Specific exercise heat stress protocol for a triathlete's return from exertional heat stroke.

A triathlete collapsed with exertional heatstroke (EHS) during 2 races over 3 months. The American College of Sports Medicine recommends a heat tolerance test (HTT) following EHS if there is a concern with return to play. The classical walking HTT may not be the best test to evaluate elite triathletes' heat tolerance due to race intensity, nor is it suited to evaluate acclimation ability, which may play a role in risk of heat illness. Is the athlete capable of returning to racing or should he retire from sport due to heat intolerance? Up to 90 min of cycling (70% of V˙O2max; 36°C, 50% relative humidity) was followed by 9 d of exercise heat acclimation and a final identical exercise heat stress test. After acclimation, exercise duration before reaching a gastrointestinal temperature (Tgi) of 39.5°C increased 25 min, sweat rate increased 0.5 L·h, initial Tgi decreased 0.85°C, and rate of Tgi rise decreased 0.6°C·h. Adaptations were deemed acceptable, and the athlete was allowed to return to competition. The athlete has since raced in hot environments without incident.