Académique Documents
Professionnel Documents
Culture Documents
School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, AUSTRALIA;
Department of Physiology, Australian Institute of Sport, Canberra, Australian Capital Territory, AUSTRALIA; and
3
School of Human Movement and Exercise Science, The University of Western Australia, Perth, Western
Australia, AUSTRALIA
2
ABSTRACT
ABBISS C. R., M. J. QUOD, D. T. MARTIN, K. J. NETTO, K. NOSAKA, H. LEE, R. SURIANO, D. BISHOP, and P. B.
LAURSEN. Dynamic Pacing Strategies during the Cycle Phase of an Ironman Triathlon. Med. Sci. Sports Exerc.,Vol. 38, No. 4, pp.
726734, 2006. Introduction: A nonlinear dynamic systems model has previously been proposed to explain pacing strategies
employed during exercise. Purpose: This study was conducted to examine the pacing strategies used under varying conditions during
the cycle phase of an Ironman triathlon. Methods: The bicycles of six well-trained male triathletes were equipped with SRM power
meters set to record power output, cadence, speed, and heart rate. The flat, three-lap, out-and-back cycle course, coupled with
relatively consistent wind conditions (1730 kmIhj1), enabled comparisons to be made between three consecutive 60-km laps and
relative wind direction (headwind vs tailwind). Results: Participants finished the cycle phase (180 km) with consistently fast
performance times (5 h, 11 T 2 min; top 10% of all finishers). Average power output (239 T 25 to 203 T 20 W), cadence (89 T
6 to 82 T 8 rpm), and speed (36.5 T 0.8 to 33.1 T 0.8 kmIhj1) all significantly decreased with increasing number of laps (P G
0.05). These variables, however, were not significantly different between headwind and tailwind sections. The deviation (SD) in
power output and cadence did not change with increasing number of laps; however, the deviations in torque (6.8 T 1.6 and 5.8 T 1.3
NIm) and speed (2.1 T 0.5 and 1.6 T 0.3 kmIhj1) were significantly greater under headwind compared with tailwind conditions,
respectively. The median power frequency tended to be lower in headwind (0.0480 T 0.0083 Hz) compared with tailwind (0.0531 T
0.0101 Hz) sections. Conclusion: These data show evidence that a nonlinear dynamic pacing strategy is used by well-trained triathletes
throughout various segments and conditions of the Ironman cycle phase. Moreover, an increased variation in torque and speed was found
in the headwind versus the tailwind condition. Key Words: NONLINEAR COMPLEX SYSTEM, SRM, FATIGUE, WIND,
FOURIER TRANSFORMATION, QUADRANT ANALYSIS
726
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
METHODS
Participants. Six well-trained male triathletes (x T SD:
age = 35 T 4 yr, mass = 78.8 T 6.5 kg, height = 179.4 T 5.5 cm,
O2peak=
sum of seven skinfolds = 51.4 T 12.8 mm, V
j1
j1
68 T 6 mLIkg Imin , maximal aerobic power = 405.7 T
21.9 W) were recruited 46 wk before the Ironman Western
Australia triathlon (Busselton, Western Australia) that took
place on November 28, 2004. Each of the participants had
previously completed an Ironman triathlon in less than
10 h 30 min. Before testing, all participants were informed
of the risks associated with the study and provided written
informed consent in accordance with the human research
ethical committees of The University of Western Australia
and Edith Cowan University.
