Effects of Medications on Heat Loss Capacity in Chronic Disease Patients: Health Implications Amidst Global Warming.

Pharmacological agents used to treat or manage diseases can modify the level of heat strain experienced by chronically ill and elderly patients via different mechanistic pathways. Human thermoregulation is a crucial homeostatic process that maintains body temperature within a narrow range during heat stress through dry (i.e., increasing skin blood flow) and evaporative (i.e., sweating) heat loss, as well as active inhibition of thermogenesis, which is crucial to avoid overheating. Medications can independently and synergistically interact with aging and chronic disease to alter homeostatic responses to rising body temperature during heat stress. This review focuses on the physiologic changes, with specific emphasis on thermolytic processes, associated with medication use during heat stress. The review begins by providing readers with a background of the global chronic disease burden. Human thermoregulation and aging effects are then summarized to give an understanding of the unique physiologic changes faced by older adults. The effects of common chronic diseases on temperature regulation are outlined in the main sections. Physiologic impacts of common medications used to treat these diseases are reviewed in detail, with emphasis on the mechanisms by which these medications alter thermolysis during heat stress. The review concludes by providing perspectives on the need to understand the effects of medication use in hot environments, as well as a summary table of all clinical considerations and research needs of the medications included in this review. SIGNIFICANCE STATEMENT: Long-term medications modulate thermoregulatory function, resulting in excess physiological strain and predisposing patients to adverse health outcomes during prolonged exposures to extreme heat during rest and physical work (e.g., exercise). Understanding the medication-specific mechanisms of altered thermoregulation has importance in both clinical and research settings, paving the way for work toward refining current medication prescription recommendations and formulating mitigation strategies for adverse drug effects in the heat in chronically ill patients.

Skeletal muscle oxidative adaptations following localized heat therapy.

Repeated heat treatment has been shown to induce oxidative adaptations in cell cultures and rodents, but similar work within human models is scarce. This study investigated the effects of 6 weeks of localized heat therapy on near-infrared spectroscopy-(NIRS) derived indices of muscle oxidative and microvascular function. Twelve physically active participants (8 males and 4 females, age: 34.9 ± 5.9 years, stature: 175 ± 7 cm, body mass: 76.7 ± 13.3 kg) undertook a 6-week intervention, where adhesive heat pads were applied for 8 h/day, 5 days/week, on one calf of each participant, while the contralateral leg acted as control. Prior to and following the intervention, the microvascular function was assessed using NIRS-based methods, where 5 min of popliteal artery occlusion was applied, and the reperfusion (i.e., re-saturation rate, re-saturation amplitude, and hyperemic response) was monitored for 2 min upon release. Participants also performed a 1-min isometric contraction of the plantar flexors (30% maximal voluntary contraction), following which a further 2 min interval was undertaken for the assessment of recovery kinetics. A 20-min time interval was allowed before the assessment protocol was repeated on the contralateral leg. Repeated localized heating of the gastrocnemius did not influence any of the NIRS-derive indices of microvascular or oxidative function (p > 0.05) following 6 weeks of treatment. Our findings indicate that localized heating via the use of adhesive heat pads may not be a potent stimulus for muscle adaptations in physically active humans.

Effect of ice slurry ingestion on thermoregulatory responses during fixed-intensity cycling in humid and dry heat.

