While an upper limit of 26°C has been shown to be protective for heat-vulnerable older occupants (DOI: 10.1289/EHP11651), this recommendation did not consider the added heat burden associated with increases in internal heat production accompanying activities of daily living or the restriction to heat loss caused by clothing insulation. To safeguard the health of older adults, health agencies worldwide recommend the remain in cool space indoors, avoid strenuous activity, wear lightweight clothing, and drink cool water regularly throughout the day. However, older adults do not sense heat as well as their younger counterparts. Consequently, they may not take appropriate countermeasures to mitigate physiological strain from indoor overheating. This may include overdressing despite high indoor temperatures. In other cases, individuals may wear insulated clothing in hot weather to observe cultural or religious modesty requirements, which serve as expressions of faith and identity rather than a tool for thermoregulation. Further, individuals may be unaware of the consequences of increases in physical activity on heat gain and may therefore not adjust their normal day-to-day activity levels to prevent potentially dangerous rises in body temperature. Consequently, this may necessitate a lowering of recommended upper indoor temperature limit during hot weather. To address these important considerations, on separate occasions the investigators will assess the change in body temperature and cardiovascular strain in older adults (65-85 years) exposed for 8 hours to the recommended indoor temperature upper limit of 26°C and 45% relative humidity equivalent humidex of 29 (considered comfortable) while they A) perform seated rest dressed in light clothing (t-shirt, shorts and socks), B) perform light exercise (stepping exercise to simulate activities of daily living, 4-4.5 METS) every hour (except during lunch hour period) dressed in light clothing, C) perform light exercise (4-4.5 METS) every hour (except during lunch hour period) dressed in light clothing (t-shirt, shorts and socks) and an added clothing layer (sweatshirt and sweatpants) and D) perform seated rest dressed in light clothing (t-shirt, shorts and socks) and an added clothing layer (sweatshirt and sweatpants). With this experimental design, investigators will assess the effects of added clothing insulation and light activity, representative in activities of daily living on physiological strain and identify whether refinements in the recommended 26°C indoor temperature limit may be required.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
SINGLE
Enrollment
10
Older adults exposed to an 8-hour simulated exposure.
University of Ottawa
Ottawa, Ontario, Canada
RECRUITINGCore temperature (Peak) during daylong exposure to indoor temperature limit.
Peak rectal temperature (15 min average) during exposure. Rectal temperature is measured continuously throughout the 8 hour exposure to the simulated indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Core temperature (AUC) during daylong exposure to indoor temperature limit.
Areas under the curve (AUC) of rectal temperature during the 8 hour exposure to the simulate indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Core temperature end of daylong exposure to indoor temperature limit.
Rectal temperature measured at hour 8 of exposure to indoor temperature limit (15-min average).
Time frame: End of 8 hour daylong exposure
Mean skin temperature (Peak) during daylong exposure to indoor temperature limit.
Peak mean skin temperature (15 min average) during exposure. Mean skin temperature as calculated from skin temperature measured across 7 body regions is measured continuously throughout the 8 hour exposure to the simulated indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Mean skin temperature (AUC) during daylong exposure to indoor temperature limit.
Areas under the curve (AUC) of mean skin temperature as calculated over 7 body regions during the 8 hour exposure to the simulate indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Mean skin temperature end of daylong exposure to indoor temperature limit.
Mean skin temperature measured over 7 body regions at hour 8 of exposure to indoor temperature limit (15-min average).
Time frame: End of 8 hour daylong exposure
Heat rate (Peak) during daylong exposure to indoor temperature limit.
Peak heart rate (15 min average) during exposure. Heart rate is measured continuously throughout the 8 hour exposure to the simulated indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Heart rate (AUC) during daylong exposure to indoor temperature limit.
Areas under the curve (AUC) of heart rate during the 8 hour exposure to the simulate indoor temperature upper limit.
Time frame: End of 8 hour daylong exposure
Heart rate end of daylong exposure to indoor temperature limit.
Heart rate measured at hour 8 of exposure to indoor temperature limit (15-min average).
Time frame: End of 8 hour daylong exposure
Heart rate variability: RMSSD during daylong exposure to indoor temperature limit.
