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Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport
  1. Borja Muniz-Pardos1,
  2. Konstantinos Angeloudis2,
  3. Fergus M Guppy2,3,
  4. Kumpei Tanisawa4,
  5. Yuri Hosokawa4,
  6. Garrett I Ash5,6,
  7. Wolfgang Schobersberger7,
  8. Andrew J Grundstein8,
  9. Fumihiro Yamasawa9,
  10. Sebastien Racinais10,
  11. Douglas J Casa11,
  12. Yannis P Pitsiladis2,12,13,14
  1. 1 GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
  2. 2 Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK
  3. 3 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
  4. 4 Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
  5. 5 Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, USA
  6. 6 Pain Research, Informatics, Multi-morbidities, and Education (PRIME), VA Connecticut Healthcare System, West haven, CT, USA
  7. 7 Institute for Sports Medicine, Alpine Medicine and Health Tourism, Tirol Kliniken Innsbruck and UMIT Tirol, Hall, Austria
  8. 8 Department of Geography, University of Georgia, Athens, Georgia, USA
  9. 9 Marubeni Health Promotion Center, Tokyo, Japan
  10. 10 Athlete Health and Performance Research Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  11. 11 Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
  12. 12 Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy
  13. 13 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
  14. 14 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
  1. Correspondence to Dr Yannis P Pitsiladis; Y.Pitsiladis{at}


The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees’ health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology’s availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.

  • sport
  • athlete
  • heat acclimatisation

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  • Contributors All authors have provided sufficient work to justify authorship and in line with the instructions to authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GIA is supported by a fellowship from the Office of Academic Affiliations at the US Veterans Health Administration.

  • Provenance and peer review Not commissioned; externally peer reviewed.