RESPIRATORY MUSCLE FATIGUE EFFECTS ON SPORT AND EXERCISE

PERFORMANCE: A LITERATURE REVIEW

DAN JOSHUA P. BERNARDINO

DEPARTMENT OF SPORTS SCIENCE

COLLEGE OF HUMAN KINETICS
UNIVERSITY OF THE PHILIPPINES
DILIMAN, QUEZON CITY

JUNE 2020
 UNIVERSITY OF THE PHILIPPINES

Bachelor of Sports Science

DAN JOSHUA P. BERNARDINO

RESPIRATORY MUSCLE FATIGUE EFFECTS ON SPORT AND EXERCISE

PERFORMANCE: A LITERATURE REVIEW

Thesis Adviser:
Asst. Prof. Revin Aaron Santos
College of Human Kinetics
University of the Philippines Diliman

Thesis Reader:
Prof. Marla Frances T. Mallari, PhD
College of Human Kinetics
University of the Philippines Diliman

Date of Submission
18 June 2020

Thesis Classification:

F
This thesis is available to the public.
 UNIVERSITY PERMISSION PAGE

I hereby grant the University of the Philippines a non-exclusive, worldwide, royalty-free license
to reproduce, publish and publicly distribute copies of this thesis or dissertation in whatever
form subject to the provisions of applicable laws, the provisions of the UP IPR policy and any
contractual obligations, as well as more specific permission marking on the Title Page.

Specifically I grant the following rights to the University:

a) To upload a copy of the work in the theses database of the

college/school/institute/department and in any other databases available
on the public internet;

b) To publish the work in the college/school/institute/department journal,

both in print and electronic or digital format and online; and

c) To give open access to above-mentioned work, thus allowing “fair use”

of the work in accordance with the provisions of the Intellectual Property
Code of the Philippines (Republic Act No. 8293), especially for teaching,
scholarly and research purposes.”

_____Dan Joshua P. Bernardino_____

Student Name over Signature and Date

 APPROVAL SHEET

This thesis entitled “RESPIRATORY MUSCLE FATIGUE EFFECTS ON

SPORT AND EXERCISE PERFORMANCE: A LITERATURE REVIEW” in partial
fulfillment of the requirements for the Degree of Bachelor of Sports Science is hereby
recommended for approval and acceptance.

_________June 18, 2020_________ ____________________________

Date REVIN AARON SANTOS
Adviser

Approved in partial fulfillment of the requirements for the Degree of Bachelor of

Sports Science by the Department of Sports Science.

_____________________________ ______________________________
Date MARLA FRANCES T. MALLARI, PhD
Chair, Department of Sports Science

Approved in partial fulfillment of the requirements for the Degree of Bachelor of

Sports Science by the Dean of the College of Human Kinetics, University of the Philippines,
Diliman, Quezon City

_____________________________ ____________________________
Date FRANCIS CARLOS B. DIAZ, MSPE
Dean
Bernardino, D.

ABSTRACT

This literature synthesis and review examined the effects of Respiratory Muscle Fatigue (RMF)

on sport and exercise performance in healthy individuals. Experimental studies aimed at

researching the effects of RMF in asymptomatic subjects were collected. Data were then

tabulated and analyzed for common themes that were mutually shared by the studies. Results

show that RMF proves to be a potential threat to sport and exercise performance mainly through

a respiratory muscle-induced metaboreflex. This metaboreflex causes a variety of physiological

effects such as a decrease in cardiac output and an increase in blood pressure and blood lactate,

which may significantly alter performance. In conclusion, RMF affects sport and exercise

performance, particularly the exercise tolerance and perceptions of exertion and breathlessness of

an individual through several physiological mechanisms.

Keywords: respiratory muscle fatigue, respiratory muscle-induced metaboreflex, sport

and exercise performance

Bernardino, D.

TABLE OF CONTENTS
INTRODUCTION……………………………………………………………………………….8
Background of the Study………………………………………………………………...8

Statement of the Problem………………………………………………………………..9

Objectives of the Study…………………………………………………………………..9

Significance of the Study………………………………………………………………...9

REVIEW OF RELATED LITERATURE…………………………..………………………..11

Prevalence of Respiratory Muscle Fatigue in Sports…………………………………11

Physiological Consequences of Respiratory Muscle Fatigue: The Respiratory Muscle

Metaboreflex………………………………………………………………………….....11

Physiological Consequences of Respiratory Muscle Fatigue: Increased Blood

Pressure……………………………………………………………………………..…...12

Physiological Consequences of Respiratory Muscle Fatigue: Cardiac Output..……12

Physiological Consequences of Respiratory Muscle Fatigue: Blood Lactate…….....13

Summary………………………………………………………………………………...13

METHODOLOGY……………………………………………………………………………..14

Research Design………………………………………………………………………...14

Scope and Delimitation…………………………………………………………………14

Operational Definition of Terms………………………………………………………15

RESULTS AND DISCUSSION………………………………………………………………..16

Summary of Research Characteristics………………………………………………...16

Respiratory Muscle Fatigue and Exercise Tolerance………………………………...17

Respiratory Muscle Fatigue and Perceptions of Effort and Breathlessness…………

17
Bernardino, D.

Respiratory Muscle Fatigue and Sport and Exercise

Performance…………………..18

Respiratory Muscle Training…………………………………………………………..19

SUMMARY, CONCLUSION, AND RECOMMENDATION……………………………….21

Summary of

Findings…………………………………………………………………...21

Conclusion………………………………………………………………………………21

Limitation……………………………………………………………………………….21

Application……………………………………………………………………………...22

Recommendations………………………………………………………………………23

REFERENCES………………………………………………………………………………….24

APPENDIX

A Matrix of Collected

Literature……………………………………………………….29

B Methodology for Further Experimental

Study……………………………………...37
Bernardino, D.

Chapter I
INTRODUCTION

Background of the Study

Our lungs are passive structures that intake and expel air when respiratory muscles

coordinate and contract. These respiratory muscles include our diaphragm, which is the primary

muscle for respiration, some of our neck muscles, our intercostals, and our abdominal muscles

which aids the diaphragm and compresses the abdominal cavity. These respiratory muscles,

while possessing incredible energy characteristics (Welch et al., 2019), incur fatigue similar to

other muscles of the body.

