Reliability of Biomarkers of Physiological Stress at Rest and
                    Post-exertional Heat Stress

Daniel Snape; Barney Wainwright; David R Woods; John Paul O’Hara

doi:10.1055/a-1890-0993

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2023; 44(03): 184-191
DOI: 10.1055/a-1890-0993

Physiology & Biochemistry

Reliability of Biomarkers of Physiological Stress at Rest and Post-exertional Heat Stress

Daniel Snape

¹Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland

,

Barney Wainwright

¹Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland

,

David R Woods

¹Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland

²Academic Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom of Great Britain and Northern Ireland

,

John Paul O’Hara

¹Research Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland

› Author Affiliations

Abstract

The purpose of this study was to assess the reliability of blood biomarkers that can signify exercise-induced heat stress in hot conditions. Fourteen males completed two heat stress tests separated by 5–7 days. Venous blood was drawn pre- and post- heat stress for the concentration of normetanephrine, metanephrine, serum osmolality, copeptin, kidney-injury molecule 1, and neutrophil gelatinase-associated lipocalin. No biomarker, except copeptin, displayed systematic trial order bias (p≥0.05). Normetanephrine, copeptin and neutrophil gelatinase-associated lipocalin presented acceptable reliability (CV range: 0.9–14.3%), while greater variability was present in metanephrine, osmolality and kidney-injury molecule 1 (CV range: 28.6–43.2%). Normetanephrine exhibited the largest increase (p<0.001) in response to heat stress (trial 1=1048±461 pmol. L^-1; trial 2=1067±408 pmol. L^-1), whilst kidney-injury molecule 1 presented trivial changes (trial 1=–4±20 ng. L^-1; trial 2=2 ± 16 ng. L^-1, p>0.05). Normetanephrine, copeptin, and neutrophil gelatinase-associated lipocalin demonstrated good reliability and sensitivity to an acute bout of heat stress. These biomarkers may be suitable for application in laboratory and field research to understand the efficacy of interventions that can attenuate the risk of thermal injury whilst exercising in the heat.

Key words

reliability - heat-stress - endurance - sympathoadrenal - fluid-regulation - kidney-function

