Effects of Hydration Changes on Neuromuscular Function of Athletes
NCT ID: NCT05380089
Last Updated: 2024-05-29
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
RECRUITING
Clinical Phase
NA
Total Enrollment
50 participants
Study Classification
INTERVENTIONAL
Study Start Date
2021-11-01
Study Completion Date
2024-12-31
Brief Summary
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Greater muscular strength and power are relevant qualities for athletic success and decreased injury rate. It is known that dehydration impairs muscular strength and power, although the explanation for this association is not entirely clear. Besides morphological factors, strength production also depends on neural factors which in turn can be affected by dehydration. Some studies tested the effects of dehydration on neuromuscular function using electromyography (EMG) analysis. However, there is no consensus among those studies.
Additionally, exercise may disturb water balance. This can further lead to dehydration if the athlete does not properly rehydrate. In this sense, the scientific evidence has identified people who are considered low drinkers that may be more susceptible to cellular shrinkage, potentially impairing health and performance. Thus, it would be expected that athletes regularly exposed to lower amounts of water intake would have beneficial effects in both performance and health if higher water ingestion was promoted, namely an improved neuromuscular function via enhanced cellular hydration. However, any potential benefit of increasing water intake on neuromuscular function is still to be determined using well-designed experimental studies and state-of-the-art methods.
Lastly, there is no consensus regarding the diagnosis of dehydration in athletes. The identification of simple indices to measure dehydration in athletes is crucial as many may be inaccurately diagnosed.
Additionally, exercise may disturb water balance. This can further lead to dehydration if the athlete does not properly rehydrate. In this sense, the scientific evidence has identified people who are considered low drinkers that may be more susceptible to cellular shrinkage, potentially impairing health and performance. Thus, it would be expected that athletes regularly exposed to lower amounts of water intake would have beneficial effects in both performance and health if higher water ingestion was promoted, namely an improved neuromuscular function via enhanced cellular hydration. However, any potential benefit of increasing water intake on neuromuscular function is still to be determined using well-designed experimental studies and state-of-the-art methods.
Lastly, there is no consensus regarding the diagnosis of dehydration in athletes. The identification of simple indices to measure dehydration in athletes is crucial as many may be inaccurately diagnosed.
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Detailed Description
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Athletes are dependent on muscular strength as it is associated with a higher rate of force development and muscular power, general and specific sports skills performance, and decreased injury rates. There is scientific evidence showing that a hypohydrated state \[i.e., 2 to 3% of body mass loss (BML) attributed to water loss\] impairs muscular strength and power. However, how this reduction affects athletic performance remains in question.
We know that muscular strength development is derived from a combination of morphological (muscle cross-sectional area, muscle architecture, and musculotendinous stiffness) and neural factors (motor unit recruitment, synchronization, and firing frequency). Thus, neural factors may be one possible explanation for the effects of dehydration. In fact, there is biological plausibility for this relation as dehydration may affect the electrolyte's concentration (particularly potassium and sodium) within intra- and extracellular spaces, leading to an alteration of the membrane electrochemical potential.
Although some studies have tested the effects of hydration changes on neuromuscular function using electromyography (EMG) analysis, there is still no consensus among them. Some authors showed effects of dehydration on muscle endurance and EMG signal, including reduction in EMG mean power frequency (MPF) and an accelerated rate of root-mean square (RMS), possibly meaning reduced membrane excitability and an accelerated central mediated regulation of motor unit activity. While others did not find any effect of dehydration on EMG values. Thus, experimental studies using well-designed trials and state-of-the-art technology are required to better understand the effects of acute dehydration on neuromuscular function, specifically in athletes.
