Instructor Resources



Instructor Resources

Chapter 4:  Balanced Hydration Program

Purpose of Chapter 4

For the student to understand:

• the importance of daily balanced hydration for health and wellness (see Educational Resources and Research for Chapter 1, See Chapter 01_Scientific Research_IR.doc, hydration articles).

• the problems associated with dehydration.

• the scientific principles of how much water a person naturally loses each day.

• the Balanced Hydration Program, which therapists can offer to their clients.

Lesson Plan: 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 next.

• Discuss the fact 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. See Figure 4-2 in text.

• Discuss where the water is found in the human body and 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 for the normal functioning of the body (see Chapter 01_Scientific Research_IR.doc, for Chapter 1, hydration articles).

• Discuss what is meant by dehydration and some of the health problems associated with dehydration.

Balanced Hydration Program

Goals 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 because it reduces not only higher caloric intake from most beverages, but also decreases the intake of food additives, preservatives, and other chemicals (see Chapter 01_Scientific Research_IR.doc, hydration articles.)

• To improve the quality of sources of water for daily hydration, including bottled water, beverages, and food, to reduce the intake of potentially harmful food additives, preservatives, and other chemicals.

• Balanced daily hydration is an essential component of a health and wellness program to allow clients to achieve and maintain all of their health and wellness goals. 

• Each year, on average, a 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 to stay properly hydrated and to reduce intake of harmful chemicals in many beverages and foods.

Steps of the Balanced Hydration Program

Client Interview—Balance Hydration Program Client Interview Form, See Balanced Hydration Program Interview Form.doc

• Client Feedback: Begin by asking clients 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 is positive or 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 she drinks very little plain drinking water each day and stays hydrated mainly by beverages, mostly soft drinks.

Client states that he drinks very little plain drinking water or beverages each day and stays hydrated mainly from water in food.

Client states that she drinks a balance of plain drinking water and beverages but does not feel she drinks enough water each day. 

Client states that he drinks most of his water and beverages in the morning and very little the rest of the day.

• Client Feedback—Amount and Source of Water Intake: Next, for each of the eight periods during the day, ask clients 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. and 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 checkmark, 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 provided in Chapter 4, evaluate if the ratio of drinking water as a percent of total daily fluid intake is in a normal range.

Sources and Quality of Sources of Water Intake: Based on the information provided in Chapter 4, evaluate the sources and quality of daily water intake.

Client Recommendations—Balanced Hydration Program Recommendation Form

Based on the information gathered in the client interview, the calculations of the input, and the evaluations of the information and calculations, make recommendations to the client for improvements in his or her balanced daily hydration program. 

Client Recommendation Form, See Balanced Hydration Program Recommendation Form.doc

• 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 and Hydration Information Chart

When educating the client about the principles of balanced daily hydration, it is very helpful to use the teaching demonstrations described in Teaching Exercise 4−1. It is also helpful to use the information contained in Figure 4−6 on page 116. (Copies can be printed from this Figure_04-06.pdf document. See the bottom of page 116.)

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 recommendations for the client, but also the opportunity to motivate the client to make positive changes and to continue to implement them on a daily basis. The therapist, in a sense, can become the client’s “hydration coach.” Positive changes in clients’ personal health and wellness can be greatly facilitated by the personal support of and ongoing interaction with a trained therapist.

Teaching Examples of the Balanced Hydration Program

See Client One Form: “Balanced Hydration Program Interview Form.doc_client 01.doc”

See Client Two Form: “Balanced Hydration Program Interview Form.doc_client 02.doc”

See Client Three Form: “Balanced Hydration Program Interview Form.doc_client 03.doc”

Suggested Readings 

Note: The information on anatomy and physiology referred to in this chapter is taken from the following textbooks:

The Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate: Institute of Medicine, Board of Health and Nutrition. (2004).

This is the key research that set the adequate intake of water guidelines. It also contains references to the key scientific studies relevant to understanding hydration. The chapter dealing with water can be viewed free online . The book may also be purchased. The entire book can also be viewed online .

Textbook of Medical Physiology (10th ed.): Guyton, A., & Hall, J. (2004). Elsevier.

This is the main textbook on anatomy and physiology used in writing this chapter and contains detailed information that provides insights into the dynamic fluid cellular functioning of the human body. 

Principles of Anatomy and Physiology (10th ed.): Tortora, G., & Grabowski, S. (2003). New York: John Wiley & Sons.

This is the standard textbook used by many schools teaching anatomy and physiology. It has high-quality illustrations, but is not nearly as detailed or comprehensive as the Textbook of Medical Physiology, listed above.

REVIEW QUESTIONS & ANSWERS

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%), and blood plasma (7%).

3. List the main physiological functions of water in the human body. Answer: Cellular metabolism, Cell environment i.e. Interstitial Fluid, Water is 55% of blood plasma. Water also for needed substances to dissolve, diffusive and be transported by circulation through the body.

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

5. Describe a few health problems associated with dehydration. Answer: Decreased mental and physical performance and increased rate of health problems such as kidney stones, dehydration of the 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 salt and sugar, as well as 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. There is no UL for daily water intake, because the body can naturally eliminate large amounts of excess water intake.

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