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Most academics use the citation count of their peer-reviewed publications to assess the impact of their research. Unfortunately, a substantial proportion of published articles are poorly cited, which suggests a minimal contribution by this work to the knowledge in a field. For example, Kortlever et al. found that 36% of the 135,029 articles published in 204 orthopedic journals between 2002-2012 could be classified as poorly cited (≤ five citations after publication). Moreover, the proportion of poorly cited articles increased from 27% (7,860) in 2002 to 43% (16,282) in 2012. A similar analysis of 164,377 articles published in 222 cardiovascular journals from 1997 to 2007 found that 46% (75,550) were poorly cited (≤ five citations within five years after publication) and that 15.6% (25,650) had no citations at all.

These findings seem to indicate that ~40% of the articles published in peer-reviewed journals add little new knowledge to a field of study. Although some of these poorly cited articles deserve the lack of attention, others simply fail to communicate their findings effectively. As a countermeasure, authors could either cite their own work at every opportunity or improve their writing skills. I contend that a key element in reaching and being noticed by an intended audience is the title of the article.

In crafting a title for an article, an author must consider how best to convey its contents to the intended audience and how to minimize errors when it is entered into the major citation database systems (e.g., Scopus, Web of Science, Google Scholar).

Effective titles share the following features:

• Informative – Use a declarative statement that summarizes the main point and scope of the article. The words included in the title are critical as they will help identify the article when readers are search databases with specific key words. Avoid using abbreviations or jargon.
• Concise – Titles should neither be too short nor too long but of sufficient length to provide concise informative statement (10-15 substantive words). An analysis of the 20,000 most-cited papers from 2007-2013 found that articles with shorter titles tended to be cited more often, a subsequent larger scale empirical study has cast doubt on this association. A colon can help keep the title concise.
• Create interest – The title must be crafted to attract the attention of the intended audience. Use words that motivate a potential reader to access the article.

What to avoid:

• Questions – Avoid posing a question in the title as it will not inform the potential reader about the main point of the article.
• Humor – The inclusion of a humorous phrase, typically after a colon, is not informative and will not be recognized by automated indexing systems. Moreover, your sense of humor will likely not be understood by many readers.
• Ambiguous characters – see the next section to learn about how characters can influence citation counts.

An under-appreciated issue that influences the citation count for an article is the robustness (ability to deal with erroneous input) of the major citation databases. The magnitude of this problem was demonstrated by Zhou et al. in a thorough evaluation of the performance of Scopus and Web of Science. The analysis was performed on 140,000 articles indexed by Scopus, and 34,892 articles indexed by Web of Science.  One of their most interesting results was that the citation count was more strongly correlated with the number of hyphens in the title rather than the length of the title. The effect was evident even when the title included only a single hyphen. Importantly, the influence of hyphenation was greater for more highly cited articles. The explanation for this finding was that the ambiguity of the hyphen character (-), which results in the compound phrase being interpreted differently by citing authors. These errors have two consequences: 1) erroneous information is added to the citation databases; 2) they are easily propagated as many authors simply copy and paste from an existing reference list without verifying the articles they cite.

Unfortunately, the inclusion of hyphens in article titles has a substantial influence on journal impact factors, which are derived from the error-prone Web of Science database. Zhou et al. found a strong negative correlation (R² = 0.47) between the impact factor of a specific engineering journal and the percentage of articles that included hyphens. Of note, they occasionally found inaccuracies in titles of articles downloaded from the Web of Science website. When the analysis was expanded to 106 software engineering journals (13,266 articles), they found that journals with higher impact factors published a lower percentage of articles with hyphenated titles. The negative influence of hyphens likely also permeates the World University Rankings that are derived from the Scopus database. Clearly, the use of hyphens in a title negatively impact the citation count for both the author and the journal.

There is no doubt that the title of your article has a significant influence on its impact. Your title must attract the attention of potential readers, and it must be simple enough to minimize errors in subsequent citations of your article. Your article title must be informative and concise, yet robust enough to minimize citation errors. 

Roger M. Enoka, Ph.D., is a professor of integrative physiology at the University of Colorado Boulder. He is the current Editor-in-Chief of Exercise and Sport Sciences Reviews (ESSR).

The Gatorade Sports Science Institute (GSSI) and ACSM recently hosted an industry-presented webinar with Lisa Heaton, MS, RD, CSSD, and Kelly Barnes, MS, entitled Fueling the Extra Mile: The Science of the Endurance Athlete.

