Run Recovery

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Andrew Rhodes, Laura Evans, Waleed Alhazzani +56 more · Critical Care Medicine · 2017 · 3,790 citations

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study

Leonard Kahn, Michele L Zygman, William Z. Rymer +1 more · Journal of NeuroEngineering and Rehabilitation · 2006 · 375 citations

BACKGROUND AND PURPOSE: Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke. Such active assistance may improve recovery by affecting somatosensory input, motor planning, spasticity or soft tissue properties, but it is labor intensive and has not been validated in controlled trials. The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke. METHODS: Nineteen individuals at least one year post-stroke were randomized into one of two groups. One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device, while a second group performed a task-matched amount of unassisted reaching. The main outcome measures were range and speed of supported arm movement, range, straightness and smoothness of unsupported reaching, and the Rancho Los Amigos Functional Test of Upper Extremity Function. RESULTS AND DISCUSSION: There were significant improvements with training for range of motion and velocity of supported reaching, straightness of unsupported reaching, and functional movement ability. These improvements were not significantly different between the two training groups. The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group. CONCLUSION: Improvements with both forms of exercise confirmed that repeated, task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke. Robotically assisting in reaching successfully improved arm movement ability, although it did not provide any detectable, additional value beyond the movement practice that occurred concurrently with it. The inability to detect any additional value of robot-assisted reaching may have been due to this pilot study's limited sample size, the specific diagnoses of the participants, or the inclusion of only individuals with chronic stroke.

Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial

Kylie Sellwood, Peter Brukner, David A. Williams +2 more · British Journal of Sports Medicine · 2007 · 214 citations

OBJECTIVE: To determine if ice-water immersion after eccentric quadriceps exercise minimises the symptoms of delayed-onset muscle soreness (DOMS). DESIGN: A prospective randomised double-blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non-dominant leg. INTERVENTIONS: Participants were randomised to three 1-min immersions in either ice water (5+/-1 degrees C) or tepid water (24 degrees C). MAIN OUTCOME MEASURES: Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one-legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann-Whitney U tests. RESULTS: No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop-for-distance or serum CK over time. There was a significant difference in pain on sit-to-stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 vs 2.0 mm, respectively, p = 0.009). CONCLUSIONS: The protocol of ice-water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes.

Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis

Yutan Wang, Hongmei Lü, Sijun Li +7 more · Journal of Rehabilitation Medicine · 2021 · 37 citations

Hot packs provide the best pain relief for delayed onset muscle soreness (DOMS) within the first 48 hours after exercise, while cryotherapy (whole-body or partial-body cold exposure) works best after 48 hours — but the evidence is weak and based on small, low-quality studies, so you should treat these rankings as provisional rather than definitive.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Andrew Rhodes, Laura Evans, Waleed Alhazzani +56 more · Intensive Care Medicine · 2017 · 6,739 citations

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Massimo Piepoli, Arno W. Hoes, Stefan Agewall +23 more · European Heart Journal · 2016 · 6,465 citations

This is not a single experiment but a clinical practice guideline that synthesises evidence from hundreds of randomised controlled trials and observational studies to recommend specific targets for blood pressure, cholesterol, blood sugar, physical activity, and diet — providing a structured framework for anyone wanting to reduce their cardiovascular risk through lifestyle and medication.

Infrared Low-Level Laser Therapy (Photobiomodulation Therapy) before Intense Progressive Running Test of High-Level Soccer Players: Effects on Functional, Muscle Damage, Inflammatory, and Oxidative Stress Markers—A Randomized Controlled Trial

Shaiane Silva Tomazoni, Caroline dos Santos Monteiro Machado, Thiago De Marchi +4 more · Oxidative Medicine and Cellular Longevity · 2019 · 78 citations

Applying infrared photobiomodulation therapy (PBMT) to leg muscles immediately before a maximal running test improved VO₂ max by about 3–4%, extended time to exhaustion by roughly 30 seconds, and significantly reduced post-exercise muscle damage markers (creatine kinase dropped by ~40%) and oxidative stress in high-level soccer players — suggesting that pre-workout light therapy might enhance performance and speed recovery in athletes.

The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study

Magdo Bôrtole, Anusha Venkatakrishnan, Fangshi Zhu +4 more · Journal of NeuroEngineering and Rehabilitation · 2015 · 347 citations

BACKGROUND: Stroke significantly affects thousands of individuals annually, leading to considerable physical impairment and functional disability. Gait is one of the most important activities of daily living affected in stroke survivors. Recent technological developments in powered robotics exoskeletons can create powerful adjunctive tools for rehabilitation and potentially accelerate functional recovery. Here, we present the development and evaluation of a novel lower limb robotic exoskeleton, namely H2 (Technaid S.L., Spain), for gait rehabilitation in stroke survivors. METHODS: H2 has six actuated joints and is designed to allow intensive overground gait training. An assistive gait control algorithm was developed to create a force field along a desired trajectory, only applying torque when patients deviate from the prescribed movement pattern. The device was evaluated in 3 hemiparetic stroke patients across 4 weeks of training per individual (approximately 12 sessions). The study was approved by the Institutional Review Board at the University of Houston. The main objective of this initial pre-clinical study was to evaluate the safety and usability of the exoskeleton. A Likert scale was used to measure patient's perception about the easy of use of the device. RESULTS: Three stroke patients completed the study. The training was well tolerated and no adverse events occurred. Early findings demonstrate that H2 appears to be safe and easy to use in the participants of this study. The overground training environment employed as a means to enhance active patient engagement proved to be challenging and exciting for patients. These results are promising and encourage future rehabilitation training with a larger cohort of patients. CONCLUSIONS: The developed exoskeleton enables longitudinal overground training of walking in hemiparetic patients after stroke. The system is robust and safe when applied to assist a stroke patient performing an overground walking task. Such device opens the opportunity to study means to optimize a rehabilitation treatment that can be customized for individuals. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/show/NCT02114450 ).

Effect of tart cherry juice on recovery and next day performance in well-trained Water Polo players

Rachel McCormick, Peter Peeling, Martyn J. Binnie +2 more · Journal of the International Society of Sports Nutrition · 2016 · 75 citations

BACKGROUND: Tart Montmorency cherries contain high concentrations of phytochemicals and anthocyanins, which have recently been linked to improved athletic recovery and subsequent performance. To date however, previous work reporting promising results has focused on land-based endurance sports, with any potential benefits to team sports remaining unknown. As such, this investigation set-out to examine the effect of supplemental tart cherry juice (CJ) on recovery and next day athletic performance in highly-trained water-based team sport athletes over seven days. METHODS: In a randomised, double-blind, repeated measures, crossover design, nine male Water Polo athletes were supplemented with CJ or a placebo equivalent (PLA) for six consecutive days. Prior to, and at the completion of the supplementation period, water-based performance testing was conducted. On day 6, participants also undertook a fatiguing simulated team game activity. Venous blood samples were collected (Pre-exercise: day 1, 6 and 7; Post-exercise: day 6) to investigate markers of inflammation [Interleukin-6 (IL-6); C-reactive protein (CRP)] and oxidative stress [Uric Acid (UA); F2-Isoprostane (F2-IsoP)]. A daily diary was also completed (total quality of recovery, delayed onset muscle soreness) as a measure of perceptual recovery. RESULTS: > 0.05). No differences were found for any performance or recovery measures. CONCLUSIONS: The lack of difference observed in the blood markers between groups may reflect the intermittent, non-weight bearing demands of Water Polo, with such activity possibly unable to create a substantial inflammatory response or oxidative stress (over 7 days) to impede performance; thereby negating any potential beneficial effects associated with CJ supplementation. TRIAL REGISTRATION: This trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR). Registration number: ACTRN12616001080415. Date registered: 11/08/2016, retrospectively registered.

