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Fluid and electrolyte supplementation for exercise heat stress1–4

Michael N Sawka and Scott J Montain

ABSTRACT During exercise in the heat, sweat output often at the beginning of exercise but incurs hyphohydration (a body
exceeds water intake, resulting in a body water deficit (hypohy- water deficit) over a prolonged period. Hypohydrated persons who
dration) and electrolyte losses. Because daily water losses can be exercise in the heat will incur significant adverse effects (9). Hypo-
substantial, persons need to emphasize drinking during exercise hydration increases physiologic strain, decreases exercise perfor-
as well as at meals. For persons consuming a normal diet, elec- mance, and negates the thermoregulatory advantages conferred by
trolyte supplementation is not warranted except perhaps during high aerobic fitness (10, 11) and heat acclimation (10, 12). If stren-
the first few days of heat exposure. Aerobic exercise is likely to uous exercise is performed by hypohydrated persons, the medical
be adversely affected by heat stress and hypohydration; the consequences can be devastating (13, 14).

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warmer the climate the greater the potential for performance We review human fluid and electrolyte balance relative to
decrements. Hypohydration increases heat storage and reduces a their effects on temperature regulation and exercise performance
person’s ability to tolerate heat strain. The increased heat storage in the heat. In addition, needs for research on fluids and elec-
is mediated by a lower sweating rate (evaporative heat loss) and trolytes will be discussed for 3 special populations: cystic fibro-
reduced skin blood flow (dry heat loss) for a given core temper- sis patients, older persons, and persons with spinal cord injuries.
ature. Heat-acclimated persons need to pay particular attention
to fluid replacement because heat acclimation increases sweat
losses, and hypohydration negates the thermoregulatory advan- FLUID AND ELECTROLYTE BALANCE
tages conferred by acclimation. It has been suggested that hyper- To support the contraction of skeletal muscles, physical exercise
hydration (increased total body water) may reduce physiologic routinely increases total body metabolism to 5–15 times the resting
strain during exercise heat stress, but data supporting that notion rate. Approximately 70–90% of this energy is released as heat,
are not robust. Research is recommended for 3 populations with which needs to be dissipated to achieve body heat balance. The rel-
fluid and electrolyte balance problems: older adults, cystic fibro- ative contributions of evaporative and dry (radiative and conduc-
sis patients, and persons with spinal cord injuries. Am J Clin tive) heat exchange to total heat loss vary according to climatic
Nutr 2000;72(suppl):564S–72S. conditions (15). In hot climates, a substantial volume of body water
may be lost via sweating to enable evaporative cooling (7).
KEY WORDS Skin blood flow, cystic fibrosis, dehydration, In addition to climatic conditions, clothing and exercise inten-
fluid redistribution, hypohydration, hyperhydration, older adults, sity influence the sweating rate (15, 16). Residents of desert cli-
spinal cord injury, sweating, thermoregulation mates often have sweating rates of 0.3–1.2 L/h while performing
occupational activities (17). Clothing may be a major concern;
persons wearing protective garments often have sweating rates of
INTRODUCTION 1–2 L/h while performing light-intensity exercise (18). For ath-
Water and electrolyte balance are critical for the function of letes performing high-intensity exercise in the heat, sweating
all organs and, indeed, for maintaining health in general (1, 2). rates of 1.0–2.5 L/h are common. Expected sweating rates from
Water provides the medium for biochemical reactions within cell running in different climatic conditions are shown in Figure 1
tissues and is essential for maintaining an adequate blood vol- (7). The influence of climate and amount of physical activity on
ume and thus the integrity of the cardiovascular system. The
ability of the body to redistribute water within its fluid compart-
ments provides a reservoir to minimize the effects of water
deficit. Each body water compartment contains electrolytes, the From the Thermal and Mountain Medicine Division, US Army Research
concentration and composition of which are critical for moving Institute of Environmental Medicine, Natick, MA.
