Characterizing fluid intake and physical activity in university students within the United States during the COVID-19 pandemic.

PURPOSE: This study determined fluid intake and physical activity behaviors among college students during the COVID-19 pandemic. METHODS: College students (n = 1014; females, 75.6%) completed an online survey during the Spring 2020 academic semester following the initial global response to the COVID-19 pandemic. Academic standing, habitation situation, and University/College responses to COVID-19 were collected. Participants completed the Godin Leisure-Time Exercise Questionnaire and a 15-item Beverage Questionnaire (BEVQ-15) to determine physical activity level and fluid intake behaviors, respectively. RESULTS: Females (1920 ± 960 mL) consumed significantly less fluid than males (2400 ± 1270 mL, p < 0.001). Living off-campus (p < 0.01) and living with a spouse/partner (p < 0.01) was associated with increased consumption of alcoholic beverages. 88.7% of participants reported being at least moderately active; however, Black/African American and Asian participants were more likely to be less active than their Caucasian/White counterparts (p < 0.05). Participants reporting no change in habitation in response to COVID-19 had a higher fluid intake (p = 0.002); however, the plain water consumption remained consistent (p = 0.116). While there was no effect of habitation or suspension of classes on physical activity levels (p > 0.05), greater self-reported physical activity was associated with greater fluid intake (std. ß = 0.091, p = 0.003). CONCLUSIONS: Fluid intake among college students during the initial response to the COVID-19 pandemic approximated current daily fluid intake recommendations. Associations between COVID-19-related disruptions (i.e., suspension of classes and changes in habitation) and increased alcohol intake are concerning and may suggest the need for the development of targeted strategies and programming to attenuate the execution of negative health-related behaviors in college students.

The effect of acute exercise on the cortisol awakening response.

The effects of acute exercise on the cortisol awakening response (CAR), characterized by the rapid increase in cortisol concentrations within the 30-45 min following sleep offset has yet to be fully elucidated. Thus, our study investigated the effects of late-evening acute exercise on the CAR the following morning. We hypothesized that exercise would have a significant effect on the CAR the following morning. Twelve participants (mean (SD): age = 23 (4) years; mass = 76.8 (8.7) kg; height = 175.6 (5.0) cm; [Formula: see text]O2max = 48.9 (7.5) ml.kg-1.min-1) reported to the laboratory in the evening (1800 h) on two occasions and were randomly assigned to either exercise for one hour (70-75% of maximal power output) or rest condition. Blood and saliva samples were assayed for cortisol. Mixed-effects models determined the effect of exercise on the cortisol response post-waking in both blood and saliva. Participants demonstrated an average exercise-induced increase in circulating cortisol of 477.3%, with actual mean (SD) heart rate relative to maximum of 87.04% (6.14%). Model results demonstrated a negative effect for exercise condition when modeling the serum and salivary cortisol responses to awakening via a quadratic growth model (serum, ßCondition = - 42.26 [95% CI - 64.52 to - 20.01], p < 0.001; saliva, ßCondition = - 11.55 [95% CI - 15.52 to - 7.57], p < 0.001). These results suggest that cortisol concentrations in saliva and blood are significantly lower the morning following a prior evening exercise session. Therefore, the CAR may serve as a useful biomarker to monitor responses to exercise training, although the underlying mechanism for these decreases in the CAR should be investigated further.

Analysis of the Sport Mental Health Assessment Tool 1 (SMHAT-1) in Team USA athletes.

