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K
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w
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s
:
Ath
letes
Diet
p
lan
Nu
tr
itio
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Swim
m
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W
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C
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m
in
g
ca
n
g
u
i
d
e
tailo
r
ed
weig
h
t m
an
ag
em
e
n
t p
r
o
g
r
am
s
.
Fo
r
ex
am
p
le,
T
an
ak
a
[
1
1
]
h
i
g
h
lig
h
t
th
e
u
tili
ty
o
f
s
wim
m
in
g
in
m
o
n
ito
r
in
g
ch
an
g
es
in
b
o
d
y
weig
h
t
a
n
d
im
p
r
o
v
i
n
g
h
ea
lth
o
u
tco
m
es.
T
h
ey
s
u
g
g
est
th
at
s
wim
m
in
g
,
alo
n
g
with
o
th
er
p
h
y
s
ical
ac
tiv
ities
,
s
h
o
u
ld
b
e
p
a
r
t
o
f
a
b
r
o
ad
e
r
s
tr
ateg
y
to
ef
f
ec
tiv
ely
g
u
id
e
weig
h
t
lo
s
s
ef
f
o
r
ts
an
d
m
ain
tain
h
ea
l
th
im
p
r
o
v
em
en
ts
o
v
e
r
tim
e.
Ad
d
itio
n
ally
,
L
ah
ar
t
an
d
Me
ts
io
s
[
1
2
]
f
o
u
n
d
th
at
s
wim
tr
ain
in
g
in
ter
v
e
n
tio
n
s
s
ig
n
if
ican
tly
im
p
r
o
v
e
b
o
d
y
m
ass
an
d
o
v
er
all
f
itn
ess
in
n
o
n
-
elite
s
wim
m
er
s
.
Fu
r
th
er
m
o
r
e
,
Sh
aw
et
a
l.
[
1
3
]
s
u
g
g
est
th
at
s
wim
m
in
g
,
co
m
b
in
ed
with
ap
p
r
o
p
r
iate
n
u
tr
itio
n
,
ca
n
o
p
tim
ize
b
o
d
y
co
m
p
o
s
itio
n
an
d
en
s
u
r
e
s
u
f
f
ic
ien
t e
n
er
g
y
av
ailab
ilit
y
.
Var
iatio
n
s
in
p
h
y
s
ical
ac
tiv
ity
p
r
ef
er
en
ce
s
ac
r
o
s
s
d
if
f
er
en
t
p
o
p
u
latio
n
s
,
as
d
is
cu
s
s
ed
b
y
B
a
illo
t
et
a
l.
[
1
4
]
,
em
p
h
asize
th
e
n
ee
d
f
o
r
p
er
s
o
n
alize
d
ap
p
r
o
ac
h
es
in
weig
h
t
m
an
ag
em
e
n
t
p
r
o
g
r
am
s
.
T
h
ese
s
tu
d
ies
in
d
icate
th
at
s
tan
d
ar
d
ized
ex
e
r
cise
r
ec
o
m
m
en
d
atio
n
s
m
ay
n
o
t
alwa
y
s
b
e
u
n
iv
er
s
ally
ap
p
licab
le,
es
p
ec
ially
in
s
p
ec
if
ic
co
n
tex
ts
lik
e
p
r
eg
n
an
cy
o
r
d
if
f
er
en
t a
g
e
g
r
o
u
p
s
.
M
o
r
e
o
v
e
r
,
G
r
i
g
o
r
e
v
a
e
t
a
l
.
[
1
5
]
e
m
p
h
a
s
i
z
e
th
e
e
f
f
e
c
t
i
v
e
n
es
s
o
f
s
w
i
m
m
i
n
g
f
o
r
w
e
i
g
h
t
l
o
s
s
a
n
d
m
a
i
n
t
e
n
a
n
c
e
,
p
a
r
t
i
c
u
la
r
l
y
f
o
r
th
e
e
l
d
e
r
l
y
,
p
r
e
g
n
a
n
t
w
o
m
e
n
,
an
d
i
n
d
i
v
i
d
u
a
l
s
w
it
h
a
r
t
h
r
i
t
is
,
d
i
a
b
et
es
,
d
is
a
b
i
li
t
y
,
o
r
o
b
e
s
it
y
.
A
d
d
i
ti
o
n
a
l
l
y
,
Z
u
b
k
o
et
a
l
.
[
1
6
]
d
e
m
o
n
s
t
r
a
t
e
t
h
e
b
e
n
e
f
i
t
s
o
f
s
w
i
m
m
i
n
g
i
n
i
m
p
r
o
v
i
n
g
c
a
r
d
i
o
v
a
s
c
u
l
a
r
h
e
a
l
th
a
n
d
a
i
d
i
n
g
w
ei
g
h
t
l
o
s
s
,
s
h
o
wi
n
g
s
i
g
n
i
f
ic
a
n
t
i
m
p
r
o
v
e
m
e
n
t
s
in
b
o
d
y
m
a
s
s
i
n
d
e
x
(
B
M
I
)
a
n
d
b
o
d
y
c
o
m
p
o
s
i
t
i
o
n
a
m
o
n
g
p
a
r
t
i
c
i
p
a
n
t
s
.
R
es
e
a
r
c
h
in
d
i
c
a
t
e
s
t
h
at
g
e
n
e
t
i
c
f
a
c
t
o
r
s
,
wh
e
n
c
o
m
b
i
n
e
d
w
i
t
h
e
n
v
i
r
o
n
m
e
n
t
s
t
h
a
t
p
r
o
m
o
t
e
o
v
e
r
e
a
t
i
n
g
a
n
d
p
h
y
s
i
c
a
l
i
n
a
c
t
i
v
i
ty
,
s
i
g
n
i
f
i
c
a
n
tl
y
i
n
c
r
e
as
e
t
h
e
r
is
k
o
f
o
b
e
s
i
t
y
[
1
7
]
.
A
d
d
i
t
i
o
n
a
l
l
y
,
d
i
e
ts
h
i
g
h
i
n
c
a
l
o
r
i
e
s
,
e
s
p
e
ci
a
ll
y
t
h
o
s
e
c
o
n
t
ai
n
i
n
g
s
a
t
u
r
at
e
d
a
n
d
t
r
a
n
s
f
a
ts
a
n
d
s
u
g
a
r
s
,
c
o
u
p
l
e
d
w
i
t
h
a
s
e
d
e
n
t
a
r
y
l
i
f
es
t
y
l
e
,
a
r
e
w
el
l
-
r
e
c
o
g
n
i
z
e
d
c
o
n
t
r
i
b
u
t
o
r
s
t
o
w
e
i
g
h
t
g
a
i
n
[
1
8
]
.
S
t
u
d
i
e
s
h
a
v
e
i
d
e
n
t
i
f
i
e
d
y
o
u
n
g
e
r
a
g
e
,
m
a
r
i
t
a
l
s
t
at
u
s
,
o
cc
u
p
a
t
i
o
n
,
i
n
c
o
m
e
l
e
v
e
l
,
a
l
c
o
h
o
l
c
o
n
s
u
m
p
ti
o
n
i
n
m
e
n
,
a
n
d
s
m
o
k
i
n
g
a
n
d
s
k
i
p
p
in
g
b
r
e
a
k
f
a
s
t
i
n
b
o
t
h
s
e
x
e
s
a
s
s
i
g
n
i
f
i
c
a
n
t
p
r
e
d
i
c
t
o
r
s
o
f
w
e
i
g
h
t
g
ai
n
[
1
9
]
.
