Fluid and electrolyte loss and replacement in exercise

Oral Rehydration Beverages for Treating Exercise-Associated Dehydration: A Systematic Review, Part II. The Effectiveness of Alternatives to Carbohydrate-Electrolyte Drinks

OBJECTIVE

Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this systematic review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated people. In part II, we perform a systematic review to compare alternative liquids, such as cow's milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise.

DATA SOURCES

Cochrane Library, MEDLINE via the PubMed interface, and Embase databases were searched up until June 1, 2022.

STUDY SELECTION

Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available.

DATA EXTRACTION

Study design, study population, intervention, outcome measures, and study limitations were extracted from each included article.

DATA SYNTHESIS

Of 3485 articles screened, 11 articles in which authors compared skim or low-fat cow's milk, coconut water, or beer (0%-5% alcohol) with water were included. Authors of 4 studies showed that drinking skim or low-fat milk, without additional food intake, led to improved volume/hydration status compared with drinking water. Authors of 3 trials showed no differences at multiple times for outcomes related to volume/hydration status after rehydration with fresh coconut water compared with water. Evidence to recommend beer (0%-5% alcohol) for rehydration is insufficient.

CONCLUSIONS

Consuming skim or low-fat cow's milk without additional food intake as compared with water appears to improve volume/hydration status in people with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.

Oral Rehydration Beverages for Treating Exercise-Associated Dehydration: A Systematic Review, Part I. Carbohydrate-Electrolyte Solutions

OBJECTIVE

Exercise-associated dehydration is a common problem, especially at sporting events. Although recommendations have been made to drink a certain volume per kilogram body mass lost after exercise, no clear guidance about the type of rehydration beverage is available. We conducted a systematic review to assess the effectiveness of carbohydrate-electrolyte (CE) solutions as a rehydration solution for exercise-associated dehydration.

DATA SOURCES

MEDLINE (via the PubMed interface), Embase, and the Cochrane Library databases were searched up until June 1, 2022.

STUDY SELECTION

Controlled trials involving adults and children were included when dehydration was the result of physical exercise and when drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included if an English abstract was available.

DATA EXTRACTION

Data on study design, study population, interventions, outcome measures, and study limitations were extracted from each included article. Certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation.

DATA SYNTHESIS

Of 3485 articles screened, 19 articles in which authors assessed CE solutions (0%-9% carbohydrate) compared with water were included. Although variability was present among the identified studies, drinking 0% to 3.9% and especially 4% to 9% CE solution may be effective for rehydration.

CONCLUSIONS

A potential beneficial effect of drinking CE drinks compared with water was observed for many of the reviewed outcomes. Commercial CE drinks (ideally 4%-9% CE drinks or alternatively 0%-3.9% CE drinks) could be suggested for rehydration in individuals with exercise-associated dehydration when whole foods are not available.

Advanced Wearable Devices for Monitoring Sweat Biochemical Markers in Athletic Performance: A Comprehensive Review

Wearable technology has advanced significantly, offering real-time monitoring of athletes' physiological parameters and optimizing training and recovery strategies. Recent developments focus on biosensor devices capable of monitoring biochemical parameters in addition to physiological ones. These devices employ noninvasive methods such as sweat analysis, which reveals critical biomarkers like glucose, lactate, electrolytes, pH, and cortisol. These biomarkers provide valuable insights into an athlete's energy use, hydration status, muscle function, and stress levels. Current technologies utilize both electrochemical and colorimetric methods for sweat analysis, with electrochemical methods providing higher precision despite potential signal interference. Wearable devices such as epidermal patches, temporary tattoos, and fabric-based sensors are preferred for their flexibility and unobtrusive nature compared to more rigid conventional wearables. Such devices leverage advanced materials and transmit real-time data to computers, tablets, or smartphones. These data would aid coaches and sports medical personnel in monitoring athletes' health, optimizing diets, and developing training plans to enhance performance and reduce injuries.

Effect of exercise training on the renin-angiotensin-aldosterone system: a meta-analysis

Blood pressure (BP) management reduces the risk of cardiovascular disease (CVD). The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating and maintaining blood volume and pressure. This analysis aimed to investigate the effect of exercise training on plasma renin, angiotensin-II and aldosterone, epinephrine, norepinephrine, urinary sodium and potassium, BP and heart rate (HR). We systematically searched PubMed, Web of Science, and the Cochrane Library of Controlled Trials until 30 November 2022. The search strategy included RAAS key words in combination with exercise training terms and medical subject headings. Manual searching of reference lists from systematic reviews and eligible studies completed the search. A random effects meta-analysis model was used. Eighteen trials with a total of 803 participants were included. After exercise training, plasma angiotensin-II (SMD -0.71; 95% CI -1.24, -0.19; p = 0.008; n = 9 trials), aldosterone (SMD -0.37; 95% CI -0.65, -0.09; p = 0.009; n = 8 trials) and norepinephrine (SMD -0.82; 95% CI -1.18, -0.46; p < 0.001; n = 8 trials) were reduced. However, plasma renin activity, epinephrine, and 24-h urinary sodium and potassium excretion remained unchanged with exercise training. Systolic BP was reduced (MD -6.2 mmHg; 95% CI -9.9, -2.6; p = 0.001) as was diastolic BP (MD -4.5 mmHg; 95% CI -6.9, -2.1; p < 0.001) but not HR (MD -3.0 bpm; 95% CI -6.0, 0.4; p = 0.053). Exercise training may reduce some aspects of RAAS and sympathetic nervous system activity, and this explains some of the anti-hypertensive response.

Compositional Aspects of Beverages Designed to Promote Hydration Before, During, and After Exercise: Concepts Revisited

Hypohydration can impair aerobic performance and deteriorate cognitive function during exercise. To minimize hypohydration, athletes are recommended to commence exercise at least euhydrated, ingest fluids containing sodium during long-duration and/or high-intensity exercise to prevent body mass loss over 2% and maintain elevated plasma osmolality, and rapidly restore and retain fluid and electrolyte homeostasis before a second exercise session. To achieve these goals, the compositions of the fluids consumed are key; however, it remains unclear what can be considered an optimal formulation for a hydration beverage in different settings. While carbohydrate-electrolyte solutions such as sports drinks have been extensively explored as a source of carbohydrates to meet fuel demands during intense and long-duration exercise, these formulas might not be ideal in situations where fluid and electrolyte balance is impaired, such as practicing exercise in the heat. Alternately, hypotonic compositions consisting of moderate to high levels of electrolytes (i.e., ≥45 mmol/L), mainly sodium, combined with low amounts of carbohydrates (i.e., <6%) might be useful to accelerate intestinal water absorption, maintain plasma volume and osmolality during exercise, and improve fluid retention during recovery. Future studies should compare hypotonic formulas and sports drinks in different exercise settings, evaluating different levels of sodium and/or other electrolytes, blends of carbohydrates, and novel ingredients for addressing hydration and rehydration before, during, and after exercise.

