Search

This paper provides a kinetic observation of both core and skin temperatures in 108 elite athletes, during various outdoor competition events, adding to the very limited data so far available in the literature taken during elite competitions. The field skin temperature findings contrast previous laboratory findings, likely due to differences in relative air velocity and its impact on the evaporation of sweat. The rapid rise in skin temperature following cessation of exercise highlights the importance of infrared thermography measurements being taken during motion, not during breaks, when being used as a measurement of skin temperature during exercise.

Purpose: To survey elite athletes and practitioners to identify (1) knowledge and application of heat acclimation/acclimatization (HA) interventions, (2) barriers to HA application, and (3) nutritional practices supporting HA. Methods: Elite athletes (n = 55) and practitioners (n = 99) completed an online survey. Mann–Whitney U tests (effect size [ES; r]) assessed differences between ROLE (athletes vs practitioners) and CLIMATE (hot vs temperate). Logistic regression and Pearson chi-square (ES Phi [ϕ]) assessed relationships. Results: Practitioners were more likely to report measuring athletes’ core temperature (training: practitioners 40% [athletes 15%]; P = .001, odds ratio = 4.0, 95% CI, 2%–9%; competition: practitioners 25% [athletes 9%]; P = .020, odds ratio = 3.4, 95% CI, 1%–10%). Practitioners (55% [15% athletes]) were more likely to perceive rectal as the gold standard core temperature measurement site (P = .013, ϕ = .49, medium ES). Temperate (57% [22% hot]) CLIMATE dwellers ranked active HA effectiveness higher (P r = .30, medium ES). Practitioners commonly identified athletes’ preference (48%), accessibility, and cost (both 47%) as barriers to HA. Increasing carbohydrate intake when training in the heat was more likely recommended by practitioners (49%) than adopted by athletes (26%; P = .006, 95% CI, 0.1%–1%). Practitioners (56% [28% athletes]) were more likely to plan athletes’ daily fluid strategies, adopting a preplanned approach (P = .001; 95% CI, 0.1%–1%). Conclusions: Practitioners, and to a greater extent athletes, lacked self-reported key HA knowledge (eg, core temperature assessment/monitoring methods) yet demonstrated comparatively more appropriate nutritional practices (eg, hydration).

ObjectivesTo adapt key components of exertional heat stroke (EHS) prehospital management proposed by the Intenational Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes.MethodsAn expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS.ResultsSimilar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (eg, autonomic dysfunction) and mechanisms for hands-on management (eg, transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete.ConclusionsPrehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.

This study examined the effect of graded hypoxia during exhaustive intermittent cycling on subsequent exercise performance and neuromuscular fatigue characteristics in normoxia. Fifteen well-trained cyclists performed an exhaustive intermittent cycling exercise (EICE 1; 15 s at 30% of anaerobic power reserve interspersed with 45 s of passive recovery) at sea level (SL; FiO2 ~ 0.21), moderate (MH; FiO2 ~ 0.16) and severe hypoxia (SH; FiO2 ~ 0.12). This was followed, after 30 min of passive recovery in normoxia, by an identical exercise bout in normoxia (EICE 2). Neuromuscular function of the knee extensors was assessed at baseline, after EICE 1 (post-EICE 1), and EICE 2 (post-EICE 2). The number of efforts completed decreased with increasing hypoxic severity during EICE 1 (SL: 39 ± 30, MH: 22 ± 13, SH: 13 ± 6; p ≤ 0.02), whereas there was no difference between conditions during EICE 2 (SL: 16 ± 9, MH: 20 ± 14, SH: 24 ± 17; p ≥ 0.09). Maximal torque (p = 0.007), peripheral (p = 0.02) and cortical voluntary activation (p

