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Exercise in the Heat - Treating Heat Exhaustion

Part 3

Yuri Elkaim, BPHE, CK

The last part to this 3-part series on exercising in the heat will deal with treating and preventing heat exhaustion. Heat exhaustion is basically a more advanced level of dehydration characterized by the inability to sustain adequate cardiac output (blood outflow from the heart), resulting from strenuous physical exercise and heat stress. The need to maintain blood pressure and essential organ function, combined with a loss of fluid due to acute dehydration, creates a challenge the body cannot meet, especially if the athlete attempts to continue exercising.

Heat exhaustion can be caused by a lack of fluid intake and/or prolonged exposure to hot environments while exercising.


1. Difficulty continuing intense exercise in heat
2. Lack or severe hyperthermia (usually <104°F/40°C), although it would be expected to find mild hyperthermia at the time of the incident (more commonly, 100°-103°F)
3. Lack or severe central nervous system (CNS) dysfunction. If any CNS dysfunction is present, it will be mild and symptoms will subside quickly with treatment and as activity is discontinued.

Other possible symptoms:

1. fatigue
2. dehydration and/or electrolyte depletion
3. loss of coordination, fainting, dizziness
4. profuse sweating, loss of color
5. headache, nausea, vomiting, diarrhea
6. stomach cramps, persistent muscle cramps
7. rapid recovery with treatment


1. Remove yourself from exercising and immediately move to a shaded or air-conditioned area.
2. Remove excess clothing and equipment
3. Cool yourself until rectal temperature is approximately101°F
4. Lie comfortably with legs propped above heart level
5. If you are not nauseated, vomiting or experiencing any CNS dysfunction, rehydrate orally with chilled water or sports drink. If you are unable to take oral fluids, implement intravenous infusion of normal saline.
6. Monitor heart rate, blood pressure, respiratory rate, rectal temperature, and CNS status (if possible)
7. Has someone transport you to the nearest emergency facility if rapid improvement does not occur

Return-to-Exercise Considerations


Before jumping back into exercise mode be sure that you meet the following criteria:

1. You be should be symptom free and fully hydrated
2. Get physician clearance or, at a minimum, a discussion with supervising physician before return
3. Rule out any underlying condition or illness
4. Avoid intense activity in the heat until at least the next day to ensure recovery from fatigue and dehydration (in severe cases, intense activity in the heat should be delayed for more than one day)
5. If the underlying cause was lack of acclimatization and/or fitness level, correct this problem before returning to full-intensity training in the heat.



Hydration is a key component to the prevention of heat exhaustion. Consider the following analogy: Imagine if you pulled a sponge out of a water bucket and threw it onto the hot Arizona pavement. Then you pulled another sponge out, wrung it out, and threw it onto the pavement. The wrung-out sponge would dry up much quicker than the soaking wet sponge. The moral of the story is to make sure you are properly hydrated before you go out into the heat and especially before you go out into the heat and exercise.

Refer back to the part 2 of this series for hydration protocols for preventing heat exhaustion.

Remember that your body needs to time to acclimate itself to exercising in hot conditions. Usually this can take up to 14 days so remember to ease into training in the heat and ensure that you are constantly hydrating your body.

Remember, if you are thirsty it’s already too late.

© 2006 Yuri Elkaim, BPHE, CK



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