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Comparison of an In-Helmet Temperature Monitor System to Rectal

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 COMPARISON OF AN IN-HELMET TEMPERATURE
MONITOR SYSTEM TO RECTAL TEMPERATURE
DURING Exercise
P. JASON WICKWIRE,1 ROBERT J. BURESH,2 LAURIE L. TIS,2 MITCHELL A. COLLINS,2
ROBERT D. JACOBS,3 AND MARLA M. BELL4
1
Exercise Physiology and Countermeasures Project, Wyle Integrated Science and Engineering, Houston, Texas; 2Department of
Health, Physical Education, and Sport Science, Kennesaw State University, Kennesaw, Georgia; 3School of Health, Physical
Education, and Recreation, University of Nebraska Omaha, Omaha, Nebraska; and 4Department of Mathematics and Statistics,
Kennesaw State University, Kennesaw, Georgia
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ABSTRACT
Wickwire, PJ, Buresh, RJ, Tis, LL, Collins, MA, Jacobs, RD, and
Bell, MM. Comparison of an in-helmet temperature monitor
system to rectal temperature during exercise. J Strength
Cond Res 26(1): 1–8, 2012—Body temperature monitoring is
crucial in helping to decrease the amount and severity of heat
illnesses; however, a practical method of monitoring temperature
is lacking. In response to the lack of a practical method of
monitoring the temperature of athletes, Hothead Technologies
developed a device (HOT), which continuously monitors an
athlete’s fluctuations in body temperature. HOT measures
forehead temperature inside helmets. The purpose of this study
was to compare HOT against rectal temperature (Trec). Male
volunteers (n = 29, age = 23.5 6 4.5 years, weight = 83.8 6
10.4 kg, height = 180.1 6 5.8 cm, body fat = 12.3 6 4.5%)
exercised on a treadmill at an intensity of 60–75% heart rate
reserve (HRR) (wet bulb globe temperature [WBGT] = 28.7° C)
until Trec reached 38.7° C. The correlation between Trec and HOT
was 0.801 (R2 = 0.64, standard error of the estimate (SEE) =
0.25, p = 0.00). One reason for this relatively high correlation is
the microclimate that HOT is monitoring. HOT is not affected by
the external climate greatly because of its location in the helmet.
Therefore, factors such as evaporation do not alter HOT
temperature to a great degree. HOT was compared with Trec
in a controlled setting, and the exercise used in this study was
moderate aerobic exercise, very unlike that used in football. In
a controlled laboratory setting, the relationship between HOT and
Trec showed favorable correlations. However, in applied settings,
helmets are repeatedly removed and replaced forcing HOT
to equilibrate to forehead temperature every time the helmet is
Address correspondence to Dr. Jason Wickwire, pjwickwire@gmail.com.
26(1)/1–8
Journal of Strength and Conditioning Research
Ó 2012 National Strength and Conditioning Association
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Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
replaced. Therefore, future studies are needed to mimic how
HOT will be used in field situations.
KEY WORDS heat injury risk, temperature monitoring device,
forehead temperature, encapsulated temperature measurement
INTRODUCTION
A
ccording to the National Center for Catastrophic
Sport Injury Research, there were 127 deaths from
heat stroke in football from 1960 to 2009 (17).
Since 1995, 46 football players (35 high school,
8 college, 2 professional, and 1 sandlot (17)) died of heat
stroke. However, these figures are probably lower than reality
as a result of these types of injuries being underreported.
Because of the high incidence and serious nature of these
injuries in sport, it is imperative that coaches and athletic
trainers make every effort to ensure athletes maintain a safe
temperature (3). Several methods have been suggested by the
National Institute for Occupational Safety and Health to
monitor those performing work in the heat, which include
heart rate, oral temperature, and/or body water loss (22).
Although heart rate is a rather easy physiological parameter
to monitor, this measure alone does not provide enough
information to assess temperature or risk of experiencing
a heat illness. In any sport setting, heart rate will fluctuate
with the given intensity of the work being accomplished.
Therefore, it would be hard to determine if the ebb and flow of
the heart rate of those performing work in these settings is
because of high temperature or because of the work itself.
Oral temperature also poses problems for monitoring
increased body temperature of athletes, especially football
players. This measure would be nearly impossible to con-
tinuously monitor in athletes because of the risk of having an
object in the mouth during play. Therefore, monitoring is only
feasible during breaks. This inherently means that coaches and
athletic trainers would not be aware of any temperature changes
between breaks. Also, this type of monitoring poses a problem
because of the burdensome workload that this puts on the
VOLUME 26 | NUMBER 1 | JANUARY 2012 | 1
 In-Helmet Temperature Monitor

