Practical Hydration Solutions for Sports

Luke N Belval, Yuri Hosokawa, Douglas J Casa, William M Adams, Lawrence E Armstrong, Lindsay B Baker, Louise Burke, Samuel Cheuvront, George Chiampas, José González-Alonso, Robert A Huggins, Stavros A Kavouras, Elaine C Lee, Brendon P McDermott, Kevin Miller, Zachary Schlader, Stacy Sims, Rebecca L Stearns, Chris Troyanos, Jonathan Wingo, Luke N Belval, Yuri Hosokawa, Douglas J Casa, William M Adams, Lawrence E Armstrong, Lindsay B Baker, Louise Burke, Samuel Cheuvront, George Chiampas, José González-Alonso, Robert A Huggins, Stavros A Kavouras, Elaine C Lee, Brendon P McDermott, Kevin Miller, Zachary Schlader, Stacy Sims, Rebecca L Stearns, Chris Troyanos, Jonathan Wingo

Abstract

Personalized hydration strategies play a key role in optimizing the performance and safety of athletes during sporting activities. Clinicians should be aware of the many physiological, behavioral, logistical and psychological issues that determine both the athlete's fluid needs during sport and his/her opportunity to address them; these are often specific to the environment, the event and the individual athlete. In this paper we address the major considerations for assessing hydration status in athletes and practical solutions to overcome obstacles of a given sport. Based on these solutions, practitioners can better advise athletes to develop practices that optimize hydration for their sports.

Keywords: athletics; exercise; fluid replacement.

Conflict of interest statement

Douglas Casa is the Chief Executive Officer of the Korey Stringer Institute, a 503.c not for profit which subsists on the donations from our corporate partners who include Gatorade, CamelBak, NFL, NATA, Mission, Eagle Pharmaceuticals and Kestrel. He has also been a recipient of grant funds from the following entities to study hydration related products: GE Healthcare, Halo Wearables, Nix Inc., CamelBak. William Adams has consulted with the following entities regarding hydration and exercise performance or the development of hydration assessment devices: BSX Athletics; Samsung Oak Holdings, Inc; Nobo, Inc; Clif Bar &Company; The Gatorade Company, Inc. Lawrence Armstrong is a hydration consultant to Danone Nutricia Research, France and the Drinking Water Research Foundation, Alexandria VA, USA. Lindsay Baker is employed by the Gatorade Sports Science Institute, a division of PepsiCo, Inc. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc. Louise Burke was a member of the Gatorade Sports Science Institute’s Expert Panel from 2014–2015 for which her workplace received an honorarium. Jose Gonzalez-Alonso was a member of the Gatorade Sports Science Institute’s Expert Panel in 2017 for which his workplace received an honorarium. Stavros Kavouras has served as scientific consultant for Quest Diagnostics, Standard Process and Danone Research and has active grants with Danone Research. The funders had no role in the in the writing of the manuscript.

Figures

Figure 1
Figure 1
Factors that contribute to the risk of hypohydration or hyperhydration during exercise.
Figure 2
Figure 2
Target fluid replacement estimates to prevent >2 ± 1 % body mass (BM) loss as water (i.e., dehydration). The 70 kg athlete in the example would need to drink a volume of fluid equal to 2.6 ± 0.7 L to prevent >2 ± 1% dehydration when losing 4 L of body water, such as during a marathon (42.1 km). During shorter distances such as 5 or 10 km when fluid losses are unlikely to reach or exceed 2% dehydration, the same athlete would not need to ingest fluids during competition as fluid losses accumulate to

References

    1. Sawka M., Pandolf K.B. Effects of body water loss on physiological function and exercise performance. In: Gisolfi C., Lamb D.R., editors. Perspectives in Exercise Science and Sports Medicine. Volume 3. Benchmark Press; Carmel, CA, USA: 1990. pp. 1–38.
    1. Sawka M.N., Wenger C.B., Pandolf K.B. Thermoregulatory Responses to Acute Exercise-Heat Stress and Heat Acclimation. In: Terjung R., editor. Comprehensive Physiology. John Wiley & Sons; Hoboken, NJ, USA: 2011. pp. 97–151.
    1. Montain S.J., Coyle E.F. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J. Appl. Physiol. 1992;73:1340–1350. doi: 10.1152/jappl.1992.73.4.1340.
    1. Montain S.J., Sawka M.N., Latzka W.A., Valeri C.R. Thermal and cardiovascular strain from hypohydration: Influence of exercise intensity. Int. J. Sports Med. 1998;19:87–91. doi: 10.1055/s-2007-971887.
    1. Sawka M.N., Young A.J., Francesconi R.P., Muza S.R., Pandolf K.B. Thermoregulatory and blood responses during exercise at graded hypohydration levels. J. Appl. Physiol. 1985;59:1394–1401. doi: 10.1152/jappl.1985.59.5.1394.
    1. Adams W.M., Ferraro E.M., Huggins R.A., Casa D.J. Influence of body mass loss on changes in heart rate during exercise in the heat: A systematic review. J. Strength Cond. Res. 2014;28:2380–2389. doi: 10.1519/JSC.0000000000000501.
    1. Kenefick R.W., Cheuvront S.N. Physiological adjustments to hypohydration: Impact on thermoregulation. Auton. Neurosci. 2016;196:47–51. doi: 10.1016/j.autneu.2016.02.003.
    1. Trangmar S.J., Gonzalez-Alonso J. New Insights into the Impact of Dehydration on Blood Flow and Metabolism during Exercise. Exerc. Sport Sci. Rev. 2017;45:146–153. doi: 10.1249/JES.0000000000000109.
    1. Gonzalez-Alonso J., Crandall C.G., Johnson J.M. The cardiovascular challenge of exercising in the heat. J. Physiol. 2008;586:45–53. doi: 10.1113/jphysiol.2007.142158.
    1. Trangmar S.J., Gonzalez-Alonso J. Heat, Hydration and the Human Brain, Heart and Skeletal Muscles. Sports Med. 2019;49:69–85. doi: 10.1007/s40279-018-1033-y.
    1. Cheuvront S.N., Carter R., 3rd, Sawka M.N. Fluid balance and endurance exercise performance. Curr. Sports Med. Rep. 2003;2:202–208. doi: 10.1249/00149619-200308000-00006.
    1. Cheuvront S.N., Kenefick R.W., Montain S.J., Sawka M.N. Mechanisms of aerobic performance impairment with heat stress and dehydration. J. Appl. Physiol. 2010;109:1989–1995. doi: 10.1152/japplphysiol.00367.2010.
    1. Barr S.I. Effects of dehydration on exercise performance. Can. J. Appl. Physiol. 1999;24:164–172. doi: 10.1139/h99-014.
    1. Sawka M.N., Burke L.M., Eichner E.R., Maughan R.J., Montain S.J., Stachenfeld N.S. American College of Sports Medicine position stand. Exercise and fluid replacement. Med. Sci. Sports Exerc. 2007;39:377–390.
    1. McDermott B.P., Anderson S.A., Armstrong L.E., Casa D.J., Cheuvront S.N., Cooper L., Kenney W.L., O′Connor F.G., Roberts W.O. National Athletic Trainers′ Association Position Statement: Fluid Replacement for the Physically Active. J. Athl. Train. 2017;52:877–895. doi: 10.4085/1062-6050-52.9.02.
    1. Judelson D.A., Maresh C.M., Anderson J.M., Armstrong L.E., Casa D.J., Kraemer W.J., Volek J.S. Hydration and muscular performance: Does fluid balance affect strength, power and high-intensity endurance? Sports Med. 2007;37:907–921. doi: 10.2165/00007256-200737100-00006.
    1. Coyle E.F. Physiological determinants of endurance exercise performance. J. Sci. Med. Sport. 1999;2:181–189. doi: 10.1016/S1440-2440(99)80172-8.
    1. Adams J.D., Sekiguchi Y., Suh H.G., Seal A.D., Sprong C.A., Kirkland T.W., Kavouras S.A. Dehydration Impairs Cycling Performance, Independently of Thirst: A Blinded Study. Med. Sci. Sports Exerc. 2018;50:1697–1703. doi: 10.1249/MSS.0000000000001597.
    1. Kenefick R.W. Drinking Strategies: Planned Drinking versus Drinking to Thirst. Sports Med. 2018;48:31–37. doi: 10.1007/s40279-017-0844-6.
    1. Bergeron M.F., Bahr R., Bartsch P., Bourdon L., Calbet J.A.L., Carlsen K.H., Castagna O., González-Alonso J., Lundby C., Maughan R.J., et al. International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. Br. J. Sports Med. 2012;46:770–779. doi: 10.1136/bjsports-2012-091296.
    1. Racinais S., Alonso J.M., Coutts A.J., Flouris A.D., Girard O., Gonzalez-Alonso J., Hausswirth C., Jay O., Lee J.K., Mitchell N., et al. Consensus recommendations on training and competing in the heat. Br. J. Sports Med. 2015;49:1164–1173. doi: 10.1136/bjsports-2015-094915.
    1. Carter J.E., Gisolfi C.V. Fluid replacement during and after exercise in the heat. Med. Sci. Sports Exerc. 1989;21:532–539. doi: 10.1249/00005768-198910000-00007.
    1. Coyle E.F., Hamilton M. Fluid replacement during exercise: Effects on physiological homeostasis and performance. In: Gisolfi C., Lamb D.R., editors. Fluid Homeostasis During Exercise. Volume 3. Benchmark Press; Carmel, CA, USA: 1990. pp. 281–308.
    1. Mora-Rodriguez R., Hamouti N., Del Coso J., Ortega J.F. Fluid ingestion is more effective in preventing hyperthermia in aerobically trained than untrained individuals during exercise in the heat. Appl. Physiol. Nutr. Metab. 2013;38:73–80. doi: 10.1139/apnm-2012-0174.
    1. Wittels P., Gunga H.C., Kirsch K., Kanduth B., Gunther T., Vormann J., Rocker L. Fluid regulation during prolonged physical strain with water and food deprivation in healthy, trained men. Wien. Klin. Wochenschr. 1996;108:788–794.
    1. Armstrong L.E. Hydration assessment techniques. Nutr. Rev. 2005;63:S40–S54. doi: 10.1111/j.1753-4887.2005.tb00153.x.
    1. Cheuvront S.N., Kenefick R.W. CORP: Improving the status quo for measuring whole body sweat losses. J. Appl. Physiol. 2017;123:632–636. doi: 10.1152/japplphysiol.00433.2017.
    1. Baker L.B., Lang J.A., Kenney W.L. Change in body mass accurately and reliably predicts change in body water after endurance exercise. Eur. J. Appl. Physiol. 2009;105:959–967. doi: 10.1007/s00421-009-0982-0.
    1. Armstrong L.E., Casa D.J. Methods to Evaluate Electrolyte and Water Turnover of Athletes. Athl. Train. Sports Health Care. 2009;1:1–11. doi: 10.3928/19425864-20090625-06.
    1. Cheuvront S.N., Kenefick R.W. Am I Drinking Enough? Yes, No, and Maybe. J. Am. Coll. Nutr. 2016;35:185–192. doi: 10.1080/07315724.2015.1067872.
    1. Armstrong L.E., Maresh C.M., Castellani J.W., Bergeron M.F., Kenefick R.W., LaGasse K.E., Riebe D. Urinary indices of hydration status. Int. J. Sport Nutr. 1994;4:265–279. doi: 10.1123/ijsn.4.3.265.
    1. Cheuvront S.N., Sawka M.N. Hydration Assessment of Athletes. Sports Sci. Exch. 2005;18:1–5.
    1. Stolwijk J.A., Saltin B., Gagge A.P. Physiological factors associated with sweating during exercise. Aerosp. Med. 1968;39:1101–1105.
    1. Parsons K. Human Thermal Environments: The Effects of Hot, Moderate and Cold Environments on Human Health, Comfort and Performance. 3rd ed. CRC Press; Boca Raton, FL, USA: 2014.
    1. Baker L.B., Barnes K.A., Anderson M.L., Passe D.H., Stofan J.R. Normative data for regional sweat sodium concentration and whole-body sweating rate in athletes. J. Sports Sci. 2016;34:358–368. doi: 10.1080/02640414.2015.1055291.
    1. Nadel E.R. Control of sweating rate while exercising in the heat. Med. Sci. Sports. 1979;11:31–35.
    1. Horner K.M., Schubert M.M., Desbrow B., Byrne N.M., King N.A. Acute exercise and gastric emptying: A meta-analysis and implications for appetite control. Sports Med. 2015;45:659–678. doi: 10.1007/s40279-014-0285-4.
    1. Budd G.M. Wet-bulb globe temperature (WBGT)—Its history and its limitations. J. Sci. Med. Sport. 2008;11:20–32. doi: 10.1016/j.jsams.2007.07.003.
    1. Kulka T.J., Kenney W.L. Heat balance limits in football uniforms how different uniform ensembles alter the equation. Physician Sportsmed. 2002;30:29–39. doi: 10.3810/psm.2002.07.377.
    1. Armstrong L.E., Johnson E.C., Casa D.J., Ganio M.S., McDermott B.P., Yamamoto L.M., Lopez R.M., Emmanuel H. The American football uniform: Uncompensable heat stress and hyperthermic exhaustion. J. Athl. Train. 2010;45:117–127. doi: 10.4085/1062-6050-45.2.117.
    1. Hooper D.R., Cook B.M., Comstock B.A., Szivak T.K., Flanagan S.D., Looney D.P., DuPont W.H., Kraemer W.J. Synthetic garments enhance comfort, thermoregulatory response, and athletic performance compared with traditional cotton garments. J. Strength Cond. Res. 2015;29:700–707. doi: 10.1519/JSC.0000000000000783.
    1. O′Brien C., Freund B.J., Sawka M.N., McKay J., Hesslink R.L., Jones T.E. Hydration assessment during cold-weather military field training exercises. Arct. Med. Res. 1996;55:20–26.
    1. Fusch C., Gfrorer W., Koch C., Thomas A., Grunert A., Moeller H. Water turnover and body composition during long-term exposure to high altitude (4900–7600 m) J. Appl. Physiol. 1996;80:1118–1125. doi: 10.1152/jappl.1996.80.4.1118.
    1. Mitchell J.W., Nadel E.R., Stolwijk J.A. Respiratory weight losses during exercise. J. Appl. Physiol. 1972;32:474–476. doi: 10.1152/jappl.1972.32.4.474.
    1. Grundstein A., Williams C., Phan M., Cooper E. Regional heat safety thresholds for athletics in the contiguous United States. Appl. Geogr. 2015;56:55–60. doi: 10.1016/j.apgeog.2014.10.014.
    1. Cheuvront S.N., Caruso E.M., Heavens K.R., Karis A.J., Santee W.R., Troyanos C., D′Hemecourt P. Effect of WBGT Index Measurement Location on Heat Stress Category Classification. Med. Sci. Sports Exerc. 2015;47:1958–1964. doi: 10.1249/MSS.0000000000000624.
    1. Casa D.J., DeMartini J.K., Bergeron M.F., Csillan D., Eichner E.R., Lopez R.M., Ferrara M.S., Miller K.C., O′Connor F., Sawka M.N., et al. National Athletic Trainers′ Association Position Statement: Exertional Heat Illnesses. J. Athl. Train. 2015;50:986–1000. doi: 10.4085/1062-6050-50.9.07.
    1. Minehan M.R., Riley M.D., Burke L.M. Effect of flavor and awareness of kilojoule content of drinks on preference and fluid balance in team sports. Int. J. Sport Nutr. Exerc. Metab. 2002;12:81–92. doi: 10.1123/ijsnem.12.1.81.
    1. Burdon C.A., Johnson N.A., Chapman P.G., O′Connor H.T. Influence of beverage temperature on palatability and fluid ingestion during endurance exercise: A systematic review. Int. J. Sport Nutr. Exerc. Metab. 2012;22:199–211. doi: 10.1123/ijsnem.22.3.199.
    1. Williams J., Tzortziou Brown V., Malliaras P., Perry M., Kipps C. Hydration strategies of runners in the London Marathon. Clin. J. Sport Med. 2012;22:152–156. doi: 10.1097/JSM.0b013e3182364c45.
    1. Chorley J., Cianca J., Divine J. Risk factors for exercise-associated hyponatremia in non-elite marathon runners. Clin. J. Sport Med. 2007;17:471–477. doi: 10.1097/JSM.0b013e3181588790.
    1. Maughan R.J., Shirreffs S.M. Development of individual hydration strategies for athletes. Int. J. Sport Nutr. Exerc. Metab. 2008;18:457–472. doi: 10.1123/ijsnem.18.5.457.
    1. Passe D., Horn M., Stofan J., Horswill C., Murray R. Voluntary dehydration in runners despite favorable conditions for fluid intake. Int. J. Sport Nutr. Exerc. Metab. 2007;17:284–295. doi: 10.1123/ijsnem.17.3.284.
    1. Hosseinlou A., Khamnei S., Zamanlu M. The effect of water temperature and voluntary drinking on the post rehydration sweating. Int. J. Clin. Exp. Med. 2013;6:683–687.
    1. Hew-Butler T., Rosner M.H., Fowkes-Godek S., Dugas J.P., Hoffman M.D., Lewis D.P., Maughan R.J., Miller K.C., Montain S.J., Rehrer N.J., et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin. J. Sport Med. 2015;25:303–320. doi: 10.1097/JSM.0000000000000221.
    1. Tyler C.J., Reeve T., Hodges G.J., Cheung S.S. The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis. Sports Med. 2016;46:1699–1724. doi: 10.1007/s40279-016-0538-5.
    1. Almond C.S., Shin A.Y., Fortescue E.B., Mannix R.C., Wypij D., Binstadt B.A., Duncan C.N., Olson D.P., Salerno A.E., Newburger J.W. Hyponatremia among runners in the Boston Marathon. N. Engl. J. Med. 2005;352:1550–1556. doi: 10.1056/NEJMoa043901.
    1. Ishunina T.A., Swaab D.F. Vasopressin and oxytocin neurons of the human supraoptic and paraventricular nucleus; size changes in relation to age and sex. J. Clin. Endocrinol. Metab. 1999;84:4637–4644. doi: 10.1210/jcem.84.12.6187.
    1. Sar M., Stumpf W. Simultaneous localization of [3 H] estradiol and neurophysin I or arginine vasopressin in hypothalamic neurons demonstrated by a combined technique of dry-mount autoradiography and immunohistochemistry. Neurosci. Lett. 1980;17:179–184. doi: 10.1016/0304-3940(80)90081-6.
    1. Barley O.R., Chapman D.W., Abbiss C.R. Weight Loss Strategies in Combat Sports and Concerning Habits in Mixed Martial Arts. Int. J. Sports Physiol. Perform. 2018;13:933–939. doi: 10.1123/ijspp.2017-0715.
    1. Bonci C.M., Bonci L.J., Granger L.R., Johnson C.L., Malina R.M., Milne L.W., Ryan R.R., Vanderbunt E.M. National athletic trainers′ association position statement: Preventing, detecting, and managing disordered eating in athletes. J. Athl Train. 2008;43:80–108. doi: 10.4085/1062-6050-43.1.80.
    1. Nuccio R.P., Barnes K.A., Carter J.M., Baker L.B. Fluid Balance in Team Sport Athletes and the Effect of Hypohydration on Cognitive, Technical, and Physical Performance. Sports Med. 2017;47:1951–1982. doi: 10.1007/s40279-017-0738-7.
    1. Garth A.K., Burke L.M. What do athletes drink during competitive sporting activities? Sports Med. 2013;43:539–564. doi: 10.1007/s40279-013-0028-y.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever