Staying healthy as an athlete

Many people assume that kids who are active in sports are automatically healthy, but that can be far from the truth. Sports do provide exercise, but not all kids participate at the same intensity level, some sports are more inherently challenging, many kids don't eat the needed foods to provide optimal nutrition, and many kids fall far short of the sleep they need to maintain healthy body and mind. There needs to be a balance: eat right, sleep adequately, and exercise daily. Kids also need time to be kids with unstructured time in addition to school, homework, and activities.

Not a typical team sport, but my kids don't do typical sports. This is from an office Bubble Soccer game. 

Eat right

First and foremost with nutrition, we all need to maintain hydration. Many kids avoid drinking at school so they don't have to use the restroom. This is of course not healthy. Talk to your kids about the importance of drinking throughout the day and troubleshoot toileting issues. When kids exercise, be sure they stay hydrated. The large majority of athletes need nothing more than water to stay hydrated. Water is by far the preferred drink of sports nutrition experts unless there is intense exercise longer than 60 - 90 minutes. This does not mean a child playing a baseball game for more than 60 minutes because they are not maintaining the level of intense exercise for the entire game. If a child is running a marathon, added electrolytes might be needed, but short of that type of intensity/duration, water is fine. Sports drinks add far too much sugar and unneeded salts to the diet. Encourage kids to take a sip or two of water every 15-20 minutes of exercise (more or less depending on how hot it is and the intensity of exercise).

As for foods, not all are equal and not all that are marketed as healthy really are healthy. Get in the habit of reading labels. The longer the ingredient list, the less healthy it probably is unless the ingredients are all foods themselves (such as a trail mix with a number of dried fruits and nuts). I've previously addressed the issues of kids getting too many calories. Far too many of our kids are overweight or obese. Many of them are active in sports, but they take in more calories than they use.

• Carbohydrates give quick energy for activity. Examples of healthy carbs are bananas, berries, oats, pasta, rice, and whole grain breads. These are recommended before exercise for energy (but kids don't usually need to carb load unless they are doing an endurance sport), and after exercise with a protein. 
• Protein is important for building and maintaining muscle. I like kids to eat foods with protein and to avoid protein shakes and powders, which are expensive and could possibly lead to too much protein. Examples of good protein sources include nuts and nut butters, eggs, lean meats and fish, yogurt (look for a brand without added sugar) and other dairy products. About 5 -15 g of protein (or about 0.5 to 0.8 grams of protein for every pound of body weight) is all that's needed after a workout, depending on age, size, and workout intensity. Many Americans get far more daily protein than is needed.
• Fat is not as bad as many people make it out to be. It is an important energy source for our bodies and helps us absorb fat-soluble vitamins. Healthy fats come from nuts, avacados, meats, dairy products, and eggs. 

Sleep

Many athletes (and teens in general) fail to get sufficient sleep for good health. They are torn between the demands of school, sports, clubs, volunteering, and making the time for sleep. The spiral typically has them staying up late to catch up on homework, only to be more tired the following day, which leads to poor focus at school - then everything takes longer to do. This encourages them to stay up even later to finish homework, which reinforces the problem. It is not uncommon for me to hear teens report anywhere between 4 and 8 hours of sleep. None of this is enough. Kids who are chronically sleep deprived suffer from more injuries, falling grades, general irritability and depression. I see many teens who want me to find a reason for their fatigue with labs, but it commonly is simply due to sleep debt.

Try to get kids to get enough sleep so they are easy to wake in the morning, stay alert all day, and aren't irritable or hyper in the evenings. If they have trouble sleeping, talk with their doctor.

From the National Sleep Foundation

I see far too many kids who claim to be very active and eat healthy, yet they have problems keeping up with other kids running or have BMIs that seem too high for the reported habits (not due to muscle mass). This could be due to an underlying problem, such as asthma, or habits that aren't as healthy as you think. Bring your child in for a yearly physical to review eating, sleeping, and exercise habits in addition to other health related issues. With most insurance companies there is no co pay for well care, so make the most of your insurance dollars and schedule a well visit! If there are any concerns, you can work with your child's doctor to find help.

