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H20

Guidelines for Proper Hydration
by: National Athletic Training Association
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Working out means working up a sweat. In fact, many people believe the more you sweat, the better the workout. But losing all that fluid is just your body's way of cooling itself. You have to give back what's lost in a workout. If you don't, you are putting yourself at risk of dehydration that could end with serious consequences.

The National Athletic Trainers' Association has a Position Statement explaining the role of proper hydration in athletic performances. Take the time to read these recommendations, or pass them on to someone you know who might benefit from the facts.

Tips for Proper Hydration

1. Establish a hydration protocol for athletes (if you are a certified athletic trainer).

2.When developing the protocol, consider each sport's unique features to determine how often rehydration will occur.

3. Beverages should be easily accessible in individual fluid containers and flavored to the athlete's preference. Clear water bottles with 100-mL marks offer a visual reminder to drink, and carrying water bottles during exercise also encourages drinking.

4. Begin all workouts well hydrated. You can tell your body is properly hydrated by the color of urine - in general, the lighter the urine, the better hydrated the body. Another easy guide: weigh yourself before and after a workout to gauge fluid loss.

5. Drink about 17-20 fluid ounces of water or a sports drink two to three hours before excercise. Then, drink about 7-10 fluid ounces 10-20 minutes before the workout.

6. Fluid replacement should approximate sweat and urine losses and at least maintain hydration at less than two percent body weight loss. Usually, this requires drinking 7-10 fluid ounces every 10-20 minutes. But be sure to tailor rehydration to each athlete and setting. Dangerous hyperhydration is also a risk if athletes drink according to published recommendations rather than individual needs.

7. Post-workout hydration should aim to correct any fluid loss. Ideally completed within two hours of the exercise, rehydration should include water to restore hydration; carbohydrates to replenish glycogen; and electrolytes to speed the process. When rehydration must occur quickly, compensate for the resulting urine losses by drinking 25-50 percent more.

8. Fluid temperature influences the amount you drink. While each person's preferences are unique, a cool beverage of 50-59 degrees Fahrenheit is recommended.

9. The Wet Bulb Globe Temperature (WBGT) should be determined in hot environments. Very high relative humidity will limit evaporative cooling; the air is nearly saturated with water vapor, and evaporation is minimized. Thus, dehydration from high sweat losses can induce a rapid core temperature increase, which in turn can lead to dangerous health conditions.

10. Carbohydrates can sometimes help with rehydration. Consuming carbs during your pre-workout hydration - along with a healthy diet - can increase your glycogen stores. If you plan an intense workout, consume carbs about a half hour beforehand. Some types of carbs are not suitable, though: limit fructose and avoid caffeine, alcohol and carbonated drinks.

11. If you supervise athletes, make sure you can recognize the following signs of dehydration:

• Thirst
• Irritability
• General discomfort
• Headache
• Weakness
• Dizziness
• Cramps
• Chills
• Vomiting or nausea
• Head or neck heat sensations
• Decreased performance

If an athlete gets dehydrated but is still mentally alert and has no gastrointestinal pain, then s/he can rehydrate by drinking beverages. But, if the athlete has lost consciousness, has become confused or is suffering GI pain, get him/her to a medical facility immediately for IV fluid replacement.

12. Consider including sodium chloride in rehydration beverages if you have not eaten, if your workout is going to last more than four hours or if you're in the first days of hot weather. Under these conditions, adding modest amounts of salt to the beverage can offset salt loss and minimize medical events associated with electrolyte imbalance (such as muscle cramps). If you want to stimulate voluntary fluid intake and decrease the risk of hyponatremia, you can add small amounts of salt (0.3 to 0.7 g/L) to beverages.

13. Whenever possible, calculate sweat rate for yourself or your athletes. (Sweat rate = pre-workout body weight - post-workout body weight + fluid intake - urine volume/workout time in hours.) This can be time-consuming, but it's the most fundamental consideration when deciding how to properly rehydrate. Average sweat rates can vary from 0.5L/h to more than 2.5L/h.

14. Heat acclimitization induces physiologic changes that may alter rehydration considerations for each person.

First, realize that sweat rates generally increase after 10-14 days of heat exposure.

Second, moving from a cool climate to a hot one increases the overall sweat rate per workout.

Third, a higher sodium intake may be warranted during the first three to five days of heat exposure. After five to 10 days, normal sodium intake should be sufficient.

15. Be careful if you practice hyperhydration by ingesting a glycerol and water beverage before working out. It's too early to tell whether this practice is suitable, as more research is needed. Also, there is a risk of side effects like headaches and gastrointestinal distress when you take glycerol.

16. If you're working with prepubescent and adolescent athletes, realize they may not fully understand the medical implications of proper hydration. Take steps to minimize environmental stress and maximize time for fluid replacement. Keep a good supply of the most palatable beverage on hand. Educate parents and coaches about rehydration and the signs of dehydration. Monitor and remove a child from activity promptly if you see any signs of dehydration.

17. If you're hosting a large event, such as a tournament or camp, plan ahead. Make sure you'll have plenty of hydration supplies (cups, beverages, coolers) on hand. Make sure you've got plenty of staff to help monitor hydration status of all the participants. Keep an eye on the WBGT and modify events if neccessary. Also, give each participant plenty of educational material explaining the role and importance of proper hydration.

18. Keep in mind these tips for hydration education:

• Make sure athletes understand how dehydration can negatively affect their physical performance.
• Show and tell athletes how to monitor hydration status.
• Convince athletes to be active participants in their own hydration protocol, based on sweat rate, drinking preferences and personal responses to different fluid quantities.
• Encourage coaches to make rehydration mandatory during practice and games.
• Provide a scale to help athletes monitor their weight before, during and after a workout.
• Provide the optimal oral rehydration solution (water, carbs and electrolytes) before, during and after exercise.
• Use your hydration protocol during all practices and games, and adapt it as needed.
• Encourage event scheduling and rule modifications to minimize the risks of exercising in the heat.

Learn More

The full text of "Position Statement: Fluid Replacement for Athletes" can be found in the Journal of Athletic Training, Vol. 35 #2, p. 212-224. The text also is available on-line at www.nata.org.

Condensed from Journal of Athletic Training 2000; 35(2): 212-224

"NATA Position Statement: Fluid Replacement for Athletes," by Douglas J. Casa, PhD, ATC, CSCS; Lawrence E. Armstrong, PhD, FACSM; Susan K. Hillman, MS, MA, ATC, PT; Scott J. Montain, PhD, FACSM; Ralph V. Reiff, MEd, ATC; Brent S.E. Rich, MD, ATC; William O. Roberts, MD, MS, FACSM; Jennifer A. Stone, MS, ATC

Copyright by the National Athletic Trainers' Association, Inc.





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