R
ec
e
n
t
r
es
e
ar
c
h
e
m
p
h
a
s
i
z
es
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
p
h
y
s
i
c
a
l
a
c
t
i
v
it
y
a
n
d
d
i
e
t
a
r
y
m
o
d
i
f
i
c
a
ti
o
n
s
i
n
t
h
e
p
r
e
v
e
n
t
i
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
o
b
e
s
i
t
y
.
E
x
e
r
c
is
e
p
l
a
y
s
a
c
r
u
c
ial
r
o
l
e
i
n
p
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n
t
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g
o
b
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i
t
y
,
f
a
ci
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it
a
t
i
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g
we
i
g
h
t
l
o
s
s
,
a
n
d
h
e
l
p
i
n
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m
a
i
n
t
a
i
n
w
e
i
g
h
t
lo
s
s
.
I
n
c
r
e
as
i
n
g
p
h
y
s
ic
a
l
a
ct
i
v
ity
,
p
a
r
t
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c
u
l
a
r
l
y
w
h
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n
c
o
m
b
i
n
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d
w
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a
l
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-
f
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d
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,
h
a
s
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n
s
h
o
w
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b
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m
o
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f
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p
p
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c
h
f
o
r
w
e
i
g
h
t
m
a
n
a
g
e
m
e
n
t
[
2
0
]
.
R
e
g
u
l
a
r
p
h
y
s
i
ca
l
a
c
ti
v
i
t
y
n
o
t
o
n
l
y
a
i
d
s
i
n
b
u
r
n
i
n
g
c
a
l
o
r
i
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s
b
u
t
a
l
s
o
h
e
l
p
s
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n
i
m
p
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v
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m
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t
a
b
o
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c
h
e
a
lt
h
a
n
d
m
a
i
n
t
a
i
n
i
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g
m
u
s
c
l
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m
as
s
d
u
r
i
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g
w
e
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g
h
t
l
o
s
s
.
I
n
t
e
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v
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n
t
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o
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b
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d
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.
D
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t
a
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m
a
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o
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t
m
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t
.
M
a
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a
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a
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ct
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d
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s
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t
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a
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d
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e
l
a
t
e
d
d
i
s
ea
s
es
[
2
1
]
.
W
e
i
g
h
t
m
a
n
a
g
e
m
e
n
t
s
t
r
a
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s
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d
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d
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h
a
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a
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t
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d
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s
.
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m
p
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e
m
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ti
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d
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et
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c
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d
t
o
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p
t
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m
a
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o
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t
c
o
m
e
s
[
2
0
]
.
E
v
i
d
e
n
c
e
-
b
as
e
d
a
p
p
r
o
a
c
h
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s
,
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n
c
l
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d
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b
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n
d
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lar
m
o
n
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c
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a
c
t
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v
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t
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,
a
r
e
c
r
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l
f
o
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f
e
ct
i
v
e
w
e
i
g
h
t
m
a
n
a
g
em
e
n
t
[
2
2
]
.
T
h
e
p
u
r
p
o
s
e
o
f
t
h
i
s
r
e
s
e
a
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p
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o
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n
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f
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ct
s
o
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s
to
m
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d
d
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a
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t
r
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n
d
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l
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t
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it
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ch
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m
m
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s
.
B
y
i
n
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e
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e
l
y
.
2.
M
E
T
H
O
D
I
n
th
is
s
tu
d
y
,
we
aim
ed
to
ex
p
lo
r
e
th
e
s
y
n
er
g
is
tic
ef
f
ec
ts
o
f
d
iet
m
o
d
if
icatio
n
s
an
d
ae
r
o
b
ic
ex
er
cise,
s
p
ec
if
ically
s
wim
m
in
g
,
o
n
b
o
d
y
co
m
p
o
s
itio
n
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u
s
cle
f
u
n
ct
io
n
,
an
d
o
v
er
all
h
ea
lth
in
ath
letes.
W
e
ca
r
ef
u
lly
s
elec
ted
p
ar
ticip
an
ts
to
r
ep
r
esen
t
a
d
iv
er
s
e
g
r
o
u
p
o
f
ath
letes
an
d
em
p
lo
y
e
d
r
ig
o
r
o
u
s
m
eth
o
d
o
lo
g
ies
to
en
s
u
r
e
th
e
v
alid
ity
o
f
o
u
r
f
in
d
in
g
s
.
Deta
iled
d
o
cu
m
en
tatio
n
o
f
o
u
r
r
esear
ch
d
esig
n
an
d
p
r
o
ce
d
u
r
es
s
u
p
p
o
r
ts
th
e
r
ep
r
o
d
u
cib
ilit
y
o
f
th
e
s
tu
d
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
5
0
-
1
45
8
1454
2
.
1
.
Study
des
ig
n a
nd
pa
rt
ici
pa
nts
W
e
co
n
d
u
cted
a
lo
n
g
itu
d
in
al,
co
n
tr
o
lled
s
tu
d
y
i
n
v
o
lv
i
n
g
tw
o
g
r
o
u
p
s
o
f
ath
letes:
o
n
e
g
r
o
u
p
f
o
llo
wed
a
s
tan
d
ar
d
d
iet
f
o
r
weig
h
t
m
ain
ten
an
ce
,
an
d
th
e
o
th
er
ad
h
er
ed
to
a
s
im
ilar
d
iet
a
u
g
m
en
te
d
b
y
r
eg
u
lar
s
wim
m
in
g
s
ess
io
n
s
aim
ed
at
weig
h
t
l
o
s
s
.
T
h
e
in
itia
l
ca
s
e
s
tu
d
y
c
o
m
p
r
is
e
d
3
7
p
a
r
ticip
an
ts
,
s
eg
m
en
te
d
i
n
to
2
0
in
th
e
weig
h
t
m
ain
ten
an
ce
g
r
o
u
p
an
d
1
7
in
t
h
e
weig
h
t
lo
s
s
g
r
o
u
p
.
T
h
e
i
n
clu
s
io
n
cr
iter
ia
wer
e
ath
letes
ag
ed
1
8
-
4
4
,
e
n
g
ag
e
d
in
r
eg
u
lar
tr
ain
in
g
,
an
d
willin
g
to
ad
h
er
e
to
th
e
d
ietar
y
an
d
e
x
er
cise p
r
o
to
co
ls
.
E
x
clu
s
io
n
c
r
iter
ia
in
clu
d
ed
an
y
m
ed
ical
co
n
d
itio
n
s
th
at
co
n
tr
a
in
d
icate
s
wim
m
in
g
o
r
r
eq
u
ir
e
s
p
ec
ial
d
iets
.
2
.
2
.
Sa
m
ple size
det
er
m
ina
t
i
o
n
A
m
in
im
u
m
s
am
p
le
s
ize
o
f
1
0
0
p
ar
ticip
a
n
ts
is
ty
p
ically
r
ec
o
m
m
en
d
e
d
f
o
r
q
u
a
n
titativ
e
m
eth
o
d
s
to
en
s
u
r
e
s
tatis
tic
al
p
o
wer
a
n
d
p
r
ec
is
io
n
,
ac
co
r
d
in
g
to
s
tan
d
ar
d
g
u
id
elin
es
f
o
r
clin
ical
an
d
b
eh
av
io
r
al
r
esear
ch
.
Ho
wev
er
,
o
u
r
s
tu
d
y
f
ac
e
d
p
r
ac
tical
co
n
s
tr
ain
ts
an
d
u
tili
ze
d
a
s
m
aller
s
am
p
le
s
ize
o
f
3
7
p
ar
ticip
an
ts
.
T
o
ad
d
r
ess
th
is
,
we
co
n
d
u
cted
a
th
o
r
o
u
g
h
an
d
d
etailed
an
aly
s
is
o
f
th
e
co
llected
d
ata,
en
s
u
r
in
g
t
h
e
r
elia
b
ilit
y
an
d
ac
cu
r
ac
y
o
f
o
u
r
f
in
d
in
g
s
.
2
.
3
.
Sa
m
ple size
lim
it
a
t
io
n
On
e
s
ig
n
if
ican
t
lim
itatio
n
o
f
t
h
is
s
tu
d
y
is
th
e
s
m
all
s
am
p
le
s
ize
o
f
3
7
p
ar
ticip
an
ts
,
wh
ic
h
f
alls
s
h
o
r
t
o
f
th
e
g
en
er
ally
r
ec
o
m
m
e
n
d
ed
m
in
im
u
m
o
f
1
0
0
p
ar
ticip
an
ts
f
o
r
q
u
an
titativ
e
r
esear
c
h
to
en
s
u
r
e
s
tatis
tical
p
o
wer
an
d
th
e
g
en
er
aliza
b
ilit
y
o
f
f
in
d
in
g
s
[
2
3
]
.
T
h
is
lim
ited
s
am
p
le
s
ize
m
ay
af
f
ec
t
t
h
e
ab
ilit
y
to
d
etec
t
s
m
all
b
u
t
p
o
ten
tially
m
ea
n
in
g
f
u
l
d
if
f
e
r
en
ce
s
b
etwe
en
g
r
o
u
p
s
an
d
c
o
u
ld
r
ed
u
ce
th
e
r
o
b
u
s
tn
ess
o
f
th
e
r
esu
lts
.
W
h
il
e
p
r
ac
tical
co
n
s
tr
ain
ts
n
ec
ess
ita
ted
th
e
s
m
aller
s
am
p
le
s
ize,
d
etailed
d
ata
an
aly
s
is
was
p
e
r
f
o
r
m
e
d
to
en
s
u
r
e
r
eliab
ilit
y
.
I
t
is
im
p
o
r
tan
t
to
n
o
te
th
at
s
tu
d
ies
with
s
m
all
s
am
p
les
ar
e
m
o
r
e
v
u
ln
er
ab
le
to
b
ias
es,
s
u
ch
as
s
elec
tio
n
b
ias o
r
th
e
in
f
l
u
en
ce
o
f
o
u
tlier
s
,
an
d
h
av
e
r
ed
u
ce
d
ex
ter
n
al
v
alid
ity
.
2
.
4
.
G
ro
up
a
llo
ca
t
io
n
Par
ticip
an
ts
in
th
e
s
tu
d
y
wer
e
r
an
d
o
m
l
y
ass
ig
n
ed
to
o
n
e
o
f
t
wo
g
r
o
u
p
s
.
T
h
e
f
ir
s
t g
r
o
u
p
,
r
e
f
er
r
ed
to
as
th
e
W
eig
h
t
Ma
in
ten
a
n
ce
Gr
o
u
p
,
co
n
s
is
ted
o
f
2
0
in
d
iv
id
u
als
wh
o
f
o
llo
wed
a
s
tan
d
ar
d
d
iet.
T
h
is
g
r
o
u
p
s
er
v
ed
as a
co
n
tr
o
l to
e
v
alu
ate
th
e
e
f
f
ec
ts
o
f
th
e
in
ter
v
e
n
tio
n
in
t
h
e
s
ec
o
n
d
g
r
o
u
p
.
T
h
e
s
ec
o
n
d
g
r
o
u
p
,
k
n
o
wn
as
t
h
e
weig
h
t
l
o
s
s
g
r
o
u
p
,
i
n
clu
d
e
d
1
7
p
a
r
ticip
an
ts
wh
o
f
o
llo
we
d
a
s
im
ilar
d
iet
b
u
t
also
en
g
ag
e
d
in
r
e
g
u
la
r
s
wim
m
in
g
s
ess
io
n
s
.
T
h
e
in
co
r
p
o
r
atio
n
o
f
s
wim
m
in
g
aim
e
d
t
o
ass
ess
th
e
im
p
ac
t
o
f
p
h
y
s
ical
ac
tiv
ity
o
n
weig
h
t
lo
s
s
wh
en
co
m
b
in
ed
with
d
iet
ar
y
m
ea
s
u
r
es.
B
y
co
m
p
ar
in
g
t
h
e
o
u
tco
m
es
o
f
th
e
two
g
r
o
u
p
s
,
t
h
e
s
tu
d
y
s
o
u
g
h
t
to
d
eter
m
in
e
th
e
e
f
f
ec
tiv
en
e
s
s
o
f
co
m
b
in
in
g
ex
e
r
cise
with
d
iet
f
o
r
ac
h
iev
i
n
g
weig
h
t r
ed
u
ctio
n
.
2
.
5
.
Diet
a
ry
inte
rv
ent
io
ns
T
h
e
d
ietar
y
ch
a
n
g
es
wer
e
s
p
ec
if
ically
tailo
r
ed
to
m
ee
t
th
e
ath
letes
'
n
ee
d
s
,
em
p
h
asizin
g
p
o
r
ti
o
n
co
n
tr
o
l,
b
alan
ce
d
m
ac
r
o
n
u
tr
ien
t
in
tak
e
,
an
d
th
e
av
o
id
an
ce
o
f
h
ig
h
-
ca
l
o
r
ie,
lo
w
-
n
u
tr
ien
t
f
o
o
d
s
.
E
ac
h
ath
lete's
n
u
tr
itio
n
al
p
lan
in
clu
d
ed
a
s
p
ec
if
ic
d
aily
ca
lo
r
ie
in
tak
e
b
ased
o
n
th
eir
in
d
iv
id
u
al
en
er
g
y
ex
p
en
d
itu
r
e.
T
h
e
g
o
al
was
to
ac
h
iev
e
a
b
alan
ce
wh
e
r
e
en
er
g
y
in
tak
e
e
q
u
als
en
er
g
y
e
x
p
en
d
itu
r
e,
tak
in
g
in
to
ac
co
u
n
t
m
ac
r
o
n
u
tr
ien
t
d
is
tr
ib
u
tio
n
an
d
m
ea
l tim
in
g
.
A
ty
p
ical
m
ea
l
p
lan
b
eg
an
with
b
r
ea
k
f
ast,
wh
ich
co
n
s
is
ted
o
f
co
r
n
o
r
o
at
f
lak
es
with
s
k
im
m
ed
m
ilk
.
