It was easily the worst day I’ve ever had covering professional football.
The date was July 31, 2001, and the place was Mankato, Minn., on an oppressively hot and humid day in the Midwest during a different time.
When I tell younger reporters we weren’t allowed to bring water on the practice field back in those days, sometimes I get the feeling that they believe it’s an exaggeration like the stories of walking uphill both ways to school in the snow an older generation has turned into a cliche.
As silly as that sounds now, it was not hyperbole.
And that’s what stands out most about that day is vivid memories of just how difficult it was to get through a nearly three-hour practice, and I was just standing there. The Minnesota Vikings were expending energy in full pads and a lot of it.
By that time Korey Stringer had already developed into one of the best right tackles in the NFL. But the big man still had the reputation of being a little overweight and he wanted to please his position coach, a hard-nosed former player himself, Mike Tice. Stringer refused breaks to prove his toughness and water was an oasis for the weak even as the thermometer soared past 90.
Pride, stubbornness and football’s archaic culture quickly turned into a toxic cocktail.
Stringer never tapped out and made it through the entire session but collapsed after practice. He was rushed to the medical trailer where he eventually lost consciousness because of dehydration.
No one knew it at the time but the battle was already lost. When Stringer arrived at the hospital his body temperature had reached nearly 109 degrees and he died early morning the next day.
The Vikings were devastated and the entire NFL was shaken to its core. A 27-year-old man in the prime of a great career had succumbed to heatstroke.
Everyone who plays this game understands football is an extremely dangerous sport and it always will be as evidenced by the ongoing debates over CTE and repetitive head trauma. This was different, however, because it was just so senseless.
Common sense says anyone engaging in any strenuous activity in the summer heat should have plenty of water.
Just 16 years later hydration is dogma in sports and life itself. The league instituted mandatory water breaks and rest periods after the Stringer tragedy long before the 2011 CBA scaled back practices in a dramatic fashion.
As the days passed and the show went on, there was an empty feeling writing about how the Vikings planned to kick Chris Liwienski out to right tackle to replace Stringer.
Each year when I returned, the first stop was to visit the tree planted in Stringer’s memory and the plaque that honored him in front of the old Gage Residence Hall where the Vikings stayed.
By 2013, Minnesota State was undergoing upgrades, Gage was demolished and the tree replanted outside Highland Center on campus. It will remain there as a remembrance even though the Vikings are leaving Mankato this August for the final time after training there for 52 consecutive years.
I’d like to believe Stringer died doing what he loved but I’m satisfied knowing he changed the game for the better and sacrificed himself to save countless lives through education. The Korey Stringer Institute has even helped improve working conditions in the heat outside of sports for members of the military as well as laborers.
That was never Stringer’s goal but it is his legacy and everyone in the NFL owes him a debt of gratitude.
Sen. Patrick J. Diegnan Jr. held a press conference at Metuchen High School on Wednesday to educate others about the risks of exertional heat stroke and heat exhaustion for student-athletes, but it was the state legislator himself who learned some paramount information about a potentially life-saving device.
Christina Emrich, a veteran athletic trainer at Red Bank Regional High School and president of the Athletic Trainers’ Society of New Jersey, introduced Diegnan during the press conference to a Wet Bulb Globe Temperature (WBGT) monitor, which experts believe is a better gauge than the heat index in determining potentially hazardous environmental conditions for exercise.
The device is currently used at the professional and collegiate levels, but is not mandatory for NJSIAA member schools, which Diegnan would like to change.
“We’re talking less than $200,000 for the entire state,” Diegnan said of making at least one WBGT monitor, which costs approximately $400, available to New Jersey’s 500 school districts. “To me, it is the definition of a no-brainer. Is it worth $200,000 to save kids’ lives? Absolutely.”
Diegnan said he plans to introduce legislation in the coming months that would require school districts to obtain and use WBGT monitors beginning next year.
“Hopefully we can get it done in the fall and have it signed into law,” Diegnan said. “Let’s get them in the districts by next August.”
Dr. Jack Kripsak, Director of Sports Medicine at Somerset Medical Center who sits on the NJSIAA’s medical advisory board and also serves as the team physician for Bridgewater-Raritan High School, said he knows of at least three school districts in Somerset County who currently use the WBGT monitor.
“The (device) is a wise investment and it should be utilized,” Kripsak said. “It’s a life-saving piece of equipment investment-wise for school districts.”
A WBGT monitor measures ambient temperature, relative humidity, wind and solar radiation from the sun to determine environmental conditions during exercise. The user relies on WBGT guidelines to determine if modifications need to be made for activity such as the removal of equipment, increased hydration breaks, the adjustment of work/rest ratios and shortening the length of or possibly even canceling practice altogether.
Emrich demonstrated the WBGT during Wednesday’s late-morning press conference, at which time she recorded a reading of 85.7 on Metuchen High School’s turf field (artificial surfaces can be at least 10 degrees hotter than grass). The measurement, according to a WBGT grid containing guidelines, indicated that a coach or athletic trainer would “consider rescheduling practice if this (reading) actually happened during the day,” Emrich said.
According to the Kory Stringer institute, established at the University of Connecticut following the death of Stringer, a former Minnesota Vikings football star who died from exertional heat stroke in August 2011, a direct correlation exists between increased temperature and humidity levels and risk of mortality as a result of exertional heat stroke.
Exertional heat stroke is an elevated core body temperature above 103 degrees associated with signs of organ system failure due to hyperthermia. Central nervous system neurologic changes are often the first indication of exertional heat stroke.
Citing National Center for Catastrophic Sports Injury research data that heat-related illness claimed the lives of 35 high school football players nationally from 1995 through 2010, Diegnan conducted Wednesday’s press conference to alert student-athletes, parents, coaches, athletic trainers and school administrators about the warning signs and prevention of heat stroke.
