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Most NFL Teams Use Pre-Game Hyperhydration with IV Fluids

​Amid questions on safety and effectiveness, pre-Game IV fluids are commonly used

Three-fourths of NFL teams "hyperhydrate" players with intravenous (IV) fluids before games—despite a lack of proven benefits and some risk of complications, according to a study in the May  Clinical Journal of Sport Medicine.  The journal is published by  Lippincott Williams & Wilkins, a part of  Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.
"Because the use of pre-game hyperhydration with IV fluids is often a player-driven routine and has potential complications, more scientific studies are needed to determine its true efficacy," concludes the report by Dr. Sean Fitzsimmons of Lenox Hill Hospital, New York, and Dr. Damion Martins of Atlantic Sports Health, Morristown, N.J.

Surprisingly High Rate of Pre-Game IV Fluid Use
The researchers surveyed the head athletic trainers of all 32 NFL teams regarding their use of pregame hyperhydration with IV fluids.  Hyperhydration means giving "extra" intravenous fluids—in excess of the body's normal fluid balance—in the hope of gaining some competitive advantage.  All teams responded to the survey.

The researchers were surprised to learn that 24 of the 32 teams administered IV fluids as part of a hyperhydration strategy.  The average number of players receiving IV fluids was five to seven, with a high of 20 per team.  On average, players were given 1.5 liters of fluid 2½ hours before games.

When the trainers were asked to identify all reasons for giving pre-game IV fluids, the most common response was the prevention of muscle cramps—cited by 23 of the 24 responses.  However, when asked to indicate the primary reason for IV administration, the most common response -- 10 of 24 responses -- was player request.

Of 27 trainers who had ever used pre-game hyperhydration, 48 percent reported some type of complication—most commonly blood clots (thromboses) of the surface veins.  Less frequent but potentially serious complications included air in the bloodstream (air embolism), an accumulation of fluid in the lungs (pulmonary edema), and swelling of the limbs (peripheral edema).

Two trainers mentioned players becoming psychologically dependent on IV fluids as a complication.  "This is interesting because player request was the primary reason that most teams administer IV fluids," Drs. Fitzsimmons and Martins write.  The study does not identify which teams use pre-game hyperhydration.

Some studies suggest that drinking extra fluids before exercise can improve the body's response to heat stress and increase exercise performance.  However, studies of hyperhydration with IV fluids have given mixed results.  The best available research shows no advantage of IV hyperhydration, compared to normal fluid intake.

"Although we believed this to be a common practice, we did not anticipate that more than half of the NFL teams would use this routine," the researchers reported.  They express concern about the high rate of IV fluid use, especially given the lack of proven benefits of pre-game hyperhydration, the risk of complications, and that the process is commonly driven by player request.
An accompanying editorial by Jeff S. Coombes, Ph.D., and Simon P. van Rosendal, Ph.D., of The University of Queensland, Brisbane, Australia, echoes those concerns.  They note that the use of IV fluids is prohibited by the World Anti-Doping Agency and the Australian Football League (though not by the NFL) and that the evidence that they improve athletic performance is "nonexistent."  The new results "confirm the widespread use of an otherwise banned, seemingly ineffective, and potentially dangerous medical procedure," they conclude.

However, NFL Medical Advisor Dr. Elliott J. Pellman cites some important limitations of the study—noting that the surveys were answered by athletic trainers, rather than by the team physicians responsible for making medical decisions for players.  In Dr. Pellman's experience, at least some players "feel better and seem to perform better" after receiving IV fluids.  He concludes, "Further research on this important topic is needed to gain additional clinical insights into prehydration best practices and patient care."

About Clinical Journal of Sport Medicine
Clinical Journal of Sport Medicine is an international refereed journal published for clinicians with a primary interest in sports medicine practice. The journal publishes original research and reviews covering diagnostics, therapeutics, and rehabilitation in healthy and physically challenged individuals of all ages and levels of sport and exercise participation.  CJSM is the official journal of the American Medical Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the Australasian College of Sports Physicians, and the Canadian Academy of Sport Medicine.

About Lippincott Williams & Wilkins 
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the  LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of  Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry.