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1.
Nutrients ; 12(5)2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32365848

RESUMO

We investigated the impact of nutrient intake on hydration biomarkers in cyclists before and after a 161 km ride, including one hour after a 650 mL water bolus consumed post-ride. To control for multicollinearity, we chose a clustering-based, machine learning statistical approach. Five hydration biomarkers (urine color, urine specific gravity, plasma osmolality, plasma copeptin, and body mass change) were configured as raw- and percent change. Linear regressions were used to test for associations between hydration markers and eight predictor terms derived from 19 nutrients merged into a reduced-dimensionality dataset through serial k-means clustering. Most predictor groups showed significant association with at least one hydration biomarker: 1) Glycemic Load + Carbohydrates + Sodium, 2) Protein + Fat + Zinc, 3) Magnesium + Calcium, 4) Pinitol, 5) Caffeine, 6) Fiber + Betaine, and 7) Water; potassium + three polyols, and mannitol + sorbitol showed no significant associations with any hydration biomarker. All five hydration biomarkers were associated with at least one nutrient predictor in at least one configuration. We conclude that in a real-life scenario, some nutrients may serve as mediators of body water, and urine-specific hydration biomarkers may be more responsive to nutrient intake than measures derived from plasma or body mass.

2.
Clin Nutr ESPEN ; 37: 129-133, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32359734

RESUMO

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.

3.
Nutrients ; 12(3)2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32210168

RESUMO

A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1-2 L·d-1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32092895

RESUMO

The combination of hyperthermia, dehydration, and strenuous exercise can result in severe reductions in kidney function, potentially leading to acute kidney injury (AKI). We sought to determine whether six days of heat acclimation (HA) mitigates the rise in clinical biomarkers of AKI during strenuous exercise in the heat. Twenty men completed two consecutive 2 h bouts of high-intensity exercise in either hot (n = 12, 40 °C, 40% relative humidity) or mild (n = 8, 24 °C, 21% relative humidity) environments before (PreHA) and after (PostHA) 4 days of 90-120 min of exercise per day in a hot or mild environment. Increased clinical biomarkers of AKI (CLINICAL) was defined as a serum creatinine increase ≥0.3 mg·dL-1 or estimated glomerular filtration rate (eGFR) reduction >25%. Creatinine similarly increased in the hot environment PreHA (0.35 ± 0.23 mg·dL-1) and PostHA (0.39 ± 0.20 mg·dL-1), with greater increases than the mild environment at both time points (0.11 ± 0.07 mg·dL-1, 0.08 ± 0.06 mg·dL-1, p ≤ 0.001), respectively. CLINICAL occurred in the hot environment PreHA (n = 9, 75%), with fewer participants with CLINICAL PostHA (n = 7, 58%, p = 0.007), and no participants in the mild environment with CLINICAL at either time point. Percent change in plasma volume was predictive of changes in serum creatinine PostHA and percent changes in eGFR both PreHA and PostHA. HA did not mitigate reductions in eGFR nor increases in serum creatinine during high-intensity exercise in the heat, although the number of participants with CLINICAL was reduced PostHA.

5.
Nutrients ; 11(12)2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31766680

RESUMO

The motivation to seek and consume water is an essential component of human fluid-electrolyte homeostasis, optimal function, and health. This review describes the evolution of concepts regarding thirst and drinking behavior, made possible by magnetic resonance imaging, animal models, and novel laboratory techniques. The earliest thirst paradigms focused on single factors such as dry mouth and loss of water from tissues. By the end of the 19th century, physiologists proposed a thirst center in the brain that was verified in animals 60 years later. During the early- and mid-1900s, the influences of gastric distention, neuroendocrine responses, circulatory properties (i.e., blood pressure, volume, concentration), and the distinct effects of intracellular dehydration and extracellular hypovolemia were recognized. The majority of these studies relied on animal models and laboratory methods such as microinjection or lesioning/oblation of specific brain loci. Following a quarter century (1994-2019) of human brain imaging, current research focuses on networks of networks, with thirst and satiety conceived as hemispheric waves of neuronal activations that traverse the brain in milliseconds. Novel technologies such as chemogenetics, optogenetics, and neuropixel microelectrode arrays reveal the dynamic complexity of human thirst, as well as the roles of motivation and learning in drinking behavior.

6.
Eur J Nutr ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31428854

RESUMO

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 Ucol. 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 Ucol changed from > 4 to < 4 (+ 1435 ± 812 mL) than those whose Ucol 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.

