PART 1

HEAT AND COLD
A. Thermal Regulation and the Human Body

1. Human Body Temperature
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 homeothermic 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.
External (climatic) and internal (metabolic) heat sources inﬂuence bodytemperature. Heavy exercise, illness, and not only hot and humid but also cold andwindy environments alter body temperature outside the normal range. Ambient
temperature, humidity, air movement, and radiant heat from the sun, as well as warmand cold surfaces, contribute to climatic heat stress. Metabolic heat is produced byexercise.
Body temperature reﬂects a careful balance between heat production and heatloss. There is a continuous heat exchange between the body and the environment.
Bi-directional routes for heat exchange are: convection (Cv), conduction (Cd), andradiation (R). There are also two uni-directional routes: metabolic heat (M) increases
the thermal load; evaporation (E) decreases the load. The net heat storage (S)formula is:
S = M +/- Cv +/- Cd +/- R - E
When the net heat storage (S) is positive, body temperature will rise and when S
is negative, it will go down.
Heat Balance

Heat Production

Heat Loss• Metabolic heat production• Exercise• Shivering• Thyroxine• Sympathetic stimulation• Q10 Effect• Radiation• Conduction• Convection• Evaporation

Figure 11-1. Heat exchange between the body and the environment.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

2. Climatic Heat Stress
Air temperature alone is not an accurate index of climatic heat stress.Temperatureand other important factors, including radiant energy, wind velocity and humidity,
contribute to climatic heat stress. To determine the overall effect of these factors,
a combination of measurements must be made. The Wet Bulb Globe Temperature(WBGT) index has been introduced to assess climatic heat stress. It consists ofthree thermometers: dry bulb (Tdb), which measures air temperature; wet bulb(Twb), which measures relative humidity; and black globe (Tg), a measure of solar
radiation. The difference between the wet and dry bulb temperatures indicates theenvironment’s capacity for cooling by evaporation. A very modern, simple andhandy apparatus to measure the WBGT is available.
The WBGT provides a single temperature reading to estimate climatic heatstress and cooling capacity of the surrounding environment.
The Wet Bulb Globe Temperature (WBGT) =(0.7 x Twb) + (0.1 x Tdb) + (0.2 x Tg) (outdoors)(0.7 x Twb) + (0.3 x Tdb) (indoors)
The importance of relative humidity is indicated by its 70% contribution to the
WBGT.
The WBGT is the basis for recommendations by the American College of Sports
Medicine (see Appendix 4, ACSM Position Statement: Heat and Cold Illnesses
During Distance Running and Appendix 5, IAAF Policy on Fluid Replacement)
for exercise under various environmental conditions for the ﬁt general population.
Highly trained elite athletes often are able to exceed these limits, but with appropriate
cautions.
3. Metabolic Heat Stress
A large part of the energy that the body generates is degraded to heat. All bodytissues produce heat that can be used to maintain body core temperature. When heatproduction exceeds the body’s heat loss, body temperature rises. Intense exercise
may increase the metabolic energy expenditure 20–25 times over resting levels. No
more than 25% of this energy is utilised for muscular movement—the remainder
is heat, which the body must dissipate. Metabolic heat is transferred by convection
from working muscles to the blood stream, and thence to the body’s core. Without
adaptive mechanisms, even moderate exercise would elevate body temperatureby 1ºC every 5–6 minutes; thus, exercise would be limited to no more than 20–30
minutes before heat stress fatigue or life-threatening hyperthermia intervened.
In fact, the body is able to respond to a heat load through a variety ofphysiologic mechanisms: sweat rate, body and skin blood ﬂow shifts, cardiac output,
respiratory rate, and a sensation of heat intensity. Well-trained endurance athletes
can sustain a core temperature of 39º–41ºC for prolonged periods. The muscles’
energy systems become more chemically effective with a small rise in muscle
temperature. However, a critical thermal maximum is reached at 42ºC (108ºF), so
there is a limited safety margin at intense levels of exercise. Heavier athletes run ahigher risk of overheating than lighter athletes when exercising at the same rate.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

