A Review of Elite Athlete Evidence-Based Knowledge and Preparation for Competing in the Heat

Abstract Elite athletes will compete in extreme heat more frequently as global land and sea temperatures increase, alongside more intense, frequent and longer duration heatwaves. Best practices to protect athlete health and performance during competition include heat acclimation/acclimatisation [(HA); i.e., long-term pre-competition preparation] complemented by pre-planned and practised cooling and hydration strategies (i.e., short-term interventions immediately before or during competition). This review explores elite athletes’ current behaviours and practices when preparing for competition in the heat and assesses the level of knowledge that has been exhibited by athletes and their practitioners in this space. Recommendations for future research, discussions of current best practices, and methods to improve translation of research into practice are provided. Available research focuses on small samples of elite endurance athletes during a selection of World Championship/Olympic/Paralympic events (~6% of competing athletes). While generally an increase in the adoption of evidence-based HA is seen chronologically from 2015 onwards, universal adoption is not seen. HA adoption is lowest in those who live/train in cold/temperate environments with cost and access to facilities/equipment being the most commonly reported barriers. Further research is required across the sporting landscape to fully characterise elite athlete behaviours and practices in these spaces. International federations and national governing bodies should continue their efforts to educate athletes and focus on regularly updated and reinvigorated release of evidence-based guidelines (in multiple germane languages) for competing in the heat, to increase the adoption of HA and other heat related best practice.