MILITARY MEDICINE, 164, 7:502, 1999
Fluid Replacement Recommendations for Training in Hot Weather
Guarantor: CPT Scott J. Montain, USA
Contributors: CPT Scott J. Montain, USA; CPT William A. Latzka, USA; Michael N. Sawka, PhD
The U.S. Army's fluid replacement guidelines emphasize fluid
replacement during hot weather training to prevent degrada-
tion of performance and minimize the risk of heat injury. Little
consideration has been given, however, to possible overhydra-
tion and development of water intoxication. Sufficient epide-
miological evidence is available to demonstrate an increasing
incidence of water intoxication during military training. This
article summarizes the development and validation of revised
fluid replacement guidelines for hot weather training. The end
product is an easy-to-read table that provides the user with the
appropriate hourly work time and fluid intake to support work
during hot weather training. The guidelines include the range
of hot weather conditions likely to be encountered during
military training and cover a broad range of military activities.
It is expected that the revised guidelines will sustain hydration
and minimize the number of heat injuries during military
training while protecting the soldier from becoming sick from
overdrinking.
Introduction
he existing Army fluid replacement guidelines 1 (Table I) were
T written to prevent heat injuries and emphasize the impor-
tance ofadequatehydration and prevention ofdehydration, with
the assumption that overdrinking would bebalanced byincreased
urine output. Little consideration, however, was given to possible
overhydration and development ofwaterintoxication.
In July 1997, Martin Community Hospital (Fort Benning,
Georgia) notified the U.S. Army CenterforHealth Promotion and
Preventive Medicine (Aberdeen Proving Ground, Maryland) that
five cases of symptomatic hyponatremia had been identified in
male trainees during the preceding month, one case endingin
death. Symptomatic hyponatremia can occur when blood so-
dium concentrations decrease to less than 130 mEq/L and is
generally caused by hypervolemia secondary to extensive over-
drinking. An epidemiological consultation revealed that between
1989and 1996there had been 125cases (anaverage ofapprox-
imately 16cases annually) ofdocumented hyposmolality/hypo-
natremiarequiring hospitalization in the U.S. Army.? Areview of
11cases ofhyponatremia duringthe 1996-1997trainingperiod
found that these cases were associated with excessive water
intakes relative to sweating losses. The average serum sodium
was 121 mEq/L (range, 116-133 mEqjL). Calculations indicate
that total body water must have increased by 3 to 5 liters to
achieve such low serum sodium values. The epidemiological
consultation team recommended that the criteriaforevaluation
and evacuation ofheat casualtiesbe revised and that the exist-
ing fluid replacement guidelines be modified.
Thermal and Mountain Medicine Division, U.S. Army Research Institute ofEnvi-
ronmental Medicine, Natick, MA01760-5007.
The views, opinions, and/or findings contained in this report are those of the
authors andshould notbeconstrued as an official Department oftheArmy position,
policy, or decision.
This manuscript was received for review in May 1998. The revised manuscript was
accepted for publication in October 1998.
Military Medicine, Vol. 164, July 1999 502
The purpose of this article is to summarize our efforts to
provide accurate, valid fluid replacement recommendations for
hot weather training. A two-step process was used to accom-
plish our objective. Initially, computer simulations were used to
predict the hourlyworktime and sweating losses during easy,
moderate, and hard military tasks for a range of hot weather
conditions. The estimates were then validated in a laboratory
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study using the predicted work times and fluid replacement
rates. Theresult is an easy-to-read table that provides the user
with recommended hourlyworktimes and fluid intakes to sus-
tain workin hot climates.
Methods
Computer Simulation
Our initial strategy was to estimate appropriate work times
and fluid intakes using existing computer model simulations
that predictcoretemperatureand sweating responsestoworkin
hot cltmates.v' Input variables for the models included the cli-
matic conditions, clothing properties, work intensity, physical
fitness, and degree ofheat acclimatization. We then constructed
a fluid replacement table that included three metabolic rates
that are frequently encountered in military tasks" and the five
heat categories that are in the current guidelines. TheU.S. Army
Research Institute ofEnvironmental Medicine heat strain mod-
el' was used to estimate sweating rates for a soldier of average
size performing easy, moderate, and hard military tasks in cli-
mates ranging from 70 to 110°F and 20 to 100% relative humid-
ityin full sun and full shade.Wind speedforallcalculations was
kept constant at 2.5 mph.Theuniform was a hot weatherbattle
dress uniform (BDU). Thematrixwas then collapsed by placing
each weather condition in the appropriate heat category based
on wet bulb globe temperature (WBGT) values, and the sweat
rate responseswere averaged by heat categories I, II, III, IV, and
V and rounded to the nearest 0.25 quart.
The fluid replacement table generated from the U.S. Army
Research InstituteofEnvironmental Medicine heat strain model
was then compared with a second model" that also estimates
sweating rates during exercise in hot climates. When the latter
model estimated sweating rates and temperature responses
lower than the former model's predictions, the work-rest cycles
and water requirements were revised to accommodate the dif-
ferences between the predictions. The work-rest cycles were
constructedto maximize workoutput while minimizing the like-
lihood ofincurringheat casualties. In all situations, the length
of the work-rest cycles were estimated from the predicted core
temperature responses to work in the specified heat category
and were set to prevent core temperatures from rising above
38.5°C during 4 hours of sustained training. The core temper-
ature of38.5°C represents 2 SDbelow the mean coretempera-
ture at whichsoldiers (healthy, euhydrated, and reasonably fit)
will discontinue workunder worst-case heat stress conditions. 5
Fluid Replacement Recommendations 503