T
h
is
was
ac
co
m
p
an
ied
b
y
a
s
lice
o
f
wh
o
le
wh
ea
t
b
r
ea
d
,
a
b
o
iled
eg
g
,
l
o
w
-
s
alt
ch
ee
s
e,
an
d
o
liv
es,
p
r
o
v
id
in
g
a
m
ix
o
f
ca
r
b
o
h
y
d
r
ates,
p
r
o
tein
s
,
an
d
h
ea
lth
y
f
ats
to
s
tar
t
th
e
d
ay
.
T
h
e
f
ir
s
t
s
n
ac
k
o
f
th
e
d
ay
was
o
n
e
o
r
a
n
g
e,
o
f
f
er
in
g
a
n
atu
r
al
s
o
u
r
ce
o
f
v
it
am
in
s
an
d
s
u
g
ar
s
f
o
r
s
u
s
tain
ed
en
er
g
y
.
Fo
r
lu
n
ch
,
th
e
ath
letes
co
n
s
u
m
ed
1
5
0
g
r
am
s
o
f
lig
h
t
m
ea
t
s
u
ch
as
ch
ick
en
o
r
tu
r
k
ey
,
p
air
ed
with
v
ar
io
u
s
v
eg
etab
les
to
s
u
p
p
l
y
ess
en
tial
n
u
tr
ien
ts
an
d
f
ib
er
.
T
h
e
af
ter
n
o
o
n
s
n
ac
k
in
clu
d
e
d
1
0
0
g
r
am
s
o
f
s
k
im
m
ed
y
o
g
u
r
t,
co
n
tr
ib
u
tin
g
a
d
d
itio
n
a
l
p
r
o
tein
an
d
aid
in
g
d
ig
esti
o
n
.
Din
n
er
was
a
b
o
wl
o
f
g
r
ee
n
s
alad
with
to
m
at
o
es
an
d
cu
c
u
m
b
er
s
o
r
a
ca
b
b
ag
e
s
a
lad
,
wh
ich
p
r
o
v
i
d
ed
ess
en
tial
v
itam
in
s
an
d
p
r
o
m
o
ted
s
atiety
with
o
u
t
e
x
ce
s
s
iv
e
ca
lo
r
ies.
2
.
6
.
E
x
er
cise pro
t
o
c
o
l
T
h
e
weig
h
t
lo
s
s
g
r
o
u
p
e
n
g
ag
ed
in
ae
r
o
b
ic
s
wim
m
in
g
ex
e
r
cises
s
ix
d
ay
s
a
wee
k
as
p
ar
t
o
f
th
eir
r
eg
im
en
.
T
h
ese
ex
er
cises
wer
e
co
n
d
u
cte
d
in
a
co
v
er
ed
s
wi
m
m
in
g
p
o
o
l
th
at
m
ea
s
u
r
e
d
2
5
m
eter
s
in
len
g
th
an
d
h
ad
a
d
ep
th
o
f
1
.
5
m
eter
s
.
T
h
e
in
d
o
o
r
s
ettin
g
p
r
o
v
id
ed
a
co
n
tr
o
lled
en
v
ir
o
n
m
en
t,
en
s
u
r
in
g
th
at
wea
th
er
co
n
d
itio
n
s
d
id
n
o
t in
te
r
f
er
e
wi
th
th
eir
s
ch
ed
u
le
d
wo
r
k
o
u
ts
.
E
ac
h
ex
er
cise
s
ess
io
n
last
ed
f
o
r
3
0
m
i
n
u
tes
an
d
was
s
tr
u
ctu
r
ed
ar
o
u
n
d
s
p
ec
if
ic
s
wim
m
in
g
ac
tiv
ities
.
Par
ticip
an
ts
s
wam
2
5
m
eter
s
u
s
in
g
a
s
lo
w
cr
awl
s
ty
le,
r
ep
e
atin
g
th
is
d
is
tan
ce
f
o
u
r
tim
es
with
in
th
e
s
ess
io
n
.
B
etwe
en
ea
ch
2
5
-
m
eter
s
wim
,
th
ey
to
o
k
a
o
n
e
-
m
in
u
te
p
au
s
e
to
r
est
b
ef
o
r
e
c
o
m
m
en
ci
n
g
t
h
e
n
ex
t
r
e
p
etitio
n
,
allo
win
g
th
em
to
r
ec
o
v
e
r
an
d
m
ain
tain
p
r
o
p
er
tech
n
iq
u
e
t
h
r
o
u
g
h
o
u
t th
e
wo
r
k
o
u
t.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
E
xp
lo
r
in
g
th
e
r
o
le
o
f sw
immin
g
in
en
h
a
n
cin
g
d
iet
-
b
a
s
ed
w
eig
h
t lo
s
s
p
r
o
g
r
a
ms
…
(
C
h
erka
o
u
i S
id
i H
a
s
s
a
n
)
1455
2
.
7
.
Da
t
a
c
o
llect
io
n
B
aselin
e
d
ata,
en
co
m
p
ass
in
g
d
em
o
g
r
a
p
h
ic
an
d
p
h
y
s
ical
ch
ar
ac
ter
is
tics
s
u
ch
as
ag
e,
m
ar
ital
s
tatu
s
,
ed
u
ca
tio
n
lev
el,
weig
h
t,
h
ei
g
h
t,
B
MI
,
an
d
p
h
y
s
ical
ac
tiv
ity
lev
els,
wer
e
co
llected
p
r
io
r
to
th
e
in
ter
v
en
tio
n
.
T
h
ese
in
itial
m
ea
s
u
r
em
en
ts
p
r
o
v
id
ed
a
co
m
p
r
e
h
en
s
iv
e
o
v
er
v
iew
o
f
p
ar
ticip
an
ts
'
h
ea
lth
s
tatu
s
.
Fo
llo
w
-
u
p
d
ata
wer
e
th
en
g
ath
e
r
ed
at
th
e
co
n
c
lu
s
io
n
o
f
th
e
f
o
u
r
-
wee
k
in
te
r
v
en
tio
n
to
ass
ess
an
y
ch
an
g
es.
2
.
8
.
St
a
t
is
t
ica
l a
na
ly
s
is
Data
wer
e
an
aly
ze
d
u
s
in
g
d
escr
ip
tiv
e
s
tatis
tic
s
to
s
u
m
m
ar
ize
th
e
p
r
e
-
an
d
p
o
s
t
-
in
ter
v
en
tio
n
m
ea
s
u
r
es.
Pair
ed
t
-
test
s
wer
e
u
s
ed
to
co
m
p
ar
e
c
h
an
g
es
with
in
an
d
b
e
twee
n
g
r
o
u
p
s
.
Statis
tical
s
ig
n
if
ican
ce
was
s
et
at
p
<0
.
0
5
to
en
s
u
r
e
th
e
r
esu
lts
wer
e
m
ea
n
in
g
f
u
l.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
De
m
o
g
r
a
ph
ic
a
nd
ph
y
s
i
ca
l c
ha
ra
ct
er
is
t
ics
T
h
e
b
aselin
e
ch
ar
ac
ter
is
tics
o
f
th
e
two
g
r
o
u
p
s
o
f
ath
lete
s
ar
e
d
etailed
in
T
ab
le
1
.