Presented at the workshop Role of Dietary Supplements for Physically
fluid between intracellular and extracellular compartments and
Active People, held in Bethesda, MD, June 3–4, 1996.
for maintaining membrane electrochemical potentials. 3
The views, opinions, and findings contained in this report are those of the
Physical exercise and heat stress cause both fluid and electrolyte authors and should not be construed as an official Department of Army posi-
imbalances that need to be corrected (3–6). Generally, persons tion or decision, unless so designated by other official documentation.
dehydrate during exercise in the heat because of the unavailability 4
Address reprint requests to MN Sawka, Thermal and Mountain Medicine
of fluids or a mismatch between thirst and water requirements (7, Division, US Army Research Institute of Environmental Medicine, Kansas
8). In these instances, the person is euhydrated (normally hydrated) Street, Natick, MA 01760-5007.

564S Am J Clin Nutr 2000;72(suppl):564S–72S. Printed in USA. © 2000 American Society for Clinical Nutrition

and osmolality 0. Sodium and chloride are primarily responsible for the Except for the first several days of heat exposure. As a result. with temperature they measured the animals’ body water. Hypohydration reduces the gastric emptying rate of ingested fluids during exercise in the heat (29. adults will dehydrate by 2–8% BWL. Because adipose tissue is 10% water but muscle tissue is 75% water. heat- by matching fluid consumption with sweat loss. 26. plasma. and that of magnesium. The water contained in body tissues is distributed between the FIGURE 1.5 mmol/L) (21). intracellular and extracellular fluid spaces. hydration. These researchers sodium by active transport. acclimated persons have lower sodium concentrations mated persons hypohydrated to various degrees are shown in in sweat (> 50% reduction) for any specific sweating rate (22). Thus. 40% of the water deficit was from 10–70 mmol/L) and varies by diet. Correspondingly. Figure 4 (33). muscle water and glycogen content parallel each other. 24). By virtue of having more dilute sweat. 30).2–1. 28). As a result. 14% from viscera. sweating rate. who have a smaller reduction supplementation is not needed (25). 20). Sweat glands reabsorb Neither the brain nor liver lost significant water. some dehydration is likely to occur during exercise in the heat. which mobilizes fluid from supplementation is not necessary because normal dietary the intracellular to the extracellular space to enable defense of sodium intake will cover the sweat losses (3. muscle. unless forced hydration is stressed. but the ability to reabsorb sweat concluded that hypohydration redistributes water largely from sodium does not increase with the sweating rate. 17). 22). maturation. trained athletes have rela- tively greater total body water than their sedentary counterparts by virtue of a smaller percentage body fat and a higher concen- tration of skeletal muscle glycogen. 27). ad libitum water intake during exercise in the heat results in an incomplete replacement of body water losses (Figure 3. that of calcium. Plasma volume decreases 0. . In addition. 20). calcium. Nose et al (32) determined the distribution daily fluid requirements is shown in Figure 2 (19. when taking fluids is stimulated by consuming food (4. 0. Humans will usually fully rehydrate at meals. and magnesium present in smaller amounts. and degree of heat acclimation (21. thirst is not perceived until a per. Because there is free fluid exchange.3–2 mmol/L). 1 mmol/L (range tion to the amount of fluid loss. probably because of the osmotic pressure exerted by glycogen granules within the muscle’s sarcoplasm (31). fluid from the intracellular space. thus. hypohydration mediated by sweating will influ- ence each fluid space. Water constitutes 45–70% of body weight (1). This concept is illus- contains vitamins. 