A third-party Navy SEAL instructor who led a strenuous training session that led to the hospitalization of lacrosse players at Tufts University appeared to lack credentials to supervise group exercise, and the university should enact stricter procedures for workouts, according to an independent review released Friday.

The Tufts men’s lacrosse team and two other students participated in the workout led by a recent graduate of the Boston-area university who was a former lacrosse team equipment manager and current Navy SEAL, the review noted. The September 2024 workout was “unusually intense,” and resulted in 24 of the 61 participants developing rhabdomyolysis, a serious and uncommon muscle injury, it stated.

Nine of the students had to be hospitalized, according to the review, which was prepared by sports medicine consultant Rod Walters and attorney Randy Aliment. The review states that the Navy SEAL’s lack of proper credentials and Tuft’s lack of a plan for transportation of students to hospitals led to a dangerous scenario that could have been avoided.

“The Navy SEAL Workout did not follow principles of acclimatization that are necessary to avoid injury during training,” the report states. “The Navy SEAL Workout was not exercise-science based, physiologically sport-specific, or tailored to the individual sport of lacrosse.”

The review stated that the Navy SEAL who led the workout declined to be interviewed, though others in the investigation were cooperative. The review does not name the Navy SEAL, and the university declined to do so. The Associated Press sent several emails and left a phone message seeking comment with Navy officials.

Students who participated in the workout were not informed of the exercises or amounts of repetitions they would be required to perform, the review states. Some accounts of the workout said students “performed about 250 burpees and other exercises over the approximately 75-minute workout,” and students who struggled with it were taken out to lower their heart rates with slower exercises, it states.

While 40% of participants completed the workout without modification, students began complaining of soreness afterward, the review states. In the coming days, cases of exertional rhabdomyolysis — a potentially life-threatening condition in which muscles break down — were identified, according to the review.

The review concludes that Tufts personnel need a better understanding of their roles and responsibilities in the future to prevent a similar scenario from happening again. That means “vetting of team workout plans that deviate from those usually employed,” it states.

The Tuft’s men’s lacrosse team is one of the most successful at the Division III level in the nation, and won the NCAA championship in 2024.

All students have recovered and returned to normal activity, Tufts president Sunil Kumar and athletics director John Morris said in a statement.

However, “it is critical that we understand what led to this situation and to take steps to develop better and safer training practices for our student-athletes,” the statement said.