Gastric emptying of a carbohydrate-electrolyte drink during a soccer match

Gastrointestinal symptoms and nutritional intake among participants in a non-professional cycling event

PURPOSE

To determine the occurrence of gastrointestinal (GI) symptoms in different settings among cyclists participating in a non-professional cycling event. The nutritional intake during the event and the association between GI symptoms and both nutritional and non-nutritional factors were also analyzed.

METHODS

A descriptive correlational study was performed among participants in the 2023 'Mallorca 312-Milestone Series' cycling event. A pre-race questionnaire was completed by 247 participants (37 women) while a post-race questionnaire was completed by 138 participants (24 women).

RESULTS

The prevalence of GI symptoms in training sessions and in previous cycling events were 22-26%. GI complaints during the race were reported by 38.4% of participants. GI symptoms during training (p = 0.003), in previous cycling events (p = 0.012) and in the Mallorca 312 event (during: p = 0.010; after p = 0.014) were associated with rest GI symptoms. Furthermore, GI symptoms during the Mallorca 312 event were associated with an immediately previous more nervous feeling (p = 0.016). Participants with shorter previous experience in similar events reported a more nervous feeling (p = 0.023). On average, participants in the Mallorca 312 achieved the recommended carbohydrate intake (59.2 g/h; recommended 30-60 g/h) and the fluid intake (500 ml; recommended 400-800 ml/h) rates. No association was found between GI symptoms and nutritional parameters or food intake.

CONCLUSION

GI symptoms at rest could be considered the main factor associated with GI symptoms in cyclists. GI symptoms during the event were also associated with a more nervous feeling, which could be explained, at least in part, by shorter previous experience.

Impact of exercise duration on gastrointestinal function and symptoms

The study aimed to determine the impact of exercise duration on gastrointestinal functional responses and gastrointestinal symptoms (GISs) in response to differing exercise durations. Endurance runners (n = 16) completed three trials on separate occasions, randomized to 1 h (1-H), 2 h (2-H), and 3 h (3-H) of running at 60% V̇o_2max in temperate ambient temperature. Orocecal transit time (OCTT) was determined by lactulose challenge, with concomitant breath hydrogen (H₂) determination. Gastric slow wave activity was recorded using cutaneous electrogastrography (cEGG) before and after exertion. GIS was determined using a modified visual analog scale (mVAS). OCTT response was classified as very slow on all trials (∼93-101 min) with no trial difference observed (P = 0.895). Bradygastria increased postexercise on all trials (means ± SD: 1-H: 10.9 ± 11.7%, 2-H: 6.2 ± 9.8%, and 3-H: 13.2 ± 21.4%; P < 0.05). A reduction in the normal gastric slow wave activity (2-4 cycles/min) was observed postexercise on 1-H only (-10.8 ± 17.6%; P = 0.039). GIS incidence and gut discomfort was higher on 2-H (81% and 12 counts) and 3-H (81% and 18 counts), compared with 1-H (69% and 6 counts) (P = 0.038 and P = 0.006, respectively). Severity of gut discomfort, total-GIS, upper-GIS, and lower-GIS increased during exercise on all trials (P < 0.05). Steady-state exercise in temperate ambient conditions for 1 h, 2 h, and 3 h instigates perturbations in gastric slow wave activity compared with rest and hampers OCTT, potentially explaining the incidence and severity on exercise-associated GIS.NEW & NOTEWORTHY Exercise stress per se appears to instigate perturbations to gastric myoelectrical activity, resulting in an increase in bradygastria frequency, inferring a reduction in gastric motility. The perturbations to gastrointestinal functional responses instigated by exercise per se, likely contribute to the high incidence and severity level of exercise-associated gastrointestinal symptoms. Cutaneous electrogastrography is not commonly used in exercise gastroenterology research, however, may be a useful aid in providing an overall depiction of gastrointestinal function. Particularly relating to gastrointestinal motility and concerning gastroparesis.

