The effect of exercise on sodium balance in humans

During exercise water and electrolytes are lost in sweat. There is a large variation in both sweat rate and sweat composition and as a consequence sweat electrolyte loss can be large, especially for sodium, the primary cation in sweat. The loss of large amounts of sodium in sweat has been linked with hyponatraemia and muscle cramps. Sodium intake is encouraged in some athletes and in some exercise situations, which is in direct contrast to guidelines aimed at the general population aimed at reducing average sodium intakes to 2.4g of sodium per day (6g salt/day). Dietary sodium intakes have been determined by numerous methods, including weighed dietary records and 24h urine collections. As dietary sodium intake in excess of basal requirement is primarily excreted in the urine in non-sweating individuals, and the basal requirement for sodium is small, 24h urine collections can provide an accurate estimate of dietary sodium intake. In Chapter 3, 24h urinary sodium excretion was measured in eighteen subjects on 4 separate occasions. Subjects consumed their normal diet with the exception of a 5g creatine supplement and 500ml of water, which was part of a separate investigation. The relationship between urine sodium excretion in each 24h collection period was weak, but on average males excreted 200 ± 48mmol of sodium per day and females excreted 157 ± 33mmol of sodium per day, which is equivalent to 4.6g and 3.6g of sodium, respectively. This is in excess of the current recommended intake. In chapter 4, the variation in sodium excretion was determined in eight subjects who consumed the same diet for 5 consecutive days. Despite the similar intake of sodium each day, a day to day variation in sodium excretion of 13% was still observed. This was not related to either sodium intake or potassium intake. In chapter 5, nine subjects consumed their normal diet for 5 consecutive days but weighed and recorded all food and drink consumed. During this period, 24h urine samples were also collected. No strenuous exercise was permitted apart from an exercise task on day 4. This involved intermittent cycling in the heat until 2% body mass (BM) was lost. Sweat was collected from four absorbent patches placed on the back, chest, forearm and thigh. Sweat sodium concentration was adjusted to account for the 35% over-estimation using this regional collection method. Subjects lost 1.51 ± 0.19L of sweat and 66 ± 16mmol (range 32 86mmol) of sodium. There was no difference in sodium balance between each 24h period due to a significant decrease in urine sodium excretion on the day of exercise (day 4). In chapter 6, the effect of prior exercise on sweat composition during a second exercise bout completed later that same day was determined. Eight healthy males cycled for 40 minutes in the heat on one or two occasions. A period of 5h elapsed between exercise bouts when two exercise sessions were performed. Sweat was collected using a whole body washdown method and by 4 absorbent patches placed on the back, chest, forearm and thigh. The main finding was that prior exercise did not affect sweat rate or sweat sodium, potassium and chloride concentrations in the second exercise bout when using the whole body washdown method. Chapter 7 determined the effects of two exercise sessions completed on the same day on electrolyte balance. Nine subjects followed their normal dietary behaviour but weighed and recorded all food and drink consumed during 5 consecutive days. During this period 24h urine samples were also collected. No strenuous exercise was permitted during this period apart from two exercise tasks on day 4. During exercise sweat was collected using a whole body washdown technique. Sweat rate and sweat sodium, potassium and chloride concentrations during the second exercise bout were found to be similar to the first exercise bout. Subjects lost 2.64L (range 1.80 3.48L) of sweat and 138 ± 106mmol of sodium (range 32 287mmol). Sodium balance was not significantly affected on the day of exercise, but urine sodium was lower than dietary sodium intake on the day of exercise (Day 4) and the day following exercise (day 5), indicating significant sodium conservation by the kidney. In contrast, no change in sodium intake was observed. In chapter 8, the effect of skimmed milk and a sports drink in restoring fluid balance was examined following exercise-induced dehydration. Seven physically active males cycled intermittently in the heat until 2% BM was lost. During a 1h rehydration period a sports drink (23mmol Na+/L) or skimmed milk (32mmol Na+/L) was consumed in a volume equivalent to 150% of BM loss. Fluid balance at the end of the 3h recovery period tended to be more positive when milk was consumed. Despite this, no difference in exercise capacity in the heat was observed. This thesis shows that exercise did not increase sodium intake, but this may be due to the already high dietary sodium intake of individuals. Sodium balance was maintained in the majority of individuals due to a significant conservation of sodium by the kidneys. When sweat sodium losses are large, urine sodium conservation may not be sufficient to prevent a negative sodium balance. When no food is consumed in the acute period post-exercise, the higher sodium content of skimmed milk than a sports drink may be partly responsible for the increased retention of the ingested fluid. But this did not enhance subsequent performance in the heat.