T
h
e
weig
h
t
m
ain
ten
an
ce
g
r
o
u
p
(
n
=
2
0
)
h
a
d
a
m
ea
n
ag
e
o
f
3
5
.
0
y
ea
r
s
(
SD
=
7
.
0
)
an
d
a
m
ea
n
weig
h
t
o
f
7
0
.
0
k
g
(
SD
=
8
.
6
)
.
T
h
e
weig
h
t
lo
s
s
g
r
o
u
p
(
n
=
1
7
)
h
a
d
a
m
ea
n
ag
e
o
f
3
4
.
4
y
ea
r
s
(
SD
=
5
.
9
)
a
n
d
a
m
ea
n
weig
h
t
o
f
8
0
.
8
k
g
(
SD
=
1
0
.
2
)
.
T
h
e
m
ea
n
B
MI
was
2
2
.
7
k
g
/m
²
(
SD
=
2
.
5
)
f
o
r
th
e
weig
h
t
m
ain
ten
a
n
ce
g
r
o
u
p
an
d
2
6
.
0
k
g
/m
²
(
SD =
2
.
2
)
f
o
r
th
e
weig
h
t lo
s
s
g
r
o
u
p
.
T
h
e
r
esu
lts
p
r
esen
ted
in
T
ab
l
e
1
ar
e
u
s
ed
to
co
m
p
ar
e
th
e
ch
ar
ac
ter
is
tics
o
f
in
d
iv
id
u
als
aim
in
g
f
o
r
weig
h
t
m
ain
ten
an
ce
v
er
s
u
s
th
o
s
e
tar
g
etin
g
weig
h
t
lo
s
s
.
I
t
h
ig
h
lig
h
ts
d
if
f
e
r
en
ce
s
in
d
em
o
g
r
ap
h
ics,
e
d
u
ca
tio
n
le
v
el,
B
MI
,
an
d
t
y
p
es
o
f
s
p
o
r
t
s
p
ar
ticip
ated
in
b
y
ea
ch
g
r
o
u
p
.
T
h
e
a
n
aly
s
is
p
r
o
v
i
d
es
in
s
ig
h
ts
in
to
h
o
w
th
ese
v
ar
iab
les m
ay
in
f
l
u
en
ce
o
r
r
el
ate
to
th
eir
weig
h
t g
o
als.
3
.
2
.
Weig
ht
a
nd
B
M
I
cha
ng
es
T
h
e
r
esu
lts
in
T
ab
le
2
o
v
er
th
e
f
o
u
r
-
wee
k
p
er
io
d
s
h
o
wed
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
b
etwe
e
n
th
e
two
g
r
o
u
p
s
.
T
h
e
weig
h
t
lo
s
s
g
r
o
u
p
,
wh
ich
co
m
b
in
ed
d
iet
with
s
wim
m
in
g
,
ex
h
i
b
ited
a
g
r
ea
te
r
r
ed
u
ctio
n
i
n
b
o
th
m
ea
n
weig
h
t
an
d
B
MI
co
m
p
ar
ed
to
t
h
e
d
iet
-
o
n
ly
g
r
o
u
p
.
Sp
ec
if
ically
,
p
ar
ticip
an
ts
in
th
e
c
o
m
b
in
ed
i
n
ter
v
en
tio
n
g
r
o
u
p
lo
s
t
an
av
er
ag
e
o
f
3
.
8
k
g
,
wh
ile
th
e
d
iet
-
o
n
ly
g
r
o
u
p
l
o
s
t
2
.
1
k
g
.
A
s
im
ilar
tr
en
d
was
o
b
s
er
v
ed
in
B
MI
r
ed
u
ctio
n
,
with
th
e
c
o
m
b
in
e
d
g
r
o
u
p
s
h
o
win
g
a
d
ec
r
ea
s
e
o
f
1
.
4
u
n
its
v
er
s
u
s
0
.
8
in
t
h
e
co
n
tr
o
l
g
r
o
u
p
.
T
h
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
in
co
r
p
o
r
atin
g
p
h
y
s
ical
ac
tiv
i
ty
,
s
u
ch
as
s
wim
m
in
g
,
ca
n
en
h
an
ce
t
h
e
ef
f
ec
tiv
en
ess
o
f
d
ietar
y
in
ter
v
en
tio
n
s
.
Mo
r
eo
v
er
,
th
e
d
if
f
er
e
n
ce
s
b
etwe
en
g
r
o
u
p
s
wer
e
s
tatis
tical
ly
s
ig
n
if
ican
t,
in
d
icatin
g
th
at
th
e
o
b
s
er
v
ed
im
p
r
o
v
e
m
en
ts
wer
e
u
n
lik
ely
d
u
e
to
ch
an
ce
.
T
h
e
d
iet
-
p
lu
s
-
s
wim
m
in
g
g
r
o
u
p
s
h
o
we
d
a
m
ea
n
weig
h
t
r
ed
u
ctio
n
o
f
5
k
g
an
d
a
B
MI
r
ed
u
ctio
n
o
f
1
.
5
9
k
g
/m
²,
wh
ile
th
e
d
iet
-
o
n
ly
g
r
o
u
p
s
h
o
wed
m
in
im
al
ch
an
g
es.
T
h
e
d
iet
-
p
lu
s
-
s
wim
m
in
g
g
r
o
u
p
also
d
em
o
n
s
tr
ated
a
h
ig
h
er
p
e
r
ce
n
tag
e
o
f
a
ctiv
e
m
ass
(
2
6
.
9
%)
co
m
p
ar
ed
to
th
e
d
iet
-
o
n
ly
g
r
o
u
p
(
2
4
.
3
%).
T
ab
l
e
1
.
C
h
ar
ac
ter
is
tics
o
f
ath
letes
C
h
a
r
a
c
t
e
r
i
s
t
i
c
G
r
o
u
p
s
b
y
w
e
i
g
h
t
g
o
a
l
s
W
e
i
g
h
t
m
a
i
n
t
e
n
a
n
c
e
(
N
=
2
0
)
W
e
i
g
h
t
l
o
ss
(
N
=
1
7
)
A
g
e
(
y
e
a
r
s)
M
e
a
n
(
S
D
)
3
5
.
0
(
7
.
0
)
3
4
.
4
(
5
.
9
)
R
a
n
g
e
1
8
.
0
-
4
3
.
0
2
2
.
0
-
4
4
.
0
M
a
r
i
t
a
l
s
t
a
t
u
s
S
i
n
g
l
e
8
.
0
(
4
0
.
0
%)
6
.
0
(
3
5
.
3
%)
M
a
r
r
i
e
d
1
2
.
0
(
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T
ab
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2
.
W
eig
h
t a
n
d
B
MI
ch
a
n
g
es
G
r
o
u
p
I
n
i
t
i
a
l
m
e
a
n
w
e
i
g
h
t
(
k
g
)
F
i
n
a
l
m
e
a
n
w
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t
(
k
g
)
I
n
i
t
i
a
l
m
e
a
n
B
M
I
(
k
g
/
m²
)
F
i
n
a
l
m
e
a
n
B
M
I
(
k
g
/
m²
)
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e
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g
h
t
m
a
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n
t
e
n
a
n
c
e
6
6
.
5
(
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D
=
4
.
8
3
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6
6
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4
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2
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ss
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3
3
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=
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1
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2
4
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6
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2
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.
