Exercise-associated muscle cramps (EAMCs) are thought to be caused by dehydration and/or electrolyte losses. In this multicenter, cross-sectional study, the authors determined whether sweat rates (SRs), sweat electrolyte concentrations, or sweat electrolyte content differed in athletes with (i.e., crampers) and without (i.e., noncrampers) a history of EAMCs and whether these variables could predict EAMC-prone athletes. Male and female collegiate athletes (N = 350) from 11 sports with (n = 245) and without (n = 105) a self-reported history of EAMCs completed a typical exercise or conditioning session. SRs, calculated from body mass, and posterior forearm sweat were analyzed for sweat sodium concentration ([Na+]sw), sweat potassium concentration ([K+]sw), and sweat chloride concentration ([Cl−]sw). The authors used SRs and sweat electrolyte concentrations to calculate sweat electrolyte content lost. Within each gender, no differences in SRs (204 males, p = .92; 146 females, p = .24); [Na+]sw (191 males, p = .55; 126 females, p = .55); Na+ sw content (191 males, p = .59; 126 females, p = .20); [K+]sw (192 males, p = .57; 126 females, p = .87); K+ sw content (192 males, p = .49; 126 females, p = .03); [Cl−]sw (192 males, p = .94; 77 females, p = .57); and Cl− sw content (192 males, p = .55; 77 females, p = .34) occurred between crampers and noncrampers. Receiver operating characteristic curve analysis revealed that sweat electrolyte content and SRs were predictive of EAMC-prone athletes in American football (area under curve = 0.65–0.72, p ≤ .005), but not in any other sport. EAMCs may not be solely caused by fluid or electrolyte losses in most athletes. Fluid and electrolyte replacement may help American footballers. Clinicians should individualize fluid and electrolyte replacement and understand different etiologies for EAMCs.
Kevin C. Miller, Brendon P. McDermott, and Susan W. Yeargin
John Faltus and Brendon P. McDermott
Edited by Jatin P. Ambegaonkar
Brendon P. McDermott, Douglas J. Casa, Susan W. Yeargin, Matthew S. Ganio, Lawrence E. Armstrong, and Carl M. Maresh
To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).
Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.
Relevant peer-reviewed, military, and published text materials were reviewed.
Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.
The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.
Future research should focus on developing a structured return-to-activity strategy following EHS.
Brendon P. McDermott, Douglas J. Casa, Susan W. Yeargin, Matthew S. Ganio, Rebecca M. Lopez, and Elizabeth A. Mooradian
Previous field research has not identified sweat rates (SR), fluid consumption (FC), or the efficacy of an educational intervention (EI) for youth during football camp.
To measure hydration status and rehydration performance and examine EI using these data.
Observational with EI randomized comparison.
Thirty-three boys (mean ± SD: 12 ± 2 y, 52.9 ± 13.6 kg, 156 ± 12 cm) volunteered during a 5-d camp with 3 (~2-h) sessions per day (WBGT: 25.6 ± 0.5°C).
Main Outcome Measures:
Hydration status, SR, and FC.
Urine osmolality averaged 796 ± 293 mOsm/L for days 2-5. Game SR (1.30 ± 0.57 L/h) was significantly greater than practice SR (0.65 ± 0.35 L/h; P = .002). Subjects dehydrated during free time but matched fluid losses with FC (0.76 ± 0.29 L/h) during football activities.
Subjects arrived at camp hypohydrated and maintained this condition. They matched FC and SR during, but dehydrated when not playing, football. This may impair recovery and subsequent performance. Hydration EI seemed to have a positive influence on hydration practices.
Cody R. Smith, Cory L. Butts, J.D. Adams, Matthew A. Tucker, Nicole E. Moyen, Matthew S. Ganio, and Brendon P. McDermott
Context: Exercising in the heat leads to an increase in body temperature that can increase the risk of heat illness or cause detriments in exercise performance. Objective: To examine a phase change heat emergency kit (HEK) on thermoregulatory and perceptual responses and subsequent exercise performance following exercise in the heat. Design: Two randomized crossover trials that consisted of 30 minutes of exercise, 15 minutes of treatment (T1), performance testing (5-10-5 pro-agility test and 1500-m run), and another 15 minutes of treatment (T2) identical to T1. Setting: Outdoors in the heat (wet-bulb globe temperature: 31.5°C [1.8°C] and relative humidity: 59.0% [5.6%]). Participants: Twenty-six (13 men and 13 women) individuals (aged 20–27 y). Interventions: Treatment was performed with HEK and without HEK (control, CON) modality. Main Outcome Measures: Gastrointestinal temperature, mean skin temperature, thirst sensation, and muscle pain. Results: Maximum gastrointestinal temperature following exercise and performance was not different between trials (P > .05). Cooling rate was faster during T1 CON (0.053°C/min [0.049°C/min]) compared with HEK (0.043°C/min [0.032°C/min]; P = .01). Mean skin temperature was lower in HEK during T1 (P < .001) and T2 (P = .05). T2 thirst was lower in CON (P = .02). Muscle pain was lower in HEK in T2 (P = .03). Performance was not altered (P > .05). Conclusions: HEK improved perception but did not enhance cooling or performance following exercise in the heat. HEK is therefore not recommended to facilitate recovery, treat hyperthermia, or improve performance.
