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Dehydration: Physiology, Assessment, and Performance Effects

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Abstract

This article provides a comprehensive review of dehydration assessment and presents a unique evaluation of the dehydration and performance literature. The importance of osmolality and volume are emphasized when discussing the physiology, assessment, and performance effects of dehydration. The underappreciated physiologic distinction between a loss of hypo‐osmotic body water (intracellular dehydration) and an iso‐osmotic loss of body water (extracellular dehydration) is presented and argued as the single most essential aspect of dehydration assessment. The importance of diagnostic and biological variation analyses to dehydration assessment methods is reviewed and their use in gauging the true potential of any dehydration assessment method highlighted. The necessity for establishing proper baselines is discussed, as is the magnitude of dehydration required to elicit reliable and detectable osmotic or volume‐mediated compensatory physiologic responses. The discussion of physiologic responses further helps inform and explain our analysis of the literature suggesting a ≥2% dehydration threshold for impaired endurance exercise performance mediated by volume loss. In contrast, no clear threshold or plausible mechanism(s) support the marginal, but potentially important, impairment in strength, and power observed with dehydration. Similarly, the potential for dehydration to impair cognition appears small and related primarily to distraction or discomfort. The impact of dehydration on any particular sport skill or task is therefore likely dependent upon the makeup of the task itself (e.g., endurance, strength, cognitive, and motor skill). © 2014 American Physiological Society. Compr Physiol 4:257‐285, 2014.

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Figure 1. Figure 1. Linear regression of plasma volume change (y) and body mass change (x) following sweat loss or diuretic dehydration. Original data are shown for 18 volunteers (54 data points) dehydrated twice by 4.1 ± 1.5% using 3 to 5 h of exercise‐heat exposure (sweat; n = 36) and once by 3.1 ± 0.5% using 40 and 80 mg diuretic (Furosemide; n = 18). Plasma volume contraction with Furosemide (yF = −3.8 + 3.6x) is double that for sweat (yS = 1.35 + 2.8x) at any given level of dehydration. Adapted, with permission, from Cheuvront et al. ().
Figure 2. Figure 2. Osmotic regulation of body water balance in response to intracellular dehydration. Schematic includes the estimated magnitude of dehydration required to stimulate the osmotic‐dependent response for compensatory water conservation and acquisition. TBW is total body water, Posm is plasma osmolality, AVP is arginine vasopressin. A change in TBW is equated with a change in body mass (1 L = 1 kg), whereby dehydration is then expressed as a percentage of body mass in accordance with: (Δ body mass/initial body mass)*100. The PV:TBW volume ratio is depicted to scale (1:10). Composite figure created, with permission, from content in Andreoli et al. () and Cheuvront et al. ().
Figure 3. Figure 3. Volume regulation of body water balance in response to extracellular dehydration. Schematic includes the estimated magnitude of dehydration required to stimulate the volume‐dependent response for compensatory water conservation and acquisition. Solid lines represent primary and dashed lines secondary responses. TBW is total body water, AVP is arginine vasopressin, RAA is rennin‐angiotensin‐aldosterone. A change in TBW is equated with a change in body mass (1 L = 1 kg), whereby dehydration is then expressed as a percentage of body mass in accordance with: (Δ body mass/initial body mass)*100. The PV:TBW volume ratio is depicted to scale (1:5). Composite figure created, with permission, from content in Schrier (), Andreoli et al. (), and Cheuvront et al. ().
Figure 4. Figure 4. Common dehydration assessment measures grouped on physiologic grounds according to their potential for detecting intracellular dehydration, extracellular dehydration, or both. Within each category, measurements are subdivided by body fluid, technology, or technique.
Figure 5. Figure 5. Inter‐relationship between urine volume, concentration, and renal solute load. The logical interpretation of dehydration from concentrated urine is based on the reciprocal nature of volume and concentration, but can be confounded by renal solute load. Redrawn, from Gamble and Butler () with permission from Wiley.
Figure 6. Figure 6. Comparison of 1‐min SSΔHR during control (well‐hydrated) and after matching dehydration by furosemide or sweat loss to 3% of body mass, and after 4.5% dehydration using sweat loss. Values are mean ± SD. † Significantly different from control (well‐hydrated) (P < 0.05). 20 b/min cut‐point provided 67% diagnostic accuracy for dehydration. Adapted, with permission, from Cheuvront et al. ().
Figure 7. Figure 7. Quadrant I of a typical RXc score graph. Axes represent dimensionless Z(Xc) and Z(R) scores plotted with population tolerance ellipses. Any point displaced outside the 95% ellipse in quadrant I is consistent with dehydration. Serial measures from any point in quadrant I extending away from or toward the origin indicate relative dehydration or rehydration, respectively ().
Figure 8. Figure 8. Review of dehydration effects on performance in 34 endurance and 43 strength or power studies. Fractions above bars provide the details for the y‐axis percentages. References for the studies reviewed can be found on‐line as Supplemental Material.
Figure 9. Figure 9. Endurance performance impairment when dehydrated by 3% to 4% body mass is a function of skin temperature (Tsk) above ∼27°C. Data are means [error bars are 95% CI] compiled from three studies () employing similar experimental procedures and time trial (TT) performance tests. Closed circles represent 15 min TT tests, open circles represent 30 min TT tests. All tests included a 30‐min constant, submaximal exercise intensity preload. Shaded area represents ±5% coefficient of variation for time trial performance. Adapted, with permission, From Sawka et al. ().


Figure 1. Linear regression of plasma volume change (y) and body mass change (x) following sweat loss or diuretic dehydration. Original data are shown for 18 volunteers (54 data points) dehydrated twice by 4.1 ± 1.5% using 3 to 5 h of exercise‐heat exposure (sweat; n = 36) and once by 3.1 ± 0.5% using 40 and 80 mg diuretic (Furosemide; n = 18). Plasma volume contraction with Furosemide (yF = −3.8 + 3.6x) is double that for sweat (yS = 1.35 + 2.8x) at any given level of dehydration. Adapted, with permission, from Cheuvront et al. ().


Figure 2. Osmotic regulation of body water balance in response to intracellular dehydration. Schematic includes the estimated magnitude of dehydration required to stimulate the osmotic‐dependent response for compensatory water conservation and acquisition. TBW is total body water, Posm is plasma osmolality, AVP is arginine vasopressin. A change in TBW is equated with a change in body mass (1 L = 1 kg), whereby dehydration is then expressed as a percentage of body mass in accordance with: (Δ body mass/initial body mass)*100. The PV:TBW volume ratio is depicted to scale (1:10). Composite figure created, with permission, from content in Andreoli et al. () and Cheuvront et al. ().


Figure 3. Volume regulation of body water balance in response to extracellular dehydration. Schematic includes the estimated magnitude of dehydration required to stimulate the volume‐dependent response for compensatory water conservation and acquisition. Solid lines represent primary and dashed lines secondary responses. TBW is total body water, AVP is arginine vasopressin, RAA is rennin‐angiotensin‐aldosterone. A change in TBW is equated with a change in body mass (1 L = 1 kg), whereby dehydration is then expressed as a percentage of body mass in accordance with: (Δ body mass/initial body mass)*100. The PV:TBW volume ratio is depicted to scale (1:5). Composite figure created, with permission, from content in Schrier (), Andreoli et al. (), and Cheuvront et al. ().


Figure 4. Common dehydration assessment measures grouped on physiologic grounds according to their potential for detecting intracellular dehydration, extracellular dehydration, or both. Within each category, measurements are subdivided by body fluid, technology, or technique.


Figure 5. Inter‐relationship between urine volume, concentration, and renal solute load. The logical interpretation of dehydration from concentrated urine is based on the reciprocal nature of volume and concentration, but can be confounded by renal solute load. Redrawn, from Gamble and Butler () with permission from Wiley.


Figure 6. Comparison of 1‐min SSΔHR during control (well‐hydrated) and after matching dehydration by furosemide or sweat loss to 3% of body mass, and after 4.5% dehydration using sweat loss. Values are mean ± SD. † Significantly different from control (well‐hydrated) (P < 0.05). 20 b/min cut‐point provided 67% diagnostic accuracy for dehydration. Adapted, with permission, from Cheuvront et al. ().


Figure 7. Quadrant I of a typical RXc score graph. Axes represent dimensionless Z(Xc) and Z(R) scores plotted with population tolerance ellipses. Any point displaced outside the 95% ellipse in quadrant I is consistent with dehydration. Serial measures from any point in quadrant I extending away from or toward the origin indicate relative dehydration or rehydration, respectively ().


Figure 8. Review of dehydration effects on performance in 34 endurance and 43 strength or power studies. Fractions above bars provide the details for the y‐axis percentages. References for the studies reviewed can be found on‐line as Supplemental Material.


