A good starting point for developing a safety plan in the weeks leading up to the exercise sessions is the average wet bulb globe temperature (WBGT) for the area. WBGT levels below that average tend to be safe for acclimatization and training. As the WBGT rises, the athletes will require more rest and longer rest breaks to maintain a safe body temperature. As the players acclimatize over the first week of practice, their heat stroke risk is reduced, but not gone. Monitoring the WBGT and modifying the work load is the best safety strategy for your athletes.
As the WBGT rises above the regional or area average, the heat load increases and players are at greater risk. There is a growing effort within the National Weather Service to replace the Heat Index with WBGT and to establish regional WBGT cascades for physical activity modification for heat safety. Two projects under construction can be accessed at http://hennepinwestmesonet.org/#/heatstress and http://www.weather.gov/tsa/wbgt. I hope you find them helpful.
This issue covers Nutrition & Ergogenic Aids and Exercise is Medicine® topics with a little something for every reader. For starters check out the two important invited commentaries entitled, "Exercise in the Treatment of Chronic Disease: An Underfilled Prescription," by Robert E. Sallis, MD, FACSM, 51st President of ACSM (2007-2008), and "The Youth Sports Machine: Destructive Juggernaut or Vehicle for Success?" by Peter K. Kriz, MD, FACSM and James P. MacDonald, MD, MPH, FACSM. The FIMS contribution to this issues provides an international perspective titled, "A Holistic Antidoping Approach for a Fairer Future for Sport."
The Nutrition & Ergogenic Aids section under the direction of Section Editor Thomas H. Trojian, MD, FACSM, features informative articles about recent developments in the use of tart cherry juice in athletes, nutritional supplements for concussions, and practical evidence-based advice for fueling the triathlete. This section also addresses the topic of body mass index as a predictor of injuries in athletics.
Dr. Sallis has coordinated a wide-ranging segment of Exercise is Medicine® focused on using exercise to help specific populations. You won't want to miss these important topics: exercise in the prevention and treatment of breast cancer, prescribing exercise to individuals with disabilities, and the practice of sport in multiple sclerosis. As more people with disabilities hear the message of Exercise is Medicine, it is critical that we react to the need and understand the concerns of exercise prescription in these populations. Drs. Osoria and Blauwet tackle the topic in their article, "Prescribing Exercise to Individuals with Disabilities: What are the Concerns?" We hope it will help you address exercise in your patients with disabilities.
This issue also contains two fascinating special communications. The first is entitled, "Triathlon Medical Coverage: A Guide for Medical Directors," which discusses the importance of maximizing safety with a preplanned, rehearsed, and well-communicated race medical plan. This is especially important with the increased interest and participation in triathlon over the past 20 years. The second, "Special Communication of a Case of Hypovolemic-Associated EAH: Lessons Learned During Recovery," looks at a case of exercise-associated hyponatremia (EAH) with encephalopathy involving an experienced male cyclist with no recollection of the event. You won't want to miss this interesting case.
Pearls & Pitfalls looks at spleens and genes. Scanning Sports Medicine covers the latest clinical research published by ACSM, and Web Alerts reviews several interesting Web sites. CAQ Review looks at dermatology issues in sports and Clinical Procedures discusses cuboid syndrome, an often overlooked cause of foot pain that you can "cure" with a simple office technique.
I hope you find this issue of CSMR helpful for your daily practice, and you have a great summer.
William O. Roberts, MD, MS, FACSM