***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 
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    ***EXAMPLES*** 
    Input: PURPOSE This study aim ed to investigate carbohydrate ( CHO ) mouth rinse response on neuromuscular activity , fuel oxidation rates , and cycling performance with different initial levels of endogenous CHO availability . METHODS In a double-blind , r and omized placebo-controlled design , eight males completed six experimental mouth rinse trials : CHO ( 6.4 % maltodextrin ) or placebo solution in a fed state ( FED ) , 12-h fasted state ( FAST ) , or a combined exercise-depleted muscle glycogen and 12-h fasted state ( DEP ) . Trials consisted of 30-min cycling at 90 % of gas exchange threshold , followed by a 20-km cycling time trial . Plasma lactate , plasma glucose , oxygen uptake , and EMG activity were measured , and CHO and fat oxidation rates were calculated . RESULTS CHO mouth rinse maintained higher plasma glucose levels as the constant load exercise progressed ( P = 0.023 ) . The reduced EMG activity in the DEP condition with the placebo during constant load exercise was ameliorated with CHO mouth rinse ( P < 0.01 ) . Furthermore , the power output and the EMG activity throughout the 20-km time trial were reduced in the DEP condition with placebo but were both restored with CHO mouth rinse ( P < 0.05 ) . Time trial performance was only improved with CHO in the DEP compared with the corresponding placebo ( P < 0.05 ) , and no differences between supplements were observed in the FED or FAST states . Analyses of the qualitative inference showed " benefit very likely " of CHO mouth rinse on exercise performance in DEP , " possibly benefit " in FAST , and " negligible or trivial " in FED . CHO mouth rinse had no effect on CHO and fat oxidation rates in either exercise mode . CONCLUSION The CHO mouth rinse influences exercise performance when endogenous CHO availability is low , and an enhanced central motor drive is potentially the main influencing mechanism The carbohydrate ( CHO ) concentration of a mouth rinsing solution might influence the CHO sensing receptors in the mouth , with consequent activation of brain regions involved in reward , motivation and regulation of motor activity . The purpose of the present study was to examine the effects of maltodextrin mouth rinsing with different concentrations ( 3 % , 6 % and 12 % ) after an overnight fast on a 20 km cycling time trial performance . Nine recreationally active , healthy males ( age : 24 ± 2 years ; V˙O2max : 47 ± 5 mL·kg−1·min−1 ) participated in this study . A double-blind , placebo-controlled r and omized study was conducted . Participants mouth-rinsed every 2.5 km for 5 s. Maltodextrin mouth rinse with concentrations of 3 % , 6 % or 12 % did not change time to complete the time trial and power output  compared to placebo (  p > 0.05 ) . Time trial completion times were 40.2 ± 4.0 , 40.1 ± 3.9 , 40.1 ± 4.4 , and 39.3 ± 4.2 min and power output 205 ± 22 , 206 ± 25 , 210 ± 24 , and 205 ± 23 W for placebo , 3 % , 6 % , and 12 % maltodextrin conditions , respectively . Heart rate , lactate , glucose , and rating of perceived exertion did not differ between trials ( p > 0.05 ) . In conclusion , mouth rinsing with different maltodextrin concentrations after an overnight fast did not affect the physiological responses and performance during a 20 km cycling time trial in recreationally active males The presence of carbohydrate in the mouth can immediately improve physical performance . How this occurs is not well understood . Here we used transcranial magnetic stimulation of primary motor cortex ( M1 ) to investigate the effects of non-sweet carbohydrate on corticomotor excitability and voluntary force production . In Experiment 1 , 16 participants performed a fatiguing isometric elbow flexion exercise for 30 min , and Motor evoked potentials ( MEPs ) were recorded from the biceps brachii during maximal voluntary force ( MVF ) produced every 2 min . After 11 min participants drank a carbohydrate solution ( CHO ) or an energy-free placebo solution ( PLA ) , in a double-blind , cross-over protocol . MEP amplitude