a. Physiologic responses
Core temperature is sensed by the hypothalamic thermoregulatory center.
This center then sets off a number of circulatory adjustments in an effort todissipate heat. Primarily this involves increasing cardiac output and redistributing blood from the visceral organs to the working muscles and skin.
During heat stress, skin blood ﬂow may be up to 20-fold higher than at rest
ing level. Sweat glands become more active for increasing evaporative heatloss.
Four mechanisms are responsible for heat exchange at the skin surface:i. Conduction has a minimal effect on body heat transfer, as it depends
upon direct contact between skin and a cooler object. Conduction could
be utilised by immersion in water to cool or warm the body.
ii. Convection is responsible for transferring heat from working muscles
and the skin surface. The circulatory system transports the heatgenerated in the active muscles to the surface of the body. The airaround the body is in constant motion and it sweeps away the warmed
air molecules on the skin surface. It is dependent upon (a) the temperature
differential between skin and the environment; and (b) the heat transfer
coefﬁcient, which varies with available body surface area and windvelocity. Minimal body fat and loose-ﬁtting clothing enhance anathlete’s convection potential.
Conduction and convection constantly remove body heat when air
temperature is lower than skin temperature. Inversely, convection andconduction cause heat gain in a very hot environment.
iii. Radiation, including solar radiation and radiant heat from tracks,
roads, and surrounding structures, can be a major contributor to an
athlete’s heat load. At rest, radiation is the primary method fordischarging the body’s excess heat. The heat is given off in the formof infrared rays. Radiation heat loss or gain depends upon thetemperature gradient between the skin and the environment.
iv. Evaporation is the most important heat dissipation mechanism inwarm environments. Though it accounts for only 20% of body heatloss at rest, more than 80% of body heat loss is achieved by evaporation
when environmental temperature exceeds 20ºC (68ºF) (Table 11-1). Fit
athletes can produce up to 30 ml of sweat per minute, but not all of thisis available for heat elimination. Evaporative rate is determined by air
velocity and the water vapor pressure gradient between the skin and theenvironment. This latter is determined by the relative humidity of theair. High humidity limits sweat evaporation and therefore, heat loss.
Each liter of effective evaporated sweat removes 580 Kcal from thebody. Evaporation plays a very important role in dissipating heat during
exercise.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

Table 11-1. Estimated heat loss at rest and during exercise at 70% VO2 max.
Mechanism of heat loss

% totalRest
Kcal/minExercise% totalKcal/minConduction and convection

20

0.3

15

2.2

Radiation

60

0.9

5

0.8

Evaporation

20

0.3

80

12.0

4. Acclimatisation to Heat and Maximising Heat Loss
Partial adaptation to heat stress occurs even with training at moderate temperatures,but full acclimatisation 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 acclimatisation. This should begin by training at a reduced intensity (60–70% of the usual load),so as to avoid heat-related disorders.
There are numerous adaptations that occur as a result of acclimatisation to
exercise in the heat:a. 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 andchloride.
b. Earlier onset of sweating leads to a lower skin temperature, improved
core-skin temperature gradient, and less demand for blood ﬂow to theskin. This latter provides improved muscle blood ﬂow and oxygen supply.
c. 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 notpotassium. More sodium is retained, which promotes water retention.
Plasma and interstitial ﬂuid volumes can increase 10–20%.
d. Body core temperature can be kept lower, as heat dissipation is more
efﬁcient.
e. Heart rate is lower at any given work load, as the core temperature islower, plasma volume is higher, skin blood ﬂow distribution is decreased,
and there is improved stroke volume.
f. The perception of heat stress is reduced.
g. Onset of fatigue is delayed, as the rate of muscle glycogen utilisation isdecreased.
Men and women acclimatise equally well. Training in a hot, humid environment
is more stressful than training in hot, dry conditions.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

5. Cold Exposure Thermoregulation and Minimising Heat Loss
The body’s hypothalamic set-point for temperature regulation is about 37ºC+/- 1ºC. A decrease in skin or core temperature signals the thermoregulatory centerin the posterior hypothalamus to set off a number of mechanisms to increase heatproduction. These include:a. Shivering—involuntary muscular contractions in response to cold. Thiscan cause a 4–5 fold increase in heat production. Shivering results indecreased muscular coordination and impairs performance.
b. Non-shivering thermogenesis. The sympathetic nervous system releases
epinephrine and nor-epinephrine in response to cold exposure, causing
anaerobic glycolysis and a release of free fatty acids from fat stores. Thismechanism occurs in young children because of their rich brown fat.
c. Increased thyroxin production. Hypothalamic thyrotropin-releasing
hormone (TRH) rises, stimulating TSH release and ultimately elevatedthyroxin production to increase general metabolic rate.
d. Peripheral vaso-constriction. The sympathetic nervous system stimulates
skin’s smooth muscle contraction, thus shunting blood away from the skinand into deeper tissues.
The balance between heat loss and heat production is controlled by a numberof factors. Generally, the greater the gradient between skin and environmental
temperature, the greater the heat loss. However, a great number of anatomic andenvironmental factors affect the rate and degree of heat loss. For example, bodysize and body composition inﬂuence heat loss. Subcutaneous fat acts as an insulator.
Smaller athletes such as children have a higher surface area/mass ratio, and maysustain greater heat loss. Clothing helps reduce heat loss.
The degree of heat loss also depends on air movement (convection), humidity,
evaporation (sweating), and ambient temperature. Wind velocity exacerbates heatlosses from convection, radiation, and evaporation. This is known as the Wind Chill
Effect, and is expressed as the Wind Chill Factor (Table 11-2).
Exercise in the cold can affect muscle function. Muscle functions best at atemperature of 40ºC. Cooling alters the nervous system and the muscle ﬁber’s
recruitment pattern. Muscle shortening velocity and power decrease when thetemperature is lowered. Muscle glycogen utilisation is higher during exercise in thecold. Epinephrine and nor-epinephrine secretion increases markedly. However, FFA
may not rise as much as in a normal environment, as blood ﬂow to subcutaneous fat
areas is lower, and less FFA are mobilised.
So long as clothing is adequate and metabolic rate remains high, the bodytemperature and function can be maintained. However, as fatigue develops andexercise intensity (i.e., race pace) slows, heat production declines and hypothermia
may develop.

