Fluid and electrolyte balance in ultra-endurance sport

Comparative effects of selected non-caffeinated rehydration sports drinks on short-term performance following moderate dehydration

BACKGROUND

The effect of moderate dehydration and consequent fluid replenishment on short-duration maximal treadmill performance was studied in eight healthy, fit (VO2max = 49.7 +/- 8.7 mL kg-1 min-1) males aged 28 +/- 7.5 yrs.

METHODS

The study involved a within subject, blinded, crossover, placebo design. Initially, all subjects performed a baseline exercise test using an individualized treadmill protocol structured to induce exhaustion in 7 to 10 min. On each of the three subsequent testing days, the subjects exercised at 70-75% VO2max for 60 min at 29-33 degrees C, resulting in a dehydration weight loss of 1.8-2.1% body weight. After 60 min of rest and recovery at 22 C, subjects performed the same treadmill test to voluntary exhaustion, which resulted in a small reduction in VO2max and a decline in treadmill performance by 3% relative to the baseline results. Following another 60 min rest and recovery, subjects ingested the same amount of fluid lost in the form of one of three lemon-flavored, randomly assigned commercial drinks, namely Crystal Light (placebo control), Gatorade(R) and Rehydrate Electrolyte Replacement Drink, and then repeated the treadmill test to voluntary exhaustion.

RESULTS

VO2max returned to baseline levels with Rehydrate, while there was only a slight improvement with Gatorade and Crystal Light. There were no changes in heart rate or ventilation with all three different replacement drinks. Relative to the dehydrated state, a 6.5% decrease in treadmill performance time occurred with Crystal Light, while replenishment with Gatorade, which contains fructose, glucose, sodium and potassium, resulted in a 2.1% decrease. In contrast, treatment with Rehydrate, which comprises fructose, glucose polymer, calcium, magnesium, sodium, potassium, amino acids, thiols and vitamins, resulted in a 7.3% increase in treadmill time relative to that of the dehydrated state.

CONCLUSIONS

The results indicate that constituents other than water, simple transportable monosaccharides and sodium are important for maximal exercise performance and effective recovery associated with endurance exercise-induced dehydration.

Estimation of prepractice hydration status of National Collegiate Athletic Association Division I athletes

CONTEXT

To our knowledge, no one has compared the prepractice hydration status of male and female National Collegiate Athletic Association (NCAA) Division I athletes or has studied the effects of the menstrual cycle phase on women's prepractice hydration status.

OBJECTIVE

To report prepractice hydration status of collegiate athletes and determine the factors that might influence that status.

DESIGN

Cross-sectional, descriptive study.

SETTING

University sports team practices.

PATIENTS OR OTHER PARTICIPANTS

Participants included 138 male and 125 female athletes (age = 19.9 + or - 1.3 years, height = 165.8 + or - 42.9 cm, mass = 77.4 + or - 17.5 kg) from an NCAA Division I New England university.

INTERVENTION(S)

One spontaneously voided (spot) urine sample was collected from each participant before his or her team practice and was measured 2 times.

MAIN OUTCOME MEASURE(S)

A refractometer was used to analyze the amount of light that passed through a small drop of urine and assess urine specific gravity. Fluid intake and menstrual history for women were also collected. Three hydration-status groups were defined based on the American College of Sports Medicine and National Athletic Trainers' Association criteria: (1) euhydrated, which was urine specific gravity less than 1.020; (2) hypohydrated, from 1.020 to 1.029; and (3) significantly hypohydrated, equal to or more than 1.030.

RESULTS

Thirteen percent of student-athletes appeared significantly hypohydrated, with a mean urine specific gravity of 1.031 + or - 0.002 (chi(2) = 12.12, P < .05); 53% appeared hypohydrated, with a mean urine specific gravity of 1.024 + or - 0.003 (chi(2) = 12.12, P < .05); and 34% appeared euhydrated, with a mean urine specific gravity of 1.012 + or - 0.005 (chi(2) = 0.03, P > .05). A greater percentage of men (47%) than women (28%) were hypohydrated (chi(2) = 8.33, P < .05). In women, no difference was evident between the luteal and follicular phases of their menstrual cycles (chi(2) = 0.02, P > .05).

