高溫訓練與比賽的聲明指南(四) | Consensus Recommendations on Training and Competing in the Heat

高溫訓練與比賽的聲明指南(四) | Consensus Recommendations on Training and Competing in the Heat

 

高溫訓練與比賽的聲明指南(四)

 

6. 給活動組織者的建議

活動組織者考慮是否重新安排或取消活動而經常遵循的一組建議，是基於美國軍方依據經驗開發的綜合溫度熱指數（又稱濕黑球溫度/Wet-Bulb Globe Temperature/WBGT），並被美國運動醫學會ACSM[183]於運動醫學中推廣且被各種體育聯會採用（表2）。

表2 各種體育管理機構根據全球濕球溫度指數建議採取的行動範例

 

不過，當汗液蒸發受到限制（即高濕度和/或低空氣流動）時，WBGT可能低估了熱負荷風險[184]（表3）。此外，WBGT是為氣候指數，並未考慮代謝產生及衣物，因次無法預測散熱[19]。有鑑於此，以下為各種體育活動提供的建議指導，並非基於WBGT指數的固定停止數值。

表3 考量WBGT低估了高濕度下的熱負荷，根據綜合溫度熱指數校正勞力性中暑風險估計表

 

6.1 活動取消或施行策略？

為了能夠按預期環境條件適當地安排賽事及保護運動員的健康，可能需要在外源性及內源性熱負荷無法取得生理性補償時停止比賽。超過補償性限制的環境條件取決於幾項因素，如代謝熱產能（取決於工作量和效率/經濟性）、運動員形態（如體表面積與質量比）、適應狀態（如出汗率）及服裝。因此，在不同的體育學科建立通用的停止數值是有瑕疵的。環境指數應被視為活動組織者實行預防對策以消除潛在熱衰竭風險的建議。推薦對策包括調整關於冷卻休息和液體提供（時間和地點）的規則規定，以及在休息期間提供主動冷卻等。同樣也建議在場域內制訂應對運動型熱衰竭的醫療響應政策及設施。

 

6.2 特殊性建議

6.2.1 運動差異

炎熱的環境條件會削弱耐力運動能力，如馬拉松賽跑[7]，卻可能改善短時間運動如跳躍或短跑[1]。在許多運動中，運動員會依據環境條件調整其活動，如與較冷條件相比，足球運動員在比賽中減少了總覆蓋距離或高強度覆蓋距離，但保持了短跑活動/能力[9, 12, 186]，在網球運動員身上則發現在炎熱比賽內(WBGT約34°C)減少了得分持續時間[8]或增加了得分之間的相距時間[10]。因此建議賽事組織者和國際總會應承認並透過調整推規則及相應地裁決來支持這種行為體溫調整策略。

 

6.2.2 特定運動中的個體差異

有研究用墨爾本（澳洲，維多利亞省）舉行的兩場鐵人三項進行比較，兩場比賽相隔兩個月，有相似的環境條件下（即WBGT在每場比賽中從22°C升至27°C），Gosling等人[187]在初夏時異常炎熱天氣中舉行的第一場比賽中觀察到共15例運動型熱病（包括3次熱衰竭），但在第二場中沒有觀察到病例。這可能顯示了無季節性熱適應的參賽者遭遇熱疾病的風險增加了[187]，並證實了早期關於初夏或炎熱天氣高峰時熱病風險增加研究[188]。不過，勞力性熱衰竭可能發生於適應良好且多次進行類性活動個體中，因其可能患有病毒感染或類似疾病[19]。在極少數將WBGT與運動員疾病聯繫起來的流行病學研究中，Bahr和Reeser[22]調查了3年多共48場沙灘排球比賽（世界巡迴和世界錦標賽）。僅報告了一例與高溫相關的醫療性棄權，是關於一名運動員因三天的急性腸胃炎[22]而導致體液平衡受損[22]。此外，雖然健康跑者也可以在溫暖潮濕環境中完成半程馬拉松而不會出現熱病問題[189]，但已經證實在寒冷天氣的馬拉松比賽中，正從病毒感染中恢復的跑者會出現運動型熱衰竭[190]。

事實上，曾經有過病毒感染正成為熱損傷/衰竭的潛在重要危險因素[19, 191]。因此活動組織者應特別關注所有可能面臨更大風險族群，包括正在生病或從最近感染中恢復者、患有腹瀉者、近期接受疫苗接種者、因醫學條件而散熱能力有限者（如殘奧會運動員）、或參加具限制散熱能力規範運動者（如防護服/設備），當然未能適應環境的參賽者也被視為有風險者。雖然在大型賽事中對每位運動員進行篩查是不切實際的想法，但仍鼓勵組織者提供訊息如報到工具包內，以告知所有運動員在折衷狀態下參與的潛在相關風險並提出對策。

 

6.3 對活動組織者的主要建議總結

– WBGT是一種環境熱負荷指數並不代表人體熱負荷。因而難以為不同運動員確定跨項目的參與臨界絕對值，在此寧願建議在制定極端高溫政策時採用預防對策或評估運動項目的具體需求。

– 策略包括根據天氣模式安排賽事開始時間、調整規則和判決以允許額外休息時間或更長的恢復時間、制定醫療響應政策和冷卻設施。

– 活動組織者應特別注意所有”高危險”人群。有鑑於未適應環境的參賽者（主於大眾參與活動）發生熱衰竭風險較高，組織者應適當告知參賽者與參賽相關風險，或是考慮在意外情況發生或異常炎熱天氣下取消活動。

 

7. 結論

目前有關於熱負荷的知識主要來自軍事及職業研究領域，而運動學科的加入則是較為近期的事。根據這些研究文獻，運動員應該最好訓練兩週或至少訓練一週，以獲得與目標競賽近似程度的熱負荷適應能力。運動員還應該謹慎地在水份充足的情況下進行訓練，並在訓練期間透過適當補液來達到最大程度地降低體內水分不足（透過觀測體重減輕得以監測）。還可以採用特定對策（如冷卻方法）以降低比賽和訓練期間的熱量存儲及生理壓力，特別是在難以克服的環境條件下。賽事組織者和體育管理機構可以透過允許額外（或更長）的恢復期，來幫助運動員得到在高溫比賽期間增加水和作用及降溫機會。

 

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文章參考來源 : https://doi.org/10.1007/s40279-015-0343-6