28

22

18

16

13

11

10

40

36

32

30

28

27

26

10

15

20

25

30

35

40

c.f. °C = (°F - 32) / 1.8

Minimal Risk

37

48

40
(4.4)

5

Wind
speed
(mph)

50
(10)

-6

-4

-2

0

4

9

16

27

30
(-1.1)

-21

-20

-18

-15

-10

-5

4

16

10
(-12.2)0(-17.8)

-53

-51

-48

-44

-39

-32

-24

-5

Increasing Risk

-37

-35

-33

-29

-25

-18

-9

6

-69

-67

-63

-59

-53

-45

-33

-15

-10
(-23.3)Equivalent Temperature (ºF)

20(-6.7)

Thermometer Reading ºF (ºC)

Table 11-2. Wind chill index.

-100

-98

-94

-88

-82

-72

-58

-36

-30
(-33.3)

Great Risk

-85

-82

-79

-74

-67

-58

-46

-26

-20
(-28.9)

-115

-113

-109

-104

-96

-85

-70

-47

-40
(-40)

-132

-129

-125

-118

-110

-99

-83

-57

-50
(-45.6)

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCECHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

B. Thermal Regulation and Disorders

1. Heat Related Disorders
Heat related disorders occur when thermoregulatory mechanisms fail tocompensate for elevations in core temperature caused by environmental or metabolicheat load. Heat related disorders might encompass a wide spectrum of symptoms ofvarying severity, ranging from heat cramps and dehydration to heat exhaustion andlife-threatening heat stroke.
a. Heat cramps, the least serious type of heat related disorders, are caused
by loss of sodium and potassium associated with heavy sweating inunacclimatised individuals.
i. Signs/symptoms: painful skeletal muscle spasms, primarily of themuscles most heavily used during exercise (e.g. calves, abdomen).
ii. Treatment: move individual to a cooler location and administer
ﬂuid/electrolyte solutions or a saline solution, generally taken orally.
iii. Prevention: adequate ﬂuid/electrolyte replacement, added salt tofood; eat a balanced, high K+ diet.
b. Dehydration commonly accompanies exercise in warm, humid
conditions, when ﬂuid replacement is inadequate. It complicates heatexhaustion and heat stroke.
i. Signs/symptoms: fatigue, lethargy, irritability, loss of coordination,
faintness, altered consciousness.
ii. Treatment: cool ﬂuids; dilute electrolyte solutions.
iii. Prevention: pre-hydrate; adequate ﬂuid replacement during activities.
c. Heat exhaustion is a serious heat illness caused by increased exercise
heat load plus dehydration. The pathophysiology of heat exhaustion is
the inability of the cardiovascular system to adequately supply blood toorgans, especially to the brain.
i. Signs/Symptoms: “core” (rectal) temperature elevated, usually notabove 39.5ºC (103ºF); “goose ﬂesh”, headache, lethargy, fatigue,dizziness, fainting, hypotension, rapid pulse, altered consciousness,
nausea, vomiting, incoordination.
ii. Treatment: (See also Appendices 8 and 9, Differential Diagnosis andTreatment of Exertional Heat Stroke and Heat Exhaustion on Site andin a Clinic Setting).
• Move to a cool, shaded area.
• Remove excess clothing.
• Elevate feet to avoid shock• Begin immediate cooling with cold or iced cloths, sponges, etc.
to torso, axillae, groin, other exposed areas.
• Begin hydrations with cool ﬂuids, orally if possible, otherwise
start IV ﬂuids (Dextrose/0.5N saline).
• Monitor vital signs, rectal temperature if possible.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE• Transfer to hospital, when unconscious or incomplete responseto therapy.
iii. Prevention:• Avoid competition under adverse conditions, or adjust pace toexisting conditions.
• Utilise acclimatisation measures prior to competition.
• Pre-hydrate; emphasise hydration during the competition.
• Wear appropriate clothing, which will “breathe” and allow
sweat to evaporate.
d. Heat stroke, a life-threatening heat-related disorder and a medical
emergency, is difﬁcult to distinguish from heat exhaustion because
sweating may continue. Heat stroke represents thermoregulatory failure,with reduction in skin blood ﬂow in order to maintain the central circulation.
Core temperature is more elevated, usually 40ºC or higher.
i. Signs/symptoms: core temperature exceeding 40ºC, cessation ofsweating, rapid pulse, rapid respiration, hypotension, CNS symptoms
predominate: unsteady gait, confusion, combative behaviour, reduced
consciousness, convulsion, and coma. These signs and symptoms
represent a medical emergency.
ii. Treatment: (see also Appendix 8)• Move to a cool, shaded area. Lay down with feet elevated.
• Loosen or remove clothing.
• Begin cooling at once. In the ﬁeld, it may be necessary to assume
that temperature is elevated, as taking a rectal temperature may
not be feasible. Oral or axillary temperature is quite unreliable.
Apply cool water, and fan to increase evaporation. Apply ice
packs over major vessels in neck, axillae, groin. Cool to a rectal
temperature of 39ºC (102ºF).
• Start IV ﬂuids (Normal saline)• Evacuate to a medical facility as early as possible. Manage as a
medical emergency, with monitoring of cardiac, neurologic, andrenal function, and electrolyte balance.
(For prevention and cautions related to thermal injuries, see Appendix 4, ACSM
Position Stand on Heat and Cold Illnesses During Distance Running and Appendix
5, IAAF Policy on Fluid Replacement.)
2. Cold Injuries
Activities in water and in alpine locales, and prolonged activity can cause
cold injuries. The cold stress conditions of concern are hypothermia and frostbite.
Hypothermia affects cardiovascular, respiratory, CNS and neuromuscular systems.
Hypothermia occurs when core body temperature decreases enough to affect bodyfunctions—usually below 35ºC (95ºF). It may be classiﬁed clinically as mild,moderate, or severe (Table 11-3).

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

Table 11-3. Categories of hypothermia.
Category

Rectal Temperature

Symptoms/Signs

Mild Hypothermia

33º–35ºC

Symptoms/Signs: shivering, very cold,
hunger, lethargy, confusion, muscle
spasm and difﬁculty with motor tasks,
decreased race pace, slurred speech,
ataxic gait, slow reﬂexes.

Moderate Hypothermia

30º–33ºC

Symptoms/Signs: may not be shivering,semi-conscious with confused actions
and irrational behaviour, extremely tired,
irritable and depressed, poor judgment, loss of memory, disoriented, poor
coordination, muscle stiffness, slurredspeech, slow and/or irregular pulse.

Severe Hypothermia

less than 30ºC

Symptoms/Signs: loss of consciousness,
pupils dilated, heartbeat faint or
undetectable.

a. Hypothermia: Mild. Rectal temperature 33º–35ºC
i. Signs/symptoms: shivering, hungry, lethargic, confused, poor
coordination, slurred speech, ataxia.
ii. Treatment: insulate the athlete with dry clothing, continue mild
exercise, and administer warm liquids.
b. Hypothermia: Moderate. Rectal temperature 30º–33ºC
i. Signs/symptoms: semi-conscious, confused, irrational, disoriented,
muscle stiffness, slow, irregular pulse.
ii. Treatment: exogenous heat via a warm shower, warm water bottles,
body contact, inhale warm, moist air; warm liquids; the athletesshould be handled with care due to myocardial irritability.
c. Hypothermia: Severe. Rectal temperature below 30ºC
i. Signs/symptoms: unconscious, pupils dilated, faint or absent
heartbeat.
ii. Treatment: transported to a medical facility by emergency vehicle.
The trunk must be rewarmed and continuous CPR may be necessary;handle the patient with care to avoid arrhythmias.
d. Frostbite occurs when there is cold-induced peripheral vasoconstriction,
leading to tissue freezing.
i. Prevention: appropriate clothing—mittens, footgear with dry woolor polypropylene socks, etc.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

ii. Treatment: leave parts frozen until thawing can be done without thepossibility of re-freezing. Keep entire body warm. Avoid physicalcontact between injured tissue and surroundings. Thaw slowly andgently in warm water, 37º–40ºC.
e. Prevention of cold injuries
i. Administrative• Plan adequately to avoid wind-exposed race courses.
• Caution athletes concerning wind-chill factor, adequate
clothing, etc.
ii. Athlete preparation• Acclimatise to cold conditions—10 days is an ideal acclimatisation period.
• Ensure adequate nutrition and use muscle glycogen loading tomaximise heat production. Avoid caffeine and alcohol. Hydrate
before and during a race.
• Wear layers of material that will draw sweat from the skin andallow evaporation. Wear head cover.
• Control pace to avoid late slowing and reduced heat production.
References

1.

Brooks, G. A., and T. D. Fahey. Exercise in the heat and cold. In Exercise
Physiology, pp. 443-466. New York: John Wiley & Sons, 1984.
2. Brukner, P., and K. Khan. Clinical Sports Medicine (2nd ed.). NSW, Australia:
McGraw-Hill, 2002.
3. Hubbard, R.W., and L. E. Armstrong (eds.). Exertional heatstroke: an international perspective. Med.Sci. Sport Exerc. 22(1):2-48, 1990.
4. International Olympic Committee. Environmental factors. In Sports Medicine
Manual. Lausanne: IOC, 1990.
5. International Olympic Committee. Nutrition for athletes. Lausanne: IOC, 2003.
6. Noakes,T. D. Deducing heatstroke pathology. Phys.and Sportsmed. 33(10):3940:58, 2005.
7. Roberts, W. O. Another viewpoint on exertional heatstroke. Phys. andSportsmed. 33(10):42-49, 2005.
8. Sutton, J. Heat illness. In Sports Medicine, R. H. Strauss (ed.), pp. 307-322.
Philadelphia: W. B. Saunders Co., 1984.
9. U.S. Army Research Institute of Environmental Medicine. Heat stress control
and heat casualty management. Technical Bulletin Medical 507. Washington,
D.C.: Department of the Army. www.usariem.army.mil/download.htm. 2003.
10. U.S. Army Research Institute of Environmental Medicine. Prevention andmanagement of cold weather injuries. Technical Bulletin Medical 508.
Washington, D.C.: Department of the Army. www.usariem.army.mil/download.
htm, 2005.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

11. Wilmore, J. H., and D. L. Costill. Physiology of Sports and Exercise (1st ed.).
Champaign, IL: Human Kinetics, 1994.

PART 2

ALTITUDE
Altitude adversely affects performance in aerobic events (i.e., those lasting morethan two minutes), because the partial pressure of oxygen decreases as barometricpressure falls. This leads to a decline in pulmonary diffusionof oxygen into the.
blood. A measurable effect on maximal oxygen uptake (VO2max) can be seen atelevations as low as 1524 m (5000 ft).
A. Environmental Conditions at Altitude

1. Atmospheric Pressure
Atmospheric pressure decreases as altitude increases, but the percentage ofgases in the air remains constant. Air always contains 20.93% oxygen, 0.03% carbon
dioxide, and 79.04% nitrogen. The pressure that oxygen molecules exert (PO2) isdirectly related to the atmospheric pressure (Pb). This change in the partial pressureof oxygen directly affects the transfer of oxygen between the lungs and the blood,and between the blood and the tissues (Table 11-4).
Table 11-4.Changes in the partial pressure of oxygen with increasing altitude.
AltitudePb (mm)PO2 (mm)0 (sea level)

760

159.2

1000

674

141.2

2000

596

124.9

3000

526

110.2

2. Air Temperature
Air temperature decreases about 1º C for every 150 m of ascent. This lower
temperature also reduces the relative humidity of the air, and increases water losses
by evaporation from the skin and the lungs. The increased respiratory rate and lossof respiratory water in dry air can lead rapidly to dehydration, especially during
exercise.
3. Solar Radiation
Solar radiation increases at altitude, as less ultraviolet light is blocked by the
reduced atmosphere and the lower water vapour pressure.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

B. Physiological Responses to Altitude

1. Respiratory Responses
a. Ventilation
As the partial pressure (PO2) of oxygen decreases, more air must be taken
in to provide adequate tissue oxygenation. This increase in ventilation
reduces the amount of alveolar and blood carbon dioxide, leading to respiratory
alkalosis. The kidney compensates by excreting more bicarbonate ion,decreasing the blood’s buffering capacity and reducing the alkalosis(compensated respiratory alkalosis).
b. Pulmonary Oxygen Diffusion
Oxygen diffusion across the alveolar-capillary membrane is dependent
upon alveolar PO2. This decreases as altitude increases, leading to a decreasein oxy-hemoglobin saturation. At sea level hemoglobin is 98% saturated, but
this falls to 92% at 2400 m (8000 ft).
c. Muscle Oxygen Gas Exchange
The pressure gradient between blood and muscle oxygen concentration is
74mm Hg at sea level (94mm–20mm). This gradient is the major factor
responsible for driving tissue oxygenation. At 2400 m the arterial PO2 isabout 60mm Hg, while tissue PO2 remains at 20mm Hg, a gradient of only
40mm Hg, or a decrease of nearly 50%.
2. Cardiovascular Responses
a. Blood Volume
Plasma volume decreases soon after altitude exposure, and levels off aftera few weeks. This leads to an increased red cell concentration (hematocrit),aiding oxygen delivery to tissues. Plasma volume is gradually restored,
and erythropoietin from the kidney stimulates red cell production.
b. Cardiac Output
Cardiac output must increase at altitude to compensate for the reduced PO2
and decreased oxygen delivery to tissues. Initially this is accomplished by anincrease in heart rate, as stroke volume is lower due to the decreased plasma
volume. After a few days, tissue oxygen extraction improves (increased a-v
O2 difference) and this reduces the cardiac demands. At maximal workloads,
maximal stroke volume, heart rate, and tissue oxygen diffusion are reduced,
thus total maximal VO2 and aerobic work are diminished.
3. Metabolic Adaptations
As oxidative pathways are limited at altitude, there is a shift toward anaerobic
energy sources. At any given work level, lactic acid production is higher than at sealevel. However, at maximal workloads lactic acid is lower, possibly because work
levels are too low to maximally activate all energy systems.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

4. Maximal Oxygen Uptake
Maximal oxygen uptake measures the ability of the body to take in, transport,
and utilise oxygen. It decreases as altitude increases, but does not begin to fall until
atmospheric PO. 2 drops below 125 mm Hg. This occurs at an altitude of about 1600m (5250 ft). VO2 max. is related to. the decline in the barometric pressure and thepartial pressure of oxygen (PO2). VO2 max. decreases 11% for each 1000 metresabove the 1600 metre level.
C. Adaptations to Chronic Altitude Exposure

1. Blood
Erythropoietin stimulates red cell production, and eventually a higher hemoglobin and hematocrit. Adequate dietary iron is essential to meet this demand forincreased erythropoiesis.
2. Muscle
Muscle cross-sectional area may decrease with chronic altitude exposure, though
capillary density increases to deliver blood to the tissues. At very high altitudes(over 2500 m), levels of muscle enzymes decline, so that muscles are less able togenerate ATP aerobically or anaerobically.
3. Cardiorespiratory
Ventilation is stimulated by the hypoxia of altitude. This causes carbon dioxide
removal and respiratory alkalosis. Bicarbonate is excreted and remains low, decreasing buffering capacity.
Muscle oxygen uptake decreases at altitude, and improves little with prolonged
exposure. This may be due to the profound hypoxia that occurs during exercise ataltitude and the consequent inability to train at an adequate intensity and volume.
D. Effects on Training

Many athletes live at altitude, and others elect to train there in hopes ofenhancing their performance at lower elevations. However, maximal aerobic capacity
and submaximal aerobic training pace decrease at altitude, especially above 2500–3000
m. Prolonged stays at altitude may be detrimental to high-intensity endurance
performance, so altitude training should be interspersed with periods near sea level.
A number of studies have shown that a programme of altitude exposure (hypoxia)
interspersed with periods of near-sea-level exposure to permit intense training, when
carried out for 3–4 weeks, enhances sea-level performance. This is most likely due
to an erythropoietin-induced increase in red cell mass and aerobic capacity, although
improved running economy may be a factor.
E. Preparation for Competition at Altitude

Many major competitions, including the Olympic Games (1968) and the WorldChampionships (1997) are conducted at altitude. While this provides an advantage

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

for sprinters, hurdlers, and jumpers, endurance events of 800 metres and longer
are adversely affected. Therefore, a period of adaptation to altitude is essential in
preparation for competition, if one lives at sea level. There is still much to be learned
about optimal preparation, but a few principles seem to be well accepted:
1. The adaptation period at altitude should be at least 3 or 4 weeks prior
to the start of competition.
2. Athletes should be in good general health, free of medical and orthopedic
problems, and not iron deﬁcient prior to beginning altitude training. Iron
supplementation should be used if ferritin levels are low.
3. Training volume, intensity, nutrition, and health should be carefully
monitored during the training and competition processes.
a. During the ﬁrst week, aerobic adaptation should be stressed. Training
volume should be moderate, about 75–80% of sea-level loads.
b. Intensity should increase in the second week, with mixed aerobic andanaerobic sessions.
c. During week three, emphasis is on maintaining speed, with aerobic
work at the highest levels possible. Intensity of runs may be
maintained by increasing rest time between interval runs.
d. Week four is for tapering and recovery prior to the start of competition.
F. Altitude Illness

Rapid ascent to elevations of 1500m or more, especially above 2400m (8000ft), may result in acute “mountain sickness” or, rarely, a severe altitude illness
syndrome, such as high altitude pulmonary oedema (HAPE), or high altitude
cerebral oedema (HACE). Caution: Athletes with sickle cell trait or G-6-P
deﬁciency may sustain a life-threatening crisis with rhabdomyolysis when exposed
to high altitude, especially with the added stress of exercise without prior adaptation.
Symptoms of altitude illness include headache, nausea, lethargy, anorexia,
vomiting, and disturbed sleep patterns. Symptoms may begin within hours of ascent,peak in 1–2 days, and generally resolve in 3–4 days.
High altitude pulmonary oedema (HAPE) is a medical emergency. Symptoms
and signs include those of altitude sickness plus cough, dyspnea, frothy sputum,chest pain, tachypnea, respiratory distress, and pulmonary rales. HAPE occurs more
often in young, active people following heavy exercise in cold air.
High altitude cerebral oedema usually occurs after rapid ascent to 4000 m or
more. Signs and symptoms include severe headache, ataxia, confusion, blurredvision, and altered consciousness. Rapid removal to a lower altitude is essential, plus
oxygen and IV glucocorticoids.
The following may help prevent altitude illness:
1. A gradual ascent of no more than 300 m–600 m per day over 2400 m
should be made.
2. Acetazolamide (Diamox) may be helpful prophylactically.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

References

1.

2.

3.
4.

5.
6.
7.

8.
9.

Brooks, G. A., and T. D. Fahey. Exercise in high and low pressure environments. In Exercise Physiology, pp. 471-498. New York: John Wiley & Sons,
1984.
Gore, C. J., and W. G. Hopkins. Positive effects of intermittent hypoxia (livehigh:train low) on exercise performance are not mediated primarily byaugmented red cell volume. J. Appl. Physiol. 99:2055-2058, 2005.
International Olympic Committee. Environmental factors. In Sports Medicine
Manual, pp. 423-452. Lausanne: IOC, 1990.
Levine, B. D., and J. Stray-Gunderson. Point: Positive effects of intermittent
hypoxia (live high:train low) on exercise performance are mediated primarily
by augmented red cell volume. J. Appl. Physiol. 99:2053-2055, 2005
Rusko, H. K., H. O. Tikkanen, and J. E. Peltonen. Altitude and endurance
training. J. Sports Sci. 22:928-944-945, 2004.
Samenza, G. L. O-2-regulated gene expression: transcriptional control ofcardio-respiratory physiology by HIF-1. J. Appl. Physiol. 96:1170-1177, 2004.
Stray-Gunderson, J., R. F. Chapman, and B. D. Levine. “Living high-traininglow” altitude training improves sea-level performance in male and female elite
runners. J. Appl. Physiol. 91:1113-1120, 2001.
Wilber, R. L. Current trends in altitude training. Sports Med. 31:249-265, 2001.
Wilmore, J. H., and D. L. Costill. Physiology of Sports and Exercise (1st ed.).
Champaign, IL: Human Kinetics, 1994.

PART 3

AIR POLLUTION
A. Air Pollution

Athletes exercising in urban environments may be exposed to a variety ofpollutants that may affect performance. The most common atmospheric pollutants
include carbon monoxide, ozone, particulate matter, sulfur oxides (SOx), nitrogenoxides (NOx), and peroxy-acetylnitrate (PAN). The “pollution index,” calculated
as pollutant concentration x ventilation volume x exposure time, is the best way tomonitor potential threats to athletes.
• Carbon monoxide (CO) readily combines with hemoglobin to reduce
tissue oxygenation, increase cardiac work, and impair psychomotor
function. It is insidious, as it causes no local irritant symptoms to the
airways.
• Oxidants (ozone) cause tracheal and bronchial irritation, chest tightness,and induce bronchospasm and reduced lung function (decreased FEV1).
They affect endurance performance at levels of 0.1-0.3 ppm. Asthmatics
may be more adversely affected and will need more thorough management.
• Particulate matter is composed of solid and liquid droplets, and may
contain acids (nitrates and sulfate), organic chemicals, allergens (pollens
and molds), metals, soil, and dust. Particles are less than 10 microns in size:“ﬁne particles are deﬁned as less than 2.5 microns, while “course” particles
are 2.5–10 microns. High levels of particulate matter may affect the healthof older people, increasing morbidity and mortality of those with pulmonary
and cardiac disease, as well as affect young people with asthma. Long-term
exposure may lead to a permanent decrease in lung function and chronic
bronchitis.
• Sulfur oxides (SOx) irritate the upper airway, causing transient bronchospasm. They are a signiﬁcant problem for asthmatics, even at low
concentrations.
• Peroxyacetylnitrate (PAN) and Nitrogen oxides (NOx) cause symptoms
similar to those triggered by ozone.
1. Prevention/Managementa. Administrative
Schedule events at locations and at times when pollutants are at thelowest levels—away from trafﬁc, near parks and oceans. To minimiseozone exposure, race early in the AM or late PM.
b. Athlete Adaptation
Adaptation to ozone and sulfur oxide may occur, with less bronchospasm and irritative symptoms. Asthmatics may be treated with cromolyn
sodium, and aerosol adrenal corticoids and/or beta-2 agonists. “Normal”

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

athletes may develop exercise-induced asthma (EIA) and require beta-agonist
therapy.
References

1.

2.
3.

Environmental Protection Agency. Particle Pollution and Your Health. http://
www.airnow.gov/index.cfm?action=particle.cover. Accessed from Medline
Plus, http://www.nlm.nih.gov/medlineplus/airpollution.html.
International Olympic Committee. Environmental factors. In Sports Medicine
Manual. Lausanne: IOC, 1990.
McCafferty, W. B. Air Pollution and Athletic Performance. Springﬁeld, IL:
Charles C. Thomas, 1981.

PART 4

JET LAG
Circadian rhythmic oscillations affect numerous physiologic functions that
contribute to athletic performance. Circadian rhythms are expressed as oscillations
in physiologic systems (body temperature, heart rate, hormone secretory rates),and responsiveness to internal stimuli (neuro-transmitters, electrolytes, metabolic
substrates) or external stimuli (environmental factors, food, drugs, other stressors).
Circadian rhythms are synchronised by periodic environmental changes (primarily
the light-dark cycle), social interactions, and other environmental factors.
A. Effects on Performance

Athletic performance can be affected by: 1) the time-dependent changes incircadian peak to trough, and amplitude of physiological variations, and by
2) disruption of circadian rhythms due to trans-meridian travel and subsequentchanges in the sleep-wake cycle (i.e., “jet lag”). Circadian dysrhythmias (“jetlag”) can result in a wide variety of symptoms, including fatigue, insomnia, sleep
disturbances, headaches, irritability, altered gastro-intestinal motility (constipation),and impaired athletic performance.
Factors that may affect the degree of circadian dysrhythmicity include therapidity of travel and number of times zones crossed, direction of ﬂight, rate ofadaptation of various systems, synchroniser intensity, diet, and individual factors(personality, age, gender, chronotype).
1. Distance and Speed
Crossing as few as two or three time zones may affect performance, but ingeneral the more time zones crossed, the greater the disruption in circadian rhythms.
Obviously, rapid travel by jet plane is more disruptive than intermittent or slower
means of travel.
2. Direction of Travel
East-bound travel is more disruptive than west-bound travel and recovery takes
longer. This is because human physiological systems prefer a circadian cycle longer
than 24 hours, and thus adapt better to a phase delay (lengthening) than to a phaseadvance (shortening). Physiological systems adapt 30–50% faster to westward travel
than to eastward travel.
3. Rate of Adaptation
Different physiological systems adapt to time-zone changes at different rates.
Those that respond to environmental cues, such a heart rate, adjust more rapidly
than internally controlled systems such as core temperature. The speciﬁc systems
responsible for decreased athletic performance have not been identiﬁed, but areprobably related to alterations in the sleep-wake cycle and the body temperature
circadian cycle.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCE

4. Synchroniser Intensity
Appropriate exposure to external synchronisers, such as daylight, regular meals,social interactions, moderate physical activity, and the establishment of regularsleep-wake cycles can help shift circadian rhythms so that they are in phase with thelocal environment.
5. DietDifferent foods cause different bodily reactions and can affect whether we feel
sleepy or awake. Starchy and sweet foods provide quick but transient energy. They
stimulate the indoleamine metabolic pathway and encourage higher concentrationsof tryptophan, an essential amino acid, to enter the brain and be converted to sleepinducing serotonin. As serotonin levels rise, sleep comes more readily. Thus, starchyand sweet foods ultimately tend to make one feel lethargic and can aid in sleep.
In contrast, high protein foods help stimulate the “get-up-and-go” catecholamine
pathway (adrenaline pathway, starting from amino acid tyrosine and resulting in thesynthesis of the neurotransmitters dopamine, norepinephrine, and epinephrine) andtend to make us more alert.
Thus, what and when one eats helps the biological clock function. Adjustments
triggered by diet help the body adapt to travel across time zones by contributing,along with other “zeitgeber” (see below), to a shift of the biological from home time
to destination time.
6. Individual Differences
Individuals differ considerably in their ability to adapt to changes in circadianrhythms. About 20–30% have little difﬁculty, while a similar percentage neveradjusts well. In general, the “lark” or morning type adapts poorly to westward travel,
while the “owl” (extrovert) adapts less well to eastward ﬂight.
Introverted and highly neurotic persons have more difﬁculty adjusting to jet-lag.
Highly motivated individuals (such as athletes) usually can overcome any tendency
to performance decrement through extra effort.
7. Minimising Jet Lag’s Effects
Everyone has an internal “biological clock” guiding daily life. This clock
prepares the digestive system to receive food at normal times and causes productionof digestive juices even before we smell food. It also helps regulate energy, strength,
and alertness, and causes one to become tired about the same time each evening.
Important steps to reduce jet lag involve adjustment of time cues, or “zeitgeber”(pronounced “tseitgaybur”). Zeitgeber are activities and inputs that help the bodyinterpret its environment, determine whether it is day or night, and decide what
activities (including conscious, unconscious, and biochemical activities) areappropriate for the time. Major zeitgebers are diet, light, exercise, drugs, and social
interaction. Adjustment of these cues before and during travel help the body reset its
internal clock more quickly and easily.

CHAPTER 11, ENVIRONMENTAL FACTORS AFFECTING HUMAN PERFORMANCEThe body’s sense of time is affected by both internal and external factors. The
biological clock is coordinated by hormones, which are produced by endocrine
glands in varying amounts and kinds throughout the day. Hormones help determinealertness, muscle proﬁciency, and mood, and their interplay with external time cues
determines how strong the body clock’s signals will be.
There are a number of steps that can help minimise the effects of jet lag(see Appendix 10, Recommendations for Minimising Jet Lag, for a summary ofrecommendations):a. Arrive at the competition site as early as possible. Allow one day for eachtime zone of eastward ﬂight, and 0.6 days for each zone of westward travel.
b. Adjust eating, sleeping, work, and training schedules in the directionof the new time zone, by 1–2 hours each day over a 4–5 day period.
This may not be practical in a family or work situation.
c. Arrange ﬂights so as to arrive close to local bed-time.
d. Eat high protein /low carbohydrate meals for 3 days prior to ﬂight, andduring ﬂight. Try to follow a meal schedule that will be used at yourdestination. After arrival, starting with breakfast and lunch, eat highprotein/low carbohydrate meals, and use tea or coffee to enhancesynchronisation.
e. Avoid alcohol as a sleep-inducer, as it interferes with REM sleep anddelays sleep-wake cycle adaptation. Do not use coffee, tea, or caffeinecontaining drinks during ﬂight. Drink large amounts of caffeine-free
drinks (juice, water) to prevent dehydration.
f. At departure, set watch to destination time, and adjust sleep, meals,
and other activities accordingly. East-bound travellers should avoid
bright lights, movies, and socialising until breakfast of the day after
arrival.
g. Upon arrival, immediately adjust schedule (social contacts, brightsunlight, meals, training, etc.) to local time. Maintain regular sleep-wakeschedules.
Stressors, such as competition anxiety, coping with climate and food changes,
and other environmental and social factors can exacerbate the effects of “jet-lag.”
Dealing successfully with these elements may minimise the effects of circadiandysrhythmias.
References

1.
2.
3.

Ehret, C. F., and L. W. Scanlan. Overcoming Jet Lag. New York: Berkeley
Publishing Corporation, 1983.
International Olympic Committee. Environmental factors. In Sports Medicine
Manual. Lausanne: IOC, 1990.
Winget, C. M., C. V. DeRoshia, and D. C. Holley. Circadian rhythms andathletic performance. Med. Sci. Sports Exerc. 17:498-516, 1985.