Triathlon and Acclimation II

We have part one acclimation where we explained what happened to one of our athletes.  I read what happened to Tommy Zaferes a week ago in Dallas and saw images of Lescure falling 50 meter before the finish line in Huatulco this past weekend.

The Seizure:

Once I crossed the line I immediately flopped on the floor and started seizing. Personnel came over and moved me out of the way like a limp bag of rice and got me to the paramedics. I apparently had a heatstroke and then a seizure (which the doctors say can cause death, brain damage, and major organ failure). They airlifted me to a hospital and called my parents right away to fly out from California. I ended up being intubated and on a ventilator for 19hrs before they moved me to another hospital. I had major short term memory loss and had no idea what was going on. I don’t remember, but I need to thank Courtney Kulick from USAT, Rob Canalas from ROKA, the Huffmans,(and anyone else I don’t remember) for being there for me until my parents, and girlfriend (who flew from London!), came. The support I received was amazing!

Bonus Material:

The doctors said that all my sodium levels were normal (if I wasn’t hydrated or if I didn’t have enough electrolytes these should have been completely depleted) so they think that I had a small virus which wasn’t showing any symptoms leading into the race and that the race conditions and effort put me over the top and caused the heatstroke and seizure. Having a heatstroke in these conditions isn’t that uncommon, but having a seizure is what caused all the panic.

My body temperature was 103 at the hospital.

I am a doctor and have followed patients who have had this problem.  It is not about temperature in itself.  It is mainly related to humidity.  32 degrees Celsius with 90% humidity makes the condition for many athletes being exposed to heatstroke.  To produce the phenomenon of heatstroke we do not need the highest temperatures, what we need is very high humidity (this is a Petri dish for heatstroke).  The body in itself takes care of increasing the temperature when is unable to decrease the temperature by sweeting (evaporation of water through sweeting is the way we use to cool down our body).  You did not have a virus Tommy; your acclimation to humidity was not enough.

12 juin 2013

ACCLIMATATION IN TRIATHLON

Several years ago, perhaps the year 1999 or 98, José Merchan was winning the race in Ixtapa, Mexico, for more than 100 meters when he felt down 200 meters before the finish line. I have seen several athletes falling after that, including Sara Groff (in a video).

 Ixtapa Triathlon - Ixtapa, Mexico (ITU Points Race)

Swim 1.5Km - Bike 40Km - Run 10Km
November 13, 1999

Men:

