Impaired thermoregulatory function during dynamic exercise in multiple sclerosis

INTRODUCTION: Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared to healthy controls (CON) exercising at similar rates of metabolic heat production. METHODS: Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass- and BSA-matched healthy controls during a single bout of cycling exercise (rate of metabolic heat production: ~4.5 W/kg) for 60 min in a climate-controlled room (25 °C, 30% RH). RESULTS: Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS: 72 ± 51; CON: 104 ± 37 g, p=0.04) and 60 min (MS: 209 ± 94; CON: 285 ± 62 g, p=0.02), as well as lower sweating thermosensitivity (MS: 0.49 ± 0.26; CON: 0.86 ± 0.30 mg/cm2/min/°C, p=0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30 or 60 min time points (p>0.05). Cutaneous vasculature responses were also not different in MS compared to CON (p>0.05). CONCLUSION: Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions.Accepted manuscrip

Sustained increases in skin blood flow are not a pre-requisite to initiate sweating during passive heat exposure

Some studies have observed a functional relationship between sweating and skin blood flow. However, the implications of this relationship during physiologically relevant conditions remain unclear. We manipulated sudomotor activity through changes in sweating efficiency to determine if parallel changes in vasomotor activity are observed. Eight young men completed two trials at 36°C and two trials at 42°C. During these trials, air temperature remained constant while ambient vapor pressure increased from 1.6 to 5.6 kPa over 2 h. Forced airflow across the skin was used to create conditions of high (HiSeff) or low (LoSeff) sweating efficiency. Local sweat rate (LSR), local skin blood flow (SkBF), as well as mean skin and esophageal temperatures were measured continuously. It took longer for LSR to increase during HiSeff at 36°C (HiSeff: 99 ± 11 vs. LoSeff: 77 ± 11 min, P < 0.01) and 42°C (HiSeff: 72 ± 16 vs. LoSeff: 51 ± 15 min, P < 0.01). In general, an increase in LSR preceded the increase in SkBF when expressed as ambient vapor pressure and time for all conditions (P < 0.05). However, both responses were activated at a similar change in mean body temperature (average across all trials, LSR: 0.26 ± 0.15 vs. SkBF: 0.30 ± 0.18°C, P = 0.26). These results demonstrate that altering the point at which LSR is initiated during heat exposure is paralleled by similar shifts for the increase in SkBF. However, local sweat production occurs before an increase in SkBF, suggesting that SkBF is not necessarily a prerequisite for sweating

Thermoregulatory dysfunction in multiple sclerosis patients during moderate exercise in a thermoneutral environment

Impairments in sudomotor function during passive heat stress have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, little is known regarding exercise induced increases in core body temperature on thermoregulatory mechanisms in MS. Thus, the aim of this study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared to healthy controls (CN) during moderate exercise. Thermoregulatory function in five patients diagnosed with relapsing-remitting MS and five mass-matched healthy controls were compared during a single bout of cycling exercise (fixed workload of 70 Watts) for 30-60 minutes in a climate-controlled room (25°C, 30% RH). Sweating thermosensitivity (MS: 0.56±0.15 vs CN: 0.81±0.13, p=0.04) was significantly lower while a delay in sweating onset time (MS: 14.8±10.0 min vs CN: 5.6±1.6 min, p=0.07) approached significance in MS patients compared to controls. These altered mechanisms of body temperature regulation likely contributed to a greater observed change in core body temperature measured rectally (MS: 0.84±0.34 °C vs CN: 0.37±0.27 °C, p=0.04) in patients with MS. This observed thermoregulatory dysfunction in MS patients may intensify disease symptoms limiting exercise tolerance