Respiratory muscle fatigue is widely believed by exercise physiologists to be

inconsequential to exercise and sport performance (McConnell, 2009). Although in the recent

years, the literature proving otherwise has been steadily growing, as new research has found

other mechanisms for respiratory muscle fatigue to impact sport performance. Additionally,

several high-quality studies have reported improvements in parameters of performance following

a respiratory muscle training regimen.

However, most of these studies have focused on the effects of training the respiratory

muscles. As such, the effects of respiratory muscle fatigue on sport performance have yet to be

fully investigated. Research on respiratory muscle fatigue should be given more importance to

establish whether it truly imposes a significant threat to exercise and to possibly develop an

effective solution to address the issue.

Currently, companies have been trying to sell respiratory muscle training to the athletic

population, with claims of improved sensations of breathlessness and perceptions of effort

exerted, among others. While being backed up by scientific evidence for a considerable amount

of time since it launched, it has still yet to be included in many strength and conditioning

8
Bernardino, D.

programs by coaches. This might be because the significance of respiratory muscle fatigue to

exercise performance still has not been clearly established. A great volume of research has

studied the contributions of exercise to respiratory muscle fatigue, yet considerably few have

looked upon the inverse, i.e. the effects of respiratory muscle fatigue to exercise performance.

There is an apparent gap in the literature that still needs to be filled before respiratory muscle

training gains traction in the world of exercise performance.

Statement of the Problem

This research synthesis examined the phenomenon of respiratory muscle fatigue in

healthy adults, and its subsequent effects to health and skill related components of physical

fitness that are relevant to sports performance. It investigates the role of respiratory muscle

fatigue to performance as it might have been previously overlooked and preemptively judged as

insignificant. The hypothesis is that sports and exercise performance are significantly deterred by

RMF.

Objectives of the Study

This literature review aims to:

1. find out how one may incur respiratory muscle fatigue during exercise.

2. investigate the physiological consequences that respiratory muscle fatigue might

impose unto the body.

3. summarize the current research on the effects of RMF to performance.

4. elucidate the significance of respiratory muscle fatigue and relate its possible

implications in the context of sport and exercise.

Significance of the Study

9
Bernardino, D.

Proving respiratory muscle fatigue as a limiting factor for intermittent-sprint sports

performance would provide a new perspective for improving athletes in those sports. The extent

of its performance consequences should also finally give coaches and athletes an idea of whether

to implement respiratory muscle training or not to their training plans. Furthermore, since it is

also relatively cost-friendly, respiratory muscle training would be a very accessible strategy for

use in improving the Filipino athlete. This study has the potential to add to the growing

knowledge of training methodologies.

It may also emphasize the importance of resistance training in athletes. A study has found

that resistance training also strengthens the respiratory muscles, and even more so than

endurance training alone (Hackett et. al, 2014). The findings of this study has the potential to add

perspective into the world of athletic training, particularly to the current value of respiratory

muscle strength in sport settings.

10
Bernardino, D.

Chapter II

REVIEW OF RELATED LITERATURE

Prevalence of Respiratory Muscle Fatigue in Sports

Similar to any other muscle group in the body, respiratory muscles also incur fatigue

during exercise. In a study by Bye et al. (1984), diaphragmatic fatigue was recorded during

short-term high intensity cycling in active young men. In another study by Babcock et al. (1996),

aerobically trained individuals were shown to develop the same level of diaphragmatic fatigue

with less aerobically fit counterparts after a sustained high-intensity bout of exercise. The high-

aerobic fitness group completed a higher absolute workload, however, this also proves that elite

endurance athletes might still incur the same level of diaphragmatic fatigue as less trained

individuals if they both work at ≥85% V˙ O2max, the intensity wherein respiratory muscle

fatigue is known to occur (Welch et al., 2019). Moreover, these studies show that even though

the respiratory demands of exercise could be amply met by the respiratory system (Coast et al.,

1990), some form of fatigue might still occur in the muscles that facilitate breathing due to the

respiratory demands induced by prolonged high-intensity exercise, as is typically encountered in

sports. Additionally, the loads placed upon the thoracic region during exercise is found to

accelerate respiratory muscle fatigue (RMF) due to the increased resistance against the

inspiratory muscles during breathing (Shei et al., 2017). These thoracic loads may be present in

sporting events such as climbing, wrestling, and swimming as well as in weight training

exercises.

Physiological Consequences of Respiratory Muscle Fatigue: The Respiratory Muscle

Metaboreflex

11
Bernardino, D.

RMF has been proven to trigger a variety of physiological reactions that primarily affect

the cardiovascular system (Dempsey et al., 2006). These effects are potentially detrimental to

sports performance. The respiratory muscle metaboreflex is one that may significantly affect

exercise performance. This reflexive reaction is triggered by metabolite accumulation caused by

fatiguing contractions of the respiratory muscles. Signals are then directed to the spine which

finally increases sympathetic vasoconstriction in the locomotor muscles (Dempsey et al., 2006).

It is similar to the blood shunting phenomenon one may experience by exercising immediately

after eating, caused by a competition for blood supply by the digestive and musculoskeletal

systems. In this case, the competitive relationship is occurring between the respiratory and the

musculoskeletal systems.

Physiological Consequences of Respiratory Muscle Fatigue: Increased Blood Pressure

Blood pressure has also been documented to be affected by respiratory muscle fatigue. A

study by Katayama et al. in 2012 showed that exercising under inspiratory muscle load

significantly increased diastolic blood pressure compared to a control trial. It has been

hypothesized since then that it was caused by the sympathetic vasoconstriction that occurs due to

the respiratory muscle metaboreflex. Moreover, the study documented the elevated diastolic

blood pressure to remain for several minutes after the trial was done. Changes in systolic blood

pressure were not significant between experimental and control trials.

Physiological Consequences of Respiratory Muscle Fatigue: Cardiac Output

In another study by Harms et al. (1998), unloading the respiratory muscles during

intermittent high-intensity cycling exercise in trained cyclists significantly increased cardiac

output when compared to a control trial, meaning respiratory muscle work reduces cardiac output

during exercise. This may again be attributed to the blood flow theft that occurs along with the

12
Bernardino, D.

respiratory muscle metaboreflex. The ~7% difference between cardiac output between the

respiratory muscle unloading trial and the control trial accounts for the decreased blood

requirements of the respiratory muscle during high-intensity exercise. Interestingly, when the

researchers increased the work of breathing through introducing inspiratory resistance, cardiac

output did not differ significantly between the increased work of breathing trial and the control

trial.

Physiological Consequences of Respiratory Muscle Fatigue: Blood Lactate

Respiratory muscle fatigue could also contribute to increases in blood lactate levels

during high-intensity exercise. In an experiment where 7 male participants were subjected to

sustained maximum voluntary ventilation (SMVV), blood lactate increased by 1.0 mmol/l (9.0

mg/100 ml) over resting values (Freedman et al., 1983). The increase in blood lactate levels were

a small but significant amount. This increase can only be attributed to the production of lactic

acid caused by the contractions of the respiratory muscles required to perform SMVV.

Summary

The current literature exposes how respiratory muscle fatigue may affect individuals

across various aerobic fitness levels. Additionally, this respiratory muscle fatigue might disturb

regular physiological processes particularly in the cardiovascular system. A notable

physiological phenomenon resulting from respiratory muscle fatigue is the respiratory muscle

metaboreflex, which causes sympathetic vasoconstriction to preserve regular blood supply in the

respiratory muscles during high-intensity exercise, where locomotor muscles might require blood

supply as well, thus competing with the respiratory muscles. This reaction may result to an

increase in diastolic blood pressure and a decrease in cardiac output. Finally, fatiguing

13
Bernardino, D.

contractions of the respiratory muscles also cause significant increases in blood lactate albeit

small.

14
Bernardino, D.

Chapter III

METHODOLOGY

Research Design

Resources gathered for the purpose of this paper were all retrieved from the online

databases Google, EBSCOhost, ResearchGate, and PubMed. The initial keywords used for the

search were “Respiratory Muscle Fatigue and Performance”. To thoroughly scan the databases

for sources, the keywords were broadened to only “Respiratory Muscle Fatigue”. Journal articles

were then inspected by title and abstract if they could prove useful in solving the research

question. Some articles were also found while investigating the citations of the previously

gathered journal articles. Relevant data were then tabulated for further analysis.

Scope and Delimitation

The search included scientific journals which had a title and an abstract pertaining to

fatigue in the respiratory muscles of humans and its effect to health and performance.

Experimental studies involving healthy participants were found to be appropriate for the purpose

of answering the research question and so were included to be examined for this review. Most of

the studies included have been published in the last 30 years, although one study published in the

year 1983 was included as its findings were found to still be significant to the present time. Upon

meeting these criteria, the full-texts of the journal articles were downloaded and scanned further

to select the final list of sources to be used for the purpose of this research. Furthermore, only

journal articles written in English or had an English version of the text were included. 17 journal

articles gathered from the initial search.

Full-text versions of the experimental journals were evaluated for their methodology:

whether their approach was valid and would produce results relevant to the purpose of this

15
Bernardino, D.

research. Journal articles were included if their methodologies involved either a control or

crossover method and investigated the effect of respiratory muscle work or fatigue on exercise

performance parameters. Studies involving respiratory muscle training within their methods have

been excluded as it is beyond the scope of this research. After validating the methodologies of

the experimental journals, the results sections were scanned to see if results produced would be

useful in answering the research question. Finally, discussion sections were read and studied as

well in order to gain insight on how the findings of the studies might help answer the research

question. 12 studies passed the selection process and were included to be further analyzed and

synthesized. A full summary of the relevant findings of these studies can be found at Appendix

A.

Operational Definition of Terms

Respiratory Muscles. A muscle group which mainly includes the external and internal

intercostals, and the diaphragm.

Respiratory Muscle Fatigue (RMF). A type of fatigue that occurs in the respiratory muscles

which likely occurs in sustained high-intensity exercise (Bye et al., 1984).

Respiratory Muscle-Induced Metaboreflex. A reflexive vasoconstriction by the body in working

locomotor muscles in an attempt to preserve an optimal level of blood supply in the

respiratory muscles. (Dempsey et al., 2006)

16
Bernardino, D.

Chapter IV

RESULTS AND DISCUSSION

Summary of Research Characteristics

All the experimental literature gathered had short-term interventions that lasted no more

than a week. The usual approach would be a crossover method wherein at least 2 days would be

dedicated to the experimental process: one day would serve as an intervention and another for

control. These experiments included ≤10 subjects only and was the design the majority of the

collected literature followed. A few experiments with more subjects available used a control

group to compare with an intervention group. Interventions would mostly comprise of techniques

inducing respiratory muscle fatigue during or before exercise to later on investigate its

corresponding effects.

Participants would range from sedentary to recreationally trained while a few studies

employed athletic populations. In all studies, all participants were ensured to be asymptomatic

and healthy, although some have not confirmed whether all participants did not participate in

smoking activities. In terms of gender, most participant samples were homogenous and

comprised of all males, although in cases where the group was heterogenous, it was still

predominantly male. Only one study by Nicks et al. in 2019 had a participant group of all female,

which was a collegiate football team. All subjects who participated were adults.

Additionally, most studies that were conducted and published were American and

European. Only 3 out of the 12 selected studies were Asian, all of which were produced in Japan.

Sociodemographic factors may vary between these groups of studies.

Meanwhile, common instruments that were utilized were a respiratory muscle training

device (or a modified version of one), a spirometer, and a cycle ergometer. Some instruments

17
Bernardino, D.

that at least a couple of experiments mutually used were an EMG, a blood lactate analyzer, and

an ECG, mainly to evaluate the effects of the intervention i.e. the alteration of respiratory muscle

work done. Most of the studies included procedures that increased or decreased the work of

breathing of the participants before or during a cycle ergometer exercise of different intensities.

They would also be tested for physiological parameters for fatigue level and performance before

and after the cycle ergometer exercise.

Respiratory Muscle Fatigue and Exercise Tolerance

Several studies reported a decrease in exercise time to exhaustion or a greater fatigue

level at exhaustion when work of breathing is increased during exercise (Bye et al., 1983; Mador

& Acevedo, 1991; Wuthrich et al., 2013). When the opposite is done, such as decreasing the

work of breathing, a 10-20% increase in exercise time to exhaustion occurs. This may be

strongly tied to the respiratory muscle metaboreflex which alters cardiac output, and

consequently Oxygen delivery. These physiological disturbances take away essential substrates

from the locomotor muscles and into the respiratory muscles. Therefore, during conditions of

respiratory muscle fatigue, metabolite removal in the locomotor muscles is hampered, and so is

recovery. Locomotor muscle fatigue consequently accelerates and time to exhaustion shortens

leading to a decrease in overall exercise performance. Furthermore, the small but significant

increases in lactate accumulation in the respiratory muscles may contribute to the overall fatigue

imposed on the body.

