International Journal of Biometeorology

, Volume 63, Issue 3, pp 405–427 | Cite as

Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA

  • Yuri HosokawaEmail author
  • Douglas J. Casa
  • Juli M. Trtanj
  • Luke N. Belval
  • Patricia A. Deuster
  • Sarah M. Giltz
  • Andrew J. Grundstein
  • Michelle D. Hawkins
  • Robert A. Huggins
  • Brenda Jacklitsch
  • John F. Jardine
  • Hunter Jones
  • Josh B. Kazman
  • Mark E. Reynolds
  • Rebecca L. Stearns
  • Jennifer K. Vanos
  • Alan L. Williams
  • W. Jon Williams


Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.


Exertional heat illness Heat hazard Safety Policy and procedure Health 



We would like to thank the National Integrated Heat Health Information System for their support in hosting the expert meeting that preceded to the writing of this paper. We would also like to acknowledge Dr. Richard J. Thomas and Dr. Aaron W. Tustin for their contributions in writing the paper.


The scientific results, views, and conclusions expressed in this publication are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), National Weather Service (NWS), National Oceanic and Atmospheric Administration (NOAA), Department of Commerce, or the US Government.


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Copyright information

© ISB 2019

Authors and Affiliations

  • Yuri Hosokawa
    • 1
    • 2
    Email author
  • Douglas J. Casa
    • 1
  • Juli M. Trtanj
    • 3
  • Luke N. Belval
    • 1
  • Patricia A. Deuster
    • 4
  • Sarah M. Giltz
    • 3
    • 5
  • Andrew J. Grundstein
    • 6
  • Michelle D. Hawkins
    • 3
  • Robert A. Huggins
    • 1
  • Brenda Jacklitsch
    • 7
  • John F. Jardine
    • 1
  • Hunter Jones
    • 3
    • 8
  • Josh B. Kazman
    • 4
  • Mark E. Reynolds
    • 9
  • Rebecca L. Stearns
    • 1
  • Jennifer K. Vanos
    • 10
  • Alan L. Williams
    • 11
  • W. Jon Williams
    • 7
  1. 1.Korey Stringer InstituteUniversity of ConnecticutStorrsUSA
  2. 2.College of Sport and Health ScienceRitsumeikan UniversityKusatsuJapan
  3. 3.National Oceanic and Atmospheric AdministrationWashington DCUSA
  4. 4.Consortium for Health and Military Performance, Department of Military and Emergency MedicineUniformed Services University of the Health SciencesBethesdaUSA
  5. 5.Louisiana Sea GrantLouisiana State UniversityBaton RougeUSA
  6. 6.Department of GeographyUniversity of GeorgiaAthensUSA
  7. 7.National Institute for Occupational Safety and HealthCincinnatiUSA
  8. 8.University Corporation for Atmospheric ResearchBoulderUSA
  9. 9.U.S. Army Public Health Center, Aberdeen Proving GroundAberdeenUSA
  10. 10.Scripps Institution of Oceanography DepartmentUniversity of California San DiegoLa JollaUSA
  11. 11.Walter Reed National Military Medical CenterBethesdaUSA

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