Exercise in the heat II

Stephen Burns

Environmental Exercise Physiology

SS3111

1
 Overview
• Introduction
• Definitions
• Behavioural strategies
• Aerobic fitness
• Heat acclimatisation
• Cooling strategies
• Clothing
• Summary
• Recommended reading

2
Introduction

3
 Minimising risk for exertional heat illness
CES
• Heat illness during exercise
may take various forms:
• Exercise associated
muscle cramps (heat
cramps)
• Heat exhaustion
• Heat stroke

• What strategies can be

implemented to
sustain/enhance performance
during training and
competition in the heat, and (Nichols, Current Reviews in Musculoskeletal Medicine, 7:355-365, 2014)
minimize the risk of exertional
heat illness?

4
 Available strategies
• Behavioural
• Aerobic fitness
• Heat acclimatization
• Cooling strategies
• Hydration

5
Definitions

6
 Definitions
• Acclimatisation: refers to physiological adaptations that occur in naturally hot
ambient conditions.

• Acclimation: refers to physiological adaptations that occur in artificially hot indoor

environments.

• Heat stress: refers to environmental (including clothing) and metabolic conditions

that tend to increase body temperatures.

• Heat strain: refers to physiological (e.g. body temperature) consequences of heat

stress.

• Compensable heat stress: exists when heat loss occurs at a rate in balance with
heat production so that a steady-state core temperature can be achieved at a
sustainable level for a requisite activity.

• Uncompensable heat stress: occurs when the individual’s evaporative cooling

requirements exceed the environment’s evaporative cooling capacity.
requirements > capacity
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Behavioural strategies

8
 Cooling breaks and rest periods
• Rest breaks provide an opportunity for body
temperature to reduce via reduced heat
production.

• Several sporting bodies (ITF, ITF-WTA, FIFA –

see lecture 2 for list) provide additional
breaks for sportspersons when the heat stress
is high (wet bulb-globe temperature).

• This strategy is also useful for individuals in

the military or in professions such as
From: Lim et al, Annals of Academic Medicine Singapore, 37:347-353, 2008 firefighting, ships stokers, steel workers.
Note: Data show a 12-km forced march in 10 male SAF recruits carrying
an ~28-kg load under an ambient temperature of 30°C and relative • May not be a realistic strategy in many
humidity of 65%. Marching was completed in three 45-min stages exercise events.
interspersed with a 15-min and 30-min rest after stage 1 and 2,
respectively.
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Aerobic fitness

10
 Aerobic fitness
• In a recent meta-analysis, aerobic fitness
stood out as the most important mitigation
strategy to favourably alter core temperature
for endurance exercise in the heat.

• Aerobic exercise training is best combined

with heat acclimation/acclimatisation for full
benefits for the individual.

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From: Alhadad et al, Frontiers in Physiology, 10:71, 2019
Heat acclimatisation

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 Habituation to hot environments
• “In 1768, James Lind published the first
report on the ability of humans to adapt to
environmental heat. He reported that when
relocating to East and West Indian climates,
Europeans were at first adversely affected by
the environment, but over a period of time,
habituated and eventually lived
comfortably.”

(Périard et al., Scandinavian Journal of Medicine & Science

in Sports, 25(S1):20-38, 2015)
James Lind (1716-1794)
(Dunn, Archives of Disease in
Childhood, 76:F64-F65, 1997)

Lind J, An Essay on Diseases, 1788 (4th Edition).

From: London School of Hygiene and Tropical Medicine

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 Habituation to hot environments

• Thermal comfort in resting individuals

changes when acclimatized to a tropical
(hot and humid) climate.

• Comfort level is altered in relation to

specific humidity (i.e. grams of water per
kilogram of air), dry bulb temperature,
and relative humidity.

(Périard et al., Scandinavian Journal of Medicine & Science in

Sports, 25(S1):20-38, 2015 – Adapted from Folk, Textbook of
Environmental Physiology, Philadelphia: Lea & Febiger, 1974)

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 Physiological adaptations to exercise in hot
environments IRRC

(Périard et al., Scandinavian

Journal of Medicine &
Science in Sports, 25(S1):20-
38, 2015)

• Several important physiological adaptations occur with heat acclimatisation that improve thermal comfort
and endurance performance. Improved sweating, reduced core temperature, reduced skin temperature and
changes to the cardiovascular system are among the most important changes.
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 Changes to sweat rate and composition
• Adaptations to sweat rate and composition
occur with heat acclimatization.

• Body core temperature threshold for the

onset of sweating is reduced.

• The sweat rate (slope) is increased.

• Concomitantly, the body core temperature

threshold for onset of cutaneous (skin)
vasodilation is reduced, whereas skin blood
flow sensitivity (i.e. slope) is increased.

(Périard et al., Scandinavian Journal of Medicine & Science • Sweat sodium and chloride concentrations
in Sports, 25(S1):20-38, 2015) are reduced.
HA, heat acclimation.

