Cross-validation of equations to predict whole-body sweat sodium concentration from regional measures during exercise

Recent Advances in Skin-Interfaced Wearable Sweat Sensors: Opportunities for Equitable Personalized Medicine and Global Health Diagnostics

Recent advances in skin-interfaced wearable sweat sensors enable the noninvasive, real-time monitoring of biochemical signals associated with health and wellness. These wearable platforms leverage microfluidic channels, biochemical sensors, and flexible electronics to enable the continuous analysis of sweat-based biomarkers such as electrolytes, metabolites, and hormones. As this field continues to mature, the potential of low-cost, continuous personalized health monitoring enabled by such wearable sensors holds significant promise for addressing some of the formidable obstacles to delivering comprehensive medical care in under-resourced settings. This Perspective highlights the transformative potential of wearable sweat sensing for providing equitable access to cutting-edge healthcare diagnostics, especially in remote or geographically isolated areas. It examines the current understanding of sweat composition as well as recent innovations in microfluidic device architectures and sensing strategies by showcasing emerging applications and opportunities for innovation. It concludes with a discussion on expanding the utility of wearable sweat sensors for clinically relevant health applications and opportunities for enabling equitable access to innovation to address existing health disparities.

Exercise-related hemoconcentration and hemodilution in hydrated and dehydrated athletes: An observational study of the Hungarian canoeists

Hemoconcentration during exercise is a well-known phenomenon, however, the extent to which dehydration is involved is unclear. In our study, the effect of dehydration on exercise-induced hemoconcentration was examined in 12 elite Hungarian kayak-canoe athletes. The changes of blood markers were examined during acute maximal workload in hydrated and dehydrated states. Dehydration was achieved by exercise, during a 120-minute extensive-aerobic preload. Our research is one of the first studies in which the changes in blood components were examined with a higher time resolution and a wider range of the measured parameters. Hydration status had no effect on the dynamics of hemoconcentration during both the hydrated (HS) and dehydrated (DHS) load, although lower maximal power output were measured after the 120-minute preload [HS Hemoglobin(Hgb)Max median 17.4 (q1 17.03; q3 17.9) g/dl vs. DHS HgbMax median 16.9 (q1 16.43; q3 17.6) g/dl (n.s); HS Hematocrit(Hct)Max 53.50 (q1 52.28; q3 54.8) % vs. DHS HctMax 51.90 (q1 50.35; q3 53.93) % (n.s)]. Thirty minutes after the maximal loading, complete hemodilution was confirmed in both exercises. Dehydration had no effect on hemoconcentration or hemodilution in the recovery period [HS HgbR30' 15.7 (q1 15.15; q3 16.05) g/dl (n.s.) vs. DHS HgbR30' 15.75 (q1 15.48; q3 16.13) g/dl (n.s.), HS HctR30' 48.15 (q1 46.5; q3 49.2) % vs. DHS HctR30' 48.25 (q1 47.48; q3 49.45) % (n.s.)], however, plasma osmolality did not follow a corresponding decrease in hemoglobin and hematocrit in the dehydrated group. Based on our data, metabolic products (glucose, lactate, sodium, potassium, chloride, bicarbonate ion, blood urea nitrogen) induced osmolality may not play a major role in the regulation of hemoconcentration and post-exercise hemodilution. From our results, we can conclude that hemoconcentration depends mainly on the intensity of the exercise.

Explaining variation in sweat sodium concentration: effect of individual characteristics and exercise, environmental, and dietary factors

This study determined the relative importance of several individual characteristics and dietary, environmental, and exercise factors in determining sweat [Na⁺] during exercise. Data from 1944 sweat tests were compiled for a retrospective analysis. Stepwise multiple regression (P < 0.05 threshold for inclusion) and T values were used to express the relative importance of each factor in a model. Three separate models were developed based on available independent variables: model 1 (1,944 sweat tests from 1,304 subjects); model 2 (subset with energy expenditure: 1,003 sweat tests from 607 subjects); model 3 (subset with energy expenditure, dietary sodium, and V̇o_2max: n = 48). Whole body sweat [Na⁺] was predicted from forearm sweat patches in models 1 and 2 and directly measured using whole body washdown in model 3. There were no significant effects of age group, race/ethnicity, relative humidity, exercise duration, pre-exercise urine specific gravity, exercise fluid balance, or dietary or exercise sodium intake on any model. Significant predictors in model 1 (adjusted r² = 0.17, P < 0.001) were season of the year (warm, T = -6.8), exercise mode (cycling, T = 6.8), sex (male, T = 4.9), whole body sweating rate (T = 4.5), and body mass (T = -3.0). Significant predictors in model 2 (adjusted r² = 0.19, P < 0.001) were season of the year (warm, T = -5.2), energy expenditure (T = 4.7), exercise mode (cycling, T = 3.6), air temperature (T = 3.0), and sex (male, T = 2.7). The only significant predictor in model 3 (r² = 0.23, P < 0.001) was energy expenditure (T = 3.8). In summary, the models accounted for 17%-23% of the variation in whole body sweat [Na⁺] and energy expenditure and season of the year (proxy for heat acclimatization) were the most important factors.NEW & NOTEWORTHY This comprehensive analysis of a large, diverse data set contributes to our overall understanding of the factors that influence whole body sweat [Na⁺]. The main finding was that energy expenditure was directly associated with whole body sweat [Na⁺], potentially via the relation between energy expenditure and whole body sweating rate (WBSR). Warmer months (proxy for heat acclimatization) were associated with lower whole body sweat [Na⁺]. Exercise mode, air temperature, and sex may also have small effects, but other variables (age group, race/ethnicity, fluid balance, sodium intake, relative V̇o_2max) had no association with whole body sweat [Na⁺]. Taken together, the models explained 17%-23% of the variation in whole body sweat [Na⁺].

The effect of sweat sample storage condition on sweat content

Due to time and logistical constraints sweat samples cannot always be analyzed immediately. The purpose of this study was to investigate the effect of storage temperature and duration on sweat electrolyte and metabolite concentrations. Twelve participants cycled for 60 min at 40 W.m⁻² in 33°C and 65% RH. Using the absorbent patch technique, six sweat samples were collected from the posterior torso. Sweat from the six samples was mixed, divided again over six samples and placed in sealed vials. Sweat sodium, chloride, potassium, ammonia, lactate and urea concentrations in one sample were determined immediately. Two samples were stored at room temperature (~25°C, 42% RH) for 7 and 28 days respectively. The remaining samples were frozen at −20°C for 1 h, 7 or 28 days respectively before analysis. Sweat sodium, chloride, potassium and urea concentrations were not affected by storage temperature and duration. Sweat lactate decreased (−1.8 ± 1.8 mmol.L⁻¹, P = 0.007) and ammonia concentrations increased (5.1 ± 3.9 mmol.L⁻¹, P = 0.017) after storage for 28 days at 25°C only. The storage temperature and duration did not affect sodium, chloride, potassium and urea concentrations. However, sweat samples should not be stored for longer than 7 days at 25°C to obtain reliable sweat lactate and ammonia concentrations. When samples are frozen at −20°C, the storage duration could be extended to 28 days for these components.

State of Sweat: Emerging Wearable Systems for Real-Time, Noninvasive Sweat Sensing and Analytics

Skin-interfaced wearable systems with integrated colorimetric assays, microfluidic channels, and electrochemical sensors offer powerful capabilities for noninvasive, real-time sweat analysis. This Perspective details recent progress in the development and translation of novel wearable sensors for personalized assessment of sweat dynamics and biomarkers, with precise sampling and real-time analysis. Sensor accuracy, system ruggedness, and large-scale deployment in remote environments represent key opportunity areas, enabling broad deployment in the context of field studies, clinical trials, and recent commercialization. On-body measurements in these contexts show good agreement compared to conventional laboratory-based sweat analysis approaches. These device demonstrations highlight the utility of biochemical sensing platforms for personalized assessment of performance, wellness, and health across a broad range of applications.

Eccrine sweat glands' maximum ion reabsorption rates during passive heating in older adults (50-84 years)

PURPOSE

We examined whether eccrine sweat glands ion reabsorption rate declined with age in 35 adults aged 50-84 years. Aerobic fitness (VO_2max) and salivary aldosterone were measured to see if they modulated ion reabsorption rates.

METHODS

During a passive heating protocol (lower leg 42 °C water submersion) the maximum ion reabsorption rates from the chest, forearm and thigh were measured, alongside other thermophysiological responses. The maximum ion reabsorption rate was defined as the inflection point in the slope of the relation between galvanic skin conductance and sweat rate.

RESULTS

The maximum ion reabsorption rate at the forearm, chest and thigh (0.29 ± 0.16, 0.33 ± 0.15, 0.18 ± 0.16 mg/cm²/min, respectively) were weakly correlated with age (r ≤  - 0.232, P ≥ 0.05) and salivary aldosterone concentrations (r ≤  - 0.180, P ≥ 0.179). A moderate positive correlation was observed between maximum ion reabsorption rate at the thigh and VO_2max (r = 0.384, P = 0.015). Salivary aldosterone concentration moderately declined with age (r =  - 0.342, P = 0.021). Whole body sweat rate and pilocarpine-induced sudomotor responses to iontophoresis increased with VO_2max (r ≥ 0.323, P ≤ 0.027) but only moderate (r =  - 0.326, P = 0.032) or no relations (r ≤  - 0.113, P ≥ 0.256) were observed with age.

CONCLUSION

The eccrine sweat glands' maximum ion reabsorption rate is not affected by age, spanning 50-84 years. Aldosterone concentration in an aged cohort does not appear to modulate the ion reabsorption rate. We provide further support for maintaining cardiorespiratory fitness to attenuate any decline in sudomotor function.

Skin-interfaced microfluidic system with personalized sweating rate and sweat chloride analytics for sports science applications

Advanced capabilities in noninvasive, in situ monitoring of sweating rate and sweat electrolyte losses could enable real-time personalized fluid-electrolyte intake recommendations. Established sweat analysis techniques using absorbent patches require post-collection harvesting and benchtop analysis of sweat and are thus impractical for ambulatory use. Here, we introduce a skin-interfaced wearable microfluidic device and smartphone image processing platform that enable analysis of regional sweating rate and sweat chloride concentration ([Cl^-]). Systematic studies (n = 312 athletes) establish significant correlations for regional sweating rate and sweat [Cl^-] in a controlled environment and during competitive sports under varying environmental conditions. The regional sweating rate and sweat [Cl^-] results serve as inputs to algorithms implemented on a smartphone software application that predicts whole-body sweating rate and sweat [Cl^-]. This low-cost wearable sensing approach could improve the accessibility of physiological insights available to sports scientists, practitioners, and athletes to inform hydration strategies in real-world ambulatory settings.

Salt and water balance after sweat loss: A study of Bikram yoga

Bikram yoga is practiced in a room heated to 105°F with 40% humidity for 90 min. During the class a large volume of water and electrolytes are lost in the sweat, specifically, sodium is lost, the main cation of the extracellular fluid. There is little known about the volume of sweat and the amount of sodium lost in sweat during Bikram yoga or the optimum quantity of fluid required to replace these losses. The participants who took part in this small feasibility study were five females with a mean age of 47.4 ± 4.7 years and 2.6 ± 1.6 years of experience at Bikram yoga. The total body weight, water consumed, serum sodium concentration, serum osmolality, and serum aldosterone levels were all measured before and after a Bikram yoga practice. Sweat sodium chloride concentration and osmolality were measured at the end of the practice. The mean estimated sweat loss was 1.54 ± 0.65 L, while the amount of water consumed during Bikram yoga was 0.38 ± 0.22 L. Even though only 25% of the sweat loss was replenished with water intake during the Bikram yoga class, we did not observe a change in serum sodium levels or serum osmolality. The sweat contained 82 ± 16 mmol/L of sodium chloride for an estimated total of 6.8 ± 2.1 g of sodium chloride lost in the sweat. The serum aldosterone increased 3.5-fold from before to after Bikram yoga. There was a decrease in the extracellular body fluid compartment of 9.7%. Sweat loss in Bikram yoga predominately produced a volume depletion rather than the dehydration of body fluids. The sweating-stimulated rise in serum aldosterone levels will lead to increased sodium reabsorption from the kidney tubules and restore the extracellular fluid volume over the next 24 hr.