Heat Risks in Athletics

  • Yuri Hosokawa
  • William M. Adams
Part of the SpringerBriefs in Medical Earth Sciences book series (BRIEFSMEEASC)


Features that are unique to sports participation, such as the timing of the season, use of protective equipment, and prolonged exposure to the sun, make athletes no exception to the risk of extreme heat. In order to attenuate the heat strain imposed on the body during exercise in the heat, heat acclimatization and activity modification guidelines are commonly utilized to enhance the physiological adaptations to the heat and control work-to-rest. Implementation of such guidelines has effectively reduced the numbers of exertional heat stroke fatalities among athletes; however, further research is warranted in establishing policies that account for the ever-increasing threat of climate change and promote the proactive use of weather and climate data to modify athletic activities.


Sports Distance running American football Road race medicine Secondary school athletics Heat acclimatization 


  1. 1.
    Aughey RJ, Goodman CA, McKenna MJ (2014) Greater chance of high core temperatures with modified pacing strategy during team sport in the heat. J Sci Med Sport Sports Med Aust 17:113–118. CrossRefGoogle Scholar
  2. 2.
    DeMartini JK, Martschinske JL, Casa DJ, Lopez RM, Ganio MS, Walz SM et al (2011) Physical demands of National Collegiate Athletic Association Division I football players during preseason training in the heat. J Strength Cond Res 25:2935–2943. CrossRefGoogle Scholar
  3. 3.
    Otani H, Kaya M, Tamaki A, Watson P, Maughan RJ (2016) Effects of solar radiation on endurance exercise capacity in a hot environment. Eur J Appl Physiol.
  4. 4.
    Otani H, Goto T, Goto H, Shirato M (2017) Time-of-day effects of exposure to solar radiation on thermoregulation during outdoor exercise in the heat. Chronobiol Int:1–15.
  5. 5.
    Link D, Weber H (2017) Effect of ambient temperature on pacing in soccer depends on skill level. J Strength Cond Res 31:1766–1770. CrossRefGoogle Scholar
  6. 6.
    Ely MR, Cheuvront SN, Roberts WO, Montain SJ (2007) Impact of weather on marathon-running performance. Med Sci Sports Exerc 39:487–493. CrossRefGoogle Scholar
  7. 7.
    Cheuvront SN, Haymes EM (2001) Thermoregulation and marathon running: biological and environmental influences. Sports Med Auckl NZ 31:743–62Google Scholar
  8. 8.
    Montain SJ, Ely MR, Cheuvront SN (2007) Marathon performance in thermally stressing conditions. Sports Med Auckl NZ 37:320–3Google Scholar
  9. 9.
    Maughan RJ, Otani H, Watson P (2012) Influence of relative humidity on prolonged exercise capacity in a warm environment. Eur J Appl Physiol 112:2313–2321. CrossRefGoogle Scholar
  10. 10.
    Adams WM, Ferraro EM, Huggins RA, Casa DJ (2014) Influence of body mass loss on changes in heart rate during exercise in the heat: a systematic review. J Strength Cond Res Natl Strength Cond Assoc 28:2380–2389. CrossRefGoogle Scholar
  11. 11.
    Hosokawa Y, Adams WM, Stearns RL, Casa DJ (2016) Comparison of gastrointestinal and rectal temperatures during recovery after a warm-weather road race. J Athl Train 51:382–388. CrossRefGoogle Scholar
  12. 12.
    Edwards AM, Clark NA (2006) Thermoregulatory observations in soccer match play: professional and recreational level applications using an intestinal pill system to measure core temperature. Br J Sports Med 40:133–138. CrossRefGoogle Scholar
  13. 13.
    Veltmeijer MTW, Eijsvogels TMH, Thijssen DHJ, Hopman MTE (2015) Incidence and predictors of exertional hyperthermia after a 15-km road race in cool environmental conditions. J Sci Med Sport 18:333–337. CrossRefGoogle Scholar
  14. 14.
