Fluid provision during exercise in the heat

Stephen Burns

Environmental Exercise Physiology

SS3111

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 Overview
• Introduction
• Hydration and performance
• Pre-exercise hydration
• Fluid intake during exercise
• Post-exercise rehydration
• Summary
• Recommended reading

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Introduction

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 How much water should an athlete drink?
• 4 glasses per day (1 litre)

• 8 glasses per day (2 litres)

• 12 glasses per day (3 litres)

• 16 glasses per day (4 litres)

• None of the above

How much water do you drink each day?

Reading:
https://www.bbc.com/future/article/20210802-is-
water-always-the-best-choice-on-a-hot-day
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Hydration
• Most exercise recommendations suggest
that athletes should not lose >2% of body
mass during exercise.

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Hydration and performance

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 Hydration and work performance
• Hypohydration degrades work performance in men
wearing protective clothing in the heat.

• Hypohydration increases rectal temperature, heart

rate and decreases tolerance time regardless of
acclimation state in both moderately-fit and
highly-fit men.

Note: Data show moderately fit men (maximum oxygen uptake

(VO2max) <50 ml/kg/min) and highly fit men (VO2max >55
ml/kg/min) undertaking light exercise in the heat (40°C) whilst
wearing nuclear, biological and chemical protective clothing in
either a euhydrated or hypohydrated (~2.5% of body mass)
condition. Tests were conducted 2-weeks before and after daily
heat acclimation exercise.
Cheung et al, Journal of Applied Physiology, 84:1731-1739, 1998
 Hydration and aerobic exercise performance
Shirreffs & Sawka, J Sports Sci, 29(S1):S39-S46, 2011
(From IOC Consensus Conference 2010) citing Kenefick
et al., J Appl Physiol, 109:79-86, 2010.
• Hypohydration degrades aerobic exercise
performance.
• Hypohydration increases heat storage and reduces
ability to tolerate exercise-induced heat strain.
• High skin blood flow and plasma volume reductions
appear to mediate performance degradations.
• One meta-analysis concluded that pre-exercise
hypohydration reduces mean power output by 3.2%
in comparison with control trials.
Note: Four groups of men completed constant intensity (50% VO2max) cycle
ergometer exercise followed by a time trial in conditions of 10, 20, 30 or 40°C
either euhydrated or hypohydrated. There was little effect on core temperature
but a stepwise effect on skin temperature.Data show percentage decrement in
time trial performance from euhydration.
 Hydration and strength performance

• There is evidence to demonstrate that

performance in some strength/power
activities is also compromised when
poorly hydrated (2.5 – 5.0%).

Note: Data from seven healthy men who

completed resistance exercise euhydrated, 2.5%
dehydrated or 5% dehydrated. ##Different
between euhydrated and both hypohydrated
Judelson et al, Medicine and Science in Sports and Exercise, 39:1817-1824, 2007. trials. *Different between euhydrated and HY50.
Pre-exercise hydration

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Hydration and work performance
• Pre-exercise hyperhydration (saline) does not appear
to reduce physiological stress, increase exercise
duration, or influence perceptual strain compared
with euhydration in moderately fit individuals
wearing personal protective equipment (firefighters).

because increase urine output

Note: Data from 10 individuals (8 M, 2F) who completed treadmill

exercise whilst wearing personal protective equipment in a euhydrated
state or after pre-hydrating with 15 mL/kg of body weight of 0.9% saline
given intravenously.

(Hostler et al, European Journal of Applied Physiology, 105:607-613, 2009)

 Glycerol and plasma expanders
• Athletes may attempt to hyperhydrate before
exercise in hot conditions where the rates of sweat
loss or restrictions on fluid intake inevitably lead to
significant fluid deficit.

• Glycerol is a molecule which when ingested is

absorbed and increases the concentration
(osmolarity) of the fluid in the blood and tissues.

• The concentration of these fluids is held constant by

the body, so water consumed with the glycerol is not
excreted until the extra glycerol is either removed by
the kidneys or broken down by the body.
(Goulet et al, International Journal of Sport Nutrition
and Exercise Metabolism, 17:391-410, 2007)
 Glycerol and performance
Note: Data from six cyclists who
hyperhydrated with glycerol and
water for 80 mins (PEH) or
remained euhydrated (PEE) and
then completed 2 h steady-state
cycling interspersed with sprints
followed by a time-trial
performance test.

(Goulet et al, Journal of Physiological Anthropology, 27:263-271, 2008)

• Glycerol is able to increase plasma volume, decrease urine volume and improve endurance capacity, time
trial performance and total power and work output.

• Concerns that the haemodilution associated with the fluid retention in the vascular space may be sufficient
to mask illegal doping practices by athletes meant that glycerol and other plasma expanders were
prohibited by the World Anti-Doping Agency from 1st January, 2010.
 Hyperhydration using water

• Pre-exercise hyperhydration with water does not

increase fluid volume substantially as there is a
greater urine output.

