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Fluid and Electrolyte Supplementation for Exercise-Heat
Stress
Michael N. Sawka, Ph.D., Scott . Montain, and William A. Latzka
Introduction
Depending on the climatic conditions, the relative contributions of
evaporative and dry (radiative and conductive) heat exchange to the total
heat loss will vary. The hotter the climate, the greater the dependence
on evaporative heat loss and, thus, on sweating. Therefore, a substantial
volume of body water may be lost via sweating to enable evaporative cooling
in hot climates. Generally, the individual dehydrates during exercise because
of fluid non availability or a mismatch between thirst and body water requirements.
In these instances, the individual starts the exercise task as euhydrated
but incurs an exercise-heat mediated dehydration over a prolonged period
of time.
Fluid and Electrolyte Needs
A person's sweating rate is dependent on the climatic conditions, clothing
worn, and exercise intensity. Persons in desert climates often have sweating
rates of 0.3-1.2 L . h-1 while performing occupational activities. Persons
wearing protective clothing often have sweating rates of 1.2 L . h-1 while
performing light-intensity exercise. Likewise, athletes performing high-intensity
exercise commonly have sweating rates of 1.0-2.5 L . h-1 while in the heat.
Fluid requirements will vary in relation to climatic heat stress, clothing
worn, acclimation state, and physical activity levels. Daily fluid requirements
might range (for sedentary to very active persons) from 2-4 L . day-1 in
temperate climates and from 4-10 L . day-1 in hot climates. Electrolytes,
primarily sodium chloride and to a lesser extent potassium, are lost in
sweat. Sweat sodium concentration averages approximately 40 mEq . L-1 (range
= lO-100 mEq L-1) and varies depending on diet, sweating rate, hydration,
and heat acclimation level. Heat-acclimated persons have relatively low
sodium concentrations (greater than 50 percent reduction) in sweat.
During exercise-heat stress, a principal problem is to avoid dehydration
by matching fluid consumption to sweat loss. This is a difficult problem
because thirst does not provide a good index of body water requirements.
Thirst is probably not perceived until an individual has incurred a water
deficit of approximately 2 percent of body weight. Numerous investigators
report that ad libitum water intake results in incomplete water replacement
or voluntary dehydration during exercise and/or heat exposure. The flavoring
and cooling of ingested fluid increase its palatability and can help
to minimize voluntary dehydration. Heat acclimation status may also influence
the voluntary dehydration incurred during exercise in the heat. Although
heat acclimation improves the relationship between thirst and body water
needs, voluntary dehydration still occurs. Since thirst provides a poor
index of body water needs, persons will dehydrate by 2-8 percent of their
body weight during situations of prolonged sweat loss.
Hypohydration and Temperature Regulation
Hypohydration (less than normal total body water) increases core temperature
responses during exercise in temperate and hot climates. A critical deficit
of 1 percent of body weight elevates core temperature during exercise.
As the magnitude of water deficit increases, there is a concomitant graded
elevation of core temperature during exercise heat stress. The magnitude
of core temperature elevation ranges from 0.10 to 0.23ƒC for every percent
body weight lost, and this elevation is greater during exercise in hot
than in temperate climates. Hypohydration not only elevates core temperature
response, but it also negates the core temperature advantages conferred
by high-aerobic fitness and heat acclimation. Therefore, heat-acclimated
persons (who have increased sweating rates) who do not drink adequately
may more rapidly experience the adverse effects of hypohydration than their
nonacclimated counterparts. Recent studies at our laboratory indicate that
the core temperature elevation is greater with increased exercise intensity
at low (3 percent body weight loss) but not higher (5 percent body weight
loss) hypohydration levels.
Hypohydration impairs both dry and evaporative heat loss (or, if the
air is warmer than the skin, dehydration aggravates dry heat gain). Hypohydration
delays sweating onset and skin vasodilitation. It also reduces sweating
sensitivity. Hypohydration may be associated with either reduced or unchanged
sweating rates at a given metabolic rate in the heat. The physiological
mechanisms mediating the reduced dry and evaporative heat loss from hypohydration
include both the separate and combined effects of plasma hyperosmolality
and reduced blood volume.
Hypohydration and Fatigue
A common complaint of hypohydrated persons is skeletal muscle fatigue;
however, little research had been conducted to address whether hypohydration
reduces skeletal muscle performance (in absence of heat stress). Recent
research at our laboratory demonstrated that, in temperate conditions,
hypohydration (4 percent body weight loss) reduced single-leg knee endurance
time by 18 percent compared with euhydration. The mechanism(s) responsible
for this are unclear, as hypohydration does not seem to markedly alter
skeletal muscle glycogen utilization. To study possible mechanism(s), subjects
are repeating these exercise experiments inside of a nuclear magnetic resonance
(NMR) magnet and 3'P spectra are being collected. It is hypothesized that
hypohydration might accelerate depletion of adenosine triphosphate (ATP)
and PCr or impair the ability to buffer hydrogen and Pj ions produced during
exercise.
Hyperhydration
Hyperhydration, or greater than normal body water, has been suggested
to improve, above euhydration levels, thermoregulation and exercise-heat
performance. The concept that hyperhydration might be beneficial for exercise
performance arose from the adverse consequences of hypohydration. It was
theorized that body water expansion might reduce the cardiovascular and
thermal strain of exercise by expanding blood volume and reducing blood
tonicity, thereby improving exercise performance. Studies that have directly
expanded blood volume (e.g., infusion) have usually reported decreased
cardiovascular strain during exercise, but have reported disparate results
on heat dissipation and exercise-heat performance. Studies that have attenuated
plasma hyperosmolality during exerciseheat stress generally report improved
heat dissipation, but have not addressed exercise performance.
Ten studies have been published that evaluated hyperhydration effects
on thermoregulation in the heat. Briefly, 6 of 10 studies observed smaller
core temperature increases during exercise with hyperhydration. Together,
these studies support the notion that hyperhydration can provide a thermoregulatory
benefit; however, most of these studies suffer from serious experimental
design flaws. Examination of their data indicates that "control" conditions
generally do not represent euhydration, and that there may have been order
problems so that subjects were more heat acclimated during hyperhydration
trials. Recent studies at our laboratory have controlled for these confounding
factors, and observed no thermal advantage with either water hyperhydration
or glycerol hyperhydration during exercise-heat stress.
References
1. Adolph EF, et al. Physiology of man in the desert. New York: Interscience,
1947.
2. Committee on Military Nutrition. In: Marriott BM, ed. Nutritional
needs in hot environments. Institute of Medicine, Washington DC:
National Academy Press, 1993.
3. Committee on Military Nutrition. In: Marriott BM, ed. Fluid replacement
and heat stress. Institute of Medicine, Washington DC:
National Academy Press, 1994.
4. Convertino VA, Armstrong LE, Coyle EF, Mack GW, Sawka MN, Senay LC,
Sherman WM. Exercise and fluid replacement:
ACSM position stand. Med Sci Sports Exerc 1996;28:(1)I-vii.
5. Greenleaf JE. Problem: thirst, drinking behavior, and involuntary
dehydration. Med Sci Sports Exerc 1992;24:645-56.
6. Sawka MN. Physiological consequences of hypohydration: body water
redistribution, exercise performance and temperature
regulation. Med Sci Sports Exerc 1992;24:657-70.
7. Sawka MN, Montain SJ, Latzka WA. Body fluid balance during exercise
- heat exposure. In: Buskirk ER, Puhl SM, eds. Body
fluid balance in exercise and sport. Boca Raton, FL: CRC Press, 1996;143
61.
8. Sawka MN, Wenger CB, Pandolf KB. Thermoregulatory responses to acute
exercise - heat stress and heat acclimation. In: Blatteis
CM, Fregley MJ, eds. Handbook of physiology, section 4: environmental
physiology. New York: Oxford University Press for the
American Physiological Society, 1996;157-86, Chapter 9.
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