We investigate the effects of seasonal heat stress on cognitive function in outdoor workers. Thirty-nine workers from an oil and gas industry in the Middle-East volunteered for cognitive testing before (5.30 to 7.00 am) and after (3.30 to 5.00 pm) their daily work-shift in hot (August – average daily temperature: ~41°C) and temperate (January – average daily temperature: ~22°C) seasons. While physical activity was reduced in hot compared to temperate season (average normalized acceleration: 96 ± 33 vs. 112 ± 31 × 10(−3) g; −12.5 ± 4.7%; P = 0.010), the average core temperature during the work-shift was higher in the hot season (37.4 ± 0.2 vs. 37.2 ± 0.2°C; P = 0.002). Peak core temperature was 38.0 ± 0.1°C and 37.8 ± 0.1°C in hot and temperate seasons, respectively. Cognitive performance did not differ between seasons for tests of recognition memory (P = 0.169), working memory (P = 0.797) and executive function (P = 0.145), independent of testing time. Whereas there was no significant main effect of testing time for tests of recognition memory (P = 0.503) and working memory (P = 0.849), the number of problems solved on the first choice for the executive function test was lower in the afternoon than the morning (−9.2 ± 5.3%; P = 0.039). There was no season × testing time interaction for any cognitive tests (P ≥ 0.145). In the absence of hyperthermia, living and working in a hot environment does not alter cognitive function in oil and gas industry workers tested in a quiet and temperature-controlled room, with reduced clothing encumbrance (relative to work). Conclusions should not be extrapolated to more stressful situations (i.e., thermal stressor present, pronounced dehydration, noise).

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

PurposeTo characterise hydration, cooling, body mass loss, and core (Tcore) and skin (Tsk) temperatures during World Athletics Championships in hot-humid conditions.MethodsMarathon 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.ResultsMost athletes (93%) had a pre-planned drinking strategy (electrolytes (83%), carbohydrates (81%)) while ice slurry was less common (11%; pcore 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%, pConclusionMost 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.

This study aimed to determine if sleep quality and psychological factors were associated with time to meet the discharge criteria to return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) among athletes. A cohort-study design included 89 athletes following ACL-R. Each participant completed a battery of questionnaires at 6 different time points: within 3 days of injury occurrence and at post-surgery (1.5 m, 3 m, 4.5 m, 6 m and when discharge criteria were met). Assessment included sleep quality and quantity, symptoms of depression, anxiety, stress, psychological readiness to RTS and fear of re-injury. The primary outcome was the time needed to meet all discharge criteria to RTS. Sleep parameters and psychological factors were not associated with time to meet the discharge criteria to RTS. However, athletes that had lower scores of anxiety (OR 1.2 (95% CI 1.0, 1.3) and insomnia (OR 1.2 (95% CI 1.0, 1.3) at baseline were more likely to meet the RTS discharge criteria. Athletes with better sleep quality at 3m, 4.5m and 6m were more likely to meet the RTS discharge criteria OR 1.3 (95% CI 1.1, 1.7), 2.0 (95% CI 1.1–3.4) and 1.4 (95% CI 1.0, 1.9) respectively. Sleep quality and psychological factors were not associated with time to meet the discharge criteria to RTS but impacted whether athletes adhered and completed their rehabilitation program or not. Monitoring sleep quality and psychological factors of athletes before and following ACL-R surgery is important to identify athletes who could have difficulties in adhering to and completing their rehabilitation program to RTS.

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. 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

This study aimed to characterise the thermoregulatory responses of elite alpine skiers. Core (gastro-intestinal) and skin temperatures were recorded continuously from 4 national team skiers representing 18 training-sessions for a total of 83 ski runs (average ambient temperature 1.9°C). Shivering responses were estimated from quadriceps and hamstrings EMG recordings during 77 chairlifts. Temperature responses were also obtained from 6 accompanying staffs representing 16 training-sessions (passive in 10 cases, following the skiers in 6 cases). Core temperature of the skiers (

PurposeTo determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions.MethodsFrom 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.ResultsPeak 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 (pcore 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%, pcore (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).ConclusionTskin, 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.

