Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update.

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Twenty-Four Percent of Wildland Firefighters Reach Critical Levels of Serum Creatine Kinase During 80-Hour Critical Training.

INTRODUCTION: Wildland firefighters (WLFFs) must undergo a 2-wk critical training (CT) period prior to deployment to the field. This stress may result in clinical risks, including severe muscle damage and rhabdomyolysis. We aimed to document the effects of WLFFs' CT on physiologic markers of muscle damage and soreness. METHODS: Two interagency hotshot crews (n=25) were followed during spring 2022 for 80 h of training. Activity counts as well as records of upper-body (US) and lower-body (LS) muscle soreness were collected daily. Body weight (BW) and skinfold measurements were recorded on Day 1 (D1) and D11 to estimate body fat (BF) and lean body weight (LBW). Blood was collected on D1 and D11 to measure muscle and liver damage markers. RESULTS: Critical training resulted in significant elevations in creatine kinase (CK) (216.9±57.4 U/L vs 5166.4±1927.8 U/L, P=0.017) and lactate dehydrogenase (LDH) (175.5±4.0 IU/L vs 340.0±42.6 IU/L, P=0.001) despite no significant changes in BW, BF, LBW, cortisol, or testosterone. Main effects of time were seen in US and LS, peaking on D11 (US: 5.2±0.4 cm, P<0.001; LS: 5.5±0.4 cm, P<0.001). Those who spent the most minutes with activity counts of >1500 counts/min showed the greatest increase in CK and LDH. CONCLUSIONS: These data suggest that WLFFs undergo significant physiologic stressors, resulting in muscle soreness and damage during CT, with 6 of the 25 subjects reaching critical levels of serum CK. It appears that much of the muscle damage and soreness occurred because of unaccustomed WLFF job-specific tasks.

Wildland Firefighter Critical Training Elicits Positive Adaptations to Markers of Cardiovascular and Metabolic Health.

INTRODUCTION: The purpose of this study was to identify physiologic changes in body composition and resting metabolic markers of health across 2 wk of critical training (CT) in wildland firefighters (WLFFs). METHODS: Twenty-two male and 3 female participants were recruited from 2 hotshot crews across the western United States prior to the 2022 fire season and monitored over their 80-h CT. Body weight (BW) and skinfolds were recorded before and after CT to estimate body fat (BF) and lean body weight (LBW). Blood was analyzed for changes in hematocrit, hemoglobin, plasma volume, and resting values of a lipid and metabolic panel. RESULTS: The high physical demands of CT resulted in improvements in total cholesterol (-19.3 mg/dL, P<0.001), triglycerides (-34.4 mg/dL, P<0.001), low-density lipoprotein cholesterol (-18.1 mg/dL, P<0.001), very-low-density lipoprotein cholesterol (-5.2 mg/dL, P<0.001), high-density lipoprotein cholesterol (+4.0 mg/dL, P=0.002), non-high-density lipoprotein cholesterol (-19.3 mg/dL, P<0.001), and fasting glucose (-4.3 mg/dL, P=0.008) from before CT to after CT. Significant decreases in hemoglobin and hematocrit were also seen (P<0.001) with corresponding increases in estimated plasma volume (+6.1%, P<0.001). These alterations were seen despite maintenance of BW, LBW, and BF. Lower pretraining BF was associated with a greater magnitude of improvements in fasting glucose and cholesterol markers. CONCLUSIONS: The observed improvements in baseline metabolic and cardiovascular markers along with plasma volume expansion suggest a positive response to the physical stress of WLFF CT. It appears that higher preseason fitness was associated with greater adaptations to the CT stressor.

Cardiovascular and Blood Oxidative Stress Responses to Exercise and Acute Woodsmoke Exposure in Recreationally Active Individuals.