OBJECTIVE: The Sport Mental Health Assessment Tool 1 (SMHAT-1) was introduced as a critical component to the athlete health evaluation. However, the effectiveness of the initial triage step questionnaire (Athlete Psychological Strain Questionnaire (APSQ)) has yet to be analysed within a National Olympic and Paralympic Committee delegation. This study evaluated the ability of the APSQ to identify athletes at risk for mental health concerns. METHODS: Athletes completed the APSQ and all subsequent screening questionnaires of the SMHAT-1 as part of their Tokyo and Beijing Olympic and Paralympic Games health history screening. Each questionnaire was scored according to published guidelines, and the false-negative rate (FNR) for the APSQ identifying athletes that were positively screened on the subsequent questionnaires was computed. RESULTS: 1066 athletes from 51 different Olympic and Paralympic and Summer and Winter sports completed the SMHAT-1. The FNRs for all athletes who were positively screened on a subsequent questionnaire with an APSQ score of <17 ranged from 4.8% to 66.7%. The global FNR for being positively screened on any questionnaire was 67.5%. Female, Paralympic and Winter athletes scored higher on one or more questionnaires compared with male, Olympic and Summer athletes, respectively (p<0.05). CONCLUSION: Due to the high FNR of the APSQ detecting a potential mental health concern, we recommend athletes complete the APSQ and all subsequent questionnaires of the SMHAT-1 rather than using only the APSQ as an initial screening test.

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games.

OBJECTIVE: The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes. METHODS: Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons. RESULTS: There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes. CONCLUSION: No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

Bidirectional Relations Between Daily Stress and Sleep Among Black Emerging Adults.

BACKGROUND: Black adults experience higher levels of stress and more dysfunctional sleep patterns compared to their White peers, both of which may contribute to racial disparities in chronic health conditions. Dysfunctional sleep patterns are also more likely in emerging adults compared to other age groups. Daily stress-sleep relations in Black emerging adults are understudied. PURPOSE: This study used ecological momentary assessment (EMA) and wrist-worn actigraphy to examine bidirectional associations between daily stress and sleep among Black emerging adults. METHODS: Black college freshmen (N = 50) completed an EMA protocol (i.e., five EMA prompts/day) and wore an accelerometer for 7 days. The first EMA prompt of each day assessed sleep duration and quality. All EMA prompts assessed stress. Wrist-worn actigraphy assessed nocturnal sleep duration, sleep onset latency, sleep efficiency, and waking after sleep onset. RESULTS: At the within-person level, stress experienced on a given day was not associated with any sleep metrics that night (p > .05). On evenings when actigraphy-based sleep duration was shorter (B = -0.02, p = .01) and self-reported sleep quality was poorer (B = -0.12, p = .02) than usual, stress was greater the following day. At the between-person level, negative bidirectional relations existed between stress and actigraphy-based waking after sleep onset (stress predicting sleep: B = -0.35, p = .02; sleep predicting stress: B = -0.27, p = .04). CONCLUSIONS: Among Black emerging adults, associations between daily sleep and stress vary at the between- and within-person level and are dependent upon the sleep metric assessed. Future research should compare these relations across different measures of stress and different racial/ethnic groups to better understand health disparities.

Examining Internal and External Physical Workloads Between Training and Competitive Matches Within Collegiate Division I Men's Soccer.

ABSTRACT: Anderson, T, Adams, WM, Martin, KJ, and Wideman, L. Examining internal and external physical workloads between training and competitive matches within collegiate Division I men's soccer. J Strength Cond Res 35(12): 3440-3447, 2021-A direct analysis comparing differences in the demands of competition relative to in-season training in Division I collegiate soccer players has yet to be reported. Thus, the primary purpose of this study was to compare the absolute and relative internal and external workloads measured during training with competitive matches. Twenty-six male college soccer players were monitored over 2 consecutive seasons using a GPS and heart rate (HR) telemetry system. Differences between outdoor training sessions and competitive matches were analyzed for internal and external absolute and relative training workloads. Differences in training workloads between the 3 days before a match were also analyzed. Absolute time in HR zone 4 (80-89% of HRmax) and 5 (90-100% of HRmax); accelerations in zone 1 (0.50-0.99 m·s-2), zone 2 (1.00-1.99 m·s-2), and zone 3 (2.00-2.99 m·s-2); all negative acceleration zones; training load; and estimated energy expenditure were greater in competition than training (p < 0.05). By contrast, when comparing training and competition values using metrics relative to session duration, relative workload in trainings were greater than competition for HR zone 1 (50-59% of HRmax), zone 2 (60-69% of HRmax), zone 3 (70-79% of HRmax), and zone 4 (80-89% of HRmax) and all acceleration and negative acceleration zones. In addition, absolute training workloads were generally greatest 3 days prior (p < 0.01), but not different 2 days before the competitive match. Absolute physical workloads of competition are significantly greater than those achieved during training; however, these differences and impact on the physical condition of players are mitigated by the greater relative workloads achieved during training. These results provide meaningful metrics that may lead to insights into proper conditioning and in-season workload management for Division I collegiate soccer programs.

