Infographic. Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

This infographic presents a summary of the prehospital management of exertional heat stroke (EHS) at sports competitions for Para athletes.1 Our original article was designed to provide Para athlete-specific modifications to the original EHS algorithm that was developed and implemented at the Tokyo 2020 Olympic Games. [...]</p

Infographic. Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

This infographic presents a summary of the prehospital management of exertional heat stroke (EHS) at sports competitions for Para athletes.1 Our original article was designed to provide Para athlete-specific modifications to the original EHS algorithm that was developed and implemented at the Tokyo 2020 Olympic Games. [...]</p

Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes

Objectives: To adapt key components of exertional heat stroke (EHS) prehospital management proposed by the International Olympic Committee (IOC) Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 so that it is applicable for the Paralympic athletes.Methods: An expert working group representing members with research, clinical and lived sports experience from a Para sports perspective reviewed and revised the IOC consensus document of current best practice regarding the prehospital management of EHS.Results: Similar to Olympic competitions, Paralympic competitions are also scheduled under high environmental heat stress; thus, policies and procedures for EHS prehospital management should also be established and followed. For Olympic athletes, the basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling, and advanced clinical care. Although these principles also apply for Paralympic athletes, slight differences related to athlete physiology (e.g., autonomic dysfunction) and mechanisms for hands-on management (e.g., transferring the collapsed athlete or techniques for whole-body cooling) may require adaptation for care of the Paralympic athlete.Conclusions: Prehospital management of EHS in the Paralympic setting employs the same procedures as for Olympic athletes with some important alterations.</div

Hydration and cooling in elite athletes: relationship with performance, body mass loss and body temperatures during the Doha 2019 IAAF World Athletics Championships

Purpose. To characterise hydration, cooling, body-mass loss, and core (Tcore) and skin (Tsk) temperatures during World Athletics Championships in hot-humid conditions. Methods. Marathon and race-walk (20km and 50km) athletes (n=83, 36 women) completed a pre-race questionnaire. Pre- and post-race body weight (n=74), Tcore (n= 56) and Tsk (n= 49; thermography) were measured. Results. Most athletes (93%) had a pre-planned drinking strategy [electrolytes (83%), carbohydrates (81%)] whilst ice-slurry was less common (11%; pConclusion. Most athletes hydration strategies were pre-planned based on personal experience. Ice-vests were the most adopted pre-cooling and the only one minimizing Tcore, suggesting that event organisers should be cognisant of logistic (i.e. freezers). Dehydration was moderate and unrelated to performance. Pre-race Tsk was related to performance and DNF, suggesting that Tsk modulation should be incorporated into pre-race strategies</div

Thermoregulatory responses during road races in hot-humid conditions at the 2019 Athletics World Championships

Purpose: To characterise thermoregulatory and performance responses of elite road-race athletes, while competing in hot, humid, night-time conditions during the 2019 IAAF World Athletic Championships.  Method: Male and female athletes, competing in the 20 km racewalk (n=20 males, 24 females), 50 km racewalk (n=19 males, 8 females) and marathon (n=15 males, 22 females) participated. Exposed mean skin (Tsk) and continuous core body (Tc) temperature were recorded with infrared thermography and ingestible telemetry pill, respectively.  Results: The range of ambient conditions (recorded roadside) were 29.3-32.7°C air temperature, 46-81 % relative humidity, 0.1-1.7 m∙s-1 air velocity and 23.5-30.6°C wet bulb globe temperature. Tc increased by 1.5 ± 0.1°C but mean Tsk decreased by 1.5 ± 0.4°C over the duration of the races. Tsk and Tc changed most rapidly at the start of the races and then plateaued, with Tc showing a rapid increase again at the end, in a pattern mirroring pacing. Performance times were between 3 to 20 % (mean = 113 ± 6%) longer during the championships compared to the personal best (PB) of athletes. Overall mean performance relative to PB was correlated with the wet-bulb globe temperature (WBGT) of each race (R2 = 0.89), but not with thermophysiological variables (R2 ≤ 0.3).  Conclusion: As previously reported in exercise heat stress, in this field study Tc rose with exercise duration, whereas Tsk showed a decline. The latter contradicts the commonly recorded rise and plateau in laboratory studies at similar ambient temperatures, but without realistic air movement.</p

Association between thermal responses, medical events, performance, heat acclimation and health status in male and female elite athletes during the 2019 Doha World Athletics Championships

PurposeTo determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions.MethodsFrom 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (Tcore; ingestible pill) and skin (Tskin; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (% personal best) and did not finish (DNF) were extracted from official results.ResultsPeak Tcore during competition reached 39.6°C±0.6°C (maximum 41.1°C). Tskin decreased from 32.2°C±1.3°C to 31.0°C±1.4°C during the races (p<0.001). Tcore was not related to DNF (25% of starters) or medical events (p≥0.150), whereas Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were (p≤0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9% of athletes) increasing the risk of in-race medical events (71% vs 17%, p<0.001). Athletes (63%) who performed 5–30 days heat acclimation before the competition: ranked better (18±13 vs 28±13, p=0.009), displayed a lower peak Tcore (39.4°C±0.4°C vs 39.8°C±0.7°C, p=0.044) and larger in-race decrease in Tskin (−1.4°C±1.0°C vs −0.9°C±1.2°C, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19% vs 30%, p=0.273) and medical events (19% vs 32%, p=0.179).ConclusionTskin, Tskin rate of decrease and Tcore-to-Tskin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events