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Robert Carter III, Samuel N. Cheuvront and Michael N. Sawka

Objectives:

We report our observations on one soldier with abnormal hyperthermia during exercise in the heat compared with prior exercise and following acute local (non-febrile) infection. Also, we report on 994 heat stroke hospitalizations in the U.S. Army. It is known that prior infection is a risk factor for heat illness and some of the 37 heat stroke deaths cited infections (eg, pneumonia, influenza) in the medical records.

Results:

This case report illustrates complete recovery from abnormal hyperthermia, which occurred in a laboratory setting during mild, low intensity exercise. In a field setting, this case may have resulted in serious heat illness. As with most of the heat stroke cases, rapid medical attention (ie, cooling and rehydration) and the age group (19 to 26) that represents majority of the heatstroke cases in U.S. Army are likely factors that contribute successful treatment of heatstroke in the field environment.

Conclusions:

We conclude that acute inflammatory response can augment the hyperthermia of exercise and possibly increase heat illness susceptibility. Furthermore, it is important for health care providers of soldiers and athletes to monitor acute local infections due to the potential thermoregulatory consequences during exercise in the heat.

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Brett R. Ely, Matthew R. Ely and Samuel N. Cheuvront

The use of caffeine supplements in athletic and military populations has increased in recent years. Excessive caffeine consumption in conjunction with exercise in a hot environment may predispose individuals to heat illness.

Purpose:

To examine heat balance induced by a large dose of caffeine during exercise in a hot environment.

Methods:

Ten men, not heat acclimated and not habitual caffeine users, consumed either caffeine (CAF; 9 mg/kg) or placebo (PLA) before performing cycle-ergometer exercise for 30 min at 50% VO2peak in a 40 °C, 25% relative humidity environment while body temperature (core and skin) and ratings of thermal comfort (TC) were monitored. Heat-exchange variables were calculated using partitional calorimetry and thermometry.

Results:

Mean body temperature (Tb) was higher (p < .05) with CAF (37.18 ± 0.15 °C) than with PLA (36.93 ± 0.15 °C) at the start of exercise. Heat production was slightly higher (~8 W, p < .05) with CAF. There were no differences in heat storage, dry heat gains, TC, or Tb during exercise.

Conclusions:

A caffeine dose of 9 mg/kg does not appreciably alter heat balance during work in a hot environment. The small increase in Tb observed with CAF was undetected by the participants and is unlikely to increase physiological strain sufficiently to affect endurance performance or risk of heat illness.

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Samuel N. Cheuvront, Robert W. Kenefick and Edward J. Zambraski

A common practice in sports science is to assess hydration status using the concentration of a single spot urine collection taken at any time of day for comparison against concentration (specific gravity, osmolality, color) thresholds established from first morning voids. There is strong evidence that this practice can be confounded by fluid intake, diet, and exercise, among other factors, leading to false positive/negative assessments. Thus, the purpose of this paper is to provide a simple explanation as to why this practice leads to erroneous conclusions and should be curtailed in favor of consensus hydration assessment recommendations.

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Scott J. Montain, Samuel N. Cheuvront and Henry C. Lukaski

Context:

Uncertainty exists regarding the effect of sustained sweating on sweat mineral-element composition.

Purpose:

To determine the effect of multiple hours of exercise-heat stress on sweat mineral concentrations.

Methods:

Seven heat-acclimated subjects (6 males, 1 female) completed 5 × 60 min of treadmill exercise (1.56 m/s, 2% grade) with 20 min rest between exercise periods in 2 weather conditions (27 °C, 40% relative humidity, 1 m/s and 35 °C, 30%, 1 m/s). Sweat was collected from a sweat-collection pouch attached to the upper back during exercise bouts 1, 3, and 5. Mineral elements were determined by using inductively coupled plasma-emission spectrography.

