Commentary: Key Aspects of Multimodal Prehabilitation in Surgical Patients With Cancer. A Practical Approach to Integrating Resistance Exercise Programmes

Surgical prehabilitation aims to optimise patients' physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme.

Perceived Exertion: Revisiting the History and Updating the Neurophysiology and the Practical Applications

The perceived exertion construct creation is a landmark in exercise physiology and sport science. Obtaining perceived exertion is relatively easy, but practitioners often neglect some critical methodological issues in its assessment. Furthermore, the perceived exertion definition, neurophysiological basis, and practical applications have evolved since the perceived exertion construct's inception. Therefore, we revisit the careful work devoted by Gunnar Borg with psychophysical methods to develop the perceived exertion construct, which resulted in the creation of two scales: the rating of perceived exertion (RPE) and the category-ratio 10 (CR10). We discuss a contemporary definition that considers perceived exertion as a conscious perception of how hard, heavy, and strenuous the exercise is, according to the sense of effort to command the limbs and the feeling of heavy breathing (respiratory effort). Thus, other exercise-evoked sensations would not hinder the reported perceived exertion. We then describe the neurophysiological mechanisms involved in the perceived exertion genesis during exercise, including the influence of the peripheral feedback from the skeletal muscles and the cardiorespiratory system (i.e., afferent feedback) and the influence of efferent copies from the motor command and respiratory drive (i.e., corollary discharges), as well as the interaction between them. We highlight essential details practitioners should consider when using the RPE and CR10 scales, such as the perceived exertion definition, the original scales utilization, and the descriptors anchoring process. Finally, we present how practitioners can use perceived exertion to assess cardiorespiratory fitness, individualize exercise intensity prescription, predict endurance exercise performance, and monitor athletes' responses to physical training.

A Video-Based Tactical Task Does Not Elicit Mental Fatigue and Does Not Impair Soccer Performance in a Subsequent Small-Sided Game

Mental fatigue can impair physical, technical, and tactical performance in sports. Since most previous research used general cognitive tasks to elicit mental fatigue, the aim of this study was to investigate whether a more sport-specific task could induce the effects of mental fatigue and impair the subsequent physical and technical performance in a soccer small-sided game. Ten soccer players performed two small-sided games on two different days in a crossover design. Before each small-sided game, they performed a video-based tactical task (30 min) and a control task (documentary watching, 30 min) in a randomized and counterbalanced order. Mental effort was measured through a visual analog scale after the tactical and control tasks. Subjective ratings of perceived exertion were assessed through the RPE questionnaire after the end of the SSG. Physical performance was assessed during the SSG through GPS technology. Results showed no differences (p > 0.05) in physical performance between the two conditions. None of the technical variables were negatively affected by the video-based tactical condition, with the number of total passes (p = 0.003; ES = 0.72 medium) and successful passes (p = 0.003; ES = 0.82 large) results even improved by the video-based tactical task. The mental effort required by the video-tactical task was significantly higher than the control task (p = 0.002; ES = 2.09 huge). However, overall RPE did not differ between conditions. The video-based tactical task did not elicit mental fatigue and did not impair subsequent physical and technical performance. The higher ecological validity of the task and the higher motivation of the participants might have contributed to the results.

Sleep Deprivation Training to Reduce the Negative Effects of Sleep Loss on Endurance Performance: A Single Case Study

PURPOSE

Sleep deprivation (SD) is very common during ultraendurance competitions. At present, stimulants such as caffeine and naps are the main strategies used to reduce the negative effects of SD on ultraendurance performance. In this case study, the authors describe the application of a novel strategy consisting of the intermittent repetition of SD (SD training [SDT]) during the weeks preceding an ultraendurance competition.

METHODS

A male ultraendurance runner underwent a 6-week SDT program (consisting of 1 night SD every Sunday) in addition to his regular physical training program before taking part in a 6-day race. Before and after SDT, the participant performed 5 consecutive days of daily 2-hour constant-pace running with SD on the first and third night. Psychological and physiological responses were measured during this multiday test.

