DKE #1 (Group 1): Knowledge of the heart rate, stroke volume, cardiac output, blood pressure responses during sub-maximal and maximal exercise.Performing exercise plays a significant demand on the cardiovascular system because the muscles physiological responses demand oxygen and nutrients to the working muscle tissues. As intensity increases, the heart beats more quickly (Kenney, Wilmore, & Costill 2015).  More nutrients and oxygen are being transported through the bloodstream, and therefore, the heart can pump more blood to maintain the supply of oxygen and nutrients by keeping up with the adaptations in the environment and the metabolic demands.Submaximal exercise indicates the amount of oxygen consumption and measures the individual’s current state of aerobic fitness by recording the heart rate response. A resting heart rate (HR) averages between 60 to 80 beats per minute in healthy individuals, and younger individuals as high as 100 beats per minute, and elite endurance athletes as low as 20 to 40 beats per minute. During submaximal exercise, HR increases as exercise intensity increase over time. The autonomic nervous system (ANS) also known as the “fight or flight system” controls involuntary functions, through two divisions, the sympathetic and parasympathetic. The sympathetic division which is an intrinsic factor is active when performing an exercise or when the participant is under stress. The parasympathetic division is an extrinsic factor and is active at rest. During training, the parasympathetic inputs the sinoatrial (SA) node declines and sympathetic input increases, increasing HR (Kenney et al., 2015). Furthermore, the sympathetic increases the rate of depolarization and the conduction speed of the heart rate.Maximal exercise also known as VO2 determines the peak oxygen consumption of the central and peripheral factors that influence the body’s capacity to pump oxygen to the blood when the HR is higher than 85% of the age-predicted value. During maximal exercise, the sympathetic response can increase up to 250 beats per minute. Also, the force of contraction in the ventricles increases as well when the exercise is performed at times of physical or emotional stress of a heart rate greater than 100 beats per minute (Kenney et al., 2015). Additionally, when the heart rate is less than 100 beats/min the parasympathetic takes complete action and this is because when the exercise begins at low intensity, the heart rate will slowly increase overtime.Stroke volume (SV) increases at rest, submaximal and maximal exercises following training. Stroke volume is determined by four factors: volume of venous blood returned to the heart, ventricular distensibility, ventricular contractility, and aortic or pulmonary pressure on the left ventricle of the heart (Kenney et al., 2015). Stroke volume increases as the exercise intensity increases between 40% to 60% of maximal oxygen consumption. At this time, the stroke volume will reach a plateau and will remain unchanged up to the point of exhaustion (Kenney et al., 2015). Also, stroke volume at resting averages 50-70 millimeters per minute in untrained individuals, 70 to 90 millimeters per minute in trained individuals and 90 to 110 millimeters per minute in world-class endurance athletes (McArdle, Katch, and Katch, 2006). The increase in stroke volume leads to an attributable greater end-diastolic filling. The greater the filling of the left ventricle then leads to adaptations due to: an increase in blood plasma and blood volume, this leads to a decrease in HR and then increases the diastolic filling time. According to the Frank-Starling mechanism, the increased filling on the left ventricle increases its elastic recoil thus producing a more forceful contraction (Kenney et al., 2015). When the heart is filled, this indicates that there is more blood to eject, it expels a more significant percentage of the end-diastolic volume (EDV) compared to training.Cardiac output (CO) is the total volume of blood pumped by the left ventricle of the heart per minute. It is the product of heart rate and stroke volume (Kenney et al., 2015). During submaximal exercise, cardiac output thus plays an essential role in meeting the oxygen demands for the work of submaximal and maximal exercises and other various work. As the rate of exercise increases, the cardiac output increases in a nearly linear manner to meet the increased oxygen demand, but only up to the point where it reaches its maximal capacity. After training, stroke volume increases at rest, during submaximal, and maximal exercise; conversely, post-training heart rate is decreased at rest and during exercise and is usually unchanged at maximal rates of work. The increase in stroke volume appears to be the dominant change and explains most of the changes observed in cardiac output.Blood Pressure (BP) is the force of contraction of a heart beat that measures the elasticity within the arterial walls. Blood pressure is recorded using two numbers, systolic blood pressure (SBP) is the top number, and this number has a likelihood of increasing due to the level of intensity the heart is exerting against the arterial walls. A normal blood pressure is 120/80 mmHg. At rest, the healthy individual’s heart rate ranges between 110 to 140 mmHg. During exercise, the pressure of contraction of the heart can increase, reaching peak values of between 200 and 240 mmHg.  