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OBJECTIVES: Explore the feasibility of lower-limb garment-integrated BFR-training. DESIGN: Observational study. SETTING: Human performance laboratory. PARTICIPANTS: Healthy males with no experience of BFR-training. MAIN OUTCOME MEASURES: Feasibility was determined by a priori thresholds for recruitment, adherence, and data collection. Safety was determined by measuring BFR torniquet pressure and the incidence of side effects. Efficacy was determined by measuring body anthropometry and knee isokinetic dynamometry. Feasibility and safety outcomes were reported descriptively or as a proportion with 95% confidence intervals (95% CI), with mean change, 95% CIs, and effect sizes for efficacy outcomes. RESULTS: Twelve participants (mean age 24.8 years [6.5]) were successfully recruited; 11 completed the study. 134/136 sessions were completed (adherence = 98.5%) and 100% of data were collected. There was one event of excessive pain during exercise (0.7%, 95% CI 0.0%, 4.0%), two events of excessive pain post-exercise (1.5%, 95% CI 0.4%, 5.5%), and one event of persistent paraesthesia post-exercise (0.7%, 95% CI 0.0%, 4.0%). Mean maximal BFR torniquet pressure was <200 mmHg. We observed an increase in knee extension peak torque (mean change 12.4 Nm), but no notable changes in body anthropometry. CONCLUSIONS: Lower-limb garment-integrated BFR-training is feasible, has no signal of important harm, and could be used independently.

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BACKGROUND: Blood flow restriction training (BFR) has been demonstrated to increase muscle hypertrophy and strength, but has logistical and cost barriers. Garment-integrated BFR has the potential to reduce these barriers by lowering equipment demands and cost. The primary aim of the study was to explore the feasibility of garment-integrated BFR in the upper limb of healthy adults, with a secondary aim of exploring safety and efficacy. METHODS: Physically active and otherwise healthy participants with no previous experience with BFR were sought. Eligible participants completed a five-week garment-integrated BFR programme that involved completing two sessions per week. Feasibility was determined by a priori defined thresholds for recruitment, adherence to the garment-integrated BFR programme, and data collection. Safety was determined by recording adverse events and by monitoring for total arterial occlusion pressure using a fingertip pulse oximeter. Efficacy was determined by measuring push-ups to volitional failure, arm girth, and number of prescribed repetitions completed. Feasibility and safety outcomes were reported descriptively or as a proportion with associated 95% confidence intervals (95% CI). Mean change, 95% CIs, and associated effect sizes were calculated for efficacy outcomes. RESULTS: Twenty-eight participants were included (15 men, 13 women; mean age 31.6 years [±9.1]) and 27 successfully completed the study. Participants were successfully recruited within three months and 278/280 sessions were successfully completed (adherence=99.3%, 95% CI 97.4%, 99.9%). Minimal adverse events were reported; one incident of localised bruising (0.36%, 95% CI 0.06%, 2.0%) and three incidences of excessive pain during or post-exercise from two separate participants (1.07%, 95% CI 0.03%, 3.1%). 82/2240 pulse oximeter readings were not recorded (3.7%, 95% CI 2.9%, 4.5%). Mean push-ups to volitional failure increased by 40% (mean change=8.0, 95% CI 6, 10, d=1.40). Mean arm girth and number of prescribed repetitions completed were unchanged. CONCLUSIONS: Garment-integrated BFR is feasible and has no signal of important harm in the upper limb of healthy adults, and could proceed to a future trial with stop/go criteria for randomisation. Further work is required to investigate the efficacy of garment-integrated BFR and determine its equivalence or superiority compared to existing BFR methods.

