International Journal of Sport Nutrition and Exercise Metabolism, 2015, 25, 78  -96

http://dx.doi.org/10.1123/ijsnem.2013-0210
© 2015 Human Kinetics, Inc
www.IJSNEM-Journal.com
ORIGINAL RESEARCH

Assessment of Physical Demands and Fluid Balance

in Elite Female Handball Players
During a 6-Day Competitive Tournament
Brian Cunniffe, Carissa Fallan, Adora Yau, Gethin H. Evans, and Marco Cardinale

Little data exists on drinking behavior, sweat loss, and exercise intensity across a competitive handball tourna-
ment in elite female athletes. Heart rate (HR), fluid balance and sweat electrolyte content were assessed on 17
international players across a 6-day tournament involving 5 games and 2 training sessions played indoors (23
± 2 °C, 30 ± 2% relative humidity). Active play (effective) mean HR was 155 ± 14 bpm (80 ± 7.5% HRmax)
with the majority of time (64%) spent exercising at intensities >80% HRmax. Mean (SD) sweat rates during
games were 1.02 ± 0.07 L · h-1 and on 56% of occasions fluid intake matched or exceeded sweat loss. A sig-
nificant relationship was observed between estimated sweat loss and fluid intake during exercise (r2 = .121,
p = .001). Mean sweat sodium concentration was 38 ± 10 mmol · L-1, with significant associations observed
between player sweat rates and time spent exercising at intensities >90% HRmax (r2 = .181, p = .001). Fluid
and electrolyte loss appear to be work rate dependent in elite female handball players, whom appear well
capable of replacing fluids lost within a tournament environment. Due to large between-athlete variations, a
targeted approach may be warranted for certain players only.

Keywords: athletic training, exercise training, exercise performance, nutrition

Handball is a fast-paced body-contact Olympic sport
played by two competing teams of seven players (includ-
ing a goalkeeper) on an indoor court (40m × 20m) over
two 30-min periods. It is generally recognized that games
are played at high-intensity due to the nature of rolling
substitutions and recent rule changes on starting the game
from the center after a goal is scored. Despite its popular-
ity, a paucity of studies exit to describe the games physi-
cal demands. Recent research on elite male handballers
has shown that players cover a mean distance of 4370 ±
702m during games, most of which is spent performing
low-intensity aerobic exercise actions interspersed by a
short duration of very high-intensity anaerobic actions
(Póvoas et al., 2012). In the latter study, players were
observed to exercise at a mean intensity of 82 ± 9.3% of
HRmax. To our knowledge, only one study describes the
physical demands within the elite women’s game with
players observed to cover distances of 4002 ± 551m and
exercise at high mean relative workloads (79.4 ± 6.4%
V·O2max) during match-play (Michalsik et al., 2013).
Handball is played indoors, and although most
playing halls have temperature-controlled environments,
Cunniffe is with the English Institute of Sport, Bisham Abbey,
UK. Fallan is with the ISEH, University College, London, UK.
Yau and Evans are with the School of Healthcare Sciences,
Manchester Metropolitan University, Manchester, UK. Cardi-
nale is with Aspire Academy, Doha, Qatar. Address author cor-
respondence to Brian Cunniffe at briancunniffe@hotmail.com.
high-intensity exercise may result in thermal stress and
subsequent disruption of body water and electrolyte
balance. Team sport players have been shown to lose
variable amounts of electrolytes in sweat (Kurdak et
al., 2010; Maughan et al., 2007b) and the magnitude of
solute loss appears dependent on both sweat rate and
composition. In soccer, large individual variations in
player sweat response are known to occur as a result of
differences in environmental temperature and humidity,
work-rates, state of acclimation and individual fitness
(Maughan, Watson, Evans, Broad & Shirreffs, 2007).
When exercising in the heat, a 1–3% loss in BM due to
sweat losses has been reported to result in elevated HR,
core temperature (Tc), rating of perceived exertion, and
plasma osmolality (Montain & Coyle, 1992; Buono &
Wall, 2000). More recently, it has been observed that
muscle glycogenolysis significantly increases early in
exercise with a BM loss of < 2% and this appears related
to a rise in core and muscle temperature (Logan-Sprenger
et al., 2013). However, available data showed that values
in excess of 2% BM are needed before aspects of team
sport physical and cognitive performance begin to be
negatively affected (Baker et al., 2007; McGregor et al.,
1999). While many studies have investigated fluid bal-
ance in team sport athletes during practice or competition
in the field (Maughan et al., 2005; Kurdak et al., 2010;
Maughan et al., 2007) few, if any, have explored changes
in these variables across a competitive tournament. In par-
ticular, there are no data available on women’s handball.

