Distinct risk factors for exertional heat exhaustion in competitive versus recreational amateur golfers: a stratified cross-sectional study.

Although preventing heat illness is critical in golf, risk profiles likely vary by engagement level. This study investigated whether risk factors for exertional heat exhaustion (EHE) differ between competitive and recreational golfers. We conducted a retrospective cross-sectional study targeting amateur golfers in Japan during the summers of 2024 and 2025. A stratified analysis was performed on competitive (n = 485) and recreational (n = 259) groups using multivariable logistic regression to identify independent risk factors. Although perceived dehydration and loss of appetite were universal risk factors (p < 0.05), distinct risk structures emerged. In the competitive group, sleep deprivation (adjusted odds ratio [aOR] = 2.27) and mental stress (aOR = 1.66) were significant, suggesting that psychophysiological strain associated with competitive pressure may affect subjective heat tolerance. Conversely, specific associations for the recreational group included playing ≥ 11 rounds/month (aOR = 3.63) and increased consumption of jelly drinks (aOR = 2.62) and ice cream (aOR = 2.37). These behaviors likely reflect a reactive response to early thermal discomfort, indicating cumulative fatigue from unmanaged loads and a maladaptive reliance on "sensory cooling" rather than effective rehydration. These findings reveal a clear dichotomy in EHE risk factors based on participants' competitive orientation. Competitive golfers exhibit risk structures associated primarily with physiological and psychological strain, whereas recreational golfers are vulnerable due to behavioral management and preparedness deficits. Hence, effective prevention requires targeted strategies that address distinct, group-specific risks.