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Journal of Sport and Health Science 4 (2015) 357–363
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Review
The effects of fluid loss on physical performance: A critical review
Andrew Carlton, Robin Marc Orr *
Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Gold Coast, Queensland 4226, Australia
Received 21 March 2014; revised 27 May 2014; accepted 17 September 2014
Available online 3 February 2015

Abstract
Purpose: The purpose of this review was to critically analyse the current evidence investigating the effect of an athlete’s hydration status on
physical performance.
Methods: A literature search of multiple databases was used to identify studies that met the inclusion criteria for this review. The included studies
were then critically appraised using the Downs and Black protocol.
Results: Nine articles were found to meet the inclusion criteria, with an average score of 79% for methodological quality representative of a “high”
standard of research.
Conclusion: The evidence suggests that dehydration has a negative impact on physical performance for activities lasting more than 30 s in
duration. However dehydration was found to have no significant impact on physical performance for activities lasting less than 15 s in duration.
© 2014 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport.
Keywords: Athlete; Dehydration; Euhydration; Hydration; Performance

1. Introduction induce a state of dehydration and reduce an athlete’s perfor-

mance, an understanding of the relationship between PA and
The idea that bodily fluid loss, in the form of dehydration,
hydration status is important if a coach wishes to optimize their
impairs an athlete’s physical performance is not new. In 1955,
athlete’s performance and prevent a potentially life threatening
Buskirk et al.1 discussed the negative impact dehydration had
incidence. On this basis, the purpose of this review was to
on VO2max. Since this research, evidence supporting dehydration
critically analyse the current literature investigating the effect
related impairments in aerobic performance,2 anaerobic
of dehydration on physical performance.
performance,3,4 and cognitive performance,5 have been pub-
lished, as have incidents whereby athlete dehydration has led to
the risk of fatality.6 2. Methods
A state of dehydration can be induced through physical A two-layered search strategy was utilized for the review.
activity (PA).7 However, the level of dehydration induced can be Firstly, a comprehensive search of online databases including
dependent upon a number of variables including the type, inten- PubMed, CINHAL, Web of Science, SPORTSDiscus, and
sity, and duration of the PA and the temperature and humidity of EBSCO: Academic Search Complete was completed. The
the environment.8 Hence studies have been undertaken to inves- search terms, “fluid loss” or “exercise induced dehydration”
tigate the impact that PA has on dehydration, and conversely the and “performance” and “physical task” or “exercise” and filters
impact that different levels of dehydration have on physical used for the searches of these databases are detailed in Table 1.
performance. The intent of these studies was to better under- All articles noted from the original database search were
stand the need for an athlete to maintain a state of euhydration checked for duplicates, and these were subsequently removed.
(absence of dehydration).8 As an athlete’s performance essen- Secondly, the reference lists of articles from the database search
tially requires a degree of PA and PA is known to potentially that were retrieved in full text were cross-checked against the
list of initial database articles and all new articles were noted
and sourced.
* Corresponding author.
All articles were then subjected to key inclusion criteria,
E-mail address: [email protected] (R.M. Orr) these being: (1) the article specifically investigated the effect of
Peer review under responsibility of Shanghai University of Sport. dehydration on physical task performance; (2) the article was
http://dx.doi.org/10.1016/j.jshs.2014.09.004
2095-2546/© 2014 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport.
358 A. Carlton and R.M. Orr

Table 1
Details of literature search: databases used, search terms, and filters.
Database Filters Number after Number after Total Duplicates New
exclusion inclusion number articles
PubMed 2003–2013, human, English, clinical trial, RCT 4 3 3 0 3
CINHAL 2003–2013, human, English, research article, 1 1 1 1 0
peer reviewed, RCT
Web of Science Article, English, 2003–2013 72 8 8 5 6
SPORTSDiscus Journal article, peer reviewed, English, 2003–2013 24 2 2 2 0
EBSCO: Academic Scholarly (peer reviewed) journals, 2003–2013, 23 2 2 2 0
Search Complete article, English
Abbreviation: RCT = randomized control trial.