increased by 30 % , and MVF increased by 2 % , immediately after carbohydrate ingestion . There was no relationship between the facilitation of MEP amplitude and plasma glucose or magnitude of fatigue . In a control experiment , 17 participants alternately mouth-rinsed CHO and PLA , in a r and omized , double-blind protocol . MEPs were recorded from right first dorsal interosseous at rest or during isometric contraction . MEP amplitude increased by 9 % with CHO , when the muscle was voluntarily activated . In both experiments , there were no effects on silent period duration , indicating that MEP facilitation was not due to reduced inhibition within M1 . This is the first demonstration that carbohydrate in the mouth immediately increases the excitability of the corticomotor pathway , prior to its ingestion . Afference from oral receptors is integrated with descending motor output , perhaps via nuclei in the brainstem . This novel form of sensorimotor integration facilitates corticomotor output to both fatigued and fresh muscle BACKGROUND Carbohydrates ( CHO ) are among the most investigated nutritional ergogenic aids , and may be consumed in different forms , e.g. , mouth rinse with carbohydrate solution ( MRCS ) . In this sense , the aim of this study was to evaluate the impact of MRCS on the performance of physically active individuals undergoing a physical exercise session carried out until the volitional exhaustion . METHODS This is a counter-balanced r and omized study , with a double-blind design . The sample consisted of twenty-one physically active healthy men with a mean ( ±SD ) of age of 22.4 ( ±2.7 ) years old , 76.7 ( ±6.0 ) cm of height,12.1 % ( ±3.7 ) of body fat mass , and 23.9 ( ±2.4 ) kg/m2 of body mass index . After familiarizing the participants with the protocol ( cycle ergometer , with oral mouth rinse procedure ) and assessing the maximal lactate steady state the cycling exercise was performed until the volitional exhaustion in the following conditions : without mouth rinse ( CONTROL ) , PLACEBO and MRCS .  RESULTS Time to reach exhaustion was statistically different ( P<0.0001 ) between conditions ( control : 43.0±27.5 minutes ; placebo : 57.4±30.6 minutes ; MRCS : 70.9±30.3 minutes ) . CONCLUSIONS The administration of MRCS was shown to be effective in improving cycling performance , increasing the time to exhaustion until the volitional exhaustion . Thus , the use of methodology proposed by the present study may help coaches and practitioners improve the performance of physically active young adults It is presently unclear whether the reported ergogenic effect of a carbohydrate ( CHO ) mouth rinse on cycling time-trial performance is affected by the acute nutritional status of an individual . Hence , the aim of this study was to investigate the effect of a CHO mouth rinse on a 60-min simulated cycling time-trial performance commenced in a fed or fasted state . Twelve competitive male cyclists each completed 4 experimental trials using a double-blinded Latin square design . Two trials were commenced 2 h after a meal that contained 2.5 g·kg(-1 ) body mass of CHO ( FED ) and 2 after an overnight fast ( FST ) . Prior to and after every 12.5 % of total time during a performance ride , either a 10 % maltodextrin ( CHO ) or a taste-matched placebo ( PLB ) solution was mouth rinsed for 10 s then immediately expectorated . There were significant main effects for both pre-ride nutritional status ( FED vs. FST ; p < 0.01 ) and CHO mouth rinse ( CHO vs. PLB ; p < 0.01 ) on power output with an interaction evident between the interventions ( p < 0.05 ) . The CHO mouth rinse improved mean power to a greater extent after an overnight fast ( 282 vs. 273 W , 3.4 % ; p < 0.01 ) compared with a fed state ( 286 vs. 281 W , 1.8 % ; p < 0.05 ) . We concluded that a CHO mouth rinse  improved performance to a greater extent in a fasted compared with a fed state ; however , optimal performance was achieved in a fed state with the addition of a CHO mouth rinse Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The aim was to investigate the influence of a carbohydrate ( CHO ) mouth rinse on the vastus