Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme最新文献

{"title":"Dietary Supplement Use and Beliefs Among Athletes at the 2025 Canada Games.","authors":"Jana Daher, Adriah Kate Sahajpal, Vijay Sahajpal, Dalia El Khoury, Zahra Farahnak","doi":"10.1139/apnm-2026-0242","DOIUrl":"https://doi.org/10.1139/apnm-2026-0242","url":null,"abstract":"<p><p>Dietary supplement use is widespread among athletes; however, limited data exist regarding supplement use and beliefs among Canadian youth athletes. This cross-sectional online study aimed to examine dietary supplement use and related beliefs among athletes competing at the 2025 Canada Games in St. John's, Newfoundland and Labrador. A total of 473 respondents participated in the survey. Of the 473 participants, 385 completed responses to the dietary supplement (DS) questions. Among participants who reported their sex, 125 were male and 189 were female. Overall, 36% of participants reported current dietary supplement use. Supplement use was significantly higher among males than females (47% vs. 23%, p < .001) and increased with age (p = .001). The most commonly reported supplements were protein powder (49%), sports drinks (46%), and creatine (45%). Primary reasons for use included maintaining good health (76%), increasing energy (54%), and promoting recovery (50%). Coaches (50%) and healthcare professionals (49%) were the most frequently reported information sources. Supplement users demonstrated significantly stronger positive beliefs regarding benefits of dietary supplements compared with non-users (all p < .001). Ordinal logistic regression showed that supplement users had greater odds of stronger agreement that supplements improve performance (OR = 5.50, 95% CI: 3.31-9.13, p < .001). These findings highlight the use of dietary supplements among Canadian youth athletes and support the need for targeted nutrition education to promote informed decision-making.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anabolic inequality among whole protein foods.","authors":"Nicholas A Burd, Žan Zupančič, Daniel R Moore, Stuart M Phillips","doi":"10.1139/apnm-2026-0070","DOIUrl":"https://doi.org/10.1139/apnm-2026-0070","url":null,"abstract":"<p><p>Dietary protein consumption in optimization strategies for supporting muscle are shifting from isolated nutrient models to integrated food-first frameworks. This perspective examines the role of food matrix integrity in regulating the primary locus of control of muscle mass in health adults: muscle protein synthesis (MPS). We propose that food processing techniques alter the matrix's physical and chemical architecture, thereby modulating the anabolic potential of whole protein foods. Consequently, identifying optimal feeding strategies requires combining mechanistic insights with food-first approaches, acknowledging that food matrix integrity is a regulatory variable in MPS regulation in support of muscle health.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where are the female participants in resistance training and muscle hypertrophy research? A review of gender/sex representation.","authors":"Nathalia F Dias, Deivid G Silva, Julio Benvenutti Bueno de Camargo, Enya T A Nacafucasaco, Talisson Santos Chaves, Cleiton A Libardi","doi":"10.1139/apnm-2026-0087","DOIUrl":"https://doi.org/10.1139/apnm-2026-0087","url":null,"abstract":"<p><p>This systematic review aimed to evaluate the representation of female participants in resistance training (RT) studies investigating hypertrophy and to assess associations between participant sex, methodological features, authorship, and temporal trends. This review included RT studies published in peer-reviewed journals that assessed hypertrophy outcomes in young adults. Reviewers independently screened studies and extracted data on participant sex, menstrual cycle phase reporting/consideration, use of molecular or biopsy analyses, and gender/sex of first and last authors. A total of 570 studies were included. Of these, 72.2% recruited male participants, 11.0% female participants, and 16.8% included both sexes. Among studies including female participants, 8.5% reported or accounted for menstrual cycle phase, while 87.3% did not mention it. Molecular analyses were nearly four times more frequent in studies with only male participants (23.6%) than those including female participants (6.5%; χ²=9.45; p<0.009). No association was found between participant sex and use of muscle biopsies or author gender/sex. A 10-fold increase in RT publications occurred in the 21st vs. 20th century, yet the sex gap persisted. Studies published in 2020-June 2023 showed modest improvement versus 2001-2019, with fewer male-only and more female-only and mixed-sex samples (χ²=16.43; p=0.00027; Cramér's V=0.18). Despite growing evidence that females and males exhibit broadly similar relative hypertrophy and molecular responses to RT, substantial sex bias persists in hypertrophy research. Although studies published since 2020 show modest improvement in sex-inclusive recruitment, male-only designs still predominate, and limited menstrual cycle phase reporting/accounting continues to constrain transparency and generalizability.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Calcium Supplementation on Bone Mineral Density and Fracture Risk in Adults: An Umbrella Review.","authors":"Payam Sharifan, Karim Karbin, Shuvam Sill, Mahdi Hejazi Laein, Mojtaba Shafiee, Nigatu Geda, Zoe L Longworth, Walid Aldoori, Amir Alavi, Hassan Vatanparast","doi":"10.1139/apnm-2026-0023","DOIUrl":"https://doi.org/10.1139/apnm-2026-0023","url":null,"abstract":"<p><p>We aimed to evaluate the impact of calcium supplementation on bone mineral density (BMD), osteoporosis, and site-specific fracture risk in adults. We conducted a systematic search of MEDLINE, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews (CDSR), and CINAHL from inception to February 13, 2025, to identify systematic reviews with meta-analyses assessing calcium supplementation and fracture or osteoporosis outcomes in adults (≥18 years). Primary-study data from eligible meta-analyses were extracted to assess pooled estimates. Certainty of evidence was assessed using the GRADE framework. Twenty-two meta-analyses were included, comprising 69 unique primary studies and 286,584 participants. Calcium supplementation, with or without vitamin D, was associated with small but statistically significant increases in BMD at the total body, hip, lumbar spine, and femoral neck, although heterogeneity was substantial. Calcium supplementation was associated with reduced risk of total, vertebral, and non-vertebral fractures, but not hip or wrist fractures. Subgroup analyses by intervention type, sex, and age showed no consistent differential effects. Certainty of evidence ranged from moderate for vertebral and non-vertebral fractures to low or very low for other outcomes. Overall, calcium supplementation confers modest skeletal benefits. Further high-quality long-term trials are still needed. (PROSPERO Registration Number: CRD420251082510).</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Restricted Ketogenic Diet Combined with Exercise Improves Cardiorespiratory Fitness but Compromises Sleep Quality in Overweight and Obese Young Adults: A Randomized Controlled Trial.","authors":"Zongze Wu, Zhaowei Kong, Mingzhu Hu, Qingde Shi, Jinlei Nie","doi":"10.1139/apnm-2026-0138","DOIUrl":"https://doi.org/10.1139/apnm-2026-0138","url":null,"abstract":"<p><strong>Background: </strong>Obesity and sleep disorders interact bidirectionally, complicating health management. Ketogenic diets (KD) aid weight loss, but their impact on sleep quality, especially when combined with exercise, remains unclear. This randomized controlled trial investigated the effects of short-term non-energy-restricted and time-restricted KD, alone or combined with moderate-intensity continuous training (MICT) or sprint interval training (SIT), on cardiorespiratory fitness (CRF) and sleep quality in overweight/obese young adults.</p><p><strong>Methods: </strong>68 participants were randomized into CON, KD-CON, KD-SIT, and KD-MICT groups (n = 17 each), with 59 completing the 4-week intervention. Primary outcomes were peak oxygen uptake (VO₂peak) for CRF and Pittsburgh Sleep Quality Index (PSQI) for sleep quality.</p><p><strong>Results: </strong>All KD groups achieved significant weight loss (5.0-6.0%, d = -2.5 to -1.9). Relative VO₂peak increased in KD-SIT (+13.0%, d = 1.1) and KD-MICT (+7.8%, d = 0.6) groups. However, all KD groups exhibited elevated PSQI scores (12.2-29.8%; d = 0.3-1.0), indicating impaired sleep quality. Daytime dysfunction scores fell in the KD-MICT (-31.3%, d = -0.2) and KD-SIT groups (-20.0%, d < 0.01), but rose in KD-CON (+66.7%). Greater weight loss correlated with larger increases in PSQI (r = -0.5, p < 0.01). Protocol adherence ranged from 82.4% to 94.1%.</p><p><strong>Conclusions: </strong>Short-term time-restricted KD reduces weight and improves CRF when combined with exercise, especially SIT, but temporarily impairs sleep quality. Exercise partially attenuated daytime dysfunction, suggesting that cardiorespiratory adaptations occur earlier than sleep-related adjustments during early KD intervention.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate-to-loud in-ear music worsens ventilatory efficiency and running biomechanics during fixed-speed treadmill running: a sex-stratified randomized crossover study.","authors":"Marco Morrone, Davide Natale, Lucia Ventura, Anna Boi, Gianluca Martinez, David G Behm, Zeevi Dvir, Pasquale Bandiera, Lucia Cugusi, Franca Deriu, Andrea Manca","doi":"10.1139/apnm-2026-0174","DOIUrl":"https://doi.org/10.1139/apnm-2026-0174","url":null,"abstract":"<p><p>Despite widespread use of in-ear music during running, its effects on ventilatory efficiency and biomechanics remain unclear. This study examined whether moderate-to-loud (85 dB SPL) in-ear tempo music affects ventilatory efficiency, running economy (RE), and spatiotemporal biomechanics during fixed-speed treadmill running, and whether responses differ by sex. Thirty-two recreationally active participants (15 women, 17 men; age 22.7±2.2 years) completed two randomized, counterbalanced sessions of 20-min treadmill running at 8 km·h⁻¹ with and without 128-bpm in-ear music. Breath-by-breath gas exchange, spatiotemporal gait parameters, and RPE were collected and analyzed via mixed-model ANOVA. In the whole sample, music induced a fast-shallow breathing pattern: breathing frequency rose by 10.0% and tidal volume fell by 4.6%, with a 5.5% increase in minute ventilation (V̇E; all p≤0.001). Ventilatory efficiency was reduced, with a 4.3% higher V̇E/V̇CO₂ and a 4.5% higher V̇E/V̇O₂ (both p<0.001). Biomechanics shifted toward a more aerial gait: stride time (+1.3%) and stride length (+1.0%; both p=0.002) increased, as did vertical oscillation (+30%, p=0.015) and flight time (+16%, p=0.002), while duty factor fell (-1.3%, p=0.006), with the aerial-gait shift more pronounced in women. Music also slightly raised RE (+1.1%; p=0.009). RPE was lower with music (12.7±2.6 vs. 13.4±2.4; p<0.001). Thus, moderate-to-loud in-ear music during treadmill running elicits an altered, fast-shallow ventilatory pattern that reduces ventilatory efficiency, also shifting running biomechanics toward a less economical pattern. The concurrent lowering of perceived exertion despite a slightly higher metabolic cost underscores a paradoxical dissociation between subjective effort and objective strain. Trial registration: NCT03506282.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review with Meta-analysis of Laboratory-Based Exercise Performance Tests in Transgender Women.","authors":"Joanna Marie Harper, Leonardo Alvares, Philip D Chilibeck, Blair Hamilton, Yanbing Zhou, Christine Jenkins, Hirofumi Tanaka","doi":"10.1139/apnm-2025-0520","DOIUrl":"https://doi.org/10.1139/apnm-2025-0520","url":null,"abstract":"<p><p>This review compared laboratory-based exercise test performance between transgender women (TW) and cisgender women (CW) and/or men (CM). Data sources included SPORTDiscus and PubMed from inception to 2025. Standardized mean differences with 95% confidence intervals were calculated and pooled effects were subsequently assessed. Fourteen studies met the inclusion criteria. Aerobic performance measures included peak oxygen consumption (V̇O2peak) and lactate threshold (LT). Muscle strength and explosiveness measures included handgrip strength, knee extension torque, Wingate peak and mean cycling power output (PPO and MPO), push-up performance, and countermovement jump (CMJ) power. A total of 259 TW (33.1±8.2 years) were included, all of whom had undergone gender-affirming hormone therapy for at least 12 months. Comparator groups included 248 CW (33.5±9.4 years) and 325 CM (34.5±8.9 years). No significant differences were observed between TW and CW in handgrip strength normalized to height2, CMJ power/body mass (BM), knee extension torque (absolute or relative to BM), Wingate PPO/BM and MPO, push-up performance, and LT. TW demonstrated significantly higher absolute V̇O2peak, g=0.65 [0.40, 0.89], and absolute handgrip strength, g=0.97 [0.45, 1.48] than CW while exhibiting lower V̇O2peak relative to BM, g= -0.34 [-0.67, -0.00]. TW scored significantly lower than CM across multiple exercise tests, including V̇O2peak, g= -1.81 [-2.42, -1.20] and for CMJ height g= -1.92 [-2.81, -1.23]. Based on limited evidence, exercise performance in TW has been interpreted as more comparable to CW than to CM; however, given the low-to-moderate inconsistencies in the reviewed studies, more high-quality data are needed to assess this conclusion.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to and Facilitators of Physical Activity in X-Linked Hypophosphatemia: Insights from Lived Experiences.","authors":"Emmett Morgante, Nicholas Tibert, Aliya Khan, Lora Giangregorio","doi":"10.1139/apnm-2026-0037","DOIUrl":"https://doi.org/10.1139/apnm-2026-0037","url":null,"abstract":"<p><p>X-linked hypophosphatemia (XLH) is a hereditary phosphate-wasting disorder that progressively impairs mobility, physical functioning and quality of life. Although physical activity (PA) can improve physical functioning for common comorbidities of XLH, such as osteoarthritis, its effects in individuals with XLH are not understood. The objective of our study was to understand how XLH impacts the experience of participating in PA and to identify barriers to and facilitators of PA specific to people with XLH. To complete our objective, we conducted semi-structured qualitative interviews with adults diagnosed with XLH. Data was analyzed using reflexive thematic analysis. 