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Wearable sensors for monitoring the physiological and biochemical profile of the athlete. NPJ Digit Med 2019; 2:72. [PMID: 31341957 PMCID: PMC6646404 DOI: 10.1038/s41746-019-0150-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
Athletes are continually seeking new technologies and therapies to gain a competitive edge to maximize their health and performance. Athletes have gravitated toward the use of wearable sensors to monitor their training and recovery. Wearable technologies currently utilized by sports teams monitor both the internal and external workload of athletes. However, there remains an unmet medical need by the sports community to gain further insight into the internal workload of the athlete to tailor recovery protocols to each athlete. The ability to monitor biomarkers from saliva or sweat in a noninvasive and continuous manner remain the next technological gap for sports medical personnel to tailor hydration and recovery protocols per the athlete. The emergence of flexible and stretchable electronics coupled with the ability to quantify biochemical analytes and physiological parameters have enabled the detection of key markers indicative of performance and stress, as reviewed in this paper.
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Belval LN, Hosokawa Y, Casa DJ, Adams WM, Armstrong LE, Baker LB, Burke L, Cheuvront S, Chiampas G, González-Alonso J, Huggins RA, Kavouras SA, Lee EC, McDermott BP, Miller K, Schlader Z, Sims S, Stearns RL, Troyanos C, Wingo J. Practical Hydration Solutions for Sports. Nutrients 2019; 11:nu11071550. [PMID: 31324008 PMCID: PMC6682880 DOI: 10.3390/nu11071550] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Personalized hydration strategies play a key role in optimizing the performance and safety of athletes during sporting activities. Clinicians should be aware of the many physiological, behavioral, logistical and psychological issues that determine both the athlete’s fluid needs during sport and his/her opportunity to address them; these are often specific to the environment, the event and the individual athlete. In this paper we address the major considerations for assessing hydration status in athletes and practical solutions to overcome obstacles of a given sport. Based on these solutions, practitioners can better advise athletes to develop practices that optimize hydration for their sports.
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Affiliation(s)
- Luke N Belval
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27402, USA
| | | | - Lindsay B Baker
- Gatorade Sports Science Institute, Barrington, IL 60010, USA
| | - Louise Burke
- Sports Nutrition, Australian Institute of Sport, Canberra, ACT 2617, Australia
| | | | | | - José González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge UB8 3PH, UK
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Stavros A Kavouras
- Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Elaine C Lee
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Brendon P McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA
| | - Kevin Miller
- Department of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA
| | - Zachary Schlader
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Stacy Sims
- Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton 3216, New Zealand
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Chris Troyanos
- International Institute of Race Medicine, Plymouth, MA 02360, USA
| | - Jonathan Wingo
- Department of Kinesiology, University of Alabama, Tuscaloosa, AL 35487, USA
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Hew-Butler T, Smith-Hale V, Pollard-McGrandy A, VanSumeren M. Of Mice and Men-The Physiology, Psychology, and Pathology of Overhydration. Nutrients 2019; 11:nu11071539. [PMID: 31284689 PMCID: PMC6682940 DOI: 10.3390/nu11071539] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 12/20/2022] Open
Abstract
The detrimental effects of dehydration, to both mental and physical health, are well-described. The potential adverse consequences of overhydration, however, are less understood. The difficulty for most humans to routinely ingest ≥2 liters (L)-or "eight glasses"-of water per day highlights the likely presence of an inhibitory neural circuit which limits the deleterious consequences of overdrinking in mammals but can be consciously overridden in humans. This review summarizes the existing data obtained from both animal (mostly rodent) and human studies regarding the physiology, psychology, and pathology of overhydration. The physiology section will highlight the molecular strength and significance of aquaporin-2 (AQP2) water channel downregulation, in response to chronic anti-diuretic hormone suppression. Absence of the anti-diuretic hormone, arginine vasopressin (AVP), facilitates copious free water urinary excretion (polyuria) in equal volumes to polydipsia to maintain plasma tonicity within normal physiological limits. The psychology section will highlight reasons why humans and rodents may volitionally overdrink, likely in response to anxiety or social isolation whereas polydipsia triggers mesolimbic reward pathways. Lastly, the potential acute (water intoxication) and chronic (urinary bladder distension, ureter dilation and hydronephrosis) pathologies associated with overhydration will be examined largely from the perspective of human case reports and early animal trials.
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Affiliation(s)
- Tamara Hew-Butler
- Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, USA.
| | - Valerie Smith-Hale
- Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, USA
| | - Alyssa Pollard-McGrandy
- Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, USA
| | - Matthew VanSumeren
- Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, USA
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Knechtle B, Chlíbková D, Nikolaidis PT. [Exercise-Associated Hyponatremia in Endurance Performance]. PRAXIS 2019; 108:615-632. [PMID: 31288661 DOI: 10.1024/1661-8157/a003261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen Am Vadianplatz, St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich, Zürich
| | - Daniela Chlíbková
- 3 Centre of Sports Activities, Brno University of Technology, Brno, Tschechien
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55
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Pomeranz D, Irwin C, Lipman GS. Large-Volume Hypertonic Saline for Empiric Treatment of Severe Exercise-Associated Hyponatremia in an Ultramarathon Runner. Curr Sports Med Rep 2019; 18:163-165. [DOI: 10.1249/jsr.0000000000000593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Ultramarathon running events and participation numbers have increased progressively over the past three decades. Besides the exertion of prolonged running with or without a loaded pack, such events are often associated with challenging topography, environmental conditions, acute transient lifestyle discomforts, and/or event-related health complications. These factors create a scenario for greater nutritional needs, while predisposing ultramarathon runners to multiple nutritional intake barriers. The current review aims to explore the physiological and nutritional demands of ultramarathon running and provide general guidance on nutritional requirements for ultramarathon training and competition, including aspects of race nutrition logistics. Research outcomes suggest that daily dietary carbohydrates (up to 12 g·kg-1·day-1) and multiple-transportable carbohydrate intake (∼90 g·hr-1 for running distances ≥3 hr) during exercise support endurance training adaptations and enhance real-time endurance performance. Whether these intake rates are tolerable during ultramarathon competition is questionable from a practical and gastrointestinal perspective. Dietary protocols, such as glycogen manipulation or low-carbohydrate high-fat diets, are currently popular among ultramarathon runners. Despite the latter dietary manipulation showing increased total fat oxidation rates during submaximal exercise, the role in enhancing ultramarathon running performance is currently not supported. Ultramarathon runners may develop varying degrees of both hypohydration and hyperhydration (with accompanying exercise-associated hyponatremia), dependent on event duration, and environmental conditions. To avoid these two extremes, euhydration can generally be maintained through "drinking to thirst." A well practiced and individualized nutrition strategy is required to optimize training and competition performance in ultramarathon running events, whether they are single stage or multistage.
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57
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Oh RC, Malave B, Chaltry JD. Collapse in the Heat - From Overhydration to the Emergency Room - Three Cases of Exercise-Associated Hyponatremia Associated with Exertional Heat Illness. Mil Med 2019; 183:e225-e228. [PMID: 29365179 DOI: 10.1093/milmed/usx105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022] Open
Abstract
Exertional heat illness and exercise-associated hyponatremia continue to be a problem in military and recreational events. Symptoms of hyponatremia can be mistaken for heat exhaustion or heat stroke. We describe three cases of symptomatic hyponatremia initially contributed to heat illnesses. The first soldier was a 31-yr-old female who "took a knee" at mile 6 of a 12-mile foot march. She had a core temperature of 100.9°F, a serum sodium level of 129 mmol/L, and drank approximately 4.5 quarts of water in 2 h. The second case was a 27-yr-old female soldier who collapsed at mile 11 of a 12-mile march. Her core temperature was 102.9°F and sodium level was 131 mmol/L. She drank 5 quarts in 2.5 h. The third soldier was a 27-yr-old male who developed nausea and vomiting while conducting an outdoor training event. His core temperature was 98.7°F and sodium level was 125 mmol/L. He drank 6 quarts in 2 h to combat symptoms of heat. All the three cases developed symptomatic hyponatremia by overconsumption of fluids during events lasting less than 3 h. Obtaining point-of-care serum sodium may improve recognition of hyponatremia and guide management for the patient with suspected heat illness and hyponatremia. Depending on severity of symptoms, exercise-associated hyponatremia can be managed by fluid restriction, oral hypertonic broth, or with intravenous 3% saline. Utilizing an ad libitum approach or limiting fluid availability during field or recreational events of up to 3 h may prevent symptomatic hyponatremia while limiting significant dehydration.
