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      IOC consensus statement on recommendations and regulations for sport events in the heat

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          Abstract

          This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes’ behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

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          American College of Sports Medicine position stand. Exercise and fluid replacement.

          This Position Stand provides guidance on fluid replacement to sustain appropriate hydration of individuals performing physical activity. The goal of prehydrating is to start the activity euhydrated and with normal plasma electrolyte levels. Prehydrating with beverages, in addition to normal meals and fluid intake, should be initiated when needed at least several hours before the activity to enable fluid absorption and allow urine output to return to normal levels. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. Because there is considerable variability in sweating rates and sweat electrolyte content between individuals, customized fluid replacement programs are recommended. Individual sweat rates can be estimated by measuring body weight before and after exercise. During exercise, consuming beverages containing electrolytes and carbohydrates can provide benefits over water alone under certain circumstances. After exercise, the goal is to replace any fluid electrolyte deficit. The speed with which rehydration is needed and the magnitude of fluid electrolyte deficits will determine if an aggressive replacement program is merited.
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            Carbohydrates for training and competition.

            An athlete's carbohydrate intake can be judged by whether total daily intake and the timing of consumption in relation to exercise maintain adequate carbohydrate substrate for the muscle and central nervous system ("high carbohydrate availability") or whether carbohydrate fuel sources are limiting for the daily exercise programme ("low carbohydrate availability"). Carbohydrate availability is increased by consuming carbohydrate in the hours or days prior to the session, intake during exercise, and refuelling during recovery between sessions. This is important for the competition setting or for high-intensity training where optimal performance is desired. Carbohydrate intake during exercise should be scaled according to the characteristics of the event. During sustained high-intensity sports lasting ~1 h, small amounts of carbohydrate, including even mouth-rinsing, enhance performance via central nervous system effects. While 30-60 g · h(-1) is an appropriate target for sports of longer duration, events >2.5 h may benefit from higher intakes of up to 90 g · h(-1). Products containing special blends of different carbohydrates may maximize absorption of carbohydrate at such high rates. In real life, athletes undertake training sessions with varying carbohydrate availability. Whether implementing additional "train-low" strategies to increase the training adaptation leads to enhanced performance in well-trained individuals is unclear.
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              American College of Sports Medicine position stand. Exertional heat illness during training and competition.

              Exertional heat illness can affect athletes during high-intensity or long-duration exercise and result in withdrawal from activity or collapse during or soon after activity. These maladies include exercise associated muscle cramping, heat exhaustion, or exertional heatstroke. While certain individuals are more prone to collapse from exhaustion in the heat (i.e., not acclimatized, using certain medications, dehydrated, or recently ill), exertional heatstroke (EHS) can affect seemingly healthy athletes even when the environment is relatively cool. EHS is defined as a rectal temperature greater than 40 degrees C accompanied by symptoms or signs of organ system failure, most frequently central nervous system dysfunction. Early recognition and rapid cooling can reduce both the morbidity and mortality associated with EHS. The clinical changes associated with EHS can be subtle and easy to miss if coaches, medical personnel, and athletes do not maintain a high level of awareness and monitor at-risk athletes closely. Fatigue and exhaustion during exercise occur more rapidly as heat stress increases and are the most common causes of withdrawal from activity in hot conditions. When athletes collapse from exhaustion in hot conditions, the term heat exhaustion is often applied. In some cases, rectal temperature is the only discernable difference between severe heat exhaustion and EHS in on-site evaluations. Heat exhaustion will generally resolve with symptomatic care and oral fluid support. Exercise associated muscle cramping can occur with exhaustive work in any temperature range, but appears to be more prevalent in hot and humid conditions. Muscle cramping usually responds to rest and replacement of fluid and salt (sodium). Prevention strategies are essential to reducing the incidence of EHS, heat exhaustion, and exercise associated muscle cramping.
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                January 2023
                23 September 2022
                : 57
                : 1
                : 8-25
                Affiliations
                [1 ] departmentResearch and Scientific Support Department , Aspetar Orthopaedic and Sports Medicine Hospital , Doha, Ad Dawhah, Qatar
                [2 ] departmentFaculty of Sport Sciences , Waseda University , Tokorozawa, Saitama, Japan
                [3 ] departmentHealth and Science Department , World Athletics , Monaco
                [4 ] Union Cycliste Internationale (UCI) , Aigle, Switzerland
                [5 ] departmentKorey Stringer Institiute, Department of Kinesiology , University of Connecticut , Storrs, Connecticut, USA
                [6 ] departmentDepartment of Geography , University of Georgia , Athens, Georgia, USA
                [7 ] departmentHeat and Health Research Incubator, Faculty of Medicine and Health , The University of Sydney , Camperdown, New South Wales, Australia
                [8 ] departmentMedical Department , Federation Internationale de Football Association , Zurich, Switzerland
                [9 ] departmentMedical Committee , World Triathlon (WT) , Lausanne, Switzerland
                [10 ] Hamilton , Stockholm, Sweden
                [11 ] World Sailing , London, UK
                [12 ] departmentSchool of Sport and Health Sciences , University of Brighton , Eastbourne, UK
                [13 ] departmentInstitute for Sports Medicine, Alpine Medicine & Health Tourism (ISAG) , UMIT Tirol – Private University for Health Sciences and technology , Hall, Austria
                [14 ] University Hospital/Tirol Kliniken , Innsbruck, Austria
                [15 ] departmentSport- und Rehabilitationsmedizin , Universitat Ulm , Ulm, Germany
                [16 ] Marubeni Health Promotion Center , Tokyo, Japan
                [17 ] International Olympic Committee Medical and Scientific Games Group , Pinner, Middlesex, UK
                [18 ] Medical and Scientific Department, International Olympic Committee , Lausanne, Switzerland
                [19 ] International Olympic Committee , Lausanne, Switzerland
                Author notes
                [Correspondence to ] Dr Sebastien Racinais, Research and Scientific Support Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar; sebastien.racinais@ 123456aspetar.com
                Author information
                http://orcid.org/0000-0003-0348-4744
                http://orcid.org/0000-0001-9138-5361
                http://orcid.org/0000-0002-3937-2448
                http://orcid.org/0000-0002-9529-2901
                http://orcid.org/0000-0002-8858-2636
                http://orcid.org/0000-0002-0574-6253
                http://orcid.org/0000-0002-6076-6337
                http://orcid.org/0000-0002-8253-932X
                http://orcid.org/0000-0001-6210-2449
                http://orcid.org/0000-0002-5657-0307
                http://orcid.org/0000-0001-6315-8479
                http://orcid.org/0000-0002-7111-6161
                Article
                bjsports-2022-105942
                10.1136/bjsports-2022-105942
                9811094
                36150754
                3a4aa6da-74b0-42f2-884b-2f958853af9f
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                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/.

                History
                : 04 September 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003965, International Olympic Committee;
                Categories
                Consensus Statement
                1506
                2314
                Custom metadata
                unlocked

                Sports medicine
                hot temperature,heat-shock response
                Sports medicine
                hot temperature, heat-shock response

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