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Rogers SM, Lopez RM, Crossway AK, Moffit DM, Sturtevant J, Hansen A. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I. J Athl Train 2024; 59:338-344. [PMID: 36735644 PMCID: PMC11064106 DOI: 10.4085/1062-6050-0311.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.
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Affiliation(s)
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
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Bates T, Lopez RM. Diversity, Equity, Inclusion, and Access: A Road Map for Athletic Trainers. J Athl Train 2024; 59:331-332. [PMID: 38662443 PMCID: PMC11064111 DOI: 10.4085/1062-6050-0331.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Affiliation(s)
- Trevor Bates
- National Athletic Trainers' Association Diversity, Equity, Inclusion & Access Council
| | - Rebecca M Lopez
- National Athletic Trainers' Association Diversity, Equity, Inclusion & Access Council
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa
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Crossway AK, Rogers SM, Hansen A, Sturtevant J, Moffit DM, Lopez RM. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Considerations for Medical Affirmation-Part II. J Athl Train 2024; 59:345-353. [PMID: 36735628 PMCID: PMC11064118 DOI: 10.4085/1062-6050-0313.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recently, with discriminatory legislation efforts and changing participation policies in organized sports, media attention surrounding transgender and gender-diverse (TGD) individuals has increased. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in subpar patient care and a misunderstanding of the athletic trainer's (AT's) role within the health care and compliance systems. This literature review is the second part of a 2-paper series, and our objective was to educate ATs on the processes relevant to medical affirmation, including compliance considerations regarding medical eligibility, and to establish the AT's role. The gender affirmation framework includes social and legal components, which are discussed in part 1 of this literature, and the medical component is thoroughly discussed in part 2. All health care providers involved in the care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender-affirmation process, including gender-affirming hormone therapy, surgical options, known risks and complications, and the general health needs of TGD patients. With this knowledge, ATs, as point-of-care providers and members of the interprofessional care team, are uniquely positioned to help reduce health and health care disparities. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility in the evolving policies of sporting organizations.
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Affiliation(s)
| | | | | | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
| | - Rebecca M Lopez
- Department of Orthopaedics & Sports Medicine, School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa
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Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Exertional Heat Illness: Adoption of Policies and Influencing Contextual Factors as Reported by Athletic Administrators. Sports Health 2024; 16:58-69. [PMID: 36872595 PMCID: PMC10732114 DOI: 10.1177/19417381231155107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption. HYPOTHESIS We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants' zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption. RESULTS Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%). CONCLUSION Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy. CLINICAL RELEVANCE Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.
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Affiliation(s)
| | - William M. Adams
- Division of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado
| | - Kelly A. Coleman
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, Connecticut
| | - Rebecca M. Lopez
- University of South Florida, School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, Tampa, Florida
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Ashley CD, Lopez RM, Tritsch AJ. Football Practices in Hot Environments Impact Subsequent Days' Hydration. J Strength Cond Res 2024; 38:90-96. [PMID: 37815236 DOI: 10.1519/jsc.0000000000004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT Ashley, CD, Lopez, RM, and Tritsch, AJ. Football practices in hot environments impact subsequent days' hydration. J Strength Cond Res 38(1): 90-96, 2024-The impact of proper hydration to prevent exertional heat illness in American football has not been evaluated during high school preseason football practices in a hot environment (wet-bulb globe temperature = 31.3 ± 1.8° C). The purposes of this study were to examine the accuracy of urinary hydration measures to assess body mass (BM) changes and to examine carryover effects of consecutive practices by comparing postpractice with the next prepractice values. Before and after each of 7 outdoor practices, 31 male high school football players (age = 16 ± 1 years, height = 181.2 ± 12.0 cm, BM = 85.7 ± 19.1 kg, body mass index = 20.8 ± 1.8) provided a urine sample and were weighed to assess hydration. Sensitivity and specificity of urine color (Ucol) and urine-specific gravity (USG) to determine BM changes were determined using receiver operating characteristic (ROC) analysis. Paired samples t -tests assessed carryover effects between practices. Repeated-measures analysis of variance assessed carryover effects across practices. Significance was set at p < 0.05. Sensitivity and specificity for using Ucol or USG to determine BM changes was not significant. For Ucol, there was a carryover effect from practice numbers 2 to 3, 6 to 7 am , 7 am to 7 pm ( p < 0.001 for all), and 10 to 11 ( p = 0.004); most with less than 24 hours between practices. The %BM loss (%BML) was significantly greater ( p = 0.001 to 0.024) after 2-a-day practices. Effects of previous days' exercise in the heat, as evidenced by higher Ucol and %BL, are greater after 2-a-day practices, which occurred on later practice days. Athletes must replenish fluids during and between practices to remain euhydrated.
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Affiliation(s)
- Candi D Ashley
- Department of Educational and Psychological Studies, University of South Florida, Tampa, Florida; and
| | - Rebecca M Lopez
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa, Florida
| | - Amanda J Tritsch
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa, Florida
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Casa DJ, Szymanski MR, Jardine JF, Stearns RL, Adams WM, Eason CM, Hosokawa Y, Huggins RA, Lopez RM, McDermott BP, Miller KC, Nolan JK, Pryor RR, Scarneo-Miller SE, Vandermark LW. Letter on the 2023 ACSM Expert Consensus Statement on Exertional Heat Illness. Curr Sports Med Rep 2023; 22:336-337. [PMID: 37678353 DOI: 10.1249/jsr.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Michael R Szymanski
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - John F Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | | | - Christianne M Eason
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University. Tokorozawa, Saitama, Japan
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Brendon P McDermott
- Exercise Science Research Center, College of Education and Health Professions, University of Arkansas, Fayetteville, AR
| | - Kevin C Miller
- Texas State University, Department of Health and Human Performance, San Marcos, TX
| | - Julie K Nolan
- Athletic Training Education Program, Sacred Heart University, Fairfield, CT
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | | | - Lesley W Vandermark
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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Bernard TE, Ashley CD, Wolf ST, Odera AM, Lopez RM, Kenney WL. Distribution of upper limit of the prescriptive zone values for acclimatized and unacclimatized individuals. J Appl Physiol (1985) 2023; 135:601-608. [PMID: 37498291 PMCID: PMC10538976 DOI: 10.1152/japplphysiol.00724.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Heat stress has an adverse impact on worker health and well-being, and the effects will increase with more frequent and severe heat events associated with global warming. Acclimatization to heat stress is widely considered to be a critical mitigation strategy and wet bulb globe temperature- (WBGT-) based occupational standards and guidelines contain adjustments for acclimatization. The purpose here was to 1) compare the mean values for the upper limit of the prescriptive zone (ULPZ, below which the rise in core temperature is minimal) between unacclimatized and acclimatized men and women; 2) demonstrate that the change in the occupational exposure limit (ΔOEL) due to acclimatization is independent of metabolic rate; 3) examine the relation between ΔOEL and body surface area (BSA); and 4) compare the exposure-response curves between unacclimatized and acclimatized populations. Empirically derived ULPZ data for unacclimatized participants from Pennsylvania State University (PSU) and acclimatized participants from University of South Florida (USF) were used to explore the difference between unacclimatized and acclimatized heat exposure limits. The findings provide support for a constant 3°C WBGT OEL decrease to account for unacclimatized workers. Body surface area explained part of the difference in ULPZ values between men and women. In addition, the pooled PSU and USF data provide insight into the distribution of individual values for the ULPZ among young, healthy unacclimatized and acclimatized populations in support of occupational heat stress guidelines.NEW & NOTEWORTHY Occupational exposure limit guidelines using wet bulb globe temperature (WBGT) distinguish between acclimatized and unacclimatized workers with about a 3°C difference between them. For the first time, empirical data from two laboratories provide support for acclimatization state adjustments. Using a constant difference rather than increasing differences with metabolic rate better describes the limit for unacclimatized participants. Furthermore, the lower upper limit of the prescriptive zone (ULPZ) values set forth for women do not relate to fitness level but are partly explained by their smaller body surface area (BSA). An examination of individual ULPZ values suggests that many unacclimatized individuals should be able to sustain safe work at the exposure limit for acclimatized workers.
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Affiliation(s)
- Thomas E Bernard
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Candi D Ashley
- Exercise Science Program, College of Education, University of South Florida, Tampa, Florida, United States
| | - S Tony Wolf
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, United States
| | - Ayub M Odera
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences, Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, Florida, United States
| | - W Larry Kenney
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, United States
- Graduate Program in Physiology, The Pennsylvania State University, University Park, Pennsylvania, United States
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Garrett B, Lopez RM, Szymanski MR, Eidt D. Proper Recognition and Management of Exertional Heat Stroke in a High School Cross-Country Runner: A Validation Clinical Case Report. J Athl Train 2022; 57:586-591. [PMID: 35969664 DOI: 10.4085/1062-6050-0462.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 14-year-old female high school cross- country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer assessed the patient, who presented with difficulty breathing and then other signs of EHS (eg, confusion and agitation). The patient was taken to the medical area and draped with a towel, and a rectal temperature (Tre) of 106.9°F (41.6°C) was obtained. The emergency action plan was activated, and emergency medical services was called. The patient was submerged in a cold-water immersion tub until emergency medical services arrived (∼15 minutes; Tre = 100.1°F; cooling rate: 0.41°F.min-1[0.25°C.min-1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. She was not admitted and returned to running without sequelae. Following best practices, secondary school athletic trainers can prevent deaths from EHS by properly recognizing the condition and providing rapid cooling before transport.
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Affiliation(s)
- Bryanna Garrett
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
| | | | - Drew Eidt
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine; Morsani College of Medicine, University of South Florida, Tampa
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Lopez RM, Lund DC, Tritsch AJ, Liebl V. Relationship Between Pre- and Post-exercise Body Mass Changes and Pre-exercise Urine Color in Female Athletes. Front Sports Act Living 2022; 4:791699. [PMID: 35392595 PMCID: PMC8980779 DOI: 10.3389/fspor.2022.791699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Although studies use body mass changes or urine color to measure hydration status, the purpose of this study was to examine the relationship between pre-practice urine color and exercise body mass changes in female tackle football players. Twenty-six female American football players (Age: 29.9 ± 7.3 years; Height: 165.2 ± 2.6 cm; Weight: 83.8 ± 24.4 kg) volunteered. Fluid consumptions (FC) was measured during tackle football practices, while urine color (Ucol), and percent body mass loss (%BML) were taken before and after practices. Subjects were grouped by %BML: lost mass (LM), gained mass (GM), or no change (NC). A one-way ANOVA compared groups on Ucol and FC. There were differences across groups for pre-practice Ucol (P < 0.01) and FC (P < 0.01). GM had a higher pre-practice Ucol than LM (P < 0.01) and NC (P < 0.05) and consumed more fluid than LM (P < 0.01) and NC (P < 0.05). A stepwise linear regression examined the extent that Ucol and FC were related to %BML. When predicting BML, FC accounted for 45% of variance (P < 0.01). The addition of pre-practice Ucol increased predicted variance explained (R2 change= 2.5%, P = 0032). Subjects who gained mass during practice arrived with elevated urine color (Ucol 5 ± 2), while those who lost mass arrived with pale urine color (Ucol 3 ± 2). Findings indicate those who arrived with an elevated urine color attempted to improve hydration status by consuming more fluid and gaining body mass during exercise.
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Scarneo-Miller SE, Lopez RM, Miller KC, Adams WM, Kerr ZY, Casa DJ. High Schools' Adoption of Evidence-Based Practices for the Management of Exertional Heat Stroke. J Athl Train 2021; 56:1142-1153. [PMID: 34662417 PMCID: PMC8530428 DOI: 10.4085/1062-6050-361-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE To investigate high schools' adoption of policies and procedures for recognizing and treating patients with EHS and the factors influencing the adoption of a comprehensive policy. DESIGN Cross-sectional study. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S) Using the National Athletic Trainers' Association position statement on exertional heat illness, we developed an online questionnaire and distributed it to ATs to ascertain their schools' current written policies for using rectal temperature and cold-water immersion. The precaution adoption process model allowed for responses to be presented across the various health behavior stages (unaware if have the policy, unaware of the need for the policy, unengaged, undecided, decided not to act, decided to act, acting, and maintaining). Additional questions addressed perceptions of facilitators and barriers. Data are presented as proportions. RESULTS A total of 531 ATs completed the questionnaire. Overall, 16.9% (n = 62) reported adoption of all components for the proper recognition and treatment of EHS. The component with the highest adoption level was "cool first, transport second"; 74.1% (n = 110) of ATs described acting on or maintaining the policy. The most variability in the precaution adoption process model responses was for a rectal temperature policy; 28.7% (n = 103) of ATs stated they decided not to act and 20.1% (n = 72) stated they maintained the policy. The most frequently cited facilitator of and barrier to obtaining rectal temperature were a mandate from the state HS athletics association (n = 274, 51.5%) and resistance to or apprehension of parents or legal guardians (n = 311, 58.5%), respectively. CONCLUSIONS Athletic trainers in the HS setting appeared to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing as the biggest challenge. Tailored strategies based on health behavior, facilitators, and barriers may aid in changing this paradigm.
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Affiliation(s)
| | | | | | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | | | - Douglas J. Casa
- Department of Kinesiology, University of Connecticut, Storrs
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Abstract
ABSTRACT Lopez, RM, Ashley, CD, Zinder, SM, and Tritsch, AJ. Thermoregulation and hydration in female American football players during practices. J Strength Cond Res 35(9): 2552-2557, 2021-Little is known about hydration practices and thermoregulation in female tackle football players. The purpose of the study was to examine the thermoregulatory and hydration responses of female professional American football players. Fifteen females from the same tackle football team volunteered for this observational field study. Each subject was observed for 4 practices for the following measures: gastrointestinal temperature (TGI), maximum TGI, heart rate (HR), maximum HR (HRmax), fluid consumption, sweat rate, percent body mass loss (%BML), urine specific gravity (USG), urine color (Ucol), perceptual measures of thirst, thermal sensations, and rating of perceived exertion (RPE). Descriptive data (mean ± SD) were calculated for all measures. Main measures were analyzed using a repeated-measures analysis of variance. Trials took place during evening practices. Average TGI during practices was 38.0 ± 0.3° C while maximum TGI was 38.4 ± 0.3° C (n = 14). Average practice HR was 118 ± 11 b·min-1, while HRmax was 148 ± 13 b·min-1. Subjects arrived at practices with Ucol of 3 ± 1 and USG of 1.018 ± 0.007. Postpractice USG (1.022 ± 0.007) was significantly higher than prepractice across all days (p < 0.001). The average sweat rate across 4 practices was 0.6 ml·h-1. Average %BML was 0.3 ± 0.4%. Thirst and thermal sensations were moderate (4 ± 1 and 5 ± 1, respectively), while RPE was 11 ± 1. Female football players tended to have similar physiological responses to males. Although subjects seemed to adequately match their sweat losses with fluid consumed during practice, there was considerable variability in hydration indices and hydration habits, with some subjects experiencing hypohydration and others overestimating their fluid needs. Those working with this population should emphasize the need for hydration education and establish individualized hydration regimens.