RESULTS

SDT was well tolerated by the athlete. A visual analysis of the data suggests that including SDT in the weeks preceding an ultraendurance competition may have beneficial effects on sleepiness and perceived mental effort in the context of 5 consecutive days of prolonged running and 2 nights of SD. This multiday test seems a feasible way for assessing ultraendurance athletes in the laboratory.

CONCLUSIONS

The results provided some encouraging initial information about SDT that needs to be confirmed in a randomized controlled trial in a group of ultraendurance athletes. If confirmed to be effective and well tolerated, SDT might be used in the future to help ultraendurance athletes and other populations that have to perform in conditions of SD.

Rating of Perceived Exertion as a Method to Determine Training Loads in Strength Training in Elderly Women: A Randomized Controlled Study

Objective: The aim of this study was to compare the effects of training using loads from a repetition maximum value (%1RM) and rating of perceived exertion (RPE) in elderly women. Methods: Twenty-five elderly women (60–75 years old) were randomly assigned to a group that trained using loads determined by 1RM test (G%; n = 12) or to a group that trained using loads determined by RPE (GPE; n = 13). Elderly women trained for 12 weeks using five exercises performed with 2–3 sets of 8–15 repetitions. Loads progressed from 45% to 75% of 1RM (G%) and from 13 to 18 from Rating Perceived Exertion of Borg Scale (GPE). The outcome measures, 1RM and maximum repetitions (RMs with 70% 1RM), were assessed before, between and after training programs. Results: Increased 1RM value and RMs were observed in both groups (20–42%, p < 0.001 and 56–76%, p < 0.001, respectively, for %G; and 17–56%, p < 0.001 and 47–106%, p < 0.001, respectively, for GPE), without differences between them. Conclusions: Prescribing loads using the RPE and 1RM might be similarly effective for training elderly women in order to promote strength gains. As a practical application, RPE could be an additional method to determine training loads. In spite of the promising results of the present study, it is not possible to state that the use of RPE is effective in monitoring loads during sub maximal strength training in elderly and more research must be carried out to confirm it.

Perceived effort for reaching is associated with self-reported fatigue

Perceived effort for goal-directed reaching may be impacted by the level of self-reported fatigue, however, the relationship between self-reported fatigue and perceived effort has not been examined. We examined how perceived effort changed under varied reach conditions and the relationship between fatigue, perceived effort and reach performance. Twenty-three young adults performed reach actions toward 9 different targets on a digitizing tablet. Perceived effort was measured using the Borg Rate of Perceived Exertion and Paas Mental Effort Rating Scale. Self-reported fatigue was quantified using the Fatigue Scales for Motor and Cognitive Functions. As reach conditions became more difficult, perceived effort increased significantly. Further, individuals who reported greater fatigue also reported greater perceived effort and showed greater endpoint error during reaching.

Interactions between perceptions of fatigue, effort, and affect decrease knee extensor endurance performance following upper body motor activity, independent of changes in neuromuscular function

Prior exercise has previously been shown to impair subsequent endurance performance in non-activated muscles. Declines in the neuromuscular function and altered perceptual/affective responses offer possible mechanisms through which endurance performance may be limited in these remote muscle groups. We thus conducted two experiments to better understand these performance-limiting mechanisms. In the first experiment, we examined the effect of prior handgrip exercise on the behavioral, perceptual, and affective responses to a sustained, sub-maximal contraction of the knee extensors. In the second experiment, transcranial magnetic stimulation was used to assess the neuromuscular function of the knee extensors before and after the handgrip exercise. The results of the first experiment demonstrated prior handgrip exercise increased the perceptions of effort and reduced affective valence during the subsequent knee extensor endurance exercise. Both effort and affect were associated with endurance performance. Subjective ratings of fatigue were also increased by the preceding handgrip exercise but were not directly related to knee extensor endurance performance. However, perceptions of fatigue were correlated with heightened effort perception and reduced affect during the knee extensor contraction. In the second experiment, prior handgrip exercise did not significantly alter the neuromuscular function of the knee extensors. The findings of the present study indicate that motor performance in the lower limbs following demanding exercise in the upper body appears to be regulated by complex, cognitive-emotional interactions, which may emerge independent of altered neuromuscular function. Subjective fatigue states are implicated in the control of perceptual and affective processes responsible for the regulation of endurance performance.

