Analysis of Exertion-Related Injuries and Fatalities in Laborers in the United States.

Laborers are particularly vulnerable to exertional injuries and illnesses, as they often engage in heavy physical work for prolonged hours, yet no studies have examined the top causes of catastrophic exertional injuries and fatalities among this population. The purpose of the investigation was to characterize the top causes of exertional injury and fatality within open access, Occupational Safety and Health Administration (OSHA) reportable data. A secondary analysis of OSHA reported injury and fatality data was performed through open access records from OSHA Severe Injury Reports (2015-2022) and OSHA fatality inspection data (2017-2020), respectively. The research team characterized each reported injury and fatality as "exertion-related" or "non-exertion-related. Injury and fatality rates were reported per 100,000 equivalent full-time worker years and included 95% confidence intervals (95% CI). Of 58,648 cases in the OSHA Severe Injury Report database from 2015-2020, 1682 cases (2.9%) were characterized as exertional (0.20 injuries per 100,000 full-time worker years, 95% CI: 0.19, 0.22). Heat-related injuries encompassed 91.9% of the exertional injuries (n = 1546). From the 2017-2022 OSHA fatality inspection database, 89 (1.9%) of 4598 fatalities were characterized as exertion-related (fatality rate: 0.0160 per 100,000 full-time equivalent workers, 95% CI: 0.009, 0.0134). The exertion-related fatalities primarily consisted of heat-related cases (87.6%). Exertion-related injuries and fatalities were most reported in Southeast states, in the construction and excavation industry, and among nonunionized workers. As heat stress continues to be recognized as an occupational health and safety hazard, this analysis further highlights the need for targeted interventions or further evaluation of the impact of heat stress on construction and excavation workers, nonunionized workers, and workers in Southeastern states.

Prospective Validation of 2B-Cool : Integrating Wearables and Individualized Predictive Analytics to Reduce Heat Injuries.

INTRODUCTION: An uncontrollably rising core body temperature (T C ) is an indicator of an impending exertional heat illness. However, measuring T C invasively in field settings is challenging. By contrast, wearable sensors combined with machine-learning algorithms can continuously monitor T C nonintrusively. Here, we prospectively validated 2B-Cool , a hardware/software system that automatically learns how individuals respond to heat stress and provides individualized estimates of T C , 20-min ahead predictions, and early warning of a rising T C . METHODS: We performed a crossover heat stress study in an environmental chamber, involving 11 men and 11 women (mean ± SD age = 20 ± 2 yr) who performed three bouts of varying physical activities on a treadmill over a 7.5-h trial, each under four different clothing and environmental conditions. Subjects wore the 2B-Cool system, consisting of a smartwatch, which collected vital signs, and a paired smartphone, which housed machine-learning algorithms and used the vital sign data to make individualized real-time forecasts. Subjects also wore a chest strap heart rate sensor and a rectal probe for comparison purposes. RESULTS: We observed very good agreement between the 2B-Cool forecasts and the measured T C , with a mean bias of 0.16°C for T C estimates and nearly 75% of measurements falling within the 95% prediction intervals of ±0.62°C for the 20-min predictions. The early-warning system results for a 38.50°C threshold yielded a 98% sensitivity, an 81% specificity, a prediction horizon of 35 min, and a false alarm rate of 0.12 events per hour. We observed no sex differences in the measured or predicted peak T C . CONCLUSION: 2B-Cool provides early warning of a rising T C with a sufficient lead time to enable clinical interventions and to help reduce the risk of exertional heat illness.

Limitations associated with thermoregulation and cardiovascular research assessing laborers performing work in the heat.