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PURPOSE: To examine the validity of ultrasound (via cloud-based software that measures pixilation intensity according to a scale of 0-100) to noninvasively assess muscle glycogen in human skeletal muscle. METHODS: In study 1, 14 professional male rugby league players competed in an 80-min competitive rugby league game. In study 2 (in a randomized repeated measures design), 16 recreationally active males completed an exhaustive cycling protocol to deplete muscle glycogen followed by 36 h of HIGH or LOW carbohydrate intake (8 g·kg vs 3 g·kg body mass). In both studies, muscle biopsies and ultrasound scans were obtained from the vastus lateralis (at 50% of the muscle length) before and after match play in study 1 and at 36 h after glycogen depletion in study 2. RESULTS: Despite match play reducing (P < 0.01) muscle glycogen concentration (pregame: 443 ± 65; postgame: 271 ± 94 mmol·kg dw, respectively) in study 1, there were no significant changes (P = 0.4) in ultrasound scores (pregame: 47 ± 6, postgame: 49 ± 7). In study 2, muscle glycogen concentration was significantly different (P < 0.01) between HIGH (531 ±129 mmol·kg dw) and LOW (252 ± 64 mmol·kg dw) yet there was no difference (P = 0.9) in corresponding ultrasound scores (HIGH: 56 ± 7, LOW: 54 ± 6). In both studies, no significant correlations (P > 0.05) were present between changes in muscle glycogen concentration and changes in ultrasound scores. CONCLUSIONS: Data demonstrate that ultrasound (as based on measures of pixilation intensity) is not valid to measure muscle glycogen status within the physiological range (i.e., 200-500 mmol·kg dw) that is applicable to exercise-induced muscle glycogen utilization and postexercise muscle glycogen resynthesis.

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OBJECTIVES: The metabolic requirements of a rugby league match simulation protocol and the timing of carbohydrate provision on glycogen re-synthesis in damaged muscle were examined. DESIGN: Fifteen (mean±SD: age 20.9±2.9 year, body-mass 87.3±14.1kg, height 177.4±6.0cm) rugby league (RL) players consumed a 6gkgday-1 CHO diet for 7-days, completed a time to exhaustion test (TTE) and a glycogen depletion protocol on day-3, a RL simulated-match protocol (RLMSP) on day-5 and a TTE on day-7. Players were prescribed an immediate or delayed (2-h-post) re-feed post-simulation. METHODS: Muscle biopsies and blood samples were obtained post-depletion, before and after simulated match-play, and 48-h after match-play with PlayerLoad and heart-rate collected throughout the simulation. Data were analysed using effects sizes±90% CI and magnitude-based inferences. RESULTS: PlayerLoad (8.0±0.7 AUmin-1) and %HRpeak (83±4.9%) during the simulation were similar to values reported for RL match-play. Muscle glycogen very likely increased from immediately after to 48-h post-simulation (272±97 cf. 416±162mmolkg-1d.w.; ES±90%CI) after immediate re-feed, but changes were unclear (283±68 cf. 361±144mmolkg-1d.w.; ES±90%CI) after delayed re-feed. CK almost certainly increased by 77.9±25.4% (0.75±0.19) post-simulation for all players. CONCLUSIONS: The RLMSP presents a replication of the internal loads associated with professional RL match-play, although difficulties in replicating the collision reduced the metabolic demands and glycogen utilisation. Further, it is possible to replete muscle glycogen in damaged muscle employing an immediate re-feed strategy.

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PURPOSE: Supplementation with dietary forms of vitamin D is commonplace in clinical medicine, elite athletic cohorts, and the general population, yet the response of all major vitamin D metabolites to high doses of vitamin D is poorly characterized. We aimed to identify the responses of all major vitamin D metabolites to moderate- and high-dose supplemental vitamin D3. METHODS: A repeated-measures design was implemented in which 46 elite professional European athletes were block randomized based on their basal 25[OH]D concentration into two treatment groups. Athletes received either 35,000 or 70,000 IU·wk vitamin D3 for 12 wk, and 42 athletes completed the trial. Blood samples were collected for 18 wk to monitor the response to supplementation and withdrawal from supplementation. RESULTS: Both doses led to significant increases in serum 25[OH]D, and 1,25[OH]2D3. 70,000 IU·wk also resulted in a significant increase of the metabolite 24,25[OH]2D at weeks 6 and 12 that persisted after supplementation withdrawal at week 18, despite a marked decrease in 1,25[OH]2D3. Intact parathyroid hormone was decreased in both groups by week 6 and remained suppressed throughout the trial. CONCLUSIONS: High-dose vitamin D3 supplementation (70,000 IU·wk) may be detrimental for its intended purposes because of increased 24,25[OH]2D production. Rapid withdrawal from high-dose supplementation may inhibit the bioactivity of 1,25[OH]2D3 as a consequence of sustained increases in 24,25[OH]2D that persist as 25[OH]D and 1,25[OH]2D concentrations decrease. These data imply that lower doses of vitamin D3 ingested frequently may be most appropriate and gradual withdrawal from supplementation as opposed to rapid withdrawal may be favorable.