Seasonal Heat Acclimatisation in Healthy Adults:A Systematic Review

BACKGROUND: Physiological heat adaptations can be induced following various protocols that use either artificially controlled (i.e. acclimation) or naturally occurring (i.e. acclimatisation) environments. During the summer months in seasonal climates, adequate exposure to outdoor environmental heat stress should lead to transient seasonal heat acclimatisation. OBJECTIVES: The aim of the systematic review was to assess the available literature and characterise seasonal heat acclimatisation during the summer months and identify key factors that influence the magnitude of adaptation. ELIGIBILITY CRITERIA: English language, full-text articles that assessed seasonal heat acclimatisation on the same sample of healthy adults a minimum of 3 months apart were included. DATA SOURCES: Studies were identified using first- and second-order search terms in the databases MEDLINE, SPORTDiscus, CINAHL Plus with Full Text, Scopus and Cochrane, with the last search taking place on 15 July 2021. RISK OF BIAS: Studies were independently assessed by two authors for the risk of bias using a modified version of the McMaster critical review form. DATA EXTRACTION: Data for the following outcome variables were extracted: participant age, sex, body mass, height, body fat percentage, maximal oxygen uptake, time spent exercising outdoors (i.e. intensity, duration, environmental conditions), heat response test (i.e. protocol, time between tests), core temperature, skin temperature, heart rate, whole-body sweat loss, whole-body and local sweat rate, sweat sodium concentration, skin blood flow and plasma volume changes. RESULTS: Twenty-nine studies were included in this systematic review, including 561 participants across eight countries with a mean summer daytime wet-bulb globe temperature (WBGT) of 24.9 °C (range: 19.5–29.8 °C). Two studies reported a reduction in resting core temperature (0.16 °C; p < 0.05), 11 reported an increased sweat rate (range: 0.03–0.53 L·h(−1); p < 0.05), two observed a reduced heart rate during a heat response test (range: 3–8 beats·min(−1); p < 0.05), and six noted a reduced sweat sodium concentration (range: − 22 to − 59%; p < 0.05) following summer. The adaptations were associated with a mean summer WBGT of 25.2 °C (range: 19.6–28.7 °C). LIMITATIONS: The available studies primarily focussed on healthy male adults and demonstrated large differences in the reporting of factors that influence the development of seasonal heat acclimatisation, namely, exposure time and duration, exercise task and environmental conditions. CONCLUSIONS: Seasonal heat acclimatisation is induced across various climates in healthy adults. The magnitude of adaptation is dependent on a combination of environmental and physical activity characteristics. Providing environmental conditions are conducive to adaptation, the duration and intensity of outdoor physical activity, along with the timing of exposures, can influence seasonal heat acclimatisation. Future research should ensure the documentation of these factors to allow for a better characterisation of seasonal heat acclimatisation. PROSPERO REGISTRATION: CRD42020201883. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40279-022-01677-0

Sustainable solutions to mitigate occupational heat strain – an umbrella review of physiological effects and global health perspectives

Background: Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need. Objectives: To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners.Methods: An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact. Results: Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation.Discussion: Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.<br

Consensus recommendations on training and competing in the heat

Exercising in the heat induces thermoregulatory and other physiological strain that can lead to impairments in endurance exercise capacity. The purpose of this consensus statement is to provide up-to-date recommendations to optimize performance during sporting activities undertaken in hot ambient conditions. The most important intervention one can adopt to reduce physiological strain and optimize performance is to heat acclimatize. Heat acclimatization should comprise repeated exercise–heat exposures over 1–2 weeks. In addition, athletes should initiate competition and training in an euhydrated state and minimize dehydration during exercise. Following the development of commercial cooling systems (e.g., cooling vests), athletes can implement cooling strategies to facilitate heat loss or increase heat storage capacity before training or competing in the heat. Moreover, event organizers should plan for large shaded areas, along with cooling and rehydration facilities, and schedule events in accordance with minimizing the health risks of athletes, especially in mass participation events and during the first hot days of the year. Following the recent examples of the 2008 Olympics and the 2014 FIFA World Cup, sport governing bodies should consider allowing additional (or longer) recovery periods between and during events for hydration and body cooling opportunities when competitions are held in the heat

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes