Robert W. Kenefick

Mechanisms of aerobic performance impairment with heat stress and dehydration.

Environmental heat stress can challenge the limits of human cardiovascular and temperature regulation, body fluid balance, and thus aerobic performance. This minireview proposes that the cardiovascular adjustments accompanying high skin temperatures (T(sk)), alone or in combination with high core body temperatures (T(c)), provide a primary explanation for impaired aerobic exercise performance in warm-hot environments. The independent (T(sk)) and combined (T(sk) + T(c)) effects of hyperthermia reduce maximal oxygen uptake (Vo(2max)), which leads to higher relative exercise intensity and an exponential decline in aerobic performance at any given exercise workload. Greater relative exercise intensity increases cardiovascular strain, which is a prominent mediator of rated perceived exertion. As a consequence, incremental or constant-rate exercise is more difficult to sustain (earlier fatigue) or requires a slowing of self-paced exercise to achieve a similar sensation of effort. It is proposed that high T(sk) and T(c) impair aerobic performance in tandem primarily through elevated cardiovascular strain, rather than a deterioration in central nervous system (CNS) function or skeletal muscle metabolism. Evaporative sweating is the principal means of heat loss in warm-hot environments where sweat losses frequently exceed fluid intakes. When dehydration exceeds 3% of total body water (2% of body mass) then aerobic performance is consistently impaired independent and additive to heat stress. Dehydration augments hyperthermia and plasma volume reductions, which combine to accentuate cardiovascular strain and reduce Vo(2max). Importantly, the negative performance consequences of dehydration worsen as T(sk) increases.

Biological variation and diagnostic accuracy of dehydration assessment markers

BACKGROUND Well-recognized markers for static (one time) or dynamic (monitoring over time) dehydration assessment have not been rigorously tested for their usefulness in clinical, military, and sports medicine communities. OBJECTIVE This study evaluated the components of biological variation and the accuracy of potential markers in plasma, urine, saliva, and body mass (B(m)) for static and dynamic dehydration assessment. DESIGN We studied 18 healthy volunteers (13 men and 5 women) while carefully controlling hydration and numerous preanalytic factors. Biological variation was determined over 3 consecutive days by using published methods. Atypical values based on statistical deviations from a homeostatic set point were examined. Measured deviations in body fluid were produced by using a separate, prospective dehydration experiment and evaluated by receiver operating characteristic (ROC) analysis to quantify diagnostic accuracy. RESULTS All dehydration markers displayed substantial individuality and one-half of the dehydration markers displayed marked heterogeneity of intraindividual variation. Decision levels for all dehydration markers were within one SD of the ROC criterion values, and most levels were nearly identical to the prospective group means after volunteers were dehydrated by 1.8-7.0% of B(m). However, only plasma osmolality (P(osm)) showed statistical promise for use in the static dehydration assessment. A diagnostic decision level of 301 plusmn 5 mmol/kg was proposed. Reference change values of 9 mmol/kg (P(osm)), 0.010 [urine specific gravity (U(sg))], and 2.5% change in B(m) were also statistically valid for dynamic dehydration assessment at the 95% probability level. CONCLUSIONS P(osm) is the only useful marker for static dehydration assessment. P(osm), U(sg), and B(m) are valid markers in the setting of dynamic dehydration assessment.

Dehydration: Physiology, Assessment, and Performance Effects

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo-osmotic body water (intracellular dehydration) and an iso-osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume-mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥ 2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill).

High skin temperature and hypohydration impair aerobic performance

This paper reviews the roles of hot skin (>35°C) and body water deficits (>2% body mass; hypohydration) in impairing submaximal aerobic performance. Hot skin is associated with high skin blood flow requirements and hypohydration is associated with reduced cardiac filling, both of which act to reduce aerobic reserve. In euhydrated subjects, hot skin alone (with a modest core temperature elevation) impairs submaximal aerobic performance. Conversely, aerobic performance is sustained with core temperatures >40°C if skin temperatures are cool‐warm when euhydrated. No study has demonstrated that high core temperature (∼40°C) alone, without coexisting hot skin, will impair aerobic performance. In hypohydrated subjects, aerobic performance begins to be impaired when skin temperatures exceed 27°C, and even warmer skin exacerbates the aerobic performance impairment (–1.5% for each 1°C skin temperature). We conclude that hot skin (high skin blood flow requirements from narrow skin temperature to core temperature gradients), not high core temperature, is the ‘primary’ factor impairing aerobic exercise performance when euhydrated and that hypohydration exacerbates this effect.

Skin temperature modifies the impact of hypohydration on aerobic performance.

