Comparison of body composition techniques before and after a 161-km ultramarathon using DXA, BIS and BIA.

The low cost, ease of application and portability of bioelectrical impedance analysis (BIA) and spectroscopy (BIS) devices make them attractive tools for measuring acute changes in body composition before and after exercise, despite potential limitations from active compartmental fluid shifts. The primary study aim was to evaluate use of dual energy x-ray absorptiometry (DXA) against BIA and BIS in measurements of percent body fat (%BF) and percent total body water (%TBW) before and after prolonged endurance exercise. 10 runners were measured pre-race and at race finish. Significant linear relationships were noted pre-race between DXA vs. BIS for %BF (r(2)=0.76; p<0.01) and %TBW (r(2)=0.74; p<0.01). Significant correlations were noted at race finish between DXA vs. BIS for %BF (r(2)=0.64; p<0.01) and %TBW (r(2)=0.66; p<0.05), but only when one outlier was removed. Limits of agreement (LOA) between DXA vs. BIS were wide for both %BF (mean difference of -3.6, LOA between 5.4 and -12.6) and %TBW (mean difference 2.4, LOA between 0.4 and -4.6). LOA was closer between the DXA vs. BIA with DXA measuring slightly higher than BIA for %BF (mean difference of 0.5, LOA between 2.1 and -3.1) and slightly lower than BIA for %TBW (mean difference 0.3, LOA between 3.3 and -2.7). Linear correlations between DXA vs. BIA were not statistically significant for %BF or %TBW before or after the race. DXA measurement of acute changes in %BF and %TBW are not congruent with BIA or BIS measurements. These 3 techniques should not be utilized interchangeably after prolonged endurance running.

Bone: an acute buffer of plasma sodium during exhaustive exercise?

Both hyponatremia and osteopenia separately have been well documented in endurance athletes. Although bone has been shown to act as a "sodium reservoir" to buffer severe plasma sodium derangements in animals, recent data have suggested a similar function in humans. We aimed to explore if acute changes in bone mineral content were associated with changes in plasma sodium concentration in runners participating in a 161 km mountain footrace. Eighteen runners were recruited. Runners were tested immediately pre- and post-race for the following main outcome measures: bone mineral content (BMC) and density (BMD) via dual-energy X-ray absorptiometry (DEXA); plasma sodium concentration ([Na+]p), plasma arginine vasopressin ([AVP]p), serum aldosterone concentration ([aldosterone]s), and total sodium intake. Six subjects finished the race in a mean time of 27.0±2.3 h. All subjects started and finished the race with [Na+]p within the normal range (137.7±2.3 and 136.7±1.6 mEq/l, pre- and post-race, respectively). Positive correlations were noted between change (Δ; post-race minus pre-race) in total BMC (grams) and [Na+]p (mEq/l) (r=0.99; p<0.0001), and between total sodium intake (mEq/kg) and %Δ lumbar spine BMD (r=0.94; p<0.001). Change in [aldosterone]s was positively correlated with: rate of total sodium intake (r=0.84; p<0.05); Δ total BMC (r=0.82; p<0.05); and Δ [Na+]p (r=0.88; p<0.05). No significant pre- to post-race mean differences were noted in BMC or BMD. Robust associations between Δ BMC and Δ [Na+]p suggest that sodium status and bone density may be inter-related during endurance exercise and should be considered in future investigations of athletic osteopenia.

First reported cases of exercise-associated hyponatremia in Asia.