PURPOSE: This study examined the thermoregulatory response and ergogenic effects of ice slurry (ICE) ingestion in hot environments with high and low relative humidity (RH). METHODS: Eight males completed four trials in a crossover manner in dry (DRY: 34.7 ± 0.2 °C, 38 ± 2%RH) and humid heat (HUM: 34.8 °C ± 0.2 °C, 80 ± 1%RH). They ingested 8.0 g·kg-1 of ICE (0.0 °C) or 37.5 °C water (CON) during 30 min before exercise, and three aliquots (3.2 g·kg-1) of ICE or CON during 45-min cycling at 50%[Formula: see text]O2peak, followed by cycling to exhaustion at 80%[Formula: see text]O2peak (TTE). Body core temperature (Tcore), mean skin temperature (Tsk), heart rate (HR), thermal comfort, thermal sensation and rating of perceived exertion (RPE) were measured. RESULTS: Relative to CON, ICE improved TTE by 76.5 ± 96.5% in HUM and 21.3 ± 44.9% in DRY (p = 0.044). End-exercise Tcore was lower in ICE versus CON in DRY (37.8 ± 0.4 °C versus 38.1 ± 0.3 °C, p = 0.005) and HUM (38.8 ± 0.4 °C versus 39.3 ± 0.6 °C, p = 0.004). ICE decreased HR, heat storage and heat strain index only in DRY (p < 0.001-0.018). ICE improved thermal sensation and comfort in DRY and HUM (p < 0.001-0.011), attenuated RPE in HUM (p = 0.012) but not in DRY (p = 0.065). CONCLUSION: ICE tended to benefit performance in humid heat more than in dry heat. This is likely due to the reduced extent of hyperthermia in dry heat and the relative importance of sensory inputs in mediating exercise capacity.

Cold for centuries: a brief history of cryotherapies to improve health, injury and post-exercise recovery.

For centuries, cold temperatures have been used by humans for therapeutic, health and sporting recovery purposes. This application of cold for therapeutic purposes is regularly referred to as cryotherapy. Cryotherapies including ice, cold-water and cold air have been popularised by an ability to remove heat, reduce core and tissue temperatures, and alter blood flow in humans. The resulting downstream effects upon human physiologies providing benefits that include a reduced perception of pain, or analgesia, and an improved sensation of well-being. Ultimately, such benefits have been translated into therapies that may assist in improving post-exercise recovery, with further investigations assessing the role that cryotherapies can play in attenuating the ensuing post-exercise inflammatory response. Whilst considerable progress has been made in our understanding of the mechanistic changes associated with adopting cryotherapies, research focus tends to look towards the future rather than to the past. It has been suggested that this might be due to the notion of progress being defined as change over time from lower to higher states of knowledge. However, a historical perspective, studying a subject in light of its earliest phase and subsequent evolution, could help sharpen one's vision of the present; helping to generate new research questions as well as look at old questions in new ways. Therefore, the aim of this brief historical perspective is to highlight the origins of the many arms of this popular recovery and treatment technique, whilst further assessing the changing face of cryotherapy. We conclude by discussing what lies ahead in the future for cold-application techniques.

Association between thermal responses, medical events, performance, heat acclimation and health status in male and female elite athletes during the 2019 Doha World Athletics Championships.

PURPOSE: To determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions. METHODS: From 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (Tcore; ingestible pill) and skin (Tskin; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (% personal best) and did not finish (DNF) were extracted from official results. RESULTS: Peak Tcore during competition reached 39.6°C±0.6°C (maximum 41.1°C). Tskin decreased from 32.2°C±1.3°C to 31.0°C±1.4°C during the races (p<0.001). Tcore was not related to DNF (25% of starters) or medical events (p≥0.150), whereas Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were (p≤0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9% of athletes) increasing the risk of in-race medical events (71% vs 17%, p<0.001). Athletes (63%) who performed 5-30 days heat acclimation before the competition: ranked better (18±13 vs 28±13, p=0.009), displayed a lower peak Tcore (39.4°C±0.4°C vs 39.8°C±0.7°C, p=0.044) and larger in-race decrease in Tskin (-1.4°C±1.0°C vs -0.9°C±1.2°C, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19% vs 30%, p=0.273) and medical events (19% vs 32%, p=0.179). CONCLUSION: Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events.

The effect of cold water immersion on the recovery of physical performance revisited: A systematic review with meta-analysis.

This review evaluated the effect of CWI on the temporal recovery profile of physical performance, accounting for environmental conditions and prior exercise modality. Sixty-eight studies met the inclusion criteria. Standardised mean differences were calculated for parameters assessed at <1, 1-6, 24, 48, 72 and ≥96 h post-immersion. CWI improved short-term recovery of endurance performance (p = 0.01, 1 h), but impaired sprint (p = 0.03, 1 h) and jump performance (p = 0.04, 6h). CWI improved longer-term recovery of jump performance (p < 0.01-0.02, 24 h and 96 h) and strength (p < 0.01, 24 h), which coincided with decreased creatine kinase (p < 0.01-0.04, 24-72 h), improved muscle soreness (p < 0.01-0.02, 1-72 h) and perceived recovery (p < 0.01, 72 h). CWI improved the recovery of endurance performance following exercise in warm (p < 0.01) and but not in temperate conditions (p = 0.06). CWI improved strength recovery following endurance exercise performed at cool-to-temperate conditions (p = 0.04) and enhanced recovery of sprint performance following resistance exercise (p = 0.04). CWI seems to benefit the acute recovery of endurance performance, and longer-term recovery of muscle strength and power, coinciding with changes in muscle damage markers. This, however, depends on the nature of the preceding exercise.

Running demands and activity profile of men's rugby sevens: a tournament scenario.

This study profiled the changes in running performances and collisions within a Rugby sevens tournament. Sixteen male players were equipped with global positioning system units while competing at the 2015 and 2016 Asia Rugby Sevens series held in Colombo and Hong Kong, respectively. Both tournaments consisted of 4 matches each, and were played over 2 days (i.e., 2 matches/day). Total distance (TD) covered increased in match 3 compared with matches 1 (19 ± 19%; p < 0.001) and 2 (16 ± 11%; p = 0.001), whilst a decrease in TD in match 4 compared with match 3 (8 ± 9%; p = 0.019) was observed. Distances covered within 6.1-12 km·h-1 and 12.1-14 km·h-1 speed bands were generally higher in matches 3 and/or 4 when compared with match 1 and/or 2 (p < 0.05). Frequency of entries into 14.1-18 km·h-1 speed zone was decreased in match 4 compared with match 3 (45 ± 41%; p = 0.009), whilst incidences of heavy, very heavy and severe collisions were generally higher in matches 3 or 4 compared with matches 1 or 2 (p < 0.05). In conclusion, while some decrements in the final match were evident, running performance were generally maintained throughout despite the competitive and congested nature of Rugby Sevens tournaments.

Changes in myocardial myosin heavy chain isoform composition with exercise and post-exercise cold-water immersion.

This study investigated the changes in myocardial myosin heavy chain (MHC) isoforms, MHC-α and MHC-ß composition in young healthy rodents following endurance training, with and without post-exercise cold-water immersion (CWI). Male rats were either trained on a treadmill for 10 weeks with (CWI) or without (Ex) regular CWI after each running session, or left sedentary (CON). Left ventricular mRNA of MHC-α, MHC-ß, thyroid receptor α1 (TR-α1) and ß (TR-ß) were analyzed using rt-PCR and semiquantitative PCR analysis. MHC isoform protein composition was determined using SDS-PAGE electrophoresis. MHC-α isoform protein was predominant in all groups. The relative expression of MHC-ß (%MHC-ß) protein was not different between groups (CWI 34.7 ± 6.9%; Ex 32 ± 5.3%; CON 35.5 ± 10%; P = 0.7). MHC-ß mRNA was reduced in Ex (0.7 ± 0.3-fold) compared to CWI (1.3 ± 0.2-fold; P < 0.001) and CON (1.01 ± 0.2-fold; P = 0.03). TRα1 mRNA was lower in CWI (0.4 ± 0.05-fold) than Ex (1.02 ± 0.3-fold) and CON (1.01 ± 0.2-fold) (P < 0.001 for both). CWI exhibited greater %MHC-ß mRNA (56.8 ± 4.1%) than Ex (44.4 ± 7.7%; P = 0.001) and CON (48.5 ± 7.8%; P = 0.03). Neither exercise nor post-exercise CWI demonstrated a distinct effect on myocardial MHC protein isoform composition. However, CWI increased the relative expression of MHC-ß mRNA compared with Ex and CON. Although this implicates a potential negative long-term impact of post-exercise CWI, future studies should include measures of cardiac function to better understand the effect of such isoform mRNA shifts following regular use of CWI.

Six weeks of localized heat therapy does not affect muscle mass, strength and contractile properties in healthy active humans.

