Exploring the risk of heat stress in high school pre-season sports training, Johannesburg, South Africa.

There is growing concern over the increased risk of heat stress induced by the changing climate, with increased global temperatures expected to exacerbate conditions. Heat stress in school sports is a critically understudied research area in South Africa (SA). As demonstrated by several studies conducted in the global north, the stress elicited by meteorological conditions on students participating in physical education lessons and after-school sports activities could have serious consequences on their health. This paper represents the first research in the region to investigate the risk of heat stress to school students during physical activity. Meteorological data were collected at a school in Johannesburg between March and July, which encompasses the seasons of late summer, autumn, and winter. These were inputted into four heat stress indices: Humidex, Heat Index, Wet Bulb Globe Temperature, and the Universal Thermal Climate Index, together with the measured Wet Bulb Temperature to determine the level of risk of heat stress during physical education lessons and after-school sports activities between March and July. Of the 2700 index scores calculated over this period, 56% indicate some level of heat stress, with almost 6% indicating a high and very high level of risk. Heat stress is calculated to be most likely to occur between 11h00-15h00, and the danger of pre-season training, which takes place in the summer months, is demonstrated by these results. Additionally, this research finds that heat stress is far more likely on artificial surfaces than on natural grass. The findings of this research intimate that school stakeholders should consider the implications of heat stress when considering timetabling and policy-making in the interests of safeguarding their students.

Effects of CurraNZ, a New Zealand Blackcurrant Extract during 1 Hour of Treadmill Running in Female and Male Marathon des Sables Athletes in Hot Conditions: Two Case Studies.

Four weeks before competition in the 2023 Marathon des Sables, a 6-stage, ~250 km running event in the Sahara Desert, we examined the effects of a 7-day intake of New Zealand blackcurrant extract (210 mg anthocyanins per day) on 1 h treadmill running-induced physiological and metabolic responses in the heat (~34 °C, relative humidity: ~30%) in non-acclimatized amateur female and male athletes (age: 23, 38 yrs, BMI: 24.2, 28.4 kg·m-2, body fat%: 29.2, 18.8%, V˙O2max: 50.1, 52.1 mL·kg-1·min-1). During the 1 h run at 50%V˙O2max (speed female: 7.3, male: 7.5 km·h-1), indirect calorimetry was used, and heart rate was recorded at 15 min intervals with core temperature monitoring (0.05 Hz). The 1 h runs took place 3 h after a light breakfast and 2 h after intake of the final dose of New Zealand blackcurrant extract with water allowed ad libitum during the run. The New Zealand blackcurrant extract had no effects on the female athlete. The respiratory exchange ratio (RER) of the female athlete in the non-supplement control condition was 0.77 ± 0.01, indicating an existing ~77% contribution of fat oxidation to the energy requirements. In the male athlete, during 1 h of running, fat oxidation was higher by 21% (p < 0.01), carbohydrate oxidation was 31% lower (p = 0.05), RER was 0.03 units lower (p = 0.04), and core temperature was 0.4 °C lower (p < 0.01) with no differences for heart rate, minute ventilation, oxygen uptake, and carbon dioxide production for the New Zealand blackcurrant condition compared to the non-supplement control condition. Seven-day intake of New Zealand blackcurrant extract (210 mg anthocyanins per day) provided beneficial physiological and metabolic responses during exertional heat stress by 1 h of indoor (~34 °C) treadmill running in a male Marathon des Sables athlete 4 weeks before competition. Future work is required to address whether New Zealand blackcurrant provides a nutritional ergogenic effect for Marathon des Sables athletes during long-duration running in the heat combined with personalized nutrition.

The effect of pre-exercise oral hyperhydration on endurance exercise performance, heart rate, and thermoregulation: a meta-analytical review.

