Optimal composition of fluid-replacement beverages

Customizing individual heat mitigation strategies to optimize performance in elite athletes

The aim of this review is twofold: 1) provide a brief discussion surrounding the interindividual variability that has been observed within the context of heat acclimation/acclimatization, body cooling, and hydration strategies, and 2) provide the reader with a practitioner-focused approach for creating individualized heat mitigation strategies. Considering individual variability for heat acclimation and heat acclimatization, various body cooling strategies, and hydration assessment/fluid replacement is important to maximize effects of these strategies, which lead to better performance and health outcomes. There are many factors to consider, and comprehensive approaches are required. The evidenced-informed decision is critical when making an individual approach, and data will help to make decisions effectively. It is important to keep adjusting the approach based on observed data as data is useful information to check if the approach is effective. Specific considerations to individualize the plan are discussed in this review.

The Effects of Consuming Mineral Water from the "Topla Voda" Spring on the Body Composition and Functional and Biochemical Parameters of Professional Male Handball Athletes: A Pilot Study

Adequate hydration is crucial to an athlete's health and performance. There is some evidence that the different compositions of various mineral water types may improve exercise performance and affect different biomarkers. The aim was to investigate the consumption of mineral water from the "Topla voda" spring in terms of its safety profile and its effect on body composition and functional and biochemical parameters in professional athletes. During the preparation phase of their mesocycle, 14 male professional handball players underwent a complete sports medical screening exam with a cardiopulmonary exercise test (CPET), blood gas analysis, and oxidative stress marker dynamics taken at four points during the CPET. The athletes were then randomized into two equal groups; the first group consumed mineral water, and the second group consumed tap water. After four weeks, the biochemical analysis and CPET were repeated. Routine analyses showed that the "mineral water" group had increased their mean corpuscular hemoglobin (ANCOVA = 0.050) and mean corpuscular hemoglobin concentration (ANCOVA = 0.001) and had a greater metabolic equivalent of task (MET) value at the end of the test (ANCOVA = 0.049), with no significant changes in the other measured parameters. Consuming "mineral water" appears to be safe, with some potential positive effects compared with tap water, mostly in terms of hemoglobin parameters and exercise tolerance.

The effect of consuming a sucrose-containing sports drink on acute kidney injury risk during a 4 h simulated occupational heat stress

Occupational heat stress increases acute kidney injury risk. Drinking a soft drink sweetened with high fructose corn syrup further elevates this acute kidney injury risk. However, the impact of sucrose, another fructose-containing sweetener, on acute kidney injury risk remains unexplored. We tested the hypothesis that drinking a sucrose-containing sports drink increases acute kidney injury risk when compared to drinking a sugar-free sports drink during 4 h of simulated occupational heat stress. Ten healthy adults consumed a sucrose-containing or sugar-free sport drink ad libitum during 4 h exposures to wet bulb globe temperatures of ∼28 °C. Thirty min of work and 30 min of rest were completed each hour. Work involved treadmill walking at a fixed rate of metabolic heat production (sucrose-containing: 6.0 ± 1.2 W/kg, sugar-free: 5.5 ± 0.9 W/kg, p = 0.267). The product of urinary insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2, normalized to urine specific gravity ([IGFBP7·TIMP-2]USG), provided an acute kidney injury risk index. Mean core (intestinal: n = 13, rectal: n = 7) temperature (sucrose-containing: 37.5 ± 0.1 °C, sugar-free: 37.5 ± 0.3 °C; p = 0.914), peak core temperature (sucrose-containing: 37.8 ± 0.2 °C, sugar-free: 37.9 ± 0.3 °C; p = 0.398), and percent changes in body mass (sucrose-containing: -0.5 ± 0.4%, sugar-free: -0.3 ± 0.6%; p = 0.386) did not differ between groups. [IGFBP7∙TIMP-2]USG increased in both groups (time effect: p = 0.025) with no drink (p = 0.675) or interaction (p = 0.715) effects. Peak change [IGFBP7∙TIMP-2]USG did not differ between sucrose-containing (median 0.0116 [-0.0012, 0.1760] (ng/mL)2/1000) and sugar-free (median 0.0021 [0.0003, 0.2077] (ng/mL)2/1000; p = 0.796). Sucrose-containing sports drink consumption during simulated occupational heat stress does not modify acute kidney injury risk when compared to sugar free-sport drink consumption.

Assessment of Exercise-Induced Dehydration Status Based on Oral Mucosal Moisture in a Field Survey

Background/Objective: Conventional techniques for evaluating hydration status include the analysis of blood, urine, and body weight. Recently, advancements in dentistry have introduced capacitance sensor-based oral epithelial moisture meters as promising avenues for assessment. This study aimed to examine the correlation between oral mucosal moisture content, as determined using a capacitance sensor, and exercise-induced dehydration. Methods: A total of 21 participants engaged in a 120 min slow distance exercise session. A series of measurements were taken before and after the exercise session, including body weight, sweat rate, secretory immunoglobulin A (s-IgA) concentration in saliva samples, saliva flow rate, and oral mucosal moisture content, which were assessed using a capacitance sensor. The relationship between physical dehydration and oral mucosal moisture content was investigated using statistical analysis. Receiver operating characteristic curves were constructed to ascertain whether variations in oral mucosal moisture content could discern body mass losses (BMLs) of 1.5% and 2%. Results: A significant correlation was observed between the sweat rate during exercise and the change in oral mucosal moisture content before and after exercise (Spearman's rank correlation coefficient: ρ = -0.58, p < 0.001). The salivary flow and s-IgA secretion rates were lower after the exercise period than before, whereas the s-IgA concentration was higher. Oral mucosal moisture decreased during the exercise period. Receiver operating characteristic curve analysis revealed that differences in oral mucosal moisture content exhibited discriminative capabilities, with area under the curve values of 0.79 at 1.5% BML and 0.72 at 2% BML. Conclusions: The measurement of oral mucosal moisture using capacitance sensors represents a promising noninvasive approach for the assessment of exercise-induced dehydration.

Skimmed, Lactose-Free Milk Ingestion Postexercise: Rehydration Effectiveness and Gastrointestinal Disturbances Versus Water and a Sports Drink in Physically Active People

Postexercise hydration is fundamental to replace fluid loss from sweat. This study evaluated rehydration and gastrointestinal (GI) symptoms for each of three beverages: water (W), sports drink (SD), and skimmed, lactose-free milk (SLM) after moderate-intensity cycling in the heat. Sixteen college students completed three exercise sessions each to lose ≈2% of their body mass. They drank 150% of body mass loss of the drink assigned in randomized order; net fluid balance, diuresis, and GI symptoms were measured and followed up for 3 hr after completion of fluid intake. SLM showed higher fluid retention (∼69%) versus W (∼40%; p < .001); SD (∼56%) was not different from SLM or W (p > .05). Net fluid balance was higher for SLM (-0.26 kg) and SD (-0.42 kg) than W (-0.67 kg) after 3 hr (p < .001), resulting from a significantly lower diuresis with SLM. Reported GI disturbances were mild and showed no difference among drinks (p > .05) despite ingestion of W (1,992 ± 425 ml), SD (1,999 ± 429 ml), and SLM (1,993 ± 426 ml) in 90 min. In conclusion, SLM was more effective than W for postexercise rehydration, showing greater fluid retention for the 3-hr follow-up and presenting with low-intensity GI symptoms similar to those with W and SD. These results confirm that SLM is an effective option for hydration after exercise in the heat.