7.
Nutrients ; 11(7)2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31324008

RESUMO

Personalized hydration strategies play a key role in optimizing the performance and safety of athletes during sporting activities. Clinicians should be aware of the many physiological, behavioral, logistical and psychological issues that determine both the athlete's fluid needs during sport and his/her opportunity to address them; these are often specific to the environment, the event and the individual athlete. In this paper we address the major considerations for assessing hydration status in athletes and practical solutions to overcome obstacles of a given sport. Based on these solutions, practitioners can better advise athletes to develop practices that optimize hydration for their sports.


Assuntos
Ingestão de Líquidos , Esportes , Água , Atletas , Desidratação/prevenção & controle , Humanos
8.
Nutr Res Rev ; 32(2): 205-217, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31258100

RESUMO

The micro-organisms which inhabit the human gut (i.e. the intestinal microbiota) influence numerous human biochemical pathways and physiological functions. The present review focuses on two questions, 'Are intestinal microbiota effects measurable and meaningful?' and 'What research methods and variables are influenced by intestinal microbiota effects?'. These questions are considered with respect to doubly labelled water measurements of energy expenditure, heat balance calculations and models, measurements of RMR via indirect calorimetry, and diet-induced energy expenditure. Several lines of evidence suggest that the intestinal microbiota introduces measurement variability and measurement errors which have been overlooked in research studies involving nutrition, bioenergetics, physiology and temperature regulation. Therefore, we recommend that present conceptual models and research techniques be updated via future experiments, to account for the metabolic processes and regulatory influences of the intestinal microbiota.

9.
J Sci Med Sport ; 22(10): 1084-1089, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31235386

RESUMO

OBJECTIVES: An exercise session in a hot environment may increase thermal strain during subsequent exercise sessions on the same and consecutive days. Therefore, this study was conducted to determine lasting physiological strain from moderate-high intensity, intermittent exercise in heat on subsequent exercise. DESIGN: Repeated measures laboratory study. METHODS: Seventeen healthy, recreationally active men (age: 22±3 y, maximal oxygen consumption: 54.6±5.3mLkg-1min-1) underwent two intermittent moderate-high intensity aerobic exercise sessions separated by 2h of rest one day, followed by one session 24h later in a 40°C, 40% relative humidity environment. Heart rate, rectal temperature, heat stress perception, and environmental symptoms were assessed. RESULTS: 100%, 35%, and 71% of participants completed the full exercise protocol during the first exercise session, second exercise session, and the following day, respectively. Exercising heart rate and rectal temperature were greater during the second exercise session (189±11bpm, 38.80±0.47°C) than the first identical exercise session (180±17bpm, p=0.004; 38.41±0.52°C, p=0.001), respectively. Immediate post-exercise heart rate, rectal temperature, thirst, thermal sensation, fatigue, and perceived exertion were similar among exercise sessions despite a shorter exercise duration during the second exercise session (93±27min, p=0.001) and the following day (113±12min, p=0.032) than the first exercise session (120±0min). CONCLUSIONS: Moderate-high-intensity intermittent exercise in the heat resulted in greater heat strain during a second exercise session the same day, and exercise the subsequent day.


Assuntos
Exercício Físico , Resposta ao Choque Térmico , Temperatura Alta , Adulto , Temperatura Corporal , Frequência Cardíaca , Humanos , Masculino , Consumo de Oxigênio , Fatores de Tempo , Adulto Jovem
12.
J Strength Cond Res ; 33(3): 727-735, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28166185

RESUMO

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.


Assuntos
Afeto/fisiologia , Desidratação/fisiopatologia , Exercício Físico/fisiologia , Temperatura Alta/efeitos adversos , Adolescente , Adulto , Teste de Esforço , Frequência Cardíaca/fisiologia , Humanos , Masculino , Adulto Jovem
13.
Nutrients ; 10(12)2018 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-30563134

RESUMO

Water is essential for metabolism, substrate transport across membranes, cellular homeostasis, temperature regulation, and circulatory function. Although nutritional and physiological research teams and professional organizations have described the daily total water intakes (TWI, L/24h) and Adequate Intakes (AI) of children, women, and men, there is no widespread consensus regarding the human water requirements of different demographic groups. These requirements remain undefined because of the dynamic complexity inherent in the human water regulatory network, which involves the central nervous system and several organ systems, as well as large inter-individual differences. The present review analyzes published evidence that is relevant to these issues and presents a novel approach to assessing the daily water requirements of individuals in all sex and life-stage groups, as an alternative to AI values based on survey data. This empirical method focuses on the intensity of a specific neuroendocrine response (e.g., plasma arginine vasopressin (AVP) concentration) employed by the brain to regulate total body water volume and concentration. We consider this autonomically-controlled neuroendocrine response to be an inherent hydration biomarker and one means by which the brain maintains good health and optimal function. We also propose that this individualized method defines the elusive state of euhydration (i.e., water balance) and distinguishes it from hypohydration. Using plasma AVP concentration to analyze multiple published data sets that included both men and women, we determined that a mild neuroendocrine defense of body water commences when TWI is ˂1.8 L/24h, that 19⁻71% of adults in various countries consume less than this TWI each day, and consuming less than the 24-h water AI may influence the risk of dysfunctional metabolism and chronic diseases.


Assuntos
Água Corporal/fisiologia , Ingestão de Líquidos , Equilíbrio Hidroeletrolítico , Desidratação , Humanos
15.
J Sports Med (Hindawi Publ Corp) ; 2018: 5724575, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29850597

RESUMO

Exertional heatstroke (EHS) is a medical emergency that cannot be predicted, requires immediate whole-body cooling to reduce elevated internal body temperature, and is influenced by numerous host and environmental factors. Widely accepted predisposing factors (PDF) include prolonged or intense exercise, lack of heat acclimatization, sleep deprivation, dehydration, diet, alcohol abuse, drug use, chronic inflammation, febrile illness, older age, and nonsteroidal anti-inflammatory drug use. The present review links these factors to the human intestinal microbiota (IM) and diet, which previously have not been appreciated as PDF. This review also describes plausible mechanisms by which these PDF lead to EHS: endotoxemia resulting from elevated plasma lipopolysaccharide (i.e., a structural component of the outer membrane of Gram-negative bacteria) and tissue injury from oxygen free radicals. We propose that recognizing the lifestyle and host factors which are influenced by intestine-microbial interactions, and modifying habitual dietary patterns to alter the IM ecosystem, will encourage efficient immune function, optimize the intestinal epithelial barrier, and reduce EHS morbidity and mortality.

16.
J Sci Med Sport ; 21(12): 1180-1184, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29784554

RESUMO

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.


Assuntos
Lesão Renal Aguda/fisiopatologia , Ciclismo/fisiologia , Temperatura Alta/efeitos adversos , Ibuprofeno/uso terapêutico , Rim/fisiopatologia , Adulto , Biomarcadores/sangue , Creatinina/sangue , Método Duplo-Cego , Feminino , Humanos , Rim/efeitos dos fármacos , Lipocalina-2/sangue , Masculino , Pessoa de Meia-Idade , Resistência Física
17.
J Athl Train ; 52(9): 877-895, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28985128

RESUMO

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.


Assuntos
Desidratação/prevenção & controle , Exercício Físico/fisiologia , Hidratação/métodos , Desempenho Atlético , Ingestão de Líquidos , Medicina Baseada em Evidências , Humanos , Esportes/fisiologia , Suor/fisiologia , Sudorese/fisiologia , Água/administração & dosagem , Equilíbrio Hidroeletrolítico/fisiologia
18.
Res Q Exerc Sport ; 88(3): 251-268, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28805553

RESUMO

Participation in organized sport and recreational activities presents an innate risk for serious morbidity and mortality. Although death during sport or physical activity has many causes, advancements in sports medicine and evidence-based standards of care have allowed clinicians to prevent, recognize, and treat potentially fatal injuries more effectively. With the continual progress of research and technology, current standards of care are evolving to enhance patient outcomes. In this article, we provided 10 key questions related to the leading causes and treatment of sudden death in sport and physical activity, where future research will support safer participation for athletes and recreational enthusiasts. The current evidence indicates that most deaths can be avoided when proper strategies are in place to prevent occurrence or provide optimal care.


Assuntos
Traumatismos em Atletas/prevenção & controle , Morte Súbita/prevenção & controle , Arritmias Cardíacas/terapia , Regulação da Temperatura Corporal , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Desfibriladores Implantáveis , Serviços Médicos de Emergência/organização & administração , Exercício Físico/fisiologia , Futebol Americano/lesões , Golpe de Calor/prevenção & controle , Golpe de Calor/terapia , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Hiponatremia/terapia , Programas de Rastreamento , Educação Física e Treinamento , Volta ao Esporte , Fatores de Risco , Traço Falciforme/complicações , Traço Falciforme/terapia , Esportes/classificação , Recursos Humanos
19.
Wilderness Environ Med ; 28(3): 197-206, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28739377

RESUMO

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.


Assuntos
Ciclismo , Hemostasia/fisiologia , Temperatura Alta , Resistência Física/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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