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Breenfeldt Andersen A, Bejder J, Bonne TC, Graae J, Seier S, Nordsborg NB. Changes in Immature Reticulocytes Aid the Indirect Detection of Microdose Recombinant Erythropoietin Use in Men and Women. Med Sci Sports Exerc 2023; 55:1695-1705. [PMID: 37095637 DOI: 10.1249/mss.0000000000003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE We investigated whether immature reticulocyte fraction (IRF) and the immature reticulocytes to red blood cells ratio (IR/RBC) are sensitive and specific biomarkers for microdose recombinant human erythropoietin (rHuEPO) and whether the inclusion of reticulocyte percentage (RET%) and the algorithm "abnormal blood profile score (ABPS)" increased the athlete biological passport (ABP) sensitivity compared with hemoglobin concentration ([Hb]) and the OFF-hr score ([Hb]-60 × √RET%). METHODS Forty-eight (♀ = 24, ♂ = 24) participants completed a 2-wk baseline period followed by a 4-wk intervention period with three weekly intravenous injections of 9 IU·kg -1 ·bw -1 epoetin β (♀ = 12, ♂ = 12) or saline (0.9% NaCl, ♀ = 12, ♂ = 12) and a 10-d follow-up. Blood samples were collected weekly during baseline and intervention as well as 3, 5, and 10 d after treatment. RESULTS The rHuEPO treatment increased [Hb] (time-treatment, P < 0.001), RET% (time-treatment, P < 0.001), IRF (time-treatment, P < 0.001) and IR/RBC (time-treatment, P < 0.001). IRF and IR/RBC were up to ~58% ( P < 0.001) and ~141% ( P < 0.001) higher compared with placebo, and calculated thresholds provided a peak sensitivity across timepoints of 58% and 54% with ~98% specificity, respectively. To achieve >99% specificity for IRF and IR/RBC, sensitivity was reduced to 46% and 50%, respectively. Across all timepoints, the addition of RET% and ABPS to the ABP increased sensitivity from 29% to 46%. Identification of true-positive outliers obtained via the ABP and IRF and IR/RBC increased sensitivity across all timepoints to 79%. CONCLUSIONS In summary, IRF, IR/RBC, RET% and ABPS are sensitive and specific biomarkers for microdose rHuEPO in both men and women and complement the ABP.
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Affiliation(s)
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | | | - Jonathan Graae
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
| | - Søren Seier
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, DENMARK
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Krumm B, Botrè F, Saugy JJ, Faiss R. Future opportunities for the Athlete Biological Passport. Front Sports Act Living 2022; 4:986875. [PMID: 36406774 PMCID: PMC9666424 DOI: 10.3389/fspor.2022.986875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
The Athlete Biological Passport (ABP) was introduced to complement the direct anti-doping approach by indirectly outlining the possible use of prohibited substances or methods in sports. The ABP proved its effectiveness, at least through a deterrent effect, even though the matrices used for longitudinal monitoring (urine and blood) are subject to many intrinsic (e.g., genetic) and extrinsic (e.g., environmental conditions) confounding factors. In that context, new and more specific biomarkers are currently under development to enhance both the sensitivity and the specificity of the ABP. Multiple strategies are presently being explored to improve this longitudinal monitoring, with the development of the current modules, the investigation of new strategies, or the screening of new types of doping. Nevertheless, due to the variability induced by indirect biomarkers, the consideration of confounding factors should continuously support this research. Beyond tremendous advances in analytical sensitivity, machine learning-based approaches seem inevitable to facilitate an expert interpretation of numerous biological profiles and promote anti-doping efforts. This perspective article highlights the current innovations of the Athlete Biological Passport that seem the most promising. Through different research axes, this short manuscript provides an opportunity to bring together approaches that are more widely exploited (e.g., omics strategies) and others in the early stages of investigation (e.g., artificial intelligence) seeking to develop the ABP.
