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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise. Eur J Appl Physiol 2024; 124:1-145. [PMID: 37796292 DOI: 10.1007/s00421-023-05276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Gilloteaux J, De Swert K, Suain V, Nicaise C. Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment. Int J Mol Sci 2023; 24:16448. [PMID: 38003639 PMCID: PMC10671465 DOI: 10.3390/ijms242216448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
A murine osmotic demyelinating syndrome (ODS) model was developed through chronic hyponatremia, induced by desmopressin subcutaneous implants, followed by precipitous sodium restoration. The thalamic ventral posterolateral (VPL) and ventral posteromedial (VPM) relay nuclei were the most demyelinated regions where neuroglial damage could be evidenced without immune response. This report showed that following chronic hyponatremia, 12 h and 48 h time lapses after rebalancing osmolarity, amid the ODS-degraded outskirts, some resilient neuronal cell bodies built up primary cilium and axon hillock regions that extended into axon initial segments (AIS) where ADP-ribosylation factor-like protein 13B (ARL13B)-immunolabeled rod-like shape content was revealed. These AIS-labeled shaft lengths appeared proportional with the distance of neuronal cell bodies away from the ODS damaged epicenter and time lapses after correction of hyponatremia. Fine structure examination verified these neuron abundant transcriptions and translation regions marked by the ARL13B labeling associated with cell neurotubules and their complex cytoskeletal macromolecular architecture. This necessitated energetic transport to organize and restore those AIS away from the damaged ODS core demyelinated zone in the murine model. These labeled structures could substantiate how thalamic neuron resilience occurred as possible steps of a healing course out of ODS.
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Affiliation(s)
- Jacques Gilloteaux
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
- Department of Anatomical Sciences, St George’s University School of Medicine, Newcastle upon Tyne NE1 JG8, UK
| | - Kathleen De Swert
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
| | - Valérie Suain
- Laboratoire d’Histologie Générale, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Bruxelles, Belgium;
| | - Charles Nicaise
- URPhyM, NARILIS, Université de Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium; (J.G.); (K.D.S.)
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Exercise-Associated Hyponatremia in Marathon Runners. J Clin Med 2022; 11:jcm11226775. [PMID: 36431252 PMCID: PMC9699060 DOI: 10.3390/jcm11226775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.
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Graybeal AJ, Kreutzer A, Willis JL, Moss K, Braun-Trocchio R, Shah M. Age Drives the Differences in Dietary Supplement Use in Endurance Athletes: A Cross-Sectional Analysis of Cyclists, Runners, and Triathletes. J Diet Suppl 2022:1-19. [DOI: 10.1080/19390211.2022.2056670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Austin J. Graybeal
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Andreas Kreutzer
- Department of Kinesiology, Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Jada L. Willis
- Department of Nutritional Sciences, College of Science & Engineering, Texas Christian University, Fort Worth, TX, USA
| | - Kamiah Moss
- Department of Kinesiology, Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Robyn Braun-Trocchio
- Department of Kinesiology, Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Meena Shah
- Department of Nutritional Sciences, College of Science & Engineering, Texas Christian University, Fort Worth, TX, USA
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López de Lara D, Ruiz-Sánchez JG, Cuesta M, Seara G, Calle-Pascual AL, Rubio Herrera MÁ, Runkle I, Verbalis JG. Exercise-Induced Hyponatremia: An Assessment of the International Hydration Recommendations Followed During the Gran Trail De Peñalara and Vitoria-Gasteiz Ironman Competitions. Front Nutr 2022; 8:781229. [PMID: 35265650 PMCID: PMC8898836 DOI: 10.3389/fnut.2021.781229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Hyponatremia often occurs during the practice of endurance sports. We evaluated the impact on hyponatremia of the hydration recommendations of the Third International Exercise-Associated Hyponatremia Consensus Development Conference 2015 (3IE-AHCD) during the 2017 Gran Trail de Peñalara marathon (GTP) and the Vitoria Gasteiz Ironman triathlon (VGI). Methods Prospective study of GTP and VGI athletes participating in four information sessions in the months prior to the events, to explain that hydration should only be according to their level of thirst, per the recommendations of the 3IE-AHCD. Consenting event finishers were included in final analysis. Pre- and post-race anthropometric and biochemical parameters were compared. Results Thirty-six GTP (33 male) and 94 VGI (88 male) finishers were evaluated. GTP race median fluid intake was 800 ml/h, with 900 ml/h in the VGI race. 83.3% GTPfin and 77.6% VGIfin remained eunatremic (blood sodium 135–145 mmol/L). Only 1/36 GTP and 1/94 VGI participant finished in hyponatremia, both with a sodium level of 134 mmol/L. Fourteen percent of GTP, and 21.2% of VGI participants finished in hypernatremia, with no increase in race completion times. No participating athlete required medical attention, except for musculoskeletal complaints. Pro-BNP and Copeptin levels rose significantly. Changes in copeptin levels did not correlate with changes in plasma osmolality, nor total body water content in impedance analysis. Conclusions Recommending that athletes' fluid intake in endurance events be a function of their thirst almost entirely prevented development of hyponatremia, without induction of clinically significant hypernatremia, or a negative repercussion on race completion times.