International society of sports nutrition position stand: energy drinks and energy shots

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of energy drink (ED) or energy shot (ES) consumption on acute exercise performance, metabolism, and cognition, along with synergistic exercise-related performance outcomes and training adaptations. The following 13 points constitute the consensus of the Society and have been approved by the Research Committee of the Society: Energy drinks (ED) commonly contain caffeine, taurine, ginseng, guarana, carnitine, choline, B vitamins (vitamins B1, B2, B3, B5, B6, B9, and B12), vitamin C, vitamin A (beta carotene), vitamin D, electrolytes (sodium, potassium, magnesium, and calcium), sugars (nutritive and non-nutritive sweeteners), tyrosine, and L-theanine, with prevalence for each ingredient ranging from 1.3 to 100%. Energy drinks can enhance acute aerobic exercise performance, largely influenced by the amount of caffeine (> 200 mg or >3 mg∙kg bodyweight [BW-1]) in the beverage. Although ED and ES contain several nutrients that are purported to affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES based on scientific evidence appear to be caffeine and/or the carbohydrate provision. The ergogenic value of caffeine on mental and physical performance has been well-established, but the potential additive benefits of other nutrients contained in ED and ES remains to be determined. Consuming ED and ES 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance with doses >3 mg∙kg BW-1. Consuming ED and ES containing at least 3 mg∙kg BW-1 caffeine is most likely to benefit maximal lower-body power production. Consuming ED and ES can improve endurance, repeat sprint performance, and sport-specific tasks in the context of team sports. Many ED and ES contain numerous ingredients that either have not been studied or evaluated in combination with other nutrients contained in the ED or ES. For this reason, these products need to be studied to demonstrate efficacy of single- and multi-nutrient formulations for physical and cognitive performance as well as for safety. Limited evidence is available to suggest that consumption of low-calorie ED and ES during training and/or weight loss trials may provide ergogenic benefit and/or promote additional weight control, potentially through enhanced training capacity. However, ingestion of higher calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as part of the total daily energy intake. Individuals should consider the impact of regular coingestion of high glycemic index carbohydrates from ED and ES on metabolic health, blood glucose, and insulin levels. Adolescents (aged 12 through 18) should exercise caution and seek parental guidance when considering the consumption of ED and ES, particularly in excessive amounts (e.g. > 400 mg), as limited evidence is available regarding the safety of these products among this population. Additionally, ED and ES are not recommended for children (aged 2-12), those who are pregnant, trying to become pregnant, or breastfeeding and those who are sensitive to caffeine. Diabetics and individuals with preexisting cardiovascular, metabolic, hepatorenal, and/or neurologic disease who are taking medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should exercise caution and consult with their physician prior to consuming ED. The decision to consume ED or ES should be based upon the beverage's content of carbohydrate, caffeine, and other nutrients and a thorough understanding of the potential side effects. Indiscriminate use of ED or ES, especially if multiple servings per day are consumed or when consumed with other caffeinated beverages and/or foods, may lead to adverse effects. The purpose of this review is to provide an update to the position stand of the International Society of Sports Nutrition (ISSN) integrating current literature on ED and ES in exercise, sport, and medicine. The effects of consuming these beverages on acute exercise performance, metabolism, markers of clinical health, and cognition are addressed, as well as more chronic effects when evaluating ED/ES use with exercise-related training adaptions.

Post-Exercise Rehydration in Athletes: Effects of Sodium and Carbohydrate in Commercial Hydration Beverages

The effects of varying sodium (Na) and carbohydrate (CHO) in oral rehydration solutions (ORS) and sports drinks (SD) for rehydration following exercise are unclear. We compared an ORS and SD for the percent of fluid retained (%FR) following exercise-induced dehydration and hypothesized a more complete rehydration for the ORS (45 mmol Na/L and 2.5% CHO) and that the %FR for the ORS and SD (18 mmol Na/L and 6% CHO) would exceed the water placebo (W). A placebo-controlled, randomized, double-blind clinical trial was conducted. To induce 2.6% body mass loss (BML, p > 0.05 between treatments), 26 athletes performed three 90 min interval training sessions without drinking fluids. Post-exercise, participants replaced 100% of BML and were observed for 3.5 h for the %FR. Mean ± SD for the %FR at 3.5 h was 58.1 ± 12.6% (W), 73.9 ± 10.9% (SD), and 76.9 ± 8.0% (ORS). The %FR for the ORS and SD were similar and greater than the W (p < 0.05 ANOVA and Tukey HSD). Two-way ANOVA revealed a significant interaction with the ORS having greater suppression of urine production in the first 60 min vs. W (SD did not differ from W). By 3.5 h, the ORS and SD promoted greater rehydration than did W, but the pattern of rehydration early in recovery favored the ORS.

Hydration Status, Fluid Intake, Sweat Rate, and Sweat Sodium Concentration in Recreational Tropical Native Runners

AIM

The purpose of this study was to evaluate hydration status, fluid intake, sweat rate, and sweat sodium concentration in recreational tropical native runners.

METHODS

A total of 102 males and 64 females participated in this study. Participants ran at their self-selected pace for 30-100 min. Age, environmental conditions, running profiles, sweat rates, and sweat sodium data were recorded. Differences in age, running duration, distance and pace, and physiological changes between sexes were analysed. A p-value cut-off of 0.05 depicted statistical significance.

RESULTS

Males had lower relative fluid intake (6 ± 6 vs. 8 ± 7 mL·kg-1·h-1, p < 0.05) and greater relative fluid balance deficit (-13 ± 8 mL·kg-1·h-1 vs. -8 ± 7 mL·kg-1·h-1, p < 0.05) than females. Males had higher whole-body sweat rates (1.3 ± 0.5 L·h-1 vs. 0.9 ± 0.3 L·h-1, p < 0.05) than females. Mean rates of sweat sodium loss (54 ± 27 vs. 39 ± 22 mmol·h-1) were higher in males than females (p < 0.05).

CONCLUSIONS

The sweat profile and composition in tropical native runners are similar to reported values in the literature. The current fluid replacement guidelines pertaining to volume and electrolyte replacement are applicable to tropical native runners.

Fully Printed Wearable Microfluidic Devices for High-Throughput Sweat Sampling and Multiplexed Electrochemical Analysis

Although the recent advancement in wearable biosensors provides continuous, noninvasive assessment of physiologically relevant chemical markers from human sweat, several bottlenecks still exist for its practical use. There were challenges in developing a multiplexed biosensing system with rapid microfluidic sampling and transport properties, as well as its integration with a portable potentiostat for improved interference-free data collection. Here, we introduce a clean-room free fabrication of wearable microfluidic sensors, using a screen-printed carbon master, for the electrochemical monitoring of sweat biomarkers during exercise activities. The sweat sampling is enhanced by introducing low-dimensional sensing compartments and lowering the hydrophilicity of channel layers via facile silane functionalization. The fluidic channel captures sweat at the inlet and directs the real-time sweat through the active sensing electrodes (within 40 s) for subsequent decoding and selective analyses. For proof of concept, simultaneous amperometric lactate and potentiometric ion sensing (Na⁺, K⁺, and pH) are carried out by a miniature circuit board capable of cross-talk-free signal collection and wireless signal transduction characteristics. All of the sensors demonstrated appreciable sensitivity, selectivity, stability, carryover efficiency, and repeatability. The floating potentiometric circuits eliminate the signal interference from the adjacent amperometric transducers. The fully integrated pumpless microfluidic device is mounted on the epidermis and employed for multiplexed real-time decoding of sweat during stationary biking. The regional variations in sweat composition are analyzed by human trials at the underarm and upperback locations. The presented method offers a large-scale fabrication of inexpensive high-throughput wearable sensors for personalized point-of-care and athletic applications.

Efficacy of Ingesting an Oral Rehydration Solution after Exercise on Fluid Balance and Endurance Performance

This study investigated the efficacy of ingesting an oral rehydration solution (DD) that has a high electrolyte concentration after exercise on fluid balance and cycling performance in comparison with a sports drink (SD) and water (WA). Nine healthy males aged 24 ± 2 years (mean ± SD), with peak oxygen uptake (VO₂ peak) 55 ± 6 mL·kg⁻¹·min⁻¹ completed three experimental trials in a randomised manner ingesting WA, SD (carbohydrates: 62 g·L⁻¹, sodium: 31 ± 3 mmol·L⁻¹) or DD (carbohydrates: 33 g·L⁻¹, sodium: 60 ± 3 mmol·L⁻¹). On all trials, fluid was ingested during 75 min cycling at 65% VO₂ peak (temperature: 30.4 ± 0.3 °C, relative humidity: 76 ± 1%, simulated wind speed: 8.0 ± 0.6 m·s⁻¹) and during 2 h of recovery (temperature: 23.0 ± 1.0 °C, relative humidity: 67 ± 2%), with the total volume equivalent to 150% of sweat loss during the ride. A 45 min pre-load cycling time trial at a 65% VO₂ peak followed by a 20 km time trial was conducted after a further 3 h of recovery. Fluid retention was higher with DD (30 ± 15%) than WA (−4 ± 19%; p < 0.001) and SD (10 ± 15%; p = 0.002). Mean ratings of palatability were similar among drinks (WA: 4.25 ± 2.60; SD: 5.61 ± 1.79; DD: 5.40 ± 1.58; p = 0.33). Although time trial performance was similar across all three trials (WA: 2365 ± 321 s; SD: 2252 ± 174 s; DD: 2268 ± 184 s; p = 0.65), the completion time was faster in eight participants with SD and seven participants with DD than with WA. Comparing SD with DD, completion time was reduced in five participants and increased in four participants. DD was more effective at restoring the fluid deficit during recovery from exercise than SD and WA without compromising the drink’s palatability with increased sodium concentration. Most individuals demonstrated better endurance exercise time trial performance with DD and SD than with WA.

The Impact of a Motor Imagery-Based Training Program on Agility, Speed, and Reaction Time in a Sample of Young Tennis Athletes during Ramadan Fasting: Insights and Implications from a Randomized, Controlled Experimental Trial

The objective of this study was to explore whether a training program incorporating motor imagery could have an effect on physical performance outcomes in terms of agility, speed, and reaction time in a sample of tennis athletes who fasted during the month of Ramadan. Recruited subjects were 27 young male tennis players, randomly allocated to two groups: the imaging training group (n = 13) and a control group (n = 14). The study was designed as a randomized, controlled experimental study. The control group was engaged in watching videos concerning the history of the Olympic Games, whereas the motor imagery group followed a motor imagery-based training program. Physical performance outcomes were assessed during four sessions (one before Ramadan and three during Ramadan) by means of field tests. Our results revealed a drop in all performance outcomes measured in the middle and at the end of Ramadan for both groups (p < 0.01). The effect of the group × time interaction (p < 0.01) was reported for all physical performance outcomes measured for the two groups. This drop in performance was greater for the control group compared to the motor imagery group in the middle and at the end of Ramadan. This study showed that fasting during Ramadan reduced agility, speed, and reaction time performance for tennis players. A motor imagery-based training program could be an effective approach to reduce the effect of fasting during Ramadan and stabilize physical performance outcomes in terms of agility, speed, and reaction time for male tennis players.

Effects of carbohydrate supplementation on aerobic exercise performance during acute high altitude exposure and after 22 days of acclimatization and energy deficit

Background

The ergogenic effects of supplemental carbohydrate on aerobic exercise performance at high altitude (HA) may be modulated by acclimatization status. Longitudinal evaluation of potential performance benefits of carbohydrate supplementation in the same volunteers before and after acclimatization to HA have not been reported.

Purpose

This study examined how consuming carbohydrate affected 2-mile time trial performance in lowlanders at HA (4300 m) before and after acclimatization.

Methods

Fourteen unacclimatized men performed 80 min of metabolically-matched (~ 1.7 L/min) treadmill walking at sea level (SL), after ~ 5 h of acute HA exposure, and after 22 days of HA acclimatization and concomitant 40% energy deficit (chronic HA). Before, and every 20 min during walking, participants consumed either carbohydrate (CHO, n = 8; 65.25 g fructose + 79.75 g glucose, 1.8 g carbohydrate/min) or flavor-matched placebo (PLA, n = 6) beverages. A self-paced 2-mile treadmill time trial was performed immediately after completing the 80-min walk.

