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Rising prescription costs, poor medication adherence, and safety issues pose persistent challenges to employer-sponsored health care plans and their beneficiaries. Comprehensive medication management (CMM), a patient-centered approach to medication optimization, enriched by pharmacogenomics (PGx), has been shown to improve the efficacy and safety of pharmaceutical regimens. This has contributed to improved health care outcomes, reduced costs of treatments, better adherence, shorter durations of treatment, and fewer adverse effects from drug therapy. Despite compelling clinical and economic evidence to justify the application of CMM guided by PGx, implementation in clinical settings remains sparse; notable barriers include limited physician adoption and health insurance coverage. Ultimately, these challenges may be overcome through comprehensive programs that include clinical decision support systems and education through employer-sponsored population health management channels to the benefit of the employees, employers, health care providers, and health care systems. This article discusses benefits, considerations, and barriers of scalable PGx-enriched CMM programs in the context of self-insured employers.

To determine if a proactive employer-sponsored mental health program closed gaps in detection and treatment of mental health conditions.Of n = 56,442 eligible, n = 8,170 (14.5%) participated in the optional screening. Participants with mental health risk were offered care concierge services including support, care planning, and connection to care. Difference in behavioral healthcare utilization, diagnoses, and prescriptions were evaluated post-intervention through claims analysis.Compared to controls (n = 2,433), those receiving concierge services (n = 369) were more likely to fill mental health prescriptions (adjusted HR = 1.2; 1.0-1.5; P = 0.042), use professional mental health services (adjusted HR = 1.4; 1.1-1.8; P = 0.02), and use new mental health services (adjusted HR = 1.9; 1.2-2.8; P = 0.004) in the following 6 months.This proactive mental health program with care concierge services identified risk, connected individuals to mental health care, and facilitated mental health treatment, among program participants.

The aims of the study are to assess adoption of a pharmacogenomic-enriched comprehensive medication management program in a self-insured employer setting and to better understand medication risks that affect employees.Employees were identified to be at high risk of medication mismanagement and were subsequently provided with a program and process to improve their health. DNA testing, a clinical decision support system, and pharmacists were used to identify medication safety and effectiveness issues and to recommend appropriate changes.A total of 10.6% of the invited employees enrolled in the program. Actionable recommendations were suggested by pharmacists for 85.8% of employees who completed the program, averaging 5.2 recommendations per person.Implementation of a PGx + CMM program in a self-insured employer setting is feasible, detects risks in prescription regimens, and offers opportunities to improve medication management and reduce the burden of healthcare expenses.

We asked whether the estimated 8-year risk of diabetes could be reduced within the first 2 years of a digital Diabetes Prevention Program (dDPP) in a workforce population.Employees and spouses were eligible if they had prediabetes-range fasting glucose or hemoglobin A 1c and body mass index ≥25 kg/m 2 . Diabetes risk was assessed using the Framingham diabetes risk score in the year before and the 2 years after dDPP initiation.Among participants completing at least nine dDPP lessons ( n = 286), diabetes risk decreased 5.3% the year after dDPP initiation, after a 5.4% increase the year before initiation (difference in differences, -10.6%; 95% confidence interval, -13.4% to -7.9%; Plt; 0.001), with risk maintained at reduced levels after the second year of the program.This dDPP reduced the estimated 8-year risk of diabetes over the first 2 years of the program.

Objective: To evaluate short-term outcomes of an employer-sponsored virtual T2D reversal program, conducted through medically supervised nutritional intervention and provider-led telehealth, in working-age adults. Methods: This pre-post study included 119 employees with T2D and high HbA1c and/or high spending on T2D prescriptions who enrolled in the T2D reversal program October 15, 2020-January 27, 2021. HbA1c, fasting glucose (FG) , body weight, body index mass (BMI) , and waist circumference pre- and post-enrollment were assessed from annual employer-sponsored wellness screening conducted 2019-2021, independently of the T2D reversal program. Program prescriptions (insulin, DPP4, GLP1, meglitinide, sulfonylurea, TZD, SGLT2) were compared pre vs. post (Table footnote 1) . Pharmacy spending for these prescriptions was estimated from a third-party claims database. Results: The program retention rate was 82% at 6 months and 67% at 1 year. Mean levels of all outcome measures declined significantly from pre to post (Table) . The number of prescriptions decreased for 47 (39.5%) of the 119 participants and increased for 3 (2.5%) . For 89 individuals participating for 6 months or more, average monthly prescription spending declined 18% (to $449 from $547) during the first 6 months after enrollment (vs. the prior 12 months) . Conclusions: A virtual T2D reversal program helped lower HbA1c, FG, body weight, BMI, and waist circumference in employees with diabetes while reducing prescriptions and pharmacy spending. Disclosure Z. Chen: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C. E. Birse: Employee; Quest Diagnostics. A. R. Arellano: Employee; Quest Diagnostics. M. S. Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. M. J. Mcphaul: Employee; Quest Diagnostics. L. A. Bare: Employee; Quest Diagnostics.

This case study describes the collaboration between a self-insured employee benefits team and a national health insurance provider to control costs while maintaining program quality and promoting population health. In 2015, Quest Diagnostics well exceeded the full-year expense target for their ∼60,000-life Group Health Insurance (GHI) program. Through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest GHI annual employer health care cost trend subsequently improved from a year-over-year trend of 5.7% for 2014 to 2015, to 4.6% for 2015 to 2016, to −1.0% for 2016 to 2017, and most recently, 0.3% for 2017 to 2018. The actuarial value of the GHI plan did not decline, and employee cost share also remained unchanged in 2017 and 2018 versus 2016 for the high-performance network option. There was a 3% premium increase for the Preferred Provider Organization option in 2018. A third-party analysis for full year 2017 showed Quest GHI to be 11% more efficient than the mean GHI for programs with a comparable benefit and employee contribution. Early results in 2018 show improvements in the health status of the health plan membership. This article describes an approach for self-insured employers to proactively collaborate with a health plan and pharmacy benefits manager to practice the Triple Aim of improving the patient health care experience and population health while reducing per capita health care spending.

