Performance and Athlete Safety:
Interview with Robert Huggins
Interview with Robert Huggins
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What are the main goals of the Korey Stringer Institute?
KSI has two main goals: First and foremost, we work tirelessly to advocate for, disseminate knowledge, and conduct research related to the prevention of sudden death in sport and the physically active. We work with many of our corporate partners to host meetings, conduct research and speak publicly about health and safety.
A prime example surrounds the improvement of health and safety policies at the high school level. We have published research ranking every state on their sports health and safety policies and are actively working with them through our “Raise Your Rank Campaign” to bring together the key stakeholders from a public health model to promote positive change that will ultimately save lives.
KSI was also contracted to conduct a multi-site project funded by the NCAA to examine if the current congested season is putting athletes at greater risk for injury and diminished health and wellness in men’s and women’s soccer. On the military front, we have been called upon by Lachland Airforce Base and Fort Bragg to improve heat illness care and train their medical staff to treat our nation’s defenders.
Secondly, the performance and testing wing of KSI strives to maximize performance in athletes and laborers related to hydration, heat acclimatization and nutrition. Routinely we test triathletes, marathoners, tennis and football players, as well as laborers who have had medical issues related to the heat previously or who are just looking to dial in their hydration and electrolyte needs for their next event.
With concussion awareness growing have you lost any momentum on the heart or hydration side of athlete safety?
If anything, the attention surrounding concussion has seemed to enhance the public’s view surrounding health and safety. At KSI we have seen a heightened sense of awareness for athlete health and the other leading causes of death. Causes that are preventable or treatable such as exertional heatstroke, sudden cardiac arrest, exertional sickling or event daily hydration and health issues we have seen more research and media attention lately which is promising.
Certainly while a great deal of media articles focus specifically on concussion because of the high incidence and familiarity in sport, many are recognizing that concussion is only one of the many health and safety issues that athletes face and that we need to be prepared to handle and treat the athletes and their issues individually.
Heat training has exploded as a way of acclimatizing athletes, do you see challenges that concern you?
While I am extremely excited that athletes and coaches are recognizing the natural benefits of training in the heat there are several issue that are concerning to me. Most concerning is when the appropriate medical supervision is not present (i.e. not having an Athletic Trainer present who is trained in the prevention, recognition, diagnosis and treatment of heat-related illnesses).
Second is the lack of implementation of proper “phasing in” of the heat acclimation process. There is a right way and a wrong way to heat acclimatize an athlete and furthermore there are many considerations one needs to take into account from fitness level, to age, intrinsic motivation, previous heat exposure, equipment, training environment, training intensity, hydration, recent illness, medications, etc. All of these factors need to be considered within each and every athlete.
Pushing the limit is what athletes and coaches do, but it should not be done at the cost of their life. Coaches and medical staff need to work together to learn and adhere to the best practice recommendations that are published by the top medical and health and safety organizations.
For “heat acc” specifically, coaches and athletic trainers need to carefully prescribe the dose and the response that they hope to observe from heat acclimatization all while monitoring players closely. That means obtaining valid body temperature during training (e.g rectal temp or gastrointestinal pill temp) to ensure that the athlete is at the temperature that most elicits the positive adaptations to the heat or at minimum, ensuring that the medical staff must be ready to assess core body temperature if the situation should arise at treat appropriately.
Before experimenting with “heat-acc” or training in the heat first you must ensure that there is a plan in case of an athletic emergency. This plan needs to be practiced and communicated regarding the who, what, where, when and why. Everyone needs to know what to do in case of an emergency and what their role is. Second, if possible appropriate medical care should be present on-site. Third, measuring the on-site environmental conditions using a “wet- blub globe thermometer” (WBGT) and adhering to the recommended work to rest ratio and hydration guidelines based on these conditions. Fourth, ensure that your acute program or training variables are phased in gradually and objectively measure body temperature throughout exercise. In this way you can be certain that you are getting the body temp up to the desired range (101.5 to 103F) and maintaining for one hour for 7 to 10 days. (Note: these days do not need to be in succession and days of every 3rd or 4th day are encourage to assist with the recovery and adaptation)
What are common mistakes coaches make when monitoring environmental conditions?
The most common mistake that teams make is not measuring the environmental conditions. Furthermore, when teams do actually monitor conditions each day (as recommended for the prevention of heat-related illness) they do so with the wrong tool or device. Many use devices or apps that only report temperature and humidity (aka= heat index) which is NOT the recommended unit from which guidelines are based. Rather, environmental conditions should be assessed ON SITE using a wet-bulb globe temperature or (WBGT) device. This takes into account the temp, humidity, radiant heat from the sun and wind speed.
Additionally, the American College of Sports Medicine, the US Army and the National Athletic Trainers’ Association all have publish and widely accepted guidelines for work to rest ratios during sport based on the WBGT measurements. One issue with these guidelines is that they are not region specific. For example, teams located in warmer climates might not be able to practice or play if they were to follow these guidelines. To assist with this, an article by Dr. Andrew Grundstein entitled “Regional heat safety thresholds for athletics in the contiguous United States in Applied Geography 56 (2015) 55-60″ divides the US into three distinct regions and adjusts the levels based on regional climate norms.
Another common mistake that teams make is that they don’t let everyone know what the conditions are and what level of activity the team should be at as conditions go from one risk level to the next. For example, the military has a flag system that corresponds to the environmental risk level that makes everyone aware of the conditions (green= low risk, yellow= moderate risk, red= high risk, black= extreme risk). This simple method of communication has been adopted by many sports teams and it lets the coaches know exactly how many rest breaks, the intensity, how much hydration and how long the duration of activities should be.
The 2020 Tokyo Olympics Could be the Hottest Ever Recorded, What Technologies or Best Practices Could Help Protect Athletes?
The most important thing that an athlete planning to compete in the 2020 Olympics in Tokyo can do is to get heat acclimatized and train specifically for the conditions that they will be competing in. This process takes 7-14 days depending on the current level of heat acclimatization and must be done with proper supervision and monitoring.
During heat acc, the core body temperature must be the determining factor to ensure that the athlete is getting the most out of the sessions. Sweat rate, heart rate, rest core temp, sweat concentration, plasma volume all undergo positive changes during this time that assist with the cooling of one’s body during exercise allowing for an athlete to maintain their performance and intensity.
Two pieces of technology that can help protect athletes are ingestible temperature sensors that allow for real-time measurement of the internal body temperature and heart rate monitors. When similar activities or benchmark tests occur in training, these sensors can be used to compare and track the adaptations and progress an athlete is making. Similarly, in competition this technology can inform the athlete or the medical team on the physiological stress that an athlete is experiencing and know when to push or back off.
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