Results

There were no differences (P > 0.05) in time trial duration between CHO and PLA at SL, acute HA, or chronic HA. Time trial duration was longer (P < 0.05) at acute HA (mean ± SD; 27.3 ± 6.3 min) compared to chronic HA (23.6 ± 4.5 min) and SL (17.6 ± 3.6 min); however, time trial duration at chronic HA was still longer than SL (P < 0.05).

Conclusion

These data suggest that carbohydrate supplementation does not enhance aerobic exercise performance in lowlanders acutely exposed or acclimatized to HA.

Trial registration

NCT, NCT02731066, Registered March 292,016

Incidence of Hyponatremia During a Continuous 246-km Ultramarathon Running Race

Purpose: The purpose of this observational study was to examine the incidence of exercise-associated hyponatremia (EAH) in a 246-km continuous ultra-marathon.

Methods: Over 2 years, 63 male finishers of the annual Spartathlon ultra-marathon foot race from Athens to Sparta, Greece were included in the data analysis. A blood sample was drawn from an antecubital vein the day before the race as well as within 15 min post-race and analyzed for sodium concentration. During the second year of data collection, blood was also drawn at the 93-km checkpoint (n = 29). Height and weight were measured pre and post-race.

Results: Mean race time of all subjects was 33 ± 3 h with a range of 23.5 and 36.0 h. Of the 63 finishers recruited, nine began the race with values indicative of mild hyponatremia. Seven runners were classified as hyponatremic at the 93-km checkpoint, three of whom had sodium levels of severe hyponatremia. After the race, 41 total finishers (65%) developed either mild (n = 27, 43%) or severe hyponatremia (n = 14, 22%). Mean change in bodyweight percentage and serum sodium from pre-race to post-race was −3.6 ± 2.7% (−2.5 ± 1.9 kg) and −6.6 ± 5.6 mmol·L⁻¹, respectively. Pre-race serum sodium level was not a significant predictor of post-race serum sodium levels (β = 0.08, R² = 0.07, P = 0.698), however, there was a significant negative association between change in bodyweight percentage and post-race serum sodium concentration (β = −0.79, R² = 0.29, P = 0.011).

Conclusion: The incidence of EAH of 52 and 65%, when excluding or including these individuals with pre-race hyponatremia, was the highest reported in current literature.

Sunscreen or simulated sweat minimizes the impact of acute ultraviolet radiation on cutaneous microvascular function in healthy humans

NEW FINDINGS

What is the central question of this study? Are ultraviolet radiation (UVR)-induced increases in skin blood flow independent of skin erythema? Does broad-spectrum UVR exposure attenuate NO-mediated cutaneous vasodilatation, and does sunscreen or sweat modulate this response? What are the main findings and their importance? Erythema and vascular responses to UVR are temporally distinct, and sunscreen prevents both responses. Exposure to UVR attenuates NO-mediated vasodilatation in the cutaneous microvasculature; sunscreen or simulated sweat on the skin attenuates this response. Sun over-exposure may elicit deleterious effects on human skin that are separate from sunburn, and sunscreen or sweat on the skin may provide protection.

ABSTRACT

Exposure to ultraviolet radiation (UVR) may result in cutaneous vascular dysfunction independent of erythema (skin reddening). Two studies were designed to differentiate changes in erythema from skin vasodilatation throughout the 8 h after acute broad-spectrum UVR exposure with (+SS) or without SPF-50 sunscreen (study 1) and to examine NO-mediated cutaneous vasodilatation after acute broad-spectrum UVR exposure with or without +SS or simulated sweat (+SW) on the skin (study 2). In both studies, laser-Doppler flowmetry was used to measure red cell flux, and cutaneous vascular conductance (CVC) was calculated (CVC = flux/mean arterial pressure). In study 1, in 14 healthy adults (24 ± 4 years old; seven men and seven women), the skin erythema index and CVC were measured over two forearm sites (UVR only and UVR+SS) before, immediately after and every 2 h for 8 h post-exposure (750 mJ cm^-2 ). The erythema index began to increase immediately post-UVR (P < 0.05 at 4, 6 and 8 h), but CVC did not increase above baseline for the first 4-6 h (P ≤ 0.01 at 6 and 8 h); +SS prevented both responses. In study 2, in 13 healthy adults (24 ± 4 years old; six men and seven women), three intradermal microdialysis fibres were placed in the ventral skin of the forearm [randomly assigned to UVR (450 mJ cm^-2 ), UVR+SS or UVR+SW], and one fibre (non-exposed control; CON) was placed in the contralateral forearm. After UVR, a standardized local heating (42°C) protocol quantified the percentage of NO-mediated vasodilatation (%NO). The UVR attenuated %NO compared with CON (P = 0.01). The diminished %NO was prevented by +SS (P < 0.01) and +SW (P < 0.01). Acute broad-spectrum UVR attenuates NO-dependent dilatation in the cutaneous microvasculature, independent of erythema. Sunscreen protects against both inflammatory and heating-induced endothelial dysfunction, and sweat might prevent UVR-induced reductions in NO-dependent dilatation.

Reliability of a wearable sweat rate monitor and routine sweat analysis techniques under heat stress in females

INTRODUCTION

The aim of the study was to evaluate the reliability of five different sweat analysis techniques which measure; whole body sweat rate [WBSR], local sweat rate [LSR] (via technical absorbent [TA] method and KuduSmart^® monitor), sweat conductivity [SC] and sweat gland activation [SGA] in a female population when exercising moderately under heat stress.

METHODS

Fourteen females (age; 26 ± 7 years, body mass; 66.5 ± 7.6 kg, height; 167.1 ± 6.4 cm) completed a preliminary threshold walking test (to determine exercise intensity) and two main trials, separated by 2 days. Main trials consisted of 30-min seated rest in the environmental chamber (35 °C, 50% relative humidity) in an upper body sauna-suit, before its removal, and walking at a moderate intensity (4 metabolic equivalents) for 30-min (speeds ranged from 4.8 to 6.5 km h^-1). WBSR was measured via nude mass pre and post exercise. The TA and Tegaderm patches (for sweat sodium chloride) were placed on the back, forearm and chest for the entire 60-min, replicated for all participants for both trials. SGA was assessed following the 60-min trial and the KuduSmart® monitor was placed on the left arm for the 30-min of exercise.

RESULTS

WBSR, LSR methods and SC demonstrated no difference between trials (p > 0.05), good agreement (within limits), strong correlations (r ≥ 0.88) and low typical error of measurements [TEM] (< 0.04 L min^-1, 0.13 mg min^-1 cm^-2 and 8 mmol L^-1, respectively). SGA method showed moderate intra-class correlation (r = 0.80), with high TEM (5 glands) and large limits of agreement.