Low-fat, lactose-free and leucine-enriched chocolate cow milk prototype: A preliminary study on sensorial acceptability and gastrointestinal complaints following exhaustive exercise

BACKGROUND

Chocolate milk has gained recent scientific support as a recovery drink. However, it is known that high exercise-demand triggers gastrointestinal discomfort which continues post-exercise, thereby hindering this nutritional strategy. In addition, those who are lactose intolerant cannot benefit from a milk-based beverage. Thus, the aim of this preliminary study was to develop a low-fat, lactose-free, and leucine-enriched chocolate cow milk prototype (CML) representing nutrition-related recommendations for football players, as well as assess athletes' individual subjective outcomes for gastrointestinal complaints and sensorial acceptability in a field-based setting following strenuous team-sport physical demands.

METHODS

This study followed a single group and repeated-measured design with 10 football players (23 ± 2 yrs., 74 ± 14 kg, 174 ± 5 cm) who consumed CML following a 90-min football match simulation protocol (FMP). The total CML intake to achieve 0.150 g leucine·kg [BW]·h^- 1 occurred in aliquots of 50, 30 and 20% at 0-, 45- and 75-min post-FMP, respectively. Athletes were evaluated by the prevalence, the type and severity (bloating, nausea, flatulence, and gastric reflux) of gastrointestinal complaints and sensorial acceptability (overall perception, appearance, consistency, and flavour) after drinking each aliquot in a 4-h recovery period.

RESULTS

The CML showed higher scores for "Product Acceptability Index" (88%) and sensorial acceptability (~ 8 in 9-point hedonic scale). Kendall's W with bootstrapped resample (95%CI) revealed agreement among respondents as "moderate" (overall perception, flavour) to "strong" (appearance, consistency) and with no significant agreement differences between rater response in the timeline analysis (0.57 up to 0.87; p > 0.05). Agresti-Caffo add-4 analysis (95% confidence interval, [95%CI]) revealed no differences in each time-point analysis versus baseline for athletes classified as having severe gastrointestinal symptoms, but confirmed concern with bloating (three athletes showed a transient response at 2-h and only one continued until 3-h; p = 0.051).

CONCLUSIONS

These preliminary findings suggest that CML presents good taste and high acceptability by the sampled athletes. Thus, CML may be an alternative sport drink for immediate post-workout supplementation to overcome the energy deficit, offer co-ingested leucine, maintain palatability and adherence including lactose intolerance following a team sport-specific fatigue.

TRIAL REGISTRATION

RBR-2vmpz9 , 10/12/2019, retrospectively registered.

Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease

BACKGROUND

"Exercise-induced gastrointestinal syndrome" refers to disturbances of gastrointestinal integrity and function that are common features of strenuous exercise.

AIM

To systematically review the literature to establish the impact of acute exercise on markers of gastrointestinal integrity and function in healthy populations and those with chronic gastrointestinal conditions.

METHODS

Search literature using five databases (PubMed, EBSCO, Web of Science, SPORTSdiscus, and Ovid Medline) to review publications that focused on the impact of acute exercise on markers of gastrointestinal injury, permeability, endotoxaemia, motility and malabsorption in healthy populations and populations with gastrointestinal diseases/disorders.

RESULTS

As exercise intensity and duration increases, there is considerable evidence for increases in indices of intestinal injury, permeability and endotoxaemia, together with impairment of gastric emptying, slowing of small intestinal transit and malabsorption. The addition of heat stress and running mode appears to exacerbate these markers of gastrointestinal disturbance. Exercise stress of ≥2 hours at 60% VO_2max appears to be the threshold whereby significant gastrointestinal perturbations manifest, irrespective of fitness status. Gastrointestinal symptoms, referable to upper- and lower-gastrointestinal tract, are common and a limiting factor in prolonged strenuous exercise. While there is evidence for health benefits of moderate exercise in patients with inflammatory bowel disease or functional gastrointestinal disorders, the safety of more strenuous exercise has not been established.

CONCLUSIONS

Strenuous exercise has a major reversible impact on gastrointestinal integrity and function of healthy populations. The safety and health implications of prolonged strenuous exercise in patients with chronic gastrointestinal diseases/disorders, while hypothetically worrying, has not been elucidated and requires further investigation.