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Affiliation(s)
- Bastien Krumm
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francesco Botrè
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland,Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Jonas J. Saugy
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Research and Expertise in Anti-Doping Sciences, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland,*Correspondence: Raphael Faiss
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BREENFELDT ANDERSEN ANDREAS, BEJDER JACOB, BONNE THOMASC, SØRENSEN HENRIK, SØRENSEN HELLE, JUNG GRACE, GANZ TOMAS, NEMETH ELIZABETA, SECHER NIELSH, JOHANSSON PÄRI, NORDSBORG NIKOLAIBAASTRUP. Hepcidin and Erythroferrone Complement the Athlete Biological Passport in the Detection of Autologous Blood Transfusion. Med Sci Sports Exerc 2022; 54:1604-1616. [DOI: 10.1249/mss.0000000000002950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Krumm B, Faiss R. Factors Confounding the Athlete Biological Passport: A Systematic Narrative Review. SPORTS MEDICINE - OPEN 2021; 7:65. [PMID: 34524567 PMCID: PMC8443715 DOI: 10.1186/s40798-021-00356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Through longitudinal, individual and adaptive monitoring of blood biomarkers, the haematological module of the athlete biological passport (ABP) has become a valuable tool in anti-doping efforts. The composition of blood as a vector of oxygen in the human body varies in athletes with the influence of multiple intrinsic (genetic) or extrinsic (training or environmental conditions) factors. In this context, it is fundamental to establish a comprehensive understanding of the various causes that may affect blood variables and thereby alter a fair interpretation of ABP profiles. METHODS This literature review described the potential factors confounding the ABP to outline influencing factors altering haematological profiles acutely or chronically. RESULTS Our investigation confirmed that natural variations in ABP variables appear relatively small, likely-at least in part-because of strong human homeostasis. Furthermore, the significant effects on haematological variations of environmental conditions (e.g. exposure to heat or hypoxia) remain debatable. The current ABP paradigm seems rather robust in view of the existing literature that aims to delineate adaptive individual limits. Nevertheless, its objective sensitivity may be further improved. CONCLUSIONS This narrative review contributes to disentangling the numerous confounding factors of the ABP to gather the available scientific evidence and help interpret individual athlete profiles.
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Affiliation(s)
- Bastien Krumm
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael Faiss
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
- Center of Research and Expertise in Anti-Doping Sciences - REDs, University of Lausanne, Lausanne, Switzerland.
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Alberty R, PupiŠ M, VachalÍk V, BÁtovskÝ M. Diurnal variation in red blood cell variables in athletes after single and repeated bouts of exercise. J Sports Med Phys Fitness 2020; 61:269-279. [PMID: 33092322 DOI: 10.23736/s0022-4707.20.11174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to examine the diurnal and exercise-related changes in red blood cell variables which serve as indirect markers of doping in sports. METHODS Ten men and 7 women, all undoped highly trained endurance athletes aged 19-34 years, were included in the study. Before and on the day with single and repeated bouts of exercise, blood samples were collected at 07:00, 09:00, 13:00, 18:00, and 21:00, at least 2 hours after exercise. Hemoglobin (Hb), hematocrit (Hct), and the reticulocytes % (Ret%) were determined by flow cytometry. Changes in OFF-hr score were also calculated and repeated-measures ANOVA was used to compare diurnal differences. RESULTS In overall, the mean Hb decreased continuously by 4.5 and 3.3% (all P<0.001) over the day with single and repeated bouts of exercise, respectively. Corresponding values for the decline in Hct were 4.2 and 5.9% (all P<0.001). In contrast, the Ret% showed no apparent diurnal rhythm but single and repeated bouts of exercise increased the relative Ret% in the evening by 12.4 and 16.7% (P<0.01), respectively. Then the calculated OFF-hr score was reduced by 6.2 and 9.8% (all P<0.01) at the end of the day. CONCLUSIONS These results confirmed the normal diurnal pattern in the examined red blood cell variables in response to exercise in highly trained athletes. Furthermore, they showed noticeable between-subject variability and the possible risk of a false suspicion of blood doping in undoped athletes after repeated bouts of exercise.
