Salt Loading Blunts Central and Peripheral Postexercise Hypotension Introduction High salt intake is a widespread cardiovascular risk factor with systemic effects. These effects include an expansion of plasma volume, which may interfere with postexercise hypotension (PEH). However, the effects of high salt intake on central and peripheral indices of PEH remain unknown. We tested the hypothesis that high salt intake would attenuate central and peripheral PEH. Methods Nineteen healthy adults (7F/12M, age=25±4 yrs; BMI=23.3±2.2 kg•m-2; VO2peak=41.6±8.7 mL•min-1•kg-1; SBP=112±9 mmHg; DBP=65±9 mmHg) participated in this double-blind, randomized, placebo-controlled crossover study. Participants were asked to maintain a 2300 mg/d sodium diet for 10 days on two occasions separated by ≥two weeks. Total salt intake was manipulated via ingestion of capsules containing either table salt (3900 mg/d) or placebo (dextrose) during each diet. On the 10th day, participants completed 50 minutes of cycling at 60% VO2peak. A subset of participants (n=8) completed 60 minutes of seated rest (sham trial). Beat-to-beat blood pressure (BP) was measured in-lab for 60 minutes post-exercise via finger photoplethysmography. Brachial and central BP were measured for 24 hours post-exercise via ambulatory BP monitor. Results Ten days of high salt intake increased urinary sodium excretion (dextrose=134±70 vs. salt=284±74 mmol•24H-1, p<0.001), expanded plasma volume (7.2±10.8%), and abolished PEH during in-lab BP monitoring (main effect of diet: p<0.001). Ambulatory systolic BPs were higher for 12 hours following exercise during the salt and sham trials compared to the dextrose trial (average change, dextrose=3.6±2.1, salt=9.9±1.4, sham=9.8±2.5 mmHg; p=0.01). Ambulatory central systolic BP was also higher during the salt trial compared to dextrose trial. Conclusion High salt intake attenuates peripheral and central PEH, potentially reducing the beneficial cardiovascular effects of acute aerobic exercise. Address for Correspondence: William B. Farquhar, PhD, FACSM, University of Delaware, Department of Kinesiology and Applied Physiology, 540 South College Avenue, 201M, Newark, DE 19713, Phone: 302-831-6178, Email: wbf@udel.edu This research was supported by ACSM Foundation Doctoral Student Research Grant 17-00521 (MCB), National Institutes of Health R01HL128388 (WBF), and American Heart Association 18POST34060020 (ATR). This publication was made possible by the Delaware COBRE in Cardiovascular Health, supported by a grant from the National Institute of General Medical Sciences – NIGMS (5 P20 GM113125) from the National Institutes of Health. The authors have no conflicts of interest to declare. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 1 October 2019 © 2019 American College of Sports Medicine

Cognitive Impairment during High-Intensity Exercise: Influence of Cerebral Blood Flow Purpose Cognitive performance appears to be impaired during high-intensity exercise, and this occurs concurrently with a reduction in cerebral blood flow (CBF). However, it is unclear whether cognitive impairment during high-intensity exercise is associated with reduced CBF. We tested the hypothesis that a reduction in CBF is responsible for impaired cognitive performance during high-intensity exercise. Methods Using a randomized crossover design seventeen healthy males performed spatial delayed-response (DR) and Go/No-Go tasks in three conditions [Exercise (EX), Exercise+CO2 (EX+CO2), and a non-exercising Control (CON)]. In the EX and EX+CO2, they performed cognitive tasks at rest and during 8-mins of moderate and high-intensity exercise. Exercise intensity corresponded to ~50% (moderate) and ~80% (high) of peak oxygen uptake. In the EX+CO2, the participants inspired hypercapnic gas (2% CO2) during high-intensity exercise. In the CON, they performed the cognitive tasks without exercise. Results Middle cerebral artery mean velocity (MCAv) increased during high-intensity exercise in the EX+CO2 relative to the EX [69.4 (10.6) cm.s-1, vs. 57.2 (7.7) cm.s-1, P < 0.001]. Accuracy of the cognitive tasks was impaired during high-intensity exercise in the EX [84.1 (13.3) %, P < 0.05] and the EX+CO2 [85.7 (11.6) %, P < 0.05] relative to rest [EX: 95.1 (5.3) %, EX+CO2: 95.1 (5.3) %]. However, no differences between the EX and the EX+CO2 were observed (P > 0.10). These results demonstrate that restored CBF did not prevent cognitive impairment during high-intensity exercise. Conclusion We conclude that a reduction in CBF is not responsible for impaired cognitive performance during high-intensity exercise. Address for correspondence: Takaaki Komiyama, Center for Education in Liberal Arts and Sciences, Osaka University, 1-17 Machikaneyamachou, Toyonaka, Osaka 560-0043, Japan; E-mail: mt.komi51@gmail.com, Tel.: +81-6-6850-6026 This study was in part supported by the Descente and Ishimoto Memorial Foundation for the Promotion of Sports Science (T.K.) and the Japan Society for the Promotion of Science KAKENHI (16H03230 to S.A.). Conflict of interest: The authors have no conflicts of interest to disclose. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 21 September 2019 © 2019 American College of Sports Medicine

Exercise Thermoregulation with a Simulated Burn Injury: Impact of Air Temperature The U.S. Army’s Standards of Medical Fitness (AR 40-501) states: “Prior burn injury (to include donor sites) involving a total body surface area of 40 percent or more does not meet the standard”. However, the standard does not account for the interactive effect of burn injury size and air temperature on exercise thermoregulation. Purpose To evaluate whether the detrimental effect of a simulated burn injury on exercise thermoregulation is dependent upon air temperature. Methods On eight occasions, nine males cycled for 60 min at a fixed metabolic heat production (6 W·kg−1) in air temperatures of 40°C or 25°C with simulated burn injuries of 0% (Control), 20%, 40%, or 60% of total body surface area (TBSA). Burn injuries were simulated by covering the skin with an absorbent, vapor-impermeable material to impede evaporation from the covered areas. Core temperature was measured in the gastrointestinal tract via telemetric pill. Results In 40°C conditions, greater elevations in core temperature were observed with 40% and 60% TBSA simulated burn injuries vs. Control (P < 0.01). However, at 25°C, core temperature responses were not different vs. Control with 20%, 40%, and 60% TBSA simulated injuries (P = 0.97). The elevation in core temperature at the end of exercise was greater in the 40°C environment with 20%, 40% and 60% TBSA simulated burn injuries (P ≤ 0.04). Conclusion Simulated burn injuries ≥20% TBSA exacerbate core temperature responses in hot, but not temperate, air temperatures. These findings suggest that the U.S. Army’s standard for inclusion of burned soldiers is appropriate for hot conditions, but could lead to the needless discharge of soldiers who could safely perform their duties in cooler training/operational settings. Address for Correspondence: Dr. Craig Crandall, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Dallas, Texas, USA, 75231, Tel: 214-345-4623, E-mail: craigcrandall@texashealth.org This work was supported by awards from the Department of Defense (W81XWH-15-1-0647 to C.G.C.), National Institutes of Health (R01GM068865 to C.G.C.), and a Natural Sciences and Engineering Research Council of Canada Postdoctoral Fellowship (to M.N.C.). CONFLICTS OF INTEREST: The authors have no conflicts of interest to disclose. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 26 September 2019 © 2019 American College of Sports Medicine

Lifelong Physical Activity Determines Vascular Function in Late Postmenopausal Women Introduction The study evaluated the role of life-long physical activity for leg vascular function in post-menopausal women (61±1 years). Method The study design was cross-sectional with 3 different groups based on their self-reported physical activity level with regard to intensity and volume over the past decade: Inactive (n=14); Moderately active (n=12) and; Very active (n=15). Endothelial dependent and smooth muscle dependent leg vascular function were assessed by ultrasound doppler measurements of the femoral artery during infusion of acetylcholine, the nitric oxide (NO) donor sodium nitroprusside and the prostacyclin analog epoprostenol. Thigh muscle biopsies and venous plasma samples were obtained for assessment of vasodilator systems. Results The very active group was found to have ~ 76% greater responsiveness to acetylcholine compared to the sedentary group accompanied by a ~200% higher prostacyclin synthesis during ach infusion. Smooth muscle cell responsiveness to sodium nitroprusside and epoprostenol was not different between groups. The protein amount of endothelial nitric oxide synthase and endogenous antioxidant enzymes in muscle tissue was higher in the very active than the inactive group. The moderately active group had a similar endothelial and smooth muscle cell responsiveness as the inactive group. A secondary comparison with a smaller group (n=5) of habitually active young (24±2 yrs) women indicated that smooth muscle cell responsiveness and endothelial responsiveness is affected by age per se. Conclusion This study shows that leg vascular function, and a greater potential to form prostacyclin and NO in late post-menopausal women, is influenced by the extent of life-long physical activity. Corresponding author: Lasse Gliemann, Department of Nutrition, Exercise and Sports, University of Copenhagen, Universitetsparken 13, DK-2100 Copenhagen Ø, Denmark, E-mail: gliemann@nexs.ku.dk The study was funded by The Danish Ministry of Culture- Foundation for Research in Sports, The Independent Research Foundation Denmark and the Toyota Foundation. Conflicts of interest: The authors declare no conflicts of interest. The results of the present study do not constitute endorsement by ACSM. the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation Accepted for Publication: 13 September 2019 © 2019 American College of Sports Medicine

Interval Exercise Lowers Circulating CD105 Extracellular Vesicles in Prediabetes BACKGROUND Extracellular vesicles (EVs) are purported to mediate type 2 diabetes (T2D) and cardiovascular disease (CVD) risk and development. Physical activity and a balanced diet reduce disease risk, but no study has tested the hypothesis that short-term interval (INT) training would reduce EVs compared with continuous (CONT) exercise in adults with prediabetes. METHODS Eighteen obese adults (age: 63.8±1.5yrs BMI: 31.0±1.3 kg/m2) were screened for prediabetes using American Diabetes Association criteria (75g OGTT). Subjects were randomized to INT (n=10, alternating 3 min intervals at 90% and 50% HRpeak,, respectively) or CONT (n=8, 70% HRpeak) training for 12 supervised sessions over 13 d for 60 min/d. Cardiorespiratory fitness (VO2peak), weight (kg), as well as ad-libitum dietary intake were assessed and arterial stiffness (augmentation index via applanation tonometry; AIx) was calculated using total AUC during a 75g OGTT performed 24 hr following the last exercise bout. Total EVs, platelet EVs (CD31+/CD41+), endothelial EVs (CD105; CD31+/ CD41-), platelet endothelial cell adhesion molecule (PECAM) (CD31+) and leukocyte EVs (CD45+; CD45+/CD41-) were analyzed via imaging flow cytometry pre-/post- intervention. RESULTS INT exercise increased VO2peak (P=0.04) compared to CONT training. While training had no effect on platelet or leukocyte EVs, INT decreased Annexin V- endothelial EV CD105 compared with CONT (P=0.04). However, after accounting for dietary sugar intake the intensity effect was lost (P=0.18). Increased ad-libitum dietary sugar intake following training was linked to elevated AV+CD105 (r=0.49, P=0.06) and AV-CD45+ (r=0.59, P=0.01). Nonetheless, increased VO2peak correlated with decreased AV+ CD105 (r=-0.60, P=0.01). CONCLUSION Interval exercise training decreases endothelial derived EVs in adults with prediabetes. Although increased sugar consumption may alter EVs following a short-term exercise intervention, fitness modifies EV count. Correspondence: Steven K. Malin, PhD, Department of Kinesiology, 210 Emmet St., 225A Memorial Gymnasium, University of Virginia, Charlottesville, VA, Phone: (434) 243 – 6624, Fax: (434) 924-1389, Email: skm6n@virginia.edu Authors Disclosure: Authors have nothing to disclose. Funding was supported by the University of Virginia’s Curry School of Education (S.K.M) and Launchpad Diabetes Award (S.K.M and U.E). S.K.M is supported by National Institutes of Health RO1-HL130296. Accepted for Publication: 5 September 2019 © 2019 American College of Sports Medicine

Oral L-Tyrosine Supplementation Improves Core Temperature Maintenance in Older Adults Introduction During cold exposure, an increase in sympathetic nerve activity evokes vasoconstriction (VC) of cutaneous vessels to minimize heat loss. In older adults, this reflex VC response is impaired thereby increasing their susceptibility to excess heat loss and hypothermia. Since L-tyrosine, the amino acid substrate necessary for catecholamine production, has been shown to augment reflex VC in aged skin, we hypothesize that oral ingestion of L-tyrosine will attenuate the decline in core temperature (Tc) during whole-body cooling in older adults. Methods In a randomized, double-blind design, nine young (25 ± 3 years) and nine older (72 ± 8 years) participants ingested either 150 mg/kg of L-tyrosine or placebo prior to commencing 90 minutes of whole-body cooling to decrease skin temperature to ~29.5oC. Esophageal temperature and forearm laser Doppler flux (LDF) were measured continuously throughout the protocol to provide an index of Tc and skin blood flow, respectively. The change in esophageal temperature (ΔTES) was the difference in temperature at the end of cooling subtracted from baseline. Cutaneous vascular conductance (CVC) was calculated as CVC = LDF/mean arterial pressure and expressed as a percent change from baseline (%ΔCVCBASELINE). Results Oral tyrosine ingestion augmented the cutaneous VC response to cooling in older adults (Placebo = 14.4 ± 2.0, Tyrosine = 32.7 ± 1.7 %ΔCVCBASELINE; p<0.05). Additionally, tyrosine improved Tc maintenance throughout cooling in older adults (Placebo = -0.29 ± 0.07, Tyrosine = -0.07 ± 0.07 ΔTES; p<0.05). Both the cutaneous VC and Tc during cooling were similar between young and older adults supplemented with tyrosine (p>0.05). Conclusions These results indicate that L-tyrosine supplementation improves Tc maintenance in response to acute cold exposure in an older population. Correspondence: James A. Lang, Ph.D., Iowa State University, Department of Kinesiology, 534 Wallace Road, Ames, IA 50011, USA, Phone: 515-294-4027, Fax: 515-294-8740, Email: jlang1@iastate.edu This work was supported by the Wilderness Medical Society (Peter Hackett – Paul Auerbach Grant). The authors report no competing interests. The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 1 October 2019 © 2019 American College of Sports Medicine

Compression Garments Reduce Muscle Movement and Activation during Submaximal Running PURPOSE The purpose of this study was to investigate the effectiveness of sports compression tights in reducing muscle movement and activation during running. METHODS A total of 27 recreationally-active males were recruited across two separate studies. For study one, 13 participants (mean ± SD; 84.1 ± 9.4 kg, 22 ± 3 y) completed two 4-min treadmill running bouts (2 min at 12 km.h-1 and 15 km.h-1) under two conditions; a no-compression control (CON1) and compression (COMP). For study two, 14 participants (77.8 ± 8.4 kg, 27 ± 5 y) completed four 9-min treadmill running bouts (3 min at 8 km.h-1, 10 km.h-1, and 12 km.h-1) under four conditions; a no-compression control (CON2) and three different commercially-available compression tights (2XU; Nike; Under Armor, UA). Using Vicon 3D motion capture technology, lower-limb muscle displacement was investigated in both study one (thigh and calf) and two (vastus lateralis + medialis, VAS; lateral + medial gastrocnemius, GAS). In addition, study two investigated the effects of compression on soft-tissue vibrations (root mean square of resultant acceleration, RMS Ar), muscle activation (iEMG), and running economy (oxygen consumption, V[Combining Dot Above]O2) during treadmill running. RESULTS Wearing compression during treadmill running reduced thigh and calf muscle displacement as compared with no compression (both studies), which was evident across all running speeds. Compression also reduced RMS Ar and iEMG during treadmill running, but had no effect on running economy (study two). CONCLUSION Lower-limb compression garments are effective in