The overarching aim of this thesis was to better understand the behavioural, cognitive, and neural corollaries of blunted cardiovascular and/or cortisol reactions to acute psychological stress. As such, it was also concerned to further test the proposition that blunted cardiovascular and cortisol reactions to acute psychological stress are markers of an unconscious dysfunction in the motivational areas of the brain. These aims were achieved by using a mixed methods interdisciplinary approach encompassing both laboratory stress studies and secondary analyses of epidemiological datasets. Chapter 2 adduced evidence that blunted cardiovascular and cortisol reactivity was associated with a non-substance addiction, namely exercise dependence. Chapter 3 demonstrated that blunted cardiovascular and cortisol reactivity was related to disordered eating behaviour. Differences in stress reactivity between healthy controls and exercise dependent individuals or disordered eaters could not be explained by actual stress task performance, how engaged or how stressful participants found the stress task, cardio-respiratory fitness, and a number of other potential confounders. Chapters 4, 5, and 6 demonstrated that poor cognitive ability was associated with blunted stress reactivity retrospectively, cross-sectionally, and prospectively. Additionally, Chapter 6 demonstrated that blunted cardiac reactivity predicted cognitive decline over a 7 year period. Chapter 7 revealed brain activation differences between pre-determined exaggerated and blunted cardiac stress reactors during an acute stress exposure in a fMRI paradigm. Blunted cardiac reactors showed hypo-activation in the areas of the brain associated with motivation and emotion compared to exaggerated reactors. There were no reactivity group differences in subjective measures of the stressfulness and difficulty of and engagement with the stress task. Overall, the research reported in this thesis provides further evidence that blunted cardiovascular and cortisol reactions to stress are associated with a number of adverse health and behavioural outcomes and may be a peripheral marker of some form of disengagement in those areas of the brain that support motivated behaviour.

Wind is fundamentally important to cyclists since it affects their performance, bicycle control, balance and road safety. The overall aim of this research is to improve the understanding of the effect of cycling position and crosswinds on the aerodynamics and performance of a cyclist. The first part of this thesis focuses on cycling position. To minimise air resistance, cyclists lower their torso to become more aerodynamic. Results show that lowering torso angle is associated with impairment of physiological functioning, which can be explained by a combination of mechanical and muscular factors. Consequently, there is a trade-off between aerodynamic gains and physiological impairment. Therefore a mathematical model has been developed predicting the optimal torso angle at different cycling speeds. The second part of this thesis aims to understand the flow mechanics around a cyclist subjected to crosswinds. Both wind tunnel experiments and computational fluid dynamics simulations of the flow around a cyclist are used to reveal the effect of crosswinds on cyclists in different cycling positions. This thesis provides a unique approach to study cycling performance and safety by jointly investigating the human physiology and aerodynamic performance.

Physical activity (PA) is a modifiable behaviour that carries implications for the mental health of the UK. Theory-driven research highlights that the reasons why we participate in PA, not just the act of participation, carry important consequences for human psychological growth, optimal functioning and well-being. Implementing cross-sectional, longitudinal, and experimental designs, this thesis, tests the application and predictive utility of Selfdetermination theory in the health domain of PA behaviour change. Results highlight that the social-environment surrounding individuals before, during and after an exercise referral programme, along with one’s motivational regulations, have important consequences for intentions to be physically active and mental well-being. A SDT-based observational instrument operationalised the environment afforded by exercise professionals during one-to-one PA interactions. This more objective measure may provide further insight into the psychological processes responsible for behavioural and psychological outcomes. Finally, this thesis commences investigations into the moderating role of motivation on the limited self-control resource and the ability to employ counteractive control strategies that help one to achieve important health goals. Knowledge of the processes responsible for psychological health and behavioural intentions before, during and after PA interventions along with the ability to employ self-control, may carry important practical implications for future PA interventions.

