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Lawrence E Armstrong,1,2 Evan C Johnson,3 William M Adams,4– 7 John F Jardine2 1Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA; 2Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA; 3Division of Kinesiology & Health, University of Wyoming, Laramie, WY, USA; 4Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, USA; 5United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, USA; 6Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA; 7School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine (NCSEM), Loughborough, UKCorrespondence: Lawrence E Armstrong, University of Connecticut, Department of Kinesiology, Human Performance Laboratory, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269, USA, Email lawrence.armstrong@uconn.eduAbstract: Few previous epidemiological studies, sports medicine position statements, and expert panel consensus reports have evaluated the similarities and differences of hyperthermia and exertional heatstroke (EHS) during endurance running, cycling, open water swimming, and triathlon competitions. Accordingly, we conducted manual online searches of the PubMed and Google Scholar databases using pre-defined inclusion criteria. The initial manual screenings of 1192 article titles and abstracts, and subsequent reviews of full-length pdf versions identified 80 articles that were acceptable for inclusion. These articles indicated that event medical teams recognized hyperthermia and EHS in the majority of running and triathlon field studies (range, 58.8 to 85.7%), whereas few reports of hyperthermia and EHS appeared in cycling and open water swimming field studies (range, 0 to 20%). Sports medicine position statements and consensus reports also exhibited these event-specific differences. Thus, we proposed mechanisms that involved physiological effector responses (sweating, increased skin blood flow) and biophysical heat transfer to the environment (evaporation, convection, radiation, and conduction). We anticipate that the above information will help race directors to distribute pre-race safety advice to athletes and will assist medical directors to better allocate medical resources (eg, staff number and skill sets, medical equipment) and optimize the management of hyperthermia and EHS.Keywords: heat illness, epidemiology, pathophysiology, thermoregulation, athlete

Recreational enthusiasts and athletes often are advised to abstain from consuming caffeinated beverages (CB). The dual purposes of this review are to (a) critique controlled investigations regarding the effects of caffeine on dehydration and exercise performance, and (b) ascertain whether abstaining from CB is scientifically and physiologically justifiable. The literature indicates that caffeine consumption stimulates a mild diuresis similar to water, but there is no evidence of a fluid-electrolyte imbalance that is detrimental to exercise performance or health. Investigations comparing caffeine (100-680 mg) to water or placebo seldom found a statistical difference in urine volume. In the 10 studies reviewed, consumption of a CB resulted in 0-84% retention of the initial volume ingested, whereas consumption of water resulted in 0-81% retention. Further, tolerance to caffeine reduces the likelihood that a detrimental fluid-electrolyte imbalance will occur. The scientific literature suggests that athletes and recreational enthusiasts will not incur detrimental fluid-electrolyte imbalances if they consume CB in moderation and eat a typical U.S. diet. Sedentary members of the general public should be at less risk than athletes because their fluid losses via sweating are smaller. [ABSTRACT FROM AUTHOR]

This research extends previous plant modelling using L-systems by means of a novel arrangement comprising synthetic plants and a refined global wheat dataset in combination with a synthetic inference application. The study demonstrates an application with direct recognition of real plant stereotypes, and augmentation via a plant-wide stochastic growth variation structure. The study showed that the automatic annotation and counting of wheat heads using the Global Wheat dataset images provides a time and cost saving over traditional manual approaches and neural networks. This study introduces a novel synthetic inference application using a plant-wide stochastic variation system, resulting in improved structural dataset hierarchy. The research demonstrates a significantly improved L-system that can more effectively and more accurately define and distinguish wheat crop characteristics.

Heat and hydration may not be the first considerations of tournament directors, coaches, and athletes, when preparing for tennis. However, health risks and performance derementis are associated with both the demands of tennis, particularly during multi-day tournaments, predispose players to increased core body temperature and large fluid losses. This combination of factors can lead to decreased performance and exertional heat illnesses such as heat cramps, heat syncope, or heat exhaustion. By identifying individual fluid and salt needs, designing a replacement plan, and reducing core body temperature during and between matches, athletes can optimize performance while minimizing risk of heat illness. [ABSTRACT FROM AUTHOR]

