Recommended Exercises for Exertional Heat Stroke: Return to Play Protocol

Exertional heat stroke is a severe condition that requires careful management and a structured return-to-play protocol to ensure athlete safety. Athletic trainers must be knowledgeable in gradual progression protocols that support a safe and efficient exertional heat stroke RTP. Understanding exercise options is crucial not only for safeguarding athletes’ health and safety but also for optimizing their recovery and performance.

Athletic trainers play a crucial role in monitoring and guiding athletes through their recovery journey, so it’s essential to incorporate appropriate exercises at each stage of the RTP protocol. In this article, we’ll discuss five fundamental exercises that can be integrated into EHS recovery, exploring their role at various stages of exertional heat stroke RTP and highlighting key considerations for their implementation.

Cycle or Elliptical in Air Conditioning

Using a stationary bike or elliptical machine in an air-conditioned environment is an appropriate option to begin engaging the athlete in cardiovascular exercise without the additional stress of external heat. This setup provides thermoneutral conditions, essential for the safe and gradual rebuilding of athletes recovering from exertional heat stroke.

• Early Stages: This exercise is ideal during the initial phases of RTP, when athletes begin to reintroduce physical activity. The thermoneutral environment prevents heat-related issues, and the low-impact nature helps reduce physical stress, allowing athletes to build their endurance and cardiovascular strength safely.
• Transition Phases: As athletes progress in their recovery, they may need more challenging and sport-specific activities. While the stationary bike or elliptical is less intense, it’s a valuable tool for maintaining cardiovascular conditioning without the risk of overheating.
• Avoiding Overuse: Athletes may want to rotate between the two options to avoid boredom. The inclusion of rowing could be a third option to consider in this beginning stage. 

Key Considerations

As an athletic trainer, it’s crucial to consider specific factors when incorporating this exercise into an athlete’s RTP protocol. Here are some key things to keep in mind to ensure a safe and effective recovery process:

• Monitor heart rate and signs of overheating closely. Regular monitoring helps prevent overexertion and ensures the athlete remains within a safe physiological range.
• Ensure the athlete is well-hydrated and takes regular breaks. Proper hydration is crucial to avoid dehydration and related complications.
• Adjust intensity based on the athlete’s response. Tailor the exercise intensity to the athlete’s comfort and recovery progress to prevent any adverse effects.

Treadmill Walk/Jog in Thermoneutral Indoor Environment

Walking or jogging on a treadmill in a temperature-controlled indoor environment is recommended for gradually increasing activity intensity from low to moderate. This setup helps athletes reintroduce cardiovascular conditioning while minimizing rises in core body temperature.

• Transitional Phases: This exercise is particularly beneficial during the transitional phase of RTP, when athletes are ready to progress from low-impact activities but may not yet be prepared for high-intensity training. The controlled indoor environment ensures the athlete remains in a safe temperature range while reintroducing moderate-level exercise intensity that involves weight-bearing.
• Exercise Variation: The athlete can still alternate with low-impact exercises, such as using an elliptical machine to provide variety to the workout. It is also important to ensure that athletes are well-hydrated before starting, as exercising indoors can still lead to dehydration.

Key Considerations

When integrating this exercise into an athlete’s RTP protocol, it’s essential to consider the following key points to maximize the benefits and safety of treadmill exercises:

• Begin with lower intensity and gradually increase as tolerated. This progressive approach helps avoid overexertion.
• Use incline adjustments to vary intensity levels. This allows for controlled increases in workload without excessive speed.
• Write out a plan for the interval ahead of time. This gives the athlete a visual plan to follow, helps them understand progression, and provides goals for them to achieve.

Mild Intensity Boot Camp with Aerobic Components in Outdoor Warm Environment

A mild-intensity boot camp with aerobic components in an outdoor warm environment can be an excellent way to rebuild cardiovascular endurance and overall fitness. This type of program is suitable for athletes who have successfully managed indoor activities and are ready to handle mild aerobic exercises outdoors.

• Transition to Outdoors: This program is appropriate for athletes transitioning from controlled indoor environments to outdoor activities. It’s beneficial for building stamina and cardiovascular endurance while acclimating the athlete to warmer conditions.
• Avoid Extreme Conditions: You should avoid recommending this program in excessively hot or humid conditions to prevent the risk of recurrent heat stroke. It might also be too intense for the initial RTP stages, where controlled environments are preferred.