Respiratory Muscle Fatigue and Perceptions of Effort and Breathlessness

Another known effect of respiratory muscle fatigue that may impair performance is an

increase in perceived exertion and breathlessness during exercise (Bye et al., 1983; Mador &

Acevedo, 1991, Sugiura et al., 2013; Wuthrich et al., 2013). This may also be an effect of the

18
Bernardino, D.

reduced Oxygen delivery to the muscles. A study by Drouin et al. in 2019 confirms the existence

of an Oxygen-Conforming Response, which suggests that the absence of Oxygen increases the

perception of effort during exercise. This reaction, coupled with the metabolite accumulation in

the locomotor muscles, might contribute to a greater perception of effort, and ultimately a

reduction in force output. Additionally, the heightened dyspnea or level of breathlessness

brought about by RMF alongside the increase in perceived exertion of effort causes additional

discomfort and may deter the exercise quality. These alterations in perception prove that RMF

may not only affect sport and exercise physiologically, but also psychologically.

Respiratory Muscle Fatigue and Sport and Exercise Performance

Therefore, it can be expected that sports which require high-intensity endurance of short

to medium durations will experience a likely negative effect from RMF. Intermittent-sprint

sports, or sports characterized by repetitive bouts of alternating high-intensity and low-intensity

work, may also suffer since Oxygen delivery, which is important to recovery during the low-

intensity bouts, is compromised. In both types of sports where the maintenance of force

production is crucial, RMF could play a significant role in success or failure.

Furthermore, water sports may incur additional RMF than sports on land. Since water

places external forces on the ribcage and consequently on the respiratory muscles, ultimately

causing more work. This additional work imposed by the water could accelerate RMF especially

in lesser trained individuals. This hypothesis is supported by a study by HajGhanbari et al.

(2013), which showed that swimmers have greater respiratory muscle strength than athletes

participating in sports based on land.

19
Bernardino, D.

It is also important to note that not only sport performances can be affected negatively,

but training as well. Respiratory muscle fatigue can affect training capacity similar to how it

affects sport performance. This cumulative reduction in training quality over time could lead to

undesired training adaptations. This could be a possible mechanism of how RMF could influence

sport performance outcomes. Figure 4.1 summarizes the mechanisms of RMF which may

theoretically lead to impairments in sport and exercise performance.

Figure 4.1: Theoretical framework explaining how RMF might affect sports performance.

Respiratory Muscle Training

A study by Nicks & Mangum in 2008 suggests that respiratory muscle strength, measured

through maximal inspiratory pressure, may protect an individual from incurring respiratory

20
Bernardino, D.

muscle fatigue and its harmful effects. This supports the case for respiratory muscle training as a

possible method of attenuating the negative effects brought about by RMF. The mechanisms by

which respiratory muscle training could improve performance are further explained in Figure 4.2

(Welch et al., 2019). The potential of RMT as a training aid for sport and exercise performance

has yet to be fully realized, as the optimal protocol for implementing RMT in athletes is yet to be

determined (Karsten et al., 2019). The type of athlete that may find RMT most advantageous is

also yet unclear (HajGhanbari et al., 2013), although evidence has shown that running, cycling,

swimming, and rowing performance may improve through this type of training (Shei, 2018).

Intermittent-sprint type sports such as basketball (Chang et al., 2016) and football (Archiza et al.,

2017; Silva et al., 2019) have also been documented to benefit in some aspects of performance

following RMT.

Figure 4.2: Theoretical model of RMT influencing sports performance (Welch et al., 2019)

21
Bernardino, D.

Chapter V

SUMMARY, CONCLUSION, AND RECOMMENDATION

Summary of Findings

Literature was searched and analyzed about how RMF might affect exercise performance.

Data investigating this issue were scanned and collected. Results were tabulated and further

analyzed and synthesized in order to answer the research question. Literature revealed several

effects that are caused by the occurrence of fatigue in the respiratory muscles. These include the

respiratory muscle metaboreflex, alterations in cardiac output and blood pressure, and small but

significant increases in blood lactate levels.

Conclusion

Respiratory muscle fatigue can influence the fitness of an individual mainly through the

respiratory muscle metaboreflex, which is a reflexive mechanism of the body during exercise to

preserve function of the respiratory muscles by redirecting the blood from locomotor muscles to

the respiratory muscles. This in turn causes alterations in blood supply and substrate delivery to

the locomotor muscles during exercise, possibly impeding recovery in those muscles. This

metaboreflex may also lead to heightened perceptions of effort and breathlessness, affecting the

drive of an individual to perform. In summary, respiratory muscle fatigue may potentially add on

the stresses incurred during sports, impairing several facets of performance, mainly recovery,

exercise tolerance, and motivation.

Limitations

All sources used for this review were accessed online. Current circumstances during the

production of this research prohibit searching potential sources in physical forms, i.e. library-

22
Bernardino, D.

based literature. Therefore, sources for the purpose of this research were limited to online

publications which have full-text versions readily accessible through the internet. Furthermore,

access to some potentially relevant journal articles were not freely available and so were not

included.

Additionally, the results collected were mostly from highly controlled experiments. Only

a single study was done in the field. Actual effects of RMF to performance outcomes in sport

that may be affected, e.g. time trial results, maintenance of peak force output, intermittent

recovery ability, have not been investigated in the collected literature.

Application

The findings of this research sheds light on the importance of respiratory muscle fatigue

in specific sport and exercise situations. Sport coaches may need to take into consideration the

implications respiratory muscle fatigue has in their respective types of sport. Alternatively,

coaches and athletes could consider respiratory muscle training as a cost efficient means to

attenuate the potential negative effects of respiratory muscle fatigue and improve their overall

performance.

Recommendations

Further research which tests the findings of this literature synthesis should be conducted

out on the field. The theoretical effects of RMF on more direct performance outcomes and in

more specific sport situations would raise the significance of RMF in athletes and coaches. A

sample of a possible research would be an experimental study investigating the effects of

respiratory muscle fatigue in intermittent sprint athletes, particularly on how RMF during

intermittent sprint bouts affects markers of performance such as speed and power maintenance.

The experiment could involve inducing RMF through making the participants undergo a

23
Bernardino, D.

respiratory muscle training bout to failure. The participants would then subsequently need to

perform a running-based anaerobic sprint test (RAST) to test if RMF affects their intermittent

sprint performance. This will allow intermittent sprint sport coaches to draw a more concrete

idea of how respiratory muscle fatigue affects their athlete. This will also elucidate the impact of

respiratory muscle fatigue in the short aerobic periods during this type of sport and how it affects

their overall recovery and performance. A detailed methodology for this type of study is further

explained in Appendix B.

