Upper-Body versus Lower-Body Cooling in Individuals with Paraplegia during Arm-Crank Exercise in the Heat.

PURPOSE: For wheelchair users with a spinal cord injury, the lower body may be a more convenient cooling site than the upper body. However, it remains unknown if leg cooling reduces thermal strain in these individuals. We compared the impact of upper-body versus lower-body cooling on physiological and perceptual outcomes during submaximal arm-crank exercise under heat stress in individuals with paraplegia. METHODS: Twelve male participants with paraplegia (T4-L2, 50% complete lesion) performed a maximal exercise test in temperate conditions, and three heat stress tests (32°C, 40% relative humidity) in which they received upper-body cooling (COOL-UB), lower-body cooling (COOL-LB), or no cooling (CON) in a randomized counterbalanced order. Each heat stress test consisted of four exercise blocks of 15 min at 50% of peak power output, with 3 min of rest in between. Cooling was applied using water-perfused pads, with 14.8-m tubing in both COOL-UB and COOL-LB. RESULTS: Gastrointestinal temperature was 0.2°C (95% confidence interval (CI), 0.1°C to 0.3°C) lower during exercise in COOL-UB versus CON (37.5°C ± 0.4°C vs 37.7°C ± 0.3°C, P = 0.009), with no difference between COOL-LB and CON ( P = 1.0). Heart rate was lower in both COOL-UB (-7 bpm; 95% CI, -11 to -3 bpm; P = 0.01) and COOL-LB (-5 bpm; 95% CI, -9 to -1 bpm; P = 0.049) compared with CON. The skin temperature reduction at the cooled skin sites was larger in COOL-LB (-10.8°C ± 1.1°C) than in COOL-UB (-6.7°C ± 1.4°C, P < 0.001), which limited the cooling capacity in COOL-LB. Thermal sensation of the cooled skin sites was improved and overall thermal discomfort was lower in COOL-UB ( P = 0.01 and P = 0.04) but not in COOL-LB ( P = 0.17 and P = 0.59) compared with CON. CONCLUSIONS: Upper-body cooling more effectively reduced thermal strain than lower-body cooling in individuals with paraplegia, as it induced greater thermophysiological and perceptual benefits.

Heat preparedness and exertional heat illness in Paralympic athletes: A Tokyo 2020 survey.

Paralympic athletes may be at increased risk for exertional heat illness (EHI) due to reduced thermoregulatory ability as a consequence of their impairment. This study investigated the occurrence of heat-stress related symptoms and EHI, and the use of heat mitigation strategies in Paralympic athletes, both in relation to the Tokyo 2020 Paralympic Games and previous events. Paralympic athletes competing in Tokyo 2020 were invited to complete an online survey five weeks prior to the Paralympics and up to eight weeks after the Games. 107 athletes (30 [24-38] years, 52% female, 20 nationalities, 21 sports) completed the survey. 57% of respondents had previously experienced heat-stress related symptoms, while 9% had been medically diagnosed with EHI. In Tokyo, 21% experienced at least one heat-stress related symptom, while none reported an EHI. The most common symptom and EHI were, respectively, dizziness and dehydration. In preparation for Tokyo, 58% of respondents used a heat acclimation strategy, most commonly heat acclimatization, which was more than in preparation for previous events (45%; P = 0.007). Cooling strategies were used by 77% of athletes in Tokyo, compared to 66% during past events (P = 0.18). Cold towels and packs were used most commonly. Respondents reported no medically-diagnosed EHIs during the Tokyo 2020 Paralympic Games, despite the hot and humid conditions in the first seven days of competition. Heat acclimation and cooling strategies were used by the majority of athletes, with heat acclimation being adopted more often than for previous competitions.

Humid Heat Equally Impairs Maximal Exercise Performance in Elite Para-Athletes and Able-Bodied Athletes.

PURPOSE: This study aimed to compare the impact of hot-humid environmental conditions on performance outcomes, thermoregulatory responses, and thermal perception during exercise between elite para- and able-bodied (AB) athletes. METHODS: Twenty elite para-athletes (para-cycling and wheelchair tennis) and 20 elite AB athletes (road cycling, mountain biking, beach volleyball) performed an incremental exercise test in a temperate environment (mean ± SD, 15.2°C ± 1.2°C; relative humidity, 54% ± 7%) and a hot-humid environment (31.9°C ± 1.6°C, 72% ± 5%). Exercise tests started with a 20-min warm-up at 70% of maximal heart rate, after which power output increased by 5% every 3 min until volitional exhaustion. RESULTS: Time to exhaustion was shorter in hot-humid versus temperate conditions, with equal performance loss for para- and AB athletes (median (interquartile range), 26% (20%-31%) vs 27% (19%-32%); P = 0.80). AB athletes demonstrated larger exercise-induced increases in gastrointestinal temperature (T gi ) in hot-humid versus temperate conditions (2.2 ± 0.7 vs 1.7 ± 0.5, P < 0.001), whereas T gi responses in para-athletes were similar between conditions (1.3 ± 0.6 vs 1.3 ± 0.4, P = 0.74). Para- and AB athletes showed similar elevations in peak skin temperature ( P = 0.94), heart rate ( P = 0.67), and thermal sensation score ( P = 0.64) in hot-humid versus temperate conditions. CONCLUSIONS: Elite para-athletes and AB athletes demonstrated similar performance decrements during exercise in hot-humid versus temperate conditions, whereas T gi elevations were markedly lower in para-athletes. We observed large interindividual variation within both groups, suggesting that in both para- and AB athletes, personalized heat mitigation plans should be developed based on individual thermal testing.

Heat acclimation does not negatively affect salivary immunoglobulin-A and self-reported illness symptoms and wellness in recreational athletes.

Heat acclimation (HA) protocols repeatedly expose individuals to heat stress. As HA is typically performed close to the pinnacle event, it is essential that the protocol does not compromise immune status, health, or wellbeing. The purpose of this study was to examine the effect of HA on resting salivary immunoglobulin-A (s-IgA) and salivary cortisol (s-cortisol), self-reported upper-respiratory tract symptoms, and self-reported wellness parameters. Seventeen participants (peak oxygen uptake 53.2 ± 9.0 mL·kg-1·min-1) completed a 10-day controlled-hyperthermia HA protocol, and a heat stress test both before (HST1) and after (HST2) HA (33°C, 65% relative humidity). Resting saliva samples were collected at HST1, day 3 and 7 of the HA protocol, HST2, and at 5 ± 1 days post-HA. Upper-respiratory tract symptom data were collected weekly from one week prior to HA until three weeks post HA, and wellness ratings were reported daily throughout HA. HA successfully induced physiological adaptations, with a lower end-exercise rectal temperature and heart rate and higher whole-body sweat rate at HST2 compared to HST1. In contrast, resting saliva flow rate, s-IgA concentration, s-cortisol concentration, and s-cortisol secretion rate remained unchanged (n = 11-14, P = 0.10-0.48). Resting s-IgA secretion rate increased by 39% from HST1 to HST2 (n = 14, P = 0.03). No changes were observed in self-reported upper respiratory tract symptoms and wellness ratings. In conclusion, controlled-hyperthermia HA did not negatively affect resting s-IgA and s-cortisol, self-reported upper-respiratory tract symptoms, and self-reported wellness parameters in recreational athletes.

Heat Reacclimation Using Exercise or Hot Water Immersion.

INTRODUCTION: The aim of this study was to compare the effectiveness of exercise versus hot water immersion heat reacclimation (HRA) protocols. METHODS: Twenty-four participants completed a heat stress test (HST; 33°C, 65% RH), which involved cycling at a power output equivalent to 1.5 W·kg-1 for 35 min whereby thermophysiological variables were measured. This was followed by a graded exercise test until exhaustion. HST1 was before a 10-d controlled hyperthermia (CH) heat acclimation (HA) protocol and HST2 immediately after. Participants completed HST3 after a 28-d decay period without heat exposure and were then separated into three groups to complete a 5-d HRA protocol: a control group (CH-CON, n = 8); a hot water immersion group (CH-HWI, n = 8), and a controlled hyperthermia group (CH-CH, n = 8). This was followed by HST4. RESULTS: Compared with HST1, time to exhaustion and thermal comfort improved; resting rectal temperature (Tre), end of exercise Tre, and mean skin temperature (Tsk) were lower; and whole body sweat rate (WBSR) was greater in HST2 for all groups (P < 0.05). After a 28-d decay, only WBSR, time to exhaustion, and mean Tsk returned to pre-HA values. Of these decayed variables, only WBSR was reinstated after HRA; the improvement was observed in both the CH-CH and the CH-HWI groups (P < 0.05). CONCLUSION: The data suggest that HRA protocol may not be necessary for cardiovascular and thermal adaptations within a 28-d decay period, as long as a 10-d CH-HA protocol has successfully induced these physiological adaptations. For sweat adaptations, a 5-d CH or HWI-HRA protocol can reinstate the lost adaptations.

Individual characteristics associated with the magnitude of heat acclimation adaptations.

PURPOSE: The magnitude of heat acclimation (HA) adaptations varies largely among individuals, but it remains unclear what factors influence this variability. This study compared individual characteristics related to fitness status and body dimensions of low-, medium-, and high responders to HA. METHODS: Twenty-four participants (9 female, 15 male; maximum oxygen uptake [[Formula: see text]O2peak,kg] 52 ± 9 mL kg-1 min-1) completed 10 daily controlled-hyperthermia HA sessions. Adaptations were evaluated by heat stress tests (HST; 35 min cycling 1.5 W  kg-1; 33 °C, 65% relative humidity) pre- and post-HA. Low-, medium-, and high responder groups were determined based on tertiles (n = 8) of individual adaptations for resting rectal temperature (Tre), exercise-induced Tre rise (ΔTre), whole-body sweat rate (WBSR), and heart rate (HR). RESULTS: Body dimensions (p > 0.3) and [Formula: see text]O2peak,kg (p > 0.052) did not differentiate low-, medium-, and high responders for resting Tre or ΔTre. High WBSR responders had a larger body mass and lower body surface area-to-mass ratio than low responders (83.0 ± 9.3 vs 67.5 ± 7.3 kg; 249 ± 12 vs 274 ± 15 cm2 kg-1, respectively; p < 0.005). Conversely, high HR responders had a smaller body mass than low responders (69.2 ± 6.8 vs 83.4 ± 9.4 kg; p = 0.02). [Formula: see text]O2peak,kg did not differ among levels of responsiveness for WBSR and HR (p > 0.3). CONCLUSION: Individual body dimensions influenced the magnitude of sudomotor and cardiovascular adaptive responses, but did not differentiate Tre adaptations to HA. The influence of [Formula: see text]O2peak,kg on the magnitude of adaptations was limited.

Sweat rate and sweat composition during heat acclimation.

