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NEW YORK (Reuters Health) - The National Athletic Trainers' Association (NATA) issued pre-season heat-acclimatization guidelines for secondary school athletes, at a press conference in San Antonio on Thursday.

"Progressive acclimatization is especially important during the initial 3 to 5 days of summer practices," the guideline authors wrote in a statement presented at the NATA annual meeting in San Antonio. The statement is also published in the Journal of Athletic Training.

"When an athlete undergoes a proper heat-acclimatization program, physiologic function, exercise heat tolerance, and exercise performance are all enhanced. In contrast, athletes who are not exposed to a proper heat-acclimatization program face measurable increased risk for exertional heat illness," the statement reads.

The heat-acclimatization guidelines "should be used for all pre-season conditioning, training, and practice activities in a warm or hot environment, whether these activities are conducted indoors or outdoors."

The guidelines define the heat-acclimatization period as the first 14 consecutive days of pre-season practice.

Days 1 through 5 of the heat-acclimatization period consist of the first 5 days of formal practice. During this time, athletes should not have more than one practice per day and total practice time should not exceed 3 hours in any 1 day, according to the guidelines.

During the first 5 days of the heat-acclimatization period, the guidelines allow for a maximum 1-hour "walk-through" -- defined as a teaching opportunity without any protective gear or sports-related equipment -- but a 3-hour recovery period should be inserted between the practice and walk-through (or vice versa).

During days 1 and 2 of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted; goalies should not wear full protective gear or perform activities that would require full gear. During days 3 through 5, shoulder pads can be added and on day 6, all protective equipment may be worn and full contact may begin.

Beginning no earlier than day 6 and continuing through day 14, a single-practice day must follow all double-practice days. On single-practice days, one walk-through is permitted, separated from practice by at least 3 hours of continuous rest. When a double-practice day is followed by a rest day, another double-practice day is permitted after the rest day.

On double-practice days, the guidelines state each practice should not exceed 3 hours and student-athletes should not participate in more than a total of 5 total hours of practice. Warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are included as part of the practice time. The two practices should also be separated by at least 3 continuous hours in a cool environment.

Because the risk of exertional heat illness during the pre-season heat-acclimatization period is high, the guidelines "strongly recommend" that an athletic trainer be on site before, during and after all practices.

In an interview with Reuters Health, Dr. Douglas J. Casa, Director of Athletic Training Education at the University of Connecticut, Storrs, and co-chair of the guideline task force, emphasized that these are the "minimum standards that we would want states to adopt and that we feel would protect athletes."

"There is no national-level governing body for high school sports that has created any kind of standards like this," Dr. Casa added. "Some states have some good standards and some states have some mediocre ones and some have no standards."

For example, "there are states where high school athletes could have three all-out practices for 2 hours a day in full gear on the first day, while others have a much more common-sense phase-in of the intensity of exercise and the amount of equipment you wear."

SOURCE: Journal of Athletic Training, June 2009.

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