CONCLUSIONS

Before activity, athletes were hypohydrated at different levels. A greater percentage of men than women were hypohydrated. Menstrual cycle phase did not appear to affect hydration in women.

ISSN exercise & sport nutrition review: research & recommendations

Sports nutrition is a constantly evolving field with hundreds of research papers published annually. For this reason, keeping up to date with the literature is often difficult. This paper is a five year update of the sports nutrition review article published as the lead paper to launch the JISSN in 2004 and presents a well-referenced overview of the current state of the science related to how to optimize training and athletic performance through nutrition. More specifically, this paper provides an overview of: 1.) The definitional category of ergogenic aids and dietary supplements; 2.) How dietary supplements are legally regulated; 3.) How to evaluate the scientific merit of nutritional supplements; 4.) General nutritional strategies to optimize performance and enhance recovery; and, 5.) An overview of our current understanding of the ergogenic value of nutrition and dietary supplementation in regards to weight gain, weight loss, and performance enhancement. Our hope is that ISSN members and individuals interested in sports nutrition find this review useful in their daily practice and consultation with their clients.

Effects of aerobic fitness on hypohydration-induced physiological strain and exercise impairment

AIM

Hypohydration exacerbates cardiovascular and thermal strain and can impair exercise capacity in temperate and warm conditions. Yet, athletes often dehydrate in exercise, are hypervolaemic and have less cardiovascular sensitivity to acute hypervolaemia. We tested the hypothesis that trained individuals have less cardiovascular, thermoregulatory and performance affect of hypohydration during exercise.

METHODS

After familiarization, six trained [VO(2 peak) = 64 (SD 8) mL kg(-1) min(-1)] and six untrained [O(2 peak) = 45 (4) mL kg(-1) min(-1)] males cycled 40 min at 70%O(2 peak) while euhydrated or hypohydrated by 1.5-2.0% body mass (crossover design), before a 40-min work trial with euhydration or ad libitum drinking (in Hypohydration trial), in temperate conditions (24.3 degrees C, RH 50%, v(a) = 4.5 m s(-1)). Baseline hydration was by complete or partial rehydration from exercise+heat stress the previous evening.

RESULTS

During constant workload, heart rate and its drift were increased in Hypohydration compared with Euhydration for Untrained [drift: 33 (11) vs. 24 beats min(-1) h(-1) (10), 95% CI 5-11] but not Trained [14 (3) vs. 13 beats min(-1) h(-1) (3), CI -2 to 3; P = 0.01 vs. Untrained]. Similarly, rectal temperature drift was faster in Hypohydration for Untrained only [by 0.57 degrees C h(-1) (0.25); P = 0.03 vs. Trained], concomitant with their reduced sweat rate (P = 0.05) and its relation to plasma osmolality (P = 0.03). Performance power tended to be reduced for Untrained (-13%, CI -35 to 2) and Trained (-7%, CI: -16 to 1), without an effect of fitness (P = 0.38).

CONCLUSION

Mild hypohydration exacerbated cardiovascular and thermoregulatory strain and tended to impair endurance performance, but aerobic fitness attenuated the physiological effects.

Fluid replacement following dehydration reduces oxidative stress during recovery

To investigate the effects of hydration status on oxidative DNA damage and exercise performance, 10 subjects ran on a treadmill until exhaustion at 80% VO(2max) during four different trials [control (C), 3% dehydration (D), 3% dehydration+water (W) or 3% dehydration+sports drink (S)]. Dehydration significantly decreased exercise time to exhaustion (D<C and S). Plasma MDA levels were significantly higher at pre-exercise in D than C. Plasma TAS was significantly lower at pre-exercise in C and S than in D, and was significantly lower in S than D at 60min of recovery. Dehydration significantly increased oxidative DNA damage during exercise, but fluid replacement with water or sports drink alleviated it equally. These results suggest that (1) dehydration impairs exercise performance and increases DNA damage during exercise to exhaustion; and (2) fluid replacement prolongs exercise endurance and attenuates DNA damage.

