Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death in Warfighters and Athletes

Abstract

Facing pressure to train for victory, warfighters and athletes (hereafter, “athletes”) face numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTP) signifies universal processes designed to prevent unnecessary bodily harm, to include injury, illness, and death, during such physical training programs. Although no formal guidelines exist for collective implementation of a defined set of precautionary UTP strategies against a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to prevention of sudden death during high school sports and collegiate conditioning sessions. A long list of critical issues must be considered as UTP, to include physical fitness factors, appropriate recovery, use of medications and dietary supplements, hydration, transition period accommodation, environmental factors and acclimatization, and importantly leadership. In this article we outline in detail, along with a corresponding strength of recommendation taxonomy, what should be considered a “universal recommendation” to minimize risk of athletes coming to harm when participating in group physical activities.

Management of the Sickle Cell Trait: An Opinion by Expert Panel Members

“…Coaches, athletic trainers, and medical staff should follow universal training precautions [38]. Coaches must be aware of the potential dangers during training; therefore, they should avoid repetitive and intense activities without breaks and stop the exercises immediately and alert the doctor if an athlete shows signs of exertional rhabdomyolysis.…”

Sickle Cell Screening in Adults: A Current Review of Point-of-Care Testing

“…As a response to these events, in the early 2000s, the US Army instituted a protocol of universal training precautions (UTPs) to decrease exercise-related injury among all recruits irrespective of SCT status. UTPs are universal procedures designed to prevent complications of physical training programs to include bodily injury, illness, and death [ 26 ]. Although no formal guideline exists to address what strategies should be implemented to prevent exercise-related health risks, individual organizations have implemented protocols that address advanced assessment of climate factors, adjustment of exertion, consistent hydration, and dedicated recovery time as a prevention strategy for all exertion-related injury [ 26 , 27 ].…”

“…UTPs are universal procedures designed to prevent complications of physical training programs to include bodily injury, illness, and death [ 26 ]. Although no formal guideline exists to address what strategies should be implemented to prevent exercise-related health risks, individual organizations have implemented protocols that address advanced assessment of climate factors, adjustment of exertion, consistent hydration, and dedicated recovery time as a prevention strategy for all exertion-related injury [ 26 , 27 ]. In light of increased awareness of SCD and SCT, the US army screens all recruits for hemoglobinopathies since 2020, and does not allow personnel to enroll who have an HbS > 45% [ 25 , 28 ].…”

Heat-Related Illness in Athletes

“…6 Organization plans may include moving a sporting event to a cooler location, changing the event to cooler early-morning times, providing rest and hydration breaks, educating staff and athletes about how to avoid and treat EHI, and having an emergency action plan that includes preparation and supplies for rapid cooling of athletes along with activation of the emergencymedicalsystem. 6 Thewet-bulbglobetemperature(WBGT) index assesses heat stress risk by combining the effect of air temperature, humidity, wind speed, and solar radiation. The index can guide rest and fluid replacement needs, with a WBGT of 65 °F (18.3 °C) considered generally safe for all individuals, including those who are not acclimatized; at WGBT greater than or equal to 32.2 °C (90 °F), training should preferentially be suspended and competition requires mandatory breaks.…”

“…2 Heat acclimatization requires 7 to 14 days with training under a heat stress comparable with the target competition. 2,6,7 At the 2019 World Athletics Championships, acclimated marathon and racewalker athletes had better final standing than those who were not acclimated (mean, 18th vs 28th place [P = .01]) and lower peak core temperatures (mean, 39.4 °C vs 39.8 °C [P = .04]). 7 Acclimatization results in increased total body water (TBW) and plasma volume, mediated by increased plasma colloid and crystalloid osmotic pressures, secondary to an upregulation of the renin-angiotensin-aldosterone system.…”