Iterative assessment of a sports rehydration beverage containing a novel amino acid formula on water uptake kinetics.

PURPOSE: Rapid gastric emptying and intestinal absorption of beverages is essential for rapid rehydration, and certain amino acids (AA) may augment fluid delivery. Three sugar-free beverages, containing differing AA concentrations (AA + PZ), were assessed for fluid absorption kinetics against commercial sugar-free (PZ, GZ) and carbohydrate-containing (GTQ) beverages. METHODS: Healthy individuals (n = 15-17 per study) completed three randomised trials. Three beverages (550-600 mL) were ingested in each study (Study 1: AA + PZ [17.51 g/L AA], PZ, GZ; Study 2: AA + PZ [6.96 g/L AA], PZ, GZ; Study 3: AA + PZ [3.48 g/L AA], PZ, GTQ), containing 3.000 g deuterium oxide (D2O). Blood samples were collected pre-, 2-min, 5-min, and every 5-min until 60-min post-ingestion to quantify maximal D2O enrichment (Cmax), time Cmax occurred (Tmax) and area under the curve (AUC). RESULTS: Study 1: AUC (AA + PZ: 15,184 ± 3532 δ‰ vs. VSMOW; PZ: 17,328 ± 3153 δ‰ vs. VSMOW; GZ: 17,749 ± 4204 δ‰ vs. VSMOW; P ≤ 0.006) and Tmax (P ≤ 0.005) were lower for AA + PZ vs. PZ/GZ. Study 2: D2O enrichment characteristics were not different amongst beverages (P ≥ 0.338). Study 3: Cmax (AA + PZ: 440 ± 94 δ‰ vs. VSMOW; PZ: 429 ± 83 δ‰ vs. VSMOW; GTQ: 398 ± 81 δ‰ vs. VSMOW) was greater (P = 0.046) for AA + PZ than GTQ, with no other differences (P ≥ 0.106). CONCLUSION: The addition of small amounts of AA (3.48 g/L) to a sugar-free beverage increased fluid delivery to the circulation compared to a carbohydrate-based beverage, but greater amounts (17.51 g/L) delayed delivery.

Forecasting individual exercise sweat losses from forecast air temperature and energy expenditure.

Introduction: Recent success in predicting individual sweat losses from air temperature and energy expenditure measurements suggests a potential for forecasting individual sweat losses for future combinations of environment and exercise. The purpose of this study is to determine the plausibility of accurately forecasting exercise sweat losses from meteorological air temperature forecasts and individual running energy expenditure forecasts. The potential impact on plasma sodium is also estimated when setting drinking rates equal to forecast sweat losses. Materials and methods: Individual exercise sweat losses (equated to water needs) and energy expended while running were measured in 33 participants along with air temperature and compared with forecasts of the same. Forecast inputs were used in a web app to forecast exercise sweat losses for comparison with observed values. The bias between forecast and observed exercise sweat losses was used to calculate the potential drinking impact on plasma sodium. Results: The concordance correlation coefficient between forecast and observed values was 0.95, 0.96, and 0.91 for air temperature, energy expenditure, and exercise sweat losses, respectively, indicating excellent agreement and no significant differences observed via t-test. Perfect matching of water intake to sweat losses would lower plasma sodium concentrations from 140 to 138 mmol/L; calculations using the 95% limits of agreement for bias showed that drinking according to forecast exercise sweat losses would alter plasma sodium concentrations from 140 to between 136 and 141 mmol/L. Conclusions: The outcomes support the strong potential for accurately forecasting exercise sweat losses from commonly available meteorological air temperature forecasts and energy expenditure from forecast running distance.

Change of Seasons: Boston Marathon Wet Bulb Globe Temperature Index in October.

