Athletes are encouraged to begin exercise well hydrated and to consume sufficient amounts of appropriate fluids during exercise to limit water and salt deficits. Available evidence suggests that many athletes begin exercise already dehydrated to some degree, and although most fail to drink enough to match sweat losses, some drink too much and a few develop hyponatremia. Some simple advice can help athletes assess their hydration status and develop a personalized hydration strategy that takes account of exercise, environment, and individual needs. Preexercise hydration status can be assessed from urine frequency and volume, with additional information from urine color, specific gravity, or osmolality. Change in hydration during exercise can be estimated from the change in body mass that occurs during a bout of exercise. Sweat rate can be estimated if fluid intake and urinary losses are also measured. Sweat salt losses can be determined by collection and analysis of sweat samples, but athletes losing large amounts of salt are likely to be aware of the taste of salt in sweat and the development of salt crusts on skin and clothing where sweat has evaporated. An appropriate drinking strategy will take account of preexercise hydration status and of fluid, electrolyte, and substrate needs before, during, and after a period of exercise. Strategies will vary greatly between individuals and will also be influenced by environmental conditions, competition regulations, and other factors.
Development of Individual Hydration Strategies for Athletes
Ronald J. Maughan and Susan M. Shirreffs
The Effects of High-Intensity Intermittent Exercise Compared With Continuous Exercise on Voluntary Water Ingestion
Stephen A. Mears and Susan M. Shirreffs
Water intake occurs following a period of high-intensity intermittent exercise (HIIE) due to sensations of thirst yet this does not always appear to be caused by body water losses. Thus, the aim was to assess voluntary water intake following HIIE. Ten healthy males (22 ± 2 y, 75.6 ± 6.9 kg, VO2peak 57.3 ± 11.4 m·kg−1·min−1; mean± SD) completed two trials (7–14 d apart). Subjects sat for 30 min then completed an exercise period involving 2 min of rest followed by 1 min at 100% VO2peak repeated for 60 min (HIIE) or 60 min continuously at 33% VO2peak (LO). Subjects then sat for 60 min and were allowed ad libitum water intake. Body mass was measured at start and end of trials. Serum osmolality, blood lactate, and sodium concentrations, sensations of thirst and mouth dryness were measured at baseline, postexercise and after 5, 15, 30, and 60 min of recovery. Vasopressin concentration was measured at baseline, postexercise, 5 min, and 30 min. Body mass loss over the whole trial was similar (HIIE: 0.77 ± 0.50; LO: 0.85 ± 0.55%; p = .124). Sweat lost during exercise (0.78 ± 0.22 vs. 0.66 ± 0.26 L) and voluntary water intake during recovery (0.416 ± 0.299 vs. 0.294 ± 0.295 L; p < .05) were greater in HIIE. Serum osmolality (297 ± 3 vs. 288 ± 4mOsmol·kg−1), blood lactate (8.5 ± 2.7 vs. 0.7 ± 0.4 mmol·L−1), serum sodium (146 ± 1 vs. 143 ± 1 mmol·L−1) and vasopressin (9.91 ± 3.36 vs. 4.43 ± 0.86 pg·ml−1) concentrations were higher after HIIE (p < .05) and thirst (84 ± 7 vs. 60 ± 21) and mouth dryness (87 ± 7 vs. 64 ± 23) also tended to be higher (p = .060). Greater voluntary water intake after HIIE was mainly caused by increased sweat loss and the consequences of increased serum osmolality mainly resulting from higher blood lactate concentrations.