This study determined the effects of hypohydration on aerobic performance in compensable [evaporative cooling requirement (E(req)) < maximal evaporative cooling (E(max))] conditions of 10 degrees C [7 degrees C wet bulb globe temperature (WBGT)], 20 degrees C (16 degrees C WBGT), 30 degrees C (22 degrees C WBGT), and 40 degrees C (27 degrees C WBGT) ambient temperature (T(a)). Our hypothesis was that 4% hypohydration would impair aerobic performance to a greater extent with increasing heat stress. Thirty-two men [22 +/- 4 yr old, 45 +/- 8 ml.kg(-1).min(-1) peak O(2) uptake (Vo(2 peak))] were divided into four matched cohorts (n = 8) and tested at one of four T(a) in euhydrated (EU) and hypohydrated (HYPO, -4% body mass) conditions. Subjects completed 30 min of preload exercise (cycle ergometer, 50% Vo(2 peak)) followed by a 15 min self-paced time trial. Time-trial performance (total work, change from EU) was -3% (P = 0.1), -5% (P = 0.06), -12% (P < 0.05), and -23% (P < 0.05) in 10 degrees C, 20 degrees C, 30 degrees C, and 40 degrees C T(a), respectively. During preload exercise, skin temperature (T(sk)) increased by approximately 4 degrees C per 10 degrees C T(a), while core (rectal) temperature (T(re)) values were similar within EU and HYPO conditions across all T(a). A significant relationship (P < 0.05, r = 0.61) was found between T(sk) and the percent decrement in time-trial performance. During preload exercise, hypohydration generally blunted the increases in cardiac output and blood pressure while reducing blood volume over time in 30 degrees C and 40 degrees C T(a). Our conclusions are as follows: 1) hypohydration degrades aerobic performance to a greater extent with increasing heat stress; 2) when T(sk) is >29 degrees C, 4% hypohydration degrades aerobic performance by approximately 1.6% for each additional 1 degrees C T(sk); and 3) cardiovascular strain from high skin blood flow requirements combined with blood volume reductions induced by hypohydration is an important contributor to impaired performance.

Physiological determinants of cross-country ski racing performance.

PURPOSE Previous laboratory testing has identified the importance of upper-body aerobic and anaerobic power to cross-country skiing performance. The purpose of this investigation was to extend laboratory research into a field setting to identify predictors of performance through ski-specific testing. METHODS Thirteen male collegiate skiers performed three field-testing sessions on roller skis to establish lactate threshold (LT) and ski economy (ECON) and maximal oxygen uptake (SK VO(2max)) and a 1-km double-pole time trial (UBTT) to determine peak upper-body oxygen uptake (UB VO(2)). As a measure of skiing performance, the subjects performed a 10-km skating time trial (TT) and were ranked according to competitive season performance (RANK). RESULTS Significant correlations (P < 0.05) were found between SK VO(2max), LT VO(2), UB VO(2), and RANK (r = -0.66 to -0.84) and TT time (r = -0.74 to -0.79), as well as ECON to RANK (r = 0.57) and TT time (r = 0.68). Time to complete the UBTT (UB time) exhibited the strongest correlation to both RANK (r = 0.95) and TT time (r = 0.92). Multiple regression analyses revealed that UB time was the best predictor of RANK and TT time, as demonstrated by the significant beta values (0.77, P < 0.001, and 0.79, P < 0.001, respectively). The importance of the UB component was further seen in that UB time was still the best predictor of performance when the subjects were divided into two distinct groups of greater and lesser competitive ability. CONCLUSIONS These findings identify the importance of the upper body component to cross-country skiing performance, suggesting a need to focus on upper-body conditioning within a well-rounded endurance training program. Additionally, the UBTT exhibits potential as a simple field test to predict cross-country skiing performance over more sophisticated and costly laboratory and field testing.

Bioimpedance spectroscopy technique: intra-, extracellular, and total body water

The purpose of this study was to test the validity of a multiple frequency bioimpedance spectroscopy (BIS) technique that estimates extracellular fluid volume (ECV), intracellular fluid volume (ICV), and total body water (TBW). Thirteen healthy males (mean +/- SD: age, 23 +/- 3 yr; body mass, 80.6 +/- 14.7 kg) had their TBW and ECV measured by ingesting dilution tracers (7.27 g deuterium oxide, 1.70 g sodium bromide; blood samples at 0 and 4 h). ICV was calculated as TBW minus ECV. Impedance was measured (50-500 kHz) at rest, on a nonconducting surface, with a BIS analyzer. Electrode placement, posture, exercise, food/fluid intake, and ambient temperature were controlled. Dilution measures (TBW, 51.00 +/- 9.30; ECV, 19.88 +/- 3.14; ICV, 31.12 +/- 6.80 L) and BIS volumes (TBW, 50.03 +/- 7.67; ECV, 20.95 +/- 3.33; ICV, 29.04 +/- 4.51 L) were significantly different for ECV (P < 0.01) and ICV (P < 0.05); some individual differences were large. The correlation coefficients of dilution versus BIS volumes (r = 0.93 to 0.96) were significant at P < 0.0001; SEEs were: TBW, 2.23 L; ECV, 1.26 L; and ICV, 1.71 L. We concluded that BIS is valid for between-subject comparisons of body fluid compartments, is appropriate in clinical settings where change in ECV/ICV ratio is important, and should be used by comparing the required level of accuracy to the inherent technique error/variance.

Effects of hydration state on plasma testosterone, cortisol and catecholamine concentrations before and during mild exercise at elevated temperature.

This investigation examined the influence of pre-exercise hydration status, and water intake during low intensity exercise (5.6 km · h−1 at 5% gradient) in the heat (33° C), on plasma testosterone (TEST), cortisol (CORT), adrenaline (A), and noradrenaline (NA) concentrations at baseline (BL), pre-exercise (PRE), and immediately (IP), 24 h (24 P), and 48 h postexercise (48 P). Ten active men participated in four experimental treatments. These treatments differed in preexercise hydration status [euhydrated or hypohydrated (HY, −3.8 (SD 0.7)% body mass)] and water intake during exercise (water ad libitum or no water intake during exercise, NW). There were no significant changes in TEST, CORT, or A concentrations with time (BL, PRE, IP, 24 P, and 48 P), or among treatments. However, significant increases from BL and PRE plasma NA concentrations were observed at IP during all four treatment conditions. In addition, HY + NW resulted in significantly higher plasma NA concentrations at IP compared to all other treatments. These results suggest that moderate levels of hypohydration during prolonged, low intensity exercise in the heat do not influence plasma TEST, CORT, or A concentrations. However, plasma NA appears to respond in a sensitive manner to these hydration and exercise stresses.

Aerobic Performance Is Degraded, Despite Modest Hyperthermia, in Hot Environments

UNLABELLED Environmental heat stress degrades aerobic performance; however, little research has focused on performance when the selected task elicits modest elevations in core body temperature (<38.5 degrees C). PURPOSE To determine the effect of environmental heat stress, with modest hyperthermia, on aerobic performance and pacing strategies. METHODS After a 30-min cycling preload at 50% VO2peak, eight euhydrated men performed a 15-min time trial on a cycle ergometer in temperate (TEMP; 21 degrees C, 50% RH) and hot (HOT; 40 degrees C, 25% RH) environments. Core and skin temperature (Tc and Tsk, respectively) and HR were continuously monitored. Performance was assessed by the total work (kJ) completed in 15 min. Pacing was quantified by comparing the percent difference in actual work performed in each of five 3-min blocks normalized to the mean work performed per 3-min block. Pace over the final 2 min was compared with the average pace from minutes 0 to 13 for end spurt analysis. RESULTS Tc and HR rose continually throughout both time trials. Peak Tc remained modestly elevated in both environments [mean (range): HOT = 38.20 degrees C (37.97-38.42 degrees C); TEMP = 38.11 degrees C (38.07-38.24 degrees C)], whereas Tsk was higher in HOT (36.19 +/- 0.40 degrees C vs 31.14 +/- 1.14 degrees C), and final HR reached approximately 95% of age-predicted maximum in both environments. Total work performed in HOT (147.7 +/- 23.9 kJ) was approximately 17% less (P < 0.05) than TEMP (177.0 +/- 25.0 kJ). Pace was evenly maintained in TEMP, but in HOT, volunteers were unable to maintain initial pace, slowing progressively over time. A significant end spurt was produced in both environments. CONCLUSIONS During a brief aerobic exercise time trial where excessive hyperthermia is avoided, total work is significantly reduced by heat stress because of a gradual slowing of pace over time. These findings demonstrate how aerobic exercise performance degrades in hot environments without marked hyperthermia.

Hydration at the Work Site

When performing physical work, sweat output often exceeds water intake, producing a body water deficit or dehydration. Specific to the work place, dehydration can adversely affect worker productivity, safety, and morale. Legislative bodies in North America such as the Occupational Safety and Health Administration (OSHA) and the American Conference of Governmental Industrial Hygienists (ACGIH) recommend replacing fluids frequently when exposed to heat stress, such as one cup (250 ml) every 20 minutes when working in warm environments. However, the majority of legislative guidelines provide vague guidance and none take into account the effects of work intensity, specific environments, or protective clothing. Improved occupational guidelines for fluid and electrolyte replacement during hot weather occupational activities should be developed to include recommendations for fluid consumption before, during, and after work.