{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T04:27:46Z","timestamp":1794284866852,"version":"4.9.0"},"reference-count":38,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2021,12,3]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Exertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from heart rate and gait instability from a trunk-worn sensor system can forward predict EHS onset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Heart rate and three-axis accelerometry data were collected from chest-worn sensors from 1806 US military personnel participating in timed 4\/5-mile runs, and loaded marches of 7 and 12 miles; in total, 3422 high EHS-risk training datasets were available for analysis. Six soldiers were diagnosed with heat stroke and all had rectal temperatures of &gt;41\u00b0C when first measured and were exhibiting CNS dysfunction. Estimated core temperature (ECTemp) was computed from sequential measures of heart rate. Gait instability was computed from three-axis accelerometry using features of pattern dispersion and autocorrelation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The six soldiers who experienced heat stroke were among the hottest compared with the other soldiers in the respective training events with ECTemps ranging from 39.2\u00b0C to 40.8\u00b0C. Combining ECTemp and gait instability measures successfully identified all six EHS casualties at least 3.5 min in advance of collapse while falsely identifying 6.1% (209 total false positives) examples where exertional heat illness symptoms were neither observed nor reported. No false-negative cases were noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of two algorithms that estimate Tcr and ataxic gate appears promising for real-time alerting of impending EHS.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2021-104081","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T18:20:18Z","timestamp":1642011618000},"page":"446-451","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Gait instability and estimated core temperature predict exertional heat stroke"],"prefix":"10.1136","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-4549","authenticated-orcid":false,"given":"Mark","family":"Buller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Fellin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Bursey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Galer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Atkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A","family":"Beidleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Marcello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyla","family":"Driver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Mesite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Seay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Weed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Telfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Royce","family":"Frazee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"2024051414522090000_56.8.446.1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1002\/cphy.c140017","article-title":"Heat stroke","volume":"5","author":"Leon","year":"2015","journal-title":"Compr Physiol"},{"key":"2024051414522090000_56.8.446.2","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1056\/NEJMra011089","article-title":"Heat stroke","volume":"346","author":"Bouchama","year":"2002","journal-title":"N Engl J Med Overseas Ed"},{"key":"2024051414522090000_56.8.446.3","first-page":"280","article-title":"Heat stroke: a review","volume":"47","author":"Shibolet","year":"1976","journal-title":"Aviat Space Environ Med"},{"key":"2024051414522090000_56.8.446.4","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200408000-00003"},{"key":"2024051414522090000_56.8.446.5","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1152\/japplphysiol.00452.2019","article-title":"Controversies in exertional heat stroke diagnosis, prevention, and treatment","volume":"127","author":"Laitano","year":"2019","journal-title":"J Appl Physiol"},{"key":"2024051414522090000_56.8.446.6","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1249\/MSS.0000000000000409","article-title":"Effectiveness of cold water immersion in the treatment of exertional heat stroke at the Falmouth road race","volume":"47","author":"DeMartini","year":"2015","journal-title":"Sci Sports Exerc"},{"key":"2024051414522090000_56.8.446.7","doi-asserted-by":"crossref","DOI":"10.3390\/medicina56110589","article-title":"Exertional heat stroke, modality cooling rate, and survival outcomes: a systematic review","volume":"56","author":"Filep","year":"2020","journal-title":"Medicina"},{"key":"2024051414522090000_56.8.446.8","doi-asserted-by":"crossref","unstructured":"Yaglou CP , Minard D . Prevention of heat casualties at marine Corps training centers. technical report. Boston, MA: Harvard school of public health, 1956: 48.","DOI":"10.21236\/AD0099920"},{"key":"2024051414522090000_56.8.446.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1957.02980320043010"},{"key":"2024051414522090000_56.8.446.10","first-page":"4","article-title":"Update: heat illness, active component, U.S. armed forces, 2019","volume":"27","year":"2020","journal-title":"MSMR"},{"key":"2024051414522090000_56.8.446.11","unstructured":"Kucera KL , Klossner D , Colgate B . Annual survey of football injury research. chapel Hill, NC: national center for catastrophic sport injury research, 2019. Available: https:\/\/nccsir.unc.edu\/wp-content\/uploads\/sites\/5614\/2019\/02\/Annual-Football-2018-Fatalities-FINAL.pdf [Accessed 26 Jan 2021]."},{"key":"2024051414522090000_56.8.446.12","first-page":"235","article-title":"Environment and fatal heat stroke; an analysis of 157 cases occurring in the Army in the U.S. during World War II","volume":"100","author":"Schickele","year":"1947","journal-title":"Mil Surg"},{"key":"2024051414522090000_56.8.446.13","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1249\/01.mss.0000227302.80783.0f","article-title":"Exertional heat stroke during a cool weather marathon","volume":"38","author":"Roberts","year":"2006","journal-title":"Sci Sports Exerc"},{"key":"2024051414522090000_56.8.446.14","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-13-00315"},{"key":"2024051414522090000_56.8.446.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)06407-7"},{"key":"2024051414522090000_56.8.446.16","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jtherbio.2014.08.009","article-title":"Seasonal heat acclimatization in wildland firefighters","volume":"45","author":"Lui","year":"2014","journal-title":"J Therm Biol"},{"key":"2024051414522090000_56.8.446.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.09.031"},{"key":"2024051414522090000_56.8.446.18","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1113\/EP088458","article-title":"Individual risk factors associated with exertional heat illness: a systematic review","volume":"106","author":"Westwood","year":"2021","journal-title":"Exp Physiol"},{"key":"2024051414522090000_56.8.446.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0221329","article-title":"Influence of prior illness on exertional heat stroke presentation and outcome","volume":"14","author":"King","year":"2019","journal-title":"PLoS One"},{"key":"2024051414522090000_56.8.446.20","doi-asserted-by":"publisher","DOI":"10.3389\/fspor.2019.00038"},{"key":"2024051414522090000_56.8.446.21","doi-asserted-by":"publisher","DOI":"10.1080\/00140139.2015.1036792"},{"key":"2024051414522090000_56.8.446.22","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/34\/7\/781"},{"key":"2024051414522090000_56.8.446.23","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199608000-00001"},{"key":"2024051414522090000_56.8.446.24","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-50.9.07"},{"key":"2024051414522090000_56.8.446.25","unstructured":"Whiting WC , Zernicke RF . Biomechanics of musculoskeletal injury. 206. Champaign, IL: Human Kinetics, 1998."},{"key":"2024051414522090000_56.8.446.26","doi-asserted-by":"crossref","first-page":"260","DOI":"10.12998\/wjcc.v1.i8.260","article-title":"Heat stroke induced cerebellar dysfunction: A \"forgotten syndrome\"","volume":"1","author":"Kosgallana","year":"2013","journal-title":"World J Clin Cases"},{"key":"2024051414522090000_56.8.446.27","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1123\/jab.2015-0200","article-title":"Validation of a torso-mounted accelerometer for measures of vertical oscillation and ground contact time during treadmill running","volume":"32","author":"Watari","year":"2016","journal-title":"J Appl Biomech"},{"key":"2024051414522090000_56.8.446.28","doi-asserted-by":"crossref","unstructured":"Clements CM , Moody D , Potter AW . Loaded and unloaded foot movement differentiation using chest mounted accelerometer signatures. In: 2013 IEEE International Conference on body sensor networks. IEEE, 2013: 1\u20135.","DOI":"10.1109\/BSN.2013.6575524"},{"key":"2024051414522090000_56.8.446.29","unstructured":"Bode V , Buller MJ , Seay J . Comparison of torso accelerations during walking across multiple loads and environments. In: The proceedings of the 5th International Congress on Soldiers\u2019 Physical Performance. Quebec, Canada, 2020: 21."},{"key":"2024051414522090000_56.8.446.30","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3182805b83"},{"key":"2024051414522090000_56.8.446.31","doi-asserted-by":"crossref","first-page":"203","DOI":"10.4085\/1062-6050-0436.19","article-title":"Movement technique and standing balance after graded exercise-induced dehydration","volume":"56","author":"Adams","year":"2021","journal-title":"J Athl Train"},{"key":"2024051414522090000_56.8.446.32","first-page":"9","article-title":"Relationship between a two mile run time and maximal oxygen uptake","volume":"2","author":"Mello","year":"1988","journal-title":"Journal of Applied Sport Science Research"},{"key":"2024051414522090000_56.8.446.33","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.7205\/MILMED-D-14-00727","article-title":"Impact of arm immersion cooling during ranger training on exertional heat illness and treatment costs","volume":"180","author":"DeGroot","year":"2015","journal-title":"Mil Med"},{"key":"2024051414522090000_56.8.446.34","unstructured":"NIST\/SEMATECH e-Handbook of Statistical Methods, Section 1.3.5.17.3 Generalized ESD Test For Outliers. Available: https:\/\/www.itl.nist.gov\/div898\/handbook\/eda\/section3\/eda35h3.htm [Accessed 11 May 2021]."},{"key":"2024051414522090000_56.8.446.35","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1152\/japplphysiol.00353.2017","article-title":"Wearable physiological monitoring for human thermal-work strain optimization","volume":"124","author":"Buller","year":"2018","journal-title":"J Appl Physiol"},{"key":"2024051414522090000_56.8.446.36","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1992.73.4.1340"},{"key":"2024051414522090000_56.8.446.37","unstructured":"Sawka MN , Young AJ . Physiological systems and their responses to conditions of heat and cold. In: Tipton CM , ed. Advanced exercise physiology. New York: Williams & Wilkins, 2006: 535\u201363."},{"key":"2024051414522090000_56.8.446.38","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1249\/JSR.0000000000000550","article-title":"Integration of wearable sensors into the evaluation of running economy and foot mechanics in elite runners","volume":"17","author":"Muniz-Pardos","year":"2018","journal-title":"Curr Sports Med Rep"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2021-104081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T22:12:12Z","timestamp":1715724732000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2021-104081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,12]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,3,31]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/bjsports-2021-104081"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2021-104081","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,12]]}}}