The 50 most-cited articles in Medicine & Science in Sports & Exercise, 2018

The physiologic mechanisms by which the four activities of sleep, sedentary behavior, light-intensity physical activity, and moderate-to-vigorous physical activity (MVPA) affect health are related, but these relationships have not been well explored in adults. Research studies have commonly evaluated how time spent in one activity affects health. Because one can only increase time in one activity by decreasing time in another, such studies cannot determine the extent that a health benefit is due to one activity versus due to reallocating time among the other activities. For example, interventions to improve sleep possibly also increase time spent in MVPA. If so, the overall effect of such interventions on risk of premature mortality is due to both more MVPA and better sleep. Further, the potential for interaction between activities to affect health outcomes is largely unexplored. For example, is there a threshold of MVPA minutes per day, above which adverse health effects of sedentary behavior are eliminated? This article considers the 24-h Activity Cycle (24-HAC) model as a…

PURPOSE: The purpose of this study was to evaluate muscular adaptations between low-, moderate-, and high-volume resistance training protocols in resistance-trained men. METHODS: Thirty-four healthy resistance-trained men were randomly assigned to one of three experimental groups: a low-volume group performing one set per exercise per training session (n = 11), a moderate-volume group performing three sets per exercise per training session (n = 12), or a high-volume group performing five sets per exercise per training session (n = 11). Training for all routines consisted of three weekly sessions performed on nonconsecutive days for 8 wk. Muscular strength was evaluated with one repetition maximum (RM) testing for the squat and bench press. Upper-body muscle endurance was evaluated using 50% of subjects bench press 1RM performed to momentary failure. Muscle hypertrophy was evaluated using B-mode ultrasonography for the elbow flexors, elbow extensors, mid-thigh, and lateral thigh. RESULTS: Results showed significant preintervention to postintervention increases in strength and…

PURPOSE: Commonly used physical activity metrics tell us little about the intensity distribution across the activity profile. The purpose of this paper is to introduce a metric, the intensity gradient, which can be used in combination with average acceleration (overall activity level) to fully describe the activity profile. METHODS: A total of 1669 adolescent girls (sample 1) and 295 adults with type 2 diabetes (sample 2) wore a GENEActiv accelerometer on their nondominant wrist for up to 7 d. Body mass index and percent body fat were assessed in both samples and physical function (grip strength, Short Physical Performance Battery, and sit-to-stand repetitions) in sample 2. Physical activity metrics were as follows: average acceleration (AccelAV); the intensity gradient (IntensityGRAD from the log-log regression line: 25-mg intensity bins [x]/time accumulated in each bin [y]); total moderate-to-vigorous physical activity (MVPA); and bouted MVPA (sample 2 only). RESULTS: Correlations between AccelAV and IntensityGRAD (r = 0.39-0.51) were similar to correlations between AccelAV and…

PURPOSE: Many studies have examined the effect of caffeine on exercise performance, but findings have not always been consistent. The objective of this study was to determine whether variation in the CYP1A2 gene, which affects caffeine metabolism, modifies the ergogenic effects of caffeine in a 10-km cycling time trial. METHODS: Competitive male athletes (n = 101; age = 25 ± 4 yr) completed the time trial under three conditions: 0, 2, or 4 mg of caffeine per kilogram body mass, using a split-plot randomized, double-blinded, placebo-controlled design. DNA was isolated from saliva and genotyped for the -163A > C polymorphism in the CYP1A2 gene (rs762551). RESULTS: Overall, 4 mg·kg caffeine decreased cycling time by 3% (mean ± SEM) versus placebo (17.6 ± 0.1 vs 18.1 ± 0.1 min, P = 0.01). However, a significant (P <0.0001) caffeine-gene interaction was observed. Among those with the AA genotype, cycling time decreased by 4.8% at 2 mg·kg (17.0 ± 0.3 vs 17.8 ± 0.4 min, P = 0.0005) and by 6.8% at 4 mg·kg (16.6 ± 0.3 vs 17.8 ± 0.4 min, P < 0.0001). In those with the CC genotype, 4 mg·kg…

PURPOSE: Resistance exercise (RE) can improve many cardiovascular disease (CVD) risk factors, but specific data on the effects on CVD events and mortality are lacking. We investigated the associations of RE with CVD and all-cause mortality and further examined the mediation effect of body mass index (BMI) between RE and CVD outcomes. METHODS: We included 12,591 participants (mean age, 47 yr) who received at least two clinical examinations 1987-2006. RE was assessed by a self-reported medical history questionnaire. RESULTS: During a mean follow-up of 5.4 and 10.5 yr, 205 total CVD events (morbidity and mortality combined) and 276 all-cause deaths occurred, respectively. Compared with no RE, weekly RE frequencies of one, two, three times or total amount of 1-59 min were associated with approximately 40%-70% decreased risk of total CVD events, independent of aerobic exercise (AE) (all P values <0.05). However, there was no significant risk reduction for higher weekly RE of more than four times or ≥60 min. Similar results were observed for CVD morbidity and all-cause mortality. In the…

INTRODUCTION: Exposure to microgravity causes alterations in multiple physiological systems, potentially impacting the ability of astronauts to perform critical mission tasks. The goal of this study was to determine the effects of spaceflight on functional task performance and to identify the key physiological factors contributing to their deficits. METHODS: A test battery comprised of seven functional tests and 15 physiological measures was used to investigate the sensorimotor, cardiovascular, and neuromuscular adaptations to spaceflight. Astronauts were tested before and after 6-month spaceflights. Subjects were also tested before and after 70 d of 6° head-down bed rest, a spaceflight analog, to examine the role of axial body unloading on the spaceflight results. These subjects included control and exercise groups to examine the effects of exercise during bed rest. RESULTS: Spaceflight subjects showed the greatest decrement in performance during functional tasks that required the greatest demand for dynamic control of postural equilibrium which was paralleled by similar decrements…