17 adults (2 male) participated, and we identified four main themes: (1) people living with XLH are unable to or are uncomfortable participating in impact exercise; (2) excessive physical activity causes fatigue and exacerbates pain and stiffness; (3) exercise as a tool to improve symptoms of XLH and function in the long term; (4) strategizing movement and tailoring exercise is essential to exercise participation. We identify two potential intervention directions leveraging identified facilitators to address the reported barriers: (1) education on pacing designed to help individuals with XLH manage fatigue and pain; (2) a continuing education resource designed to help exercise providers tailor exercise for individuals with XLH. Future research should focus on understanding PA in XLH to inform the development of feasible and appropriate interventions. In addition, improving understanding of the pathophysiology of consequences such as osteomalacia, OA, and enthesopathies may help clarify risks associated with PA and XLH.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoglycemia limits endurance performance without carbohydrate ingestion, but what limits it when blood glucose is maintained via periodic carbohydrate ingestion?","authors":"Adriano Eduardo Lima-Silva, Claudio Andre Barbosa de Lira, Romulo Bertuzzi","doi":"10.1139/apnm-2026-0208","DOIUrl":"https://doi.org/10.1139/apnm-2026-0208","url":null,"abstract":"<p><p>The mechanisms underlying fatigue during prolonged exercise remain a topic of ongoing debate. A recent review by Noakes et al. proposes that exercise-induced hypoglycemia (EIH), rather than skeletal muscle glycogen depletion, is a primary determinant of exercise termination, and that prolonged exercise is interrupted by centrally mediated protective mechanism to ensure that fatal neuroglycopenia does not develop. By reanalyzing studies reporting blood glucose at exhaustion, we highlight that, in the absence of carbohydrate (CHO) ingestion, exercise termination consistently coincides with clinically relevant hypoglycemia, supporting the suggestion that low levels of blood glucose operate as an important afferent signal to the brain. However, when CHO is periodically ingested during exercise, exercise termination occurs despite the maintenance of blood glucose within near-resting levels. Thus, blood glucose concentration may no longer represent the dominant afferent signal contributing to exercise termination when CHO is ingested. Instead, other physiological constraints, such as thermal and cardiovascular strain and peripheral muscle perturbations may become increasingly relevant as exercise is prolonged by CHO ingestion. A deeper understanding of how multiple afferent signals interact to regulate muscle recruitment during prolonged exercise may provide new insights for both exercise physiology and sports nutrition. While the recent review of Noakes et al. represents a major advancement toward redefining the role of blood glucose in exercise capacity, it also opens a compelling avenue for future research to clarify the primary limiting factors when prolonged exercise is terminated in the absence of hypoglycemia.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The tightening grip of heat: Understanding human survivability in the face of rising heat extremes - A physiological perspective inspired by the legacy of John R. Sutton.","authors":"Glen P Kenny","doi":"10.1139/apnm-2026-0247","DOIUrl":"https://doi.org/10.1139/apnm-2026-0247","url":null,"abstract":"<p><p>Rising global temperatures and increasingly frequent heatwaves pose a growing threat to human health. Understanding how humans tolerate environmental heat has therefore become a central challenge in environmental physiology. Building upon the scientific legacy of John R. Sutton, this narrative review examines the physiological determinants of human heat tolerance and their implications for health in a warming climate. We first consider approaches used to characterize thermal strain, highlighting evidence that body temperature measurements provide only a partial representation of whole-body heat storage and physiological burden. We then review advances in whole-body calorimetry that have improved understanding of thermoregulatory capacity and revealed substantial variability in heat dissipation associated with aging, chronic disease, biological sex, fitness, acclimation, and other modifying factors. Foundational concepts of compensable and uncompensable heat stress are discussed alongside recent efforts to define critical environmental limits and human survivability thresholds. Emerging evidence indicates that heat tolerance reflects dynamic interactions between thermal demand and heat dissipation capacity rather than a single physiological or environmental threshold. We further examine findings from prolonged heat exposure and heatwave simulation studies demonstrating that physiological strain may develop under thermally compensable conditions and accumulate across multiple systems even when the body is able to maintain thermal equilibrium. These findings highlight an important distinction between human survivability and liveability during extreme heat events. Collectively, the evidence supports an integrative framework in which human heat tolerance is viewed as a dynamic, multisystem process shaped by environmental conditions, exposure duration, recovery opportunities, mitigation strategies, and individual physiological capacity.</p>","PeriodicalId":93878,"journal":{"name":"Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}