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International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes
  1. MF Bergeron1,2,
  2. R Bahr3,
  3. P Bärtsch4,
  4. L Bourdon5,
  5. JAL Calbet6,
  6. KH Carlsen7,8,9,
  7. O Castagna5,
  8. J González-Alonso10,
  9. C Lundby11,
  10. RJ Maughan12,
  11. G Millet13,
  12. M Mountjoy14,15,16,
  13. S Racinais17,
  14. P Rasmussen11,18,
  15. AW Subudhi19,20,21,
  16. AJ Young22,
  17. T Soligard23,
  18. L Engebretsen24
  1. 1National Youth Sports Health & Safety Institute, USA
  2. 2Department of Paediatrics, Sanford School of Medicine of The University of South Dakota, Sanford Children's Health Research Center, Sioux Falls, SD, USA
  3. 3Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  4. 4Department of Internal Medicine, Division VII: Sports Medicine, University Hospital, 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 Palmas de Gran Canaria, Spain
  7. 7Faculty of Medicine, University of Oslo, Oslo, Norway
  8. 8Norwegian School of Sport Sciences, Oslo, Norway
  9. 9Department of Paediatrics, Rikshospitalet, Oslo University Hospital, Oslo, Norway
  10. 10Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, United Kingdom
  11. 11ZIHP and Institute of Physiology, University of Zurich, Zurich, Switzerland
  12. 12School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
  13. 13ISSUL Institute of Sport Sciences, Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
  14. 14Medical Commission, Fédération Internationale de Natation, Lausanne, Switzerland
  15. 15Medical Commission, International Olympic Committee, Lausanne, Switzerland
  16. 16McMaster University, Hamilton, Canada
  17. 17ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Research and Education Centre, Doha, Qatar
  18. 18Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
  19. 19Medical Committee, Fédération Internationale de Football Association, Zurich, Switzerland
  20. 20Medical Commission, Badminton World Federation, Kuala Lumpur, Malaysia
  21. 21Medical Committee, Asian Football Confederation, Bukit Jalil, Kuala Lumpur, Malaysia
  22. 22Department of Biology and Altitude Research Center, University of Colorado, Colorado Springs and Anschutz Medical Campuses, USA
  23. 23Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
  24. 24Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland
  1. Correspondence to Professor Lars Engebretsen, University of Oslo/IOC Medical& Scientific Department, Orthopaedic Surgery, Kirkeveien 111, Oslo 0407, Norway; lars.engebretsen{at}


Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the International Olympic Committee (IOC) Medical Commission convened a panel of experts to review the scientific evidence base, reach consensus, and underscore practical safety guidelines and new research priorities regarding the unique environmental challenges Olympic and other international-level athletes face. For non-aquatic events, external thermal load is dependent on ambient temperature, humidity, wind speed and solar radiation, while clothing and protective gear can measurably increase thermal strain and prompt premature fatigue. In swimmers, body heat loss is the direct result of convection at a rate that is proportional to the effective water velocity around the swimmer and the temperature difference between the skin and the water. Other cold exposure and conditions, such as during Alpine skiing, biathlon and other sliding sports, facilitate body heat transfer to the environment, potentially leading to hypothermia and/or frostbite; although metabolic heat production during these activities usually increases well above the rate of body heat loss, and protective clothing and limited exposure time in certain events reduces these clinical risks as well. Most athletic events are held at altitudes that pose little to no health risks; and training exposures are typically brief and well-tolerated. While these and other environment-related threats to performance and safety can be lessened or averted by implementing a variety of individual and event preventative measures, more research and evidence-based guidelines and recommendations are needed. In the mean time, the IOC Medical Commission and International Sport Federations have implemented new guidelines and taken additional steps to mitigate risk even further.

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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