Acute Aerobic Swimming Exercise Induces Distinct Effects in the Contractile Reactivity of Rat Ileum to KCl and Carbachol

Aerobic exercise promotes short-term physiological changes in the intestinal smooth muscle associated to the ischemia-reperfusion process; however, few studies have demonstrated its effect on the intestinal contractile function. Thus, this work describes our observations regarding the influence of acute aerobic swimming exercise in the contractile reactivity, oxidative stress, and morphology of rat ileum. Wistar rats were divided into sedentary (SED) and acutely exercised (EX-AC) groups. Animals were acclimated by 10, 10, and 30 min of swimming exercise in intercalated days 1 week before exercise. Then they were submitted to forced swimming for 1 h with a metal of 3% of their body weight attached to their body. Animals were euthanized immediately after the exercise section and the ileum was suspended in organ baths for monitoring isotonic contractions. The analysis of lipid peroxidation was performed in order to determinate the malondialdehyde (MDA) levels as a marker of oxidative stress, and intestinal smooth muscle morphology by histological staining. Cumulative concentration-response curves to KCl were altered in the EX-AC with an increase in both its efficacy and potency (E_max = 153.2 ± 2.8%, EC₅₀ = 1.3 ± 0.1 × 10⁻² M) compared to the SED group (E_max = 100%, EC₅₀ = 1.8 ± 0.1 × 10⁻² M). Interestingly, carbachol had its efficacy and potency reduced in the EX-AC (E_max = 67.1 ± 1.4%, EC₅₀ = 9.8 ± 1.4 × 10⁻⁷ M) compared to the SED group (E_max = 100%, EC₅₀ = 2.0 ± 0.2 × 10⁻⁷ M). The exercise did not alter the MDA levels in the ileum (5.4 ± 0.6 μ mol/mL) in the EX-AC compared to the SED group (8.4 ± 1.7 μ mol/mL). Moreover, neither the circular nor the longitudinal smooth muscle layers thickness were modified by the exercise (66.2 ± 6.0 and 40.2 ± 2.6 μm, respectively), compared to the SED group (61.6 ± 6.4 and 34.8 ± 3.7 μm, respectively). Therefore, the ileum sensitivity to contractile agents is differentially altered by the acute aerobic swimming exercise, without affecting the oxidative stress and the morphology of ileum smooth muscle.

Carbohydrate Nutrition and Team Sport Performance

The common pattern of play in 'team sports' is 'stop and go', i.e. where players perform repeated bouts of brief high-intensity exercise punctuated by lower intensity activity. Sprints are generally 2-4 s long and recovery between sprints is of variable length. Energy production during brief sprints is derived from the degradation of intra-muscular phosphocreatine and glycogen (anaerobic metabolism). Prolonged periods of multiple sprints drain muscle glycogen stores, leading to a decrease in power output and a reduction in general work rate during training and competition. The impact of dietary carbohydrate interventions on team sport performance have been typically assessed using intermittent variable-speed shuttle running over a distance of 20 m. This method has evolved to include specific work to rest ratios and skills specific to team sports such as soccer, rugby and basketball. Increasing liver and muscle carbohydrate stores before sports helps delay the onset of fatigue during prolonged intermittent variable-speed running. Carbohydrate intake during exercise, typically ingested as carbohydrate-electrolyte solutions, is also associated with improved performance. The mechanisms responsible are likely to be the availability of carbohydrate as a substrate for central and peripheral functions. Variable-speed running in hot environments is limited by the degree of hyperthermia before muscle glycogen availability becomes a significant contributor to the onset of fatigue. Finally, ingesting carbohydrate immediately after training and competition will rapidly recover liver and muscle glycogen stores.

Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations

Gastrointestinal problems are common, especially in endurance athletes, and often impair performance or subsequent recovery. Generally, studies suggest that 30-50% of athletes experience such complaints. Most gastrointestinal symptoms during exercise are mild and of no risk to health, but hemorrhagic gastritis, hematochezia, and ischemic bowel can present serious medical challenges. Three main causes of gastrointestinal symptoms have been identified, and these are either physiological, mechanical, or nutritional in nature. During intense exercise, and especially when hypohydrated, mesenteric blood flow is reduced; this is believed to be one of the main contributors to the development of gastrointestinal symptoms. Reduced splanchnic perfusion could result in compromised gut permeability in athletes. However, although evidence exists that this might occur, this has not yet been definitively linked to the prevalence of gastrointestinal symptoms. Nutritional training and appropriate nutrition choices can reduce the risk of gastrointestinal discomfort during exercise by ensuring rapid gastric emptying and the absorption of water and nutrients, and by maintaining adequate perfusion of the splanchnic vasculature. A number of nutritional manipulations have been proposed to minimize gastrointestinal symptoms, including the use of multiple transportable carbohydrates, and potentially the use of nutrients that stimulate the production of nitric oxide in the intestine and thereby improve splanchnic perfusion. However, at this stage, evidence for beneficial effects of such interventions is lacking, and more research needs to be conducted to obtain a better understanding of the etiology of the problems and to improve the recommendations to athletes.