INTRODUCTION: The importance of providing wet bulb globe temperature (WBGT) heat stress flag category measurements in real time is well recognized by road race directors, and it is bound to become even more important with the rise of extreme weather and pandemic outbreaks. The purpose of this paper is to describe the WBGT index and its components measured during the 125th running of the Boston Marathon on October 11, 2021, for qualitative comparison to measurements made similarly on its traditional April date, 2014 to 2019. METHODS: Monitoring occurred at the 7 km, 18 km, and 32 km marks of the race in the towns of Ashland, Natick-Wellesley, and Newton. The outdoor WBGT index was calculated from direct hourly measurements of the dry bulb, black globe, and natural wet bulb temperatures from 0900 to 1500 h. RESULTS: The WBGT index was not different among towns; thus, the average hourly values for the 3 towns were compared to historical data averaged identically. Although the black globe temperature fluctuated considerably in response to changing cloud cover, on average, partly cloudy skies kept the solar load comparable to what has been observed in April. Dry bulb and wet bulb temperatures were higher than those on most April dates shown, which resulted in a yellow (or amber) flag day for most of the race. CONCLUSIONS: The historic October Boston Marathon was among the warmest in recent history. Like the impact of COVID-19 on the 2021 Boston Marathon, future climate challenges around outdoor activities could necessitate rescheduling; they underscore the importance of real-time WBGT index measures.

Post-exercise rehydration: Comparing the efficacy of three commercial oral rehydration solutions.

Introduction: This study compared the efficacy of three commercial oral rehydration solutions (ORS) for restoring fluid and electrolyte balance, after exercise-induced dehydration. Method: Healthy, active participants (N = 20; ♀ = 3; age ∼27 y, V˙O2peak ∼52 ml/kg/min) completed three randomised, counterbalanced trials whereby intermittent exercise in the heat (∼36°C, ∼50% humidity) induced ∼2.5% dehydration. Subsequently, participants rehydrated (125% fluid loss in four equal aliquots at 0, 1, 2, 3 h) with a glucose-based (G-ORS), sugar-free (Z-ORS) or amino acid-based sugar-free (AA-ORS) ORS of varying electrolyte composition. Urine output was measured hourly and capillary blood samples collected pre-exercise, 0, 2 and 5 h post-exercise. Sodium, potassium, and chloride concentrations in urine, sweat, and blood were determined. Results: Net fluid balance peaked at 4 h and was greater in AA-ORS (141 ± 155 ml) and G-ORS (101 ± 195 ml) than Z-ORS (-47 ± 208 ml; P ≤ 0.010). Only AA-ORS achieved positive sodium and chloride balance post-exercise, which were greater for AA-ORS than G-ORS and Z-ORS (P ≤ 0.006), as well as for G-ORS than Z-ORS (P ≤ 0.007) from 1 to 5 h. Conclusion: when provided in a volume equivalent to 125% of exercise-induced fluid loss, AA-ORS produced comparable/superior fluid balance and superior sodium/chloride balance responses to popular glucose-based and sugar-free ORS.

Effectiveness of an amino acid beverage formulation in diarrhea-predominant irritable bowel syndrome: A pragmatic real-world study.

BACKGROUND: Amino-acid based medical foods have shown promise in alleviating symptoms of drug induced gastrointestinal side effects; particularly, diarrhea-predominant symptoms. Irritable bowel syndrome (IBS) is a gastrointestinal disorder that affects up to 9% of people globally, with diarrhea predominant IBS (IBS-D) being the most prevalent subtype. Further trials are needed to explore potential added benefits when integrated into standard care for IBS-D. AIM: To assess the effectiveness of an amino acid-based medical food as an adjunct to standard of care for adults with IBS-D. METHODS: This is a pragmatic, real world, open label, single arm study comparing a 2-week baseline assessment to a 2-week intervention period. One hundred adults, aged 18 to 65 years, with IBS-D, according to Rome IV criteria, were enrolled after completing a 2-week baseline assessment period and received a 2-week supply of an amino acid based medical food which was consumed at home twice daily on top of their standard of care. The primary outcome was an assessment of tolerability after 2-weeks of consumption, while secondary outcomes included changes in stool consistency (Bristol Stool Form Scale), severity of abdominal pain & discomfort, symptoms of urgency, Global Improvement Survey (GIS), and the IBS severity scoring system (IBS-SSS). RESULTS: The test product was well-tolerated as each participant successfully completed the full 14-day trial, and there were no instances of dropouts or discontinuation of the study product reported. Forty percent of participants achieved a 50% or more reduction in the number of days with type 6-7 bowel movements (IBS-D stool consistency responders). Fifty-three percent of participants achieved a clinically meaningful reduction of 30% in mean weekly pain scores, and 55% experienced the same for mean weekly discomfort scores (IBS-D pain and discomfort responders). Participants experienced a mean -109.4 (95% confidence interval: -130.1, -88.8) point reduction on the IBS-SSS and 52% experienced a minimally clinically important difference of > 95 points. An IBS-SSS category shift from severe to moderate or mild occurred in 69% of participants. For functional symptoms, 76% of participants reported symptom relief on the GIS. CONCLUSION: The amino acid-based medical food was well-tolerated, when added to the standard of care, and demonstrated improvements in both overall IBS symptom severity and IBS-D symptoms within just 2 wk.

