Athletes w/ Special Considerations

Special considerations explored in this section will include:

• Individuals with sickle cell trait
• Individuals with religious considerations
• The recognition of heat illness and the role of hydration
• Recommendations on how to measure hydration status
  • Recommendations on measuring hydration in athletes with eating disorders

Individuals with Sickle Cell Trait

Sickle cell trait (SCT) is typically considered a benign condition, meaning it typically causes the individual no harm, most commonly seen in individuals of African descent¹. However, in athletes with SCT can be at risk for a sudden death episode related to their condition. The cause of this is often accredited to the heat and dehydration experienced by the body during exercise¹. This is why hydration is so important in preventing a medical emergency in athletes with SCT.

Athletes with SCT should follow a hydration protocol that ensures they are hydrating before, during, and after exercise in order to help prevent the risk of experiencing a medical emergency.

Such protocols should include the following²:

• consume at least 17-20 fl oz 2 to 3 hours pre-exercise and then another 7-10 fl oz 10-20 minutes pre-exercise
• Generally, you should consume at least 7-10 fl oz every 10-20 minutes during exercise to ensure proper replacement of fluids. Consider consuming more if you are prone to high rates of sweating with exercise
• After exercise, aim to have completely replaced any lost fluid within 2 hours of completing activity.

Individuals with Religious Considerations³

Individuals that practice religions such as Islam observe a month of fasting known as Ramadan. Other religions such as Judaism, Christianity, Buddhism, and Hinduism also fast as part of their religious practices. It is important for athletes who are participating in religious fasts to ensure that they are properly hydrated to maximize performance and to prevent the adverse effects of dehydration on the body.

In individuals that are fasting, it is crucial that they maximize their fluid intake when possible throughout the fasting period to ensure full hydration.

It is important to consider how the practice of fasting may impact the methods used to assess hydration. A common practice of assessing hydration and water loss is to measure body mass before and after exercise. During a fast, individuals may see a decrease in fat stores in the body which may impact the effectiveness of using this method³. Utilizing urine-specific gravity to assess hydration may also be impacted by the athlete’s fast due to the timing of their fast. The limitations on the food and fluid intake can impact the effectiveness of this method of assessing hydration³.

Heat Illness and the Role of Hydration

Heat illness is a major concern for active individuals and athletes. These conditions include⁴:

• Exercise-associated muscle cramps (EAMCs)
  • These are sudden and involuntary, painful contractions of the muscle during or after exercise.
  • Signs and symptoms include:
    • tics, twinges, stiffness, tremors, or contractures of the muscle
• Heat Syncope
  • This is orthostatic dizziness that is most commonly seen in athletes who are unfit or not heat-acclimatized
• Heat Exhaustion
  • This is a condition that is manifested by an elevated core body temperature, heavy sweating, and dehydration
  • This is typically seen in athletes who have not been heat-acclimatized or are dehydrated
• Exertional Heat Injury
  • This is a moderate to severe heat illness that is characterized by organ and tissue damage that is due to a sustained high body temperature
• Exertional Heat Stroke (EHS)
  • This is the most severe form of heat illness
  • It is characterized by a core body temperature of 105 degrees Fahrenheit or higher
  • It presents with central nervous system dysfunction (collapse, aggressiveness, irritability, confusion, seizures, and altered consciousness)
  • This condition is a medical emergency and can lead to sudden death if not recognized and treated efficiently

Now that heat illness has been defined, it is crucial that the role of proper hydration in preventing these conditions is understood. Dehydration is a major risk factor for many heat illnesses and rehydration is one of the treatments for them as well. It is attributed to excessive sweating and inadequate fluid intake. It is proved that proper hydration can reduce exercise heart rate, fatigue, and core body temperature⁴. It only takes dehydration of 2% of body weight for the body’s thermoregulation systems to be negatively impacted⁴. The National Athletic Trainers’ Association (NATA) recommends that proper hydration and fluid replacement is one of the key components to preventing heat illnesses from occurring⁴. It suggests you follow the recommendations outlined by the NATA’s position statement on fluid replacement.

Recommendations on Assessing Hydration Status

Hydration status can be assessed in many different ways. The NATA states that the preferred method of assessing hydration status in the field is to measure body-weight change before, during, and after activity over a period of time⁴. While this method is the quickest and least invasive, it is important to consider the use of this method in teams that contain athletes suffering from eating disorders as the individuals may be suffering from weight fixation. The use of this method could be detrimental to the mental health of the athletes and other methods should be considered for the entire team to prevent singling any single athlete out.

Some methods include measuring the components of the blood with the sample being collected by venepuncture or a simple finger prick using a lancet⁵. These methods are typically more invasive and expensive, so they are less popular for assessing hydration in the field and are more commonly used in clinical settings⁵. Tests that assess hydration using blood include hematocrit measurements, plasma/serum osmolality tests, and serum sodium tests⁵.

Another body fluid that is used to assess hydration is urine. Urine is composed of water and other substances, and these substances increase in concentration when the amount of water is decreased in the urine⁵. Common tests include urine-specific gravity (USG), urine volume, and urine color. The target measurement for USG is 1.000 and a measurement of 1.020 is considered hypohydrated or dehydrated⁵. Assessing urine color is subjective and utilizes a Likert scale⁵. It operates on the fact that a hydrated individual’s urine will be pale yellow or clear while a dehydrated individual’s urine will be dark yellow or almost brown in color. Using urine to assess hydration is less invasive than testing blood and is fairly inexpensive. This method could be used to monitor teams with individuals suffering from an eating disorder.