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

Martin Schwellnus, Torbjørn Soligard, Juan Manuel Alonso +14 more · British Journal of Sports Medicine · 2016 · 831 citations

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load-including rapid changes in training and competition load, competition calendar congestion, psychological load and travel-and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.

Curcumin and Piperine Supplementation and Recovery Following Exercise Induced Muscle Damage: A Randomized Controlled Trial.

Barthélémy Delecroix, Abd Elbasset Abaïdia, Cédric Leduc +2 more · PubMed · 2017 · 61 citations

The aim of this study was to analyze the effects of oral consumption of curcumin and piperine in combination on the recovery kinetics after exercise-induced muscle damage. Forty-eight hours before and following exercise-induced muscle damage, ten elite rugby players consumed curcumin and piperine (experimental condition) or placebo. A randomized cross-over design was performed. Concentric and isometric peak torque for the knee extensors, one leg 6 seconds sprint performance on a non-motorized treadmill, counter movement jump performance, blood creatine kinase concentration and muscle soreness were assessed immediately after exercise, then at 24h, 48h and 72h post-exercise. There were moderate to large effects of the exercise on the concentric peak torque for the knee extensors (Effect size (ES) = -1.12; Confidence interval at 90% (CI90%): -2.17 to -0.06), the one leg 6 seconds sprint performance (ES=-1.65; CI90% = -2.51to -0.80) and the counter movement jump performance (ES = -0.56; CI90% = -0.81 to -0.32) in the 48h following the exercise. There was also a large effect of the exercise on the creatine kinase level 72h after the exercise in the control group (ES = 3.61; CI90%: 0.24 to 6.98). This decrease in muscle function and this elevation in creatine kinase indicate that the exercise implemented was efficient to induce muscle damage. Twenty four hours post-exercise, the reduction (from baseline) in sprint mean power output was moderately lower in the experimental condition (-1.77 ± 7.25%; 1277 ± 153W) in comparison with the placebo condition (-13.6 ± 13.0%; 1130 ± 241W) (Effect Size = -1.12; Confidence Interval 90%=-1.86 to -0.86). However, no other effect was found between the two conditions. Curcumin and piperine supplementation before and after exercise can attenuate some, but not all, aspects of muscle damage.

Effects of antioxidant-rich foods on altitude-induced oxidative stress and inflammation in elite endurance athletes: A randomized controlled trial

Anu Koivisto, Thomas Olsén, Ingvild Paur +7 more · PLoS ONE · 2019 · 44 citations

Eating antioxidant-rich foods (berries, dark chocolate, walnuts, and fruit/vegetable smoothies) during a 3-week altitude training camp increased blood antioxidant capacity and reduced some markers of inflammation in elite endurance athletes, but did not prevent altitude-induced oxidative stress or alter the acute inflammatory response to maximal exercise.

Recovery and Performance in Sport: Consensus Statement

Michael Kellmann, Maurizio Bertollo, Laurent Bosquet +14 more · International Journal of Sports Physiology and Performance · 2018 · 731 citations

The relationship between recovery and fatigue and its impact on performance has attracted the interest of sport science for many years. An adequate balance between stress (training and competition load, other life demands) and recovery is essential for athletes to achieve continuous high-level performance. Research has focused on the examination of physiological and psychological recovery strategies to compensate external and internal training and competition loads. A systematic monitoring of recovery and the subsequent implementation of recovery routines aims at maximizing performance and preventing negative developments such as underrecovery, nonfunctional overreaching, the overtraining syndrome, injuries, or illnesses. Due to the inter- and intraindividual variability of responses to training, competition, and recovery strategies, a diverse set of expertise is required to address the multifaceted phenomena of recovery, performance, and their interactions to transfer knowledge from sport science to sport practice. For this purpose, a symposium on Recovery and Performance was organized at the Technical University Munich Science and Study Center Raitenhaslach (Germany) in September 2016. Various international experts from many disciplines and research areas gathered to discuss and share their knowledge of recovery for performance enhancement in a variety of settings. The results of this meeting are outlined in this consensus statement that provides central definitions, theoretical frameworks, and practical implications as a synopsis of the current knowledge of recovery and performance. While our understanding of the complex relationship between recovery and performance has significantly increased through research, some important issues for future investigations are also elaborated.

21 days of mammalian omega-3 fatty acid supplementation improves aspects of neuromuscular function and performance in male athletes compared to olive oil placebo

Evan J.H. Lewis, Peter W. Radonic, Thomas M.S. Wolever +1 more · Journal of the International Society of Sports Nutrition · 2015 · 71 citations

BACKGROUND: Omega-3 polyunsaturated fatty acids (N-3) are essential nutrients for human health and integral components of neural tissues. There is evidence that N-3 supplementation may benefit exercise performance, however, no study has investigated the ergogenic potential of N-3 supplementation. Our objective was to determine the effect of short-term N-3 supplementation on neuromuscular-function and physical-performance in well-trained athletes. METHODS: Male athletes (n = 30), 25 years (SD 4.6), training 17 h(.)wk(-1) (SD 5) completed this randomized, placebo-controlled, parallel-design study. At baseline a blood sample was collected, maximal voluntary isometric contractions (MVC) with electromyography (EMG) recordings were measured, and participants underwent various performance tests including a Wingate test and 250 kJ time trial (TT) followed by repeated MVC and EMG measurement. Participants were then randomly assigned to receive N-3 (5 ml seal oil, 375 mg EPA, 230 mg DPA, 510 mg DHA) or placebo (5 ml olive oil) for 21-days after which baseline testing was repeated. The magnitude-based inference approach was used to estimate the probability that N-3 had a beneficial effect on neuromuscular-function and performance of at least ±1%. Data are shown as mean ± 90% confidence-interval. RESULTS: Plasma EPA was higher on N-3 than placebo (p = 0.004) but the increases in DPA and DHA were not significant (p = 0.087, p = 0.058). N-3 supplementation had an unclear effect on MVC force (4.1 ± 6.6%) but increased vastus lateralis EMG by 20 ± 18% vs placebo (very likely beneficial). N-3 supplementation reduced Wingate percent power drop by 4.76 ± 3.4 % vs placebo (very likely beneficial), but the difference in TT performance was unclear (-1.9 ± 4.8%). CONCLUSION: Our data indicates N-3 PUFA supplementation improved peripheral neuromuscular function and aspects of fatigue with an unclear effect on central neuromuscular function. Clinical trial registration NCT0201433.

