Biomedical subjects

S J Montain

Publications and source records attributed to S J Montain.

At least 19 recordsLinked to original sources

PubMed2006

Exercise associated hyponatraemia: quantitative analysis to understand the aetiology.

BACKGROUND: The development of symptomatic hyponatraemia consequent on participation in marathon and ultraendurance races has led to questions about its aetiology and prevention. OBJECTIVES: To evaluate: (a) the assertion that sweat sodium losses cannot contribute to the development of hyponatraemia during endurance exercise; (b) the adequacy of fluid replacement recommendations issued by the International Marathon Medical Directors Association (IMMDA) for races of 42 km or longer; (c) the effectiveness of commercial sports drinks, compared with water, for attenuating plasma sodium reductions. METHODS: A mathematical model was used to predict the effects of different drinking behaviours on hydration status and plasma sodium concentration when body mass, body composition, running speed, weather conditions, and sweat sodium concentration were systematically varied. RESULTS: Fluid intake at rates that exceed sweating rate is predicted to be the primary cause of hyponatraemia. However, the model predicts that runners secreting relatively salty sweat can finish ultraendurance exercise both dehydrated and hyponatraemic. Electrolyte-containing beverages are predicted to delay the development of hyponatraemia. The predictions suggest that the IMMDA fluid intake recommendations adequately sustain hydration over the 42 km distance if qualifiers-for example, running pace, body size-are followed. CONCLUSIONS: Actions to prevent hyponatraemia should focus on minimising overdrinking relative to sweating rate and attenuating salt depletion in those who excrete salty sweat. This simulation demonstrates the complexity of defining fluid and electrolyte consumption rates during athletic competition.

Body Composition↗

PubMed2001

Hydration effects on thermoregulation and performance in the heat.

During exercise, sweat output often exceeds water intake, producing a water deficit or hypohydration. The water deficit lowers both intracellular and extracellular fluid volumes, and causes a hypotonic-hypovolemia of the blood. Aerobic exercise tasks are likely to be adversely effected by hypohydration (even in the absence of heat strain), with the potential affect being greater in hot environments. Hypohydration increases heat storage by reducing sweating rate and skin blood flow responses for a given core temperature. Hypertonicity and hypovolemia both contribute to reduced heat loss and increased heat storage. In addition, hypovolemia and the displacement of blood to the skin make it difficult to maintain central venous pressure and thus cardiac output to simultaneously support metabolism and thermoregulation. Hyperhydration provides no advantages over euhydration regarding thermoregulation and exercise performance in the heat.

Body Temperature Regulation↗

PubMed2001

Hyponatremia associated with exercise: risk factors and pathogenesis.

Exercise-related hyponatremia is an infrequent but potentially life-threatening accompaniment of prolonged exercise. This condition results from sodium losses in sweat, excessive water intake, or both. We review the risk factors for development of this condition and discuss evidence that there is a population at increased risk of hyponatremia during prolonged exercise.

Cystic Fibrosis↗

PubMed2001

Physiologic tolerance to uncompensable heat: intermittent exercise, field vs laboratory.