The Effect of Barefoot Running on EMG Activity in the Gastrocnemius and Tibialis Anterior in Active College-Aged Females

Running is one of the most popular forms of exercise, thus overuse injuries such as plantar fasciitis, shin splints, and tibial stress fractures are also common. Barefoot/forefoot running has shown promise to reduce overuse injuries by decreasing the impact upon contact with the ground. The arch of the foot utilizes a 'spring' system that simultaneously reduces impact and propels the stride forward. Increased muscle activity in a particular location is indicative of greater impact forces, suggesting a larger risk for overuse injuries. The current study investigated the role of the barefoot condition on electromyography (EMG) activity in the tibialis anterior (TA) and the lateral gastrocnemius head (GAS) in recreationally active college-aged females when forefoot striking. Seventeen healthy and active female participants 18-23 years old were recruited for this study. Participants ran on a treadmill for 10 minutes in shod and barefoot conditions at 9 km/h and 1% incline. Paired t-tests were used to compare EMG values for each muscle and rating of perceived exertion (RPE) between shod and barefoot conditions. An of 3% of maximum voluntary contraction (MVC) was recorded in the TA in the barefoot condition (p = 0.04). There was a trending, though non-significant, increase of 3%MVC in GAS activity in the barefoot condition (p = 0.056). No differences in RPE were noted between conditions. Though recruitment varied (e.g. athlete vs recreational) we only found minimal differences in RPE. Caution is warranted in this population engaging in barefoot/forefoot running due to the potential increase in muscle demand, potentially leading to overuse injuries.

Transcranial Direct Current Stimulation over the Left Dorsolateral Prefrontal Cortex Improves Inhibitory Control and Endurance Performance in Healthy Individuals

The dorsolateral prefrontal cortex (DLPFC) is a crucial brain region for inhibitory control, an executive function essential for behavioral self-regulation. Recently, inhibitory control has been shown to be important for endurance performance. Improvement in inhibitory control was found following transcranial direct current stimulation (tDCS) applied over the left DLPFC (L-DLPFC). This study examined the effect tDCS on both an inhibitory control and endurance performance in a group of healthy individuals. Twelve participants received either real tDCS (Real-tDCS) or placebo tDCS (Sham-tDCS) in randomized order. The anodal electrode was placed over the L-DLPFC while the cathodal electrode was placed above Fp2. Stimulation lasted 30min with current intensity set at 2mA. A Stroop test was administered to assess inhibitory control. Heart rate (HR), ratings of perceived exertion (RPE), and leg muscle pain (PAIN) were monitored during the cycling time to exhaustion (TTE) test, while blood lactate accumulation (∆B[La^-]) was measured at exhaustion. Stroop task performance was improved after Real-tDCS as demonstrated by a lower number of errors for incongruent stimuli (p=0.012). TTE was significantly longer following Real-tDCS compared to Sham-tDCS (p=0.029, 17±8 vs 15±8min), with significantly lower HR (p=0.002) and RPE (p<0.001), while no significant difference was found for PAIN (p>0.224). ∆B[La^-] was significantly higher at exhaustion in Real-tDCS (p=0.040). Our findings provide preliminary evidence that tDCS with the anodal electrode over the L-DLPFC can improve both inhibitory control and endurance cycling performance in healthy individuals.

"Men are Better Than Women!" The Positive Effect of a Negative Stereotype Toward Women on a Self-Paced Cycling Exercise

Previous research on the stereotype threat phenomenon has shown that inducing a negative stereotype toward a group debilitates motor performance despite the increase in motivation. Most of the studies focused on tasks requiring technical skills. However, what happens when the task does not require technical skills but focuses on energy expenditure? To examine this question, 34 male and female participants were assigned to a negative stereotype toward women and a nullified-stereotype condition and performed 20 min of self-paced cycling exercise. The authors hypothesized better performances when participants were assigned to the negative stereotype toward women condition than when assigned to the nullified-stereotype condition. As predicted, men and women increased their performances, accompanied by increases in heart rate. Concerning women, this result provides support for the notion that the effect of inducing a negative stereotype is task dependent, but further research is needed to more deeply investigate the mechanisms involved.

