INTRODUCTION

The combination of exercise with environments that are hot, humid, cold, at high altitude,
underwater, or after significant time-zone shifts will place a significant burden on the human
body as it attempts to maintain homeostasis. The body has natural responses to exposure to
such environments and to coping with acute exercise in these circumstances. A series of
acclimatization adjustments exists for most environments and these may protect against the
deleterious effects of exercise combined with environmental stress.When exercise is
performed in the heat, the strain experienced by the thermoregulatory systemis further
magnified. The extent of the physiological stress depends on several factors, including the
individual’s heat acclimatization, level of physical fitness, and hydration state. These factors
affectthe athlete’s ability to perform. Under severe environmental conditions, exercising in
the heat poses asignificant risk to health and well-being.

The stresses of physical exertion often are complicated by environmental thermal

conditions. Performing in extreme heat or cold places adds a heavy burden on the
mechanisms that regulate body temperature. Although these mechanisms are amazingly
effective in regulating body temperature under normal conditions, mechanisms of
thermoregulation can be inadequate when we are subjected to extreme heat or cold.
Fortunately, our bodies are able to adapt to such environmental stresses with continued
exposure over time, a process known as acclimation (which refers to a short-term
adaptation, e.g., days to weeks) or acclimatization (the proper term when we are referring to
natural adaptations gained over long periods of time, e.g., months to years).

Humans are homoeothermic, which means that internal body temperature is physiologically
regulated to keep it nearly constant even when environmental temperature changes.During
prolonged heavy exercise, fever due to illness, or extreme conditions of heat or cold do
bodytemperatures deviate from the normal baseline range.Body temperature reflects a
careful balance between heat production and heat loss. Core temperature is sensed by the
hypothalamic thermoregulatory center and the center sets off a number of circulatory
adjustments in an effort to dissipate heat. Primarily this involves increasing cardiac output
and redistributingblood from the visceral organs to the working muscles and skin.

1. EXERCISE IN THE HEAT ENVIRONMET

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The human body’s core temperature varies from day to day, and from time to time, but
these fluctuations are small, usually no more than 1.0ºC. Humans are homoeothermic and
body temperature is regulated at about 37ºC +/- 1ºC. The thermoregulatory center in the
hypothalamus plays a very active role in keeping body temperature in the normal range.
Many sporting events and recreational activities occur in hot environments. Strenuous
exercise and environmental extremes can combine to overwhelm the thermoregulatory
capacity of the body. Body temperature increases during prolonged exercise because heat
production exceeds heat dissipation. The increase in core temperature is proportional to the
metabolic power output performed and is largely independent of environmental
temperature over a fairly wide range of temperatures. This suggests that the heat-
dissipating mechanisms of the body can compensate for the increased metabolic heat
production and stabilize body temperature.When the body cannot dissipate the metabolic
heat generated during exercise, body temperature continues to rise.

1.1. How the Body Dissipates Heat during Exercise

Heat production and heat transfer occur by the same mechanisms during exercise as they do
at rest. However, during exercise the total body metabolism may increase to 15–20 times
the resting rate. In this situation, metabolic heat production may increase to a greater extent
than heat dissipation; thus, the body stores heat and body temperature increases. The
increase in body temperature with exercise is termed hyperthermia.

Metabolic heat produced in the muscles is transported to the core of the body and skin by
the blood. Heat is also transferred to the skin and exchanged with the environment by
conduction, convection, radiation, and evaporation. Two physiological mechanisms allow the
body to dissipate heat in an attempt to maintain thermal balance during exercise: an
increase in sweating rate and vasodilation of the cutaneous (skin) vessels. Evaporative
cooling of sweat is the primary mechanism by which the body cools itself during exercise in
warm temperatures. Vasodilation of cutaneous vessels brings the more warm blood close to
the body’s surface so that heat can be dissipated to the environment via conduction,
radiation, and convection, assuming that the ambient temperature is cooler than the body.
During heavy exercise, the sweat rate can increase dramatically. Sweat rates vary
considerably among individuals, depending on genetics and fitness level. A fit person begins
sweating at a lower body temperature and sweats more profusely. For any one individual,
sweat rate depends on environmental conditions, exercise intensity, fitness level, degree of
acclimatization, and hydration status. Notice how common it is for sweating rates to exceed
1 L·hr−1 of sweat. Clearly, a water loss will lead to a decrease in total body water and plasma
volume and will have deleterious effects on cardiovascular function if fluid is not replaced.
The evaporation of sweat is the primary defense against heat stress. Sweating itself does not
cool the body; the sweat must evaporate. The evaporation of sweat produces a cooling of
the body because energy is needed to convert the liquid sweat into a vapor, and this energy

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is extracted from the immediate surroundings. The amount of energy needed for the
evaporation of sweat can be

Non evaporative heat loss is the result of the combined effects of conduction, radiation, and
convection. Conduction is heat exchange between two solid surfaces that are in direct
contact. The rate of conductance depends on the temperature difference between the two
surfaces. Conduction may have limited value during exercise in the heat because of the
limited surface area that is in direct contact with the ground. It accounts for less than 2% of
heat loss in most situations. Conduction is easily illustrated by the example of a person
camping out during the winter months. When the camper sleeps on snow-covered ground,
significant heat exchange occurs between the person’s body and the ground. In the morning,
the camper wakes up lying in a depression that was created as body heat melted the packed
snow beneath the tent floor. Radiation is the transfer of energy waves that are emitted by
one object and absorbed by another. Convection is heat exchange that occurs between a
surface and a fluid medium. Both air and body fluids can dissipate heat through convective
means. As mentioned previously, evaporative heat loss is severely reduced during exercise in
a hot, wet environment. The body relies more on radiation and convection to dissipate heat
under these conditions.

Fig, 1 Heat exchange mechanism during exercise

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 1.2. CARDIOVASCULAR DEMANDS AND RESPONCES OF EXERCISE IN HEAT

The cardiovascular system faces several interrelated problems in hyper thermic conditions:

1. The skin and the muscles compete for blood flow. The muscles need increased blood flow
to meet the demands of metabolic activity, and the skin needs increased blood flow to
dissipate heat from the body’s core.

2. Vasodilation in cutaneous vessels effectively decreases venous return, thus decreasing

stroke volume. Therefore, cardiac output may be reduced at a time when the demands for
flow are greatest.

3. Sweating results in a reduced plasma volume, contributing to the reduction in stroke

volume and, therefore, cardiac output.

4. Adequate blood pressure must be maintained to perfuse the vital organs, including the
brain, kidney, and liver. The ability to maintain blood pressure is challenged by widespread
vasodilation in the skeletal muscle beds and cutaneous vessels, which decreases total
peripheral resistance.

Cardio vascular system has various responses to various intensities of exercise (light,
moderate, and heavy). During short-term, light submaximal exercise, cardiac output
increases to a similar degree in both hot and thermo neutral environments. However,
cardiac output in a hot environment is achieved by a higher heart rate and a lower stroke
volume than in a thermo neutral environment. This reduced stroke volume occurs during hot
conditions because of sweating and vasodilation in the cutaneous vessels, which decreases
central venous volume. Mean arterial pressure is similar to or only slightly lower in hot
environments than in thermo neutral environments because of vasoconstriction in the
kidneys and digestive tract.

During prolonged, heavy submaximal exercise in the heat, cardiac output increases less than
in a thermo neutral environment. Although the heart rate is higher, it cannot compensate
fully for the reduced stroke volume during heavy exercise in hot conditions. Thus, cardiac
output is lower in hot conditions than in thermo neutral conditions. During long-term, heavy
submaximal exercise in the heat, vasoconstriction occurs in the digestive and renal areas in
an attempt to maintain mean arterial blood pressure. Vasoconstriction may result in
ischemia and even tissue damage in extreme conditions. The regulatory mechanisms that
maintain blood pressure are stressed by the excessive water loss that occurs with profuse
sweating. If this fluid is not replaced, stroke volume, cardiac output, and blood pressure will
decrease. Additionally, performance will suffer, and heat illness becomes increasingly likely.

