Transcript Assessment of the Relationship between Pre

Assessment of the Relationship between Prepractice Hydration Status and Hydration
Education in High School, NAIA, and NCAA
Division III Collegiate Athletes
LAUREN MINOR AND DR. HAMILTON
APRIL 14,2012
Introduction
 What is dehydration?
 A dynamic loss of body water or the transition from
euhydration to hypohydration
 Euhydration: normal water content
 USG < 1.020
 Hypohydration: water deficit
 USG between 1.020 and 1.029
 Significant Hypohydration: severe/chronic water
deficit

USG 1.030 and above
USG Values: American College of Sports Medicine and the National Athletic Trainers’ Association
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Why research pre-practice hydration in
conjunction with hydration education?
 Study with NCAA Div. I
athletes from New England
 66% were hypohydrated
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13% within this 66% were
significantly hypohydrated
 34% were euhydrated
 What would be expected
for Div. II or Div. III
athletes?
 Would implementation of
hydration education create
improvements?
(Volpe, Poule and Bland)
Materials and Methods: Participants
 Participants: n=22
Sport Type
 High School: n=7
 NCAA Div. III: n=10
Softball
23%
 NAIA Scholarship n=5
 Females: n=14
 Males: n=8
 *All athletes were either
in conditioning or in
season competing
Soccer
4%
Football
14%
Track/XC
59%
Materials and Methods: Procedures
 Pre-Practice Urine Collection
 Athlete urinates in cup (midstream)
 Handheld Refractometer utilized to measure USG
 Fluid Intake Survey
 Hydration Education Survey
 Hydration Education Presentation
 Wait approximately one month
 Return and repeat urine collection and both surveys
 Debriefing
Materials and Methods: Surveys
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Hydration Education
1. To maximize fluid retention, would you sip the liquid when
hydrating or gulp the liquid?
2. You should avoid losing more than ________% of body
weight during exercise.
A. 20% B. 10% C. 5% D. 2%
3. True or False: Vomiting is one of the signs of the early stages
in dehydration
4. When should you include drinks that have carbohydrates
when hydrating during exercise?
A. You should always include carbohydrate drinks during
exercise
B. When the duration lasts longer than 2 hours
C. When the duration lasts longer than 45-50 minutes
D. When the intensity is very high
E. Both B and D
F. Both C and D
5. Why could drinks with caffeine impair your hydration
status?
6. Does dehydration increase or decrease your core body
temperature?
7. Put a star next to the color in which you think the urine
would start indicating dehydration:
8. For every 1% of body weight lost, the heart rate:
A. Rises 3-5 beats per minute
B. Rises 8-10 beats per minute
C. slows down 3-5 beats per minute
D. slows down 8-10 beats per minute
Additional questions:
9. Do you ever restrict hydrating before competition in fear of
having a full bladder and being uncomfortable?
10. Is there always water available and near when
practicing/competing?
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Fluid Intake
For the following, write in the average amount of
beverage consumed in fluid ounces per day. If you do not
consume the particular beverage listed leave it blank (fl
oz/day)
Water, caffeinated/decaf coffee and tea, milk, fruit juice,
sport drinks, nutrition drinks, energy drinks,
caffeinated/decaf soda, alcohol
*Nutrition Drinks include items such as ensure, boost,
protein shakes, etc.
How many ounces a day of overall fluid do you drink?
How many ounces and of what beverage do you drink:
One hour before practice or competition:
During practice/competition:
One hour after practice/competition:
How many times a day do you urinate? Circle the
estimated number
0-2
2-4
4-6
7-8
9-10
11-12
13-14
over 15 times
What color is your urine typically? Mark a star by the
color
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List below any vitamins, minerals, or nutrition
supplements (proteins, creatine powders) that you take:
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Lastly, list below any training habits or other lifestyle
occurrences that may have had an effect on your
hydration status:
Materials and Methods: Education
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To calculate your sweat rate:
Weigh yourself
Workout for one hour in the conditions
you will be practicing and performing in
Track the amount of fluid you consume
during that hour
Weigh yourself after the workout
Pre-exercise weight-post exercise
weight=Weight lost
Convert this into ounces (multiply the
weight lost by 16)
Add the ounces you drank during the
workout to the ounces you lost during the
workout
This is how much you need to drink in one
hour during exercise
Example: you drank 16 oz during the hour
of exercise and lost 8 ounces (0.5 lb).