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Affiliation(s)
| | - Candi D Ashley
- Educational and Psychological Studies, University of South Florida, Tampa, Florida; and
| | - Steven M Zinder
- School of Health and Applied Human Sciences, University of North Carolina, Wilmington, North Carolina
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Abbasi IS, Lopez RM, Kuo YT, Shapiro BS. Efficacy of an Educational Intervention for Improving the Hydration Status of Female Collegiate Indoor-Sport Athletes. J Athl Train 2021; 56:829-835. [PMID: 33237996 DOI: 10.4085/1062-6050-0495.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Research focusing on improving hydration status and knowledge in female indoor-sport athletes is limited. Investigators have demonstrated that hydration education is an optimal tool for improving the hydration status of athletes. OBJECTIVE To assess the hydration status and fluid intake of collegiate female indoor-sport athletes before and after a 1-time educational intervention. DESIGN Controlled laboratory study. SETTING Collegiate women's volleyball and basketball practices. PATIENTS OR OTHER PARTICIPANTS A total of 25 female collegiate volleyball and basketball athletes (age = 21 ± 1 years, height = 173.5 ± 8.7 cm, weight = 72.1 ± 10.0 kg) were assessed during 6 days of practices. INTERVENTION(S) Participants' hydration status and habits were monitored for 3 practice days before they underwent a hydration educational intervention. Postintervention, participants were observed for 3 more practice days. MAIN OUTCOME MEASURE(S) Change in body mass, fluid consumed, urine specific gravity (Usg), urine color (Ucol), and sweat rate were recorded for 6 practice days. Participants completed a hydration-knowledge questionnaire before and after the intervention. RESULTS Three-day mean Usg and Ucol were considered euhydrated prepractice (Usg = 1.015 ± 0.006, Ucol = 4 ± 1) and remained euhydrated postpractice (Usg = 1.019 ± 0.005, Ucol = 5 ± 2) during the preintervention period. Decreased prepractice Ucol (P < .01) and increased hydration knowledge (P < .01) were present postintervention. Basketball athletes had greater body mass losses from prepractice to postpractice than did volleyball athletes (P < .001). Overall increases were evident when we compared prepractice and postpractice measures of Usg and Ucol in the preintervention (P < .001 and P = .001, respectively) and postintervention (P = .001 and P < .001) period, respectively. No correlation was found between hydration knowledge and physiological indices of hydration and fluid intake. CONCLUSIONS Overall, female collegiate indoor-sport athletes were hydrated and knowledgeable on hydration. However, our variable findings indicated that further research on these athletes is needed; clinically, attention should be given to the individual needs of each athlete. More examination will demonstrate whether a 1-time educational intervention may be an effective tool for improving hydration status in this population.
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Affiliation(s)
- Isabella S Abbasi
- Department of Orthopaedics and Sports Medicine, School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa
| | - Rebecca M Lopez
- Department of Orthopaedics and Sports Medicine, School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa
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Morrissey MC, Casa DJ, Brewer GJ, Adams WM, Hosokawa Y, Benjamin CL, Grundstein AJ, Hostler D, McDermott BP, McQuerry ML, Stearns RL, Filep EM, DeGroot DW, Fulcher J, Flouris AD, Huggins RA, Jacklitsch BL, Jardine JF, Lopez RM, McCarthy RB, Pitisladis Y, Pryor RR, Schlader ZJ, Smith CJ, Smith DL, Spector JT, Vanos JK, Williams WJ, Vargas NT, Yeargin SW. Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers. Geohealth 2021; 5:e2021GH000443. [PMID: 34471788 PMCID: PMC8388206 DOI: 10.1029/2021gh000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 06/04/2023]
Abstract
The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.
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Affiliation(s)
- Margaret C. Morrissey
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Douglas J. Casa
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Gabrielle J. Brewer
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - William M. Adams
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - Yuri Hosokawa
- Faculty of Sports SciencesWaseda UniversitySaitamaJapan
| | | | | | - David Hostler
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Brendon P. McDermott
- Department of Health, Human Performance and RecreationUniversity of ArkansasFayettevilleARUSA
| | | | - Rebecca L. Stearns
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Erica M. Filep
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - David W. DeGroot
- Fort Benning Heat CenterMartin Army Community HospitalFort BenningGAUSA
| | | | - Andreas D. Flouris
- Department of Exercise ScienceFAME LaboratoryUniversity of ThessalyTrikalaGreece
| | - Robert A. Huggins
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | | | - John F. Jardine
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Rebecca M. Lopez
- School of Physical Therapy & Rehabilitation SciencesMorsani College of MedicineUniversity of South FloridaTampaFLUSA
| | | | - Yannis Pitisladis
- Collaborating Centre of Sports MedicineUniversity of BrightonBrightonUK
| | - Riana R. Pryor
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Zachary J. Schlader
- Department of KinesiologySchool of Public HealthIndiana UniversityBloomingtonIAUSA
| | - Caroline J. Smith
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNCUSA
| | - Denise L. Smith
- Department of Health and Human Physiological SciencesFirst Responder Health and Safety LaboratorySkidmore CollegeSaratoga SpringsNYUSA
| | - June T. Spector
- Department of Environmental and Occupational Health SciencesSchool of Public HealthUniversity of WashingtonSeattleWAUSA
| | | | - W. Jon Williams
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL)National Institute for Occupational Safety and Health (NIOSH)PittsburghPAUSA
| | - Nicole T. Vargas
- Faculty of Health SciencesUniversity of SydneySydneyNSWAustralia
| | - Susan W. Yeargin
- Department of Exercise ScienceArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
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Miller KC, Casa DJ, Adams WM, Hosokawa Y, Cates J, Emrich C, Fitzpatrick T, Hopper M, Jardine JF, LaBotz M, Lopez RM, O'Connor F, Smith MS. Roundtable on Preseason Heat Safety in Secondary School Athletics: Prehospital Care of Patients With Exertional Heat Stroke. J Athl Train 2021; 56:372-382. [PMID: 33290540 PMCID: PMC8063668 DOI: 10.4085/1062-6050-0173.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE First, we will update recommendations for the prehospital management and care of patients with exertional heat stroke (EHS) in the secondary school setting. Second, we provide action items to aid clinicians in developing best-practice documents and policies for EHS. Third, we supply practical strategies clinicians can use to implement best practice for EHS in the secondary school setting. DATA SOURCES An interdisciplinary working group of scientists, physicians, and athletic trainers evaluated the current literature regarding the prehospital care of EHS patients in secondary schools and developed this narrative review. When published research was nonexistent, expert opinion and experience guided the development of recommendations for implementing life-saving strategies. The group evaluated and further refined the action-oriented recommendations using the Delphi method. CONCLUSIONS Exertional heat stroke continues to be a leading cause of sudden death in young athletes and the physically active. This may be partly due to the numerous barriers and misconceptions about the best practice for diagnosing and treating patients with EHS. Exertional heat stroke is survivable if it is recognized early and appropriate measures are taken before patients are transported to hospitals for advanced medical care. Specifically, best practice for EHS evaluation and treatment includes early recognition of athletes with potential EHS, a rectal temperature measurement to confirm EHS, and cold-water immersion before transport to a hospital. With planning, communication, and persistence, clinicians can adopt these best-practice recommendations to aid in the recognition and treatment of patients with EHS in the secondary school setting.