“Heat stroke in student-athletes is completely preventable and while New Jersey is at the forefront of athletic training for our high school athletes, we must continue to refine our best practices to ensure we avoid future tragedies while allowing our children the simple joy of competition in sports,” said Diegnan, whose press conference on the topic came less than a week before NJSIAA schools are officially permitted to begin fall sports practices, some of which are conducted during extreme heat in the month of August.
Heightened awareness about the importance of hydration, the increased use of cold-water immersion tubs, the presence of certified athletics trainers at practice (Emrich said approximately 90 percent of NJSIAA member schools have an athletic trainer on site) and the adoption of an “acclimatization period” by football conferences in 11 statewide athletic associations nationwide — including New Jersey — appear to have contributed to reducing the incidence of heat-related illness and death.
Still, exertional heat stroke results in thousands of emergency room visits and hospitalizations throughout the nation each year, Diegnan said.
The NJSIAA was among the first statewide athletic associations in the nation to adopt acclimatization guidelines for football, which state teams cannot wear full pads during the first three days of training camp. In addition, practices cannot exceed five hours and a five-hour practice day may not be followed by a practice day greater than three hours. Warmup, stretching, conditioning, weight training and cool down periods are all considered practice.
Emrich noted that student-athletes in other sports, such as field hockey goaltenders who wear cumbersome equipment, must also consider the risks of practicing in extreme heat.
Some statewide athletics associations encourage, but do not mandate, that practice be canceled when the heat index soars above 100 and that practice time be limited if the heat index rises above 95. The WBGT and its guidelines could replace the heat index in New Jersey, should Diegnan’s bill become law. A reading above 92.1 on the WBGT would indicate practice should be deferred until later in the day.
Dr. Ken Herman, Chief of Emergency Services at J.F.K. Medical Center in Edison, said signs and symptoms of heat-related illness are recognizable and that “the tragedy (of the deaths that have occurred) is that it’s preventable.”
Herman said each August J.F.K. Emergency Services is called upon to treat an athlete who has been subject to excessive heat stress while practicing for high school athletics under conditions of high heat and humidity.
“Coaches, trainers, parents and athletes should look for signs of heat illness such as muscle cramping, excessive sweating, fatigue, dizziness, pale skin, weak pulse, fainting, and confusion,” Herman said. “Athletes themselves should be educated to hydrate before, during, and after training sessions, and athletes should be trained to maintain the color of their urine as light yellow to clear as a measure of hydration status. Treatment includes immediate transfer to a cooler environment, wetting the skin, and creating air flow to facilitate evaporation. Should symptoms persist, or be more serious, transport to a Hospital Emergency Department for definitive treatment would be appropriate.”
According to the Centers for Disease Control and Prevention, signs of heat exhaustion include heavy sweating, weakness, cold, pale and clammy skin, fast, weak pulse, nausea or vomiting and fainting. Those experiencing symptoms should move to a cooler location, lie down and loosen clothing, apply cool, wet cloths to as much of the body as possible, sip water and seek medical attention immediately if he or she has vomited.
Signs of heat stroke include a body temperature above 103 degrees, hot, red, dry or moist skin, a rapid and strong pulse and possible unconsciousness. The CDC qualifies those symptoms as an emergency requiring immediate medical attention. Individuals suffering from heat stroke should be moved to a cooler environment, be placed under cool cloths or even in a cool bath to reduce his or her body temperature and should not be given fluids.
“Exertional heat stroke is non-discriminatory,” said David Csillan, Athletic Trainer, Ewing High School and Co-Author, NATA Preseason Heat Acclimatization Guidelines for Secondary School Athletics. “It can occur across different sports, to both boys and girls, from the varsity to freshman teams, and as people may not know between in-door and outdoor sports.”
This is where Korey Stringer took his final steps.
This is where he slept his last night and ate his final meal.
This is the road the ambulance followed as it delivered him to the hospital where he died.
As the Minnesota Vikings train at Minnesota State University, Mankato, for the last time this summer, team officials and fans alike are awash in sentimental thoughts. Memories surface from the meals they ate at institutions such as Jake’s Pizza, with its framed photographs of players and coaches dating back six decades. They range from the bizarre — Remember Dimitrius Underwood, a first-round draft choice who reported to camp in military fatigues and went missing the next day? — to the tragic.
For those who were here on Aug. 1, 2001, it is impossible to experience Mankato without staggering at the memory of Stringer’s death. Even 16 years to the day later, we see the physical and emotional triggers, and it is no less shocking that a healthy 27-year-old star died because he got overheated during a humid football practice.
I hope that Stringer’s memory, and the frightening lessons of his demise, will not fade when the Vikings shift their camp to their new year-round facility next summer. His death spurred overdue changes in the way professional sports teams train in summer heat, and efforts that culminated in the creation of the Korey Stringer Institute (KSI) have improved conditions for members of the military and outdoor laborers as well.
But on the anniversary of Stringer’s death and during the Vikings’ final trip to Mankato, it’s important to understand how much work remains. Tragically, the number of documented cases of heat stroke deaths at the high school and college football levels has risen since 2001, as the accompanying chart shows. KSI has developed a heat acclimation plan targeted at state-level high school sports associations, but fewer than half of the states have adopted it.
“The big thing is that we know death from heat stroke is 100 percent preventable,” said Douglas Casa, the CEO of KSI and a professor of kinesiology at the University of Connecticut. “Globally, we’ve made a lot of progress in saving people’s lives. There has not been a single death in cases of heat stroke where our guidelines were followed. But there are still these hard-core situations, mostly at the high school level in July when kids are working out without supervision, where they’re not doing the things they could, and it sometimes ends in tragedy.”
