Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations.

The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

International Association of Athletics Federations Consensus Statement 2019: Nutrition for Athletics.

The International Association of Athletics Federations recognizes the importance of nutritional practices in optimizing an Athlete's well-being and performance. Although Athletics encompasses a diverse range of track-and-field events with different performance determinants, there are common goals around nutritional support for adaptation to training, optimal performance for key events, and reducing the risk of injury and illness. Periodized guidelines can be provided for the appropriate type, amount, and timing of intake of food and fluids to promote optimal health and performance across different scenarios of training and competition. Some Athletes are at risk of relative energy deficiency in sport arising from a mismatch between energy intake and exercise energy expenditure. Competition nutrition strategies may involve pre-event, within-event, and between-event eating to address requirements for carbohydrate and fluid replacement. Although a "food first" policy should underpin an Athlete's nutrition plan, there may be occasions for the judicious use of medical supplements to address nutrient deficiencies or sports foods that help the athlete to meet nutritional goals when it is impractical to eat food. Evidence-based supplements include caffeine, bicarbonate, beta-alanine, nitrate, and creatine; however, their value is specific to the characteristics of the event. Special considerations are needed for travel, challenging environments (e.g., heat and altitude); special populations (e.g., females, young and masters athletes); and restricted dietary choice (e.g., vegetarian). Ideally, each Athlete should develop a personalized, periodized, and practical nutrition plan via collaboration with their coach and accredited sports nutrition experts, to optimize their performance.

Effects of Three Oral Nutritional Supplements on Human Hydration Indices.

Urine color (Ucol) as a hydration assessment tool provides practicality, ease of use, and correlates moderately to strongly with urine specific gravity (Usg) and urine osmolality (Uosm). Indicative of daily fluid turnover, along with solute and urochrome excretion in 24-hr samples, Ucol may also reflect dietary composition. Thus, the purpose of this investigation was to determine the efficacy of Ucol as a hydration status biomarker after nutritional supplementation with beetroot (880 mg), vitamin C (1000 mg), and riboflavin (200 mg). Twenty males (Mean ± SD; age, 21 ± 2 y; body mass, 82.12 ± 15.58 kg; height, 1.77 ± 0.06 m) consumed a standardized breakfast and collected all urine voids on one control day (CON) and 1 day after consuming a standardized breakfast and a randomized and double-blinded supplement (SUP) over 3 weeks. Participants replicated exercise and diet for one day before CON, and throughout CON and SUP. Ucol, Usg, Uosm, and urine volume were measured in all 24-hr samples, and Ucol and Usg were measured in all single samples. Ucol was a significant predictor of single sample Usg after all supplements (p < .05). Interestingly, 24-hr Ucol was not a significant predictor of 24-h Usg and Uosm after riboflavin supplementation (p = .20, p = .21). Further, there was a significant difference between CON and SUP 24-h Ucol only after riboflavin supplementation (p < .05). In conclusion, this investigation suggests that users of the UCC (urine color chart) should consider riboflavin supplementation when classifying hydration status and use a combination of urinary biomarkers (e.g., Usg and Ucol), both acutely and over 24 hr.

Hypohydration and hyperthermia impair neuromuscular control after exercise.

PURPOSE: This study aimed to evaluate the effects of hypohydration and hyperthermia during exercise on movement technique and postural control. METHODS: Twelve healthy men (age = 20 ± 2 yr, height = 182 ± 8 cm, mass = 74.0 ± 8.2 kg, V˙O2max = 57.0 ± 6.0 mL·kg·min; mean ± SD) completed four randomized test sessions: euhydrated temperate (EUT), euhydrated hot (EUH), hypohydrated temperate (HYT), and hypohydrated hot (HYH). Temperate and hot conditions were performed in 18.0°C ± 0.2°C, 50.0% ± 3.5% relative humidity, and 34.0°C ± 0.3°C, 45.0% ± 4.5% relative humidity, respectively. Movement technique and postural control were assessed before exercise (PRE), after exercise (POST), and after recovery (REC). Movement technique was evaluated using the Landing Error Scoring System (LESS). Postural control was assessed using the Balance Error Scoring System (BESS) and center-of-pressure sway velocity (SV) and elliptical sway area (ESA) during a dynamic balance test. The 90-min treadmill exercise protocol (1.34-1.78 m·s; 5% grade) required subjects to walk carrying a 20.5-kg rucksack. Subjects sat quietly in the test environment during a 60-min recovery period after exercise. Repeated-measures ANOVAs with a Tukey-HSD post hoc test evaluated differences between time and condition for dependent variables. RESULTS: Exercise during HYH significantly increased LESS scores (PRE = 3.72 ± 1.73, POST = 4.42 ± 1.75) compared with HYT (3.75 ± 1.76) and EUH (3.61 ± 1.71) (P < 0.05). LESS scores remained elevated during REC for HYH compared with EUT (4.39 ± 1.47 vs 3.47 ± 2.05, P < 0.05). The HYH condition caused the greatest number of BESS errors (P = 0.02), largest ESA (P < 0.05), and highest SV (P = 0.02). Regardless of the condition, participants had the most BESS errors (P = 0.002) and highest SV (P = 0.003) during POST compared with the PRE and REC. CONCLUSIONS: Hypohydration during exercise in the heat impairs neuromuscular control. These findings suggest that physical activity in the heat while dehydrated may affect parameters associated with a higher risk of injury.

