UNCLASSIFIED. Heat production during dynamic exercise can elevate core temperature rapidly. Thus, it believed

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1 Robert Carter III, Ph.D., M.P.H. Captain, US ARMY Department of Human Factors Centre de Recherches du Service de Santé des Armées La Tronche, FRANCE HEAT INDUCED FATIGUE Heat production during dynamic exercise can elevate core temperature rapidly. Thus, it believed that hyperthermia during prolonged exercise in hot environments is an independent cause of exercise fatigue. Nonetheless, the mechanisms underlying hyperthermia-induced fatigue during prolonged, dynamic exercise in the heat is not well understood. Typically, heat induced fatigue has been thought to do due to limitations of 1) cardiovascular system (strain), 2) central nervous system, 3) high body temperature, and / or 4) muscle metabolism. However, recently, more intention has been directed to a modified definition of fatigue which incorporates perceived inability and cognitive measures into the model of heat related fatigue. 1.0 INTRODUCTION Heat production during dynamic exercise can elevate core temperature rapidly, and it appears that hyperthermia during prolonged exercise in hot environments is an independent cause of fatigue. Nonetheless, the mechanisms underlying hyperthermia-induced fatigue during prolonged, dynamic exercise in the heat is not well understood. Classically, fatigue has been defined as an inability to maintain force-generating capacity or power output. These changes in force and power may develop for a range of motives and can occur at various sites along the pathway from the central nervous system to the contractile machinery of the muscles. Typically, research has focused on investigating heat induced fatigue related to the 1) cardiovascular PUB REF NBR (e.g. RTO-MP-IST-999) PAPER NBR - 1

2 system (strain), 2) central nervous system, 3) high body temperature, and 4) muscle metabolism. However, recently, more intention has been directed to a modified definition of fatigue which incorporates perceived inability and cognitive measures into the model of heat related fatigue. 2.0 BRAIN FUNCTION DURING HYPERTHERMIA Indirect evidence such as confusion, seizures, loss of consciousness, poor decision making all suggest, significant changes in brain function and alterations of the central nervous system during hyperthermia. Recent technological advances has allowed for measurement of brain temperature and blood flow, which were previous were only available during animal studies (Nelson and Nunneley, 1998). In general, the hyperthermic brain is associated with reduced blood flow, alterations in electrical brain activity, and decreased voluntary activation of peripheral nervous pathways and neuromuscular drive (Nagasaka et al, 1998) and decreased physiological function. 2.1 Brain Temperature Brain temperature can be thought of as the balance on heat produced by cerebral energy turnover and the heat that is removed [assessed by cerebral blood flow (CBF)]. The convection of heat between tissue and capillaries is considered to be very high thus, the temperature of the cerebral venous blood likely equal to the cerebral tissue. Recently, thermoregulation of brain (human) has been evaluated by measuring the internal jugular venous to arterial blood temperature difference. Nybo and colleagues has shown that exercise in the heat is associated with an elevated cerebral oxygen consumption at the same time as a total reduction in CBF (Nybo and Nielsen, 2002). 2.2 Central Nervous System and Muscular Fatigue Ftaiti and colleagues (2001) observed that electromyogram (EMG) amplitude was unchanged during dynamic exercise with progressively occuring hyperthermia. In addition, severe hyperthermia has associated with fatigue-induced changes in motor unit recruitment and/or PAPER NBR - 2 PUB REF NBR (e.g. RTO-MP-IST-999)