Watch the full webinar here

Several questions were asked by attendees during the webinar and the answers pertaining to Exercise, Diets, and more are below.

Read the first half of the QnA here.

Key Points:

1. The sport nutrition needs for all athletes can be divided into 3 major categories: energy, hydration, and structure.




2. The body has an abundant storage of fats that can be used for fuel, but that is what the body turns to for the slower, less intense exercise.As exercise intensity increases, the body’s need for the fuel of carbohydrate increases; however this fuel storage is limited within the body.




3. The hydration needs of endurance athletes are unique, because as exercise intensity and duration increase, so do sweat losses — both fluid and electrolytes (specifically sodium, chloride, and potassium).To figure out sweat fluid losses, athletes should weigh themselves before and after exercise.Additional details on this testing and a calculator can be found at

   https://www.gssiweb.org/toolbox/fluidLoss/calculator.

Q: What specific protein sources would you recommend for those who cannot have milk/dairy/whey due to lactose intolerance or whey due to gluten intolerant?

Gluten is a protein that is found within wheat, barley and rye. For those individuals, products that contain gluten should be avoided. It is always important to check food labels for hidden sources of gluten, even in recovery products. For those with lactose intolerance, there are several lactose-free dairy products available at the grocery store. These products will contain the milk protein, but do not contain lactose. Please note there is a difference between lactose intolerance and a dairy allergy. For those that have an allergy to dairy, soy-based products are a complete protein option that will provide all of the essential amino acids the body cannot make, though the leucine content is just not quite as high as in whey/milk. That does not mean that the athlete will not receive a benefit though. There are also blends of various incomplete protein sources (missing or low in certain essential amino acids) appearing on the market that theoretically provide all the essential amino acids once combined. Currently, there is little research validating this theoretical assumption but hopefully in the future we will start to see that emerge. In terms of general diet, the only other plant-based protein that is complete is Quinoa. Otherwise, consuming a variety of plant-based foods (starchy and non-starchy vegetables, beans, legumes, etc.) throughout the day will support the necessary essential amino acid intake.

Q: Please explain the physiology behind beta-alanine... does it act as a base?

Beta-alanine acts as a hydrogen buffer during high intensity exercise; thus, helping to normalize pH.

Q: How is sweat rate calculated during swimming?

Sweating rate during swimming is calculated almost the same as during any other sport.  The only difference is that we need to ask the athletes to be very diligent about not consuming water or urinating while swimming.  We often have the athletes get into the water first, come out and towel dry as thoroughly as possible, then step on the scale for a pre-exercise body mass.  Then when they are finished swimming, we ask them to towel dry in the same exact manner as they did pre-exercise prior to the post-exercise body mass.

Q: Why not any protein during his actual competition? His hx of GI upset?  Why is having protein with "Jons" breakfast not ideal? I always thought slowing carb digestion a bit was preferred in endurance athletes.

Protein can slow gastric emptying and is not a primary source of fuel during exercise; therefore, it is better suited for after exercise. In the case study, Jon was consuming his breakfast less than 2 hours prior to his training session/race. The goal was to get the carbohydrate (glucose) into his body to allow it to be utilized as fuel as he started his training. We wanted to avoid slowing digestion prior to exercise to limit potential for GI issues when he started.

Q: What are electrolytes? What's in them?

Sodium, chloride and potassium are the electrolytes lost in the highest quantity in sweat and are the most important for replacement.  For this reason, these electrolytes, along with others such as calcium, magnesium, and zinc, are often found in sport nutrition products.

Q: Regarding the 30g/60g/90g based on training duration, when was that intake supposed to occur?

These numbers all related to the quantities of carbohydrate that an athlete should consume during exercise.  This intake should start just before or even at the start of exercise and should continue gradually for the duration of the exercise — ensuring the that quantity of carbohydrate is met. The athlete should test out the amount and timing that works best for them in training. Many athletes will split their hourly carbohydrate intake similarly to how they split fluid intake; e.g., every 20 minutes.

Q: Can you speak about sports drinks that have a higher potassium and lower sodium content?

Sodium is the electrolyte lost in the highest quantity in sweat and should be the focus for replacement.  Beverages with higher levels of other electrolytes can help with fluid retention, but not sodium replacement, and can be used when sodium losses are lower, exercise duration is shorter, or there is ample time between exercise sessions to replace electrolytes through food.