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 Temperature and cardiovascular adjustments
• Aerobic training in temperate
environments can reduce
physiological strain and improve
exercise capabilities in the heat.

• Heat acclimation is the preferred

method of adaptation.

• Core and skin temperature are

lowered with acclimation.

• Heart rate reduces whilst stroke

volume increases. Cardiac output
(Sawka et al., Comprehensive Physiology, 1:1883-1928, 2011) improves and plasma volume
Note: Participants completed an initial exercise heat test (4 h
increases with heat acclimation.
at 35% of maximum aerobic power). Then 11-wks training of
1-h for 4-d/wk in temperate conditions. Finally, 8-d of exercise
training for 4-h/d at 35% of maximum aerobic power in heat.
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 Cardiorespiratory and performance changes
Acclimation to the heat
leads to improvements
• Acclimation to the heat leads to in MMLT

improvements in maximum oxygen uptake,

increases in lactate threshold, increases in
maximal cardiac output and improvements
in time trial performance.
depends on
• The magnitude of any heat adaptations FIDN

depend on the intensity, duration,

frequency, and number of heat exposures.

Note: Heat acclimation group received 10-d at 40°C

for 100-min at 50% of maximum oxygen uptake.
Control group completed same exercise for 10-d in a
temperate climate. Both groups tested pre and post in
hot and temperate environments.

(Sawka et al., Comprehensive Physiology, 1:1883-1928, 2011)

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 Environment
• Heat acclimatisation in dry heat improves
exercise in humid heat and vice versa.

• However, acclimatization in humid heat

evokes higher skin temperatures and
circulatory adaptations, potentially increasing
maximum skin wettedness and therefore
maximum rate of evaporative heat loss.

• Athletes unable to travel to naturally hot

ambient conditions (acclimatization) can train
in artificially hot indoor environments
(acclimation).

• Training outdoors is more specific and allows

athletes to experience the exact nature of (Périard et al., Scandinavian Journal of Medicine & Science in
heat stress. Sports, 25(S1):20-38, 2015)
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 Time course of adaptations to heat stress
• Heat acclimation occurs rapidly
– 75-80% of adaptations in first
4-7 days.

• Considered:
- short-term: < 7 days
- medium-term: 8-14 days
- long-term: > 15 days

• Exercise in the heat is the most

effective method for
developing heat acclimation
but passive heat exposure can
(Périard et al., Scandinavian Journal of Medicine & Science in Sports, 25(S1):20-38, 2015) also result in some adaptation.

• Remember: To achieve optimal adaptation, work rate and environmental conditions should closely
replicate those of the competition setting.
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 Decay
• Heat acclimation is transient and
gradually disappears if not maintained
by repeated heat exposures.

• Heart rate improvements are lost more

rapidly than thermoregulatory
responses.

• There is no agreement on the rate of

decay. Aerobic fitness and regular
exercise appear to contribute to
(Flouris et al., European Journal of Applied Physiology, 114:2119-2128, 2014)
retaining the benefits of heat
Note: Data show 14-d of heat acclimation followed by 14-d of no exercise in acclimation for longer.
the heat.

• However, the rate of decay is generally slower than its induction allowing maintenance of most benefits for
2-4 weeks. Moreover, (re) acclimatization during this period is faster than the first acclimatization.
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 Heat acclimatization strategies

From: Racinais et al, Scandinavian Journal of Medicine and Science in Sports, 25(S1):6-19, 2015

• Heat acclimatisation strategies will vary depending on the stage of training and in relation to
competition performance.

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Heat as a training stimulus
• There has been recent movement toward examining exercise
training in the heat as a stimulus to improve performance.

• Some studies have shown improvements in maximum

TCM-LS
oxygen uptake, time trial performance, lactate threshold,
cardiac output and stroke volume with heat acclimation.

• Athletes may consider using training camps in hot ambient

conditions to improve physical performance both in-season
and pre-season.

• However, training quality should not be compromised.

• Experienced athletes requiring a novel stimulus may benefit

most.
From: Lorenzo et al, Journal of Applied Physiology, 25(S1):6-19, 2015
Note: Data showed 12 trained cyclists after 10-d heat acclimation vs 8 matched
controls after 10-d in a cool environment.
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Cooling strategies

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 Cold water immersion (CWI)
• Heat loss to water is four times greater than that to air at
the same temperature.

• CWI may take different forms e.g. prolonged duration in

tepid water (22-30°C; shorter duration in cooler water (17-
18°C); cold shower or water spray/mist; recovery cooling
between exercise bouts.

• Most are effective at reducing skin temperature and often

core temperature. Concomitant increases in performance
have been noted.
(Kay et al, Journal of Sports Sciences, 17:937-944, 1999

Note: Data show 30-min of self-paced cycling under

• Once criticism is that blood flow to the active musculature
warm and humid conditions (31°C and 60% RH) after may be reduced causing the athlete the need to re-warm
either pre-cooling (water immersion) or control. up before competition.

• An alternative is selected cooling or part-body immersion

of non-active body parts.
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 Cooling garments

(Arngrímsson et al, Journal of Applied Physiology, 96:1867-1874, 2004)

Note: Data show 5-km time trial core temperature after pre-cooling with ice vest or wearing t-shirt (control).
• Ice-cooling jackets are a development from the earlier practice of using iced towels for cooling athletes
before or during exercise.

• Cooling garments are practical in reducing skin temperature and can be worn during warm-up and recovery.

• Data shows they are effective in reducing thermal strain during early stages of exercise but they can
improve exercise performance. 26
 Cold fluids and ice slurry
• Cold fluid or ice slurry ingestion leads to internal
heat transfer which may represent an additional
method to the four avenues of heat transfer at the
skin surface.

• However, ingestion of cold fluids appears to lead to

transient reductions in skin blood flow and sweating
(Jay & Morris, Sports Medicine, 48(S1):S17-S29, 2018) which reduce evaporative and dry heat loss and
negate the additional internal heat loss.

• These strategies may be of most use in hot and

humid climates where evaporative cooling is
impaired or for athletes with physiological
disruptions to sweating such as spinal cord injury or
burn injuries as their capacity for skin surface
evaporative heat loss is lower.
Note: Data show 200-m pacing over 10-km after ice slurry vs ambient
temperature drink.
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(Yeo et al, International Journal of Sports Medicine, 33:859-866, 2012)
 Combining strategies

(Duffield et al, Journal of Strength and Conditioning Research, 23:2524-2532, 2009)

Note: Data are from 30-min intermittent sprint conditioning test with pre-cooling (ice vests, cold neck towels and ice pack to
quadriceps) or no cooling.

• Combining techniques (i.e. both external and internal cooling strategies) has a higher cooling capacity
than the same techniques used in isolation, allowing for a greater benefit on exercise performance.

• For athletes this can be achieved by combining simple methods such as ingestion of ice slurry, wearing
cooling vests, and providing fanning. 28
Clothing

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 Clothing
• Dry clothing retards heat exchange. Evaporative heat loss
occurs when clothing is wet!

• Cottens and linens readily absorb moisture.

• Sweatshirts, rubber or plastic produce high relative

humidity close to the skin.

• Moisture-wicking garments optimally transfer heat and

moisture.

• Dark colours absorb light and add to radiant heat; light

colours reflect heat rays away from the body.

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 American football
• In American football the uniform retards
heat loss and adds to the weight of the
athlete.

Note: Data show walking in shorts only (blue), with

shorts and a pack equivalent in weight to an American
football uniform (yellow), or wearing the uniform
(orange).

From: Exercise Physiology: Energy, Nutrition and

Human Performance. McArdle WD, Katch FI, Katch VL
7th Edition, 2010. Lippincott Williams and Wilkins.

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 Summary I
• Strategies to sustain/enhance performance during training and competition in the heat, and
minimize the risk of heat illnesses include changing behaviour, improving aerobic fitness,
acclimatization, body cooling, and fluid intake.

• Changes in behaviour can mitigate heat strain to the greatest extent. Whilst rest breaks are a
useful strategy to reduce body temperature used in certain sports, the military and selected
vocations they may not be a realistic option in many sports.

• Aerobic fitness is suggested to be one of the most important measures to favourably alter core
temperature for endurance exercise in the heat but improving fitness whilst training in hot and
humid environments is more helpful.

• Heat acclimatization/acclimation can help reduce physiological strain and optimize performance
in the heat.

• Heat acclimatization should comprise repeated exercise-heat exposures over 1-2 weeks.

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 Summary II
• Heat acclimatization results in increased sweating, reduced core temperature, reduced skin
temperature, changes to the cardiovascular system and improved endurance performance.

• Cold water immersion reduces skin and core temperature but may reduce blood flow to active
musculature – part-body immersion may be a better strategy.

• Cooling garments reduce skin temperature and can be worn during warm-up and recovery to aid
performance.

• Cold fluid or ice slurry ingestion leads to internal heat transfer but also transient reductions in
skin blood flow and sweating which negate any additional internal heat loss. Optimal use may
be in environment where evaporative cooling is impaired or for athletes with physiological
disruptions to sweating.

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 Summary III
• Combining cooling strategies is a useful strategy to aid performance.

• The type of clothing worn should be a consideration for athletes competing/training in the heat.

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 Recommended reading
• Exercise Physiology: Energy, Nutrition and Human Performance. McArdle WD, Katch FI,
Katch VL 8th Edition, 2015. Lippincott Williams and Wilkins. Chapter 25: Exercise and
Thermal Stress. Pgs. 615-642.

• Exercise Physiology: Theory and Application to Fitness and Performance. Powers SK, Howley
WT. 8th Edition, 2012. McGraw-Hill. Chapter 12: Temperature Regulation. Pgs.261-280.

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