BY:

MS. LOURADEL M. ULBATA, RN, MAN

TEMPERATURE REGULATION &
MOBILITY
Simple Facts
A reduction in body water results in a decrease in
performance
Hydration status is determined by water intake
and loss
Lack of water consumption impairs the body and
after several days, can result in death
Over consumption of water can also result in
problems
50-60% of the bodys mass is water

Simple facts (cont.)
Lean body mass (LBM) is comprised of 75%
water
Fat contains 5% water
154lb male=42L
154lb female=35L
Sweating: uses water to cool body and prevent
hyperthermia

Body Temperature
measure of the body's ability to generate and get rid of heat
The temperature of the deep tissues of the body which is
known as the core temperature remains almost exactly
constant except when a person develops a febrile illness.
On the other hand the skin temperature rises & falls with the
temperature of the surroundings.
The core body temperature can be measured either orally or
rectally. The oral temperature is normally 0.5
0
C lower than
the rectal temp., is affected by many factors including
ingestion of hot or cold fluids & mouth breathing.
The average normal oral temperature in young adults
measured in the morning is 37C with a range between 36.3
and 37.1 C.
Core body temperature: deep tissues
Shell body temperature: peripheral
Core temperature rises quickly when heat gain exceeds heat
loss during vigorous exercise in a warm environment.
Physiological variations in body
temperature
1. Normally, the body temp. undergoes a regular
circadian fluctuation of about 0.6
0
C being
lowest in the morning & highest in the evening.
2. In Woman there is a monthly cycle of temp.
variation characterized by a rise in basal temp.
of about 0.5
0
C at the time of ovulation &during
the second half of the menstrual cycle.A similar
rise occurs during the first trimester of
pregnancy.


3. In children temp. regulation is less precise and
they may normally have a temp. that is 0.5
0
C
above the normal for adults.
4. During exercise, excess heat is produced in the
body and the rectal temp. can normally rise to as
high as 40
0
C .
5. Emotional excitement slightly increases the body
temp. probably due to unconscious tensing of
muscles.
6. When the metabolic rate is high the body temp. is
chronically elevated by as much as 0.5
0
C and vice
verse.
7. Constitutional hyperthermia.
The balance between heat
production & heat loss :
The body temp. is kept constant when the rate of
heat production in the body is equal to the rate of
heat loss.
Heat is produced in the body by the basal rate of
metabolism, contraction of skeletal muscles, food
ingestion and extra metabolism caused by the slow
but prolonged effect of thyroxin on the cells and the
rapid but short lived effect of epinephrine, nor
epinephrine and sympathetic effects on the cells.
Most of the heat produced in the
body is generated in the organs
especially in the liver, the brain
the heart and the skeletal muscles
especially during exercise.
Therefore, heat loss from the body
occurs in two steps :
A. Conduction of heat from the deeper organs
and tissues to the skin.
B. Transfer of heat from the skin to the
surrounding.
A.) Heat Conduction to the
Skin
The skin and the subcutaneous tissues
especially the fat form a heat insulator system
for the body. This system maintains the normal
core temp., although the temp. of the skin may
approach the temp.of the surrounding.
Blood vessels penetrate the fatty subcutaneous
tissues and are distributed beneath the skin.
The amount of heat reaching the skin from the
deep tissues depends upon the blood flow into
the cutaneous blood vessels which is
determined by the degree of vasoconstriction of
the vessels.
This vasoconstriction in turn is controlled
almost entirely by the sympathetic nervous
system. The rate of heat conduction to the skin
is known as tissue conductance.
B.) Heat loss from the skin
surface
1. Radiation :
- It means transfer of heat as infrared
electromagnetic rays from one object to another
at a different temp. with which it is not contact.
- Human body radiates heat rays in all directions
but is also exposed to heat rays radiated from the
surrounding.
- Therefore, heat is lost by this method when the
temp. of the surrounding is less than the body
temp.
- At normal temp. about 60% of the total heat
loss from a nude person occurs by radiation.
2. Conduction :
It means heat exchange between
objects at different temp. that are in
contact with one another.
Only minute amount of heat are
normally lost from the body by direct
conduction to other objects such as
a chair or bed (3%). On the other
hand large amounts of heat are lost
by conduction to air.

3. Convection :
It is the removal of heat from the
body by convection air currents.
Heat must first be conducted to the
air and then carried away by the
convection current.
About 12% of heat loss from the body
occurs by conduction to the air and
then by convection.
When the body is exposed to wind
heat loss by convection is greatly
increased.
4. Evaporation :
Evaporation of 1g water removes about 0.6 Kcal. Of
heat. Even when a person is not sweating, a certain
amount of water still evaporates from the skin and
lungs at a rate of about 600 ml/day. This is known as
the insensible water loss.
Sweating provides a very important way of heat loss
from the body which can be regulated.

5. Small amounts of
heat are removed in the
urine and Feces.

Exercise Generates Heat
Core temperature normally increases during
exercise.
The relative stress of exercise determines the
magnitude of the increase.
A well-regulated temperature increase creates a
more favorable environment for physiologic and
metabolic functions.

Cutaneous and muscle blood flow increase
during exercise in the heat, while other tissues
temporarily compromise their blood supply.
For every liter of oxygen (O2), 4 calories of heat
are produced, with only 1 calorie used for energy
An athlete using 4L O2/minute, heat production is
about 917 calories for hour

Thermoregulation
Thermoregulation is the bodys mechanism to
regulate body temperature and prevent
overheating
The hypothalamus serves as the thermostat
for temperature regulation.

Temperature regulating centres
:
The temp. of the body is regulated almost entirely
by temp. regulating centers located in the
hypothalamus.

1. The anterior hypothalamus-preoptic area :
The preoptic & anterior hypothalamic nuclei
contain two types of neurons :
A) Heat Sensitive neurons(receptors) which are
present in large numbers.They increase their rate
of firing as the temp. rises.
B)Cold sensitive neurons (receptors)
which are less in number than the heat
sensitive neurons.Their firing rate increase
when the body temp. falls.Both of these
types of cells function as temp. sensor for
controlling body temp.
2. The posterior hypothalamus :
The posterior hypothalamus contains a special area that
receives signals from the anterior hypothalamus -
preoptic area and from peripheral receptors where they
are combined to provide mainly the heat producing and
heat conserving reactions.
(it is the regulating C., it is the thermostat.)
Peripheral receptors for detection
of Temperature
These receptors play an important role in temp.
regulation. They are present in the following sites:

A) The skin :- Where both cold and warmth
receptors are present.However, there are far more
cold receptors than warmth receptors. Therefore,
skin receptors mainly concerns detection of cold
rather than warm temp. of the body surface.

B) Deep body tissues :
Mainly in the spinal cord, in the
abdominal viscera, and around the
great veins. These receptors detect
body core temp. rather than the
body surface temperature.
Yet . Like the skin receptors they
detect cold. Therefore, both the skin
and deep body receptors are
concerned with preventing low body
temperatures.
Temp. regulating
mechanisms :
When the body core temp. either increase above or
decreases below almost exactly 37
o
C, several
thermoregulatory responses take place to bring it
back to this temp. Therefore, this critical temp. level
is called theset-point of the temp. control system.

The temp. regulating mechanisims include
autonomic,somatic endocrine & behavioral
changes.When the body temp. increases above the
critical temp,(the set-point in the hypothalamus),one
group of these changes take place to increase heat
loss & decreases heat production.
On the other hand, when the body temp. decreases
below the set point. Another group of change takes
place to decrease heat loss & increase heat production.

Temp. decreasing mechanisms
activated by heat :

A) Increase heat loss :
1) Cutaneous vaso dilatation :
This occurs in almost all areas of the body.It
is caused by inhibition of the sympathetic
centers in the posterior hypothalamus that
causes vasoconstriction. Cutaneous
vasodilatation increase the rate of heat tranfer
to the skin.
2. Sweating :
When the anterior hypothalamus-preoptic
area is stimulated by heat, impulses are
transmitted to the spinal cord and then
through the sympathetic cholinergic fibers
to the sweat glands to increase their
secretion. This in turn increases the
evaporative heat loss. Sweat gland can
also be stimulated by epinephrine or nor
epinephrine circulating in the blood. This
is important during exercise.
Acclimatization of the sweating
mechanism :
When a normal person is exposed to hot weather
for 1 to 6 weeks, two changes take place which
are called acclimatization of the sweating
mechanism.
These are :

A) Sweat production increases to as much 2
liters/hour.
B) Decreased concentration of sodium chloride in
the sweat caused by increased secretion of
aldosterone.

3. Behavioral responses
:
B) Decrease heat production :
1. Strong inhibition of mechanisms which cause
excess heat production.
2. Anorexia.
3. Apathy and inertia
II. Temp. increasing mechanisms activated by cold
A) Decrease heat loss :
1.) Cutaneous vasoconstriction :
Caused by stimulation of the posterior
hypothalamus sympathetic centers. This
decreases the rate of heat transfer to the skin.
2. Pilo erection
Which is caused by sympathetic stimulation of the
erector pili muscles.This mechanism is not
important in the human being and is manifested by
goose skin, but in lower animals upright
projection of the hairs allows them to entrap a thick
layer of insulator air next to the skin.

3.) Behavioral responses.(to put on
suitable clothes.)




B) Increase heat production:
1) Shivering :
It is an involuntary response of the skeletal
muscles which is controlled by an area in the
posterior hypothalamus called the primary motor
center for shivering .
This area is normally inhibited by signals from the
heat center in the anterior hypothalamus but is
excited by cold signals from the skin and spinal
cord. Therefore, this center becomes activated
when the body temp. falls even slightly below
37
0
C.
It then transmits signals down the brain stem
and spinal cord to the anterior motor neurons
to increase the tone of the skeletal muscles
throughout the body. When the tone rises
above a certain critical level, shivering
begins.During Maximum shivering,body heat
production can rise to as high as five times
normal.
2. Semiconscious general
increase in motor activity.
3. Increased secretion of nor
epinephrine and epinephrine
This can cause an immediate increase in the rate of
cellular metabolism.
This effect is called chemical thermo genesis This
process occurs in brown fat.
Adults do not have a significant amount of this type
of fat, therefore chemical thermo genesis increases
the rate of heat production only 10%.
On the other hand, infants have some brown fat in
the interscapular space & chemical thermo genesis
can increase the rate of heat production as much as
100% which is very important factor in maintaining
their normal body temp.
4) Increased thyroxin secretion
Exposure to cold increase the production of
thyrotropin-releasing hormone by the hypothalamus
which stimulates the secretion of the thyroid
stimulating hormone (TSH) from the anterior pituitary
gland.
TSH in turn stimulates increased output of thyroid
gland.Thyroxin increase the rate of cellular
metabolism throughout the body I.e.it is another
mechanism of chemical thermo genesis .However,
this increase in metabolism requires several weeks
for the thyroid gland to hypertrophy before it reaches
its new level of thyroxin secretion. Moreover, it is of
little significance in adult humans.
Sweating and Exercise
Increased sweating strains fluid reserves,
creating a relative state of dehydration.
Excessive sweating without fluid replacement
decreases plasma volume and causes core
temperature to rise precipitously.

Water Loss
Dehydration
Considerable water loss occurs during several
hours of intense exercise in a hot environment.
Both intracellular and extracellular compartments
contribute to fluid deficit.
The risk of heat illness greatly increases when a
person begins exercising in a dehydrated state.
Sweat is hypotonic with other body fluids.

Dehydration and Exercise
Just about any degree of dehydration impairs the
capacity of circulatory and temperature-regulating
mechanisms to adjust to exercise demands.
Dehydration of as little as 2% body mass impairs
physical work capacity and physiologic function
and predisposes to heat injury when exercising in
a hot environment.
The risk for dehydration increases during
vigorous cold-weather exercise.
Exercise Clothing
Cottons and linens readily absorb moisture.
Heavy sweatshirts and rubber or plastic
garments produce high relative humidity close to
the skin.
Dark colors absorb light rays and add to radiant
heat gain.
Light colors reflect heat rays away from the body.
Moisture-wicking fabrics provide optimal transfer
of heat and moisture from the skin to the
environment.
Dangerous Conditions:
Physiological Effects of Dehydration
Decreased blood volume
Decreased blood flow to skin
Decreased sweat rate (due to increased blood
osmolarity)
Decreased heat dissipation
Increased core temperature
Increased muscle glycogen use
Decreased cardiac output
Decreased gastric emptying 20-25% (@5%
dehydration)
Heat stress from the environment alone can decrease
VO2max by 7%

Dangerous Conditions:
Effects of Dehydration on Exercise
Performance
2% dehydration impairs performance
5% dehydration decreases work capacity by
about 30% (impedes heat dissipation,
compromises cardiovascular function, and
diminishes exercise capacity)
2.5% dehydration decreases sprinting capacity
(can occur with acute dehydration)
7% dehydration will increase fatigue due to heat
strain

