A psycho-cognitive model for exertional heatstroke: theory and preliminary testing using self-report measures in a case-control study

Background Exertional heatstroke (EHS) stands as the most severe manifestation within the spectrum of heat-related illnesses arising during sport competition or physical activity within specific contexts such as military training. Despite substantial progress in comprehending the physiological aspects of EHS, current evidence underscores the necessity for a more comprehensive perspective that incorporates psycho-cognitive factors. Methods The present study introduces a psycho-cognitive model for EHS and initiates its empirical validation through self-report measures in a case-control study. Our central hypothesis suggests that EHS may emanate from a disruption in the cost-benefit trade-off associated with prolonged physical activity. Specifically, we propose that EHS could be a consequence of overvaluing the benefits linked to physical activity due to excessive motivation to succeed and undervaluing effort exertion costs resulting from low interoceptive awareness, characterized by disrupted processing of signals related to the body’s internal state. Results Analysis of our psychometric data revealed that individuals with a history of EHS (cases, N=51) self-report diminished interoceptive awareness compared to their healthy counterparts (controls, n=43). There was no significant difference in the global motivation trait between cases and controls. Furthermore, cases exhibited a less developed trait mindfulness compared to controls. Conclusion Our study establishes theoretical foundations and offers preliminary support for a psycho-cognitive model of EHS. The results suggest that relatively straightforward measures, such as self-report questionnaires, can be instrumental in identifying intrinsic (i.e., individual-specific) risk factors for EHS. The psycho-cognitive approach to understanding EHS holds promise for informing innovative prevention strategies aimed at mitigating its risk in sports competitions and military settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is part of a project supported by the French Military Health Service. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study has been approved by the regional ethics committee of the Agence Régionale de Santé Occitanie (Comité de Protection des Personnes Sud-Ouest et Outre-Mer II, ID-RCB: 2020-A01967-32) on September 29, 2020. The study was conducted in accordance with ethical standards of the 1964 Helsinki declaration and its later amendments. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data and materials are currently private for peer review.