A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study

Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to analyze the specific psychophysiological response in a Paralympic athlete during competitive activities. We collected the following psychophysiological me...

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Autores:
Belinchon-De-Miguel, Pedro
Ruisoto, Pablo
Clemente Suárez, Vicente Javier
Tipo de recurso:
Article of journal
Fecha de publicación:
2018
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/3300
Acceso en línea:
https://hdl.handle.net/11323/3300
https://repositorio.cuc.edu.co/
Palabra clave:
Cortical arousal
Lactate
Rate of perceived exertion
Spinal cord
Injury
Strength
Excitación cortical
Lactato
Tasa de esfuerzo percibido
Médula espinal
Lesión
Fuerza
Rights
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License
Attribution-NonCommercial-ShareAlike 4.0 International
id RCUC2_66ec8da30d7e91c634c3ba9cf9956042
oai_identifier_str oai:repositorio.cuc.edu.co:11323/3300
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
dc.title.translated.spa.fl_str_mv Un completo perfil psicofisiológico de un paralímpico.
title A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
spellingShingle A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
Cortical arousal
Lactate
Rate of perceived exertion
Spinal cord
Injury
Strength
Excitación cortical
Lactato
Tasa de esfuerzo percibido
Médula espinal
Lesión
Fuerza
title_short A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
title_full A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
title_fullStr A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
title_full_unstemmed A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
title_sort A complete psychophysiological profile of a paralympic athlete in a ultraendurance. a case study
dc.creator.fl_str_mv Belinchon-De-Miguel, Pedro
Ruisoto, Pablo
Clemente Suárez, Vicente Javier
dc.contributor.author.spa.fl_str_mv Belinchon-De-Miguel, Pedro
Ruisoto, Pablo
Clemente Suárez, Vicente Javier
dc.subject.spa.fl_str_mv Cortical arousal
Lactate
Rate of perceived exertion
Spinal cord
Injury
Strength
Excitación cortical
Lactato
Tasa de esfuerzo percibido
Médula espinal
Lesión
Fuerza
topic Cortical arousal
Lactate
Rate of perceived exertion
Spinal cord
Injury
Strength
Excitación cortical
Lactato
Tasa de esfuerzo percibido
Médula espinal
Lesión
Fuerza
description Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to analyze the specific psychophysiological response in a Paralympic athlete during competitive activities. We collected the following psychophysiological measurements: anxiety-trait, anxiety-state, locus of control, perceived psychological stress, stress-copying style, rate of perceived exertion, perceived muscle pain, body temperature, forced vital capacity, blood oxygen saturation, blood glucose and lactate concentrations, isometric hand strength, cortical arousal, heart rate variability, heart rate and velocities of a female Paralympic spinal cord injured athlete in a 11 hours and 44 minutes mountain ultraendurance event. An increase in sympathetic autonomous nervous system, heart rate, lactate, muscular pain and rated of perceived exertion and a decrease in cortical arousal and hand strength and inspiratory muscle fatigue. These results are consistent with the expected response during a highly stressful situation and consistent with previous findings in athletes without spinal cord injurie.