Dehydration (DEH) is believed to impair cognitive performance but which domains are affected and at what magnitude of body mass loss (BML) remains unclear. PURPOSE: To conduct systematic literature review and meta-analysis to determine the effect size (ES) of DEH on cognitive performance and influence of experimental design factors (e.g., DEH > 2% BML). METHODS: Thirty-three studies were identified, providing 280 ES estimates from 413 subjects with DEH ranging from 1% to 6% BML. Outcome variables (accuracy, reaction time), cognitive domains, and methods to induce DEH varied. Effect sizes were calculated using standardized mean differences and multivariate meta-analysis. RESULTS: Impairment of cognitive performance (all domains/outcomes) with DEH was small but significant (ES = -0.21; 95% confidence interval [CI]: -0.31 to -0.11; P < 0.0001) with significant heterogeneity (Q(279) = 696.0, P < 0.0001; I = 37.6%). Tasks of executive function (ES = -0.24; 95% CI: -0.37 to -0.12), attention (ES = -0.52; 95% CI: -0.66 to -0.37), and motor coordination (ES = -0.40 to 95% CI: -0.63 to…

PURPOSE: The purpose of this study was to determine the accuracy of 14-step counting methods under free-living conditions. METHODS: Twelve adults (mean ± SD age, 35 ± 13 yr) wore a chest harness that held a GoPro camera pointed down at the feet during all waking hours for 1 d. The GoPro continuously recorded video of all steps taken throughout the day. Simultaneously, participants wore two StepWatch (SW) devices on each ankle (all programmed with different settings), one activPAL on each thigh, four devices at the waist (Fitbit Zip, Yamax Digi-Walker SW-200, New Lifestyles NL-2000, and ActiGraph GT9X (AG)), and two devices on the dominant and nondominant wrists (Fitbit Charge and AG). The GoPro videos were downloaded to a computer and researchers counted steps using a hand tally device, which served as the criterion method. RESULTS: The SW devices recorded between 95.3% and 102.8% of actual steps taken throughout the day (P > 0.05). Eleven step counting methods estimated less than 100% of actual steps; Fitbit Zip, Yamax Digi-Walker SW-200, and AG with the moving average vector…

PURPOSE: Exercise has cardiovascular benefits which might be related to endothelial progenitor cells (EPC). Meanwhile, there is evidence suggesting that EPC-derived exosomes (EPC-EX) promote vascular repair and angiogenesis through their carried microRNA (miR)-126. In this study, we investigated whether exercise could increase the levels of circulating EPC-EX and their miR-126 cargo, and by which promote the protective function of EPC-EX on endothelial cells (EC). METHODS: Plasma EPC-EX from sedentary, low, or moderate exercise mice, respectively, denoted as EPC-EX, EPC-EX, and EPC-EX, were isolated using microbead-based sorting techniques and characterized by nanoparticle tracking analysis, Western blot, and quantitative real-time polymerase chain reaction assessments of biomarkers and miR-126. High glucose (25 mM) with hypoxia (1% O2) was used for inducing an EC injury model. The injured EC were treated by coculturing with vehicle, EPC-EX, EPC-EX, EPC-EX, or EPC-EX + anti-miR-126. After that, EC were used for flow cytometry analysis of apoptosis, assessments of tube formation and…

PURPOSE: Aberrant walking biomechanics after anterior cruciate ligament reconstruction (ACLR) are hypothesized to be associated with deleterious changes in knee cartilage. T1ρ magnetic resonance imaging (MRI) is sensitive to decreased proteoglycan density of cartilage. Our purpose was to determine associations between T1ρ MRI interlimb ratios (ILR) and walking biomechanics 6 months after ACLR. METHODS: Walking biomechanics (peak vertical ground reaction force (vGRF), vGRF loading rate, knee extension moment, knee abduction moment) were extracted from the first 50% of stance phase in 29 individuals with unilateral ACLR. T1ρ MRI ILR (ACLR limb/uninjured limb) was calculated for regions of interest in both medial and lateral femoral (LFC) and medial and lateral tibial condyles. Separate, stepwise linear regressions were used to determine associations between biomechanical outcomes and T1ρ MRI ILR after accounting for walking speed and meniscal/chondral injury (P ≤ 0.05). RESULTS: Lesser peak vGRF in the ACLR limb was associated with greater T1ρ MRI ILR for the LFC (posterior ΔR = 0.14,…

PURPOSE: To investigate the effects of blood flow-restricted resistance exercise (BFRRE) on myofiber areas (MFA), number of myonuclei and satellite cells (SC), muscle size and strength in powerlifters. METHODS: Seventeen national level powerlifters (25 ± 6 yr [mean ± SD], 15 men) were randomly assigned to either a BFRRE group (n = 9) performing two blocks (weeks 1 and 3) of five BFRRE front squat sessions within a 6.5-wk training period, or a conventional training group (Con; n = 8) performing front squats at 60%-85% of one-repetition maximum (1RM). The BFRRE consisted of four sets (first and last set to voluntary failure) at ~30% of 1RM. Muscle biopsies were obtained from m. vastus lateralis (VL) and analyzed for MFA, myonuclei, SC and capillaries. Cross-sectional areas (CSA) of VL and m. rectus femoris were measured by ultrasonography. Strength was evaluated by maximal voluntary isokinetic torque (MVIT) in knee extension and 1RM in front squat. RESULTS: BFRRE induced selective increases in type I MFA (BFRRE: 12% vs Con: 0%, P < 0.01) and myonuclear number (BFRRE: 18% vs Con: 0%, P…

