This review examines the cardiovascular adaptations along with total body water and plasma volume adjustments that occur in parallel with improved heat loss responses during exercise-heat acclimation. The cardiovascular system is well recognized as an important contributor to exercise-heat acclimation that acts to minimize physiological strain, reduce the risk of serious heat illness and better sustain exercise capacity. The upright posture adopted by humans during most physical activities and the large skin surface area contribute to the circulatory and blood pressure regulation challenge of simultaneously supporting skeletal muscle blood flow and dissipating heat via increased skin blood flow and sweat secretion during exercise-heat stress. Although it was traditionally held that cardiac output increased during exercise-heat stress to primarily support elevated skin blood flow requirements, recent evidence suggests that temperature-sensitive mechanisms may also mediate an elevation in skeletal muscle blood flow. The cardiovascular adaptations supporting this challenge include an increase in total body water, plasma volume expansion, better sustainment and/or elevation of stroke volume, reduction in heart rate, improvement in ventricular filling and myocardial efficiency, and enhanced skin blood flow and sweating responses. The magnitude of these adaptations is variable and dependent on several factors such as exercise intensity, duration of exposure, frequency and total number of exposures, as well as the environmental conditions (i.e. dry or humid heat) in which acclimation occurs.

Objective To characterise the core temperature response and power output profile of elite male and female cyclists during the 2016 UCI Road World Championships. This may contribute to formulating environmental heat stress policies. Methods Core temperature was recorded via an ingestible capsule in 10, 15 and 15 cyclists during the team time trial (TTT), individual time trial (ITT) and road race (RR), respectively. Power output and heart rate were extracted from individual cycling computers. Ambient conditions in direct sunlight were hot (37°C±3°C) but dry (25%±16% relative humidity), corresponding to a wet-bulb globe temperature of 27°C±2°C. Results Core temperature increased during all races (p<0.001), reaching higher peak values in TTT (39.8°C±0.9°C) and ITT (39.8°C±0.4°C), relative to RR (39.2°C±0.4°C, p<0.001). The highest temperature recorded was 41.5°C (TTT). Power output was significantly higher during TTT (4.7±0.3 W/kg) and ITT (4.9±0.5 W/kg) than RR (2.7±0.4 W/kg, p<0.001). Heart rate increased during the TTs (p<0.001) while power output decreased (p<0.001). Conclusion 85% of the cyclists participating in the study (ie, 34 of 40) reached a core temperature of at least 39°C with 25% (ie, 10 of 40) exceeding 40°C. Higher core temperatures were reached during the time trials than the RR.

Claude Bernard’s milieu intérieur (internal environment) and the associated concept of homeostasis are fundamental to the understanding of the physiological responses to exercise and environmental stress. Maintenance of cellular homeostasis is thought to happen during exercise through the precise matching of cellular energetic demand and supply, and the production and clearance of metabolic by-products. The mind-boggling number of molecular and cellular pathways and the host of tissues and organ systems involved in the processes sustaining locomotion, however, necessitate an integrative examination of the body’s physiological systems. This integrative approach can be used to identify whether function and cellular homeostasis are maintained or compromised during exercise. In this review, we discuss the responses of the human brain, the lungs, the heart, and the skeletal muscles to the varying physiological demands of exercise and environmental stress. Multiple alterations in physiological function and differential homeostatic adjustments occur when people undertake strenuous exercise with and without thermal stress. These adjustments can include: hyperthermia; hyperventilation; cardiovascular strain with restrictions in brain, muscle, skin and visceral organs blood flow; greater reliance on muscle glycogen and cellular metabolism; alterations in neural activity; and, in some conditions, compromised muscle metabolism and aerobic capacity. Oxygen supply to the human brain is also blunted during intense exercise, but global cerebral metabolism and central neural drive are preserved or enhanced. In contrast to the strain seen during severe exercise and environmental stress, a steady state is maintained when humans exercise at intensities and in environmental conditions that require a small fraction of the functional capacity. The impact of exercise and environmental stress upon whole-body functions and homeostasis therefore depends on the functional needs and differs across organ systems.

