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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 66-71

Physiological response during match simulation in youth soccer players


1 Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
2 Faculty of Sports Science and Recreation, Universiti Teknologi MARA; Sports Engineering and Artificial Intelligence Center, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
3 National Sports Institute of Malaysia, Kuala Lumpur, Malaysia
4 Selangor Football Club, Red Giant FC Sdn Bhd, Shah Alam, Selangor, Malaysia
5 Faculty of Sports Science and Recreation, Universiti Teknologi MARA; Sports Engineering and Artificial Intelligence Center, Universiti Teknologi MARA; Selangor Football Club, Red Giant FC Sdn Bhd, Shah Alam, Selangor, Malaysia

Date of Submission11-Sep-2022
Date of Decision20-Nov-2022
Date of Acceptance21-Nov-2022
Date of Web Publication22-Feb-2023

Correspondence Address:
Raja Mohammed Firhad Raja Azidin
Faculty of Sports Science and Recreation, Universiti Teknologi MARA; Sports Engineering and Artificial Intelligence Center, Universiti Teknologi MARA; Selangor Football Club, Red Giant FC Sdn Bhd, Shah Alam, Selangor
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mohe.mohe_29_22

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  Abstract 

Introduction: The aim of this study was to investigate physiological changes of heart rate (HR), rating of perceived exertion (RPE) and vertical jump (VJ) height responses during a Youth Soccer Match Simulation (YSMS90).
Materials and Methods: Twenty (n = 20) male academy soccer players (age:17 ± 2 years, height: 1.69 ± 0.6, weight: 67.9 ± 6 kg) volunteered for this study. In a repeated measures study design, each participant completed the 90 min of soccer match simulation. Heart rate, subjective RPE and VJ were recorded every 5 min throughout the simulation.
Results: The mean HR, RPE and VJ height during the YSMS90 were 147 ± 19 beats/min, 16 ± 1 and 34 ± 4 cm, respectively. There was a significant increase of HR and RPE throughout the YSMS90. The VJ performance reduced during the second half of the simulation.
Conclusions: The findings from this study suggest that YSMS90 elicited similar physiological responses to soccer match play and may justify the use of YSMS90 for replicating the demands of youth soccer as an ecologically valid soccer match play simulation.

Keywords: Match-simulation, soccer, youth


How to cite this article:
Nordin MN, Hamdan M, Hasan H, Yeo WK, Sulaiman M, Raja Azidin RM. Physiological response during match simulation in youth soccer players. Malays J Mov Health Exerc 2022;11:66-71

How to cite this URL:
Nordin MN, Hamdan M, Hasan H, Yeo WK, Sulaiman M, Raja Azidin RM. Physiological response during match simulation in youth soccer players. Malays J Mov Health Exerc [serial online] 2022 [cited 2023 Sep 25];11:66-71. Available from: http://www.mohejournal.org/text.asp?2022/11/2/66/370240


  Introduction Top


Soccer has recently ranked among the sports that have received the most attention from scientists working in a variety of fields. Soccer performance depends on the interaction of several factors concerning the tactical, technical, physical, physiological and psychological dimensions (Castells et al., 2015). Monitoring the physical and physiological responses in soccer matches contributes not only to the evolution of these indicators specifically but also to the tactics, that is, to the management of the playing space, as a result of the organisation in the field and the decision-making (Teoldo et al., 2020). In an effort to mimic the demands of soccer match play, many attempts have been made to simulate the erratic pattern of locomotion based on motion analysis of real soccer match play.

Numerous simulations specifically designed for overground soccer have reproduced the mechanical and physiological responses to such intermittent activity (Harper et al., 2016; Thatcher and Batterham, 2004). These simulations were designed to replicate the activity patterns seen in actual matches. They have the advantage of enabling controlled experimental evaluations of the player's performance as well as precise control over speed and distance travelled. Thatcher and Batterham (2004) demonstrated the comparability of physiological responses between individuals participating in actual match play and a non-motorised treadmill protocol. However, the lack of lateral and backwards movements performed in unidirectional treadmill protocols limits the validity of this protocol.