Role of nutrition in human performance in military populations

The role of nutrition and performance is well established. Service members' physical and cognitive performance, sleep and mood are impacted by nutritional choices. Although many eating patterns have emerged, consensus among experts recommend a dietary pattern focused on predominantly whole plant-based foods. Adequate intakes of fruits, vegetables, whole grains, beans, legumes, nuts and seeds should be prioritised. Implementation of strategic and intentional fuelling strategies around times of activity maintain adequate energy stores, enhance recovery and protect against training injuries. Carbohydrates are prioritised before, during and after activity or a mission, although the type and amount will vary based on duration and intensity of activity. Protein is generally the focus after activity or a mission and may be included before activity depending on individual tolerance. There are no specific recommendations for fat consumption before, during and after exercise that will improve performance. That said, Service members generally tolerate low-fat meals/snacks prior to exercise, limit fat intake during exercise, may include fat as part of the post exercise meal/snack, and generally consume most fat during the maintenance and growth phase. Careful consideration and planning for food and fluid requirements should be made when Service members are exposed to heat, cold and/or altitude. Operational rations are formulated to meet the nutritional needs of all Service members across a variety of diverse climates, environments and altitudes. Service members may use dietary supplements to improve their performance and need to be aware of available resources to help them make informed decisions.

Trends and Missing Links in (De)Hydration Research: A Narrative Review

Despite decades of literature on (de)hydration in healthy individuals, many unanswered questions remain. To outline research and policy priorities, it is fundamental to recognize the literature trends on (de)hydration and identify current research gaps, which herein we aimed to pinpoint. From a representative sample of 180 (de)hydration studies with 4350 individuals, we found that research is mainly limited to small-scale laboratory-based sample sizes, with high variability in demographics (sex, age, and level of competition); to non-ecological (highly simulated and controlled) conditions; and with a focus on recreationally active male adults (e.g., Tier 1, non-athletes). The laboratory-simulated environments are limiting factors underpinning the need to better translate scientific research into field studies. Although, consistently, dehydration is defined as the loss of 2% of body weight, the hydration status is estimated using a very heterogeneous range of parameters. Water is the most researched hydration fluid, followed by alcoholic beverages with added carbohydrates (CHO). The current research still overlooks beverages supplemented with proteins, amino acids (AA), and glycerol. Future research should invest more effort in "real-world" studies with larger and more heterogeneous cohorts, exploring the entire available spectrum of fluids while addressing hydration outcomes more harmoniously.

Evaluation of salivary α-amylase and immunoglobulin A responses after endurance exercise in adolescent males and females with similar aerobic fitness

The objective of this study was to clarify whether there are sex-specific differences in salivary α-amylase and immunoglobulin A responses following acute endurance exercise in adolescent males and females with equivalent cardiorespiratory fitness levels. Twenty-six aerobically trained adolescent males and females with similar training status were enrolled in this study. Each individual executed a 1-h prolonged cycling exercise corresponding to a constant power output at 65% of peak oxygen uptake. Unstimulated whole salivary samples were taken with the passive drooling method at the 10-min period before and after exercise for the determination of salivary responses [α-amylase, immunoglobulin A, total protein and flow rate]. Salivary α-amylase activity, immunoglobulin A concentration and total protein concentration were significantly augmented immediately after acute endurance exercise. Regarding sex differences, only the salivary flow rate was significantly lower in females than in males. The findings of the present study imply that adolescent males and females appear to have similar salivary responses after acute endurance exercise, as represented by salivary α-amylase activity and immunoglobulin A concentration in connection with total protein concentration and salivary flow rate, when they are matched for peak oxygen uptake relative to fat-free body mass.

Compositional Aspects of Beverages Designed to Promote Hydration Before, During, and After Exercise: Concepts Revisited

Hypohydration can impair aerobic performance and deteriorate cognitive function during exercise. To minimize hypohydration, athletes are recommended to commence exercise at least euhydrated, ingest fluids containing sodium during long-duration and/or high-intensity exercise to prevent body mass loss over 2% and maintain elevated plasma osmolality, and rapidly restore and retain fluid and electrolyte homeostasis before a second exercise session. To achieve these goals, the compositions of the fluids consumed are key; however, it remains unclear what can be considered an optimal formulation for a hydration beverage in different settings. While carbohydrate-electrolyte solutions such as sports drinks have been extensively explored as a source of carbohydrates to meet fuel demands during intense and long-duration exercise, these formulas might not be ideal in situations where fluid and electrolyte balance is impaired, such as practicing exercise in the heat. Alternately, hypotonic compositions consisting of moderate to high levels of electrolytes (i.e., ≥45 mmol/L), mainly sodium, combined with low amounts of carbohydrates (i.e., <6%) might be useful to accelerate intestinal water absorption, maintain plasma volume and osmolality during exercise, and improve fluid retention during recovery. Future studies should compare hypotonic formulas and sports drinks in different exercise settings, evaluating different levels of sodium and/or other electrolytes, blends of carbohydrates, and novel ingredients for addressing hydration and rehydration before, during, and after exercise.

Pure Juice Supplementation: Its Effect on Muscle Recovery and Sports Performance

Strenuous exercise causes increased production of reactive oxygen species (ROS), creating an imbalance between ROS and antioxidants. The reduced antioxidant defence leads to defective elimination of ROS and consequently, delayed-onset muscle soreness (DOMS). DOMS due to exhaustive or prolonged exercise typically peaks between 24 h and 72 h after exercise results in soreness, inflammation, pain and decreased muscle function. As a result, muscle strength will be reduced progressively and this situation might be detrimental to one's athletic performance, especially amidst competition season. Therefore, supplementation to improve muscle recovery and sports performance has become a common practice among athletes. However, it is suggested to consume natural-based fruit-derived antioxidants as a more effective and safe nutritional strategy. Fruits containing a high amount of polyphenol protect muscle cells from excessive and harmful ROS due to their anti-inflammatory and antioxidant characteristics. To date, there are several expended studies on the consumption of supplements from various antioxidant-rich fruits to provide evidence on their effectiveness, giving better solutions and wider choices of supplementation to the athletes. Therefore, this review aims to provide a comprehensive overview of nutritional standpoint from previous literature on the effect of fruit juices supplementation on muscle recovery and sports performance.