The objective of this thesis was to examine how psychological theories and sociological concepts can be used to better understand health behaviour change amongst families living in Everton, north-west England. In doing so, three research questions are addressed: (1) What is the social composition and health status of Everton families and how can these insights be used to inform the development of an intervention which aims to generate positive behaviour change within these families?; (2) How can sociological theories and psychological concepts be used to explain processes of behaviour change amongst families involved in The People’s Family Project?; and (3) How effective is the community-based People’s Family Project in generating positive behaviour change and what are the core mechanisms and processes which help account for any behaviour change? A three-phase approach to the research was adopted in this mixed-methods study undertaken with parents and children and explored using an ecological framework. A process evaluation approach, which drew upon the key sociological theories of figurations, networks of interdependency, habitus, power and capital alongside the psychological constructs of behaviour change, namely self-efficacy and motivation was also used. Phase 1 explored the social demographics and health behaviours of families living in Everton (N=55) to provide the basis of a holistic family-based health intervention (the PFP). Phase 2 included the deployment of pre-intervention measures, intervention delivery, and mid- and immediate-post-intervention outcomes (N=14 families), and Phase 3 included repeat measurements at 6- and 12-months post-intervention (N=7). Results demonstrated that the intervention had little impact on smoking and alcohol behaviours but did have a significant and long-term impact on parental physical activity (PA), and a significant impact on mental well-being and dietary quality, however these changes were not maintained statistically at follow-up. Qualitative analysis suggested the intervention led to various physical, social and psychological benefits for families, which were explained using the programme theory developed as part of the process evaluation.

This thesis used a multi-methods approach to explore children’s out-of-school physical activity (PA). Study 1 found that children living in the most deprived neighbourhoods represent an important target group for future PA and health interventions. Further, the study also revealed that self-reported PA was positively associated with independent mobility. Study 2 confirmed that the weekend was a period of low moderate-to-vigorous PA (MVPA), and revealed that raw PA levels derived from the wrist-worn GENEActiv are not comparable with hip-worn ActiGraph. Agreement between the devices differed according to PA intensity and time of day, with the greatest difference occurring in light PA (LPA) during school hours. Using children’s recounted perceptions and experiences of out-of-school PA, study 3 demonstrated how an inclusive, interactive and child-centred methodology (i.e., write, draw show and tell; WDST) may be advantageous when compared to traditional singular qualitative methods. In study 4 parental safety concerns were reported to be the most consistent barrier to children’s out-of-school PA. The family case studies demonstrated how family perceptions and constraints can influence children’s out-of-school PA levels and activity mode (i.e., active school travel, outdoor play and organised sport). Such constraints include factors such as, school proximity, neighbourhood perceptions and family context. Study 5 revealed substantial intra-individual variability in children’s weekend MVPA. PA diary data revealed that children's weekend PA was mostly unstructured in nature and undertaken with friends, whereas a greater proportion of parents’ weekend PA was undertaken alone in structured settings. Family case studies demonstrated that in the selected cases MVPA levels and variability across weekends were contingent on mode of PA participation. This thesis contributes evidence to inform future out-of-school PA interventions. The research has demonstrated that children’s out-of-school PA is influenced by a complex interaction of individual, social and environmental factors. Specific highlights include the family and neighbourhood environment. The weekend is associated with low PA and as such represents an important time period to promote PA in children. Future weekend PA interventions should target specific modes of activity, as the facilitators and barriers to these activities vary considerably. Moreover, in future, research and practice should focus on ways in which to modify neighbourhood attributes to support children’s out-of-school active living.

Rugby is a complex, high-intensity, intermittent, collision sport with emphasis placed on players possessing high lean body-mass and low body-fat. After an 8-12 week pre-season focused on physiological adaptations, emphasis shifts towards optimizing competitive performance and recovery through periodising player’s diets and training. In Chapter 4 the physiological demands and nutritional intakes of 45 elite rugby players were assessed during a pre-season through a battery of strength and conditioning tests, quantification of training demands using global positioning system (GPS), and two 24-hour diet recalls. Mean weekly distance covered during training was 9774 ± 1404 and 11585 ± 1810 m with a total mean weekly session RPE (sRPE) of 3398 ± 335 and 2944 ± 410 arbitrary units (AU) for forwards and backs respectively. Mean daily energy intake was 14.8 ± 1.9 and 13.3 ± 1.9 MJ, carbohydrate (CHO) intake was 3.3 ± 0.7 and 4.14 ± 0.4 g·kg-1 body mass, protein intake was 2.52 ± 0.3 and 2.59 ± 0.6 g·kg-1 body mass, and fat intake was 1.0 ± 0.3 and 0.95 ± 0.3 g·kg-1 body mass for forwards and backs respectively. Markers of physical performance (1-RM strength, speed, and repeated sprint tests) and anthropometry (body fat, and estimated lean mass) significantly improved in all players, despite players’ self-selecting a ‘low’ CHO ‘high’ protein diet. It may be speculated therefore that ‘low’ CHO ‘high’ protein intakes are appropriate to fuel the pre-season, although whether these intakes are sufficient to fuel the in-season is unknown. Once the demands of the pre-season were established, the next aim of the thesis was to examine if requirements changed during the playing season, as well as quantifying energy expenditure. In Chapter 5 in-season training load using GPS and sRPE, alongside six-day assessments of energy intake (EI) and energy expenditure (EE) was measured in 44 elite Rugby Union players. Mean weekly distance covered was 7827 ± 954 m and 9572 ± 1233 m with a total mean weekly sRPE of 1776 ± 355 and 1523 ± 434 AU for forwards and backs, respectively. Mean daily EI was 16.6 ± 1.5 and 14.2 ± 1.2 MJ, and EE was 15.9 ± 0.5 and 14 ± 0.5 MJ for forwards and backs respectively. Mean CHO intake was 3.5 ± 0.8 and 3.4 ± 0.7 g·kg-1 body mass, protein intake was 2.7 ± 0.3 and 2.7 ± 0.5 g·kg-1 body mass, and fat intake was 1.4 ± 0.2 and 1.4 ± 0.3 g·kg-1 body mass for forwards and backs respectively. All players who completed the food diary self-selected a ‘low’ CHO ‘high’ protein diet during the early part of the week which increased in the days leading up to a match. EI and EE followed an inverse trend, with expenditure exceeding intake during the first four-days of the training week and then reversed in the day leading up to competition with intake exceeding expenditure. Despite this, mean EI exceeded EE which alongside no micronutrient deficiencies, suggest that the current dietary practices of these elite rugby players seem sufficient to fuel training during the in-season, providing energy intake and CHO are increased leading up to a match. Given that intakes reported in this study are still below recommended CHO intake for elite athletes (Burke et al 2011), however, it is still possible that such intakes are not optimal for match day performance. Given that in Chapters 4 and 5 it was found that elite Rugby players appear to deliberately select a low carbohydrate intake, it was deemed important to assess match-play glycogen demands following a low (the amount self selected in chapter 4) and higher (the amount self selected leading in to competition in chapter 5) carbohydrate diet. Therefore, in Chapter 6 the metabolic and physiological demands of rugby competition was assessed in 16 professional Rugby League players following either a 6g·kg (HCHO) or 3g·kg (LCHO) CHO diet for 36-hours. Muscle biopsy and blood was collected, alongside monitoring internal and external load through GPS and heart rate. Mean distance covered was 93.7 ± 12.4 and 89.4 ± 9.8 m·min-1 in the first, and 85.3 ± 13.1 and 86.9 ± 9.7 m·min-1 in the second half for HCHO and LCHO conditions respectively. Mean %HRpeak was 82.9 ± 6.1 and 81.9 ± 7.2 % in the first and 82.5 ± 7.5 and 78.4 ± 10.5 % in the second half for HCHO and LCHO conditions respectively. Mean muscle glycogen was 448.6 ± 50.8 and 444.2 ± 81.1 mmol·kg d·w-1 pre-game, and 243.4 ± 42.5 and 297.7 ± 130.5 mmol·kg d·w-1 post-game for HCHO and LCHO conditions respectively. Results demonstrate that a competitive RL match can result in ~40% muscle glycogen depletion and that match-day performance variables did not differ between conditions. It was postulated that an absolute amount of ~600 g CHO consumed 36-hours pre-match is a recommended strategy for rugby league players, although optimal dietary strategies to refuel after rugby competition are unknown. The final aim of the thesis was to examine if the current post exercise CHO guidelines are appropriate for rugby players. In Chapter 7 the magnitude of muscle glycogen repletion after consuming an immediate, or delayed re-feed post Rugby League Match Simulation Protocol (RLMSP) was assessed in 16 university rugby league players using muscle biopsy and blood letting techniques. Muscle glycogen very likely increased 48-h post-simulation (272 ± 97 cf. 416 ± 162 mmol·kg-1d.w.) after an immediate re-feed, but changes were unclear (283 ± 68 cf. 361 ± 144 mmol·kg-1d.w.) after a delayed re-feed. Creatine Kinase (CK) almost certainly increased by 77.9 ± 25.4 % (0.75 ± 0.19) post-simulation for all players. Player Load (8 ± 0.7 AU) and %HRpeak (83 ± 4.9 %) were consistent with professional RL match-play. Time to exhaustion performance test revealed no difference between conditions. This study found that simulated RL match-play elicits lower muscle glycogen utilisation (21 cf. 40 %) despite similar player load and metabolic demands to a professional RL match. This may be attributed to the difficulties of replicating extensive structural damage and physical exertion from collisions during a simulation. It was also found that substantial muscle glycogen resynthesis was possible in the immediate dietary re-feed group despite evidence of muscle damage via increased blood proteins, indicating that with appropriate feeding strategies it is possible to replenish a damaged muscle. Taken together, this thesis has characterized the training demands and energy balance of elite rugby players during the pre-season and in-season, alongside quantifying the metabolic demands of elite rugby match-play, and the most appropriate strategies to load and replenish muscle glycogen around such exercise. Future studies must now further titrate these studies and assess muscle glycogen utilisation over a number of games whilst assessing the glycogen content of individual muscle fibre types.

Childhood obesity is becoming increasingly prevalent in the UK and globally. Over the last 10 years, there has been a rise in prevalence of risk factors for health and a decline in physical activity. Obesity is major health risk factor for a number of other chronic diseases, some of which are prevalent in children. Regular physical activity is associated with reduced adiposity, healthier metabolic status lower risk factors of diabetes and CHD and enhanced bone mineral accrual and protection against osteoporosis. Recent literature suggests that children may not be meeting the recommended daily guideline for physical activity of 60 min per day (Riddoch et al., 2007), while others suggest this guideline is insufficient to protect against risk factors in children. Assessment of programmes promoting physical activity, with robust health related outcome measures are therefore warranted Initially, sixty-one children were recruited for a 9-week exploratory trial. The trial assessed the effect of a structured high impact exercise (STEX) and a lifestyle intervention (PASS). Changes in dual-energy X-ray absorptiometry (DXA) derived body composition and bone mineral were compared to age matched controls (CaNT). The STEX intervention resulted in an additional mean increase in total body BMC of 63.3 g (P= 0.019) and an additional increase of 0.011 g.cm-2 (P= 0.018) for BMD over changes observed in controls. Neither intervention stimulated significant increases in BMC or BMD at the femoral neck or lumbar spine (P > 0.05) compared with the controls. No significant changes were found in fat mass index (P > 0.05), lean mass index (P > 0.05) or percent body fat (p = 0.09) in any groups. Structured impact exercise promoted significant and clinically relevant increases in bone measures, without significant changes to body composition. The exploratory finding therefore supported the need for a larger, definitive randomised trial to confirm the results. Following this, a large cohort of Liverpool school children (n=152) was recruited for cross-sectional analysis. Measures included 3-day physical activity using a uniaxial accelerometer, maturity status, cardia-respiratory fitness and skin-fold measurements in addition to body composition, bone mineral content and density. Analysis of variance was used to uncover any sex differences, partial correlation analysis was performed to investigate relationships between health-related variables and physical activity, with maturity offset as the controlling variable. Regression analysis was performed to find the best predictor of BMC and BMD (primary outcome variable), using LM, FM, Mass, and maturity offset as predictor variables. The results showed that children participated in the recommended amount of activity. However, body fat measures indicated that the children fell between the 85th-95% percentile for overweight. Further more BMD status of both sexes also fell below reference values. The dose-response relationship was highlighted as children who participated in < 60 mln.oay" recommendation were less physically fit (P=0.001) and fatter (P < 0.001) than children achieving this guideline. Children participating in over >90 min.day" had significantly lower percent body fat (P=0.005) and fat mass (P=0.04) than children who participated in < 60 min.day" and significantly lower percent body fat (P=0.02)than all children who participated in < 90 min.day". The findings highlight the importance of the high volume ( > 90 rnin.day") and high-intensity physical activity (over 10 min.day") as a precursor to low body fat and high bone mineral in children. The one hundred and fifty-two children from the baseline cohort were allocated to 1 of 4 groups over a 12 month period. Three groups received a different physical activity intervention; a high-intensity programme ('HIPA'), a skill development programme ('FMS') or a lifestyle-based programme ('PASS'). The 'HIPA' and 'FMS' groups participated in an after-school club (2x60 min.week"), the 'PASS' group attended weekly classroom sessions (1 x week) delivered by a lifestyle coach during the school day. The control group ('CaNT') received health information. All baseline measures were repeated at 9 and 12 months (during and after) intervention. All interventions minimised fat mass accumulation, with the 'HIPA' intervention being most effective (P=0.03), implying that the high-intensity nature of the activity sessions was more effective at minimising body fat accumulation. The greatest magnitude of change in femoral neck BMC (P < 0.001) and BMD (P < 0.001) and cardiorespiratory fitness (P=0.023) was also reported by the 'HIPA' group which is likely to be attributable to the intensity of the weight-bearing activities included in the 'HIPA' programme. The findings suggested that the 'HIPA' intervention was most beneficial for health outcomes, but all interventions had significant effect on increasing time spent in physical