Tight Margins: Compression Garment Use during Exercise and Recovery—A Systematic Review

Alana J. Leabeater, Lachlan P. James, Matthew Driller · Textiles · 2022 · 27 citations

Compression garments provide small but real benefits for recovery after exercise (faster time trials, less muscle soreness) but only trivial effects on performance *during* exercise, meaning they are worth testing for post-workout recovery but unlikely to make you faster mid-run.

Creatine-Kinase- and Exercise-Related Muscle Damage Implications for Muscle Performance and Recovery

Marianne Baird, Scott M. Graham, Julien S. Baker +1 more · Journal of Nutrition and Metabolism · 2012 · 727 citations

The appearance of creatine kinase (CK) in blood has been generally considered to be an indirect marker of muscle damage, particularly for diagnosis of medical conditions such as myocardial infarction, muscular dystrophy, and cerebral diseases. However, there is controversy in the literature concerning its validity in reflecting muscle damage as a consequence of level and intensity of physical exercise. Nonmodifiable factors, for example, ethnicity, age, and gender, can also affect enzyme tissue activity and subsequent CK serum levels. The extent of effect suggests that acceptable upper limits of normal CK levels may need to be reset to recognise the impact of these factors. There is a need for standardisation of protocols and stronger guidelines which would facilitate greater scientific integrity. The purpose of this paper is to examine current evidence and opinion relating to the release of CK from skeletal muscle in response to physical activity and examine if elevated concentrations are a health concern.

What is the ideal dose and power output of low-level laser therapy (810 nm) on muscle performance and post-exercise recovery? Study protocol for a double-blind, randomized, placebo-controlled trial

Adriano Rodrigues de Oliveira, Adriane Aver Vanin, Thiago De Marchi +9 more · Trials · 2014 · 42 citations

BACKGROUND: Recent studies involving phototherapy applied prior to exercise have demonstrated positive results regarding the attenuation of muscle fatigue and the expression of biochemical markers associated with recovery. However, a number of factors remain unknown, such as the ideal dose and application parameters, mechanisms of action and long-term effects on muscle recovery. The aims of the proposed project are to evaluate the long-term effects of low-level laser therapy on post-exercise musculoskeletal recovery and identify the best dose andapplication power/irradiation time. DESIGN AND METHODS: A double-blind, randomized, placebo-controlled clinical trial with be conducted. After fulfilling the eligibility criteria, 28 high-performance athletes will be allocated to four groups of seven volunteers each. In phase 1, the laser power will be 200 mW and different doses will be tested: Group A (2 J), Group B (6 J), Group C (10 J) and Group D (0 J). In phase 2, the best dose obtained in phase 1 will be used with the same distribution of the volunteers, but with different powers: Group A (100 mW), Group B (200 mW), Group C (400 mW) and Group D (0 mW). The isokinetic test will be performed based on maximum voluntary contraction prior to the application of the laser and after the eccentric contraction protocol, which will also be performed using the isokinetic dynamometer. The following variables related to physical performance will be analyzed: peak torque/maximum voluntary contraction, delayed onset muscle soreness (algometer), biochemical markers of muscle damage, inflammation and oxidative stress. DISCUSSION: Our intention, is to determine optimal laser therapy application parameters capable of slowing down the physiological muscle fatigue process, reducing injuries or micro-injuries in skeletal muscle stemming from physical exertion and accelerating post-exercise muscle recovery. We believe that, unlike drug therapy, LLLT has a biphasic dose-response pattern. TRIAL REGISTRATION: The protocol for this study is registered with the Protocol Registry System, ClinicalTrials.gov identifier NCT01844271.

Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 4th Edition

R. Norman Harden, Ann Louise Oaklander, Allen W. Burton +7 more · Pain Medicine · 2013 · 527 citations

OBJECTIVE: This is the fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy). METHODS: Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking. RESULTS: The research quality, clinical relevance, and "state of the art" of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature. CONCLUSIONS: In the humanitarian spirit of making the most of all current thinking in the area, balanced by a careful case-by-case analysis of the risk/cost vs benefit analysis, the authors offer these "practical" guidelines.

Influence of recovery strategies upon performance and perceptions following fatiguing exercise: a randomized controlled trial

Fiona Crowther, Rebecca Sealey, Melissa Crowe +2 more · BMC Sports Science Medicine and Rehabilitation · 2017 · 38 citations

BACKGROUND: Despite debate regarding their effectiveness, many different post-exercise recovery strategies are used by athletes. This study compared five post-exercise recovery strategies (cold water immersion, contrast water immersion, active recovery, a combined cold water immersion and active recovery and a control condition) to determine which is most effective for subsequent short-term performance and perceived recovery. METHODS: Thirty-four recreationally active males undertook a simulated team-game fatiguing circuit followed by the above recovery strategies (randomized, 1 per week). Prior to the fatiguing exercise, and at 1, 24 and 48 h post-exercise, perceptual, flexibility and performance measures were assessed. RESULTS: Contrast water immersion significantly enhanced perceptual recovery 1 h after fatiguing exercise in comparison to active and control recovery strategies. Cold water immersion and the combined recovery produced detrimental jump power performance at 1 h compared to the control and active recovery strategies. No recovery strategy was different to the control at 24 and 48 h for either perceptual or performance variables. CONCLUSION: For short term perceptual recovery, contrast water therapy should be implemented and for short-term countermovement power performance an active or control recovery is desirable. At 24 and 48 h, no superior recovery strategy was detected. TRIAL REGISTRATION: Retrospectively registered; ISRCTN14415088; 5/11/2017.

The effects of cold water immersion with different dosages (duration and temperature variations) on heart rate variability post-exercise recovery: A randomized controlled trial

Aline Castilho de Almeida, Aryane Flauzino Machado, Maíra Campos de Albuquerque +5 more · Journal of science and medicine in sport · 2015 · 38 citations

Psychological monitoring of overtraining and staleness.

William P. Morgan, Donna Brown, John S. Raglin +2 more · British Journal of Sports Medicine · 1987 · 651 citations

It is widely agreed that overtraining should be employed in order to achieve peak performance but it is also recognised that overtraining can actually produce decrements in performance. The challenge appears to be one of monitoring stress indicators in the athlete in order to titrate the training stimulus and prevent the onset of staleness. The present paper summarises a ten-year research effort in which the mood states of competitive swimmers have been monitored at intervals ranging from 2-4 weeks during individual seasons for the period 1975-1986. The training cycle has always involved the indoor season which extends from September to March and the athletes who served as subjects were 200 female and 200 male competitive swimmers. The results indicate that mood state disturbances increased in a dose-response manner as the training stimulus increased and that these mood disturbances fell to baseline levels with reduction of the training load. Whilst these results have been obtained in a realistic setting devoid of experimental manipulation, it is apparent that monitoring of mood state provides a potential method of preventing staleness.