TABLE I stress duringthe experimental testing. The 5-dayheat acclima-

CURRENT ARMY FLUID REPIACEMENT GUIDELINES FOR HOT tion period was chosen because most adaptations to repeated
WEATHER TRAININGl heat stress, including increased sweatrate, occurwithin4 days
of heat exposure." The heat acclimation protocol consisted of
Criteria Controls two 50-minute exercise bouts separated by 10 minutes ofrest.
Heat Condition/ WBGTIndex Water Intake Work-Rest Volunteers walked on a treadmill at 3.5 mph at a 4% gradein a
Category (OF) (qt/h) Cycle (min) hot dry climate (46°C, 25% relative humidity) wearing the U.S.
1 78-81.9 At least 0.5 Continuous Army physical training uniform. Rectal temperature and heart
2 82-84.9 At least 0.5 50/10 rate were measured throughout the exercise period. Water was
3 85-87.9 At least 1 45/15 provided ad libitum during the heat acclimation procedures.
4 88-89.9 At least 1.5 30/30 After completing the heat acclimation protocol, the volunteers
5 90+ More than 2 20/40 performed up to 12 exercise-heat stress test (HST) trials: walk-
ing at three exercise intensities (approximately 250, 425, and
A potential problem with the predicted values, however, was 600 W) in three humid climates (Table III) and walking at the

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that the models estimated core temperatures, sweating rates,
and fluid requirements based on an algorithm developed using
a variety ofclothing and conditions but with relatively few data
from persons wearing desert or hot weather BDUs. The recom-
mendations, therefore, required validation before they couldbe
used to determine Army fluid replacement policy. Furthermore,
because the water requirements and work-rest cycles were set
within heat categories defined by WBGT range, it was also im-
portantto determine ifthe models provide appropriate estimates
for sweating in both hot-dry and hot-wet climates with similar
WBGT values.
Laboratory Validation
The purpose of this study was to validate the water require-
ments of soldiers working at intensities approximating easy,
moderate, and hard military tasks in three hot weather condi-
tionswhile wearing hot weatherBDUs. It was hypothesized that
the sweating rates would be similar to the fluid replacement
estimates derived from the computer simulations.
Subjects
Twenty soldiers (14 men and 6 women) volunteered to partic-
ipate in the study. However, one malevolunteer dropped out of
the study before beginning experimental testing and was not
included in the data analysis. Table II presents the remaining
soldiers' physical characteristics. They were healthy, 18 to 29
yearsofage, withno medical historyofheat intolerance or heart
disease. The protocol was approved by the appropriate institu-
tional review boards, and all volunteers were informed both
verbally and in writing of the objectives and procedures of the
study.
Experimental Design
The volunteers performed a 5-dayheat acclimation program
before experimental testingbeganto minimize thermaland car-
diovascular adaptations associated with repeated exercise-heat
TABLE IT
PHYSICAL CHARACTERISTICS OF THE STUDYVOLUNTEERS
Age Height 2-Mile Run
(years) (cm) Weight (kg) Time (min)
Men (N = 13) 20 ± 3 173 ± 7 78.9 ± 11.7 13.9 ± 0.9
Women (N= 6) 21 ± 3 165 ± 9 66.9±11 17.0±0.7
Data are means ± SD.
moderate exercise intensityin three dry climates (Table IV). The
orderofclimatic conditions forthe HSTs were randomized, with
the exception that the dryconditions were generally tested after
completion ofthe humid climate HSTs.
During the HSTs, volunteers wore hot weather BDUs with
tennis shoes (to help prevent blisters). Sleeves were down and
pants were bloused. All volunteers wore the warmweatherBDU
cap.Thework-rest cycles predicted by the models were used for
each weather-exercise intensity combination, with volunteers
sittingon a bench duringeach rest period. Thetotal heat stress
exposure was 120minutesforeach condition. Theworkperiods
were evenly spacedwithineach 120-minute exercise exposure.
Thevolunteers drank the recommended volumes ofwatergiven
in Tables III and IV. Metabolic rates were measuredbetween 10
and 20 minutesintoeachwork period. When no limitwasplaced
on exercise time, a second metabolic rate measurement was
collected between 70 and 80 minutes of exercise.
Start times for all HSTs were held constant for each subject
throughout the experimental protocol to control for circadian
rhythms. Seminude bodyweight and clothed weight were mea-
sured before and aftereach HST to determine whole body sweat
loss. Males wore Spandex shorts and females wore Spandex
shorts and sports bras under their BDUs to facilitate weighing.
Experimental Procedures
Rectal temperatures were measured with a thermistor in-
serted approximately 8 to 10 ernpast the anal sphincter. Heart
rate was measuredusingthe Polar HeartRateMonitor. Douglas
bags (2-minute collection) and indirectcalorimetry were used to
determine the metabolic cost of exercise between 10 and 20
minutes of each work period. Body weights were measured to
the nearest ±20 g before and after exercise. Whole body sweat-
ing rate was calculated from the change in preexercise to pos-
texercise bodyweight (measured seminude) after correcting for
waterintake, urine production, metabolic water loss (assuming
0.12 g/kcall, and respiratory water loss (0.11 g/kcall,
Statistical Analysis
Thesamplesizewas chosento obtaina normaldistribution of
the data. Preliminary power estimates suggested that approxi-
mately 20 people per cell would be adequateto detecta 0.2 L/h
difference in sweating at p < 0.05 and a power of90. Descriptive
statistics were used to compare the study results with the pre-
dicted values. Adifference ofgreaterthan ±1SDwasconsidered
significant, and the water replacement table was modified ac-
cordingly. Data are presentedas means ± SD

Military Medicine, Vol. 164, July 1999

504 Fluid Replacement Recommendations

TABLEm
WORK-REST CYCLESAND WATERINTAKE FOR HUMID CLIMATE TESTS

Easy Work (250 W) Moderate Work (425 W) Hard Work (600 W)

Temperature, Water Water Water
Heat Relative Work-Rest Intake Work-Rest Intake Work-Rest Intake
Category WBGT Humidity Cycle (min) Iqt/hl Cycle (min) (qt/h) Cycle (min) (qt/hl
I 25.6°C 28°C, 75% NL 0.5 NL 0.75 40/20 1.0
III 29.5°C 32°C, 75% NL 1.0 40/20 1.0 30/30 1.25
V 33.3°C 36°C, 75% NL 1.25 30/30 1.25 20/40 1.25
NL, no limit.