PURPOSE: This study determined whether exercise (30 min)-rest (10 min) cycles alter physiologic tolerance to uncompensable heat stress (UCHS) when outdoors in the desert. In addition, the relationship between core temperature and exhaustion from heat strain previously established in laboratory studies was compared with field studies. METHODS: Twelve men completed four trials: moderate intensity continuous exercise (MC), moderate intensity exercise with intermittent rest (MI), hard intensity continuous exercise (HC), and hard intensity exercise with intermittent rest (HI). UCHS was achieved by wearing protective clothing and exercising (estimated at 420 W or 610 W) outdoors in desert heat. RESULTS: Heat Stress Index values were 200%, 181%, 417%, and 283% for MC, MI, HC, and HI, respectively. Exhaustion from heat strain occurred in 36 of 48 trials. Core temperatures at exhaustion averaged 38.6 +/- 0.5 degrees, 38.9 +/- 0.6 degrees, 38.9 +/- 0.7 degrees, and 39.0 +/- 0.7 degrees C for MC, MI, HC, and HI, respectively. Core temperature at exhaustion was not altered (P > 0.05) by exercise intensity or exercise-rest cycles and 50% of subjects incurred exhaustion at core temperature of 39.4 degrees C. These field data were compared with laboratory and field data collected over the past 35 years. Aggregate data for 747 laboratory and 131 field trials indicated that 50% of subjects incurred exhaustion at core temperatures of 38.6 degrees and 39.5 degrees C, respectively. When heat intolerant subjects (exhaustion < 38.3 degrees C core temperature) were removed from the analysis, subjects from laboratory studies (who underwent short-term acclimation) still demonstrated less (0.8 degrees C) physiological tolerance than those from field studies (who underwent long-term acclimatization). CONCLUSION: Exercise-rest cycles did not alter physiologic tolerance to UCHS. In addition, subjects from field studies demonstrate greater physiologic tolerance than subjects from laboratory studies.

Adaptation, Physiological↗

PubMed2001

Intracellular monocyte and serum cytokine expression is modulated by exhausting exercise and cold exposure.

This study tested the hypothesis that exercise elicits monocytic cytokine expression and that prolonged cold exposure modulates such responses. Nine men (age, 24.6 +/- 3.8 y; VO(2 peak), 56.8 +/- 5.6 ml. kg(-1). min(-1)) completed 7 days of exhausting exercise (aerobic, anaerobic, resistive) and underwent three cold, wet exposures (CW). CW trials comprised </=6 h (six 1-h rest-work cycles) exposure to cold (5 degrees C, 20 km/h wind) and wet (5 cm/h rain) conditions. Blood samples for the determination of intracellular and serum cytokine levels and circulating hormone concentrations were drawn at rest (0700), after exercise (approximately 1130), and after CW (~2000). Whole blood was incubated with (stimulated) or without (spontaneous) lipopolysaccharide (LPS; 1 microgram/ml) and stained for CD14 monocyte surface antigens. Cell suspensions were stained for intracellular cytokine expression and analyzed by flow cytometry. The proportion of CD14(+) monocytes exhibiting spontaneous and stimulated intracellular expression of interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha increased after exercise, but these cells produced less IL-1beta and TNF-alpha after CW when CW was preceded by exhausting exercise. Serum cytokine concentrations followed a parallel trend. These findings suggest that blood monocytes contribute to exercise-induced cytokinemia and that cold exposure can differentially modulate cytokine production, upregulating expression of IL-6 and IL-1 receptor antagonist but downregulating IL-1beta and TNF-alpha. The cold-induced changes in cytokine expression appear to be linked to enhanced catecholamine secretion associated with cold exposure.

Adult↗

PubMed2001

Hyponatremia associated with overhydration in U.S. Army trainees.

This report describes a series of hyponatremia hospitalizations associated with heat-related injuries and apparent over-hydration. Data from the U.S. Army Inpatient Data System were used to identify all hospitalizations for hyposmolality/hyponatremia from 1996 and 1997. Admissions were considered as probable cases of overhydration hyponatremia if this was the only, or primary, diagnosis or if it was associated with any heat-related diagnosis. Seventeen medical records were identified, and the events leading to hospitalization were analyzed. The average serum sodium level was 122 +/- 5 mmol/L (range, 115-130 mmol/L). All 17 patients were soldiers attending training schools. Seventy-seven percent of hyponatremia cases occurred in the first 4 weeks of training. Nine patients had water intake rates equal to or exceeding 2 quarts per hour. Most patients were in good health before developing hyponatremia. The most common symptoms were mental status changes (88%), emesis (65%), nausea (53%), and seizures (31%). In 5 of 6 cases in which extensive history was known, soldiers drank excess amounts of water before developing symptoms and as part of field treatment. The authors conclude that hyponatremia resulted from too aggressive fluid replacement practices for soldiers in training status. The fluid replacement policy was revised with consideration given to both climatic heat stress and physical activity levels. Field medical policy should recognize the possibility of overhydration. Specific evacuation criteria should be established for exertional illness.

Fatal Outcome↗

PubMed2000

Fluid and electrolyte supplementation for exercise heat stress.

During exercise in the heat, sweat output often exceeds water intake, resulting in a body water deficit (hypohydration) and electrolyte losses. Because daily water losses can be substantial, persons need to emphasize drinking during exercise as well as at meals. For persons consuming a normal diet, electrolyte supplementation is not warranted except perhaps during the first few days of heat exposure. Aerobic exercise is likely to be adversely affected by heat stress and hypohydration; the warmer the climate the greater the potential for performance decrements. Hypohydration increases heat storage and reduces a person's ability to tolerate heat strain. The increased heat storage is mediated by a lower sweating rate (evaporative heat loss) and reduced skin blood flow (dry heat loss) for a given core temperature. Heat-acclimated persons need to pay particular attention to fluid replacement because heat acclimation increases sweat losses, and hypohydration negates the thermoregulatory advantages conferred by acclimation. It has been suggested that hyperhydration (increased total body water) may reduce physiologic strain during exercise heat stress, but data supporting that notion are not robust. Research is recommended for 3 populations with fluid and electrolyte balance problems: older adults, cystic fibrosis patients, and persons with spinal cord injuries.

Adult↗

PubMed2000

Impact of muscle injury and accompanying inflammatory response on thermoregulation during exercise in the heat.

This study examined whether muscle injury and the accompanying inflammatory responses alter thermoregulation during subsequent exercise-heat stress. Sixteen subjects performed 50 min of treadmill exercise (45-50% maximal O(2) consumption) in a hot room (40 degrees C, 20% relative humidity) before and at select times after eccentric upper body (UBE) and/or eccentric lower body (LBE) exercise. In experiment 1, eight subjects performed treadmill exercise before and 6, 25, and 30 h after UBE and then 6, 25, and 30 h after LBE. In experiment 2, eight subjects performed treadmill exercise before and 2, 7, and 26 h after LBE only. UBE and LBE produced marked soreness and significantly elevated creatine kinase levels (P < 0.05), but only LBE increased (P < 0.05) interleukin-6 levels. In experiment 1, core temperatures before and during exercise-heat stress were similar for control and after UBE, but some evidence for higher core temperatures was found after LBE. In experiment 2, core temperatures during exercise-heat stress were 0.2-0.3 degrees C (P < 0.05) above control values at 2 and 7 h after LBE. The added thermal strain after LBE (P < 0.05) was associated with higher metabolic rate (r = 0.70 and 0.68 at 2 and 6-7 h, respectively) but was not related (P > 0.05) to muscle soreness (r = 0.47 at 6-7 h), plasma interleukin-6 (r = 0.35 at 6-7 h), or peak creatine kinase levels (r = 0.22). Local sweating responses (threshold core temperature and slope) were not altered by UBE or LBE. The results suggest that profuse muscle injury can increase body core temperature during exercise-heat stress and that the added heat storage cannot be attributed solely to increased heat production.

Acclimatization↗

PubMed2000

National athletic trainers' association position statement: fluid replacement for athletes.

OBJECTIVE: To present recommendations to optimize the fluid-replacement practices of athletes. BACKGROUND: Dehydration can compromise athletic performance and increase the risk of exertional heat injury. Athletes do not voluntarily drink sufficient water to prevent dehydration during physical activity. Drinking behavior can be modified by education, increasing accessibility, and optimizing palatability. However, excessive overdrinking should be avoided because it can also compromise physical performance and health. We provide practical recommendations regarding fluid replacement for athletes. RECOMMENDATIONS: Educate athletes regarding the risks of dehydration and overhydration on health and physical performance. Work with individual athletes to develop fluid-replacement practices that optimize hydration status before, during, and after competition.

Journal Article↗

PubMed1999

Water and electrolyte requirements for exercise.

Exercise performance can be compromised by a body water deficit, particularly when exercise is performed in hot climates. It is recommended that individuals begin exercise when adequately hydrated. This can be facilitated by drinking 400 mL to 600 mL of fluid 2 hours before beginning exercise and drinking sufficient fluid during exercise to prevent dehydration from exceeding 2% body weight. A practical recommendation is to drink small amounts of fluid (150-300 mL) every 15 to 20 minutes of exercise, varying the volume depending on sweating rate. Core temperature, heart rate, and perceived effort remain lowest when fluid replacement comes closest to matching the rate of sweat loss. During exercise lasting less than 90 minutes, water alone is sufficient for fluid replacement. During prolonged exercise lasting longer than 90 minutes, commercially available carbohydrate electrolyte beverages should be considered to provide an exogenous carbohydrate source to sustain carbohydrate oxidation and endurance performance. Electrolyte supplementation is generally not necessary because dietary intake is adequate to offset electrolytes lost in sweat and urine; however, during initial days of hot-weather training or when meals are not calorically adequate, supplemental salt intake may be indicated to sustain sodium balance.

Carbohydrate Metabolism↗

PubMed1999

Effects of creatine supplementation on the energy cost of muscle contraction: a 31P-MRS study.

Five women and 3 men (29.8 +/- 1.4 yr) performed dynamic knee-extension exercise inside a magnetic resonance system (means +/- SE). Two trials were performed 7-14 days apart, consisting of a 4- to 5-min exhaustive exercise bout. To determine quadriceps cost of contraction, brief static and dynamic contractions were performed pre- and postexercise. (31)P spectra were used to determine pH and relative concentrations of P(i), phosphocreatine (PCr), and betaATP. Subjects consumed 0.3 g. kg(-1). day(-1) of a placebo (trial 1) or creatine (trial 2) for 5 days before each trial. After creatine supplementation, resting DeltaPCr increased from 40.7 +/- 1.8 to 46. 6 +/- 1.1 mmol/kg (P = 0.04) and PCr during exercise declined from -29.6 +/- 2.4 to -34.1 +/- 2.8 mmol/kg (P = 0.02). Muscle static (DeltaATP/N) and dynamic (DeltaATP/J) costs of contraction were unaffected by creatine supplementation as well as were ATP, P(i), pH, PCr resynthesis rate, and muscle strength and endurance. DeltaATP/J and DeltaATP/N were greatest at the onset of the exercise protocol (P < 0.01). In summary, creatine supplementation increased muscle PCr concentration, which did not affect muscle ATP cost of contraction.

Adenosine Triphosphate↗

PubMed1999

Fluid replacement recommendations for training in hot weather.

The U.S. Army's fluid replacement guidelines emphasize fluid replacement during hot weather training to prevent degradation of performance and minimize the risk of heat injury. Little consideration has been given, however, to possible overhydration and development of water intoxication. Sufficient epidemiological evidence is available to demonstrate an increasing incidence of water intoxication during military training. This article summarizes the development and validation of revised fluid replacement guidelines for hot weather training. The end product is an easy-to-read table that provides the user with the appropriate hourly work time and fluid intake to support work during hot weather training. The guidelines include the range of hot weather conditions likely to be encountered during military training and cover a broad range of military activities. It is expected that the revised guidelines will sustain hydration and minimize the number of heat injuries during military training while protecting the soldier from becoming sick from overdrinking.

Adult↗

PubMed1999

Cross validation of USARIEM heat strain prediction models. U.S. ARMY Research Institute of Environmental Medicine.