It is well established that resistance exercise can damage muscle tissue, but the combined effects of hypohydration and resistance exercise on muscle damage are unclear. Two common circulating markers of muscle damage, myoglobin (Mb) and creatine kinase (CK) may be attenuated by fluid ingestion post-exercise. The purpose of this study was to examine the combined effect of resistance exercise and hydration state on muscle damage. Seven healthy resistance-trained males (age = 23 +/- 4 years; body mass = 87.8 +/- 6.8 kg; body fat = 11.5 +/- 5.2%) completed 3 identical resistance exercise bouts (6 sets of up to 10 repetitions of the back squat) in different hydration states: euhydrated (HY0), hypohydrated approximately 2.5% body mass (HY2.5), and hypohydrated approximately 5.0% body mass (HY5). Subjects achieved desired hydration states via controlled water deprivation, exercise-heat stress, and fluid intake. Both Mb and CK were measured during euhydrated rest (PRE). Mb was also measured immediately post-exercise, 1 hour (+1H) and 2 hours (+2H) post-exercise; CK was measured at 24 and 48 hours post-exercise. Body mass decreased 0.2 +/- 0.4%, 2.4 +/- 0.4%, and 4.8 +/- 0.4% during HY0, HY2.5, and HY5, respectively. Mb concentrations increased significantly (effect size >or=1, p < 0.05) from PRE (2.6 +/- 1.1, 3.5 +/- 2.8, and 3.2 +/- 1.6 nmol x L(-1)) to +1H (5.3 +/- 3.4, 6.8 +/- 3.2, and 7.6 +/- 2.8 nmol x L(-1)), and +2H (5.5 +/- 3.8, 6.2 +/- 3.0, and 7.2 +/- 3.0 nmol x L(-1)) for HY0, HY2.5, and HY5, respectively, but were not significantly different between trials. CK concentrations remained within the normal resting range at all time points. Thus, hypohydration did not enhance muscle damage following the resistance exercise challenge. Despite these results, athletes are encouraged to commence exercise in a euhydrated state to maximize endogenous hormonal, mechanical, and metabolic benefits. [ABSTRACT FROM AUTHOR]

Recent advances in molecular biology have elucidated some of the mechanisms that regulate skeletal muscle growth. Logically, muscle physiologists have applied these innovations to the study of resistance exercise (RE), as RE represents the most potent natural stimulus for growth in adult skeletal muscle. However, as this molecular-based line of research progresses to investigations in humans, scientists must appreciate the fundamental principles of RE to effectively design such experiments. Therefore, we present herein an updated paradigm of RE biology that integrates fundamental RE principles with the current knowledge of muscle cellular and molecular signalling. RE invokes a sequential cascade consisting of: (i) muscle activation; (ii) signalling events arising from mechanical deformation of muscle fibres, hormones, and immune/inflammatory responses; (iii) protein synthesis due to increased transcription and translation; and (iv) muscle fibre hypertrophy. In this paradigm, RE is considered an 'upstream' signal that determines specific downstream events. Therefore, manipulation of the acute RE programme variables (i.e. exercise choice, load, volume, rest period lengths, and exercise order) alters the unique 'fingerprint' of the RE stimulus and subsequently modifies the downstream cellular and molecular responses. [ABSTRACT FROM AUTHOR]

The ergogenic effects of caffeine on athletic performance have been shown in many studies, and its broad range of metabolic, hormonal, and physiologic effects has been recorded, as this review of the literature shows. However, few caffeine studies have been published to include cognitive and physiologic considerations for the athlete. The following practical recommendations consider the global effects of caffeine on the body: Lower doses can be as effective as higher doses during exercise performance without any negative coincidence; after a period of cessation, restarting caffeine intake at a low amount before performance can provide the same ergogenic effects as acute intake; caffeine can be taken gradually at low doses to avoid tolerance during the course of 3 or 4 days, just before intense training to sustain exercise intensity; and caffeine can improve cognitive aspects of performance, such as concentration, when an athlete has not slept well. Athletes and coaches also must consider how a person's body size, age, gender, previous use, level of tolerance, and the dose itself all influence the ergogenic effects of caffeine on sports performance. [ABSTRACT FROM AUTHOR]

Significant scientific evidence documents the deleterious effects of hypohydration (reduced total body water) on endurance exercise performance; however, the influence of hypohydration on muscular strength, power and high-intensity endurance (maximal activities lasting >30 seconds but <2 minutes) is poorly understood due to the inconsistent results produced by previous investigations. Several subtle methodological choices that exacerbate or attenuate the apparent effects of hypohydration explain much of this variability. After accounting for these factors, hypohydration appears to consistently attenuate strength (by ~=2%), power (by ~=3%) and high-intensity endurance (by ~10%), suggesting alterations in total body water affect some aspect of force generation. Unfortunately, the relationships between performance decrement and crucial variables such as mode, degree and rate of water loss remain unclear due to a lack of suitably uninfluenced data. The physiological demands of strength, power and high-intensity endurance couple with a lack of scientific support to argue against previous hypotheses that suggest alterations in cardiovascular, metabolic and/or buffering function represent the performance-reducing mechanism of hypohydration. On the other hand, hypohydration might directly affect some component of the neuromuscular system, but this possibility awaits thorough evaluation. A critical review of the available literature suggests hypohydration limits strength, power and high-intensity endurance and, therefore, is an important factor to consider when attempting to maximise muscular performance in athletic, military and industrial settings. [ABSTRACT FROM AUTHOR]