TABLEIV women in Table VI. Again, the work rates chosen elicited the
WORK-REST CYCLESAND WATER REQUIREMENTS FOR MODERATE desired metabolic rates, averaging 252 ± 51, 420 ± 36, and

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WORK IN DRY CLIMATES 619 ± 55Wforeasy,moderate, and hard work, respectively. The
measuredsweating rates were substantiallyless than predicted
Moderate Work (425 W)
from the models, averaging 0.27,0.58, and 0.57 qt/h less than
Temperature, Water predicted forheat category I, III, and Vconditions, respectively.
Heat Relative Work-Rest Intake Rectal temperature responses to the easy, moderate, and
Category WBGT Humidity Cycle (min) (qt/h]
hard exercise trials are reported for heat categories I, III, and V
I 25.6°C 36°C, 25% NL 0.75 in Figures 1, 2, and 3, respectively. Underheat category I con-
III 29.5°C 41 °C, 250/0 40/20 1.0
V 33.3°C 46°C, 25% 30/30 1.25
ditions, there were no restrictions placed on worktime during
low- and moderate-intensity work, and rectal temperaturesap-
NL, no limit.
peared to plateau at approximately 37.4 and 37.7°C, respec-
tively. Hard workproduced a rapid increase in rectal tempera-
Results ture that reached a peak of approximately 38.0°C during both
The volunteers completed the 12 trials withoutmedical inci- work periods 1 and 2. These results suggested that the work-
dent. On several occasions, however, one or more volunteers rest ratioswere adequately conservative to support soldier work
were not available to test on a specific day. The data for the for sustained periods (>4 hours).
exercise intensity-heat categories, therefore, were compared Under heat category III conditions, the suggested work-rest
with predicted values using the smallersamplesize. ratios for low, moderate, and hard work were appropriate to
The metabolic rates and measured sweating rates for each prevent progressive core temperature increments during the
exercise-heat category combination are presentedforthe menin 2-hourworkperiod. During low-intenstty exercise, coretemper-
Table V. The work rates chosen elicited the desired metabolic ature plateauedafter approximately 50 minutes ofexercise at a
rates, averaging 304 ± 39,415 ± 42, and 614 ± 66 Wforeasy, rectaltemperatureof37.5°C, withlittleadditional increasedur-
moderate, and hard work, respectively. In general, the mea- ing the final 70 minutes of exercise. During moderate-intensity
sured sweating rates were lower than predicted, with seven of exercise, the coretemperatureincrease accompanying 40 min-
nine exercise-heat category combinations averaging > 1 SDless utes ofworkresultedin temperaturesof37.7 and 37.8°C at the
than the predicted values, and two of nine categories (heat end of work periods 1 and 2, respectively. During hard work,
category III at low and hard intensity) averaging >2 SDless than male rectal temperatures increased to 38.0 and 38.2°C during
predicted. The magnitude of deviation varied depending on the work periods 1 and 2, respectively, providing sufficient safety
heat category and the exercise intensity, but it rangedfrom 0.03 marginbelow our criterion value of 38.5°C to suggest that the
to 0.38 qt/h less than predicted. 30/30 work-rest ratiowas appropriate forhard workunder heat
The metabolic rates and measured sweating rates for each category 3 conditions.
exercise-heat category combination are presented for the Under heat category V conditions, the core temperature re-
TABLEV
METABOLIC RATES AND SWEATING RATES FOR MEN DURINGWORK IN THE HEAT

Easy Work Moderate Work Hard Work

Heat Metabolic Sweating Metabolic Sweating Metabolic Sweating
Category Climate Rate (W) Rate (qt/hl Rate (W) Rate (qt/h) Rate (W) Rate (qt/h)
Wet 296 ± 44 0.38 ± 0.07 414 ± 41 0.62 ± 0.10 611 ± 66 0.79 ± 0.12
Dry 410 ± 41 0.83 ± 0.14
III Wet 308 ± 53 0.67 ± 0.14 430 ± 38 0.77 ± 0.14 610 ± 67 0.87 ± 0.15
Dry 395 ± 46 0.76 ± 0.09
V Wet 307 ± 39 1.13 ± 0.35 421 ± 38 1.10±0.13 622 ± 65 1.07 ± 0.12
Dry 418 ± 48 0.93 ± 0.14
Data are means ± SD.

Military Medicine, Vol. 164, July 1999

Fluid Replacement Recommendations 505

TABLE VI
METABOLIC RATES AND SWEATING RATES FOR WOMEN DURING WORK IN THE HEAT

Easy Work Moderat e Work Hard Work

Heat Metabolic Sweating Metabolic Sweating Metabolic Sweating
Category Climate Rate (W) Rate (qt/h) Rate (W) Rate (qt/h) Rate (W) Rate (qt/h)
I Wet 256 :!: 69 0.26 ::': 0.11 424 :!: 29 0.52:!: 0.14 590 :!: 50 0.57 :!: 0.17
Dry 402 ::': 43 0.71::':0.13
III Wet 245 :!: 36 0.35 :!: 0.16 433:!: 29 0.60::': 0.14 643 :!: 55 0.57:!: 0.17°
Dry 412 ::': 30 0.60::': 0.13
V Wet 255 ::': 47 0.68 :!: 0.3 1 426:!: 43 0.72::': 0.35 624::': 59 0.81 :!: 0.23
Dry 425 :!: 41 0.65:!: 0.18
Data are rneans z SD.
°Contains the data of several volunteers who did not perform the prescribed amount of work because they achieved 90% of the age-predicted

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heart rate.

39.0 , - - -- - -- - -- - -- - - -----, 39.0 ,.-- -- - - - - - - -- - - - - ---,

Heat Category I, Low Intensity Heat Ca tego ry III, Low Intensit y
~ 38.5 oo 38.5
~ ~
.3 38.0 .3 38.0
~ ~
<ll <ll - - -- -- _ .
a.
E
<ll
37.5 a.
E
<ll
37.5 .. ~ ---
I- I-
]j 37.0 - All m 37.0 - All
o - - Males '0 - - Males
<ll <ll - Females
0:: 36.5 - Females 0:: 36.5

36.0 L-,.-----.----r---r----,--.,---,.-~ 36.0 L_,--_...,...---_---.--_-,-_---,-_~-___.-____I

o 20 40 60 80 100 120 140

o 20 40 60 80 100 120 140
39.0,-- - - - - - -- -- - - - - ----, 39 .0 .,-- - - - -- - - -- - - - - ,
Heat Categ ory I, Moderate Intensity
Heat Category III, Moderate Intensity
~ 38.5 ~ 38 .5
~ ~
.3 38 .0 :::> 38 .0
~ 1§
<ll
a. 37 .5 <ll
a.
E 37 .5
<ll E
I-
m 37.0 ~
'0
m 37 .0
<ll '0
0:: 36 .5 <ll
0:: 36 .5
36 .0 L_.,--_,--_...,...---_.,.-_---.--_---r-_~-_
36.0 L-,---.,.-----r--~-~-__,_-~-____I
o 20 40 60 80 100 120 140
o 20 40 60 80 100 120 140
39 .0 .,--- -- - - - - - - - - - - - - 1 39 .0 .,-- - - - -- - - - - - - - - ,

~
ai
::;
38.5

38.0
Heat Category I, High Intensity
~

~
38 .5
Heat Category III, High Intensity

.: .
/.
."' ..

1§ .3 38.0 )/'-......;\; ~~::Y."~ _

<ll
a. 37.5
~
<ll
a. 37.5
/::f' '---- ,P
E
<ll E
I- <ll
37.0 I-
_ 37 .0
]j
U
<ll
0:: 36 .5
tl
<ll
0:: 36 .5
36 .0 L _ , - - _ . , - - _,--_...,...---_.,.-_-r-_---.--_-l
36.0 L_.--_r--_.,--_.,--_.,--_~-,__-----1
o 20 40 60 80 100 120 140
o 20 40 60 80 100 120 140
Time, min
Time , min
Fig. 1. Rectal temperature responses during work in heat catego ry I conditions.
Fig. 2. Rectal temperatu re res ponses duri ng work in heat category ill conditions.

sponse to work increased progressively withsuccessive bouts of

exercise and/or time. During low-intensity work, the rectaltem- temperatures did not exceed our 38SC criterion, the steady
peraturesincreased steadily duringthe 2 hours, and the group increase suggested that incorporation of a short rest period
mean reached 38.3°C after 120 minutes of exercise. Although should be considered. During moderate-intensity exercise, the

