The 2026 International Federation of Association Football (FIFA) Men’s World Cup will be held in the US, Mexico, and Canada from June 11 to July 19, with host cities spread across 4300 km (roughly 2671 miles) from east to west and about 4000 km from north to south. A scientific article published in Sports Medicine analyzes the challenges of the 2026 World Cup for players and, based on scientific studies and data, offers recommendations for protection.

The authors state that the geographic distribution characteristic of this year’s World Cup exposes players to environmental challenges that can negatively affect their health and performance. Among the main challenges are extreme heat, altitude, air pollution, and travel. No previous FIFA World Cup has ever presented such an extreme combination of factors.

Extreme Heat in Host Cities

Extreme heat is expected in 14 of the 16 host cities, with record-high values for the Wet Bulb Globe Temperature index ranging from 21 °C to 35 °C, while average ambient temperatures range from 19.1 °C to 32.7 °C.

“Heat stress can always be a problem, not just in soccer but in any sport in general. High temperatures, dehydration, and fatigue negatively affect performance, also increasing the risk of injury and potentially leading to the dreaded heatstroke,” Claudio Vázquez Colomo, head of the medical services at the Royal Spanish Football Federation, told El Médico Interactivo.

The review offers evidence-based strategies to reduce the impact of the challenges teams face. In addition to acclimatization before matches, strategies for cooling the body before play are particularly important to delay the rise in temperature during exercise. Hydration is recommended before, during, and after the match, for example, with beverages containing electrolytes and carbohydrates.

Moderate Altitudes in Guadalajara and Mexico City

The FIFA World Cup includes matches at moderate altitudes in Guadalajara, which sits 1566 m above sea level (roughly 5138 ft) and in Mexico City, at 2240 m (7350 ft above sea level). “This can also pose a problem. Oxygen deprivation can cause fatigue, dizziness, and weakness in players,” said Vázquez.

The article cites traditional altitude training strategies: live high-train high and live high-train low. It also mentions innovative altitude training strategies, such as live low-train high, considering repeated sprint training in hypoxia to be one of the most effective.

Altitude training requires medical supervision to prevent fatigue, injuries, and illness. Some players may suffer from altitude sickness. Among the clinical considerations, experts note that altitude increases iron requirements, so they recommend monitoring ferritin levels, in addition to tracking oxygen saturation, heart rate, and hydration.

Air Pollution and Seasonal Allergens

Experts also note that increased human activity during major events raises players’ susceptibility to airborne illnesses, as well as the risk for their spread. Furthermore, differences in air pollution and allergen levels between the players’ home club locations and the host cities could also affect their health.

Public health and elite sports guidelines recommend reducing exposure to pollution and pollen. However, many common strategies — such as wearing masks or protective eyewear — are not compatible with the World Cup. Therefore, it is advisable to monitor air quality in real time, track local data, check pollen forecasts, and adjust performance levels if pollution levels are high.

Up to 19 Time Zones to Reach Base Camp

Experts warn that jetlag — up to 19 time zones to reach the teams’ base camps — and travel fatigue — up to three time zones crossed and up to 7 hours of flight time during the tournament — can affect players’ mental and physical health, reducing athletic performance.

“The change in time zones could affect a player’s performance, since rest is the most important factor in performance, along with nutrition. Ideally, teams should travel with enough time for players to acclimate to the new schedule as effectively as possible,” said Vázquez.

Behavioral strategies should be prioritized over the use of medication. It is recommended to avoid sleeping pills and focus on sleep hygiene, light control, meal schedules, and physical activity. Melatonin may be helpful, but it requires medical supervision due to potential side effects and anti-doping concerns.

Competitive Load and Recovery

Added to this context is the tournament’s high competitive load, as 104 matches are played. With this new format, teams can play up to eight matches instead of the usual seven. “In a short tournament with many matches, few rest days, and a lot of travel, the load has a major impact. It’s important to focus heavily on what we call ‘invisible training’: rest, nutrition, and hydration,” explained Vázquez.

In this highly demanding context, strength and conditioning coaches use the concept of load ready, which refers to a player having an optimal workload — balancing training, intensity, and rest — and being physically prepared for the match.

Today performance monitoring and immediate diagnostic technologies are used to quickly assess players, such as “on-field” ultrasound and global positioning system-based workload tracking systems. “‘On-field’ ultrasound is important, above all, for assessing or ruling out a possible injury that occurs during the match. Once evaluated, if any type of injury is detected, an MRI is performed afterward,” said Vázquez.

“The work with the national team is different from that of a club, since we typically manage and work with healthy, uninjured players. For this reason, we focus primarily on recovery strategies,” explained Vázquez. The therapeutic approach frequently used in these types of tournaments includes cryotherapy — the application of cold for muscle recovery — red light therapy, or hyperbaric chambers.

Concussions in Soccer

“Concussions have become a major focus of medical attention in the world of soccer. There appears to be a direct link between repetitive head impacts, concussions, and degenerative processes. After a concussion, the player must rest to avoid the risk of a second impact that could worsen the initial condition. During this rest period, the use of electronic devices should be avoided, and a gradual return to the playing field should be undertaken,” explained Vázquez.

The Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, PhD, stated: “Concussion is a public health issue of concern at all levels of soccer and many other sports, requiring greater levels of awareness and action.” Since 2014, the WHO has been collaborating with FIFA on the “Suspect and Protect” campaign to protect soccer players around the world — both young and old — from the risks for concussions.

Spain at the World Cup

The Spanish national soccer team is in Group H alongside Uruguay, Saudi Arabia, and Cape Verde:

Spain vs Cape Verde → June 15

Spain vs Saudi Arabia → June 21

Uruguay vs Spain → June 27

This story was translated from Univadis Spain, part of the Medscape Professional Network.