Pre-game intravenous hyperhydration, anyone?

The editorial in this month’s CJSM by Coombes and colleagues on Intravenous Rehydration in the National Football League highlights the widespread prevalence of the practice of pre-game hyperhydration as reported in the study by Fitzsimmons and colleagues, also in this month’s Journal here .

Fitzsimmons and colleagues surveyed the head athletic trainers of 32 NFL teams using an online survey tool and managed to achieve an impressive 100% response rate. They found that 75% of all teams had used pre-game hyperhydration with iv fluids, with an average of 5 to 7 players per team per game receiving intravenous fluids prior to play. The most common reasons for this strategy cited by trainers were to prevent muscle cramps (23 out of 24), prevent dehydration (19), at the request of the player (17), to prevent heat illness (14), and to improve player exercise tolerance (8).

It is somewhat alarming to find out that this practice is so widespread, especially in view of the fact that iv fluid administration pre-competition and intra-competition is clearly prohibited under the prohibited methods category of the 2011 WADA anti-doping code , and as discussed by Coombes and colleagues, it will be interesting to see how WADA and the NFL react to the results of this study.

An additional point to note, again as highlighted by Coombes and colleagues, is that there is practically no evidence that pre-game hyperhydration actually achieves any of the desired outcomes cited by trainers.

This study highlights yet another example of a dubious and potentially dangerous practice being adopted by elite teams in the absence of evidence of effectiveness of the intervention to achieve desired outcomes.

One wonders why such widespread practice is allowed to occur without action being taken against individual Clubs and players engaging in the use of these methods, or why the practice is not specifically banned under the code of the NFL.

Surely now is the time for a formal investigation into this issue?

CJSM would like to hear your views.