Huggins, RA, Fortunati, AR, Curtis, RM, Looney, DP, West, CA, Lee, EC, Fragala, MS, Hall, ML, and Casa, DJ. Monitoring blood biomarkers and training load throughout a collegiate soccer season. J Strength Cond Res 33(11): 3065-3077, 2019-This observational study aimed to characterize the responses of a comprehensive panel of biomarkers, observed ranges, training load (TL) metrics, and performance throughout the collegiate soccer season (August-November). Biomarkers (n = 92) were collected before the start of pre-season (PS), in-season weeks (W)1, W4, W8, and W12 in NCAA Division I male soccer players (n = 20, mean ± SD; age = 21 ± 1 years, height = 180 ± 6 cm, body mass = 78.19 ± 6.3 kg, body fat = 12.0 ± 2.6%, VO2max 51.5 ± 5.1 ml·kg·min). Fitness tests were measured at PS, and W12 and TL was monitored daily. Changes in biomarkers and performance were calculated via separate repeated-measures analysis of variance. Despite similar fitness (p0.05), endocrine, muscle, inflammatory, and immune markers changed over time (p0.05). Total and free testosterone was lower in W1 vs. PS, whereas free cortisol remained unchanged at PS, W1, and W4 (0.94 mg·dL). Oxygen transport and iron metabolism markers remained unchanged except for HCT (W1 vs. PS) and total iron binding capacity (W8-W12 vs. W1). Hepatic markers albumin, globulin, albumin:globulin, and total protein levels were elevated (p0.05) at W12 vs. W1, whereas aspartate aminotransferase and alanine aminotransferase levels were elevated at W1-W12 and W8-W12 vs. PS, respectively. Vitamin E, zinc, selenium, and calcium levels were elevated (p0.05) at W12 vs. W1, whereas Vitamin D was decreased (p0.05). Fatty acids and cardiovascular markers (omega-3 index, cholesterol:high-density lipoprotein [HDL], docosahexenoic acid, low-density lipoprotein [LDL], direct LDL, non-HDL, ApoB) were reduced at W1 vs. PS (p ≤ 0.05). Immune, lipid, and muscle damage biomarkers were frequently outside clinical reference ranges. Routine biomarker monitoring revealed subclinical and clinical changes, suggesting soccer-specific reference ranges. Biomarker monitoring may augment positive adaptation and reduce injuries from stressors incurred during soccer.

Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

The coronavirus disease-2019 (COVID-19) pandemic is having a widespread impact on societies across the globe. As part of the effort to control transmission in the United States, many businesses either closed or instituted nonpharmaceutical control measures and allowed only essential workers on-site. During summer and fall of 2020, employers began formulating "return to work" strategies designed to mitigate the risk of transmission among employees. On a population level, several countries implemented national testing and surveillance strategies that proved effective in mitigating citizen-to-citizen transmission and contributed to suppressing COVID-19. A crucial component of many such strategies is population-based testing to identify and engage individuals with asymptomatic or presymptomatic infection, which also is relevant to return-to-work strategies. The authors describe an approach that multisite employers might use to help mitigate transmission of COVID-19 in the workplace. This approach leverages a bioinformatics platform informed by real-time PCR test data at the county and subcounty (eg, Public Use Microdata Area) level, allowing for population-based testing to be selectively targeted for employees in geographies with elevated SARS-CoV-2 positivity. A "Command Center" application integrates data from multiple sources (eg, local infection trends, employee symptom diaries, Bluetooth thermometers) in real time, which can be used to inform decisions regarding surveillance and employee self-isolation or quarantine; a mobile phone-based application provides for rapid, secure communication with employees. This overview is based on peer-reviewed literature and the early experience of a large employer with implementing bioinformatics tools to mitigate the impact of the pandemic on the workplace.

Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has abruptly transformed the outlook of employer health benefits plans for 2020 and 2021. Containing the spread of the virus and facilitating care of those infected have quickly emerged as immediate priorities. Employers have adjusted health benefits coverage to make COVID-19 testing and treatment accessible and remove barriers to care in order to facilitate the containment of the disease. Employers also are introducing strategies focused on testing, surveillance, workplace modifications, and hygiene to keep workforces healthy and workplaces safe. This paper is intended to provide evidence-based perspectives for self-insured employers for managing population health during the COVID-19 pandemic. Such considerations include (1) return to work practices focused on mitigating the spread of COVID-19 through safety practices, testing and surveillance; and (2) anticipating the impact of COVID-19 on health benefits and costs (including adaptations in delivery of care, social and behavioral health needs, and managing interrupted care for chronic conditions).

Objective To evaluate a proactive, voluntary screening program designed to identify employees with emerging mental health risk and engage them in care. Methods Risk was proactively identified through online screening of 344 participants. At-risk participants were offered a mental health care concierge to provide support, develop a care plan, and connect to care. Results Risk for common mental health conditions was identified in 244 (71%) participants, of whom 66 (27%) connected with a care concierge. Compared with participants who did not connect to a care concierge, those who did were more likely to report a financial crisis (68.2% vs 50.8%) and less likely to report verbal abuse (9.1% vs 19.6%) and difficulty meeting daily needs (12.1% vs 25.1%). Conclusion Implementation of this screening program identified employees at risk for mental health conditions and facilitated connection to care.

Background Androgen deprivation therapy (ADT) contributes to lean mass loss and adiposity increases in prostate cancer patients. Radiotherapy during ADT might act synergistically and further worsen body composition. Previous investigations have shown that resistance training is an effective method of preserving body composition during ADT, however, most have not accounted for direct or indirect effects of other therapies, such as radiotherapy. Therefore, the purpose of this study was to examine training adaptations of the tissue composition in patients receiving radiation therapy (RT) prior or during ADT. Methods Analyses were performed by combining data from two previous trials for a total of 131 prostate cancer patients who underwent a combination of resistance and aerobic exercise training (N = 70, age: 68.9 ± 6.6y, RT-before: 13%, RT-during: 14%) or usual care (N = 61, age: 67.5 ± 7.9y, RT-before: 16%, RT-during: 20%) for 3 months upon ADT onset. Whole-body lean mass (LM), fat percentage and appendicular LM were determined by dual energy x-ray absorptiometry, and lower-leg muscle area and density by peripheral computed tomography at baseline (onset of ADT) and at 3 months post-intervention. Covariates included RT prior and during the intervention, demographic characteristics, physical symptoms, and chronic conditions. Results Radiotherapy before or during the intervention did not affect body composition. Only the usual care group experienced a significant decrease in whole-body LM (−994 ± 150 g, P