Repeated high intensity bouts with long recovery: are bicarbonate or carbohydrate supplements an option?

The effects of varying recovery modes and the influence of preexercise sodium bicarbonate and carbohydrate ingestion on repeated high intensity performance, acid-base response, and recovery were analyzed in 12 well-trained males. They completed three repeated high intensity running bouts to exhaustion with intervening recovery periods of 25 min under the following conditions: sodium bicarbonate, active recovery (BIC); carbohydrate ingestion, active recovery (CHO); placebo ingestion, active recovery (ACTIVE); placebo ingestion, passive recovery (PASSIVE). Blood lactate (BLa), blood gases, heart rate, and time to exhaustion were collected. The three high intensity bouts had a duration of 138 ± 9, 124 ± 6, and 121 ± 6 s demonstrating a decrease from bout 1 to bout 3. Supplementation strategy had no effect on performance in the first bout, even with differences in pH and bicarbonate (HCO3(-)). Repeated sprint performance was not affected by supplementation strategy when compared to ACTIVE, while PASSIVE resulted in a more pronounced decrease in performance compared with all other interventions. BIC led to greater BLa, pH, and HCO3(-) values compared with all other interventions, while for PASSIVE the opposite was found. BLa recovery was lowest in PASSIVE; recovery in pH, and HCO3(-) was lower in PASSIVE and higher in BIC.

Postprandial glucose fluxes and insulin sensitivity during exercise: a study in healthy individuals

Quantifying the effect size of acute exercise on insulin sensitivity (SI(exercise)) and simultaneous measurement of glucose disappearance (R(d)), endogenous glucose production (EGP), and meal glucose appearance in the postprandial state has not been developed in humans. To do so, we studied 12 healthy subjects [5 men, age 37.1 ± 3.1 yr, body mass index 24.1 ± 1.1 kg/m², fat-free mass (FFM) 50.9 ± 3.9 kg] during moderate exercise at 50% V(O₂max) for 75 min, 120-195 min after a triple-tracer mixed meal consumed at time 0. Tracer infusion rates were adjusted to achieve constant tracer-to-tracee ratio and minimize non-steady-state errors. Glucose turnover was estimated by accounting for the nonstationary kinetics introduced by exercise. Insulin sensitivity index was calculated in each subject both in the absence [time (t) = 0-120 min, SI(rest)] and presence (t = 0-360 min, SI(exercise)) of physical activity. EGP at t = 0 min (13.4 ± 1.1 μM·kg FFM⁻¹·min⁻¹) fell at t = 120 min (2.4 ± 0.4 μM·kg FFM⁻¹·min⁻¹) and then rapidly rose almost eightfold at t = 180 min (18.2 ± 2.6 μM·kg FFM⁻¹·min⁻¹) before gradually falling at t = 360 min (10.6 ± 0.9 μM·kg FFM⁻¹·min⁻¹). R(d) rapidly peaked at t = 120 min at the start of exercise (89.5 ± 11.6 μM·kg FFM⁻¹·min⁻¹) and then gradually declined at t = 195 min (26.4 ± 3.3 μM·kg FFM⁻¹·min⁻¹) before returning to baseline at t = 360 min. SI(exercise) was significantly higher than SI(rest) (21.6 ± 3.7 vs. 12.5 ± 2.0 10⁻⁴ dl·kg⁻¹·min⁻¹ per μU/ml, P < 0.0005). Glucose turnover was estimated for the first time during exercise with the triple-tracer technique. Our results, applying state-of-the-art techniques, show that moderate exercise almost doubles postprandial insulin sensitivity index in healthy subjects.

Carbohydrate ingestion during team games exercise: current knowledge and areas for future investigation

There is a growing body of research on the influence of ingesting carbohydrate-electrolyte solutions immediately prior to and during prolonged intermittent, high-intensity exercise (team games exercise) designed to replicate field-based team games. This review presents the current body of knowledge in this area, and identifies avenues of further research. Almost all early work supported the ingestion of carbohydrate-electrolyte solutions during prolonged intermittent exercise, but was subject to methodological limitations. A key concern was the use of exercise protocols characterized by prolonged periods at the same exercise intensity, the lack of maximal- or high-intensity work components and long periods of seated recovery, which failed to replicate the activity pattern or physiological demand of team games exercise. The advent of protocols specifically designed to replicate the demands of field-based team games enabled a more externally valid assessment of the influence of carbohydrate ingestion during this form of exercise. Once again, the research overwhelmingly supports carbohydrate ingestion immediately prior to and during team games exercise for improving time to exhaustion during intermittent running. While the external validity of exhaustive exercise at fixed prescribed intensities as an assessment of exercise capacity during team games may appear questionable, these assessments should perhaps not be viewed as exhaustive exercise tests per se, but as indicators of the ability to maintain high-intensity exercise, which is a recognized marker of performance and fatigue during field-based team games. Possible mechanisms of exercise capacity enhancement include sparing of muscle glycogen, glycogen resynthesis during low-intensity exercise periods and attenuated effort perception during exercise. Most research fails to show improvements in sprint performance during team games exercise with carbohydrate ingestion, perhaps due to the lack of influence of carbohydrate on sprint performance when endogenous muscle glycogen concentration remains above a critical threshold of ∼200  mmol/kg dry weight. Despite the increasing number of publications in this area, few studies have attempted to drive the research base forward by investigating potential modulators of carbohydrate efficacy during team games exercise, preventing the formulation of optimal carbohydrate intake guidelines. Potential modulators may be different from those during prolonged steady-state exercise due to the constantly changing exercise intensity and frequency, duration and intensity of rest intervals, potential for team games exercise to slow the rate of gastric emptying and the restricted access to carbohydrate-electrolyte solutions during many team games. This review highlights fluid volume, carbohydrate concentration, carbohydrate composition and solution osmolality; the glycaemic index of pre-exercise meals; fluid and carbohydrate ingestion patterns; fluid temperature; carbohydrate mouthwashes; carbohydrate supplementation in different ambient temperatures; and investigation of all of these areas in different subject populations as important avenues for future research to enable a more comprehensive understanding of carbohydrate ingestion during team games exercise.

Nutrition in team sports

Team sports are based on intermittent high-intensity activity patterns, but the exact characteristics vary between and within codes, and from one game to the next. Despite the challenge of predicting exact game demands, performance in team sports is often dependent on nutritional factors. Chronic issues include achieving ideal levels of muscle mass and body fat, and supporting the nutrient needs of the training program. Acute issues, both for training and in games, include strategies that allow the player to be well fuelled and hydrated over the duration of exercise. Each player should develop a plan of consuming fluid and carbohydrate according to the needs of their activity patterns, within the breaks that are provided in their sport. In seasonal fixtures, competition varies from a weekly game in some codes to 2-3 games over a weekend road trip in others, and a tournament fixture usually involves 1-3 days between matches. Recovery between events is a major priority, involving rehydration, refuelling and repair/adaptation activities. Some sports supplements may be of value to the team athlete. Sports drinks, gels and liquid meals may be valuable in allowing nutritional goals to be met, while caffeine, creatine and buffering agents may directly enhance performance.

Living, training and playing in the heat: challenges to the football player and strategies for coping with environmental extremes

Dehydration and hyperthermia both, if sufficiently severe, will impair exercise performance. Dehydration can also impair performance of tasks requiring cognition and skill. Body temperature may exceed 40 °C in competitive games played in hot weather, but limited data are available. Football played in the heat, therefore, poses a challenge, and effects on some aspects of performance become apparent as environmental temperature increases above about 12-15 °C. Prior acclimatization will reduce the impact of high environmental temperatures but provides limited protection when humidity is also high. Ingestion of fluids is effective in limiting the detrimental effects on performance: drinks with added carbohydrate and electrolytes are generally more effective than plain water and drinks may be more effective if taken cold than if taken at ambient temperature. Pre-exercise lowering of body temperature may aid some aspects of performance, but the efficacy has not been demonstrated in football.