PURPOSE: To quantify the current literature and limitations associated with research examining thermoregulatory and cardiovascular strain in laborers working in the heat. METHODS: PubMed, SCOPUS, and SPORTDiscus were searched for terms related to the cardiovascular system, heat stress, and physical work. Qualifying studies included adult participants (18-65 years old), a labor-intensive environment or exercise protocol simulating a labor environment, a minimum duration of 120 min of physical work, and environmental heat stress (ambient temperature ≥26.0°C and ≥30% relative humidity). Studies included at least one of the following outcomes: pre- and peak physical work, core temperature, heart rate (HR), systolic blood pressure, diastolic blood pressure, HR variability, and rate pressure product. RESULTS: Twenty-one out of 1559 potential studies qualified from our search. There was a total of 598 participants (mean = 28 ± 50 participants per study, range = 4-238 participants per study), which included 51 females (8.5%) and 547 males (91.5%). Of the participants, 3.8% had cardiovascular risk factors (diabetes: n = 10; hypertension: n = 13) and 96.2% were characterized as "healthy". Fifty-seven percent of the included studies were performed in a laboratory setting. CONCLUSIONS: Studies were predominantly in men (91.5%), laboratory settings (57%), and "healthy" individuals (96.2%). To advance equity in protection against occupational heat stress and better inform future heat safety recommendations to protect all workers, future studies must focus on addressing these limitations. Employers, supervisors, and other safety stakeholders should consider these limitations while implementing current heat safety recommendations.

Efficacy of two intermittent cooling strategies during prolonged work-rest intervals in the heat with personal protective gear compared with a control condition.

INTRODUCTION: Personal protective equipment (PPE) inhibits heat dissipation and elevates heat strain. Impaired cooling with PPE warrants investigation into practical strategies to improve work capacity and mitigate exertional heat illness. PURPOSE: Examine physiological and subjective effects of forearm immersion (FC), fan mist (MC), and passive cooling (PC) following three intermittent treadmill bouts while wearing PPE. METHODS: Twelve males (27 ± 6 years; 57.6 ± 6.2 ml/kg/min; 78.3 ± 8.1 kg; 183.1 ± 7.2 cm) performed three 50-min (10 min of 40%, 70%, 40%, 60%, 50% vVO2max) treadmill bouts in the heat (36 °C, 30% relative humidity). Thirty minutes of cooling followed each bout, using one of the three strategies per trial. Rectal temperature (Tcore), skin temperature (Tsk), heart rate (HR), heart rate recovery (HRR), rating of perceived exertion (RPE), thirst, thermal sensation (TS), and fatigue were obtained. Repeated-measures analysis of variance (condition x time) detected differences between interventions. RESULTS: Final Tcore was similar between trials (P > .05). Cooling rates were larger in FC and MC vs PC following bout one (P < .05). HRR was greatest in FC following bouts two (P = .013) and three (P < .001). Tsk, fluid consumption, and sweat rate were similar between all trials (P > .05). TS and fatigue during bout three were lower in MC, despite similar Tcore and HR. CONCLUSION: Utilizing FC and MC during intermittent work in the heat with PPE yields some thermoregulatory and cardiovascular benefit, but military health and safety personnel should explore new and novel strategies to mitigate risk and maximize performance under hot conditions while wearing PPE.

Effects of Heat Acclimation Following Heat Acclimatization on Whole Body Heat Exchange in Trained Endurance Athletes.

