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

Individualized Relative Intensity Physical Activity Accelerometer Cut-points Purpose Physical activity (PA) intensity is expressed as either absolute or relative intensity. Absolute intensity refers to the energy required to perform an activity. Relative intensity refers to a level of effort that takes into account how hard an individual is working relative to their maximum capacity. We sought to develop methods for obtaining individualized relative intensity accelerometer cut-points using data from a maximal graded exercise treadmill test (GXT) so that each individual has their own cut-point. Methods 2363 men and women aged 38 to 50 years from the CARDIA Fitness Study wore Actigraph 7164 accelerometers during a maximal GXT and for seven consecutive days in 2005-2006. Using mixed-effects regression models, we regressed accelerometer counts on heart rate as a percentage of maximum (%HRmax) and on rating of perceived exertion (RPE). Based on these two models, we obtained a moderate intensity (%HRmax=64% or RPE=12) count cut-point that is specific to each participant. We applied these subject-specific cut-points to the available CARDIA accelerometer data. Results Using RPE, the mean moderate-intensity accelerometer cut-point was 4004 (SD=1120) counts per minute (cts/min). On average, cut-points were higher for men (4189 cts/min) versus women (3865 cts/min), and were higher for Whites (4088 cts/min) versus African Americans (3896 cts/min). Cut-points were correlated with BMI (rho=-0.11) and GXT duration (rho=0.33). Mean daily minutes of absolute and relative intensity moderate-to-vigorous PA (MVPA) were 34.1 (SD=31.1) min/day and 9.1 (SD=18.2) min/day, respectively. RPE cut-points were higher than those based on %HRmax. This is likely due to some participants ending the GXT prior to achieving their maximum heart rate. Conclusions Accelerometer-based relative intensity PA may be a useful measure of intensity relative to maximal capacity. Address correspondence to: Juned Siddique, Department of Preventive Medicine, Northwestern, University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611; Email:siddique@northwestern.edu The Coronary Artery Risk Development in Young Adults Study (CARDIA) is supported by contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C from the National Heart, Lung, and Blood Institute (NHLBI), the Intramural Research Program of the National Institute on Aging (NIA), and an intra-agency agreement between NIA and NHLBI (AG0005). JS, DA, SM, SS, and PF were supported by NHLBI grant R01 HL131606. WW was supported by NCI grant T32 CA193193. The CARDIA Fitness Study was funded by NHLBI grant R01 HL078972. Dr. Freedson has served as a paid consultant for ActiGraph. The remaining authors have no conflicts of interest to disclose. Results of the present study do not constitute endorsement by ACSM. Results are presented clearly (as possible), honestly, and without fabrication, falsification or inappropriate data manipulation. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the NHLBI; the National Institutes of Health; or the U.S. Department of Health and Human Services. Accepted for Publication: 26 August 2019 © 2019 American College of Sports Medicine

Moderators of Exercise Effects on Cancer-related Fatigue: A Meta-analysis of Individual Patient Data Purpose Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCTs) to investigate moderators of exercise intervention effects on cancer-related fatigue. Methods We used individual patient data from 31 exercise RCTs worldwide, representing 4,366 patients, of whom 3,846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z-score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test. Results Exercise interventions had statistically significant beneficial effects on fatigue (β= -0.17 [95% confidence interval (CI) -0.22;-0.12]). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference= -0.18 [95%CI -0.28;-0.08]). Supervised interventions with a duration ≤12 weeks showed larger effects on fatigue (β= -0.29 [95% CI -0.39;-0.20]) than supervised interventions with a longer duration. Conclusions – In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration. Registration PROSPERO, CRD42013003805. Anne M. May and Laurien M. Buffart shared last authorship Corresponding author’s contact information: Dr. Laurien Buffart, Amsterdam UMC, Department of Epidemiology and Biostatistics, De Boelelaan 1089a. 1081 HV Amsterdam, The Netherlands. Phone: +31 (0)20 444 9931, Email: l.buffart@vumc.nl The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and results of the present study do not constitute endorsement by ACSM. Conflicts of interest: None declared. Source of funding: The POLARIS study is supported by the Bas Mulder Award, granted to L.M. Buffart by the Alpe d’HuZes foundation/Dutch Cancer Society (VU2011-5045). The contribution of J.K. van Vulpen is financially supported by the World Cancer Research Fund The Netherlands (WCRF NL, project number 2013/997). Accepted for Publication: 26 July 2019. © 2019 American College of Sports Medicine

