O impacto do calor extremo em eventos esportivos com grande público: implicações para a Austrália e outros países.
DOI:
https://doi.org/10.15517/86rse790Resumo
OBJETIVOS: Com o aumento das temperaturas em todo o mundo devido às mudanças climáticas, a exposição humana ao calor extremo representa um desafio para a saúde pública. Durante eventos esportivos, atletas, árbitros, espectadores e funcionários correm o risco de sofrer de estresse térmico e doenças relacionadas. O objetivo desta revisão foi explorar o impacto do calor nos resultados de saúde desses grupos e no sistema de saúde em geral, bem como analisar as implicações para eventos esportivos ao ar livre que envolvem grandes aglomerações na Austrália. PROJETO: Foi realizada uma revisão sistemática para identificar a literatura publicada entre 2010 e 2023. MÉTODO: Foram realizadas buscas em sete bases de dados — incluindo Web of Science, SportDiscus, Scopus, Medline, CINAHL, Emcare e PsychInfo — utilizando termos de busca relevantes, como «heatwave» "onda de calor", «heat stress» "estresse térmico", «extreme heat» "calor extremo", «stadium» "estádio", «arena» "arena", «sports facilit*» "instalações esportivas", «sport» "esporte", «athletic» "atlético" e «Olympic» "Olímpico". Foi realizada uma análise temática indutiva. A qualidade dos artigos foi verificada utilizando as ferramentas de avaliação crítica do Instituto Joanna Briggs, e os dados foram extraídos para uma planilha, tabulados e sintetizados. RESULTADOS: Quarenta artigos foram incluídos na análise final: 17 quantitativas e 23 descritivas e qualitativas (incluindo revisões). Os resultados de saúde analisados na literatura incluíram doenças relacionadas ao calor durante o esforço físico, insolação por esforço físico, hipertermia e doenças gerais induzidas pelo calor. Emergiram seis tópicos de recomendação: planejamento, estratégias de mitigação, aspectos médicos, políticas, pesquisa e educação. CONCLUSÕES: O impacto do calor nos resultados de saúde durante eventos esportivos é significativo e deve ser levado em consideração por participantes, treinadores, árbitros e organizadores antes, durante e depois de eventos esportivos com grande público. Essas descobertas podem servir como base para estratégias de preparação baseadas em evidências para proteger a saúde daqueles que frequentam ou competem em eventos esportivos com grande público, tanto agora quanto no futuro.
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Referências
Arsad, F. S., Hod, R., Ahmad, N., Ismail, R., Mohamed, N., Baharom, M., Osman, Y., Radi, M. F. M., & Tangang, F. (2022). The impact of heatwaves on mortality and morbidity and the associated vulnerability factors: A systematic review. International Journal of Environmental Research and Public Health, 19(23), 16356. https://doi.org/10.3390/ijerph192316356 DOI: https://doi.org/10.3390/ijerph192316356
American College of Sports Medicine, Armstrong, L. E., Casa, D. J., Millard-Stafford, M., Moran, D. S., Pyne, S. W., & Roberts, W. O. (2007). American College of Sports Medicine position stand: Exertional heat illness during training and competition. Medicine & Science in Sports & Exercise, 39(3), 556–572. https://doi.org/10.1249/MSS.0b013e31802fa199 DOI: https://doi.org/10.1249/MSS.0b013e31802fa199
