Cross-adaptation from heat stress to hypoxia: A systematic review and exploratory meta-analysis.

Cross-adaptation (CA) refers to the successful induction of physiological adaptation under one environmental stressor (e.g., heat), to enable subsequent benefit in another (e.g., hypoxia). This systematic review and exploratory meta-analysis investigated the effect of heat acclimation (HA) on physiological, perceptual and physical performance outcome measures during rest, and submaximal and maximal intensity exercise in hypoxia. Database searches in Scopus and MEDLINE were performed. Studies were included when they met the Population, Intervention, Comparison, and Outcome criteria, were of English-language, peer-reviewed, full-text original articles, using human participants. Risk of bias and study quality were assessed using the COnsensus based Standards for the selection of health status Measurement INstruments checklist. Nine studies were included, totalling 79 participants (100 % recreationally trained males). The most common method of HA included fixed-intensity exercise comprising 9 ± 3 sessions, 89 ± 24-min in duration and occurred within 39 ± 2 °C and 32 ± 13 % relative humidity. CA induced a moderate, beneficial effect on physiological measures at rest (oxygen saturation: g = 0.60) and during submaximal exercise (heart rate: g = -0.65, core temperature: g = -0.68 and skin temperature: g = -0.72). A small effect was found for ventilation (g = 0.24) and performance measures (peak power: g = 0.32 and time trial time: g = -0.43) during maximal intensity exercise. No effect was observed for perceptual outcome measures. CA may be appropriate for individuals, such as occupational or military workers, whose access to altitude exposure prior to undertaking submaximal activity in hypoxic conditions is restricted. Methodological variances exist within the current literature, and females and well-trained individuals have yet to be investigated. Future research should focus on these cohorts and explore the mechanistic underpinnings of CA.

Altitude training in endurance running: perceptions of elite athletes and support staff.

This study sought to establish perceptions of elite endurance athletes on the role and worth of altitude training. Elite British endurance runners were surveyed to identify the altitude and hypoxic training methods utilised, along with reasons for use, and any situational, cultural and behaviour factors influencing these. Prior to the 2012 Olympics Games, 39 athletes and 20 support staff (coaches/practitioners) completed an internet-based survey to establish differences between current practices and the accepted "best-practice". Almost all of the athletes (98%) and support staff (95%) surveyed had utilised altitude and hypoxic training, or had advised it to athletes. 75% of athletes believed altitude and hypoxia to be a "very important" factor in their training regime, with 50% of support staff believing the same. Athletes and support staff were in agreement of the methods of altitude training utilised (i.e. 'hypoxic dose' and strategy), with camps lasting 3-4 weeks at 1,500-2,500 m being the most popular. Athletes and support staff are utilising altitude and hypoxic training methods in a manner agreeing with research-based suggestions. The survey identified a number of specific challenges and priorities, which could provide scope to optimise future altitude training methods for endurance performance in these elite groups.

Short-Term Heat Acclimation and Precooling, Independently and Combined, Improve 5-km Time Trial Performance in the Heat.

James, CA, Richardson, AJ, Watt, PW, Willmott, AGB, Gibson, OR, and Maxwell, NS. Short-term heat acclimation and precooling, independently and combined, improve 5-km time trial performance in the heat. J Strength Cond Res 32(5): 1366-1375, 2018-Following heat acclimation (HA), endurance running performance remains impaired in hot vs. temperate conditions. Combining HA with precooling (PC) demonstrates no additive benefit in intermittent sprint, or continuous cycling exercise protocols, during which heat strain may be less severe compared to endurance running. This study investigated the effect of short-term HA (STHA) combined with mixed methods PC, on endurance running performance and directly compared PC and HA. Nine amateur trained runners completed 5-km treadmill time trials (TTs) in the heat (32° C, 60% relative humidity) under 4 conditions; no intervention (CON), PC, short-term HA (5 days-HA) and STHA with PC (HA + PC). Mean (±SD) performance times were; CON 1,476 (173) seconds, PC 1,421 (146) seconds, HA 1,378 (116) seconds and HA + PC 1,373 (121) seconds. This equated to the following improvements versus CON; PC -3.7%, HA -6.6% and HA + PC -7.0%. Statistical differences were only observed between HA and CON (p = 0.004, d = 0.68, 95% CI [-0.27 to 1.63]) however, similar effect sizes were observed for HA + PC vs. CON (d = 0.70, 95% CI [-0.25 to 1.65]), with smaller effects between PC vs. CON (d = 0.34, 95% CI [-0.59 to 1.27]), HA vs. PC (d = 0.33, 95% CI [-0.60 to 1.26]) and HA + PC vs. PC (d = 0.36, 95% CI [-0.57 to 1.29]). Pilot testing revealed a TT typical error of 16 seconds (1.2%). Precooling offered no further benefit to performance in the acclimated individual, despite modest alleviation of physiological strain. Maintenance of running speed in HA + PC, despite reduced physiological strain, may indicate an inappropriate pacing strategy therefore, further familiarization is recommended to optimize a combined strategy. Finally, these data indicate HA, achieved through cycle training, yields a larger ergogenic effect than PC on 5-km running performance in the heat, although PC remains beneficial when HA is not possible.

