The fan cooling vest use reduces thermal and perceptual strain during outdoor exercise in the heat on a sunny summer day.

The fan cooling vest is coming into very common use by Japanese outdoor manual workers. We examined that to what extent using this vest reduces thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Ten male baseball players in high school conducted two baseball training sessions for 2-h with (VEST) or without (CON) a commercially available fan cooling vest on a baseball uniform. These sessions commenced at 10 a.m. on separate days in early August. The fan airflow rate attached the vest was 62 L·s-1. Neither ambient temperature (Mean ± SD: VEST 31.9 ± 0.2°C; CON 31.8 ± 0.7°C), wet-bulb globe temperature (VEST 31.2 ± 0.4°C; CON 31.4 ± 0.5°C) nor solar radiation (VEST 1008 ± 136 W·m-2; CON 1042 ± 66 W·m-2) was different between trials. Mean skin temperature (VEST 34.5 ± 1.1°C; CON 35.1 ± 1.4°C), infrared tympanic temperature (VEST 38.9 ± 0.9°C; CON 39.2 ± 1.2°C), heart rate (VEST 127 ± 31 bpm; CON 139 ± 33 bpm), body heat storage (VEST 140 ± 34 W·m-2; CON 160 ± 22 W·m-2), thermal sensation (- 4-4: VEST 0 ± 2; CON 3 ± 1) and rating of perceived exertion (6-20: VEST 11 ± 2; CON 14 ± 2) were lower in VEST than CON (all P < 0.05). Total distance measured with a global positioning system (VEST 3704 ± 293 m; CON 3936 ± 501 m) and body fluid variables were not different between trials. This study indicates that the fan cooling vest use can reduce thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Cooling with this vest would be effective to mitigate thermal risks and perceptual stress in athletes and sports participants under such settings.

IOC consensus statement on recommendations and regulations for sport events in the heat.

This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes' behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes.

OBJECTIVES: To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes. METHODS: An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS. RESULTS: Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete. CONCLUSIONS: Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.

Sudden Death in High School Athletes: A Case Series Examining the Influence of Sickle Cell Trait.

ABSTRACT: Athletes with sickle cell trait (SCT) have up to a 37-fold increased risk of exercise-related death. Exertional collapse associated with sickle cell trait (ECAST) is uncommon but can lead to exercise-related death due to exertional sickling. We present a case series of fatal ECAST in high school athletes aged 14 to 16 years. All 3 athletes experienced collapse during practice sessions with muscle pain or weakness. Upon evaluation at the hospital, the athletes had a significant metabolic acidosis that did not respond as expected to fluid resuscitation. Admitting diagnoses for the athletes included exertional heat stroke or dehydration. All 3 athletes had profound rhabdomyolysis leading to acute renal failure, worsening metabolic acidosis, and hyperkalemia. They rapidly progressed to disseminated intravascular coagulation, multiorgan system failure, and death. The autopsies of all 3 athletes showed extensive sickle cell vaso-occlusion involving the spleen liver, and muscles. Final clinical and pathologic diagnosis supported ECAST with fatal exertional rhabdomyolysis. Exertional collapse associated with sickle cell trait is an uncommon but potentially deadly condition that is often underrecognized or misdiagnosed as exertional heat stroke. The development of ECAST is thought to be multifactorial with exercise intensity, recent illness, and exercising conditions (ie, heat and altitude). Prevention should be the primary goal for athletes with SCT through exercise modification, education of precipitation factors, and cessation of exercise with recent illness. Athletes with suspected ECAST should undergo aggressive resuscitation with a low threshold for early transfer to a tertiary care facility for further management and potential hemodialysis.

Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020.

OBJECTIVES: This document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management. METHODS: Members of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management. RESULTS: Sports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site. CONCLUSIONS: A coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

Comparison of the effect of post-exercise cooling with ice slurry ingestion between males and females.

This study aimed to compare the effects of ice slurry ingestion on post-exercise cooling in males and females. Twenty-four healthy adults (male n = 12; body weight [BW], 65.8 ± 10.3 kg; female, n = 12; BW, 58.2 ± 10.0 kg) participated in this study. Participants ingested 7.5 g/kg of either ice slurry at -1 °C (ICE) or control fluid at 20 °C (CON) during recovery after cycling at 55% VO2max until the rectal temperature reached 38.5 °C or exhaustion in a hot environment (controlled at 38 °C, 40% relative humidity). Rectal (Tre) and skin (Tsk) temperature, ratings of thermal sensation (TS), thermal comfort (TC), heart rate (HR), mean arterial pressure (MAP), and whole body sweat loss (WBSL) were measured 60 min after exercise. Ice slurry ingestion reduced Tre and TS and improved post-exercise hypotension only in females (p < 0.05). In comparison, males did not receive cooling effect from post- exercise cooling with ice slurry ingestion. WBSL tended to be lower in ICE than CON in males (ICE, 454.3 ± 172.3 g; CON, 539.7 ± 157.2 g; p = 0.065). In conclusion, sex differences were observed in the effects of post-exercise cooling with ice slurry ingestion.