Supplemental digital content is available in the text., Introduction This study evaluated how single or combinations of weather parameters (temperature, humidity, wind speed, and solar load) affect peak performance during endurance running events and identified which events are most vulnerable to varying weather conditions. Methods Results for the marathon, 50-km racewalking, 20-km racewalking, and 10,000-, 5000-, and 3000-m steeplechase were obtained from the official Web sites of large competitions. We identified meteorological data from nearby (8.9 ± 9.3 km) weather stations for 1258 races held between 1936 and 2019 across 42 countries, enabling analysis of 7867 athletes. Results The wet bulb globe temperature (WBGT) across races ranged from −7°C to 33°C, with 27% of races taking place in cold/cool, 47% in neutral, 18% in moderate heat, 7% in high heat, and 1% in extreme heat conditions, according to the World Athletics classification. Machine learning decision trees (R2 = 0.21–0.58) showed that air temperature (importance score = 40%) was the most important weather parameter. However, when used alone, air temperature had lower predictive power (R2 = 0.04–0.34) than WBGT (R2 = 0.11–0.47). Conditions of 7.5°C–15°C WBGT (or 10°C–17.5°C air temperature) increased the likelihood for peak performance. For every degree WBGT outside these optimum conditions, performance declined by 0.3%–0.4%. Conclusion More than one-quarter of endurance running events were held in moderate, high, or extreme heat, and this number reached one-half when marathons were excluded. All four weather parameters should be evaluated when aiming to mitigate the health and performance implications of exercising at high intensities in a hot environment with athletes adopting heat mitigation strategies when possible.

This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes’ behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team., publishedVersion

We examined whether mild heat exposure alters performance, perceptual responses and neural drive to the quadriceps during two sets of repeated sprints matched for initial mechanical output.Repeated measures.Twelve males performed 10 × 6-s sprints (recovery = 30 s), followed 6 min later by 5 × 6-s sprints (recovery = 30 s) in either COOL (24 °C/30% rH) or HOT (35 °C/40% rH) conditions. Subsequently, two sets of five consecutive sprints matched for initial mechanical output were compared.On the basis of peak power, performance in sprint 2 was not significantly different to sprint 11 in both conditions (p ≥ 0.32). Average peak power across the five sprints compared (i.e., sprints 2-6 and 11-15, respectively) was 2.6 ± 3.4% higher in HOT compared to COOL (p = 0.025). Electromyographic activity (root mean square value) of the vastus lateralis muscle remained unchanged. Core (sprints 2-6: 37.85 ± 0.21 vs. 37.53 ± 0.19 °C, sprints 11-15: 38.26 ± 0.33 vs. 37.89 ± 0.24 °C; p 0.001) and skin (sprints 2-6: 36.21 ± 0.29 vs. 30.72 ± 0.52 °C, sprints 11-15: 36.37 ± 0.28 vs. 30.99 ± 0.55 °C; p 0.001) temperatures were overall higher in HOT compared to COOL. Heart rate, thermal sensation and comfort were significantly elevated in HOT compared to COOL (p ≤ 0.02), irrespective of sprint number.When two sets of repeated sprints were matched for initial mechanical output, performance was enhanced with mild heat exposure. This occurred despite higher thermal, cardiovascular, and perceptual strain, and without alterations in quadriceps neural drive.

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Background Heat-related illness, including heat exhaustion and heat stroke, is seen as a major risk for athletes with a physical impairment. Objective Primary: To survey the illness statistics during the 2015 Para Athletics World Championships and report on any cases of significant heat-related illnesses. Secondary: To document the heat countermeasures taken on behalf of the organizing committee. Design Retrospective audit. Setting Medical records collected at medical centers during the 2015 Para Athletics World Championships. Participants Athletes participating in the 2015 Para Athletics World Championships. Methods Illness statistics and records of hospitalizations of athletes participating in the championships were recorded by the medical officials during the precompetition (3 days) and competition (10 days) periods. Furthermore, wet-bulb globe temperatures (WBGTs) were measured at the competition venues. Main outcome measurements Incidence rates of illness during the precompetition and competition periods. Results WBGTs ranged from 24.6°C to 36.0°C, regularly exceeding the American College of Sports Medicine (ACSM) and International Association of Athletics Federations (IAAF) guidelines for cancelation in the morning both during the competition (ACSM, 52%; IAAF, 97%) and precompetition periods (ACSM, 75%; IAAF, 100%). These guidelines were not exceeded as regularly during the evening and noon for both the precompetition and competition periods (ACSM, 0%-5%; IAAF, 0%-58%). The illness incidence rate was 2.89 per 1000 athlete-days (incidence proportion = 3.76%; confidence interval = 2.69%-4.83%). Only seven cases of heat-related illness were recorded, of which three required hospitalization. Conclusion This study indicates low rates of illness, including hospitalization and intravenous administration for heat-related illness among athletes participating in the 2015 Para Athletics World Championships. Level of evidence III.

