Validity of combined hydration self-assessment measurements to estimate a low vs. high urine concentration in a small sample of (tactical) athletes.

PURPOSE: Relationships between body weight, urine color (Uc), and thirst level (WUT) have been proposed as a simple and inexpensive self-assessment method to predict dehydration. This study aimed to determine if this method also allowed us to accurately identify a low vs. high urine concentration in (tactical) athletes. METHODS: A total of n = 19 Army Reserve Officer Training Corps cadets and club sports athletes (22.7 ± 3.8 years old, of which 13 male) were included in the analysis, providing morning body weight, thirst sensation, and Uc for five consecutive days. Each item received a score 0 or 1, resulting in a WUT score ranging from 0 (likely hydrated) to 3 (very likely dehydrated). WUT model and individual item outcomes were then compared with a ≥ 1.020 urine specific gravity (USG) cut-off indicating a high urine concentration, using descriptive comparisons, generalized linear mixed models, and logistic regression (to calculate the area under the curve (AUC)). RESULTS: WUT score was not significantly predictive of urine concentration, z = 1.59, p = 0.11. The AUC ranged from 0.54 to 0.77 for test days, suggesting a fair AUC on most days. Only Uc was significantly related to urine concentration, z = 2.49, p = 0.01. The accuracy of the WUT model for correctly classifying urine samples with a high concentration was 68% vs. 51% of samples with a low concentration, resulting in an average accuracy of 61%. CONCLUSION: This study shows that WUT scores were not predictive of urine concentration, and the method did not substantially outperform the accuracy of Uc scoring alone.

Voluntary Urinary Retention Effects on Cognitive Performance.

INTRODUCTION: Aircrew in-flight bladder relief remains an understudied stressor; specifically the effects of withholding urination on flight-relevant cognitive performance. This quasi-experimental study investigated whether voluntary urinary retention over a 3-h period negatively impacted cognitive performance.METHODS: We assessed vigilance using the psychomotor vigilance task (PVT) and measured the P3b event-related potential (ERP) in response to PVT stimuli. We also measured working memory (WM) performance using a change detection task and assessed the contralateral delay activity during the WM task using electroencephalography (EEG). Subjects (N = 29) completed a baseline test on both tasks, following bladder voiding and immediately after consuming 0.75 L of water. Subjects performed tasks at 1, 2, and 3 h post-void and urgency to void one's bladder was assessed regularly. A total of 17 subjects were able to complete the entire study protocol. Repeated-measures ANOVAs assessed changes in PVT and WM outcomes.RESULTS: Reaction time (RT) on the PVT was significantly impaired (5% slower) with longer urinary retention time and showed a 2.5-fold increase in the number of lapses (RT > 500 ms) with increased retention time. Together these results indicate that sustained attention was impaired with increased voluntary urine retention. We did not see significant changes in WM performance with our manipulations. Additionally, neural measures acquired with EEG for both tasks did not show any significant effect.DISCUSSION: As measured with the PVT, sustained attention was impaired during 3 h of voluntary urinary retention, highlighting the need for further development of adequate bladder relief systems in military aviation.Griswold CA, Vento KA, Blacker KJ. Voluntary urinary retention effects on cognitive performance. Aerosp Med Hum Perform. 2023; 94(2):79-85.

Funding and college-provided nutritional resources on diet quality among female athletes.

ObjectiveTo examine funding and college-provided nutritional resources and to assess whether these are associated with diet quality and subsequent dietitian referral among female collegiate athletes of different sports levels. Participants: Female athletes (N = 120) from NCAA, NJCAA, and Club sports. Methods: Differences in questionnaire-based demographics, diet quality, and dietitian referrals were analyzed using Kruskal-Wallis and Chi-Square tests, with p < 0.05. Factors associated with diet quality and dietitian referral were examined using regression. Results: NCAA reported more funding than Club and NJCAA (p < 0.05). NJCAA expressed insufficient funds for purchasing food and reported fewer college-provided nutritional resources (p < 0.05) while showing lower diet quality scores and higher subsequent dietitian referrals than NCAA and Club. No significant associations for dietary quality and dietitian referrals were found. Conclusions: Athletes across all sports levels reported insufficient funds for purchasing food and low diet quality, with NJCAA, showing the least funding and fewest nutritional resources.

Sex comparisons in physiological and cognitive performance during hypoxic challenge.