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OBJECTIVES: Although the physical demands of Rugby League (RL) match-play are well-known, the fuel sources supporting energy-production are poorly understood. We therefore assessed muscle glycogen utilisation and plasma metabolite responses to RL match-play after a relatively high (HCHO) or relatively low CHO (LCHO) diet. DESIGN: Sixteen (mean±SD age; 18±1 years, body-mass; 88±12kg, height 180±8cm) professional players completed a RL match after 36-h consuming a non-isocaloric high carbohydrate (n=8; 6gkgday-1) or low carbohydrate (n=8; 3gkgday-1) diet. METHODS: Muscle biopsies and blood samples were obtained pre- and post-match, alongside external and internal loads quantified using Global Positioning System technology and heart rate, respectively. Data were analysed using effects sizes ±90% CI and magnitude-based inferences. RESULTS: Differences in pre-match muscle glycogen between high and low carbohydrate conditions (449±51 and 444±81mmolkg-1d.w.) were unclear. High (243±43mmolkg-1d.w.) and low carbohydrate groups (298±130mmolkg-1d.w.) were most and very likely reduced post-match, respectively. For both groups, differences in pre-match NEFA and glycerol were unclear, with a most likely increase in NEFA and glycerol post-match. NEFA was likely lower in the high compared with low carbohydrate group post-match (0.95±0.39mmoll-1 and 1.45±0.51mmoll-1, respectively), whereas differences between the 2 groups for glycerol were unclear (98.1±33.6mmoll-1 and 123.1±39.6mmoll-1) in the high and low carbohydrate groups, respectively. CONCLUSIONS: Professional RL players can utilise ∼40% of their muscle glycogen during a competitive match regardless of their carbohydrate consumption in the preceding 36-h.

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Rugby League is a high-intensity collision sport competed over 80 min. Training loads are monitored to maximize recovery and assist in the design of nutritional strategies although no data are available on the total energy expenditure (TEE) of players. We therefore assessed resting metabolic rate (RMR) and TEE in six Super League players over 2 consecutive weeks in-season including one game per week. Fasted RMR was assessed followed by a baseline urine sample before oral administration of a bolus dose of hydrogen (deuterium 2H) and oxygen (18O) stable isotopes in the form of water (2H218O). Every 24 hr thereafter, players provided urine for analysis of TEE via DLW method. Individual training load was quantified using session rating of perceived exertion (sRPE) and data were analyzed using magnitude-based inferences. There were unclear differences in RMR between forwards and backs (7.7 ± 0.5 cf. 8.0 ± 0.3 MJ, respectively). Indirect calorimetry produced RMR values most likely lower than predictive equations (7.9 ± 0.4 cf. 9.2 ± 0.4 MJ, respectively). A most likely increase in TEE from Week 1 to 2 was observed (17.9 ± 2.1 cf. 24.2 ± 3.4 MJ) explained by a most likelyincrease in weekly sRPE (432 ± 19 cf. 555 ± 22 AU), respectively. The difference in TEE between forward and backs was unclear (21.6 ± 4.2 cf. 20.5 ± 4.9 MJ, respectively). We report greater TEE than previously reported in rugby that could be explained by the ability of DLW to account for all match and training-related activities that contributes to TEE.