Cardiac output increases during exercise in both conditions. However, cardiac output at
V.O2max is less in the hot environment, presumably because blood is displaced in cutaneous
veins, thus decreasing venous return and stroke volume. Blood flow to the active skeletal

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muscles increases throughout exercise in both conditions. However, blood flow to skeletal
muscle is a smaller proportion of total blood flow in a hot environment than in a thermo
neutral environment, because skin blood flow accounts for a larger portion of the blood
flow.

At V.O2max in the hot condition, visceral blood flow is severely reduced in an effort to
support the muscles with adequate blood flow and maintain blood pressure. The lower
cardiac output and the decrease in blood flow when maximal exercise is performed in a hot
environment both contribute to a lower V.O2max and an earlier onset of fatigue.

1.3. FACTORS AFFECTING CARDIOVASCULAR EFFICENCY IN HEAT

ENVIRONMENT

Several factors affect an individual’s response to exercise in the heat. The following four key
factors affect cardio vascular response: acclimatization, cardiovascular fitness, body
composition, and hydration level.

1.3.1. Acclimatization

Acclimatization refers to adaptive changes in an individual who undergoes prolonged or

repeated exposure to a stressful environment; these changes reduce the physiological strain
produced by such an environment. Acclimatization to heat results from repeated exposure
to heat and sufficient to increase core body temperature and elicit moderate to profuse
sweating. Light to moderate exercise in the heat for 1–2 hours a day can lead to positive
adaptations within a few days.

Acclimatization to heat involves three underlying mechanisms:

1. Cardiovascular changes decrease the heart rate and cardiovascular strain at a given level
of exercise in the heat.

2. Sweating begins earlier and at a lower body temperature.

3. The sweating rate for a given core temperature is higher and can be maintained longer

Proper acclimatization ensures that individuals can perform longer and more safely in the
heat.

1.3.2. Fitness Level

According to different research results aerobic fitness improves an individual’s thermo

regulatory function and heat tolerance. Endurance training results in a lower resting core
temperature, a larger plasma volume, an earlier onset of sweating, and a smaller decrease in
plasma volume during exercise. Therefore, individuals who are aerobically fit are better able

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to handle the cardiovascular demands of exercise in hot conditions than sedentary
individuals.

1.3.3. Body Composition

Excessive body fat is a liability for thermoregulation during exercise in the heat. Greater
adiposity contributes to heat stress by two primary mechanisms. First, adipose tissue
interferes with the dissipation of heat; body fat acts to insulate the core. Second, body fat
adds to the metabolic cost of activity by adding weight to the body that must be moved.
Heat illness is more common in overweight individuals and is more likely to be fatal to these
individuals.

1.3.4. Hydration Level

An individual’s level of hydration has a large impact on exercise tolerance and on the
cardiovascular responses to long-term exercise in the heat. Dehydration increases
physiological strain and perceived effort for the same absolute amount of exercise and this
effect is exacerbated when exercise is performed in the heat. Body water accounts for 65–
70% of the total body mass of an average adult. During long-term exercise in the heat, if fluid
is not replaced profuse sweating leads to large acute losses of total body water and a
reduction in plasma volume. The reduced plasma volume, in turn, leads to decreased stroke
volume and an increased heart rate during prolonged exercise.

Therefore, it is recommended that fluid ingestion during exercise be sufficient to prevent

excessive dehydration (>2% of body weight) and excessive loss of electrolytes to prevent
compromised performance and health risks. Individuals vary considerably in the amount of
sweat lost during activity, because of both external factors (such as the exercise intensity
and duration, environmental conditions, clothing) and individual factors (such as genetic
makeup, heat acclimatization, initial hydration status, and training and health status).
Careful monitoring of body weight following an exercise bout is necessary to determine an
individual’s typical sweat loss with exercise and the required fluid intake to offset this loss.

Thirst is an inadequate stimulus for adequately replacing the fluid lost during exercise. Even
with unlimited access to water, most individuals do not voluntarily consume enough water
to replace the water lost during physical activity, resulting in a relative state of dehydration.

