Effects of an Active Lifestyle on Water Balance

  • Gethin H. Evans
  • Ronald J. Maughan
  • Susan M. Shirreffs
Part of the Nutrition and Health book series (NH)


Water is the most abundant chemical constituent of the human body, typically making up approximately two thirds of body mass, but body water content is maintained within relatively narrow limits by a number of regulatory mechanisms. Both a reduction (hypohydration) and increase (hyperhydration) in body water may, if sufficiently severe, lead to adverse health and performance consequences. Active lifestyles, warm climates, and high altitude, as well as some infectious illnesses, increase the likelihood of becoming hypohydrated due to an increase in water loss. Moderate reductions in body water result in changes in cardiovascular system function as well as altering cognitive function and mood. A significant number of elite athletes, recreational exercisers and those with active occupations begin their daily activities in a hypohydrated state and incur large sweat losses during periods of activity, and thus risk negative effects on physiological function. Sweat rate and fluid intake during physical exertion are highly variable between individuals, suggesting that an individual hydration strategy may be necessary to avoid significant levels of hypohydration. Rehydration after the completion of physical activity may also be necessary to avoid starting further bouts of activity in a hypohydrated state. Undertaking physical activity in a hypohydrated state appears to increase an individual’s perceived exertion which may negatively influence exercise performance and self-selected exercise intensity, and may decrease the likelihood of further participation in physical activity. This is, therefore, an important consideration for public health as well as competitive sportspeople, be they elite or otherwise. Certain populations, such as the elderly, are more likely to become hypohydrated, which may lead to other illnesses and contribute to morbidity and mortality.


Hydration Hypohydration Water turnover Physical activity Occupational activity Perceived exertion Exercise performance Exercise participation Over-hydration 