Preliminary measurements. Two to three weeks
before the Ironman event, participants were measured for
height, mass, and the sum of seven skinfolds (triceps,
subscapular, biceps, supraspinale, abdominal, midthigh, and
calf) using calibrated Harpenden skinfold calipers (British
Indicators, England). Anthropometric measurements were
assessed by a Level 2 International Society for the Advancement of Kinanthropometry (ISAK) anthropometrist. Participants then performed a laboratory-based incremental
exercise test on a calibrated, wind-braked, cycle ergometer
(Evolution Pty. Ltd., Adelaide, Australia). The seat and
handlebar positions were adjusted to replicate the participants own habitual cycling position. The participants
used their own cycling shoes and pedal-cleat system. The
cycle ergometer had six gear ratios, and participants were
instructed to maintain their preferred cycling cadence
throughout the test. Power output was calculated using a
custom-made computer program (Cyclemax, School of
Human Movement and Exercise Science, The University of
Western Australia). Power output was determined at 0.2-s
increments and was displayed on a computer screen visible to
the participant. Throughout the duration of the test, oxygen
O2), ventilation, and respiratory exchange
consumption (V
ratio values were continuously recorded every 15 s using
Ametek gas analyzers (SOV S-3A and COV CD3A,
Pittsburgh, PA). The gas analyzers were calibrated immediately before and verified after each test, using three certified
gravimetric beta-grade gas mixtures (BOC Gases,
Chatswood, Australia). Throughout the tests, heart rate was
recorded every 5 s with a Polar Vantage heart rate monitor
(Polar Electro Oy, Kempele, Finland). Following a 10-min
warm-up (75 W), participants performed the incremental
exercise test. The test commenced at a workload of 100 W
for 4 min and increased 40 W every 4 min until volitional
O2peak was defined as the average of the
exhaustion. V
O2 values recorded during a 1-min
highest consecutive V
period, whereas maximal aerobic power (MAP) was defined
Medicine & Science in Sports & Exercised
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
727
as the highest power output completed during the incremental test. If the participant finished partway through a
4-min stage, MAP was calculated in a pro rata manner. For
example, if a subject finished 2 min into the 300-W stage,
their MAP would be [(2 min/4 min] 40) + 300 = 320 W.
Ironman event. The 2004 Ironman Western Australia
Triathlon involved a 3.8-km swim, followed by a 180-km
cycle, and finally a 42.2-km marathon run. No
recommendations were given to participants as to quantities
and types of food and fluids that should be consumed during
their race, and fuel and fluid intake was ad libitum throughout
the event. However, all participants were experienced
triathletes, familiar with the requirements for adequate
ingestion of energy sources. Moreover, pre- and postrace
blood glucose concentrations (i-STAT Corporation, East
Windsor, NJ) were 7.7 T 1.7 and 6.4 T 1.4 mmolILj1
(P. Laursen, unpublished data, 2005), suggestive of the fact
that participants maintained euglycemia. Performance times
for the swim, cycle, and run phases for all triathletes were
retrieved from the race timing results that were posted
online following the event (http://www.ironmanwa.com).
Every 30 min, both ambient temperature and relative
humidity (rh) were recorded with a portable digital weather
tracker (Kestrel 4000, Nielsen-Kellerman, Australia). Wind
direction and speed were retrieved from the Bureau of
Meteorology (http://www.bmo.gov.au) following the event.
Both wind direction and speed were recorded from the
foreshore (Busselton Jetty) and taken as an average of the
10-min period before 9:00 a.m. and 3:00 p.m. Wind
direction was reported based on a 16-point compass.
Altitude was recorded every minute with the use of a Polar
heart rate monitor fitted to a subjects bike (s720i, Polar
Electro Oy, Kempele, Finland).
Before the event, each subjects own bicycle was fitted
with a calibrated SRM professional power meter (Schoberer Rad Mebtechnik, Germany). The SRM power meter
measured torque, cadence, and speed every 2 s (30 Hz)
throughout the cycle phase of the event. Heart rate was also
recorded every 2 s with the use of the SRM system and a
compatible chest electrode (Polar Electro Oy, Kempele,
Finland). One subject opted not to wear a chest electrode,
and thus heart rate data were available for only five of the
six participants. From the net torque per revolution and the
average velocity per revolution (cadence), the SRM system
calculates power output over an entire revolution. As a
result, power output is not an instantaneous measure, and
thus the power output reported does not contain artifact
caused by the instantaneous crank angle. From power
output and cadence reported by the SRM system, the net
torque over an entire revolution was calculated via the
following equation:
Net pedal torque power 60 = cadence 2 3 :1416
Each participants average effective pedal force and circumferential pedal velocity over the entire Ironman cycle
phase was used to separate force and velocity into quadrants
rather than forcevelocity at ventilation or lactate threshold.