PURPOSE: Animal and human studies have shown that repeated heating may induce skeletal muscle adaptations, increasing muscle strength. The aim of this study is to investigate the effect of 6 weeks of localized heating on skeletal muscle strength, volume and contractile properties in healthy humans. METHODS: Fifteen active participants (8 males/7 females, 35 ± 6 years, 70 ± 14 kg, 173 ± 7 cm, average training of 87 min per week) were subjected to 6 weeks of single-leg heat therapy. Heat pads were applied for 8 h/day, 5 days/week, on one randomly selected calf of each participant, while the contralateral leg acted as control. The heat pads increased muscle temperature by 4.6 ± 1.2 °C (p < 0.001). Every 2 weeks, participants were tested for morphological (MRI), architectural (ultrasound), contractile (electrically evoked twitch), and force (isometric and isokinetic) adaptations. RESULTS: Repeated localized heating did not affect the cross-sectional area (p = 0.873) or pennation angle (p = 0.345) of the gastrocnemius muscles; did not change the evoked peak twitch amplitude (p = 0.574) or rate of torque development (p = 0.770) of the plantar flexors; and did not change maximal voluntary isometric (p = 0.214) or isokinetic (p = 0.973) plantar flexor torque. CONCLUSION: Whereas previous studies have observed improved skeletal muscle function following whole-body and localized heating in active and immobilized humans, respectively, the current data suggested that localized heating may not be a potent stimulus for muscle adaptations in active humans.

Hydration and cooling in elite athletes: relationship with performance, body mass loss and body temperatures during the Doha 2019 IAAF World Athletics Championships.

PURPOSE: To characterise hydration, cooling, body mass loss, and core (Tcore) and skin (Tsk) temperatures during World Athletics Championships in hot-humid conditions. METHODS: Marathon and race-walk (20 km and 50 km) athletes (n=83, 36 women) completed a pre-race questionnaire. Pre-race and post-race body weight (n=74), Tcore (n=56) and Tsk (n=49; thermography) were measured. RESULTS: Most athletes (93%) had a pre-planned drinking strategy (electrolytes (83%), carbohydrates (81%)) while ice slurry was less common (11%; p<0.001). More men than women relied on electrolytes and carbohydrates (91%-93% vs 67%-72%, p≤0.029). Drinking strategies were based on personal experience (91%) rather than external sources (p<0.001). Most athletes (80%) planned pre-cooling (ice vests (53%), cold towels (45%), neck collars (21%) and ice slurry (21%)) and/or mid-cooling (93%; head/face dousing (65%) and cold water ingestion (52%)). Menthol usage was negligible (1%-2%). Pre-race Tcore was lower in athletes using ice vests (37.5°C±0.4°C vs 37.8°C±0.3°C, p=0.024). Tcore (pre-race 37.7°C±0.3°C, post-race 39.6°C±0.6°C) was independent of event, ranking or performance (p≥0.225). Pre-race Tsk was correlated with faster race completion (r=0.32, p=0.046) and was higher in non-finishers (did not finish (DNF); 33.8°C±0.9°C vs 32.6°C±1.4°C, p=0.017). Body mass loss was higher in men than women (-2.8±1.5% vs -1.3±1.6%, p<0.001), although not associated with performance. CONCLUSION: Most athletes' hydration strategies were pre-planned based on personal experience. Ice vests were the most adopted pre-cooling strategy and the only one minimising Tcore, suggesting that event organisers should be cognisant of logistics (ie, freezers). Dehydration was moderate and unrelated to performance. Pre-race Tsk was related to performance and DNF, suggesting that Tsk modulation should be incorporated into pre-race strategies.

Running Demands and Activity Profile of the New Four-Quarter Match Format in Men's Field Hockey.

