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From the NATA and Korey Stringer Institute

Tips for Exercising Safely in the Heat

DALLAS, March 1, 2011 - With the end of winter finally here, temperatures will continue to rise over the next few months. The National Athletic Trainers' Association (NATA) has teamed up with the Korey Stringer Institute (KSI) to prepare a list of important tips that people of all ages can follow to enjoy physical activity and exercise and also reduce the risk of exertional heat illness that may occur from activity in the spring and summer.  March also marks National Athletic Training Month with the theme "Not All Athletes Wear Jerseys: Athletic Trainers Treat the Athlete in You."

"We can't completely prevent heat illness, but the following tips can help in any instance of physical activity in the heat," said athletic trainer Brendon McDermott, PhD, ATC, with the University of Tennessee at Chattanooga and member of the KSI Medical and Science Advisory Board. "The goal is to avoid potential consequences through education of athletes, coaches, parents and health care providers about what can be done to prevent and treat exertional heat illnesses."  Young cyclist drinking water from squirt bottle

"Rapid and proper treatment of exertional heat stroke has had a 100 percent survival rate," said Douglas Casa, PhD, ATC, FNATA, FACSM, chief operating officer of KSI and director of athletic training, Neag School of Education, University of Connecticut. "Knowing the warning signs and the appropriate steps to take are critical to avoid a potential catastrophic outcome."

Tips to Reduce Onset of Heat Illness

To guard against heat illnesses, NATA and KSI recommend following these easy steps:

  1. Gradually increase activity in terms of intensity and duration in the heat. This prepares your body for more intense, longer duration exercise in warm conditions, and helps prevent injury and heat illness. This is known as heat acclimatization.
  2. Intersperse periods of rest during activity and assure adequate rest between exercise bouts. Rest breaks are an important defense against heat illness, and proper sleeping habits decrease your risk as well.
  3. Begin outdoor activities only after you're properly hydrated. Drink water or sports drinks throughout physical activity in the heat. Make sure fluid is easily accessible in ample quantities during rest breaks and during exercise when possible.
  4. A darker urine color is a quick indicator of dehydration. Your urine should look more like lemonade (hydrated) than apple juice (dehydrated).
  5. Exercise during cooler portions of the day (early morning or late evening), if possible.
  6. Do not participate in intense exercise if you show signs of an existing illness (i.e. fever, diarrhea, extreme fatigue, etc.). These can decrease your body's exercise heat tolerance and increase your risk of a heat illness. If you are suddenly not feeling well during exercise in the heat, back off on exercise intensity or duration (i.e. walk instead of run, cut the session short, etc.)
  7. Athletic events should employ an athletic trainer for coverage to assure proper medical supervision, recognition and treatment of possible injuries and heat illness.
  8. Acclimatize to warm weather activities over a 14-day period. The goal is to increase exercise heat tolerance and enhance the ability to exercise safely and effectively in warm and hot conditions.

Heat-related ailments

"We are not invincible when it comes to exercise in the heat" said McDermott. "In extreme cases, if medical care is not provided in a timely manner, long-term damage and sometimes death can occur. Watching for certain factors is key to safe warm weather activities."

Following is an overview of the heat-related ailments to be aware of when working or playing in the heat:

1. Exertional Heat stroke is an extremely serious illness that can result in death unless quickly recognized and properly treated. Signs and symptoms include an increase in core body temperature (usually above 104-105°F/40-40.5°C at time of collapse); central nervous system dysfunction, such as altered consciousness, seizures, confusion, emotional instability, irrational behavior or decreased mental acuity; nausea, vomiting, or diarrhea; headache, dizziness, or weakness; increased heart rate; decreased blood pressure or fast breathing; dehydration; and combativeness.

What to do: It's very important that treatment for exertional heat stroke be both aggressive and immediate, provided adequate medical personnel are on site. Key steps to take when exertional heat stroke is identified include calling 911 to activate the emergency response system. It is critical at that same time to ensure immediate whole-body cooling, preferably through cold-water immersion, begins immediately on-site. No time should be lost with regard to all efforts being focused on the rapid reduction of body temperature (the number of minutes severely hyperthermic will dictate outcome). If proper medical staff is on-site (physician or athletic trainer) and if cooling via cold water immersion is available on-site then the medical protocol should be cool first (on-site down to under 102oF), then transport second to an emergency room.

2. Heat exhaustion is a moderately serious illness resulting from fluid or sodium loss. Signs and symptoms include loss of coordination; dizziness or fainting; profuse sweating or pale skin; headache, nausea, vomiting or diarrhea; stomach/intestinal cramps or persistent muscle cramps.

What to do: Heat exhaustion patients should immediately be moved to a cool, shaded environment with feet elevated, and fluids should be replaced. If their condition worsens or does not improve within minutes, heat stroke or another condition should be considered and appropriate treatment should ensue. Those suffering from heat exhaustion should avoid intense activity in the heat until at least the next day. A trip to the physician's office is also recommended to rule out any underlying conditions that predispose them to heat exhaustion.

3. Heat cramps are often present in those who perform strenuous exercise in the heat. Conversely, cramps also occur in the absence of warm or hot conditions, which is common in ice hockey players. Signs and symptoms include intense pain (not associated with pulling or straining a muscle) and persistent muscle contractions that continue during and after exercise.

What to do: People suffering from heat cramps should cease activity, consume high sodium food and be sure to drink to overcome dehydration, preferably with a sports drink, and stretch the affected muscle. They should also be assessed by an athletic trainer to determine if they can return to activity. If cramping progresses in severity or number of muscle groups, patients should be transported to the emergency room for more advanced treatment. The etiology of heat cramps is not completely understood and is likely multi-faceted. Fatigue, especially from a unique or extremely intense activity, along with electrolyte and hydration issues, have been implicated as potential causes.

4. Hyponatremia is a potentially fatal illness that occurs when a person's blood sodium levels decrease, either due to over-hydration or inadequate sodium intake, or both. While technically not a heat illness, it often presents itself in similar circumstances and medical complications can result in cerebral and/or pulmonary edema. Signs and symptoms of this illness include excessive fluid consumption before, during and after exercising (weight gain during activity); increasing headache; nausea and vomiting (often repetitive); and swelling of extremities (hands and feet).

What to do: Hyponatremia cases that involve mental confusion and intense headache should be seen by a physician so proper treatment can be administered. A physician should also be consulted prior to resuming outdoor activity in the heat. Always listen to your body. If you are participating in any fitness routines or general activity in the heat, and you start to feel ill or strange, you should stop immediately and seek medical attention, as needed.

Source: National Athletic Trainer's Association

Posted March 1, 2011