PURPOSE: The objective of this systematic review of literature was to evaluate and summarize published research that has investigated the association between exercise and gut microbial composition in mammals. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases searched for this review included: PubMed; PubMed Central; Medline; Cumulative Index of Nursing and Allied Health Literature; Web of Science; Commonwealth Agricultural Bureaux Direct; Health Source: Nursing Academic Edition; Clinicaltrials.gov; International Prospective Register of Systematic Reviews (PROSPERO); and the Cochrane Library. RESULTS: Twenty-five articles met the inclusion criteria: 17 rodent, one canine, two equine, and five human studies. All studies in rodents and equines included control groups; whereas only one study in humans included a control group. The remaining were cross-sectional or cohort studies. All studies in rodents controlled for dietary intake and one study in humans implemented a 3-d dietary control.…

PURPOSE: A statistical method called "magnitude-based inference" (MBI) has gained a following in the sports science literature, despite concerns voiced by statisticians. Its proponents have claimed that MBI exhibits superior type I and type II error rates compared with standard null hypothesis testing for most cases. I have performed a reanalysis to evaluate this claim. METHODS: Using simulation code provided by MBI's proponents, I estimated type I and type II error rates for clinical and nonclinical MBI for a range of effect sizes, sample sizes, and smallest important effects. I plotted these results in a way that makes transparent the empirical behavior of MBI. I also reran the simulations after correcting mistakes in the definitions of type I and type II error provided by MBI's proponents. Finally, I confirmed the findings mathematically; and I provide general equations for calculating MBI's error rates without the need for simulation. RESULTS: Contrary to what MBI's proponents have claimed, MBI does not exhibit "superior" type I and type II error rates to standard null…

PURPOSE: Ingestion of exogenous ketones alters the metabolic response to exercise and may improve exercise performance, but it has not been explored in variable-intensity team sport activity, or for effects on cognitive function. METHODS: On two occasions in a double-blind, randomized crossover design, 11 male team sport athletes performed the Loughborough Intermittent Shuttle Test (part A, 5 × 15-min intermittent running; part B, shuttle run to exhaustion), with a cognitive test battery before and after. A 6.4% carbohydrate-electrolyte solution was consumed before and during exercise either alone (PLA) or with 750 mg·kg of a ketone ester (KE) supplement. Heart rate, RPE, and 15-m sprint times were recorded throughout, and serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate. RESULTS: KE resulted in plasma β-hydroxybutyrate concentrations of ~1.5 to 2.6 mM during exercise (P < 0.001). Plasma glucose and lactate concentrations were lower during KE compared with PLA (moderate-to-large effect sizes). Heart rate, RPE, and 15-m sprint times did not…

PURPOSE: The treatment of partial-thickness rotator cuff tears (PTRCT) remains controversial. Few studies have focused on the conservative and new measurements of small to medium PTRCT. The use of sodium hyaluronate (SH) or platelet-rich plasma (PRP) as a method for rotator cuff repair requires further investigation. The aim of this study was to evaluate the combined use of SH and PRP in the treatment of small to medium PTRCT. STUDY DESIGN: A double-blinded randomized trial was used in this study. METHODS: Individuals with PTRCT detected by clinical examination and magnetic resonance imaging (MRI) were included in this study. The patients were randomly assigned to receive subacromial injections of normal saline, SH, PRP, or SH + PRP once a week for 4 wk. The primary outcome measure was the Constant score, and the secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and the visual analog scale scores. All of the clinical outcomes were assessed at pretreatment and 1, 3, 6, and 12 months posttreatment. MRI was used to evaluate the evolution of the cuff defect…

PURPOSE: This study aimed to examine the effects of static and dynamic stretching routines performed as part of a comprehensive warm-up on flexibility and sprint running, jumping, and change of direction tests in team sport athletes. METHODS: A randomized, controlled, crossover study design with experimenter blinding was conducted. On separate days, 20 male team sport athletes completed a comprehensive warm-up routine. After a low-intensity warm-up, a 5-s static stretch (5S), a 30-s static stretch (30S; 3 × 10-s stretches), a 5-repetition (per muscle group) dynamic stretch (DYN), or a no-stretch (NS) protocol was completed; stretches were done on seven lower body and two upper body regions. This was followed by test-specific practice progressing to maximum intensity. A comprehensive test battery assessing intervention effect expectations as well as flexibility, vertical jump, sprint running, and change of direction outcomes was then completed in a random order. RESULTS: There were no effects of stretch condition on test performances. Before the study, 18/20 participants nominated…

PURPOSE: To investigate the joint-specific contributions to the total lower-extremity joint work during a prolonged fatiguing run. METHODS: Recreational long-distance runners (n = 13) and competitive long-distance runners (n = 12) performed a 10-km treadmill run with near-maximal effort. A three-dimensional motion capture system synchronized with a force-instrumented treadmill was used to calculate joint kinetics and kinematics of the lower extremity in the sagittal plane during the stance phase at 13 distance points over the 10-km run. RESULTS: A significant (P < 0.05) decrease of positive ankle joint work as well as an increase of positive knee and hip joint work was found. These findings were associated with a redistribution of the individual contributions to total lower-extremity work away from the ankle toward the knee and hip joint which was more distinctive in the recreational runner group than in the competitive runner group. This redistribution was accomplished by significant (P < 0.05) reductions of the external ground-reaction force lever arm and joint torque at the ankle…

INTRODUCTION: Weakness of foot muscles may contribute to a variety of loading-related injuries. Supportive footwear may contribute to intrinsic foot muscle weakness by reducing the muscles' role in locomotion (e.g., absorbing forces and controlling motion). Increased stimulus to the foot muscles can be provided through a variety of mechanisms, including minimalist footwear and directed exercise. PURPOSE: To determine the effect of walking in minimalist footwear or performing foot strengthening exercises on foot muscle size and strength. METHODS: Fifty-seven runners were randomly assigned to one of three groups-minimalist shoe walking (MSW), foot strengthening (FS) exercise, or control (C). All groups maintained their prestudy running mileage throughout the study. The MSW group walked in provided footwear, increasing weekly the number of steps per day taken in the shoes. The FS group performed a set of progressive resistance exercises at least 5 d·wk. Foot muscle strength (via custom dynamometers) and size (via ultrasound) were measured at the beginning (week 0), middle (week 4), and…