Solar radiation and the validity of infrared tympanic temperature during exercise in the heat.

We investigated the validity of infrared tympanic temperature (IR-Tty) during exercise in the heat with variations in solar radiation. Eight healthy males completed stationary cycling trials at 70% peak oxygen uptake until exhaustion in an environmental chamber maintained at 30°C with 50% relative humidity. Three solar radiation conditions, 0, 250 and 500 W/m2, were tested using a ceiling-mounted solar simulator (metal-halide lamps) over a 3 × 2 m irradiated area. IR-Tty and rectal temperature (Tre) were similar before and during exercise in each trial (P > 0.05). Spearman's rank correlation coefficient (rs) demonstrated very strong (250 W/m2, rs = 0.87) and strong (0 W/m2, rs = 0.73; 500 W/m2, rs = 0.78) correlations between IR-Tty and Tre in all trials (P < 0.001). A Bland-Altman plot showed that mean differences (SD; 95% limits of agreement; root mean square error) between IR-Tty and Tre were - 0.11°C (0.46; - 1.00 to 0.78°C; 0.43 ± 0.16°C) in 0 W/m2, - 0.13°C (0.32; - 0.77 to 0.50°C; 0.32 ± 0.10°C) in 250 W/m2 and - 0.03°C (0.60; - 1.21 to 1.14°C; 0.46 ± 0.27°C) in 500 W/m2. A positive correlation was found in 500 W/m2 (rs = 0.51; P < 0.001) but not in 250 W/m2 (rs = 0.04; P = 0.762) and 0 W/m2 (rs = 0.04; P = 0.732), indicating a greater elevation in IR-Tty than Tre in 500 W/m2. Percentage of target attainment within ± 0.3°C between IR-Tty and Tre was higher in 250 W/m2 (100 ± 0%) than 0 (93 ± 7%) and 500 (90 ± 10%; P < 0.05) W/m2. IR-Tty is acceptable for core temperature monitoring during exercise in the heat when solar radiation is ≤ 500 W/m2, and its accuracy increases when solar radiation is 250 W/m2 under our study conditions.

Differences between sexes in thermoregulatory responses and exercise time during endurance exercise in a hot environment following pre-cooling with ice slurry ingestion.

This study aimed to examine differences between sexes in thermoregulatory responses and exercise time after ice slurry ingestion in a hot environment. Twenty-four healthy adults (male n = 12, body weight (BW) = 65.8 ± 10.3; female n = 12, BW = 58.2 ± 10.0) ingested 7.5 g/kg of either ice slurry at -1 °C (ICE) or control water at 20 °C (CON) before cycling at 55%VO2 max in a hot environment (controlled at 38 °C, 40% relative humidity). Rectal (Tre) and skin (Tsk) temperature, heart rate, sweat rate, respiratory gases, ratings of thermal sensation (TS), thermal comfort (TC), and rating of perceived exertion (RPE) were measured. Ice slurry did not improve exercise time in both sexes despite Tre was significantly lower in ICE than CON in both sexes. Tre, Tsk, HR, sweat rate and TS did not differ between sexes. TC and RPE in ICE were significantly higher during exercise in males than in females. In conclusion, there were no sex differences in the effects of pre-cooling with ice slurry ingestion; however, pre-cooling with ice slurry may be more effective in mitigating ratings of TC and RPE in females than males.

Environmental Conditions, Preseason Fitness Levels, and Game Workload: Analysis of a Female NCAA DI National Championship Soccer Season.