Introduction: The Diabetes Prevention Program (DPP) was shown to reduce body weight and lower incidence of diabetes in a cost-effective manner. Digital versions of the DPP (dDPP) have recently been implemented and shown to reduce body weight and other risk factors for chronic disease. We asked whether implementation of a dDPP in a workplace setting would reduce medical costs. Methods: Employees and spouses of a nation-wide medical diagnostic provider were eligible to participate in dDPP (Omada Health) if they had prediabetes (fasting glucose 100 to 125 mg/dL or HbA 1C 5.7% to 6.4%) and BMI ≥25 kg/m 2 at baseline (September to December 2017), and were continuously enrolled in a health plan from September 2016 to December 2019. Of those eligible (n=3,098), 432 participated and completed ≥1 lesson (dDPP group). A control group (n=856) was matched to the dDPP group by baseline age, sex, race, geography, comorbidities, health plan type, and medical and prescription costs. Generalized estimating equations adjusted for age, race and BMI were used to obtain all estimates. Allowed costs from administrative claims data were evaluated per member per month (PMPM); dDPP costs were not included. Results: In the control group, costs were higher in the post-dDPP period (2017-2019) compared to the pre-dDPP period (2016-2017) for inpatient ($124 vs $64, P= 0.01), prescription ($183 vs $155, P =0.02), and total ($696 vs $558, P P =0.02; Figure). Conclusion: In the first two years of dDPP implementation, medical costs were unchanged in dDPP participants but higher in matched controls.

Evaluate the effect of a digital Diabetes Prevention Program (dDPP) on chronic disease risk factors in a workplace population.dDPP participants were employees and spouses with BMI ≥ 24 kg/m and prediabetes or diabetes (n = 84). Annual change in risk factors before and after dDPP were assessed in the dDPP group and in a retrospectively identified matched control group drawn from those who participated in a dDPP after the conclusion of this study (n = 252).In the dDPP group, body weight, BMI, fasting glucose, triglycerides, total cholesterol and LDL-cholesterol decreased in the post-dDPP period compared with the pre-dDPP period (P 0.05). In the control group, no difference between the annual change before and after dDPP was observed (P 0.37).The dDPP was effective in reducing risk factors for chronic disease in a workplace setting.

Background: A digital Diabetes Prevention Program (dDPP) has been shown to reduce the 8-year risk of diabetes in the first year of implementation in a workforce setting. We asked whether the dDPP reduced the risk of diabetes in a second year. Methods: Individuals were included in the study if they (i) participated in an employer-sponsored wellness program with year-end biometric screening for 4 consecutive years (2016 to 2019), (ii) had prediabetes-range fasting glucose (100 to 125 mg/dL) or Hb1Ac (5.7% to 6.4%), (iii) a BMI ≥25 kg/m2 at the end of 2017, and (iv) completed ≥9 lessons in a dDPP initiated at the beginning of 2018. In the first year of the dDPP, individuals participated in weekly online lessons. In the second year, no new content was introduced, but individuals had access to lessons delivered in year 1. Results: The baseline characteristics from the 2017 year-end screen are provided (Table). On average, participants (n=401) completed 25.1 lessons (SD: 12.3). In the second year of intervention, levels of BMI, fasting glucose, triglycerides and HDL-C, all components of the 8-year diabetes risk score, improved relative to changes observed in the year before intervention. The 8-year risk of developing diabetes was also reduced (Table). Conclusions: The risk of developing type 2 diabetes was reduced in the second year of a dDPP. Disclosure C.E. Birse: Employee; Self; Quest Diagnostics. M.S. Fragala: Employee; Self; Quest Diagnostics. A.R. Arellano: None. L.A. Bare: Employee; Self; Quest Diagnostics. C. Castro Sweet: Employee; Self; Omada Health. R.J. Lagier: Employee; Self; Quest Diagnostics. Employee; Spouse/Partner; Thermo Fisher Scientific.

Hormones are largely responsible for the integrated communication of several physiological systems responsible for modulating cellular growth and development. Although the specific hormonal influence must be considered within the context of the entire endocrine system and its relationship with other physiological systems, three key hormones are considered the "anabolic giants" in cellular growth and repair: testosterone, the growth hormone superfamily, and the insulin-like growth factor (IGF) superfamily. In addition to these anabolic hormones, glucocorticoids, mainly cortisol must also be considered because of their profound opposing influence on human skeletal muscle anabolism in many instances. This review presents emerging research on: (1) Testosterone signaling pathways, responses, and adaptations to resistance training; (2) Growth hormone: presents new complexity with exercise stress; (3) Current perspectives on IGF-I and physiological adaptations and complexity these hormones as related to training; and (4) Glucocorticoid roles in integrated communication for anabolic/catabolic signaling. Specifically, the review describes (1) Testosterone as the primary anabolic hormone, with an anabolic influence largely dictated primarily by genomic and possible non-genomic signaling, satellite cell activation, interaction with other anabolic signaling pathways, upregulation or downregulation of the androgen receptor, and potential roles in co-activators and transcriptional activity; (2) Differential influences of growth hormones depending on the "type" of the hormone being assayed and the magnitude of the physiological stress; (3) The exquisite regulation of IGF-1 by a family of binding proteins (IGFBPs 1-6), which can either stimulate or inhibit biological action depending on binding; and (4) Circadian patterning and newly discovered variants of glucocorticoid isoforms largely dictating glucocorticoid sensitivity and catabolic, muscle sparing, or pathological influence. The downstream integrated anabolic and catabolic mechanisms of these hormones not only affect the ability of skeletal muscle to generate force; they also have implications for pharmaceutical treatments, aging, and prevalent chronic conditions such as metabolic syndrome, insulin resistance, and hypertension. Thus, advances in our understanding of hormones that impact anabolic: catabolic processes have relevance for athletes and the general population, alike.

Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.

Due to the important interactions of proenkephalin fragments (e.g., proenkephalin [107-140] Peptide F) to enhance activation of immune cells and potentially combat pain associated with exercise-induced muscle tissue damage, we examined the differential plasma responses of Peptide F to different exercise training programs. Participants were tested pre-training (T1), and after 8 weeks (T2) of training. Fifty-nine healthy women were matched and then randomly assigned to one of four groups: heavy resistance strength training (STR, n=18), high intensity endurance training (END, n=14), combined strength and endurance training (CMB, n=17), or control (CON, n=10). Blood was collected using a cannula inserted into a superficial vein in the antecubital fossa with samples collected at rest and immediately after an acute bout of 6 X 10 RM in a squat resistance exercise before training and after training. Prior to any training, no significant differences were observed for any of the groups before or after acute exercise. With training, significant (P≤0.95) elevations were observed with acute exercise in each of the exercise training groups and this effect was significantly greater in the CMB group. These data indicate that in untrained women exercise training will not change resting of plasma Peptide F concentrations unless both forms of exercise are performed but will result in significant increases in the immediate post-exercise responses. Such findings appear to indicate adrenal medullary adaptations opioid production significantly altered with exercise training.