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Affiliation(s)
- Robert C Oh
- Department of Family Medicine, Martin Army Community Hospital, Fort Benning, GA 31905
| | - Bryan Malave
- Department of Family Medicine, Martin Army Community Hospital, Fort Benning, GA 31905
| | - Justin D Chaltry
- Department of Family Medicine, Martin Army Community Hospital, Fort Benning, GA 31905
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58
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Heled Y, Yarom Y, Epstein Y. Hyponatremia Following a Marathon, A Multifactorial Case with over Infusion of Fluids. Curr Sports Med Rep 2019; 18:115-117. [DOI: 10.1249/jsr.0000000000000580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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59
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Ayus JC, Moritz ML. Misconceptions and Barriers to the Use of Hypertonic Saline to Treat Hyponatremic Encephalopathy. Front Med (Lausanne) 2019; 6:47. [PMID: 30931308 PMCID: PMC6428704 DOI: 10.3389/fmed.2019.00047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Hyponatremic encephalopathy is a potentially life-threatening condition with a high associated morbidity and mortality. It can be difficult to diagnose as the presenting symptoms can be non-specific and do not always correlate with the degree of hyponatremia. It can rapidly progress leading to death from transtentorial herniation. Hypertonic saline is the recommended treatment for hyponatremic encephalopathy, whether acute or chronic, yet it is infrequently used. We believe that the main barriers to its use is the perception that hypertonic saline is associated with a significant risk for cerebral demyelination, that it can't be administered through a peripheral IV and that it requires monitoring in the ICU. Two illustrative cases are presented followed by a discussion of how intermittent bolus's of 100−150 ml of 3% NaCl in rapid succession to acutely increase the plasma sodium by 4−6 mEq/L is a safe and effective way to treat hyponatremic encephalopathy, that can be administered through a peripheral IV in a non-ICU setting.
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Affiliation(s)
- Juan Carlos Ayus
- Renal Consultants of Houston, Houston, TX, United States.,Division of Nephrology, School of Medicine Irvine, University of California, Irvine, Irvine, CA, United States
| | - Michael L Moritz
- Division of Nephrology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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60
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Abstract
The syndrome of inappropriate antidiuresis (SIAD) is a common cause of hyponatremia in hospitalized children. SIAD refers to euvolemic hyponatremia due to nonphysiologic stimuli for arginine vasopressin production in the absence of renal or endocrine dysfunction. SIAD can be broadly classified as a result of tumors, pulmonary or central nervous system disorders, medications, or other causes such as infection, inflammation, and the postoperative state. The presence of hypouricemia with an elevated fractional excretion of urate can aid in the diagnosis. Treatment options include fluid restriction, intravenous saline solutions, oral sodium supplements, loop diuretics, oral urea, and vasopressin receptor antagonists (vaptans).
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Affiliation(s)
- Michael L Moritz
- Pediatric Nephrology, Pediatric Dialysis, Division of Nephrology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, The University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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61
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Chlíbková D, Nikolaidis PT, Rosemann T, Knechtle B, Bednář J. Maintained Hydration Status After a 24-h Winter Mountain Running Race Under Extremely Cold Conditions. Front Physiol 2019; 9:1959. [PMID: 30687135 PMCID: PMC6336898 DOI: 10.3389/fphys.2018.01959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022] Open
Abstract
Background: To date, no study has examined the hydration status of runners competing in a 24-h winter race under extremely cold environmental conditions. Therefore, the aim was to examine the effect of a 24-h race under an average temperature of -14.3°C on hydration status. Methods: Blood and urine parameters and body mass (BM) were assessed in 20 finishers (women, n = 6; men, n = 14) pre- and post-race. Results: Five (25%) ultra-runners had lower pre-race plasma sodium [Na+] and 11 (52%) had higher pre-race plasma potassium [K+] values than the reference ranges. Post-race plasma [Na+], plasma osmolality, urine osmolality and urine specific gravity remained stable (p > 0.05). The estimated fluid intake did not differ (p > 0.05) between women (0.30 ± 0.06 L/h) and men (0.46 ± 0.21 L/h). Runners with a higher number of completed ultra-marathons (r = -0.50, p = 0.024) and higher number of training kilometers (r = -0.68, p = 0.001) drank less than those with lower running experience. Pre-race and post-race plasma [Na+] were related to plasma osmolality (r = 0.65, p = 0.002, r = 0.69, p < 0.001, respectively) post-race, but not to fluid intake (p > 0.05). BM significantly decreased post-race (p = 0.002) and was not related to plasma [Na+] or fluid intake (p > 0.05). Post-race hematocrit and plasma [K+] decreased (p < 0.001) and transtubular potassium gradient increased (p = 0.008). Higher pre-race plasma [K+] was related to higher plasma [K+] loss post-race (p = -0.85, p < 0.001). Conclusion: Hydration status remained stable despite the extremely cold winter weather conditions. Overall fluid intake was probably sufficient to replenish the hydration needs of 24-h runners. Current recommendations may be too high for athletes competing in extremely cold conditions.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | | | | | - Beat Knechtle
- Exercise Physiology Laboratory, Nikaia, Greece.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Josef Bednář
- Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czechia
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Nolte HW, Nolte K, Hew-Butler T. Ad libitum water consumption prevents exercise-associated hyponatremia and protects against dehydration in soldiers performing a 40-km route-march. Mil Med Res 2019; 6:1. [PMID: 30678725 PMCID: PMC6346586 DOI: 10.1186/s40779-019-0192-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It remains unclear if ad libitum water drinking, as a hydration strategy, prevents exercise-associated hyponatremia (EAH) during prolonged exercise. The aim of this study was to determine the incidence of EAH within the broader context of fluid regulation among soldiers performing a 40-km route-march ingesting water ad libitum. METHODS Twenty-eight healthy male soldiers participated in this observational trial. Pre- and post-exercise body mass, blood and urine samples were collected. Blood samples were assessed for serum sodium ([Na+]), glucose, creatinine, urea nitrogen (BUN), plasma osmolality, creatine kinase (CK), and plasma arginine vasopressin (AVP) concentrations. Plasma volume (PV) was calculated using hematocrit and hemoglobin. Urine samples were analyzed for osmolality and [Na+]. Water intake was assessed by weighing bottles before, during and after the march. The mean relative humidity was 55.7% (21.9-94.3%) and the mean dry bulb temperature was 27.1 °C (19.5 °C - 37.0 °C) during the exercise. RESULTS Twenty-five soldiers (72 ± 10 kg) (Mean ± SD) completed the march in 09:11 ± 00:43 (hr:min). Participants consumed 736 ± 259 ml/h of water and lost 2.8 ± 0.9 kg (4.0% ± 1.4%, P < 0.05) of body mass. Significant (pre-march vs. post-march; P < 0.05) decreases in serum [Na+] (141 mmol/L vs. 136 mmol/L), plasma osmolality (303 mOsmol/kg H2O vs. 298 mOsmol/kg H2O), and serum creatinine (111 μmol/L vs. 101 μmol/L) and urine [Na+] (168 mmol/L vs. 142 mmol/L), as well as significant increases in plasma AVP (2 pg/ml vs. 11 pg/ml), plasma CK (1423 U/L vs. 3894 U/L) and urine osmolality (1035 mOsmol/kg H2O vs. 1097 mOsmol/kg H2O) were found. The soldier (72 kg) with the lowest post-exercise sodium level completed the march in 08:38. He drank 800 ml/h, lost 2% body mass, and demonstrated (pre-post) increases in plasma osmolality (294-314 mOsmol/kg H2O), BUN (20-30 mg/dl), AVP (2-16 pg/ml) and PV (41%). His urine osmolality decreased from 1114 mOsmol/kg H2O to 1110 mOsmol/kg H2O. No participants finished the route-march with a serum [Na+] indicating hypernatremia (range, 134-143 mmol/L). CONCLUSIONS Ad libitum drinking resulted in 4% body mass loss with a 2 mmol/L serum [Na+] reduction in conjunction with high urine osmolality (> 1000 mOsmol/kg H2O) and plasma AVP. No single hydration strategy likely prevents EAH, but hypernatremia (cellular dehydration) was not seen despite > 2% body mass losses and high urine osmolality.
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Affiliation(s)
- Heinrich W Nolte
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kim Nolte
- Division Biokinetics and Sport Science, Department of Physiology, University of Pretoria, Pretoria, South Africa
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63
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Abstract
The health and performance of ultra-endurance athletes is dependent on avoidance of performance limiting hypohydration while also avoiding the potentially fatal consequences of exercise-associated hyponatremia due to overhydration. In this work, key factors related to maintaining proper hydration during ultra-endurance activities are discussed. In general, proper hydration need not be complicated and has been well demonstrated to be achieved by simply drinking to thirst and consuming a typical race diet during ultra-endurance events without need for supplemental sodium. As body mass is lost from oxidation of stored fuel, and water supporting the intravascular volume is generated from endogenous fuel oxidation and released with glycogen oxidation, the commonly promoted hydration guidelines of avoiding body mass losses of >2% can result in overhydration during ultra-endurance activities. Thus, some body mass loss should occur during prolonged exercise, and appropriate hydration can be maintained by drinking to the dictates of thirst.
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64
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Hew-Butler T, Angelakos K, Szczepanski J. Sodium loading, treadmill walking, and the acute redistribution of bone mineral content on dual energy X-ray absorptiometry scans. Am J Physiol Regul Integr Comp Physiol 2019; 316:R59-R67. [PMID: 30427698 DOI: 10.1152/ajpregu.00227.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to assess relationships between plasma sodium concentration ([Na+]) and bone mineral content (BMC) after an acute sodium load plus treadmill walking and then quantify the amount of sodium the dual energy X-ray absorptiometry (DXA) scan could detect. The primary study was a single-blind randomized control crossover trial under two conditions: ingestion of six flour tablets (placebo trial) or six 1-g NaCl tablets (salt intervention trial). The tablets were ingested after baseline blood and urine collection followed immediately by the DXA scan. After 60 min of rest, a 45-min treadmill walk was conducted. Immediately postexercise, blood and urine were collected and the DXA scan was repeated. Main outcomes included changes (∆: post minus pre) in plasma [Na+] and BMC. Additionally, six 1-g NaCl tablets were superimposed over a DXA spine phantom for separate quantification of sodium as BMC. Fourteen subjects completed the primary study. Two-way repeated measures ANOVA tests revealed significant interaction ( F = 13.06; P = 0.0007), condition ( F = 21.88; P < 0.001), and time ( F = 6.51; P = 0.014) effects in plasma [Na+]. A significant condition ( F = 6.46; P = 0.014) effect was also noted in urine [Na+]. Total body BMC∆ was negatively correlated with plasma [Na+]∆ ( r = -0.43; P = 0.02) and urine [Na+]∆ ( r = -0.47; P = 0.01). Total body BMC∆ in the salt intervention trial [-5.5 (27) g] closely approximated the amount of NaCl ingested and subsequently absorbed into the bloodstream. The DXA scan quantified 67% of NaCl tablets as BMC in spine phantom analyses. Total body BMC∆ was negatively related to plasma and urine [Na+]∆ after treadmill walking. Reductions in total body BMC closely approximated the amount of NaCl ingested (~6 g). The DXA scan quantified NaCl as BMC.
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Affiliation(s)
- Tamara Hew-Butler
- Oakland University, Rochester, Michigan.,Division of Kinesiology, Health, and Sport Studies, Wayne State University , Detroit, Michigan
| | - Kailyn Angelakos
- Oakland University, Rochester, Michigan.,Division of Kinesiology, Health, and Sport Studies, Wayne State University , Detroit, Michigan
| | - Joshua Szczepanski
- Oakland University, Rochester, Michigan.,Michigan State University , Macomb, Michigan
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65
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Hoffman MD. Predicted Risk for Exacerbation of Exercise-Associated Hyponatremia from Indiscriminate Postrace Intravenous Hydration of Ultramarathon Runners. J Emerg Med 2018; 56:177-184. [PMID: 30545731 DOI: 10.1016/j.jemermed.2018.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Asymptomatic or mildly symptomatic exercise-associated hyponatremia (EAH) can be exacerbated by aggressive hydration. OBJECTIVE This work predicts the percentage of athletes at risk for exacerbation of EAH from indiscriminate hydration after an ultramarathon. METHODS Postrace serum sodium, creatinine, creatine kinase (CK), and urea nitrogen concentrations were determined for 161-km ultramarathon participants. Body mass was measured prior to and immediately after the race. Incidents when serum CK was > 20,000 U/L or creatinine ≥ 1.5 times estimated baseline were considered to be "at risk for receiving I.V. hydration" if presenting to a hospital. Those with EAH without body mass loss during the race were considered "overhydrated" and "at risk for EAH exacerbation." RESULTS Among 627 finishers, 16 (2.6%) were at risk for EAH exacerbation. Considering 421 observations at risk for receiving I.V. hydration, 16 (47.1%) of the 34 observations with EAH were at risk for EAH exacerbation. Among those at risk for receiving I.V. hydration and with EAH, serum urea nitrogen and creatine concentration as a multiple of estimated baseline were lower (p < 0.05) for those at risk for EAH exacerbation, compared with those without overhydration, but there were no clinically useful laboratory findings to distinguish these two groups due to considerable overlap of values. CONCLUSIONS Whether in the field or hospital setting, I.V. hydration of an athlete after an ultramarathon carries a notable risk for exacerbating EAH, so clinicians should use caution when hydrating athletes after endurance events.
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Affiliation(s)
- Martin D Hoffman
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs, Northern California Health Care System, Sacramento, California; University of California Davis Medical Center, Sacramento, California; Ultra Sports Science Foundation, El Dorado Hills, California
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66
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Whatmough S, Mears S, Kipps C. Serum sodium changes in marathon participants who use NSAIDs. BMJ Open Sport Exerc Med 2018; 4:e000364. [PMID: 30588325 PMCID: PMC6280910 DOI: 10.1136/bmjsem-2018-000364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction The primary mechanism through which the development of exercise-associated hyponatraemia (EAH) occurs is excessive fluid intake. However, many internal and external factors have a role in the maintenance of total body water and non-steroidal anti-inflammatory medications (NSAIDs) have been implicated as a risk factor for the development of EAH. This study aimed to compare serum sodium concentrations ([Na]) in participants taking an NSAID before or during a marathon (NSAID group) and those not taking an NSAID (control group). Methods Participants in a large city marathon were recruited during race registration to participate in this study. Blood samples and body mass measurements took place on the morning of the marathon and immediately post marathon. Blood was analysed for [Na]. Data collected via questionnaires included athlete demographics, NSAID use and estimated fluid intake. Results We obtained a full data set for 28 participants. Of these 28 participants, 16 took an NSAID on the day of the marathon. The average serum [Na] decreased by 2.1 mmol/L in the NSAID group, while it increased by 2.3 mmol/L in the control group NSAID group (p=0.0039). Estimated fluid intake was inversely correlated with both post-marathon serum [Na] and ∆ serum [Na] (r=-0.532, p=0.004 and r=-0.405 p=0.032, respectively). Conclusion Serum [Na] levels in participants who used an NSAID decreased over the course of the marathon while it increased in those who did not use an NSAID. Excessive fluid intake during a marathon was associated with a lower post-marathon serum [Na].
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Affiliation(s)
- Steven Whatmough
- Institute of Sport, Exercise and Health, University College London, London, UK
| | | | - Courtney Kipps
- Institute of Sport, Exercise and Health, University College London, London, UK
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67
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Abstract
In humans, thirst tends to be alleviated before complete rehydration is achieved. When sweating rates are high and ad libitum fluid consumption is not sufficient to replace sweat losses, a cumulative loss in body water results. Body mass losses of 2% or greater take time to accumulate. Dehydration of ≥ 2% body mass is associated with impaired thermoregulatory function, elevated cardiovascular strain and, in many conditions (e.g., warmer, longer, more intense), impaired aerobic exercise performance. Circumstances where planned drinking is optimal include longer duration activities of > 90 min, particularly in the heat; higher-intensity exercise with high sweat rates; exercise where performance is a concern; and when carbohydrate intake of 1 g/min is desired. Individuals with high sweat rates and/or those concerned with exercise performance should determine sweat rates under conditions (exercise intensity, pace) and environments similar to that anticipated when competing and tailor drinking to prevent body mass losses > 2%. Circumstances where drinking to thirst may be sufficient include short duration exercise of < 1 h to 90 min; exercise in cooler conditions; and lower-intensity exercise. It is recommended to never drink so much that weight is gained.
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Affiliation(s)
- Robert W Kenefick
- Thermal and Mountain Medicine Division, US Army Research Institute, Natick, MA, USA.
