Table 1

Examples of medical condition specific to Paralympic athletes in relation to thermoregulation

DiagnosisThermoregulation considerations for in-competition performancePara sportReporting of heat-related illness/ symptoms
Spinal cord-related disorders
  • Impairments in skin blood flow and sweat responses below the lesion level,24 25 reduced venous return,26 and higher body fat will all contribute to increased heat storage for a given workload.27

  • Tc typically increases continuously throughout competition, as well as passive heating28 (without cooling aids), highlighting the level of thermoregulatory disruption.

Wheelchair Rugby
Para Athletics
Para Archery
Paratriathlon
Heat-related disorientation29
Convulsion5
Heat-related fatigue22
Heat-related illness30
Non-spinal cord-related neurological disorders
  • Greater metabolic heat production of locomotion, for a given workload, when compared with Olympic athletes.31

  • High muscular tone impairs venous return, increasing the cardiovascular strain and relative intensity of exercise.32

  • Impaired pace awareness may increase their risk of thermoregulatory strain.33

  • Increases in body and/or environmental temperature (without cooling) can exacerbate neurological symptoms, including fatigue, in those with multiple sclerosis,34 where the sudomotor response to heating is already impaired.35

Para Athletics
Paratriathlon
Heat exhaustion5
Heat-related illness5
Heat-related illness30
Limb deficiency
  • Display limited body surface area for evaporative and convective heat loss, increasing heat storage.36

  • Closer coupling of Tc and Tsk which is further exacerbated by socket liners and prostheses limiting heat dissipation.37

  • Skin grafts remove a portion of the skin capable of sweating and cutaneous vasodilation, augmenting the impairment in thermoregulatory capacity.38

  • Significant gait asymmetries, elevating metabolic heat production for a given workload.39

Para Athletics
Paratriathlon
Cramps and collapse5
Heat exhaustion5
Heat-related illness5
Heat-related illness30
Visual impairment
  • Impaired pace awareness (depending on level of visual feedback) may increase their risk of thermoregulatory strain.40

  • Difficulties in self-monitoring hydration through urine colour or volume may cause issues during competition.41

  • Athletes with albinism are prone to sunburn in situations of high radiant load. This exacerbates thermal sensation and limits thermoregulation during exercise through a locally mediated effect on sweat gland responsiveness and capacity.42

Para Athletics
Paratriathlon
Dermatological burn5
Heat exhaustion5
Heat-related illness5
Heat-related illness30
  • Grobler et al 5 competitive athletics taking place in wet-globe temperatures 24.6–36.0°C; Griggs et al 29 wheelchair rugby match play at 18.4–20.9°C and 31.1%–45.1% relative humidity; Handrakis et al 22 competitive archery outdoors for 10 hours (conditions not reported); Stephenson et al 30 competitive paratriathlon in 33°C relative humidity 35%–41%. The reader is guided to Westaway et al 43 for lists of medications that can interfere with thermoregulation, dehydration and heat-related illness.

  • Adapted from Stephenson and Goosey-Tolfrey44 and evidence of heat-related illness reported in Paralympic sports.3 16–18

  • Tc, body core temperature; Tsk, skin temperature.