Daily Fluid Intake Behaviors and Associated Health Effects Among Australian and United States Populations

Minimal data exist exploring intercontinental differences in fluid intake (FI) beliefs and behaviors and the impact on fluid intake practices (i.e., fluid intake volume, beverage type, and timing of fluid intake). Therefore, this study explored the impact that FI beliefs and behaviors had on FI practices among emerging adults living in the United States (USA) and Australia (AUS). A total of 489 individuals (74.5% female; USA, 79.4%; age, 25 ± 6 years completed a 23-item survey between November 2020 and June 2021). Participants detailed their FI practices. FI beliefs were evaluated to determine their contribution to FI behaviors across the day. Multinomial and multiple linear regression analyses explored the association of daily FI beliefs and behaviors across multiple domains. Independent sample t-tests and chi-square analyses were conducted to compare FI practices, beliefs, and behaviors between individuals in the USA and AUS. FI behaviors were significantly different between countries, with the USA more likely to consume fluids to meet a total target volume (β = 1.150, p = 0.036) and consume fluid at the same time as structured daily activities (β = 0.773, p = 0.046) compared to FI alongside food intake. However, there were no differences in the types of beverage consumed (juice, sugar-sweetened beverages, tea, and coffee), total fluid volume, and physical activity (PA) between countries (p &gt; 0.05). Beverage consumption was higher among USA than AUS residents for water, beer, and wine (p &lt; 0.05). Total fluid consumption was greater among males (3,189 ± 2,407 ml) than females (2,215 ± 1,132 ml; β = 3.61, p &lt; 0.001), individuals who regularly consumed fluid during the day to meet a targeted volume (β = 1,728.5, p &lt; 0.001), and those who regularly consumed fluid as a habitual behavior (β = 3.97, p &lt; 0.001) compared to those individuals who only consumed fluid alongside mealtimes (β = 1,041.7, p &lt; 0.001). FI behaviors differed between the USA and AUS; however, total volume consumed, type of beverage consumed, and FI beliefs were similar. FI practices and behaviors appear to be individualized and context-specific among the studied populations.

Effects of Trehalose Solutions at Different Concentrations on High-Intensity Intermittent Exercise Performance

Trehalose solution ingested during exercise induces gradual increases in blood glucose levels and the insulin response compared with glucose solution. Trehalose solution aids in the maintenance of performance in the later stages of prolonged exercise. The purpose of this study was to identify the lowest concentration at which the properties of trehalose could be exploited. Groups of 12 healthy men (21.3 ± 1.3 years) and 10 healthy men (21.1 ± 0.7 years) with recreational training were included in experiments 1 and 2, respectively. Both experiments followed the same protocol. After fasting for 12 h, the participants performed a 60 min constant-load exercise at 40% V˙O₂ peak using a bicycle ergometer and ingested 500 mL of a trial drink (experiment 1: water, 8% glucose, and 6 or 8% trehalose; experiment 2: 4 or 6% trehalose). They performed four sets of the Wingate test combined with a 30 min constant-load exercise at 40% V˙O₂ peak. The experiment was conducted using a randomized cross-over design; trial drink experiments were conducted over intervals of 7 to 12 days. The exercise performance was evaluated based on mean power in the Wingate test. Blood was collected from the fingertip at 12 points during each experiment to measure blood glucose levels. During the high-intensity 5 h intermittent exercise, no differences were found between the groups in exercise performance in the later stages with concentrations of 8, 6, and 4% trehalose solution. The results suggest that trehalose could be useful for making a new type of mixed carbohydrate solution. Further studies to determine the trehalose response of individual athletes during endurance exercise are needed.

Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports

The majority of reviews on sports nutrition issues focus on macronutrients, often omitting or paying less attention to substances such as sodium. Through the literature, it is clear that there are no reviews that focus entirely on the effects of sodium and in particular on endurance sports. Sodium intake, both at high and low doses, has been found to be associated with health and performance issues in athletes. Besides, there have been theories that an electrolyte imbalance, specifically sodium, contributes to the development of muscle cramps (EAMC) and hyponatremia (EAH). For this reason, it is necessary to create this systematic review, in order to report extensively on the role of sodium consumption in the population and more specifically in endurance and ultra-endurance athletes, the relationship between the amount consumed and the occurrence of pathological disorders, the usefulness of simultaneous hydration and whether a disturbance of this substance leads to EAH and EAMC. As a method of data collection, this study focused on exploring literature from 2000–2021. The search was conducted through the research engines PubMed and Scopus. In order to reduce the health and performance effects in endurance athletes, simultaneous emphasis should be placed on both sodium and fluid intake.

Utility of an Isotonic Beverage on Hydration Status and Cardiovascular Alterations

This study determined the beverage hydration index (BHI) and postprandial cardiac autonomic activity after consuming an isotonic beverage (IB) compared to distilled water (DW). Twenty-two participants (50% female; mean ± SD; age, 27 ± 3 year; height, 169.1 ± 12.6 cm; weight, 73.3 ± 13.8 kg; BF%, 23 ± 10%) completed two experimental trials where they consumed 1 L DW or an IB; after which urine volume and cardiac autonomic activity was measured through 240 min. Cardiac autonomic activity was quantified using heart rate (HR), log transformed heart rate variability measures (root mean square of successive R–R intervals; RMSSD; low frequency, LF; and high frequency, HF) and systolic time intervals (pre-ejection period, PEP). BHI was significantly greater after IB consumption at min 0 (MD [95% CI]; 1.31 [0.35, 2.27]), 180 min (0.09 [0.022, 0.16]), and 240 min (0.1 [0.03, 0.17]) compared to DW (p = 0.031). Net fluid balance was significantly greater in IB than DW at 180 min (90 [−16.80, 196.81]) and 240 min (106 [−13.88, 225.88]) (p = 0.037). HR decreased over time in both beverage trials but was higher following IB ingestion at 0 min (3.9 [−2.42, 10.22]), 30 min (5.3 [−0.94, 11.54]), and 60 min (2.7 [−3.42, 8.82]) (p = 0.0002). lnHF was greater 30 min post DW ingestion compared to IB (0.45 [−0.23, 1.13]) (p = 0.039). IB promotes greater fluid retention capacity compared to DW within 4 hours of consumption. The variations in cardiac autonomic measures may warrant further investigation in clinical populations (i.e., patients with autonomic failure).

In-Season Nutrition Strategies and Recovery Modalities to Enhance Recovery for Basketball Players: A Narrative Review

Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players' recovery for training and competition throughout the season.

Meta-Analysis of Carbohydrate Solution Intake during Prolonged Exercise in Adults: From the Last 45+ Years' Perspective

Carbohydrate (CHO) supplementation during prolonged exercise postpones fatigue. However, the optimum administration timing, dosage, type of CHO intake, and possible interaction of the ergogenic effect with athletes' cardiorespiratory fitness (CRF) are not clear. Ninety-six studies (from relevant databases based on predefined eligibility criteria) were selected for meta-analysis to investigate the acute effect of ≤20% CHO solutions on prolonged exercise performance. The between-subject standardized mean difference [SMD = ([mean post-value treatment group-mean post-value control group]/pooled variance)] was assessed. Overall, SMD [95% CI] of 0.43 [0.35, 0.51] was significant (p < 0.001). Subgroup analysis showed that SMD was reduced as the subjects' CRF level increased, with a 6-8% CHO solution composed of GL:FRU improving performance (exercise: 1-4 h); administration during the event led to a superior performance compared to administration before the exercise, with a 6-8% single-source CHO solution increasing performance in intermittent and 'stop and start' sports and an ~6% CHO solution appearing beneficial for 45-60 min exercises, but there were no significant differences between subjects' gender and age groups, varied CHO concentrations, doses, or types in the effect measurement. The evidence found was sound enough to support the hypothesis that CHO solutions, when ingested during endurance exercise, have ergogenic action and a possible crossover interaction with the subject's CRF.

