Pressure is mounting on the NRL to curb gruelling pre-season training sessions following the “tragic” death of young Manly player Keith Titmuss, after the Rugby League Players Association (RLPA) threw their support behind all 12 recommendations from a coronial inquest.

The 20-year-old Titmuss suffered a seizure after an indoor workout at the Sydney club’s northern beaches base in 2020. The coroner found on Friday that the young forward’s cause of death was exertional heat stroke and the session “was, more likely than not, inappropriate”.

The recommendations include requiring the NRL to look at mandating a two-week acclimatisation period when players return from their off-season and adjusting training plans based on a player’s level of fitness and size.

“Keith’s death was tragic and possibly avoidable,” the RLPA stated. “The state coroner’s findings must ensure that Keith’s legacy can be used to further protect all current and future elite rugby league players and other athletes in this country.”

Both the RLPA and NRL have expressed condolences to Titmuss’ family and friends. His mother, Lafo Titmuss, urged all involved to adopt the recommendations last week.

The RLPA said: “These findings must be taken under serious consideration by the NRL and should play a significant part in developing future policies for our members, who are people participating in a workplace.”

An NRL spokesperson said the governing body “acknowledges” the findings, and it was already looking at implementing recommendations.

“The NRL has already commenced work on the coroner’s recommendations and will commission experts to further review our policies and update them to ensure best practice,” the spokesperson added.

Professor Ollie Jay from the University of Sydney, and Dr Douglas Casa, chief executive of the Korey Stringer Institute based in the US, have been undertaking a review of the NRL’s heat policy since December.

Deputy state coroner Derek Lee recommended to NRL chief executive Andrew Abdo that Prof Jay and Dr Casa be asked to consider several reforms to training as part of their work.

These included mandating “a 14 day period of controlled training load (acclimatisation) for players who return to training after an extended break from training”.

Players are often subjected to intense training sessions when they return from the off-season breaks, and the pre-season is seen by coaches as a crucial opportunity for players to build strength and fitness ahead of the season.

Lee also recommended players be classified “according to the known risk factors for exertional heat illness such as fitness levels (low aerobic capacity), size, high body mass index and training history,” with their training to be adjusted accordingly.

The RLPA statement said Titmuss was “a person first and then an employee of a club”.

“These findings must be taken under serious consideration by the NRL and should play a significant part in developing future policies for our members, who are people participating in a workplace.”

The issue of acceptable training practices in the NRL has been thrust into the spotlight by the death of Titmuss, as well as a case brought by Jackson Topine against his former club Canterbury after he was allegedly forced to wrestle 30 to 35 teammates as punishment for being late to training.

The RLPA said it would “advocate for and work with the NRL and all clubs to consider and adopt all the state coroner’s recommendations”.