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Published in: Sports Medicine 1/2018

Open Access 01-03-2018 | Review Article

Drinking Strategies: Planned Drinking Versus Drinking to Thirst

Author: Robert W. Kenefick

Published in: Sports Medicine | Special Issue 1/2018

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Abstract

In humans, thirst tends to be alleviated before complete rehydration is achieved. When sweating rates are high and ad libitum fluid consumption is not sufficient to replace sweat losses, a cumulative loss in body water results. Body mass losses of 2% or greater take time to accumulate. Dehydration of ≥  2% body mass is associated with impaired thermoregulatory function, elevated cardiovascular strain and, in many conditions (e.g., warmer, longer, more intense), impaired aerobic exercise performance. Circumstances where planned drinking is optimal include longer duration activities of >  90 min, particularly in the heat; higher-intensity exercise with high sweat rates; exercise where performance is a concern; and when carbohydrate intake of 1 g/min is desired. Individuals with high sweat rates and/or those concerned with exercise performance should determine sweat rates under conditions (exercise intensity, pace) and environments similar to that anticipated when competing and tailor drinking to prevent body mass losses >  2%. Circumstances where drinking to thirst may be sufficient include short duration exercise of <  1 h to 90 min; exercise in cooler conditions; and lower-intensity exercise. It is recommended to never drink so much that weight is gained.
Literature
1.
go back to reference Hoffman MD, Cotter JD, Goulet ED, et al. VIEW: is drinking to thirst adequate to appropriately maintain hydration status during prolonged endurance exercise? Yes. Wilderness Environ Med. 2016;27:192–5.CrossRefPubMed Hoffman MD, Cotter JD, Goulet ED, et al. VIEW: is drinking to thirst adequate to appropriately maintain hydration status during prolonged endurance exercise? Yes. Wilderness Environ Med. 2016;27:192–5.CrossRefPubMed
2.
go back to reference Hoffman MD, Hew-Butler T, Stuempfle KJ. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exercise. 2013;45:784–91.CrossRef Hoffman MD, Hew-Butler T, Stuempfle KJ. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exercise. 2013;45:784–91.CrossRef
3.
go back to reference Sawka MN, Noakes TD. Does dehydration impair exercise performance? Med Sci Sports Exercise. 2007;39:1209–17.CrossRef Sawka MN, Noakes TD. Does dehydration impair exercise performance? Med Sci Sports Exercise. 2007;39:1209–17.CrossRef
4.
go back to reference Sawka MN, Cheuvront SN, Kenefick RW. Hypohydration and human performance: impact of environment and physiological mechanisms. Sports Med. 2015;45:S51–60.CrossRefPubMed Sawka MN, Cheuvront SN, Kenefick RW. Hypohydration and human performance: impact of environment and physiological mechanisms. Sports Med. 2015;45:S51–60.CrossRefPubMed
5.
go back to reference Sawka MN, Burke LM, Eichner ER, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exercise. 2007;39:377–90.CrossRef Sawka MN, Burke LM, Eichner ER, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exercise. 2007;39:377–90.CrossRef
6.
go back to reference Hew-Butler T, Rosner MH, Fowkes-Godek S, et al. Statement of the third international exercise-associated hyponatremia consensus development conference. Clin J Sport Med. 2015;25:303–20.CrossRefPubMed Hew-Butler T, Rosner MH, Fowkes-Godek S, et al. Statement of the third international exercise-associated hyponatremia consensus development conference. Clin J Sport Med. 2015;25:303–20.CrossRefPubMed
7.
go back to reference Hew-Butler T, Verbalis JG. Noakes TD; International Marathon Medical Directors Association. Updated fluid recommendation: position statement from the International Marathon Medical Directors Association (IMMDA). Clin J Sport Med. 2006;16:283–92.CrossRefPubMed Hew-Butler T, Verbalis JG. Noakes TD; International Marathon Medical Directors Association. Updated fluid recommendation: position statement from the International Marathon Medical Directors Association (IMMDA). Clin J Sport Med. 2006;16:283–92.CrossRefPubMed
8.
go back to reference Ormerod JK, Elliott TA, Scheett TP, et al. Drinking behavior and perception of thirst in untrained women during 6 weeks of heat acclimation and outdoor training. Int J Sport Nutr Exercise Metab. 2003;13:15–28.CrossRef Ormerod JK, Elliott TA, Scheett TP, et al. Drinking behavior and perception of thirst in untrained women during 6 weeks of heat acclimation and outdoor training. Int J Sport Nutr Exercise Metab. 2003;13:15–28.CrossRef
10.