Military Medicine, Vol. 164, J uly 1999

506 Fluid Replacement Recommendations

39 .0 39 .0
Heat Category V , Low Intens ity Heat Category I Dry, Moderate Intensity
38.5
~
38.5 ~
a.i !!!' 38 .0
.3 38 .0 .3
~ .---- - I. _ J\ ~ _
~
Ql
a. 37 .5
Ql
a. 37 .5 . .. .~....-.
.... ~ - ---===-~
- .-c. - . . ....
E E
Ql
Ql
f- - All
f- - All 37 .0
37.0 iii - - Males
~
- - Males - Females
- Females ts
Ql Ql
0::: 36.5 0::: 36.5

36 .0 36 .0
o 20 40 60 80 100 120 140 o
39 .0 39.0
Heat Catego ry V , Moderate Intensity Heat Category 111 Dry, Moderate Intensity

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38.5 38 .5
~ ~
!!!' 38 .0 !!!' 38 .0
.3 .3
~ ~
Ql Ql
a. 37.5 a. 37 .5
E
Ql
E
Ql
f- f-
37 .0 37 .0
~
o
Ql
~Ql
0::: 36 .5 0::: 36.5

36 .0 36 .0
o 20 40 60 80 100 120 140 o 20 40 60 80 100 120 140

39.0 39 .0
Heat Category V , High Intensity --........ Heat Category V Dry, Moderat e Intensity
~
38.5 .............. / .~
~
38.5

!!!' ~ --........ /1-- "'" !!!'

.3 38.0 It -'- --. .'- ~ . . :::> 38.0
~
Ql
a. 37 .5 ..
/;/ .
---- --./
1ii
iii
a. 37 .5
E EQl
Ql
f- f-
37 .0 37 .0
~
~
Ql
o
Ql
0::: 36 .5 0::: 36.5

36.0 36 .0
o 20 40 60 80 100 120 140 o 20 40 60 80 100 120 140

Time, min Time.min

Fig. 3. Rectal temperature responses during work in heat category Vconditions.
30/3 0 work-rest ratio did not prevent a 0.3°C higher rectal
temperature after work period 2 and core temperatures of ap-
proximately 38.2°C after 2 hours of exercise-heat exposure.
During hard work. rectal temperatures increased from approx-
imately 37°C at rest to 38°C after 15minutesofwork. Forty-five
minutesofrest didnot provide adequate cooling to reduce core
temperature to less than 37.rC. and the second IS-minute
bout increased core temperature to more than 38.SoC. These
findings suggest that even boutsof15minutesplace excess heat
stress on the soldier attempting to perform hard work in heat
category V conditions. and further reductions in work time are
necessary if no modifications to clothing (unblouse pants. re-
move BDU top) and/or work intensity are madeto sustain work
in these heat category conditions.
Figure 4 presents the rectal temperature responses of the
soldiers performing moderate-intensity work in the desert cli-
mates eliciting heat category I, III. and Vconditions. In general.
the rectal temperature response to moderate-intensity exercise
in the hot-wet and hot-dry climates were similar whennormal-
ized to WBGT. In heat category I conditions. the core tempera-
Fig. 4. Rectal temperature responses during moderate-intensity exercise in a dry
climate eliciting heat category I. m. and Vconditions. The abrupt rectal temperature
increase at 49 minutes for females in heat category I was attri buta ble to two
volunteers stopping temporarily to urinate.
ture increased to 37.6 or 37.7°C with no upward drift in tem-
perature in both the wet and dry weather conditions. In heat
category III conditions. the core temperature increased 0.1 to
0.2°C less in the dry climate than in the wetclimate. despite no
differencein hourly sweating rate. In bothwetand dryclimates.
the hourly work time restrictions were conservative enough to
prevent upward drift in rectal temperature during the 2-hour
work period. In heat category Vconditions. the rectal tempera-
ture response was nearly identical between the wet and dry
conditions. with a progressive increase in rectal temperature
from work period 1 towork period 2. which supportsthe neces-
sityofincorporating a more conservative work time for moderate
work in heat category Vconditions.
Revisions to the Table
Based on the sweating rate and rectal temperature responses
to exercise in each heat category. the recommended water in-