Urine output and performance of runners in a 12-hour ultramarathon

OBJECTIVE

To understand the urination pattern and to determine the relationships between urine output and performance of ultramarathon runners.

DESIGN

Prospective observational study.

SETTING

The 2005 Soochow University international ultramarathon, in which each athlete ran for 12 hours.

PARTICIPANTS

All entrants in the 12-hour race were invited to participate in the study.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Athletes were weighed immediately before and after the race. Urine samples were collected during the race and immediately after the race.

RESULTS

There was a trend toward better performance of the group with less urination (LU), although the difference was not statistically significant. Further analysis of hourly running distances between groups showed better performance in the group with LU during the first 11 hours of the competition. Comparison of athletes in 3 levels of running distance (tertiles) showed statistically significant differences between groups in total urine output. The fastest tertile had lower prerace body weight and greater body weight change than the slowest and intermediate tertiles, but the differences were not statistically significant. Linear regression analysis using the stepwise method showed that total urine output and prerace body weight were negatively associated with performance.

CONCLUSIONS

Runners with LU had better performance during the first 11 hours of the competition. Linear regression analysis showed that total urine output and prerace body weight were negatively associated with performance.

Musculoskeletal performance and hydration status

Maximal performance during competition is the drive many competitors use to train harder. However, there are several variables that contribute to impair a competitor's performance. These variables work by altering the homeostatic mechanisms within the body. Once homeostasis is altered the competitor's body is no longer optimized to face the stresses of the athletic competition. The environment works as an all encompassing variable that will affect sweat rate. During increased environmental heat strain, one must adjust for critical variables, such as temperature regulation, hydration status, and electrolyte levels, as they can contribute to impaired performance. Acclimatization through training and competition will reduce or slow down the effects of these stress factors. Ever evolving recommendations are produced to aid competitors in maintaining homeostasis. Despite all the generic recommendations that are made, however, every athlete needs to individualize their training and competition regimens to optimize personal performance.

Athletic performance and serial weight changes during 12- and 24-hour ultra-marathons

OBJECTIVE

The principal objective of this study was to evaluate serial weight changes in athletes during 12- and 24-hour ultra-marathons and to correlate these changes with athletic performance, namely the distance covered.

DESIGN

This was a prospective study.

SETTING

The 2003 Soochow University international ultra-marathon.

PARTICIPANTS

Fifty-two race participants.

INTERVENTIONS

12- or 24-hour ultra-marathon.

MAIN OUTCOME MEASUREMENTS

Body weight changes were measured before, at 4-hour intervals during, and immediately after the 12- and 24-hour races.

RESULTS

Significant overall decreases in body weight were apparent at the conclusion of both races. The mean relative body weight change after the 12-hour race was -2.89 +/- 1.56%, ranging from 0 to 6.5%. The mean relative body weight change after the 24-hour race was -5.05 +/- 2.28%, ranging from -0.77% to -11.40%. Of runners in the 24-hour race, 26% lost greater than 7% of baseline body weight during the race. During both the 12- and 24-hour races, the greatest weight change (decrease) occurred during the first 4 hours. Weight remained relatively stable after 8 hours, although a further decrease was apparent between 16 and 20 hours in the 24-hour participants. Weight change had no bearing on performance in the 12-hour race, whereas weight loss was positively associated with performance in the 24-hour race.

CONCLUSIONS

Our findings demonstrate that the majority of weight decrease/dehydration in both the 12- and 24-hour races occurred during the first 8 hours. Hence, to maintain body weight, fluid intake should be optimized in the first 8 hours for both 12- and 24-hour runners and in 16 to 20 hours for 24-hour marathon runners.