The purpose of this study was to examine the changes in metabolic heat production (Hprod), evaporative heat loss (Hevap), and dry heat loss (Hdry), following heat acclimatization (HAz) and heat acclimation (HA). Twenty-two male endurance athletes (mean ± standard deviation; age, 37 ± 12 y; body mass, 73.4 ± 8.7 kg; height, 178.7 ± 6.8 cm; and VO2max, 57.1 ± 7.2 mL·kg−1·min−1) completed three trials (baseline; post-HAz; and post-HA), which consisted of 60 min steady state exercise at 59 ± 2% velocityVO2max in the heat (ambient temperature [Tamb], 35.2 ± 0.6 °C; relative humidity [%rh] 47.5 ± 0.4%). During the trial, VO2 and RER were collected to calculate Hprod, Hevap, and Hdry. Following the baseline trial, participants completed self-directed outdoor summer training followed by a post-HAz trial. Then, five days of HA were completed over eight days in the heat (Tamb, 38.7 ± 1.1 °C; %rh, 51.2 ± 2.3%). During the HA sessions, participants exercised to maintain hyperthermia (38.50 °C and 39.75 °C) for 60 min. Then, a post-HA trial was performed. There were no differences in Hprod between the baseline (459 ± 59 W·m−2), post-HAz (460 ± 61 W·m−2), and post-HA (464 ± 55 W·m−2, p = 0.866). However, Hevap was significantly increased post-HA (385 ± 84 W·m−2) compared to post-HAz (342 ± 86 W·m−2, p = 0.043) and the baseline (332 ± 77 W·m−2, p = 0.037). Additionally, Hdry was significantly lower at post-HAz (125 ± 8 W·m−2, p = 0.013) and post-HA (121 ± 10 W·m−2, p < 0.001) compared to the baseline (128 ± 7 W·m−2). Hdry at post-HA was also lower than post-HAz (p = 0.049). Hprod did not change following HAz and HA. While Hdry was decreased following HA, the decrease in Hdry was smaller than the increases in Hevap. Adaptations in body heat exchange can occur by HA following HAz.

Pre-sleep protein supplementation after an acute bout of evening resistance exercise does not improve next day performance or recovery in resistance trained men.

Background: To evaluate the effect of pre-sleep protein supplementation after an acute bout of evening resistance training on next day performance and recovery the following day in physically active men. Methods: Eighteen resistance trained men performed a single bout of resistance exercise then received either a pre-sleep protein (PRO) supplement containing 40 g of casein protein (PRO; n = 10; mean ± SD; age = 24 ± 4 yrs; height = 1.81 ± 0.08 m; weight = 84.9 ± 9.5 kg) or a non-caloric, flavor matched placebo (PLA; n = 8; age = 28 ± 10 yrs; height = 1.81 ± 0.07 m; weight = 86.7 ± 11.0 kg) 30 min before sleep (1 h after a standard recovery drink). Blood samples were obtained pre-exercise and the following morning (+12-h) to measure creatine kinase and C-reactive protein. Visual analog scales were utilized to assess perceived pain, hunger, and recovery. One-repetition maximum (1RM) tests for barbell bench press and squat were performed pre-exercise and the following morning (+12-h). Statistical analysis was performed using SPSS (V.23) and p ≤ 0.05 was considered statistically significant. Results: There were no significant differences between the groups in next morning performance or muscle damage biomarkers. However, pre-sleep PRO resulted in a lower perception of hunger that approached significance the following morning when compared to PLA (PRO:43.6 ± 31.2, PLA: 69.4 ± 2.22; 95% C.I. = -53.6, 2.0; p = 0.07; d = 0.95). Conclusions: Following an evening bout of exercise, pre-sleep PRO did not further improve next morning muscle damage biomarkers or maximal strength performance in resistance trained men compared to a non-caloric PLA. However, there may be implications for lower perceived hunger the next morning with pre-sleep PRO consumption compared to PLA.

Corrigendum: Estrogen to Progesterone Ratio and Fluid Regulatory Responses to Varying Degrees and Methods of Dehydration.

[This corrects the article DOI: 10.3389/fspor.2021.722305.].

Relationships Between WUT (Body Weight, Urine Color, and Thirst Level) Criteria and Urine Indices of Hydration Status.