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Affiliation(s)
- Diego López de Lara
- Endocrinología Pediátrica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Martín Cuesta
- Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Germán Seara
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Alfonso Luis Calle-Pascual
- Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Miguel Ángel Rubio Herrera
- Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
| | - Isabelle Runkle
- Endocrinología y Nutrición, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria Biomédica San Carlos (IdISSC), Madrid, Spain
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What are the Limiting Factors During an Ultra-Marathon? A Systematic Review of the Scientific Literature. J Hum Kinet 2020; 72:129-139. [PMID: 32269654 PMCID: PMC7126261 DOI: 10.2478/hukin-2019-0102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review aimed to analyse factors that limited performance in ultra-marathons and mountain ultra-marathons. A literature search in one database (PubMed) was conducted in February 2019. Quality of information of the articles was evaluated using the Oxford´s level of evidence and the Physiotherapy Evidence Database (PEDro) scale. The search strategy yielded 111 total citations from which 23 met the inclusion criteria. Twenty one of the 23 included studies had a level of evidence 2b (individual cohort study), while the 2 remaining studies had a level of evidence of 5 (expert opinion). Also, the mean score in the PEDro scale was 3.65 ± 1.61, with values ranging from 0 to 7. Participants were characterised as experienced or well-trained athletes in all of the studies. The total number of participants was 1002 (893 men, 86 women and 23 unknown). The findings of this review suggest that fatigue in ultra-endurance events is a multifactorial phenomenon that includes physiological, neuromuscular, biomechanical and cognitive factors. Improved exercise performance during ultra-endurance events seems to be related to higher VO2max values and maximal aerobic speed (especially during submaximal efforts sustained over a long time), lower oxygen cost of transport and greater running experience.
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Hoppel F, Calabria E, Pesta D, Kantner-Rumplmair W, Gnaiger E, Burtscher M. Physiological and Pathophysiological Responses to Ultramarathon Running in Non-elite Runners. Front Physiol 2019; 10:1300. [PMID: 31749706 PMCID: PMC6843057 DOI: 10.3389/fphys.2019.01300] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022] Open
Abstract
Ultramarathon running represents a major physical challenge even for elite athletes. Runners wellbeing may be challenged by fluid and electrolyte disturbances, hemolysis and skeletal muscle damage, decline in hepatic function and kidney injury. We hypothesized that these effects may even be exacerbated in non-elite runners. Physiological, hematological and biochemical parameters of ten males (26–45 years, weekly training time 8.5 h), participating in a mountain ultramarathon (67 km; approximately 4,500 m of total ascent), were determined before (PRE), immediately after finishing the ultramarathon (POST), and 24 h after the individual finish (REC). Race times of the 8 finishers (2 drop-outs due to hot ambient temperature) varied between 10.4 and 16.1 h, which almost represents the range of the entire starter field (8.82 h–17.47 h). The following changes in mean values of selected markers for skeletal muscle damage and kidney injury were observed from PRE to POST: creatine kinase (CK) + 1289%, lactate dehydrogenase (LDH) + 87%, serum creatinine (CR) + 72%, blood urea nitrogen (BUN) + 96%, and estimated glomerular filtration rate (eGFR) – 45%. Values of CK + 1447%, LDH + 56%, and BUN + 71% remained elevated at REC. White blood cells were increased (+ 137%) only POST. In conclusion, CK and LDH levels and leucocytosis may be considered to be relatively harmless “side-effects” of prolonged running in this group of male subjects with rather moderate ultramarathon experience and training status. However, acute kidney injury may become clinically relevant in this population under the certain conditions, which should be considered by responsible race managers and medical advisors.