Atrial natriuretic peptide


Arginine vasopressin


European Food Safety Authority






Rating of Perceived Exertion


Maximum oxygen uptake


  1. 1.
    Adolph EF, Barker JP, Hoy PA. Multiple factors in thirst. Am J Physiol. 1954;178:538–62.PubMedGoogle Scholar
  2. 2.
    Almond CSD, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, Duncan CN, Olson DP, Salerno AE, Newburger JW, Greenes DS. Hyponatremia among runners in the Boston marathon. New Eng J Med. 2005;352:1550–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Armstrong LE, Costill DL, Fink WJ. Influence of diuretic-induced dehydration on competitive running performance. Med Sci Sports Exerc. 1985;17:456–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Armstrong LE, Johnson EC, Kunces LJ, Ganio MS, Judelson DA, Kupchak BR, Vingren JL, Munoz CX, Huggins RA, Hydren JR, Moyen NE, Williamson KH. Drinking to thirst versus drinking ad libitum during road cycling. J Athl Train. 2014;49:624–31.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Baker LB, Dougherty KA, Chow M, Kenney WL. Progressive dehydration causes a progressive decline in basketball skill performance. Med Sci Sports Exerc. 2007;39:1114–23.CrossRefPubMedGoogle Scholar
  6. 6.
    Barr SI, Costill DL, Fink WJ. Fluid replacement during prolonged exercise: effects of water, saline, or no fluid. Med Sci Sports Exerc. 1991;23(7):811–7.PubMedGoogle Scholar
  7. 7.
    Bates GP, Miller VS, Joubert DM. Hydration status of expatriate manual workers during summer in the middle East. Ann Occup Hyg. 2010;54:137–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Baylis PH. Osmoregulation and control of vasopressin secretion in healthy humans. Am J Physiol. 1987;253:R671–8.PubMedGoogle Scholar
  9. 9.
    Below PR, Mora-Rodríguez R, González-Alonso J, Coyle EF. Fluid and carbohydrate ingestion independently improve performance during 1 h of intense exercise. Med Sci Sports Exerc. 1995;27:200–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Biggs C, Paterson M, Maunder E. Hydration status of South African forestry workers harvesting trees in autumn and winter. Ann Occup Hyg. 2011;55:6–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMedGoogle Scholar
  12. 12.
    Bouchard C, Blair SN, Katzmarzyk PT. Less sitting, more physical activity, or higher fitness. Mayo Clin Proc. 2015;90:1533–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Brake R. Fluid consumption sweat rates and hydration status of thermally-stressed underground miners and the implications for heat illness and shortened shifts. 2001. Available at: Accessed 7 Mar 2016.
  14. 14.
    Carter III R, Cheuvront SN, Vernieuw CR, Sawka MN. Hypohydration and prior heat stress exacerbates decreases in cerebral blood flow velocity during standing. J Appl Physiol. 2006;101:1744–50.CrossRefPubMedGoogle Scholar
  15. 15.
    Cheuvront SN, Carter III R, Castellani JW, Sawka MN. Hypohydration impairs endurance exercise performance in temperate but not cold air. J Appl Physiol. 2005;99:1972–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Cheuvront SN, Kenefick RW. Dehydration: physiology, assessment, and performance effects. Compr Physiol. 2014;4:257–85.CrossRefPubMedGoogle Scholar
  17. 17.
    Courtney M, O’Reilly M, Edwards H, Hassall S. The relationship between clinical outcomes and quality of life for residents of aged care facilities. Aust J Adv Nurs. 2009;26:49–57.Google Scholar
  18. 18.
    Cunniffe B, Fallan C, Yau A, Evans GH, Cardinale M. Assessment of physical demands and fluid balance in elite female handball players during a 6-day competitive tournament. Int J Sport Nutr Exerc Metab. 2015;25:78–88.CrossRefPubMedGoogle Scholar
  19. 19.
    D’Ippoliti D, Michelozzi P, Marino C, de’Donato F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramon M, Paldy A, Atkinson R, Kovats S, Bisanti L, Schneider A, Lefranc A, Iniguez C, Perucci CA. The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Env Health. 2010; 9:37.Google Scholar
  20. 20.
    El-Sharkawy AM, Watson P, Neal KR, Ljungqvist O, Maughan RJ, Sahota O, Lobo DN. Hydration and outcome in older patients admitted to hospital (the HOOP prospective cohort study). Age Ageing. 2015;44:943–7.Google Scholar
  21. 21.
    European Food Safety Authority (EFSA) Panel on Dietetic Products. Nutrition, and Allergies (NDA): scientific opinion on dietary reference values for water. EFSA J. 2010;8:1459–507.CrossRefGoogle Scholar
  22. 22.
