Exercise and Heatstroke: Summer Running Safety
Exercise and Heatstroke: Summer Running Safety
Summer running can be great exercise, but athletes need to understand the potential hazards of exercising in hot weather. Heatstroke is a life-threatening condition that cannot be taken lightly. In less developed countries, the mortality rate is roughly 50%. Even in developed nations people die every year from an affliction that is usually preventable. Even those who recover may still experience significant long-term effects, from brain damage to liver failure and beyond.
To this day, heatstroke remains poorly understood. Different people have different thresholds for succumbing to heatstroke. The reason some experience permanent damage at temperatures others can tolerate isn't well understood. Despite this uncertainty, the best thing athletes can do is take steps so they never have to discover their threshold and experience the potentially tragic consequences thereof.
Heatstroke Defined
Medically, heatstroke occurs when one's core body temperature rises above 40C and one experiences the onset of neurological symptoms such as delerium and coma. These two factors must be present for a diagnosis of heatstroke. Neurological symptoms may be subtle, manifesting only as inappropriate behavior or impaired judgment; more often, however, patients have delirium or frank coma. Heatstroke is caused by exposure to high temperatures or a sharp increase in body temperature due to exercise. Those with heatstroke tend not to be drenched in sweat; generally, they will have hot and dry skin, which indicates a deficiency in the body's ability to regulate temperature. The severe effects of the illness include a systemic inflammatory response leading to a syndrome of multiorgan dysfunction, similar to sepsis, and even death.
The Science of Heatstroke
At high temperatures, blood is redirected from core circulation to peripheral circulation, causing sweating and the transfer of heat from the body to the surrounding environment . When this process of thermoregulation breaks down, heatstroke is more likely. Still, the body has a natural heat-shock response. When temperatures increase suddenly, cells produce heat-shock proteins that allow the cells to survive otherwise intolerable heat-stress . People with lower levels of these protective proteins may be more likely to succumb to heatstroke.
Strenuous exercise increases intestinal mucosal permeability. Endotoxins from the gut can leak into the bloodstream, which then affects the body's thermoregulation. In humans, high concentrations of endotoxin, inflammatory cytokines, and acute-phase proteins are found in the blood after strenuous exercise. This type of intestinal permeability occurs in athletes who are exercising at 80 percent or more of maximal oxygen consumption. The resultant inflammation erodes the body's ability to regulate temperature. Further, inflammatory cytokines are associated with high intracranial pressure, decreased cerebral blood flow, and severe neuronal injury. This explains the neurological symptoms associated with heatstroke.
The dangers of heatstroke aren't simply secondary. Heat itself can directly damage cells. While individual heat tolerance varies, the critical thermal maximum in humans is a body temperature of 41.6C to 42C for 45 minutes to 8 hours; at temperatures of 49C to 50C all cellular structures are destroyed and cellular necrosis occurs in less than five minutes.
Heatstroke Recovery
Heatstroke recovery is highly individualized, with no measured variable that predicts it. Recovery has been called idiosyncratic and may require up to 1 year in severe cases. In the short term, the key to maximize the chances of surviving exertional heatstroke is rapidly decreasing the elevated core body temperature. This is done is a few ways, though the most common ones are to immerse the patient in cold water or to repeatedly wet the skin while fanning the patient, thus encouraging evaporation. The alleviation of neurological symptoms is considered a positive indicator of recovery; Residual brain damage occurs in about 20 percent of the patients and is associated with high mortality. After the immediate danger has passed, sodium and potassium levels need to be stabilized and doctors provide support for organ systems. Because recovery is dependent on individual physiology, there is no defined amount of time after which the patient is presumed healthy. A return to exercise should be cleared by a doctor after the physical symptoms have passed.
Summer Running Safety
Preventing heat-related injuries should be of paramount importance for anyone running during the hot summer months. In warm weather, the importance of hydration cannot be overstated. Dehydration exacerbates heat stress and makes heatstroke more likely. Still, despite the seriousness of the risks, it is possible to exercise safely in the summer. Above all, athletes should make sure to stay hydrated and should avoid depleting their salt levels. They should take care with substances that may alter the body's water and salt balance; these include diuretics, tranquilizers, and amphetamines, among others. Wear permeable clothing while running so that sweat can evaporate and cool the body. If possible, people may want to avoid exercising at the hottest part of the day. With adequate planning and forethought, runners can ensure that they don't fall victim to heatstroke, a thoroughly preventable illness.
Benefits of Training in the Heat
Athletes can benefit from training in the heat, so long as they do it safely. Acclimating to higher temperatures actually reduces the risk of heatstroke. Successive increments in the level of work performed in a hot environment result in adaptations that eventually allow a person to work safely at levels of heat that were previously intolerable or life-threatening. Heat acclimation leads to an increase in sweating response and a decrease in heart rate, core temperature and skin temperature, and perceived exertion during exercise in the heat. Fit individuals acclimate more rapidly to warmer temperatures. As always, hydration is vital toward realizing all of these benefits.
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