reducing muscle displacement, soft-tissue vibrations, and muscle activation associated with the impact forces experienced during running. Corresponding Author: James R Broatch, Institute for Health and Sport (iHeS), Victoria University, PO Box 14428, Melbourne VIC 8001, Australia. james.broatch@vu.edu.au The authors acknowledge the participants for their generous involvement in this study, and the compression garment manufacturer 2XU (Australia) for providing research funding. CONFLICTS OF INTEREST AND SOURCE OF FUNDING: JRB, NB-W, EJP, SLH, and DJB received a research grant from compression garment manufacturer 2XU (Australia). For the remaining authors none were declared. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 17 September 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

Effect of Cuff Pressure on Blood Flow during Blood Flow–restricted Rest and Exercise Purpose This study investigated the relationship between blood flow restriction (BFR) cuff pressure and blood flow at rest and during exercise, with the aim of determining if lower cuff pressures will provide an ischemic stimulus comparable to higher pressures. Methods The relationship between blood flow and cuff pressure at rest was determined by measuring blood flow (Doppler Ultrasound) through the superficial femoral artery (SFA) in 23 adults across a range of pressures (0-100% Arterial Occlusion Pressure at rest, rAOP). The interplay between cuff pressure, blood flow and exercise was assessed by determining AOP at rest and during plantar flexion exercise (eAOP) and subsequently measuring the blood flow response to plantar flexion exercise with BFR cuff pressure set to either 40% rAOP or 40% eAOP. Results At rest, a non-linear relationship between cuff pressure and blood flow through the SFA exhibited a plateau at moderate pressures, with non-significant differences in blood flow (~9%, P = 1.0) appearing between pressures ranging from 40-80% rAOP. While eAOP was greater than rAOP (229±1.5 vs. 202±1.5 mmHg, P<0.01), blood flow during plantar flexion exercise did not significantly differ (P=0.49) when applying 40% rAOP or 40% eAOP. Conclusion Blood flow through the SFA exhibits a non-linear relationship with cuff pressure, such that cuff pressures in the range of 40-80% rAOP reduce blood flow to approximately the same degree. BFR interventions opting for lower (e.g. 40% AOP), more comfortable pressures will likely provide an ischemic stimulus comparable to that of higher (80% AOP), less-comfortable pressures. Corresponding Author: Jayson R. Gifford, Department of Exercise Sciences, Brigham Young University, Provo, UT, 84602, jaysongifford@byu.edu The results of the present study do not constitute endorsement by ACSM. This study was funded in by an IRA Fulton College of Life Sciences Grant, and by the BYU Inspiring Learning Funds. The authors have no conflicts of interest to report. Accepted for Publication: 4 September 2019 © 2019 American College of Sports Medicine

Diet and Exercise Training Influence Skeletal Muscle Long-Chain acyl-CoA Synthetases Introduction Long-chain acyl-CoA synthetases (ACSLs) are implicated as regulators of oxidation and storage of fatty acids within skeletal muscle; however, to what extent diet and exercise alter skeletal muscle ACSLs remains poorly understood. Purpose To determine effects of diet and exercise training on skeletal muscle ACSLs and examine relationships between ACSL1 and ACSL6 and fat oxidation and fat storage, respectively. Methods Male C57BL/6J mice consumed a 60% high-fat diet (HFD) for 12 weeks to induce obesity compared with low-fat diet (LFD). At week 4, mice began aerobic exercise (EX-Tr) or remained sedentary (SED) for 8 weeks. At week 12, protein abundance of 5 known ACSL isoforms and mRNA expression for ACSL1 and ACSL6 were measured in gastrocnemius muscle, as was skeletal muscle lipid content. Fat oxidation was measured using metabolic cage indirect calorimetry at week 10. Results Of 5 known ACSL isoforms, 4 were detected at the protein level. HFD resulted in greater, yet non-significant, ACSL1 protein abundance (+18%, P=0.13 vs. LFD), greater ACSL6 (+107%, P<0.01 vs. LFD), and no difference in ACSL4 or ACSL5. Exercise