The Loughborough Intermittent Shuttle Test (LIST) was an intermittent exercise simulation that has been used to examine the effects of various ergogenic aids on exercise performance (Erith et al., 2006). The LIST consisted of 75 min of intermittent activity that was followed by a shuttle run to exhaustion. This free-running exercise simulation replicated the movement demands of soccer and was an improvement over earlier unidirectional treadmill-based protocols (e.g., Nevill et al., 1993). However, the omission of a half-time period and the lack of game specific skills, some of which have been previously found to have an energy consuming consequence (e.g., dribbling; Reilly and Ball, 1984), reduces the ecological validity of the LIST and may also compromise the integrity of the physiological strain imposed by this protocol when compared to actual match play.

In early research, soccer skills were rarely incorporated into simulated soccer exertion protocols. This practice might be concerning considering the influence that soccer skills have in defining success. Players with a lower skill level might lack the ability to simultaneously perform skills throughout the duration of an exercise simulation, thereby compromising the overall exercise intensity required. In lieu of that, Hamdan et al. (2020) introduced a soccer simulation that incorporated soccer skills (i.e., dribbling, shooting, passing and heading) with multidirectional running to match the activity profiles of professional soccer match play as closely as possible. Unfortunately, several modifications are needed to be applied to the simulation to allow better representation of soccer demands in the youth population. As a result, the validity of an exercise simulation that better replicates the demands of actual match play within a single population of participants must be evaluated. Heart rate (HR), rating of perceived exertion (RPE) and vertical jump (VJ) height have been shown to be promising indicators to identify fatigue among athletes. Several studies have revealed that HR and RPE were increased during fatigued state (Bossuyt et al., 2016; Impellizzeri et al., 2004; Jones et al., 2015; Raja Azidin et al., 2015; Thatcher and Batterham, 2004). These studies imply that when developing exercise regimes and match play simulations, physiological and physical parameters must be given attention and must correctly represent actual match play settings to increase the effectiveness of the regime or the validity of the simulation. Therefore, the main aim of this study was to investigate the physical and physiological responses to Youth Soccer Match Simulation (YSMS90) among recreational youth soccer players.


  Methods Top


Participants

Twenty (n = 20) male, academy youth soccer players volunteered for this study (age: 17 ± 2 years, height: 1.69 ± 0.6 m and mass: 67.9 ± 6 kg). An a-priori calculation for sample size determination was conducted based on previous studies (Russell et al., 2011) and using the G*Power software (version 3.0.10, Universität Kiel, Germany) and it was determined that to achieve 95% statistical power and an effect size of 0.25, a minimum number of 18 participants is required for this study. Participants were questioned on their injury history within the previous 6 months that could interfere with their performance of utility skills. Written consent was obtained from all the participants and the study was performed in accordance with the university ethics committee guidelines. The study was conducted in accordance with the university ethics committee guidelines.

Experimental design

This study took form of a single group, repeated measures design. Participants attended a familiarization session 4–7 days prior to the actual testing session. The familiarization session consisted of a 15-min submaximal trial of the YSMS90 and a set of soccer specific physiological and physical responses (HR, RPE and VJ) assessments. During the actual testing session, participants completed 90 minutes of the YSMS90 interceded by a 15-minute half time interval. Heart rate, RPE, and VJ were assessed every 5 minutes throughout the simulation. The duration of the testing session was selected to suit the standard Fédération Internationale de Football Association (FIFA) match-play timeline. Participants were guided through a 20-min standardized dynamic warm-up according to FIFA 11+ procedure followed by 5-minutes of passive rest before the soccer simulation commences [Figure 1].
Figure 1: Soccer match simulation timeline. RPE: Rating of perceived exertion

