Efficacy of two intermittent cooling strategies during prolonged work-rest intervals in the heat with personal protective gear compared with a control condition

Eur J Appl Physiol. 2023 May;123(5):1125-1134. doi: 10.1007/s00421-023-05139-x. Epub 2023 Jan 18.


Introduction: Personal protective equipment (PPE) inhibits heat dissipation and elevates heat strain. Impaired cooling with PPE warrants investigation into practical strategies to improve work capacity and mitigate exertional heat illness.

Purpose: Examine physiological and subjective effects of forearm immersion (FC), fan mist (MC), and passive cooling (PC) following three intermittent treadmill bouts while wearing PPE.

Methods: Twelve males (27 ± 6 years; 57.6 ± 6.2 ml/kg/min; 78.3 ± 8.1 kg; 183.1 ± 7.2 cm) performed three 50-min (10 min of 40%, 70%, 40%, 60%, 50% vVO2max) treadmill bouts in the heat (36 °C, 30% relative humidity). Thirty minutes of cooling followed each bout, using one of the three strategies per trial. Rectal temperature (Tcore), skin temperature (Tsk), heart rate (HR), heart rate recovery (HRR), rating of perceived exertion (RPE), thirst, thermal sensation (TS), and fatigue were obtained. Repeated-measures analysis of variance (condition x time) detected differences between interventions.

Results: Final Tcore was similar between trials (P > .05). Cooling rates were larger in FC and MC vs PC following bout one (P < .05). HRR was greatest in FC following bouts two (P = .013) and three (P < .001). Tsk, fluid consumption, and sweat rate were similar between all trials (P > .05). TS and fatigue during bout three were lower in MC, despite similar Tcore and HR.

Conclusion: Utilizing FC and MC during intermittent work in the heat with PPE yields some thermoregulatory and cardiovascular benefit, but military health and safety personnel should explore new and novel strategies to mitigate risk and maximize performance under hot conditions while wearing PPE.

Keywords: Body cooling; Exercise; Heat stress; Military; Thermoregulation.

MeSH terms

  • Body Temperature
  • Body Temperature Regulation* / physiology
  • Fatigue
  • Heart Rate / physiology
  • Hot Temperature*
  • Humans
  • Male
  • Personal Protective Equipment
  • Protective Clothing
  • Skin Temperature