Summer Sports Safety in the Great Outdoors
By Jennifer Sisk, MA
Today’s Dietitian
Vol. 8 No. 7 P. 36

Nice weather calls for moving indoor workouts outside, but ensure your clients exercise some caution while having fun in the sun.

Summer, an eagerly awaited time for many exercisers and athletes who live in a seasonal climate, is a time to enjoy physical activity in the fresh air and sunshine. For some exercisers, summer means moving a running or walking workout from an indoor treadmill to an outdoor trail or a tennis game from an indoor court to an outdoor one. For others, summer is a time to engage in entirely different activities, such water sports, mountain biking, and hiking, or to train for an upcoming fall sport, such as football, soccer, and field hockey. While exercising outdoors can provide certain fitness benefits, it also has associated health risks summer exercisers must consider.

The Benefits of Moving Exercise Outdoors
After spending winter workout sessions fighting for a treadmill or stationary bicycle in a crowded health club or at home exercising in front of a television, runners, walkers, and cyclists who move outdoors during the spring and summer can increase the variety and intensity of their workouts. Differences in terrain and location can challenge muscles that are used to running, walking, or cycling in place inside. Changes in scenery and traveling from one location to another can motivate exercisers to keep moving for longer periods of time.

Changes in outdoor terrain provide visible physical demands and mental stimulation far more challenging than adjusting resistance or incline on an indoor treadmill or bicycle. No treadmill can adequately mimic running on the beach or hiking up a rocky mountain trail, and no indoor cycle can effectively duplicate mountain biking up and down hills on gravelly woodland paths. Laurie Washington, personal trainer for Platoon Fitness in suburban Philadelphia, says, “Running on a surface you’re not accustomed to challenges the body to work a little harder. Also, taking a basic move, such as walking lunges, and moving them uphill adds to the challenge of the exercise routine.”

Even without challenging terrain, exercising outdoors can be motivation in and of itself. Just moving exercise outdoors can motivate exercisers to work harder. “Besides the obvious benefits of moving out into the fresh air, moving your workout outdoors can affect not only the physical aspect of training but the mental aspect as well,” Washington says. “Who doesn’t feel energized when those first few days of spring and summer hit and we can’t wait to take that run or bike ride outdoors? It’s an automatic boost in energy levels,” she adds.

Platoon Fitness specializes in outdoor training year-round and clients rise at the crack of dawn to participate in boot camp-style workout sessions. Summer weather and earlier morning sunlight make rising for these training sessions easier for many clients.

For indoor exercisers who are uncertain about how to structure an outdoor workout after using health club equipment for so long, a personal trainer can demonstrate outdoor exercises for variety and physical challenge. Washington says, “Outdoor workouts are about moving as much as you can in the environment that you have. If there’s a park bench, then try some triceps dips or step-ups to work upper and lower body. Something as simple as a curb in a parking lot can change the way you perform a move. Do a push-up on a decline to make it more challenging or on an incline if you’re a beginner. We, as trainers, just want to continually challenge our clients.”

Summer Exercise Risks
Although outdoor exercise in the summer can add variety, intensity, and fun, there are risks for exercisers and athletes, including injuries, heat-related exhaustion, sun exposure and related damage to skin and eyes, tick- and mosquito-borne diseases, asthma, and dehydration. While outdoor terrain provides benefits in exercise intensity, it can also contribute to a higher risk of injuries. Runners and walkers who tend to “zone out” on a treadmill or stationary cycle must be more alert when moving their workouts outdoors.

Robert Berkow, MD, editor-in-chief of Your Health Now/YourHealthNow.com and editor emeritus of The Merck Manuals, says vehicle injuries are a risk for joggers and cyclists exercising in high-traffic areas, and falls are common for hikers in hilly and rocky terrain. “An unfamiliar environment can have unexpected obstacles, like ruts or curbs. It’s very easy to trip or turn an ankle,” Washington adds. For runners, walkers, and hikers, buying shoes appropriate for outdoor exercise, such as athletic shoes for trail running, can help provide more stability while running or walking on uneven terrain. “Wearing shoes designed for an outdoor workout give the most support and safety,” Washington says.

For cyclists, wearing a properly fitted helmet at all times is essential to prevent head injuries in case of an accident. Statistics from the Bicycle Helmet Safety Institute indicate that wearing a helmet reduces the risk of head and brain injury for cyclists by approximately 85%. According to the Long Island Head Injury Association, ventilated helmets can help keep cyclists cool during summer cycling, and brightly colored helmets, along with bike reflectors and headlights, can increase the visibility of the cyclist to automobile drivers.

Some Like It Hot ... or Not
Active individuals accustomed to exercising in air conditioning may not be able to perform for the same duration and intensity on an outdoor summer run as they do in cool, indoor air on a treadmill. Time to acclimate the body to summer heat is necessary to avoid heat exhaustion. Beautiful summer weather may inspire previously inactive individuals to begin an exercise program. A deconditioned body, combined with hot temperatures, can contribute to an increased risk of heat-related problems.