 1. Doug Friman          (USA)   1:51:51  (16:59, 0:59:59, 34:38)

 2. Alec Rukosuev        (USA)   1:52:18  (16:56, 0:58:59, 34:58)

 3. Jose Luis Zepeda     (MEX)   1:52:27  (16:54, 0:58:56, 35:15)

 4. Victor Plata         (USA)   1:53:07  (17:02, 0:59:08, 35:34)

 5. Wes Hobson           (USA)   1:53:38  (17:28, 0:58:40, 36:10)

 6. David Hyan           (RSA)   1:54:33  (17:00, 0:58:55, 37:10)

 7. Eligio Cervantes     (MEX)   1:54:39  (17:28, 1:01:46, 34:05)

 8. Leandro Macedo       (BRA)   1:54:48  (17:36, 1:01:59, 33:45)

 9. Rob Barel            (NED)   1:55:13  (17:42, 1:01:02, 25:52)

10. Uzziel Valderrabano  (MEX)   1:55:46  (17:57, 1:01:35, 34:56)

11. Arturo Garza         (MEX)   1:56:10

12. Javier Macias        (MEX)   1:57:36

13. Jim Quinn            (USA)   1:57:47

14. Alvaro Martinez      (MEX)   1:58:09

15. Philippe LeDuff      (FRA)   1:58:58

16. Sergio Quezada       (MEX)   1:59:10

17. Francisco Serrano    (MEX)   1:59:34

18. Enrique Molina       (MEX)   1:59:48

19. Allan Villanueva     (MEX)   2:00:21

20. Rodrigo Quevedo      (MEX)   2:01:03

21. Carlos Probert       (MEX)   2:01:56

22. Fernando Gomez       (MEX)   2:02:19

23. Marcus Ornellas      (BRA)   2:04:36

24. Jose Merchan         (ESP)   2:05:41

Merchan finished the race after falling.  It was very humid and hot when that happened.  This year the same thing happened, one of our athletes was stopped from racing before falling (9km) into the running.  He started to have problems after 3k running.  Ixtapa had above 32 degrees Celsius and 90% humidity.  Our athlete was used to the temperature but not to that degree of humidity (it rained the night before and the race was at 10am).  He was hydrated with 3 liters of water and electrolytes in the last two hours before the race.  He was second when passing the first lap (2.5k), after that he started to slow down until he was ready to fall at the 9k mark.  Our athlete mentioned that since he started to slow down he had problems focusing things and does not remembered when he was stopped until he was taken to the hospital and his temperature was decreased to normal levels, when he recovered consciousness was in the hospital.  His blood pressure was 90/40 when he arrived, his skin was dry and hot, he was able to stand up and walked with difficulties but he was incoherent.  Potasium, sodium, magnesium was within the normal limits; CPK mildly elevated 200 as well as creatinine 1.5, BUN within normal levels; his albumin was less than 3 (he eats 4g of proteins per kilo on daily basis).  Liver enzymes were within normal levels.  He was able to leave the hospital two hour later and took the plane back home four hour after the incident.  His temperature was within the normal levels after he left the hospital.  Laboratory test will be done today again.  There is a good article written regarding this subject for runners.  A one subject research (himself) that gives plenty information.

Heat Acclimation for Runners

April 9, 2010 by Bill Henderson, MD · 18 Comments 

How Heat Affects Running Performance
There is little doubt that exercise performance is impaired in hot environments. While the effect of heat on performance varies with the sport (for example, less effect on cycling than running), there is a great deal of empirical data showing a link between ambient temperature and performance. Various authors have suggested performance impairments of between 1.6 and 3% in marathon times for every 10 degrees above 55 degrees Fahrenheit. Below is an interesting table from a paper by Scot Montain and colleagues at the US Army Research Institute of Environmental Medicine illustrates the relationship between elite marathoner finishing times and course temperature in the New York City Marathon.

New York City Marathon: Top Times vs Temperature

The effect seems to be less dramatic for faster runners. The following table from a 2007 paper by Matthew Ely demonstrates this nicely:

Effect of heat on slower vs faster marathoners.

Why are we slower in hot conditions? There are a variety of proposed mechanisms, but the one that is most widely accepted is based on cardiac output limitations.

When we exercise, we produce a great deal of heat. One of the principle ways that we get rid of this excess heat is through sweating (evaporative heat loss), as well as conduction and radiation of heat from our skin. To achieve this, our bodies have to send a considerable amount of blood to the skin. This blood is therefore not available to perfuse working muscles and deliver oxygen to them. So a portion of our blood volume is essentially no longer able to participate in oxygen delivery and energy formation in our exercising muscles. The greater the amount of heat that we need to dissipate, the greater the proportion of blood that is diverted to the skin (up to a point – this can’t increase forever).

What is necessary for cooling isn’t the hemoglobin (the red blood cells in blood) but the plasma, which is essentially water with a number of different proteins and electrolytes in it. However, your body can’t separate the red cells (which are the oxygen carriers) from the plasma – they all go along for the ride to the skin.

How We Acclimate to Heat
If it is plasma that is the essential cooling component, is it possible to improve this problem by increasing our total plasma volume? Yes, and that is exactly what happens as we adapt to heat over time. Whether you acclimate naturally to higher temperatures over the course of a season, or in a heat chamber, the most significant change that occurs is an increase in plasma volume. Other things occur as well (such as changes in sweat sodium concentration, resting core temperature and heart rate), but plasma volume expansion is the key. After extensive acclimatization, plasma volume can have expanded by as much as 2 liters!

This may explain why the fittest athletes adapt to heat stress more quickly than the less fit. One of the by-products of endurance training (especially at high intensities) is an increase in plasma volume. So just by training hard, you can derive some amount of heat acclimation. What about specifically training in a hot environment to improve performance in a hot race? There is extensive evidence that it is possible to improve our performance in hot environments by training in similar conditions prior to competition. Several studies have demonstrated performance improvements in terms of maximum work rate, perceived exertion, time to failure at submaximal work rates, and time to complete a specific distance.