The aim of this study was to compare how respiratory compensation point (RCP) and end-test power (EP) change in response to the same four-week high intensity interval training (HIIT). The power output associated with RCP and EP before and after HIIT were recorded in 24 recreationally-active participants (14 men and 10 women). RCP was determined from an incremental exercise test and EP was derived from a three-minute maximal effort test on a cycle ergometer. A significant time (pretest/posttest) × measurement (EP/RCP) interaction was found (F(1, 23)=5.119, p

Early detection of disease enables prompt treatment that can prevent disease progression and costly health outcomes. We report incidence of previously unrecognized disease and investigate the expected effect of early detection and care on health outcomes.Population health study based on laboratory evidence.Laboratory evidence of prediabetes, diabetes, chronic kidney disease, and colorectal cancer was evaluated in an employee and spouse population (65% women; mean [SD] age = 46 [12] years). Expected disease progression was assessed.Annual screening found laboratory evidence for 1185 previously unrecognized cases of prediabetes, 287 cases of diabetes, 73 cases of chronic kidney disease, and 669 positive colorectal screens per 10,000 people.Early identification and appropriate medical care may delay 34 cases of end-stage kidney disease and prevent diabetes-related complications, 210 cases of diabetes, and 3 cases of late-stage colorectal cancer over 5 years per 1000 cases identified.

Background: Digital behavioral counseling has previously been shown to reduce levels of risk factors for diabetes including fasting glucose and HbA1c. We asked whether the 8-year risk of developing diabetes could be reduced within the first year of a digital counseling program. Methods: Individuals were included in the study if they (i) participated in an employer-sponsored wellness program with year-end biometric screening for 3 consecutive years (2016, 2017, and 2018), (ii) had prediabetes-range fasting glucose (100 to 125 mg/dL) or Hb1Ac (5.7% to 6.4%), (iii) a BMI ≥25 kg/m2 at the end of 2017, and (iv) completed at least 9 lessons in a digital behavioral counseling program initiated at the beginning of 2018. Paired t-Tests were used to assess changes in yearly trajectories of diabetes risk factors before and after intervention (Table). Results: The baseline characteristics of the cohort at the 2017 year-end screen are provided (Table). On average, participants (n=460) were engaged in the counseling program for 9.1 months (SD: 1.2) and completed 25.1 lessons (SD: 12.3). After participation, levels of all biometric variables included in the 8-year risk model* shifted in a favorable direction; the 8-year risk of developing diabetes was reduced (Table). Conclusions: Digital behavioral counseling was effective in reducing risk factors and the 8-year risk of diabetes during the first year of the program. Disclosure C.E. Birse: Employee; Self; Quest Diagnostics. Stock/Shareholder; Self; Quest Diagnostics. M.S. Fragala: Employee; Self; Quest Diagnostics. A. Satish: None. K.C. McNamara: Employee; Self; Omada Health, Inc. C.M. Castro Sweet: Employee; Self; Omada Health, Inc. R.J. Lagier: Employee; Self; Quest Diagnostics.

Short-term unilateral resistance training results in cross education of strength without changes in muscle size, activation, or endocrine response. J Strength Cond Res 30(5): 1213-1223, 2016-The purpose of this study was to assess the cross education of strength and changes in the underlying mechanisms (muscle size, activation, and hormonal response) after a 4-week unilateral resistance training (URT) program. A group of 9 untrained men completed a 4-week URT program on the dominant leg (DOM), whereas cross education was measured in the nondominant leg (NON); and were compared with a control group (n = 8, CON). Unilateral isometric force (PKF), leg press (LP) and leg extension (LE) strength, muscle size (by ultrasonography) and activation (by electromyography) of the rectus femoris and vastus lateralis, and the hormonal response (testosterone, growth hormone, insulin, and insulin-like growth factor-1) were tested pretraining and posttraining. Group × time interactions were present for PKF, LP, LE, and muscle size in DOM and for LP in NON. In all interactions, the URT group improved significantly better than CON. There was a significant acute hormonal response to URT, but no chronic adaptation after the 4-week training program. Four weeks of URT resulted in an increase in strength and size of the trained musculature, and cross education of strength in the untrained musculature, which may occur without detectable changes in muscle size, activation, or the acute hormonal response.

This study examined the influence of recovery time on fatigue indices, performance (total work [TW], peak power [PP], and mean power [MP]), and oxygen consumption during repeated sprint ability (RSA) on a cycle ergometer. Eight recreationally-trained men performed 3 RSA protocols consisting of 10 × 6 s sprints with 12 s, 18 s, and 24 s rest intervals between each sprint. Fatigue indices were determined as percent decrement (%Dec) and rate of decline using either a log transform method or standard slope approach for TW, PP, and MP during respective RSA protocols. The maximal VO2 value in response to given sprint intervals and the minimal VO2 value in response to given rest periods (VO2 work and VO2 rest, respectively) were recorded. A repeated measures analysis of variance was used to analyze all variables. Average VO2 work was not different among rest interval trials. Average VO2 rest with 12 s rest was greater than 18 s and 24 s (2.16 ± 0.17 L · min(-1), 1.91 ± 0.18 L · min(-1), 1.72 ± 0.15 L · min(-1), respectively), while 18 s was greater than 24 s. Average TW and MP were greater with 24 s rest than 12 s (4,604.44 ± 915.98 J vs. 4,305.46 ± 727.17 J, respectively), with no differences between RSA protocols for PP. No differences in %Dec were observed. Both methods of calculating rates of decline per sprint for PP and TW were greater during 12 s than 18 s or 24 s. Since changes were only noted between the 12 s and 24 s protocols, a 6 s differential in rest intervals may not be enough to elicit alterations in TW, PP, MP, or %Dec in RSA performance. Rate of decline may be a more sensitive measure of fatigue than %Dec.

