International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes’ heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; T_CORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; T_SKIN: Skin temperature; V̇O_2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature

Purpose: To examine the effect of a hot humid (HH) compared with a hot dry (HD) environment, matched for heat stress, on intermittent-sprint performance. In comparison with HD, HH environments compromise evaporative heat loss and decrease exercise tolerance. It was hypothesized that HH would produce greater physiological strain and reduce intermittent-sprint exercise performance compared with HD.Method: Eleven male team-sport players completed the cycling intermittent-sprint protocol (CISP) in 3 conditions, temperate (TEMP; 21.2°C ± 1.3°C, 48.6% ± 8.4% relative humidity [rh]), HH (33.7°C ± 0.5°C, 78.2% ± 2.3% rh), and HD (40.2°C ± 0.2°C, 33.1% ± 4.9% rh), with both heat conditions matched for heat stress.Results: All participants completed the CISP in TEMP, but 3 failed to completed the full protocol of 20 sprints in HH and HD. Peak power output declined in all conditions (P< .05) but was not different between any condition (sprints 1–14 [N = 11]: HH 1073 ± 150 W, HD 1104 ± 127 W, TEMP, 1074 ± 134; sprints 15–20 [N = 8]: HH 954 ± 114 W, HD 997 ± 115 W, TEMP 993 ± 94;P> .05). Physiological strain was not significantly different in HH compared with HD, but HH was higher than TEMP (P< .05).Conclusion: Intermittent-sprint exercise performance of 40 min duration is impaired, but it is not different in HH and HD environments matched for heat stress despite evidence of a trend toward greater physiological strain in an HH environment.

This experiment aimed to investigate the efficacy of twice‐daily, nonconsecutive heat acclimation (TDHA) in comparison to once‐daily heat acclimation (ODHA) and work matched once‐ or twice‐daily temperate exercise (ODTEMP, TDTEMP) for inducing heat adaptations, improved exercise tolerance, and cytokine (immune) responses. Forty males, matched biophysically and for aerobic capacity, were assigned to ODHA, TDHA, ODTEMP, or TDTEMP. Participants completed a cycling‐graded exercise test, heat acclimation state test, and a time to task failure (TTTF) at 80% peak power output in temperate (TTTF_TEMP: 22°C/40% RH) and hot conditions (TTTF_HOT: 38°C/20% RH), before and after 10‐sessions (60 min of cycling at ~2 W·kg⁻¹) in 45°C/20% RH (ODHA and TDHA) or 22°C/40% RH (ODTEMP or TDTEMP). Plasma IL‐6, TNF‐α, and cortisol were measured pre‐ and postsessions 1, 5, and 10. ODHA and TDHA induced equivalent heat adaptations (P < 0.05) (resting rectal temperature [−0.28 ± 0.22, −0.28 ± 0.19°C], heart rate [−10 ± 3, −10 ± 4 b·min⁻¹], and plasma volume expansion [+10.1 ± 5.6, +8.5 ± 3.1%]) and improved heat acclimation state (sweat set point [−0.22 ± 0.18, −0.22 ± 0.14°C] and gain [+0.14 ± 0.10, +0.15 ± 0.07 g·sec⁻¹·°C⁻¹]). TTTF_HOT increased (P < 0.001) following ODHA (+25 ± 4%) and TDHA (+24 ± 10%), but not ODTEMP (+5 ± 14%) or TDTEMP (+5 ± 17%). TTTF_TEMP did not improve (P > 0.05) following ODHA (+14 ± 4%), TDHA (14 ± 8%), ODTEMP (9 ± 10%) or TDTEMP (8 ± 13%). Acute (P < 0.05) but no chronic (P > 0.05) increases were observed in IL‐6, TNF‐α, or cortisol during ODHA and TDHA, or ODTEMP and TDTEMP. Once‐ and twice‐daily heat acclimation conferred similar magnitudes of heat adaptation and exercise tolerance improvements, without differentially altering immune function, thus nonconsecutive TDHA provides an effective, logistically flexible method of HA, benefitting individuals preparing for exercise‐heat stress.