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Lawrence E. Armstrong and Carl M. Maresh

Exercise-heat tolerance (EHT) in children is influenced by many physiological factors, including sweat gland activity, cardiac output, exercise economy, ability to acclimate to heat, and maturation of organ systems. It is generally believed that children cannot tolerate hot environments as well as adults, although some children exhibit EHT that is superior to that of adults. There has been no research showing large exercise-induced differences between the core body temperatures of children versus adults, but differences in the time to onset of syncope and fatigue have been observed. This suggests that the greatest risk of heat illness for children is heat exhaustion (i.e., cardiovascular instability) and not heat stroke (i.e., hyperthermia). Therefore this review (a) examines the conclusions of previous studies to clarify misinterpretations of data, and (b) identifies research questions that require future study.

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David R. Hooper, William J. Kraemer, Rebecca L. Stearns, Brian R. Kupchak, Brittanie M. Volk, William H. DuPont, Carl M. Maresh, and Douglas J. Casa

Purpose: Prior research has illustrated that high volumes of aerobic exercise result in a reduction in basal concentrations of testosterone in men. Those studies were mostly conducted on recreational runners and identified reduced testosterone, but not concentrations low enough to be considered pathological. Therefore, the purpose of this study was to assess the basal concentrations of testosterone and cortisol in elite triathletes, as well as the impact of a World Championship race, on the acute responses of these hormones. Methods: A total of 22 men (age 40.6 [11.5] y, height 179 [6] cm, weight 77.0 [7.0] kg) who participated in the 2011 Ironman World Championships served as subjects. Resting blood samples were taken 2–4 d prior to provide a baseline (BL), as well as immediately, 1 d, and 2 d after the event and were later analyzed for total testosterone and cortisol concentrations. Results: At BL, 9 men had a normal testosterone concentration, whereas 9 men fell within a “gray zone” and 4 other men demonstrated concentrations suggestive of deficiency. Testosterone was significantly lower than BL at 1 d (95% confidence interval [CI] 0.10–0.34, P < .001, ES = 0.53) and 2 d (95% CI 0.01–0.21, P = .034, ES = 0.35) after the event. Cortisol was significantly different from BL at immediate post (95% CI 1.07–0.83, P < .001, ES = 8.0). There were significant correlations between time and age (R = .68, P = .001), as well as BL testosterone and cortisol (R = .51, P = .015). Conclusion: Elite ultraendurance athletes may demonstrate not only reduced testosterone but also sometimes clinically low concentrations that could be indicative of androgen deficiency.

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Lindsey E. Eberman, Stephanie M. Mazerolle, Kelly D. Pagnotta, Kristin A. Applegate, Douglas J. Casa, and Carl M. Maresh

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Kate Sanders, Carl M. Maresh, Kevin D. Ballard, Brent C. Creighton, J. Luke Pryor, William J. Kraemer, Jeff S. Volek, and Jeff M. Anderson

Compared with their physically active peers, overweight sedentary postmenopausal women demonstrate impaired vascular endothelial function (VEF), substantially increasing the risk for cardiovascular disease (CVD). Habitual exercise is associated with improved VEF and reduced CVD risk. The purpose of this study was to compare brachial artery flow mediated dilation (FMD), a measure of VEF, in overweight, postmenopausal women who were physically active (EX: n = 17, BMI: 29.3 ± 3.11 kg/m2) or sedentary (CON: n = 8, BMI: 30.3 ± 3.6 kg/m2). Anthropomorphic measures were similar in both groups (P > .05). FMD was significantly greater in EX (10.24 ± 2.36%) versus CON (6.60 ± 2.18%) (P < .002). FMD was not significantly correlated with estimated VO2max (EX: r = .17, P = .52; CON: r = .20, P = .60) but was negatively associated with percent body fat in EX group (EX: r = -.48, P = .05; CON: r = .41, P = .31). These results are consistent with the positive effects of habitual exercise on VEF in overweight postmenopausal women.

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Sharon L. Miller, P. Courtney Gaine, Carl M. Maresh, Lawrence E. Armstrong, Cara B. Ebbeling, Linda S. Lamont, and Nancy R. Rodriguez

This study determined the effect of nutritional supplementation throughout endurance exercise on whole-body leucine kinetics (leucine rate of appearance [Ra], oxidation [Ox], and nonoxidative leucine disposal [NOLD]) during recovery. Five trained men underwent a 2-h run at 65% VO2max, during which a carbohydrate (CHO), mixed protein-carbohydrate (milk), or placebo (PLA) drink was consumed. Leucine kinetics were assessed during recovery using a primed, continuous infusion of 1-13C leucine. Leucine Ra and NOLD were lower for milk than for PLA. Ox was higher after milk-supplemented exercise than after CHO or PLA. Although consuming milk during the run affected whole-body leucine kinetics, the benefits of such a practice for athletes remain unclear. Additional studies are needed to determine whether protein supplementation during exercise can optimize protein utilization during recovery.

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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.

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Lawrence E. Armstrong, Amy C. Pumerantz, Kelly A. Fiala, Melissa W. Roti, Stavros A. Kavouras, Douglas J. Casa, and Carl M. Maresh

It is difficult to describe hydration status and hydration extremes because fluid intakes and excretion patterns of free-living individuals are poorly documented and regulation of human water balance is complex and dynamic. This investigation provided reference values for euhydration (i.e., body mass, daily fluid intake, serum osmolality; M ± SD); it also compared urinary indices in initial morning samples and 24-hr collections. Five observations of 59 healthy, active men (age 22 ± 3 yr, body mass 75.1 ± 7.9 kg) occurred during a 12-d period. Participants maintained detailed records of daily food and fluid intake and exercise. Results indicated that the mean total fluid intake in beverages, pure water, and solid foods was >2.1 L/24 hr (range 1.382–3.261, 95% confidence interval 0.970–3.778 L/24 hr); mean urine volume was >1.3 L/24 hr (0.875–2.250 and 0.675–3.000 L/24 hr); mean urine specific gravity was >1.018 (1.011–1.027 and 1.009–1.030); and mean urine color was ≥4 (4–6 and 2–7). However, these men rarely (0–2% of measurements) achieved a urine specific gravity below 1.010 or color of 1. The first morning urine sample was more concentrated than the 24-h urine collection, likely because fluids were not consumed overnight. Furthermore, urine specific gravity and osmolality were strongly correlated (r2 = .81–.91, p < .001) in both morning and 24-hr collections. These findings provide euhydration reference values and hydration extremes for 7 commonly used indices in free-living, healthy, active men who were not exercising in a hot environment or training strenuously.

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Lawrence E. Armstrong, Jorge A. Herrera Soto, Frank T. Hacker Jr., Douglas J. Casa, Stavros A. Kavouras, and Carl M. Maresh

This investigation evaluated the validity and sensitivity of urine color (Ucol), specific gravity (Usg), and osmolality (Uosm) as indices of hydration status, by comparing them to changes in body water. Nine highly trained males underwent a 42-hr protocol involving dehydration to 3.7% of body mass (Day 1, −2.64 kg), cycling to exhaustion (Day 2, −5.2% of body mass, −3.68 kg), and oral rehydration for 21 hr. The ranges of mean (across time) blood and urine values were Ucol, 1-7; Usg, 1.004-1.029; U08m, 117-1,081 mOsm • kg−1; and plasma osmolality (Posm), 280-298 mOsm ⋅ kg−1. Urine color tracked changes in body water as effectively as (or better than) Uosm, Usg, urine volume, Posm, plasma sodium, and plasma total protein. We concluded that (a) Ucol, Uosm, and Usg are valid indices of hydration status, and (b) marked dehydration, exercise, and rehydration had little effect on the validity and sensitivity of these indices.

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Lawrence E. Armstrong, Carl M. Maresh, John W. Castellani, Michael F. Bergeron, Robert W. Kenefick, Kent E. LaGasse, and Deborah Riebe

Athletes and researchers could benefit from a simple and universally accepted technique to determine whether humans are well-hydrated, euhydrated, or hypohydrated. Two laboratory studies (A, B) and one field study (C) were conducted to determine if urine color ( U col ) indicates hydration status accurately and to clarify the interchangeability of U col , urine osmolality ( U osm ), and urine specific gravity ( U sg ) in research. U col , U osm , and U sg were not significantly correlated with plasma osmolality, plasma sodium, or hemato-crit. This suggested that these hematologic measurements are not as sensitive to mild hypohydration (between days) as the selected urinary indices are. When the data from A, B, and C were combined, U col was strongly correlated with U hg and U„sm. It was concluded that (a) U col may be used in athletic/industrial settings or field studies, where close estimates of U sg or U osm are acceptable, but should not be utilized in laboratories where greater precision and accuracy are required, and (b) U osm and U sg may be used interchangeably to determine hydration status.

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Michael F. Bergeron, Carl M. Maresh, Lawrence E. Armstrong, Joseph F. Signorile, John W. Castellani, Robert W. Kenefick, Kent E. LaGasse, and Deborah A. Riebe

Twenty (12 male and 8 female) tennis players from two Division I university tennis teams performed three days of round-robin tournament play (i.e., two singles tennis matches followed by one doubles match per day) in a hot environment (32.2 ± 1.5   C ° and 53.9 ± 2.4% rh at 1200 hr), so that fluid-electrolyte balance could be evaluated. During singles play, body weight percentage changes were minimal and were similar for males and females (males -1.3 ± 0.8%, females -0.7 ± 0.8%). Estimated daily losses (mmol · day 1 ) of sweat sodium (Na+) and potassium (K+) (males, Na + 158.7, K + 31.3; females, Na + 86.5, K + 18.9) were met by the players' daily dietary intakes (mmol · day 1 ) of these electrolytes (males, Na + 279.1 ± 109.4, K + 173.5 ± 57.7; females, Na + 178.9 ± 68.9, K + 116.1 ± 37.5). Daily plasma volume and electrolyte (Na+, K + ) levels were generally conserved, although, plasma [Na+] was lower (p < .05) on the morning of Day 4. This study indicated that these athletes generally maintained overall fluid-electrolyte balance, in response to playing multiple tennis matches on 3 successive days in a hot environment, without the occurrence of heat illness.