Objective. To investigate the use of infrared thermography (IRT) for skin temperature measurement of moving athletes during competition and its sensitivity to factors that are traditionally standardised. Approach. Thermograms were collected for 18 female athletes during the 20 km racewalk at the 2019 World Athletics Championships, with a medium-wave, cooled indium antimonide medium wave infrared band (MWIR) and a long-wave, uncooled microbolometer longwave infrared band (LWIR) infrared camera. Main results. The MWIR provided greater clarity images of motion due to a shorter exposure and response time and produced a higher percentage of acceptable images. Analysing acceptable images only, the LWIR and WMIR produced good levels of agreement, with a bias of −0.1 ± 0.6 °C in mean skin temperature for the LWIR. As the surface area of an ROI was reduced, the measured temperature became less representative of the whole ROI. Compared to measuring the whole area ROI, a single central pixel produced a bias of 0.3 ± 0.3 °C (MWIR) and 0.1 ± 0.4 °C (LWIR) whilst using the maximum and minimum temperature pixels resulted in deviations of 1.3 ± 0.4 °C and −1.1 ± 0.3 °C (MWIR) and 1.2 ± 0.3 °C and −1.3 ± 0.4 °C (LWIR). The sensitivity to air and reflected temperatures was lower for the LWIR camera, due to the higher emissivity of skin in its wavelength. Significance. IRT provides an appropriate tool for the measurement of skin temperature during real-world competition and critically during athlete motion. The cheaper LWIR camera provides a feasible alternative to the MWIR in low rate of motion scenarios, with comparable precision and sensitivity to analysis. However, the LWIR is limited when higher speeds prevent the accurate measurement and ability to capture motion.

Objective To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics. Data Sources An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed. Conclusions A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.

The aim of this study was to assess the history of exertional heat illness (EHI), heat preparation, cooling strategies, heat related symptoms, and hydration during an ultra-endurance running event in a warm and humid environment. This survey-based study was open to all people who participated in one of the three ultra-endurance races of the Grand Raid de la Réunion. Ambient temperature and relative humidity were 18.6 ± 5.7 °C (max = 29.7 °C) and 74 ± 17%, respectively. A total of 3317 runners (56% of the total eligible population) participated in the study. Overall, 78% of the runners declared a history of heat-related symptoms while training or competing, and 1.9% reported a previous diagnosis of EHI. Only 24.3% of study participants living in temperate climates declared having trained in the heat before the races, and 45.1% of all respondents reported a cooling strategy during the races. Three quarter of all participants declared a hydration strategy. The planned hydration volume was 663 ± 240 mL/h. Fifty-nine percent of the runners had enriched their food or drink with sodium during the race. The present study shows that ultra-endurance runners have a wide variability of hydration and heat preparation strategies. Understandings of heat stress repercussions in ultra-endurance running need to be improved by specific field research.

This study characterised the thigh muscle-tendon unit length variations (MTUv) in elite alpine skiing. MTUv were modelled for seven muscles from knee and hip angles in 17 national team skiers during 1602 cycles (546 Slalom (SL), 908 Giant-Slalom (GS), 136 Super-Giant (SG) and 12 Downhill (DH) cycles). The biarticular

International outdoor athletics championships are typically hosted during the summer season, frequently in hot and humid climatic conditions. Therefore, we analyzed the association between apparent temperature and heat-related illnesses occurrence during international outdoor athletics championships and compared its incidence rates between athletics disciplines. Heat-related illnesses were selected from illness data prospectively collected at seven international outdoor athletics championships between 2009 and 2018 using a standardized methodology. The Universal Thermal Climate Index (UTCI) was calculated as a measure of the apparent temperature based on weather data for each day of the championships. Heat-related illness numbers and (daily) incidence rates were calculated and analyzed in relation to the daily maximum UTCI temperature and between disciplines. During 50 championships days with UTCI temperatures between 15celcius and 37celcius, 132 heat-related illnesses were recorded. Average incidence rate of heat-related illnesses was 11.7 (95%CI 9.7 to 13.7) per 1000 registered athletes. The expected daily incidence rate of heat-related illnesses increased significantly with UTCI temperature (0.12 more illnesses per 1000 registered athletes/degrees C; 95%CI 0.08-0.16) and was found to double from 25 to 35 degrees C UTCI. Race walkers (RR = 45.5, 95%CI 21.6-96.0) and marathon runners (RR = 47.7, 95%CI 23.0-98.8) had higher heat-related illness rates than athletes competing in short-duration disciplines. Higher UTCI temperatures were associated with more heat-related illnesses, with marathon and race walking athletes having higher risk than athletes competing in short-duration disciplines. Heat-related illness prevention strategies should predominantly focus on marathon and race walking events of outdoor athletics championships when high temperatures are forecast.

International audience; The present study aimed to determine the effect of hyperthermia on both electrochemical and mechanical components of the electromechanical delay (EMD), using very-high-frame-rate ultrasound. Electrically evoked peak twitch force, EMD, electrochemical (D m ; i.e., delay between stimulation and muscle fascicle motion), and mechanical (T m ; i.e., delay between fascicle motion and force production onset) components of EMD were assessed in 16 participants. Assessments were conducted in a control ambient environment (CON; 26 C, 34% relative humidity) and in a hot ambient environment (HOT; 46-50 C, 18% relative humidity, after $127 min of heat exposure). Following heat exposure, gastrocnemius medialis temperature was 37.0 ± 0.6 C in HOT vs. 34.0 ± 0.8 C in CON (P < 0.001). EMD was shorter (9.4 ± 0.8 ms) in HOT than in CON (10.8 ± 0.6 ms, P < 0.001). Electrochemical processes were shorter in HOT than in CON (4.0 ± 0.8 ms vs. 5.5 ± 0.9 ms, respectively, P < 0.001), whereas mechanical processes were unchanged (P = 0.622). These results demonstrate that hyperthermia reduces electromechanical delay via accelerated electrochemical processes, whereas force transmission along the active and passive parts of the series elastic component is not affected following heat exposure. The present study demonstrates that heat exposure accelerates muscle contraction thanks to faster electrochemical processes. Further investigations during voluntary contractions would contribute to better understand how these findings translate into motor performance. NEW & NOTEWORTHY Hyperthermia (targeted core temperature: 38.5 C) reduces the time between gastrocnemius medialis stimulation and the onset of plantar flexor force production in vivo. This reduction in electromechanical delay is concomitant to an earlier motion of muscle fascicle compared with thermoneutral environment. However, hyperthermia has no impact on the duration of force transmission along aponeurosis and tendon, thereby reflecting different effects of heat exposure on contractile and elastic properties of the muscle-tendon unit.

To compare the effects of different hypoxia severities on exercise capacity, cardio-respiratory, tissue oxygenation and neuromuscular fatigue characteristics in response to exhaustive intermittent cycling. Eleven well-trained cyclists, repeated supra-maximal cycling efforts of 15 s (30% of anaerobic power reserve, 609 ± 23 W), interspersed with 45 s of passive rest until task failure. The exercise was performed on separate days in normoxia (SL; simulated altitude/end-exercise arterial oxygen saturation = 0 m/~ 96%), moderate (MH; 2200 m/~ 90%) and severe (SH; 4200 m/~ 79%) hypoxia in a cross-over design. Neuromuscular tests, including brief (5 s) and sustained (30 s) maximal isometric voluntary contractions of the knee extensors, were performed at baseline and exhaustion. Exercise capacity decreased with hypoxia severity (23 ± 9, 16 ± 6 and 9 ± 3 cycle efforts in SL, MH and SH, respectively; P

