Hematological Adaptations Following a Training Camp in Hot and/or Hypoxic Conditions in Elite Rugby Union Players.

PURPOSE: To investigate the effects of a training camp with heat and/or hypoxia sessions on hematological and thermoregulatory adaptations. METHODS: Fifty-six elite male rugby players completed a 2-week training camp with 5 endurance and 5 repeated-sprint sessions, rugby practice, and resistance training. Players were separated into 4 groups: CAMP trained in temperate conditions at sea level, HEAT performed the endurance sessions in the heat, ALTI slept and performed the repeated sprints at altitude, and H + A was a combination of the heat and altitude groups. RESULTS: Blood volume across all groups increased by 140 mL (95%CI, 42-237; P = .006) and plasma volume by 97 mL (95%CI 28-167; P = .007) following the training camp. Plasma volume was 6.3% (0.3% to 12.4%) higher in HEAT than ALTI (P = .034) and slightly higher in HEAT than H + A (5.6% [-0.3% to 11.7%]; P = .076). Changes in hemoglobin mass were not significant (P = .176), despite a ∼1.2% increase in ALTI and H + A and a ∼0.7% decrease in CAMP and HEAT. Peak rectal temperature was lower during a postcamp heat-response test in HEAT (0.3 °C [0.1-0.5]; P = .010) and H + A (0.3 °C [0.1-0.6]; P = .005). Oxygen saturation upon waking was lower in ALTI (3% [2% to 5%]; P < .001) and H + A (4% [3% to 6%]; P < .001) than CAMP and HEAT. CONCLUSION: Although blood and plasma volume increased following the camp, sleeping at altitude impeded the increase when training in the heat and only marginally increased hemoglobin mass. Heat training induced adaptations commensurate with partial heat acclimation; however, combining heat training and altitude training and confinement during a training camp did not confer concomitant hematological adaptations.

Reliability of bioreactance-derived hemodynamic monitoring during simulated sustained gravitational transitions induced by short-arm human centrifugation.

Precise, sensitive, and non-invasive estimates of stroke volume index (SVI) would facilitate clinical decision making and tracking of cardiorespiratory fitness in space. Thoracic electrical bioreactance (TEBR) is capable of providing valid SVI estimates on Earth; however, its reliability in response to simulated sustained gravitational transitions is unknown. Ten healthy male subjects underwent short-arm human centrifugation (SAHC) equivalent to 1 g and 1.5 g at their center of mass along the z-axis (gz) for 10 min each (first 5 min: passive; last 5 min: active, leg press movements), interspersed by periods without centrifugation (µg). The TEBR-based device Starling™ SV was used to estimate SVI during the five distinct passive gz phases. Precision of SVI measurements and sensitivity to hemodynamic changes induced by simulated gz transitions were determined. Overall SVI precision was very high (coefficient of variation = 3.6%), whereas mean sensitivity to SVI changes was satisfactory (sensitivity index = 75%). This study shows that the TEBR-based device Starling™ SV is precise and sensitive to hemodynamic changes in response to simulated sustained gz transitions induced by SAHC. Thus, it may be a suitable non-invasive hemodynamic monitor during human spaceflight. Further evaluation of Starling™ SV against a reference method in simulated microgravity is warranted.

Physiological Function during Exercise and Environmental Stress in Humans-An Integrative View of Body Systems and Homeostasis.

Claude Bernard's milieu intérieur (internal environment) and the associated concept of homeostasis are fundamental to the understanding of the physiological responses to exercise and environmental stress. Maintenance of cellular homeostasis is thought to happen during exercise through the precise matching of cellular energetic demand and supply, and the production and clearance of metabolic by-products. The mind-boggling number of molecular and cellular pathways and the host of tissues and organ systems involved in the processes sustaining locomotion, however, necessitate an integrative examination of the body's physiological systems. This integrative approach can be used to identify whether function and cellular homeostasis are maintained or compromised during exercise. In this review, we discuss the responses of the human brain, the lungs, the heart, and the skeletal muscles to the varying physiological demands of exercise and environmental stress. Multiple alterations in physiological function and differential homeostatic adjustments occur when people undertake strenuous exercise with and without thermal stress. These adjustments can include: hyperthermia; hyperventilation; cardiovascular strain with restrictions in brain, muscle, skin and visceral organs blood flow; greater reliance on muscle glycogen and cellular metabolism; alterations in neural activity; and, in some conditions, compromised muscle metabolism and aerobic capacity. Oxygen supply to the human brain is also blunted during intense exercise, but global cerebral metabolism and central neural drive are preserved or enhanced. In contrast to the strain seen during severe exercise and environmental stress, a steady state is maintained when humans exercise at intensities and in environmental conditions that require a small fraction of the functional capacity. The impact of exercise and environmental stress upon whole-body functions and homeostasis therefore depends on the functional needs and differs across organ systems.