“A common occurrence is that people who are inactive tend to suddenly become very active in nice weather and ‘overdo it’ without adequately working up to the exertion,” says Berkow. Spending time outdoors for two to three hours per day to adjust to hotter temperatures and decreasing the intensity of exercise sessions for the first several workouts in higher temperatures can help minimize the risk of heat exhaustion. According to the American Council on Exercise (ACE), the acclimation process takes approximately seven to 14 days of repeated heat exposure.

Appropriate clothing can also help prevent heat-related problems during summer exercise. “Wearing clothing that wicks away sweat and keeps the body dry and cool is helpful,” Washington says. However, she adds, “The No. 1 thing to do when it’s hot is to stay well-hydrated.” According to Chante Rodenas, MEd, ATC, assistant athletic trainer at La Salle University in Philadelphia, common heat-related problems in summer athletes often stem from dehydration. Rodenas, who treats athletes involved in summer training, notes, “Dehydration can lead to serious illness such as heat exhaustion and heat stroke.”

Symptoms of heat exhaustion include profuse sweating, flushed skin, elevated body temperature, dizziness, hyperventilation, and rapid pulse, she says. “Heat-related problems are extremely common, especially in August when team members return for preseason training,” says Rodenas. Heat stroke is a life-threatening emergency and is characterized by sudden collapse, loss of consciousness, pale skin, lack of sweating, and a core body temperature of 106° or higher, Rodenas explains. “While serious heat-related problems have a higher prevalence in athletes who play sports with protective equipment during summer heat [such as football players], everyone exercising in hot summer weather is susceptible,” she says.

Summer athletes and exercisers can prevent heat-related problems by ensuring they are eating a balanced diet and by drinking enough fluids before, during, and after physical activity, according to Rodenas. “Ideally, fluids should include water and sports drinks [such as Gatorade]. Caffeinated drinks should be avoided because they can act as a diuretic,” she notes. Rodenas recommends that athletes and exercisers weigh themselves prior to training or exercise and then immediately following the activity. “Replenish the amount of weight lost with food and fluid before the next training session,” she says.

In addition to staying properly hydrated during summer activity, athletes and exercisers should know the symptoms of a heat-related problem and pay attention to their physical status during and after exercise. “Dizziness and nausea probably mean the exerciser is overheated or dehydrated. Knowing when to stop is important,” Washington says.

Fresh Air and Sunshine: Not Always a Good Thing
Beautiful weather is a big attraction for summer exercisers. However, fresh air and sunshine are not always beneficial. For individuals with asthma and/or allergies, exercising outdoors can aggravate these conditions. According to ACE, outdoor running is most likely to induce an asthma attack compared with treadmill running, walking, or swimming. Pollen and air pollution, two allergy and asthma irritants, are often higher in the summer. For exercisers with allergies or asthma, exercising indoors early in the morning may be a better alternative, or if exercising outdoors, early in the morning before pollen and pollution particulate levels rise. Many local weather channels and weather Web sites provide information on outdoor air quality, which exercisers and athletes can use to gauge the risk for respiratory irritation.

Another common risk for summer exercisers and athletes, says Berkow, is exposure to sun and the possibility of sunburn, which causes premature aging of skin and skin cancer. “This is difficult to deal with because summer exercise usually calls for less clothing. It’s best to exercise in the shade or before 10 am or after 4 pm,” he recommends, to avoid the strongest summer sun. Sweatproof and waterproof sunscreens are a must for exercisers and athletes who are exposed to sun between 10 am and 4 pm.

In addition to sunburn and skin cancer, sun exposure during summer exercise can damage the eyes. Prolonged exposure to ultraviolet (UV) rays from the sun can cause burns to the eye’s surface, and the cumulative effect of UV damage has been linked to cataracts and age-related macular degeneration. Chuck Larson, proprietor of OptimEYES, LLC, and a lens product development consultant for Costa Del Mar, a sports sunglasses company, says sunglasses that have embedded UV protection, rather than just a UV coating, provide better protection over time. With sunglass lenses that are only coated with UV protection, the coating may rub off, fade, or become ineffective due to scratches and abrasions on the lenses. UV protection that is integrated into the lens when it is manufactured will ensure that athletes and summer exercisers have appropriate UV protection during sports and outdoor exercise, says Larson. “Just because a lens is tinted does not mean it offers UV defense,” he says.

Many summer athletes and exercisers may forego wearing sunglasses because they may interfere with vision during their activity or they are too heavy or slip off their face. “A plastic-based lens material, such as polycarbonate, will enhance [sports] performance by making weight concerns a nonissue,” Larson says. Outdoor athletes should wear sunglasses that provide adequate coverage for UV protection but that do not interfere with visibility during exercise or participation in sports, he says. Sunglasses with features specially designed for athletes are available. Rimless nylon frames are lightweight and flexible and allow for ventilation compared with a full frame, according to Larson. “Also, polarized lenses are an absolute must for water sports,” he adds. For athletes involved in contact sports or who are at risk for impact during their training or exercise, sunglasses should also be made from impact-resistant materials.

Ticks
Individuals moving their exercise outdoors in summer weather may forget about the tiny hazards that come with warm temperatures: ticks. In the United States, ticks may transmit Lyme disease, Rocky Mountain spotted fever, and other diseases.

Although there are no statistics specific to the incidence of tick-borne disease in outdoor exercisers, Berkow says, ticks probably transmit more diseases to humans than any other vector. According to the Centers for Disease Control and Prevention’s (CDC) most current data, approximately 24,000 cases of Lyme disease were reported in 2002, a 40% increase from 2001. Lyme disease cases were reported in all states except Hawaii, Montana, and Oklahoma. Berkow notes that Lyme disease is generally underreported and the true incidence is most likely higher than reported. Twelve states have a higher incidence than the national average and account for 95% of all cases reported in the United States (see sidebar).

Rocky Mountain spotted fever is more rare but more severe than Lyme disease. The CDC has had only 250 to 1,200 reported cases over the last 50 years, but notes that, like Lyme disease, this tick-borne infection is underreported. More than one half of reported Rocky Mountain spotted fever cases occurred in the South-Atlantic states (see sidebar); the Pacific and West South-Central states also have a higher incidence of cases. “The states with the highest incidences of Rocky Mountain spotted fever are North Carolina and Oklahoma, with 35% of the total number of U.S. cases reported,” says Berkow.

While all outdoor exercisers and athletes should take proper precautions to prevent tick-borne infections, those in states with a higher incidence of reported cases should take preventive measures before each outdoor workout and perform frequent checks for ticks following any outdoor activity in grassy and wooded areas. Avoiding areas where ticks are more likely to live, such as tall grasses, weeds, and forested areas, and in areas with large populations of deer (a primary source of the Lyme disease bacteria), can help minimize the risk of infection, says Berkow.

“Hikers or joggers going through wooded or grassy areas should try to stay in the center of paths. The best protection is to cover as much of the body with clothing as possible—the lighter the color of clothing the better because it makes it easier to spot ticks,” Berkow advises.

Using appropriate tick repellants on the skin and/or clothes also helps deter ticks from attaching. Even if these protective measures are taken, everyone who may be exposed to a tick-infested area should examine themselves daily for ticks, Berkow recommends.

Although summer outdoor workouts may seem to require more preparation and may have more associated risks than indoor exercise, the risks are outweighed by the benefits—fun and variety—that summer activities can add to one’s workout regimen.

— Jennifer Sisk, MA, is a certified wellness educator with the American College of Wellness, a certified fitness instructor with the Aerobics and Fitness Association of America, and an editorial advisor for Today’s Diet & Nutrition magazine.

Resources
American Council on Exercise, www.acefitness.org/fitfacts/fitfacts_list.aspx

Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, www.cdc.gov/ncidod/dvbid

Costa Del Mar Sunglasses, www.costadelmar.com

Long Island Head Injury Association, http://lihia.org

Sea Jogger, www.seajogger.com

Your Health Now, www.merck.com/yourhealthnow

Tick-borne Disease
Lyme disease occurs more frequently in the following states:

• Connecticut;

• Delaware;

• Maine;

• Maryland;

• Massachusetts;

• Minnesota;

• New Hampshire;

• New Jersey;

• New York;

• Pennsylvania;

• Rhode Island; and

• Wisconsin.

More than one half of Rocky Mountain spotted fever infections are reported from the South-Atlantic region of the United States (Delaware, Maryland, Washington, D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida). Infection also occurs in the Pacific region (Washington, Oregon, and California) and West South-Central region (Arkansas, Louisiana, Oklahoma, and Texas). Combined, North Carolina and Oklahoma accounted for 35% of the total number of U.S. cases reported to the Centers for Disease Control and Prevention from 1993 to 1996. Although Rocky Mountain spotted fever was first identified in the Rocky Mountain states, less than 3% of the U.S. cases were reported from that area during the same interval.

— Source: Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases

Sea Jogger — Walking on Water!
For individuals looking for an innovative new water-based exercise, the recently introduced Sea Jogger allows you to get a walking workout—on water. Invented by Russian-born electrical engineer and medical electronics researcher Gregory Lekhtman, the Sea Jogger consists of a collapsible frame, two inflatable pontoons, flexible elongated fins, a flexible floor that attaches to the frame, and a rudder with a steering column and handlebar. By walking on the flexible floor, the exerciser powers the fin propulsion system, and the Sea Jogger is propelled across water. The Sea Jogger Web site dubs it a “personal water propulsion system that provides no-impact exercise.”

Because the Sea Jogger is very stable, exercisers can use it while fully clothed and wearing shoes. According to a Sea Jogger representative, the new system is being purchased for use on lakes, primarily by individuals who may have a second vacation home. Buyers have been located all across the United States, and current users are located in Florida, upstate New York, Connecticut, Texas, Wisconsin, and Seattle. The Sea Jogger costs $899.