Health & Safety
American College of Sports Medicine: Fluid Replacement
The primary objective for replacing body water loss during exercise is to maintain normal hydration. To minimize risk of heat injury and impairment of exercise performance during exercise, water intake should attempt to equal fluid loss. At equal exercise intensity, the requirement for fluid replacement becomes greater with increased sweating during environmental heat stress.
To minimize the potential for thermal injury, it is advocated that water losses due to sweating during exercise be replaced at a rate equal to the sweat rate. Inadequate water intake can lead to premature exhaustion. During exercise, humans do not typically drink as much water as they sweat and, at best, voluntary drinking only replaces about two-thirds of the body water lost as sweat
ACSM concludes it would be premature to recommend drinking something other than water during exercise lasting less than 1 hour. However, during intense exercise lasting longer than 1 hour, a sports drink containing carbohydrates can delay the onset of fatigue.
In addition, ACSM concludes that there is little physiological basis for the presence of sodium in an oral rehydration solution (for example, sports drink) for enhancing intestinal water absorption as long as sodium is sufficiently available in the gut from the previous meal.
A primary rationale for electrolyte supplements in sports drinks is to replace electrolytes lost from sweating during exercise greater than 4-5 h in duration.
However, if the presence of sodium enhances palatability, then ACSM find that its presence in a replacement solution may be justified because drinking can be maximized by improving taste qualities of the ingested fluid.
The American Academy of Pediatrics also found that children might be more likely to drink a flavored sports drink over water. Even though most children wouldn’t need the sports drink for their intended purpose, electrolyte replacement, sports drinks may encourage young athletes to increase fluid intake and stay hydrated.
American College of Sports Medicine Calls for Caution in Preseason Practice
The American College of Sports Medicine (ACSM) re-issued its call for major caution in preseason practice and training for high school players during hot summer days.
ACSM emphasizes high heat and humidity represent a significant danger for heat illnesses and heat stroke unless precautions are taken and guidelines are followed.
ACSM recommends fluid replacement and acclimatization to the heat, as well as practice uniform and other modifications in order to reduce the risk for heat exhaustion and exertional heat stroke in young football players.
Severe incidents from heat-related complications are notoriously problematic for young football players, particularly during preseason practices. The overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.
"The primary reasons for a football player to overheat on the field are intensity and duration of practice, the environment, and the uniform," said Michael F. Bergeron, Ph.D., FACSM. "There's also a variety of problems that a football player can have related to sweat losses and consequent fluid and electrolyte deficits. That can range from feeling a little 'off,' to not performing well, to heat cramps or heat exhaustion—or if it were unattended, even heat stroke. If a player's body temperature reaches a certain threshold and they no longer have the capacity to regulate temperature, it can run away from them and readily lead to death."
Among its recommendations, ACSM guidelines suggest high school football players and their parents be aware and understand the impact of HEAT:
1) Hydration
2) Environmental Conditions
3) Acclimatization
4) Treatment
Hydration
Environmental Conditions
Acclimatization
Treatment (Monitoring/Emergency Readiness)
Between 1995 and 2001, 21 high school football players died of heat stroke, and there have been other fatalities since this time. Two severe incidents, one resulting in death, occurred last season during preseason training in Oklahoma and Texas, respectively.
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.
Keep Energy High with Proper Diet, Hydration
By Micah Simon
August 31, 2009, revised September 15, 2009
As football season begins for youth athletes, it's important for them to take care of their bodies before, during and after physical activity. Drinking the right fluids and eating the right foods is the best way for athletes to stay energized and hydrated. Oftentimes, however, kids and their parents aren't aware of what's really best to eat and drink during football season.
Kim Schwabenbauer is the Corporate Dietitian for Super Bakery and a member of USA Football's Health and Safety Committee. She said an important thing for parents of athletes ages 7 to 14 to be mindful of is proper fluid intake.
"I would say my first tip would be to drink two cups or 16 ounces of water about two hours prior to practice or prior to a game," Schwabenbauer said. "You do need to have water within your system because you are going to be sweating quite profusely whenever it's this hot in the fall."
Schwabenbauer also mentioned drinking sports drinks such as Gatorade for physical activity lasting longer than one hour.
"In practices or games that are lasting over an hour, they do want to consider consuming an electrolyte beverage - meaning something that has sodium and potassium," she said. "The kids don't necessarily need them in the first hour, but they do need them from an hour on."