BACKGROUND: A Venn diagram consisting of percentage body mass loss, urine color, and thirst perception (weight, urine, thirst [WUT]) has been suggested as a practical method to assess hydration status. However, no study to date has examined relationships between WUT and urine hydration indices. Thus, the purpose of this study was to investigate relationships between urine specific gravity, urine osmolality, and the WUT criteria. HYPOTHESIS: Urine specific gravity and urine osmolality indicate hypohydration when the WUT criteria demonstrate hypohydration (≥2 markers). STUDY DESIGN: Laboratory cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 22 women (mean ± SD; age, 20 ± 1 years; mass, 65.4 ± 12.6 kg) and 21 men (age, 21 ± 1 years; body mass, 78.7 ± 14.6 kg) participated in this study. First morning body mass, urine color, urine specific gravity, urine osmolality, and thirst level were collected for 10 consecutive days in a free-living situation. Body mass loss >1%, urine color >5, and thirst level ≥5 were used as the dehydration thresholds. The number of markers that indicated dehydration levels were counted and categorized into either 3, 2, 1, or 0 WUT markers that indicated dehydration. One-way analysis of variance with Tukey pairwise comparisons was used to assess the differences in urine specific gravity and urine osmolality between the different number of WUT markers. RESULTS: Urine specific gravity in 3 WUT markers (mean ± SD [effect size], 1.021 ± 0.007 [0.57]; P = 0.025) and 2 WUT markers (1.019 ± 0.010 [0.31]; P = 0.026) was significantly higher than 1 WUT marker (1.016 ± 0.009). Urine mosmolality in 2 WUT markers (705 ± 253 mOsmol [0.43]; P = 0.018) was significantly higher than 1 WUT (597 ± 253 mOsmol). Meeting at 3 WUT resulted in specificity of 0.956 and at 0 WUT resulted in sensitivity of 0.937 for urine osmolality>700mOsm. CONCLUSION: These results suggest that when 3 WUT markers are met, urine specific gravity and urine osmolality indicated hypohydration and 0 WUT represents a high likelihood of euhydration. 1 and 2 WUT values are indeterminate of hydration status. The WUT criterion is a useful tool to use in field settings to assess hydration status when first morning urine sample was used. CLINICAL RELEVANCE: Athletes, coaches, sports scientists, and medical professionals can use WUT criteria to monitor dehydration with reduced cost and time.

Sleep Duration Correlates With Performance in Ultra-Endurance Triathlon.

The relationship between sleep duration, sleep quality, and race completion time during each stage of a 3-day ultra-endurance triathlon (stage 1: 10-km swim, 146-km cycle; stage 2: 276-km cycle; and stage 3: 84.4-km run) was investigated. Seventeen triathletes partook in sleep analysis throughout the ultra-endurance multiday triathlon using an actigraphy wristband. The participants wore the band to record objective sleep outcomes for approximately 4 days (1-2 d prerace, 3 race days, and 1 d postrace), except while racing. The total sleep time (TST; prerace: 414.1 [95.3] min, prestage 1: 392.2 [138.3] min, prestage 2: 355.6 [62.5] min, and prestage 3: 299.7 [107.0] min) significantly decreased over time (P < .05). Significant Pearson moment-product correlations were found between TST and subsequent race-day performance for race stage 1 (r = -.577; P = .019) and stage 3 (r = -.546; P = .035), with further analysis revealing that TST explained 33% and 30% of the variation in performance for stages 1 and 3, respectively. During a 3-day ultra-endurance triathlon, the TST was reduced and had a significant negative correlation to exercise performance, indicating that sleep loss was associated with slower performances. Sleep onset latency, wake episodes, and sleep efficiency did not significantly change over the course of this investigation, which may stem from the close proximity of exercise to sleep.

Estrogen to Progesterone Ratio and Fluid Regulatory Responses to Varying Degrees and Methods of Dehydration.

The purpose of this study was to investigate the relationship between volume regulatory biomarkers and the estrogen to progesterone ratio (E:P) prior to and following varying methods and degrees of dehydration. Ten women (20 ± 1 year, 56.98 ± 7.25 kg, 164 ± 6 cm, 39.59 ± 2.96 mL•kg•min-1) completed four intermittent exercise trials (1.5 h, 33.8 ± 1.3°C, 49.5 ± 4.3% relative humidity). Testing took place in two hydration conditions, dehydrated via 24-h fluid restriction (Dehy, USG > 1.020) and euhydrated (Euhy, USG ≤ 1.020), and in two phases of the menstrual cycle, the late follicular phase (days 10-13) and midluteal phase (days 18-22). Change in body mass (%BMΔ), serum copeptin concentration, and plasma osmolality (Posm) were assessed before and after both dehydration stimuli (24-h fluid restriction and exercise heat stress). Serum estrogen and progesterone were analyzed pre-exercise only. Estrogen concentration did not differ between phases or hydration conditions. Progesterone was significantly elevated in luteal compared to follicular in both hydration conditions (Dehy-follicular: 1.156 ± 0.31, luteal: 5.190 ± 1.56 ng•mL-1, P < 0.05; Euhy-follicular: 0.915 ± 0.18, luteal: 4.498 ± 1.38 ng·mL-1, P < 0.05). As expected, E:P was significantly greater in the follicular phase compared to luteal in both hydration conditions (Dehy-F:138.94 ± 89.59, L: 64.22 ± 84.55, P < 0.01; Euhy-F:158.13 ± 70.15, L: 50.98 ± 39.69, P < 0.01, [all •103]). Copeptin concentration was increased following 24-h fluid restriction and exercise heat stress (mean change: 18 ± 9.4, P < 0.01). We observed a possible relationship of lower E:P and higher copeptin concentration following 24-h fluid restriction (r = -0.35, P = 0.054). While these results did not reach the level of statistical significance, these data suggest that the differing E:P ratio may alter fluid volume regulation during low levels of dehydration but have no apparent impact after dehydrating exercise in the heat.

Impact of occupational heat stress on worker productivity and economic cost.

Heat stress is a growing concern in the occupational setting as it endangers worker health, safety, and productivity. Heat-related reductions in physical work capacity and missed workdays directly and indirectly cause productivity losses and may substantially affect the economic wellbeing of the organization. This review highlights the physiological, physical, psychological, and financial harms of heat stress on worker productivity and proposes strategies to quantify heat-related productivity losses. Heat stress produces a vicious-cycle feedback loop that result in adverse outcomes on worker health, safety, and productivity. We propose a theoretical model for implementing an occupational heat safety plan that disrupts this loop, preventing heat-related productivity losses while improving worker health and safety.

Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers.

The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.

Wearable and telemedicine innovations for Olympic events and elite sport.

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Changes in Hydration Factors Over the Course of Heat Acclimation in Endurance Athletes.

The purpose of this study was to examine the effect of heat acclimation (HA) on thirst levels, sweat rate, and percentage of body mass loss (%BML), and changes in fluid intake factors throughout HA induction. Twenty-eight male endurance athletes (mean ± SD; age, 35 ± 12 years; body mass, 73.0 ± 8.9 kg; maximal oxygen consumption, 57.4 ± 6.8 ml·kg-1·min-1) completed 60 min of exercise in a euhydrated state at 58.9 ± 2.3% velocity of maximal oxygen consumption in the heat (ambient temperature, 35.0 ± 1.3 °C; relative humidity, 48.0 ± 1.3%) prior to and following HA where thirst levels, sweat rate, and %BML were measured. Then, participants performed 5 days of HA while held at hyperthermia (38.50-39.75 °C) for 60 min with fluid provided ad libitum. Sweat volume, %BML, thirst levels, and fluid intake were measured for each session. Thirst levels were significantly lower following HA (pre, 4 ± 1; post, 3 ± 1, p < .001). Sweat rate (pre, 1.76 ± 0.42 L/hr; post, 2.00 ± 0.60 L/hr, p = .039) and %BML (pre, 2.66 ± 0.53%; post, 2.98 ± 0.83%, p = .049) were significantly greater following HA. During HA, thirst levels decreased (Day 1, 4 ± 1; Day 2, 3 ± 2; Day 3, 3 ± 2; Day 4, 3 ± 1; Day 5, 3 ± 1; p < .001). However, sweat volume (Day 1, 2.34 ± 0.67 L; Day 2, 2.49 ± 0.58 L; Day 3, 2.67 ± 0.63 L; Day 4, 2.74 ± 0.61 L; Day 5, 2.74 ± 0.91 L; p = .010) and fluid intake (Day 1, 1.20 ± 0.45 L; Day 2, 1.52 ± 0.58 L; Day 3, 1.69 ± 0.63 L; Day 4, 1.65 ± 0.58 L; Day 5, 1.74 ± 0.51 L; p < .001) increased. In conclusion, thirst levels were lower following HA even though sweat rate and %BML were higher. Thirst levels decreased while sweat volume and fluid intake increased during HA induction. Thus, HA should be one of the factors to consider when planning hydration strategies.

Sex difference in initial thermoregulatory response to dehydrated exercise in the heat.

Although it is well established that dehydration has a negative impact on thermoregulation during exercise in the heat, it is unclear whether this effect of dehydration is different between men and women, or across the phases of the menstrual cycle (MC). Twelve men and seven women (men: 20 ± 2 years, 70.13 ± 10.5 kg, 173.4 ± 6.0 cm, 54.2 ± 8.6 ml kg-1  min-1 ; women: 20 ± 2 years, 57.21 ± 7.58 kg, 161 ± 5 cm, 40.39 ± 3.26 ml kg-1  min-1 ) completed trials either euhydrated (urine specific gravity, USG ≤ 1.020, Euhy) or dehydrated (USG > 1.020, Dehy). Trial order was randomized and counterbalanced; men completed two trials (MEuhy and MDehy) and women completed four over two MC phases (late follicular: days 10-13, FDehy, FEuhy; midluteal: days 18-22, LDehy, LEuhy). Each trial consisted of 1.5 h, split into two 30 min blocks of exercise (B1 and B2, 15 min at 11 W/kg & 15 min at 7 W/kg) separated by 15 min rest in between and after. Rectal temperature (Tre ) was measured continuously and estimated sweat loss was calculated from the body mass measured before and after each block of exercise. When dehydrated, the rate of rise in Tre was greater in women in the first block of exercise compared to men, independently of the MC phase (MDehy: 0.03 ± 0.03°C/min, FDehy: 0.06 ± 0.02, LDehy: 0.06 ± 0.02, p = 0.03). Estimated sweat loss was lower in all groups in B1 compared to B2 when dehydrated (p < 0.05), with no difference between sexes for either hydration condition. These data suggest that women may be more sensitive to the negative thermoregulatory effects of dehydration during the early stages of exercise in the heat.

The effects of hydration status and ice-water dousing on physiological and performance indices during a simulated soccer match in the heat.

OBJECTIVES: To assess the effects of hydration status and ice-water dousing on physiological and performance parameters. DESIGN: Randomized, crossover. METHODS: Twelve athletes (mean[M] ±â€¯standard deviation[SD]; age, 20 ±â€¯1 years; height, 174 ±â€¯8 cm; body mass, 72.1 ±â€¯11.0 kg; VO2max 53.9 ±â€¯7.3 mL⋅kg-1⋅min-1) completed four trials (euhydrated without dousing, hypohydrated without dousing, euhydrated with dousing, and hypohydrated with dousing), which involved intermittent treadmill running (five 15-minute bouts) in the heat (M ±â€¯SD; ambient temperature, 34.7 ±â€¯2.1 °C; relative humidity, 46 ±â€¯3%; wet-bulb globe temperature, 28.0 ±â€¯0.4 °C). Participants also completed four cognitive, power, agility, reaction time, and repeated sprint performance tests throughout each trial. Heart rate (HR) and rectal temperature (Trec) were measured continuously. Repeated measures ANOVAs were performed to assess differences between physiological and performance variables. Alpha was set at ≤0.05, a priori. Data are reported as mean difference ±â€¯standard error (MD ±â€¯SE). RESULTS: HR was significantly lower in euhydrated trials compared to hypohydrated trials, irrespective of dousing (8 ±â€¯2 bpm; p = 0.001). Dousing did not significantly impact HR (p = 0.455) and there was no interaction between hydration and dousing (p = 0.893). Trec was significantly lower in euhydrated trials compared to hypohydrated trials (0.39 ±â€¯0.05 °C, p < 0.001), with no effect from dousing alone (p = 0.113) or the interaction of hydration and dousing (p = 0.848). Dousing resulted in improved sprint performance (11 ±â€¯3 belt rotations, p = 0.007), while hydration status did not (p = 0.235). CONCLUSIONS: Athletes should aim to maintain euhydration during exercise in the heat for improved physiological function and cooling with ice-water dousing elicits additional performance benefits.

