Athletes who live in warm climates often have to deal with environmental concerns in their training and competition. In warm weather areas and seasons, heat illness is unfortunately a cause for concern. It is a spectrum of disorders that can range from mild forms (heat edema, rash, or cramps), progressing to more serious disease (heat exhaustion), and ending with the life-threatening heat stroke. Fortunately heat illness is completely preventable. Recognizing the signs and symptoms and initiating treatment for heat illness is essential, but it is even more important to understand its risk factors and implement strategies to prevent the problem in the first place. Tips for safe exercise in heat. 

Forms of heat illness

Heat edema is a mild form of heat illness that is noted by swelling of the body, usually the lower extremities. It usually occurs in individuals who have not adjusted to a warmer climate. Most often it is older individuals who move to a warmer location. Heat rash usually appears as a pinpoint rash that often itches significantly. It is most often seen in areas that are covered with clothing, such as the trunk or groin. Heat cramps occur when the athlete sweats heavily. The loss of fluids and electrolytes, especially sodium, causes painful muscle contractions and spasms. Heat exhaustion is a more serious form of heat illness characterized by profuse sweating, dizziness, headaches, nausea, vomiting, and fainting. Heat stroke occurs when heat exhaustion goes untreated, and the athlete starts to exhibit mental status changes, such as confusion, loss of balance, and irritability. Immediate recognition and treatment are crucial to prevent possibly fatal outcomes.

Risk factors for heat stroke

There are many factors that increase the risk of heat illness in athletes, even healthy ones. Dehydration, either from lack of sufficient fluid intake or excessive fluid loss through sweating, is a critical factor. Certain populations, including the elderly and children, are thought to be at higher risk. Some medical conditions, such as obesity, recent fever, and sickle cell trait, can predispose individuals to heat illness. Numerous medications, including antihistamines, antidepressants, antipsychotics, stimulants, diuretics, and blood pressure medicines can increase the risk of heat illness. Environmental factors, including temperature, level of humidity, and type of clothing, are important as well.

Treatment for heat stroke

All forms of treatment for the various types of heat illness focus on reducing core body temperature. In milder forms, such as exertional heat illness, taking an athlete off the field and sitting him or her on the bench might be sufficient. Going to a shaded area or inside an air-conditioned building is ideal if possible. Rest, elevation, and use of compressive stockings can reduce swelling from heat edema. If a heat rash is present, removing some of the clothing covering the area and using an anti-inflammatory cream is appropriate. If the athlete feels faint, lying on his or her back with the legs elevated can help return blood to the brain and resolve the condition. Rest, gentle stretching and massage of the muscles, and cooling with ice can relieve heat cramps. In all of these milder types of heat illness, replacement of fluids and electrolytes orally is critical. If the symptoms are severe, IV fluids might be indicated.

Soccer players resting to prevent heat stroke

More severe forms of heat illness require more aggressive treatments. If the athlete has symptoms of heat exhaustion, such as nausea, vomiting, or dizziness, his or her temperature needs to be checked. Cold sports drinks might be enough to reduce body temperature. If the temperature continues to remain elevated or the symptoms are severe, ice bags in the armpits and groin can help. Heat stroke requires rapid and emergent treatment. Ice baths or spraying cold water on the body and using fans to help evaporate the heat are critical, but transportation to an emergency facility is crucial.

Also read:
Exertional heat stroke – Treatment

Prevention of heat stroke

Recognizing the signs and symptoms of heat illness is necessary for adequate treatment, but understanding the risk factors is vital to prevent a problem in the first place. Adequate hydration is essential. Fluids, especially those with electrolytes such as sports drinks, should be readily available. Supplements with stimulants to enhance performance should be strongly discouraged. Athletes must adjust to warmer climates gradually and maintain appropriate fitness levels for their sports. Maintenance of healthy body weight should be emphasized. Athletes with medical conditions such as a recent illness with a fever should be closely watched if allowed to play at all. Wearing light-colored clothes that are loose fitting and allow sweat to evaporate heat is beneficial. Taking frequent breaks and resting in cool locations should be encouraged. Restricting practice and competition when the temperature and humidity make the risk of heat illness significant is critical. Efforts to prevent heat illness in all athletes not only decrease risk of injury and illness but also can enhance performance.

Boy drinking water to prevent heat stroke

Also read:
Exertional heat stroke – Prevention