PURPOSE: Although running economy (RE) is recognized as an integral component of successful endurance performance and is affected by numerous factors, little is known about the influence of body water loss on RE. This investigation examined the effects of hypohydration (HY) on RE and associated physiological responses. METHODS: Ten highly trained collegiate distance runners (mean +/- SD; age, 20 +/- 3 yr; height, 178.5 +/- 6.3 cm; body mass, 66.7 +/- 5.4 kg; VO2max, 66.5 +/- 4.1 mL x kg(-1) x min(-1)) participated in four experiments on separate days, twice in a euhydrated (EU) and twice in a HY state (-5.5 and -5.7% body mass loss achieved during 24 h). At each hydration level, subjects performed one 10-min treadmill run per day (23 degrees C environment), at either 70% VO2max (EU 70% or HY 70%) or 85% VO2max (EU 85% or HY 85%) in a randomized, repeated-measures design. Cardiopulmonary, metabolic, thermal, hormonal, and perceptual variables were measured. RESULTS: No between-treatment differences existed for RE (EU 70%, 46.3 +/- 3.2; HY 70%, 47.2 +/- 3.8; EU 85%, 58.6 +/- 2.8; HY 85%, 58.9 +/- 4.1 mL x kg(-1) x min(-1)), postexercise plasma lactate concentration (EU 70%, 1.9 +/- 0.6; HY 70%, 1.8 +/- 0.6; EU 85%, 6.5 +/- 3.5; HY 85%, 6.4 +/- 3.5 mmol x L(-1)), or rating of perceived exertion. HY resulted in a greater (P < 0.05 to 0.001) heart rate (HR), rectal temperature, and plasma norepinephrine concentration (NE), concurrent with reduced cardiac output, stroke volume, and respiratory exchange ratio. CONCLUSION: HY did not alter the RE or lactate accumulation of endurance athletes during 10 min of exercise at 70 and 85% VO2max. These findings indicate that HY had no effect on RE, but that it increased physiological strain in a 23 degrees C environment. [ABSTRACT FROM AUTHOR]

Objective: To present recommendations to optimize the fluid-replacement practices of athletes. Background: Dehydration can compromise athletic performance and increase the risk of exertional heat injury. Athletes do not voluntarily drink sufficient water to prevent dehydration during physical activity. Drinking behavior can be modified by education, increasing accessibility, and optimizing palatability. However, excessive overdrinking should be avoided because it can also compromise physical performance and health. We provide practical recommendations regarding fluid replacement for athletes. Recommendations: Educate athletes regarding the risks of dehydration and overhydration on health and physical performance. Work with individual athletes to develop fluidreplacement practices that optimize hydration status before, during, and after competition. [ABSTRACT FROM AUTHOR]

Hyponatremia is a serious medical condition in which blood sodium (NA+) levels are below 130 mmol[middle dot]L-1. This can occur when an individual drinks more fluid than necessary or large amounts of Na+ are lost through sweat. Symptoms include disorientation, altered mental status, coma, headache, vomiting, bloating, lethargy, and swelling of the extremities. These symptoms may develop during exercise or several hours after exercise is discontinued. Reducing the risk of hyponatremia includes the ingestion of Na+ containing fluids and the avoidance of overdrinking. Coaches and athletes should be aware of the signs and symptoms of hyponatremia, how to reduce the risk of hyponatremia, and when to contact medical professionals. [ABSTRACT FROM AUTHOR]

