Recreational enthusiasts and athletes often are advised to abstain from consuming caffeinated beverages (CB). The dual purposes of this review are to (a) critique controlled investigations regarding the effects of caffeine on dehydration and exercise performance, and (b) ascertain whether abstaining from CB is scientifically and physiologically justifiable. The literature indicates that caffeine consumption stimulates a mild diuresis similar to water, but there is no evidence of a fluid-electrolyte imbalance that is detrimental to exercise performance or health. Investigations comparing caffeine (100-680 mg) to water or placebo seldom found a statistical difference in urine volume. In the 10 studies reviewed, consumption of a CB resulted in 0-84% retention of the initial volume ingested, whereas consumption of water resulted in 0-81% retention. Further, tolerance to caffeine reduces the likelihood that a detrimental fluid-electrolyte imbalance will occur. The scientific literature suggests that athletes and recreational enthusiasts will not incur detrimental fluid-electrolyte imbalances if they consume CB in moderation and eat a typical U.S. diet. Sedentary members of the general public should be at less risk than athletes because their fluid losses via sweating are smaller.
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Caffeine, Body Fluid-Electrolyte Balance, and Exercise Performance
Lawrence E. Armstrong
Fluid-Electrolyte Balance during Labor and Exercise: Concepts and Misconceptions
Yoram Epstein and Lawrence E. Armstrong
Body water and electrolyte balance are essential to optimal physiological function and health. During exercise, work, or high temperatures, a significant level of dehydration can develop, and the ratio of extracellular to intracellular fluid can change, despite an ample supply of water. Physical and cognitive performance are impaired at 1-2% dehydration, and the body can collapse when water loss approaches 7%. Because fluid needs and intakes vary, formulating one general guideline for fluid replacement is difficult. Knowing the amount of water lost in sweat may enable predicting fluid needs via mathematical models for industrial, athletic, and military scenarios. Sodium imbalance might result from excessive Na+ loss or from gross o verity dration. In most work or exercise lasting < 3-4 hr, the major concern is that fluid be available to prevent heat-related illnesses, which can be prevented if fluid and electrolyte losses are balanced with intake, using the recommendations presented.
Return to Exercise Training after Heat Exhaustion
Lawrence E. Armstrong and Rebecca M. Lopez
Context:
Exertional heat exhaustion (HEX) is the most common form of heat illness experienced by athletes, laborers, and military personnel. Both dehydration stemming from a water and/or salt deficiency and a high ambient temperature must exist for HEX to occur. In the field, appropriate therapy can reduce recovery time.
Objective:
This manuscript provides clinical guidance regarding return to activity. The primary focus of this paper is to describe the evaluation of residual effects and the underlying personal characteristics that initially predispose the athlete to HEX. Attention to these factors will reduce the risk of future episodes.
Exercise-Heat Tolerance of Children and Adolescents
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.
Endurance Cyclist Fluid Intake, Hydration Status, Thirst, and Thermal Sensations: Gender Differences
Lawrence E. Armstrong, Evan C. Johnson, Amy L. McKenzie, Lindsay A. Ellis, and Keith H. Williamson
This field investigation assessed differences (e.g., drinking behavior, hydration status, perceptual ratings) between female and male endurance cyclists who completed a 164-km event in a hot environment (35 °C mean dry bulb) to inform rehydration recommendations for athletes. Three years of data were pooled to create 2 groups of cyclists: women (n = 15) and men (n = 88). Women were significantly smaller (p < .001) than men in height (166 ± 5 vs. 179 ± 7 cm), body mass (64.6 ± 7.3 vs. 86.4 ± 12.3 kg), and body mass index (BMI; 23.3 ± 1.8 vs. 26.9 ± 3.4) and had lower preevent urinary indices of hydration status, but were similar to men in age (43 ± 7 years vs. 44 ± 9 years) and exercise time (7.77 ± 1.24 hr vs. 7.23 ± 1.75 hr). During the 164-km ride, women lost less body mass (−0.7 ± 1.0 vs. −1.7 ± 1.5 kg; −1.1 ± 1.6% vs. −1.9 ± 1.8% of body weight; p < .005) and consumed less fluid than men (4.80 ± 1.28 L vs. 5.59 ± 2.13 L; p < .005). Women consumed a similar volume of fluid as men, relative to body mass (milliliters/kilogram). To control for performance and anthropomorphic characteristics, 15 women were pair-matched with 15 men on the basis of exercise time on the course and BMI; urine-specific gravity, urine color, and body mass change (kilograms and percentage) were different (p < .05) in 4 of 6 comparisons. No gender differences were observed for ratings of thirst, thermal sensation, or perceived exertion. In conclusion, differences in relative fluid volume consumed and hydration indices suggest that professional sports medicine organizations should consider gender and individualized drinking plans when formulating pronouncements regarding rehydration during exercise.