Cold-water dousing with ice massage to treat exertional heat stroke: a case series.

INTRODUCTION: We sought to determine the rate of cooling via a novel water ice therapy (WIT) as an alternative to cold-water immersion for the acute treatment of exertional heat stroke (EHS). METHODS: Observations were made at the 2004-2008 Marine Corps Marathons (mean +/- SD: 16.3 +/- 4.9 degrees C dry bulb, 32 +/- 6% RH). Nine (seven men, two women) EHS patients (33 +/- 6 yr of age; 268 +/- 54 min average race time for six who finished) were observed during on-site treatment. Patients were treated while lying supine on a porous stretcher resting on a tub filled with cold water (approximately 10-12 degrees C). Medical personnel monitored T(re), doused the patient with water and massaged major muscle groups with ice bags until T(re) decreased to 38.9 degrees C. Patients were not immersed in water. Serial T(re) and time were used to calculate cooling rates. RESULTS: Final T(re) (39.12 +/- 0.63 degrees C) was significantly lower than initial T(re) (41.43 +/- 0.71 degrees C, P < 0.05). Cooling rates were 0.13 +/- 0.04 degrees C min(-1). The decrease in T(re) for the initial 6 min of WIT (0.38 +/- 0.13 degrees C) was significantly less than for the subsequent 6-min time period (1.31 +/- 0.34 degrees C, P < 0.001). Cooling rates for these time periods were significantly different (0.06 +/- 0.02 degrees C x min(-1) and 0.22 +/- 0.06 degrees C x min(-1), respectively, P < 0.05). Initial T(re) was not correlated with overall cooling rate (r = 0.434, P = 0.244), or total cooling time required (17 +/- 4 min; r = 0.207, P = 0.593). Survival rate was 100%. CONCLUSION: WIT provided cooling rates that were 70% as effective as those published for cold-water immersion with 8 degrees C water (0.19 degrees C x min(-1)) and resulted in 100% patient survival.

The influence of nutritional ergogenic aids on exercise heat tolerance and hydration status.

Exercise in the heat may predispose an athlete to an exertional heat illness. It is imperative to be knowledgeable on the influence of various nutritional supplements on exercise tolerance and hydration status. Because of the variety of nutritional ergogenic aids that are easily accessible to athletes, medical and health professionals must rely on empirical evidence when making conclusions about the efficacy of a supplement while not ignoring significant anecdotal reports that may resemble real-life situations more closely.

Does creatine supplementation hinder exercise heat tolerance or hydration status? A systematic review with meta-analyses.

OBJECTIVE: To critically assess original research addressing the effect of creatine supplementation on exercise heat tolerance and hydration status. DATA SOURCES: We searched the electronic databases PubMed, Scopus, Web of Science, SPORTDiscus, and Rehabilitation & Physical Medicine, without date limitations, for the following key words: creatine, exercise, thermoregulation, dehydration, hyperthermia, heat tolerance, exertional heat illnesses, and renal function. Our goal was to identify randomized clinical trials investigating the effect of creatine supplementation on hydration status and thermoregulation. Citations from related articles also were identified and retrieved. DATA SYNTHESIS: Original research was reviewed using the Physiotherapy Evidence Database (PEDro) Scale. One author initially screened all articles. Fifteen of 95 articles examined the effects of creatine on thermoregulation or hydration status (or both). Two independent reviewers then reviewed these articles. Ten studies were selected on the basis of inclusion and exclusion criteria. The PEDro scores for the 10 studies ranged from 7 to 10 points (maximum possible score = 10 points). CONCLUSIONS: No evidence supports the concept that creatine supplementation either hinders the body's ability to dissipate heat or negatively affects the athlete's body fluid balance. Controlled experimental trials of athletes exercising in the heat resulted in no adverse effects from creatine supplementation at recommended dosages.

Cold water immersion: the gold standard for exertional heatstroke treatment.

The key to maximize the chances of surviving exertional heatstroke is rapidly decreasing the elevated core body temperature. Many methods exist to cool the body, but current evidence strongly supports the use of cold water. Preferably, the athlete should be immersed in cold water. If lack of equipment or staff prevents immersion, a continual dousing with cold water provides an effective cooling modality. We refute the many criticisms of this treatment and provide scientific evidence supporting cold water immersion for exertional heatstroke.

Exertional heat stroke in competitive athletes.

Exertional heat stroke (EHS) is a serious medical condition that can have a tragic outcome if proper assessment and treatment are not initiated rapidly. This article focuses on critical misconceptions that pertain to the prevention, recognition, and treatment of EHS, including 1) the randomness of EHS cases, 2) the role of nutritional supplements in EHS, 3) temperature assessment, 4) onset of EHS and the possible lucid interval, 5) rapid cooling, and 6) return to play. Exploration of these topics will enhance the medical care regarding EHS.