Key Considerations

As you incorporate this program into an athlete’s RTP, consider these crucial factors to ensure a safe and effective recovery:

• Provide adequate access to hydration before, during, and after exercise. Adequate hydration is important to prevent heat-related issues.
• Monitor for heat-related symptoms and adjust intensity as needed. Being vigilant helps in early detection and prevention of complications.
• Schedule sessions during cooler times of the day. Early mornings or late afternoons are preferable to avoid peak heat.
• Monitor heart rate. The goal is to achieve moderate intensity throughout the boot camp activities by incorporating a variety of strength and aerobic stations, alternated with breaks. Reaching this intensity level in an outdoor environment is crucial for initiating the body’s heat acclimatization process.

Sport-Specific Drills in Outdoor Warm Environment – Mild to Moderate Intensity

Mild to moderate intensity sport-specific drills in a warm outdoor environment are beneficial for athletes approaching the end of their RTP protocol. These drills help athletes regain sport-specific skills and coordination, making them an essential component of the advanced RTP phases.

• Advanced Phases: These drills are suitable for athletes who have successfully managed less intense activities and are ready to start reacquiring specific sports skills in a warm environment. They help bridge the gap between general conditioning and readiness for an entire game.
• Adjusting for Recovery: If athletes show signs of poor recovery from previous stages, it may be necessary to revert to lower intensity or indoor activities. Additionally, being cautious or delaying outdoor activities may be warranted if there are high temperatures or humidity levels.

Key Considerations

For successful and safe implementation of these sport-specific drills in an athlete’s RTP program, consider the following factors:

• Tailor drills to the athlete’s sport and position. Specificity helps in returning to previous skill level. 
• Include frequent rest periods and hydration breaks. This prevents fatigue and heat stress.
• Monitor environmental conditions and adjust intensity accordingly. Adapt the drills based on weather conditions. To complete this workout, prioritize the early morning or evening when conditions are coolest.
• Ensure adequate heat acclimatization. Ideally, this stage and the previous stage should add up to approximately 7 days of heat exposure. This approach will help encourage the body to continue building heat adaptations.

Sport-Specific Drills in Outdoor Warm Environment – Moderate to High Intensity

Moderate to high-intensity sport-specific drills are suitable for athletes ready to fully return to their sport. These drills prepare athletes for the physical and mental demands of competition and are appropriate for the final RTP phases.

• Final Stages: These drills are ideal for athletes who have completed all previous RTP stages and are ready for full-intensity training, such as sprinting, agility drills, and sport-specific conditioning. They help ensure the athlete is fully prepared for competitive play, improving both physical and mental readiness.
• Avoiding Risks: Athletes experiencing lingering symptoms of heat intolerance or other health issues should avoid engaging in high-intensity outdoor activities and/or return to earlier stages.

Key Considerations

For successful and safe implementation of these sport-specific drills in an athlete’s RTP program, consider the following:

• Gradually increase drill intensity and complexity. A gradual increase in work-to-rest ratios helps in better adaptation and reduces injury risk.
• Ensure proper acclimatization to the outdoor environment. For optimal heat acclimatization benefits and to prevent heat-related complications, the focus should be on achieving at least 10 days of heat exposure.
• Monitor for any signs of heat stress or exhaustion. Early detection of heat stress symptoms is crucial for athlete safety.

Ensuring a Safe Return to Play: Key Takeaways for Athletic Trainers

To help athletes make a successful comeback, athletic trainers must gradually introduce appropriate exercises at each stage of recovery, starting with low-intensity, controlled exercises and gradually progressing to more intense, sport-specific activities. Continuous assessment of the athlete’s response, monitoring environmental conditions, and ensuring proper hydration and nutrition are essential to prevent unneeded rises in core body temperature, fatigue, and other adverse reactions.

Each athlete is unique, so tailoring the return-to-play protocol to their specific needs based on their sport, position, and overall health is vital. Keeping open lines of communication with athletes, coaches, the strength and conditioning team, and the rest of the medical staff about the importance of each stage of the RTP process and the risks of rushing it helps maintain a cohesive and supportive recovery environment. By closely examining any signs of heat-related complications and prioritizing the athlete’s health, you can play a vital role in ensuring a safe and efficient recovery from exertional heat stroke.