23Bahr, R., & Reeser, J. C. (2012). New guidelines are needed to manage heat stress in elite sports: The Fédération Internationale de Volleyball (FIVB) Heat Stress Monitoring Programme. British Journal of Sports Medicine, 46(11), 805–809. https://doi.org/10.1136/bjsports-2012-091102 DOI: https://doi.org/10.1136/bjsports-2012-091102
40Bergeron, M. F. (2014). Hydration and thermal strain during tennis in the heat. British Journal of Sports Medicine, 48(Suppl 1), i12–i17. https://doi.org/10.1136/bjsports-2013-093256 DOI: https://doi.org/10.1136/bjsports-2013-093256
36Bergeron, M. F., Bahr, R., Bärtsch, P., Bourdon, L., Calbet, J. A., Carlsen, K. H., Castagna, O., González-Alonso, J., Lundby, C., Maughan, R. J., Millet, G., Mountjoy, M., Racinais, S., Rasmussen, P., Singh, D. G., Subudhi, A. W., Young, A. J., Soligard, T., & Engebretsen, L. (2012). International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. British Journal of Sports Medicine, 46(11), 770–779. https://doi.org/10.1136/bjsports-2012-091296 DOI: https://doi.org/10.1136/bjsports-2012-091296
Bermon, S., & Adami, P. E. (2019). Meteorological risks in Doha 2019 Athletics World Championships: Health considerations from organizers. Frontiers in Sports and Active Living, 1, 58. https://doi.org/10.3389/fspor.2019.00058 DOI: https://doi.org/10.3389/fspor.2019.00058
Bongers, C. C., Hopman, M. T., & Eijsvogels, T. M. (2017). Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations. Temperature, 4(1), 60–78. https://doi.org/10.1080/23328940.2016.1277003 DOI: https://doi.org/10.1080/23328940.2016.1277003
26Breslow, R. G., Collins, J. E., Troyanos, C., Cohen, M. C., D'Hemecourt, P., Dyer, K. S., & Baggish, A. (2021a). Exertional heat stroke at the Boston Marathon: Demographics and the environment. Medicine & Science in Sports & Exercise, 53(9), 1818–1825. https://doi.org/10.1249/MSS.0000000000002652 DOI: https://doi.org/10.1249/MSS.0000000000002652
Breslow, R. G., Giberson-Chen, C. C., & Roberts, W. O. (2021b). Burden of injury and illness in the road race medical tent: A narrative review. Clinical Journal of Sport Medicine, 31(6), e499–e505. https://doi.org/10.1097/JSM.0000000000000829 DOI: https://doi.org/10.1097/JSM.0000000000000829
26Breslow, R. G., Shrestha, S., Feroe, A. G., Katz, J. N., Troyanos, C., & Collins, J. E. (2019). Medical tent utilization at 10-km road races: Injury, illness, and influencing factors. Medicine & Science in Sports & Exercise, 51(12), 2451–2457. https://doi.org/10.1249/MSS.0000000000002068 DOI: https://doi.org/10.1249/MSS.0000000000002068
Bureau of Meteorology. (s.f.). Climate statistics for Australian locations. http://www.bom.gov.au/climate/averages/tables/cw_031011.shtml
Casa, D. J., DeMartini, J. K., Bergeron, M. F., Csillan, D., Eichner, E. R., Lopez, R. M., Ferrara, M. S., Miller, K. C., O'Connor, F., Sawka, M. N., & Yeargin, S. W. (2015). National Athletic Trainers' Association position statement: Exertional heat illnesses. Journal of Athletic Training, 50(9), 986–1000. https://doi.org/10.4085/1062-6050-50.9.07 DOI: https://doi.org/10.4085/1062-6050-50.9.07
38Chalmers, S., Anderson, G., & Jay, O. (2020). Considerations for the development of extreme heat policies in sport and exercise. BMJ Open Sport & Exercise Medicine, 6(1), e000774. https://doi.org/10.1136/bmjsem-2020-000774 DOI: https://doi.org/10.1136/bmjsem-2020-000774
Chalmers, S., Esterman, A., Eston, R., Bowering, K. J., & Norton, K. (2014). Short-term heat acclimation training improves physical performance: A systematic review, and exploration of physiological adaptations and application for team sports. Sports Medicine, 44(7), 971–988. https://doi.org/10.1007/s40279-014-0178-6 DOI: https://doi.org/10.1007/s40279-014-0178-6
