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Effects of oral salt supplementation on physical performance during a half-ironman: A randomized controlled trial: Salt supplementation during triathlon races

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Abstract

The aim of this study was to investigate the effectiveness of oral salt supplementation to improve exercise performance during a half-ironman triathlon. Twenty-six experienced triathletes were matched for age, anthropometric data, and training status, and randomly placed into the salt group (113 mmol Na(+) and 112 mmol Cl(-) ) or the control group (cellulose). The experimental treatments were ingested before and during a real half-ironman triathlon competition. Pre- and post-race body mass, maximal force during a whole-body isometric strength test, maximal height during a countermovement jump, were measured, and blood samples were obtained. Sweat samples were obtained during the running section. Total race time was lower in the salt group than in the control group (P = 0.04). After the race, whole-body isometric strength (P = 0.17) and jump height (P = 0.49) were similarly reduced in both groups. Sweat loss (P = 0.98) and sweat Na(+) concentration (P = 0.72) were similar between groups. However, body mass tended to be less reduced in the salt group than in the control group (P = 0.09) while post-race serum Na(+) (P = 0.03) and Cl(-) (P = 0.03) concentrations were higher in the salt group than in the control group. Oral salt supplementation was effective to lessen body mass loss and increase serum electrolyte concentration during a real half-ironman. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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... The aim of salt intake during exercise is to partially replace the amount of sodium (Na + ) and chloride (Cl − ) lost by thermoregulatory sweat, in order to enhance the maintenance of body water and electrolyte homeostasis [1] and to ameliorate physical and muscle performance decrements [2]. Salt intake is important for a myriad of sport modalities and training routines but it is even more relevant for endurance sports where large exercise times can trigger the occurrence of excessive fluid and electrolyte losses by sweating [3]. ...
... To estimate the requirements of salt during exercise, several investigations have been conducted to assess sweat Na + concentrations during different exercise and sport activities. As a range, sweat Na + concentration is 38-53 mmol·L −1 in football [4,5], 20-62 mmol·L −1 in soccer [6,7], 43-65 mmol·L −1 in swimming [8,9], 34-38 mmol·L −1 in handball [10,11], 54-73 mmol·L −1 in ice hockey [12,13], 17-73 mmol·L −1 in marathon [14] and 46-48 mmol·L −1 in triathlon [1]. A recent retrospective analysis with 506 athletes [15] has determined that sweat Na + concentration during exercise might vary from 13 to 105 mmol·L −1 but these data were obtained from athletes of very different sport disciplines (American football, baseball, basketball, soccer, tennis, cycling, running and triathlon) in very diverse weather conditions (15 to 50°C of dry temperature). ...
... However, these characteristics do not fully explain the high inter-individual variance found in these previous investigations. Perhaps, the relatively small sample sizes used in these studies (number of participants between 10 and 55) [1,[4][5][6][7][8][9][10][11][12][13][14] have limited the possibility of obtaining explanations for the variation of sweat Na + concentration during exercise. ...
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Background Sodium (Na⁺) intake during exercise aims to replace the Na⁺ lost by sweat to avoid electrolyte imbalances, especially in endurance disciplines. However, Na⁺ needs can be very different among individuals because of the great inter-individual variability in sweat electrolyte concentration. The aim of this investigation was to determine sweat electrolyte concentration in a large group of marathoners. Methods A total of 157 experienced runners (141 men and 16 women) completed a marathon race (24.4 ± 3.6 °C and 27.7 ± 4.8 % of humidity). During the race, sweat samples were collected by using sweat patches placed on the runners’ forearms. Sweat electrolyte concentration was measured by using photoelectric flame photometry. Results As a group, sweat Na⁺ concentration was 42.9 ± 18.7 mmol·L−1 (minimal-maximal value = 7.0–95.5 mmol·L−1), sweat Cl− concentration was 32.2 ± 15.6 mmol·L−1 (7.3–90.6 mmol·L−1) and sweat K⁺ concentration was 6.0 ± 0.9 mmol·L−1 (3.1–8.0 mmol·L−1). Women presented lower sweat Na⁺ (33.9 ± 12.1 vs 44.0 ± 19.1 mmol·L−1; P = 0.04) and sweat Cl− concentrations (22.9 ± 10.5 vs 33.2 ± 15.8 mmol·L−1; P = 0.01) than men. A 20 % of individuals presented a sweat Na⁺ concentration higher than 60 mmol·L−1 while this threshold was not surpassed by any female marathoner. Sweat electrolyte concentration did not correlate to sweat rate, age, body characteristics, experience or training. Although there was a significant correlation between sweat Na⁺ concentration and running pace (r = 0.18; P = 0.03), this association was weak to interpret that sweat Na⁺ concentration increased with running pace. Conclusions The inter-individual variability in sweat electrolyte concentration was not explained by any individual characteristics except for individual running pace and sex. An important portion (20 %) of marathoners might need special sodium intake recommendations due to their high sweat salt losses.
... The five studies investigated the effect of sodium ingestion during exercise on different aspects of endurance performance. One study [23] used a time trial, one a distance-test [24], one time to exhaustion following steady state exercise [25], and two provided known quantities of sodium during an organized endurance competition [26,27]. Each of these performance types will be described separately. ...
... All studies provided sodium in the form of sodium chloride. In four of the studies this was provided in capsules and compared to a placebo capsule that contained no sodium in a blinded manner [23,[25][26][27], whilst in the fifth study [24] sodium was provided unblinded in a solution, with a high and low sodium concentration as well as a water only control. The quantity of sodium provided varied between studies from 280 to 900 mg/h. ...
... Two studies assessed the effect of sodium intake on performance during an organized half-(n= 26, all male) [26] and full-Ironman (IM) triathlon (n= 114, 104 male) [27]. Participants were randomised to consume either sodium or placebo capsules throughout the race (half-IM 504 mg/h, IM 284 mg/h). ...
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Sports nutrition guidelines frequently encourage sodium ingestion during endurance exercise, and much work has been undertaken to quantify sweat sodium losses during exercise. However, current guidelines for sodium do not recommend specific quantities, nor provide justification for the effectiveness of sodium to improve endurance performance. A systematic review was undertaken using six databases (CINAHL, Embase, Medline Ovid, Scopus, SPORTDiscus, and Web of Science) to determine the effect of sodium ingestion during exercise on endurance performance. Five studies met the inclusion criteria. They varied in quantity of sodium consumed (280 to 900mg/h), ingestion method (capsules or solutions), fluid intake (programmed or ad libitum) and performance outcomes (time trial, distance-test, time to exhaustion following steady state exercise, and finish time in an organized competition). Only one study reported a significant benefit from sodium ingestion (504mg/h) of 7.8%. All other studies found no significant effect of sodium on performance. Several limitations were found, including different ambient conditions across study days, ad libitum carbohydrate intake that was not reported, and performance measured during an organized competition where other factors may have influenced finish time. No study measured performance in hot ambient conditions (e.g., ≥30°C), and no study quantified each participant’s sweat sodium losses beforehand, thus providing sodium intake as a proportion of expected losses. It is concluded that there is currently minimal evidence that sodium ingestion during exercise improves endurance performance. The limited number and quality of existing studies indicates a need for future work in this area.
... These included 152 participants (females, n = 23), consisting of three RCT's, one of which referred to elite athletes. The articles investigated exercise/athletic performance-related variables with combinations of minerals (in a number of biological forms) inadvertently or deliberately to investigate their cumulative effect, with mixed results [51,164,[213][214][215]. ...
... There is some evidence of improvements in 'real-world' endurance performance with multi-mineral supplementation. Del Coso et al. [213] loaded 13 triathletes with an electrolyte combination of 2580 mg of Na, 3979 mg of Cl, 756 mg of K, and 132 mg of Mg, divided into three dosing intervals, during a half ironman race and compared the results to a placebo group of 13 athletes. The supplemented group had a faster cycle speed and tendency towards faster running speed along with a quicker finishing time (by~25 min), compared to the placebo group. ...
... There is currently little evidence for the beneficial effects of mineral combinations from either metal element combinations or natural complexes on athletic performance. Nonetheless, there is some evidence that a combination of Na, K and Mg loading may improve aspects of half ironman performance [213]. However, real-world replication is needed with complementary controlled laboratory evidence before this strategy can be recommended. ...
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Minerals and trace elements (MTEs) are micronutrients involved in hundreds of biological processes. Deficiency in MTEs can negatively affect athletic performance. Approximately 50% of athletes have reported consuming some form of micronutrient supplement; however, there is limited data confirming their efficacy for improving performance. The aim of this study was to systematically review the role of MTEs in exercise and athletic performance. Six electronic databases and grey literature sources (MEDLINE; EMBASE; CINAHL and SportDISCUS; Web of Science and clinicaltrials.gov) were searched, in accordance with PRISMA guidelines. Results: 17,433 articles were identified and 130 experiments from 128 studies were included. Retrieved articles included Iron (n = 29), Calcium (n = 11), Magnesium, (n = 22), Phosphate (n = 17), Zinc (n = 9), Sodium (n = 15), Boron (n = 4), Selenium (n = 5), Chromium (n = 12) and multi-mineral articles (n = 5). No relevant articles were identified for Copper, Manganese, Iodine, Nickel, Fluoride or Cobalt. Only Iron and Magnesium included articles of sufficient quality to be assigned as 'strong'. Currently, there is little evidence to support the use of MTE supplementation to improve physiological markers of athletic performance, with the possible exception of Iron (in particular, biological situations) and Magnesium as these currently have the strongest quality evidence. Regardless, some MTEs may possess the potential to improve athletic performance, but more high quality research is required before support for these MTEs can be given. PROSPERO preregistered (CRD42018090502).
... This may hold especially true for athletes engaged in longer sporting events such as a marathon or Ironman triathlon, where the loss of fluid through sweat is substantial [32]. Supplementation with higher sodium sports drinks or salt capsules may be advisable for athletes engaged in prolonged exercise of 3 h or more in order to maintain serum electrolyte concentrations [33,34]. Based on these studies and others, the longer an event, the more critical it appears to be to have an adequate hydration plan in place that considers sweat rate and composition [1,34]. ...
... Supplementation with higher sodium sports drinks or salt capsules may be advisable for athletes engaged in prolonged exercise of 3 h or more in order to maintain serum electrolyte concentrations [33,34]. Based on these studies and others, the longer an event, the more critical it appears to be to have an adequate hydration plan in place that considers sweat rate and composition [1,34]. In our study, most of the participants engaged in training sessions lasting between 70 min to two hours and the benefits were apparent. ...
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Background: Athletes commonly consume insufficient fluid and electrolytes just prior to, or during training and competition. Unlike non-athletes or athletes who do not engage in frequent rigorous and prolonged training sessions, "hard trainers" may require additional sodium and better benefit from a hydration plan tailored to their individual physiology. The purpose of this randomized cross-over study was to determine whether a hydration plan based off of an athlete's sweat rate and sodium loss improves anaerobic and neurocognitive performance during a moderate to hard training session as well as heart rate recovery from this session. Methods: Collegiate athletes who were injury free and could exercise at ≥ 75% of their maximum heart rate for a minimum of 45 min were recruited for this randomized, cross-over study. After completing a questionnaire assessing hydration habits, participants were randomized either to a prescription hydration plan (PHP), which considered sweat rate and sodium loss or instructed to follow their normal ad libitum hydration habits (NHP) during training. Attention and awareness, as well as lower body anaerobic power (standing long jump) were assessed immediately before and after a moderate to hard training session of ≥ 45 min. Heart rate recovery was also measured. After a washout period of 7 days, the PHP group repeated the training bout with their normal hydration routine, while the NHP group were provided with a PHP plan and were assessed as previously described. Results: Fifteen athletes from three different sports, aged 20 ± 0.85 years, participated in this study. Most participants reported feeling somewhat or very dehydrated after a typical training session. Compared to their NHP, participants following a PHP jumped 4.53 ± 3.80 in. farther, tracked moving objects 0.36 ± 0.60 m/second faster, and exhibited a faster heart rate recovery following a moderate to hard training session of 45-120 min in duration. Conclusion: A tailored hydration plan, based on an athlete's fluid and sodium loss has the potential to improve anaerobic power, attention and awareness, and heart rate recovery time.
... For endurance exercise, exceeding ≥4 hours, where the incidence of EIGS is greatest, body mass changes may not adequately reflect hydration status, and care is needed in interpretation of fluid balance assessments undertaken over this duration [100,105,106]. Drinking fluid ad libitum during such endurance exercise bouts appears to be adequate for most individuals to maintain euhydration [102,110]. However, a fluid balance assessment with the additional A c c e p t e d M a n u s c r i p t 22 assessment for gastrointestinal tolerance to fluids may help to identify individuals where ad libitum fluid consumption may not be adequate. ...
... Anecdotally, one rationale for sodium supplementation is the focus and belief on attenuating dehydration, and subsequently reducing occurrence and severity of GIS. It has been observed that sodium ingestion during submaximal exercise increases thirst and voluntary fluid intake when fluid is consumed ad libitum [110], and this could result in greater plasma volume over multiple hours of exercise that influence both the circulatory-gastrointestinal and neuroendocrine-gastrointestinal pathways. However, sodium intake does not appear to exert any effect on core body temperature independent of water intake [111]. ...