The COVID-19 pandemic has created many challenges to ensure a safe environment for competitive sport. While modern medicine has already developed effective protocols for the treatment and prevention of the disease, there are serious concerns about hosting a sporting event of the scale of the Olympic Games, where more than 11 000 athletes from over 200 nations are expected to participate. Accordingly, there have been many calls to cancel the Tokyo Olympic Games, also known as Tokyo 2020, in both the international press and the scientific literature. A recent perspective published in the New England Journal of Medicine (NEJM)1 highlights the complexity and risks of convening the Tokyo Olympic Games during the COVID-19 pandemic. Despite the many uncertainties,1 much has been learnt over the past 18 months and many policies trialled and tested to protect athletes during sports participation. To develop a rapid understanding of the perspectives from the international sports and exercise medicine community, an informal survey of the International Federation of Sports Medicine (FIMS) Executive Committee, Commissions, and Collaborating Centres of Sports Medicine agreed that the Tokyo Olympic Games could go ahead safely based on the plans addressing the pandemic developed by the IOC (figure 1). This international network of 26 research laboratories and clinics has a mission to promote best practice …

Purpose: To measure core temperature (Tcore) in open-water (OW) swimmers during a 25-km competition and identify the predictors of Tcore drop and hypothermia-related dropouts. Methods: Twenty-four national- and international-level OW swimmers participated in the study. Participants completed a personal questionnaire and a body fat/muscle mass assessment before the race. The average speed was calculated on each lap over a 2500-m course. Tcore was continuously recorded via an ingestible temperature sensor (e-Celsius, BodyCap). Hypothermia-related dropouts (H group) were compared with finishers (nH group). Results: Average prerace Tcore was 37.5°C (0.3°C) (N = 21). 7 participants dropped out due to hypothermia (H, n = 7) with a mean Tcore at dropout of 35.3°C (1.5°C). Multiple logistic regression analysis found that body fat percentage and initial Tcore were associated with hypothermia (G2 = 17.26, P < .001). Early Tcore drop ≤37.1°C at 2500 m was associated with a greater rate of hypothermia-related dropouts (71.4% vs 14.3%, P = .017). Multiple linear regression found that body fat percentage and previous participation were associated with Tcore drop (F = 4.95, P = .019). There was a positive correlation between the decrease in speed and Tcore drop (r = .462, P < .001). Conclusions: During an OW 25-km competition at 20°C to 21°C, lower initial Tcore and lower body fat, as well as premature Tcore drop, were associated with an increased risk of hypothermia-related dropout. Lower body fat and no previous participation, as well as decrease in swimming speed, were associated with Tcore drop.

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

ObjectivesTo analyse 11 years of FIVB heat stress-monitoring data to determine the relative influence of the different environmental parameters in increasing the likelihood of a heat-related medical time-out (MTOheat).MethodsA total of 8530 matches were recorded. The referee measured air temperature, black globe temperature, relative humidity and wet-bulb globe temperature (WBGT) before the matches, and registered the MTOheat. The absolute humidity was computed at posteriori.ResultsThere were 20 MTOheat cases, but only 3 resulted in forfeiting the match. MTOheat incidence was not statistically impacted by sex (p=0.59). MTOheat cases were more prevalent during the games played in Asia during the 4th quarter of the year (pConclusionsThe current data showed that an increase in ambient or black globe temperature, but not relative humidity, increased the risk of a MTOheat; but that the absolute risk remained low in elite beach volleyball players. However, suffering or recovering from a recent illness may represent a risk factor for a MTOheat to lead to player forfeit.