Energy balance during two days of continuous stationary cycling

This study examined the capabilities of an ultraendurance athlete to self-regulate their diet during an attempt on the record for the longest period of stationary cycling. The attempt required the athlete to complete at least 20 km/hr, with a 15 minute break allowed every eight hours. Laboratory tests determined a heart rate-oxygen consumption regression equation enabling calculation of energy expenditure from heart rate during the attempt. Energy intake was determined by a non-weighed dietary record collected at the time of consumption. The athlete completed 46.7 hours, covering 1126 km, at a speed of 24 +/- 1.6 km/hr. He expended 14486 kcal and consumed 11098 kcal resulting in an energy deficit (-3290 kcal) and a weight loss (-0.55 kg). The carbohydrate (42 +/- 32 g/hr), water (422 +/- 441 ml/hr), and sodium (306 +/- 465 mg/hr) intake were all below current recommendations. The athlete was unable to self-regulate his diet or exercise intensity to prevent a negative energy balance.

Body mass changes and nutrient intake of dinghy sailors while racing

Dinghy sailing is a physically challenging sport with competitors on water for several hours. Regulations and space in the boat limit the amount of food and fluid competitors can carry. Consequently, it is possible that the hydration and nutritional status of dinghy sailors may be compromised while racing. Despite this, the food and fluid intake of sailors while racing are unknown. The aim of this study was to assess the dietary intake of a group of club sailors while racing and compare this with current sports nutrition guidelines. Thirty-five sailors (9 females, 26 males) were monitored during a club regatta. Body mass changes were measured before and after racing, as were food and fluid intake. Results showed that most participants were in negative fluid balance after racing (males: mean -2.1%[95% confidence limits -1.7 to -2.5%]; females: -0.9%[0 to -1.8%]), most likely due to low voluntary fluid intake (males: 1215 ml [734 to 1695 ml]; females: 792 ml [468 to 1117 m]). Carbohydrate intake (males: 59 g [21 to 97 g]; females: 30 g [0 to 61 g]) was below recommendations for normal sports activity. Results revealed that the nutritional practices of club sailors do not comply with current sports nutrition guidelines. However, the performance implications of a compromise in nutrient intake remain to be investigated. Practical advice on methods of overcoming space limitations for the carriage of adequate fluid and food is offered.

Patient hydration: a major source of laboratory uncertainty

Movement of body water from compartment to compartment during any time period is attributable to forces active within and upon each space. The result of these forces leads to transfer of water between intravascular and extravascular compartments, as well as shifts between extracellular and intracellular spaces. The importance of these shifts and of the associated mechanism was described by Ernest Starling in 1896 in very much the same manner as it is viewed today. The end result of fluid transfer and its physiological and laboratory consequences has not been fully appreciated. Despite awareness that fluid shifts can affect laboratory analytical results, little recent investigation has addressed the problem in the routine clinical laboratory. Thus, the potential for significant misinterpretation remains. For example, it is known that individual laboratory test values can vary widely, depending on many factors including the subject's posture during and immediately before phlebotomy, leading to significant changes in the interpretation of blood analyte values. Furthermore, a variety of ubiquitous environmental effects have additional impact on fluid distribution and thus on test values. In other words, patient hydration status is a major pre-analytical variable that needs to be addressed by the clinical laboratory. The need to adjust data for patient hydration status is especially important in the case of colloid analytes for which the dynamic range includes a narrow "gray zone" where hydration changes of a few percentage points can change the clinical implications. The crucial importance of this adjustment is underscored by the fact that neither the testing laboratory nor the clinician are aware of this unseen circumstance and are thus compelled to work with data that do not necessarily reflect the clinical situation.

Safe and healthy school environments

Children spend much of their waking time at school. Many of the factors in the school environment can be improved with careful planning and allocation of resources. The pediatrician, as a child advocate, is in an excellent position to influence the allocation of school resources to improve the educational outcome. This article summarizes some of the current understanding gathered from applying an environmental health approach to the school setting and provides a basis for the interested physician and other child advocate to learn more and get involved.