Personalized Hydration Requirements of Runners.

This study sought to (a) estimate how the duration of running influences sweat losses and contributes to the daily fluid requirement, and (b) empirically estimate the drinking rates required to prevent significant dehydration (≥2% body weight as body water). Individual sweating data and running duration were obtained from male (n = 83) and female (n = 36) runners (n = 146 total observations) performing under highly heterogeneous conditions and over a range of exercise durations (33-280 min). Running <60 min/day increased daily fluid needs by a factor of 1.3, whereas running >60 min/day increased the daily fluid need by a factor of 1.9-2.3. Running <60 min/day generally required no fluid intake to prevent significant dehydration before run completion (31/35 runners). In contrast, running >60 min/day required more than 50% replacement of sweating rates to prevent the same (65/111 runners). Overall sweat losses ranged from ∼0.2 to ∼5.0 L/day, whereas the drinking rates required to prevent significant dehydration ranged from 0 to 1.4 L/hr. The characterization of sweat losses, sweat rate, and required drinking among runners in this study indicate wide individual variability that warrants personalized hydration practices, particularly when running is prolonged (>60 min) and performance is important. This study may serve as a useful guidepost for sports dietitians when planning and communicating fluid needs to athletes, as well as complement guidance related to both personalized programmed and thirst-driven drinking strategies.

Earlier Boston Marathon Start Time Mitigates Environmental Heat Stress.

PURPOSE: This study aimed to compare the wet bulb globe temperature (WBGT) index and other environmental parameters between early and late Boston Marathon race start times from 1995 to 2016. METHODS: Environmental data from 1995 to 2016 (excluding 1996) were used to compare two identical time frames using the 0900-1300 h start versus the 1100-1500 h start. This included the WBGT, dry bulb (Tdb), black globe (Tbg), wet bulb (Twb), solar radiation, relative humidity, and air water vapor pressure. To make comparisons between start times, the difference in the area under the curve (AUC) for each environmental variable was compared within each year with a Wilcoxon signed rank test with a Holm-Bonferroni correction. RESULTS: AUC exposures for WBGT (P = 0.027), Twb (P = 0.031), Tdb (P = 0.027), Tbg (P = 0.055), and solar radiation (P = 0.004) were reduced with an earlier start, whereas those for relative humidity and air water vapor pressure were not. Overall, an earlier race start time by 2 h (0900 vs 1100 h) reduced the odds of experiencing a higher flag category 1.42 times (ß = 0.1744, P = 0.032). CONCLUSIONS: The 2007 decision to make the Boston Marathon start time earlier by 2 h has reduced by ~1.4 times the odds that runners will be exposed to environmental conditions associated with exertional heat illness.

Are oral rehydration solutions optimized for treating diarrhea?

BACKGROUND: A historical turning point occurred in the treatment of diarrhea when it was discovered that glucose could enhance intestinal sodium and water absorption. Adding glucose to salt water (oral rehydration solution, ORS) more efficiently replaced intestinal water and salt losses. AIM: Provide a novel hypothesis to explain why mainstream use of ORS has been strongly recommended, but weakly adopted. METHODS: Traditional (absorptive) and novel (secretory) physiological functions of glucose in an ORS were reviewed. RESULTS: Small amounts of glucose can stimulate both intestinal absorption and secretion. Glucose can exacerbate a net secretory state and may aggravate pathogen-induced diarrhea, particularly for pathogens that affect glucose transport. CONCLUSION: A hypothesis is made to explain why glucose-based ORS does not appreciably reduce diarrheal stool volume and why modern food science initiatives should focus on ORS formulations that replace water and electrolytes while also reducing stool volume and duration of diarrhea.

Personalized fluid and fuel intake for performance optimization in the heat.

