Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport

Borja Muniz-Pardos, Konstantinos Angeloudis, Fergus M. Guppy, Kumpei Tanisawa, Yuri Hosokawa, Garrett I. Ash, Wolfgang Schobersberger, Andrew J. Grundstein, Fumihiro Yamasawa, Sebastien Racinais, Douglas J. Casa, Yannis P. Pitsiladis

Research output: Contribution to journalArticlepeer-review


The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-Acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees' health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-Time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology's availability to all athletes. Furthermore, the real potential to obtain real-Time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all.

Original languageEnglish
Article numbere001041
JournalBMJ Open Sport and Exercise Medicine
Issue number2
Publication statusPublished - 12 Apr 2021

Bibliographical note

Funding Information:
Twitter Sebastien Racinais @ephysiol Contributors All authors have provided sufficient work to justify authorship and in line with the instructions to authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests GIA is supported by a fellowship from the Office of Academic Affiliations at the US Veterans Health Administration. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.


  • athlete
  • heat acclimatisation
  • sport


Dive into the research topics of 'Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport'. Together they form a unique fingerprint.

Cite this