AB Introduction: The fine aspiration microbiopsy is a relatively new biopsy technique, which allows muscle physiologists to sample skeletal muscle less invasively. However, the small sample size obtained is often deemed insufficient for certain analyses. The aim of the current study was to develop procedures for muscle fiber morphology and immunohistological analysis from a microbiopsy technique. Methods: Microbiopsies of the vastus lateralis were taken with a 14-gauge microbiopsy needle from four healthy men on two separate occasions. The tissue was oriented in a cryomold, embedded in Tissue-Tek(R) then frozen in liquid nitrogen cooled isopentane. The muscle sections were stained with hematoxylin and eosin, laminin, MHCI, MHCIIa, and Pax7 for fiber number, mean fiber area, muscle fiber typing, and satellite cell observation. Results: The mean +/- SD (range) microbiopsy sample weight was 18.3 +/- 2.9 mg (14-22 mg). The mean fiber number within the microbiopsy specimens was 150.4 +/- 120.6 (64-366). All viable fibers were measured in each sample, and the mean fiber area was 4385.1 +/- 1265.8 [mu]m2 (977.0-10,132.93 [mu]m2). There was no significant time difference (P = 0.69) in mean fiber area. Discussion: Results suggest the potential use of a "minimally invasive" muscle biopsy technique for immunohistological and morphological analysis. This could provide clinicians and investigators additional data in future research. Further investigations are needed to determine the usefulness and potential limiting factors of this technique.

Introduction Obstructive sleep apnea (OSA) is common in individuals with metabolic syndrome (MetS) and increases risk of cardiovascular (CVD) events. Once recognized, therapeutic interventions can reduce OSA severity and associated CVD risk. Of the 25 million Americans with OSA, 80% are unaware of their disease. To facilitate and improve diagnosis of OSA, diagnostic devices for at-home OSA testing have been developed in clinical studies and approved by FDA. We evaluated an employer-sponsored healthcare outreach program and at-home OSA testing as a means of identifying individuals likely to have OSA and referring them into care. Methods Nine-hundred individuals with MetS, positive OSA Berlin questionnaire score and no prior diagnosis of OSA, as determined by annual workplace screening and health claims, were invited to participate in the sleep program. Those who agreed to participate (9.9%) received a diagnostic device for at-home OSA testing. Apnea-hypoapnea index (AHI) results recorded on returned diagnostic devices were evaluated by a sleep specialist. A telephone consultation with a program physician then provided each participant with an explanation of test results and referral into care. Based on AHI we identified individuals with moderate (AHI 16-30) to severe (AHI >30) OSA and referred them to care. Results Of the 89 participating individuals, 21% had 3 MetS components, 53% had 4 components, and 20% had 5 components; 30% were diabetic; 83% had hypertension; and >50% were obese. Moderate to severe OSA was diagnosed in 52 (58%) of participants. Of those, 50% had moderate OSA and 50%, had severe OSA. Among individuals with moderate to severe OSA, 29 (56%) had a physician consultation and were referred to treatment. Conclusion A personalized employer-sponsored healthcare outreach program identified individuals with unrecognized OSA and referred them into care. Support

Fragala, MS, Goldman, SM, Goldman, MM, Bi, C, Colletti, JD, Arent, SM, Walker, AJ, and Clarke, NJ. Measurement of cortisol and testosterone in athletes: Accuracy of LC-MS/MS assays for cortisol and testosterone measurement in whole-blood microspecimens. J Strength Cond Res 32(9): 2425-2434, 2018-Biomarker monitoring provides insight into athletes' training tolerance but is limited by the need for office-based specimen collection. To facilitate self-collection during training, we developed liquid chromatography-tandem mass spectrometry-based tests that measure circulating total cortisol and testosterone using a finger stick volumetric absorptive microsampler. Here, we describe the analytical validation of these tests. Forty-six Division I athletes (18-22 years, 30 women, 16 men) provided a 20-µL finger stick microspecimen and a 5-ml venous blood specimen from the forearm; the venous blood sample was analyzed using both normal volume serum analysis and analysis of dried whole blood (from the microsampler). Liquid chromatography-tandem mass spectrometry on standard serum specimens obtained by venipuncture yielded total cortisol levels of 26.2 ± 11.6 µg·dl (women and men), and total testosterone levels of 37 ± 17 ng·dl in women and 564 ± 171 ng·dl in men. Analytical measurement ranges of the microspecimen assay were 0.3-440 µg·dl (CV

The effect of altitude on soccer game activity profiles was retrospectively examined in six NCAA Division I female soccer players. Comparisons were made between two matches played at sea level (SL) and one match played at a moderate altitude (1839 m). A 10-Hz global positioning system device was used to measure distance and velocity. The rate of total distance capacity (TDC) and high intensity running (HIR) as well as percent of time at HIR were evaluated. Significant differences were seen in the distance rate (120.55 ± 8.26 m·min-1 versus 105.77 ± 10.19 m·min-1) and the HIR rate (27.65 ± 9.25 m·min-1 versus 25.07 ± 7.66 m·min-1) between SL and altitude, respectively. The percent of time at HIR was not significantly different (p = 0.064), yet tended to be greater at SL (10.4 ± 3.3%) than at altitude (9.1 ± 2.2%). Results indicate that teams residing at SL and competing at a moderate altitude may have a reduced ability in distance covered and a high intensity run rate.

The purpose of this study was to investigate the effects of short term resistance exercise on neuromuscular fatigue threshold (PWCFT), strength, functional performance, and body composition in older adults. Twenty-three participants (71.2 ± 6.0 yr) were randomly assigned to 6 weeks of resistance exercise (EXE) or control (CONT). A submaximal cycle ergometer test, physical working capacity at fatigue threshold, was used to determine PWCFT. Strength was assessed with predicted leg extension 1-RM and functional performance with time to complete 5 chair rises (CHAIR) and walk an 8-ft course (WALK). PWCFT, 1-RM and CHAIR significantly (p

To examine the efficacy of l-alanyl-l-glutamine ingestion with a commercially available sports drink compared to the sports drink only on time to exhaustion and physiological measures during prolonged endurance exercise.Twelve endurance-trained men (23.5 ± 3.7 years; 175.5 ± 5.4 cm; 70.7 ± 7.6 kg) performed 4 trials, each consisting of a 1-hour treadmill run at 75% VO2peak followed by a run to exhaustion at 90% VO2peak. One trial consisted of no hydration (NHY), another required ingestion of only a sports drink (ED), and 2 trials required ingestion of a low dose (LD; 300 mg·500 ml(-1)) and high dose (HD) of l-alanyl-l-glutamine (1 g·500 ml(-1)) added to the sports drink. During the fluid ingestion trials, 250 ml was consumed every 15 minutes. Plasma glutamine, glucose, electrolytes, and osmolality were measured prior to the run (PRE) and at 30, 45, and 60 minutes. VO2, respiratory quotient (RQ), and heart rate (HR) were measured every 15 minutes.Time to exhaustion was significantly longer during the LD and HD trials compared to NHY. No differences were noted in time to exhaustion between ED and NHY. Plasma glutamine concentrations were significantly elevated at 45 minutes in LD and HD trials and remained elevated at 60 minutes during HD. Sodium concentrations increased from the beginning of exercise and remained stable for the duration of the 1-hour run. At 60 minutes, plasma sodium was significantly lower in all trials compared to NHY.Results indicated that ingestion of the alanine-glutamine dipeptide at either the low or high dose significantly improved time to exhaustion during high-intensity exercise compared to a no-hydration trial.

To evaluate the time course of EMG frequency changes during a three-minute maximal effort cycling test (3MT) session and to examine which parameter between mean (MNF) and median (MDF) frequency is more suitable for evaluation of changes in neuromuscular function throughout a 3MT. Eighteen recreationally-active men volunteered to participate in this study. Maximum voluntary contraction (MVC) was measured using a dynamometer to determine maximal EMG frequency of the vastus lateralis (VL) of the kicking leg during isometric knee extension. A maximal oxygen consumption test (VO2peak) on a cycle ergometer was performed to establish the appropriate load profile for the 3MT which was completed after a period of at least 48 hours. MNF, MDF and power output (PO) values were measured at 10-second epochs throughout the duration of the 3MT. Repeated measures analysis of variance was used to compare the changes in EMG frequency, relative to maximal values from the MVC, and change in PO during the testing procedure. MNF, Root Mean Square (RMS), and PO significantly decreased during the 3MT, while MDF did not change significantly. Statistically, EMG frequency and PO decreased at first and remained constant in response to the 3MT, which may be reflective of differing patterns of muscle fiber type fatigue throughout the testing session. Due to decreased variability, changes in neuromuscular function during this protocol may be better evaluated using MNF than MDF.

This study compared caffeine pharmacokinetics, glycerol concentrations, metabolic rate, and performance measures following ingestion of a time-release caffeine containing supplement (TR-CAF) versus a regular caffeine capsule (CAF) and a placebo (PL). Following a double-blind, placebo-controlled, randomized, cross-over design, ten males (25.9 ± 3.2 y) who regularly consume caffeine ingested capsules containing either TR-CAF, CAF, or PL. Blood draws and performance measures occurred at every hour over an 8-hour period. Plasma caffeine concentrations were significantly greater (p < 0.05) in CAF compared to TR-CAF during hours 2-5 and significantly greater (p = 0.042) in TR-CAF compared to CAF at hour 8. There were no significant differences between trials in glycerol concentrations (p = 0.86) or metabolic measures (p = 0.17-0.91). Physical reaction time was significantly improved for CAF at hour 5 (p=0.01) compared to PL. Average upper body reaction time was significantly improved for CAF and TR-CAF during hours 1-4 (p = 0.04 and p = 0.01, respectively) and over the 8-hour period (p = 0.04 and p = 0.001, respectively) compared to PL. Average upper body reaction time was also significantly improved for TR-CAF compared to PL during hours 5-8 (p = 0.004). TR-CAF and CAF showed distinct pharmacokinetics yielding modest effects on reaction time, yet did not alter glycerol concentration, metabolic measures, or other performance measures.

Purpose:During the competitive soccer season, women’s intercollegiate matches are typically played on Friday evenings and Sunday afternoons. The efficacy of a 42-h recovery period is not well understood. This investigation was conducted to determine performance differences between Friday and Sunday matches during a competitive season.Methods:Ten NCAA Division I female soccer players (20.5 ± 1.0 y, 166.6 ± 5.1 cm, 61.1 ± 5.8 kg) were monitored with 10-Hz GPS devices across 8 weekends with matches played on Friday evenings and Sunday afternoons. The players were outside backs, midfielders, and forwards. All players had to participate in a minimum of 45 min/match to be included in the study. Average minutes played, total distance covered, total distance of high-intensity running (HIR) (defined as running at a velocity equal to or exceeding 3.61 m/s for longer than 1 s), the number of HIR efforts, and the number of sprints were calculated for each match. Data for Friday vs Sunday matches were averaged and then compared using dependent t tests.Results:No differences were seen in minutes played, distance rate, or number of sprints between Friday and Sunday matches. A significant (P = .017) decrease in rate of HIR between Friday (25.37 ± 7.22 m/min) and Sunday matches (22.90 ± 5.70 m/min) was seen. In addition, there was a trend toward a difference (P = .073) in the number of efforts of HIR between Friday (138.41 ± 36.43) and Sunday (126.92 ± 31.31).Conclusions:NCAA Division I female soccer players cover less distance of HIR in games played less than 48 h after another game. This could be due to various factors such as dehydration, glycogen depletion, or muscle damage.

Context:Resistance training is a common form of exercise for competitive and recreational athletes. Enhancing recovery from resistance training may improve the muscle-remodeling processes, stimulating a faster return to peak performance.Objective:To examine the effects of 2 different recovery modalities, neuromuscular electrical stimulation (NMES) and cold-water immersion (CWI), on performance and biochemical and ultrasonographic measures.Participants:Thirty resistance-trained men (23.1 ± 2.9 y, 175.2 ± 7.1 cm, 82.1 ± 8.4 kg) were randomly assigned to NMES, CWI, or control (CON).Design and Setting:All participants completed a high-volume lower-body resistance-training workout on d 1 and returned to the human performance laboratory 24 (24H) and 48 h (48H) postexercise for follow-up testing.Measures:Blood samples were obtained preexercise (PRE) and immediately (IP), 30 min (30P), 24 h (24H), and 48 h (48H) post. Subjects were examined for performance changes in the squat exercise (total repetitions and average power per repetition), biomarkers of inflammation, and changes in cross-sectional area and echo intensity (EI) of the rectus femoris (RF) and vastus lateralis muscles.Results:No differences between groups were observed in the number of repetitions (P = .250; power: P = .663). Inferential-based analysis indicated that increases in C-reactive protein concentrations were likely increased by a greater magnitude after CWI compared with CON, while NMES possibly decreased more than CON from IP to 24H. Increases in interleukin-10 concentrations between IP and 30P were likely greater in CWI than NMES but not different from CON. Inferential-based analysis of RF EI indicated a likely decrease for CWI between IP and 48H. No other differences between groups were noted in any other muscle-architecture measures.Conclusions:Results indicated that CWI induced greater increases in pro- and anti-inflammatory markers, while decreasing RF EI, suggesting that CWI may be effective in enhancing short-term muscle recovery after high-volume bouts of resistance exercise.