1
0
Evaluation Warning : The document was created with Spire.PDF for Python.
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I
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Hea
lth
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l.
14
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No
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Sep
tem
b
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20
25
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45
8
1456
3
.
3
.
I
nte
rpre
t
a
t
io
n
o
f
f
ind
ing
s
T
h
e
s
ig
n
if
ican
t
weig
h
t
an
d
B
MI
r
ed
u
ctio
n
s
in
th
e
d
iet
-
p
lu
s
-
s
wim
m
in
g
g
r
o
u
p
s
u
g
g
est
th
at
in
co
r
p
o
r
atin
g
s
wim
m
in
g
in
to
a
d
ietar
y
in
ter
v
en
tio
n
e
n
h
an
c
es
weig
h
t
lo
s
s
ef
f
ec
tiv
en
ess
.
T
h
is
f
in
d
in
g
alig
n
s
with
p
r
ev
io
u
s
s
tu
d
ies
th
at
em
p
h
asize
th
e
b
en
ef
its
o
f
ae
r
o
b
ic
ex
er
cise,
s
u
ch
as
s
wim
m
in
g
,
in
weig
h
t
m
an
ag
em
en
t
p
r
o
g
r
am
s
.
Swim
m
in
g
,
as
a
f
u
ll
-
b
o
d
y
wo
r
k
o
u
t,
lik
ely
p
r
o
v
id
es
ad
d
itio
n
al
m
etab
o
lic
an
d
ca
r
d
io
v
ascu
lar
b
en
e
f
its
,
am
p
l
if
y
in
g
t
h
e
ef
f
ec
ts
o
f
d
iet
alo
n
e.
T
h
e
in
cr
ea
s
ed
ac
tiv
e
m
ass
p
er
ce
n
tag
e
in
t
h
e
s
wim
m
in
g
g
r
o
u
p
in
d
icate
s
n
o
t
o
n
ly
weig
h
t
lo
s
s
b
u
t
also
m
u
s
cle
m
as
s
p
r
eser
v
atio
n
o
r
g
ain
,
wh
ich
is
cr
u
cial
f
o
r
o
v
er
all
p
h
y
s
ical
f
itn
ess
an
d
m
etab
o
lic
h
ea
lth
.
3
.
4
.
Co
m
pa
riso
n
wit
h o
t
her
s
t
ud
ies
Ou
r
f
in
d
in
g
s
a
r
e
c
o
n
s
is
ten
t
with
th
e
ex
is
tin
g
b
o
d
y
o
f
r
e
s
ea
r
ch
th
at
e
m
p
h
asizes
th
e
m
u
ltifa
ce
ted
b
en
ef
its
o
f
in
teg
r
atin
g
e
x
er
c
is
e
with
d
ietar
y
in
ter
v
en
tio
n
s
f
o
r
weig
h
t
m
an
ag
em
en
t
a
n
d
o
v
er
all
h
ea
lth
.
Z
h
an
g
et
a
l.
[2
4
]
d
em
o
n
s
tr
at
ed
th
at
m
o
d
e
r
ate
-
in
ten
s
ity
ae
r
o
b
ic
ex
er
cise
co
m
b
in
ed
with
r
esis
tan
ce
tr
ain
in
g
s
ig
n
if
ican
tly
im
p
r
o
v
es
g
ly
ce
m
ic
co
n
tr
o
l
an
d
ca
r
d
io
v
ascu
la
r
h
ea
lth
in
p
r
ed
iab
etic
in
d
iv
i
d
u
als,
s
u
p
p
o
r
tin
g
th
e
em
p
ir
ical
b
en
ef
its
o
f
d
iv
e
r
s
e
ex
er
cise
m
o
d
alities
.
Kh
alaf
i
et
a
l.
[2
5
]
f
o
u
n
d
th
at
e
x
er
c
is
e
co
m
b
in
e
d
with
in
ter
m
itten
t
f
asti
n
g
y
ield
s
s
u
p
er
io
r
b
o
d
y
co
m
p
o
s
itio
n
ch
a
n
g
es,
u
n
d
er
s
co
r
in
g
t
h
e
p
r
ac
tical
v
alu
e
o
f
in
teg
r
atin
g
m
u
ltip
le
h
ea
lth
s
tr
ateg
ies.
Hu
an
g
et
a
l.
[2
6
]
id
en
tifie
d
h
i
g
h
-
in
ten
s
ity
co
m
b
in
e
d
e
x
er
cise
a
s
th
e
m
o
s
t
ef
f
ec
tiv
e
f
o
r
im
p
r
o
v
i
n
g
B
MI
a
n
d
r
e
d
u
c
in
g
f
at
m
ass
in
y
o
u
t
h
,
h
i
g
h
lig
h
tin
g
th
e
m
eth
o
d
o
lo
g
ical
im
p
o
r
tan
ce
o
f
ex
e
r
cise
in
ten
s
ity
an
d
ty
p
e
.
B
allen
g
er
e
t a
l.
[2
7
]
s
h
o
we
d
s
ig
n
if
ica
n
t p
h
y
s
ical
f
itn
ess
im
p
r
o
v
em
en
ts
i
n
ad
u
lts
with
d
o
wn
s
y
n
d
r
o
m
e
th
r
o
u
g
h
tailo
r
ed
ex
e
r
cise
p
r
o
g
r
am
s
,
in
d
icatin
g
th
e
b
r
o
ad
ap
p
licab
ilit
y
o
f
s
tr
u
ctu
r
e
d
p
h
y
s
ical
ac
tiv
ity
.
T
h
eo
d
o
u
lo
u
et
a
l.
[2
8
]
co
n
f
ir
m
ed
th
at
b
eh
a
v
io
r
al
weig
h
t
m
an
ag
em
en
t
p
r
o
g
r
am
s
e
n
h
an
ce
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
,
wh
ich
alig
n
s
with
o
u
r
f
in
d
in
g
s
o
n
th
e
m
en
tal
h
e
alth
b
en
e
f
its
o
f
in
teg
r
ated
h
ea
lth
in
ter
v
e
n
tio
n
s
.
P
en
g
et
a
l.
[
29
]
d
em
o
n
s
tr
ated
th
e
ef
f
ec
tiv
e
n
ess
o
f
p
e
d
o
m
eter
-
b
ased
in
ter
v
e
n
tio
n
s
in
i
n
cr
ea
s
in
g
p
h
y
s
ical
ac
tiv
ity
an
d
weig
h
t
lo
s
s
am
o
n
g
co
lle
g
e
s
tu
d
en
ts
,
f
u
r
th
er
v
alid
atin
g
th
e
m
eth
o
d
o
l
o
g
ical
u
s
e
o
f
m
o
n
ito
r
in
g
to
o
ls
.
L
ig
ib
el
et
a
l
.
[3
0
]
p
r
o
v
id
e
d
g
u
i
d
elin
es
f
o
r
ex
er
cise
d
u
r
in
g
ca
n
ce
r
tr
ea
tm
en
t,
r
ein
f
o
r
cin
g
th
e
t
h
er
ap
eu
tic
p
o
ten
tial
o
f
p
h
y
s
ical
ac
tiv
ity
.
C
h
en
et
a
l
.
