Practical and accessible cooling strategies for mitigating exertional hyperthermia in low-resource workplaces

Climate change is intensifying heat-related health risks, necessitating the identification of effective personal cooling interventions, particularly within low-resource work settings where access to air-conditioning may not be available. This systematic review evaluated core temperature cooling rates of practical, low-cost personal cooling strategies for moderate-to-severe hyperthermia. We searched five databases for original research, screening 4420 studies, identifying 145 eligible studies. Strategies included air-conditioning (included as comparator point of reference), passive rest, limb immersion, whole-body immersion (cool-temperate water), fanning, misting, water dousing, and ice application. On average, whole-body water immersion (15–25°C) was the most effective cooling method, eliciting cooling rates of 0.13°C·min−1. This was followed by temperate (25–28°C) whole-body immersion (0.06°C·min−1), cold (5–15°C) limb immersion (0.05°C·min−1). Most strategies outperformed or were equal to passive rest in air-conditioning (0.03°C·min−1) and were superior to passive rest in warm-hot conditions (0.02°C·min−1). Although the observed cooling rates are insufficient for treating clinical heatstroke, they offer viable strategies to manage moderate hyperthermia by reducing core temperature by ≥1°C during short rest periods (≤30 min). These strategies could be implemented across various workplace settings depending upon occupational demands. Notably, most studies focused on healthy young adults, limiting generalizability to diverse and more at-risk populations (e.g. older workers). Future research should assess these interventions in vulnerable groups and in real-world settings, including evaluating combined cooling practices. This review provides a foundation for developing heat-resilient workplaces and reducing reliance on, or provide alternatives to, carbon intensive air-conditioning.