Q: If an athlete is going to train for 2-3 hours, do they start eating carbohydrate after the first 30 minutes, or after the first hour?

When an athlete is planning to train for that extended duration, they should be consuming carbohydrate in the hours leading up to training and all throughout training.  There is no need to wait to start consuming. The athlete should consider the small amount of carbohydrate they take in in the hour prior to training as the “start” of their fueling. This carbohydrate will not be stored as glycogen; rather, it will still be circulating in the blood stream as glucose and can be pulled in by working muscles as a fuel source.

Q: The example persona had an ideal weight. In general, how would the nutrition plan change if he were overweight?

Again, this would depend on the goal of the exercise.  If the goal of the exercise is performance, then an overweight person would have the same recommendations as an ideal weight person.

Q: What is your suggestion for the athlete not losing weight pre/post workout but having cramping issues?

Exercise-associated muscle cramping can be caused by a few different factors.  Some may be related to dehydration, some to electrolyte imbalance, and some to neuromuscular fatigue.  If this same athlete is hydrating properly, but still cramping, do you see white (salt) residue on their skin or clothing after exercise?  The addition of electrolytes to the sport nutrition plan may help.  However, if the cause is neuromuscular fatigue, then proper hydration and electrolyte replacement may cause less cramping but will not eliminate it.

Q: There's more data coming out that acknowledges the differences between men and women and I'm wondering why these differences weren't presented or if you can talk about those. For example, the glycogen turnover difference and how that affects the carb intake. Or the digestion of fructose difference between men and women (women don’t digest as well and are more likely to get GI distress from fructose such as Gu).

The research in this area is still fairly novel and we did not have time to cover it within the session. Many endurance-based studies have been conducted in men because undertaking a controlled research study with women has posed a challenge based upon hormone changes during the menstrual cycle. Fortunately, there are researchers who are attempting to answer these questions.

Q: Can you debunk the carb load myth....carb load the day before? Is this beneficial or is it 2 days before?

Athletes do not need to go crazy overconsuming carbohydrates the night before competition.  Their routine carbohydrate intake should be about 7-10 g of carbohydrate per kilogram body weight per day.

Q: General recommendation for appropriate foods (specific meats, veggies, etc.) to meet carbohydrate and protein consumption recommendations?

The last few slides of the webinar address this question in detail.

Q: Do we know if 20g of protein following exercise is just as applicable to young athletes?  Why is 24g of protein the amount that is recommended to consume per serving? If an athlete consumed more than that would this not be digested?

All protein consumed will be digested; however, the human body does not store excess protein beyond what can be used at a given moment (e.g., muscle protein synthesis, hormone production) and will be de-aminated and oxidized for energy. The timing of protein intake intervals, type of protein, and the size/type of athlete will dictate how much can be absorbed and used. It is recommended that the athlete consume protein at regular intervals throughout the day to maximize the opportunities for the body to use the protein. Around 20 grams is a good amount post-exercise for most athletes; however, recent research has teased out the amount of 0.25-0.3g/kg protein and can allow the athlete to tailor intake further.

In terms of daily protein intake, the amount can range anywhere from 1.2-2.0 g/kg (potentially more if the athlete is attempting to lose weight) and should depend upon the individual athlete’s needs. Once calculated, the total protein intake could be broken down between 4-6 meals/snacks to maximize the utilization of the protein.  

Q: How do we do a sweat analysis?

The hydration needs of endurance athletes are unique, because as exercise intensity and duration increase, so do sweat losses — both fluid and electrolytes (specifically sodium, chloride, and potassium).  To figure out sweat fluid losses, athletes should weigh themselves before and after exercise.  Additional details on this testing and a calculator can be found at https://www.gssiweb.org/toolbox/fluidLoss/calculator.

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Nutrition and the Exercise Professional’s Scope of Practice

Coaches Kyle Kercher and Peter Ronai show you simple push up and bench press tips that you can use right away. This clip is from the two-part course Do it Right -Teaching Barbell Movements and Implementing a Premium Strength Program in Your Facility.

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• Describe how to undertake an initial proficiency assessment of primary movements and utilize the information to structure an individualized program.
• Implement teachable progressions for primary lifts.
• Identify the key elements of implementing a safe premium strength and conditioning program at your facility for both novice and intermediate-level participants.

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Integrating Nutrition Into Training

An exercise professional can and should discuss nutrition with their patients and clients.