Full Text

References

References
1 González-Alonso J. Human thermoregulation and the cardiovascular system. Exp Physiol 2012; 97: 340-346
2 Racinais S, Alonso J-M, Coutts AJ. et al. Consensus recommendations on training and competing in the heat. Scand J Med Sci Sports 2015; 25: 6-19
3 Karlsen A, Nybo L, Nørgaard S. et al. Time course of natural heat acclimatization in well-trained cyclists during a 2-week training camp in the heat. Scand J Med Sci Sports 2015; 25: 240-249
4 Stacey MMJ, Delves S, Woods D. et al. Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status. Eur J Appl Physiol 2018; 118: 165-174
5 Stacey MJ, Woods DR, Brett SJ. et al. Heat acclimatization blunts copeptin responses to hypertonicity from dehydrating exercise in humans. Physiol Rep 2018; 6: e13851
6 Schlader ZJ, Chapman CL, Sarker S. et al. Firefighter work duration influences the extent of acute kidney injury. Med Sci Sports Exerc 2017; 49: 1745-1753
7 Bongers CC, Alsady M, Nijenhuis T. et al. Impact of acute versus prolonged exercise and dehydration on kidney function and injury. Physiol Rep 2018; 6: e13734
8 Rowell LB, O’Leary DS. Reflex control of the circulation during exercise: chemoreflexes and mechanoreflexes. J Appl Physiol (1985) 1990; 69: 407-418
9 Armstrong RG, Ahmad S, Seely AJ. et al. Heart rate variability and baroreceptor sensitivity following exercise-induced hyperthermia in endurance trained men. Eur J Appl Physiol 2012; 112: 501-511
10 Brenner IK, Thomas S, Shephard RJ. Autonomic regulation of the circulation during exercise and heat exposure. Sports Med 1998; 26: 85-99
11 Parekh A, Lee CM. Heart rate variability after isocaloric exercise bouts of different intensities. Med Sci Sports Exerc 2005; 37: 599-605
12 Bracken RM, Linnane DM, Brooks S. Plasma catecholamine and nephrine responses to brief intermittent maximal intensity exercise. Amino Acids 2009; 36: 209-217
13 Peaston RT, Weinkove C. Measurement of catecholamines and their metabolites. Ann Clin Biochem 2004; 41: 17-38
14 Raber W, Raffesberg W, Kmen E. et al. Pheochromocytoma with normal urinary and plasma catecholamines but elevated plasma free metanephrines in a patient with adrenal incidentaloma. Endocrinologist 2000; 10: 65-68
15 Epstein Y, Horowitz M, Shapiro Y. Hypothalamic and extrahypothalamic-limbic system vasopressin concentration under exposure to hyperosmolarity, hypovolemia and heat stress. J Therm Biol 1990; 15: 177-181
16 Christ-Crain M, Fenske W. Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis. Nat Rev Endocrinol 2016; 12: 168-176
17 Mellor A, Boos C, Ball S. et al. Copeptin and arginine vasopressin at high altitude: relationship to plasma osmolality and perceived exertion. J Appl Physiol (1985) 2015; 115: 91-98
18 Christ-Crain M. The stress hormone copeptin: a new prognostic biomarker in acute illness. Swiss Med Wkly 2010; 140: w13101
19 Patterson MJ, Stocks JM, Taylor NA. Whole-body fluid distribution in humans during dehydration and recovery, before and after humid-heat acclimation induced using controlled hyperthermia. Acta Physiol (Oxf) 2014; 210: 899-912
20 Maughan RJ, Shirreffs SM. Development of individual hydration strategies for athletes. Int J Sport Nutr Exerc Metab 2008; 18: 457-472
21 Adolph EF. Water metabolism. Annu Rev Physiol 1947; 9: 381-408
22 McAllister RM. Adaptations in control of blood flow with training: splanchnic and renal blood flows. Med Sci Sports Exerc 1998; 30: 375-381
23 Otani H, Kaya M, Tsujita J. Effect of the volume of fluid ingested on urine concentrating ability during prolonged heavy exercise in a hot environment. J Sports Sci Med 2013; 12: 197-204
24 Hoffman MD, Weiss RH. Does acute kidney injury from an ultramarathon increase the risk for greater subsequent injury?. Clin J Sport Med 2016; 26: 417-422
25 Hodgson L, Walter E, Venn R. et al. Acute kidney injury associated with endurance events – is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med 2017; 3: e000093
26 McDermott BP, Smith CR, Butts CL. et al. Renal stress and kidney injury biomarkers in response to endurance cycling in the heat with and without ibuprofen. J Sci Med Sport 2018; 21: 1180-1184
27 Ravanelli N, Barry H, Schlader ZJ. et al. Impact of passive heat acclimation on markers of kidney function during heat stress. Exp Physiol 2021; 106: 269-281
28 Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005; 4: 287-291
29 Costa R, Snipe R, Kitic C. et al. Systematic review: exercise-induced gastrointestinal syndrome – implications for health and intestinal disease. Aliment Pharmacol Ther 2017; 46: 246-265
30 Sawka MN, Burke LM, Eichner ER. et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 2007; 39: 377-390
31 Drust B, Waterhouse J, Atkinson G. et al. Circadian rhythms in sports performance – an update. Chronobiol Int 2005; 22: 21-44
32 Waterhouse J, Drust B, Weinert D. et al. The circadian rhythm of core temperature: origin and some implications for exercise performance. Chronobiol Int 2005; 22: 207-225
33 DuBois D. Clinical calorimetry. X. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863-871
34 Bell PG, Furber MJ, Van Someren KA. et al. The physiological profile of a multiple Tour de France winning cyclist. Med Sci Sports Exerc 2017; 49: 115-123
35 Winter EM, Jones AM, Davison RR. et al. Sport and Exercise Physiology Testing Guidelines: Volume I – Sport Testing: The British Association of Sport and Exercise Sciences Guide. Abingdon: Routledge; 2007
36 Byrne C, Lim CL. The ingestible telemetric body core temperature sensor: a review of validity and exercise applications. Br J Sports Med 2007; 41: 126-133
37 Hunt AP, Bach AJ, Borg DN. et al. The systematic bias of ingestible core temperature sensors requires a correction by linear regression. Front Physiol 2017; 8: 260
38 Ramanathan N. A new weighting system for mean surface temperature of the human body. J Appl Physiol 1964; 19: 531-533
39 Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-381
40 Toner MM, Drolet LL, Pandolf KB. Perceptual and physiological responses during exercise in cool and cold water. Percept Mot Skills 1986; 62: 211-220
41 Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998; 26: 217-238
42 Vincent W, Weir J. Quantifying reliability. Statistics in Kinesiology. Champaign, IL: Human Kinetics; 1995: 214-228
43 Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol 2013; 4: 863
44 Hopkins WG, Marshall SW, Batterham AM. et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-13
45 Woods DR, O’Hara JP, Boos CJ. et al. Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude. Eur J Appl Physiol 2017; 117: 893-900
46 Aylward PE, Floras JS, Leimbach W. et al. Effects of vasopressin on the circulation and its baroreflex control in healthy men. Circulation 1986; 73: 1145-1154
47 Judelson DA, Maresh CM, Yamamoto LM. et al. Effect of hydration state on resistance exercise-induced endocrine markers of anabolism, catabolism, and metabolism. J Appl Physiol (1985) 2008; 105: 816-824
48 Tremblay MS, Copeland JL, Van Helder W. Effect of training status and exercise mode on endogenous steroid hormones in men. J Appl Physiol (1985) 2004; 96: 531-539
49 West DW, Phillips SM. Associations of exercise-induced hormone profiles and gains in strength and hypertrophy in a large cohort after weight training. Eur J Appl Physiol 2012; 112: 2693-2702
50 Koyner JL, Parikh CR. Clinical utility of biomarkers of AKI in cardiac surgery and critical illness. Clin J Am Soc Nephrol 2013; 8: 1034-1042
51 Schlader ZJ, Hostler D, Parker MD. et al. The potential for renal injury elicited by physical work in the heat. Nutrients 2019; 11: 2087
52 Mansour SG, Verma G, Pata RW. et al. Kidney injury and repair biomarkers in marathon runners. Am J Kidney Dis 2017; 70: 252-261
53 Fitzpatrick D, Walter E, Leckie T. et al. Association between collapse and serum creatinine and electrolyte concentrations in marathon runners: a 9-year retrospective study. Eur J Emerg Med 2021; 28: 34-42
54 Junglee NA, Di Felice U, Dolci A. et al. Exercising in a hot environment with muscle damage: effects on acute kidney injury biomarkers and kidney function. Am J Physiol Renal Physiol 2013; 305: 813-820