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PubMed1997

A prospective study of work-related physical exertion and spontaneous abortion.

We examined the relation of physical exertion to spontaneous abortion in a prospective study of 5,144 pregnant women. In a first trimester interview, we obtained data on employment and physical activity at work and at home, as well as other potential risk factors for spontaneous abortion. We measured exertion as follows: time spent working, standing and bending at work, hours between breaks, and hours spent doing housework or yardwork; shift worked; number of times lifted weights and more than 15 pounds at work or at home; number of children under age 5 years cared for at home. None of the exertion measures was appreciably associated with an increased risk of spontaneous abortion overall. In addition, physical activity at work and at home combined was not related to increased risk. For women with a history of two or more spontaneous abortions, standing at work more than 7 hours per day was associated with an adjusted odds ratio (OR) of 4.3 [95% confidence limits (CL) = 1.6, 11.7], whereas standing at work for 7 hours or less was associated with an adjusted OR of 1.7 (95% CL = 1.1, 2.6). Women without such a history who stood more than 7 hours at work had an adjusted OR near unity.

Abortion, Spontaneous↗
PubMed1992

The physical exertion factor in compensable work injuries. A hidden flaw in previous research.

Studies of the industrially injured worker invariably suggest that compensation reinforces pain and prolongs disability. These claims may be spurious. Researchers have historically failed to take into account the fact that return to work is partly contingent on the amount of physical labor involved in the job, and that compensation and noncompensation groups differ on this variable in important ways. Patients on compensation are more likely involved in heavy physical exertion on their jobs. In this study, 1,191 workers with low-back pain who were injured on the job were compared with 389 workers who were injured away from work on variables of disability time and pain intensity. To disentangle the effects of physical exertion, four levels ranging from none to heavy were examined. The results suggest that injury on the job operates both independent of level of physical exertion, as well as in interaction with it, to extend the period of disability. Injury on the job is associated with prolonged disability time, irrespective of the type of job performed.

Adult↗
PubMed1994

Ratings of perceived thigh and back exertion in forest workers during repetitive lifting using squat and stoop techniques.

STUDY DESIGN: Local thigh and low back perceived exertion (RPE), sagittal peak load moments, and leg and trunk muscular activity during repetitive submaximal lifting, with squat and stoop technique, were investigated. OBJECTIVES: This study analyzed changes in kinetic variables caused by changes in body movements during the lifting bouts, and the contribution of the biomechanical and physiologic variables to the variability in the local RPE responses. SUMMARY OF BACKGROUND DATA: Despite instructions that emphasize the "correct" lifting technique as the squat technique, the stoop technique is reported as more commonly used in practice. Few studies have investigated the effect of lifting technique on differentiated perceptual responses in repetitive lifting. METHODS: Ten experienced forest workers performed submaximal repetitive lifting bouts until steady-state VO2 was reached, using five different weight and frequency combinations with both squat and stoop techniques. Borg's scale was used for RPE measurements. Muscular activity in lumbar, hip, knee extensors, and knee flexors was recorded with surface electrodes. Kinematic data was obtained from electronic liquid-level sensors, and vertical ground reaction forces from a two-dimensional force plate. RESULTS: Low back RPE was higher for stoop than for squat, whereas the opposite was true for thigh RPE. The total accountable variance (R2) for the biomechanical and physiologic variables to the RPE responses ranged from 0.25 (low back RPE in squat lifting) to 0.61-0.76 for the other assessments. During the time course in squat lifting at the highest frequency, the knee load moment decreased and the vertical ground reaction forces increased. CONCLUSIONS: The study indicates that "movement strategies" to reduce the demand on the knee-extensor muscles were used during the squat lifting bouts at the highest frequencies, which combined with the relatively high assessed thigh exertions, leads to the hypothesis that quadriceps muscle exertion is the "weak link" for the squat technique. The study also indicates a discrepancy between the measured and perceived low back stress in squat repetitive lifting.

Adult↗
PubMed2003

Successful conservative management of acute hepatic failure following exertional heatstroke.