Sweat rate= 24 oz per hour
Sample Hydration Protocol Worksheet
(Casa, Armstrong and Hillman)
Purposes
 To assess the change of pre-practice hydration status
(USG) of three different classes of athletes after a
hydration education program and a one-month time
period
 To relate the hydration status changes to the changes
in results of the fluid intake survey and the hydration
education survey
 Examine the effectiveness of self-assessment
methods in athletes
Questions
 Is hypohydration a problem for athletes in training? If so,
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why?
Are there significant differences between male and
female athlete hydration?
How did the high school aged participants compare to
the collegiate participants?
After education, will the athletes’ fluid intake improve?
Do athletes purposefully dehydrate themselves?
Is water available to them during practice/competition?
Hypothesis
 The majority of athletes for the first collection will be
in a hypohydrated state prior to practice
 By the second collection, there will be an overall
improvement in the hydration statuses, and this will
be attributed to improvement on the surveys, and
furthermore retention of the hydration education
information presented
 Younger athletes will show a greater improvement
 College athletes will have improved surveys, but not
necessarily improved urine
USG
USG Comparisons
1.032
1.031
1.03
1.029
1.028
1.027
1.026
1.025
1.024
1.023
1.022
1.021
1.02
1.019
1.018
1.017
1.016
1.015
1.014
1.013
1.012
1.011
1.01
1.009
1.008
1.007
1.006
1.005
1.004
1.003
1.002
1.001
1
USG 1
USG2
1
2
3
4
5
6
7
8
9
10
11
12
13
Participant
14
15
16
17
18
19
20
21
22
Results
 USG 1
 USG 2
 50% euhydrated (n=11)
 68% euhydrated (n=15)
 50% hypohydrated
 32% hypohydrated (n=7)
(n=11)
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5% of the 50% was
significantly hypohydrated
(n=1)
 50% females
hypohydrated (n=7)
 50% males hypohydrated
(n=4)
 36% females
hypohydrated (n=5)
 25% males hypohydrated
(n=2)
Results
t-Test: Paired Two Sample for Means
USG 1
Mean
St. Dev
Sample Size
Claim: USG 1 > USG 2
P-value=0.0258<0.05
The data support the claim
USG 2
1.019318
0.006979
22
1.015818
0.007182
22
Results
Mean Change in USG
1.022
1.02
USG
1.018
USG 1
1.016
USG 2
1.014
1.012
1.01
1
Results
Phi Coefficient Calculation: The phi coefficient is a measure of the degree
of association between two binary variables.
USG 1
USG 2
Euhydrated
Hypohydrated
totals
Euhydrated
9
6
15
Hypohydrated
2
5
7
totals
11
11
22
Phi Coefficient= 0.29
Little or no association between the hydration status 1 and
hydration status 2
What would it ideally look like? 0 (but in the favorable rows)
Results
Mean increase in Hydration Scores:
Mean
1.59
Std Dev
1.30
Max
4
Min
0
n
22
95% CI
1.59 +/- 0.57
With a confidence level of 95%, the true mean increases for this
population is 1.59 with a margin of error of +/- 0.57
(1.02, 2.16)
Results
Correlation between the change in exam score and the change in USG:
0.4549
There is an association between the two changes
An improvement in exam score is associated with an increase in USG
correlation
0.015
change in USG
0.01
0.005
change in USG
0
-0.005
0
2
4
Linear (change in
USG)
-0.01
-0.015
-0.02
6
change in survey
Results
t-Test: Two-Sample Assuming Unequal Variances
Increase 0-1
Mean
Variance
Observations
Hypothesized Mean Difference
df
t Stat
P(T<=t) one-tail
t Critical one-tail
P(T<=t) two-tail
t Critical two-tail
Increase 2-4
-0.007909091
5.58909E-05
11
0
19
3.083173819
0.003060145
1.729132792
0.00612029
2.09302405
0.000909091
3.40909E-05
11
7
7
7
7
6
4
3
4
3
7
3
4
6
5
3
4
4
4
3
2
5
2
7
7
7
7
6
4
4
5
4
8
4
6
8
7
5
7
7
7
6
5
8
6
0
0
0
0
0
0
1
1
1
1
1
2
2
2
2
3
3
3
3
3
3
4
Results: Fluid Intake
10 NCAA FRS water/day
7 HS FRS water/day
5 NAIA FRS water/day
10 NCAA FRS fluid/day
7 HS FRS fluid/day
5 NAIA FRS fluid/day
overall water per day
overall fluid per day
female fluids/day
male fluids/day
female water/day
male water/day
t-Test: Paired Two Sample for Means:
0.209, 0.309, 0.155, 0.478
1
51
51.7
35.4
73.1
100.1
55.4
47.7
77.9
73.8
85.3
46.1
50.5
2
58.2
57.7
22.2
82.3
110.7
48.4
49.9
83.6
82.5
84.6
47.9
53.3
Discussion/Conclusion
 It can be claimed that the mean hydration status did
improve overall
 However, the Phi coefficient calculation displayed
that there was little to no association between binary
variables.
