RQES Table of Contents

Top 10 Research Questions Related to Preventing Sudden Death in Sport and Physical Activity

Rachel K. Katch, Samantha E. Scarneo, William M. Adams, Lawrence E. Armstrong, Luke N. Belval, Julie M. Stamm, and Douglas J. Casa

Participation in sport and physical activity is on the rise, with an estimated 7.8 million and 482,533 studentathletes participating in sport at the secondary school and collegiate levels, respectively (Kucera, Yau, Thomas, Wolff, & Cantu, 2016). These numbers, stemming from the 2014 to 2015 academic year in the United States, have nearly doubled in the last 40 years (National Federation of State High School Associations, 2015a). Additionally, according to the 2017 U.S. labor force statics (U.S. Department of Labor, 2017) and National Defense Authorization Act (2016), there are an estimated 1.2 million labor workers and approximately 2.9 million U.S. military personnel (i.e., active, guard, reserve, and civilian). Combined, that number is approximately 12.4 million individuals who are involved in athletics, warfighting, and physical labor and are exposed to strenuous workloads and intensities that could potentially lead to suffering sudden death.

At the collegiate and secondary school levels during 2013 to 2014, there were a total of 92 catastrophic injuries/illnesses, with the most common areas of the body affected being the heart (46%), neck/cervical spine (14%), and the head/brain (13%; Kucera et al., 2016). Investigating the sport of football alone at the same levels of participation, Boden, Breit, Beachler, Williams, and Mueller (2013) broke down the causes of 243 catastrophic deaths from 1990 to 2010 (Figure 1) and found the leading causes of death to be cardiacrelated (41%), head injuries (25%), and heat illness (16%). In examining the warfighter, Eckhart et al. (2004) investigated all nontraumatic deaths in the U.S. military during a 25-year period and found out of 126 deaths, 108 (86%) were related to exercise, while identifiable cardiac abnormalities (51%) were among the top causes of death. Unfortunately, as physical activity participation rates increase, so do the number of catastrophic injuries; however, many of these cases of sudden death could have been prevented and/or survivable if current evidence-based best practices and guidelines were followed (Andersen, Courson, Kleiner, & McLoda, 2002; Armstrong et al., 2007; Casa et al., 2000, 2012, 2013, 2015; Heck, Clarke, Peterson, Torg, & Weis, 2004; Maron & Zipes, 2005).

With the enhancement of technology naturally comes the enhancement of strategies to prevent sudden death, leading to best-practice guidelines requiring regular review and sometimes revision. Thus, this manuscript will provide insight into some of the field’s most pressing research questions regarding a multitude of different topics and may potentially question the norm on what truly are the best methods for preventing sudden death in sport and physical activity.

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