Acute hepatic failure is a rare complication of exertional heatstroke with poor prognosis. We herein report a 24-year-old man presenting with acute hepatic failure and rhabdomyolysis following exertional heatstroke during hard physical work on a construction site. Acute hepatic failure occurred after 2 days and led to massive impairment of coagulation parameters. On day 3 after heatstroke the patient fulfilled standard criteria for emergency liver transplantation (i.e. the 'London criteria' and the 'Clichy criteria') but was not transplanted. Nevertheless liver function improved spontaneously thereafter and the patient recovered completely within 12 days. In contrast, the outcome of emergency liver transplantation was dismal in three cases of exertional heatstroke in the literature. Thus conservative management appears to be justified in heatstroke-associated liver failure even in the presence of accepted criteria for emergency liver transplantation.

Adult↗
PubMed1975

Muscular exertion: a test of pituitary function in children.

The elevated level of growth hormone after moderate standardized physical exercise was compared with that induced by intravenous arginine infusion and by insulin induced hypoglycemia in children with normal pituitary function. Tests were performed on 49 prepubertal children (34 boys and 15 girls); in 42 cases the increase was significant for all three tests, in 5 cases the response was minimal after insulin stimulation but normal after arginine and physical exertion; in 1 case arginine produced no response but the other tests were positive; in 1 case there was a response to arginine but none to insulin or physical exertion. The results indicate that frequently more than one test is necessary for the diagnosis of normal pituitary function; physical exertion being a physiologic test, is simple to perform, acceptable to the children and without side effects. It appears the test of first choice because it can be used in patients seen ambulatorily, other tests being performed in case of doubt or negative response.

Arginine↗
PubMed2004

Relation between physical exertion and heart rate variability characteristics in professional cyclists during the Tour of Spain.

BACKGROUND: Continued exposure to prolonged periods of intense exercise may unfavourably alter neuroendocrine, neuromuscular, and cardiovascular function. OBJECTIVE: To examine the relation between quantifiable levels of exertion (TRIMPS) and resting heart rate (HR) and resting supine heart rate variability (HRV) in professional cyclists during a three week stage race. METHOD: Eight professional male cyclists (mean (SEM) age 27 (1) years, body mass 65.5 (2.3) kg, and maximum rate of oxygen consumption (VO(2)max) 75.6 (2.2) ml/kg/min) riding in the 2001 Vuelta a España were examined for resting HR and HRV on the mornings of day 0 (baseline), day 10 (first rest day), and day 17 (second rest day). The rest days followed stages 1-9 and 10-15 respectively. HR was recorded during each race stage, and total HR time was categorised into a modified, three phase TRIMPS schema. These phases were based on standardised physiological laboratory values obtained during previous VO(2)max testing, where HR time in each phase (phase I = light intensity and less than ventilatory threshold (VT; approximately 70% VO(2)max); phase II = moderate intensity between VT and respiratory compensation point (RCP; approximately 90% VO(2)max); phase III = high intensity (>RCP)) was multiplied by exertional factors of 1, 2, and 3 respectively. RESULTS: Multivariate analysis of variance showed that total TRIMPS for race stages 1-9 (2466 (90)) were greater than for stages 10-15 (2055 (65)) (p<0.0002). However, TRIMPS/day were less for stages 1-9 (274 (10)) than for stages 10-15 (343 (11)) (p<0.01). Despite a trend to decline, no difference in supine resting HR was found between day 0 (53.2 (1.8) beats/min), day 10 (49.0 (2.8) beats/min), and day 17 (48.0 (2.6) beats/min) (p = 0.21). Whereas no significant group mean changes in HR or HRV indices were noted during the course of the race, significant inverse Pearson product-moment correlations were observed between all HRV indices relative to total TRIMPS and TRIMPS/day accumulated in race stages 10-15. Total TRIMPS correlated with square root of mean squared differences of successive RR intervals (r = -0.93; p<0.001), standard deviation of the RR intervals (r = -0.94; p<0.001), log normalised total power (r = -0.97; p<0.001), log normalised low frequency power (r = -0.79; p<0.02), and log normalised high frequency power (r = -0.94; p<0.001). CONCLUSION: HRV may be strongly affected by chronic exposure to heavy exertion. Training volume and intensity are necessary to delineate the degree of these alterations.

Adult↗
PubMed2003

The influence of exercise test protocol on perceived exertion at submaximal exercise intensities in children.