It is well appreciated that a loss of body water (dehydration) can impair endurance performance and that the effect is magnified by environmental heat stress. A majority of professional sports medicine and nutrition organizations recommend drinking during exercise to replace sweat losses and prevent dehydration, while also avoiding frank over-hydration. Knowledge of sweating rate, which is highest in the heat for any given metabolic rate, is therefore considered key to developing a sound drinking strategy. Exercise duration and the provision of liquid fuel interacts with required drink volumes in important ways that are infrequently discussed but are of utmost practical concern. This review details some challenges related to the optimized coupling of fluid and fuel needs during prolonged exercise in the heat and the need for personalization.

Heat Acclimation Improves Heat Tolerance Test Specificity in a Criteria-dependent Manner.

PURPOSE: This study aimed to characterize HTT specificity and to determine any effect of HA on the outcome. METHODS: Thirteen unacclimatized, healthy men (V˙O2peak, 43.0 ± 4.8 mL·kg-1⋅min-1) with no previous history of heat illness completed 8 d of HA using the HTT protocol (40°C/40% RH; 120 min; 5 km·h-1 and 2% grade). Heart rate (HR) and core temperature (Tcore) recorded every 5 min during exercise and at the end of 120 min (terminal value) were compared between days 1 and 8. Test specificity (given no previous history of heat illness, the probability of being heat tolerant) was calculated on days 1 and 8. RESULTS: There was a significant reduction in HR and Tcore between days 1 and 8, indicating successful HA. All volunteers successfully completed 120 min of walking on all days. HTT specificity ranged between 54% and 85% on day 1 and between 77% and 92% on day 8, depending on the HTT criteria used. CONCLUSION: Young healthy men without any previous heat illness experienced a 15% to 46% false-positive fail rate for the HTT without HA. After HA, the false-positive fail rate decreased to between 8% and 13%. Outcomes of the HTT are significantly affected by the criteria used and by HA status. The use of HTT for RTA decisions should be done with the recognition of these effects.

Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent.

Toussaint, Claudia M., Robert W. Kenefick, Frank A. Petrassi, Stephen R. Muza, and Nisha Charkoudian. Altitude, acute mountain sickness, and acetazolamide: recommendations for rapid ascent. High Alt Med Biol. 22:5-13, 2021. Background: Sea level natives ascending rapidly to altitudes above 1,500 m often develop acute mountain sickness (AMS), including nausea, headaches, fatigue, and lightheadedness. Acetazolamide (AZ), a carbonic anhydrase inhibitor, is a commonly used medication for the prevention and treatment of AMS. However, there is continued debate about appropriate dosing, particularly when considering rapid and physically demanding ascents to elevations above 3,500 m by emergency medical and military personnel. Aims: Our goal in the present analysis was to evaluate and synthesize the current literature regarding the use of AZ to determine the most effective dosing for prophylaxis and treatment of AMS for rapid ascents to elevations >3,500 m. These circumstances are specifically relevant to military and emergency medical personnel who often need to ascend rapidly and perform physically demanding tasks upon arrival at altitude. Methods: We conducted a literature search from April 2018 to February 2020 using PubMed, Google Scholar, and Web of Science to identify randomized controlled trials that compared AZ with placebo or other treatment with the primary endpoint of AMS incidence and severity. We included only research articles/studies that focused on evaluation of AZ use during rapid ascent. Results: Four doses of AZ (125, 250, 500, and 750 mg daily) were identified as efficacious in decreasing the incidence and/or severity of AMS during rapid ascents, with evidence of enhanced effectiveness with higher doses. Conclusions: For military, emergency medical, or other activities involving rapid ascent to altitudes >3,500 m, doses 500-750 mg/day within 24 hours of altitude exposure appear to be the most effective for minimizing symptoms of AMS.

Independent Influence of Skin Temperature on Whole-Body Sweat Rate.

PURPOSE: It is often assumed that a person with a higher mean skin temperature (Tsk) will sweat more during exercise. However, it has not yet been demonstrated whether Tsk describes any individual variability in whole-body sweat rate (WBSR) independently of the evaporative requirement for heat balance (Ereq). METHODS: One hundred forty bouts of 2-h treadmill walking completed by a pool of 21 participants (23 ± 4 yr, 174 ± 8 cm, 76 ± 11 kg, 1.9 ± 0.2 m) under up to nine conditions were analyzed. Trials employed varying rates of metabolic heat production (Hprod; 197-813 W), and environmental conditions (15°C, 20°C, 25°C, 30°C; all 50% relative humidity), yielding a wide range of Ereq (86-684 W) and Tsk values (26.9°C-34.4°C). RESULTS: The individual variation observed in WBSR was best described using Ereq (in watts; R = 0.784) as a sole descriptor, relative to Ereq (in watts per meter squared; R = 0.735), Hprod (in watts; R = 0.639), Hprod (in watts per meter squared; R = 0.584), ambient air temperature (Ta) (R = 0.263), and Tsk (R = 0.077; all, P < 0.001). A multiple stepwise linear regression included only Ereq (in watts; adjusted R = 0.784), with Tsk not significantly correlating with the residual variance (P = 0.285), independently of Ereq (in watts). Hprod (in watts) had similar predictive strength to Ereq (in watts) at a fixed air temperature, explaining only 5.2% at 30°C, 4.9% at 25°C, 2.7% at 20°C, and 0.5% at 15°C (all, P < 0.001) less variance in WBSR compared with Ereq. However, when data from all ambient temperatures were pooled, Hprod alone was a markedly worse predictor of WBSR than Ereq (R = 0.639 vs 0.784; P < 0.001). CONCLUSIONS: Ereq (in watts) explained approximately four-fifths of the individual variation in WBSR over a range of ambient temperatures and exercise intensities, whereas Tsk did not explain any residual variance independently of Ereq.

Endurance test selection optimized via sample size predictions.

Selecting the most appropriate performance test is critical in detecting the effect of an intervention. In this investigation we 1) used time-trial (TT) performance data to estimate sample size requirements for test selection and 2) demonstrated the differences in statistical power between a repeated-measures ANOVA (RM-ANOVA) and analysis of covariance (ANCOVA) for detecting an effect in parallel group design. A retrospective analysis of six altitude studies was completed, totaling 105 volunteers. We quantified the test-retest reliability [i.e., intraclass correlation coefficient (ICC) and standard error of measurement (SEM)] and then calculated the standardized effect size for a 5-20% change in TT performance. With these outcomes, a power analysis was performed and required sample sizes were compared among performance tests. Relative to TT duration, the 11.2-km run had the lowest between-subject variance, and thus greatest statistical power (i.e., required smallest sample size) to detect a given percent change in performance. However, the 3.2-km run was the most reliable test (ICC: 0.89, SEM: 81 s) and thus better suited to detect the smallest absolute (i.e., seconds) change in performance. When TT durations were similar, a running modality (11.2-km run; ICC: 0.83, SEM: 422 s) was far more reliable than cycling (720-kJ cycle; ICC: 0.77, SEM: 480 s). In all scenarios, the ANCOVA provided greater statistical power than the RM-ANOVA. Our results suggest that running tests (3.2 km and 11.2 km) using ANCOVA analysis provide the greatest likelihood of detecting a significant change in performance response to an intervention, particularly in populations unaccustomed to cycling.NEW & NOTEWORTHY This is the first investigation to utilize time-trial (TT) data from previous studies in simulations to estimate statistical power. We developed an easy-to-use decision aid detailing the required sample size needed to detect a given change in TT performance for the purpose of test selection. Furthermore, our detailed methods can be applied to any scenario in which there is an impact of a stressor and the desire to detect a treatment effect.

Effect of 8 days of exercise-heat acclimation on aerobic exercise performance of men in hypobaric hypoxia.

