Metabolic and thermodynamic responses to dehydration-induced reductions in muscle blood flow in exercising humans

Dehydration: physiology, assessment, and performance effects

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).

Performance in the heat-physiological factors of importance for hyperthermia-induced fatigue

This article presents a historical overview and an up-to-date review of hyperthermia-induced fatigue during exercise in the heat. Exercise in the heat is associated with a thermoregulatory burden which mediates cardiovascular challenges and influence the cerebral function, increase the pulmonary ventilation, and alter muscle metabolism; which all potentially may contribute to fatigue and impair the ability to sustain power output during aerobic exercise. For maximal intensity exercise, the performance impairment is clearly influenced by cardiovascular limitations to simultaneously support thermoregulation and oxygen delivery to the active skeletal muscle. In contrast, during submaximal intensity exercise at a fixed intensity, muscle blood flow and oxygen consumption remain unchanged and the potential influence from cardiovascular stressing and/or high skin temperature is not related to decreased oxygen delivery to the skeletal muscles. Regardless, performance is markedly deteriorated and exercise-induced hyperthermia is associated with central fatigue as indicated by impaired ability to sustain maximal muscle activation during sustained contractions. The central fatigue appears to be influenced by neurotransmitter activity of the dopaminergic system, but inhibitory signals from thermoreceptors arising secondary to the elevated core, muscle and skin temperatures and augmented afferent feedback from the increased ventilation and the cardiovascular stressing (perhaps baroreceptor sensing of blood pressure stability) and metabolic alterations within the skeletal muscles are likely all factors of importance for afferent feedback to mediate hyperthermia-induced fatigue during submaximal intensity exercise. Taking all the potential factors into account, we propose an integrative model that may help understanding the interplay among factors, but also acknowledging that the influence from a given factor depends on the exercise hyperthermia situation.

Optimal composition of fluid-replacement beverages

The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications. Early pioneering research involving fluid replacement in persons suffering from diarrheal disease and in military, occupational, and athlete populations incurring exercise- and/or heat-induced sweat losses has provided much of the insight regarding basic principles on beverage palatability, voluntary fluid intake, fluid absorption, and fluid retention. We review this work and also discuss more recent advances in the understanding of fluid replacement as it applies to various populations (military, athletes, occupational, men, women, children, and older adults) and situations (pathophysiological factors, spaceflight, bed rest, long plane flights, heat stress, altitude/cold exposure, and recreational exercise). We discuss how beverage carbohydrate and electrolytes impact fluid replacement. We also discuss nutrients and compounds that are often included in fluid-replacement beverages to augment physiological functions unrelated to hydration, such as the provision of energy. The optimal composition of a fluid-replacement beverage depends upon the source of the fluid loss, whether from sweat, urine, respiration, or diarrhea/vomiting. It is also apparent that the optimal fluid-replacement beverage is one that is customized according to specific physiological needs, environmental conditions, desired benefits, and individual characteristics and taste preferences.

Are we being drowned in hydration advice? Thirsty for more?

Hydration pertains simplistically to body water volume. Functionally, however, hydration is one aspect of fluid regulation that is far more complex, as it involves the homeostatic regulation of total body fluid volume, composition and distribution. Deliberate or pathological alteration of these regulated factors can be disabling or fatal, whereas they are impacted by exercise and by all environmental stressors (e.g. heat, immersion, gravity) both acutely and chronically. For example, dehydration during exercising and environmental heat stress reduces water volume more than electrolyte content, causing hyperosmotic hypohydration. If exercise continues for many hours with access to food and water, composition returns to normal but extracellular volume increases well above baseline (if exercising upright and at low altitude). Repeating bouts of exercise or heat stress does likewise. Dehydration due to physical activity or environmental heat is a routine fluid-regulatory stress. How to gauge such dehydration and - more importantly-what to do about it, are contested heavily within sports medicine and nutrition. Drinking to limit changes in body mass is commonly advocated (to maintain ≤2% reduction), rather than relying on behavioural cues (mainly thirst) because the latter has been deemed too insensitive. This review, as part of the series on moving in extreme environments, critiques the validity, problems and merits of externally versus autonomously controlled fluid-regulatory behaviours, both acutely and chronically. Our contention is that externally advocated hydration policies (especially based on change in body mass with exercise in healthy individuals) have limited merit and are extrapolated and imposed too widely upon society, at the expense of autonomy. More research is warranted to examine whether ad libitum versus avid drinking is beneficial, detrimental or neither in: acute settings; adapting for obligatory dehydration (e.g. elite endurance competition in the heat), and; development of chronic diseases that are associated with an extreme lack of environmental stress.

Bovine colostrum, training status, and gastrointestinal permeability during exercise in the heat: a placebo-controlled double-blind study

Heat stress can increase gastrointestinal permeability, allowing ingress of gram-negative bacterial fragments and thus potentially inflammation and ultimately endotoxemia. Permeability may rise with intense exercise, yet some data indicate that endotoxemia may be mitigated with bovine colostrum supplementation. Using a double-blind, randomised, placebo-controlled crossover study, we tested whether bovine colostrum (COL; 1.7 g·kg(-1)·day(-1) for 7 days) would attenuate physiological strain and aid exercise capacity in the heat, especially in untrained individuals. Seven trained men (T; peak oxygen uptake 64 ± 4 mL·kg(-1)·min(-1)) and 8 untrained men (UT, peak oxygen uptake 46 ± 4 mL·kg(-1)·min(-1)) exercised for 90 min in 30 °C (50 % relative humidity) after COL or placebo (corn flour). Exercise consisted of 15-min cycling at 50 % heart rate reserve (HRR) before and after 60 min of running (30 min at 80 % HRR then 30-min distance trial). Heart rate, blood pressure (Finometer), esophageal, and skin temperatures were recorded continuously. Gastrointestinal permeability was assessed from urine (double-sugar model, using high-performance liquid chromatography) and blood (intestinal fatty acid-binding protein, I-FABP). The T group ran ∼2.4 km (35%) further than the UT group in the distance trial, and I-FABP increased more in the T group than in the UT group, but physiological and performance outcomes were unaffected by colostrum supplementation, irrespective of fitness. Circulating pro- and anti-inflammatory cytokine concentrations were higher following exercise, but were not modulated by fitness or COL. Despite substantial thermal and cardiovascular strain incurred in environmental conditions in which exertional endotoxemia may occur, bovine colostrum supplementation had no observable benefit on the physiology or performance of either highly trained endurance athletes or untrained individuals.