Maintenance of a euhydrated state is crucial for the proper physiological functioning of the body, being achieved by physiological and behavioral factors. However, exercise can disturb water balance, particularly when performed in hot environments, increasing water loss. This can further lead to dehydration if the athlete does not properly rehydrate. In this sense, the scientific evidence has identified people who are considered low drinkers (i.e., people who are exposed to a low regular water intake) and high drinkers (i.e., people who are exposed to a high regular water intake). These differences in water intake lead to different physiological responses such as serum arginine vasopressin (AVP) levels and also in mood states. Although no specific total water intake guidelines have been established for athletes, when compared to the European Food Safety Authority guidelines for water intake in healthy adults, they do not meet the guidelines, specifically when higher hydration needs are considered. As mentioned before, AVP has been used to distinguish low drinkers from high drinkers, namely elevated plasma AVP in low drinkers suggesting intracellular dehydration.
In fact, changes in total body water (TBW) and its compartments \[i.e., intracellular water (ICW) and the extracellular water (ECW)\] have been studied regarding their impact on sports performance. Silva and colleagues observed that judo athletes who decrease TBW, namely by decreasing ICW, were those that decreased upper-body power, regardless of changes in weight and arms' lean-soft tissue. Also, ICW was the only body water compartment whose reductions explained the higher probability of losing \>2% of forearm maximal strength, independently of changes in weight and arms' lean-soft tissue. Finally, ICW was also considered the main predictor of strength and jumping height over the season in national-level athletes. Thus, ICW and cellular hydration appear to play a relevant role in athletic power and strength, although further research is needed to link these structural fluid compartments with changes in the hydration status and its connection with neuromuscular function.
Lastly, hydration testing has been considered a controversial topic and despite existing a substantial body of research, there is no clear protocol regarding the best practice for assessing hydration status in athletes. Moreover, new methods that provide hydration status safely, accurately, reliably, and feasibly are also needed. Bioelectrical Impedance Analysis (BI) is an alternative technique for this specific context. The BI method utilizes the components of impedance: resistance (R) and reactance (Xc). Phase angle (PhA) is also provided, representing a relevant indicator of cellular health and muscle functionality, but research is lacking on the usefulness of this marker for tracking strength/power in athletes exposed to short-term changes in hydration status.
To summarize, there is a lack of evidence-based protocols with the state-of-the-art methodology to test the effects of modifying water intake on neuromuscular function using EMG analysis in the athletic population. Moreover, the currently available experimental designs present methodological limitations in assessing hydration status and body water compartments. Hence, to overcome the shortcomings, innovative research with cutting-edge technology is required. Thus, our primary aim is to determine the effects of hydration changes (i.e., a 4-day intervention targeting raises in water intake and acute dehydration) on the strength and power (with EMG analysis for the neuromuscular response) of athletes. Secondary aims include: i) to compare the effects of acute dehydration on neuromuscular function before and after the intervention; ii) to analyze the effects of the intervention on TBW, ECW, ICW, and fat-free mass (FFM) hydration; iii) to analyze the effects of hydration changes (I.e., a 4-day intervention targeting raises in water intake and acute dehydration) on several hydration indexes (serum, saliva, and urine osmolality) and biochemical markers (AVP and sodium concentration); iv) to test the usefulness of segmental and whole-body raw BI parameters in detecting acute dehydration using serum osmolality as the reference technique; v) to explore if PhA can be used as a marker of neuromuscular function;
We know that muscular strength development is derived from a combination of morphological (muscle cross-sectional area, muscle architecture, and musculotendinous stiffness) and neural factors (motor unit recruitment, synchronization, and firing frequency). Thus, neural factors may be one possible explanation for the effects of dehydration. In fact, there is biological plausibility for this relation as dehydration may affect the electrolyte's concentration (particularly potassium and sodium) within intra- and extracellular spaces, leading to an alteration of the membrane electrochemical potential.
Although some studies have tested the effects of hydration changes on neuromuscular function using electromyography (EMG) analysis, there is still no consensus among them. Some authors showed effects of dehydration on muscle endurance and EMG signal, including reduction in EMG mean power frequency (MPF) and an accelerated rate of root-mean square (RMS), possibly meaning reduced membrane excitability and an accelerated central mediated regulation of motor unit activity. While others did not find any effect of dehydration on EMG values. Thus, experimental studies using well-designed trials and state-of-the-art technology are required to better understand the effects of acute dehydration on neuromuscular function, specifically in athletes.
Maintenance of a euhydrated state is crucial for the proper physiological functioning of the body, being achieved by physiological and behavioral factors. However, exercise can disturb water balance, particularly when performed in hot environments, increasing water loss. This can further lead to dehydration if the athlete does not properly rehydrate. In this sense, the scientific evidence has identified people who are considered low drinkers (i.e., people who are exposed to a low regular water intake) and high drinkers (i.e., people who are exposed to a high regular water intake). These differences in water intake lead to different physiological responses such as serum arginine vasopressin (AVP) levels and also in mood states. Although no specific total water intake guidelines have been established for athletes, when compared to the European Food Safety Authority guidelines for water intake in healthy adults, they do not meet the guidelines, specifically when higher hydration needs are considered. As mentioned before, AVP has been used to distinguish low drinkers from high drinkers, namely elevated plasma AVP in low drinkers suggesting intracellular dehydration.
In fact, changes in total body water (TBW) and its compartments \[i.e., intracellular water (ICW) and the extracellular water (ECW)\] have been studied regarding their impact on sports performance. Silva and colleagues observed that judo athletes who decrease TBW, namely by decreasing ICW, were those that decreased upper-body power, regardless of changes in weight and arms' lean-soft tissue. Also, ICW was the only body water compartment whose reductions explained the higher probability of losing \>2% of forearm maximal strength, independently of changes in weight and arms' lean-soft tissue. Finally, ICW was also considered the main predictor of strength and jumping height over the season in national-level athletes. Thus, ICW and cellular hydration appear to play a relevant role in athletic power and strength, although further research is needed to link these structural fluid compartments with changes in the hydration status and its connection with neuromuscular function.
Lastly, hydration testing has been considered a controversial topic and despite existing a substantial body of research, there is no clear protocol regarding the best practice for assessing hydration status in athletes. Moreover, new methods that provide hydration status safely, accurately, reliably, and feasibly are also needed. Bioelectrical Impedance Analysis (BI) is an alternative technique for this specific context. The BI method utilizes the components of impedance: resistance (R) and reactance (Xc). Phase angle (PhA) is also provided, representing a relevant indicator of cellular health and muscle functionality, but research is lacking on the usefulness of this marker for tracking strength/power in athletes exposed to short-term changes in hydration status.
To summarize, there is a lack of evidence-based protocols with the state-of-the-art methodology to test the effects of modifying water intake on neuromuscular function using EMG analysis in the athletic population. Moreover, the currently available experimental designs present methodological limitations in assessing hydration status and body water compartments. Hence, to overcome the shortcomings, innovative research with cutting-edge technology is required. Thus, our primary aim is to determine the effects of hydration changes (i.e., a 4-day intervention targeting raises in water intake and acute dehydration) on the strength and power (with EMG analysis for the neuromuscular response) of athletes. Secondary aims include: i) to compare the effects of acute dehydration on neuromuscular function before and after the intervention; ii) to analyze the effects of the intervention on TBW, ECW, ICW, and fat-free mass (FFM) hydration; iii) to analyze the effects of hydration changes (I.e., a 4-day intervention targeting raises in water intake and acute dehydration) on several hydration indexes (serum, saliva, and urine osmolality) and biochemical markers (AVP and sodium concentration); iv) to test the usefulness of segmental and whole-body raw BI parameters in detecting acute dehydration using serum osmolality as the reference technique; v) to explore if PhA can be used as a marker of neuromuscular function;
Conditions
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Dehydration
Hyperhydration
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
A randomized controlled trial (RCT)
Primary Study Purpose
BASIC_SCIENCE
Blinding Strategy
NONE
Given the nature of the study, it is not possible to blind neither participants nor research team members regarding the allocated groups.
Study Groups
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Experimental group
Over a 4-day period, participants randomly assigned to the experimental group will be instructed to maintain normal solid food choices, but to increase water intake to achieve a total water intake of ≥45ml/kg/day. Prepared bottles of water with the required amount will be given to each participant every morning and collected empty the following day. Instructions to drink small amounts of water every hour be transmitted.