Aim: Intestinal temperature telemetry systems are promising monitoring and research tools in athletes. However, the additional equipment that must be carried to continuously record temperature data limits their use to training. The purpose of this study was to assess the validity and reliability of a new gastrointestinal temperature data logging and telemetry system (e-Celsius™) during water bath experimentation and exercise trials. Materials and Methods: Temperature readings of 23 pairs of e-Celsius (T_eC) and VitalSense (T_VS) ingestible capsules were compared to rectal thermistor responses (T_rec) at 35, 38.5 and 42°C in a water bath. Devices were also assessed in vivo during steady-state cycling (n = 11) and intermittent running (n = 11) in hot conditions. Results: The water bath experiment showed T_VS and T_eC under-reported T_rec (P<0.001). This underestimation of T_rec also occurred during both cycling (mean bias vs T_VS: 0.21°C, ICC: 0.84, 95% CI: 0.66–0.91; mean bias vs. T_eC: 0.44°C, ICC: 0.68, 95% CI: 0.07–0.86, P<0.05) and running trials (mean bias vs. T_VS: 0.15°C, ICC: 0.92, 95% CI: 0.83–0.96; mean bias vs. T_eC: 0.25, ICC: 0.86, 95% CI: 0.61–0.94, P<0.05). However, calibrating the devices attenuated this difference during cycling and eliminated it during running. During recovery following cycling exercise, T_eC and T_VS were significantly lower than T_rec despite calibration (P<0.01). Conclusion: These results indicate that both T_eC and T_VS under-report T_rec during steady-state and intermittent exercise in the heat, with T_eC predicting T_rec with the least accuracy of the telemetry devices. It is therefore recommended to calibrate these devices at multiple temperatures prior to use.

Purpose: This study aimed to characterize the adaptive responses to heat acclimation (HA) with controlled heart rate (HR) and determine whether hydration strategy alters adaptations. The influence of HA on maximal oxygen uptake (V˙O_2max) in cool conditions and self-paced exercise in the heat was also determined.Methods: Eight men (V˙O_2max, 55 ± 7 mL·kg⁻¹·min⁻¹) completed two 10-d interventions in a counterbalanced crossover design. Fluid intakes differed between interventions to either maintain euhydration (HA-EUH) or elicit similar daily body mass deficits (2.85% ± 0.26%; HA-DEH). HA consisted of 90 min of cycling in 40°C and 40% relative humidity. Initial workload (172 ± 22 W) was adjusted over the last 75 min to maintain exercising HR equivalent to 65% V˙O_2max. A V˙O_2maxtest in cool conditions and 30-min time trial in hot-humid conditions were completed before and after HA.Results: HR at the end of the initial 15 min workload was 10 ± 5 bpm lower on day 10 in both interventions (P< 0.001). The workload necessary to maintain exercising HR (145 ± 7 bpm) increased throughout HA-EUH (25 ± 10 W,P= 0.001) and HA-DEH (16 ± 18 W,P= 0.02). There was a main effect of HA on sweat rate (P= 0.014), which tended to increase with HA-EUH (0.19 ± 0.18 L·h⁻¹,P= 0.06), but not HA-DEH (P= 0.12). Skin temperature decreased during HA-EUH (0.6°C ± 0.5°C,P= 0.03), but not HA-DEH (P= 0.30). There was a main effect of HA on V˙O_2max(~3 mL·kg⁻¹·min⁻¹,P= 0.02); however, neither intervention independently increased V˙O_2max(both,P= 0.08). Time-trial performance increased after HA-EUH (19 ± 16 W,P= 0.02), but not HA-DEH (P= 0.21).Conclusions: Controlled HR exercise in the heat induces several HA adaptations, which may be optimized by maintaining euhydration. HA-EUH also improves self-paced exercise performance in the heat. However, HA does not seem to significantly increase V˙O_2maxin cool conditions.

Purpose Assess the health status and heat preparation strategies of athletes competing in a World Cycling Championships held in hot ambient conditions (37°C, 25% relative humidity, wet-bulb-globe-temperature 27°C) and monitor the medical events arising during competition. Methods 69 cyclists (~9% of the world championships participants) completed a pre-competition questionnaire. Illnesses and injuries encountered by the Athlete Medical Centre (AMC) were extracted from the race reports. Results 22% of respondents reported illness symptoms in the 10 days preceding the Championships. 57% of respondents had previously experienced heat-related symptoms (cramping most commonly) while 17% had previously been diagnosed with exertional heat illness. 61% of the respondents had undergone some form of heat exposure prior to the Championships, with 38% acclimating for 5 to 30 days. In addition, several respondents declared to live in warm countries and all arrived in Qatar ~5 days prior to their event. 96% of the respondents used a pre-cooling strategy for the time trials and 74% did so before the road race (p<0.001), with ice vests being the most common. The AMC assessed 46 injuries and 26 illnesses in total, with three cyclists diagnosed with heat exhaustion. Conclusions The prevalence of previous heat illness in elite cyclists calls for team and event organisation doctors to be trained on heat illness management, including early diagnosis and rapid on-site cooling. Some cyclists had been exposed to the heat prior to the Championships, but few had a dedicated plan, calling for additional education on the importance of heat acclimation. Pre-cooling was widely adopted.