Thermoregulatory, cardiovascular, and perceptual responses to intermittent cooling during exercise in a hot, humid outdoor environment.

Decreasing core body temperature during exercise may improve exercise tolerance, facilitate acclimatization, and prevent heat illness during summer training. We sought to evaluate the effectiveness of intermittent superficial cooling on thermoregulatory, cardiovascular, and perceptual responses during exercise in a hot humid environment. We used a randomized, counterbalanced, repeated measures investigation with 2 conditions (control and cooling) during exercise and recovery outdoors on artificial turf in a hot, humid tropical climate in the sun (wet bulb globe temperature outdoors [WBGTo], 27.0 ± 0.8° C; range, 25.8-28.1° C) and in the shade (WBGTo, 25.4 ± 0.9° C; range, 24.3-26.8° C). Participants were 10 healthy males (age, 22.6 ± 1.6 years; height, 176.0 ± 6.9 cm; mass, 76.5 ± 7.8 kg; body fat, 15.6 ± 5.4%) who wore shorts and T-shirt (control) or "phase change cooling" vest (cooling) during 5-minute rest breaks during 60 minutes of intense American football training and conditioning exercises in the heat and 30 minutes of recovery in the shade. Throughout, we measured core (Tgi) and skin (Tchest) temperature, heart rate (HR), thermal and thirst sensations, and rating of perceived exertion. We found significant (p ≤ 0.001) hypohydration (-2.1%); for Tgi, we found no significant differences between conditions (p = 0.674) during exercise and progressive decreases during recovery (p < 0.001). For [INCREMENT]Tg,i we found no significant (p = 0.090) differences. For Tchest, we found significantly (p < 0.001) decreased skin temperature in the cooling condition (Tchest, 31.85 ± 0.43° C) compared with the control condition (Tchest, 34.38 ± 0.43° C) during exercise and significantly (p < 0.001) lower skin temperature in the cooling condition (Tchest, 31.24 ± 0.47° C) compared with the control condition (Tchest, 33.48 ± 0.47° C) during recovery. For HR, we found no significant difference (p = 0.586) between the conditions during exercise; however, we did find significantly (p < 0.001) lower HR during recovery. Thermal sensations were significantly (p = 0.026) decreased in the cooling (4.4 ± 0.2 points) compared with the control (5.0 ± 0.2 points) condition but not for other perceptual responses. The cooling effects of "phase change cooling" material were effective in reducing skin temperature but did not sufficiently reduce core body temperature or cardiovascular strain.

Superficial cooling does not decrease core body temperature before, during, or after exercise in an American football uniform.

The purpose of this study was to identify the effects of superficial cooling on thermoregulatory responses while exercising in a hot humid environment while wearing an American football uniform. Nine male and female subjects wore a superficial cooling garment while in a cooling (CS) experimental condition or a no cooling (NCS) control condition during an exercise task consisting of warm-up (WU), exercise (EX), and recovery (R). The exercise task simulated an American football conditioning session with subjects wearing a full American football uniform and performing anaerobic and aerobic exercises in a hot humid environment. Subjects were allowed to drink water ad libitum during rest breaks. During the WU, EX, and R periods, core body temperature (T(c)) was measured to assess the effect of the cooling garment. Neither baseline resting before warm-up T(c) nor after warm-up T(c) was significantly different between trials. No significant differences in exercise T(c) between conditions were found. Time to return to baseline T(c) revealed no significant differences between the experimental and control conditions. The authors found that the volume of fluid consumed was 34% less in the experimental condition (711.1 ± 188.0 ml) compared with the control condition (1,077.8 ± 204.8 ml). The findings indicate that the cooling garment was not effective in blunting the rise in T(c) during warm-up, attenuating a rise in T(c) during intermittent exercise, or in increasing a return to baseline T(c) during a resting recovery period in a hot humid environment while wearing an American football uniform.

Comparisons of age-predicted maximum heart rate equations in college-aged subjects.

This study investigated the accuracy of age-predicted equations to predict heart rate maximum (HRmax) in a college-age sample and establish efficacy of short-duration anaerobic capacity tests to determine the actual HRmax. A criterion HRmax (CHRmax) was obtained from 96 (52 men and 44 women, age = 22.0 ± 2.8 years, height = 163.9 ± 9.5 cm, 70.6 ± 14.7 kg, resting HR = 68.9 ± 11.2 b·min) healthy volunteers during 2 200-m sprint trials on a standard track. Maximal effort was confirmed via plasma lactate ≥7 mmol·L(-1) and rating of perceived exertion ≥17 points. The CHRmax was compared to 7 age-predicted HRmax equations: Fox et al., 3 equations from Gellish et al., Tanaka et al., and gender-specific equations from Fairbarn et al., and Hossack et al. Descriptive statistics and standard errors of estimate (SEEs) were calculated. One-way analysis of variance was used to assess differences between the criterion HRmax and the age-predicted HRmax from the 7 equations. The predicted HRmax from the Fox equation and those of Gellish(3), Tanaka, and Hossack were all significantly higher (p ≤ 0.05) than the CHRmax. The Fox equation resulted in overpredicting HRmax in 88.5% of the cases compared to the CHRmax. Compared to the CHRmax, the age-predicted HRmax equations resulted in the following percentages of the CHRmax: Fox = 104.8%, SEE = 12.7; Gellish(1) = 95.2%, SEE = 12.2; Gellish(2) = 99.6%, SEE = 8.3; Gellish(3) = 101.8%, SEE = 9.1; Tanaka = 102.0%, SEE = 9.3; Fairbarn = 100.1%, SEE = 8.5; and Hossack = 105.2%, SEE = 13.9 of CHRmax. It was concluded that the Gellish(2) and Fairbarn equations were the most accurate of the age-predicted HRmax equations in a college-age population. In practical application, 2 200-m sprint trials provide a reasonable estimate of HRmax compared to a graded exercise test.

Exertional rhabdomyolysis in an adolescent athlete during preseason conditioning: a perfect storm.

Cleary, MA, Sadowski, KA, Lee, SY-C, Miller, GL, and Nichols, AW. Exertional rhabdomyolysis in an adolescent athlete during preseason conditioning: a perfect storm. J Strength Cond Res 25(12): 3506-3513, 2011-The purpose of this brief review is to present a case of a healthy, male adolescent athlete (age = 16 years, body mass = 67.9 kg, height = 165.5 cm) who participated in a 3-day preseason wrestling camp which resulted in hospitalization for exertional rhabdomyolysis. As part of the preseason conditioning program directed by the coaches, the athlete completed 60 minutes of short, intense intervals of wall-sits, squats, sit-ups, push-ups, lunges, and plyometric jumps. The following day, the athlete continued his vigorous training consisting of running drills. That night he noticed voiding dark brown urine the color of cola. The day after the camp ended, the athlete reported to his Athletic Trainers with the chief complaint of severe bilateral leg pain in his quadriceps. Two days after the initial assessment, he was admitted to the hospital where he was diagnosed with exertional rhabdomyolysis based on creatine kinase (CK) levels that peaked at 146,000 IU·L, elevated far beyond normal (normal range = 58-280 IU·L). The athlete was hospitalized for 6 days where he received intravenous normal saline for rehydration, and his CK levels were assessed daily. Athletic Trainers, personal trainers, physical education teachers, and coaches should be aware that exertional rhabdomyolysis is the most common form of rhabdomyolysis and affects individuals who participate in novel and intense exercise to which they are unaccustomed. Stressful ambient conditions may lead to dehydration and exacerbation of the condition, particularly when the individual is not accustomed to the exercise intensity.

Active dehydration impairs upper and lower body anaerobic muscular power.