Results:

At 27 °C, sweat sodium (863 [563] µg/mL; mean [SD]), potassium (222 [48] µg/mL), calcium (16 [7]) µg/mL), magnesium (1265 [566] ng/mL), and copper (80 [56] ng/mL) remained similar to baseline over 7 h of exercise-heat stress, whereas sweat zinc declined 42–45% after the initial hour of exercise-heat stress (Ex1 = 655 [362], Ex3 = 382 [168], Ex5 = 355 [288] µg/mL, P < 0.05). Similar outcomes were observed for sweat zinc at 35 °C when sweat rates were higher. Sweat rate had no effect on sweat trace-element composition.

Conclusions:

Sweat sodium, potassium, and calcium losses during multiple hours of sustained sweating can be predicted from initial sweat composition. Estimates of sweat zinc losses, however, will be overestimated if sweat zinc conservation is not accounted for in sweat zinc-loss estimates.

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Samuel N. Cheuvront, Robert Carter III, Scott J. Montain and Michael N. Sawka

The purpose of this study was to quantify the variability and stability of 1st morning body mass (BM) fluctuations during daily exercise in the heat while following traditional fluid intake guidance. Data from 65 men were examined retrospectively. BM fluctuations were monitored over 4 to 15 consecutive days. Group daily variation in BM was 0.51 ± 0.20 kg. Group coefficient of variation was 0.66 ± 0.24%, normally distributed, and not related to either absolute BM (r = 0.04) or number of measurements (r = 0.34). Three days resulted in a similar variability estimate compared to 6 or 9 d, although precision was improved with 9 d. In conclusion, 3 consecutive BM measurements provide an accurate assessment of daily BM variability, which is less than 1% for active men when replacing 100% of sweat losses during exercise. The data also suggest that daily BM is a sufficiently stable physiological parameter for potential daily fluid balance monitoring.

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Keith C. DeRuisseau, Samuel N. Cheuvront, Emily M. Haymes and Regina G. Sharp

The purpose of this study was to examine the effects of a 2-hour exercise bout on sweat iron and zinc concentrations and losses in males and females. Nine male and 9 female recreational cyclists exercised at ~50% V̇O2peak in a temperate environment (Ta = 23 °C, RH = 51%). Sweat samples were collected for 15 min during each of four 30-min exercise bouts. No significant differences were observed between males’ and females’ sweat iron or zinc concentrations or losses. Sweat iron concentrations decreased significantly between 60 and 90 min of exercise. Sweating rates increased significantly from 30 to 60 min and remained constant during the second hour. Sweat iron losses were significantly lower during the second hour (0.042 mg/m2/h) than the first hour of exercise (0.060 mg/m2/h). Sweat zinc concentrations also decreased significantly over the 2-hour exercise bout. Dietary intakes of iron and zinc were not significantly correlated to sweat iron and zinc concentrations. Sweat iron and zinc losses during 2 hours of exercise represented 3% and 1% of the RDA for iron and 9% and 8% of the RDA for zinc for men and women, respectively. These results suggest a possible iron conservation that prevents excessive iron loss during prolonged exercise.

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Samuel N. Cheuvront, Robert J. Moffatt, Kyle D. Biggerstaff, Shawn Bearden and Paul McDonough

Claims that ENDUROX™ enhances performance by altering metabolic responses to exercise were tested. In a double-blind crossover design, 10 male subjects were randomly assigned to consume 400 mg of placebo or 800 mg ENDUROX™ for 7 days. Cycle ergometry was performed for 30 minutes at 25%, followed by 10 min at 65% of peak oxygen consumption. After a 1-week washout period, subjects performed the identical exercise protocol following 7 days of reciprocal supplemental conditions. Expired gases were collected and analyzed continuously for oxygen consumption, minute ventilation, and respiratory exchange ratio. Heart rate, blood pressure, rating of perceived exertion, blood lactate, and serum glycerol data were also collected at regular intervals. A two-way ANOVA with repeated measures revealed no significant main or interaction effects involving group differences (p > 0.05) between trials for any variable during rest, 25% or 65% (VO2 peak), or recovery. Our findings do not support the ergogenic claims for ENDUROX™.