Youth athletes should also have a different diet from youths not involved in sports. Given their higher level of physical activity, youth athletes should also have a slightly higher calorie intake to stay energized.
"They are expending energy and therefore calories are being burned through activity, so their activity rate is higher so they need higher calories," Schwabenbauer said. "At the same time, the makeup of the diet would also be different in that the carbohydrate portion of the diet needs to be a higher proportion."
Schwabenbauer said 60 to 65 percent of the child's diet should be complex carbohydrates, meaning those that contain fiber and whole grains. Carbohydrates are the main fuel source during activity, making it important for kids to eat carbohydrates at every meal.
Two or three hours before a game, Schwabenbauer suggests kids eat a snack or small meal. Kids don't need to eat anything during a game as much as they need to take proper fluids.
"All they really have to consume during the actual game would be water for the first hour and then an electrolyte beverage after that," she said. "In excessive heat, I would say an electrolyte beverage for the first hour."
Schwabenbauer also emphasized the importance of not diluting electrolyte beverages. She said kids do this a lot because it helps the drink taste better, but it actually takes away from the nutritional benefits of the drink.
"This practice I see quite a bit when they dilute the Gatorade with a lot of water, and something they need to know is that it doesn't perform in the same way that it's actually supposed to," Schwabenbauer said. "It doesn't give them as many electrolytes, calories, energy and things like that when they dilute it."
Within 30 minutes after a game, youth athletes should have at least a snack that has both carbohydrates and protein. Within two hours after practice or a game, Schwabenbauer said kids need to have an actual meal.
"That meal should contain all the components of a regular meal they would be eating, such as a high quality protein source like turkey, baked chicken breast or tacos with vegetables on it," she said. "They're also going to need a carbohydrate so they're going to need a pasta or bread component."
Schwabenbauer said the after-activity meal doesn't have to be dinner food. It could also be breakfast food such as omelets with meat and veggies and whole wheat bread as long as the meal contains a protein and carbohydrate.
For parents, planning ahead is an easier and healthier choice to make for their kids. They can grab food for practice when they need it and make sure they have healthy choices easily accessible.
"You save that time," Schwabenbauer said. "Portioning out snacks for the week, such as grapes and carrots, and it's all set and ready to go. It's just easy to whip out the snack from the refrigerator and not have to think a thing of it."
Proper nutrition is a key part of success for youth athletes on and off the field. Throughout the season, the right nutritious choices can help make the best of a young athlete's performance on the football field, while instilling healthful habits for life.
What Parents Should Know About Concussions in all Sports
By Nicole Lukosius
June 3, 2009, revised December 28, 2009
It's the last thing parents and coaches ever want to think about, but unfortunately, concussions do happen and they're certainly not something that should slip under the radar. It's very important to be educated about how to recognize when a youth player has suffered an injury of this type, and if so, what the next steps should be.
According to Centers for Disease Control and Prevention expert Vik Kapil, DO, FACEP, a concussion in its most basic description is an injury to the brain caused by a blow or jolt to the head that disrupts the function of the brain in some way.
Signs and symptoms that a player has suffered a concussion can include appearing dazed or stunned, moving clumsily, answering questions slowly, losing consciousness (even briefly) and overall confusion. A youth player can also experience headaches, nausea, balance problems and blurred vision.
"Generally we do recommend that people seek medical attention right away if a child has sustained a jolt or a blow to the head and just doesn't seem right," Kapil said. "Calling a doctor and getting input from a physician or other health care provider is really important to have them evaluate the seriousness of the potential injury."
Kapil also stressed that children shouldn't be returned to any strenuous physical activity or even strenuous mental activities and emotional situations until an evaluation has been performed by a professional.
But concussions can be tricky because sometimes symptoms do not show themselves right away after a big play. So it is up to the parents of youth football players to make sure that they are able to identify when something is wrong. Because parents know their children better than anyone, they have the ability to see the subtle differences in behavior that can happen when an injury has occurred.
"Parents often see some changes and sometimes they're not as clear cut, sometimes they're changes in emotions or things like that," Kapil said. "So a day later or in the evening after the event is done and the injury itself has been forgotten, the child may be more irritable, may appear very anxious or they may even have disturbances in sleep for example.
"They could be sleeping more than normal, less than normal, having trouble falling asleep or become drowsy at unusual times of the day. Most importantly, the role of parents is to recognize these kinds of subtle changes, which are not nearly as obvious."