This study examined ratings of perceived exertion (RPE) using Borg's 6-20 scale at 50 W, 80 W, and ventilatory threshold (VT) in 10-year-old children (n = 15) during two different graded exercise tests. Power output was increased by 10 W.min(-1) in one protocol and by 30 W.3 min(-1) in the other. The cardiorespiratory responses at VT and peak exercise were similar between protocols. At 50 W and 80 W the cardiorespiratory responses were generally lower (P < 0.05) in the 10W trial. However, RPE was 11.5 +/- 2.9 and 12.1 +/- 3.2 at 50 W and 15.1 +/- 2.7 and 15.3 +/- 2.8 at 80 W in the 10-W and 30-W trials, respectively (P > 0.05). The RPE at VT was 13.9 +/- 2.4 in the 10-W trial and 12.4 +/- 2.4 in the 30-W trial (P < 0.05). In that variations in submaximal RPE did not coincide with variations in central mediators of exertion, locals cues of exertion may have provided the dominate sensory signal.

Analysis of Variance↗
PubMed2002

Effect of naloxone on perceived exertion and exercise capacity during maximal cycle ergometry.

We assessed the effects of naloxone, an opioid antagonist, on exercise capacity in 13 men and 5 women (mean age = 30.1 yr, range = 21-35 yr) during a 25 W/min incremental cycle ergometer test to exhaustion on different days during familiarization trial and then after 30 mg (iv bolus) of naloxone or placebo (Pl) in a double-blind, crossover design. Minute ventilation (Ve), O(2) consumption (Vo(2)), CO(2) production, and heart rate (HR) were monitored. Perceived exertion rating (0-10 scale) and venous samples for lactate were obtained each minute. Lactate and ventilatory thresholds were derived from lactate and gas-exchange data. Blood pressure was obtained before exercise, 5 min postinfusion, at maximum exercise, and 5 min postexercise. There were no control-Pl differences. The naloxone trial demonstrated decreased exercise time (96% Pl; P < 0.01), total cumulative work (96% Pl; P < 0.002), peak Vo(2) (94% Pl; P < 0.02), and HR (96% Pl; P < 0.01). Other variables were unchanged. HR and Ve were the same at the final common workload, but perceived exertion was higher (8.1 +/- 0.5 vs. 7.1 +/- 0.5) after naloxone than Pl (P < 0.01). The threshold for effort perception amplification occurred at approximately 60 +/- 4% of Pl peak Vo(2). Thus we conclude that peak work capacity was limited by perceived exertion, which can be attenuated by endogenous opioids rather than by physiological limits.

Adult↗
PubMed1978

A study in mice of benzodiazephine-anticholinergic interaction: protection against restraint-immersion and forced exertion-induced gastric mucosal erosion.

The effectiveness of benzodiazepines and anticholinergics administered alone or in combination in preventing restraint-immersion and forced exertion-induced gastric mucosal erosion was investigated in mice. The benzodiazepines used were diazepam and chlordiazepoxide HCI and the anticholinergics were propantheline bromide and clidinium bromide. The administratio of a benzodiazepine with an anticholinergic resulted in additive or supra-additive protective effects in both systems. In the restraint-immersion system, diazepam combined with propantheline bromide at a ratio of 1 to 13.7 yielded a 4.53-fold supra-additive effect. At ratios of 4.6 or 1.5 parts of propantheline bromide to 1 part of diazepam an additive effect was observed. One part of diazepam, when combined with 1.4 to 12.0 parts of clidinium bromide resulted in supra-additive effects of about 1.5-fold. The co-administration of chlordiazepoxide HCI and clidinium bromide in ratios of 2 to 1 or 2.5 to 1 resulted in supra-additive effects of 2.4- and 1.85-fold, respectively. At higher and lower ratios additive effects were demonstrated. In the forced exertion system, diazepam combined with either anticholinergic resulted in supra-additive effects of 2- to 3-fold which occurred at ratios of diazepam to the anticholinergic varying over an 8-fold range. The co-administration of 2 parts of chlordiazepoxide HCI and 1 part of clidinium bromide resulted in a 2.84-fold supra-additive effect in the forced exertion system. These results are discussed in relation to the use of benzodiazepine anticholinergic combinations in the treatment of human gastric and duodenal ulcer disease.

Animals↗
PubMed1975

[Mechanics of breathing and exertion dyspnea in silicosis (author's transl)].