HYPOTHESIS: This study was a cross validation of three heat strain prediction models developed at the U.S. Army Research Institute of Environmental Medicine: the ARIEM, HSDA, and ARIEM-EXP models ability to predict core temperature. METHODS: Seven heat-acclimated subjects completed twelve experimental tests, six in each of two hot climates, at three exercise intensities and two uniform configurations in each climate. RESULTS: Experimental results showed physiological responses as expected with heat strain increasing with work load and level of protective clothing, but with similar heat strain between the two environments matched for wet bulb, globe index. Neither the ARIEM or HSDA model closely predicted core temperatures over the course of the experiment, due mostly to an abrupt initial rise in core temperature in both models. A proportionality constant in the ARIEM-EXP buffered some of this abrupt rise. CONCLUSIONS: Comparisons of the core temperature and tolerance times data with the three models led to the conclusions that for healthy males: 1) the ARIEM and HSDA models provide conservative safety limits as a result of predicting rapid initial increases in core temperature; 2) the ARIEM-EXP most closely represents core temperature responses; 3) the ARIEM-EXP requires modifications with an alternate proportionality coefficient to increase accuracy for low metabolic cost exercise; 4) all of the models require additional input from existing research on tolerance to heat strain to better predict tolerance times; and 5) additional models should be examined to investigate the transient state of the body as it is affected by environment, clothing and exercise.

Acclimatization↗

PubMed1998

Thermal and cardiovascular strain from hypohydration: influence of exercise intensity.

This study determined the effects of exercise intensity on the physiologic (thermal and cardiovascular) strain induced from hypohydration during heat stress. We hypothesized that the added thermal and cardiovascular strain induced by hypohydration would be greater during high intensity than low intensity exercise. Nine heat-acclimated men completed a matrix of nine trials: three exercise intensities, 25%, 45% and 65% VO2 max; and three hydration levels, euhydration and hypohydration at 3% and 5% body weight loss (BWL). During each trial, subjects attempted 50 min of treadmill exercise in a hot room (30 degrees C db, 50% rh) while body temperatures and cardiac output were measured. Hypohydration was achieved by exercise and fluid restriction the day preceding the trials. Core temperature increased (P<0.05) 0.12 degrees C per%BWL at each hypohydration level and was not affected by exercise intensity. Cardiac output was reduced (P<0.05) compared to euhydration levels and was reduced more during high compared to low intensity exercise after 5% BWL. It was concluded that: a) the thermal penalty (core temperature increase) accompanying hypohydration is not altered by exercise intensity; and b) at severe hypohydration levels, the cardiovascular penalty (cardiac output reduction) increases with exercise intensity.

Acclimatization↗

PubMed1998

Hydration effects on temperature regulation.

During exercise in the heat, sweat output often exceeds water intake which results in a body water deficit (hypohydration) and electrolyte losses. Daily water losses can be substantial and persons need to emphasize drinking during exercise as well as at mealtime. Aerobic exercise tasks are likely to be adversely affected by heat stress and hypohydration; and the warmer the climate the greater the potential for performance decrements. Hypohydration increases heat storage and reduces one's ability to tolerate heat strain. The increased heat storage is mediated by reduced sweating rate (evaporative heat loss) and reduced skin blood flow (dry heat loss) for a given core temperature. Hyperhydration (increased total body water) has been suggested to reduce physiologic strain during exercise heat stress, however, data supporting that notion are not robust.

Body Temperature Regulation↗

PubMed1998

Evaluation of different levels of hydration using a new physiological strain index.