Exercise Heat Acclimation With Dehydration Does Not Affect Vascular and Cardiac Volumes or Systemic Hemodynamics During Endurance Exercise.

Permissive dehydration during exercise heat acclimation (HA) may enhance hematological and cardiovascular adaptations and thus acute responses to prolonged exercise. However, the independent role of permissive dehydration on vascular and cardiac volumes, ventricular-arterial (VA) coupling and systemic hemodynamics has not been systematically investigated. Seven males completed two 10-day exercise HA interventions with controlled heart rate (HR) where euhydration was maintained or permissive dehydration (-2.9 ± 0.5% body mass) occurred. Two experimental trials were conducted before and after each HA intervention where euhydration was maintained (-0.5 ± 0.4%) or dehydration was induced (-3.6 ± 0.6%) via prescribed fluid intakes. Rectal (Tre) and skin temperatures, HR, blood (BV) and left ventricular (LV) volumes, and systemic hemodynamics were measured at rest and during bouts of semi-recumbent cycling (55% V̇O2 peak) in 33°C at 20, 100, and 180 min. Throughout HA sweat rate (12 ± 9%) and power output (18 ± 7 W) increased (P < 0.05), whereas Tre was 38.4 ± 0.2°C during the 75 min of HR controlled exercise (P = 1.00). Neither HA intervention altered resting and euhydrated exercising Tre, BV, LV diastolic and systolic volumes, systemic hemodynamics, and VA coupling (P > 0.05). Furthermore, the thermal and cardiovascular strain during exercise with acute dehydration post-HA was not influenced by HA hydration strategy. Instead, elevations in Tre and HR and reductions in BV and cardiac output matched pre-HA levels (P > 0.05). These findings indicate that permissive dehydration during exercise HA with controlled HR and maintained thermal stimulus does not affect hematological or cardiovascular responses during acute endurance exercise under moderate heat stress with maintained euhydration or moderate dehydration.

Intensified Training Supersedes the Impact of Heat and/or Altitude for Increasing Performance in Elite Rugby Union Players.

PURPOSE: To investigate whether including heat and altitude exposures during an elite team-sport training camp induces similar or greater performance benefits. METHODS: The study assessed 56 elite male rugby players for maximal oxygen uptake, repeated-sprint cycling, and Yo-Yo intermittent recovery level 2 (Yo-Yo) before and after a 2-week training camp, which included 5 endurance and 5 repeated-sprint cycling sessions in addition to daily rugby training. Players were separated into 4 groups: (1) control (all sessions in temperate conditions at sea level), (2) heat training (endurance sessions in the heat), (3) altitude (repeated-sprint sessions and sleeping in hypoxia), and (4) combined heat and altitude (endurance in the heat, repeated sprints, and sleeping in hypoxia). RESULTS: Training increased maximal oxygen uptake (4% [10%], P = .017), maximal aerobic power (9% [8%], P < .001), and repeated-sprint peak (5% [10%], P = .004) and average power (12% [14%], P < .001) independent of training conditions. Yo-Yo distance increased (16% [17%], P < .001) but not in the altitude group (P = .562). Training in heat lowered core temperature and increased sweat rate during a heat-response test (P < .05). CONCLUSION: A 2-week intensified training camp improved maximal oxygen uptake, repeated-sprint ability, and aerobic performance in elite rugby players. Adding heat and/or altitude did not further enhance physical performance, and altitude appears to have been detrimental to improving Yo-Yo.

Exercise heat acclimation has minimal effects on left ventricular volumes, function and systemic hemodynamics in euhydrated and dehydrated trained humans.