    Périard JD, Racinais S, Knez WL, Herrera CP, Christian RJ, Girard O (2014) Thermal, physiological and perceptual strain mediate alterations in match-play tennis under heat stress. Br J Sports Med 48(Suppl 1):i32–i38. CrossRefGoogle Scholar
  15. 15.
    DeMartini JK, Casa DJ, Belval LN, Crago A, Davis RJ, Jardine JJ et al (2014) Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the Falmouth Road Race. J Athl Train 49:478–485. CrossRefGoogle Scholar
  16. 16.
    Kulka TJ, Kenney WL (2002) Heat balance limits in football uniforms how different uniform ensembles alter the equation. Phys Sportsmed 30:29–39. CrossRefGoogle Scholar
  17. 17.
    Armstrong LE, Johnson EC, Casa DJ, Ganio MS, McDermott BP, Yamamoto LM et al (2010) The American football uniform: uncompensable heat stress and hyperthermic exhaustion. J Athl Train 45:117–127. CrossRefGoogle Scholar
  18. 18.
    Johnson EC, Ganio MS, Lee EC, Lopez RM, McDermott BP, Casa DJ et al (2010) Perceptual responses while wearing an American football uniform in the heat. J Athl Train 45:107–116. CrossRefGoogle Scholar
  19. 19.
    Adams WM, Hosokawa Y, Huggins RA, Mazerolle SM, Casa DJ (2016) An exertional heat stroke survivor’s return to running: an integrated approach on the treatment, recovery, and return to activity. J Sport Rehabil 25:280–287. CrossRefGoogle Scholar
  20. 20.
    Grundstein AJ, Ramseyer C, Zhao F, Pesses JL, Akers P, Qureshi A et al (2012) A retrospective analysis of American football hyperthermia deaths in the United States. Int J Biometeorol 56:11–20. CrossRefGoogle Scholar
  21. 21.
    Cooper ER, Ferrara MS, Casa DJ, Powell JW, Broglio SP, Resch JE et al (2016) Exertional heat illness in American football players: when is the risk greatest? J Athl Train.
  22. 22.
    Yeargin SW, Kerr ZY, Casa DJ, Djoko A, Hayden R, Parsons JT et al (2016) Epidemiology of exertional heat illnesses in youth, high school, and college football. Med Sci Sports Exerc 48:1523–1529. CrossRefGoogle Scholar
  23. 23.
    Yeargin SW, Cahoon E, Hosokawa Y, Mensch JM, Dompier TP, Kerr ZY (2017) Environmental conditions and seasonal variables in American youth football leagues. Clin Pediatr (Phila). 9922816684603.
  24. 24.
    Kerr ZY, Marshall SW, Comstock RD, Casa DJ (2014) Exertional heat stroke management strategies in United States high school football. Am J Sports Med 42:70–77. CrossRefGoogle Scholar
  25. 25.
    McDermott BP, Adams WM (2016) Sudden death in sport. In: Adams M, Swiger W (eds) Epidemiology for athletic trainers: integrating evidence-based practice. Slack Inc, Thorofare, NJ, pp 119–135Google Scholar
  26. 26.
    Thomas LC, Kerr ZY, Kucera KL, Roos K, Casa DJ (2017) Fatal and catastrophic injuries in athletics: epidemiologic data and challenging circumstances. In: Casa D, Stearns RL (eds) Preventing sudden death in sport and physical activity, Second edn. Jones & Bartlett, Sudbury, MA, pp 17–32Google Scholar
  27. 27.
    Kerr ZY, Casa DJ, Marshall SW, Comstock RD (2013) Epidemiology of exertional heat illness among U.S. high school athletes. Am J Prev Med 44:8–14. CrossRefGoogle Scholar
  28. 28.
    Yard EE, Gilchrist J, Haileyesus T, Murphy M, Collins C, McIlvain N et al (2010) Heat illness among high school athletes--United States, 2005-2009. J Saf Res 41:471–474. CrossRefGoogle Scholar
  29. 29.
    Mueller FO, Colgate B (2011) Survey of football injury research: annual report 2010. University of North Carolina Chapel Hill, Chapel Hill, NCGoogle Scholar
  30. 30.
    Smith MT, Reid M, Kovalchik S, Woods TO, Duffield R (2017) Heat stress incident prevalence and tennis matchplay performance at the Australian open. J Sci Med Sport.
  31. 31.