An athlete may not always realize that they have suffered a concussion either, especially if they aren't aware of what the signs and symptoms may be. Talking with a youth player before he or she takes the field can open up the lines of communication between parents and their child in the event that something should go wrong.
Although it can be somewhat uncomfortable for parents to discuss this issue, Centers for Disease Control and Prevention expert Marlena Wald, MPH, MLS, believes educating the athletes themselves can make it much easier when there actually is a problem.
"The athletes themselves need to learn about this long before they've ever had a head injury so that they can tell their coach or their parent, 'You know, I get up out of a chair and I'm dizzy like grandma,'" Wald said. "It's OK to talk about and learn about these things beforehand because if you tore a ligament or sprained your ankle you would definitely tell your coach and your parent.
"These are signs and symptoms that the athletes need to learn about so they can recognize it in themselves and say, 'Mom, dad, something isn't right.'"
It is also recommended that youth players not return to physical activity until being cleared by their physician. Athletes may feel pressure from their peers to return sooner than they should, so it's important to receive the nod from a professional to ensure the child can safely take to the field again.
"I think the bottom line for the parents on Saturday or Sunday after the big game is if they see any of these symptoms, even if their young athlete is not reporting it directly, seek medical attention right away," Wald said. "Tell them that you want them to not go to the practice Monday until you get to the doctor and get an assessment.
"Also talk to the coach and see his perspective because the coach on the bench is closer to the field of play than mom and dad up in the bleachers, so you can have a discussion about what he might have seen in the minutes after the quarterback sack. These are things that have to be done, so don't let that weekend pass without taking some steps."
The primary objective for replacing body water loss during exercise is to maintain normal hydration. To minimize risk of heat injury and impairment of exercise performance during exercise, water intake should attempt to equal fluid loss. At equal exercise intensity, the requirement for fluid replacement becomes greater with increased sweating during environmental heat stress.
To minimize the potential for thermal injury, it is advocated that water losses due to sweating during exercise be replaced at a rate equal to the sweat rate. Inadequate water intake can lead to premature exhaustion. During exercise, humans do not typically drink as much water as they sweat and, at best, voluntary drinking only replaces about two-thirds of the body water lost as sweat
ACSM concludes it would be premature to recommend drinking something other than water during exercise lasting less than 1 hour. However, during intense exercise lasting longer than 1 hour, a sports drink containing carbohydrates can delay the onset of fatigue.
In addition, ACSM concludes that there is little physiological basis for the presence of sodium in an oral rehydration solution (for example, sports drink) for enhancing intestinal water absorption as long as sodium is sufficiently available in the gut from the previous meal.
A primary rationale for electrolyte supplements in sports drinks is to replace electrolytes lost from sweating during exercise greater than 4-5 h in duration.
However, if the presence of sodium enhances palatability, then ACSM find that its presence in a replacement solution may be justified because drinking can be maximized by improving taste qualities of the ingested fluid.
The American Academy of Pediatrics also found that children might be more likely to drink a flavored sports drink over water. Even though most children wouldn’t need the sports drink for their intended purpose, electrolyte replacement, sports drinks may encourage young athletes to increase fluid intake and stay hydrated.
American College of Sports Medicine Calls for Caution in Preseason Practice
The American College of Sports Medicine (ACSM) re-issued its call for major caution in preseason practice and training for high school players during hot summer days.
ACSM emphasizes high heat and humidity represent a significant danger for heat illnesses and heat stroke unless precautions are taken and guidelines are followed.
ACSM recommends fluid replacement and acclimatization to the heat, as well as practice uniform and other modifications in order to reduce the risk for heat exhaustion and exertional heat stroke in young football players.
Severe incidents from heat-related complications are notoriously problematic for young football players, particularly during preseason practices. The overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.
"The primary reasons for a football player to overheat on the field are intensity and duration of practice, the environment, and the uniform," said Michael F. Bergeron, Ph.D., FACSM. "There's also a variety of problems that a football player can have related to sweat losses and consequent fluid and electrolyte deficits. That can range from feeling a little 'off,' to not performing well, to heat cramps or heat exhaustion—or if it were unattended, even heat stroke. If a player's body temperature reaches a certain threshold and they no longer have the capacity to regulate temperature, it can run away from them and readily lead to death."
Among its recommendations, ACSM guidelines suggest high school football players and their parents be aware and understand the impact of HEAT:
1) Hydration
2) Environmental Conditions
3) Acclimatization
4) Treatment
Hydration
Environmental Conditions
- The length of each practice session should not exceed three hours (including warm-up, conditioning, instruction, breaks, and cool-down) and should be modified appropriately, in accordance with the environmental conditions (heat, humidity, and exposure to direct sunlight) in order to effectively reduce the associated risks and improve the overall safety for young football athletes.
