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Andrew A. Flatt and Michael R. Esco


This study evaluated the 7-d mean and coefficient of variation (CV) of supine and standing ultrashort log-transformed root mean square of successive R-R intervals multiplied by 20 (lnRMSSDx20) obtained with a smartphone application (app) in response to varying weekly training load (TL). In addition, the authors aimed to determine if these values could be accurately assessed in as few as 5 or 3 d/wk.


Nine women from a college soccer team performed daily heart-rate-variability measures with an app in supine and standing positions over 3 wk of moderate, high, and low TL. The mean and CV over 7, 5, and 3 d were compared within and between weeks.


The 5- and 3-d measures within each week provided very good to nearly perfect intraclass correlations (ICCs .74–.99) with typical errors ranging from 0.64 to 5.65 when compared with the 7-d criteria. The 7, 5, and 3-d supine CV and the 7-day standing CV were moderately lower during the low-load than the high-load week (P .003–.045, effect sizes 0.86–0.92), with no significant changes occurring in the other measures.


This study supports the use of the mean and CV of lnRMSSD measured across at least 5 d for reflecting weekly values. The supine lnRMssDx20 CV as measured across 7, 5, and 3 d was the most sensitive marker to the changes in TL in the 3-wk period.

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Zackary S. Cicone, Oleg A. Sinelnikov, and Michael R. Esco

Purpose: The purpose of this study was to compare the differences between measured (MHRobt) and predicted (MHRpred) maximal heart rate (MHR) in youth athletes. Methods: In total, 30 male soccer players [14.6 (0.6) y] volunteered to participate in this study. MHRobt was determined via maximal-effort graded exercise test. Age-predicted MHR (MHRpred) was calculated for each participant using equations by Fox, Tanaka, Shargal, and Nikolaidis. Mean differences were compared using Friedman’s 2-way analysis of variance and post hoc pairwise comparisons. Agreement between MHRobt and MHRpred values was calculated using the Bland–Altman method. Results: There were no significant differences between MHRobt and MHRpred from the Fox (P = .777) and Nikolaidis (P = .037) equations. The Tanaka and Shargal equations significantly underestimated MHRobt (P < .001). All 4 equations produced 95% limits of agreement of ±15.0 beats per minute around the constant error. Conclusions: The results show that the Fox and Nikolaidis equations produced the smallest mean difference in predicting MHRobt. However, the wide limits of agreement suggests that none of the equations adequately account for individual variability in MHRobt. Practitioners should avoid applying these equations in youth athletes and utilize a lab or field testing protocol to obtain MHR.

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Michael R. Esco, Brett S. Nickerson, Sara C. Bicard, Angela R. Russell, and Phillip A. Bishop

The purpose of this investigation was to evaluate measurements of body-fat percentage (BF%) in 4 body-mass-index- (BMI) -based equations and dual-energy X-ray absorptiometry (DXA) in individuals with Down syndrome (DS). Ten male and 10 female adults with DS volunteered for this study. Four regression equations for estimating BF% based on BMI previously developed by Deurenberg et al. (DEBMI-BF%), Gallagher et al. (GABMI-BF%), Womersley & Durnin (WOBMI-BF%), and Jackson et al. (JABMI-BF%) were compared with DXA. There was no significant difference (p = .659) in mean BF% values between JABMI-BF% (BF% = 40.80% ± 6.3%) and DXA (39.90% ± 11.1%), while DEBMI-BF% (34.40% ± 9.0%), WOBMI-BF% (35.10% ± 9.4%), and GABMI-BF% (35.10% ± 9.4%) were significantly (p < .001) lower. The limits of agreement (1.96 SD of the constant error) varied from 9.80% to 16.20%. Therefore, BMI-based BF% equations should not be used in individuals with DS.

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Andrew A. Flatt, Jeff R. Allen, Clay M. Keith, Matthew W. Martinez, and Michael R. Esco

Purpose: To track cardiac-autonomic functioning, indexed by heart-rate variability, in American college football players throughout a competitive period. Methods: Resting heart rate (RHR) and the natural logarithm root mean square of successive differences (LnRMSSD) were obtained throughout preseason and ∼3 times weekly leading up to the national championship among 8 linemen and 12 nonlinemen. Seated 1-minute recordings were performed via mobile device and standardized for time of day and proximity to training. Results: Relative to preseason, linemen exhibited suppressed LnRMSSD during camp-style preparation for the playoffs (P = .041, effect size [ES] = −1.01), the week of the national semifinal (P < .001, ES = −1.27), and the week of the national championship (P = .005, ES = −1.16). As a combined group, increases in RHR (P < .001) were observed at the same time points (nonlinemen ES = 0.48–0.59, linemen ES = 1.03–1.10). For all linemen, RHR trended upward (positive slopes, R 2 = .02–.77) while LnRMSSD trended downward (negative slopes, R 2 = .02–.62) throughout the season. Preseason to postseason changes in RHR (r = .50, P = .025) and LnRMSSD (r = −.68, P < .001) were associated with body mass. Conclusions: Heart-rate variability tracking revealed progressive autonomic imbalance in the lineman position group, with individual players showing suppressed values by midseason. Attenuated parasympathetic activation is a hallmark of impaired recovery and may contribute to cardiovascular maladaptations reported to occur in linemen following a competitive season. Thus, a descending pattern may serve as an easily identifiable red flag requiring attention from performance and medical staff.

