By Dr. David Carfagno, D.O., C.A.Q.S.M.

Arizona summers can be scorchers, but that doesn’t mean you have to put exercise on the back burner. There are several ways to break a sweat without going to the emergency room.

For the past two decades I have been the medical director for several high-profile races locally and nationally, including the Rock ‘n’ Roll Marathon Series and Ironman Arizona, and manage and supervise all of the medical issues that present at the events and with that provide tips on how athletes can keep from getting overheated while training and during their big race.

Heat illness is one of the most common serious problems that someone can encounter. On a hot day, the main concern is fluid and sodium replacement. You sweat water, but also a significant amount of electrolytes, including sodium, potassium and magnesium.  

Here are a few of my recommendations to not suffer from heat illness when training for your race: 

-Prepare. Acclimatize your body in similar temperature conditions as you will be performing in. Don’t show up at a race/event that is at 100 degrees and 90% humidity after training indoors at 75 degrees. The same goes with nutritional/hydration strategy.  Practice similar fluid/food preparation during your practice runs/bikes/swim as you would on race day.  

-Avoid the outdoors this time of year during the daylight hours. Temperatures are in the triple digits earlier now and into the evening.  This will not only affect your chances of having a heat illness, but affect your overall energy levels and ability to prepare for your next workout.  Aim to go early in the morning, or evening, or indoors if possible.  

-Train up north. Cooler temperatures drive many athletes to get their volume work, longer distances, in Flagstaff, Prescott and Payson.  

-Track your numbers. Weigh yourself before and after each longer workout.  Each pound loss is equivalent to 16-20 ounces of fluid and will give you the approximate amount of fluid you will need per hour for workouts. Are you a heavy sweater?  If so, you may need to add salt — 1.3 grams of sodium per body weight loss in pounds is an old equation we have used since my Cleveland Clinic Fellowship days. On average we aim for 20-32 ounces an hour. Carbohydrates in the form of gels, goos, etc, aim for approximately 50-60 grams/hour. Remember, for most exercise sessions less than 60 minutes, usually just water as your hydration is adequate.

-Cross train: Add resistance training in some form whether it’s body weight, yoga, weight training, pilates, boot camp, etc.  Recovery methods aimed at restoring the body’s physiological demands to the tissue can be massage, stretching, manual medicine or compression technology like vibrational devices (Theragun, Hypervolt, etc.). Don’t forget getting adequate restorative sleep, aiming for deep sleep.

On the day of the race, I suggest doing the following: 

-If you have calculated your replacement needs in advance, plan on a little extra fluid and sodium. If not, you should limit your intake to no more than 8 ounces per 20 minutes for a 4-5 hour race, or 4-6 ounces per 20 minutes for a race greater than 5 hours. 

-A simple way to avoid overhydration is to drink only when thirsty. You should concentrate on getting enough Gatorade, which contains 200 mg of sodium per 8 ounces. If you’re a heavy sweater, I recommend adding a small salt pack, available at all First Aid stations and the midpoint of each race, to a cup of the fluid. If you start to notice a decrease in sweat rate, or develop a headache, nausea, edema (puffiness), or muscle cramping, you likely need more salt. 

-You should wear sunblock with SPF 30 or greater because sunburned skin does not sweat well. I would avoid the 
waterproof brands, which block pores and impair sweating.

-I suggest pinning your bib number on your shorts and not over your chest or abdomen, where it will obstruct the flow of air to cool the core.

-Don’t forget to protect your eyes with sunglasses or a lightweight hat and, finally, unless you have trained or 
acclimatized for these race conditions, slow down and make this a fun experience for everyone.

If you have any questions, concerns, or you want customized advice for your workouts or races, call us at 480-664-4615 or go to to schedule an appointment. Our world-renowned sports medicine team can help you.