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Sports Medicine Recommendations for Exercising in the Heat and Avoiding Heat Illness

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Sports Medicine Recommendations for Exercising in the Heat and Avoiding Heat Illness

By Nicole Fillingame, MS, ATC, LAT, CES, PES

During the heat of summer, it is important to take precautions and protect your student-athletes from heat illness while exercising outdoors. Heat illness is absolutely preventable and knowing the steps for prevention can help keep them safe.

Prior to exercise or an athletic season


  • Be sure each athlete has a pre-participation physical exam by a physician to identify a history of heat illness or any risk factors.
  • Help athletes adjust to the heat gradually over a period of seven to 14 days by progressively increasing the intensity and duration of exercise.
  • If the athletes wear protective equipment for their sport, phase it into workouts or practices gradually.
  • Avoid exercise if athletes are sick, have a fever, or have a skin rash. Do not allow them to resume exercising until all illnesses and conditions have resolved. 


When to exercise and how much  


  • When exercising in high heat and humidity, offer frequent rest breaks.  
  • Avoid the midday sun by exercising before 10 a.m. or after 6 p.m., if possible. 
  • If exercise must be done in the middle of the day, be sure the athletes have access to shade and identify an air-conditioned place inside if they need to cool down. 


What to wear 


  • Wear light-weight and breathable clothing. 
  • Avoid dark clothing.  
  • Change wet clothing frequently. 
  • Wear sunscreen. A sunburn can make it harder for the body to cool itself. 


What to drink and how much  


  • Make water and sports drinks easily accessible before, during and after physical activity.
  • Before exercise (two to four hours) athletes should drink 16-20 ounces of fluid (approximately one bottle of water or sports drink).
  • During exercise, they should drink 5-10 ounces every 15-20 minutes.1
  • After exercise, they should consume 16-24 ounces of fluid for every pound lost during exercise and refuel (i.e., drink and eat) within two hours of activity. 2
  • Athletes should avoid caffeinated, protein and alcoholic drinks (including soda, coffee and tea). 


Signs and symptoms of heat illness


  • Nausea  
  • Headache 
  • Weakness  
  • Poor concentration
  • Flushed skin 
  • Lightheadedness 
  • Fatigue 
  • Vomiting
  • Cramps
  • Confusion
  • Excessive sweating/flushing
  • Chills 


If anyone under your supervision develops any of these symptoms, take steps to lower their body temperature and get hydrated: 


  • Stop exercising immediately and get them out of the heat. 
  • Encourage them to cool their body down by removing extra clothing and equipment. 
  • Suggest sitting in a tub of cold water or placing wet towels or ice packs on the neck, forehead and under the arms.  
  • Continue to promote drinking fluids. 
  • If the condition gets worse or the athlete doesn’t start to feel better, seek medical help.  


Prevention of heat illness also means these athletes should take care of themselves after physical activity has ended each day. This includes eating a balanced diet and sleeping for a minimum of seven hours each night in a cool environment.  Prepare your athletes to exercise in the heat with these recommendations, know the signs and symptoms of heat illness, and allow proper recovery each day to ensure safe participation in physical activity and sports.  


1 National Athletic Trainers' Association Position Statement: Exertional Heat Illness. Casa DJ, DeMartini JK, Bergeron MF, et. al. (2015, September). Journal of Athletic Training, 50(9), 986-1000.  

2 Exercise and Fluid Replacement. American College of Sports Medicine. (2007). Medicine & Science in Sports & Exercise, 377-390. doi: 10.1249/mss.0b013e31802ca597.   


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