ABSTRACT: Ihsan, M, Yeo, V, Tan, F, Joseph, R, Lee, M, and Aziz, AR. Running demands and activity profile of the new four-quarter match format in men's field hockey. J Strength Cond Res 35(2): 512-518, 2021-This study determined the running demands of men's field hockey with regards to the revised four-quarter match format. Twenty-eight male field hockey players were equipped with global positioning system units while competing in 14 competitive international games over a 1-year period. All matches allowed for unlimited substitutions, and consisted of four 15-minute quarters (i.e., Q1-Q4). A progressive decline in total distance (TD) was observed in Q2 (2,072 ± 141 m) to Q4 (2,055 ± 212 m) compared with Q1 (2,171 ± 195 m, p < 0.05). However, the decline in TD was due to decreases in low-intensity activity (<15 km·h-1, p < 0.05), as high-intensity running (HIR; >15 km·h-1) distances were similar throughout Q1-Q4 (p = 0.263). Positional data demonstrated a similar profile, where significant decreases in TD, but not in HIR, was observed across all playing positions at some point over the 4 quarters (p < 0.05). DEF accumulated the lowest amount of TD (7,631 ± 753 m), HIR (2,257 ± 498 m), and high-intensity decelerations (60 ± 9, >-2m·s-2) compared with MID and FWD (p < 0.05). By contrast, FWD performed the highest amount of HIR (3,090 ± 565 m) and high-intensity accelerations (110 ± 9, >2 m·s-2) compared with MID and DEF (p < 0.05). In conclusion, our results showed that although there was a progressive decline in TD over the 4 quarters of match play, high-intensity running performance (i.e., HIR and high-intensity acceleration) was maintained throughout the match regardless of playing position.

Effect of regular precooling on adaptation to training in the heat.

PURPOSE: This study investigated whether regular precooling would help to maintain day-to-day training intensity and improve 20-km cycling time trial (TT) performed in the heat. Twenty males cycled for 10 day × 60 min at perceived exertion equivalent to 15 in the heat (35 °C, 50% relative humidity), preceded by no cooling (CON, n = 10) or 30-min water immersion at 22 °C (PRECOOL, n = 10). METHODS: 19 participants (n = 9 and 10 for CON and PRECOOL, respectively) completed heat stress tests (25-min at 60% [Formula: see text] and 20-km TT) before and after heat acclimation. RESULTS: Changes in mean power output (∆MPO, P = 0.024) and heart rate (∆HR, P = 0.029) during heat acclimation were lower for CON (∆MPO - 2.6 ± 8.1%, ∆HR - 7 ± 7 bpm), compared with PRECOOL (∆MPO + 2.9 ± 6.6%, ∆HR - 1 ± 8 bpm). HR during constant-paced cycling was decreased from the pre-acclimation test in both groups (P < 0.001). Only PRECOOL demonstrated lower rectal temperature (Tre) during constant-paced cycling (P = 0.002) and lower Tre threshold for sweating (P = 0.042). However, skin perfusion and total sweat output did not change in either CON or PRECOOL (all P > 0.05). MPO (P = 0.016) and finish time (P = 0.013) for the 20-km TT were improved in PRECOOL but did not change in CON (P = 0.052 for MPO, P = 0.140 for finish time). CONCLUSION: Precooling maintains day-to-day training intensity and does not appear to attenuate adaptation to training in the heat.

Skeletal Muscle Microvascular Adaptations Following Regular Cold Water Immersion.

This study investigated the effect of endurance training and regular post-exercise cold water immersion on changes in microvascular function. Nine males performed 3 sessions∙wk-1 of endurance training for 4 weeks. Following each session, participants immersed one leg in a cold water bath (10°C; COLD) for 15 min while the contra-lateral leg served as control (CON). Before and after training, microvascular function of the gastrocnemius was assessed using near-infrared spectroscopy, where 5 min of popliteal artery occlusion was applied and monitored for 3 min upon cuff release. Changes in Hbdiff (oxyhemoglobin - deoxyhemoglobin) amplitude (O-AMP), area under curve (O-AUC) and estimated muscle oxygen consumption (mVO2) were determined during occlusion, while the reperfusion rate (R-RATE), reperfusion amplitude (R-AMP) and hyperemic response (HYP) were determined following cuff release. Training increased O-AMP (p=0.010), O-AUC (p=0.011), mVO2 (p=0.013), R-AMP (p=0.004) and HYP (p=0.057). Significant time (p=0.024) and condition (p=0.026) effects were observed for R-RATE, where the increase in COLD was greater compared with CON (p=0.026). In conclusion, R-RATE following training was significantly higher in COLD compared with CON, providing some evidence for enhanced microvascular adaptations following regular cold water immersion.