• Subsequently, there appears to be no effect on

performance with pre-exercise water
hyperhydration.

• Attempts to hyperhydrate with water may be

dangerous and lead to hyponatraemia.

Note: Data from 11 individuals who hyperhydrated with water or

glycerol over 150 mins pre-exercise, dehydrated during exercise over 120
mins, and then rehydrated with water or glycerol over 90mins.
(Magal et al, Medicine and Science in Sports and Exercise,
35:150-156, 2003)
 Recommendations for pre-exercise fluid intake

• “Athletes may achieve euhydration before exercise by consuming a fluid volume equivalent
to 5 to 10 mL/kg BW in the 2 to 4 hours before exercise to achieve urine that is pale yellow in
color while allowing for sufficient time for excess fluid to be voided.”
(Position Paper: Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of
Sports Medicine. Journal of the Academy of Nutrition and Dietetics. 501-528, 2016)

• “Endurance athletes should strive to start exercise well hydrated, which can be achieved by
keeping thirst sensation low and urine color pale and drinking approximately 5–10 mL/kg
body weight of water 2 h before exercise.”
(Goulet, Nutrition Reviews, 70(S2):S132-S136, 2012)
Fluid intake during exercise

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 Fluid replacement and performance

• Sports drinks can improve exercise

capacity in the heat.

• Note that this may be as much from

carbohydrate intake as fluid
replacement.

(Maughan RJ and Shirreffs SM In: Physiological Bases of Sports

Performance. Editors: Hargreaves M, Hawley J. 2003. McGraw-Hill.
Chapter 4: Thermoregulation and Fluid Balance. Pg.72.)
 Recommendations for drinking during exercise
SAD-SSD
• “Sufficient fluid should be consumed during exercise to limit dehydration to less than about 2% of body
mass…sodium should be included when sweat losses are high, especially if exercise lasts more than
about 2 h. Athletes should not drink so much that they gain weight during exercise. During recovery
from exercise, rehydration should include replacement of both water and salts lost in sweat.”
(Shirreffs & Sawka, Journal of Sports Sciences, 29(S1):S39-S46, 2011 – Statements taken from IOC Consensus
Conference 2010 and citing 2004 Consensus Statement)

• “Sodium should be included in fluids consumed during exercise if the exercise lasts more than 2 h. It
should also be included in fluids consumed by individuals in any event who lose more than 3–4 g of
sodium in their sweat.”
(Coyle, Journal of Sports Sciences, 22:39-55, 2004)

• “Ideally, athletes should drink sufficient fluids during exercise to replace sweat losses such that the
total body fluid deficit is limited to <2% BW…..Sodium should be ingested during exercise when large
sweat sodium losses occur. Scenarios include athletes with high sweat rates (>1.2 L/h), salty sweat, or
prolonged exercise exceeding 2 hours in duration.”
(Position Paper: Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports
Medicine. Journal of the Academy of Nutrition and Dietetics. 501-528, 2016)
 ACSM - 1996 Position Stand Controversy
“During exercise, athletes should start drinking early and at regular intervals in an attempt to
consume fluids at a rate sufficient to replace all the water lost through sweating (i.e., body weight
loss), or consume the maximal amount that can be tolerated.”

(American College of Sports Medicine Position Stand: Exercise and Fluid Replacement, 28(1):i-viii, 1996)
Post-exercise rehydration

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 Post-exercise rehydration

(Maughan et al, British Journal of Sports Medicine, 31:175-182, 1997)

Note: Data from men who dehydrated by ~2% body weight during exercise and then rehydrated with a fluid portions
equivalent to 1.5 times the mass lost.

• There is a direct relationship between the sodium concentration of a drink and the fluid retained post-
exercise.
 Food versus fluid

(Maughan et al, British Journal of Sports Medicine, 31:175-182, 1997)

• In most instances there is sufficient recovery time between exercise bouts for athletes to rehydrate
slowly through the intakes of fluids (water) and foods.

• A meal with water is more effective than a sports drink with the same volume of fluid for post-exercise
rehydration probably because of the greater electrolyte (cations Na+ and K+) content.
 Milk for post-exercise rehydration
Note: Individuals dehydrated to
1.8% of body mass in a warm
environment and then
rehydrated with a fluid volume
equivalent to 150% of mass
lost.
• Closed circles:water
• Open circles: carbohydrate-
electrolyte sports drink
• Closed triangles: milk
• Open triangles: milk with
added sodium

(Shirreffs et al, British Journal of Nutrition, 98:173-180, 2007)

• It is difficult to infuse sports drinks with a high sodium concentration because of palatability issues.

• Milk is a potential candidate for an effective post-exercise solution, as it has a naturally high electrolyte
content (~sodium 40 mmol/L), contains carbohydrate similar to many commercially available sports drinks and
is a source of protein and calcium.

• Whilst milk is a palatable drink, there may be issues with milk in lactose intolerant groups.
 Alcohol and rehydration
Note: Individuals exercised
and then rehydrated with a
fluid volume equivalent to
150% of mass lost.
• Squares: 0% alcohol
• Diamonds: 1% alcohol
• Circles: 2% alcohol
• Triangles: 4% alcohol

(Shirreffs & Maughan, Journal of Applied Physiology, 83:1152-1158, 1997)

• Alcohol has a negligible diuretic effect when consumed in dilute solution after a moderate level of
hypohydration (loss of 2% body mass) induced by exercise in the heat.

• There is no difference in alcohol free beverage with 2% alcohol drinks for rehydration, but drinks containing 4%
alcohol tend to delay recovery.
increase in CUSM

• However, alcohol increases calorie load, suppresses fat oxidation, increases unplanned food consumption and
may compromise achievement of body composition goals.
 Caffeine and rehydration
• Despite popular assertions, daily caffeine intake
of <300 mg induces only a mild diuresis similar to
water, with no evidence of any fluid-electrolyte
imbalances detrimental to health or exercise
performance when a normal diet is consumed.

• In one review, 12 of 15 studies involving caffeine

(100-680 mg) versus water or placebo found no
statistical difference in urine volume.

Note: Investigations A-F show rest. Investigations G and H are rehydration

after post-exercise dehydration. Investigation I shows 4 hours of cycling
only.
CB, caffeinated beverage

(Armstrong, International Journal of Sports Nutrition and Exercise Metabolism, 12:189-206, 2002)
 Menstrual cycle and rehydration

(Maughan et al, British Journal of Sports Medicine, 31:175-182, 1997)

Note: Women exercised in the heat and dehydrated by 1.8% body mass before rehydrating fluid volumes equivalent to 150% of mass
lost.
• There is concern over whether the cyclical changes in steroid hormones that occur with the menstrual cycle
may influence fluid balance.

• Published data suggest that in regularly menstruating women there is little influence of these hormones on
fluid restoration/urine volume after exercise-induced sweat loss in the heat.
 Recommendations for post-exercise fluid intake
• “After exercise that has resulted in body mass loss due to sweat loss, water and sodium should be
consumed in a quantity greater than those in the losses to optimize recovery of water and electrolyte
balance.”
(Shirreffs et al, Journal of Sports Sciences, 22:57-63, 2004)

• “Most athletes finish exercising….may need to restore euhydration during the recovery period.
Rehydration strategies should primarily involve the consumption of water and sodium at a modest rate
…..The presence of dietary sodium/sodium chloride (from foods or fluids) helps to retain ingested fluids,
especially extracellular fluids, including plasma volume. Therefore, athletes should not be advised to
restrict sodium in their postexercise nutrition...Because sweat losses and obligatory urine losses
continue during the postexercise phase, effective rehydration requires the intake of a greater volume of
fluid (eg, 125% to 150%) than the final fluid deficit (eg, 1.25 to 1.5 L fluid for every 1 kg BW lost).
Excessive intake of alcohol in the recovery period is discouraged due to its diuretic effects. However, the
previous warnings about caffeine as a diuretic appear to be overstated when it is habitually consumed
in moderate (e.g., <180 mg) amounts.”
(Position Paper: Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports
Medicine. Journal of the Academy of Nutrition and Dietetics. 501-528, 2016)
 Summary I
• How much individuals should drink each day is dependent on the exercise they perform.

• Hypohydration degrades work tolerance in protective clothing, and aerobic and strength
exercise performance in many laboratory-based studies.

• Hyperhydrating before exercise using glycerol or other plasma expanders is effective and can
improve performance but concerns over their misuse in relation to illegal doping practices has
led to their prohibition by WADA.

• Athletes should consume 5 to 10 mL/kg BW of fluid in the 2 to 4 hours before exercise training
to ensure adequate hydration.

• The intake of fluids during exercise can improve exercise performance. Sports drinks may be
suitable.

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 Summary II
• Recommendations suggest athletes should try to limit fluid losses during exercise in the heat to
<2% of body mass.

• Post-exercise, athletes should rehydrate adequately before their next exercise training session
or competition.

• Food with water is ideal for rehydration purposes but a sports drink equivalent to 150% of the
fluid lost during exercise can also be used if food is not available.

• Milk may be a good rehydration fluid in lactose tolerant individuals.

• Mild alcohol intake does not impair post-exercise rehydration but athletes should avoid alcohol
for the other negative effects associated with its consumption.

• The menstrual cycle does not appear to affect post-exercise fluid restoration.

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 Recommended reading
• Exercise Physiology: Energy, Nutrition and Human Performance. McArdle WD, Katch FI,
Katch VL 8th Edition, 2015. Lippincott Williams and Wilkins. Chapter 25: Exercise and
Thermal Stress. Pgs. 615-642.

• Exercise Physiology: Theory and Application to Fitness and Performance. Powers SK, Howley
WT. 8th Edition, 2012. McGraw-Hill. Chapter 12: Temperature Regulation. Pgs.261-280.

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