There are no reported cases of exercise-associated hyponatremia (EAH) in tropical Asia. This study aimed to investigate the incidence of EAH at the on-site medical tent and fluid balance in long distance foot races in a warm and humid environment. Body mass was taken before and after the races (42-km marathon; 84-km ultra-marathon). Blood sodium concentration was measured for symptomatic runners admitted to the medical tent. Mean (SD) dry bulb temperature was 29.0 (0.6)°C, relative humidity 89 (2)% and wind speed 0.3 (0.5) m/s. Three out of the 8 symptomatic runners admitted to the medical tent were diagnosed with hyponatremia, with blood sodium concentrations of 134 mmol/L in a 42-km runner, and 131 and 117 mmol/L in two 84-km runners. In the 42-km race, mean % ΔBM was -1.6 (1.2)%, ranging from -5.7 to 1.4%, and 22 runners (7%) gained weight. In the 84-km race, mean % ΔBM was -2.3 (1.7)%, ranging from -8.0 to 1.4%, and 9 runners (8%) gained weight. In addition to the 3 cases of symptomatic hyponatremia observed, 8% of the 84-km runners and 7% of the 42-km runners gained weight during the race. This indicates the need to disseminate advice for the prevention and treatment of EAH for races held in the tropics.

Changes in plasma arginine vasopressin concentrations in cyclists participating in a 109-km cycle race.

OBJECTIVE: To evaluate the osmotic and non-osmotic regulation of arginine vasopressin (AVP) during endurance cycling. DESIGN: Observational study. Setting 109 km cycle race. PARTICIPANTS: 33 Cyclists. INTERVENTIONS: None. MAIN OUTCOME MEASUREMENTS: Plasma sodium concentration ([Na(+)]), plasma volume (PV) and plasma arginine vasopressin (AVP) concentration ([AVP](p)). RESULTS: A fourfold increase in [AVP](p) occurred despite a 2-mmol l(-1) decrease in plasma [Na(+)] combined with only modest (5%) PV contraction. A significant inverse correlation was noted between [AVP](p) Delta and urine osmolality Delta (r = -0.41, p<0.05), whereas non-significant inverse correlations were noted between [AVP](p) and both plasma [Na(+)] Delta and % PV Delta. Four cyclists finished the race with asymptomatic hyponatraemia. The only significant difference between the entire cohort with this subset of athletes was postrace plasma [Na(+)] (137.7 vs 133.5 mmol l(-1), p<0.001) and plasma [Na(+)] Delta (-1.9 vs -5.1 mmol l(-1), p<0.05). The mean prerace [AVP](p) of these four cyclists was just below the minimum detectable limit (0.3 pg ml(-1)) and increased marginally (0.4 pg ml(-1)) despite the decline in plasma [Na(+)]. CONCLUSIONS: The osmotic regulation of [AVP](p) during competitive cycling was overshadowed by non-osmotic AVP secretion. The modest decrease in PV was not the primary non-osmotic stimulus to AVP. Partial suppression of AVP occurred in four (12%) cyclists who developed hyponatraemia during 5 h of riding. Therefore, these results confirm that non-osmotic AVP secretion and exercise-associated hyponatraemia does, in fact, occur in cyclists participating in a 109 km cycle race. However, the stimuli to AVP is likely different between cycling and running.

Acute changes in arginine vasopressin, sweat, urine and serum sodium concentrations in exercising humans: does a coordinated homeostatic relationship exist?

The parallel response of sweat rate and urine production to changes in plasma osmolality and volume support a role for arginine vasopressin (AVP) as the main endocrine regulator of both excretions. A maximal test to exhaustion and a steady-state run on a motorised treadmill were both completed by 10 moderately trained runners, 1 week apart. Sweat, urine and serum sodium concentrations ([Na+]) were evaluated in association with the plasma concentrations of cytokines, neurohypophyseal and natriuretic peptides, and adrenal steroid hormones. When data from both the high-intensity and steady-state runs were combined, significant linear correlations were noted between: sweat [Na+] versus postexercise urine [Na+] (r=0.80; p<0.001), postexercise serum [Na+] versus both postexercise urine [Na+] (r=0.56; p<0.05) and sweat [Na+] (r=0.64; p<0.01) and postexercise urine [Na+] versus postexercise plasma arginine vasopressin concentration ([AVP](P)) (r=0.48; p<0.05). A significant positive correlation was noted between postexercise [AVP](P) and sweat [Na+] during the steady-state condition only (r=0.66; p<0.05). These correlations suggest that changes in serum [Na+] during exercise may evoke corresponding changes in sweat and urine [Na+], which are likely regulated coordinately by changes in [AVP](P) to preserve body fluid homeostasis.

