Exertional Hyponatremia and Serum Sodium Change During Ultraendurance Cycling.

INTRODUCTION: Exertional hyponatremia (EH) during prolonged exercise involves all avenues of fluid-electrolyte gain and loss. Although previous research implicates retention of excess fluid, EH may involve either loss, gain, or no change of body mass. Thus, the etiology, predisposing factors, and recommendations for prevention are vague-except for advice to avoid excessive drinking. PURPOSE: This retrospective field study presents case reports of two unacquainted recreational cyclists (LC, 31y and AM, 39 years) who began exercise with normal serum electrolytes but finished a summer 164-km ride (ambient, 34±5°C) with a serum [Na+] of 130 mmol/L. METHODS: To clarify the etiology of EH, their pre- and post-exercise measurements were compared to a control group (CON) of 31 normonatremic cyclists (mean ± SD; 37±6 years; 141±3 mmol Na+/L). RESULTS: Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. These two hyponatremic cyclists consumed a large and similar volume of fluid (191 and 189 ml/kg), experienced an 11 mmol/L decrease of serum [Na+], reported low thirst sensations; however, LC gained 3.1 kg (+4.3% of body mass) during 8.9 hr of exercise and AM maintained body mass (+0.1kg, +0.1%, 10.6h). In the entire cohort (n = 33), post-event serum [Na+] was strongly correlated with total fluid intake (R2 = 0.45, p < .0001), and correlated moderately with dietary sodium intake (R2=0.28, p = .004) and body mass change (R2 = 0.22, p = .02). Linear regression analyses predicted the threshold of EH onset (<135 mmol Na+/L) as 168 ml fluid/kg. CONCLUSIONS: The wide range of serum [Na+] changes (+6 to -11 mmol/L) led us to recommend an individualized rehydration plan to athletes because the interactions of factors were complex and idiosyncratic.

Effect of Caffeine on Perceived Soreness and Functionality Following an Endurance Cycling Event.

Caldwell, AR, Tucker, MA, Butts, CL, McDermott, BP, Vingren, JL, Kunces, LJ, Lee, EC, Munoz, CX, Williamson, KH, Armstrong, LE, and Ganio, MS. Effect of caffeine on perceived soreness and functionality following an endurance cycling event. J Strength Cond Res 31(3): 638-643, 2017-Caffeine can reduce muscle pain during exercise; however, the efficacy of caffeine in improving muscle soreness and recovery from a demanding long-duration exercise bout has not been established. The purpose of this study was to investigate the effects of caffeine intake on ratings of perceived muscle soreness (RPMS) and perceived lower extremity functionality (LEF) following the completion of a 164-km endurance cycling event. Before and after cycling RPMS (1-to-6; 6 = severe soreness) and LEF (0-to-80; 80 = full functionality) were assessed by questionnaires. Subjects ingested 3 mg/kg body mass of caffeine or placebo pills in a randomized, double-blind fashion immediately after the ride and for the next 4 mornings (i.e., ∼800 hours) and 3 afternoons (i.e., ∼1200 hours). Before each ingestion, RPMS and LEF were assessed. Afternoon ratings of LEF were greater with caffeine ingestion the first day postride (65.0 ± 6.1 vs. 72.3 ± 6.7; for placebo and caffeine, respectively; p = 0.04), but at no other time points (p > 0.05). The caffeine group tended to have lower overall RPMS in the afternoon versus placebo (i.e., main effect of group; 1.1 ± 0.2 vs. 0.5 ± 0.2; p = 0.09). Afternoon RPMS for the legs was significantly lower in the caffeine group (main effect of caffeine; 1.3 ± 0.2 vs. 0.5 ± 0.3; p = 0.05). In conclusion, ingesting caffeine improved RPMS for the legs, but not LEF in the days following an endurance cycling event. Athletes may benefit from ingesting caffeine in the days following an arduous exercise bout to relieve feelings of soreness and reduced functionality.

Blood Hemostatic Changes During an Ultraendurance Road Cycling Event in a Hot Environment.