Availability of a Flavored Beverage and Impact on Children's Hydration Status, Sleep, and Mood.

Euhydration remains a challenge in children due to lack of access and unpalatability of water and to other reasons. The purpose of this study was to determine if the availability/access to a beverage (Creative Roots®) influences hydration in children and, therefore, sleep quality and mood. Using a crossover investigation, 46 participants were randomly assigned to a control group (CON) or an intervention group and received Creative Roots® (INT) for two-week periods. We recorded daily first morning and afternoon urine color (Ucol), thirst perception, and bodyweight of the two groups. Participants reported to the lab once per week and provided first morning urine samples to assess Ucol, urine specific gravity (USG), and urine osmolality (Uosmo). Participants also completed the questionnaires Profile of Mood States-Adolescents (POMS-a) and Pittsburgh Sleep Quality Index (PSQI). Dependent t-tests were used to assess the effects of the intervention on hydration, mood, and sleep quality. Uosmo was greater and Ucol was darker in the control group (mean ± SD) [Uosmo: INT = 828 ± 177 mOsm·kg-1, CON = 879 ± 184 mOsm·kg-1, (p = 0.037], [Ucol:INT = 5 ± 1, CON = 5 ± 1, p = 0.024]. USG, POMS-a, and PSQI were not significant between the groups. At-home daily afternoon Ucol was darker in the control group [INT = 3 ± 1, CON = 3 ± 1, p = 0.022]. Access to Creative Roots® provides a small, potentially meaningful hydration benefit in children. However, children still demonstrated consistent mild dehydration based on Uosmo, despite consuming the beverage.

The impact of body fat on thermoregulation during exercise in the heat: A systematic review and meta-analysis.

OBJECTIVES: We performed a systematic review and meta-analysis to examine the effect of body fat on thermoregulatory responses to exercise in the heat. DESIGN: Systematic Review and Meta-analysis. METHODS: We systematically searched databases (N = 8) for studies that included: healthy participants; an aerobic exercise intervention under heat stress; a measure of body fat by a high and low body fat group; pre- and post-exercise internal temperature, and/or post-exercise mean skin temperature and whole body sweat loss. Criteria to distinguish high body fat and low body fat were determined by each qualifying study. Out of 1222 potential studies, 10 qualified. Robust variance estimation models were utilized to determine the pooled effect size (ES, 95% CI) for interventions that performed unbias comparisons between groups. RESULTS: Participants (n = 211) were mostly male (70%) and young (19.3 ±â€¯7.1 years) with a maximal oxygen consumption of 50.42 ±â€¯9.3 ml∙kg-1∙min-1 by high body fat (36.7 ±â€¯11.8%) and low body fat (17.8 ±â€¯5.7%). Exercise duration was between 30 and 60 min at moderate-high intensity (44.1-71.4% VO2max) at 28-40.3 °C and 26-50% humidity. Of the 7 interventions that normalized metabolic heat production to body mass and 5 interventions that normalized to external workload, there were no differences in any of the three outcome variables between groups. CONCLUSIONS: Many of the included studies did not control for confounding factors that may affect the relationship between body fat and thermoregulation during exercise in the heat such as metabolic heat production and body mass. Given the small number of interventions included, future work must make unbiased comparisons to appropriately assess the independent influence of body fat.