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Affiliation(s)
- Roman Alberty
- Department of Biology and Ecology, Matej Bel University, Banská Bystrica, Slovakia -
| | - Martin PupiŠ
- Department of Physical Education and Sports, Matej Bel University, Banská Bystrica, Slovakia
| | - Vladimír VachalÍk
- Diagnostic Laboratory, Military Sports Center Dukla, Banská Bystrica, Slovakia
| | - Miloš BÁtovskÝ
- Diagnostic Laboratory, Military Sports Center Dukla, Banská Bystrica, Slovakia
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Mullen J, Bækken L, Bergström H, Björkhem Bergman L, Ericsson M, Ekström L. Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle. Drug Test Anal 2020; 12:1229-1240. [DOI: 10.1002/dta.2873] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Jenny Mullen
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
| | - Lasse Bækken
- Nordic Athlete Passport Management Unit Anti‐Doping Norway, Sognsveien Oslo Norway
| | - Helena Bergström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden
| | - Linda Björkhem Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden
| | - Magnus Ericsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
| | - Lena Ekström
- Department of Laboratory Medicine, Division of Clinical Pharmacology Karolinska Institutet Karolinska University Hospital, Stockholm Sweden
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Robinson N, Saugy J, Schütz F, Faiss R, Baume N, Giraud S, Saugy M. Worldwide distribution of blood values in elite track and field athletes: Biomarkers of altered erythropoiesis. Drug Test Anal 2018; 11:567-577. [DOI: 10.1002/dta.2526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Neil Robinson
- Swiss Laboratory for Doping Analyses (LAD), University Centre of Legal Medicine, Lausanne and GenevaCentre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland
| | - Jonas Saugy
- Centre of Research and Expertise in anti‐Doping sciences ‐ REDsUniversity of Lausanne Switzerland
| | - Frédéric Schütz
- Bioinformatics Core Facility; SIB Swiss Institute of Bioinformatics Lausanne Switzerland
- Centre for Integrative GenomicsUniversity of Lausanne Switzerland
| | - Raphael Faiss
- Centre of Research and Expertise in anti‐Doping sciences ‐ REDsUniversity of Lausanne Switzerland
| | - Norbert Baume
- Swiss Laboratory for Doping Analyses (LAD), University Centre of Legal Medicine, Lausanne and GenevaCentre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland
| | - Sylvain Giraud
- Swiss Laboratory for Doping Analyses (LAD), University Centre of Legal Medicine, Lausanne and GenevaCentre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland
| | - Martial Saugy
- Swiss Laboratory for Doping Analyses (LAD), University Centre of Legal Medicine, Lausanne and GenevaCentre Hospitalier Universitaire Vaudois and University of Lausanne Switzerland
- Centre of Research and Expertise in anti‐Doping sciences ‐ REDsUniversity of Lausanne Switzerland
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Saugy M, Lundby C, Robinson N. Monitoring of biological markers indicative of doping: the athlete biological passport. Br J Sports Med 2014; 48:827-32. [DOI: 10.1136/bjsports-2014-093512] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sanchis-Gomar F, Lippi G. Physical activity - an important preanalytical variable. Biochem Med (Zagreb) 2014; 24:68-79. [PMID: 24627716 PMCID: PMC3936967 DOI: 10.11613/bm.2014.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/11/2013] [Indexed: 01/13/2023] Open
Abstract
The concentration of several biochemical and hematological biomarkers is strongly influenced by a number of preanalytical variables. Several lines of evidence attest that short, middle, and long-term exercise, as well as the relative intensity of physical effort (from mild to strenuous), may influence a broad array of laboratory variables. The amount of extracellular release and clearance from blood of most of these biomarkers is markedly influenced by the biological characteristics of the molecule(s), level of training, type, intensity and duration of exercise, and time of recovery after training. It is hence noteworthy that test results that fall outside the conventional reference ranges in athletes not only may reflect the presence of a given disease, but may frequently mirror an adaptation to regular training or changes that have occurred during and/or following strenuous exercise, and which should be clearly acknowledged to prevent misinterpretation of laboratory data. The aim of this narrative review is to provide an update about the most significant changes of some biochemical and hematological biomarkers in response to physical exercise, for appropriate interpretation of these changes in the context of physically active subjects.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia; Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
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Abstract
Reticulocytes are young red blood cells which develop from erythroblasts and circulate in the bloodstream for about 1-4 days before maturing into erythrocytes. With the introduction of reticulocyte count in equations and statistical models for detecting suspected blood doping, its application to sports medicine has attracted growing interest in reticulocyte behavior during training and competition seasons in athletes and experimental blood doping treatment in healthy volunteers. An update on recent publications is therefore needed to improve the interpretation of reticulocyte analysis and its variability in sportsmen. Reticulocyte count constitutes a robust parameter during the preanalytical phase, but cell stability can be assured only if blood samples are kept at constantly cold temperatures (4 degrees C) and test results will differ depending on the blood analyzer system used. Marked intraindividual variability is the principal finding to be evaluated when exercise-induced changes are observed or illicit procedures suspected. Furthermore, reticulocyte variability is greater than that of other hematological parameters such as hemoglobin or hematocrit. Ideally, any variation should be interpreted against long-term time series for the individual athlete: values obtained from large athlete cohorts ought to be used only for extrapolating outliers that deserve further examination. Reticulocyte distribution in athletes is similar to that found in the general population, and a gender effect in some sports disciplines or selected athlete groups may be seen. Reticulocyte variability is strongly influenced by seasonal factors linked to training and competition schedules and by the type of sports discipline. Published experimental data have confirmed the high sensitivity of reticulocyte analysis in identifying abnormal bone marrow stimulation by either erythropoietin administration or blood withdrawal and reinfusion.