Fatigue-independent alterations in muscle activation and effort perception during forearm exercise: role of local oxygen delivery

The oxygen-conforming response (OCR) of skeletal muscle refers to a downregulation of muscle force for a given muscle activation when oxygen delivery (O₂D) is reduced, which is rapidly reversed when O₂D is restored. We tested the hypothesis that the OCR exists in voluntary human exercise and results in compensatory changes in muscle activation to maintain force output, thereby altering perception of effort. In eight men and eight women, electromyography (EMG), oxyhemoglobin (O₂Hb) and deoxyhemoglobin (HHb), forearm blood flow (FBF), and task effort awareness (TEA) were measured. Participants completed two nonfatiguing rhythmic handgrip tests consisting of 5-min steady state (SS) followed by two bouts of 2-min brachial artery compression to reduce FBF by ~50% of SS (C1 and C2), separated by 2 min of no compression (NC1) and ending with 2 min of no compression (NC2). When FBF was compromised during C1, EMG/Force (1.58 ± 0.39) increased compared with SS (1.31 ± 0.33, P = 0.001). However, EMG/Force was not restored upon FBF restoration at NC1 (1.48 ± 0.38, P = 0.479), consistent with C1 evoking skeletal muscle fatigue. When FBF was compromised during C2, EMG/Force increased (1.73 ± 0.50) compared with NC1 (1.48 ± 0.38, P = 0.013). EMG/Force returned to NC1 levels during NC2 (1.50 ± 0.39, P = 0.016), consistent with an OCR in C2. TEA (SS 2.2 ± 2.3, C1 3.9 ± 2.5, NC1 3.4 ± 2.7, C2 4.6 ± 2.7, NC2 3.9 ± 2.8) mirrored changes in EMG. It is noteworthy that during the second compromise and then restoration of muscle oxygenation EMG and TEA were rapidly restored to precompromise levels. We interpreted these findings to support the existence of an OCR and its ability to rapidly modify perception of effort during voluntary exercise. NEW & NOTEWORTHY In healthy individuals, when force output is maintained during rhythmic handgrip exercise, muscle activation and perception of effort rapidly increase with compromised muscle oxygen delivery (O₂D) and then return to precompromised levels when muscle O₂D is restored. These findings suggest that an oxygen-conforming response (OCR) exists and is able to modify perception of effort during voluntary exercise. Therefore, similar to fatigue, an OCR may have implications for exercise tolerance.

Differences in Cardiorespiratory Responses in Winter Mountaineering According to the Pathway Snow Conditions

Locomotion during ascent requires higher energy consumption than on flat terrain. Locomotion efficiency decreases in snowy terrain, with changes in the biomechanical pattern of walking. This study aims to evaluate differences in both cardiorespiratory responses and energy expenditure between locomotion over snowy terrain with an established footstep pathway (FP) and fresh snow (FS) that has not previously been compacted. Fifteen volunteers with experience in mountain activities at a competition level and a regular training schedule of up to 10 hours a week participated in the study. Estimated maximal theoretical oxygen consumption showed a mild increase (2.6%, 95% confidence interval: 0.9%-4.5%, t = 3.2, p = 0.005) when subjects followed the FP compared with FS. More time was necessary to complete locomotion in FS (256 ± 30 seconds) than FP (225 ± 29 seconds; p = 0.01). Uphill walking velocity increased by 0.43 ± 0.11 km/h (t = 4.2, p = 0.01) in FP compared with FS; and the FS respiratory rate was higher (by 2.3 ± 2.4 beats/min, t = 4.0, p = 0.001). For a same itinerary, locomotion in snow that has not been compacted before requires more time and represents a higher energetic cost, either at maximal or submaximal intensities. This should be considered in scheduling mountain ascents as part of the safety strategies. Climbing on virgin snow impedes developing maximal aerobic power, so athletes must regard the value of strength work of lower limbs to improve performance. Indirect calculation of maximal oxygen consumption based on time to complete locomotion in FP can have practical application as a field test.

