After a few deaths on Arizona hiking trails this summer, the Phoenix Parks and Recreation Board met last week to discuss whether to close the city’s hiking trails in extreme heat. The proposal was rejected after opposition from hikers, although the board did approve a ban on dogs on hiking trails when the temperature reaches 100 degrees.

One couple from Great Neck, New York, has made it their mission to educate people about the dangers of hiking in extreme heat conditions. Mark and Ellen Newman worked together with Yoram Epstein of Tel Aviv University and Dr. Douglas Casa of the University of Connecticut’s Korey Stringer Institute to create Ariel’s Checklist, which includes 10 points that every hiker and hike leader needs to know to prevent exertional heat stroke (EHS).

Source: Jewish News

By Ryan Curtis, MS, ATC, CSCS, Associate Director of Athlete Performance and Safety

With the Summer Olympics in Rio de Janeiro set to begin in less than a month, athletes are making their final preparations for their opportunity to compete on the world’s biggest stage. For some athletes their performance in the Rio Olympic games may not be solely reliant on the calculated training program and countless hours they’ve dedicated. Instead, their performance could hinge on their ability to prepare for the abnormal heat expected in Rio. With average August temperatures in Rio ranging from the mid 60’s to mid 70’s, temperatures have been forecasted to be in the mid 80’s throughout the games. This potential obstacle outdoor athletes in the Rio might face presents a great opportunity to review key essentials and strategies to optimizing performance in the heat.

1. Acclimatization Strategy

• Heat acclimatization is a process in which the body undergoes adaptations to better handle exercise in warm environments
• A minimum of 10-14 days should be used to properly adapt to heat stress, however 2-3 months may be required for optimal performance benefits
• Repetitively exercising in the heat improves cardiovascular efficiency and therefore performance through expansion of blood plasma volume, which leads to increased stroke volume and decreased heart rate.
• Heat acclimatization improves sweat rate and sweat sensitivity so that evaporative heat loss is enhanced and internal core temperatures remain cooler.
• Athletes competing in high ambient temperatures should ensure repeated bouts of training in the heat for biological adaptation that lower physical strain and improve performance
• Exercise in the heat should be at least 60 minutes per day to induce physiological adaptations.
• If possible, train in the same environment as the competition or plan to train at or near the venue for several weeks prior to competition.

2. Hydration Strategy

• Exercising in hot environments increases evaporative heat loss (via sweating) and can lead to progressive dehydration (i.e. reduced plasma volume) and increased rates of heat storage if fluids are not adequately replaced.
• Athletes exercising in hot environments often lose 1-1.5 liters of sweat per hour, however some individuals sweat rates can exceed 2.5 liters/hour.
• Athletes should develop individualized hydration strategies based on their sweat rate in a hot environment as drinking to thirst often results in body water deficits which can exceed 2-3% body mass. 2-3% body mass deficits have been associated with decreased performance.
• Athletes training and competing in a warm-hot environment have higher sodium (i.e. salt) losses and therefore requires more sodium than athletes competing in a cooler environment or the general population.
• Post-training hydration routine should include fluid, sodium, carbohydrates and protein.

3. Cooling Strategy

• Athletes should develop an appropriate cooling strategy applying external cooling methods (i.e. ice towels, ice bath, or cooling garments) and internal cooling methods (i.e. cold fluid ingestion) specific to their sport, event and individual needs.
• Skin cooling can reduce cardiovascular strain, while whole body cooling can reduce organ and muscle tissue temperature.
• Athletes can cool prior exercise to decrease body temperature and heart rate, during exercise to decrease rate of temperature rise, and after exercise to decrease muscle damage and reduce metabolic response to exercise.

4. Sleep and Travel Strategy

• Sleep deprivation can impede thermoregulation in hot environment by decreasing evaporative heat loss mechanisms (i.e. sweat rate and sensitivity).
• Travel, especially across several time zones, can disrupt the body’s natural sleep and wake cycle (i.e. circadian rhythm disruption). Rapid adjustment of the body’s biological rhythms is necessary for ensuring sleep quantity and quality is gained and maximal performance is not lost.
• Plan for 1 day of sleep recovery for every time zone crossed. For example, two weeks of adjustment time would be optimal for travel across the 14 time zones between NY, USA and Sydney, Australia.
• Practice good sleep hygiene habits such as reducing alcohol and caffeine prior to bed, prioritize a 20-30 minute wind down time, maintain a consistent sleep schedule, and power down technology one hour prior to bed.

References:

1. Racinais S, Alonso JM, Coutts AJ, Flouris AD, Girard O, González-Alonso J, et al. Consensus recommendations on training and competing in the heat. Br J Sports Med. 2015
2. Pryor RR, Casa DJ, Adams WM, Belval LN, DeMartini JK, Huggins RA, et al. Maximizing Athletic Performance in the Heat: Strength and Conditioning Journal. 2013 Dec;35(6):24–33.

By Alicia Pike, Associate Director of Research

The staff at KSI spent the past week at the 67^th Annual NATA Clinical Symposia & AT Expo in Baltimore, MD. Although the meeting brings athletic trainers from all around the country to one location year after year, this year’s attendance was noteworthy. NATA’s Associate Executive Director, Rachael Oates, confirmed this year’s symposia was the second most attended in NATA history, falling close behind Las Vegas’ 15,000 attendees with an impressive 13,000!

This meeting is always a unique opportunity for KSI to showcase all of the notable research that has been conducted over the past years. It serves as a means of educating the athletic trainers in attendance with novel research topics and findings. William Adams, Vice President of Sport Safety, kicked the list of KSI presentations off with his minicourse titled, “Developing and Implementing Evidence-Based Best Practice and Procedure for the Prevention of Sudden Death in Sport.” On Thursday morning, Lesley Vandermark presented information about medical care provided in lieu of an athletic trainer in the public secondary school setting, a small subset of data that came from the CATCH-ON study investigating the prevalence of athletic training services in the public sector. Congratulations to Lesley, as she was one of the Doctoral Oral Student Award Finalists!

On Thursday afternoon, three of our staff members all had Free Communication Poster Presentations at this year’s symposia. Rachel Vanscoy presented data  on the shortened environmental symptoms questionnaire and it’s ability to represent physiological adaptations following heat acclimation. Yuri Hosokawa, Director of Communication and Education, presented on the effectiveness of tarp-assisted cooling as a method for cooling hyperthermic individuals. KSI’s Director of Research and Military and Occupational Safety, Luke Belval, also presented data on cooling individuals with exercise-induced hyperthermia, but with a novel cooling vest. The day’s presentations from KSI staff continued with William Adams, Rachel Katch, and Sarah Attanasio presenting in a rapid-fire oral presentation session titled “Trends & Interventions for Heat & Hydration Risk Reduction.” Will spoke about policy changes reducing exertional sickling related deaths in DI football players. Similarly, pertaining to policy changes, Sarah, Assistant Director of Research, presented data on the occurrence of exertional heat stroke in high school football athletes prior to and following the implementation of heat acclimatization guidelines. Rachel, KSI’s Associate Director of Military and Occupational Safety, was the last KSI staff member presenting her work in this session from her Master’s thesis titled, “Use of the Heat Stress Score to Predict Preparedness to Run in an Outdoor, Warm Weather Race.”

Yuri Hosokawa and Dr. Douglas Casa, KSI’s CEO, both presented in a feature presentation on malignant hyperthermia in physically active populations. Yuri provided attendees with a summary of case reports, while Dr. Casa followed up with clinical implications. Alicia Pike, Associate Director of Research, presented data on the various individuals that secondary schools use to provide medical care when an athletic trainer is not employed. KSI’s Director of Sport Safety, Samantha Scarneo, presented data on agility and injury risk in youth basketball players. Last but certainly not least, Rebecca Stearns, KSI’s COO, had the opportunity to present a special topic on the effectiveness of protein as an ingredient in hydration beverages. It was a special year as almost all staff members at KSI were given the opportunity to present their research and knowledge to the attendees.

This year’s symposium was especially unique as the NATA Research and Education Foundation turned 25! In celebrating the silver anniversary, the NATA Foundation hosted a remarkable dinner on Friday night to celebrate their yearlong theme of “Remembering Our Roots, Growing Our Future.” The staff at KSI had the opportunity to attend the spectacular event and support all the Foundation has accomplished and what they will continue to do in the coming years! The attendees heard from Dr. Brian Hainline, chief medical officer of the NCAA, who championed for athletic trainers and showed utmost support for the profession.