published within the last 10 years; (3) the research involved internal validity and external validity of the selected research
human participants; (4) the article was published in English; articles were found to have reasonably high methodological
and (5) the article was an original research article. For the scores (mean = 79% ± 4%) ranging from 72% to 81% using the
purpose of this review, dehydration was defined as an increase Downs and Black checklist.9 These scores are considered to
in osmolality or similarly a decrease in body mass from a single represent a high standard of research.11 Both the inability to
exercise session/heat exposure. Physical tasks were defined as blind the participants and the researchers, and poorly repre-
tasks that require physical exertion or activities that challenge sented populations were identified as the main limitations of the
the participant in a physical capacity. studies identified for review.
The methodological quality of selected articles was assessed The populations of the studies were all males, who were
using the Downs and Black protocol.9 The Downs and Black classified as healthy and active. Some of the participants were
protocol employs a 27-question checklist to assess five key involved in specific sports including cycling,8,12 rugby,2 golf,13
areas of methodological quality: statistical power, internal soccer,14 and triathlon7 with the remaining participants from the
validity (bias and confounding), external validity, and reporting general population.3,4,15 The average population size for the
quality. The checklist comprised closed answer questions, studies was nine participants ranging from seven to 12 partici-
where a “yes” is awarded 1 point and a “no” or “unable to pants. Seven of the nine studies2,7,8,12–15 utilized a randomized
determine” is awarded 0 point. There are two questions that crossover trial to allow for the capture of results from all par-
have more points assigned to them. Question 5, reporting of ticipants across conditions whilst removing confounding effects
confounding factors associated with the participants, is scored in both learning and fatigue. The remaining two studies3,4 used
out of two (0 = no list, 1 = a partial list, 2 = a complete list of a one-day trial where the participants started in an euhydration
principle confounders). Question 27, a statistical power ques- state with exercise or heat exposure prescribed to achieve the
tion, has scores derived from the number of participants dehydration condition for post-testing. There were a number of
involved in the clinical trial and is scored out of five. Scores
were converted to a percentage of the total score by dividing
each article’s score by 32 (total possible score) and multiplying
by 100. All studies were independently rated by the authors with
the level of agreement measured using a Cohen’s Kappa (κ)
analysis of all raw scores (27 scores per paper). For final scores,
any disagreements in points awarded were settled by consensus.

3. Results
From the initial search, 124 possible articles were identified
from the database searches (Fig. 1). Of these articles, 108 were
removed following review of the titles and abstracts against the
five inclusion criteria. An additional seven articles were
removed due to duplication. Six articles were added from the
search of reference lists which identified previously unidenti-
fied articles. The remaining 15 articles were then reviewed in
detail and considered against the inclusion criteria with nine
papers retained for critical review.
The participants, methods, main findings and critical
appraisal of the articles are shown in Table 2. The κ statistic for
inter-tester agreement of the methodological quality of the
studies indicated a “substantial” agreement (κ = 0.744).10 The
critical appraisal measures of power, quality of reporting, Fig. 1. A flow chart of the process used for the literature review.
Fluid loss and physical performance 359