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Affiliation(s)
- Kevin C. Miller
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant
| | - Douglas J. Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - William M. Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | | | | | | | | | - John F. Jardine
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Rebecca M. Lopez
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | - Francis O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
| | - M. Seth Smith
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville
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Scarneo-Miller SE, Lopez RM, Miller KC, Adams WM, Kerr ZY, Casa DJ. High Schools Struggle to Adopt Evidence Based Practices for the Management of Exertional Heat Stroke. J Athl Train 2021:461689. [PMID: 33626130 DOI: 10.4085/361-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Exertional heat stroke (EHS) deaths can be prevented by adhering to best practices. OBJECTIVE We investigated the adoption of policies and procedures for the recognition and treatment of EHS and the factors influencing the adoption of a comprehensive policy. DESIGN Cross Sectional. SETTING Online questionnaire. PATIENTS OR OTHER PARTICIPANTS Athletic trainers (ATs) practicing in the high school (HS) setting. MAIN OUTCOME MEASURE(S) Using the NATA Position Statement: Exertional Heat Illness, an online questionnaire was developed and distributed to ATs to ascertain their schools' current written policies for the use of rectal temperature and cold-water immersion (CWI). The Precaution Adoption Process Model (PAPM), allowed for responses to be presented across the various health behavior stages ("Unaware if have the policy", "Unaware for the need for the policy", "Unengaged", "Undecided", "Decided Not to Act", "Decided to Act", "Acting", and "Maintaining"). Additional questions included perceptions of facilitators and barriers. Data are presented as proportions. RESULTS A total of 531 ATs completed this questionnaire. Overall, 16.9% (n=62) report adoption of all components for proper recognition and treatment of EHS. The policy component with the highest adoption was "cool first transport second" with 74.1% (n=110) of ATs reporting "Acting" or "Maintaining." The most variability in the PAPM responses was for a rectal temperature policy, with 28.7% (n=103) of ATs reporting "Decided not to Act" and 20.1% (n=72) reporting "Maintaining." The most commonly reported facilitator and barrier for rectal temperature included state mandate from state HS athletics association (n=274,51.5%) and resistance or apprehension from parents or legal guardians (n=311,58.5%), respectively. CONCLUSIONS ATs in the HS setting appear to be struggling to adopt a comprehensive EHS strategy, with rectal temperature continuing to appear as the biggest undertaking. Tailored strategies based on health behavior, facilitators and barriers may aid in changing this paradigm.
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Affiliation(s)
- S E Scarneo-Miller
- Samantha E. Scarneo-Miller, PhD, ATC, Division of Athletic Training, School of Medicine, West Virginia University, , Twitter Handle: @SScarneoMiller
| | - R M Lopez
- Rebecca M. Lopez, PhD, ATC, Department of Orthopaedics & Sports Medicine, University of South Florida , Twitter Handle: @RLopez1010
| | - K C Miller
- Kevin C. Miller, PhD, ATC, School of Rehabilitation and Medical Sciences, Central Michigan University
| | - W M Adams
- William M. Adams, PhD, ATC, Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro, , Twitter Handle: @william_m_adams
| | - Z Y Kerr
- Zachary Y. Kerr, PhD, Department of Exercise and Sport Science, Department of University of North Carolina-Chapel Hill,
| | - D J Casa
- Douglas J. Casa, Korey Stringer Institute, Department of Kinesiology, University of Connecticut, , Twitter Handle: @CasaDouglas
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Bazarian JJ, Elbin RJ, Casa DJ, Hotz GA, Neville C, Lopez RM, Schnyer DM, Yeargin S, Covassin T. Validation of a Machine Learning Brain Electrical Activity-Based Index to Aid in Diagnosing Concussion Among Athletes. JAMA Netw Open 2021; 4:e2037349. [PMID: 33587137 PMCID: PMC7885039 DOI: 10.1001/jamanetworkopen.2020.37349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE An objective, reliable indicator of the presence and severity of concussive brain injury and of the readiness for the return to activity has the potential to reduce concussion-related disability. OBJECTIVE To validate the classification accuracy of a previously derived, machine learning, multimodal, brain electrical activity-based Concussion Index in an independent cohort of athletes with concussion. DESIGN, SETTING, AND PARTICIPANTS This prospective diagnostic cohort study was conducted at 10 clinical sites (ie, US universities and high schools) between February 4, 2017, and March 20, 2019. A cohort comprising a consecutive sample of 207 athletes aged 13 to 25 years with concussion and 373 matched athlete controls without concussion were assessed with electroencephalography, cognitive testing, and symptom inventories within 72 hours of injury, at return to play, and 45 days after return to play. Variables from the multimodal assessment were used to generate a Concussion Index at each time point. Athletes with concussion had experienced a witnessed head impact, were removed from play for 5 days or more, and had an initial Glasgow Coma Scale score of 13 to 15. Participants were excluded for known neurologic disease or history within the last year of traumatic brain injury. Athlete controls were matched to athletes with concussion for age, sex, and type of sport played. MAIN OUTCOMES AND MEASURES Classification accuracy of the Concussion Index at time of injury using a prespecified cutoff of 70 or less (total range, 0-100, where ≤70 indicates it is likely the individual has a concussion and >70 indicates it is likely the individual does not have a concussion). RESULTS Of 580 eligible participants with analyzable data, 207 had concussion (124 male participants [59.9%]; mean [SD] age, 19.4 [2.5] years), and 373 were athlete controls (187 male participants [50.1%]; mean [SD] age, 19.6 [2.2] years). The Concussion Index had a sensitivity of 86.0% (95% CI, 80.5%-90.4%), specificity of 70.8% (95% CI, 65.9%-75.4%), negative predictive value of 90.1% (95% CI, 86.1%-93.3%), positive predictive value of 62.0% (95% CI, 56.1%-67.7%), and area under receiver operator characteristic curve of 0.89. At day 0, the mean (SD) Concussion Index among athletes with concussion was significantly lower than among athletes without concussion (75.0 [14.0] vs 32.7 [27.2]; P < .001). Among athletes with concussion, there was a significant increase in the Concussion Index between day 0 and return to play, with a mean (SD) paired difference between these time points of -41.2 (27.0) (P < .001). CONCLUSIONS AND RELEVANCE These results suggest that the multimodal brain activity-based Concussion Index has high classification accuracy for identification of the likelihood of concussion at time of injury and may be associated with the return to control values at the time of recovery. The Concussion Index has the potential to aid in the clinical diagnosis of concussion and in the assessment of athletes' readiness to return to play.
