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Background: Daily nutrition plays an important role in supporting training adaptions and endurance performance. The objective of this 10-week study was to investigate the consequences of varying carbohydrate consumption and the glycaemic index (GI) together with an endurance training regimen on substrate oxidation, muscle energy storage and endurance performance under free-living conditions. Sixty-five moderately trained healthy men (29 ± 4 years; VO2 peak 55 ± 8 mL min−1 kg−1) were randomized to one of three different nutritional regimes (LOW-GI: 50–60% CHO with ≥ 65% of these CHO with GI < 50 per day, n = 24; HIGH-GI: 50–60% CHO with ≥ 65% CHO with GI > 70 per day, n = 20; LCHF: ≤ 50 g CHO daily, n = 21). Metabolic alterations and performance were assessed at baseline (T0) and after 10 weeks (T10) during a graded exercise treadmill test. Additionally, a 5 km time trial on a 400-m outdoor track was performed and muscle glycogen was measured by magnet resonance spectroscopy. Results: Total fat oxidation expressed as area under the curve (AUC) during the graded exercise test increased in LCHF (1.3 ± 2.4 g min−1 × km h−1, p < 0.001), remained unchanged in LOW-GI (p > 0.05) and decreased in HIGH-GI (− 1.7 ± 1.5 g min−1 × km h−1, p < 0.001). After the intervention, LOW-GI (− 0.4 ± 0.5 mmol L−1 × km h−1, p < 0.001) and LCHF (− 0.8 ± 0.7 mmol L−1 × km h−1, p < 0.001) showed significantly lower AUC of blood lactate concentrations. Peak running speed increased in LOW-GI (T0: 4.3 ± 0.4 vs. T10: 4.5 ± 0.3 m s−1, p < 0.001) and HIGH-GI (T0: 4.4 ± 0.5 vs. T10: 4.6 ± 0.4 m s−1), while no improvement was observed in LCHF. Yet, time trial performance improved significantly in all groups. Muscle glycogen content increased for participants in HIGH-GI (T0: 97.3 ± 18.5 vs. T10: 144.5 ± 39.8 mmol L wet-tissue−1, p = 0.027) and remained unchanged in the LOW-GI and the LCHF group. At the last examination, muscle glycogen concentration was significantly higher in LOW-GI compared to LCHF (p = 0.014). Conclusion: Changes in fat oxidation were only present in LCHF, however, lower lactate concentrations in LOW-GI resulted in changes indicating an improved substrate metabolism. Compared to a LCHF diet, changes in peak running speed, and muscle glycogen stores were superior in LOW- and HIGH-GI diets. The low GI diet seems to have an influence on substrate metabolism without compromising performance at higher intensities, suggesting that a high-carbohydrate diet with a low GI is a viable alternative to a LCHF or a high GI diet. Trial registration: Clinical Trials, NCT05241730. https://clinicaltrials.gov/study/NCT05241730. Registered 25 January 2021. Key Points: While only the LCHF diet showed an improvement in fat oxidation and the HIGH-GI group increased peak running speed and showed a trend towards an improvement in time to exhaustion, the LOW-GI group appears to combine both effects on substrate metabolism and performance. Administered under free-living conditions, energy intake changed in LOW-GI diet, possible due to higher intake of fibre, stable insulin levels and associated higher feeling of satiety. Energy intake in HIGH-GI showed no changes and in LCHF a trend towards a reduced intake was observed. While changes in body weight and composition were more pronounced in LOW-GI and LCHF group, muscle energy storage showed beneficial improvements in endurance runners on a high glycaemic index diet. With the muscle glycogen content being significantly lower in LCHF compared to LOW-GI group, it can be assumed that this might be a limiting factor in maximum values for the graded exercise test. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of a supplementation with specific collagen peptides (SCP) combined with resistance training (RT) on changes in structural properties of the patellar tendon. Furthermore, tendon stiffness as well as maximal voluntary knee extension strength and cross-sectional area (CSA) of the rectus femoris muscle were assessed. In a randomized, placebo-controlled study, 50 healthy, moderately active male participants completed a 14-week resistance training program with three weekly sessions (70-85% of 1 repetition maximum [1RM]) for the knee extensors. While the SCP group received 5g of specific collagen peptides daily, the other group received the same amount of a placebo (PLA) supplement. The SCP supplementation led to a significant