Military Medicine. Vol. 164. July 1999

Fluid Replacement Recommendations 507

take was reduced from our initial recommendation. We also
added a work-rest recommendation to the easy work in heat
category Vconditions and modified the work-rest recommenda-
tion initially recommended formoderate and hard workin heat
category Vconditions. Thesework-rest modifications were made
to reduce the likelihood of a soldier becoming a heat casualty
from excessive increases in core temperature during training.
The revised table is presented in Table VII.
All changes to the fluid replacement recommendations were
based on the sweating rate data of the male soldiers. This was
done because men make up the majority of soldiers and they
generally sweatmore profusely than women. It was feltthat this
would provide sufficient water intakes to sustain hydration of
most soldiers without allowing the soldiers with the highest
mission required deviation from the recommended guidance.
This was accomplished by adding upper limits for hourly and
daily water intake.
We initially predicted the work-rest ratios that would support
workin the hot weather using a computer simulation program
that predicts core temperature and sweating responses of sol-
diers duringwork. We then validated the predictions by having
soldiers walk at intensities that produced the metabolic rates
accompanying low, moderate, and hard military tasks in cli-
matic conditions eliciting heat category I, III, and Vconditions.
Thesethree hot weatherconditions were chosento evaluate the
full range ofheat categories withinthe table. We choseto focus
on warm, humid conditions because these are the prevailing
climatic conditions for most U.S. Army basic trainingposts.

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sweating rates to become overly dehydrated during 4 hours of An important finding from our laboratory experiments was
work. Adjustments to the work-rest recommendations were that the computer simulations modestly overpredicted the
made, where appropriate, to decrease the likelihood that sol- sweating responses. The sweating rates for men ranged from
dierswould exceed rectaltemperatures of38.5 to 38.7°C during 0.03 to 0.33 qt/h lower than the predicted values. The experi-
4 hours ofwork. ments produced several instances in which the difference be-
tween the observed and predicted values equaled or exceeded
Discussion 0.25 qt/h, In these instances, the recommended volumes were
modified to reflect the responses of the men. In situations in
The objective ofthis project was to develop fluid replacement which the measured sweating rate averaged between the pre-
gutdelines to provide valid gutdance regarding appropriate work dicted value and 0.25 qt/h less than the predicted value, the
time and fluid intake during hot weather training. To accom- range of responses was examined and an arbitrary judgment
plish this objective, the table needed to include recommenda- was made between potentially underestimating or overestimat-
tions based on the existing climatic conditions and the planned ingsweatlossbya smallamount.In allcases, the recommended
physical activity, because these two variables determine the fluid intakewas set to fully replace the expected sweatloss.Why
sweatrate and thermalstrain accompanying training. Thetable the models modestly overestimated the sweating rate is not
also needed to include an upper limitof hourly and daily fluid known, but it likely was attributable to two factors: (1) the fact
intake to restrict soldiers from vastly overdrinking when the that the sweating rate algorithm was derived from subjects
TABLE vn
FLUID REPLACEMENT GUIDELINES FOR HOTWEATHER TRAINING (AVERAGE ACCLIMATED SOLDIERWEARING BDU, HOTWEATHER)

Easy Work Moderate Work Hard Work

Heat WBGT Work-Rest Water Work-Rest Water Work-Rest Water
Category Index (OF) Cycle (min) Intake Iqt/h) Cycle (min) Intake (qt/h) Cycle (min) Intake (qt/hl
1 78-81.9 NL 0.5 NL 0.75 40/20 0.75
2 82-84.9 NL 0.5 50/10 0.75 30/30 1
3 85-87.9 NL 0.75 40/20 0.75 30/30 1
4 88-89.9 NL 0.75 30/30 0.75 20/40 1
5 >90 50/10 1 20/40 1 10/50 1
The work-rest times and fluid replacement volumes will sustain performance and hydration for at least 4 hours of work in the specified heat
category. Individual water needs will vary ±0.25 qt/h.
NL, no limit to work time per hour. Rest means minimal physical activity (sitting or standing) and should be accomplished in shade if possible.
Caution: Hourly fluid intake should not exceed 1.5 quarts.
Daily fluid intake should not exceed 12 quarts.
Mission-Oriented Protective Posture gear adds 10°F to WBGTindex.
Examples of work intensities are shown below.
Easy Work Moderate Work Hard Work
Weapon maintenance Walking loose sand at 2.5 mph, no load Walking hard surface at 3.5 mph, ~40-lb load
Walking hard surface at 2.5 mph, ~30-lb Walking hard surface at 3.5 mph, ~40-lb Walking loose sand at 2.5 mph with load
load load
Manual of arms Calisthenics
Marksmanship training Patrolling
Drill and ceremony Individual movement techniques, Le., low
crawl, high crawl
Defensive position construction
Field assaults

