Exertional heat illness (EHI) is common in athletics. As fall sports teams convene this month to prepare for their seasons, they will be met with 90-plus degree temperatures and high heat indices. In this weather, athletes are at high risk for EHI including exertional heat stroke (EHS).
Athletes and heat illness, what do you know?
True or false?
1. Deaths among football players from heat stroke declined in 2008.
2. Heat index is a more accurate guide for EHI risk than temperature.
3. Water and sports drinks should be freely available to players.
EHS is 100 percent preventable. Since 1995, over 40 football players have died from EHS, most during practice. Dizziness, nausea, lightheadedness, weakness and headache are all indicators of heat illness. At first symptom the athlete should stop activity, cool down and hydrate before considering returning to play.
The first two weeks of practice present the greatest risk for EHI because it takes about 10-14 days for the body to become acclimatized to heat. In large groups there are those more conditioned and acclimatized than others. Some take medications or have medical conditions that increase risk for heat-related illness. For instance, some medications commonly prescribed for attention deficit disorder, may increase risk for heat-related illness.
Coaches simply cannot determine individual fluid needs nor can they be expected to understand an athlete’s individual risk factors. However, coaches can control practice times and type of equipment worn by players to decrease risk for EHI. Fluids should be readily and freely available to players and should never be used as a reward or withheld for punishment. Athletes should be encouraged to inform athletic trainers or coaches when they are not feeling well or need a fluid break. Withholding fluids or continuing to practice with heat illness symptoms does not accelerate acclimatization and is dangerous.
Thirst is an unreliable guide for hydration. By the time an athlete is thirsty, he or she is likely dehydrated. Dark urine is a sign of dehydration. A urine color chart can be accessed at http://at.uwa.edu/admin/UM/urinecolorchart.doc
The American College of Sports Medicine recommends drinking 16 ounces of fluid 2 hours before practice; 8 to 16 ounces 15 minutes before practice; and 4 to 16 ounces of fluid every 15 to 20 minutes during practice. Water is fine at first, but a sports drink after about 45-60 minutes of practice is best to replenish fuel and electrolytes.
After practice, drinking 24 ounces of fluid for every pound lost during practice is recommended. Weighing before and after practice is very helpful in determining whether there has been proper hydration. A greater than 2% loss in weight indicates dehydration and significant risk for heat illness.
