***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives —To evaluate the hormonal response to strenuous endurance exercise performed by elite athletes . Methods —Nine professional cyclists ( mean ( SD ) age 28 ( 1 ) years ; mean ( SD ) Vo2max 75.3 ( 2.3 ) ml/kg/min ) who participated in a three week tour race ( Vuelta a España 1999 ) were selected as subjects . Morning urinary levels of 6-sulphatoxymelatonin ( aMT6s ) and morning serum levels of testosterone , follicle stimulating ( FSH ) , luteinising hormone ( LH ) , and cortisol were measured in each subject at t0 ( before the competition ) , t1 ( end of first week ) , t2 ( end of second week ) , and t3 ( end of third week ) . Urine sample s of aMT6s were also evaluated in the evening at t0 , t1 , t2 , and t3 . Results —Mean urinary aMT6s levels had increased significantly ( p<0.01 ) during the day after each stage ( 1091 ( 33 ) v 683 ( 68 ) ng/ml at t1 ; 955 ( 19 ) v 473 ( 53 ) ng/ml at t2 ; 647 ( 61 ) v 337 ( 47 ) ng/ml at t3 ) . Both morning and evening aMT6s levels decreased significantly during the study . A similar pattern was observed for morning serum levels of cortisol and testosterone . Conclusions —The results suggest that the basal activity of the pineal gl and , adrenal gl and s , and testis may be decreased after consecutive days of intense , long term exercise The acute response of free salivary testosterone ( T ) and cortisol ( C ) concentrations to four  resistance exercise ( RE ) protocol s in 23 elite men rugby players was investigated . We hypothesized that hormonal responses would differ among individuals after four distinct RE protocol s : four sets of 10 repetitions ( reps ) at 70 % of 1 repetition maximum ( 1RM ) with 2 minutes ' rest between sets ( 4 × 10 - 70 % ) ; three sets of five reps at 85 % 1RM with 3 minutes ' rest ( 3 × 5 - 85 % ) ; five sets of 15 reps at 55 % 1RM with 1 minute 's rest ( 5 × 15 - 55 % ) ; and three sets of five reps at 40 % 1RM with 3 minutes ' rest ( 3 × 5 - 40 % ) . Each athlete completed each of the four RE protocol s in a r and om order on separate days . T and C concentrations were measured before exercise ( PRE ) , immediately after exercise ( POST ) , and 30 minutes post exercise ( 30 POST ) . Each protocol consisted of four exercises : bench press , leg press , seated row , and squats . Pooled T data did not change as a result of RE , whereas C declined significantly . Individual athletes differed in their T response to each of the protocol s , a difference that was masked when examining the pooled group data . When individual data were retrospectively tabulated according to the protocol in which each athlete showed the highest T response , a significant protocol -dependent T increase for all individuals was revealed . Therefore , RE induced significant individual , protocol -dependent hormonal changes lasting up to 30 minutes after exercise . These individual responses may have important ramifications for modulating adaptation to RE and could explain the variability often observed in studies of hormonal response to RE PURPOSE To assess the effects of different modes of morning ( AM ) exercise on afternoon ( PM ) performance and salivary hormone responses in professional rugby union players . METHODS On 4 occasions ( r and omized , crossover design ) , 15 professional rugby players provided AM ( ~8 AM ) and PM ( ~2 PM ) saliva sample s before PM assessment s of countermovement-jump height , reaction time , and repeated-sprint ability . Control ( passive rest ) , weights ( bench press : 5 × 10 repetitions , 75 % 1-repetition maximum , 90-s intraset recovery ) , cycling ( 6 × 6-s maximal sprint cycling , 7.5 % body mass load , 54-s intraset recovery ) , and running ( 6 × 40-m maximal sprints , 20-s intraset recovery ) interventions preceded ( ~5 h ) PM testing . RESULTS PM sprint performance improved ( P < .05 ) after weights ( > 0.15 ± 0.19 s , > 2.04 % ± 2.46 % ) and running ( > 0.15 ± 0.17 s , > 2.12 % ± 2.22 % ) but not cycling ( P > .05 ) . PM jump height increased after cycling ( 0.012 ± 0.009 m , 2.31 % ± 1.76 % , P < .001 ) and running ( 0.020 ± 0.009 m , 3.90 % ± 1.79 % , P < .001 ) but not weights ( P = .936 ) . Reaction time remained unchanged between trials ( P = .379 ) . Relative to control ( 131 ± 21 pg/mL ) , PM testosterone was greater in weights ( 21 ± 23 pg/mL , 17 % ± 18 % , P = .002 ) and running ( 28 ± 26 pg/mL , 22 % ± 20 % , P = .001 ) but not cycling ( P = .072 ) . Salivary cortisol was unaffected by AM exercise ( P = .540 ) . CONCLUSIONS All modes of AM exercise