This information, however, should be limited to general, non-medical nutrition information that is accurate and delivered to healthy individuals.
Examples of this include:

• Principles of healthy food shopping and preparation
• Foods to be included in the normal daily diet of HEALTHY individuals
• Recommended amounts of the essential nutrients (dietary reference intakes) for HEALTHY individuals
• The effects of deficiencies or excesses of nutrients
• Specific foods or supplements that are sources of essential nutrients
• Providing information about food guidance systems (e.g., USDA Dietary Guidelines, food labels and MyPlate)
• The actions of nutrients on the body
• The basic roles of carbohydrates, proteins, fats, vitamins, minerals and water
• Giving statistical information about the relationship between chronic disease and the excesses or deficiencies of certain nutrients
• Following ACSM guidelines for proper hydration in HEALTHY individuals

Additional information on this topic can be found in a related post: Nutrition and the Exercise Professional’s Scope of Practice

1. Should I Consume Sports Drinks or Does Water Work Just as Well?

Sports drinks contain carbohydrate and electrolytes that are useful in maintaining water and energy balance. Studies of endurance athletes, athletes in stop-and-go sports and athletes in power sports all show that consumption of sports drinks during practice and competition does a better job of enhancing athletic performance than water alone.

2. Should I Skip Lunch If I’m Trying to Lower My Body Fat Level?

Skipping meals is one of the biggest reasons people have high body fat levels. If you are trying to lose body fat, your goal should be to maintain blood sugar levels through the consumption of small, frequent meals. Declines in blood sugar will trigger feelings of hunger which often lead to overeating. 

3. Should I Eat or Drink Anything during Exercise?

Maintaining a constant flow of carbohydrates to muscles and maintaining blood sugar during competition is an important strategy for success. Your clients should consider sipping on a sports beverage (approximately ½ to 1 cup every 15-20 minutes) during competition to achieve this result. If there are long breaks during an exercise workout, then consuming a carbohydrate snack (e.g., crackers, bread) might be acceptable provided that fluid is also consumed.

4. I’m a Profuse Sweater and Occasionally Get Serious Cramps. Is There Anything I Should Be Doing to Avoid this Problem?

Cramps are typically associated with dehydration and sodium loss. Try making certain that sufficient sodium-containing fluids (i.e., sports beverages) are consumed during practice and competition. Unless you have a history of high blood pressure, you should also consider adding a small amount of salt to the food you eat, following with plenty of water.

5. How Can I Tell if I’m Dehydrated?

The easiest way to tell is that your urine will be dark, and there won’t be very much of it. Light-colored or clear urine is a sign of adequate hydration, whereas dark urine suggests dehydration. It takes time to rehydrate, so avoiding dehydration is the appropriate strategy.

These FAQs are based on content from chapter 6, Nutrition and Human Performance of ACSM’s Resources for the Personal Trainer, 5^th edition

Additional Resources

• Kruskall LJ. Nutrition and the Exercise Professional’s Scope of Practice. ACSM Certification Blog [Internet]. 2019 Sept 9 [cited 2019 Oct 21].
• Battista RA, editor. ACSM’s Resources for the Personal Trainer, 5^th edition. Philadelphia (PA): Wolters Kluwer Health; 2018.
• Benardot D. ACSM’s Nutrition for Exercise Science. Philadelphia (PA): Wolters Kluwer Health; 2018.
• Kruskall LJ, Manore MM, Eickhoff-Shemek JM, Ehrman JK. Drawing the Line: Understanding the Scope of Practice among Registered Dietitian Nutritionists and Exercise Professionals. American College of Sports Medicine Health & Fitness Journal. 2017;21(1):23-32.

Author: 

Laura J. Kruskall, PhD, RDN, CSSD, LD, FACSM, FAND, ACSM-EP
Dr. Kruskall is an Associate Professor at University of Nevada, Las Vegas (UNLV) and is the Director of the Dietetic Internship & the UNLV Nutrition Center.  Her areas of expertise are sports nutrition, weight management and medical nutrition therapy. Her research interests include the effects of nutrition or exercise intervention on body composition and energy metabolism.  In addition to her duties at the university, Dr. Kruskall is a member of the Editorial Board for ACSM’s Health & Fitness Journal®, is an ACSM Certified Exercise Physiologist, and is a nutrition consultant for Canyon Ranch Spaclub and Cirque du Soleil in Las Vegas.

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