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Sara R. Sherman, Clifton J. Holmes, Bjoern Hornikel, Hayley V. MacDonald, Michael V. Fedewa, and Michael R. Esco

Purpose: To assess the agreement of the root mean square of successive R-R interval (RMSSD) values when recorded immediately upon waking to values recorded later in the morning prior to practice, and to determine the associations of the RMSSD recordings with performance outcomes in female rowers. Methods: A total of 31 National Collegiate Athletic Association Division I rowers were monitored for 6 consecutive days. Two seated RMSSD measurements were obtained on at least 3 mornings using a smartphone-based photoplethysmography application. Each 1-minute RMSSD measure was recorded following a 1-minute stabilization period. The first (T1) measurement occurred at the athlete’s home following waking, while the second (T2) transpired upon arrival at the team’s boathouse immediately before practice. From the measures, the RMSSD mean and coefficient of variation were calculated. Two objective performance assessments were conducted on an indoor rowing ergometer on separate days: 2000-m time trial and distance covered in 30 minutes. Interteam rank was determined by the coaches, based on subjective and objective performance markers. Results: The RMSSD mean (intraclass correlation coefficient = .82; 95% CI, .63 to .92) and RMSSD coefficient of variation (intraclass correlation coefficient = .75; 95% CI, .48 to .88) were strongly correlated at T1 and T2, P < .001. The RMSSD mean at T1 and T2 was moderately associated with athlete rank (r = −.55 and r = −.46, respectively), 30-minute distance (r = .40 and r = .41, respectively), and 2000 m at T1 (r = −.37), P < .05. No significant correlations were observed for the RMSSD coefficient of variation. Conclusion: Ultrashort RMSSD measurements taken immediately upon waking show very strong agreement with those taken later in the morning, at the practice facility. Future research should more thoroughly investigate the relationship between specific performance indices and the RMSSD mean and coefficient of variation for female collegiate rowers.

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Tori M. Stone, Jonathan E. Wingo, Brett S. Nickerson, and Michael R. Esco

The purpose of this study was to validate single-frequency hand-to-foot bioelectrical impedance analysis (HFBIA) for estimating bone mineral content (BMC) using dual-energy X-ray absorptiometry as the criterion measure in healthy men and women aged 18–40 years. A total of 80 men and women participated in this study. BMC was estimated on the same day using HFBIA and dual-energy X-ray absorptiometry. The HFBIA device provided higher mean BMC values in men and the entire sample, but not in women. A smaller standard error of estimate was observed in women (0.20, corresponding to 8% of the mean reference BMC values) compared with men (0.39, corresponding to 12% of the mean reference BMC values) and the combined sample (0.31). HFBIA provided a smaller constant error and individual estimation error indicated by the 95% limits of agreement in women (−0.05 ± 0.39) compared with men (−0.16 ± 0.78) and the entire sample (−0.10 ± 0.63). In conclusion, although BMC values were found to be more accurate in women, HFBIA overestimated BMC compared with dual-energy X-ray absorptiometry, especially in individuals with lower values. Given these results, using HFBIA to measure BMC would be inappropriate for diagnostic purposes.

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Brett S. Nickerson, Michael R. Esco, Phillip A. Bishop, Brian M. Kliszczewicz, Kyung-Shin Park, and Henry N. Williford

The purpose of this study was twofold: 1) compare body volume (BV) estimated from dual energy X-ray absorptiometry (DXA) to BV from a criterion underwater weighing (UWW) with simultaneous residual lung volume (RLV), and 2) compare four-compartment (4C) model body fat percentage (BF%) values when deriving BV via DXA (4CDXA) and UWW (4CUWW) in physically active men and women. One hundred twenty-two adults (62 men and 60 women) who self-reported physical activity levels of at least 1,000 MET·min·wk-1 volunteered to participate (age = 22 ± 5 years). DXA BV was determined with the recent equation from Smith-Ryan et al. while criterion BV was determined from UWW with simultaneous RLV. The mean BV values for DXA were not significant compared with UWW in women (p = .80; constant error [CE] = 0.0L), but were significantly higher in the entire sample and men (both p < .05; CE = 0.3 and 0.7L, respectively). The mean BF% values for 4CDXA were not significant for women (p = .56; CE = –0.3%), but were significantly higher in the entire sample and men (both p < .05; CE = 0.9 and 2.0%, respectively). The standard error of estimate (SEE) ranged from 0.6–1.2L and 3.9–4.2% for BV and BF%, respectively, while the 95% limits of agreement (LOA) ranged from ±1.8–2.5L for BV and ±7.9–8.2% for BF%. 4CDXA can be used for determining group mean BF% in physically active men and women. However, due to the SEEs and 95% LOAs, the current study recommends using UWW with simultaneous RLV for BV in a criterion 4C model when high individual accuracy is desired.