To Play or Not to Play: Protecting Students from Poor Air Quality

Wildfire smoke from Canada and the Western United States routinely travels thousands of miles and causes hazardous air quality for large swaths of the United States. Wildfire smoke is not the only cause of poor air quality; wind-driven dust events, temperature inversions, and high temperatures combined with emissions, which cause elevated levels of ozone, are also culprits.

These hazardous air quality events often overlap with outdoor activities for high school students, and this overlap poses a dilemma for coaches, athletic trainers and athletic directors who are responsible for protecting the health of their students.

Participating in outdoor sports is a healthy option for teens, but strenuous activity when the air is unhealthy can harm students. They are particularly vulnerable to unhealthy air because their lungs are developing. During exercise, students breathing rate can increase by up to a factor of 5, thus taking in more polluted air (Sheff 2016).

Over the short term, exercising in polluted conditions reduces cardiopulmonary function, increases blood pressure, and can exacerbate asthma (Lee et al. 2023; Tiano et al. 2021). It also decreases athletic performance, and this decrease can last for days (Rundel 2012; Mullins 2018, Granella 2021). Over the long term, exposure to elevated levels of pollution is associated with increased rates of asthma, cancer and premature death (NIH 2026).

How do you decide when to cancel, relocate or reschedule outdoor practices or games on account of poor air quality?
The NCAA and several states, including California, Illinois, Oregon, Minnesota, Nebraska, Oregon, Utah and Washington have guidelines for youth physical activity and air quality. These guidelines are typically based on air quality index (AQI), which considers the five major indicators of air pollution: ozone, particulate matter, carbon monoxide, nitrogen dioxide and sulfur dioxide. The measured pollutant concentrations are then converted into a number on a scale of 0 to 500. Higher numbers correlate to a greater level of air pollution. Under the Clean Air Act, the National Ambient Air Quality Standard is 100 (US EPA 2026b). Figure 2 shows EPA’s AQI and the corresponding health categories.

The NFHS Sports Medicine Advisory Committee (SMAC) has a position statement on physical activity, air quality and wildfires. This statement directs responsible individuals to EPA’s AirNow.gov site, a primary AQI source, although EPA’s new smoke and fire map, which includes low-cost sensors may be useful (US EPA 2026c).

The NFHS also introduces the 5-3-1 Visibility Index Method — using pre-identified landmarks at 5, 3 and 1 miles from each venue — as a practical backup tool when air quality information is unavailable or unreliable in your area. Visibility methods or a low-cost sensor are particularly useful strategies for rural regions or when conditions are changing rapidly. Figure 3 provides an example of how AQI compares the visibility index method. It is worth noting that visibility is a useful tool for wildfire smoke or dust events, but it is not useful for ozone or other pollutants.

The NFHS position statement on air quality, along with state and organizational guidelines, are great ways to start protecting students participating in outdoor activities. It is important to establish appropriate modifications to activities during periods of poor air quality, particularly for those youth who have increased sensitivities, such as asthma or other respiratory illnesses. These modifications might include increased rest periods and substitutions.

Several guidelines recommend that when the AQI is greater than 150, outdoor activities should be shortened, and exertion should be minimized by decreasing the intensity of the activity; and, if there is substantive evidence that the AQI will remain consistently above 200, those competitions should be postponed, canceled, rescheduled or relocated. If activities are to be moved indoors, check with maintenance staff to ensure that existing HVAC systems provide properly filtered indoor air.

As these air quality principles apply to all youth participating in outdoor activities, it would be beneficial to establish uniform, best practice guidelines for all stakeholders involved, which may include the Board of Education, Department of Health and Human Services, Division of Air Quality, the state association’s Sports Medicine Advisory Committee, the state’s Athletic Trainers Association, Parks and Recreation Association, Parent Teacher Association, school superintendents and state legislators.

Once appropriate guidelines and recommendations are provided, it will be necessary to determine who is responsible for making the appropriate decisions and modifications during activities experiencing poor air quality. Even in states with air quality guidelines, some districts have not yet adopted their state’s guidelines, and some athletic organizations are unaware of air quality guidelines and unsure where to find accurate resources on which to base their decisions (Armendariz et al. 2026). As air quality hazards increase, protecting our students will require uniform guidelines and additional education of our communities.