This was done because subjects performed the cycle phase
of the event well below power output at lactate threshold
(71 T 5% LT).
The cycle phase of the Ironman triathlon consisted of
three flat (elevation change of 12.3 T 0.6 m per lap
recorded over three consecutive laps) 60-km laps, thus
allowing comparisons of pacing strategies used over
consecutive laps to be made. In addition, the specific
arrangement of the course and environmental conditions on
the day resulted in participants riding 10.9 km (from 11.45
to 22.35 km) of each lap with a near direct tailwind.
Following this, subjects performed a 180- turn and cycled
the same 10.9-km section of road (from 22.35 to 33.25 km)
into a headwind. This allowed for further comparisons to
be made on the influence of tailwinds and headwinds on
oscillatory pacing strategies during the cycle phase of the
event. Using customized software written in Labview
(V6.1; National Instruments Corporation, Austin, TX),
power output over the three consecutive laps and also
during the headwind and tailwind section of the road was
analyzed using discrete Fourier transformation to obtain a
power spectrum. The median frequency was then obtained
from the power spectrum.
Statistical analysis. The average and standard deviation (SD) of each dependent variable (power output,
cadence, torque, and speed) over each entire lap were
analyzed for significant effects (between laps) using a
one-way repeated-measures ANOVA. The SD of each
dependent variable (deviation) for each participant was
measured and offers an average of the oscillatory nature of
each dependent variable (power output, cadence, torque,
and speed). Median power output frequency was also
analyzed for significant effects (between laps) using a
one-way repeated-measure ANOVA. A two-way repeatedmeasure ANOVA, with two within-subject variables (lap
and wind direction) was used to determine significant
effects between lap and wind direction. Where a significant
effect was found between laps, the main effect was analyzed
using the least significant difference test for pairwise
comparisons. The least significant difference test was used
in the present study because of the overly conservative type
I error control of other post hoc comparisons. Least
significant difference does not correct for multiple comparisons resulting in an increased statistical power at the
risk of increased type I errors. All statistical tests were
conducted using SPSS version 10.0 (Chicago, IL), and data
http://www.acsm-msse.org
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
TABLE 1. Average power output, cadence, net torque, speed, heart rate, performance
time, and median power frequency for successive laps.
Power (W)
Cadence (rpm)
Torque (NIm)
Speed (kgIhj1)
Heart rate (bpm)
Performance time (min)
Median power frequency
(Hz)
Lap 1
Lap 2
Lap 3
239 T 25
89 T 6
25.4 T 2.0
36.5 T 0.8
150 T 12
97.0 T 1.9
0.0606 T 0.0049
224 T 19
85 T 8
24.9 T 2.9
34.9 T 0.5
146 T 9
101.6 T 1.3
0.0624 T 0.0042
203 T 20*
82 T 8*
23.3 T 2.4
33.1 T 0.8
140 T 8
108.2 T 2.4
0.0605 T 0.004
RESULTS
Throughout the cycle phase of the Ironman, ambient
temperature ranged from 21 to 25-C (23.7 T 1.7-C), and
relative humidity ranged from 52 to 84% rh (65 T 11%).
Wind direction (and speed) were reported to be northwest
(17 kmIhj1) at 9:00 a.m., and had shifted to west southwest
(30 kmIhj1) by 3:00 p.m. Thus, wind direction tended to be
from a westerly direction throughout the event. During the
race, participants were cycling between the times of 7:00 a.m.
and 12:30 p.m., and during postrace interview they reported
the noticeable head- or tailwind present on the cycle course,
depending on their cycle direction (traveling east vs west).
Overall triathlon performance time was 589.3 T 8.4 min
(within the top 10% of all finishers) with swim, cycle, and
run times equating to 56.9 T 5.5, 310.7 T 2.3, and 221.7 T
10.3 min, respectively. The participants completed the cycle
phase of the Ironman at a power output of 221 T 18 W (55 T
4% of MAP), a speed of 34.8 T 0.4 kmIhj1, a cadence of 85 T
7 rpm, and a heart rate of 146 T 10 bpm (83 T 5% HRmax).
Mean lap time significantly increased (P G 0.001), and
average power output, cadence, and speed all significantly
declined with increasing number of laps (P G 0.05; Table 1).
