Study Examines Sudden Deaths in Youth Athletes (Athletic Business)

New research by the Korey Stringer Institute (KSI) and the University of Connecticut revealed the most common cause of sudden death in American youth sports for athletes aged 6-17 years.

According to a press release by the National Athletic Trainers’ Association, which published the first-of-its-kind study in its Journal of Athletic Training, the majority of sudden deaths among youth athletes were cardiac-related and took place during practices within organized middle school sports.

The research looked at data from 2007-2015, where there were 45 cases of sudden deaths reported in American youth sports. It found that sudden cardiac death accounted for 76 percent of those deaths. The researchers found that basketball was the most deadly sport, accounting for 36 percent of sudden deaths. Baseball and football each accounted for 16 percent of sudden deaths, and soccer accounted for 13 percent.

Fully 73 percent of sudden deaths occurred in kids between the ages of 12 and 14, and about 80 percent of the sudden deaths were boys.

“Until this study, sudden deaths occurring in youth sport had been grouped with sudden deaths occurring in older athletic populations in previous epidemiological studies,” Brad Endres, the study’s lead author and the assistant director of sport safety at KSI said. “Our goal was to clearly define the understanding of ‘youth sport’ so that more appropriate and evidence-based policy decisions aimed at improving youth sport safety can be implemented.”

In the release announcing the research, NATA and the National Basketball Athletic Trainers’ Association recommended five tips for keeping their student-athletes safe while playing basketball:

  1. Get a checkup before play. The groups advised parents of athletes to get a pre-participation evaluation from a medical professional, even when it’s not required.

  2. Ask about the coach. The groups recommended ensuring that a coach creates an environment where players feel comfortable to report injuries and get medical attention if necessary.

  3. Ask about emergency plans. The groups suggested asking about venue-specific emergency action plans.

  4. Get a CPR/AED-certified person at every practice and game. The groups suggested knowing where the nearest AED is, and asking if someone certified in administering it in an emergency would be present at every event (practices and games). If not, the groups recommended advocating for that equipment and those roles.

  5. Ask if there is an athletic trainer. Having athletic trainers on hand at every event can be an additional boon to emergency and cardiac care.

Source: Athletic Business

NCAA’s role in protecting student-athletes could be clouded by legal liability, among other factors (Sporting News)

By Dan Bernstein

The NCAA could end up becoming more liable to lawsuits if proposed measures aimed at protecting student-athletes pass, just one of the barriers to the organization taking a more active role in player health and safety issues.

As the NCAA introduces regulatory policies like guidelines to prevent non-traumatic deaths and improved accreditation standards for strength and conditioning coaches, it might expand its legal duty to provide care, thus making it more vulnerable to civil negligence claims, according to attorney Bob Wallace, who represents athletes and sports teams for national law firm Thompson Coburn. Two Oregon football players hospitalized in a January 2017 workout have filed such cases against the NCAA and the University of Oregon.

“When organizations or companies or industries are regulating conduct,” Wallace said, “there’s always a balancing act of how far can you go, should you go before you shift a bunch of the responsibility onto your organization.”

NCAA spokesman Christopher Radford, however, told Sporting News in a statement that “NCAA health and safety efforts are not calculated by whether there is increased legal liability but on what is in the best interests of our student-athletes.”

Fear of liability is one of several explanations offered by legal analysts, medical experts and college sports officials as to why the NCAA has not substantially addressed the issue of student-athlete fatalities. At least 27 Division I college football players have died in offseason conditioning sessions from non-traumatic causes since 2000, according to a 2017 study authored by Oklahoma head athletic trainer Scott Anderson.

Dr. Douglas Casa, who leads the Korey Stringer Institute (named after the former Minnesota Vikings player who died of heatstroke complications in 2001), blamed the NCAA’s hesitation to act on player safety issues on a philosophical disagreement between its sports science department — which is adamant the organization should have a role in health and safety issues — and the priorities of individual conferences and athletic departments, particularly as it relates to football.

“You have really stubborn people working in football (and college athletics) who don’t think in a particular way for a really long time,” Casa said, “and they don’t want to be told what to do.”

Casa’s view was echoed by several sources with direct knowledge of how conferences and member institutions think, including two who have participated in NCAA Committee on Infractions hearings, representing both the NCAA and member institutions.

Even so, Dr. Brian Hainline, chief medical officer of the NCAA’s Sports Science Institute, told SN “the needle is shifting rather rapidly” toward his organization playing a greater role in health and safety matters. He said he was aware of several NCAA investigations into schools that did not implement an NCAA-mandated independent care model, instituted in 2017.

Radford declined to elaborate on those investigations, but told SN its legislation was intended to reinforce standards of care and help schools understand their obligations.

“The NCAA does not determine the medical standard of care or second-guess the judgments exercised by health care professionals,” Radford said. “NCAA legislation does allow for limited review of whether our institutions have the structures and policies to support the health and safety of student-athletes.”

NCAA’s history with student-athlete safety issues

Anderson, the Oklahoma trainer who has become a leading advocate of student-athlete safety, said doctors realized in the late 1990s that people who carried the trait for sickle-cell anemia were at increased risk for collapsing during workouts, particularly when training in hot climates. This had led to a string of deaths in offseason conditioning sessions.

Anderson said a unified movement to screen for the trait — and educate athletic departments of its perils — began soon after, eventually leading the NCAA to require sickle-cell screening, starting in 2010.

Anderson said the screenings have prevented deaths, and he lauded the NCAA’s independent care model measure that discourages trainers from reporting directly to coaches or athletic personnel. The NCAA has also begun addressing concussions, a lightning-rod issue that has brought it criticism and put it in the crosshairs of frequent litigation.

But Anderson said it has been frustrating to watch other initiatives struggle to gain traction.

Student-athlete deaths have largely followed a pattern, wherein players are jeopardized by strenuous offseason workouts that follow sustained periods of inactivity, such as winter break or between spring and summer practices. Misunderstanding of basic medical principles has also played a role in hospitalizations.

Maryland football player Jordan McNair died in June 2018 after being asked to complete a conditioning test of 10 110-yard sprints in the team’s first organized conditioning session of the summer. His heatstroke was initially misdiagnosed, and trainers did not apply cold water immersion, a widely accepted practice to counter the effects of heat-related illness.

Those who have criticized the NCAA for not taking a more active stance as it relates to player safety say the organization could mitigate those kinds of mistakes with stronger regulation, such as the proposed best practice guidelines for preventing non-traumatic deaths.

“When you’re a 17-year-old kid or 18-year-old kid, and parents say you’re going to play in a sport and you’re provided with a scholarship, they’re basically turning that child over to make sure that kid is taken care of,” Wallace said. “And so there’s a whole bunch of things you could have a real discussion about with college athletics and the way they’re treating athletes.”

Legacy of NCAA’s stances on non-health scandals

If the NCAA was worried about how regulation might impact its legal liability before 2013, the events of that year seemingly added to its level of concern, according to ESPN college basketball analyst Jay Bilas and several legal experts.

Penn State took the NCAA to court after the latter imposed heavy sanctions on the Nittany Lions following former assistant coach Jerry Sandusky’s years of sexual abuse of children (sometimes on Penn State property). At first, the NCAA imposed a $60 million fine, four-year postseason bowl ban, scholarship reduction and vacation of all Penn State wins after 1998. It was forced to rescind many of those penalties, however, as part of a settlement with the school.

“They basically overreacted and they imposed an enormous amount of sanctions that then they had to pull back from,” said a source who has worked with the NCAA as a legal consultant. “Now they’re just hesitant to do anything.”

Since then, the NCAA has not reacted to most off-field issues, not just those relating to offseason workouts. Recent abuse cases such as former Michigan State doctor Larry Nassar’s decades-long sexual abuse of gymnasts went unpunished by the NCAA.

“I think the NCAA and those in charge within the structure, the presidents, they realize they screwed up with regard to the Penn State matter and how they went outside of the normal structure,” Bilas said. “And you can tell that because they haven’t taken any similar action in any way, shape or form on nearly identical cases that have come up afterward.”

Scandals that have involved competitive advantages or threats to amateurism, such as an FBI probe into college basketball programs paying athletes through shoe companies, have been met with more forceful responses.

“These allegations, if true, point to systematic failures that must be fixed and fixed now if we want college sports in America,” NCAA president Mark Emmert wrote of the FBI probe. “Simply put, people who engage in this kind of behavior have no place in college sports. They are an affront to all those who play by the rules.”

While Bilas does not believe the NCAA should govern any off-field issues, he said it was hypocritical for it to offer such strong public rebukes while it remained relatively quiet in instances of student-athlete deaths. The NCAA did not condemn Maryland after McNair suffered a fatal heatstroke at the team workout.

“Essentially the silence is deafening,” Bilas said. “Where’s the commission on that? Where’s the outcry on that? And there isn’t one.”

Moving forward

When Casa was a senior in high school in 1985, he suffered a heat stroke during a 10K race. He collapsed and spent several hours in a coma. He nearly died.

As a result, he has devoted his life to reforming conditioning sessions so student-athletes are no longer endangered. But given the seemingly constant wave of negative news at the collegiate level — there is an average of more than one death every offseason — it can be difficult for him to remain confident in the level of progress being made.

“You have to balance the things, right?” Casa said. “The frustration of all of these things happening, but you still need to have the motivation and the passion to continue to try to make the changes.”

Casa is optimistic the two proposed measures currently being considered by the NCAA will make a difference. But given the obstacles that have limited its role in safety matters in the past — some of which continue to weigh on the organization — it remains unclear to what extent the NCAA will play a role in managing the healthy and safety of its student-athletes.

Molly Richman, an attorney who has represented both the NCAA and schools in infractions cases, said the NCAA becoming a stronger regulatory body faces challenges that eclipse simple liability in lawsuits.

She noted member schools would need to agree to the shift in the NCAA’s philosophy and maintain respect for it, even when under investigation. She said an expanded rulebook would necessitate the NCAA hiring additional enforcement staff members. She also emphasized other areas the NCAA has traditionally monitored — like recruiting — have not been clear of wrongdoing.

But she didn’t rule out the possibility the NCAA would take that challenge on in the future.

“It’s a hard question,” Richman said. “I think it depends on the member schools, and then you have to get all the internal protocols in place for being able to enforce those rules because you don’t want to just make rules that you can’t enforce.”

Source: Sporting News

A dirty little secret vexes high school sports in Utah: Athletic trainers aren’t required for practices and games, so many schools go without. It needs to be addressed. (The Salt Lake Tribune)

There’s a dirty little secret plaguing high school sports in Utah. The fact that the plague might not be as bad here as it is in some other states shouldn’t bring much comfort.

Here’s what would bring comfort: More full-time athletic trainers hired and utilized at Utah schools.

At a conference on safety in prep sports held on Thursday in a suite at Rice-Eccles Stadium, David Perrin, Dean of the College of Health at the University of Utah, asked a significant question: “Don’t high school athletes deserve the same care as college and professional athletes in the treating and prevention of injuries?”

Anybody who answers that question with a big old negatory never pulled on the pads or laced up a hightop or a soccer or baseball cleat, or had a kid in his or her family who did so. And to those who claim that schools can’t afford it, Perrin says they should count the number of remunerated coaches on the sidelines: “They can afford it, if they will. It has to be a priority.”

Right now, it is not.

Lisa Walker, a veteran athletic trainer at Springville High School who has been on the state’s Sports Medicine Advisory Council, as well as national committees for her profession and who addressed Thursday’s conference, estimates that just more than half the high schools in Utah have “access” to an athletic trainer, but that schools that have athletic trainers on site during school days, at practices and games are “significantly fewer.”

“There is no requirement in Utah for an athletic trainer or medical personnel to be on hand,” she says. “Schools that make it a requirement should be commended. But there is no [statewide] mandate. To me, it’s disturbing.”

Doug Casa, a professor at UConn, the CEO of the Korey Stringer Institute, a national expert on exertional heat stroke, and a speaker also featured at the conference, says the problem reaches far beyond Utah: “We contacted all 21,000 high schools in America and found that only 40 percent of them had full-time athletic trainers on campus. Some schools had two or three, some had none. A third had no access to an athletic trainer, at all.”

Casa’s organization, KSI, is in the middle of a four-year outreach to enlighten and educate administrators at schools around the country about the importance of proper preparation and planning for health emergencies among student-athletes. With national and local concerns growing about concussions and heat strokes and heart events among athletes, awareness about preventing and treating such issues is on the rise.

“In the past three to five years, we’ve made more progress than the last 25 years combined,” Casa says. “We need to expand education for coaches in proper tackling techniques and in other areas and in other sports. We’re going to see good news in that space, but education needs to be mandatory for all sports.”

He adds that deaths in high school sports occur 15-20 times annually, but that lasting effects from improperly treated conditions, such as in cases of heat exhaustion and head-and-neck injuries, affect hundreds of student-athletes.

“We’re fighting to have the right protocols in place.” he says.

In 70 percent of the cases where prep athletes died over the past year, there was no athletic trainer present.

Walker, Perrin and Casa are all trying to limit, prevent those tragedies.

One of the keys to change, attendant with pushing for additional athletic trainers at schools, is changing the over-the-top macho culture that persists in some athletic programs, including coaches who not only neglect to call for appropriate treatment for distressed players, but who ridicule those who struggle in training and conditioning.

“At any time, an athlete can have head, heart or heat issues,” Walker says. “It’s not just in June or July. Education is so important — for athletes, parents, coaches and administrators. Most coaches aren’t looking to do harm, but they might not know. That’s why it’s so important to have licensed athletic trainers on hand.”

She pauses.

“It always comes down to money. I’m sensitive to that. But you would never go wrong to have an athletic trainer at each school protecting the lives of the kids. Prevention is better than having to deal with a tragedy.”

Walker concurs with Casa that progress in policy-making is rising — for instance, a 14-day-heat-acclimation period is now required for prep sports in Utah, eliminating so-called hell weeks, in which back-to-back-to-back-to-back two-a-day practices are implemented.

“Some would say, ‘Ah, you’re making the kids weak,’” Walker says. “My response is, ‘No, we’re preserving their health for today and the future.’”

A state law on concussions requires a plan and protocol for treating a high school athlete suspected of suffering one, approved by a parent.

“Any athlete thought to have had a concussion must be evaluated by a health-care professional specifically trained in concussion in the last three years,” she says. “That suspicion can come from a coach, a parent, a player.”

It should come from an athletic trainer, paid to be present at the school.

“We encourage schools to provide the best medical care they can for their students and their school community,” says Jon Oglesby, assistant director of the UHSAA. ”We have trainers at our championships.”

But making athletic trainers comprehensively mandatory would have to come from the State Legislature.

In Utah, all coaches must be current in first-aid and CPR, among other certifications, and some schools have physicians who volunteer their services at games, but that’s not enough. Immediate treatment should be available on campus throughout the day — at practices, games, even for P.E. classes.

That’s a conclusion that everyone — those at Thursday’s conference, coaches, parents and especially the athletes themselves — should agree with and find comfort in.

Source: The Salt Lake Tribune

Preventing Student Athlete Injury or Sudden Death – Interview with Dr. Douglas Casa (Principal Matters)

Dr. Douglas Casa began his study of student athletic safety in 1985 when he suffered an exertional heat stroke while running a 10K race.

As he explains, “I was fortunate to receive amazing care on-site from the athletic trainer; the EMT’s in the ambulance; and at the hospital from the emergency room physicians and nurses. I only survived because of the exceptional care I received. I was just 16 years old at the time, but I have been driven by this experience since that day.”

Whether you a leading an elementary school or high school, school activities and athletics play such an important role in the lives of your students. These programs also contribute to the overall culture and climate of your school community. As positive as these opportunities can be, it is equally important that best-practices are in place for activities, practices, and games. This includes knowing ahead of time how you or your staff will handle emergency situations.

Meet Dr. Doug Casa

Dr. Douglas Casa is a Professor at the University of Connecticut and the Chief Executive Officer for the Korey Stringer Institute.Additionally, he is the editor of a book titled: Preventing Sudden Death in Sport and Physical Activity (2nd edition, 2017), published by Jones & Bartlett in cooperation with the American College of Sports Medicine. His new book titled Sports and Physical Activity in the heat: Maximizing Performance and Safety will be published by Springer soon.

The Korey Stringer Institute

In August 2001, Korey Stringer, an All-Pro offensive tackle for the Minnesota Vikings of the NFL, died from exertional heat stroke. In April 2010, Kelci Stringer (Korey’s widow), James Gould (Korey’s agent), and the NFL asked Dr. Casa to develop and run the Korey Stringer Institute (KSI) at the University of Connecticut. The mission of the KSI is to provide research, education, advocacy, and consultation, to maximize performance, optimize safety, and prevent sudden death for the athlete, warfighter, and laborer.

For the past 18 years, Dr. Casa has worked toward his goals at the Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut. You can read his entire bio here.

Interview Takeaways

In this podcast interview, Dr. Casa explains several important ways schools can be prepared with sound prevention policies and procedures:

  1. Find out where you state ranks in comparison to other states in the rubric provided for KSI on safety and prevention. (See KSI’s State Rankings page here.)
  2. Discover best practices for the four H’s. (Explore KSI’s website under the tab, Emergency Conditions for information on):
      • Heart
      • Heat
      • Head injuries
      • Hemoglobin, sickle-cell trait
  3. Explore affordable and practical ways to be prepared for heat-related incidents.
  4. Be prepared with written emergency plans for multiple settings on and off campus where students practice or perform.
  5. Understand the sickle-cell trait tendencies so that student athletes are appropriately rested and treated.

Let’s Wrap This Up

Dr. Casa also explains how his own story of heat stroke has come full-circle after more than 30-years in a compelling and surprising story he tells at the end this interview. Take time to listen and share this episode with others in your schools or communities who want best practices for keeping activities safe and healthy for students.

Now It’s Your Turn

What are ways you can evaluate your own school or district policies and practices in light of the KSI’s recommendations for best-practices? Do you have emergency plans for practice or competition locations? Study KSI’s state rankings and see where where your policies or procedures may need revisiting.

Source: Principal Matters

NCAA considering guidelines to help prevent offseason workout deaths (Sporting News)

The document outlines how schools should acclimate student-athletes into workouts following low-activity periods, which carry greater risk of injury or death because players have not yet adjusted to strenuous drills. It would also discourage the use of intensive workouts as a form of punishment, and establish how to properly diagnose and treat heatstroke.

Fourteen medical organizations, including the National Athletic Trainers’ Association and the Korey Stringer Institute — which strives to prevent sudden death among athletes at all levels — are reviewing the proposal and suggesting amendments. Brian Hainline, chief medical officer of the NCAA’s Sports Science Institute, said roughly half the organizations involved in the process have approved it, and the rest are expected to deliver formal reviews by Jan. 31. Hainline said he expects the document will be officially enacted and published by late spring.

“It’s a huge leap forward,” Hainline told SN, “because frankly, and we state this in the document, the vast majority of these non-traumatic catastrophic deaths and injuries are preventable.”

According to a 2017 study by University of Oklahoma head athletic trainer Scott Anderson published in the Journal of Athletic Training, 27 Division I athletes — all football players — have died from non-traumatic causes since 2000. That number does not include Maryland football player Jordan McNair, who died in June following a May 29 workout.

Still, it’s unclear how the best practices would be enforced, or whether the NCAA would eventually penalize institutions that don’t abide by the guidelines.

“Hopefully it’ll spur some dialogue and attention and cause some people to look at their programs,” Anderson said. “And you know I hear all the time, ‘The NCAA, all that is is a guideline. It has no teeth. There’s no punishment in there.’ And I understand that. But I also understand the power of a guideline.

“It’s not a law or a bylaw or legislation or anything else like that, but there’s a standard of care, and medically we violate that at our own peril. We’ve had to elevate our standard of care, our standard of how we train people. There needs to be absolutely some level of accountability and transparency.”

There was little public response from the NCAA when McNair died from heatstroke, eight months before initial review of the NCAA’s best practices guidelines. McNair’s medical treatment was marred by some of the same shortcomings that have contributed to the non-traumatic deaths of other student-athletes over the past two decades. The NCAA’s best practices proposal offers ways to avoid those mistakes.

The workout in which McNair suffered the heatstroke was the team’s first conditioning session of the summer, according to records obtained by Maryland student newspaper The Diamondback. Rather than being gradually acclimated to camp, McNair, a rising sophomore, was asked to complete a conditioning test of 10 110-yard sprints. He showed signs of exhaustion midway through the test and struggled to complete the drill, according to an independent reportcompleted by private investigative firm Walters Inc.

Maryland’s trainers then failed to meet basic protocol for diagnosing and treating heatstroke, not applying cold water immersion therapy to McNair, according to the same report. Cold water immersion is known to help patients recover from heatstroke when applied right away, according to Community Healthcare System athletic trainer John Doherty, who advises trainers in the Midwest how to respond to emergencies.

“It’s a very simple step that I work with my athletic trainers both at the collegiate and high school level constantly,” Doherty said. “I’m always reminding them that especially when there’s hot weather around, how valuable and necessary the cold water immersion stuff is because it is such a simple step and its success rate is to my knowledge 100 percent.”

After Maryland accepted “legal and moral responsibility” for McNair’s death during an August news conference, an NCAA spokeswoman told The Washington Post the university had “offered steps to ensure this does not happen again.”

At that point, however, DJ Durkin was still the Terrapins’ football coach, and assistant athletic director of athletic training Steve Nordwall and head football trainer Wes Robinson had not yet been dismissed. An independent investigationinto the football program’s culture, which found frequent instances of verbal abuse from coaches, would not conclude for another two-plus months.

When contacted for an update on Maryland’s plans to prevent future deaths, a school spokeswoman linked SN to a page listing corrective measures, saying 17 of 20 changes recommended by Walters Inc. had been completed. (Those recommendations can be found on page 67 of the below document).

The lack of action from the NCAA regarding McNair’s death consequently led critics to point out the organization’s refusal to weigh in on player safety issues while openly investigating and disciplining schools for competitive-balance violations, like paying college basketball players.

“Essentially the silence is deafening,” ESPN college basketball analyst Jay Bilas told SN. “It’s an odd feeling to see the NCAA sort of act in one fashion with regard to amateurism, and then with health and safety of athletes there’s not the same sense of urgency.”

An NCAA spokesman said the best practices currently being reviewed are the result of an NCAA-hosted information-gathering summit in 2016. That said, the document uses recommendations from a 2012 inter-association task force — composed of leading organizations in the sports medicine industry — that met independent of the NCAA and presented its findings in hopes of being formally adopted by the organization.

Hainline — who wasn’t affiliated with the NCAA at the time the 2012 task force presented its findings — said he felt the organization has moved at an appropriate pace in putting the document together. He cited required input from people throughout the college landscape, including athletic departments and school presidents who make up the board of governors.

Korey Stringer Institute head Dr. Douglas Casa, though, said better cooperation at all levels of the NCAA, particularly from football coaches, could have facilitated change sooner.

“If (the NCAA) had endorsed that back in 2012, there’s a really good chance the deaths that have happened since 2012 would have never happened,” Casa said. “Some of the things we had written were simple things that would have required modifications to prevent these deaths for happening. You know, Jordan McNair is the perfect example because it was extremely simple solutions to save Jordan’s life.”

Hainline hopes by publishing these guidelines, the NCAA can begin taking a more active stance on student-athlete health and safety. And while he and Casa both feel the best practices now being weighed are a sign of progress for improving student-athlete safety, the impact of that document will likely hinge on the receptiveness of the college sports community.

A high-ranking conference official with direct knowledge of how institutions view the NCAA’s place on this issue told SN it could prove difficult for the NCAA or conference leadership to regulate workouts. The official said schools are fiercely independent and bristle at attempts to manage their practices. Most do follow proper protocol already, the official added.

“(The NCAA and conferences) are not in the trenches, we’re not there on a daily basis,” the official said. “Now could we or should we be? That’s a philosophical question, one we’re not built for today.

“Historically, institutions have a strong desire to have their autonomy when it comes to how they spend their money, their academic integrity … and their medical training.”

To that end, Hainline emphasized his belief in a “philosophical shift” from the traditional model of self-regulating institutions to one where the NCAA provides oversight on health and safety matters — potentially even punishing schools unwilling or incapable of following along.

“I believe there should be consequences. I believe the membership and board of governors are moving in that direction,” Hainline said. “The needle is shifting. … I would say for an organization like (the NCAA), the needle is shifting rather rapidly. Others can say it’s 100 years too slow.”

Source: Sporting News

30 NCAA Football Players Have Died During Workouts Since 2000, HBO Reveals (American Council on Science and Health)

When writing about this topic three weeks ago, our focus was mostly on the failure of high schools to protect student-athletes from potentially-fatal heat stroke.

Little did we know what the big boys – for a much longer time – were failing to do as well.

With a key preventive measure being so simple – the availability of a tub full of ice water – it defies all logic that this simple step isn’t being taken everywhere strenuous workouts are being held.

But now comes the revelation that NCAA football players are being worked so hard during practice that they’ve been regularly dying of heat stroke since the beginning of this century.

This week, the HBO newsmagazine show “Real Sports with Bryant Gumbel” reported that “since the year 2000, 30 players have died as a result of college football workouts.” The cause: heat stroke, which is completely preventable if college officials overseeing grueling practices – usually athletic trainers – can identify a stricken player’s physical distress while it’s happening and immediately have him immersed in a nearby ice bath.

Yes. Thirty dead players in 18 years, or nearly two every year.

And inevitably, when grieving parents ask what could have been done to prevent such a senseless tragedy, they are always – always, 100 percent of the time – presented with this overlooked remedy. A solution so simple, in fact, that is must make their loss even more painful.

“A tub, ice and water would have saved their child’s life. That simple,” states Dr. Douglas Casa, who is “among the leading experts of sudden death in sports,” according to correspondent Jon Frankel. “It will save their life, every time.”

And yet, having icing tubs available during practice is not mandated by the NCAA.

Even more frustrating, HBO‘s Frankel revealed that Dr. Casa, who leads the Korey Stringer Institute, a leading organization on heat stroke and its link to player fatalities, has collaborated with colleagues in drafting a list of specific recommendations that detail how these type of fatalities can be prevented.

The document, “The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations,” was sent in 2012 to the NCAA, which has failed to enact the practices, in their entirety or even partially. The organization said the changes would be too difficult for member colleges and universities to implement. (photo of Dr. Casa courtesy: Korey Stringer Institute)

In the meantime, college football players continue to die from heat stroke. Most recently it was Jordan McNair, a 19-year-old at the University of Maryland, whose core body temperature soared to 106 degrees during a May 29 workout while undergoing intensive conditioning that included repeated 100-yard sprints. The freshman was not placed in an ice bath while awaiting EMTs and died 15 days later.

In addition, there’s this: “The rise in the deaths during workouts has corresponded with another sharp rise,” Frankel noted, “the rise in the prominence and pay of strength and conditioning coaches.” Men in these positions have been given ever-greater influence to push football players to their physical limits, and they’ve been doing just that.

But Frankel tells us that there’s one substantial shortcoming with their professional education in this field: strength and conditioning coaches can get certified without learning anything about player health. All they have to do is pass a 13-hour course – one that includes no safety training at all.

“The deaths, at this point in time, absolutely it’s predictable. They’re going to occur. It’s disturbing. It’s really inexcusable,” said Scott Anderson, the longtime athletic trainer for the University of Oklahoma. “Without question, the role of the strength and conditioning coaches has grown over time. There should be some accountability that comes with that.”

In the wake of these 30 deaths, the NCAA has yet to mandate any safety or medical training for strength and conditioning coaches, HBO reports. And not one has ever been disciplined as a result of a player fatality during their watch.

Source: American Council on Science and Health

3 Simple Things I Do to Make Winter Running More Enjoyable (SELF)

Long gone are the days of heading out the door in shorts, a sports bras, and sunglasses.

While the days are getting shorter, colder, and grayer, I love nothing more than combating the winter blues with running shoes, an extra layer, and an hour on the trails. I realize I might be in the minority here. I do know it feels like pulling teeth to step outside into the ice-cold air and take that first step.

Once I start moving, I’m routinely reminded that I actually prefer running in the winter. I’m here to gently persuade you into realizing that winter running might not be as torturous as you think, while providing some suggestions to make it, dare I say, enjoyable! I spoke with a few experts too, who helped explain why exercising in the cold is actually proven to be easier on the body. With science on our side, there’s no reason not to fall in love with running in the cool, crisp air.

Yes, it’s actually easier to run in the cold.

One reason I prefer running in the cold is it actually feels less strenuous on my body. I wanted to find out if there’s actually a reason why moving in the cold might be advantageous.

“Running in the cold is massively easier on the body,” says Doug Casa, Ph.D., professor of kinesiology at the University of Connecticut. He explains that with the warm weather, you have to cool yourself down and your body works to bring a massive amount of blood supply to the surface of the skin to avoid overheating. In cooler temperatures, you don’t need to sweat much. Therefore, your blood can be conserved for the muscles and your heart. The outcome? You may find you can reach a faster pace with the same amount of effort.

“There’s a reason all distance records occur in the 45-degree weather,” he adds. This makes sense to me; think of all the iconic marathons that take place in late spring or fall, when the temps are usually in the 40s: New York City, Chicago, and Boston, to name a few.

Kelly Pritchett, Ph.D., R.D., C.S.S.D., associate professor in nutrition and exercise science agrees, reiterating that when the body doesn’t have to fight the ambient temperature to stay cool, we likely feel better. “It’s easier for the body to maintain homeostasis in terms of core temperature in a cool environment.”

However, it’s not just about the weather. How you feel and exert energy when you run will also vary depending on the environment you’re acclimated to. “If you live in a hot and humid climate your body is more efficient in that environment than someone from a cooler climate who’s traveling to that area,” Pritchett explains. So if you live in a very warm place year-round, jumping into the cold might feel harder for you than someone who is a little more used to cooler temps. If you live in Alaska, I’m sure this winter running stuff is child’s play.

There are a few ways you can make it more bearable, and honestly, fun.

If you’re now even slightly convinced that running through the winter months could be do-able, here are some tips that’ll help you stay warm, safe, and injury-free.

1. Warm up inside.

In cold weather, it takes longer to get your body temperature up and muscles warm in order to reach your maximum efficiency. Furthermore, jumping straight into sprints could increase your risk of injury if you’re not properly warmed up. When it’s extra chilly, Casa recommends hopping on an exercise bike or treadmill for a few minutes before heading outside. If you don’t have that at home, try doing burpees (I know, I know), mountain climbers, or use a jump rope to get your blood flowing. Heck, you can even run in place!

Another advantage to warming up inside is you’re less likely to wear too many layers when you journey out into the cold. How many times do you feel like you want to strip off a jacket once you’re 10 minutes into a run? By warming up first, you avoid bringing more clothes than you typically need.

2. Don’t worry too much about speed, distance, and all the other data you normally track on your runs.

While running in cooler temps might indeed be easier on the body, once you start running in the extremes, it takes a toll on the body. Small studies suggest that exercising in extreme heat or cold (we’re talking below freezing) can play a major role in exercise performance. Plus, the introduction of snow, ice, or a loss of light will inevitably make you pump the breaks a bit. In other words, your data might look different in the winter. That’s why I suggest giving your trackers and apps a break and running by feel versus getting hung up on the numbers.

3. Get good gear.

Perhaps the most important part of winter running is wearing the right clothing to make sure you’re warm enough, but don’t overheat either.

Here’s my go-to gear guide for staying warm:
  • Start with a skintight base layer. “The best thing you could ever do is the initial base layer—as tight as possible—so your legs, arms, and chest are covered,” says Casa. I personally love Oiselle’s Wazzie Wool base layer, which absorbs moisture and has convenient thumbholes. After a good base layer is on, you can add one or two layers on top, depending on how cold it is. For anything under 30 degrees, I throw a long-sleeved tech shirt over my base layer (races often include these in your entry fee!) and if it’s extra cold, snowing, or windy, I top it with a water and windproof jacket. Pro tip: Target carries the Champion brand, which has great jacket options at a more affordable price.

  • Cover up as much as possible. Make sure that most of your exposed skin is covered—this includes ankles, neck, fingers, head, toes—where heat can be easily lost. I always wear good socks that cover the space between my heels and the ends of my running tights. I personally love Stance crew socks. I also always look for layers with thumbholes to keep my wrists covered, wear Smartwool liner gloves, and usually throw on a buff so my neck and chin can stay covered, too. I also never leave the house without a good running hat. If you have long hair, make sure to buy one that has a hole in the back for your ponytail!

  • Use reflective gear—and a headlamp. With dark mornings and even darker evenings, you’ll most likely find yourself running with the sun either rising or setting. It’s critical you wear some reflective gear, and if it’s super dark, always bring a headlamp. Many clothing brands carry clothes that are reflective. I am personally a vest fan; you barely notice they’re on, and it keeps you fully in sight!

  • Invest in weatherproof shoes. In the winter, you’ll most likely come face to face with snow at least a few times on your runs. Weatherproof shoes will prevent moisture from seeping through to your toes and will ensure your sneakers last through the harsh winter months. I wear Altra Lone Peak trail shoes, which allow me to run through muddy puddles and sleet-filled trails. These shoes also prevent me from having any excuse to get out the door. As I like to say: If your clothes can be weatherproof, so can you.

With the right layers, attitude, and perspective, running in the winter can actually be fun, I promise! I always have to remind myself that the hardest part is stepping out the door. Once I start moving, my body quickly warms up, and I remember the reason I fell in love with running in the first place: No matter where I am or what time of year it is, running provides a sense of strength, freedom, and joy.

Source: SELF

Why college football players are still dying preventable deaths (WTOP)

WASHINGTON — When University of Maryland football player Jordan McNair collapsed during a workout last spring, doctors who are experts in the field say his death was 100 percent preventable. And yet, it’s not the anomaly you might think it is, either.

Since the year 2000, more than 30 college football players have collapsed and died during workouts. That number climbs to more than 50 when you factor in other Division 1 athletes.

During the same period of time, only one NFL player has suffered the same fate. In 2001, Korey Stringer collapsed and died during a training camp workout with the Minnesota Vikings.

What’s behind the disparity?

“It has a multifaceted answer,” said Dr. Douglas Casa, the CEO of the Korey Stringer Institute at the University of Connecticut. “One of the factors is that the players have no representation at the college level. There’s no union, nobody to look out for them in terms of making sure we don’t have ridiculous strength and condition sessions.”

A school has never been punished by the NCAA because one of its athletes has died after a practice, he said.

“Can you imagine if the NCAA put as much effort into protecting college football players as they did worrying about what to do about all the money (that) comes in,” Casa said. “We would never have to worry about a death. There would be best practices implemented at every level.”

“At the pro level you have representation,” Casa said. “At the pro level they’re seeing them more as a big investment and you’re not going to something that’s going to jeopardize the health and safety of one of your players you’re paying $25 million a year to. In college they’re disposable. These are dispensable commodities. They can just put another player in their spot.”

That dynamic comes even as college are putting more emphasis on workouts, Casa said, part of what he calls the “arms race” in the strength and conditioning sector.

“We have a situation where we have unchecked strength and conditioning profession able to do whatever they want to do,” Casa said. “A lack of supervision on site and a lack of regulation on the national level create a problematic scenario.”

While the strength and conditioning coach at the University of Maryland was hired by the recently fired coach DJ Durkin, there was ambiguity about who he actually reported to. Casa said it should be crystal clear, and that the strength coach should never report to the head football coach.

Casa said the NCAA has also missed the opportunity to take action and enact standards that would help athletes.

“In 2012 we released a document, ‘Preventing Sudden Death in Collegiate Conditioning Sessions,’ which was endorsed by 14 leading sports medicine organizations,” he said. “The NCAA did not endorse that document or did not bring those recommendations forward to invoke new policy. And the problem continues.”

Source: WTOP

Experts question why previous heatstrokes at Maryland colleges weren’t a wake-up call before McNair’s death (The Baltimore Sun)

The two football practices unfolded roughly four years and 40 miles apart.

At each one, a teenage football player ran drills outside, the temperature hovering in the 80s. When each started showing signs of exertional heatstroke, training staff applied cooling packs to the player’s armpits and groins. But the trainers stopped short of best practices: taking the athlete’s rectal temperature and immersing him in cold water.

About two weeks later, both student-athletes were dead.

Jordan McNair, a 19-year-old offensive lineman at the University of Maryland, College Park, died of heatstroke in June.

Marquese Meadow, an 18-year-old defensive lineman at Morgan State University, died of heatstroke in August 2014.

A year before that, a third football player in the state suffered heatstroke during practice. After a long hospitalization, Towson University’s Gavin Class survived, which he attributes to the trainers’ quick action in treating him with cold-water immersion.

Experts question why other major heatstroke incidents in Maryland college football didn’t serve as a wake-up call before McNair’s death — and they wonder what could be different now.

After Minnesota Vikings offensive tackle Korey Stringer died of heatstroke following a 2001 training camp practice, the NFL took a hard look at its protocols. No professional football player has died of heatstroke since. Meanwhile, according to the research institute named for Stringer, more than a dozen college football players have died of heatstroke since 2000.

“Reactive change is a problem. We need people to be proactive,” said Robert Huggins, president of research and athlete performance and safety at the Korey Stringer Institute, a University of Connecticut-based nonprofit that studies sudden deaths in sports. “We’ve had enough heatstroke cases, enough deaths, enough near-deaths to learn from and to serve as examples.

“Heatstroke is 100 percent preventable. We scream that from the mountaintops.”

McNair was attempting 10 repetitions of a 110-yard run during a May 29 practice when he started showing signs of exhaustion. Trainers eventually moved him to the football field house for treatment, about 30 minutes after the onset of symptoms. Another half-hour would pass before anyone called 911, records show. The trainers did not take his rectal temperature or use cold-water immersion treatment, which experts say are the two steps that could have saved his life. He died June 13.

After McNair’s death, media reports labeling the flagship’s football culture “toxic” brought more national scrutiny to campus, leading to a second investigation into allegations of bullying and abuse.

“I do feel the public eye is on the McNair case quite closely,” Huggins said. “I hope people really start to pay attention.”

The University System of Maryland’s governing body has been actively involved in overseeing the two investigations into the Terps’ football program. Board of Regents Chair James Brady spoke at a news conference last month, during which sports medicine consultant Dr. Rod Walters presented the findings from his review of the athletic department’s safety protocols.

Brady said the university system was “anxious” to learn from McNair’s death. He said Walters’ recommendations would be implemented not just in College Park, but at all other system institutions with football programs.

“We can and must learn from what happened,” he said, “and make any appropriate and necessary changes to make sure it never happens again.”

A University System of Maryland spokesman provided an emailed statement Wednesday, but it did not directly address questions about whether the heatstroke incidents involving Class and Meadow sounded alarms at universities across the state. Towson is part of the university system. Morgan State, though a Baltimore-based public institution, is not.

The system has already shared the Walters report with every campus, asking them to review the recommendations and implement any necessary changes to their procedures and protocols,” the statement read.

A University of Maryland spokeswoman was not immediately available to comment for this article.

Towson athletic director Tim Leonard said Walters was also hired to review Towson’s protocols after Class’ hospitalization in 2013. While the Board of Regents was provided with those findings, Leonard said, the system never assumed control of the investigation, nor were there attempts to broaden the scope beyond his school.

Class said he was disappointed other state institutions didn’t double down on heatstroke prevention and treatment awareness after his harrowing medical saga. He collapsed during an Aug. 12, 2013, football practice, and his body temperature reached an estimated 111 degrees. He arrived at the hospital in a coma, with significant organ failure. He was later transferred to the Maryland Shock Trauma Center, where his heart stopped and doctors resuscitated him. After he was stabilized, he required a liver transplant.

“It didn’t shake anybody until Jordan,” said Class, now an assistant strength and conditioning coach at Johns Hopkins University. “You’d think after Marquese dying, too, that things would’ve been shaken up, but nope.”

The law firm representing McNair’s parents wrote a letter to Brady last month demanding to know what the university system had gleaned from what happened to Class and Meadow.

“The facts that need to be disclosed now involve the systemic failures throughout the University System that preceded Jordan’s death, despite having actual knowledge that an incident like this had occurred before,” lawyer Billy Murphy wrote.

Much of the Board of Regents has turned over since 2014.

Dr. David Chao, who served as the head team physician for the San Diego Chargers for 17 years, said college football programs should’ve learned their lessons after Stringer died — and even more so when a heatstroke incident hit closer to home.

“One death of a child or adult from heatstroke playing football is one too many,” he said.

Since McNair’s death, a number of changes have been made within the Maryland football program.

The Terps added more on-site cooling stations and boosted the amount of medical staff on hand during practices and games. Student-athletes use a new tool that helps them monitor hydration levels and they have expanded access to cold-water immersion therapy. Walters led in-service training for athletic department staff on implementing emergency plans.

Walters’ review found the flagship’s athletics protocols on exertional heat illness meet standards, but proper steps were not followed May 29 in McNair’s case. The football team’s practice site was moved at the last minute, so the cold-water immersion tanks that are usually part of the field setup were not there on the day McNair fell ill. The university also didn’t monitor weather statistics in the recommended manner.

Walters said the failure of trainers to recognize McNair’s signs of heat illness was “a concern.”

Universities not only have to put the right protocols in place, Huggins said, but understand how to execute them properly.

In January 2012 — more than a year before Class was hospitalized — a group of leading athlete safety experts drafted a series of 10 recommendations for preventing sudden deaths in college sports.

They recommended conditioning periods be phased in gradually “to encourage proper exercise acclimatization and to minimize the risk of adverse effects on health.” McNair’s final workout was his first team activity in more than a month.

And they recommended that exercise and conditioning activities should not be used as punishment. Meadow fell ill while running during a “punishment practice,” according to a lawsuit filed by his mother.

The lawsuit, which ended in a settlement, states that Meadow attended a practice on Aug. 10, 2014, that was “scheduled to punish certain individuals on the team for team rule violations.” About an hour in, Meadow began stumbling and became disoriented — his temperature eventually reaching 106 degrees. At the hospital, he went into liver and kidney failure and suffered a brain injury because of the loss of oxygen. He remained in the intensive care unit on a ventilator for two weeks, before he died surrounded by family.

His mother, Benita Meadow, said when she saw McNair’s death reported in the news, it took her right back to the day her son fell ill.

“I couldn’t believe it was happening again,” she said in an interview. “The University of Maryland and Morgan State are like sister schools. It scared me and it made me angry — how is this still happening, so close and in the same way?

“This can’t be swept under the rug. … There has to be a change now.”

The Morgan State football team has since implemented new protocols, The Sun reported in August. Before practice, each athlete receives a 1-gallon jug of water. The players take two mandatory water breaks, without their helmets on. At the end of each workout, the players pile into ice tubs on the sidelines for a required 20-minute cool-down. Morgan State officials did not respond to requests for comment for this article.

After Class’ heatstroke, Towson also re-emphasized preventative measures, Leonard said. Mandatory breaks are written into the practice schedule. Coaches and trainers preach the importance of hydration. Officials are always monitoring for new evidence-based recommendations on avoiding heatstroke.

It remains to be seen what impact McNair’s death will have on other athletics department practices across the state.

But his grieving parents are hoping for change.

They’ve launched a foundation in their son’s honor, aimed at promoting awareness of heat-related illnesses, improving player safety and reducing heatstroke incidents among student-athletes. They say they don’t want any other parents going through what they are.

“While Jordan is not with us to build his legacy, as a family we are doing it for him,” his father, Marty, wrote in an open letter on the foundation’s website. “This is his legacy.”

Benita Meadow befriended McNair’s parents after their twin tragedies. She never imagined a friendship could stem from her grief, but she said their connection gives her renewed strength to talk about her son, whom she remembers for his drive, his big personality and his desire to be a humanitarian.

For years, it was too hard to tell her story. Now that heatstroke has struck another Maryland college athlete, it’s different.

“Marquese is telling me to help,” she said.

Source: The Baltimore Sun

The First-Time Marathoner’s Guide to Fuel and Hydration for Your Marathon Training (SELF)

First-time marathoners, if your training program is overwhelming you (and, if you’re anything like I was during training for my first 26.2, it is), I’m here to make one particular part of your marathon journey significantly less complicated and confusing: fuel. Specifically how to go about it when your runs get long.

When training for a marathon, people tend to focus on (and stress about) the obvious: running long and often. However, an overlooked—yet super important—component of crossing the finish line and staying healthy throughout your entire training cycle is midrun nutrition.

For some, it might seem simple: Can’t I just chomp down on half a banana during a long run? For others, it might be confusing: Is eating lots of sugar OK? What about GI issues, cramping, or bloating?

Use this as your guide to eating and drinking on the run, which is necessary for anyone training for a marathon. From gels to chews, hydration tabs to caffeine, here’s the deal, not only with what to consume while running, but why it’s one of the most important things to think about when it comes to crossing the finish line.

Note: This is specifically for athletes tackling a road marathon. Trail running—which typically equates to slower running with more elevation variation—usually means stomachs can handle different types of food and therefore follows a different race-day nutrition plan.

Midrun fueling—Why bother?

Before we dive into the what, let’s look at the why. Why the heck is it important to eat during a run? What’s going on inside our bodies?

“We only have so much glycogen stored, which is what the body uses for energy while running,” explains Kelly Hogan, M.S., R.D., who works with athletes and has run 11 marathons herself. “We can use up all of those stores in about two hours. That’s when people start feeling like they’re going to bonk.” (The bonk, by the way, is the point at which your body, brain, or both feel like they can’t take another step and it typically happens to endurance athletes especially when they’re not properly fueled.)

It’s important to start fueling well before our bodies are close to using up all our glycogen stores. For most runners, that’s 30 to 45 minutes into a long run. Still, every body is different, and it’s essential to practice fueling during your training runs so you don’t introduce something your stomach can’t handle on race day.

“The biggest mistake I see—by far—is people doing something different in their race versus training,” says Douglas Casa, Ph.D., professor of kinesiology at the University of Connecticut. He, too, has worked with athletes for years and is an avid trail runner. He continues: “Regardless of exact amounts—those are nitpicky things—a lot of ranges [for food and drink consumption] can be successful. Instead, it’s a matter of asking: Is your body ready for it? The crux of it is you have to rehearse.”

OK, I’m ready for rehearsal! Can I grab a Snickers?

Actually, yes! (Well, OK, maybe a mini Snickers.) The main rule of thumb for midrun food is to find something that will give you energy and is easy to digest, and kid-sized candy is actually something that many runners stick in their pockets before heading out the door. As a rule, the body needs fast-absorbing carbohydrates that will boost blood glucose levels and send sugars through the bloodstream and into the muscles.

It doesn’t have to be a candy bar, though. Most runners get their quick-digesting carbs from gel packets or sports chews (GU, Hammer, and Clif are great options), which are easy to slurp down while running. Other examples of easy-to-eat simple sugars include sports beans, fruit drops, and even thin, cookielike waffles. (In my opinion the Honey Stinger honey waffle will get anyone out the door for a long run.) You can also get sugars from a sports drink, like Gatorade or Maurten, a drink mix that’s an alternative to mainstream sports drinks and that’s used by many elite runners.

“I think GU and gels are getting knocked since they are processed sugar,” explains Hogan. “But it’s only sugar for a reason—we need it for running.”

That said, not everyone can tolerate the same types of foods. “It’s important to test different foods to see what your body can handle,” Hogan reiterates. If highly processed foods aren’t your thing, she recommends trying a less processed option, like dried fruit or pretzels. My personal go-to is Spring Energy gels, which use whole ingredients like rice, banana, and peanut butter, blended into a gel-like substance. As long as you can get over the fact is has the consistency of baby food, you’ll be set.

For coffee lovers, there are caffeinated fuel options! Certain energy gels also include caffeine; the amount typically ranges from 20 to 40 milligrams, though some are packed with up to 150 mg. (In comparison, a grande Starbucks coffee has 100 to 120 mg of caffeine.) While caffeine can give runners a nice jolt of energy, it isn’t a necessary additive to your fueling regimen. “Caffeine intake during the run is meant to give a bit of an energy boost, but is different in how it affects various individuals,” Hogan explains. “Starting out at the lower end of caffeine—that’s 20 to 30 mg—is a good idea to see how the body reacts, as opposed to going for a gel with 75 to 100 mg of caffeine right at the start.” Hogan also suggests alternating between noncaffeinated and caffeinated gels just to stay on the safe side. Unlike sugar in gels, caffeine stays in our system longer. “We don’t want to be up all night after a long run or race, or having lingering feelings of the jitters, nerves, or anxiety.”

So, what should I avoid?

As far as what should be on the “do not eat” list, foods that are too heavy on protein and fat might do more harm than help.

“Save the protein for after the race,” advises Hogan. “Calories from protein and fat won’t do much for your body. Fat especially can be the culprit of GI issues since we digest it the slowest.” Fiber could cause tummy trouble, too, since it also takes a toll on our digestive system.

For this reason, avoid foods like leafy greens, cruciferous vegetables (like broccoli and cabbage), and beans, along with red meats, fish, and cheese 12 hours before a long run or your race. Aim to have your prerace meal be about 75 percent carbohydrates, and stick to mainly carb consumption when you’re out on the course.

When should I eat? And also, how much should I eat?

Now that you know what to eat, when should you eat it? And how much is enough?

“The general idea is to start with consuming 30 to 60 grams of carbohydrates per hour,” says Hogan, which is the range our bodies can absorb glucose and varies slightly depending on how big you are, how fast you’re running, and how quickly you’re burning through your calories. This amount of carbs per hour could include two 1-ounce bags of sport beans or two energy gels. “For most people, start to fuel 30 to 45 minutes into the run to get a head start on your glycogen storage.”

If two gels seem too hard to stomach, go for a combo: a mixture of chews, beans, or a gel will also do the trick. Keep in mind that sports drinks, though they’re liquid, provide carbs, so you should factor that in when calculating your carb intake.

What’s the deal with water?

Hydration is another critical component of your fueling strategy. Casa recommends carrying water with you—whether in a hydration pack, fuel belt, or handheld water bottle—so you can sip water throughout your run versus relying on aid stations, where people tend to gather to chug down fluids.

“This allows you to drink whenever you want and you avoid the rush of people at the aid stations,” he explains. (I will vouch for him here; while aid stations volunteers are super helpful, and the tables are always stocked with food and drink, they sometimes can get overwhelmingly crowded.)

Just like calorie consumption, there isn’t a one-size-fits-all amount when it comes to hydration. In general, your fluid intake should depend on your sweat rate, which is the amount of fluid you’re losing through sweat while exerting energy. Sweat rates vary depending on body size, activity intensity, and environmental conditions. For example, a larger person who is running 7-minute miles in 80-degree heat might need 2 liters of water an hour, versus a smaller person running 10-minute miles in mild conditions might suffice with a half liter.

Luckily, there’s a foolproof method for figuring out your sweat rate at home. Simply urinate, get naked, and weigh yourself in kilograms. Then head out on an hour-long run without consuming any water or food. Once you return, weigh yourself again. The difference will show you how many liters you sweat per hour. For example, if you weighed 60 kg before your run and 59 kg after, you sweated 1 liter per hour. This is the amount of water you should drink every 60 minutes. That said, you definitely don’t have to use this strategy. The trial-and-error method is just fine, too.

Calculating this sweat rate not only ensures you’re drinking enough but protects you from drinking too much.

“Pay attention if your body feels super full and you have a sloshy feeling in your stomach,” Hogan says. “This is one of the first warning signs of hyponatremia.”

Hyponatremia is a rare and dangerous medical condition that occurs when the concentration of sodium in your blood is abnormally low, which can happen if you drink too much water. While Hogan notes that hyponatremia is rare, it’s important to understand the warning signs. When you’re drinking, make sure your body feels satisfied but not overly full. If you feel extra bloated and start to become dizzy and disoriented, it’s critical you pump the breaks and get medical attention. Casa echoes this sentiment; if you’re aiming for a five-hour finish time and the race conditions are mild, it’s easy to overcompensate and think you need to be drinking a ton. Figuring out your sweat rate will give you peace of mind and more confidence when you toe the line, because of course, you still do need to hydrate adequately throughout the race to avoid dehydration, another dangerous (and more common) condition.

A guideline I like to follow is taking in 3 or 4 long sips of water every 15 or so minutes. On long runs, I’ll often fill my hydration pack with water that has a hydration tab mixed in it, called Nuun, which has added electrolytes, like sodium. Electrolytes are minerals that keep our systems functioning and, in the case of extensive sweat loss, will need to be replenished. It’s easy to add electrolytes—especially sodium—into your running diet; sipping on Gatorade, using Nuun tablets, or even munching on some pretzels will help restore the electrolytes that become depleted in the body.

“Sodium is extremely helpful in a beverage,” notes Casa. “It keeps the thirst mechanism on longer so you replace the fluids you need, conserve urine, and replenish the sodium you’re losing in sweat.” Everyone loses different levels of sodium in their sweat. Casa says a gram of sodium per liter is generally a good amount, which is the serving size found in products like Nuun and Gatorade Endurance Formula.

Now that you know the why, what, and when of eating on the run, here are some handy tips to keep in your (running shorts) back pocket.

1. Practice your fueling and hydration strategy until you perfect it

Let’s be real. No matter what the guidelines say, it’s nearly impossible for anyone besides you to know exactly what your body needs. That’s why practicing your fueling techniques on long runs prior to your race is so, so important. Figure out what your stomach can handle, what you personally like to eat and drink, and how it makes you feel. Use your long runs as trial workouts before your marathon. You don’t want to introduce anything new to your body when you toe the line, so get it used to the exact things you’ll consume.

2. Find out what will be provided on the course and after you finish.

Check the race website or contact the race host to see what food and drink will be available on the course. Many races supply water, Gatorade, and gels at different aid stations, but it really depends on the race. See if there’s a course map that tells you what’s available and where, so you can figure out what you need to carry with you versus what you can snag at the aid table.

3. Figure out how to carry your fuel.

Speaking of carrying fuel, it’s important to decide how you’re going to do that. Embarrassingly, for my first marathon I stuffed a few Gu gels in my sports bra, and after the race, I had cuts on my breasts from the hard plastic poking into my skin. Nowadays, there is running apparel with plenty of pocket options for small snacks, or you can choose to run with a hydration belt, handheld water bottle, or even a hydration pack. As Casa reminded me, carrying water and sipping it throughout has its benefits, and most packs are designed so you don’t even feel like you’re carrying extra weight.

4. Get comfortable with the idea that you really do need more carbs (usually in the form of sugar), to keep running long and hard.

The most important takeaway is simply that your body needs calories while you’re running long, especially if you’re a new marathoner, which means it’s your first time putting your body through a 26.2-mile race. Trying to run long with too few calories will likely make it tough (if not miserable) to finish the race without bonking. Plus, it will make it much harder to recover from the race, says Hogan.

For your first marathon, remember what Hogan told me: “Carbohydrates are your friend, sugar is your friend.” Don’t be afraid to consume sugar on the course, drink moderate amounts of fluids throughout, and pay attention to how your body reacts to it. Although staying fueled while running can get complex, it really comes down to tuning into your energy levels, checking in on your stomach, and getting used to the types of foods your body really craves while hitting the pavement. Whether that’s an energy gel, handful of raisins, or Snickers bar is up to you and your gut.

Source: SELF