Up and down the east coast we are in the midst of a heat wave. You can sometimes manage by spending more time inside in the AC and drinking plenty of cold drinks. However, for athletes often refusing to go outside is just not an option. Exercising in the heat can be dangerous, and even more so for athletes with existing health concerns. I will discuss two common concern; exercise/heat exhaustion and exertional heat stroke.
Heat Exhaustion is the inability to continue exercise due to dehydration, sodium loss through sweating, and energy depletion. A person with heat exhaustion may feel dizziness, lightheadedness or nauseous. They may also have diarrhea, a headache or cramping. Their core body temperature will be elevated, often between 97 and 104 degrees. The athlete should be moved to a cool and shaded area immediately and start rehydrating. Additional cooling can come from fans, ice towels or ice bags on peripheral arteries. If the athlete is not rapidly recovering, he should be transported to a hospital for additional treatment.
Another health risk of exercising in the heat is Exertional Heat Stroke (EHS). EHS can, but is not always, a progression of untreated heat exhaustion. The major distinctions between EHS and heat exhaustion are; a core body temperature over 104 degrees, neurological changes, and the risk of loss of consciousness. Neurological changes may be expressed as irrational behavior, confusion, aggression or hysteria. EHS can be fatal if it is not recognized and rapidly treated. EHS, unlike classic heat stroke, occurs only during physical activity and is life threatening due to organs overheating and ultimately malfunctioning. Classic heat stroke, commonly seen in babies and the elderly, is due to insufficient body temperature regulation. If an athlete has EHS, he needs to be cooled as quickly as possible. The most effective, and evidence proven, method is ice water immersion. Core body temperature should be monitored if possible, and the athlete should be under constant surveillance in case he loses consciousness. Because treatment is so time-sensitive, cooling the athlete is of the utmost importance. Emergency medical personnel should be contacted as well, but the athlete should not be transported until cooled. Even if the athlete seems to have returned to “normal” he still needs to be seen by a physician as there may be internal organ damage.
Some people may be at an elevated risk of heat illnesses due to predisposing factors. These include; dehydration, illness, a history of heat illness, being out of shape, excessive clothing, certain medications, or an electrolyte imbalance. These people need to be especially aware of how they feel while exercising on hot days. Humidity also increases the chance of a heat illness. Coaches, parents and athletes need to be aware of the weather forecast and risks associated with exercising in the heat. Precautions can be taken through; practicing without pads, more frequent water breaks, and access to ice towels or ice bags. Ultimately, a practice or game in excessive heat can be counterproductive and even life threatening and it may be in everyone’s best interest to postpone.
Binkley H, Beckett J, Casa D, Kleiner D, Plummer P. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. NATA Position, Consensus, Official and Support Statements. 2008;12- 22