Drinking policies and exercise-associated hyponatraemia: is anyone still promoting overdrinking?

OBJECTIVES: The purpose of this review is to describe the evolution of hydration research and advice on drinking during exercise from published scientific papers, books and non-scientific material (advertisements and magazine contents) and detail how erroneous advice is likely propagated throughout the global sports medicine community. DESIGN: Hydration advice from sports-linked entities, the scientific community, exercise physiology textbooks and non-scientific sources was analysed historically and compared with the most recent scientific evidence. CONCLUSIONS: Drinking policies during exercise have changed substantially throughout history. Since the mid-1990s, however, there has been an increase in the promotion of overdrinking by athletes. While the scientific community is slowly moving away from "blanket" hydration advice in which one form of advice fits all and towards more modest, individualised, hydration guidelines in which thirst is recognised as the best physiological indicator of each subject's fluid needs during exercise, marketing departments of the global sports drink industry continue to promote overdrinking.

Semmelweis and the aetiology of puerperal sepsis 160 years on: an historical review.

It is generally accepted that Professor Ignaz Semmelweis was the first to identify the mode of transmission of puerperal sepsis. However no appropriate statistical analysis of Semmelweis's data supporting his theory has been reported. Mean annual percent maternal mortality rates for the Allgemeines Krankenhaus and Dublin Maternity Hospitals (1784-1858) were analysed. The introduction of pathological anatomy at the Allgemeines Krankenhaus in 1823 was associated with increased mortality. After 1840 maternal mortality was higher in Clinic 1 which was staffed by male obstetricians and medical students who, unlike the midwives in Clinic 2, attended autopsies. The introduction of chlorine washing of the male clinicians' hands in Clinic 1 by Semmelweis in 1847 reduced mortality, whereas the cessation of handwashing after Semmelweis left Vienna in 1850 was associated with increased mortality. This statistical analysis supports Semmelweis's hypothesis that 'the cadaveric particles adhering to the hand had ... caused the preponderant mortality in the first Clinic'.

Sodium supplementation is not required to maintain serum sodium concentrations during an Ironman triathlon.

CONTEXT: Critical assessment of recommendations that athletes consume additional sodium during athletic events. OBJECTIVE: To evaluate if sodium supplementation is necessary to maintain serum sodium concentrations during prolonged endurance activity and prevent the development of hyponatraemia. DESIGN: Prospective randomised trial of athletes receiving sodium (620 mg table salt), placebo (596 mg starch), or no supplementation during a triathlon. The sodium and placebo tablets were taken ad libitum, with the suggested range of 1-4 per hour. SETTING: The 2001 Cape Town Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). SUBJECTS: A total of 413 triathletes completing the Ironman race. MAIN OUTCOME MEASURES: Sodium supplementation was not necessary to maintain serum sodium concentrations in athletes completing an Ironman triathlon nor required to prevent hyponatraemia from occurring in athletes who did not ingest supplemental sodium during the race. RESULTS: Subjects in the sodium supplementation group ingested an additional 3.6 (2.0) g (156 (88) mmol) sodium during the race (all values are mean (SD)). There were no significant differences between the sodium, placebo, and no supplementation groups with regard to age, finishing time, serum sodium concentration before and after the race, weight before the race, weight change during the race, and rectal temperature, systolic and diastolic blood pressure after the race. The sodium supplementation group consumed 14.7 (8.3) tablets, and the placebo group took 15.8 (10.1) tablets (p = 0.55; NS). CONCLUSIONS: Ad libitum sodium supplementation was not necessary to preserve serum sodium concentrations in athletes competing for about 12 hours in an Ironman triathlon. The Institute of Medicine's recommended daily adequate intake of sodium (1.5 g/65 mmol) seems sufficient for a healthy person without further need to supplement during athletic activity.