The Hydrating Effects of Hypertonic, Isotonic and Hypotonic Sports Drinks and Waters on Central Hydration During Continuous Exercise: A Systematic Meta-Analysis and Perspective

Background

Body-fluid loss during prolonged continuous exercise can impair cardiovascular function, harming performance. Delta percent plasma volume (dPV) represents the change in central and circulatory body-water volume and therefore hydration during exercise; however, the effect of carbohydrate–electrolyte drinks and water on the dPV response is unclear.

Objective

To determine by meta-analysis the effects of ingested hypertonic (> 300 mOsmol kg⁻¹), isotonic (275–300 mOsmol kg⁻¹) and hypotonic (< 275 mOsmol kg⁻¹) drinks containing carbohydrate and electrolyte ([Na⁺] < 50 mmol L⁻¹), and non-carbohydrate drinks/water (< 40 mOsmol kg⁻¹) on dPV during continuous exercise.

Methods

A systematic review produced 28 qualifying studies and 68 drink treatment effects. Random-effects meta-analyses with repeated measures provided estimates of effects and probability of superiority (p₊) during 0–180 min of exercise, adjusted for drink osmolality, ingestion rate, metabolic rate and a weakly informative Bayesian prior.

Results

Mean drink effects on dPV were: hypertonic − 7.4% [90% compatibility limits (CL) − 8.5, − 6.3], isotonic − 8.7% (90% CL − 10.1, − 7.4), hypotonic − 6.3% (90% CL − 7.4, − 5.3) and water − 7.5% (90% CL − 8.5, − 6.4). Posterior contrast estimates relative to the smallest important effect (dPV = 0.75%) were: hypertonic-isotonic 1.2% (90% CL − 0.1, 2.6; p₊ = 0.74), hypotonic-isotonic 2.3% (90% CL 1.1, 3.5; p₊ = 0.984), water-isotonic 1.3% (90% CL 0.0, 2.5; p₊ = 0.76), hypotonic-hypertonic 1.1% (90% CL 0.1, 2.1; p₊ = 0.71), hypertonic-water 0.1% (90% CL − 0.8, 1.0; p₊ = 0.12) and hypotonic-water 1.1% (90% CL 0.1, 2.0; p₊ = 0.72). Thus, hypotonic drinks were very likely superior to isotonic and likely superior to hypertonic and water. Metabolic rate, ingestion rate, carbohydrate characteristics and electrolyte concentration were generally substantial modifiers of dPV.

Conclusion

Hypotonic carbohydrate–electrolyte drinks ingested continuously during exercise provide the greatest benefit to hydration.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01558-y.

Comment on Fan et al. Efficacy of Ingesting an Oral Rehydration Solution after Exercise on Fluid Balance and Endurance Performance. Nutrients 2020, 12, 3826

Our lab read with interest the recent article published in Nutrients comparing different drink composition on fluid balance [...].

Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers

The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.

The Importance of 'Durability' in the Physiological Profiling of Endurance Athletes

Profiling physiological attributes is an important role for applied exercise physiologists working with endurance athletes. These attributes are typically assessed in well-rested athletes. However, as has been demonstrated in the literature and supported by field data presented here, the attributes measured during routine physiological-profiling assessments are not static, but change over time during prolonged exercise. If not accounted for, shifts in these physiological attributes during prolonged exercise have implications for the accuracy of their use in intensity regulation during prolonged training sessions or competitions, quantifying training adaptations, training-load programming and monitoring, and the prediction of exercise performance. In this review, we argue that current models used in the routine physiological profiling of endurance athletes do not account for these shifts. Therefore, applied exercise physiologists working with endurance athletes would benefit from development of physiological-profiling models that account for shifts in physiological-profiling variables during prolonged exercise and quantify the 'durability' of individual athletes, here defined as the time of onset and magnitude of deterioration in physiological-profiling characteristics over time during prolonged exercise. We propose directions for future research and applied practice that may enable better understanding of athlete durability.

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

Primary, Secondary, and Tertiary Effects of Carbohydrate Ingestion During Exercise

The purpose of this current opinion paper is to describe the journey of ingested carbohydrate from 'mouth to mitochondria' culminating in energy production in skeletal muscles during exercise. This journey is conveniently described as primary, secondary, and tertiary events. The primary stage is detection of ingested carbohydrate by receptors in the oral cavity and on the tongue that activate reward and other centers in the brain leading to insulin secretion. After digestion, the secondary stage is the transport of monosaccharides from the small intestine into the systemic circulation. The passage of these monosaccharides is facilitated by the presence of various transport proteins. The intestinal mucosa has carbohydrate sensors that stimulate the release of two 'incretin' hormones (GIP and GLP-1) whose actions range from the secretion of insulin to appetite regulation. Most of the ingested carbohydrate is taken up by the liver resulting in a transient inhibition of hepatic glucose release in a dose-dependent manner. Nonetheless, the subsequent increased hepatic glucose (and lactate) output can increase exogenous carbohydrate oxidation rates by 40-50%. The recognition and successful distribution of carbohydrate to the brain and skeletal muscles to maintain carbohydrate oxidation as well as prevent hypoglycaemia underpins the mechanisms to improve exercise performance.

Managing Travel Fatigue and Jet Lag in Athletes: A Review and Consensus Statement

Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.

Ingestion of maple-based and other carbohydrate sports drinks: effect on sensory perceptions during prolonged exercise

Background

Taste and appreciation of sports drinks can affect perceived exertion during exercise. Anecdotal evidence shows that maple products are regularly consumed by recreational and professional athletes but very few studies have reported on their effects during exercise. The purpose of the current study is to report the taste, appreciation and perceived exertion following the ingestion of maple-based sports drinks and other carbohydrate drinks during prolonged exercise.

Methods

Recreationally and competitively active male subjects (n = 76, mass = 73.7 ± 10.3 kg, maximum oxygen consumption (VO₂max) = 4.4 ± 0.5 L/min, maximal aerobic power (MAP) = 309 ± 42 W) ingested one of four carbohydrate solutions (all at 60 g CHO/L): concentrated maple sap (MW), diluted maple syrup (MS), glucose (G), a commercial sports drink (CSD), or a placebo (P; water sweetened with stevia) at every 30 min during 120 min of steady-state exercise (SSE) on a cycle ergometer at 66% MAP. Ratings of perceived exertion (RPE, Borg CR-10) were recorded at each 30 min throughout SSE. A questionnaire was administered to assess sensory characteristics (sweetness, acidity, refreshing, and overall taste on a visual analogue scale, converted to decimals from 0 to 1) and appreciation (sweet, acid and overall on a 9-point hedonic scale) 30 min before (immediately after the first ingestion) and immediately after SSE.

Results

Sweetness was perceived to be higher for MW than G and P (pre: 0.60 ± 0.19, 0.51 ± 0.17 and 0.50 ± 0.17 and post: 0.69 ± 0.19, 0.34 ± 0.18 and 0.48 ± 0.22; p < 0.05, respectively) and MS was rated higher than MW for the appreciation of the sweet taste (pre: 6.5 ± 1.5 vs. 4.6 ± 1.8 and post: 6.8 ± 1.8 and 4.1 ± 1.8; p < 0.05, respectively). Furthermore, subjects that had ingested MW, reported a significantly lower RPE than those with P at 120 min (14.1 ± 2.2 vs. 16.0 ± 2.0, respectively).

