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      National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active

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          Abstract

          <div class="section"> <a class="named-anchor" id="st1"> <!-- named anchor --> </a> <h5 class="section-title" id="d7115793e206">Objective: </h5> <p id="d7115793e208">To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals. </p> </div><div class="section"> <a class="named-anchor" id="st2"> <!-- named anchor --> </a> <h5 class="section-title" id="d7115793e211">Background: </h5> <p id="d7115793e213">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. </p> </div><div class="section"> <a class="named-anchor" id="st3"> <!-- named anchor --> </a> <h5 class="section-title" id="d7115793e216">Recommendations: </h5> <p id="d7115793e218">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. </p> </div>

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          Most cited references177

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          National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses.

          To present best-practice recommendations for the prevention, recognition, and treatment of exertional heat illnesses (EHIs) and to describe the relevant physiology of thermoregulation.
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            Urinary indices of hydration status.

            Athletes and researchers could benefit from a simple and universally accepted technique to determine whether humans are well-hydrated, euhydrated, or hypohydrated. Two laboratory studies (A, B) and one field study (C) were conducted to determine if urine color (Ucol) indicates hydration status accurately and to clarify the interchangeability of Ucol, urine osmolality (Uosm), and urine specific gravity (Usg) in research. Ucol, Uosm, and Usg were not significantly correlated with plasma osmolality, plasma sodium, or hematocrit. This suggested that these hematologic measurements are not as sensitive to mild hypohydration (between days) as the selected urinary indices are. When the data from A, B, and C were combined, Ucol was strongly correlated with Usg and Uosm. It was concluded that (a) Ucol may be used in athletic/industrial settings or field studies, where close estimates of Usg or Uosm are acceptable, but should not be utilized in laboratories where greater precision and accuracy are required, and (b) Uosm and Usg may be used interchangeably to determine hydration status.
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              Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans

              Literature from the past 168 years has been filtered to provide a unified summary of the regional distribution of cutaneous water and electrolyte losses. The former occurs via transepidermal water vapour diffusion and secretion from the eccrine sweat glands. Daily insensible water losses for a standardised individual (surface area 1.8 m2) will be 0.6–2.3 L, with the hands (80–160 g.h−1) and feet (50–150 g.h−1) losing the most, the head and neck losing intermediate amounts (40–75 g.h−1) and all remaining sites losing 15–60 g.h−1. Whilst sweat gland densities vary widely across the skin surface, this same individual would possess some 2.03 million functional glands, with the highest density on the volar surfaces of the fingers (530 glands.cm−2) and the lowest on the upper lip (16 glands.cm−2). During passive heating that results in a resting whole-body sweat rate of approximately 0.4 L.min−1, the forehead (0.99 mg.cm−2.min−1), dorsal fingers (0.62 mg.cm−2.min−1) and upper back (0.59 mg.cm−2.min−1) would display the highest sweat flows, whilst the medial thighs and anterior legs will secrete the least (both 0.12 mg.cm−2.min−1). Since sweat glands selectively reabsorb electrolytes, the sodium and chloride composition of discharged sweat varies with secretion rate. Across whole-body sweat rates from 0.72 to 3.65 mg.cm−2.min−1, sodium losses of 26.5–49.7 mmol.L−1 could be expected, with the corresponding chloride loss being 26.8–36.7 mmol.L−1. Nevertheless, there can be threefold differences in electrolyte losses across skin regions. When exercising in the heat, local sweat rates increase dramatically, with regional glandular flows becoming more homogeneous. However, intra-regional evaporative potential remains proportional to each local surface area. Thus, there is little evidence that regional sudomotor variations reflect an hierarchical distribution of sweating either at rest or during exercise.
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                Author and article information

                Journal
                Journal of Athletic Training
                Journal of Athletic Training
                Journal of Athletic Training/NATA
                1062-6050
                September 2017
                September 2017
                : 52
                : 9
                : 877-895
                Article
                10.4085/1062-6050-52.9.02
                5634236
                28985128
                965341d6-bd47-47e6-ab99-7ce46e5933a0
                © 2017
                History

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