78
 Fluid Balance in Handball   79

Olympic handball teams may play up to 5 games in 9 portable thermohygrometer (Higbo, Oregon Scientific,
days during group stages of a major competition. Since Berkshire, UK).
prior hypohydration will amplify the effects of any fluid Study approval was obtained from the national
deficit incurred during exercise, added emphasis on fluid- governing body involved and collection of data arose
electrolyte replacement may be required during such time as part of the service provision supplied to the team in
periods to ensure adequate recovery between games. For preparation for competition (Winter & Maughan, 2009).
this reason, understanding the pattern of fluid and elec- All athletes agreed to take part and signed consent was
trolytes losses during a tournament may assist with the obtained. To ensure player confidentiality, data were
provision of targeted interventions in players with high anonymized before analysis.
sweat rates or where failure to replace lost fluids might
raise concerns of an ergolytic effect. Testing Procedures
The main aim of this investigation was to observe
normal fluid balance behavior and quantify electrolyte Players wore shorts and short sleeve T-shirts throughout
losses across a competitive tournament in a team pre- testing. On the morning of training or games, players
paring for the Olympic Games. Secondary aims were to provided a urine sample (first void) into a prelabeled
describe the physical demands of elite women handball urine collection pot (60 ml, Greiner Bio-One Ltd,
players and investigate whether fluid-electrolyte losses Stroud, UK). Urine refractive index (Pocket Osmocheck,
could be explained from exercise intensity and effort Vitech Scientific Ltd, Sussex, UK) was subsequently
distribution. determined to provide an index of preexercise hydration
status (Shirreffs, 2003; Sparks and Close, 2012). Play-
ers were provided with dietary plans by the affiliated
Methods nutritionist in the lead up to and following training/
games. As per norm, food was self-prepared (from set
Participants planned menus) in large player groups within nearby
shared accommodation to the team home venue and
Data were collected on an international team (n = 17)
this was not altered during the investigation. Neither
of female handball players (26 ± 5 yr, 1.72 ± 0.06 m,
dinner nor breakfast was recorded or standardized so as
70.7 ± 8.5 kg: mean ± SD) during a tournament scenario
to avoid interference with player’s normal dietary/fluid
over 6 days.
habits. Player menstrual state was not recorded during
the 6-day tournament.
Experimental Design
The team participated in two training sessions and five
competitive friendly games against top club opposition
whom were normally playing at the highest standard in
European handball competition (Figure 1). Data col-
lection took place at two training venues seven months
before the 2012 Olympic Games which the team under
investigation subsequently participated. Games were
played according to international handball federation
rules and with the exception of game 4 (lasted 90 min due
to a prior agreement between coaching teams), consisted
of two periods of 30 min. The team under investigation
recorded three wins and two losses during the investiga-
tion. Training sessions lasted 104 ± 2.1 min, consist-
ing of warm-up, calisthenics, position-specific drills,
small-sided games and technical drills. Environmental
conditions during the games/training sessions are shown
in Table 1 and all measurements were recorded with a Figure 1 — Testing schedule across the tournament.

Table 1  Environmental Conditions of Temperatures (°C) and Relative Humidity (%) Taken at 15-Min
Intervals During the Games
Conditions Game 1 Game 2 Game 3 Game 4 Game 5 Training*
Temperature (°C) 21 ± 0 25 ± 0 24 ± 0 22 ± 2 21 ± 1 23 ± 2
Relative humidity (%) 30 ± 2 27 ± 1 30 ± 1 33 ± 2 27 ± 3 31 ± 0
Note. Data are presented as mean ± SD
*Mean data from two training sessions at same venue.
80  Cunniffe et al.
Over a 15-min period (–45 to –30 min) before
the start of each game/training, players were weighed
(nude) to the nearest 20 g on a calibrated electronic scale
(Marsden W/M, Oxford, UK). After entry to the playing
court, players were fitted with a heart rate (HR) strap
and individual HR data were subsequently collected
wirelessly at one-second intervals (Polar Team System,
Polar Electro, Kempele, Finland). Following team warm-
down, players were reweighed (towelled dry nude) on the
same calibrated scale. Body mass changes were used as
a proxy measure for sweat losses. While this represents a
limitation of the study, previous work has indicated that
this represents a realistic field measurement to estimate
hypohydration (Maughan et al., 2007a). Players were
asked to refrain from eating between weighing points
but were free to drink fluids ad libitum and whenever
breaks in play were permitted (1 min time-out per-half
is allowed by handball rules). Players were asked to
consume drink products which they would normally
consume during everyday practice and games. This
included either tap water or tap water mixed with sugar
free cordial for the current player group. Observed
checks confirmed that no player consumed commercial
drink products or electrolyte sachets during exercise.
Therefore electrolyte intake during sessions/games was
considered negligible.
All bottles were individually numbered and players
drank from bottles assigned to them by team staff. All
players were left to behave as they wished with regard to
fluid consumption. During the time period from weigh-
ing players before and after exercise, each player’s fluid
intake was measured to the nearest 0.001kg on a cali-
brated scale (Adam Equipment Ltd., Milton Keynes, UK).
A volume of 1 ml ingested fluid was assumed to weigh
1 g. In the event of players wishing to urinate during the
analysis period, they were accompanied by research staff
to the toilet and provided with a preweighed urine collec-
tion bag with funnel (P-Bag, Medipost Ltd, Dorset, UK).
Filled urine collection bags were subsequently weighed
to aid in determination of fluid balance. All bottles/col-
lection devices were weighed out of view of the players
at all times.
Sweat Collection and Analysis.  Before three of the
five games, players were prepared for sweat sample col-
lection using methods outlined previously (Maughan et
al., 2007b; Maughan & Shirreffs, 2008). Briefly, players
had absorbent patches (Tegaderm + pads, 3M, Loughbor-
ough, UK) placed on four body locations (chest, upper
forearm, back and thigh). Before attaching patches to
the skin, the locations were washed thoroughly with
deionized water and dried with electrolyte-free gauze.
At the end of each game, patches were removed with
sterile forceps and each patch was subsequently placed
into preweighed screw-top containers (20 ml, Sterlin,
Cambridge, UK) until analysis. No patch showed signs
of undue saturation (e.g., dripping) across the period of
investigation. Following collection, samples were stored
at 4 °C before analysis (within one week of collection).
To determine electrolyte concentrations, each sweat
patch and container were weighed to the nearest 4 deci-
mal places before 1 ml of deionized water was added.
After mixing, the sample was analyzed for sodium and
potassium concentration using flame photometry (Sher-
wood 410, Sherwood Scientific, Cambridge, UK) and
for chloride concentration using the mercuric thiocynate
method (Randox, Crumlin, UK). All samples were ana-
lyzed in duplicate and intrarun coefficients of variations
were <5%.
Heart Rate Data.  Player heart rate max data (HR max)
were obtained in the weeks leading up to experimentation
using an incremental running test to exhaustion (Yo-Yo
IE2 test) conducted by strength and conditioning staff.
Confirmatory HRmax analysis was achieved by comparing
these results to those achieved previously (–4 months)
using a laboratory incremental test to exhaustion. Previ-
ous work has shown that no systematic differences occur
between HRmax achieved using the Yo-Yo IE2 test and
incremental treadmill test in intermittent sport (Bradley
et al., 2011).
Heart-rate readings were classified into five inten-
sity zones, ranging from 50–59%, 60–69%, 70–79%,
80–89%, and 90–100% HRmax for assessment of physi-
ological load in team handball (Póvoas et al., 2012). The
percentage of time spent exercising in each zone was
determined to provide an indication of exercise intensity
for each player and all HR values were analyzed during
the first and second halves. Given that team handball
rules allow for unlimited substitutions, it is unusual that
one athlete plays an entire game. Furthermore, a one-
minute time-out period is allowed for each team per-half.
Therefore, HR during the games were analyzed (a) as
total HR (i.e., HR during the total game time) to provide
an index of global cardiovascular load and (b) HR during
active play time (effective HR) to classify game demands
during time when a player was actually on the playing
court (Póvoas et al., 2012). The time period for the half-
time break was excluded from HR analysis.
Calculations.  Sweat rate (SwtR: L · h-1) was estimated
as net body mass loss (kg) during the training session/
game plus the total fluid intake divided by the exercise
time (min). Corrections for any individual player urine
loss were also made:
SwtR = {[preexercise mass (kg)
– postexercise mass (kg)] – urine volume (L)
+ fluids consumed (L)}/time (hr)].
Fluid intake (L · h-1) was calculated as total fluid
intake during the recorded exercise session divided by the
exercise time (per hour). Changes in BM before and after
exercise were to assess acute changes in hydration status
(% fluid deficit). Net balance of respiratory and metabolic
contributions to BM loss was considered negligible as
observed previously under similar environmental condi-
tions for indoor team sport (Hamouti et al., 2010). Sweat
electrolyte losses (in grams) were calculated from the
sweat electrolyte concentration, the molecular weight of