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Affiliation(s)
- Florian Hoppel
- Oroboros Instruments, Innsbruck, Austria.,Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Elisa Calabria
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dominik Pesta
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine University, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Wilhelm Kantner-Rumplmair
- Psychosomatic Pain Ambulance, University Hospital for Medical Psychology and Psychotherapy, Innsbruck, Austria
| | - Erich Gnaiger
- Oroboros Instruments, Innsbruck, Austria.,D. Swarovski Research Laboratory, Department of Visceral, Transplant Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Knechtle B, Chlíbková D, Papadopoulou S, Mantzorou M, Rosemann T, Nikolaidis PT. Exercise-Associated Hyponatremia in Endurance and Ultra-Endurance Performance-Aspects of Sex, Race Location, Ambient Temperature, Sports Discipline, and Length of Performance: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E537. [PMID: 31455034 PMCID: PMC6780610 DOI: 10.3390/medicina55090537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 12/05/2022]
Abstract
Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | - Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, 61669 Brno, Czech Republic
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
| | - Maria Mantzorou
- Food Science and Nutrition Department, University of the Aegean, 81400 Myrina, Greece
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
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Hermand E, Chabert C, Hue O. Ultra-endurance events in tropical environments and countermeasures to optimize performances and health. Int J Hyperthermia 2019; 36:753-760. [PMID: 31429600 DOI: 10.1080/02656736.2019.1635718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Physical performance in a tropical environment, combining high heat and humidity, is a difficult physiological challenge that requires specific preparation. The elevated humidity of a tropical climate impairs the thermoregulatory mechanisms by limiting the rate of sweat evaporation. Hence, a proper management of whole-body temperature is required to complete an ultra-endurance event in such an environment. In these long-duration events, which can last from 8 to 20 h, held in hot and humid settings, performance is tightly linked to the ability in maintaining an optimal hydration status. Indeed, the rate of withdrawal in these longer races was associated with lower water intake, and the majority of finishers exhibited alterations in electrolyte balance (e.g., sodium). Hence, this work reviews the effects on performance of high heat and humidity in two representative ultra-endurance sports, ultramarathons and long-distance triathlons, and several countermeasures to counteract the impact of these harsh environmental stresses and maintain a high level of performance, such as hydration, cooling strategies and heat acclimation.
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Affiliation(s)
- E Hermand
- Laboratory « Adaptations au Climat Tropical, Exercice et Santé » (EA 3596 ACTES), French West Indies University , Pointe-à-Pitre , France.,Laboratory « Handicap, Activité, Vieillissement, Autonomie, Environnement » (EA 6310 HAVAE), University of Limoges , Limoges , France
| | - C Chabert
- Laboratory « Adaptations au Climat Tropical, Exercice et Santé » (EA 3596 ACTES), French West Indies University , Pointe-à-Pitre , France
| | - O Hue
- Laboratory « Adaptations au Climat Tropical, Exercice et Santé » (EA 3596 ACTES), French West Indies University , Pointe-à-Pitre , France
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Knechtle B, Chlíbková D, Nikolaidis PT. [Exercise-Associated Hyponatremia in Endurance Performance]. PRAXIS 2019; 108:615-632. [PMID: 31288661 DOI: 10.1024/1661-8157/a003261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.
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Affiliation(s)
- Beat Knechtle
- 1 Medbase St. Gallen Am Vadianplatz, St. Gallen
- 2 Institut für Hausarztmedizin, Universität Zürich, Zürich
| | - Daniela Chlíbková
- 3 Centre of Sports Activities, Brno University of Technology, Brno, Tschechien
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Shchekochikhin DY, Kozlovskaya NL, Kopylov FY, Syrkin AL, Shilov EM. Hyponatremia: A clinical approach. TERAPEVT ARKH 2017; 89:134-140. [DOI: 10.17116/terarkh2017898134-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hyponatremia is the most common electrolyte metabolic abnormality in clinical practice. The unfavorable course of many diseases is associated with hyponatremia. Acute severe hyponatremia is life-threatening because cerebral edema may develop. Less obvious chronic hyponatremia increases the risk of balance problems, falls and fractures, especially in elderly patients. In any occasion, hyponatremia should not be now regarded only as a laboratory phenomenon in critically ill patients, but it necessitates a thorough clinical analysis of each individual case and appropriate therapy. The paper presents approaches to diagnosing and treating hyponatremia in various clinical situations.
