Intro: This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm Caitlin Whyte. And in this episode, we are talking about exercising safely in the heat with Dr. Fred Brennan, Jr. a Family Medicine and Sports Medicine Physician with BayCare. So, Doctor it's a hot summer day, but we want to get some movement in, what should we do to prep even before we leave the house?

Fred H. Brennan Jr. DO, FAOASM, FAAFP, FACSM, FAMSSM (Guest): Well, I think the biggest thing is, you know, you have to really work into being acclimated and getting used to being out in the heat. And I think one of the biggest problems that people do is, you know, it starts getting warm, they want to get outside, so exercising more, but don’t realize, especially here in Florida, how hot it can be.

And I think one of the things to do is really to think about how you're going to acclimate. And that is to get going slowly, not to go outside in the middle of the day where it's blazing hot and then go for an hour walk when for the most part you've been inside for most of the spring or the winter.

So, I think that's really important to you know, start off slowly, you know, wear cool clothes, light clothes, not dark clothes, a hat. Certainly again, if you're in a hot, sunny place to apply sunscreen to the areas that could potentially get burned, because as you know it doesn't take very long in this heat to get burned, but to acclimate, you know, really to plan on that the first two weeks or so gradually building up, you know, for the first couple of days, just go out for 10 or 15 minutes and definitely plan on going on the cooler part of the days. Again, not to go out at noon time, but more to go out first thing in the morning until your body starts to acclimate. And it does take a good couple of weeks of being exposed to the heat for your body to acclimate and get used to the heat.

Host: That does lead me into my next question. Talking about timing. What are some of the best times to workout outside?

Dr. Brennan: It's tough. I mean, folks often don't like to get up too early. I spent a lot of time in the military. So, I'm used to getting up early, but I realize that some people between their work hours and things, sometimes that's not the best, but honestly, you know, the first part of the day is a good time to get out before the sun really comes up where it's light enough and safe enough to go out and exercise, but that it's not, you know, direct beaming sunshine on you. So, I like to tell people to get out again, depending on the time of the year, really before the sun gets fully up over the tree line, so that the temperatures haven't had a chance to rise yet. The other time it's not bad also, is you know, at the end of the day, we have about an hour, 45 minutes before the sun sets, where again, things are starting to cool down, the sun's not directly on you anymore. And, that's also a better time to get out and exercise.

Host: And what kinds of exercise and movement should we be doing in the heat of the day?

Dr. Brennan: Well, running is rough, right? In the sense that you exert yourself pretty heavy when you run. I think cycling is a good, is a good thing because you know, as we're moving on a bike, you have the natural breeze cooling you as you ride. So, I think if you really don't have an option of exercising in an earlier or later part of the day, and you say, well, the only time I can get out and exercise is noontime, then I think cycling is a good exercise for that. Obviously, swimming you know, if you have access to a swimming pool and you can get out and swim, that's obviously a good time to swim because you have the water to cool you off.

Host: So let's talk about fluids, the correct amount and the type of fluids to drink. How do we know how much to consume?

Dr. Brennan: Well, you know, there's been a lot of old school thoughts on this, you know, we used to say that, well, if you wait until you're thirsty, you've missed the boat. Right? And it actually, the studies are sort of conflicting. Some studies have said that thirst is a good indicator that you haven't had enough to drink. And other studies say, no, it's too late, you've missed the boat. I think, you know, in general, water is always good. And the next thing would be if you're going to exercise, you know, more than an hour in the high heat, it's a good idea to have something with some electrolytes, like a sports drink.

Because you will lose, if you're really sweating, you're going to lose sodium, which if you get to sodium depleted, you may be cramping. You just may feel sluggish. And so I usually tell folks if it's less than an hour, you're probably going to be okay with just replenishing with water, depending on how hot it is and how much you sweat.

Some people sweat a lot more than others, you know, 12 to 24 ounces in an hour may be fine depending on again, how hot it is and how much you sweat. I think it's better to sort of graze on the water if you will, as opposed to trying to chug 12 ounces at a time, because most of us don't tolerate that very well.

So, just constantly, you know, every five or 10 minutes taking a good mouthful of water is a good idea. Now, again, if you're going to go for more than an hour, especially in the heat, and when you're really sweating a lot, you are going to want to get some sort of sodium replacement and that could be eating some pretzels. It could be eating some potato chips. It could be just a sports drink will give you some sodium back, which will lose in your sweat and you definitely need to replenish.

Host: And then what are some signs or symptoms that unfortunately you may be succumbing to the heat physically?

Dr. Brennan: Yeah, that's a good question. And I spent a lot of time in the military and this is a big issue in the military is when you're training, when are you getting in trouble and heat injuries are sort of on a continuum between a lot of people will get some heat cramps initially. And then other times they may start to get heat exhaustion.

And usually what you'll start to feel is feeling tired, running out of energy, flushed. They may be profusely sweating or not sweating much at all, but a lot of times it's a fatigue factor. They feel like they're running out of gas. They just feel really tired and sluggish, and there may be cramping, as we talked about, they may be cramping up. When it gets to the point where they're getting into heat stroke, that's of course an emergency. And a lot of people might not realize they're getting there. Someone else will notice it. Like someone will notice their partner who they are exercising with, is starting to act odd or starting to swerve for example, when they're running, they're starting to run awkwardly. But the biggest thing is mental status changes. They're not acting right in the heat. And that's when you really have to worry that this has gotten to the point where they are now in heat stroke, that's an emergency. You have to get them to medical care and cool them off immediately.

Host: And on that note, how about some cool-down or recovery techniques?

Dr. Brennan: Well, the biggest thing, you know, the most effective way to cool someone off that's in heat stroke is, believe it or not, ice water immersion, but most of us that are walking around, don't have access to an ice tub, right? Full of water. But you want to get someone, if you suspect, for example, you're exercising with a friend and it's really hot out, and they're starting to act really odd, strange, slurring words, or just look confused. And you're saying, I think I'm worried that this person is heat stroke. First thing you got to do is get them, get them off into the shade, get them out of the direct sun.

Start taking some layers off if they're really bundled up for whatever reason, you know, keeping modesty in mind. You want to remove as much of the clothing as you can, whatever you have to cool off is going to help, whether it's pouring a bottle of ice water over their head, whether it's fanning them, you know, anything you can do to start to, you know, get them under a fan, get them into a building that's air conditioned as quick as you can.

And then of course, if you suspect like wow they're acting really strange and they're really hot too, you know, call 911 and get, get somebody to help. But the biggest thing is recognizing that they're in trouble or could be in trouble, getting them out of that heat. Get them into air conditioning, get some of the layers off, get them out of the direct sun and then immediately start the cooling process with any means you have again, fan, cold bottle of ice water over their head, over their torso. Anything that can start the cooling process is going to help hopefully reverse the process or start the reversal of the overheating.

Host: Great, well, Doctor some great tips here. Is there anything else you'd like to add to this conversation on working out in the heat?

Dr. Brennan: Yeah, again, I think the key points are acclimating, wearing the correct clothing, you know, not being overdressed, being able to shed layers. If you start off exercising it's cooler and it gets warmer, be able to shed the layers off. Exercise in the cooler part of the days, not the hotter part of the days. You know, beware of the humidity, it will sneak up on you quickly. And if you're not feeling right in the heat to get out of the heat, go inside where it's air conditioned, give yourself a break. And then if you feel well enough to go back out, okay. If you don't just call it a day and go back the next day.

Host: Well, Doctor, we appreciate your time today and hope you're staying cool this summer. Head on over to our website at BayCare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlin Whyte. Stay well.