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68
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Hoffman MD, Goulet EDB, Maughan RJ. Considerations in the Use of Body Mass Change to Estimate Change in Hydration Status During a 161-Kilometer Ultramarathon Running Competition. Sports Med 2018; 48:243-250. [PMID: 28895063 DOI: 10.1007/s40279-017-0782-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hydration guidelines found in the scientific and popular literature typically advise that body mass losses beyond 2% should be avoided during exercise. In this work, we demonstrate that these guidelines are not applicable to prolonged exercise of several hours where body mass loss does not reflect an equivalent loss of body water due to the effects of body mass change from substrate use, release of water bound with muscle and liver glycogen, and production of water during substrate metabolism. These effects on the body mass loss required to maintain body water balance are shown for a 161-km mountain ultramarathon running competition participant utilizing published data for the total energy cost, exogenous energy consumption and percentage from each fuel source, average participant body mass, and the extent of soft tissue fluid accumulation during an ultramarathon. We assumed that total energy derived from protein ranges from 5 to 10%, all exogenous energy is used to support the energy cost of the race, glycogen utilization ranges from 300 to 500 g, water linked with glycogen ranges from 1 to 3 g per g of glycogen, and the mass of the bladder and gastrointestinal tract is unchanged from pre-race to post-race body mass measurements. These calculations show that the average participant of 68.8 kg must lose 1.9-5.0% body mass to maintain the water supporting body water balance while also avoiding overhydration. Future hydration guidelines should consider these findings so that the proper hydration message is conveyed to those who participate in prolonged exercise.
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Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, 10535 Hospital Way, Sacramento, CA, 95655-1200, USA. .,Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA, USA. .,Ultra Sports Science Foundation, El Dorado Hills, CA, USA.
| | - Eric D B Goulet
- Research Centre on Aging and Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
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69
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Greene R, Fields D. Additional Exertion, Unsupported Assertions, and Hyperhydration Confound Rhabdomyolysis Case Study. Mil Med 2018; 183:262-263. [PMID: 30281076 PMCID: PMC6490305 DOI: 10.1093/milmed/usy237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Russell Greene
- CrossFit Inc., 1250 Connecticut Ave NW Ste 700, Washington, DC
| | - Derek Fields
- CrossFit Inc., 1250 Connecticut Ave NW Ste 700, Washington, DC
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70
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Effects of Intravenous Cold Saline on Hyperthermic Athletes Representative of Large Football Players and Small Endurance Runners. Clin J Sport Med 2018; 28:493-499. [PMID: 29112514 DOI: 10.1097/jsm.0000000000000505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the cooling effects of intravenous (IV) cold normal (0.9%) saline on hyperthermic athletes. DESIGN Randomized crossover study design. SETTING Controlled research laboratory. PARTICIPANTS Twelve male participants who were representative of a collegiate cross-country (6) and American football (6) population. INTERVENTIONS Participants underwent body composition analysis using a BodPod. They were placed in an environmentally controlled chamber and brought to a Tc of 39.5°C with dynamic exercise. When temperatures were reached, they were treated with either 2 L of cold saline (CS) (4°C) or intravenous room temperature (22°C) saline (RS) over a ∼30-minute period. Tre was measured with a rectal temperature probe every minute during the treatment period. MAIN OUTCOME MEASURES Total ΔTre (ending Tre - starting Tre) and cooling rate (total change in Tre/time) were measured for each condition, and body composition variables calculated included body surface area (BSA), BSA-to-mass ratio (BSA/mass), lean body mass, and body fat percentage (%BF) (P < 0.05). RESULTS Statistically significant differences were found in the total ΔTre and cooling rate between the CS and RS trials. The cooling rate for the CS trials was significantly correlated to mass, BSA, BSA/mass, and %BF. CONCLUSIONS In hyperthermic athletes, core temperature was reduced more effectively using chilled saline during IV infusion. Body composition had a significant impact on overall cooling revealing that the smaller and leaner participants cooled at a greater rate. When indicated, CS infusion could be considered for cooling hyperthermic individuals when other methods are not available.
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71
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Changes in Pain and Nutritional Intake Modulate Ultra-Running Performance: A Case Report. Sports (Basel) 2018; 6:sports6040111. [PMID: 30287789 PMCID: PMC6316849 DOI: 10.3390/sports6040111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 12/22/2022] Open
Abstract
Ultra-endurance running provides numerous physiological, psychological, and nutritional challenges to the athlete and supporting practitioners. We describe the changes in physiological status, psychological condition, and nutritional intake over the course of two 100-mile running races, with differing outcomes: non-completion and completion. Athlete perception of pain, freshness, and motivation differed between events, independent of rating of perceived exertion. Our data suggest that the integration of multiple sensations (freshness, motivation, hunger, pain, and thirst) produce performance. Increases in carbohydrate feeding (+5 g·h−1) and protein intake (+0.3 g·kg−1) also likely contributed to successful completion of a 100-mile race, by reducing the fractional utilization of maximal oxygen uptake and satiating hunger, respectively. Nutritional data support the notion that the gut is a trainable, and critical organ with respect to ultra-endurance performance. Finally, we propose future research to investigate the rate at which peak feeding occurs throughout ultra-endurance events, as this may further serve to personalize sports nutrition strategies.
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72
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Scrivin R, Black K. Sports Drinks Consumed During Exercise, Which Affect Thermoregulation and/or Athletic Performance in the Heat: A Review. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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73
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Alcock R, McCubbin A, Camões-Costa V, Costa RJS. Case Study: Providing Nutritional Support to an Ultraendurance Runner in Preparation for a Self-Sufficient Multistage Ultramarathon: Rationed Versus Full Energy Provisions. Wilderness Environ Med 2018; 29:508-520. [PMID: 30249353 DOI: 10.1016/j.wem.2018.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/14/2018] [Accepted: 06/13/2018] [Indexed: 01/24/2023]
Abstract
To assess the impact of rationed versus full estimated energy provisions on markers of physiological strain in response to a simulated 250 km multistage ultramarathon (MSUM), on two separate occasions, the ultraendurance runner performed a laboratory simulated MSUM, with rationed (RP: 3303±75 kcal⋅day-1) and full (FP: 7156±359 kcal⋅day-1) provisions. Total daily energy expenditure was determined using dual-method indirect calorimetry. Resting metabolic rate, iDXA, and body water were measured at baseline, day 3, and post-MSUM. Blood, urine, and feces were collected, and mood state was measured, d 1 to 5 (before and after running) to determine various physiological strain indices. Heart rate, RPE, thermal comfort, gastrointestinal symptoms, and non-protein oxidation rates were measured every 30 min during running. Data were analyzed using single-subject design analysis and interpreted using Cohen's effect size. Energy expenditure was lower on RP (6943±145 kcal⋅day-1) than FP (7486±143 kcal⋅day-1) (Cohen's δ=-3.1). More pronounced exertional strain (RPE δ=1.2, thermal conform δ=0.6, rectal temperature δ=1.0, and plasma cortisol concentration δ=1.7) was observed on RP as the MSUM progressed. Total carbohydrate and fat oxidation during running decreased (0.76 vs. 1.82 g⋅min-1; δ=-3.9) and increased (0.91 vs. 0.54 g⋅min-1; δ=3.7), respectively, more profoundly on RP as the MSUM progressed. Gastrointestinal symptoms were modestly lower in RP (δ=-0.26). Exercise-induced leukocytosis, cytokinaemia, and neutrophil responses were higher on RP. Iron status markers were trivial. Higher mood disturbance and fatigue were reported on RP. The ultraendurance runner presented greater physiological and psychophysiological disturbances, in response to a laboratory simulated MSUM, on rationed energy provisions, despite the lighter pack-weight.
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Affiliation(s)
- Rebekah Alcock
- Sports Nutrition, Australian Institute of Sport, Australian Sports Commission, Bruce, Australia (Ms Alcock)
| | - Alan McCubbin
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa)
| | - Vera Camões-Costa
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa); Health & Aging Research Group, Swinburne University of Technology, Victoria, Australia (Dr Camões-Costa)
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics & Food, Monash University, Victoria, Australia (Mr McCubbin and Drs Camões-Costa and Costa).
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74
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Chlíbková D, Ronzhina M, Nikolaidis PT, Rosemann T, Knechtle B. Non-steroidal Anti-inflammatory Drug Consumption in a Multi-Stage and a 24-h Mountain Bike Competition. Front Physiol 2018; 9:1272. [PMID: 30246809 PMCID: PMC6139357 DOI: 10.3389/fphys.2018.01272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/21/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose: Excessive or inappropriate non-steroidal anti-inflammatory drug (NSAID) use during ultra-endurance events could cause potential risk to athletes’ health. Reports on NSAID consumption in mountain bikers or ultra-mountain bikers are scarce. Therefore, the aim of this study was to investigate the prevalence of NSAID consumption immediately before, during and immediately after a mountain bike (MTB) race and to compare NSAID consumption in two different MTB competitions. Methods: This observational study took place at a three-stage MTB race (SMTB) (n = 63) and at a 24-h MTB race (24MTB) (n = 68), both held in the Czechia in 2017. NSAID consumption was evaluated via self-reported electronic questionnaires. Results: Of all finishers (n = 131), fourteen (10%) consumed NSAID at least once during the competition day (immediately before, during or immediately after the race). The number of NSAID consumers was the same in both competitions. Nevertheless, only three athletes (2%), all of them from the 24MTB, consumed NSAID during the race and 5% of all mountain bikers reported consumption after the race. In contrast to the SMTB, the intake reported by the 24MTB participants was quite homogeneous in terms of the timing of NSAID consumption. The NSAID users were older (p = 0.043) than the non-users. Ibuprofen was most commonly used by 79% of all consumers. Conclusion: The prevalence of NSAID use was higher in the older participants and seems to be lower in comparison with results from studies about runners, ultra-runners and triathletes suggesting that it is determined by the discipline (i.e., cycling). On the other hand, the timing of NSAID consumption was probably affected by the competition character (e.g., MTBS or 24MTB). Future studies should focus on a larger sample size of cyclists from various disciplines.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | - Marina Ronzhina
- Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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75
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Hoffman MD, Stellingwerff T, Costa RJS. Considerations for ultra-endurance activities: part 2 - hydration. Res Sports Med 2018; 27:182-194. [PMID: 30056755 DOI: 10.1080/15438627.2018.1502189] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
It is not unusual for those participating in ultra-endurance (> 4 hr) events to develop varying degrees of either hypohydration or hyperhydration. Yet, it is important for ultra-endurance athletes to avoid the performance limiting and potentially fatal consequences of these conditions. During short periods of exercise (< 1 hr), trivial effects on the relationship between body mass change and hydration status result from body mass loss due to oxidation of endogenous fuel stores, and water supporting the intravascular volume being generated from endogenous fuel oxidation and released with glycogen oxidation. However, these effects have meaningful implications during prolonged exercise. In fact, body mass loses well over 2% may be required during some ultra-endurance activities to avoid hyperhydration. Therefore, the typical hydration guidelines to avoid more than 2% body mass loss do not apply in ultra-endurance activities and can potentially result in hyperhydration. Fortunately, achieving the balance of proper hydration during ultra-endurance activities need not be complicated and has been well demonstrated to generally be achieved by simply drinking to thirst and avoiding excessive sodium supplementation with intention of replacing all sodium losses during the exercise.
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Affiliation(s)
- Martin D Hoffman
- a Physical Medicine and Rehabilitation Service, Department of Veterans Affairs , Northern California Health Care System , Sacramento , CA , USA.,b Department of Physical Medicine and Rehabilitation , University of California Davis Medical Center , Sacramento , CA , USA.,c Ultra Sports Science Foundation , El Dorado Hills , CA , USA
| | | | - Ricardo J S Costa
- e Department of Nutrition Dietetics and Food , Monash University , Notting Hill , Victoria , Australia
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76
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Changstrom B, Brill J, Hecht S. Severe Exercise-Associated Hyponatremia in a Collegiate American Football Player. Curr Sports Med Rep 2018; 16:343-345. [PMID: 28902757 DOI: 10.1249/jsr.0000000000000399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Bradley Changstrom
- 1CU Sports Medicine, Division of General Internal Medicine, Department of Internal Medicine, Department of Orthopedics, University of Colorado Hospital; 2McKay-Dee Family Medicine Residency, McKay-Dee Porter Family Medicine Clinic, Ogden, UT; and 3Department of Family Medicine and Community Health, Program in Sports Medicine, University of Minnesota, Minneapolis, MN
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77
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Oh RC, Galer M, Bursey MM. Found in the Field — A Soldier With Heat Stroke, Exercise-Associated Hyponatremia, and Kidney Injury. Curr Sports Med Rep 2018; 17:123-125. [PMID: 29629971 DOI: 10.1249/jsr.0000000000000471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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78
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Sicard J. L’hydratation, au cœur de la stratégie nutritionnelle du sportif. ACTUALITES PHARMACEUTIQUES 2018. [DOI: 10.1016/j.actpha.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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79
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Kenefick RW. Author's Reply to Valenzuela et al.: Comment on "Drinking Strategies: Planned Drinking Versus Drinking to Thirst". Sports Med 2018; 48:2215-2217. [PMID: 29582379 DOI: 10.1007/s40279-018-0902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert W Kenefick
- Thermal and Mountain Medicine Division, US Army Research Institute, Natick, MA, USA.
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80
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Lewis D, Blow A, Tye J, Hew-Butler T. Considering exercise-associated hyponatraemia as a continuum. BMJ Case Rep 2018. [PMID: 29523608 DOI: 10.1136/bcr-2017-222916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Exercise-associated hyponatraemia (EAH) always involves a component of overhydration relative to available exchangeable sodium stores. In the majority of cases, this is purely due to excessive consumption of fluids during exercise. In a lesser number of cases, it is apparent that excessive sodium loss through sweat may play a role by decreasing the amount of acutely available exchangeable sodium. Two cases demonstrating the latter, one in an individual with cystic fibrosis (CF) and another in an endurance athlete without CF, demonstrate how elevated dermal sweat losses may contribute to a relative dilutional EAH along a pathophysiological continuum.
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Affiliation(s)
- Douglas Lewis
- Family and Community Medicine, Via Christi Health System, Wichita, Kansas, USA
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81
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Chlíbková D, Nikolaidis PT, Rosemann T, Knechtle B, Bednář J. Fluid Metabolism in Athletes Running Seven Marathons in Seven Consecutive Days. Front Physiol 2018; 9:91. [PMID: 29483882 PMCID: PMC5816349 DOI: 10.3389/fphys.2018.00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/26/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: Hypohydration and hyperhydration are significant disorders of fluid metabolism in endurance performance; however, little relevant data exist regarding multi-stage endurance activities. The aim of the present study was to examine the effect of running seven marathons in 7 consecutive days on selected anthropometric, hematological and biochemical characteristics with an emphasis on hydration status. Methods: Participants included 6 women and 20 men (age 42.6 ± 6.2 years). Data was collected before day 1 (B1) and after day 1 (A1), 4 (A4), and 7 (A7). Results: The average marathon race time was 4:44 h:min (ranging from 3:09 – 6:19 h:min). Plasma sodium, plasma potassium and urine sodium were maintained during the race. Body mass (p < 0.001, η2 = 0.501), body fat (p < 0.001, η2 = 0.572) and hematocrit (p < 0.001, η2 = 0.358) decreased. Plasma osmolality (Posm) (p < 0.001, η2 = 0.416), urine osmolality (Uosm) (p < 0.001, η2 = 0.465), urine potassium (p < 0.001, η2 = 0.507), urine specific gravity (Usg) (p < 0.001, η2 = 0.540), plasma urea (PUN) (p < 0.001, η2 = 0.586), urine urea (UUN) (p < 0.001, η2 = 0.532) and transtubular potassium gradient (p < 0.001, η2 = 0.560) increased at A1, A4, and A7 vs. B1. Posm correlated with PUN at A1 (r = 0.59, p = 0.001) and A4 (r = 0.58, p = 0.002). The reported post-race fluid intake was 0.5 ± 0.2 L/h and it correlated negatively with plasma [Na+] (r = −0.42, p = 0.007) at A4 and (r = −0.50, p = 0.009) at A7. Uosm was associated with UUN at A1 (r = 0.80, p < 0.001), at A4 (r = 0.81, p < 0.001) and at A7 (r = 0.86, p < 0.001) and with Usg (r = 0.71, p < 0.001) at A1, (r = 0.52, p = 0.006) at A4 and (r = 0.46, p = 0.02) at A7. Conclusions: Despite the decrease in body mass, fluid and electrolyte balance was maintained with no decrease in plasma volume after running seven marathons in seven consecutive days. Current findings support the hypothesis that body mass changes do not reflect changes in the hydration status during prolonged exercise.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czechia
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland.,Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Josef Bednář
- Faculty of Mechanical Engineering, Brno University of Technology, Brno, Czechia
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82
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Therapeutic Advances in Hyponatremia: Fluids, Diuretics, Vaptans, and More. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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83
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Hoffman MD, Cotter JD, Goulet ÉD, Laursen PB. REBUTTAL from "Yes". Wilderness Environ Med 2017; 27:198-200. [PMID: 27291701 DOI: 10.1016/j.wem.2016.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA.