This study aimed to determine the effect of pre-exercise hyperhydration on endurance performance (primary outcome), heart rate, thermoregulation, and perceptual responses (secondary outcomes). Six academic databases were searched to February 2023. Only studies reporting differences in hydration between intervention and placebo/control were included. Meta-analysis determined overall effect size (Hedges' g), and meta-regression the influence of independent moderators (ambient temperature, hyperhydration agent, exercise mode, extent of hyperhydration). Overall, 10 publications generating 19 effect estimates for primary outcomes, and 11 publications reporting 48 effect estimates for secondary outcomes, were included. A small-to-moderate improvement in time-to-exhaustion (TTE) (Hedges' g = 0.31, 95% CI: 0.13-0.50, p = 0.001) and time trial (TT) (g = 0.25, 95% CI: 0.002-0.51, p = 0.049) but not total work (TW) tasks (p = 0.120) was found following hyperhydration. No moderating effects were observed. No effect of hyperhydration was found for heart rate following steady state (SS) exercise (p = 0.069) or the performance task (p = 0.072), nor for body temperature post-SS (p = 0.132) or post-performance task (p = 0.349), but meta-regression of sodium versus glycerol showed lower body temperature post-performance task with sodium (g = 0.80, t (5) = 2.65, p = 0.046). No effects were found for perceived exertion or thermal comfort. Study heterogeneity was low, lacking representation of elite and female athletes, and weight-bearing (i.e., running) exercise modalities. These results suggest pre-exercise hyperhydration provides a small-to-moderate benefit to endurance performance in TTE and TT, but not TW performance tasks. While no moderating effects were observed, lack of heterogeneity makes it difficult to generalise these findings.

Effect of Personalized Sodium Replacement on Fluid and Sodium Balance and Thermophysiological Strain During and After Ultraendurance Running in the Heat.

PURPOSE: To investigate the effect of personalized sweat sodium replacement on drinking behavior, sodium and water balance, and thermophysiological responses during and after ultraendurance running in hot conditions. METHODS: Nine participants (7 male, 2 female) completed two 5-hour treadmill runs (60% maximum oxygen uptake, 30°C ambient temperature), in a double-blind randomized crossover design, consuming sodium chloride (SODIUM) capsules to replace 100% of previously assessed losses or placebo (PLACEBO). Fluid was consumed ad libitum. RESULTS: No effect of SODIUM was observed for ad libitum fluid intake or net fluid balance (P > .05). Plasma sodium concentration increased in both trials, but to a greater extent in SODIUM at 2.5 hours (mean [SD]: 4 [4] mmol·L-1 vs 1 [5] mmol·L-1; P < .05) and postexercise (4 [3] mmol·L-1 vs 1 [5] mmol·L-1; P < .05). Plasma volume change was not different between trials (P > .05) but was strongly correlated with sodium balance in SODIUM (r = .880, P < .01). No effect of sodium replacement was observed for heart rate, rectal temperature, thermal comfort, perceived exertion, or physiological strain index. During the 24 hours postexercise, ad libitum fluid intake was greater following SODIUM (2541 [711] mL vs 1998 [727] mL; P = .04), as was urinary sodium excretion (NaCl: 66 [35] mmol, Pl: 21 [12] mmol; P < .01). CONCLUSIONS: Personalized sweat sodium replacement during ultraendurance running in hot conditions, with ad libitum fluid intake, exacerbated the rise in plasma sodium concentration compared to no sodium replacement but did not substantially influence overall body-water balance or thermophysiological strain. A large sodium deficit incurred during exercise leads to substantial renal sodium conservation postexercise.

Effect of prebiotics, probiotics, and synbiotics on gastrointestinal outcomes in healthy adults and active adults at rest and in response to exercise-A systematic literature review.

