Robert Huggins, Ph.D., ATC, has been traveling with the Korey Stringer Institute (KSI) for the last four years with a mission. Data shows that more than 90% of sports-related deaths among high school athletes are due to cardiac arrest, exertional heat stroke, traumatic brain injuries and exertional sickling, according to a press release from KSI. And yet, simple, cost-effective strategies can prevent nearly all of these deaths. And tools exist to prevent problems stemming from the heart.
Those are the facts, and Huggins’ mission is to make sure the world knows.
Often, he hears the same pushback, and it reveals itself when the words “budget” or “funding” rear their ugly heads. Realistically though, these words need not enter the equation when we’re talking about the purchase of a large Rubbermaid stock tank and the need to fill it with ice water. Click this link to see just how easy that is: https://www.rubbermaidcommercial.com/material-handling/farm-garden/stock-tanks/
This low-cost solution to saving an athlete’s life shouldn’t even be an item on the agenda. It should just get done.
“It’s a one-time investment, and it will pay for itself even if it’s used once over 50 years,” says Huggins. “Essentially, we try to identify areas where there’s low-hanging fruit where we can really try to make a difference or make a change. We advocate for these best-practice policies.”
Huggins, who is currently President of Research & Athlete Performance and Safety, as well as Director of the ATLAS Project for KSI, focuses on two major areas of research: athlete health and safety, and athlete performance. From a “health and safety in sport” perspective, his research has focused on improving athletic training services at the high school level, emergency best practices in youth athletes, and the economic impact of medical services rendered by athletic trainers. From an “exercise science” perspective, his research interests include heat illness, hydration, and the assessment of physiological biomarkers, exercise stress, and training load on sport performance.
“We call it the four Hs: head, heart, heat and hemoglobin,” says Huggins. “In the month of August, heat tends to lead those causes by virtue of when we in the U.S. start our fall athletic seasons. The heat of the summer is when we see a lot of deaths occurring. But, cardiac is the leading cause. I think we’ve just seen that recently in the media with the coverage of Damar Hamlin and the importance of having emergency action plans, the importance of having AEDs on site, the importance of CPR, first aid training, compression only CPR, and really getting those things going because what you do in the first 30 minutes of any of these causes will indicate whether or not that person will survive.”
Measuring Heart Rate Variability
For strength and sport coaches at the high school level, it’s often difficult to know when an individual athlete may be approaching his or her breaking point. After all, it’s not easy to see when a given student’s internal body temperature is approaching dangerous levels when all of your student-athletes are giving it their best shot during conditioning drills under a hot sun.
Huggins, who now coaches youth hockey but has coached hockey at the high school level, knows this all too well.
“As coaches – and even as performance and exercise scientists – it is our job to push athletes to their limit,” he says. “That’s how you see gains in an athlete, by pushing the boundaries. But there is a fine line between pushing a boundary for performance and overdoing it, having a kid go down on your watch. That’s a really tough thing to live with, especially if it results in that kid succumbing to that injury.”
For coaches interested in utilizing hardware and software to identify where that line exists, Huggins points at the Polar H10, which he uses for laboratory work and the Polar Team Pro System, which he uses for fieldwork. Both have been developed and optimized over many years by Polar. These hardware systems monitor and measure an athlete’s heart rate over time to capture heart rate variability data, which is one of those biomarkers that identifies variance in exercise stress and training load on individual athletes.
“Since the advent of the heart rate monitor, which was a very long time ago, Polar has always led the way when it comes to valid and reliable measurements of heart rate,” says Huggins. “We use them in our laboratory at the Korey Stringer Institute, which is known as the Mission Heat Lab. It’s a state-of-the-art chamber where we bring people up to 104F body temperature. Monitoring those vitals becomes critical when you push someone to the limit.
“We keep track of heart rate and we know the maximum of an individual. There’s easy calculations that you can do — but Polar already had this built in.”
Huggins plugs in a test subject’s personalized information before any test. This information is based on their age or their training status, and Huggins and his team can see when the athlete overexerts or their load is too high.
“When you rev that engine too high and the RPMs get too elevated – same thing with your heart – you are going to either stop what you’re doing or you’re going to get horizontal real quick and you’re going to pass out,” he says. “We monitor heart rate very closely for all of those reasons. That’s the ‘why.’ But in the field, I’ve used the Polar Team Pro system, because it has GPS- and accelerometry-based capabilities within the device. It’s built in a way that allows me to track players’ load on a day-to-day or week-to-week level.”
This allows Huggins to understand readiness and resiliency, and where an athlete is starting a practice and ending a practice from a heart-rate perspective. It allows him to tell coaches – or as a coach, use it as a tool – to understand exactly how difficult a given drill is for an individual athlete. Where this matters is understanding an individual’s load levels during drills relative to their real-time athletic performance capabilities.
“If I’m doing really high-intensity repeated bouts — whether it be for hockey, football, soccer, lacrosse, you name it – some of these drills can be quantified into different load levels,” says Huggins. “Polar has a load metric that uses heart rate through an equation called the Training Impulse (TRIMP), and it gives a score of that player’s load in that session.”
This allows coaches to individualize training sessions, and bring all players up to the same level in a consistent and safe manner, without unknowingly pushing an individual over the threshold of safe exertion that could culminate in catastrophe.
“It’s actually better to train each kid individually,” says Huggins. “I know that sounds daunting, but with technology such as this, you can actually see (an athlete) worked his tail off today and it took him longer to get to the same level as (another athlete), but we’re able to look at that and say, okay, you’re done today.
“You’ve reached the same load as the other. You didn’t perform the same amount of distance that he did, but you’re at that same level. The heart-rate stress was the same. You’re done for today. We’re going to go on to tomorrow.”
It’s also knowing when to stop because sudden death or over-training comes into play when someone pushes beyond their abilities, and that’s when the body starts to react in ways that aren’t going to benefit performance and start to become dangerous.
“What the Polar Team Pro system does – how I use it with women’s basketball, hockey, baseball and soccer here at UConn – we use these systems to make better decisions about what’s coming that week,” says Huggins. “What am I doing gameday minus one, gameday minus two, gameday minus three? When am I going to push these players? Early in the week? When am I going to focus on strategy? When am I going to reduce my load and allow them to recover? A lot of times we get into these patterns of ‘more is better,’ when actually, ‘less with higher intensity’ is probably better because you don’t have the same wear and tear on your players’ bodies over the course of the week. You can actually see them not only recover, but super compensate for what they’re working on.”
Head Where Your Heart Is: Advocating For Your Athletes
Regardless of how deeply into the realm of hardware and software coaches are willing to delve at the high school level, there are ways strength and conditioning coaches can help lead the way on preventing sudden death in sport. Though Huggins and his team have already visited over 30 states and met with key stakeholders – including high school sports safety committees, athletic associations, superintendents, legislators and their staffs, principals, athletic trainers and medical professionals – the coaches are the ones who spend the most time interacting with students in an athletic setting. Therefore, coaches are key.
“Help us advocate for your athletes,” says Huggins. “These kids deserve to go home at the end of the day from their sport and they deserve medical care. I have data from a project that I work on called the ATLAS Project, and it shows that there are 7,000 high schools in this country that don’t have athletic training services of any kind. Athletic trainers are the most appropriate healthcare providers who are trained, in the event, to treat and manage and prevent emergencies.”
Coaches can advocate to have an athletic trainer at their practices, at their games, at their schools. They can advocate for what that athletic trainer needs from an equipment standpoint. They can work with booster clubs and the district to fund the purchase of an AED that goes with the coaches at all times. Coaches can reach out to the high school athletic association and tell them that they support the Team Up For Sports Safety project. Coaches can be vocal about shoring up the medical support student-athletes often require in the case of an emergency.
“At KSI, we track the deaths that occur across the country in sport, in high school and the collegiate setting,” says Huggins. “Most of the time, unfortunately, it’s a reactive approach to what’s going on. This is a coach’s opportunity to be proactive. It’s an opportunity to learn from cases like Korey Stringer, cases like Damar Hamlin, cases we see in the news all the time. They say, “It’s not going to happen to me; I’ve been doing this for 20 or 30 years.’ It takes one practice, one kid who isn’t feeling well, one kid with an undiagnosed condition. The impact it can have on a school, on a team, on a community, can be devastating.
“The best thing you can do for yourself and your athletes is educate yourself. We have so much information at https://ksi.uconn.com. The best thing that you can do to support this effort is, when you hear that KSI is coming to your state, reach out to those you know above you who can make a difference and be vocal about your support.”