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Fig 2, Dehydration and Performance

1.4. HEAT ILLNESS

When humans exercise there is a huge increase in heat production at the muscle and an
integrated response under the control of the thermoregulatory center to promote heat loss
to maintain core temperature. If, however, this response is inadequate and we see core
temperature rise beyond normal limits we are said to be hyper thermic and at risk for a
range of heat illnesses.

Heat cramps, the least serious complaint, reflects cramping in the muscles. The exact cause
of this cramping is not known but may reflect restricted blood flow as well as electrolyte
disturbances associated with hyperthermiaand fluid loss. If these occur people should cease
exercise and promote heat loss in a cool environment and seek medical attention.

Heat exhaustion, Isa more serious concern that is associated with fatigue,
disorientation/dizziness, vomiting and fainting. Blood pressure may be low with a weak
pulse. As such the body cannot cope with the thermoregulatory demands placed upon it and
is likely suffering from severe fluid loss. Again people must stop exercise immediately, seek a
cool environment and medical help for fluid replacement and core temperature monitoring.

Heat stroke can develop from heat exhaustion and is a serious medical condition that can
lead to death. In these circumstances the thermoregulatory systems have failed and heat
stroke is associated with confusion, loss of consciousness, lack of sweating, rapid pulse and
high core temperature (>40°C). Medical attention is required urgently to decrease core
temperature possibly by immersion in cold water or ice. If not treated, temperature will
continue to rise and tissues such as muscles will begin to break down releasing proteins into
the bloodstream which can cause damage and failure in organs such as the heart and kidney.

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Heat Syncope: Heat syncope (fainting) is rare in a conditioned athlete.In most instances, it
occurs when individualsstand for a prolonged period of time in the heat or exercise for a
prolonged period in an upright position.Heat syncope is caused by a pooling of bloodin the
vasculature of the limbs and skin because ofexcessive ambient temperatures.

Heat illness can occur in all types of exercisers from those of low fitness to elite athletes.
Poor preparation, insufficient fluid replacement, muscular body type and extremely high
levels of motivation (over-riding warning signs) are all potential problems. Be aware that
exercising conditions do not have to be hot and humid for heat illness to occur. It can be a
common occurrence in polar conditions when exercising with multiple protective layers of
clothing. Prevention of heat illness includes careful planning, sensible decision-making and
awareness of key symptoms. Apart from issues related to the day of exercise (is it too hot to
exercise, drinking enough, etc.) one of the most important things to do to prevent heat
illness is to gain some acclimatization to hot and/or humid conditions.

The following recommendations may help minimizethe risk of heat illnesses for individuals
preparing toexercise in the heat:

• Before exercise, determine the heat stressindex and make appropriate adjustments tothe
workout.

• Wear lightweight, loose-fitting clothing.

• Exercise at cooler times of the day.

• Avoid long warm-ups on hot, humid days.

• Ensure proper hydration before exercise (bodyweight should be within 1% of average

bodyweight).

• Ensure proper hydration during exercise byreplacing fluids lost through sweating (drink1 L
water for every kilogram of body weightlost during exercise).

• Ensure proper salt intake at meals.

• Know the signs and symptoms of heat illnesses.

1.5. HEAT AND PERFORMANCE

Exercising in the heat has significant effects on athletic performance. However, the
magnitude and direction of the effect (degree of improvement or decrement) depend on the
extent of hyperthermia as well as the mode of activity being performed.

1.5.1. Aerobic Exercise in a Hot Environment

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When exercise is performed in the heat, the maximal aerobic capacity (V .O2max) of the
athlete has been lowered. V .O2max appears to decrease regardless of the individual’s state
of heat acclimatization or physical fitness. The physiological mechanisms responsible for
these performance decrements are likely related to the increased blood flow diverted to the
peripheral vasculature. Dilation of the peripheral vascular beds may also result in a diversion
of some blood from the exercising muscles to the skin. This would also contribute to the
reduced cardiac output available to the muscles, affecting the metabolism of muscle
contraction.

During submaximal exercise in the heat, an increase in core temperature causes a shift in
metabolism from primarily aerobic to anaerobic in the exercising muscles and the liver. The
greater reliance on anaerobic metabolism indicates an increased reliance on carbohydrate
stores within the body to fuel exercise. This likely plays a significant role in the quicker rate
of fatigue seen during exercise in the heat.

1.5.2. Anaerobic Exercise in a Hot Environment

Studies showed that anaerobic exercise in the heat have generally shown either no change
or an increase in strength or power performance. The improved power production during
exercise in the heat may be related to a warm-up effect. The higher ambient temperatures
likely cause a greater increase in muscle temperature.

The higher power performances in the heat may be related to an increase in speed of
muscle contraction or a faster metabolic rate .Studies showed that a high ambient
temperature did not appear to affect recovery from exercise compared with a
thermoneutral condition. The ability to maintain anaerobic power performance in a hot
environment may have been related to the ability to keep the subjects rehydrated during
the recovery period.

1.6. ADAPTATIONS OF HEAT ACCLIMATIZATION

There are numerous adaptations that occur as a result of acclimatization to exercise in the
heat:

 Sweat rate in the skin areas exposed to heat is higher, thus enhancing evaporative
capacity. An increased production of aldosterone can strongly stimulate the sweat
glands and cause them to reabsorb more sodium and chloride.

 Earlier onset of sweating leads to a lower skin temperature, improved core-skin

temperature gradient, and less demand for blood flow to the skin. This latter
provides improved muscle blood flow and oxygen supply.

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  Plasma volume is increased, due to an increased production of aldosterone and
antidiuretic hormone (ADH). Aldosterone causes sodium and chloride retention by
the renal and sweat tubules, and ADH increases renal water retention. Hence, there
is a decrease in sweat sodium and chloride, but not potassium. More sodium is
retained, which promotes water retention. Plasma and interstitial fluid volumes can
increase 10–20%.

 Body core temperature can be kept lower, as heat dissipation is more efficient.

 Heart rate is lower at any given work load, as the core temperature is lower, plasma
volume is higher, skin blood flow distribution is decreased, and there is improved
stroke volume.

 The perception of heat stress is reduced.

 Onset of fatigue is delayed, as the rate of muscle glycogen utilization is decreased.

Men and women acclimatize equally well. Training in a hot, humid environment is
more stressful than training in hot, dry conditions.

SUMMARY
During exercise, heat production and loss from the skin occurs via evaporation (convection)
and conduction. If the environment is hotter, heat is gained and if the environment is humid,
decreased evaporation of heat occurs.The increase in core temperature is proportional to
the metabolic power output performed and is largely independent of environmental
temperature over a fairly wide range of temperatures.

Considerable water loss occurs during several hours of intense exercise in a hot
environment.Both intracellular and extracellular compartments contribute to fluid deficit.
The risk of heat illness greatly increases when a person begins exercising in a dehydrated
state.

Just about any degree of dehydration impairs the capacity of circulatory and temperature-
regulating mechanisms to adjust to exercise demands. Dehydration of as little as 2% body
mass impairs physical work capacity and physiologic function and predisposes to heat injury
when exercising in a hot environment.

When temperature is rise beyond normal limits we are said to be hyper thermic and we are
at risk of heat illnesses. Heatcramps: Involuntary muscle spasms that occur after intense
physical activity. Heatexhaustion: Most common heat illness that is associated with fatigue,
disorientation/dizziness, vomiting and fainting. Heat stroke: Most serious and requires
immediate medical attention.

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Adaptation to heat stress occurs even with training at moderate temperatures, but full
acclimatization can be achieved only with repeated bouts of exercise in theheat. At least five
to ten days of training in the heat are required for full acclimatization.This should begin by
training at a reduced intensity (60–70% of the usual load),so as to avoid heat-related
disorders.

REFERENCES

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Jay Hoffman etal( 2014).Physiological Aspects of Sport Training and Performance. Second
edition,University of Central Florida.

W. Larry Kenney(2012). Physiology of Sport and Exercise, 5 theditition, Pennsylvania State

University, University Park

Edward M. Winter etal (2007).SPORT AND EXERCISE PHYSIOLOGY TESTING GUIDELINES. , The
British Association of Sport and Exercise Sciences Guide Volume II:

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