CONCLUSION

Sudomotor function is reliable, as demonstrated by good reliability, small TEM and strong correlations. The use of these sweat techniques is appropriate and practical in females who are exercising at moderate intensity under heat stress, and so, may aid future interventions. SGA shows larger variation and should be used with caution.

Repeat Effort Performance Is Reduced 24 Hours After Acute Dehydration in Mixed Martial Arts Athletes

Barley, OR, Iredale, F, Chapman, DW, Hopper, A, and Abbiss, C. Repeat effort performance is reduced 24 hours after acute dehydration in mixed martial arts athletes. J Strength Cond Res 32(9): 2555-2561, 2018-This study sought to determine the influence of acute dehydration on physical performance and physiology in mixed martial arts (MMA). Mixed martial arts athletes (n = 14; age: 23 ± 4 years) completed in a randomized counterbalanced order a dehydration protocol, (DHY: 3-hour cycling at 60 W in 40° C to induce 5% dehydration) or thermoneutral control (25° C: CONT) exercise, followed by ad libitum fluid/food intake. Performance testing (a repeat sled push test, medicine ball chest throw, and vertical jump) was completed 3 hours and 24 hours after the intervention, whereas urine and blood samples were collected before, 20 minutes, 3 hours, and 24 hours after the intervention. Body mass was reduced (4.8 ± 0.8%) after DHY (p < 0.001) and remained lower than CONT at 3 hours and 24 hours after DHY (p = 0.003 and p = 0.024, respectively). Compared with CONT, average sled push times were slower 3 hours and 24 hours after DHY (19 ± 15%; p = 0.001; g = 1.229 and 14 ± 15%; p = 0.012; g = 0.671, respectively). When compared with the CONT, handgrip was weaker 3 hours after DHY (53 ± 8 and 51 ± 8 kg; p = 0.044, g = 0.243, respectively) and medicine ball chest throw distances were shorter 24 hours after DHY (474 ± 52 and 449 ± 44 cm; p = 0.016, g = 0.253, respectively). No significant differences were observed in vertical jump (p = 0.467). Urine specific gravity was higher than CONT 20 minutes (p = 0.035) and 24 hours (p = 0.035) after DHY. Acute dehydration of 4.8% body mass results in reduced physical performance 3 and 24 hours after DHY. There is need for caution when athletes use dehydration for weight loss 24 hours before competition.

Roll-to-Roll Gravure Printed Electrochemical Sensors for Wearable and Medical Devices

As recent developments in noninvasive biosensors spearhead the thrust toward personalized health and fitness monitoring, there is a need for high throughput, cost-effective fabrication of flexible sensing components. Toward this goal, we present roll-to-roll (R2R) gravure printed electrodes that are robust under a range of electrochemical sensing applications. We use inks and electrode morphologies designed for electrochemical and mechanical stability, achieving devices with uniform redox kinetics printed on 150 m flexible substrate rolls. We show that these electrodes can be functionalized into consistently high performing sensors for detecting ions, metabolites, heavy metals, and other small molecules in noninvasively accessed biofluids, including sensors for real-time, in situ perspiration monitoring during exercise. This development of robust and versatile R2R gravure printed electrodes represents a key translational step in enabling large-scale, low-cost fabrication of disposable wearable sensors for personalized health monitoring applications.

Effect of chronic exercise on fluoride metabolism in fluorosis-susceptible mice exposed to high fluoride

The present study investigated the effect of chronic exercise on fluoride (F) metabolism in fluorosis-susceptible mice exposed to high-F and explored the relationship between F concentrations in bone and plasma. Thirty male mice were randomised into three groups: Group I (No-F, No-Exercise), Group II (50 ppmF, No-Exercise), Group III (50 ppmF, Exercise). Body weight and physical performance of all mice were measured at baseline and end of experiment. F concentrations of plasma and bone were measured at the end of experiment. Mean plasma F concentration was significantly higher (p < 0.001) in Groups II and III compared with Group I. Mean bone F concentration was also significantly higher (p < 0.01) in Groups II and III compared with Group I. There was a significant correlation (p = 0.01, r = 0.54) between F concentration of plasma and bone. Mean body weight of Group I mice was significantly higher than Group II (p < 0.001) and Group III (p = 0.001) mice at the end of the experiment. This study, which provides the first data on the effect of chronic exercise on F metabolism in fluorosis-susceptible mice, suggests no effect of chronic exercise on F in plasma and bone. However, exposure to high-F resulted in lower body weight and exercise capacity in mice.

Effect of α-tocopherol megadoses on hematologic parameters and antioxidant capacity of rats in an ultraendurance probe

This study was aimed to analyze the effect of two different megadoses of α-tocopherol (vit E) in the antioxidant activity and red and white blood series of Wistar rats after a 180-min ultraendurance probe. Three groups of 10 rats were analyzed; VEAG: acute administration of a megadoses of 5,000 IU/kg of vit E the day before the probe; VECG: chronic administration of 1,000 IU/kg/day of vit E for 6 days before the probe; CG: placebo administration. VEAG presented white cells, red blood cells, hematocrit, hemoglobin values significantly higher than CG and VECG (p < 0.05). The mean corpuscular hemoglobin and lymphocytes concentrations were significantly higher in the VECG than in the other two groups (p < 0.05). Similarly, VEAG presented a significantly higher vit E blood concentration than VECG and CG (p < 0.05), and VECG than CG (p < 0.05). Finally, we found a significantly positive correlation between trolox equivalent antioxidant capacity (TEAC) and red blood cells concentration (r = 0.374) and a significantly inverse correlation between TEAC and blood lactate concentration (r = -0.365). Our findings suggest that acute vit E megadoses could protect against transitory sport anemia symptoms and increase the white blood cell count in comparison with the chronic dose and control groups after an ultraendurance probe.

Individual fluid plans versus ad libitum on hydration status in minor professional ice hockey players

Background

Despite exercising in cool environments, ice hockey players exhibit several dehydration risk factors. Individualized fluid plans (IFPs) are designed to mitigate dehydration by matching an individual’s sweat loss in order to optimize physiological systems and performance.

Methods

A randomized control trial was used to examine IFP versus ad libitum fluid ingestion on hydration in 11 male minor professional ice hockey players (mean age = 24.4 ± 2.6 years, height = 183.0 ± 4.6 cm, weight = 92.9 ± 7.8 kg). Following baseline measures over 2 practices, participants were randomly assigned to either control (CON) or intervention (INT) for 10 additional practices. CON participants were provided water and/or carbohydrate electrolyte beverage to drink ad libitum. INT participants were instructed to consume water and an electrolyte-enhanced carbohydrate electrolyte beverage to match sweat and sodium losses. Urine specific gravity, urine color, and percent body mass change characterized hydration status. Total fluid consumed during practice was assessed.

Results

INT consumed significantly more fluid than CON (1180.8 ± 579.0 ml vs. 788.6 ± 399.7 ml, p = 0.002). However, CON participants replaced only 25.4 ± 12.9% of their fluid needs and INT 35.8 ± 17.5%. Mean percent body mass loss was not significantly different between groups and overall indicated minimal dehydration (<1.2% loss). Pre-practice urine specific gravity indicated CON and INT began hypohydrated (mean = 1.024 ± 0.007 and 1.024 ± 0.006, respectively) and experienced dehydration during practice (post = 1.026 ± 0.006 and 1.027 ± 0.005, respectively, p < 0.001). Urine color increased pre- to post-practice for CON (5 ± 2 to 6 ± 1, p < 0.001) and INT (5 ± 1 to 6 ± 1, p < 0.001).

Conclusions

Participants consistently reported to practice hypohydrated. Ad libitum fluid intake was not significantly different than IFP on hydration status. Based on urine measures, both methods were unsuccessful in preventing dehydration during practice, suggesting practice-only hydration is inadequate to maintain euhydration in this population when beginning hypohydrated.

Eyeglasses based wireless electrolyte and metabolite sensor platform

The demand for wearable sensors has grown rapidly in recent years, with increasing attention being given to epidermal chemical sensing. Here, we present the first example of a fully integrated eyeglasses wireless multiplexed chemical sensing platform capable of real-time monitoring of sweat electrolytes and metabolites. The new concept has been realized by integrating an amperometric lactate biosensor and a potentiometric potassium ion-selective electrode into the two nose-bridge pads of the glasses and interfacing them with a wireless electronic backbone placed on the glasses' arms. Simultaneous real-time monitoring of sweat lactate and potassium levels with no apparent cross-talk is demonstrated along with wireless signal transduction. The electrochemical sensors were screen-printed on polyethylene terephthalate (PET) stickers and placed on each side of the glasses' nose pads in order to monitor sweat metabolites and electrolytes. The electronic backbone on the arms of the glasses' frame offers control of the amperometric and potentiometric transducers and enables Bluetooth wireless data transmission to the host device. The new eyeglasses system offers an interchangeable-sensor feature in connection with a variety of different nose-bridge amperometric and potentiometric sensor stickers. For example, the lactate bridge-pad sensor was replaced with a glucose one to offer convenient monitoring of sweat glucose. Such a fully integrated wireless "Lab-on-a-Glass" multiplexed biosensor platform can be readily expanded for the simultaneous monitoring of additional sweat electrolytes and metabolites.

Urinary extracellular vesicles. A promising shortcut to novel biomarker discoveries

Proteomic and genomic techniques have reached full maturity and are providing unforeseen details for the comprehensive understanding of disease pathologies at a fraction of previous costs. However, for kidney diseases, many gaps in such information remain to inhibit major advances in the prevention, treatment and diagnostics of these devastating diseases, which have enormous global impact. The discovery of ubiquitous extracellular vesicles (EV) in all bodily fluids is rapidly increasing the fundamental knowledge of disease mechanisms and the ways in which cells communicate with distant locations in processes of cancer spread, immunological regulation, barrier functions and general modulation of cellular activity. In this review, we describe some of the most prominent research streams and findings utilizing urinary extracellular vesicles as highly versatile and dynamic tools with their extraordinary protein and small regulatory RNA species. While being a highly promising approach, the relatively young field of EV research suffers from a lack of adherence to strict standardization and carefully scrutinized methods for obtaining fully reproducible results. With the appropriate guidelines and standardization achieved, urine is foreseen as forming a unique, robust and easy route for determining accurate and personalized disease signatures and as providing highly useful early biomarkers of the disease pathology of the kidney and beyond.

Swim drink study: a randomised controlled trial of during-exercise rehydration and swimming performance

OBJECTIVE

To determine whether during-exercise rehydration improves swimming performance and whether sports drink or water have differential effects on performance.

DESIGN

Randomised controlled multiple crossover trial.

SETTING

A UK competitive swimming club.

SUBJECTS

19 club-level competitive swimmers, median age (range) 13 (11-17) years.

INTERVENTIONS

Subjects were scheduled to drink ad libitum commercial isotonic sports drink (3.9 g sugars and 0.13 g salt per 100 mL) or water (three sessions each) or no drink (six sessions) in the course of twelve 75 min training sessions, each of which was followed by a 30 min test set of ten 100 m maximum-effort freestyle sprints each starting at 3 min intervals.

MAIN OUTCOME MEASURE

Times for the middle 50 m of each sprint measured using electronic timing equipment in a Federation Internationale de Natation (FINA)-compliant six-lane 25 m competition swimming pool.

RANDOMISATION

Software-generated individual random session order in sealed envelopes. Analysis subset of eight sessions randomly selected by software after data collection completed.

MASKING

Participants blind to drink allocation until session start.

RESULTS

In the analysis data set of 1118 swims, there was no significant difference between swim times for drinking and not drinking nor between drinking water or a sports drink. Mean (SEM) 50 m time for no-drink swims was 38.077 (0.128) s and 38.105 (0.131) s for drink swims, p=0.701. Mean 50 m times were 38.031 (0.184) s for drinking sports drink and 38.182 (0.186) s for drinking water, p=0.073. Times after not drinking were 0.027 s faster than after drinking (95% CI 0.186 s faster to 0.113 s slower). Times after drinking sports drink were 0.151 s faster than after water (95% CI 0.309 s faster to 0.002 s slower). Mean (SEM) dehydration from exercise was 0.42 (0.11)%.

CONCLUSIONS

Drinking water or sports drink over 105 min of sustained effort swimming training does not improve swimming performance.

TRIAL REGISTRATION

ISRCTN: 49860006.

Acute exercise and gastric emptying: a meta-analysis and implications for appetite control

BACKGROUND

Gastric emptying (GE) could influence exercise-induced changes in appetite and energy intake. GE also could contribute to changes in gastric symptoms and the availability of nutrients during exercise, which will subsequently affect performance.