training resulted in greater ACSL6 protein abundance in LFD mice (P=0.05 LFD EX-Tr vs. SED) while ACSL4 was lower following exercise training compared with sedentary, regardless of diet. Under fasted conditions, skeletal muscle ACSL1 protein abundance was not related to measures of whole-body fat oxidation. Conversely, skeletal muscle ACSL6 protein abundance was positively correlated with intramyocellular lipid content (P<0.01, r2=0.22). Conclusion We present evidence that ACSL isoforms 1, 4 and 6 may undergo regulation by HFD and/or exercise training. We further conclude increased skeletal muscle ACSL6 may facilitate increased intramyocellular fat storage during HFD-induced obesity. Corresponding Author: Sean A. Newsom, Ph.D., 118E Milam Hall, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR. sean.newsom@oregonstate.edu. P. (541) 737-1613 The results of the present investigation do not constitute endorsement by the American College of Sports Medicine. We declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Disclosures: The authors have no conflict of interest to declare. Grants: This project was partly supported by the American College of Sports Medicine Northwest Regional Student Research Grant awarded to H.D.S. The mouse project was supported by DK103829 from the National Institutes of Health awarded to M.M.R. S.A.N. is supported by KL2TR002370 as part of the Oregon Clinical & Translational Research Institute Clinical Translational Science Award UL1TR002371 from the National Institutes of Health. H.D.S. and S.E.E. are supported by fellowships from Oregon State University. Accepted for Publication: 9 September 2019. © 2019 American College of Sports Medicine

MICT or HIIT ± RT Programs for Altering Body Composition in Postmenopausal Women Purpose To compare body composition changes induced by moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), or HIIT + resistance training (RT) programs (3 days/week, 12 weeks) in postmenopausal women with overweight/obesity, and to determine whether fat mass reduction is related to greater fat oxidation (FatOx). Methods Participants (n=27) were randomized in three groups: MICT (40min at 55-60% of peak power output, PPO), HIIT (60 x 8s at 80-90% of peak heart rate, 12s active recovery), and HIIT + RT (HIIT + 8 whole-body exercises: 1 set of 8-12 repetitions). DXA was used to measure whole-body and abdominal/visceral fat mass (FM) and fat-free mass (FFM). FatOx was determined at rest, during a moderate-intensity exercise (40min at 50% of PPO), and for 20 minutes post-exercise, before and after training. Results Overall, energy intake and physical activity levels did not vary from the beginning to the end of the intervention. Body weight and total FM decreased in all groups over time, but significant abdominal/visceral FM losses were observed only in HIIT and HIIT + RT groups. When expressed in percentage, total FM, FFM, and muscle mass were significantly modified only by HIIT + RT training. FatOx did not change at rest, but increased similarly in the three groups during and after exercise. Therefore, the HIIT-induced greater FM loss was not related to higher FatOx during or after exercise. Conclusions MICT or HIIT ± RT could be proposed to non-dieting postmenopausal women with overweight/obesity to decrease weight and whole-body FM. The HIIT programs were more effective than MICT in reducing abdominal/visceral FM. RT addition did not potentiate this effect, but increased the percentage of muscle mass. Corresponding author: Professor Nathalie Boisseau (PhD). Laboratoire des Adaptations Métaboliques à l’Exercice en conditions Physiologiques et Pathologiques (AME2P), 3 rue de la Chebarde, 63171, Aubière Cedex, France. Email:nathalie.boisseau@uca.fr The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare that they have no competing interests. The MATISSE Study was funded by the University of Clermont Auvergne (AME2P laboratory). The funders had no role in the study design, the collection, analysis, and interpretation of data, the writing of the manuscript, and the decision to submit the article for publication. Accepted for Publication: 6 September 2019. © 2019 American College of Sports Medicine