Fluid and fuel intake during exercise

Physiological regulation of marathon performance

Running a marathon at the fastest speed possible appears to be regulated by the rate of aerobic metabolism (i.e. marathon oxygen uptake) of a limited amount of carbohydrate energy (i.e. muscle glycogen and blood glucose) and the velocity that can be maintained without developing hyperthermia. According to a model proposed by Joyner in 1991, people possess the physiological ability to run a marathon in approximately 1:58:00. This could be accomplished if the current world record pace for the 'half-marathon' is maintained for the entire marathon. The ultimate limit to marathon performance might be dictated by the limits of running economy and a recruitment of the running musculature with a pattern that minimises fatigue, possibly by spreading the work over many motor neuron.

Dysnatremia predicts a delayed recovery in collapsed ultramarathon runners

OBJECTIVE

To assess (1) the incidence of dysnatremia in collapsed runners presenting to the medical tent of the 89-km Comrades Marathon and whether dysnatremia influences time to discharge, and (2) whether intravenous fluids could restore serum sodium concentration ([Na+]) to 140 mM faster than could the administration of oral fluids.

DESIGN

Prospective randomized controlled trial.

SETTING

2005 Comrades Marathon.

PARTICIPANTS

One hundred thirty-three collapsed runners and 31 control-group runners.

INTERVENTIONS

Collapsed runners presenting to the medical tent at the finish of the 2005 Comrades Marathon were randomized into an intravenous or oral fluid administration group, with the type and amount of fluid administered dictated by initial [Na+].

MAIN OUTCOME MEASURES

Time to discharge, serum [Na+].

RESULTS

Forty-five percent of collapsed runners were hypernatremic, 2% were hyponatremic, and 53% were normonatremic. Normonatremic runners spent significantly less time in the medical tent (80 +/- 31 minutes) compared with hypernatremic (102 +/- 36 minutes) and hyponatremic (146 +/- 122 minutes) runners. Intravenous fluid therapy produced larger but nonsignificant reductions in [Na+] than oral therapy (-2.1 +/- 3.1 versus -0.7 +/- 1.8 mM); however, 45% of runners assigned to the oral fluid group could not tolerate oral rehydration.

CONCLUSIONS

A slight majority of collapsed runners were normonatremic and spent significantly less time in the medical tent compared with hyper- and hyponatremic athletes. Initial rates of correction of hypernatremia were similar with intravenous and oral hypotonic fluid therapy. Clinicians should be advised that intravenous fluid resuscitation may best benefit hypernatremic collapsed runners who are intolerant to oral fluid ingestion.

Drinking guidelines for exercise: what evidence is there that athletes should drink "as much as tolerable", "to replace the weight lost during exercise" or "ad libitum"?

The most recent (1996) drinking guidelines of the American College of Sports Medicine (ACSM) propose that athletes should drink "as much as tolerable" during exercise. Since some individuals can tolerate rates of free water ingestion that exceed their rates of free water loss during exercise, this advice has caused some to overdrink leading to water retention, weight gain and, in a few, death from exercise-associated hyponatraemic encephalopathy. The new drinking guidelines of the International Olympic Committee (IOC), recently re-published in this Journal, continue to argue that athletes must drink enough to replace all their weight lost during exercise and to ingest sodium chloride since sodium is "the electrolyte most critical to performance and health". In this rebuttal to that Consensus Document, I argue that these new guidelines, like their predecessors, lack an adequate, scientifically proven evidence base. Nor have they been properly evaluated in appropriately controlled, randomized, prospective clinical trials. In particular, these new guidelines provide erroneous recommendations on five topics. If novel universal guidelines for fluid ingestion during exercise are to be promulgated by important international bodies including the IOC, they should first be properly evaluated in appropriately controlled, randomized, prospective clinical trials conducted under environmental and other conditions that match those found in "out-of-doors" exercise. This, and the potential influence of commercial interests on scientific independence and objectivity, are the two most important lessons to be learned from the premature adoption of those 1996 ACSM drinking guidelines that are not evidence-based. These concerns need to be addressed before the novel IOC guidelines are accepted uncritically. Otherwise the predictable consequences of the premature adoption of the 1996 ACSM guidelines will be repeated.

Errors in the estimation of hydration status from changes in body mass

Hydration status is not easily measured, but acute changes in hydration status are often estimated from body mass change. Changes in body mass are also often used as a proxy measure for sweat losses. There are, however, several sources of error that may give rise to misleading results, and our aim in this paper is to quantify these potential errors. Respiratory water losses can be substantial during hard work in dry environments. Mass loss also results from substrate oxidation, but this generates water of oxidation which is added to the body water pool, thus dissociating changes in body mass and hydration status: fat oxidation actually results in a net gain in body mass as the mass of carbon dioxide generated is less than the mass of oxygen consumed. Water stored with muscle glycogen is presumed to be made available as endogenous carbohydrate stores are oxidized. Fluid ingestion and sweat loss complicate the picture by altering body water distribution. Loss of hypotonic sweat results in increased osmolality of body fluids. Urine and faecal losses can be measured easily, but changes in the water content of the bladder and the gastrointestinal tract cannot. Body mass change is not always a reliable measure of changes in hydration status and substantial loss of mass may occur without an effective net negative fluid balance.

