***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: PURPOSE To investigate the effect of ice slurry ingestion on thermoregulatory responses and submaximal running time in the heat . METHODS On two separate occasions , in a counterbalanced order , 10 males ingested 7.5 g·kg(-1 ) of either ice slurry ( -1 ° C ) or cold water ( 4 ° C ) before running to exhaustion at their first ventilatory threshold in a hot environment ( 34.0 ° C ± 0.2 ° C , 54.9 % ± 5.9 % relative humidity ) . Rectal and skin temperatures , HR , sweating rate , and ratings of thermal sensation and perceived exertion were measured . RESULTS Running time was longer ( P = 0.001 ) after ice slurry ( 50.2 ± 8.5 min ) versus cold water ( 40.7 ± 7.2 min ) ingestion . Before running , rectal temperature dropped 0.66 ° C ± 0.14 ° C after ice slurry ingestion compared with 0.25 ° C ± 0.09 ° C ( P = 0.001 ) with cold water and remained lower for the first 30 min of exercise . At exhaustion , however , rectal temperature was higher ( P = 0.001 ) with ice slurry ( 39.36 ° C ± 0.41 ° C ) versus cold water ingestion ( 39.05 ° C ± 0.37 ° C ) . During exercise , mean skin temperature was similar between conditions ( P = 0.992 ) , as was HR ( P = 0.122 ) and sweat rate ( P = 0.242 ) . After ice slurry ingestion , subjects stored more heat during exercise ( 100.10 ± 25.00 vs 78.93 ± 20.52 W·m(-2 ) , P = 0.005 ) , and mean ratings of thermal sensation ( P = 0.001 ) and perceived exertion ( P = 0.022 ) were lower . CONCLUSIONS Compared with cold water , ice slurry ingestion  lowered preexercise rectal temperature , increased submaximal endurance running time in the heat ( + 19 % ± 6 % ) , and allowed rectal temperature to become higher at exhaustion . As such , ice slurry ingestion may be an effective and practical precooling maneuver for athletes competing in hot environments PURPOSE To develop and investigate the efficacy of a new precooling strategy combining external and internal techniques on the performance of a cycling time trial ( TT ) in a hot and humid environment . METHODS Eleven well-trained male cyclists undertook three trials of a laboratory-based cycling TT simulating the course characteristics of the Beijing Olympic Games event in a controlled hot and humid environment ( 32 ° C-35 ° C at 50%-60 % relative humidity ) . The trials , separated by 3 - 7 d , were undertaken in a r and omized crossover design and consisted of the following : 1 ) CON-no treatment apart from the ad libitum consumption of cold water ( 4 ° C ) , 2 ) STD COOL-whole-body immersion in cold ( 10 ° C ) water for 10 min followed by wearing a cooling jacket , or 3 ) NEW COOL-combination of consumption of 14 g of ice slurry ( " slushie " ) per kilogram body mass made from a commercial sports drink while applying iced towels . RESULTS There was an observable effect on rectal temperature ( T(rec ) ) before the commencement of the TT after both precooling techniques ( STD COOL < NEW COOL < CON , P < 0.05 ) , but pacing of the TT result ed in similar T(rec ) , HR , and RPE throughout the cycling protocol in all trials . NEW COOL was associated with a 3.0 % increase in power ( approximately 8 W ) and a 1.3 % improvement in performance time ( approximately 1:06 min ) compared with the CON trial , with the true likely effects ranging from a trivial to a large benefit . The effect of the STD COOL trial compared with the CON trial was " unclear . " CONCLUSIONS This new precooling strategy represents a practical and effective technique that could be used by athletes in preparation for endurance events undertaken in hot and humid conditions PURPOSE To determine the effect of thermal state and thermal comfort on cycling performance in the heat . METHODS Seven well-trained male triathletes completed 3 performance trials consisting of 60 min cycling at a fixed rating of perceived exertion ( 14 ) followed immediately by a 20-km time trial in hot ( 30 ° C ) and humid ( 80 % relative humidity ) conditions . In a r and omized order , cyclists either drank ambient-temperature ( 30 ° C ) fluid ad libitum during exercise ( CON ) , drank ice slurry ( -1 ° C ) ad libitum during exercise ( ICE ) , or precooled with iced towels and ice slurry ingestion ( 15 g/kg ) before drinking ice slurry ad libitum during exercise ( PC+ICE )  . Power output , rectal temperature , and ratings of thermal comfort were measured . RESULTS Overall mean power output was possibly higher in ICE ( + 1.4%±1.8 % [ 90 % confidence limit ] ; 0.4 > smallest worthwhile change [ SWC ] ) and likely higher PC+ICE ( + 2.5%±1.9 % ; 1.5>SWC ) than in CON ; however , no substantial differences were shown between PC+ICE and ICE ( unclear ) . Time-trial performance was likely enhanced in ICE compared with CON ( + 2.4%±2.7 % ; 1.4>SWC ) and PC+ICE ( + 2.9%±3.2 % ; 1.9>SWC ) . Differences in mean rectal temperature during exercise were unclear between trials . Ratings of thermal comfort were likely and very likely lower during exercise in ICE and PC+ICE , respectively , than in CON . CONCLUSIONS While PC+ICE had a stronger effect on mean power output compared with CON than ICE did , the ICE strategy enhanced late-stage time-trial performance the most . Findings suggest that thermal comfort may be as important as thermal state for maximizing performance in the heat We used incorrect visual feedback of ambient and core temperature in the heat to test the hypothesis that deception would alleviate the decrement in cycling performance compared to a no deception trial . Seven males completed