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

The Effects of Diet, Dietary Supplements, Drugs and Exercise on Physical, Diagnostic Values of Urine Characteristics

Background/Objectives: This review summarizes the current knowledge about factors that affect the physical characteristics of urine. It highlights proper urine sample collection and displays factors like diet, hydration status, and medications that can alter urine color, odor, clarity, specific gravity and pH. Results: Urinalysis is a minimally invasive examination of a patient's health, especially concerning nephrological and endocrinological abnormalities, as well as dietary habits and stimulants used. Certain deviations in appearance, composition or frequency/pain during urination may indicate an ongoing disease process in the body. Based on laboratory results, further medical treatment is determined. The reason for a change in the color of the urine, for its clouding or intense odor may be a disease, as well as the consumption of food, medication, intensive physical exercise or inadequate hydration of the body. Well-standardized procedures for collecting, transporting, preparing and analyzing samples should become the basis for an effective diagnostic strategy in urinalysis. It is worth noting that pharmacists in pharmaceutical care are often the first people to whom a patient turns for health advice and for the interpretation of simple laboratory tests. Acquiring the ability to interpret the results of laboratory tests and the principles of proper sampling for laboratory tests is indispensable in the process of possible counseling and providing reliable answers to patients' questions. Conclusions: Although urinalysis is not recommended as a routine screening tool for the general population, it can prove to be a valuable source of patient health data in some cases as the data will be useful to physicians and pharmacists to more effectively diagnose and better care for patients.

Limited Effect of Dehydrating via Active vs. Passive Heat Stress on Plasma Volume or Osmolality, Relative to the Effect of These Stressors per Se

The physiological, perceptual, and functional effects of dehydration may depend on how it is incurred (e.g., intense exercise releases endogenous water via glycogenolysis) but this basic notion has rarely been examined. We investigated the effects of active (exercise) heat- vs. passive heat-induced dehydration, and the kinetics of ad libitum rehydration following each method. Twelve fit participants (five females and seven males) completed four trials in randomised order: DEHydration to -3% change in body mass (∆BM) under passive or active heat stress, and EUHydration to prevent ∆BM under passive or active heat stress. In all trials, participants then sat in a temperate-controlled environment, ate a standard snack and had free access to water and sports drink during their two-hour recovery. During mild dehydration (≤2% ∆BM), active and passive heating caused comparable increases in plasma osmolality (P_osm: ~4 mOsmol/kg, interaction: p = 0.138) and reductions in plasma volume (PV: ~10%, interaction: p = 0.718), but heat stress per se was the main driver of hypovolaemia. Thirst in DEHydration was comparably stimulated by active than passive heat stress (p < 0.161) and shared the same relation to P_osm (r ≥ 0.744) and ∆BM (r ≥ 0.882). Following heat exposures, at 3% gross ∆BM, PV reduction was approximately twice as large from passive versus active heating (p = 0.003), whereas P_osm perturbations were approximately twice as large from EUHydration versus DEHydration (p < 0.001). Rehydrating ad libitum resulted in a similar net fluid balance between passive versus active heat stress and restored PV despite the incomplete replacement of ∆BM. In conclusion, dehydrating by 2% ∆BM via passive heat stress generally did not cause larger changes to PV or P_osm than via active heat stress. The heat stressors themselves caused a greater reduction in PV than dehydration did, whereas ingesting water to maintain euhydration produced large reductions in P_osm in recovery and therefore appears to be of more physiological significance.

Rehydration during Endurance Exercise: Challenges, Research, Options, Methods

During endurance exercise, two problems arise from disturbed fluid-electrolyte balance: dehydration and overhydration. The former involves water and sodium losses in sweat and urine that are incompletely replaced, whereas the latter involves excessive consumption and retention of dilute fluids. When experienced at low levels, both dehydration and overhydration have minor or no performance effects and symptoms of illness, but when experienced at moderate-to-severe levels they degrade exercise performance and/or may lead to hydration-related illnesses including hyponatremia (low serum sodium concentration). Therefore, the present review article presents (a) relevant research observations and consensus statements of professional organizations, (b) 5 rehydration methods in which pre-race planning ranges from no advanced action to determination of sweat rate during a field simulation, and (c) 9 rehydration recommendations that are relevant to endurance activities. With this information, each athlete can select the rehydration method that best allows her/him to achieve a hydration middle ground between dehydration and overhydration, to optimize physical performance, and reduce the risk of illness.

Acute Effects of Triathlon Race on Oxidative Stress Biomarkers

The response to strenuous exercise was investigated by reactive oxygen species (ROS) production, oxidative damage, thiol redox status, and inflammation assessments in 32 enrolled triathlon athletes (41.9 ± 7.9 yrs) during Ironman® (IR), or half Ironman® (HIR) competition. In biological samples, inflammatory cytokines, aminothiols (glutathione (GSH), homocysteine (Hcy), cysteine (Cys), and cysteinylglycine (CysGly)), creatinine and neopterin, oxidative stress (OxS) biomarkers (protein carbonyl (PC), thiobarbituric acid-reactive substances (TBARS)), and ROS were assessed. Thirteen HIR and fourteen IR athletes finished the race. Postrace, ROS (HIR +20%; IR +28%; p < 0.0001), TBARS (HIR +57%; IR +101%), PC (HIR +101%; IR +130%) and urinary neopterin (HIR +19%, IR +27%) significantly (range p < 0.05-0.0001) increased. Moreover, HIR showed an increase in total Cys +28%, while IR showed total aminothiols, Cys, Hcy, CysGly, and GSH increase by +48, +30, +58, and +158%, respectively (range p < 0.05-0.0001). ROS production was significantly correlated with TBARS and PC (R 2 = 0.38 and R 2 = 0.40; p < 0.0001) and aminothiols levels (range R 2 = 0.17-0.47; range p < 0.01-0.0001). In particular, ROS was directly correlated with the athletes' age (R 2 = 0.19; p < 0.05), with ultraendurance years of training (R 2 = 0.18; p < 0.05) and the days/week training activity (R 2 = 0.16; p < 0.05). Finally, the days/week training activity (hours/in the last 2 weeks) was found inversely correlated with the IL-6 postrace (R 2 = -0.21; p < 0.01). A strenuous performance, the Ironman® distance triathlon competition, alters the oxidant/antioxidant balance through a great OxS response that is directly correlated to the inflammatory parameters; furthermore, the obtained data suggest that an appropriate training time has to be selected in order to achieve the lowest ROS production and IL-6 concentration at the same time.

