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American College of Sports Medicine position stand. Exercise and Fluid Replacement
Abstract
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.
... Beverages containing electrolytes and carbohydrates should be consumed to ensure adequate hydration to optimise cognitive function and remain euhydrated. [13,22,23] Supplement Use ...
... Numerous competitions are played in the summer months and often in the hottest part of the day, illustrating the importance of hydration. Dehydration can potentially affect exercise performance by increasing core body temperature, cardiovascular strain and additional glycogen utilisation, impairing cognitive performance [22,40]. Dehydration of >2% BW has consistently been shown to impair endurance performance and mild dehydration of ≥1-2% BW has been shown to impair sport-specific cognitive performance [22,41]. ...
... Dehydration can potentially affect exercise performance by increasing core body temperature, cardiovascular strain and additional glycogen utilisation, impairing cognitive performance [22,40]. Dehydration of >2% BW has consistently been shown to impair endurance performance and mild dehydration of ≥1-2% BW has been shown to impair sport-specific cognitive performance [22,41]. ...
Golf is predominantly a skill-based sport where technical aspects are regarded as a priority area for improving performance. At present, most of the existing literature has focused on improving a player’s physicality, endurance and technical attributes in an effort to enhance performance. While important, the role of nutrition in elite golf has received little attention to date. The energy demands of the sport can vary depending on the level of the individual (recreational–professional), with distances of up to 20 km being covered and the time spent on the course ranging approximately 4–8 h each day. Like other sports, a focus on pre-game, during and post-game nutrition, including hydration, is integral to ensuring that individuals are adequately fuelled, hydrated and optimally recovered. For the elite athletes who travel extensively to international tournaments, it is important to understand the additional impact of travel on the body and consider the role nutrition can play in preventing illness and ensuring minimal disruption to golf performance. Lastly, the role of dietary supplements to enhance the performance of golfers is also important to consider. This review aims to consolidate the findings of the existing research focusing on nutrition strategies for golf performance and identify areas for potential future research.
... The body fluid regulatory system vitally interacts with the thermoregulatory system, and thermally induced hypohydration, which causes plasma hyperosmolality and/or hypovolemia, attenuates thermoregulatory responses to elevated body core temperature, such as sweating and cutaneous vasodilation [3][4][5][6][7]. Thus, hypohydration is a risk factor for heat-related illness, and maintaining euhydration by fluid ingestion is recommended as a measure against heat-related illness [8][9][10][11]. Furthermore, some reports have indicated that improving one's hydration status throughout life might decrease the prevalence of degenerative diseases [12,13]. ...
... In addition, Maughan et al. reported that urine output for 4 h after ingestion of one liter of tea, which contains caffeine at ~ 18 mg/100 ml, or caffeine up to 400 mg was not different from the response to the same volume of water ingestion in euhydrated individuals [27,28]. However, the influence of caffeine-containing beverage intake on body fluid balance and urine output in dehydrated individuals is not well documented [8]. ...
... Maughan et al. reported that the renal response to ingesting one liter of tea containing ~ 18 mg/100 ml caffeine was not different from the response to ingestion of the same volume of water in euhydrated subjects [27]. In the present study, we examined the effect of green tea or caffeine (20 mg/100 ml) intake in individuals under mild hypohydration on body fluid balance because the influence of caffeine consumption on urine output in dehydrated individuals has not been studied sufficiently [8]. The mean total caffeine intake was 83 ± 7.7 to 118 ± 11 mg, or 1.43 ± 0.10 to 2.04 ± 0.15 mg/ kg, from ingesting GT (14-20 mg/100 ml caffeine) and ~ 118 ± 12 mg, or ~ 2.03 ± 0.13 mg/kg, from ingesting Caf-H 2 O (20 mg/100 ml caffeine) in the present study. ...
Purpose
Maintaining an appropriate hydration level by ingesting fluid in a hot environment is a measure to prevent heat-related illness. Caffeine-containing beverages, including green tea (GT), have been avoided as inappropriate rehydration beverages to prevent heat-related illness because caffeine has been assumed to exert diuretic/natriuretic action. However, the influence of caffeine intake on urine output in dehydrated individuals is not well documented. The aim of the present study was to examine the effect of fluid replacement with GT on body fluid balance and renal water and electrolyte handling in mildly dehydrated individuals.
Methods
Subjects were dehydrated by performing three bouts of stepping exercise for 20 min separated by 10 min of rest. They were asked to ingest an amount of water (H2O), GT, or caffeinated H2O (20 mg/100 ml; Caf-H2O) that was equal to the volume of fluid loss during the dehydration protocol; fluid balance was measured for 2 h after fluid ingestion.
Results
The dehydration protocol induced hypohydration by ~ 10 g/kg body weight (~ 1% of body weight). Fluid balance 2 h after fluid ingestion was significantly less negative in all trials, and the fluid retention ratio was 52.2 ± 4.2% with H2O, 51.0 ± 5.0% with GT, and 47.9 ± 6.2% with Caf-H2O; those values did not differ among the trials. After rehydration, urine output, urine osmolality, and urinary excretions of osmotically active substances, sodium, potassium and chloride were not different among the trials.
Conclusion
The data indicate that ingestion of GT or an equivalent caffeine amount does not worsen the hydration level 2 h after ingestion and can be effective in reducing the negative fluid balance for acute recovery from mild hypohydration.
Trial registration
ISRCTN53057185; retrospectively registered.
... Posterior al ejercicio, se puede utilizar el glicerol como parte de la estrategia de rehidratación para corregir las pérdidas de fluidos acumuladas durante un evento deportivo o entrenamiento y especialmente en eventos consecutivos o en días consecutivos (87,88). Una vez ingerido el glicerol, se alcanza la máxima retención de fluidos a las 4 horas y se excretará gradualmente en las siguientes 24 a 48 ...
The primary aim of this study was to assess the impact of fluid intake on hydration status indices in men at work. The secondary aim was to determine the type of fluids drunk at work in different thermal conditions. Fifty-nine male foresters were examined before and after one working day during summer, autumn, and winter. Before and after work, urine and blood samples were obtained from foresters. Immediately after a shift, participants completed a questionnaire regarding fluid intake during one working day. The amount of fluid consumed affects the hydration urine indices. Urine specific gravity and urine osmolality significantly decreased with increasing fluid intake (r = − 0.385 and r = − 0.405, respectively). Moreover, an impact of season on the type of fluids consumed by workers was observed. Tea was significantly more often chosen by workers to drink in winter (68%) than in summer (32%) (p = 0.026). The consumption of any non-alcoholic fluids contributes to the daily total water intake, but it is necessary to create individualized fluid replacement plans. Workers should know how much and what types of drinks to consume at work.
The prevalence of rapid weight loss (RWL) among martial arts athletes including judo is very high. Many applied RWL strategies could be dangerous to health and even lead to death. Therefore, the International Judo Federation (IJF) introduced changes in the weigh-in rules, changing the official weigh-in for the day before the competition. Thus, the purpose of this study was to examine the impact of the new IJF rules on hydration status and weight loss strategies among professional judo athletes. Seventeen elite judo athletes participated in the study. Body mass and hydration status, were analyzed before the competition. Moreover, competition result and practice of RWL survey were collected. All subjects reached their weight category limits for the competition. RWL resulted in body mass changes ( p < 0.001, η p ² = 0.79) and dehydration among participants (urine osmolality > 700 [mOsmol * kg] ⁻¹ and urine specific gravity > 1.020 [g * cm ³ ] ⁻¹ ). However, urine osmolality ( p > 0.05, η p ² = 0.18), as well as urine specific gravity ( p > 0.05, η p ² = 0.16), at subsequent time points of measurement revealed no statistical differences. The prevalence of RWL was 100%, and only 17.6% of the athletes declared that they would compete in a different weight category if the competition would be conducted on the same day of the weigh-in. All judo athletes applied RWL procedures using traditional methods to achieve the required body mass (i.e., increased exercise, reduced fluid, and food intake). Dehydration state was not associated with competitive performance ( p > 0.05).
Objective
Direct urine color assessment has been shown to correlate with hydration status. However, this method is subject to inter- and intra-observer variability. Digital image colorimetry provides a more objective method. This study evaluated the diagnostic accuracy of urine photo colorimetry using different smartphones under different lighting conditions, and determined the optimal cut-off value to predict clinical dehydration.
Methods
The urine samples were photographed in a customized photo box, under five simulated lighting conditions, using five smartphones. The images were analyzed using Adobe Photoshop to obtain Red, Green, and Blue (RGB) values. The correlation between RGB values and urine laboratory parameters were determined. The optimal cut-off value to predict dehydration was determined using area under the receiver operating characteristic curve.
Results
A total of 56 patients were included in the data analysis. Images captured using five different smartphones under five lighting conditions produced a dataset of 1400 images. The study found a statistically significant correlation between Blue and Green values with urine osmolality, sodium, urine specific gravity, protein, and ketones. The diagnostic accuracy of the Blue value for predicting dehydration were “good” to “excellent” across all phones under all lighting conditions with sensitivity >90% at cut-off Blue value of 170.
Conclusions
Smartphone-based urine colorimetry is a highly sensitive tool in predicting dehydration.
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-h 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° and 22°C (59° and 72°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 an oral rehydration solution for enhancing intestinal water absorption as long as sodium is sufficiently available from the previous meal.
Objective: To record weight changes, fluid intake and changes in serum sodium concentration in ultradistance triathletes.
Design: Descriptive research.
Setting: Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). Air temperature at 1200 h was 21°C, (relative humidity 91%). Water temperature was 20.7°C.
Participants: 18 triathletes.
Interventions: None.
Main Outcome Measures: Subjects were weighed and had blood drawn for serum sodium concentration [Na], hemoglobin, and hematocrit, pre-race, post-race, and at 0800 h on the morning following the race (recovery); subjects were also weighed at transitions. Fluid intake during the race was estimated by athlete recall.
Results: Median weight change during the race = -2.5 kg (p < 0.0006). Subjects lost weight during recovery (median = -1.0 kg) (p < 0.03). Median hourly fluid intake = 716 ml/h (range 421-970). Fluid intakes were higher on the bike than on the run (median 889 versus 632 ml/h, p = 0.03). Median calculated fluid losses cycling were 808 ml/h and running were 1,021 ml/h. No significant difference existed between pre-race and post-race [Na] (median 140 versus 138 mmol/L) or between post-race and recovery [Na] (median 138 versus 137 mmol/L). Plasma volume increased during the race, median + 10.8% (p = 0.0005). There was an inverse relationship between change in [Na] pre-race to post-race and relative weight change (r = -0.68, p = 0.0029). Five subjects developed hyponatremia ([Na] 128-133 mmol/L).
Conclusions: Athletes lose 2.5 kg of weight during an ultra-distance triathlon, most likely from sources other than fluid loss. Fluid intakes during this event are more modest than that recommended for shorter duration exercise. Plasma volume increases during the ultradistance triathlon. Subjects who developed hyponatremia had evidence of fluid overload despite modest fluid intakes.
While exercise heat stress and hydration status are known to independently influence heart rate variability (HRV), the combined effect of these physiological stressors is unknown. Thus, heat-acclimated subjects (n=5) performed exercise heat trials (40 °C, 20% relative humidity) in the euhydrated and hypohydrated state (3.9±0.7% body weight loss). During each trial, cardiac cycle R–R interval data were collected for 45 min at rest (pre-) and after (post-) completing 90 min of cycle ergometer exercise. Pre- and post-exercise RRI data were analyzed by Fast Fourier Power Spectral analysis to determine the high-frequency (HF), low-frequency (LF), very low-frequency (VLF), and total power (TP) components of HRV. Overall HRV was decreased by both hypohydration and exercise heat stress. Hypohydration reduced TP, LF, VLF, and LF:HF ratio (P<0.05) while HF was significantly higher. The change in both LF and HF power (pre- vs. post-exercise) were blunted during hypohydration compared to euhydration. These data suggest that dehydration alone positively influences the parasympathetic (HF) control of HRV, but the reduction in overall HRV and the blunted oscillations in LF and HF power following exercise heat stress support an overall deleterious effect of dehydration on autonomic cardiac stability.
Dehydration by means of exercise, heat, diuretics, semistarvation, or a combination of these is common practice among competitors in weight class sports. Many studies have demonstrated a reduced aerobic work capacity following each of these forms of dehydration. The effects of these practices on performance that requires energy derived primarily from anaerobic sources is not well documented. The purpose of this study was to examine the effects of progressive, acute, thermal dehydration on performance of an anaerobic criterion task. Eleven collegiate wrestlers performed the Wingate Anaerobic Test (WAnT) prior to and after each of the following mean weight losses: 2%, 4%, and 5%. Weight loss was induced by passive thermal dehydration (56°C, 15% RH). Approximately 2 h were required in the environmental chamber to lose the required weight at each stage. There was no significant change (P > 0.05) in the ability to perform the WAnT or its various indices at any stage of dehydration, nor were blood lactate concentrations post WAnT significantly different from predehydration levels. This suggests that anaerobic performance may not be impaired to the extent that aerobic performance is by passive, thermal dehydration to a 5% body weight loss. However, deleterious physiologic effects may result from dehydration practices even though performance levels are maintained.
To determine the differences in sweat composition between sweat induced by thermal stress alone and that induced by physical exercise, seven young healthy men first sat in a hot room and then performed running exercise. A 20-minute stay in a climate chamber at 40°C resulted in a 5% reduction in body weight. The same body weight loss was induced by running exercise. Both sodium and chloride concentrations were much lower in the sweat induced by thermal exposure than that induced by the running exercise (p<0.01), while urea nitrogen and creatinine concentrations were significantly higher after thermal exposure than after the running exercise (p<0.01). Potassium concentrations did not differ significantly with either procedure. These findings suggest that sweat composition varies with the kind of induction and that more salt seems to be lost through exercise-induced sweating than by just sitting in a hot environment.
The aim of this study was to examine if the pattern of fluid intake with a carbohydrate-electrolyte solution during 4 h recovery from prolonged, submaximal running would influence the subsequent endurance capacity. Seven well-trained athletes aged 19.8 +/- 0.3 years (mean +/- s(mean)) took part in the study, which had university ethical committee approval. They ran at 70% VO2 max on a level treadmill for 90 min (T1), or until volitional fatigue, whichever came first, on two occasions, at least 7-10 days apart. Four hours later, the subjects ran at the same speed for as long as possible (T2), as a measure of their endurance capacity. During the 4 h rehydration recovery period, the runners were allowed to drink a carbohydrate-electrolyte solution (6.9% Lucozade-Sport; sodium, 24 mmol l(-1); potassium, 2.6 mmol l(-1); calcium, 1.2 mmol l(-1); osmolality, 300 mOsm kg(-1)) ad libitum on one occasion. On the other occasion, the volume of the same fluid was prescribed from calculations of the body mass loss during T1 (2.6% of pre-exercise body mass). All subjects completed the 90 min run during T1 on both trials. However, during T2, in the prescribed intake trial, the exercise time to exhaustion was 16% longer (P< 0.05) than during T2 in the ad libitum trial (69.9 +/- 9.1 vs 60.2 +/- 10.2 min). Although there was no difference between conditions in the total volume ingested (1499 +/- 155 vs 1405 +/- 215 ml), the volume of carbohydrate-electrolyte solution ingested in the fourth hour of the rehydration recovery period was greater in the prescribed intake trial than in the ad libitum trial (258 +/- 52 vs 78 +/- 34 ml; P< 0.05). The amount of glucose ingested in this period during the prescribed intake trial was also greater than during the ad libitum trial (17.8 +/- 3.6 vs 5.4 +/- 2.4 g; P< 0.05). There was a higher blood lactate concentration at the start of T2 in the prescribed intake trial than in the ad libitum trial (1.12 +/- 0.20 vs 0.94 +/- 0.09 mmol l(-1); P< 0.05), but there were no differences in blood glucose, plasma insulin, free fatty acid concentrations or urine volume between trials. The results of this study suggest that drinking a prescribed volume of a carbohydrate-electrolyte solution after prolonged exercise, calculated to replace the body fluid losses, restores endurance capacity to a greater extent than ad libitum rehydration during 4 h of recovery, even though the total volumes ingested were the same between trials.
To examine the effects of rapid dehydration on isometric muscular strength and endurance, seven men were tested at baseline (control) and after a dehydration (dHST) and a euhydration (eHST) heat stress trial. The dHST consisted of intermittent sauna exposure until 4% of body mass was lost, whereas the eHST consisted of intermittent sauna exposure (same duration as dHST) with water replacement. Peak torque was determined for the knee extensors and elbow flexors during three isometric maximal voluntary contractions. Time to fatigue was determined by holding a maximal voluntary contraction until torque dropped below 50% peak torque for 5 s. Strength and endurance were assessed 3.5 h after the HSTs (no food or water intake). Body mass was decreased 3.8+/-0.4% post dHST and 0.4+/-0.3% post eHST. Plasma volume was decreased 7.5+/-4.6% and 5.7+/-4.4%, 60 and 120 min post dHST, respectively. A small (1.6 mEq x L[-1]) but significant increase was found for serum Na+ concentration 60 min post dHST but had returned to predehydration level 120 min post dHST. Serum K+ and myoglobin concentrations were not affected by HSTs. Peak torque was not different (P > 0.05) among control, dHST, and eHST for the knee extensors (Mean (Nm)+/-SD, 285+/-79, 311+/-113, and 297+/-79) and elbow flexors (79+/-12, 83+/-15, and 80+/-12). Time to fatigue was not different (P > 0.05) among control, dHST and eHST for the knee extensors (Mean (s)+/-SD. 42.4+/-11.5, 45.3+/-7.6, and 41.8+/-6.0) and elbow flexors (48.2+/-8.9, 44.0+/-9.4, and 46.0+/-6.4). These results provide evidence that isometric strength and endurance are unaffected 3.5 h after dehydration of approximately 4% body mass.
Exertional rhabdomyolysis is an uncommon diagnosis, but because its complications can be severe, clinicians need a thorough understanding of this syndrome. When skeletal muscle cell membranes are damaged, their intracellular contents enter the bloodstream and can cause potentially serious sequelae, even death. Intense exercise, some viral infections, and certain genetic disorders increase the risk. Serum creatine kinase levels are the diagnostic gold standard. The treatment of rhabdomyolysis consists of early detection, therapy for the underlying cause, measures to prevent renal failure, and correction of metabolic complications.
Evaporative water loss was measured in 8 Sudanese soccer players during 3 olympic qualifying matches in 3 different environmental conditions. Losses of up to 3% of body weight were found. Fluid replacement during half time interval were found to be inadequate and the results are discussed.