Fluid and fuel intake during exercise

The amounts of water, carbohydrate and salt that athletes are advised to ingest during exercise are based upon their effectiveness in attenuating both fatigue as well as illness due to hyperthermia, dehydration or hyperhydration. When possible, fluid should be ingested at rates that most closely match sweating rate. When that is not possible or practical or sufficiently ergogenic, some athletes might tolerate body water losses amounting to 2% of body weight without significant risk to physical well-being or performance when the environment is cold (e.g. 5-10 degrees C) or temperate (e.g. 21-22 degrees C). However, when exercising in a hot environment ( > 30 degrees C), dehydration by 2% of body weight impairs absolute power production and predisposes individuals to heat injury. Fluid should not be ingested at rates in excess of sweating rate and thus body water and weight should not increase during exercise. Fatigue can be reduced by adding carbohydrate to the fluids consumed so that 30-60 g of rapidly absorbed carbohydrate are ingested throughout each hour of an athletic event. Furthermore, sodium should be included in fluids consumed during exercise lasting longer than 2 h or by individuals during any event that stimulates heavy sodium loss (more than 3-4 g of sodium). Athletes do not benefit by ingesting glycerol, amino acids or alleged precursors of neurotransmitter. Ingestion of other substances during exercise, with the possible exception of caffeine, is discouraged. Athletes will benefit the most by tailoring their individual needs for water, carbohydrate and salt to the specific challenges of their sport, especially considering the environment's impact on sweating and heat stress.

Evidence-Based Approach to Lingering Hydration Questions

Studies related to fundamental hydration issues have required clinicians to re-examine certain practices and concepts. The ingestion of substances such as creatine, caffeine, and glycerol has been questioned in regards to safety and hydration status. Reports of overdrinking (hyponatremia) also have brought into question the practices of drinking appropriate fluid amounts and the role that fluid-electrolyte balance has in the etiology of heat illnesses such as heat cramps. This article offers a fresh perspective on timely topics related to hydration, fluid balance, and exercise in the heat.

Role of Sodium in Fluid Homeostasis with Exercise

This paper provides a review of recent literature concerning the interactive effects of sodium and fluid ingestion in maintaining fluid homeostasis during and following exposure to heat and exercise. Heavy sweating during exercise combined with heat exposure commonly produces fluid deficits corresponding to 1-8% loss in body mass. Thus, a great deal of attention has been focused on developing fluid replacement guidelines and products for active people. Recently, there have been reports of more frequent cases of hyponatremia among individuals who tend to over-ingest water during exercise lasting more than four hours, and inclusion of sodium chloride in the fluid replacement beverage is often suggested as a potential means of reducing risk of hyponatremia. Although hyponatremia is not likely to be a major risk factor for the general population, ultra-endurance athletes and people with occupational physical activity and heat exposure may benefit from these recommendations. Replacement of fluid deficits after exercise and heat exposure is another area that has received considerable attention. Studies in this area suggest that if water is consumed, the volume ingested needs to exceed the fluid deficit by approximately 150% to compensate for the urinary losses that will occur with water ingestion. Inclusion of sodium chloride and other solutes in the rehydration beverage reduces urinary water loss, leading to more rapid recovery of the fluid balance. Data are presented in this paper that suggest a quantifiable interactive relationship between sodium content and fluid volume in promoting rapid recovery of fluid balance after exercise and thermal-induced dehydration.

Nutritional considerations in triathlon

Triathlon combines three disciplines (swimming, cycling and running) and competitions last between 1 hour 50 minutes (Olympic distance) and 14 hours (Ironman distance). Independent of the distance, dehydration and carbohydrate (CHO) depletion are the most likely causes of fatigue in triathlon, whereas gastrointestinal (GI) problems, hyperthermia and hyponatraemia are potentially health threatening, especially in longer events. Although glycogen supercompensation may be beneficial for triathlon performance (even Olympic distance), this does not necessarily have to be achieved by the traditional supercompensation protocol. More recently, studies have revealed ways to increase muscle glycogen concentrations to very high levels with minimal modifications in diet and training. During competition, cycling provides the best opportunity to ingest fluids. The optimum CHO concentration seems to be in the range of 5-8% and triathletes should aim to achieve a CHO intake of 60-70 g/hour. Triathletes should attempt to limit body mass losses to 1% of body mass. In all cases, a drink should contain sodium (30-50 mmol/L) for optimal absorption and prevention of hyponatraemia.Post-exercise rehydration is best achieved by consuming beverages that have a high sodium content (>60 mmol/L) in a volume equivalent to 150% of body mass loss. GI problems occur frequently, especially in long-distance triathlon. Problems seem related to the intake of highly concentrated carbohydrate solutions, or hyperosmotic drinks, and the intake of fibre, fat and protein. Endotoxaemia has been suggested as an explanation for some of the GI problems, but this has not been confirmed by recent research. Although mild endotoxaemia may occur after an Ironman-distance triathlon, this does not seem to be related to the incidence of GI problems. Hyponatraemia has occasionally been reported, especially among slow competitors in triathlons and probably arises due to loss of sodium in sweat coupled with very high intakes (8-10 L) of water or other low-sodium drinks.