The effects of lower body passive heating combined with mixed-method cooling during half-time on second-half intermittent sprint performance in the heat.

PURPOSE: This study examined the effects of combined cooling and lower body heat maintenance during half-time on second-half intermittent sprint performances. METHODS: In a repeated measures design, nine males completed four intermittent cycling trials (32.1 ± 0.3 °C and 55.3 ± 3.7% relative humidity), with either one of the following half-time recovery interventions; mixed-method cooling (ice vest, ice slushy and hand cooling; COOL), lower body passive heating (HEAT), combined HEAT and COOL (COMB) and control (CON). Peak and mean power output (PPO and MPO), rectal (Tre), estimated muscle (Tes-Mus) and skin (TSK) temperatures were monitored throughout exercise. RESULTS: During half-time, the decrease in Tre was substantially greater in COOL and COMB compared with CON and HEAT, whereas declines in Tes-Mus within HEAT and COMB were substantially attenuated compared with CON and COOL. The decrease in TSK was most pronounced in COOL compared with CON, HEAT and COMB. During second-half, COMB and HEAT resulted in a larger decrease in PPO and MPO during the initial stages of the second-half when compared to CON. In addition, COOL resulted in an attenuated decrease in PPO and MPO compared to COMB in the latter stages of second-half. CONCLUSION: The maintenance of Tes-Mus following half-time was detrimental to prolonged intermittent sprint performance in the heat, even when used together with cooling.

Reliability of laser Doppler, near-infrared spectroscopy and Doppler ultrasound for peripheral blood flow measurements during and after exercise in the heat.

This study examined the test-retest reliability of near-infrared spectroscopy (NIRS), laser Doppler flowmetry (LDF) and Doppler ultrasound to assess exercise-induced haemodynamics. Nine men completed two identical trials consisting of 25-min submaximal cycling at first ventilatory threshold followed by repeated 30-s bouts of high-intensity (90% of peak power) cycling in 32.8 ± 0.4°C and 32 ± 5% relative humidity (RH). NIRS (tissue oxygenation index [TOI] and total haemoglobin [tHb]) and LDF (perfusion units [PU]) signals were monitored continuously during exercise, and leg blood flow was assessed by Doppler ultrasound at baseline and after exercise. Cutaneous vascular conductance (CVC; PU/mean arterial pressure (MAP)) was expressed as the percentage change from baseline (%CVCBL). Coefficients of variation (CVs) as indicators of absolute reliability were 18.7-28.4%, 20.2-33.1%, 42.5-59.8%, 7.8-12.4% and 22.2-30.3% for PU, CVC, %CVCBL, TOI and tHb, respectively. CVs for these variables improved as exercise continued beyond 10 min. CVs for baseline and post-exercise leg blood flow were 17.8% and 10.5%, respectively. CVs for PU, tHb (r2 = 0.062) and TOI (r2 = 0.002) were not correlated (P > 0.05). Most variables demonstrated CVs lower than the expected changes (35%) induced by training or heat stress; however, minimum of 10 min exercise is recommended for more reliable measurements.

Regular postexercise cooling enhances mitochondrial biogenesis through AMPK and p38 MAPK in human skeletal muscle.

This study investigated the effect of regular postexercise cold water immersion (CWI) on muscle aerobic adaptations to endurance training. Eight males performed 3 sessions/wk of endurance training for 4 wk. Following each session, subjects immersed one leg in a cold water bath (10°C; COLD) for 15 min, while the contralateral leg served as a control (CON). Muscle biopsies were obtained from vastus lateralis of both CON and COLD legs prior to training and 48 h following the last training session. Samples were analyzed for signaling kinases: p38 MAPK and AMPK, peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α), enzyme activities indicative of mitochondrial biogenesis, and protein subunits representative of respiratory chain complexes I-V. Following training, subjects' peak oxygen uptake and running velocity were improved by 5.9% and 6.2%, respectively (P < 0.05). Repeated CWI resulted in higher total AMPK, phosphorylated AMPK, phosphorylated acetyl-CoA carboxylase, ß-3-hydroxyacyl-CoA-dehydrogenase and the protein subunits representative of complex I and III (P < 0.05). Moreover, large effect sizes (Cohen's d > 0.8) were noted with changes in protein content of p38 (d = 1.02, P = 0.064), PGC-1α (d = 0.99, P = 0.079), and peroxisome proliferator-activated receptor α (d = 0.93, P = 0.10) in COLD compared with CON. No differences between conditions were observed in the representative protein subunits of respiratory complexes II, IV, and V and in the activities of several mitochondrial enzymes (P > 0.05). These findings indicate that regular CWI enhances p38, AMPK, and possibly mitochondrial biogenesis.

