Knowledge, Attitudes, and Behaviours Regarding Hydration

among Sub-elite Combat Sports Athletes

Muhammad Ikhwan Zein

, Djoko Pekik Irianto

, Danardono

Faculty of Sports Science, Universitas Negeri Yogyakarta, Jl. Colombo no.1, Yogyakarta, Indonesia

Keywords: Combat sports, Martial arts, Dehydration, Fluid intake, Athletes

Abstract: Loss of body fluids or dehydration can reduce athletes’ performance and lead to health problems such as heat

illness. The purpose of this study was to determine the level of knowledge, attitudes, and behaviours regarding

hydration among Indonesian sub-elite combat sports athletes. A questionnaire containing questions pertaining

to knowledge, attitudes, and behaviours on hydration was distributed to the Indonesian sub-elite combat

athletes during their training. Twenty-six subjects from six martial arts including Taekwondo, Wushu, Judo,

Kempo, Pencak Silat, and Tarung Derajat participated in this study (mean age 21.73 + 4.14 years old; weight

62.12 + 11.71 kg; height 1.67 + 0.09 m). The mean score for knowledge, attitudes, and behaviours was 12.54

+2.14; 11.62 +1.86; 12.65 +2.26 out of a maximum of 17. No perfect score was achieved by the subjects.

Majority of athletes knew that dehydration could decrease performance, and they understood that urine colour

monitoring could be used to determine the dehydration. Unfortunately, the majority of them still using thirst

as the best indicator of dehydration. The results of this study indicate that the level of knowledge, attitudes,

and behaviours of Indonesian sub-elite combat sports athletes are good. Dehydration prevention program can

be developed based on questionnaire with low score answer.

1 INTRODUCTION

Combat sports refer to a class of contact sports where

the athletes engage in one on one combat that can

involve striking techniques such as punches, kicks,

grappling, or combines of it (Barley et al., 2019).

Combat sports are high-intense activities, which

characteristic tends to lose body fluid through a high

rate of sweating or dehydration (Barley et al., 2019).

Dehydration gives impact to performance, decreases

cognitive skill, and leads to other serious health

problems, such as heat stroke and heat illnesses,

particularly if body fluid loss more than 2% (Ghaemi

et al., 2014; Moghaddami et al., 2016). Cognitive

impairs due to dehydration during practice can cause

injury through technical incorrect or slower response.

The effects of dehydration in contact sports with a

high incidence of injury, such as combat sports, need

to be thoroughly evaluated. (Lystad, 2015; Del

Vecchio et al., 2018).

Combat sports competition or match is commonly

performed in bodyweight class. Fluid restriction is a

common method used by athletes to reduce their

weight for a competition in lower weight classes

(Brito et al., 2012). Combination of high-intense

exercise with fluid restriction method in combat

sports can increase the risk of dehydration and health

complication among athletes.

American College of Sports Medicine (ACSM)

and National Athletic Trainer Association (NATA)

provide the guidelines of fluid replacement during

exercise to prevent dehydration (Sawka et al., 2007;

Mcdermott et al., 2017). Although the

recommendation was published, combat sports

athletes still lack of knowledge to maintain their body

fluid and prevent dehydration. Research showed that

weight class sports athletes have a low level of

knowledge regarding hydration (Esa et al., 2015).

Knowledge is related to routine behaviours. Thus, it

is important to improve athletes’ knowledge to

prevent dehydration, particularly in weight class

sports category.

Sub-elite athletes are those who are trained to

compete in the districts or provinces sports events.

Unlike amateur or recreational athletes, they have

routine training schedule as intensive as elite athletes

do but in limited sources. In contrast to the elite

athletes who have a complete official team, including

sports medicine personal, i.e., nutritionist and

medical doctor, sub-elite athletes do not have private

Zein, M., Pekik Irianto, D. and Danardono, .

Knowledge, Attitudes, and Behaviours Regarding Hydration among Sub-elite Combat Sports Athletes.

DOI: 10.5220/0009894507510755

In Proceedings of the 3rd Yogyakarta Inter national Seminar on Health, Physical Education, and Sport Science in conjunction with the 2nd Conference on Interdisciplinary Approach in Sports

(YISHPESS and CoIS 2019), pages 751-755

ISBN: 978-989-758-457-2

751

medical professional support. This situation leads

sub-elite athletes to have limited knowledge due to

lack of information and professional education. The

number of sub-elite athletes is more than elite-

athletes, so this population needs attention.

Level of knowledge, attitudes, and behaviours

measurement are important because they are basic

steps to develop an education strategy to prevent

dehydration. The objective of this study was to

determine the level of knowledge, attitudes, and

behaviours regarding hydration among Indonesian

sub-elite combat sports athletes.

