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Abstract

Fluid balance is crucial for maintaining health. It is well documented that dehydration increases physiologic strain and decreases athletic performance, especially in hot environments. Although there are numerous studies evaluating hydration status in adults, limited data concerning hydration levels in athletic youth exist. Nevertheless, most of these studies clearly indicate that (a) dehydration is a major and common problem within children exercising in the heat; and (b) children do not have the capacity to translate hydration awareness to successful hydration strategies. Further research is needed, and constant efforts must be made toward the development of more efficient hydration strategies in order to educate young people about the benefits of optimal hydration status.

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... Previous studies have shown that children demonstrate a similar pattern of insufficient drinking and dehydration as adults when they participate in physical activities or exercise in a hot environment (5,6). Moreover, children may be in a state of chronic hypohydration when fluids are not replenished (3,14,33). Therefore, it has been suggested recently that children cannot translate hydration awareness into successful hydration strategies (14). ...
... Moreover, children may be in a state of chronic hypohydration when fluids are not replenished (3,14,33). Therefore, it has been suggested recently that children cannot translate hydration awareness into successful hydration strategies (14). ...
... To our knowledge, the current study is the first to investigate the effect of flavors on the ad libitum fluid intake in Chinese children when they exercise in a hot and humid environment. As children usually do not have successful hydration strategies (14), it is very important to encourage children to drink enough fluids when exercising in a hot environment. The perceived taste of the beverage is important for fluid replacement during exercise (35). ...
Article
The purpose of the current study was to examine the effect of flavor on voluntary drinking and thermoregulatory responses in Chinese boys and girls exercising intermittently in a hot environment. Fourteen boys and girls (9 to 11 years old) performed four 3-hour intermittent exercise sessions (20-min walking sessions at 50% VO2peak followed by a 25-minute rest period) in a hot and humid environment (~30 °C ambient temperature and ~70% relative humidity). The participants consumed 1 of 4 beverages ad libitum in a randomized sequence by using a Latin-square principle: unflavored water (W), orange-flavored water (OF), lemon-flavored water (LF), and grape-flavored water (GF). No differences were observed in the total fluid intake (W vs. OF vs. LF vs. GF: Boys, 441 ± 114 vs. 493 ± 106 vs. 387 ± 83 vs. 568 ± 146 ml; Girls, 613 ± 131 vs. 923 ± 204 vs. 825 ± 157 vs. 790 ± 166 ml), urine and sweat output, and physiological perceptual variables among trials and between sexes. The results suggested that Chinese children can maintain body fluid balance while exercising moderately in a hot and humid environment by ad libitum drinking. The flavor of the beverages had no impact on the voluntary drinking and the state of hydration in the current study.
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This study investigated the relationship between runners' perceptions of fluid needs and drinking behavior under conditions of compensable heat stress (ambient temperature = 20.5 +/- 0.7 degrees C, 68.9 degrees F; relative humidity = 76.6%). Eighteen experienced runners (15 men, 40.5 +/- 2.5 y, and 3 women, 42 +/- 2.3 y) were given ad libitum access to a sports drink (6% carbohydrate-electrolyte solution) at Miles 2, 4, 6, and 8. After the run (75.5 +/- 8.0 min), subjects completed questionnaires that required them to estimate their individual fluid intake and sweat loss. Dehydration averaged 1.9% +/- 0.8% of initial body weight (a mean sweat loss of 21.6 +/- 5.1 mL.kg-1.h-1). Subjects replaced only 30.5% +/- 18.1% of sweat loss and underestimated their sweat loss by 42.5% +/- 36.6% (P <or= 0.001). Subjects' self-estimations of fluid intake (5.2 +/- 3.2 mL.kg-1.h-1) were not significantly different from actual fluid intake (6.1 +/- 3.4 mL.kg-1.h-1) and were significantly correlated (r = 0.63, P = 0.005). The data indicate that even under favorable conditions, experienced runners voluntarily dehydrate (P <or= 0.001), possibly because they are unable to accurately estimate sweat loss and consequently cannot subjectively judge how much fluid to ingest to prevent dehydration. This conclusion suggests that runners should not depend on self-assessment to maintain adequate hydration, underscores the need for runners to enhance their ability to self-assess sweat losses, and suggests that a predetermined regimen of fluid ingestion might be necessary if they wish to maintain more optimal hydration.
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Results of new research indicate that, contrary to previous thinking, youth do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared with adults during exercise in the heat when adequate hydration is maintained. Accordingly, besides poor hydration status, the primary determinants of reduced performance and exertional heat-illness risk in youth during sports and other physical activities in a hot environment include undue physical exertion, insufficient recovery between repeated exercise bouts or closely scheduled same-day training sessions or rounds of sports competition, and inappropriately wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in outdoor sports and other physical activities through a wide range of challenging warm to hot climatic conditions.
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Sweat evaporation can be a key thermoregulatory mechanism and it causes a loss of water from all compartments of the body. Hypohydration can also develop with restricted fluid intake or with intake of diuretics. Hypohydration can affect physical and/or mental performance and/or have implications for dietary recommendations. A variety of different types and modes of exercise performance can be influenced by hydration state. Reviews of the published literature are currently most conclusive for endurance exercise. Dehydration equivalent to 2% body mass loss during exercise in a hot environment (31-32 degrees C) impairs endurance performance, but when the exercise is performed in a temperate environment (20-21 degrees C) a 2% body mass loss appears to have a lesser and inconsequential effect. In cold environments a body mass loss >2% may be tolerable for endurance exercise. There is a less conclusive picture as to the effects of hypohydration on other types of physical performance, including strength and power activities, team sports and the skills component of many sports, and for mental performance. A number of physiological mechanisms are responsible for the effects observed. Fluid consumption can be used to attenuate the development of a water deficit or to correct it. The composition and temperature of a drink and the volume and rate of its consumption can all influence the physiological responses to ingestion and can impact on exercise performance.
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Humans may lose large amounts of water and electrolytes from sweat during prolonged exercise in a hot climate. Gender and maturational differences for the total sweat electrolyte losses have not been reported. The purpose of this study was to compare sweat electrolyte losses of prepubescent (PP), pubescent (P) and young adult (YA) males and females, under the same environmental conditions and relative exercise intensities. Twenty-five females (8 PP, 9 P, 8 YA) and 26 males (10 PP, 8 P, 8 YA) cycled for two 20-min bouts at 50% of their peak VO2 in a climatic chamber (42 degrees C, 18% relative humidity). Sweat was collected from a plastic bag attached to the lower back. Total body sweat loss was calculated from the differences in nude body weight corrected for fluid intake, urine, and respiratory water loss. Sweat [Na+] and [Cl-] tended to increase with maturation while sweat [K+] was lower in YA compared with that of PP. Children had a lower sweating rate than YA, even when corrected for body surface area. As a result, total Na+ and Cl- losses per kg body weight from sweat (mEq.kg-1.h-1) were higher in YA compared with those of PP and P; however, no maturational difference was found in K+ losses. Within the same maturational group, there were no gender differences in any of the electrolyte losses. These results may be useful in recommending "optimal" fluid-electrolyte drinks for children exercising in the heat.
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Sweating rate (SR) of boys is lower than that of men. To assess the association between the response of individual sweat glands and physical growth and maturation, three groups of circumpubertal boys cycled at 50% VO2max in a climatic chamber (42 degrees C, 20% relative humidity). Based on Tanner staging (pubic hair), 16 were classified as prepubertal (PP, Tanner 1), 15 as midpubertal (MP, Tanner 2-4), and five as late-pubertal (LP, Tanner 5). Population density (PD) of the heat-activated sweat glands, the mean area of sweat drops (DA), and the proportion of skin covered by sweat (%A) were measured by skin photography and computer-assisted imaging analysis. Other measurements included rectal and skin temperatures (Tre, Tsk, respectively), heart rate (HR), and total body SR. The rise in HR, Tre and Tsk did not differ among groups. Whole body SR was significantly higher in the LP group compared with PP (PP = 4.95 +/- 0.23, MP = 5.79 +/- 0.20, LP = 6.70 +/- 0.42 ml.min-1.m-2) (mean +/- SEM). PD was significantly higher in the PP group (PP = 128 +/- 8, MP = 97 +/- 9, LP = 74 +/- 9 glands.cm-2), while DA was higher in the LP group (PP = 5.47 +/- 0.59, MP = 6.92 +/- 0.47, LP = 12.83 +/- 1.41 microns2.10(4)). %A did not differ among groups. The calculated SR per gland was higher among the LP groups compared with the less mature ones (PP = 4.6 +/- 0.3, MP = 7.2 +/- 0.8, LP = 9.6 +/- 1.0 nl.min-1).(ABSTRACT TRUNCATED AT 250 WORDS)
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During exercise in a hot climate, children have been reported to have a less effective temperature regulation capability, compared with adults. It is likely that the transition from a child-like to an adult-like response occurs during puberty. To assess the association between the thermoregulatory response and physical maturation, three groups of circum-pubertal boys cycled at 50% VO2max (three 20-min bouts with 10-min rests), in a climatic chamber (42 degrees C, 20% relative humidity). Based on Tanner staging (pubic hair), 10 were classified as prepubertal (PP), 13 as midpubertal (MP), and eight as late pubertal (LP). Measurements included rectal and skin temperatures (Tre, Tsk), heart rate (HR), sweating rate (SR), oxygen consumption (VO2), and forearm blood flow (FBF). Tre, Tsk, and HR increased with time, with no significant difference among groups. Relative VO2 (ml O2.kg-1) was similar among groups. FBF was consistently higher in PP compared with LP. In spite of the higher SR (PP = 4.9 +/- 0.2, MP = 5.7 +/- 0.3, LP = 6.6 +/- 0.4 ml.min-1.m-2) (mean +/- SEM) among LP compared with PP, the rate of heat storage (PP = 5.5 +/- 0.4, MP = 5.3 +/- 0.4, LP = 6.8 +/- 0.3, kJ.h-1.kg-1) was also significantly higher among those in the LP group. Three of eight LP did not complete the session due to high Tre, while two of the 10 PP were unable to complete the session even though the physiologic heat strain was not high. The results suggest that the transition from a child-like to an adult-like thermoregulatory effectiveness in a hot, dry climate may occur at a somewhat later stage, but not during puberty.
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
Fourteen postheatstroke (HS) subjects and nine normal control subjects (C) with similar (V̇O2max) underwent a 180-min heat-tolerance test (ambient temperature 40°C, relative humidity 40%; 12 steps.min⁻¹ on a 30-cm high bench). In group HS nine subjects (NHS) thermoregulated similar to group C, while five subjects were identified as heat intolerant (HI), characterized by significantly higher heart rate (HR), rectal temperature (Tre), and heat storage (ΔS) than groups NHS and C (at the end of the 2nd h, HR 159 ± 9, 124 ± 4, and 118 ± 3 beats.min⁻¹, Tre 38.9 ± 0.1, 37.9 ± 0.1, and 37.9 ± 0.1 °C, ΔS 24 ± 5, 10 ± 2, and 12 ± 4 W.m⁻² in groups HI, NHS, and C, respectively). The work efficiency (η) was significantly lower in groups HI and NHS when compared with C (10.2 ± 0.7, 10.4 ± 0.5, and 11.8 ± 0.6%, respectively). Skin surface area-to-body mass ratio (AD/W) in group HI was significantly lower than in group NHS or C (247 ± 7,271 ± 5, and 272 ± 4 cm².kg⁻¹, respectively). Multiple linear regression analysis between each one of the dependent variables, HR, Tre, and ΔS, mean weighted skin temperature, and sweat rate, against the two independent variables, η and AD/W, yielded significant correlations (r = 0.74, 0.73, 0.58, 0.59, and 0.44, respectively). The results suggest that a reduced η and/or a reduced AD/W play a role in heat intolerance, causing increased heat production and a concomitantly less effective heat dissipation.
Article
This study was intended to assess the influence of drink flavor and composition on voluntary drinking and hydration status in children exercising intermittently at 35 +/- 1 degrees C and 45-50% relative humidity. Twelve boys (9-12 yr) performed three 3-h identical sessions (four 20-min cycling bouts at 50% maximal O2 uptake followed by 25-min rest). One of three beverages (chilled to 8-10 degrees C) was assigned to each session in a Latin-square sequence: unflavored water (W), grape-flavored water (FW), and grape-flavored water plus 6% carbohydrate and 18 mmol/l NaCl (CNa). Drinking was ad libitum. Body weight, heart rate, rectal and skin temperatures, and thirst and stomach fullness perceptions were monitored periodically. Total intake was 610, 882, and 1,157 g in W, FW, and CNa, respectively (CNa-W and CNa-FW; P < 0.05). Hypohydration was observed with W (-0.65% body wt) and FW (-0.32% body wt), but drinking CNa resulted in slight overhydration (+0.47% body wt, CNa-W, CNa-FW; P < 0.05). Other physiological and all perceptual variables were insignificantly different among trails. In conclusion, while flavoring of water reduces children's voluntary dehydration, further addition of 6% carbohydrates and 18 mmol/l NaCl prevents it altogether.
Article
Football players lose 3.5 to 5 kg of body weight during preseason practices because of heavy sweating. This fluid may be difficult to replace when practices occur 2 times per day on consecutive days. Football players are hypohydrated during twice-a-day preseason training in a hot, humid environment. Descriptive laboratory study. In 10 college football players, body weight was measured, and blood and urine samples were obtained before and after practices on days 2 through 8 of preseason training. Baseline samples were obtained when subjects were euhydrated. Blood samples were used to calculate plasma volume changes. Urine samples were analyzed for specific gravity, sodium, and potassium. Sweat rate was calculated. Core temperature was monitored during half- and full-padded practices. Mean wet bulb temperatures were 23.3 degrees C during morning practices and 23.7 degrees C during afternoon practices. Plasma volume was below baseline on day 2 and expanded by day 6. Urine specific gravity was higher than baseline for 12 of 20 measurements over the 8 days. It was 1.0175 +/- 0.006 at baseline but subsequently ranged from 1.0214 +/- 0.007 to 1.0321 +/- 0.004. Mean daily urine sodium dropped from baseline to day 2 (194 +/- 43 vs 43 +/- 38 mmol x L-1), remaining lower on days 3, 4, and 6 (40 +/- 39, 39 +/- 39, and 68 +/- 40 mmol x L-1, respectively). Urine potassium was lower on days 6 and 8 compared with baseline and day 3. Body weight was below baseline before and after both daily practices. Core temperature was higher in full pads; sweat rate and body weight loss were not different between half and full pads. Body weight, plasma volume, urine specific gravity, and urine sodium indicate that football players become dehydrated by day 2 of preseason training. Urine sodium increased to near baseline by day 8; urine specific gravity was elevated. Football players struggle to maintain euhydration during preseason twice-a-day sessions.
Article
The purpose of this study was to determine whether high-school football players showed risks of fluid deficits during two-a-day training (Part 1), and whether implementing a drinking strategy could acutely improve the markers of hydration (Part 2). In Part 1, pre-training urine specific gravity (USG) and pre- and post-training body weight were measured at the morning session for 5 consecutive days of two-a-day practices to monitor the hydration status of 13 varsity players. The mean pre-training body weight was consistently lower (mean decrease of 0.5 kg, p<0.05) following the first day of measurement. Pre-training USG values remained consistently high each day (range for daily means: 1.022+/-0.003 to 1.024+/-0.005). Part 2 consisted of assessing hydration status in 46 varsity and junior varsity players prior to morning training during two-a-day training before and following implementing a drinking strategy. In association with the strategy, mean body weight increased 0.5 kg (p<0.01) and mean USG decreased from 1.021 to 1.016 (p<0.01) following the drinking protocol. The slight decline in body weight and consistently high USG (Part 1) suggested that standard fluid replacement strategies were less than optimal for a majority of the players. Implementing a drinking strategy appeared to improve hydration status based on changes in body weight and USG (Part 2).
Article
Children possess certain physiological and anatomic characteristics that have traditionally been considered to impair thermoregulatory responses to exercise in the heat: low exercise economy, high ratio of body surface area to mass, diminished sweating capacity, and less cardiac output at the same work load compared with adults. Consequently, children have been regarded as an at-risk group for not only decrements of physical performance but also heat injury during physical activities performed in conditions of high ambient temperature. Recent investigations that have directly compared thermoregulatory responses to exercise in the heat in children and adults have challenged these traditional concepts. Such studies have failed to indicate group differences in heat dispersal when adult-child comparisons are appropriately considered in respect to relative exercise intensity. These findings imply that no maturational differences exist in thermal balance or endurance performance during exercise in the heat, nor that child athletes are more vulnerable to heat injury.