Nutrient intake and performance during a mountain marathon: an observational study

In order to study nutrient intake of amateur runners during a mountain marathon, compliance with recommendations, and association with performance, an intake of 42 participants in a Swiss mountain marathon was assessed by direct observation. Data on demographics, dietary preparation and race experience were obtained by questionnaires. Anthropometrical measures were performed before and after the race. Mean hourly intakes (SD) of fluid, carbohydrate, energy and sodium were 545 (158) ml, 31 (14) g, 141 (63) kcal [or 590 (264) kJ], and 150 (203) mg respectively. A third of the runners drank 600 ml h(-1) or more, 52% consumed less than 30 g h(-1 )carbohydrates, 95% consumed less than 500 mg h(-1) sodium. Mean weight loss was 4 (1.5) kg; 30 runners (71%) lost over 3% body mass. Mean running time was 7 h 3 min (1 h 17 min). Most participants failed to meet nutritional recommendations. None were at risk of overhydration. Body composition and race experience were correlated with performance, but not nutrient intake. Because experienced runners are well trained, fitter, and know better their personal needs during such a race, it is difficult to disentangle these associations. As causal relationship cannot be proven with this cross-sectional design, non-compliance with intake recommendations requires additional experimental research on the impact of nutrient intake on field performance.

[Scintigraphic study of gastric emptying of rehydration drinks in athletes]

This study aims to evaluate how rehydration beverage ingestion influences gastric emptying rate (in cycle ergometer) at rest and during exercise at 70 % of maximal oxygen consumption (VO2max).

MATERIAL AND METHOD

26 well-trained cyclists performed a preliminary maximal test until exhaustion to evaluate their VO2max, and two submaximal exercise tests at 70 % of their mode-specific VO2max. Each test was separated by one week. During the two submaximal tests, cyclists consumed 200 ml of a 99mTc-DTPA labeled rehydration beverage (A or B) and scintigraphy determinations were performed at rest. After, exercise was initiated for 60 minutes with an intake rate of 200 ml every 15 minutes, making gastric serial scintigraphy determinations. The difference regarding chemical composition between A and B drinks resides in the fact that drink A contains a smaller load in carbohydrates (10.3 g/100 ml versus 15.2 g/100 ml of B), proteins in form of serum milk and antioxidants in form of fruit juice. Both contain ions and vitamins.

RESULTS

at rest, gastric count number was significantly reduced (p > 0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p < 0.031).

CONCLUSIONS

The A beverage, a rehydration drink on the market with protein and antioxidants with fruit juice content, has a faster gastric emptying rate than the B sport beverage.

Concentrations of trace elements in sweat during sauna bathing

Trace elements in sweat during sauna bathing were assessed. Sweat collected by the whole body method was compared with that collected by the arm bag method. The sweat samples were collected from ten healthy male adults aged 22-26 years, by heat exposure in dry sauna bathing (60 degrees C, 30 minutes). Concentrations of major (Na, Cl, K, Ca, P and Mg) and trace (Zn, Cu, Fe, Ni, Cr and Mn) elements in sweat tended to be lower in the arm bag method than in the whole body method. It was found that Ca, Mg, Fe and Mn concentrations in the arm bag method were significantly lower than those in the whole body method. The amount of trace elements in sweat measured by the arm bag method was less than that by the whole body method; significant differences were observed in Fe and Mn amounts. These observations suggest that excretion of trace elements by sweating induces trace element decrease. Therefore, athletes and workers who work in a hot environment and sweat much habitually should ingest adequate amounts of trace elements.