Additionally, the increase in systolic is caused by the increased cardiac output, which outweighs the decrease in resistance. Diastolic blood pressure (DBP) remains relatively unchanged regardless of exercise intensity. Diastolic remains relatively consistent because of peripheral vasodilation, which facilitates blood flow to the working muscles. The small rise in systolic blood pressure and the lack of a significant change in diastolic because the mean arterial pressure (MAP) to rise only slightly, following the pattern of systolic.One article focused on the precapillary pulmonary hypertension (PH) would be slower than those of healthy subjects, but no study has been conducted to observe maximal exercises responses. (Lador, Bringard, Bengueddache, Ferretti, Bendjelid, Soccal, & Sitbon, 2016). The study consisted of five patients with precapillary pulmonary hypertension (four with pulmonary arterial hypertension, and 1 with chronic thromboembolic pulmonary hypertension) and ten healthy control patients were collected. Patients in the healthy group displayed an increase at the beginning of exercise reaching a new steady state, whereas pulmonary hypertension patients cardiac output decreased between three to five beats, stabilizing 20 seconds during the exercise thus, reaching a new steady state level. The healthy control group displayed a decrease in heart rate on the onset of exercise, but the change was not seen in pulmonary hypertension participants. Also, assessing cardiac output in pulmonary hypertension patients using beat-by-beat kinetics displaced a decrease in response at a supine position on the cycle ergometer, making the hypothesis statistically significant. Before the decrease in cardiac output on the onset of exercise, there was a drop-in stroke volume.I chose this DKE because by I learned how to distinguish heart rate, stroke volume, cardiac output and blood pressure between submaximal and maximal exercise tests. Which test is more approriate for patients who have experienced chronic obstructive pulmonary disease COPD), to those who suffer from cardiovascular disease. I found it beneficial that performing a submaximal test would be more applicable to people who suffer from cardiovascular disease, and those who are not exposed to exercise that often, or individuals whose goal is to measure baseline endurance. An individual can use a treadmill test to increase the elevation or a bike test to increase resistance in such instances of submaximal testing. Submaximal tests stop when the heart rate reaches 85 percent of the max heart rate. Whereas, a maximal test would be used to measure the direct oxygen consumption and maximum heart rate and the amount of carbon dioxide that one expels during the test. DKE #2 (Group 3): Knowledge of the role of carbohydrates, fats, and proteins as fuels for aerobic exercise.The capacity of an individual to perform an aerobic exercise allows the body to extract energy from three main macronutrients that are large and energy-yielding as potential fuel sources: carbohydrates, fats, and proteins. Macronutrients are foods that are consumed and complied with distinctive metabolic paths within the body. However, all of them ultimately yield water, carbon dioxide, and chemical energy referred to as adenosine triphosphate (ATP). ATP, in truth, is the most effective molecule capable of providing energy to muscle fibers to power muscle contractions.Carbohydrates are categorized as sugar and starch and provide 4 kilo calories per gram; it is the most crucial energy supply that is broken down into the form of glucose, which provides a rapid release of energy that is called glycolysis (Thompson, Manore, 2018). When the body is in need of oxygen and is limited, the end product of glycolysis is pyruvic acid, is then converted into lactic acid. Lactic acid plays a significant role in breaking down glucose to supply energy to the working muscles, heart, and tissues.  Glucose may be used immediately as a fuel or may be sent to the liver and muscular tissues and stored as glycogen. At some point of exercising, muscle glycogen is converted returned into glucose, which only the muscle fibers can use as fuel. The liver converts its glycogen again into glucose, too; but, it is released directly into the bloodstream to maintain your blood sugar (blood glucose) level (Kenney, Wilmore, & Costill 2015). In the course of exercising, your muscle mass selects up to a number of this glucose and use it in addition to their private glycogen stores. Blood glucose additionally serves as the maximum vast source of energy for the brain, both at rest and during submaximal and maximal exercis. The body always uses and replenishes its glycogen stores. The carbohydrate content material of your eating regimen and the type and quantity of training which you undertake affect the size of your glycogen stores. The potential of your body to store muscle and liver glycogen, but, is limited to approximately 1,800 to 2,000 calories worth of energy, or sufficient fuel for 90 to one hundred twenty minutes of continuous, vigorous activity (Thompson et al., 2018). As the individual continues to exercise, muscle glycogen reserves continually decrease, and blood glucose plays an increasing role in meeting the body’s energy needs.Fats also known as a “lipid or adipose