the electrolyte, and the total sweat loss of the individual
(Maughan et al., 2007a). It was assumed that the mean
sodium concentration (from 4 collected sites) represented
mean whole-body sodium concentration although it is
acknowledged that this may be an overestimate (Shirreffs
& Maughan, 1997).
Statistical Analysis
Data sets were initially tested for normality of distribu-
tion using the Shapiro–Wilk test. Comparisons between
data were then made using paired t tests and a one-way
repeated measures analysis of variance (ANOVA). Dif-
ferences in regional sweat electrolyte concentration were
determined by 1-way ANOVA and with Tukey’s test of
honestly significant difference. Relationships between
parameters were performed using a least-squares regres-
sion model, and the coefficient of determination (r2) is
reported (Maughan et al., 2005). All statistical analyses
were performed using SPSS v. 20. Data sets are presented
as mean ± SD (SD) with range of data given in parenthe-
ses. Statistical significance was set at p < .05.
Results
Heart Rate
Player HRmax achieved during incremental running test
was 191 ± 7 bpm. Peak HR over the 5 games (182 ± 9
bpm; 93 ± 5% of HRmax) was significantly higher than
values recorded in training (169 ± 13 bpm; 86 ± 5% of
HRmax); p < .05. Player effective mean HR (155 ± 14
bpm; 80 ± 8% of HRmax) was also significantly higher
than values observed in training (129 ± 10 bpm; 65 ±
5% of HRmax) and total mean game HR (131 ± 14 bpm)
(p < .05). Average time spent by players in “active” play
during games was 33 ± 15 min.
No between game-half differences were observed
for either total or effective mean player HR (Figure 2).
Furthermore, no significant differences were observed
between game halves at different interval percentages
of players’ HRmax (Figure 3). The majority of effective
game time (64%) was spent exercising at intensity >80%
HRmax, with 23% of game time spent exercising >90%
HRmax. No between game differences were observed for
percentage of effective or total game time spent any of
the designated HR zones.
Morning Hydration Status
On the mornings of the games, 47% of players awoke
with a urine refractive index ³ 700 mOsmol/kg. No
relationship was observed between previous days fluid
intake during exercise and the following mornings urine
refractive index (p = .116). Furthermore, no relationship
was observed between morning urine refractive index and
subsequent fluid intake during exercise, (r2 = .014; p =
.307; Figure 4a). A significant relationship was observed
between morning urine refractive index and percentage
Fluid Balance in Handball   81
change in player BM during training/games (r2 = .159;
p = .001), Figure 4b. No between game differences in
morning measures of hydration status were observed
(Figure 6).
Fluid Balance
Across the games, mean team fluid intake was 1.05 ± 0.16
L. After correction for amount of fluid ingested, estimated
mean team sweat loss was 1.08 ± 0.18 L. A significant
relationship was observed between fluid intake during
exercise and estimated fluid (sweat) loss (r2 = .121; p =
.001 (Figure 5). Fluid intake (L) was significantly lower
during training sessions in comparison with games 2, 3
and 4 (p < .001) (Figure 6). Between game comparisons
indicated that players consumed significantly more fluid
during game 4 than games 2 and 5. Larger volumes of
fluids were also consumed during game 3 in comparison
with game 5 (p < .001).
Mean player sweat rates during games (1.02 ± 0.07 L
· h-1) were significantly higher than those observed during
training (0.56 ± 0.15 L · h-1) despite similar environmen-
tal temperatures (p < .05; Table 1). No between game
differences were observed. A relationship was observed
between individual player sweat rates (L · h-1) and time
spent exercising at intensities >90% HRmax (r2 = .181; p
= .001). During games, 51% of players had a sweat rate
< 1 L · h-1 and 47% had a sweat rate between 1 and 2 L ·
h-1. Only on two occasions did player sweat rates exceed
2 L · h-1 during games. In contrast, all players had sweat
rates < 1 L · h-1 during training. A large interindividual
variability was observed in sweating response between
players (Figure 5).
On 56% of occasions, player fluid intake matched or
exceeded fluid (sweat) loss during training and games.
Sweat loss was significantly higher during game 4 than
training sessions and game 2 (p < .05), game 3 and 5 (p
< .01). Across the five games, 43% of players lost body
mass (BM) as a result of exercise with most (36%) of the
group recording losses of <1% BM. In turn, 7% of the
player group recorded a loss of >1% BM and no player
was dehydrated >2% of BM. Conversely, 6% of the
players gained more than 1% in BM across the games.
On average, 0.0 ± 0.1% and 0.1 ± 0.1% net fluid deficits
were recorded following games and training respectively.
Electrolyte Loss
The mean (4 site) sweat sodium, chloride and potassium
concentrations were 38 ± 10 mmol · L-1, 27 ± 11 mmol ·
L-1 and 5 ± 1 mmol · L-1, respectively (Table 2). No sig-
nificant effects for time (between games) were observed
for sweat sodium, chloride or potassium content (p > .05).
Mean sodium content of sweat in game 4 was significantly
higher than game 5 (p < .01) while higher sweat chloride
content was also observed in game 4 compared with game
2 and game 5 (p = .03). Sodium concentrations in the
sweat patches of the “back” torso were lower compared
with all other sites (p < .001). Higher “arm” chloride
82
Figure 2 — Mean and maximal total and effective HR during the first and second halves and total match time. Data presented as absolute and relative to indi-
vidual maximal HR values (means ± SD). *Significantly different from total HR (p = .00). Inset showing effective and total HR data recorded during training.
 Figure 3 — Percentage of effective match time spent at different interval percent-
ages of player maximal HR in the first and second halves. Values are means ± SD.

Figure 4 — (a). Relationship between measured preexercise urine refractive index and measured fluid intake during training/games, r2 = .014, p = .307. (b). Relationship between

83
morning urine refractive index and percentage change in player body mass during training/games, r2 = .159, p = .001.
84  Cunniffe et al.

Figure 5 — Relationship between volume of fluid consumed during training/games and the amount of
sweat loss (L), r2 = .121, p = .001.

Figure 6 — Rate of fluid intake and sweat loss in players across the tournament. *Significantly higher
than training sessions (p < .05). Morning urine refractive index values per game throughout tournament
also provided. Values are mean ± SD.

concentration was observed in comparison with values
recorded from players “back” and “thigh” (p < .001).
In turn, chest chloride concentrations were higher than
both “back” and “thigh” samples (p < .001). Arm potas-
sium concentrations were higher than back, chest and
thigh concentrations while thigh concentrations were
higher than back and chest (p < .001; Table 2). No asso-
ciation was observed between mean player sweat sodium
concentration and sweat rate (r2 = .001; p = .57).
A significant correlation was observed for total sodium
loss (1.03 ± 0.43 g) and percentage of time spent by players
exercising between 90–100% HRmax (r2 = .210; p = .016).
 Fluid Balance in Handball   85

Table 2  Between Game Comparison of Sweat Electrolyte Concentrations (mmol×L-1) per

Collection Site
Game 2 Game 4 Game 5
Mean (SD) Range Mean (SD) Range Mean (SD) Range Mean (SD) Range
Mean sodium 36 (13) 19–70 40 (8) 27–54 35 (7)* 24–47 38 (10) 23–57
 Arm 38 (14) 16–60 44 (12) 29–67 39 (13) 18–61 41 (13) 16–66
 Chest 40 (14) 16–55 46 (11) 23–64 40 (10)* 24–54 42 (12) 16–65
 Back 31 (12) 14–60 33 (10) 17–46 27 (7) 14–40 31 (10) 14–60
 Thigh 36 (15) 19–75 42 (11) 26–70 38 (8) 24–48 39 (12) 19–75
Mean chloride 24 (16)* 2–54 31 (9) 16–47 25 (8)* 15–37 27 (11) 11–46
 Arm 26 (16) * 2–50 33 (14) 12–58 31 (12) 16–52 30 (15) 3–57
 Chest 29 (18) * 2–55 38 (11) 19–53 33 (10) * 21–46 34 (13) 3–55
 Back 20 (13) 2–27 24 (10) 8–40 20 (9) 9–35 22 (11) 2–47
 Thigh 20 (15)* 6–52 27 (11) 10–46 21 (8)* 6–33 23 (11) 6–52
Mean potassium 5 (2) 3–7 6 (1) 4–7 5 (1) * 3–7 5 (1) 3–7
 Arm 6 (2)* 3–9 8 (2) 5–12 7 (3) 3–12 7 (2) 3–12
 Chest 5 (0) 4–5 5 (1) 3–6 4 (1)* 2–5 4 (1) 2–6
 Back 4 (1) 2–6 5 (1) 4–7 5 (1)* 3–6 5 (1) 2–7
 Thigh 6 (1)# 5–8 7 (3) 3–14 5 (1)* 3–6 6 (2) 3–14
*Significantly different from game 4, p < .05.
#Significantly different from game 5, p < .05.

Discussion
The aim of this investigation was to assess fluid bal-
ance behavior and determine electrolyte losses across a
competitive tournament in elite female handball players.
Secondary aims were to assess physical demands and
whether observed changes in the above variables could
be explained from player exercise intensity data.
While a limited number of studies have documented
intensity of exercise in elite men’s handball, to date, only
one study has been carried out in the elite women’s game
(Michalsik et al., 2013). Present data show that female
players exercise at a similar mean relative intensity
(155 ± 14 bpm; 80 ± 8% of HRmax) to their elite male
counterparts (Chelly et al., 2011; Póvoas et al., 2012)
and that the majority of time (64%) is spent performing
movements at high >80% HRmax exercise intensities. As
expected, mean exercise HR was considerably higher
during competition in comparison with those observed
in training sessions. This was due to the fact that the
coaches used the training sessions with a tactical focus
and structured lower intensity than normal to ensure play-
ers were not fatigued during the tournament. However,
team HR values did not decrease during the second half
of games as observed previously in the elite men’s game
(Póvoas et al., 2012). In the latter study, modest average
relative body weight losses (0.9 ± 0.3%) were recorded.
This, combined with data from the current study (0.0
± 0.1% fluid deficit), suggests that factors other than
dehydration may be responsible for any observed drop
off in exercise intensity in Handball. Although dehydra-
tion due to sweat loss is a known factor which can impair
exercise performance (Coyle, 2004); other factors such as
game rotation strategy, score differential, physiological
or physical factors may all contribute to game fatigue.
It should also be noted that HR data only provides an
indication of cardiovascular demands and time-motion
characteristics should be studied to better understand how
fatigue affects movement patterns.
In the current study, player sweat rates (1.02 ± 0.07
L · h-1) were similar to the ones observed in female bas-
ketball players (Brandenburg & Gaetz, 2012), indoor
male handball (1.1 ± 0.3 L · h-1) and volleyball (1.2 ± 0.3
L.h-1) players but considerably lower than indoor soccer
players (1.8 ± 0.7 L · h-1) (Hamouti et al., 2010). How-
ever, a large interindividual variability (range 0.26–2.1
L) was observed, as noted previously (Maughan et al.,
2007b; Hamouti et al., 2010). This, taken together with
the large variability in fluid intake across the investigation
(range 0.25–2.74 L) highlights the need for individual-
ized assessment of fluid balance strategies in a team sport
environment (Shirreffs, Sawka & Stone, 2006). With
respect to the current athlete group, it was noted that 6%
of players gained more than 1% in body mass (BM) by
the end of the games, suggesting that some players might
consume excessive fluids. Overall, 56% of players either
maintained or increased their BM at the end of the game
and this was particularly evident for goalkeepers and
rolling substitutes, some of whom consistently consumed
more fluids than were lost in sweat. This was most likely
due to increased time available on the bench and ease of
access to drinking bottles. During handball competition,
86  Cunniffe et al.
BM has to be moved against gravity and theoretically
an increase in BM from resultant fluid intake might
have negative effects on performance in particular when
fatigue develops.
It has been reported that as little as a 2% loss in BM
due to dehydration affects many physiological factors
thought to indirectly affect performance. These include
elevations in HR, core temperature (Tc), rating of per-
ceived exertion (Montain & Coyle, 1992; Buono & Wall,
2000) and muscle glycogenolysis (Logan-Sprenger et al.,
2013). In this study, no player was dehydrated >2% BM
despite moderate to high sweat rates in some players. The
most recent position stand from the American College of
Sports Medicine (Sawka et al., 2007) has suggested that
fluid intake during prolonged exercise should be sufficient
to limit any BM loss to <2% of preexercise mass and that
athletes should never drink so much that they gain BM
during exercise. Therefore, the female handball players
observed in this study appear to adequately replace fluids
lost during exercise, and in some cases, education around
the risks of overconsumption of fluids is warranted.
Across the 6-day tournament, 54% of players awoke
with a urine refractive index of <700 mOsmol/kg, values
previously suggestive of euhydration (Sawka et al. 2007).
Research has reported that 91% of elite male athletes from
a number of indoor team sports awoke in hypohydrated
state before practice (Hamouti et al., 2010). Therefore,
data suggests that fluid management following exercise
appeared adequate in the current player group. Start time
of training and games varied considerably between days
and no difference in markers of hydration status was
observed between sampling points. It is possible that given
the elite nature of the current team and the tournament
scenario, players were proactive in making sure to replace
lost fluids during exercise. Alternatively, it is possible
that fluid replacement strategies were altered by players
as a result of been observed during the experimentation
period. However, given that study experimenters were
familiar with players and training environment before
experimentation, the repeated observations and failure to
identify trends in fluid intake across the study period; it
does not appear that this was the case. It should be noted
a small number of players (8%) consistently provided
morning urine samples which were indicative as being
very dehydrated (1,000–1,129 mOsmol/kg; Armstrong et
al., 2010) suggesting the need for targeted fluid replace-
ment in such a player group. There is some evidence of a
positive correlation between pretraining urine osmolality
and the volume of fluid ingested during a training session
where fluids are freely available (Maughan et al., 2005).
Therefore, athletes who begin training with higher urine
osmolality/specific gravity may be likely to drink more
due to a greater sensation of thirst. In the current study,
no relationship was observed between morning urine
measures and subsequent fluid intake. Such findings
have been observed previously (Maughan et al., 2007b)
and may be dependent on the time period from morning
hydration assessment and exercise onset. In this study,
some games started at 3 p.m. and so it is feasible that
athletes had adequate time to correct any fluid imbal-
ance through normal sensory means. Unlike previous
findings (Maughan et al., 2007b; Hamouti et al., 2010),
a modest but positive association was observed between
the amount of sweat lost and volume of fluid consumed
(Greenleaf, 1982), indicating that sensation of thirst and
perhaps most likely, ample fluid breaks was capable in
offsetting major disturbances in fluid balance. Further
work should be carried out to determine the strength of
this relationship in athlete groups whom display a wide
range in sweat rates.
Data from tennis (Bergeron, 2003) and American
football (Stofan et al., 2005; Horswill et al., 2009), have
suggested that athletes who sweat profusely and have a
high sweat sodium concentration may be more likely to
experience muscle cramps. However, few if any studies
have investigated whether electrolyte losses vary through-
out a condensed tournament environment when replace-
ment of salts lost in sweat may be of added importance
to the recovery process. In the current study, mean sweat
electrolyte concentrations were on the lower end of those
reported previously (Maughan et al., 2005; Hamouti et
al., 2010). Very few studies have investigated electrolyte
losses in elite female athletes (Kilding et al., 2009) and
it is possible that gender differences may account for
observed differences. Although speculative, given that
players in this study voluntarily chose to consume plain
water during exercise, it is also possible that this may,
in part, account for the lower mean sweat sodium (38 ±
10 mmol.L-1) concentrations observed (Sigal & Dobson,
1968). A large interindividual variation was observed for
all sweat electrolyte concentration (Table 2) as noted
elsewhere (Maughan et al., 2007b). Given that players
were rather homogenous in terms of fitness level (had
similar daily exercise programs), dietary intake (same
food menus) and degree of acclimation, it’s possible that
genetic factors may underpin this finding. As observed
previously, no relationships were found between whole
body sweat rate and sweat concentration of any electro-
lyte (Maughan et al., 2007b; Kilding et al., 2009). This is
in contrast to recent data in tennis which suggests sweat
sodium concentration is related to an individual athletes
sweat rate (Bergeron, 2014). Given that a significant
correlation did exist between player sweat rates and time
spent exercising at higher intensities, present data are
suggestive that time exposure to intense exercise may,
in part, have a role in overall electrolyte loss (Hamouti
et al., 2011).
Regional differences in sweat electrolyte composi-
tion were observed as previously reported (Maughan
et al., 2007b). In this study, lower back torso sodium
concentrations were observed compared with other col-
lection sites. These findings are in contrast to previous
work carried out on male cyclists (Patterson, Galloway &
Nimmo, 2000) and both male and female athletes cycling
in a heat chamber (Baker et al., 2009). Future studies
should be carried out on female athletes undertaking
differing exercise modes to explore further why such
regional differences occur. While previous studies which

have primarily focused on either once off sweat composi-
tion measurements, the current study assessed electrolyte
losses across three games in a 6-day tournament. Results
showed that with the exception of game 4, electrolyte
concentrations in sweat were consistent between games.
With respect to game 4, both teams agreed to play across
3 × 30 min period (90 min total) for technical develop-
ment reasons. Although between game sweat rates did not
differ in this study and stability of electrolyte concentra-
tions has been observed across varying exercise durations
(Montain, Cheuvront, & Lukaski., 2007), current data
suggests that length of sweat patch sampling time does
need to be taken into account when assessing electrolyte
loss in athletes. A significant association was observed
for total sodium deficit (1.03 ± 0.43 g) and per-cent
change in BM. Although statistically significant, only
a moderate correlation was observed (r2 = .367) which,
perhaps is not surprising given that salt losses through
exercise are influenced by both sweat loss and electrolyte
concentration. Although moderate sodium deficits were
incurred, a large variability in sodium loss was observed
(range: 0.3–2.37 g). Given that the current player group
refrained from consuming electrolytes during exercise,
recommendations to a few select individuals (whom
experienced high sodium losses) on consumption of
electrolyte containing beverages during exercise to may
be required reduce the sodium deficit and to better retain
ingested fluid. This may be particularly relevant during
a tournament scenario where players have a game every
other day.
Present results indicate that moderate sweat and
electrolyte losses occur during handball games played
in temperate conditions and the magnitude of such
losses appear related to time spent exercising at higher
intensities. Furthermore, it seems evident that specific
approaches need to be considered for certain individuals,
not only to minimize fluids losses but also to avoid over-
consumption of fluids which might have negative effects
on performance. Lastly, our data seems to suggest that
the cardiovascular demands of handball games in women
are similar to those reported for men, albeit further stud-
ies are needed to quantify time-motion characteristics of
elite women’s handball.
Acknowledgments
Thanks to staff at British Handball, in particular the performance
director Lorraine Brown, the coaches Jesper Holmris and Vigdis
Holmeset, Lauren Bradshaw, Lee Ottey and Dr. Polly Baker,
for their assistance with coordination of this study. Our appre-
ciation is also extended to the players who kindly participated
in this study. The study was supported by the British Olympic
Association.
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©2010 • Paperback • 208 pp
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Apply the basics of sport
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 Fueling strategies for optimal performance
Far beyond the basics, plates, and pyramids, this new edition of Advanced Sports Nutrition from world-
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Sport Nutrition for Health and Performance, Second
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duplicate the text. Tables should be formatted using the
table function of the word-processing program rather than
by aligning columns in text with tabs and spaces or using
text boxes. Tables should be double-spaced on separate
sheets and each should include a brief title and a legend
that highlights any statistically sign  Papers submitted to
the journal may be sent for review to a statistician if the
Editor is not satisfied that appropriate procedures have
been followed. When data sets are normally distributed,
variance should be given as the SD rather than SEM.
Nonparametric statistical analysis should be used when
data sets are not normally distributed.
Reference Style.  IJSNEM follows a modified version
of the style laid out in the Publication Manual of the
American Psychological Association (APA), 6th ed.
Please consult the APA manual. http://www.apastyle.org/
learn/tutorials/basics-tutorial.aspx. References should
be listed in alphabetical order at the end of the text and
should be cited in the text using author name(s) and date
of publication. In the case of in-text citations, where there
are more than two authors, the first author’s name can
be followed by “et al.” Example: “Burke, Clooney, Pitt,
and Riewoldt (2009) found that supplementation achieved
positive outcomes” can be replaced by “Supplementation
was found to achieve positive outcomes (Burke et al.,
2009).” References should not be numbered in the refer-
ence list. Examples of the three most common forms of
references are shown below. For other variations, please
consult the APA manual.
Burke, L M., Clooney, G., Pitt, B., & Riewoldt, N. (2009). Cacao
supplementation does not affect sprint performance in
elite team sport players. Journal of Clinical Inspiration,
67, 1966–1971.
Wadler, G.I., & Hainline, B. (1989). Drugs and the athlete.
Philadelphia: F.A. Davis.
Haymes, E. Proteins, vitamins, and iron. (1983). In M.H.
Williams (Ed.), Ergogenic aids in sport (pp. 27–55).
Champaign, IL: Human Kinetics.
Submission.  Manuscripts should be submitted elec-
tronically via IJSNEM’s Manuscript Central site at http://
mc.manuscriptcentral.com/hk_ijsnem. The Manuscript
Central system manages the electronic transfer of manu-
scripts throughout the article review process, providing
step-by-step instructions and a user-friendly design.
The Review Process.  Manuscripts are read by an
editor and two reviewers; reviews will not be blind.
Authors are required to provide the names and email
addresses of a minimum of two potential peer reviewers
when they submit their manuscripts. The review process
should not take more than about 6-8 weeks.
Copyright.  Authors of manuscripts accepted for pub-
lication are required to transfer copyright to Human
Kinetics. The copyright form can be from the journal’s
94  Submission Guidelines
website (http://ijsnem-journal.com) and will also be sent
to the author once a submitted paper is accepted.
Guidelines for Specific Papers
Original Research
Scope.  Original Research papers should cover topics
of novelty and high impact in relation to sport nutrition
or exercise metabolism. Even in cases where research
has been conducted carefully and has been appropriately
written up, a manuscript may be rejected if it is deemed to
be of insufficient interest and quality to attract attention.
Title.  Where possible, the title should be brief but
instructive of the outcome of the study: Example: “Caf-
feine fails to improve 200 m swimming time in elite
swimmers” is preferred to “Effect of caffeine on swim-
ming performance in elite swimmers”
Text.  Length. 3,000 words (excludes title page, abstract,
acknowledgements, references, figures, tables)
Sections. Sections include Introduction, Methods,
Results, and Discussion; each of these sections should
follow the standard processes. Where appropriate, the
text should conclude with two brief sections: novelty
statement (one or two sentences should sum up the new
information that has been gained as a result of the study)
and practical application statement (one or two sentences
should sum up the way that this information could be
put into practice).
Acknowledgements.  Note that the contribution of each
author to the paper should be outlined
References.  A maximum of 40 references can be cited
Figures and Tables.  A total of six figures and/or tables
may be used to illustrate the data in this study. The total
of six assumes no more than one page for each figure. If a
figure has multiple panels requiring more than one page,
the total number of figures should be reduced accord-
ingly. If you feel that additional panels or figures are
needed, please be sure to address this in your cover letter.
Rapid Communication
Scope.  IJSNEM offers the opportunity for highly novel
research data to receive an expedited publication process.
Authors are required to produce succinct manuscripts
of abbreviated length (see instructions below) and to
outline the key reasons that their work should receive
special attention. The Editor or Special Projects Editor
will assess the merits of this case. The work will be
subjected to peer review with a rapid turnaround (2-week
maximum period for each stage) and authors will need to
be willing to attend to any revisions or proofing within a
similar timeframe. On acceptance of publication, Rapid
Communication papers will be granted epub status and
will immediately be moved into production for full pub-
lication in the next journal issue.
Title.  The title should be brief but promote the novel out-
comes of the study. Example: “Caffeine fails to improve
200 m swimming time in elite swimmers” is preferred
to “Effect of caffeine on swimming performance in elite
swimmers”
Text.  Length. 2,000 words (excludes title page, abstract,
acknowledgements, references, figures, tables)
Sections. Sections include Introduction, Methods,
Results, and Discussion; each of these sections should
follow the standard processes. Where appropriate, the
text should conclude with two brief sections: novelty
statement (one or two sentences should sum up the new
information that has been gained as a result of the study)
and practical application statement (one or two sentences
should sum up the way that this information could be
put into practice).
Acknowledgements.  Note that the contribution of each
author to the paper should be outlined.
References.  A maximum of 25 references can be cited.
Figures and Tables.  A total of four figures and/or
tables may be used to illustrate the data in this study.
The total of four assumes no more than one page for
each figure. If a figure has multiple panels requiring
more than one page, the total number of figures should
be reduced accordingly. If you feel that additional panels
or figures are needed, please be sure to address this in
your cover letter.
Case Study
Scope.  The case study should present a novel situation
in which a sport nutrition practitioner has observed a
nutrition challenge in sport or assisted in the implementa-
tion of a nutrition plan to overcome such a challenge. The
aim of a case study publication is to a present a brief but
insightful summary of a unique situation in sport nutri-
tion. Authors should note the requirement that all material
maintain the anonymity of the subject(s).The subject(s)
should have the opportunity to read the case study in its
entirety before giving their written permission for publi-
cation to the authors. Authors should download and use
the consent form to show that they have this permission.
When the authors’ institutions require approval from
their own human ethics committees for the presentation
of such a case study, it should be documented that this
was sought and granted.
Title.  The title should begin with “Case study” and
provide an informative description of the issue that is
covered: Example: “Case study: cyclist with multiple
food intolerances completes 3 week Grand tour event
(Giro D’Italia)”.
Text.  Length. 2,000 words (excludes title page, abstract,
acknowledgements, references, figures, tables)
Authors are encouraged to write objectively in pre-
senting the background, assessments, and nutrition plan