| | - James D Cotter
- Exercise and Environmental Physiology, School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand(Dr Cotter)?>
| | - Éric D Goulet
- Research Centre on Aging, Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, Quebec, Canada
| | - Paul B Laursen
- High Performance Sport New Zealand, and Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Aukland, Auckland, New Zealand
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84
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Hoffman MD, Weiss RH. The Presented Evidence to Support Symptomatic Hypovolemic-Associated EAH Is Not Convincing. Curr Sports Med Rep 2017; 16:464-466. [PMID: 29135648 DOI: 10.1249/jsr.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, University of California Davis Medical Center, Sacramento, CA, Ultra Sports Science Foundation, El Dorado Hills, CA. Departments of Medicine, Department of Veterans Affairs, Northern California Health Care System, and Division of Nephrology; Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA
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85
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Hew-Butler T. Response to Letter-to-the-Editor "The Presented Evidence to Support Symptomatic Hypovolemic-Associated EAH Is Not Convincing". Curr Sports Med Rep 2017; 16:467-468. [PMID: 29135649 DOI: 10.1249/jsr.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Tamara Hew-Butler
- School of Health Sciences, Oakland University, Rochester, MI, Exercise Science Oakland University, 433 Meadow Brook Rd, Rochester, MI 48309,
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86
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Baker LB, Reimel AJ, Sopeña BC, Barnes KA, Nuccio RP, De Chavez PJD, Stofan JR, Carter JM. Trapped sweat in basketball uniforms and the effect on sweat loss estimates. Physiol Rep 2017; 5:5/18/e13463. [PMID: 28963129 PMCID: PMC5617937 DOI: 10.14814/phy2.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022] Open
Abstract
The aims of this study were to determine: (1) trapped sweat (TS) in basketball uniforms and the effect on sweat loss (SL) estimates during a laboratory-based basketball simulation protocol; (2) the impact of exercise intensity, body mass, age, and SL on TS; and (3) TS during on-court training to assess the ecological validity of the laboratory-based results. Twenty-four recreational/competitive male basketball players (23 ± 10 years, 77.0 ± 16.7 kg) completed three randomized laboratory-based trials (Low, Moderate, and High intensity) consisting of 150-min intermittent exercise. Eighteen elite male players (23 ± 4 years, 92.0 ± 20.6 kg) were observed during coach-led, on-court training. Nude and clothed body mass were measured pre and postexercise to determine TS. Data are mean ± SD. There was a significant effect of intensity on SL and TS (P < 0.001, Low<Moderate<High, ANOVA). During Low, subjects lost 1.10 ± 0.59 kg sweat and TS was 0.11 ± 0.15 kg (8.0 ± 5.1% SL). During Moderate, subjects lost 1.60 ± 0.56 kg sweat and TS was 0.21 ± 0.21 kg (11.6 ± 6.3% SL). During High, subjects lost 2.12 ± 0.66 kg sweat and TS was 0.38 ± 0.28 kg (16.0 ± 7.4% SL). Multiple regression and partial correlation analysis suggested TS was significantly related to SL (P < 0.0001; partial r = 0.81-0.89), whereas the contributions of body mass (P = 0.22-0.92) and age (P = 0.29-0.44) were not significant. TS during on-court training was 0.35 ± 0.36 kg, which was associated with a 14.1 ± 11.5% underestimation in SL, and was not statistically different than laboratory-based results (P = 0.59). Clothed body mass measurements should be used with caution, as TS is highly variable and can cause a significant underestimation in SL in athletes with high sweating rates.
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Affiliation(s)
| | - Adam J Reimel
- Gatorade Sports Science Institute, Barrington, Illinois
| | | | | | - Ryan P Nuccio
- Gatorade Sports Science Institute, Barrington, Illinois
| | | | - John R Stofan
- Gatorade Sports Science Institute, Barrington, Illinois
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87
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Hoffman MD, Joslin J, Rogers IR. Management of Suspected Fluid Balance Issues in Participants of Wilderness Endurance Events. Curr Sports Med Rep 2017; 16:98-102. [PMID: 28282356 DOI: 10.1249/jsr.0000000000000344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Dehydration and exercise-associated hyponatremia (EAH) are both relatively common conditions during wilderness endurance events. Whereas dehydration is treated with fluids, EAH is appropriately managed with fluid restriction and a sodium bolus but can worsen with isotonic or hypotonic fluids. Therefore, caution is recommended in the provision of postevent rehydration in environments where EAH is a potential consideration because accurate field assessment of hydration status can be challenging, and measurement of blood sodium concentration is rarely possible in the wilderness. Dehydration management with oral rehydration is generally adequate and preferred to intravenous rehydration, which should be reserved for athletes with sustained orthostasis or inability to tolerate oral fluid ingestion after some rest. In situations where intravenous hydration is initiated without known blood sodium concentration or hydration status, an intravenous concentrated sodium solution should be available in the event of acute neurological deterioration consistent with the development of EAH encephalopathy.
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Affiliation(s)
- Martin D Hoffman
- 1Department of Physical Medicine and Rehabilitation, Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA; 2Department of Emergency Medicine, State University of New York Upstate Medical University, Syracuse, NY; 3St. John of God Murdoch Hospital & University of Notre Dame, Murdoch, WA, Australia
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Abstract
OBJECTIVES Hyponatremic encephalopathy, symptomatic cerebral edema due to a low osmolar state, is a medical emergency and often encountered in the ICU setting. This article provides a critical appraisal and review of the literature on identification of high-risk patients and the treatment of this life-threatening disorder. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION Online search of the PubMed database and manual review of articles involving risk factors for hyponatremic encephalopathy and treatment of hyponatremic encephalopathy in critical illness. DATA SYNTHESIS Hyponatremic encephalopathy is a frequently encountered problem in the ICU. Prompt recognition of hyponatremic encephalopathy and early treatment with hypertonic saline are critical for successful outcomes. Manifestations are varied, depending on the extent of CNS's adaptation to the hypoosmolar state. The absolute change in serum sodium alone is a poor predictor of clinical symptoms. However, certain patient specific risks factors are predictive of a poor outcome and are important to identify. Gender (premenopausal and postmenopausal females), age (prepubertal children), and the presence of hypoxia are the three main clinical risk factors and are more predictive of poor outcomes than the rate of development of hyponatremia or the absolute decrease in the serum sodium. CONCLUSIONS In patients with hyponatremic encephalopathy exhibiting neurologic manifestations, a bolus of 100 mL of 3% saline, given over 10 minutes, should be promptly administered. The goal of this initial bolus is to quickly treat cerebral edema. If signs persist, the bolus should be repeated in order to achieve clinical remission. However, the total change in serum sodium should not exceed 5 mEq/L in the initial 1-2 hours and 15-20 mEq/L in the first 48 hours of treatment. It has recently been demonstrated in a prospective fashion that 500 mL of 3% saline at an infusion rate of 100 mL per hour can be given safely. It is critical to recognize the early signs of cerebral edema (nausea, vomiting, and headache) and intervene with IV 3% sodium chloride as this is the time to intervene rather than waiting until more severe symptoms develop. Cerebral demyelination is a rare complication of overly rapid correction of hyponatremia. The principal risk factors for cerebral demyelination are correction of the serum sodium more than 25 mEq/L in the first 48 hours of therapy, correction past the point of 140 mEq/L, chronic liver disease, and hypoxic/anoxic episode.
