Postexercise hot-water immersion does not further enhance heat adaptation or performance in endurance athletes training in a hot environment

Purpose: Hot-water immersion (HWI) after training in temperate conditions has been shown to induce thermophysiological adaptations and improve endurance performance in the heat; however, the potential additive effects of HWI and training in hot outdoor conditions remain unknown. Therefore, this study aimed to determine the effect of repeated postexercise HWI in athletes training in a hot environment. Methods: A total of 13 (9 female) elite/preelite racewalkers completed a 15-day training program in outdoor heat (mean afternoon high temperature = 34.6°C). Athletes were divided into 2 matched groups that completed either HWI (40°C for 30–40 min) or seated rest in 21°C (CON), following 8 training sessions. Pre–post testing included a 30-minute fixed-intensity walk in heat, laboratory incremental walk to exhaustion, and 10,000-m outdoor time trial. Results: Training frequency and volume were similar between groups (P = .54). Core temperature was significantly higher during immersion in HWI (38.5 [0.3]) than CON (37.8°C [0.2°C]; P .05). There were significant (P < .05) pre–post differences for both groups in submaximal exercising heart rate (∼11 beats·min−1), sweat rate (0.34–0.55 L·h−1) and thermal comfort (1.2–1.5 arbitrary units), and 10,000-m racewalking performance time (∼3 min). Conclusions: Both groups demonstrated significant improvement in markers of heat adaptation and performance; however, the addition of HWI did not provide further enhancements. Improvements in adaptation appeared to be maximized by the training program in hot conditions

Post-exercise hot-water immersion does not further enhance heat adaptation or performance in endurance athletes training in hot environment

INTRODUCTION: Hot-water immersion (HWI) after training in temperate conditions has been shown to induce thermophysiological adaptations and improve endurance performance in the heat, however, the potential additive effects of HWI and training in hot outdoor conditions remain unknown. Therefore, this study aimed to determine the effect of repeated post-exercise HWI in athletes training in a hot environment. METHODS: Thirteen (9 female) elite/pre-elite partially heat acclimatized racewalkers completed a 15-day training program in outdoor heat (mean afternoon high temperature=34.6°C). Athletes were divided into two groups matched for VO2max and 10,000 m walking performance time that completed either HWI (40°C for 30-40 min) or seated rest in 21°C (CON), following 8 training sessions. Pre-post testing included a 30-min fixed-intensity walk in heat, laboratory incremental walk to exhaustion and 10,000 m outdoor time-trial. RESULTS: Training frequency and volume was similar between groups (P=0.54). Core temperature was significantly higher during immersion in HWI (38.5 ± 0.3) than CON (37.8 ± 0.2°C; P0.05). There were significant (P<0.05) pre-post differences for both groups in submaximal exercising heart rate (~11 bpm) sweat rate (0.34-0.55 L.h-1) and thermal comfort (1.2–1.5 arbitrary units), and 10,000 m racewalking performance time (~3 min). CONCLUSION: After a 15-day heat training intervention, we observed significantly improved submaximal exercising heart rate, sweat rate, and thermal comfort, as well as improved 10,000 m racewalking performance in both groups. However, the addition of HWI did not further enhance heat adaptation or performance in partially heat-acclimatized athletes. Physiological adaptation appeared to be optimized from training in hot conditions alone

Competing in hot conditions at the Tokyo Olympic Games : Preparation strategies used by Australian race walkers