Resistance exercise as a treatment for sarcopenia: prescription and delivery

Christopher Hurst, Siân Robinson, Miles D. Witham +8 more · Age and Ageing · 2022 · 295 citations

Sarcopenia is a generalised skeletal muscle disorder characterised by reduced muscle strength and mass and associated with a range of negative health outcomes. Currently, resistance exercise (RE) is recommended as the first-line treatment for counteracting the deleterious consequences of sarcopenia in older adults. However, whilst there is considerable evidence demonstrating that RE is an effective intervention for improving muscle strength and function in healthy older adults, much less is known about its benefits in older people living with sarcopenia. Furthermore, evidence for its optimal prescription and delivery is very limited and any potential benefits of RE are unlikely to be realised in the absence of an appropriate exercise dose. We provide a summary of the underlying principles of effective RE prescription (specificity, overload and progression) and discuss the main variables (training frequency, exercise selection, exercise intensity, exercise volume and rest periods) that can be manipulated when designing RE programmes. Following this, we propose that an RE programme that consists of two exercise sessions per week and involves a combination of upper- and lower-body exercises performed with a relatively high degree of effort for 1-3 sets of 6-12 repetitions is appropriate as a treatment for sarcopenia. The principles of RE prescription outlined here and the proposed RE programme presented in this paper provide a useful resource for clinicians and exercise practitioners treating older adults with sarcopenia and will also be of value to researchers for standardising approaches to RE interventions in future sarcopenia studies.

Position statement. Part two: Maintaining immune health.

Neil P. Walsh, Michael Gleeson, David B. Pyne +6 more · Loughborough University Institutional Repository (Loughborough University) · 2011 · 371 citations

The physical training undertaken by athletes is one of a set of lifestyle or behav-ioural factors that can influence immune function, health and ultimately exercise performance. Others factors including potential exposure to pathogens, health status, lifestyle behaviours, sleep and recovery, nutrition and psychosocial issues, need to be considered alongside the physical demands of an athlete’s training pro-gramme. The general consensus on managing training to maintain immune health is to start with a programme of low to moderate volume and intensity; employ a gradual and periodised increase in training volumes and loads; add variety to limit training monotony and stress; avoid excessively heavy training loads that could lead to exhaustion, illness or injury; include non-specific cross-training to offset stale-ness; ensure sufficient rest and recovery; and instigate a testing programme for identifying signs of performance deterioration and manifestations of physical stress. Inter-individual variability in immunocompetence, recovery, exercise capacity, non-training stress factors, and stress tolerance likely explains the differ-

UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

James Collins, Ronald J. Maughan, Michael Gleeson +28 more · British Journal of Sports Medicine · 2020 · 269 citations

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Review on Wearable Technology in Sports: Concepts, Challenges and Opportunities

Ahmet Çağdaş Seçkin, Bahar Ateş, Mine Seçkin · Applied Sciences · 2023 · 222 citations

Wearable technology is increasingly vital for improving sports performance through real-time data analysis and tracking. Both professional and amateur athletes rely on wearable sensors to enhance training efficiency and competition outcomes. However, further research is needed to fully understand and optimize their potential in sports. This comprehensive review explores the measurement and monitoring of athletic performance, injury prevention, rehabilitation, and overall performance optimization using body wearable sensors. By analyzing wearables’ structure, research articles across various sports, and commercial sensors, the review provides a thorough analysis of wearable sensors in sports. Its findings benefit athletes, coaches, healthcare professionals, conditioners, managers, and researchers, offering a detailed summary of wearable technology in sports. The review is expected to contribute to future advancements in wearable sensors and biometric data analysis, ultimately improving sports performance. Limitations such as privacy concerns, accuracy issues, and costs are acknowledged, stressing the need for legal regulations, ethical principles, and technical measures for safe and fair use. The importance of personalized devices and further research on athlete comfort and performance impact is emphasized. The emergence of wearable imaging devices holds promise for sports rehabilitation and performance monitoring, enabling enhanced athlete health, recovery, and performance in the sports industry.

Exercise in space: human skeletal muscle after 6 months aboard the International Space Station

Scott Trappe, D. L. Costill, Philip M. Gallagher +5 more · Journal of Applied Physiology · 2009 · 443 citations

The aim of this investigation was to document the exercise program used by crewmembers ( n = 9; 45 ± 2 yr) while aboard the International Space Station (ISS) for 6 mo and examine its effectiveness for preserving calf muscle characteristics. Before and after spaceflight, we assessed calf muscle volume (MRI), static and dynamic calf muscle performance, and muscle fiber types (gastrocnemius and soleus). While on the ISS, crewmembers had access to a running treadmill, cycle ergometer, and resistance exercise device. The exercise regimen varied among the crewmembers with aerobic exercise performed ∼5 h/wk at a moderate intensity and resistance exercise performed 3–6 days/wk incorporating multiple lower leg exercises. Calf muscle volume decreased ( P < 0.05) 13 ± 2% with greater ( P < 0.05) atrophy of the soleus (−15 ± 2%) compared with the gastrocnemius (−10 ± 2%). Peak power was 32% lower ( P < 0.05) after spaceflight. Force-velocity characteristics were reduced ( P < 0.05) −20 to −29% across the velocity spectrum. There was a 12–17% shift in myosin heavy chain (MHC) phenotype of the gastrocnemius and soleus with a decrease ( P < 0.05) in MHC I fibers and a redistribution among the faster phenotypes. These data show a reduction in calf muscle mass and performance along with a slow-to-fast fiber type transition in the gastrocnemius and soleus muscles, which are all qualities associated with unloading in humans. Future long-duration space missions should modify the current ISS exercise prescription and/or hardware to better preserve human skeletal muscle mass and function, thereby reducing the risk imposed to crewmembers.

Effectiveness of manual therapies: the UK evidence report

Gert Brønfort, Mitch Haas, Roni Evans +2 more · Chiropractic & Osteopathy · 2010 · 436 citations

Early High-Intensity Rehabilitation Following Total Knee Arthroplasty Improves Outcomes

Michael Bade, Jennifer E. Stevens‐Lapsley · Journal of Orthopaedic and Sports Physical Therapy · 2011 · 178 citations

STUDY DESIGN: Prospective cohort study with an age-matched and sex-matched control group. OBJECTIVES: To assess the clinical outcomes of a high-intensity rehabilitation program (HI) compared to those of a group of age-matched and sex-matched controls who underwent a lower intensity rehabilitation program. BACKGROUND: Total knee arthroplasty (TKA) successfully alleviates pain from knee osteoarthritis; but deficits in function can persist long term. Despite these well-known deficits, there is little evidence supporting the use of rehabilitation interventions following TKA. METHODS: Eight patients, who participated in the HI program, were compared to 8 age-matched and sex-matched patients who participated in a lower intensity rehabilitation program (control group). Patients were assessed preoperatively, and at 3.5, 6.5, 12, 26, and 52 weeks postoperatively. Assessment of patients included measures of pain, range of motion (ROM), functional performance, and quadriceps strength and activation. RESULTS: There were no differences in knee ROM and pain between the HI and control groups at any postoperative time point. At the 3.5-week and 12-week (end of rehabilitation) time points, the HI group had better functional performance and quadriceps strength compared to the control group (P<.05). At the 52-week time point, the HI group continued to demonstrate better functional performance compared to the control group (P<.05), along with greater quadriceps strength (P = .08). CONCLUSION: A HI program leads to better short- and long-term strength and functional performance outcomes compared to a lower intensity rehabilitation program. The HI program did not impair knee ROM and did not result in any musculoskeletal injuries in this small group of patients. LEVEL OF EVIDENCE: Therapy, level 2b.