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Affiliation(s)
- Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Robert J. Elbin
- Office for Sports Concussion Research, University of Arkansas, Fayetteville
| | | | - Gillian A. Hotz
- UHealth Concussion Program, University of Miami, Miami, Florida
| | - Christopher Neville
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York
| | - Rebecca M. Lopez
- Morsani College of Medicine, Orthopedics and Sports Medicine, University of South Florida, Tampa
| | | | - Susan Yeargin
- Arnold School of Public Health, University of South Carolina, Columbia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
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Abstract
CONTEXT Health care providers, including athletic trainers (ATs), may not be using the best practices for diagnosing exertional heat stroke (EHS), including rectal thermometry. Therefore, patients continue to be susceptible to death from EHS. OBJECTIVE To examine the health belief model and its association with using rectal thermometry as the best practice for diagnosing EHS. DESIGN Cross-sectional study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 208 secondary school ATs completed an online survey, and the data of 159 were included in the analysis. MAIN OUTCOME MEASURE(S) The survey contained 2 primary sections: AT characteristics and health belief model structured questions assessing perceptions and techniques used to diagnose EHS. Answers to the latter questions were rated on a 5-point Likert scale. We performed a binary logistic regression to ascertain the effects of the health belief model constants (eg, perceived susceptibility, barriers), age, sex, and the type of school at which the AT worked on the likelihood that participants would use best practice for diagnosing patients with EHS. RESULTS Only 33.3% (n = 53) of the participating ATs reported they used best practice, including rectal thermometers to obtain core body temperature. The binary logistic regression was different for the 5 constructs: perceived susceptibility (\(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\(\chi _6^2\) = 22.30, P = .001), perceived benefits (\(\chi _6^2\) = 71.79, P < .001), perceived barriers (\(\chi _6^2\) = 111.22, P < .001), perceived severity (\(\chi _6^2\) = 56.27, P < .001), and self-efficacy (\(\chi _6^2\) = 64.84, P < .001). Analysis of these data showed that older ATs were at greater odds (P ≤ .02) of performing best practice. CONCLUSIONS These data suggested that the health belief model constructs were associated with the performance of best practice, including using rectal thermometry to diagnose EHS. Researchers should aim to create tailored interventions based on health behavior to improve the adoption of best practice.
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Affiliation(s)
- Danyale R. McLean
- Morsani College of Medicine, Department of Orthopedics and Sports Medicine, University of South Florida, Tampa
| | | | - Rebecca M. Lopez
- Morsani College of Medicine, Department of Orthopedics and Sports Medicine, University of South Florida, Tampa
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Yeargin S, Lopez RM, Snyder Valier AR, DiStefano LJ, McKeon PO, Medina McKeon JM. Navigating Athletic Training Position Statements: The Strength of Recommendation Taxonomy System. J Athl Train 2020; 55:863-868. [PMID: 32577741 DOI: 10.4085/1062-6050-240-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Susan Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
| | - Rebecca M Lopez
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | - Alison R Snyder Valier
- Department of Interdisciplinary Health Sciences; School of Osteopathic Medicine in Arizona; Research Support, A.T. Still University, Mesa, AZ
| | | | - Patrick O McKeon
- Department of Exercise Science and Athletic Training, Ithaca College, NY
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Lopez RM, Lamadrid P, Ashley CD, Tritsch AJ, Moore EM, Ackerman B, Guzman-Ramos J, Johnson T. Body Mass And Urinary Hydration Measures During Preseason High School Football Practices In The Heat. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000686040.60092.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Del Rossi G, Anania T, Lopez RM. Early Aerobic Exercise for the Treatment of Acute Pediatric Concussions. J Athl Train 2020; 55:649-657. [DOI: 10.4085/1062-6050-404-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sport-related concussion is a common injury that has garnered the attention of the media and general public because of the potential for prolonged acute symptoms and increased risk for long-term impairment. Currently, a growing body of evidence supports the use of various therapies to improve recovery after a concussion. A contemporary approach to managing concussion symptoms is to use aerobic exercise as treatment. To date, several studies on both pediatric and adult patients have established that controlled aerobic exercise is a safe and effective way to rehabilitate patients experiencing delayed recovery after concussion. However, less is known about the utility of an early exercise protocol for optimizing recovery after acute concussion and reducing the risk for persistent postconcussive symptoms, particularly in pediatric populations. Thus, the purpose of our paper was to review and evaluate the available literature on the implementation of aerobic exercise for the treatment of acute pediatric concussion.
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Affiliation(s)
- Gianluca Del Rossi
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | - Thomas Anania
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | - Rebecca M. Lopez
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
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21
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Ashley CD, Lamadrid P, Lopez RM. Physiological Changes During Five Days Of Heat Acclimation. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679920.43796.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lopez RM, Gorrell P, Del Rossi G. Examining the Impact of a Prospective WBGT Heat Policy on High School Football Practices. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562196.21009.f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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DeMartini-Nolan JK, Martschinske JL, Casa DJ, Lopez RM, Stearns RL, Ganio MS, Coris E. Examining the Influence of Exercise Intensity and Hydration on Gastrointestinal Temperature in Collegiate Football Players. J Strength Cond Res 2019; 32:2888-2896. [PMID: 29210954 DOI: 10.1519/jsc.0000000000002137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
DeMartini-Nolan, JK, Martschinske, JL, Casa, DJ, Lopez, RM, Stearns, RL, Ganio, MS, and Coris, E. Examining the influence of exercise intensity and hydration on gastrointestinal temperature in collegiate football players. J Strength Cond Res 32(10): 2888-2896, 2018-Debate exists regarding the influence of intensity and hydration on body temperature during American football. The purpose of this study was to observe body core temperature responses with changes in intensity and hydration. Twenty-nine male football players (age = 21 ± 1 year, height = 187 ± 9 cm, mass = 110.1 ± 23.5 kg, body mass index [BMI] = 31.3 ± 5.0, and body surface area [BSA] = 2.34 ± 0.27 m) participated in 8 days of practice in a warm environment (wet bulb globe temperature: 29.6 ± 1.6° C). Participants were identified as starters (S; n = 12) or nonstarters (n = 17) and linemen (L; n = 14) or nonlinemen (NL; n = 15). Variables of interest included core body temperature (T), hydration status, and physical performance characteristics as measured by a global positioning system. Intensity measures of average heart rate (138 ± 9 bpm), low-velocity movement (4.2 ± 1.7%), high-velocity movement (0.6 ± 0.6%), and average velocity (0.36 ± 0.10 m·s) accounted for 42% of the variability observed in T (38.32 ± 0.34° C, r = 0.65, p = 0.01). Hydration measures (percent body mass loss = -1.56 ± 0.80%, urine specific gravity [Usg] = 1.025 ± 0.006, and urine color [Ucol] = 6 ± 1) did not add to the prediction of T (p = 0.83). Metrics of exercise intensity accounted for 39% of the variability observed in maximum T (38.83 ± 0.42° C, r = 0.62, p = 0.02). Hydration measures did not add to this prediction (p = 0.40). Low-velocity movement, high-velocity movement, average velocity, BMI, and BSA were significantly different (p = 0.002, p < 0.001, p = 0.02, p < 0.001, p < 0.001, respectively) between L vs. NL. Heart rate and T were not different between L and NL (p > 0.05). Exercise intensity primarily accounted for the rise in core body temperature. Although L spent less time at higher velocities, T was similar to NL, suggesting that differences in BMI and BSA added to thermoregulatory strain.