different approaches employed by the studies to achieve a dehy- 15 min or a high hydration protocol of 300 mL per 15 min. The
drated state including: heat exposure,2–4 fluid restriction,2,7,8,12,13 investigators note that during and following 120 min of
and exercise.7,12,14 There was one study that directly considered submaximal riding there was a significant increase in the
the effect of dehydration on aerobic performance,2 whilst most heart rates (low hydration: 187 ± 146 bpm; high hydration
looked at its effect on anaerobic performance.3,4,7,8,12–15 Two of 183 ± 146 bpm; p = 0.02) and core body temperatures (low
these anaerobic studies did however consider the effect dehy- hydration: 39.5 °C ± 0.3 °C; high hydration: 39.1 °C ± 0.3 °C;
dration had on the aerobic exercise that was undertaken to p < 0.001) of the low hydration riders. Both the increased heart
induce a dehydrated state.8,12 rate and increased body temperature are considered to be det-
Two studies used sport specific skills to assess performance,13,14 rimental to performance.12 There was one study that investi-
two the Wingate test,3,15 and another two a graded exercise test to gated just the aerobic performance on participants.2 Aldridge
exhaustion.7,12 One study looked at distance travelled in 30 min2 et al.2 explored the impact of dehydration on heart rate, per-
while another used a 5-km time trial to determine performance ceived rating of exertion, and mean VO2. They found significant
impacts.8 In the remaining study,4 knee strength and standing differences in all three variables when comparing euhydration
vertical jump were used to determine the effect of dehydration on condition to the dehydration condition (p ≤ 0.01, p ≤ 0.05,
performance. Given these outcomes measure, the majority of the p ≤ 0.001, respectively).
studies came to the conclusion that dehydration decreases As opposed to aerobic exercise, the majority of studies
performance2–4,7,8,12–14 although one study found no difference investigated the effect of dehydration on anaerobic
between the euhydration and hypohydration trials.15 exercise.3,4,7,8,12–15 Unlike the aerobic exercise studies, which had
Four studies found that with dehydration there was an asso- consistent findings, the studies investigating anaerobic exercise
ciated decrease in power output.3,7,8,12 In addition, the captured produced varying results. In the performance tests that lasted
studies noted increases in relative VO2 and heart rate with for longer periods of time (≥30 s) the investigators found that
dehydration,2 decreased gross efficiency,7 decreased speed,8 dehydration had a negative effect on performance.3,4,7,8,12–14
decreased time to exhaustion,12 and decreased sport-specific However, for tests that lasted shorter than 15 s, including the
skills.13 Two studies identified an increase in “Ratings of standing vertical jump and 15 s Wingate anaerobic test there
Perceived Exertion” levels with dehydration2,14 with a third were no observed changes in performance.4,15 A reason for these
study noting a 70% increase in the severity of fatigue with differences may relate to the energy system predominately used
dehydration.3 In contrast, one study did find only a slight, non- for each test. There are two main energy components that con-
significant increase in fatigue severity with dehydration.15 tribute to anaerobic performance, the alactic and anaerobic
glycolytic (lactic) components.16 These components work in
conjunction with the aerobic energy system to meet the energy
4. Discussion
demand during exercise. Each energy system is active through-
Fluid loss due to PA is a daily occurrence for humans. out exercise however one is usually more dominant than the
Without replacement this fluid loss can lead to a state of dehy- others with the duration and intensity of the exercise influenc-
dration. With the methodological scores of the evidence con- ing this.16 For high intensity exercise that lasts up to 15–20 s the
sidered in this review found to be of good standard, the majority body predominately utilizes the alactic component;16 this
of research suggests that dehydration has a detrimental effect on system does not require water.17 For high intensity activity that
physical performance, with the potential exception of activities lasts up to 2–3 min the body predominately uses the anaerobic
lasting less than 15 s. This is unsurprising given evidence sug- glycolytic component;16 a system that utilizes water to help in
gesting that a decrease in hydration of 3% has been shown to energy synthesis.17 Water is used in the anaerobic glycolytic
have an effect on the performance of further PAs.3 energy system to resynthesize pyruvate into glucose so that it
Upon investigating the impact of dehydration on aerobic can be recycled through the energy systems to create more
performance most studies were found to only consider an energy, likewise the hydrogen ions stripped from the water
aerobic exercise section as a segue between pre- and post-test. produces energy when shuttled through the electron transport
Aerobic exercise was used to help achieve the level of dehydra- chain.17,18 Water is utilized by the aerobic energy system to
tion that the researches had set as their criteria.4,7,8,12,14 However, perform the same roles.17 As such, a dehydrated state, where
some studies did utilize aerobic exercise as an outcome measure bodily water is limited, may reduce the ability of the anaerobic
and not merely an intervention.8,12 During these latter glycolytic and aerobic energy pathways to produce energy, and
investigations the researchers found a decrease in aerobic as such, have a negative impact on performance of tasks lasting
performance with the participants that were in a hypohydrated 30 s or longer in duration.
or dehydrated state compared to baseline or euhydration state. The general findings from the reviewed research follow
Hillman et al.8 discovered that with the reduced hydration in a earlier studies prior to the review period. In regards to aerobic
warm climate (33.9 °C ± 0.9 °C vs. 23.0 °C ± 1.0 °C) the performance, previous research has typically found dehydration
distance covered in their 90 min of cycling on a stationary to negatively impact performance.19–22 One study by Dengel
ergometer significantly decreased (p < 0.03) when compared to et al.23 did however fail to find changes in aerobic performance
a euhydrated state in the same participant. with hypohydration. It should be noted that participants in
Ebert et al.12 found similar results. In their study, riders were this study cycled at sub maximal intensities (50% VO2max)
allocated a low hydration restriction protocol of 50 mL per for the duration. Similarly, findings investigating anaerobic
360 A. Carlton and R.M. Orr

