Fit to play with Jim Johnson: The end of summer

August 15 was the end of my summer in south Louisiana. Forget everything you normally do; you only have energy for one thing — preseason football. We faced preseason football with mixed emotions; excitement for a sport we loved intermixed with dread of the next two weeks. Two practices a day in high heat and humidity, endless exercises, repeated hitting, coaches yelling, constant sweating, but above all — no water. The air always seemed to have a haze about it, a slap in the face when you walked outside. And forget relief, the heat was a constant.

In the 1950’s it was commonly believed that water restriction was the best way to get in shape, that wearing the full football uniform in the heat toughened up players. In the movie Remember the Titans, Denzel Washington’s character said “Water is for cowards.” It’s a wonder no one died.

But some did die. One reported incident told the story of a boy (let’s call him Bryan) who reported for football in west Texas. Bryan, 16, was overweight, out of shape, not ready for football. His coach decided he needed extra conditioning, so following practice he made him wear a nylon suit over his uniform and run laps. The nylon suit prevented evaporation. As he ran his body temperature rose and he collapsed. Bryan died two days later of organ failure. There are many similar stories in the 1950’s.

As research showed that water restriction in the heat was irrational, sport federations began to advocate fluid replenishment. But old beliefs were hard to drop and it wasn’t until the death of Korey Stringer in 2001 that practices really started to change. Stringer was 27, healthy, and a top player for the Minnesota Vikings. He died of exertional heatstroke (EHS), an easily preventable condition. In Stringer’s case, it wasn’t the absence of water that killed him; the combination of intense exercise in high heat and humidity while wearing a football uniform overwhelmed his ability to keep his core temperature from soaring to a dangerous level.

It took the death of a popular athlete for something to happen, and in 2010 the Korey Stringer Institute was founded to advocate research and prevention of exertional heatstroke. As a result of the Institute’s advocacy, heat related deaths have reduced by 51-percent. The Institute began the unpopular task of rating every state’s sport federation in regard to their heat illness policy. States were graded on three policies: gradual preseason conditioning guidelines, presence of a cooling tub, and whether the heat stress index was evaluated.

Twelve states required cooling tubs and only six monitored the heat index. Cooling tubs are the most effective way of reducing core temperature and would have saved the life of Bryan and Stringer. The heat stress index measures temperature, humidity, and radiation from sun and field, factors related to heat transfer and risk. Once coaches know the stress index, practice can be adjusted accordingly. A simple temperature measurement is not sufficient to determine risk since cooling through evaporation is related to humidity. Even if athletes are well hydrated, sweating doesn’t lose heat; evaporation of sweat does. This is why monitoring the heat index is important. A heat stress monitor can be purchased for $131. Massachusetts’ sport federation requires cooling tubs but not a heat stress monitor.

Heat illnesses are preventable. The combination of the high temperature, high humidity, direct sunlight, and a football uniform present a serious challenge to young athletes, but a careful preseason exercise program can result in players who resist heat illness and adapt to the heat. Exercising in the cooler part of the day, monitoring the environmental risk, and providing a cooling tub are easy practices. Fluids need to be readily available before, during, and after practice.

An immediate replacement of fluids is virtually impossible for big athletes. When I worked as an athletic trainer at LSU, we weighed all players before and after practice. Some of the larger athletes would lose over 20 pounds in one workout. Imagine trying to drink 20 pounds of water. What about commercial fluid replacement drinks? The main benefit is not the electrolytes; it’s the sugar. When the drink is sweeter, athletes will drink more.

My teammates and I made it through the preseason. South Louisiana is a tough place to play football in August; it is even hotter now, there and everywhere. Hot, humid weather is encroaching everywhere. Today, recreation enthusiasts face serious heat challenges. My next column covers how water can be a life saver and a killer.

Jim Johnson is a retired professor of exercise and sport science after teaching 52 years at Smith College and Washington University in St. Louis. He comments about sport, exercise, and sports medicine. He can be reached at jjohnson@smith.edu