activity. The studies within this thesis have provided a unique insight in to the current bone health status, body composition and physical activity of 9-11 year old Liverpool school children. Further data were also generated on the effect of different physical activity interventions on bone health, body composition and physical activity. The findings from this thesis conclude that a proportion of 9- 11 year old children were overweight despite meeting physical activity recommendations of 60 min.day". The high-intensity physical activity intervention had the most beneficial impact on bone health, body composition and cardio-respiratory fitness when compared to the controls. The quantity of physical activity and the time spent in high intensity activity warrants further investigation to quantify an optimal dose.

No description available.

During the 9th lunar month of each year around 1 billion Muslims adhere to the religious 4- week festival of Ramadan, which is considered as a time for empathy for those less fortunate, a time for restraint, and goodwill. The main focus of the religious intervention of Ramadan is the intermittent fast whereby, each day between dawn and sunset nutritional abstinence is practiced. Empirical evidence from experienced soccer coaches in Qatar has indicated that the 4-week intermittent fast during Ramadan impedes the quality and quantity of training, as well as match play. However, there has been lack of attention directed to the consequences associated with Ramadan and football (soccer) players. Greater understanding of the consequences of Islamic soccer players adhering to lifestyle changes and intermittent fasting would facilitate soccer coaches in a systematic approach to addressing potential negative performance effects associated with Ramadan in future soccer-seasons. In order to address the research problem, a soccer-specific battery of tests was required; as there is no established gold standard battery of soccer-specific field tests preliminary technical and methodological studies were required. In Study-1 a soccer-specific anaerobic capacity field test (Liverpool Anaerobic Speed Test or LAST) was piloted for validity, reliability, and practicality since, the choice for suitable soccer-specific anaerobic capacity tests were inadequate. It was found that two familiarisation sessions are necessary to reduce systematic bias markedly and habituate players with procedures of the LAST. The total measurement error (ratio of Limits of Agreement) of the LAST was 2.5% (± 18 m), and peak blood lactate values produced were 17.6 mmol.l⁻¹, which were greater than the 14.7 mmol.l⁻¹ criteria set for maximal anaerobic effort before the pilot study. The test set-up and administration proved to be practical, facilitating large numbers of subjects to be evaluated relatively quickly ( < 20 min). Therefore, the LAST was included in the soccer-specific battery of field tests, which then provided a comprehensive analysis of the separate components soccer performance. The available facility to conduct this investigation was the soccer-field at Al-Ahli Sports Club Doha, Qatar and therefore, further methodological investigations were necessary; temperatures within Qatar can vary during different times of the season, and at times are quite severe with respect to heat and humidity. The purpose of Study-2 was to examine how robust the discrete soccer-specific field tests were which, would be used during the intervention of Ramadan, using a repeated measures counter-balanced design of indoor and outdoor conditions. It was found that during the Yo-Yo Intermittent Recovery Test (YYIRT) (Krustrup et al., 2003) outdoor assessment maximal performance was reduced by 19% in contrast to the YYIRT conducted indoors, despite the subjects attaining similar maximal heart rates. Consequently, the YYIRT to volitional exhaustion was excluded from the battery of tests to be used during the intervention of Ramadan; all other soccer-specific field tests were found to be robust for use in the heat. The aim of Study-3 was a qualitative investigation to observe current soccer-practice and related factors surrounding training; this brief included bedtime, wake-up time, sleep duration, environmental conditions, pre-training dehydration, body fluids lost during training, body-core temperature, and relative training intensity. During Ramadan it was found that bedtime and wake-up time were significantly delayed and sleep duration lengthened compared to normal. Post-Ramadan was found to be akin to eastward time travel with advancement in bedtime, wake-up and return to normal sleep duration. Dehydration was significantly greater pre-training during Ramadan in comparison to non- Ramadan training weeks, and body fluid loss during training in both Ramadan and non- Ramadan periods was considerable. Relative training workload was also quantified during this time and highlighted important practical problems.