athletic trainers (and others) that would be responsible for

obtaining the oral temperatures. Because of the time that this
would take, it is conceivable that athletes in whom oral
temperature was measured last might be in greater danger of
incurring a heat illness because the athletic trainers would not be
aware of their excessively elevated temperature for an extended
amount of time. Thus, these particular athletes’ treatment would
inherently be delayed. Additionally, oral temperature is not
a valid predictor of core temperature (8). This means that even
if oral temperature was a practical monitoring technique, it is of
little value in tracking heat illness risk.
The last of these recommendations by the National
Institute for Occupational Safety and Health, monitoring
body water loss, which is also a recommendation of the
National Athletic Training Association (NATA) (3), is not
a practical method for an estimate of the degree of heat illness
risk either. This measure could tell a great deal about an
athlete’s heat illness risk, but, again, it is not a practical
method because athletes would have to be undressed to
minimal clothing at several points throughout a practice or
training session to be weighed. Coaches and athletic trainers
are not likely to go to this trouble. Also, this innately means
that athletes could not be continuously monitored while they
are practicing, which means that the coaches and athletic
trainers may not know, in a timely manner, whether or not
a particular athlete had reached a potentially dangerous
core temperature. However, athletes’ weight should still be
checked prepractice and postpractice to ensure that these
athletes are not being chronically dehydrated over time.
Another problem with all 3 of the above variables (heart
rate, oral temperature, and body water loss) is that they
are subject to considerable interindividual variability while
Figure 1. Photograph of the HOT monitor tag and thermocouple.
performing work in the heat (4,9,11,15,16,23,25). Some phys-
iological factors that can influence the above parameters
include hydration level, alcohol consumption, presence of
infection, and acclimatization (9).
Although estimating increased
body temperature is desirable in
athletic settings because of its
practicality, the most accurate
method for determining some-
one’s risk for heat illness is to
monitor core temperature. The
most valid method for deter-
mining core temperature is by
measuring it rectally or esoph-
ageally. Whereas other factors
are needed to determine if a heat
illness has occurred, measuring
rectal temperature would allow
for the quickest estimate of the
degree of risk of heat illness
(given available equipment and
Figure 2. Photograph of the location in the helmet of the HOT monitor tag and thermocouple. subject cooperation). Further-
more, some physiologists may
the TM

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argue that core temperature is typically defined as the tem- TX, USA) estimates core temperature from forehead
perature measured within the pulmonary artery (6). However, temperature. In as much as HOT is in the helmet, football
this method would be extremely invasive. Therefore, for the athletes can be continuously monitored for their heat illness
purpose of this manuscript, core temperature will refer to rectal risk. Therefore, the purpose of this study was to compare
temperature because it is recommended by the NATA (3) and the HOT monitor to rectal temperature (Trec), which was
because it is the most accurate method possible for monitoring the criterion for evaluating the effectiveness of the HOT
core temperature in the field (1,14,20–22). The purpose of monitor.
mentioning rectal temperature as a measure of core temper-
ature in the introduction is to speak to the lack of practicality of
this method in a sport setting.
Rectal temperature monitoring systems are common for
single participant use in a controlled laboratory setting but lack
practical large-scale application in a sport setting. Therefore,
one of the few practical ways to continuously monitor risk of
heat illness by means of core temperature (or by predicting core
temperature) would be by monitoring temperature at an easily
accessible and noninvasive site and predict core temperature
from the temperature being monitored. Another method of
measuring core temperature would be by way of a remote
capsule system. This method is suggested for future research by
the American College of Sports Medicine: Roundtable
Consensus Statement regarding heat stress and injury risk in
youth football (2). These types of systems require each athlete
to swallow a capsule that monitors core temperature by
sending a remote signal to a base station. Although this would
seem to be the most practical method of determining core
temperature, there are inherent problems with this method that
would prevent accurate measures of core temperature. One of
these problems is that when the athlete ingests fluids, the fluids
lower the temperature of the capsule (24) by way of convection
and/or conduction. One might argue that if the capsule is
ingested long enough before monitoring temperature, ingested
fluids will not affect the measured temperature of the capsule.
According to Wilkinson et al. (24), the capsule ‘‘cannot be used
to measure core body temperature accurately in all individuals
for 30-60 minutes after the ingestion of cool fluids during the
following 8 hour period’’ after the capsule is ingested.
Wilkinson et al. (24) goes on to report that fluid ingestion
no longer has a major effect on capsule temperature 10 hours
after the capsule is ingested. Therefore, if the capsule system
was to be used to help football athletes reduce their risk of heat
illness, then the capsule would have to be ingested in the early
hours of the morning or the night before it is needed. It is not
likely that athletic trainers could trust their athletes to wake
themselves to ingest the capsule. Also, if the capsule is ingested
before sleep the previous night, there would be a risk of the
athlete passing the pill through normal bowel movements.
Another of the problems with the capsule system is that the
transmission range between the capsules and the data recorder
is limited (12–18 inches).
As a response to the lack of a viable method of moni-
toring increased body temperature of athletes, Hothead
Technologies developed a device that can monitor the body Figure 3. Photograph of the personal digital assistant that is used to
temperature of football athletes. The Heat Observation monitor the athletes’ thermal stress status.
Technology system (HOT; Hothead Technologies, Dallas,

VOLUME 26 | NUMBER 1 | JANUARY 2012 | 3

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 In-Helmet Temperature Monitor
METHODS
Experimental Approach to the Problem
This study was designed to compare the HOT monitor to Trec.
To accomplish this purpose, subjects performed treadmill
exercise in an environmental chamber (Wet Bulb Globe
Temperature [WBGT] = 28.9 6 2.0° C; relative humidity =
32.6 6 11.0%) while donning a helmet that was fitted with
the HOT device. Subjects’ Trec was also measured during the
experiment. It was only necessary to test subjects on one
occasion because of the forehead temperature (as monitored
by the HOT device) and Trec being measured simultaneously.
Subjects
Subjects were apparently healthy male volunteers (n = 29)
with a mean age of 23.5 6 4.5 years. Participants had a
mean body weight of 83.8 6 10.4 kg, a mean height of
180.1 6 5.8 cm, and a mean percent body fat of 12.3 6 4.5%.
All subjects signed an informed consent approved by the
institutional review board of Kennesaw State University for
the protection of human participants. Therefore, this study
meets widely accepted ethical standards (10).
Procedures
To minimize the risk of participants experiencing a heat
illness, a predetermined temperature of 38.7° C was chosen
as the exercising stopping point for this study. The rationale
for using of a terminal temperature of 38.7° C was because it
is a temperature at which most people will not experience
a heat illness, but is still high enough so that HOT can
be effectively evaluated. It is understood that heat illnesses
would occur at a temperature greater than 38.7° C. However,
a terminal temperature of 38.7° C was chosen in the interest
of safety regarding the prevention of heat illness for the
subjects who volunteered their time to this study.
On arrival, participants signed the informed consent. Then
their target heart rate (HR) was calculated using the Karvonen
Figure 4. Scatterplot to illustrate the relationship between HOT and Trec. Includes all data (n = 29).
the
4 Journal of Strength and Conditioning Research
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heart rate reserve (12,13) formula [{(Maximal HR 2 Resting
HR) 3 Intensity (60 or 75%)} + Resting HR]. In as much as
the purpose of this study was to compare the HOT monitor
to Trec, especially at higher temperatures, each participant
exercised at a target heart rate range of 60–75% of heart
rate reserve. This relative intensity was used so that par-
ticipants did not fatigue themselves before reaching the
terminal temperature (38.7° C) and to prevent excessive exer-
cise duration.
Before beginning the exercise portion of the experiment,
participants inserted a rectal thermometer (RET-1; Phys-
itemp Instruments Inc., Clifton, NJ, USA) covered with an
impermeable sheath approximately 8 cm past the rectal
sphincter for Trec to be measured throughout the experiment.
Next, a heart rate monitor (Polar S120; Polar Electro,
Kempele, Finland) was fitted to the chest and a football
helmet was placed on the head. Varying size helmets (3
helmets total) were used for this study to accommodate for
different size heads. Each helmet had 2 HOT monitors
installed in them. Therefore, the same HOT monitors were
not used for every test. The use of different HOT monitors in
each helmet allowed for the analysis of ‘‘intermonitor’’
reliability. Furthermore, besides the football helmet, partic-
ipants exercised in typical exercise clothing.
The participants walked or jogged in on a treadmill that was
housed in a heat chamber at a speed and grade that would
elicit the calculated target heart rate range. Core temperature
was recorded using a computerized temperature monitoring
system (THERMES USB WFi; Physitemp Instruments Inc.).
The test was terminated when participants reached a Trec
of 38.7° C. As is expected with a study such as this, the
thermocouple used to determine Trec was displaced in a
few participants during the early minutes of the exercise
protocol. To keep Trec and HOT temperatures matched,
when the thermocouple was displaced, previous Trec and
HOT temperature data were
deleted, the thermocouple was
replaced by the participant, and
data collection was reinitiated.
This was not found to have a
significant impact on the results
of this study because of the fact
that the most important data
were collected when the par-
ticipants were at high temper-
atures (i.e., near 38.7° C).
HOT Technical Note
The HOT system (v1.0.2) con-
sists of a preinstalled helmet
monitoring sensor, a handheld
personal digital assistant (PDA)
field monitoring device, and
a desktop data management
system. The helmet monitoring
TM
 the TM

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(Figure 3). Using the desktop

data management system, the
data can be downloaded from
the PDA, which allows the
generation of data reports.
Measured forehead skin tem-
peratures are used to estimate
core temperature using a pro-
prietary algorithm (v1.0.2). The
algorithm was formulated by
the manufacturer based on in-
house testing.

Statistical Analyses
Pearson correlations were calcu-
lated to determine agreement
between Trec and HOT using
Figure 5. Scatterplot to illustrate the relationship between HOT and Trec. Excludes data of 2 participants that did
all data. Furthermore, a Pearson
not fit the normal curve (n = 27). correlation was calculated that
excluded 2 participants’ data that
fell outside of the normal curve.
sensor (Figure 1) is composed of a wireless radio-frequency Reliability among the 2 HOT monitors in each helmet was
identification (RFID) transponder and a proprietary encap- examined. This was not an examination of test-retest
sulated temperature sensor. The RFID transponder has reliability. This was intermonitor reliability. To test inter-
a read/write range up to 1,200 m, with an operation tag monitor reliability, 3 separate correlations were calculated.
that beacons every 15 seconds, providing 3 temperature Three correlations were calculated because 3 different
samples and an identification code. The temperature sensor helmets were used and there were 2 different HOT monitors
is mounted in the helmet (Figure 2) at a location slightly in each helmet.
superior to the eyebrow. The sensor measures temperature to Repeated measures analysis of variance (ANOVA) was used
one hundredth of a degree Celsius. The custom wireless to compare Trec vs. HOT at every 0.1° C (Trec), starting at
RFID tag gathers data from the temperature sensor and 38.0° C. Data lower than 38.0° C was not used because
transmits it to the handheld PDA field monitoring device subjects’ initial Trec varied from 37.0 to 38.0° C. Therefore, too
much data are missing below
a Trec of 38.0° C, which renders
this data of little value. An
alpha level of 0.05 was estab-
lished for all statistical analyses.