Founded in 2010 at UConn with contributions from the NFL, Gatorade and other corporations, KSI has worked to set a medically based standard for exertion in heat. Its recommendations include a number of protocols that could have saved Stringer’s life.
I was covering camp on July 31, 2001, the Vikings’ second day of practices that summer. The heat index approached 90 degrees by mid-morning, and it was so humid that my laptop screen fogged over when I opened it for the first time. Stringer practiced for nearly three hours in full pads, refusing breaks, and collapsed shortly after the practice’s conclusion.
He was led into a medical trailer, and as medical staffers observed what they believed to be dehydration, Stringer lost consciousness. He was taken by ambulance to a regional hospital, where his core body temperature was recorded at 108.8 when he arrived. He died early the next morning.
The KSI heat acclimatization plan calls for limiting practices to one per day for the first five days of activity and waiting until the sixth day to wear full pads. It warns high school-level parents that kids who spend much of their summer inside — most of them, in other words — will need a more gradual heat acclimatization timetable. And it suggests having manual cooling methods, including ice tubs and cold towels, on hand to use immediately if needed.
“It is so important to start bringing down that body temperature right away,” Cass said. “We don’t want it to wait until people go to the hospital.”
This week, KSI announced the results of an eight-month study performed in conjunction with WHOOP, a company that produces a device known as the Strap 2.0 to measure athletic performance, sleep quality and other health-related data. (WHOOP also partnered recently with the NFL Players Association to help professional-level players monitor their own exertion.) Among the biggest conclusions, according to WHOOP CEO Will Ahmed, is that quality and quantity of sleep correlated to performance and health in hot conditions.
WHOOP devices measure the stages and length of sleep to use in a “recovery score” that gives the user a sense of the body’s condition relative to its baseline.
“A lot of what we’re measuring has preventative capabilities,” Ahmed said.
These protocols and research results generate benefits beyond the world of sports. Members of the KSI staff spent time recently at Lackland Air Force Base in Texas, working on strategies to help airmen perform better and more safely at boot camp. Among the implemented changes was hiring athletic trainers to supervise recruits’ conditioning work. KSI also has worked with government agencies such as OSHA to standardize conditions for outdoor laborers.
Without a doubt, awareness and treatment of heat stroke have improved dramatically in the years since Stringer’s death. I still remember walking onto the field to cover my first NFL training camp in 2000 with a bottle of water in my hand on a hot day.
A security guard quickly pounced.
“No water on the field,” he said.
I asked why. His response stunned me: Players weren’t allowed to get water whenever they wanted to, so no one else on the field could, either.
Needless to say, that barbaric policy soon faded away. Now every NFL training camp is equipped with the tools it needs to prevent and treat heat stroke. But the fatality statistics at the college and high school levels remind us that heat stroke remains a threat.
Yes, a healthy but unprepared person really can die by overheating while exercising. We saw it happen 16 years ago. The echoes are everywhere. It’s impossible to forget.
BOSTON & STORRS, Conn.–(BUSINESS WIRE)–WHOOP, the human performance company, and the Korey Stringer Institute (KSI) at the University of Connecticut (UCONN) today announced the completion of a landmark performance study involving Division I Collegiate athletes. The study, which was conducted with 40 UCONN athletes (26 males and 14 females) from March 2016—December 2016, was designed to explore areas of human athletic performance and recovery, and how sleep, heart rate (HR) and heart rate variability (HRV) metrics can be integrated together and inform decision making to promote optimal performance, speed recovery, and promote general health and wellness. It is the most comprehensive study of its kind to date—collecting close to one terabyte of physiological data over the course of 8 months—and the initial findings were presented earlier this month at the 40th Annual NSCA Conference in Las Vegas, NV.
“The magnitude and quality of the data collected, including sleep and recovery metrics from WHOOP, has made this the most comprehensive study of athlete performance conducted to-date.”
“It has always been critical for us to ground WHOOP’s technology in science and push the boundaries to unlock human performance. This collaboration between KSI and WHOOP will help us better educate and guide best-practices for maximizing performance and recovery,” said John Capodilupo, WHOOP Co-Founder and CTO. “The magnitude and quality of the data collected, including sleep and recovery metrics from WHOOP, has made this the most comprehensive study of athlete performance conducted to-date.”
The study examined the recovery metrics of the UCONN men’s soccer and women’s cross country teams participating in the 2016-2017 season. Data collection was conducted during off-season training phases and over the course of their full athletic season. Along with collecting sleep and recovery assessments using the WHOOP strap, other variables measured included athlete demographics, training and competition loads, fitness and hydration status, wellness and blood-biomarkers.
“As scientists and practitioners, we are continually trying to connect critical pieces of the performance puzzle and ‘bridge the gap’ between science and practice. However, the critical piece missing is often the time athletes spend outside of training,” said Ryan Curtis, Associate Director of Athlete Performance and Safety, Korey Stringer Institute. “The collaboration with WHOOP allowed us for the first time to gather objective data on how our athletes were recovering outside of training. This is allowing us to define relationships not previously shown and in turn, give actionable insights to coaches, practitioners and researchers.”
The first analysis of the data focused on the relationship between sleep, training load and fitness and revealed positive correlations between:
Training load metrics such as total and average distance, high speed distance, high-intensity accelerations and deceleration and light sleep time
Athlete body fat percentage and average sleep disturbances
Athletes average slow wave sleep time (important for recovery and anabolic hormone release) and high-intensity running.
The ongoing analysis of the study will also explore relationships between WHOOP Recovery and associated metrics with other physiological data collected throughout the study.
“The Korey Stringer Institute at the University of Connecticut is passionately committed to maximizing the performance and health of athletes, warfighters and laborers,” said Douglas Casa, Chief Executive Officer of UCONN’s Korey Stringer Institute. “Our work with WHOOP has enhanced our ability to achieve our goals as an organization since they are committed to the same ideals and have a product that can assist with understanding important components of recovery an athlete is currently experiencing. Our data indicates that WHOOP has the potential to be an important tool in the decision-making process regarding training planning.”
WHOOP, a company committed to unlocking human performance, is transforming how athletes understand their bodies and inner potential. Designed for the 24-hour performance lifestyle, the award-winning WHOOP Strap 2.0 is worn by the most elite athletes in the world to positively change behavior, provide actionable recommendations and avoid overtraining. WHOOP provides individuals, teams, and their coaches and trainers with a continuous and personalized understanding of Strain, Recovery, and Sleep to balance training, reduce injuries, and predict performance. Join the best athletes in the world and learn more by visiting www.WHOOP.com.
About the Korey Stringer Institute
The Korey Stringer Institute (KSI) is housed in the Department of Kinesiology within the College of Agriculture, Health and Natural Resources at the University of Connecticut (UConn). UConn’s Department of Kinesiology has a strong tradition and reputation as one of the leading institutions studying health and safety issues for athletes and the physically active. The mission of KSI is to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer. For more information, visit: www.ksi.uconn.edu.
Beers, burgers, and county-fair funnel cake aren’t the only things that might weigh you down this summer: sweltering weather can make even a short run feel like a trudge through six inches of mud. As the sun beats down, your core temperature shoots up, sending blood away from muscles to the surface of skin to help heat dissipate.
It’s uncomfortable, but science says training in the heat is worth the trouble: Hot-weather workouts teach your body to sweat more (which keeps you cool), increase your blood-plasma volume (which benefits cardiovascular fitness), and lower your core body temp—all adaptations that help you perform better in any weather. But how hot is too hot? “I tell people to use caution when it’s more than 80 degrees out, or 90 degrees if you’re heat-acclimatized, and if the humidity is high, you need to make even more adjustments,” says Douglas Casa, Ph.D., head of the University of Connecticut’s Korey Stringer Institute, which studies enhancing performance in the heat. Follow these specific tweaks depending on what you’re training for.Try RW Art Director Erin Benner’s workout for steamy days: Grab a noodle, jog 10 to 15 minutes to your local pool, then remove your shoes and jump in. Spend 15 to 20 minutes aqua-jogging with the noodle looped under your ’pits, then put your shoes on and jog home. Apply antichafing balm prerun to avoid postpool discomfort.
If you’ve penciled in a long run and starting at 4 or 5 a.m. isn’t an option, make sure you’ve had a solid night’s rest, which enhances heat tolerance, says Casa. Avoid out-and-back routes (which don’t give you the option to bail), and tweak your expectations: “Many of us are around 10 percent slower in the heat,” says Casa. Try running for time instead of distance on super-hot days: If an 18-miler normally takes you three hours (10:00 pace), run for three hours at the same effort level.
Prep for postwork races by packing hydrating fruit and veggie snacks (like carrots, cucumbers, strawberries, and cantaloupe) to nosh on throughout the day. And chill a bandanna to wrap around your neck during the run: A recent study found that such cooling tactics during a race are more effective than precooling strategies when it comes to boosting performance in the heat. You’ll also want to halve your standard warmup to avoid overheating, says Ben Rosario, head coach of Hoka One One Northern Arizona Elite. So if you typically jog for 10 minutes and do dynamic stretches for 10 minutes prerace, do each for five instead—your muscles warm up more quickly in hot conditions. Set goals depending on how the elements look that day. One idea is to focus on place instead of time: If you know you’re among the top 50 in a given race on a cooler day, shoot for the same approximate place when it’s hot.
Stay flexible as you cross off your two or three swimming, biking, and running workouts per week: “We ensure we’re swimming in the heat of the day and running and biking when it’s cooler, and we’ll pick bike routes that pass gas stations for ice to put in jerseys and sports bras,” says Jeff Bowman, owner and coach at Rev Tri Coaching in Tallahassee, Florida. During warm workouts, experiment with hydration to find the right balance of fluids and electrolytes for your needs, and practice drinking on the bike and on the run. When there’s a heat advisory, Bowman’s athletes move running and biking workouts indoors, where they can put in an intense effort with workouts such as the compound brick: “It’s pretty common for us to have to train inside—we’ll do run/bike/run/bike/run/bike (or vice versa) and increase the intensity each subsequent run/bike block,” he says. “But we make sure there’s air conditioning, fans directed at your face and body, and cool fluids.”
If the weather’s taking the life out of your workout, change plans: Join a spin class, pop in a workout DVD, or go for an aqua-jog. As long as you’re clocking at least three moderate to tough runs weekly (inside or outside), for at least half of your usual weekly volume, you’ll maintain base fitness and be able to ease back into your normal schedule as the days become more tolerable. When you’re enduring hot temps, trade heat-radiating roads and sidewalks for dirt or grass; run shaded loops where you can re-up on water and ice; and go by feel instead of pace.
These four tips will help keep you from overheating during summer workouts
By Catherine Roberts
July 23, 2017
With summer in full swing, you’re probably outside more than usual. And chances are it feels hot out there, particularly when you’re exerting yourself.
Most of the time, your body is quite good at regulating its internal temperature. “The body’s main way that it cools itself is through sweat,” says Michelle Cleary, Ph.D., associate dean of graduate programs at Chapman University, in Orange, Calif.
But if you aren’t drinking enough to keep up with the fluid lost in sweat, your body can heat up too much and become dehydrated.
When you’re physically active under these conditions, you can feel lethargic and uncomfortable, but in some cases, you can actually become dangerously sick. A 2011 study found that playing sports, exercising, and doing yard work were among the most common causes of heat-related emergency room visits.
But you don’t have to stay inside this summer to stay safe. These best practices will help keep you from overheating during your summer workouts.
Dress Right and Safeguard Your Skin
What you wear can help keep you cooler when you’re exercising or working outdoors.
“You want to avoid anything that traps moisture against your skin,” Cleary says. Opt for lightweight, loose-fitting items, which allow sweat to evaporate more easily. Also, stick with light colors, which absorb less heat than dark ones. Moisture-wicking polyesters may help move sweat away from your skin, where it can evaporate and cool you down.
Protect yourself from the sun’s rays, too, by wearing sunscreen with an SPF of 40 or higher (check our sunscreen ratings for best brands) during your outdoor summer workouts. Apply it at least 15 minutes before you go outside, and reapply at least every two hours.
Not only does sunburn raise your risk of skin cancer, but, according to Luke Pryor, Ph.D., professor of kinesiology at California State University, Fresno, it can hamper your body’s ability to cool itself by damaging your sweat glands.
Your body is about 60 percent water, which allows your kidneys to filter out waste and your blood to transport nutrients throughout your system. Your sweat mechanism also helps keeps your body at the right temperature, between 97 and 99 degrees Fahrenheit.
How much water do you need? The Institute of Medicine recommends that men consume 3.7 liters of water daily and women 2.7 liters (from food and non-alcoholic beverages).
Instead of trying to keep track of your liters, Sarah Fowkes Godek, Ph.D., director of the HEAT Institute at West Chester University of Pennsylvania, recommends that you rely on your sense of thirst to tell you how much water to drink.
“Our thirst mechanism is adequate and very well developed,” Fowkes Godek says. The exception is older adults. Your sense of thirst diminishes as you age, so relying on thirst for seniors may not be sufficient to keep them hydrated. See our advice for older adults here.
As for what to drink, water is best, says Fowkes Godek. While you do lose important nutrients known as electrolytes —such as sodium, magnesium and potassium—when you sweat, she says most people have no need for sports drinks or other beverages fortified with electrolytes. Most people get enough nutrients from meals and snacks to replace what they lose, and sports drinks often contain a lot of added sugars.
The exceptions: People who work out for more than an hour at a time, and workers who labor for long hours outside in the heat may need to replace electrolytes.
Consuming water-rich foods like melon, citrus, and leafy greens can also help keep you hydrated. And while the heat may blunt your appetite, try to have a small snack of about 150 to 200 calories an hour to 30 minutes ahead of your workout—if you haven’t had a meal within the prior four hours. Refuel within an hour afterward. (See our advice on what foods are best to eat before and after any workout.)
Time Your Activity Right
During the summer, do as much of your outdoor physical activity in the morning or evening, when it’s slightly cooler. When outside, stay in the shade as much as possible.
It’s also important to let your body acclimate to exercising or working in the heat, says Douglas Casa, Ph.D., CEO of the University of Connecticut’s Korey Stringer Institute, which produces research and advice on the prevention of heat-related deaths for athletes and workers.
That means, ideally, slowly working up to a full intensity training session or work day. A 2016 analysis found that taking eight to 14 days to acclimatize to exercising or working in the heat may be most effective for minimizing heat stress to your body. But that’s not always practical. Still, if you have an outdoor activity such as a big hiking trip, long-distance run, or a major yard project planned, try to work up to it over a period of days.
Adults who supervise groups of children, at camps or in sports teams, for instance, should make sure they give youngsters a chance to adapt to the heat as well. See tips from the American Academy of Pediatrics on how to keep youngsters safe in the heat.
Watch Out for the Symptoms of Heat Stroke
If you notice any signs of dehydration or heat-related illness—including dizziness or lightheadedness, headache, fatigue, nausea or vomiting, and muscle cramps—take a break from your activity, find shade or a cool room, and drink water.
And note that while the ability to cope with heat and humidity do vary from person to person, some weather conditions merit precautions for all. So, pay attention to heat watches, advisories, and warnings in your area (available through the National Weather Service). On days with these alerts, take extra care to stay hydrated, and consider modifying your activity level or moving your summer workout indoors for the day.
And be on the lookout for signs of heat stroke, which can be fatal if not addressed quickly. The two most important symptoms are body temperature above 104 degrees and central nervous system problems such as losing consciousness, irritable or irrational behavior, mood changes, and disorientation.
You may not have a thermometer on hand, but if you experience one or more of the behavioral symptoms mentioned above during a summer workout, or notice them in someone else, take action: “Get body temperature down as fast as humanly possible,” says Casa at the University of Connecticut.
Move out of the heat and direct sun, and into a cold bath or shower (or use water from the garden hose or any other water that’s available if you can’t get indoors). Flip on a fan or air conditioning to speed cooling. After taking action to cool the person down, call 911.
By: Ryan Curtis MS, ATC, CSCS, Associate Director of Athlete Performance and Safety, Korey Stringer Institute
Athlete monitoring is becoming standard practice for maximizing player performance,reducing injury risk, and optimizing competition readiness. For high-performance programs, monitoring load-performance and load-injury relationships are essential for providing insight into how athletes are responding to stresses incurred during and outside of training and competition. Ultimately, how an athlete performs is impacted by the accumulation of stress and the efficacy of training. Therefore, it is important to evaluate stress imposed during training and match sessions, as well as, the strain incurred by each athlete. Understanding the difference between stressors (i.e., intense exercise, heat, cold, altitude, etc) and the strain (body’s response to stress) experienced by a biological system (i.e., human body) is essential to monitoring and manipulating parameters important for athlete preparation. Other benefits to monitoring athletes beyond determining training efficacy, such as gathering scientific explanations for changes in performance or injury risk, enhancing coach and practitioner confidence when manipulating training loads, and boosting athlete-coach- practitioner relationships all contribute to the efficacy and buy-in of monitoring practices. There are four main purposes for monitoring athletes; optimizing readiness, ensuring proper prescription of stress and recovery (periodization), reducing injury risk, and monitoring safe and effective return to play programs (Figure 1). While each of these purposes are important, emphasis and priority placed on these purposes will vary based on team’s load monitoring philosophy.