Fluid and Electrolyte Balance During 24-Hour Fluid and/or Energy Restriction
Lewis J. James and Susan M. Shirreffs
Weight categorized athletes use a variety of techniques to induce rapid weight loss (RWL) in the days leading up to weigh in. This study examined the fluid and electrolyte balance responses to 24-hr fluid restriction (FR), energy restriction (ER) and fluid and energy restriction (F+ER) compared with a control trial (C), which are commonly used techniques to induce RWL in weight category sports. Twelve subjects (six male, six female) received adequate energy and water (C) intake, adequate energy and restricted water (~10% of C; FR) intake, restricted energy (~25% of C) and adequate water (ER) intake or restricted energy (~25% of C) and restricted (~10% of C) water intake (F+ER) in a randomized counterbalanced order. Subjects visited the laboratory at 0 hr, 12 hr, and 24 hr for blood and urine sample collection. Total body mass loss was 0.33% (C), 1.88% (FR), 1.97% (ER), and 2.44% (F+ER). Plasma volume was reduced at 24 hr during FR, ER, and F+ER, while serum osmolality was increased at 24 hr for FR and F+ER and was greater at 24 hr for FR compared with all other trials. Negative balances of sodium, potassium, and chloride developed during ER and F+ER but not during C and FR. These results demonstrate that 24 hr fluid and/or energy restriction significantly reduces body mass and plasma volume, but has a disparate effect on serum osmolality, resulting in hypertonic hypohydration during FR and isotonic hypohydration during ER. These findings might be explained by the difference in electrolyte balance between the trials.
Voluntary Water Intake during and Following Moderate Exercise in the Cold
Stephen A. Mears and Susan M. Shirreffs
Exercising in cold environments results in water losses, yet examination of resultant voluntary water intake has focused on warm conditions. The purpose of the study was to assess voluntary water intake during and following exercise in a cold compared with a warm environment. Ten healthy males (22 ± 2 years, 67.8 ± 7.0 kg, 1.77 ± 0.06 m, VO2peak 60.5 ± 8.9 ml·kg−1·min−1) completed two trials (7–8 days). In each trial subjects sat for 30 min before cycling at 70% VO2peak (162 ± 27W) for 60 min in 25.0 ± 0.1 °C, 50.8 ± 1.5% relative humidity (RH; warm) or 0.4 ± 1.0 °C, 68.8 ± 7.5% RH (cold). Subjects then sat for 120 min at 22.2 ± 1.2 °C, 50.5 ± 8.0% RH. Ad libitum drinking was allowed during the exercise and recovery periods. Urine volume, body mass, serum osmolality, and sensations of thirst were measured at baseline, postexercise and after 60 and 120 min of the recovery period. Sweat loss was greater in the warm trial (0.96 ± 0.18 l v 0.48 ± 0.15 l; p < .0001) but body mass losses over the trials were similar (1.15 ± 0.34% (cold) v 1.03 ± 0.26% (warm)). More water was consumed throughout the duration of the warm trial (0.81 ± 0.42 l v 0.50 ± 0.49 l; p = .001). Cumulative urine output was greater in the cold trial (0.81 ± 0.46 v 0.54 ± 0.31 l; p = .036). Postexercise serum osmolality was higher compared with baseline in the cold (292 ± 2 v 287 ± 3 mOsm.kg−1, p < .0001) and warm trials (288 ± 5 v 285 ± 4 mOsm·kg−1; p = .048). Thirst sensations were similar between trials (p > .05). Ad libitum water intake adjusted so that similar body mass losses occurred in both trials. In the cold there appeared to a blunted thirst response.
Making Decisions About Supplement Use
Ronald J. Maughan, Susan M. Shirreffs, and Alan Vernec
The use of dietary supplements is widespread among athletes in all sports and at all levels of competition, as it is in the general population. For the athlete training at the limits of what is sustainable, or for those seeking a shortcut to achieving their aims, supplements offer the prospect of bridging the gap between success and failure. Surveys show, however, that this is often not an informed choice and that the knowledge level among consumers is often low and that they are often influenced in their decisions by individuals with an equally inadequate understanding of the issues at stake. Supplement use may do more harm than good, unless it is based on a sound analysis of the evidence. Where a deficiency of an essential nutrient has been established by appropriate investigations, supplementation can provide a rapid and effective correction of the problem. Supplements can also provide a convenient and time-efficient solution to achieving the necessary intake of key nutrients such as protein and carbohydrate. Athletes contemplating the use of supplements should consider the potential for both positive and negative outcomes. Some ergogenic supplements may be of benefit to some athletes in some specific contexts, but many are less effective than is claimed. Some may be harmful to health of performance and some may contain agents prohibited by anti-doping regulations. Athletes should make informed choices that maximize the benefits while minimizing the risks.