We examined the effects of active dehydration by exercise in a hot, humid environment on anaerobic muscular power using a test-retest (euhydrated and dehydrated) design. Seven subjects (age, 27.1 +/- 4.6 years; mass, 86.4 +/- 9.5 kg) performed upper and lower body Wingate anaerobic tests prior to and after a 1.5-hour recovery from a heat stress trial of treadmill exercise in a hot, humid environment (33.1 +/- 3.1C = 55.1 +/- 8.9% relative humidity) until a 3.1 +/- 0.3% body mass loss was achieved. Dehydration was confirmed by a significant body mass loss (P < 0.001), urine color increase (P = 0.004), and urine specific gravity increase (P = 0.041). Motivation ratings were not significantly different (P = 0.059), and fatigue severity was significantly (P = 0.009) increased 70% in the dehydrated compared to the euhydrated condition. Compared to the euhydrated condition, the dehydrated condition mean power was significantly (P = 0.014) decreased 7.17% in the upper body and 19.20% in the lower body. Compared to the euhydrated condition, the dehydrated condition peak power was significantly (P = 0.013) decreased 14.48% in the upper body and 18.36% in the lower body. No significant differences between the euhydrated and dehydrated conditions were found for decrease in power output (P = 0.219, power = 0.213). Our findings suggest that dehydration of 2.9% body mass decreases the ability to generate upper and lower body anaerobic power. Coaches and athletes must understand that sports performance requiring anaerobic strength and power can be impaired by inadequate hydration and may contribute to increased susceptibility to musculoskeletal injury.

Dehydration and symptoms of delayed-onset muscle soreness in normothermic men.

CONTEXT: A dehydrated individual who performs eccentric exercise may exacerbate skeletal muscle damage, leading to structural, contractile, and enzymatic protein denaturation, in addition to the myofiber and connective damage resulting from the eccentric muscle tension. OBJECTIVE: To identify the effects of dehydration on 5 physiologic characteristics of delayed-onset muscle soreness (DOMS) in normothermic men after an eccentric exercise perturbation. DESIGN: Randomized group test-retest design. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten healthy male volunteers randomly assigned to either a euhydration (age = 26.2 +/- 4.9 years, height = 174.1 +/- 6.0 cm, mass = 86.5 +/- 15.3 kg) or dehydration (age = 25.8 +/- 2.2 years, height = 177.2 +/- 3.1 cm, mass = 84.4 +/- 3.8 kg) group. INTERVENTION(S): Subjects performed treadmill walking for 45 minutes in either a thermoneutral (euhydration) or a hot, humid (dehydration) environment. After a rest period to allow for return to the normothermic condition, DOMS was induced with a 45-minute downhill run. MAIN OUTCOME MEASURES: We assessed 5 physiologic characteristics of DOMS before and at intervals after the eccentric exercise. The characteristics were perceived pain of the bilateral quadriceps and overall body, bilateral punctate tenderness of the superficial quadriceps muscles, bilateral knee-flexion passive range of motion, bilateral thigh circumference, and bilateral isometric quadriceps muscle strength. Thermoregulatory and cardiovascular measures were obtained to monitor participants' heat load during exercise. RESULTS: The experimental protocol produced a 0.9% increase in body mass of the euhydration group and a significant 2.7% decrease in body mass of the dehydration group. The downhill-running exercise perturbation induced DOMS in both the euhydrated and dehydrated participants, based on increased bilateral quadriceps and overall body perceived pain and punctate tenderness of the bilateral vastus medialis muscle. The signs and symptoms of DOMS after an eccentric exercise perturbation were not exacerbated by moderate dehydration of 2.7% body mass after rest and return to the normothermic condition. CONCLUSIONS: Significantly dehydrated participants who rested and returned to a normothermic condition did not experience increased characteristics of DOMS.

Development of a High-Throughput Gene Expression Screen for Modulators of RAS-MAPK Signaling in a Mutant RAS Cellular Context.

The RAS-MAPK pathway controls many cellular programs, including cell proliferation, differentiation, and apoptosis. In colorectal cancers, recurrent mutations in this pathway often lead to increased cell signaling that may contribute to the development of neoplasms, thereby making this pathway attractive for therapeutic intervention. To this end, we developed a 26-member gene signature of RAS-MAPK pathway activity utilizing the Affymetrix QuantiGene Plex 2.0 reagent system and performed both primary and confirmatory gene expression-based high-throughput screens (GE-HTSs) using KRAS mutant colon cancer cells (SW837) and leveraging a highly annotated chemical library. The screen achieved a hit rate of 1.4% and was able to enrich for hit compounds that target RAS-MAPK pathway members such as MEK and EGFR. Sensitivity and selectivity performance measurements were 0.84 and 1.00, respectively, indicating high true-positive and true-negative rates. Active compounds from the primary screen were confirmed in a dose-response GE-HTS assay, a GE-HTS assay using 14 additional cancer cell lines, and an in vitro colony formation assay. Altogether, our data suggest that this GE-HTS assay will be useful for larger unbiased chemical screens to identify novel compounds and mechanisms that may modulate the RAS-MAPK pathway.

