Prefrontal cortex oxygenation during a mentally fatiguing task in normoxia and hypoxia.

Mental fatigue (MF) and hypoxia impair cognitive performance through changes in brain hemodynamics. We want to elucidate the role of prefrontal cortex (PFC)-oxygenation in MF. Twelve participants (22.9 ± 3.5 years) completed four experimental trials, (1) MF in (normobaric) hypoxia (MF_HYP) (3.800 m; 13.5%O2), (2) MF in normoxia (MF_NOR) (98 m; 21.0%O2), (3) Control task in HYP (CON_HYP), (4) Control in NOR (CON_NOR). Participants performed a 2-back task, Digit Symbol Substitution test and Psychomotor Vigilance task before and after a 60-min Stroop task or an emotionally neutral documentary. Brain oxygenation was measured through functional Near Infrared Spectroscopy. Subjective feelings of MF and physiological measures (heart rate, oxygen saturation, blood glucose and hemoglobin) were recorded. The Stroop task resulted in increased subjective feelings of MF compared to watching the documentary. 2-back accuracy was lower post task compared to pre task in MF_NOR and CON_NOR, while no differences were found in the other cognitive tasks. The fraction of inspired oxygen did not impact feelings of MF. Although performing the Stroop resulted in higher subjective feelings of MF, hypoxia had no effect on the severity of self-reported MF. Additionally, this study could not provide evidence for a role of oxygenation of the PFC in the build-up of MF.

Electrophysiological impact of mental fatigue on brain activity during a bike task: A wavelet analysis approach.

This study explored how mental fatigue affects brain activity during a low-intensity bike task utilising a continuous wavelet transformation in electroencephalography (EEG) analysis. The aim was to examine changes in brain activity potentially linked to central motor commands and to investigate their relationship with ratings of perceived exertion (RPE). In this study, sixteen participants (age: 21 ± 6 y, 7 females, 9 males) underwent one familiarization and two experimental trials in a randomised, blinded, cross-over study design. Participants executed a low-intensity bike task (9 min; 45 rpm; intensity (W): 10 % below aerobic threshold) after performing a mentally fatiguing (individualized 60-min Stroop task) or a control (documentary) task. Physiological (heart rate, EEG) and subjective measures (self-reported feeling of mental fatigue, RPE, cognitive load, motivation) were assessed prior, during and after the bike task. Post-Stroop, self-reported feeling of mental fatigue was higher in the intervention group (EXP) (74 ± 16) than in the control group (CON) (37 ± 17; p < 0.001). No significant differences in RPE during the bike task were observed between conditions. EEG analysis revealed significant differences (p < 0.05) in beta frequency (13-30 Hz) during the bike task, with EXP exhibiting more desynchronization during the pedal push phase and synchronization during the pedal release phase. These results suggest that mental fatigue, confirmed by both subjective and neurophysiological markers, did not significantly impact RPE during the bike task, possibly due to the use of the CR100 scale or absence of a performance outcome. However, EEG data did reveal significant beta band alterations during the task, indicating increased neural effort under mental fatigue. These findings reveal, for the first time, how motor-related brain activity at the motor cortex is impacted during a low-intensity bike task when mentally fatigued.

Prolonged theoretical classes impact students' perceptions: an observational study.

Mental fatigue (MF) arises during prolonged demanding cognitive activity and results in acute feelings of tiredness and a decreased physical and/or cognitive performance capacity. An often-overlooked population that is significantly at risk for the development of MF are university students. The current study investigated the impact of prolonged in-person theoretical classes on the perceptions of MF, boredom, and sleepiness among 27 Slovenian university students (first-year physiotherapy). Their subjective experiences at various time points during a 4-h class interspersed with a 20 min break were assessed with a repeated measures ANOVA and consequent Bonferroni post-hoc tests (significance set at <0.05). Subjective MF and sleepiness significantly increased during the first and the second part of the class (p < 0.05), while they significantly decreased during the break (p < 0.05). Boredom levels only increased significantly during the second part of the class (p < 0.05). Additionally, students who had inadequate sleep the night before the class reported higher levels of MF at the beginning of the class. This study highlighted a significant impact of a theoretical class on subjective feelings of mental fatigue and showed that a break in the middle of the class temporarily alleviated this negative impact. These results emphasize the importance of adequate sleep, effective breaks, and strategies to manage cognitive workload in optimizing students' cognitive well-being and academic performance. Further research is needed to better understand the underlying factors and develop targeted interventions to support students' cognitive functioning and well-being during prolonged academic sessions.