Mechanics of breathing as studied in patients with different stages of silicosis in rest and during exercise show the following: dynamic compliance and work against elastic and viscous resistances could not be found to be decisive indices of exertion dyspnea. Evidence of exertion dyspnea could only be achieved by means of the ration VT/PT (VT equals tidal volume, PT equals tidal esophageal pressure). Exertion dyspnea was observed at less than 0,081 VT per cm H20 PT. In accordance with Campbell and Howell, dyspnea is seen as an inappropriateness between ventilation and pressure needed.

Dyspnea↗
PubMed1984

Myocardial ischemia during ergonovine testing: different susceptibility to coronary vasoconstriction in patients with exertional and variant angina.

Coronary spasm is an accepted cause of transient myocardial ischemia in patients with variant angina; more recently it has been suggested that dynamic stenoses could also play an important role in the pathophysiology of exertional angina. To test this hypothesis we submitted 31 patients with histories typical of exertional angina to ergonovine testing and compared the electrocardiographic and clinical responses to those observed in seven patients with variant angina. All underwent bicycle ergometric exercise testing and coronary angiographic examination. For all tests, ST segment shifts of 0.1 mV or greater were considered to be diagnostic of myocardial ischemia. In patients with exertional angina, exercise testing produced diagnostic ST segment depression in 21 (68%). Ergonovine testing produced diagnostic ST segment depression in nine (29%). All nine had positive exercise test results and two- or three-vessel disease, yet the test was negative in seven other patients with positive exercise test results and similar angiographic findings. Conversely, in the seven patients with variant angina, results of exercise testing were positive in five (ST segment depression in two, ST elevation in three), while ergonovine produced ST segment elevation in all seven. Coronary angiographic examination showed normal arteries in two, one-vessel disease in four, and three-vessel disease in one. Results of all ergonovine tests were positive at values of rate pressure product much lower than those observed during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Exertional fatigue due to skeletal muscle dysfunction in patients with heart failure.

BACKGROUND: Exertional fatigue in patients with chronic heart failure is usually attributed to skeletal muscle underperfusion. Recently, skeletal muscle atrophy, abnormal muscle metabolic responses, and reduced muscle enzyme levels have been noted in such patients, raising the possibility that some patients may develop muscle fatigue due to intrinsic muscle abnormalities. The present study was undertaken to determine if a subpopulation of patients with heart failure develops exertional fatigue due to skeletal muscle dysfunction rather than to reduced muscle flow. METHODS AND RESULTS: All exercise hemodynamic studies performed in our laboratory on patients with heart failure were reviewed to identify those who exhibited peak exercise VO2 levels < or = 18 ml.min-1 x kg-1 due to leg fatigue and who underwent insertion of a Swan-Ganz catheter and leg blood flow catheter. Thirty-four patients were identified. Six normal subjects were also studied to define normal leg flow and femoral venous lactate responses to exercise. Patients with peak exercise leg flow levels within the normal mean flow level +/- 2 SEM were considered to have normal skeletal muscle flow during exercise. Nine of the 34 patients with heart failure were found to have normal leg blood flow during exercise. All of these patients terminated exercise due to leg fatigue, and all exhibited abnormal increases in femoral venous lactate concentrations (slope of work load versus femoral venous lactate: normal, 0.33 +/- 0.07 mg/W; heart failure with normal flow, 0.81 +/- 0.08 mg/W; p < 0.002). There was no significant difference between patients with normal leg flows and those with reduced flow in age, ejection fraction, and resting hemodynamic measurements. However, patients with normal flows exhibited more normal cardiac output responses to exercise and tended to have higher peak exercise VO2 (14.1 +/- 0.9 versus 11.5 +/- 0.7 ml.min-1 x kg-1, p < 0.05). CONCLUSIONS: A substantial percentage of patients with chronic heart failure develop exertional fatigue due to skeletal muscle dysfunction rather than to reduced skeletal muscle blood flow. In such patients, therapeutic interventions probably should be directed at improving the skeletal muscle abnormalities rather than at improving skeletal muscle flow.

Adult↗
PubMed1994

Physical fatigue in high and very high frequency manual materials handling: perceived exertion and physiological indicators.

This paper presents the results of a preliminary laboratory study undertaken to determine the perceived exertion and physiological responses of highly trained and experienced workers to high (up to 16 repetitions/min) and very high frequency (above 16 repetitions/min) manual lifting, lowering, and carrying/turning tasks. The results indicate that workers engaged in such highly repetitive and physically demanding tasks may operate at psychophysical workloads that may clearly be considered physically fatiguing and unacceptable according to the current physiological design criteria. In this study subjects performing lifting and lowering tasks, on the average, operated at 57% and 52% of their uphill treadmill aerobic capacity, respectively. For carrying and turning tasks, the average metabolic energy expenditure rate corresponded to 43% of subjects' aerobic capacity. The overall heart rates of the study subjects were 155 beats per minute (bpm) for lifting, 144 bpm for lowering, and 142 bpm for carrying and turning. These physiological responses, when compared with recommended physiological design criteria, are excessively high. The ratings of perceived exertion (RPE) for the shoulder, back, and whole body were highest for lifting (range, 10.20-15.50) and least for carrying and turning (range, 10.30-13.40; carrying and turning activities also included RPE of arms). Generally workers perceived the associated physical exertions as acceptable.

Adult↗
PubMed1986

Histochemical and morphometric evaluation of skeletal muscle from horses with exertional rhabdomyolysis (tying-up).

Thirteen horses with histories of exertional rhabdomyolysis were exercised for 20 minutes to induce clinical signs of lameness, elevated serum creatine kinase (CK), and aspartate aminotransferase (AST) activities and skeletal muscle morphologic lesions. The clinical signs exhibited by affected horses included trembling, sweating, increased rate of respiration, and restricted limb movement. Serum CK reached maximal activity between 4 and 8 hours after the exercise period and serum AST activity peaked between 24 and 48 hours. Histologically, the skeletal muscle lesions in muscle biopsies 24 hours after the exercise period consisted of segmental muscle fiber degeneration. Damaged muscle fibers were repaired by myoblastic regeneration. Horses with moderate (greater than 1,500 U/liter) to severe (greater than 5,000 U/liter) elevations of serum CK activity accompanied by clinical signs of muscle soreness induced by exercise, had visible muscle fiber degeneration microscopically. Frozen sections of biopsies of the gluteus medius muscle from affected (n = 13) and control (n = 11) groups of horses were processed to demonstrate myofibrillar ATPase activity. These sections were then used to determine fiber types, area percentages, and mean cross sectional fiber sizes. The mean type I, type II, and intermediate fiber sizes were significantly larger in the affected group than in the control group. In the gluteus medius muscles of the affected group, there was a significantly greater percentage of intermediate fibers and a significantly greater percentage of area occupied by intermediate fibers than in the control group. In the muscle samples with acute lesions of exertional rhabdomyolysis, type II fibers were selectively but not exclusively affected. In one horse which was subsequently necropsied 24 hours after the exercise period, lesions were present in several postural muscles, the masseter muscle and the heart. We conclude that the gluteus medius muscle fibers of affected horses are larger in cross sectional area than those of control horses and that there is preferential degeneration of type II fibers in acute lesions of exertional rhabdomyolysis.

Adenosine Triphosphatases↗
PubMedDate not supplied

Surgical management of exertional compartment syndrome of the lower leg. Long-term followup.

Forty-six limbs in 28 patients were surgically treated for exertional compartment syndrome. One group of 16 patients (26 limbs) underwent a fasciotomy for exertional anterior compartment syndrome (Group 1). A second group of 12 patients (20 limbs) underwent a fasciotomy for exertional deep posterior compartment syndrome (Group 2). Patients in Group 2 experienced symptoms for a significantly longer time than those in Group 1:16 versus 6.8 months (P < 0.01). All three of the pressure measurements used in this study (resting pressure, 1 minute after exercise, and 5 minutes after exercise) were significantly higher in both groups than in normal controls (P < 0.01). The 1 minute after exercise values were significantly higher in Group 1 (mean, 36.5) than in Group 2 (mean, 29.1) (P < 0.01). In Group 1, 25 of 26 limbs (96%) had excellent results. In Group 2, 13 of 20 limbs (65%) had satisfactory results (5 excellent and 8 good) and 7 (35%) had unsatisfactory results (4 fair and 3 poor). Those patients who had an unsatisfactory outcome did so within 6 months. Patients in Group 1 had a significantly higher rate of satisfactory results than those in Group 2 (P < 0.05).

Adolescent↗
PubMed1982

Effects of propranolol on perceived exertion soon after myocardial revascularization surgery.

Effect of propranolol on perceived exertion soon after myocardial revascularization surgery. Med. Sci. Sports Exercise. Vol. 14, No. 4, pp. 276-280, 1982. This study evaluated the effects of propranolol on ratings of perceived exertion (RPE), heart rate (HR), and systolic blood pressure (SBP) during graded exercise testing of myocardial revascularization surgery patients before hospital discharge. Eighty-six men performed a symptom-limited, graded exercise test on a treadmill an average of 11 d after surgery. Patients were assigned to three groups: those not taking propranolol (no-propranolol group, N = 54), those taking propranolol (propranolol group, N = 22), and those exhibiting exertional hypotension during testing (hypotensive group, N = 10). Test results showed that estimated METs during peak exercise were similar for the three groups. The propranolol group demonstrated a lower HR for submaximal and peak exercise when compared with the no-propranolol group, but RPE was the same for matched exercise intensities. The hypotensive group failed to increase SBP during exercise, but perceived the matched exercise intensities to be the same as the other two groups. The HR response of the hypotensive group was similar to that of the no-propranolol group. Thus, an abnormal SBP response during exercise was not reflected in a changed RPE when compared with patients who increased SBP appropriately. It was concluded that propranolol does not affect RPE during graded exercise testing soon after cardiac surgery.

Adult↗
PubMed1982

Clinical applications of perceived exertion.

The purpose of this paper is to review those studies related to the clinical applications of perceived exertion. The Borg Scale has been used most widely to evaluate the subjective response of patients during graded exercise tests. More recently, ratings of perceived exertion (RPE) have been shown to be an accurate predictor of aerobic capacity. Appraisal of angina pectoris during exercise is discussed relative to its interaction with effort perceptions. Two groups of investigators have recently studied the validity of using stress-test perceptions to control exercise intensity during training. Caution is suggested when perceptual prescriptions are based upon estimation techniques in exercise tests but require production techniques by patients in exercise programs. One investigation was reviewed to illustrate the use of perceptual information in solving occupational problems: three lifting techniques were compared relative to perceptual acceptability, the recommended squat technique being the least acceptable. A variety of sport applications were discussed: perception of pace, sex differences in perception of effort, perceptual recovery from exercise, and the new Borg Category-Ratio Scale in the measurement of anaerobic stress and several recommendations were made for future study of clinical applications of perceived exertion.

Exercise Test↗
PubMed2005

Effect of carbohydrate and prolonged exercise on affect and perceived exertion.

INTRODUCTION: It has been reported that perceptions of exertion are attenuated during prolonged cycle exercise, following CHO ingestion. However, no studies to date have examined the influence of such feedings on psychological affect during prolonged exercise, even though affect and perceived exertion are different constructs. PURPOSE: To examine the influence of regular CHO beverage ingestion on affect (pleasure-displeasure) and perceived exertion during prolonged cycle exercise. METHODS: In a randomized, double-blind, counterbalanced design, nine endurance trained males cycled for 2 h at 70% VO2max on two occasions, separated by 1 wk. On each occasion, they consumed either a water placebo (PLA) or a 6.4% carbohydrate-electrolyte solution (CHO) immediately before they cycled (5 mL x kg(-1) body mass) and every 15 min thereafter (2 mL x kg(-1) body mass). Pleasure-displeasure was assessed before, during, and after the prolonged bout of cycling. RESULTS: During exercise, reported pleasure initially improved and was subsequently maintained in the CHO trial, in contrast to a decline reported in the PLA trial. Ratings of pleasure-displeasure were more positive during recovery in the CHO trial compared with the PLA trial (P < 0.05) and the only significant increase (P < 0.05) in pleasure occurred 15 min postexercise in the CHO trial only. RPE increased (P < 0.05) over the course of the bout of cycling and was lower (P < 0.05) 75 min into exercise in the CHO trial. Immediately postexercise, plasma glucose concentration was higher in the CHO compared with the PLA trial (P < 0.05). A main effect of trial was found for plasma cortisol concentration, with higher values reported in PLA trial. CONCLUSION: Results suggest that CHO ingestion enhanced feelings of pleasure during and following prolonged cycling and highlighted the importance of assessing not only "what," but also "how" a person feels.

Adult↗