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Shin KA, Kim YJ. Safety Assessment of Osmolality Concentration and Biochemical Factors Changes in Electrolyte Metabolism during an Ultra-marathon (100 km). KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2016. [DOI: 10.15324/kjcls.2016.48.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kyung-A Shin
- Department of Clinical Laboratory Science, Shinsung University, Dangjin 31801, Korea
| | - Young-Joo Kim
- Department of Rehabilitation Medicine, Sanggye-Paik Hospital, Seoul 01757, Korea
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Hew-Butler T, Rosner MH, Fowkes-Godek S, Dugas JP, Hoffman MD, Lewis DP, Maughan RJ, Miller KC, Montain SJ, Rehrer NJ, Roberts WO, Rogers IR, Siegel AJ, Stuempfle KJ, Winger JM, Verbalis JG. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med 2015; 25:303-20. [PMID: 26102445 DOI: 10.1097/jsm.0000000000000221] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Tamara Hew-Butler
- *Exercise Science Program, Oakland University, Rochester, Michigan; †Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia; ‡Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; §The Vitality Group, Chicago, Illinois; ¶Department of Physical Medicine and Rehabilitation, VA Northern California Health Care System and University of California Davis, Sacramento, California; ‖Family Medicine Residency Program, Via Christi Hospitals Wichita, Inc, Wichita, Kansas; **Department of Sport and Exercise Nutrition, Loughborough University, Leicestershire, United Kingdom; ††Athletic Training Program, Central Michigan University, Mount Pleasant, Michigan; ‡‡Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts; §§School of Physical Education, Sport and Exercise Science, University of Otago, Dunedin, New Zealand; ¶¶Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; ‖‖Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Perth, Western Australia; ***Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts; †††Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania; ‡‡‡Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois; and §§§Department of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, District of Columbia
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Ulsamer S, Rüst CA, Rosemann T, Lepers R, Knechtle B. Swimming performances in long distance open-water events with and without wetsuit. BMC Sports Sci Med Rehabil 2014; 6:20. [PMID: 24891942 PMCID: PMC4041346 DOI: 10.1186/2052-1847-6-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 05/14/2014] [Indexed: 11/18/2022]
Abstract
Background Existing literature showed improved swimming performances for swimmers wearing wetsuits competing under standardized conditions in races held in pools on short to middle distances. Data about the influence of wetsuits on swimming performances in long and ultra-long open-water swimming races are missing. It is unknown whether the benefit of wearing wetsuits is comparable in men and women. The aim of this study was to investigate the influence of wearing a wetsuit on open-water swimming performances at the 26.4 km ‘Marathon Swim in Lake Zurich’ in Lake Zurich, Switzerland, and the 3.8 km Lake Ontario Swim Team-Race (LOST-Race) in Lake Ontario, Canada. Methods Race times of the fastest female and male swimmers competing with and without wetsuit were compared using multi-level regression analyses and analysis of variance. Results In the ‘Marathon Swim’ in Lake Zurich, wearing a wetsuit had no effect on race time regarding the gender where athletes wearing a wetsuit were not faster than athletes without wetsuit. However, the ten fastest men wearing a wetsuit (410.6 ± 26.7 min) were faster (32.7%, p < 0.01) than the ten fastest women without wetsuit (544.9 ± 81.3 min). In the ‘LOST-Race’, the top ten men wearing a wetsuit (51.7 ± 2.5 min) were faster (13.2%, p < 0.01) than the top ten women wearing a wetsuit (58.5 ± 3.2 min). Additionally, the top ten men without wetsuit (52.1 ± 2.4 min) were faster (19.6%, p < 0.01) than the top ten women without wetsuit (62.3 ± 2.5 min). The top ten women wearing a wetsuit (58.5 ± 3.2 min) were faster (6.5%, p < 0.01) than top ten women without a wetsuit (62.3 ± 25 min). Conclusions These results suggest that wearing a wetsuit had a positive influence on swimming speed for both women and men but the benefit of the use of wetsuits seemed to depend on additional factors (i.e. race distance). Women seemed to benefit more from wearing wetsuits than men in longer open-water ultra-distance swimming races.