5). active persons need to stress drinking at meals to avoid persistent hypohydration. Daily in the rat of body water loss among the fluid spaces as well as requirements for sedentary to very active persons range from among different body organs. hypohydration must be avoided water deficit (36). An approximation of hourly sweating rates as a function of climate and running speed (7). Because heat acclimation improves the ability to reabsorb Resting plasma volume and osmolality values for heat-accli- sodium. Neufer et al (29). vitamin trated by heat-acclimated persons. This is difficult acclimated persons have additional solutes remaining within the because thirst is not a good indicator of body water require. for example. Forty-one potassium. Although sweat plasma volume in hypohydrated persons. electrolyte elevated plasma osmolality (34. found a reduction of 20–25% in the gastric emptying rate when their subjects were hypohydrated (5% body weight) that was related to increased core temperature. at high the intracellular and extracellular spaces of muscle and skin as a sweating rates the concentration of sodium increases (15). 26. Sweat-induced hypohydration will decrease The potassium concentration in sweat averages 5 mmol/L plasma volume and increase plasma osmotic pressure in propor- (range: 3–15 mmol/L). their concentrations are low.8 mmol/L (range because it provides the precursor fluid for sweat. and 14% from bone. Sex. they thermally dehydrated rats by 2–4 L/d in temperate climates and from 4–10 L/d in hot climates. beginning FIGURE 2. 2013 Sodium chloride is the primary electrolyte in sweat. son has incurred a water deficit of 2% body weight loss (BWL) ( by guest on June 25. thus. percent of the water deficit was intracellular and 59% was extra- The sodium concentration in sweat averages 35 mmol/L (range: cellular. in plasma volume than do unacclimated persons for a given body During exercise in the heat. and aging do not appear increases because sweat is ordinarily hypotonic relative to to affect sweat electrolyte concentrations markedly (23. 30% from skin. the average male (75 kg) has 45 L of water (about 60% of body weight). During situations of stress and prolonged high sweat loss. FLUID AND ELECTROLYTE SUPPLEMENTATION 565S important not only to minimize hypohydration but also to maxi- mize the bioavailability of the ingested fluids. In terms of organs. Influence of climatic temperature and daily metabolic fluid intake during the early stages of exercise heat stress is rate on daily fluid requirements (19. 35). Thus. 10% BWL and after the animals regained their normal core Downloaded from ajcn. 17). In general. extracellular space to exert an osmotic pressure and redistribute ments (17.nutrition. way of maintaining blood volume. a person’s total body water varies by body composition (1).

with a much greater ratio of plasma work” for occupational tasks but “moderate work” for athletes) loss to body water loss than in either exercise. plays an important role in the reduced exercise performance mediated by a body water deficit. tion on maximal aerobic power and physical work capacity (33). Inc. PA). 5000-. TBW. Diuretic-induced hypohydration generally results in an et al (17). 38). moderate-intensity exercise (43–45). work output was decreased by 50%. A substantial volume of blood could be redirected to the skin and thus be Persons who use diuretics for medical purposes or to reduce removed from the effective central circulation and be unavailable their body weight are at increased risk of hypohydration because to perfuse the skeletal muscles (47. and a 2. . During maximal exercise. For example. Persons who tion (water deficit) during ad libitum drinking by heat-acclimated per. It appears that the thermoregulatory system. the superficial skin veins reflexively dilate to increase cutaneous blood flow and volume. For euhydrated persons. climatic heat stress alone decreases maximal aerobic power by 7% (46). perhaps via increased body tempera- tures. 40). Philadel. Several investigators reported a ten- dency for reduced cardiac output when subjects are hypohydrated during short-term. 37. maximal aerobic power reportedly letes.566S SAWKA AND MONTAIN volume and cardiac output. Hoechst-Roussel. The physical work capacity for aerobic exercise of progressive intensity is decreased when a person is hypohydrated (33).org by guest on June 25. Relatively less intracellular fluid is lost after (49). Hypohyration resulted in much larger decrements of phys- ical work capacity in hot than in temperate climates. output and therefore oxygen delivery during maximal exercise. Lederle Laboratories. were experienced together. 