{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:01:44Z","timestamp":1784613704162,"version":"3.55.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100030902","name":"Martin-Luther-Universit\u00e4t Halle-Wittenberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100030902","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Training medical students is a demanding task, and some contents remain difficult to teach and understand. This also applies to topics that require increasing attention. For instance, obesity rates keep rising, while almost each year turns out to be hotter than the last. Consequently, it is inevitable that current healthcare students will one day be confronted with these challenges. But the underlying physiological principles are concepts that prove difficult to understand. To remedy this situation and improve students\u2019 awareness and understanding of impacted patients, we have developed an educational tool to illustrate the concepts of metabolic rate and thermoregulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following a \u2018learning by doing\u2019 approach, we designed practical courses covering these topics and comprising data production, collection and analysis. Students measure their heart rates, metabolism rates (indirect calorimetry) and body temperature, at rest and during moderate-intensity exercise. They then (i) quantify the amounts of energy expended as muscular work or heat, (ii) characterize heat dissipation mechanisms, and (iii) estimate theoretical core temperature rise in the absence of thermoregulatory control. Their data are ultimately integrated into a large cohort dataset (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200989), enabling the study of confounding variables (e.g. sex, body size). This course is evaluated by the students via an anonymized web-based survey.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Exercise-induced changes in heart rate showed that the test subjects were primarily healthy and challenged at a moderate level only. The measurements and subsequent calculations illustrated that this moderate-intensity exercise induced a strong increase in metabolic rate, and that this additional energy is spent as heat rather than muscle work. A dramatic shift in the relative contributions of the heat dissipation pathways during physical activity were also observed. Finally, average increase rates of core temperature of 1.33\u00a0\u00b0C\/h at rest and 4.4\u00a0\u00b0C\/h during moderate-intensity exercise were estimated. Only minor differences between female and male subjects were observed. This course has received very positive evaluations in recent years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We present a readily implementable approach that integrates education and science. It is designed to favor medical students\u2019 comprehension of metabolic balance and thermoregulation while fostering critical evaluation of data quality and analytical rigor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-09954-6","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:54:11Z","timestamp":1784548451000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A practical approach to illustrate the importance of the bodily energy and heat balances and of the associated regulatory loops to healthcare students"],"prefix":"10.1186","volume":"26","author":[{"given":"Anne","family":"Riemann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Nolze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Schwerdt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gekle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-8940","authenticated-orcid":false,"given":"Virginie","family":"Dubourg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"9954_CR1","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","volume":"403","author":"NH Phelps","year":"2024","unstructured":"Phelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403:1027\u201350. https:\/\/doi.org\/10.1016\/S0140-6736(23)02750-2.","journal-title":"Lancet"},{"key":"9954_CR2","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1016\/S0140-6736(22)01540-9","volume":"400","author":"M Romanello","year":"2022","unstructured":"Romanello M, Di Napoli C, Drummond P, Green C, Kennard H, Lampard P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet. 2022;400:1619\u201354. https:\/\/doi.org\/10.1016\/S0140-6736(22)01540-9.","journal-title":"Lancet"},{"key":"9954_CR3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1038\/d41586-025-02461-6","volume":"644","author":"O Jay","year":"2025","unstructured":"Jay O, Vanos J, Gagnon D, Tartarini F. To save lives in heatwaves, focus on how human bodies work. Nature. 2025;644:35\u20138. https:\/\/doi.org\/10.1038\/d41586-025-02461-6.","journal-title":"Nature"},{"key":"9954_CR4","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s00148-024-01039-2","volume":"37","author":"K Huang","year":"2024","unstructured":"Huang K, Hong Q. The impact of global warming on obesity. J Popul Econ. 2024;37:59. https:\/\/doi.org\/10.1007\/s00148-024-01039-2.","journal-title":"J Popul Econ"},{"key":"9954_CR5","doi-asserted-by":"publisher","first-page":"108962","DOI":"10.1016\/j.envres.2019.108962","volume":"182","author":"S Kanazawa","year":"2020","unstructured":"Kanazawa S. Does global warming contribute to the obesity epidemic? Environ Res. 2020;182:108962. https:\/\/doi.org\/10.1016\/j.envres.2019.108962.","journal-title":"Environ Res"},{"key":"9954_CR6","doi-asserted-by":"publisher","first-page":"1198877","DOI":"10.3389\/fpubh.2023.1198877","volume":"11","author":"N Prvulovi\u0107","year":"2023","unstructured":"Prvulovi\u0107 N, Djordjevi\u0107 M, Panteli\u0107 S. Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis. Front Public Health. 2023;11:1198877. https:\/\/doi.org\/10.3389\/fpubh.2023.1198877.","journal-title":"Front Public Health"},{"key":"9954_CR7","doi-asserted-by":"publisher","first-page":"101783","DOI":"10.1016\/j.ando.2025.101783","volume":"86","author":"A Scheen","year":"2025","unstructured":"Scheen A. Obesity and global warming: A two-way relationship? Ann d\u2019Endocrinologie. 2025;86:101783. https:\/\/doi.org\/10.1016\/j.ando.2025.101783.","journal-title":"Ann d\u2019Endocrinologie"},{"key":"9954_CR8","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/S0140-6736(18)32822-8","volume":"393","author":"BA Swinburn","year":"2019","unstructured":"Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet. 2019;393:791\u2013846. https:\/\/doi.org\/10.1016\/S0140-6736(18)32822-8.","journal-title":"Lancet"},{"key":"9954_CR9","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1038\/s41558-025-02398-8","volume":"15","author":"P He","year":"2025","unstructured":"He P, Xu Z, Chan D, Liu P, Bai Y. Rising temperatures increase added sugar intake disproportionately in disadvantaged groups in the USA. Nat Clim Chang. 2025;15:963\u201370. https:\/\/doi.org\/10.1038\/s41558-025-02398-8.","journal-title":"Nat Clim Chang"},{"key":"9954_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/23328940.2017.1281872","volume":"4","author":"L Imeri","year":"2017","unstructured":"Imeri L. Thermoregulation as a non-unified system: A difficult to teach concept. Temperature. 2017;4:1\u20138. https:\/\/doi.org\/10.1080\/23328940.2017.1281872.","journal-title":"Temperature"},{"key":"9954_CR11","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/13639080.2012.718749","volume":"27","author":"J-C Smeby","year":"2014","unstructured":"Smeby J-C, Heggen K. Coherence and the development of professional knowledge and skills. J Educ Work. 2014;27:71\u201391. https:\/\/doi.org\/10.1080\/13639080.2012.718749.","journal-title":"J Educ Work"},{"key":"9954_CR12","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1177\/0956797615569355","volume":"26","author":"C Kontra","year":"2015","unstructured":"Kontra C, Lyons DJ, Fischer SM, Beilock SL. Physical Experience Enhances Science Learning. Psychol Sci. 2015;26:737\u201349. https:\/\/doi.org\/10.1177\/0956797615569355.","journal-title":"Psychol Sci"},{"key":"9954_CR13","unstructured":"Jessen C. Temperature Regulation in Humans and Other Mammals. 1st edition. Springer; 2011."},{"key":"9954_CR14","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/archinte.1916.00080130010002","volume":"17","author":"D Du Bois","year":"1916","unstructured":"Du Bois D, Du Bois EF. A Formula to Estimate the Approximate Surface Area if Height and Weight Be Known. Arch Intern Med. 1916;17:863\u201371. https:\/\/doi.org\/10.1001\/archinte.1916.00080130010002.","journal-title":"Arch Intern Med"},{"key":"9954_CR15","doi-asserted-by":"publisher","unstructured":"Gagge AP. A new physiological variable associated with sensible and insensible perspiration. Am J Physiology-Legacy Content. 120. https:\/\/doi.org\/10.1152\/ajplegacy.1937.120.2.277.","DOI":"10.1152\/ajplegacy.1937.120.2.277"},{"key":"9954_CR16","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1152\/physrev.00047.2021","volume":"102","author":"MN Cramer","year":"2022","unstructured":"Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev. 2022;102:1907\u201389. https:\/\/doi.org\/10.1152\/physrev.00047.2021.","journal-title":"Physiol Rev"},{"key":"9954_CR17","unstructured":"Oczenski W. Atmen - Atemhilfen, Atemphysiologie und Beatmungstechnik. 11th edition. Thieme."},{"key":"9954_CR18","unstructured":"Boron WF, Boupaep EL. Medical physiology. 3rd Edition. Elsevier; 2016."},{"key":"9954_CR19","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1152\/jappl.1972.32.4.456","volume":"32","author":"CB Wenger","year":"1972","unstructured":"Wenger CB. Heat of evaporation of sweat: thermodynamic considerations. J Appl Physiol. 1972;32:456\u20139. https:\/\/doi.org\/10.1152\/jappl.1972.32.4.456.","journal-title":"J Appl Physiol"},{"key":"9954_CR20","doi-asserted-by":"crossref","unstructured":"Cole CR, Lauer MS. Heart-Rate Recovery Immediately after Exercise as a Predictor of Mortality. HEAR T.; 1999.","DOI":"10.1056\/NEJM199910283411804"},{"key":"9954_CR21","doi-asserted-by":"publisher","first-page":"e039792","DOI":"10.1161\/JAHA.124.039792","volume":"14","author":"D Velmeden","year":"2025","unstructured":"Velmeden D, S\u00f6hne J, Schuch A, Zeid S, Schulz A, Troebs S, et al. Role of Heart Rate Recovery in Chronic Heart Failure: Results From the MyoVasc Study. JAHA. 2025;14:e039792. https:\/\/doi.org\/10.1161\/JAHA.124.039792.","journal-title":"JAHA"},{"key":"9954_CR22","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-70178-3","volume-title":"Sex and Gender Factors Affecting Metabolic Homeostasis, Diabetes and Obesity","year":"2017","unstructured":"Mauvais-Jarvis F, editor. Sex and Gender Factors Affecting Metabolic Homeostasis, Diabetes and Obesity. Cham: Springer International Publishing; 2017. https:\/\/doi.org\/10.1007\/978-3-319-70178-3."},{"key":"9954_CR23","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1111\/nyas.14140","volume":"1454","author":"GW Lambert","year":"2019","unstructured":"Lambert GW, Schlaich MP, Eikelis N, Lambert EA. Sympathetic activity in obesity: a brief review of methods and supportive data. Ann N Y Acad Sci. 2019;1454:56\u201367. https:\/\/doi.org\/10.1111\/nyas.14140.","journal-title":"Ann N Y Acad Sci"},{"key":"9954_CR24","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/obr.12266","volume":"16","author":"SM Phelan","year":"2015","unstructured":"Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, Van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16:319\u201326. https:\/\/doi.org\/10.1111\/obr.12266.","journal-title":"Obes Rev"},{"key":"9954_CR25","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1038\/s41392-024-01929-7","volume":"9","author":"Y Shi","year":"2024","unstructured":"Shi Y, Ma J, Li S, Liu C, Liu Y, Chen J, et al. Sex difference in human diseases: mechanistic insights and clinical implications. Sig Transduct Target Ther. 2024;9:238. https:\/\/doi.org\/10.1038\/s41392-024-01929-7.","journal-title":"Sig Transduct Target Ther"},{"key":"9954_CR26","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1089\/154099903321576565","volume":"12","author":"FB Hu","year":"2003","unstructured":"Hu FB. Overweight and Obesity in Women: Health Risks and Consequences. J Women\u2019s Health. 