Monitoring Training and Competition Load
When monitoring the dosage of stress imposed during training or competition, practitioners and scientists typically refer to training load. Load is simply the product of duration and intensity of activity. Training load can be further described as either external (work imposed independent of internal strain) or internal (response of the body to external load), as shown in Figure 2. The association between external and internal load can give great insight into the status of the athlete (i.e., fresh vs. fatigued). With advancements in wearable technology, monitoring of athletes’ external load has received a great deal of attention. Specifically, global positioning systems (GPS) capabilities have allowed ease of monitoring parameters such as distance, time, and efforts in multiple velocity zones (0-7.2 km/h-walk, 7.2-14.4 km/h-jog, 14.4-21.6 km/h-run, >21.6 km/h-sprint) used for tracking running performance. GPS-enabled devices use positional differentiation to calculate distance and acceleration.
Beyond quantifying the intensity distribution of session types (i.e., match, training, conditioning, etc.), GPS metrics are often reported as aggregate measures such as high-intensity running distance (distance >14.4 km/h), number of sprints (efforts > 25.2 km/h), and average speed (meters per minute). However, GPS technology is limited in its ability to detect external movement beyond positional change and additionally, has serious limitations with tracking movement indoors. This leaves monitoring of indoor team sports such as basketball and volleyball at a disadvantage. However, modern player tracking technology typically uses integrated inertial sensors such as accelerometers, gyroscopes, and magnetometers to help quantify stress imposed in all three planes. Calculated metrics such as PlayerLoad TM (Catapult) from integrated inertial sensors have a strong relationship with running performance measures such as total distance covered, while additionally estimating general load on the body and therefore stress from actions such as tackling, accelerations, decelerations, changes of direction and collisions. Due to the inertial movement sensors ability to detect magnitude of movement (i.e., g-forces) in 3 planes of motion, a single arbitrary unit of load might give a more accurate display of total stresses incurred during activity.
Both physiological and psychological measures such as heart rate, lactate, muscle oxygen, and rating of perceived exertion (RPE) can be used to monitor loads sustained internally. Of the numerous methods of objectively quantifying internal load, heart rate derivatives such as time in heart rate zones, expressed as percent of maximum heart rate, and weighted scores such as training impulse (TRIMP) are most commonly used. These measures allow categorization of training stress into relative zones such as high, moderate, and low. Of the methods to quantify internal load by subjective means, using RPE and session RPE (sRPE) are by far the most common. sRPE is simply the product of session duration and the athlete-reported RPE post-training/competition. This subjective measure has shown good association with external running performance measures.
Monitoring Readiness, Recovery and Wellness
Monitoring readiness, recovery, and wellness requires both physiological and psychological assessment in order to gain understanding of an athlete’s true state. These assessments could be as simple as asking the athlete “how do you feel?” or as complex as using microtechnology (telemetry or photoplesthsmography) to ascertain the variability in heart beat to beat intervals during rest or sleep. Monitoring the response to training and/or competition gives the practitioner great insight into individual dose-response relationships and helps to promote precision with recovery practices. For example, if an athlete is excessively fatigued, coaches may prescribe a recovery session or reduce training load for that day. Current practices in monitoring athlete readiness prior to activity include heart rate-based autonomic nervous system assessment (i.e., heart rate variability, HRV; heart rate recovery, HRR), neuromuscular function tests (i.e., counter movement jump, CMJ; reaction tests), and wellness questionnaires/assessments (i.e., stress, fatigue, soreness, anxiety). More extensive monitoring such as biochemical/immunological/hormonal assessment (i.e., blood, saliva, and urine-biomarkers) and psychological inventories (i.e., Profile of Mood States, Sport Anxiety Scale, Rest and Recovery Questionnaire) can give insight into overtraining or maladaptation if assessed longitudinally.
Limitations in Athlete Monitoring
While there is much to gain from monitoring athletes, there are several limitations that must be considered when implementing a monitoring program. Monitoring athletes does not always require large funding sources (i.e. subjective markers of training load combined with wellness reporting), however analyzing data does require time, manpower, and experience/skill. With vast amounts of data pouring in from sometimes multiple technologies and questionnaires, persons experienced in data management and analysis are often needed derive meaning and interpretation beyond simple descriptive reporting. In addition, attaining buy-in from athletes and coaching staff is sometimes difficult if immediate returns are not seen. Regarding technological limitations, very little validation and reliability testing is conducted by parties outside of the technology manufacturer. With that, the way in which raw data is processed and filtered varies by manufacturer and software version. Because software updates can occur quite often and the way in which data is filtered and reported is changed, validity and reliability of the device will change concurrently. This has severe implications when determining the precision and consistency of measurement longitudinally.
Taken together, programs must weigh the benefits and limitations of athlete monitoring together. Without structure in data management, plans for implementation based on data analysis, and athlete-coach buy-in, monitoring athletes can be a waste of time and resources that could be used to gain advantage elsewhere. However, if care is taken in promoting, structuring, and implementing a purposeful and practical monitoring program, teams stand to gain a great advantage in maximizing the health and performance of their athletes.
So has anybody ever heard a story about an idea that was born in a bar or restaurant, with the initial concepts drawn on a napkin? I know I was skeptical of such tales. That was until I was part of this exact situation.
Picture three athletic trainers, one of whom had talked to both individuals, but the other two had never met before. We met at the first annual Collaborative Solutions for Safety in Sport conference in New York City in 2015. I saw this as an opportunity to finally bring a guy with previous experience using a program called Zee Maps together with an athletic trainer who is also a researcher and explain that the three of us needed to collaborate on a project to assist with collecting data on the secondary school setting. The venue where this meeting took place was a restaurant called Dos Caminos in New York City.