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Douglas J. Casa, Samuel N. Cheuvront, Stuart D. Galloway and Susan M. Shirreffs

The 2019 International Amateur Athletics Federation Track-and-Field World Championships will take place in Qatar in the Middle East. The 2020 Summer Olympics will take place in Tokyo, Japan. It is quite likely that these events may set the record for hottest competitions in the recorded history of both the Track-and-Field World Championships and Olympic Games. Given the extreme heat in which track-and-field athletes will need to train and compete for these games, the importance of hydration is amplified more than in previous years. The diverse nature of track-and-field events, training programs, and individuality of athletes taking part inevitably means that fluid needs will be highly variable. Track-and-field events can be classified as low, moderate, or high risk for dehydration based on typical training and competition scenarios, fluid availability, and anticipated sweat losses. This paper reviews the risks of dehydration and potential consequences to performance in track-and-field events. The authors also discuss strategies for mitigating the risk of dehydration.

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Joseph F. Seay, Brett R. Ely, Robert W. Kenefick, Shane G. Sauer and Samuel N. Cheuvront

We examined the effect of body water deficits on standing balance and sought to determine if plasma hyperosmolality (Posm) and/or volume reduction (%ΔVplasma) exerted independent effects. Nine healthy volunteers completed three experimental trials which consisted of a euhydration (EUH) balance test, a water deficit session and a hypohydration (HYP) balance test. Hypohydration was achieved both by exercise-heat stress to 3% and 5% body mass loss (BML), and by a diuretic to 3% BML. Standing balance was assessed during quiet standing on a force platform with eyes open and closed. With eyes closed, hypohydration significantly decreased medial-lateral sway path and velocity by 13% (both p < .040). However, 95% confidence intervals for the mean difference between EUH and HYP were all within the coefficient of variation of EUH measures, indicating limited practical importance. Neither Vplasma loss nor Posm increases were associated with changes in balance. We concluded that standing balance was not altered by hypohydration.

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Matthew R. Ely, Robert W. Kenefick, Samuel N. Cheuvront, Troy Chinevere, Craig P. Lacher, Henry C. Lukaski and Scott J. Montain

Heat acclimation (HA) reportedly conveys conservation in sweat micromineral concentrations when sampled from arm sweat, but time course is unknown. The observation that comprehensive cleaning of the skin surface negates sweat micromineral reductions during prolonged sweating raises the question of whether the reported HA effect is real or artifact of surface contamination.

Purpose:

To measure sweat mineral concentrations serially during HA and determine if surface contamination plays a role in the reported mineral reductions.

Methods:

Calcium (Ca), copper (Cu), magnesium (Mg), and zinc (Zn) were measured in sweat obtained from 17 male volunteers using an arm bag on Day 1, 5, and 10 of a HA protocol. To study the role of contamination, sweat was simultaneously (n = 10 subjects) sampled twice daily from a cleaned site (WASH) and unclean site (NO WASH) on the scapular surface.

Results:

Sweat Ca, Cu, and Mg from Arm Bag trended progressively downward from Day 1 to Day 10 of HA (p = .10–0.25). Micromineral concentrations from the WASH site did not change between Day 1, 5, or 10 (Ca = 0.30 ± 0.12 mmol/L, Cu 0.41 ± 0.53 μmol/L; Zn 1.11 ± 0.80 μmol/L). Surface contamination can confound sweat mineral estimates, as sweat Ca and Cu from NO WASH site were initially higher than WASH (p < .05) but became similar to WASH when sampled serially.

Conclusion:

Heat acclimation does not confer reductions in sweat Ca, Cu, Mg, or Zn. When the skin surface is not cleaned, mineral residue inflates initial sweat mineral concentrations. Earlier reports of micromineral reductions during HA may have been confounded by interday cleaning variability.