RESULTS
The Pearson correlation be-
tween HOT and Trec for all data
was 0.801. This relationship
was not found to be signifi-
cantly different (p = 0.000,
Figure 4). The Pearson correla-
tion for the data when the data
of 2 participants that did not fit
the normal curve were excluded
was 0.808. This relationship
Figure 6. Mean of Trec and HOT plotted over time (SDs are reported for HOT temperatures only because SD = 0 for was not found to be signifi-
Trec). Asterisk represents a Trec of 38.0° C. Repeated measures analysis of variance was conducted comparing Trec cantly different (p = 0.000,
vs. HOT starting at a Trec of 38.0° C to 38.7° C. No significant differences were found between Trec and HOT at Figure 5) as well.
each 0.1° C of Trec. Data below a Trec of 38.0° C are depicted to show how the relationship between Trec and HOT
improves as Trec increases, but no statistical measures were used below a Trec of 38.0° C because of a multitude of The Pearson correlation be-
missing data points below 38.0° C. tween monitor 1 and 2 was 1.00.
The Pearson correlation between

VOLUME 26 | NUMBER 1 | JANUARY 2012 | 5

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Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
 In-Helmet Temperature Monitor
monitor 3 and 4 was 0.975. The Pearson correlation between
monitor 5 and 6 was 0.998. All correlations for intermonitor
reliability were not found to be significantly different (p = 0.000).
Repeated measures ANOVA showed a significant main
effect between Trec and HOT. However, no significant
differences were found when comparing Trec with HOT at
each 0.1° C. It should be noted that even though it was not
significant, the comparison between a Trec of 38.7° C and the
corresponding HOT temperature was approaching signifi-
cance (p = 0.062). Figure 6 depicts the comparison of Trec
with HOT.
DISCUSSION
A practical, accurate, and reliable method of monitoring
increased body temperature of football athletes practicing or
playing in the heat could help to ensure the safety of these
athletes and potentially minimize heat-related illnesses and
fatalities. Current recommendations regarding factors that
should be monitored (i.e., heart rate, oral temperature, and
body water loss (22)) are either not practical to monitor in
a football setting or do not provide sufficient information to
allow for assessment of increased body temperature. In a
recent Roundtable Consensus Statement (2), recommenda-
tions were made regarding the heat illness risk of youth
football players. In this consensus statement, it was suggested
that future research is warranted that would include the
monitoring of youths’ core temperature utilizing ingestible
temperature sensor telemetry systems. Whereas this would
be an ideal means of determining the heat illness risk of these
athletes, it is not a plausible approach. Caution is warranted
because of the fact that the temperature reported by these
types of devices can be negatively affected by ingested
fluids (25). It is not practical to ask a football player not to
drink (which would increase heat illness risk) so that heat
illness risk can be accurately monitored. Another confound-
ing factor in using a system such as this is the close proximity
the data recorder must be to the player for a temperature
to be reported. This would prevent most core temperature
measurements from being reported until the athlete was
taking a break. Therefore, a player may be at risk, but the staff
monitoring the body temperature of the athletes may not
know in time to take action. Another practical reason for
the ingestible sensors not being a plausible approach to
monitoring body temperature is because of the high cost.
Most schools, especially high schools, are not likely to invest
in such a high cost means of protecting their athletes.
In response to this need for a more practical means of
monitoring increased body temperature of these athletes,
a device was developed to monitor forehead temperature
in football helmets. This method offers a practical and
reasonably accurate means of predicting core temperature
continuously. To test the effectiveness of the HOT monitor,
the current study compared the HOT monitor with Trec
during sustained aerobic exercise in a hyperthermic labora-
tory environment.
the TM
6 Journal of Strength and Conditioning Research
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Pearson correlations were calculated for all data and when
excluding 2 participants’ data that did not fit the normal curve.
As can be seen from Figure 4, data of one participant that did
not fit the normal curve were on the low end of the
temperature range and those of the other participant that
did not fit the normal curve were on the high end of the
temperature range. Because the temperature curves of these
2 participants did not match those of the other participants,
data were analyzed both including and excluding those
participants. However, as can also be seen from Figures 4
and 5, removing these 2 participants’ data from the analysis
did not significantly nor practically change the correlation.
Repeated measures ANOVA at the terminal temperature
(38.7° C) showed that the difference between Trec and HOT
was approaching significance (p = 0.062). Even though this
difference was approaching significance, in most cases it is
not practically significant, given the interindividual variability
in heat tolerance, heat dissipation capacity, etc. That is, it is
not possible to define a ‘‘dangerous’’ temperature so precisely,
and usage of any such device would likely call for identifying
a temperature low enough to be consistently safe to serve as
an alarm point so that athletes reaching that temperature can
be provided water, pulled from practice, or simply observed
more closely.
Previous research that tested the validity of devices that
measured variables other than core temperature in an attempt
to predict core temperature did not produce favorable results.
One of these devices measured heart rate and chest skin
temperature (19). Another device that attempted to predict
core temperature did so by measuring ear canal temperature
(9). Both of these devices’ predictions of core temperature
were approximately 1–2° C lower than actual core temper-
ature. While the HOT monitor temperature had wide
variability at core temperatures lower than 38.0° C, the
HOT monitor temperature was, on average, 0.16° C lower
(SD = 0.22° C) than core temperature at 38.7° C. Therefore,
at higher temperatures (where accuracy is the most
important), HOT predicted core temperature much more
accurately than previous devices that attempted to do the
same.
One might also suggest the use of devices that measure
aural, oral, axillary, or even forehead stickers in a football
setting. According to Ganio et al. (8), even during laboratory
exercise in a controlled environment, devices used to mea-
sure forehead, temporal, oral, aural, and axillary body sites
did not provide valid estimates of rectal temperature. Casa
et al. (5) agreed with Ganio’s findings stating that oral,
axillary, aural, temporal, and field forehead temperatures
were significantly different from Trec and are considered
invalid for assessing hyperthermia in individuals exercising
outdoors in the heat. Also, Coso et al. (6) reported that
infrared tympanic thermometry dangerously underestimates
Trec when exercising in a hot environment with airflow or
during a cooling treatment. However, all the above-
mentioned methods of monitoring body temperature would

