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Br J Sports Med. 2017 Feb;51(4):264-270. doi: 10.1136/bjsports-2016-096579. Epub 2016 Nov 4.

Strategies and factors associated with preparing for competing in the heat: a cohort study at the 2015 IAAF World Athletics Championships.

Author information

Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Athletics Research Center, Linköping University, Linköping, Sweden.
Swedish Athletics Association, Stockholm, Sweden.
Department of Orthopaedics and Rehabilitation, Moi University, Eldoret, Kenya.
Young Adults Centre, Region Östergötland, Linköping, Sweden.
Sports Medicine Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.



Assess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies.


Of the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis.


48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5-1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001).


At a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat.


Elite performance; Exertional heat stress; Heat acclimatisation; Hydration

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