Augmented-Feedback Training Improves Cognitive Motor Performance of Soccer Players Purpose In this study, we tested the hypothesis that augmented feedback (AF) training can improve both perceptual-cognitive and/or motor skills specific to soccer. Methods Three groups of young elite players (U14-U15 categories) performed a test consisting in passing the ball as accurately and as quickly as possible towards a visual target moving briefly across a large screen located at 6 meters from the player. The performed task required players to correctly perceive the target, anticipate its future location and to adequately adjust the pass direction and power. The control group (CON) performed normal soccer training and was compared with two visuomotor training groups (AF and No-Feedback NF) that followed the same training regime but integrated series of 32 passes three times per week over a seventeen-day period into their normal soccer training. Objective measurements of the passing performance were provided using a high-technology system (COGNIFOOT) prior to, during and after training. During training, only players of the AF-group received visuo-auditory feedback immediately after each trial informing them about the accuracy of their passes. Results The results show that only players of the AF-group significantly improved passing accuracy, reactiveness, and global passing performance (+22 %) whereas the NF-group only improved passing accuracy. None of these parameters was improved in the CON-group. The objectively measured changes in passing performance were compared to the more subjectively judged passing performance provided by coaches and players. Coaches’ judgments were more reliable than players’ judgments and exhibited a training group effect comparable to the ones objectively measured by COGNIFOOT. Conclusion This study provides evidence that the training of cognitive motor performance in soccer players highly benefits from the use of augmented feedback. Corresponding author: Dr Halim Hicheur, C/O Unité des Sciences du Sport (W. Taube), Pérolles 90, CH-1700 Fribourg, Suisse. E-mail: halim.hicheur@gmail.com The authors declare that there is no conflict of interest regarding the publication of this article. The authors declare that the results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 11 July 2019. © 2019 American College of Sports Medicine

Exercise Training Modulates Gut Microbiota Profile and Improves Endotoxemia Inrtroduction Intestinal metabolism and microbiota profiles are impaired in obesity and insulin resistance. Moreover, dysbiotic gut microbiota has been suggested to promote systemic low-grade inflammation and insulin resistance through the release of endotoxins particularly lipopolysaccharides. We have previously shown that exercise training improves intestinal metabolism in healthy men. To understand whether changes in intestinal metabolism interact with gut microbiota and its release of inflammatory markers, we studied the effects of sprint interval (SIT) and moderate intensity continuous training (MICT) on intestinal metabolism and microbiota in insulin resistance. Methods Twenty-six, sedentary subjects (prediabetic n=9, T2D n=17; age 49[SD 4] years; BMI 30.5[SD 3]) were randomized into SIT or MICT. Intestinal insulin-stimulated glucose uptake (GU) and fatty acid uptake (FAU) from circulation were measured using PET. Gut microbiota composition was analysed by 16S rRNA gene sequencing and serum inflammatory markers with multiplex assays and enzyme-linked immunoassay kit. Results VO2peak improved only after SIT (p=0.01). Both training modes reduced systematic and intestinal inflammatory markers (TNF α, LBP) (time p<0.05). Training modified microbiota profile by increasing Bacteroidetes phylum (time p=0.03) and decreasing Firmicutes/Bacteroidetes ratio (time p=0.04). Moreover, there was a decrease in Clostridium genus (time p=0.04) and Blautia (time p=0.051). Only MICT decreased jejunal FAU (p=0.02). Training had no significant effect on intestinal GU. Colonic GU associated positively with Bacteroidetes and inversely with Firmicutes phylum, ratio Firmicutes/Bacteroidetes and Blautia genus. Conclusion Intestinal substrate uptake associates with gut microbiota composition and activity and whole-body insulin sensitivity. Exercise training improves gut microbiota profiles and reduces endotoxemia. Corresponding author: Jarna C. Hannukainen, PhD, Turku PET Center, University of Turku, Turku P.O. Box 52, FIN-20521, Finland. Email: jarna.hannukainen@tyks.fi ORCID: 0000-0002-8692-4049 This study was conducted within the Centre of Excellence in Cardiovascular and Metabolic Diseases and supported by the Academy of Finland, the University of Turku, Turku University Hospital, and Åbo Akademi University. The study was financially supported by the European Foundation for the Study of Diabetes, the Finnish Cultural Foundation, Varsinais-Suomi Regional Fund, Juho Vainio Foundation, Emil Aaltonen Foundation, Hospital District of Southwest Finland, Orion Research Foundation, Finnish Diabetes Foundation, Ministry of Education of the State of Finland, Academy of Finland (grants 251399 and 256470), Paavo Nurmi Foundation, Novo Nordisk Foundation and the Centre of Excellence funding. Conflict of interest: No conflict of interest. Accepted for Publication: 23 July 2019. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 American College of Sports Medicine

Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy PURPOSE This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-and-see approach on pain, disability, global improvement and pain-free grip strength in individuals with lateral elbow tendinopathy (LET). METHODS Forty participants with unilateral LET of at least 6 weeks’ duration were randomised to either wait-and-see (N=19) or a single supervised instruction session by a physiotherapist, followed by an 8-week unsupervised daily program of progressive isometric exercise (N=21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation (PRTEE), global rating of change on a 6-point scale (GROC, dichotomised to success and no success) and pain-free grip strength at 8 weeks. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale (NRS), and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS Thirty-nine (98%) participants completed 8-week measurements. The exercise group had lower PRTEE scores compared to wait-and-see at 8 weeks (standardised mean difference (SMD) -0.92, 95% CI -1.58 to -0.26). No group differences were found for success on GROC (29% exercise vs 26% wait-and-see (risk difference 2.3%, 95% CI -24.5 to 29.1)), or pain-free grip strength (SMD -0.33, 95% CI -0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD -0.80, 95% CI -1.45 to -0.14). CONCLUSION Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared to wait-and-see at 8 weeks. With only one out of the three primary outcomes being significantly different following isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment. Address for correspondence: Bill Vicenzino, School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Building 84A, St Lucia QLD 4072. Email: b.vicenzino@uq.edu.au Funding was provided by a program grant from the National Health and Medical Research Council of Australia (ID631717). V.V. is supported by a University of Queensland Research Scholarship. The authors report no conflicts of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 8 August 2019. © 2019 American College of Sports Medicine

Does Eccentric-Only and Concentric-Only Activation Increase Power Output? Purpose The aim of study was to evaluate changes in power output and bar velocity in the bench press throw (BPT) following the bench press exercise as a conditioning activity (CA) with concentric only (CONONLY) and eccentric only (ECCONLY) contractions. Methods Thirty-two (n=32) healthy strength-trained men participated in this study (age: 28.4±4.5 years; height: 177±7.6 cm; body mass: 93.5±9.3 kg; BP-1RM: 143.6±17.5 kg). The experiment was performed following a randomized crossover design, where each participant performed 2 sets of 2 repetitions using the bench press exercise as the CA at 90%1RM ECCONLY, 90%1RM CONONLY, 110%1RM ECCONLY or 130%1RM ECCONLY contraction. The BPT was performed to assess changes in peak, mean power (PP; MP) and peak, mean velocity (PV; MV) before and after CA. The differences between analyzed variables before and after the CA were verified using ANOVA with repeated measures. Statistical significance was set at p<0.05. Results There were statistically significant differences between baseline and post-activation value of PP and PV in the BPT (p<0.05) after the CA with ECCONLY contraction at 110%1RM and at 130%1RM as well between baseline and post-activation value of MV in the BPT (p<0.05) after CA with contraction at 110%1RM. There were no significant differences between baseline and post-activation values of PP, MP, PV and MV in the BPT after the CA with CONONLY contraction at 90%1RM and CA with ECCONLY contraction at 90%1RM. Conclusion Partial movement with ECCONLY contraction is effective in short-term power output development, but only when the load used in the CA exceeds 100%1RM. Corresponding author: Michal Wilk, Department of Sports Training, The Jerzy Kukuczka Academy of Physical Education, ul. Mikolowska 72a, 40-065 Katowice Poland. E-mail: m.wilk@awf.katowice.pl The study was supported and funded by the statutory research of the Jerzy Kukuczka Academy of Physical Education in Katowice, Poland - research leaders Michał Wilk as well as by a grant of the Ministry of Science and Higher Education in Poland NRSA4 040 54. The authors declare that they have no conflict of interest. The authors herewith state that the results of the present study do not constitute endorsement by the American College of Sports Medicine and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 29 July 2019. © 2019 American College of Sports Medicine

Aerobic Recovery following Radical Prostatectomy: A Case Study Purpose This case study examined the recovery following radical prostatectomy (RP) of an endurance-trained 65-year old man. Methods A maximal incremental exercise test and a one-hour steady-state test were performed just prior to and three months following robotic RP to determine maximal oxygen consumption (VO2max) and other cardiorespiratory variables. The patient recorded his training as he prepared for an endurance event that was to occur three months after RP, the Norwegian Foot March (NFM), a 30-km road march carrying 11.4 kg. Results In the month prior to RP, the patient performed 2-3 hours of vigorous-intensity aerobic exercise per week, fast walking carrying an 11.4-kg pack, with the longest individual session being a 16-km road march. Just prior to surgery, VO2max was 36.7 mL.min-1.kg-1, heart rate during 30 min at 7.2 km.hr-1 and 0% grade was 77% of heart rate reserve (HRR), and during 30 min at 5.3 km.hr-1 and 10% grade was 92% HRR. On post-surgery day 44, he did a 19-km road march carrying 11.4 kg, exceeding the training level of the month pre-surgery. Three months post-surgery, VO2max was 42.7 mL.min-1.kg-1, and heart rates during the flat and uphill 30-min sessions at the same absolute-intensity as pre-surgery were 70% and 83% HRR, respectively. He completed the NFM 93 days post-surgery in 4:24:37, with an average heart rate of 72% HRR. Conclusion This case study demonstrates that an aerobically trained prostate cancer patient can return to high-level aerobic training in as little as seven weeks post-radical prostatectomy, and even exceed pre-surgery fitness. This finding has implications for prognosis given the beneficial effect of vigorous-intensity exercise on prostate cancer progression. Corresponding author: David P. Swain, PhD, Department of Human Movement Sciences, SRC 2024, Old Dominion University, Norfolk, VA 23529, Ph: 757-683-6028, Fax: 757-683-4270. dswain@odu.edu The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Results of the present study do not constitute endorsement by ACSM. There was no funding for this study. There are no conflicts of interest. Accepted for Publication: 9 August 2019. © 2019 American College of Sports Medicine

Physical Activity and Academic Performance: Genetic and Environmental Associations Introduction Physical activity and academic performance are believed to be associated. Though both traits are partially heritable, it remains unclear whether these traits also share a genetic and/or environmental background in common. We aimed to examine to what extent leisure-time physical activity and academic performance share genetic and environmental effects from early adolescence to young adulthood. Methods Participants were Finnish twins (2543–2693 individuals/study wave) who reported their leisure-time physical activity at ages 12, 14, 17 and 24. Academic performance was assessed with teacher-reported grade point averages at ages 12 and 14 and by self-reported educational levels at ages 17 and 24. Bivariate quantitative genetic modeling at each age and between different ages was performed to decompose the trait correlation between academic performance and physical activity into genetic and environmental components. Results The trait correlations between leisure-time physical activity and academic performance were positive, but modest at most (rtrait=0.08–0.22 in males, and 0.07–0.18 in females). The genetic correlations between leisure-time physical activity and academic performance were higher than the trait correlations (rA=0.17–0.43 in males, and 0.15–0.25 in females). Common genetic influences explained 43–100% of the trait correlations. Environmental influences shared by co-twins between leisure-time physical activity and academic performance were also correlated (rC=0.27–0.54 in males, and 0.21–0.69 in females) explaining 41–100% of the trait correlations. Unique environmental influences were correlated only in females (rE=0.10–0.15). Conclusion Both common genetic background and shared family environment (i.e., familial background) partially account for the associations observed between leisure-time physical activity and academic performance. However, the estimates vary in magnitude by age. Corresponding author: Sari Aaltonen Ph.D., Institute for Molecular Medicine (FIMM), University of Helsinki, P.O. Box 20 (Tukholmankatu 8), FIN-00014 University of Helsinki, Helsinki, Finland. E-mail: sari.s.aaltonen@helsinki.fi The research work has been supported by the Academy of Finland (grant 266592 to S.A., A.J. and K.S., grant 277209 to A.L. and grants 100499, 205585, 141054, 265240, 263278 and 264146 to J.K.), the Finnish Ministry of Education and Culture (to S.A., U.M.K. and K.S.), the Juho Vainio Foundation (to S.A., U.M.K. and K.S.), and the Finnish Cultural Foundation (to S.A.). Data collection of the FinnTwin12 study has also been supported by the U.S. National Institute of Alcohol Abuse and Alcoholism (grants AA-12502, AA-00145 and AA-09203 to R.J.R.). The authors declare no conflict of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors state that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 August 2019. © 2019 American College of Sports Medicine