Benjamin, CL, Hosokawa, Y, Curtis, RM, Schaefer, DA, Bergin, RT, Abegg, MR, and Casa, DJ. Environmental conditions, preseason fitness levels, and game workload: Analysis of a female NCAA DI National Championship Soccer Season. J Strength Cond Res 34(4): 988-994, 2020-The purpose of this study was to determine the independent and combined moderating effect of aerobic fitness and environmental conditions on physical workloads during collegiate female soccer matches. Nineteen National Collegiate Athletic Association female soccer athletes were included in this study (mean ± SD: age, 20.6 ± 1.4 years; height, 169 ± 6.1 cm; body mass 64.7 ± 5.3 kg). Maximal oxygen consumption (V[Combining Dot Above]O2max) was estimated from the yo-yo intermittent recovery test before preseason training and wet-bulb globe temperature (WBGT) was recorded onsite for home matches and at the nearest weather station for away matches. Relative distance (TD), relative high-speed running distance (%HSD), and relative high metabolic load (%HML) performance were collected during each match using a global positioning system unit (Viper Pod; STATSports, Chicago, IL). Statistically significant differences were observed in TD between LOW WBGT and MOD WBGT (mean difference [MD] = 7.08 m·min; effect size [ES] = 0.54; p < 0.001), in %HSD between LOW WBGT and MOD WBGT (MD = 1.97%; ES = 0.64; p = 0.01) and between LOW WBGT and HIGH WBGT (MD = 2.71%; ES = 1.01; p < 0.001), and in %HML between LOW WBGT and MOD WBGT (MD = 1.24%; ES = 0.56; p < 0.001) and between LOW WBGT and HIGH WBGT (MD = 1.55%; ES = 0.78; p = 0.01). There was a significant interaction between WBGT and V[Combining Dot Above]O2max for %HSD (p = 0.03). These findings demonstrate that physical performance metrics were affected by increased WBGT. In addition, aerobic fitness seemed to moderate the effect of increasing WBGT on %HSD, meaning maximizing aerobic capacity is important for optimizing running performance in the heat. Coaches and sports medicine staff could alter training time and session length based on environmental conditions as well as potentially use aggressive cooling strategies to mitigate the imposed heat stress and decrements in physical performance.

Chemically Activated Cooling Vest's Effect on Cooling Rate Following Exercise-Induced Hyperthermia: A Randomized Counter-Balanced Crossover Study.

Background and objectives: Exertional heat stroke (EHS) is a potentially lethal, hyperthermic condition that warrants immediate cooling to optimize the patient outcome. The study aimed to examine if a portable cooling vest meets the established cooling criteria (0.15 °C·min-1 or greater) for EHS treatment. It was hypothesized that a cooling vest will not meet the established cooling criteria for EHS treatment. Materials and Methods: Fourteen recreationally active participants (mean ± SD; male, n = 8; age, 25 ± 4 years; body mass, 86.7 ± 10.5 kg; body fat, 16.5 ± 5.2%; body surface area, 2.06 ± 0.15 m2. female, n = 6; 22 ± 2 years; 61.3 ± 6.7 kg; 22.8 ± 4.4%; 1.66 ± 0.11 m2) exercised on a motorized treadmill in a hot climatic chamber (ambient temperature 39.8 ± 1.9 °C, relative humidity 37.4 ± 6.9%) until they reached rectal temperature (TRE) >39 °C (mean TRE, 39.59 ± 0.38 °C). Following exercise, participants were cooled using either a cooling vest (VEST) or passive rest (PASS) in the climatic chamber until TRE reached 38.25 °C. Trials were assigned using randomized, counter-balanced crossover design. Results: There was a main effect of cooling modality type on cooling rates (F[1, 24] = 10.46, p < 0.01, η2p = 0.30), with a greater cooling rate observed in VEST (0.06 ± 0.02 °C·min-1) than PASS (0.04 ± 0.01 °C·min-1) (MD = 0.02, 95% CI = [0.01, 0.03]). There were also main effects of sex (F[1, 24] = 5.97, p = 0.02, η2p = 0.20) and cooling modality type (F[1, 24] = 4.38, p = 0.047, η2p = 0.15) on cooling duration, with a faster cooling time in female (26.9 min) than male participants (42.2 min) (MD = 15.3 min, 95% CI = [2.4, 28.2]) and faster cooling duration in VEST than PASS (MD = 13.1 min, 95% CI = [0.2, 26.0]). An increased body mass was associated with a decreased cooling rate in PASS (r = -0.580, p = 0.03); however, this association was not significant in vest (r = -0.252, p = 0.39). Conclusions: Although VEST exhibited a greater cooling capacity than PASS, VEST was far below an acceptable cooling rate for EHS treatment. VEST should not replace immediate whole-body cold-water immersion when EHS is suspected.

Exertional Heat Illness Preparedness Strategies: Environmental Monitoring Policies in United States High Schools.