11.
go back to reference Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: The National Academies Press; 2005. Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: The National Academies Press; 2005.
12.
go back to reference Cheuvront SN, Kenefick RW. Dehydration: physiology, assessment, and performance effects. Comp Physiol. 2014;4:257–85.CrossRef Cheuvront SN, Kenefick RW. Dehydration: physiology, assessment, and performance effects. Comp Physiol. 2014;4:257–85.CrossRef
13.
go back to reference Adolph EF, Dill DB. Observations on water metabolism in the desert. Am J Physiol. 1938;123:369–499. Adolph EF, Dill DB. Observations on water metabolism in the desert. Am J Physiol. 1938;123:369–499.
14.
go back to reference Cheuvront SN, Carter R III, Montain SJ, et al. Daily body mass variability and stability in active men undergoing exercise-heat stress. Int J Sport Nutr Exercise Metab. 2004;14:532–40.CrossRef Cheuvront SN, Carter R III, Montain SJ, et al. Daily body mass variability and stability in active men undergoing exercise-heat stress. Int J Sport Nutr Exercise Metab. 2004;14:532–40.CrossRef
15.
go back to reference Reeves WB, Bichet DG, Andreoli TE. The posterior pituitary and water metabolism. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, editors. Williams textbook of endocrinology. Philadelphia: WB Saunders Co.; 1998. p. 341–87. Reeves WB, Bichet DG, Andreoli TE. The posterior pituitary and water metabolism. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, editors. Williams textbook of endocrinology. Philadelphia: WB Saunders Co.; 1998. p. 341–87.
16.
go back to reference Shirreffs SM, Merson SJ, Fraser SM, et al. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr. 2004;91:951–8.CrossRefPubMed Shirreffs SM, Merson SJ, Fraser SM, et al. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr. 2004;91:951–8.CrossRefPubMed
17.
go back to reference Cheuvront SN, Kenefick RW, Charkoudian N, et al. Physiologic basis for understanding quantitative dehydration assessment. Am J Clin Nutr. 2013;97:455–62.CrossRefPubMed Cheuvront SN, Kenefick RW, Charkoudian N, et al. Physiologic basis for understanding quantitative dehydration assessment. Am J Clin Nutr. 2013;97:455–62.CrossRefPubMed
18.
go back to reference Cheuvront SN, Kenefick RW, Montain SJ, et al. Mechanisms of aerobic performance impairment with heat stress and dehydration. J Appl Physiol. 2010;109:1989–95.CrossRefPubMed Cheuvront SN, Kenefick RW, Montain SJ, et al. Mechanisms of aerobic performance impairment with heat stress and dehydration. J Appl Physiol. 2010;109:1989–95.CrossRefPubMed
19.
20.
go back to reference Dill DB, Hill AV, Edwards HT. Mechanisms for dissipating heat in man and dog. Am J Physiol. 1933;104:36–43. Dill DB, Hill AV, Edwards HT. Mechanisms for dissipating heat in man and dog. Am J Physiol. 1933;104:36–43.
21.
go back to reference Adolph EF. Physiology of man in the desert. New York: Interscience Publishers Inc.; 1947. Adolph EF. Physiology of man in the desert. New York: Interscience Publishers Inc.; 1947.
22.
go back to reference Bean WB, Eichna LW. Performance in relation to environmental temperature: reactions of normal young men to simulated desert environment. Fed Proc. 1945;2:144–58. Bean WB, Eichna LW. Performance in relation to environmental temperature: reactions of normal young men to simulated desert environment. Fed Proc. 1945;2:144–58.
23.
go back to reference Greenleaf JE, Brock PJ, Keil LC, et al. Drinking and water balance during exercise and heat acclimation. J Appl Physiol. 1983;54:414–9.CrossRefPubMed Greenleaf JE, Brock PJ, Keil LC, et al. Drinking and water balance during exercise and heat acclimation. J Appl Physiol. 1983;54:414–9.CrossRefPubMed
24.
go back to reference Dion T, Savoie FA, Asselin A, et al. Half-marathon running performance is not improved by a rate of fluid intake above that dictated by thirst sensation in trained distance runners. Eur J Appl Physiol. 2013;113:3011–20.CrossRefPubMed Dion T, Savoie FA, Asselin A, et al. Half-marathon running performance is not improved by a rate of fluid intake above that dictated by thirst sensation in trained distance runners. Eur J Appl Physiol. 2013;113:3011–20.CrossRefPubMed
25.
go back to reference Greenleaf JE. Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exercise. 1992;24:645–56.CrossRef Greenleaf JE. Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exercise. 1992;24:645–56.CrossRef
26.
go back to reference Bourque CW. Central mechanisms of osmosensation and systemic osmoregulation. Nat Rev Neurosci. 2008;9:519–31.CrossRefPubMed Bourque CW. Central mechanisms of osmosensation and systemic osmoregulation. Nat Rev Neurosci. 2008;9:519–31.CrossRefPubMed
27.
go back to reference Denton D, Shade R, Zamarippa F, et al. Correlation of regional cerebral blood flow and change of plasma sodium concentration during genesis and satiation of thirst. Proc Nat Acad Sci USA. 1999;96:2532–7.CrossRefPubMedPubMedCentral Denton D, Shade R, Zamarippa F, et al. Correlation of regional cerebral blood flow and change of plasma sodium concentration during genesis and satiation of thirst. Proc Nat Acad Sci USA. 1999;96:2532–7.CrossRefPubMedPubMedCentral
28.
go back to reference Geelen G, Keil LC, Kravik SE, et al. Inhibition of plasma vasopressin after drinking in dehydrated humans. Am J Physiol. 1984;247:R968–71.PubMed Geelen G, Keil LC, Kravik SE, et al. Inhibition of plasma vasopressin after drinking in dehydrated humans. Am J Physiol. 1984;247:R968–71.PubMed
29.
go back to reference Rolls BJ, Wood RJ, Rolls ET, et al. Thirst following water deprivation in humans. Am J Physiol. 1980;239:R476–82.PubMed Rolls BJ, Wood RJ, Rolls ET, et al. Thirst following water deprivation in humans. Am J Physiol. 1980;239:R476–82.PubMed
30.
go back to reference Takamata A, Mack GW, Gillen CM, et al. Osmoregulatory modulation of thermal sweating in humans: reflex effects of drinking. Am J Physiol. 1995;268:R414–22.PubMed Takamata A, Mack GW, Gillen CM, et al. Osmoregulatory modulation of thermal sweating in humans: reflex effects of drinking. Am J Physiol. 1995;268:R414–22.PubMed
31.
go back to reference Thompson CJ, Burd JM, Baylis PH. Acute suppression of plasma vasopressin and thirst after drinking in hypernatremic humans. Am J Physiol. 1987;252:R1138–42.PubMed Thompson CJ, Burd JM, Baylis PH. Acute suppression of plasma vasopressin and thirst after drinking in hypernatremic humans. Am J Physiol. 1987;252:R1138–42.PubMed
32.
go back to reference Cheuvront SN, Montain SJ, Sawka MN. Fluid replacement and performance during the marathon. Sports Med. 2007;37:353–7.CrossRefPubMed Cheuvront SN, Montain SJ, Sawka MN. Fluid replacement and performance during the marathon. Sports Med. 2007;37:353–7.CrossRefPubMed
33.
go back to reference Greenleaf JE, Morimoto T. Mechanisms controlling fluid ingestion: thirst and drinking. In: Buskirk P, editor. Body fluid balance: exercise and sport. Boca Raton: CRC Press; 1996. p. 3–17. Greenleaf JE, Morimoto T. Mechanisms controlling fluid ingestion: thirst and drinking. In: Buskirk P, editor. Body fluid balance: exercise and sport. Boca Raton: CRC Press; 1996. p. 3–17.
34.
go back to reference Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exercise. 2001;33:1524–32.CrossRef Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exercise. 2001;33:1524–32.CrossRef
35.
go back to reference Sawka MN, Coyle EF. Influence of body water and blood volume on thermoregulation and exercise performance in the heat. Exercise Sport Sci Rev. 1999;27:167–218. Sawka MN, Coyle EF. Influence of body water and blood volume on thermoregulation and exercise performance in the heat. Exercise Sport Sci Rev. 1999;27:167–218.
36.
go back to reference Montain SJ, Coyle EF. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol. 1992;73:1340–50.CrossRefPubMed Montain SJ, Coyle EF. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol. 1992;73:1340–50.CrossRefPubMed
37.
go back to reference Montain SJ, Latzka WA, Sawka MN. Control of thermoregulatory sweating is altered by hydration level and exercise intensity. J Appl Physiol. 1995;79:1434–9.CrossRefPubMed Montain SJ, Latzka WA, Sawka MN. Control of thermoregulatory sweating is altered by hydration level and exercise intensity. J Appl Physiol. 1995;79:1434–9.CrossRefPubMed
38.
go back to reference Sawka MN, Young AJ, Francesconi RP, et al. Thermoregulatory and blood responses during exercise at graded hypohydration levels. J Appl Physiol. 1985;59:1394–401.CrossRefPubMed Sawka MN, Young AJ, Francesconi RP, et al. Thermoregulatory and blood responses during exercise at graded hypohydration levels. J Appl Physiol. 1985;59:1394–401.CrossRefPubMed
39.
go back to reference Fortney SM, Wenger CB, Bove JR, et al. Effect of hyperosmolality on control of blood flow and sweating. J Appl Physiol. 1984;57:1688–95.CrossRefPubMed Fortney SM, Wenger CB, Bove JR, et al. Effect of hyperosmolality on control of blood flow and sweating. J Appl Physiol. 1984;57:1688–95.CrossRefPubMed
40.
go back to reference Takamata A, Nagashima K, Nose H, et al. Role of plasma osmolality in the delayed onset of thermal cutaneous vasodilation during exercise in humans. Am J Physiol. 1998;275:R286–90.PubMed Takamata A, Nagashima K, Nose H, et al. Role of plasma osmolality in the delayed onset of thermal cutaneous vasodilation during exercise in humans. Am J Physiol. 1998;275:R286–90.PubMed
41.
go back to reference Nadel ER, Fortney SM, Wenger CB. Circulatory adjustments during heat stress. In: Paoletti R, editor. Exercise bioenergetics and gas exchange. North-Holland Biomedical Press, Amsterdam; 1980. Nadel ER, Fortney SM, Wenger CB. Circulatory adjustments during heat stress. In: Paoletti R, editor. Exercise bioenergetics and gas exchange. North-Holland Biomedical Press, Amsterdam; 1980.
42.
go back to reference Gonzalez-Alonso J, Mora-Rodriguez R, Coyle EF. Stroke volume during exercise: interaction of environment and hydration. Am J Physiol. 2000;278:H321–30. Gonzalez-Alonso J, Mora-Rodriguez R, Coyle EF. Stroke volume during exercise: interaction of environment and hydration. Am J Physiol. 2000;278:H321–30.
43.
go back to reference Saltin B. Circulatory response to submaximal and maximal exercise after thermal dehydration. J Appl Physiol. 1964;19:1125–32.CrossRefPubMed Saltin B. Circulatory response to submaximal and maximal exercise after thermal dehydration. J Appl Physiol. 1964;19:1125–32.CrossRefPubMed
44.
go back to reference Rowell LB. Human circulation: regulation during physical stress. New York: Oxford University Press; 1986. p. 363–406. Rowell LB. Human circulation: regulation during physical stress. New York: Oxford University Press; 1986. p. 363–406.
45.
go back to reference Sawka MN. Physiological consequences of hydration: exercise performance and thermoregulation. Med Sci Sports Exercise. 1992;24:657–70. Sawka MN. Physiological consequences of hydration: exercise performance and thermoregulation. Med Sci Sports Exercise. 1992;24:657–70.
46.
go back to reference Mack GW, Nadel ER. Body fluid balance during heat stress in humans. In: Fregly MJ, Blatteis CM, editors. Environmental physiology. New York: Oxford University Press; 1996. p. 187–214. Mack GW, Nadel ER. Body fluid balance during heat stress in humans. In: Fregly MJ, Blatteis CM, editors. Environmental physiology. New York: Oxford University Press; 1996. p. 187–214.