Exercise-heat acclimation (EHA) induces adaptations that improve tolerance to heat exposure. Whether adaptations from EHA can also alter responses to hypobaric hypoxia (HH) conditions remains unclear. This study assessed whether EHA can alter time-trial performance and/or incidence of acute mountain sickness (AMS) during HH exposure. Thirteen sea-level (SL) resident men [SL peak oxygen consumption (V̇o2peak) 3.19 ± 0.43 L/min] completed steady-state exercise, followed by a 15-min cycle time trial and assessment of AMS before (HH1; 3,500 m) and after (HH2) an 8-day EHA protocol [120 min; 5 km/h; 2% incline; 40°C and 40% relative humidity (RH)]. EHA induced lower heart rate (HR) and core temperature and plasma volume expansion. Time-trial performance was not different between HH1 and HH2 after 2 h (106.3 ± 23.8 vs. 101.4 ± 23.0 kJ, P = 0.71) or 24 h (107.3 ± 23.4 vs. 106.3 ± 20.8 kJ, P > 0.9). From HH1 to HH2, HR and oxygen saturation, at the end of steady-state exercise and time-trial tests at 2 h and 24 h, were not different (P > 0.05). Three of 13 volunteers developed AMS during HH1 but not during HH2, whereas a fourth volunteer only developed AMS during HH2. Heat shock protein 70 was not different from HH1 to HH2 at SL [1.9 ± 0.7 vs. 1.8 ± 0.6 normalized integrated intensities (NII), P = 0.97] or after 23 h (1.8 ± 0.4 vs. 1.7 ± 0.5 NII, P = 0.78) at HH. Our results indicate that this EHA protocol had little to no effect-neither beneficial nor detrimental-on exercise performance in HH. EHA may reduce AMS in those who initially developed AMS; however, studies at higher elevations, having higher incidence rates, are needed to confirm our findings.

Potential for dehydration to impact the athlete biological passport.

In order to inform the Athlete Biological Passport (ABP), this study determined whether the elevation in hemoglobin (Hb) following intracellular or extracellular dehydration would trigger an atypical passport finding (ATPF). Seven male and three female volunteers (age: 23 ± 4 y; height: 170 ± 8 cm; body mass: 78 ± 12 kg) were carefully euhydrated (EUH) to determine baseline Hb levels. Volunteers then completed both an exercise-induced sweating dehydration (SW) protocol and a diuretic-induced dehydration (DI) protocol. Dehydration was assessed via body mass changes and Hb was measured via a bench-top automated hematology analyzer. Using the ABP module, the expected baseline range for each individual was determined using EUH trials, and the impact of each dehydration protocol was then assessed in comparison with these thresholds. Volunteers lost on average 3.1% and 3.7% body mass in the SW and DI trials, respectively. While only one subject exceeded the upper threshold following DI dehydration, six additional subjects demonstrated highly unusual ABP profiles; this was not the case for SW. Sweating is not a feasible explanation for elevated Hb during ABP testing; however, recent illness such as secretory diarrhea, which is mimicked by diuretic administration, may be capable of producing elevated Hb in athletes' biological passports.

Effect of Environmental Temperature and Humidity on Permethrin Biomarkers of Exposure in U.S. Soldiers Wearing Permethrin-Treated Uniforms.

Environmental factors, including high temperature and humidity, can influence dermal absorption of chemicals. Soldiers can be dermally exposed to permethrin while wearing permethrin-treated uniforms. This study aimed at examining the effects of high temperature and a combined high temperature and humid environment on permethrin absorption compared with ambient conditions when wearing a permethrin-treated uniform. Twenty-seven male enlisted soldiers wore study-issued permethrin-treated army uniforms for 33 consecutive hours in three different environments: 1) simulated high temperature (35°C, 40% relative humidity [rh]) (n = 10), 2) simulated high temperature and humidity (30°C, 70% rh) (n = 10), and 3) ambient conditions (13°C, 60% rh) (n = 7). Spot urine samples, collected at 21 scheduled time points before, during, and after wearing the study uniforms, were analyzed for permethrin exposure biomarkers (3-phenoxybenzoic acid, cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid) and creatinine. Biomarker concentrations were 60-90% higher in the heat and combined heat/humidity groups (P < 0.001-0.022) than the ambient group. Also, the average daily permethrin dose, calculated 12 hours after removing the treated uniforms, was significantly higher in the heat (P = 0.01) and the heat/humidity (P = 0.03) groups than the ambient group. There were no significant differences in biomarker concentrations or computed average daily dose between the heat and the heat/humidity groups. Both hot and combined hot and humid environmental conditions significantly increased permethrin absorption in soldiers wearing permethrin-treated uniforms.

Biochemical recovery from exertional heat stroke follows a 16-day time course.