    Evans GH, Shirreffs SM, Maughan RJ. Post-exercise rehydration in man: the effects of osmolality and carbohydrate content of ingested drinks. Nutrition. 2009;25:905–13.CrossRefPubMedGoogle Scholar
  23. 23.
    Ferry M. Strategies for ensuring good hydration in the elderly. Nutr Rev. 2005;63:S22–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Fleming J, James LJ. Repeated familiarisation with hypohydration attenuates the performance decrement caused by hypohydration during treadmill running. Appl Physiol Nutr Metab. 2014;39:124–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S, Lopez RM, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011;106:1535–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Gonzalez-Alonso J, Calbet JA, Nielsen B. Muscle blood flow is reduced with dehydration during prolonged exercise in humans. J Physiol. 1998;513:895–905.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Gonzalez-Alonso J, Mora-Rodriguez R, Below PR, Coyle EF. Dehydration reduces cardiac output and increases systemic and cutaneous vascular resistance during exercise. J Appl Physiol. 1995;79:1487–96.PubMedGoogle Scholar
  28. 28.
    Gonzalez-Alonso J, Mora-Rodriguez R, Below PR, Coyle EF. Dehydration markedly impairs cardiovascular function in hyperthermic endurance athletes during exercise. J Appl Physiol. 1997;82:1229–36.PubMedGoogle Scholar
  29. 29.
    Greenleaf JE. Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc. 1992;24:645–56.CrossRefPubMedGoogle Scholar
  30. 30.
    Hew-Butler T, Rosner MH, Fowkes-Godek S, et al. Statement of the 3rd international exercise-associated hyponatremia consensus development conference, Carlsbad, California, 2015. Clin J Sports Med. 2015;25:303–20.CrossRefGoogle Scholar
  31. 31.
    Institute of Medicine. Panel on dietary reference intakes for electrolytes and water, dietary reference intakes for water, potassium, sodium, chloride and sulfate. Washington, DC: The National Academies Press; 2005.Google Scholar
  32. 32.
    Ishijima T, Hashimoto H, Satou K, Muraoka I, Suzuki K, Hiquchi M. The different effects of fluid with and without carbohydrate ingestion on subjective responses of untrained men during prolonged exercise in a hot environment. J Nutr Sci Viaminol. 2009;55:506–10.CrossRefGoogle Scholar
  33. 33.
    James LJ, Clayton D, Evans GH. Effect of milk protein addition to a carbohydrate-electrolyte solution ingested after exercise in the heat. Br J Nutr. 2011;105:393–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Jeukendrup AE, McLaughlin J. Carbohydrate ingestion during exercise: effects on performance, training adaptations and trainability of the gut. In: Maughan RJ, Burke LM, editors. Sports nutrition: more than just calories – triggers for adaptation. Nestle Nutrition Institute Workshop Series. 2011;69:1–17.Google Scholar
  35. 35.
    Judelson DA, Maresh CM, Anderson JM, Armstrong LE, Casa DJ, Kraemer WJ, Volek JS. Hydration and muscular performance – does fluid balance effect strength, power and high-intensity endurance? Sports Med. 2007;37:907–21.CrossRefPubMedGoogle Scholar
  36. 36.
    Kenefick RW, Cheuvront SN, Leon LR, O’Brien KK. Dehydration and rehydration. In: Auerbach PS, editor. Wilderness medicine. USA: Elsevier; 2012. p. 1393–404.Google Scholar
  37. 37.
    Kenefick RW, O’Moore KM, Mahood NV, Castellani JW. Rapid IV versus oral rehydration: responses to subsequent exercise heat stress. Med Sci Sports Exerc. 2006;38:2125–31.CrossRefPubMedGoogle Scholar
  38. 38.
    Khalaj B, Lloyd G, Sheppeard V, Dear K. The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Envrion Health. 2010;83:833–42.CrossRefGoogle Scholar
  39. 39.
    Kovacs EMR, Schmahl RM, Senden LMG, Brouns F. Effect of high and low rates of fluid intake on post-exercise rehydration. Int J Sports Nutr Exerc Metab. 2002;12:14–23.CrossRefGoogle Scholar
  40. 40.
    Lang F. Mechanisms and significance of cell volume regulation. J Am Coll Nutr. 2007;26(5 Suppl):613S–23.CrossRefPubMedGoogle Scholar
  41. 41.
    Leiper JB, Carnie A, Maughan RJ. Water turnover rates in sedentary and exercising middle aged men. Br J Sports Med. 1996;30:24–6.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Leiper JB, Broad NP, Maughan RJ. Effect of intermittent high-intensity exercise on gastric emptying in man. Med Sci Sports Exerc. 2001;33:1270–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Leiper JB, Pitsiladis Y, Maughan RJ. Comparison of water turnover rates in men undertaking prolonged cycling exercise and sedentary men. Int J Sports Med. 2001;22:181–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Leiper JB, Primrose CS, Primrose WR, Phillimore J, Maughan RJ. A comparison of water turnover in older people in community and institutional settings. J Nutr Health Aging. 2005;9:189–93.PubMedGoogle Scholar
