Introduction:
Arbaeen is one of the world's largest religious gatherings, during which millions of pilgrims walk long distances under extreme heat conditions, increasing the risk of heat-related illnesses such as heatstroke, dehydration, and exhaustion. Adequate hydration, electrolyte balance, and proper nutrition are therefore essential for maintaining physical performance and preventing health complications. This systematic review aimed to evaluate the role of hydration, electrolyte balance, and diet in preventing heatstroke among
Arbaeen pilgrims. Method: This systematic review searched PubMed, Web of Science, Scopus, Google Scholar, MagIran, and SID for relevant Persian and English studies published up to May ۲۵, ۲۰۲۵. Official reports and documents from international organizations, including the WHO, CDC, FEMA, IFRC, UN, and FAO, were also reviewed. The review process followed PRISMA guidelines, and qualitative content analysis was used to synthesize the extracted data. Result: A total of ۹,۹۱۳ records were identified, of which ۱۰ studies met the inclusion criteria and were included in the final analysis. The findings were categorized into five main themes, ۱۴ categories, and ۲۸ subcategories. Major themes included factors contributing to heatstroke among pilgrims, the role of
hydration and nutrition in thermoregulation, the importance of fluid and electrolyte intake during extreme heat exposure, the impact of diet on physical and mental performance, and strategies to improve
hydration and dietary practices during the
Arbaeen pilgrimage. Evidence indicated that adequate fluid intake, electrolyte replacement (particularly sodium and potassium), and balanced dietary patterns reduce dehydration, fatigue, and thermal stress while improving endurance and overall well-being. Conclusion: Hydration, electrolyte balance, and proper nutrition play a critical role in preventing heatstroke among
Arbaeen pilgrims. Culturally appropriate nutritional strategies and
hydration practices can enhance pilgrims' safety and physical resilience during this demanding journey. Further field-based and longitudinal studies are recommended to develop evidence-based health guidelines for mass religious gatherings.
