• 10 Best Practices for Preventing Sudden Death in Collegiate Conditioning Sessions
    The National Athletic Trainers’ Association (NATA) and the National Strength and Conditioning Association (NSCA) collaborated in January 2012 to form a committee focused on the issue of sudden death in collegiate conditioning. Together, the NATA and NSCA developed 10 best practices regarding preventative measures.
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    The National Athletic Trainers’ Association (NATA) and the National Strength and Conditioning Association (NSCA) collaborated during a January 2012 meeting to form a committee to discuss and gain insight into the issue of sudden death in collegiate conditioning sessions. As a result of this meeting, the NATA and NSCA made recommendations regarding sudden death and preventative measures that should be taken. With that said, many governing bodies of sports and athletics have now endorsed the committee’s recommendations.  

    Since 2000, 21 National Collegiate Athletic Association (NCAA) football athletes have died in the course of conditioning workouts (2).  

    The three main causes of these deaths were exercise-related sudden death associated with sickle cell trait, exertional heat stroke, and cardiac conditions (1).     

    Another condition that has been on the rise in collegiate athletics is exertional rhabdomyolysis – a life-threatening condition affecting skeletal muscle and other tissues resulting from overly intense workouts that push athletes beyond their limits (1). As it seems that conditioning workouts may continue to be a channel to possible tragic outcomes, the NCAA Task Force has come up with the following 10 key areas for universities to abide by for the safety of their athletes (1):  

    1. Acclimatize Progressively for Utmost Safety. Conditioning should be gradually and progressively introduced, especially over the first seven to 10 days of any new conditioning cycle. It is recommended that traditional periods (such as returning from a school break) utilize appropriate work-to-rest ratios specific to the sport. A 1:4 work-to-rest ratio for intense conditioning sessions is a good rule of thumb to allow appropriate recovery.  
    2. Introduce New Conditioning Activities Gradually. New exercises should be introduced in a specific and properly progressed manner by a certified strength and conditioning coach.  
    3. Do Not Use Exercise and Conditioning Activities as Punishment. Physical activity should never be used for discipline purposes.  
    4. Ensure Proper Education, Experience, and Credentialing of Strength and Conditioning Coaches. 
      1. Education: All strength and conditioning coaches need to obtain an undergraduate degree and credentials.  
      2. Experience: Collegiate strength and conditioning coaches need to have mentoring and experience prior to implementing individual and team conditioning programs.  
      3. Credentials: All strength and conditioning coaches should be required to pass a certification examination credentialed by an independent accreditation agency, and should maintain certification in first aid, CPR, and AED.     
    5. Provide Appropriate Medical Coverage. A strength and conditioning coach should be present at all strength and conditioning sessions and be prepared to provide proper assistance immediately if an athlete displays any of the warning signs.  
    6. Develop and Practice Emergency Action Plans. All strength and conditioning sites should have specific Emergency Action Plans that are approved, reviewed, and rehearsed annually by all staff involved.  
    7. Be Cognizant of Medical Conditions. Supervisors must be familiar with the characteristics of exertional collapse and the different diagnoses of other conditions.  
    8. Administer Strength and Conditioning Programs. A strength and conditioning coach and a sports medicine staff member should be part of the institution’s athletic administration to encourage institutional ownership of the sports performance and sports medicine.  
    9. Partner With Recognized Professional Organizations. Key organizations directly responsible for athletes’ safety during strength and conditioning training should formalize a partnership to review best practices.  
    10. Provide Adequate Continuing Education for the Coaching and Medical Teams. Key professionals should adopt requirements for education and training and require individuals to demonstrate knowledge in the area of preventing sudden death in sports.   
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    About the Author:

    Scott Caulfield, CSCS,*D, RSCC

    Scott Caulfield is the Performance Center Manager and Head Strength and Conditioning Coach at the NSCA. HE is responsible for the day-to-day supervision and training of all athletes, interns, and coaches at the NSCA’s 6,000-square-foot Performance Center. He also serves as the Head Strength and Conditioning Coach for Colorado College Men’s Ice Hockey. Scott works diligently to promote the NSCA and its coaches, including work with national governing bodies such as the United States Olympic Committee, U.S. Ski and Snowboard Association, USA Bobsled and Skeleton Federation, U.S. Figure Skating, USA Hockey, and USA Ultimate. He has been a certified member of the NSCA since 2003 and most recently served as an Assistant Strength and Conditioning Coach at Dartmouth College.


    Casa, D, Anderson, S, Baker, L, Bennett, S, et al. The inter-association task force for preventing sudden death in collegiate conditioning sessions: Best practices recommendations. J Athletic Training 47(4): 477-480, 2012.  

    National Center for Catastrophic Sport Injury Research. Annual Research Injury Report. Accessed March 14, 2012 from The National Center for Catastrophic Sport Injury Research.   

  • Disclaimer: The National Strength and Conditioning Association (NSCA) encourages the exchange of diverse opinions. The ideas, comments, and materials presented herein do not necessarily reflect the NSCA’s official position on an issue. The NSCA assumes no responsibility for any statements made by authors, whether as fact, opinion, or otherwise. 
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