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Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration ( U D; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or U D is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LEA is a Board of Trustees member and occasional consultant for the Drinking Water Research Foundation, Alexandria, VA; MFB – no conflicts of interest; CXM – is an occasional consultant for and has an active research grant with Kraft Heinz Co.; SAK has active research grants during the past 36 months from the National Science Foundation, USDA, Kraft Heinz, Unilever, and Standard Process. During this time, he was a lead research aerospace physiologist at Luke Air Force Base, AZ and served as a member of the science advisory board for Hyduro Inc, Zico Rising, and Rockley Photonics. He has also provided scientific consultation to the American Beverage Association, Unilever, Pepsico, and Kraft Heinz Co.

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.

Thirst motivates consumption of water necessary for optimal health and cognitive-physiological functions. Other than thirst, little is known about coexisting perceptions and moods that provide information to the brain and participate in body water homeostasis. The purpose of this investigation was to observe perceptions, somatic sensations, and moods during controlled changes of hydration status. During routine daily activities interspersed with laboratory visits, 18 healthy young men (age, 23±3 y; body mass, 80.13±10.61 kg) self-reported hourly ratings (visual analog scales, VAS) of 17 subjective perceptions, across two 24-h periods (ad libitum food and water intake while euhydrated; water restriction with dry food intake [WR]) and during a 30-min rehydration session (R 30 , 1.46±0.47 L water intake). At the end of WR, body mass loss reached 1.67 kg (2.12%). Distinct perceptions were identified during euhydration, WR and immediately after R 30 . Starting approximately 4 h after WR began (body mass loss of ∼0.5%), perceptual changes included progressively intensifying ratings of thirst, mouth dryness, desire for water, and pleasantness of drinking. In comparison, immediately after R 30 , participants reported a reversal of the perceptions observed during WR (above) plus cooler thermal sensation, increased satisfaction, and stomach fullness. These VAS ratings suggested that aversive moods contributed to drinking behavior and supported previously published animal studies. In conclusion, this investigation delineates previously unreported perceptions and their evolution (e.g., appearance, extinction, time course) that motivated drinking during WR and discouraged overdrinking after R 30 ., (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)

Current models of afferent inputs to the brain, which influence body water volume and concentration via thirst and drinking behavior, have not adequately described the interactions of subconscious homeostatic regulatory responses with conscious perceptions. The purpose of this investigation was to observe the interactions of hydration change indices (i.e., plasma osmolality, body mass loss) with perceptual ratings (i.e., thirst, mouth dryness, stomach emptiness) in 18 free-living, healthy adult men (age, 23 ± 3 y; body mass, 80.09 ± 9.69 kg) who participated in a 24-h water restriction period (Days 1-2), a monitored 30-min oral rehydration session (REHY, Day 2), and a 24-h ad libitum rehydration period (Days 2-3) while conducting usual daily activities. Laboratory and field measurements spanned three mornings and included subjective perceptions (visual analog scale ratings, VAS), water intake, dietary intake, and hydration biomarkers associated with dehydration and rehydration. Results indicated that total water intake was 0.31 L/24 h on Day 1 versus 2.60 L/24 h on Day 2 (of which 1.46 L/30 min was consumed during REHY). The increase of plasma osmolality on Day 1 (297 ± 4 to 299 ± 5 mOsm/kg) concurrent with a body mass loss of 1.67 kg (2.12%) paralleled increasing VAS ratings of thirst, desire for water, and mouth dryness but not stomach emptiness. Interestingly, plasma osmolality dissociated from all perceptual ratings on Day 3, suggesting that morning thirst was predominantly non-osmotic (i.e., perceptual). These findings clarified the complex, dynamic interactions of subconscious regulatory responses with conscious perceptions during dehydration, rehydration, and reestablished euhydration.

Purpose: This investigation had three purposes: (a) to evaluate changes in hydration biomarkers in response to a graded rehydration intervention (GRHI) following 3 days of water restriction (WR), (b) assess within-day variation in urine concentrations, and (c) quantify the volume of fluid needed to return to euhydration as demonstrated by change in U col ., Methods: 115 adult males and females were observed during 1 week of habitual fluid intake, 3 days of fluid restriction (1000 mL day -1 ), and a fourth day in which the sample was randomized into five different GRHI groups: no additional water, CON; additional 500 mL, G +0.50 ; additional 1000 mL, G +1.00 ; additional 1500 mL, G +1.50 ; additional 2250 mL, G +2.25 . All urine was collected on 1 day of the baseline week, during the final 2 days of the WR, and during the day of GRHI, and evaluated for urine osmolality, color, and specific gravity., Results: Following the GRHI, only G +1.50 and G +2.25 resulted in all urinary values being significantly different from CON. The mean volume of water increase was significantly greater for those whose U col changed from > 4 to < 4 (+ 1435 ± 812 mL) than those whose U col remained ≥ 4 (+ 667 ± 722 mL, p < 0.001)., Conclusions: An additional 500 mL of water is not sufficient, while approximately 1500 mL of additional water (for a total intake between 2990 and 3515 mL day -1 ) is required to return to a urine color associated with adequate water intake, following 3 days of WR.

Background: Individuals of all ages are encouraged to monitor their hydration status daily to prevent clinically severe fluid imbalances such as hyponatremia or dehydration. However, acute oral nutritional supplementation may alter urinary hydration assessments and potentially increase the likelihood of inappropriate clinical decisions or diagnosis. This investigation sought to examine the influence of three common over-the-counter nutritional supplements (beetroot, riboflavin, and Vitamin C) on urinary hydration assessments in physically active young men after a 2% exercise-induced dehydration., Design: Eight males (Mean ± SD; age: 22 ± 3 yr; body mass index: 27 ± 5.0) consumed either a standard meal with supplementation (intervention) or a standard meal without supplementation (control). Participants performed a variety of aerobic or resistance exercises until reaching ≥2% body mass loss in a counter-balanced, double-blinded design. Following exercise participation, urine samples were collected for an 8 h observational period during which food consumption was replicated. Urine samples were analyzed for urine color, specific gravity, volume, and osmolality. Maintenance of ~2% body mass loss (2.6 ± 0.5%; range: 1.7-4.0%) was confirmed following the 8 h observational period., Results: Statistically significant (p < 0.05) changes were noted in urine color following Vitamin C supplementation compared to control; however, the difference was not clinically meaningful., Conclusions: These findings indicate that urine color, specific gravity, and osmolality maintain clinical utility to detect moderate levels of dehydration in physically active men consuming commercially available doses of beetroot, riboflavin, or Vitamin C., (Copyright © 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Adams, EL, Casa, DJ, Huggins, RA, DeMartini-Nolan, JK, Stearns, RL, Kennedy, RM, Bosworth, MM, DiStefano, LJ, Armstrong, LE, and Maresh, CM. Heat exposure and hypohydration exacerbate physiological strain during load carrying. J Strength Cond Res 33(3): 727-735, 2019-Heat exposure and hypohydration induce physiological and psychological strain during exercise; however, it is unknown if the separate effects of heat exposure and hypohydration are synergistic when co-occurring during loaded exercise. This study compared separate and combined effects of heat exposure and hypohydration on physiological strain, mood state, and visual vigilance during loaded exercise. Twelve men (mean ± SD; age, 20 ± 2 years; body mass, 74.0 ± 8.2 kg; maximal oxygen uptake, 57.0 ± 6.0 ml·kg·min) completed 4 trials under the following conditions: euhydrated temperate (EUT), hypohydrated temperate (HYT), euhydrated hot (EUH), and hypohydrated hot (HYH). Exercise was 90 minutes of treadmill walking (∼50% V[Combining Dot Above]O2max, 5% grade) while carrying a 45-lb rucksack. Profile of Mood States and the Scanning Visual Vigilance Test were completed before and after exercise. The separate effects of heat exposure (EUH) and hypohydration (HYT) on post-exercise rectal temperature (Tre) were similar (38.25 ± 0.63°C vs. 38.22 ± 0.29°C, respectively, p > 0.05), whereas in combination (HYH), post-exercise Tre was far greater (39.32 ± 0.43°C). Increase in Tre per 1% body mass loss (BML) for HYH (vs. EUH) was greater than HYT (vs. EUT) (0.32 vs. 0.04°C, respectively, p = 0.02); heart rate increase per 1% BML for HYH (vs. EUH) was 7 b·min compared with HYT (vs. EUT) at 3 b·min (p = 0.30). Hypohydrated hot induced greater mood disturbance (post-exercise - pre-exercise) (35 ± 21 units) compared with other conditions (EUT = 3 ± 9 units; HYT = 3 ± 16 units; EUH = 16 ± 26 units; p < 0.001). No differences occurred in visual vigilance (p > 0.05). Independently, heat exposure and hypohydration induced similar physiological strain during loaded exercise; when combined, heat exposure with hypohydration, synergistically exacerbated physiological strain and mood disturbance.

