Purpose Thermal perception, including thermal sensation (TS), influences exercise performance in the heat. TS is a widely used measure and we examined the impact of initial TS (iTS) on performance loss during exercise in simulated Tokyo environmental conditions among elite athletes. Methods 105 Elite outdoor athletes (endurance, skill, power and mixed trained) participated in this crossover study. Participants performed a standardized exercise test in control (15.8 ± 1.2 °C, 55 ± 6% relative humidity (RH)) and simulated Tokyo (31.6 ± 1.0 °C, 74 ± 5% RH) conditions to determine performance loss. TS was assessed ± 5 min prior to exercise (iTS) and every 5 min during the incremental exercise test (TS). Based on iTS in the Tokyo condition, participants were allocated to a neutral (iTS = 0, n = 11), slightly warm (iTS = 1, n = 50), or warm-to-hot (iTS = 2/3, n = 44) subgroup. Results For the whole cohort iTS was 1 [1-2] and TS increased to 3 [3-3] at the end of exercise in the Tokyo condition. Average performance loss was 26.0 ± 10.7% in the Tokyo versus control condition. The slightly warm subgroup had less performance loss (22.3 ± 11.3%) compared to the warm-to-hot subgroup (29.4 ± 8.5%, p = 0.003), whereas the neutral subgroup did not respond different (28.8 ± 11.0%, p = 0.18) from the slightly warm subgroup. Conclusion iTS impacted the magnitude of performance loss among elite athletes exercising in hot and humid conditions. Athletes with a warm-to-hot iTS had more performance loss compared to counterparts with a slightly warm iTS, indicating that pre-cooling strategies and/or heat acclimation may be of additional importance for athletes in the warm-to-hot iTS group to mitigate the impact of heat stress.
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