Beat the Heat: Safe Strategies for Back-to-School Sports Training

For millions of young athletes, back-to-school signals the start of intensive athletic training for fall sports – in sultry August temperatures. To safeguard kids against heat-related illness, experts have some advice for the athletes, coaches and parents: Don’t let the competitive sports culture overtake common sense. Safety should be the top priority.

Heat illness during practice or competition is a leading cause of death and disability among U.S. high school athletes, according to the Centers for Disease Control & Prevention. But heat illness is entirely preventable, says Michael Swartzon, M.D., a primary care physician at Doctors Hospital’s Center for Orthopedics & Sports Medicine. With proper training, practice scheduling, water intake, rest periods and emergency treatment available on the sidelines, most young athletes can safely participate in outdoor sports in warm weather.

The American Academy of Pediatrics (AAP) recommends youth sports programs implement comprehensive strategies to protect athletes. One component of primary prevention is the requirement that all student-athletes undergo a medical examination administered by a physician before participating in preseason practices. This exam can identify predisposing factors related to several safety concerns, including increased risk for heat illness, says Dr. Swartzon.

“It’s important to identify athletes with the sickle cell trait and those taking certain supplements or medications, such as ADHD medications, because these factors can make them more susceptible to heat illness,” Dr. Swartzon explained.

After athletes are cleared for training, gradually increasing practice frequency, duration and intensity minimizes exertional heat-illness risk, experts say. The National Athletic Trainers Association (NATA) has issued guidelines on how to acclimatize athletes to hot-weather activity over a 14-day period. Among the recommendations: No more than one practice per day for the first five days; no equipment beyond a helmet the first two days; and no more than a helmet and shoulder pads on days three through five.

Acclimatization is particularly important during preseason football practices, which typically occur during the hottest period of summer and when participants are least physically fit. The goal of acclimatization is to increase exercise heat tolerance and enhance an athlete’s ability to exercise safely and effectively in hot conditions, Dr. Swartzon says.

The AAP and NATA advise school sports programs to follow prevention strategies to guard against heat-related illness. First on their list of recommendations: Have athletic trainers on-site to recognize and treat possible injuries and heat illness.

“Athletic trainers are the frontline for sports medicine and they play an important role in keeping athletes safe,” Dr. Swartzon said. “Athletic trainers are medically trained personnel, and their goal is to protect the athletes. The physicians at Doctors Hospital have a close relationship with many athletic trainers at Miami-Dade County schools. They partner with us when they are faced with an issue that is beyond their normal scope.”

Additional prevention strategies from the AAP and NATA include:

  • Keep athletes well hydrated before, during and after exercise. Coaches should allow free access to water and sports drinks.
  • Evaluate athletes individually for play in hot weather. Kids who are more vulnerable, including those who are overweight or have diabetes, should be closely monitored.
  • Sit out kids who show signs of illness, such as fever, diarrhea or extreme fatigue, or who were recently ill. These symptoms can decrease the body’s exercise-heat tolerance.
  • Intersperse rest periods during practices to lower body temperature and allow ample time to hydrate. Athletes should rest two to three hours between same-day practices or games in hot weather.
  • Schedule practices during cooler times of the day, such as early morning or late evening. Some schools hold football practices at 6:30 a.m. and 6:30 p.m. during August.
  • Advise athletes to wear lightweight, light-colored, loose-fitting clothing. The best choice is moisture-wicking, quick-drying gear that doesn’t absorb sweat.
  • Ensure all coaches, trainers and athletes know the signs of heat stress, which include dizziness, confusion, muscle cramps, headache, nausea, weakness, excessive thirst, cool and clammy skin. Athletes should be encouraged to report if a teammate appears to be struggling.
  • Have an emergency action plan. When the risk of heat illness is high, NATA advises trainers to have an immersion tub filled with ice and water ready to cool potential victims.
  • “Immediate cold water immersion is critical to reducing an athlete’s temperature rapidly,” said Dr. Swartzon. “Treatment for heat illness centers on cooling the body to prevent or reduce damage to the brain and vital organs.”

    According to NATA, the treatment rule is: Cool first and transport to the emergency room second. If an immersion tub is not available, trainers should lie the athlete down in a cool, shady area while waiting for emergency personnel to arrive. Tight clothing or safety gear should be removed and ice packs or water applied to promote cooling.

    “Heat illness is preventable with appropriate precautions and response,” added Dr. Swartzon.

    “When athletic programs implement these important guidelines, the health and safety of the athletes are primary.”

    Athletes, parents and sports training personnel can learn more about keeping athletes safe at a free seminar, Young Athletes: Injuries & Prevention, on Wednesday, Sept. 17, 7 p.m., at West Kendall Baptist Hospital.



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