Objective:   To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals., Background:   Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals., Recommendations:   Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.

Aim: Urine concentration measured via osmolality (U OSM ) and specific gravity (U SG ) reflects the adequacy of daily fluid intake, which has important relationships to health in pregnant (PREG) and lactating (LACT) women. Urine color (U COL ) may be a practical, surrogate marker for whole-body hydration status., Purpose: To determine whether U COL was a valid measure of urine concentration in PREG and LACT, and pair-matched non-pregnant, non-lactating control women (CON)., Methods: Eighteen PREG/LACT (age 31 ± 1 years, pre-pregnancy BMI 24.3 ± 5.9 kg m -2 ) and eighteen CON (age 29 ± 4 years, BMI 24.1 ± 3.7 kg m -2 ) collected 24-h and single-urine samples on specified daily voids at five time points (15 ± 2, 26 ± 1, and 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation; CON visits were separated by similar time intervals) for measurement of 24-h U OSM , U SG , and U COL and single-sample U OSM and U COL ., Results: Twenty-four-hour U COL was significantly correlated with 24-h U OSM (r = 0.6085-0.8390, P < 0.0001) and 24-h U SG (r = 0.6213-0.8985, P < 0.0001) in all groups. A 24-h U COL  ≥ 4 (AUC = 0.6848-0.9513, P < 0.05) and single-sample U COL  ≥ 4 (AUC = 0.9094-0.9216, P < 0.0001) indicated 24-h U OSM  ≥ 500 mOsm kg -1 (representing inadequate fluid intake) in PREG, LACT, and CON., Conclusions: Urine color was a valid marker of urine concentration in all groups. Thus, PREG, LACT, and CON can utilize U COL to monitor their daily fluid balance. Women who present with a U COL  ≥ 4 likely have a U OSM  ≥ 500 mOsm kg -1 and should increase fluid consumption to improve overall hydration status., Competing Interests: On behalf of all authors, the corresponding author states that there is no conflict of interest.

Purpose of Review: The purpose of the review is to provide recommendations to improve clinical decision-making based on the strengths and weaknesses of commonly used hydration biomarkers and clinical assessment methods., Recent Findings: There is widespread consensus regarding treatment, but not the diagnosis of dehydration. Even though it is generally accepted that a proper clinical diagnosis of dehydration can only be made biochemically rather than relying upon clinical signs and symptoms, no gold standard biochemical hydration index exists. Other than clinical biomarkers in blood (i.e., osmolality and blood urea nitrogen/creatinine) and in urine (i.e., osmolality and specific gravity), blood pressure assessment and clinical symptoms in the eye (i.e., tear production and palpitating pressure) and the mouth (i.e., thirst and mucous wetness) can provide important information for diagnosing dehydration., Summary: We conclude that clinical observations based on a combination of history, physical examination, laboratory values, and clinician experience remain the best approach to the diagnosis of dehydration.

Lopez, RM, Casa, DJ, Jensen, K, Stearns, RL, DeMartini, JK, Pagnotta, KD, Roti, MW, Armstrong, LE, and Maresh, CM. Comparison of two fluid replacement protocols during a 20-km trail running race in the heat. J Strength Cond Res 30(9): 2609-2616, 2016-Proper hydration is imperative for athletes striving for peak performance and safety, however, the effectiveness of various fluid replacement strategies in the field setting is unknown. The purpose of this study was to investigate how two hydration protocols affect physiological responses and performance during a 20-km trail running race. A randomized, counter-balanced, crossover design was used in a field setting (mean ± SD: WBGT 28.3 ± 1.9° C). Well-trained male (n = 8) and female (n = 5) runners (39 ± 14 years; 175 ± 9 cm; 67.5 ± 11.1 kg; 13.4 ± 4.6% BF) completed two 20-km trail races (5 × 4-km loop) with different water hydration protocols: (a) ad libitum (AL) consumption and (b) individualized rehydration (IR). Data were analyzed using repeated measures ANOVA. Paired t-tests compared pre-race-post-race measures. Main outcome variables were race time, heart rate (HR), gastrointestinal temperature (TGI), fluid consumed, percent body mass loss (BML), and urine osmolality (Uosm). Race times between groups were similar. There was a significant condition × time interaction (p = 0.048) for HR, but TGI was similar between conditions. Subjects replaced 30 ± 14% of their water losses in AL and 64 ± 16% of their losses in IR (p < 0.001). Ad libitum trial experienced greater BML (-2.6 ± 0.5%) compared with IR (-1.3 ± 0.5%; p < 0.001). Pre-race to post-race Uosm differences existed between AL (-273 ± 146 mOsm) and IR (-145 ± 215 mOsm, p = 0.032). In IR, runners drank twice as much fluid than AL during the 20-km race, leading to > 2% BML in AL. Ad libitum drinking resulted in 1.3% greater BML over the 20-km race, which resulted in no thermoregulatory or performance differences from IR.

Objectives: The physiological regulation of total body water and fluid concentrations is complex and dynamic. The human daily water requirement varies because of differences in body size, dietary solute load, exercise, and activities. Although chronically concentrated urine increases the risk of renal diseases, an empirical method to determine inadequate daily water consumption has not been described for any demographic group; instead, statistical analyses are applied to estimate nutritional guidelines (i.e., adequate intake). This investigation describes a novel empirical method to determine the 24-h total fluid intake (TFI; TFI = water + beverages + moisture in food) and 24-h urine volume, which correspond to inadequate 24-h water intake (defined as urine osmolality of 800 mOsm/kg; U800)., Methods: Healthy young women (mean ± standard deviation; age, 20 ± 2 y, mass, 60.8 ± 11.7 kg; n = 28) were observed for 7 consecutive days. A 24-h urine sample was analyzed for volume and osmolality. Diet records were analyzed to determine 24-h TFI., Results: For these 28 healthy young women, the U800 corresponded to a TFI ≥2.4 L/d (≥39 mL/kg/d) and a urine volume ≥1.3 L/d., Conclusions: The U800 method could be employed to empirically determine 24-h TFI and 24-h urine volumes that correspond to inadequate water intake in diverse demographic groups, residents of specific geographic regions, and individuals who consume specialized diets or experience large daily water turnover. Because laboratory expertise and instrumentation are required, this technique provides greatest value in research and clinical settings., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Context: Clinicians and athletes can benefit from field-expedient measurement tools, such as urine color, to assess hydration state; however, the diagnostic efficacy of this tool has not been established., Objective: To determine the diagnostic accuracy of urine color assessment to distinguish a hypohydrated state (≥2% body mass loss [BML]) from a euhydrated state (<2% BML) after exercise in a hot environment., Design: Controlled laboratory study., Setting: Environmental chamber in a laboratory., Patients or Other Participants: Twenty-two healthy men (age = 22 ± 3 years, height = 180.4 ± 8.7 cm, mass = 77.9 ± 12.8 kg, body fat = 10.6% ± 4.6%)., Intervention(s): Participants cycled at 68% ± 6% of their maximal heart rates in a hot environment (36°C ± 1°C) for 5 hours or until 5% BML was achieved. At the point of each 1% BML, we assessed urine color., Main Outcome Measure(s): Diagnostic efficacy of urine color was assessed using receiver operating characteristic curve analysis, sensitivity, specificity, and likelihood ratios., Results: Urine color was useful as a diagnostic tool to identify hypohydration after exercise in the heat (area under the curve = 0.951, standard error = 0.022; P < .001). A urine color of 5 or greater identified BML ≥2% with 88.9% sensitivity and 84.8% specificity (positive likelihood ratio = 5.87, negative likelihood ratio = 0.13)., Conclusions: Under the conditions of acute dehydration due to exercise in a hot environment, urine color assessment can be a valid, practical, inexpensive tool for assessing hydration status. Researchers should examine the utility of urine color to identify a hypohydrated state under different BML conditions.

Purpose: Human daily total water intake (TWI) has a large inter-individual range. Recently, water supplementation has been suggested as a potential preventative and therapeutic modality. Thus, we aimed to measure hydration biomarkers in women with high (HIGH) versus low (LOW) daily TWI to determine baseline differences, and the efficacy of these markers during a systematic alteration in TWI., Methods: This cohort study identified 14 HIGH [3.34 (0.56) L day(-1)] and 14 LOW [1.62 (0.48) L day(-1)] from 120 women. Next, fluid intake was decreased in HIGH [2.00 (0.21) L day(-1)] while LOW increased [3.50 (0.13) L day(-1)] across 4 days. Body mass, fluid intake, serum osmolality (S osmo), total plasma protein (TPP), 24 h urine osmolality, and 24 h urine volume, were measured on each day of modified TWI. Estimated plasma volume (E pv) was calculated using measured body mass and hematocrit values., Results: At baseline, urinary markers and TPP differentiated HIGH from LOW [7.0 (0.3) versus 7.3 (0.3) mg dL(-1), respectively]. Upon TWI intervention, (1) body mass decreased in HIGH [-0.7 (1.1) kg, p = 0.010)] but did not increase in LOW [+0.0 (0.6) kg, p = 0.110], (2) E pv decreased 2.1 (2.4) %, p = 0.004, (3) urine osmolality increased in HIGH [397 (144)-605 (230) mOsm kg(-1), p < 0.001] and decreased in LOW [726 (248)-265 (97) mOsm kg(-1) p < 0.001], and (4) no changes of serum osmolality occurred in either HIGH or LOW (all p > 0.05)., Conclusions: Urinary markers and TPP are sensitive measures to habitual high and low TWI and to changes in TWI. Both groups through urinary and some hematological responses following TWI manipulation achieved regulation of hemoconcentration.

Laboratory-based studies indicate mild dehydration adversely affects mood. Although ultra-endurance events often result in mild to moderate dehydration, little research has evaluated whether the relationship between hydration status and mood state also exists in these arduous events. Therefore, the purpose of this study was to evaluate how hydration status affected mood state and perceptual measures during a 161 km ultra-endurance cycling event. One hundred and nineteen cyclists (103 males, 16 females; age = 46 ± 9 years; height = 175.4 ± 17.9 cm; mass = 82.8 ± 16.3 kg) from the 2011 and 2013 Hotter'N Hell events participated. Perceived exertion, Thermal, Thirst, and Pain sensations, Brunel Profile of Mood States, and urine specific gravity (USG) were measured pre- (~1 h before), mid- (~97 km), and post-ride. Participants were classified at each time point as dehydrated (USG ≥ 1.022) or euhydrated (USG ≤ 1.018). Independent of time point, dehydrated participants (USG = 1.027 ± 0.004) had decreased Vigour and increased Fatigue, Pain, Thirst, and Thermal sensations compared to euhydrated participants (USG = 1.012 ± 0.004; all P < 0.01). USG significantly correlated with Fatigue (r = 0.36), Vigour (r = -0.27), Thirst (r = 0.15), and Pain (r = 0.22; all P < 0.05). In conclusion, dehydrated participants had greater Fatigue and Pain than euhydrated participants. These findings indicate dehydration may adversely affect mood state and perceptual ratings during ultra-endurance cycling.

Context: The sensation of thirst is different from the complex behavior of drinking ad libitum. Rehydration recommendations to athletes differ, depending on the source, yet no previous researchers have systematically compared drinking to thirst (D(TT)) versus ad libitum drinking behavior (D(AL))., Objective: To compare 2 groups of trained cyclists (D(TT) and D(AL)) who had similar physical characteristics and training programs (P > .05). The D(TT) group (n = 12, age = 47 ± 7 years) drank only when thirsty, whereas the D(AL) group (n = 12, age = 44 ± 7 years) consumed fluid ad libitum (ie, whenever and in whatever volume desired)., Design: Cohort study., Setting: Road cycling (164 km) in the heat (36.1 °C ± 6.5 °C)., Patients or Other Participants: Ultraendurance cyclists (4 women, 20 men)., Intervention(s): We recorded measurements 1 day before the event, on event day before the start, at 3 roadside aid stations, at the finish line, and 1 day after the event., Main Outcome Measure(s): Body mass, urinary hydration indices, and food and fluids consumed., Results: No between-groups differences were seen on event day for total exercise time (DTT = 6.69 ± 0.89 hours, DAL = 6.66 ± 0.77 hours), urinary indices (specific gravity, color), body mass change (D(TT) = -2.22% ± 1.73%, DAL = -2.29% ± 1.62%), fluid intake (D(TT) = 5.63 ± 2.59 L/6.7 h, D(AL) = 6.04 ± 2.37 L/6.7 h), dietary energy intake, macronutrient intake, ratings of thirst (D(TT) start = 2 ± 1, D(TT) finish = 6 ± 1, DAL start = 2 ± 1, D(AL) finish = 6 ± 1), pain, perceived exertion, or thermal sensation. Total fluid intake on recovery day +1 was the primary significant difference (D(AL) = 5.13 ± 1.87 L/24 h, D(TT) = 3.13 ± 1.53 L/24 h, t18 = 2.59, P = .02)., Conclusions: Observations on event day indicated that drinking to thirst and drinking ad libitum resulted in similar physiologic and perceptual outcomes. This suggests that specific instructions to "drink to thirst" were unnecessary. Indeed, if athletes drink ad libitum, they can focus on training and competition rather than being distracted by ongoing evaluation of thirst sensations.

Context: Athletic trainers recommend and use a multitude of rehydration (REHY) methods with their patients. The REHY modality that most effectively facilitates recovery is unknown., Objective: To compare 5 common REHY methods for thermoregulatory and stress hormone recovery after exercise dehydration (EXDE) in trained participants., Design: Randomized, cross-over, controlled study., Patients or Other Participants: Twelve physically active, non-heat-acclimatized men (age = 23 ± 4 years, height = 180 ± 6 cm, mass = 81.3 ± 3.7 kg, VO2max = 56.9 ± 4.4 mL·min(-1)·kg(-1), body fat = 7.9% ± 3%) participated., Intervention(s): Participants completed 20-hour fluid restriction and 2-hour EXDE; they then received no fluid (NF) or REHY (half-normal saline) via ad libitum (AL), oral (OR), intravenous (IV), or combination IV and OR (IV + OR) routes for 30 minutes; and then were observed for another 30 minutes., Main Outcome Measure(s): Body mass, rectal temperature, 4-site mean weighted skin temperature, plasma stress hormone concentrations, and environmental symptoms questionnaire (ESQ) score., Results: Participants were hypohydrated (body mass -4.23% ± 0.22%) post-EXDE. Rectal temperature for the NF group was significantly greater than for the IV group (P = .023) at 30 minutes after beginning REHY (REHY30) and greater than OR, IV, and IV + OR (P ≤ .009) but not AL (P = .068) at REHY60. Mean weighted skin temperature during AL was less than during IV + OR at REHY5 (P = .019). The AL participants demonstrated increased plasma cortisol concentrations compared with IV + OR, independent of time (P = .015). No differences existed between catecholamine concentrations across treatments (P > .05). The ESQ score was increased at REHY60 for NF, AL, OR, and IV (P < .05) but not for IV + OR (P = .217). The NF ESQ score was greater than that of IV + OR at REHY60 (P = .012)., Conclusions: Combination IV + OR REHY reduced body temperature to a greater degree than OR and AL REHY when compared with NF. Future studies addressing clinical implications are needed.

Our purpose was to compare the common modes of rehydration (REHY) on cardiovascular and fluid regulation recovery after exercise dehydration (EXDE). Twelve nonheat-acclimatized trained subjects (age: 23 ± 4 years, weight: 81.3 ± 3.7 kg, height: 180 ± 6 cm, V[Combining Dot Above]O2max: 56.9 ± 4.4 ml·min·kg , and body fat: 7.8 ± 3.0%) completed 20-hour fluid restriction and 2-hour EXDE to -4% body mass, and then were rehydrated to -2% body mass in a randomized, crossover design. The REHY methods included no fluid (NF), ad libitum, oral (OR), intravenous (IV), and a combination of IV and OR (IV + OR) of 1/2-normal saline (0.45% NaCl). The REHY occurred for 30 minutes, and the subjects were observed during rest for 30 minutes. Seated, standing, and mean arterial pressure (MAP) and blood pressure (BP) were measured every 15 minutes throughout REHY. Heart rate (HR), plasma arginine vasopressin concentration [AVP], and thirst perception were measured throughout REHY. The EXDE resulted in a body mass loss of 4.32 ± 0.22%. The REHY returned the subjects to -2.13 ± 0.47% body mass for controlled trials. Seated systolic BP was greater for IV + OR compared with that for OR (p = 0.015). Seated systolic BP and MAP during REHY showed that IV + OR was greater than OR, independent of time (p ≤ 0.011). Upon standing, IV + OR demonstrated a greater BP than both NF (p = 0.012) and OR (p = 0.031) did. The HR was reduced by IV and IV + OR to a greater extent than NF at REHY30 and REHY60 (p < 0.05). The IV + OR [AVP] demonstrated a strong trend for decreasing over time (p = 0.054) and was significantly less than NF at REHY60 (p = 0.003). Practical application seeking to restore cardiovascular function after EXDE, the combined use of IV + OR rather than a single REHY method seems to be most expedient.

Purpose: This study aimed to evaluate the effects of hypohydration and hyperthermia during exercise on movement technique and postural control., Methods: Twelve healthy men (age = 20 ± 2 yr, height = 182 ± 8 cm, mass = 74.0 ± 8.2 kg, V˙O2max = 57.0 ± 6.0 mL·kg·min; mean ± SD) completed four randomized test sessions: euhydrated temperate (EUT), euhydrated hot (EUH), hypohydrated temperate (HYT), and hypohydrated hot (HYH). Temperate and hot conditions were performed in 18.0°C ± 0.2°C, 50.0% ± 3.5% relative humidity, and 34.0°C ± 0.3°C, 45.0% ± 4.5% relative humidity, respectively. Movement technique and postural control were assessed before exercise (PRE), after exercise (POST), and after recovery (REC). Movement technique was evaluated using the Landing Error Scoring System (LESS). Postural control was assessed using the Balance Error Scoring System (BESS) and center-of-pressure sway velocity (SV) and elliptical sway area (ESA) during a dynamic balance test. The 90-min treadmill exercise protocol (1.34-1.78 m·s; 5% grade) required subjects to walk carrying a 20.5-kg rucksack. Subjects sat quietly in the test environment during a 60-min recovery period after exercise. Repeated-measures ANOVAs with a Tukey-HSD post hoc test evaluated differences between time and condition for dependent variables., Results: Exercise during HYH significantly increased LESS scores (PRE = 3.72 ± 1.73, POST = 4.42 ± 1.75) compared with HYT (3.75 ± 1.76) and EUH (3.61 ± 1.71) (P < 0.05). LESS scores remained elevated during REC for HYH compared with EUT (4.39 ± 1.47 vs 3.47 ± 2.05, P < 0.05). The HYH condition caused the greatest number of BESS errors (P = 0.02), largest ESA (P < 0.05), and highest SV (P = 0.02). Regardless of the condition, participants had the most BESS errors (P = 0.002) and highest SV (P = 0.003) during POST compared with the PRE and REC., Conclusions: Hypohydration during exercise in the heat impairs neuromuscular control. These findings suggest that physical activity in the heat while dehydrated may affect parameters associated with a higher risk of injury.

The purpose of this article is to review the effects of chronic mild dehydration and fluid consumption on specific health outcomes including obesity. The electronic databases PubMed and Google Scholar were searched for relevant literature published from the time of their inception to 2011, with results restricted to studies performed on human subjects and reports in the English language. Key words included the following: dehydration, hypohydration, water intake, fluid intake, disease, and the names of specific disease states. Strength of evidence categories were described for 1) medical conditions associated with chronic dehydration or low daily water intake, and 2) randomized-controlled trials regarding the effects of increased water consumption on caloric intake, weight gain, and satiety. This process determined that urolithiasis is the only disorder that has been consistently associated (i.e., 11 of 13 publications) with chronic low daily water intake. Regarding obesity and type 2 diabetes, evidence suggests that increased water intake may reduce caloric intake for some individuals. Recommendations for future investigations include measuring total fluid intake (water + beverages + water in solid food), conducting randomized-controlled experiments, identifying novel hydration biomarkers, and delineating hydration categories., (© 2012 International Life Sciences Institute.)

Limited information is available regarding the effects of mild dehydration on cognitive function. Therefore, mild dehydration was produced by intermittent moderate exercise without hyperthermia and its effects on cognitive function of women were investigated. Twenty-five females (age 23.0 ± 0.6 y) participated in three 8-h, placebo-controlled experiments involving a different hydration state each day: exercise-induced dehydration with no diuretic (DN), exercise-induced dehydration plus diuretic (DD; furosemide, 40 mg), and euhydration (EU). Cognitive performance, mood, and symptoms of dehydration were assessed during each experiment, 3 times at rest and during each of 3 exercise sessions. The DN and DD trials in which a volunteer attained a ≥1% level of dehydration were pooled and compared to that volunteer's equivalent EU trials. Mean dehydration achieved during these DN and DD trials was -1.36 ± 0.16% of body mass. Significant adverse effects of dehydration were present at rest and during exercise for vigor-activity, fatigue-inertia, and total mood disturbance scores of the Profile of Mood States and for task difficulty, concentration, and headache as assessed by questionnaire. Most aspects of cognitive performance were not affected by dehydration. Serum osmolality, a marker of hydration, was greater in the mean of the dehydrated trials in which a ≥1% level of dehydration was achieved (P = 0.006) compared to EU. In conclusion, degraded mood, increased perception of task difficulty, lower concentration, and headache symptoms resulted from 1.36% dehydration in females. Increased emphasis on optimal hydration is warranted, especially during and after moderate exercise.

The purpose of this study was to determine the effects of dehydration at a controlled relative intensity on physiological responses and trail running speed. Using a randomized, controlled crossover design in a field setting, 14 male and female competitive, endurance runners aged 30 ± 10.4 years completed 2 (hydrated [HY] and dehydrated [DHY]) submaximal trail runs in a warm environment. For each trial, the subjects ran 3 laps (4 km per lap) on trails with 4-minute rests between laps. The DHY were fluid restricted 22 hours before the trial and during the run. The HY arrived euhydrated and were given water during rest breaks. The subjects ran at a moderate pace matched between trials by providing pacing feedback via heart rate (HR) throughout the second trial. Gastrointestinal temperature (T(GI)), HR, running time, and ratings of perceived exertion (RPE) were monitored. Percent body mass (BM) losses were significantly greater for DHY pretrial (-1.65 ± 1.34%) than for HY (-0.03 ± 1.28%; p < 0.001). Posttrial, DHY BM losses (-3.64 ± 1.33%) were higher than those for HY (-1.38 ± 1.43%; p < 0.001). A significant main effect of T(GI) (p = 0.009) was found with DHY having higher T(GI) postrun (DHY: 39.09 ± 0.45°C, HY: 38.71 ± 0.45°C; p = 0.030), 10 minutes post (DHY: 38.85 ± 0.48°C, HY: 38.46 ± 0.46°C; p = 0.009) and 30 minutes post (DHY: 38.18 ± 0.41°C, HY: 37.60 ± 0.25°C; p = 0.000). The DHY had slower run times after lap 2 (p = 0.019) and lap 3 (p = 0.025). The DHY subjects completed the 12-km run 99 seconds slower than the HY (p = 0.027) subjects did. The RPE in DHY was slightly higher than that in HY immediately postrun (p = 0.055). Controlling relative intensity in hypohydrated runners resulted in slower run times, greater perceived effort, and elevated T(GI), which is clinically meaningful for athletes using HR as a gauge for exercise effort and performance.

The present study assessed the effects of mild dehydration on cognitive performance and mood of young males. A total of twenty-six men (age 20·0 (sd 0·3) years) participated in three randomised, single-blind, repeated-measures trials: exercise-induced dehydration plus a diuretic (DD; 40 mg furosemide); exercise-induced dehydration plus placebo containing no diuretic (DN); exercise while maintaining euhydration plus placebo (EU; control condition). Each trial included three 40 min treadmill walks at 5·6 km/h, 5 % grade in a 27·7°C environment. A comprehensive computerised six-task cognitive test battery, the profile of mood states questionnaire and the symptom questionnaire (headache, concentration and task difficulty) were administered during each trial. Paired t tests compared the DD and DN trials resulting in >1 % body mass loss (mean 1·59 (sd 0·42) %) with the volunteer's EU trial (0·01 (sd 0·03) %). Dehydration degraded specific aspects of cognitive performance: errors increased on visual vigilance (P = 0·048) and visual working memory response latency slowed (P = 0·021). Fatigue and tension/anxiety increased due to dehydration at rest (P = 0·040 and 0·029) and fatigue during exercise (P = 0·026). Plasma osmolality increased due to dehydration (P < 0·001) but resting gastrointestinal temperature was not altered (P = 0·238). In conclusion, mild dehydration without hyperthermia in men induced adverse changes in vigilance and working memory, and increased tension/anxiety and fatigue.