2013 of solutes. viscosity-mediated increased FIGURE 4. Climatic heat stress reduced submaximal work output at all diuretic administration because there is no extracellular solute hydration levels. and the reduction is larger with increasing water deficits. Hypohydration also impairs endurance performance in ath- In temperate climates. It is not surprising that climatic heat stress potentiates the hypohydration-mediated reduction in maximal aerobic power and physical work capacity for progressive-intensity exercise.or heat-induced was assumed. Relation between sweating rate and voluntary dehydra. both climatic heat diuretics increase urine formation and generally result in the loss stress and hypohydration can act independently to limit cardiac Downloaded from ajcn. carbonic anhydrase The effects of hypohydration and air temperature on submaxi- inhibitors (eg. Physi- cal work capacity has been shown to be decreased by marginal (1–2% BWL) water deficits that do not alter maximal aerobic power (37. Diuril. The redirection of blood flow to the cutaneous vasculature could decrease maximal aerobic power by 1) reducing the portion of cardiac output that perfuses contracting muscles or 2) decreasing the effective central blood volume and central venous pressure. Diamox Parenteral. A metabolic rate of 650 W (which represents “hard isoosmotic hypovolemia. total body water. be hypovolemic and still have to perfuse simultaneously the cuta- neous vasculature and contracting skeletal muscles. mal work output are illustrated in Figure 5. thereby reducing venous return and cardiac output. decreased blood volume increases blood viscosity and can reduce venous return. water deficits of 2–4% BWL were reported by Craig and Cummings (39) to cause a large reduction in maximal aerobic power. Armstrong et al (40) had athletes compete in 1500-. however. Data from this study indi- cate a disproportionately larger decrease in maximal aerobic power with an increased magnitude of body water deficit. In hot climates. if these events Numerous studies have examined the influence of hypohydra. with an air temperature of 43 C and low humidity hypohydration. FIGURE 3. decreases when hypohydration reaches or exceeds 3% BWL (10. and 10 000-m races when euhydrated and when hypohydrated. Thus. Merck & Co. West Point. Hypohydration is associated with decreased blood (plasma) volume during both rest and exercise (41.5% BWL (compared with euhy- EXERCISE PERFORMANCE dration) reduced work output by the same amount. Commonly used diuretics include thiazides (eg. heat stress and hypohydration were additive (17).nutrition. Somerville. the work output decrements from excess to stimulate redistribution of body water. exposure to 43 C reduced work output by 25% (compared with temperate conditions). In the heat. In addition. Lasix. Body water loss effects on plasma osmolality and plasma resistance and reduced cardiac filling could decrease both stroke volume (PV) in heat-acclimated persons (33). and furosemide (eg. 48). research conducted > 50 y ago in the California desert by Adolph NJ). A reduced maximal cardiac output might be the physiologic mechanism by which hypohydration decreases a person’s maximal aerobic power and physical work capacity for progressive-inten- sity exercise. which draws on phia). are hypohydrated and encounter environmental heat stress would sons in the desert (17). 42).

56). subjects (2%) and 15 of 70 nondrinking subjects (21%) suffered hypohydration reduces both effector heat loss responses for a exhaustion from heat strain during an attempted 8-h desert walk. found that it took hypohydration (5% BWL) on core temperature responses in the the rowers an average of 22 s longer to complete the task when same persons when unacclimated and when acclimated are they were hypohydrated than when they were euhydrated.5 km/h [ambient temperature (Ta) 38 C] and either drank Hypohydration impairs both dry and evaporative heat loss (or. but more important. dry bulb temperature. soldiers induced by hypohydration was greater in heat-acclimated than in attempted endurance (2–23 h) walks in the California desert at unacclimated persons. which decreased plasma volume by 11%. For the 7% hypohydration experiments. Hypohydration reduced tolerance time from 121 to 55 min. and 7% BWL. relative humidity = 20%) and power. 