Article
Exercise-induced gastrointestinal syndrome (EIGS) is a common characteristic of exercise. The causes appear to be multi-factorial in origin, but stem primarily from splanchnic hypoperfusion and increased sympathetic drive. These primary causes can lead to secondary outcomes that include increased intestinal epithelial injury and gastrointestinal hyperpermeability, systemic endotoxaemia and responsive cytokinaemia, and impaired gastrointestinal function (i.e., transit, digestion and absorption). Impaired gastrointestinal integrity and functional responses may predispose individuals, engaged in strenuous exercise, to gastrointestinal symptoms (GIS) and health complications of clinical significance, both of which may have exercise performance implications. There is a growing body of evidence indicating heat exposure during exercise (i.e., exertional-heat stress) can substantially exacerbate these gastrointestinal perturbations, proportionally to the magnitude of exertional-heat stress, which is of major concern for athletes preparing for and competing in the upcoming 2020 Tokyo Olympic Games. To date, various hydration and nutritional strategies have been explored to prevent or ameliorate exertional-heat stress associated gastrointestinal perturbations. The aims of the current review are to comprehensively explore the impact of exertional-heat stress on markers of EIGS, examine the evidence for the prevention and (or) management of EIGS in relation to exertional-heat stress, and establish best-practice nutritional recommendations for athletes preparing for and competing in Tokyo 2020.
... 79 For a Half-Ironman, however, oral salt supplementation improved performance. 80 Additionally, oral salt supplementation was effective to lessen body mass loss and to increase serum electrolyte concentration. 80 ...
... 80 Additionally, oral salt supplementation was effective to lessen body mass loss and to increase serum electrolyte concentration. 80 ...
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Objective: This narrative review summarizes findings for Ironman triathlon performance and intends to determine potential predictor variables for Ironman race performance in female and male triathletes. Methods: A literature search was performed in PubMed using the terms "Ironman", "triathlon", and "performance". All resulting articles were searched for related citations. Results: Age, previous experience, sex, training, origin, anthropometric and physiological characteristics, pacing, and performance in split disciplines were predictive. Differences exist between the sexes for anthropometric characteristics. The most important predictive variables for a fast Ironman race time were age of 30-35 years (women and men), a fast personal best time in Olympic distance triathlon (women and men), a fast personal best time in marathon (women and men), high volume and high speed in training where high volume was more important than high speed (women and men), low body fat, low skin-fold thicknesses and low circumference of upper arm (only men), and origin from the United States of America (women and men). Conclusion: These findings may help athletes and coaches to plan an Ironman triathlon career. Age and previous experience are important to find the right point in the life of a triathlete to switch from the shorter triathlon distances to the Ironman distance. Future studies need to correlate physiological characteristics such as maximum oxygen uptake with Ironman race time to investigate their potential predictive value and to investigate socio-economic aspects in Ironman triathlon.
... Ad libitum fluid intake is the best way to maintain plasma Na + concentration in triathletes. In a Half Ironman, however, oral salt supplementation improved performance 48 , effectively lessening body mass loss and increasing serum electrolyte concentration 48 . ...
... Ad libitum fluid intake is the best way to maintain plasma Na + concentration in triathletes. In a Half Ironman, however, oral salt supplementation improved performance 48 , effectively lessening body mass loss and increasing serum electrolyte concentration 48 . ...
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The importance of physical activity in preventing chronic cardiovascular and metabolic diseases and the role of exercise as an adjunct therapy are widely recognized. Triathlon is a typically endurance discipline. Prolonged and intensive exercise is known to cause changes in blood rheological properties and biochemical markers; sometimes athletes participating in strenuous competitions need medical attention. To understand the phenomena occurring in the body in such situations, we decided to study participants’ biomarkers after the XTERRA Poland 2017 triathlon competition. The study involved 10 triathletes. The XTERRA Poland 2017 event comprised 1500-m swimming, 36-km cycling, and 10-km mountain running. Blood samples were collected 2 days before, immediately after, and 16 h after the competition. Immediately after the race, white blood cells count, platelets, and uric acid levels were signifcantly (P< 0.001) increased; haematocrit, Na+, Cl–, and IgA were decreased. On the following day, Na+, Cl–, and C-reactive protein levels were signifcantly (P< 0.001) increased; white blood cells count, red blood cells count, haemoglobin, haematocrit, mean corpuscular volume, platelets, IgG, and IgA were decreased. Assessing rheological parameters such as erythrocyte deformability and aggregation is useful for monitoring adverse efects of intensive and exhaustive exercise. The study illustrates the change in blood rheological properties and biochemical markers after intensive physical efort. Despite these diferences, the indicators were within the reference range for the general population, which may demonstrate normal body function in the studied triathletes.
... These counsellors are necessary, because unlike animals, humans seek salt to please their palate, but not to save their life ( 78) . Hence, many sports authorities recommend sodium supplementation for safety, as well as to maintain athletic performance and accelerate recovery after it ( 78,113,114,15) . Such effects could condition a salt preference and contribute to its intake ( 76) . ...
... Hyponatraemic humans, however, require health workers to both diagnose their condition and administer sodium ( 68,78,111,112,113,114) . Further, sodium deficient animals recognise sodium in any mineral form ( 68) , whereas humans do not, taking only the single form, table salt (sodium chloride), suggesting that sodium, the life-essential ion, is not the target cation taste as it is for animals ( 15) . ...
Article
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Expensive and extensive studies on the epidemiology of excessive sodium intake and its pathology have been conducted over four decades. The resultant consensus that dietary sodium is toxic, as well as the contention that it is less so, ignore the root cause of the attractiveness of salted food. The extant hypotheses are that most sodium is infiltrated into our bodies via heavily salted industrialized food without our knowledge and that mere exposure early in life determines lifelong intake. However, these hypotheses are poorly evidenced and are meagre explanations for the comparable salt intake of people worldwide despite their markedly different diets. The love of salt begins at birth for some, vacillates in infancy, climaxes during adolescent growth, settles into separate patterns for men and women in adulthood, and, with age, fades for some and persists for others. Salt adds flavour to food. It sustains and protects humans in exertion, may modulate their mood, and contributes to their ailments. It may have as yet unknown benefits that may promote its delectability, and it generates controversy. An understanding of the predilection for salt should allow a more evidence-based and effective reduction of the health risks associated with sodium surfeit and deficiency. It is the purpose of this brief review to show the need for research into the determinants of salt intake by summarising the little we know.
... Additionally, it needs to be mentioned that only one 25 of the five studies that explored the effects of sodium bicarbonate used a sodium-matched placebo comparison. Given that there are cases in which sodium can also be ergogenic, 45 future studies on this topic should consider adding a condition with an equimolar amount of salt to the sodium bicarbonate condition to isolate the effects of bicarbonate. 46 In the included studies, caffeine and sodium bicarbonate were provided in isolation. ...
Article
OBJECTIVES: To conduct a systematic review and a meta-analysis of studies exploring the effects of caffeine and/or sodium bicarbonate on performance in the Yo-Yo test. DESIGN: Systematic review/meta-analysis. METHODS: A total of six databases were searched, and random-effects meta-analyses were performed examining the isolated effects of caffeine and sodium bicarbonate on performance in the Yo-Yo test. RESULTS: After reviewing 988 search records, 15 studies were included. For the effects of caffeine on performance in the Yo-Yo test, the meta-analysis indicated a significant favoring of caffeine as compared with the placebo conditions (p = 0.022; standardized mean difference [SMD] = 0.17; 95% CI: 0.08, 0.32; +7.5%). Subgroup analyses indicated that the effects of caffeine were significant for the level 2 version of the Yo-Yo test, but not level 1. Four out of the five studies that explored the effects of sodium bicarbonate used the level 2 version of the Yo-Yo test. The pooled SMD favored the sodium bicarbonate condition as compared with the placebo/control conditions (p = 0.007; SMD: 0.36; 95% CI: 0.10, 0.63; +16.0%). CONCLUSIONS: This review demonstrates that isolated ingestion of caffeine and sodium bicarbonate enhances performance in the Yo-Yo test. Given these ergogenic effects, the intake of caffeine and sodium bicarbonate before the Yo-Yo test needs to be standardized (i.e., either restricted or used in the same way before each testing session). Furthermore, the results suggest that individuals competing in sports involving intermittent exercise may consider supplementing with caffeine or sodium bicarbonate for acute improvements in performance.
... While it is clear that sports drinks may attenuate the decline in serum [Na + ], especially when fluid intake matches sweat losses [52,53] , sports drinks cannot prevent EAH during exercise if ingested in excess [53] . Although there has been evidence to suggest that ingesting a high sodium diet may increase serum [Na + ] within the normal range [54] , the effect of ingesting salt tablets on serum [Na + ] during races has been supported in some studies [55] but not in others [56] . ...
Chapter
Exercise-associated hyponatremia (EAH) refers to below-normal serum sodium concentrations [Na⁺] that develop during exercise. The pathogenesis of EAH is best described as a spectrum ranging between profound polydipsia to modest sweat sodium losses with hypovolemia and relative dilution. Non-osmotic arginine vasopressin (AVP) remains the unifying pathogenic stimulus to abnormal renal water retention in acute symptomatic EAH. Cases of hyponatremia are mostly reported after endurance sports, but are also observed after shorter duration events and in team sport athletes. The signs and symptoms of EAH are vague, and include bloating, vomiting, headache, and altered mental status. A diagnosis of EAH can only be confirmed by a blood test, whereas signs/symptoms guide the most appropriate treatment strategy. Mild-to-moderate EAH (without encephalopathy) can be treated with either fluid restriction or an oral bolus of a hypertonic saline solution. Severe EAH (with encephalopathy) is a life-threatening emergency and should be urgently treated with intravenous 100 mL boluses of 3% saline until the resolution of encephalopathy symptoms. The prevention of EAH is evolutionarily rooted in preventing overdrinking during exercise. Drinking according to the dictates of thirst is the most individualized strategy to prevent life-threatening dysnatremia during exercise, regardless of sport.
... Most hydration guidelines recommend that athletes drink beyond thirst to prevent the detrimental health and performance consequences of dehydration [10]. Alternatively, although it is suggested that sodium intake during exercise will prevent hyponatremia [10], some studies support this claim [17], while other do not [5]. Accordingly, recommendations to drink enough fluids to maintain body mass losses < 2% or keep urine clear (UOsm < 700 mOsmol/kg H 2 O) [10] would have likely induced hyponatremia instead of preventing cellular dehydration (hypernatremia), which did not occur in this cohort with ad libitum drinking. ...
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Background It remains unclear if ad libitum water drinking, as a hydration strategy, prevents exercise-associated hyponatremia (EAH) during prolonged exercise. The aim of this study was to determine the incidence of EAH within the broader context of fluid regulation among soldiers performing a 40-km route-march ingesting water ad libitum. Methods Twenty-eight healthy male soldiers participated in this observational trial. Pre- and post-exercise body mass, blood and urine samples were collected. Blood samples were assessed for serum sodium ([Na⁺]), glucose, creatinine, urea nitrogen (BUN), plasma osmolality, creatine kinase (CK), and plasma arginine vasopressin (AVP) concentrations. Plasma volume (PV) was calculated using hematocrit and hemoglobin. Urine samples were analyzed for osmolality and [Na⁺]. Water intake was assessed by weighing bottles before, during and after the march. The mean relative humidity was 55.7% (21.9–94.3%) and the mean dry bulb temperature was 27.1 °C (19.5 °C - 37.0 °C) during the exercise. Results Twenty-five soldiers (72 ± 10 kg) (Mean ± SD) completed the march in 09:11 ± 00:43 (hr:min). Participants consumed 736 ± 259 ml/h of water and lost 2.8 ± 0.9 kg (4.0% ± 1.4%, P < 0.05) of body mass. Significant (pre-march vs. post-march; P < 0.05) decreases in serum [Na⁺] (141 mmol/L vs. 136 mmol/L), plasma osmolality (303 mOsmol/kg H2O vs. 298 mOsmol/kg H2O), and serum creatinine (111 μmol/L vs. 101 μmol/L) and urine [Na⁺] (168 mmol/L vs. 142 mmol/L), as well as significant increases in plasma AVP (2 pg/ml vs. 11 pg/ml), plasma CK (1423 U/L vs. 3894 U/L) and urine osmolality (1035 mOsmol/kg H2O vs. 1097 mOsmol/kg H2O) were found. The soldier (72 kg) with the lowest post-exercise sodium level completed the march in 08:38. He drank 800 ml/h, lost 2% body mass, and demonstrated (pre-post) increases in plasma osmolality (294–314 mOsmol/kg H2O), BUN (20–30 mg/dl), AVP (2–16 pg/ml) and PV (41%). His urine osmolality decreased from 1114 mOsmol/kg H2O to 1110 mOsmol/kg H2O. No participants finished the route-march with a serum [Na⁺] indicating hypernatremia (range, 134–143 mmol/L). Conclusions Ad libitum drinking resulted in 4% body mass loss with a 2 mmol/L serum [Na⁺] reduction in conjunction with high urine osmolality (> 1000 mOsmol/kg H2O) and plasma AVP. No single hydration strategy likely prevents EAH, but hypernatremia (cellular dehydration) was not seen despite > 2% body mass losses and high urine osmolality.
... In a triathlon field study, oral salt supplementation improved half-Ironman performance through faster cycling (p < 0.05) and showed a similar trend in the running leg (p = 0.06), with reduced sweat rate and limited electrolyte deficit [56]. The consensus recommendation is thus to ingest 0.5-0.7 g L −1 h −1 for long endurance races [57] and up to 1.5 g L −1 h −1 for athletes prone to develop muscle cramping [58]. ...
Chapter
Physical performance in tropical environments, which combine heat and high humidity, is a challenge that requires specific preparation. The high humidity of a tropical climate alters thermoregulatory capacity by limiting the rate of sweat evaporation. Proper management of whole-body temperature is thus essential to complete an endurance event like a long-distance triathlon or an ultramarathon in such an environment. In triathlon and ultra-endurance races, which can last from 8 to 20 h, performance in tropical settings is closely linked to the capacity to maintain hydration status. Indeed, the rate of withdrawal in these longer events has been associated with water intake, with many finishers showing alterations in electrolyte (e.g., sodium) balance. To counterbalance the impact of a tropical climate and maintain performance, several countermeasures can be adopted, such as using hydration and cooling strategies, and heat acclimation.
... In addition to its importance in terms of regulating water and fluid balance [16], it is vital for the stimulation of muscle and nerve cells and is also involved in the control of the acid-base balance [17]. In the sport section, sodium helps to maintain serum electrolyte concentrations resulting in a balance of intravascular osmotic pressure and plasma volume [18]. It increases the thirst stimulus and reduces the amount of urine produced [19], effects that ultimately reduce physical fatigue and medical problems associated with these homeostatic imbalances in endurance sports [20]. ...
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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.
... The estimated time for these stoppages was subtracted from the race time. Participants also filled out a detailed questionnaire about fluid and food intake during the race (Del Coso et al. 2016). Data on this questionnaire was used to calculate fluid intake during the race using the nutritional facts on the products consumed and nutrition software (PCN software, Cesnid, Spain). ...
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PurposeAlpha-actinin-3, encoded by the ACTN3 gene, is an actin-binding protein with an important role in myofibril contraction and muscle force output. In humans, there is a relatively common deficiency of the α-actinin-3 due to homozygosity in a polymorphism of the ACTN3 gene (R577X, rs1815739), that has been related to decreased resistance to strain during voluntary muscle contractions. The purpose of this study was to investigate the influence of the ACTN3 genotype on the level of exercise-induced muscle damage attained by 23 experienced triathletes during an official half-ironman competition. Methods Before and after the race, a sample of venous blood was obtained and jump height was measured during a countermovement jump. The changes in serum creatine kinase (CK-MM isoform) were measured in the blood samples and muscle pain was measured with a visual analogue scale (0–10 cm). Data from RX heterozygotes and XX mutant homozygotes were grouped as X-allele carriers (n = 13) and compared to RR homozygotes (n = 10). ResultsRace time was very similar between groups (313 ± 31 vs. 313 ± 25 min; P = 0.45); however, pre-to-post-competition reduction in jump height was greater in X-allele carriers than RR homozygotes (−18.4 ± 11.4 vs. −8.2 ± 6.9%; P = 0.04). At the end of the race, X-allele carriers presented higher serum CK-MM concentrations (682 ± 144 vs. 472 ± 269 U/L; P = 0.03), and there was also a tendency for higher self-reported values of lower limb muscle pain (7.7 ± 1.1 vs. 6.3 ± 2.3 cm; P = 0.06). ConclusionsX-allele triathletes in the ACTN3 R577X polymorphism presented greater signs of exercise-induced muscle damage during a half-ironman race than RR homozygotes.
... Ultramarathon running events have increased in popularity around the world, with voluntary electrolyte supplements used by 90% to 96% of participants. 1 Sodium supplements in endurance runners are believed to prevent a myriad of symptoms including nausea, muscle cramping, and impaired performance 1 and are advocated by American College of Sports Medicine Guidelines to help prevent hyponatremia. 2 Although fluid ingestion with sodium may maintain plasma volume better than water alone during exercise, 3 and supplements may help maintain serum sodium levels, 4,5 most evidence suggests that these are not protective against development of exerciseassociated hyponatremia (EAH). 1,3,6-8 Exercise-associated hyponatremia is defined as a serum sodium concentration below 135mEq/L. ...
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Objective: Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. Design: Prospective observational study. Setting: The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts. Participants: All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire. Intervention: Weight change and finish line serum sodium levels were gathered. Main outcome measures: Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L) and hypernatremia (>145 mmol·L) by sodium ingestion and climate. Results: Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races. Conclusions: This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.
... Thirty minutes before the race, participants were weighed (± 50 g scale; Radwag, Radom, Poland) in their competition clothes and after they had emptied their bladders. At this time, two sweat patches (Tegaderm + Pad, 3M, Minnesota, USA) were placed on the forearm to collect sweat samples during the race, as previously described (Del Coso et al., 2015). For this measurement, the forearm skin was gently cleaned with distilled water and alcohol and dried with clean gauze to eliminate any remains of previous sweat/electrolytes from the skin. ...
Article
The aim of this investigation was to determine the influence of CFTR genotype on body water and electrolyte balance during a marathon. Fifty-one experienced runners completed a marathon race. Before and after the race, body mass and a sample of venous blood were obtained. During the race, sweat samples were collected using sweat patches, and fluid and electrolyte intake were obtained using self-reported questionnaires. Thirty-eight participants (74.5% of the total) were 7T/7T homozygotes, 11 (21.6%) were 7T/9T heterozygotes, and one participant presented the rare genotype 5T/7T. Another participant with 9T/9T presented the mutation p.L206W. Participants with 7T/7T showed higher sweat sodium concentrations (42.2 ± 21.6 mmol/L) than 7T/9T (29.0 ± 24.7 mmol/L; P = 0.04). The runner with the 5T/7T genotype (10.2 mmol/L) and the participant with the p.L206W mutation (20.5 mmol/L) exhibited low-range sweat sodium concentrations. However, post-race serum sodium concentration was similar in 7T/7T and 7T/9T (142.1 ± 1.3 and 142.4 ± 1.6 mmol/L, respectively; P = 0.27) and did not show abnormalities in participants with the 5T/7T genotype (140.0 mmol/L) and the p.L206W mutation (143.0 mmol/L). Runners with the CFTR-7T/7T genotype exhibited increased sweat sodium concentrations during a marathon. However, this phenotype was not related with increased likelihood of suffering body water and electrolyte imbalances during real competitions. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
... This is not surprising because, due to logistics and testing di culties, it is extremely di cult to conduct randomised controlled studies during real endurance competitions. Indeed, only a handful of such pragmatic trials have been published (Utter et al. 2002;Hansen et al. 2014;Del Coso et al. 2016;Rowlands and Houltham 2017;McCormick et al. 2018;Pugh et al. 2019). ...
Preprint
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Purpose It is well established that mental fatigue impairs performance during lab-based endurance tests lasting < 45 min. However, the effects of mental fatigue on longer-duration endurance events and in field settings are unknown. The aim of this study was to investigate the effect of mental fatigue on performance during a half-marathon race. Methods Forty-six male amateur runners (means ± SD: age 43.8 ± 8.6 years, V̇O2max 46.0 ± 4.1 ml/kg/min) completed an half-marathon after being randomly allocated to performing a 50-min mentally-fatiguing task (mental fatigue group) or reading magazines for 50 min (control group). Running speed, heart rate, and perceived effort were measured during the race. Results The mental fatigue group completed the half-marathon approximately four minutes slower (106.2 ± 12.4 min) than the control group (102.4 ± 10.2 min), but this difference was not statistically significant (Cohen’s d = 0.333; p = 0.265). However, equivalence was not established (t(40.88) = 0.239, p = 0.594) and equivalence testing analysis excluded a worthwhile positive effect of mental fatigue on half-marathon performance. Conclusion Due to its posttest-only design and the achievable sample size, the study did not have enough power to provide evidence that the observed 4-minute increase in half-marathon time is statistically significant. However, equivalence testing suggests that mental fatigue has no beneficial effects on half-marathon performance in male amateur runners, and harmful effects cannot be excluded. Overall, it seems prudent for endurance athletes to avoid mentally-fatiguing tasks before competitions.
... There has been scant evidence supporting the performance benefit of sodium supplementation in endurance exercise or finishing status [22,23]. Studies found no differences in triathlon race time between those taking salt tablets versus no electrolytes [5,6,24], no benefit of sodium concentrations on distances run in 4 h [25], or differences in race time in ultramarathon finishers versus small groups of runners with no electrolytes [26]. As only relatively small endurance running studies have investigated the impact of sodium supplementation on performance, an analysis of weight-based sodium ingestion rates in a larger cohort could provide further insight into this debate. ...
Article
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Background Sodium supplements are ubiquitous in endurance running, but their impact on performance has been subjected to much debate. The objective of the study was to assess the effect of sodium supplementation as a weight-based predictor of race performance in ultramarathon runners. Methods Prospective observational study during an 80 km (50 mi) stage of a 6-stage 250 km (155 mi) ultramarathon in Chile, Patagonia, Namibia, and Mongolia. Finish line hydration status as measured by weight change, point-of-care serum sodium, and questionnaire provided sodium ingestion categories at 33rd percentile and 66th percentile both for weight-adjusted rate and total sodium consumption, then analyzed for significant relationships to race performance, dysnatremia, and hydration. Results Two hundred sixty-six participants were enrolled, with 217 (82%) with complete sodium supplement rate data, 174 (80%) with finish line sodium, and 161 (74%) with both pre-race weights and total sodium ingestion allowing weight-based analysis. Sodium intake ranged from 131–533 mg/h/kg (2–7.2 gm), with no statistically significant impact on pace, race time, or quintile rank. These outcomes did not change when sodium intake was analyzed as a continuous variable or by sub-group analysis of the 109 (68%) normonatremic runners. When controlled for weight-adjusted sodium intake, performance was poorly correlated with hydration (r = − 0.152, 95% CI − 0.348–0.057). Dehydrated runners outperformed those overhydrated, with 11% of top 25th percentile finishers dehydrated (versus 2.8% overhydrated), with 3.6 min/km faster pace and time 4.6 h faster finishing time. Conclusions No association was found between sodium supplement intake and ultramarathon performance. Dehydrated runners were found to have the best performance. This reinforces the message to avoid overhydration.
... In a triathlon field study, oral salt supplementation improved half-Ironman performance through faster cycling (p < 0.05) and showed a similar trend in the running leg (p = 0.06), with reduced sweat rate and limited electrolyte deficit [56]. The consensus recommendation is thus to ingest 0.5-0.7 g L −1 h −1 for long endurance races [57] and up to 1.5 g L −1 h −1 for athletes prone to develop muscle cramping [58]. ...
Book
Physical performance in a tropical environment, combining high heat and humidity, is a difficult physiological challenge that requires specific preparation. The elevated humidity of a tropical climate impairs the thermoregulatory mechanisms by limiting the rate of sweat evaporation. Hence, a proper management of whole-body temperature is required to complete an ultra-endurance event in such an environment. In these long-duration events, which can last from 8 to 20 h, held in hot and humid settings, performance is tightly linked to the ability in maintaining an optimal hydration status. Indeed, the rate of withdrawal in these longer races was associated with lower water intake, and the majority of finishers exhibited alterations in electrolyte balance (e.g., sodium). Hence, this work reviews the effects on performance of high heat and humidity in two representative ultra-endurance sports, ultramarathons and long-distance triathlons, and several countermeasures to counteract the impact of these harsh environmental stresses and maintain a high level of performance, such as hydration, cooling strategies and heat acclimation.
... Although this may appear somewhat surprising given the significant reduction in body mass after exercise (i.e. dehydration), these data are consistent with other studies indicating that 120 min of hyperthermic exercise may not be long enough to induce significant changes in pOsm or electrolytes particularly when subjects are allowed to consume fluids ad-libitum (Greenleaf et al., 1983;Del Coso et al., 2016). Blood glucose decreased during hyperthermic exercise in the water and electrolytes only conditions and remained stable during normothermic exercise (Fig. 4). ...
Article
Introduction To determine if electrolyte or carbohydrate supplementation vs. water would limit the magnitude of dehydration and decline in cognitive function in humans following long-duration hyperthermic-exercise. Methods 24 subjects performed 3 visits of 2hrs walking (3mph/7% grade) in an environmental chamber (33 °C/10% relative humidity). In random order, subjects consumed water (W), electrolytes (Gatorade Zero; E), or electrolytes+carbohydrates (Gatorade; E+C). Throughout exercise (EX), subjects carried a 23kg pack and drank ad-libitum. Pre-and post-EX, body mass (BM) and plasma osmolality (pOsm) were measured. Physiological Strain Index (PSI) and core temperature (TC) were recorded every 15mins. Plasma glucose (GLU) was measured every 30mins. Cognitive processing (SCWT) was measured post-EX and compared to baseline (BL). A subset of 8 subjects performed a normothermic (N) protocol (21 °C/ambient humidity) to ascertain how the exercise stimulus influenced hydration status and cognition without heat. Results There were no significant differences between fluid conditions (W, E, E+C) for BM loss (Δ2.5 ± 0.2, 2.5 ± 0.2, 2.3 ± 0.2kg), fluid consumption (1.9 ± 0.2, 1.9 ± 0.2, 1.8 ± 0.2L), pOsm (Δ1.5 ± 2.7, 2.2 ± 2.4, 2.0 ± 1.5mmol/L), peak-PSI (7.5 ± 0.4, 7.0 ± 0.6, 7.9 ± 0.5), and peak-TC (38.7 ± 0.1, 38.6 ± 0.2, 38.8 ± 0.2 °C). GLU decreased significantly in W and E, whereas it increased above BL in E+C at 60, 90, and 120mins (P < 0.05). Compared to BL values (43.6 ± 26ms), SCWT performance significantly decreased in all conditions (463 ± 93, 422 ± 83, 140 ± 52ms, P < 0.05). Importantly, compared to W and E, the impairment in SCWT was significantly attenuated in E+C (P < 0.05). As expected, when compared to the heat-stress protocol (W, E, E+C), N resulted in lower BM loss, fluid consumption, and peak-PSI (1.1 ± 0.1kg, 1.2 ± 0.7L, 4.8, respectively), and improved SCWT performance. Conclusions These data are the first to suggest that, independent of supplementation variety, cognitive processing significantly decreases immediately following long-duration exercise in the heat in healthy humans. Compared to water and fluids supplemented with only electrolytes, fluids supplemented with carbohydrates significantly blunts this decrease in cognitive function.
... This is not surprising because, due to logistics and testing issues, it is extremely difficult to conduct randomised controlled studies during real endurance competitions. Indeed, only a handful of such pragmatic trials have been published [13][14][15][16][17][18]. ...
Article
Full-text available
Purpose It is well established that mental fatigue impairs performance during lab-based endurance tests lasting less than 45 min. However, the effects of mental fatigue on longer duration endurance events and in field settings are unknown. The aim of this study was to investigate the effect of mental fatigue on performance during a half-marathon race. Methods Forty-six male amateur runners (means ± SD: age 43.8 ± 8.6 years, VO 2peak 46.0 ± 4.1 ml/kg/min) completed a half-marathon after being randomly allocated to performing a 50-min mentally fatiguing task (mental fatigue group) or reading magazines for 50 min (control group). Running speed, heart rate, and perceived effort were measured during the race. Results Runners in the mental fatigue group completed the half-marathon approximately 4 min slower (106.2 ± 12.4 min) than those in the control group (102.4 ± 10.2 min), but this difference was not statistically significant (Cohen's d = 0.333; p = 0.265). However, equivalence was not established [t(40.88) = 0.239, p = 0.594] and equivalence testing analysis excluded a beneficial effect of mental fatigue on half-marathon performance. Conclusion Due to its posttest-only design and the achievable sample size, the study did not have enough power to provide evidence that the observed 4-min increase in half-marathon time is statistically significant. However, equivalence testing suggests that mental fatigue has no beneficial effect on half-marathon performance in male amateur runners, and a harmful effect cannot be excluded. Overall, it seems prudent for endurance athletes to avoid mentally fatiguing tasks before competitions.
... and showed a similar trend in the running leg (p ¼ .06), with reduced sweat rate and limited electrolyte deficit [66]. Thus, the consensus recommendation is to ingest 0.5-0.7 g.L À1 .h ...
Article
Full-text available
Physical performance in a tropical environment, combining high heat and humidity, is a difficult physiological challenge that requires specific preparation. The elevated humidity of a tropical climate impairs the thermoregulatory mechanisms by limiting the rate of sweat evaporation. Hence, a proper management of whole-body temperature is required to complete an ultra-endurance event in such an environment. In these long-duration events, which can last from 8 to 20 h, held in hot and humid settings, performance is tightly linked to the ability in maintaining an optimal hydration status. Indeed, the rate of withdrawal in these longer races was associated with lower water intake, and the majority of finishers exhibited alterations in electrolyte balance (e.g., sodium). Hence, this work reviews the effects on performance of high heat and humidity in two representative ultra-endurance sports, ultramarathons and long-distance triathlons, and several countermeasures to counteract the impact of these harsh environmental stresses and maintain a high level of performance, such as hydration, cooling strategies and heat acclimation.
Article
The aim of this investigation was to determine the influence of sweat electrolyte concentration on body water and electrolyte homeostasis during a marathon. Fifty-one runners completed a marathon race in a warm and dry environment (24.4 ± 3.6 °C). Runners were classified as low-salt sweaters (n = 21; <30 mmol/L of sweat Na(+) concentration), typical sweaters (n = 20; ≥30 and <60 mmol/L of sweat Na(+) concentration), and salty sweaters (n = 10; ≥60 mmol/L of sweat Na(+) concentration). Before and after the race, body mass and a sample of venous blood were obtained. During the race, sweat samples were collected by using sweat patches, and fluid and electrolyte intake were recorded by using self-reported questionnaires. Low-salt, typical and salty sweaters presented similar sweat rates (0.93 ± 0.2, 0.92 ± 0.29, 0.99 ± 0.21 L/h, respectively), body mass changes (-3.0 ± 1.0, -3.3 ± 1.0, -3.2 ± 0.8%), total Na(+) intake (12.7 ± 8.1, 11.5 ± 9.7, 14.5 ± 16.6 mmol), and fluid intake (1.3 ± 0.8, 1.2 ± 0.8, 1.2 ± 0.6 L) during the race. However, salty sweaters presented lower post-race serum Na(+) concentration (140.8 ± 1.3 vs 142.5 ± 1.1, 142.4 ± 1.4 mmol/L; P < 0.01) and serum osmolality (297 ± 6 vs 299 ± 5, 301 ± 6 mOsm/kg; P < 0.05) than low-salt and typical sweaters. Sweat electrolyte concentration could influence post-race serum electrolyte concentration in the marathon. However, even the saltiest sweaters did not develop exercise-associated hyponatremia or associated symptoms.
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International guidelines suggest limiting sodium intake to 86-100 mmol/day, but average intake exceeds 150 mmol/day. Participants in physical activities are, however, advised to increase sodium intake before, during and after exercise to ensure euhydration, replace sodium lost in sweat, speed rehydration and maintain performance. A similar range of health benefits is attributable to exercise and to reduction in sodium intake, including reductions in blood pressure (BP) and the increase of BP with age, reduced risk of stroke and other cardiovascular diseases, and reduced risk of osteoporosis and dementia. Sweat typically contains 40-60 mmol/L of sodium, leading to approximately 20-90 mmol of sodium lost in one exercise session with sweat rates of 0.5-1.5 L/h. Reductions in sodium intake of 20-90 mmol/day have been associated with substantial health benefits. Homeostatic systems reduce sweat sodium as low as 3-10 mmol/L to prevent excessive sodium loss. "Salty sweaters" may be individuals with high sodium intake who perpetuate their "salty sweat" condition by continual replacement of sodium excreted in sweat. Studies of prolonged high intensity exercise in hot environments suggest that sodium supplementation is not necessary to prevent hyponatraemia during exercise lasting up to 6 hours. We examine the novel hypothesis that sodium excreted in sweat during physical activity offsets a significant fraction of excess dietary sodium, and hence may contribute part of the health benefits of exercise. Replacing sodium lost in sweat during exercise may improve physical performance, but may attenuate the long-term health benefits of exercise.
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Objective: To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals. Background: Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals. Recommendations: Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.
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The purpose of this study was to expand our previously published sweat normative data/analysis (n = 506) to establish sport-specific normative data for whole-body sweating rate (WBSR), sweat [Na⁺], and rate of sweat Na⁺ loss (RSSL). Data from 1303 athletes were compiled from observational testing (2000–2017) using a standardized absorbent sweat patch technique to determine local sweat [Na⁺] and normalized to whole-body sweat [Na⁺]. WBSR was determined from change in exercise body mass, corrected for food/fluid intake and urine/stool loss. RSSL was the product of sweat [Na⁺] and WBSR. There were significant differences between sports for WBSR, with highest losses in American football (1.51 ± 0.70 L/h), then endurance (1.28 ± 0.57 L/h), followed by basketball (0.95 ± 0.42 L/h), soccer (0.94 ± 0.38 L/h) and baseball (0.83 ± 0.34 L/h). For RSSL, American football (55.9 ± 36.8 mmol/h) and endurance (51.7 ± 27.8 mmol/h) were greater than soccer (34.6 ± 19.2 mmol/h), basketball (34.5 ± 21.2 mmol/h), and baseball (27.2 ± 14.7 mmol/h). After ANCOVA, significant between-sport differences in adjusted means for WBSR and RSSL remained. In summary, due to the significant sport-specific variation in WBSR and RSSL, American football and endurance have the greatest need for deliberate hydration strategies. Abbreviations: WBSR: whole body sweating rate; SR: sweating rate; Na⁺: sodium; RSSL: rate of sweat sodium loss
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Sweat sensors introduced in recent years have targeted a variety of sweat features and biomarkers for non-invasive health monitoring. Amongst these targets, reliable monitoring of sweat rate is crucial due to its modulation of sweat analyte concentrations and its intrinsic significance to numerous medical and physiological health conditions. Here we present a sweat rate sensor structure comprising of electrodes with interdigitated fingers in a microfluidic channel. Each time the accumulating sweat impinges on an electrode finger, the sensor reports a jump in admittance that can be simply and efficiently counted to estimate sweat rate, overcoming selectivity limitations of previously reported sweat rate sensors. We further integrate an impedimetric sensor for measuring total ionic charge concentration and an electrochemical Na+ sensor, together creating a multi-modal system for analyzing fluid and electrolyte secretion. We demonstrate how low analyte diffusion rates through this microfluidic device allow for multi-purpose sensor function, including utilizing the sweat rate sensor signal to corroborate total ionic sensor measurements. This cross-verification capability ensures data integrity in real time, satisfying a vital consideration for personalized healthcare technologies. We use the presented patch for continuous analysis of sweat rate, total ionic charge concentration, and Na⁺ concentration during exercise, while demonstrating how multi-modal cross-verification brings new trust to sensor readings.
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Exercising in hot, humid temperatures increases the risk for heat-related illnesses, ranging from mild heat edema to severe heat stroke. With increasing globalization in the world of sports, athletes are sometimes expected to compete in unforgiving conditions that expose them to these risks. In an effort to improve exercise capacity and reduce the risk of serious heat injury, many athletes are recommended to undergo heat acclimatization program prior to competing in climates with elevated average temperature. This article will look at current recommendations as well as studies on differing techniques for acclimatization and acclimation, with hopes to provide guidance for the modern-day clinician and athletes.
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Exertional heat stress presents a different acute challenge to salt balance compared to at rest. Sodium (Na⁺) and chloride (Cl⁻) losses during exercise are overwhelmingly driven by eccrine sweat glands (the “leader”), with minimal urinary excretion. Total salt losses are therefore largely influenced by thermoregulatory need, although adaptations from prior heat exposure or altered dietary intake influences sweat gland ion reabsorption, and therefore sweat Na⁺ ([Na⁺]sweat) and Cl⁻ concentrations. The hypotheses that body Na⁺ and Cl⁻ conservation, or their release from osmotically inactive stores, can occur during the timeframe of a single bout of exertional heat stress, has not been studied to date. The consequences of unreplaced Na⁺ and Cl⁻ losses during exertional heat stress appear limited primarily to their interactions with water balance. However, the water volume ingested is substantially more influential than salt intake on total body water, plasma volume, osmolality, and thermoregulation during exercise. Acute salt and water loading 1–3 h prior to exercise can induce isosmotic hyperhydration in situations where this is deemed beneficial. During exercise, only scenarios of whole body [Na⁺]sweat > 75th centile, combined with fluid replacement >80% of losses, are likely to require significant replacement to prevent hyponatremia. Post-exercise, natriuresis resumes as the main regulator of salt losses, with the kidneys (the “follower”) working to restore salt balance incurred from any exercise-induced deficit. If such a deficit exceeds usual dietary intake, and rapid restoration of hydration status is desirable, a deliberate increase in salt intake may assist in volume restoration.
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Abstract Triathlon is a popular outdoor endurance sport performed under a variety of environmental conditions. The aim of this study was to assess physiological variables before and after a half-ironman triathlon in the heat and to analyse their relationship with performance. Thirty-four well-trained triathletes completed a half-ironman triathlon in a mean dry temperature of 29 ± 3ºC. Before and within 1 min after the end of the race, body mass, core temperature, maximal jump height and venous blood samples were obtained. Mean race time was 315 ± 40 min, with swimming (11 ± 1%), cycling (49 ± 2%) and running (40 ± 3%) representing different amounts of the total race time. At the end of the competition, body mass changed by -3.8 ± 1.6% and the change in body mass correlated positively with race time (r= 0.64; P< 0.001). Core temperature increased from 37.5 ± 0.6ºC to 38.8 ± 0.7ºC (P< 0.001) and post-race core temperature correlated negatively with race time (r= -0.47; P =0.007). Race time correlated positively with the decrease in jump height (r= 0.38; P= 0.043), post-race serum creatine kinase (r= 0.55; P= 0.001) and myoglobin concentrations (r= 0.39; P= 0.022). In a half-ironman triathlon in the heat, greater reductions in body mass and higher post-competition core temperatures were present in faster triathletes. In contrast, slower triathletes presented higher levels of muscle damage and decreased muscle performance.
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This study aimed at investigating the effectiveness of compression stockings to prevent muscular damage and preserve muscular performance during a half-ironman triathlon. Thirty-six experienced triathletes volunteered for this study. Participants were matched for age, anthropometric data and training status and placed into the experimental group (N = 19; using ankle-to-knee graduated compression stockings) or control group (N = 17; using regular socks). Participants competed in a half-ironman triathlon celebrated at 29 ± 3 °C and 73 ± 8 % of relative humidity. Race time was measured by means of chip timing. Pre- and post-race, maximal height and leg muscle power were measured during a countermovement jump. At the same time, blood myoglobin and creatine kinase concentrations were determined and the triathletes were asked for perceived exertion and muscle soreness using validated scales. Total race time was not different between groups (315 ± 45 for the control group and 310 ± 32 min for the experimental group; P = 0.46). After the race, jump height (-8.5 ± 3.0 versus -9.2 ± 5.3 %; P = 0.47) and leg muscle power reductions (-13 ± 10 versus -15 ± 10 %; P = 0.72) were similar between groups. Post-race myoglobin (718 ± 119 versus 591 ± 100 μg/mL; P = 0.42) and creatine kinase concentrations (604 ± 137 versus 525 ± 69 U/L; P = 0.60) were not different between groups. Perceived muscle soreness (5.3 ± 2.1 versus 6.0 ± 2.0 arbitrary units; P = 0.42) and the rating of perceived effort (17 ± 2 versus 17 ± 2 arbitrary units; P = 0.58) were not different between groups after the race. Wearing compression stockings did not represent any advantage for maintaining muscle function or reducing blood markers of muscle damage during a triathlon event.
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Background Sodium ingestion during exercise may exert beneficial effects on endurance performance by either its ability to attenuate the decrease in plasma volume or reduce the risk of Exercise Associated Hyponatremia (EAH). This study aimed to investigate the effect of sodium supplements on endurance performance during a 72 km road cycling time-trial in cool conditions (13.8 ± 2.0°C). Methods Nine well-trained cyclists (5 male, 4 female) participated in this randomized, double-blinded cross-over study, receiving either a 700 mg.h-1 salt capsule, or a corn flour placebo during the time trial. Water was ingested ad-libitum throughout the time trial. Measurements were taken pre, post, and 40 min following time-trials, analysing blood, sweat, and urinary hydration and sodium concentration. Results Sodium supplements had no effect on time-trial performance (overall time = 171 min sodium vs. 172 min placebo; p = 0.46). There was also no effect on the change in plasma sodium concentration from pre to post time trial between trials (relative plasma [Na+] change (pre-post): sodium = 0.56%, placebo = 0.47%; p = 0.60). The greatest difference observed was a significantly change in plasma volume from pre to post exercise between the salt and the placebo trial (p = 0.02), which corresponded with an increased thirst with sodium supplementation. Conclusion Sodium supplements therefore do not improving performance during exercise of approximately 3 h duration in cool conditions.
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Background Completing a marathon is one of the most challenging sports activities, yet the source of running fatigue during this event is not completely understood. The aim of this investigation was to determine the cause(s) of running fatigue during a marathon in warm weather. Methodology/Principal Findings We recruited 40 amateur runners (34 men and 6 women) for the study. Before the race, body core temperature, body mass, leg muscle power output during a countermovement jump, and blood samples were obtained. During the marathon (27 °C; 27% relative humidity) running fatigue was measured as the pace reduction from the first 5-km to the end of the race. Within 3 min after the marathon, the same pre-exercise variables were obtained. Results Marathoners reduced their running pace from 3.5 ± 0.4 m/s after 5-km to 2.9 ± 0.6 m/s at the end of the race (P<0.05), although the running fatigue experienced by the marathoners was uneven. Marathoners with greater running fatigue (> 15% pace reduction) had elevated post-race myoglobin (1318 ± 1411 v 623 ± 391 µg L−1; P<0.05), lactate dehydrogenase (687 ± 151 v 583 ± 117 U L−1; P<0.05), and creatine kinase (564 ± 469 v 363 ± 158 U L−1; P = 0.07) in comparison with marathoners that preserved their running pace reasonably well throughout the race. However, they did not differ in their body mass change (−3.1 ± 1.0 v −3.0 ± 1.0%; P = 0.60) or post-race body temperature (38.7 ± 0.7 v 38.9 ± 0.9 °C; P = 0.35). Conclusions/Significance Running pace decline during a marathon was positively related with muscle breakdown blood markers. To elucidate if muscle damage during a marathon is related to mechanistic or metabolic factors requires further investigation.
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To investigate the cause/s of muscle fatigue experienced during a half-iron distance triathlon. We recruited 25 trained triathletes (36±7 yr; 75.1±9.8 kg) for the study. Before and just after the race, jump height and leg muscle power output were measured during a countermovement jump on a force platform to determine leg muscle fatigue. Body weight, handgrip maximal force and blood and urine samples were also obtained before and after the race. Blood myoglobin and creatine kinase concentrations were determined as markers of muscle damage. Jump height (from 30.3±5.0 to 23.4±6.4 cm; P<0.05) and leg power output (from 25.6±2.9 to 20.7±4.6 W · kg(-1); P<0.05) were significantly reduced after the race. However, handgrip maximal force was unaffected by the race (430±59 to 430±62 N). Mean dehydration after the race was 2.3±1.2% with high inter-individual variability in the responses. Blood myoglobin and creatine kinase concentration increased to 516±248 µg · L(-1) and 442±204 U · L(-1), respectively (P<0.05) after the race. Pre- to post-race jump change did not correlate with dehydration (r = 0.16; P>0.05) but significantly correlated with myoglobin concentration (r = 0.65; P<0.001) and creatine kinase concentration (r = 0.54; P<0.001). During a half-iron distance triathlon, the capacity of leg muscles to produce force was notably diminished while arm muscle force output remained unaffected. Leg muscle fatigue was correlated with blood markers of muscle damage suggesting that muscle breakdown is one of the most relevant sources of muscle fatigue during a triathlon.
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Although triathlon is growing in popularity at a remarkable rate, it has not been extensively studied. The aims of this research were to identify preparation strategies used by triathletes and to categorize these strategies according to gender and consultation with triathlon coaches. Survey data collected from 401 triathletes (207 males, 194 females) revealed training, nutritional, and mental preparation habits. Most participants engaged in strength training, consumed food and/or fluids during and after training, set training and competition goals, and applied mental preparation strategies during training and the hour before racing. Water was the most commonly consumed fluid; positive self-talk was the most used mental strategy. Participants were more likely to consult with a triathlon coach than a nutrition or sport psychology professional. Athletes with more years of experience in triathlon and those competing in longer distances were more likely to consult a triathlon coach. Female triathletes were more likely than male triathletes to train with others, use mental preparation strategies, and report feeling anxious before competitions. More male triathletes reported using nutritional supplements during training than their female counterparts. These findings add to the limited research base on triathletes' training habits, and hopefully will help guide practitioners who work with this group. The results provide guidance for collaborative efforts among training, nutrition, and mental health professionals to best support triathletes.
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The aim of this study was to investigate the prerace and during-race carbohydrate intakes of elite-level triathletes contesting draft-legal Olympic-distance triathlon (ODT) events. Self-reported prerace and during-race nutrition data were collected at 3 separate ODT events from 51 elite senior and under-23 triathletes. One hundred twenty-nine observations of food and fluid intake representing actual prerace (n = 62) and during-race (n = 67) nutrition practices from 36 male and 15 female triathletes were used in the final analysis of this study. Female triathletes consumed significantly more carbohydrate on the morning before race start when corrected for body mass and race start time than their male counterparts (p < .05). Male and female triathletes consumed 26% more energy (kJ/kg) and 24% more carbohydrate (g/kg) when commencing a race after midday (1:00-1:30 p.m.) than for a late morning (11:00-11:15 a.m.) race start. During the race, triathletes consumed less than 60 g of carbohydrate on 66% of occasions, with average total race intakes of 48 ± 25 and 49 ± 25 g carbohydrate for men and women, respectively. Given average race times of 1:57:07 hr and 2:08:12 hr, hourly carbohydrate intakes were ~25 g and ~23 g for men and women, respectively. Although most elite ODT triathletes consume sufficient carbohydrate to meet recommended prerace carbohydrate intake guidelines, during-race carbohydrate intakes varied considerably, with many failing to meet recommended levels.
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Sodium replacement during prolonged exercise in the heat may be critically important to maintaining fluid and electrolyte balance and muscle contractility. To examine the effectiveness of sodium-containing sports drinks in preventing hyponatremia and muscle cramping during prolonged exercise in the heat. Randomized crossover study. Thirteen active men. Participants completed 4 trials of an exercise protocol in the heat (30 degrees C) consisting of 3 hours of exercise (alternating 30 minutes of walking and cycling at a heart rate of 130 and 140 beats per minute, respectively); a set of standing calf raises (8 sets of 30 repetitions); and 45 minutes of steep, brisk walking (5.5 km x h(-1) on a 12% grade). During exercise, participants consumed fluids to match body mass loss. A different drink was consumed for each trial: carbohydrate-electrolyte drink containing 36.2 mmol/L sodium (HNa), carbohydrate-electrolyte drink containing 19.9 mmol/L sodium (LNa), mineral water (W), and colored and flavored distilled water (PL). Serum sodium, plasma osmolality, plasma volume changes, and muscle cramping frequency. During both HNa and LNa trials, serum sodium remained relatively constant (serum sodium concentration at the end of the protocol was 137.3 mmol/L and 136.7 mmol/L, respectively). However, a clear decrease was observed in W (134.5 +/- 0.8 mmol/L) and PL (134.4 +/- 0.8 mmol/L) trials compared with HNa and LNa trials (P < .05). The same trends were observed for plasma osmolality (P < .05). Albeit not significant, plasma volume was preserved during the HNa and LNa trials, but a reduction of 2.5% was observed in the W and PL trials. None of the volunteers experienced cramping. The data suggest that sodium intake during prolonged exercise in the heat plays a significant role in preventing sodium losses that may lead to hyponatremia when fluid intake matches sweat losses.
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It is the position of the American College of Sports Medicine that adequate fluid replacement helps maintain hydration and, therefore, promotes the health, safety, and optimal physical performance of individuals participating in regular physical activity. This position statement is based on a comprehensive review and interpretation of scientific literature concerning the influence of fluid replacement on exercise performance and the risk of thermal injury associated with dehydration and hyperthermia. Based on available evidence, the American College of Sports Medicine makes the following general recommendations on the amount and composition of fluid that should be ingested in preparation for, during, and after exercise or athletic competition: 1) It is recommended that individuals consume a nutritionally balanced diet and drink adequate fluids during the 24-hr period before an event, especially during the period that includes the meal prior to exercise, to promote proper hydration before exercise or competition. 2) It is recommended that individuals drink about 500 ml (about 17 ounces) of fluid about 2 h before exercise to promote adequate hydration and allow time for excretion of excess ingested water. 3) During exercise, athletes should start drinking early and at regular intervals in an attempt to consume fluids at a rate sufficient to replace all the water lost through sweating (i.e., body weight loss), or consume the maximal amount that can be tolerated. 4) It is recommended that ingested fluids be cooler than ambient temperature [between 15 degrees and 22 degrees C (59 degrees and 72 degrees F])] and flavored to enhance palatability and promote fluid replacement. Fluids should be readily available and served in containers that allow adequate volumes to be ingested with ease and with minimal interruption of exercise. 5) Addition of proper amounts of carbohydrates and/or electrolytes to a fluid replacement solution is recommended for exercise events of duration greater than 1 h since it does not significantly impair water delivery to the body and may enhance performance. During exercise lasting less than 1 h, there is little evidence of physiological or physical performance differences between consuming a carbohydrate-electrolyte drink and plain water. 6) During intense exercise lasting longer than 1 h, it is recommended that carbohydrates be ingested at a rate of 30-60 g.h(-1) to maintain oxidation of carbohydrates and delay fatigue. This rate of carbohydrate intake can be achieved without compromising fluid delivery by drinking 600-1200 ml.h(-1) of solutions containing 4%-8% carbohydrates (g.100 ml(-1)). The carbohydrates can be sugars (glucose or sucrose) or starch (e.g., maltodextrin). 7) Inclusion of sodium (0.5-0.7 g.1(-1) of water) in the rehydration solution ingested during exercise lasting longer than 1 h is recommended since it may be advantageous in enhancing palatability, promoting fluid retention, and possibly preventing hyponatremia in certain individuals who drink excessive quantities of fluid. There is little physiological basis for the presence of sodium in n oral rehydration solution for enhancing intestinal water absorption as long as sodium is sufficiently available from the previous meal.
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During exercise in the heat, sweat output often exceeds water intake, resulting in a body water deficit (hypohydration) and electrolyte losses. Because daily water losses can be substantial, persons need to emphasize drinking during exercise as well as at meals. For persons consuming a normal diet, electrolyte supplementation is not warranted except perhaps during the first few days of heat exposure. Aerobic exercise is likely to be adversely affected by heat stress and hypohydration; the warmer the climate the greater the potential for performance decrements. Hypohydration increases heat storage and reduces a person's ability to tolerate heat strain. The increased heat storage is mediated by a lower sweating rate (evaporative heat loss) and reduced skin blood flow (dry heat loss) for a given core temperature. Heat-acclimated persons need to pay particular attention to fluid replacement because heat acclimation increases sweat losses, and hypohydration negates the thermoregulatory advantages conferred by acclimation. It has been suggested that hyperhydration (increased total body water) may reduce physiologic strain during exercise heat stress, but data supporting that notion are not robust. Research is recommended for 3 populations with fluid and electrolyte balance problems: older adults, cystic fibrosis patients, and persons with spinal cord injuries.
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It is well known that fluid and electrolyte balance are critical to optimal exercise performance and, moreover, health maintenance. Most research conducted on extreme sporting endeavour (>3 hours) is based on case studies and studies involving small numbers of individuals. Ultra-endurance sportsmen and women typically do not meet their fluid needs during exercise. However, successful athletes exercising over several consecutive days come close to meeting fluid needs. It is important to try to account for all factors influencing bodyweight changes, in addition to fluid loss, and all sources of water input. Increasing ambient temperature and humidity can increase the rate of sweating by up to approximately 1 L/h. Depending on individual variation, exercise type and particularly intensity, sweat rates can vary from extremely low values to more than 3 L/h. Over-hydration, although not frequently observed, can also present problems, as can inappropriate fluid composition. Over-hydrating or meeting fluid needs during very long-lasting exercise in the heat with low or negligible sodium intake can result in reduced performance and, not infrequently, hyponatraemia. Thus, with large rates of fluid ingestion, even measured just to meet fluid needs, sodium intake is vital and an increased beverage concentration [30 to 50 mmol/L (1.7 to 2.9g NaCl/L) may be beneficial. If insufficient fluids are taken during exercise, sodium is necessary in the recovery period to reduce the urinary output and increase the rate of restoration of fluid balance. Carbohydrate inclusion in a beverage can affect the net rate of water assimilation and is also important to supplement endogenous reserves as a substrate for exercising muscles during ultra-endurance activity. To enhance water absorption, glucose and/or glucose-containing carbohydrates (e.g. sucrose, maltose) at concentrations of 3 to 5% weight/volume are recommended. Carbohydrate concentrations above this may be advantageous in terms of glucose oxidation and maintaining exercise intensity, but will be of no added advantage and, if hyperosmotic, will actually reduce the net rate of water absorption. The rate of fluid loss may exceed the capacity of the gastrointestinal tract to assimilate fluids. Gastric emptying, in particular, may be below the rate of fluid loss, and therefore, individual tolerance may dictate the maximum rate of fluid intake. There is large individual variation in gastric emptying rate and tolerance to larger volumes. Training to drink during exercise is recommended and may enhance tolerance.
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To investigate the effect of different sodium concentrations in replacement fluids on haematological variables and endurance performance during prolonged exercise. Thirteen female endurance athletes completed three four hour runs on a 400 m track. Environmental conditions differed between the three trials: 5.3 degrees C and snow (trial 1), 19.0 degrees C and sunny weather (trial 2), 13.9 degrees C and precipitation (trial 3). They consumed 1 litre of fluid an hour during the trials with randomised intake of fluids: one trial (H) with high sodium concentration (680 mg/l), one trial (L) with low sodium concentration (410 mg/l), and one trial with only water (W). Before and after the trials, subjects were weighed and blood samples were taken for analysis of [Na(+)](plasma), packed cell volume, and mean corpuscular volume. The mean (SD) decrease in [Na(+)](plasma) over the whole trial was significantly (p<0.001) less in trial H (2.5 (2.5) mmol/l) than in trial W (6.2 (2.1) mmol/l). Mild hyponatraemia ([Na(+)](plasma) = 130-135 mmol/l) was observed in only six women (46%) in trial H compared with nine (69%) in trial L, and 12 (92%) in trial W. Two subjects (17%) in trial W developed severe hyponatraemia ([Na(+)](plasma)<130 mmol/l). No significant differences were found in performance or haematological variables with the three different fluids. There was no significant correlation between[Na(+)](plasma) after the run and performance. There was a significant correlation between changes in [Na(+)](plasma) and changes in body weight. Exercise induced hyponatraemia in women is likely to develop from fluid overload during prolonged exercise. This can be minimised by the use of replacement fluids of high sodium concentration. Sodium replacement of at least 680 mg/h is recommended for women in a state of fluid overload during endurance exercise of four hours. However, higher [Na(+)](plasma) after the run and smaller decreases in [Na(+)](plasma) during the trials were no indication of better performance over four hours.
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The development of symptomatic hyponatraemia consequent on participation in marathon and ultraendurance races has led to questions about its aetiology and prevention. To evaluate: (a) the assertion that sweat sodium losses cannot contribute to the development of hyponatraemia during endurance exercise; (b) the adequacy of fluid replacement recommendations issued by the International Marathon Medical Directors Association (IMMDA) for races of 42 km or longer; (c) the effectiveness of commercial sports drinks, compared with water, for attenuating plasma sodium reductions. A mathematical model was used to predict the effects of different drinking behaviours on hydration status and plasma sodium concentration when body mass, body composition, running speed, weather conditions, and sweat sodium concentration were systematically varied. Fluid intake at rates that exceed sweating rate is predicted to be the primary cause of hyponatraemia. However, the model predicts that runners secreting relatively salty sweat can finish ultraendurance exercise both dehydrated and hyponatraemic. Electrolyte-containing beverages are predicted to delay the development of hyponatraemia. The predictions suggest that the IMMDA fluid intake recommendations adequately sustain hydration over the 42 km distance if qualifiers-for example, running pace, body size-are followed. Actions to prevent hyponatraemia should focus on minimising overdrinking relative to sweating rate and attenuating salt depletion in those who excrete salty sweat. This simulation demonstrates the complexity of defining fluid and electrolyte consumption rates during athletic competition.
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Critical assessment of recommendations that athletes consume additional sodium during athletic events. To evaluate if sodium supplementation is necessary to maintain serum sodium concentrations during prolonged endurance activity and prevent the development of hyponatraemia. Prospective randomised trial of athletes receiving sodium (620 mg table salt), placebo (596 mg starch), or no supplementation during a triathlon. The sodium and placebo tablets were taken ad libitum, with the suggested range of 1-4 per hour. The 2001 Cape Town Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). A total of 413 triathletes completing the Ironman race. Sodium supplementation was not necessary to maintain serum sodium concentrations in athletes completing an Ironman triathlon nor required to prevent hyponatraemia from occurring in athletes who did not ingest supplemental sodium during the race. Subjects in the sodium supplementation group ingested an additional 3.6 (2.0) g (156 (88) mmol) sodium during the race (all values are mean (SD)). There were no significant differences between the sodium, placebo, and no supplementation groups with regard to age, finishing time, serum sodium concentration before and after the race, weight before the race, weight change during the race, and rectal temperature, systolic and diastolic blood pressure after the race. The sodium supplementation group consumed 14.7 (8.3) tablets, and the placebo group took 15.8 (10.1) tablets (p = 0.55; NS). Ad libitum sodium supplementation was not necessary to preserve serum sodium concentrations in athletes competing for about 12 hours in an Ironman triathlon. The Institute of Medicine's recommended daily adequate intake of sodium (1.5 g/65 mmol) seems sufficient for a healthy person without further need to supplement during athletic activity.
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This Position Stand provides guidance on fluid replacement to sustain appropriate hydration of individuals performing physical activity. The goal of prehydrating is to start the activity euhydrated and with normal plasma electrolyte levels. Prehydrating with beverages, in addition to normal meals and fluid intake, should be initiated when needed at least several hours before the activity to enable fluid absorption and allow urine output to return to normal levels. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. Because there is considerable variability in sweating rates and sweat electrolyte content between individuals, customized fluid replacement programs are recommended. Individual sweat rates can be estimated by measuring body weight before and after exercise. During exercise, consuming beverages containing electrolytes and carbohydrates can provide benefits over water alone under certain circumstances. After exercise, the goal is to replace any fluid electrolyte deficit. The speed with which rehydration is needed and the magnitude of fluid electrolyte deficits will determine if an aggressive replacement program is merited.
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This study was conducted during the high-hormone phase of both natural and oral contraceptive pill (OCP)-mediated menstrual cycles to determine whether preexercise ingestion of a concentrated sodium beverage would increase plasma volume (PV), reduce physiological strain, and aid endurance of moderately trained women cycling in warm conditions. Thirteen trained cyclists [peak O(2) uptake 52 ml x kg(-1) x min(-1) (SD 2), age 26 yr (SD 6), weight 60.8 kg (SD 5)] who were oral contraceptive users (n = 6) or not (n = 7) completed this double-blind, crossover experiment. Cyclists ingested a concentrated-sodium (High Na(+): 164 mmol Na(+)/l) or low-sodium (Low Na(+): 10 mmol Na(+)/l) beverage (10 ml/kg) before cycling to exhaustion at 70% Peak O(2) uptake in warm conditions (32 degrees C, 50% relative humidity, air velocity 4.5 m/s). Beverage (approximately 628 ml) was ingested in seven portions across 60 min beginning 105 min before exercise, with no additional fluid given until the end of the trial. Trials were separated by one to two menstrual cycles. High Na(+) increased PV (calculated from hematocrit and hemoglobin concentration) before exercise, whereas Low Na(+) did not [-4.4 (SD 1.1) vs. -1.9% (SD 1.3); 95% confidence interval: for the difference 5.20, 6.92; P < 0.0001], and it involved greater time to exhaustion [98.8 (SD 25.6) vs. 78.7 (SD 24.6) min; 95% confidence interval: 13.3, 26.8; P < 0.0001]. Core temperature rose more quickly with Low Na(+) [1.6 degrees C/h (SD 0.2)] than High Na(+) [1.2 degrees C/h (SD 0.2); P = 0.04]. Plasma [AVP], [Na(+)] concentration, and osmolality, and urine volume, [Na(+)], and osmolality decreased with sodium loading (P < 0.05) independent of pill usage. Thus preexercise ingestion of a concentrated sodium beverage increased PV, reduced thermoregulatory strain, and increased exercise capacity for women in the high-hormone phase of natural and oral contraceptive pill-mediated menstrual cycles, in warm conditions.
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The effects that rehydrating drinks ingested during exercise may have on anaerobic exercise performance are unclear. This study aimed to determine which of four commercial rehydrating drinks better maintains leg power and force during prolonged cycling in the heat. Seven endurance-trained and heat-acclimatized cyclists pedaled for 120 min at 63% maximum oxygen consumption in a hot, dry environment (36 degrees C; 29% humidity, 1.9 m.s-1 airflow). In five randomized trials, during exercise, subjects drank 2.4 +/- 0.1 L of (i) mineral water (WAT; San Benedetto), (ii) 6% carbohydrate-electrolyte solution (Gatorade lemon), (iii) 8% carbohydrate-electrolyte solution (Powerade Citrus Charge), (iv) 8% carbohydrate-electrolyte solution with lower sodium concentration than other sports drinks (Aquarius orange), or (v) did not ingest any fluid (DEH). Fluid balance, rectal temperature (Trec), maximal cycling power (Pmax), and leg maximal voluntary isometric contraction (MVC) were measured. During DEH, subjects lost 3.7 +/- 0.2% of initial body mass, whereas subjects lost only 0.8% +/- 0.1% in the other trials (p < 0.05). Final Trec was higher in DEH than in the rest of the trials (39.4 +/- 0.1 degrees C vs. 38.7 +/- 0.1 degrees C; p < 0.05). Pmax was similar among all trials. Gatorade and Powerade preserved MVC better than DEH (-3.1% +/- 2% and -3.8% +/- 2% vs. -11% +/- 2%, p < 0.05), respectively, whereas WAT and Aquarius did not (-6% +/- 2%). Compared with DEH, rehydration with commercially available sports drinks during prolonged exercise in the heat preserves leg force, whereas rehydrating with water does not. However, low sodium concentration in a sports drink seems to preclude its ergogenic effects on force.
Article
This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athletes participated in one 1-h exercise pretrial to estimate fluid needs and two 3-h experimental trials on a cycle ergometer at 55% of maximum O 2 consumption at 34°C and 65% relative humidity. In the experimental trials, fluid loss was replaced by distilled water (W) or a sodium-containing (18 mmol/l) sports drink, Gatorade (G). Six subjects did not complete 3 h in trial W, and four did not complete 3 h in trial G. The rate of change in plasma sodium concentration in all subjects, regardless of exercise time completed, was greater with W than with G (−2.48 ± 2.25 vs. −0.86 ± 1.61 mmol ⋅ l ⁻¹ ⋅ h ⁻¹ , P = 0.0198). One subject developed hyponatremia (plasma sodium 128 mmol/l) at exhaustion (2.5 h) in the W trial. A decrease in sodium concentration was correlated with decreased exercise time ( R = 0.674; P = 0.022). A lower rate of urine production correlated with a greater rate of sodium decrease ( R = −0.478; P = 0.0447). Sweat production was not significantly correlated with plasma sodium reduction. The results show that decreased plasma sodium concentration can result from replacement of sweat losses with plain W, when sweat losses are large, and can precipitate the development of hyponatremia, particularly in individuals who have a decreased urine production during exercise. Exercise performance is also reduced with a decrease in plasma sodium concentration. We, therefore, recommend consumption of a sodium-containing beverage to compensate for large sweat losses incurred during exercise.
Article
Objective: The objective of this study was to determine whether sodium supplementation 1) influences changes in body weight, serum sodium [Na], and plasma volume (PV), and 2) prevents hyponatremia in Ironman triathletes. Setting: The study was carried out at the South African Ironman triathlon. Participants: Thirty-eight athletes competing in the triathlon were given salt tablets to ingest during the race. Data collected from these athletes [salt intake group (SI)] were compared with data from athletes not given salt [no salt group (NS)]. Interventions: Salt tablets were given to the SI group to provide approximately 700 mg/h of sodium. Main Outcome Measurements: Serum sodium, hemoglobin, and hematocrit were measured at race registration and after the race. Weights were measured before and after the race. Members of SI were retrospectively matched to subjects in NS for 1) weight change and 2) pre-race [Na]. Results: The SI group developed a 3.3-kg weight loss (p < 0.0001) and significantly increased their [Na] (A[Na] 1.52 mmol/L; p = 0.005). When matched for weight change during the race, SI increased their [Na] compared with NS (mean 1.52 versus 0.04 mmol/L), but this did not reach statistical significance (p = 0.08). When matched for pre-race [Na], SI had a significantly smaller percent body weight loss than NS (-4.3% versus -5.1%; p = 0.04). There was no significant difference in the increase of [Na] in both groups (1.57 versus 0.84 mmol/L). PV increased. equally in both groups. None of the subjects finished the race with [Na] < 135 mmol/L. Conclusions: Sodium ingestion was associated with a decrease in the extent of weight loss during the race. There was no evidence that sodium ingestion significantly influenced changes in [Na] or PV more than fluid replacement alone in the Ironman triathletes in this study. Sodium supplementation Was not necessary to prevent the development of hyponatremia in these athletes who lost weight, indicating that they had only partially replaced their fluid and other losses during the Ironman triathlon.
Article
Salt consists of sodium and chloride, and is important for normal physiologic function. High sweat rates in athletes result in loss of both fluids and sodium. Fluid replacement with hypotonic solutions will lead to incomplete rehydration and possible complications such as hyponatremia, decreased performance, heat cramps, or other heat-related illness. There is significant individual variation in sodium loss during activity. In some the losses can be replaced by normal dietary intake, whereas in others the losses can be dramatic and increased dietary intake is essential. There are various methods to increase sodium intake, such as increased use of table salt on foods, salty snacks, adding salt to sports drinks, and use of salt tablets. Emphasis on replacement of fluids is also important, but care must be taken to avoid overhydration. Simple measures such as recording daily pre- and postexercise body weight can aid in making fluid and sodium ingestion decisions; in some cases, a comprehensive evaluation is necessary.
Article
The aim of this study was to determine the changes in body mass and myoglobinuria concentration in recreational runners during a marathon in a warm environment, and the relation of these changes to muscle fatigue. We recruited 138 amateur runners (114 men and 24 women) for the study. Before the race, leg muscle power output was measured during a countermovement jump on a force platform, body weight was measured, and a urine sample was obtained. Within 3 min of race completion (28 °C; 46% relative humidity), the runners repeated the countermovement jump, body weight was measured again, and a second urine sample was obtained. Myoglobin concentration was determined in the urine samples. After the race, mean body mass reduction was 2.2% ± 1.2%. Fifty-five runners (40% of the total) reduced their body mass by less than 2%, and 10 runners (7.2%) reduced their body mass by more than 4%. Only 3 runners increased their body mass after the marathon. Mean leg muscle power reduction was 16% ± 10%. Twenty-four runners reduced their muscle power by over 30%. No myoglobin was detected in the prerace urine specimens, whereas postrace urinary myoglobin concentration increased to 3.5 ± 9.5 μg·mL(-1) (p < 0.05). Muscle power change after the marathon significantly correlated with postrace urine myoglobin concentration (r = -0.55; p < 0.001), but not with body mass change (r = -0.08; p = 0.35). After a marathon in a warm environment, interindividual variability in body mass change was high, but only 7% of the runners reduced their body mass by more than 4%. The correlation between myoglobinuria and muscle power change suggests that muscle fatigue is associated with muscle breakdown.
Article
We studied if salt and water ingestion alleviates the physiological strain caused by dehydrating exercise in the heat. Ten trained male cyclists ( V ˙ O 2 m ⁢ a x  : 60 ± 7 mL/kg/min) completed three randomized trials in a hot-dry environment (33 °C, 30% rh, 2.5 m/s airflow). Ninety minutes before the exercise, participants ingested 10 mL of water/kg body mass either alone (CON trial) or with salt to result in concentrations of 82 or 164 mM Na(+) (ModNa(+) or HighNa(+) trial, respectively). Then, participants cycled at 63% of V ˙ O 2 m ⁢ a x for 120 min immediately followed by a time-trial. After 120 min of exercise, the reduction in plasma volume was lessened with ModNa(+) and HighNa(+) trials (-11.9 ± 2.1 and -9.8 ± 4.2%) in comparison with CON (-16.4 ± 3.2%; P < 0.05). However, heat accumulation or dissipation (forearm skin blood flow and sweat rate) were not improved by salt ingestion. In contrast, both salt trials maintained cardiac output (∼1.3 ± 1.4 L/min; P < 0.05) and stroke volume (∼10 ± 11 mL/beat; P < 0.05) above CON after 120 min of exercise. Furthermore, the salt trials equally improved time-trial performance by 7.4% above CON (∼289 ± 42 vs 269 ± 50 W, respectively; P < 0.05). Our data suggest that pre-exercise ingestion of salt plus water maintains higher plasma volume during dehydrating exercise in the heat without thermoregulatory effects. However, it maintains cardiovascular function and improves cycling performance.
Article
To describe the drinking behaviors of elite male marathon runners during major city marathons. Retrospective analysis of drinking behaviors. Institutional. Ten (9 winners and 1 second position) male marathon runners during 13 major city marathons. Total drinking durations and fluid intake rates during major city marathons. The ambient conditions during the 13 studied marathon races were 15.3°C ± 8.6°C and 59% ± 17% relative humidity; average marathon competition time was 02:06:31 ± 00:01:08 (hours:minutes:seconds). Total drinking duration during these races was 25.5 ± 15.0 seconds (range, 1.6-50.7 seconds) equating to an extrapolated fluid intake rate of 0.55 ± 0.34 L/h (range, 0.03-1.09 L/h). No significant correlations were found between total drink duration, fluid intake (rate and total), running speed, and ambient temperature. Estimated body mass (BM) loss based on calculated sweat rates and rates of fluid ingestion was 8.8% ± 2.1% (range, 6.6%-11.7%). Measurements of the winner in the 2009 Dubai marathon revealed a BM loss of 9.8%. The most successful runners, during major city marathons, drink fluids ad libitum for less than approximately 60 seconds at an extrapolated fluid ingestion rate of 0.55 ± 0.34 L/h and comparable to the current American College of Sports Medicine's recommendations of 0.4-0.8 L/h. Nevertheless, these elite runners do not seem to maintain their BM within current recommended ranges of 2%-3%.
Article
The purpose of this study was to determine whether sweat sodium concentration ([Na(+)](sweat)) during exercise in the heat differs between aerobically trained and untrained individuals. On three occasions, ten endurance-trained (Tr) and ten untrained (UTr) subjects (VO2peak = 4.0 ± 0.8 vs. 3.4 ± 0.7 L min(-1), respectively; P < 0.05) cycled in a hot-ventilated environment (36 ± 1°C; 25 ± 2% humidity, airflow 2.5 m s(-1)) at three workloads (i.e., 40, 60, and 80% VO2peak). Whole-body (SR(WB)) and back sweat rates (SR(BACK)) were measured. At the conclusion of the study, Na(+) in sweat and blood samples was analyzed to calculate Na(+) secretion and reabsorption rates. SR(WB) and SR(BACK) were highly correlated in Tr and UTr (r = 0.74 and 0.79, respectively; P < 0.0001). In both groups, SR(BACK) increased with the increases in exercise intensity (P < 0.05). Likewise, [Na(+)](sweat) increased with the exercise intensity in both groups (P < 0.05) and it tended to be higher in Tr than in UTr at 60 and 80% VO2peak (~22 mmol L(-1) higher; P = 0.06). However, when normalized for SR(BACK), [Na(+)](sweat) was not different between groups. In both groups, Na(+) secretion and reabsorption rates increased with the increases in SR(BACK) (P < 0.05). However, Na(+) reabsorption rate was lower in the Tr than in the UTr (mean slope = 48 vs. 82 ηmol cm(-2) min(-1); P = 0.03). In conclusion, using a cross-sectional study design, our data suggest that aerobic fitness level does not reduce sweat Na(+) secretion or enhance Na(+) reabsorption during prolonged exercise in the heat that induced high sweat rates.
Article
To understand potential mechanisms explaining interindividual variability observed in human sweat sodium concentration ([Na(+)]), we investigated the relationship among [Na(+)] of thermoregulatory sweat, plasma membrane expression of Na(+) and Cl(-) transport proteins in biopsied human eccrine sweat ducts, and basal levels of vasopressin (AVP) and aldosterone. Lower ductal luminal membrane expression of the Cl(-) channel cystic fibrosis transmembrane conductance regulator (CFTR) was observed in immunofluorescent staining of sweat glands from healthy young adults identified as exceptionally "salty sweaters" (SS) (n = 6, P < 0.05) and from patients with cystic fibrosis (CF) (n = 6, P < 0.005) compared with ducts from healthy young adults with "typical" sweat [Na(+)] (control, n = 6). Genetic testing of healthy subjects did not reveal any heterozygotes ("carriers") for any of the 39 most common disease-causing CFTR mutations in the United States. SS had higher baseline plasma [AVP] compared with control (P = 0.029). Immunostaining to investigate a potential relationship between higher plasma [AVP] (and sweat [Na(+)]) and ductal membrane aquaporin-5 revealed for all groups a relatively sparse and location-dependent ductal expression of the water channel with localization primarily to the secretory coil. Availability of CFTR for NaCl transport across the ductal membrane appears related to the significant physiological variability observed in sweat salt concentration in apparently healthy humans. At present, a heritable link between healthy salty sweaters and the most prevalent disease-causing CFTR mutations cannot be established.
Article
Endurance performance is impaired in the heat, and a combination of high temperature and high humidity presents a major challenge to the elite marathon runner, who must sustain a high metabolic rate throughout the race. The optimum temperature for marathon performance is generally about 10-12 °C. The optimum temperature may be lower for faster runners than for slower runners. Sweat evaporation limits the rise in core temperature, but dehydration will impair cardiovascular function, leading to a fall in blood flow to muscle, skin and other tissues. There is growing evidence that the effects of high ambient temperature and dehydration on performance of exercise may be mediated by effects on the central nervous system. This seems to involve serotonergic and dopaminergic functions.
Article
Dehydration, if sufficiently severe, impairs both physical and mental performance, and performance decrements are greater in hot environments and in long-lasting exercise. Athletes should begin exercise well hydrated and should drink during exercise to limit water and salt deficits. Many athletes are dehydrated to some degree when they begin exercise. During exercise, most drink less than their sweat losses, some drink too much and a few develop hyponatraemia. Athletes should learn to assess their hydration needs and develop a personalized hydration strategy that takes account of exercise, environment and individual needs. Pre-exercise hydration status can be assessed from urine frequency and volume, with additional information from urine color, specific gravity or osmolality. Changes in hydration status during exercise can be estimated from the change in body mass: sweat rate can be estimated if fluid intake and urinary losses are also measured. Sweat salt losses can be determined by collection and analysis of sweat samples. An appropriate, individualized drinking strategy will take account of pre-exercise hydration status and of fluid, electrolyte and substrate needs before, during and after a period of exercise.
Article
This investigation determined the effect of different rates of dehydration, induced by ingesting different volumes of fluid during prolonged exercise, on hyperthermia, heart rate (HR), and stroke volume (SV). On four different occasions, eight endurance-trained cyclists [age 23 +/- 3 (SD) yr, body wt 71.9 +/- 11.6 kg, maximal O2 consumption 4.72 +/- 0.33 l/min] cycled at a power output equal to 62-67% maximal O2 consumption for 2 h in a warm environment (33 degrees C dry bulb, 50% relative humidity, wind speed 2.5 m/s). During exercise, they randomly received no fluid (NF) or ingested a small (SF), moderate (MF), or large (LF) volume of fluid that replaced 20 +/- 1, 48 +/- 1, and 81 +/- 2%, respectively, of the fluid lost in sweat during exercise. The protocol resulted in graded magnitudes of dehydration as body weight declined 4.2 +/- 0.1, 3.4 +/- 0.1, 2.3 +/- 0.1, and 1.1 +/- 0.1%, respectively, during NF, SF, MF, and LF. After 2 h of exercise, esophageal temperature (Tes), HR, and SV were significantly different among the four trials (P < 0.05), with the exception of NF and SF. The magnitude of dehydration accrued after 2 h of exercise in the four trials was linearly related with the increase in Tes (r = 0.98, P < 0.02), the increase in HR (r = 0.99, P < 0.01), and the decline in SV (r = 0.99, P < 0.01). LF attenuated hyperthermia, apparently because of higher skin blood flow, inasmuch as forearm blood flow was 20-22% higher than during SF and NF at 105 min (P < 0.05). There were no differences in sweat rate among the four trials. In each subject, the increase in Tes from 20 to 120 min of exercise was highly correlated to the increase in serum osmolality (r = 0.81-0.98, P < 0.02-0.19) and the increase in serum sodium concentration (r = 0.87-0.99, P < 0.01-0.13) from 5 to 120 min of exercise. In summary, the magnitude of increase in core temperature and HR and the decline in SV are graded in proportion to the amount of dehydration accrued during exercise.
Article
The phenomenon of involuntary dehydration, the delay in full restoration of a body water deficit by drinking, has been described extensively but relatively little is known about its physiological mechanism. It occurs primarily in humans when they are exposed to various stresses including exercise, environmental heat and cold, altitude, water immersion, dehydration, and perhaps microgravity, singly and in various combinations. The level of involuntary dehydration is approximately proportional to the degree of total stress imposed on the body. Involuntary dehydration appears to be controlled by more than one factor including social customs that influence what is consumed, the capacity and rate of fluid absorption from the gastrointestinal system, the level of cellular hydration involving the osmotic-vasopressin interaction with sensitive cells or structures in the central nervous system, and, to a lesser extent, hypovolemic-angiotensin II stimuli. Since humans drink when there is no apparent physiological stimulus, the psychological component should always be considered when investigating the total mechanisms for drinking.
Article
This study assessed the need to replace sodium in endurance exercise less than or equal to 6 h in duration by comparing responses to fluid replacement with water, saline (25 mmol.l-1), or no fluid. Eight subjects (five male, three female) participated in three 6-h exercise trials on an electrically braked cycle ergometer at 55% VO2max, at 30 degrees C and 50% r.h. In the water (W) and saline (S) trials, sufficient fluid was ingested to balance sweat and urinary fluid losses, while in the third trial, no fluid (NF) was ingested. Plasma sodium less than or equal to 130 mmol.l-1 was a criterion for trial termination. In the NF trial, heart rate, rectal temperature, plasma sodium, plasma aldosterone, and rating of perceived exertion were all significantly higher (P less than 0.001) than during W and S, whereas plasma volume was lower (P less than 0.001). On average, subjects terminated this trial 1.5 h prior to its scheduled completion, having lost 6.4% body weight. In contrast, no significant differences between fluid replacement with W or S were detected, although the effect of time on all aforementioned variables was highly significant (P less than 0.001). Saline intake was not associated with significantly higher plasma sodium during exercise than was water intake: plasma sodium decreased significantly during both W (to 135.5 +/- 0.5 mmol.l-1) and S (to 137.3 +/- 0.7 mmol.l-1). No subject had to terminate a trial based on plasma sodium less than or equal to 130 mmol.l-1.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This study investigated the hypothesis that addition of Na+ to a rehydration beverage would stimulate drinking and augment restoration of body water in individuals dehydrated during 90 min of continuous treadmill exercise in the heat. Following a 3.0 +/- 0.2% decrease in body weight (BW), 6 subjects sat in a thermoneutral environment for 30 min to allow body fluid compartments to stabilize. Over the next 3 hr, subjects rehydrated ad libitum using either flavored/artificially sweetened water (H2O-R) or a flavored, 6% sucrose drink containing either 25 (LNa(+)-R) or 50 (HNa(+)-R) mmol/L NaCl. Results demonstrated that rapid removal of the osmotic stimulus, during H2O-R, and the volume-dependent dipsogenic stimuli, during HNa(+)-R, are important factors in limiting fluid intake during rehydration, compared to LNa(+)-R. It was also found that the pattern of fluid replacement and restoration of fluid balance following dehydration is influenced by the dehydration protocol used to induce the loss in total body water and the sodium content of the rehydration beverage.
Article
Sodium and water loss during, and replacement after, exercise-induced volume depletion was investigated in six volunteers volume depleted by 1.89 +/- 0.17% (SD) of body mass by intermittent exercise in a warm, humid environment. Subjects exercised in a large, open plastic bag, allowing collection of all sweat secreted during exercise. For over 60 min beginning 40 min after the end of exercise, subjects ingested drinks containing 0, 25, 50, or 100 mmol/l sodium (trials 0, 25, 50, and 100) in a volume (ml) equivalent to 150% of the mass lost (g) by volume depletion. Body mass loss and sweat electrolyte (Na+, K+, and Cl-) loss were the same on each trial. The measured sweat sodium concentration was 49.2 +/- 18.5 mmol/l, and the total loss (63.9 +/- 38.7 mmol) was greater than that ingested on trials 0 and 25. Urine production over the 6-h recovery period was inversely related to the amount of sodium ingested. Subjects were in whole body negative sodium balance on trials 0 (-104 +/- 48 mmol) and 25 (-65 +/- 30 mmol) and essentially in balance on trial 50 (-13 +/- 29 mmol) but were in positive sodium balance on trial 100 (75 +/- 40 mmol). Only on trial 100 were subjects in positive fluid balance at the end of the study. There was a large urinary loss of potassium over the recovery period on trial 100, despite a negligible intake during volume repletion. These results confirm the importance of replacement of sodium as well as water for volume repletion after sweat loss. The sodium intake on trial 100 was appropriate for acute fluid balance restoration, but its consequences for potassium levels must be considered to be undesirable in terms of whole body electrolyte homeostasis for anything other than the short term.
Article
This study assessed whether replacing sweat losses with sodium-free fluid can lower the plasma sodium concentration and thereby precipitate the development of hyponatremia. Ten male endurance athletes participated in one 1-h exercise pretrial to estimate fluid needs and two 3-h experimental trials on a cycle ergometer at 55% of maximum O2 consumption at 34 degrees C and 65% relative humidity. In the experimental trials, fluid loss was replaced by distilled water (W) or a sodium-containing (18 mmol/l) sports drink, Gatorade (G). Six subjects did not complete 3 h in trial W, and four did not complete 3 h in trial G. The rate of change in plasma sodium concentration in all subjects, regardless of exercise time completed, was greater with W than with G (-2.48 +/- 2.25 vs. -0.86 +/- 1.61 mmol. l-1. h-1, P = 0.0198). One subject developed hyponatremia (plasma sodium 128 mmol/l) at exhaustion (2.5 h) in the W trial. A decrease in sodium concentration was correlated with decreased exercise time (R = 0.674; P = 0.022). A lower rate of urine production correlated with a greater rate of sodium decrease (R = -0. 478; P = 0.0447). Sweat production was not significantly correlated with plasma sodium reduction. The results show that decreased plasma sodium concentration can result from replacement of sweat losses with plain W, when sweat losses are large, and can precipitate the development of hyponatremia, particularly in individuals who have a decreased urine production during exercise. Exercise performance is also reduced with a decrease in plasma sodium concentration. We, therefore, recommend consumption of a sodium-containing beverage to compensate for large sweat losses incurred during exercise.
Article
In the study presented here, we examined the affects of a close to complete replacement of sweat water and Na+ losses on fluid shifts during exercise. Six cyclists performed three 4-h rides at 55% of their peak oxygen uptake in a 20 degrees C environment while consuming 3.85 l of an 8% carbohydrate solution containing 5, 50 or 100 mEq.l-1 of Na+. Increases in Na+ intake reduced renal free water clearance from around 40 ml.h-1 to -8 and -121 ml.h-1 and led to a decrease in urine volume from approximately equal to 1.0 to 0.5 l (P < 0.05). In contrast, the 3.5-3.9 l fluid and 150-190 mEq Na+ losses in sweat were similar in each trial, as were the approximately equal to 80 mEq K+ losses in sweat and urine and the 282-288 mosmol.kg-1 plasma osmolalities. During the low-Na+ trial, plasma osmolality was maintained by a approximately equal to 1.3 l contraction of extracellular fluid (ECF) with the loss of approximately equal to 200 mEq Na+. However, in the other trials, approximately equal to 1.3 l of water was lost from the intracellular fluid. During the medium-Na+ trial, a loss of only approximately equal to 40 mEq Na+ maintained ECF volume, and during the high-Na+ trial, a gain of approximately equal to 160 mEq Na+ expanded the ECF by approximately equal to 0.8 l. However, corresponding changes in plasma volumes from -0.20 to 0.15 l had no effect on cardiovascular drift or thermoregulation. These data suggest that during prolonged exercise of moderate intensity under mild environmental conditions when sweat rates are approximately equal to 0.9 l.h-1, complete Na+ replacement maintains plasma volume and reduces dehydration, but when fluid intake matches sweat rate, has little effect on plasma osmolality.
Article
The objective of this study was to determine whether sodium supplementation 1) influences changes in body weight, serum sodium [Na], and plasma volume (PV), and 2) prevents hyponatremia in Ironman triathletes. The study was carried out at the South African Ironman triathlon. Thirty-eight athletes competing in the triathlon were given salt tablets to ingest during the race. Data collected from these athletes [salt intake group (SI)] were compared with data from athletes not given salt [no salt group (NS)]. Salt tablets were given to the SI group to provide approximately 700 mg/h of sodium. Serum sodium, hemoglobin, and hematocrit were measured at race registration and after the race. Weights were measured before and after the race. Members of SI were retrospectively matched to subjects in NS for 1) weight change and 2) pre-race [Na]. The SI group developed a 3.3-kg weight loss (p < 0.0001) and significantly increased their [Na] (delta[Na] 1.52 mmol/L; p = 0.005). When matched for weight change during the race, SI increased their [Na] compared with NS (mean 1.52 versus 0.04 mmol/L), but this did not reach statistical significance (p = 0.08). When matched for pre-race [Na], SI had a significantly smaller percent body weight loss than NS (-4.3% versus -5.1%; p = 0.04). There was no significant difference in the increase of [Na] in both groups (1.57 versus 0.84 mmol/L). PV increased equally in both groups. None of the subjects finished the race with [Na] < 135 mmol/L. Sodium ingestion was associated with a decrease in the extent of weight loss during the race. There was no evidence that sodium ingestion significantly influenced changes in [Na] or PV more than fluid replacement alone in the Ironman triathletes in this study. Sodium supplementation was not necessary to prevent the development of hyponatremia in these athletes who lost weight, indicating that they had only partially replaced their fluid and other losses during the Ironman triathlon.
Article
This study was conducted to determine whether preexercise ingestion of a highly concentrated sodium beverage would increase plasma volume (PV) and reduce the physiological strain of moderately trained males running in the heat. Eight endurance-trained (.VO2max: 58 mL.kg(-1).min(-1) (SD 5); 36 yr (SD 11)) runners completed this double-blind, crossover experiment. Runners ingested a high-sodium (High Na+: 164 mmol Na+.L(-1)) or low-sodium (Low Na+: 10 mmol Na+.L(-1)) beverage (10 mL.kg(-1)) before running to exhaustion at 70% .VO2max in warm conditions (32 degrees C, 50% RH, V(a) approximately equal to 1.5 m.s(-1)). Beverages (approximately 757 mL) were ingested in seven portions across 60 min beginning 105 min before exercise. Trials were separated by 1-3 wk. Heart rate and core and skin temperatures were measured throughout exercise. Urine and venous blood were sampled before and after drinking and exercise. High Na+ increased PV before exercise (4.5% (SD 3.7)), calculated from Hct and [Hb]), whereas Low Na+ did not (0.0% (SD 0.5); P = 0.04), and involved greater time to exercise termination in the six who stopped because of an ethical end point (core temperature 39.5 degrees C: 57.9 min (SD 6) vs 46.4 min (SD 4); P = 0.04) and those who were exhausted (96.1 min (SD 22) vs 75.3 min (SD 21); P = 0.03; High Na+ vs Low Na+, respectively). At equivalent times before exercise termination, High Na+ also resulted in lower core temperature (38.9 vs 39.3 degrees C; P = 0.00) and perceived exertion (P = 0.01) and a tendency for lower heart rate (164 vs 174 bpm; P = 0.08). Preexercise ingestion of a high-sodium beverage increased plasma volume before exercise and involved less thermoregulatory and perceived strain during exercise and increased exercise capacity in warm conditions.
Article
Salt consists of sodium and chloride, and is important for normal physiologic function. High sweat rates in athletes result in loss of both fluids and sodium. Fluid replacement with hypotonic solutions will lead to incomplete rehydration and possible complications such as hyponatremia, decreased performance, heat cramps, or other heat-related illness. There is significant individual variation in sodium loss during activity. In some the losses can be replaced by normal dietary intake, whereas in others the losses can be dramatic and increased dietary intake is essential. There are various methods to increase sodium intake, such as increased use of table salt on foods, salty snacks, adding salt to sports drinks, and use of salt tablets. Emphasis on replacement of fluids is also important, but care must be taken to avoid overhydration. Simple measures such as recording daily pre- and postexercise body weight can aid in making fluid and sodium ingestion decisions; in some cases, a comprehensive evaluation is necessary.
Arnaoutis Rehrer NJ. Fluid and electrolyte balance in ultra-endurance sport
  • Anastasiou Ca
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Anastasiou CA, Kavouras SA, Arnaoutis Rehrer NJ. Fluid and electrolyte balance in ultra-endurance sport. Sports Med 2001: 31: 701–715.