As the past chair of the Committee on Competitive Safeguards and Medical Aspects of Sports, I have been actively involved in discussions regarding student-athlete health and safety as they relate to football. I have welcomed the support for reform expressed by medical colleagues, student-athletes, parents, coaches and athletics administrators who address these issues. However, there has been some confusion and disagreement about the importance of implementing the new out-of-season/preseason conditioning model for football.

Out-of-season and preseason physical preparation is one of college athletics' most complicated and controversial issues, and no sport is more complex than football. The untimely deaths of three football student-athletes in 2001 in varied, out-of-season conditioning situations prompted a review of the process and beyond to the preseason where nearly 50 percent of all football practice injuries occur and more than 90 percent of all fall heat illnesses are reported.

The team of experts that developed the out-of-season/preseason conditioning model focused on the following factors during their work: (1) providing sufficient time to physically prepare for the demands of college football; (2) addressing health and safety concerns during these times; (3) allowing adequate time for academic and social development; (4) creating a model that could operate within existing academic calendars; (5) avoiding significant addition of existing staff responsibilities, and (6) staying relatively budget neutral.

The model is in three parts that go together like a puzzle. The advent of discretionary time, which doesn't permit organized strength and conditioning workouts to occur for eight weeks in the traditional off-season, appears at first glance to have little to do with health and safety. However, discretionary time given early in the off-season permits the student-athlete to recuperate from the grind of a long season that has hopefully culminated in a bowl appearance. It gives time for rest and rehabilitation before the start of heavy strength training.

During the remainder of the off-season, judicious use of this discretionary time can permit student-athletes to better cycle their weight training to optimize performance and reduce the risk of injury. For the student-athlete who wants to work out during these times, such opportunities are available.

The summer period of nine weeks of organized strength and conditioning is an essential component of the model. This time (eight hours/week) prepares the student-athlete for the preseason period, allowing a gradual acclimation to the heat while physically conditioning to be in peak condition for preseason practice. While this period is non-mandatory for the student-athlete, it really is to their benefit to participate.

One significant change is the mandatory presence of an individual from the sports-medicine staff at each conditioning session. This individual has the unchallengeable authority to cancel or modify the workout for an individual student-athlete or the team as appropriate. While this may add to the workload of the school's sports-medicine staff, it's a necessary and appropriate safeguard for the student-athlete. Not only do strength and conditioning coaches have to be certified in CPR and first aid, they need to take proper ownership of the health and safety of the student-athletes in their charge. Emergency care plans need to be in place and practiced by all involved.

The most striking changes can be found in the preseason practice format. The new football preseason will start with an initial five-day acclimatization period, allowing a gradual transition to wearing a complete football uniform in the August heat. Only one on-field practice will be permitted per day in this five-day period. No more than three hours of on-the-field time will be allowed. This includes a walk-through, warm-ups, cool downs, etc. The length of the actual practice time should be adjusted according to local environmental factors and individualized based on the student-athlete's fitness level. With an expected majority of student-athletes taking part in summer conditioning, this puts a premium on proper heat acclimatization, less the football uniform, before starting preseason practice.

The second major change is the elimination of back-to-back multiple daily practice sessions. The injury rate across all NCAA divisions in preseason practice is four times that of the regular-season practice rate. Fatigue is the primary factor in many of these injuries. Student-athletes need recovery time between strenuous workouts to refuel, hydrate and repair. Ideally, the quality of the workouts should improve along with a reduction in injuries.

The 2-1-2-1 format permits a similar number of practices as the old format. An overwhelming majority of schools have sufficient flexibility to avoid practicing on most Sundays and not be incapacitated by inclement weather. Good planning can alleviate much of the skepticism. At one major Division I school that already has been using this format, injuries in the preseason have been reduced by more than 40 percent and heat-related problems have dropped by more than 70 percent.

Education plays a large role in the success of these recent initiatives to improve the health and safety of student-athletes. Student-athletes should be encouraged to share all use of ingested medications and nutritional supplements and current medical conditions with the medical/athletic training staff. Ideally, this should take place at the pre-participation exam. Student-athletes should be encouraged to tell the health-care providers and/or coaches on the field if they feel ill during a workout session. This should trigger appropriate evaluation and management.

The out-of-season conditioning educational campaign initiated by the Football Study Oversight Committee in 2002 was designed to increase awareness of institutional responsibility for the health and safety of student-athletes participating in out-of-season activities. Athletics personnel and student-athletes should review this information annually to ensure that everyone involved in football has the appropriate information to provide a safe playing environment.

These efforts will assist NCAA member institutions in reducing injuries among their football student-athletes. Coaches for all sports and administrators should review these reforms since many of these concepts can be universally applied to any sport.

Bryan Smith, M.D., is the head team physician at the University of North Carolina, Chapel Hill.