three 30 min cycling time trials in a r and omised order on a Kingcycle ergometer . One time trial was in temperate , control conditions ( CON : 21.8 ± 0.6 ° C ; 43.3 ± 4.3%rh ) , the others in hot , humid conditions ( HOT : 31.4 ± 0.3 ° C ; 63.9 ± 4.5%rh ) . In one of the hot , humid conditions ( 31.6 ± 0.5 ° C ; 65.4 ± 4.3%rh ) , participants were deceived ( DEC ) into thinking the ambient conditions were 26.0 ° C ; 60.0%rh and their core temperature was 0.3 ° C lower than it really was . Compared to CON ( 16.63 ± 2.43 km ) distance covered was lower in HOT ( 15.88 ± 2.75 km ; P < 0.05 ) , but DEC ameliorated this ( 16.74 ± 2.87 km ; P < 0.05 ) . Mean power output was greater in DEC ( 184.4 ± 60.4 W ) than HOT ( 168.1 ± 54.1 W ; P < 0.05 ) and no difference was observed between CON and DEC . Rectal temperature and iEMG of the vastus lateralis were not different , but RPE in the third minute was lower in DEC than HOT ( P < 0.05 ) . Deception improved performance in the heat by creating a lower RPE , evidence of a subtle mismatch between the subconscious expectation and conscious perception of the task dem and QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis ABSTRACT This investigation compared the effects of external pre-cooling and mid-exercise cooling methods on running time trial performance and associated physiological responses . Nine trained male runners completed familiarisation and three r and omised 5 km running time trials on a non-motorised treadmill in the heat ( 33 ° C ) . The trials included pre-cooling by cold-water immersion ( CWI ) , mid-exercise cooling by intermittent facial water spray ( SPRAY ) , and a control of no cooling ( CON ) . Temperature , cardiorespiratory , muscular activation , and perceptual responses were measured as well as blood concentrations of lactate and prolactin . Performance time was significantly faster with CWI ( 24.5 ± 2.8 min ; P = 0.01 ) and SPRAY ( 24.6 ± 3.3 min ; P = 0.01 ) compared to CON ( 25.2 ± 3.2 min ) . Both cooling strategies significantly ( P < 0.05 ) reduced forehead temperatures and thermal sensation , and increased muscle activation . Only pre-cooling  significantly lowered rectal temperature both pre-exercise ( by 0.5 ± 0.3 ° C ; P < 0.01 ) and throughout exercise , and reduced sweat rate ( P < 0.05 ) . Both cooling strategies improved performance by a similar magnitude , and are ergogenic for athletes . The observed physiological changes suggest some involvement of central and psychophysiological mechanisms of performance improvement Abstract Although pre-cooling is known to enhance exercise performance , the optimal cooling intensity is unknown . We hypothesized that mild cooling opposed to strong cooling circumvents skin vasoconstriction and thermogenesis , and thus improves cooling efficiency reflected in improved time to exhaustion . Eight males undertook three r and omized trials , consisting of a pre-cooling and an exercise session . During the pre-cooling , performed in a room of 24.6 ± 0.4 ° C and 24 ± 6 % relative humidity , participants received either 45 min of mild cooling using an evaporative cooling shirt or strong cooling using an ice-vest . A no-cooling condition was added as a control . Subsequent cycling exercise was performed at 65%[Vdot]O2peak in a climatic chamber of 29.3 ± 0.2 ° C and 80 ± 3 % relative humidity . During the pre-cooling session , mild and strong cooling decreased the skin blood flow compared with the control . However , no differences were observed between mild and strong cooling  . No thermogenesis was observed in any conditions investigated . The reduction of body heat content after pre-cooling  was two times larger with strong cooling ( 39.5 ± 8.4 W · m−2 ) than mild cooling ( 21.2 ± 5.1 W · m−2 ) . This result ed in the greatest improvement in time to exhaustion with strong cooling . We conclude that the cooling intensities investigated had a similar effect on cooling efficiency ( vasoconstriction and thermogenesis ) and that the improved performance after strong cooling is attributable to the greater decrease in body heat content Abstract This study investigated the effect of ice slurry ingestion during a triathlon on intragastric temperature and 10 km running performance in the heat . Nine well-trained male triathletes performed two r and omised trials of a simulated Olympic distance triathlon in hot conditions ( 32–34 ° C ) .  Exercise intensity during the swim ( 1500 m ) and cycle ( 1 hr ) legs was st and ardised , and the 10 km run leg was a self-paced time trial . During the cycle leg , either 10 g · kgBM−1 of ice slurry ( < 1 ° C ) or room temperature fluid ( 32–34 ° C ) was ingested . In the run leg of the ice slurry trial , performance time ( 43.4 ± 3.7 vs. 44.6 ± 4.0 min ; P = 0.03 ) , intragastric temperature ( at 1.5 km ; 35.5 ± 1.2 vs. 37.5 ± 0.4 ° C ; P = 0.002 ) and perceived thermal stress ( at 5 km ; 73 ± 9 vs. 80 ± 7 mm ; P = 0.04 ) were significantly lower . Oxygen consumption was significantly higher in the ice trial between 9.5–10 km ( 52.4 ± 3.4 vs. 47.8 ± 5.4 mL · kg−1 · min−1 ; P = 0.04 ) . The results suggest ice slurry ingestion was an effective ergogenic aid for triathlon running performance in 
    Output:
    
Current evidence suggests that whilst other strategies ameliorate physiological or perceptual responses throughout endurance exercise in hot conditions , ingesting cooling aids before and during exercise provides a small benefit , which is of practical significance to athletes ' time trial performance