Test-retest, intra- and inter-rater reliability of the reactive balance test in patients with chronic ankle instability.

Introduction: The Reactive Balance Test (RBT) could be a valuable addition to research on chronic ankle instability (CAI) and clinical practice, but before it can be used in clinical practice it needs to be reliable. It has already been proven reliable in healthy recreational athletes, but not yet in patients with CAI who have shown persistent deficits in dynamic balance. The study aimed to determine the test-retest, intra-, and inter-rater reliability of the RBT in patients with CAI, and the test-retest and inter-rater reliability of the newly developed RBT score sheet. Methods: We used a repeated-measures, single-group design to administer the RBT to CAI patients on three occasions, scored by multiple raters. We included 27 participants with CAI. The study used multiple reliability measures, including Pearson r, intra-class correlations (ICC), standard error of measurement (SEM), standard error of prediction (SEP), minimal detectable change (MDC), and Bland-Altman plots, to evaluate the reliability of the RBT's outcome measures (visuomotor response time and accuracy). It also assessed the test-retest and inter-rater reliability of the RBT score sheet using the same measures. Results: The ICC measures for test-retest reliability were similar for accuracy (0.609) and VMRT (0.594). Intra-rater reliability had high correlations and ICCs for accuracy (r = 0.816, ICC = 0.815) and VMRT (r = 0.802, ICC = 0.800). Inter-rater reliability had a higher ICC for VMRT (0.868) than for accuracy (0.690). Conclusion: Test-retest reliability was moderate, intra-rater reliability was good, and inter-rater reliability showed moderate reliability for accuracy and good reliability for VMRT. Additionally, the RBT shows robust SEM and mean difference measures. The score sheet method also demonstrated moderate test-retest reliability, while inter-rater reliability was good to excellent. This suggests that the RBT can be a valuable tool in assessing and monitoring balance in patients with CAI.

Deficits in neurocognitive performance in patients with chronic ankle instability during a neurocognitive balance task - A retrospective case-control study.

OBJECTIVES: To assess the neurocognitive performance while maintaining balance of patients experiencing CAI compared to healthy controls. In patients with CAI, the affected limb was also compared to the contralateral limb. DESIGN: A retrospective case-control study. SETTING: Laboratory study. PARTICIPANTS: We included 27 patients with CAI and 21 healthy controls. METHODS: The study consisted of two sessions, namely familiarisation and experimentation, which were scheduled with a gap of at least one week between them. During the experimental trial, both groups performed the Y-Balance Test and Reactive Balance Test once on each limb. MAIN OUTCOME MEASURES: The main outcome measures are accuracy and visuomotor response time (VMRT) calculated via video-analysis and with the Fitlight™-hardware and software respectively during the Reactive Balance Test (RBT). RESULTS: No data was excluded from the final analysis. Patients with CAI exhibited significantly lower accuracy than healthy controls, with a mean difference of 8.7% (±3.0)%. There were no differences for VMRT between groups. Additionally, no significant differences were observed between the affected and contralateral limb of the patient group for both accuracy and VMRT. CONCLUSIONS: Patients with CAI showed lower accuracy, but similar VMRT compared to healthy controls during a neurocognitive balance task, indicating impaired neurocognitive function. Patients exhibit comparable speed to healthy individuals when completing neurocognitive balance tasks, yet they display a higher frequency of accuracy errors in accurately perceiving their environment and making decisions under time constraints. Future research should gain more insights in which other cognitive domains are affected in patients with CAI for a better grasp of this condition's underlying mechanism.

The impact of an active and passive industrial back exoskeleton on functional performance.

Due to differences in actuation and design, active and passive industrial back exoskeletons could influence functional performance, i.e., work performance, perceived task difficulty, and discomfort, differently. Therefore, this study investigated and compared the impact of the active CrayX (7 kg) and passive Paexo Back (4.5 kg) on functional performance. Eighteen participants performed twelve work-related tasks with both types of exoskeletons and without (NoExo). The CrayX hindered work performance up to 22% in multiple tasks, compared to the Paexo Back and NoExo, while work performance between NoExo and the Paexo Back condition was more comparable, except for stair climbing (13% hindrance). Perceived task difficulty and discomfort seldomly varied between both exoskeletons. Although the CrayX shows promise to benefit workers, limitations in hindrance and comfort should first be addressed. The Paexo Back has demonstrated an advantage in certain static tasks. However, increasing its potential across a broader range of tasks seems warranted.Practitioner Summary: Differences between industrial back exoskeletons with regard to functional performance, i.e. work performance, discomfort and perceived task difficulty, were investigated by evaluating the active CrayX and passive Paexo Back back exoskeletons. The CrayX significantly hindered functional performance, while the Paexo Back seldomly affected functional performance.Abbreviations: WMSD: Work-related musculoskeletal disorder; NoExo: No Exoskeleton; GD: General discomfort; PTD: Perceived task difficulty; BMI: Body Mass Index.

