The Effects of Transcranial Direct Current Stimulation on Chronic Ankle Instability Purpose Given maladaptive neuroplasticity following musculoskeletal injury, interventions capable of restoring corticospinal excitability should be considered. We therefore aimed to determine if 4-weeks of anodal transcranial direct current stimulation (aTDCS) with eccentric exercise would improve neural excitability, functional performance, and patient-reported function in individuals with chronic ankle instability (CAI). Methods Twenty-six individuals with CAI were recruited to undergo 4-weeks of eccentric evertor strengthening. Subjects were randomized into aTDCS (n=13) and sham (n=13) groups, where the aTDCS group received 18-minutes of aTDCS (1.5mA) over the primary motor cortex. Participants were assessed for cortical excitability, dynamic balance & muscle activation, functional performance & strength, and patient-reported function at baseline, week-2, week-4, and week-6. Results Twenty-two subjects completed the training and test sessions. Cortical excitability (resting motor threshold) to peroneus longus in aTDCS increased from baseline (36.92±11.53) to week-6 (32.91±12.33, p=0.024), while sham increased excitability from baseline (36.67±12.74) to week-2 (27.86±14.69, p=0.007), but decreased at week-4 (35.63±13.10, p=0.022) & week-6 (35.99±13.52, p=0.006). Dynamic balance and muscle activation also improved in the aTDCS group from baseline to week-6 (p=0.034). Functional performance on a side-hop test increased in all participants from baseline to week-2 (p=0.003). The aTDCS group had decreased perceived disablement from week-2 (18.09±6.41) to week-4 (15.55±4.82, p=0.046), whereas the sham group reported increased disablement from baseline (17.91±4.59) to week-2 (21.00±8.52, p=0.047). Conclusions Our results provide preliminary evidence that 4-weeks of eccentric training with aTDCS improves cortical excitability, functional performance, and patient-reported function in individuals with CAI. These data are the first to show the efficacy of non-invasive brain stimulation therapies in patients with musculoskeletal injury, and demonstrates the link between improved neural excitability and functional outcomes. Corresponding Author: Alan R. Needle, Ph.D., ATC, CSCS, ASU Box 32071, 1179 State Farm Rd. Boone, NC 28608, Office: 828-262-4039; Fax: 828-262-3138, needlear@appstate.edu Funding for this study was provided by the Appalachian State University Research Council. Conflict of Interest Statement: The authors have no conflicts of interest to disclose relative to the results of this study. The results of this 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 omission. Accepted for Publication: 8 August 2019. © 2019 American College of Sports Medicine

Breaking Up Sedentary Behavior Optimally to Enhance Mood Introduction Experimental evidence shows that breaking-up sedentary behavior is positively associated with positive mental health outcomes. However, whether sedentary breaks influence mood in everyday life is largely unknown. Moreover, it is unclear which break patterns are most beneficial to enhance mood. Methods To investigate the degree to which sedentary break patterns influence mood dimensions in everyday life, we conducted an Ecological Momentary Assessment (EMA) study in 92 university employees over 5 days. We continuously measured physical behavior (physical activity and sedentary behavior) objectively via accelerometers and assessed mood 10 times a day on smartphone diaries. We defined distinct break patterns, such as variations in frequency (number of breaks), duration (length of breaks), intensity (metabolic equivalent) and context (home or work), and used multilevel modeling to analyze the within-subject effects of sedentary break patterns on mood. Results Break intensity was positively associated with subsequent valence (P< 0.01), energetic arousal (P< 0.01) and calmness (P< 0.05). Break frequency was positively associated with subsequent valence and energetic arousal (all Ps < 0.01), but break duration was not associated with mood. Exploratory analyses indicated that breaking-up sedentary behavior was more beneficial at home than at work. Conclusions These ecologically valid findings suggest breaking-up sedentary behavior as a promising strategy to enhance mood in everyday life. In particular, breaking-up sedentary behavior frequently and intensively, for example by walking instead of standing, may be most beneficial. We call for future studies to substantiate these accounts and to identify both practical and optimal break patterns among different samples. This evidence informs official public health recommendations aiming to “minimize sedentary time in everyday life”. Corresponding author: Marco Giurgiu, Karlsruhe Institute of Technology (KIT), Mental mHealth Lab, Department of Sports and Sports Science, Hertzstr. 16, 76187 Karlsruhe, Telephone: +49 721 / 608-41974. Email: marco.giurgiu@kit.edu All authors declare no conflicts of interest and that the study was not funded. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Furthermore, the results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 August 2019. © 2019 American College of Sports Medicine