publishDate 2018
dc.date.issued.none.fl_str_mv 2018-10-24
dc.date.accessioned.none.fl_str_mv 2019-05-13T14:36:55Z
dc.date.available.none.fl_str_mv 2019-05-13T14:36:55Z
dc.type.spa.fl_str_mv Artículo de revista
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_6501
dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/article
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/ART
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
format http://purl.org/coar/resource_type/c_6501
status_str acceptedVersion
dc.identifier.isbn.spa.fl_str_mv 978-145036518-5
dc.identifier.uri.spa.fl_str_mv https://hdl.handle.net/11323/3300
dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv REDICUC - Repositorio CUC
dc.identifier.repourl.spa.fl_str_mv https://repositorio.cuc.edu.co/
identifier_str_mv 978-145036518-5
Corporación Universidad de la Costa
REDICUC - Repositorio CUC
url https://hdl.handle.net/11323/3300
https://repositorio.cuc.edu.co/
dc.language.iso.none.fl_str_mv eng
language eng
dc.relation.ispartof.spa.fl_str_mv DOI: 10.1145/3284179.3284259
dc.relation.references.spa.fl_str_mv 1] Hicks A, Martin K, Ditor D, Latimer A, Craven C, Bugaresti J, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord 2003;41(1):34. [2] Jacobs PL, NASH MS, RUSINOWSKI JW. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc 2001;33(5):711-717. [3] Ditor D, Latimer A, Ginis KM, Arbour K, McCartney N, Hicks A. Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain. Spinal Cord 2003;41(8):446. [4] Brizuela G, Polo M, Martos J, Sanchis E. Influencia del diámetro del aro de propulsión sobre la frecuencia cardiaca y la lactacidemia en un atleta en silla de ruedas de elite mundial. Motricidad. Eur. J. Hum. Mov. 2006;16. [5] Turbanski S, Schmidtbleicher D. Effects of heavy resistance training on strength and power in upper extremities in wheelchair athletes. J Strength Cond Res 2010;24(1):8-16. [6] Tordi N, Dugue B, Klupzinski D, Rasseneur L, Rouillon J, Lonsdorfer J. Interval training program on a wheelchair ergometer for paraplegic subjects. Spinal Cord 2001;39(10):532. [7] Keyser RE, Rasch EK, Finley M, Rodgers MM. Improved upper-body endurance following a 12-week home exercise program for manual wheelchair users. J Rehabil Res Dev 2003;40(6):501. [8] Lakomy HK, Campbell I, Williams C. Treadmill performance and selected physiological characteristics of wheelchair athletes. Br J Sports Med 1987;21(3):130-133. [9] Vinet A, Le Gallais D, Bouges S, Bernard P, Poulain M, Varray A, et al. Prediction of VO2peak in wheelchair-dependent athletes from the adapted Leger and Boucher test. Spinal Cord 2002;40(10):507. [10] Suarez VJC, Arroyo, Victor Eugenio Munoz Fernandez, Campo DR, Valdivielso FN, Rave JMG, Santos-Garcia DJ. Analysis of selected physiological performance determinants and muscle damage in a 24-hour ultra-endurance relay race: Brief clinical report. Int Sportmed J 2011;12(4):179-186. [11] Suarez VC, Valdivielso FN, Rave JMG. Changes in biochemical parameters after a 20-hour ultra-endurance kayak and cycling event. Int Sportmed J 2011;12(1):1-6. [12] Page AJ, Reid SA, Speedy DB, Mulligan GP, Thompson J. Exercise-associated hyponatremia, renal function, and nonsteroidal antiinflammatory drug use in an ultraendurance mountain run. Clin J Sport Med 2007;17(1):43-48. [13] Belinchon-deMiguel P, Clemente-Suárez VJ. Psychophysiological, Body Composition, Biomechanical and Autonomic Modulation Analysis Procedures in an Ultraendurance Mountain Race. J Med Syst 2018;42(2):32. [14] Clemente-Suárez VJ. Psychophysiological response and energy balance during a 14-h ultraendurance mountain running event. Appl Physiol Nutr Metab 2014;40(3):269-273. [15] Neumayr G, Ganzer H, Sturm W, Pfister R, Mitterbauer G, Hortnagl H. Physiological effects of an ultra-cycle ride in an amateur athlete - a case