@article{discovery10169137,
           month = {February},
            year = {2022},
          number = {8},
           pages = {439--445},
           title = {Association between thermal responses, medical events, performance, heat acclimation and health status in male and female elite athletes during the 2019 Doha World Athletics Championships},
       publisher = {BMJ PUBLISHING GROUP},
          volume = {56},
            note = {http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},
         journal = {British Journal of Sports Medicine},
            issn = {0306-3674},
        keywords = {Science \& Technology, Life Sciences \& Biomedicine, Sport Sciences, exercise, hot temperature, EXERCISE, STRATEGIES, SYMPTOMS, COHORT, SEX},
        abstract = {Purpose To determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions. Methods From 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (Tcore; ingestible pill) and skin (Tskin; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (\% personal best) and did not finish (DNF) were extracted from official results. Results Peak Tcore during competition reached 39.6oC{$\pm$}0.6oC (maximum 41.1oC). Tskin decreased from 32.2oC{$\pm$}1.3oC to 31.0oC{$\pm$}1.4oC during the races (p{\ensuremath{<}}0.001). Tcore was not related to DNF (25\% of starters) or medical events (p{$\ge$}0.150), whereas Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were (p{$\leq$}0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9\% of athletes) increasing the risk of in-race medical events (71\% vs 17\%, p{\ensuremath{<}}0.001). Athletes (63\%) who performed 5-30 days heat acclimation before the competition: ranked better (18{$\pm$}13 vs 28{$\pm$}13, p=0.009), displayed a lower peak Tcore (39.4oC{$\pm$}0.4oC vs 39.8oC{$\pm$}0.7oC, p=0.044) and larger in-race decrease in Tskin (?1.4oC{$\pm$}1.0oC vs ?0.9oC{$\pm$}1.2oC, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19\% vs 30\%, p=0.273) and medical events (19\% vs 32\%, p=0.179). Conclusion Tskin, Tskin rate of decrease and Tcore-to-Tskin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events.},
          author = {Racinais, Sebastien and Havenith, George and Aylwin, Polly and Ihsan, Mohammed and Taylor, Lee and Adami, Paolo Emilio and Adamuz, Maria-Carmen and Alhammoud, Marine and Alonso, Juan Manuel and Bouscaren, Nicolas and Buitrago, Sebastian and Cardinale, Marco and van Dyk, Nicol and Esh, Chris J and Gomez-Ezeiza, Josu and Garrandes, Frederic and Holtzhausen, Louis and Labidi, Mariem and Lange, Gunter and Lloyd, Alexander and Moussay, Sebastien and Mtibaa, Khouloud and Townsend, Nathan and Wilson, Mathew G and Bermon, Stephane},
             url = {http://dx.doi.org/10.1136/bjsports-2021-104569}
}