When should a heat-tolerance test be scheduled after clinical recovery from an exertional heat illness?

Haggai Schermann, Shir Hazut-Krauthammer, Yael Weksler*, Sagi Spitzer, Yoram Epstein, Gary Kalmanovich, Ran Yanovich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Researchers have produced a hypothesis of transient heat intolerance (HI) after exertional heat stroke (EHS). Based on this hypothesis, heat-tolerance testing (HTT) has been postponed until weeks 6 to 8 after EHS and other types of exertional heat illness (EHI). We compared the HTT results of participants after either EHS or other EHI who were tested earlier (≤6-week group) versus those who were tested later (>6-week group) to verify the hypothesis. Design: Cohort study. Setting: Data obtained from records of military athletes who experienced EHS or EHI. Patients or Other Participants: All participants who underwent HTT after EHI or EHS experienced between 2014 and 2018 and for whom complete data regarding the severity of the event (rectal temperature, neurologic symptoms, and laboratory results) and HTT results were available were included. Participants with suspected EHS and those with other EHIs were evaluated separately. Main Outcome Measure(s): The percentages of participants with HI and mean probability of heat tolerance were compared between those tested within 6 weeks of the event and those tested later. Results: A total of 186 participants were included in this study (EHS: 12 in the <6-week group, 9 in the >6-week group; EHI: 94 in the <6-week group, 71 in the >6-week group). In the EHS group, the percentages with HI (33% versus 44%, P = .67) and mean probability of heat tolerance (0.82 versus 0.82, P = .98) did not differ. In the EHI group, participants who were tested after 6 weeks had a greater chance of being diagnosed with HI (38% versus 21.3%, P < .02) Conclusions: The HTT results were similar between participants with EHS who were tested early (<6 weeks) and those tested late (>6 weeks). Further investigation of heat-tolerance changes in larger cohorts of patients after EHS is required to verify the theory of transient HI.

Original languageEnglish
Pages (from-to)289-294
Number of pages6
JournalJournal of Athletic Training
Issue number3
StatePublished - Mar 2020


  • Exertional heat stroke
  • Heat intolerance
  • Probability of heat tolerance
  • Return to duty


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