lateralis ( VL ) and rectus femoris ( RF ) electromyographic activity ( EMG ) and time to exhaustion ( TE ) during moderate ( MIE ) and high-intensity cycling exercise ( HIE ) . Thirteen participants cycled at 80 % of their respiratory compensation point and at 110 % of their peak power output to the point of exhaustion . Before the trials and every 15 min during MIE , participants rinsed with the CHO or Placebo ( PLA ) solutions . The root mean square was calculated . CHO had no effect on the TE during HIE ( CHO : 177.3 ± 42.2 s ; PLA : 163.0 ± 26.7 s , p = 0.10 ) , but the TE was increased during MIE ( CHO : 76.6 ± 19.7 min ; PLA : 65.4 ± 15.2 min ; p = 0.01 ) . The EMG activity in the VL was higher than PLA at 30 min ( CHO : 10.5 % ± 2.6 % ; PLA : 7.7 % ± 3.3 % ; p = 0.01 ) and before exhaustion ( CHO : 10.3 % ± 2.5 % ; PLA : 8.0 % ± 2.9 % ; p = 0.01 ) with CHO rinsing . There was no CHO effect on the EMG activity of RF during MIE or for VL and RF during HIE . CHO mouth rinse maintains EMG activity and enhances performance for MIE but not for HIE Abstract Ispoglou , T , O'Kelly , D , Angelopoulou , A , Bargh , M , O'Hara , JP , and Duckworth , LC . Mouth rinsing with carbohydrate solutions at the postpr and ial state fail to improve performance during simulated cycling time trials . J Strength Cond Res 29(8 ) : 2316–2325 , 2015—Mouth rinsing with carbohydrate ( CHO ) solutions during cycling time trials results in performance enhancements ; however , most studies have used approximately 6 % CHO solutions . Therefore , the purpose of this study was to compare the effectiveness of mouth rinsing with 4 , 6 , and 8 % CHO solutions on 1-hour simulated cycling time trial performance . On 4 occasions , 7 trained male cyclists completed at the postpr and ial period , a set amount of work as fast as possible in a r and omized counterbalanced order . The subjects rinsed their mouth for 5 seconds , on completion of each 12.5 % of the trial , with 25 ml of a non-CHO placebo and 4 , 6 , and 8 % CHO solutions . No additional fluids were consumed during the time trial . Heart rate ( HR ) , ratings of perceived exertion ( RPE ) , thirst ( TH ) , and subjective feelings ( SF ) were recorded after each rinse . Furthermore , blood sample s were drawn every 25 % of the trial to measure blood glucose and blood lactate concentrations , whereas whole-body CHO oxidation was monitored continuously . Time to completion was not significant between conditions with the placebo , 4 , 6 , and 8 % conditions completing the trials in 62.0 ± 3.0 , 62.8 ± 4.0 , 63.4 ± 3.4 , and 63 ± 4.0 minutes , respectively . There were no significant differences between conditions in any of the variables mentioned above ; however , significant time effects were observed for HR , RPE , TH , and SF . Post hoc analysis showed that TH and SF of subjects in the CHO conditions but not in the placebo were significantly increased by completion of the time trial . In conclusion , mouth rinsing with CHO solutions did not impact 1-hour cycling performance in the postpr and ial period and in the absence of fluid intake . Our findings suggest that there is scope for further research to explore the activation regions of the brain and whether they are receptive to CHO dose , before specific recommendations for athletic population s are established . Consequently , mouth rinsing as a practical strategy for coaches and athletes is question able under specific conditions and should be carefully considered before its inclusion . Emphasis should be focused on appropriate dietary and fluid strategies during training and competition PURPOSE To investigate the influence of ingesting versus mouth rinsing a carbohydrate-electrolyte solution on 1-h running performance . METHODS After a 14- to 15-h fast , 10 endurance-trained male runners ( mean ± SD : VO2peak = 65.0 ± 4.4 mL·kg(-1)·min(-1 ) ) completed 
    Output:
    
Conclusion The present systematic and meta-analytic review supports the notion that a carbohydrate mouth rinse has the potential to increase mean power output in cycling trials , despite showing no superiority over placebo in improving time to complete the trials