Heat intolerance: the challenge of returning to duty post-exertional heatstroke

Exertional heatstroke, a critical and severe condition precipitated by intense physical exertion in high-temperature settings, frequently culminates in a protracted state of heat intolerance among athletes and military personnel. This condition not only jeopardizes individual health but also impedes their capacity to resume their duties. Emerging research indicates that the chronic heat intolerance that follows exertional heatstroke is markedly distinct from the pathophysiological trajectories of acute heat injury, encompassing intricate alterations across various systems and levels. The present paper provides a comprehensive narrative review of the underlying mechanisms of heat intolerance post-exertional heatstroke, along with the diagnostic criteria and therapeutic strategies for heat endurance rehabilitation. Furthermore, it scrutinizes the shortcomings inherent in current diagnostic and therapeutic methodologies and anticipates future research trajectories, with the ultimate goal of enhancing the return-to-duty efficiency of individuals who have suffered from heatstroke.