  45. 45.
    Lindseth PD, Lindseth GN, Petros TV, Jensen WC, Caspers J. Effect of hydration on cognitive function in pilots. Mil Med. 2013;178:792–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Manz F, Wentz A. The importance of good hydration for the prevention of chronic diseases. Nutr Rev. 2005;63:S2–5.CrossRefPubMedGoogle Scholar
  47. 47.
    Maughan RJ. Hydration, morbidity and mortality in vulnerable populations. Nutr Rev. 2012;70:S152–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Maughan RJ, Leiper JB, Shirreffs SM. Restoration of fluid balance after exercise-induced dehydration: effects of food and fluid intake. Eur J Appl Physiol Occup Physiol. 1996;73:317–25.CrossRefPubMedGoogle Scholar
  49. 49.
    Maughan RJ, Merson SJ, Broad NP, Shirreffs SM. Fluid and electrolyte intake and loss in elite soccer players during training. Int J Sport Nutr Exerc Metab. 2004;14:333–46.CrossRefPubMedGoogle Scholar
  50. 50.
    Maughan RJ, Shirreffs SM. Development of individual hydration strategies for athletes. Int J Sports Nutr Exerc Metab. 2008;18:457–72.CrossRefGoogle Scholar
  51. 51.
    Maughan RJ, Shirreffs SM, Merson SJ, Horswill CA. Fluid and electrolyte balance in elite male football (soccer) players training in a cool environment. J Sports Sci. 2005;23:73–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Maughan RJ, Watson P, Evans GH, Broad N, Shirreffs SM. Water balance and salt losses in competitive football. Int J Sport Nutr Ex Metab. 2007;17:583–94.CrossRefGoogle Scholar
  53. 53.
    Mears SA, Shirreffs SM. Assessing hydration status and reported beverage intake in the workplace. Am J Lifestyle Med. 2015;9:157–68.CrossRefGoogle Scholar
  54. 54.
    McConell GK, Burge CM, Skinner SL, Hargreaves M. Influence of ingested fluid volume on physiological responses during prolonged exercise. Acta Physiol Scand. 1997;160:149–56.CrossRefPubMedGoogle Scholar
  55. 55.
    Miller VS, Bates GP. The thermal work limit is a simple reliable heat index for the protection of workers in thermally stressful environments. Ann Occup Hyg. 2007;51:553–61.CrossRefPubMedGoogle Scholar
  56. 56.
    Miller VS, Bates GP. Hydration, hydration, hydration. Ann Occup Hyg. 2010;54:134–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Montain SJ, Coyle EF. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol. 1992;73:1340–50.PubMedGoogle Scholar
  58. 58.
    Murray SR, Michael TJ, McClellan PD. The influence of fluid replacement rate on heart rate and RPE during exercise in a hot, humid environment. J Strength Cond Res. 1995;9:251–4.Google Scholar
  59. 59.
    Nielsen B, Sjogaard G, Bondepettersen F. Cardiovascular, hormonal and body-fluid changes during prolonged exercise. Eur J Appl Physiol Occup Physiol. 1984;53:63–70.CrossRefPubMedGoogle Scholar
  60. 60.
    Nitschke M, Tucker G, Bi P. Morbidity and mortality during heatwaves in metropolitan Adelaide. Med J Aust. 2007;187:662–5.Google Scholar
  61. 61.
    Noakes TD. Commentary: role of hydration in health and exercise. BMJ. 2012;345:e4171.CrossRefPubMedGoogle Scholar
  62. 62.
    Noakes T, Mekler J, Pedoe DT. Jim Peters’ collapse in the 1954 Vancouver Empire Games marathon. S Afr Med J. 2008;98:596–600.PubMedGoogle Scholar
  63. 63.
    Noakes TD, Sharwood K, Collins M, Perkins DR. The dipsomania of great distance: water intoxication in an Ironman triathlete. Br J Sports Med. 2004;38:E16.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Nose H, Mack GW, Shi XR, Nadel ER. Role of osmolality and plasma volume during rehydration in humans. J Appl Physiol. 1988;65:325–31.PubMedGoogle Scholar
  65. 65.
    Nybo L, Jensen T, Nielsen B, Gonzalez-Alonso J. Effects of marked hyperthermia with and without dehydration on VO2 kinetics during intense exercise. J Appl Physiol. 2001;90:1057–64.PubMedGoogle Scholar
  66. 66.
    Polkinghorne BG, Gopaldasani V, Furber S, Davies B, Flood VM. Hydration status of underground miners in a temperate Australian region. BMC Public Health. 2013;13:426.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Riebe D, Maresh CM, Armstrong LE, Kenefick RW, Castellani JW, Echegaray ME, Clark BA, Camaione DN. Effects of oral and intravenous rehydration on ratings of perceived exertion and thirst. Med Sci Sports Exerc. 1997;29:117–24.CrossRefPubMedGoogle Scholar
  68. 68.