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Affiliation(s)
- Julie K DeMartini-Nolan
- Athletic Training Education Program, College of Health Professions, Sacred Heart University, Fairfield, Connecticut
| | - Jessica L Martschinske
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Mansfield, Connecticut
| | - Douglas J Casa
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Mansfield, Connecticut
| | - Rebecca M Lopez
- Department of Orthopaedics, University of South Florida, Tampa, Florida
| | - Rebecca L Stearns
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Mansfield, Connecticut
| | - Matthew S Ganio
- Department of Kinesiology, University of Arkansas, Fayetteville, Arkansas
| | - Eric Coris
- Department of Orthopedics, University of South Florida, Tampa, Florida
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Abstract
OBJECTIVE To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg). BACKGROUND The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital. DIFFERENTIAL DIAGNOSIS Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia. TREATMENT The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses. UNIQUENESS Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season. CONCLUSIONS Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of implementing a safe RTP protocol after EHS and may serve as a guide to ATs working in the high school setting. This case also highlights the need for more research in this area.
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Affiliation(s)
- Rebecca M Lopez
- Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa
| | | | - Sarah Irani
- Division of Sports Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - P Patrick Mularoni
- Division of Sports Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL
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Lopez RM, Moran B, Ashley C, Tritsch AJ, Shukla K, Coris E. Effectiveness of a Mobile Cooling Unit on Perceptual Responses During Preseason Collegiate Female Soccer Practices. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518104.08015.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ashley CD, Lopez RM, Aguillar D, Bernard TE. Thermal Exposure Limit for Mine Refuge Chambers. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517118.01103.f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Poole JA, Stearns RL, Lopez RM. Heat Acclimatization and Exertional Heat Illness Prevention in Youth Football Programs. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gordillo F, Mestas L, Castillo G, Perez MA, Lopez RM, Arana JM. [The neural networks of facial expression]. Rev Neurol 2017; 64:125-132. [PMID: 28128430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Face perception involves a broad network of connections between cortical and subcortical regions for the exchange and synchronization of information using white matter fibers. This precise communication system can be affected by the structures and the pathways that connect them. AIMS To establish the neural substrate underlying the perception of facial expression and to analyze the different factors involved in modulating the integrity of this neural network, with the aim being to introduce improvements into rehabilitation programs. DEVELOPMENT When the complex neural network involved in the perception of facial expression is altered by trauma, neurodegenerative disorders, developmental disorders, social isolation or negative contexts, the adaptive capacity to interact with the environment also deteriorates. CONCLUSIONS Maintaining the neural network integrity responsible for processing facial expression requires considering different variables. To a greater or lesser extent, these variables modify the structure or function of neural networks, such as aerobic training, transcranial magnetic stimulation, transcranial electrical stimulation, and learning. These variables are affected by age, and the type and course of the condition or generator context, and raise the need for rehabilitation protocols that are adapted and designed to delimit the deficient neuronal substrate.
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Affiliation(s)
- F Gordillo
- Universidad Camilo Jose Cela (UCJC), Madrid, Espana
| | - L Mestas
- Universidad Nacional Autonoma de Mexico. Facultad de Estudios Superiores Zaragoza, Mexico DF, Mexico
| | - G Castillo
- Universidad Camilo Jose Cela (UCJC), Madrid, Espana
| | - M A Perez
- Universidad Camilo Jose Cela (UCJC), Madrid, Espana
| | - R M Lopez
- Fundacion Universitaria Behavior , Mostoles, Espana
| | - J M Arana
- Universidad de Salamanca, Salamanca, Espana
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Affiliation(s)
- Rebecca L Stearns
- 1Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT; 2Uniformed Services University of the Health Sciences, Bethesda, MD; and 3University of South Florida, Tampa, FL
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Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, Ferrara MS, Miller KC, O'Connor F, Sawka MN, Yeargin SW. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train 2016; 50:986-1000. [PMID: 26381473 DOI: 10.4085/1062-6050-50.9.07] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation. BACKGROUND Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes. RECOMMENDATIONS Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.
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Affiliation(s)
| | | | | | | | - E Randy Eichner
- University of Oklahoma Health Sciences Center, Oklahoma City
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Lopez RM, Casa DJ, Jensen KA, Stearns RL, DeMartini JK, Pagnotta KD, Roti MW, Armstrong LE, Maresh CM. Comparison of Two Fluid Replacement Protocols During a 20-km Trail Running Race in the Heat. J Strength Cond Res 2016; 30:2609-16. [PMID: 26840437 DOI: 10.1519/jsc.0000000000001359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lopez, RM, Casa, DJ, Jensen, K, Stearns, RL, DeMartini, JK, Pagnotta, KD, Roti, MW, Armstrong, LE, and Maresh, CM. Comparison of two fluid replacement protocols during a 20-km trail running race in the heat. J Strength Cond Res 30(9): 2609-2616, 2016-Proper hydration is imperative for athletes striving for peak performance and safety, however, the effectiveness of various fluid replacement strategies in the field setting is unknown. The purpose of this study was to investigate how two hydration protocols affect physiological responses and performance during a 20-km trail running race. A randomized, counter-balanced, crossover design was used in a field setting (mean ± SD: WBGT 28.3 ± 1.9° C). Well-trained male (n = 8) and female (n = 5) runners (39 ± 14 years; 175 ± 9 cm; 67.5 ± 11.1 kg; 13.4 ± 4.6% BF) completed two 20-km trail races (5 × 4-km loop) with different water hydration protocols: (a) ad libitum (AL) consumption and (b) individualized rehydration (IR). Data were analyzed using repeated measures ANOVA. Paired t-tests compared pre-race-post-race measures. Main outcome variables were race time, heart rate (HR), gastrointestinal temperature (TGI), fluid consumed, percent body mass loss (BML), and urine osmolality (Uosm). Race times between groups were similar. There was a significant condition × time interaction (p = 0.048) for HR, but TGI was similar between conditions. Subjects replaced 30 ± 14% of their water losses in AL and 64 ± 16% of their losses in IR (p < 0.001). Ad libitum trial experienced greater BML (-2.6 ± 0.5%) compared with IR (-1.3 ± 0.5%; p < 0.001). Pre-race to post-race Uosm differences existed between AL (-273 ± 146 mOsm) and IR (-145 ± 215 mOsm, p = 0.032). In IR, runners drank twice as much fluid than AL during the 20-km race, leading to > 2% BML in AL. Ad libitum drinking resulted in 1.3% greater BML over the 20-km race, which resulted in no thermoregulatory or performance differences from IR.