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Affiliation(s)
- Steven G Achinger
- 1Department of Nephrology, Watson Clinic LLP, Lakeland, FL. 2Renal Consultants of Houston, Department of Research, Houston, TX. 3Department of Nephrology, Hospital Italiano, Buenos Aires, Argentina. 4Department of Nephrology, Hospital Austral, Austral University, Buenos Aires, Argentina. 5Department of Nephrology, University of California, Irvine, CA
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89
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Krabak BJ, Lipman GS, Waite BL, Rundell SD. Exercise-Associated Hyponatremia, Hypernatremia, and Hydration Status in Multistage Ultramarathons. Wilderness Environ Med 2017; 28:291-298. [PMID: 28781178 DOI: 10.1016/j.wem.2017.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/29/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dysnatremia and altered hydration status are potentially serious conditions that have not been well studied in multistage ultramarathons. The purpose of this study was to assess the incidence and prevalence of exercise-associated hyponatremia (EAH) (Na+ <135 mmol·L-1) and hypernatremia (Na+ >145 mmol·L-1) and hydration status during a multistage ultramarathon. METHODS This study involved a prospective observational cohort study of runners competing in a 250-km (155-mile) multistage ultramarathon (in the Jordan, Atacama, or Gobi Desert). Prerace body weight and poststage (stage [S] 1 [42 km], S3 [126 km], and S5 [250 km]) body weight and serum sodium concentration levels were obtained from 128 runners. RESULTS The prevalence of EAH per stage was 1.6% (S1), 4.8% (S3), and 10.1% (S5) with a cumulative incidence of 14.8%. Per-stage prevalence of hypernatremia was 35.2% (S1), 20.2% (S3), and 19.3% (S5) with a cumulative incidence of 52.3%. Runners became more dehydrated (weight change <-3%) throughout the race (S1=22.1%; S3=51.2%; S5=53.5%). Body weight gain correlated with EAH (r=-0.21, P = .02). Nonfinishers of S3 were significantly more likely to have EAH compared with finishers (75% vs 5%, P = .001), but there was no difference in either EAH or hypernatremia between nonfinishers and finishers of S5. CONCLUSIONS The incidence of EAH in multistage ultramarathons was similar to marathons and single-stage ultramarathons, but the cumulative incidence of hypernatremia was 3 times greater than that of EAH. EAH was associated with increased weight gain (overhydration) in early stage nonfinishers and postrace finishers.
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Affiliation(s)
- Brian J Krabak
- Department of Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA (Dr Krabak).
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA (Dr Lipman)
| | - Brandee L Waite
- Department of Physical Medicine and Rehabilitation, University of California, Davis Sports Medicine, Sacramento, CA (Dr Waite)
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA (Dr Rundell)
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90
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Asplund CA, Miller TK, Creswell L, Getzin A, Hunt A, Martinez J, Diehl J, Hiller WD, Berlin P. Triathlon Medical Coverage: A Guide for Medical Directors. Curr Sports Med Rep 2017; 16:280-288. [PMID: 28696992 DOI: 10.1249/jsr.0000000000000382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Interest and participation in triathlon has grown rapidly over the past 20 yr and with this growth, there has been an increase in the number of new events. To maximize the safety of participation, triathlons require medical directors to plan and oversee medical care associated with event participation. Provision of proper medical care requires knowledge of staffing requirements, common triathlon medical conditions, impact of course design, communication skill, and a familiarity of administrative requirements. These guidelines serve as a tool for triathlon medical and race directors to improve race safety for athletes.
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Affiliation(s)
- Chad A Asplund
- 1Georgia Southern University, Statesboro, Statesboro, GA; 2Sports Medicine, Carilion Clinic; 3Virginia Tech/Carilion School of Medicine; 4Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, MS; 5Sports Medicine and Athletic Performance Cayuga Medical Center Ithaca, NY; 6University of Chicago Pritzker School of Medicine/Northshore University Healthcare; 7TriRock San Diego, ITU San Diego World Championships Kaiser Permanente Sports Medicine, San Diego, CA; 8Riverside Methodist Sports Medicine, Columbus, OH; 9 ITU Medical Committee, University of Hawaii Medical School, Honolulu, HI; and 10Ironman Triathlon World Championship
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91
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Hew-Butler T, Hamilton R, Hamilton B, Colesa Z. Special Communication of a Case of Hypovolemic-Associated EAH: Lessons Learned During Recovery. Curr Sports Med Rep 2017; 16:289-293. [PMID: 28696993 DOI: 10.1249/jsr.0000000000000380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Severe exercise-associated hyponatremia (EAH) is largely dilutional, whereas contributions of sodium loss remain equivocal. We present a case of EAH with encephalopathy involving an experienced male cyclist with no recollection of the event. We thereby conducted a retrospective analysis of biochemical trajectories during hospital recovery. The normalization of serum [Na], in context with changes in other variables, offered a 'reverse' perspective of the underlying pathophysiology. The following biochemical changes were temporally observed, with the return of normonatremia: 1) a decrease in serum potassium and calcium concentrations (absence of extracellular fluid dilution); 2) a decrease in total protein, blood urea nitrogen, hematocrit and hemoglobin (plasma volume expansion); and 3) an increase in mean platelet and red cell corpuscular volumes (cellular expansion after total body water and sodium deficits). Collectively, these temporal changes provide biochemical evidence suggesting that this patient's severe symptomatic EAH was associated with volume depletion from underreplaced sodium losses.
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Affiliation(s)
- Tamara Hew-Butler
- 1Exercise Science, Oakland University, Rochester, MI; 2Men's Health Melbourne, Melbourne, AUSTRALIA; and 3Department of Nursing, University of Melbourne, Melbourne, AUSTRALIA
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92
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Hoffman MD, Cotter JD, Goulet ÉD, Laursen PB. VIEW: Is Drinking to Thirst Adequate to Appropriately Maintain Hydration Status During Prolonged Endurance Exercise? Yes. Wilderness Environ Med 2017; 27:192-5. [PMID: 27291699 DOI: 10.1016/j.wem.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Martin D Hoffman
- Department of Physical Medicine & Rehabilitation Department of Veterans Affairs, Northern California Health Care System, and University of California Davis Medical Center, Sacramento, CA, USA (Dr Hoffman)
| | - James D Cotter
- Exercise and Environmental Physiology, School of Physical Education, Sport and Exercise Sciences Division of Sciences, University of Otago, Dunedin New Zealand (Dr Cotter)
| | - Éric D Goulet
- Research Centre on Aging, Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC Canada (Dr Goulet)
| | - Paul B Laursen
- High Performance Sport New Zealand, and Sports Performance Research Institute New Zealand (SPRINZ) Auckland University of Technology, Auckland New Zealand (Dr Laursen)
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93
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Chlíbková D, Nikolaidis PT, Rosemann T, Knechtle B, Bednář J. Reported Hydration Beliefs and Behaviors without Effect on Plasma Sodium in Endurance Athletes. Front Physiol 2017; 8:259. [PMID: 28512433 PMCID: PMC5411442 DOI: 10.3389/fphys.2017.00259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: Little information is available on the association of hydration beliefs and behaviors in endurance athletes and exercise-associated hyponatremia (EAH). The aim of the present study was to determine hydration beliefs and behaviors in endurance athletes. Method: A 100 and 38 recreational athletes [107 mountain bikers (MTBers) and 31 runners] competing in seven different endurance and ultra-endurance races completed pre- and post-race questionnaires, and a subgroup of 113 (82%) participants (82 MTBers and 31 runners) also provided their blood samples. Result: More than half of the participants had some pre-race (59%), mid-race (58%), and post-race (55%) drinking plan. However, the participants simultaneously reported that temperature (66%), thirst (52%), and plan (37%) affected their drinking behavior during the race. More experienced (years of active sport: p = 0.002; number of completed races: p < 0.026) and trained (p = 0.024) athletes with better race performance (p = 0.026) showed a more profound knowledge of EAH, nevertheless, this did not influence their planned hydration, reported fluid intake, or post-race plasma sodium. Thirteen (12%) hyponatremic participants did not differ in their hydration beliefs, race behaviors, or reported fluid intake from those without post-race EAH. Compared to MTBers, runners more often reported knowledge of the volumes of drinks offered at fluid stations (p < 0.001) and information on how much to drink pre-race (p < 0.001), yet this was not associated with having a drinking plan (p > 0.05). MTBers with hydration information planned more than other MTBers (p = 0.004). In comparison with runners, more MTBers reported riding with their own fluids (p < 0.001) and planning to drink at fluid stations (p = 0.003). On the whole, hydration information was positively associated with hydration planning (n = 138) (p = 0.003); nevertheless, the actual reported fluid intake did not differ between the group with and without hydration information, or with and without a pre-race drinking plan (p > 0.05). Conclusion: In summary, hydration beliefs and behaviors in the endurance athletes do not appear to affect the development of asymptomatic EAH.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of TechnologyBrno, Czechia
| | | | - Thomas Rosemann
- Institute of Primary Care, University of ZurichZurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of ZurichZurich, Switzerland.,Gesundheitszentrum St. GallenSt. Gallen, Switzerland
| | - Josef Bednář
- Faculty of Mechanical Engineering, Brno University of TechnologyBrno, Czechia
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94
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Berger I. Oral versus intravenous hypertonic saline for exercise-associated hyponatraemia. J Paediatr Child Health 2017; 53:507-509. [PMID: 28470800 DOI: 10.1111/jpc.13521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 11/27/2022]
Abstract
Exercise-associated hyponatraemia is a potentially serious acute condition that may present early as asymptomatic or mildly symptomatic. Standard treatment is intravenous hypertonic saline, which can be challenging and carries some risk. An alternative may be oral therapy. We undertook a review of existing literature to assess whether paediatric populations should receive oral or intravenous hypertonic saline solutions. One study addressed our question but was aimed at a presumably adult population of runners. That study found that intravenous and oral solutions provide similar effects on biochemistry, but intravenous hypertonic saline provides superior effects on subjective relief and plasma volume.