Root mean squared standard deviation of normal-to-normal R-wave to R-wave intervals (RMSSD) measured during 5 minutes of paced breathing (15 breaths/min) with participants in the supine position. RMSSD will be evaluated twice, during two paced breathing periods (separated by 4 min of supine rest).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Heart rate variability: SDNN during daylong exposure to indoor temperature limit.
Standard deviation of normal-to-normal R-wave to R-wave intervals (SDNN) measured during 5 minutes of paced breathing (15 breaths/min) with participants in the supine position. SDNN will be evaluated twice, during two paced breathing periods (separated by 4 min of supine rest).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Cardiac response to standing from supine (30:15 ratio) during daylong exposure to indoor temperature limit.
Cardiac response to standing evaluated as the ratio between the highest R-wave to R-wave interval (lowest heart rate) measured at the 30th heart beat after standing from supine (+/- 5 beats) and the lowest R-wave to R-wave interval (highest heart rate) measured at the 15th heart beat after standing (+/- 5 beats). Cardiac response to standing will be evaluated twice, during two lying-to-standing tests (separated by 10 min of supine rest).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Systolic response to standing from supine during daylong exposure to indoor temperature limit.
Systolic blood pressure response to standing evaluated as the difference in blood pressure measured between the standing and supine. Standing systolic blood pressure will be taken as the lowest value of those measured after 60 and 120 seconds of standing. Systolic response to standing will be evaluated twice, during two lying-to-standing tests (separated by 10 min of supine rest).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Systolic blood pressure during daylong exposure to indoor temperature limit.
Systolic blood pressure measured in triplicate via automated oscillometry (\~60 seconds between measures).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Diastolic blood pressure during daylong exposure to indoor temperature limit.
Diastolic blood pressure measured in triplicate via automated oscillometry (\~60 seconds between measures).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Rate pressure product during daylong exposure to indoor temperature limit.
Rate pressure product, an index of myocardial work and strain, calculated as systolic blood pressure x heart rate.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Reaction time during daylong exposure to indoor temperature limit (cognitive function).
Participants will be provided with a tablet device with the Sway Medical testing platform for the assessment of reaction time. Participants will be asked to initiate a movement of the device in response to a visual cue.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Impulse control during daylong exposure to indoor temperature limit (cognitive function).
Participants will be provided with a tablet device with the Sway Medical testing platform for the assessment of impulse control. Participants will be asked to respond to both "go" and "no-go" visual cues. In response to the "go" cue, participants will initiate a movement of the device.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
CDC 4-Stage Balance Test during daylong exposure to indoor temperature limit (postural stability).
To assess postural stability, participants hold a tablet to their chest, then auditory cues guide participants through four consecutive stances, feet side by side, instep of one foot touching the big toe of the other foot, tandem stand with one foot in front of the other, heel touching toe, and stand on one foot. The balance assessment will be evaluated based on movement detected by an accelerometer integrated into the hardware of the tablet device (Sway Medical Inc).
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
BTrackS Balance Assessment during daylong exposure to indoor temperature limit (postural stability).
To assess postural stability, participants will be asked to stand on a BTracks force plate with their feet spread out to shoulder width while looking straight ahead. The assessment will comprise of one trial lasting 120 seconds in length. Center of pressure (COP) vector data along vertical (y) and horizontal (x) axes will be summed for the total path excursion length (cm) during each trial.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Fluid consumption during daylong exposure to indoor temperature limit.
Average hourly fluid consumption calculated by weighing participant water intake at the start and end of each hour of exposure (normalized to the exposure duration).
Time frame: At end of 8 hour daylong exposure
Fluid loss during daylong exposure to indoor temperature limit.
Fluid loss calculated as the change in body mass during each exposure presented as a percentage of baseline body mass (corrected for food consumption).
Time frame: At end of 8 hour daylong exposure
Change in plasma volume during daylong exposure to indoor temperature limit.
Change in plasma volume from baseline values calculated from duplicate measurements of hemoglobin and hematocrit at the start and end of each exposure using the technique by Dill and Costill.
Time frame: At end of 8 hour daylong exposure.
Thermal comfort scale during daylong exposure to indoor temperature limit.
Thermal comfort assessed via a visual analog scale ("How comfortable does your body temperature feel?") ranging from "very uncomfortable" to "comfortable".
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Thirst sensation scale during daylong exposure to indoor temperature limit.
Thirst sensation assessed via a visual analog scale ranging from "very, very thirsty" to "not thirsty at all".
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Arousal scale during daylong exposure to indoor temperature limit.
Felt arousal scale assessed via a visual analog scale ("How worked up are you?") ranging from "high arousal" to "low arousal".
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Thermal sensation scale during daylong exposure to indoor temperature limit.
Thermal sensation assessed via a visual analog scale ("How hot do you feel?") ranging from "extremely hot" to "neutral"(midpoint: hot)
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Thermal sensation 2 scale during daylong exposure to indoor temperature limit.
Thermal sensation assessed via a visual analog scale ("How do you feel?") ranging from "hot" to "cold"(midpoint: neutral)
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Orthostatic intolerance symptoms assessment during daylong exposure to indoor temperature limit.
Cumulative sum of scores on 6 questions asking participant to rank symptoms associated with orthostatic intolerance during the lying to standing tests. All symptoms scored on a scale from 0 (none) to 10 (worst possible) and include feelings of: (1) "dizziness, lightheadedness, feeling faint, or feeling like you might black out"; (2) "Problems with vision (blurring, seeing spots, tunnel vision, etc.)"; (3) "Weakness"; (4) "Fatigue"; (5) "Trouble concentrating"; and (6) "Head and neck discomfort".
Time frame: At end of 8 hour daylong exposure.
Feel good scale during daylong exposure to indoor temperature limit.
Feel good assessed via a visual analog scale ("How good do you feel?") ranging from "very good" to "very bad"(midpoint: neutral)
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Perceived exertion scale during daylong exposure to indoor temperature limit.
Perceived exertional assessed via a visual analog scale ("How hard are you working?") ranging from "no exertional at all" to "maximal exertion"
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Hydration status during daylong exposure to indoor overheating
Hydration status measured via assessing the urine specific gravity of a urine sample.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Activity levels during daylong exposure to indoor overheating
Activity levels assessed via a wearable monitor (Actical) containing an accelerometer worn on the wrist and hip.
Time frame: End of 8 hour daylong exposure
Profiles of Mood States (POMS) during daylong exposure to indoor temperature limit.
Potential changes in mood (7 subscales of mood: tension, anger, depression, fatigue, confusion, vigor and esteem related affect). The POMS-40 is a validated, self-administered questionnaire that examines seven distinct aspects of mood state across two positive subscales (Esteem-Related Affect, and Vigor) and five negative subscales (Fatigue, Tension, Confusion, Anger, and Depression), which are described across 40 distinct adjectives. For each individual item, participants were asked to describe "how you feel right now" by responding using a 5-point Likert scale (0 = "Not at all", 1 = "A little", 2 = "Moderately", 3 = "Quite a lot", or 4 = "Extremely"). The values of items associated with a specific subscale (e.g., Fatigue) were summed to calculate its score.
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Environmental Symptoms Questionnaire (ESQ) during daylong exposure to indoor temperature limit.
Self-reported environmental reactions and medical symptomatology associated with prolonged heat exposure. The ESQ-IV is a validated 68-item, self-administered questionnaire that has been used successfully in identifying symptomatology during exposure to a wide variety of environmental conditions, including heat exposure \[24, 25\]. Participants are asked to assess and described "how you have been feeling today" by responding to each item using a 6-point Likert scale (0 = "Not at all", 1 = "Slight", 2 = "Somewhat", 3 = "Moderate", 4 = "Quite a bit", or 5 = "Extreme"). Total Symptom Score was calculated from this data by taking the sum of the intensity ratings from all 68 individual items using reverse scores for the three positive items from the list ("I Felt Good", "I Felt Alert", and "I Felt Wide Awake").
Time frame: At the start (hour 0) and end of 8 hour daylong exposure
Sleep quality and quantify assessment during daylong exposure to indoor temperature limit.
The Pittsburg Sleep Quality Index will be administered to provide an overview of the sleep quantity and quality of individuals over the previous month.
Time frame: At start of 8 hour daylong exposure.
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