The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies–A Systematic Review

Abstract

Background: In individuals with a spinal cord injury thermoregulatory mechanisms are fully or partially interrupted. This could lead to exercise-induced hyperthermia in temperate conditions which can be even more distinct in hot conditions. Hyperthermia has been suggested to impair physiological mechanisms in athletes, which could negatively influence physical performance and subjective well-being or cause mild to severe health issues.Objective: The aim was to evaluate the literature on the thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise in temperate and hot conditions taking the effects of cooling techniques and heat acclimation into account.Data sources: Two electronic databases, PubMed and Web of Science were searched. Studies were eligible if they observed the influence of exercise on various thermoregulatory parameters (e.g., core and skin temperature, sweat rate, thermal sensation) in individuals with a spinal cord injury.Results: In total 32 articles were included of which 26 were of strong, 3 of moderate and 3 of weak quality. Individuals with a high lesion level, especially those with a tetraplegia, reached a higher core and skin temperature with a lower sweat rate. The use of cooling techniques before and during exercise can positively affect the burden of the impaired thermoregulatory system in all individuals with a spinal cord injury.Conclusion: Due to the absence of normal thermoregulatory abilities, individuals with a high-level spinal cord injury need special attention when they are exercising in temperate and hot conditions to prevent them from potential heat related issues. The use of cooling techniques can reduce this risk.

Characteristics of Official Wheelchair Basketball Games in Hot and Temperate Conditions

“…In AB, it was observed that hot environmental conditions seem to influence the activity patterns (i.e., reduced high-intensity activity, total distance) [20]. As a result of the loss of vasomotor control and the absence of sweating response below the lesion level in individuals with a SCI (the sympathetic innervation of the eccrine sweat glands exits the spinal cord at T1-L2) [30,31], it has to be noted that the impairment of the thermal and thermoregulatory responses depends on the level of the lesion and the completeness of the spinal rupture [13]. Therefore, it can be expected that the performance of players with a low-level lesion would not be affected by the same amount as in cases of athletes with a high-level lesion.…”

“…It can be argued that low lesion level players with a lesion below T6 are able to thermoregulate their body similar to AB. Players with a high lesion level (i.e., above T6) are associated with considerably worse thermoregulation [13]. Hence, it makes sense to take a closer look at players with a lesion level above and below T6 (Tables 4 and 5).…”

“…WCB is, among others, played by athletes with a traumatic spinal cord injury (SCI). As a consequence of the injury, the regulation of body core temperature is impaired among individuals with SCI [13]. This has been demonstrated to occur even during exercise in a cool ambient temperature, and it is further exacerbated during exercise in the heat [13].…”

“…As a consequence of the injury, the regulation of body core temperature is impaired among individuals with SCI [13]. This has been demonstrated to occur even during exercise in a cool ambient temperature, and it is further exacerbated during exercise in the heat [13]. The risk for heat-related illness and consequently a reduction in exercise performance is also elevated with increasing environmental temperature in athletes with SCI with a lesion level above T6 [13,14].…”

“…This has been demonstrated to occur even during exercise in a cool ambient temperature, and it is further exacerbated during exercise in the heat [13]. The risk for heat-related illness and consequently a reduction in exercise performance is also elevated with increasing environmental temperature in athletes with SCI with a lesion level above T6 [13,14]. However, the effect of environmental heat stress on performance parameters and activity profiles has not been examined in an official game situation in wheelchair sports so far.…”