Training and playing football in hot environments

The FIFA Medical Committee and F-MARC – FIFA Medical Assessment and Research Centre – received a mandate from the FIFA Executive Committee to study the different environmental conditions to which football players are exposed while training for or playing football. The mandate was to conduct a thorough review of the available literature, to carry out new research where necessary, and to develop recommendations for organizers of competitions and match officials who have to deal with matches being played in extreme conditions. Team physicians and medical officers, who are responsible for all medical issues relating to the teams and competitions, raised concerns relating to health issues that might result from exposure to extreme conditions without appropriate acclimatization. There are three environmental conditions that raise concerns in relation to performance issues and, more important, to the wellbeing of players and also accompanying staff and spectators. Specific questions were raised with regard to: high altitude, cold, heat and humidity. The issue of training and playing football at high altitude was addressed in a supplement of this journal in 2008 as a consensus statement, which resulted in additional research studies currently in progress with football teams. The majority of the previously published literature related to individual sports and many of the studies were performed in artificial conditions. The issue of training and playing team sports, in particular football, in extremely cold conditions has not been studied in a satisfactory manner, and recommendations have not been issued by sport's governing bodies. On August 23, 2008 the final football match of the 2008 Olympic Games in Beijing was played at noon. The medical staff carefully monitored the wet-bulb-globe temperature (WBGT) on the pitch in the Bird-Nest stadium, as the potential for high heat and humidity was recognized during the planning stage. Concerns were expressed on the morning of the final that the environmental conditions were developing unfavorably for the match. There was blue sky with full sun radiation, no wind and increasing humidity due to the watering of the pitch. Thirty minutes before kick-off the WBGT had risen to 34.3 °C, indicating a high risk to the human organism at rest, let alone while performing at the highest level. The FIFA Chief Medical Officer, together with the local organizing committee, took all possible precautions for the match by ensuring an adequate supply of cold drinks and ice cubes and by reducing the temperature in the locker rooms to facilitate pre-match cooling down. Additional cooling measures were made available during the half-time break. In addition to these general precautions, the FIFA Chief Medical Officer took the decision, after discussion with the match commissioner and the referees, to order a short break after 30 minutes of play in each half of the game. This decision was based upon the preliminary scientific results of the “Turkish study” presented in this supplement by the F-MARC group under the leadership of Prof. Ron Maughan. The FIFA administration was informed about the decision and fully endorsed it, understanding the need to reduce the risk of heat illness of the players and all involved around the pitch to a minimum. The team doctors of the two finalists were also informed before the start of the game, and the players of Argentina and Nigeria appreciated and applauded the decision of the FIFA doctors and the endorsement of the FIFA Executive. During the additional cooling breaks, the players were supplied with cold water and iced towels to help lower skin temperature and hopefully reduce the body-core temperature. This is an example of how science and football can work together to develop optimal conditions for sporting activities in extreme conditions and reduce the health risk to a minimum. Heat is a problem, well documented and recognized in football, however detailed knowledge is lacking on the effect of dry vs humid conditions as well as to best practice to acclimatize and possibly develop objective criteria for recommendations, when playing in critically hot environments. The current supplement of the journal includes the proceedings of a conference on sporting activities in extreme heat conditions, held by ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, a FIFA Medical Centre of Excellence in Doha, and supported by F-MARC. In addition there is a series of original papers investigating the impact of hot environments when playing football. The executive summary presents the current state of knowledge as well as recommendations for officials and physicians on how to plan and act when confronted with sporting activities that take place in conditions of extreme heat and humidity. We would like to congratulate and thank ASPETAR for the initiative taken to contribute to the solution of this challenging problem. Football matches and other sporting activities will continue to take place almost daily around the globe and the information in this supplement will contribute to the health and wellbeing of players. Conflicts of interest: The authors have no potential conflicts of interest.