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ObjectiveTo characterise the core temperature response and power output profile of elite male and female cyclists during the 2016 UCI Road World Championships. This may contribute to formulating environmental heat stress policies.MethodsCore temperature was recorded via an ingestible capsule in 10, 15 and 15 cyclists during the team time trial (TTT), individual time trial (ITT) and road race (RR), respectively. Power output and heart rate were extracted from individual cycling computers. Ambient conditions in direct sunlight were hot (37°C±3°C) but dry (25%±16% relative humidity), corresponding to a wet-bulb globe temperature of 27°C±2°C.ResultsCore temperature increased during all races (p<0.001), reaching higher peak values in TTT (39.8°C±0.9°C) and ITT (39.8°C±0.4°C), relative to RR (39.2°C±0.4°C, p<0.001). The highest temperature recorded was 41.5°C (TTT). Power output was significantly higher during TTT (4.7±0.3 W/kg) and ITT (4.9±0.5 W/kg) than RR (2.7±0.4 W/kg, p<0.001). Heart rate increased during the TTs (p<0.001) while power output decreased (p<0.001).Conclusion85% of the cyclists participating in the study (ie, 34 of 40) reached a core temperature of at least 39°C with 25% (ie, 10 of 40) exceeding 40°C. Higher core temperatures were reached during the time trials than the RR.

To examine the impact of hot ambient conditions on physical performance and physiological responses during football match-play. Two experimental games were completed in temperate (∼ 21°C; CON) and hot ambient conditions (∼ 43°C; HOT). Physical performance was assessed by match analysis in 17 male elite players during the games and a repeated sprint test was conducted after the two game trials. Core and muscle temperature were measured and blood samples were obtained, before and after the games. Muscle and core temperatures were ∼ 1°C higher (P<0.05) in HOT (40.3 ± 0.1 and 39.5 ± 0.1°C, respectively) compared to CON (39.2 ± 0.1 and 38.3 ± 0.1°C). Average heart rate, plasma lactate concentration, body weight loss as well as post-game sprint performance were similar between the two conditions. Total game distance declined (P<0.05) by 7% and high intensity running (>14 km ⋅ h(-1)) by 26% in HOT compared to CON), but peak sprint speed was 4% higher (P<0.05) in HOT than in CON, while there were no differences in the quantity or length of sprints (>24 km ⋅ h(-1)) between CON and HOT. In HOT, success rates for passes and crosses were 8 and 9% higher (P<0.05), respectively, compared to CON. Delta increase in core temperature and absolute core temperature in HOT were correlated to total game distance in the heat (r = 0.85 and r = 0.53, respectively; P<0.05), whereas, total and high intensity distance deficit between CON and HOT were not correlated to absolute or delta changes in muscle or core temperature. Total game distance and especially high intensity running were lower during a football game in the heat, but these changes were not directly related to the absolute or relative changes in core or muscle temperature. However, peak sprinting speed and execution of successful passes and crosses were improved in the HOT condition.