Context: Rectal temperature is recommended by the National Athletic Trainers' Association as the criterion standard for recognizing exertional heat stroke, but other body sites commonly are used to measure temperature. Few authors have assessed the validity of the thermometers that measure body temperature at these sites in athletic settings. Objective: To assess the validity of commonly used temperature devices at various body sites during outdoor exercise in the heat. Design: Observational field study. Setting: Outdoor athletic facilities. Patients or Other Participants: Fifteen men and 10 women (age = 26.5 ± 5.3 years, height = 174.3 ± 11.1 cm, mass = 72.73 ± 15.95 kg, body fat = 16.2 ± 5.5%). Intervention(s): We simultaneously tested inexpensive and expensive devices orally and in the axillary region, along with measures of aural, gastrointestinal, forehead, temporal, and rectal temperatures. Temporal temperature was measured according to the instruction manual and a modified method observed in medical tents at local road races. We also measured forehead temperatures directly on the athletic field (other measures occurred in a covered pavilion) where solar radiation was greater. Rectal temperature was the criterion standard used to assess the validity of all other devices. Subjects' temperatures were measured before exercise, every 60 minutes during 180 minutes of exercise, and every 20 minutes for 60 minutes of postexercise recovery. Temperature devices were considered invalid if the mean bias (average difference between rectal temperature and device temperature) was greater than ±0.27°C (±0.5°F). Main Outcome Measure(s): Temperature from each device at each site and time point. Results: Mean bias for the following temperatures was greater than the allowed limit of ±0.27°C (-0.5°F): temperature obtained via expensive oral device (±1.20°C [±2.17°F]), inexpensive oral device (-1.67°C [-3.00°F]), expensive axillary device (-2.58°C [-4.65°F]), inexpensive axillary device (-2.07°C [-3.73°F]), aural method (-1.00°C [-1.80°F]), temporal method according to instruction manual (-1.46°C [-2.64°F]), modified temporal method (-1.36°C [-2.44°F]), and forehead temperature on the athletic field (0.60°C [1.08°F]). Mean bias for gastrointestinal temperature (-0.19°C [-0.34°F]) and forehead temperature in the pavillion (-0.14°C [-0.25°F]) was less than the allowed limit of ±0.27°C (±0.5°F). Forehead temperature depended on the setting in which it was measured and showed greater variation than other temperatures. Conclusions: Compared with rectal temperature (the criterion standard), gastrointestinal temperature was the only measurement that accurately assessed core body temperature. Oral, axillary, aural, temporal, and field forehead temperatures were significantly different from rectal temperature and, therefore, are considered invalid for assessing hyperthermia in individuals exercising outdoors in the heat. [ABSTRACT FROM AUTHOR]

Context: Creatine monohydrate (CrM) use is highly prevalent in team sports (eg, football, lacrosse, ice hockey) and by athletes at the high school, college, professional, and recreational levels. Concerns have been raised about whether creatine use is associated with increased cramping, muscle injury, heat intolerance, and risk of dehydration.Objective: To assess whether 1 week of CrM supplementation would compromise hydration status, alter thermoregulation, or increase the incidence of symptoms of heat illness in dehydrated men performing prolonged exercise in the heat.Design: Double-blind, randomized, crossover design.Setting: Human Performance Laboratory.Patients or Other Participants: Twelve active males, age = 22 +/- 1 year, height = 180 +/- 3 cm, mass = 78.8 +/- 1.2 kg, body fat = 9 +/- 1%, Vo(2)peak = 50.9 +/- 1 ml.kg(-1).min(-1).Intervention(s): Subjects consumed 21.6 g.d(-1) of CrM or placebo for 7 days, underwent 48 +/- 10 days of washout between treatments, and then crossed over to the alternate treatment in the creatine group. On day 7 of each treatment, subjects lost 2% body mass by exercising in 33.5 degrees C and then completed an 80-minute exercise heat-tolerance test (33.5 degrees C +/- 0.5 degrees C, relative humidity = 41 +/- 12%). The test consisted of four 20-minute sequences of 4 minutes of rest, alternating a 3-minute walk and 1-minute high-intensity run 3 times, and walking for 4 minutes.Main Outcome Measures: Thermoregulatory, cardiorespiratory, metabolic, urinary, and perceptual responses.Results: On day 7, body mass had increased 0.88 kg. No interaction or treatment differences for placebo versus CrM during the exercise heat-tolerance test were noted in thermoregulatory (rectal temperature, 39.3 +/- 0.4 degrees C versus 39.4 +/- 0.4 degrees C) cardiorespiratory (Vo(2), 21.4 +/- 2.7 versus 20.0 +/- 1.8 ml.kg(-1).min(-1); heart rate, 192 +/- 10 versus 192 +/- 11 beats.min(-1); mean arterial pressure, 90 +/- 9 versus 88 +/- 5 mm Hg), metabolic (lactate, 6.7 +/- 2.7 versus 7.0 +/- 3.0 mmol.L(-1)), perceptual thirst (thirst, 7 +/- 1 versus 7 +/- 1; thermal sensation, 8 +/- 2 versus 8 +/- 1; rating of perceived exertion, 17 +/- 3 versus 17 +/- 2), plasma glucose (0-20 minutes of exercise heat-tolerance, 6.5 +/- 1.2 versus 6.8 +/- 0.8 mmol.L(-1)), plasma (297 +/- 5 versus 300 +/- 4 mOsm.kg(-1)) and urine (792 +/- 117 versus 651 +/- 134 mOsm.kg(-1)), urine specific gravity (1.025 +/- 0.003 versus 1.030 +/- 0.005) and urine color (7 +/- 1 versus 6 +/- 1) measures were increased during CrM. Environmental Symptoms Questionnaire scores were similar between treatments. The levels of dehydration incurred during dehydration and the exercise heat-tolerance test were similar and led to similar cumulative body mass losses (-4.09 +/- 0.53 versus -4.38 +/- 0.58% body mass).Conclusions: Short-term CrM supplementation did not increase the incidence of symptoms or compromise hydration status or thermoregulation in dehydrated, trained men exercising in the heat. [ABSTRACT FROM AUTHOR]

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration ( U D; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or U D is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LEA is a Board of Trustees member and occasional consultant for the Drinking Water Research Foundation, Alexandria, VA; MFB – no conflicts of interest; CXM – is an occasional consultant for and has an active research grant with Kraft Heinz Co.; SAK has active research grants during the past 36 months from the National Science Foundation, USDA, Kraft Heinz, Unilever, and Standard Process. During this time, he was a lead research aerospace physiologist at Luke Air Force Base, AZ and served as a member of the science advisory board for Hyduro Inc, Zico Rising, and Rockley Photonics. He has also provided scientific consultation to the American Beverage Association, Unilever, Pepsico, and Kraft Heinz Co.

Purpose: The purpose was to determine the effect of a single-dose prophylactic ibuprofen use before a 164-km road cycling event in high ambient temperature on the circulating cytokine and leukocyte responses. Methods: Twenty-three men (53 ± 8 y, 172.0 ± 22.0 cm, 85.1 ± 12.8 kg, 19.6 ± 4.4% body fat) completed a 164-km self-paced recreational road cycling event in a hot, humid, sunny environment (WBGT = 29.0 ± 2.9°C) after consuming 600 mg of ibuprofen (n = 13) or a placebo (n = 10). Blood samples were obtained one to two hours before (PRE) and immediately after (POST) the event, and analyzed for concentrations of circulating cytokines interleukins (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, GM-CSF, IFN-γ, and TNF-α and leukocytes (total leukocytes, granulocytes, monocytes, and lymphocytes). Results: Event completion time was 400.2 ± 74.8 min. Concentrations of all cytokines (except IL-1β, IL-2, IL-5, IL-12, GM-CSF, and IFN-γ) and of all leukocyte subsets increased from PRE to POST. Ibuprofen ingestion attenuated the increase in IL-10 (86% increase with Ibuprofen; 270% increase with placebo). Conclusions: Consuming 600 mg of Ibuprofen prior to a 164-km road cycling event in a hot-humid environment attenuates exercise-induced increases in the concentration of the anti-inflammatory cytokine IL-10, but does not alter the effect of the exercise event on concentrations of other circulating cytokines or leukocyte subset concentrations.

Abstract: Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care., (Copyright © 2023 by the American College of Sports Medicine.)

Background: Athletes training in heat experience physiological and perceptual symptoms that risk their safety and performance without adaptation., Purpose: We examined the changes in environmental symptoms, assessed with the Environmental Symptoms Questionnaire (ESQ), during heat acclimatization (HAz), heat acclimation (HA), and intermittent heat training (HT)., Methods: Twenty-seven participants (mean ± standard deviation [M ± SD], age of 35 ± 12 y, VO 2max of 57.7 ± 6.8 mL·kg -1 ·min -1 ) completed five trials involving 60 mins of running (60% vVO 2max ) followed by a 4 km time trial in heat (M ± SD, temperature of 35.5 ± 0.7 °C, humidity of 46.4 ± 1.5%). The trials occurred at baseline, post-HAz, post-HA, at week 4 of HT (post-HT4), and at week 8 of HT (post-HT8). The participants completed HT once/week (HT MIN ), completed HT twice/week (HT MAX ), or did not complete HT (HT CON ). ESQ symptoms, thermal sensation (TS), and heart rate (HR) were measured pre- and post-trial., Results: Post-ESQ symptoms improved post-HA (3[0.40, 4.72], p = 0.02) and post-HAz (3[0.35, 5.05], p = 0.03) from baseline. During HT, symptoms improved in the HT MAX group and worsened in the HT MIN and HT CON groups. Symptoms improved in the HT MAX group versus the HT CON group at post-HT8 (4[1.02, 7.23], p = 0.012). Higher TS and HR values were weakly associated with ESQ symptoms during HT ( r = 0.20, p = 0.04), only explaining 20% of variance., Conclusions: ESQ symptoms improved during HAz, HA, and HT 2x/week. ESQ symptoms were not statistically correlated with HR during exercise heat stress. TS was not sensitive to detecting adaptation and did not subjectively change. The ESQ may be valuable in monitoring adaptation and may contribute to performance post-acclimation.

