[Heat-related illnesses: advice for clinicians and healthcare professionals]. / Maladies liées à la chaleur : conseils aux médecins et professionnels de santé.

The increase in heatwaves, a significant consequence of global warming, represents a major public health issue and is the main cause of death related to hyperthermia. The seriousness of such exposure to extreme ambient temperature lies in the difficulty to the general population to identify the warning signs and take appropriate protective measures. This article therefore presents guidelines for the prevention, recognition and treatment of heat-related illnesses, and thus arms clinicians and healthcare professionals who are on the front line in protecting the general population from this 'silent killer'.

L'augmentation des épisodes de canicule, conséquence notable du changement climatique, constitue un enjeu majeur de santé publique et représente la principale cause de mortalité liée à l'hyperthermie. La gravité de ces épisodes de chaleur extrême réside dans la difficulté pour la population générale d'identifier les signes avant-coureurs et de mettre en place des mesures de protection adéquates. Cet article présente des directives pour la prévention, la reconnaissance et le traitement des maladies liées à la chaleur, afin d'équiper les médecins et professionnels de santé qui sont en première ligne pour protéger la population générale de ce « tueur silencieux ¼.

Test-retest reliability of gastrocnemius medialis fascicle force-length relationship.

Fascicle force-length relationship is one major basic mechanical property of skeletal muscle, subsequently influencing movement mechanics. While force-length properties are increasingly described through ultrafast ultrasound imaging, their test-retest reliability remains unknown. Using ultrafast ultrasound, and electrically evoked contractions at various ankle angles, gastrocnemius medialis fascicle force-length relationship was assessed twice, few days apart, in sixteen participants. The test-retest reliability of the resulting fascicle force-length relationship key parameters - i.e., maximal force (Fmax), and optimal fascicle length (L0) - was evaluated considering (i) all the trials obtained at each ankle joint and (ii) the mean of the two trials obtained at each tested angle. Considering all trials, L0 indicated a 'high' test-retest reliability, with intra-class correlation coefficients (ICC) of 0.89 and Fmax a 'moderate' reliability (ICC = 0.71), while when averaging the two trials L0 reliability was 'very-high' (ICC = 0.91), and Fmax reliability 'moderate' (ICC = 0.73). All values of coefficient of variation and standard error of measurement were low, i.e., ≤7.7 % and ≤0.35 cm for L0 and ≤3.4 N for Fmax, respectively. Higher absolute reliability was reported for L0 than Fmax, with better reliability when averaging the two trials at each angle. All these parameters, in accordance with the limit of agreement, demonstrated that L0 and Fmax test-retest reliability is acceptable, particularly when averaging multiple points obtained at a given angle. Interestingly, the shape of the fascicle force-length relationship is more variable. Therefore, L0 and Fmax can be used to compare between days-effects following an intervention, while a comparison of fascicle operating lengths may require more precautions.

Running 40 Minutes under Temperate or Hot Environment Does Not Affect Operating Fascicle Length.

PURPOSE: Muscle mechanics is paramount in our understanding of motor performance. However, little is known regarding the sensitivity of fascicle dynamics and connective tissues stiffness to exercise duration and ambient temperature during running, both increasing muscle temperature. This study aimed to determine gastrocnemius medialis (GM) fascicle dynamics in vivo during running in temperate and hot conditions, as well as muscle-tendon unit responses. METHODS: Using ultrafast ultrasound, 15 participants (8 men, 7 women; 26 ± 3 yr) were tested before, during (2 and 40 min), and after a running task (40 min at 10 km·h -1 ) in temperate (TEMP; ~23°C) and hot (HOT: ~38°C) conditions. RESULTS: Although core, skin temperatures, and heart rate increased from the beginning to the end of the exercise and in a larger extent in HOT than TEMP ( P < 0.001), the physiological stress elicited did not alter running temporal parameters and GM fascicle operating lengths, with similar behavior of the fascicles on their force-length relationship, over time (2 vs 40 min) or across condition (TEMP vs HOT; P ≥ 0.248). Maximal voluntary force production did not reported statistical changes after exercise ( P = 0.060), and the connective tissues stiffness measured (i.e., passive muscle and stiffness of the series-elastic elements) did not show neither time ( P ≥ 0.281), condition ( P ≥ 0.256) nor time-condition interaction ( P ≥ 0.465) effect. CONCLUSIONS: This study revealed that prolonged running exercise does not alter muscle-tendon unit properties and interplay, which are not influenced by ambient temperature. These findings may rule out potential detrimental effects of heat on muscle properties and encourage further investigations on longer and more intense running exercise.

Active Heat Acclimation Does Not Alter Muscle-Tendon Unit Properties.

PURPOSE: Heat acclimation (HA) is recommended before competing in hot and humid conditions. HA has also been recently suggested to increase muscle strength, but its effects on human's muscle and tendon mechanical properties are not yet fully understood. This study investigated the effect of active HA on gastrocnemius medialis (GM) muscle-tendon properties. METHODS: Thirty recreationally active participants performed 13 low-intensity cycling sessions, distributed over a 17-d period in hot (HA = ~38°C, ~58% relative humidity; n = 15) or in temperate environment (CON = ~23°C, ~35% relative humidity; n = 15). Mechanical data and high-frame rate ultrasound images were collected during electrically evoked and voluntary contractions pre- and postintervention. Shear modulus was measured at rest in GM, and vertical jump performance was assessed. RESULTS: Core temperature decreased from the first to the last session in HA (-0.4°C ± 0.3°C; P = 0.015), while sweat rate increased (+0.4 ± 0.3 L·h -1 ; P = 0.010), suggesting effective HA, whereas no changes were observed in CON (both P ≥ 0.877). Heart rate was higher in HA versus CON and decreased throughout intervention in groups (both P ≤ 0.008), without an interaction effect ( P = 0.733). Muscle-tendon unit properties (i.e., maximal and explosive isometric torque production, contractile properties, voluntary activation, joint and fascicular force-velocity relationship, passive muscle, and active tendon stiffness) and vertical jump performance did not show training ( P ≥ 0.067) or group-training interaction ( P ≥ 0.232) effects. CONCLUSIONS: Effective active HA does not alter muscle-tendon properties. Preparing hot and humid conditions with active HA can be envisaged in all sporting disciplines without the risk of impairing muscle performance.

Faster early rate of force development in warmer muscle: an in vivo exploration of fascicle dynamics and muscle-tendon mechanical properties.

Although heat exposure has been shown to increase the skeletal rate of force development (RFD), the underlying processes remain unknown. This study investigated the effect of heat on gastrocnemius medialis (GM) muscle-tendon properties and interactions. Sixteen subjects performed electrically evoked and voluntary contractions combined with ultrafast ultrasound under thermoneutral [control (CON): 25.8 ± 1.8°C, core temperature 37.0 ± 0.3°C, muscle temperature 34.0 ± 1.1°C] and passive heat exposure [hot (HOT): 47.4 ± 1.8°C, core temperature 38.4 ± 0.3°C, muscle temperature 37.0 ± 0.8°C] conditions. Maximal voluntary force changes did not reach statistical significance (-5.0 ± 11.3%, P = 0.052) whereas voluntary activation significantly decreased (-4.6 ± 8.7%, P = 0.038) in HOT. Heat exposure significantly increased voluntary RFD before 100 ms from contraction onset (+48.2 ± 62.7%; P = 0.013), without further changes after 100 ms. GM fascicle dynamics during electrically evoked and voluntary contractions remained unchanged between conditions. Joint velocity at a given force was higher in HOT (+7.1 ± 6.6%; P = 0.004) but the fascicle force-velocity relationship remained unchanged. Passive muscle stiffness and active tendon stiffness were lower in HOT than CON (P ≤ 0.030). This study showed that heat-induced increases in early voluntary RFD may not be attributed to changes in contractile properties. Late voluntary RFD was unaltered, possibly due to decreased soft tissues' stiffness in heat. Further investigations are required to explore the influence of neural drive and motor unit recruitment in the enhancement of explosive strength elicited by heat exposure.

Hyperthermia reduces electromechanical delay via accelerated electrochemical processes.

The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (Dm; i.e., delay between stimulation and muscle fascicle motion), and mechanical (Tm; i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26°C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50°C, 18% relative humidity, after ∼127 min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0 ± 0.6°C in HOT vs. 34.0 ± 0.8°C in CON (P < 0.001). EMD was shorter (9.4 ± 0.8 ms) in HOT than in CON (10.8 ± 0.6 ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0 ± 0.8 ms vs. 5.5 ± 0.9 ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance.NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5°C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.