Fatness but Not Fitness Linked to BrainAge: Longitudinal Changes in Brain Aging during an Exercise Intervention.

PURPOSE: Fitness, physical activity, body composition, and sleep have all been proposed to explain differences in brain health. We hypothesized that an exercise intervention would result in improved fitness and body composition and would be associated with improved structural brain health. METHODS: In a randomized controlled trial, we studied 485 older adults who engaged in an exercise intervention ( n = 225) or a nonexercise comparison condition ( n = 260). Using magnetic resonance imaging, we estimated the physiological age of the brain (BrainAge) and derived a predicted age difference compared with chronological age (brain-predicted age difference (BrainPAD)). Aerobic capacity, physical activity, sleep, and body composition were assessed and their impact on BrainPAD explored. RESULTS: There were no significant differences between experimental groups for any variable at any time point. The intervention group gained fitness, improved body composition, and increased total sleep time but did not have significant changes in BrainPAD. Analyses of changes in BrainPAD independent of group assignment indicated significant associations with changes in body fat percentage ( r (479) = 0.154, P = 0.001), and visceral adipose tissue (VAT) ( r (478) = 0.141, P = 0.002), but not fitness ( r (406) = -0.075, P = 0.129), sleep ( r (467) range, -0.017 to 0.063; P range, 0.171 to 0.710), or physical activity ( r (471) = -0.035, P = 0.444). With linear regression, changes in body fat percentage and VAT significantly predicted changes in BrainPAD ( ß = 0.948, P = 0.003) with 1-kg change in VAT predicting 0.948 yr of change in BrainPAD. CONCLUSIONS: In cognitively normal older adults, exercise did not appear to impact BrainPAD, although it was effective in improving fitness and body composition. Changes in body composition, but not fitness, physical activity, or sleep impacted BrainPAD. These findings suggest that focus on weight control, particularly reduction of central obesity, could be an interventional target to promote healthier brains.

The Impact of Mental Fatigue on a Strength Endurance Task: Is There a Role for the Movement-Related Cortical Potential?

PURPOSE: Several mechanisms have been proposed to explain how mental fatigue degrades sport performance. In terms of endurance performance, a role for an increased perceived exertion has been demonstrated. Using electroencephalography and, more specifically, the movement-related cortical potential (MRCP), the present study explored the neural mechanisms that could underlie the mental fatigue-associated increase in perceived exertion. METHODS: Fourteen participants (age, 23 ± 2 yr; 5 women, 9 men) performed one familiarization and two experimental trials in a randomized, blinded, crossover study design. Participants had to complete a submaximal leg extension task after a mentally fatiguing task (EXP; individualized 60-min Stroop task) or control task (CON; documentary). The leg extension task consisted of performing 100 extensions at 35% of 1 repetition maximum, during which multiple physiological (heart rate, electroencephalography) and subjective measures (self-reported feeling of mental fatigue, cognitive load, behand motivation, ratings of perceived exertion) were assessed. RESULTS: Self-reported feeling of mental fatigue was higher in EXP (72 ± 18) compared with CON (37 ± 17; P < 0.001). A significant decrease in flanker accuracy was detected only in EXP (from 0.96 ± 0.03% to 0.03%; P < 0.05). No significant differences between conditions were found in MRCP characteristics and perceived exertion. Specifically in EXP, alpha wave power increased during the leg extension task ( P < 0.01). CONCLUSIONS: Mental fatigue did not impact the perceived exertion or MRCP characteristics during the leg extension task. This could be related to low perceived exertion and/or the absence of a performance outcome during the leg extension task. The increase in alpha power during the leg extension task in EXP suggests that participants may engage a focused internal attention mechanism to maintain performance and mitigate feelings of fatigue.

Prolonged cognitive effort impairs inhibitory control and causes significant mental fatigue after an endurance session with an auditive distractor in professional soccer players.