- Players should not use stimulants, including ephedrine and high-dose caffeine often found in dietary supplements or "energy" drinks.
Acclimatization
- When players report to camp, they generally are not as well conditioned and acclimatized as college players, which may contribute to earlier fatigue and greater risk of injury.
- The body needs up to 14 days of progressive activity in the heat to undergo the physiological changes that allow for safe and sufficient acclimatization (the first three to five days are the most critical).
- Players should practice in light-colored clothing, and wear shorts with helmets and shoulder pads only (not full equipment) or shorts only (with all protective equipment removed) for the first week of practice. Helmets should be removed whenever possible (during instruction).
Treatment (Monitoring/Emergency Readiness)
- Players should be closely monitored by the team support staff (including athletic trainers) for signs and symptoms of developing heat-related injury during practice.
- Any changes in player performance, personality, or well-being should be sufficient reason to stop practice immediately for that individual. Teams should use the "buddy" system, by assigning two players to help monitor each other.
- If exertional heat stroke is suspected, players should be stripped of equipment and immediately cooled in a tub of ice water until emergency personnel can assume care and evacuate the athlete to the nearest emergency facility.
- Thirst
- Irritability
- Headache and dizziness
- Muscle cramping and unusual fatigue
- Nausea and/or vomiting
- Hyperventilation
- Confusion and change in personality
Between 1995 and 2001, 21 high school football players died of heat stroke, and there have been other fatalities since this time. Two severe incidents, one resulting in death, occurred last season during preseason training in Oklahoma and Texas, respectively.
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.
Keep Energy High with Proper Diet, Hydration
By Micah Simon
August 31, 2009, revised September 15, 2009
As football season begins for youth athletes, it's important for them to take care of their bodies before, during and after physical activity. Drinking the right fluids and eating the right foods is the best way for athletes to stay energized and hydrated. Oftentimes, however, kids and their parents aren't aware of what's really best to eat and drink during football season.
Kim Schwabenbauer is the Corporate Dietitian for Super Bakery and a member of USA Football's Health and Safety Committee. She said an important thing for parents of athletes ages 7 to 14 to be mindful of is proper fluid intake.
"I would say my first tip would be to drink two cups or 16 ounces of water about two hours prior to practice or prior to a game," Schwabenbauer said. "You do need to have water within your system because you are going to be sweating quite profusely whenever it's this hot in the fall."
Schwabenbauer also mentioned drinking sports drinks such as Gatorade for physical activity lasting longer than one hour.
"In practices or games that are lasting over an hour, they do want to consider consuming an electrolyte beverage - meaning something that has sodium and potassium," she said. "The kids don't necessarily need them in the first hour, but they do need them from an hour on."
Youth athletes should also have a different diet from youths not involved in sports. Given their higher level of physical activity, youth athletes should also have a slightly higher calorie intake to stay energized.
"They are expending energy and therefore calories are being burned through activity, so their activity rate is higher so they need higher calories," Schwabenbauer said. "At the same time, the makeup of the diet would also be different in that the carbohydrate portion of the diet needs to be a higher proportion."
Schwabenbauer said 60 to 65 percent of the child's diet should be complex carbohydrates, meaning those that contain fiber and whole grains. Carbohydrates are the main fuel source during activity, making it important for kids to eat carbohydrates at every meal.
Two or three hours before a game, Schwabenbauer suggests kids eat a snack or small meal. Kids don't need to eat anything during a game as much as they need to take proper fluids.
"All they really have to consume during the actual game would be water for the first hour and then an electrolyte beverage after that," she said. "In excessive heat, I would say an electrolyte beverage for the first hour."
Schwabenbauer also emphasized the importance of not diluting electrolyte beverages. She said kids do this a lot because it helps the drink taste better, but it actually takes away from the nutritional benefits of the drink.
"This practice I see quite a bit when they dilute the Gatorade with a lot of water, and something they need to know is that it doesn't perform in the same way that it's actually supposed to," Schwabenbauer said. "It doesn't give them as many electrolytes, calories, energy and things like that when they dilute it."
Within 30 minutes after a game, youth athletes should have at least a snack that has both carbohydrates and protein. Within two hours after practice or a game, Schwabenbauer said kids need to have an actual meal.