Activity Mapping of Children in Play Using Multivariate Analysis of Movement Events Purpose i. To develop an automated measurement technique for the assessment of both the form and intensity of physical activity undertaken by children during play. ii. To profile the varying activity across a cohort of children using a multivariate analysis of their movement patterns. Methods Ankle-worn accelerometers were used to record 40-minutes of activity during a school recess, for 24 children over 5 consecutive days. Activity events of 1.1 s duration were identified within the acceleration time trace and compared to a reference motif, consisting of a single walking stride acceleration trace, obtained on a treadmill operating at a speed of 4 km h-1. Dynamic time warping (DTW) of motif and activity events provided metrics of comparative movement duration and intensity, which formed the data set for multivariate mapping of the cohort activity using a principal component analysis (PCA). Results The 2-D PCA plot provided clear differentiation of children displaying diverse activity profiles and clustering of those with similar movement patterns. The 1st component of the PCA correlated to the integrated intensity of movement over the 40 min. period whilst the 2nd component informed on the temporal phasing of activity. Conclusion By defining movement events and then quantifying them by reference to a motion-standard, meaningful assessment of highly varied activity within free play can be obtained. This allows detailed profiling of individual children’s activity and provides an insight on social aspects of play through identification of matched activity time profiles for children participating in conjoined play. Cain. T. Clark – Present address: Centre for Sport, Exercise and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, U.K. Corresponding author: Huw D. Summers, Systems and Process Engineering Centre, College of Engineering, Swansea University, Fabian Way, Swansea SA1 8EN, U.K.; e-mail – h.d.summers@swansea.ac.uk JNR undertook this work whilst on a research visit funded by the Erasmus+ Credit Mobility Programme (2017-1-PT01-KA103-035245), C.M. Barnes was funded under a UK EPSRC Doctoral Training Grant. The results of the present study do not constitute endorsement by ACSM. The results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 16 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

Reporting of Resistance Training Dose, Adherence, and Tolerance in Exercise Oncology Purpose While general guidelines (such as CONSORT or CERT) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence and tolerance in patients with cancer. Methods A total of 47 prostate cancer patients (70.1 ± 8.9 yrs, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 weeks. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (Exercise relative dose intensity (ExRDI), dose modification, and exercise interruption). Total training volume in kilograms (repetitions x sets x training load (weight)) was calculated for each patient. Results Attendance assessed from traditional metrics was 79.5±17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean ExRDI of 77.4% ± 16.6% (range: 19.4% - 99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol. Conclusion Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence and tolerance may have important applications for future studies and clinical practice. Ciaran M. Fairman and Tormod S. Nilsen denote equal contribution to the manuscript. Corresponding Author: Professor Daniel Galvão, PhD, FACSM, Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, AUSTRALIA, T +61 8 6304 3420. F +61 8 6304 2499. Email: d.galvao@ecu.edu.au Ciaran M. Fairman is supported by an NHMRC CRE Postdoctoral Fellowship. Tormod S. Nilsen is supported by AKTIV Against Cancer. Nicolas H. Hart and Carolyn McIntyre are supported by Cancer Council of Western Australia Postdoctoral Research Fellowships. Daniel A. Galvão and Robert U. Newton are funded by a National Health and Medical Research Council Centre for Research Excellence in Prostate Cancer Survivorship. The sponsors did not participate in the design or conduct of the study; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. All authors had no conflict of interest, including relevant financial interests, activities, relationships, and affiliations to declare relating to this manuscript. The results of the study are presented clearly, honestly, without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine. 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. Accepted for Publication: 20 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

Diet Quality Is Associated with Physical Performance and Special Forces Selection Purpose This study determined associations between diet quality measured by the Healthy Eating Index (HEI)-2015, physical performance, and successful selection following a U.S. Army Special Forces Assessment and Selection (SFAS) course characterized by arduous cognitive and physical demands. Methods HEI-2015 scores were calculated from usual diet assessed with a Block food frequency questionnaire among 782 Soldiers attending SFAS. Differences in HEI-2015 scores according to demographics and physical performance were determined with analysis of variance. Differences in likelihood of selection according to HEI-2015 scores were determined with logistic regression. Models were adjusted for potential confounders: age, education, body mass index (BMI), duration and type of resistance training, and smoking. Results HEI-2015 total score was higher among older Soldiers (≥ 25 years), those with more education (≥ some college), higher BMI (≥ 25), longer duration of resistance training (≥ 400 min/week), those that reported use of free weights, suspension training, Olympic lifting, and non-smokers (p < 0.05). HEI-2015 total score was higher among those with higher Army Physical Fitness Test (APFT) total scores, APFT sit-up score, APFT run score, and faster loaded road march times (p < 0.05).Those with higher HEI-2015 total scores were 75% (quartile 3 vs. 1: OR = 1.75, 95% CI = 1.09-2.817) and 65% (quartile 4 vs. 1: OR = 1.65, 95% CI = 1.03-2.65) more likely to be selected. Higher scores for total vegetables, greens and beans, seafood and plant protein, and refined grains, but lower sodium scores (indicating more sodium consumed), were associated with better physical performance (p < 0.05). Conclusion Dietary patterns that conform to federal dietary guidelines (except sodium) are associated with physical performance and Special Forces selection. Corresponding author: Emily K. Farina, PhD, RD, U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA 01760. emily.k.farina.civ@mail.mil. (253) 229-1186 This work was supported by the US Army Medical Research and Development Command (USAMRDC). The views, opinions and findings in this report are those of the authors and should not be construed as an official Department of Defense policy, or decision, unless so designated by other official documentation. Citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of these organizations. The authors declare no conflicts of interest. Results of the present study do not constitute endorsement by the American College of Sports Medicine. Results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 9 July 2019. © 2019 American College of Sports Medicine

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