Thermoregulatory responses of athletes with a spinal cord injury during rest and exercise

Following on from Rio de Janeiro 2016, the Tokyo 2020 Paralympic Games will present a unique challenge for athletes, needing to prepare and adapt to the potential challenging environmental conditions of 20-27°C and ~73% relative humidity. It is well known that during exercise in hot and/or humid climates, able-bodied athletes experience an increase in thermal strain and a reduction in performance compared to cooler/drier conditions. Yet these conditions prove even more problematic for athletes, who as a consequence of their impairment have a dysfunctional thermoregulatory system, such as athletes with a spinal cord injury (SCI). To date, the thermoregulatory responses of athletes with an SCI have been an under-studied area of research. To gain a greater understanding of how heat balance is altered in individuals with an SCI and the thermoregulatory consequences as a result, studies need to first be conducted at rest, removing the additional metabolic heat production from exercise. Although a large majority of athletes with an SCI compete indoors in wheelchair court sports (e.g. wheelchair basketball and rugby), exercising even in these climate-controlled environments has been shown to place these athletes under considerable thermal strain. In light of this, it is remarkable that existing research on the thermoregulatory responses of athletes with an SCI during exercise is scarce, especially studies encompassing real-world sporting environments. Athletes with high level lesions (tetraplegia, TP) are a particularly under-studied population group shown to have a greater thermoregulatory impairment than individuals with low level lesions (paraplegia, PA) during continuous exercise. Thus the aim of this thesis was to investigate the thermoregulatory responses of athletes with an SCI at rest and during real-world sporting scenarios, with specific focus on athletes with TP. Study 1 aimed to determine how evaporative heat loss is altered, as a result of an SCI, compared to the able-bodied (AB), and the effect lesion level has on this response. The results provide evidence that in individuals with TP, even at rest, evaporative heat loss is not large enough to balance the heat load, when evaporation is the primary source of heat dissipation. Even though in individuals with PA Tgi increased by a smaller magnitude and they possessed a greater sweating capacity than individuals with TP, at ambient temperatures above Tsk latent heat loss is insufficient to attain heat balance, compared to the AB. To investigate the thermoregulatory responses of athletes with an SCI during real-world sporting scenarios Study 2 examined athletes with TP compared to athletes with PA during 60 min of intermittent sprint wheelchair exercise on a wheelchair ergometer. The study was conducted in conditions representative of an indoor playing environment for wheelchair rugby and basketball (~21°C, 40% relative humidity). Results demonstrated that, despite similar external work, athletes with TP were under greater thermal strain than athletes with PA. Study 3 s novel approach investigated both physiological responses and activity profiles of wheelchair rugby players during competitive match play. Despite players with TP covering 17% less distance and pushing on average 10% slower, they were under a greater amount of thermal strain than players with non-spinal related physical impairments (NON-SCI). Furthermore, this study demonstrated that players with TP that had a larger body mass, larger lean mass, covered a greater relative distance and/or were a higher point player had a greater end Tgi. These data provide an insight for coaches and support staff regarding which players may need greater attention in regards to cooling strategies or breaks in play. The effectiveness of cooling practices currently employed by athletes with TP has not been previously investigated. Study 4 determined the effectiveness of pre-cooling, using an ice vest alone and in combination with water sprays between quarters, at attenuating thermal strain in athletes with TP. Using the activity profile data from Study 3, an intermittent sprint protocol, conducted on a wheelchair ergometer, was used to represent a wheelchair rugby match. The combination of cooling methods lowered Tgi and Tsk to a greater extent than pre-cooling only, despite neither cooling condition having a positive or negative effect on performance. Unexpectedly, the pre-cooling only condition lowered Tgi, compared to no cooling, throughout the subsequent exercise protocol, even though the reduction in Tsk was not long lasting. This thesis provides comprehensive evidence that athletes with TP experience heightened thermal strain during both rest and real-world sporting scenarios compared to the AB, athletes with PA, and within the sport of wheelchair rugby. Athletes with TP should employ practices, such as appropriate cooling methods or alter playing tactics to reduce thermal strain and the likelihood of attaining a heat related injury.