greater (p < 0.05) increase in patellar tendon CSA compared with the PLA group at 60% and 70% of the patellar tendon length starting from the proximal insertion. Both groups increased tendon stiffness (p < 0.01), muscle CSA (p < 0.05) and muscular strength (p < 0.001) throughout the intervention without significant differences between the groups. The current study shows that in healthy, moderately active men, supplementation of SCP in combination with RT leads to greater increase in patellar tendon CSA than RT alone. Since underlying mechanisms of tendon hypertrophy are currently unknown, further studies should investigate potential mechanisms causing the increased morphology adaptions following SCP supplementation. [ABSTRACT FROM AUTHOR]

Background: First evidence indicates that the supplementation of specific collagen peptides (SCP) is associated with a significant improvement in running performance in physically active women; however, it is unclear if the same is true in males. The purpose of the present study was to investigate the effects of a concurrent training program including 60 min of continuous moderate intensity running training and 15 min of dynamic resistance training combined with supplementation of SCP on parameters of running performance in moderately trained males. Methods: In a double-blind, placebo-controlled, randomized trial, participants performed a 12 weeks concurrent training and ingested 15 g of SCP [treatment group (TG)] or placebo [control group (CG)] daily. Before and after the intervention, running endurance performance was measured by a 1-h time trial on a running track. Velocity at the lactate threshold (VLT) and at the individual anaerobic threshold (VIAT) were assessed on a treadmill ergometer. Body composition was evaluated by bioelectrical impedance analysis. Results: Thirty-two men (28.4 ± 5.2 years) completed the study and were included in the analysis. After 12 weeks, TG had a statistically significant (p ≤ 0.05) higher increase in running distance (1727 ± 705 m) compared to the CG (1018 ± 976 m) in the time trial. VLT increased in the TG by 0.680 ± 1.27 km h−1 and slightly decreased by − 0.135 ± 0.978 km h−1 in the CG, resulting in statistically significant group differences (p ≤ 0.05). A significantly higher improvement in VIAT (p ≤ 0.05) was shown in the TG compared with the CG only (1.660 ± 1.022 km h−1 vs 0.606 ± 0.974 km h−1; p ≤ 0.01). Fat mass decreased (TG − 1.7 ± 1.6 kg; CG − 1.2 ± 2.0 kg) and fat free mass increased (TG 0.2 ± 1.2 kg; CG 0.5 ± 1.3 kg) in both groups with no significant group differences. Conclusion: In summary, supplementation with 15 g of SCP improved running performance in a 1-h time trial and enhanced indicators of endurance capacity at submaximal exercise intensities such as an increased velocity at the lactate as well as the anaerobic threshold more effectively than CT alone. Trial registration: ETK: 123/17; DRKS-ID: DRKS00015529 (Registered 07 November 2018—Retrospectively registered); https://drks.de/search/de/trial/DRKS00015529 [ABSTRACT FROM AUTHOR]

Web-based lifestyle interventions are a new area of health research. This randomized controlled trial evaluated the effectiveness of an interactive web-based health program on physical fitness and health. N = 189 healthy adults participated in a 12-week interactive (intervention) or non-interactive (control) web-based health program. The intervention provided a web-based lifestyle intervention to promote physical activity and fitness through individualized activities as part of a fully automated, multimodal health program. The control intervention included health information. Cardiorespiratory fitness measured as maximum oxygen uptake (VO2max) was the primary outcome, while musculoskeletal fitness, physical activity and dietary behavior, and physiological health outcomes were assessed as secondary outcomes (t0: 0 months, t1: 3 months, t2: 9 months, t3: 15 months). Statistical analysis was performed with robust linear mixed models. There were significant time effects in the primary outcome (VO2max) (t0–t1: p = 0.018) and individual secondary outcomes for the interactive web-based health program, but no significant interaction effects in any of the outcomes between the interactive and non-interactive web-based health program. This study did not demonstrate the effectiveness of an interactive compared with a non-interactive web-based health program in physically inactive adults. Future research should further develop the evidence on web-based lifestyle interventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of specific collagen peptides (SCP) combined with resistance training (RT) on changes in tendinous and muscular properties. In a randomized, placebo‐controlled study, 40 healthy male volunteers (age: 26.3 ± 4.0 years) completed a 14 weeks high‐load resistance training program. One group received a daily dosage of 5g SCP while the other group received 5g of a placebo (PLA) supplement. Changes in Achilles tendon cross‐sectional area (CSA), tendon stiffness, muscular strength, and thickness of the plantar flexors were measured. The SCP supplementation led to a significantly (p = 0.002) greater increase in tendon CSA (+11.0%) compared with the PLA group (+4.7%). Moreover, the statistical analysis revealed a significantly (p = 0.014) greater increase in muscle thickness in the SCP group (+7.3%) compared with the PLA group (+2.7%). Finally, tendon stiffness and muscle strength increased in both groups, with no statistical difference between the groups. In conclusion, the current study shows that the supplementation of specific collagen peptides combined with RT is associated with a greater hypertrophy in tendinous and muscular structures than RT alone in young physically active men. These effects might play a role in reducing tendon stress (i.e., deposition of collagen in load‐bearing structures) during daily activities. [ABSTRACT FROM AUTHOR]

Background: A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation.Methods: The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT.Discussion: We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020.Trial Registration: German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019. [ABSTRACT FROM AUTHOR]

The purpose of the present randomized controlled trial was to investigate potential synergistic effects of whole-body vibration (WBV) training combined with blood flow restriction (BFR) on muscle mass and strength, and jump performance. Fifty healthy women (26.1 ± 4.6 years) were randomly allocated to one of the following experimental groups: WBV training combined with BFR (WBV + BFR) or WBV only. Before and after the 10-week training intervention, muscle cross-sectional area (CSA) of the vastus lateralis (VL) and gastrocnemius medialis (GM) was evaluated. Additionally, changes in muscle strength and jump performance were assessed before and after the intervention. The level of significance was set to p < 0.05. Vastus lateralis muscle CSA increased in both groups (p < 0.05). The increase in CSA was less pronounced after WBV than WBV + BFR, although the difference was not significant (p = 0.30). Likewise, GM CSA demonstrated comparable increases in both groups with a significant main effect of time (p < 0.05) but no interaction effect (p = 0.89). Assessment of muscular strength (p = 0.70) and jump performance (p = 0.40) did not reveal significant differences between the groups. The results of the present study indicate that the combination of WBV training with BFR shows a noticeable trend toward higher increases in muscle CSA compared with WBV alone. Despite the lack of significance, the results imply clinical relevance particularly in populations showing contraindications toward high training loads. This, however, needs to be confirmed in future research. [ABSTRACT FROM AUTHOR]

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Protein supplementation in combination with resistance training may increase muscle mass and muscle strength in elderly subjects. The objective of this study was to assess the influence of post-exercise protein supplementation with collagen peptides v. placebo on muscle mass and muscle function following resistance training in elderly subjects with sarcopenia. A total of fifty-three male subjects (72·2 (sd 4·68) years) with sarcopenia (class I or II) completed this randomised double-blind placebo-controlled study. All the participants underwent a 12-week guided resistance training programme (three sessions per week) and were supplemented with either collagen peptides (treatment group (TG)) (15 g/d) or silica as placebo (placebo group (PG)). Fat-free mass (FFM), fat mass (FM) and bone mass (BM) were measured before and after the intervention using dual-energy X-ray absorptiometry. Isokinetic quadriceps strength (IQS) of the right leg was determined and sensory motor