This study identified the changes in hypertrophy/atrophy and mitochondrial-related signaling in human skeletal muscle following whole-body (WB) and localized single leg (SL) heat treatment. Nine active male participants were administered either 60 min of passive WB (44–50°C, 50% humidity) or SL (water-perfused suit at 49.5 ± 1.4°C) heat treatment at least 1 week apart in a counterbalanced order. The untreated leg during SL was considered as control (CON). Core, skin, and quadriceps muscle temperature were monitored throughout the experimental trials. Muscle microbiopsy samples were obtained prior to (PRE), and 30 min and 3 h post (POST) following heat treatment. Muscle temperature increased with time (p < 0.0001) in both WB and SL, with no differences between conditions (38.8 ± 0.5°C vs. 38.1 ± 0.6°C, p = 0.065). Core temperature increased only following WB, and was significantly higher compared with SL (39.1 ± 0.3°C vs. 37.1 ± 0.1, p < 0.0001). Compared with PRE, WB up-regulated the phosphorylation status of the majority of the Akt/mTOR pathway (Akt, mTOR, S6K1, rpS6, and p-eIF4E; p ≤ 0.050), with the exception of 4EBP1 (p = 0.139). WB also increased the mRNA of HSPs 72, 90, and 25 (all p < 0.021), and increased or tended to increase the phosphorylation of FOXO1 (p = 0.066) and FOXO3a (p = 0.038). In addition, most (NRF1, NRF2, COX2, and COX4-I2; all p ≤ 0.050), but not all (CS, Cyt c, and COX4-I1; p > 0.441) mRNA content indicative of mitochondrial biogenesis were increased following WB, with no changes evident in these parameters in SL or CON (all p > 0.090). These results indicate that 1 h of WB heat treatment enhanced anabolic (Akt/mTOR), mitochondrial, and cyto-protective signaling (HSP), with a concomitant possible inhibition of FOXO transcription factors.

The games of the XXXII Olympiad have been announced from 23 July to 8 August 2021, coinciding with the height of the Japanese summer. Heat acclimation/acclimatisation (HA) is the most important countermeasure athletes can adopt to safeguard their health and performance when competing in the heat. However, it is important for practitioners to recognise that repeated daily exposures to heat stress is a physiologically demanding endeavour. Prolonged heat exposure is characterised by increased thermal and cardiovascular strain, augmented glycogen utilisation and fluid losses, increased hormonal responses (ie, increased cortisol and catecholamine secretion), cytokinaemia and endotoxaemia, which may result in sleep and gastrointestinal disturbances, augmented lethargy and delayed physical recovery.1–3 For instance, consecutive days of training in the heat, particularly at high exercise intensities, can result in a state of over-reaching, despite signs of successful heat adaptation.4 It is therefore imperative to manage recovery when training in the heat, as accumulated fatigue may impact on the overall success of the HA programme, as well as interfere with the quality of other training sessions. This editorial aims to provide practitioners and coaches with an up-to-date synopsis of recovery strategies during HA (figure 1). Figure 1 Schematic illustration on the responses to repeated training in the heat and recovery strategies. Pre-exercise nutritional strategies are crucial in limiting fluid and electrolyte imbalance during exertional heat stress, such that HA sessions can be optimally …

As presented in the first editorial from this series, the Tokyo Olympics are expected to be the hottest in modern history.1 While the postponing from 2020 to 2021 will not change the period of the year, it will allow more time for athletes to plan for multiple heat acclimation camps. Indeed, heat acclimation is the most important countermeasure athletes can adopt to protect their health and enhance performance.2 Heat acclimation develops following repeated training in hot conditions in response to marked increases in core and skin temperature, skin blood flow and sweat rate.2 It is commonly accepted that daily training in the heat for 60–90 min for 2 weeks allows for adaptations to occur, including plasma volume expansion and enhanced heat dissipation.3 These adaptations contribute to lower the cardiovascular response associated with exercising in the heat and thus improve performance.3 The time course of these adaptations is relatively rapid with a large fraction of adaptations occurring during …