Background Although the acquisition of heat acclimation (HA) is well-documented, less is known about HA decay (HAD) and heat re-acclimation (HRA). The available literature suggests 1 day of HA is lost following 2 days of HAD. Understanding this relationship has the potential to impact upon the manner in which athletes prepare for major competitions, as a HA regimen may be disruptive during final preparations (i.e., taper). Objective The aim of this systematic review and meta-analysis was to determine the rate of HAD and HRA in three of the main physiological adaptations occurring during HA: heart rate (HR), core temperature ( T c ), and sweat rate (SR). Data Sources Data for this systematic review were retrieved from Scopus and critical review of the cited references. Study Selection Studies were included when they met the following criteria: HA, HAD, and HRA (when available) were quantified in terms of exposure and duration. HA had to be for at least 5 days and HAD for at least 7 days for longitudinal studies. HR, T c , or SR had to be monitored in human participants. Study Appraisal The level of bias in each study was assessed using the McMaster critical review form. Multiple linear regression techniques were used to determine the dependency of HAD in HR, T c , and SR from the number of HA and HAD days, daily HA exposure duration, and intensity. Results Twelve studies met the criteria and were systematically reviewed. HAD was quantified as a percentage change relative to HA (0% = HA, 100% = unacclimated state). Adaptations in end-exercise HR decreased by 2.3% ( P  < 0.001) for every day of HAD. For end-exercise T c , the daily decrease was 2.6% ( P  < 0.01). The adaptations in T c during the HA period were more sustainable when the daily heat exposure duration was increased and heat exposure intensity decreased. The decay in SR was not related to the number of decay days. However, protracted HA-regimens seem to induce longer-lasting adaptations in SR. High heat exposure intensities during HA seem to evoke more sustained adaptations in SR than lower heat stress. Only eight studies investigated HRA. HRA was 8–12 times faster than HAD at inducing adaptations in HR and T c , but no differences could be established for SR. Limitations The available studies lacked standardization in the protocols for HA and HAD. Conclusions HAD and HRA differ considerably between physiological systems. Five or more HA days are sufficient to cause adaptations in HR and T c ; however, extending the daily heat exposure duration enhances T c adaptations. For every decay day, ~ 2.5% of the adaptations in HR and T c are lost. For SR, longer HA periods are related to better adaptations. High heat exposure intensities seem beneficial for adaptations in SR, but not in T c . HRA induces adaptations in HR and T c at a faster rate than HA. HRA may thus provide a practical and less disruptive means of maintaining and optimizing HA prior to competition.

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.

Purpose This study investigated the isolated and combined effects of heat [temperate (22 °C/30 % rH) vs. hot (35 °C/40 % rH)] and hypoxia [sea level (FiO 2 0.21) vs. moderate altitude (FiO 2 0.15)] on exercise capacity and neuromuscular fatigue characteristics. Methods Eleven physically active subjects cycled to exhaustion at constant workload (66 % of the power output associated with their maximal oxygen uptake in temperate conditions) in four different environmental conditions [temperate/sea level (control), hot/sea level (hot), temperate/moderate altitude (hypoxia) and hot/moderate altitude (hot + hypoxia)]. Torque and electromyography (EMG) responses following electrical stimulation of the tibial nerve (plantar-flexion; soleus) were recorded before and 5 min after exercise. Results Time to exhaustion was reduced ( P  < 0.05) in hot (−35 ± 15 %) or hypoxia (−36 ± 14 %) compared to control (61 ± 28 min), while hot + hypoxia (−51 ± 20 %) further compromised exercise capacity ( P  < 0.05). However, the effect of temperature or altitude on end-exercise core temperature ( P  = 0.089 and P  = 0.070, respectively) and rating of perceived exertion ( P  > 0.05) did not reach significance. Maximal voluntary contraction torque, voluntary activation (twitch interpolation) and peak twitch torque decreased from pre- to post-exercise (−9 ± 1, −4 ± 1 and −6 ± 1 % all trials compounded, respectively; P  < 0.05), with no effect of the temperature or altitude. M-wave amplitude and root mean square activity were reduced ( P  < 0.05) in hot compared to temperate conditions, while normalized maximal EMG activity did not change. Altitude had no effect on any measured parameters. Conclusion Moderate hypoxia in combination with heat stress reduces cycling time to exhaustion without modifying neuromuscular fatigue characteristics. Impaired oxygen delivery or increased cardiovascular strain, increasing relative exercise intensity, may have also contributed to earlier exercise cessation.