Military Medicine, Vol. 164, July 1999

508
wearing clothingwith varying insulation properties during hot
weather exercise," whereas the volunteers in this study wore
onlythe hot weather BDU, and (2) the intersubjectvariability in
sweatingduring hot weather work.
Examination of the rectal temperature responses to the
2-hour exercise-heat stress revealed that the predicted work
times were approximately correct; under most exercise condi-
tions, rectal temperatures remained below 38.5°C during the
2-hour observation period, and extrapolation to 4 hours did not
suggestthat coretemperatures would exceed 38.5°C duringthis
longerperiod. Thesedata suggestthat the work-restrecommen-
dations are appropriately conservative to limit the number of
soldiers expected to become heat casualties from working too
long and/or too hard in hot weather. In the three instances
(low-intensity work, heat category V; moderate-intensity work,
heat category V; and high-intensity work, heat category V) in
which the predicted work-rest times did not prevent core tem-
perature from increasing progressively during work, work-rest
times were modified to reduce the amount of work performed
each hour.
The original predictions for fluid intake were substantially
greater than the observed sweatingrates for the female volun-
teers. This was expected, however, because the sweating algo-
rithm used by the models? was derived using male volunteers
who had a larger body mass than the women in this study.
Furthermore, women generally sweat less profusely than men,
particularlyin hot, humid climates." Although the modifications
to the fluid intake portion of the gutdelines correct for some of
the differences between the observed female sweating rate and
the predicted sweating rates, a phrase was added to the table
legendthat states that actual fluid replacement needs may de-
viate from the recommended amount by ±O.25 qt/h,
The proposed fluid replacement gutdelmes are presented in
table format (Table VII) and designed to provide the user with
easy-to-interpretrecommendations forwork-resttime and fluid
intake during hot weather operations. The user locates the ex-
isting weather condition in the left column and then reads the
recommended work-rest time and fluid intake for the planned
physical activity. The table includes reference tasks for each
work intensity to help the user determinewhether a given task
is an easy,moderate, or hard soldiertask. ThegUidelines inform
the user that the recommendations are set to support 4 hours of
work. The table also specifies an upper limitforhourlyand daily
water intake to provide an additional safeguard against over-
drinking and development ofwater intoxication.
One weakness of the gutdeltnes, however, is that they only
Military Medicine, Vol. 164, July 1999
Fluid Replacement Recommendations
provide guidance for sustained work in a specified heat cate-
gory. In many scenarios, 1 to 2 hours ofmoderateor hard work
will be planned interspersed with severalhours ofeasywork. In
this scenario, the recommended work times for moderate and
hard work periods are overly conservative. However, the infor-
mation in the table is sufficiently robust that the soldier com-
muntty should be able to modify the table for its needs and still
sustain appropriate hydration. For example, if soldiers deviate
from the recommended work time and attempt to extrapolate
the appropriatehourlyfluidintake, the legend cautions the user
not to drink in excessof 1.5 qt/h and no morethan 12 qt/d, In
the eventthat soldiersincrease their worktime per hour but do
not modify their fluidintake, the original recommendations will
still prevent excessive dehydration during several hours of
Downloaded from https://academic.oup.com/milmed/article/164/7/502/4832244 by guest on 25 April 2023
activity.
In conclusion, this article summarizes the development and
validation offluid replacement gutdelines for hot weather train-
ing. The end product is an easy-to-read table that provides the
user with the appropriate work-rest time and fluid intake to
support workduring hot weather training. It includes the range
ofhot weather conditions likely to be encounteredduring train-
ing/military operations and covers a broad range of military
activities. It is expected that the tablewill sustain hydrationand
minimize the number of heat injuries during military training
while protecting the soldier from becoming sickfrom overdrinking.
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