Introduction: The Tokyo 2021 Olympic Games was anticipated to expose athletes to the most challenging climatic conditions experienced in the history of the modern Olympic Games. This study documents strategies executed by Australian endurance athletes during the team holding camp and Olympic Games experiences, including (1) baseline physiological data, training data, and heat acclimation/acclimatization practices; (2) pre- and in-race cooling and nutritional strategies, and (3) Olympic Games race performance data. Methods: Six athletes (three males, three females; age 24 ± 4 years; VO2max 63.2 ± 8.7 mL⋅kg–1⋅min–1; sum of 7 skinfolds 53.1 ± 23.4 mm) were observed prior to and during the team holding camp held in Cairns, QLD, Australia. Athletes completed 6–7 weeks of intermittent heat acclimation training, utilizing a combination of 2–4 passive and active acclimation sessions per week. Active acclimation was systematically increased via exposure time, exercise intensity, temperature, and humidity. In the team holding camp, athletes undertook a further 23 heat acclimatization training sessions over 18 days in a continuous fashion. Hyperhydration (using sodium and glycerol osmolytes), and internal and external pre-and in-race cooling methods were also utilized. A low energy availability intervention was implemented with two athletes, as a strategy to periodize ideal race body composition. Race performance data and environmental conditions from the 2021 Olympic Games were also documented. Results: The highest values for aerobic capacity were 63.6 mL⋅kg–1⋅min–1 for female race walkers and 73.7 mL⋅kg–1⋅min–1 for males. Training volume for the six athletes was the highest in the second week of the team holding camp, and training intensity was lowest in the first week of the team holding camp. Performance outcomes included 6th place in the women’s 20 km event (1:30:39), which was within 2% of her 20 km personal best time, and 8th place in the men’s 50 km event (3:52:01), which was a personal best performance time. Conclusion: Periodized training, heat acclimation/acclimatization, cooling and nutritional strategies study may have contributed to the race outcomes in Olympic Games held hot, humid conditions, for the race walkers within this observational study

The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery

INTRODUCTION: Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. METHODS AND ANALYSIS: The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients' outcomes, with the aim of supporting local quality improvement. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians

Predicting severe pain after major surgery: a secondary analysis of the Peri-operative Quality Improvement Programme (PQIP) dataset

Acute postoperative pain is common, distressing and associated with increased morbidity. Targeted interventions can prevent its development. We aimed to develop and internally validate a predictive tool to pre-emptively identify patients at risk of severe pain following major surgery. We analysed data from the UK Peri-operative Quality Improvement Programme to develop and validate a logistic regression model to predict severe pain on the first postoperative day using pre-operative variables. Secondary analyses included the use of peri-operative variables. Data from 17,079 patients undergoing major surgery were included. Severe pain was reported by 3140 (18.4%) patients; this was more prevalent in females, patients with cancer or insulin-dependent diabetes, current smokers and in those taking baseline opioids. Our final model included 25 pre-operative predictors with an optimism-corrected c-statistic of 0.66 and good calibration (mean absolute error 0.005, p = 0.35). Decision-curve analysis suggested an optimal cut-off value of 20–30% predicted risk to identify high-risk individuals. Potentially modifiable risk factors included smoking status and patient-reported measures of psychological well-being. Non-modifiable factors included demographic and surgical factors. Discrimination was improved by the addition of intra-operative variables (likelihood ratio χ2 496.5, p < 0.001) but not by the addition of baseline opioid data. On internal validation, our pre-operative prediction model was well calibrated but discrimination was moderate. Performance was improved with the inclusion of peri-operative covariates suggesting pre-operative variables alone are not sufficient to adequately predict postoperative pain

Oral versus intravenous antibiotics for bone and joint infection

BACKGROUND The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication. METHODS We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points. RESULTS Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%). CONCLUSIONS Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year. (Funded by the National Institute for Health Research; OVIVA Current Controlled Trials number, ISRCTN91566927. opens in new tab.

Increased hypoxic dose after training at low altitude with 9h per night at 3000m normobaric hypoxia

This study examined effects of low altitude training and a live-high: train-low protocol (combining both natural and simulated modalities) on haemoglobin mass (Hbmass), maximum oxygen consumption (VO2max), time to exhaustion, and submaximal exercise measures. Eighteen elite-level race-walkers were assigned to one of two experimental groups; lowHH (low Hypobaric Hypoxia: continuous exposure to 1380 m for 21 consecutive days; n = 10) or a combined low altitude training and nightly Normobaric Hypoxia (lowHH+NHnight: living and training at 1380 m, plus 9 h.night-1 at a simulated altitude of 3000 m using hypoxic tents; n = 8). A control group (CON; n = 10) lived and trained at 600 m. Measurement of Hbmass, time to exhaustion and VO2max was performed before and after the training intervention. Paired samples t-tests were used to assess absolute and percentage change pre and post-test differences within groups, and differences between groups were assessed using a one-way ANOVA with least significant difference post-hoc testing. Statistical significance was tested at p &lt; 0.05. There was a 3.7% increase in Hbmass in lowHH+NHnight compared with CON (p = 0.02). In comparison to baseline, Hbmass increased by 1.2% (&plusmn;1.4%) in the lowHH group, 2.6% (&plusmn;1.8%) in lowHH+NHnight, and there was a decrease of 0.9% (&plusmn;4.9%) in CON. VO2max increased by ~4% within both experimental conditions but was not significantly greater than the 1% increase in CON. There was a ~9% difference in pre and post-intervention values in time to exhaustion after lowHH+NH-night (p = 0.03) and a ~8% pre to post-intervention difference (p = 0.006) after lowHH only. We recommend low altitude (1380 m) combined with sleeping in altitude tents (3000 m) as one effective alternative to traditional altitude training methods, which can improve Hbmass

Core Temperature Responses to Elite Racewalking Competition

Purpose: The core temperature responses during exercise and effects of different cooling strategies on endurance performance under heat stress have been investigated in recreational athletes. This investigation aimed to determine peak rectal temperatures during elite racewalking competitions and to detail any cooling strategies used. Methods: Rectal temperature was measured in 14 heat-adapted elite/preelite race walkers (9 females) via a telemetric capsule across 4 outdoor events, including the 2018 Commonwealth Games (race 1: 20 km, 25°C, 74% relative humidity [RH], n = 2) and 3 International Association of Athletics Federations–sanctioned 10-km events (race 2: 19°C, 34% RH, n = 2; race 3: 29°C, 47% RH, n = 14; and race 4: 23°C, 72% RH, n = 11). All athletes completed race 3, and a subsample completed the other events. Their use of cooling strategies and symptoms of heat illness were determined. Results: Peak rectal temperatures >40°C were observed in all events. The highest rectal temperature observed during an event was 41.2°C. These high rectal temperatures were observed without concomitant heat illness, with the exception of cramping in one athlete during race 1. The rectal temperatures tended to reach a steady state in the second half of the 20-km event, but no steady state was observed in the 10-km events. The athletes used cooling strategies in race 1 only, implementing different combinations of cold-water immersion, ice-slurry ingestion, ice-towel application, ice-vest application, and facial water spraying. Conclusions: Elite/preelite race walkers experience rectal temperatures >40°C during competition despite only moderate-warm conditions, and even when precooling and midcooling strategies are applied

Increased Hypoxic Dose After Training at Low Altitude with 9h Per Night at 3000m Normobaric Hypoxia

This study examined effects of low altitude training and a live-high: train-low protocol (combining both natural and simulated modalities) on haemoglobin mass (Hbmass), maximum oxygen consumption (VO2max), time to exhaustion, and submaximal exercise measures. Eighteen elite-level race-walkers were assigned to one of two experimental groups; lowHH (low Hypobaric Hypoxia: continuous exposure to 1380 m for 21 consecutive days; n = 10) or a combined low altitude training and nightly Normobaric Hypoxia (lowHH+NHnight: living and training at 1380 m, plus 9 h.night-1 at a simulated altitude of 3000 m using hypoxic tents; n = 8). A control group (CON; n = 10) lived and trained at 600 m. Measurement of Hbmass, time to exhaustion and VO2max was performed before and after the training intervention. Paired samples t-tests were used to assess absolute and percentage change pre and post-test differences within groups, and differences between groups were assessed using a one-way ANOVA with least significant difference post-hoc testing. Statistical significance was tested at p < 0.05. There was a 3.7% increase in Hbmass in lowHH+NHnight compared with CON (p = 0.02). In comparison to baseline, Hbmass increased by 1.2% (±1.4%) in the lowHH group, 2.6% (±1.8%) in lowHH+NHnight, and there was a decrease of 0.9% (±4.9%) in CON. VO2max increased by ~4% within both experimental conditions but was not significantly greater than the 1% increase in CON. There was a ~9% difference in pre and post-intervention values in time to exhaustion after lowHH+NH-night (p = 0.03) and a ~8% pre to post-intervention difference (p = 0.006) after lowHH only. We recommend low altitude (1380 m) combined with sleeping in altitude tents (3000 m) as one effective alternative to traditional altitude training methods, which can improve Hbmass