We sought to examine the effectiveness of an acute prolonged exercise session on post-exercise executive function in physically active adults and to assess if age or pre-exercise cognitive performance was predictive of the magnitude of change in executive task performance. Self-registered cyclists were recruited prior to participating in a 161-km mass-participation cycling event. Cyclists were excluded if they had not previously participated in a similar endurance event, were young (<18 y), or were cognitively impaired (Mini Cog TM < 3 units). Immediately after completing the exercise session, the time taken to complete Trail Making Test Part A and Part B (TMT A + B) was assessed. A faster time to complete the TMT A + B was observed after exercise (+8.5%; p = 0.0003; n = 62; age range = 21-70 y). The magnitude of change in TMT A + B performance (pre vs. post) was influenced by pre-exercise TMT A + B performance (r 2 = 0.23, p < 0.0001), not age (r 2 =0.002; p = 0.75). Prolonged exercise had a small-to-moderate effect on post-exercise compared to pre-exercise executive function task performance ( Cohen's d = 0.38-0.49). These results support the effectiveness of a single prolonged exercise bout to augment executive function in physically active adults, irrespective of age.

Objective: To examine the effects of euhydration, mild-dehydration, rehydration, and ad libitum drinking on countermovement jump (CMJ), handgrip strength, and performance of balance error scoring system test (BESS)., Methods: Eighteen healthy male subjects (mean[M]±standard deviation[SD]; age, 23±3y; body mass, 80.1 ± 9.7 kg; height, 175.8 ± 5.7 cm) participated in this study. Participants reported to the laboratory to perform CMJ, handgrip strength, and BESS with different hydration statuses (euhydrated, EUH; when they initially sensed thirst, THIRST; dehydrated, DEH; following 30 minutes of rehydration, REH; and following 24-h ad libitum drinking, AD)., Results: CMJ at EUH (M±SD; 54.6 ± 3.0 cm) was significantly higher than DEH (52.8 ± 3.0 cm, p = 0.027) and REH (52.6 ± 2.8 cm, p < 0.001). However, there was no difference between DEH and REH (p = 0.643). CMJ at THIRST (54.9 ± 3.0 cm, p = 0.004) was higher than REH. Also, AD (53.8 ± 2.8 cm, p = 0.027) was higher than REH. In left handgrip strength, THIRST (48.6 ± 9.5 kg) was higher than EUH (46.7 ± 10.1 kg, p = 0.018), DEH (45.8 ± 10.0 kg, p = 0.013), REH (46.1 ± 9.5 kg, p = 0.004), and AD (47.1 ± 9.7 kg, p = 0.05). Additionally, in the single-leg stance on a foam pad, more BESS errors were found at THIRST (6 ± 2) compared to EUH (5 ± 2, p = 0.007) and AD (5 ± 2, p = 0.002)., Conclusion: The findings of this study were: ∼2% of mild dehydration induced by 24-h fluid restriction decreased lower body power measured by CMJ, acute rehydration did not restore the loss of lower body power induced by dehydration, and ∼0.5-0.9% of dehydration did not decrease lower body power., Competing Interests: Authors have no conflict of interests., (© 2022 The Society of Chinese Scholars on Exercise Physiology and Fitness. Published by Elsevier (Singapore) Pte Ltd.)