Celiac disease in an elite female collegiate volleyball athlete: a case report.

OBJECTIVE: To present the case of an elite female volleyball player who complained of diarrhea and fatigue after preseason training. BACKGROUND: The athlete lost 8.1 kg during the first 20 days of training, and we initially suspected an eating disorder. The sports medicine team interviewed the athlete and found she did not have psychological symptoms indicative of an eating disorder. The results of routine blood tests revealed critically high platelet counts; in conjunction with the physical findings, the athlete was referred to a gastroenterologist. DIFFERENTIAL DIAGNOSIS: Our initial suggestion was an eating disorder. Therefore, the differential diagnosis included anorexia athletica, anorexia nervosa, and bulimia nervosa. On referral, the differential diagnosis was anemia, gastrointestinal dysfunction, lymphoma, or bowel adenocarcinoma. Diarrhea, weight loss, and blood test results were suggestive of active celiac disease, and a duodenal biopsy specimen confirmed this diagnosis. TREATMENT: The athlete was treated with a gluten-free diet, which excludes wheat, barley, and rye. Dietary substitutions were incorporated to maintain adequate caloric intake. UNIQUENESS: The presence of active celiac disease may not be uncommon. However, elite athletes who face celiac disease present a new challenge for the athletic trainer. The athletic trainer can help guide the athlete in coping with the lifestyle changes associated with a gluten-free diet. CONCLUSIONS: One in every 200 to 400 individuals has celiac disease; many of these individuals are asymptomatic and, therefore, their conditions are undiagnosed. Undiagnosed, untreated celiac disease and patients who fail to follow the gluten-free diet increase the risk of further problems.

Dehydration and symptoms of delayed-onset muscle soreness in hyperthermic males.

CONTEXT: Exercise in the heat produces cellular conditions that may leave skeletal muscle susceptible to exercise-induced microdamage. Delayed-onset muscle soreness (DOMS) is a clinical model of contraction-induced skeletal muscle injury. OBJECTIVE: To determine whether thermoregulation during exercise heat stress adversely affects muscle injury and the accompanying DOMS. DESIGN: Randomized group test-retest design. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Ten healthy male volunteers were randomly assigned to either the euhydration/hyperthermic or dehydration/hyperthermic group. INTERVENTION(S): Participants were randomly assigned to treadmill walking in a hot, humid environmental chamber (40 degrees C and 75% relative humidity) with either oral rehydration (euhydration/hyperthermic) or fluid restriction (dehydration/hyperthermic). Immediately after heat exposure and while hyperthermic, participants performed an eccentrically biased downhill run to induce DOMS. MAIN OUTCOME MEASURE(S): We measured DOMS characteristics pre-exercise and at 0.5, 24, 48, 72, and 96 hours postexercise. RESULTS: Treadmill exercise and exposure to the hot ambient environment elicited a 0.9% body mass loss for the euhydrated/ hyperthermic (mean rectal temperature after 60 minutes of heat-stress trial = 38.2 +/- 0.4 degrees C) and 3.3% body mass loss for the dehydrated/hyperthermic participants (mean rectal temperature after 60 minutes of heat-stress trial = 38.1 +/- 0.4 degrees C). Quadriceps perceived pain was significantly higher (F(5,40) = 18.717, P

Hydration behaviors before and after an educational and prescribed hydration intervention in adolescent athletes.

CONTEXT: The effectiveness of education in modifying hydration behaviors in adolescent athletes is unclear. OBJECTIVE: To assess the hydration status and behaviors of female athletes before and after a 1-time educational intervention and prescribed hydration intervention in a warm, humid, tropical environment. DESIGN: Cohort study. SETTING: Non-air-conditioned gymnasium in a tropical environment (indoor wet bulb globe temperature = 24.0 ± 0.2°C). Patient or Other Participants: Thirty-six female adolescent elite volleyball players (age = 14.8 ± 0.8 years, height = 168.2 ± 8.2 cm, mass = 60.8 ± 9.0 kg, body mass index = 21.7 ± 2.7, body surface area = 1.65 ± 0.14 m(2), body surface area to mass ratio = 2.71 ± 0.18 m(2)·kg(-1)·10(-2)) participated. INTERVENTION(S): Four observational periods consisting of 3 practices per observational period separated by 48 hours. The 4 periods included a control period, educational intervention, prescribed hydration intervention (PHI), and observational follow-up (OF-U). After the control period, an educational intervention consisting of a slide presentation was provided to the participants, followed by a week of observation. In the PHI, a precalculated volume of water based on individual sweat rate was consumed every 20 minutes during each 2-hour practice. During all other periods, participants consumed their fluid of choice ad libitum. The order of the treatment periods was not randomized and was the same for all participants. MAIN OUTCOME MEASURE(S): Prepractice to postpractice changes in body mass (ΔBM), percentage of body mass lost (%BML), urine specific gravity, urine color, urine osmolality, sweat rate, and volume of fluid consumed (F(vol)). RESULTS: The PHI was the only period during which participants maintained body mass (ΔBM = 0.05 ± 1.3%); F(vol) consumed was greatest during this time (F(vol) = 1.3 ± 0.4 L; F(1,3) = 34.869, P ≤ .001). TheΔBM was less for the PHI (ΔBM = 0.05 ± 0.9 kg, %BML = 0.04 ± 1.3%) than the OF-U period (ΔBM = -0.7 ± 1.1 kg, %BML = -1.2 ± 1.9%; F(1,3) = 6.220, P = .01). The F(vol) (1.3 ± 0.4 L) and percentage of fluid consumed (143.7 ± 110.8%) to restore sweat loss for the PHI period were higher than for any other period (F(1,3) = 34.869, P ≤ .001). None of the participants experienced serious dehydration in any of the conditions. CONCLUSIONS: A 1-time education session alone was not successful in changing hydration behaviors. However, prescribing individualized hydration protocols improved hydration for adolescents exercising in a warm, humid environment.

Development of a heat-illness screening instrument using the Delphi panel technique.

CONTEXT: Exertional heat illness (EHI) is the third leading cause of death among athletes, but with preparticipation screening, risk factors can be identified, and some EHIs can be prevented. OBJECTIVE: To establish content validity of the Heat Illness Index Score (HIIS), a 10-item screening instrument designed to identify athletes at risk for EHI during a preparticipation examination. DESIGN: Delphi study. SETTING: The Delphi technique included semistructured face-to-face or telephone interviews and included electronic questionnaires administered via e-mail. PATIENTS OR OTHER PARTICIPANTS: Six individuals with extensive research experience and/or clinical expertise in EHI participated as expert panelists. MAIN OUTCOME MEASURE(S): We used a Delphi panel technique (3 rounds) to evaluate the HIIS with the consensus of expert opinions. For round 1, we conducted face-to-face interviews with the panelists. For round 2, we solicited panelists' feedback of the transcribed data to ensure trustworthiness, then provided the participants with the revised HIIS and a questionnaire eliciting their levels of agreement for each revision from the previous round on a visual analog scale (11.4 cm) with extreme indicators of strongly disagree and strongly agree. We calculated the mean and SD for each revision and accepted when the mean was greater than 7.6 cm (agree) and the SD still permitted a positive response (> 5.7 cm), suggesting consensus. For round 3, we instructed participants to indicate their levels of agreement with each final, revised item and their levels of agreement with the entire instrument on a 4-point Likert scale (1 = strongly disagree, 4 = strongly agree). RESULTS: In round 1, panelists supported all 10 items but requested various revisions. In round 2, 16.3% (7 of 43) revisions were rejected, and 2 revisions were modified. In round 3, 100% of panelists reported agreeing (n = 3 of 6) or strongly agreeing (n = 3 of 6) with the final instrument. CONCLUSIONS: Panelists were able to achieve consensus and validated the content of the HIIS, as well as the instrument itself. Implementation and further analysis are necessary to effectively identify the diagnostic accuracy of the HIIS.

Thermoregulatory influence of a cooling vest on hyperthermic athletes.

CONTEXT: Athletic trainers must have sound evidence for the best practices in treating and preventing heat-related emergencies and potentially catastrophic events. OBJECTIVE: To examine the effectiveness of a superficial cooling vest on core body temperature (T(c)) and skin temperature (T(sk)) in hypohydrated hyperthermic male participants. DESIGN: A randomized control design with 2 experimental groups. SETTING: Participants exercised by completing the heat-stress trial in a hot, humid environment (ambient temperature = 33.1 +/- 3.1 degrees C, relative humidity = 55.1 +/- 8.9%, wind speed = 2.1 +/- 1.1 km/hr) until a T(c) of 38.7 +/- 0.3 degrees C and a body mass loss of 3.27 +/- 0.1% were achieved. PATIENTS OR OTHER PARTICIPANTS: Ten healthy males (age = 25.6 +/- 1.6 years, mass = 80.3 +/- 13.7 kg). INTERVENTION(S): Recovery in a thermoneutral environment wearing a cooling vest or without wearing a cooling vest until T(c) returned to baseline. MAIN OUTCOME MEASURE(S): Rectal T(c), arm T(sk), time to return to baseline T(c), and cooling rate. RESULTS: During the heat-stress trial, T(c) significantly increased (3.6%) and, at 30 minutes of recovery, T(c) had decreased significantly (2.6%) for both groups. Although not significant, the time for return to baseline T(c) was 22.6% faster for the vest group (43.8 +/- 15.1 minutes) than for the no-vest group (56.6 +/- 18.0 minutes), and the cooling rate for the vest group (0.0298 +/- 0.0072 degrees C/min) was not significantly different from the cooling rate for the no-vest group (0.0280 +/- 0.0074 degrees C/min). The T(sk) during recovery was significantly higher (2.1%) in the vest group than in the no-vest group and was significantly lower (7.1%) at 30 minutes than at 0 minutes for both groups. CONCLUSIONS: We do not recommend using the cooling vest to rapidly reduce elevated T(c). Ice-water immersion should remain the standard of care for rapidly cooling severely hyperthermic individuals.

Temporal Pattern of the Repeated Bout Effect of Eccentric Exercise on Delayed-Onset Muscle Soreness.

OBJECTIVE: To determine the temporal pattern of the repeated bout effect of eccentric exercise on perceived pain and muscular tenderness associated with delayed-onset muscle soreness (DOMS). DESIGN AND SETTING: Subjects completed 2 identical eccentric exercise bouts separated by 6, 7, 8, or 9 weeks. The experiment was conducted in a biokinetics research laboratory. SUBJECTS: Sixteen male and 15 female untrained subjects (age = 24.59 +/- 4.42 years, height = 171.71 +/- 7.81 cm, weight = 73.00 +/- 11.20 kg). MEASUREMENTS: Two physiologic characteristics of DOMS were measured immediately before and 0, 24, 48, and 72 hours after each eccentric exercise bout. Perceived pain was measured using a visual analog scale (VAS), and muscular tenderness was measured using a punctate tenderness gauge (PTG). RESULTS: Two 4 x 2 x 5 (group x bout x time) analyses of variance with repeated measures on the bout and time factors were performed on the VAS and PTG data. Significant (P <.05) main effects were found for group, bout, and time for the VAS and the PTG data. No significant interactions were detected. Post hoc analysis revealed significantly less perceived pain for the 9-week group than the 8-week group. The 7-week group had significantly less and the 8-week group had significantly more muscular tenderness than any other group. Perceived pain and muscular tenderness were significantly less after exercise bout 2 than after exercise bout 1. All subjects had significantly less perceived pain and muscular tenderness pre-exercise than 0 and 24 hours after the eccentric exercise bouts. CONCLUSIONS: An effective prophylaxis for perceived pain and muscular tenderness associated with DOMS is the performance of an eccentric exercise bout 6 to 9 weeks before a similar exercise bout.