Muniz-Pardos B, Angeloudis K, Guppy FM, et al. Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport. BMJ Open Sport & Exercise Medicine 2021;7:e001041. doi:10.1136/ bmjsem-2021-001041.


Yannis Pitsiladis
Tell us more about yourself and the author team

I [Pitsiladis] have an established history of research and teaching into the importance of lifestyle and genetics for human health and performance. My research interests are diverse but coalesce around the promotion of sports integrity. I am a member of the Medical and Scientific Commission of the International Olympic Committee (IOC), member of the Executive Committee and Chair of the Scientific Commission of International Federation of Sports Medicine (FIMS), member of the Scientific Commission of the European Federation of Sports Medicine (EFSMA), member of World Anti-Doping Agency (WADA) Health Medical Research Committee.

The team comprises a subgroup (n=7), with interest in wearable technology and sport) of the IOC Adverse Weather Impact Expert Working Group for the Tokyo Olympic Games 2020 and a subgroup of the FIMS Guiding Reference Standard (GRS) for Wearables (n=5). The main objective of the FIMS GRS is to encourage technological innovations for use in sport and provide high-quality, external, and non-profit validity testing of this technology.


What is the story behind your study?

The Tokyo Summer Olympics will be held in environmental conditions in excess of 30oC and >70%. These conditions are expected to play havoc with the performances of athletes and threaten also their health. It is imperative therefore that we utilize all technological innovations available, or develop these when they do not exist to assess the true impact of the extreme conditions on high-level performance and help develop solutions to protect the health of athletes. Many heat mitigation solutions will be on show in Tokyo ranging from highly technological (i.e., colling devices) to improvised solutions (i.e., ice caps).

For example, we are developing and plan to implement an ecosystem that provides live feedback of land and air temperature, heart rate and a range of biomechanical variables facilitated through a Cloud-based portal allowing medical teams to view the data on a desktop, tablet, or a smartphone. We are working systematically to develop such innovative wearable solutions in time for Tokyo 2020 (in the first instance, and perfect for Paris 2024 and LA2028), to protect the health of athletes competing in the heat.


In your own words, what did you find?

The need for this review emerged from the rapid evolution and development of wearable technology (such as what we plan to implement) and the need for a regulated implementation of this technology. There is an urgent need to better understand the functionality, utility and applicability of these technologies in order to optimise their effectiveness. However, currently, there is no independent expert group or regulatory body empowered to regulate the use of wearables during competition according to their validity and availability to all athletes/technical teams. This review is motivated to highlight the need for new technological innovations but an informed and considered implementation. With this objective in mind, concerted efforts of our research team in collaboration with the International Federation of Sports Medicine (FIMS) have already proceeded in order to encourage exciting new technological innovations but also to establish a Guiding Reference Standard (GRS) for wearable devices. The main objective of this GRS is to provide high-quality, external, and non-profit validity testing for impactful wearable technology. This validity and certification process would be necessary so that both the athlete’s physical integrity and sports integrity prevail.


What was the main challenge?

The utilization of technology will undoubtedly become the norm at major sporting events as international sporting federations seek to make their sport more interesting and accessible to wider audiences. Such technological innovations are being accelerated due to Covid-19 and are destined to offer coaches, athletes and support teams an unheralded opportunity to use either performance metrics and/or bio-metrics to improve performance. Today, much of this technology is not athlete user-friendly, lacks validation and threatens the “universality of sport principle” i.e., equal access to all. Solutions are needed such as developing more symbiotic partnerships between sport, health and technology that encourages and harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete’s care. Such partnerships would encourage new technological innovations that would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions).


If there is one take-home message from your study, what would that be?

Technology will undoubtedly revolutionize sports in numerous ways (e.g., performance benefit, improve spectator experience, protect the health of athletes). However, like any game-changing innovation, technology must be implemented into sports in a considered manner that protects the integrity of the competition. It is hoped that the discussion this review will encourage will motivate the governing bodies of sport to develop an independent “technological fairness expert group” to safeguard the integrity of sport.

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