and COOL-LB (-5 bpm; 95% CI, -9 to -1 bpm; P = 0.049) compared with CON. The skin temperature reduction at the cooled skin sites was larger in COOL-LB (-10.8°C ± 1.1°C) than in COOL-UB (-6.7°C ± 1.4°C, P < 0.001), which limited the cooling capacity in COOL-LB. Thermal sensation of the cooled skin sites was improved and overall thermal discomfort was lower in COOL-UB ( P = 0.01 and P = 0.04) but not in COOL-LB ( P = 0.17 and P = 0.59) compared with CON. CONCLUSIONS: Upper-body cooling more effectively reduced thermal strain than lower-body cooling in individuals with paraplegia, as it induced greater thermophysiological and perceptual benefits.

Mathematical modeling of thermal and circulatory effects during hemodialysis.

Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis (HD) treatment. The initiating factor of IDH is a decrease in blood volume, which is related to an imbalance between ultrafiltration (UF) and refilling rate. Impaired reactivity of resistance and capacitance vessels in reaction to hypovolemia plays possibly a major role in the occurrence of IDH. These vessels also fulfill an important function in body temperature regulation. UF-induced cutaneous vasoconstriction would result in a reduced surface heat loss and an increase in core temperature. To release body heat, skin blood flow is increased at a later stage of the HD treatment, whereby possibly IDH can occur. The aim of the study is to develop a mathematical model that can provide insight into the impact of thermoregulatory processes on the cardiovascular (CV) system during HD treatment. The mathematical procedure has been created by coupling a thermo-physiological model with a CV model to study regulation mechanisms in the human body during HD + UF. Model simulations for isothermal versus thermoneutral HD + UF were compared with measurement data of patients on chronic intermittent HD (n = 13). Core temperature during simulated HD + UF sessions increased within the range of measurement data (0.23°C vs. 0.32 ± 0.41°C). The model showed a decline in mean arterial pressure of -7% for thermoneutral HD + UF versus -4% for isothermal HD + UF after 200 min during which relative blood volume changed by -13%. In conclusion, simulation results of the combined model show possibilities for predicting circulatory and thermal responses during HD + UF.

Cooling vests alleviate perceptual heat strain perceived by COVID-19 nurses.

Cooling vests alleviate heat strain. We quantified the perceptual and physiological heat strain and assessed the effects of wearing a 21°C phase change material cooling vest on these measures during work shifts of COVID-19 nurses wearing personal protective equipment (PPE). Seventeen nurses were monitored on two working days, consisting of a control (PPE only) and a cooling vest day (PPE + cooling vest). Sub-PPE air temperature, gastrointestinal temperature (Tgi), and heart rate (HR) were measured continuously. Thermal comfort (2 [1-4] versus 1 [1-2], pcondtition < 0.001) and thermal sensation (5 [4-7] versus 4 [2-7], pcondition < 0.001) improved in the cooling vest versus control condition. Only 18% of nurses reported thermal discomfort and 36% a (slightly) warm thermal sensation in the cooling vest condition versus 81% and 94% in the control condition (OR (95%CI) 0.05 (0.01-0.29) and 0.04 (<0.01-0.35), respectively). Accordingly, perceptual strain index was lower in the cooling vest versus control condition (5.7 ± 1.5 versus 4.3 ± 1.7, pcondition < 0.001, respectively). No differences were observed for the physiological heat strain index Tgi and rating of perceived exertion across conditions. Average HR was slightly lower in the cooling vest versus the control condition (85 ± 12 versus 87 ± 11, pcondition = 0.025). Although the physiological heat strain among nurses using PPE was limited, substantial perceptual heat strain was experienced. A 21°C phase change material cooling vest can successfully alleviate the perceptual heat strain encountered by nurses wearing PPE.

Impact of different climatic conditions on peak core temperature of elite athletes during exercise in the heat: a Thermo Tokyo simulation study.

Objectives: To evaluate how separate and combined climatic parameters affect peak core temperature during exercise in the heat using computer simulations fed with individual data. Methods: The impact of eight environmental conditions on rectal temperature (Tre) was determined for exercise under heat stress using the Fiala-thermal-Physiology-and-Comfort simulation model. Variations in ambient temperature (Ta±6°C), relative humidity (RH±15%) and solar radiation (SR+921 W/m2) were assessed in isolation and combination (worst-case/best-case scenarios) and compared with baseline (Ta32°C, RH 75%, SR 0 W/m2). The simulation model was fed with personal, anthropometric and individual exercise characteristics. Results: 54 athletes exercised for 46±10 min at baseline conditions and achieved a peak core temperature of 38.9±0.5°C. Simulations at a higher Ta (38°C) and SR (921 W/m2) resulted in a higher peak Tre compared with baseline (+0.6±0.3°C and +0.5±0.2°C, respectively), whereas a higher RH (90%) hardly affected peak Tre (+0.1±0.1°C). A lower Ta (26°C) and RH (60%) reduced peak Tre by -0.4±0.2°C and a minor -0.1±0.1°C, respectively. The worst-case simulation yielded a 1.5±0.4°C higher Tre than baseline and 2.0±0.7°C higher than the best-case condition. Conclusion: Combined unfavourable climatic conditions produce a greater increase in peak core temperature than the sum of its parts in elite athletes exercising in the heat.

