‘Too much of a coincidence’: identical twins with exertional heatstroke in the same race

Smith, Robin; Jones, Norman L.; Martin, Daniel; Kipps, Courtney

doi:10.1136/bcr-2015-212592

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…Technological developments to allow affordable measurement of real-time insight into core temperature may also aid in assessing the risk for heat stroke using wearables, as such measurements are currently largely restricted to the science domain. Furthermore, the involvement of genetics should be further explored as an increasing number of studies suggest a role for inherited factors (444,918,924).…”

Section: Contemporary Controversies and Avenues Of Researchmentioning

confidence: 99%

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

Périard

Eijsvogels²,

Daanen

2021

Physiological Reviews

212

166

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A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat, by examining the benefits of heat acclimation, cooling strategies and hyperhydration. Finally, contemporary controversies are summarized and future research directions provided.

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Section: Contemporary Controversies and Avenues Of Researchmentioning

confidence: 99%

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

Périard

Eijsvogels²,

Daanen

2021

Physiological Reviews

212

166

View full text Add to dashboard Cite

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“…It has an estimated incidence of 1 in every 1000 athletes [62], and it is frequently observed in adventure races, climbing, hiking, cycling competitions, and ultra-endurance races [52,62]. In the latter, it is most common in marathons [14,44,45] and in ultra-marathons several cases of athletes that did not finish because of heat-related factors, as an inadequately heat acclimatization have been reported [29,35].…”

Section: Stress Heat Stroke (Ehs) During Physical Exercise Under Extrmentioning

confidence: 99%

“…The weather conditions constitute a very important factor in endurance and ultra-endurance sports, and may lead to problems for athletes during the competition [14]. During prolonged effort in a hot condition, exercise hyperthermia cause an important challenge at thermoregulatory level [15].…”

Section: Introductionmentioning

confidence: 99%

Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations

Sanz

Nuñez

Sospedra

et al. 2020

IJERPH

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During the last few years, the numbers of competitors in endurance and ultra-endurance sports modalities have increased significantly. This type of competition is an extreme challenge for athletes. Therefore, they have an increased the risk of developing medical and nutritional problems. The aim of the work is to estimate the incidence of nutrition-related adverse outcomes in endurance and ultra-endurance sports, considering the variables that influence them. A critical review was carried out based on the PubMed database, by means of a search strategy based on keywords separated by Boolean connectors. For all the results obtained in a period from 2008 to 2019, a series of inclusion/exclusion criteria was applied to select only the studies that fitted the objective of the present study. Results and discussion: Of the 871 publications identified, 33 met the inclusion criteria. The adverse outcomes found included exercise-associated hyponatremia (EAH), heat stroke by exertion (EHS), gastrointestinal (GI) problems, dehydration, and hypothermia; the provision of misinformation to athletes about nutrient intake and hydration during competition was identified as the main cause. Conclusions: The main adverse outcomes in endurance and ultra-endurance sports modalities are EAH, GI inconveniences, and EHS. These problems can affect the performance and health status of the athlete during and post-competition. Several nutritional guidelines have been suggested that can prevent these adverse outcomes, and it is essential to individualize and adjust the nutritional intake and hydration status according to the characteristics of each competition.

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“…While previous history of EHS remains a cited risk factor for future EHS risk [ 1 , 9 , 12 , 13 ], very little clinical data exist to support this statement. The current literature relies heavily on military data and a few case studies of individuals with multiple instances of EHS [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Therefore, it has yet to be established, beyond a handful of case reports [ 14 , 17 , 18 , 20 ], that repeated EHS cases exist within the athlete or civilian population.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, two theories are posited for why subsequent EHS risk exists: the former suggests that initial care may dictate outcome and future risk, while the latter suggests patients may possess an innate risk profile that may not be modifiable or managed. For the latter, emerging evidence suggests that risk mitigation for EHS recurrence may not always be possible due to genetic factors that have been shown to be associated with increased EHS risk [ 17 , 20 , 21 , 22 , 23 ]. Therefore, some EHS cases may be a manifestation of a genetic disorder (e.g., malignant hyperthermia) that increases an individual’s risk for EHS rather than a temporary impairment of heat tolerance.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race

et al. 2020

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Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003–2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2–4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (−4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1–12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3–5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

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‘Too much of a coincidence’: identical twins with exertional heatstroke in the same race

Cited by 8 publications

References 22 publications

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations

Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race

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