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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.

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Melissa J. Benton and Pamela D. Swan

Research suggests that ingesting protein after resistance exercise (RE) increases muscle protein synthesis and results in greater muscle gains. The effect on energy expenditure and substrate utilization, however, is unclear. This study evaluated the effect of RE and post exercise protein on recovery energy expenditure and substrate utilization in 17 women (age 46.5 ± 1.2 y). A whey-protein supplement (120 kcal, 30 g protein) was ingested immediately after 1 bout of RE (PRO) and a non caloric placebo after another (PLA). VO2 and respiratory-exchange ratio (RER) were measured before and for 120 min after each exercise session. RE resulted in a significant increase in VO2 that persisted through 90 min of recovery (P < 0.01) and was not affected by protein supplementation. RE significantly lowered RER, resulting in an increase in fat oxidation for both PLA and PRO (P < 0.01). For PRO, however, RER returned to baseline values earlier than for PLA, resulting in a reduced fat-oxidation response (P = 0.02) and earlier return to pre exercise baseline values than for PLA. Substrate utilization was significantly different between conditions (P = 0.02), with fat contributing 77.76% ± 2.19% for PLA and 72.12% ± 2.17% for PRO, while protein oxidation increased from 17.18% ± 1.33% for PLA to 20.82% ± 1.47% for PRO. Post exercise protein did not affect energy expenditure, but when protein was available as an alternate fuel fat oxidation was diminished. Based on these findings it might be beneficial for middle-aged women to delay protein intake after RE to maximize fat utilization.

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Michael J. Cramer, Charles L. Dumke, Walter S. Hailes, John S. Cuddy and Brent C. Ruby

A variety of dietary choices are marketed to enhance glycogen recovery after physical activity. Past research informs recommendations regarding the timing, dose, and nutrient compositions to facilitate glycogen recovery. This study examined the effects of isoenergetic sport supplements (SS) vs. fast food (FF) on glycogen recovery and exercise performance. Eleven males completed two experimental trials in a randomized, counterbalanced order. Each trial included a 90-min glycogen depletion ride followed by a 4-hr recovery period. Absolute amounts of macronutrients (1.54 ± 0.27 g·kg-1 carbohydrate, 0.24 ± 0.04 g·kg fat-1, and 0.18 ± 0.03g·kg protein-1) as either SS or FF were provided at 0 and 2 hr. Muscle biopsies were collected from the vastus lateralis at 0 and 4 hr post exercise. Blood samples were analyzed at 0, 30, 60, 120, 150, 180, and 240 min post exercise for insulin and glucose, with blood lipids analyzed at 0 and 240 min. A 20k time-trial (TT) was completed following the final muscle biopsy. There were no differences in the blood glucose and insulin responses. Similarly, rates of glycogen recovery were not different across the diets (6.9 ± 1.7 and 7.9 ± 2.4 mmol·kg wet weight- 1·hr-1 for SS and FF, respectively). There was also no difference across the diets for TT performance (34.1 ± 1.8 and 34.3 ± 1.7 min for SS and FF, respectively. These data indicate that short-term food options to initiate glycogen resynthesis can include dietary options not typically marketed as sports nutrition products such as fast food menu items.

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Ben Desbrow, Danielle Cecchin, Ashleigh Jones, Gary Grant, Chris Irwin and Michael Leveritt

The addition of 25 mmol·L−1 sodium to low alcohol (2.3% ABV) beer has been shown to enhance post exercise fluid retention compared with full strength (4.8% ABV) beer with and without electrolyte modification. This investigation explored the effect of further manipulations to the alcohol and sodium content of beer on fluid restoration following exercise. Twelve male volunteers lost 2.03 ± 0.19% body mass (mean ± SD) using cycling-based exercise. Participants were then randomly allocated a different beer to consume on four separate occasions. Drinks included low alcohol beer with 25 mmol·L−1 of added sodium [LightBeer+25], low alcohol beer with 50 mmol·L−1 of added sodium [LightBeer+50], midstrength beer (3.5% ABV) [Mid] or midstrength beer with 25 mmolL−1 of added sodium [Mid+25]. Total drink volumes in each trial were equivalent to 150% of body mass loss during exercise, consumed over a 1h period. Body mass, urine samples and regulatory hormones were obtained before and 4 hr after beverage consumption. Total urine output was significantly lower in the LightBeer+50 trial (1450 ± 183 ml) compared with the LightBeer+25 (1796 ± 284 ml), Mid+25 (1786 ± 373 ml) and Mid (1986 ± 304 ml) trials (allp < .05). This resulted in significantly higher net body mass following the LightBeer+50 trial (-0.97 ± 0.17kg) compared with all other beverages (LightBeer+25 (-1.30 ± 0.24 kg), Mid+25 (-1.38 ± 0.33 kg) and Mid (-1.58 ± 0.29 kg), all p < .05). No significant changes to aldosterone or vasopressin were associated with different drink treatments. The electrolyte concentration of low alcohol beer appears to have more significant impact on post exercise fluid retention than small changes in alcohol content.