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Soccer match simulation

The Youth Soccer Match Simulation (YSMS90) developed by Nordin et al. (2021) used in this study was a variation of the Ball-Oriented Soccer Simulation (BOSS) developed by Hamdan et al. (2020), which was adapted from the overground soccer match-play simulation by (Raja Azidin et al., 2015) to include ball handling actions observed in actual soccer match-play such as heading, shooting, dribbling, and passing. The overground soccer match-play simulation consisted of similar running profiles [Table 1] to that of an actual soccer match to reproduce the physiological and physical demands of soccer in a controlled setting (Raja Azidin et al., 2015). The YSMS90 was modified to cover a total distance of 8.02 km, which corresponded to similar distances covered in actual youth soccer matches (Mendez-villanueva et al., 2013). Ball handling actions were integrated into the overground soccer match-play simulation to match similar frequencies of actions (i.e. heading, passing, shooting) and total distance traveled with a ball (i.e. dribbling) per player per match as according to the data reported by Di Salvo et al. (2007), Link and Hoernig (2017), and Ruiz et al. (2017) [Figure 2].
Figure 2: Schematic layout of the YSMS90. (*) indicates significant different compared to pre test value. YSMS90: Youth Soccer Match Simulation

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Table 1: Running distances and running speeds for different activities during the Youth Soccer Match Simulation90

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Physiological responses assessment

Throughout the soccer simulation, the participants' physiological responses were monitored using a HR monitor (Polar HR System, Electro, Finland), VJ assessment (Vertec, Sports Import, Hilliard, OH) and the rate of perceived exertion (RPE, 20-point Borg Scale). All measurements were recorded at every 5 min intervals throughout the simulation. During the 15-min passive half-time interval, participants were instructed to remain seated and were allowed to drink water.

Data analyses

One-way repeated measures ANOVA was conducted for each dependent variable using the Statistical Package for the Social Sciences (SPSS v. 26, IBM, New York, USA) with the alpha level fixed at < 0.05. Time was treated as a dependent variable, whereas HR, RPE and VJ were treated as independent variables. Equality of variances between limbs was assessed using Mauchly's test of sphericity, where sphericity violations were corrected according to the Greenhouse–Geisser epsilon. An epsilon value of < 0.75 warrants the application of the Greenhouse–Geisser correction, while epsilon values > 0.75 deserve the Hyunh–Feldt correction (Girden, 1992). Bonferroni post hoc correction procedures were applied to control Type 1 errors as similar outcome measures were analysed at each repeated measure.


  Results Top


Heart rate

There was a significant effect of time on heart rate throughout the YSMS90 (F3.58,68.07 = 93.18; P = 0.000; partial η2 = 0.83). Pairwise comparisons revealed that the heart rates during the YSMS90 were significantly elevated from 15 min to 105 min in comparison to pretest values [P < 0.001; [Figure 3]].
Figure 3: Heart rate responses over time during the YSMS90. (*) indicates significant different compared to pre test value. YSMS90: Youth Soccer Match Simulation

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Rating of perceived exertion

There was a significant effect of time on the rating of perceived exertion throughout the YSMS90 (F4.72,89.65 = 602.23; P = 0.000; partial η2 = 0.97). Pairwise comparisons revealed that the rating of perceived exertion during the YSMS90 were significantly elevated from 5 min to 105 min when compared to pretest values [P < 0.001; [Figure 4]].
Figure 4: Rating of perceived exertion responses over time during the YSMS90. (*) indicates significant different compared to pre test value. YSMS90: Youth Soccer Match Simulation

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Vertical jump

There was a significant effect of time on the vertical jump parameter (F2.80,53.21 = 51.30; P = 0.000; partial η2 = 0.73). Pairwise comparisons revealed that the vertical jumps during the YSMS90 were significantly reduced in the second half of the YSMS90 (75 min to 105 min) in comparison to pretest values [P < 0.001; [Figure 5]].
Figure 5: Vertical Jump height changes over time during the YSMS90. (*) indicates significant different compared to pre test value. YSMS90: Youth Soccer Match Simulation

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  Discussion Top


The main findings of this study indicated that YSMS90 values for HR and RPE were significantly elevated throughout the simulation, whereas VJ height decreased significantly over time. Further discussion on the responses and factors influencing the outcomes was addressed in this section.

