title: [Physical risks whilst walking the Nijmegen Four Days Marches in 2007: electrolyte imbalance in 1 in 5 walkers].
abstract: OBJECTIVE
  To determine the physiological impact and health risks for walkers during the Nijmegen (the Netherlands) Four Days Marches in 2007, the largest walking event in the world with more than 45,000 participants.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  66 volunteers were randomly selected and counterbalanced for distance walked and gender in this observational study. Subjects walked 30 km (n = 20; 10 men), 40 km (n = 25; 14 men) or 50 km (n = 21; 10 men) per day, for 4 consecutive days. Core body temperature, fluid intake, changes in body weight, plasma sodium concentrations and energy usage were measured before and after the marches.
  
  
  RESULTS
  During this event, ambient temperatures ranged from 11.0 degrees C to a maximum 25.4 degrees C expressed as 'wet bulb globe temperature' (WBGT). Heart rate (+38 beats per minute) and core body temperature (+0.8 degree C) significantly increased in all subjects during each day (about 9 hours walking per day at an average of 4.6 km/h), but hyperthermia was not diagnosed (definition: > 39.0 degrees C). Average fluid intake varied between 2.6 and 3.3 l/d with a range of 0.3-12 l/d. The relative change in body weight associated with this was -3.1 to +4.3%. Mean plasma sodium concentration decreased from 142.4 to 140.6 mmol/l over each walking day. The plasma sodium correlated negatively with fluid intake (r = -0.32; p < o.001), change in body weight (r = -0.13; p < 0.05), and walking time (r = -0.37; p < 0.001). A high prevalence of hyponatraemia (5%) and hypernatraemia (16%) was observed; extrapolating these findings to the entire field a large group (about 10,000) would have been at risk with this electrolyte imbalance.
  
  
  CONCLUSIONS
  This study showed that walking the Four Days Marches in Nijmegen with mild ambient conditions led to one in five participants incurring disturbances in fluid and electrolyte balance. Nonetheless, the participants were well able to keep their increasing core temperature within safe limits. Apart from the frequent electrolyte imbalance, the fluid intake varied strongly between individuals.
authors: Universitair Medisch Centrum St Radboud, Nijmegen.
authors: T M H
authors: TM
authors: Eijsvogels
authors: D H J
authors: DH
authors: Thijssen
authors: F
authors: F
authors: Poelkens
authors: M
authors: M
authors: Binkhorst
authors: C W
authors: CW
authors: Wouters
authors: B J J W
authors: BJ
authors: Schouwenberg
authors: M T E
authors: MT
authors: Hopman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature / Q000502:physiology; D003681:Dehydration / Q000453:epidemiology; D005260:Female; D006339:Heart Rate; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology; D007010:Hyponatremia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D013696:Temperature; D013997:Time Factors; D016138:Walking / Q000502:physiology*; D014882:Water-Electrolyte Balance / Q000502:physiology*