Context: Authors of most field studies have not observed decrements in physiologic function and performance with increases in dehydration, although authors of well-controlled laboratory studies have consistently reported this relationship. Investigators in these field studies did not control exercise intensity, a known modulator of body core temperature., Objective: To directly examine the effect of moderate water deficit on the physiologic responses to various exercise intensities in a warm outdoor setting., Design: Semirandomized, crossover design., Setting: Field setting., Patients or Other Participants: Seventeen distance runners (9 men, 8 women; age = 27 +/- 7 years, height = 171 +/- 9 cm, mass = 64.2 +/- 9.0 kg, body fat = 14.6% +/- 5.5%)., Intervention(s): Participants completed four 12-km runs (consisting of three 4-km loops) in the heat (average wet bulb globe temperature = 26.5 degrees C): (1) a hydrated, race trial (HYR), (2) a dehydrated, race trial (DYR), (3) a hydrated, submaximal trial (HYS), and (4) a dehydrated, submaximal trial (DYS)., Main Outcome Measure(s): For DYR and DYS trials, dehydration was measured by body mass loss. In the submaximal trials, participants ran at a moderate pace that was matched by having them speed up or slow down based on pace feedback provided by researchers. Intestinal temperature was recorded using ingestible thermistors, and participants wore heart rate monitors to measure heart rate., Results: Body mass loss in relation to a 3-day baseline was greater for the DYR (-4.30% +/- 1.25%) and DYS trials (-4.59% +/- 1.32%) than for the HYR (-2.05% +/- 1.09%) and HYS (-2.0% +/- 1.24%) trials postrun (P < .001). Participants ran faster for the HYR (53.15 +/- 6.05 minutes) than for the DYR (55.7 +/- 7.45 minutes; P < .01), but speed was similar for HYS (59.57 +/- 5.31 minutes) and DYS (59.44 +/- 5.44 minutes; P > .05). Intestinal temperature immediately postrun was greater for DYR than for HYR (P < .05), the only significant difference. Intestinal temperature was greater for DYS than for HYS postloop 2, postrun, and at 10 and 20 minutes postrun (all: P < .001). Intestinal temperature and heart rate were 0.22 degrees C and 6 beats/min higher, respectively, for every additional 1% body mass loss during the DYS trial compared with the HYS trial., Conclusions: A small decrement in hydration status impaired physiologic function and performance while trail running in the heat.

Context: Previous researchers have not investigated the thermoregulatory responses to multiple consecutive days of American football in adolescents., Objective: To examine the thermoregulatory and hydration responses of high school players during formal preseason football practices., Design: Observational study., Setting: Players practiced outdoors in late August once per day on days 1 through 5, twice per day on days 6 and 7, and once per day on days 8 through 10. Maximum wet bulb globe temperature averaged 23 +/- 4 degrees C., Patients or Other Participants: Twenty-five heat-acclimatized adolescent boys (age = 15 +/- 1 years, height = 180 +/- 8 cm, mass = 81.4 +/- 15.8 kg, body fat = 12 +/- 5%, Tanner stage = 4 +/- 1)., Main Outcome Measure(s): We observed participants within and across preseason practices of football. Measures included gastrointestinal temperature (T(GI)), urine osmolality, sweat rate, forearm sweat composition, fluid consumption, testosterone to cortisol ratio, perceptual measures of thirst, perceptual measures of thermal sensation, a modified Environmental Symptoms Questionnaire, and knowledge questionnaires assessing the participants' understanding of heat illnesses and hydration. Results were analyzed for differences across time and were compared between younger (14-15 years, n = 13) and older (16-17 years, n = 12) participants., Results: Maximum daily T(GI) values remained less than 40 degrees C and were correlated with maximum wet bulb globe temperature (r = 0.59, P = .009). Average urine osmolality indicated that participants generally experienced minimal to moderate hypohydration before (881 +/- 285 mOsmol/kg) and after (856 +/- 259 mOsmol/kg) each practice as a result of replacing approximately two-thirds of their sweat losses during exercise but inadequately rehydrating between practices. Age did not affect most variables; however, sweat rate was lower in younger participants (0.6 +/- 0.2 L/h) than in older participants (0.8 +/- 0.1 L/h) (F(1,18) = 8.774, P = .008)., Conclusions: Previously heat-acclimatized adolescent boys (T(GI) < 40 degrees C) can safely complete the initial days of preseason football practice in moderate environmental conditions using well-designed practice guidelines. Adolescent boys replaced most sweat lost during practice but remained mildly hypohydrated throughout data collection, indicating inadequate hydration habits when they were not at practice.

The purpose of this study was to determine the influence of hydration status on pacing of trail runners in the heat (wet bulb globe temperature = 26.2 +/- 1.8 degrees C). A randomized, crossover design was used and the participation occurred within a 2-week period. Seventeen competitive, well-trained distance runners (9 men, 8 women, age 27 +/- 7 years, height 171 +/- 9 cm, weight 64.2 +/- 9.0 kg, body fat 14.6 +/- 5.5%) completed the study. Subjects started maximum effort trials that were either hydrated (HYR) and dehydrated (DHR). Each trial subjects ran three 4-km loops with a 4-minute rest between loops. Significance was set at p < or = 0.05. The DHR had a significantly greater body mass loss at the pre- and posttrial time points (-2.05 +/- 1.25 and -4.3 +/- 1.25%, respectively) vs. HYR (-0.79 +/- 0.95 and -2.05 +/- 1.09%, respectively). Subjects ran the 12 km faster (p < 0.001) in HYR (3,191 +/- 366 seconds) vs. DHR (3,339 +/- 450 seconds). Differences between fastest and slowest loops during HYR (54 +/- 40 seconds) were significantly smaller than DHR (111 +/- 93 seconds; p = 0.041). Additionally, loop times were slower for loop 1 (HYR 1,039 +/- 116 seconds vs. DHR 1,071 +/- 123 seconds; p = 0.028), loop 2 (HYR 1,066 +/- 123 seconds vs. DHR 1,105 +/- 148 seconds; p = 0.01) and loop 3 (HYR 1,081 +/- 132 seconds vs. DHR 1,168 +/- 189 seconds; p = 0.003) when dehydrated. Percent of the race completed by loop as calculated by finishing time was significantly different at loop 2 between HYR (33.6 +/- 0.36%) and DHR (33.1 +/- 0.35%, p = 0.002) and loop 3 (33.8 +/- 0.75% vs. 34.9 +/- 1.35%, respectively, p = 0.01). Total variation from the mean pace for the duration of the HYR compared to the DHR approached significance (p = 0.064). Average percent of variance approached significance between trials (p = 0.057). Differences between the fastest and slowest loops between trials demonstrated an increased ability for hydrated individuals to evenly pace themselves. While total variation from the mean pace was not significantly different, it could have practical applicability. These findings reveal that dehydration is associated with decreases in a runners' ability to evenly pace themselves during a competitive situation.

It is well established that resistance exercise can damage muscle tissue, but the combined effects of hypohydration and resistance exercise on muscle damage are unclear. Two common circulating markers of muscle damage, myoglobin (Mb) and creatine kinase (CK) may be attenuated by fluid ingestion post-exercise. The purpose of this study was to examine the combined effect of resistance exercise and hydration state on muscle damage. Seven healthy resistance-trained males (age = 23 +/- 4 years; body mass = 87.8 +/- 6.8 kg; body fat = 11.5 +/- 5.2%) completed 3 identical resistance exercise bouts (6 sets of up to 10 repetitions of the back squat) in different hydration states: euhydrated (HY0), hypohydrated approximately 2.5% body mass (HY2.5), and hypohydrated approximately 5.0% body mass (HY5). Subjects achieved desired hydration states via controlled water deprivation, exercise-heat stress, and fluid intake. Both Mb and CK were measured during euhydrated rest (PRE). Mb was also measured immediately post-exercise, 1 hour (+1H) and 2 hours (+2H) post-exercise; CK was measured at 24 and 48 hours post-exercise. Body mass decreased 0.2 +/- 0.4%, 2.4 +/- 0.4%, and 4.8 +/- 0.4% during HY0, HY2.5, and HY5, respectively. Mb concentrations increased significantly (effect size >or=1, p < 0.05) from PRE (2.6 +/- 1.1, 3.5 +/- 2.8, and 3.2 +/- 1.6 nmol x L(-1)) to +1H (5.3 +/- 3.4, 6.8 +/- 3.2, and 7.6 +/- 2.8 nmol x L(-1)), and +2H (5.5 +/- 3.8, 6.2 +/- 3.0, and 7.2 +/- 3.0 nmol x L(-1)) for HY0, HY2.5, and HY5, respectively, but were not significantly different between trials. CK concentrations remained within the normal resting range at all time points. Thus, hypohydration did not enhance muscle damage following the resistance exercise challenge. Despite these results, athletes are encouraged to commence exercise in a euhydrated state to maximize endogenous hormonal, mechanical, and metabolic benefits.

Hypohydration (decreased total body water) exacerbates the catabolic hormonal response to endurance exercise with unclear effects on anabolic hormones. Limited research exists that evaluates the effect of hypohydration on endocrine responses to resistance exercise; this work merits attention as the acute postexercise hormonal environment potently modulates resistance training adaptations. The purpose of this study was to examine the effect of hydration state on the endocrine and metabolic responses to resistance exercise. Seven healthy resistance-trained men (age = 23 +/- 4 yr, body mass = 87.8 +/- 6.8 kg, body fat = 11.5 +/- 5.2%) completed three identical resistance exercise bouts in different hydration states: euhydrated (EU), hypohydrated by approximately 2.5% body mass (HY25), and hypohydrated by approximately 5.0% body mass (HY50). Investigators manipulated hydration status via controlled water deprivation and exercise-heat stress. Cortisol, epinephrine, norepinephrine, testosterone, growth hormone, insulin-like growth factor-I, insulin, glucose, lactate, glycerol, and free fatty acids were measured during euhydrated rest, immediately preceding resistance exercise, immediately postexercise, and during 60 min of recovery. Body mass decreased 0.2 +/- 0.4, 2.4 +/- 0.4, and 4.8 +/- 0.4% during EU, HY25, and HY50, respectively, supported by humoral and urinary changes that clearly indicated subjects achieved three distinct hydration states. Hypohydration significantly 1) increased circulating concentrations of cortisol and norepinephrine, 2) attenuated the testosterone response to exercise, and 3) altered carbohydrate and lipid metabolism. These results suggest that hypohydration can modify the hormonal and metabolic response to resistance exercise, influencing the postexercise circulatory milieu.

This investigation evaluated the effects of a nutritional supplement (the organic osmolyte betaine) in rehydration solutions, with and without carbohydrate and electrolytes. Ten male runners ((mean +/- SD) age, 20 +/- 2 years; weight, 70.6 +/- 6.8 kg; maximal aerobic power, 63.5 +/- 4.1 mL O2 x kg(-1) x min(-1)) dehydrated to -2.7% of body weight. They next rehydrated to -1.4% of body weight by consuming 1 L fluid during each of four experiments (double-blind, randomized, cross-over design): flavored, non-caloric water (W); W + 5 g x L(-1) betaine (W+B); 6% carbohydrate-electrolyte fluid (C); or C + 5 g x L(-1) betaine (C+B). Subjects then performed prolonged treadmill running (75 minutes at 65%Vo2max) plus a performance sprint to volitional exhaustion (3.1-3.8 minutes at 84%Vo2max) in an environmental chamber (31.1 degrees C, 88.0 degrees F). Only W versus W+B and C versus C+B statistical comparisons were germane to the research questions. Observations indicated that rehydration with fluids containing betaine resulted in significant differences (p < 0.05) of plasma volume, oxygen consumption, plasma lactate concentration, and thermal sensation. The present experiments did not support the use of betaine to improve sprint duration, but nonsignificant trends occurred when betaine trials were compared with non-betaine trials (mean C+B > C by 32 seconds, +16%; mean W+B > W by 38 seconds, +21%). We interpret the increases of both aerobic and anaerobic metabolism (C+B > C) to mean that further investigation of betaine as a nutritional supplement, using other types of exercise, is warranted.

Purpose: Although many studies have attempted to examine the effect of hypohydration on strength, power, and high-intensity endurance, few have successfully isolated changes in total body water from other variables that alter performance (e.g., increased core temperature), and none have documented the influence of hypohydration on an isotonic, multiset, multirepetition exercise bout typical of resistance exercise training. Further, no investigations document the effect of hypohydration on the ability of the central nervous system to stimulate the musculature, despite numerous scientists suggesting this possibility. The purposes of this study were to examine the isolated effect of hydration state on 1) strength, power, and the performance of acute resistance exercise, and 2) central activation ratio (CAR)., Methods: Seven healthy resistance-trained males (age = 23 +/- 4 yr, body mass = 87.8 +/- 6.8 kg, body fat = 11.5 +/- 5.2%) completed three resistance exercise bouts in different hydration states: euhydrated (EU), hypohydrated by approximately 2.5% body mass (HY25), and hypohydrated by approximately 5.0% body mass (HY50). Investigators manipulated hydration status via exercise-heat stress and controlled fluid intake 1 d preceding testing., Results: Body mass decreased 2.4 +/- 0.4 and 4.8 +/- 0.4% during HY25 and HY50, respectively. No significant differences existed among trials in vertical jump height, peak lower-body power (assessed via jump squat), or peak lower-body force (assessed via isometric back squat). CAR tended to decrease as hypohydration increased (EU = 95.6 +/- 4.9%, HY25 = 94.0 +/- 3.1%, HY50 = 92.5 +/- 5.1%; P = 0.075, eta(p)(2) = 0.41). When evaluated as a function of the percentage of total work completed during a six-set back squat protocol, hypohydration significantly decreased resistance exercise performance during sets 2-3 and 2-5 for HY25 and HY50, respectively., Conclusion: These data indicate that hypohydration attenuates resistance exercise performance; the role of central drive as the causative mechanism driving these responses merits further research.

Acknowledging that total body water (TBW) turnover is complex, and that no measurement is valid for all situations, this review evaluates 13 hydration assessment techniques. Although validated laboratory methods exist for TBW and extracellular volume, no evidence incontrovertibly demonstrates that any concentration measurement, including plasma osmolality (P(osm)), accurately represents TBW gain and loss during daily activities. Further, one blood or urine sample cannot validly represent fluctuating TBW and fluid compartments. Future research should (a) evaluate novel techniques that assess hydration in real time and are precise, accurate, reliable, non-invasive, portable, inexpensive, safe, and simple; and (b) clarify the relationship between P(osm) and TBW oscillations in various scenarios.

Studies related to fundamental hydration issues have required clinicians to re-examine certain practices and concepts. The ingestion of substances such as creatine, caffeine, and glycerol has been questioned in regards to safety and hydration status. Reports of overdrinking (hyponatremia) also have brought into question the practices of drinking appropriate fluid amounts and the role that fluid-electrolyte balance has in the etiology of heat illnesses such as heat cramps. This article offers a fresh perspective on timely topics related to hydration, fluid balance, and exercise in the heat.

Significant scientific evidence documents the deleterious effects of hypohydration (reduced total body water) on endurance exercise performance; however, the influence of hypohydration on muscular strength, power and high-intensity endurance (maximal activities lasting >30 seconds but <2 minutes) is poorly understood due to the inconsistent results produced by previous investigations. Several subtle methodological choices that exacerbate or attenuate the apparent effects of hypohydration explain much of this variability. After accounting for these factors, hypohydration appears to consistently attenuate strength (by approximately 2%), power (by approximately 3%) and high-intensity endurance (by approximately 10%), suggesting alterations in total body water affect some aspect of force generation. Unfortunately, the relationships between performance decrement and crucial variables such as mode, degree and rate of water loss remain unclear due to a lack of suitably uninfluenced data. The physiological demands of strength, power and high-intensity endurance couple with a lack of scientific support to argue against previous hypotheses that suggest alterations in cardiovascular, metabolic and/or buffering function represent the performance-reducing mechanism of hypohydration. On the other hand, hypohydration might directly affect some component of the neuromuscular system, but this possibility awaits thorough evaluation. A critical review of the available literature suggests hypohydration limits strength, power and high-intensity endurance and, therefore, is an important factor to consider when attempting to maximise muscular performance in athletic, military and industrial settings.

Purpose: Although running economy (RE) is recognized as an integral component of successful endurance performance and is affected by numerous factors, little is known about the influence of body water loss on RE. This investigation examined the effects of hypohydration (HY) on RE and associated physiological responses., Methods: Ten highly trained collegiate distance runners (mean +/- SD; age, 20 +/- 3 yr; height, 178.5 +/- 6.3 cm; body mass, 66.7 +/- 5.4 kg; VO2max, 66.5 +/- 4.1 mL x kg(-1) x min(-1)) participated in four experiments on separate days, twice in a euhydrated (EU) and twice in a HY state (-5.5 and -5.7% body mass loss achieved during 24 h). At each hydration level, subjects performed one 10-min treadmill run per day (23 degrees C environment), at either 70% VO2max (EU 70% or HY 70%) or 85% VO2max (EU 85% or HY 85%) in a randomized, repeated-measures design. Cardiopulmonary, metabolic, thermal, hormonal, and perceptual variables were measured., Results: No between-treatment differences existed for RE (EU 70%, 46.3 +/- 3.2; HY 70%, 47.2 +/- 3.8; EU 85%, 58.6 +/- 2.8; HY 85%, 58.9 +/- 4.1 mL x kg(-1) x min(-1)), postexercise plasma lactate concentration (EU 70%, 1.9 +/- 0.6; HY 70%, 1.8 +/- 0.6; EU 85%, 6.5 +/- 3.5; HY 85%, 6.4 +/- 3.5 mmol x L(-1)), or rating of perceived exertion. HY resulted in a greater (P < 0.05 to 0.001) heart rate (HR), rectal temperature, and plasma norepinephrine concentration (NE), concurrent with reduced cardiac output, stroke volume, and respiratory exchange ratio., Conclusion: HY did not alter the RE or lactate accumulation of endurance athletes during 10 min of exercise at 70 and 85% VO2max. These findings indicate that HY had no effect on RE, but that it increased physiological strain in a 23 degrees C environment.

This investigation evaluated the new National Collegiate Athletic Association model of heat acclimatization for football players using physiological, psychological, fluid balance, anthropometric, and nutritional variables. Eleven football players (20 +/- 1 year, 1.88 +/- 0.05 m, and 115.36 +/- 18.85 kg) from a Division I football team were observed for the first 8 days of preseason practices. Measurements such as heart rate and gastrointestinal temperature (T(GI)) via telemetric sensor were taken before, 3 times during, and after practice daily. An average 1.39-kg (1.2%) decrease of body mass occurred from prepractice to postpractice (p < 0.01). Consistent with mild body mass losses, urinary indices of hydration status (i.e., color, specific gravity, and osmolality) indicated mild fluid deficits. A significant increase (p < 0.05) from pre- to postpractice was observed in urine color and urine specific gravity, but chronic hypohydration over the 8 days was not noted. The Environmental Symptoms Questionnaire (ESQ) postpractice score was significantly higher (p < 0.05) than the prepractice score was, but averages did not differ across practice days. There was no difference in postpractice T(GI) measurements across days (p < 0.05). Heart rate, T(GI), and ESQ measurements indicated that football players experienced gradual heat acclimatization and enhanced heat tolerance, despite progressive increases of exercise variables, clothing, and environmental stressors.

Unlabelled: Diuretic-induced dehydration impairs prolonged running performance (> 1500 m). Sprinting performance may suffer by similar mechanisms (i.e., altered cardiovascular strain, heat storage, and metabolism) or may improve because of reduced mass to accelerate and carry., Purpose: To examine sprint and power performance after diuretic-induced dehydration., Methods: After six sprint practice sessions, nine male former sprinters (mean +/- SD; age, 21 +/- 2 yr; body mass (BM), 80.0 +/- 5.2 kg; height, 1.78 +/- 0.08 m; body fat, 14 +/- 4%) participated in a 50-m race, a 200-m race, a 400-m race, and a vertical jump on an indoor synthetic track, once when dehydrated (40-mg furosemide; DD) and once with no diuretic (CON) using a counter-balanced crossover design. Plasma volume change (%deltaPV), heart rate (HR), blood pressure, rectal temperature, serum electrolytes, plasma lactate, plasma glucose, rating of perceived exertion, thirst, and thermal sensations were measured before and after each race., Results: Sprint times (DD vs CON) for the 50 m (6.72 +/- 0.28 vs 6.73 +/- 0.29 s), 200 m (25.95 +/- 1.20 vs 26.21 +/- 1.42 s), and 400 m (59.01 +/- 4.26 vs 58.68 +/- 3.68 s) were similar for both conditions, as was vertical jump height (0.67 +/- 0.10 vs 0.66 +/- 0.11 m). This occurred despite losing 2.2 +/- 0.4% BM and 7.3 +/- 6.7%deltaPV (50/200 m) or 2.5 +/- 0.4% BM and 7.1 +/- 2.7% deltaPV (VJ/400 m) in response to DD., Conclusions: Diuretic-induced dehydration was not detrimental to sprint and power performance. Metabolic, thermoregulatory, and cardiovascular variables were not significantly altered by DD. Furthermore, the theoretical benefit of dehydration on performance (i.e., BM reduction) was not supported in this subject cohort.

Water in the human body is essential for metabolism, temperature regulation, and numerous other physiological processes that are consistent with good health. Accurate, precise, and reliable methods to assess body fluid compartments are needed. This review describes the hydration assessment techniques of isotope dilution, neutron activation analysis, bioelectrical impedance, body mass change, thirst, tracer appearance, hematologic indices, and urinary markers. It also provides guidance for selecting techniques that are appropriate for use with unique individuals and situations.

This investigation determined if 3 levels of controlled caffeine consumption affected fluid-electrolyte balance and renal function differently. Healthy males (mean +/- standard deviation; age, 21.6 +/- 3.3 y) consumed 3 mg caffeine . kg(-1) . d(-1). on days 1 to 6 (equilibration phase). On days 7 to 11 (treatment phase), subjects consumed either 0 mg (C0; placebo; n= 20), 3 mg (C3; n = 20), or 6 mg (C6; n = 19) caffeine . kg(-1) . d(-1) in capsules, with no other dietary caffeine intake. The following variables were unaffected (P > 0.05) by different caffeine doses on days 1, 3, 6, 9, and 11 and were within normal clinical ranges: body mass, urine osmolality, urine specific gravity, urine color, 24-h urine volume, 24-h Na+ and K+ excretion, 24-h creatinine, blood urea nitrogen, serum Na+ and K+, serum osmolality, hematocrit, and total plasma protein. Therefore, C0, C3, and C6 exhibited no evidence of hypohydration. These findings question the widely accepted notion that caffeine consumption acts chronically as a diuretic.

The purposes of this study were to characterize measures of fluid intake and perception of thirst in women over a 6-week period of exercise-heat acclimation and outdoor training and examine if this lengthy acclimation period would result in changes in fluid intake that differ from those previously reported in men utilizing a shorter acclimation protocol of 8-10 days. Voluntary water intake (11-17 degrees C) and perception of thirst were measured in a group of 5 women (21-26 yr) undergoing exercise-heat acclimation for 90 min/day, 3 days/wk (36 degrees C, rh 50-70%) and outdoor training 3 days/wk for 6 weeks. Decreased drinking during acclimation was characterized by a decrease in the number of drinks (35 +/- 10 to 17 +/- 5; p <.05), greater time to first drink (9.9 +/- 2.0 to 23.1 +/- 4.7 min; p <.05), and a decrease in total volume ingested per week (3310 +/- 810 to 1849 +/- 446 ml; p <.05) through the 6-week study. Mean perceived thirst measurements remained low and showed only slight variance (3 +/- 0.4 to 5 +/- 0.4). These observations support a psycho-physiological response pattern different than that previously observed during 8-10 day acclimation protocols in men.

To examine the effects of euhydration, mild-dehydration, rehydration, and ad libitum drinking on countermovement jump (CMJ), handgrip strength, and performance of balance error scoring system test (BESS). Eighteen healthy male subjects (mean[M]±standard deviation[SD]; age, 23±3y; body mass, 80.1 ± 9.7 kg; height, 175.8 ± 5.7 cm) participated in this study. Participants reported to the laboratory to perform CMJ, handgrip strength, and BESS with different hydration statuses (euhydrated, EUH; when they initially sensed thirst, THIRST; dehydrated, DEH; following 30 minutes of rehydration, REH; and following 24-h ad libitum drinking, AD). CMJ at EUH (M±SD; 54.6 ± 3.0 cm) was significantly higher than DEH (52.8 ± 3.0 cm, p = 0.027) and REH (52.6 ± 2.8 cm, p < 0.001). However, there was no difference between DEH and REH (p = 0.643). CMJ at THIRST (54.9 ± 3.0 cm, p = 0.004) was higher than REH. Also, AD (53.8 ± 2.8 cm, p = 0.027) was higher than REH. In left handgrip strength, THIRST (48.6 ± 9.5 kg) was higher than EUH (46.7 ± 10.1 kg, p = 0.018), DEH (45.8 ± 10.0 kg, p = 0.013), REH (46.1 ± 9.5 kg, p = 0.004), and AD (47.1 ± 9.7 kg, p = 0.05). Additionally, in the single-leg stance on a foam pad, more BESS errors were found at THIRST (6 ± 2) compared to EUH (5 ± 2, p = 0.007) and AD (5 ± 2, p = 0.002). The findings of this study were: ∼2% of mild dehydration induced by 24-h fluid restriction decreased lower body power measured by CMJ, acute rehydration did not restore the loss of lower body power induced by dehydration, and ∼0.5–0.9% of dehydration did not decrease lower body power. [ABSTRACT FROM AUTHOR]

Urine color (Ucol) as a hydration assessment tool provides practicality, ease of use, and correlates moderately to strongly with urine specific gravity (Usg) and urine osmolality (Uosm). Indicative of daily fluid turnover, along with solute and urochrome excretion in 24-hr samples, Ucol may also reflect dietary composition. Thus, the purpose of this investigation was to determine the efficacy of Ucol as a hydration status biomarker after nutritional supplementation with beetroot (880 mg), vitamin C (1000 mg), and riboflavin (200 mg). Twenty males (Mean ± SD\ age, 21 ± 2 y; body mass, 82.12 ± 15.58 kg; height, 1.77 ± 0.06 m) consumed a standardized breakfast and collected all urine voids on one control day (CON) and 1 day after consuming a standardized breakfast and a randomized and double-blinded supplement (SUP) over 3 weeks. Participants replicated exercise and diet for one day before CON, and throughout CON and SUP. Ucol, Usg, Uosm, and urine volume were measured in all 24-hr samples, and Ucol and Usg were measured in all single samples. Ucol was a significant predictor of single sample Usg after all supplements (p < .05). Interestingly, 24-hr Ucol was not a significant predictor of 24-h Usg and Uosm after riboflavin supplementation (p = .20, p = .21). Further, there was a significant difference between CON and SUP 24-h Ucol only after riboflavin supplementation (p < .05). In conclusion, this investigation suggests that users of the UCC (urine color chart) should consider riboflavin supplementation when classifying hydration status and use a combination of urinary biomarkers (e.g., Usg and Ucol), both acutely and over 24 hr. [ABSTRACT FROM AUTHOR]

Postexercise protein and sodium supplementation may aid recovery and rehydration. Preserved beef provides protein and contains high quantities of sodium that may alter performance related variables in runners. The purpose of this study was to determine the effects of consuming a commercial beef product postexercise on sodium and water balance. A secondary objective was to characterize effects of the supplementation protocols on hydration, blood pressure, body mass, and running economy. Eight trained males (age = 22 ± 3 y, ...O2max = 66.4 ± 4.2 ml⋅kg-1⋅min-1) completed three identical weeks of run training (6 run⋅wk-1, 45 ± 6 min⋅run-1, 74 ± 5% HRR). After exercise, subjects consumed either, a beef nutritional supplement (beef jerky; [B]), a standard recovery drink (SRD), or SRD+B in a randomized counterbalanced design. Hydration status was assessed via urinary biomarkers and body mass. No main effects of treatment were observed for 24 hr urine volume (SRD, 1.7 ± 0.5; B, 1.8 ± 0.6; SRD+B, 1.4 ± 0.4 L⋅d-1), urine specific gravity (1.016 ± 0.005, 1.018 ± 0.006, 1.017 ± 0.006) or body mass (68.4 ± 8.2, 68.3 ± 7.7, 68.2 ± 8.1 kg). No main effect of treatment existed for sodium intake--loss (-713 ± 1486; -973 ± 1123; -980 ± 1220 mg⋅d-1). Mean arterial pressure (81.0 ± 4.6, 81.1 ± 7.3, 83.8 ± 5.4 mm Hg) and average exercise running economy (...O2: SRD, 47.9 ± 3.2; B, 47.2 ± 2.6; SRD+B, 46.2 ± 3.4 ml⋅kg-1⋅min-1) was not affected. Urinary sodium excretion accounted for the daily sodium intake due to the beef nutritional supplement. Findings suggest the commercial beef snack is a viable recovery supplement following endurance exercise without concern for hydration status, performance decrements, or cardiovascular consequences. [ABSTRACT FROM AUTHOR]

Hypohydration has been shown to alter neuromuscular function. However, the longevity of these impairments remains unclear. To examine the effects of graded exercise-induced dehydration on neuromuscular control 24 hours after exercise-induced hypohydration. Crossover study. Laboratory. A total of 23 men (age = 21 ± 2 years, height = 179.8 ± 6.4 cm, mass = 75.24 ± 7.93 kg, maximal oxygen uptake [VO2max] = 51.7 ± 5.5 mL·kg−1·min−1, body fat = 14.2% ± 4.6%). Participants completed 3 randomized exercise trials: euhydrated arrival plus fluid replacement (EUR), euhydrated arrival plus no fluid (EUD), and hypohydrated arrival plus no fluid (HYD) in hot conditions (ambient temperature = 35.2°C ± 0.6°C, relative humidity = 31.3% ± 2.5%). Each trial consisted of 180 minutes of exercise (six 30-minute cycles: 8 minutes at 40% VO2max; 8 minutes, 60% VO2max; 8 minutes, 40% VO2max; 6 minutes, passive rest) followed by 60 minutes of passive recovery. We used the Landing Error Scoring System and Balance Error Scoring System (BESS) to measure movement technique and postural control at pre-exercise, postexercise and passive rest (POSTEX), and 24 hours postexercise (POST24). Differences were assessed using separate mixed-design (trial × time) repeated-measures analyses of variance. The magnitude of hypohydration at POSTEX was different among EUR, EUD, and HYD trials (0.2% ± 1%, 3.5% ± 1%, and 5% ± 0.9%, respectively; P <.05). We observed no differences in Landing Error Scoring System scores at pre-exercise (2.9 ± 1.6, 3.0 ± 2.1, 3.0 ± 2.0), POSTEX (3.3 ± 1.5, 3.0 ± 2.0, 3.1 ± 1.9), or POST24 (3.3 ± 1.9, 3.2 ± 1.4, 3.3 ± 1.6) among the EUD, EUR, and HYD trials, respectively (P =.90). Hydration status did not affect BESS scores (P =.11), but BESS scores at POSTEX (10.4 ± 1.1) were greater than at POST24 (7.7 ± 0.9; P =.03). Whereas exercise-induced dehydration up to 5% body mass did not impair movement technique or postural control 24 hours after a prolonged bout of exercise in a hot environment, postural control was impaired at 60 minutes after prolonged exercise in the heat. Consideration of the length of recovery time between bouts of exercise in hot environments is warranted. [ABSTRACT FROM AUTHOR]

Context: Exertional heat exhaustion (HEX) is the most common form of heat illness experienced by athletes, laborers, and military personnel. Both dehydration stemming from a water and/or salt deficiency and a high ambient temperature must exist for HEX to occur. In the field, appropriate therapy can reduce recovery time. Objective: This manuscript provides clinical guidance regarding return to activity. The primary focus of this paper is to describe the evaluation of residual effects and the underlying personal characteristics that initially predispose the athlete to HEX. Attention to these factors will reduce the risk of future episodes. [ABSTRACT FROM AUTHOR]

Context: Dieticians, physiologists, athletic trainers, and physicians have recommended refraining from caffeine intake when exercising because of possible fluid-electrolyte imbalances and dehydration. Objective: To assess how 16-hour rehydration is affected by caffeine ingestion. Design: Dose-response. Setting: Environmental chamber. Participants: 59 college-age men. Intervention: Sub-jects consumed a chronic caffeine dose of 0 (placebo), 3, or 6 mg · kg-1 · day-1 and performed an exercise heat-tolerance test (EHT) consisting of 90 minutes of walking on a treadmill (5.6 km/h) in the heat (37.7 °C). Outcome Measures: Fluid-electrolyte measures. Results: There were no between-group differences immediately after and 16 hours after EHT in total plasma protein, hematocrit, urine osmolality, specific gravity, color, and volume. Body weights after EHT and the following day (16 hours) were not different between groups (P > .05). Conclusion: Hydration status 16 hours after EHT did not change with chronic caffeine ingestion. [ABSTRACT FROM AUTHOR]

Presents a review which aimed to critique controlled investigations regarding the effects of caffeine on dehydration and exercise performance and ascertain whether abstaining from caffeinated beverages is scientifically and physiologically justifiable. Consumption of caffeine; Discussion on caffeine pharmacology; Metabolic and ergogenic properties of caffeine; Regulations of sports governing bodies.

Exercise, especially in the heat, can contribute to acute kidney injury, which can expedite chronic kidney disease onset. The additional stress of ibuprofen use is hypothesized to increase renal stress.Objectives: To observe the effects of endurance cycling in the heat on renal function. Secondarily, we investigated the effect of ibuprofen ingestion on kidney stress.Design: Randomized, placebo controlled and observational methods were utilized.Methods: Forty cyclists (52±9y, 21.7±6.5% body fat) volunteered and completed an endurance cycling event (5.7±1.2h) in the heat (33.2±5.0°C, 38.4±10.7% RH). Thirty-five participants were randomized to ingest a placebo (n=17) or 600mg ibuprofen (n=18) pre-event. A blood sample was drawn before and following the event. Serum creatinine was assessed by colorimetric assay. An ELISA was used to measure serum neutrophil gelatinase-associated lipocalin. Fractional excretion of sodium was calculated after urinary and serum electrolyte analyses.Results: Placebo versus ibuprofen groups contributed no significant difference in any variable (p>0.05). Serum creatinine significantly increased from pre- (0.52±0.14mg/dL) to post-event (0.88±0.21mg/dL; p<0.001). Serum neutrophil gelatinase-associated lipocalin significantly increased (pre: 68.51±17.54ng/mL; post: 139.12±36.52ng/mL; p<0.001) and fractional excretion of sodium was significantly reduced from pre- (0.52±0.24%) to post-event (0.27±0.18%; p<0.001).Conclusions: Changes in renal biomarkers suggest mild acute kidney injury and reduced kidney function during a single bout of endurance cycling in the heat, without influence from moderate ibuprofen ingestion. [ABSTRACT FROM AUTHOR]