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International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes
  1. Michael F Bergeron1,2,
  2. Roald Bahr3,
  3. Peter Bartsch4,
  4. L Bourdon5,
  5. Jose Antonio Lopez Calbet6,
  6. Kai Håkon Carlsen7,8,
  7. O Castagna5,
  8. Juan Manuel Alonso9,
  9. Carsten Lundby10,
  10. Ron Maughan11,
  11. Gregoire P Millet12,
  12. Margo Mountjoy13,14,
  13. Sebastien Racinais15,
  14. Peter Rasmussen10,16,
  15. Dato Guruchan Singh17,18,
  16. Andrew W Subudhi19,
  17. Andrew John Young20,
  18. Torbjørn Soligard21,
  19. Lars Engebretsen22
  1. 1National Institute for Athletic Health & Performance, Sanford USD Medical Center, Sioux Falls, South Dakota, USA
  2. 2National Youth Sports Health & Safety Institute, Indianapolis, Indiana, USA
  3. 3Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
  4. 4Internal Medicine, Divison VII: Sports Medicine, Heidelberg, Germany
  5. 5Institut de recherche biomedicale de defense – Ecole du Val-de-Grace (IRBA-EVDG), Paris, France
  6. 6Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palams de Gran Canaria, Spain
  7. 7Department of Paediatrics, Rikshospitalet, Oslo University Hospital, Oslo, Norway
  8. 8Department of Medicine, University of Oslo, Oslo, Norway
  9. 9Medical and Anti-doping Commission, IAAF, Madrid, Spain
  10. 10ZIHP and Institute of Physiology, University of Zurich, Zurich, Switzerland
  11. 11School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
  12. 12ISSUL Institute of Sport Sciences, Department of Physiology, University of Lausanne, Lausanne, Switzerland
  13. 13Health and Performance Centre, University of Guelph, Guelph, Canada
  14. 14Medical Commission, Fédération Internationale de Natation, Lausanne, Lausanne, Switzerland
  15. 15Research Education Centre, ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  16. 16Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
  17. 17Medical Committee, FIFA, Zurich, Switzerland
  18. 18Medical Committee, Asian Football Confederation, Bukit Jalil, Kuala Lumpur, Malaysia
  19. 19Biology and Altitude Research Center, University of Colorado, Aurora, Colorado, USA
  20. 20Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
  21. 21Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland
  22. 22Orthopaedic Surgery, University of Oslo/IOC Medical & Scientific Department, Oslo, Norway
  1. Correspondence to Professor Lars Engebretsen, University of Oslo/IOC Medical & Scientific Department, Orthopaedic Surgery, Kirkeveien 111, Oslo 0407, Norway; lars.engebretsen{at}

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Protecting the health of Olympic athlete is the highest priority of the International Olympic Committee (IOC) Medical Commission.1 Emphasising this commitment, an injury surveillance system was established for all team sports during the 2004 Athens Olympic Games.2 This was followed by including individual sports in the IOC injury surveillance system, beginning with the 2008 Beijing games.3 For the 2010 Vancouver winter games, the surveillance system was expanded to include newly sustained illnesses.4

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of athlete. As athletes must also contend with the unique physical requirements of their respective sport, universal safety guidelines do not always sufficiently address sport-specific injury and other clinical risks. The interaction between the demands of the sport and the environmental conditions – even with seemingly benign environments that represent limited danger to the general population under less intense and/or shorter recreational scenarios – can present a substantial potential hazard to the health of Olympic athlete or other elite athlete who is making an all-out effort for an extended period of time. For example, exertional heatstroke has been reported in a marathon runner recovering from a viral syndrome during a race held in a cool (6.1–9.4°C) but humid (62–99% relative humidity – RH) environment.5 Conversely, during a 21 km event in warm and humid conditions (WBGT 26.0–29.2°C), all runners finished the race without symptoms of exertional heat illness, despite body core temperature being >39°C for all of the 18 screened runners. Moreover, 10 of those asymptomatic screened finishers had a body core temperature >40°C, while two reached 41°C.6 Notably, a number of individual factors (eg, experience, recent health history and status, fitness, acclimatisation, physical and psychological make-up, nutritional and hydration status and sweat loss rate) each …

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