Prevention
Factors to be aware of:
Hydration status
Environmental temperature
Consume fluids prior to exercise (hyperhydrate)
Consume fluid during early stages (minimize
dehydration and maximize availability)
Acclimate slowly
Be aware of heat-related illness signs
Rehydration
Properly scheduling fluid replacement
maintains plasma volume, so circulation and
sweating progress optimally
A well-hydrated individual always functions at
a higher physiologic and performance level
than a dehydrated -person.
Achieving hyperhydration before exercising in
a hot environment protects against heat stress
because it:
Delays dehydration
Increases sweating during exercise
Diminishes the rise in core temperature
Adequacy of Rehydration
Body weight changes indicate the extent of water
loss from exercise and adequacy of rehydration
during and after exercise or athletic competition.
Urine and hydration:
Dark yellow urine with a strong odor = inadequate
hydration
Large volume, light color, without a strong odor =
adequate hydration
Sodium and Rehydration
A moderate amount of sodium added to a
rehydration beverage provides more complete
rehydration.
Maintaining a relatively high plasma
concentration of sodium helps:
Sustain the thirst drive
Promote retention of ingested fluids
More rapidly restore lost plasma volume during
rehydration
Hyponatremia
Low blood level of sodium (<135 mEq/L)
Can occur due to excessive water intake
A sustained low plasma sodium concentration
creates an osmotic imbalance across the blood
brain barrier that causes rapid water influx into
the brain.
The resulting swelling of brain tissue produces a
cascade of symptoms that range from mild to
severe.
Heat Illnesses
Heat cramps
Involuntary muscle spasms that occur after
intense physical activity
Heat exhaustion
Most common heat illness
Heat stroke
Most serious and requires immediate medical
attention
Heat Illnesses
Increases if athlete is dehydrated, less trained,
and less acclimatized
Initial stages:
Exercise increase energy production & increases
heat which will increase core temperature
Increased blood flow to the skin, decreased blood to
organs
Increased toxins occur, causing blood poisoning,
decreased BP, and fainting

Abnormalities Of Body Temp.
Regulation
Fever ( pyrexia) : It means an elevation of
core body temp. above the level which is normally
maintained by the individual.
- It results when the set point of the hypothalamic
temp. control system is elevated to a new point
above 37
0
C.
- Consequently, all the mechanisms for raising the
body temp. are activated including shivering and
cutaneous vasoconstriction.
- Within few hours the body Temperature
approaches the new set point temperature which
rarely exceeds 41.1
0
C.
Pathogenesis Of Fever :
Substances which elevate the set point are
called pyrogens and they include bacterial
toxins,components of various micro organisms
and products of tissue degeneration.These
substances act on cells of the immune system
including monocytes,macrophages and kupffer
cells to produce cytokines that act as
endogenous pyrogens (EP
S
)eg. Interleukin 6 (IL-
6), tumour necrosis factor or (TNF), IL-1 and
several interferons.
Therefore cytokines activate the preoptic area of the
hypothalamus most probably through local release
of prostaglandins.They may inter act directly with
neutral tissues.Drugs that reduce the level of fever
are called antipyreticse.g. aspirin.They act by
blocking the synthesis of prostaglandins.
Fever within limits is presumably beneficial
because it may inhibit the growth of many micro
organisms and increase antibody production.
However very high temp. are harmful.When the
rectal temp. is over 41
0
C for prolonged periods,
some permanent brain damage results.
Hyperthermia :
It means an elevation of body temp. higher than
the thermoregulatory set point, usually due to an
exogenous cause.
It may be caused by :
1) Increased heat production e.g. by severe
muscular exercise or high environmental temp.,
which exceeds the normal capacity of heat loss
mechanism.
2) Impaired heat loss e.g. due to high humidity or
drugs that impair sweating such as
anticholinergics.
3) Brain tumors compressing the
hypothalamus.
When the rectal temp. is over 43
0
C, the person
develops heat stroke which commonly causes
death because :
A) There is a limit to the rate at which the body can
loss heat even with maximal sweating.
B) When the hypothalamus becomes excessively
heated,its heat regulating ability becomes greatly
depressed and sweating diminishes. As a result a
high body temp. tends to perpetuate itself.
Symptoms of heat stroke include
dizziness, abdominal distress, delirium
and eventually loss of consciousness
and death.These manifestations result
from two causes :

1) Direct damaging effect of very
high body temperature on all
body tissues especially the
brain.
2) Some degree of circulatory
shock caused by excessive loss
of fluid and electrolytes in the
sweat.
Treatment of hyperthermia
exceeding 41.1
o
C must be
immediate
Removal from direct sunlight, removal of clothing,
wetting the body surface and fanning are simple
measures which can be undertaken on the spot. If
these are not enough the most effective action is to
immerse the patient in the ice water bath while
monitoring core temperature to be certain that a
state of hypothermia is not induced.
Hypothermia :
It is defined as core body temperature of less than
35
0
C.
Hypothermia is caused by exposure to cold
especially when associated with other conditions
such as advanced age, decreased metabolic rate,
CNS diseases, malnutrition, drugs as alcohol and
paralysis.
Effects of hypothermia on the body include
depressed mental status followed by loss of
consciousness, shivering which stops below 32
0
C,
very slow respiration, low heart rate, decreased
blood pressure and arrhythmias .
At rectal temp. of about 28
0
C, ability to
spontaneously return the temp. to
normal is lost. However, if the
individual is rewarmed with external
heat, he survives and returns to a
normal state.

END