RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

The Effects of 12-Week Physical

Exercise Tapping High-level Cog-
nitive Functions
Zhiguang Ji1, Tian Feng2, and Hongbiao Wang1
1
Shanghai University of Medicine and Health Sciences, Shanghai, China
2
Physical Education College of Zhengzhou University, Zhengzhou, China
ABSTRACT

The purpose of this study was to investigate the effects of physical exercise tapping high-level
cognitive functions on both cognitive function and fitness in older adults. In total, 96 healthy older
adults took part in the study. Participants were randomly assigned to four groups: a cognitive train-
ing group (CG), physical exercise group (PG), simultaneous cognitive training and physical exercise
group (C+PG), and the healthy control group (HG; received physical exercise materials but did not
participate in a cognitive or exercise programme). The outcomes were the changes in the 6-minute
walk test (6MWT), timed up-and-go (TUG) test, and the computerized modified Stroop task, which
included two conditions, a naming condition (nonexecutive) and an executive condition. The re-
sults showed that the dynamic balance, cardiorespiratory endurance, and physical activity levels
of the PG and C+PG were significantly better than those of the HG after the 12-week intervention.
KEYWORDS The times of the TUG test in these two groups were also significantly faster than those in the HG.
Additionally, the C+PG exhibited better dual-task function than the PG. Over 12 weeks, the CG, PG,
older adults
and C+PG demonstrated improved performance of executive function, but only the C+PG showed
cognitive function
a general facilitative effect on nonexecutive control. Physical exercise tapping high-level cognitive
fitness
functions and cognitive training can thus improve executive function more quickly than physical
physical exercise tapping
exercise alone. Moreover, physical exercise tapping high-level cognitive functions showed better
high-level cognitive func-
fitness improvement than cognitive training alone, especially in dynamic balance.
tions

INTRODUCTION
With the ageing of the body, the organs and physiology of elderly exercise leading to the greatest degree of these positive effects remains
individuals decline, age-related degeneration occurs, and cognitive unclear. While most previous studies used physical exercise, some re-
function, an important indicator of brain function, is also impaired. searchers believe that low cognitive requirements and highly automatic
Cognitive function refers to the ability of the human brain to process, physical exercise have less of an impact on the inhibitory function of
store, and extract information. Cognitive ageing refers to the decline elderly people (Huang et al., 2014). Therefore, researchers have begun
in cognitive function that occurs during ageing, mainly in memory. to pay attention to exercises with high cognitive requirements. León
While multiple aspects of cognitive function have been linked to age- et al. (2015) found that exercises with high cognitive requirements
ing, the cognitive domain of executive function is particularly relevant. (such as Tai Chi) had a larger impact on cognitive function than ex-
Executive function describes the complex and higher-order cognitive ercises with low cognitive requirements (such as walking or cycling).
processes used to monitor, manage, and regulate a set of self-directed, Similarly, Fabre et al. (2002) found that a combination of physical and
purpose-oriented actions to reach a desired goal.
Although it has been confirmed in many studies that exercise can Corresponding author: Hongbiao Wang, 279 Zhouzhu Highway, Pudong New
delay age-related cognitive decline (Albinet et al., 2016), the type of Area, Shanghai, 201318, P. R. China. E-mail: [email protected]