control (SMC) was investigated by a standardised one-leg stabilisation test. Following the training programme, all the subjects showed significantly higher (P<0·01) levels for FFM, BM, IQS and SMC with significantly lower (P<0·01) levels for FM. The effect was significantly more pronounced in subjects receiving collagen peptides: FFM (TG +4·2 (sd 2·31) kg/PG +2·9 (sd 1·84) kg; P<0·05); IQS (TG +16·5 (sd 12·9) Nm/PG +7·3 (sd 13·2) Nm; P<0·05); and FM (TG –5·4 (sd 3·17) kg/PG –3·5 (sd 2·16) kg; P<0·05). Our data demonstrate that compared with placebo, collagen peptide supplementation in combination with resistance training further improved body composition by increasing FFM, muscle strength and the loss in FM. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effect of a 6-wk intervention with either lifestyle intervention (increased physical activity and a low-calorie diet) or a meal replacement regimen on glycemic control in patients who are prediabetic and have impaired fasting glucose. Methods: Forty-two overweight or obese men and women (age 54 ± 8 y; weight 95.1 ± 11.9 kg; body mass index [BMI] 32.8 ± 2.89 kg/m²) were included in this randomized controlled clinical trial. Patients in the lifestyle group (LS; n = 14) received dietary counseling sessions (fat-restricted low-calorie diet) and instructions on how to increase physical activity. Patients in the meal replacement group (MR; n = 28) were instructed to replace two daily meals with a low-calorie, high soy-protein drink with a low glycemic index. Results: Both interventions resulted in a significant decrease in body weight and BMI, although the reduction was more pronounced (P < 0.05) in the MR group. In both groups, glucose concentrations decreased significantly (LS: -12 mg/dL, P < 0.01; MR: -11 mg/dL, P < 0.01), and mean glucose levels returned to the normal range. Insulin (LS: -1 mU/mg [not significant]; MR: -6.3 mU/ mg, P < 0.01) and homeostasis model assessment of insulin resistance (HOMA-IR; LS -0.92, P < 0.01; MR: -2.1, P < 0.01) were also significantly lower following both interventions; again improvements were more pronounced in the MR group (insulin: P < 0.05; HOMA P < 0.01) Conclusion: It can be concluded that meal replacement is an effective intervention for rapid improvement of elevated fasting glucose and increased insulin concentrations, these being important biomarkers of the prediabetic state. The 6-wk intervention has shown that the effect of meal replacement on fasting blood glucose was comparable to the effect of lifestyle intervention. The alterations in BMI, insulin, and HOMA-IR were significantly more pronounced following the meal replacement regimen. [ABSTRACT FROM AUTHOR]

Objective To determine the changes in endurance capacity as well as in metabolic, hormonal and inflammatory markers induced by endurance training combined with a soy protein based supplement. Design Randomized controlled study consisting of moderate endurance training without (G0) or with (G1) a soy protein based supplement. Subjects Two groups of 15 subjects (10 males and 5 females in each group): healthy sports students aged 23.6 ± 1.9 years. Measurements Body composition (body mass (BM), body density (BD) by air displacement) and physical fitness (determined by treadmill ergometry) were measured at baseline and after 6 weeks of the intervention; changes in circulating metabolic and hormonal parameters (glucose, lactate, urea, uric acid, ammonia, cortisol, insulin, IGF-1), and exercise-induced stress and inflammatory markers (CK, LDH, myoglobin, hs-CRP, IL-6, IL-10, blood cell counts) were determined after the intervention period in a field test (11.5 km running on hilly ground). Results 30 participants completed the 6-week study; 28 students were able to perform the field test. No significant changes in BM and BD were noted after intervention with only slight increases in running performance and maximum aerobic capacity in the total group (2%, p=0.016). Subjects in the G1 group showed significant improvements in running velocity and lower lactate values following the intervention (-12%, p=0,003). In addition, the G1 group showed significantly lower differences in the exercise-induced increase of metabolic parameters (triglycerides, uric acid) and insulin in the post-exercise recovery period. Conclusions Our data suggest that moderate endurance training in combination with a soy-based protein supplement improves aerobic energy supply and metabolic function in healthy sports students, even without changes in body composition and without changes in the exercise-induced stress and inflammatory reaction. [ABSTRACT FROM AUTHOR]

Objective. To determine changes in body composition, physical performance, metabolic and hormonal parameters induced by lifestyle counselling, resistance training and resistance training with soy protein based supplemention in middle aged males. Design. Randomised controlled study consisting of resistance training without (RT-G) or with (RTS-G) a soy protein based supplement and a control group with lifestyle education only (LE-G). Subjects. Forty healthy middle aged men (50-65 years, BMI 25-29.9 kg/m2). Measurements. Changes in body weight (BW) and waist circumference (WC) were measured and body composition (BC), fat mass (FM), lean body mass (LBM) were measured by skin fold anthropometry at baseline and after 12 weeks of intervention. In addition, changes in physical fitness, metabolic and hormonal parameters (lipids, glucose, fructosamines, insulin, insulin-like growth factor-1, Leptin, human growth hormone, dehydroepiandrosterone, testosterone, hs-CRP, Il-6) were evaluated. Results. Thirty-five participants completed the 12 week study. No significant changes in BW were noted although RM and WC dropped and LBM increased after training, particularly in the RTS group (FM 22.6 ± 5.5 kg to 21.2 ± 4.7 kg; LBM 68.5 ± 7.2 kg to 70.1 ± 7.4; p < 0.01). Subjects in the RTS group experienced more pronounced improvements in the strength measurements than the RT group. After the training intervention there were significant changes in hormonal and metabolic parameters as well as in glycemic control, particularly in the RTS group. Conclusions. Our data suggest that resistance training, particularly in combination with a soy protein based supplement improves body composition and metabolic function in middle aged untrained and moderately overweight males. [ABSTRACT FROM AUTHOR]

High-intensity interval training (HIIT) has been demonstrated to increase the generation of reactive oxygen species (ROS). Therefore, strategies to mitigate excessive ROS productions could be useful to reduce the negative consequences of oxidative damage for health, as well as for physical, performances. The aim of this study was to investigate the acute effects of pre-exercise oatmeal consumption on exercise-induced ROS generation in young, healthy women. Thirty-four participants were randomly allocated in one of two groups: oatmeal prior to HIIT (oatmeal; n = 17) or HIIT alone (control; n = 17). Blood samples were obtained at pre-meal, pre-HIIT, immediately post-HIIT, and 15 min after HIIT. Electron paramagnetic resonance (EPR) spectroscopy was used to analyze the concentrations of ROS in the capillary blood. In addition, the blood glucose and blood lactate levels were measured. Immediately post-HIIT, the ROS generation in the oatmeal group was significantly lower in contrast to the control group (p < 0.05). A significant interaction effect of time × meal (p < 0.05; η2 = 0.234) was detected from the pre-meal to 15 post-HIIT for ROS production. Moreover, significant differences in the blood glucose levels were observed between the groups at pre-HIIT and immediately post-HIIT (p < 0.05). In conclusion, the consumption of oatmeal before HIIT may mitigate exercise-induced ROS production. [ABSTRACT FROM AUTHOR]

Introduction: Low-load resistance training with blood flow restriction (LL-BFR) has emerged as a viable alternative to conventional high-load (HL) resistance training regimens. Despite increasing evidence confirming comparable muscle adaptations between LL-BFR and HL resistance exercise, only very little is known about tendinous mechanical and morphological adaptations after LL-BFR. Therefore, the aim of the present study was to examine the effects of 14 wk of LL-BFR and HL training on patellar tendon adaptations. Methods: Twenty-nine recreationally active male participants were randomly allocated into the following two groups: LL-BFR resistance training (20%–35% one-repetition maximum (1RM)) or HL resistance training (70%–85% 1RM). Both groups trained three times per week for 14 wk. One week before and after the intervention, patellar tendon mechanical and morphological properties were assessed via ultrasound and magnetic resonance imaging. In addition, changes in muscle cross-sectional area were quantified by magnetic resonance imaging and muscle strength via dynamic 1RM measurements. Results: The findings demonstrated that both LL-BFR and HL training resulted in comparable changes in patellar tendon stiffness (LL-BFR: +25.2%, P = 0.003; HL: +22.5%, P = 0.024) without significant differences between groups. Similar increases in tendon cross-sectional area were observed in HL and LL-BFR. Muscle mass and strength also significantly increased in both groups but were not statistically different between HL (+38%) and LL-BFR (+34%), except for knee extension 1RM where higher changes were seen in LL-BFR. Conclusions: The present results support the notion that both HL and LL-BFR cause substantial changes in patellar tendon properties, and the magnitude of changes is not significantly different between conditions. Further studies that examine the physiological mechanisms underlying the altered tendon properties after LL-BFR training are needed. [ABSTRACT FROM AUTHOR]

Blood flow restriction (BFR) training has been shown to induce favorable changes in muscle mass and strength with a considerably low training load (20 -- 30% 1RM). However, it has never been evaluated if an additional post-exercise protein supplementation enhances the effects of this training regimen. Thirty healthy older men (60.1 ± 7.6 years) were enrolled in the 8-week intervention and randomly allocated to one of the following groups: low-load BFR training with protein (collagen hydrolysate) supplementation (BFR-CH), low-load BFR training with placebo (BFR-PLA), or a control group without training, but with protein supplementation (CON). Muscle cross-sectional area (CSA), muscle strength, circulating reactive oxygen species and IGF-1 were measured before and after the intervention. Muscle CSA increased in both BFR-CH and BFR-PLA groups by 6.7 ± 3.2 % (p < 0.001) and 5.7 ± 2.7 % (p < 0.001) respectively. No significant changes were observed in the CON group (1.1 ± 1.7 %, p = 0.124). Evaluation of isometric strength (p = 0.247), insulin-like growth factor 1 (p = 0.705) and the production of reactive oxygen species (pt1 = 0.229; pt2 = 0.741) revealed no significant interaction effect but a significant long-term time effect (p < 0.001). Our results demonstrate that BFR training is an effective alternative for increasing muscle CSA in older men. Although there was a trend towards greater muscle mass adaptations in the BFR-CH group, these findings showed no statistical significance. Further research with larger sample sizes is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Following an initial ankle sprain it is not unlikely that chronic ankle instability (CAI) will develop. CAI is associated with impaired perceived functional and mechanical properties of the ligaments. Nutritional supplementation with collagen peptides has been shown to improve the functional and mechanical properties of the connective tissue. The purpose of this study was to investigate the effectiveness of specific collagen peptide supplementation (SCP) to improve ankle stability in athletes with CAI. 50 male and female athletes with CAI completed a randomized, double-blinded and placebo-controlled study with a daily oral administration of either 5 g SCP or 5 g placebo (Maltodextrin) over a period of six months. Both, the Cumberland Ankle Instability Tool (CAIT) and the German version of the Foot and Ankle Ability Measure (FAAM-G) were used to measure the subjective perceived function of the ankle. Additionally, the mechanical stability was determined by measuring the ankle stiffness by an ankle arthrometer. Finally, a three-month follow-up was performed. ANOVA analysis indicated that the subjective ankle stability was improved in both the CAIT (p < 0.001) and the FAAM-G (p < 0.001) following SCP supplementation compared with placebo. No significant changes between the groups were detected in the results of the ankle arthrometer. After six month the subjective report of the ankle stability function significantly improved and the three month follow-up revealed a significant decline in the number of ankle joint injuries (p < 0.05). These data support the concept that specific collagen peptide supplementation in athletes with chronic ankle instability results in significant improvements in subjective perceived ankle stability. The reduction in the re-injury rate of ankle sprains in the follow-up period suggests that these findings have clinical relevance. [ABSTRACT FROM AUTHOR]