Matthew S. Ganio, Jennifer F. Klau, Elaine C. Lee, Susan W. Yeargin, Brendon P. McDermott, Maxime Buyckx, Carl M. Maresh, and Lawrence E. Armstrong
The purpose of this study was to compare the effects of a carbohydrate-electrolyte plus caffeine, carnitine, taurine, and B vitamins solution (CE+) and a carbohydrate-electrolyte-only solution (CE) vs. a placebo solution (PLA) on cycling performance and maximal voluntary contraction (MVC). In a randomized, double-blind, crossover, repeated-measures design, 14 male cyclists (M ± SD age 27 ± 6 yr, VO2max 60.4 ± 6.8 ml · kg−1 · min−1) cycled for 120 min submaximally (alternating 61% ± 5% and 75% ± 5% VO2max) and then completed a 15-min performance trial (PT). Participants ingested CE+, CE, or PLA before (6 ml/kg) and every 15 min during exercise (3 ml/kg). MVC was measured as a single-leg isometric extension (70° knee flexion) before (pre) and after (post) exercise. Rating of perceived exertion (RPE) was measured throughout. Total work accumulated (KJ) during PT was greater (p < .05) in CE+ (233 ± 34) than PLA (205 ± 52) but not in CE (225 ± 39) vs. PLA. MVC (N) declined (p < .001) from pre to post in PLA (988 ± 213 to 851 ± 191) and CE (970 ± 172 to 870 ± 163) but not in CE+ (953 ± 171 to 904 ± 208). At Minutes 60, 90, 105, and 120 RPE was lower in CE+ (14 ± 2, 14 ± 2, 12 ± 1, 15 ± 2) than in PLA (14 ± 2, 15 ± 2, 14 ± 2, 16 ± 2; p < .001). CE+ resulted in greater total work than PLA. CE+, but not PLA or CE, attenuated pre-to-post MVC declines. Performance increases during CE+ may have been influenced by lower RPE and greater preservation of leg strength during exercise in part as a result of the hypothesized effects of CE+ on the central nervous system and skeletal muscle.
Lawrence E. Armstrong, Elaine C. Lee, Douglas J. Casa, Evan C. Johnson, Matthew S. Ganio, Brendon P. McDermott, Jakob L. Vingren, Hyun M. Oh, and Keith H. Williamson
Exertional hyponatremia (EH) during prolonged exercise involves all avenues of fluid-electrolyte gain and loss. Although previous research implicates retention of excess fluid, EH may involve either loss, gain, or no change of body mass. Thus, the etiology, predisposing factors, and recommendations for prevention are vague—except for advice to avoid excessive drinking.
This retrospective field study presents case reports of two unacquainted recreational cyclists (LC, 31y and AM, 39 years) who began exercise with normal serum electrolytes but finished a summer 164-km ride (ambient, 34±5°C) with a serum [Na+] of 130 mmol/L.
To clarify the etiology of EH, their pre- and post-exercise measurements were compared to a control group (CON) of 31 normonatremic cyclists (mean ± SD; 37±6 years; 141±3 mmol Na+/L).
Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. These two hyponatremic cyclists consumed a large and similar volume of fluid (191 and 189 ml/kg), experienced an 11 mmol/L decrease of serum [Na+], reported low thirst sensations; however, LC gained 3.1 kg (+4.3% of body mass) during 8.9 hr of exercise and AM maintained body mass (+0.1kg, +0.1%, 10.6h). In the entire cohort (n = 33), post-event serum [Na+] was strongly correlated with total fluid intake (R2 = 0.45, p < .0001), and correlated moderately with dietary sodium intake (R2=0.28, p = .004) and body mass change (R2 = 0.22, p = .02). Linear regression analyses predicted the threshold of EH onset (<135 mmol Na+/L) as 168 ml fluid/kg.
The wide range of serum [Na+] changes (+6 to -11 mmol/L) led us to recommend an individualized rehydration plan to athletes because the interactions of factors were complex and idiosyncratic.