Heat acclimation or acclimatization (HA) occurs with repeated exposure to heat inducing adaptations that enhance thermoregulatory mechanisms and heat tolerance leading to improved exercise performance in warm-to-hot conditions. HA is an essential heat safety and performance enhancement strategy in preparation for competitions in warm-to-hot conditions for both individual and team sports. Yet, some data indicate HA is an underutilized pre-competition intervention in athletes despite the well-known benefits; possibly due to a lack of practical information provided to athletes and coaches. Therefore, the aim of this review is to provide actionable evidence-based implementation strategies and protocols to induce and sustain HA. We propose the following suggestions to circumvent potential implementation barriers: 1) incorporate multiple induction methods during the initial acclimation period, 2) complete HA 1–3 weeks before competition in the heat to avoid training and logistical conflicts during the taper period, and 3) minimize adaptation decay through intermittent exercise-heat exposure or re-acclimating immediately prior to competition with 2–4 consecutive days of exercise-heat training. Use of these strategies may be desirable or necessary to optimize HA induction and retention around existing training or logistical requirements.

Introduction: Existing predictive equations underestimate the metabolic costs of heavy military load carriage. Metabolic costs are specific to each type of military equipment, and backpack loads often impose the most sustained burden on the dismounted warfighter. Purpose: This study aimed to develop and validate an equation for estimating metabolic rates during heavy backpacking for the US Army Load Carriage Decision Aid (LCDA), an integrated software mission planning tool. Methods: Thirty healthy, active military-age adults (3 women, 27 men; age, 25 ± 7 yr; height, 1.74 ± 0.07 m; body mass, 77 ± 15 kg) walked for 6–21 min while carrying backpacks loaded up to 66% body mass at speeds between 0.45 and 1.97 m·s⁻¹. A new predictive model, the LCDA backpacking equation, was developed on metabolic rate data calculated from indirect calorimetry. Model estimation performance was evaluated internally by k-fold cross-validation and externally against seven historical reference data sets. We tested if the 90% confidence interval of the mean paired difference was within equivalence limits equal to 10% of the measured metabolic rate. Estimation accuracy and level of agreement were also evaluated by the bias and concordance correlation coefficient (CCC), respectively. Results: Estimates from the LCDA backpacking equation were statistically equivalent (P < 0.01) to metabolic rates measured in the current study (bias, −0.01 ± 0.62 W·kg⁻¹; CCC, 0.965) and from the seven independent data sets (bias, −0.08 ± 0.59 W·kg⁻¹; CCC, 0.926). Conclusions: The newly derived LCDA backpacking equation provides close estimates of steady-state metabolic energy expenditure during heavy load carriage. These advances enable further optimization of thermal-work strain monitoring, sports nutrition, and hydration strategies.

Context: : The National Athletic Trainers' Association recommends using onsite wet-bulb globe temperature (WBGT) measurement to determine whether to modify or cancel physical activity. However, not all practitioners do so and instead they may rely on the National Weather Service (NWS) to monitor weather conditions. Objective: : To compare regional NWS WBGT estimates with local athletic-surface readings and compare WBGT measurements among various local athletic surfaces. Design: : Observational study. Setting: : Athletic fields. Main Outcome Measure(s): : Measurements from 2 identical WBGT devices were averaged on 10 athletic surfaces within an NWS station reporting radius. Athletic surfaces consisted of red and black all-weather tracks (track), blue and black hard tennis courts (tennis), nylon-knit artificial green turf, green synthetic turfgrass, volleyball sand, softball clay, natural grass (grass), and a natural lake (water). Measurements (n = 143 data pairs) were taken over 18 days (May through September) between 1 pm and 4:30 pm in direct sunlight 1.2 m above ground. The starting location was counterbalanced across surfaces. The NWS weather data were entered into an algorithm to model NWS WBGT. Results: : Black tennis, black track, red track, and volleyball sand WBGT recordings were greater than NWS estimates (P ≤ .05). When all athletic-surface measurements were combined, NWS (26.85°C ± 2.93°C) underestimated athletic-surface WBGT measurements (27.52°C ± 3.13°C; P < .001). The range of difference scores (−4.42°C to 6.14°C) and the absolute mean difference (1.71°C ± 1.32°C) were large. The difference between the onsite and NWS WBGT measurements resulted in misclassification of the heat-safety activity category 45% (65/143) of the time (= 3.857, P = .05). The WBGT of water was 1.4°C to 2.7°C lower than that of all other athletic surfaces (P = .04). We observed no other differences among athletic surfaces but noted large WBGT measurement variability among athletic playing surfaces. Conclusions: : Clinicians should use an onsite WBGT device to determine environmental conditions and the need for modification of athletic events, especially as environmental conditions worsen. Given the large WBGT variability among athletic surfaces, WBGT measurements should be obtained from each athletic surface.

The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot (n = 12, 40 °C, 40% relative humidity) or mild (n = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90–120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL⁻¹ or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL⁻¹) and PostHA (0.39 ± 0.20 mg·dL⁻¹), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL⁻¹, 0.08 ± 0.06 mg·dL⁻¹, p ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA (n = 9, 75%), with fewer participants with CLINICAL PostHA (n = 7, 58%, p = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.