either pose a comfort issue for the athlete and/or could not
be continuously monitored by the coach or athletic trainer.
Therefore, even if these temperature-monitoring methods
did accurately assess Trec, they still offer little use to a football
setting because of their lack of practicality for this setting.
One reason for HOT having such a high correlation with Trec
may be because of the microclimate in which HOT is
measuring temperature (forehead temperature inside helmets).
So much heat is lost through the head that it is often referred
as a ‘‘heat sink.’’ It is referred to as a heat sink because for every
1° C increase in arterial blood temperature, there is an
increment in heat flow to the cranium of approximately 45 W
(18). In a football context, little of this heat is dissipated
because of the helmet acting as an insulator. Not only does the
helmet acts as an insulator, it also minimizes influences of the
external climate (external to the helmet). In other words,
cooling factors, such as evaporation and convection, are
severely diminished. Due to the helmet reducing influences of
the external climate, a relatively constant and high tem-
perature (higher than typical skin temperature) is maintained
as compared with other parts of the body that have a greater
exposure to the external climate. Although the effects of
wearing the helmet on core temperature contribute to the heat
stress associated with football, it is also conducive to increasing
the accuracy of predicting core temperature via encapsulated
forehead skin temperature. Furthermore, the stability of the
microclimate in which the HOT sensor resides may also
explain some of the enhanced accuracy of this system relative
to other systems that may operate in a location that is more
influenced by the external climate (i.e., ear and oral).
As can be seen from Figures 4 and 5, the HOT monitor
lagged in its ability to predict Trec. This lag could be because
of a couple of basic issues. One of these issues could be
the HOT monitor needed time to equilibrate to forehead
temperature. To minimize the lack of agreement between
HOT and Trec at low temperatures, or when the helmet was
first fitted to the head, participants were required to stand for
several minutes in a thermoneutral environment before being
allowed to start the exercise portion of the experiment in the
heated chamber. In other words, the participants stood idly
until the HOT temperature reached a plateau. However, this
procedure did not completely diminish the lack of agreement
between HOT and Trec at low core temperatures. Therefore,
another explanation for the lack of agreement between HOT
and Trec could be that the microclimate inside the helmet
was not heated to a point that would allow HOT temperature
to accurately predict Trec at the beginning of the exercise
portion of the experiment. Additionally, a lag time between
core temperature increases and skin temperature increases
could be another explanation for the lack of agreement
between HOT and Trec at low temperatures. In other words,
an increase in core temperature may not immediately equal
a concomitant increase in skin temperature, thereby causing a
natural lag in the prediction of core temperature by the HOT
monitor. Because of the inability of HOT to predict Trec at
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lower temperatures, the HOT monitor should be modified to
detect these lower temperatures so that the initial lag time is
mitigated because this equilibration time could cause
a problem in field-based situations. Unlike the current study
where the helmet was left on continuously, helmets will be
removed and replaced many times during a typical football
setting. Each time the helmet is removed, the HOT
temperature may change significantly. This could cause
HOT to have to equilibrate each time the helmet is put back
on the head. If a scenario occurs where a player is near
a critical temperature and then takes his helmet off and puts it
back on and then returns to practice, the HOT monitor may
not alert the user that he should be removed from practice
because of the player reaching a critical temperature while
the HOT monitor was equilibrating to forehead tempera-
ture. Furthermore, if the user is undergoing self-cooling (i.e.,
pouring cold water on their head or helmet), based on the
current results, it is unknown if an exaggerated amount of
time will be required for the HOT monitor to equilibrate to
forehead temperature.
For the HOT monitor to read forehead temperature
optimally, there must be firm contact between the forehead
and the HOT thermocouple. There are several situations in
which this requirement could cause the HOT monitor to
report an inaccurate prediction of core temperature. One of
these situations would be if a player’s hair becomes wedged
between the monitoring point on the forehead and the HOT
thermocouple in the helmet. A problem could also occur if the
player has so much hair in the helmet that it does not allow
proper contact between the HOT thermocouple and the
forehead. Therefore, if this device is to be used as an accurate
predictor of the core temperature of football players, hair
length and location must be addressed. Future research is
warranted to determine the effect of hair and thermocouple
location on the ability of HOT to predict Trec.
It is important to note that the exercise stimulus used in
this study is very different from what typifies football practice
or game situations. This study used a continuous bout of
moderate-intensity aerobic exercise to ensure that Trec and
HOT temperature could be monitored continuously over
time while Trec increased, which is very unlike the repeated
intermittent anaerobic bouts of all out activity that is
performed in a typical football setting. Although this type
of exercise may not affect the accuracy of estimated core
temperature provided by HOT, future research is warranted
incorporating repeated bouts of anaerobic activity.
PRACTICAL APPLICATIONS
An overarching question that arises from the current study is,
can HOT predict core temperature with a great degree of
accuracy? Even though HOT was not perfect, it was able
to predict Trec more accurately than several predecessors
(7,16) that attempted to predict core temperature from
other physiological variables, especially as core temperature
reached potentially dangerous levels. However, limitations of
VOLUME 26 | NUMBER 1 | JANUARY 2012 | 7
 In-Helmet Temperature Monitor
the current study (i.e., helmet left on consistently, hair
location, and type of exercise) should be addressed in future
studies. Therefore, although the current study does show
that HOT worked well in a controlled laboratory setting,
more work is needed in field-based situations to fully answer
the question above. If HOT is shown to be accurate under
conditions other than a controlled laboratory setting, this
device could help to ease the effort required by athletic
trainers and coaches to ensure the safety from heat injury of
their athletes. HOT also has potential applications in settings
such as industrial workers (especially those wearing ‘‘hard
hats’’), firefighters, car racing, and others performing work in
the heat. However, each of these potential applications
would need to be separately evaluated in future studies.
ACKNOWLEDGMENTS
This study was supported by the funding from Hothead
Technologies, Inc. The results of the present study do not
constitute endorsement of the product by the authors or the
National Strength and Conditioning Association.
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