Universal Training Precautions: A Review of Evidence and Recommendations for Prevention of Exercise-Related Injury, Illness, and Death

Abstract Facing pressure to train for victory, warfighters and athletes (hereafter, “athletes”) face numerous health risks that are directly related to their regular physical training. The concept of universal training precautions (UTP) signifies universal processes designed to prevent unnecessary bodily harm, to include injury, illness, and death, during such physical training programs. Although no formal guidelines exist for collective implementation of a defined set of precautionary UTP strategies against a broad scope of exercise-related health risks, recommendations and guidelines have been published relating to prevention of sudden death during high school sports and collegiate conditioning sessions. A long list of critical issues must be considered as UTP, to include physical fitness factors, appropriate recovery, use of medications and dietary supplements, hydration, transition period accommodation, environmental factors and acclimatization, and importantly leadership. In this article we outline in detail, along with a corresponding strength of recommendation taxonomy, what should be considered a “universal recommendation” to minimize risk of athletes coming to harm when participating in group physical activities.