tissue” is assessed as an organic compound this is hydrophobic to water. Fat provides 9 kcal per gram. Fat is visible in forms along with triglycerides, free fatty acids (FFA’s), phospholipids, and sterols (Kenney et al., 2015). Triglycerides are composed of a glycerol backbone and are attached to three FFA’s and are stored inside the body and are taken into consideration as the most concentrated source of energy which means that it provides more energy than carbohydrates in which they have 4 kilo calories per gram. For the duration of exercise, the triglycerides are damaged and broken down into fatty acids. These fatty acids are broken down into types: saturated (no double bond, and has a most hydrogen bond) and unsaturated (consists of a monosaturated molecule) are transported through the blood to muscle tissue for fuel. There are two advantages of utilizing fat as a fuel source; one is fat is an abundant energy source and fat as nine kcal per gram which is twice the energy a carbohydrate will provide. The two disadvantages are, that fat breaks down relatively slow and fat are more beneficial during a low-intensity and duration of an exercise (Thompson et al., 2018). In contrast to the  glycogen storage, which are limited, body fat is a virtually limitless source of energy for athletes. Consuming fat for an athlete acting on an aerobic exercise is vital because the muscle and glycogen storage is confined so while the free fatty acids are available, it is going to delay exhaustion and fatigue throughout exercising by way of presenting power to the body (Thompson et al., 2018). Now not only does fat stimulate the muscle tissue to perform, but it does no longer promote fat loss. Ingesting high-fat food products will most effective elevate the breakdown of the food, therefore providing the body for energy.As for protein, also known as amino acids are not the primary source of energy during exercise and provide 4 kilo calories per gram. Proteins are primarily used to maintain blood glucose levels during exercise as a fuel source. As an alternative, protein are used to build, support, and repair body tissues, as well as to synthesize vital enzymes and hormones. Under normal circumstances, protein meets only 5 percent of the body’s energy needs (Kenney et al., 2015). In some conditions, however, including when an individual eats little calorie daily or not enough carbohydrate, as well as for the duration of following ranges of endurance exercise while glycogen reserves are depleted, skeletal muscle is damaged down and used as gasoline. At this rate the body needs amino acids that can convert into glucose for energy (Thompson et al., 2018). Take into account; the human brain also needs a consistent, steady supply of glucose to function optimally. Protein is used in the later stages during a longer duration of a workout,The body will then breakdown amino acids that are located in the skeletal muscle mass to supply the body energy. In this case, the body is pressured to rely on protein to meet its energy needs, leading to the breakdown of lean muscle groups (Kenney et al., 2015).One study included eight physically active premenopausal women and aimed to compare the metabolic responses between a single low carbohydrate and low-fat meal following an aerobic exercise (Gregory, Wood, Matthews, VanLangen, Sawyer, & Hedley, 2011). The methodology involved four testing sessions that included eight premenopausal females between the ages of 20 and 45 years old. Premenopausal women are defined to have missed 2 or more menstrual cycles in a year. Women recruited were moderately active and exercised 3 to 4 days a week for the last six months before testing. Results show that there was statistical significance among meal and time, insulin levels expanded during low-sugar and low-fat intake, however during postprandial, the insulin levels were brought down after the two eating regimens. There were no indications of insulin between the meals and after exercise. At the onset of exercise, carbohydrates are converted into fuel as an immediate energy source. Secondly, fats are converted to fuel when there is an adequate amount of oxygen in an individual’s body. As a person continues to exercise and perform aerobic activity, the body will convert fat into fuel and allow workouts to continue for longer durations. This benefits in weight loss, and reducing the risks associated with cardiovascular disease. Proteins are the repair, maintain, and grow mechanism that allows for muscle rebuild from strength and aerobic training. The structural damage that is done to the tissues sends the body a signal to build and repair muscle tissue to take on longer duration of exercises.I chose this DKE because I learned that the carbohydrates are the primary energy fuel for the muscles. Fats act a backdrop to fuel the body when the human body is running low on energy and thus releases triglycerides. Proteins act a repair mechanism to rebuild the tear in the connective and muscle tissue after exercise. I find this DKE to be very beneficial because it f allows me to apply the knowledge to my cardiac and pulmonary patients who are unaware of their food intake and dietary restrictions and habits. This article expanded my knowledge to take into considerations the proper macronutrient intake pre and post exercise and the effects. DKE #3 (Group 3): Knowledge