55). responses when subjects were euhydrated. More recently. BWL. 2013 Running performance was impaired at all distances but more in Hypohydration not only elevates core temperature responses the longer races (5% for the 5000 and 10 000 m) than in the but also negates the core temperature advantages conferred by shortest race (3% for the 1500 m). hypohydration increases the incidence of exhaustion from heat strain. A critical deficit of 1% of body weight elevates core temperature during exer- cise (54). Clearly. water ad libitum or refrained from drinking. db. The magnitude of core Hypohydration (2% BWL) was achieved by diuretic administra. age point of body weight lost (17.1 to 0. so that different combinations of salt and water. relative humidity = 20%) environment when euhydrated and when hypohydrated by 3%. Thus. high aerobic fitness and heat acclimation (10–12). even when hypohydration is associated with no change in 140-min walk in a hot (Ta = 38 C) environment while ingesting sweating rate. 9. 4–6. 57). the core temperature penalty in the heat. · weight loss) during exercise heat stress (33). To address whether hypohydration alters physiologic toler- ance to heat strain. there is a concomitant graded elevation of core temperature during exercise FIGURE 5. In research conducted by Adolph et al (17). These investigators if the air is warmer than the skin. These findings suggest that hypohydration not only impairs exercise perfor- mance but also reduces physiologic tolerance to heat strain. Ladell (51) had subjects attempt a ever. sweating rates at a given metabolic rate in the heat (60). 6 subjects discontinued after completing only 64 min (mean). who exam. Relation between the elevation in core temperature tion in either a euhydrated or hypohydrated (8% of total body (above euhydration) and hypohydration (measured as percentage body water) state. when they were hypo- Surprisingly. hypohydration reduced average power by 5%. TEMPERATURE REGULATION Hypohydration increases core temperature responses during exercise in temperate (11. 53) and hot (12. In shown in Figure 7 (12). it reduced the core temperature a person could tolerate (the core temperature at heat exhaustion was 0. . 7. The experiments were designed so that the com. All 8 subjects completed the euhydration and 3% hypohydration experiments. Exhaustion from heat strain occurred in 9 of 12 (75%) experiments when subjects received neither water nor salt and 3 of 41 (7%) experiments when subjects received only water. The effects of ined simulated 2000-m rowing performance. temperature elevation ranges from 0. Sawka et al (52) had subjects walk to exhaus. Burge et al (50). Sawka et al (41) had subjects attempt lengthy treadmill walks (25% of maximal oxygen uptake for 140 min) in a hot-dry (Ta = 49 C. As the magnitude of water deficit increases. How- About a decade later. FLUID AND ELECTROLYTE SUPPLEMENTATION 567S exercise intensity (47% of maximal oxygen uptake) would not allow thermal equilibrium. given core temperature (36).4 degrees lower in the hypohydrated state). hypohydration is usu- The magnitude of hypohydration was not provided in either set ally associated with either reduced or unchanged whole-body of experiments. In Figure 8. 55. few investigators have documented the effects of hydrated. 41) climates.23 C for every percent- tion (furosemide). and 7 of 8 completed the 5% hypohydration experiments. dehydration aggravates dry reported that 1 of 59 (2%) soldiers who drank and 11 of 70 heat gain) (6. FIGURE 6. Relations between body water loss and core submaximal work output (17). Acclimation lowered core temperature addition. the core temperature is usually elevated. As shown. VO2max. maximal aerobic bined environment (Ta = 49 C. body weight loss from by guest on June 25. 5%. temperature elevations reported by studies that examined several water deficits are shown in Figure 6 (33). In addition. (58) and skin blood flow responses (59) to hypohydration (5% In subsequent experiments. Downloaded from ajcn. 41. they reported that 1 of 59 drinking BWL) during exercise in the heat are illustrated. and heat exhaustion would eventually occur. the local sweating response (16%) who did not drink suffered exhaustion from heat strain. similar core temperature responses were observed for hypohydration on physiologic tolerance to submaximal exercise both acclimation states.nutrition. Effects of hydration level and climatic temperature on heat stress (41.