Relationship Between Heart Rate Variability and Acute:Chronic Load Ratio Throughout a Season in NCAA D1 Men's Soccer Players.

ABSTRACT: Sekiguchi, Y, Huggins, RA, Curtis, RM, Benjamin, CL, Adams, WM, Looney, DP, West, CA, and Casa, DJ. Relationship between heart rate variability and acute:chronic load ratio throughout a season in NCAA D1 men's soccer players. J Strength Cond Res 35(4): 1103-1109, 2021-The purpose of this study was twofold: (a) to examine the relationship between heart rate variability (HRV) and acute:chronic workload ratio (ACWR)-based training load (TL) metrics and (b) to examine relationships across various A:C ratio-based TL metrics. Heart rate variability in 23 male college soccer players (mean ± SD; age, 21 ± 1 years; body mass, 80.3 ± 5.8 kg; height, 181.9 ± 6.5 cm; %body fat, 11.9 ± 2.0%; and V̇o2max, 51.9 ± 5.0 ml·kg-1·min-1) was measured at 5 time points: week(W)1, W3, W7, W12, and W14 during the 2015 NCAA men's soccer season. Heart rate variability was calculated from beat to beat intervals using a heart rate monitor. Players donned a global position satellite-enabled device that measured the following TL metrics: session time (ST), Player Load (PL), PL·min-1, and total distance (TD). Acute:chronic workload ratio was calculated for each TL metric: ACWR-based ST (ACWRST), ACWR-based PL (ACWRPL), ACWR-based PL·min-1 (ACWRPLM), and ACWR-based TD (ACWRTD): ACWR = week average TLs/mo average (30 ± 1 days) TLs. Relationships between HRV and ACWR-based each TL metric were evaluated using mixed effects models. Tukey pairwise comparisons were used to examine differences between types of ACWR-based TL metrics. An increase in ACWRST significantly reduced HRV throughout a season (-7.4 ± 3.6 m·s-1; p = 0.04). There were significant differences between ACWRPLM and ACWRST, ACWRPL and ACWRTD at W1, ACWRPLM and ACWRST at W3 (p < 0.05). In conclusion, ACWRST, ACWRPL, and ACWRTD were significantly different from ACWRPLM. ACWRST was found to significantly predict HRV; higher ACWRST was significantly associated with lower HRV. Therefore, tracking of the ACWR using ST may help to optimize athlete's physiological state throughout a season.

The Relationships Between Perceived Wellness, Sleep, and Acute: Chronic Training Load in National Collegiate Athletics Association Division I Male Soccer Players.

ABSTRACT: Sekiguchi, Y, Curtis, RM, Huggins, RA, Benjamin, CL, Walker, AJ, Arent, SM, Adams, WM, Anderson, T, and Casa, DJ. The relationships between perceived wellness of, sleep of, and acute: chronic training load on National Collegiate Athletics Association division I male soccer players. J Strength Cond Res 35(5): 1326-1330, 2021-The purpose of this study was to investigate relationships between perceived wellness, sleep, and acute: chronic workload ratio (ACWR) throughout a collegiate men's soccer season. Sixty male collegiate soccer players (mean[M] ± SD; age, 21±2 year; body mass, 77.6 ± 6.5 kg; height, 180.1 ± 6.4 cm; body fat%, 9.9 ± 3.9% ; and V̇o2max, 53.1 ± 5.0 ml·kg-1·min-1) participated in this study. During each session, players used a heart rate and global positioning satellite-enabled chest strap to measure training impulse and ACWR. The ACWR values were trichotomized at the individual level giving an equal number of observations within each ACWR category of low, moderate, and high ACWR (M ± SD; low, 0.658 ± 0.23; moderate, 0.92 ± 0.15; and high, 1.17 ± 0.16). Stress, fatigue, and soreness levels were collected using 1-10 Likert scales and sleep duration, and sleep quality were measured by the Karolinska Sleep Diary. Stress, fatigue, soreness levels, and sleep quality were transformed to corresponding z-scores at the individual level. Fatigue levels were significantly higher when ACWR was high compared with low (mean difference [95% confidence intervals], effect size, p-value; 0.31 [0.21, 0.42], 0.29, p < 0.001) and moderate (0.14 [0.03, 0.24], 0.13, p = 0.01). Fatigue levels were also significantly higher when the ACWR was moderate compared with low (0.18 [0.07, 0.28], 0.16, p = 0.001). Soreness levels were significantly higher when the ACWR was high compared with low (0.25 [0.14, 0.36], 0.23, p < 0.001). Stress levels were significantly greater when the ACWR was high compared with low (0.19, [0.08, 0.29], 0.18, p < 0.001) and compared with moderate (0.15, [0.05, 0.25], 0.14, p = 0.004). There were no differences in sleep duration or sleep quality in different ACWR. The ACWR may be a useful tool to achieve an appropriate balance between training and recovery to manage daily fatigue and soreness levels in athletes.

Contextual Factors Influencing External and Internal Training Loads in Collegiate Men's Soccer.

Curtis, RM, Huggins, RA, Benjamin, CL, Sekiguchi, Y, Adams, WM, Arent, SM, Jain, R, Miller, SJ, Walker, AJ, and Casa, DJ. Contextual factors influencing external and internal training loads in collegiate men's soccer. J Strength Cond Res 34(2): 374-381, 2020-This study investigated factors influencing training loads (TL) in collegiate men's soccer. Total distance, high-speed running distance (>14.4 km·h), high-intensity heart-rate zone duration (HI HRZ, >70% heart rate relative to maximum), and session rating of perceived exertion were assessed daily from 107 male soccer players competing for 5 National Collegiate Athletics Association Division I teams. Differences between athlete role (starter and reserve), position (defender, midfielder, and forward), season phase (preseason, in-season, and postseason), days relative to match (MD-1 to MD-5+), days between matches (<4, 4-5, >5 days), previous match outcome (win, loss, and draw), and upcoming opponent relative ranking (weaker, trivial, and stronger) were examined. Mean differences (MD) and effect sizes (ESs) with 90% confidence intervals were reported. There were trivial and insignificant differences by player role, position, or upcoming opponent strength, and small-moderate increases in preseason TL compared with in-season (ES [range] = 0.4-0.9). TLs were lower for MD-1 and higher for MD-5+ (ES [range] = 0.4-1.3) when compared with MD-2-4. External loads (ES = -0.40 ± 0.20) were less after wins compared with losses. TLs are increased in the preseason, when training sessions occur greater than 5 days from a match and after losses. Contextualizing factors affecting TLs has implications for developing workload prescription and recovery strategies.

Regional Requirements Influence Adoption of Exertional Heat Illness Preparedness Strategies in United States High Schools.

Background and objectives: Exertional heat stroke (EHS) continues to be a prevalent health issue affecting all athletes, including our pediatric populations. The purpose of this study was to evaluate the effect of a state policy requirement for EHS prevention and treatment on local high school policy adoption in the United States (US). Materials and Methods: Athletic trainers (ATs) from high schools across the US participated in an online survey (n = 365). This survey inquired about their compliance with nine components of an EHS policy which was then compared to their state requirements for the policies. Evaluation of the number of components adopted between states with a requirement versus states without a requirement was conducted with a Wilcoxon Sign Rank test. Finally, an ordinal logistic regression with proportional odds ratios (OR) with 95% confidence intervals (CI) were run to determine the effect of a state requirement and regional differences on the number of components adopted. Results: ATs working in states with a requirement reported adoption of more components in their heat modification policy compared to states that did not require schools to develop a heat modification policy (with requirement mean = 5.34 ± 3.68, median = 7.0; without requirement mean = 4.23 ± 3.59, median = 5.0; Z = -14.88, p < 0.001). ATs working in region 3 (e.g., hotter regions) reported adopting more components than those in region 1 (e.g., cooler regions) (OR = 2.25, 95% CI: 1.215-4.201, p = 0.010). Conclusions: Our results demonstrate a positive association between state policy requirements and subsequently increased local policy adoption for EHS policies. Additionally, the results demonstrate that regional differences exist, calling for the need for reducing disparities across the US. These findings may imply that policy adoption is a multifactorial process; furthermore, additional regional specific investigations must be conducted to determine the true determinants of high school policy adoption rates for EHS policies.

Chemically Activated Cooling Vest's Effect on Cooling Rate Following Exercise-Induced Hyperthermia: A Randomized Counter-Balanced Crossover Study.

Background and objectives: Exertional heat stroke (EHS) is a potentially lethal, hyperthermic condition that warrants immediate cooling to optimize the patient outcome. The study aimed to examine if a portable cooling vest meets the established cooling criteria (0.15 °C·min-1 or greater) for EHS treatment. It was hypothesized that a cooling vest will not meet the established cooling criteria for EHS treatment. Materials and Methods: Fourteen recreationally active participants (mean ± SD; male, n = 8; age, 25 ± 4 years; body mass, 86.7 ± 10.5 kg; body fat, 16.5 ± 5.2%; body surface area, 2.06 ± 0.15 m2. female, n = 6; 22 ± 2 years; 61.3 ± 6.7 kg; 22.8 ± 4.4%; 1.66 ± 0.11 m2) exercised on a motorized treadmill in a hot climatic chamber (ambient temperature 39.8 ± 1.9 °C, relative humidity 37.4 ± 6.9%) until they reached rectal temperature (TRE) >39 °C (mean TRE, 39.59 ± 0.38 °C). Following exercise, participants were cooled using either a cooling vest (VEST) or passive rest (PASS) in the climatic chamber until TRE reached 38.25 °C. Trials were assigned using randomized, counter-balanced crossover design. Results: There was a main effect of cooling modality type on cooling rates (F[1, 24] = 10.46, p < 0.01, η2p = 0.30), with a greater cooling rate observed in VEST (0.06 ± 0.02 °C·min-1) than PASS (0.04 ± 0.01 °C·min-1) (MD = 0.02, 95% CI = [0.01, 0.03]). There were also main effects of sex (F[1, 24] = 5.97, p = 0.02, η2p = 0.20) and cooling modality type (F[1, 24] = 4.38, p = 0.047, η2p = 0.15) on cooling duration, with a faster cooling time in female (26.9 min) than male participants (42.2 min) (MD = 15.3 min, 95% CI = [2.4, 28.2]) and faster cooling duration in VEST than PASS (MD = 13.1 min, 95% CI = [0.2, 26.0]). An increased body mass was associated with a decreased cooling rate in PASS (r = -0.580, p = 0.03); however, this association was not significant in vest (r = -0.252, p = 0.39). Conclusions: Although VEST exhibited a greater cooling capacity than PASS, VEST was far below an acceptable cooling rate for EHS treatment. VEST should not replace immediate whole-body cold-water immersion when EHS is suspected.

Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race.

Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003-2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2-4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (-4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1-12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3-5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

Relationships between resting heart rate, heart rate variability and sleep characteristics among female collegiate cross-country athletes.

Even though sleep has been shown to be influenced by athletes' training status, the association with resting heart rate and heart rate variability remains unclear. The purpose of this study was to compare the changes in and relationships between resting heart rate, heart rate variability and sleep characteristics across a female collegiate cross-country season. Ten NCAA Division I collegiate female cross-country athletes (mean ± SD; age, 19 ± 1 year; height, 167.6 ± 7.6 cm; body mass, 57.7 ± 10.2 kg; VO2max , 53.3 ± 5.9 ml kg-1  min-1 ) participated in this study. Resting heart rate, heart rate variability and the percentage of time in slow wave sleep were captured using a wrist-worn multisensor sleep device throughout the 2016 competitive cross-country season (12 weeks). Linear mixed-effects models and magnitude-based inferences were used to assess differences between each week. Pearson product moment correlations were used to investigate relationships between variables. Resting heart rate at the end of the season, specifically during weeks 10-12 (mean ± SE; week 10, 48 ± 2; week 11, 48 ± 3; week 12, 48 ± 3), showed a practically meaningful increase compared to the beginning of the season, weeks 2-4 (week 2, 44 ± 2; week 3, 45 ± 2; week 4, 44 ± 2). Higher resting heart rate (r = 0.55) and lower heart rate variability (r = -0.62) were largely associated with an increase in percentage of time spent in slow wave sleep. These data suggest that when physiological state was impaired, meaning the physiological restorative demand was higher, the percentage of time in slow wave sleep was increased to ensure recovery. Thus, it is important to implement sleep hygiene strategies to promote adequate slow wave sleep when the body needs physiological restoration.

Giant vertebrobasilar aneurysm: a rare cause of central sleep apnoea.

We report a case of central sleep apnoea (CSA) due to a giant vertebrobasilar aneurysm with brainstem compression. A flow diverter stent was deployed with coil embolization of the right vertebral artery distal to the posterior inferior cerebellar artery (PICA) to occlude the aneurysm. The patient's symptoms improved following therapy.

Exertional Heat Stroke within Secondary School Athletics.

Exertional heat stroke (EHS) remains one of the leading causes of sudden death in sport despite clear evidence showing 100% survivability with the proper standards of care in place and utilized. Of particular concern are student athletes competing at the secondary school level, where the extent of appropriate health care services remains suboptimal compared with organized athletics at the collegiate level and higher. While rapid recognition and rapid treatment of EHS ensures survival, the adoption and implementation of these lifesaving steps within secondary school athletics warrant further discussion within the sports medicine community. Establishing proper policies regarding the prevention and care of EHS coupled with utilizing an interdisciplinary care approach is essential for 1) minimizing risk and 2) guaranteeing optimal outcomes for the patient.

Consensus Statement- Prehospital Care of Exertional Heat Stroke.

Exertional heat stroke (EHS) is one of the most common causes of sudden death in athletes. It also represents a unique medical challenge to the prehospital healthcare provider due to the time sensitive nature of treatment. In cases of EHS, when cooling is delayed, there is a significant increase in organ damage, morbidity, and mortality after 30 minutes, faster than the average EMS transport and ED evaluation window. The purpose of this document is to present a paradigm for prehospital healthcare systems to minimize the risk of morbidity and mortality for EHS patients. With proper planning, EHS can be managed successfully by the prehospital healthcare provider.

Exertional heat illness incidence and on-site medical team preparedness in warm weather.

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Pacing Strategy of a Full Ironman Overall Female Winner on a Course With Major Elevation Changes.

Pryor, JL, Adams, WM, Huggins, RA, Belval, LN, Pryor, RR, and Casa, DJ. Pacing strategy of a full Ironman overall female winner on a course with major elevation changes. J Strength Cond Res 32(11): 3080-3087, 2018-The purpose of this study was to use a mixed-methods design to describe the pacing strategy of the overall female winner of a 226.3-km Ironman triathlon. During the race, the triathlete wore a global positioning system and heart rate (HR)-enabled watch and rode a bike outfitted with a power and cadence meter. High-frequency (every km) analyses of mean values, mean absolute percent error (MAPE), and normalized graded running pace and power (accounting for changes in elevation) were calculated. During the bike, velocity, power, cadence, and HR averaged 35.6 km·h, 199 W, 84 rpm, and 155 b·min, respectively, with minimal variation except for velocity (measurement unit variation [MAPE]: 7.4 km·h [20.3%], 11.8 W [7.0%], 3.6 rpm [4.6%], 3 b·min [2.3%], respectively). During the run, velocity and HR averaged 13.8 km·h and 154 b·min, respectively, with velocity varying four-fold more than HR (MAPE: 4.8% vs. 1.2%). Accounting for elevation changes, power and running pace were less variable (raw [MAPE] vs. normalized [MAPE]: 199 [7.0%] vs. 204 W [2.7%]; 4:29 [4.8%] vs. 4:24 min·km [3.6%], respectively). Consistent with her planned pre-race pacing strategy, the triathlete minimized fluctuations in HR and watts during the bike and run, whereas velocity varied with changes in elevation. This case report provides observational evidence supporting the utility of a pacing strategy that allows for an oscillating velocity that sustains a consistent physiological effort in full Ironman races.