PurposeAssess the health status and heat preparation strategies of athletes competing in a World Cycling Championships held in hot ambient conditions (37°C, 25% relative humidity, wet-bulb-globe-temperature 27°C) and monitor the medical events arising during competition.Methods69 cyclists (~9% of the world championships participants) completed a pre-competition questionnaire. Illnesses and injuries encountered by the Athlete Medical Centre (AMC) were extracted from the race reports.Results22% of respondents reported illness symptoms in the 10 days preceding the Championships. 57% of respondents had previously experienced heat-related symptoms (cramping most commonly) while 17% had previously been diagnosed with exertional heat illness. 61% of the respondents had undergone some form of heat exposure prior to the Championships, with 38% acclimating for 5 to 30 days. In addition, several respondents declared to live in warm countries and all arrived in Qatar ~5 days prior to their event. 96% of the respondents used a pre-cooling strategy for the time trials and 74% did so before the road race (pConclusionsThe prevalence of previous heat illness in elite cyclists calls for team and event organisation doctors to be trained on heat illness management, including early diagnosis and rapid on-site cooling. Some cyclists had been exposed to the heat prior to the Championships, but few had a dedicated plan, calling for additional education on the importance of heat acclimation. Pre-cooling was widely adopted.

The 17th International Association of Athletics Federations (IAAF) World Championships were staged in Doha, Qatar from September 27 to October 6, 2019. In recent years, the Qatari capital Doha had an extensive history as a host of international athletics events from the first ever IAAF Grand Prix in 1997 to the 2010 IAAF World Indoor Championships and the Doha Diamond League. However, the 2019 IAAF World Championships has been the largest sporting event held in Doha to date in terms of global reach and impact. Doha welcomed over 200 countries and 2,000 athletes with ~10,000 international guests, 30,000 spectators from outside Qatar, and more than 2,000 media personnel.

We tested the hypothesis that backward downhill walking (eccentric component) impairs both voluntary activation and muscle contractile properties in the plantar flexors and delays recovery as compared to a gradient and distance-matched uphill walk. Fourteen males performed two 30-min walking exercises (velocity: 1 m/ s; grade: 25%; load: 12% of body weight), one downhill (DW) and one uphill (UP), in a counterbalanced order, separated by 6 weeks. Neuromuscular test sessions were performed before, after, 24-, 48- and 72-h post-exercise, including motor nerve stimulations during brief (5 s) and sustained (1 min) maximal isometric voluntary contractions of the plantar flexors. DW (-18.1 ± 11.1%, P .001), but not UP (-6.0 ± 7.7%, P =.15), decreased torque production during brief contractions for at least three days post-exercise (P .05). Voluntary activation during brief contractions decreased after DW (P .05), but not UP, and recovered by 24 h. Both UP (-9.3 ± 9.0%, P = .024) and DW (-25.6 ± 10.3%, P .001) decreased torque production during sustained contractions but voluntary activation (P = .001) was lower in DW than UP. Peak twitch torque and maximum rates of torque development and relaxation were equally reduced after UP and DW (P .05), and recovered by 24 h. DW induced an increase in muscle soreness with peak values observed 48 h post-walking (P .001), whereas post-UP exercise changes were non-significant (all P .05). Using a direct comparison, the capacity to drive the plantar flexors during sustained contractions remains sub-optimal during the three-day recovery period in response to non-exhaustive, downhill backward walking in reference to an uphill exercise matched for distance covered.

The environmental conditions during Tokyo Summer Olympics are expected to be comparable to previous years1 with air temperatures and relative humidity in excess of 30°C and >70%, respectively.2 A previous consensus statement highlighted the main considerations for prevention, recognition and treatment of exertional heat illnesses,3 while the impact of extreme heat on athletic performance is examined elsewhere.4 Cooling strategies applied before and during the exercise in the heat have been shown to help athletes better maintain their performances5 by lowering body heat storage and core body temperature.6 The Tokyo Games have also encouraged the development of wearable technologies that could also be used for prevention, diagnosis and real-time monitoring of skin and core temperature and will be trialled during competition in Tokyo 2020. Here, we aim to highlight the potential application of current novel technologies and the associated ethical dilemmas regarding their effectiveness, the use of athlete biodata and predictive algorithms. Recently, manufacturers have developed new cooling wearables that have the potential to reduce exertional heatstroke (EHS) risk and to reduce the decline in athletic performance in hot environments, with the most novel summarised in table 1. Here, the focus is not on cooling …