Fluid-Electrolyte Balance Associated with Tennis Match Play in a Hot Environment
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 ±
Responses to Moderate and Low Sodium Diets during Exercise-Heat Acclimation
Lawrence E. Armstrong, Roger W. Hubbard, E. Wayne Askew, Jane P. De Luca, Catherine O'Brien, Angela Pasqualicchio, and Ralph P. Francesconi
This investigation examined whether low sodium (Na+) (LNA; 68 mEq Na+·d-1) or moderate Na+ (MNA; 137 mEq Na+.d-1) intake allowed humans to maintain health, exercise, and physiologic function during 10 days of prolonged exercise-heat acclimation (HA). Seventeen volunteers, ages 19 to 21, consumed either LNA (n=8) or MNA (n=9) during HA (41°C, 21% RH; treadmill walking for 30 min.h-1, 8 h·d-1 at 5.6 kmh-l, 5% grade), which resulted in significantly reduced heart rate, rectal temperature, and urine Na+ for both groups. There were few between-diet differences in any variables measured. Mean plasma volume in LNA expanded significantly less than in MNA by Days 11 and 15, but reached the MNA level on Day 17 (+12.3 vs. +12.4%). The absence of heat illness, the presence of normal physiologic responses, and the total distance walked indicated successful and similar HA with both levels of dietary Na+.
Urinary Indices of Hydration Status
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 (
Hydration Status and Sodium Balance of Endurance Runners Consuming Postexercise Supplements of Varying Nutrient Content
J. Luke Pryor, Evan C. Johnson, Jeffery Del Favero, Andrew Monteleone, Lawrence E. Armstrong, and Nancy R. Rodriguez
Postexercise protein and sodium supplementation may aid recovery and rehydration. Preserved beef provides protein and contains high quantities of sodium that may alter performance related variables in runners. The purpose of this study was to determine the effects of consuming a commercial beef product postexercise on sodium and water balance. A secondary objective was to characterize effects of the supplementation protocols on hydration, blood pressure, body mass, and running economy. Eight trained males (age = 22 ± 3 y, V̇O2max = 66.4 ± 4.2 ml·kg-1·min-1) completed three identical weeks of run training (6 run·wk-1, 45 ± 6 min·run-1, 74 ± 5% HRR). After exercise, subjects consumed either, a beef nutritional supplement (beef jerky; [B]), a standard recovery drink (SRD), or SRD+B in a randomized counterbalanced design. Hydration status was assessed via urinary biomarkers and body mass. No main effects of treatment were observed for 24 hr urine volume (SRD, 1.7 ± 0.5; B, 1.8 ± 0.6; SRD+B, 1.4 ± 0.4 L·d-1), urine specific gravity (1.016 ± 0.005, 1.018 ± 0.006, 1.017 ± 0.006) or body mass (68.4 ± 8.2, 68.3 ± 7.7, 68.2 ± 8.1 kg). No main effect of treatment existed for sodium intake—loss (-713 ± 1486; -973 ± 1123; -980 ± 1220 mg·d-1). Mean arterial pressure (81.0 ± 4.6, 81.1 ± 7.3, 83.8 ± 5.4 mm Hg) and average exercise running economy (V̇O2: SRD, 47.9 ± 3.2; B, 47.2 ± 2.6; SRD+B, 46.2 ± 3.4 ml·kg-1·min-1) was not affected. Urinary sodium excretion accounted for the daily sodium intake due to the beef nutritional supplement. Findings suggest the commercial beef snack is a viable recovery supplement following endurance exercise without concern for hydration status, performance decrements, or cardiovascular consequences.
Effects of Three Oral Nutritional Supplements on Human Hydration Indices
Lindsay A. Ellis, Brandon A. Yates, Amy L. McKenzie, Colleen X. Muñoz, Douglas J. Casa, and Lawrence E. Armstrong
Urine color (Ucol) as a hydration assessment tool provides practicality, ease of use, and correlates moderately to strongly with urine specific gravity (Usg) and urine osmolality (Uosm). Indicative of daily fluid turnover, along with solute and urochrome excretion in 24-hr samples, Ucol may also reflect dietary composition. Thus, the purpose of this investigation was to determine the efficacy of Ucol as a hydration status biomarker after nutritional supplementation with beetroot (880 mg), vitamin C (1000 mg), and riboflavin (200 mg). Twenty males (Mean ± SD; age, 21 ± 2 y; body mass, 82.12 ± 15.58 kg; height, 1.77 ± 0.06 m) consumed a standardized breakfast and collected all urine voids on one control day (CON) and 1 day after consuming a standardized breakfast and a randomized and double-blinded supplement (SUP) over 3 weeks. Participants replicated exercise and diet for one day before CON, and throughout CON and SUP. Ucol, Usg, Uosm, and urine volume were measured in all 24-hr samples, and Ucol and Usg were measured in all single samples. Ucol was a significant predictor of single sample Usg after all supplements (p < .05). Interestingly, 24-hr Ucol was not a significant predictor of 24-h Usg and Uosm after riboflavin supplementation (p = .20, p = .21). Further, there was a significant difference between CON and SUP 24-h Ucol only after riboflavin supplementation (p < .05). In conclusion, this investigation suggests that users of the UCC (urine color chart) should consider riboflavin supplementation when classifying hydration status and use a combination of urinary biomarkers (e.g., Usg and Ucol), both acutely and over 24 hr.