{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T12:13:04Z","timestamp":1790338384975,"version":"4.1.0"},"reference-count":43,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The incidence of nontraumatic fatalities in high school (HS) and National Collegiate Athletic Association (NCAA) football players has continued at a constant rate since the 1960s.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To describe the causes of nontraumatic fatalities in HS and NCAA football players and provide prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Descriptive epidemiology study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We reviewed 187 fatalities in HS and NCAA nontraumatic football players catalogued by the National Registry of Catastrophic Sports Injuries during a 20-year period between July 1998 and June 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The majority (n = 162; 86.6%) of fatalities occurred during a practice or conditioning session. Most fatalities, when timing was known, (n = 126; 70.6%) occurred outside of the regular playing season, with the highest incidence in the August preseason (n = 64; 34.2%). All documented conditioning sessions were supervised by a coach (n = 92) or strength and conditioning coach (n = 40). The exercise regimen at the time of the fatality involved high-intensity aerobic training in 94.7%. Punishment was identified as the intent in 36 fatalities. The average body mass index of the athletes was 32.6 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . For athletes who died due to exertional heat stroke, the average body mass index was 36.4 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and 97.1% were linemen.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Most nontraumatic fatalities in HS and NCAA football players occurred during coach-supervised conditioning sessions. The primary cause of exertion-related fatalities was high-intensity aerobic workouts that might have been intended as punishment and\/or excess repetitions. Exertion-related fatalities are potentially preventable by applying standards in workout design, holding coaches accountable, and ensuring compliance with the athlete\u2019s health and current welfare policies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2325967120943491","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T12:16:42Z","timestamp":1597925802000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Nontraumatic Exertional Fatalities in Football Players, Part 2: Excess in Conditioning Kills"],"prefix":"10.1177","volume":"8","author":[{"given":"Barry P.","family":"Boden","sequence":"first","affiliation":[{"name":"The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken M.","family":"Fine","sequence":"additional","affiliation":[{"name":"The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiahna A.","family":"Spencer","sequence":"additional","affiliation":[{"name":"The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Breit","sequence":"additional","affiliation":[{"name":"The Orthopaedic Center, Centers for Advanced Orthopaedics, Rockville, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Athletics, University of Oklahoma, Norman, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"bibr1-2325967120943491","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-51.4.14"},{"key":"bibr2-2325967120943491","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-52.3.02"},{"key":"bibr3-2325967120943491","doi-asserted-by":"publisher","DOI":"10.1519\/JSC.0b013e31824f2091"},{"key":"bibr4-2325967120943491","unstructured":"Azar FM, Bernstein BL, Ehrlich RLJr, et al. 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