Chalmers, S., Siegler, J., Lovell, R., Lynch, G., Gregson, W., Marshall, P., & Jay, O. (2019). Brief in-play cooling breaks reduce thermal strain during football in hot conditions. Journal of Science and Medicine in Sport, 22(8), 912–917. https://doi.org/10.1016/j.jsams.2019.04.009 DOI: https://doi.org/10.1016/j.jsams.2019.04.009
22Chan, G. A., & Wagner, D. R. (2020). Wet bulb globe temperature use in National Collegiate Athletic Association Football bowl subdivision athletic training staffs. International Journal of Athletic Therapy and Training, 25(6), 314–317. https://doi.org/10.1123/ijatt.2019-0103 DOI: https://doi.org/10.1123/ijatt.2019-0103
Coates, L., Haynes, K., O’Brien, J., McAneney, J., & De Oliveira, F. D. (2014). Exploring 167 years of vulnerability: An examination of extreme heat events in Australia 1844–2010. Environmental Science & Policy, 42, 33–44. https://doi.org/10.1016/j.envsci.2014.05.003 DOI: https://doi.org/10.1016/j.envsci.2014.05.003
Cole, S., & McCarthy, L. (2011). NASA research finds 2010 tied for warmest year on record. https://www.nasa.gov/topics/earth/features/2010-warmest-year.html
Ebi, K. L., Capon, A., Berry, P., Broderick, C., de Dear, R., Havenith, G., Honda, Y., Kovats, R. S., Ma, W., Malik, A., Morris, N. B., Nybo, L., Seneviratne, S. I., Vanos, J., & Jay, O. (2021). Hot weather and heat extremes: Health risks. The Lancet, 398(10301), 698–708. https://doi.org/10.1016/S0140-6736(21)01208-3 DOI: https://doi.org/10.1016/S0140-6736(21)01208-3
FitzGerald, G. J., Capon, A., & Aitken, P. (2019). Resilient health systems: Preparing for climate disasters and other emergencies. The Medical Journal of Australia, 210(7), 304–305. https://doi.org/10.5694/mja2.50115 DOI: https://doi.org/10.5694/mja2.50115
Franklin, R. C., Mason, H. M., King, J. C., & Ebi, K. L. (2020). Heatwaves and mortality in Queensland 2010–2019: Implications for a homogenous state-wide approach. International Journal of Biometeorology, 67(3), 503–515. https://doi.org/10.1007/s00484-023-02430-6 DOI: https://doi.org/10.1007/s00484-023-02430-6
41Gamage, P. J., Fortington, L. V., & Finch, C. F. (2020). Epidemiology of exertional heat illnesses in organised sports: A systematic review. Journal of Science and Medicine in Sport, 23(8), 701–709. https://doi.org/10.1016/j.jsams.2020.02.008 DOI: https://doi.org/10.1016/j.jsams.2020.02.008
57Gibson, O. R., James, C. A., Mee, J. A., Willmott, A. G. B., Turner, G., Hayes, M., & Maxwell, N. S. (2020). Heat alleviation strategies for athletic performance: A review and practitioner guidelines. Temperature, 7(1), 3–36. https://doi.org/10.1080/23328940.2019.1666624 DOI: https://doi.org/10.1080/23328940.2019.1666624
67Girard, O. (2015). Thermoregulation in wheelchair tennis: How to manage heat stress? Frontiers in Physiology, 6, 175. https://doi.org/10.3389/fphys.2015.00175 DOI: https://doi.org/10.3389/fphys.2015.00175
11Griggs, K. E., Stephenson, B. T., Price, M. J., & Goosey-Tolfrey, V. L. (2020). Heat-related issues and practical applications for Paralympic athletes at Tokyo 2020. Temperature, 7(1), 37–57. https://doi.org/10.1080/23328940.2019.1617030 DOI: https://doi.org/10.1080/23328940.2019.1617030