Aging is often accompanied by declines in physical functioning which impedes older adults' quality of life, sense of independence, and ability to perform daily tasks. Age-related decreases in skeletal muscle quantity, termed sarcopenia, have traditionally been blamed for these physical decrements. However, recent evidence suggests that the quality of muscle tissue may be more functionally relevant than its quantity. 'Muscle quality' has been emerging as a means to elucidate and describe the intricate intramuscular changes associated with muscle performance in the context of aging and sarcopenia. While muscle quality has most commonly been defined in terms of muscle composition or relative strength, at the core, muscle quality really describes muscle's ability to function. Skeletal muscle displays a strong structure-function relationship by which several architectural characteristics factor into its functional capacity. This review describes the structural, physiological, and functional determinants of muscle quality at the tissue and cellular level, while also introducing other novel parameters such as sarcomere spacing and integrity, circulating biomarkers, and the muscle quality index. Muscle qualitative features are described from the perspective of how physical exercise may improve muscle quality in older adults. This broad, multidimensional perspective of muscle quality in the context of aging and sarcopenia offers comprehensive insights for consideration and integration in developing improved prognostic tools for research and clinical care, while also promoting translational approaches to the design of novel targeted intervention strategies designed to maintain function and mobility into late life.

To determine if exercise training alters the pattern and magnitude of plasma concentrations of proenkephalin Peptide F and epinephrine, plasma proenkephalin [107–140] Peptide Fir and catecholamines were examined pre-training (T-1), and after 4- (T-2), 8- (T-3), and 12-weeks (T-4) of training. 26 healthy men were matched and randomly assigned to one of three groups: heavy resistance strength training (Strength, n = 9), high intensity endurance training (Endurance, n = 8), or both training modalities combined (Combined, n = 9). Blood was collected using a syringe with a cannula inserted into a superficial arm vein with samples collected at rest, after each 7 min stage and 5 and 15 min into recovery. With training, all groups observed shifted plasma Peptide F responses to graded exercise, where significant increases were observed at lower exercise intensities. Increases in plasma epinephrine with exercise were observed in all groups. The Combined group saw increases at 25% at T-3 and for 50% at T-2, T-3, and T-4 which was higher than T-1. The Endurance group demonstrated increases for 50% at T-1, T-2, T-3 but not at T-4. The plasma epinephrine response to graded exercise was reduced in the Strength group. Increases in plasma norepinephrine above rest were observed starting at 50% . The Strength group demonstrated a significant reduction in norepinephrine observed at 100% at T-3 and T-4. Peptide F and catecholamines responses to graded exercise can be altered by different types of physical exercise training. Simultaneous high intensity training may produce adrenal medulla exhaustion when compared to single mode training.

Objectives Physical exercise may affect levels of blood-based biomarkers. However, exercise status is seldom considered in the interpretation of laboratory results. This study reports the associations between habitual exercise participation and clinical laboratory test results. Methods The effects of days per week of aerobic and strength exercise participation on laboratory test results for 26 biomarkers in young adults aged 18 to 34 years (n = 80,111) were evaluated using percentile distribution analyses and multivariate regression. Results In both men and women, more days per week of either aerobic or strength exercise were significantly associated with lower levels of glucose, hemoglobin A1c, LDL cholesterol, total cholesterol, triglycerides, estimated glomerular filtration rate, globulin, and C-reactive protein, and significantly higher levels of HDL cholesterol, creatinine, iron, and percent saturation (all p < .05). Type of exercise or gender influenced the observed relationships with exercise frequency for total cholesterol, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, uric acid, bilirubin, and iron binding capacity. Conclusions Physical exercise shifted the distribution of results into the direction suggestive of better health. Reported relationships may help clinicians and patients to better understand and interpret laboratory results in athletic populations and possibly re-evaluate interpretation of reference intervals for physically active populations.

Objective The consequences of age-related decline in the somatotropic axis of humans are complex and remain largely unresolved. We tested the hypothesis that hGH measurements of plasma by bioassay vs immunoassay from samples obtained from free-living, elderly individuals would reveal a dichotomy in GH activities that are correlated with the functional status of the donors, i.e. their healthspan. Design Forty-one men and women of advanced age (men: N = 16, age, 80.5 ± 6.5 years; height, 173.1 ± 6.9 cm; body mass, 81.8 ± 13.0 kg) and (women: N = 25, age, 80.7 ± 7.2 years; height, 157.7 ± 6.0 cm; body mass, 68.8 ± 17 kg), were recruited for a cross-sectional study. Participants filled out PROMIS (Patient-Reported Outcomes Measurement Information System, U. S. Department of Health and Human Services) scales, undertook physical performance tests and had fasted blood samples obtained at rest for measurement of hormonal and immunology biomarkers. Results When measured by the well-established rat tibial line GH bioassay, one half of the plasma samples (n = 20) contained bioassayable GH (bGH), but the other half (n = 21) failed to mount increases in tibial plate width above saline injected controls. This difference did not correlate with the age, sex or physical functionality of the plasma donor. It also did not correlate with hGH concentrations measured by immunoassay. In those cases in which bGH was detected, various hierarchical regression models predicted that GHRH, c-peptide, VEGF, NPY, IL-4 and T-regulatory lymphocytes were associated with the difference and predicted bGH. Conclusion Results from this study suggest that the actions of bGH at the cellular level may be modified by other factors and that this may explain the lack of correlations observed in this study.

To determine if unilateral measures of muscle architecture in the rectus femoris (RF) and vastus lateralis (VL) were related to (and predictive of) sprinting speed and unilateral (and bilateral) force (FRC) and power (POW) during a 30 s maximal sprint on the Woodway Curve 3.0 non-motorized treadmill. Twenty-eight healthy, physically active men (n = 14) and women (n = 14) (age = 22.9 ± 2.4 years; body mass = 77.1 ± 16.2 kg; height = 171.6 ± 11.2 cm; body-fa t = 19.4 ± 8.1%) completed one familiarization and one 30-s maximal sprint on the TM to obtain maximal sprinting speed, POW and FRC. Muscle thickness (MT), cross-sectional area (CSA) and echo intensity (ECHO) of the RF and VL in the dominant (DOM; determined by unilateral sprinting power) and non-dominant (ND) legs were measured via ultrasound. Pearson correlations indicated several significant (p < 0.05) relationships between sprinting performance [POW (peak, DOM and ND), FRC (peak, DOM, ND) and sprinting time] and muscle architecture. Stepwise regression indicated that POW(DOM) was predictive of ipsilateral RF (MT and CSA) and VL (CSA and ECHO), while POW(ND) was predictive of ipsilateral RF (MT and CSA) and VL (CSA); sprinting power/force asymmetry was not predictive of architecture asymmetry. Sprinting time was best predicted by peak power and peak force, though muscle quality (ECHO) and the bilateral percent difference in VL (CSA) were strong architectural predictors. Muscle architecture is related to (and predictive of) TM sprinting performance, while unilateral POW is predictive of ipsilateral architecture. However, the extent to which architecture and other factors (i.e. neuromuscular control and sprinting technique) affect TM performance remains unknown.