 With a bigger population, more could be determined
about how these trends are related
Discussion/ Conclusion
 There was a mean increase in hydration education scores
 However, those that increased their score by 2-4 points
had higher USG than those that only improved by none
or one point
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Why? Wouldn’t it be expected that with more education the surveys
would improve along with the hydration status?
 Participants that did not improve much in score had high
scores to start out with
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These athletes were the best educated, and also showed the most
improvement in hydration status
 Knowledge of Hydration does impact hydration status
Discussion/Conclusion
 Hydration Education needs to be implemented early
on. As the athlete transitions from high school to
college, duration and intensity of workouts increase
which puts them at a high risk for dehydration and
heat-related illnesses if the athlete does not exhibit
proper hydration habits. These habits are developed
early in the athletes’ careers, thus education should
be implemented early
Discussion/ Conclusions
1
2
Correct
prediction
12
13
Incorrect
prediction
10
9
1
2
Dehydrated &
incorrect
6
6
Dehydrated &
correct
5
1
Hydrated and
incorrect
4
3
Hydrated and
correct
7
12
Supplemental Data
9. Do you ever restrict hydrating before competition in fear of having a full
bladder and being uncomfortable?
10. Is there always water available and near when practicing/competing?
#10
#9
no
9%
yes
41%
no
59%
yes
91%
#9
No: n=13
Yes: n=9
#10
No: n=2
Yes: n=20
Improvements for future research
 First morning void
 Increase the number of participants
 Involve the participation of younger athletes
 Longer time span for collection
 comparing seasonal variances
 2 collections both trials (to get an average)
 Obtain a more equal male to female ratio
 More coach involvement with older athletes, more
parent education in younger
Acknowledgements
 We thank Cornerstone Care for the donations of the
urine analysis supplies, Waynesburg University
athletic training department for lending the
handheld refractometer, Pro Performance Rx, Dr.
James Bush for assistance with statistical analysis,
Marietta Wright for assistance with analysis, and all
participants.
References
 Casa, Douglas J., et al. "National Athletic Trainers' Association Position
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Statement: Fluid Replacement for Athletes." Journal of Athletic Training
(2000): 212-224.
Casa, Douglas J., Priscilla M. Clarkson and William O. Roberts. "American
College of Sports Medicine Roundtable on Hydration and Physical Activity:
Consensus Statements." ACSM Roundtable on Hydration and Physical
Activity (2005): 115-127.
Cheuvront, Samuel N. and N Michael Sawka. "Hydration Assessment of
Athletes." Sports Science Exchange (2005): 1-6.
Clark, Nancy. "Working Up a Sweat." American Fitness (2008): 32-34.
Krost, WS, JJ Mistovich and DD Limmer. "Beyond the Basics: Electrolyte
Disturbances." EMS Magazine (2009): 47-55.
Oppliger, Robert and Cynthia Bartok. "Hydration Testing of Athletes."
Sports Med (2002): 959-971.
Volpe, Stella, Kristen A. Poule and G. Erica Bland. "Estimation of
Prepractice Hydration Status of National Collegiate Athletic Association
Division I Athletes." Journal of Athletic Training (2009): 624-629.
Questions?
High School Age
Distribution
SO
14%
NCAA Div III Age
Distribution
FR
0%
Athletic Population
JR
0%
SR
FR 0% JR
30%
30%
SR
86%
SO
40%
High School
Male/Female
F
57%
M
43%
High School
32%
NAIA
Collegiate
NAIA Age
23%
Distribution
FR
0%
SO
40%
SR
20%
JR
40%
NCAA
Divison III
Collegiate
45%
NCAA Div III
Male/Female
NAIA
Male/Female
F
50%
M
F
M
50%
Comparisons among groups
NCAA USG 1
NCAA USG 2
hypohydrated
hypohydrated
n=4
euhydrated
n=2
n=6
euhydrated
n=8
20%
40%
60%
80%
Comparisons among groups
NAIA USG1
hypohydrated
euhydrated
n=2
n=2
NAIA USG 2
severly hypohydrated
hypohydrated
n=1
20%
n=2
n=3
40%
20%
60%
60%
euhydrated
Comparisons among groups
HS USG1
hypohydrated
n=5
HS USG2
euhydrated
hypohydrated
n=2
n=3
29%
euhydrated
n=4
43%
57%
71%