Figure 9. Endurance performance impairment when dehydrated by 3% to 4% body mass is a function of skin temperature (Tsk) above ∼27°C. Data are means [error bars are 95% CI] compiled from three studies () employing similar experimental procedures and time trial (TT) performance tests. Closed circles represent 15 min TT tests, open circles represent 30 min TT tests. All tests included a 30‐min constant, submaximal exercise intensity preload. Shaded area represents ±5% coefficient of variation for time trial performance. Adapted, with permission, From Sawka et al. ().
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Aerobic Exercise Studies

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  17. Kenefick RW, Cheuvront SN, Palombo LJ, Ely BR and Sawka MN. Skin temperature modifies the impact of hypohydration on aerobic performance. J Appl Physiol 109: 79-86, 2010.
  18. Lopez RM, Casa DJ, Jensen KA, DeMartini JK, Pagnotta KD, Ruiz RC, Roti MW, Stearns RL, Armstrong LE and Maresh CM. Examining the influence of hydration status on physiological responses and running speed during trail running in the heat with controlled exercise intensity. J Strength Cond Res 25: 2944-2954, 2011.
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  31. Smith MS, Dyson R, Hale T, Harrison JH and McManus P. The effects in humans of rapid loss of body mass on a boxing-related task. Eur J Appl Physiol 83: 34-39, 2000.
  32. Stearns RL, Casa DJ, Lopez RM, McDermott BP, Ganio MS, Decher NR, Scruggs IC, West AE, Armstrong LE and Maresh CM. Influence of hydration status on pacing during trail running in the heat. J Strength Cond Res 23: 2533-2541, 2009.
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  34. Walsh RM, Noakes TD, Hawley JA and Dennis SC. Impaired high-intensity cycling performance time at low levels of dehydration. Int J Sports Med 15: 392-398, 1994.

Anaerobic Exercise Studies

  1. Bigard AX, Sanchez H, Claveyrolas G, Martin S, Thimonier B and Arnaud MJ. Effects of dehydration and rehydration on EMG changes during fatiguing contractions. Med Sci Sports Exerc 33: 1694-1700, 2001.
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  5. Cheuvront SN, Carter R III, Haymes EM and Sawka MN. No effect of moderate hypohydration or hyperthermia on anaerobic exercise performance. Med Sci Sports Exerc 38: 1093-1097, 2006.
  6. Cheuvront SN, Kenefick RW, Ely BR, Harman EA, Castellani JW, Frykman PN, Nindl BC and Sawka MN. Hypohydration reduces vertical ground reaction impulse but not jump height. Eur J Appl Physiol 109: 1163-1170, 2010.
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  9. Evetovich TK, Boyd JC, Drake SM, Eschbach LC, Magal M, Soukup JT, Webster MJ, Whitehead MT and Weir JP. Effect of moderate dehydration on torque, electromyography, and mechanomyography. Muscle Nerve 26: 225-231, 2002.
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  11. Fritzsche RG, Switzer TW, Hodgkinson BJ, Lee SH, Martin JC and Coyle EF. Water and carbohydrate ingestion during prolonged exercise increase maximal neuromuscular power. J Appl Physiol 88: 730-737, 2000.
  12. Ftaiti F, Grelot L, Coudreuse JM and Nicol C. Combined effect of heat stress, dehydration and exercise on neuromuscular function in humans. Eur J Appl Physiol 84: 87-94, 2001.
  13. Ftaiti F, Kacem A, Latiri I, Ben MS, Tabka Z, Zouari N, Ellouze F and Grelot L. Comparison of male and female thermal, cardiac, and muscular responses induced by a prolonged run undertaken in a hot environment. Can J Appl Physiol 30: 404-418, 2005.
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  15. Gutierrez A, Mesa JL, Ruiz JR, Chirosa LJ and Castillo MJ. Sauna-induced rapid weight loss decreases explosive power in women but not in men. Int J Sports Med 24: 518-522, 2003.
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  17. Hickner RC, Horswill CA, Welker JM, Scott J, Roemmich JN and Costill DL. Test development for the study of physical performance in wrestlers following weight loss. Int J Sports Med 12: 557-562, 1991.
  18. Hoffman JR, Stavsky H and Falk B. The effect of water restriction on anaerobic power and vertical jumping height in basketball players. Int J Sports Med 16: 214-218, 1995.
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  20. Houston ME, Marrin DA, Green HJ and Thomson JA. The effect of rapid weight loss on physiological functions in wrestlers. Physician Sportsmed 8: 73-78, 1981.
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How to Cite

Samuel N. Cheuvront, Robert W. Kenefick. Dehydration: Physiology, Assessment, and Performance Effects. Compr Physiol 2014, 4: 257-285. doi: 10.1002/cphy.c130017