Effects of Exercise on Plantar Pressure during Walking in Children with Overweight/Obesity Purpose To investigate the effect of a 13-week exercise program, based on “movement quality” and “multigames” work, on plantar pressure during walking in children with overweight/obesity (OW/OB). Method Seventy children (10.8 ± 1.2 years, 58.5% girls) with OW/OB, as defined by the World Obesity Federation, were assigned to either a 13-week exercise program (intervention group [EG]; n=39), or to a usual lifestyle control group (CG) (n=31). Children underwent assessments of basic anthropometry (weight and height) and plantar pressure during walking before and after the intervention period, recording plantar surface area (cm2), maximum force (N), and force-time integrals (N/s). Results After the 13-week intervention period, the EG participants showed no significant change in total plantar surface area, while the CG participants experienced an increase in this variable (small effect size: -2.5 SDs; p=0.015). Compared to the GC participants, the EG participants showed a greater increase in the maximum force supported beneath the forefoot during walking at the end of the intervention period (small effect size: 0.33 SDs; p=0.012), specifically under the lateral and medial forefoot (both p<0.05). Force-time changed similarly in both groups by the end of the intervention period (all regions p>0.05). Conclusions These results suggest the exercise program led to positive structural and functional changes in plantar pressure during walking. The increase in maximum force supported by the forefoot in the EG children might indicate a change towards a more normal foot rollover pattern and a more adult gait. Corresponding author: Pablo Molina-Garcia, Department of Physical and Sports Education, Faculty of Sports Science, University of Granada, Carretera de Alfacar s/n, Granada 18071, Spain. Tel. +34 958 244353. E-mail: pablomolinag5@ugr.es This study was funded by the Spanish Ministry of Economy and Competitiveness/FEDER (DEP2013-47540, DEP2016-79512-R, RYC-2011-09011). JM-G and JHM were funded by the Spanish Ministry of Education, Culture and Sport (FPU14/06837 and FPU15/02645, respectively). IE-C was funded by a grant from the Alicia Koplowitz Foundation. CC-S was funded by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). PM-G was funded by a grant from European Union’s Horizon 2020 research and innovation program (No 667302). Additional support was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health (UCEES); the SAMID III network, RETICS, the PN I+D+I 2017-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022), and the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005-00046/ACTI). The results of the present study do not constitute endorsement by the American College of Sports Medicine. CONFLICTS OF INTEREST: None to declare. Accepted for Publication: 30 August 2019 © 2019 American College of Sports Medicine

Exercise Core Temperature Response with a Simulated Burn Injury: Effect of Body Size Although the severity of a burn injury is often associated with the percentage of total body surface area burned (%TBSA), the thermoregulatory consequences of a given %TBSA injury do not account for the interactive effects of body morphology and metabolic heat production (Hprod). Purpose Using a simulated burn injury model to mimic the detrimental effect of a 40% TBSA injury on whole-body evaporative heat dissipation, core temperature response to exercise in physiologically uncompensable conditions between morphologically-disparate groups were examined at (i) an absolute Hprod (watts, W), and (ii) a mass-specific Hprod (watts per kilogram of body mass, W·kg−1). Methods Healthy, young, non-burned individuals of small (SM, n = 11) or large (LG, n = 11) body size cycled for 60 min at 500 W or 5.3 W·kg-1 of Hprod in 39°C and 20% relative humidity conditions. A 40% burn injury was simulated by affixing a highly absorbent, vapor-impermeable material across the torso (20% TBSA), arms (10% TBSA), and legs (10% TBSA) to impede evaporative heat loss in those regions. Results While the elevation in core temperature was greater in SM compared to LG at a Hprod of 500 W (SM: 1.69 ± 0.26°C, LG: 1.05 ± 0.26°C, P < 0.01), elevations in core temperature were not different at a Hprod of 5.3 W·kg-1 between groups (SM: 0.99 ± 0.32°C, LG: 1.05 ± 0.26°C, P = 0.66). Conclusion These data suggest that among individuals with a 40% TBSA burn injury, a smaller body size leads to exacerbated elevations in core temperature during physical activities eliciting the same absolute Hprod (non-weight-bearing tasks) but not activities eliciting the same mass-specific Hprod (weight-bearing tasks). 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.). 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: 6 September 2019 © 2019 American College of Sports Medicine

The Anthropometry of Economical Running The influence of anthropometry and body composition on running economy is unclear, with previous investigations involving small relatively homogeneous groups of runners and limited anthropometric/composition measurements. Purpose To comprehensively investigate the relationships of anthropometry and body composition with running economy within a large heterogeneous sample of runners. Methods Eighty-five runners (Males (M), n=45; Females (F) n=40), of diverse competitive standard, performed a discontinuous protocol of incremental treadmill running (4 min stages, 1 km·h-1 increments) to establish locomotory energy cost (LEc) of running at submaximal speeds (averaged across 10-12 km·h-1; the highest common speed < lactate turnpoint). Measurements of anthropometry, including segment lengths, perimeters, masses and moments of inertia (MoI), and body composition were obtained using tape-based measurements and dual-energy x-ray absorptiometry (DXA). Results Absolute LEc (ABSLEc, kcal·km-1) was positively correlated with 21 (out of 27) absolute anthropometric variables in both male and female cohorts. Multiple regression analysis revealed that one variable (mean perimeter z-score) explained 49.4% (M) and 68.9% (F) of the variance in ABSLEc. Relative LEc (RELLEc, kcal·kg-1·km-1) was also correlated with 5 (M) and 7 (F) normalised anthropometric variables, and regression analysis explained 31.6% (M; percentage bone mass and normalised hip perimeter) and 33.3% (F, normalised forearm perimeter) of the variance in RELLEc. Conclusions These findings provide novel and robust evidence that anthropometry and body composition variables, predominantly indicative of relative slenderness, explain a considerable proportion of the variance in running economy (i.e., more slender, lower energy cost). We therefore recommend that runners and coaches are attentive to relative slenderness in selecting and training athletes with the aim of enhancing running economy, and improving distance running performance. Address for Correspondence: Jonathan P. Folland, Ph.D, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, United Kingdom. Tel: +44 (0)1509 226 334, E-mail: J.P.Folland@lboro.ac.uk This work was financially supported by MAS Holdings, Sri Lanka. None of the authors have any conflict of interest to disclose. The results of the present study do not constitute endorsement by ACSM. We declare that the results of the present study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 September 2019 © 2019 American College of Sports Medicine