Encapsulated environment

In many occupational settings, clothing must be worn to protect individuals from hazards in their work environment. However, personal protective clothing (PPC) restricts heat exchange with the environment due to high thermal resistance and low water vapor permeability. As a consequence, individuals who wear PPC often work in uncompensable heat stress conditions where body heat storage continues to rise and the risk of heat injury is greatly enhanced. Tolerance time while wearing PPC is influenced by three factors: (i) initial core temperature (Tc), affected by heat acclimation, precooling, hydration, aerobic fitness, circadian rhythm, and menstrual cycle (ii) Tc tolerated at exhaustion, influenced by state of encapsulation, hydration, and aerobic fitness; and (iii) the rate of increase in Tc from beginning to end of the heat-stress exposure, which is dependent on the clothing characteristics, thermal environment, work rate, and individual factors like body composition and economy of movement. Methods to reduce heat strain in PPC include increasing clothing permeability for air, adjusting pacing strategy, including work/rest schedules, physical training, and cooling interventions, although the additional weight and bulk of some personal cooling systems offset their intended advantage. Individuals with low body fatness who perform regular aerobic exercise have tolerance times in PPC that exceed those of their sedentary counterparts by as much as 100% due to lower resting Tc, the higher Tc tolerated at exhaustion and a slower increase in Tc during exercise. However, questions remain about the importance of activity levels, exercise intensity, cold water ingestion, and plasma volume expansion for thermotolerance.

Fatigue index and fatigue rate during an anaerobic performance under hypohydrations

Background

Since hypohydration commonly occurs in sports, studies on anaerobic exercise performance under this condition have been extensively carried out. When describing anaerobic performance, authors usually refer to a drop in anaerobic performance as fatigue index (FI) which is conventionally calculated using peak and low power data points. Meanwhile, another possible method in explaining anaerobic fatigue is using the rate constant which is derived from the exponential decline of power output known as fatigue rate (FR). Few studies have demonstrated that there was no change in anaerobic performance under mild hypohydrations.

Purpose

This study aimed to compare the kinetics of power output using FI and FR of an anaerobic performance (Wingate test) under 2, 3 and 4% state of hypohydrations.

Method

Thirty two collegiate cyclists (age  = 22±2 years; body weight  = 71.45±3.43 kg; height  = 173.23±0.04 cm) were matched using their baseline anaerobic peak power (APP) then randomly divided into 4 groups of EU (euhydrated), 2H, 3H and 4H respectively.

Results

As expected the, FI, APP, anaerobic lower power (ALP) and rating of perceived exertion (RPE) did not show significant differences between and within the groups. However, the FR in 3H (0.018±0.005s⁻¹) and 4H (0.019±0.010s⁻¹) were significantly lower than EU (0.033±0.012s⁻¹). Post-test FR also showed significant reduction in 3H and 4H compared to their pre-test values (p<0.05).

Conclusion

Despite the lack of changes in APP and RPE, subjects in 3H and 4H showed evidence of lower reduction of power output over time. The findings support earlier reports which showed no change in anaerobic performance under mild hypohydrations. The relatively lower FR suggests higher drive in maintaining power output under hypohydrations of 3 and 4% body weight.

Effects of dehydration during cycling on skeletal muscle metabolism in females

INTRODUCTION

This study investigated the effects of progressive dehydration on the time course of changes to whole body substrate oxidation and skeletal muscle metabolism during 120 min of cycling in hydrated females.

METHODS

Subjects (n = 9) cycled for 120 min at approximately 65% VO(2peak) on two occasions: with no fluid (DEH) and with fluid (HYD) replacement to match sweat losses. Venous blood samples were taken at rest and every 20 min and muscle biopsies taken at 0, 60, and 120 min of exercise.

RESULTS

DEH subjects lost 0.9% body mass from 0 to 60 min and 1.1% from 60 to 120 min (2.0% total). HR and core temperature (Tc) were significantly greater from 30 to 120 min, plasma volume (Pvol) loss from 40 to 120 min, and RPE from 60 to 120 min in the DEH trial. There were no differences in VO(2) or sweat loss between trials. RER (HYD, 0.85 ± 0.01, vs. DEH, 0.87 ± 0.01) and total CHO oxidation (175 ± 17 vs. 191 ± 17 g) were higher in the DEH trial. Blood (La) was significantly higher in the DEH trial, with no change in plasma free fatty acid and epinephrine concentrations. Muscle glycogenolysis was 31% greater in the DEH trial (252 ± 49 vs. 330 ± 33 mmol.kg(-1) dry muscle), and muscle (La) was also higher at 60 min.

CONCLUSION

Progressive dehydration significantly increased HR, Tc, RPE, Pvol loss, whole body CHO oxidation, and muscle glycogenolysis, and these changes were already apparent in the first hour of exercise when body mass losses were ≤ 1%. The increased muscle glycogenolysis with DEH appeared to be due to increased core and muscle temperature, secondary to less efficient movement of heat from the core to the periphery.