    Roberts DF, Donnelly S. Fluid balance and sweat rates during strenuous physical labour by timber harvesters. Med Sci Sports Exerc. 2006;38:S173–4.CrossRefGoogle Scholar
  69. 69.
    Robertson GL. Vasopressin in osmotic regulation in man. Annu Rev Med. 1974;25:315–22.CrossRefPubMedGoogle Scholar
  70. 70.
    Robertson R, Noble BJ. Perception of physical exertion: methods, mediators and application. Exerc Sport Sci Res. 1997;25:407–52.Google Scholar
  71. 71.
    Rolls BJ, Wood RJ, Rolls ET, Lind H, Lind W, Ledingham JGG. Thirst following water deprivation in humans. Am J Physiol. 1980;239:R476–82.PubMedGoogle Scholar
  72. 72.
    Roy BD, Green HJ, Burnett ME. Prolonged exercise following diuretic-induced hypohydration: effects on cardiovascular and thermals strain. Can J Physiol Pharmacol. 2000;78:541–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Sardon JP. The 2003 heat wave. Euro Surveill. 2007;12:226.PubMedGoogle Scholar
  74. 74.
    Saunders CJ, de Milander L, Hew-Butler T, Xenophontos SL, Cariolou MA, Anastassiades LC, Noakes TD, Collins M. Dipsogenic genes associated with weight changes during Ironman triathlons. Hum Mol Genet. 2006;15:2980–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Savoie FA, Kenefick RW, Ely BR, Cheuvront SN, Goulet EDB. Effect of hypohydration on muscle endurance, strength, anaerobic power and capacity and vertical jumping ability: a meta-analysis. Sports Med. 2015;45:1207–27.CrossRefPubMedGoogle Scholar
  76. 76.
    Shimamoto H, Komiya S. The turnover of body water as an indicator of health. J Physiol Anthropol Appl Human Sci. 2000;19:207–12.CrossRefPubMedGoogle Scholar
  77. 77.
    Shirreffs SM, Maughan RJ. Volume repletion following exercise-induced volume depletion in man: replacement of water and sodium losses. Am J Physiol. 1998;43:F868–75.Google Scholar
  78. 78.
    Shirreffs SM, Merson SJ, Fraser SM, Archer DT. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr. 2004;91:951–8.CrossRefPubMedGoogle Scholar
  79. 79.
    Shirreffs SM, Taylor AJ, Leiper JB, Maughan RJ. Post-exercise rehydration in man: effects of volume consumed and drink sodium content. Med Sci Sports Exerc. 1996;28:1260–71.CrossRefPubMedGoogle Scholar
  80. 80.
    St Clair Gibson A, Baden DA, Lambert MI, Lambert V, Harley YXR, Hampson D, Russell VA, Noakes TD. The conscious perception of the sensation of fatigue. Sports Med. 2003;33:167–76.Google Scholar
  81. 81.
    Vist GE, Maughan RJ. Gastric emptying of ingested solutions in man: effect of beverage glucose concentration. Med Sci Sports Exerc. 1994;26:1269–73.CrossRefPubMedGoogle Scholar
  82. 82.
    Wang XW, Lyles MF, You TJ, Berry MJ, Rejeski WJ, Nicklas BJ. Weight regain is related to decreases in physical activity during weight loss. Med Sci Sports Exerc. 2008;40:1781–8.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Warren JL, Bacon WE, Harris T, McBean AM, Foley DJ. The burden and outcomes associated with dehydration among US elderly, 1991. Am J Public Health. 1994;84:1265–9.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Watson P, Black KE, Clark SC, Maughan RJ. Exercise in the heat: effect of fluid ingestion on blood-brain barrier permeability. Med Sci Sports Exerc. 2006;42:2197–204.CrossRefGoogle Scholar
  85. 85.
    Watson P, Whale A, Mears SA, Reyner LA, Maughan RJ. Mild hypohydration increases the frequency of driver errors during a prolonged, monotonous driving task. Physiol Behav. 2015;147:313–8.CrossRefPubMedGoogle Scholar
  86. 86.
    Wolff A, Stuckler D, McKee M. Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatremia and in-hospital mortality. J R Soc Med. 2015;108:259–65.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Wu T, Gao X, Chen M, van Dam RM. Long-term effectiveness of diet plus exercise interventions vs diet only interventions for weight loss: a meta-analysis. Obes Rev. 2009;10:313–23.CrossRefPubMedGoogle Scholar
  88. 88.
    Yau MWA, Moss A, James LJ, Gilmore W, Ashworth JJ, Evans GH. The influence of angiotensin converting enzyme and bradykinin B2 receptor gene variants on voluntary fluid intake and fluid balance in healthy men during moderate intensity exercise in the heat. Appl Physiol Nutr Metab. 2015;40:184–90.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Gethin H. Evans
    • 1
  • Ronald J. Maughan
    • 2
  • Susan M. Shirreffs
    • 3
  1. 1.School of Healthcare ScienceManchester Metropolitan UniversityManchesterUK
  2. 2.School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
  3. 3.Department of MedicineSt Andrews UniversitySt AndrewsUK

Personalised recommendations