OBJECTIVE: This study aims to examine blood hemostatic responses to completing a 164-km road cycling event in a hot environment. METHODS: Thirty-seven subjects (28 men and 9 women; 51.8±9.5 [mean±SD] y) completed the ride in 6.6±1.1 hours. Anthropometrics (height, body mass [taken also during morning of the ride], percent body fat [%]) were collected the day before the ride. Blood samples were collected on the morning of the ride (PRE) and immediately after (IP) the subject completed the ride. Concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers (platelet factor 4, ß-thromboglobulin, von Willebrand factor antigen, thrombin-antithrombin complex, thrombomodulin, and D-Dimer) were measured. Associations between changes from PRE- to IP-ride were examined as a function of event completion time and subject characteristics (demographics and anthropometrics). RESULTS: All blood hemostatic markers increased significantly (P < .001) from PRE to IP. After controlling for PRE values, finishing time was negatively correlated with platelet factor 4 (r = 0.40; P = .017), while percent body fat (%BF) was negatively correlated with thrombin-antithrombin complex (r = -0.35; P = .038) and to thrombomodulin (r = -0.36; P = .036). In addition, male subjects had greater concentrations of thrombin-antithrombin complex (d = 0.63; P < .05) and natural logarithm thrombomodulin (d = 6.42; P < .05) than female subjects. CONCLUSION: Completing the 164-km road cycling event in hot conditions resulted in increased concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers in both men and women. Although platelet activation and coagulation occurred, the fibrinolytic system markers also increased, which appears to balance blood hemostasis and may prevent clot formation during exercise in a hot environment.

Endurance Cyclist Fluid Intake, Hydration Status, Thirst, and Thermal Sensations: Gender Differences.

This field investigation assessed differences (e.g., drinking behavior, hydration status, perceptual ratings) between female and male endurance cyclists who completed a 164-km event in a hot environment (35 °C mean dry bulb) to inform rehydration recommendations for athletes. Three years of data were pooled to create 2 groups of cyclists: women (n = 15) and men (n = 88). Women were significantly smaller (p < .001) than men in height (166 ± 5 vs. 179 ± 7 cm), body mass (64.6 ± 7.3 vs. 86.4 ± 12.3 kg), and body mass index (BMI; 23.3 ± 1.8 vs. 26.9 ± 3.4) and had lower preevent urinary indices of hydration status, but were similar to men in age (43 ± 7 years vs. 44 ± 9 years) and exercise time (7.77 ± 1.24 hr vs. 7.23 ± 1.75 hr). During the 164-km ride, women lost less body mass (-0.7 ± 1.0 vs. -1.7 ± 1.5 kg; -1.1 ± 1.6% vs. -1.9 ± 1.8% of body weight; p < .005) and consumed less fluid than men (4.80 ± 1.28 L vs. 5.59 ± 2.13 L; p < .005). Women consumed a similar volume of fluid as men, relative to body mass (milliliters/kilogram). To control for performance and anthropomorphic characteristics, 15 women were pair-matched with 15 men on the basis of exercise time on the course and BMI; urine-specific gravity, urine color, and body mass change (kilograms and percentage) were different (p < .05) in 4 of 6 comparisons. No gender differences were observed for ratings of thirst, thermal sensation, or perceived exertion. In conclusion, differences in relative fluid volume consumed and hydration indices suggest that professional sports medicine organizations should consider gender and individualized drinking plans when formulating pronouncements regarding rehydration during exercise.

Effect of cycling in the heat for 164 km on procoagulant and fibrinolytic parameters.

PURPOSE: We assessed the impact of completing the Hotter'n Hell Hundred (HHH), an annual 164 km road cycling event performed in a hot environment, on hemostatic balance in men. METHODS: Sixteen men who completed the ride in <6 h were included in this study. Plasma samples were collected on that morning of the ride (PRE) and immediately on the completion of the ride (IP). Primary hemostasis was assessed by platelet count and von Willebrand factor antigen (vWF:Ag). Coagulation was assessed by measuring prothrombin fragment 1 + 2 (PTF 1 + 2) and thrombin-antithrombin complex (TAT), whereas fibrinolysis was assessed by plasminogen activator inhibitor antigen (PAI-1 Ag), tissue plasminogen activator (tPA Ag), and D-Dimer analyses. RESULTS: Compared to PRE, increases (p < 0.001) were observed at IP for platelets (39 %), vWF:Ag (65 %), PTF 1 + 2 (47 %), TAT (81 %), tPA Ag (231 %), PAI-1 Ag (148 %), and D-Dimer (54 %). PRE PAI-1 Ag concentrations were directly related to BMI and waist circumference (p < 0.05). D-Dimer concentrations at IP correlated positively with age (p < 0.05). CONCLUSIONS: Completing the HHH activated the coagulation and fibrinolytic systems in balance. Age was positively correlated with IP D-Dimer concentrations. Additionally, participants displaying a larger BMI and waist circumference exhibited a positive correlation with PRE PAI-1 Ag concentrations.

Effective body water and body mass changes during summer ultra-endurance road cycling.

Because body mass change (ΔMb) does not represent all water losses and gains, the present field investigation determined if (a) ΔMb equalled the net effective body water change during ultra-endurance exercise and (b) ground speed and exercise duration influenced these variables. Thirty-two male cyclists (age range, 35-52 years) completed a 164-km event in a hot environment, were retrospectively triplet matched and placed into one of three groups based on exercise duration (4.8, 6.3, 9.6 h). Net effective body water loss was computed from measurements (body mass, total fluid intake and urine excreted) and calculations (water evolved and mass loss due to substrate oxidation, solid food mass and sweat loss), including (ΔEBWgly) and excluding (ΔEBW) water bound to glycogen. With all cyclists combined, the mean ΔMb (i.e. loss) was greater than that of ΔEBWgly by 1200 ± 200 g (P = 1.4 × 10(-18)), was similar to ΔEBW (difference, 0 ± 200 g; P = .21) and was strongly correlated with both (R(2) = .98). Analysis of equivalence indicated that ΔMb was not equivalent to ΔEBWgly, but was equivalent to ΔEBW. Due to measurement complexity, we concluded that (a) athletes will not calculate the effective body water calculations routinely and (b) body mass change remains a useful field-expedient estimate of net effective body water change.

Ultraendurance cycling in a hot environment: thirst, fluid consumption, and water balance.

The purpose of this field investigation was to identify and clarify factors that may be used by strength and conditioning professionals to help athletes drink adequately but not excessively during endurance exercise. A universal method to accomplish this goal does not exist because the components of water balance (i.e., sweat rate, fluid consumed) are different for each athlete and endurance events differ greatly. Twenty-six male cyclists (mean ± SD; age, 41 ± 8 years; height, 177 ± 7 cm; body mass, 81.85 ± 8.95 kg) completed a summer 164-km road cycling event in 7.0 ± 2.1 hours (range, 4.5-10.4 hours). Thirst ratings, fluid consumed, indices of hydration status, and body water balance (ingested fluid volume - [urine excreted + sweat loss]) were the primary outcome variables. Measurements were taken before the event, at designated aid stations on the course (52, 97, and 136 km), and at the finish line. Body water balance during exercise was not significantly correlated with exercise time on the course, height, body mass, or body mass index. Thirst ratings were not significantly correlated with any variable. We also observed a wide range of total sweat losses (4.9-12.7 L) and total fluid intakes (2.1-10.5 L) during this ultraendurance event. Therefore, we recommend that strength and conditioning professionals develop an individualized drinking plan for each athlete, by calculating sweat rate (milliliter per hour) on the basis of body mass change (in kilograms), during field simulations of competition.

Nutritional, physiological, and perceptual responses during a summer ultraendurance cycling event.

Despite the rapid growth of mass participation road cycling, little is known about the dietary, metabolic, and behavioral responses of ultraendurance cyclists. This investigation describes physiological responses, perceptual ratings, energy balance, and macronutrient intake of 42 men (mean ± SD; age, 38 ± 6 years; height, 179.7 ± 7.1 cm; body mass, 85.85 ± 14.79 kg) and 6 women (age, 41 ± 4 years; height, 168.0 ± 2.9 cm; body mass, 67.32 ± 7.21 kg) during a summer 164-km road cycling event. Measurements were recorded 1 day before, and on the Event Day (10.5 hours) at the start (0 km), at 2 aid stations (52 and 97 km), and at the finish line (164 km). The ambient temperature was >39.0° C during the final 2 hours of exercise. The mean finish times for men (9.1 ± 1.2 hours) and women (9.0 ± 0.2 hours) were similar, as were mean gastrointestinal temperature (TGI), 4 hydration biomarkers, and 5 perceptual (e.g., thermal, thirst, pain) ratings. Male cyclists consumed enough fluids on the Event Day (5.91 ± 2.38 L; 49% water) to maintain body mass within 0.76 kg, start to finish, despite a sweat loss of 1.13 ± 0.54 L·h(-1) and calculated energy expenditure of 3,115 kcal·10.5·h(-1). However, men voluntarily underconsumed food energy (deficit of 2,594 kcal, 10.9 MJ) and specific macronutrients (carbohydrates, 106 ± 48 g; protein, 8 ± 7 g; and sodium, 852 ± 531 mg) between 0530 and 1400 hours. Also, a few men exhibited extreme final values (i.e., urine specific gravity of 1.035-1.038, n = 5; body mass loss >4 kg, n = 2; T(GI), 39.4 and 40.2°C). We concluded that these findings provide information regarding energy consumption, macronutrient intake, hydration status, and the physiological stresses that are unique to ultraendurance exercise in a hot environment.

Drinking to thirst versus drinking ad libitum during road 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.