By: Ali El-Kerdi, M.S., C.A.T.(C.), A.T.,C, C.S.C.S., S.D.P.T.

Adopted from: “NATA Position Statement: Fluid Replacement for Athletes”, Casa, D. J., Armstrong, L. E., Hillman, S. K., Montain, S. J., Reiff, R. V., Rich, B. S. E., Roberts, W. O., Stone, J. A., NATA News, May 2001, 35-36

            Rugby is an extremely demanding sport.  Practicing for and/or playing rugby during the hot summer months entails working up a sweat.   In fact, one may loose up to one liter of water during a game or practice session depending on climate conditions.  One must rehydrate at the same if not at a superior rate as what’s lost in a workout.  Otherwise, the body is placed at risk of dehydration that could end in serious consequences.  The National Athletic Trainer’s Association has a Position Statement explaining the role of proper hydration in athletic performance.  The following was adapted from this Statement and the reader is encouraged to refer to the said Statement for further information.

Tips for Proper Hydration

1. The club should establish a hydration protocols for all their athlete’s

2. When developing the protocol, consider the physical demands of rugby and the climate in which the season is to be played.

3. Beverages should be easily accessible in individual fluid containers and flavored to the athlete’s preference.  Clear water bottles with 100-ml marks offer a visual reminder to drink, and carrying water bottles during competition also encourages drinking.

4. Begin all practice sessions or games WELL hydrated.  An indication of proper hydration is the color of urine.  In general, the lighter the urine, the better hydrated the body.  Another method of tracking fluid loss is by self-weighting before and after activity.  The amount of body weight loss is a direct indication of how much fluid one needs to ingest.

5. Dink 500-700-ml of water or a sports drink two to three hours before a practice and/or game.  Then, drink about 200-300-ml 10-20 minutes before a practice and/or game.

6. Fluid replacement should approximate sweat and urine losses and at least maintain hydration at less than two percent of body weight loss.  Usually, that entails drinking about 200-300-ml of fluids every 10-20 minutes during the activity.  In a game situation however, where water breaks are not permitted, one should drink at least 500-750-ml 10-20 minutes prior to kick-off and again at half time.  On the other hand, each athlete should know how much water the can ingest without compromising performance.  Dangerous hyperhydration is also a risk if athletes drink according to published recommendations rather than individual needs.

7. Post practice/game hydration should aim to correct any fluid loss.  Ideally completed within two hours of practice/game, rehydration should include water to restore hydration, carbohydrates to replenish glycogen (energy), and electrolytes to speed the process.  This may be accomplished through sports drinks and/or nutritional means (fruits, juice, etc.).  When rehydration must occur quickly (in a tournament setting, back to back practices/games, etc.), compensate for the resulting urine losses by drinking 20-50% more fluid.

8. Fluid temperature influences the amount the ingested by an athlete.  While each person’s preferences are unique, a cool beverage of 5-10°C is recommended.

9. In cases of very high relative humidity, water evaporation is very limited and hence the body’s cooling mechanism is hindered.  Thus, dehydration from excessive sweat loss can induce a rapid core temperature increase, which in turn can lead to dangerous health condition such as heat stroke and heat exhaustion.

10. Ingestion of carbohydrates (CBH) may sometimes aide with rehydration.  Also, consuming CBH prior to practice and/or game – along with a healthy diet – can increase your glycogen stores giving you more energy.  In anticipation of an intense workout session, consume a CBO solution about 30 minutes prior to said activity.  Take note, that some CBO are not suitable: limit fructose, and avoid caffeine, alcohol and carbonated drinks

11. Some signs of dehydration:

-         Thirst

-         Irritability

-         General discomfort

-         Headache

-         Weakness

-         Dizziness

-         Cramps

-         Chills

-         Vomiting or Nausea

-         Head r neck heat sensations

-         Decreased performance

If an athlete becomes dehydrated but is still mentally alert and has no gastrointestinal (GI) pain, then rehydration by drinking beverages is highly recommended.  However, if the athlete had lost consciousness, has become confused or is suffering from GI pain, activation of the Emergency Medical System is crucial to commence IV fluid replacement.

12. The athlete should consider including Sodium Chloride in rehydration beverages if s/he has not eaten, if the event is lasting more then 4 hours, or in the beginning of the hot summer days.  Under these conditions, adding a modest amount of salt to a beverage can offset salt loss and minimize medical events associated with electrolyte imbalances (such as muscle cramps).  To stimulate voluntary fluid intake and decrease the risk of hyponatremia (low sodium levels in the blood), add a small amount of salt (0.3 to 0.7 g/L) to beverages.

13. Whenever possible, take sweat rate into consideration.  This is time consuming but it is the most fundamental consideration when deciding how to properly rehydrate.  Average sweat rates can vary between 0.5L/hr to more than 2.5L/hr!

Sweat rate =

(Pre-work-out body weight) – (post work-out body weight) + (fluid intake) – (urine volume/workout time (Hr.))

14. Heat acclimatization induces physiological changes that may alter rehydration considerations for each athlete.  The athlete must realize that sweat rates generally increase after 10-14 days of heat exposure.  Also, moving from a cool climate to a hot one increases the overall sweat rate per workout.  Lastly, a higher sodium intake may be warranted during the first three to five days of heat exposure.  After five to ten days, normal sodium intake should be sufficient

15. Protective equipment may increase the risk of dehydration.  Players using scrum caps and shoulder pads on hot and/or humid summer days should consider hyperhydrating to offset fluid losses through excessive sweat.

16. Athletes should be aware if practicing hyperhydration methods by ingesting a glycerol and water beverage before exercising.  This practice is still under scientific investigation and long-term studies are still needed to make a suitable recommendation.  Also, beware of side effects such as headaches and GI distress with the ingestion of glycerol solutions

17. The prepubescent and adolescent athlete may not fully understand the medical implications of proper hydration.  Steps should be taken to minimize environmental stress and maximize time for fluid replacement.  A sufficient supply of most palatable beverages should be kept on hand.  Parents and coaches should be educated about rehydration and the signs of dehydration.  Children must be monitored and REMOVED from competition IMMEDIATLEY if signs of dehydration are present.

18. Tournament or large event organizers should plan ahead.  Plenty of hydration supplies (cups, beverages, coolers) should be on hand. 

19. Clubs should consider educating their athletes on hydration and other pertinent nutritional information.

In conclusion, hydration is a key element in athletic performance.  It is better to be hyperhydrated than dehydrated.  Athletes must take charge of their own well-being and ensure that plenty of fluids are ingested.  To learn more about hydration or if you have any questions or comments regarding this paper, please do not hesitate to contact the author or a qualified individual.