improved at least 1 marker of PM performance , but running appeared the most beneficial to professional rugby union players . A rationale therefore exists for preceding PM competition with AM exercise BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Abstract This study assessed the acute response of salivary testosterone and cortisol concentrations to four exercise protocol s in 27 elite male rugby players . Each athlete completed four protocol s in r and om order on separate in-season weeks . Two protocol s were resistance training based consisting of four exercises ( high pull , bench press , squat and chin-ups/prone row ) : Protocol 1 consisted of 5 sets of 15 repetitions at 55 % of 1 repetition maximum ( 1 RM ) with 1-minute rest ( 5 × 15–55 % ) . Protocol 2 consisted of three sets of five repetitions at 85 % 1 RM with 2-minute rest ( 3 × 5–85 % ) . Protocol 3 was a strongman ( STRNG ) session consisting of three stations within a circuit of exercises that included exercises such as battling ropes , prowler push , farmer 's walk and tyre flips . Protocol 4 was based on boxing and wrestling inspired exercises ( combative – COMB )  . Salivary testosterone and cortisol concentrations were measured before ( PRE ) and immediately after exercise ( POST ) . Testosterone did not significantly change as a result of any intervention , whereas cortisol declined and the testosterone to cortisol ( T/C ) ratio increased significantly in both the 5 × 15–55 % and 3 × 5–85 % protocol . When results were retrospectively grouped and analysed according to the protocol that demonstrated the greatest absolute testosterone response , significant ( P < 0.01 ) increases for the 5 × 15–55 % , STRNG and COMB protocol s were observed . The individualised hormone response to exercise observed in this study highlights the importance of recognising a protocol -dependent approach to training athletes . Furthermore this study also highlights a potential usefulness of employing STRNG and COMB training protocol s as an alternative stimulus to resistance training Previous studies have shown that visual images can produce rapid changes in testosterone concentrations . We explored the acute effects of video clips on salivary testosterone and cortisol concentrations and subsequent voluntary squat performance in highly trained male athletes ( n=12 ) . Saliva sample s were collected on 6 occasions immediately before and 15 min after watching a brief video clip ( approximately 4 min in duration ) on a computer screen . The watching of a sad , erotic , aggressive , training motivational , humorous or a neutral control clip was r and omised . Subjects then performed a squat workout aim ed at producing a 3 repetition maximum ( 3RM ) lift . Significant ( P<0.001 ) relative ( % ) increases in testosterone concentrations were noted with watching the erotic , humorous , aggressive and training videos ( versus control and sad ) , with testosterone decreasing significantly ( versus control ) after the sad clip . The aggressive video also produced an elevated cortisol response ( % change ) and more so than the control and humorous videos ( P<0.001 ) . A significant ( P<0.003 ) improvement in 3RM performance was noted after the erotic , aggressive and training clips ( versus control ) . A strong within-individual correlation ( mean r=0.85 ) was also noted between the relative changes in testosterone and the 3RM squats across all video sessions ( P<0.001 ) . In conclusion , different video clips were associated with different changes in salivary free hormone concentrations and the relative changes in testosterone closely mapped 3RM squat performance in a group of highly trained males . Thus , speculatively , using short video presentations in the pre-workout environment offers an opportunity for underst and ing the outcomes of hormonal change , athlete behaviour and subsequent voluntary performance 
    Output:
    
This review found that both physical and psychosocial interventions can alter testosterone and cortisol , and physical performance areas important for rugby union are affected by these changes .
The limited literature in the field supports the notion that physical interventions of short duration and high intensity , and psychosocial interventions that create a positive environment may elicit a hormonal response that is associated with favorable performance outcomes .
Overall , this review identified that when the testosterone responses to an intervention are notably greater than that of cortisol , favorable outcomes are likely .