Plasmalemma Function is Rapidly Restored in Mdx Muscle after Eccentric Contractions Purpose Muscle that lacks dystrophin, as in the mdx mouse, has a heightened sensitivity to eccentric (ECC) contraction-induced strength loss, but an enhanced rate of recovery. However, the timeline and mechanisms underlying why mdx muscle recovers quicker has yet to be determined. We used an electromyographic (EMG) approach to analyze plasmalemma electrophysiological function during and following ECC contraction-induced injury to test the hypothesis that loss of plasmalemmal excitability is a transient event in mdx muscle. Methods Mice were implanted with stimulating electrodes on the common peroneal nerve and EMG electrodes on the tibialis anterior muscle. Anterior crural muscles of anesthetized mice performed 1 or 2 bouts of 50 injurious ECC contractions, and recovery of maximal isometric torque and M-wave root mean square (M-wave RMS) were assessed following each bout. Results Maximal isometric torque and M-wave RMS were equally reduced 62% (P < 0.001) in mdx mice immediately following the initial ECC injury. For these mdx mice, M-wave RMS was still reduced at 2 days post-injury (P = 0.034) but was not different from pre-injury values by 6 days (P = 0.106), while torque took up to 9 days to recover (P = 0.333). M-wave RMS did not change (P = 0.390) in wildtype mice in response to ECC injury while torque decreased 35% (P < 0.001) and recovered by day 2 (P = 0.311). Results from the second bout of ECC contractions were similar to those observed during and after the initial injury. Conclusion Functional dystrophin is necessary for excitation to occur at the plasmalemma during ECC contractions but is not essential for complete recovery of plasmalemma electrophysiological function or maximal isometric strength. Correspondence: Cory W. Baumann, Division of Rehabilitation Science and Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, USA. Electronic Address: cbaumann@umn.edu This work was funded by the National Institutes of Health (T32-AG029796 and T32-AR007612 to C.W.B.), a University of Minnesota Bob Allison Ataxia Research Center Grant (to D.A.L.) and a Research Endowment from the American College of Sports Medicine Foundation (to C.W.B). The authors have no conflict of interest, declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and that the results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 7 August 2019. © 2019 American College of Sports Medicine

A Mobile Application for Exercise Intervention in People Living with HIV Purpose To assess 16-weeks improvements of physical fitness, metabolic and psychologic parameters in people living with HIV (PLWH) exercising with the support of a smartphone application, as compared to a control group exercising without application. Methods This was a randomized, open-label, pilot study enrolling PLWH in a 16-week protocol consisting of moderate physical activity three times/week, which included an initial coach-supervised period of 4 weeks, followed by 12 weeks where participants trained independently. Participants were allocated to either an experimental group that trained with the use of a smartphone application (APP) or a control group that practiced following a hard copy training program (No-APP). At baseline (BL) and after 16-weeks (W16), patients were assessed for cardiorespiratory fitness, body composition, blood lipid profile, and profile of mood states (POMS). Results Forty-eight PLWH were screened and 38 were eligible: 20 were allocated to the APP group and 18 to the No-APP group. Two APP and two No-APP participants were lost to follow-up. Intention-to-treat analysis showed a W16 improvement from BL of ≥15% V[Combining Dot Above]O2peak in 13 of 18 (72%) in APP, but only in 3 of 16 (19%) in No-APP participants (p=0.025). Significant W16 improvements were observed in APP, but not in No-APP participants, in V[Combining Dot Above]O2peak, fat mass and fat-free mass %, total-, LDL-cholesterol and triglycerides, vigour and total mood by POMS. Accordingly, significant % change differences between the APP and the No-APP groups were observed in V[Combining Dot Above]O2peak, fat and fat-free mass %, total-, LDL-cholesterol and triglycerides, and in depression, vigour, anger and total mood by POMS. Conclusions Exercising with the use of a smartphone application improved cardiorespiratory fitness, body composition, cholesterol profiles and psychological outcomes in PLWH. Corresponding author: Matteo Bonato, Ph.D, LaMSS – Laboratory of Movement and Sport Science. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4. 20161 - Milano, Italia, Phone/Fax: +390266214980, e-mail: matteo.bonato@grupposandonato.it. ORCID-ID: http://orcid.org/0000-0002-5589-7957 All authors gave the approval for the final version of the manuscript submitted for publication. Authors declare that the results of the study are presented clearly, honestly, and without fabrication, or inappropriate data manipulation and statement that results of the present study do not constitute endorsement by ACSM. The authors have no conflicts of interest to disclose. This work was supported by an unrestricted grant from Gilead Sciences. Accepted for Publication: 5 August 2019. © 2019 American College of Sports Medicine