[
3
1
]
f
o
u
n
d
s
ig
n
if
ican
t
im
p
r
o
v
em
en
ts
in
B
MI
an
d
ca
r
d
i
o
v
as
cu
lar
r
is
k
f
ac
to
r
s
in
ch
ild
r
en
th
r
o
u
g
h
ae
r
o
b
ic
an
d
r
esis
tan
ce
ex
er
cises
,
alig
n
in
g
with
o
u
r
s
tu
d
y
'
s
em
p
h
asis
o
n
co
m
p
r
eh
en
s
iv
e
h
ea
lth
b
en
ef
its
.
B
ellich
a
et
a
l.
[3
2
]
h
i
g
h
lig
h
ted
t
h
e
f
a
v
o
r
ab
le
ef
f
ec
ts
o
f
ex
e
r
cise
o
n
weig
h
t
lo
s
s
an
d
b
o
d
y
co
m
p
o
s
itio
n
in
ad
u
lts
with
o
b
esit
y
,
wh
ich
p
ar
allels o
u
r
f
in
d
in
g
s
o
n
th
e
b
en
ef
its
o
f
co
m
b
in
in
g
d
iet
with
s
wim
m
in
g
.
Fin
ally
,
B
ek
h
et
et
a
l.
[3
3
]
d
em
o
n
s
tr
ate
d
th
e
m
en
tal
h
ea
lth
b
en
e
f
its
o
f
ae
r
o
b
ic
ex
er
cise
in
ca
n
ce
r
s
u
r
v
iv
o
r
s
,
s
u
p
p
o
r
tin
g
o
u
r
o
b
s
er
v
at
io
n
s
o
n
th
e
h
o
lis
tic
b
en
ef
its
o
f
in
te
g
r
ated
h
ea
lth
in
ter
v
en
tio
n
s
.
3
.
5
.
Study
lim
it
a
t
io
n
T
h
e
p
r
im
a
r
y
lim
itatio
n
o
f
t
h
is
s
tu
d
y
is
th
e
s
m
aller
s
am
p
l
e
s
ize
(
n
=
3
7
)
,
wh
ich
m
ay
af
f
ec
t
th
e
g
en
er
aliza
b
ilit
y
o
f
th
e
f
in
d
in
g
s
.
W
h
ile
th
e
d
etailed
an
aly
s
is
en
s
u
r
ed
t
h
e
r
eliab
ilit
y
o
f
t
h
e
r
esu
lts
,
f
u
tu
r
e
s
tu
d
ies
with
lar
g
er
s
am
p
le
s
izes
ar
e
n
ee
d
ed
to
co
n
f
ir
m
t
h
ese
f
in
d
in
g
s
.
Ad
d
itio
n
ally
,
th
e
s
tu
d
y
d
u
r
atio
n
was
r
elativ
ely
s
h
o
r
t
(
f
o
u
r
wee
k
s
)
,
an
d
l
o
n
g
er
-
ter
m
s
tu
d
ies
ar
e
n
ec
ess
ar
y
to
u
n
d
er
s
tan
d
th
e
s
u
s
tain
ed
ef
f
ec
ts
o
f
co
m
b
in
in
g
d
iet
with
s
wim
m
in
g
o
n
weig
h
t
m
an
ag
em
en
t.
O
u
r
s
tu
d
y
lim
itatio
n
is
d
u
e
o
f
th
e
co
n
s
tr
ain
ts
o
f
t
h
e
av
ailab
ilit
y
o
f
th
e
elite
ath
letes d
u
e
to
th
eir
s
ch
e
d
u
le
tim
e
.
4.
CO
NCLU
SI
O
N
Ou
r
s
tu
d
y
ex
p
l
o
r
ed
th
e
s
y
n
e
r
g
is
tic
ef
f
ec
ts
o
f
cu
s
to
m
ized
d
ietar
y
s
tr
ateg
ies
an
d
ae
r
o
b
ic
ex
er
cise,
s
p
ec
if
ically
s
wim
m
in
g
,
o
n
ac
h
iev
in
g
weig
h
t
lo
s
s
wh
ile
p
r
e
s
er
v
in
g
m
u
s
cle
m
ass
in
ath
let
es.
T
h
e
g
r
o
u
p
t
h
at
co
m
b
in
ed
d
iet
with
s
wim
m
in
g
s
h
o
wed
s
ig
n
if
ican
tly
g
r
ea
te
r
r
ed
u
ctio
n
s
in
weig
h
t
an
d
B
MI
co
m
p
ar
ed
to
t
h
e
d
iet
-
o
n
ly
g
r
o
u
p
,
h
ig
h
lig
h
tin
g
t
h
e
en
h
an
ce
d
ef
f
ec
tiv
en
ess
o
f
i
n
co
r
p
o
r
atin
g
s
wim
m
in
g
in
to
d
ietar
y
in
ter
v
en
tio
n
s
.
Ad
d
itio
n
ally
,
th
e
d
iet
-
p
l
u
s
-
s
wim
m
in
g
g
r
o
u
p
e
x
h
ib
ited
a
h
ig
h
er
p
er
ce
n
tag
e
o
f
ac
tiv
e
m
ass
,
in
d
icatin
g
n
o
t
o
n
ly
weig
h
t
lo
s
s
b
u
t
also
th
e
p
r
eser
v
atio
n
o
r
g
ain
o
f
m
u
s
cle
m
ass
,
wh
ich
is
c
r
u
cial
f
o
r
m
etab
o
lic
h
ea
lth
an
d
p
h
y
s
ical
f
itn
ess
.
T
h
ese
f
in
d
in
g
s
r
ei
n
f
o
r
ce
th
e
n
ec
ess
ity
o
f
a
h
o
lis
tic
ap
p
r
o
ac
h
to
weig
h
t
m
an
ag
em
e
n
t
th
at
co
m
b
i
n
es
b
o
t
h
d
ietar
y
m
o
d
if
icatio
n
s
an
d
p
h
y
s
ical
ac
tiv
ity
.
Per
s
o
n
alize
d
s
tr
ateg
ies
th
at
co
n
s
id
er
i
n
d
iv
id
u
al
p
r
ef
er
e
n
ce
s
,
ch
ar
ac
ter
is
tics
,
an
d
n
ee
d
s
c
an
en
h
an
ce
th
e
s
u
s
tain
ab
ili
ty
an
d
ef
f
ec
tiv
en
ess
o
f
we
ig
h
t
m
an
a
g
em
en
t
in
ter
v
en
tio
n
s
.
T
h
e
r
esu
lts
p
r
o
v
id
e
a
f
o
u
n
d
atio
n
f
o
r
d
e
v
elo
p
in
g
co
m
p
r
eh
en
s
iv
e
weig
h
t
m
an
a
g
em
en
t
g
u
id
elin
es
f
o
r
ath
letes,
in
teg
r
atin
g
d
iet
a
n
d
ex
er
cise
to
o
p
tim
ize
h
ea
lth
an
d
p
er
f
o
r
m
an
ce
with
o
u
t
c
o
m
p
r
o
m
is
in
g
m
u
s
cle
m
ass
.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
a
im
to
in
clu
d
e
lar
g
er
a
n
d
m
o
r
e
d
iv
er
s
e
p
o
p
u
latio
n
s
to
co
n
f
ir
m
th
ese
f
in
d
i
n
g
s
an
d
ex
p
lo
r
e
th
eir
ap
p
licab
ilit
y
ac
r
o
s
s
d
if
f
er
en
t
d
em
o
g
r
ap
h
ic
g
r
o
u
p
s
.