Differentiated ratings of perceived exertion between overweight and non-overweight children during submaximal cycling

OBJECTIVE

Few studies have examined differences in ratings of perceived exertion (RPE) between overweight (OW) and non-OW (NW) youth. With lower voluntary participation in physical activity in OW children, it seems plausible that these youth may experience elevated RPE. Therefore, this study compared RPE during two separate steady-state cycling bouts OW (>95^th body mass index [BMI] percentile) and NW (<90^th BMI percentile) children.

METHODS

Participants completed one of two 20-min cycling trials; one performed at 70% age-predicted peak heart rate (HR) (70%) (OW n = 12 and NW n = 21) and a self-selected intensity (SS) (OW n = 6 and NW n = 13) with RPE overall, RPE legs (RPE-L), and RPE chest estimated at 5, 10, 15, and 20 min.

RESULTS

A repeated measures ANOVA revealed that OW individuals had significantly lower RPE-L values at 5, 15, and 20 min during the SS trial. No significant differences were identified during the 70% trial.

CONCLUSIONS

OW youth do not perceive cycling at 70% age-predicted peak HR or at SS intensities more difficult than NW children. It may be that cycling could serve as an attractive mode to encourage physical activity in this population and perhaps increase self-efficacy of exercise in this population.

Effects of Transcranial Direct Current Stimulation on Psychophysiological Responses to Maximal Incremental Exercise Test in Recreational Endurance Runners

Previous studies have suggested that transcranial direct current stimulation (tDCS) might improve exercise performance and alter psychophysiological responses to exercise. However, it is presently unknown whether this simple technique has similar (or greater) effects on running performance. The purpose of this study was, therefore, to test the hypothesis that, compared with sham and cathodal tDCS, anodal tDCS applied over the M1 region would attenuate perception of effort, improve affective valence, and enhance exercise tolerance, regardless of changes in physiological responses, during maximal incremental exercise. In a double-blind, randomized, counterbalanced design, 13 healthy recreational endurance runners, aged 20-42 years, volunteered to participate in this study. On three separate occasions, the subjects performed an incremental ramp exercise test from rest to volitional exhaustion on a motor-driven treadmill following 20-min of brain stimulation with either placebo tDCS (sham) or real tDCS (cathodal and anodal). Breath-by-breath pulmonary gas exchange and ventilation and indices of muscle hemodynamics and oxygenation were collected continuously during the ramp exercise test. Ratings of perceived exertion (RPE) and affective valence in response to the ramp exercise test were also measured. Compared with sham, neither anodal tDCS nor cathodal tDCS altered the physiological responses to exercise (P > 0.05). Similarly, RPE and affective responses during the incremental ramp exercise test did not differ between the three experimental conditions at any time (P > 0.05). The exercise tolerance was also not significantly different following brain stimulation with either sham (533 ± 46 s) or real tDCS (anodal tDCS: 530 ± 44 s, and cathodal tDCS: 537 ± 40 s; P > 0.05). These results demonstrate that acute tDCS applied over the M1 region did not alter physiological responses, perceived exertion, affective valence, or exercise performance in recreational endurance runners.

Caffeine Improves Triathlon Performance: A Field Study in Males and Females

The ergogenic effect of caffeine on endurance exercise is commonly accepted. We aimed to elucidate realistically the effect of caffeine on triathlon event performance using a field study design, while allowing investigation into potential mechanisms at play. A double-blind, randomized, crossover field trial was conducted. Twenty-six triathletes (14 males and 12 females; mean ± SD: age = 37.8 ± 10.6 years, habitual caffeine intake = 413 ± 505 mg/day, percentage body fat = 14.5 ± 7.2%, and training/week = 12.8 ± 4.5 hr) participated in this study. Microencapsulated caffeine (6 mg/kg body weight) was supplemented 60 min pretrial. Performance data included time to completion, rating of perceived exertion, and profile of mood states. Blood samples taken before, during, and postrace were analyzed for cortisol, testosterone, and full blood count. Capillary blood lactate concentrations were assessed prerace, during transitions, and 3, 6, 9, 12, and 15 min after triathlons. Caffeine supplementation resulted in a 3.7% reduction in swim time (33.5 ± 7.0 vs. 34.8 ± 8.1 min, p < .05) and a 1.3% reduction in time to completion (149.6 ± 19.8 vs. 151.5 ± 18.6 min, p < .05) for the whole group. Gender differences and individual responses are also presented. Caffeine did not alter the rating of perceived exertion significantly, but better performance after caffeine supplementation suggests a central effect resulting in greater overall exercise intensity at the same rating of perceived exertion. Caffeine supplementation was associated with higher postexercise cortisol levels (665 ± 200 vs. 543 ± 169 nmol/L, p < .0001) and facilitated greater peak blood lactate accumulation (analysis of variance main effect, p < .05). We recommend that triathlon athletes with relatively low habitual caffeine intake may ingest 6 mg/kg body weight caffeine, 45-60 min before the start of Olympic-distance triathlon to improve their performance.

Cycling Versus Uphill Walking: Impact on Locomotor Muscle Fatigue and Running Exercise

PURPOSE

To describe the effects of uphill walking versus cycling exercises on knee-extensor (KE) neuromuscular properties and subsequent running exercise.

METHODS

Nine athletes performed 4 different sessions (1 familiarization and 3 experimental sessions, visit 2-4). Visit 2 (cycling +10-km condition) consisted of the completion of 1-h cycling followed by a 10-km running time trial. Visit 3 consisted of the completion of 1-h uphill walking followed by a 10-km running exercise (RE). During the fourth visit, athletes only ran 10 km. Visits 3 and 4 were randomized. The uphill walking and cycling exercises were performed at the same intensity, and pacing of the RE was similar between conditions. Neuromuscular function of the KE was assessed before warm-up, after first exercise, and after RE. Heart rate and rating of perceived exertion (RPE) were recorded during all exercises.

RESULTS

RPE during RE was greater following the 1-h cycling and uphill walking exercises than during RE alone. KE force (-21%), twitch torque (-20%), doublet torque (-16%), and twitch rate of force development (-13%) significantly decreased following cycling exercise and not after uphill walking exercise. Postactivation potentiation was observed after uphill walking and RE. KE force-production capacity partially recovered after running in the cycling +10-km condition.

CONCLUSION

Uphill walking and running induced postactivation potentiation, limiting the decrease in KE force postexercise. Despite different alterations in force-production capacity induced by cycling and uphill walking, both exercises increased perception of effort during the subsequent RE.

Peripheral and central fatigue after high intensity resistance circuit training

INTRODUCTION

The aim of this study was to investigate the effects of high intensity resistance circuit (HIRC) and traditional strength training (TST) on neuromuscular fatigue and metabolic responses.

METHODS

Twelve trained young subjects performed HIRC and TST in a counterbalanced order with 1 week rest in-between. The amount of workload and the inter-set time for each local muscle group were matched (180 s), however, the time between successive exercises differed. The twitch interpolation technique was used to test neuromuscular function of the knee extensor muscles. Blood lactate concentration was used to evaluate metabolic responses.

RESULTS

Maximum voluntary contraction and resting potentiated twitch amplitude (Q_tw ) were significantly reduced after HIRC, but there were not changes after TST, while reductions in voluntary activation were similar. Lactate concentration increased significantly more after HIRC.

CONCLUSIONS

The higher lactate concentration after HIRC probably impaired excitation-contraction coupling, indicating larger peripheral fatigue than after TST. Muscle Nerve 56: 152-159, 2017.

A Reduction in Maximal Incremental Exercise Test Duration 48 h Post Downhill Run Is Associated with Muscle Damage Derived Exercise Induced Pain

Purpose: To examine whether exercise induced muscle damage (EIMD) and muscle soreness reduce treadmill maximal incremental exercise (MIE) test duration, and true maximal physiological performance as a consequence of exercise induced pain (EIP) and perceived effort.