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

59 2020 • volume 16(1) • 59-66 http://www.ac-psych.org

DOI • 10.5709/acp-0284-5
RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

cognitive exercises led to greater benefits than performing one of the may cause distraction and are an important risk factor for falls in older
activities alone (Fabre et al., 2002). adults (Muir et al., 2012). The current study focused on the improve-
Exercise with high cognitive requirements improved not only cog- ment of cognitive function in physical exercise by tapping high-level
nitive, but also executive functions in elderly people. Some studies have cognitive functions and the assessment of fitness-related functional
shown that Tai Chi can simultaneously improve the performance of the levels.
Trail Making Test A and B (TMT-A and TMT-B; (Hung & Andreas, This experiment explored the effects of a 12-week programme of
2012; Reid-Arndt et al., 2012). In contrast, Matthews and Williams physical exercise tapping high-level cognitive functions, physical exercise
(2008) found that the Tai Chi group improved in TMT-B, but not in alone, or cognitive training alone on the cognitive function and fitness of
TMT-A. The TMT-A and TMT-B tests can be considered to involve elderly people. In this study, we used a dual-task mode to represent the
different cognitive processing levels, attention and executive functions requirements of physical exercise tapping high-level cognitive functions.
(Smith et al., 2010). Studies have also shown that Tai Chi improves We hypothesized that participation in a 12-week programme of physical
mental attention and memory, not just executive control (Kim et al., exercise tapping high-level cognitive functions would have a significantly
2016; Man et al., 2010). In a study on physical exercise, the benefits of higher inhibitory effect on the elderly than on other groups, and that the
exercise for cognitive decline were found to be selective rather than effect of physical exercise tapping high-level cognitive functions on physi-
universal (Boucard et al., 2012). Specifically, cognitive functions, which cal fitness would be similar to that of physical exercise, although it appears
are highly dependent on the execution control process of the frontal earlier.
lobe, are more prone to age-related decline and are also more sensi-
tive to exercise, including inhibition. Thus, many of these features are
MATERIALS AND METHODS
suitable for physical exercise tapping high-level cognitive functions.
Therefore, its specificity of influence has yet to be investigated. A recent
review reinforced this idea by using training programmes combined Participants
with physical and cognitive activities, as this combination is more
This experiment recruited 162 healthy elderly individuals aged 65 to 70
beneficial for neuronal recruitment and cognitive function (Curlik
years from a community in Shanghai. Participants were requested to have
2nd & Shors, 2013). Zhu et al. (2016) analysed 20 interventional stud-
no regular exercise habits in the past year (the frequency of exercise was
ies including 2667 participants. The results showed that there was no
less than twice a week) and to not regularly participate in any high-level
significant difference between the cognitive interventions, but the ef-
cognitive activities, such as mah-jong, chess, or card activities. Additional
fects of cognitive function were greater than those of physical exercise.
inclusion criteria included age between 60 and 70 years, ability to walk
However, current research lacks separate consideration of motor and
for at least 5 minutes unassisted, and a Mini-Mental State Examination
cognitive factors, making it difficult to determine whether simultane-
(MMSE) score > 26. Through a preliminary questionnaire survey based
ous exercise and cognitive activity can provide additional cognitive
on the above criteria, 100 elderly people were ultimately included in
benefits compared with individual exercise or cognitive training.
the experiment. Participants were randomly assigned to four groups:
Inhibition refers to the ability of the brain to suppress an independ-
a healthy control group (HG), cognitive training group (CG), physical
ent stimulus or advantageous response that may interfere with the
exercise group (PG), and simultaneous cognitive and physical exercise
current task to complete the current task at the time of information
group (C+PG). Among the subjects, four withdrew from the experiment
processing. The inhibitory function plays an important role in cogni-
for personal reasons. Therefore, 96 subjects completed the intervention
tive decline. Hartman and Hasher (1991) put forward the theory of
experiment. The basic information of the participants is shown in Table 1.
inhibition of cognitive function ageing, according to which the indi-
vidual can attend to irrelevant information with increasing age, and Experimental Procedure
it is difficult to focus attention on the target information. In a large
Each participant was asked to participate in a questionnaire before the
number of studies, the decline in cognitive function in elderly people
formal experiment. The participants signed the consent form and com-
is shown to be largely due to the inability to effectively suppress ir-
pleted the following questionnaires: health history and demographic
relevant information, which is regarded as one of the most important
questionnaires, physical activity questionnaire (International Physical
components of execution function. Therefore, related research on the
Activity Questionnaire, IPAQ, Hallal & Victora, 2004), exercise habit ques-
decline in inhibitory function plays a very important role in the study
tionnaire, and the Mini Mental State Examination (MMSE, Cockrell &
of the deterioration of cognitive function.
Folstein, 1988). The total of 100 elderly subjects who met the experimental
On the other hand, although studies have examined sports for
requirements were randomly divided into the four groups and subjected to
physical fitness, there are few studies on physical fitness for different
cognitive tests and fitness assessments before, during, and after the inter-
cognitive requirements, especially for those in close association with
vention. The experimental flow chart is shown below in Figure 1.
daily life. For example, dual-task processing capability is clinically
important because it is related to reaction time (RT), walking speed, Intervention
the likelihood of contact with obstacles while walking, and the risk of
The intervention lasted for 12 weeks. According to the recommenda-
falls (Pichierri et al., 2011). Age-related declines in executive function
tions of the American College of Sports Medicine (Brent, 2009), the

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RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

TABLE 1.
Participant Characteristics
C+PG (n =
PG (n = 25) CG (n = 22) HG (n = 25) F(3,92) p
24)
Age, years 65.45±4.40 66.52±5.25 65.53±4.32 66.34±3.33 0.81 .50
Gender (women, n) 14 13 12 14 0.41 .74
Weight, kg 59.52±5.32 57.68±5.12 58.71±6.89 57.85±5.12 0.41 .75
Height, cm 163.79±6.42 162.04±5.97 162.21±7.89 161.43±7.46 1.07 .37
BMI 22.31±2.45 22.75±1.43 22.21±1.54 22.11±1.53 0.42 .73
MMSE 27.54±0.53 27.21±0.65 27.23±0.52 27.43±0.42 1.20 .32
Education, years 10.21±2.43 11.53±2.47 10.21±2.35 10.12±2.43 0.62 .60

Note. C+PG = Simultaneous cognitive and physical exercise group; PG = Physical exercise group; CG = Cognitive training
group; HG = Healthy control group.

intervention group had three classes per week, lasting approximately the opposite of the password, including raising the right arm - left arm,
60 minutes each class. Each group had two experimenters to guide and raising the right leg - left leg, closing the right eye - left eye, sitting - stand-
supervise the activities. ing, turning right - turning left, looking forward - looking backwards,
The HG did not participate in any intervention activities and re- looking up - bowing down, and so forth.
ceived weekly physical exercise materials and a health exercise lecture The PG was required to complete the exercise (treadmill walking)
every four weeks. at the activity centre. Each exercise included a 10-minute warm-up and
The curriculum of the CG was designed to improve executive func- a 10-minute cool-down. The intensity of the exercise was maintained at
tion and memory. Specific courses included verbal fluency tests, mental 55%–60% of the heart rate reserve. The monitoring method used a polar
arithmetic tasks, visual search tasks, and reverse passwords. Participants heart rate monitoring system.
completed all cognitive interventions at the indoor activity centre. The The C+PG simultaneously performed cognitive training and physical
verbal fluency test training allowed the participants to recall as many exercise. For example, participants performed a verbal working memory
words as possible, including vegetables, fruits, countries, sports, occupa- task while simultaneously walking on the treadmill.
tions, and so forth (Hartman & Hasher, 1991). The mental arithmetic
tasks required the subject to perform continuous addition or subtraction Anthropometrics and Fitness
as required (Shinya & Ryuta, 2008). Visual search tasks required the cur- Height (in meters) and body weight (in kilograms) were used to cal-
rent scene features of the subject to be described as required (Gates et culate the body mass index (BMI, kg/m2). Hand-grip strength was
al., 2011). Reverse password practice allowed the subject to respond to measured with a hand-held dynamometer (Jamar; Sammons Preston

FIGURE 1.
The experimental flowcharts.

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RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

FIGURE 2.
Illustration of the modified Stroop task.

