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Exercise Fluid Replacement

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Exercise Fluid Replacement ARTIGO DE REVISÃO Hidratação durante o exercício: a sede é suficiente?* Christiano Antônio Machado-Moreira, Ana Carolina Vimieiro-Gomes, Emerson Silami-Garcia e Luiz Oswaldo Carneiro Rodrigues RESUMO Palavras-chave: Sede. Hidratação. Exercício. O objetivo deste trabalho é fazer uma revisão sobre a hidratação Keywords: Thirst. Hydration. Exercise. e discutir se, durante o exercício, a reposição de líquidos de acor- Palabras-clave: Sed. Hidratación. Ejercicio. do com a sede é suficiente para hidratar o indivíduo. A perda hídri- ca pela sudorese induzida pelo exercício, especialmente realizado em ambientes quentes, pode levar à desidratação, pode alterar o during physical activities have been proposed. According to the equilíbrio hidroeletrolítico, dificultar a termorregulação e, assim, American College of Sports Medicine (ACSM), about 500 mL of representar um risco para a saúde e/ou provocar uma diminuição fluid on the two hours before the exercise must be ingested. Dur- no desempenho esportivo. Tem sido citado que os atletas não in- ing exercise, they propose that athletes should start fluid replace- gerem voluntariamente água suficiente para prevenir a desidrata- ment since the beginning in regular periods and should drink ção durante uma atividade física. Em função disso, têm sido pro- enough fluid to restore all the sweating losses or ingest the max- postas recomendações internacionais sobre a hidratação. Segundo imal volume tolerated. The National Athletic Trainer’s Association o American College of Sports Medicine (ACSM), deve-se ingerir (NATA) proposes the following recommendations: ingestion of 500 aproximadamente 500mL de líquidos nas duas horas anteceden- to 600 mL of water two or three hours before exercise or other tes ao exercício. Durante o exercício, os atletas devem começar a sport drink and ingestion of 200 to 300 mL 10 to 20 minutes be- beber desde o início e em intervalos regulares, em volume sufi- fore exercise starting. During exercise, the fluid replacement should ciente para repor as perdas pela sudorese ou o máximo tolerado. A match the sweating and urine losses and at least should maintain National Athletic Trainer’s Association (NATA) faz as seguintes re- hydration status reaching maximal body weight losses of 2%. Af- comendações: ingerir 500 a 600mL de água ou outra bebida espor- ter the exercise, fluid replacement must restore all the fluid loss- tiva duas a três horas antes do exercício e 200 a 300mL 10 a 20 es accumulated. In addition, ACSM and NATA asserted about fluid minutos antes do exercício; durante o exercício, a reposição deve temperature and palatability, beverage carbohydrate and electro- aproximar as perdas pelo suor e pela urina e pelo menos manter a lyte additions according to exercise duration and intensity and rec- hidratação, com perdas máximas correspondentes a 2% de perda ommended hydration schedules to provide easier access to fluid de peso corporal; após o exercício a hidratação deve ter como ob- ingestion. However, other authors contest the use of hydration jetivo corrigir quaisquer perdas líquidas acumuladas. Além disso, o schedules based on predetermined fluid volumes and suggest that ACSM e o NATA fazem referências sobre temperatura e palatabili- fluid replacement according to thirst is enough to maintain body dade do líquido, adição de carboidratos e eletrólitos de acordo com homeostasis. a intensidade e duração do exercício e estratégias de hidratação para facilitar a acessibilidade do atleta ao líquido. No entanto, ou- tros autores questionam o uso da reidratação em volumes prede- RESUMEN terminados e sugerem que a ingestão de líquidos de acordo com a Hidratación durante el ejercicio: ¿la sed es suficiente? sede seja capaz de manter a homeostase. El objetivo de este trabajo es hacer una revisión sobre la hidra- tación y discutir si, durante el ejercicio, la reposición de líquidos ABSTRACT de acuerdo con la sed es suficiente para hidratar al individuo. La Exercise fluid replacement: is thirst enough? pérdida hídrica por la sudoración inducida por el ejercicio, espe- cialmente realizado en ambientes calurosos, puede llevar a la des- The present work proposes a review about exercise fluid repla- hidratación, puede alterar el equilibrio hidroelectrolítico, dificultar cement and a discussion whether, during exercise, the fluid in- la termorregulación y, así, representar un riesgo para la salud y/o gested according to thirst is sufficient to maintain hydration. Exer- provocar una disminución en el desempeño deportivo. Ha sido cise sweat loss, mainly in the heat, can cause dehydration, can citado que los atletas no ingieren voluntariamente agua suficiente alter the hidroelectrolyte balance, disturb thermoregulation, pre- para prevenir la deshidratación durante una actividad física. En senting a health risk and/or impairing the athletic performance. It función de eso, han sido propuestas recomendaciones internacio- has been asserted that athletes do not drink, spontaneously, the nales sobre la