of the nutrition and exercise effects on blood glucose levels in diabetes.Diabetes is a chronic disease in which the body can no longer maintain glucose within normal limits. Diabetes has affected over 25.8 million of American’s across the United States of America, and this includes children and adults (Thompson, Manore, 2018). Furthermore, when there is chronic exposure of blood glucose levels, this will damage the blood vessels in the circulatory system, When it is left untreated, glucose levels will rise and will cause a chemical imbalance allows the glucose to attach to proteins and ones that make up the blood vessels. Damage to the larger vessels will cause cardiovascular disease because there is a plaque build up on the artery wall which will block the pathway preventing oxygen and nutrient flow to the bloodstream. When the artery is damaged, and there are not enough nutrients and oxygen, the nerves become damaged as well. There are four types of diabetes, but the two primary forms are types I and II, third, gestational diabetes, and lastly, secondary diabetes.Type I diabetes is caused by the inability of the pancreas to produce a sufficient amount of insulin and beta cells.  In cases of Type II diabetes, the patient lacks insulin their body and fails to transport an adequate amount of glucose to the cell. Therefore, insulin resistance means that the insulin concentration in the blood is less than what the body should be producing. The primary role of insulin is to transport glucose into the cell and across the cell membrane. Both type I and type II diabetes plasma glucose level must be higher than 125 mg/dL following an 8h fast, whereas an impaired fasting glucose plasma level is between 100 and 125 mg/dL. Gestational diabetes is developed in women who are pregnant, but it usually goes away when the mother is giving birth to her child. If it is present, there will be complications. Secondary diabetes occurs when there are impaired fasting glucose and impaired glucose tolerance. Whether an individual has diabetes is determined by a glucose intolerance test.I If the plasma level is higher than 200 mg/dL the individual has a case of diabetes. Blood glucose values between 140 and 199 mg/dL are an impaired glucose intolerance or prediabetes, and blood glucose values of 140 mg/dL and below are considered normal values.Signs and symptoms of Type I diabetes include frequent urination, excessive thirst, extreme hunger, fatigue, and irritability. Neuropathy occurs when there is a loss of sensation in the hands and feet; this happens when the blood vessels are damaged and are unable to supply oxygen and nutrients to the nerve cells. The limbs are affected as well due to the lack of circulation.  Patients with Type II, on the other hand, have experienced similar symptoms of Type I diabetes, although they also experience blurred vision, numbness and tingling in hands, cuts, bruises, and infections through the skin, gum, and bladder. If diabetes is uncontrolled, the body will begin to impair carbohydrates as they start to break down to store fat. Therefore, it begins to produce an excessive number of ketones that can lead to ketoacidosis, in which the brain does not get enough glucose to function correctly.The way to treat and balance out blood glucose levels in diabetes patients is insulin administration, diet, and exercise. Taking insulin each day will allow a sufficient amount of carbohydrates, fats, and proteins into an individual’s metabolism to maintain glycemic control. For individuals with Type II diabetes, one of the most prominent solutions is to lose weight and to become more cautious of the carbohydrate intake. Patients should familiarize themselves with the nutrition label and reach the American College of Sports Medicine Guidelines (ACSM) of exercising 150 minutes a week, which is equivalent to 3 to 4 days a week of aerobic and strength training exercises. The role of exercise between Type I and Type II diabetes is different. Individuals with Type I diabetes have a low insulin level count and are prone to hypoglycemia during and after exercise because the liver fails to release a sufficient amount of glucose to keep up with glucose utilization. Individuals who experience this will have an imbalance of glucose in their system, which is not manageable with the disease. Although exercise does not entirely improve blood glucose levels for patients with Type I diabetes, exercise also serves other potential benefits to reduce the risk of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. For individuals with Type II diabetes, exercise plays a significant role in glycemic control. This disease is insulin resistant because the hormone cannot facilitate and transports glucose across the cell membrane; therefore, it is insulin sensitive. Additionally, intervals of exercise can decrease insulin resistance and increase insulin sensitivity. When this happens, the individual can decrease the insulin dosages.Type II diabetes can be balanced by proper nutrition, according to the Academy of Nutrition and Dietetics, which has emphasized that there be no single meal plan for individuals with diabetes. To reduce the risk of heart disease, obesity, and cancer an individual must follow guidelines. One guideline is to reduce the amount of carbohydrate intake and to increase fats and proteins to help