Fluid Balance and Performance Are Improved with Ad Libitum

Carbohydrate-Electrolyte Beverage Intake in the Heat

Johannsen 1,2
NM , Buyckx 3
M, Cocreham 2
S, Earnest CP, Kramer 2
K, Lupo 2
M, Rodarte 2
RQ , Staten 3
R, and Church TS 2
1 Louisiana State University, Baton Rouge, LA; 2Pennington Biomedical Research Center, Baton Rouge, LA; 3The Coca-Cola Company, Atlanta, GA

Abstract
Fluid balance (FB) in long-duration exercise is vital to maintain optimal performance. Carbohydrate-electrolyte (CE) beverage intake has been shown to improve exercise
performance likely due to exogenous carbohydrate intake. Whether ad libitum CE beverages alter fluid balance and performance in an adequately-powered, placebo-

†‡
controlled study has not been investigated. PURPOSE: The APEX (Ad libitum fluid intake and Performance EXercise) study examined whether ad libitum fluid intake and
performance are improved with CE beverage intake compared with water (WATER) and a color/flavor-matched, non-caloric placebo (PLA). METHODS: Seventeen healthy,

* †‡#
trained men (age=25±4y, VO2peak=53.3±6.8mL·kg-1·min-1; mean±SD) were randomized in a double-blind, crossover manner to three, 2-hour steady-state (SS) cycling
sessions at 68.4±9.3% VO2peak in the heat (WBGT=24.4±1.7˚C). Immediately after SS, participants completed a 30min performance test. Beverages during SS were
served cool (10˚C) and drinking behavior was monitored by bottle weight changes after each drink. RESULTS: Total fluid intake (1952±674g) and fluid balance (-
0.88±0.68kg) were improved with CE compared to WATER (1625±559g and -1.20±0.46kg, resp) and PLA (1682±590g and -1.14±0.65kg; treatment P<0.001 and <0.004,
*
resp) at the end of SS. Greater fluid intake was especially noted during the last hour of exercise for CE (90min vs. WATER (P=0.001) and PLA (P<0.001); 120min vs.
WATER (P=0.01) and PLA (P=0.02)). Urine outputs (P=0.93) and sweat rates (P=0.93) during SS were similar across all treatments. Plasma osmolality was higher after
90min in CE compared to WATER and after 120min compared to WATER and PLA (all P<0.05; interaction P<0.08). Perceived thirst responses were similar across all
treatments (interaction P=0.76). Deuterium oxide accumulation during the first 30min of exercise was similar in CE compared to WATER and PLA (interaction P=0.30).
Physical performance (total work) was 13% and 9% higher with CE (351±79kJ) compared to WATER (312±80kJ; P<0.001) and PLA (322±84kJ; P<0.001). CONCLUSION:
CE promotes greater fluid intake without compromising overall gastric uptake. Greater fluid intake in CE may be a compensatory mechanism to normalize perceived thirst
despite higher plasma osmolality levels. Funded by The Coca-Cola Company NCT01893853

Introduction
• Fluid balance in long-duration exercise is vital for optimal performance.
• Carbohydrate-electrolyte beverages (CES) have been shown to
improve performance during exercise in the heat.
• Whether ad libitum CES intake during 2 hours of exercise in the heat
promotes improves fluid balance and subsequent performance Fluid balance (change in body weight; mean±SD) after 2 h of steady-state exercise heated Total fluid intake (mean±SD) during 2 h of steady-state exercise in a heated environment. WATER,
environment. WATER, water; PLA,
Table 2. placebo;
Drinking CES, carbohydrate-electrolyte
Behavior beverage.
during 2 h of steady-state Treatment
exercise at ~70% VOwater; PLA, placebo; CES, carbohydrate-electrolyte beverage. Treatment effect; P<0.001.
2peak in the heat.
compared with ad libitum water (WATER) or color- and flavor-matched, effect; P<0.004. Plasma osmolality (mean±SD) responses during 2 h of steady-state exercise ~in a heated
environment. WATER, water; PLA, placebo; CES, carbohydrate-electrolyte beverage; *P<0.05 vs.
non-caloric, electrolyte-free placebo (PLA) has not been studied. Drinking behavior during 2 h of steady-state exercise in the heat. baseline; †P<0.05 vs. 30 min; ‡ P<0.05 vs. WATER; #P<0.05 vs. PLA.
P value
The purpose of the Ad libitum fluid intake and Performance EXercise Treatment
(APEX) study was to determine whether: mean±SD WATER PLA CES Treatment Time x Time
Drink Volume (g)
1. CES during 2 hours of exercise in the heat improves fluid balance by
increasing ad libitum fluid intake compared to WATER and PLA.
0-30 min 470.1 ± 71.7 465.5 ± 73.1 463.9 ± 69.7 <0.001 0.17 <0.07
#
31-60 min 328.4 ± 244.9 393.4 ± 272.6 450.6 ± 249.9* CES>WATER,PLA
2. CES improves physical performance in a 30 minute subsequent 61-90 min 380.4 ± 202.2 369.3 ± 185.8 500.1 ± 266.1*
† †
†
exercise bout compared to WATER and PLA 91-120 min 446.2 ± 186.3 453.7 ± 215.0 537.1 ± 236.4*

3. CES alters physiological and/or behavioral mechanisms known to alter

Volume per Drink (g)
drinking behavior. 0-30 min N/A N/A N/A
31-60 min 101.8 ± 57.5 120.7 ± 74.2 126.8 ± 66.6 0.07 0.20 0.60
Methods 61-90 min 131.0 ± 84.2 126.1 ± 52.2 147.3 ± 85.8 CES>WATER
91-120 min 119.4 ± 57.9 122.4 ± 57.2 144.6 ± 75.4
Experimental Design (see figure below):
Healthy (n=17) trained men (age=25.4±4y; VO2peak=53.3±6.8mL/kgmin; Number of Drinks
mean±SD) from the APEX study participated in 3 intervention trials in a 0-30 min N/A N/A N/A
31-60 min 2.9 ± 1.9 3.2 ± 1.8 3.5 ± 1.7 0.38 <0.008 0.67
randomized, double-blind, counter-balanced, cross-over design. Each
61-90 min 3.2 ± 1.3 3.2 ± 1.6 3.8 ± 1.8 120>60,90min
intervention trial consisted of 2 hours of exercise on a cycle ergometer at Ratings of perceived thirst (mean±SD) during 2 h of steady-state exercise in a heated
91-120 min 4.1 ± 1.8 4.1 ± 2.1 4.1 ± 1.7 environment. WATER, water; PLA, placebo; CES, carbohydrate-electrolyte beverage; †P<0.05 vs.
68.4±9.3% VO2peak followed by a 30-minute physical performance test WATER,water;
WATER, water;PLA,
PLA,placebo;
calorie CES,
and electrolyte-free, beverage.
colored, flavored
carbohydrate-electrolyte *P<0.05CES,
placebo; vs. WATER; †P<0.05 vs. PLA.
commercially- PLA; #P<0.05 vs. 30 and 60 min.
in the heat (WBGT=24.4±1.7C). Fluid intake was measured by bottle available carbohydrate-electrolyte beverage. *P<0.05 vs. WATER; †P<0.05 vs. PLA.
weight change on an electronic scale after each drink. Conclusions
Intervention Trials; Ad libutum fluid intake throughout exercise:
WATER: Commercially-available, electrolyte-free water Methods CES promotes improved fluid balance compared with WATER and PLA:
• Total fluid intake was greater in CES compared to WATER and PLA.
PLA: Color- and flavor-matched, non-caloric, electrolyte-free placebo
• CES does not slow gastric uptake compared to WATER or PLA.
CES: Commercially-available, carbohydrate-electrolyte beverage • Trend for a treatment x time interaction (P<0.07) for drink volume across
Experimental protocol. 30 min time periods with higher volumes in CES suggestive of altered
drinking behavior despite reduced perceptions of thirst.
• The changes in drinking behavior with CES may be partially due to higher
plasma osmolality; a known regulator of thirst.
• Sweat rates (P=0.92) and urine outputs (P=0.54) were similar across
treatments.
CES improves physical performance during a 30 minute time trial.
• Total work was 14.2% (95% CI; 6.8%, 21.7%) and 10.4% (95%CI; 4.8%,
16.0%) greater in CES compared to WATER and PLA, respectively.
• We are unable to determine the individual effects of fluid balance and
Plasma D2O enrichment (mean±SD) during the initial 30 min of exercise in a heated environment Total work accumulated (mean±SD) during the 30 min performance trial. WATER, water; PLA,
after a bolus of the experimental beverage (6ml/kg body weight). WATER, water; PLA, placebo; placebo; CES, carbohydrate-electrolyte beverage. Treatment effect, P<0.001. carbohydrate/electrolyte intake on physical performance.
CES, carbohydrate-electrolyte beverage.

This study was funded by The Coca-Cola Company, Atlanta, GA.