Neuromuscular Consequences of an Extreme Mountain Ultra-Marathon

Guillaume Y. Millet, Katja Tomažin, Samuel Vergès +6 more · PLoS ONE · 2011 · 247 citations

We investigated the physiological consequences of one of the most extreme exercises realized by humans in race conditions: a 166-km mountain ultra-marathon (MUM) with 9500 m of positive and negative elevation change. For this purpose, (i) the fatigue induced by the MUM and (ii) the recovery processes over two weeks were assessed. Evaluation of neuromuscular function (NMF) and blood markers of muscle damage and inflammation were performed before and immediately following (n = 22), and 2, 5, 9 and 16 days after the MUM (n = 11) in experienced ultra-marathon runners. Large maximal voluntary contraction decreases occurred after MUM (-35% [95% CI: -28 to -42%] and -39% [95% CI: -32 to -46%] for KE and PF, respectively), with alteration of maximal voluntary activation, mainly for KE (-19% [95% CI: -7 to -32%]). Significant modifications in markers of muscle damage and inflammation were observed after the MUM as suggested by the large changes in creatine kinase (from 144 ± 94 to 13,633 ± 12,626 UI L(-1)), myoglobin (from 32 ± 22 to 1,432 ± 1,209 µg L(-1)), and C-Reactive Protein (from <2.0 to 37.7 ± 26.5 mg L(-1)). Moderate to large reductions in maximal compound muscle action potential amplitude, high-frequency doublet force, and low frequency fatigue (index of excitation-contraction coupling alteration) were also observed for both muscle groups. Sixteen days after MUM, NMF had returned to initial values, with most of the recovery process occurring within 9 days of the race. These findings suggest that the large alterations in NMF after an ultra-marathon race are multi-factorial, including failure of excitation-contraction coupling, which has never been described after prolonged running. It is also concluded that as early as two weeks after such an extreme running exercise, maximal force capacities have returned to baseline.

Effects of Whole-Body Cryotherapy vs. Far-Infrared vs. Passive Modalities on Recovery from Exercise-Induced Muscle Damage in Highly-Trained Runners

Christophe Hausswirth, Julien Louis, François Bieuzen +4 more · PLoS ONE · 2011 · 234 citations

Enhanced recovery following physical activity and exercise-induced muscle damage (EIMD) has become a priority for athletes. Consequently, a number of post-exercise recovery strategies are used, often without scientific evidence of their benefits. Within this framework, the purpose of this study was to test the efficacy of whole body cryotherapy (WBC), far infrared (FIR) or passive (PAS) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race. In 3 non-adjoining weeks, 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill, designed to induce muscle damage. Immediately (post), post 24 h, and post 48 h after exercise, all participants tested three different recovery modalities (WBC, FIR, PAS) in a random order over the three separate weeks. Markers of muscle damage (maximal isometric muscle strength, plasma creatine kinase [CK] activity and perceived sensations [i.e. pain, tiredness, well-being]) were recorded before, immediately after (post), post 1 h, post 24 h, and post 48 h after exercise. In all testing sessions, the simulated 48 min trail run induced a similar, significant amount of muscle damage. Maximal muscle strength and perceived sensations were recovered after the first WBC session (post 1 h), while recovery took 24 h with FIR, and was not attained through the PAS recovery modality. No differences in plasma CK activity were recorded between conditions. Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities.

Regeneration of injured skeletal muscle after the injury

Tero A.H. Järvinen, M. Järvinen, Hannu Kalimo · Muscles Ligaments and Tendons Journal · 2019 · 230 citations

Muscle injuries are one of the most common traumas occurring in sports. Despite their clinical importance, few clinical studies exist on the treatment of these traumas. Thus, the current treatment recommendations for muscle injuries have either been derived from experimental studies or been tested only empirically. Although non operative treatment should almost always be the 1 st choice as it results in good functional outcomes in the majority of athletes with muscle injuries, the consequences of failed treatment can be very dramatic, possibly postponing an athlete's return to sports for weeks or even months. Moreover, the recognition of some basic principles of skeletal muscle regeneration and healing processes can considerably help in both avoiding the imminent dangers and accelerating the return to competition. Accordingly, in this review, the authors have summarized the prevailing understanding on the biology of muscle regeneration in hopes of extending these findings to clinical practice in an attempt to propose an evidence-based approach for the diagnosis and optimal treatment of skeletal muscle injuries.

Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial

Christina Routsi, Vasiliki Gerovasili, Ioannis Vasileiadis +6 more · Critical Care · 2010 · 318 citations

Abstract Introduction Critical illness polyneuromyopathy (CIPNM) is a common complication of critical illness presenting with muscle weakness and is associated with increased duration of mechanical ventilation and weaning period. No preventive tool and no specific treatment have been proposed so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. Aim of our study was to assess the efficacy of EMS in preventing CIPNM in critically ill patients. Methods One hundred and forty consecutive critically ill patients with an APACHE II score ≥ 13 were randomly assigned after stratification to the EMS group (n = 68) (age:61 ± 19 years) (APACHE II:18 ± 4, SOFA:9 ± 3) or to the control group (n = 72) (age:58 ± 18 years) (APACHE II:18 ± 5, SOFA:9 ± 3). Patients of the EMS group received daily EMS sessions. CIPNM was diagnosed clinically with the medical research council (MRC) scale for muscle strength (maximum score 60, &lt;48/60 cut off for diagnosis) by two unblinded independent investigators. Duration of weaning from mechanical ventilation and intensive care unit (ICU) stay were recorded. Results Fifty two patients could be finally evaluated with MRC; 24 in the EMS group and 28 in the control group. CIPNM was diagnosed in 3 patients in the EMS group as compared to 11 patients in the control group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was significantly higher in patients of the EMS group as compared to the control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median (range), P = 0.04). The weaning period was statistically significantly shorter in patients of the EMS group vs. the control group [1 (0 to 10) days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003]. Conclusions This study suggests that daily EMS sessions prevent the development of CIPNM in critically ill patients and also result in shorter duration of weaning. Further studies should evaluate which patients benefit more from EMS and explore the EMS characteristics most appropriate for preventing CIPNM. Trial Registration Number ClinicalTrials.gov NCT00882830

The Beneficial Effects of Lactobacillus plantarum PS128 on High-Intensity, Exercise-Induced Oxidative Stress, Inflammation, and Performance in Triathletes

Wen-Ching Huang, Chen-Chan Wei, Chi‐Chang Huang +2 more · Nutrients · 2019 · 153 citations

A triathlon, which consists of swimming, bicycling, and running, is a high-intensity and long-term form of exercise that can cause injuries such as muscular damage, inflammation, oxidative stress, and energy imbalance. Probiotics are thought to play an important role in disease incidence, health promotion, and nutrient metabolism, but only a few studies have focused on physiological adaptations to exercise in sports science. Previous studies indicated that Lactobacillus supplementation could improve oxidative stress and inflammatory responses. We investigate the effects of Lactobacillus plantarum PS128 supplementation on triathletes for possible physiological adaptation. The triathletes were assigned to one of two groups with different exercise intensity stimulations with different time-points to investigate the effects of body compositions, inflammation, oxidative stress, performance, fatigue, and injury-related biochemical indices. L. plantarum PS128 supplementation, combined with training, can significantly alleviate oxidative stress (such as creatine kinase, Thioredoxin, and Myeloperoxidase indices) after a triathlon (p < 0.05). This effect is possibly regulated by a 6⁻13% decrease of indicated pro-inflammation (TNF-α, IL-6, and IL-8) cytokines (p < 0.05) and 55% increase of anti-inflammation (IL-10) cytokines (p < 0.05) after intensive exercise stimulation. In addition, L. plantarum PS128 can also substantially increase 24⁻69% of plasma-branched amino acids (p < 0.05) and elevate exercise performance, as compared to the placebo group (p < 0.05). In conclusion, L. plantarum PS128 may be a potential ergogenic aid for better training management, physiological adaptations to exercise, and health promotion.

Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

Martina Zügel, Constantinos N. Maganaris, Jan Wilke +10 more · British Journal of Sports Medicine · 2018 · 207 citations

The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.

The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers

Kai Schmidt, Jaime E. Duarte, Martin Grimmer +4 more · Frontiers in Neurorobotics · 2017 · 199 citations

Muscle weakness-which can result from neurological injuries, genetic disorders, or typical aging-can affect a person's mobility and quality of life. For many people with muscle weakness, assistive devices provide the means to regain mobility and independence. These devices range from well-established technology, such as wheelchairs, to newer technologies, such as exoskeletons and exosuits. For assistive devices to be used in everyday life, they must provide assistance across activities of daily living (ADLs) in an unobtrusive manner. This article introduces the Myosuit, a soft, wearable device designed to provide continuous assistance at the hip and knee joint when working with and against gravity in ADLs. This robotic device combines active and passive elements with a closed-loop force controller designed to behave like an external muscle (exomuscle) and deliver gravity compensation to the user. At 4.1 kg (4.6 kg with batteries), the Myosuit is one of the lightest untethered devices capable of delivering gravity support to the user's knee and hip joints. This article presents the design and control principles of the Myosuit. It describes the textile interface, tendon actuators, and a bi-articular, synergy-based approach for continuous assistance. The assistive controller, based on bi-articular force assistance, was tested with a single subject who performed sitting transfers, one of the most gravity-intensive ADLs. The results show that the control concept can successfully identify changes in the posture and assist hip and knee extension with up to 26% of the natural knee moment and up to 35% of the knee power. We conclude that the Myosuit's novel approach to assistance using a bi-articular architecture, in combination with the posture-based force controller, can effectively assist its users in gravity-intensive ADLs, such as sitting transfers.

Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Crystal S. Denlinger, Tara Sanft, K. Scott Baker +31 more · Journal of the National Comprehensive Cancer Network · 2018 · 194 citations

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.

Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi Exposures following Severe Exercise

Hervé Pournot, François Bieuzen, Julien Louis +3 more · PLoS ONE · 2011 · 184 citations

The objectives of the present investigation was to analyze the effect of two different recovery modalities on classical markers of exercise-induced muscle damage (EIMD) and inflammation obtained after a simulated trail running race. Endurance trained males (n = 11) completed two experimental trials separated by 1 month in a randomized crossover design; one trial involved passive recovery (PAS), the other a specific whole body cryotherapy (WBC) for 96 h post-exercise (repeated each day). For each trial, subjects performed a 48 min running treadmill exercise followed by PAS or WBC. The Interleukin (IL) -1 (IL-1), IL-6, IL-10, tumor necrosis factor alpha (TNF-α), protein C-reactive (CRP) and white blood cells count were measured at rest, immediately post-exercise, and at 24, 48, 72, 96 h in post-exercise recovery. A significant time effect was observed to characterize an inflammatory state (Pre vs. Post) following the exercise bout in all conditions (p<0.05). Indeed, IL-1β (Post 1 h) and CRP (Post 24 h) levels decreased and IL-1ra (Post 1 h) increased following WBC when compared to PAS. In WBC condition (p<0.05), TNF-α, IL-10 and IL-6 remain unchanged compared to PAS condition. Overall, the results indicated that the WBC was effective in reducing the inflammatory process. These results may be explained by vasoconstriction at muscular level, and both the decrease in cytokines activity pro-inflammatory, and increase in cytokines anti-inflammatory.

Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

Chris Bleakley, Suzanne McDonough, Evie Gardner +3 more · Cochrane Database of Systematic Reviews · 2012 · 183 citations

BACKGROUND: Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise. OBJECTIVES: To determine the effects of cold-water immersion in the management of muscle soreness after exercise. SEARCH METHODS: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts.In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms). DATA COLLECTION AND ANALYSIS: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model. MAIN RESULTS: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events.Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardised mean difference (SMD) -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD -1.70; 95% CI -2.49 to -0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery (MD 0.97; 95% CI -0.10 to 2.05; 10 units scale, worst to best) immediately after the end of cold-water immersion.Five studies compared cold-water with contrast immersion. Pooled data for pain showed no evidence of differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). Similar findings for pooled analyses at 24, 48 and 72 hour follow-ups applied to the four studies comparing cold-water with warm-water immersion. Single trials only compared cold-water immersion with respectively active recovery, compression and a second dose of cold-water immersion at 24 hours. AUTHORS' CONCLUSIONS: There was some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention. There was insufficient evidence to conclude on other outcomes or for other comparisons. The majority of trials did not undertake active surveillance of pre-defined adverse events. High quality, well reported research in this area is required.

Supplement

Judith K. Sluiter, Kathleen M. Rest, Monigue HW HW Frings-Dresen · Scandinavian Journal of Work Environment & Health · 2001 · 361 citations

Although many hypotheses have been suggested in the last few decades about possible underlying mechanisms for the development of nonspecific musculoskeletal symptoms in particular and (chronic) pain in general, definitive knowledge is still lacking. One wellknown potential mechanism at the muscular level is the Cinderella hypothesis, namely, that the lack of recovery from repeated recruitment of the same motor units is responsible for fatigue and complaints when the same movements and forces are asked for in a repetitive manner. Interested readers are referred to, for example, the reports of Hagberg & Wegman (8), Johansson & Sojka (17), Armstrong et al (9), Wright (18), Main & Watson (19),.

Pharmacological but not physiological GDF15 suppresses feeding and the motivation to exercise

Anders B. Klein, Trine S. Nicolaisen, Niels Ørtenblad +22 more · Nature Communications · 2021 · 124 citations

Growing evidence supports that pharmacological application of growth differentiation factor 15 (GDF15) suppresses appetite but also promotes sickness-like behaviors in rodents via GDNF family receptor α-like (GFRAL)-dependent mechanisms. Conversely, the endogenous regulation of GDF15 and its physiological effects on energy homeostasis and behavior remain elusive. Here we show, in four independent human studies that prolonged endurance exercise increases circulating GDF15 to levels otherwise only observed in pathophysiological conditions. This exercise-induced increase can be recapitulated in mice and is accompanied by increased Gdf15 expression in the liver, skeletal muscle, and heart muscle. However, whereas pharmacological GDF15 inhibits appetite and suppresses voluntary running activity via GFRAL, the physiological induction of GDF15 by exercise does not. In summary, exercise-induced circulating GDF15 correlates with the duration of endurance exercise. Yet, higher GDF15 levels after exercise are not sufficient to evoke canonical pharmacological GDF15 effects on appetite or responsible for diminishing exercise motivation.

Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers

Erik Hansson, Jason Glaser, Kristina Jakobsson +9 more · Nutrients · 2020 · 119 citations

BACKGROUND: Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS: Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS: Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION: Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.

Montmorency Cherries Reduce the Oxidative Stress and Inflammatory Responses to Repeated Days High-Intensity Stochastic Cycling

Phillip Bell, Ian H. Walshe, Gareth W. Davison +2 more · Nutrients · 2014 · 160 citations

This investigation examined the impact of Montmorency tart cherry concentrate (MC) on physiological indices of oxidative stress, inflammation and muscle damage across 3 days simulated road cycle racing. Trained cyclists (n = 16) were divided into equal groups and consumed 30 mL of MC or placebo (PLA), twice per day for seven consecutive days. A simulated, high-intensity, stochastic road cycling trial, lasting 109 min, was completed on days 5, 6 and 7. Oxidative stress and inflammation were measured from blood samples collected at baseline and immediately pre- and post-trial on days 5, 6 and 7. Analyses for lipid hydroperoxides (LOOH), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-8 (IL-8), interleukin-1-beta (IL-1-β), high-sensitivity C-reactive protein (hsCRP) and creatine kinase (CK) were conducted. LOOH (p < 0.01), IL-6 (p < 0.05) and hsCRP (p < 0.05) responses to trials were lower in the MC group versus PLA. No group or interaction effects were found for the other markers. The attenuated oxidative and inflammatory responses suggest MC may be efficacious in combating post-exercise oxidative and inflammatory cascades that can contribute to cellular disruption. Additionally, we demonstrate direct application for MC in repeated days cycling and conceivably other sporting scenario's where back-to-back performances are required.

Effectiveness of post-match recovery strategies in rugby players: Figure 1

Nicholas D. Gill, C. Martyn Beaven, Christian J. Cook · British Journal of Sports Medicine · 2006 · 316 citations

OBJECTIVES: To examine the effectiveness of four interventions on the rate and magnitude of muscle damage recovery, as measured by creatine kinase (CK). METHODS: 23 elite male rugby players were monitored transdermally before, immediately after, 36 hours after, and 84 hours after competitive rugby matches. Players were randomly assigned to complete one of four post-match strategies: contrast water therapy (CWT), compression garment (GAR), low intensity active exercise (ACT), and passive recovery (PAS). RESULTS: Significant increases in CK activity in transdermal exudate were observed as a result of the rugby match (p<0.01). The magnitude of recovery in the PAS intervention was significantly worse than in the ACT, CWT, and GAR interventions at the 36 and 84 hour time points (p<0.05). CONCLUSIONS: An enhanced rate and magnitude of recovery was observed in the ACT, CWT, and GAR treatment groups when compared with the PAS group. Low impact exercise immediately post-competition, wearing compression garments, or carrying out contrast water therapy enhanced CK clearance more than passive recovery in young male athletes.

Dysfunctional Endogenous Analgesia DuringExercise in Patients with Chronic Pain: ToExercise or Not to Exercise?

Jo Nijs · Pain Physician · 2012 · 283 citations

Background: Exercise is an effective treatment for various chronic pain disorders, including fibromyalgia, chronic neck pain, osteoarthritis, rheumatoid arthritis, and chronic low back pain. Although the clinical benefits of exercise therapy in these populations are well established (i.e. evidence based), it is currently unclear whether exercise has positive effects on the processes involved in chronic pain (e.g. central pain modulation). Objectives: Reviewing the available evidence addressing the effects of exercise on central pain modulation in patients with chronic pain. Methods: Narrative review. Results: Exercise activates endogenous analgesia in healthy individuals. The increased pain threshold following exercise is due to the release of endogenous opioids and activation of (supra)spinal nociceptive inhibitory mechanisms orchestrated by the brain. Exercise triggers the release of β-endorphins from the pituitary (peripherally) and the hypothalamus (centrally), which in turn enables analgesic effects by activating µ-opioid receptors peripherally and centrally, respectively. The hypothalamus, through its projections on the periaqueductal grey, has the capacity to activate descending nociceptive inhibitory mechanisms. However, several groups have shown dysfunctioning of endogenous analgesia in response to exercise in patients with chronic pain. Muscle contractions activate generalized endogenous analgesia in healthy, pain-free humans and patients with either osteoarthritis or rheumatoid arthritis, but result in increased generalised pain sensitivity in fibromyalgia patients. In patients having local muscular pain (e.g. shoulder myalgia), exercising non-painful muscles activates generalized endogenous analgesia. However, exercising painful muscles does not change pain sensitivity either in the exercising muscle or at distant locations. Limitations: The reviewed studies examined acute effects of exercise rather than long-term effects of exercise therapy. Conclusions: A dysfunctional response of patients with chronic pain and aberrations in central pain modulation to exercise has been shown, indicating that exercise therapy should be individually tailored with emphasis on prevention of symptom flares. The paper discusses the translation of these findings to rehabilitation practice together with future research avenues. Key words: Whiplash, fibromyalgia, chronic pain, low back pain, exercise, rehabilitation, chronic fatigue syndrome, osteoarthritis, rheumatoid arthritis, sensitization, shoulder

Intramyocellular lipid droplets increase with progression of cachexia in cancer patients

Nathan Stephens, Richard J. E. Skipworth, Alisdair J. MacDonald +3 more · Journal of Cachexia Sarcopenia and Muscle · 2011 · 153 citations

BACKGROUND: Intramyocellular lipids are an important source of fuel for mitochondrial fat oxidation and play an important role in intramuscular lipid homeostasis. We hypothesised that due to the phenotype associated with cancer cachexia, there would exist an association between increasing weight loss and the number/size of intramyocellular lipid droplets. METHODS: Nineteen cancer patients and 6 controls undergoing surgery were recruited. A rectus abdominis biopsy was performed and processed for transmission electron microscopy (TEM). The number of intramyocellular lipid droplets and lipid droplet diameter were calculated from the TEM images. CT scans, performed as part of patients' routine care, were analysed to determine amount of adipose (intermuscular, visceral and subcutaneous) and muscle tissue. RESULTS: Compared with controls, cancer patients had increased numbers of lipid droplets (mean (SD) 1.8 (1.9) vs. 6.4 (9.1) per ×2,650 field, respectively, p = 0.036). Mean (SD) lipid droplet diameter was also higher in cancer patients compared with controls (0.42 (0.13) vs. 0.24 (0.21) μm, p = 0.015). Mean lipid droplet count correlated positively with the severity of weight loss (R = 0.51, p = 0.025) and negatively with CT-derived measures of intermuscular fat (R = -0.53, p = 0.022) and visceral fat (R = -0.51, p = 0.029). CONCLUSIONS: This study suggests that the number and size of intramyocellular lipid droplets is increased in the presence of cancer and increases further with weight loss/loss of adipose mass in other body compartments.

Strength training in soccer with a specific focus on highly trained players

João Renato Silva, George P. Nassis, António Rebelo · Sports Medicine - Open · 2015 · 206 citations

BACKGROUND: Data concerning the physical demands of soccer (e.g., activity pattern) suggest that a high level of performance requires well-developed neuromuscular function (NF). Proficient NF may be relevant to maintain and/or increase players' short- (intense periods of soccer-specific activity; accelerations, decelerations, and sprinting) and long-term performance during a match and throughout the season. OBJECTIVE: This review examines the extent to which distinct modes of strength training improve soccer players' performance, as well as the effects of concurrent strength and endurance training on the physical capacity of players. DATA SOURCES: A selection of studies was performed in two screening phases. The first phase consisted of identifying articles through a systematic search using relevant databases, including the US National Library of Medicine (PubMed), MEDLINE, and SportDiscus. Several permutations of keywords were utilized (e.g., soccer; strength; power; muscle function), along with the additional scanning of the reference lists of relevant manuscripts. Given the wide range of this review, additional researchers were included. The second phase involved applying six selection criteria to the articles. RESULTS AND CONCLUSIONS: After the two selection phases, 24 manuscripts involving a total sample of 523 soccer players were considered. Our analysis suggests that professional players need to significantly increase their strength to obtain slight improvements in certain running-based actions (sprint and change of direction speed). Strength training induces greater performance improvements in jump actions than in running-based activities, and these achievements varied according to the motor task [e.g., greater improvements in acceleration (10 m) than in maximal speed (40 m) running movements and in non-squat jump (SJ) than in SSC-based actions (countermovement jump)]. With regard to the strength/power training methods used by soccer players, high-intensity resistance training seems to be more efficient than moderate-intensity resistance training (hypertrophic). From a training frequency perspective, two weekly sessions of strength training are sufficient to increase a player's force production and muscle power-based actions during pre-season, with one weekly session being adequate to avoid in-season detraining. Nevertheless, to further improve performance during the competitive period, training should incorporate a higher volume of soccer-specific power-based actions that target the neuromuscular system. Combined strength/power training programs involving different movement patterns and an increased focus on soccer-specific power-based actions are preferred over traditional resistance exercises, not only due to their superior efficiency but also due to their ecological value. Strength/power training programs should incorporate a significant number of exercises targeting the efficiency of stretch-shortening-cycle activities and soccer-specific strength-based actions. Manipulation of training surfaces could constitute an important training strategy (e.g., when players are returning from an injury). In addition, given the conditional concurrent nature of the sport, concurrent high-intensity strength and high-intensity endurance training modes (HIT) may enhance a player's overall performance capacity. Our analysis suggests that neuromuscular training improves both physiological and physical measures associated with the high-level performance of soccer players.

Time‐course effect of exercise‐induced muscle damage on localized muscle mechanical properties assessed using elastography

Lilian Lacourpaille, Antoine Nordez, François Hug +3 more · Acta Physiologica · 2014 · 151 citations

AIM: Changes in muscle stiffness after exercise-induced muscle damage have been classically inferred from passive torque-angle curves. Elastographic techniques can be used to estimate the shear modulus of a localized muscular area. This study aimed to quantify the changes in shear elastic modulus in different regions of the elbow flexors after eccentric exercise and their relation to muscle length. METHODS: Shear elastic modulus and transverse relaxation time (T2 ) were measured in the biceps brachii and brachialis muscles of sixteen participants, before, 1 h, 48 h and 21 days after three sets of ten maximal isokinetic eccentric contractions performed at 120° s(-1) . RESULTS: The shear elastic modulus of the elbow flexors significantly increased 1 h (+46%; P = 0.005), with no significant change at 48 h and 21D, post-exercise. In contrast, T2 was not modified at 1 h but significantly increased at 48 h (+15%; P < 0.05). The increase in shear elastic modulus was more pronounced at long muscle lengths and reached a similar extent in the different regions of the elbow flexors. The normalized hysteresis area of shear elastic modulus-length relationship for the biceps brachii increased 1 h post-exercise (31%) in comparison with the pre-exercise value (18%), but was not significantly altered after five stretching cycles (P = 0.63). CONCLUSION: Our results show homogeneous changes in muscle shear elastic modulus within and between elbow flexors. The greater increase in shear elastic modulus observed at long muscle lengths suggests the putative involvement of both cross-bridges number and titin in the modifications of muscle shear elastic modulus after damaging exercise.

Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage

Saied Jalal Aboodarda, AJ Spence, Duane C. Button · BMC Musculoskeletal Disorders · 2015 · 203 citations

BACKGROUND: The aim of the present study was to determine the acute effect of rolling massage on pressure pain threshold (PPT) in individuals with tender spots in their plantar flexor muscles. METHODS: In a randomized control trial and single blinded study, tender spots were identified in 150 participants' plantar flexor muscles (gastrocnemius or soleus). Then participants were randomly assigned to one of five intervention groups (n = 30): 1) heavy rolling massage on the calf that exhibited the higher tenderness (Ipsi-R), 2) heavy rolling massage on the contralateral calf (Contra-R), 3) light stroking of the skin with roller massager on the calf that exhibited the higher tenderness (Sham), 4) manual massage on the calf that exhibited the higher tenderness (Ipsi-M) and 5) no intervention (Control). PPT was measured at 30 s and up to 15 min post-intervention via a pressure algometer. RESULTS: At 30 s post-intervention, the Ipsi-R (24 %) and Contra-R (21 %) demonstrated higher (p < 0.03) PPT values compared with Control and Sham. During 15 min post-intervention, PPT was higher (p < 0.05) following Ipsi-R (19.2 %), Contra-R (15.9 %) and Ipsi-M (10.9 %) compared with Control. There was no difference between the effects of three deep tissue massages (Ipsi-R, Ipsi-M and Contra-R) on PPT. DISCUSSION: Whereas the increased PPT following ipsilateral massage (Ipsi-R and Ipsi-M) might be attributed to the release of fibrous adhesions; the non-localized effect of rolling massage on the contralateral limb suggests that other mechanisms such as a central pain-modulatory system play a role in mediation of perceived pain following brief tissue massage. CONCLUSION: Overall, rolling massage over a tender spot reduces pain perception. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02528812 ), August 19(th), 2015.

Mathematical analysis and digital simulation of the respiratory control system.

Fred S. Grodins, Jennifer S. Buell, A J Bart · Journal of Applied Physiology · 1967 · 292 citations

The report expresses the basic material balance relationships for the lung-blood-tissue gas transport and exchange system in a set of differential- difference equations containing a number of dependent time delays. Additional equations define the chemical details of transport and acid-base buffering, concentration equilibria, and blood flow behavior. Finally, a control function is included defining the dependence of ventilation upon CSF (H(+)), and arterial (H(+)) and PO2 at the carotid chemoceptors. A Fortran program was written for convenient digital simulation of the responses of the system to a wide variety of forcings, including CO2 inhalation, hypoxia at sea level, altitude hypoxia, and metabolic disturbances in acid-base balance. Both dynamic and steady-state behavior of the model were reasonably realistic.

Match Running Performance During Fixture Congestion in Elite Soccer: Research Issues and Future Directions

Christopher Carling, Warren Gregson, Alan McCall +3 more · Sports Medicine · 2015 · 143 citations