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Journal of Athletic Training · 2017

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Brendon P. McDermott, Scott A. Anderson, Lawrence E. Armstrong, Douglas J. Casa, Samuel N. Cheuvront, Larry Cooper, W. Larry Kenney, Francis G. O'Connor, William O Roberts

National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active

National Athletic Trainers' Association. 52(9). 877-895.

Study type
Position statement and evidence synthesis
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Full text reviewed

Hydration during exercise is a balance problem, not a contest to drink the most. The authors recommend starting activity adequately hydrated, limiting bodyweight loss to less than about 2% during exercise, and avoiding weight gain from excessive drinking. These are planning principles for physically active people, not proof that a single threshold predicts everyone's performance. Sweat losses, conditions, activity, and access to fluids all matter. Too little fluid can impair function, but drinking beyond losses can also be dangerous. In particular, excess fluid can contribute to exercise-associated hyponatremia, meaning an abnormally low sodium concentration in the blood.

The paper does not reduce hydration to replacing every drop immediately. It supports individualized plans that consider sweat losses and the circumstances of exercise. Importantly, sports drinks do not make overdrinking safe. The amount consumed still matters even when a drink contains sodium. Changes in bodyweight can help estimate fluid balance, but they are one part of assessment rather than a standalone diagnosis.

How Does This Show Up in Real Life?

The useful question is whether a drinking plan fits the activity you are actually doing. The authors describe using bodyweight before and after exercise, together with fluid intake and other losses, to estimate sweat loss. Repeating that assessment in realistic conditions can be more informative than borrowing a teammate's bottle schedule. A cool training session does not necessarily establish the right plan for a hot event. When individual sweat rates are unknown, the authors identify drinking to thirst as a way to reduce the risk of excessive intake. This is not a promise that thirst produces the best performance in every situation. The practical lesson is to avoid both neglecting fluid needs and forcing intake beyond them, while allowing the plan to change with the setting.

Recommendations have different evidence grades, and some rely more heavily on clinical experience or less consistent research. Exercise studies also vary in temperature, duration, and how dehydration is produced. These differences limit the precision of universal thresholds. A plan tested in one setting is not evidence that the same intake remains suitable across seasons, events, or changes in fitness.

Why We Cite It

Alpekin gains a boundary for digital guidance: symptoms alone cannot reliably distinguish dehydration from dangerously low blood sodium. Educational tools should not turn every exercise headache or nausea report into an instruction to drink more. The paper supports clear escalation to trained medical assessment when serious symptoms appear.

Take the safety principles seriously while treating exact intake as context-dependent. A useful hydration plan is one that can be assessed and revised, not a rigid amount to finish. More fluid is not automatically more protection, and concerning symptoms require more than guessing at their cause.

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