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Affiliation(s)
- Rebecca M Lopez
- 1Morsani College of Medicine, University of South Florida, Tampa, Florida; 2Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut; 3College of Health Professions, Sacred Heart University, Fairfield, CT; 4Department of Kinesiology, Temple University, Philadelphia, Pennsylvania; 5Department of Movement Science, Sport & Leisure Studies, Westfield State University, Westfield, Massachusetts; and 6Department of Human Sciences, Ohio State University, Columbus, Ohio
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Casa DJ, Anderson SA, Baker L, Bennett S, Bergeron MF, Connolly D, Courson R, Drezner JA, Eichner ER, Epley B, Fleck S, Franks R, Guskiewicz KM, Harmon KG, Hoffman J, Holschen JC, Jost J, Kinniburgh A, Klossner D, Lopez RM, Martin G, McDermott BP, Mihalik JP, Myslinski T, Pagnotta K, Poddar S, Rodgers G, Russell A, Sales L, Sandler D, Stearns RL, Stiggins C, Thompson C. The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Casa DJ, DeMartini JK, Bergeron MF, Csillan D, Eichner ER, Lopez RM, Ferrara MS, Miller KC, O'Connor F, Sawka MN, Yeargin SW. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train 2015. [PMID: 26381473 DOI: 10.4085/1062-6050-50-9-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation. BACKGROUND Certified athletic trainers recognize and treat athletes with EHIs, often in high-risk environments. Although the proper recognition and successful treatment strategies are well documented, EHIs continue to plague athletes, and exertional heat stroke remains one of the leading causes of sudden death during sport. The recommendations presented in this document provide athletic trainers and allied health providers with an integrated scientific and clinically applicable approach to the prevention, recognition, treatment of, and return-to-activity guidelines for EHIs. These recommendations are given so that proper recognition and treatment can be accomplished in order to maximize the safety and performance of athletes. RECOMMENDATIONS Athletic trainers and other allied health care professionals should use these recommendations to establish onsite emergency action plans for their venues and athletes. The primary goal of athlete safety is addressed through the appropriate prevention strategies, proper recognition tactics, and effective treatment plans for EHIs. Athletic trainers and other allied health care professionals must be properly educated and prepared to respond in an expedient manner to alleviate symptoms and minimize the morbidity and mortality associated with these illnesses.
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Affiliation(s)
| | | | | | | | - E Randy Eichner
- University of Oklahoma Health Sciences Center, Oklahoma City
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Cleary MA, Toy MG, Lopez RM. Thermoregulatory, cardiovascular, and perceptual responses to intermittent cooling during exercise in a hot, humid outdoor environment. J Strength Cond Res 2014; 28:792-806. [PMID: 23897015 DOI: 10.1519/jsc.0b013e3182a20f57] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Decreasing core body temperature during exercise may improve exercise tolerance, facilitate acclimatization, and prevent heat illness during summer training. We sought to evaluate the effectiveness of intermittent superficial cooling on thermoregulatory, cardiovascular, and perceptual responses during exercise in a hot humid environment. We used a randomized, counterbalanced, repeated measures investigation with 2 conditions (control and cooling) during exercise and recovery outdoors on artificial turf in a hot, humid tropical climate in the sun (wet bulb globe temperature outdoors [WBGTo], 27.0 ± 0.8° C; range, 25.8-28.1° C) and in the shade (WBGTo, 25.4 ± 0.9° C; range, 24.3-26.8° C). Participants were 10 healthy males (age, 22.6 ± 1.6 years; height, 176.0 ± 6.9 cm; mass, 76.5 ± 7.8 kg; body fat, 15.6 ± 5.4%) who wore shorts and T-shirt (control) or "phase change cooling" vest (cooling) during 5-minute rest breaks during 60 minutes of intense American football training and conditioning exercises in the heat and 30 minutes of recovery in the shade. Throughout, we measured core (Tgi) and skin (Tchest) temperature, heart rate (HR), thermal and thirst sensations, and rating of perceived exertion. We found significant (p ≤ 0.001) hypohydration (-2.1%); for Tgi, we found no significant differences between conditions (p = 0.674) during exercise and progressive decreases during recovery (p < 0.001). For [INCREMENT]Tg,i we found no significant (p = 0.090) differences. For Tchest, we found significantly (p < 0.001) decreased skin temperature in the cooling condition (Tchest, 31.85 ± 0.43° C) compared with the control condition (Tchest, 34.38 ± 0.43° C) during exercise and significantly (p < 0.001) lower skin temperature in the cooling condition (Tchest, 31.24 ± 0.47° C) compared with the control condition (Tchest, 33.48 ± 0.47° C) during recovery. For HR, we found no significant difference (p = 0.586) between the conditions during exercise; however, we did find significantly (p < 0.001) lower HR during recovery. Thermal sensations were significantly (p = 0.026) decreased in the cooling (4.4 ± 0.2 points) compared with the control (5.0 ± 0.2 points) condition but not for other perceptual responses. The cooling effects of "phase change cooling" material were effective in reducing skin temperature but did not sufficiently reduce core body temperature or cardiovascular strain.
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Affiliation(s)
- Michelle A Cleary
- 1Athletic Training Education Program, College of Educational Studies, Chapman University, Orange, California; 2Dellarmine College Preparatory, San Jose, California; and 3Department of Orthopedics and Sports Medicine, University of South Florida, Tampa, Florida
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Casa DJ, Almquist J, Anderson SA, Baker L, Bergeron MF, Biagioli B, Boden B, Brenner JS, Carroll M, Colgate B, Cooper L, Courson R, Csillan D, Demartini JK, Drezner JA, Erickson T, Ferrara MS, Fleck SJ, Franks R, Guskiewicz KM, Holcomb WR, Huggins RA, Lopez RM, Mayer T, McHenry P, Mihalik JP, O'Connor FG, Pagnotta KD, Pryor RR, Reynolds J, Stearns RL, Valentine V. The inter-association task force for preventing sudden death in secondary school athletics programs: best-practices recommendations. J Athl Train 2013; 48:546-53. [PMID: 23742253 PMCID: PMC3718357 DOI: 10.4085/1062-6050-48.4.12] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Box U-1110, Storrs, CT 06269-1110, USA.
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Lopez RM, Eberman LE, Cleary MA. Superficial cooling does not decrease core body temperature before, during, or after exercise in an American football uniform. J Strength Cond Res 2013; 26:3432-40. [PMID: 23007493 DOI: 10.1519/jsc.0b013e3182736e5b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to identify the effects of superficial cooling on thermoregulatory responses while exercising in a hot humid environment while wearing an American football uniform. Nine male and female subjects wore a superficial cooling garment while in a cooling (CS) experimental condition or a no cooling (NCS) control condition during an exercise task consisting of warm-up (WU), exercise (EX), and recovery (R). The exercise task simulated an American football conditioning session with subjects wearing a full American football uniform and performing anaerobic and aerobic exercises in a hot humid environment. Subjects were allowed to drink water ad libitum during rest breaks. During the WU, EX, and R periods, core body temperature (T(c)) was measured to assess the effect of the cooling garment. Neither baseline resting before warm-up T(c) nor after warm-up T(c) was significantly different between trials. No significant differences in exercise T(c) between conditions were found. Time to return to baseline T(c) revealed no significant differences between the experimental and control conditions. The authors found that the volume of fluid consumed was 34% less in the experimental condition (711.1 ± 188.0 ml) compared with the control condition (1,077.8 ± 204.8 ml). The findings indicate that the cooling garment was not effective in blunting the rise in T(c) during warm-up, attenuating a rise in T(c) during intermittent exercise, or in increasing a return to baseline T(c) during a resting recovery period in a hot humid environment while wearing an American football uniform.