INTRODUCTION: Those who work and recreate outdoors experience woodsmoke exposure during fire season. Exercise during woodsmoke exposure harms the cardiovascular system, but the acute physiologic and biochemical responses are understudied. The purpose of this pilot laboratory-based study was to examine the effect of exercise during woodsmoke exposure on acute indicators of cardiovascular function, including heart rate variability (HRV), pulse wave velocity (PWV), blood pressure (BP), augmentation index (AIx), and blood oxidative stress. METHODS: Ten participants performed 2 moderate-intensity exercise (70% V˙O2 max) trials (clean air 0 µg·m-3, woodsmoke 250 µg·m-3) in a crossover design. HRV, PWV, BP, AIx, and blood oxidative stress were measured before, after, and 90 min after exercise for each trial. Blood oxidative stress was quantified through lipid damage (LOOH, 8-ISO), protein damage (3-NT, PC), and antioxidant capacity (TEAC). RESULTS: A 45-min woodsmoke exposure combined with moderate-intensity exercise did not result in a statistically significant difference in HRV, PWV, BP, AIx, or oxidative stress (P>0.05). CONCLUSIONS: Despite the known deleterious effects of smoke inhalation, moderate-intensity aerobic exercise while exposed to woodsmoke particulate matter (250 µg·m-3) did not result in a statistically significant difference in HRV, PWV, or blood oxidative stress in this methodologic context. Although findings do not negate the negative impact of woodsmoke inhalation, additional research approaches are needed to better understand the acute effects of smoke exposure on the cardiovascular system.

Comment on Fan et al. Efficacy of Ingesting an Oral Rehydration Solution after Exercise on Fluid Balance and Endurance Performance. Nutrients 2020, 12, 3826.

Our lab read with interest the recent article published in Nutrients comparing different drink composition on fluid balance [...].

Impact of Hypoxic Exercise Recovery on Skeletal Muscle Glycogen and Gene Expression.

Slivka, Dustin, Charles Dumke, Walter Hailes, and Brent Ruby. Impact of hypoxic exercise recovery on skeletal muscle glycogen and gene expression. High Alt Med Biol. 22:300-307, 2021. Background: The impact of altitude during recovery from exercise is largely unknown. The purpose of this study was to determine the acute gene response and muscle glycogen re-synthesis after exercise when exposed to simulated high altitude during recovery. Materials and Methods: Twelve male participants (age, 25 ± 2 years; height, 178 ± 7 cm; weight, 78.8 ± 7.8 kg; VO2peak, 4.25 ± 0.59 l/min; Wpeak 307 ± 44 W; and body fat, 13.1% ± 1.2%) completed two trials (random order), which consisted of cycling for 90 minutes in laboratory conditions and then recovering for 6 hours in laboratory conditions (975 m; normoxia) or at a high simulated altitude (5,000 m; hypoxia). Results: Skeletal muscle biopsies from the vastus lateralis were obtained before exercise, after exercise, and 6 hours after exercise for the measurement of metabolic gene expression and muscle glycogen. Muscle glycogen decreased with exercise (61% ± 13%, p < 0.05) and increased with recovery (78% ± 35%, p < 0.05) with no difference between trials (p > 0.05). Hypoxia-inducible factor (HIF)-1α, HIF-2α, optic atrophy gene 1 (OPA-1), mitofusin 2 (MFN-2), and peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) gene expression were suppressed after altitude exposure (p < 0.05), while mitochondrial fission 1 protein (FIS-1), phosphofructokinase (PFK), Cytochrome c oxidase (COX), and hexokinase (HK) were unaffected by altitude exposure (p > 0.05). Conclusions: High-altitude exposure during recovery from exercise inhibits gene expression associated with mitochondrial development without affecting muscle glycogen re-synthesis.

Alterations in Metabolic and Cardiovascular Risk Factors During Critical Training in Wildland Firefighters.