Longitudinal Associations between Aerobic Capacity and Academic Achievement in Youth Introduction Data from clinical trials have justified the promotion of fitness as a means to enhance facets of cognitive control and academic achievement in youth. However, such associations, when tested under real-world conditions, are equivocal. The purpose of this study, therefore, was to evaluate longitudinal associations between aerobic capacity (AC), weight status, and academic achievement within a large urban county. Methods Longitudinal data were obtained from a sample of third, fifth, and seventh grade students in schools within an urban county in Georgia. Data on body mass index (BMI) were available from 11639 students; AC data from 5735 students. Data on both indicators were obtained through the established FitnessGram assessment battery with two-year changes calculated using standardized Z scores. Academic achievement data were available from three subjects (math, science, and reading) for 3rd, 5th, and 7th grade students and two-year changes were computed using changes in Z scores for each test. Data were analyzed using generalized logistic models to test associations between change in BMI and AC in relation to changes in academic achievement. Results Positive associations were observed between improvements in weight status and academic achievement for the 5th grade boys and girls ([reading] OR=1.47; CI=1.25,1.72 [science] OR=1.22, CI= 1.04,1.42). Maintaining weight status was associated with improved scores in the 3rd grade ([math] OR=1.16, CI=1.012-1.327, [reading] OR=1.47 CI=1.25,1.72) and 5th grade cohorts (math OR=1.20 CI=1.00.1.43). For AC, no significant associations were found for any age cohort. Conclusions Modest associations between improvements in weight status, AC, and academic achievement are noteworthy, despite the lack of statistical significance for AC. The results provide a robust evaluation of associations between fitness and academic achievement. Correspondence: Gabriella M. McLoughlin, PhD, Iowa State University, 247 Forker Building, Department of Kinesiology, 534 Wallace Rd, Ames IA 50011, gmclough@iastate.edu The results of this study are presented clearly, honestly, and without fabrication, falsification, 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 report. This research was supported by the Georgia Shape foundation who coordinated all data collection and sharing procedures. Accepted for Publication: 4 September 2019 © 2019 American College of Sports Medicine

Dysregulated Inflammatory Response Related to Cartilage Degradation after ACL Injury Purpose Elevated synovial fluid concentrations of pro-inflammatory cytokines, degradative enzymes, and cartilage breakdown markers at the time of anterior cruciate ligament (ACL) reconstruction are associated with worse postoperative patient-reported outcomes and cartilage quality. However, it remains unclear if this is due to a more robust or dysregulated inflammatory response or is a function of a more severe injury. The objective of this study was to evaluate the association of the molecular composition of the synovial fluid, patient demographics and injury characteristics to cartilage degradation after acute ACL injury. Methods We performed a cluster analysis of synovial fluid (SF) concentrations of pro- and anti-inflammatory cytokines, and biomarkers of cartilage degradation, bony remodeling, and hemarthrosis. We evaluated the association of biomarker clusters with patient demographics, days between injury, VAS pain, SF aspirate volumes and bone bruise volumes measured on MRI. Results Two clusters were identified from the 35 patients included in this analysis; Dysregulated Inflammation and Low Inflammation. The Dysregulated Inflammation cluster consisted of 10 patients and demonstrated significantly greater concentrations of biomarkers of cartilage degradation (p<0.05) as well as a lower ratio of anti-inflammatory to pro-inflammatory cytokines (p=0.053) when compared to the Low Inflammation cluster. Patient demographics, bone bruise volumes, SF aspirate volumes, pain, and concomitant injuries did not differ between clusters. Conclusion A subset of patients exhibited dysregulation of the inflammatory response following acute ACL injury which may increase the risk of posttraumatic osteoarthritis. This response does not appear to be a function of injury severity. Correspondence: Cale Jacobs, 740 S. Limestone, Suite K401, Lexington, KY 40536-0284, Phone: (859) 797-8197, Fax: (859) 323-2412, Email: cale.jacobs@uky.edu This study received funding from The Arthritis Foundation of America. Dr. Lattermann was supported by a K-23 career development award from the NIH-NIAMS (5K23AR060275). Data collection and study administration was supported by the University of Kentucky CTSA award (UL1TR000117). Results of the present study do not constitute endorsement by the American College of Sports Medicine, and the authors declare no conflicts of interest. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 3 September 2019 © 2019 American College of Sports Medicine