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Anemia, heart failure and exercise training. Int J Cardiol 2012; 165:587-8. [PMID: 23031281 DOI: 10.1016/j.ijcard.2012.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/03/2012] [Accepted: 09/15/2012] [Indexed: 11/22/2022]
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DÍAZ V, LOMBARDI G, RICCI C, JACOBS RA, MONTALVO Z, LUNDBY C, BANFI G. Reticulocyte and haemoglobin profiles in elite triathletes over four consecutive seasons. Int J Lab Hematol 2011; 33:638-44. [DOI: 10.1111/j.1751-553x.2011.01348.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanchis-Gomar F, Martinez-Bello VE, Gomez-Cabrera MC, Viña J. Current limitations of the Athlete's Biological Passport use in sports. Clin Chem Lab Med 2011; 49:1413-5. [PMID: 21619474 DOI: 10.1515/cclm.2011.609] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Athletes Biological Passport (ABP) has received both criticisms and support during this year. In a recent issue of The Lancet, Michael Wozny considered that the use of the ABP makes it more difficult to take banned substances and that it was successfully used against the Italian elite cyclist Franco Pellizotti. After that, Italy's anti-doping tribunal considered that there was not enough evidence to prove manipulation of his own blood profile in Pellizotti's case. However, the UCI appealed to the Court of Arbitration for Sport (CAS) that sanctioned Pellizotti with a suspension of 2 years. Since its implementation, some problems have emerged. From 2010 to date, a large number of reports regarding the stability of the blood variables used to determine the ABP have been published, showing mixed results. This study considers that there is a risk of misinterpreting the physiological variations of the hematological parameters determined by the anti-doping authorities in the ABP. The analytical variability due to exercise training and competitions and/or to different metabolic energy demands, hypoxia treatments, etc. could lead to an increase in false-positives when using the ABP with the dramatic consequences that they might cause in major sports events like the forthcoming London Olympic Games. Moreover, the ABP characteristics, procedures, thresholds, or individual determination of reference ranges, abnormal out-comes, strikes, "how the profile differs from what is expected in clean athletes" should be clearly stated and explained in a new public technical document to avoid misunderstandings and to promote transparency.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia, Fundacion Investigacion Hospital Clinico Universitario/INCLIVA, Spain
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Ashenden M, Gough CE, Garnham A, Gore CJ, Sharpe K. Current markers of the Athlete Blood Passport do not flag microdose EPO doping. Eur J Appl Physiol 2011; 111:2307-14. [DOI: 10.1007/s00421-011-1867-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/03/2011] [Indexed: 11/28/2022]
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Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2011; 3:1-14. [DOI: 10.1002/dta.245] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/19/2010] [Indexed: 12/13/2022]
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Schumacher YO, Sahm D, Baumstark MW, Pottgiesser T. Reticulocytes in athletes: Longitudinal aspects and the influence of long- and short-term exercise. Drug Test Anal 2010; 2:469-74. [DOI: 10.1002/dta.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Preanalytical variability: the dark side of the moon in blood doping screening. Eur J Appl Physiol 2010; 109:1003-5. [PMID: 20333397 DOI: 10.1007/s00421-010-1437-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2010] [Indexed: 10/19/2022]
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