hidratación. Según American College of Sports sufficient fluid volume to prevent dehydration during the physical Medicine (ACSM), se debe ingerir aproximadamente 500 ml de activity. Thus, international recommendations to fluid replacement líquidos durante las dos horas antecedentes al ejercicio. Durante el ejercicio, los atletas deben comenzar a beber desde el inicio y a intervalos regulares, en volumen suficiente para reponer las pérdi- das por la sudoración o el máximo tolerado. La National Athletic * Laboratório de Fisiologia do Exercício, Escola de Educação Física e Trainer´s Association (NATA) hace las siguientes recomendacio- Terapia Ocupacional. Universidade Federal de Minas Gerais. Belo Hori- nes: ingerir 500 a 600 ml de agua u otra bebida deportiva dos a zonte, MG, Brasil. tres horas antes del ejercicio y 200 a 300 ml de 10 a 20 minutos Recebido em 4/8/05. Versão final recebida em 23/12/05. Aceito em 7/6/06. antes del ejercicio; durante el ejercicio, la reposición debe aproxi- Endereço para correspondência: Av. Antônio Carlos, 6.627, Campus Pam- marse a las pérdidas por el sudor y por la orina y por lo menos pulha – 31310-250 – Belo Horizonte, MG, Brasil. Telefax: (31) 3499-2325. mantener la hidratación, con pérdidas máximas correspondientes E-mail: [email protected] a 2% de pérdida de peso corporal; después del ejercicio la hidrata- Rev Bras Med Esporte _ Vol. 12, Nº 6 – Nov/Dez, 2006 405 ción debe tener como objetivo corregir cualesquier pérdidas líqui- A ingestão de fluidos reduz as respostas da temperatura retal das acumuladas. Además de esto, la ACSM y la NATA hacen refe- somente após 60-80min de exercício(6,9-10). Nenhum efeito da in- rencias sobre temperatura y palatabilidad del líquido, adición de gestão de líquidos na temperatura retal foi encontrado em um es- carbohidratos y electrólitos de acuerdo con la intensidad y dura- tudo de menor duração, com maior intensidade(16), possivelmente ción del ejercicio y estrategias de hidratación para facilitar la acce- devido à duração do exercício (menos de 80min). Cheuvront e Hay- sibilidad del atleta al líquido. A pesar de esto, otros autores cues- mes(17), num estudo em que foi avaliado o efeito da ingestão de tionan el uso de la rehidratación en volúmenes predeterminados y água de acordo com a sede sobre as respostas termorregulatórias sugieren que la ingestión de líquidos de acuerdo con la sed sea durante exercício a 71% do VO2max realizado sob diferentes es- capaz de mantener la homeostasis. tresses térmicos (frio, moderado e quente), não encontraram dife- renças na temperatura interna nas três situações. Concluiu-se que as repostas termorregulatórias são compensáveis quando há in- INTRODUÇÃO gestão de acordo com a sede e reposição de aproximadamente A perda hídrica pela sudorese durante o exercício pode levar o 60-70% das perdas pelo suor. organismo à desidratação, com aumento da osmolalidade, da con- A freqüência cardíaca é aumentada(7-8,12) e o volume de ejeção centração de sódio no plasma(1-2) e diminuição do volume plasmá- reduzido em proporção ao déficit de fluidos que ocorre durante o tico. Quanto maior a desidratação, menor a capacidade de redistri- exercício(10). Mesmo uma leve desidratação (um por cento da massa buição do fluxo sanguíneo para a periferia, menor a sensibilidade corporal) pode aumentar o esforço cardiovascular, o que pode ser hipotalâmica para a sudorese e menor a capacidade aeróbica para visto através de um aumento desproporcional da freqüência car- um dado débito cardíaco(3). Os ajustes fisiológicos decorrentes da díaca durante o exercício, além de limitar a capacidade corporal de desidratação, os protocolos de ingestão de fluidos e o papel da transferir calor dos músculos em contração para a superfície da sede constituem o foco da presente revisão. pele, onde pode ser dissipado para o ambiente. Portanto, um dé- Um dos primeiros estudos a respeito das modificações do ba- ficit hídrico pode reduzir o desempenho e aumentar a possibilida- lanço hídrico em ambientes quentes foi realizado em 1938, o que de de ocorrer uma complicação térmica(18). No entanto, o débito demonstra, desde então, a preocupação em se observar o com- cardíaco e o volume de ejeção não diminuem quando a taxa de portamento fisiológico do organismo em atividades realizadas em ingestão de líquidos é suficiente para prevenir a desidratação. ambiente quente. Adolph e Dill(4) analisaram as perdas hídricas A ingestão de fluidos mantém maiores taxas de fluxo sanguí- pela urina e pela sudorese, a ingestão de líquidos e a concentra- neo no antebraço durante o exercício(9-10), assim como no antebra- ção da urina (gravidade específica) no exercício no deserto (am- ço e na panturrilha em repouso durante uma exposição prolonga- biente quente e seco), encontrando aumento da sudorese, com da ao calor(19). A redução do fluxo sanguíneo no antebraço é conseqüente aumento na ingestão de líquidos, estabilização ou proporcional ao nível de desidratação(10). Logo, a ingestão de líqui- diminuição na excreção de urina e aumento na concentração da dos durante o exercício pode atenuar o desenvolvimento da hiper- urina.
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