involved in the case but may present their reflections in
an active or first-person form.
Sections.  The following sections are recommended:
Background to issue.  Summary of the topic/sport/
context in which the athlete’s nutritional challenge has
emerged
Examples: Overview of an event or sport, an issue in
a sport (e.g., making weight), or a clinical nutrition issue
(e.g., celiac disease, Type 1 diabetes)
Presentation of athlete/subject  Confidential presenta-
tion of the subject of the case study.
A statement that the subject has provided written
permission for publication of the case study after having
read the paper. Where applicable, there should also be a
statement that the paper has been approved by a human
ethics committee of the authors’ institution(s).
Details of the situation that led to the involvement
of the subject and author(s) in the observation, project,
or collaboration.
Athlete/subject assessment  your cover letter.
Personal and sporting history
Physique and physiological characteristics (as
applicable)
Medical or clinical history (if relevant)
Nutritional assessment and history (as applicable)
Overview of nutrition plan/intervention  Details of
the recommended plan with scientific/nutritional support
for this approach.
Outcome of the implementation of the plan
Reflections
Acknowledgements.  Note that the contribution of each
author to the paper should be outlined
References.  A maximum of 25 references can be cited
Figures and Tables.  A total of four figures and/or tables
may be used to illustrate the data in this study. The total
of four assumes no more than one page for each figure. If
a figure has multiple panels requiring more than one page,
the total number of figures should be reduced accordingly.
If you feel that additional panels or figures are needed,
please be sure to address this in your cover letter.
Scholarly Review
Scope.  IJSNEM publishes scholarly reviews including
narrative reviews and meta-analyses that offer a new
summary or insight into a topic of interest.
Title.  The title should be brief but instructive: Example:
“Dairy protein promotes superior muscle protein syn-
thesis following resistance exercise: a meta-analysis”
is preferred to “The effect of dairy protein on muscle
protein synthesis following resistance exercise”
Submission Guidelines   95
Text.  Length. 5,000 words (excludes title page, abstract,
acknowledgements, references, figures, tables)
Sections.  Section headings should be set according to
the topic and where appropriate, the text should conclude
with two brief sections: novelty statement (one or two sen-
tences should sum up the new information that has been
gained as a result of the review) and practical application
statement (one or two sentences should sum up the way
that this information could be put into practice).
Acknowledgements.  Note that the contribution of
each author to the paper should be outlined
References.  A maximum of 75 references can be cited
Figures and Tables.  A total of eight figures and/or
tables may be used to illustrate the data in this study.
The total of six assumes no more than one page for each
figure. If a figure has multiple panels requiring more
than one page, the total number of figures should be
reduced accordingly. If you feel that additional panels
or figures are needed, please be sure to address this in
Methodology Review
Scope.  IJSNEM publishes reviews regarding methodolo-
gies in sport nutrition research to assist with the design,
implementation, and interpretation of studies in sport
nutrition. These articles will generally be commissioned
from experts in the field, and will provide a commentary
on optimum ways to conduct and report on aspects of sport
nutrition research. All such reviews will undergo the usual
peer-review process. The Special Projects Editor can be
contacted to discuss potential topics of interest.
Methodology Reviews will be made accessible to
readers by open access status on PubMed. They can also
be downloaded from the IJSNEM website here.
Title.  The title should be brief but instructive and
include the words Methodology Review in the title.
Remaining formatting characteristics for Methodol-
ogy Reviews will follow the instructions for Scholarly
Reviews above.
10 Questions; 10 Experts
Scope.  This publication will summarize the outcomes
of symposia delivered at major sports medicine and sport
nutrition conferences following the 10 Questions; 10
Experts format in which a topic of interest is divided into
10 separate questions with a brief answer being provided
by an expert in the field. Publication will require each
expert to present their response within a limit of 300
words plus three citations. The summary will be edited
with a brief introduction and summary provided by the
Chairperson(s) and the sequential presentation of each
expert’s responses. The full manuscript will be subject to
peer review prior to final acceptance, and acknowledge-
ment of the Symposium will be included in the paper.
96  Submission Guidelines
The Special Projects Editor should be contacted to
discuss the potential publication of such a symposium.
Title.  The title should contain the 10 Questions; 10
Experts brief. Example: “10 Questions; 10 Experts:
Timing, type and doses of protein intake to optimise
the benefits of resistance training”
Abstract.  Where possible, the 10 questions should be
outlined in the 250 word abstract.
Text.  Length. 4,000 words (excludes title page,
abstract, acknowledgements, references, figures, tables)
Sections.   Introduction, ten 300-word expert responses
(with the three additional references immediately fol-
lowing), and Summary.
Acknowledgements.  The authors should be listed
in the order of their presentation, with the chairperson(s)
or organiser of the publication being acknowledged as
primary author
Figures and Tables.  A total of six figures and/or
tables may be used, but may not be considered necessary
for this type of presentation. The total of six assumes
no more than one page for each figure. If a figure has
multiple panels requiring more than one page, the total
number of figures should be reduced accordingly. If
authors feel that additional panels or figures are needed,
this should be addressed in the cover letter.
Other 
From time to time, IJSNEM will publish other types of
papers, including invited editorials and special reviews
from conference presentations. In most cases, these pieces
will be commissioned and specific instructions will be
provided to authors for their preparation. All articles will
still be submitted to a peer-review process. The editor or
special projects editor can be contacted regarding such
papers.