OBJECTIVE: To identify physiologic stressors related to cardiovascular disease via changes in metabolic, inflammatory, and oxidative stress biomarkers during 2 weeks of preseason training in wildland firefighters (WLFFs). METHODS: Participants were recruited from a local hotshot crew and monitored during preseason training. Fitness was assessed via the Bureau of Land Management fitness challenge. Venipuncture blood was collected on days 1, 4, 8, and 11 and analyzed for changes in a lipid and glucose panel, C-reactive protein, and oxidative stress markers 8-isoprostane (8ISO), 3-nitrotyrosine (3NT), lipid hydroperoxides (LOOH), and protein carbonyls. RESULTS: The high physical demands of training resulted in significant (P < 0.05) reductions in total cholesterol, glucose, and hemoglobin A1c. A main effect for time was observed in 8ISO, 3NT, and LOOH. CONCLUSIONS: Alterations in metabolic and oxidative stress markers suggest an acute, high-intensity physical stress during WLFF preseason training.

Muscle Damage and Overreaching During Wildland Firefighter Critical Training.

OBJECTIVE: To document the effects of wildland firefighter (WLFF) critical training (CT) on physiologic markers of muscle damage and acute overreaching. METHODS: Eighteen male and three female WLFFs were studied during an 11-day CT. Upper-body (US), lower-body (LS) muscle soreness and body weight (BW) were collected daily. Blood was collected on days 1, 4, 8, and 11 to measure creatine kinase (CK), lactate dehydrogenase (LDH), cortisol, and testosterone. Skinfolds were taken on days 1 and 11 to estimate body fat (BF) and lean body weight (LBW). RESULTS: CT resulted in a significant depression in BF and elevation in LBW, while main effects of time were seen in US, LS, CK, LDH, cortisol, and testosterone/cortisol ratio (P < 0.05). CONCLUSION: These data suggest WLFFs undergo significant physiological stressors resulting in muscle soreness, damage, and possible overreaching during CT.

Short term heat acclimation reduces heat stress, but is not augmented by dehydration.

Heat acclimation lowers physiological strain when exercising in the heat, and may be enhanced by promoting dehydration during acclimation. The purpose was to compare fluid intake during heat acclimation by promoting dehydration (DEH=0.5 mL kg-1 15 min-1, ~2.4% dehydration per acclimation session) compared to euhydration (EUH=2.0 mL kg-1 15 min-1, ~1.4% dehydration per acclimation session) following four heat acclimation bouts on thermal strain, and exercise performance. Thirteen males completed 90 min heat stress tests (HST) at 50% VO2max (40 °C, 30%RH) before and after three 90 min heat acclimation trials, involving consecutive bouts with 4-fold less fluid (DEH) or EUH. DEH and EUH trials were separated by 48 h and assigned in a random crossover design separated by a 5 week washout. Wildland firefighter (WLFF) Nomex: shirt, pants, and a cotton T-shirt baselayer were worn. Peak core temperature (Tc) from the HST significantly decreased following both DEH (39.5 ±â€¯0.1-39.0 ±â€¯0.1 °C: P < 0.001) and EUH acclimation (39.5 ±â€¯0.1-38.9 ±â€¯0.1 °C: P < 0.001). HR, RPE, physiological strain index (PSI), and total work (J) completed in a graded exercise test to exhaustion were improved (P < 0.001) in effect for acclimation, but not different when comparing DEH or EUH fluid delivery. SBF was unchanged (P = 0.313). Sweat rate increased greater following DEH (1.52 ±â€¯0.06-1.89 ±â€¯0.09 L h-1) compared to EUH acclimation (1.57 ±â€¯0.06-1.79 ±â€¯0.08 L h-1: P = 0.015). Resting plasma volume increased in effect for acclimation (P = 0.002). Aldosterone decreased in effect for acclimation (P < 0.001) at rest and following exercise, and total protein was unaffected (P = 0.83). In conclusion, short-term heat acclimation (~360 min) attenuates heat stress, and improves exercise capacity in the heat, and was not impaired nor improved by promoting DEH during acclimation.

Experimental Woodsmoke Exposure During Exercise and Blood Oxidative Stress.

OBJECTIVES: The current laboratory study quantified blood oxidative stress to woodsmoke exposure. METHODS: Participants inhaled woodsmoke during three randomized crossover exercise trials (Clean Air [0 µg/m], Low Exposure [250 µg/m], and High Exposure [500 µg/m], Woodsmoke [particulate matter less than 2.5 µm, PM2.5]). Trolox equivalent antioxidant capacity (TEAC), uric acid (UA), 8-isoprostanes (8-ISO), lipid hydroperoxides (LOOH), protein carbonyls (PC), nitrotyrosine (3-NT), 8-isoprostane, and myeloperoxidase (MPO) were quantified in Pre, immediately Post, and 1- (1Hr) hour post blood samples. RESULTS: UA decreased following Low Exposure, while plasma TEAC levels increased Post and 1Hr. LOOH levels decreased 1Hr Post (High Exposure), while 8-Iso increased following both smoke trials. PC and MPO were unchanged following all trials, while 3-NT increased over Clean Air. CONCLUSION: Blood oxidative stress occurred largely independent of PM2.5 concentrations. Future studies should employ longer duration smoke and exercise combined with physiologic parameters.

Metabolic Demand of Hiking in Wildland Firefighting.

INTRODUCTION: The objective of this study was to document characteristics of hiking during wildland firefighter (WLFF) training and wildfire suppression. For the first time, the overall physical demands during wildland firefighting were evaluated in the field using global positioning systems coupled with wireless physiological monitoring and load carriage prediction models. METHODS: Male (n=116) and female (n=15) interagency hotshot crew and type II WLFFs on wildfires volunteered for this direct observation study. Participants' heart rate, internal temperature, speed, and elevation gain were monitored throughout training and during wildfire suppression. The Pandolf and Santee equations were used to predict metabolic rate to estimate oxygen consumption of uphill and downhill hiking. RESULTS: Equipment weight varied by crew type (type II: 24±9 kg and interagency hotshot crew: 28±6 kg; P<0.05). Grade of terrain was steepest during training hikes, and ingress hikes were statistically different from egress and training hikes (ingress: 4±9%, shift: 4±9%, egress: 1±8%, training hikes: 10±9%; P<0.01). Estimated oxygen consumption was highest during ingress hikes and was significantly different from all other hike types on fire assignments (ingress: 22±12, shift: 19±12, egress: 19±12 mL·kg-1·min-1; P=0.01). Oxygen consumption was higher during training hikes (34±14 mL·kg-1·min-1) than during job-related hikes (P<0.01). CONCLUSIONS: The greatest metabolic demand during wildfire assignments occurred during ingress hikes. On average, this was close to the estimated metabolic demand of the job qualification arduous pack test. However, greater metabolic demand occurred for periods during both shift (on the job) and training hikes. These data quantify the demands associated with actual wildland performance of WLFFs and can help define future work capacity testing and training procedures.

Comparison of Sports Drink Versus Oral Rehydration Solution During Exercise in the Heat.