Table 2
Summary of the critical appraisal of included articles in this review.
Author Participant Variable Intervention Main finding Critical
appraisal
score (%)
Aldridge Eight regularly active Independent: Randomised crossover 1. UOsm values for EUH and 81
et al.2 male athletes – university hydration status 1. 1 × 30 min cycle HYPO conditions were
rugby players (EUH/HYPO) ergometer at 75 W 385 ± 184 mOsm/kg and
Dependent: 815 ± 110 mOsm/kg, respectively
aerobic exercise 2. There was significant increases
performance between EUH and HYPO
conditions in mean VO2
(p ≤ 0.001), HR (p ≤ 0.01), RPE
(p ≤ 0.05) at the 30 min point of
the test
Cheuvront Eight healthy and Independent: Randomised crossover 1. HYPO condition had a 81
et al.15 physically active male hydration status 1. 1 × 15 s Wingate significantly decreased body mass
subjects (EUH/HYPO) (WAnT) compared to EUH (p < 0.001)
Dependent: 2. 3 h passive heat 2. No significant differences seen in
anaerobic exercise exposure relative peak power output
performance 3. 3 × WAnT’s at 0, 30, between EUH and HYPO
and 60 min’s post heat conditions (11.4 ± 1.0 and
exposure 11.7 ± 1.3 W/kg)
Ebert et al.12 Eight well-trained male Independent: 1 × maximal graded 1. Significant difference between 72
cyclists hydration status (HIGH cycling test on a LOW CHO and HIGH CHO
CHO/LOW CHO) stationary ergometer to conditions in body mass loss
Dependent: determine MAP (3.6 ± 0.6 and 1.3 ± 0.5 % body
cycling hill climbing Randomised crossover mass respectively, p < 0.05)
performance 1. 2 h ride on a stationary 2. Significant difference in time to
ergometer at 53% MAP exhaustion on hill climb test
2. Hill climb between LOW CHO and HIGH
time-to-exhaustion at CHO conditions (p = 0.002), with
88% MAP, own their a 28.6% ± 13.8% decrease in
own bike on an 8% times in the LOW group
inclined treadmill
Edwards Eleven moderately active Independent: Randomised crossover 1. USGM significantly increased 75
et al.14 male soccer players (two (FI, NF, and MR) 1. 45 min pre-match (p < 0.05) post-match compared
players did not complete Dependent: cycle ergometer (90% to pre-match in the NF test,
MR conditions) soccer match VT) however no significant change in
play and fitness 2. Completion of a the FI and MR tests
variables 45 min soccer match 2. A significant decrease in both
3. Immediate post-match NF and MR (13% and 15%,
sport-specific and respectively) in distance covered
mental concentration in the post-match performance
tests test when compared to the FI test
Hayes and Twelve male university Independent: 1. Six resistance exercise 1. Subjects had a significant 75
Morse4 students hydration status bouts Heat exposure decrease in body mass, maximal
increasing levels of between each bout isometric, and isokinetic strength
HYPO 2. Heat exposure of 20 min during the study (p < 0.001,
Dependent: jogging in a warm p < 0.05, p < 0.05, respectively)
strength, jump environment chamber 2. However no significant change
capacity, and 3. Resistance exercise bouts was seen in jump height, EMG, or
neuromuscular consisted of a unilateral maximal isokinetic strength at
function knee extension in 120°/s
isometric and isokinetic
concentric conditions and
a standing vertical jump
Hillman et al.8 Seven competitive male Independent: Randomised crossover 1. % DE significantly increased in 81
cyclists hydration status (EUH 1. 90 min cycling at 95% the DE–W condition compared to
and DE in W and T lactate threshold pre-exercise (p < 0.01)
conditions) 2. 5 km TT 2. DE–W also had significant
Dependent: decreases in power output
5 km cycling TT compared to all other conditions
in both the 90 min cycle and
5 km TT (p < 0.03, p < 0.02)
(continued on next page)
Fluid loss and physical performance 361