24
Bernardino, D.

References:

Archiza, B., Andaku, D. K., Caruso, F. C. R., Bonjorno, J. C., Oliveira, C. R. D., Ricci, P. A., …

Borghi-Silva, A. (2017). Effects of inspiratory muscle training in professional women

football players: a randomized sham-controlled trial. Journal of Sports Sciences, 36(7),

771–780. doi: 10.1080/02640414.2017.1340659

Babcock, M. A., Pegelow, D. F., Johnson, B. D., & Dempsey, J. A. (1996). Aerobic fitness

effects on exercise-induced low-frequency diaphragm fatigue. Journal of Applied

Physiology, 81(5), 2156-2164. doi:10.1152/jappl.1996.81.5.2156

Bye, P. T., Esau, S. A., Walley, K. R., Macklem, P. T., & Pardy, R. L. (1984). Ventilatory

muscles during exercise in air and oxygen in normal men. Journal of Applied

Physiology, 56(2), 464–471. doi: 10.1152/jappl.1984.56.2.464

Chang, Y.-C., Lan, Y.-C., Tsai, M.-W., & Chou, L.-W. (2016). Effects of 3-week Respiratory

Muscle Training on Sport Performance in College Basketball Athletes. Medicine &

Science in Sports & Exercise, 48, 941. doi: 10.1249/01.mss.0000487817.91902.2e

Coast, J. R., Clifford, P. S., Henrich, T. W., Stray-Gundersen, J., & Johnson, R. L. (1990).

Maximal inspiratory pressure following maximal exercise in trained and untrained

subjects. Medicine & Science in Sports & Exercise, 22(6), 811. doi: 10.1249/00005768-

199012000-00013

Dempsey, J. A., Romer, L., Rodman, J., Miller, J., & Smith, C. (2006). Consequences of

exercise-induced respiratory muscle work. Respiratory Physiology &

Neurobiology, 151(2-3), 242–250. doi: 10.1016/j.resp.2005.12.015

Dominelli, P. B., Archiza, B., Ramsook, A. H., Mitchell, R. A., Peters, C. M., Molgat-Seon, Y.,

… Sheel, A. W. (2017). Effects of respiratory muscle work on respiratory and locomotor

25
Bernardino, D.

blood flow during exercise. Experimental Physiology, 102(11), 1535–1547. doi:

10.1113/ep086566

Drouin, P. J., Kohoko, Z. I. N., Mew, O. K., Lynn, M. J. T., Fenuta, A. M., & Tschakovsky, M.

E. (2019). Fatigue-independent alterations in muscle activation and effort perception

during forearm exercise: role of local oxygen delivery. Journal of Applied

Physiology, 127(1), 111–121. doi: 10.1152/japplphysiol.00122.2019

Freedman, S., Cooke, N., & Moxham, J. (1983). Production of lactic acid by respiratory muscles.

Thorax, 38(1), 50-54. doi:10.1136/thx.38.1.50

Hackett, D. A., Johnson, N., & Chow, C. (2013). Respiratory muscle adaptations: a comparison

between bodybuilders and endurance athletes. The Journal of Sports Medicine and

Physical Fitness, 53(2), 139–145. Retrieved from

https://www.researchgate.net/publication/236181042

Hajghanbari, B., Yamabayashi, C., Buna, T. R., Coelho, J. D., Freedman, K. D., Morton, T. A.,

… Reid, W. D. (2013). Effects of Respiratory Muscle Training on Performance in

Athletes. Journal of Strength and Conditioning Research, 27(6), 1643–1663. doi:

10.1519/jsc.0b013e318269f73f

Harms, C. A., Babcock, M. A., Mcclaran, S. R., Pegelow, D. F., Nickele, G. A., Nelson, W. B.,

& Dempsey, J. A. (1997). Respiratory muscle work compromises leg blood flow during

maximal exercise. Journal of Applied Physiology, 82(5), 1573-1583.

doi:10.1152/jappl.1997.82.5.1573

Harms, C. A., Wetter, T. J., Mcclaran, S. R., Pegelow, D. F., Nickele, G. A., Nelson, W. B., . . .

Dempsey, J. A. (1998). Effects Of Respiratory Muscle Work On Cardiac Output And Its

26
Bernardino, D.

Distribution During Maximal Exercise. Cardiopulmonary Physical Therapy Journal,

9(4), 11. doi:10.1097/01823246-199809040-00009

Karsten, M., Ribeiro, G. S., Esquivel, M. S., & Matte, D. L. (2019). Maximizing the

effectiveness of inspiratory muscle training in sports performance: A current

challenge. Physical Therapy in Sport, 36, 68–69. doi: 10.1016/j.ptsp.2019.01.004

Katayama, K., Iwamoto, E., Ishida, K., Koike, T., & Saito, M. (2012). Inspiratory muscle fatigue

increases sympathetic vasomotor outflow and blood pressure during submaximal

exercise. American Journal of Physiology-Regulatory, Integrative and Comparative

Physiology, 302(10). doi: 10.1152/ajpregu.00006.2012

Katayama, K., Goto, K., Shimizu, K., Saito, M., Ishida, K., Zhang, L., … Sheel, A. W. (2018).

Effect of increased inspiratory muscle work on blood flow to inactive and active limbs

during submaximal dynamic exercise. Experimental Physiology. doi: 10.1113/ep087380

Mador, M. J., & Acevedo, F. A. (1991). Effect of respiratory muscle fatigue on subsequent

exercise performance. Journal of Applied Physiology, 70(5), 2059-2065.

doi:10.1152/jappl.1991.70.5.2059

Nicks, C. R., & Mangum, M. (2008). Influence of Baseline Respiratory Muscle Strength on

Respiratory Muscle Fatigue Following Exhaustive Intermittent Exercise. Medicine &

Science in Sports & Exercise, 40(Supplement).

doi:10.1249/01.mss.0000323646.92095.56

Pessoa, I. M. S., Parreira, V. F., Fregonezi, G. A., Sheel, A. W., Chung, F., & Reid, W. D.

(2014). Reference Values for Maximal Inspiratory Pressure: A Systematic

Review. Canadian Respiratory Journal, 21(1), 43–50. doi: 10.1155/2014/982374

27
Bernardino, D.

Romer, L. M., & Polkey, M. I. (2008). Exercise-induced respiratory muscle fatigue: implications

for performance. Journal of Applied Physiology, 104(3), 879–888. doi:

10.1152/japplphysiol.01157.2007

Shei, R.-J., Chapman, R. F., Gruber, A. H., & Mickleborough, T. D. (2017). Respiratory Effects

of Thoracic Load Carriage Exercise and Inspiratory Muscle Training as a Strategy to

Optimize Respiratory Muscle Performance with Load Carriage. Springer Science

Reviews, 5(1-2), 49–64. doi: 10.1007/s40362-017-0046-5

Shei, R.-J. (2018). Recent Advancements in Our Understanding of the Ergogenic Effect of

Respiratory Muscle Training in Healthy Humans. Journal of Strength and Conditioning

Research, 32(9), 2665–2676. doi: 10.1519/jsc.0000000000002730

Silva, R. L. C., Hall, E., & Maior, A. S. (2019). Inspiratory muscle training improves

performance of a repeated sprints ability test in professional soccer players. Journal of

Bodywork and Movement Therapies, 23(3), 452–455. doi: 10.1016/j.jbmt.2019.01.016

Sugiura, H., Sako, S., & Oshida, Y. (2013). Effect of Expiratory Muscle Fatigue on the

Respiratory Response during Exercise. Journal of Physical Therapy Science, 25(11),

1491-1495. doi:10.1589/jpts.25.1491

Thébault, N., Léger, L. A., & Passelergue, P. (2011). Repeated-Sprint Ability and Aerobic

Fitness. Journal of Strength and Conditioning Research, 25(10), 2857–2865. doi:

10.1519/jsc.0b013e318207ef37

Welch, J. F., Kipp, S., & Sheel, A. W. (2019). Respiratory muscles during exercise: Mechanics,

energetics, and fatigue. Current Opinion in Physiology, 10, 102-109.

doi:10.1016/j.cophys.2019.04.023

28
Bernardino, D.

Wüthrich, T. U., Notter, D. A., & Spengler, C. M. (2013). Effect of inspiratory muscle fatigue on

exercise performance taking into account the fatigue-induced excess respiratory drive.

Experimental Physiology, 98(12), 1705-1717. doi:10.1113/expphysiol.2013.073635

Zagatto, A. M., Beck, W. R., & Gobatto, C. A. (2009). Validity of the Running Anaerobic Sprint

Test for Assessing Anaerobic Power and Predicting Short-Distance

Performances. Journal of Strength and Conditioning Research, 23(6), 1820–1827. doi:

10.1519/jsc.0b013e3181b3df32

29
Bernardino, D.

Appendix A

Matrix of Collected Literature

Journal articles that met the search criteria were gathered and tabulated here. Data from the articles that were collected include

titles, authors, dates of publication, problem statements, participant characteristics, instruments used, findings, and conclusions. 12

articles were included in total. The collective findings of these articles were used to formulate the results and discussion section.

Participant
Title, Author, and Date Problem Statement Instruments Finding Conclusion
Description

1.) Effect of increased Does increased Healthy young Custom designed  Arm blood flow was reduced  The respiratory
inspiratory muscle sympathetic men (n=10, 20 ± ergometer, while leg blood flow was muscle-induced
work on blood flow vasoconstriction 2 yrs), inspiratory preserved during mild leg metaboreflex affects
to inactive and active originating from the sedentary, non- threshold resistance exercise with inspiratory sympathetic blood
limbs respiratory smokers device resistance. flow redistribution
during submaximal musculature elicit a  Brachial artery blood flow from active limbs.
dynamic exercise, reduction in blood (inactive
Katayama et al., 2018 flow to an inactive limb) was reduced, while femoral
limb in order to artery blood flow (active limb)
maintain blood flow to was maintained during
an active limb? submaximal leg exercise with
inspiratory resistance.
2.) Ventilatory muscles How does short-term 7 normal young EMG, Cycle  Diaphragmatic fatigue occurs in  Diaphragmatic fatigue
during exercise high-intensity exercise men age 26-36, ergometer short-term (~6mins) high intensity occurs in constant high
in air and oxygen in affect ventilatory recreationally exercise (80% max workload) at a intensity exercise.
normal men. Bye et muscle fatigue? active constant workload in young men  Oxygen saturation of
al., 1984 (26-36yr) air affects onset of
diaphragmatic fatigue

30
Bernardino, D.

3.) Inspiratory muscle To elucidate the 8 healthy males. Inspiratory muscle  Exercise with inspiratory load  Inspiratory
fatigue increases influence of All were training device, induced changes in muscle muscle fatigue induces
sympathetic inspiratory muscle sedentary, mouth pressure sympathetic nerve activity and increases in muscle
vasomotor outflow fatigue nonsmokers, and meter, ergometer, diastolic blood pressure sympathetic vasomotor
and blood on muscle sympathetic with no history ECG outflow and blood
pressure during nerve activity of pressure during
submaximal exercise (MSNA) and blood cardiorespiratory dynamic leg exercise
Katayama et al., 2012 pressure diseases. at mild intensity.
(BP) response during
submaximal exercise.
4.) Respiratory muscle We hypothesized that 7 male cyclists Cycle ergometer,  Significant correlations  We conclude that Wb
work compromises during exercise at Ventilator existed (r 5 0.74–0.90; P , 0.05) normally incurred
leg blood flow maximal Oxygen between work of during maximal
during maximal consumption (V˙ breathing (Wb) and Q ˙ legs exercise causes
exercise, Harms et O2max), high (inverse), leg vascular resistance vasoconstriction
al., 1997 demand for respiratory (LVR), and leg V˙ O2 (V˙ O2 legs; in locomotor muscles
muscle blood flow (Q˙ inverse), and between LVR and and compromises
) would elicit norepinephrine spillover. locomotor
locomotor muscle  Respiratory muscle loading and muscle perfusion and
vasoconstriction and unloading affected changes in V˙ O2 [in legs]
compromise limb Q vasoconstriction in leg muscles.
5.) Effect of Expiratory The aim of this study 9 healthy adult ECG, gas analyzer,  The results showed that compared  These results suggest
Muscle Fatigue on was to reveal the men (mean age spirometer, cycle with the CON-EX that during medium-
the effect of expiratory 21.0 ergometer condition, no change in VE, an intensity exercise,
Respiratory Response muscle fatigue (EMF) ± 0.5 years, increase in f, or a decrease in VT EMF modulates the
during Exercise, on respiratory mean body was observed under the medium- respiratory response by
Sugiura H. et. al. response under two height 171.2 ± intensity EMF-EX inducing shallow and
2013 different exercise 2.3 cm, mean condition, while high-intensity fast
conditions: exercise body exercise reduced VE and f breathing to increase
(EX) with EMF weight 64.8 ± without changing VT. ventilation volume.
(EMF-EX) and control 5.7 kg, mean
EX without body mass index
EMF (CON-EX). (BMI) 22.1 ±
1.8 kg/m2), who
did not smoke
and were not
athletes.

31
Bernardino, D.

6.) EFFECTS OF Does manipulating the Eight healthy oesophageal  We found that when the WOB  Our findings support
RESPIRATORY work of breathing subjects (n=5M, balloon catheters, was reduced during exercise, the theory of a
MUSCLE WORK (WOB) during high- n=3W), All resistors, respiratory muscle blood competitive
ON RESPIRATORY intensity exercise alter recreationally proportional assist flow decreased while locomotor relationship
AND LOCOMOTOR respiratory and active ventilation, near- muscle blood flow increased. between locomotor
BLOOD locomotor muscle infrared Conversely, when the and respiratory
FLOW DURING blood flow? spectoscopy WOB was increased, respiratory muscles during intense
EXERCISE, muscle blood flow increased exercise.
Dominelli et al., 2017 while locomotor muscle
blood flow decreased.
7.) Effect of respiratory The purpose of this Ten healthy Spirometer,  After induction of fatigue,  We conclude that
muscle fatigue on study was to subjects, seven pneumotachograph, exercise time was reduced induction of
subsequent exercise determine whether men and three breathing compared inspiratory
performance. Mador induction of women, apparatus. with control (P < 0.001). muscle fatigue can
& Acevedo, 1991 inspiratory muscle volunteered for  During the last minute of impair subsequent
fatigue might impair this study. exercise, Oxygen consumption performance of
subsequent exercise and heart rate high-intensity exercise
performance were lower after induction of and alter the pattern of
fatigue than during control. breathing during
 At exercise isotime, minute such exercise.
ventilation and the visual
analogue scale for respiratory
effort
were larger after induction of
fatigue than during control.

32
Bernardino, D.

8.) Production of lactic Do normal, 7 healthy male Spirometer, Blood  With SMVV subjects sustained  Maximal Ventilation
acid by respiratory asymptomatic subjects lactate analyser on average 68% of the and Respiratory
muscles. Freedman et individuals produce an predicted maximum breathing Loading induced
al., 1983 increase in systemic capacity and achieved final lactate significant increases in
blood lactate during concentrations of 1.9 mmol/l blood lactate albeit
breathing under (17X1 mg/100 ml), representing small.
respiratory load? an average increase of about 1*0
mmol/l (9.0 mg/100 ml) over
resting values.
 There was a wide range between
individuals, from no increase at
all to 2-7 mmol/l,
despite similar levels of
ventilation.
 Breathing against added loads
produced much smaller
changes in blood lactate.

33
Bernardino, D.

9.) Effect of inspiratory Inspiratory muscle 14 healthy males magnetic nerve  The time to exhaustion in the PF-  Thus, prior-induced
muscle fatigue on fatigue (IMF) limits stimulation, cycle EX conditions was IMF
exercise exercise performance ergometer, visual significantly reduced by 14% reduces exercise
performance taking and can augment analog scale, compared with C-EX. performance, probably
into account the ventilatory custom inspiratory  The reduction in Ptw and Qtw as a result of the
fatigue-induced drive, which could per pressure inducer was greater increased quadriceps
excess respiratory se impair performance after PF-EX (Ptw, 17.3±9.7%; muscle fatigue and
drive. Wuthrich et. al, due to greater Qtw, 32.0±10.8%) than after thus greater perception
2013 respiratory muscle MATCH-ISO (Ptw, 10.8±10.3%; of exertion
work. Using Qtw, 23.3±15.2%; P <0.05), independent of the
magnetic nerve which may explain the increased excess respiratory
stimulation to assess perception of exertion and drive when cycling
fatigue, we tested earlier task failure with prior- with fatigued
whether the IMF- induced IMF. inspiratory muscles.
induced decrease
in exercise
performance results
from increased
respiratory muscle
work alone and/or a
metaboreflex-
mediated increase in
quadriceps muscle
fatigue.

34
Bernardino, D.

10.) Influence of Baseline The purpose of this 16 Female Portable mouth  Average PImax and PEmax  RMF occurs after
Respiratory Muscle study was to Collegiate pressure meter, values were 118.6 ± 8.0 and 128.3 intense exercise which
Strength determine the severity Athletes Yo-Yo Test ±28.1 cmH2O, respectively. includes intermittent-
on Respiratory of There was a significant drop in sprint sports
Muscle Fatigue inspiratory muscle both PImax (-15.4± 12.4%; p  Respiratory muscle
Following fatigue (IMF) and =.000) and PEmax (-12.8 ± 9.7%, strength measured
Exhaustive expiratory muscle p = .000) following the through PImax may
Intermittent Exercise. fatigue (EMF) completion of the IRT. PImax and protect individual from
Nicks & Mangum, following exhaustive level of IMF were inversely RMF, although no
2008 intermittent exercise in related, significant differences
female athletes. The although not significantly (r = were found between
study also -.40; p = .061). high PImax and low
addressed the question  PEmax and EMF were not PImax athletes.
of whether higher significantly related (r = .004; p
values of inspiratory =.494).
muscle  RMF was compared between
strength (PImax) or participants (n = 4) exhibiting the
expiratory muscle highest PImax (HPI) to the lowest
strength (PEmax) (LPI, n= 4), (140.3 ± 8.8 cmH20
relate to the severity vs. 96.3 ± 13.6 cmH20). HPI
of respiratory muscle experienced a -20 ±16.1 cmH20 (-
fatigue (RMF) after 13.9 ± 11.3%) drop in PImax post
intermittent exercise. exercise compared to a
-25.5 ± 8.4 cmH20 (-27.7 ±
12.9%) drop in LPI.

35
Bernardino, D.

11.) Aerobic fitness THIS STUDY WAS Twenty-four Bilateral Phrenic  The supramaximal BPNS test  High-fit subjects
effects on exercise- AIMED at subjects (20 men Nerve Stimulation showed a significant showed diaphragm
induced determining the effects and 4 women) (BPNS), reduction (P , 0.01) in the BPNS fatigue
low-frequency of Spirometer transdiaphragmatic pressure as a result of heavy
diaphragm fatigue, aerobic capacity or (Pdi) immediately after exercise endurance exercise but
Babcock et al., 1996 maximal Oxygen of 223.1 6 3.1% for the were also
consumption (V˙ high-fit group and 223.1 6 3.8% partially protected
O2max) (P . 0.05) for the fit group. from excessive fatigue,
on exercise-induced Recovery of the BPNS Pdi took despite high
diaphragm fatigue 60 min in both groups. ventilatory
 The high-fit group exercised at a requirements
higher absolute workload, which  This might be because
resulted in a higher CO2 their hyperventilatory
production (126%), a greater response
ventilatory demand (116%) to endurance exercise
throughout the exercise, and an was reduced, their
increased diaphragm force output diaphragm was
(128%) over the initial utilized less in
60% of the exercise period. providing the total
 Thereafter, diaphragm force ventilatory response,
output declined, despite a rising and
minute ventilation, and it possibly their
was not different between most of diaphragm aerobic
the high-fit and fit subjects. capacity was greater.

36
Bernardino, D.

12.) Effects of respiratory Our present study Eight male 8 channel tape  Stroke volume, CO,  Respiratory muscle
muscle work on examined the effects cyclists recorder, PAV, and pulmonary Oxygen work normally
cardiac output of changes in [maximal catheter, blood-gas consumption (V˙ O2) were not expended
and its distribution the work of breathing Oxygen analyzer, pressure different (P . during maximal
during maximal on cardiac output consumption transducer, lactate 0.05) between control and loaded exercise has two
exercise. Harms et (CO) during maximal (V˙ O2max): 62 analyzer, cycle trials at V ˙ O2 max but were significant effects on
al., 1998 exercise. 6 5 ml·kg21 ergometer lower (28, 29, and 27%, the
·min21] respectively) than control with cardiovascular system:
inspiratory muscle unloading at V 1) up to 14–16% of the
˙ O2 max. CO is directed
to the respiratory
muscles; and 2) local
reflex vasoconstriction
significantly
compromises blood
flow to leg locomotor
muscles.

37
Bernardino, D.

Appendix B

Methodology for Further Experimental Study

Research Design

The experiment would be using a crossover method. Participants would be randomly

assigned into two groups. After accomplishing a specific warm-up, one group would perform a

running-based anaerobic sprint test (RAST) after respiratory muscle training (RMT) to failure

and the other would perform RAST after a placebo RMT. Each group would then crossover to

the other so that all participants would receive both treatments.

Participants

The target population for this research are athletes who participate in intermittent-sprint

type sports. The athletes who are accessible for the purpose of this research are collegiate

intermittent-sprint type athletes who are 18 to 24 years old. To ensure the quality of the results of

this study, at least 15 male participants who are learned with sprinting will be secured to

participate. Subjects are excluded if they incurred any orthopedic injuries in the past 6 months,

have any lung or cardiovascular disease, or are smokers. Furthermore, each will have to give

their informed consent before participating in this study. This study will follow the Declaration

of Helsinki.

Research Instruments

38
Bernardino, D.

The running-based anaerobic sprint test has been proven reliable (r=0.88) and has been

validated to measure peak power (r=0.46), mean power (r=0.53), and fatigue index (r=0.63) and

can be used to predict anaerobic, short-distance performance (Zagatto et al., 2009). The test will

involve a 35-meter maximal sprint followed by a 10-second recovery period, to be repeated 6

times. Each sprint time will be recorded using a stopwatch.

Respiratory muscle fatigue will be induced using PowerBreathe Plus, a breathing trainer

designed to improve the inspiratory muscles. The PowerBreathe Plus provides a threshold

resistance for the inspiratory muscles to overcome before allowing air to enter.

Procedure

Participants would be briefed to take an adequate amount of sleep prior to each testing

day and refrain from any food 2 hours prior to each testing period. During the test proper,

participants’ body weight in kilograms would be collected prior to the warm-up. Both groups

would then perform the same warm-up and a maximal 35m sprint to also familiarize with the

test. They would then rest for 3 minutes before doing RMT. The experimental group would then

attempt to breathe using the PowerBreathe Plus set at level 2.5 (~68.5 cmH2O) up to which they

cannot accomplish another breath, while the placebo group will attempt 10 breaths using the

same instrument set at level 0 (~23 cmH20). The values for the experimental group are derived

from an approximation of the 50% of their maximal inspiratory pressure using established norms

39
Bernardino, D.

(Pessoa et al., 2014). This protocol is the recommended protocol for RMT (HajGhanbari et al.,

2013). Both groups would then immediately start the RAST, in which they would sprint for 35

meters followed by a recovery period of 10 seconds to be repeated for a total of 6 sprints. The

time for each sprint as well as the RPE and RPB for each RAST will be collected. The sprint

time and body weight data will be used to calculate the peak power output, mean power, and

fatigue index of each participant. A pilot study will also be conducted.

Analysis of Data

The hypothesis is that respiratory muscle fatigue will negatively influence the recovery

capacity during the repeated-sprinting bouts and consequently, intermittent-sprint sports

performance. This is derived from the theory of blood flow theft by the respiratory muscles from

the locomotor muscles due to the respiratory muscle induced metaboreflex. It can also stem from

the psychological factors of increased RPE and RPB.

40
Bernardino, D.

Also, it has been found that aerobic fitness is positively correlated with repeated sprint-

ability (Thebault et al., 2011; Tomlin & Wenger, 2001), which might mean that if aerobic fitness

is compromised, repeated sprint-ability will be impaired. It can be postulated that the capability

of the respiratory muscles plays a role in this correlation, and thus, hampering that role may lead

to a decrease in the recovery capacity during the test. This might be another mechanism of how

respiratory muscle fatigue can significantly affect intermittent-sprint sport performance.

A T-test will be used to determine if there exists a significant difference between the

measures from the two trials done. Sub-group analysis for each sport of the participants could

also be done to determine if their specific sports influence the scores and how significant its

effect may be. This is also to offset the differences of results in between each sport due to the

varying natures of each sporting event (e.g. movement patterns, environment, etc.).

Null Hypothesis:

Ho: The fatigue index of the experimental group is not significantly greater than the fatigue

index of the control group.

41