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Affiliation(s)
- Rebecca M Lopez
- Department of Orthopedics & Sports Medicine, University of South Florida, Tampa, Florida, USA.
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Casa DJ, Anderson SA, Baker L, Bennett S, Bergeron MF, Connolly D, Courson R, Drezner JA, Eichner ER, Epley B, Fleck S, Franks R, Guskiewicz KM, Harmon KG, Hoffman J, Holschen JC, Jost J, Kinniburgh A, Klossner D, Lopez RM, Martin G, McDermott BP, Mihalik JP, Myslinski T, Pagnotta K, Poddar S, Rodgers G, Russell A, Sales L, Sandler D, Stearns RL, Stiggins C, Thompson C. The inter-association task force for preventing sudden death in collegiate conditioning sessions: best practices recommendations. J Athl Train 2013; 47:477-80. [PMID: 22889664 DOI: 10.4085/1062-6050-47.4.08] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Storrs, CT 06269-1110, USA.
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Lopez RM, Casa DJ, Jensen KA, DeMartini JK, Pagnotta KD, Ruiz RC, Roti MW, Stearns RL, Armstrong LE, Maresh CM. Examining the Influence of Hydration Status on Physiological Responses and Running Speed During Trail Running in the Heat With Controlled Exercise Intensity. J Strength Cond Res 2011; 25:2944-54. [DOI: 10.1519/jsc.0b013e318231a6c8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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DeMartini JK, Martschinske JL, Casa DJ, Lopez RM, Ganio MS, Walz SM, Coris EE. Physical Demands of National Collegiate Athletic Association Division I Football Players During Preseason Training in the Heat. J Strength Cond Res 2011; 25:2935-43. [DOI: 10.1519/jsc.0b013e318231a643] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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DeMartini JK, Ranalli GF, Casa DJ, Lopez RM, Ganio MS, Stearns RL, McDermott BP, Armstrong LE, Maresh CM. Comparison of Body Cooling Methods on Physiological and Perceptual Measures of Mildly Hyperthermic Athletes. J Strength Cond Res 2011; 25:2065-74. [DOI: 10.1519/jsc.0b013e3182259b1d] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lopez RM, Casa DJ, McDermott BP, Stearns RL, Armstrong LE, Maresh CM. Exertional Heat Stroke in the Athletic Setting: A Review of the Literature. ACTA ACUST UNITED AC 2011. [DOI: 10.3928/19425864-20101230-06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stearns RL, Casa DJ, O'Connor FG, Lopez RM. Heat Illness - Two Marathon Runners (A Comparative Case Study). Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000400601.57793.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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DeMartini JK, Martschinske JL, Casa DJ, Jay O, Lopez RM, McDermott BP, Minton DM, Pagnotta KD, Stearns RL, Walz SM, Coris EE. Examining Work Output in NCAA Division I Football Players During Pre-season Training in the Heat. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402473.94396.a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ganio MS, Johnson EC, Lopez RM, Stearns RL, Emmanuel H, Anderson JM, Casa DJ, Maresh CM, Volek JS, Armstrong LE. Caffeine lowers muscle pain during exercise in hot but not cool environments. Physiol Behav 2011; 102:429-35. [DOI: 10.1016/j.physbeh.2010.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 11/10/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
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Armstrong LE, Johnson EC, Casa DJ, Ganio MS, McDermott BP, Yamamoto LM, Lopez RM, Emmanuel H. The American football uniform: uncompensable heat stress and hyperthermic exhaustion. J Athl Train 2010; 45:117-27. [PMID: 20210615 DOI: 10.4085/1062-6050-45.2.117] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT In hot environments, the American football uniform predisposes athletes to exertional heat exhaustion or exercise-induced hyperthermia at the threshold for heat stroke (rectal temperature [T(re)] > 39 degrees C). OBJECTIVE To evaluate the differential effects of 2 American football uniform configurations on exercise, thermal, cardiovascular, hematologic, and perceptual responses in a hot, humid environment. DESIGN Randomized controlled trial. SETTING Human Performance Laboratory. PATIENTS OR OTHER PARTICIPANTS Ten men with more than 3 years of competitive experience as football linemen (age = 23.8 +/- 4.3 years, height = 183.9 +/- 6.3 cm, mass = 117.41 +/- 12.59 kg, body fat = 30.1% +/- 5.5%). INTERVENTION(S) Participants completed 3 controlled exercise protocols consisting of repetitive box lifting (lifting, carrying, and depositing a 20.4-kg box at a rate of 10 lifts per minute for 10 minutes), seated recovery (10 minutes), and up to 60 minutes of treadmill walking. They wore one of the following: a partial uniform (PART) that included the National Football League (NFL) uniform without a helmet and shoulder pads; a full uniform (FULL) that included the full NFL uniform; or control clothing (CON) that included socks, sneakers, and shorts. Exercise, meals, and hydration status were controlled. MAIN OUTCOME MEASURE(S) We assessed sweat rate, T(re), heart rate, blood pressure, treadmill exercise time, perceptual measurements, plasma volume, plasma lactate, plasma glucose, plasma osmolality, body mass, and fat mass. RESULTS During 19 of 30 experiments, participants halted exercise as a result of volitional exhaustion. Mean sweat rate, T(re), heart rate, and treadmill exercise time during the CON condition were different from those measures during the PART (P range, .04-.001; d range, 0.42-0.92) and FULL (P range, .04-.003; d range, 1.04-1.17) conditions; no differences were detected for perceptual measurements, plasma volume, plasma lactate, plasma glucose, or plasma osmolality. Exhaustion occurred during the FULL and PART conditions at the same T(re) (39.2 degrees C). Systolic and diastolic blood pressures (n = 9) indicated that hypotension developed throughout exercise (all treatments). Compared with the PART condition, the FULL condition resulted in a faster rate of T(re) increase (P < .001, d = 0.79), decreased treadmill exercise time (P = .005, d = 0.48), and fewer completed exercise bouts. Interestingly, T(re) increase was correlated with lean body mass during the FULL condition (R(2) = 0.71, P = .005), and treadmill exercise time was correlated with total fat mass during the CON (R(2) = 0.90, P < .001) and PART (R(2) = 0.69, P = .005) conditions. CONCLUSIONS The FULL and PART conditions resulted in greater physiologic strain than the CON condition. These findings indicated that critical internal temperature and hypotension were concurrent with exhaustion during uncompensable (FULL) or nearly uncompensable (PART) heat stress and that anthropomorphic characteristics influenced heat storage and exercise time to exhaustion.
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Affiliation(s)
- Lawrence E Armstrong
- Department of Kinesiology, University of Connecticut, Storrs, Mr Johnson is now at the Naval Health Research Center, San Diego, CA, USA.
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