Short-term heat acclimation prior to a multi-day desert ultra-marathon improves physiological and psychological responses without compromising immune status.

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day‒1, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and Tre was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising Tre and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

Power Relative to Body Mass Best Predicts Change in Core Temperature During Exercise-Heat Stress.

Gibson, OR, Willmott, AGB, James, CA, Hayes, M, and Maxwell, NS. Power relative to body mass best predicts change in core temperature during exercise-heat stress. J Strength Cond Res 31(2): 403-414, 2017-Controlling internal temperature is crucial when prescribing exercise-heat stress, particularly during interventions designed to induce thermoregulatory adaptations. This study aimed to determine the relationship between the rate of rectal temperature (Trec) increase, and various methods for prescribing exercise-heat stress, to identify the most efficient method of prescribing isothermic heat acclimation (HA) training. Thirty-five men cycled in hot conditions (40° C, 39% R.H.) for 29 ± 2 minutes. Subjects exercised at 60 ± 9% V[Combining Dot Above]O2peak, with methods for prescribing exercise retrospectively observed for each participant. Pearson product moment correlations were calculated for each prescriptive variable against the rate of change in Trec (° C·h), with stepwise multiple regressions performed on statistically significant variables (p ≤ 0.05). Linear regression identified the predicted intensity required to increase Trec by 1.0-2.0° C between 20- and 45-minute periods and the duration taken to increase Trec by 1.5° C in response to incremental intensities to guide prescription. Significant (p ≤ 0.05) relationships with the rate of change in Trec were observed for prescriptions based on relative power (W·kg; r = 0.764), power (%Powermax; r = 0.679), rating of perceived exertion (RPE) (r = 0.577), V[Combining Dot Above]O2 (%V[Combining Dot Above]O2peak; r = 0.562), heart rate (HR) (%HRmax; r = 0.534), and thermal sensation (r = 0.311). Stepwise multiple regressions observed relative power and RPE as variables to improve the model (r = 0.791), with no improvement after inclusion of any anthropometric variable. Prescription of exercise under heat stress using power (W·kg or %Powermax) has the strongest relationship with the rate of change in Trec with no additional requirement to correct for body composition within a normal range. Practitioners should therefore prescribe exercise intensity using relative power during isothermic HA training to increase Trec efficiently and maximize adaptation.

Ischaemic preconditioning does not alter the determinants of endurance running performance in the heat.

PURPOSE: Ischaemic preconditioning (IP) has been shown to be ergogenic for endurance performance in normothermic conditions and alleviate physiological strain under hypoxia, potentially through haemodynamic and/or metabolic mechanisms. Exertional hyperthermia is characterised by competition for blood flow between the muscles and skin, an enhanced metabolic strain and impaired endurance performance. This study investigated the effect of IP on the determinants of endurance performance, through an incremental exercise test in the heat. METHOD: Eleven males completed two graded exercise tests in the heat (32 °C, 62 % RH) until volitional exhaustion, preceded by IP (4 × 5 min 220 mmHg bilateral upper leg occlusion) or a control (CON) condition (4 × 5-min 50 mmHg bilateral). RESULT: IP did not improve running speeds at fixed blood lactate concentrations of 2 and 4 mMol L(-1) (p = 0.828), or affect blood glucose concentration throughout the trial [mean (±SD); CON 5.03 (0.94) mMol L(-1), IP 5.47 (1.38) mMol L(-1), p = 0.260). There was no difference in [Formula: see text]O2max [CON 55.5 (3.7) mL kg(-1) min(-1), IP 56.0 (2.6) mL kg(-1) min(-1), p = 0.436], average running economy [CON 222.3 (18.0) mL kg(-1) km(-1), IP 218.9 (16.5) mL kg(-1) km(-1), p = 0.125], or total running time during graded exercise [CON 347 (42) s, IP 379 (68) s, p = 0.166]. The IP procedure did not change muscle temperature [CON ∆ = 0.55 (0.57) °C, IP ∆ = 0.78 (0.85) °C, p = 0.568], but did reduce T CORE during exercise (~-0.1 °C, p = 0.001). CONCLUSION: The novel application of IP prior to exercise in the heat does not enhance the determinants of endurance performance. For events where IP appears ergogenic, muscle warming strategies are unnecessary as IP does not influence deep muscle temperature.