2011 and 2012 Early Careers Achievement Awards: metabolic priorities during heat stress with an emphasis on skeletal muscle

Environmental heat stress undermines efficient animal production resulting in a significant financial burden to agricultural producers. The reduction in performance during heat stress is traditionally thought to result from reduced nutrient intake. Recently, this notion has been challenged with observations indicating that heat-stressed animals may exploit novel homeorhetic strategies to direct metabolic and fuel selection priorities independent of nutrient intake or energy balance. Alterations in systemic physiology support a shift in metabolism, stemming from coordinated interactions at whole-body and tissue-specific levels. Such changes are characterized by increased basal and stimulated circulating insulin concentration in addition to the ostensible lack of basal adipose tissue lipid mobilization coupled with reduced adipocyte responsiveness to lipolytic stimuli. Hepatic and skeletal muscle cellular bioenergetics also exhibit clear differences in carbohydrate production and use, respectively, due to heat stress. The apparent dichotomy in intermediary metabolism between the 2 tissue types may stem from factors such as tricarboxylic acid cycle substrate flux and mitochondrial respiration. Thus, the heat stress response markedly alters postabsorptive carbohydrate, lipid, and protein metabolism through coordinated changes in fuel supply and use across tissues in a manner that is distinct from commonly recognizable changes that occur in animals on a reduced plane of nutrition. Perhaps most intriguing is that the coordinated systemic, cellular, and molecular changes appear conserved across physiological states and among different ruminant and monogastric species. Ultimately, these changes result in the reprioritization of skeletal muscle fuel selection during heat stress, which may be important for whole-body metabolism and overall physiological adaptation to hyperthermia.

Temperature-dependent release of ATP from human erythrocytes: mechanism for the control of local tissue perfusion

Human limb muscle and skin blood flow increases significantly with elevations in temperature, possibly through physiological processes that involve temperature-sensitive regulatory mechanisms. Here we tested the hypothesis that the release of the vasodilator ATP from human erythrocytes is sensitive to physiological increases in temperature both in vitro and in vivo, and examined potential channel/transporters involved. To investigate the source of ATP release, whole blood, red blood cells (RBCs), plasma and serum were heated in vitro to 33, 36, 39 and 42°C. In vitro heating augmented plasma or ‘bathing solution’ ATP in whole blood and RBC samples, but not in either isolated plasma or serum samples. Heat-induced ATP release was blocked by niflumic acid and glibenclamide, but was not affected by inhibitors of nucleoside transport or anion exchange. Heating blood to 42°C enhanced (P < 0.05) membrane protein abundance of cystic fibrosis transmembrane conductance regulator (CFTR) in RBCs. In a parallel in vivo study in humans exposed to whole-body heating at rest and during exercise, increases in muscle temperature from 35 to 40°C correlated strongly with elevations in arterial plasma ATP (r² = 0.91; P = 0.0001), but not with femoral venous plasma ATP (r² = 0.61; P = 0.14). In vitro, however, the increase in ATP release from RBCs was similar in arterial and venous samples heated to 39°C. Our findings demonstrate that erythrocyte ATP release is sensitive to physiological increases in temperature, possibly via activation of CFTR-like channels, and suggest that temperature-dependent release of ATP from erythrocytes might be an important mechanism regulating human limb muscle and skin perfusion in conditions that alter blood and tissue temperature.

The limitations of the constant load and self-paced exercise models of exercise physiology

The fundamental tenets of exercise physiology are to describe energy transformations during physical work and make predictions about physical performance during different conditions. Historically, the most popular method to observe such responses during exercise has been the constant load or fixed intensity protocol based largely on the assumption that there is a threshold response of the organism under given conditions. However, constant load exercise does not fully allow for randomness or variability as the biological system is overridden by a predetermined externally imposed load which cannot be altered. Conversely, in self-regulated (paced) exercise there is almost an immediate reduction in power output and muscle recruitment upon commencing exercise. This observation suggests the existence of a neural inhibitory command processes. This difference in regulation demonstrates the inherent importance of variability in the biological system; for in tightly controlled energy expenditure, as is the case during constant load exercise, sensory cues cannot be fully integrated to provide a more appropriate response to the given task. The collective evidence from conventional constant load versus self-regulated exercise studies suggest that energy transformations are indeed different so that the inherent biological variability accounts for the different results achieved by the two experimental paradigms.

Brain temperature and exercise performance

Events arising within the central nervous system seem to be a major factor in the aetiology of hyperthermia-induced fatigue. Thus, various studies with superimposed electrical nerve stimulation or transcranial magnetic stimulation have shown that both passive and exercise-induced hyperthermia will impair voluntary motor activation during sustained maximal contractions. In humans, the brain temperature increases in parallel with that of the body core, making it very difficult to evaluate the independent effect of the cerebral temperature. Experiments with separate manipulation of the brain temperature in exercising goats indicate that excessive brain hyperthermia will directly affect motor performance. However, several homeostatic changes arise in parallel with hyperthermia, including factors that may influence both peripheral and central fatigue, and it is likely that these changes interact with the inhibitory effect of an elevated brain temperature.

Effects of heat exposure and 3% dehydration achieved via hot water immersion on repeated cycle sprint performance

This study examined effects of heat exposure with and without dehydration on repeated anaerobic cycling. Males (n = 10) completed 3 trials: control (CT), water-bath heat exposure (∼39°C) to 3% dehydration (with fluid replacement) (HE), and similar heat exposure to 3% dehydration (DEHY). Hematocrit increased significantly from pre to postheat immersion in both HE and DEHY. Participants performed 6 × 15s cycle sprints (30s active recovery). Mean Power (MP) was significantly lower vs. CT (596 ± 66 W) for DEHY (569 ± 72 W), and the difference approached significance for HE (582 ± 76 W, p = 0.07). Peak Power (PP) was significantly lower vs. CT (900 ± 117 W) for HE (870 ± 128 W) and approached significance for DEHY (857 ± 145 W, p = 0.07). Postsprint ratings of perceived exertion was higher during DEHY (6.4 ± 2.0) and HE (6.3 ± 1.6) than CT (5.7 ± 2.1). Combined heat and dehydration impaired MP and PP (decrements greatest in later bouts) with HE performance intermediate to CT and DEHY.

Central fatigue and neurotransmitters, can thermoregulation be manipulated?

Fatigue is a complex phenomenon that can be evoked by peripheral and central factors. Although it is obvious that fatigue has peripheral causes such as glycogen depletion and cardiovascular strain, recent literature also focuses on the central origin of fatigue. It is clear that different brain neurotransmitters--such as serotonin, dopamine and noradrenaline--are implicated in the occurrence of fatigue, but manipulation of these neurotransmitters produced no conclusive results on performance in normal ambient temperature. Exercise in the heat not only adds an extra challenge to the cardiorespiratory system, but also to the brain. This provides a useful tool to investigate the association between exercise-induced hyperthermia and central fatigue. This review focuses on the effects of pharmacological manipulations on performance and thermoregulation in different ambient temperatures. Dopaminergic reuptake inhibition appears to counteract hyperthermia-induced fatigue in 30 °C, while noradrenergic neurotransmission shows negative effects on performance in both normal and high temperature, and serotonergic manipulations did not lead to significant changes in performance. It is, however, unlikely that one neurotransmitter system is responsible for the delay or onset of fatigue. Further research is required to determine the exact mechanisms of fatigue in different environmental conditions.

Mechanisms of aerobic performance impairment with heat stress and dehydration

Environmental heat stress can challenge the limits of human cardiovascular and temperature regulation, body fluid balance, and thus aerobic performance. This minireview proposes that the cardiovascular adjustments accompanying high skin temperatures (Tsk), alone or in combination with high core body temperatures (Tc), provide a primary explanation for impaired aerobic exercise performance in warm-hot environments. The independent (Tsk) and combined (Tsk + Tc) effects of hyperthermia reduce maximal oxygen uptake (V̇o2max), which leads to higher relative exercise intensity and an exponential decline in aerobic performance at any given exercise workload. Greater relative exercise intensity increases cardiovascular strain, which is a prominent mediator of rated perceived exertion. As a consequence, incremental or constant-rate exercise is more difficult to sustain (earlier fatigue) or requires a slowing of self-paced exercise to achieve a similar sensation of effort. It is proposed that high Tsk and Tc impair aerobic performance in tandem primarily through elevated cardiovascular strain, rather than a deterioration in central nervous system (CNS) function or skeletal muscle metabolism. Evaporative sweating is the principal means of heat loss in warm-hot environments where sweat losses frequently exceed fluid intakes. When dehydration exceeds 3% of total body water (2% of body mass) then aerobic performance is consistently impaired independent and additive to heat stress. Dehydration augments hyperthermia and plasma volume reductions, which combine to accentuate cardiovascular strain and reduce V̇o2max. Importantly, the negative performance consequences of dehydration worsen as Tsk increases.

Cardiovascular function in the heat-stressed human

Heat stress, whether passive (i.e. exposure to elevated environmental temperatures) or via exercise, results in pronounced cardiovascular adjustments that are necessary for adequate temperature regulation as well as perfusion of the exercising muscle, heart and brain. The available data suggest that generally during passive heat stress baroreflex control of heart rate and sympathetic nerve activity are unchanged, while baroreflex control of systemic vascular resistance may be impaired perhaps due to attenuated vasoconstrictor responsiveness of the cutaneous circulation. Heat stress improves left ventricular systolic function, evidenced by increased cardiac contractility, thereby maintaining stroke volume despite large reductions in ventricular filling pressures. Heat stress-induced reductions in cerebral perfusion likely contribute to the recognized effect of this thermal condition in reducing orthostatic tolerance, although the mechanism(s) by which this occurs is not completely understood. The combination of intense whole-body exercise and environmental heat stress or dehydration-induced hyperthermia results in significant cardiovascular strain prior to exhaustion, which is characterized by reductions in cardiac output, stroke volume, arterial pressure and blood flow to the brain, skin and exercising muscle. These alterations in cardiovascular function and regulation late in heat stress/dehydration exercise might involve the interplay of both local and central reflexes, the contribution of which is presently unresolved.

Alterations in central fatigue by pharmacological manipulations of neurotransmitters in normal and high ambient temperature

The scientific evidence is reviewed for the involvement of the brain monoamines serotonin, dopamine and noradrenaline (norepinephrine) in the onset of fatigue, in both normal and high ambient temperatures. The main focus is the pharmacological manipulations used to explore the central fatigue hypothesis. The original central fatigue hypothesis emphasizes that an exercise-induced increase in serotonin is responsible for the development of fatigue. However, several pharmacological studies attempted and failed to alter exercise capacity through changes in serotonergic neurotransmission in humans, indicating that the role of serotonin is often overrated. Recent studies, investigating the inhibition of the reuptake of both dopamine and noradrenaline, were capable of detecting changes in performance, specifically when ambient temperature was high. Dopamine and noradrenaline are prominent in innervated areas of the hypothalamus, therefore changes in the catecholaminergic concentrations may also be expected to be involved with the regulation of body core temperature during exercise in the heat. Evidence from different studies suggests that it is very unlikely that one neurotransmitter system is responsible for the appearance of central fatigue. The exact mechanism of fatigue is not known; presumably a complex interplay between both peripheral and central factors induces fatigue. Central fatigue will be determined by the collaboration of the different neurotransmitter systems, with the most important role possibly being for the catecholamines dopamine and noradrenaline.

The effect of oral vs. Intravenous rehydration on circulating myoglobin and creatine kinase

Physical activity of significant intensity and duration may cause varying degrees of skeletal muscle damage, but it is unclear whether mode of rehydration will attenuate muscle tissue disruption caused by exercise in the heat. To examine the effects of the mode of rehydration on markers of muscle damage (myoglobin and creatine kinase [CK]), 11 healthy active men (age = 23 +/- 4 years, body mass = 80.9 +/- 3.9 kg, height = 180.5 +/- 5.4 cm) completed 4 experimental trials consisting of an exercise dehydration protocol (to -4% of baseline body mass), followed by a rehydration period (oral, intravenous [IV], oral and IV combined, and ad libitum), and finishing with an intense exercise challenge that included treadmill running and sprinting and a box lifting protocol. During rehydration, subjects returned to -2% of baseline body mass unless completing the ad libitum trial during which they consumed fluids as thirst dictated. Myoglobin (Mb) and CK were measured during euhydrated rest. Post-exercise blood was drawn at 1 and 24 hours post exercise challenge for Mb and CK, respectively. Urine was collected during euhydrated rest and 1-hour post exercise challenge for measurement of Mb clearance. Mb concentrations increased significantly from pre (1.06 +/- 0.20, 0.88 +/- 0.07, 1.15 +/- 0.25 and 0.92 +/- 0.06 nmol.L) to post (1.52 +/- 0.28, 1.44 +/- 0.11, 1.71 +/- 0.45 and 1.58 +/- 0.39) for IV, oral, oral and IV combined, and ad libitum, respectively, but were not significantly different among trials. Serum CK concentrations remained within the normal physiological range for all trials. Thus, despite previous research that clearly indicates the benefit of ingesting fluids during exercise to attenuate muscle damage, there were no significant differences between the modes of rehydration on circulating Mb and CK.

Core temperature responses and match running performance during intermittent-sprint exercise competition in warm conditions

This study investigated the thermoregulatory responses and match running performance of elite team sport competitors (Australian Rules football) during preseason games in a warm environment. During 2 games in dry bulb temperatures above 29 degrees C (>27 degrees C wet bulb globe temperature), 10 players were monitored for core temperature (Tcore) via a telemetric capsule, in-game motion patterns, blood lactate ([La]), body mass changes, urine specific gravity, and pre- and postgame vertical jump performance. The results showed that peak Tcore was achieved during the final quarter at 39.3 +/- 0.7 degrees C and that several players reached values near 40.0 degrees C. Further, the largest proportion of the total rise in Tcore (2.1 +/- 0.7 degrees C) occurred during the first quarter of the match, with only small increases during the remainder of the game. The game distance covered was 9.4 +/- 1.5 km, of which 2.7 +/- 0.9 km was at high-intensity speeds (>14.4 km x h(-1)). The rise in Tcore was correlated with first-quarter high-intensity running velocity (r = 0.72) and moderate-intensity velocity (r = 0.68), second-quarter Tcore and low-intensity activity velocity (r = -0.90), second-quarter Tcore and moderate-intensity velocity (r = 0.88), fourth-quarter rise in Tcore and very-high-intensity running distance (r = 0.70), and fourth-quarter Tcore and moderate-intensity velocity (r = 0.73). Additional results included mean game [La-] values of 8.7 +/- 0.1 mmol x L(-1), change in body mass of 2.1 +/- 0.8 kg, and no change (p > 0.05) in pre- to postgame vertical jump. These findings indicate that the plateau in Tcore may be regulated by the reduction in low-intensity activity and that pacing strategies may be employed during competitive team sports in the heat to ensure control of the internal heat load.

Influence of hypohydration on intermittent sprint performance in the heat

PURPOSE

To examine the effect of hypohydration on physiological strain and intermittent sprint exercise performance in the heat (35.5 +/- 0.6 degrees C, 48.7 +/- 3.4% relative humidity).

METHODS

Eight unacclimatized males (age 23.4 +/- 6.2 y, height 1.78 +/- 0.04 m, mass 76.8 +/- 7.7 kg) undertook three trials, each over two days. On day 1, subjects performed 90 min of exercise/heat-induced dehydration on a cycle ergometer, before following one of three rehydration strategies. On day 2, subjects completed a 36-min cycling intermittent sprint test (IST) with a -0.62 +/- 0.74% (euhydrated, EUH), -1.81 (0.99)% (hypohydrated1, HYPO1), or -3.88 +/- 0.89% (hypohydrated2, HYPO2) body mass deficit.

RESULTS

No difference was observed in average total work (EUH, 3790 +/- 556 kJ; HYPO1, 3785 +/- 628 kJ; HYPO2, 3647 +/- 339 kJ, P = 0.418), or average peak power (EUH, 1315 +/- 129 W; HYPO1, 1304 +/- 175 W; HYPO2, 1282 +/- 128 W, P = 0.356) between conditions on day 2. Total work and peak power output in the sprint immediately following an intense repeated sprint bout during the IST were lower in the HYPO2 condition. Physiological strain index was greater in the HYPO2 vs. the EUH condition, but without changes in metabolic markers.

CONCLUSION

A greater physiological strain was observed with the greatest degree of hypohydration; however, sprint performance only diminished in the most hypohydrated state near the end of the IST, following an intense bout of repeating sprinting.

Glucose ingestion during endurance training does not alter adaptation

Glucose ingestion during exercise attenuates activation of metabolic enzymes and expression of important transport proteins. In light of this, we hypothesized that glucose ingestion during training would result in 1) an attenuation of the increase in fatty acid uptake and oxidation during exercise, 2) lower citrate synthase (CS) and β-hydroxyacyl-CoA dehydrogenase (β-HAD) activity and glycogen content in skeletal muscle, and 3) attenuated endurance performance enhancement in the trained state. To investigate this we studied nine male subjects who performed 10 wk of one-legged knee extensor training. They trained one leg while ingesting a 6% glucose solution (Glc) and ingested a sweetened placebo while training the other leg (Plc). The subjects trained their respective legs 2 h at a time on alternate days 5 days a week. Endurance training increased peak power (Pmax) and time to fatigue at 70% of Pmax ∼14% and ∼30%, respectively. CS and β-HAD activity increased and glycogen content was greater after training, but there were no differences between Glc and Plc. After training the rate of oxidation of palmitate (Rox) and the % of rate of disappearance that was oxidized (%Rdox) changed. %Rdox was on average 16.4% greater during exercise after training whereas, after exercise %Rdox was 30.4% lower. Rox followed the same pattern. However, none of these parameters were different between Glc and Plc. We conclude that glucose ingestion during training does not alter training adaptation related to substrate metabolism, mitochondrial enzyme activity, glycogen content, or performance.

Effect of hypohydration on hyperthermic hyperpnea and cutaneous vasodilation during exercise in men

We tested the hypothesis that, in humans, hypohydration attenuates hyperthermic hyperpnea during exercise in the heat. On two separate occasions, thirteen male subjects performed a fluid replacement (FR) and a no-fluid replacement (NFR) trial in random order. The subjects performed two bouts of cycle exercise (Ex1 and Ex2, 30–60 min) at 50% peak oxygen uptake (V̇o2 peak) in 35°C separated by a 70- to 80-min rest period, during which they drank water containing 25 mosmol/l sodium in the FR trial but not the NFR trial. The drinking in the FR trial nearly restored the body fluid to the euhydrated condition, so that the body fluid status differed between the trials before Ex2 (the difference in plasma osmolality before Ex2 was 9.4 mosmol/kgH2O; plasma volume was 7.6%, and body weight was 2.5%). The slopes of the linear relationships between ventilatory variables (minute ventilation, ventilatory equivalents for oxygen uptake and carbon dioxide output, tidal volume, respiratory frequency, and end-tidal CO2 pressure) and esophageal temperature (Tes) did not significantly differ between Ex1 and Ex2, or between the FR and NFR trials. On the other hand, during Ex2 in the NFR trial, the Tes threshold for the onset of increased forearm vascular conductance (FVC) was higher, and the slope and peak values of the relationship between FVC and Tes were lower than during Ex1 in the NFR trial and during Ex2 in the FR trial. These findings suggest that hypohydration does not affect the hyperthermic hyperpnea during exercise, although it markedly attenuates the cutaneous vasodilatory response.

Physiological limits to exercise performance in the heat

Exercise in the heat results in major alterations in cardiovascular, thermoregulatory, metabolic and neuromuscular function. Hyperthermia appears to be the key determinant of exercise performance in the heat. Thus, strategies that attenuate the rise in core temperature contribute to enhanced exercise performance. These include heat acclimatization, pre-exercise cooling and fluid ingestion which have all been shown to result in reduced physiological and psychophysical strain during exercise in the heat and improved performance.

The cardiovascular challenge of exercising in the heat

Exercise in the heat can pose a severe challenge to human cardiovascular control, and thus the provision of oxygen to exercising muscles and vital organs, because of enhanced thermoregulatory demand for skin blood flow coupled with dehydration and hyperthermia. Cardiovascular strain, typified by reductions in cardiac output, skin and locomotor muscle blood flow and systemic and muscle oxygen delivery accompanies marked dehydration and hyperthermia during prolonged and intense exercise characteristic of many summer Olympic events. This review focuses on how the cardiovascular system is regulated when exercising in the heat and how restrictions in locomotor skeletal muscle and/or skin perfusion might limit athletic performance in hot environments.

Hyperthermia and fatigue

The present review addresses mechanisms of importance for hyperthermia-induced fatigue during short intense activities and prolonged exercise in the heat. Inferior performance during physical activities with intensities that elicit maximal oxygen uptake is to a large extent related to perturbation of the cardiovascular function, which eventually reduces arterial oxygen delivery to the exercising muscles. Accordingly, aerobic energy turnover is impaired and anaerobic metabolism provokes peripheral fatigue. In contrast, metabolic disturbances of muscle homeostasis are less important during prolonged exercise in the heat, because increased oxygen extraction compensates for the reduction in systemic blood flow. The decrease in endurance seems to involve changes in the function of the central nervous system (CNS) that lead to fatigue. The CNS fatigue appears to be influenced by neurotransmitter activity of the dopaminergic system, but may primarily relate to inhibitory signals from the hypothalamus arising secondary to an increase in brain temperature. Fatigue is an integrated phenomenon, and psychological factors, including the anticipation of fatigue, should not be neglected and the interaction between central and peripheral physiological factors also needs to be considered.

Hyperthermia impairs brain, heart and muscle function in exercising humans

Marathon running poses a severe challenge to multiple regulatory systems and cellular homeostasis, especially when performed in hot environments without fluid replacement. During exercise in the heat, the ensuing dehydration causes hyperthermia and the synergistic effects of both stressors reduce cardiac output and blood flow to muscle, skin, brain and possibly splanchnic tissues. The drop in blood flow beyond the regulatory adjustment to concurrent increases in blood oxygen content leads to reductions in oxygen delivery, suppressed muscle aerobic energy turnover and greater reliance of the exercising muscles on anaerobic metabolism before fatigue. The accelerated hyperthermia-mediated fatigue during prolonged and maximal exercise is preceded by functional alterations in multiple bodily systems including the brain, heart and muscle. It is proposed that the impaired marathon running performance in warm environments is associated with a greater thermal, cardiovascular and metabolic strain, and perception of effort that prevents marathon runners from running at their personal record speed without inducing an accelerated regulatory dysfunction in multiple bodily systems.

Effects of acute heat exposure on prosencephalic c-Fos expression in normohydrated, water-deprived and salt-loaded rats

In the present study, the distribution pattern of c-Fos protein immunoreactivity (Fos-IR) in prosencephalic areas of the brain involved in thermoregulatory and osmoregulatory responses was investigated, in rats exposed or not exposed to a hyperthermic environment, under three different conditions: normohydration, dehydration induced by water deprivation and hyperosmolarity induced by an acute intragastric salt load. Normohydrated, water-deprived or salt-loaded male Wistar rats (270+/-30 g) were submitted or not to acute heat exposure (33 degrees C for 45 min). A separate group of animals was submitted to the same experimental protocol and had blood samples collected before and after the heating period to measure serum osmolarity and sodium. The brains were processed for c-Fos immunohistochemistry using the avidin-biotin peroxidase method. After analyzing Fos-IR in the brains of animals in the present study, three different types of prosencephalic areas were identified: (1) those that respond to hydrational and to heat conditions, with an interaction between these two factors (PaMP and SON); (2) those that respond to hydrational and to heat conditions, but with no interaction between these factors (MnPO, LSV and OVLT); and (3) those that respond only to hydrational status (SFO and PaLM).

Fluid and fuel intake during exercise

The amounts of water, carbohydrate and salt that athletes are advised to ingest during exercise are based upon their effectiveness in attenuating both fatigue as well as illness due to hyperthermia, dehydration or hyperhydration. When possible, fluid should be ingested at rates that most closely match sweating rate. When that is not possible or practical or sufficiently ergogenic, some athletes might tolerate body water losses amounting to 2% of body weight without significant risk to physical well-being or performance when the environment is cold (e.g. 5-10 degrees C) or temperate (e.g. 21-22 degrees C). However, when exercising in a hot environment ( > 30 degrees C), dehydration by 2% of body weight impairs absolute power production and predisposes individuals to heat injury. Fluid should not be ingested at rates in excess of sweating rate and thus body water and weight should not increase during exercise. Fatigue can be reduced by adding carbohydrate to the fluids consumed so that 30-60 g of rapidly absorbed carbohydrate are ingested throughout each hour of an athletic event. Furthermore, sodium should be included in fluids consumed during exercise lasting longer than 2 h or by individuals during any event that stimulates heavy sodium loss (more than 3-4 g of sodium). Athletes do not benefit by ingesting glycerol, amino acids or alleged precursors of neurotransmitter. Ingestion of other substances during exercise, with the possible exception of caffeine, is discouraged. Athletes will benefit the most by tailoring their individual needs for water, carbohydrate and salt to the specific challenges of their sport, especially considering the environment's impact on sweating and heat stress.

Physiological Basis of Fatigue

This work summarizes our knowledge of the physiological basis of fatigue and the effects of exercise and pharmacological interventions on fatigue. Fatigue may be defined as physical and/or mental weariness resulting from exertion, that is, an inability to continue exercise at the same intensity with a resultant deterioration in performance. The concept of deconditioning in patients is discussed as well as the implications for their rehabilitation and exercise. Because fatigue may result from a number of causes, including loss of muscle mass, deconditioning, nutritional deficiencies, oxygen delivery, and anemia, it should be treated comprehensively. Antifatigue therapy should be the standard of care for most chronic conditions associated with fatigue.

Hydration and Muscular Performance

Significant scientific evidence documents the deleterious effects of hypohydration (reduced total body water) on endurance exercise performance; however, the influence of hypohydration on muscular strength, power and high-intensity endurance (maximal activities lasting >30 seconds but <2 minutes) is poorly understood due to the inconsistent results produced by previous investigations. Several subtle methodological choices that exacerbate or attenuate the apparent effects of hypohydration explain much of this variability. After accounting for these factors, hypohydration appears to consistently attenuate strength (by approximately 2%), power (by approximately 3%) and high-intensity endurance (by approximately 10%), suggesting alterations in total body water affect some aspect of force generation. Unfortunately, the relationships between performance decrement and crucial variables such as mode, degree and rate of water loss remain unclear due to a lack of suitably uninfluenced data. The physiological demands of strength, power and high-intensity endurance couple with a lack of scientific support to argue against previous hypotheses that suggest alterations in cardiovascular, metabolic and/or buffering function represent the performance-reducing mechanism of hypohydration. On the other hand, hypohydration might directly affect some component of the neuromuscular system, but this possibility awaits thorough evaluation. A critical review of the available literature suggests hypohydration limits strength, power and high-intensity endurance and, therefore, is an important factor to consider when attempting to maximise muscular performance in athletic, military and industrial settings.

Exercise and heat stress: cerebral challenges and consequences

This review deals with new aspects of exercise in the heat as a challenge that not only influences the locomotive and cardiovascular systems, but also affects the brain. Activation of the brain during such exercise is manifested in the lowering of the cerebral glucose to oxygen uptake ratio, the elevated ratings of perceived exertion and increased release of hypothalamic hormones. While the slowing of the electroencephalographic (EEG), the decreased endurance and hampered ability to activate the skeletal muscles maximally during sustained isometric and repeated isokinetic contractions appear to relate to central fatigue arising as the core/brain increases, the central fatigue during exercise with hyperthermia thus can be considered as the ultimate safety break against catastrophic hyperthermia. This would force the subject to stop exercising or decrease the internal heat production. It appears that the dopaminergic system is important, but several other factors may interact and feedback from the skeletal muscles and internal temperature sensors are probably also involved. The complexity of brain fatigue response is discussed based on our own investigations and in the light of recent literature.

Skeletal muscle mitochondrial DNA content in exercising humans

Several weeks of intense endurance training enhances mitochondrial biogenesis in humans. Whether a single bout of exercise alters skeletal muscle mitochondrial DNA (mtDNA) content remains unexplored. Double-stranded mtDNA, estimated by slot-blot hybridization and real time PCR and expressed as mtDNA-to-nuclear DNA ratio (mtDNA/nDNA) was obtained from the vastus lateralis muscle of healthy human subjects to investigate whether skeletal muscle mtDNA changes during fatiguing and nonfatiguing prolonged moderate intensity [2.0–2.5 h; ∼60% maximal oxygen consumption (V̇o2 max)] and short repeated high-intensity exercise (5–8 min; ∼110% V̇o2 max). In control resting and light exercise (2 h; ∼25% V̇o2 max) studies, mtDNA/nDNA did not change. Conversely, mtDNA/nDNA declined after prolonged fatiguing exercise (0.863 ± 0.061 vs. 1.101 ± 0.067 at baseline; n = 14; P = 0.005), remained lower after 24 h of recovery, and was restored after 1 wk. After nonfatiguing prolonged exercise, mtDNA/nDNA tended to decline ( n = 10; P = 0.083) but was reduced after three repeated high-intensity exercise bouts (0.900 ± 0.049 vs. 1.067 ± 0.071 at baseline; n = 7; P = 0.013). Our findings indicate that prolonged and short repeated intense exercise can lead to significant reductions in human skeletal muscle mtDNA content, which might function as a signal stimulating mitochondrial biogenesis with exercise training.

The downed runner

Race coverage can be a rewarding experience for the sports medicine clinician. Several conditions are likely to present to the medical tent, and accurate diagnosis is critical to proper treatment. An algorithm approach as outlined in this article can provide a starting point for the assessment of the downed runner. Recognition of the primary causes for collapse can help to instigate the correct treatment approach. A proper history and physical examination often can help to differentiate significant cardiac events from the more innocuous EAC. Furthermore, avoiding immediate i.v. fluids in the downed runner is prudent, at least until an appropriate diagnosis is made. This will help to prevent iatrogenic hyponatremia. In sum, proper preparation and knowledge of the ailments that affect long distance runners will help to maintain an effective medical tent on race day.

The Importance of Good Hydration for Work and Exercise Performance

This review covers published literature on the influence of whole-body hydration status on exercise performance. The majority of information in this area relates to endurance exercise performance, but information on power, strength, and sporting skills has also been investigated. These areas form the focus of the current review. It is apparent that some individuals can tolerate body water losses amounting to 2% of body mass without significant risk to physical well-being or endurance exercise performance when the environment is cold (for example 5 degrees C-10 degrees C) or temperate (for example 20 degrees C-22 degrees C). However, when exercising in a hot environment (an environmental temperature of 30 degrees C or more), dehydration by 2% of body mass impairs exercise performance and increases the possibility of suffering a heat injury.

Effects of blackcurrant anthocyanin intake on peripheral muscle circulation during typing work in humans

This double-blind, placebo-controlled, crossover study investigated the effect of blackcurrant anthocyanin (BCA) intake on peripheral circulation during rest and during typing work by using near-infrared spectroscopy (NIRS), and it also assessed improvement in shoulder stiffness caused by poor local circulation. In a resting circulation study, nine healthy male subjects took capsules of BCA at a dosage of 17 mg kg(-1) or placebo (isoenergetic sugar). NIRS was used to measure left forearm blood flow (FBF) following venous occlusion and muscle oxygen consumption following arterial occlusion prior to and hourly for 4 h after ingestion of BCA. Plasma anthocyanin concentration was measured prior to ingestion and 1, 2, and 4 h later. FBF increased significantly 2 h after BCA ingestion [BCA 1.22 (0.13)-fold increase relative to pre-values vs placebo 0.83 (0.06) of pre-values; P < 0.05] and then tended to increase for a further 3 h after ingestion [BCA 1.26 (0.15)-fold increase relative to pre-values vs placebo 0.82 (0.07) of pre-values; P = 0.078]. There was, however, no significant difference in muscle oxygen consumption between BCA and placebo intake at any time point. In a typing work study, 11 healthy subjects took capsules of BCA (7.7 mg kg(-1)) or placebo (isoenergetic sugar) daily for 2 weeks. The subjects then performed intermittent typing workload for 30 min in order to induce acute shoulder stiffness. During the workload, total hemoglobin and oxygenated hemoglobin (oxy-Hb) were determined using NIRS and myoelectric signals measured in the right trapezius muscle using electromyography (EMG). The viscoelasticity of the trapezius muscle was also evaluated using a muscle stiffness meter before and after the typing workload. BCA intake prevented the decrease in oxy-Hb significantly (P < 0.05), and also tended to alleviate the increase in root mean square (RMS) of the EMG during the typing workload, and also muscle stiffness after the workload. There was no improvement in typing performance with BCA intake. The results of this study suggest that intake of BCA may improve shoulder stiffness caused by typing work by increasing peripheral blood flow and reducing muscle fatigue.

Pulmonary gas exchange at maximal exercise in Danish lowlanders during 8 wk of acclimatization to 4,100 m and in high-altitude Aymara natives

We aimed to test effects of altitude acclimatization on pulmonary gas exchange at maximal exercise. Six lowlanders were studied at sea level, in acute hypoxia (AH), and after 2 and 8 wk of acclimatization to 4,100 m (2W and 8W) and compared with Aymara high-altitude natives residing at this altitude. As expected, alveolar Po2was reduced during AH but increased gradually during acclimatization (61 ± 0.7, 69 ± 0.9, and 72 ± 1.4 mmHg in AH, 2W, and 8W, respectively), reaching values significantly higher than in Aymaras (67 ± 0.6 mmHg). Arterial Po2(PaO2) also decreased during exercise in AH but increased significantly with acclimatization (51 ± 1.1, 58 ± 1.7, and 62 ± 1.6 mmHg in AH, 2W, and 8W, respectively). PaO2in lowlanders reached levels that were not different from those in high-altitude natives (66 ± 1.2 mmHg). Arterial O2saturation (SaO2) decreased during maximum exercise compared with rest in AH and after 2W and 8W: 73.3 ± 1.4, 76.9 ± 1.7, and 79.3 ± 1.6%, respectively. After 8W, SaO2in lowlanders was not significantly different from that in Aymaras (82.7 ± 1%). An improved pulmonary gas exchange with acclimatization was evidenced by a decreased ventilatory equivalent of O2after 8W: 59 ± 4, 58 ± 4, and 52 ± 4 l·min·l O2−1, respectively. The ventilatory equivalent of O2reached levels not different from that of Aymaras (51 ± 3 l·min·l O2−1). However, increases in exercise alveolar Po2and PaO2with acclimatization had no net effect on alveolar-arterial Po2difference in lowlanders (10 ± 1.3, 11 ± 1.5, and 10 ± 2.1 mmHg in AH, 2W, and 8W, respectively), which remained significantly higher than in Aymaras (1 ± 1.4 mmHg). In conclusion, lowlanders substantially improve pulmonary gas exchange with acclimatization, but even acclimatization for 8 wk is insufficient to achieve levels reached by high-altitude natives.