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NCAA resources help student-athletes beat the heat

By Chris Radford
NCAA.org

As preseason football practice kicks into gear across campuses, NCAA institutions are encouraged to take steps to reduce the risk factors for heat-related illness.

While heat illness can occur in any sport – and no single risk factor can predict when it will occur – understanding the multiple factors involved and taking the proper precautions can minimize the risks.  

Practice or competition in hot and humid environmental conditions poses special problems for student-athletes. Heat stress and resulting heat illness is a primary concern in these conditions – 96 percent of all heat illnesses in football occur in the month of August, for example. 

Although deaths from heat illness are rare, exertional heat stroke is the third-leading cause of on-the-field sudden death in student-athletes. Constant surveillance and education are necessary to prevent heat-related problems. 

The NCAA has taken steps to provide a safer environment for student-athletes with the adoption of football practice season regulations and wrestling weight management policies. Most notably, institutions are required to conduct a five-day, single practice acclimatization period at the beginning of fall practice followed by a maximum 2-1-2 practice per day schedule that allows student-athletes to acclimate to the new stresses of the hot and humid weather, intensity and duration of exercise, and the impact of equipment on body heat retention.

Heat illnesses are often due to a combination of risk factors.  Risk factors associated with heat illness include:

• Intensity of exercise. This factor can increase core body temperature higher and faster than any other.
• Environmental conditions. Heat and humidity combine for what is referred to as a high “wet-bulb globe temperature” that can quickly raise the heat stress on the body. The web-bulb globe temperature includes the measurement of wet-bulb temperature (humidity), dry-bulb temperature (air temperature) and globe temperature (heat from direct sunlight).
• Duration and frequency of exercise. Minimize multiple practice sessions during the same day and allow at least three hours of recovery between sessions.
• Dehydration. Fluids must be readily available and consumed to help the body regulate itself and reduce the effects of heat stress.
• Nutritional supplements. Nutritional supplements may contain stimulants, such as ephedrine, mahuang or caffeine, which can have a negative effect on hydration and increase metabolism and heat production. They are of particular concern in people with underlying medical conditions such as sickle cell trait, hypertension, asthma and thyroid dysfunction. (Stimulant drugs such as amphetamines, ecstasy, ephedrine and caffeine are on the NCAA-banned substance list and may be known by other names.)
• Medication/drugs. Certain medications and drugs have similar effects as nutritional supplements. These substances may be ingested through over-the counter or prescription medications, recreational drugs, or consumed in food. Examples include antihistamines, decongestants, certain asthma medications, Ritalin, diuretics and alcohol.
• Medical conditions. Examples include illness with fever, gastro-intestinal illness, previous heat illness, obesity or sickle cell trait.
• Acclimatization/fitness level. Lack of acclimatization to the heat or poor conditioning are dangerous conditions.
• Clothing. Dark clothing absorbs heat and protective equipment limits heat dissipation.
• Limited knowledge of heat illness. Signs and symptoms can include elevated body-core temperature, pale or flushed skin, profound weakness, muscle cramping, rapid weak pulse, nausea, dizziness, excessive fatigue, fainting, confusion and visual disturbances.

Best practices

The NCAA has recommended that member institutions follow best practices when training in hot conditions. They include:

• The NCAA requires an initial complete medical history and physical evaluation, followed by the completion of a yearly health status questionnaire before practice begins.
• Student-athletes should gradually increase exposure to hot and humid environmental conditions during a minimum period of seven to 10 days. When environmental conditions are extreme, training or competition should be held during a cooler time of day.
• Frequent rest periods should be scheduled so that the gear and clothing can be removed or loosened to allow heat dissipation. During the acclimatization process, it may be advisable to use a minimum of protective gear and clothing and to practice in T-shirts, shorts, socks and shoes.
• To identify heat stress conditions, regular measurements of environmental conditions are recommended.
• Exertional heat stroke has the greatest potential of occurrence at the start of preseason practices and with the introduction of protective equipment during practice sessions. The inclusion of multiple practice sessions during the same day may also increase the risk of EHS.
• Student-athletes should be encouraged to drink fluids frequently throughout a practice session.
• During the preseason or periods of high environmental stress, the student-athletes’ weight should be recorded before and after every workout, practice and competition.
• Some student-athletes may be more susceptible to heat illness, including those with sickle cell trait, inadequate acclimatization or aerobic fitness, excess body fat, a history of heat illness, a febrile condition, inadequate rehydration, and those who regularly push themselves to capacity.
• Student-athletes should be educated on the signs and symptoms of exertional heat stroke, such as elevated core temperature, weakness, cramping, rapid and weak pulse, pale or flushed skin, excessive fatigue, nausea, unsteadiness, disturbance of vision, mental confusion and incoherency.

First aid

Heat exhaustion is a moderate illness characterized by the inability to sustain adequate cardiac output, resulting from strenuous physical exercise and environmental heat stress. Symptoms usually include profound weakness and exhaustion, and often dizziness, syncope, muscle cramps, nausea and a core temperature below 104 degrees Fahrenheit with excessive sweating and flushed appearance. 

First aid should include removal from activity, taking off all equipment and placing the student-athlete in a cool, shaded environment. Fluids should be given orally. Core temperature and vital signs should be serially assessed. The student-athlete should be cooled by ice immersion and ice towels, and IV fluid replacement should be determined by a physician.

Although rapid recovery is typical, student-athletes should not be allowed to practice or compete for the remainder of that day.

Heatstroke is a medical emergency. Medical care must be obtained at once; a delay in treatment can be fatal. This condition is characterized by a very high body temperature (104 degrees Fahrenheit or greater) and sometimes, but not always, hot, dry skin, which indicates failure of the primary temperature-regulating mechanism (sweating), and CNS dysfunction (for example, altered consciousness, seizure, coma).

First aid includes activation of the emergency action plan, assessment of core temperature/vital signs and immediate cooling of the body with cold water immersion. Another method for cooling includes using or cold, wet ice towels on a rotating basis. Student-athletes who incur heatstroke should be hospitalized and monitored carefully.

Athletes presenting with any of these signs and symptoms should be referred to a healthcare professional and basic steps taken while awaiting such medical care. Many other potentially life threatening conditions can present as a heat illness and emphasis should be placed on proper medical diagnosis.