Rehydration after Exercise in the Heat: A Comparison of 4 Commonly Used Drinks
Susan M. Shirreffs, Luis F. Aragon-Vargas, Mhairi Keil, Thomas D. Love, and Sian Phillips
To determine the effectiveness of 3 commonly used beverages in restoring fluid and electrolyte balance, 8 volunteers dehydrated by 1.94% ± 0.17% of body mass by intermittent exercise in the heat, then ingested a carbohydrate-electrolyte solution (Gatorade), carbonated water/apple-juice mixture (Apfelschorle), and San Benedetto mineral water in a volume equal to 150% body-mass loss. These drinks are all are perceived to be effective rehydration solutions, and their effectiveness was compared with the rehydration effectiveness of Evian mineral water, which is not perceived in this way by athletes. Four hours after rehydration, the subjects were in a significantly lower hydration status than the pretrial situation on trials with Apfelschorle (–365 ± 319 mL, P = 0.030), Evian (–529 ± 319 mL, P < 0.0005), and San Benedetto (–401 ± 353 mL, P = 0.016) but were in the same hydration status as before the dehydrating exercise on Gatorade (–201 ± 388 mL, P = 0.549). Sodium balance was negative on all trials throughout the study; only with Apfelschorle did subjects remain in positive potassium balance. In this scenario, recovery of fluid balance can only be achieved when significant, albeit insufficient, quantities of sodium are ingested after exercise. There is a limited range of commercially available products that have a composition sufficient to achieve this, even though the public thinks that some of the traditional drinks are effective for this purpose.
Water Balance and Salt Losses in Competitive Football
Ronald J. Maughan, Phillip Watson, Gethin H. Evans, Nicholas Broad, and Susan M. Shirreffs
Fluid balance and sweat electrolyte losses were measured in the players and substitutes engaged in an English Premier League Reserve competitive football match played at an ambient temperature of 6–8 °C (relative humidity 50–60%). Intake of water and/or sports drink and urine output were recorded, and sweat composition was estimated from absorbent swabs applied to 4 skin sites for the duration of the game. Body mass was recorded before and after the game. Data were obtained for 22 players (age 21 y, height 180 cm, mass 78 kg) and 9 substitutes (17 y, 181 cm, 72 kg). All were male. Two of the players were dismissed during the game, and none of the substitutes played any part in the game. Mean ± SD sweat loss of players amounted to 1.68 ± 0.40 L, and mean fluid intake was 0.84 ± 0.47 L (n = 20), with no difference between teams. Corresponding values for substitutes, none of whom played in the match, were 0.40 ± 0.24 L and 0.78 ± 0.46 L (n = 9). Prematch urine osmolality was 678 ± 344 mOsm/kg: 11 of the 31 players provided samples with an osmolality of more than 900 mOsm/kg. Sweat sodium concentration was 62 ± 13 mmol/L, and total sweat sodium loss during the game was 2.4 ± 0.8 g. These descriptive data show a large individual variability in hydration status, sweat losses, and drinking behaviors in a competitive football match played in a cool environment, highlighting the need for individualized assessment of hydration status to optimize fluid-replacement strategies.