The effects of hypohydration on cardiovascular responses to exercise have been investigated by several researchers (70. 81–83) but have not addressed exercise performance. Both the singular and combined effects of plasma hyperosmo- Downloaded from ajcn. venous return.nutrition. by hypohydration reduces skin blood flow for a given core tempera. person is hypohydrated (60). Other studies reported that acute unloading of atrial 84. the control condition represented hypohydration showed that hypohydration-mediated hypovolemia increases rather than euhydration) (33). As body temperature increases during exercise. which thermoregulation in the heat. thereby improving exercise performance. Fortney (76–78) during exercise but have yielded disparate results on et al (69) provided a rationale as to why an isoosmotic hypohydra. which is associated with increased cuta. infusion) have usually reported decreased cardiovascular strain ture and thus the potential for dry heat exchange (67. theorizing that Studies that attenuated plasma hyperosmolality during exercise hypovolemia might reduce cardiac preload and alter the activity of heat stress generally have reported improved heat dissipation atrial baroreceptors. 73–75). a reduced atrial filling pressure might modify neural Many studies have examined the effects of hyperhydration on information to the hypothalamic thermoregulatory centers. the sweating rate for a given core temperature is lower when a and thus cardiac output decrease below euhydration values. Hyperhydration (greater than normal body water) has been sug- Changes in plasma osmolality may relate to tonicity changes in the gested to improve thermoregulation and exercise heat performance extracellular fluid that bathes the hypothalamic neurons (61–63). 48). During submaximal exercise with little heat by guest on June 25. As a result of decreased blood volume and blood displacement to cutaneous vascular beds. Some investigators reported lower plasma norepinephrine. 5% body weight loss) persons neous vasodilation occurs and the superficial veins become more both before (UA) and after (HA) being heat acclimated. Isotonic Studies in which blood volume was directly expanded (eg. heat strain of exercise by expanding blood volume and reducing Isotonic hypohydration alone can impair heat loss and increase blood tonicity. 72). thus decreasing venous resistance and pressure (15). 2013 lality and hypovolemia have been suggested as mediating the HYPERHYDRATION reduced heat loss response during exercise heat stress (36). during hypohy- dration a decreased blood volume reduces central venous pres- sure (73) and cardiac filling. several studies (83. The theory was sitive and osmosensitive. Gonzalez-Alonso et al (70) problems (eg.568S SAWKA AND MONTAIN pressure (physiologic technique to unload cardiopulmonary barore- ceptors) impairs heat loss and increases core temperature (71. heat stress. Also. core temperatures during exercise after hyperhydration (83–87). preoptic. but cardiac output does not usually change from what is seen in a euhydrated state (43–45). Thus. compliant. (58. heat dissipation (77–79) and exercise heat performance (79. 89). mus. hypo- hydration elicits an increase in heart rate and decrease in stroke volume. 90) reported higher sweating rates with hyperhydration. dration might benefit exercise performance arose from observation anterior hypothalamic neurons are present that are both thermosen. The combi- nation of exercise with heat strain results in competition between the central and peripheral circulations for a limited blood volume FIGURE 7. central venous pressure. 88. which have afferent input to the hypothala. core temperature during exercise heat exposure (66–68). 80). Such data suggest a central interaction that expanding body water might reduce the cardiovascular and between thermoregulation and body water regulation (65). neous vascular resistance and reduced blood flow during exercise but other researchers did not (75. cuta- euhydrated (EU) and hypohydrated (hypo. Core temperature responses during exercise heat stress in (47. which reduces stroke volume and requires a compensatory increase in heart rate (75). tion might reduce skin blood flow and sweating rate. 69). In all baroreceptors during exercise with periods of lower-body negative studies. of the adverse consequences of hypohydration. but most suffer from serious design control skin blood flow and sweating. . Local sweating rate and forearm skin blood flow (FBF) response data for euhydrated (Eu) () and hypohydrated () [5% body weight loss (BWL)] persons during exercise heat stress. above that achieved with hypohydration. Apparently. The idea that hyperhy- Silva and Boulant (64) showed that in rat brain slices. heart rate was lower during exercise with hyperhydration FIGURE 8.

