The cumulative effects of consecutive days of prolonged, physical work or activity on heat strain and physical performance: a systematic review.

With climate warming, there is an urgent need to understand the health effects of occupational heat exposure. This systematic review examined the cumulative effects of consecutive days of prolonged physical work or activity on heat strain and physical performance. Electronic databases MEDLINE, SPORTDiscus, PsychInfo, and Academic Search Complete were searched until July 2024 with terms related to work, consecutive days, and heat. Studies were included if they involved ≥4 h of physical work/activity on ≥2 consecutive days, and included a measure of heat strain (e.g., core temperature) or physical performance (e.g., repetitions). After removing duplicates, 6030 studies were screened (title and abstract), 133 progressed to full-text screening, and 33 met the inclusion criteria with risk of bias assessed. However, only five studies used standardized environmental and work conditions across days. Synthesis of the cumulative effects (without meta-analysis) was therefore restricted to these studies. None observed a cumulative impact on heat strain, as indexed by a higher core temperature or heart rate compared to day 1. None reported a reduction in physical task performance across days. These findings indicate that the cumulative effects of occupational heat exposure on heat strain and physical task performance were minimal, although evidence supporting this conclusion is sparse. PROSPERO registration: CRD42023452936.