In June 2017 a group of experts in anthropology, biology, kinesiology, neuroscience, physiology, and psychology convened in Canterbury, UK, to address questions relating to the placebo effect in sport and exercise. The event was supported exclusively by Quality Related (QR) funding from the Higher Education Funding Council for England (HEFCE). The funder did not influence the content or conclusions of the group. No competing interests were declared by any delegate. During the meeting and in follow-up correspondence, all delegates agreed the need to communicate the outcomes of the meeting via a brief consensus statement. The two specific aims of this statement are to encourage researchers in sport and exercise science to 1. Where possible, adopt research methods that more effectively elucidate the role of the brain in mediating the effects of treatments and interventions. 2. Where possible, adopt methods that factor for and/or quantify placebo effects that could explain a percentage of inter-individual variability in response to treatments and intervention.

An athlete's pacing strategy is widely recognised as an essential determinant for performance during individual events. Previous research focussed on the importance of internal bodily state feedback, revealed optimal pacing strategies in time-trial exercise, and explored concepts such as teleoanticipation and template formation. Recently, human-environment interactions have additionally been emphasized as a crucial determinant for pacing, yet how they affect pacing is not well understood. Therefore, this literature review focussed on exploring one of the most important human-environment interactions in sport competitions: the interaction among competitors. The existing literature regarding the regulation of exercise intensity and the effect of competition on pacing and performance is critically reviewed in this paper. The PubMed, CINAHL and Web of Science electronic databases were searched for studies about pacing in sports and (interpersonal) competition between January 2000 to October 2017, using the following combination of terms: (1) Sports AND (2) Pacing, resulting in 75 included papers. The behaviour of opponents was shown to be an essential determinant in the regulation of exercise intensity, based on both observational (N = 59) and experimental (N = 16) studies. However, adjustment in the pacing response related to other competitors appears to depend on the competitive situation and the current internal state of the athlete. The findings of this review emphasize the importance of what is happening around the athlete for the outcome of the decision-making process involved in pacing, and highlight the necessity to incorporate human-environment interactions into models that attempt to explain the regulation of exercise intensity in sports and exercise.

Methods 77With the intention to obtain all papers reporting on biomechanics in Paralympic sports and 78Paralympic athletes, the key words "Paralympic Biomechanics", "Paralympic Sport 79Performance", "Paralympic Athlete Performance" and "Paralympic Athlete" were entered 80into PubMed (July 2016). All studies on biomechanics in Paralympic and World Class 81 athletes were included, including case-studies. Interviews, editorials, reviews, studies not 82 available online and studies not in English were excluded (Figure 1). 83Insert figure 1 about here 84 85 Results 86Twenty articles were identified using the keywords "Paralympic Biomechanics", 124 using 87 the keywords "Paralympic Sport Performance", 110 using the keywords "Paralympic Athlete 88Performance", and 220 using the keywords "Paralympic Athlete". After applying the 89 exclusion criteria, eleven, 2-12 ten, 13-22 one, 23 and seven 24-30 articles were selected respectively. 90Based on the authors' knowledge, five more studies were included, 31-35 on biomechanics in 91Paralympic athletes. In total, 34 studies were included (Tables 1-3). One case-study 36 was 92 selected using the keywords "Paralympic Biomechanics" and two 37-38 using the keywords 93"Paralympic Sport Performance" (Table 4). Based on the authors' knowledge, four more case-94 studies were included (Table 4). 39-42 95Biomechanical studies in Paralympic athletes (non case-studies) mainly contributed to 96 performance enhancement by technical optimization (n=32) [2][3][4][5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34][35] and injury prevention 97 (n=6) ( Tables 1-3). 3,14,22,24,25,29 Also, biomechanics were important in evidence-based 98 classification in Paralympic sports (n=6; some studies addressed more than one of these 99 points) (Tables 1-3). 5,6,10,11,17,32 In the current review, sports were subdivided into three main 100 groups based on Bernardi et al. 43: sitting, standing, and visually-impaired athletes. However, 101no studies specifically on visually impaired athletes and biomechanics were found. Instead, 102several studies on biomechanics and swimming were included, and we defined swimming as a 103 third group, replacing the group of visually-impaired athletes. 104Studies on biomechanics in Paralympic summer (n=29, 85% of the included studies) 105and winter sports (n=5, 15% of the included studies), the number of participants, type of 106 sport, type of impairment, test used, and main outcome are presented (Tables 1-3). Thirteen 107 studies (38% of the included studies) [5][6][7][8][9][10][11]17,23,27,[30][31][32] were performed during the Paralympic 108Games or World Championships, whereas the remaining twenty-one studies (62% of the 109 included studies) were performed in a laboratory setting studying Paralympic athletes. 2-4,12-110 16,18-22,24-26,28,29,33-35 Furthermore, 41% (n=14) of the studies were performed on sitting sports, 11138% on standing sports (n=13), and 21% (n=7) on swimming. 135Handcycling could successfu...

Citation: Eerden, Sophia, Dekker, Rienk and Hettinga, Florentina (2018) Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disability and Rehabilitation, 40 Clinical Rehabilitation. 27 28 2 Purpose: To summarize the available maximal and submaximal aerobic exercise tests for 29 wheelchair-dependent persons with a spinal cord injury and to identify useful applications for 30 clinical rehabilitation. 31 Method: The databases of PubMed, CINAHL ® , EMBASE and PsycINFO ® were searched for 32 English-language studies published prior to March 2015. Two independent raters identified 33 and examined studies that reported on laboratory-based aerobic exercise tests in persons with 34 a spinal cord injury, according to the PRISMA statement. 35 Results: The test protocols of maximal (n = 105) and submaximal (n = 28) exercise tests, 36 covered by 95 included studies, were assessed. A large variety in patient characteristics, test 37 objectives, test protocols, exercise modes and outcome parameters was reported. Few studies 38 reported on adherence to recommendations, adverse events and peak outcome validation. 39 Conclusion: An incremental test protocol with small, individualized, increments per stage 40 seems preferable for testing maximal aerobic capacity, but additional validation of the 41 available test modes is required to draw conclusions. Submaximal testing is relevant for 42 assessing the performance at daily life intensities and for estimating VO2peak. Consensus 43 regarding reporting test procedures and outcomes needs to be achieved to enhance 44 comparability of rehabilitation results. 45 46

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Scientific interest in pacing goes back >100 years. Contemporary interest, both as a feature of athletic competition and as a window into understanding fatigue, goes back >30 years. Pacing represents the pattern of energy use designed to produce a competitive result while managing fatigue of different origins. Pacing has been studied both against the clock and during head-to-head competition. Several models have been used to explain pacing, including the teleoanticipation model, the central governor model, the anticipatory-feedback-rating of perceived exertion model, the concept of a learned template, the affordance concept, the integrative governor theory, and as an explanation for “falling behind.” Early studies, mostly using time-trial exercise, focused on the need to manage homeostatic disturbance. More recent studies, based on head-to-head competition, have focused on an improved understanding of how psychophysiology, beyond the gestalt concept of rating of perceived exertion, can be understood as a mediator of pacing and as an explanation for falling behind. More recent approaches to pacing have focused on the elements of decision making during sport and have expanded the role of psychophysiological responses including sensory-discriminatory, affective-motivational, and cognitive-evaluative dimensions. These approaches have expanded the understanding of variations in pacing, particularly during head-to-head competition.

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