INTRODUCTION: This study compared 2 commercially available beverages, an oral rehydration solution (ORS; 60.9 mM Na+; 3.4% carbohydrate) and a sports drink (SDS; 18.4 mM Na+; 5.9% carbohydrate), on hydration and metabolism during submaximal exercise in the heat. METHODS: Ten male subjects completed two 90-min exercise trials (39ºC, 30%) of walking at 50% VO2max followed by a 30-min rest period in the heat while wearing wildland firefighter personal protective clothing. After 45 min of exercise, fluid delivery by either ORS or SDS replaced 150% of sweat loss. Subjects continued the exercise for 45 additional minutes followed by a 30-min rest period. Blood samples were collected pre-exercise (0 min), post-exercise (90 min), and post-trial (120 min) to measure plasma volume (%) and blood glucose (mg·dL-1). Expired gases were collected twice for 3 min for substrate oxidation. RESULTS: The sweat rate and percent dehydration did not differ between the groups (P=0.86 and P=0.79, respectively). Changes in plasma volume did not differ (P=0.55). Hemoglobin levels significantly increased in both groups post-trial (P=0.009). Blood glucose was significantly greater post-trial in SDS versus ORS (116±19 vs 103±13 mg·dL-1, respectively; P=0.01). Fat oxidation was lower post-exercise in SDS vs ORS (0.38±0.1 vs 0.47±0.2 g·min-1, respectively; P=0.049). CONCLUSIONS: These data indicate no difference in fluid retention between ORS or SDS when supplemented during exercise in the heat. This implies that fluid volume, and not drink contents, may be more important when ingested during exercise in a hot environment.

Lung function measures following simulated wildland firefighter exposures.

Across the world, biomass smoke is a major source of air pollution and is linked with a variety of adverse health effects. This is particularly true in the western U.S. where wood smoke from wildland forest fires are a significant source of PM2.5. Wildland firefighters are impacted as they experience elevated PM2.5 concentrations over extended periods of time, often occurring during physical exertion. Various epidemiological studies have investigated wood smoke impacts on human health, including occupational field exposures experienced by wildland firefighters. As there are numerous challenges in carrying out these field studies, having the ability to research the potential health impacts to this occupational cohort in a controlled setting would provide important information that could be translated to the field setting. To this end, we have carried out a simulated wildland firefighter exposure study in a wood smoke inhalation facility. Utilizing a randomized crossover trial design, we exposed 10 participants once to clean filtered-air, 250 µg/m3, and 500 µg/m3 wood stove-generated wood smoke PM2.5. Participants exercised on a treadmill at an absolute intensity designed to simulate wildland firefighting for 1.5 hr. In addition to measured PM2.5 smoke concentrations, mean levels of CO2, CO, and % relative humidity were continuously monitored and recorded and were representative of occupational "real-world" exposures. Pulmonary function was measured at three time points: before, immediately after, and 1-hr post-exposure. Although there were some reductions in FVC, FEV1, and FVC:FEV1 measures, results of the spirometry testing did not show significant changes in lung function. The development of this wood smoke inhalational facility provides a platform to further address unique research questions related to wood smoke exposures and associated adverse health effects.

Measured Pulmonary and Systemic Markers of Inflammation and Oxidative Stress Following Wildland Firefighter Simulations.

OBJECTIVE: A controlled human exposure study was conducted to investigate the impact of inhalational exposures to wood smoke PM2.5 on measured concentrations of airway and systemic inflammatory biomarkers. METHODS: Mimicking wildland firefighter activities, 10 participants were exposed to three doses of wood smoke PM2.5 (filtered-air, 250 µg/m, and 500 µg/m) while exercising on a treadmill. Exhaled breath condensate (EBC) and blood plasma samples were obtained pre-, immediately post-, and 1-hour postexposure. 8-isoprostane, pH, and myeloperoxidase were measured in EBC, while H2O2, surfactant protein D, and pentraxin-3 (PTX3) were measured in both EBC and plasma. RESULTS: Only pH, 8-isoprostane, and PTX3 displayed significant changes when comparing pre- and postexposures. CONCLUSIONS: Markers of inflammation and oxidative stress, including PTX3, pH, and 8-isoprostane in EBC and/or plasma, are sensitive to wood smoke inhalation, with further investigations warranted.

Relationships between maximal strength, muscle size, and myosin heavy chain isoform composition and postactivation potentiation.