Conclusions

A sports drink containing maple syrup is well appreciated during prolonged exercise and appears to be a viable alternatives to more common sources of carbohydrates.

Trial registration

NCT02880124. Registered on 26 August 2016.

Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging

The kidneys' integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.

Influence of Nutrient Intake on 24 Hour Urinary Hydration Biomarkers Using a Clustering-Based Approach

Previous work focusing on understanding nutrient intake and its association with total body water homeostasis neglects to consider the collinearity of types of nutrients consumed and subsequent associations with hydration biomarkers. Therefore, the purpose of this study was to analyze consumption patterns of 23 a priori selected nutrients involved in osmotic homeostasis, as well as their association with 24 h urinary hydration markers among fifty African–American first-year college students through a repeated measures observation in a daily living setting. Through application of hierarchical clustering, we were able to identity four clusters of nutrients based on 24 h dietary recalls: (1) alcohol + pinitol, (2) water + calcium + magnesium + erythritol + inositol + sorbitol + xylitol, (3) total calories + total fat + total protein + potassium + sodium + zinc + phosphorous + arginine, and (4) total carbohydrates + total fiber + soluble fiber + insoluble fiber + mannitol + betaine. Furthermore, we found that consumption of nutrients in Cluster #2 was significantly predictive of urine osmolality (p = 0.004); no other clusters showed statistically significant associations with 24 h urinary hydration biomarkers. We conclude that there may be some nutrients that are commonly consumed concomitantly (at the day level), across a variety of settings and populations, and that a limited subset of the clustering of these nutrients may associate with body water status.

Effects of 120 vs. 60 and 90 g/h Carbohydrate Intake during a Trail Marathon on Neuromuscular Function and High Intensity Run Capacity Recovery

BACKGROUND

Current carbohydrate (CHO) intake recommendations for ultra-trail activities lasting more than 2.5 h is 90 g/h. However, the benefits of ingesting 120 g/h during a mountain marathon in terms of post-exercise muscle damage have been recently demonstrated. Therefore, the aim of this study was to analyze and compare the effects of 120 g/h CHO intake with the recommendations (90 g/h) and the usual intake for ultra-endurance athletes (60 g/h) during a mountain marathon on internal exercise load, and post-exercise neuromuscular function and recovery of high intensity run capacity.

METHODS

Twenty-six elite trail-runners were randomly distributed into three groups: LOW (60 g/h), MED (90 g/h) and HIGH (120 g/h), according to CHO intake during a 4000-m cumulative slope mountain marathon. Runners were measured using the Abalakov Jump test, a maximum a half-squat test and an aerobic power-capacity test at baseline (T1) and 24 h after completing the race (T2).

RESULTS

Changes in Abalakov jump time (ABKJT), Abalakov jump height (ABKH), half-squat test 1 repetition maximum (HST1RM) between T1 and T2 showed significant differences by Wilcoxon signed rank test only in LOW and MED (p < 0.05), but not in the HIGH group (p > 0.05). Internal load was significantly lower in the HIGH group (p = 0.017) regarding LOW and MED by Mann Whitney u test. A significantly lower change during the study in ABKJT (p = 0.038), ABKH (p = 0.038) HST1RM (p = 0.041) and in terms of fatigue (p = 0.018) and lactate (p = 0.012) within the aerobic power-capacity test was presented in HIGH relative to LOW and MED.

CONCLUSIONS

120 g/h CHO intake during a mountain marathon might limit neuromuscular fatigue and improve recovery of high intensity run capacity 24 h after a physiologically challenging event when compared to 90 g/h and 60 g/h.

Effect of Drinking Rate on the Retention of Water or Milk Following Exercise-Induced Dehydration

This study investigated the effect of drinking rate on fluid retention of milk and water following exercise-induced dehydration. In Part A, 12 male participants lost 1.9% ± 0.3% body mass through cycle exercise on four occasions. Following exercise, plain water or low-fat milk equal to the volume of sweat lost during exercise was provided. Beverages were ingested over 30 or 90 min, resulting in four beverage treatments: water 30 min, water 90 min, milk 30 min, and milk 90 min. In Part B, 12 participants (nine males and three females) lost 2.0% ± 0.3% body mass through cycle exercise on four occasions. Following exercise, plain water equal to the volume of sweat lost during exercise was provided. Water was ingested over 15 min (DR15), 45 min (DR45), or 90 min (DR90), with either DR15 or DR45 repeated. In both trials, nude body mass, urine volume, urine specific gravity and osmolality, plasma osmolality, and subjective ratings of gastrointestinal symptoms were obtained preexercise and every hour for 3 hr after the onset of drinking. In Part A, no effect of drinking rate was observed on the proportion of fluid retained, but milk retention was greater (p < .01) than water (water 30 min: 57% ± 16%, water 90 min: 60% ± 20%, milk 30 min: 83% ± 6%, and milk 90 min: 85% ± 7%). In Part B, fluid retention was greater in DR90 (57% ± 13%) than DR15 (50% ± 11%, p < .05), but this was within test-retest variation determined from the repeated trials (coefficient of variation: 17%). Within the range of drinking rates investigated the nutrient composition of a beverage has a more pronounced impact on fluid retention than the ingestion rate.

International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing

Background

In this Position Statement, the International Society of Sports Nutrition (ISSN) provides an objective and critical review of the literature pertinent to nutritional considerations for training and racing in single-stage ultra-marathon. Recommendations for Training. i) Ultra-marathon runners should aim to meet the caloric demands of training by following an individualized and periodized strategy, comprising a varied, food-first approach; ii) Athletes should plan and implement their nutrition strategy with sufficient time to permit adaptations that enhance fat oxidative capacity; iii) The evidence overwhelmingly supports the inclusion of a moderate-to-high carbohydrate diet (i.e., ~ 60% of energy intake, 5–8 g·kg^− 1·d^− 1) to mitigate the negative effects of chronic, training-induced glycogen depletion; iv) Limiting carbohydrate intake before selected low-intensity sessions, and/or moderating daily carbohydrate intake, may enhance mitochondrial function and fat oxidative capacity. Nevertheless, this approach may compromise performance during high-intensity efforts; v) Protein intakes of ~ 1.6 g·kg^− 1·d^− 1 are necessary to maintain lean mass and support recovery from training, but amounts up to 2.5 g.kg^− 1·d^− 1 may be warranted during demanding training when calorie requirements are greater; Recommendations for Racing. vi) To attenuate caloric deficits, runners should aim to consume 150–400 Kcal·h^− 1 (carbohydrate, 30–50 g·h^− 1; protein, 5–10 g·h^− 1) from a variety of calorie-dense foods. Consideration must be given to food palatability, individual tolerance, and the increased preference for savory foods in longer races; vii) Fluid volumes of 450–750 mL·h^− 1 (~ 150–250 mL every 20 min) are recommended during racing. To minimize the likelihood of hyponatraemia, electrolytes (mainly sodium) may be needed in concentrations greater than that provided by most commercial products (i.e., > 575 mg·L^− 1 sodium). Fluid and electrolyte requirements will be elevated when running in hot and/or humid conditions; viii) Evidence supports progressive gut-training and/or low-FODMAP diets (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) to alleviate symptoms of gastrointestinal distress during racing; ix) The evidence in support of ketogenic diets and/or ketone esters to improve ultra-marathon performance is lacking, with further research warranted; x) Evidence supports the strategic use of caffeine to sustain performance in the latter stages of racing, particularly when sleep deprivation may compromise athlete safety.

Pediatric Thermoregulation: Considerations in the Face of Global Climate Change

Predicted global climate change, including rising average temperatures, increasing airborne pollution, and ultraviolet radiation exposure, presents multiple environmental stressors contributing to increased morbidity and mortality. Extreme temperatures and more frequent and severe heat events will increase the risk of heat-related illness and associated complications in vulnerable populations, including infants and children. Historically, children have been viewed to possess inferior thermoregulatory capabilities, owing to lower sweat rates and higher core temperature responses compared to adults. Accumulating evidence counters this notion, with limited child-adult differences in thermoregulation evident during mild and moderate heat exposure, with increased risk of heat illness only at environmental extremes. In the context of predicted global climate change, extreme environmental temperatures will be encountered more frequently, placing children at increased risk. Thermoregulatory and overall physiological strain in high temperatures may be further exacerbated by exposure to/presence of physiological and environmental stressors including pollution, ultraviolet radiation, obesity, diabetes, associated comorbidities, and polypharmacy that are more commonly occurring at younger ages. The aim of this review is to revisit fundamental differences in child-adult thermoregulation in the face of these multifaceted climate challenges, address emerging concerns, and emphasize risk reduction strategies for the health and performance of children in the heat.

Fluid Needs for Training, Competition, and Recovery in Track-and-Field Athletes

The 2019 International Amateur Athletics Federation Track-and-Field World Championships will take place in Qatar in the Middle East. The 2020 Summer Olympics will take place in Tokyo, Japan. It is quite likely that these events may set the record for hottest competitions in the recorded history of both the Track-and-Field World Championships and Olympic Games. Given the extreme heat in which track-and-field athletes will need to train and compete for these games, the importance of hydration is amplified more than in previous years. The diverse nature of track-and-field events, training programs, and individuality of athletes taking part inevitably means that fluid needs will be highly variable. Track-and-field events can be classified as low, moderate, or high risk for dehydration based on typical training and competition scenarios, fluid availability, and anticipated sweat losses. This paper reviews the risks of dehydration and potential consequences to performance in track-and-field events. The authors also discuss strategies for mitigating the risk of dehydration.

Yogurt Drink Effectively Rehydrates Athletes After a Strenuous Exercise Session

Dehydration and electrolyte imbalance as a result of prolonged strenuous exercise leads to poor thermoregulation and impaired muscle performance. Thus, appropriate rehydration during and after exercise with a solution that has a balanced combination of nutrients including electrolytes, carbohydrates and proteins is crucial in preventing the side effects of dehydration. Yogurt drink as a traditional drink with an appropriate nutritious content could be used as an alternative to expensive commercially available drinks for rehydrating athletes after long exercises in warm and humid environments and in developing countries. In this cross-over trial we examined the rehydration potential of yogurt drink in comparison to water and a commercial drink after a strenuous exercise (cycling) session in a hot and humid environment. Blood measurements included blood osmolality, serum glucose, hematocrit and serum electrolytes. Urine measurements included urine volume, osmolality and electrolyte concentrations. The results showed that early after rehydration Yogurt drink compared to water significantly increased urine sodium (mmol/L) (138.8 ± 93.4 vs. 90.0 ± 50.7, P < 0.01), urine potassium (mmol/L) (105.6 ± 55.1 vs. 35.8 ± 22.0, P < 0.05) and urine chloride (mmol/L) (113.2 ± 28.4 vs. 35.8 ± 25.1 P < 0.01). This degree of improvement was the same as with the commercial drink for urine sodium, potassium, and chloride. Yogurt drink prevented dehydration-induced changes in the blood as it stabilized the hematocrit and serum sodium, potassium and osmolality within the normal range after exercise. Finally, our results indicated that yogurt drink, as a natural and affordable rehydration option, can be considered to restore fluid and electrolyte losses after strenuous exercises in hot and humid environments.

Immunometabolism: A Multi-Omics Approach to Interpreting the Influence of Exercise and Diet on the Immune System

Immunometabolism is an evolving field of scientific endeavor that merges immunology and metabolism and has provided valuable context when evaluating the influence of dietary interventions on exercise-induced immune dysfunction. Metabolomics, lipidomics, and proteomics provide a system-wide view of the metabolic response to exercise by simultaneously measuring and identifying a large number of small-molecule metabolites, lipids, and proteins. Many of these are involved with immune function and regulation and are sensitive to dietary influences, especially acute carbohydrate ingestion from either sugar beverages or fruits such as bananas. Emerging evidence using large multi-omics data sets supports the combined intake of fruit sugars and phytochemicals by athletes during heavy exertion as an effective strategy to improve metabolic recovery, augment viral defense, and counter postexercise inflammation and immune dysfunction at the cell level. Multi-omics methodologies have given investigators new outcome targets to assess the efficacy of various dietary interventions for physiologically stressed athletes.

Selected In-Season Nutritional Strategies to Enhance Recovery for Team Sport Athletes: A Practical Overview

Team sport athletes face a variety of nutritional challenges related to recovery during the competitive season. The purpose of this article is to review nutrition strategies related to muscle regeneration, glycogen restoration, fatigue, physical and immune health, and preparation for subsequent training bouts and competitions. Given the limited opportunities to recover between training bouts and games throughout the competitive season, athletes must be deliberate in their recovery strategy. Foundational components of recovery related to protein, carbohydrates, and fluid have been extensively reviewed and accepted. Micronutrients and supplements that may be efficacious for promoting recovery include vitamin D, omega-3 polyunsaturated fatty acids, creatine, collagen/vitamin C, and antioxidants. Curcumin and bromelain may also provide a recovery benefit during the competitive season but future research is warranted prior to incorporating supplemental dosages into the athlete's diet. Air travel poses nutritional challenges related to nutrient timing and quality. Incorporating strategies to consume efficacious micronutrients and ingredients is necessary to support athlete recovery in season.

Fundamentals of glycogen metabolism for coaches and athletes

The ability of athletes to train day after day depends in large part on adequate restoration of muscle glycogen stores, a process that requires the consumption of sufficient dietary carbohydrates and ample time. Providing effective guidance to athletes and others wishing to enhance training adaptations and improve performance requires an understanding of the normal variations in muscle glycogen content in response to training and diet; the time required for adequate restoration of glycogen stores; the influence of the amount, type, and timing of carbohydrate intake on glycogen resynthesis; and the impact of other nutrients on glycogenesis. This review highlights the practical implications of the latest research related to glycogen metabolism in physically active individuals to help sports dietitians, coaches, personal trainers, and other sports health professionals gain a fundamental understanding of glycogen metabolism, as well as related practical applications for enhancing training adaptations and preparing for competition.

The availability of water associated with glycogen during dehydration: a reservoir or raindrop?

PURPOSE

This study evaluated whether glycogen-associated water is a protected entity not subject to normal osmotic homeostasis. An investigation into practical and theoretical aspects of the functionality of this water as a determinant of osmolality, dehydration, and glycogen concentration was undertaken.

METHODS

In vitro experiments were conducted to determine the intrinsic osmolality of glycogen-potassium phosphate mixtures as would be found intra-cellularly at glycogen concentrations of 2% for muscle and 5 and 10% for liver. Protected water would not be available to ionic and osmotic considerations, whereas free water would obey normal osmotic constraints. In addition, the impact of 2 L of sweat loss in situations of muscle glycogen repletion and depletion was computed to establish whether water associated with glycogen is of practical benefit (e.g., to increase "available total body water").

RESULTS

The osmolality of glycogen-potassium phosphate mixtures is predictable at 2% glycogen concentration (predicted 267, measured 265.0 ± 4.7 mOsmol kg^-1) indicating that glycogen-associated water is completely available to all ions and is likely part of the greater osmotic system of the body. At higher glycogen concentrations (5 and 10%), there was a small amount of glycogen water (~ 10-20%) that could be considered protected. However, the majority of the glycogen-associated water behaved to normal osmotic considerations. The theoretical exercise of selective dehydration (2 L) indicated a marginal advantage to components of total body water such as plasma volume (1.57% or 55 mL) when starting exercise glycogen replete.

CONCLUSION

Glycogen-associated water does not appear to be a separate reservoir and is not able to uniquely replete water loss during dehydration.

Normative data on regional sweat-sodium concentrations of professional male team-sport athletes

BACKGROUND

The purpose of this paper was to report normative data on regional sweat sweat-sodium concentrations of various professional male team-sport athletes, and to compare sweat-sodium concentrations among sports. Data to this effect would inform our understanding of athlete sodium requirements, thus allowing for the individualisation of sodium replacement strategies. Accordingly, data from 696 athletes (Soccer, n = 270; Rugby, n = 181; Baseball, n = 133; American Football, n = 60; Basketball, n = 52) were compiled for a retrospective analysis. Regional sweat-sodium concentrations were collected using the pilocarpine iontophoresis method, and compared to self-reported measures collected via questionnaire.

RESULTS

Sweat-sodium concentrations were significantly higher (p < 0.05) in American football (50.4 ± 15.3 mmol·L-1), baseball (54.0 ± 14.0 mmol·L-1), and basketball (48.3 ± 14.0 mmol·L-1) than either soccer (43.2 ± 12.0 mmol·L-1) or rugby (44.0 ± 12.1 mmol·L-1), but with no differences among the N.American or British sports. There were strong positive correlations between sweat-sodium concentrations and self-reported sodium losses in American football (rs = 0.962, p < 0.001), basketball (rs = 0.953, p < 0.001), rugby (rs = 0.813, p < 0.001), and soccer (rs = 0.748, p < 0.001).

CONCLUSIONS

The normative data provided on sweat-sodium concentrations might assist sports science/medicine practitioners in generating bespoke hydration and electrolyte-replacement strategies to meet the sodium demands of professional team-sport athletes. Moreover, these novel data suggest that self-reported measures of sodium loss might serve as an effective surrogate in the absence of direct measures; i.e., those which are more expensive or non-readily available.

Why do team-sport athletes drink fluid in excess when exercising in cool conditions?

This study assessed the potential physiological and perceptual drivers of fluid intake and thirst sensation during intermittent exercise. Ten male rugby players (17 ± 1 years, stature: 179.1 ± 4.2 cm, body mass (BM): 81.9 ± 8.1 kg) participated in six 6-min small-sided games, interspersed with 2 min rest, where fluid intake was ad libitum during rest periods. Pre- and postmeasurements of BM, subjective ratings (thirst, thermal comfort, thermal sensation, mouth dryness), plasma osmolality (POsm), serum sodium concentration (S[Na⁺]), haematocrit and haemoglobin (to calculate plasma volume change; PV) were taken. Fluid intake was measured during rest periods. BM change was -0.17 ± 0.59% and fluid intake was 0.88 ± 0.38 L. Pre- to post-POsm decreased (-3.1 ± 2.3 mOsm·kg^-1; p = 0.002) and S[Na⁺] remained similar (-0.3 ± 0.7 mmol·L^-1, p = 0.193). ΔPV was 5.84 ± 3.65%. Fluid intake displayed a relationship with pre-POsm (r = -0.640, p = 0.046), prethermal comfort (r = 0.651; p = -0.041), ΔS[Na⁺] (r = 0.816, p = 0.004), and ΔPV (r = 0.740; p = 0.014). ΔThirst sensation displayed a relationship with premouth dryness (r = 0.861, p = 0.006) and Δmouth dryness (r = 0.878, p = 0.004). Yet a weak positive relationship between Δthirst sensation and fluid intake was observed (r = 0.085, p = 0.841). These data observed in an ambient temperature of 13.6 ± 0.9 °C, suggest team-sport athletes drink in excess of fluid homeostasis requirements and thirst sensation in cool conditions; however, this was not influenced by thermal discomfort.

Are Habitual Hydration Strategies of Female Rugby League Players Sufficient to Maintain Fluid Balance and Blood Sodium Concentration During Training and Match-Play? A Research Note From the Field

Limited data exist on the hydration status of female athletes, with no data available on female rugby players. The objective of this study was to investigate the habitual hydration status on arrival, sweat loss, fluid intake, sweat Na loss, and blood [Na+] during field training and match-play in 10 international female rugby league players. Urine osmolality on arrival to match-play (382 ± 302 mOsmol·kg(-1)) and training (667 ± 260 mOsmol·kg(-1)) was indicative of euhydration. Players experienced a body mass loss of 0.50 ± 0.45 and 0.56 ± 0.53% during match-play and training, respectively. During match-play, players consumed 1.21 ± 0.43 kg of fluid and had a sweat loss of 1.54 ± 0.48 kg. During training, players consumed 1.07 ± 0.90 kg of fluid, in comparison with 1.25 ± 0.83 kg of sweat loss. Blood [Na+] was well regulated (Δ-0.7 ± 3.4 and Δ-0.4 ± 2.6 mmol·L(-1)), despite sweat [Na+] of 47.8 ± 5.7 and 47.2 ± 6.3 mmol·L(-1) during match-play and training. The findings of this study show mean blood [Na+] that seems to be well regulated despite losses of Na in sweat and electrolyte-free fluid consumption. For the duration of the study, players did not experience a body mass loss (dehydration >2%) indicative of a reduction in exercise performance, thus habitual hydration strategies seem adequate. Practitioners should evaluate the habitual hydration status of athletes to determine whether interventions above habitual strategies are warranted.

Volume kinetic evaluation of fluid turnover after oral intake of tap water, lemonade and saline in volunteers

Background

Volume kinetic fluid turnover of three beverages was investigated for the purpose of estimating their rates of absorption and elimination as well as their maximum effect on the blood volume. The results were then used to simulate the effects of ingesting different combinations of these fluids.

Method

Ten healthy volunteers ingested 0.5 L of tap water, lemonade (90 g/L carbohydrates) and isotonic saline (9 g/L) on different occasions. Venous blood samples for measurement of the blood haemoglobin (Hb), haematocrit and glucose concentrations were collected on 10 occasions over 2 h. A kinetic model based on haemoglobin dilution and urinary excretion was used to estimate the rate of absorption, the blood volume expansion over time, and the rate of elimination. Obtained kinetic data was used to simulate combinations of the three beverages in order to reach a predetermined goal of a 1:1 hydration of the blood volume and peripheral tissues over 6 h.