8. In a study by Blyth and Burt (95). They have high sweating rates and very high sweat sodium significantly less of the water load than did those consuming chloride losses that are not abated by heat acclimation (100). In addition. and reduced poten- The mechanisms responsible for the lower exercise core tem. because of the high sweat solute losses. glycerol hyperhydration produced a higher sweating rate and substantially lower core temperature (0. Riedesel et al (92) were the first to report that ness. tial to dissipate body heat (96–98). For one trial. and thirst sensation and fluid improve heat dissipation during the exercise period. fluid intakes were plotted against thirst sensation. In water alone. 85. Often. reported that expansion Downloaded from ajcn. the first to report the effects of hyperhydration on per- formance during exercise heat stress. 99). and in the other 2 trials subjects ingested fluid as well as do their healthy counterparts (99). fluid ingestion was restricted to patients are forced to drink. Other stud. Together. 2013 of blood volume (by 450–500 mL) increased simulated time trial performance by 10% (81 compared with 90 min). FLUID AND ELECTROLYTE SUPPLEMENTATION 569S water (21. and persons who men during exercise heat stress and the relation between drinking behav- ior and thirst sensation. they tolerate the consumed 5. Ninety minutes after this hyperhydration period.3 compared with 16. much of the fluid overload is hydration on thermoregulation in this group. older adults (> 55 y) have reduced thirst tion might reduce the thermal and cardiovascular strain of exercise. both groups were before exercise. exercise per se did not exacerbate the difference that existed exercise heat stress.5% BWL. cystic fibrosis patients have suppressed thirst sensations Lyons et al (90) studied whether glycerol-mediated hyperhy. reported greater exercise sweating rates when sub. Research from our own laboratory has failed to show any thermoregulatory advan- tages of either water or glycerol hyperhydration during exercise heat stress (93. Compared with drinking water alone. the subjects began exercise. by having subjects overdrink water or take water-electrolyte adding solute to stimulate thirst (2)] to optimize fluid and elec- solutions. 90). these factors cause large body stress. suffer a high incidence of heat injury or ill- glycerol (91. have suffered a spinal cord injury all have unique problems associated with fluid and electrolyte balance during exercise heat stress. RESEARCH NEEDS FIGURE 9. they have the hyperhydrated. More recently. a multisystem disorder that alters retention can be achieved with an aqueous solution containing sweat gland function. 94). persons with cystic fibrosis. however. therefore. the 2 groups jects were hyperhydrated (84. but the difference in average time to exhaustion (17. Thus. subjects ran to exhaustion in a hot climate (49 C) when normally hydrated and when hyperhydrated by drinking 2 L of fluid 30 min before exercise. Research issues include the testing of strategies [eg. Several older persons experience when fluid homeostasis is challenged studies reported that overdrinking before exercise lowers body (96) is illustrated in Figure 9 from the research of Mack et al core temperature before exercise (84.9 min) was not statistically significant. Subjects completed 3 trials in which they exercised in a water deficits during exercise heat stress (99). these findings support the notion that hyperhydra. groups. sensation. However. This observation is important in light of hyperhydration may improve heat dissipation during exercise the reduced ability of older persons to conserve water and elec- heat stress.4 mL/kg body wt. older persons have a reduced (87) found that sweating began earlier when subjects were thirst sensation. when matched ies. If cystic fibrosis hot (42 C) climate. Few studies have examined whether hyperhydration improves exercise performance or heat tolerance. which reduce the osmotic dration improves thermoregulatory responses to exercise heat drive for thirst (2. Together. For example. (65–78 y) persons for thirst sensation and fluid intake during ies. these approaches have resulted in only transients trolyte replacement in these populations and the effects of hypo- expansions of body water. Grucza et al drank the same amounts. Subjective thirst sensation of younger () and older () Older adults. Research . Hyperhydration. In addition. 92). additional research is needed on all 3 of these (33). apparently did not hypohydrated by 2. during exercise. Those investigators compared younger (18–28 y) and older to the energy cost of warming the ingested fluid. probably because of fluid or electrolyte imbalances (99.nutrition. rapidly excreted (91). Thirteen of 18 subjects ran longer when hyperhydrated. After this perturbation. trolytes in their kidneys when challenged by body water Although many studies have tried to induce hyperhydration deficits.4 mL/kg) with or without a bolus of glycerol (1 g/kg). less ability to concentrate urine. but for a given thirst sensation. In these stud. after hyperhydration with a glycerol by guest on June 25. intakes were lower in the older group. however. 85). Luetkemeier and Thomas (80). The reduced thirst sensation peratures in the hyperhydrated state remain unclear.7 C) than did control conditions and water hyperhydration. but this is likely due (98). who examined whether hyperv- olemia improved cycling performance. Evidence has accrued that greater fluid Persons with cystic fibrosis. The findings of these last 4 studies suggest that same drinking behavior. subjects excreted 100). glycerol ingestion increased fluid retention by 30%. addition.

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