The purpose of this study was to examine the relationships between maximal voluntary postactivation potentiation (PAP) and maximal knee extensor torque, quadriceps cross-sectional area (CSA) and volume, and type II myosin heavy chain (MHC) isoform percentage in human skeletal muscle. Thirteen resistance-trained men completed a test protocol consisting of 2 isokinetic knee extensions at 180°·s(-)(1) performed before and 1, 4, 7, and 10 min after the completion of 4 maximal knee extensions at 60°·s(-)(1) (i.e., a conditioning activity (CA)). Magnetic resonance imaging and muscle microbiopsy procedures were completed on separate days to assess quadriceps CSA and volume and MHC isoform content. Maximal voluntary PAP response was assessed as the ratio of the highest knee extensor torques measured before and after the CA. There were large to very large correlations between maximal voluntary PAP response and maximal knee extensor torque (r = 0.62) and quadriceps CSA (r = 0.68) and volume (r = 0.63). Nonetheless, these correlations were not statistically significant after adjusting for the influence of type II MHC percentage using partial correlation analysis. By contrast, the strongest correlation was observed for type II MHC percentage (r = 0.77), and this correlation remained significant after adjusting for the other variables. Maximal voluntary PAP response is strongly correlated with maximal knee extensor torque and quadriceps CSA and volume, but is mostly clearly associated with the type II myosin isoform percentage in human skeletal muscle.

Impact of extreme exercise at high altitude on oxidative stress in humans.

Exercise and oxidative stress research continues to grow as a physiological subdiscipline. The influence of high altitude on exercise and oxidative stress is among the recent topics of intense study in this area. Early findings indicate that exercise at high altitude has an independent influence on free radical generation and the resultant oxidative stress. This review provides a detailed summary of oxidative stress biochemistry as gleaned mainly from studies of humans exercising at high altitude. Understanding of the human response to exercise at altitude is largely derived from field-based research at altitudes above 3000 m in addition to laboratory studies which employ normobaric hypoxia. The implications of oxidative stress incurred during high altitude exercise appear to be a transient increase in oxidative damage followed by redox-sensitive adaptations in multiple tissues. These outcomes are consistent for lowland natives, high altitude acclimated sojourners and highland natives, although the latter group exhibits a more robust adaptive response. To date there is no evidence that altitude-induced oxidative stress is deleterious to normal training or recovery scenarios. Limited evidence suggests that deleterious outcomes related to oxidative stress are limited to instances where individuals are exposed to extreme elevations for extended durations. However, confirmation of this tentative conclusion requires further investigation. More applicably, altitude-induced hypoxia may have an independent influence on redox-sensitive adaptive responses to exercise and exercise recovery. If correct, these findings may hold important implications for athletes, mountaineers, and soldiers working at high altitude. These points are raised within the confines of published research on the topic of oxidative stress during exercise at altitude.

Graded hypoxia and blood oxidative stress during exercise recovery.

Altitude exposure and exercise elicit oxidative stress in blood; however, exercise recovery at 5000 m attenuates oxidative stress. The purpose was to determine the altitude threshold at which blood oxidative stress is blunted during exercise recovery. Twelve males 18-28 years performed four-cycle ergometry bouts (60 min, 70% VO2max, at 975 m). In a randomised counterbalanced crossover design, participants recovered 6 h at 0, 1667, 3333 and 5000 m in a normobaric hypoxia chamber (recovery altitudes were simulated by using a computerised system in an environmental chamber by lowering the partial pressure of oxygen to match that of the respective altitude). Oxygen saturation was monitored throughout exercise recovery. Blood samples obtained pre-, post-, 1 h post- and 5 h post-exercise were assayed for ferric-reducing antioxidant plasma, Trolox equivalent antioxidant capacity, uric acid, lipid hydroperoxides and protein carbonyls. Muscle biopsies obtained pre and 6 h were analysed by real-time polymerase chain reaction to quantify expression of hemeoxgenase 1, superoxide dismutase 2 and nuclear factor (euthyroid-derived 2)-like factor. Pulse oximetry data were similar during exercise, but decreased for the three highest recovery elevations (0 m = 0%, 1667 m = -3%; 3333 m = -7%; 5000 m = -17%). A time-dependent oxidative stress occurred following exercise for all variables, but the two highest recovery altitudes partially attenuated the lipid hydroperoxide response (0 m = +135%, 1667 m = +251%, 3333 m = +99%; 5000 m = +108%). Data may indicate an altitude threshold between 1667 and 3333 m, above which the oxidative stress response is blunted during exercise recovery.