INTRODUCTION: Despite knowledge of cardiorespiratory fitness (CRF) training responders and nonresponders, it is not well understood how the exercise intensity prescription affects the incidence of response. The purpose of this study was to determine CRF training responsiveness based on cohort-specific technical error after 12 wk of standardized or individually prescribed exercise and the use of a verification protocol to confirm maximal oxygen uptake (V˙O2max). METHODS: Sedentary adult participants (9 men, 30 women; 48.2 ± 12.2 yr) completed exercise training on 3 d·wk for 12 wk, with exercise intensity prescribed based on standardized methods using heart rate reserve or an individualized approach using ventilatory thresholds. A verification protocol was used at baseline and 12 wk to confirm the identification of a true V˙O2max and subsequent relative percent changes to quantify CRF training responsiveness. A cohort-specific technical error (4.7%) was used as a threshold to identify incidence of response. RESULTS: Relative V˙O2max significantly increased (P < 0.05) from 24.3 ± 4.6…

INTRODUCTION: Exercise has been shown to be effective for preventing and treating substance abuse in both clinical and preclinical studies. Less is known, however, regarding the underlying neurobiological mechanisms driving these changes in drug-seeking behavior. One possibility is that exercise may alter the mesolimbic dopamine pathway in such a way that makes drugs of abuse less salient and/or rewarding. METHODS: To examine possible exercise-induced changes in dopamine signaling, male and female Lewis rats were split into exercise and sedentary groups at 8 wk of age. Exercise rats were run on a treadmill at 10 m·min, 5 d·wk, for 6 wk, whereas sedentary rats remained in their home cage. Rats were killed after the 6 wk of treatment, and their brains were used for in vitro autoradiography using [H]SCH 23,390, [H]Spiperone, and [H]WIN55,428 ligands to quantify dopamine type 1-like receptor (D1R)-like, dopamine type 2-like receptor (D2R)-like, and dopamine transporter binding, respectively. RESULTS: Exercised rats had 18% and 21% lower D1R-like binding levels compared to sedentary rats…

INTRODUCTION: Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated. OBJECTIVE: This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma. METHODS: Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment. RESULTS: After 3 months, the WL + E group…

PURPOSE: Aerobic training (AT) and high-intensity intermittent training (HIIT) reduce arterial stiffness, whereas resistance training (RT) induces deterioration of or no change in arterial stiffness. However, the molecular mechanism of these effects of different exercise modes remains unclear. This study aimed to clarify the difference of different exercise effects on endothelial nitric oxide synthase (eNOS) signaling pathway and arterial stiffness in rats and humans. METHODS: In the animal study, forty 10-wk-old male Sprague-Dawley rats were randomly divided into four groups: sedentary control (CON), AT (treadmill running, 60 min at 30 m·min, 5 d·wk for 8 wk), RT (ladder climbing, 8-10 sets per day, 3 d·wk for 8 wk), and HIIT (14 repeats of 20-s swimming session with 10-s pause between sessions, 4 d·wk for 6 wk from 12-wk-old) groups (n = 10 in each group). In the human study, we confirmed the effects of 6-wk HIIT and 8-wk AT interventions on central arterial stiffness and plasma nitrite/nitrate level in untrained healthy young men in randomized controlled trial (HIIT, AT, and CON;…

PURPOSE: The purpose of this study was to explore whether methods adapted from oncology pharmacological trials have utility in reporting adherence (tolerability) of exercise treatment in cancer. METHODS: Using a retrospective analysis of a randomized trial, 25 prostate cancer patients received an aerobic training regimen of 72 supervised treadmill walking sessions delivered thrice weekly between 55% and 100% of exercise capacity for 24 consecutive weeks. Treatment adherence (tolerability) was assessed using conventional (lost to follow-up and attendance) and exploratory (e.g., permanent discontinuation, dose modification, and relative dose intensity) outcomes. RESULTS: The mean total cumulative "planned" and "completed" dose was 200.7 ± 47.6 and 153.8 ± 68.8 MET·h, respectively, equating to a mean relative dose intensity of 77% ± 24%. Two patients (8%) were lost to follow-up, and mean attendance was 79%. A total of 6 (24%) of 25 patients permanently discontinued aerobic training before week 24. Aerobic training was interrupted (missing ≥3 consecutive sessions) or dose reduced in a…

PURPOSE: Medial tibial stress syndrome (MTSS) is one of the most common overuse injuries sustained by runners. Despite the prevalence of this injury, risk factors for developing MTSS remain unclear. The purpose of this study was to prospectively evaluate differences in passive range of motion, muscle strength, plantar pressure distributions, and running kinematics between runners who developed MTSS and those who did not. METHODS: Twenty-four National Collegiate Athletic Association Division 1 cross-country runners participated in this study. Participants underwent a clinical examination documenting passive range of motion and muscle strength at the hips and ankles. Plantar pressure analysis was used to quantify mediolateral pressure balances while walking and 3D motion capture was used to quantify running kinematics. Participants were followed up for a 2-yr period during which time any runners who developed MTSS were identified by the team's certified athletic trainer. RESULTS: Runners who developed MTSS demonstrated tighter iliotibial bands (P = 0.046; effect size [ES] = 1.07),…

PURPOSE: Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) is associated with an array of adverse effects, including reduced bone mineral density (BMD) predisposing patients to increased fracture risk. Our purpose was to examine the effects of targeted exercise modes on BMD in men with PCa undergoing ADT. METHODS: Between 2009 and 2012, 154 PCa patients 43-90 yr old on ADT were randomized to exercise targeting the musculoskeletal system (impact loading + resistance training [ImpRes], n = 57) supervised for 12 months, cardiovascular and muscular systems (aerobic + resistance training, n = 50) supervised for 6 months followed by a 6-month home-based program, or delayed aerobic exercise (DelAer, n = 47) received exercise information for 6 months followed by 6 months of supervised aerobic exercise (stationary cycling). End points were lumbar spine, hip and whole-body BMD measured by dual-energy x-ray absorptiometry with secondary end points of lean and fat mass, appendicular skeletal muscle mass, and neuromuscular strength. ANOVA was used to compare the exercise…

PURPOSE: The association between lower-extremity loading and clinically relevant knee symptoms at different time points after anterior cruciate ligament reconstruction (ACLR) is unclear. Vertical ground reaction force (vGRF) from walking was compared between individuals with and without clinically relevant knee symptoms in three cohorts: <12 months post-ACLR, 12-24 months post-ACLR, and >24 months post-ACLR. METHODS: One hundred twenty-eight individuals with unilateral ACLR were classified as symptomatic or asymptomatic, based on previously defined cutoff values for the Knee Osteoarthritis and Injury Outcome Score (<12 months post-ACLR [symptomatic n = 28, asymptomatic n = 24]; 12-24 months post-ACLR [symptomatic n = 15, asymptomatic n = 15], and >24 months post-ACLR [symptomatic, n = 13; asymptomatic, n = 33]). Vertical ground reaction force exerted on the ACLR limb was collected during walking gait, and functional analyses of variance were used to evaluate the effects of symptoms and time post-ACLR on vGRF throughout stance phase (α = 0.05). RESULTS: Symptomatic individuals, <12…

INTRODUCTION: When physical activity is promoted in urban outdoor settings (e.g., walking and cycling), individuals are also exposed to air pollution. It has been reported that short-term lung function increases as a response to physical activity, but this beneficial effect is hampered when elevated air pollution concentrations are observed. Our study assessed the long-term impact of air pollution on the pulmonary health benefit of physical activity. METHODS: Wearable sensors were used to monitor physical activity levels (SenseWear) and exposure to black carbon (microAeth) of 115 healthy adults during 1 wk in three European cities (Antwerp, Barcelona, London). The experiment was repeated in three different seasons to approximate long-term behavior. Spirometry tests were performed at the beginning and end of each measurement week. All results were averaged on a participant level as a proxy for long-term lung function. Mixed effect regression models were used to analyze the long-term impact of physical activity, black carbon and their interaction on lung function parameters, forced…

Excessive vertical ground reaction force (VGRF) load rates have been linked with running injuries. Increasing cadence (CAD) has been shown to reduce load rates; however, relationships between habitual cadence and load rates across a population of runners have not been examined. PURPOSE: To examine the relationships between habitual running cadence and vertical load rates in healthy and injured runners using habitual footstrike patterns. As CAD increased, we expected vertical load rates would decrease. METHODS: Healthy runners (n = 32, 25 men) and injured runners (n = 93, 45 men) seeking treatment were analyzed. Footstrike classifications were heel at initial contact (rearfoot strike [RFS]) or forefoot at initial contact (forefoot strike [FFS]). Runners were divided into four injury status/footstrike pattern (FSP) subgroups: healthy RFS (n = 19), injured RFS (n = 70), healthy FFS (n = 13), and injured FFS (n = 23). The VGRF and CAD were recorded as participants ran on an instrumented treadmill at self-selected speed (x¯ = 2.6 m·s ±0.12). Healthy runners used laboratory footwear…

PURPOSE: Training methods that require maximal intensity efforts against light and heavy resistance are commonly used for athletic development. Typically, these sessions are separated by at least 48 h recovery on the assumption that such efforts elicit marked fatigue of the central nervous system (CNS), but this posit has not been well studied. The aim of the study was to assess the etiology and recovery of fatigue after heavy-resistance (strength), jump, and sprint training methods. METHODS: Ten male athletes completed three training sessions requiring maximal efforts that varied in their loading characteristics: (i) heavy-resistance exercise (10 × 5 back squats at 80% one-repetition maximum [1RM]) (STR), (ii) jumping exercise (10 × 5 jump squats) (JUMP), and (iii) maximal sprinting (15 × 30 m) (SPR). Preparticipants, postparticipants, and 24-, 48-, and 72-h postparticipants completed a battery of tests to measure neuromuscular function using electrical stimulation of the femoral nerve, and single- and paired-pulse magnetic stimulation of the motor cortex, with evoked responses…

INTRODUCTION: This study investigated the safety and effectiveness of a new integrated aerobic and resistance exercise training prescription (SPRINT) using two different sets of exercise equipment: a suite of large International Space Station-like exercise equipment similar to what is found on the International Space Station and a single device with aerobic and resistance exercise capability in the spaceflight analog of bed rest (BR). METHODS: Subjects (n = 34) completed 70 d of 6° head down tilt BR: 9 were randomized to remain sedentary (CONT), 9 to exercise training using traditional equipment (EX), 8 to exercise using traditional equipment and low-dose testosterone supplementation (ExT), and 8 to exercise using a combined resistance and aerobic flywheel device. Peak aerobic capacity, ventilatory threshold, cardiac morphology and function (echocardiography), muscle mass (magnetic resonance imaging) and strength/power (isokinetic, leg press, and vertical jump), and bone health (bone mineral density, blood and urine bone markers) were assessed before and after BR. RESULTS: The…

PURPOSE: It has been suggested that napping is the best recovery strategy for athletes. However, researches on the impacts of napping on athletic performances are scarce. The aim of this study was to determine the effects of a 30-min nap after a partial sleep deprivation, or a normal night condition, on alertness, fatigue, and cognitive and physical outcomes. METHODS: Thirteen national-level male karate athletes were randomized to experience nap and no-nap conditions, after either a reference or a partial sleep deprivation night. The nap lasted 30 min at 1:00 PM. The postnap testing session started at 2:00 PM by quantifying subjective alertness and fatigue. Cognitive and physical performances were respectively measured before and after the karate-specific test (KST) by simple reaction time (SRT) test, lower reaction test (LRT), mental rotation test (MRT), squat jump (SJ), and counter movement jump (CMJ) tests. RESULTS: After a reference night, the nap improved alertness and cognitive outcomes (SRT, LRT, and MRT). No effects on subjective fatigue and physical performances were found.…

PURPOSE: The purpose was to evaluate tandem gait (TG), Balance Error Scoring System (BESS), and modified Balance Error Scoring System (mBESS) performance acutely after concussion in collegiate student-athletes. In addition, we sought to evaluate the psychometric properties of TG, including minimal detectable change (MDC), sensitivity, and specificity. METHODS: Seventy-six National Collegiate Athletic Association student-athletes performed TG and BESS tests: 38 acutely after concussion and 38 controls. Participants were tested at baseline (time 1) and again acutely after concussion, or the following year for controls (time 2). Ten controls, tested simultaneously by two researchers, established a TG interrater minimal detectable change. A 2 × 2 mixed-design ANOVA compared each outcome variable. An receiver operating characteristic curve analysis was used to evaluate sensitivity, specificity, and area under the curve (AUC). RESULT: There was a significant interaction (F = 8.757, P = 0.004) for TG whereby the concussion group was slower after concussion (10.59 ± 1.53 vs 11.80 ± 2.67 s),…

PURPOSE: Although high-intensity interval training (HIIT) and moderate-intensity continuous exercise have comparable health outcomes in the laboratory setting, effectiveness studies in real-world environments are lacking. The aim of this study was to determine the effectiveness of an unsupervised HIIT program in overweight/obese adults over 12 months. METHODS: Two hundred and fifty overweight/obese adults could choose HIIT or current exercise guidelines of 30 min·d moderate-intensity exercise. HIIT participants received a single training session and were advised to independently perform HIIT three times per week using a variety of protocols. Mixed models, with a random effect for participant, compared differences in weight, body composition, blood pressure, aerobic fitness, physical activity, and blood indices at 12 months, adjusting for relevant baseline variables. RESULTS: Forty-two percent (n = 104) of eligible participants chose HIIT in preference to current guidelines. At 12 months, there were no differences between exercise groups in weight (adjusted difference HIIT vs…

PURPOSE: This study aimed to examine how accelerometer-assessed physical activity accumulation patterns (e.g., is activity performed daily or only 1 or 2 d·wk or is activity accrued in bouts) may affect the association with mortality. METHODS: Adults (N = 3438), age 40 yr and older, who wore an accelerometer (ActiGraph 7164), were drawn from the longitudinal follow-up of the National Health and Nutritional Examination Survey (2003-2006), a population-based survey of the United States. Accelerometer-assessed moderate-to-vigorous physical activity (MVPA) was described by activity patterns. Participants engaging in the majority of their activity on only 1 or 2 d·wk· were classified as "weekend warriors." Activity bouts were defined as a period of at least moderate intensity lasting at least 10 min. Bout characteristics included bout frequency and length. Mortality was assessed through National Death Index matching through 2013. Mortality rates were compared among groups with different activity patterns. RESULTS: Over an average follow-up of 77.4 months, 394 deaths occurred. Compared to…

PURPOSE: To compare psychological responses to, and preferences for, moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), and sprint interval training (SIT) among inactive adults; and to investigate the relationships between affect, enjoyment, exercise preferences, and subsequent exercise behavior over a 4-wk follow-up period. METHODS: Thirty inactive men and women (21.23 ± 3.81 yr), inexperienced with HIIT or SIT, completed three trials of cycle ergometer exercise in random order on separate days: MICT (45 min continuous; approximately 70% to 75% of HR maximum (HRmax)); HIIT (10 × 1 min bouts at approximately 85% to 90% HRmax with 1-min recovery periods); and SIT (3 × 20-s "all-out" sprints with 2-min recovery periods). Perceived exertion (RPE), affect, and arousal were measured throughout the trials and enjoyment was measured postexercise. Participants rank-ordered the protocols (1-3) according to preference and logged their exercise over a 4-wk follow-up. RESULTS: Despite elevated HR, RPE, and arousal during work periods (P's < 0.05), and…

PURPOSE: To compare training loads between men and women during 14 wk of British Army standard entry basic training. METHODS: Thirty-one male (mean ± SD: age, 21 ± 4 yr; height, 1.78 ± 0.08 m; mass, 77.1 ± 10.5 kg) and 28 female (age, 22 ± 4 yr; height, 1.65 ± 0.05 m; mass, 63.9 ± 8.9 kg) British Army recruits had external (distance) and internal (HR, training impulse [TRIMP], RPE) training loads measured during weeks 1, 2, 6, 12, and 13 of basic training. Total energy expenditure was measured during weeks 1 to 2 and weeks 12 to 13. RESULTS: Daily distance was higher for men than women (13,508 ± 666 vs 11,866 ± 491 m, respectively, P < 0.001). Average daily HR (29% ± 3% vs 30% ± 3% HR reserve) and RPE (4 ± 1 vs 4 ± 1) were not different between men and women, respectively (P ≥ 0.495). Daily TRIMP was higher for women than men (492 ± 130 vs 261 ± 145 au, respectively, P < 0.001). Total energy expenditure was higher for men than women during weeks 1 to 2 (4020 ± 620 vs 2847 ± 323 kcal·d, respectively) and weeks 12 to 13 (4253 ± 556 kcal·d vs 3390 ± 344 kcal·d, respectively) (P <…

INTRODUCTION: Accurately monitoring 24-h movement behaviors is a vital step for progressing the time-use epidemiology field. Past accelerometer-based measurement protocols are either hindered by lack of wear time compliance, or the inability to accurately discern activities and postures. Recent work has indicated that skin-attached dual-accelerometers exhibit excellent 24-h uninterrupted wear time compliance. This study extends this work by validating this system for classifying various physical activities and sedentary behaviors in children and adults. METHODS: Seventy-five participants (42 children) were equipped with two Axivity AX3 accelerometers; one attached to their thigh, and one to their lower back. Ten activity trials (e.g., sitting, standing, lying, walking, running) were performed while under direct observation in a lab setting. Various time- and frequency-domain features were computed from raw accelerometer data, which were then used to train a random forest machine learning classifier. Model performance was evaluated using leave-one-out cross-validation. The efficacy…