Adherence to instructions regarding water intake will be determined by the return of drinking bottles, analysis of daily food records, assessment of water flux (i.e., collecting urines after subjects being dosed with deuterium), and daily screening questions. These samples will be delivered on a subsequent morning during a daily laboratory visit to collect urine and saliva samples, as well as BI assessment. On the 4th day, participants will perform a neuromuscular function assessment.
Group Type
EXPERIMENTAL
Increasing water intake
Intervention Type
OTHER
Participants randomly assigned to the experimental group will be instructed to maintain habitual solid food choices and to increase water intake to achieve a total water intake of ≥45ml/kg/day.
Control group
Participants randomly assigned to the control group will be instructed to maintain normal solid food choices and water intake based on their average intake reported on the food records. Adherence to instructions regarding water intake will be determined and assessments performed will occur as mentioned previously for the experimental group.
Group Type
NO_INTERVENTION
No interventions assigned to this group
Interventions
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Increasing water intake
Participants randomly assigned to the experimental group will be instructed to maintain habitual solid food choices and to increase water intake to achieve a total water intake of ≥45ml/kg/day.
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* Highly trained athletes (i.e., participating in national and international championships and/or ≥6 h of training per week)
* Athletes considered low drinkers (i.e., total water intake ≤ 35ml/kg/)
* Aged between 18 and 35 years
* Living in Lisbon and/or its surroundings
* All women should have a (self-reported) normal menstrual cycle (i.e., cycles at median intervals of less than 35 days)
* Completion of the sport's medical examination
* Athletes considered low drinkers (i.e., total water intake ≤ 35ml/kg/)
* Aged between 18 and 35 years
* Living in Lisbon and/or its surroundings
* All women should have a (self-reported) normal menstrual cycle (i.e., cycles at median intervals of less than 35 days)
* Completion of the sport's medical examination
Exclusion Criteria
* Total water intake above 35ml/kg/day.
* Clinical history compatible with exertional heat illness (i.e., heat stroke, heat exhaustion, hyperthermia, among other events that suggest poor response to thermically challenging environments)
* Taking medication known to alter the normal fluid-electrolyte balance, plasma osmolality, urinary osmolality, or the chronotropic response to exercise (e.g., diuretics, antidiuretics, laxatives, oral contraceptives, drugs to control blood pressure (39)
* Exhibiting self-reported metabolic disorders or malfunction of salivary glands
* Active smoking status
* Unwilling to abstain from alcohol during this study
* Respiratory disorders, including asthma
* Injuries that would limit exercise performance
* Mechanical prostheses
* Pregnancy /planning to get pregnant within the next 8 months
* Having been pregnant within the past 6 months or breastfeeding
* Failure to complete the dietary intake and physical activity recording
* Unable to communicate with local study staff
* Needle phobia
* Inability to complete the study within the designated time frame because of plans to move out of the study area or occurrence of competition periods during the study timeframe
* Inability to attend the visits/appointments and evaluation measurements
* Clinical history compatible with exertional heat illness (i.e., heat stroke, heat exhaustion, hyperthermia, among other events that suggest poor response to thermically challenging environments)
* Taking medication known to alter the normal fluid-electrolyte balance, plasma osmolality, urinary osmolality, or the chronotropic response to exercise (e.g., diuretics, antidiuretics, laxatives, oral contraceptives, drugs to control blood pressure (39)
* Exhibiting self-reported metabolic disorders or malfunction of salivary glands
* Active smoking status
* Unwilling to abstain from alcohol during this study
* Respiratory disorders, including asthma
* Injuries that would limit exercise performance
* Mechanical prostheses
* Pregnancy /planning to get pregnant within the next 8 months
* Having been pregnant within the past 6 months or breastfeeding
* Failure to complete the dietary intake and physical activity recording
* Unable to communicate with local study staff
* Needle phobia
* Inability to complete the study within the designated time frame because of plans to move out of the study area or occurrence of competition periods during the study timeframe
* Inability to attend the visits/appointments and evaluation measurements
Minimum Eligible Age
18 Years
Maximum Eligible Age
35 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
Yes
Sponsors
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Faculdade de Motricidade Humana
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Analiza Silva, PhD
Role: PRINCIPAL_INVESTIGATOR
Faculdade Motricidade Humana
Locations
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Faculdade Motricidade Humana
Lisbon, , Portugal
Site Status
RECRUITING
Countries
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Portugal
Central Contacts
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Facility Contacts
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References
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Puga AM, Lopez-Oliva S, Trives C, Partearroyo T, Varela-Moreiras G. Effects of Drugs and Excipients on Hydration Status. Nutrients. 2019 Mar 20;11(3):669. doi: 10.3390/nu11030669.