regulate glucose levels. An individual must eat meals and snacks regularly at planned times throughout the day every 2 to 3 hours. In the attempt to eating the same amount and types of foods, depends on the individual’s preference to eat and to follow the Dietary Guidelines for Americans or the USDA food patterns (Thompson et al., 2018). Individuals with diabetes must avoid alcoholic beverages which can cause hypoglycemia and a drop in blood glucose levels that can cause the person to feel confused, clumsy, and faint. If diabetes is left untreated, it can lead to consequences such as death, seizures, and comas.One study focused on the dietary intake and the amount of physical activity from a sample of adults with type II diabetes (Nelson, Reibar, Boyko, 2002). This study examines the national guidelines for physical activity and the total fat, saturated fat, and fruit and vegetables intake. Secondly, the study examines the socioeconomic factors of diet and exercise to determine which groups are at risk for physical inactivity and inadequate dietary intake. The methodology involved a total of 20,005 adults over the age of 17 years, and 1,608 adults reported they had diabetes. Adults who have type II diabetes consumed a high saturated fat diet and less than five servings of fruits and vegetables that are recommended in the total daily nutrient intake. Most of these participants have reported that they do not perform regular physical activity (Nelson et al., 2002). Adults who are over the age of 65 years of age exercise regularly, consumed less saturated fat, and more fruits and vegetables. In this study, individuals have reported that they were unable to walk a quarter mile were less likely to perform regular physical activity. Interventions of balancing type II diabetes include participating in physical activity, diet, exercise, and behavior modifications, which can be achieved at gyms, public health programs, and cardiac rehab.I chose this DKE because I learned that Type I & Type II diabetes is the most common form of diabetes in Americans. I learned that when the pancreas is unable to produce insulin, glucose then travels to cells to provide energy due to the destruction of the insulin production, also known as the beta cells. Type II diabetes can be caused by various factors, but most commonly by physical inactivity, stress, poor diet, family history, artificial sweeteners, and consuming large amounts of processed foods. There is no cure for diabetes but can be treated through diet and regular exercise. I can use this in the future in clinical practice to patients who have diabetes by educating them how to reduce the risks. This article expanded my knowledge understanding that performing exercise regularly allows the sensitivity of insulin pulls glucose out of the blood, and that causes a decrease in blood sugar  and utilizes the energy storage.DKE #4 (Group 3): Knowledge of common nutritional ergogenic aids, the purported mechanism of action, and any risk and/or benefits (Carbohydrates & Caffeine) Ergogenic aids are commonly used by athletes who believe that taking these supplements will enhance their overall performance (Kenney, Wilmore, & Costill, 2015). There are 14 proposed ergogenic aids which fall under the categories of pharmacological, hormones, physiological, and nutritional substances used in sport and exercise performance. Carbohydrates and caffeine are the most commonly used substances to improve athletic performance. Caffeine is used to stimulate the central nervous system to help improve perception and reduce the sensation of fatigue while performing an aerobic or strength training exercise. Carbohydrates are used to prolong the exercise intensity and the duration to oxidize skeletal muscle mass tissue.Caffeine is a pharmacological substance, which is found in coffee, tea, pre-workout drinks, soda, and “energy” drinks and can be physically addictive (Kenny et al., 2015). It is a stimulant in the central nervous system that acts on the adenosine receptors, which trigger the individual’s awareness of the autonomic nervous systems’ fight or flight response. Athletes consuming a caffeinated beverage or drug believe they will perform longer before reaching their peak threshold, therefore reducing the onset of fatigue. Caffeine is known to have metabolic side effects in the adipose tissue which increase in mobilization and the use of free fatty acids, therefore using muscle glycogen and prolonging the endurance activity. Some results that have been proven while taking a caffeine supplement are an increase in environmental awareness, focus, concentration, free fatty acid mobilization, and changes in mood. There is a decrease in onset fatigue and reaction time. Caffeine has been used in studies to demonstrate whether taking caffeine will improve endurance related activities. Caffeine has been shown to enhance endurance times in a fixed paced work (Kenny et al., 2015). Caffeine can help assist in improving the recovery immediately post exercise because the muscle glycogen percentage can increase the blood glucose and plasma insulin. Caffeine plays a significant role in the central nervous system (CNS) in which the individual is more alert and focused. When caffeine is ingested, the epinephrine levels in the blood will likely increase at the onset of exercise. Epinephrine is associated with