47.
go back to reference Cheuvront SN, Carter R, Sawka MN. Fluid balance and endurance exercise performance. Curr Sports Med Rep. 2003;2:202–8.CrossRefPubMed Cheuvront SN, Carter R, Sawka MN. Fluid balance and endurance exercise performance. Curr Sports Med Rep. 2003;2:202–8.CrossRefPubMed
48.
go back to reference Casa DJ, Stearns RL, Lopez RM, et al. Influence of hydration on physiological function and performance during trail running in the heat. J Athl Train. 2010;45:147–56.CrossRefPubMedPubMedCentral Casa DJ, Stearns RL, Lopez RM, et al. Influence of hydration on physiological function and performance during trail running in the heat. J Athl Train. 2010;45:147–56.CrossRefPubMedPubMedCentral
49.
go back to reference Kenefick RW, Cheuvront SN. Hydration for recreational sport and physical activity. Nutr Rev. 2012;70:S137–42.CrossRefPubMed Kenefick RW, Cheuvront SN. Hydration for recreational sport and physical activity. Nutr Rev. 2012;70:S137–42.CrossRefPubMed
50.
go back to reference Daries HN, Noakes TD, Dennis SC. Effect of fluid intake volume on 2-h running performances in a 25 degrees C environment. Med Sci Sports Exercise. 2000;32:1783–9.CrossRef Daries HN, Noakes TD, Dennis SC. Effect of fluid intake volume on 2-h running performances in a 25 degrees C environment. Med Sci Sports Exercise. 2000;32:1783–9.CrossRef
51.
go back to reference Beis LY, Wright-Whyte M, Fudge B, et al. Drinking behaviors of elite male runners during marathon competition. Clin J Sport Med. 2012;22:254–61.CrossRefPubMed Beis LY, Wright-Whyte M, Fudge B, et al. Drinking behaviors of elite male runners during marathon competition. Clin J Sport Med. 2012;22:254–61.CrossRefPubMed
52.
go back to reference Berkulo MA, Bol S, Levels K, Lamberts RP, et al. Ad-libitum drinking and performance during a 40-km cycling time trial in the heat. Eur J Sport Sci. 2016;16:213–20.CrossRefPubMed Berkulo MA, Bol S, Levels K, Lamberts RP, et al. Ad-libitum drinking and performance during a 40-km cycling time trial in the heat. Eur J Sport Sci. 2016;16:213–20.CrossRefPubMed
53.
go back to reference Dugas JP, Oosthuizen U, Tucker R, et al. Rates of fluid ingestion alter pacing but not thermoregulatory responses during prolonged exercise in hot and humid conditions with appropriate convective cooling. Eur J Appl Physiol. 2009;105:69–80.CrossRefPubMed Dugas JP, Oosthuizen U, Tucker R, et al. Rates of fluid ingestion alter pacing but not thermoregulatory responses during prolonged exercise in hot and humid conditions with appropriate convective cooling. Eur J Appl Physiol. 2009;105:69–80.CrossRefPubMed
54.
go back to reference Bardis CN, Kavouras SA, Adams JD, et al. Prescribed drinking leads to better cycling performance than ad libitum drinking. Med Sci Sports Exercise. 2017;49:1244–51.CrossRef Bardis CN, Kavouras SA, Adams JD, et al. Prescribed drinking leads to better cycling performance than ad libitum drinking. Med Sci Sports Exercise. 2017;49:1244–51.CrossRef
55.
go back to reference Knechtle B, Senn O, Imoberdorf R, et al. Maintained total body water content and serum sodium concentrations despite body mass loss in female ultra-runners drinking ad libitum during a 100 km race. Asia Pac J Clin Nutr. 2010;19:83–90.PubMed Knechtle B, Senn O, Imoberdorf R, et al. Maintained total body water content and serum sodium concentrations despite body mass loss in female ultra-runners drinking ad libitum during a 100 km race. Asia Pac J Clin Nutr. 2010;19:83–90.PubMed
56.
go back to reference Hoffman MD, Cotter JD, Goulet ED, et al. REBUTTAL from “Y. Wilderness Environ Med. 2016;27:198–200.CrossRefPubMed Hoffman MD, Cotter JD, Goulet ED, et al. REBUTTAL from “Y. Wilderness Environ Med. 2016;27:198–200.CrossRefPubMed
57.
go back to reference Hoffman MD, Stuempfle KJ. Hydration strategies, weight change and performance in a 161 km ultramarathon. Res Sports Med. 2014;22:213–25.CrossRefPubMed Hoffman MD, Stuempfle KJ. Hydration strategies, weight change and performance in a 161 km ultramarathon. Res Sports Med. 2014;22:213–25.CrossRefPubMed
Metadata
Title
Drinking Strategies: Planned Drinking Versus Drinking to Thirst
Author
Robert W. Kenefick
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue Special Issue 1/2018
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-017-0844-6

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