Water and Salt Balance of Well-Trained Swimmers in Training
Ronald J. Maughan, Lisa A. Dargavel, Rachael Hares, and Susan M. Shirreffs
This study investigated fluid and electrolyte balance in well-trained male and female swimmers during 2 training sessions. Participants were 17 nationally ranked swimmers measured during a period of intensive training. Sweat loss was assessed from changes in body mass after correction for fluid intake and urine collection. Sweat composition was measured from waterproof absorbent patches applied at 4 skin sites. Air and pool-water temperatures were 36 °C and 27.4 °C, respectively. Training lasted 105 min in each session. All measured variables were similar on the 2 testing days. Mean sweat-volume loss was 548 ± 243 ml, and mean sweat rate was 0.31 ± 0.1 L/hr. Mean fluid intake was 489 ± 270 ml. Mean body-mass loss was 0.10 ± 0.50 kg, equivalent to 0.1% ± 0.7% dehydration. Mean pretraining urine osmolality was 662 ± 222 mOsm/kg, which was negatively associated with both mean drink volume consumed (p = .044, r 2 = .244) and mean urine volume produced during training (p = .002, r 2 = .468). Mean sweat Na+, K+, and Cl− concentrations (mmol/L) were 43 ± 14, 4 ± 1, and 31± 9, respectively; values were not different between males and females and were not different between days except for a marginal difference in K+ concentration. The average swimmer remained hydrated during the session, and calculated sweat rates were similar to those in previous aquatic studies.
Influence of Beverage Temperature on Exercise Performance in the Heat: A Systematic Review
Catriona A. Burdon, Helen T. O’Connor, Janelle A. Gifford, and Susan M. Shirreffs
Increased core temperature (Tc), impaired cardiovascular function, and dehydration contribute to fatigue during prolonged exercise in the heat. Although many studies have examined mechanisms addressing these factors, few have investigated the effect of cold beverage temperature on thermoregulation and exercise performance in the heat.
Citations from MEDLINE (Ovid), Sport Discus (EBSCOhost), AUSPORT and AusportMed (Informit), Web of Science, and SCOPUS were identified from the earliest record until September 2008 using the search terms drink temperature, beverage temperature, fluid temperature, water temperature, and cold fluid combined with body temperature and thermoregulation. To be included, studies needed to assess core or rectal temperature during exercise in moderate or hot environmental conditions. After quality rating was completed by two reviewers, the difference in mean Tc and exercise performance was calculated.
Ten studies meeting search inclusion criteria were available for analysis. Three were excluded because sufficient detail or statistical data were not reported. A meta-analysis was not performed because the studies were deemed too different to group. Three of the remaining 7 studies found modulated Tc with cold beverage consumption, and from the 4 that conducted exercise performance tests, performance improved by 10% with cold fluids.
Cold fluid may attenuate Tc rise and improve exercise performance in the heat; however, study findings are mixed. Research using well-trained athletes and fluid-ingestion protocols replicating competition scenarios is required. Potential sensory effects of cold fluid in maintaining motivation also need to be assessed as a mechanism underpinning improved performance.
Fluid and Electrolyte Intake and Loss in Elite Soccer Players during Training
Ronald J. Maughan, Stuart J. Merson, Nick P. Broad, and Susan M. Shirreffs
This study measured fluid balance during a 90-min preseason training session in the first team squad (24 players) of an English Premier League football team. Sweat loss was assessed from changes in body mass after correction for ingested fluids and urine passed. Sweat composition was measured by collection from patches attached to the skin at 4 sites. The weather was warm (24-29 °C), with moderate humidity (46–64%). The mean ± SD body mass loss over the training session was 1.10 ± 0.43 kg, equivalent to a level of dehydration of 1.37 ± 0.54% of the pre-training body mass. Mean fluid intake was 971 ± 303 ml. Estimated total mean sweat loss was 2033 ±413 ml. Mean sweat electrolyte concentrations (mmol/L) were: sodium,49± 12; potassium,6.0± 1.3;chloride, 43 ± 10. Total sweat sodium loss of 99 ± 24 mmol corresponds to a salt (sodium chloride) loss of 5.8 ± 1.4 g. Mean urine osmolality measured on pre-training samples provided by the players was 666 ±311 mosmol/kg (n=21). These data indicate that sweat losses of water and solute in football players in training can be substantial but vary greatly between players even with the same exercise and environmental conditions. Voluntary fluid intake also shows wide inter-individual variability and is generally insufficient to match fluid losses.