BACKGROUND: The aim of this study was to characterize the time-resolved progression of clinical laboratory disturbances days-following an exertional heat stroke (EHS). Currently, normalization of organ injury clinical biomarker values is the primary indicator of EHS recovery. However, an archetypical biochemical recovery profile following EHS has not been established. METHODS: We performed a retrospective analysis of EHS patient records in US military personnel from 2008-2014 using the Military Health System Data Repository (MDR). We focused on commonly reported clinical laboratory analytes measured on the day of injury and all proceeding follow-up visits. RESULTS: Over the prescribed period, there were 2,529 EHS episodes treated at 250 unique treatment locations. Laboratory results, including a standardized set of blood, serum and urine assays, were analyzed from 0-340 days following the initial injury. Indicators of acute kidney injury, including serum electrolyte disturbances and abnormal urinalysis findings, were most prevalent on the day of the injury but normalized within 24-48hours (creatinine, blood urea nitrogen, and blood and protein in urine). Muscle damage and liver function-associated markers peaked 0-4 days after injury and persisted outside their respective reference ranges for 2-16 days (alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, myoglobin, prothrombin time). CONCLUSION: Biochemical recovery from EHS spans a 16-day time course, and markers of end-organ damage exhibit distinct patterns over this period. This analysis underscores the prognostic value of each clinical laboratory analyte and will assist in evaluating EHS patient presentation, injury severity and physiological recovery.

Aerobic Exercise Performance During Load Carriage and Acute Altitude Exposure.

Coffman, KE, Luippold, AJ, Salgado, RM, Heavens, KR, Caruso, EM, Fulco, CS, and Kenefick, RW. Aerobic exercise performance during load carriage and acute altitude exposure. J Strength Cond Res 34(4): 946-951, 2020-This study quantified the impact of combined load carriage and acute altitude exposure on 5-km running time-trial (TT) performance and self-selected pacing strategy. Furthermore, this study developed a velocity prediction tool (nomogram) for similar aerobic exercise tasks performed under various combinations of altitude and load stress. Nine volunteers (6M/3F, age: 24 ± 7 years, height: 171 ± 6 cm, body mass: 72 ± 7 kg, and V[Combining Dot Above]O2peak: 50.5 ± 5.2 ml·min·kg) completed a randomized, repeated-measures design protocol. Volunteers performed 3 familiarization (FAM) trials at sea level (SL; 250 m) with no-load carriage. Experimental testing included 3 self-paced, blinded 5-km running TT on a treadmill while carrying a 30% body mass external load at SL, moderate altitude (MA; 2000 m), and high altitude (HA; 3000 m). At SL, load carriage resulted in a 36% decrement in 5-km exercise performance in comparison with FAM trials (43 ± 7 vs. 32 ± 3 minutes; p < 0.001). Time required to complete the 5-km distance while carrying an external load was increased by 11% when performed at HA vs. SL (48 ± 7 vs. 43 ± 7 minutes; p = 0.001). TT pace was not different among experimental conditions (load carriage at SL, MA, and HA) until after 1 km of the running distance had been completed. Heart rate was not different among experimental conditions throughout the entire TT (170 ± 17 b·min). These data quantify the anticipated reduction in aerobic exercise performance under various combinations of acute altitude exposure and load carriage conditions. The self-paced running TT approach used presently allowed for development of an altitude-load nomogram for use in recreational, occupational, or military settings.

Biological variation of arginine vasopressin.

PURPOSE: There is growing interest in the measurement of plasma levels of arginine vasopressin (AVP) for the assessment of mild dehydration. However, the principles of biological variation have not been applied to the study of AVP and understanding biological variation of AVP may provide insights regarding measurement thresholds. The purpose of this investigation was to determine the biological variation of AVP in healthy euhydrated individuals to understand the potential for establishing both static and/or change thresholds of importance. METHODS: We studied 29 healthy volunteers (24 men and 5 women) while controlling for hydration and pre-analytical factors. All subjects completed between 2-8 trials where biological variation was determined using widely published methods. We determined the intraindividual, interindividual, and analytical coefficients of variation (CVI, CVG, and CVA, respectively) and subsequently the index of individuality and heterogeneity (II and IH, respectively). RESULTS: AVP did not reach the IH threshold required to be considered useful in the dynamic assessment of physiological deviations from normal. AVP levels approached the II threshold required to be considered useful in the static assessment of physiological deviations from normal. CONCLUSIONS: This analysis demonstrates that AVP assessment is unlikely to yield useful information about hydration status.