Milk as an effective post-exercise rehydration drink

The effectiveness of low-fat milk, alone and with an additional 20 mmol/l NaCl, at restoring fluid balance after exercise-induced hypohydration was compared to a sports drink and water. After losing 1.8 (sd 0.1) % of their body mass during intermittent exercise in a warm environment, eleven subjects consumed a drink volume equivalent to 150 % of their sweat loss. Urine samples were collected before and for 5 h after exercise to assess fluid balance. Urine excretion over the recovery period did not change during the milk trials whereas there was a marked increase in output between 1 and 2 h after drinking water and the sports drink. Cumulative urine output was less after the milk drinks were consumed (611 (sd 207) and 550 (sd 141) ml for milk and milk with added sodium, respectively, compared to 1184 (sd 321) and 1205 (sd 142) ml for the water and sports drink; P < 0.001). Subjects remained in net positive fluid balance or euhydrated throughout the recovery period after drinking the milk drinks but returned to net negative fluid balance 1 h after drinking the other drinks. The results of the present study suggest that milk can be an effective post-exercise rehydration drink and can be considered for use after exercise by everyone except those individuals who have lactose intolerance.

Maintenance of plasma volume and serum sodium concentration despite body weight loss in ironman triathletes

OBJECTIVE

To examine the relationship between body weight, plasma volume, and serum sodium concentration ([Na]) during prolonged endurance exercise.

DESIGN

Observational field study.

SETTINGS

2000 South African Ironman Triathlon.

PARTICIPANTS

181 male triathletes competing in an Ironman triathlon.

MAIN OUTCOME MEASURES

Body weight, plasma volume, and serum ([Na]) change from pre- to postrace.

RESULTS

Significant body weight loss occurred (-4.9 +/- 1.7%; P < 0.0001), while both plasma volume (1.0 +/- 11.2%; P = 0.4: NS) and serum [Na] (0.6 +/- 2.4%; P < 0.001) increased from pre- to postrace. Blood volume (-0.6 +/- 6.6%) and red cell volume (-2.6 +/- 5.5%; P < 0.001) decreased in conjunction with the body weight loss. There was a strong correlation between blood and plasma volume change, both as a percentage, and absolute change in fluid volume (r = 0.9; P < 0.001). Body weight change was positively correlated with plasma volume change (r = -0.4; P < 0.001), but inversely correlated with serum [Na] change (r = -0.4; P < 0.001). Plasma volume change was not significantly correlated with serum [Na] change (r = 0.0; NS). Serum [Na] change was inversely correlated with both percentage of red cell volume change (r = -0.2; P < 0.05) and percentage body weight change (r = -0.4; P < 0.001).

CONCLUSION

Plasma volume and serum [Na] were maintained in male Ironman triathletes, despite significant (5%) body weight loss during the course of the race. Body weight was not an accurate "absolute" surrogate of fluid balance homeostasis during prolonged endurance exercise. Clinicians should be warned against viewing these three regulatory parameters as interchangeable during an Ironman triathlon.

The influence of water ingestion during prolonged exercise on affect

This study examined the influence of water ingestion on affect and perceived exertion during sub-maximal running. Fifteen endurance-trained men performed two counterbalanced 90-min treadmill runs at 70% V O2 max. No fluid was ingested during one trial (NF-trial), whereas a single water bolus (5.0 mLkg(-1) body mass) was ingested immediately preexercise and every 20 min during exercise (2.0 mLkg(-1) bodymass) in a fluid replacement trial (FR-trial). Affect and perceived exertion were repeatedly assessed and physiological changes monitored. Perceived exertion and heart rate increased significantly during the run but there were no differences between conditions. Such similarities were not reflected in the pleasure-displeasure ratings, which were maintained above baseline levels during exercise in the FR-trial but declined below baseline during the NF-trial. A significant postexercise improvement in rated pleasure-displeasure was found only in the FR-trial, leading to significantly higher ratings of pleasure-displeasure during the recovery period compared to the NF-trial. Self-reported Energy was also enhanced postexercise only in the FR-trial. Body mass decrease was significantly larger and thirst ratings were significantly higher in the NF-trial compared to the FR-trial. In summary, water ingestion attenuated the during-exercise decrease in pleasure-displeasure and elicited an improvement after prolonged, submaximal running.

Influence of Hydration Status on Thermoregulation and Cycling Hill Climbing

PURPOSE

Although dehydration can impair endurance performance, a reduced body mass may benefit uphill cycling by increasing the power-to-mass ratio. This study examined the effects of a reduction in body mass attributable to unreplaced sweat losses on simulated cycling hill-climbing performance in the heat.

METHODS

Eight well-trained male cyclists (mean +/- SD: 28.4 +/- 5.7 yr; 71.0 +/- 5.9 kg; 176.7 +/- 4.7 cm; VO2peak: 66.2 +/- 5.8 mL x kg(-1) x min(-1)) completed a maximal graded cycling test on a stationary ergometer to determine maximal aerobic power (MAP). In a randomized crossover design, cyclists performed a 2-h ride at 53% MAP on a stationary ergometer, immediately followed by a cycling hill-climb time-to-exhaustion trial (88% MAP) on their own bicycle on an inclined treadmill (8%) at approximately 30 degrees C. During the 2-h ride, they consumed either 2.4 L of a 7% carbohydrate (CHO) drink (HIGH) or 0.4 L of water (LOW) with sport gels to match for CHO content.

RESULTS

After the 2-h ride and before the hill climb, drinking strategies influenced body mass (LOW -2.5 +/- 0.5% vs HIGH 0.3 +/- 0.4%; P < 0.001), HR (LOW 158 +/- 15 vs HIGH 146 +/- 15 bpm; P = 0.03), and rectal temperature (T(re): LOW 38.9 +/- 0.2 vs HIGH 38.3 +/- 0.2 degrees C; P = 0.001). Despite being approximately 1.9 kg lighter, time to exhaustion was significantly reduced by 28.6 +/- 13.8% in the LOW treatment (LOW 13.9 +/- 5.5 vs HIGH 19.5 +/- 6.0 min, P = 0.002), as was the power output for a fixed speed (LOW 308 +/- 28 vs HIGH 313 +/- 28 W, P = 0.003). At exhaustion, T(re) was higher in the LOW treatment (39.5 vs HIGH 39.1 degrees C; P < 0.001), yet peak HR, blood lactate, and glucose were similar.

CONCLUSION

Exercise-induced dehydration in a warm environment is detrimental to laboratory cycling hill-climbing performance despite reducing the power output required for a given speed.

Exercise and Fluid Replacement

This Position Stand provides guidance on fluid replacement to sustain appropriate hydration of individuals performing physical activity. The goal of prehydrating is to start the activity euhydrated and with normal plasma electrolyte levels. Prehydrating with beverages, in addition to normal meals and fluid intake, should be initiated when needed at least several hours before the activity to enable fluid absorption and allow urine output to return to normal levels. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. Because there is considerable variability in sweating rates and sweat electrolyte content between individuals, customized fluid replacement programs are recommended. Individual sweat rates can be estimated by measuring body weight before and after exercise. During exercise, consuming beverages containing electrolytes and carbohydrates can provide benefits over water alone under certain circumstances. After exercise, the goal is to replace any fluid electrolyte deficit. The speed with which rehydration is needed and the magnitude of fluid electrolyte deficits will determine if an aggressive replacement program is merited.

Dose-Response Effects of Ingested Carbohydrate on Exercise Metabolism in Women

PURPOSE

The effect of different quantities of carbohydrate (CHO) intake on CHO metabolism during prolonged exercise was examined in endurance-trained females.

METHOD

On four occasions, eight females performed 2 h of cycling at approximately 60% .VO2max with ingestion of beverages containing low (LOW, 0.5 g.min(-1)), moderate (MOD, 1.0 g.min(-1)), or high (HIGH, 1.5 g.min(-1)) amounts of CHO, or water only (WAT). Test solutions contained trace amounts of [U-13C] glucose. Indirect calorimetry combined with measurement of expired 13CO2 and plasma 13C enrichment enabled calculation of exogenous CHO, liver-derived glucose, and muscle glycogen oxidation during the last 30 min of exercise.

RESULTS

The highest rates of exogenous CHO oxidation were observed in MOD, with no further increases in HIGH (peak rates of 0.33 +/- 0.02, 0.50 +/- 0.03, and 0.48 +/- 0.05 g.min(-1) for LOW, MOD, and HIGH, respectively; P < 0.05 for LOW vs MOD and HIGH). Endogenous CHO oxidation was lowest in MOD (0.99 +/- 0.06, 0.82 +/- 0.08, 0.70 +/- 0.07, and 0.89 +/- 0.09 g.min(-1); P < 0.05 for MOD vs all other trials). Compared with WAT, CHO ingestion reduced liver glucose oxidation during exercise by approximately 30% (P < 0.05 for WAT vs all CHO). Differential rates of muscle glycogen oxidation were observed with different CHO doses (0.57 +/- 0.07, 0.53 +/- 0.08, 0.41 +/- 0.07, and 0.60 +/- 0.09 g.min(-1) for WAT, LOW, MOD, and HIGH respectively; P < 0.05 for MOD vs HIGH).

CONCLUSION

In endurance-trained women, the highest rates of exogenous CHO oxidation and greatest endogenous CHO sparing was observed when CHO was ingested at moderate rates (1.0 g.min(-1), 60 g.h(-1)) during exercise.

Physiological Aspects of Soccer Refereeing Performance and Training

The role of the referee is far from minimal in the economy of soccer, as very often, particularly in professional soccer, a wrong judgment may have profound implications on the outcome of the game. In this regard, a better knowledge of soccer refereeing can obviously benefit the game. Recent studies have shown that during a competitive match, an elite soccer referee may cover 9-13 km attaining approximately 85-90% and approximately 70-80% of maximal heart rate and maximal oxygen uptake (VO2max), respectively. Of the total distance covered about 4-18% is covered at high intensity. Blood lactate concentration has been reported to be in the range of 4-5 mmol/L; however, during competitive matches, blood lactate concentrations as high as 14 mmol/L have been observed. This figure is similar to that extensively reported for soccer players, specifically paralleling that observed in midfield players. However, compared with players, referees are 15-20 years older, often have a non-professional status and cannot be substituted during the game. Furthermore, this important physical stress superimposes onto a high perceptual-cognitive workload throughout the entire game. In relation to fitness status, referees possess VO2max values somewhat lower than the players they officiate, with mean values in the range of 44-50 mL/kg/min. However, the methods used by the Federation Internationale de Football Association and the Union of European Football Associations to test referee fitness need to be changed as the current fitness tests do not relate to match performance. More task-specific tests such as the Yo-Yo Intermittent Recovery Test (YYIRT) have been devised and validated for use with referees. Given that aerobic performance is positively correlated with match performance, it is important that referees are trained to improve their ability to cover large distances during a match and also to repeat high-intensity efforts. A number of studies have shown large improvements in YYIRT performance following both short-term (12 weeks) and long-term (16 months) high-intensity interval training. Future research needs to focus on a number of important areas including the decision-making ability of referees when officiating under different conditions, such as high thermal strain, and the impact of age on both physical and mental performance.

Thermoregulation during Exercise in the Heat

As a result of the inefficiency of metabolic transfer, >75% of the energy that is generated by skeletal muscle substrate oxidation is liberated as heat. During exercise, several powerful physiological mechanisms of heat loss are activated to prevent an excessive rise in body core temperature. However, a hot and humid environment can significantly add to the challenge that physical exercise imposes on the human thermoregulatory system, as heat exchange between body and environment is substantially impaired under these conditions. This can lead to serious performance decrements and an increased risk of developing heat illness. Fortunately, there are a number of strategies that athletes can use to prevent and/or reduce the dangers that are associated with exercise in the heat. In this regard, heat acclimatisation and nutritional intervention seem to be most effective. During heat acclimatisation, the temperature thresholds for both cutaneous vasodilation and the onset of sweating are lowered, which, in combination with plasma volume expansion, improve cardiovascular stability. Effective nutritional interventions include the optimisation of hydration status by the use of fluid replacement beverages. The latter should contain moderate amounts of glucose and sodium, which improve both water absorption and retention.

Evidence-Based Approach to Lingering Hydration Questions

Studies related to fundamental hydration issues have required clinicians to re-examine certain practices and concepts. The ingestion of substances such as creatine, caffeine, and glycerol has been questioned in regards to safety and hydration status. Reports of overdrinking (hyponatremia) also have brought into question the practices of drinking appropriate fluid amounts and the role that fluid-electrolyte balance has in the etiology of heat illnesses such as heat cramps. This article offers a fresh perspective on timely topics related to hydration, fluid balance, and exercise in the heat.

Special populations: the female player and the youth player

Females and youth are frequently described as "special" populations in football literature, but together these two populations outnumber male players. What makes females "special" is that they tend to eat less when training and competing than their male counterparts, leading to lower intakes of energy, carbohydrate, and some nutrients. Youth football players are special in regard to energy and nutrient requirements to promote growth and development, as well as to fuel sport. There is limited research on the dietary habits of these two populations, but the available literature suggests that many female and youth players need to increase carbohydrate intake, increase fluid intake, and develop dietary habits to sustain the demands of training and competition.

No Effect of 5% Hypohydration on Running Economy of Competitive Runners at 23°C

PURPOSE

Although running economy (RE) is recognized as an integral component of successful endurance performance and is affected by numerous factors, little is known about the influence of body water loss on RE. This investigation examined the effects of hypohydration (HY) on RE and associated physiological responses.

METHODS

Ten highly trained collegiate distance runners (mean +/- SD; age, 20 +/- 3 yr; height, 178.5 +/- 6.3 cm; body mass, 66.7 +/- 5.4 kg; VO2max, 66.5 +/- 4.1 mL x kg(-1) x min(-1)) participated in four experiments on separate days, twice in a euhydrated (EU) and twice in a HY state (-5.5 and -5.7% body mass loss achieved during 24 h). At each hydration level, subjects performed one 10-min treadmill run per day (23 degrees C environment), at either 70% VO2max (EU 70% or HY 70%) or 85% VO2max (EU 85% or HY 85%) in a randomized, repeated-measures design. Cardiopulmonary, metabolic, thermal, hormonal, and perceptual variables were measured.

RESULTS

No between-treatment differences existed for RE (EU 70%, 46.3 +/- 3.2; HY 70%, 47.2 +/- 3.8; EU 85%, 58.6 +/- 2.8; HY 85%, 58.9 +/- 4.1 mL x kg(-1) x min(-1)), postexercise plasma lactate concentration (EU 70%, 1.9 +/- 0.6; HY 70%, 1.8 +/- 0.6; EU 85%, 6.5 +/- 3.5; HY 85%, 6.4 +/- 3.5 mmol x L(-1)), or rating of perceived exertion. HY resulted in a greater (P < 0.05 to 0.001) heart rate (HR), rectal temperature, and plasma norepinephrine concentration (NE), concurrent with reduced cardiac output, stroke volume, and respiratory exchange ratio.

CONCLUSION

HY did not alter the RE or lactate accumulation of endurance athletes during 10 min of exercise at 70 and 85% VO2max. These findings indicate that HY had no effect on RE, but that it increased physiological strain in a 23 degrees C environment.

[Volume and electrolyte disturbances in endurance sport]

Long-lasting endurance exercise is associated with significant losses of fluid and sodium chloride, mainly due to sweat loss. To maintain endurance capacity and to avoid negative health consequences, endurance athletes should, therefore, drink fluids containing electrolytes during and after training or competition. In long-lasting endurance exercise it is recommended that athletes drink about 600-800 ml/h of fluid including adequate substitution of sodium. The excessive ingestion of fluid, however, brings about a danger of hyponatremia, which can be avoided by suitable measures. Body weight control is one of the parameters that should be carefully monitored before and after intensive endurance exercise.

Triathlon

From its roots in San Diego to its Olympic debut in Sydney in 2000, triathlon has emerged as a popular sport with a wide variety of participants. Because of the nature of the sport, excessive training resulting in overuse injuries is common. Triathlon injuries can also be unique from the individual sports involved in that they are attributed to a cumulative effect of multi-sport training. Because many triathletes have not grown up participating in the individual sports, biomechanics in each of the disciplines must also be considered as a source of injury. Nutrition and environmental factors and the role that they play in the endurance athlete should also not be overlooked. The sport of triathlon is rapidly growing, and the ability to recognize the unique aspects of these injuries can help the multisport athlete to train properly and be healthier and more successful.

Failure of Protein to Improve Time Trial Performance when Added to a Sports Drink

INTRODUCTION

Recent studies have reported that adding approximately 2% protein to a carbohydrate sports drink increased cycle endurance capacity compared with carbohydrate alone. However, the practical implications of these studies work are hampered by the following limitations: (a) the rate of carbohydrate ingestion was less than what is considered optimal for endurance performance, and (b) the performance test (exercise time to fatigue) did not mimic the way in which athletes typically compete (i.e., a race in which a fixed distance or set amount of work is performed as quickly as possible).

PURPOSE

We tested the hypothesis that adding 2% protein to a 6% carbohydrate drink (CHO-PRO) would improve 80-km cycling time trial performance, as compared with a 6% carbohydrate drink (CHO) and a nonenergetic sweetened placebo (PLAC).

METHODS

Ten trained male cyclists (24 +/- 2 yr; VO2peak = 63 +/- 2 mL.kg(-1).min(-1); mean +/- SE) performed an 80-km laboratory time trial (TT) on three occasions separated by 7 d. In a double-blind crossover manner, subjects ingested CHO-PRO, CHO, or PLAC at a rate of 250 mL every 15 min with no temporal, verbal, or physiological feedback.

RESULTS

Time to complete the TT was 4.4% lower (P < 0.002) during CHO (135 +/- 9 min) and CHO-PRO (135 +/- 9) compared with PLAC (141 +/- 10), with no difference between CHO and CHO-PRO (P = 0.92).

CONCLUSION

Ingesting 6% carbohydrate at a rate of 1 L.h(-1) (60 g.h(-1)) improved an 80-km TT performance in trained male cyclists. However, adding 2% protein to a 6% carbohydrate drink provided no additional performance benefit during a task that closely simulated the manner in which athletes typically compete.

Effect of low-level laser (Ga-Al-As 655 nm) on skeletal muscle fatigue induced by electrical stimulation in rats

We investigated whether low-level laser therapy (LLLT) can reduce muscular fatigue during tetanic contractions in rats. Thirty-two male Wistar rats were divided into four groups receiving either one of three different LLLT doses (0.5, 1.0, and 2.5 J/cm2) or a no-treatment control group. Electrical stimulation was used to induce six tetanic muscle contractions in the tibial anterior muscle. Contractions were stopped when the muscle force fell to 50% of the initial value for each contraction (T50%). There was no significant difference between the 2.5 J/cm2 laser-irradiated group and the control group in mean T50% values. Laser-irradiated groups (0.5 and 1.0 J/cm2) had significantly longer T50% values than the control group. The relative peak force for the sixth contraction in the laser-irradiated groups were significantly higher at 92.2% (SD 12.6) for 0.5 J/cm2, 83.2% (SD 20.5) for 1.0 J/cm2, and 82.9% (SD 18.3) for 2.5 J/cm2 than for the control group [50% (SD 15)]. Laser groups receiving 0.5 and 1.0 J/cm2 showed significant increases in mean performed work compared with both the control group and their first contraction values. Muscle damage was indirectly measured by creatine kinase levels in plasma. A distinct dose-response pattern was found in which 1.0 and 2.5 J/cm2 LLLT groups had significantly lower creatine kinase levels than the 0.5 J/cm2 LLLT group and the control group. We conclude that LLLT doses of 0.5 and 1.0 J/cm2 can prevent development of muscular fatigue in rats during repeated tetanic contractions.

Water and electrolyte needs for football training and match-play

The high metabolic rates sustained by soccer players during training and match-play cause sweat to be produced in both warm and temperate environments. There is limited published information available on the effects of this sweat loss on performance in soccer. However, this limited information, together with knowledge of the effects of sweat loss in other sports with skill components as well as endurance and sprint components, suggests that the effects of sweating will be similar to the effects in these other activities. Therefore, the generalization that a body mass reduction equivalent to 2% should be the acceptable limit of sweat losses seems reasonable. This amount, or more, of sweat loss reflected in body mass loss is a common experience for some players. Sodium is the main electrolyte lost in sweat and the available data indicate considerable variability in sodium losses between players due to differences in sweating rate and sweat electrolyte concentration. Additionally, the extent of sodium loss is such that its replacement will be warranted for some of these players during training sessions and matches. Although soccer is a team sport, the great individual variability in sweat and electrolyte losses of players in the same training session or match dictates that individual monitoring to determine individual water and electrolyte requirements should be an essential part of a player's nutritional strategy.

Nutrition on match day

What players should eat on match day is a frequently asked question in sports nutrition. The recommendation from the available evidence is that players should eat a high-carbohydrate meal about 3 h before the match. This may be breakfast when the matches are played around midday, lunch for late afternoon matches, and an early dinner when matches are played late in the evening. The combination of a high-carbohydrate pre-match meal and a sports drink, ingested during the match, results in a greater exercise capacity than a high-carbohydrate meal alone. There is evidence to suggest that there are benefits to a pre-match meal that is composed of low-glycaemic index (GI) carbohydrate foods rather than high-GI foods. A low-GI pre-match meal results in feelings of satiety for longer and produces a more stable blood glucose concentration than after a high-GI meal. There are also some reports of improved endurance capacity after low-GI carbohydrate pre-exercise meals. The physical demands of soccer training and match-play draw heavily on players' carbohydrate stores and so the benefits of good nutritional practices for performance and health should be an essential part of the education of players, coaches, and in particular the parents of young players.

Carbohydrate intake and tennis: are there benefits?

Carbohydrate supplementation in prolonged aerobic exercise has been shown to be effective in improving performance and deferring fatigue. However, there is confounding evidence with regard to carbohydrate supplementation and tennis performance, which may be due to the limited number of studies on this topic. This evidence based review, using database searches of Medline and SPORTDiscus, summarises the limited relevant literature to determine if carbohydrate supplementation benefits tennis performance, and, if so, the appropriate amounts and timing. Although more research is required, it appears that it may be beneficial in tennis sessions lasting more than 90 minutes.

Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon

CONTEXT

Critical assessment of recommendations that athletes consume additional sodium during athletic events.

OBJECTIVE

To evaluate if sodium supplementation is necessary to maintain serum sodium concentrations during prolonged endurance activity and prevent the development of hyponatraemia.

DESIGN

Prospective randomised trial of athletes receiving sodium (620 mg table salt), placebo (596 mg starch), or no supplementation during a triathlon. The sodium and placebo tablets were taken ad libitum, with the suggested range of 1-4 per hour.

SETTING

The 2001 Cape Town Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run).

SUBJECTS

A total of 413 triathletes completing the Ironman race.

MAIN OUTCOME MEASURES

Sodium supplementation was not necessary to maintain serum sodium concentrations in athletes completing an Ironman triathlon nor required to prevent hyponatraemia from occurring in athletes who did not ingest supplemental sodium during the race.

RESULTS

Subjects in the sodium supplementation group ingested an additional 3.6 (2.0) g (156 (88) mmol) sodium during the race (all values are mean (SD)). There were no significant differences between the sodium, placebo, and no supplementation groups with regard to age, finishing time, serum sodium concentration before and after the race, weight before the race, weight change during the race, and rectal temperature, systolic and diastolic blood pressure after the race. The sodium supplementation group consumed 14.7 (8.3) tablets, and the placebo group took 15.8 (10.1) tablets (p = 0.55; NS).

CONCLUSIONS

Ad libitum sodium supplementation was not necessary to preserve serum sodium concentrations in athletes competing for about 12 hours in an Ironman triathlon. The Institute of Medicine's recommended daily adequate intake of sodium (1.5 g/65 mmol) seems sufficient for a healthy person without further need to supplement during athletic activity.

Metabolic response to carbohydrate ingestion during exercise in males and females

The present study investigated potential sex-related differences in the metabolic response to carbohydrate (CHO) ingestion during exercise. Moderately endurance-trained men and women (n = 8 for each sex) performed 2 h of cycling at approximately 67% Vo(2 max) with water (WAT) or CHO ingestion (1.5 g of glucose/min). Substrate oxidation and kinetics were quantified during exercise using indirect calorimetry and stable isotope techniques ([(13)C]glucose ingestion, [6,6-(2)H(2)]glucose, and [(2)H(5)]glycerol infusion). In both sexes, CHO ingestion significantly increased the rates of appearance (R(a)) and disappearance (R(d)) of glucose during exercise compared with WAT ingestion [males: WAT, approximately 28-29 micromol x kg lean body mass (LBM)(-1) x min(-1); CHO, approximately 53 micromol x kg LBM(-1) x min(-1); females: WAT, approximately 28-29 micromol x kg LBM(-1) x min(-1); CHO, approximately 61 micromol x kg LBM(-1) x min(-1); main effect of trial, P < 0.05]. The contribution of plasma glucose oxidation to the energy yield was significantly increased with CHO ingestion in both sexes (from approximately 10% to approximately 20% of energy expenditure; main effect of trial, P < 0.05). Liver-derived glucose oxidation was reduced, although the rate of muscle glycogen oxidation was unaffected with CHO ingestion (males: WAT, 108 +/- 12 micromol x kg LBM(-1) x min(-1); CHO, 108 +/- 11 micromol x kg LBM(-1) x min(-1); females: WAT, 89 +/- 10 micromol x kg LBM(-1) x min(-1); CHO, 93 +/- 11 micromol x kg LBM(-1) x min(-1)). CHO ingestion reduced fat oxidation and lipolytic rate (R(a) glycerol) to a similar extent in both sexes. Finally, ingested CHO was oxidized at similar rates in men and women during exercise (peak rates of 0.70 +/- 0.08 and 0.65 +/- 0.06 g/min, respectively). The present investigation suggests that the metabolic response to CHO ingestion during exercise is largely similar in men and women.

Metabolic fate of a large amount of 13C-glycerol ingested during prolonged exercise

We have shown that the oxidation rate of exogenous glycerol and glucose during prolonged exercise were similar when ingested in small amounts (0.36 g/kg) (J Appl Physiol 90:1685,2001). The oxidation rate of exogenous carbohydrate increases with the amount ingested. We, thus, hypothesized that the oxidation rate of exogenous glycerol would also be larger when ingested in large amount. The study was conducted on six male subjects exercising for 120 min at 64 (2)% VO(2)max while ingesting 1 g/kg of (13)C-glycerol. Substrate oxidation was measured using indirect respiratory calorimetry corrected for protein oxidation, and from V(13)CO(2) at the mouth. The (13)C enrichment of plasma glucose was also measured in order to follow the possible conversion of (13)C-glycerol into glucose. In spite of the large amount of glycerol ingested and absorbed (plasma glycerol concentration = 8.0 (0.3) mmol/l at min 100), exogenous glycerol oxidation over the last 80 min of exercise [8.8 (1.6) g providing 4.1 (0.7)% of the energy yield] was similar to that observed when 0.36 g/kg was ingested. The comparison between the (13)C enrichment of plasma glucose and the oxidation rate of (13)C-glycerol showed that a portion of exogenous glycerol was converted into glucose before being oxidized, but also suggested that another portion could have been directly oxidized in peripheral tissues.

Three independent biological mechanisms cause exercise-associated hyponatremia: evidence from 2,135 weighed competitive athletic performances

To evaluate the role of fluid and Na+ balance in the development of exercise-associated hyponatremia (EAH), changes in serum Na+ concentrations ([Na+]) and in body weight were analyzed in 2,135 athletes in endurance events. Eighty-nine percent of athletes completed these events either euhydrated (39%) or with weight loss (50%) and with normal (80%) or elevated (13%) serum [Na+]. Of 231 (11%) athletes who gained weight during exercise, 70% were normonatremic or hypernatremic, 19% had a serum [Na+] between 129-135 mmol/liter, and 11% a serum [Na+] of <129 mmol/liter. Serum [Na+] after racing was a linear function with a negative slope of the body weight change during exercise. The final serum [Na+] in a subset of 18 subjects was predicted from the amount of Na+ that remained osmotically inactive at the completion of the trial. Weight gain consequent to excessive fluid consumption was the principal cause of a reduced serum [Na+] after exercise, yet most (70%) subjects who gained weight maintained or increased serum [Na+], requiring the addition of significant amounts of Na+ (>500 mmol) into an expanded volume of total body water. This Na+ likely originated from osmotically inactive, exchangeable stores. Thus, EAH occurs in athletes who (i) drink to excess during exercise, (ii) retain excess fluid because of inadequate suppression of antidiuretic hormone secretion, and (iii) osmotically inactivate circulating Na+ or fail to mobilize osmotically inactive sodium from internal stores. EAH can be prevented by insuring that athletes do not drink to excess during exercise, which has been known since 1985.

Exogenous carbohydrate oxidation rates are elevated after combined ingestion of glucose and fructose during exercise in the heat

The first purpose of this study was to investigate whether a glucose (GLU)+fructose (FRUC) beverage would result in a higher exogenous carbohydrate (CHO) oxidation rate and a higher fluid availability during exercise in the heat compared with an isoenergetic GLU beverage. A second aim of the study was to examine whether ingestion of GLU at a rate of 1.5 g/min during exercise in the heat would lead to a reduced muscle glycogen oxidation rate compared with ingestion of water (WAT). Eight trained male cyclists (maximal oxygen uptake: 64+/-1 ml.kg-1.min-1) cycled on three different occasions for 120 min at 50% maximum power output at an ambient temperature of 31.9+/-0.1 degrees C. Subjects received, in random order, a solution providing either 1.5 g/min of GLU, 1.0 g/min of GLU+0.5 g/min of FRUC, or WAT. Exogenous CHO oxidation during the last hour of exercise was approximately 36% higher (P<0.05) in GLU+FRUC compared with GLU, and peak oxidation rates were 1.14+/-0.05 and 0.77+/-0.08 g/min, respectively. Endogenous CHO oxidation was significantly lower (P<0.05) in GLU+FRUC compared with WAT. Muscle glycogen oxidation was not different after ingestion of GLU or WAT. Plasma deuterium enrichments were significantly higher (P<0.05) in WAT and GLU+FRUC compared with GLU. Furthermore, at 60 and 75 min of exercise, plasma deuterium enrichments were higher (P<0.05) in WAT compared with GLU+FRUC. Ingestion of GLU+FRUC during exercise in the heat resulted in higher exogenous CHO oxidation rates and fluid availability compared with ingestion of GLU and reduced endogenous CHO oxidation compared with ingestion of WAT.

[Comparison of male and female thermal, cardiac, and muscular responses induced by a prolonged run undertaken in a hot environment]

The aim of this study was to compare male and female thermal, cardiac, and muscular responses induced by a prolonged run undertaken in a hot environment. Twelve volunteers participated in this study. The first group consisted of 6 men and the second one consisted of 6 women. After determination of their VO(2)max and maximal aerobic velocity (MAV), each athlete completed a 40-min run at 65% MAV in a hot and dry environment (temperature 31-33 degrees C, relative humidity 30%). Immediately before and after the run, each subject performed two different vertical jumps, i.e., a squat jump (SJ) and a counter-movement jump (CMJ) on a force platform. Force, velocity, power, and jump height were measured during each jump. The completion of the run was associated with a significant loss (p < 0.001) of body mass (BM) and significant increases (p < 0.001) in heart rate, tympanic temperature, and lactate concentration ([La]). Muscle power was significantly improved (+9%, p < 0.05) during the SJ only in the women. A significant enhancement of this parameter was also demonstrated during the CMJ in both groups (men: +10%, p < 0.05; women: +8%, p < 0.01). Surprisingly, a comparison of thermal, cardiac, and muscular responses did not reveal any significant differences between the sexes. Moderate dehydration (-2.0 to -2.3% of BM) and a rise in core temperature (above 39.2 degrees C) induced by the 40-min run led to an improvement of muscular strength in both men and women. However, the results of this study did not reveal any significant between-sex differences in thermal, cardiac, and muscular responses after exercising in the heat.

Nutritional considerations in triathlon

Triathlon combines three disciplines (swimming, cycling and running) and competitions last between 1 hour 50 minutes (Olympic distance) and 14 hours (Ironman distance). Independent of the distance, dehydration and carbohydrate (CHO) depletion are the most likely causes of fatigue in triathlon, whereas gastrointestinal (GI) problems, hyperthermia and hyponatraemia are potentially health threatening, especially in longer events. Although glycogen supercompensation may be beneficial for triathlon performance (even Olympic distance), this does not necessarily have to be achieved by the traditional supercompensation protocol. More recently, studies have revealed ways to increase muscle glycogen concentrations to very high levels with minimal modifications in diet and training. During competition, cycling provides the best opportunity to ingest fluids. The optimum CHO concentration seems to be in the range of 5-8% and triathletes should aim to achieve a CHO intake of 60-70 g/hour. Triathletes should attempt to limit body mass losses to 1% of body mass. In all cases, a drink should contain sodium (30-50 mmol/L) for optimal absorption and prevention of hyponatraemia.Post-exercise rehydration is best achieved by consuming beverages that have a high sodium content (>60 mmol/L) in a volume equivalent to 150% of body mass loss. GI problems occur frequently, especially in long-distance triathlon. Problems seem related to the intake of highly concentrated carbohydrate solutions, or hyperosmotic drinks, and the intake of fibre, fat and protein. Endotoxaemia has been suggested as an explanation for some of the GI problems, but this has not been confirmed by recent research. Although mild endotoxaemia may occur after an Ironman-distance triathlon, this does not seem to be related to the incidence of GI problems. Hyponatraemia has occasionally been reported, especially among slow competitors in triathlons and probably arises due to loss of sodium in sweat coupled with very high intakes (8-10 L) of water or other low-sodium drinks.

Exercise and the Institute of Medicine Recommendations for Nutrition

The Food and Nutrition Board of the Institutes of Medicine (IOM) recently released energy, macronutrient, and fluid recommendations, which acknowledged for the first time that active individuals have unique nutritional needs. The IOM calculated an acceptable macronutrient distribution range for carbohydrate (45%-65% of energy), protein (10%-35% of energy), and fat (20%-35% of energy; limit saturated and trans fats). These proportions provide a range broad enough to cover the macronutrient needs of most active individuals, but specific carbohydrate and protein recommendations are also typically made based on a g/kg body weight formula. These ranges are 5 to 12 g of carbohydrate/kg body weight and 1.2 to 1.8 g/kg body weight for protein depending on the level of physical activity. The IOM report also gives recommendations for the two essential fatty acids: linoleic acid (men, 14-17 g/d; women, 11-12 g/d) and linolenic acid (men, 1.6 g/d; women, 1.1 g/d). Baseline adequate intakes for fluid (water + other beverages) were set at 3.0 L and 2.2 L for sedentary men and women, respectively, with higher intakes needed to account for physical activity and exposure to extreme environments.

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.

Carbohydrate intake during exercise and performance

It is generally accepted that carbohydrate (CHO) feeding during exercise can improve endurance capacity (time to exhaustion) and exercise performance during prolonged exercise (>2 h). More recently, studies have also shown ergogenic effects of CHO feeding during shorter exercise of high intensity ( approximately 1 h at >75% of maximum oxygen consumption). During prolonged exercise the mechanism behind this performance improvement is likely to be related to maintenance of high rates of CHO oxidation and the prevention of hypoglycemia. Nevertheless, other mechanisms may play a role, depending on the type of exercise and the specific conditions. The mechanism for performance improvements during higher-intensity exercise is less clear, but there is some evidence that CHO can have central effects. In the past few years, studies have investigated ways to optimize CHO delivery and bioavailability. An analysis of all studies available shows that a single CHO ingested during exercise will be oxidized at rates up to about 1 g/min, even when large amounts of CHO are ingested. Combinations of CHO that use different intestinal transporters for absorption (e.g., glucose and fructose) have been shown to result in higher oxidation rates, and this seems to be a way to increase exogenous CHO oxidation rates by 20% to 50%. The search will continue for ways to further improve CHO delivery and to improve the oxidation efficiency resulting in less accumulation of CHO in the gastrointestinal tract and potentially decreasing gastrointestinal problems during prolonged exercise.

Carbohydrates and fat for training and recovery

An important goal of the athlete's everyday diet is to provide the muscle with substrates to fuel the training programme that will achieve optimal adaptation for performance enhancements. In reviewing the scientific literature on post-exercise glycogen storage since 1991, the following guidelines for the training diet are proposed. Athletes should aim to achieve carbohydrate intakes to meet the fuel requirements of their training programme and to optimize restoration of muscle glycogen stores between workouts. General recommendations can be provided, preferably in terms of grams of carbohydrate per kilogram of the athlete's body mass, but should be fine-tuned with individual consideration of total energy needs, specific training needs and feedback from training performance. It is valuable to choose nutrient-rich carbohydrate foods and to add other foods to recovery meals and snacks to provide a good source of protein and other nutrients. These nutrients may assist in other recovery processes and, in the case of protein, may promote additional glycogen recovery when carbohydrate intake is suboptimal or when frequent snacking is not possible. When the period between exercise sessions is < 8 h, the athlete should begin carbohydrate intake as soon as practical after the first workout to maximize the effective recovery time between sessions. There may be some advantages in meeting carbohydrate intake targets as a series of snacks during the early recovery phase, but during longer recovery periods (24 h) the athlete should organize the pattern and timing of carbohydrate-rich meals and snacks according to what is practical and comfortable for their individual situation. Carbohydrate-rich foods with a moderate to high glycaemic index provide a readily available source of carbohydrate for muscle glycogen synthesis, and should be the major carbohydrate choices in recovery meals. Although there is new interest in the recovery of intramuscular triglyceride stores between training sessions, there is no evidence that diets which are high in fat and restricted in carbohydrate enhance training.