3 discharge rates (Gonzàlez-Alonso et al, 1999). Other investigations, have shown hyperthermiainduced signs of muscular fatigue during submaximal exercise and maximal, suggesting central (motor cortex) and peripheral factors contributing to the development of fatigue. On the other hand, hyperthermia has been reported not to affect the ability of the muscles to generate force. Some studies suggested that increased difficulty to retain power output during during hyperthermia do not correlate with rating of perceived exertion (RPE), supporting the idea that reduced force and power output may be under the control of mutiple factors (Fuller et al, 1998). Changes in Alpha / Beta (brain waves) index is correlated with increased of RPE suggests EEG frequency shift might reflect decreased arousal; and altered ability of the brain to sustain motor activity during hyperthermia (Nielsen et al, 2001). Taken together data existing data suggest that exercise in heat, is associated with altered brain activity and reduced blood flow. However, further investigations are required to understand the relationship among hyperthermia, altered brain activity, muscle function, and central fatigue. 2.3 Neurohumoral Factors Recently, research has focused on alterations in brain neurotransmitters and hormones such as serotonergic and dopamine activity. Due to the complexity of measuring these substances in humans, indirect from peripheral blood markers suggests that serotonin is increased in the brain and likely contribute to central fatigue in the heat (Low et al, 2005). In fact, levels of dopamine has been suggested to increase during exercise heat stress and as fatigue approaches dopamine levels rapidly fall (Meesen et al, 2006). However, it is not known how much of the dopamine and serotonin that is measure from peripheral blood is from the brain. It is, likely that various tissues during exercise and hyperthermia release dopamine and serotonin during these times. PUB REF NBR (e.g. RTO-MP-IST-999) PAPER NBR - 3

4 3.0HIGH TEMPERATURE AND FATIGUE The mechanism by which hyperthermia causes fatigue is not well understood. Several studies have examined the relationship of elevated body temperature and exercise fatigue. González- Alonso and colleagues (1999), showed that trained subjects fatigued at similar core body temperatures. In addition, demonstrated that time to exhaustion ranged from 28 to 63 min, being shortest with highest initial body temperature and higher rate of heat storage. Trained subjects fatigued with core temperatures of ~40 C when working at 50-60% O 2 peak in the heat (40 C, 10% RH) for 9-12 consecutive days. It appears that hyperthermia is an important factor causing fatigue in the heat. However, other factors such as hydration status, training, heat acclimation, and weather conditions might interact and alter the physiological responses during exercise in the heat, leading to fatigue. 4.0 CARDIOVASCULAR RESPONSES Cardiovascular strain has been associated with reduced exercise performance and time to fatigue (stoppage of exercise). Previously investigations observed a significantly lower cardiac output, central blood volume, and SV during exercise in hot weather compared to temperate environments during moderate intensity exercise. It has been suggested that the decrease in cardiac output with hyperthemia is attributed to the larger decline in SV (González-Alonso et al, 1999). The mechanism leading to these changes in SV during heat stress has not been directly clarified. The hypothesis is that reductions in SV with hyperthermia are due to increased skin blood flow and skin blood volume. However, the mechanisms mediating SV reductions with heat stress are complex and may be influenced by many factors. 5.0 COGNITION AND MENTAL RESPONSES Heat stress may negatively affect cogntion, mood, and mental status during exercise and at rest. Furthermore, there is emerging evidence that the the ability to sustain exercise performance in the hot environment comes from a conscious effort. It remains to be understood how and by PAPER NBR - 4 PUB REF NBR (e.g. RTO-MP-IST-999)

5 which mechanisms mental status, mood, and perception affects exercise performance and fatigue in the heat. However, before these effects are universally accepted as a plausible factor for reduced exercise performance during hot weather exposure much research is needed to identify mechanisms which may include central nervous system and higher brain centers. Nevertheless, subjective measurements (perceived exertion, mood state profiles) suggest that an altered conscious effect is associated with reduced exercise performance and early onset of fatigue in the heat. In addition, heat stress has been shown to reduce cognition and mental processing that are important for decision making and simple to complex tasking (Hancock and Vasmatzidis, 2003). It appears the degree of decrements of these tasks is directly related to the deep body temperature which is a function of duration and intensity of heat exposure (Hancock and Vasmatzidis, 2003). Moreover, previous studies have demonstrates that significant differences occur at 2 3% dehydration for many neuropsychological tests and task assessment measures (Ramsey et al, 1995). Physiologically, the basis for decreased cognitive performance may be attributed to a variety of mechanisms, all of which remain largely theoretical (Hancock, 1982). More research studies are necessary to identify specific physiological mechanisms to explain brain function in an exercise heat stress environment as well as the directs of heat stress on cognition independent of exercise. Some scientists theorized the existence of a cognitive reserve, whereby subjects have at their disposal a certain amount of neural resources that can be allocated to the performance of cognitive tasks and activities when resources are diminished as during hyperthermia (Valenzuela and Sachdev, 2006). PUB REF NBR (e.g. RTO-MP-IST-999) PAPER NBR - 5

6 6.0 CONCLUSION The mechanisms by which exercise and cognitive fatigue occurs in the heat are not well understood. Typically, research has focused on investigating heat induced fatigue related to the 1) cardiovascular system (strain), 2) central nervous system, 3) high body temperature, and 4) muscle metabolism. However, recently, much intention has been directed to a modified definition of fatigue which incorporates perceived inability and cognitive factors into the model of heat related fatigue. It is likely that exercise and cognitive performance decrements occur as a result of multiple factors. The role of each factor may have individual variability and 7.0 REFERENCES Ftaiti, F, Grélot L, Coudreuse JM, and Nicol C. Combined effect of heat stress, dehydration and exercise on neuromuscular function in humans. Eur J Appl Physiol 84: 87-94, Fuller, A, Carter RN, and Mitchell D. Brain and abdominal temperatures at fatigue in rats exercising in the heat. J Appl Physiol 84: , Hancock PA, Vasmatzidis I. Effects of heat stress on cognitive performance: the current state of knowledge. Int J Hyperthermia. May-Jun;19(3):355-72, Hancock PA. Task categorization and the limits of human performance in extreme heat. Aviat Space Environ Med Aug;53(8): González-Alonso, J, Calbet JA, and Nielsen B. Metabolic and thermodynamic responses to dehydration-induced reductions in muscle blood flow in exercising humans. J Physiol (Lond) 520: , González-Alonso, J, Teller C, Andersen S, Jensen F, Hyldig T, and Nielsen B. Influence of body temperature on the development of fatigue during prolonged exercise in the heat. J Appl Physiol 86: , Low D, Purvis A, Reilly T, Cable NT. The prolactin responses to active and passive heating in man. Exp Physiol Nov;90(6):909-17, PAPER NBR - 6 PUB REF NBR (e.g. RTO-MP-IST-999)

7 Nagasaka, T. Brinnel, H., Hales, J. R. & Ogawa, T. Selective brain cooling in hyperthermia: the mechanisms and medical implications. Medical Hypotheses 50, , Nelson, D. A. & Nunneley, S. A. Brain temperature and limits on transcranial cooling in humans: quantitative modelling results. European Journal of Applied Physiology Occupational Physiology 78, , Nielsen, B, Hyldig T, Bidstrup F, and Gonzalez-Alonso J. Brain activity and fatigue during prolonged exercise in the heat. Pflügers Arch 442: 41-48, Nybo, L, and Nielsen B. Middle cerebral artery blood flow velocity is reduced with hyperthermia during prolonged exercise in humans. J Physiol (Lond) 534: , Valenzuela MJ, Sachdey P. Brain reserve and cognitive decline: a non-parametric systematic review. Psychol Med. Aug;36(8): , PUB REF NBR (e.g. RTO-MP-IST-999) PAPER NBR - 7

8 Figure 1. Model of Heat induce Fatigue Mood, perception, etc? Heat Stress (Hyperthermia) Cardiovascular Strain Central Nervous System Cognition Decrements Performance Degradation Muscle Metabolism Classically, fatigue and performance degradation has been defined as a inability to maintain force-generating capacity or power output. These changes in force and power may develop for a range of motives and can occur at various sites along the pathway from the central nervous system to the contractile machinery of the muscles. However, recently, much intention has been directed to a modified definition of fatigue which incorporates perceived inability and cognitive factors into the model of heat related fatigue. PAPER NBR - 8 PUB REF NBR (e.g. RTO-MP-IST-999)

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