2003;12:163\u201372. https:\/\/doi.org\/10.1089\/154099903321576565.","journal-title":"J Women\u2019s Health"},{"key":"9954_CR27","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1161\/01.CIR.89.3.991","volume":"89","author":"MG Goldschmid","year":"1994","unstructured":"Goldschmid MG, Barrett-Connor E, Edelstein SL, Wingard DL, Cohn BA, Herman WH. Dyslipidemia and ischemic heart disease mortality among men and women with diabetes. Circulation. 1994;89:991\u20137. https:\/\/doi.org\/10.1161\/01.CIR.89.3.991.","journal-title":"Circulation"},{"key":"9954_CR28","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/0895-4356(93)90072-9","volume":"46","author":"RP Donahue","year":"1993","unstructured":"Donahue RP, Goldberg RJ, Chen Z, Gore JM, Alpert JS. The influence of sex and diabetes mellitus on survival following acute myocardial infarction: A community-wide perspective. J Clin Epidemiol. 1993;46:245\u201352. https:\/\/doi.org\/10.1016\/0895-4356(93)90072-9.","journal-title":"J Clin Epidemiol"},{"key":"9954_CR29","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s41235-023-00474-1","volume":"8","author":"C Lakhlifi","year":"2023","unstructured":"Lakhlifi C, Lejeune F-X, Rouault M, Khamassi M, Rohaut B. Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey. Cogn Res. 2023;8:23. https:\/\/doi.org\/10.1186\/s41235-023-00474-1.","journal-title":"Cogn Res"},{"key":"9954_CR30","doi-asserted-by":"publisher","unstructured":"Gigerenzer G, Gaissmaier W, Kurz-Milcke E, Schwartz LM, Woloshin S. Helping Doctors and Patients Make Sense of Health Statistics. Psychol Sci Public Interest. 2007;8(2):53\u201396. https:\/\/doi.org\/10.1111\/j.1539-6053.2008.00033.x.","DOI":"10.1111\/j.1539-6053.2008.00033.x"},{"key":"9954_CR31","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1152\/physrev.00038.2020","volume":"101","author":"JD P\u00e9riard","year":"2021","unstructured":"P\u00e9riard JD, Eijsvogels TMH, Daanen HAM. Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies. Physiol Rev. 2021;101:1873\u2013979. https:\/\/doi.org\/10.1152\/physrev.00038.2020.","journal-title":"Physiol Rev"},{"key":"9954_CR32","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.3390\/educsci14111173","volume":"14","author":"M Gellisch","year":"2024","unstructured":"Gellisch M, Bablok M, Brand-Saberi B, Sch\u00e4fer T. Social Diversity in Focus: Assessing the Impact of Socioeconomic Backgrounds and Work Experience on Psychological Well-Being and Academic Confidence Among German First-Year Medical Students. Educ Sci. 2024;14:1173. https:\/\/doi.org\/10.3390\/educsci14111173.","journal-title":"Educ Sci"},{"key":"9954_CR33","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.3390\/healthcare11121662","volume":"11","author":"OR Groene","year":"2023","unstructured":"Groene OR, Huelmann T, Hampe W, Emami P. German Physicians and Medical Students Do Not Represent the Population They Serve. Healthcare. 2023;11:1662. https:\/\/doi.org\/10.3390\/healthcare11121662.","journal-title":"Healthcare"},{"key":"9954_CR34","doi-asserted-by":"publisher","unstructured":"Autret K, Bekelman T. Socioeconomic Status and Obesity. JES. 2024;8. https:\/\/doi.org\/10.1210\/jendso\/bvae176.","DOI":"10.1210\/jendso\/bvae176"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-026-09954-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-09954-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-09954-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:08:09Z","timestamp":1784610489000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12909-026-09954-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["9954"],"URL":"https:\/\/doi.org\/10.1186\/s12909-026-09954-6","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"27 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Ethics Committee of the Medical Faculty-Martin Luther University Halle-Wittenberg (2025\u2013203) approved the study, which is in accordance to the Declaration of Helsinki. Because the data included here cannot be assigned to a specific person, the project did not require consent to participate and was also not subject to upstream ethics consultation obligation (according to \u00a7\u00a015 I 1 of the professional code of the Medical Association of Saxony-Anhalt).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1186"}}