Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes.J Strength Cond Res31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.

This investigation evaluated the validity and sensitivity of urine color (U_col), specific gravity (U_sg), and osmolality (U_osm) as indices of hydration status, by comparing them to changes in body water. Nine highly trained males underwent a 42-hr protocol involving dehydration to 3.7% of body mass (Day 1, −2.64 kg), cycling to exhaustion (Day 2, −5.2% of body mass, −3.68 kg), and oral rehydration for 21 hr. The ranges of mean (across time) blood and urine values were U_col, 1-7; U_sg, 1.004-1.029; U_08m, 117-1,081 mOsm • kg⁻¹; and plasma osmolality (P_osm), 280-298 mOsm ⋅ kg⁻¹. Urine color tracked changes in body water as effectively as (or better than) U_osm, U_sg, urine volume, P_osm, plasma sodium, and plasma total protein. We concluded that (a) U_col, U_osm, and U_sg are valid indices of hydration status, and (b) marked dehydration, exercise, and rehydration had little effect on the validity and sensitivity of these indices.

Caffeine is the most widely consumed psychoactive ‘drug’ in the world and probably one of the most commonly used stimulants in sports. This is not surprising, since it is one of the few ergogenic aids with documented efficiency and minimal side effects. Caffeine is rapidly and completely absorbed by the gastrointestinal tract and is readily distributed throughout all tissues of the body. Peak plasma concentrations after normal consumption are usually around 50 μM, and half-lives for elimination range between 2.5–10 h. The parent compound is extensively metabolized in the liver microsomes to more than 25 derivatives, while considerably less than 5% of the ingested dose is excreted unchanged in the urine. There is, however, considerable inter-individual variability in the handling of caffeine by the body, due to both environmental and genetic factors. Evidence from in vitro studies provides a wealth of different cellular actions that could potentially contribute to the observed effects of caffeine in humans in vivo. These include potentiation of muscle contractility via induction of sarcoplasmic reticulum calcium release, inhibition of phosphodiesterase isoenzymes and concomitant cyclic monophosphate accumulation, inhibition of glycogen phosphorylase enzymes in liver and muscle, non-selective adenosine receptor antagonism, stimulation of the cellular membrane sodium/potassium pump, impairment of phosphoinositide metabolism, as well as other, less thoroughly characterized actions. Not all, however, seem to account for the observed effects in vivo, although a variable degree of contribution cannot be readily discounted on the basis of experimental data. The most physiologically relevant mechanism of action is probably the blockade of adenosine receptors, but evidence suggests that, at least under certain conditions, other biochemical mechanisms may also be operational.

It is difficult to describe hydration status and hydration extremes because fluid intakes and excretion patterns of free-living individuals are poorly documented and regulation of human water balance is complex and dynamic. This investigation provided reference values for euhydration (i.e., body mass, daily fluid intake, serum osmolality; M ± SD); it also compared urinary indices in initial morning samples and 24-hr collections. Five observations of 59 healthy, active men (age 22 ± 3 yr, body mass 75.1 ± 7.9 kg) occurred during a 12-d period. Participants maintained detailed records of daily food and fluid intake and exercise. Results indicated that the mean total fluid intake in beverages, pure water, and solid foods was >2.1 L/24 hr (range 1.382–3.261, 95% confidence interval 0.970–3.778 L/24 hr); mean urine volume was >1.3 L/24 hr (0.875–2.250 and 0.675–3.000 L/24 hr); mean urine specific gravity was >1.018 (1.011–1.027 and 1.009–1.030); and mean urine color was ≥4 (4–6 and 2–7). However, these men rarely (0–2% of measurements) achieved a urine specific gravity below 1.010 or color of 1. The first morning urine sample was more concentrated than the 24-h urine collection, likely because fluids were not consumed overnight. Furthermore, urine specific gravity and osmolality were strongly correlated (r2 = .81–.91, p < .001) in both morning and 24-hr collections. These findings provide euhydration reference values and hydration extremes for 7 commonly used indices in free-living, healthy, active men who were not exercising in a hot environment or training strenuously.

Understanding the importance of euhydration in humans in order to ensure good health in various situations, the purpose of this review is to examine the available techniques in assessing hydration status. During the past 20 years, many indices have been developed to assess hydration levels accurately in humans. Changes in body weight, haematological and urine parameters, bioelectrical impedance, skinfold thickness, heart rate and blood pressure changes are among these indices. Plasma osmolality, urine osmolality and urine specific gravity are the most widely used markers of hydration. However, urine colour has also been used with reasonable accuracy when laboratory analysis is not available or when a quick estimate of hydration is necessary. Some data indicate that urine colour is as good indicator of hydration as plasma or urine osmolality or urine specific gravity. Although there is no 'gold standard' for assessment of hydration status, it appears that changes in body weight, along with urine osmolality, specific gravity, conductivity and colour are among the most widely used indices. Furthermore, they provide reasonable results, especially when the analysis is based on the first morning urine sample.