Heat Strain and Use of Heat Mitigation Strategies among COVID-19 Healthcare Workers Wearing Personal Protective Equipment-A Retrospective Study.

The combination of an exacerbated workload and impermeable nature of the personal protective equipment (PPE) worn by COVID-19 healthcare workers increases heat strain. We aimed to compare the prevalence of heat strain symptoms before (routine care without PPE) versus during the COVID-19 pandemic (COVID-19 care with PPE), identify risk factors associated with experiencing heat strain, and evaluate the access to and use of heat mitigation strategies. Dutch healthcare workers (n = 791) working at COVID-19 wards for ≥1 week, completed an online questionnaire to assess personal characteristics, heat strain symptoms before and during the COVID-19 pandemic, and the access to and use of heat mitigation strategies. Healthcare workers experienced ~25× more often heat strain symptoms during medical duties with PPE (93% of healthcare workers) compared to without PPE (30% of healthcare workers; OR = 25.57 (95% CI = 18.17-35.98)). Female healthcare workers and those with an age <40 years were most affected by heat strain, whereas exposure time and sports activity level were not significantly associated with heat strain prevalence. Cold drinks and ice slurry ingestion were the most frequently used heat mitigation strategies and were available in 63.5% and 30.1% of participants, respectively. Our findings indicate that heat strain is a major challenge for COVID-19 healthcare workers, and heat mitigations strategies are often used to counteract heat strain.

Human vulnerability and variability in the cold: Establishing individual risks for cold weather injuries.

Human tolerance to cold environments is extremely limited and responses between individuals is highly variable. Such physiological and morphological predispositions place them at high risk of developing cold weather injuries [CWI; including hypothermia and/or non-freezing (NFCI) and freezing cold injuries (FCI)]. The present manuscript highlights current knowledge on the vulnerability and variability of human cold responses and associated risks of developing CWI. This review 1) defines and categorizes cold stress and CWI, 2) presents cold defense mechanisms including biological adaptations, acute responses and acclimatization/acclimation and, 3) proposes mitigation strategies for CWI. This body of evidence clearly indicates that all humans are at risk of developing CWI without adequate knowledge and protective equipment. In addition, we show that while body mass plays a key role in mitigating risks of hypothermia between individuals and populations, NFCI and FCI depend mainly on changes in peripheral blood flow and associated decrease in skin temperature. Clearly, understanding the large interindividual variability in morphology, insulation, and metabolism is essential to reduce potential risks for CWI between and within populations.

The Protective Performance of Process Operators' Protective Clothing and Exposure Limits under Low Thermal Radiation Conditions.

During the early stage of a fire, a process operator often acts as the first responder and may be exposed to high heat radiation levels. The present limit values of long- (>15 min) and short-term exposure (<5 min), 1.0 and 1.5 kW/m2, respectively, have been set using physiological models and manikin measurements. Since human validation is essentially lacking, this study investigated whether operators' protective clothing offers sufficient protection during a short-term deployment. Twelve professional firefighters were exposed to three radiation levels (1.5, 2.0, and 2.5 kW/m2) when wearing certified protective clothing in front of a heat radiation panel in a climatic chamber (20 °C; 50% RH). The participants wore only briefs (male) or panties and a bra (female) and a T-shirt under the operators' clothing. Skin temperatures were continuously measured at the chest, belly, forearm, thigh, and knee. The test persons had to stop if any skin temperature reached 43 °C, at their own request, or when 5 min of exposure was reached. The experiments showed that people in operators' clothing can be safely exposed for 5 min to 1.5 kW/m2, up to 3 min to 2.0 kW/m2, and exposure to 2.5 kW/m2 or above must be avoided unless the clothing can maintain an air gap.

Human performance research for military operations in extreme cold environments.

OBJECTIVES: Soldier performance in the Arctic depends on planning and training, protective equipment, and human physiological limits. The purpose of this review was to highlight the span of current research on enhancing soldier effectiveness in extreme cold and austere environments. METHODS: The practices of seasoned soldiers who train in the Arctic and cold-dwelling natives inform performance strategies. We provide examples of research and technology that build on these concepts. RESULTS: Examples of current performance research include evaluation of equipment and tactics such as the bioenergetics of load carriage over snow in Norwegian exercises; Canadian field monitoring of hand temperatures and freezing cold injuries for better protection of manual dexterity; and Dutch predictive modeling of cold-wet work tolerances. Healthy young men can respond to cold with a substantial thermogenic response based on US and Canadian studies on brown adipose tissue and other mechanisms of non-shivering thermogenesis; the potential advantage of greater fat insulation is offset in obese unfit subjects by a smaller thermogenic response. Current physiological studies are addressing previously unanswered problems of cold acclimation procedures, thermogenic enhancement and regulation, and modulation of sympathetic activation, all of which may further enhance cold survival and expand the performance envelope. CONCLUSION: There is an inseparable behavioral component to soldier performance in the Arctic, and even the best equipment does not benefit soldiers who have not trained in the actual environment. Training inexperienced soldiers to performance limits may be helped with personal monitoring technologies and predictive models.