Hydration: special issues for playing football in warm and hot environments

The high metabolic rates and body temperatures sustained by football players during training and matches causes sweating--particularly when in warm or hot environments. There is limited published data on the effects of this sweat loss on football performance. The limited information available, together with knowledge of the effects of sweat loss in other sports with skill components as well as endurance and sprint components, suggests that the effects of sweating will be similar as in these other activities. Therefore, the generalization that, on average, a body mass reduction equivalent to 2% should be the acceptable limit of sweat losses seems reasonable. This magnitude and more, of sweat loss is a common occurrence for some players. Sodium is the main electrolyte lost in sweat but there is large variability in sodium losses between players. However, the extent of sodium losses in some players may be such that its replacement is warranted for these players. Although football is a team sport, the great individual variability in sweat and electrolyte losses of players in the same training session or match dictates that individual monitoring to determine individual water and electrolyte requirements should be an essential part of a player's nutrition strategy.

Fluid provision and metabolic responses to soccer-specific exercise

The present study aimed to investigate the impact on metabolism of altering the timing and volume of ingested carbohydrate during soccer-specific exercise. Twelve soccer players performed a soccer-specific protocol on three occasions. On two, 7 ml kg(-1) carbohydrate-electrolyte or placebo were ingested at 0 and 45 min. On a third, the same total volume of carbohydrate-electrolyte was consumed but at 0, 15, 30, 45, 60 and 75 min. Carbohydrate-electrolyte ingestion increased blood glucose, insulin and carbohydrate oxidation, whilst suppressing NEFA, glycerol and fat oxidation (P < 0.05) although manipulating the schedule of carbohydrate ingestion elicited similar metabolic responses (P > 0.05). However, consuming fluid in small volumes reduced the sensation of gut fullness (P < 0.05). The results demonstrated that when the total volume of carbohydrate consumed is equal, manipulating the timing and volume of ingestion elicits similar metabolic responses. Furthermore, consuming a small volume of fluid at regular intervals reduces the sensation of gut fullness.

Musculoskeletal performance and hydration status

Maximal performance during competition is the drive many competitors use to train harder. However, there are several variables that contribute to impair a competitor's performance. These variables work by altering the homeostatic mechanisms within the body. Once homeostasis is altered the competitor's body is no longer optimized to face the stresses of the athletic competition. The environment works as an all encompassing variable that will affect sweat rate. During increased environmental heat strain, one must adjust for critical variables, such as temperature regulation, hydration status, and electrolyte levels, as they can contribute to impaired performance. Acclimatization through training and competition will reduce or slow down the effects of these stress factors. Ever evolving recommendations are produced to aid competitors in maintaining homeostasis. Despite all the generic recommendations that are made, however, every athlete needs to individualize their training and competition regimens to optimize personal performance.

Influence of moderate dehydration on soccer performance: physiological responses to 45 min of outdoor match-play and the immediate subsequent performance of sport-specific and mental concentration tests

OBJECTIVE

To determine whether moderate water loss (approximately 1.5-2% of body mass (BM)) represents a significant impairment to soccer match-play and the related fitness variables.

METHODS

11 moderately active male soccer players (mean (SD) age 24.4 (3) years, BM 74.03 (10.5) kg, peak oxygen consumption 50.91 (4.0) ml/kg/min) volunteered to participate. The experimental procedure comprised: (1) a 45 min pre-match period of cycle ergometry exercise (90% of individual ventilatory threshold); (2) the completion of a 45 min soccer match; and (3) the immediate post-match performance of sport-specific and mental concentration tests. The subjects completed the procedure on three occasions each in a different experimental condition (fluid intake (FL), no fluid (NF) and mouth rinse (MR)) in an individually randomised order. Core temperature (Tc), heart rates, plasma and urine osmolalities, BM, sweat rates and heat storage were all measured.

RESULTS

The only condition-dependent difference during the match-play element of the protocol was a significantly increased Tc in the NF condition compared with the FL condition (39.28 degrees C (0.35 degrees C) and 38.8 degrees C (0.47 degrees C), respectively; p<0.05). The immediate post-match performance of a sport-specific fitness test was significantly impaired where FL had been denied (p<0.01). The post-test evaluation of rating of perceived exertion and thirst indicated that the NF condition was perceived to be the most challenging (p<0.05).

CONCLUSIONS

The condition-dependent differences in match-play and post-match tests demonstrate that moderate dehydration is detrimental to soccer performance. However, it remains unclear whether this could be attributable to water loss in itself or the negative psychological associations derived from a greater perception of effort in that condition.

The effect of intermittent high-intensity running on gastric emptying of fluids in man

PURPOSE

This study examined the effect of variable-intensity shuttle running on gastric emptying of a carbohydrate-free placebo (Plac) drink and of a 6.4% carbohydrate-electrolyte (CHO) sports drink.

METHOD

We compared the volume of test drink emptied during two 15-min periods of walking exercise (WE) with that during two 15-min periods of the Loughborough Intermittent Shuttle Test (LIST). Gastric emptying was measured on the four trials using a double-sampling aspiration technique in eight healthy males after ingestion of a 420 +/- 49 mL and a 168 +/- 20 mL bolus of the appropriate test drink at the start of the first and second exercise period, respectively.

RESULTS

During the initial 15 min of exercise, the mean (+/-SD) volume of Plac (124 +/- 95 mL) and CHO (71 +/- 43 mL) drink emptied was similar between the two LIST trials, but the volume of Plac (227 +/- 85 mL) and CHO (159 +/- 63 mL) drinks emptied on the WE trials was greater than for the respective test drinks on the LIST trials. Similar volumes of test drinks were emptied on all trials (P = 0.20) during the second 15 min of exercise. Over the 30 min of each trial, the exercise intensity of the LIST reduced the volume of the Plac (211 +/- 108 mL) and CHO (208 +/- 83 mL) drink emptied compared with that on the WE trial for the Plac (396 +/- 74 mL) and CHO (293 +/- 73 mL) drink, respectively.

CONCLUSIONS

The exercise intensity of the LIST is sufficient to slow gastric emptying of carbohydrate and noncarbohydrate containing drinks compared with walking. Dilute carbohydrate-electrolyte drinks empty at about the same rate as carbohydrate-free beverages during variable-intensity running.

Water and electrolyte needs for football training and match-play

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

Recommendations for treatment of hyponatraemia at endurance events

This review focuses on possible pathophysiology of exercise-associated hyponatraemia and its implication on evaluation and treatment of collapsed athletes during endurance events. Rehydration guidelines and field care have traditionally been based on the belief that endurance events create a state of significant fluid deficit in athletes, which must be corrected by liberal hydration. Beliefs in the necessity of liberal hydration may have contributed to cases of hyponatraemia. Assumptions that fluid loss accounts for the entire weight loss during exercise and that fluid ingestion is the only source of water gain during exercise may lead to an overestimation of the degree of volume depletion and the amount of fluid needed for replacement. Increasing evidence suggests that hyponatraemic athletes are fluid overloaded; ingestion of large amount of hypotonic fluid in combination with inappropriate or inadequate physiological responses leads to excessive retention of free fluid. Risk factors include hot weather, female sex, slower finishing time, and possibly the use of nonsteroidal anti-inflammatory medications. Symptoms of hyponatraemia can be subtle and can mimic those of other exercise-related illnesses, thereby complicating its diagnosis and leading to possible inappropriate treatment. Most athletes who collapse at the finish line experience exercise-associated collapse, a benign and transient form of postural hypotension that can be treated simply by continued ambulation after finishing or elevation of legs while in a supine position for those who cannot walk. Care providers should consider the use of intravenous hydration with normal saline carefully since it is not needed by most collapsed athletes and may worsen the condition of patients with unsuspected hyponatraemia. Historic information and clinical signs of volume depletion should be elicited prior to its use. Most hyponatraemic athletes will recover uneventfully with careful observation while awaiting spontaneous diuresis. Use of hypertonic saline should be reserved for patients with severe symptoms. Moderate consumption of carbohydrate-electrolyte solution during exercise may allow the maintenance of adequate hydration and the prevention of hyponatraemia.