Assessing the Validity of Aural Thermometry for Measuring Internal Temperature in Patients With Exertional Heat Stroke.

CONTEXT: The use of aural thermometry as a method for accurately measuring internal temperature has been questioned. No researchers have examined whether aural thermometry can accurately measure internal body temperature in patients with exertional heat stroke (EHS). OBJECTIVE: To examine the effectiveness of aural thermometry as an alternative to the criterion standard of rectal thermometry in patients with and those without EHS. DESIGN: Cross-sectional study. SETTING: An 11.3-km road race. PATIENTS OR OTHER PARTICIPANTS: A total of 49 patients with EHS (15 men [age = 38 ± 17 years], 11 women [age = 28 ± 10 years]) and 23 individuals without EHS (10 men [age = 62 ± 17 years], 13 women [age = 45 ± 14 years]) who were triaged to the finish-line medical tent for suspected EHS. MAIN OUTCOME MEASURE(S): Rectal and aural temperatures were obtained on arrival at the medical tent for patients with and those without EHS and at 8.3 ± 5.2 minutes into EHS treatment (cold-water immersion) for patients with EHS. RESULTS: The mean difference between temperatures measured using rectal and aural thermometers in patients with EHS at medical tent admission was 2.4°C ± 0.96°C (4.3°F ± 1.7°F; mean rectal temperature = 41.1°C ± 0.8°C [106.1°F ± 1.4°F]; mean aural temperature = 38.8°C ± 1.1°C [101.8°F ± 2.0°F]). Rectal and aural temperatures during cold-water immersion in patients with EHS were 40.4°C ± 1.0°C (104.6°F ± 1.8°F) and 38.0°C ± 1.2°C (100.3°F ± 2.2°F), respectively. Rectal and aural temperatures for patients without EHS at medical tent admission were 38.8°C ± 0.87°C (101.9°F ± 1.6°F) and 37.2°C ± 1.0°C (99.1°F ± 1.8°F), respectively. CONCLUSIONS: Aural thermometry is not an accurate method of diagnosing EHS and should not be used as an alternative to rectal thermometry. Using aural thermometry to diagnosis EHS can result in catastrophic outcomes, such as long-term sequelae or fatality.

Effects of sex and menstrual cycle on volume-regulatory responses to 24-h fluid restriction.

Reproductive hormones have significant nonreproductive physiological effects, including altering fluid regulation. Our purpose was to explore the impact of sex and menstrual cycle (MC) phase on volume-regulatory responses to 24-h fluid restriction (24-h FR). Participants (men: n = 12, 20 ± 2 yr; women: n = 10, 20 ± 1 yr) were assigned two randomized and counterbalanced fluid prescriptions [Euhy: euhydrated, urine specific gravity (USG) < 1.020; Dehy: 24-h FR, USG > 1.020]. Men completed both (MEuhy, MDehy), while women completed both in the late-follicular (days 10-13; FDehy, FEuhy) and midluteal (days 18-22; LDehy, LEuhy) phases. We measured body mass, plasma and urine osmolality (Posm, Uosm), urine specific gravity (USG), urine color (Ucol), and serum copeptin; 24-h FR yielded mild dehydration without influence of sex or MC (P > 0.05). Copeptin increased in men following Dehy (pre: 8.2 ± 5.2, post: 15.8 ± 12.6, P = 0.04) but not in women (FDehy pre: 4.3 ± 1.6, post: 10.5 ± 6.9, P = 0.06; LDehy pre: 5.6 ± 3.5, post: 10.4 ± 6.2, P = 0.16). In FDehy, Posm increased following FR (pre: 288 ± 2, post: 292 ± 1, P = 0.03) but not in men (pre: 292 ± 3, post: 293 ± 2, P = 0.46). No MC differences were observed between body mass loss, Posm, Uosm, USG, and copeptin (P > 0.05). These results suggest that volume-regulatory responses to 24-h FR were present in men but not in women, without apparent effects of the menstrual cycle.