Ultrasound-derived Biceps Femoris Long-Head Fascicle Length: Extrapolation Pitfalls Purpose To compare biceps femoris long-head (BFlh) fascicle lengths (Lfs) obtained with different ultrasound-based approaches: 1) single ultrasound images and linear Lf extrapolation; 2) single ultrasound images and one of two different trigonometric equations (termed equations A and B); and 3) extended field of view (EFOV) ultrasound images. Methods Thirty-seven elite alpine skiers (21.7±2.8 yrs) without a previous history of hamstring strain injury were tested. Single ultrasound images were collected with a 5 cm linear transducer from BFlh at 50% femur length and were compared with whole muscle scans acquired by EFOV ultrasound. Results The intra-session reliability (ICC3,k = intra-class correlation coefficient) of Lf measurements was very high for both single ultrasound images (i.e., Lf estimated by linear extrapolation; ICC3,k = 0.96-0.99, SEM = 0.18 cm) and EFOV scans (ICC3,k = 0.91 -0.98, SEM = 0.19 cm). Although extrapolation methods showed cases of overestimation and underestimation of Lf when compared with EFOV scans, mean Lf measured from EFOV scans (8.07±1.36 cm) was significantly shorter than Lf estimated by trigonometric equations A (9.98±2.12 cm, P<0.01) and B (8.57±1.59 cm, P=0.03), but not significantly different from Lf estimated with manual linear extrapolation (MLE) (8.40±1.68 cm, p=0.13). Bland-Altman analyses revealed mean differences in Lfs obtained from EFOV scans and those estimated from equation A, equation B and MLE of 1.91±2.1 cm, 0.50±1.0 cm and 0.33±1.0 cm, respectively. Conclusions The typical extrapolation methods used for estimating Lf from single ultrasound images are reliable within the same session, but not accurate for estimating BFlh Lf at rest with a 5-cm FOV. We recommend that EFOV scans are implemented to accurately determine intervention-related Lf changes in BFlh. Address for correspondence: Dr Martino Franchi Institute of Physiology, Department of Biomedical Sciences, University of Padua, Italy martino.franchi@unipd.it The authors would like to thank Swiss Ski and Balgrist foundation stitftung for the financial support for the present study. The authors declare the non-presence of any conflict of interests. The results of the present study do not constitute endorsement by ACSM. The results of the present study are presented clearly, honestly, without fabrication, falsification or inappropriate data manipulation. Accepted for Publication: 26 July 2019 © 2019 American College of Sports Medicine

Can Creatine Combat the Mental Fatigue–associated Decrease in Visuomotor Skills? Purpose The importance of the brain in sports was recently confirmed by the negative effect of mental fatigue (MF) on sport-specific psychomotor skills. Creatine supplementation improves strength, but can also improve cognitive functioning. To explore the role of creatine in combatting MF, we evaluated whether creatine supplementation counteracts the MF-associated impairment in sport-specific psychomotor skills. Methods In 23°C, 14 healthy participants (4F 10M; mean ± SD; age:24 ± 3 y; mass:74 ± 13 kg; height:179 ± 9 cm) performed -counterbalanced, crossover and double blinded- a 90-min mentally fatiguing task (i.e. Stroop task) in two different conditions: after a 7-day creatine supplementation (CR; 20 g/day) and after a 7-day calcium lactate supplementation (PLAC; placebo), separated by a 5-week washout. In both conditions, a 7-min sport-specific visuomotor task, a dynamic handgrip strength endurance task and a 3-min Flanker task was performed before and after the mentally fatiguing task. Physiological and perceptual responses were measured throughout the protocol. Results Handgrip strength endurance was higher in CR compared to PLAC (p=0.022). MF impaired visuomotor response time (+4.4%; p=0.022) and Flanker accuracy (-5.0%; p=0.009) in both conditions. Accuracy on the Stroop task was higher in CR compared to PLAC (+4.9%; p=0.026). Within the perceptual and physiological parameters, only motivation and vigor (p≤0.027) were lower in CR compared to PLAC. Conclusion Creatine supplementation improved physical (strength endurance) and prolonged cognitive (Stroop accuracy) performance, yet it did not combat mental fatigue-induced impairments in short sport-specific psychomotor or cognitive (Flanker) performance. These results warrant further investigation in the potential role of creatine in combatting the MF-associated decrements in prolonged (e.g. 90-min soccer game) sport performance, and suggest a role of brain-phosphocreatine in MF. Corresponding author: Romain Meeusen Human Physiology and Sports Physiotherapy Research Group Pleinlaan 2 B-1050 Brussels, Belgium Email: romain.meeusen@vub.be Tel: +32 2 629 27 32 The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The results of the present study do not constitute endorsement by ACSM. No conflict of interest is declared by the authors. Accepted for Publication: 5 August 2019 © 2019 American College of Sports Medicine