BACKGROUND: Throughout official soccer matches, the presence of cheer by the crowd could be considered a critical auditive distraction that could further impair the cognitive interference control system, multiple object tracking (MOT) skill, heart rate variability (HRV), and increase mental fatigue. As the resource is not immediately replenished, the impairment of the cognitive interference control system may be delayed following a soccer game. Then, evaluating the recovery time course of the cognitive interference control system, MOT skill, HRV, and mental fatigue after prolonged tasks combining physical, endurance, and cognitive effort are essential. PURPOSE: We aimed to analyze the acute effect of cognitive effort and auditive distractor with 24-h follow-up throughout a prolonged endurance session on inhibitory control, subjective mental fatigue, MOT skill, and HRV in professional soccer players. METHODS: Twenty professional male soccer players were recruited (23.56 ± 3.8 years, 78.1 ± 6.9 kg, 1.77 ± 0.06 m, and 12.5 ± 5.3% body fat). The sessions were performed in a randomized and counterbalanced crossover design, divided into four experimental conditions: endurance, endurance + MOT, endurance + MOT + AD, and endurance + AD. The soccer players completed the incongruent Stroop task utilizing an eye-tracker to assess cognitive effort. MOT task, subjective mental fatigue, and HRV were evaluated before the endurance training (60%Δ of maximal aerobic velocity during 40-min) and after 30-min and 24-h of recovery. These sessions were designed to investigate the acute effect of prolonged cognitive effort (repeated MOT throughout the endurance task) and AD (constant crowd noise and coach's voice each 15-40 s, totalizing = 80 voices) on inhibitory control, MOT skills, HRV, and subjective mental fatigue after a fixed endurance training session. RESULTS: There was no condition × time interaction for accuracy of inhibitory control (p > 0.05, ηp2 = 0.001). There was a significant condition × time interaction for inhibitory control response time (p < 0.05, ηp2 = 0.16). A higher response time of inhibitory control was found for the endurance + MOT + AD and endurance + MOT experimental sessions (p < 0.05). There was a significant condition × time interaction for subjective mental fatigue (p < 0.05, ηp2 = 0.46). A higher subjective mental fatigue was found for the endurance + MOT + AD and endurance + MOT experimental sessions (p < 0.05). There was no condition × time interaction for HRV (p > 0.05, ηp2 = 0.02). CONCLUSION: We concluded that cognitive effort throughout a prolonged endurance session impaired inhibitory control and increased mental fatigue without promoting greater MOT skill and HRV changes in professional soccer players.

Effects of Nutritional Interventions on Athletic Performance.

The search to comprehend the fundamental physiological factors that contribute to the exceptional endurance performance of elite human athletes is a long-standing endeavor within the field of sports science research [...].

A cross-sectional case-control study on the structural connectome in recovered hospitalized COVID-19 patients.

COVID-19 can induce neurological sequelae, negatively affecting the quality of life. Unravelling this illness's impact on structural brain connectivity, white-matter microstructure (WMM), and cognitive performance may help elucidate its implications. This cross-sectional study aimed to investigate differences in these factors between former hospitalised COVID-19 patients (COV) and healthy controls. Group differences in structural brain connectivity were explored using Welch-two sample t-tests and two-sample Mann-Whitney U tests. Multivariate linear models were constructed (one per region) to examine fixel-based group differences. Differences in cognitive performance between groups were investigated using Wilcoxon Rank Sum tests. Possible effects of bundle-specific FD measures on cognitive performance were explored using a two-group path model. No differences in whole-brain structural organisation were found. Bundle-specific metrics showed reduced fiber density (p = 0.012, Hedges' g = 0.884) and fiber density cross-section (p = 0.007, Hedges' g = 0.945) in the motor segment of the corpus callosum in COV compared to healthy controls. Cognitive performance on the motor praxis and digit symbol substitution tests was worse in COV than healthy controls (p < 0.001, r = 0.688; p = 0.013, r = 422, respectively). Associations between the cognitive performance and bundle-specific FD measures differed significantly between groups. WMM and cognitive performance differences were observed between COV and healthy controls.

Thinking About Elite Performance: The Experience and Impact of Mental Fatigue in Elite Sport Coaching.

PURPOSE: Mental fatigue causes decreases in aspects of athletes' performance. Elite coaches commonly undertake cognitively demanding tasks and are seemingly at similar risk of subsequent performance impairment. However, elite sport coaches' experiences of mental fatigue, alongside other markers of psychobiological stress, have yet to be quantified. METHODS: Three elite coaching and performance staff (2 women and 1 man) provided 100-mm visual analog scale ratings of mental fatigue, physical fatigue, readiness to perform, and salivary samples for later cortisol (sCort) and alpha-amylase (sAA) analysis. Data were obtained on the same morning each week across a 16-week preseason. Data were subset by individual coach for descriptive and repeated-measures correlational analyses. RESULTS: Fluctuating mental fatigue was observed over the 16 weeks (min-max; coach 1 = 25-86 AU; coach 2 = 0-51 AU; and coach 3 = 15 - 76 AU). Elevated levels of mental fatigue were reported at multiple time points, with individual variability observed. sCort (in nanomoles per liter), sAA (in micromoles per liter), and sAA:sCort indicated that coaches experienced psychophysiological stress (min-max; coach 1 sCort = 8.42-17.31, sAA = 52.40-113.06, sAA:sCort = 3.20-12.80; coach 2 sCort = 4.20-9.70, sAA = 158.80-307.20, sAA:sCort = 21.10-61.70; and coach 3 sCort = 6.81-19.66, sAA = 86.55-495.85, sAA:sCort = 4.90-35.50). A significant inverse relationship between mental fatigue and readiness to perform (r = -.44 [-.64 to -.17], P = .002) was identified. CONCLUSIONS: Elite sport coaches report elevated instances of mental fatigue during a preseason training period. Those involved in elite sports should act to understand the presence and potential subsequent impacts of staff mental fatigue and consider management or mitigation strategies. Optimization of the cognitive performance of coaches and performance staff presents as a potential source of competitive advantage.

Brain Neuroplasticity Related to Lateral Ankle Ligamentous Injuries: A Systematic Review.

BACKGROUND: Lateral ankle sprains are the most common ankle injuries in sports and have the highest recurrence rates. Almost half of the patients experiencing lateral ankle sprains develop chronic ankle instability. Patients with chronic ankle instability experience persistent ankle dysfunctions and detrimental long-term sequelae. Changes at the brain level are put forward to explain these undesirable consequences and high recurrence rates partially. However, an overview of possible brain adaptations related to lateral ankle sprains and chronic ankle instability is currently lacking. OBJECTIVE: The primary purpose of this systematic review is to provide a comprehensive overview of the literature on structural and functional brain adaptations related to lateral ankle sprains and in patients with chronic ankle instability. METHODS: PubMed, Web of Science, Scopus, Embase, EBSCO-SPORTDiscus and Cochrane Central Register of Controlled Trials were systematically searched until 14 December, 2022. Meta-analyses, systematic reviews and narrative reviews were excluded. Included studies investigated functional or structural brain adaptations in patients who experienced a lateral ankle sprain or with chronic ankle instability and who were at least 18 years of age. Lateral ankle sprains and chronic ankle instability were defined following the recommendation of the International Ankle Consortium. Three authors independently extracted the data. They extracted the authors' name, publication year, study design, inclusion criteria, participant characteristics, the sample size of the intervention and control groups, methods of neuroplasticity testing, as well as all means and standard deviations of primary and secondary neuroplasticity outcomes from each study. Data reported on copers were considered as part of the control group. The quality assessment tool for observational and cross-sectional studies was used for the risk of bias assessment. This study is registered on PROSPERO, number CRD42021281956. RESULTS: Twenty articles were included, of which only one investigated individuals who experienced a lateral ankle sprain. In all studies combined, 356 patients with chronic ankle instability, 10 who experienced a lateral ankle sprain and 46 copers were included. White matter microstructure changes in the cerebellum have been related to lateral ankle sprains. Fifteen studies reported functional brain adaptations in patients with chronic ankle instability, and five articles found structural brain outcomes. Alterations in the sensorimotor network (precentral gyrus and supplementary motor area, postcentral gyrus and middle frontal gyrus) and dorsal anterior cingulate cortex were mainly found in patients with chronic ankle instability. DISCUSSION: The included studies demonstrated structural and functional brain adaptations related to lateral ankle sprains and chronic ankle instability compared to healthy individuals or copers. These adaptations correlate with clinical outcomes (e.g. patients' self-reported function and different clinical assessments) and might contribute to the persisting dysfunctions, increased re-injury risk and long-term sequelae seen in these patients. Thus, rehabilitation programmes should integrate sensorimotor and motor control strategies to cope with neuroplasticity related to ligamentous ankle injuries.

Work performance in industry: The impact of mental fatigue and a passive back exoskeleton on work efficiency.