A physiological strain index (PSI), based on rectal temperature (Tre) and heart rate (HR), was recently suggested for evaluating heat stress. The purpose of this study was to evaluate the PSI for different combinations of hydration level and exercise intensity. This index was applied to two databases. The first database was obtained from eight endurance-trained men dehydrated to four different levels (1.1, 2.3, 3.4, and 4.2% of body wt) during 120 min of cycling at a power output of 62-67% maximum O2 consumption (VO2 max) in the heat [33 degrees C and 50% relative humidity (RH)]. The second database was obtained from nine men performing exercise in the heat (30 degrees C and 50% RH) for 50 min. These subjects completed a matrix of nine trials of exercise on a treadmill at three exercise intensities (25, 45, and 65% VO2 max) and three hydration levels (euhydration and hypohydration at 3 and 5% of body wt). Tre, HR, esophageal temperature (Tes), and local sweating rate were measured. PSI (obtained from either Tre or Tes) significantly (P < 0.05) differentiated among all exposures in both databases categorized by exercise intensity and hydration level, and we assessed the strain on a scale ranging from 0 to 10. Therefore, PSI applicability was extended for heat strain associated with hypohydration and continues to provide the potential to be universally accepted.

Adult↗

PubMed1998

Hyperhydration: tolerance and cardiovascular effects during uncompensable exercise-heat stress.

This study examined the efficacy of glycerol and water hyperhydration (1 h before exercise) on tolerance and cardiovascular strain during uncompensable exercise-heat stress. The approach was to determine whether 1-h preexercise hyperhydration (29.1 ml H2O/kg lean body mass with or without 1.2 g/kg lean body mass of glycerol) provided a physiological advantage over euhydration. Eight heat-acclimated men completed three trials (control euhydration before exercise, and glycerol and water hyperhydrations) consisting of treadmill exercise-heat stress (ratio of evaporative heat loss required to maximal capacity of climate = 416). During exercise ( approximately 55% maximal O2 uptake), there was no difference between glycerol and water hyperhydration methods for increasing (P < 0.05) total body water. Glycerol hyperhydration endurance time (33. 8 +/- 3.0 min) was longer (P < 0.05) than for control (29.5 +/- 3.5 min), but was not different (P > 0.05) from that of water hyperhydration (31.3 +/- 3.1 min). Hyperhydration did not alter (P > 0.05) core temperature, whole body sweating rate, cardiac output, blood pressure, total peripheral resistance, or core temperature tolerance. Exhaustion from heat strain occurred at similar core and skin temperatures and heart rates in each trial. Symptoms at exhaustion included syncope and ataxia, fatigue, dyspnea, and muscle cramps (n = 11, 10, 2, and 1 cases, respectively). We conclude that 1-h preexercise glycerol hyperhydration provides no meaningful physiological advantage over water hyperhydration and that hyperhydration per se only provides the advantage (over euhydration) of delaying hypohydration during uncompensble exercise-heat stress.

Adult↗

PubMed1998

Hypohydration effects on skeletal muscle performance and metabolism: a 31P-MRS study.

The purpose of this study was to determine whether hypohydration reduces skeletal muscle endurance and whether increased H+ and Pi might contribute to performance degradation. Ten physically active volunteers (age 21-40 yr) performed supine single-leg, knee-extension exercise to exhaustion in a 1.5-T whole body magnetic resonance spectroscopy (MRS) system when euhydrated and when hypohydrated (4% body wt). 31P spectra were collected at a rate of one per second at rest, exercise, and recovery, and were grouped and averaged to represent 10-s intervals. The desired hydration level was achieved by having the subjects perform 2-3 h of exercise in a warm room (40 degrees C dry bulb, 20% relative humidity) with or without fluid replacement 3-8 h before the experiment. Time to fatigue was reduced (P < 0.05) by 15% when the subjects were hypohydrated [213 +/- 12 vs. 251 +/- 15 (SE) s]. Muscle strength was generally not affected by hypohydration. Muscle pH and Pi/beta-ATP ratio were similar during exercise and at exhaustion, regardless of hydration state. The time constants for phosphocreatine recovery were also similar between trials. In summary, moderate hypohydration reduces muscle endurance, and neither H+ nor Pi concentration appears to be related to these reductions.

Adenosine Triphosphate↗