Acknowledgment
This material is based upon work supported by the National Science Foundation under Award No. 2322009. Any opinions findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

References
S. Armendariz, S.K. Yeo, K.E. Kelly (2026) Understanding High School Athletic Trainers’ Perspectives and Decision-Making Related to Air Quality Concerns in Utah. Journal of Athletic Training Education and Practice. May;22(2):122–130. doi:10.4085/1947-380X-25-081

F. Granella (2021) You can’t run from air pollution: the effect of fine particulate matter on physical tasks (July 26, 2021). Available at SSRN: https://ssrn.com/abstract=3893692

H.Y. Lee, H.J. Kim, H.J. Kim, G.Na , Y. Jang, S. H. Kim, N.H. Kim, H.C. Kim, Y.J. Park, H.C.l Kim, Y-K. Yun, S.W. Lee (2023) The impact of ambient air pollution on lung function and respiratory symptoms in elite athletes. Science of the Total Environment, 855, 158862. https://doi.org/10.1016/j.scitotenv.2022.158862

NFHS (2023) Position Statement on Physical Activity, Air Quality and Wildfires, cited August 10, 2026. https://assets.nfhs.org/umbraco/media/7212236/nfhs-position-statement-on-air-qualityapril-2023-final.pdf

NIH (2026) Air pollution and your health. https://www.niehs.nih.gov/health/topics/agents/ air-pollution

J. T. Mullins (2018) Ambient air pollution and human performance: Contemporaneous and acclimatization effects of ozone exposure on athletic performance, Health Economics, 27: 1189–1200. https://doi.org/10.1002/hec.3667

K. W. Rundell (2012) Effect of air pollution on athlete health and performance. B.r J. Sports Med. 46:407–412. doi:10.1136/bjsports-2011-090823

Sheff (2016) Your lungs and exercise. Breathe, 12(1):97-100. doi: 10.1183/20734735.

M. Tainio, Z.J.Andersen, M.J. Nieuwenhuijsen, L. Hu, A. de Nazelle, R. An, L. M.T. Garcia, S. Goenka, B. Zapata-Diomedi, F. Bull, T.H. de Sá (2021) Air pollution, physical activity and health: A mapping review of the evidence, Environment International, 147, 105954.

US EPA (2026a) Communicating Air Quality Conditions: The Air Quality Index, cited August 8, 2026. https://www.epa.gov/wildfire-smoke-course/communicating-air-quality-conditions-air-quality-index

US EPA (2026b) AirNow.gov, cited August 8, 2026. https://www.epa.gov/wildfire-smokecourse/ communicating-air-quality-conditions-air-quality-index US EPA (2026b) AirNow.gov, cited August 8, 2026. https://fire.airnow.gov/#6/41/-98

Kerry Kelly, PE, Ph.D. is a professional engineer and an associate professor of chemical engineering at the University of Utah. Her research focuses on understanding the connections between energy, air quality and health. More recently, she has focused on using cost-effective, air-quality sensing to understand and address local- scale, air quality challenges. She served eight years on Utah’s Air Quality Board and five years on the state’s air quality policy board.

Douglas Gregory, M.D., is a general pediatrician at Bayview Physicians Group in Suffolk, Virginia. He has been a high school team physician at Western Branch High School in Chesapeake, Virginia for 42 years. Dr. Gregory has been active with the NATA and athletic training education with the Commission on Accreditation of Athletic Training Education and Board of Certification for the Athletic Trainer. Dr. Gregory chairs the Virginia High School League Sports Medicine Advisory Committee. He is a former member of the NFHS Sports Medicine Advisory Committee.

Karl Weenig, M.D., is a primary care sports physician at Intermountain Health Sports Medicine in Provo, Utah. Prior to working as a sports medicine physician, he taught and coached high school students. Weenig chairs the Utah High School Activities Association Sports Medicine Advisory Committee and is a former member of the NFHS Sports Medicine Advisory Committee.