The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations

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In January 2012, the National Athletic Trainers' Association, along with the National Strength and Conditioning Association, convened a meeting in Colorado Springs, Colorado. Its purpose was to hold an interdisciplinary forum and gather input to address sudden death in collegiate conditioning sessions. Based on these discussions, a writing group drafted the following recommendations. To date, these best practices have been endorsed by the American College of Emergency Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, Canadian Athletic Therapists' Association, Collegiate Strength and Conditioning Coaches association, Gatorade Sports Science Institute, Korey Stringer Institute, National Academy of Sports Medicine, National Athletic Trainers' Association, and National Strength and Conditioning Association. Other reviewers and meeting participants are listed with the professional organizations they represent at the end of this article.Maximizing strength and conditioning sessions has become fundamental to sport. The right combination of strength, speed, cardiorespiratory fitness, and other components of athletic capacity can complement skill and enhance performance for all athletes. A sound and effective training program that relies on scientific principles of exercise physiology and biomechanics intended to produce outcomes that are sensitive and specific to the sport should be the goals. Unfortunately, the athlete's development, health, and safety are sometimes overshadowed by a culture that values making athletes tough, instilling discipline, and focusing on success at all costs.This ill-conceived philosophy has been a contributor to the alarming increase in collegiate athlete deaths and serious injuries during conditioning sessions. A total of 21 National Collegiate Athletic Association (NCAA) football players have died during conditioning workouts since 2000.1 The 3 most common causes of the fatalities were (in order) exercise-related sudden death associated with sickle cell trait (SCT), exertional heat stroke, and cardiac conditions.1 Seventy-five percent of the fatalities (n = 16) were Division I football players.Also, the incidence of exertional rhabdomyolysis in collegiate athletes appears to be increasing. Excesses in strength training and conditioning—workouts that are too novel, too much, too soon, or too intense (or a combination of these)—have a strong connection to exertional rhabdomyolysis. Introducing full-intensity workouts too quickly is especially high risk: 11 of the 21 deaths occurred during day 1 or day 2 workouts.Rule changes enacted in 2003 related to heat acclimatization procedures during August football practices have been extremely effective. In the NCAA Division I Football Bowl Subdivision, no player died from practicing or playing in a game between 2000 and 2011. However, conditioning workouts continue to be a catalyst for catastrophic outcomes. It is imperative that similar guidelines be implemented to improve the safety of conditioning sessions. This consensus statement provides specific conditioning recommendations with the intent of ending conditioning-related morbidity and deaths of collegiate athletes.Conditioning periods should be phased in gradually and progressively to encourage proper exercise acclimatization and to minimize the risk of adverse effects on health. The first 7 to 10 days (at minimum, the first 4 separate-day workouts) of any new conditioning cycle (including but not limited to return in January, after spring break, return in summer, and return after an injury) are referred to as transitional periods. A written, progressive program of increasing volume, intensity, mode, and duration should be instituted for all transitional periods. These conditioning programs should be approved by a credentialed strength and conditioning coach ([S&CC] see following paragraphs). The S&CC should work cooperatively with medical staff (certified athletic trainer, team physician, or both) when developing transitional workout plans, particularly if the athlete is recovering from an injury or if any uncertainty exists regarding the pace of exercise progression.Transitional periods should invoke an appropriate work-to-rest ratio for the sport. A 1:4 work-to-rest ratio (with greater rest permissible) when conducting serial activity of an intense nature, for example, is a good starting place to emphasize recovery.A qualified S&CC is knowledgeable about and uses acclimatization principles. Participation in summer workouts on campus under the supervision of an S&CC is preferable to unsupervised workouts elsewhere or workouts conducted by unqualified individuals.Training programs should be individualized. Some athletes will require a longer acclimatization process. An athlete at a different level of preparedness from his or her teammates (due to injury or time away from training) should use a training program tailored to his or her level.Any new exercise introduced into a strength and conditioning program should be added in a deliberate, gradual fashion by a qualified S&CC. This guideline is true for any aspect of the regimen but is particularly important during the early stages of a conditioning program.Physical activity should not be used as retribution, for coercion, or as discipline for unsatisfactory athletic or academic performance or unacceptable behavior. No additional physical burden that would increase the risk of injury or sudden death should be placed on the athlete under any circumstance.All S&CCs are required to obtain an undergraduate degree to sit for the examination and become credentialed. It is recommended that the degree be in exercise science or a related field of study.The strength and conditioning profession is urged to establish an accredited educational curriculum at the collegiate level for entry-level programs. A suitable amount of coursework should be dedicated to the health and safety concerns of and challenges facing athletes, with a focus on preventing sudden death. This includes the prevention, recognition, and management of on-field emergencies. Continuing education requirements should ensure that certified S&CCs engage in educational opportunities that provide applicable, up-to-date information regarding important health and safety topics, emergency procedures, and preventing sudden death. Content should be reviewed annually, so that timely topics can be incorporated.Collegiate S&CCs should have adequate mentoring and experience to independently design and implement individual and team conditioning programs.All S&CCs should be required to pass a certification examination credentialed by an independent accreditation agency. Competency standards, ongoing assessment, and continuing education requirements should be clearly documented.All S&CCs should maintain certification in first aid, cardiopulmonary resuscitation (CPR), and use of an automated external defibrillator (AED).An S&CC should be present during all strength and conditioning sessions and be prepared to provide first aid as soon as an athlete shows signs of distress. The S&CC should be able to administer CPR, apply an AED, and activate the emergency action plan (EAP) if needed. An athletic trainer or team physician should be present during each high-risk collegiate conditioning session (eg, sprinting, timed sessions, mat drills, stations). For lower-risk conditioning sessions and the strength portion of a conditioning program, an S&CC should be present and an athletic trainer should be on campus and accessible to assist if a problem arises. The institution should determine the need for and level of medical coverage for conditioning sessions. Among the factors to be considered are squad size, type of athlete, time of year (eg, immediately postseason, off season, in season, summer), expected environmental conditions, and planned duration and inten

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