report. J Sports Sci Med 2002 20;1(1):20-26. [16] Laursen PB, Rhodes EC, Langill RH. The effects of 3000-m swimming on subsequent 3-h cycling performance: implications for ultraendurance triathletes. Eur J Appl Physiol 2000;83(1):28-33. [17] Schumacher YO, Jankovits R, Bültermann D, Schmid A, Berg A. Hematological indices in elite cyclists. Scand J Med Sci Sports 2002;12(5):301-308. [18] Fallon KE, Sivyer G, Sivyer K, Dare A. The biochemistry of runners in a 1600 km ultramarathon. Br J Sports Med 1999;33(4):264-269. [19] Warburton DE, Welsh RC, Haykowsky MJ, Taylor DA, Humen DP. Biochemical changes as a result of prolonged strenuous exercise. Br J Sports Med 2002;36(4):301-303. [20] Clemente-Suárez V, Mielgo-Ayuso J, Quiles J, Varela-Lopez A, Aranda P. Effect of α -tocopherol megadoses on hematologic parameters and antioxidant capacity of rats in an ultraendurance probe. Physiol Int 2017;104(4):291-300. [21] Neumayr G, Pfister R, Mitterbauer G, Gaenzer H, Sturm W, Hoertnagl H. Heart rate response to ultraendurance cycling. Br J Sports Med 2003 Feb;37(1):89-90. [22] Gratze G, Rudnicki R, Urban W, Mayer H, Schlogl A, Skrabal F. Hemodynamic and autonomic changes induced by Ironman: prediction of competition time by blood pressure variability. J Appl Physiol 2005;99(5):1728-1735. [23] Jeukendrup AE, Moseley L, Mainwaring GI, Samuels S, Perry S, Mann CH. Exogenous carbohydrate oxidation during ultraendurance exercise. J Appl Physiol 2006;100(4):1134-1141. [24] Marteau TM, Bekker H. The development of a six‐item short‐form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992;31(3):301-306. [25] Rotter JB. Internal versus external control of reinforcement: A case history of a variable. Am Psychol 1990;45(4):489. [26] Remor E. Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Span J Psychol 2006;9(1):86-93. [27] Simon E, Verboon P. Psychological inflexibility and child anxiety. J Child Fam Stud 2016;25(12):3565-3573. [28] Scheier MF, Wrosch C, Baum A, Cohen S, Martire LM, Matthews KA, et al. The life engagement test: Assessing purpose in life. J Behav Med 2006;29(3):291. [29] Freund W, Weber F, Billich C, Birklein F, Breimhorst M, Schuetz UH. Ultra‐ Marathon Runners Are Different: Investigations into Pain Tolerance and Personality Traits of Participants of the TransEurope FootRace 2009. Pain Pract 2013;13(7):524-532. [30] Schütz UH, Schmidt-Trucksäss A, Knechtle B, Machann J, Wiedelbach H, Ehrhardt M, et al. The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486 km transcontinental ultramarathon. BMC medicine 2012;10(1):78. [31] Steyn BJ. Strategies used by South African non-elite athletes to cope with the environmental stressors associated with endurance events. S Afr J Res Sport Phys Educ Recreation 2007;29(2):99-107. [32] Baker J, Côté J, Deakin J. Cognitive characteristics of expert, middle of the pack, and back of the pack ultra-endurance triathletes. Psychol Sport Exerc 2005;6(5):551-558. [33] McCarthy P, Barker J, Jones M, Moran AP. Single-case research methods in sport and exercise psychology. Routledge; 2011. [34] Keegan RJ, Schinke R, Chirban S, Durand-Bush N, Cotterill S. Guidelines for writing applied case studies in sport and exercise psychology. Rev Psico Deporte 2017;26(3). [35] Kinugasa T. The application of single-case research designs to study elite athletes’ conditioning: An update. J Appl Sport Psychol 2013;25(1):157-166. [36] Clemente-Suarez VJ, Robles-Pérez JJ. Acute effects of caffeine supplementation on cortical arousal, anxiety, physiological response and marksmanship in close quarter combat. Ergonomics 2015;58(11):1842-1850. [37] Clemente-Suárez VJ, Arroyo-Toledo J. Use of biotechnology devices to analyse fatigue process in swimming training. J Med Syst 2017;41(6):94. [38] Saito S. Does fatigue exist in a quantitative measurement of eye movements? Ergonomics 1992;35(5-6):607-615. [39] Clemente-Suárez VJ, de la Vega R, Robles-Pérez JJ, Lautenschlaeger M, Fernández-Lucas J. Experience modulates the psychophysiological response of airborne warfighters during a tactical combat parachute jump. Int J Psychophysiol 2016;110:212-216. [40] Clemente-Suarez VJ, Robles-Perez JJ. Mechanical, physical, and physiological analysis of symmetrical and asymmetrical combat. J Strength Cond Res 2013 Sep;27(9):2420-2426. [41] Beltrán-Velasco AI, Bellido-Esteban A, Ruisoto-Palomera P, Clemente-Suárez VJ. Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination. J Med Syst 2018;42(2):35. [42] Clemente-Suárez VJ, Robles-Pérez JJ, Fernández-Lucas J. Psycho-physiological response in an automatic parachute jump. J Sports Sci 2017;35(19):1872-1878. [43] Fox, Stuart Ira Agud Aparicio, Luis J. Fisiología humana. ; 2003. [44] Lippi G, Brocco G, Franchini M, Schena F, Guidi G. Comparison of serum creatinine, uric acid, albumin and glucose in male professional endurance athletes compared with healthy controls. Clin Chem Lab Med 2004;42(6):644- 647. [45] Langberg H, Bjørn C, Boushel R, Hellsten Y, Kjaer M. Exercise‐induced increase in interstitial bradykinin and adenosine concentrations in skeletal muscle and peritendinous tissue in humans. J Physiol 2002;542(3):977-983. [46] Clemente-Suárez VJ. The application of cortical arousal assessment to control neuromuscular fatigue during strength training. J Mot Behav 2017;49(4):429- 434. [47] Clemente-Suárez VJ. Cortical arousal and central nervous system fatigue after a mountain marathon.(Activación cortical y fatiga del sistema nervioso después de una maratón de montaña). CCD. 2017;12(35):143-148. doi: 10.12800/ccd [48] Vallverdú M, Ruiz-Muñoz A, Roca E, Caminal P, Rodríguez FA, Irurtia A, et al. Assessment of Heart Rate Variability during an Endurance Mountain Trail Race by Multi-Scale Entropy Analysis. Entropy 2017;19(12):658. [49] Clemente-Suárez VJ, Arroyo-Toledo JJ. The Use of Autonomic Modulation Device to Control Training Performance after High-Intensity Interval Training Program. J Med Syst 2018;42(3):47. [50] Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol 2008;104(3):879-888. [51] Clemente-Suarez VJ. Periodized training archive better autonomic modulation and aerobic performance than non periodized training. J Sports Med Phys Fitness 2017 doi: 10.23736/S0022-4707.17.07582-X [52] Clemente-Suárez VJ, Dalamitros A, Ribeiro J, Sousa A, Fernandes RJ, VilasBoas JP. The effects of two different swimming training periodization on physiological parameters at various exercise intensities. Eur J Sport Sci 2017;17(4):425-432.
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spelling Belinchon-De-Miguel, PedroRuisoto, PabloClemente Suárez, Vicente Javier2019-05-13T14:36:55Z2019-05-13T14:36:55Z2018-10-24978-145036518-5https://hdl.handle.net/11323/3300Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Psychophysiological response of athletes with spinal cord injurie has not been reported yet in scientific literature. The aim of this study is to analyze the specific psychophysiological response in a Paralympic athlete during competitive activities. We collected the following psychophysiological measurements: anxiety-trait, anxiety-state, locus of control, perceived psychological stress, stress-copying style, rate of perceived exertion, perceived muscle pain, body temperature, forced vital capacity, blood oxygen saturation, blood glucose and lactate concentrations, isometric hand strength, cortical arousal, heart rate variability, heart rate and velocities of a female Paralympic spinal cord injured athlete in a 11 hours and 44 minutes mountain ultraendurance event. An increase in sympathetic autonomous nervous system, heart rate, lactate, muscular pain and rated of perceived