Average net torque (P = 0.17) and heart rate (P = 0.06)
tended to decline with increasing number of laps, but these
differences were not statistically significant (Table 1). The
median power frequency was not significantly different between
laps (P = 0.58; Table 1), however, and was significantly lower
during the headwind (0.0480 T 0.0083 Hz) compared with the
tailwind (0.0531 T 0.0101 Hz; P G 0.05) sections. Table 2
shows the SD in power output, cadence, torque, and speed.
None of these variables were found to change significantly
between laps (Table 2). In the tailwind and headwind sections
(10.9-km windows), average power output, cadence, and speed
all significantly declined as the number of laps increased (P G
0.05), whereas average net torque did not (P = 0.13; Fig. 1).
TABLE 2. Deviation (SD) in power output, cadence, net torque, speed, and heart rate
during each lap.
Lap 1
Power (W)
Cadence (rpm)
Torque (NIm)
Speed (kmIhj1)
Heart rate (bpm)
60 T 11
12 T 2
6.8 T 1.4
2.5 T 0.2
5T1
Lap 2
59
13
7.0
2.1
3
T7
T3
T 1.1
T 0.3
T1
Lap 3
55 T 7
14 T 3
6.7 T 1.2
2.2 T 0.2
4T1
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
729
I
II
III
IV
1376 T 470
255 T 134
167 T 92
1110 T 501
Lap 2
893 T
560 T
365 T
1231 T
149
250
161
322
Lap 3
392
774
931
1149
T
T
T
T
233*
263*
429*
334
* P G 0.05, vs lap 1.
DISCUSSION
730
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
the cyclist per lap deviated very little from the target speed
(53.0 kmIhj1) or the actual mean of 53.040 kmIhj1 (24).
The ability to separate the 180-km cycle phase of the
present study into three 60-km laps has allowed us to
maintain relatively consistent external conditions. We have
found that lap performance times significantly increased
as the trial progressed (Table 1). This finding indicates
that these participants self-selected a positive pacing strategy during the cycle phase of the Ironman triathlon. Similarly, a number of researchers have shown progressive
reductions in running speed (18) and heart rate (19) during
self-paced ultraendurance events. Whether or not the
overall performance times of the participants in the present
study may have been improved had athletes adopted a
more consistent speed per lap is unclear and requires
further investigation.
It should be noted, however, that the progressive
reduction in lap speed found in the present study may
have been influenced as a result of changes in environmental conditions as wind speed increased by 13 kmIhj1
from 9:00 a.m. to 3:00 p.m. (5,33). The increase in lap
performance time, however, was associated with a decrease
in power output and cadence (Fig. 1) and a shift in the
forcevelocity relationship from quadrant I to quadrant II
and III (Table 2, Fig. 3), suggesting that environmental
conditions were not solely responsible for the significant
reduction in speed. The shift in the forcevelocity
FIGURE 3Quadrant analysis of an individual subject over progressive laps. Quadrants were separated by the mean effective pedal force
and circumferential pedal velocity of that subject, over the entire
Ironman event.
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
731
distance, (b) lower levels of fatigue-related afferent sensory feedback at the beginning of the trial (i.e., pain,
perceived exertion, muscle glycogen content), and (c) an
initial high anxiety level or excitement when competing in
the event.
Interestingly, the reductions in power output, cadence,
and speed over the three laps in this study did not follow
significant increases in the deviation in any measured
variables (e.g., torque, speed, power). Based on classic
cause-and-effect models, it was hypothesized that as the
trial progressed, afferent sensory signals related to fatigue
(i.e., reduced muscle glycogen content, perceived pain, and
changes in neuromuscular recruitment) (1) would have
induced a greater influence on the pacing strategies used,
even in these well-trained triathletes. Consequently, it was
proposed that as the trial progressed, participants would
find it more and more difficult to maintain a steady or
optimal pace, resulting in a progressively greater variation
in power output, cadence, torque, and speed; however, this
was not found (Table 2). Although power output significantly declined (Table 1), no significant increase occurred
in the deviation of these variables with increased cycling
distance (Table 2). Further, as the event progressed (laps),
no significant change was noted in the median power
frequency (Table 1), suggesting that no considerable shift
occurred in the distribution (i.e., amplitude and frequency)
of power output. This may suggest that the reductions in
power output were not directly caused by the inability to
maintain physiological homeostasis. Instead, the decrease
in power, without a significant increase in the variation,
may indicate that the reduction in power output was
controlled in a more dynamic, nonlinear manner.
Although the above information may suggest that a
constant power output applied to the pedals would provide
the optimal pacing strategy during the entire cycle phase of
the Ironman, the determination of the best possible pacing
strategy is complicated by the effects of external conditions
such as wind. As mentioned, evidence for this comes from
a study performed by Atkinson and Brunskill (5), which
examined the effects of a simulated 8.05-kmIhj1 headwind
and tailwind over a 16.1-km simulated time trial. It was
found that the optimal pacing strategy involved cyclists
increasing power output into the headwind (5% above
mean), followed by a reduction in power output with a
tailwind (5% below mean). This pacing strategy induces
faster performance times primarily because of the greater
time that is spent in the headwind compared with the
tailwind section. Thus, in comparison with a constant
power output, a lower power output during a tailwind
section but with a greater power output during a headwind
section results in an improved overall performance time
(5,7,33). Field-based support for this comes from a study
by Atkinson and Edwards (7), which showed that during
the 1997 British womens time trial championship, cyclists
who road the first, wind-assisted half of a 16-km time trial
at a relatively slower pace, but then increased pace into a
headwind, produced the fastest overall performance times.
However, a limitation of the aforementioned study is that
732
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
deviated significantly throughout these sections, the variation in power output would not solely be related to
environmental and geographical factors. Further, the cycle
phase of the Ironman triathlon is essentially an individual
time trial event, free from drafting behind competitors or
team members wheels. Thus, the stochastic nature of
power output and heart rate seen in the present study are
unrelated to drafting or group dynamics. We therefore
believe that the oscillatory variations in power output
shown in the present study indicate that multiple inputs are
responsible for the control of power output during the cycle
phase of the Ironman event, and thus provide evidence for
the interrelationship of the numerous linear physiological
fatigue systems reacting in a complex nonlinear pattern
(32,34). Within this complex systems model, it is believed
that multiple peripheral physiological systems provide
feedback to the brain, resulting in a dynamic, nonlinear
control of power to maintain homeostatic control of each
physiological system (17). The continual oscillatory variations in power output, therefore, may indicate a delay
between afferent signaling and efferent control of power
output (17). Interestingly, the fluctuations in power output
were significantly more variable than the oscillations in heart
rate shown over the same time period (P G 0.05; Fig. 4). This
then supports the premise that, although the measurement of
heart rate may indicate the physiological stress, current
portable heart rate monitors are not adequately sensitive to
show minor fluctuations in power output and, thus, pacing
(5). As a result, future studies should address the cyclic oscillatory patterns of power output during cycling and their influence
on pacing during field cycling performance. In addition, research
should examine the effects of more or less oscillation (variation)
on pacing and overall exercise performance.
In conclusion, the present study has shown that, although
these well-trained participants finished within the top 10%
of the Ironman Western Australia event, power output and
speed declined with increasing distance, suggesting that
pacing strategies during the cycle phase of the event may
have been suboptimal. As a result, participants may have
benefited from the use of a more constant speed over the
duration of the cycle phase of the event. Further, this study
has shown that average power output, cadence, net torque,
and speed were not significantly different between headwind and tailwind sections. The deviation (variation) in
speed and torque, however, were significantly greater into
a headwind, which was most likely caused by an increase
in aerodynamic drag. Finally, this study has provided some
evidence to support the hypothesis that pacing during
cycling is controlled through continual dynamic regulation strategies that concomitantly attempt to maintain
homeostasis while completing known amounts of work as
fast as possible.
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
733
REFERENCES
1. ABBISS, C. R., and P. B. LAURSEN. Models to explain fatigue during
prolonged endurance cycling. Sports Med. 35:865898, 2005.
2. ALBERTUS, Y., R. TUCKER, A. S. C. GIBSON, E. V. LAMBERT, D. B.
HAMPSON, and T. D. NOAKES. Effect of distance feedback on pacing
strategy and perceived exertion during cycling. Med. Sci. Sports
Exerc. 37:461468, 2005.
3. ANSLEY, L., E. SCHABORT, A. ST. CLAIR GIBSON, M. LAMBERT, and
T. D. NOAKES. Regulation of pacing strategies during successive
4-km time trials. Med. Sci. Sports Exerc. 36:18191825, 2004.
4. ARMADA-DA-SILVA, P. A., J. WOODS, and D. A. JONES. The effect of
passive heating and face cooling on perceived exertion during
exercise in the heat. Eur. J. Appl. Physiol. 91:563571, 2004.
5. ATKINSON, G., and A. BRUNSKILL. Pacing strategies during a cycling
time trial with simulated headwinds and tailwinds. Ergonomics
43:14491460, 2000.
6. ATKINSON, G., R. DAVISON, A. JEUKENDRUP,and L. PASSFIELD. Science
and cycling: current knowledge and future directions for research.
J. Sports Sci. 21:767787, 2003.
7. ATKINSON, G.,and B. EDWARDS. Pacing strategy and cycling
performance: field data from the 1997 British 16 km time-trial
championship. In: Proceedings of the Third Annual Congress of
the European College of Sports Science, Liverpool: Centre for
Health Care Development, 1998, p. 211.
8. BANGSBO, J., K. MADSEN, B. KIENS, and E. A. RICHTER. Effect of
muscle acidity on muscle metabolism and fatigue during intense
exercise in man. J. Physiol. 495:587596, 1996.
9. CALLOW, M., A. MORTON, and M. GUPPY. Marathon fatigue: the role
of plasma fatty acids, muscle glycogen and blood glucose. Eur. J.
Appl. Physiol. Occup. Physiol. 55:654661, 1986.
10. DE KONING, J. J., M. F. BOBBERT, and C. FOSTER. Determination of
optimal pacing strategy in track cycling with an energy flow
model. J. Sci. Med. Sport 2:266277, 1999.
11. FABIATO, A., and F. FABIATO. Effects of pH on the myofilaments
and the sarcoplasmic reticulum of skinned cells from cardiac and
skeletal muscles. J. Physiol. 276:233255, 1978.
12. FARIA, E. W., D. L. PARKER, and I. E. FARIA. The science of
cycling: factors affecting performancepart 2. Sports Med.
35:313337, 2005.
13. FOSTER, C., J. J. DEKONING, F. HETTINGA, et al. Effect of competitive
distance on energy expenditure during simulated competition. Int.
J. Sports Med. 25:198204, 2004.
14. FOSTER, C., A. C. SNYDER, N. N. THOMPSON, M. A. GREEN, M.
FOLEY, and M. SCHRAGER. Effect of pacing strategy on cycle
time trial performance. Med. Sci. Sports Exerc. 25:383388,
1993.
15. GONZALEZ-ALONSO, J., C. TELLER, S. L. ANDERSEN, F. B. JENSEN,
T. HYLDIG, and B. NIELSEN. Influence of body temperature on the
development of fatigue during prolonged exercise in the heat.
J. Appl. Physiol. 86:10321039, 1999.
16. JONSSON, B. Quantitative electromyographic evaluation of muscular
load during work. Scand. J. Rehabil. Med. 6:6974, 1978.
17. LAMBERT, M., A. ST CLAIR GIBSON, and T. D. NOAKES. Complex
systems model of fatigue: integrative homoestatic control of
peripheral physiological systems during exercise in humans. Br.
J. Sports Med. 39:5262, 2005.
18. LAMBERT, M. I., J. P. DUGAS, M. C. KIRKMAN, G. G. MOKONE, and
M. R. WALDECK. Changes in running speeds in a 100 km ultramarathon race. J. Sports Sci. Med. 3:167173, 2004.
19. LAURSEN, P. B., E. C. RHODES, R. H. LANGILL, D. C. MCKENZIE, and
734
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
http://www.acsm-msse.org
Copyright @ 2006 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.