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.
Lawrence E. Armstrong
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.
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.
Lawrence E. Armstrong and Rebecca M. Lopez
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.
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.
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.
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 (
Sharon L. Miller, Carl M. Maresh, Lawrence E. Armstrong, Cara B. Ebbeling, Shannon Lennon, and Nancy R. Rodriguez
The interaction of substrates and hormones in response to ingestion of intact proteins during endurance exercise is unknown. This study characterized substrate and hormone responses to supplementation during endurance exercise. Nine male runners participated in 3 trials in which a non-fat (MILK), carbohydrate (CHO), or placebo (PLA) drink was consumed during a 2-hour treadmill >· run at 65% V̇O2max. Circulating levels of insulin, glucagon, epinephrine, norepi-nephrine, growth hormone, testosterone, and cortisol were measured. Plasma substrates included glucose, lactate, free fatty acids, and select amino acids. Except for insulin and cortisol, hormones increased with exercise. While post-exercise insulin concentrations declined similarly in all 3 trials, the glucagon increase was greatest following MILK consumption. CHO blunted the post-exercise increase in growth hormone compared to levels in MILK. Free fatty acids and plasma amino acids also were responsive to nutritional supplementation with both CHO and MILK attenuating the rise in free fatty acids compared to the increase observed in PLA. Correspondingly, respiratory exchange ratio increased during CHO. Essential amino acids increased significantly only after MILK and were either unchanged or decreased in CHO. PLA was characterized by a decrease in branched-chain amino acid concentrations. Modest nutritional supplementation in this study altered the endocrine response as well as substrate availability and utilization following and during an endurance run, respectively.
Jennifer K. Ormerod, Tabatha A. Elliott, Timothy P. Scheett, Jaci L. VanHeest, Lawrence E. Armstrong, and Carl M. Maresh
The purposes of this study were to characterize measures of fluid intake and perception of thirst in women over a 6-week period of exercise-heat acclimation and outdoor training and examine if this lengthy acclimation period would result in changes in fluid intake that differ from those previously reported in men utilizing a shorter acclimation protocol of 8–10 days. Voluntary water intake (11–17 °C) and perception of thirst were measured in a group of 5 women (21–26 yr) undergoing exercise-heat acclimation for 90 min/day, 3 days/wk (36 °C, rh 50–70%) and outdoor training 3 days/wk for 6 weeks. Decreased drinking during acclimation was characterized by a decrease in the number of drinks (35 ± 10 to 17 ± 5; p < .05), greater time to first drink (9.9 ± 2.0 to 23.1 ± 4.7 min; p < .05), and a decrease in total volume ingested per week (3310 ± 810 to 1849 ± 446 ml; p < .05) through the 6-week study. Mean perceived thirst measurements remained low and showed only slight variance (3 ± 0.4 to 5 ± 0.4). These observations support a psycho-physiological response pattern different than that previously observed during 8–10 day acclimation protocols in men.
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.
Marcos Echegaray, Lawrence E. Armstrong, Carl M. Maresh, Deborah Riebe, Robert W. Kenefick, John W. Castellani, Stavros Kavouras, and Douglas Casa
This study assessed the plasma glucose (PG) and hormonal responses to carbohydrate ingestion, prior to exercise in the heat, in a hypohydrated state versus partial rehydration with intravenous solutions. On separate days, 8 subjects (21.0 ± 1.8 years; 57.3 ± 3.7 ml · kg−1 · min−1) exercised at 50% V̇O2maxin a 33 °C environment until a 4% body weight loss was achieved. Following this, subjects were rehydrated (25 ml · kg−1) with either: 0.45% IV saline (45IV), 0.9% IV saline (9IV), or no fluid (NF). Subjects then ingested 1 g · kg−1 of carbohydrate and underwent an exercise test (treadmill walking, 50% V̇O2max, 36 °C) for up to 90 min. Compared to pre-exercise level (294 mg · dl−1), PG increased significantly (>124 mg · dl−1) at 15 min of the exercise test in all trials and remained significantly elevated for 75 min in NF, 30 min more than in the 2 rehydration trials. Although serum Insulin increased significantly at 15 min of exercise in the 45IV trial (7.2 ± 1.2 vs. 23.7 ± 4.7 μIU · ml−1) no significant differences between trials were observed. Peak plasma norepinephrine was significantly higher in NF (640 ± 66 pg · ml−1) compared to the 45IV and 9IV trials (472 ± 55 and 474 ± 52 pg · ml−1, respectively). In conclusion, ingestion of a small solid carbohydrate load prior to exercise in the 4% hypohydration level resulted in prolonged high PG concentration compared to partial IV rehydration.