Exercise responses to repeated cycle sprints with continuous and intermittent hypoxic exposure.

We examine the impact of the acute manipulation of oxygen availability during discrete phases (active and passive) of a repeated-sprint cycling protocol on performance, physiological, and perceptual responses. On separate days, twelve trained males completed four sets of five 5-s 'all out' cycle sprints (25-s inter-sprint recovery and 5-min interset rest) in four randomized conditions: normobaric hypoxia (inspired oxygen fraction of 12.9%) applied continuously (C-HYP), intermittently during only the sets of sprints (I-HYPSPRINT) or between-sets recovery periods (I-HYPRECOVERY), or not at all (C-NOR). Peak and mean power output, peripheral oxygen saturation, heart rate, blood lactate concentration, exercise-related sensations, and vastus lateralis muscle oxygenation using near-infrared spectroscopy were assessed. Peak and mean power output was ∼4%-5% lower for C-HYP compared to C-NOR (P ≤ 0.050) and I-HYPRECOVERY (P ≤ 0.027). Peripheral oxygen saturation was lower during C-HYP and I-HYPSPRINT compared with C-NOR and I-HYPRECOVERY during sets of sprints (∼83-85 vs. ∼95%-97%; P < 0.001), while lower values were obtained for C-HYP and I-HYPRECOVERY than C-NOR and I-HYPSPRINT during between-sets rest period (∼84-85 vs. ∼96%; P < 0.001). Difficulty in breathing was ∼21% higher for C-HYP than C-NOR (P = 0.050). Ratings of perceived exertion (P = 0.435), limb discomfort (P = 0.416), heart rate (P = 0.605), blood lactate concentration (P = 0.976), and muscle oxygenation-derived variables (P = 0.056 to 0.605) did not differ between conditions. In conclusion, the method of hypoxic exposure application (continuous vs. intermittent) affects mechanical performance, while internal demands remained essentially comparable during repeated cycle sprints.

Precooling via immersion in CO2-enriched water at 25°C decreased core body temperature but did not improve 10-km cycling time trial in the heat.

This study compared the effects of precooling via whole-body immersion in 25°C CO2-enriched water (CO2WI), 25°C unenriched water (WI) or no cooling (CON) on 10-km cycling time trial (TT) performance. After 30 min of precooling (CO2WI, CON, WI) in a randomized, crossover manner, 11 male cyclists/triathletes completed 30-min submaximal cycling (65%VO2peak), followed by 10-km TT in the heat (35°C, 65% relative humidity). Average power output and performance time during TT were similar between conditions (p = 0.387 to 0.833). Decreases in core temperature (Tcore) were greater in CO2WI (-0.54 ± 0.25°C) than in CON (-0.32 ± 0.09°C) and WI (-0.29 ± 0.20°C, p = 0.011 to 0.022). Lower Tcore in CO2WI versus CON was observed at 15th min of exercise (p = 0.050). Skin temperature was lower in CO2WI and WI than in CON during the exercise (p < 0.001 to 0.031). Only CO2WI (1029 ± 305 mL) decreased whole-body sweat loss compared with CON (1304 ± 246 mL, p = 0.029). Muscle oxygenation by near-infrared spectroscopy (NIRS), thermal sensation, and thermal comfort were lower in CO2WI and WI versus CON only during precooling (p < 0.001 to 0.041). NIRS-derived blood volume was significantly lower in CO2WI and WI versus CON during exercise (p < 0.001 to 0.022). Heart rate (p = 0.998) and rating of perceived exertion (p = 0.924) did not differ between conditions throughout the experiment. These results suggested that CO2WI maybe more effective than WI for enhanced core body cooling and minimized sweat losses.