increased heart rate (HR), vasoconstricting blood vessels, vasodilating the airway passage, and increasing the blood lactate levels, thus stimulating glycolysis in the muscle. Each individual responds differently to caffeine ingestion. There are some risks of ingesting the stimulant for individuals who are not accustomed to caffeine. Some symptoms a person can experience are restlessness, nervousness, insomnia, headaches, and the jittery feeling. Caffeine takes a considerable toll on the entire body system because caffeine acts as a diuretic increasing the potential risk of dehydration and several illnesses, whether the person is in a hot or cold environment.Carbohydrates (CHO) or glycogen is the primary fuel source that is stored in the muscle and liver. The amount of carbohydrate intake varies based on individuals’ training intensity, as well as considerations like height, weight, age, and environmental conditions. When an individual is performing an exercise for more than one hour, muscle glycogen will deplete and cause onset fatigue and exhaustion. Fatigue is often associated with glycogen depletion. Once the body has used all of its glycogen stores, it begins metabolizing fat, which is much less efficient for producing Adenosine Triphosphate (ATP). This is the high-energy molecule that stores the energy an individual need to complete just about anything they do. Exogenous glucose is the glucose people ingest from outside dietary sources. Objects containing carbohydrates are metabolized into glycogen to go into glycolysis, which is the first energetic process in living cells in which CHO are subsequently broken down into ATP. Endogenous glucose is the body’s glycogen stores, that is stored in three ways: as liver glycogen, blood glycogen, and muscle glycogen, with muscle glycogen because of the most abundant store. Consuming adequate quantities of CHO throughout a persistence event is crucial. However, athletes need to be conscious that a drink containing over 8% carbohydrate is commonly regarded as a cause of gastrointestinal distress (GI) distress. Signs and symptoms of gastrointenstinal distress entail delayed emptying of the belly and small intestines which ends up in cramping, nausea, bloating, vomiting and diarrhea (Williams, 2010). In essence, utilizing taking in more CHO than their body can tolerate, the athlete is inhibiting their overall performance. When muscle groups begin to eat, the blood glucose ranges will lower, resulting in hypoglycemia, wherein insulin secretion starts. Consequently, the muscle groups are energy deprived. It’s far recommended that athletes and people ought to ingest carbohydrates 15 to forty-five minutes before exercise training (Kenny et al., 2015), this could allow the insulin to stimulate and balance out during the exercising activity. While carbohydrates are ingested at some point in education, there is a little boom in blood glucose and muscle permeability. Carbohydrates act as an ergogenic resource to athletes without delay after an extended duration and high-depth exercising.One study hypothesized whether or not caffeine rinses would improve endurance cycling performance in recreationally active college-aged female athletes (Lesniak, Davis, Moir, & Sauers, 2016). Endurance athletes will consume carbohydrates that are liquid and solids to improve their performance during an event preventing hypoglycemia and allowing blood glucose to activate at peak exercise. The study recruited college-aged female athletes. Participants participated in an incremental exercise test to exhaustion measuring their VO2 max and their workload max. The study recruited college-aged female athletes. Written consent was provided. Each participant took a familiarization trial test to familiarize themselves with the cycle ergometers, metabolic equipment, and Borg rate of perceived exertion (RPE) scale. Also, each participant was asked to refrain from exhaustive exercises 24 hours before their experimental trials, as well as ingestion of medications, foods, and beverages for three days. This study was a double-blind, randomized test that consisted of four tests that were carried out on a cycle ergometer. On the first visit, participants participated in an incremental exercise test to exhaustion measuring their VO2 max and their workload max. Each 12.5% completed, they were given a mouth rinse for five seconds they were given randomly where one of the three mouth rinses, 6% carbohydrate solution, 1.2% caffeine solution or carbohydrate-caffeine 6%. Carbohydrates  was available in a fruit punch flavor, available using Gatorade, PepsiCo, USA. The caffeine powder was mixed with powder using Nutrabio, Middlesex, NJ with a non-caloric lemon-flavored powder available using Crystal Light, Kraft Foods, and the USA. Lastly, the carbohydrate-caffeine solution was a sports drink mixed with caffeine powder.I chose this DKE because I learned that ingesting carbohydrates and caffeine will boost endurance performance. By ingesting both ergogenic aids, I found it interesting how it can increase the individuals cognitive focus and delay onset fatigue during strength and endurance training. I did not realize that carbohydrates are classified as an ergogenic aid. I would use this in the future, to educate my patients that carbohydrates is a primary fuel source for the body and are broken down into gluc