Instructor Resources

Chapter 4: Balanced Hydration Program

Purpose of Chapter 4

For the Student to understand:

• To understand the importance of daily balanced hydration for health & wellness (see Scientific Research: Hydration Link)
  
  
• To understand problems associated with dehydration
  
  
• To understand the scientific principles of how much water a person naturally loses each day
  
  
• To learn the Balanced Hydration Program which a therapist can then offer to their clients

Lesson: Balanced Hydration Program

Have the students read the chapter and then discuss the chapter during a classroom session. Refer to the textbook for detailed information for the discussion and teaching exercises discussed below.

• Discuss: That the human body is approximately 60% water (10 gallons) and that all of this water is involved in multiple essential aspects of the functioning of the body.
  
  
• Discuss: Where the water is in the human bodyand what it is doing.
  
  
• Discuss: How the body naturally loses approximately 2.5 qt/l of water per day and more if there is sweating to cool the body.
  
  
• Discuss: The essential aspects of the human body that involve water, that are all functioning at the same time,  and why a normal level of hydration is essential to allowing the normal functioning of the body. (see Scientific Research: Hydration Link)
  
  
• Discuss: What is meant by dehydration and what are some of the health problems associated with dehydration.

Balanced Hydration Program

Goal of the Balanced Hydration Program for Clients

• Balanced daily hydration to maintain normal levels of hydration and prevent any harmful levels of dehydration.
  
  
• To improve the daily ratio of water intake from drinking plain water as compared to beverages. A high ratio of plain drinking water to beverages is generally preferable which reduces not only higher caloric intake from most beverages, but also decreases the intake of food additive, preservatives and other chemicals. (see Scientific Research: Hydration Link)
  
  
• To improve the quality of sources of water for daily hydration including bottled water, beverages and food. Suggestions to improve the quality of sources that make up the total daily intake of water to reduce the intake potentially harmful food additives, preservatives and other chemicals.
  
  
• Balanced daily hydration is an essential component of a health & wellness program to allow clients to achieve and maintain all of their health & wellness goals. 
  
  
• Each year, on average an person will have an intake of approximately 275 gallons of water (2,300 lbs.), 80% coming from drinking water and beverages and 20% coming from the water contained in food. It is very important the a person stay properly hydrated and that the intake of harmful chemicals in many beverages and food be reduced.

Steps of the Balanced Hydration Program

Client Interview   Balance Hydration Program Client Interview Form Link

• Client Feedback: Begin by asking the client for their understanding and evaluation of their own daily hydration behavior. Most clients are already aware of what they are doing each day that they feel are positive and negative regarding their daily hydration. This feedback provides very useful information and also acts as a starting point and baseline to compare the clients progress. The following are some examples of feedback from clients:
  Client states that they drink very little plain drinking water each day and stay hydrated mainly by beverages, mostly soft drinks.
  Client states that they drink very little plain drinking water or beverage each day and stay hydrated mainly from water in food.
  Client states that they drink a balance of  plain drinking water and beverages but do not feel they drink enough water each day. 
  Client states that they drink most of their water and beverages in the morning and very little the rest of the day.
  
  
• Client Feedback - Amount & Source of Water Intake: Next, for each of the 8 periods during the day, ask the client the amount of Plain Drinking Water and Beverages that they consume during this period. Some clients will provide more accurate feedback than others, but regardless, this will provide useful information about the daily patterns of water intake. Also, make a note about the types of beverages that are being consumed for each period.
  Amount of Water Intake from Food: For a normal diet for an average sized person, the daily intake of water from food is approximately 20 oz. The range is generally between 17 oz. to 24 oz. Place this number in the Total Water Intake from Food line.
  
  
• Calculations:
  Total Plain Water: Add the Amount of Plain Water intake from each of the 8 Daily Periods and place this number in the Total Plain Water line.
  Total Beverages: Add the Amount of Beverages intake from each of the 8 Daily Periods and place this number in the Total Beverages line.
  Total Daily Fluid Intake: Add the amount of Total Plain Water and the amount of Total Beverages to get the Total Daily Fluid Intake. Place this number in the Total Daily Fluid Intake line.
  Total Daily Water Intake: Add the amount of the Total Daily Fluid Intake plus the amount of Total Water Intake from Food plus the amount of Total Daily Metabolic Water to get the amount of Total Daily Water Intake. (see Chapter 4 for an explanation of Metabolic Water).
  Place this number on the line for the amount to Total Daily Water Intake line in the Range of Total Daily Water Intake Box. Place the number line in a position between 2.7 qt (86 oz. and 3.75 qt (120 oz.).
  Percent (Ratio) of Drinking Water to Beverages: Divided the amount of the Total Plain Water by the amount of the Total Daily Fluid Intake to get the Percent (Ratio) of Drinking Water to Beverages.
  Client Size: On the Client Size line in the Range of Total Daily Water Intake Box, note on the line with a check mark, where the client fits in a range between a Small Adult to a Large Adult. See Chapter 4 for details on making this calculation.
  
