A psycho-cognitive model for exertional heatstroke: theory and preliminary testing using self-report measures in a case-control study

Abstract

AbstractBackgroundExertional heatstroke (EHS) is the most serious condition in the spectrum of heat illnesses that can occur during sport competition or physical effort under environmental stress. Despite substantial progress in understanding the pathophysiology of EHS, evidence appears to be insufficient for confining its description to a purely physiological syndrome.MethodsWe introduce a psycho-cognitive model for EHS, and we initiate its experimental validation using self-report measures in a case-control study. Our working hypothesis is that EHS might be the consequence of the alteration of cost-benefit trade-off associated with prolonged physical activity. Specifically, we propose that EHS might result from the overvaluation of benefits associated with physical effort, as a consequence of overmotivation to succeed, and/or the undervalued costs of effort exertion that result from low interoceptive body awareness,i.e. disrupted processing of signals about the internal (physiological) state of the body.ResultsOur psychometric data showed that subjects with a history of EHS (cases, N=51) self-report lower interoceptive body awareness compared to healthy subjects (controls, n=43), but do not differ in terms of motivational trait (global motivation). In addition, we found that cases show a less developed trait mindfulness compared to controls.ConclusionWe provide theoretical foundations and preliminary support for a psycho-cognitive model of EHS. Our findings suggest that relatively simple measures (self-report questionnaires) may have utility in identifying intrinsic (individual-specific) risk factors for EHS. Psycho-cognitive approach of the EHS could potentially lead to novel prevention strategies to mitigate its risk in sport competitions.