Methods: Fifty (14 female), apparently healthy participants randomly allocated into a control group (CON, n = 10), or experimental group (EXP, n = 40) visited the laboratory a total of six times: visit 1 (familiarization), visit 2 (pre 1), visit 3 (pre 2), visit 4 (intervention), visit 5 (24 h post) and visit 6 (48 h post). Both groups performed identical testing during all visits, except during visit 4, where only EXP performed a 30 min downhill run and CON performed no exercise. During visits 2, 3, and 6 all participants performed MIE, and the following measurements were obtained: time to exhaustion (TTE), EIP, maximal oxygen consumption (V·O2max), rate of perceived exertion (RPE), maximum heart rate (HR_max), maximum blood lactate (BLa_max), and the contribution of pain to terminating the MIE (assessed using a questionnaire). Additionally during visits 1, 2, 3, 5, and 6 the following markers of EIMD were obtained: muscle soreness, maximum voluntary contraction (MVC), voluntary activation (VA), creatine kinase (CK).

Results: There were no significant differences (p ≥ 0.32) between any trials for any of the measures obtained during MIE for CON. In EXP, TTE decreased by 34 s (3%), from pre 2 to 48 h post (p < 0.001). There was a significant association between group (EXP, CON) and termination of the MIE due to “pain” during 48 h post (χ² = 14.7, p = 0.002).

Conclusion: EIMD resulted in premature termination of a MIE test (decreased TTE), which was associated with EIP, MVC, and VA. The exact mechanisms responsible for this require further investigation.

The Ergogenic Effects of Transcranial Direct Current Stimulation on Exercise Performance

The physical limits of the human performance have been the object of study for a considerable time. Most of the research has focused on the locomotor muscles, lungs, and heart. As a consequence, much of the contemporary literature has ignored the importance of the brain in the regulation of exercise performance. With the introduction and development of new non-invasive devices, the knowledge regarding the behavior of the central nervous system during exercise has advanced. A first step has been provided from studies involving neuroimaging techniques where the role of specific brain areas have been identified during isolated muscle or whole-body exercise. Furthermore, a new interesting approach has been provided by studies involving non-invasive techniques to manipulate specific brain areas. These techniques most commonly involve the use of an electrical or magnetic field crossing the brain. In this regard, there has been emerging literature demonstrating the possibility to influence exercise outcomes in healthy people following stimulation of specific brain areas. Specifically, transcranial direct current stimulation (tDCS) has been recently used prior to exercise in order to improve exercise performance under a wide range of exercise types. In this review article, we discuss the evidence provided from experimental studies involving tDCS. The aim of this review is to provide a critical analysis of the experimental studies investigating the application of tDCS prior to exercise and how it influences brain function and performance. Finally, we provide a critical opinion of the usage of tDCS for exercise enhancement. This will consequently progress the current knowledge base regarding the effect of tDCS on exercise and provides both a methodological and theoretical foundation on which future research can be based.

Effects of knowing the task duration on players' pacing patterns during soccer small-sided games

The aim of this study was to identify the influence of prior knowledge of exercise duration on players' pacing patterns during soccer small-sided games. Twenty semi-professional male soccer players participated in this study. In the first game scenario, players were not informed how long they would be required to play the small-sided game and the activity was terminated after 20 min (Unknown Condition). In the second game scenario, players were told that they would play the small-sided game for 10 min, but immediately after completing the 10-min game, they were asked to complete another 10 min (Partially Condition). In the third game scenario, players were instructed that they would play the small-sided game for 20 min and then they completed the 20-min game (Known Condition). The results presented a tendency of higher values in all performance variables in the [0'-10'] min compared with the [10'-20'] min. As the players' previous knowledge about the tasks duration increased, the performance between two moments tended to be similar. Considering the entire 20-min game duration, the Partially Condition of the exercise was the most demanding condition. In conclusion, the knowledge of shorter durations of the exercise seems to lead to an increase of exercise duration demand, and longer exercise durations possibly tend to decrease differences between full knowledge and not knowing the exercise duration.