2 METHODS

2.1 Participants

Twenty-seven sub-elite combat sports athletes who

are registered as Yogyakarta province athletes for

National Sports Games (Pekan Olahraga Nasional) in

Papua 2020 were recruited in this study. These

subjects have not become the Indonesia National

athletes for participating in the International event.

These subjects were actively trained and joined

training centre program for six martial arts including

Taekwondo, Wushu, Judo, Kempo, Pencak Silat, and

Tarung Derajat. Pencak silat and Tarung Derajat.

These are traditional combat sports that are held in the

National Sports Event. Pencak Silat has even been

competed in SEA-Games and has also been competed

in ASIAN GAMES 2018 for the first time.

2.2 Assessment of Knowledge,

Attitudes and Behaviours

Regarding Hydration

The subjects answered the questionnaire to determine

their knowledge, attitudes, and behaviours on

hydration. The questionnaire was developed from the

previous research and was adapted to Indonesian

language (Nichols et al., 2005). The language

validation was conducted using experts and a small

group of collegiate athletes from Faculty of Sports

Science, Universitas Negeri Yogyakarta, Indonesia.

The questionnaire consists of 3 parts, namely part

A for knowledge’s assessment, part B for attitudes

assessment, and part C for behaviours assessment.

Each part comprised of 17 questions in the form of

true or false statement in part A, five-point Likert

scale (strongly agree to strongly disagree) in part B

and yes or no question in part C. Scoring “0” and “1”

point was applied in each part of the questionnaire. In

part A, score “1” was given for every correct answer

and “0” for the wrong answer. In part B, Positive

statement was scored “1” if subjects answered

“strongly agree”, “agree”, otherwise it was scored “0”

for “neutral”, and “strongly disagree”, “disagree”. On

the other hand, a negative statement was scored “1” if

subjects answered “strongly disagree”, “disagree”,

otherwise it was scored “0” for “neutral” and

“strongly agree”, “agree”. In part C, score “1” was

given to answer based on proper behaviour and score

“0” was given for poor behaviour

2.3 Data Collection and Analysis

The collected data were tabulated and presented using

SPSS 25 software. Descriptive data were presented in

the mean and standard deviation. Normality test was

performed using Shapiro Wilk (total subjects < 50).

Pearson test was conducted to determine the

relationships between knowledge, attitudes, and

behaviours on hydration of the subjects. Spearman

(non-parametric) test was performed as an alternative

for the Pearson test when the data were not normally

distributed. The significant levels were set to 0.05 (p

< 0.05).

3 RESULT

Twenty-six subjects from 6 martial arts participated

in this study including Taekwondo (n = 10), Wushu

(n = 4), Judo (n = 2), Kempo (n = 3), Pencak Silat (n

= 6) and Tarung Derajat (n = 1). Subjects’ ages range

from 15 to 33 years old. Their heights and weights

were 1.45 to 1.87 meter and 48 to 95 kg, respectively.

Characteristics of the subjects are shown in Table 1.

A total score of questionnaires for each part

ranged from 0 to 17, with a higher score representing

better knowledge, attitudes, and behaviours regarding

hydration compared to the lower score. No perfect

score was achieved by the subjects. Result of the

questionnaire showed in Table 2.

Table 1: Subject’s Characteristics

No Characteristics (n =26) Mean + SD

1 Age (years) 21.73 + 4.14

Male (n = 17) 22.88 + 4.46

Female (n = 9) 19.56 + 3.61

2 Height (m) 1.67 + 0.09

3 Weight (kg) 62.12 + 11.71

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

752

Table 2: Score of the Questionnaire Regarding

Hydration

No Part Score

(mean

+ SD)

Minimum

score

Max

Score

1 Knowledge 12.54

+2.14

6 15

2 Attitudes 11.62

+1.86

8 15

3 Behaviors 12.65

+2.26

8 16

3.1 Knowledge Regarding Hydration

The mean knowledge scores among all subjects were

12.54 +2.14. Nine subjects (34.6%) had good

knowledge (total score 14 or higher), sixteen subjects

(61.5%) had moderate knowledge (total score

between 9 to 13), and one subject (3.8%) had poor

knowledge (total score below 9). General dehydration

statement such as dehydration decreases sports

performance and excessive sweating, thirsty, and

cramping are signs of dehydration were answered

correctly by 26 (100%) subjects. All (100%) subjects

also knew that monitoring colour urine could be used

as dehydration judgment.

Majority of subjects (92.3%) lacked in knowledge

about dehydration indicator and assumed that thirst

was the best indicator for dehydration. Knowledge of

sports drink consumption was low. Only 14 subjects

(53%) knew that an athlete should consume sports

drinks after training more than one hour.

3.2 Attitudes Regarding Hydration

The mean attitudes score among all subjects was

11.62 +1.86, which indicated a positive attitudes rate

(score above 10). All subjects (100%) strongly agreed

and agreed that monitoring urine colour was a way to

judge the dehydration status. Twenty -five subjects

(96%) also strongly agreed and agreed that the

availability of fluid during practice was very

important. Only one subject (3%) answered correctly

in a negative statement that a thirst was the best

indicator of dehydration.

3.3 Behaviours Regarding Hydration

The mean behaviours score among all subjects was

12.65 +2.26. Twenty-five subjects (96%) prepared

fluids during practice and competition. They also

knew the signs of dehydration, including excessive

sweating, and muscle cramps. About 80% of subjects

followed ACSM recommendation including drink

500-600 cc of water or sports drink a couple of hours

before exercise and continue to drink 200 – 300 cc

10-20 minutes before competition.

Only 12 subjects (46%) consumed sports drinks

while training for more than 1 hours. It may be related

to other facts that only ten subjects (38%) preferred

to consume sports drinks than water because it

restored glycogen in the muscle. Nineteen subjects

(5%) reported drinking more than alcoholic

beverages the day before the competition.

Shapiro Wilk test showed that the result in part

“knowledge” was not normally distributed (p=0.03),

so the Spearman test was conducted. Spearman

correlation analysis showed significant positive

correlations between knowledge, attitudes, and

behaviours (p < 0.05). Level of correlation was

moderate (r -value between 0.40 to 0.60). The result

of correlation test showed in Table 3.

Table 3: Spearman Correlation Coefficients Between

Variables Tested

Knowledge Attitudes Behavi

Knowled

e 1.00 0.41

0.48

Attitudes 0.41

1.00 0.42

Behavio

s0.48

0.42

1.00

Significant at p < 0.05

4 DISCUSSION

This study has shown that the majority of sub-elite

athletes had good score in knowledge, attitudes, and

behaviours regarding hydration with mean score 73,

86, and 74 out of a maximum of 100, respectively.

The majority of athletes still used the thirst as the

best indicator of dehydration. Thirst is a bad indicator

because athletes who feel thirsty mean that their body

has dehydration and has potential in decreasing

performance (Adams et al., 2018). Periodical body

fluid fulfilled without waiting to be thirsty can

prevent dehydration. ACSM and NATA recommend

consuming 250-300 cc of fluid every 15-20 minutes

during exercise. Arnaoutis et al. (2013) show that

consuming fluids when desired (ad libitum) still

causes dehydration. Education program to improve

athletes’ knowledge regarding body fluid fulfilled

without waiting to be thirsty needs to be developed as

a strategy to prevent dehydration.

Most of the athletes knew that dehydration could

decrease performance so they could prevent losing

Knowledge, Attitudes, and Behaviours Regarding Hydration among Sub-elite Combat Sports Athletes

753

weight method through fluid restriction. Nutritional

education regarding weight loss based on ACSM (0.5

– 1 kg /week) needs to be socialized (Jakicic et al.,

2001).

These athletes also understood that urine colour

monitoring could be used to determine the

dehydration. This method is quite easy and applicable

to maintain the hydration level of the athletes before

practice or competition (Casa et al., 2000; Webb &

Salandy, 2016).

5 LIMITATION

This study only involved sub-elite athletes from

one province, i.e. Special Region of Yogyakarta out

of 34 provinces in Indonesia. Further research

involving large scale subjects need to be done to

determine the level of knowledge, attitudes, and

behaviours regarding hydration among Indonesian

sub-elite athletes.

6 CONCLUSIONS

The results of this study have shown that the level

of knowledge, attitudes, and behaviours of

Indonesian sub-elite combat sports athletes are good.

Dehydration prevention program can be developed

based on questionnaire with low score answer.

REFERENCES

Adams, J. D., Sekiguchi, Y., Suh, H. G., Seal, A. D., Sprong

C. A., Kirkland, T.W., et al. (2018). Dehydration

Impairs Cycling Performance, Independently of Thirst:

A Blinded Study., Medicine&Science in Sports and

Exercise, Publish Ahead of Print. doi:

10.1249/MSS.0000000000001597.

Arnaoutis, G., Kavouras, S. A., Kotsis, Y. P., Tsekouras, Y.