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Francisco R, Jesus F, Nunes CL, Santos P, Alvim M, Campa F, Schoeller DA, Lukaski H, Mendonca GV, Sardinha LFCB, Silva AMLA. H2OAthletes study protocol: effects of hydration changes on neuromuscular function in athletes. Br J Nutr. 2024 May 14;131(9):1579-1590. doi: 10.1017/S0007114524000308. Epub 2024 Feb 1.
Reference Type
DERIVED
Other Identifiers
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H2O Athletes
Identifier Type: -
Identifier Source: org_study_id
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RECRUITING
A Physiological Profile of Recovery From Resistance, Endurance, and Mixed Exercise Types
NCT03083509
COMPLETED
NA
Neuromuscular Training in Female Youth Soccer
NCT06136299
COMPLETED
NA
Safety and Prevention of OveRTraining
NCT03833973
UNKNOWN
Study of Hydration Levels in Sports and Non-sports Schoolchildren (EHC)
NCT06170554
ACTIVE_NOT_RECRUITING
The Importance of Exercise to Prevent Injuries in Athletes
NCT04078256
COMPLETED
NA
Energy Availability in Female Athletes
NCT03593382
COMPLETED
The Effect of Exercise on Amateur American Football Players
NCT05868655
COMPLETED
NA
Effect of Muscle Pain in Late Cold Water Immersion, Muscular Recruitment, Postural Control Dynamic and Sleep Quality
NCT02806609
COMPLETED
NA
Autonomic Nervous System, Fatigue and Intolerance to Physical Training, and Overtraining in High-Level Athletes
NCT01463761
COMPLETED
Epidemiology of Incidents and Accidents in Sport. Influence of Moisture.
NCT02346786
UNKNOWN
PHASE3
Effects of a High Intensity Resistance Training in Muscular Strength, Agility, and Body Composition of Anorexia Nervosa Restricting Type Patients
NCT01906320
COMPLETED
NA
Post-activation Potentiation and Sprinting Performance
NCT06619899
COMPLETED
NA
Core Training to Improve Abdominal Strength Strength and Ankle Proprioception in Basketball Players
NCT03870321
COMPLETED
NA
Recovery Kinetics After the Use of Small Sided Games With a Small and Large Number of Players and Large Pitch Area
NCT03970707
UNKNOWN
NA
Effects of Injury Prevention Exercises on Performance and Neuromuscular Function
NCT03251404
COMPLETED
NA
Effect of Neck Training on Outcomes Related to Sport-Related Concussion
NCT06774976
NOT_YET_RECRUITING
NA
Functional and Performance Effects of a 4-week Weightlifting Program in Highly Trained Adolescent Basketball Athletes
NCT05824780
COMPLETED
NA
Effect of Wearing a Compression Sock During Running on Muscle Soreness in Distance Runners.
NCT06225388
ENROLLING_BY_INVITATION
NA
Effects of Rehydration During Physical Exercise on Acute Kidney Injury Biomarkers
NCT04310514
UNKNOWN
NA
Investigating the Effects of Diet and Physical Activity on Esport Performance
NCT05881018
COMPLETED
NA
Comparison of Trunk Muscle Performance Between Sprinters With and Without Hamstring Strain Injury History
NCT06089681
COMPLETED
Using Energy Availability as a Strategy to Explore the Effects of Relative Energy Deficiency in Sport on Athletes
NCT05649267
UNKNOWN
Verbal Encouragement in Swimming
NCT05573971
COMPLETED
NA