"That meal should contain all the components of a regular meal they would be eating, such as a high quality protein source like turkey, baked chicken breast or tacos with vegetables on it," she said. "They're also going to need a carbohydrate so they're going to need a pasta or bread component."
Schwabenbauer said the after-activity meal doesn't have to be dinner food. It could also be breakfast food such as omelets with meat and veggies and whole wheat bread as long as the meal contains a protein and carbohydrate.
For parents, planning ahead is an easier and healthier choice to make for their kids. They can grab food for practice when they need it and make sure they have healthy choices easily accessible.
"You save that time," Schwabenbauer said. "Portioning out snacks for the week, such as grapes and carrots, and it's all set and ready to go. It's just easy to whip out the snack from the refrigerator and not have to think a thing of it."
Proper nutrition is a key part of success for youth athletes on and off the field. Throughout the season, the right nutritious choices can help make the best of a young athlete's performance on the football field, while instilling healthful habits for life.
What Parents Should Know About Concussions in all Sports
By Nicole Lukosius
June 3, 2009, revised December 28, 2009
It's the last thing parents and coaches ever want to think about, but unfortunately, concussions do happen and they're certainly not something that should slip under the radar. It's very important to be educated about how to recognize when a youth player has suffered an injury of this type, and if so, what the next steps should be.
According to Centers for Disease Control and Prevention expert Vik Kapil, DO, FACEP, a concussion in its most basic description is an injury to the brain caused by a blow or jolt to the head that disrupts the function of the brain in some way.
Signs and symptoms that a player has suffered a concussion can include appearing dazed or stunned, moving clumsily, answering questions slowly, losing consciousness (even briefly) and overall confusion. A youth player can also experience headaches, nausea, balance problems and blurred vision.
"Generally we do recommend that people seek medical attention right away if a child has sustained a jolt or a blow to the head and just doesn't seem right," Kapil said. "Calling a doctor and getting input from a physician or other health care provider is really important to have them evaluate the seriousness of the potential injury."
Kapil also stressed that children shouldn't be returned to any strenuous physical activity or even strenuous mental activities and emotional situations until an evaluation has been performed by a professional.
But concussions can be tricky because sometimes symptoms do not show themselves right away after a big play. So it is up to the parents of youth football players to make sure that they are able to identify when something is wrong. Because parents know their children better than anyone, they have the ability to see the subtle differences in behavior that can happen when an injury has occurred.
"Parents often see some changes and sometimes they're not as clear cut, sometimes they're changes in emotions or things like that," Kapil said. "So a day later or in the evening after the event is done and the injury itself has been forgotten, the child may be more irritable, may appear very anxious or they may even have disturbances in sleep for example.
"They could be sleeping more than normal, less than normal, having trouble falling asleep or become drowsy at unusual times of the day. Most importantly, the role of parents is to recognize these kinds of subtle changes, which are not nearly as obvious."
An athlete may not always realize that they have suffered a concussion either, especially if they aren't aware of what the signs and symptoms may be. Talking with a youth player before he or she takes the field can open up the lines of communication between parents and their child in the event that something should go wrong.
Although it can be somewhat uncomfortable for parents to discuss this issue, Centers for Disease Control and Prevention expert Marlena Wald, MPH, MLS, believes educating the athletes themselves can make it much easier when there actually is a problem.
"The athletes themselves need to learn about this long before they've ever had a head injury so that they can tell their coach or their parent, 'You know, I get up out of a chair and I'm dizzy like grandma,'" Wald said. "It's OK to talk about and learn about these things beforehand because if you tore a ligament or sprained your ankle you would definitely tell your coach and your parent.
"These are signs and symptoms that the athletes need to learn about so they can recognize it in themselves and say, 'Mom, dad, something isn't right.'"
It is also recommended that youth players not return to physical activity until being cleared by their physician. Athletes may feel pressure from their peers to return sooner than they should, so it's important to receive the nod from a professional to ensure the child can safely take to the field again.
"I think the bottom line for the parents on Saturday or Sunday after the big game is if they see any of these symptoms, even if their young athlete is not reporting it directly, seek medical attention right away," Wald said. "Tell them that you want them to not go to the practice Monday until you get to the doctor and get an assessment.
"Also talk to the coach and see his perspective because the coach on the bench is closer to the field of play than mom and dad up in the bleachers, so you can have a discussion about what he might have seen in the minutes after the quarterback sack. These are things that have to be done, so don't let that weekend pass without taking some steps."