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Rugby union (RU) is a complex high-intensity intermittent collision sport with emphasis placed on players possessing high lean body mass and low body fat. After an 8 to 12-week pre-season focused on physiological adaptations, emphasis shifts towards competitive performance. However, there are no objective data on the physiological demands or energy intake (EI) and energy expenditure (EE) for elite players during this period. Accordingly, in-season training load using global positioning system and session rating of perceived exertion (sRPE), alongside six-day assessments of EE and EI were measured in 44 elite RU players. Mean weekly distance covered was 7827 ± 954 m and 9572 ± 1233 m with a total mean weekly sRPE of 1776 ± 355 and 1523 ± 434 AU for forwards and backs, respectively. Mean weekly EI was 16.6 ± 1.5 and 14.2 ± 1.2 megajoules (MJ) and EE was 15.9 ± 0.5 and 14 ± 0.5 MJ. Mean carbohydrate (CHO) intake was 3.5 ± 0.8 and 3.4 ± 0.7 g.kg(-1) body mass, protein intake was 2.7 ± 0.3 and 2.7 ± 0.5 g.kg(-1) body mass, and fat intake was 1.4 ± 0.2 and 1.4 ± 0.3 g.kg(-1) body mass. All players who completed the food diary self-selected a 'low' CHO 'high' protein diet during the early part of the week, with CHO intake increasing in the days leading up to a match, resulting in the mean EI matching EE. Based on EE and training load data, the EI and composition seems appropriate, although further research is required to evaluate if this diet is optimal for match day performance.

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Rugby Union (RU) is a high-speed collision sport consisting of an intermittent activity profile. Given the extreme physical demands of the sport, significant emphasis is placed on players possessing high lean body mass while minimizing body fat. Anecdotally, the most significant changes in body composition are observed during the preseason; however, there are no objective data on the physiological demands and energy intake during this time. We therefore monitored 45 elite European RU players over the 10-week preseason period by assessing training load using Global Positioning System and session rate of perceived exertion (sRPE) while also assessing changes in anthropometry and physical performance. For forwards and backs, respectively, mean weekly distance covered was 9,774 m (1,404) and 11,585 m (1,810) with a total mean weekly sRPE of 3,398 (335) arbitrary units and 2,944 (410) arbitrary units. Mean daily energy intake was 14.8 MJ (1.9) and 13.3 MJ (1.9), carbohydrate (CHO) intake was 3.3 (0.7) and 4.14 (0.4) g·kg body mass, protein intake was 2.52 (0.3) and 2.59 (0.6) g·kg body mass, and fat intake was 1.0 (0.3) and 0.95 (0.3) g·kg body mass for forwards and backs, respectively. Markers of physical performance (1 repetition maximum strength, speed, and repeated sprint tests) and anthropometry (body fat and estimated lean mass) improved in all players. Interestingly, all players self-selected a "low" CHO "high" protein diet. Based on physiological improvements the training load and energy intake seems appropriate, although further research is required to evaluate if such energy intakes would also be suitable for match day performance.

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BACKGROUND: Vitamin D deficiency is common in the general public and athletic populations and may impair skeletal muscle function. We therefore assessed the effects of vitamin D3 supplementation on serum 25[OH]D concentrations and physical performance. METHODS: 30 club-level athletes were block randomised (using baseline 25[OH]D concentrations) into one of three groups receiving either a placebo (PLB), 20 000 or 40 000 IU/week oral vitamin D3 for 12 weeks. Serum 25[OH]D and muscle function (1-RM bench press and leg press and vertical jump height) were measured presupplementation, 6 and 12 weeks postsupplementation. Vitamin D deficiency was defined in accordance with the US Institute of Medicine guideline (<50 nmol/l). RESULTS: 57% of the subject population were vitamin D deficient at baseline (mean±SD value 51±24 nmol/l). Following 6 and 12 weeks supplementation with 20 000 IU (79±14 and 85±10 nmol/l, respectively) or 40 000 IU vitamin D3 (98±14 and 91±24 nmol/l, respectively), serum vitamin D concentrations increased in all participants, with every individual achieving concentrations greater than 50 nmol/l. In contrast, vitamin D concentration in the PLB group decreased at 6 and 12 weeks (37±18 and 41±22 nmol/l, respectively). Increasing serum 25[OH]D had no significant effect on any physical performance parameter (p>0.05). CONCLUSIONS: Both 20 000 and 40 000 IU vitamin D3 supplementation over a 6-week period elevates serum 25[OH]D concentrations above 50 nmol/l, but neither dose given for 12 weeks improved our chosen measures of physical performance.

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