The purpose of this study was to determine local sweat rate (LSR) and sweat composition during heat acclimation (HA). For ten consecutive days of HA, eight participants cycled in 33 °C and 65% relative humidity at an intensity such that a rectal temperature of 38.5 °C was reached within ~40 min, followed by a 60-min clamp of this rectal temperature (i.e., controlled hyperthermia). Four participants extended HA by a 28-day decay period and five consecutive days of heat re-acclimation (HRA) using controlled hyperthermia. Sweat from the upper arm and upper back was collected three times during each heat exposure session. LSR and sweat sodium, chloride, lactate, and potassium concentrations were determined. Relative to HA day 1, LSR was increased at the final day of HA (day 10) (arm: +58%, P < 0.001; back: +36%, P < 0.05). Concentrations of sodium, chloride, and lactate significantly (P < 0.05) decreased to ~60% at HA day 10 compared to day 1 on the arm and back. Potassium concentration did not significantly differ on HA day 10 compared to day 1 (arm: +11%, P > 0.05; back: +8%, P > 0.05). The induction patterns of the sudomotor adaptations were different. Whilst LSR increased from HA day 8 on the arm and from HA day 7 on the back, sodium and chloride conservation already occurred from HA day 3 on both skin sites. Lastly, the sweat lactate reduction occurred from HA day 6 on the arm and back. Initial evidence is provided that adaptations were partly conserved after decay (28 days) and that a 5-day HRA may be sufficient to restore HA adaptations. In conclusion, ten days of exercise-induced HA using controlled hyperthermia led to increases in LSR and concomitant reductions of sweat sodium, chloride, and lactate concentrations, whilst potassium concentrations remained relatively constant.

Sweat rate and sweat composition following active or passive heat re-acclimation: A pilot study.

The purpose of this study was to investigate local sweat rate (LSR) and sweat composition before and after active or passive heat re-acclimation (HRA). Fifteen participants completed four standardized heat stress tests (HST): before and after ten days of controlled hyperthermia (CH) heat acclimation (HA), and before and after five days of HRA. Each HST consisted of 35 min of cycling at 1.5W·kg-1 body mass (33°C and 65% relative humidity), followed by a graded exercise test. For HRA, participants were re-exposed to either CH (CH-CH, n = 6), hot water immersion (water temperature ~40°C for 40 min; CH-HWI, n = 5) or control (CH-CON, n = 4). LSR, sweat sodium, chloride, lactate and potassium concentrations were determined on the arm and back. LSR increased following HA (arm +18%; back +41%, P ≤  0.03) and HRA (CH-CH: arm +31%; back +45%; CH-HWI: arm +65%; back +49%; CH-CON arm +11%; back +11%, P ≤ 0.021). Sweat sodium, chloride and lactate decreased following HA (arm 25-34; back 21-27%, P < 0.001) and HRA (CH-CH: arm 26-54%; back 20-43%; CH-HWI: arm 9-49%; back 13-29%; CH-CON: arm 1-3%, back 2-5%, P < 0.001). LSR increases on both skin sites were larger in CH-CH and CH-HWI than CH-CON (P ≤ 0.010), but CH-CH and CH-HWI were not different (P ≥ 0.148). Sweat sodium and chloride conservation was larger in CH-CH than CH-HWI and CH-CON on the arm and back, whilst CH-HWI and CH-CON were not different (P ≥ 0.265). These results suggest that active HRA leads to similar increases in LSR, but more conservation of sweat sodium and chloride than passive HRA. Abbreviations: ANOVA: Analysis of variance; ATP: Adenosine triphosphate; BSA (m2): Body surface area; CH: Controlled hyperthermia; CH-CH: Heat re-acclimation by controlled hyperthermia; CH-CON: Control group (no heat re-acclimation); CH-HWI: Heat re-acclimation by hot water immersion; CV (%): Coefficient of variation; dt (min): Duration of a stimulus; F: Female; GEE: Generalized estimating equations; HA: Heat acclimation; HRA : Heat re-acclimation; HST: Heat stress test; LSR (mg·cm-2·min-1) : Local sweat rate; LOD (mmol·L-1): Limit of detection; M: Male; m x (mg): Mass of x; RH (%): Relative humidity; RT: Recreationally trained; SA (cm2): Surface area; t (min): Time; T: Trained; Tsk (°C): Skin temperature; Tre (°C): Rectal temperature; USG : Urine specific gravity; VO2peak (mL·kg-1·min-1): Peak oxygen uptake; WBSL (L): Whole-body sweat loss; WBSR (L·h-1): Whole-body sweat rate.