Results

Tap water had the fastest absorption but primarily hydrated peripheral tissues. Maximum hydration was reached after 17 min. Lemonade effectively expanded the blood volume and was absorbed and excreted at a high rate. The maximum hydration from isotonic saline occurred 60 min after ingestion. Slow excretion could make it possible to use saline to prolong the effects of the other two beverages.

Conclusions

It is possible to use the kinetic model to evaluate fluid turnover and compartmental distribution. Composition and timing of fluid intake can be calculated mathematically to meet predetermined goals of hydration and distribution.

Trial registration

NCT01360333 Date of registration: 05/23/2011.

Electronic supplementary material

The online version of this article (doi:10.1186/s13102-016-0045-x) contains supplementary material, which is available to authorized users.

Effects of Beer, Non-Alcoholic Beer and Water Consumption before Exercise on Fluid and Electrolyte Homeostasis in Athletes

Fluid and electrolyte status have a significant impact on physical performance and health. Pre-exercise recommendations cite the possibility of consuming beverages with high amounts of sodium. In this sense, non-alcoholic beer can be considered an effective pre-exercise hydration beverage. This double-blind, randomized study aimed to compare the effect of beer, non-alcoholic beer and water consumption before exercise on fluid and electrolyte homeostasis. Seven male soccer players performed 45 min of treadmill running at 65% of the maximal heart rate, 45 min after ingesting 0.7 L of water (W), beer (AB) or non-alcoholic beer (NAB). Body mass, plasma Na⁺ and K⁺ concentrations and urine specific gravity (USG) were assessed before fluid consumption and after exercise. After exercise, body mass decreased (p < 0.05) in W (−1.1%), AB (−1.0%) and NAB (−1.0%). In the last minutes of exercise, plasma Na⁺ was reduced (p < 0.05) in W (−3.9%) and AB (−3.7%), plasma K⁺ was increased (p < 0.05) in AB (8.5%), and USG was reduced in W (−0.9%) and NAB (−1.0%). Collectively, these results suggest that non-alcoholic beer before exercise could help maintain electrolyte homeostasis during exercise. Alcoholic beer intake reduced plasma Na⁺ and increased plasma K⁺ during exercise, which may negatively affect health and physical performance, and finally, the consumption of water before exercise could induce decreases of Na⁺ in plasma during exercise.

ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults

Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings.

Prevalence of Dehydration Before Training Sessions, Friendly and Official Matches in Elite Female Soccer Players

This study aimed to evaluate and compare the hydration states prior to different sporting events (training sessions, friendly and official matches) in elite female soccer players and relate that to the importance that the player attached to the hydration state as a determinant of sports performance. The hydration state of 17 female elite soccer players (age: 21.5 ± 3 years; body mass: 62 ± 6 kg; body height: 165 ± 9 cm) was determined by measuring their urine specific gravity (USG) prior to three different sports events: training sessions (PT), friendly (PF) and official (PO) matches. The importance that each player attached to the hydration state as a determinant of sports performance was evaluated through a simple questionnaire. An average of 47.05% of the soccer players were severely dehydrated (USG > 1.030), 33.33% were significantly dehydrated (USG > 1.020), 17.64% were mildly dehydrated (USG > 1.010) and 1.96% were euhydrated (USG < 1.010). The average USG was 1.027 ± 0.007 (PT = 1.029 ± 0.009; PF = 1.023 ± 0.010 and PO = 1.030 ± 0.006). Differences were found between urine specific gravity prior to a friendly and an official match (p = 0.03). No relationship was found between urine specific gravity and the importance each player attached to the hydration state as a determinant of sports performance. The results show that dehydration is the most prevalent hydration state of elite soccer players before training sessions, friendly and official matches. Players were most dehydrated prior to official matches, which was unlinked to the players’ perceived importance of hydration for sports performance.

Metabolomics-Based Analysis of Banana and Pear Ingestion on Exercise Performance and Recovery

Bananas and pears vary in sugar and phenolic profiles, and metabolomics was utilized to measure their influence on exercise performance and recovery. Male athletes (N = 20) cycled for 75 km while consuming water (WATER), bananas (BAN), or pears (PEAR) (0.6 g carbohydrate/kg each hour) in randomized order. UPLC-MS/MS and the library of purified standards maintained by Metabolon (Durham, NC) were used to analyze metabolite shifts in pre- and postexercise (0-h, 1.5-h, 21-h) blood samples. Performance times were 5.0% and 3.3% faster during BAN and PEAR versus WATER (P = 0.018 and P = 0.091, respectively), with reductions in cortisol, IL-10, and total leukocytes, and increases in blood glucose, insulin, and FRAP. Partial Least Square Discriminant Analysis (PLS-DA) showed a distinct separation between trials immediately (R(2)Y = 0.877, Q(2)Y = 0.457) and 1.5-h postexercise (R(2)Y = 0.773, Q(2)Y = 0.441). A total of 107 metabolites (primarily lipid-related) increased more than 2-fold during WATER, with a 48% and 52% reduction in magnitude during BAN and PEAR recovery (P < 0.001). Increases in metabolites unique to BAN and PEAR included fructose and fruit constituents, and sulfated phenolics that were related to elevated FRAP. These data indicate that BAN and PEAR ingestion improves 75-km cycling performance, attenuates fatty acid utilization and oxidation, and contributes unique phenolics that augment antioxidant capacity.

Acute Effects of Carbohydrate Supplementation on Intermittent Sports Performance

Intermittent sports (e.g., team sports) are diverse in their rules and regulations but similar in the pattern of play; that is, intermittent high-intensity movements and the execution of sport-specific skills over a prolonged period of time (~1–2 h). Performance during intermittent sports is dependent upon a combination of anaerobic and aerobic energy systems, both of which rely on muscle glycogen and/or blood glucose as an important substrate for energy production. The aims of this paper are to review: (1) potential biological mechanisms by which carbohydrate may impact intermittent sport performance; (2) the acute effects of carbohydrate ingestion on intermittent sport performance, including intermittent high-intensity exercise capacity, sprinting, jumping, skill, change of direction speed, and cognition; and (3) what recommendations can be derived for carbohydrate intake before/during exercise in intermittent sports based on the available evidence. The most researched intermittent sport is soccer but some sport-specific studies have also been conducted in other sports (e.g., rugby, field hockey, basketball, American football, and racquet sports). Carbohydrate ingestion before/during exercise has been shown in most studies to enhance intermittent high-intensity exercise capacity. However, studies have shown mixed results with regards to the acute effects of carbohydrate intake on sprinting, jumping, skill, change of direction speed, and cognition. In most of these studies the amount of carbohydrate consumed was ~30–60 g/h in the form of a 6%–7% carbohydrate solution comprised of sucrose, glucose, and/or maltodextrin. The magnitude of the impact that carbohydrate ingestion has on intermittent sport performance is likely dependent on the carbohydrate status of the individual; that is, carbohydrate ingestion has the greatest impact on performance under circumstances eliciting fatigue and/or hypoglycemia. Accordingly, carbohydrate ingestion before and during a game seems to have the greatest impact on intermittent sports performance towards the end of the game.