30Grobler, L., Derman, W., Racinais, S., Ngai, A. S. H., & van de Vliet, P. (2019). Illness at a Para Athletics Track and Field World Championships under hot and humid ambient conditions. PM&R, 11(9), 919–925. https://doi.org/10.1002/pmrj.12086 DOI: https://doi.org/10.1002/pmrj.12086
27Grundstein, A. J., Ramseyer, C., Zhao, F., Pesses, J. L., Akers, P., Qureshi, A., Becker, L., Knox, J. A., & Petro, M. (2012). A retrospective analysis of American football hyperthermia deaths in the United States. International Journal of Biometeorology, 56(1), 11–20. https://doi.org/10.1007/s00484-010-0391-4 DOI: https://doi.org/10.1007/s00484-010-0391-4
Guo, Y., Gasparrini, A., Li, S., Sera, F., Vicedo-Cabrera, A. M., de Sousa Zanotti Stagliorio Coelho, M., Saldiva, P. H. N., Lavigne, E., Tawatsupa, B., Punnasiri, K., Overcenco, A., Correa, P. M., Ortega, N. V., Kan, H., Osorio, S., Jaakkola, J. J. K., Ryti, N. R. I., Goodman, P. G., Zeka, A., Michelozzi, P., … Tong, S. (2018). Quantifying excess deaths related to heatwaves under climate change scenarios: A multicountry time series modelling study. PLOS Medicine, 15(7), e1002629. https://doi.org/10.1371/journal.pmed.1002629 DOI: https://doi.org/10.1371/journal.pmed.1002629
34Ho, W. H., Koenig, K. L., & Quek, L. S. (2014). Formula one night race in Singapore: A 4-year analysis of a planned mass gathering. Prehospital and Disaster Medicine, 29(5), 489–493. https://doi.org/10.1017/S1049023X14000971 DOI: https://doi.org/10.1017/S1049023X14000971
7Hollander, K., Klöwer, M., Richardson, A., Navarro, L., Racinais, S., Scheer, V., Murray, A., Branco, P., Timpka, T., Junge, A., & Edouard, P. (2021a). Apparent temperature and heat-related illnesses during international athletic championships: A prospective cohort study. Scandinavian Journal of Medicine & Science in Sports, 31(11), 2092–2102. https://doi.org/10.1111/sms.14029 DOI: https://doi.org/10.1111/sms.14029
28Hollander, K., Klöwer, M., Richardson, A., Navarro, L., Racinais, S., Scheer, V., Murray, A., Branco, P., Timpka, T., Junge, A., & Edouard, P. (2021b). High risk of heat-related illnesses for endurance athletes during athletics championships in hot climate: 611. Medicine & Science in Sports & Exercise, 53(8S), 205. https://doi.org/10.1249/01.mss.0000761444.67818.62 DOI: https://doi.org/10.1249/01.mss.0000761444.67818.62
52Hosokawa, Y., Adami, P. E., Stephenson, B. T., Blauwet, C., Bermon, S., Webborn, N., Racinais, S., Derman, W., & Goosey-Tolfrey, V. L. (2022). Prehospital management of exertional heat stroke at sports competitions for Paralympic athletes. British Journal of Sports Medicine, 56(11), 599–604. https://doi.org/10.1136/bjsports-2021-104786 DOI: https://doi.org/10.1136/bjsports-2021-104786
21Hosokawa, Y., Adams, W. M., Belval, L. N., Casa, D. J., & Vanos, J. K. (2018). Exertional heat illness incidence and on-site medical team preparedness in warm weather. International Journal of Biometeorology, 62(7), 1147–1153. https://doi.org/10.1007/s00484-018-1517-3 DOI: https://doi.org/10.1007/s00484-018-1517-3
64Hosokawa, Y., Casa, D. J., Trtanj, J. M., Belval, L. N., Deuster, P. A., Giltz, S. M., Grundstein, A. J., Hawkins, M. D., Huggins, R. A., Jacklitsch, B., Jardine, J. F., Jones, H., Kazman, J. B., Reynolds, M. E., Stearns, R. L., Vanos, J. K., Williams, A. L., & Williams, W. J. (2019). Activity modification in heat: Critical assessment of guidelines across athletic, occupational, and military settings in the USA. International Journal of Biometeorology, 63(3), 405–427. https://doi.org/10.1007/s00484-019-01673-6 DOI: https://doi.org/10.1007/s00484-019-01673-6
Hosokawa, Y., Racinais, S., Akama, T., Zideman, D., Budgett, R., Casa, D. J., Bermon, S., Grundstein, A. J., Pitsiladis, Y. P., Schobersberger, W., & Yamasawa, F. (2021). Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020. British Journal of Sports Medicine, 55(24), 1405–1410. https://doi.org/10.1136/bjsports-2020-103854 DOI: https://doi.org/10.1136/bjsports-2020-103854
32Inoue, H., Tanaka, H., Sakanashi, S., Kinoshi, T., Numata, H., Yokota, H., & Ohnishi, H. (2023). Incidence and factor analysis for the heat-related illness on the Tokyo 2020 Olympic and Paralympic Games. BMJ Open Sport & Exercise Medicine, 9(1), e001467. https://doi.org/10.1136/bmjsem-2022-001467 DOI: https://doi.org/10.1136/bmjsem-2022-001467
Intergovernmental Panel on Climate Change (2021). Summary for policymakers. In V. Masson-Delmotte, P. Zhai, A. Pirani, S. L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M. I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J. B. R. Matthews, T. K. Maycock, T. Waterfield, O. Yelekçi, R. Yu, & B. Zhou (Eds.), Climate change 2021: The physical science basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change (pp. 3–32). Cambridge University Press. https://www.ipcc.ch/report/ar6/wg1/downloads/report/IPCC_AR6_WGI_SPM_final.pdf
37Jay, O., Broderick, C., & Smallcombe, J. (2021). Extreme heat policy. Sports Medicine Australia. https://sma.org.au/wp-content/uploads/2023/03/SMA-Extreme-Heat-Policy-2021-Final.pdf
Jay, O., Capon, A., Berry, P., Broderick, C., de Dear, R., Havenith, G., Honda, Y., Kovats, R. S., Ma, W., Malik, A., Morris, N. B., Nybo, L., Seneviratne, S. I., Vanos, J., & Ebi, K. L. (2021). Reducing the health effects of hot weather and heat extremes: From personal cooling strategies to green cities. The Lancet, 398(10301), 709–724. https://doi.org/10.1016/S0140-6736(21)01209-5 DOI: https://doi.org/10.1016/S0140-6736(21)01209-5
JBI. (n.d.). Critical appraisal tools. https://jbi.global/critical-appraisal-tools
46Kakamu, T., Wada, K., Smith, D. R., Endo, S., & Fukushima, T. (2017). Preventing heat illness in the anticipated hot climate of the Tokyo 2020 Summer Olympic Games. Environmental Health and Preventive Medicine, 22(1), 68. https://doi.org/10.1186/s12199-017-0675-y DOI: https://doi.org/10.1186/s12199-017-0675-y
Klöwer, M., Edouard, P., Niess, A. M., Racinais, S., Pitsiladis, Y. P., Pappenberger, F., & Hollander, K. (2023). Forecasting feels-like temperatures as a strategy to reduce heat illnesses during sport events. British Journal of Sports Medicine, 57(10), 559–561. https://doi.org/10.1136/bjsports-2022-106413 DOI: https://doi.org/10.1136/bjsports-2022-106413
70Mallen, C., Dingle, G., & McRoberts, S. (2025). Climate impacts in sport: Extreme heat as a climate hazard and adaptation options. Managing Sport and Leisure, 30(2), 207–224. https://doi.org/10.1080/23750472.2023.2166574 DOI: https://doi.org/10.1080/23750472.2023.2166574
Mason, H., King, J. C., Peden, A. E., & Franklin, R. C. (2022). Systematic review of the impact of heatwaves on health service demand in Australia. BMC Health Services Research, 22(1), Article 960. https://doi.org/10.1186/s12913-022-08341-3 DOI: https://doi.org/10.1186/s12913-022-08341-3
Mountjoy, M., Alonso, J. M., Bergeron, M. F., Dvorak, J., Miller, S., Migliorini, S., & Singh, D. G. (2012). Hyperthermic-related challenges in aquatics, athletics, football, tennis and triathlon. British Journal of Sports Medicine, 46(11), 800–804. https://doi.org/10.1136/bjsports-2012-091272 DOI: https://doi.org/10.1136/bjsports-2012-091272