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Paula Robson-Ansley, Martin Barwood, Clare Eglin and Les Ansley

Fatigue is a predictable outcome of prolonged physical activity; yet its biological cause remains uncertain. During exercise, a polypeptide messenger molecule inter-leukin-6 (IL-6) is actively produced. Previously, it has been demonstrated that administration of recombinant IL-6 (rhIL-6) impairs 10-km run performance and heightened sensation of fatigue in trained runners. Both high carbohydrate diets and carbohydrate ingestion during prolonged exercise have a blunting effect on IL-6 levels post endurance exercise. We hypothesized that carbohydrate ingestion may improve performance during a prolonged bout of exercise as a consequence of a blunted IL-6 response. Seven recreationally trained fasted runners completed two 90-min time trials under CHO supplemented and placebo conditions in a randomized order. The study was of a double-blinded, placebo-controlled, cross-over study design. Distance covered in 90 min was significantly greater following exogenous carbohydrate ingestion compared with the placebo trial (19.13 ± 1.7 km and 18.29 ± 1.9 km, respectively, p = .0022). While post exercise IL-6 levels were significantly lower in the CHO trial compared with the placebo trial (5.3 ± 1.9 pg·mL−1 and 6.6 ± 3.0 pg·mL−1, respectively; p = .0313), this difference was considered physiologically too small to mediate the improvement in time trial performance.

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Nicola C. Sutton, David J. Childs, Oded Bar-Or and Neil Armstrong

The purpose of this study was to develop a nonmotorized treadmill sprint test (ExNMT) to assess children’s short-term power output, to establish the test’s repeatability, and to compare the results to corresponding Wingate anaerobic test (WAnT) measurements. Nineteen children (aged 10.9±0.3 years) completed 2 ExNMTs and 2 WAnTs. Statistical analysis revealed coefficients of repeatability for the ExNMT that compared very favorably with the WAnT for both peak power (26.6 vs. 44.5 W) and mean power (15.3 vs. 42.1 W). The validity of the ExNMT as a test of anaerobic performance is reflected by significant correlations (p ≤.05) with the WAnT (peak power, r = 0.82; mean power, r = 0.88) and reinforced by the relatively high post-exercise blood lactate concentrations (7.1 ± 1.3 vs. 5.6 ± 1.5 mmol · L−1 for the ExNMT and WAnT, respectively). This study has developed a promising laboratory running test with which to examine young people’s short-term power output.

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Dru A. Henson, David C. Nieman, E. Edward Pistilli, Brian Schilling, AnnaRita Colacino, Allan C. Utter, Omar R. Fagoaga, Debra M. Vinci and Sandra L. Nehlsen-Cannarella

The influence of 6% carbohydrate ingestion and age on PHA-induced lymphocyte proliferation and in vitro cytokine production was studied in 48 runners following a competitive marathon. Runners were randomly assigned to carbohydrate (C; n = 23) and placebo (P; n = 25) groups, with blood samples taken before, immediately after, and 1.5 hr post-race. C versus P ingestion resulted in higher plasma glucose, lower plasma corlisol, reduced neutrophilia, and mono-cytosis during recovery, but had no effect on the post-exercise reduction in T-lymphocytes or NK cells, or on race times. No group differences were observed for PHA-induced lymphocyte proliferation or cytokine production. However, for all subjects combined, lymphocyte proliferation and IFN-γ secretion decreased significantly below pre-race values by 1.5 hr of recovery, and these were negatively correlated with plasma cortisol. Young (<50 years; n = 36) and old (≥50 years; n = 12) runners exhibited parallel post-race declines in lymphocyte proliferation and IFN-γ secretion, with the older group exhibiting a 33–59% lower proliferation at each time point. In conclusion, PHA-induced lymphocyte proliferation and cytokine production decreased significantly following a marathon, and this decrease was strongly linked to cortisol and only partially linked to T-cell changes. This decrease occurred in both younger and older runners and was not influenced by carbohydrate.

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Daniel G. Syrotuik, Kirsten L. MacFadyen, Vicki J. Harber and Gordon J. Bell

To examine the effects of elk velvet antler supplementation (EVA) combined with training on resting and exercise-stimulated hormonal response, male (n = 25) and female (n = 21) rowers ingested either E VA (560 mg/d) or placebo (PL) during 10 wk of training. VO2max, 2000 m rowing time, leg and bench press strength were determined before and after 5 and 10 wk of training. Serum hormone levels were measured prior to and 5 and 60 min after a simulated 2000 m rowing race. VO2max and strength increased and 2000 m times decreased similarly (P < 0.05) with training. There was no significant difference between the EVA and PL group for any hormonal response. Testosterone (males only) and growth hormone (both genders) were higher 5 min after the simulated race (P < 0.05) but returned to baseline at 60 min. Cortisol was higher 5 and 60 min compared to rest (both genders) (P < 0.05) and was higher 60 min post-exercise following 5 and 10 wk of training. It appears that 10 wk of EVA supplementation does not significantly improve rowing performance nor alter hormonal responses at rest or after acute exercise than training alone.

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Marcia A. Chan, Alexander J. Koch, Stephen H. Benedict and Jeffrey A. Potteiger

The effect of carbohydrate supplementation (CHO) on interleukin 2 (IL-2) and interleukin 5 (IL-5) secretion following acute resistance exercise was examined in 9 resistance-trained males. Subjects completed a randomized, double-blind protocol with exercise separated by 14 days. The exercise consisted of a high intensity, short rest interval squat workout. Subjects consumed 1.0 g · kg body mass-1 CHO or an equal volume of placebo (PLC) 10 min prior to and 10 min following exercise. Blood was collected at rest (REST), immediately post exercise (POST), and at 1.5 h of recovery (1.5 h POST). Isolated peripheral blood mononuclear cells were stimulated with PHA and assayed for IL-2 and IL-5 secretion. IL-2 secretion was significantly decreased at POST for both the PLC and CHO groups. However, the degree of decrease was less in the CHO group (16%) than in the PLC group (48%), and this difference was statistically significant. These responses were transient, and the values returned to normal by 1.5 h POST. A mild and transient but significant decrease in IL-5 secretion by the PLC group was observed at POST (26%) compared to REST. No significant decrease was observed in IL-5 secretion for CHO from REST to POST (12%). These data support a possible effect of carbohydrate supplementation on IL-2 and IL-5 secretion following high-intensity resistance exercise.

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Glen Davison and Michael Gleeson

The aim of the present study was to investigate the effect of vitamin C with or without carbohydrate consumed acutely in beverages before and during prolonged cycling on immunoendocrine responses. In a single blind, randomized manner six healthy, moderately trained males exercised for 2.5 h at 60% VO2max and consumed either placebo (PLA), carbohydrate (CHO, 6% w/v), vitamin C (VC, 0.15% w/v) or CHO+VC beverages before and during the bouts; trials were separated by 1 wk. CHO and CHO+VC significantly blunted the post-exercise increase in plasma concentrations of cortisol, ACTH, total leukocyte, and neutrophil counts and limited the decrease in plasma glucose concentration and bacteria-stimulated neutrophil degranulation. VC increased plasma antioxidant capacity (PAC) during exercise (P < 0.05) but had no effect on any of the immunoendocrine responses (P > 0.05). CHO+VC increased PAC compared to CHO but had no greater effects, above those observed with CHO alone, on any of the immunoendocrine responses. In conclusion, acute supplementation with a high dose of VC has little or no effect on the hormonal, interleukin-6, or immune response to prolonged exercise and combined ingestion of VC with CHO provides no additional effects compared with CHO alone.