exertion and a decrease in cortical arousal and hand strength and inspiratory muscle fatigue. These results are consistent with the expected response during a highly stressful situation and consistent with previous findings in athletes without spinal cord injurie.La respuesta psicofisiológica de los atletas con lesión de la médula espinal no se ha informado todavía en la literatura científica. El objetivo de este estudio es analizar la respuesta psicofisiológica específica en un atleta paralímpico durante las actividades competitivas. Recolectamos las siguientes medidas psicofisiológicas: rasgo de ansiedad, estado de ansiedad, locus de control, estrés psicológico percibido, estilo de copiado del estrés, tasa de esfuerzo percibido, dolor muscular percibido, temperatura corporal, capacidad vital forzada, saturación de oxígeno en la sangre, glucosa en la sangre y las concentraciones de lactato, la fuerza isométrica de la mano, la excitación cortical, la variabilidad de la frecuencia cardíaca, la frecuencia cardíaca y las velocidades de una atleta femenina con lesión medular paralímpica en un evento de ultra resistencia de montaña de 11 horas y 44 minutos. Aumento del sistema nervioso simpático autónomo, frecuencia cardíaca, lactato, dolor muscular y clasificación del esfuerzo percibido y disminución de la excitación cortical y fuerza de la mano y fatiga muscular inspiratoria. Estos resultados son consistentes con la respuesta esperada durante una situación altamente estresante y consistente con los hallazgos previos en atletas sin lesión de la médula espinal.Belinchon-De-Miguel, Pedro-ae7a0d9a-7abe-4e83-afd3-29b3296f8d1a-0Ruisoto, Pablo-dd45b34b-4320-4b69-8b67-2f440de526d1-0Clemente Suárez, Vicente Javier-0000-0002-2397-2801-600engAssociation for Computing MachineryDOI: 10.1145/3284179.32842591] Hicks A, Martin K, Ditor D, Latimer A, Craven C, Bugaresti J, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord 2003;41(1):34. [2] Jacobs PL, NASH MS, RUSINOWSKI JW. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc 2001;33(5):711-717. [3] Ditor D, Latimer A, Ginis KM, Arbour K, McCartney N, Hicks A. Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain. Spinal Cord 2003;41(8):446. [4] Brizuela G, Polo M, Martos J, Sanchis E. Influencia del diámetro del aro de propulsión sobre la frecuencia cardiaca y la lactacidemia en un atleta en silla de ruedas de elite mundial. Motricidad. Eur. J. Hum. Mov. 2006;16. [5] Turbanski S, Schmidtbleicher D. Effects of heavy resistance training on strength and power in upper extremities in wheelchair athletes. J Strength Cond Res 2010;24(1):8-16. [6] Tordi N, Dugue B, Klupzinski D, Rasseneur L, Rouillon J, Lonsdorfer J. Interval training program on a wheelchair ergometer for paraplegic subjects. Spinal Cord 2001;39(10):532. [7] Keyser RE, Rasch EK, Finley M, Rodgers MM. Improved upper-body endurance following a 12-week home exercise program for manual wheelchair users. J Rehabil Res Dev 2003;40(6):501. [8] Lakomy HK, Campbell I, Williams C. Treadmill performance and selected physiological characteristics of wheelchair athletes. Br J Sports Med 1987;21(3):130-133. [9] Vinet A, Le Gallais D, Bouges S, Bernard P, Poulain M, Varray A, et al. Prediction of VO2peak in wheelchair-dependent athletes from the adapted Leger and Boucher test. Spinal Cord 2002;40(10):507. [10] Suarez VJC, Arroyo, Victor Eugenio Munoz Fernandez, Campo DR, Valdivielso FN, Rave JMG, Santos-Garcia DJ. Analysis of selected physiological performance determinants and muscle damage in a 24-hour ultra-endurance relay race: Brief clinical report. Int Sportmed J 2011;12(4):179-186. [11] Suarez VC, Valdivielso FN, Rave JMG. Changes in biochemical parameters after a 20-hour ultra-endurance kayak and cycling event. Int Sportmed J 2011;12(1):1-6. [12] Page AJ, Reid SA, Speedy