Recovering Athletes: Returning Post-Heat Stroke

Heat illness is a spectrum of conditions that range from mild (heat oedema, heat rash) to life-threatening (heat stroke). The recovery time for athletes who have suffered from heat stroke depends on the severity of their heat illness. For milder forms of heat illness, athletes can return to play within 24 hours with proper hydration and should be evaluated by a physician prior to returning. For more severe cases, athletes should wait at least one week before resuming exercise, first in a cool environment with light activity, and then gradually progress intensity, heat exposure, and amount of equipment. Athletes with exercise-associated muscle (heat) cramps, heat syncope or heat exhaustion should wait to return to play until after 24 hours of rest. Athletes with exertional heat stroke may initiate return after a 7 to 21-day rest period, demonstrated normal blood-work results, and obtained physician clearance.

Recovery time depends on the severity of the heat stroke

For milder forms of heat illness, it is probably safe for athletes to return to play within 24 hours with proper hydration. However, athletes should be evaluated by a physician prior to returning to play.

In the case of exertional heat stroke (EHS), a specific return-to-play (RTP) strategy should be implemented. The athlete must be asymptomatic and lab tests should be normal before returning to play. The athlete should begin a gradual RTP protocol under the direct supervision of an appropriate healthcare professional, such as an athletic trainer or physician. In general, athletes should wait at least one week before resuming exercise, first in a cool environment with light activity, and then gradually progress in intensity, heat exposure, and amount of equipment.

Following a minor EHS event, athletes are generally able to resume short-duration, light physical activity after 48 hours, under the supervision of an exercise physiologist with expertise in thermoregulation. Following a significant EHS event, athletes should avoid exercise for at least one week. Once ready to resume sport after one week, under the guidance of an exercise physiologist, athletes should progress through a series of stages during the forthcoming weeks, including:

• Light exercise in temperate conditions
• Strenuous exercise in temperate conditions
• Light exercise in heat
• Strenuous exercise in heat

The third and fourth stages should be monitored with physiological equipment.

The duration of time spent above critical thresholds of core temperature, and the time taken to receive appropriate medical attention, will ultimately determine the magnitude of physiological disturbances and, thus, recovery time.

Athletes should wait at least a week before resuming exercise

Heat stroke is characterised by a core body temperature of over 40°C and altered central nervous system functions such as irritability, confusion, combativeness, or loss of consciousness. It is the most severe form of heat illness, which includes milder forms such as heat oedema, heat rash, heat syncope, heat cramps, and heat exhaustion.

The recovery time for athletes will depend on the severity of their heat illness. For milder forms of heat illness, athletes can usually return to exercise within 24 hours with proper hydration. However, for more severe cases of heat stroke, athletes should follow a specific return-to-play (RTP) strategy that includes:

• Physician clearance before returning to physical activity, ensuring the athlete is asymptomatic and has normal lab results.
• A gradual RTP protocol under the supervision of an appropriate healthcare professional such as an athletic trainer or physician.
• Resuming exercise in a cool environment with light activity, gradually progressing to more intense exercise, heat exposure, and use of equipment.

The timeline for returning to sport after heat stroke also depends on the duration spent above critical core temperature thresholds and the time taken to receive medical attention. Athletes may experience temporary or permanent heat intolerance following an episode of heat stroke. It is important to comply with return-to-sport guidelines and seek medical clearance before resuming physical activity.

Athletes should first exercise in a cool environment with light activity

Returning to exercise after heat stroke is a gradual process that should be undertaken with caution and under the supervision of a medical professional. The first step is to obtain medical clearance, ensuring that the athlete is asymptomatic and that lab tests are normal. The athlete should then begin with light activity in a cool environment, before gradually progressing to more intense exercise in hotter conditions.

The recovery time for athletes after heat stroke depends on the severity of the heat illness. For milder forms of heat illness, athletes can usually return to exercise within 24 hours, provided they are properly hydrated. However, for more severe cases of heat stroke, athletes should wait at least a week before resuming exercise.

The National Athletic Trainers' Association (NATA) recommends a 7- to 21-day rest period for athletes recovering from heat stroke. During this time, athletes should begin with light activity in a cool environment and gradually increase the intensity and duration of exercise. This progression should be supervised by a qualified healthcare professional, such as an athletic trainer or physician.

It is important to monitor the athlete's body temperature during the recovery process, as heat stroke can cause temporary or permanent heat intolerance. Athletes should also ensure proper hydration and make a gradual return to full physical activity to avoid further complications.

In summary, athletes recovering from heat stroke should follow a supervised, gradual return-to-play protocol that begins with light activity in a cool environment and progresses to more intense exercise over time. This process should be tailored to the individual athlete and their specific needs, with close monitoring by medical professionals.

Gradually progress intensity, heat exposure, and amount of equipment

The recovery from heat stroke is highly individualised and depends on the presence of any sequelae resulting from the event. Athletes with exercise-associated muscle (heat) cramps, heat syncope, or heat exhaustion can return to play within 24 hours with proper hydration and should be evaluated by a physician before returning to play.

For athletes with exertional heat stroke, a specific return-to-play (RTP) strategy should be implemented. The athlete should begin a gradual RTP protocol under the direct supervision of an appropriate healthcare professional such as an athletic trainer or physician. In general, they should wait at least 1 week before resuming exercise, first in a cool environment with light activity, and then gradually progress intensity, heat exposure, and amount of equipment.

The athlete must be asymptomatic and lab tests should be normal before returning to play. The athlete should be cleared by a physician prior to returning to physical activity. Recovery time is primarily dictated by the severity of the illness.

Return to play should be supervised by a healthcare professional

For more severe cases of heat illness, such as exertional heat stroke (EHS), a specific return-to-play (RTP) strategy should be implemented. This strategy should include:

• Physician clearance before returning to physical activity. The athlete must be asymptomatic, and lab tests should be normal.
• A gradual RTP protocol under the direct supervision of a healthcare professional, such as an athletic trainer or physician.
• Generally, athletes should wait at least one week before resuming exercise, first in a cool environment with light activity, and then gradually progressing intensity, heat exposure, and amount of equipment.

Frequently asked questions