Fascicle force-length relationship is one major basic mechanical property of skeletal muscle, subsequently influencing movement mechanics. While force-length properties are increasingly described through ultrafast ultrasound imaging, their test-retest reliability remains unknown. Using ultrafast ultrasound, and electrically evoked contractions at various ankle angles, gastrocnemius medialis fascicle force-length relationship was assessed twice, few days apart, in sixteen participants. The test-retest reliability of the resulting fascicle force-length relationship key parameters — i.e., maximal force (Fmax), and optimal fascicle length (L0) — was evaluated considering (i) all the trials obtained at each ankle joint and (ii) the mean of the two trials obtained at each tested angle. Considering all trials, L0 indicated a ‘high’ test-retest reliability, with intra-class correlation coefficients (ICC) of 0.89 and Fmax a ‘moderate’ reliability (ICC = 0.71), while when averaging the two trials L0 reliability was ‘very-high’ (ICC = 0.91), and Fmax reliability ‘moderate’ (ICC = 0.73). All values of coefficient of variation and standard error of measurement were low, i.e., ≤7.7 % and ≤0.35 cm for L0 and ≤3.4 N for Fmax, respectively. Higher absolute reliability was reported for L0 than Fmax, with better reliability when averaging the two trials at each angle. All these parameters, in accordance with the limit of agreement, demonstrated that L0 and Fmax test-retest reliability is acceptable, particularly when averaging multiple points obtained at a given angle. Interestingly, the shape of the fascicle force-length relationship is more variable. Therefore, L0 and Fmax can be used to compare between days-effects following an intervention, while a comparison of fascicle operating lengths may require more precautions.

This case study aims to examine changes in the lower limb joint kinematic profile and performance stability induced by repeated ski runs in two world‐class alpine skiers. Two Olympic medallist alpine skiers were tested during their slalom training, with continuous recording of right knee and hip angles, along with turn time and run time. The eight runs of the training session were analysed with linear mixed models. Results showed no effect of runs repetition on performance (i.e., run and turn time; P ≥ 0.279). There was no global effect of runs repetition on minimal and maximal angles for either the knee or the hip (P > 0.151). There was an interaction between run and leg for the maximal angle of both the knee and hip (P ≤ 0.047), which increased across runs for the outside leg and decreased for the inside leg. The maximal angular velocity for both the knee and hip increased with runs repetition in extension (P ≤ 0.028). There were no overall changes in maximal angular velocity in flexion with runs repetition (P ≥ 0.264), but there was an interaction between run and leg for the knee (P < 0.001) due to faster eccentric velocities across runs for the outside leg and slower velocities for the inside leg. In conclusion, the observed joint kinematic alterations without concomitant performance impairment support the concept of multiple movement strategies in athletes to achieve similar performance, especially under fatigue conditions. What is the main observation in this case? Joint kinematics showed minor alterations across a training session as world‐class skiers performed eight slaloms. What insights does it reveal? In the absence of changes in turn and run time, these alterations should be interpreted as adaptations in skiing style rather than a shift towards a less functional skiing technique. Some of these adaptations support the concept of multiple movement strategies in athletes to achieve similar performance, especially under fatigue conditions.

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.

While vitamin D deficiency is well recognized in Middle Eastern women as a result of cultural norms of remaining covered, Middle Eastern men are an under-reported group. Vitamin D is now known to have multiple effects, including an impact on muscle function, thereby increasing the relevance for sportsmen. The aim of the present study was to evaluate serum 25-hydroxyvitamin D (25(OH)D) levels in young male Middle Eastern athletes. Cross-sectional study. Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. Ninety-three Middle Eastern men presenting to hospital for an annual screening undertook a blood test to evaluate their vitamin D status. Ninety-one per cent of athletes were found to be deficient in 25(OH)D (serum concentration <20 ng/ml). Athletes with severe deficiencies were significantly younger than those with less marked deficiency. A subset of athletes underwent bone mineral density assessment and 59 % were shown to have at least one Z-score less than -1; despite this, however, no athletes reported a stress fracture. There was no correlation between 25(OH)D concentration and sunlight exposure, skin coverage and skin colouring. The study revealed that 25(OH)D deficiency is very common among otherwise healthy Middle Eastern male athletes. Given the potentially significant long- and short-term effects of 25(OH)D deficiency, serum 25(OH)D evaluation should be part of the routine assessment in this region.

PurposeAssess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies.MethodsOf the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis.Results48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5–1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001).ConclusionsAt a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat.