Moving gradually into summertime practice may help prevent heat-related illness and deaths among young football players, according to new recommendations laid out by an expert panel.

The panel, convened by the American College of Sports Medicine, is advising high school and youth league coaches to start the preseason slow - with less-intense practice and helmets alone, rather than full gear - in order to prevent heat exhaustion and potentially deadly cases of heat Stroke.

Keeping kids properly hydrated, with water or sports drinks, is also “integral,” said Dr. Michael F. Bergeron, co-chairman of the panel and an assistant professor of physical therapy at the Medical College of Georgia in Augusta.

However, he said, that the “overriding, driving” factors in young football players’ heat illnesses are the intensity of the workout, players’ attire and the heat and humidity of the day.

Between 1995 and 2001, 21 young football players reportedly died of heat stroke in the U.S., and many more suffer less-severe consequences of heat and dehydration - including episodes of “exertional collapse” that can land them in the hospital, Bergeron noted.

The panel, he said, drew on recent research to make its recommendations on preventing such injuries. Some of that research, by Bergeron and others, has found that young players often come to their first day of practice dehydrated, and the problem only gets worse over the following days, increasing their risk of overheating.

Also, young players frequently show up to the preseason out of shape, and they need time to get acclimated to exercising under late-summer conditions, according to the panel.

Indeed, most heat-stroke deaths among high school and college football players happen in the first four days of the preseason, Bergeron and his colleagues note in their report, published in the August issue of the journal Medicine & Science in Sports & Exercise.

Among its recommendations for high school teams, the panel advises coaches to avoid twice-daily workouts for the first week of the preseason. Total practice time for the first week - including warm-ups, breaks and cool-downs - should not exceed 3 hours a day.

In addition, the panel suggests that helmets be the only protective gear players wear for the first couple days of practice, with other equipment being introduced gradually. Training, Bergeron noted, would be designed so that unprotected players wouldn’t risk injury.

Players in youth football leagues should have an even more gradual build-up in their activities, according to the panel, since prepubescent children need a longer time to adapt to hot and humid conditions.

When heat and humidity are particularly high, the panel advises, football practice should be moved into an air-conditioned space, conducted outdoors only as a “walk-through” session or canceled altogether.

The panel advises coaches to allow frequent breaks during practice - at least every 30 to 45 minutes - for players to rest and replace their lost fluids with water or sports drinks.

Coaches should also discourage players from using stimulants, like the high-dose caffeine found in some supplements and “energy” drinks, since they promote fluid loss.

SOURCE: Medicine & Science in Sports & Exercise, August 2005.