Heat acclimation (HA) may improve the regulation of cardiac output (Q̇) through increased blood volume (BV) and left ventricular (LV) diastolic filling and attenuate reductions in Q̇ during exercise-induced dehydration; however, these hypotheses have never been directly tested. Before and following 10-days exercise HA, eight males completed two trials of submaximal exercise in 33°C and 50% relative humidity while maintaining preexercise euhydrated body mass (EUH; -0.6 ± 0.4%) or becoming progressively dehydrated (DEH; -3.6 ± 0.7%). Rectal (Tre) and skin (Tsk) temperatures, heart rate (HR), LV volumes and function, systemic hemodynamics and BV were measured at rest and during bouts of semirecumbent cycling (55% V̇o2max) at 20, 100 and 180 min, interspersed by periods of upright exercise. Tre, BV, HR, LV volumes, LV systolic and diastolic function, and systemic hemodynamics were similar between trials at rest and during the first 20 min of exercise (all P > 0.05). These responses were largely unaffected by HA at 180 min in either hydration state. However, DEH induced higher Tre (0.6 ± 0.3°C) and HR (16 ± 7 beats/min) and lower end-diastolic volume (29 ± 16 mL), stroke volume (26 ± 16 mL), and Q̇ (2.1 ± 0.8 L/min) compared with EUH at 180 min (all P < 0.05), yet LV twist and untwisting rate were increased or maintained (P = 0.028 and 0.52, respectively). Findings indicate HA has minimal effects on LV volumes, LV mechanical function, and systemic hemodynamics during submaximal exercise in moderate heat, where HR and BV are similar. In contrast, DEH evokes greater hyperthermia and tachycardia, reduces BV, and impairs diastolic LV filling, lowering Q̇, regardless of HA state.NEW & NOTEWORTHY This study demonstrates that 10 days of exercise heat acclimation has minimal effects on left ventricular volumes, intrinsic cardiac function, and systemic hemodynamics during prolonged, repeated semirecumbent exercise in moderate heat, where heart rate and blood volume are similar to preacclimation levels. However, progressive dehydration is consistently associated with similar degrees of hyperthermia and tachycardia and reductions in blood volume, diastolic filling of the left ventricle, stroke volume, and cardiac output, regardless of acclimation state.

Heat Acclimation with Controlled Heart Rate: Influence of Hydration Status.

PURPOSE: This study aimed to characterize the adaptive responses to heat acclimation (HA) with controlled heart rate (HR) and determine whether hydration strategy alters adaptations. The influence of HA on maximal oxygen uptake (V˙O2max) in cool conditions and self-paced exercise in the heat was also determined. METHODS: Eight men (V˙O2max, 55 ± 7 mL·kg·min) completed two 10-d interventions in a counterbalanced crossover design. Fluid intakes differed between interventions to either maintain euhydration (HA-EUH) or elicit similar daily body mass deficits (2.85% ± 0.26%; HA-DEH). HA consisted of 90 min of cycling in 40°C and 40% relative humidity. Initial workload (172 ± 22 W) was adjusted over the last 75 min to maintain exercising HR equivalent to 65% V˙O2max. A V˙O2max test in cool conditions and 30-min time trial in hot-humid conditions were completed before and after HA. RESULTS: HR at the end of the initial 15 min workload was 10 ± 5 bpm lower on day 10 in both interventions (P < 0.001). The workload necessary to maintain exercising HR (145 ± 7 bpm) increased throughout HA-EUH (25 ± 10 W, P = 0.001) and HA-DEH (16 ± 18 W, P = 0.02). There was a main effect of HA on sweat rate (P = 0.014), which tended to increase with HA-EUH (0.19 ± 0.18 L·h, P = 0.06), but not HA-DEH (P = 0.12). Skin temperature decreased during HA-EUH (0.6°C ± 0.5°C, P = 0.03), but not HA-DEH (P = 0.30). There was a main effect of HA on V˙O2max (~3 mL·kg·min, P = 0.02); however, neither intervention independently increased V˙O2max (both, P = 0.08). Time-trial performance increased after HA-EUH (19 ± 16 W, P = 0.02), but not HA-DEH (P = 0.21). CONCLUSIONS: Controlled HR exercise in the heat induces several HA adaptations, which may be optimized by maintaining euhydration. HA-EUH also improves self-paced exercise performance in the heat. However, HA does not seem to significantly increase V˙O2max in cool conditions.

Health status, heat preparation strategies and medical events among elite cyclists who competed in the heat at the 2016 UCI Road World Cycling Championships in Qatar.

PURPOSE: Assess the health status and heat preparation strategies of athletes competing in a World Cycling Championships held in hot ambient conditions (37°C, 25% relative humidity, wet-bulb-globe-temperature 27°C) and monitor the medical events arising during competition. METHODS: 69 cyclists (~9% of the world championships participants) completed a pre-competition questionnaire. Illnesses and injuries encountered by the Athlete Medical Centre (AMC) were extracted from the race reports. RESULTS: 22% of respondents reported illness symptoms in the 10 days preceding the Championships. 57% of respondents had previously experienced heat-related symptoms (cramping most commonly) while 17% had previously been diagnosed with exertional heat illness. 61% of the respondents had undergone some form of heat exposure prior to the Championships, with 38% acclimating for 5 to 30 days. In addition, several respondents declared to live in warm countries and all arrived in Qatar ~5 days prior to their event. 96% of the respondents used a pre-cooling strategy for the time trials and 74% did so before the road race (p<0.001), with ice vests being the most common. The AMC assessed 46 injuries and 26 illnesses in total, with three cyclists diagnosed with heat exhaustion. CONCLUSIONS: The prevalence of previous heat illness in elite cyclists calls for team and event organisation doctors to be trained on heat illness management, including early diagnosis and rapid on-site cooling. Some cyclists had been exposed to the heat prior to the Championships, but few had a dedicated plan, calling for additional education on the importance of heat acclimation. Pre-cooling was widely adopted.

