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Quantifying Exercise Heat Acclimatisation in Athletes and Military Personnel: A Systematic Review and Meta-analysis

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Abstract

Background

Athletes and military personnel are often expected to compete and work in hot and/or humid environments, where decrements in performance and an increased risk of exertional heat illness are prevalent. A physiological strategy for reducing the adverse effects of heat stress is to acclimatise to the heat.

Objective

The aim of this systematic review was to quantify the effects of relocating to a hotter climate to undergo heat acclimatisation in athletes and military personnel.

Eligibility Criteria

Studies investigating the effects of heat acclimatisation in non-acclimatised athletes and military personnel via relocation to a hot climate for < 6 weeks were included.

Data Sources

MEDLINE, SPORTDiscus, CINAHL Plus with Full Text and Scopus were searched from inception to June 2022.

Risk of Bias

A modified version of the McMaster critical review form was utilised independently by two authors to assess the risk of bias.

Data Synthesis

A Bayesian multi-level meta-analysis was conducted on five outcome measures, including resting core temperature and heart rate, the change in core temperature and heart rate during a heat response test and sweat rate. Wet-bulb globe temperature (WBGT), daily training duration and protocol length were used as predictor variables. Along with posterior means and 90% credible intervals (CrI), the probability of direction (Pd) was calculated.

Results

Eighteen articles from twelve independent studies were included. Fourteen articles (nine studies) provided data for the meta-analyses. Whilst accounting for WBGT, daily training duration and protocol length, population estimates indicated a reduction in resting core temperature and heart rate of − 0.19 °C [90% CrI: − 0.41 to 0.05, Pd = 91%] and − 6 beats·min−1 [90% CrI: − 16 to 5, Pd = 83%], respectively. Furthermore, the rise in core temperature and heart rate during a heat response test were attenuated by − 0.24 °C [90% CrI: − 0.67 to 0.20, Pd = 85%] and − 7 beats·min−1 [90% CrI: − 18 to 4, Pd = 87%]. Changes in sweat rate were conflicting (0.01 L·h−1 [90% CrI: − 0.38 to 0.40, Pd = 53%]), primarily due to two studies demonstrating a reduction in sweat rate following heat acclimatisation.

Conclusions

Data from athletes and military personnel relocating to a hotter climate were consistent with a reduction in resting core temperature and heart rate, in addition to an attenuated rise in core temperature and heart rate during an exercise-based heat response test. An increase in sweat rate is also attainable, with the extent of these adaptations dependent on WBGT, daily training duration and protocol length.

PROSPERO Registration

CRD42022337761.

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Acknowledgements

The authors thank Dr Andrew Woodward for his statistical consultations.

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Authors and Affiliations

  1. Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, ACT, Australia

    Harry A. Brown, Thomas H. Topham, Brad Clark, Richard D. Telford & Julien D. Périard

  2. FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece

    Leonidas G. Ioannou & Andreas D. Flouris

  3. Faculty of Medicine and Health, Heat and Health Research Incubator, The University of Sydney, Sydney, NSW, Australia

    James W. Smallcombe & Ollie Jay

Authors
  1. Harry A. Brown
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  2. Thomas H. Topham
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  3. Brad Clark
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  4. Leonidas G. Ioannou
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  5. Andreas D. Flouris
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  6. James W. Smallcombe
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  7. Richard D. Telford
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  8. Ollie Jay
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  9. Julien D. Périard
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Corresponding author

Correspondence to Julien D. Périard.

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Funding

This study was funded by the National Health and Medical Research Council and the University of Canberra Research Institute for Sport and Exercise.

Conflicts of Interest

Harry Brown, Thomas Topham, Brad Clark, Leonidas Ioannou, Andreas Flouris, James Smallcombe, Richard Telford, Ollie Jay and Julien Périard declare that they have no conflicts of interest relevant to the content of this review.

Availability of Data and Material

Extracted data are available as supplementary materials at the Open Science Framework (https://osf.io/hwa4b/?view_only=cf1c7a75af5e481589bb14cffd0673a4).

Authors’ Contributions

HB, TT BC and JP were involved in database searches, data extraction and methodological quality assessment. HB, BC, LI, AF and JP were involved in the conception, design and interpretation of data. HB completed initial drafting of the manuscript, which was reviewed and edited by TT, BC, LI, AF, JS, RT, OJ and JP. All authors approved the final version of the submitted manuscript.

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Supplementary Information

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Supplementary file1 (DOCX 28 KB)

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Brown, H.A., Topham, T.H., Clark, B. et al. Quantifying Exercise Heat Acclimatisation in Athletes and Military Personnel: A Systematic Review and Meta-analysis. Sports Med 54, 727–741 (2024). https://doi.org/10.1007/s40279-023-01972-4

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