PURPOSE: Findings from cross-sectional research indicate that the relationship between sleep quality and physical activity is mixed. For research that does indicate a significant association, the interpretation of the finding most often is that physical activity leads to better sleep, or less frequently, that better sleep leads to more involvement in physical activity (see sleep deprivation studies). Cross-sectional studies, however, are not able to assess the direction of these effects, and experimental studies have tested only one direction of the effects. Longitudinal studies, with their focus on temporal order, are needed to specifically examine the link between sleep and physical activity as well as the direction of effects. The current study had three goals: to examine 1) the longitudinal relationship between sleep and physical activity, 2) the direction of effects, and 3) whether emotion regulation mediates the relationship between sleep and physical activity. METHODS: Participants included a sample of 827 (Mage at baseline = 19.04 yr, SD = 0.92 yr, 73.88% female) students at…

Increased vertical impact loading during running has been associated with a variety of running related injuries including stress fractures, patellofemoral pain, and plantar fasciitis. PURPOSE: The purpose of this study was to examine the acute and long-term effect of a gait retraining program aimed at teaching runners with high impact loading to run softer. METHODS: Nineteen runners with high tibial shock (TS) first underwent a control period of eight sessions of treadmill running over 2 wk, progressing from 15 to 30 min. This was followed by eight sessions of gait retraining over 2 wk using the identical treadmill protocol. Real-time feedback of TS was provided as the participant ran. Feedback was gradually removed during the last four sessions. Variables of interest included peak TS, vertical impact peak and vertical average loading rate, and vertical instantaneous loading rate. These variables were assessed at intervals following the retraining and at a 1-yr follow-up. RESULTS: All variables of interest were significantly reduced post-retraining (P < 0.001). TS was reduced by…

PURPOSE: Athletes in weight-bearing sports may benefit from higher bone mineral density (BMD). However, some athletes are at risk for impaired BMD with female athlete triad (Triad). The purpose of this study is to understand the influence of sports participation and Triad on BMD. We hypothesize that athletes in high-impact and multidirectional loading sports will have highest BMD, whereas nonimpact and low-impact sports will have lowest BMD. Triad risk factors are expected to reduce BMD values independent of sports participation. METHODS: Two hundred thirty-nine female athletes participating in 16 collegiate sports completed dual-energy x-ray absorptiometry (DXA) scans to measure BMD z-scores of the lumbar spine (LS) and total body (TB). Height and weight were measured to calculate body mass index (BMI). Triad risk assessment variables were obtained from preparticipation examination. Mean BMD z-scores were compared between sports and by sport category (high-impact, multidirectional, low-impact, and nonimpact). Multivariable regression analyses were performed to identify differences…

INTRODUCTION: The acute blood pressure (BP) decrease is greater after evening than morning exercise, suggesting that evening training (ET) may have a greater hypotensive effect. OBJECTIVE: This study aimed to compare the hypotensive effect of aerobic training performed in the morning versus evening in treated hypertensives. METHODS: Fifty treated hypertensive men were randomly allocated to three groups: morning training (MT), ET, and control (C). Training groups cycled for 45 min at moderate intensity (progressing from the heart rate of the anaerobic threshold to 10% below the heart rate of the respiratory compensation point), while C stretched for 30 min. Interventions were conducted 3 times per week for 10 wk. Clinic and ambulatory BP and hemodynamic and autonomic mechanisms were evaluated before and after the interventions. Clinic assessments were performed in the morning (7:00-9:00 AM) and evening (6:00-8:00 PM). Between-within ANOVA was used (P ≤ 0.05). RESULTS: Only ET decreased clinic systolic BP differently from C and MT (morning assessment -5 ± 6 mm Hg and evening…

PURPOSE: To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults. METHODS: A United States nationally representative sample of 17,747 older adults from the Health and Retirement Study were followed up for 8 yr. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADL was self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality. RESULTS: Every 5-kg decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for…

INTRODUCTION: Changes in the parameters of the power-time relationship (critical power (CP) and W') during endurance exercise would have important implications for performance. We tested the hypotheses that CP and W', estimated using the end-test power (EP) and the work done above EP (WEP), respectively, during a the 3-min all-out test (3MT), can be reliably determined, and would be lower, after completing 2 h of heavy-intensity exercise. METHODS: In study 1, six cyclists completed a 3MT immediately after 2 h of heavy-intensity exercise on two occasions to establish the reliability of EP and WEP. In study 2, nine cyclists completed a control 3MT, and a fatigued 3MT and constant power output tests to 30 min or the limit of tolerance (Tlim) below and above F-EP after 2 h of heavy-intensity exercise. RESULTS: In study 1, EP (273 ± 52 vs 276 ± 58 W) and WEP (12.4 ± 4.3 vs 12.8 ± 4.3 kJ) after 2 h of heavy-intensity exercise were not different (P > 0.05) and were highly correlated (r = 0.99; P < 0.001). In study 2, both EP (F-EP: 282 ± 52 vs C-EP: 306 ± 56 W; P < 0.01) and WEP (F-WEP:…

BACKGROUND: In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. PURPOSE: To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. METHODS: An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). RESULTS: A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non-wear…