Core temperature up to 41.5ºC during the UCI Road Cycling World Championships in the heat.

OBJECTIVE: To characterise the core temperature response and power output profile of elite male and female cyclists during the 2016 UCI Road World Championships. This may contribute to formulating environmental heat stress policies. METHODS: Core temperature was recorded via an ingestible capsule in 10, 15 and 15 cyclists during the team time trial (TTT), individual time trial (ITT) and road race (RR), respectively. Power output and heart rate were extracted from individual cycling computers. Ambient conditions in direct sunlight were hot (37°C±3°C) but dry (25%±16% relative humidity), corresponding to a wet-bulb globe temperature of 27°C±2°C. RESULTS: Core temperature increased during all races (p<0.001), reaching higher peak values in TTT (39.8°C±0.9°C) and ITT (39.8°C±0.4°C), relative to RR (39.2°C±0.4°C, p<0.001). The highest temperature recorded was 41.5°C (TTT). Power output was significantly higher during TTT (4.7±0.3 W/kg) and ITT (4.9±0.5 W/kg) than RR (2.7±0.4 W/kg, p<0.001). Heart rate increased during the TTs (p<0.001) while power output decreased (p<0.001). CONCLUSION: 85% of the cyclists participating in the study (ie, 34 of 40) reached a core temperature of at least 39°C with 25% (ie, 10 of 40) exceeding 40°C. Higher core temperatures were reached during the time trials than the RR.

Validation of an ingestible temperature data logging and telemetry system during exercise in the heat.

Aim: Intestinal temperature telemetry systems are promising monitoring and research tools in athletes. However, the additional equipment that must be carried to continuously record temperature data limits their use to training. The purpose of this study was to assess the validity and reliability of a new gastrointestinal temperature data logging and telemetry system (e-Celsius™) during water bath experimentation and exercise trials. Materials and Methods: Temperature readings of 23 pairs of e-Celsius (TeC) and VitalSense (TVS) ingestible capsules were compared to rectal thermistor responses (Trec) at 35, 38.5 and 42°C in a water bath. Devices were also assessed in vivo during steady-state cycling (n = 11) and intermittent running (n = 11) in hot conditions. Results: The water bath experiment showed TVS and TeC under-reported Trec (P<0.001). This underestimation of Trec also occurred during both cycling (mean bias vs TVS: 0.21°C, ICC: 0.84, 95% CI: 0.66-0.91; mean bias vs. TeC: 0.44°C, ICC: 0.68, 95% CI: 0.07-0.86, P<0.05) and running trials (mean bias vs. TVS: 0.15°C, ICC: 0.92, 95% CI: 0.83-0.96; mean bias vs. TeC: 0.25, ICC: 0.86, 95% CI: 0.61-0.94, P<0.05). However, calibrating the devices attenuated this difference during cycling and eliminated it during running. During recovery following cycling exercise, TeC and TVS were significantly lower than Trec despite calibration (P<0.01). Conclusion: These results indicate that both TeC and TVS under-report Trec during steady-state and intermittent exercise in the heat, with TeC predicting Trec with the least accuracy of the telemetry devices. It is therefore recommended to calibrate these devices at multiple temperatures prior to use.

Cardiovascular adaptations supporting human exercise-heat acclimation.

This review examines the cardiovascular adaptations along with total body water and plasma volume adjustments that occur in parallel with improved heat loss responses during exercise-heat acclimation. The cardiovascular system is well recognized as an important contributor to exercise-heat acclimation that acts to minimize physiological strain, reduce the risk of serious heat illness and better sustain exercise capacity. The upright posture adopted by humans during most physical activities and the large skin surface area contribute to the circulatory and blood pressure regulation challenge of simultaneously supporting skeletal muscle blood flow and dissipating heat via increased skin blood flow and sweat secretion during exercise-heat stress. Although it was traditionally held that cardiac output increased during exercise-heat stress to primarily support elevated skin blood flow requirements, recent evidence suggests that temperature-sensitive mechanisms may also mediate an elevation in skeletal muscle blood flow. The cardiovascular adaptations supporting this challenge include an increase in total body water, plasma volume expansion, better sustainment and/or elevation of stroke volume, reduction in heart rate, improvement in ventricular filling and myocardial efficiency, and enhanced skin blood flow and sweating responses. The magnitude of these adaptations is variable and dependent on several factors such as exercise intensity, duration of exposure, frequency and total number of exposures, as well as the environmental conditions (i.e. dry or humid heat) in which acclimation occurs.