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Deadly Combination; Extreme Heat and Overweight Athletes.

by The Kid's Doctor Staff

Football season usually means cooler weather and exciting times for high school and college age kids. This year though, the extreme heat is not only causing great concern among parents, students and coaches- it’s been responsible for at least 3 deaths.

So far this year, there have been four football-related deaths; two teenage football players from Georgia, a high school player in South Carolina, and a 55-year-old football coach in Texas.

According to a recent study excess weight, along with the high temperatures, could be a contributing factor for certain athletes.

An analysis of 58 heat-related deaths among U.S. football players from 1980 to 2009 showed that about 80% involved players who were obese by the conventional definition of a body mass index of over 30.  Ninety-five percent were overweight or obese.

The rate of heat-related illness and death among football players has increased since the mid-1990s, according to Andrew J. Grundstein, PhD, of the University of Georgia in Athens, first author of the study. The reason for the increase is not entirely clear but could reflect the increasing body weight of players, he said.

Most of the deaths occurred in August, when fall practice typically begins, and most occurred within the first two weeks of practice. Surprisingly, a majority of the deaths occurred during morning practices. ”Mornings may be cooler, and a lot of coaches may recommend having practices in the morning because it is cooler, but high humidity levels can make the conditions very oppressive and stressful,” Grundstein said during a teleconference, sponsored by the Union of Concerned Scientists. ”I think people may put their guard down because they think the risk of heat-related illness is less in the morning,” he added.  Grundstein also noted that more than 60% of the deaths happened on days when practice should have been cancelled.

More coaches are being trained in how to help their athletes practice safely in the heat, but poor hydration, bad sleep habits, the added weight of football equipment and pressure to perform at a high level adds to the risk of a heat-related illness says Michael Bergeron, PhD, director of the National Institute for Athletic Health & Performance at Sanford USD Medical Center in Sioux Falls, S.D.

The American College of Sports Medicine (ACSM) assesses the risk of heat-related illness by means of the wet bulb globe temperature, a measure that incorporates temperature, humidity, and solar radiation.

The ACSM has developed a course of action to reduce the risks of heat-related illnesses. They recommend an approach for high-school players that includes limitation or elimination of twice-daily practices, limitations on practicing in full uniforms until players become acclimated to the high temperatures, and no scrimmaging for the first two weeks.

The American Academy of Pediatrics has also come up with advice on how to keep young athletes safe when exercising in the heat.

Previous research had suggested that children are less effective than adults at regulating body temperature and are at higher risk of heat-related illness. But new research shows that children and adults of comparable fitness levels have similar responses to heat exertion when they are well hydrated.

“Most healthy children and athletes can safely participate in outdoor sports and activities in a wide range of warm to hot weather, but adults sometimes create situations that are potentially dangerous,” researcher Stephen G. Rice, MD, former member of the executive committee of the AAP Council on Sports Medicine and Fitness, says in a news release. “Heat illness is entirely preventable if coaches and other adults take some precautions to protect the young athletes.”

Researchers say heat stroke and heat exhaustion, can happen even in moderate heat, but the highest risk occurs when children and adolescents are vigorously active outdoors in hot and humid conditions. “While coaches should make on-the-field decisions to improve safety for a team or event as a whole, individual participants may require more or less concern based on their health status and conditioning,” said Bergeron.

For example, a physically fit, well-hydrated, 12-year-old soccer player who is used to the heat would typically be fine playing on a 95-degree day. But an overweight football player recovering from an illness and running wind sprints at the end of a long day of workouts on the first day of preseason football would be at higher risk even if its only 85 degrees.

Hydration seems to be a key factor in surviving extreme or even moderate heat and humidity. Researchers say the biggest change in the guidelines is the recognition that children can tolerate and adapt to exercising in the heat as well as adults of similar fitness levels as long as they are adequately hydrated.

To reduce the risk of heat-related illnesses, the guidelines recommend:

  • Modifying activity as needed, given the heat and limitations of individual athletes. Practices and games may need to be canceled or rescheduled to cooler times.
  • Providing rest periods of at least two hours between same-day contests in warm to hot weather.
  • Limiting participation of children who have had a recent illness or have other risk factors that would reduce exercise-heat tolerance.
  • Providing risk-reduction training for coaches, trainers, and other adults.
  • Ensuring trained staff is available on site to monitor for and promptly treat heat illness.
  • Educating children about preparing for the heat to improve safety and reduce the risk for heat illness.
  • Allowing children to gradually adapt to physical activity in the heat.
  • Offering time for and encouraging sufficient fluid intake before, during, and after exercise.
  • Developing and having in place an emergency action plan.

Parents, students, and schools naturally get excited about their sports programs. This year, and any year, where extreme heat is putting our young athletes at risk, it’s a good idea use caution and common sense on the playing field.

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