OBJECTIVE

The objective of this review was to determine the effects of acute exercise on GE using a systematic review and meta-analysis. The most common parameters to determine GE were selected, consisting of half-emptying time and volume emptied. Oral-caecal transit time (OCTT) was also examined.

DATA SOURCES

Research databases (PubMed, Scopus, Google Scholar, EBSCOhost, SPORTDiscus) were searched through November 2013 for original studies, abstracts, theses and dissertations that examined the influence of acute exercise on GE.

STUDY SELECTION

Studies were included if they evaluated GE or OCTT during and/or after exercise and involved a resting control trial.

STUDY APPRAISAL AND SYNTHESIS

Initially, 195 studies were identified. After evaluation of study characteristics and quality and validity, data from 20 studies (35 trials) involving 221 participants (157 men; 52 women; 12 unknown) were extracted for meta-analysis. Random-effects meta-analyses were utilised for the three main outcome variables, and effect sizes (ES) are reported as Hedge's g due to numerous small sample sizes.

RESULTS

Random-effects modelling revealed non-significant and small/null main effect sizes for volume emptied (ES = 0.195; 95% CI -0.25 to 0.64), half-time (ES = -0.109, 95% CI -0.66 to 0.44) and OCTT (ES = 0.089; 95% CI -0.64 to 0.82). All analyses exhibited significant heterogeneity and numerous variables moderated the results. There was a dose response of exercise intensity; at lower intensities GE was faster, and at high exercise intensities GE was slower. Walking was associated with faster GE and cycling with slower GE. Greater volume of meal/fluid ingested, higher osmolality of beverage and longer exercise duration were also associated with slower GE with exercise.

LIMITATIONS

The major limitation is that the majority of studies utilised a liquid bolus administered pre-exercise to determine GE; the relationship to post-exercise appetite and energy intake remains unknown. Study populations were also generally active or trained individuals. Furthermore, our review was limited to English language studies and studies that utilised resting control conditions.

CONCLUSIONS

These results suggest that exercise intensity, mode, duration and the nature of meal/fluid ingested all influence GE during and after acute exercise. The relationship of GE parameters with appetite regulation after exercise remains largely unexplored. Further integrative studies combining GE and alterations in gut hormones, as well as in populations such as overweight and obese individuals are needed.

Pre-exercise nutrition: the role of macronutrients, modified starches and supplements on metabolism and endurance performance

Endurance athletes rarely compete in the fasted state, as this may compromise fuel stores. Thus, the timing and composition of the pre-exercise meal is a significant consideration for optimizing metabolism and subsequent endurance performance. Carbohydrate feedings prior to endurance exercise are common and have generally been shown to enhance performance, despite increasing insulin levels and reducing fat oxidation. These metabolic effects may be attenuated by consuming low glycemic index carbohydrates and/or modified starches before exercise. High fat meals seem to have beneficial metabolic effects (e.g., increasing fat oxidation and possibly sparing muscle glycogen). However, these effects do not necessarily translate into enhanced performance. Relatively little research has examined the effects of a pre-exercise high protein meal on subsequent performance, but there is some evidence to suggest enhanced pre-exercise glycogen synthesis and benefits to metabolism during exercise. Finally, various supplements (i.e., caffeine and beetroot juice) also warrant possible inclusion into pre-race nutrition for endurance athletes. Ultimately, further research is needed to optimize pre-exercise nutritional strategies for endurance performance.

Variability of measurements of sweat sodium using the regional absorbent-patch method

CONTEXT

There is interest in including recommendations for the replacement of the sodium lost in sweat in individualized hydration plans for athletes.

PURPOSE

Although the regional absorbent-patch method provides a practical approach to measuring sweat sodium losses in field conditions, there is a need to understand the variability of estimates associated with this technique.

METHODS

Sweat samples were collected from the forearms, chest, scapula, and thigh of 12 cyclists during 2 standardized cycling time trials in the heat and 2 in temperate conditions. Single measure analysis of sodium concentration was conducted immediately by ion-selective electrodes (ISE). A subset of 30 samples was frozen for reanalysis of sodium concentration using ISE, flame photometry (FP), and conductivity (SC).

RESULTS

Sweat samples collected in hot conditions produced higher sweat sodium concentrations than those from the temperate environment (P = .0032). A significant difference (P = .0048) in estimates of sweat sodium concentration was evident when calculated from the forearm average (mean ± 95% CL; 64 ± 12 mmol/L) compared with using a 4-site equation (70 ± 12 mmol/L). There was a high correlation between the values produced using different analytical techniques (r2 = .95), but mean values were different between treatments (frozen FP, frozen SC > immediate ISE > frozen ISE; P < .0001).

CONCLUSION

Whole-body sweat sodium concentration estimates differed depending on the number of sites included in the calculation. Environmental testing conditions should be considered in the interpretation of results. The impact of sample freezing and subsequent analytical technique was small but statistically significant. Nevertheless, when undertaken using a standardized protocol, the regional absorbent-patch method appears to be a relatively robust field test.

The effect of prescribed fluid consumption on physiology and work behavior of wildfire fighters

The purpose of this study was to examine 1) wildfire fighters' ability to consume the prescribed fluid volume (1200 mL h(-1)), 2) the effect of fluid intake on plasma sodium and hydration, and 3) the effect of fluid intake on firefighters' heart rate, core temperature and activity during emergency suppression shifts.

METHODS

Thirty-four firefighters were divided into ad libitum (AD, n = 17) and prescribed (PR, n = 17) drinking groups.

RESULTS

PR drinkers did not meet the prescribed fluid target, yet consumed over double the volume of AD drinkers. No differences between groups in plasma sodium or hydration were noted. PR drinking resulted in lower core temperature between 2 and 6 h. This did not coincide with reduced cardiovascular strain, greater work activity or larger distances covered when compared to AD drinkers.

CONCLUSION

Extra fluid consumption (above AD) did not improve firefighter activity or physiological function (though PR firefighters core temperature was lower earlier in their shift). Firefighter can self-regulate their fluid consumption behavior and work rate to leave the fireground euhydrated.

Water and sodium intake habits and status of ultra-endurance runners during a multi-stage ultra-marathon conducted in a hot ambient environment: an observational field based study

Background

Anecdotal evidence suggests ultra-runners may not be consuming sufficient water through foods and fluids to maintenance euhydration, and present sub-optimal sodium intakes, throughout multi-stage ultra-marathon (MSUM) competitions in the heat. Subsequently, the aims were primarily to assess water and sodium intake habits of recreational ultra-runners during a five stage 225 km semi self-sufficient MSUM conducted in a hot ambient environment (T_max range: 32°C to 40°C); simultaneously to monitor serum sodium concentration, and hydration status using multiple hydration assessment techniques.

Methods

Total daily, pre-stage, during running, and post-stage water and sodium ingestion of ultra-endurance runners (UER, n = 74) and control (CON, n = 12) through foods and fluids were recorded on Stages 1 to 4 by trained dietetic researchers using dietary recall interview technique, and analysed through dietary analysis software. Body mass (BM), hydration status, and serum sodium concentration were determined pre- and post-Stages 1 to 5.

Results

Water (overall mean (SD): total daily 7.7 (1.5) L/day, during running 732 (183) ml/h) and sodium (total daily 3.9 (1.3) g/day, during running 270 (151) mg/L) ingestion did not differ between stages in UER (p < 0.001 vs. CON). Exercise-induced BM loss was 2.4 (1.2)% (p < 0.001). Pre- to post-stage BM gains were observed in 26% of UER along competition. Pre- and post-stage plasma osmolality remained within normal clinical reference range (280 to 303 mOsmol/kg) in the majority of UER (p > 0.05 vs. CON pre-stage). Asymptomatic hyponatraemia (<135 mmol/L) was evident pre- and post-stage in n = 8 UER, corresponding to 42% of sampled participants. Pre- and post-stage urine colour, urine osmolality and urine/plasma osmolality ratio increased (p < 0.001) as competition progressed in UER, with no change in CON. Plasma volume and extra-cellular water increased (p < 0.001) 22.8% and 9.2%, respectively, from pre-Stage 1 to 5 in UER, with no change in CON.

Conclusion

Water intake habits of ultra-runners during MSUM conducted in hot ambient conditions appear to be sufficient to maintain baseline euhydration levels. However, fluid over-consumption behaviours were evident along competition, irrespective of running speed and gender. Normonatraemia was observed in the majority of ultra-runners throughout MSUM, despite sodium ingestion under benchmark recommendations.

A dual-column solid phase extraction strategy for online collection and preparation of continuously flowing effluent streams for mass spectrometry

Current desalination techniques for mass spectrometry-based protocols are problematic for performing temporal response studies where increased temporal resolution requires small samples and faster sampling frequencies, which greatly increases the number of samples and sample preparation time. These challenges are pertinent to cellular dynamics experiments, where it is important to sample the biological system frequently and with as little sample waste as possible. To address these needs, we present a dual-column online solid phase extraction (SPE) approach capable of preconcentrating and preparing a constantly perfusing sample stream, with minimal to no sample loss. This strategy is evaluated for use in microfluidic bioreactor studies specifically aimed at characterizing suitable sample flow rates, temporal resolving power, and analyte concentrations. In this work, we demonstrate that this strategy may be used for flow rates as low as 500 nL/min, with temporal resolving power on the order of 3 min, with analyte loadings ranging from femtomoles to picomoles for metabolites. Under these conditions, recoveries of ca. 80% are obtained even at femtomole loadings.

The effects of weight loss strategies on gastric emptying and appetite control

The gastrointestinal tract plays an important role in the improved appetite control and weight loss in response to bariatric surgery. Other strategies which similarly alter gastrointestinal responses to food intake could contribute to successful weight management. The aim of this review is to discuss the effects of surgical, pharmacological and behavioural weight loss interventions on gastrointestinal targets of appetite control, including gastric emptying. Gastrointestinal peptides are also discussed because of their integrative relationship in appetite control. This review shows that different strategies exert diverse effects and there is no consensus on the optimal strategy for manipulating gastric emptying to improve appetite control. Emerging evidence from surgical procedures (e.g. sleeve gastrectomy and Roux-en-Y gastric bypass) suggests a faster emptying rate and earlier delivery of nutrients to the distal small intestine may improve appetite control. Energy restriction slows gastric emptying, while the effect of exercise-induced weight loss on gastric emptying remains to be established. The limited evidence suggests that chronic exercise is associated with faster gastric emptying, which we hypothesize will impact on appetite control and energy balance. Understanding how behavioural weight loss interventions (e.g. diet and exercise) alter gastrointestinal targets of appetite control may be important to improve their success in weight management.

Energy balance during two days of continuous stationary cycling

This study examined the capabilities of an ultraendurance athlete to self-regulate their diet during an attempt on the record for the longest period of stationary cycling. The attempt required the athlete to complete at least 20 km/hr, with a 15 minute break allowed every eight hours. Laboratory tests determined a heart rate-oxygen consumption regression equation enabling calculation of energy expenditure from heart rate during the attempt. Energy intake was determined by a non-weighed dietary record collected at the time of consumption. The athlete completed 46.7 hours, covering 1126 km, at a speed of 24 +/- 1.6 km/hr. He expended 14486 kcal and consumed 11098 kcal resulting in an energy deficit (-3290 kcal) and a weight loss (-0.55 kg). The carbohydrate (42 +/- 32 g/hr), water (422 +/- 441 ml/hr), and sodium (306 +/- 465 mg/hr) intake were all below current recommendations. The athlete was unable to self-regulate his diet or exercise intensity to prevent a negative energy balance.

The use of recovery methods post‐exercise

Competitive soccer engages many of the body's systems to a major extent. The musculoskeletal, nervous, immune and metabolic systems are stressed to a point where recovery strategies post-exercise become influential in preparing for the next match. Intense activity at a 7-day training camp causes participants to experience lowered concentrations of non-killer cells and T-helper cells. Two consecutive games in 24 h produce disturbances in the testosterone-cortisol ratio. When competitive schedules are congested, the recovery process should be optimized for performance capabilities to be restored to normal as soon as possible. There is evidence that glycogen stores are reduced near to depletion at the end of a soccer game and that a diet high in carbohydrates can aid recovery. Water alone is not the best means of restoring body fluids, since carbohydrate-electrolyte drinks display better intestinal absorption and reduce urine output. Some relief from muscle soreness may be achieved by means of a warm-down. Deep-water running regimens can replace conventional physical training in the days after competition. Massage, cryotherapy and alternative therapies have not been shown to be consistently effective. It is concluded that optimizing recovery post-exercise depends on a combination of factors that incorporate a consideration of individual differences and lifestyle factors. The procedures to facilitate recovery processes should start immediately the game or training finishes. Match administrators and tournament planners should consider the stressful consequences for players in periods of congested fixtures and alleviate the physiological strain as far as possible by allowing 72 h between competitive games. This frequency of competition is unlikely to be sustainable in the long term.