Effect of Plyometrics on the Energy Cost of Running and MHC and Titin Isoforms.

UNLABELLED: Several training strategies such as plyometrics have been shown to improve running economy; however, its physiological basis remains elusive. PURPOSE: To examine the effect of plyometric training on the energy cost of running (ECR, J · kg(-1) · min(-1)), titin, and myosin heavy chain (MHC) isoforms. METHODS: Subjects were randomly assigned to a 6-wk plyometric treatment (P; n = 11) or control group (C; n = 11). Preintervention and postintervention outcomes included body composition, vertical jump, sit-and-reach, maximal oxygen consumption (VO2max), speed at onset of blood lactate, 3-km time trial performance, ECR, and a vastus lateralis muscle biopsy for protein analysis. RESULTS: Plyometric intervention resulted in improved time trial (P, 2.6% faster, P = 0.04; C, 1.6%, P = 0.17). VO2max improved in the P group (5.2%, P = 0.03), whereas the C group increased by 3.1% (P = 0.20). The ECR decreased in the P group as the result of 6 wk of plyometric training (P = 0.02 for stage 3), whereas it increased in the C group (P = 0.02 for stage 3). The ECR correlated strongly with performance at stages 2, 3, and 4 (r > 0.8, P < 0.001) independent of group. There was no significant main effect of group, time, or interaction on any of the protein isoforms analyzed. A negative correlation was found between the ECR at stage 7 and MHC IIa (r = -0.96, P < 0.001), and the ECR at stage 6 with titin isoform 1 (T1)/T2 ratio (r = -0.69, P = 0.007) independent of group. CONCLUSION: Six weeks of plyometric training improved running performance and the ECR despite no measurable changes in MHC and titin isoforms. However, higher MHC IIa and lower T1/T2 isoform ratios correlated to lower ECR.

The Effect of Environmental Temperature on Glucose and Insulin After an Oral Glucose Tolerance Test in Healthy Young Men.

OBJECTIVE: The purpose of this study was to compare glucose and insulin responses during an oral glucose tolerance test (OGTT) in cold (C), neutral (N), and hot (H) environments. METHODS: Eleven males completed three 4-hour climate-controlled OGTT trials (C, 7.2°C; N, 22°C; and H, 43°C). Participants remained semireclined for 60 minutes before ingesting a 1.8 g/kg glucose beverage. Skin and rectal core temperatures were continuously monitored. Blood was collected just before glucose ingestion (time 0) and at 15, 30, 60, 90, 120, and 180 minutes, and analyzed for serum glucose, insulin, hematocrit, and hemoglobin. Expired gases were collected upon entering the chamber (-60 minutes), before glucose ingestion (0 minutes), and at 60, 120, and 180 minutes to determine V(O2) and respiratory exchange ratio. RESULTS: Rectal core temperature was greater in the H condition compared with both C and N (P < .001). Rectal core temperature was not different between C and N, whereas skin temperature was different across all trials (H greater than N greater than C). The V(O2) was greater in C than in both H and N during all time points. Carbohydrate oxidation was greater in C compared with H and N (P < 0.001). Glucose was higher during H compared with C and N (P ≤ 0.002). Glucose was elevated in C compared with N. Insulin was higher in H compared with C (P = 0.009). Area under the curve for serum glucose was greater in H compared with C and N (P ≤ 0.001); however, there was no significant difference in area under the curve for insulin. CONCLUSIONS: These data indicate that after an OGTT, glucose and insulin are elevated in a hot environment.