Background: The purpose of this study was to investigate effects of heat acclimatization (HAz) followed by heat acclimation (HA), and intermittent heat training (IHT) on time-trial performance., Hypothesis: Time-trial performance will improve after HA and will further improve with twice a week of IHT., Study Design: Interventional study., Level of Evidence: Level 3., Methods: A total of 26 male athletes (mean ± SD; age, 35 ± 12 years; body mass, 72.8 ± 8.9 kg; peak oxygen consumption [VO 2peak ], 57.3 ± 6.7 mL·kg -1 ·min -1 ) completed five 4-km time trials (baseline, post-HAz, post-HA, post-IHT4, post-IHT8) in the heat (ambient temperature, 35.4°C ± 0.3°C; relative humidity, 46.7% ± 1.2%) on a motorized treadmill. After baseline time trial, participants performed HAz (109 ± 10 days) followed by post-HAz time trial. Then, participants completed 5 days of HA, which involved exercising to induce hyperthermia (38.50°C-39.75°C) for 60 minutes. Participants were then divided into 3 groups and completed IHT either twice per week (IHT MAX ), once per week (IHT MIN ), or not at all (IHT CON ) over an 8-week period. The exercise used for the IHT matched the HA. Four-kilometer time trials were performed after 4 weeks (post-IHT4) and 8 weeks of IHT (post-IHT8)., Results: Time trial was faster in post-HA (17.98 ± 2.51 minutes) compared with baseline (18.61 ± 3.06 minutes; P = 0.037) and post-HAz (18.66 ± 3.12 minutes; P = 0.023). Percentage change in time trial was faster in IHT MAX (-3.9% ± 5.2%) compared with IHT CON (11.5% ± 16.9%) ( P = 0.020) and approached statistical significance with large effect (effect size = 0.96) compared with IHT MIN (1.6% ± 6.2%; P = 0.059) at post-IHT8. Additionally, IHT MAX (-2.2% ± 4.2%) was faster than IHT CON (3.6% ± 6.9%) ( P = 0.05) at post-IHT4., Conclusion: These results indicate that HA after HAz induces additional improvement in time-trial performance. IHT twice per week shows improvement after 8 weeks, while once per week maintains performance for 8 weeks. No IHT results in a loss of adaptations after 4 weeks and even greater losses after 8 weeks., Clinical Relevance: HA after HAz improves time-trial performance, twice a week of IHT improves performance further, and once a week of IHT maintains performance for at least 8 weeks.

The purpose of this study was to examine the changes in metabolic heat production (Hprod), evaporative heat loss (Hevap), and dry heat loss (Hdry), following heat acclimatization (HAz) and heat acclimation (HA). Twenty-two male endurance athletes (mean ± standard deviation; age, 37 ± 12 y; body mass, 73.4 ± 8.7 kg; height, 178.7 ± 6.8 cm; and VO2max, 57.1 ± 7.2 mL·kg−1·min−1) completed three trials (baseline; post-HAz; and post-HA), which consisted of 60 min steady state exercise at 59 ± 2% velocityVO2max in the heat (ambient temperature [Tamb], 35.2 ± 0.6 °C; relative humidity [%rh] 47.5 ± 0.4%). During the trial, VO2 and RER were collected to calculate Hprod, Hevap, and Hdry. Following the baseline trial, participants completed self-directed outdoor summer training followed by a post-HAz trial. Then, five days of HA were completed over eight days in the heat (Tamb, 38.7 ± 1.1 °C; %rh, 51.2 ± 2.3%). During the HA sessions, participants exercised to maintain hyperthermia (38.50 °C and 39.75 °C) for 60 min. Then, a post-HA trial was performed. There were no differences in Hprod between the baseline (459 ± 59 W·m−2), post-HAz (460 ± 61 W·m−2), and post-HA (464 ± 55 W·m−2, p = 0.866). However, Hevap was significantly increased post-HA (385 ± 84 W·m−2) compared to post-HAz (342 ± 86 W·m−2, p = 0.043) and the baseline (332 ± 77 W·m−2, p = 0.037). Additionally, Hdry was significantly lower at post-HAz (125 ± 8 W·m−2, p = 0.013) and post-HA (121 ± 10 W·m−2, p < 0.001) compared to the baseline (128 ± 7 W·m−2). Hdry at post-HA was also lower than post-HAz (p = 0.049). Hprod did not change following HAz and HA. While Hdry was decreased following HA, the decrease in Hdry was smaller than the increases in Hevap. Adaptations in body heat exchange can occur by HA following HAz.