Ad
d
i
tio
n
all
y
,
in
v
esti
g
a
tin
g
th
e
lo
n
g
-
ter
m
ef
f
ec
ts
o
f
co
m
b
in
ed
d
ietar
y
an
d
ex
er
cise in
ter
v
e
n
tio
n
s
will b
e
cr
u
cial
in
u
n
d
er
s
tan
d
in
g
th
ei
r
s
u
s
tain
ab
ilit
y
an
d
lo
n
g
-
ter
m
b
en
ef
its
f
o
r
weig
h
t
m
an
ag
em
en
t
a
n
d
o
v
er
all
h
ea
lt
h
.
T
h
e
s
tu
d
y
’
s
f
in
d
in
g
s
h
ig
h
lig
h
t
th
e
p
o
te
n
tial
o
f
co
m
b
in
in
g
s
wim
m
in
g
with
d
ietar
y
m
o
d
if
icatio
n
s
to
ac
h
iev
e
s
u
p
er
io
r
weig
h
t
m
an
a
g
em
en
t
o
u
tco
m
es,
em
p
h
asizin
g
th
e
im
p
o
r
tan
ce
o
f
a
h
o
lis
tic,
p
er
s
o
n
alize
d
ap
p
r
o
a
ch
to
weig
h
t
m
an
a
g
em
en
t
an
d
p
r
o
v
id
i
n
g
v
alu
a
b
le
in
s
ig
h
ts
f
o
r
b
o
t
h
th
e
r
esear
c
h
f
ield
an
d
p
r
ac
tical
ap
p
licatio
n
s
in
ath
lete
h
ea
lth
m
an
a
g
em
en
t.
Evaluation Warning : The document was created with Spire.PDF for Python.
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t
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f
t
h
e
Helsin
k
i D
ec
lar
atio
n
.
RE
F
E
R
E
NC
E
S
[
1
]
L.
M
c
C
a
r
g
a
r
,
S
.
R
a
ma
g
e
,
A
.
F
a
r
mer,
a
n
d
K
.
A
.
Ec
c
l
e
s,
“
S
t
r
a
t
e
g
i
e
s
f
o
r
su
c
c
e
ssf
u
l
w
e
i
g
h
t
l
o
ss
a
n
d
w
e
i
g
h
t
m
a
i
n
t
e
n
a
n
c
e
:
a
sy
s
t
e
m
a
t
i
c
r
e
v
i
e
w
,
”
C
a
n
a
d
i
a
n
J
o
u
rn
a
l
o
f
D
i
a
b
e
t
e
s
,
v
o
l
.
3
7
,
n
o
.
2
,
p
.
S
2
5
5
,
A
p
r
.
2
0
1
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
c
j
d
.
2
0
1
3
.
0
3
.
2
1
4
.
[
2
]
D
.
W
.
J
o
n
e
s
e
t
a
l
.
,
“
T
h
e
e
f
f
e
c
t
o
f
w
e
i
g
h
t
l
o
s
s
i
n
t
e
r
v
e
n
t
i
o
n
o
n
a
n
t
i
h
y
p
e
r
t
e
n
s
i
v
e
m
e
d
i
c
a
t
i
o
n
r
e
q
u
i
r
e
m
e
n
t
s
i
n
t
h
e
H
y
p
e
r
t
e
n
s
i
o
n
O
p
t
i
m
a
l
T
r
e
a
t
m
e
n
t
(
H
O
T
)
s
t
u
d
y
,
”
Am
e
r
i
c
a
n
J
o
u
r
n
a
l
o
f
H
y
p
e
r
t
e
n
s
i
o
n
,
v
o
l
.
1
2
,
n
o
.
1
2
,
p
p
.
1
1
7
5
–
1
1
8
0
,
1
9
9
9
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
8
9
5
-
7
0
6
1
(
9
9
)
0
0
1
2
3
-
5.
[
3
]
C
.
D
.
S
a
m
u
e
l
-
H
o
d
g
e
e
t
a
l
.
,
“
R
a
n
d
o
m
i
z
e
d
t
r
i
a
l
o
f
a
b
e
h
a
v
i
o
r
a
l
w
e
i
g
h
t
l
o
ss
i
n
t
e
r
v
e
n
t
i
o
n
f
o
r
l
o
w
-
i
n
c
o
me
w
o
me
n
:
t
h
e
w
e
i
g
h
t
w
i
s
e
p
r
o
g
r
a
m
,
”
O
b
e
s
i
t
y
(
S
i
l
v
e
r
S
p
ri
n
g
,
Md
.
)
,
v
o
l
.
1
7
,
n
o
.
1
0
,
p
p
.
1
8
9
1
-
1
8
9
9
,
2
0
0
9
,
d
o
i
:
1
0
.
1
0
3
8
/
o
b
y
.
2
0
0
9
.
1
2
8
.
[
4
]
I
.
M
.
Le
e
e
t
a
l
.
,
“
Ef
f
e
c
t
o
f
p
h
y
si
c
a
l
i
n
a
c
t
i
v
i
t
y
o
n
m
a
j
o
r
n
o
n
-
c
o
mm
u
n
i
c
a
b
l
e
d
i
s
e
a
ses
w
o
r
l
d
w
i
d
e
:
a
n
a
n
a
l
y
s
i
s
o
f
b
u
r
d
e
n
o
f
d
i
sea
s
e
a
n
d
l
i
f
e
e
x
p
e
c
t
a
n
c
y
,
”
T
h
e
L
a
n
c
e
t
,
2
0
1
2
,
v
o
l
.
3
8
0
,
n
o
.
9
8
3
8
,
p
p
.
2
1
9
-
229
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
4
0
-
6
7
3
6
(
1
2
)
6
1
0
3
1
-
9
.
[
5
]
S
.
J
.
A
t
h
i
n
a
r
a
y
a
n
a
n
e
t
a
l
.
,
“
L
o
n
g
-
t
e
r
m
e
f
f
e
c
t
s
o
f
a
n
o
v
e
l
c
o
n
t
i
n
u
o
u
s
r
e
m
o
t
e
c
a
r
e
i
n
t
e
r
v
e
n
t
i
o
n
i
n
c
l
u
d
i
n
g
n
u
t
r
i
t
i
o
n
a
l
k
e
t
o
s
i
s
f
o
r
t
h
e
m
a
n
a
g
e
m
e
n
t
o
f
t
y
p
e
2
d
i
a
b
e
t
e
s
:
A
2
-
y
e
a
r
n
o
n
-
r
a
n
d
o
m
i
z
e
d
c
l
i
n
i
c
a
l
t
r
i
a
l
,
”
F
r
o
n
t
i
e
r
s
i
n
E
n
d
o
c
r
i
n
o
l
o
g
y
,
2
0
1
9
,
d
o
i
:
1
0
.
3
3
8
9
/
f
e
n
d
o
.
2
0
1
9
.
0
0
3
4
8
.
[
6
]
R
.
R
.
W
i
n
g
a
n
d
J.
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[
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