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Affiliation(s)
- Sebastian Ulsamer
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland
| | - Christoph Alexander Rüst
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, Switzerland
| | - Romuald Lepers
- INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, France
| | - Beat Knechtle
- Facharzt FMH für Allgemeinmedizin, Vadianstrasse 26, Gesundheitszentrum St. Gallen, St. Gallen, Switzerland
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Chlíbková D, Knechtle B, Rosemann T, Žákovská A, Tomášková I. The prevalence of exercise-associated hyponatremia in 24-hour ultra-mountain bikers, 24-hour ultra-runners and multi-stage ultra-mountain bikers in the Czech Republic. J Int Soc Sports Nutr 2014; 11:3. [PMID: 24512517 PMCID: PMC3929155 DOI: 10.1186/1550-2783-11-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 02/05/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To assess the prevalence of exercise-associated hyponatremia (EAH) in two 24-hour mountain bike (MTB) (R1,R2), one 24-hour running (R3) and one multi-stage MTB (R4) races held in the Czech Republic in a cluster of four cross-sectional studies. METHODS In 27 ultra-mountain bikers (ultra-MTBers), 12 ultra-runners, and 14 multi-stage MTBers, fluid intake, changes (Δ) in body mass, hematocrit, plasma volume, plasma [Na+], plasma [K+], plasma osmolality, urine [Na+], urine [K+], urine specific gravity, urine osmolality, K+/Na+ ratio in urine, transtubular potassium gradient and glomerular filtration rate were measured and calculated. The use of non-steroidal anti-inflammatory drugs and symptoms of EAH were recorded using post-race questionnaires. RESULTS Of the 53 finishers, three (5.7%) developed post-race EAH, thereof one (3.7%) ultra-MTBer, one (8.3%) ultra-runner and one (7.1%) multi-stage MTBer. Plasma [Na+] decreased significantly (p < 0.001) only in R4. Urine osmolality (R1, R3, R4 p < 0.001; R2 p < 0.05) and glomerular filtration rate (p < 0.001) increased, and body mass decreased in all races (p < 0.05). Δ body mass was inversely related to the number of kilometers achieved (p < 0.001) in R2 where better ultra-MTBers tended to lose more weight. Δ body mass (p < 0.001) and %Δ body mass (p = 0.05) were positively related to lower post-race plasma [Na+] in R3 that was associated with increased loss in body mass. Fluid intake was positively related to race performance in R1 and R2 (R1: p = 0.04; R2: p = 0.01) where ultra-MTBers in R1 and R2 who drank more finished ahead of those who drank less. Post-race plasma [Na+] was negatively associated with race performance in ultra-MTBers in R2 (p < 0.05), similarly ultra-runners in R3 (p < 0.05) where finishers with more kilometres had lower post-race plasma [Na+]. CONCLUSIONS The prevalence of EAH in the Czech Republic was no higher compared to existing reports on ultra-endurance athletes in other countries. Lower plasma [Na+] and development of EAH may be attributed to overdrinking, a pituitary secretion of vasopressin, an impaired mobilization of osmotically inactive sodium stores, and/or an inappropriate inactivation of osmotically active sodium.
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Affiliation(s)
- Daniela Chlíbková
- Centre of Sports Activities, Brno University of Technology, Brno, Czech Republic
| | - Beat Knechtle
- Institute of General Practise and for Health Services Research, University of Zurich, Zurich, Switzerland
- Facharzt FMH für Allgemeinmedizin, Gesundheitszentrum St. Gallen, Vadianstrasse 26, 9001 St. Gallen, Switzerland
| | - Thomas Rosemann
- Institute of General Practise and for Health Services Research, University of Zurich, Zurich, Switzerland
| | - Alena Žákovská
- Institute of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Ivana Tomášková
- Faculty of Forestry and Wood Sciences, Czech University of Life Sciences, Prague, Czech Republic
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da Fonseca-Engelhardt K, Knechtle B, Rüst CA, Knechtle P, Lepers R, Rosemann T. Participation and performance trends in ultra-endurance running races under extreme conditions - 'Spartathlon' versus 'Badwater'. EXTREME PHYSIOLOGY & MEDICINE 2013; 2:15. [PMID: 23848985 PMCID: PMC3710197 DOI: 10.1186/2046-7648-2-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/04/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The aim of the present study was to compare the trends in participation, performance and age of finishers in 'Badwater' and 'Spartathlon' as two of the toughest ultramarathons in the world of more than 200 km of distance. METHODS Running speed and age of male and female finishers in Badwater and Spartathlon were analyzed from 2000 to 2012. Age of peak performance and sex difference in running speed were investigated during the studied period. RESULTS The number of female and male finishes increased in Badwater and Spartathlon. Women accounted on average for 21.5% ± 6.9% in Badwater and 10.8% ± 2.3% in Spartathlon. There was a significant increase in female participation in Badwater from 18.4% to 19.1% (p < 0.01) and in Spartathlon from 11.9% to 12.5% (p = 0.02). In men, the age of finishers was higher in Badwater (46.5 ± 9.3 years) compared to Spartathlon (44.8 ± 8.2 years) (p < 0.01). The age of female finishers of both races was similar with 43.0 ± 7.5 years in Badwater and 44.5 ± 7.8 years in Spartathlon (p > 0.05). Over the years, the age of the annual five fastest men decreased in Badwater from 42.4 ± 4.2 to 39.8 ± 5.7 years (p < 0.05). For women, the age remained unchanged at 42.3 ± 3.8 years in Badwater (p > 0.05). In Spartathlon, the age was unchanged at 39.7 ± 2.4 years for men and 44.6 ± 3.2 years for women (p > 0.05). In Badwater, women and men became faster over the years. The running speed increased from 7.9 ± 0.7 to 8.7 ± 0.6 km/h (p < 0.01) in men and from 5.4 ± 1.1 to 6.6 ± 0.5 km/h (p < 0.01) in women. The sex difference in running speed remained unchanged at 19.8% ± 4.8% (p > 0.05). In Spartathlon, the running speed was stable over time at 10.8 ± 0.7 km/h for men and 8.7 ± 0.5 km/h for women (p > 0.05). The sex difference remained unchanged at 19.6% ± 2.5% (p > 0.05). CONCLUSIONS These results suggest that for both Badwater and Spartathlon, (a) female participation increased, (b) the fastest finishers were approximately 40 to 45 years, and (c) the sex difference was at approximately 20%. Women will not outrun men in both Badwater and Spartathlon races. Master ultramarathoners can achieve a high level of performance in ultramarathons greater than 200 km under extreme conditions.
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Affiliation(s)
| | - Beat Knechtle
- Gesundheitszentrum St. Gallen, St. Gallen, 9000, Switzerland
- Facharzt FMH für Allgemeinmedizin, Gesundheitszentrum St. Gallen, Vadianstrasse 26, St. Gallen, 9001, Switzerland
| | - Christoph Alexander Rüst
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, 8091, Switzerland
| | | | - Romuald Lepers
- INSERM U1093, Faculty of Sport Sciences, University of Burgundy, Dijon, Cedex, 21078, France
| | - Thomas Rosemann
- Institute of General Practice and for Health Services Research, University of Zurich, Zurich, 8091, Switzerland
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The effect of physiology and hydration beliefs on race behavior and postrace sodium in 161-km ultramarathon finishers. Int J Sports Physiol Perform 2013; 8:536-41. [PMID: 23412802 DOI: 10.1123/ijspp.8.5.536] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine if beliefs about physiology and rehydration affect ultramarathon runners' hydration behaviors or if these beliefs increase the risk for exercise-associated hyponatremia (EAH). METHODS Participants of the 2011 161-km Western States Endurance Run completed a prerace questionnaire, prerace and postrace body-mass measurements, and postrace assessment of serum sodium ([Na⁺]). RESULTS Of 310 finishers, 309 (99.7%) completed the prerace questionnaire and 207 (67%) underwent postrace blood studies. Twelve (5.8%) finishers had asymptomatic EAH ([Na⁺] range 131-134 mmol/L). The most common hydration plan (43.1%) was drinking according to schedule, and these runners did so to replace fluid lost when sweating (100%) and to avoid dehydration (81.2%). Prerace drinking plan was not associated with postrace [Na⁺] or the development of postrace hyponatremia. There also were no group differences between those with and those without EAH for any other variables including planned energy intake or knowledge of fluid balance. Runners not planning to drink to thirst trended toward more influence from advertisements (P = .056) and were significantly more influenced by scientific organizations (P = .043) than runners with other drinking plans. Finally, runners who believe that EAH is caused by excessive drinking adopted a lower-volume drinking plan (P = .005), while runners who believe that EAH is caused by sodium loss via sweating reported more common use of sodium supplementation during the race (P = .017). CONCLUSIONS Beliefs regarding the causes of EAH alter race behaviors including drinking plan and sodium supplementation but do not appear to affect the likelihood of developing EAH during a 161-km ultramarathon.
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Freund W, Faust S, Birklein F, Gaser C, Wunderlich AP, Müller M, Billich C, Juchems MS, Schmitz BL, Grön G, Schütz UH. Substantial and reversible brain gray matter reduction but no acute brain lesions in ultramarathon runners: experience from the TransEurope-FootRace Project. BMC Med 2012; 10:170. [PMID: 23259507 PMCID: PMC3566943 DOI: 10.1186/1741-7015-10-170] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 12/21/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND During the extremely challenging 4,487 km ultramarathon TransEurope-FootRace 2009, runners showed considerable reduction of body weight. The effects of this endurance run on brain volume changes but also possible formation of brain edema or new lesions were explored by repeated magnetic resonance imaging (MRI) studies. METHODS A total of 15 runners signed an informed consent to participate in this study of planned brain scans before, twice during, and about 8 months after the race. Because of dropouts, global gray matter volume analysis could only be performed in ten runners covering three timepoints, and in seven runners who also had a follow-up scan. Scanning was performed on three identical 1.5 T Siemens MAGNETOM Avanto scanners, two of them located at our university. The third MRI scanner with identical sequence parameters was a mobile MRI unit escorting the runners. Volumetric 3D datasets were acquired using a magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Additionally, diffusion-weighted (DWI) and fluid attenuated inversion recovery (FLAIR) imaging was performed. RESULTS Average global gray matter volume as well as body weight significantly decreased by 6% during the race. After 8 months, gray matter volume returned to baseline as well as body weight. No new brain lesions were detected by DWI or FLAIR imaging. CONCLUSIONS Physiological brain volume reduction during aging is less than 0.2% per year. Therefore a volume reduction of about 6% during the 2 months of extreme running appears to be substantial. The reconstitution in global volume measures after 8 months shows the process to be reversible. As possible mechanisms we discuss loss of protein, hypercortisolism and hyponatremia to account for both substantiality and reversibility of gray matter volume reductions. Reversible brain volume reduction during an ultramarathon suggests that extreme running might serve as a model to investigate possible mechanisms of transient brain volume changes. However, despite massive metabolic load, we found no new lesions in trained athletes participating in a multistage ultramarathon.See related commentary http://www.biomedcentral.com/1741-7015/10/171.
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Affiliation(s)
- Wolfgang Freund
- Department of Diagnostic and Interventional Radiology, University Hospitals Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Abstract
Hyponatraemia--the most common serum electrolyte disorder--has also emerged as an important marker of the severity and prognosis of important diseases such as heart failure and cirrhosis. Acute hyponatraemia can cause severe encephalopathy, but the rapid correction of chronic hyponatraemia can also profoundly impair brain function and even cause death. With the expanding elderly population and the increased prevalence of hyponatraemia in this segment of society, prospective studies are needed to examine whether correcting hyponatraemia in the elderly will diminish cognitive impairment, improve balance and reduce the incidence of falls and fractures. Given that polypharmacy is also common in the elderly population, the various medications that may stimulate arginine vasopressin release and/or enhance the hormone's action to increase water absorption must also be taken into consideration. Whether hyponatraemia in a patient with cancer is merely a marker of poor prognosis or whether its presence may alter the patient's quality of life remains to be examined. In any case, hyponatraemia can no longer be considered as just a biochemical bystander in the ill patient. A systematic diagnostic approach is necessary to determine the specific aetiology of a patient's hyponatraemia. Therapy must then be dictated not only by recognized reversible causes such as advanced hypothyroidism, adrenal insufficiency, diuretics or other medicines, but also by whether the hyponatraemia occurred acutely or chronically. Information is emerging that the vast majority of cases of hyponatraemia are caused by the nonosmotic release of arginine vasopressin. Now that vasopressin V2-receptor blockers are available, a new era of clinical investigation is necessary to examine whether hyponatraemia is just a marker of severe disease or whether correction of hyponatraemia could improve a patient's quality of life. Such an approach must involve prospective randomized studies in different groups of patients with hyponatraemia, including those with advanced heart failure, those with cirrhosis, patients with cancer, and the elderly.