Core Temperature Response During the Marathon Portion of the Ironman World Championship (Kona-Hawaii)

The Ironman triathlon consists of a 3.8 km swim, 180 km bike, and 42.195 km run. Thermoregulation responses play an important role in performance optimization and injury prevention. Factors such as environmental conditions including heat and humidity, athlete training level, and race duration can affect thermoregulation. Hyperthermia occurs when the core temperature rises above 38.5°C. The present study aims to describe core temperature (Tcore) in top-level and well-trained age group triathletes during the marathon of Ironman World Championship 2014 in Kona-Hawaii under thermal stress conditions. Tcore of 15 triathletes (age: 36.11 ± 7.36 years, body mass: 71.14 ± 7.12 kg, height: 179 ± 0.04 cm, and fat %: 8.48 ± 0.85) who classified for the Ironman World Championship was measured by an ingestible pill telemetry system prior to competition, during the marathon and 60 min after finishing the race. Mean wet bulb globe temperature (WBGT) during the marathon was 24.66°C (range 22.44–28.50°C). Body mass index (BMI) and perceived exertion (Borg Scale and Visual Analog Scale-Pain) were collected before the race and 60 min after the event. Time variables were extracted from their official race time and split times. Finish time was 10: 06:56 ± 0:48:30. Tcore was initially 36.62 ± 0.17°C, increased at the end of the event (38.55 ± 0.64; p < 0.01) and remained elevated 60 min after the event (38.65 ± 0.41°C; p < 0.002). BMI significantly decreased after the event (22.85 ± 1.11 vs. 21.73 ± 1.36; p < 0.05), whereas both exercise perceived exertion [Borg Scale (10.2 ± 1.64 vs. 18.60 ± 1.67; p < 0.003)] and perceived muscle pain [VAS Pain (2.75 ± 1.59 vs. 9.08 ± 1.13; p < 0.001)] increased significantly after the event. Tcore during competition correlated negatively with position in age group (r − 0.949, p = 0.051), but not with race time (r = −0.817; p = 0.183). High-level age group triathletes competing under thermal stress conditions in the Kona Ironman reached a state of hyperthermia during the marathon. After 60 min of recovery the hyperthermia persisted. Strategies to aid post-event cooling and recovery should be considered to avoid the potentially dangerous adverse health effects of hyperthermia.

Hydration Status After an Ironman Triathlon: A Meta-Analysis

The Ironman is one of the most popular triathlon events in the world. Such a race involves a great number of tactical decisions for a healthy finish and best performance. Dehydration is widely postulated to decrease performance and is known as a cause of dropouts in Ironman. Despite the importance of hydration status after an Ironman triathlon, there is a clear lack of review and especially meta-analysis studies on this topic. Therefore, the objective was to systematically review the literature and carry out a meta-analysis investigating the hydration status after an Ironman triathlon. We conducted a systematic review of the literature up to June 2016 that included the following databases: PubMed, SCOPUS, Science Direct and Web of Science. From the initial 995 references, we included 6 studies in the qualitative analysis and in the meta-analysis. All trials had two measures of hydration status after a full Ironman race. Total body water, blood and urine osmolality, urine specific gravity and sodium plasma concentration were considered as hydration markers. Three investigators independently abstracted data on the study design, sample size, participants’ and race characteristics, outcomes, and quantitative data for the meta-analysis. In the pooled analysis, it seems that the Ironman event led to a moderate state of dehydration in comparison to baseline values (SMD 0.494; 95% CI 0.220 to 0.767; p = 0.001). Some evidence of heterogeneity and consistency was also observed: Q = 19.6; I² = 28.5%; τ² = 2.39. The results suggest that after the race athletes seem to be hypo-hydrated in comparison to baseline values.

Influence of cold-water immersion on recovery of elite triathletes following the ironman world championship

OBJECTIVES

Cold water immersion (CWI) has been widely used for enhancing athlete recovery though its use following an Ironman triathlon has never been examined. The purpose of this paper is to determine the influence of CWI immediately following an Ironman triathlon on markers of muscle damage, inflammation and muscle soreness.

DESIGN

Prospective cohort study.

METHODS

Thirty three (22 male, 11 female), triathletes participating in the Ironman World Championships volunteered to participate (mean±SD: age=40±11years; height=174.5±9.1cm; body mass=70±11.8kg; percent body fat=11.4±4.1%, finish time=11:03.00±01:25.08). Post race, participants were randomly assigned to a 10-min bout of 10°C CWI or no-intervention control group. Data collection occurred pre-intervention (PRE), post-intervention (POST), 16h (16POST) and 40h (40POST) following the race. Linear mixed model ANOVA with Bonferroni corrections were performed to examine group by time differences for delayed onset muscle soreness (DOMS), hydration indices, myoglobin, creatine kinase (CK), cortisol, C-reactive protein (CRP), IL-6 and percent body mass loss (%BML). Pearson's bivariate correlations were used for comparisons with finishing time. Alpha level was set a priori at 0.05.

RESULTS

No significant group by time interactions occurred. Significant differences occurred for POST BML (-1.7±0.9kg) vs. 16POST, and 40POST BML (0.9±1.4, -0.1±1.2kg, respectively; p<0.001). Compared to PRE, myoglobin, CRP and CK remained significantly elevated at 40POST. Cortisol returned to PRE values by 16POST and IL-6 returned to PRE values by 40POST.

CONCLUSION

A single bout of CWI did not provide any physiological benefit during recovery from a triathlon within 40h post race. Effect of CWI beyond this time is unknown.

Total Body Water, Electrolyte, and Thermoregulatory Responses to Ad Libitum Water Replacement Using Two Different Water Delivery Systems During a 19-km Route March

Hands-free hydration systems are often advocated for improved hydration and performance in military populations. The aim was to assess whether such systems indeed result in improved hydration in exercising soldiers. Subjects were required to complete a route march while consuming water ad libitum from either a hydration bladder (BG) or traditional canteen (CG). Water intakes of 538 ml·h⁻¹ (BG) and 533 ml·h⁻¹ (CG) resulted in no differences for changes in body mass, serum [Na], plasma osmolality, total body water, or time required to complete the march. There were no differences between peak exercise core temperature of the BG (38.9° C) and CG (38.7° C) groups. There were no differences between the groups for fluid balance, thermoregulation, or performance. This is a not a surprising finding because the amount of fluid consumed ad libitum is determined by changes in serum osmolality and not the fluid delivery system as often proposed.

Body Weight, Serum Sodium Levels, and Renal Function in an Ultra-Distance Mountain Run

OBJECTIVE

To determine body weight and serum [Na] changes in runners completing an 85-km mountain run, particularly with reference to their "in-race" hydration protocols.

DESIGN

Prospective observational cohort study.

SETTING

Cradle Mountain Run, Tasmania, Australia, February 2011.

PARTICIPANTS

Forty-four runners (86% of starters) prospectively enrolled, with 41 runners (80% of starters) eligible for inclusion in final data set.

MAIN OUTCOME MEASURES

Body weight change, serum sodium concentration change, and hydration plan (according to thirst vs preplanned fluid consumption).

RESULTS

There was 1 case of exercise-associated hyponatremia (EAH) [postrace [Na], 132 mmol/L]. This runner was asymptomatic. There was a strongly significant correlation between the change in serum [Na] and body weight change during the race. There was a significant inverse correlation between serum [Na] and volume of fluid consumed. Change of serum [Na] was not correlated with the proportion of water versus electrolyte drink consumed. Runners drinking to thirst consumed significantly lower average fluid volumes and had higher postrace serum [Na] than those complying with a preplanned hydration protocol (142 mmol/L vs 139 mmol/L). More experienced runners tended to drink to thirst.

CONCLUSIONS

There was a 2% incidence of EAH in this study. Serum [Na] change during an 85-km mountain run was inversely correlated with the volume of fluid consumed. The results provide further evidence that EAH is a dilutional hyponatremia caused by excessive consumption of hypotonic fluids. Drinking to thirst represents a safe hydration strategy for runners in a wilderness environment.

CLINICAL RELEVANCE

Drinking to thirst during endurance running events should be promoted as a safe hydration practice.

What predicts performance in ultra-triathlon races? - a comparison between Ironman distance triathlon and ultra-triathlon

Objective

This narrative review summarizes recent intentions to find potential predictor variables for ultra-triathlon race performance (ie, triathlon races longer than the Ironman distance covering 3.8 km swimming, 180 km cycling, and 42.195 km running). Results from studies on ultra-triathletes were compared to results on studies on Ironman triathletes.

Methods

A literature search was performed in PubMed using the terms “ultra”, “triathlon”, and “performance” for the aspects of “ultra-triathlon”, and “Ironman”, “triathlon”, and “performance” for the aspects of “Ironman triathlon”. All resulting papers were searched for related citations. Results for ultra-triathlons were compared to results for Ironman-distance triathlons to find potential differences.

Results

Athletes competing in Ironman and ultra-triathlon differed in anthropometric and training characteristics, where both Ironmen and ultra-triathletes profited from low body fat, but ultra-triathletes relied more on training volume, whereas speed during training was related to Ironman race time. The most important predictive variables for a fast race time in an ultra-triathlon from Double Iron (ie, 7.6 km swimming, 360 km cycling, and 84.4 km running) and longer were male sex, low body fat, age of 35–40 years, extensive previous experience, a fast time in cycling and running but not in swimming, and origins in Central Europe.

Conclusion

Any athlete intending to compete in an ultra-triathlon should be aware that low body fat and high training volumes are highly predictive for overall race time. Little is known about the physiological characteristics of these athletes and about female ultra-triathletes. Future studies need to investigate anthropometric and training characteristics of female ultra-triathletes and what motivates women to compete in these races. Future studies need to correlate physiological characteristics such as maximum oxygen uptake (VO_2max) with ultra-triathlon race performance in order to investigate whether these characteristics are also predictive for ultra-triathlon race performance.

Effective body water and body mass changes during summer ultra-endurance road cycling

Because body mass change (ΔMb) does not represent all water losses and gains, the present field investigation determined if (a) ΔMb equalled the net effective body water change during ultra-endurance exercise and (b) ground speed and exercise duration influenced these variables. Thirty-two male cyclists (age range, 35-52 years) completed a 164-km event in a hot environment, were retrospectively triplet matched and placed into one of three groups based on exercise duration (4.8, 6.3, 9.6 h). Net effective body water loss was computed from measurements (body mass, total fluid intake and urine excreted) and calculations (water evolved and mass loss due to substrate oxidation, solid food mass and sweat loss), including (ΔEBWgly) and excluding (ΔEBW) water bound to glycogen. With all cyclists combined, the mean ΔMb (i.e. loss) was greater than that of ΔEBWgly by 1200 ± 200 g (P = 1.4 × 10(-18)), was similar to ΔEBW (difference, 0 ± 200 g; P = .21) and was strongly correlated with both (R(2) = .98). Analysis of equivalence indicated that ΔMb was not equivalent to ΔEBWgly, but was equivalent to ΔEBW. Due to measurement complexity, we concluded that (a) athletes will not calculate the effective body water calculations routinely and (b) body mass change remains a useful field-expedient estimate of net effective body water change.

The prevalence of exercise-associated hyponatremia in 24-hour ultra-mountain bikers, 24-hour ultra-runners and multi-stage ultra-mountain bikers in the Czech Republic

BACKGROUND

To assess the prevalence of exercise-associated hyponatremia (EAH) in two 24-hour mountain bike (MTB) (R1,R2), one 24-hour running (R3) and one multi-stage MTB (R4) races held in the Czech Republic in a cluster of four cross-sectional studies.

METHODS

In 27 ultra-mountain bikers (ultra-MTBers), 12 ultra-runners, and 14 multi-stage MTBers, fluid intake, changes (Δ) in body mass, hematocrit, plasma volume, plasma [Na+], plasma [K+], plasma osmolality, urine [Na+], urine [K+], urine specific gravity, urine osmolality, K+/Na+ ratio in urine, transtubular potassium gradient and glomerular filtration rate were measured and calculated. The use of non-steroidal anti-inflammatory drugs and symptoms of EAH were recorded using post-race questionnaires.

RESULTS

Of the 53 finishers, three (5.7%) developed post-race EAH, thereof one (3.7%) ultra-MTBer, one (8.3%) ultra-runner and one (7.1%) multi-stage MTBer. Plasma [Na+] decreased significantly (p < 0.001) only in R4. Urine osmolality (R1, R3, R4 p < 0.001; R2 p < 0.05) and glomerular filtration rate (p < 0.001) increased, and body mass decreased in all races (p < 0.05). Δ body mass was inversely related to the number of kilometers achieved (p < 0.001) in R2 where better ultra-MTBers tended to lose more weight. Δ body mass (p < 0.001) and %Δ body mass (p = 0.05) were positively related to lower post-race plasma [Na+] in R3 that was associated with increased loss in body mass. Fluid intake was positively related to race performance in R1 and R2 (R1: p = 0.04; R2: p = 0.01) where ultra-MTBers in R1 and R2 who drank more finished ahead of those who drank less. Post-race plasma [Na+] was negatively associated with race performance in ultra-MTBers in R2 (p < 0.05), similarly ultra-runners in R3 (p < 0.05) where finishers with more kilometres had lower post-race plasma [Na+].

CONCLUSIONS

The prevalence of EAH in the Czech Republic was no higher compared to existing reports on ultra-endurance athletes in other countries. Lower plasma [Na+] and development of EAH may be attributed to overdrinking, a pituitary secretion of vasopressin, an impaired mobilization of osmotically inactive sodium stores, and/or an inappropriate inactivation of osmotically active sodium.

Plasma electrolyte and hematological changes after marathon running in adolescents

PURPOSE

The objective of this research is to study plasma electrolyte and hematological changes in adolescent runners completing a standard 42.2-km marathon run.

METHODS

Fifty adolescents (30 healthy males and 20 healthy females) between ages 13 and 17 yr participated in the study. The participants had to undergo a routine physical examination including ECG records. Blood was taken before the race, immediately after the race, and 24 h after the race to determine complete blood cell count and electrolyte concentration.

RESULTS

Forty-seven runners completed the race with a mean finishing time of 4 h 57 min (range: 3 h 17 min 09 s to 6 h 14 min). None of the participants experienced an adverse medical event during or after the race. Only slight changes in plasma electrolytes without any cases of hyper- or hyponatremia and a marked increase in white blood cell count were demonstrated immediately after the race. At this time, the hemoglobin concentration and hematocrit were decreased (P < 0.05), indicating an approximately 11% increase in plasma volume. Some of these changes were still present 24 h postrace. No differences were observed between sexes.

CONCLUSIONS

This is the first study evaluating plasma electrolyte and hematological changes in a relatively large sample of young runners completing a standard marathon. The presented findings indicate that well-trained and educated adolescent marathon runners are not at risk to develop clinically significant electrolyte or hematological changes.

Increased platelet oxidative metabolism, blood oxidative stress and neopterin levels after ultra-endurance exercise

The purpose of the present investigation was to identify muscle damage, inflammatory response and oxidative stress blood markers in athletes undertaking the ultra-endurance MultiSport Brazil race. Eleven well-trained male athletes (34.3 ± 3.1 years, 74.0 ± 7.6 kg; 172.2 ± 5.1 cm) participated in the study and performed the race, which consisted of about 90 km of alternating off-road running, mountain biking and kayaking. Twelve hours before and up to 15 minutes after the race a 10 mL blood sample was drawn in order to measure the following parameters: lactate dehydrogenase and creatine kinase activities, lipid peroxidation, catalase activity, protein carbonylation, respiratory chain complexes I, II and IV activities, oxygen consumption and neopterin concentrations. After the race, plasma lactate dehydrogenase and creatine kinase activities were significantly increased. Erythrocyte TBA-RS levels and plasma protein carbonylation were markedly augmented in post-race samples. Additionally, mitochondrial complex II activity and oxygen consumption in post-race platelet-rich plasma were also increased. These altered biochemical parameters were accompanied by increased plasma neopterin levels. The ultra-endurance event provoked systemic inflammation (increased neopterin) accompanied by marked oxidative stress, likely by increasing oxidative metabolism (increased oxidative mitochondrial function). This might be advantageous during prolonged exercise, mainly for efficient substrate oxidation at the mitochondrial level, even when tissue damage is induced.

Markers of hydration status in a 3-day trail running event

OBJECTIVE

To examine the relationships between changes in static prestage and poststage measures of commonly used hematological and urinary markers of hydration status and body mass (BM) in participants in a 3-day trail run.

DESIGN

Descriptive field study.

SETTING

Three Cranes Challenge trail run, South Africa.

PARTICIPANTS

Twenty (6 men and 14 women) amateur runners.

INTERVENTIONS

In stage 1 (S1), 29.3 km and 37.9 km in stage 2 (S2), and 27.8 km in stage 3 (S3).

MAIN OUTCOME MEASURES

Prestage and poststage individual changes in serum osmolality (S osm), serum sodium (s[Na]), plasma volume (PV), urine osmolality (U osm), urine specific gravity (U sg), and BM.

RESULTS

Consistently, mild environmental conditions were experienced on the 3 days of the race (ambient temperature range, 11.5-22.8°C). Mean S osm increased by 5 ± 6, 7 ± 9, and 3 ± 4 mOsm/kg during S1, S2, and S3, respectively, and returned to baseline pre-S2 and pre-S3. The correlation between individual prestage and poststage changes in S osm, Uosm, and U sg (n = 60) were nonsignificant (P > 0.05; r = 0.0047, r = 0.0074). There was a significant, but relatively low correlation between changes in S osm and percentage reduction in BM (r = 0.35; P < 0.01) and prechange and postchange in s[Na] (r = 0.45; P < 0.001).

CONCLUSIONS

Serum osmality values confirm appropriate interstage rehydration. Changes in U osm, U sg, BM, s[Na+], and PV are not closely related to changes in S osm as markers of hydration assessment in multiday events in which single static measures of hydration status are required. These measures of hydration station status are therefore not recommended in this field setting.

Body mass change and ultraendurance performance: a decrease in body mass is associated with an increased running speed in male 100-km ultramarathoners

We investigated, in 50 recreational male ultrarunners, the changes in body mass, selected hematological and urine parameters, and fluid intake during a 100-km ultramarathon. The athletes lost (mean and SD) 2.6 (1.8) % in body mass (p < 0.0001). Running speed was significantly and negatively related to the change in body mass (p < 0.05). Serum sodium concentration ([Na⁺]) and the concentration of aldosterone increased with increasing loss in body mass (p < 0.05). Urine-specific gravity increased (p < 0.0001). The change in body mass was significantly and negatively related to postrace serum [Na⁺] (p < 0.05). Fluid intake was significantly and positively related to both running speed (r = 0.33, p = 0.0182) and the change in body mass (r = 0.44, p = 0.0014) and significantly and negatively to both postrace serum [Na⁺] (r = -0.42, p = 0.0022) and the change in serum [Na⁺] (r = -0.38, p = 0.0072). This field study showed that recreational, male, 100-km ultramarathoners dehydrated as evidenced by the decrease in >2 % body mass and the increase in urine-specific gravity. Race performance, however, was not impaired because of the loss in body mass. In contrast, faster athletes lost more body mass compared with slower athletes while also drinking more. The concept that a loss of >2% in body mass leads to dehydration and consequently impairs endurance performance must be questioned for ultraendurance athletes competing in the field. For practical applications, a loss in body mass during a 100-km ultramarathon was associated with a faster running speed.

Effect of a multistage ultraendurance triathlon on aldosterone, vasopressin, extracellular water and urine electrolytes

Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.

Intravenous fluid use in athletes

CONTEXT

Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently.

EVIDENCE ACQUISITION

PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance.

RESULTS

Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid.

CONCLUSION

The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency-governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes.

A faster running speed is associated with a greater body weight loss in 100-km ultra-marathoners

In 219 recreational male runners, we investigated changes in body mass, total body water, haematocrit, plasma sodium concentration ([Na(+)]), and urine specific gravity as well as fluid intake during a 100-km ultra-marathon. The athletes lost 1.9 kg (s = 1.4) of body mass, equal to 2.5% (s = 1.8) of body mass (P < 0.001), 0.7 kg (s = 1.0) of predicted skeletal muscle mass (P < 0.001), 0.2 kg (s = 1.3) of predicted fat mass (P < 0.05), and 0.9 L (s = 1.6) of predicted total body water (P < 0.001). Haematocrit decreased (P < 0.001), urine specific gravity (P < 0.001), plasma volume (P < 0.05), and plasma [Na(+)] (P < 0.05) all increased. Change in body mass was related to running speed (r = -0.16, P < 0.05), change in plasma volume was associated with change in plasma [Na(+)] (r = -0.28, P < 0.0001), and change in body mass was related to both change in plasma [Na(+)] (r = -0.36) and change in plasma volume (r = 0.31) (P < 0.0001). The athletes consumed 0.65 L (s = 0.27) fluid per hour. Fluid intake was related to both running speed (r = 0.42, P < 0.0001) and change in body mass (r = 0.23, P = 0.0006), but not post-race plasma [Na(+)] or change in plasma [Na(+)] (P > 0.05). In conclusion, faster runners lost more body mass, runners lost more body mass when they drank less fluid, and faster runners drank more fluid than slower runners.

An increased fluid intake leads to feet swelling in 100-km ultra-marathoners - an observational field study

BACKGROUND

An association between fluid intake and changes in volumes of the upper and lower limb has been described in 100-km ultra-marathoners. The purpose of the present study was (i) to investigate the association between fluid intake and a potential development of peripheral oedemas leading to an increase of the feet volume in 100-km ultra-marathoners and (ii) to evaluate a possible association between the changes in plasma sodium concentration ([Na+]) and changes in feet volume.

METHODS

In seventy-six 100-km ultra-marathoners, body mass, plasma [Na+], haematocrit and urine specific gravity were determined pre- and post-race. Fluid intake and the changes of volume of the feet were measured where the changes of volume of the feet were estimated using plethysmography.

RESULTS

Body mass decreased by 1.8 kg (2.4%) (p < 0.0001); plasma [Na+] increased by 1.2% (p < 0.0001). Haematocrit decreased (p = 0.0005). The volume of the feet remained unchanged (p > 0.05). Plasma volume and urine specific gravity increased (p < 0.0001). Fluid intake was positively related to the change in the volume of the feet (r = 0.54, p < 0.0001) and negatively to post-race plasma [Na+] (r = -0.28, p = 0.0142). Running speed was negatively related to both fluid intake (r = -0.33, p = 0.0036) and the change in feet volume (r = -0.23, p = 0.0236). The change in the volume of the feet was negatively related to the change in plasma [Na+] (r = -0.26, p = 0.0227). The change in body mass was negatively related to both post-race plasma [Na+] (r = -0.28, p = 0.0129) and running speed (r = -0.34, p = 0.0028).

CONCLUSIONS

An increase in feet volume after a 100-km ultra-marathon was due to an increased fluid intake.

Hyponatremia in the 2009 161-km Western States Endurance Run

PURPOSE

To determine the incidence of exercise-associated hyponatremia (EAH), the associated biochemical measurements and risk factors for EAH, and whether there is an association between postrace blood sodium concentration ([Na+]) and changes in body mass among participants in the 2009 Western States Endurance Run, a 161-km mountain trail run.

METHODS

Change in body mass, postrace [Na+], and blood creatine phosphokinase (CPK) concentration, and selected runner characteristics were evaluated among consenting competitors.

RESULTS

Of the 47 study participants, 14 (30%) had EAH as defined by a postrace [Na+] <135 mmol/L. Postrace [Na+] and percent change in body mass were directly related (r = .30, P = .044), and 50% of those with EAH had body mass losses of 3-6%. EAH was unrelated to age, sex, finish time, or use of nonsteroidal anti-inflammatory drugs during the run, but those with EAH had completed a smaller (P = .03) number of 161-km ultramarathons. The relationship of CPK levels to postrace [Na+] did not reach statistical significance (r = -.25, P = .097).

CONCLUSIONS

EAH was common (30%) among finishers of this 161-km ultramarathon and it was not unusual for those with EAH to be dehydrated. As such, changes in body mass should not be relied upon in the assessment for EAH during 161-km ultramarathons.

Do male 100-km ultra-marathoners overdrink?

PURPOSE

Fluid overload is considered a main risk factor for exercise-associated hyponatremia (EAH). The aim of this study was to investigate the incidence of EAH in ultra-runners at the 100 km ultra-run in Biel, Switzerland.

METHODS

Pre- and postrace, body mass, urinary specific gravity, hemoglobin, hematocrit, plasma [Na+], and plasma volume were determined.

RESULTS

Of the 145 finishers, seven runners (4.8%) developed asymptomatic EAH. While running, the athletes consumed a total of (median and interquartile ranges) 6.9 (5.1-8.8) L over the 100 km distance, equal to 0.58 (0.41-0.79) L/h. Fluid intake correlated negatively and significantly with race time (r = -.50, P < .0001). Body mass decreased, plasma [Na+] remained unchanged, hematocrit and hemoglobin decreased, and urinary specific gravity increased. Plasma volume increased by 4.6 (-2.3 to 12.8) %. Change in body mass correlated with both postrace plasma [Na+] and Δ plasma [Na+]. Postrace plasma [Na+] correlated to Δ plasma [Na+]. Fluid intake was associated neither with postrace plasma [Na+] nor with Δ plasma [Na+]. Fluid intake was related to Δ body mass (r = .21, P = .012), but not to postrace body mass. Fluid intake showed no correlation to Δ plasma volume. Change in plasma volume was associated with postrace [Na+].

CONCLUSIONS

Incidences of EAH in 100 km ultra-marathoners were lower compared with reports on marathoners. Body mass decreased, plasma volume increased, and plasma [Na+] was maintained. Since fluid intake was related neither to Δ plasma volume nor to Δ plasma [Na+], we assume that factors other than fluid intake maintained body fluid homeostasis.

Metabolic profile of the Ironman World Championships: a case study

PURPOSE

The purpose of this study was to determine the metabolic profile during the 2006 Ironman World Championship in Kailua-Kona, Hawaii.

METHODS

One recreational male triathlete completed the race in 10:40:16. Before the race, linear regression models were established from both laboratory and field measures to estimate energy expenditure and substrate utilization. The subject was provided with an oral dose of ²H2(18)O approximately 64 h before the race to calculate total energy expenditure (TEE) and water turnover with the doubly labeled water (DLW) technique. Body weight, blood sodium and hematocrit, and muscle glycogen (via muscle biopsy) were analyzed pre-and postrace.

RESULTS

The TEE from DLW and indirect calorimetry was similar: 37.3 MJ (8,926 kcal) and 37.8 MJ (9,029 kcal), respectively. Total body water turnover was 16.6 L, and body weight decreased 5.9 kg. Hematocrit increased from 46 to 51% PCV. Muscle glycogen decreased from 152 to 48 mmoL/kg wet weight pre- to postrace.

CONCLUSION

These data demonstrate the unique physiological demands of the Ironman World Championship and should be considered by athletes and coaches to prepare sufficient nutritional and hydration plans.

Changes in copeptin and bioactive vasopressin in runners with and without hyponatremia

OBJECTIVE

To evaluate changes in both the N-terminal (arginine vasopressin; AVP) and C-terminal (copeptin) fragments of the vasopressin prohormone before, during, and after an ultramarathon race and to assess vasopressin and copeptin concentrations in runners with and without hyponatremia.

DESIGN

Observational study.

SETTING

Three trials (2 sodium balance and 1 hyponatremia treatment) in 2 separate approximately 160-km footraces [Western States Endurance Run (WSER) and Javelina Jundred (JJ100)].

PARTICIPANTS

Six hyponatremic and 20 normonatremic runners; 19 finishers with 7 completing 100 km.

MAIN OUTCOME MEASURES

Plasma AVP ([AVP]p), copeptin ([copeptin]p), sodium ([Na]p), and protein (%plasma volume change; %PV) concentrations.

RESULTS

In the WSER Sodium Trial, a 3-fold prerace to postrace increase in both [AVP]p (0.7 ± 0.4 to 2.7 ± 1.9 pg/mL; P < 0.05) and [copeptin]p (10.3 ± 12.5 to 28.2 ± 16.3 pmol/L; nonsignificant) occurred, despite a 2 mEq/L decrease in [Na]p (138.7 ± 2.3 to 136.7 ± 1.6 mEq/L; NS). A significant correlation was noted between [AVP]p and [copeptin]p postrace (r = 0.82; P < 0.05). In the WSER Treatment Trial, despite the presence of hyponatremia pretreatment versus posttreatment ([Na]p = 130.3 vs 133.5 mEq/L, respectively), both [AVP]p (3.2 vs 2.1 pg/mL) and [copeptin]p (22.5 vs 24.9 pmol/L) were well above the detectable levels. A significant correlation was noted between [AVP]p and [copeptin]p 60 minutes after treatment (r = 0.94; P < 0.05). In the JJ100 Sodium Trial, significant correlations were found between [copeptin]p change and %PV change (r = -0.34; P < 0.05) and between [AVP]p change and [Na]p change (r = 0.39; P < 0.05) but not vice-versa.

CONCLUSIONS

[Copeptin]p seems to be a reliable surrogate of stimulated [AVP]p during exercise. Nonosmotic vasopressin stimulation occurs during ultradistance running. [Copeptin]p may better reflect chronic (%PV) vasopressin secretion under conditions of endurance exercise.

No exercise-associated hyponatremia found in an observational field study of male ultra-marathoners participating in a 24-hour ultra-run

In a recent study of male ultra-marathoners who participated in a 161-km ultra-run, the prevalence of exercise-associated hyponatremia (EAH) was reported to be 50%, which is a considerably higher percentage than that seen in marathoners. We investigated the prevalence of EAH in male ultra-marathoners competing in a 24-hour run held in Basel, Switzerland. Body weight, hematocrit levels, plasma volume, plasma sodium concentration, urine specific gravity, and fluid intake were recorded in 15 male ultra-marathoners (mean age ± standard deviation [SD], 46.7 [5.8] years; plasma sodium, 71.1 [6.8] kg; height, 1.76 [0.07] m; body weight, 23.1 [1.84] kg/m(2)). Plasma sodium was measured at 135.3 (2.8) mmol/L before the race and remained unchanged at 135.4 (3.6) mmol/L after the race. The competitors consumed a total of 15.1 (5.1) L during the race, equal to 0.62 (0.21) L/hour. Fluid intake correlated to the mean running speed (r = -0.87; P = 0.0001). Body weight decreased significantly (P = 0.0009) by 2.2 kg. Hematocrit remained unchanged, and urine specific gravity increased significantly (P = 0.0005). Plasma volume increased by 4.9% (15.8%). Changes in body weight showed no association with post-race plasma sodium. The normal resting value should be 140 mmol/L so that a decrease of 5 mmol/L is described as EAH. Because the starting plasma sodium in this study was 135 mmol/L, it is not possible to define EAH as a value that is < 135 mmol/L. Instead, the correct definition should be a plasma sodium concentration of 130 mmol/L (ie, 5 mmol/L below the normal resting value). Following this definition, it was determined that no athlete developed EAH in this 24-hour run.

Low prevalence of exercise-associated hyponatremia in male 100 km ultra-marathon runners in Switzerland

We investigated the prevalence of exercise-associated hyponatremia (EAH) in 145 male ultra-marathoners at the '100-km ultra-run' in Biel, Switzerland. Changes in body mass, urinary specific gravity, haemoglobin, haematocrit, plasma [Na(+)], and plasma volume were determined. Seven runners (4.8%) developed asymptomatic EAH. Body mass, haematocrit and haemoglobin decreased, plasma [Na(+)] remained unchanged and plasma volume increased. Δ body mass correlated with both post race plasma [Na(+)] and Δ plasma [Na(+)]. Δ plasma volume was associated with post race plasma [Na(+)]. The athletes consumed 0.65 (0.30) L/h; fluid intake correlated significantly and negatively (r = -0.50, p < 0.0001) to race time. Fluid intake was neither associated with post race plasma [Na(+)] nor with Δ plasma [Na(+)], but was related to Δ body mass. To conclude, the prevalence of EAH was low at ~5% in these male 100 km ultra-marathoners. EAH was asymptomatic and would not have been detected without the measurement of plasma [Na(+)].

Arginine vasopressin, fluid balance and exercise: is exercise-associated hyponatraemia a disorder of arginine vasopressin secretion?

The ability of the human body to regulate plasma osmolality (POsm) within a very narrow and well defined physiological range underscores the vital importance of preserving water and sodium balance at rest and during exercise. The principle endocrine regulator of whole body fluid homeostasis is the posterior pituitary hormone, arginine vasopressin (AVP). Inappropriate AVP secretion may perpetuate either slow or rapid violation of these biological boundaries, thereby promoting pathophysiology, morbidity and occasional mortality. In the resting state, AVP secretion is primarily regulated by changes in POsm (osmotic regulation). The osmotic regulation of AVP secretion during exercise, however, may possibly be enhanced or overridden by many potential non-osmotic factors concurrently stimulated during physical activity, particularly during competition. The prevalence of these highly volatile non-osmotic AVP stimuli during strenuous or prolonged physical activity may reflect a teleological mechanism to promote water conservation during exercise. However, non-osmotic AVP secretion, combined with high fluid availability plus sustained fluid intake (exceeding fluid output), has been hypothesized to lead to an increase in both the incidence and related deaths from exercise-associated hyponatraemia (EAH) in lay and military populations. Inappropriately, high plasma AVP concentrations ([AVP](p)) associated with low blood sodium concentrations facilitate fluid retention and sodium loss, thereby possibly reconciling both the water intoxication and sodium loss theories of hyponatraemia that are currently under debate. Therefore, given the potential for a variety of exercise-induced non-osmotic stimuli for AVP secretion, hydration strategies must be flexible, individualized and open to change during competitive events to prevent the occurrence of rare, but life-threatening, EAH. This review focuses on the potential osmotic and non-osmotic stimuli to AVP secretion that may affect fluid homeostasis during physical activity. Recent laboratory and field data support: (i) stimulatory effects of exercise intensity and duration on [AVP](p); (ii) possible relationships between changes in POsm with changes in both sweat and urinary osmolality; (iii) alterations in the AVP osmoregulatory set-point by sex steroid hormones; (iv) differences in [AVP](p) in trained versus untrained athletes; and (v) potential inter-relationships between AVP and classical (aldosterone, atrial natriuretic peptide) and non-classical (oxytocin, interleukin-6) endocrine mediators. The review concludes with a hypothesis on how sustained fluid intakes beyond the capacity for fluid loss might possibly facilitate the development of hyponatraemia if exercise-induced non-osmotic stimuli override 'normal' osmotic suppression of AVP when hypo-osmolality exists.

ATriple Iron triathlon leads to a decrease in total body mass but not to dehydration

A loss in total body mass during an ultraendurance performance is usually attributed to dehydration. We identified the changes in total body mass, fat mass, skeletal muscle mass, and selected markers of hydration status in 31 male nonprofessional ultratriathletes participating in a Triple Iron triathlon involving 11.4 km swimming, 540 km cycling and 126.6 km running. Measurements were taken prior to starting the race and after arrival at the finish line. Total body mass decreased by 1.66 kg (SD = 1.92; -5.3 kg to +1.2 kg; p < .001), skeletal muscle mass by 1.00 kg (SD = 0.90; -2.54 kg to +2.07 kg; p < .001), and fat mass by 0.58 kg (SD = 0.78; -1.74 kg to +0.87 kg; p < .001). The decrease in total body mass was associated with the decrease in skeletal muscle mass (r = .44; p < .05) and fat mass (r = .51; p < .05). Total body water and urinary specific gravity did not significantly change. Plasma urea increased significantly (p < .001); the decrease in skeletal muscle mass and the increase in plasma urea were associated (r = .39; p < .05). We conclude that completing a Triple Iron triathlon leads to decreased total body mass due to reduced fat mass and skeletal muscle mass but not to dehydration. The association of decrease in skeletal muscle mass and increased plasma urea suggests a loss in skeletal muscle mass.

Oxidative stress and inflammatory parameters after an Ironman race

OBJECTIVE

The aim of the present study was to investigate oxidative stress markers and inflammatory response in triathletes after an Ironman race (IR).

DESIGN

Descriptive research.

PARTICIPANTS

Eighteen well-trained male triathletes (mean age, 34.7 +/- 2.15 years; weight, 69.3 +/- 1.9 kg; height, 1.81 +/- 0.58 cm) participated in the study.

SETTING

Ironman Triathlon (3.8-km swim, 180-km cycle, 42.2-km run). Mean environmental conditions ranged from 20 to 25 degrees C and from 79% to 85% relative humidity.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Before the race and up to 20 minutes after completing the full race, the weights and heights of volunteers were measured and a 10 mL blood sample was drawn from an antecubital vein. Aliquots of washed/lysed red blood cells and plasma/serum samples were stored at -80 degrees C. Lipid peroxidation, protein carbonylation, superoxide dismutase and catalase activities, and cytokines levels [tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, IL-10, and IL-1ra] were determined.

RESULTS

After the IR, the results showed a significant increase in TBARS levels (prerace = 1.15 +/- 0.11; postrace = 1.98 +/- 0.27), lipid hydroperoxide content (prerace = 0.75 +/- 0.03; postrace = 1.46 +/- 0.18), protein carbonylation (prerace = 0.67 +/- 0.12; postrace = 2 0.15 +/- 0.60), superoxide dismutase (prerace = 2.67 +/- 0.62; postrace = 3.97 +/- 1.48), and catalase (prerace = 1.48 +/- 0.18; postrace = 2.84 +/- 0.39). TNF-alpha, IL-6, and IL-10 were not detected at basal conditions, but all markers were significantly increased after the IR (TNF-alpha: prerace = ND and postrace = 67.47 +/- 10.34; IL-6: prerace = ND and postrace = 55.41 +/- 3.45; IL-10: prerace = ND and postrace = 122.53 +/- 9.69; IL-1ra: prerace = 127.79 +/- 25.65 and postrace = 259.51 +/- 32.9).

CONCLUSIONS

An Ironman race provokes significant alterations in oxidative stress and inflammatory parameters. Thus, more studies with other markers and different designs are needed to elucidate the cellular alterations induced by an IR.

Can changes in body mass and total body water accurately predict hyponatremia after a 161-km running race?

OBJECTIVE

To relate changes in body mass, total body water (TBW), extracellular fluid (ECF), and serum sodium concentration ([Na]) from a 161-km ultramarathon to finish time and incidence of hyponatremia.

DESIGN

Observational.

SETTING

: The 2008 Rio Del Lago 100-Mile (161-km) Endurance Run in Granite Bay, California.

PARTICIPANTS

Forty-five runners.

MAIN OUTCOME MEASUREMENTS

Pre-race and post-race body mass, TBW, ECF, and serum [Na].

RESULTS

Body mass and serum [Na] significantly decreased 2% to 3% (P < 0.001) from pre-race to post-race, but TBW and ECF were unchanged. Significant relationships were observed between finish time and percentage change in body mass (r = 0.36; P = 0.01), TBW (r = 0.50; P = 0.007), and ECF (r = 0.61; P = 0.003). No associations were found between post-race serum [Na] and percentage change in body mass (r = -0.04; P = 0.94) or finish time (r = 0.5; P = 0.77). Hyponatremia (serum [Na] < 135 mmol/L) was present among 51.2% of finishers. Logistic regression prediction equation including pre-race TBW and percentage changes in TBW and ECF had an 87.5% concordance with the classification of hyponatremia.

CONCLUSIONS

Hyponatremia occurred in over half of the 161-km ultramarathon finishers but was not predicted by change in body mass. The combination of pre-race TBW and percentage changes in TBW and ECF explained 87.5% of the variation in the incidence of hyponatremia.

CLINICAL SIGNIFICANCE

Exercise-associated hyponatremia can occur simultaneously with dehydration and cannot be predicted by weight checks at races.

Bike Transalp 2008: liquid intake and its effect on the body's fluid homeostasis in the course of a multistage, cross-country, MTB marathon race in the central Alps

OBJECTIVES

To investigate the drinking behavior of the participants in a multi-day mountain bike (MTB) cross-country competition, to monitor its effect on the body's fluid compartments and body mass, and to evaluate the prevalence of exercise-associated dysnatremia.

DESIGN

Descriptive field study.

SETTING

The Jeantex Bike Transalp Competition 2008 (8 stages; 665.40 km; 21 691 m height).

PARTICIPANTS

Twenty-five male, amateur MTB cyclists.

INDEPENDENT VARIABLES

Reported fluid intake during the race, air temperature.

MAIN OUTCOME MEASURES

Changes in body mass and body composition from pre to post race and throughout the competition week, serum sodium concentration at finish line of stages 5 and 6.

RESULTS

Mean (+ or - SD) hourly fluid intake during the race correlated with air temperature (r = 0.868, P < .05) and ranged between 494 + or - 191 mL/h and 754 + or - 254 mL/h. In absence of exercise-induced hyponatremia (EAH) cases, we report 5 and 4 cases of asymptomatic post-race hypernatremia, on days 5 and 6, respectively. When related to race time and body mass, the liquid intake during the race (in mL x kg(-1) x h(-1)) correlated with post-race serum sodium concentration (stage 5: r = -0.463, P < .05, n = 24; stage 6: r = -0.589, P < .01, n = 23); no correlation was found between the change in body mass from pre to post race and serum sodium concentration at finish line.

CONCLUSIONS

Ad libitum fluid consumption during competition was spontaneously adjusted to the unsettled weather conditions in the course of the 2008 "Bike Transalp." The inverse linear relationship between hourly fluid intake and post-race serum sodium concentrations suggests underdrinking to be one contributing factor to the high reported incidence of hypernatremia in the absence of EAH. Experimental studies are requested to confirm this hypothesis and to further examine the pathogenesis of exercise-associated dysnatremia. In this setting, body mass monitoring was not an accurate instrument to control body fluid homeostasis.

Exercise-associated hyponatremia: overzealous fluid consumption

Exercise-associated hyponatremia is hyponatremia occurring during or up to 24 hours after prolonged exertion. In its more severe form, it manifests as cerebral and pulmonary edema. There have now been multiple reports of its occurring in a wilderness setting. It can now be considered the most important medical problem of endurance exercise. The Second International Exercise-Associated Hyponatremia Consensus Conference gives an up-to-date account of the nature and management of this disease. This article reviews key information from this conference and its statement. There is clear evidence that the primary cause of exercise-associated hyponatremia is fluid consumption in excess of that required to replace insensible losses. This is usually further complicated by the presence of inappropriate arginine vasopressin secretion, which decreases the ability to renally excrete the excess fluid consumed. Women, those of low body weight, and those taking nonsteroidal anti-inflammatory drugs are particularly at risk. When able to be biochemically diagnosed, severe exercise-associated hyponatremia is treated with hypertonic saline. In a wilderness setting, the key preventative intervention is moderate fluid consumption based on perceived need ("ad libitum") and not on a rigid rule. (Editor's Note: This paper was written at my request in an effort to increase awareness of this important clinical entity among members of the wilderness community, many of whom are involved in activities that place them at risk of its development. I thank the authors for their diligent efforts.)

No dehydration in mountain bike ultra-marathoners

OBJECTIVE

To assess the change in body composition and hydration status in cyclists in a mountain bike ultra-marathon.

DESIGN

Prospective observational field study.

SETTING

"Swiss Bike Masters" 2008 over 120 km with a total climb of 5000 m in altitude.

PARTICIPANTS

Thirty-seven male mountain bikers.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Prerace and postrace, body mass, percent body fat, skeletal muscle mass, and selected hematologic and urinary parameters were measured to quantify changes in body mass and hydration status. Athletes reported their fluid intake during the race.

RESULTS

The athletes lost 1.4 kg in body mass (P < 0.001), equal to 1.9% body mass. Fat mass remained stable and skeletal muscle mass decreased by 0.4 kg (P < 0.05). Prerace fat mass was correlated to total race time (r = 0.37, P < 0.05). The cyclists drank 6.5 (1.8) L of fluids during the race corresponding to 0.7 (0.2) L per hour. A significant inverse relationship was seen between change in body mass and race time when controlled for change in skeletal mass and fluid intake during the race (P > 0.05). Plasma sodium decreased by 0.7% (P < 0.05), plasma volume increased by 1.4%, and plasma urea increased by 40% (P < 0.05). Urinary-specific gravity increased by 0.4% (P < 0.05). The decrease in skeletal muscle mass was associated with the increase in plasma urea (r = -0.34; P < 0.05). Fluid intake was associated with the change in urinary-specific gravity (r = -0.45; P < 0.01).

CONCLUSIONS

We conclude that these mountain bike ultra-marathoners suffered a significant decrease in body mass and skeletal muscle mass but no dehydration.