Periodization of Carbohydrate Intake: Short-Term Effect on Performance

Background: “Sleep-low” consists of a sequential periodization of carbohydrate (CHO) availability—low glycogen recovery after “train high” glycogen-depleting interval training, followed by an overnight-fast and light intensity training (“train low”) the following day. This strategy leads to an upregulation of several exercise-responsive signaling proteins, but the chronic effect on performance has received less attention. We investigated the effects of short-term exposure to this strategy on endurance performance. Methods: Following training familiarization, 11 trained cyclists were divided into two groups for a one-week intervention—one group implemented three cycles of periodized CHO intake to achieve the sleep-low strategy over six training sessions (SL, CHO intake: 6 g·kg⁻¹·day⁻¹), whereas the control group consumed an even distribution of CHO over the day (CON). Tests were a 2 h submaximal ride and a 20 km time trial. Results: SL improved their performance (mean: +3.2%; p < 0.05) compared to CON. The improvement was associated with a change in pacing strategy with higher power output during the second part of the test. No change in substrate utilization was observed after the training period for either group. Conclusion: Implementing the “sleep-low” strategy for one week improved performance by the same magnitude previously seen in a three-week intervention, without any significant changes in selected markers of metabolism.

Mental fatigue induced by prolonged self-regulation does not exacerbate central fatigue during subsequent whole-body endurance exercise

It has been shown that the mental fatigue induced by prolonged self-regulation increases perception of effort and reduces performance during subsequent endurance exercise. However, the physiological mechanisms underlying these negative effects of mental fatigue are unclear. The primary aim of this study was to test the hypothesis that mental fatigue exacerbates central fatigue induced by whole-body endurance exercise. Twelve subjects performed 30 min of either an incongruent Stroop task to induce a condition of mental fatigue or a congruent Stroop task (control condition) in a random and counterbalanced order. Both cognitive tasks (CTs) were followed by a whole-body endurance task (ET) consisting of 6 min of cycling exercise at 80% of peak power output measured during a preliminary incremental test. Neuromuscular function of the knee extensors was assessed before and after CT, and after ET. Rating of perceived exertion (RPE) was measured during ET. Both CTs did not induce any decrease in maximal voluntary contraction (MVC) torque (p = 0.194). During ET, mentally fatigued subjects reported higher RPE (mental fatigue 13.9 ± 3.0, control 13.3 ± 3.2, p = 0.044). ET induced a similar decrease in MVC torque (mental fatigue -17 ± 15%, control -15 ± 11%, p = 0.001), maximal voluntary activation level (mental fatigue -6 ± 9%, control -6 ± 7%, p = 0.013) and resting twitch (mental fatigue -30 ± 14%, control -32 ± 10%, p < 0.001) in both conditions. These findings reject our hypothesis and confirm previous findings that mental fatigue does not reduce the capacity of the central nervous system to recruit the working muscles. The negative effect of mental fatigue on perception of effort does not reflect a greater development of either central or peripheral fatigue. Consequently, mentally fatigued subjects are still able to perform maximal exercise, but they are experiencing an altered performance during submaximal exercise due to higher-than-normal perception of effort.

Non-conscious visual cues related to affect and action alter perception of effort and endurance performance

The psychobiological model of endurance performance proposes that endurance performance is determined by a decision-making process based on perception of effort and potential motivation. Recent research has reported that effort-based decision-making during cognitive tasks can be altered by non-conscious visual cues relating to affect and action. The effects of these non-conscious visual cues on effort and performance during physical tasks are however unknown. We report two experiments investigating the effects of subliminal priming with visual cues related to affect and action on perception of effort and endurance performance. In Experiment 1 thirteen individuals were subliminally primed with happy or sad faces as they cycled to exhaustion in a counterbalanced and randomized crossover design. A paired t-test (happy vs. sad faces) revealed that individuals cycled significantly longer (178 s, p = 0.04) when subliminally primed with happy faces. A 2 × 5 (condition × iso-time) ANOVA also revealed a significant main effect of condition on rating of perceived exertion (RPE) during the time to exhaustion (TTE) test with lower RPE when subjects were subliminally primed with happy faces (p = 0.04). In Experiment 2, a single-subject randomization tests design found that subliminal priming with action words facilitated a significantly longer TTE (399 s, p = 0.04) in comparison to inaction words. Like Experiment 1, this greater TTE was accompanied by a significantly lower RPE (p = 0.03). These experiments are the first to show that subliminal visual cues relating to affect and action can alter perception of effort and endurance performance. Non-conscious visual cues may therefore influence the effort-based decision-making process that is proposed to determine endurance performance. Accordingly, the findings raise notable implications for individuals who may encounter such visual cues during endurance competitions, training, or health related exercise.