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Affiliation(s)
- Israel Berger
- University of Sydney, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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95
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Kanjanauptom P, Cheek JA. Drinking water and disorientation: The perils of a long, hot, Australian summer. Emerg Med Australas 2017; 29:370-371. [PMID: 28320047 DOI: 10.1111/1742-6723.12760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/01/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Panida Kanjanauptom
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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96
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Hew-Butler T, Loi V, Pani A, Rosner MH. Exercise-Associated Hyponatremia: 2017 Update. Front Med (Lausanne) 2017; 4:21. [PMID: 28316971 PMCID: PMC5334560 DOI: 10.3389/fmed.2017.00021] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/16/2017] [Indexed: 12/21/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was initially described in the 1980s in endurance athletes, and work done since then has conclusively identified that overdrinking beyond thirst and non-osmotic arginine vasopressin release are the most common etiologic factors. In recent years, EAH has been described in a broader variety of athletic events and also has been linked to the development of rhabdomyolysis. The potential role of volume and sodium depletion in a subset of athletes has also been described. This review focuses on the most recent literature in the field of EAH and summarizes key new findings in the epidemiology, pathophysiology, treatment, and prevention of this condition.
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Affiliation(s)
| | - Valentina Loi
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Antonello Pani
- SC Nephrology and Dialysis, Brotzu Hospital , Cagliari , Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System , Charlottesville, VA , USA
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97
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Cheung SS, Lee JKW, Oksa J. Thermal stress, human performance, and physical employment standards. Appl Physiol Nutr Metab 2017; 41:S148-64. [PMID: 27277564 DOI: 10.1139/apnm-2015-0518] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many physically demanding occupations in both developed and developing economies involve exposure to extreme thermal environments that can affect work capacity and ultimately health. Thermal extremes may be present in either an outdoor or an indoor work environment, and can be due to a combination of the natural or artificial ambient environment, the rate of metabolic heat generation from physical work, processes specific to the workplace (e.g., steel manufacturing), or through the requirement for protective clothing impairing heat dissipation. Together, thermal exposure can elicit acute impairment of work capacity and also chronic effects on health, greatly contributing to worker health risk and reduced productivity. Surprisingly, in most occupations even in developed economies, there are rarely any standards regarding enforced heat or cold safety for workers. Furthermore, specific physical employment standards or accommodations for thermal stressors are rare, with workers commonly tested under near-perfect conditions. This review surveys the major occupational impact of thermal extremes and existing employment standards, proposing guidelines for improvement and areas for future research.
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Affiliation(s)
- Stephen S Cheung
- a Environmental Ergonomics Laboratory, Department of Kinesiology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada
| | - Jason K W Lee
- b Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore.,c Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,d Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Juha Oksa
- e Finnish Institute of Occupational Health, Physical Work Capacity team, Oulu, Finland
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98
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Evans GH, James LJ, Shirreffs SM, Maughan RJ. Optimizing the restoration and maintenance of fluid balance after exercise-induced dehydration. J Appl Physiol (1985) 2017; 122:945-951. [PMID: 28126906 DOI: 10.1152/japplphysiol.00745.2016] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/10/2017] [Accepted: 01/17/2017] [Indexed: 11/22/2022] Open
Abstract
Hypohydration, or a body water deficit, is a common occurrence in athletes and recreational exercisers following the completion of an exercise session. For those who will undertake a further exercise session that day, it is important to replace water losses to avoid beginning the next exercise session hypohydrated and the potential detrimental effects on performance that this may lead to. The aim of this review is to provide an overview of the research related to factors that may affect postexercise rehydration. Research in this area has focused on the volume of fluid to be ingested, the rate of fluid ingestion, and fluid composition. Volume replacement during recovery should exceed that lost during exercise to allow for ongoing water loss; however, ingestion of large volumes of plain water results in a prompt diuresis, effectively preventing longer-term maintenance of water balance. Addition of sodium to a rehydration solution is beneficial for maintenance of fluid balance due to its effect on extracellular fluid osmolality and volume. The addition of macronutrients such as carbohydrate and protein can promote maintenance of hydration by influencing absorption and distribution of ingested water, which in turn effects extracellular fluid osmolality and volume. Alcohol is commonly consumed in the postexercise period and may influence postexercise rehydration, as will the coingestion of food. Future research in this area should focus on providing information related to optimal rates of fluid ingestion, advisable solutions to ingest during different duration recovery periods, and confirmation of mechanistic explanations for the observations outlined.
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Affiliation(s)
- Gethin H Evans
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom;
| | - Lewis J James
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom; and
| | - Susan M Shirreffs
- School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Ronald J Maughan
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom; and
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99
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Roberts WO, Dorman JC, Bergeron MF. Recurrent Heat Stroke in a Runner: Race Simulation Testing for Return to Activity. Med Sci Sports Exerc 2017; 48:785-9. [PMID: 26694842 DOI: 10.1249/mss.0000000000000847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Exertional heat stroke (EHS) occurs in distance runners and is a life-threatening condition. A 30-yr-old healthy recreational male distance runner (CR) collapsed at the 12-mile mark in two half marathon races 6 wk apart in fall 2009. In both episodes, CR was found on the ground confused, incoherent, sweaty, and warm to touch. The emergency medical team responded, and he was treated empirically for suspected EHS by cooling en route to the emergency department. In the emergency department, rectal temperatures were 40°C and 40.5°C for each episode, respectively. The first race start temperature was 16°C with 94% relative humidity (RH), and the second was 3°C, 75% RH. Heat tolerance test was within the normal range indicating low EHS risk. A race simulation test (environmental chamber, 25°C, 60% RH) at a treadmill pace of 10.5-12.9 km·h was stopped at 70 min coincident with a rectal temperature of 39.5°C. CR's body weight dropped 3.49 kg with an estimated sweat loss of 4.09 L and an estimated total sweat Na loss of 7610 mg. We recommended that he limit his runs to <1 h and replace salt and fluid during and (mostly) after activity, run with a partner, acclimate to heat before racing, and reduce his pace or stop at the first sign of symptoms. Race simulation testing should be considered in athletes with recurrent EHS to assist with the return-to-activity recommendation.
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Affiliation(s)
- William O Roberts
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD; 3Youth Sports of the Americas, Birmingham, AL; 4Lemak Health, Birmingham, AL
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100
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Krabak BJ, Parker KM, DiGirolamo A. Exercise-Associated Collapse: Is Hyponatremia in Our Head? PM R 2017; 8:S61-8. [PMID: 26972268 DOI: 10.1016/j.pmrj.2015.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/25/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022]
Abstract
Exercise-associated hyponatremia (EAH) is one of the most common causes of exercise-associated collapse. The primary pathogenesis of EAH is largely the result of excessive fluid intake but is influenced by other factors, including hormonal abnormalities (ie, inappropriate arginine vasopressin secretion), renal abnormalities, and mobilization of sodium stores. Early recognition of EAH is crucial to appropriate treatment, because symptoms are varied and may be confused with other causes of exercise-associated collapse. Onsite testing of [Na+] will confirm the diagnosis but is not always available. Rapid treatment of EAH will depend upon the type and severity of symptoms. Treatment protocols range from fluid restriction or oral hypertonic fluids for mild symptoms to intravenous hypertonic fluids for more severe symptoms. Preventative strategies should emphasize fluid consumption based on thirst and athlete/coach/staff education regarding proper hydration practices.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98105; and University of Washington and Seattle University(∗).
| | - Kelsey M Parker
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA(†)
| | - Anthony DiGirolamo
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA(‡)
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