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Changes in Total Body Water Content During Running Races of 21.1 km and 56 km in Athletes Drinking Ad libitum

Objective:To measure changes in body mass (BM), total body water (TBW), fluid intake, and blood biochemistry in athletes during 21.1-km and 56-km foot races. Design:Observational study. Setting:2009 Two Oceans Marathon, South Africa. Participants:Twenty-one (21.1 km) and 12 (56 km) participants were advised to drink according to thirst or their own race drink plan (ad libitum). Main Outcome Measures:Body mass, TBW, plasma osmolality, plasma sodium (p[Na+]), and plasma total protein ([TP]) concentrations were measured before and after race. Fluid intake was recorded from recall after race. Results:Significant BM loss occurred in both races (21.1 km; −1.4 ± 0.6 kg; P < 0.000 and 56 km; −2.5 ± 1.1 kg; P < 0.000). Total body water was reduced in the 56-km race (−1.4 ± 1.1 kg; P < 0.001). A negative linear relationship was found between percentage change (%Δ) in TBW and %Δ in BM in the 56-km runners (r = 0.6; P < 0.01). Plasma osmolality and [TP] increased significantly in the 56-km runners (6.8 ± 8.2 mOsm/kg H2O; P < 0.05 and 5.4 ± 4.4 g/L; P < 0.01, respectively), but all other biochemical measures were within the normal range. Conclusions:Although TBW decreased in the 56-km race and was maintained in the 21.1-km race, the change in TBW over both races was less than the BM, suggesting that not all BM lost during endurance exercise is a result purely of an equivalent reduction in TBW. These findings support the interpretation that the body primarily defends p[Na+] and not BM during exercise and that a reduction in BM can occur without an equivalent reduction in TBW during prolonged exercise. Furthermore, these data support that drinking without controlling for BM loss may allow athletes to complete these events.