Table 2 (continued)
Author Participant Variable Intervention Main finding Critical
appraisal
score (%)
Jones et al.3 Seven healthy males Independent: 1. 2 × UL and LL – 30 s 1. UL and LL mean PO were 81
hydration status Wingate tests significantly decreased between
(EUH/HYPO) 2. Heat exposure until EUH and HYPO (7.17%,
Dependent: dehydration of 3.0% p = 0.016; 19.20%, p = 0.002)
UL and LL PO body mass loss was 2. UL and LL peak PO were
achieved significantly decreased between
3. 2 × UL and LL – 30 s EUH and HYPO (14.48%,
Wingate tests p = 0.013; 18.36%, p = 0.013)
Smith et al.13 Seven athletic Independent: Randomised crossover 1. Body mass in the DE condition 81
low-handicap hydration status 1. Sport-specific was significantly reduced when
experienced (EUH/DE) performance test: compared to base line (p < 0.01)
male golfers Dependent: hitting 30 golf balls in 2. Shot distance and off target
sport-specific and a laboratory-based accuracy were both significantly
cognitive motor netted, enclosed swing different between the EUH and
performance area DE conditions. (−14.1%,
2. Cognitive ability test: p < 0.001; 3.8%, p = 0.001)
distance judgment 3. There was also a significant
decrease between EU and DE
conditions in the cognitive tests
(p < 0.001)
Van Schuylenbergh et al.7 Nine national level male Independent: Randomised crossover 1. DE post-exercise test was 81
triathletes hydration status 1. Graded cycling test to significantly shorter and had
(EUH/DE) exhaustion reduced PO than the other tests
Dependent: 2. 2 h endurance exercise (p < 0.05)
HR, PO, RER bout (including fluid 2. Oxygen uptake was not
replacement for the significantly different and RER
EUH condition) was significantly decreased in all
3. Graded cycling test to post-exercise test conditions
exhaustion (p < 0.05)
Abbreviations: EUH = euhydration; HYPO/DE = hypohydration/dehydration; HIGH CHO = high carbohydrate; LOW CHO = low carbohydrate; HR = heart rate;
RPE = rating of perceived exertion; MAP = maximal aerobic power; VT = ventilatory threshold; W = warm; T = thermoneutral; TT = time trial; PO = power output;
UL = upper limb; LL = lower limb; RER = respiratory gas exchange ratio; MR = mouth rinse; FI = fluid intake; NF = no fluid; EMG = electromyography;
VO2 = oxygen consumption.

performance were mixed.20 Where one study by Greiwe at al.24 method, USG can be captured through various means including
found no change in isometric strength or muscle endurance hydrometry, reagent strips, and refractometry with refractom-
following a sauna induced state of hypohydration, a study by etry considered the more accurate.26 USG scores from these
Torranin et al.25 did find a decrease in muscle strength- measures can then be compared to ratings tables (like those
endurance likewise following a sauna induced hypohydration provided by Casa et al.27) to measure an athlete’s level of
state. hydration. Apart from USG, there are some other methods for
Given the findings of this review and consideration of earlier measuring hydration status including urine osmolality (labora-
research, research suggests that athletes participating in exer- tory measure) and pre- and post-body weight mass (field
cise of greater than 30 s in duration would benefit from pre- measure). Urine osmolality measures may be more timely and
hydrating to a state of euhydration prior to their event, and to delayed28,29 and are considered interchangeable with USG
continually ingest fluids to match those lost during exercise to measures.29 In the field, body mass measures can provide a guide
maintain a state of euhydration. While coaches often broadly as to fluid loss through sweat loss. As a general guide, a loss of
consider hydration status (potentially more often during more than 1%–2% of body mass indicates that the athlete did not
games as opposed to training), they may not fully appreciate the ingest sufficient fluid during the event.30 Conversely, if body
impact a dehydrated state could have on performance or the mass loss was lower than this amount fluid intake may have been
potentially life threatening incidence that may arise from this more than that was required for the event or activity.30 It should
physiological state. As such, through maintaining a state of be noted, however, that changes in body weight do not account
euhydration, the athlete’s level of fatigue may be decreased, as for athletes that are dehydrated on their initial pre-activity
may their relative VO2, heart rate, and rating of perceived exer- measure. As such, the latter statement regarding limited body
tion, the consequences of which will see an increased level of mass changes and sufficient hydration may be misleading.30
performance. When considering the research presented and choice of
Urine specific gravity (USG) presents one means monitoring hydration measures, the coach should consider the potential
an athlete’s level of hydration. Typically a quick and easy differences in athlete sweat rates. Research does suggest that
362 A. Carlton and R.M. Orr

sweat rates differ from person to person, through factors like 5. Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto
fitness and percentage of body fat.30,31 Furthermore, higher LM, et al. Mild dehydration impairs cognitive performance and mood of
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