E., Makrillos, M., Bardis, C. N., (2013). Ad Libitum

Fluid Intake Does Not Prevent Dehydration in Sub-

optimally Hydrated Young Soccer Players During a

Training Session of a Summer Camp. International

Journal of Sport Nutrition and Exercise Metabolism,

23, 245–251.

Barley, O. R., Chapman, D. W., Guppy, S. N and Abbiss,

C. R., (2019). Considerations When Assessing

Endurance in Combat Sport Athletes. Frontiers in

Physiology, 10, 1–9. doi: 10.3389/fphys.2019.00205.

Barley, O. R., Chapman, D. W. and Abbis, C. R. (2019).

The Current State of Weight-Cutting in Combat Sports.

Sports. 7(123), 13–17.

Brito, C. J., Roas, A. F. C. M., Brito, I.S.S., Marins, J.C.B.,

Cordova C and Franchini, E., (2012). Methods of Body-

Mass Reduction by Combat Sport Athletes.

International Journal of Sports Nutrition and Exercise

Metabolism, 22, 89–97.

Casa, D. J., Armstrong, L. E., Hillman, S. K., Montain, S.

J., Reiff, R. V., Rich, B. S. E., Robert, W. O., et al.

(2000). National Athletic Trainers Association Position

Statement: Fluid Replacement for Athletes. Journal of

Athletic Training, 35(2),212–224. doi: 10.4085/1062-

6050-52.9.02.

Del Vecchio, F. B., Farias, C.B., de Leon, R.. Rocha,

A.C.C.A., Galliano, L. M., Coswig, V.S., (2018).

Injuries in Martial Arts and Combat Sports :

Prevalence, Characteristics and Mechanisms. Science

et Sports. doi: 10.1016/j.scispo.2018.02.003.

Esa, N. H., Saad, H. A., Phing, C. H., Karppaya, H. (2015).

Knowledge, Attitudes and Behaviours Regarding

Hydration and Hydration Status of Malaysian National

Weight Category Sports Athletes. Journal of Physical

Education and Sport, 15(2),452–459. doi:

10.7752/jpes.2015.03068.

Ghaemia, J., Rashidlamira, A., Hosseinia S.R.A., (2014).

Comparison of Effects of Rapid and Gradual Weight

Loss Methods on Body Composition, Aerobic

Capacity, and Anaerobic Power in Trained Wrestlers.

International Journal of Wrestling Science, 4(1), 79-94.

doi: 10.1080/21615667.2014.10879003.

Jakicic, J. M., Clark, K., Coleman, E., Donelly, J. E.,

Foreyt, J., Melanson., et al. (2001). ACSM Position

Stand on the Appropriate Intervention Strategies for

Weight Loss and Prevention of Weight Regain for

Adults. Medicine & Science in Sport and Exercise,

33(12), 2145-56

Lystad, R. P.,(2015). Epidemiology of Injuries in Full-

Contact Combat Sports. Australasian Epidemiologist,

22(114), 14-8.

Mcdermott, B. P., Anderson, S. A., Armstrong, L. E., Casa,

D. J., Cheuvront, S. N., Cooper, L., et al. (2017).

National Athletic Trainers’ Association Position

Statement: Fluid Replacement for the Physically

Active. Journal of Athletic Training, 52(9), 877–95.

doi: 10.4085/1062-6050-52.9.02.

Moghaddami, A. Gerek, Z., Karimiasl, A., Nozohouri, H.

(2016). The Effect of Acute Dehydration and

Rehydration on Biomechanical Parameters of Elite

Wrestling Techniques. Journal of Sports Science, 4,

93–101. doi: 10.17265/2332-7839/2016.02.005.

Nichols, P. E., Jonnalagadda, S. S., Rosenbloom, C. A.,

Trinkaus, M. (2005). Knowledge , Attitudes , and

Behaviors Regarding Hydration and Fluid Replacement

of Collegiate Athletes. International Journal of Sport

Nutrition and Exercise Metabolism, 15, 515–527.

Sawka, M. N., Burke, L. M., Eichner, E. R., Maughan, R.

J., Montain, S. J., Stachenfeld, N. S. (2007). Exercise

and fluid replacement. Medicine and Science in Sports

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

754

and Exercise, 39(2), 377–390. doi:

10.1249/mss.0b013e31802ca597.

Webb, M. C. and Salandy, S. T. (2016). Monitoring

Hydration Status Pre- and Post-Training among

University Athletes Using Urine Color and Weight

Loss Indicators. Journal of American College Health.

doi: 10.1080/07448481.2016.1179195.

Knowledge, Attitudes, and Behaviours Regarding Hydration among Sub-elite Combat Sports Athletes

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