Physiological and psychological responses in Fire Instructors to heat exposures.

AIM: Fire Service Instructors (FSI) are exposed to many repeated periods of high environmental temperatures when training firefighters. Such repeated exposures will impose significant strains on the function of instructors. We aimed to measure the effects of a training programme including repeated exposures to heat, termed "Wears" in the fire service, on the physiological, psychological some immunological markers of Fire Service Instructors. METHODS: Six FSI and six physiologically matched controls completed blood and cardiovascular tests pre and post a 4wk heat instruction training block, controls completed the tests only. FSI were given a 7wk period of no heat exposure prior to starting the training. Physiological and perceptual measures were taken pre and post the first and last Wear of the 4wk training protocol. RESULTS: There were acute effects of a Wear on core temperature and physiological strain index, as well as measures of fatigue. The acute exposure to heat during a Wear led to a consistent decrease in CRP (-10% to -40%), increased IL6 concentrations 33-45%) as well as increased RPE and TSS. Over the training programme significantly lower quantities of white cells, particularly neutrophils, leukocytes and monocytes were found in the FSI group. Between the start and the end of the 4 week training programme the FSI showed a significantly greater physiological strain index (PSI) to the Wears, which nearly doubled from 2.5 to 4.7 (p<0.05). CONCLUSION: Physiological and psychological measures indicate that FSI may be experiencing symptoms and changes to their health consistent with an overtraining type condition.

Repeatability of a running heat tolerance test.

At present there is no standardised heat tolerance test (HTT) procedure adopting a running mode of exercise. Current HTTs may misdiagnose a runner's susceptibility to a hyperthermic state due to differences in exercise intensity. The current study aimed to establish the repeatability of a practical running test to evaluate individual's ability to tolerate exercise heat stress. Sixteen (8M, 8F) participants performed the running HTT (RHTT) (30 min, 9 km h(-1), 2% elevation) on two separate occasions in a hot environment (40 °C and 40% relative humidity). There were no differences in peak rectal temperature (RHTT1: 38.82 ± 0.47 °C, RHTT2: 38.86 ± 0.49 °C, Intra-class correlation coefficient (ICC)=0.93, typical error of measure (TEM) = 0.13 °C), peak skin temperature (RHTT1: 38.12 ± 0.45, RHTT2: 38.11 ± 0.45 °C, ICC = 0.79, TEM = 0.30 °C), peak heart rate (RHTT1: 182 ± 15 beats min(-1), RHTT2: 183 ± 15 beats min(-1), ICC = 0.99, TEM = 2 beats min(-1)), nor sweat rate (1721 ± 675 g h(-1), 1716 ± 745 g h(-1), ICC = 0.95, TEM = 162 g h(-1)) between RHTT1 and RHTT2 (p>0.05). Results demonstrate good agreement, strong correlations and small differences between repeated trials, and the TEM values suggest low within-participant variability. The RHTT was effective in differentiating between individuals physiological responses; supporting a heat tolerance continuum. The findings suggest the RHTT is a repeatable measure of physiological strain in the heat and may be used to assess the effectiveness of acute and chronic heat alleviating procedures.

Isothermic and fixed intensity heat acclimation methods induce similar heat adaptation following short and long-term timescales.