Within the tactical aviation community, human performance research lags in considering potential psychophysiological differences between male and female aviators due to little inclusion of females during the design and development of aircraft systems. A poor understanding of how male and female aviators differ with respect to human performance results in unknown potential sex differences on aeromedically relevant environmental stressors, perchance leading to suboptimal performance, safety, and health guidelines. For example, previous hypoxia studies have excluded female participants or lacked a sizeable sample to examine sex comparisons. As such, progress toward sensor development and improving hypoxia familiarization training are stunted due to limited knowledge of how individual differences, including sex, may or may not underlie hypoxia symptoms and performance impairment. Investigating sex differences bridges the gap between aerospace medicine and operational health, and addressing hypoxia is one of many facets yet to be studied. In the current study, we retrospectively examined N = 6 hypoxia studies with male-female participant samples (total, N = 189; male, n = 118; female, n = 71). We explored sex as a predictor of physiological response, sensory deficits, the severity of cognitive performance declines, and symptom manifestation via linear and binary logistic regression models. We found that the female sex predicted lower peripheral oxygen saturation and the likelihood of headache reporting in response to hypoxic challenge, yet explained little variance when combined with age and body mass index. The sensory and cognitive performance models did not converge, suggesting high intra-individual variability. Together, sex, age, and body mass index were not the most robust predictors in responses to hypoxic challenge; we cannot infer this for sensory deficits and cognitive performance within an experimentally induced hypoxic environment. The findings have implications for improving hypoxia familiarization training, monitoring sensor development, and emergency response and recovery protocols in case of a hypoxia occurrence suitable for all aircrew. We recommend continuing to elucidate the impact of sex and intrapersonal differences in hypoxia and other aeromedically relevant stressors in tactical aviation.

Effect of increased water intake on uropathogenic bacterial activity of underhydrated menstruating young adult women: A randomized crossover trial.

Background: Females are prone to urinary tract infections (UTIs) due to estrogen fluctuations affecting vaginal flora. While menstruating, increased fluid consumption to support urination frequency and void volume may be important, as the urethra and urinary tract are more predisposed to bacteria, particularly UTI pathogens. Aim: This study aimed to investigate the impact of hydration on urinary tract health during menstruation among underhydrated premenopausal women. Methods: Thirteen females participated in a 60-day 2 × 2 randomized crossover trial to evaluate the effectiveness of consuming ≥2.2 L of total beverage fluid intake, with 1.9 L being water, (intervention, INT) and maintaining habitual fluid intake (control, CON) on two subsequent menses. Participants completed fluid and urination diaries at days 2 and 5 after the onset of bleeding (day 1) to determine the fluid amount consumed and urination frequency. Urine concentration was assessed in afternoon (days 2 and 5) and uropathogenic bacterial activity in first-morning (days 3 and 6) urinations. General linear models assessed differences in bacterial and hydration outcomes. Results: The intervention led to a 62% mean total fluid increase, INT 3.0 ± 1.1 L and CON 1.9 ± 0.9 L, p < 0.001, η2 = 0.459. Urination frequency was greater and urine concentration less in the INT to CON, all ps < 0.05, η2 range = 0.023-0.019. Only four cultures detected uropathogenic bacteria, with no patterns between conditions or days, making it difficult to determine the intervention's effectiveness. Conclusion: Fluid intake increased, and hydration status improved. No differences in uropathogenic bacterial activity were seen between the hydration and control conditions.

The effects of three different types of macronutrient feedings on golf performance and levels of fatigue and alertness.

Background: No study has evaluated the effect of macronutrient feedings on golf performance. Aim: Determine the effect of feedings during simulated golf game using a randomized cross-over study design. Methods: Male participants (n = 6, USGA handicap index 8.5 ± 6.72) played three standardized nine-hole rounds, consuming 30 g of carbohydrate, 15 g + 15 g protein and carbohydrate, or a zero-calorie control. Measurements of driving, chipping, and putting distance and accuracy were taken, as well as perceived levels of fatigue and alertness. Results: No relevant differences (P > 0.05) were seen in golf performance or alertness, but self-reported fatigue differed between conditions (P = 0.02), with scores of 2.5 (0.8 to 3.6) for the combination of carbohydrate and protein, 3.0 (1.5 to 4.3) for carbohydrate, and 4.0 (2.9 to 6.5) for the control, with higher levels indicating more fatigue. Conclusion: Macronutrient feedings led to a significantly lower level of self-reported fatigue without affecting golf performance and alertness compared to a control.

Using Nutrition Knowledge and Diet Quality Questionnaires as Screening Tools to Identify Female Collegiate Athletes in Need of Dietitian Referral.

The purpose of this study was to evaluate nutrition knowledge and diet quality in collegiate athletes to determine if referral to a sports registered dietitian (RD) is warranted. This cross-sectional study analyzed four sections of the Nutrition for Sport Knowledge Questionnaire and the Rapid Eating Assessment for Patients Questionnaire, both validated in athletic populations. The relationship between nutrition knowledge and diet quality was evaluated. Significance was set at P ≤ 0.05. One hundred and twenty athletes reported a median nutrition score of 52 (45-61), and a dietary quality score of 53 (46-58), with a weak, positive association between both (r = 0.28 (95% CI: 0.11-0.44), P < 0.01). Fifty-four percent were categorized as needing a referral to a sports RD. Diet quality scores differed between dietitian referral group with 49 (43-54) versus 58 (52-62) for the nonreferral group, respectively (P < 0.01, V = 0.71), with no difference in nutrition knowledge observed, P = 0.73. Overall, nutrition knowledge and diet quality in our sample of collegiate athletes was poor. College athletic departments with limited access to sports RD should use these questionnaires to evaluate knowledge and the need of dietitian referral separately.

Lipid Profiles of College Female Student-Athletes Participating at Different Competition Levels of Organized Sport.

College-aged women are not meeting weekly moderate-to-vigorous physical activity to support lipids protecting against cardiovascular disease onset. Participating in organized sport could assist in physical activity engagement and maintenance while positively impacting lipids predicting cardiovascular disease. However, women may be discouraged from participating in sports if they perceive benefits to be mostly seen at the higher competition levels, thus hindering seeking sports involvement at lesser-intensity levels. A total of N = 78 female athletes participating at the National Collegiate Athletic Association (n = 21), National Junior College Athletic Association (n = 29), and student club (n = 28) completed a personal characteristics questionnaire and provided blood samples to compare physical activity involvement and lipid health profiles. Linear regression modeling was used to assess how the independent variables (i.e., sport level, age, systolic blood pressure, race/ethnicity, sport/physical activity involvement hours per week, and years playing sports) on the dependent variables [i.e., total cholesterol, high density lipid (HDL), and total cholesterol-HDL ratio]. Total sample cholesterol 165.7 ± 34.0, HDL 62.8 ± 15.03, and total cholesterol-HDL ratio 2.8 ± 0.6 were all within a healthy recommendation range, along with per sport level. NJCAA sport level significantly predicted lower total cholesterol, p = 0.043, while identifying as Black significantly predicted higher total cholesterol, p = 0.008. Similarly, identifying as Black significantly predicted higher HDL, p = 0.021. Furthermore, increased systolic blood pressure significantly predicted higher total cholesterol-HDL ratios, p = 0.014. Organized sports participation may help meet physical activity requirements, support healthy lipid profiles, and ward off cardiovascular disease development in female college students regardless of competition level.

Athletes' Self-Assessment of Urine Color Using Two Color Charts to Determine Urine Concentration.

Our objective was to determine self-reported accuracy of an athletic population using two different urine color (Uc) charts (8-color vs. 7-color Uc chart). After approval by the Institutional Review Board, members of an athletic population (n = 189, 20 (19-22) year old student- or tactical athletes and coaches, with n = 99 males and n = 90 females) scored their Uc using two charts. To determine the diagnostic value of Uc, results were compared with urine concentration (osmolality and urine specific gravity, USG). Uc was scored slightly darker with the 8-color vs. 7-color Uc chart (2.2 ± 1.2 vs. 2.0 ± 1.2, respectively, p < 0.001), with a moderate correlation between charts (r = 0.76, 95% CI: 0.69-0.81). Bland-Altman analysis showed a weak reporting bias (r = 0.15, p = 0.04). The area under the curve for correct urine sample classification ranged between 0.74 and 0.86. Higher accuracy for both methods was found when Uc scores were compared to USG over osmolality, indicated by 4.8-14.8% range in difference between methods. The optimal Uc cut-off value to assess a low vs. a high urine concentration for both Uc charts varied in this study between 1 and ≤2 while accuracy for charts was similar up to 77% when compared to USG.

A 5-day Heat Acclimation Program Improves Heat Stress Indicators While Maintaining Exercise Capacity.

ABSTRACT: Wardenaar, FC, Ortega-Santos, CP, Vento, K, Beaumont, JS, Griffin, SC, Johnston, C, and Kavouras, SA. A 5-day heat acclimation program improves heat stress indicators while maintaining exercise capacity. J Strength Cond Res 35(5): 1279-1286, 2021-This study aimed to evaluate whether a daily 60 minutes isothermic biking protocol during a 5-day period could improve physiological heat acclimation and exercise performance capacity in partially acclimated subjects. A quasi-experimental study consisted of an intervention (INT, n = 7) and control (CON, n = 7) group completing 2 12 minutes Cooper tests (pre-CT on day 1 and post-CT on day 7) and a heat stress test (HST, on day 9). INT performed additional intensive exercise 1 hour per day on days 1-5, whereas CON did not. During CTs and HST, core temperature (Tc, telemetric capsule), skin temperature (Tsk, sensors at neck, right shoulder, left hand, and right shin), and heart rate (HR, chest strap) were continuously monitored and baseline, average, peak, and increment were calculated. During the HST, the INT group showed a smaller baseline-peak Tc increment (INT 0.88 ± 0.27 vs. CON 1.64 ± 0.90° C, p = 0.02), a lower HR peak (150.2 ± 12.6 vs. 173.0 ± 16.8 b·min-1, p = 0.02), and lower Tsk peak (36.47 ± 0.62 vs. 36.54 ± 0.46° C, p = 0.04). There was a nonsignificant, but practical difference based on a moderate effect size for change in pre-CT to post-CT performance of nearly +2.7 ± 12.3% in INT and -3.0 ± 8.5% in CON (p = 0.32 and d = 0.51), and HST distance covered resulting in a nonsignificant difference of 464 ± 849 m between INT and CON (p = 0.38 and d = 0.44). In conclusion a short-term 5-day heat acclimation program including 300 minutes of extra exercise resulted in positive physiological adaptions to heat stress, as indicated by lower core temperature and HR in comparison with a control group.

A lavatory urine color (LUC) chart method can identify hypohydration in a physically active population.

PURPOSE: To provide a new and efficient at-the-toilet-bowl method of self-assessing urine concentration via urine color (Uc) to identify hypohydration. METHODS: A large athletic population (n = 189) delivered a urine sample, then chose a color panel that was displayed on the back wall of the lavatory stall. Selection was based on duration of urine voiding time, so that for a short-duration, the lighter panel was selected; for a mid-duration, the mid color panel; and for a longer-void-duration, the darker panel was selected. Then, subjects noted if their urine was lighter than, similar to, or darker than the selected color panel. Trained investigators also rated subjects' urine samples. To assess validity of Uc classification, the outcome was compared with a urine concentration (urine specific gravity, USG, and urine osmolality) threshold indicating hypohydration. RESULTS: Urine color was scored similarly by subjects and investigators (P = 0.99). Based on receiver operating curves (ROC), the method scored fair, i.e., the area under the curve ranging 0.73-0.82, with an accuracy of participants and investigators correctly classifying 72% and 75% urine samples compared to a USG threshold of 1.020, respectively, and 62% and 70% compared to a urine osmolality threshold of 836 mmol·kg-1, respectively. CONCLUSION: This new lavatory urine color (LUC) method of scoring Uc levels to assess potential hypohydration gives results similar to those of traditional urine color charts, but it has the advantage of an immediate assessment of hydration status based on scoring urine color directly from the toilet bowl.

Dutch Olympic and Non-Olympic Athletes Differ in Knowledge of and Attitudes Toward Third-party Supplement Testing.

Knowledge of third-party testing is important for elite athletes using nutritional supplements to reduce the chances of a positive doping incident. Therefore, we compared the self-reported knowledge and attitudes of N = 601 Dutch Olympic status and non-Olympic status athletes toward an independent Dutch third-party tested system (NZVT) for purchasing nutritional supplements (NSs). Most of the athletes believed that contaminated NSs could lead to a positive doping test (68.0%), and found it unacceptable to use a contaminated NS as a result of incomplete labeling (87.8%). More Olympic status athletes were familiar with the NZVT system (71.1%) than non-Olympic status athletes (24.5%, p < 0.001). Of the athletes knowing about NZVT, Olympic status athletes reported more frequently using the NZVT than non-Olympic athletes (81.7% vs. 50.0%, p < 0.001). Apart from status, more females were familiar with and used the NZVT system for purchasing NSs than males, p < 0.01. In conclusion, many athletes were not familiar with nor used the preferred third-party testing supplement system in the Netherlands when purchasing NSs. While doping warnings and regulations have been in place, considering the risk of unintentional doping use for over two decades, the knowledge of Olympic status and non-Olympic status high-level athletes could still be improved, as many are not reporting the use of third-party testing systems.