Introduction: A systematic literature search was undertaken to assess the impact of pre-, pro-, and syn-biotic supplementation on measures of gastrointestinal status at rest and in response to acute exercise. Methods: Six databases (Ovid MEDLINE, EMBASE, Cinahl, SportsDISCUS, Web of Science, and Scopus) were used. Included were human research studies in healthy sedentary adults, and healthy active adults, involving supplementation and control or placebo groups. Sedentary individuals with non-communicable disease risk or established gastrointestinal inflammatory or functional diseases/disorders were excluded. Results: A total of n = 1,204 participants were included from n = 37 papers reported resting outcomes, and n = 13 reported exercise-induced gastrointestinal syndrome (EIGS) outcomes. No supplement improved gastrointestinal permeability or gastrointestinal symptoms (GIS), and systemic endotoxemia at rest. Only modest positive changes in inflammatory cytokine profiles were observed in n = 3/15 studies at rest. Prebiotic studies (n = 4/5) reported significantly increased resting fecal Bifidobacteria, but no consistent differences in other microbes. Probiotic studies (n = 4/9) increased the supplemented bacterial species-strain. Only arabinoxylan oligosaccharide supplementation increased total fecal short chain fatty acid (SCFA) and butyrate concentrations. In response to exercise, probiotics did not substantially influence epithelial injury and permeability, systemic endotoxin profile, or GIS. Two studies reported reduced systemic inflammatory cytokine responses to exercise. Probiotic supplementation did not substantially influence GIS during exercise. Discussion: Synbiotic outcomes resembled probiotics, likely due to the minimal dose of prebiotic included. Methodological issues and high risk of bias were identified in several studies, using the Cochrane Risk of Bias Assessment Tool. A major limitation in the majority of included studies was the lack of a comprehensive approach of well-validated biomarkers specific to gastrointestinal outcomes and many included studies featured small sample sizes. Prebiotic supplementation can influence gut microbial composition and SCFA concentration; whereas probiotics increase the supplemented species-strain, with minimal effect on SCFA, and no effect on any other gastrointestinal status marker at rest. Probiotic and synbiotic supplementation does not substantially reduce epithelial injury and permeability, systemic endotoxin and inflammatory cytokine profiles, or GIS in response to acute exercise.

Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice.

Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as "exercise-induced gastrointestinal syndrome." When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines.

The impact of exercise modality on exercise-induced gastrointestinal syndrome and associated gastrointestinal symptoms.

OBJECTIVES: This study aimed to determine the impact of running and cycling exercise modalities on the magnitude of exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS). DESIGN: Parallel group trial design. METHODS: Twenty-eight endurance athletes (male n = 14, female n = 14) completed 2 h running at 55 % of maximal oxygen uptake or cycling at 55 % of maximal aerobic power in Tamb 35 °C and 22 % RH. Pre- and post-exercise blood samples were collected and analysed for markers of intestinal epithelial integrity perturbations (i.e., plasma intestinal fatty acid protein (I-FABP), soluble (s)CD14, and lipopolysaccharide binding protein (LBP)) and systemic inflammatory cytokines (i.e., plasma IL-1ß, TNFα, IL-10, and IL-1ra). GIS were assessed pre-exercise and every 10 min during exercise. RESULTS: Exercise-associated Δ for plasma I-FABP (191 and 434 pg‧ml-1) and LBP (-1228 and 315 ng‧ml-1) did not differ between running and cycling, respectively; however for sCD14 was higher (p = 0.030) on cycling (116 ng‧ml-1) vs running (96 ng‧ml-1). There were no differences in absolute pre- and post-exercise systemic inflammatory cytokine concentration, with large individual variation observed. Exercise-associated plasma TNF-α, (p = 0.041) and IL-10 (p = 0.019) responses were greater in running than cycling, but did not lead to a greater systemic inflammatory response profile (p = 0.305) between running (5.0arb.units) and cycling (-2.5arb.units). Although greater GIS incidence occurred in running (44 %) compared with cycling (25 %), there was no difference between groups for GIS severity. CONCLUSIONS: When running and cycling exercise is performed with similar duration, intensity, ambient conditions, and with confounder control, the exercise modality does not substantially impact the magnitude of EIGS or associated GIS severity.

A 3-D virtual human model for simulating heat and cold stress.