Objectives: To examine the efficacy of weekly and bi-weekly heat training to maintain heat acclimatization (HAz) and heat acclimation (HA) for 8 weeks in aerobically trained athletes., Design: Randomized, between-group., Methods: Twenty-four males (mean [m ± standard deviation [sd]; (age, 34 ± 12 y; body mass, 72.6 ± 8.8 kg, VO 2peak , 57.7 ± 6.8 mL·kg -1 ·min -1 ) completed five trials (baseline, following HAz, following HA (HAz + HA), four weeks into heat training [HT WK4 ], and eight weeks into HT [HT WK8 ] that involved 60 min of steady-state exercise (59.1 ± 1.8% vVO 2peak ) in an environmental laboratory (wet bulb globe temperature [WBGT], 29.6 ± 1.4 °C) on a motorized treadmill. Throughout exercise, heart rate (HR) and rectal temperature (T rec ) were recorded. Following HAz + HA, participants were assigned to three groups: control group (HT 0 ), once per week heat training (HT 1 ), and twice per week heat training (HT 2 ). HT involved heated exercise (WBGT, 33.3 ± 1.3 °C) to achieve hyperthermia (38.5-39.75 °C) for 60 min. Repeated measures ANOVAs were used to determine differences., Results: HAz + HA resulted in significant improvements in HR (p < 0.001) and T rec (p < 0.001). At HT WK8 , HR was significantly higher in HT 0 (174 ± 22 beats⋅min -1 ) compared to HT 2 (151 ± 17 beats⋅min -1 , p < 0.023), but was not different than HT 1 (159 ± 17 beats⋅min -1 , p = 0.112). There was no difference in % change of T rec from post-HAz + HA to HT WK4 (0.6 ± 1.3%; p = 0.218), however, HT WK8 (1.8 ± 1.4%) was significantly greater than post-HAz + HA in HT 0 (p = 0.009)., Conclusions: Bi-weekly HT provided clear evidence for the ability to maintain physiological adaptions for 8 weeks following HA., (Copyright © 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

The phenomenon of reduced athletic performance following sustained, intense training (Overtraining Syndrome, and OTS) was first recognized more than 90 years ago. Although hundreds of scientific publications have focused on OTS, a definitive diagnosis, reliable biomarkers, and effective treatments remain unknown. The present review considers existing models of OTS, acknowledges the individualized and sport-specific nature of signs/symptoms, describes potential interacting predisposing factors, and proposes that OTS will be most effectively characterized and evaluated via the underlying complex biological systems. Complex systems in nature are not aptly characterized or successfully analyzed using the classic scientific method (i.e., simplifying complex problems into single variables in a search for cause-and-effect) because they result from myriad (often non-linear) concomitant interactions of multiple determinants. Thus, this review 1) proposes that OTS be viewed from the perspectives of complex systems and network physiology, 2) advocates for and recommends that techniques such as trans-omic analyses and machine learning be widely employed, and 3) proposes evidence-based areas for future OTS investigations, including concomitant multi-domain analyses incorporating brain neural networks, dysfunction of hypothalamic-pituitary-adrenal responses to training stress, the intestinal microbiota, immune factors, and low energy availability. Such an inclusive and modern approach will measurably help in prevention and management of OTS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Armstrong, Bergeron, Lee, Mershon and Armstrong.)

Abstract: Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care., (Copyright © 2021 by the American College of Sports Medicine.)

Objectives: Determine whether five days of heat acclimation reduces cardiovascular and thermoregulatory strain during consecutive exercise-heat exposures on the sixth day in the heat., Design: Pair-matched randomized control trial., Methods: Twenty-four males completed two, 120min exercise sessions (Session 1, Session 2) in a single day before (Day 1) and after (Day 6) four additional days of exercise in either hot (HOT: 40°C, 40% relative humidity, n=16) or temperate (CON: 23°C, 25% relative humidity, n=8) environments. A mixed-methods heat acclimation approach was implemented. Day 2 consisted of 120min of moderate-high intensity treadmill exercise. Days 3-5 consisted of 90min of moderate-high intensity exercise, with HOT completing this in a hyperthermia clamped manner at rectal temperature ≥38.5°C, and CON<38.5°C., Results: Session 1 end of exercise rectal temperature and heart rate were lower on Day 6 compared to Day 1 for HOT (p=0.012, p=0.003) but not CON (p=0.152, p=0.437). Session 2 end of exercise rectal temperature was not different between days for HOT (p=0.104) or CON (p=0.275). Session 2 end of exercise heart rate was lower on Day 6 compared to Day 1 for HOT (p=0.004) and CON (p=0.039). Session 1 sweat sensitivity was greater on Day 6 compared to Day 1 for HOT (p=0.039) but not CON (p=0.257). Sweat rate was unchanged for HOT and CON between days during Session 1 (p=0.184, p=0.962) and Session 2 (p=0.051, p=0.793), respectively., Conclusions: Five days of heat acclimation reduced cardiovascular strain but not thermoregulatory strain during the second, consecutive exercise-heat exposure. CLINICALTRIALS., Gov Identifier: NCT04053465., (Copyright © 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)