Mental fatigue (MF) is likely to occur in the industrial working population. However, the link between MF and industrial work performance has not been investigated, nor how this interacts with a passive lower back exoskeleton used during industrial work. Therefore, to elucidate its potential effect(s), this study investigated the accuracy of work performance and movement duration through a dual task paradigm and compared results between mentally fatigued volunteers and controls, with and without the exoskeleton. No main effects of MF and the exoskeleton were found. However, when mentally fatigued and wearing the exoskeleton, movement duration significantly increased compared to the baseline condition (ßMF:Exo = 0.17, p = .02, ω2 = .03), suggesting an important interaction between the exoskeleton and one's psychobiological state. Importantly, presented data indicate a negative effect on production efficiency through increased performance time. Further research into the cognitive aspects of industrial work performance and human-exoskeleton interaction is therefore warranted.

Correction: Habay et al. Mental Fatigue-Associated Decrease in Table Tennis Performance: Is There an Electrophysiological Signature? Int. J. Environ. Res. Public Health 2021, 18, 12906.

In the published publication [...].

A Multiday Professional Padel Tournament Impairs Sleep, Mental Toughness, and Reaction Time: A World Padel Tour Field Study.

This study aimed to assess, for the first time, how self-reported sleep, mental toughness, and reaction time are impacted by a professional padel tournament. In addition, we evaluated whether sex, age, and/or ranking play a role in this possible effect of a tournament on these variables. Twenty-three professional players (15 men, Mage = 24 ± 6 years; eight women, Mage = 21 ± 5 years) were evaluated on two occasions: (a) baseline, in a noncompetitive week and (b) postmeasure, the morning after an individual was eliminated from the tournament. The Pittsburgh Sleep Quality Index, the Mental Toughness Questionnaire, and the psychomotor vigilance task were used to evaluate the dependent variables. Wilcoxon tests or paired samples t tests were employed to assess the effect of participating in the tournament. To test correlations between variables, Pearson correlation coefficients (quantitative variables) or chi-square distributions (qualitative variables) were employed. Results showed that self-reported sleep (p < .01), mental toughness (p = .01), and reaction time (p = .04) were significantly impaired by the tournament. Exploring moderating variables, results showed that mental toughness did not correlate with sleep impairments (p > .05). In contrast, a nearly significant correlation between sleep impairments and higher reaction times was found (p = .066). No significant effects of age, sex, and ranking were observed. In conclusion, participating in a padel competition impairs the self-reported sleep, mental toughness, and reaction time of professional padel players. A trend toward a significant correlation between the competition-related impairment in sleep and reaction time was observed, whereas age, ranking, and sex were not found to be moderators of any of these impairments.

Interindividual Variability in Mental Fatigue-Related Impairments in Endurance Performance: A Systematic Review and Multiple Meta-regression.

BACKGROUND: The negative effect of mental fatigue (MF) on physical performance has recently been questioned. One reason behind this could lie in the interindividual differences in MF-susceptibility and the individual features influencing them. However, the range of individual differences in mental fatigue-susceptibility is not known, and there is no clear consensus on which individual features could be responsible for these differences. OBJECTIVE: To give an overview of interindividual differences in the effects of MF on whole-body endurance performance, and individual features influencing this effect. METHODS: The review was registered on the PROSPERO database (CRD42022293242). PubMed, Web of Science, SPORTDiscus and PsycINFO were searched until the 16th of June 2022 for studies detailing the effect of MF on dynamic maximal whole-body endurance performance. Studies needed to include healthy participants, describe at least one individual feature in participant characteristics, and apply at least one manipulation check. The Cochrane crossover risk of bias tool was used to assess risk of bias. The meta-analysis and regression were conducted in R. RESULTS: Twenty-eight studies were included, with 23 added to the meta-analysis. Overall risk of bias of the included studies was high, with only three presenting an unclear or low rating. The meta-analysis shows the effect of MF on endurance performance was on average slightly negative (g = - 0.32, [95% CI - 0.46; - 0.18], p < 0.001). The multiple meta-regression showed no significant influences of the included features (i.e. age, sex, body mass index and physical fitness level) on MF-susceptibility. CONCLUSIONS: The present review confirmed the negative impact of MF on endurance performance. However, no individual features influencing MF-susceptibility were identified. This can partially be explained by the multiple methodological limitations such as underreporting of participant characteristics, lack of standardization across studies, and the restricted inclusion of potentially relevant variables. Future research should include a rigorous description of multiple different individual features (e.g., performance level, diet, etc.) to further elucidate MF mechanisms.