Hostname: page-component-cb9f654ff-mnl9s Total loading time: 0 Render date: 2025-08-26T01:25:51.894Z Has data issue: false hasContentIssue false

Racing in Rising Global Temperatures: A Scoping Review of Heat-related Illnesses in Endurance Running

Published online by Cambridge University Press:  24 July 2025

Sophia Görgens*
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
Attila J. Hertelendy
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, USA
Fadi Issa
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
David Fernandez
Affiliation:
Simulation and Education Fellowship, Department of Emergency Medicine, https://ror.org/04a9tmd77 Icahn School of Medicine at Mount Sinai , New York, NY, USA
Ahmad Alshadad
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
Lindsay Davis
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
Jeffrey M. Franc
Affiliation:
Department of Emergency Medicine, https://ror.org/0160cpw27 University of Alberta , Alberta, Canada
Janice Kung
Affiliation:
Geoffrey & Robyn Sperber Health Sciences Library, https://ror.org/0160cpw27 University of Alberta , Alberta, Canda
Christina Ann Woodward
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
Amalia Voskanyan
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
Greg Ciottone
Affiliation:
BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, https://ror.org/04drvxt59 Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, USA
*
Corresponding author: Sophia Gorgens; Email: sgorgens@bidmc.harvard.edu

Abstract

Objectives

As temperatures globally continue to rise, sporting events such as marathons will take place on warmer days, increasing the risk of exertional heat stroke (EHS).

Methods

The medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, SPORTDiscus, Scopus, and Web of Science Core Collection. Relevant keywords were selected. The results underwent title, abstract, and full text screening in a web-based tool called Covidence, and were analyzed for pertinent data.

Results

A total of 3918 results were retrieved. After duplicate removal and title, abstract, and full text screening, 38 articles remained for inclusion. There were 22 case reports, 12 retrospective reviews, and 4 prospective observational studies. The races included half marathons, marathons, and other long distances. In the case reports and retrospective reviews, the mean environmental temperatures were 21.3°C and 19.8°C, respectively. Discussions emphasized that increasing environmental temperatures result in higher incidences of EHS.

Conclusion

With rising global temperatures from climate change, athletes are at higher risk of EHS. Early ice water immersion is the best treatment for EHS. Earlier start times and cooling stations for races may mitigate incidences of EHS. Future work needs to concentrate on the establishment of EHS prevention and mitigation protocols.

Information

Type
Original Research
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Nichols, AW. Heat-related illness in sports and exercise. Curr Rev Musculoskelet Med. 2014;7(4):355365. doi:10.1007/s12178-014-9240-0CrossRefGoogle ScholarPubMed
Zhao, Q, Yu, P, Mahendran, R, et al. Global climate change and human health: pathways and possible solutions. Eco-Environment and Health. 2022;1(2):5362. doi:10.1016/j.eehl.2022.04.004CrossRefGoogle ScholarPubMed
Tricco, AC, Lillie, E, Zarin, W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467473. doi:10.7326/M18-0850/SUPPL_FILE/M18-0850_SUPPLEMENT.PDFCrossRefGoogle ScholarPubMed
Asserraji, M, Benameur, I, Maoujoud, O, et al. Late care in marathon runs leading to exertional heat stroke with multiple organ failure. Asian J Sports Med. 2014;4(6):136138. https://login.ezproxy.library.ualberta.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=97416206&site=ehost-live&scope=siteGoogle Scholar
Azzopardi, N, Chetcuti, S, Sant, J, et al. Acute liver impairment in a young, healthy athlete: hypoxic hepatitis and rhabdomyolysis following heat stroke. Case Rep Gastroenterol. 2012;6(2):563568. doi:https://doi.org/10.1159/000338838CrossRefGoogle Scholar
Carvalho, AS, Rodeia, SC, Silvestre, J, et al. Exertional heat stroke and acute liver failure: a late dysfunction. BMJ Case Rep. 2016;2016(101526291). doi:https://doi.org/10.1136/bcr-2016-214434CrossRefGoogle ScholarPubMed
Gessel, T, Lin, CY. Exertional heatstroke in a marathon runner complicated by concurrent use of an antipsychotic medication affecting thermoregulation. Clin J Sport Med. 2020;30(5):e166e168. doi:https://doi.org/10.1097/JSM.0000000000000750CrossRefGoogle Scholar
Epstein, Y, Roberts, WO, Golan, R, et al. Sepsis, septic shock, and fatal exertional heat stroke. Curr Sports Med Rep. 2015;14(1):6469. doi:10.1249/JSR.0000000000000112CrossRefGoogle ScholarPubMed
Heneghan, HM, Nazirawan, F, Dorcaratto, D, et al. Extreme heatstroke causing fulminant hepatic failure requiring liver transplantation: a case report. Transplant Proc. 2014;46(7):24302432. doi:https://doi.org/10.1016/j.transproceed.2013.12.055CrossRefGoogle ScholarPubMed
Koh, YH. Heat stroke with status epilepticus secondary to Posterior Reversible Encephalopathy Syndrome (PRES). Case Rep Crit Care. 2018;2018(101598416):3597474. doi:https://doi.org/10.1155/2018/3597474Google ScholarPubMed
Leckie, T, Stacey, MJ, Woods, D, et al. Military standard operating procedures translated into civilian best practice: delivery of cold water immersion to treat exertional heat stroke at Brighton marathon 2023. BMJ Mil Health. 2025;171(2):182183. doi:https://doi.org/10.1136/military-2023-002460CrossRefGoogle ScholarPubMed
Masood, U, Sharma, A, Syed, W, et al. Bowel ischemia from heat stroke: a rare presentation of an uncommon complication. Case Rep Med. 2016;2016(101512910):5217690. doi:https://doi.org/10.1155/2016/5217690CrossRefGoogle ScholarPubMed
O’Donnell, TFJ. The hemodynamic and metabolic alterations associated with acute heat stress injury in marathon runners. Ann N Y Acad Sci. 1977;301(5nm, 7506858):262269. doi:https://doi.org/10.1111/j.1749-6632.1977.tb38204.xCrossRefGoogle Scholar
Poggiali, E, Cervellin, G, Valenti, G, et al. Reversible supraventricular tachycardia and left bundle branch block in a marathon runner with exertional heat stroke in the Po Valley. Acta Biomed. 2023;94(S1):e2023224–. doi:https://doi.org/10.23750/abm.v94iS1.14917Google Scholar
Robertson, B, Walter, E.Cool runnings:” heat stroke in cool conditions. Emerg Med J. 2010;27(5):387388. doi:10.1136/emj.2009.083667CrossRefGoogle ScholarPubMed
Roberts, WO. Exertional heat stroke during a cool weather marathon: a case study. Med Sci Sports Exerc. 2006;38(7):11971203. doi:https://doi.org/10.1249/01.mss.0000227302.80783.0fCrossRefGoogle ScholarPubMed
Roberts, WO. Every Picture tells a story: managing exertional heatstroke with rotating ice water towels. Curr Sports Med Rep. 2024;23(5):171173. doi:https://doi.org/10.1249/JSR.0000000000001165CrossRefGoogle Scholar
Roberts, WO, Dorman, JC, Bergeron, MF. Recurrent heat stroke in a runner: race simulation testing for return to activity. Med Sci Sports Exerc. 2016;48(5):785789. doi:https://doi.org/10.1249/MSS.0000000000000847CrossRefGoogle Scholar
Smith, R, Jones, N, Martin, D, et al.Too much of a coincidence:” identical twins with exertional heatstroke in the same race. BMJ Case Rep. 2016;2016(101526291). doi:https://doi.org/10.1136/bcr-2015-212592CrossRefGoogle ScholarPubMed
Sort, P, Mas, A, Salmeron, JM, et al. Recurrent liver involvement in heatstroke. Liver. 1996;16(5):335337. doi:https://doi.org/10.1111/j.1600-0676.1996.tb00756.xCrossRefGoogle ScholarPubMed
Stearns, RL, Casa, DJ, O’Connor, FG, et al. A tale of two heat strokes: a comparative case study. Curr Sports Med Rep. 2016;15(2):9497. doi:10.1249/JSR.0000000000000244CrossRefGoogle ScholarPubMed
Weigand, K, Riediger, C, Stremmel, W, et al. Are heat stroke and physical exhaustion underestimated causes of acute hepatic failure?. World J Gastroenterol. 2007;13(2):306309. doi:https://doi.org/10.3748/wjg.v13.i2.306CrossRefGoogle ScholarPubMed
Whitworth, JAG, Wolfman, ML. Fatal heat-stroke in a long-distance runner. Br Med J. 1983;287(6397):948. doi:10.1136/bmj.287.6397.948CrossRefGoogle Scholar
Yoshizawa, T, Omori, K, Takeuchi, I, et al. Heat stroke with bimodal rhabdomyolysis: a case report and review of the literature. J Intensive Care. 2016;4(101627304):71. doi:https://doi.org/10.1186/s40560-016-0193-9CrossRefGoogle ScholarPubMed
Seth, P, Juliana, P. Exertional heat stroke in a marathon runner with extensive healed deep burns: a case report. Int J Emerg Med. 2011;4(101469435):12. doi:https://doi.org/10.1186/1865-1380-4-12CrossRefGoogle Scholar
Breslow, RG, Collins, JE, Troyanos, C, et al. Exertional heat stroke at the Boston Marathon: demographics and the environment. Med Sci Sports Exerc. 2021;53(9):18181825. doi:10.1249/MSS.0000000000002652CrossRefGoogle ScholarPubMed
Chan, PYN, Mok, KL, Wong, YT, et al. Presentations of runners in Kong Kong Marathon to a local ED: a 10 years’ glance. Hong Kong J Emerg Med. 2014;21(4):197204. doi:http://doi.org/10.1177/102490791402100401CrossRefGoogle Scholar
Chan, JL, Constantinou, V, Fokas, J, et al. An overview of Chicago (Illinois USA) Marathon prehospital care demographics, patient care operations, and injury patterns. Prehosp Disaster Med. 2019;34(3):308316. doi:https://doi.org/10.1017/S1049023X19004345CrossRefGoogle ScholarPubMed
Divine, JG, Daggy, MW, Dixon, EE, et al. Case series of exertional heat stroke in runners during early spring: 2014 to 2016 Cincinnati Flying Pig Marathon. Curr Sports Med Rep. 2018;17(5):151158. doi:https://doi.org/10.1249/JSR.0000000000000485CrossRefGoogle Scholar
Driscoll, TR, Cripps, R, Brotherhood, JR Heat-related injuries resulting in hospitalisation in Australian sport. J Sci Med Sport. 2008;11(1):4047. doi:https://doi.org/10.1016/j.jsams.2007.04.003CrossRefGoogle ScholarPubMed
Finch, CF, Boufous, S. The descriptive epidemiology of sports/leisure-related heat illness hospitalisations in New South Wales, Australia. J Sci Med Sport. 2008;11(1):4851. doi:https://doi.org/10.1016/j.jsams.2007.08.008CrossRefGoogle ScholarPubMed
Hawes, R, McMorran, J, Vallis, C. Exertional heat illness in half marathon runners: experiences of the Great North Run. Emerg Med J. 2010;27(11):866867. doi:https://doi.org/10.1136/emj.2010.090928CrossRefGoogle ScholarPubMed
Hostler, D, Franco, V, Martin-Gill, C, et al. Recognition and treatment of exertional heat illness at a marathon race. Prehosp Emerg Care. 2014;18(3):456459. doi:https://doi.org/10.3109/10903127.2013.864357CrossRefGoogle Scholar
Joslin, J, Mularella, J, Bail, A, et al. Mandatory rest stops improve athlete safety during event medical coverage for ultramarathons. Prehosp Disaster Med. 2016;31(1):4345. doi:https://doi.org/10.1017/S1049023X15005555CrossRefGoogle ScholarPubMed
Sloan, BK, Kraft, EM, Clark, D, et al. On-site treatment of exertional heat stroke. Am J Sports Med. 2015;43(4):823829. doi:https://doi.org/10.1177/0363546514566194CrossRefGoogle ScholarPubMed
Sugawara, M, Manabe, Y, Yamasawa, F, et al. Athlete medical services at the marathon and race walking events during Tokyo 2020 Olympics. Front Sports Act Living. 2022;4(101765780):872475. doi:https://doi.org/10.3389/fspor.2022.872475CrossRefGoogle ScholarPubMed
Yankelson, L, Sadeh, B, Gershovitz, L, et al. Life-threatening events during endurance sports: is heat stroke more prevalent than arrhythmic death?. J Am Coll Cardiol. 2014;64(5):463469. doi:https://doi.org/10.1016/j.jacc.2014.05.025CrossRefGoogle ScholarPubMed
Gerardin, B, Guedeney, P, Bellemain-Appaix, A, et al. Life-threatening and major cardiac events during long-distance races: updates from the prospective RACE PARIS registry with a systematic review and meta-analysis. Eur J Prev Cardiol. 2021;28(6):679686. doi:https://doi.org/10.1177/2047487320943001CrossRefGoogle ScholarPubMed
Hollander, K, Klower, M, Richardson, A, et al. Apparent temperature and heat-related illnesses during international athletic championships: a prospective cohort study. Scand J Med Sci Sports. 2021;31(11):20922102. doi:https://doi.org/10.1111/sms.14029CrossRefGoogle ScholarPubMed
Ogwumike, OO, Adeniyi, AF. The SPLASH/ICPC integrity marathon in Ibadan, Nigeria: incidence and management of injuries and marathon-related health problems. BMC Sports Sci Med Rehabil. 2013;5(1):6. doi:https://doi.org/10.1186/2052-1847-5-6CrossRefGoogle ScholarPubMed
Stacey, MJ, Hill, NE, Parsons, IT, et al. Relative changes in brain and kidney biomarkers with Exertional Heat Illness during a cool weather marathon. PLoS One. 2022;17(2):e0263873–. doi:https://doi.org/10.1371/journal.pone.0263873CrossRefGoogle ScholarPubMed
Global Temperature. NASA. Published 2023. Accessed October 27, 2024. https://climate.nasa.gov/vital-signs/global-temperature/?intent=121Google Scholar
Casey, JA, Parks, RM, Bruckner, TA, et al. Excess injury mortality in Washington State during the 2021 Heat Wave. Am J Public Health. 2023;113(6):657660. doi:10.2105/AJPH.2023.307269CrossRefGoogle ScholarPubMed
National Center for Health Statistics Mortality Data on CDC WONDER. CDC. Published April 2024. Accessed October 27, 2024. https://wonder.cdc.gov/Google Scholar
Climate Change Indicators: Heat-Related Deaths. EPA. Published June 2024. Accessed October 8, 2024. https://www.epa.gov/climate-indicators/climate-change-indicators-heat-related-deathsGoogle Scholar
Hulteen, RM, Smith, JJ, Morgan, PJ, et al. Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis. Prev Med (Baltim). 2017;95:1425. doi:10.1016/J.YPMED.2016.11.027CrossRefGoogle ScholarPubMed
Woods, RA. Sports and Exercise. U.S. Bureau of Labor Statistics. Published May 2017. Accessed October 27, 2024. https://www.bls.gov/spotlight/2017/sports-and-exercise/Google Scholar
Knight, N, Parkin, J, Smith, R, Kipps, C. The incidence of exertional heat stroke during mass-participation thriathlon races: optimizing athlete safety. Br J Sports Med. 2017;51(4):344345. doi:10.1136/BJSPORTS-2016-097372.155CrossRefGoogle Scholar
Gamage, PJ, Fortington, LV, Finch, CF. Epidemiology of exertional heat illnesses in organised sports: a systematic review. J Sci Med Sport. 2020;23(8):701709. doi:10.1016/j.jsams.2020.02.008CrossRefGoogle ScholarPubMed
Kim, JH, Rim, AJ, Miller, JT, et al. Cardiac Arrest during long-distance running races. JAMA. Published online 2025. doi:10.1001/JAMA.2025.3026CrossRefGoogle Scholar
Klingert, M, Nikolaidis, PT, Weiss, K, et al. Exercise-associated hyponatremia in marathon runners. J Clin Med. 2022;11(22):6775. doi:10.3390/JCM11226775CrossRefGoogle ScholarPubMed
Tietze, DC, Borchers, J. Exertional rhabdomyolysis in the athlete: a clinical review. Sports Health. 2014;6(4):336. doi:10.1177/1941738114523544CrossRefGoogle ScholarPubMed
Kruijt, N, van den Bersselaar, LR, Hopman, MTE, et al. Exertional heat stroke and rhabdomyolysis: a medical record review and patient perspective on management and long-term symptoms. Sports Med Open. 2023;9(1):33. doi:10.1186/S40798-023-00570-YCrossRefGoogle ScholarPubMed
Liu, S, Xing, L, Wang, Q, et al. Association between early stage-related factors and mortality in patients with exertional heat stroke: a retrospective study of 214 cases. Int J Gen Med. 2021;14:46294638. doi:10.2147/IJGM.S322910,CrossRefGoogle ScholarPubMed
Garcia, CK, Renteria, LI, Leite-Santos, G, et al. Exertional heat stroke: pathophysiology and risk factors. BMJ Med. 2022;1(1):e000239. doi:10.1136/BMJMED-2022-000239CrossRefGoogle ScholarPubMed
Leyk, D. Health risks and interventions in exertional heat stress. Dtsch Arztebl Int. Published online August 5, 2019. doi:10.3238/arztebl.2019.0537Google Scholar
DeMartini, JK, Casa, DJ, Belval, LN, et al. Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the falmouth road race. J Athl Train. 2014;49(4):478485. doi:10.4085/1062-6050-49.3.26CrossRefGoogle ScholarPubMed