Background and objectives: Environmental monitoring allows for an analysis of the ambient conditions affecting a physically active person's ability to thermoregulate and can be used to assess exertional heat illness risk. Using public health models such as the precaution adoption process model (PAPM) can help identify individual's readiness to act to adopt environmental monitoring policies for the safety of high school athletes. The purpose of this study was to investigate the adoption of policies and procedures used for monitoring and modifying activity in the heat in United States (US) high schools. Materials and Methods: Using a cross-sectional design, we distributed an online questionnaire to athletic trainers (ATs) working in high schools in the US. The questionnaire was developed based on best practice standards related to environmental monitoring and modification of activity in the heat as outlined in the 2015 National Athletic Trainers' Association Position Statement: Exertional Heat Illness. The PAPM was used to frame questions as it allows for the identification of ATs' readiness to act. PAPM includes eight stages: unaware of the need for the policy, unaware if the school has this policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining. Invitations were sent via email and social media and resulted in 529 complete responses. Data were aggregated and presented as proportions. Results: Overall, 161 (161/529, 30.4%) ATs report they do not have a written policy and procedure for the prevention and management of exertional heat stroke. The policy component with the highest adoption was modifying the use of protective equipment (acting = 8.2%, maintaining = 77.5%). In addition, 28% of ATs report adoption of all seven components for a comprehensive environmental monitoring policy. Conclusions: These findings indicate a lack of adoption of environmental monitoring policies in US high schools. Secondarily, the PAPM, facilitators and barriers data highlight areas to focus future efforts to enhance adoption.

Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race.

Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003-2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2-4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (-4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1-12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3-5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

The Epidemiology and Management of Exertional Heat Illnesses in High School Sports During the 2012/2013­2016/2017 Academic Years.

Context: Recent data on exertional heat illness (EHI) in high school sports are limited yet warranted to identify specific settings with the highest risk of EHI. Objective: To describe the epidemiology of EHI in high school sports during the 2012/2013-2016/2017 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from athletic trainers working in high school sports in the United States. Patients or Other Participants: High school athletes during the 2012/2013-2016/2017 academic years. Intervention: High School Reporting Information Online surveillance system data from the 2012/2013-2016/2017 academic years were analyzed. Main Outcome Measures: EHI counts, rates per 10,000 athlete exposures (AEs), and distributions were examined by sport, event type, and US census region. EHI management strategies provided by athletic trainers were analyzed. Injury rate ratios with 95% confidence intervals (CIs) compared EHI rates. Results: Overall, 300 EHIs were reported for an overall rate of 0.13/10,000 AE (95% CI, 0.11 to 0.14). Of these, 44.3% occurred in American football preseason practices; 20.7% occurred in American football preseason practices with a registered air temperature ≥90°F and ≥1 hour into practice. The EHI rate was higher in American football than all other sports (0.52 vs 0.04/10,000 AE; injury rate ratio = 11.87; 95% CI, 9.22 to 15.27). However, girls' cross-country had the highest competition EHI rate (1.18/10,000 AE). The EHI rate was higher in the South US census region than all other US census regions (0.23 vs 0.08/10,000 AE; injury rate ratio = 2.96; 95% CI, 2.35 to 3.74). Common EHI management strategies included having medical staff on-site at the onset of EHI (92.7%), removing athlete from play (85.0%), and giving athlete fluids via the mouth (77.7%). Conclusions: American football continues to have the highest overall EHI rate although the high competition EHI rate in girls' cross-country merits additional examination. Regional differences in EHI incidence, coupled with sport-specific variations in management, may highlight the need for region- and sport-specific EHI prevention guidelines.

Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA.

Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.

Wireless measurement of rectal temperature during exercise: Comparing an ingestible thermometric telemetric pill used as a suppository against a conventional rectal probe.

