Beat Knechtle

Daniel Rojas-Valverde

Jennifer Crowe

Frontiers in Physiology

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Editorial: Acute and long-termhealth issues of occupationalexposure to heat and high physicalloadsJennifer Crowe1*, Beat Knechtle2 and Daniel Rojas-Valverde3,4*1Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional de Costa Rica,Heredia, Costa Rica, 2Institute for Family Medicine, Faculty of Medicine, University of Zurich, Zurich,Switzerland, 3Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD-NARS), EscuelaCiencias del Movimiento Humano y Calidad de Vida, Universidad Nacional de Costa Rica, Heredia, CostaRica, 4Sport Injury Clinic, Escuela Ciencias del Movimiento Humano y Calidad de Vida, UniversidadNacional de Costa Rica, Heredia, Costa RicaKEYWORDSwork-related injuries, heat, occupational health, physiological stress, heat stress,ergonomicsEditorial on the Research TopicAcute and Long-term health issues of occupational exposure to heat andhigh physical loadsIn recent years, light has been shed on the dangers of excessive heat and the strenuousdemands of physical labor in occupational settings. In the case of heat, some of this attentionis driven by increased awareness of climate change, making us more conscious of heat events,which are projected to continue to be more frequent and severe (Intergovernmental Panel onClimate Change, 2023). Unfortunately, some of our awareness also comes from the fact thatundesired health outcomes have been documented in working populations (Arbury et al.,2014; Heinzerling et al., 2020; Spector et al., 2023). The same is true for heavy or repetitivemovements in the workplace where, despite clear evidence that these exposures can causesevere acute (Lucas et al., 2020) or chronic health outcomes (López-Ruiz et al., 2015),workers continue to be exposed in alarming numbers (Lucas et al., 2020).For many populations across the globe, the simultaneous combination of high physicaldemands, inadequate worker protection measures, and high heat exposure continues to be amajor challenge for employers, policymakers and, most of all, workers (Morris et al., 2020).Working in heat, particularly with high physical demands can cause a variety of acute healthproblems ranging from relatively mild heat illness to a dangerous rise in core bodytemperature that when left untreated, can have catastrophic outcomes (Sorensen andHess, 2022). These issues are magnified in populations in the informal sector whereindividuals often juggle more than one job (Venugopal et al., 2021). Even for those inthe formal sector, professions including fire fighters, miners, athletes, agricultural laborers,and soldiers, can be in situations where they are quite literally pushing their bodies’endurance and resistance to the maximum (Lazaro and Momayez, 2021; Carballo-Leyenda et al., 2022; Kim and Lee, 2023). Occupational heat exposure is associated witha number of undesirable health outcomes ranging from headache and nausea to more severeoutcomes such as cardiovascular failure (Ebi et al., 2021) or acute kidney injury (Kupfermanet al., 2018; Wesseling et al., 2020). Likewise, heavy or repetitive workloads are associatedOPEN ACCESSEDITED AND REVIEWED BYRichard D. Boyle,National Aeronautics and SpaceAdministration (NASA), United States*CORRESPONDENCEJennifer Crowe,jennifer.crowe@una.crDaniel Rojas-Valverde,drojasv@hotmail.comRECEIVED 29 September 2023ACCEPTED 04 October 2023PUBLISHED 11 October 2023CITATIONCrowe J, Knechtle B andRojas-Valverde D (2023), Editorial: Acuteand long-term health issues ofoccupational exposure to heat and highphysical loads.Front. Physiol. 14:1304229.doi: 10.3389/fphys.2023.1304229COPYRIGHT© 2023 Crowe, Knechtle and Rojas-Valverde. This is an open-access articledistributed under the terms of theCreative Commons Attribution License(CC BY). The use, distribution orreproduction in other forums ispermitted, provided the original author(s)and the copyright owner(s) are creditedand that the original publication in thisjournal is cited, in accordance withaccepted academic practice. No use,distribution or reproduction is permittedwhich does not comply with these terms.Frontiers in Physiology frontiersin.org01TYPE EditorialPUBLISHED 11 October 2023DOI 10.3389/fphys.2023.1304229with outcomes ranging from fatigue to acute or chronicmusculoskeletal problems (Briggs et al., 2018). Both heavyworkload and heat exposure increase the probability that workerswill be injured on the job (Fatima et al., 2021; Morrissey et al., 2023).This Research Topic casts a wide net, covering a variety of issuesthat collectively highlight the nuances of workload and heat exposurewhile also demonstrating the different areas of science thatmight lead tobetter understanding of the physiology of heat exposure or ways tocombat health effects resulting from that exposure. Each line of researchprovides a new bit of knowledge, whether it is the identification of novelbiomarkers for the early detection of health issues (Schlader et al., 2019;Burtscher et al., 2022) or the creation of workplace regulations andmethods that reduce heat stress (Borg et al., 2021; Morris et al., 2021).The investigation of fatigue recovery approaches and cutting-edge bodycooling techniques is the rallying cry for innovation that might reduceoccupational risk (Douma et al., 2020; Foster et al., 2020). Additionally,the ability to forecast heat exposure in the face of a changing climate andthe continual creation of workforce adaptation techniques are essentialfor a resilient future (Morris et al., 2020; Habibi et al., 2021; Ioannouet al., 2022). Evidence and solutions are still needed to confront theproblems that are triggered when there is an interaction between heatexposure and high physical load in occupational populations (e.g.,dehydration, heat stress, renal injury) (see Figure 1).We invited experts from multiple fields to share results related tohealth issues resulting from acute and prolonged exposure to heat orheavy physical demands resulting in the four original manuscriptspublished in this Research Topic. The first manuscript contributed byArbeille et al., delves into the interplay between isolation and physicalactivity, demonstrating a lack of physiological effects from a 40-dayisolation in a cavern, possibly attributed to sustained physical activityand reduced environmental stress. The second manuscript, contributedby Faricier et al., investigates the acute impact of lower-body cold-waterimmersion on neuromuscular fatigue after high-intensity exercise,revealing that short-term immersion did not significantly alterneuromuscular function during a maximal intensity fatigue task. Thethird study from Nguyen et al., illuminates the prevalence ofneuropathic pain (e.g., spinal and osteoarthritis pain) amongVietnamese industrial workers, identifying several risk factors relatedto physical load, emphasizing the importance of ergonomicconsiderations, and noting other risk factors that were morecommon in those that reported neuropathic pain including noise,dust and heat. Finally, the fourth manuscript submitted by Wanget al., introduces an innovative approach, employing over-the-counteranalgesic creams (e.g., 20% methyl salicylate and 6% L-menthol) aspotential tools to enhance skin cooling and core body heat loss duringexercise-induced hyperthermia.Collectively, thesemanuscripts highlight themultidimensionality ofthe challenges faced by workers subjected to heat exposure and/ordemanding physical loads. The diverse spectrum of outcomes discussed- from arterial wall adaptations to neuromuscular function, fromneuropathic pain prevalence to skin cooling interventions -underscores the intricate interplay between the physiological andenvironmental factors influencing occupational health and thereforethe diverse fields of science needed to reduce exposure and treatundesired outcomes when they happen.As we reflect on the four manuscripts included here together withwork published elsewhere in recentmonths, we encourage researchersfrom diverse backgrounds to continue to study occupational exposureto heat and high physical loads and to consider populations that mayface less obvious risk. For example, heat exposure should beresearched in populations including professional athletes andindoor workers in places with internal heat sources such aslaundry. Similarly, research on high physical demands is neededfor workers in confined spaces or unusual settings such asspacecraft. Finally, research is needed on both topics for workersin the informal sector (López-Ruiz et al., 2015; Julià et al., 2019). Wehope this Research Topic encourages academics, professionals, andpolicymakers to pay special attention to occupational exposures toheat and physical load and to act from their areas of expertise in orderto pave the way for safer working conditions.Author contributionsJC: Conceptualization, Methodology, Writing–original draft,Writing–review and editing. BK: Conceptualization, Methodology,Writing–review and editing. DR-V: Conceptualization, Methodology,Writing–original draft, Writing–review and editing.FundingThe author(s) declare that no financial support was received forthe research, authorship, and/or publication of this article.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that could beconstrued as a potential conflict of interest.FIGURE 1Occupational health issues intersection diagram: Heat exposureand physical strain.Frontiers in Physiology frontiersin.org02Crowe et al. 10.3389/fphys.2023.1304229Publisher’s noteAll claims expressed in this article are solely those of the authorsand do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.ReferencesArbury, S., Jacklitsch, B., Farquah, O., Hodgson, M., Lamson, G., Martin, H., et al.(2014). Heat illness and death among workers—United States, 2012–2013. MMWRMorb. Mortal. Wkly. Rep. 63 (31), 661–665.Borg, M. A., Xiang, J., Anikeeva, O., Pisaniello, D., Hansen, A., Zander, K., et al.(2021). Occupational heat stress and economic burden: a review of global evidence.Environ. Res. 195, 110781. doi:10.1016/j.envres.2021.110781Briggs, A. M., Woolf, A. D., Dreinhöfer, K., Homb, N., Hoy, D. G., Kopansky-Giles,D., et al. (2018). Reducing the global burden of musculoskeletal conditions. Bull. WorldHealth Organ. 96 (5), 366–368. doi:10.2471/BLT.17.204891Burtscher, J., Vanderriele, P.-E., Legrand, M., Predel, H.-G., Niebauer, J., O’Keefe,J. H., et al. (2022). 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Salud Pública 44, e15. doi:10.26633/RPSP.2020.15Frontiers in Physiology frontiersin.org03Crowe et al. 10.3389/fphys.2023.1304229

Editorial: Acute and long-term health issues of occupational exposure to heat and high physical loads

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