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Meyer M, Knechtle B, Bürge J, Knechtle P, Mrazek C, Wirth A, Ellenrieder B, Rüst CA, Rosemann T. Ad libitum fluid intake leads to no leg swelling in male Ironman triathletes - an observational field study. J Int Soc Sports Nutr 2012; 9:40. [PMID: 22937792 PMCID: PMC3524467 DOI: 10.1186/1550-2783-9-40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/30/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND An association between fluid intake and limb swelling has been described for 100-km ultra-marathoners. We investigated a potential development of peripheral oedemata in Ironman triathletes competing over 3.8 km swimming, 180 km cycling and 42.2 km running. METHODS In 15 male Ironman triathletes, fluid intake, changes in body mass, fat mass, skeletal muscle mass, limb volumes and skinfold thickness were measured. Changes in renal function, parameters of skeletal muscle damage, hematologic parameters and osmolality in both serum and urine were determined. Skinfold thicknesses at hands and feet were measured using LIPOMETER® and changes of limb volumes were measured using plethysmography. RESULTS The athletes consumed a total of 8.6 ± 4.4 L of fluids, equal to 0.79 ± 0.43 L/h. Body mass, skeletal muscle mass and the volume of the lower leg decreased (p <0.05), fat mass, skinfold thicknesses and the volume of the arm remained unchanged (p >0.05). The decrease in skeletal muscle mass was associated with the decrease in body mass (p <0.05). The decrease in the lower leg volume was unrelated to fluid intake (p >0.05). Haemoglobin, haematocrit and serum sodium remained unchanged (p >0.05). Osmolality in serum and urine increased (p <0.05). The change in body mass was related to post-race serum sodium concentration ([Na+]) (r = -0.52, p <0.05) and post-race serum osmolality (r = -0.60, p <0.05). CONCLUSIONS In these Ironman triathletes, ad libitum fluid intake maintained plasma [Na+] and plasma osmolality and led to no peripheral oedemata. The volume of the lower leg decreased and the decrease was unrelated to fluid intake. Future studies may investigate ultra-triathletes competing in a Triple Iron triathlon over 11.4 km swimming, 540 km cycling and 126.6 km running to find an association between fluid intake and the development of peripheral oedemata.
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Affiliation(s)
- Michael Meyer
- Institute of Primary Care and Health Services Research, University of Zurich, Zurich, Switzerland.
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Knechtle B, Eichenberger E, Rüst CA, Lepers R, Rosemann T, Onywera VO. The aspect of nationality and performance in a mountain ultra-marathon - the ‘Swiss Alpine Marathon’. JOURNAL OF HUMAN SPORT AND EXERCISE 2012. [DOI: 10.4100/jhse.2012.74.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Wagner S, Knechtle B, Knechtle P, Rüst CA, Rosemann T. Higher prevalence of exercise-associated hyponatremia in female than in male open-water ultra-endurance swimmers: the 'Marathon-Swim' in Lake Zurich. Eur J Appl Physiol 2011; 112:1095-106. [PMID: 21748367 DOI: 10.1007/s00421-011-2070-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/30/2011] [Indexed: 11/29/2022]
Abstract
We investigated the prevalence of exercise-associated hyponatremia (EAH) in 25 male and 11 female open-water ultra-endurance swimmers participating in the 'Marathon-Swim' in Lake Zurich, Switzerland, covering a distance of 26.4 km. Changes in body mass, fat mass, skeletal muscle mass, total body water, urine specific gravity, plasma sodium concentration [Na(+)] and haematocrit were determined. Two males (8%) and four females (36%) developed EAH where one female was symptomatic with plasma sodium [Na(+)] of 127 mmol/L. Body mass and plasma [Na(+)] decreased (p < 0.05). The changes in body mass correlated in both male and female swimmers to post-race plasma [Na(+)] (r = -0.67, p = 0.0002 and r = -0.80, p = 0.0034, respectively) and changes in plasma [Na(+)] (r = -0.68, p = 0.0002 and r = -0.79, p = 0.0039, respectively). Fluid intake was neither associated with changes in body mass, post-race plasma [Na(+)] or the change in plasma [Na(+)]. Sodium intake showed no association with either the changes in plasma [Na(+)] or post-race plasma [Na(+)]. We concluded that the prevalence of EAH was greater in female than in male open-water ultra-endurance swimmers.
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Affiliation(s)
- Sandra Wagner
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
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Fluid intake and changes in limb volumes in male ultra-marathoners: does fluid overload lead to peripheral oedema? Eur J Appl Physiol 2011; 112:991-1003. [DOI: 10.1007/s00421-011-2056-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 06/18/2011] [Indexed: 11/25/2022]
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No case of exercise-associated hyponatraemia in top male ultra-endurance cyclists: the ‘Swiss Cycling Marathon’. Eur J Appl Physiol 2011; 112:689-97. [DOI: 10.1007/s00421-011-2024-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
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