In the last few paragraphs we’ve explored a bit about the effect of heat on performance (bad) and the effects of acclimation on this (good). The most meaningful physiological adaptation that occurs is an increase in plasma volume (a lot like adding more radiator fluid to a car). However, there are some other adaptations that occur – changes in sweat rate, changes in sweat sodium concentration and changes in core resting temperature, to name a few. The various adaptations occur with different amounts of acclimatization. Here’s a graphical representation of the times over which an athlete can gain these benefits...:

Heat Acclimation Methods and Considerations
The work needed to achieve the benefits heat acclimation is reasonable. Most laboratory based heat acclimation protocols have athletes spend about 1 hour a day in a heat chamber for 7-10 days. Importantly, this needs to occur as close to the time of the competition as possible, as the adaptations conferred by acclimation decay rapidly without ongoing exposure. So there’s no point in spending 2 weeks in a heat chamber a month before the race – the effects will decay in 1-3 weeks.

As previously mentioned, the benefits of heat acclimation decay rapidly if you do not maintain heat exposure. Estimates vary, but it’s possible that you could lose half of the benefit in 10 days without ongoing heat exposure. This raises some logistical problems for athletes living in cold environments who are attempting to acclimate for a hot weather event. To benefit maximally from acclimatization, the heat training sessions should occur as close as possible to the event. That seems pretty straight forward. The problem is that acclimation is quite physically demanding, and most athletes attempt to taper in the week(s) prior to a big race. So, if you want to acclimatize optimally, it needs to occur during your taper – which may cause overtraining, or at least minimize the benefits of tapering.

As with all training, the more specific, the better. When it comes to heat acclimatization this means that your training climate should reflect the competition environment as closely as possible – the same temperatures as well as humidity. Why is humidity important? As anyone who has survived an East Coast summer knows, humidity makes it harder to lose heat via sweating. Training in a humid environment does confer some benefit it you are training for a dry, hot race, but not as much as training in a dry, hot chamber. Interestingly, there is better “transfer” of acclimation if you train in a dry, hot climate and then race in a humid, hot race than the other way round. So, as much as possible, match humidity and temperature of your acclimation phase to your race environment.

What about passive acclimation? That is, will sitting in a sauna at the YMCA get us ready for running in Death Valley? Essentially – a bit, but not much. Acclimatization is vastly greater (and more rapid) is you exercise during the heat exposure. Whether this is again the principle of specificity, or whether it is simply that core temperature rises faster with active acclimation (increased core temperature is probably the stimulus for the adaptions that occur) is not clear.

My Experiences
To address these problems, I worked with the exercise physiologists at Simon Fraser University’s Environmental Physiology Unit. They put together a low intensity heat acclimation program specifically tailored to my needs (the Marathon des Sables in Morocco). In brief, I ran on a treadmill at 50-60% VO2max for 45-75 minutes over 9 sessions. The first 3 sessions were at 95F (35C) and the next 5 were at 113F (45C). In the final (9th) session the temperature was reduced back to 95F (35C). This allowed us to compare my physiological data from the first and the last sessions. ..

Change in perceived exertion after 9 days of heat acclimation.

The Borg Scale above is used to assess subjective overall effort – I clearly felt that the same speed was easier in the heat after 9 days. The “thermal comfort score” below shows that I was bothered less by the heat after acclimation...

Change in thermal comfort rating after 9 days of heat acclimation.

One of the most important ways to prevent heat injuries and to maintain performance in extremely hot environments is to drink adequate amounts of fluid. This seems obvious, but it is actually surprisingly hard to do this if you are focusing on running. I think that one of the most useful benefits (for me – not living somewhere hot) was learning to drink earlier and more frequently. That I learned this lesson is well demonstrated in the graph of fluid balances on Days 1 and 9 below...

Change in fluid balance after 9 days of heat acclimation.

Finally, what happened to heart rate? As you can see below, my heart rate at the same speed and temperature decreased by about 9% – a very significant improvement. Now, it didn’t get as low as what I would expect it to be in “normal temps,” but the improvement was significant, and could be expected to translate into a tangible benefit in competition...

Change in exercise heart rate after 9 days of heat acclimation.

So, in my experience, heat acclimation based on well documented scientific principles can give athletes a significant performance enhancement in hot environments. However, it is important to recognize the effect of acclimation on the tapering period and to plan accordingly.

http://www.irunfar.com/2010/04/heat-acclimation-for-runners.html

You can see why some slow runners have a chance as it was the case in Atlanta 1996.