A systematic review of exercise-induced hyperthermia treatment options, based on a review of seven studies, was published this month in the Journal of Athletic Training (JAT), the National Athletic Trainers’ Association’s scientific publication. It reveals that ice-water or cold-water immersion provides the most efficient treatment for exercise-induced hyperthermia.

According to “Acute Whole-Body Cooling for Exercise-Induced Hyperthermia: A Systematic Review,” whenever possible athletic trainers should use ice-water or cold-water immersion to treat exertional heat stroke (EHS). It is also the most effective treatment for reducing hyperthermia caused by physical exertion; however, when those methods are not feasible, immediate and continual dousing of the patient — combined with fanning and continually rotating cold, wet towels — represents a viable onsite alternative, until immersive cooling can occur.

“To prevent possible serious consequences or fatalities, athletic trainers are called on to assess, and appropriately care for, individuals who are experiencing heat illnesses,” said Brendon McDermott, MS, ATC, instructor, athletic training education program, University of Connecticut. “Our review of treatment options helps ensure athletic trainers and other health care professionals understand the most effective methods to care for people who become overheated as they exercise.” 

The most serious heat-related illness is exertional heat stroke (EHS), which is a condition marked by an elevated core body temperature (between 40.6°C and 41.6°C) and central nervous system dysfunction. The next most serious illness, exertional heat exhaustion, is diagnosed when an individual exhibits a moderately elevated core body temperature (generally less than 40.6°C) and is unable to continue exercising. Exertional heat stroke can develop if heat exhaustion is managed improperly; however, heat exhaustion does not necessarily precipitate EHS.

Based on the available research, when setting up an action plan for EHS, cold-water immersion should be included if possible. Ice in coolers adjacent to tubs filled with water can act as a rapid cooling tub for EHS patients. In areas not conducive to having cold-water tubs available, athletic trainers should plan to have a cooler available containing ice, water and towels. The cold, wet towels should be changed every two to three minutes as a means of reducing body temperature. 

Alternatively, a large water supply should be available for the continual dousing of a patient (either from a hose or multiple water containers). In extreme cases, when individuals may complete training runs at remote locations and EHS is suspected, cooling should be implemented as soon as possible using a water source of some sort (e.g., garden hose, stream, lake, pond). The recommendation of cooling first and transporting second cannot be overemphasized, according to the JAT review findings.

“The longer a person’s body remains above a critical temperature, the more chance there is that serious injury or death can occur,” McDermott said. “As our research suggests, patients should always be cooled first at the scene, before being transported to a hospital, clinic or emergency room.”

Among the treatment modalities that were deemed not to be as effective at cooling EHS patients by full-body immersion were the following: fanning the body; wet-towel application to the thorax and abdomen; ice-pack application to neck, groin and armpits; and showering the body with water combined with fanning.

To read this systematic review of treatment options in its entirety, visit: 

The National Athletic Trainers' Association (www.nata.org) represents and supports 30,000 members of the athletic training profession. NATA advocates for equal access to athletic trainers for patients and clients of all ages. NATA members adhere to a code of ethics.