The purpose of this study was to examine the effect of the L-Alanyl-L-Glutamine dipeptide (AG) on cognitive function and reaction time (RT) following endurance exercise. Twelve male endurance athletes (23.5 ± 3.7 y; 175.5 ± 5.4 cm; 70.7 ± 7.6 kg) performed four trials, each consisting of running on a treadmill at 70% of VO2max for 1h, then at 90% of VO2max until exhaustion. One trial consisted of no hydration (DHY), another required ingestion of only a sports electrolyte drink (ED) and two trials required ingestion of a low dose (LD; 300 mg·500 ml(-1)) and high dose (HD) of AG (1 g·500ml(-1)) added to the ED. Cognitive function and reaction tests were administered pre- and post-exercise. Magnitude based inferences were used to analyze ∆ cognitive function and ∆ reaction test data. Results indicated that DHY had a possible negative effect on number of hits in a 60-sec reaction test compared to LD and HD, while ED appeared to have a negative effect compared to HD. Analysis of lower body quickness indicated that LD and HD were likely improved in comparison to DHY. Performance on the serial subtraction test appeared to be possibly better in ED than DHY, while other comparisons between groups regarding cognitive function were unclear. In conclusion, rehydrating with AG during submaximal exercise may maintain or enhance subsequent RT in upper and lower body activities compared to DHY. These same effects were not apparent when participants consumed ED.

ADAM J. WELLS, MS, DAVID H. FUKUDA, PhD, JAY R. HOFFMAN, PhD, ADAM M. GONZALEZ, MEd,ADAM R. JAJTNER, MS, JEREMY R. TOWNSEND, MS, GERALD T. MANGINE, MEd, MAREN S. FRAGALA, PhD, andJEFFREY R. STOUT, PhDInstitute of Exercise Physiology and Wellness, University of Central Florida (UCF), 4000 Central Florida Blvd Orlando, Florida, 32816,USAAccepted 21 February 2014ABSTRACT: Introduction: Variations in transverse point of mea-sure on the vastus lateralis (VL) may significantly affect therelationship between structure and function. The purpose of thisstudy was to compare changes in muscle architecture at 2commonly used points of measure (VL0 and VL5). Methods:Maximal strength (1-repetition maximum [1RM] barbell squat)and muscle architecture were assessed PRE and POST 15weeks of periodized resistance training. VL0 was 50% of thestraight line distance between the greater trochanter and lateralepicondyle of the femur. VL5 was 5cm medial to VL0. Results:Increases in 1RM strength (3.762.4 kg; P50.004) wereobserved. Changes in muscle thickness (MT) at VL5 were sig-nificantly greater than at VL0 (P50.006). Changes in strengthcorrelated with changes in muscle architecture at VL0 only (MT:r50.561; fascicle length: r50.503). Conclusions: Changes inmuscle architecture appear to occur in a non-homogeneousmanner.

The purpose of this randomized, cross-over design study was to examine the effect of three different muscle potentiation protocols on acute changes in muscle architecture and vertical jump performance. Eleven experienced, resistance trained men (25.2±3.6y) completed three potentiation squat protocols using moderate intensity (MI; 75%, 3 sets x 10 repetitions), high intensity (HI; 90%, 3 sets x 3 repetitions) and 100% (1RM; 1 set x 1repetition) of their 1RM. In addition, all participants completed a control session (CTL) in which no protocol was performed. During each testing session, muscle architecture and vertical jump testing were assessed at baseline (BL), 8min post (8P) and 20min post (20P) workout. Ultrasound measures included cross sectional area (CSA) and pennation angle (PANG) of both the rectus femoris (RF) and vastus lateralis (VL). Following each ultrasound measure, peak vertical jump power (PVJP) and mean (MVJP) power was assessed using an accelerometer. Magnitude based inferences were used to make comparisons between trials. The MI trial resulted in a likely greater increase from BL to 8P and 20P in RF-CSA and VL-CSA, while the HI trial resulted in a likely greater change from BL to 20P in both RF-CSA and VL-CSA. Meanwhile, changes in PVJP and MVJP for the MI trial was likely decreased at BL-8P and BL–20P, while the HI trial was shown to result in a likely or possible decrease compared to CTL at BL-8P and BL–20P, respectively. A likely negative relationship was observed between changes in VL-PANG and MVJP (r = -0.35; p , 0.018) at BL-8P, and between changes in PVJP and RF-CSA (r = -0.37; p , 0.014) at BL–20P. Results of this study were unable to demonstrate any potentiation response from the trials employed, however these protocols did result in acute muscle architectural changes.

The purpose of this study was to determine the relationship between visual tracking speed (VTS) and reaction time (RT) on basketball-specific measures of performance. Twelve professional basketball players were tested before the 2012-13 season. Visual tracking speed was obtained from 1 core session (20 trials) of the multiple object tracking test, whereas RT was measured by fixed- and variable-region choice reaction tests, using a light-based testing device. Performance in VTS and RT was compared with basketball-specific measures of performance (assists [AST]; turnovers [TO]; assist-to-turnover ratio [AST/TO]; steals [STL]) during the regular basketball season. All performance measures were reported per 100 minutes played. Performance differences between backcourt (guards; n = 5) and frontcourt (forward/centers; n = 7) positions were also examined. Relationships were most likely present between VTS and AST (r = 0.78; p < 0.003), STL (r = 0.77; p < 0.003), and AST/TO (r = 0.78; p < 0.003), whereas a likely relationship was also observed with TO (r = 0.49; p < 0.109). Reaction time was not related to any of the basketball-specific performance measures. Backcourt players were most likely to outperform frontcourt players in AST and very likely to do so for VTS, TO, and AST/TO. In conclusion, VTS seems to be related to a basketball player's ability to see and respond to various stimuli on the basketball court that results in more positive plays as reflected by greater number of AST and STL and lower turnovers.