By the end of the evening, we had the name of the project, the data that we wanted to collect, and the questions that would be asked all jotted down on a napkin. We all found something we were passionate about and were brainstorming how we could best merge all our ideas together. We were so busy and lost in thought and dialogue that we totally lost track of time and found that the restaurant staff had cleaned the entire place and got ready for the next day before we ever knew what was going on around us. This is where the Athletic Training Locations and Services (ATLAS) project was born and started to develop its personality. The players were Ronnie Harper, EdD, ATC, co-owner of My Sports Dietitian and Head Athletic Trainer at Dutchtown High School in Geismar, La., Rob Huggins, PhD, ATC, Vice President of Research and Athlete Performance at the Korey Stringer Institute (KSI), and myself.
As of today, 71 percent of all secondary schools in the country have been mapped on the ATLAS project. Currently, NATA Districts 1, 2, and 3 are tied with 91 percent of the schools mapped in their districts.
Since that time, the ATLAS program has evolved into a living, breathing project that is just starting to realize its potential. While its original goal was to collect data on employment status, hiring practices, the number of athletic trainers at a particular secondary school, and the size of school, it has grown to push student safety initiatives, track emergency action plan (EAP) use, track trends in hiring practices, see how athletic trainers work with their team physicians, track who has AEDs, track the number of student-athletes, track what sports are offered, and more. State leaders, legislators, state and national medical associations, parent groups, and school administrators are now asking for data that helps change the landscape of athletic health care at the secondary school level.
If you haven’t taken the time to get your high school accurately mapped or taken the five-minute survey, then you are in the minority. As of today, 71 percent of all secondary schools in the country have been mapped. Currently, NATA Districts 1, 2, and 3 are tied with 91 percent of the schools mapped in their districts.
While we still have a ways to go, the ATLAS project marks the first time we’ve been able to collect information on all of the approximately 22,000 high schools across the country. Before, data collection was not as robust, and we relied on other school personnel for the information. Now, we are dealing directly with athletic trainers. This in itself has helped to increase involvement and accuracy.
While the ATLAS questionnaire consists of 27 questions total, here is a snapshot of the information requested:
• School name and address
• Public or private or other type of institution?
• Are you full time or part time?
• How are you employed?
• Do you have venue-specific EAPs?
• Do you have Standard Operating Procedures (SOPs)?
• Who signs off on your SOPs?
• What is the specialty of your team physician?
• Are you a Safe Sports School Award Winner?
• Are you a Gatorade Award Winner?
• Number of sports your school offers?
• How many athletes?
• Do you teach?
• What do you teach?
So you may be asking yourself: How can this benefit me? Well, do your teams ever travel out of state? Do your teams compete in state tournaments against teams that you are not familiar with? If you answered yes to either of these, the ATLAS project can be a method of communicating with the athletic trainer from a team in another state or a school on the other end of the state.
We will also be able to use the information we gather as a conduit for release of material that is of particular value to our setting. If you have read the news lately, there are many states that have had their athletic trainers’ credentials attacked. ATLAS would have been a great way to mobilize state members to contact their legislators and other stakeholders in a short period of time.
I hope that you can now see how and why Ronnie, Rob, and I got so busy planning the premise of this project that evening in New York City. We saw endless possibilities to benefit the secondary school setting and the athletic training profession. So next time you’re at a restaurant with a group of professional colleagues and the ideas start flying, grab a napkin and start writing. You never know what could happen.
Get on board, and help the NATA and KSI get all of the secondary schools across the country mapped. Your profession depends upon it. Go to http://ksi.uconn.edu/nata-atlas/and take the survey to get your school mapped.
Special thanks to Ronnie Harper for planting the seed and to Rob Huggins and Sarah Attanasio, ATC, Assistant Director of Research at KSI, for their continued help, support, and dedication to make this project a success.
Larry Cooper, MS, LAT, ATC, is Head Athletic Trainer at Penn-Trafford High School in Harrison City, Pa., where he also teaches health, physical education, and sports medicine classes. Since 2012, he has served as Chair of the NATA Secondary School Athletic Trainers’ Committee. Winner of a 2016 NATA Most Distinguished Athletic Trainer Award, 2015 T&C Most Valuable Athletic Trainer Award, and 2014 NATA Athletic Training Service Award, he was inducted into the Pennsylvania Athletic Trainers’ Society Hall of Fame in 2014. Cooper can be reached at: email@example.com.
Growing up as an athlete in Louisiana, I was one of many teenagers who took to the football field for summer two-a-day practices. In the nearly tropical summer heat and humidity, we would practice and play in triple-digit temperatures – almost always in full padding. Between sessions, my teammates and I sometimes stood under cold showers for 15 minutes, wearing our full uniforms, just to try to cool ourselves down. It was in those temperatures that a player I knew collapsed and died on the field from exertional heatstroke, or EHS.
EHS can occur in otherwise healthy individuals and is different from classic heatstroke, which usually affects those who are very young, elderly or have pre-existing medical conditions. Athletes and soldiers whose uniforms require heavy gear are especially vulnerable.
Treatment for EHS has evolved very little over the centuries, essentially relying on external cooling methods. Water immersion, an earlier version of cold water immersion (today’s first line treatment for EHS), was described by the Greek physician Hippocrates in 400 B.C. But even as today’s young athletes and their parents are becoming better informed about the risks of concussion and dehydration out on the field, many believe that heat is merely uncomfortable and do not recognize the dire risks it can present.
Some of this risk could be reduced if high school athletic organizations followed the lead of professional and college teams in banning two-a-day summer practices, which unnecessarily subject young athletes to the risk of exertional heatstroke.