  
• Evaluations
  Amount of Total Daily Water Intake: Based on the information provided in Chapter 4, evaluate if the Total Daily Water Intake is in a normal range or less than or greater than a normal range.
  Timing of Water Intake: Based on the information provided in Chapter 4, evaluate if the timing of water intake throughout the day is in a normal range.
  Percent (Ratio) of Drinking Water to Beverages: Based on the information provide in Chapter 4, evaluate if the ratio of drinking water as a percent of total daily fluid intake is in a normal range.
  Source & Quality of Sources of Water Intake: Based on the information provided in Chapter 4, evaluate the source and quality of daily water intake.
  

Client Recommendations - Balanced Hydration Program Recommendation Form

Based on the information taken from the Client Interview, the calculations of the input and the evaluations of the information and calculations, make recommendations to the client for improvements in their balanced daily hydration program.  Client Recommendation Form Link

• On the Balanced Hydration Program Recommendation Form, enter the:
  Daily Total Hydration Goal
  Current Total Daily Water Intake
  Goal of Ratio of Plain Water to Beverages
  Current Percentage (%) of Plain Water to Beverages
  
  
• Using the Balanced Hydration Program Recommendation Form for each of the 8 daily time periods, based on information in Chapter 4, make recommendations for:
  Plain Drinking Water, the amount and source
  Beverages: the amount and source
  Food Intake (source of 20% of daily water intake): Recommendations can be made regarding daily water intake from food.
  
  
• Teaching Demonstrations & Hydration Information Chart
  When educating the client about the principles of balanced daily hydration, it is very helpful to use the teaching demonstrations describe in Teaching Exercise 4-1. It also helpful to use the information contained in Figure 4-6 Copies can be printed from this website. Link

Client Follow-up

An important part of the success of the Balanced Hydration Program is ongoing client follow-up. This allows for evaluation of the progress of the client and for additional recommendations for changes in the program. Also, a personal interview with a therapist provides not only the opportunity for feedback and recommendation for the client, but it provides the opportunity to motivate the client to not only make positive changes but to continue to implement them on a daily basis. The therapist, in a sense, can become the client's Hydration Coach. Make positive changes in clients personal health & wellness can greatly facilitated by the personal support and ongoing interaction with a trained therapist.

Teaching Examples of the Balanced Hydration Program

Client One: Link

Client Two: Link

Client Three: Link

Suggested Reading 

Note: All of the information on anatomy & physiology referred to in this chapter, were taken from the textbooks listed below.

The Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate, Institute of Medicine, Board of Health and Nutrition, Feb 2004.
This is the key research that set the Adequate Intake of Water. It also contains the references to the key scientific studies relevant to understanding hydration. The chapter dealing with water can be viewed free online Link. The book may also be purchased. The entire book can also be viewed online Link

Textbook of Medical Physiology: Guyton, A., & Hall, J. (2004).  10th ed.). Elsevier.
This was the main textbook on anatomy & physiology used in writing of this textbook and contains detailed information that provides insights into the dynamic fluid cellular functioning of  the human body. 

Principles of Anatomy and Physiology: Tortora, G., & Grabowski, S. (2003).  (10th ed.). New York: John Wiley & Sons.
This is the standard textbook used by many schools teaching anatomy & physiology. It has high quality illustrations, but is not nearly as detailed nor comprehensive as the Textbook of Medical Physiology, listed above

REVIEW QUESTIONS

1. What is the approximate percent of water in the human body? Answer: 60%

2. Where are the three main areas where this water is located in the body? Answer: Inside the Cells (66%), interstitial fluid (27%), blood plasma (7%)

3. List the main physiological functions of water in the human body. Answer: 

4. Can the body store extra water? Answer: No

5. Describe a few health problems associated with dehydration. Answer: Decrease mental performance, physical performance and increased rate of health problems such as kidney stones, dehydration of skin and even some forms of cancer.

6. How much water does the body naturally lose each day? Answer: 2.5 qt/L

7. Name three ways the body naturally loses water. Answer: Urine, sweat, evaporation from the lungs.

8. What are the three general categories of daily sources of water intake? Answer: Plain drinking water, beverages and food.

9. List some problems associated with drinking beverages. Answer: Beverages can contain high amounts of calories, excess intake of salt and sugar as well as increase intake of harmful substances, such as food additives and preservatives. 

10. What percentage of our daily water do we get from food? Answer: Approximately 20%

11. What does the IOM recommend as the AI (adequate intake) for water? What is the IOM recommendation for UL (upper limit) of water intake? Answer: AI for men is 3.7 qt/L per day, AI for women is 2.7 qt/L per day. The is no UL for daily water intake, because the body can naturally eliminate large amounts of excess water intake.