Rolyan; Nottinghamshire, UK). Participants performed grip tests twice The executive condition included inhibition and switch. Thirty trials (20
on each hand and analysed them with the best results. The level of inhibition and 10 switch) were included in one block of the executive
physical activity was assessed using the Taiwanese version of the IPAQ condition (see Figure 2). The experimental blocks were interspersed with
(Liou et al., 2008). The short version of the IPAQ is an eight-item scale a 1 min condition called “rest.” The total Stroop task duration was ap-
that estimates the number of minutes of high-intensity and moderate- proximately 15 minutes.
intensity activities, walking, and sedentary behaviour over the past
seven days. Statistical Analyses
The 6-minute walk test (6MWT) is widely used to assess cardiores- A one-way analysis of variance (ANOVA) was used to analyse age, weight,
piratory fitness (Burr et al., 2011; Camarri et al., 2006). The participants height, BMI, MMSE score, and education level. A 4 × 3 (Group [HG, CG,
are instructed to “cover as much distance as possible” during the test. PG, and C+PG] × 3 Time [baseline, midpoint, and post-intervention])
The number of metres walked is recorded. mixed-design ANOVA was used to analyse grip strength, 6MWT, and
The timed up-and-go (TUG) test was used to evaluate dynamic bal- IPAQ scores among the four groups. A 4 × 3 × 3 (Group [HG, CG,
ance (Clark et al., 2010; Porciuncula et al., 2016). The participants are PG, and C+PG] × Time [baseline, midpoint, and post-intervention] ×
instructed to stand up from a seated position and walk to a marked post Conditions [TUG, mTUG, and cTUG tests]) mixed design was used to
3 m away as quickly and safely as possible, and then turn around, walk analyse group, time, and TUG test interactions.
back to the chair and sit. The study selected the following two condi- E-Prime (version 1.1) software was used to collect the RT data (i.e.,
tions for the dual-task TUG test: (a) in the mTUG task, remember six the elapsed time from the presence of the test stimulus to the press of the
random numbers while walking and recall the correct numbers after button) and the correct rate data. All erroneous trials and trials with more
sitting down, and (b) in the cTUG task, go across a 17 cm high (kerb than three SDs were considered outliers and removed prior to analysis. A
height) obstacle while walking. The tests were completed three times, 4 × 3 × 2 (Group [HG, CG, PG, and C+PG] × Time [baseline, midpoint,
and the shortest duration for each task was recorded (Shumway-Cook and post-intervention] × 2 Conditions [non-executive conditions, and
et al., 2000). execution conditions]) mixed design was used to analyse the RT and cor-
rect rate in the Stroop task and numbers comparing tasks for each group.
Modified Stroop Task Post hoc comparisons were performed using Fisher’s least significant
The computerized modified Stroop task included the following two con- difference (LSD) to test differences between groups. The magnitude of
ditions: a naming condition (nonexecutive) and an executive condition the effect is expressed as a deviation of η2 to assess the effects when main
(Bohnen et al., 1992; Dupuy et al., 2015). All the experimental trials began and interaction effects reach significant levels. The significance threshold
with a fixation cross for 1 s, and all visual stimuli appeared at the centre was set to p < 0.05.
of the computer screen for a duration of 2 s. The participants provided
their responses by pressing the “F” button for “blue” and the “J” button for
RESULTS
“red”. Each condition included two blocks, and each block was composed
of 30 trials, resulting in 120 trials for the two experimental conditions.
In the naming condition, a visual stimulus (the letters “XXX”) coloured Grip Strength, 6-minute Walk Test,
red or blue was presented, with 15 trials for each colour. Half of the trials and Physical Activity Level
were the same as the original Stroop task, in which the response was the
No significant main effects of time, F(2, 184) = 0.22, p = .81, or group,
colour of the word (inhibition). In the other trials, the participants were
F(3, 92) = 0.13, p = .95, were found in grip strength. No interaction effect
instructed to read the word and ignore the colour of the writing (switch).

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RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

FIGURE 3.
The results of the grip strength, 6-minute walk test, and physi- FIGURE 4.
cal activity level. Changes in the timed up-and-go test during the interventions.

was found between time and group, F(6, 184) = 0.46, p = .84. In the TUG test. There was no significant difference between the four groups at
6MWT, there was a significant main effect of time, F(2, 184) = 15.49, p < the baseline and midpoint, but at the post-intervention, the C+PG was
.01, η2 = .14, and interaction between time and group, F(6, 184) = 4.89, p found to be significantly faster than all the other groups (p < .05), and the
< .01, η = .14, but no main effect of group, F(3, 92) = 1.91, p = .13. The
2
PG was faster than the HG (p < .05) on the mTUG test.
main effects of time, F(2, 184) = 20.53, p < 0.01, η2 = .18, and group, F(3,
92) = 11.47, p < .01, η2 = 0.27, and the interaction of time × group, F(6, Stroop Task
184) = 5.77, p < 0.01, η2 = .16, were also found for physical activity. Post When RT was considered, the results show that the main effects of time,
hoc analysis showed that at baseline, the HG was greater than the CG F(2, 184) = 8.01, p < .01, η2 = .08, task, F(1, 92) = 1383.07, p < .01, η2 = .94,
(p < .05), the C+PG and PG were greater than the HG (p < .01) in the and group, F(3, 92) = 6.52, p < .01, η2 = .13, were significant and that the
middle test, and the C+PG and PG were greater than the HG (p < .01) in interactions of time × task × group, F(6, 184) = 2.49, p < .05, η2 = .08, and
the post-test. All results are presented in Figure 3. time × group, F(6, 184) = 5.89, p < .01, η2 = .16, were significant. The in-
teractions of time × task, F(2, 184) = 2.21, p = .11, and task × group, F(3,
The Timed Up-and-Go Test 92) = 0.28, p = .84, were nonsignificant. Post hoc analyses indicated that
The TUG test results show (see Figure 4) that the main effects of time, the PG had shorter post-test RT than that at baseline on the executive
F(2, 184) = 3.91, p < .05, η2 = .04, and conditions, F(2, 184) = 69.65, p < task (p = .46). The CG had a shorter post-test RT than the RT at baseline
.01, η = .43, were significant, but there was no significant main effect of
2
on the naming task (p < .05). The C+PG group had a shorter post-test RT
group, F(3, 92) = 1.08, p = 0.36. The interaction of time × condition × than the RT at baseline on both tasks (p < .05).
group, F(12, 372) = 2.8, p < .01, η2 = .08, was significant. Post hoc analyses There were no main effects of task, F(1, 92)= 42.91, p < .01, η2 = .36,
indicated that the C+PG had faster times than the HG and CG (p < .05), time, F(2, 184) = 0.33, p = .72, or group, F(3, 92) = 0.12, p = .97, on the
and both the PG and CG had faster times than the HG (p < .05) in the correct rate. The interactions of time × task × group, F(6, 184) = 0.15, p =

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RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

FIGURE 5.
Reaction times in the modified Stroop task.

.99, time × group, F(6, 184) = 0.19, p = .99, time × task, F(2, 184) = 0.22, al. (2008) believe that a complex task can effectively promote cognitive
p = .81, and task × group, F(3, 92) = 0.12, = .98 were also nonsignificant. neural networks. At the same time, in this experiment, cognitive train-
ing also had a significant effect on cognitive function, which is different
from the results of our prior research (Ji et al., 2019). It is speculated
DISCUSSION
that the influence of cognitive training on cognitive function may not
depend entirely on the influence of brain activation. In addition to
The purpose of this study was to investigate the effects of physical ex-
examining the effect of exercise on cognitive function, our study also
ercise tapping high-level cognitive functions on cognitive function and
examined the effects of different intervention times. We found that the
fitness in older adults. The results of the study showed that 12 weeks of
effect of physical exercise on inhibitory function occurred in the 12th
training in physical exercise alone, high-level cognitive physical exer-
week of the test, and the effects of cognitive training and exercise re-
cise, or cognitive training alone can improve executive function, which
quiring high cognition levels on cognitive function appeared in the 8th
is consistent with previous studies (Law et al., 2014). In addition, the
week. This is consistent with previous findings that the 6-week training
high cognitive requirements of the PG and CG also had a significant
plan used by Owen et al. (2010) can significantly improve cognitive
impact on processing speed. The results of this experiment are similar
functions, such as reasoning, memory, planning, visual spatial skills,
to previous research (Ji et al., 2017), and the combined motion with
and attention. In a study by Theill et al. (2013), cognitive training in-
higher cognitive requirements has broader motor benefits for inhibi-
terventions were similar to cognitive interventions. The effect of physi-
tion, which supports the research hypothesis. The results of physical
cal exercise on the inhibition function was set at 12 weeks. Therefore,
fitness showed that the cardiorespiratory endurance and dynamic bal-
exercise requiring high cognitive levels is more efficient than physical
ance of the PG were better than those of the HG and CG.
exercise in improving cognitive function, and the effect is better than
This experiment used short-term interventions to explore the ef-
simple cognitive training.
fects of different cognitive requirements on inhibition. The required
The current studyexamined the effects of various activities on
pattern of exercise combined with cognition for the physical exercise
cognitive function and physical fitness. Physical fitness (i.e., cardiopul-
tapping high-level cognitive functions condition led to the most sig-
monary endurance and muscle strength) also included exercise adapt-
nificant improvement in cognitive function, not only in the executive
ability (i.e., flexibility, speed, balance, and good coordination), and
conditions but also in perception speed. This is consistent with our
exercise can improve the level of fitness (Brent, 2009). On one hand,
early research (Ji et al., 2019), and it can be speculated that the effect
we could examine the improvement of physical fitness after different
of physical exercise tapping high-level cognitive functions on cognitive
activities, while on the other hand, we could examine whether the
function may be related to the effects of different exercise patterns on
improvement of the inhibitory function after the exercise with high
brain activation, especially different intensities of prefrontal activa-
cognitive requirements sacrifices improvements in physical fitness. The
tion. This result also supports the theory of adaptive ability, and the
results showed that the physical fitness indices indicating the dynamic
result that physical exercise combined with cognitive training showed
balance, cardiorespiratory endurance, and physical activity level were
a more significant improvement compared to the other three groups. A
significantly better than the HG in the 12-week post-test. The times
study with 138 volunteers by León et al. (2015) found that physical and
of the TUG and mTUG tests were also significantly shorter than that
cognitive exercise programmes produced significant positive effects,
of the HG, which suggests that exercise requires a longer intervention
with improvements in both simple and selective responses. Curlik 2nd
time for the improvement of physical fitness compared with inhibition.
and Shors (2013) believe that the physiological responses obtained
At the same time, the improvement of cognitive function by physical
through physical and cognitive exercise programmes seem to require
exercise tapping high-level cognitive functions does not affect the
neurogenesis and keep new cells alive over time. Therefore, Budde et
impact of exercise on the fitness level due to increased cognitive re-

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RESEARCH ARTICLE ADVANCES IN COGNITIVE PSYCHOLOGY

quirements (Hiyamizu et al., 2012). The results of the relevant studies Cockrell, J. R., & Folstein, M. F. (1988). Mini-Mental State
are consistent, and different cognitive requirements can result in the Examination (MMSE). Psychopharmacological Bulletin, 24,
benefits of physical fitness (Hiyamizu et al., 2012). In our experiment, 689–692.
high cognition required that the CG exhibit a better dual-task func- Curlik 2nd, D., & Shors, T. (2013). Training your brain: Do
tion than the PG, which is consistent with previous experimental and mental and physical (MAP) training enhance cognition
research hypotheses. High cognitive motion requires attention to the through the process of neurogenesis in the hippocampus?
allocation of exercise to simultaneously accomplish two tasks, so the Neuropharmacology, 64, 506–514. doi: 10.1016/j.neurop-
improvement of dual-task processing is more significant. harm.2012.07.027
Dupuy, O., Gauthier, C. J., Fraser, S. A., Laurence, D. C., Michèle,
D., Said, M., . . . Louis, B. (2015). Higher levels of cardiovascu-
CONCLUSION
lar fitness are associated with better executive function and
prefrontal oxygenation in younger and older women. Frontiers
Physical exercise tapping high-level cognitive functions and cognitive
in Human Neuroscience, 9, 66. doi: 10.3389/fnhum.2015.00066
training can improve executive function more quickly than physi-
cal exercise alone. The effects of physical exercise tapping high-level
Fabre, C., Chamari, K., Mucci, P., Massé-Biron, J., & Préfaut, C.
cognitive functions and physical exercise alone showed no significant
(2002). Improvement of cognitive function by mental and/
differences in physical fitness, but they were both better than cognitive
or individualized aerobic training in healthy elderly subjects.
training alone, especially regarding dynamic balance effects.
International Journal of Sports Medicine, 23, 415–421. doi:
10.1055/s-2002-33735
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