INTRODUCTION: Cardiopulmonary exercise testing is an essential tool to assess cardiorespiratory fitness (CRF) in children. There is a paucity of adequate pediatric reference values that are independent of body size and pubertal stage. The purpose of this study is to provide Z score equations for several maximal and submaximal CRF parameters derived from a prospectively recruited sample of healthy children. METHODS: In this cross-sectional multicenter study, we prospectively recruited 228 healthy children 12 to 17 yr old in local schools. We performed a symptom-limited cardiopulmonary exercise testing progressive ramp protocol on an electronically braked cycle ergometer. Eighteen CRF parameters were analyzed. We tested several regression models to obtain prediction curves that minimized residual association with age, body size, and pubertal stage. Both the predicted mean and the predicted SD were modeled to account for heteroscedasticity. RESULTS: We identified nonlinear association of CRF parameters with body size and significant heteroscedasticity. To normalize CRF parameters, the…

PURPOSE: To determine the relationship between vitamin D status and exercise performance in a large, prospective cohort study of young men and women across seasons (study 1). Then, in a randomized, placebo-controlled trial, to investigate the effects on exercise performance of achieving vitamin D sufficiency (serum 25(OH)D ≥ 50 nmol·L) by a unique comparison of safe, simulated-sunlight and oral vitamin D3 supplementation in wintertime (study 2). METHODS: In study 1, we determined 25(OH)D relationship with exercise performance in 967 military recruits. In study 2, 137 men received either placebo, simulated sunlight (1.3× standard erythemal dose in T-shirt and shorts, three times per week for 4 wk and then once per week for 8 wk) or oral vitamin D3 (1000 IU·d for 4 wk and then 400 IU·d for 8 wk). We measured serum 25(OH)D by high-pressure liquid chromatography tandem mass spectrometry and endurance, strength and power by 1.5-mile run, maximum dynamic lift and vertical jump, respectively. RESULTS: In study 1, only 9% of men and 36% of women were vitamin D sufficient during wintertime.…

PURPOSE: Aerobic exercise prescription is often based on a linear relationship between pulmonary oxygen consumption (V˙O2) and heart rate (HR). The aim of the present study was to test the hypothesis that during constant work rate (CWR) exercises at different intensities, the slow component of HR kinetics occurs at lower work rate and is more pronounced that the slow component of V˙O2 kinetics. METHODS: Seventeen male (age, 27 ± 4 yr) subjects performed on a cycle ergometer an incremental exercise to voluntary exhaustion and several CWR exercises: 1) moderate CWR exercises, below gas exchange threshold (GET); 2) heavy CWR exercise, at 45% of the difference between GET and V˙O2 peak (Δ); 3) severe CWR exercise, at 95% of Δ; 4) "HRCLAMPED" exercise in which work rate was continuously adjusted to maintain a constant HR, slightly higher than that determined at GET. Breath-by-breath V˙O2, HR, and other variables were determined. RESULTS: In moderate CWR exercises, no slow component of V˙O2 kinetics was observed, whereas a slow component with a relative amplitude (with respect to the…

PURPOSE: Walking pace is associated with all-cause and cardiovascular disease (CVD) mortality. Whether this association extends to other health outcomes and whether it is independent of total amount of time walked are currently unknown. Therefore, the aim of this study was to investigate whether usual walking pace is associated with a range of health outcomes. METHODS: UK Biobank participants (318,185 [54%] women) age 40 to 69 yr were included. Walking pace and total walking time were self-reported. The outcomes comprised: all-cause mortality as well as incidence and mortality from CVD, respiratory disease and cancer. The associations were investigated using Cox proportional hazard models. RESULTS: Over a mean of 5.0 yr [ranging from 3.3 to 7.8], 5890 participants died, 18,568 developed CVD, 5430 respiratory disease and 19,234 cancer. In a fully adjusted model, compared to slow pace walkers, men and women, respectively, with a brisk pace having lower risk of mortality from all-causes (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.69-0.90 and HR, 0.73; 95% CI, 0.62-0.85),…

PURPOSE: Muscle injury is the most common sports injury. Muscle stiffness, a risk factor for muscle injury, is lower in females than in males, implying that sex-related genetic polymorphisms influence muscle injury associated with muscle stiffness. The present study aimed to clarify the associations between two genetic polymorphisms (rs2234693 and rs9340799) in the estrogen receptor 1 gene (ESR1) and muscle injury or muscle stiffness. METHODS: In study 1, a questionnaire was used to assess the muscle injury history of 1311 Japanese top-level athletes. In study 2, stiffness of the hamstring muscles was assessed using ultrasound shear wave elastography in 261 physically active young adults. In both studies, rs2234693 C/T and rs9340799 G/A polymorphisms in the ESR1 were analyzed using the TaqMan SNP Genotyping Assay. RESULTS: In study 1, genotype frequencies for ESR1 rs2234693 C/T were significantly different between the injured and noninjured groups in a C-allele dominant (CC + CT vs TT: odds ratio, 0.62; 95% confidence interval, 0.43-0.91) and additive (CC vs CT vs TT: odds ratio,…

INTRODUCTION: Low-intensity endurance training (ET) performed with blood flow restriction (BFR) can improve muscle strength, cross-sectional area (CSA) and cardiorespiratory capacity. Whether muscle strength and CSA as well as cardiorespiratory capacity (i.e., V˙O2max) and underlying molecular processes regulating such respective muscle adaptations are comparable to resistance and ET is unknown. PURPOSE: To determine the respective chronic (i.e., 8 wk) functional, morphological, and molecular responses of ET-BFR training compared with conventional, unrestricted resistance training (RT) and ET. METHODS: Thirty healthy young men were randomly assigned to one of three experimental groups: ET-BFR (n = 10, 4 d·wk, 30-min cycling at 40% of V˙O2max), RT (n = 10, 4 d·wk, 4 sets of 10 repetitions leg press at 70% of one repetition maximum with 60 s rest) or ET (n = 10, 4 d·wk, 30-min cycling at 70% of V˙O2max) for 8 wk. Measures of quadriceps CSA, leg press one repetition maximum, and V˙O2max as well as muscle biopsies were obtained before and after intervention. RESULTS: Both RT and ET-BFR…