What is the treatment for hyperhidrosis (excessive sweating) in an individual when exercising?

Treatment for Extreme Sweating During Exercise

For individuals experiencing extreme sweating during exercise, the primary management focuses on optimizing hydration and electrolyte replacement rather than treating the sweating itself, as exercise-induced sweating is a normal physiological response that should not be suppressed. 1

Understanding Exercise-Induced Sweating vs. Pathological Hyperhidrosis

It is critical to distinguish between normal exercise-induced sweating and pathological hyperhidrosis:

• Normal exercise sweating ranges from 1.0-1.5 L/h during vigorous activity in hot environments, with some individuals exceeding 2.5 L/h, which is physiologically appropriate and protective against heat illness 1
• Pathological hyperhidrosis occurs at rest or with minimal activity and requires medical treatment with topical aluminum chloride, botulinum toxin, or anticholinergics 2, 3

The sweating you describe during exercise is almost certainly normal thermoregulation and should not be treated with antiperspirants or antisweating medications, as this would increase the risk of dangerous heat illness. 1, 4

Proper Management Strategy: Hydration and Electrolyte Replacement

Pre-Exercise Preparation

• Drink 6 mL of fluid per kg body mass every 2-3 hours before exercise to ensure you start exercise euhydrated 1
• For a 70 kg person, this equals approximately 420 mL (14 oz) every 2-3 hours
• Consume 5-10 mL/kg water 2-4 hours prior to exercise if starting dehydrated 1

During Exercise Hydration

• Consume 0.4-0.8 L/h (400-800 mL/h) during exercise, which can be achieved by drinking to thirst 1
• Include sodium supplementation of 0.5-0.7 g/L of fluid for exercise lasting longer than 1 hour 1
• If experiencing muscle cramping, increase sodium to 1.5 g/L 1
• Add 30-60 g/h of carbohydrates for exercise over 1 hour, or up to 90 g/h for events over 2.5 hours 1
• Minimize body water mass losses without increasing body weight to reduce physiological strain 1

Post-Exercise Rehydration

• Replace 100-150% of body mass losses after exercise 1
• Include sodium, carbohydrates (0.8 g/kg/h), and protein (0.2-0.4 g/kg/h) in recovery drinks 1
• Consume fluids with salty foods rather than water alone 1
• Chocolate milk with a 4:1 carbohydrate-to-protein ratio is an excellent recovery option 1

Monitoring Hydration Status

Track your hydration using these validated methods 1:

• Daily body mass changes <1% (measure post-void nude body mass in morning)
• Urine specific gravity <1.020 (first morning urine preferred)
• Plasma osmolality <290 mmol/kg (if laboratory testing available)

Critical Safety Considerations

When NOT to Suppress Sweating

Never use antiperspirants, anticholinergics, or other antisweating treatments for exercise-induced sweating, as these medications impair thermoregulation and dramatically increase the risk of life-threatening heat illness 1, 4. Medications that impair sweating include:

• Anticholinergic medications 4
• Dopamine-reuptake inhibitors 4
• Diuretics (through volume depletion) 1, 4

Environmental Adjustments

• If air temperature exceeds 70°F, slow your pace and increase fluid intake 1
• If temperature exceeds 80°F, exercise in early morning or late afternoon 1
• Allow 12-14 days for heat acclimatization 1
• Stop immediately if experiencing headache, dizziness, faintness, nausea, coolness, cramps, or palpitations 1

Special Populations at Higher Risk

Individuals with these conditions require extra caution and may have impaired sweating responses 4:

• Diabetes mellitus (autonomic neuropathy affecting sweat glands)
• Obesity (impaired thermoregulation)
• Cystic fibrosis (altered sweat electrolyte composition)
• Those taking diuretics or antihypertensive medications

When to Consider Medical Evaluation

Seek medical evaluation if you experience 4:

• Absent or markedly reduced sweating during exercise (anhidrosis)
• Excessive sweating at rest or with minimal activity
• Heat intolerance or recurrent heat illness
• Underlying conditions like diabetes, thyroid disease, or autonomic dysfunction

The bottom line: Extreme sweating during exercise is normal and protective—manage it with proper hydration and electrolyte replacement, not with antisweating treatments that could be dangerous.