فاطمه سادات حسینی

Purpose: Extreme sport tourism has become a rapidly expanding segment of the global tourism industry, involving high-risk activities such as rafting, climbing, sky running, and canyoning. The objective of this review was to synthesize current scientific evidence on the physiological and organizational determinants of safety in extreme sport tourism and to present an integrated framework applicable to diverse adventure sport contexts. Method: A narrative review methodology was adopted. Peer-reviewed studies published between 2000 and 2025 were identified through PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. Included studies addressed physiological stress responses, environmental exposure, guide competence, safety management systems, and emergency preparedness in extreme or adventure sport settings. Findings were thematically synthesized across physiological and organizational domains. Results: The review identified key physiological determinants of safety, including cardiovascular strain, hypoxic and respiratory stress, thermoregulatory imbalance, dehydration, neuromuscular fatigue, and neuroendocrine stress responses, all of which influence performance, cognition, and decision-making under extreme conditions. Organizational determinants included structured risk assessment, guide training and certification, equipment standards, communication systems, emergency response planning, and organizational safety culture. Evidence indicated that inadequate organizational control amplifies physiological risk and contributes to accident occurrence. Conclusion: Safety in extreme sport tourism requires an integrated, multidisciplinary approach aligning human physiological limits with organizational management to improve participant safety and support sustainable destination development.