Static and dynamic balance are essential in daily and sports life. Many factors have been identified as influencing static balance control, two of which are carrying additional weight and localized muscle fatigue but their influence on dynamic balance in sport activities has not been fully established. Therefore, the aim of this thesis was to investigate the characteristics of dynamic balance in sport related activities, with specific reference to the influence of body mass changes and muscular fatigue. Study one: The objectives of study one (methodological study, n = 5) were to apply the extrapolated Centre of Mass (XCoM) method and other relevant variables (centre of pressure, CoP; Centre of Mass, CoM; shear forces, Fh; kinetic energy, KE; momentum, P; and angular impulse, AI) to investigate sport related activities such as hopping and jumping. Many studies have represented the CoP data without mentioning its accuracy so several experiments were done to establish the agreement between the CoP and the projected CoM in a static condition. It was found that there was an inaccuracy with the average difference about 4mm. This meant that the angular impulse could not be reliably calculated. Its horizontal component, representing the Friction Torque (Q), could be reliably computed for dynamic balance. The implementation of the XCoM method was found to be practical for evaluating both static and dynamic balance. The general findings were that the CoP, the CoM, the XCoM, Fh, and Qwere more informative than the other variables (e.g. KE, P, and AI) during static and dynamic balance. The XCoM method was found to be applicable to dynamic balance as well as static balance. Study 2: The objectives of study two (baseline study, n =20) were to implement Matlab procedures for quantifying selected static and dynamic balance variables, establish baseline data of selected variables which characterize static and dynamic balance activities in a population of healthy young adult males, and to examine any trial effects on these variables. The results indicated that the implementation of Matlab procedures for quantifying selected static and dynamic balance variables was practical and enabled baseline data to be established for selected variables. There was no significant trial effect. Recommendations were made for suitable tests to be used in later studies. Specifically it was found that one foot-tiptoes tests either in static or dynamic balance are too challenging for most participants in normal circumstances. A one foot-flat eyes open test was considered to be representative and challenging for static balance, while adding further vertical jump and landing tests (two feet flat and one foot flat vertical jump) to the horizontal jumping and hopping for dynamic balance was considered to be more representative of sports situations. The main differences between horizontal and vertical jumping were in anterior-posterior direction. Study 3: The objectives of study three (differentiation study, n =20) were to establish the influence of physical (external added weight) and neurophysiological (fatigue) factors on static and dynamic balance in sport related activities. This was typified statically by the Romberg test (one foot flat, eyes open) and dynamically by jumping and hopping in both horizontal and vertical directions. Statically, added weight increased body's inertia and therefore decreased body sway in anterior-posterior direction though not significantly. Dynamically, added weight significantly increased body sway in both mideo-lateral and anterior-posterior directions, indicating instability, and the use of the counter rotating segments mechanism to maintain balance was demonstrated. Fatigue on the other hand significantly increased body sway during static balance as a neurophysiological adaptation primarily to the inverted pendulum mechanism. Dynamically, fatigue significantly increased body sway in both mideo-lateral and anterior-posterior directions again indicating instability but with a greater use of counter rotating segments mechanism. Differential adaptations for each of the two balance mechanisms (inverted pendulum and counter rotating segments) were found between one foot flat and two feet flat dynamic conditions, as participants relied more heavily on the first in the one foot flat conditions and relied more on the second in the two feet flat conditions. Conclusion: Results from this thesis are expected to aid towards advancing the understanding of balance in sport related activities, and can provide a solid foundation for future work in this area. In particular, a method was established to assess static and dynamic balance, baseline data for these associations was provided, and differential adaptations to physical or neurophysiological constraints were found. Valuable associations between specific variables and the first two mechanisms of balance were demonstrated.