Heat acclimation requires the interaction between hot environments and exercise to elicit thermoregulatory adaptations. Optimal synergism between these parameters is unknown. Common practise involves utilising a fixed workload model where exercise prescription is controlled and core temperature is uncontrolled, or an isothermic model where core temperature is controlled and work rate is manipulated to control core temperature. Following a baseline heat stress test; 24 males performed a between groups experimental design performing short term heat acclimation (STHA; five 90 min sessions) and long term heat acclimation (LTHA; STHA plus further five 90 min sessions) utilising either fixed intensity (50% VO2peak), continuous isothermic (target rectal temperature 38.5 °C for STHA and LTHA), or progressive isothermic heat acclimation (target rectal temperature 38.5 °C for STHA, and 39.0 °C for LTHA). Identical heat stress tests followed STHA and LTHA to determine the magnitude of adaptation. All methods induced equal adaptation from baseline however isothermic methods induced adaptation and reduced exercise durations (STHA = -66% and LTHA = -72%) and mean session intensity (STHA = -13% VO2peak and LTHA = -9% VO2peak) in comparison to fixed (p < 0.05). STHA decreased exercising heart rate (-10 b min(-1)), core (-0.2 °C) and skin temperature (-0.51 °C), with sweat losses increasing (+0.36 Lh(-1)) (p<0.05). No difference between heat acclimation methods, and no further benefit of LTHA was observed (p > 0.05). Only thermal sensation improved from baseline to STHA (-0.2), and then between STHA and LTHA (-0.5) (p<0.05). Both the continuous and progressive isothermic methods elicited exercise duration, mean session intensity, and mean T(rec) analogous to more efficient administration for maximising adaptation. Short term isothermic methods are therefore optimal for individuals aiming to achieve heat adaptation most economically, i.e. when integrating heat acclimation into a pre-competition taper. Fixed methods may be optimal for military and occupational applications due to lower exercise intensity and simplified administration.

Effect of Practical Precooling on Neuromuscular Function and 5-km Time-Trial Performance in Hot, Humid Conditions Among Well-Trained Male Runners.

This study investigated whether torso and thigh precooling during a warm-up effects neuromuscular function and 5-km time-trial performance in hot, humid conditions. Eight well-trained male runners completed 3 randomized time-trials in 32.2 ± 0.8° C and 48.6 ± 6.7% relative humidity. A 30-minute warm-up was completed with no cooling (Control), precooling by an ice vest (Vest), or ice packs covering the thighs (Packs). Before the warm-up and after the time-trial, supramaximal femoral nerve stimulation was delivered during and following maximal isometric contractions. Core and skin temperature, heart rate, and perceptual ratings were recorded before and during the warm-up and time-trial. Overall performance time was improved in Packs compared with Control (1,407 ± 80 seconds vs. 1,492 ± 88 seconds; p ≤ 0.05) but not in Vest (1,444 ± 71 seconds; p > 0.05). In Packs, a higher exercise intensity (p ≤ 0.05) and less cumulative time (p < 0.01) were evident during the last kilometer compared with Control. Maximum voluntary force, voluntary activation, muscle contractility, and membrane excitability were not different after exercise or between conditions. Ten minutes after the warm-up, skin temperature was lower in Vest and Packs compared with Control (p < 0.01). Thermal strain and body heat content change was lower in Vest and Packs, respectively (p ≤ 0.05). Findings indicate that torso and thigh precooling during a warm-up reduces thermoregulatory strain. However, thigh opposed to torso precooling provides greater performance improvements. Neuromuscular function did not aid performance, indicating that transient changes in afferent feedback and muscle recruitment may enhance endurance trial performance.

Prediction of physiological responses and performance at altitude using the 6-minute walk test in normoxia and hypoxia.

OBJECTIVE: The 6-minute walk test (6MWT) is a reliable and valid tool for determining an individual's functional capacity, and has been used to predict summit success. The primary aim of the study was to evaluate whether a 6MWT in normobaric hypoxia could predict physiological responses and exercise performance at altitude. The secondary aim was to determine construct validity of the 6MWT for monitoring acclimatization to 3400 m (Cuzco, Peru). METHODS: Twenty-nine participants performed six 6MWTs in four conditions: normoxic outdoor (NO), normoxic treadmill (NT), and hypoxic treadmill (HT) were each performed once; and hypoxic outdoor (HO) was performed three times, at 42 hours (HO1), 138 hours (HO2), and 210 hours (HO3) after arrival at Cuzco. RESULTS: One-way analysis of variance revealed no difference (P>.05) between NO and HO1 for 6MWT distance. HT and HO protocols were comparable for the measurement of delta heart rate (HR) and post-test peripheral oxygen saturation (%Spo2; P>.05). Acclimatization was evidenced by reductions (P<.05) in resting HR and respiratory rate (RR) between HO1, HO2, and HO3, and preservation of Spo2 between HO1 and HO2. Postexercise HR and RR were not different (P>.05) with acclimatization. The duration to ascend to 4215 m on a trek was moderately correlated (P<.05) to HR during the trek and the 6MWT distance during HT; no other physiological markers predicted performance. CONCLUSIONS: The 6MWT is a simple, time-efficient tool for predicting physiological responses to simulated and actual altitude, which are comparable. The 6MWT is effective at monitoring elements of acclimatization to moderate altitude.

Precooling does not improve 2,000-m rowing performance of females in hot, humid conditions.

Precooling lowers skin (Tsk) and core temperature (Tre) and can improve performance in hot conditions, but has predominantly been studied in males. This study investigated the effects of precooling on self-paced 2,000-m rowing performance, within females, in hot, humid conditions. Eight physically active females (19.9 ± 1.5 years, 66.8 ± 3.1 kg, 30.0 ± 5.0% body fat) performed 2,000-m rows in a randomized order within 3 conditions {control (CONT) (20° C, 40% relative humidity [RH]); hot (HOT) (35° C, 60% RH); precooling (PREC) (35° C, 60% RH, preceded by precooling)}. The precooling condition consisted of 20-minute precooling with a cold water shower, followed by a 2,000-m row. In contrast, CONT and HOT consisted of 20-minute passive rest in place of precooling. Tre, Tsk, and power output were recorded every 100 m of the rows. Muscle temperature (Tmu) was recorded at baseline, after 20-minute passive rest/precooling and post-row. No differences were observed between conditions for performance time (CONT, 8.89 ± 0.45 minutes; HOT, 9.01 ± 0.55 minutes; PREC, 8.87 ± 0.48 minutes; p = 0.42). Mean Tre during the row was not different between conditions (CONT, 37.8 ± 0.2° C; HOT, 37.7 ± 0.3° C; PREC, 37.5 ± 0.2° C; p = 0.12; main effect), although lower Tre was observed at 1,600 and 1,800 m in PREC compared with HOT (p ≤ 0.05). Tmu was significantly reduced after precooling (p = 0.03). Precooling did not enhance 2,000-m rowing performance, despite differences in Tre, Tsk, and Tmu. The lack of observed improvement in rowing performance after cold shower precooling may have been due to the short exercise time. An improvement in performance may have been observed using an alternate method of precooling, which has been shown to be ergogenic in other sports.

Partial heat acclimation of athletes with spinal cord lesion.

Heat acclimation (HA) can improve thermoregulatory stability in able-bodied athletes in part by an enhanced sweat response. Athletes with spinal cord lesion are unable to sweat below the lesion and it is unknown if they can HA. Five paralympic shooting athletes with spinal cord lesion completed seven consecutive days HA in hot conditions (33.4 ± 0.6 °C, 64.8 ± 3.7 %rh). Each HA session consisted of 20 min arm crank exercise at 50 % [Formula: see text] followed by 40 min rest, or simulated shooting. Aural temperature (T (aur)) was recorded throughout. Body mass was assessed before and after each session and a sweat collection swab was fixed to T12 of the spine. Fingertip whole blood was sampled at rest on days 1 and 7 for estimation of the change in plasma volume. Resting T (aur) declined from 36.3 ± 0.2 °C on day 1 to 36.0 ± 0.2 °C by day 6 (P < 0.05). During the HA sessions mean, T (aur) declined from 37.2 ± 0.2 °C on day 1, to 36.7 ± 0.3 °C on day 7 (P < 0.05). Plasma volume increased from day 1 by 1.5 ± 0.6 % on day 7 (P < 0.05). No sweat secretion was detected or changes in body mass observed from any participant. Repeated hyperthermia combined with limited evaporative heat loss was sufficient to increase plasma volume, probably by alterations in fluid regulatory hormones. In conclusion, we found that although no sweat response was observed, athletes with spinal cord lesion could partially HA.

Peak power output provides the most reliable measure of performance in prolonged intermittent-sprint cycling.

The aims of this study were to determine the reliability of an intermittent-sprint cycling protocol and to determine the efficacy of one practice session on main trials. Eleven men, moderately trained team-sport athletes, completed three visits to the laboratory involving a graded-exercise test and practice session and two trials of a cycling intermittent-sprint Protocol separated by three days. Data for practice and main trials were analysed using typical error of measurement, intra-class correlation and least-products regression to determine reliability. Typical error of measurement (expressed as a coefficient of variation) and intra-class correlation for peak power output from all 20 sprints for trial 1 and trial 2 were 2.9 ± 12.8% (95% confidence interval: 2.0-5.0%) and 0.96 (95% confidence interval: 0.85-0.99), respectively. Typical errors of measurement and intra-class correlation for mean power output for all 20 sprints for trials 1 and 2 were 4.2 ± 11.9% (95% confidence interval: 2.9-7.4%) and 0.90 (95% confidence interval: 0.66-0.97), respectively. The results suggest that peak power output provides a more reliable measure than mean power output. The Cycling Intermittent-Sprint Protocol provides reliable measures of intermittent-sprint performance.

A feasibility study of the use of UmbiFlow™ to assess the impact of heat stress on fetoplacental blood flow in field studies.

OBJECTIVE: To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS: This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS: A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS: The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect.

Altitude training for elite endurance performance: a 2012 update.

Altitude training is commonly used by endurance athletes and coaches in pursuit of enhancement of performance on return to sea level. The purpose of the current review article was to update and evaluate recent literature relevant to the practical application of altitude training for endurance athletes. Consequently, the literature can be considered in either of two categories: performance-led investigations or mechanistic advancements/insights. Each section discusses the relevant literature and proposes future directions where appropriate.

Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study.

BACKGROUND: Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS: We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS: Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION: Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING: The Wellcome Trust.

Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa.

Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.

Heat acclimation improves sweat gland function and lowers sweat sodium concentration in an adult with cystic fibrosis.

We present novel data concerning the time-course of adaptations and potential benefits of heat acclimation for people with cystic fibrosis (pwCF), who are at greater risk of exertional heat illness. A 25-year-old male (genotype: delta-F508 and RH117, forced expiratory volume in 1-second: 77% predicted and baseline sweat [Na+]: 70 mmol·L - 1), who had previously experienced muscle cramping during exercise in ambient heat, underwent 10-sessions of heat acclimation (90-min at 40°C and in 40% relative humidity). Adaptations included; lower resting core temperature (-0.40°C) and heart rate (-6 beats·min-1), plasma volume expansion (+6.0%) and, importantly, increased sweat loss (+370 mL) and sweat gland activity (+12 glands·cm2) with decreased sweat [Na+] (-18 mmol·L - 1). Adaptations were maintained for at least 7-days, with no evidence of cramping during follow-up exercise-heat stress testing. These data suggest pwCF may benefit from heat acclimation to induce sudomotor function improvements, particularly reductions in sweat [Na+], however, further research is required.

Exercise heat acclimation and post-exercise hot water immersion improve resting and exercise responses to heat stress in the elderly.

OBJECTIVES: To investigate the efficacy of heat acclimation (HA) in the young (YEX) and elderly (EEX) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (EHWI). DESIGN: Cross-sectional study. METHOD: Twenty-six participants (YEX: n = 11 aged 22 ±â€¯2 years, EEX:n = 8 aged 68 ±â€¯3 years, EHWI: n = 7 aged 73 ±â€¯3 years) completed two pre-/post-tests, separated by five intervention days. YEX and EEX exercised in hot conditions to raise rectal temperature (Trec) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. EHWI completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg-1 Hprod), and a six-minute walk test (6MWT), all in 35 °C, 50% RH. RESULTS: The HA protocols did not elicit different mean heart rate (HR), Trec, and duration Trec ≥ 38.5 °C (p > 0.05) between YEX, EEX, and EHWI groups. Resting Trec, peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p < 0.05), with no difference between groups. YEX also demonstrated a reduction in resting HR (p < 0.05). No change was observed in peak Trec or HR, vascular conductance, sweat rate, or thermal comfort in any group (p > 0.05). CONCLUSIONS: Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (EEX), and post-exercise HWI (EHWI) are considered viable interventions to prepare the elderly for heat stress.