Expert consensus on passive heating interventions to promote skeletal muscle strength and mass: a delphi study

Passive heating has emerged as a potential non‑exercise method to support muscle strength and mass, but its application is limited by inconsistent protocols and unclear dosage and safety guidelines. This study used a Delphi methodology to establish expert consensus on key parameters for passive heating interventions targeting neuromuscular and muscle morphology outcomes.

An international panel of academic experts (≥ 3 peer‑reviewed publications in passive heating and neuromuscular function) completed a two‑round Delphi process. Round 1 gathered open‑ended responses on passive heating strategies, intervention targets, and safety. In Round 2, experts ranked the importance of generated statements. Consensus was defined as ≥ 70% ranking a statement as either first or second in importance.

Eleven experts completed Round 1 and ten in Round 2. From 177 qualitative responses, 130 statements were evaluated, with 11 reaching consensus (80-100% agreement; interquartile range = 0-1). Hot‑water immersion was prioritised as the most optimal passive heating modality. Experts agreed on targeting muscle temperatures of 39-40 °C, ~ 60-minute session durations, and once‑daily exposure as key intervention parameters. Strong consensus was also reached for monitoring core temperature and cardiovascular strain (e.g., heart rate, blood pressure) to ensure participant safety. No consensus was reached on a single target population or the total intervention duration.

This Delphi study provides a consensus‑based framework outlining key parameters and safety considerations for passive heating interventions. These findings do not establish efficacy but identify priority variables to inform future experimental research and cautious translation into applied and clinical contexts.