DB, Mulligan GP, Thompson J. Exercise-associated hyponatremia, renal function, and nonsteroidal antiinflammatory drug use in an ultraendurance mountain run. Clin J Sport Med 2007;17(1):43-48. [13] Belinchon-deMiguel P, Clemente-Suárez VJ. Psychophysiological, Body Composition, Biomechanical and Autonomic Modulation Analysis Procedures in an Ultraendurance Mountain Race. J Med Syst 2018;42(2):32. [14] Clemente-Suárez VJ. Psychophysiological response and energy balance during a 14-h ultraendurance mountain running event. Appl Physiol Nutr Metab 2014;40(3):269-273. [15] Neumayr G, Ganzer H, Sturm W, Pfister R, Mitterbauer G, Hortnagl H. Physiological effects of an ultra-cycle ride in an amateur athlete - a case report. J Sports Sci Med 2002 20;1(1):20-26. [16] Laursen PB, Rhodes EC, Langill RH. The effects of 3000-m swimming on subsequent 3-h cycling performance: implications for ultraendurance triathletes. Eur J Appl Physiol 2000;83(1):28-33. [17] Schumacher YO, Jankovits R, Bültermann D, Schmid A, Berg A. Hematological indices in elite cyclists. Scand J Med Sci Sports 2002;12(5):301-308. [18] Fallon KE, Sivyer G, Sivyer K, Dare A. The biochemistry of runners in a 1600 km ultramarathon. Br J Sports Med 1999;33(4):264-269. [19] Warburton DE, Welsh RC, Haykowsky MJ, Taylor DA, Humen DP. Biochemical changes as a result of prolonged strenuous exercise. Br J Sports Med 2002;36(4):301-303. [20] Clemente-Suárez V, Mielgo-Ayuso J, Quiles J, Varela-Lopez A, Aranda P. Effect of α -tocopherol megadoses on hematologic parameters and antioxidant capacity of rats in an ultraendurance probe. Physiol Int 2017;104(4):291-300. [21] Neumayr G, Pfister R, Mitterbauer G, Gaenzer H, Sturm W, Hoertnagl H. Heart rate response to ultraendurance cycling. Br J Sports Med 2003 Feb;37(1):89-90. [22] Gratze G, Rudnicki R, Urban W, Mayer H, Schlogl A, Skrabal F. Hemodynamic and autonomic changes induced by Ironman: prediction of competition time by blood pressure variability. J Appl Physiol 2005;99(5):1728-1735. [23] Jeukendrup AE, Moseley L, Mainwaring GI, Samuels S, Perry S, Mann CH. Exogenous carbohydrate oxidation during ultraendurance exercise. J Appl Physiol 2006;100(4):1134-1141. [24] Marteau TM, Bekker H. The development of a six‐item short‐form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992;31(3):301-306. [25] Rotter JB. Internal versus external control of reinforcement: A case history of a variable. Am Psychol 1990;45(4):489. [26] Remor E. Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Span J Psychol 2006;9(1):86-93. [27] Simon E, Verboon P. Psychological inflexibility and child anxiety. J Child Fam Stud 2016;25(12):3565-3573. [28] Scheier MF, Wrosch C, Baum A, Cohen S, Martire LM, Matthews KA, et al. The life engagement test: Assessing purpose in life. J Behav Med 2006;29(3):291. [29] Freund W, Weber F, Billich C, Birklein F, Breimhorst M, Schuetz UH. Ultra‐ Marathon Runners Are Different: Investigations into Pain Tolerance and Personality Traits of Participants of the TransEurope FootRace 2009. Pain Pract 2013;13(7):524-532. [30] Schütz UH, Schmidt-Trucksäss A, Knechtle B, Machann J, Wiedelbach H, Ehrhardt M, et al. The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486 km transcontinental ultramarathon. BMC medicine 2012;10(1):78. [31] Steyn BJ. Strategies used by South African non-elite athletes to cope with the environmental stressors associated with endurance events. S Afr J Res Sport Phys Educ Recreation 2007;29(2):99-107. [32] Baker J, Côté J, Deakin J. Cognitive characteristics of expert, middle of the pack, and back of the pack ultra-endurance triathletes. Psychol Sport Exerc 2005;6(5):551-558. [33] McCarthy P, Barker J, Jones M, Moran AP. Single-case research methods in sport and exercise psychology. 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