HR was significantly elevated over time throughout the YSMS90, indicating increased physiological demand. The mean HR for the YSMS90 was 147 ± 19 beats min-1, which corresponded to roughly 72% of the players' maximum HR. The mean percentage of maximum HR for the YSMS90 simulation was similar to the previous study (Hamdan et al., 2018a; Hamdan et al., 2018b; Hamdan et al., 2020; Raja Azidin et al., 2015). The lower HR values reported in this study compared to the average range of 156–167 beats min-1 reported by Saeidi and Khodamoradi (2017) may be attributed to the difference in playing level, in the reported studies (recreational youth vs. elite players). For example, the work rates of recreational players in this study may be limited to a lesser amount of high-intensity physical exertion time than elite players, thus totalling to a reduced total work done during the simulation. Furthermore, it is important to note the large variability in HR reading in this study, which may explain the discrepancies between the two studies.

Available research suggests that RPE is a valid indicator of high-intensity intermittent exercise, when compared with HR and blood lactate concentration during football-specific exercise (Coutts et al., 2009). The mean RPE for the YSMS90 was 16 ± 1. In this study, RPE was observed to be significantly elevated throughout the simulation compared to baseline values, suggesting an increased demand of physical exertion taking place throughout the simulation. Rates of perceived exertion profiles were in line with HR response profiles during simulation. Similar as with heart rate responses, subjective RPE during simulation matched previous studies (Hamdan et al., 2020; Raja Azidin et al., 2015), suggesting that the YSMS90 was able to induce similar physiological response as an actual soccer match for the youth athletes. This increased RPE may be attributed to the repeated multiple utility movements and skills execution during the simulation. Bloomfield et al. (2007) observing approximately 500 deceleration movements during a football match has postulated that the highly repetitive movements increase eccentric stress. These movements have been reported to significantly increase the physiological load, metabolic cost and muscular fatigue in soccer.

The mean VJ for YSMS90 was 34 ± 4 cm, which indicated that the reading matched the range of 31–45 cm reported by Krustrup et al. (2010) in an observation. Due to the necessity of repetitive physical exertions during 90 min of intermittent exercise, soccer players may be susceptible to different types of fatigue. Reilly et al. (2008) defined fatigue to entail the "inability to sustain the required work rate" which is also understood as a reduction of physical capability as a result of inhibited force generation potential. This was reflected in this study by the decrease in jump height towards the end of the simulation. In actual soccer match play, the self-chosen activity patterns and the presence of external factors (i.e., opposition players) may have greater or lesser effect on fatigue accumulation. Physical stress during soccer has been reported to be a consequence from a myriad of factors including thermoregulation, substrate depletion and metabolite accumulation (Currell et al., 2009) throughout the engagement of sporting exertions.

Practical implications

Several practical implications may be highlighted based on the findings of this study. First, this study found that YSMS90 managed to elicit similar physiological demand among youth athletes as in actual match play. The addition of ball handling skills and actions to the simulation increases the ecological validity of the simulation when compared to an actual soccer match play. The findings of this study, therefore, support the utility of YSMS for various applications in training and research in the youth soccer demographic. For example, the inclusion of YSMS in injury risk screening procedures or in skills-related fitness assessments may reveal valuable information of a player's physical condition compared to the assessments under normal, pre-fatigue conditions alone.

Another practical application in this study involves the utility of simple, wearable technology in match-or training-load monitoring of athletes. The utility of HR sensors, when paired with a subjective feedback by the player (i.e., RPE), may reveal noteworthy information on the physical and physiological load of a match or training program towards the athletes, thus providing coaches and therapists greater insight to organise or design appropriate interventions in order to keep athletes in their optimum performance level and reduce the risk of overuse injuries.

Limitation

Several limitations should be considered in this study. First, this focused on a small number of variables which is HR, RPE and VJ. Several other physiological variables (i.e., VO2 consumption, blood lactate accumulation, creatine kinase, hydration) still warrant further investigation to provide better information and understanding to represent physiological demand in soccer match play. Furthermore, physical loading demands for the YSMS90 (i.e., acceleration and deceleration, duration of high intensity running) still warrant investigation using the global positioning system or accelerometers or inertial measurement units to confirm validity and reproducibility of the YSMS90.


  Conclusion Top


The YSMS90 elicited similar physiological and physical demands to soccer match play in youth soccer players. Therefore, this study proposes that YSMS90 may be used as a tool that replicates the demands of soccer match play of youth soccer when maintaining experimental control. The YSMS90 has potential application to researchers who wish to examine the effects of various ergogenic aids such as nutritional supplements and strength and conditioning regimes that aim to improve performance in youth soccer players. Furthermore, this study supports monitoring physiological changes during match play as a precautionary measure to counteract the changes in work rate as a function of fatigue in soccer to sustain 90 min of match play. Future research could focus on interventions that attenuate reductions in skilled performance. In addition, the physiological, metabolic and performance responses to the YSMS90 demonstrated test–retest repeatability and were representative of match play. The close similarities between physiological responses observed during the present study and values reported from actual match play may justify the use of YSMS90 for replicating the demands of youth soccer as an ecologically valid soccer match play simulation. Perhaps, the YSMS90 protocol could also be used to assess how interventions affect youth soccer players.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bloomfield, J., Polman, R., & O'Donoghue, P. (2007). Physical demands of different positions in FA Premier League soccer. Journal of Science and Medicine in Sport, 6(1), 63-70.  Back to cited text no. 1
    
2.
Bossuyt, F. M., García-Pinillos, F., Azidin, R. R., Vanrenterghem, J., & Robinson, M. A. (2016). The utility of a high-intensity exercise protocol to prospectively assess ACL injury risk. International Journal of Sports Medicine, 37(2), 125-133.  Back to cited text no. 2
    
3.
Castells, B., Romero, G., García, F., & Cruz, A. (2015). Current methods of soccer match analysis. International Journal of Medicine and Science of Physical Activity and Sport, 15(60), 785-803.  Back to cited text no. 3
    
4.
Coutts, A. J., Rampinini, E., Marcora, S. M., Castagna, C., & Impellizzeri, F. M. (2009). Heart rate and blood lactate correlates of perceived exertion during small-sided soccer games. Journal of Science and Medicine in Sport, 12(1), 79-84.  Back to cited text no. 4
    
5.
Currell, K., Conway, S., & Jeukendrup, A. E. (2009). Carbohydrate ingestion improves performance of a new reliable test of soccer performance. International Journal of Sport Nutrition and Exercise Metabolism, 19(1), 34-46.  Back to cited text no. 5
    
6.
Di Salvo, V., Baron, R., Tschan, H., Montero, F. C., Bachl, N., & Pigozzi, F. (2007). Performance characteristics according to playing position in elite soccer. International Journal of Sports Medicine, 28(3), 222-227.  Back to cited text no. 6
    
7.
Erith, S., Williams, C., Stevenson, E., Chamberlain, S., Crews, P., & Rushbury, I. (2006). The effect of high carbohydrate meals with different glycemic indices on recovery of performance during prolonged intermittent high-intensity shuttle running. International Journal of Sport Nutrition and Exercise Metabolism, 16(4), 393-404. doi: 10.1123/ijsnem.16.4.393.  Back to cited text no. 7
    
8.
Girden, E. R. (1992). ANOVA: Repeated Measures (No. 84). Sage.  Back to cited text no. 8
    
9.
Hamdan, M., Ang, G. Y., Sharir, R., Kian, Y. W., & Azidin, R. M. F. R. (2020). Changes in hamstring eccentric peak torques and angles of peak torque following 90 minutes of soccer specific exertions. Malaysian Journal of Movement, Health & Exercise, 9(2), 85-100.  Back to cited text no. 9
    
10.
Hamdan, M., Ismail, S., Hassan, H., Ismail, H., & Raja Azidin, R. (2018a). The effects of a 90-minute simulated soccer match-play on knee and hip kinematics. Movement, Health & Exercise (MoHE), 7(1), 59-72.  Back to cited text no. 10
    
11.
Hamdan, M., Mohd Noh, S., Hasan, H., Ismail, H., & Raja Azidin, R. (2018b). Knee and hip extension responses to prolonged simulated soccer match-play: A 2D study. International Journal of Engineering and Technology (UAE), 7(4), 6-14.  Back to cited text no. 11
    
12.
Harper, L. D., Briggs, M. A., McNamee, G., West, D. J., Kilduff, L. P., Stevenson, E., & Russell, M. (2016). Physiological and performance effects of carbohydrate gels consumed prior to the extra-time period of prolonged simulated soccer match-play. Journal of Science and Medicine in Sport, 19(6), 509-514.  Back to cited text no. 12
    
13.
Impellizzeri, F. M., Rampinini, E., Coutts, A. J., Sassi, A., & Marcora, S. M. (2004). Use of RPE-based training load in soccer. Medicine and Science in Sports and Exercise, 36(6), 1042-1047.  Back to cited text no. 13
    
14.
Jones, R. I., Ryan, B., & Todd, A. I. (2015). Muscle fatigue induced by a soccer match-play simulation in amateur Black South African players. Journal of Sports Sciences, 33(12), 1305-1311.  Back to cited text no. 14
    
15.
Krustrup, P., Zebis, M., Jensen, J. M., & Mohr, M. (2010). Game-induced fatigue patterns in elite female soccer. The Journal of Strength & Conditioning Research, 24(2), 437-441.  Back to cited text no. 15
    
16.
Link, D., & Hoernig, M. (2017). Individual ball possession in soccer. PLoS One, 12(7), e0179953.  Back to cited text no. 16
    
17.
Mendez-Villanueva, A., Buchheit, M., Simpson, B., & Bourdon, P. C. (2013). Match play intensity distribution in youth soccer. International Journal of Sports Medicine, 34(2), 101-110.  Back to cited text no. 17
    
18.
Nevill, M. E., Williams, C., Roper, D., Slater, C., & Nevill, A. M. (1993). Effect of diet on performance during recovery from intermittent sprint exercise. Journal of Sports Sciences, 11, 119-126.  Back to cited text no. 18
    
19.
Nordin, M. N. A., Raja Azidin, R. M. F., Hasan, H., Abdul Kadir, Z., Hamdan, M., & Zulkifli, M. (2021). Does Simulated Soccer Match-Play Affect Passing Skills Performance in Recreationally Trained Youth Players? Paper presented at International Sports Medicine and Exercise Science Conference (ISMESC). Kuala Lumpur, Malaysia.  Back to cited text no. 19
    
20.
Raja Azidin, R. F., Sankey, S., Drust, B., Robinson, M. A., & Vanrenterghem, J. (2015). Effects of treadmill versus overground soccer match simulations on biomechanical markers of anterior cruciate ligament injury risk in side cutting. Journal of Sports Sciences, 33(13), 1332-1341.  Back to cited text no. 20
    
21.
Reilly, T., & Ball, D. (1984). The net physiological cost of dribbling a soccer ball. Research Quarterly for Exercise and Sport, 55, 267-271.  Back to cited text no. 21
    
22.
Reilly, T., Drust, B., & Clarke, N. (2008). Muscle fatigue during football match-play. Sports Medicine, 38(5), 357-367.  Back to cited text no. 22
    
23.
Ruiz, H., Power, P., Wei, X., & Lucey, P. (2017). "The Leicester City Fairytale?" Utilizing New Soccer Analytics Tools to Compare Performance in the 15/16 & 16/17 EPL Seasons. In Proceedings of the 23rd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. p. 1991-2000.  Back to cited text no. 23
    
24.
Russell, M., Benton, D., & Kingsley, M. (2011). The effects of fatigue on soccer skills performed during a soccer match simulation. International Journal of Sports Physiology and Performance, 6(2), 221-233.  Back to cited text no. 24
    
25.
Saeidi, A., & Khodamoradi, A. (2017). Physical and physiological demand of soccer player based on scientific research. International Journal of Applied Science in Physical Education, 1(2), 1-12.  Back to cited text no. 25
    
26.
Teoldo, I., Guilherme, J., Garganta, J. (2017). Training football for smart playing: on tactical performance of teams and players. 1st ed. Curitiba: Appris.  Back to cited text no. 26
    
27.
Thatcher, R., & Batterham, A. (2004). Development and validation of a sport-specific exercise protocol for elite youth soccer players. Journal of Sports Medicine and Physical Fitness, 44(1), 15.  Back to cited text no. 27
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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