In April, the National Collegiate Athletic Association banned two-a-day summer practices for Division I college football players, on the basis of recommendations from medical professionals, coaches and administrators. The change is intended not only to control exertion on the field and promote recovery from it, but also to minimize injuries such as concussion and lower the risk of EHS.
The National Football League banned two-a-day practices six years ago, in 2011. But many high school football players still face the risks associated with two-a-day practices. Currently, guidelines vary across state lines. While states like Iowa have banned two-a-day practices, others like Georgia and Texas ban only back-to-back two-a-day sessions and other states still allow them.
I’ve served as a physician, researcher and consultant for more than 20 years in an effort to bring wide attention to the issues and threat of concussions in football. And now I have ample grounds to believe that EHS qualifies as an issue of similar importance. While many people think of EHS as a temperature issue, it’s truly a neurological and metabolic emergency that, if not treated, can result in irreversible damage to the brain, other vital organs, or even death. According to research published in the American Journal of Preventive Medicine, the number of injuries associated with exertional heat illness in the United States – most of which involved young people playing sports – increased by more than 130 percentbetween 1997 and 2006.
It is vital for EHS to be identified as early as possible, so that the person can be removed from the hot and humid environment and be treated. EHS occurs when the core body temperature rises to dangerous levels – 104 degrees Fahrenheit or greater. Such a high core body temperature, even for a short period of time, can cause permanent damage to the brain, liver, kidneys and other organs.
It’s particularly ominous when the central nervous system becomes involved; there is the potential for progression to coma and death. For those who survive, long-term and potentially irreversible neurological damage can occur, affecting cognition, movement, coordination and sensory systems. I’ve personally seen how such nervous system deficits can devastate patients, impairing everything from performing basic tasks to engaging in social interactions with friends. These effects often strike young, active patients who are in the prime of their lives. And because the effects of heat are cumulative, people who have had other heat stress experiences are more likely to experience heat illnesses – like EHS – again, and should take particular caution when exerting themselves in hot or humid conditions.
As a physician dedicated to the practice of sports medicine and as a former athlete, I’m committed to raising awareness of EHS and ensuring that parents, coaches, athletic trainers and others are prepared to recognize EHS and respond.
The Korey Stringer Institute, named for the Minnesota Vikings player who died of exertional heatstroke in 2001 at age 27, offers useful guidance on its website. In addition to a high core body temperature, the signs and symptoms of exertional heatstroke include fainting or dizziness, vomiting, confusion and disorientation and unusual behavior like aggression. Exertional heatstroke is a medical emergency, and fast treatment is critical.
If you see anyone exhibiting the signs and symptoms of EHS, call 911 immediately and initiate rapid cooling, ideally with an ice bath. It’s important to remember that seemingly healthy people can be at risk.
If organizations that represent high school athletes consider adopting the N.C.A.A.’s complete ban on two-a-day practices, they may help prevent fatalities like that of the player I knew years ago in Louisiana.
Julian Bailes is director of the department of neurosurgery and co-director of the NorthShore University HealthSystem Neurological Institute.
Associate Director of Communication and Assistant Director of Athlete Performance and Safety
Members of KSI had the opportunity to travel to Las Vegas, Nevada for the 40th annual National Strength and Conditioning Conference
where strength and conditioning coaches, personal trainers, sport scientists, sport nutritionists, and health enthusiasts gathered to present, network, and honor certain outstanding members.
We were fortunate to attend a lecture given by this year’s Sport Scientists of the Year, Shawn M, Arent, and Dave DiFabio from Polar, whom we had the opportunity to work with in the past. They discussed the use of wearable technology and how coaches and sport scientists should start thinking about applying the knowledge we gather from this data to practice.
Ryan Curtis, Yasuki Sekiguchi, and I presented some of the recent research findings from the KSI. I presented a poster titled, “Analysis of Women’s Cross Country Lab Tests Results and Training Over the Course of a Competitive Fall Season” on Thursday (7/13/17). I examined the change in lactate testing, VO2 max and training of the UCONN Women’s Cross Country team during their fall season. The major finding of this study was the vOBLA (velocity at onset of blood lactate) was significantly higher during the middle of the season while VO2 max did not change throughout the season. During my presentation, I was very excited to reconnect with two of my former colleagues from Florida State University. Daniel Shaefer was the former director of strength and conditioning at FSU and is now working on is PhD at the University of Wisconsin-Madison. Jon Jost was the former FSU director of strength and conditioning and recently accepted a position with Gatorade. I am hopeful that we will get an opportunity to collaborate on future research. I also had the fortune to meet Kristen Holmes-Winn, from WHOOP, who funded the research Ryan and I presented at this conference.
Yasuki Sekiguchi presented a poster titled “Heartrate Variability between Starters and Nonstarters throughout a Collegiate Soccer Season.” During this study, HRV and training load metrics were monitored over the course of D1
college soccer season. The relationship between these variables were examined for all players, starters, and nonstarters. The major finding of this research was that acute:chronic training load ratio might be used to explain the changes in HRV over the course of a Division 1 male soccer team
Ryan Curtis did an oral presentation on Saturday (7/15/17) titled “Relationship between Sleep, Training Load and Fitness in Collegiate Soccer.” Overall this study illustrated that sleep quality may be more sensitive to increased training load than sleep quantity. Collegiate athletes with increased training loads have increased light sleep but not REM sleep or overall sleep duration.
Outside of the conference, we had a fantastic time exploring the Las Vegas strip and the beautiful hotel hosting us and the conference, Paris Las Vegas. I am extremely thankful to the NSCA and KSI for the opportunity to collaborate and learn from others in the field while making memories that will last a lifetime. I look forward to attending this event next year and present the results from our upcoming projects.