Heart Screenings for Athletes - Are they worth it?

In recent years I've been getting more and more reports of athletic heart screenings. The schools and sports clubs locally are offering for athletes to get a heart work up for a relatively small fee.

Why are they offering this? Because sudden cardiac death in athletes has been in the news a lot over the years, and we all want to minimize the risk that our child has an undiagnosed heart condition that may cause sudden death when exercising. We want to prevent sudden death by identifying those at risk and keeping them from the activities that increase risk. Communities and schools now are more likely to have defibrillators on hand in case of problems, but some children might benefit from an implantable defibrillator. (Side note: if you've not taken a CPR class in the past few years, a lot has changed, including teaching people how to use defibrillators. And you no longer follow "A B C" so it is very different. CPR is recommended for all teens and adults.)

Is the cost of a heart screen worth it?

A new report, Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology, is a review of whether or not electrocardiograms (ECGs) are beneficial for all athletes prior to sport participation and is endorsed by the Pediatric and Congenital Electrophysiology Society and American College of Sports Medicine.

There has been a lot of controversy over the years whether or not routine ECG screening of athletes is a a cost-effective means to find at risk young people. Northeastern Italy has done a comprehensive screening program of competitive athletes and has lowered their sudden cardiac death rate, which is evidence for the ECG screening. Despite this shown benefit, there are many problems with the feasibility of testing a broad range of athletes to evaluate for risk of sudden death (SD). Complex issues from the Statement linked above:

1. the low prevalence of cardiovascular diseases responsible for SD in the young population
2. the low risk of SD among those with these diseases
3. the large sizes of the populations proposed for screening
4. the imperfection of the 12-lead ECG as a diagnostic test in this venue 

It is generally agreed upon that screening to detect cardiovascular abnormalities in otherwise healthy young competitive athletes is justifiable in principle on ethical, legal, and medical grounds. Reliable exclusion of cardiovascular disease by such screening may provide reassurance to athletes and their families.

In short: To do an ECG screening on all athletes is not inheritantly unwarranted nor discouraged, but it isn't recommended either.

Although an ECG is not recommended, it is recommended to do a 14 point questionnaire for all athletes at their pre-participation sports exam. This is available below.

Positive findings on the history (questionnaire) or physical exam may require further testing, but using an ECG as the initial screen for underlying problems in the 12- to 25-year age group hasn’t been found to save lives.

Changes in the heart in growing teenagers can make it difficult to tell if an ECG is abnormal or a variation for age (unless read by a pediatric cardiologist, which is often not possible for these mass screenings).

False negative and positive results can lead to missed diagnoses (normal ECG but real underlying condition) or unneeded testing (abnormal ECG with a normal heart).

Mass ECG screening of athletes would be very expensive.

If your family can bear the cost and wants to do the screening, it should be done. But if the screen is abnormal, do not jump to the conclusion that your athlete will be banned from sports forever. A more complete exam by a pediatric cardiologist will sort that out.

Know that hearts can change over time, so one normal screen does not guarantee there will never be a cardiac event in your child.

If you do not feel that the screening is something you want to pay for or if you feel that it is not necessary for your child who has a negative 14 point screening, you should not be required to do so. The evidence does not support mass required screenings.

If however, your child has identified risks based on the questionnaire, a more thorough testing should be done.

These 14 points are listed in Table 1 of the above linked statement:

The 14-Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes

Medical history* 
  Personal history
    1. Chest pain/discomfort/tightness/pressure related to exertion
    2. Unexplained syncope/near-syncope†
    3. Excessive and unexplained dyspnea/fatigue or palpitations, associated with exercise
    4. Prior recognition of a heart murmur
    5. Elevated systemic blood pressure
    6. Prior restriction from participation in sports
    7. Prior testing for the heart, ordered by a physician
 Family history
    8. Premature death (sudden and unexpected, or otherwise) before 50 y
of age attributable to heart disease in ≥1 relative
    9. Disability from heart disease in close relative <50 y of age
    10. Hypertrophic or dilated cardiomyopathy, long-QT syndrome, or other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias; specific knowledge of genetic cardiac conditions in family members

Physical examination
    11. Heart murmur‡
    12. Femoral pulses to exclude aortic coarctation 
    13. Physical stigmata of Marfan syndrome
    14. Brachial artery blood pressure (sitting position)§

AHA indicates American Heart Association.
*Parental verification is recommended for high school and middle school athletes.
†Judged not to be of neurocardiogenic (vasovagal) origin; of particular concern when occurring during or after physical exertion.
‡Refers to heart murmurs judged likely to be organic and unlikely to be innocent; auscultation should be performed with the patient in both the supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.
§Preferably taken in both arms.
Modified with permission from Maron et al.3 Copyright © 2007, American Heart Association, Inc. 

Concussions in Athletes

Concussions in athletes has been the subject of many headlines over the past couple years.  For as much as we know about concussions, there is still much more we need to learn about head injuries and their healing. While most kids recover from concussions within days to weeks, there are some who suffer for months.  This can disrupt not only sport participation, but also reading, concentration, and the ability to learn.

What we know:

• We know that children's brains are still developing and are more at risk with concussions than mature brains. 
• We know that many athletes attempt to hide symptoms of a concussion so they can continue to play. (Bad idea!)
• After a concussion -- even serious ones that affect the daily activities of a teen -- kids are often eager to return to the game that puts them at risk for another injury.
• Symptoms of a concussion range from mild to severe.

• headache
• nausea or vomiting
• slurred speech 
• dizziness 
• ringing in the ears
• trouble concentrating
• sensitivity to light or noise
• sleep problems
• balance problems
• memory loss  

Treatments:

• There are no specific treatments for concussion.
• Rest is important. This includes not only avoiding activities that increase the risk of another injury, but also brain rest. Some kids need quiet time in bed without lights, sounds, television, computers, or books.
• Headaches can be treated with pain relievers and sometimes migraine medications.
• Memory and thinking problems are treated with rehabilitation and memory devices (like a calendar or planner).  Occasionally stimulants (the medicines used for ADHD) are used temporarily.
• Depression and anxiety should be managed by someone experienced in dealing with post-concussion syndrome.

Return to play is a gradual process, in which the athlete progresses in a step wise manner.  If any symptoms return during the stepwise process, the athlete must stop activities and return to a medical practitioner for evaluation.

Step 1: Light aerobic exercise 5-10 minutes without weight lifting, resistance training or other exercises

Step 2: Moderate aerobic exercise 15-20 minutes of running at moderate intensity without a helmet or other equipment.

Step 3: Non-contact training drills in full uniform. May begin weight lifting and resistance training.

Step 4: Full contact practice.

Step 5: Full game play.

Kansas has a new Concussion Law effective July 1, 2011, that requires the State Board of Education and the Kansas State High School Activities Association to provide information about the risks of head injury to coaches, athletes, and parents and guardians of the school athletes. This information should include the risks of playing or practicing with a concussion.  Under the new law an athlete may not participate in a school sport or practice unless the athlete and the parent/guardian have turned in a signed head injury release form each year.  Any school athlete who is suspected of having a concussion or head injury will immediately be removed from play or practice and will be allowed to return to play only after a health care provider gives medical clearance to return to play.

Athletic trainers are available at many local schools to help identify the athletes at risk of concussion. They will be testing kids with various methods, and at this time there is still a lot of variability in what each school program is doing.  It is best to have baseline testing done BEFORE any brain injuries (ie the start of the season) to compare to testing done after a suspected concussion.

If your child is suspected of having a concussion, bring any available test results (both from before and after injury if possible) to your appointment with a healthcare provider.

Prevention is still the best medicine!

• Wear proper gear at all times.  
• Be sure helmets are in good condition and fit properly. 
• Wear mouth guards at all times.  
• Follow the rules of the game. 
• Sit out if injured.  
• If you suspect someone might have a concussion, speak up!

To read the Kansas State High School Activities Association Recommendations for Compliance with the Kansas School Sports Head Prevention Act and Implementation of the National Federation Sports Playing Rules Related to Concussions, click here.