The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis.

Background: Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear.

Objectives: (1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature.

Data Source: PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms.

Study Selection: English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement.

Data Extraction: Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation.

Data Grouping: Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used.

Data Analyses: Hedges' g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate.

Results: Ninety-six articles were reviewed. The most common duration was 7-14 days and the most common method of HA was the controlled work-rate approach. HA had a moderately beneficial effect on exercise capacity and performance in the heat irrespective of regimen; however, longer regimens were more effective than shorter approaches. HA had a moderate-to-large beneficial effect on lowering core body temperature before and during exercise, maintaining cardiovascular stability, and improving heat-loss pathways. Data are limited but HA may reduce oxygen consumption during subsequent exercise, improve glycogen sparing, increase the power output at lactate threshold, reduce lactate concentrations during exercise, have a trivial effect on increasing extracellular concentrations of Hsp, and improve perceived ratings of exertion and thermal sensation.

Conclusion: HA regimens lasting <14 days induce many beneficial physiological and perceptual adaptations to high ambient temperatures, and improve subsequent exercise performance and capacity in the heat; however, the extent of the adaptations is greatest when HA regimens lasting longer than 14 days are adopted. Large methodological differences in the HA literature mean that there is still uncertainty regarding the magnitude and time course of potential adaptation for a number of physiological and perceptual variables.