In this study, we extended our previously developed anatomically detailed three-dimensional (3-D) thermoregulatory virtual human model for predicting heat stress to allow for predictions of heat and cold stress in one unified model. Starting with the modified Pennes bioheat transfer equation to estimate the spatiotemporal temperature distribution within the body as the underlying modeling structure, we developed a new formulation to characterize the spatial variation of blood temperature between body elements and within the limbs. We also implemented the means to represent heat generated from shivering and skin blood flow that apply to air exposure and water immersion. Then, we performed simulations and validated the model predictions with experimental data from nine studies, representing a wide range of heat- and cold-stress conditions in air and water and physical activities. We observed excellent agreement between model predictions and measured data, with average root mean squared errors of 0.2°C for core temperature, 0.9°C for mean skin temperature, and 27 W for heat from shivering. We found that a spatially varying blood temperature profile within the limbs was crucial to accurately predict core body temperature changes during very cold exposures. Our 3-D thermoregulatory virtual human model consistently predicted the body's thermal state accurately for each of the simulated hot and cold environmental conditions and exertional heat stress. As such, it serves as a reliable tool to assess whole body, localized tissue, and, potentially, organ-specific injury risks, helping develop injury prevention and mitigation strategies in a systematic and expeditious manner.NEW & NOTEWORTHY This work provides a new, unified modeling framework to accurately predict the human body's thermal response to both heat and cold stress caused by environmental conditions and exertional physical activity in one mathematical model. We show that this 3-D anatomically detailed model accurately predicts the spatiotemporal temperature distribution in the body under extreme conditions for exposures to air and water and could be used to help design medical interventions and countermeasures to prevent injuries.

Female (Under) Representation in Exercise Thermoregulation Research.

BACKGROUND: Despite an increasing rate of women participating in professional sports, emergency services, and military settings where they are exposed to exertional heat stress, our understanding of female thermoregulation and the detrimental effects of heat on women's performance, especially regarding the menstrual cycle, is limited. This review aimed to quantify the representation of women in exercise thermoregulation research between 2010 and 2019 and the frequency that these articles reported details pertaining to female participants' menstrual cycle to determine the volume of novel research that is directly relevant to this growing population. METHODS: Original exercise thermoregulatory studies published in three major sports medicine databases (PubMed, MEDLINE, and SPORTDiscus) between 2010 and 2019 were surveyed. Articles were screened to determine the number of female and male participants in the study and whether studies involving women reported menstrual orientation or phase. Research involving healthy adult participants and an exercise protocol with a thermoregulatory outcome measure were included in the review. RESULTS: A total of 1407 articles were included in the review, involving 28,030 participants. The annual representation of women ranged from a mean of 11.6% [95% credible interval (CI); 9.2, 14.3] to 17.8% [95% CI; 15.2, 20.6] across the 10 years, indicating studies predominantly included men. Nonetheless, there was a small statistical increase in the overall proportion of women, with a mean overall proportion change of 0.7% [95% CI; 0.2, 1.2] per year. The increase appeared to be driven by a reduction in the number of studies including only men, rather than studies including more women alongside men, or increased women-only studies. Less than one third of articles involving women reported the menstrual orientation of participants and less than one quarter reported both menstrual orientation and phase. This study shows that women were proportionally underrepresented in exercise thermoregulation research during the past decade and the majority of studies did not report menstrual cycle details of female participants. Researchers should consider including women in future work where their inclusion could contribute meaningful data that enhance the evidence-based and ultimately improves our comprehension of women's thermal physiology.

A 3-D virtual human thermoregulatory model to predict whole-body and organ-specific heat-stress responses.

OBJECTIVE: This study aimed at assessing the risks associated with human exposure to heat-stress conditions by predicting organ- and tissue-level heat-stress responses under different exertional activities, environmental conditions, and clothing. METHODS: In this study, we developed an anatomically detailed three-dimensional thermoregulatory finite element model of a 50th percentile U.S. male, to predict the spatiotemporal temperature distribution throughout the body. The model accounts for the major heat transfer and thermoregulatory mechanisms, and circadian-rhythm effects. We validated our model by comparing its temperature predictions of various organs (brain, liver, stomach, bladder, and esophagus), and muscles (vastus medialis and triceps brachii) under normal resting conditions (errors between 0.0 and 0.5 °C), and of rectum under different heat-stress conditions (errors between 0.1 and 0.3 °C), with experimental measurements from multiple studies. RESULTS: Our simulations showed that the rise in the rectal temperature was primarily driven by the activity level (~ 94%) and, to a much lesser extent, environmental conditions or clothing considered in our study. The peak temperature in the heart, liver, and kidney were consistently higher than in the rectum (by ~ 0.6 °C), and the entire heart and liver recorded higher temperatures than in the rectum, indicating that these organs may be more susceptible to heat injury. CONCLUSION: Our model can help assess the impact of exertional and environmental heat stressors at the organ level and, in the future, evaluate the efficacy of different whole-body or localized cooling strategies in preserving organ integrity.