Wireless measurement of rectal temperature during exercise may circumvent some limitations associated with the use of a conventional wired probe. We determined, for the first time, whether temperatures provided in vivo by wireless ingestible thermometric telemetric pills and a rectal probe compare favorably under conditions producing slow and rapid increases and decreases in rectal temperature. While wearing a rectal probe linked to a wireless ingestible thermometric telemetric pill, 13 participants completed the following phases: 1) 30 min sitting; 2) 45 min passive heat exposure (40-42 °C); 3) 45 min sitting while ingesting 7.5 g of ice slurry · kg body mass-1; 4) running exercise (38 °C) at 68% V˙O2max until a 39.5 °C increase in rectal probe temperature and; 5) cold-water (10 °C) immersion until a 1.5 °C decrease in rectal probe temperature. Acceptable differences between devices were taken as ≤ 0.3 °C. Mean differences within phases were all < 0.3 °C, whereas 95% limits of agreement ranged from ±0.2 °C to ±0.4 °C, coefficient of variations from ±0.3% to ±0.6% and typical error of measurements from ±0.1 °C to ±0.2°. Of the 14881 rectal temperature values measured over the experiment with the wireless ingestible thermometric telemetric pills and rectal probe, 91% of the differences between devices were found to be ≤ 0.3 °C. Results suggest that rectal temperatures provided by a wireless ingestible thermometric telemetric pill used as a suppository agree with those of a conventional wired probe. Hence, rectal temperature can reliably be measured using a wireless ingestible thermometric telemetric pill as a suppository.

Solar Radiation Exposure Has Diurnal Effects on Thermoregulatory Responses During High-Intensity Exercise in the Heat Outdoors.

Otani, H, Goto, T, Goto, H, Hosokawa, Y, and Shirato, M. Solar radiation exposure has diurnal effects on thermoregulatory responses during high-intensity exercise in the heat outdoors. J Strength Cond Res 33(10): 2608-2615, 2019-This study investigated the diurnal effects of variations in solar radiation associated with changing solar elevation angle on thermoregulatory responses during high-intensity exercise in the heat outdoors. Ten male high school soccer players completed two 2-hour soccer training sessions under a clear sky in the heat of summer. These sessions were commenced at 0900 hours (AM) and 1600 hours (PM) on separate days. Solar radiation and elevation angle were higher in AM (820-1,070 W·m and 45-69°) than PM (620-110 W·m and 34-10°: both p < 0.001). Neither ambient temperature (AM 29-32° C; PM 31-31° C) nor wet-bulb globe temperature was different between trials. Although mean skin temperature was not different between trials, infrared tympanic temperature was higher at the end of exercise in AM than PM (p < 0.001). Heart rate (p < 0.01) and body heat gain from the sun (p < 0.001) were greater during exercise in AM than PM. Dry heat loss was smaller, but evaporative heat loss was greater in AM than PM (both p < 0.001). Thermal sensation and rating of perceived exertion were similar between trials, but GPS measurements showed a less total distance and distance covered by walking, jogging, and running in AM than PM (p < 0.01). This study demonstrates a greater thermoregulatory strain in AM than PM during 2-hour high-intensity soccer training in the heat under a clear sky. This observation is accompanied by a progressive increase in environmental heat stress with rising solar radiation and elevation angle in AM and a greater body heat gain from the sun in AM compared with PM.

The Influence of Compression Socks During a Marathon on Exercise-Associated Muscle Damage.

CONTEXT: Compression socks have become increasingly popular with athletes due to perceived enhancement of exercise performance and recovery. However, research examining the efficacy of compression socks to reduce exercise-associated muscle damage has been equivocal, with few direct measurements of markers of muscle damage. OBJECTIVE: To examine the influence of compression socks worn during a marathon on creatine kinase (CK) levels. DESIGN: A randomized controlled trial. SETTING: 2013 Hartford Marathon, Hartford, CT. PARTICIPANTS: Adults (n = 20) randomized to control (CONTROL; n = 10) or compression sock (SOCK; n = 10) groups. MAIN OUTCOME MEASURES: Blood samples were collected 24 hours before, immediately after, and 24 hours following the marathon for the analysis of CK, a marker of muscle damage. RESULTS: Baseline CK levels did not differ between CONTROL (89.3 [41.2] U/L) and SOCK (100.0 [56.2] U/L) (P = .63). Immediately following the marathon (≤1 h), CK increased 273% from baseline (P < .001 for time), with no difference in exercise-induced changes in CK from baseline between CONTROL (+293.9 [278.2] U/L) and SOCK (+233.1 [225.3] U/L; P = .60 for time × group). The day following the marathon (≤24 h), CK further increased 1094% from baseline (P < .001 for time), with no difference in changes in CK from baseline between CONTROL (+ 1191.9 [1194.8] U/L) and SOCK (+889.1 [760.2] U/L; P = .53 for time × group). These similar trends persisted despite controlling for potential covariates such as age, body mass index, and race finishing time (Ps > .29). CONCLUSIONS: Compression socks worn during a marathon do not appear to mitigate objectively measured markers of muscle damage immediately following and 24 hours after a marathon.

Consensus Statement- Prehospital Care of Exertional Heat Stroke.

Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.