62Muniz-Pardos, B., Sutehall, S., Angeloudis, K., Shurlock, J., & Pitsiladis, Y. P. (2019). The use of technology to protect the health of athletes during sporting competitions in the heat. Frontiers in Sports and Active Living, 1, 38. https://doi.org/10.3389/fspor.2019.00038 DOI: https://doi.org/10.3389/fspor.2019.00038
63Nakamura, S., Wada, K., Yanagisawa, N., & Smith, D. R. (2018). Health risks and precautions for visitors to the Tokyo 2020 Olympic and Paralympic Games. Travel Medicine and Infectious Disease, 22, 3–7. https://doi.org/10.1016/j.tmaid.2018.01.005 DOI: https://doi.org/10.1016/j.tmaid.2018.01.005
National Centers for Environmental Information. (2024). Climate at a glance: Global time series. NOAA. https://www.ncei.noaa.gov/access/monitoring/climate-at-a-glance/global/time-series/globe/land_ocean/ytd/12/2010-2023
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 1–13. https://doi.org/10.1177/1609406917733847 DOI: https://doi.org/10.1177/1609406917733847
Oxford Centre for Evidence-Based Medicine. (2009). Oxford Centre for Evidence-Based Medicine: Levels of evidence (March 2009). https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Palandrani, P. (2020). A decade of change: How tech evolved in the 2010s and what’s in store for the 2020s. Global X ETFs. https://www.globalxetfs.com/a-decade-of-change-how-tech-evolved-in-the-2010s-and-whats-in-store-for-the-2020s/
49Pyne, D. B., Guy, J. H., & Edwards, A. M. (2014). Managing heat and immune stress in athletes with evidence-based strategies. International Journal of Sports Physiology and Performance, 9(2), 241–250. https://doi.org/10.1123/ijspp.2014-0232 DOI: https://doi.org/10.1123/ijspp.2014-0232
Queensland Government. (s.f.). Heatwave. https://www.getready.qld.gov.au/understand-your-risk/types-natural-disasters/heatwave
66Racinais, S., Hosokawa, Y., Akama, T., Bermon, S., Bigard, X., Casa, D. J., Grundstein, A., Jay, O., Massey, A., Migliorini, S., Mountjoy, M., Nikolic, N., Pitsiladis, Y. P., Schobersberger, W., Steinacker, J. M., Yamasawa, F., Zideman, D. A., Engebretsen, L., & Budgett, R. (2023). IOC consensus statement on recommendations and regulations for sport events in the heat. British Journal of Sports Medicine, 57(1), 8–25. https://doi.org/10.1136/bjsports-2022-105942 DOI: https://doi.org/10.1136/bjsports-2022-105942
59Roberts, W. O. (2010). Determining a "do not start" temperature for a marathon on the basis of adverse outcomes. Medicine & Science in Sports & Exercise, 42(2), 226–232. https://doi.org/10.1249/MSS.0b013e3181b1cdcf DOI: https://doi.org/10.1249/MSS.0b013e3181b1cdcf
6Schneider, S., von Winning, A., Grüger, F., Anderer, S., Hoffner, R., & Anderson, L. (2022). Physical activity, climate change and health: A conceptual model for planning public health action at the organizational level. International Journal of Environmental Research and Public Health, 19(8), 4664. https://doi.org/10.3390/ijerph19084664 DOI: https://doi.org/10.3390/ijerph19084664
28Sewry, N., Wiggers, T., & Schwellnus, M. (2023). Medical encounters among 94,033 race starters during a 16.1-km running event over 3 years in the Netherlands: SAFER XXVI. Sports Health, 15(2), 210–217. https://doi.org/10.1177/19417381221083594 DOI: https://doi.org/10.1177/19417381221083594
33Shimizu, K., Gilmour, S., Mase, H., Le, P. M., Teshima, A., Sakamoto, H., & Nomura, S. (2021). COVID-19 and heat illness in Tokyo, Japan: Implications for the Summer Olympic and Paralympic Games in 2021. International Journal of Environmental Research and Public Health, 18(7), 3620. https://doi.org/10.3390/ijerph18073620 DOI: https://doi.org/10.3390/ijerph18073620
24Sloan, B. K., Kraft, E. M., Clark, D., Schmeissing, S. W., Byrne, B. C., & Rusyniak, D. E. (2015). On-site treatment of exertional heat stroke. The American Journal of Sports Medicine, 43(4), 823–829. https://doi.org/10.1177/0363546514566194 DOI: https://doi.org/10.1177/0363546514566194
Surk, B., & Petrequin, S. (2023). Paris aims to keep Olympians cool without air conditioners. AP News. https://apnews.com/article/olympics-paris-2024-air-conditioning-climate-change-78b47a6f1bf0e1fcae9889cce9debcd9
31Tajima, T., Takazawa, Y., Yamada, M., Moriya, T., Sato, H., Higashihara, J., Toyama, Y., Chosa, E., Nakamura, A., & Kono, I. (2020). Spectator medicine at an international mega sports event: Rugby World Cup 2019 in Japan. Environmental Health and Preventive Medicine, 25(1), 72. https://doi.org/10.1186/s12199-020-00914-0 DOI: https://doi.org/10.1186/s12199-020-00914-0
35Tanaka, H., Tanaka, S., Yokota, H., Otomo, Y., Masuno, T., Nakano, K., Sugita, M., Tokunaga, T., Sugimoto, K., Inoue, J., Kato, N., Kinoshi, T., Sakanashi, S., Inoue, H., Numata, H., Nakagawa, K., Miyamoto, T., & Akama, T. (2023). Acute in-competition medical care at the Tokyo 2020 Olympics: A retrospective analysis. British Journal of Sports Medicine, 57(21), 1361–1370. https://doi.org/10.1136/bjsports-2022-105778 DOI: https://doi.org/10.1136/bjsports-2022-105778
Turkish Journal of Endocrinology and Metabolism. (2010). Diabetes management in special situations. Turkish Journal of Endocrinology and Metabolism, 14(Suppl.), 85–100. https://doi.org/10.1016/S0889-8529(05)70271-1 DOI: https://doi.org/10.1016/S0889-8529(05)70271-1
University of Sydney. (2019). New AusOpen heat policy informed by University of Sydney research. https://www.sydney.edu.au/news-opinion/news/2019/01/14/new-ausopen-heat-policy-informed-by-university-of-sydney-researc.html
Vidal, J. (2010). 2010 to be hottest year on record, says environment review. The Guardian. https://www.theguardian.com/environment/2010/dec/14/hottest-year-environment-review-vidal
World Meteorological Organization. (2023). Past eight years confirmed to be the eight warmest on record. https://wmo.int/news/media-centre/past-eight-years-confirmed-be-eight-warmest-record
Wu, Y., Xia, T., Jatowt, A., Zuo, Z., & Xie, M. (2021). Context-aware heatstroke relief station placement and route optimization for large outdoor events. International Journal of Health Geographics, 20(1), Article 23. https://doi.org/10.1186/s12942-021-00275-z DOI: https://doi.org/10.1186/s12942-021-00275-z
Xu, Z., Sheffield, P. E., Su, H., Wang, X., Bi, Y., & Tong, S. (2014). The impact of heat waves on children's health: A systematic review. International Journal of Biometeorology, 58(2), 239–247. https://doi.org/10.1007/s00484-013-0655-x DOI: https://doi.org/10.1007/s00484-013-0655-x
39Yamasaki, L., & Nomura, S. (2022). Global warming and the Summer Olympic and Paralympic games: A perspective from the Tokyo 2020 Games. Environmental Health and Preventive Medicine, 27, 7. https://doi.org/10.1265/ehpm.21-00024 DOI: https://doi.org/10.1265/ehpm.21-00024