    Centers for Disease Control and Prevention (CDC) (2010) Heat illness among high school athletes --- United States, 2005-2009. MMWR Morb Mortal Wkly Rep 59:1009–1013Google Scholar
  32. 32.
    Demartini JK, Casa DJ, Stearns R, Belval L, Crago A, Davis R et al (2015) Effectiveness of cold water immersion in the treatment of exertional heat stroke at the falmouth road race. Med Sci Sports Exerc 47:240–245. CrossRefGoogle Scholar
  33. 33.
    Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO (2007) American college of sports medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc 39:556–572. CrossRefGoogle Scholar
  34. 34.
    Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM et al (2015) National Athletic Trainers’ association position statement: exertional heat illnesses. J Athl Train 50:986–1000. CrossRefGoogle Scholar
  35. 35.
    Casa DJ, Csillan D (2009) Preseason heat-acclimatization guidelines for secondary school athletics. J Athl Train 44:332–333CrossRefGoogle Scholar
  36. 36.
    Ferrara MS, Swearngin R, Adams WM, Casa DJ (2014) Developing safety policies for oranized sports. Emerg. Manag. Sport Phys. Act. 1st edn. Jones and Bartlett LearningGoogle Scholar
  37. 37.
    National Collegiate Athletic Association. 2013-14 NCAA Sports Medicine Handbook. 24th ed. IndianapolisGoogle Scholar
  38. 38.
    Armstrong LE, Maresh CM (1991) The induction and decay of heat acclimatisation in trained athletes. Sports Med Auckl NZ 12:302–12Google Scholar
  39. 39.
    Adams WM, Scarneo SE, Casa DJ (2017) State-level implementation of health and safety policies to prevent sudden death and catastrophic injuries within secondary school athletics. Orthop J Sports Med 5:2325967117727262. CrossRefGoogle Scholar
  40. 40.
    Tripp BL, Eberman LE, Smith MS (2015) Exertional heat illnesses and environmental conditions during high school football practices. Am J Sports Med 43:2490–2495. CrossRefGoogle Scholar
  41. 41.
    American College of Sports Medicine (1984) American College of Sports Medicine position stand on prevention of thermal injuries during distance running. Med Sci Sports Exerc 16:ix–xivGoogle Scholar
  42. 42.
    Casa DJ, Almquist J, Anderson SA, Baker L, Bergeron MF, Biagioli B et al (2013) The inter-association task force for preventing sudden death in secondary school athletics programs: best-practices recommendations. J Athl Train 48:546–553. CrossRefGoogle Scholar
  43. 43.
    (2000) Climatic heat stress and the exercising child and adolescent. American Academy of Pediatrics. Committee on sports medicine and fitness. Pediatrics 106:158–159Google Scholar
  44. 44.
    Mears S, Watson P (2015) IIRM medical care manual. International Institute for Race Medicine. Loughborough, EnglandGoogle Scholar
  45. 45.
    Roberts WO (2010) Determining a “do not start” temperature for a marathon on the basis of adverse outcomes. Med Sci Sports Exerc 42:226–232. CrossRefGoogle Scholar
  46. 46.
    Grundstein A, Williams C, Phan M, Cooper E (2015) Regional heat safety thresholds for athletics in the contiguous United States. Appl Geogr 56:55–60. CrossRefGoogle Scholar
  47. 47.
    Grundstein A, Elguindi N, Cooper E, Ferrara MS (2013) Exceedance of wet bulb globe temperature safety thresholds in sports under a warming climate. Clim Res 58:183–191. CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Yuri Hosokawa
    • 1
    • 2
  • William M. Adams
    • 3
    • 4
  1. 1.College of Sport and Health ScienceRitsumeikan UniversityKusatsuJapan
  2. 2.Korey Stringer Institute, University of ConnecticutStorrsUSA
  3. 3.Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroUSA
  4. 4.Korey Stringer Institute, University of ConnecticutStorrsUSA

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